PHILADELPHIA’S COMMUNITY HEALTH ASSESSMENT
HEALTH OF THE CITY 2018 2 HEALTH OF THE CITY 2018
TABLE OF CONTENTS
INTRODUCTION ...... 2 Behavioral Health...... 11 CLINICAL CARE ...... 30 About Philadelphia...... 3 Infectious Health Conditions ...... 14 PHYSICAL ENVIRONMENT ...... 34 HEALTH OUTCOMES ...... 4 Infant and Child Health ...... 18 SOCIAL & ECONOMIC Summary Health Measures ...... 4 Injuries ...... 22 DETERMINANTS ...... 37 Chronic Health Conditions ...... 7 HEALTH BEHAVIORS ...... 26 ACKNOWLEDGMENTS ...... 43
INTRODUCTION
Health is infl uenced by many factors, including social and economic conditions, the built environment, accessibility of healthy products, the behavioral choices people make, and the medical care system. Health of the City describes the health and well-being of people who live in Philadelphia. The Philadelphia Department of Public Health produces this annual report to help health care providers, city offi cials, people who make decisions for non-governmental organizations, and individual residents make more informed decisions about health.
Health of the City includes summaries of data from various sources to describe the demographics of the city’s residents as well as health outcomes and key factors that infl uence health in fi ve broad areas:
1 2 3 4 5
HEALTH HEALTH CLINICAL PHYSICAL SOCIAL AND OUTCOMES BEHAVIORS CARE ENVIRONMENT ECONOMIC represent how healthy include behaviors encompasses both includes air quality DETERMINANTS Philadelphians are, that directly impact access to and quality and access to include education, including measures health, such as of preventive, primary, housing and employment, income of quality of life, rates nutrition, exercise, and acute care. transportation. and community of infectious and tobacco and drug safety. chronic illnesses, and use, and sexual premature death. activity. HEALTH OF THE CITY 2018 3
ABOUT PHILADELPHIA
THE SIXTH LARGEST CITY POPULATION BY AGE GROUP | 2017
Philadelphia is the sixth largest city 0-4 5-9 in the United States (behind New 10-14 York City, Los Angeles, Chicago, 15-19 20-24 Houston, and Phoenix), with an 25-29 estimated population of 1,580,863 30-34 35-39 in 2017. Philadelphia’s young adult 40-44 45-49 population (ages 20 to 34 years) 50-54 continued to grow and represented 55-59 60-64 the largest portion of the population. 65-69 70-74 75-59 80-84 85+
15% 10% 5% 0% 5% 10% 15% SOURCE: 2017 American Community Survey Estimates, U.S. Census Bureau MALE FEMALE
A DIVERSE CITY POPULATION BY RACE/ETHNICITY | 2017 Philadelphia is racially and ethnically 41% 35% 15% 8% 2% diverse – 41 percent non-Hispanic black, 35 percent non-Hispanic white, 15 percent Hispanic, and 8 percent WHITE ASIAN OTHER BLACK
Asian. Yet, Philadelphia continued to HISPANIC be segregated along racial lines, with one race or ethnic group representing the majority in 84 percent of the city’s 381 census tracts. SOURCE: 2017 American Community Survey Estimates, U.S. Census Bureau
FORTY-EIGHT ZIP CODES PHILADELPHIA ZIP CODES POPULATION BY PLANNING AND EIGHTEEN PLANNING AND PLANNING DISTRICTS DISTRICTS | 2017 UPPER FAR DISTRICTS NORTHEAST 65,824 LOWER FAR NORTHESAT Philadelphia consists of forty- CENTRAL 69,905 NORTHEAST LOWER UPPER NORTHWEST 84,634 eight zip codes and eighteen NORTHWEST 84,013 UPPER 52,765 NORTH 155,100 planning districts representing LOWER NORTH DELAWARE NORTHEAST 105,560 92,209 distinct economic, geographic, NORTH 139,780 and social units. WEST PARK LOWER RIVER 44,707 71,168 NORTH WARDS 91,603 Ɲ44,707
WEST CENTRAL 112,437 Ɲ UNIVERSITY/ 80,645 123,803 SOUTHWEST Zip Codes Ɲ SOUTH Planning Districts 138,507 Ɲ SOURCE: 2017 American Community Survey LOWER LOWER SOUTH 5,835 Estimates, U.S. Census Bureau SOUTHWEST 41,443 Ɲ 4 HEALTH OF THE CITY 2018
SUMMARY HEALTH MEASURES
Measuring life expectancy and examining trends in causes of death show how people are dying, who is dying prematurely and how these deaths may be prevented. After improving for more than a decade, life expectancy in Philadelphia and nationally has started to decline for many groups. Increases in premature mortality due to drug overdoses and homicides are the primary causes. Increases in chronic conditions and other poor health behaviors are likely to further reverse the trend. HEALTH MOST RECENT POPULATIONS WITH CHANGE IN ESTIMATE POORER OUTCOMES RECENT YEARS
DEATHS OUTCOMES (ALL CAUSES) 857.2 per >> IMPROVING 100,0001 Despite experiencing one of the worst public health crises of our time — the YEARS OF POTENTIAL LIFE LOST BEFORE AGE 75 opioid epidemic — most key health indicators in Philadelphia continued 9,900.8 Non-Hispanic blacks << WORSENING 1 to improve over the last year. Yet, some years health indicators have moved in the wrong direction and Philadelphia’s health LIFE EXPECTANCY (MALES) signifi cantly lags behind other major cities. Also, many disparities in key 72.4 Non-Hispanic blacks << WORSENING years1 health outcomes and behaviors persist particularly for racial/ethnic minorities LIFE EXPECTANCY and those experiencing poverty. The (FEMALES) following sections provide more details. 79.3 << WORSENING years1
ADULTS SELF-REPORTING POOR OR FAIR HEALTH
2 22% Hispanics; NO CHANGE Non-Hispanic blacks
SOURCE: 1 2017 Preliminary Vital Statistics Report, PDPH 2 2017 PA Behavioral Risk Factor Surveillance System HEALTH OF THE CITY 2018 5
SUMMARY HEALTH MEASURES
OVERALL MORTALITY DEATH RATE | 2006–2017
In 2017, an estimated 15,776 1,200 Philadelphia residents died. CITYWIDE 857.2 100,000) 1,000 Heart disease, cancer and 959.3 BLACK unintentional injuries were the 800 848.6 WHITE leading causes of death. 695.5 HISPANIC 600
400 305.9 ASIAN 200
AGE-ADJUSTED DEATH RATE (PER (PER RATE DEATH AGE-ADJUSTED 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
LEADING CAUSES OF DEATH IN PHILADELPHIA | 2017
Heart disease 3,472 Cancer 3,021 Drug overdoses 1,041 Cerebrovascular diseases 714 Chronic respiratory diseases 558 Diabetes mellitus 374 Chronic kidney disease 354 Septicemia 349 Unintenional Injuries 331 Homicide 322 0 500 1000 1500 2000 2500 3000 3500 SOURCE: 2007-2017 Vital Statistics, PDPH NUMBER OF DEATHS
PREMATURE DEATHS YEARS OF POTENTIAL LIFE LOST BEFORE AGE 75 BY RACE/ETHNICITY | 2006–2017
Premature deaths are those 20,000 that occur before age 75. As CITYWIDE 9,901 many of these deaths may 15,000 be preventable, estimating the years of potential life lost 12,311 BLACK (YPLL) is a key measure of 10,000 9,296 WHITE YEARS Philadelphia’s health. From 2000 7,911 HISPANIC to 2014 YPLL declined, reaching 5,000 a low of 9,004 years in 2014. In 2015, this trend reversed 2,471 ASIAN and has continued to increase 0 due to increasing deaths from 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 drug overdoses and homicides among young adults. SOURCE: 2007-2017 Vital Statistics, PDPH 6 HEALTH OF THE CITY 2018
SUMMARY HEALTH MEASURES
LIFE EXPECTANCY LIFE EXPECTANCY BY RACE AND SEX
Similarly, life expectancy 100 98.0 at birth in men and women 80 88.2 84.9 increased until 2014 and 79.7 79.6 77.9 72.4 73.8 74.7 declined in recent years. 60 69.1 Non-Hispanic Asians had the highest life expectancy overall. YEARS 40 Life expectancy at birth was 20 shortest among non-Hispanic black men at 69.1 years. 0 Citywide White Black Asian Hispanic (Non-Hispanic) (Non-Hispanic) (Non-Hispanic)
Male Female SOURCE: 2017 Preliminary Vital Statistics, PDPH
Life expectancy varies LIFE EXPECTANCY BY CENSUS TRACT considerably by neighborhood in Philadelphia. Life expectancy was lowest in communities with high rates of adverse behavioral and economic determinants, including poverty, substance use/abuse, and community violence.
SOURCE: U.S. Small-area Life Expectancy Estimates Project 64.3 87.08 (USALEEP): Life Expectancy Estimates File, National Center for Health Statistics via City Health Higher values (lighter colors) Dashboard indicate greater life expectancy
SELF-REPORTED HEALTH SELF-REPORTED POOR OR FAIR HEALTH
STATUS 40% 35% While life expectancy indicates 36.2% how long people are living, 30% self-reported health status 25% 25.2% provides a measure of quality 20% 15% of life. Overall, 22 percent of 16.0% Philadelphians rated their health 10% as poor or fair. There were 5% 7.0% 0 signifi cant differences among White Black Hispanic Asian racial/ethnic groups with rates being highest among Hispanics. SOURCE: 2015-2017 PA Behavioral Risk Factor Surveillance System HEALTH OF THE CITY 2018 7
CHRONIC HEALTH CONDITIONS
MOST RECENT POPULATIONS WITH CHANGE IN ESTIMATE POORER OUTCOMES RECENT YEARS
OBESITY IN CHILDREN (AGES 5 – 18) Six of the leading causes of 1 21.9% Hispanic boys; << WORSENING death in Philadelphia are Non-Hispanic black girls related to chronic health conditions: heart disease, OBESITY IN ADULTS cancer, cerebrovascular disease, 2 35.0% Non-Hispanic blacks; << WORSENING chronic respiratory disease, Hispanics diabetes, and chronic kidney disease. These conditions often HYPERTENSION IN ADULTS signifi cantly reduce quality 2 33.0% Non-Hispanic blacks << WORSENING of life and life expectancy, and lead to disability and DIABETES IN ADULTS high health care costs. Many 2 12.0% Non-Hispanic blacks NO CHANGE factors, particularly poor health behaviors and lack of access CANCER INCIDENCE to care, contribute to these 502.5 >> IMPROVING conditions, resulting in varying per 100,0003 rates among the population. CHILDHOOD ASTHMA HOSPITALIZATIONS
58.8 Non-Hispanic blacks; IMPROVING per 100,0004 Hispanics >>
SOURCE: 1 2016 – 2017 School District of Philadelphia 2 2017 PA Behavioral Risk Factor Surveillance System 3 2013 – 2015 PA Department of Health Cancer Registry 4 2016 Hospital Discharges, PA Health Care Cost Containment Council 8 HEALTH OF THE CITY 2018
CHRONIC HEALTH CONDITIONS
CHRONIC DISEASES AMONG PREVALENCE OF DIABETES, HYPERTENSION AND OBESITY AMONG ADULTS ADULTS 40% 34% 35% Children and adults with obesity 35% 33.5% 33% 33% 33% 33% 33% are at increased risk for developing 30% 33% 30% 30% 29% chronic health conditions like high 25% 28% 27% blood pressure, type 2 diabetes, 20% asthma, and cardiovascular 15% 12% 13% 12% disease. Approximately 1 in 3 10% 11% 11% 11% 10% adults had obesity, with rates 5% being highest among non-Hispanic 0 blacks. Similar patterns were 2011 2012 2013 2014 2015 2016 2017 observed for hypertension among adults. The rate of diabetes Adult Diabetes Adult Hypertension Adult Obesity remained stable and was highest 60% among non-Hispanic blacks and Hispanics. 50%
40% 45.7% 39.6% 34.8% 30% 32.1%
20% 25.7% 21.6% 16.7% 10% 12.0% 9.3% 0 Adult Obesity Adult Hypertension Adult Diabetes
White Black Hispanic
SOURCE: 2011 – 2017 PA Behavioral Risk Factor Surveillance System
CHILDHOOD OBESITY OBESITY AMONG CHILDREN (AGES 5 – 18)
In 2017, just over 1 in 5 children ages 30% 5 to 18 in public schools had obesity. Male Female 25% 27.5% This high rate of obesity among 23.8% 23.2% children undoubtedly contributes 20% 22.8% 22.0% 21.4% 20.4% 20.3% to the growing epidemic of obesity 18.5% 15% among adults. Non-Hispanic black girls and Hispanic boys had the 10% 10.3% highest rates of obesity. Prevalence 5% of childhood obesity declined slightly over the last decade, but that 0% Citywide Black White Hispanic Asian trend seems to have slowed and potentially reversed in recent years. SOURCE: 2016 – 2017 School District of Philadelphia HEALTH OF THE CITY 2018 9
CHRONIC HEALTH CONDITIONS
CHILDHOOD ASTHMA ASTHMA HOSPITALIZATIONS PER 10,000 CHILDREN (AGE <18)
98.8 97.1 Asthma is a signifi cant problem 100 94.6 for many children in Philadelphia. 90 85.6 The rate of asthma-related 80 71.0 hospitalizations declined to a 70 59.5 58.8 low of 58.8 hospitalizations per 60 71.2 10,000 children in 2016. Non- 50 Hispanic black and Hispanic 40 children had the highest rates of 30 asthma-related hospitalizations, 20
5 to 6 times higher than that of 10,000) (PER HOSPITALIZATIONS 10 non-Hispanic white children. Rates 0 were also highest among children 2009 2010 2011 2012 2013 2014 2015 2016 living in the upper North and West Philadelphia. ASTHMA HOSPITALIZATIONS PER 10,000 CHILDREN (AGE <18) BY RACE/ETHNICITY
100 90 80 70 74.8 60 67.8 50 40 30 20
HOSPITALIZATIONS (PER 10,000) (PER HOSPITALIZATIONS 10 14.8 10.6 0 White Black Asian Hispanic
ASTHMA HOSPITALIZATIONS PER 10,000 CHILDREN (AGE <18) BY ZIPCODE
ASTHMA HOSPITALIZATIONS PER 10,000 CHILDREN ƶ Ƶ Ƶ Ƶ Ƶ No data/Non-residential
SOURCE: 2016 Hospital Discharges, PA Health Care Cost Containment Council 10 HEALTH OF THE CITY 2018
BEHAVIORAL HEALTH
MOST RECENT POPULATIONS WITH CHANGE IN ESTIMATE POORER OUTCOMES RECENT YEARS The term “behavioral health” DIAGNOSED DEPRESSIVE DISORDER IN ADULTS includes conditions related to mental illness, substance 1 22% NO CHANGE use, and emotional well-being.
Behavioral health conditions FREQUENT MENTAL STRESS AMONG ADULTS are often associated with 1 16% Low income NO CHANGE disability and premature death. In partnership with the city’s SUICIDE IDEATION IN TEENS (AGE 14-18) Department of Behavioral 13.8%2 NO CHANGE Health and Intellectual Disability Services, new SUICIDE DEATHS indicators related to behavioral 10.1 Non-Hispanic NO CHANGE health conditions are included per 100,0003 white males in this year’s report. PRESCRIPTION OPIOID USE
35%1
OPIOID-RELATED DEATHS
59.0 Non-Hispanic << WORSENING per 100,0003 white males
ER VISITS FOR DRUG OVERDOSES
8,0654 << WORSENING
SOURCE: 1 2017 PA Behavioral Risk Factor Surveillance System 2 2017 Philadelphia Youth Risk Behavior Survey 3 2017 Preliminary Vital Statistics, PDPH 4 2017 Syndromic Surveillance, PDPH
For more data about behavioral health system in Philadelphia, please visit https://dbhids.org/wp-content/uploads/2018/10/ CBH-2017-Annual-Report-1.pdf. HEALTH OF THE CITY 2018 11
BEHAVIORAL HEALTH
DIAGNOSED DEPRESSIVE DIAGNOSED DEPRESSIVE DISORDER AMONG ADULTS | 2011–2017 DISORDER 25% 23% In 2017, roughly 1 in 5 adults 22% 22% had a diagnosed depressive 20% disorder, which was nearly 20% 19% 19% 19% double the amount 15 years 15% ago. Rates remained relatively stable in recent years and were highest among Hispanics. These 10% estimates include only diagnosed depressive conditions and may be 5% an underestimate of adults with poor mental health. 0% 2011 2012 2013 2014 2015 2016 2017
30%
25% 27.4%
20% 22.8% 21.1% 15%
10%
5%
0 White Black Hispanic
SOURCE: 2011-2017 PA Behavioral Risk Factor Surveillance System
FREQUENT MENTAL STRESS AMONG ADULTS
Overall health depends on both physical and mental well- being. Mental stress impacts APPROXIMATELY quality of life and has been linked to several physical 16 PERCENT OF ADULTS health conditions, particularly REPORTED FREQUENT hypertension. MENTAL STRESS. 12 HEALTH OF THE CITY 2018
BEHAVIORAL HEALTH
SUICIDE IDEATION SUICIDE IDEATION IN YOUTH | 2001–2017 AMONG TEENS
Nearly 1 in 7 high school 18% 16.6% students reported seriously 16% 14.0% 14.1% 14.0% 13.8% considering suicide in 2017. 14% 13.0% 14.0% 14.2% 12% 10% 8% 6% 4% 2% 0 2001 2003 2007 2009 2011 2013 2015 2017
SOURCE: 2001 – 2017 Philadelphia Youth Risk Behavior Survey
SUICIDE DEATHS SUICIDE DEATHS | 2007–2017
Suicide death rates 14 remained fairly stable in 12.0 12 11.4 Philadelphia, approximately 10.1 10.4 10.1 175 each year. Suicides 10 10.2 9.7 10.2 9.8 were most common among 8 9.4 8.7 non-Hispanic white men. 6
4
2 AGE-ADJUSTED DEATH RATE (PER 100,000) (PER RATE DEATH AGE-ADJUSTED 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
SOURCE: 2007 – 2017 Vital Statistics, PDPH HEALTH OF THE CITY 2018 13
BEHAVIORAL HEALTH THE OPIOID EPIDEMIC An opioid epidemic is occurring in Philadelphia and nationwide. This epidemic is largely fueled by years of over prescribing of highly addictive pharmaceutical opioids to treat chronic pain. In 2017, approximately 1 in 3 Philadelphians reported taking a prescription opioid in the last year — rates were high across all age, sex, and racial/ethnic groups.
OVERDOSE DEATHS OPIOID OVERDOSE DEATHS | 2007–2017 59.0 Drug overdose deaths among 60 Philadelphia residents increased nearly 4-fold in recent years. Most 50 drug overdose deaths involve 40.3 opioids, which include both heroin 40 32.7 and pharmaceutical opioids. 28.4 In 2017, the opioid overdose 30 23.1 25.2 mortality rate reached a peak of 20.3
DEATH RATE (PER 100,000) (PER RATE DEATH 20 59.0 deaths per 100,000 people 21.0 18.6 (914 deaths among Philadelphia 17.4 17.5 residents) – 84 percent of these 10 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 deaths involved fentanyl, a lethal synthetic opioid that has penetrated the illicit drug market. SOURCE: 2007 - 2017 Medical Examiner’s Offi ce, PDPH
OVERDOSE ER VISITS EMERGENCY ROOM VISITS FOR DRUG OVERDOSES | 2007–2017
Fatal drug overdoses are just the 10,000 tip of the iceberg. Emergency 8,065 rooms and emergency response 8,000 units are responding to signifi cant increases of non-fatal drug 5,930 6,000 overdoses. In 2017, there were over 5,084 8,000 ER visits for drug overdoses 4,056 4,047 in Philadelphia. However, this is an 4,000 3,028 underestimate of the total non-fatal 3,782 NUMBER OF ER ENCOUNTERS ER OF NUMBER 3,428 3,465 drug overdoses as many individuals 3,252 3,168 never go to the ER when overdoses 2,000 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 are reversed in community settings.
SOURCE: 2007 – 2017 Syndromic Surveillance, PDPH 14 HEALTH OF THE CITY 2018
INFECTIOUS HEALTH CONDITIONS
MOST RECENT POPULATIONS WITH CHANGE IN ESTIMATE POORER OUTCOMES RECENT YEARS
HIV INCIDENCE Infectious diseases are spread between people or animals via 32.5 Non-Hispanic black men >> IMPROVING per 100,0001 who have sex with men food, water, air, insects, blood or (MSM) other bodily fl uids. Advances in public health, specifi cally GONORRHEA CASES sanitation, antibiotics, and << WORSENING 21,0662 Young adult females universal vaccinations, during the twentieth century CHLAMYDIA CASES dramatically reduced illness and << WORSENING 7,2752 Young adult females deaths related to communicable diseases. With the exception CHLAMYDIA AND GONORRHEA AMONG TEENS of conditions transmitted via >> IMPROVING 4.0%2 Teenage girls sexual contact and needle sharing, communicable disease SYPHILIS incidence rates remain low in << WORSENING 1,0262 Non-Hispanic Philadelphia. black MSM
SOURCE: 1 2017 HIV Surveillance Data, AIDS Activity Coordinating Offi ce, PDPH 2 2017 STD Surveillance, PDPH Division of Disease Control HEALTH OF THE CITY 2018 15
INFECTIOUS HEALTH CONDITIONS
HIV/AIDS NEW HIV DIAGNOSES | 2017
The number of new HIV 60 diagnoses has declined by 50 nearly half over the last decade. 52.6 There were an estimated 32.5 40 44.2 new cases per 100,000 people 30 in 2017, representing a slight 32.5 increase from 2016. Despite 20 signifi cant declines in the 100,000 PER INCIDENCE 10 number of transmissions due to 11.4 heterosexual contact, the number 0 Total population Black, non-Hispanic White, non-Hispanic Hispanic of new diagnoses among men who have sex with men (MSM) SOURCE: 2017 HIV Surveillance Data, AIDS Activity Coordinating Offi ce, PDPH remained stable and increased among persons who inject drugs. NEW HIV DIAGNOSES BY TRANSMISSION CATEGORY | 2007–2017 This increase was driven by an outbreak related to the ongoing 600 547 opioid epidemic in Philadelphia. 500 Overall, rates were nearly 5 times 447 higher in non-Hispanic blacks 400 333 316 313 313 332 and Hispanics than non-Hispanic 281 305 291 309 300 273 whites and Asians. 305 300 286 270 200 250 150 127 225 NUBER OF NEW CASES NEW OF NUBER 103 83 187 108 In 2016, HIV incidence 100 76 70 162 40 40 38 was highest in Philadelphia 30 27 compared to other large cities 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 and nationwide. Injection Heterosexual Male-to-Male Drug Use Contact Sexual Contact For more data about HIV/AIDS in Philadelphia, SOURCE: 2007-2017 HIV Surveillance Data, AIDS Activity Coordinating Offi ce, PDPH please visit https://www.phila. gov/documents/hiv-aids-data- NEW HIV DIAGNOSES IN LARGE U.S. CITIES | 2016 and-research/ PHILADELPHIA 31.5
New York City 18.8
Los Angeles 18.2
Chicago 15.4
Dallas 21.4
Nationwide 12.3 0 5 10 15 20 25 30 35 40 45
INCIDENCERATE PER 100,000 SOURCE: 2016 HIV Surveillance Report, CDC 16 HEALTH OF THE CITY 2018
INFECTIOUS HEALTH CONDITIONS
CHLAMYDIA AND REPORTED CHLAMYDIA AND GONORRHEA CASES | 2008–2017 GONORRHEA
Reported cases of chlamydia 25000 and gonorrhea continued to 20,803 21,106 rise. There were 21,066 cases 20,471 19,992 19,428 19,570 19,169 of chlamydia and 7,275 cases 20000 17,012 CHLAMYDIAC A 18,935 of gonorrhea reported in 2017. 18,104 15000 Rates of sexually transmitted infections among teens trended downward in recent 10000 6,671 7,293 GONORRHEAO A years. Rates of chlamydia 6,533 6,304 5,961 6,260 NUMBER OF REPORTED CASES REPORTED OF NUMBER 4,950 were nearly 5 times higher 4,823 6,967 7,275 5000 than gonorrhea among teens. Overall, rates of both
gonorrhea and chlamydia were 0 higher in teen girls than boys. 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
CHLAMYDIA AND GONORRHEA AMONG PUBLIC HIGH SCHOOL STUDENTS | 2008-2018
Launch of Condom Distribution in Schools
10% 10% 10% FEMALE 9.7% 8% 7.7% 8% 6.9% 6.9% 7.8% 7.1% 6.6% 7.5% 6.6% 6.3% 6.1% 6% 5.3% 5.3% 4.9% 4.6% 4.7% ALL 4.4% 4.5% 5.4% 3.9% 4.8% 4% 4% 3.4% 3.4% 3.1% 3.1% 3.9%
% OF PUBLIC HIGH SCHOOL STUDENTS SCHOOL HIGH PUBLIC OF % 2.8% 2.8% 2.4% MALE 2% ‘07-'08 ‘09-'10 ‘11-'12 ‘13-'14 ‘15-'16 ‘17-'18 ‘08–'09 ‘10-'11 ‘12-'13 ‘14-'15 ‘16-'17
SOURCE: 2008-2017 STD Surveillance, PDPH Division of Disease Control HEALTH OF THE CITY 2018 17
INFECTIOUS HEALTH CONDITIONS
SYPHILIS REPORTED SYPHILIS CASES | 2008–2017
The number of syphilis cases 1200 per year has increased nearly 5 times since 2004, with over 1000 1000 cases reported in 2017. 567 This resurgence of syphilis 494 infections is largely among 800 young adult men who have sex with men (MSM), who 368 600 333 accounted for nearly three- 332 261 fourths of new cases in 2017. 255 400 223 242 428 459
NUMBER OF REPORTED CASES REPORTED OF NUMBER 178 308 314 For more data about infectious 269 278 200 238 diseases in Philadelphia, 218 207 150 please visit http://www.phila. 0 gov/health/diseasecontrol/ ‘08 ‘09 ‘10 ‘11 ‘12 ‘13 ‘14 ‘15 ‘16 ‘17 Epidemiology.html. Early Latent Syphilis Primary & Secondary Syphilis
REPORTED SYPHILIS CASES BY RISK GROUP | 2008–2017
800 701 700
600
500
400
300
NUMBER OF REPORTED CASES REPORTED OF NUMBER 200 126 119 100 81 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Men who have Sex with Men 4 Men who have Sex with Women Female Men Unknown Sex Preference
SOURCE: 2008-2017 STD Surveillance, PDPH Division of Disease Control 18 HEALTH OF THE CITY 2018
INFANT AND CHILD HEALTH
MOST RECENT POPULATIONS WITH CHANGE IN ESTIMATE POORER OUTCOMES RECENT YEARS
INFANT DEATHS Health outcomes at birth and
8.4 per 1,000 Non-Hispanic blacks NO CHANGE during childhood are key live births1 indicators of a population’s health. Giving children a LOW BIRTH WEIGHT
healthy start greatly increases 1 10.8% Non-Hispanic blacks NO CHANGE their likelihood of good health outcomes as adults. PRETERM BIRTH
10.0%1 Non-Hispanic blacks >> IMPROVING
NEONATAL ABSTINENCE SYNDROME
13.7 per 1,000 Non-Hispanic white << WORSENING live births2
BREASTFEEDING INITIATED AT BIRTH
80.9%1 >> IMPROVING
CHILDREN (AGE < 3) WITH POTENTIAL DEVELOPMENTAL DELAYS
18.8%3
CHILDREN (AGE 3-6) WITH POTENTIAL DEVELOPMENTAL DELAYS
18.7% 3
INCIDENCE OF CHILD BLOOD LEAD EXPOSURE
4 4.2% Lowest income >> IMPROVING neighborhoods
SOURCE: 1 2017 Preliminary Vital Statistics, PDPH 2 2016 Hospital Discharges, PA Health Care Cost Containment Council 3 2017 Offi ce of Child Development and Early Learning Report, PA DHS 4 2017 Childhood Lead Surveillance Report, PDPH HEALTH OF THE CITY 2018 19
INFANT AND CHILD HEALTH
INFANT DEATHS INFANT DEATHS | 2007–2017
After declining for several 20 years, infant (age less than 1) death rates remained stable in 15 recent years in Philadelphia. 13.5 BLACK Non- Hispanic black babies were three times as likely as 10 8.4 CITYWIDE non-Hispanic white babies to die 5.4 WHITE before their fi rst birthday. Many 5 4.1 HISPANIC of these deaths were related to 3.4 ASIAN DEATH RATE (PER 1,000 LIVE BIRTHS) LIVE 1,000 (PER RATE DEATH improper sleep positioning and 0 thus preventable. 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
In 2015, the most recent SOURCE: 2007-2017 Vital Statistics, PDPH year with comparable data, infant mortality was higher in Philadelphia than in other large cities and nationwide.
LOW BIRTH WEIGHT LOW BIRTH WEIGHT (<2,500 GRAMS) | 2007–2017
In 2017, approximately 1 out of 16% every 11 babies was born with 14% 14.4 BLACK a low birth weight, less than 12% 2,500 grams. Non-Hispanic 10.8 CITYWIDE 10% black babies were twice as 9.1 HISPANIC likely to be born at a low birth 8% 7.6 ASIAN 6.8 WHITE weight than non-Hispanic 6% white babies. While overall 4% rates remained stable, rates 2% among non-Hispanic blacks 0 rose in recent years. 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
SOURCE: 2007-2017 Vital Statistics, PDPH 20 HEALTH OF THE CITY 2018
INFANT AND CHILD HEALTH
PRETERM BIRTH PRETERM BIRTH (<37 WEEKS) | 2007–2017
Rates of premature birth (before 16% CITYWIDE 10.0 37 weeks of pregnancy) slowly 14% 12.5 declined in recent years in 12% BLACK Philadelphia. Rates of preterm 10% 9.8 birth were highest among non- HISPANIC 8% Hispanic blacks. 6.9 WHITE 6% 6.3 ASIAN
4%
2%
0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
SOURCE: 2007-2017 Vital Statistics, PDPH
CHILD LEAD EXPOSURE VENOUS LEAD LEVELS AMONG CHILDREN <6 YEARS OLD | 2007-2017
In 2017, approximately 3.4 12 10.3 percent of tested children 9.4 BLL 5-9 μg/dL 10 &00ƶvKH0 (ages 5 and under) had blood 8.0 lead levels 5-9 μg/dL and 0.8 8 percent were above 10 μg/dL — 6.8 6 % OF CHILREN SCREENED all above the CDC-designated 3.9 4.5 3.8 3.9 3.3 3.4 “reference level” of 5 μg/ 4 2.2 2.4 4.2 dL. Rates of childhood lead 1.8 1.6 2 exposure are highest among 1.1 1.0 0.8 0.9 0.9 0.7 0.8 the neighborhoods with high 0 poverty rates and older 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 housing. POVERTY AND CHILDHOOD LEAD EXPOSURE For more data on childhood
lead poisoning in Philadelphia, % OF PEOPLE % CHILDREN please visit http://www.phila. IN POVERTY ;-8,&00ƶvKH0 <1% gov/health//childhoodlead/ 6-12% "Ɓ index.html. 13–18% 19–25% Ɓ 26–37% Ɓ >37% Non-residential Ɓ
SOURCE: 2017 Childhood Lead Surveillance Report, PDPH 19112 HEALTH OF THE CITY 2018 21
INFANT AND CHILD HEALTH
NEONATAL ABSTINENCE NEONATAL ABSTINENCE SYNDROME | 2002 - 2017 SYNDROME
Neonatal abstinence syndrome 16 13.7 13.67 (NAS) is a condition that 14 occurs when newborns are 12 withdrawing from exposure 9.33 10.93 10 to drugs in the womb. Rates 8.42 of NAS rose substantially in 9.15 8 6.53 recent years due to use of 6.15 6 both pharmaceutical and illicit 4.44 6.19 3.23 3.29 opioids. In 2017, the rate of BIRTHS) LIVE 1,000 (PER RATE 4 4.29 3.95 4.49 NAS was 13.7 per 1,000 live 2 3.09 births, nearly 4 times the rate 0 a decade ago. 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
SOURCE: 2002-2017 Hospital Discharges, PA Health Care Cost Containment Council
DEVELOPMENTAL DELAYS Developmental delay in young children can occur in one or many areas – for example, gross or fi ne motor, language, social or thinking skills – and can have lasting impact on a child’s long-term outcomes.
Developmental delay is most often fi rst detected by Based on data from the early intervention programs physicians using simple screening tools to assess in Philadelphia, almost 19 percent of children under developmental milestones during well child visits the age of 6 exhibit some signs of delay in reaching during the fi rst three years of life. Delay could be their developmental milestones. While some of these the result of genetic causes, like Down syndrome, children catch-up without any interventional services, complications of pregnancy and birth, like prematurity ensuring those with delays are identifi ed and referred or NAS, environmental exposures during early years, to services is critical. like lead exposure or infections, or have no identifi able cause. Most children with developmental delay can catch up with specialized early intervention services, which are available to all families in Philadelphia. 22 HEALTH OF THE CITY 2018
INJURIES
MOST RECENT POPULATIONS WITH CHANGE IN ESTIMATE POORER OUTCOMES RECENT YEARS
HOMICIDE DEATHS Injuries that result in 19.8 Young non-Hispanic << WORSENING premature death are broadly per 100,0001 black males categorized into two groups: unintentional (e.g. traffi c PEDESTRIAN AND BICYCLE INJURIES accidents, poisonings, drug 129.4 Center City, University City, 2 IMPROVING overdoses) and intentional (e.g. per 100,000 and North Philadelphia >> areas homicides, suicides, assaults, etc.). Unintentional injuries as SOURCE: 1 2017 Preliminary Vital Statistics, PDPH a group are the third leading 2 2017 PA Department of Transportation cause of death overall and the leading cause of death for adults ages 25 to 44 in Philadelphia. HOMICIDES
After declining for several years, the homicide mortality rate in Philadelphia increased over the past few years.
HOMICIDE DEATHS | 2007–2017
24.4 25% 21.2 20.5 21.2 19.5 19.1 19.8 20% 17.8 17.8 15% 15.5 15.3 10%
5%
DEATH RATE (PER 100,000) (PER RATE DEATH 0% 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
SOURCE: 2007-2017 Vital Statistics, PDPH HEALTH OF THE CITY 2018 23
INJURIES
HOMICIDES HOMICIDE DEATHS BY RACE/ETHICITY
The homicide mortality rate 40 was highest among non- 35 36.7 Hispanic blacks, nearly ten 30 times higher than non-Hispanic 25 whites and double the rate 20 among Hispanics. 15 18.8 17.6 DEATH RATE (PER 100,000) (PER RATE DEATH 10
5 4.9 0 Total population Black, White, Hispanic non-Hispanic non-Hispanic
SOURCE: 2007-2017 Vital Statistics, PDPH
HOMICIDES IN LARGE U.S. CITIES
Cook (Chicago) 28.1 Philadelphia (Philadelphia) 17.8 Dallas (Dallas) 12.9 Harris (Houston) 12.9 Bexar (San Antonio) 9.9 Maricopa (Phoenix) 9.2 Los Angeles (Los Angeles) 7.3 Nationwide 5.3 Santa Clara (San Jose) 4.5 New York City 3.9 San Diego (San Diego) 3.5
0% 5% 10% 15% 20% 25% 30%
SOURCE: 2016 FBI Uniform Crime Reports 24 HEALTH OF THE CITY 2018
INJURIES
GUN VIOLENCE GUN VIOLENCE AND POVERTY
Over 84 percent of homicides involved a fi rearm. In addition to the roughly 300 fatal shootings, there were approximately 900 non-fatal shootings in 2017. Shootings clustered in socio- economically disadvantaged neighborhoods. SHOOTING VICTIMS HOMICIDES
PERCENT BELOW POVERTY Ɓ Ɓ Ɓ Ɓ Ɓ White census tracts have no available data
PEDESTRIAN AND PEDESTRIAN AND BICYCLE INJURIES, 2011–2017 BICYCLE INJURIES 148.6 Pedestrian and bicycle 150 crashes declined slightly 145.2 142.6 from 2011 to 2017. Rates 139.5 were highest in Center City, 140 University City, and North 135.2 Philadelphia areas. 132.2 129.4 130 CRASH RATE (PER 100,000) (PER RATE CRASH
120 2011 2012 2013 2014 2015 2016 2017
SOURCE: 2017 PA Department of Transportation HEALTH OF THE CITY 2018 25
HEALTH FACTORS
The Robert Wood Johnson Foundation County Health Rankings presents an index of health at the county level that assigns weights to these health factor types. The largest weights are assigned not to clinical health care, but instead social and economic determinants of health (40 percent) and modifi able health behaviors (30 percent), refl ecting a consensus of experts based on extensive research that these factors have the most powerful infl uence on population health. Similar to the HEALTH health conditions discussed above, in recent years some risk factors have improved while others persist or have worsened.
FACTORS LENGTH OF LIFE 50% Health Outcomes QUALITY OF LIFE 50%
Many potentially modifi able factors infl uence health, including behaviors, Tobacco Use accessibility and use of clinical care, HEALTH Diet & Exercise social and economic conditions, and BEHAVIORS 30% Alcohol & Drug Use the physical environment. Monitoring Sexual Activity and addressing these factors is critical to reducing preventable illness and improving the health of Philadelphians.
CLINICAL Access to Care CARE 30% Quality of Care
Health Factors
Education Employment SOCIAL AND ECONOMIC Income FACTORS Family & Social Support 40% Community Safety
Policies PHYSICAL Air & Water Quality & Programs ENVIRONMENT 10% Housing & Transit 26 HEALTH OF THE CITY 2018
HEALTH BEHAVIORS
MOST RECENT POPULATIONS WITH CHANGE IN ESTIMATE POORER OUTCOMES RECENT YEARS
CIGARETTE SMOKING AMONG ADULTS (>18) The CDC recommends four key 23.0%1 Non-Hispanic blacks >> IMPROVING health behaviors that contribute to a healthy life: no tobacco or CIGARETTE SMOKING AMONG TEENS (15-18) drugs, healthy nutrition, regular 3.5%2 Non-Hispanic whites >> IMPROVING exercise, and limited alcohol consumption. All of these are E-VAPOR USE AMONG TEENS (GRADES 9–12) associated with lower risk of 5.0%2 >> IMPROVING chronic health conditions, like cardiovascular disease, cancer, TOBACCO USE AMONG TEENS (GRADES 9–12) and diabetes, which are major 10.2%2 Non-Hispanic whites >> IMPROVING causes of death and illness in Philadelphia. BINGE DRINKING AMONG ADULTS (>18)
1 22.0% Non-Hispanic whites; NO CHANGE Hispanics
BINGE DRINKING AMONG TEENS (GRADES 9–12)
6.9%2 Non-Hispanic whites >> IMPROVING
ADULTS (>18) CONSUMING >1 SWEETENED BEVERAGE
31.6% Non-Hispanic blacks; >> IMPROVING Hispanics
TEENS (GRADES 9–12) CONSUMING >1 SWEETENED BEVERAGE
17.6%2 Non-Hispanic blacks; >> IMPROVING Hispanics
SEXUAL ACTIVITY: TEEN BIRTHS (AGE 15–19)
25.6 per 1,0003 Non-Hispanic blacks; >> IMPROVING Hispanics
SEXUAL ACTIVITY: TEEN CONDOM USE (GRADES 9–12)
2 55.2% NO CHANGE
SOURCE: 1 2017 PA Behavioral Risk Factor Surveillance System 2 2017 Philadelphia Youth Risk Behavior Survey 3 2017 Preliminary Vital Statistics, PDPH HEALTH OF THE CITY 2018 27
HEALTH BEHAVIORS
ADULT CIGARETTE ADULT CIGARETTE SMOKING, 2011–2017 SMOKING 2011 2012 2013 2014 2015 2016 2017 In 2017, 23 percent of adults 30% reported current cigarette 25% 23% 25% smoking. While cigarette 24% 24% 23% 20% 22% 22% smoking among adults is slowly declining, Philadelphia 15% 10% continues to have the highest 30% smoking rate among large 5% 29.3% U.S. cities. 25% 0% 24.9% 22.4% 20%
15%
10%
5%
0% White Black Hispanic
SOURCE: 2011 – 2017 PA Behavioral Risk Factor Surveillance System
TEEN CIGARETTE TEEN CIGARETTE USE, 2001-2017 SMOKING 2001 2003 2007 2009 2011 2013 2015 2017 Among teens, cigarette 16% 15.8% 13.9% smoking declined. In 2017, 14% 12% 3.5 percent of teens reported 9.6% 10% cigarette smoking and 10.7% 10.8% 7.5% 7.2% 8% 10.2 percent reported any 6% tobacco use. 3.5% 4% 2% 8% 0% 7% 7.0% 6% 5% 4% 3.9% 3.3% 3% 2% 1% 0% White Black Hispanic
SOURCE: 2001 – 2017 Philadelphia Youth Behavior Risk Survey 28 HEALTH OF THE CITY 2018
HEALTH BEHAVIORS
ALCOHOL BINGE DRINKING, 2011–2017 25% 24% In 2017, 22 percent of adults 25% 22% and 6.9 percent of teens 19% 19% 20% engaged in at least occasional 20% 15.2% 18% binge or heavy drinking. 15% 10.8% Rates of binge drinking have 13.9% remained stable among adults 10% 6.9% and declined among teens in 5% recent years. 0% 2011 2012 2013 2014 2015 2016 2017 Adult Teen
SOURCE: 2011 – 2017 PA Behavioral Risk Factor Surveillance System, Philadelphia Youth Behavior Risk Survey
SWEETENED ADULTS AND TEENS DRINKING 1 OR MORE SWEETENED BEVERAGES DAILY BEVERAGES
Drinking sugary drinks 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 40% increases risk of obesity and 35.4% 31.1% 31.6% diabetes. Daily consumption 37.4% 30% of sugar sweetened beverages 25.0% 23.7% 28.0% 21.6% declined among teens 17.6% 20% and adults in recent years.
In 2017, the fi rst year of 10% the Philadelphia Beverage Tax implementation, 17.6 0% percent of teens consumed Adult Teen at least one sugar sweetened
beverage daily -- down from 50% nearly 22 percent in 2015. 39.4 41.3 Rates were highest among 40% non-Hispanic blacks and Hispanics. 30% 22.7 20.7 19.5 19.7 20% 13.3 9.4 10%
0% TEEN ADULT TEEN ADULT TEEN ADULT TEEN ADULT White Black Hispanic Asian
SOURCE: 2007 – 2017 Philadelphia Youth Behavior Risk Survey, 2010 – 2015 PHMC Household Survey HEALTH OF THE CITY 2018 29
HEALTH BEHAVIORS
HEALTHY FOOD ACCESS FOOD ACCESS AND POVERTY
Often, neighborhoods with high poverty also have lower access to healthy food outlets. Neighborhoods with low walkable access to food and high poverty rates cluster in the North, River Wards and Southwest regions of Philadelphia.
FOOD ACCESS AND POVERTY Typical food access and low poverty Low food access and low poverty Low food access and high poverty
SOURCE: 2015 Food Access Research Atlas, USDA
TEEN BIRTHS TEEN BIRTHS BY MOTHER’S RACE/ETHNICITY, 2007-2017
High-risk sexual behaviors, particularly among teens, can affect immediate and long- 100 term health. Two key indicators of these high-risk behaviors 80 among teens are condom use and teen births, which are 60 most often unplanned. Teen 9.8 HISPANIC 40
births continued to decline in FEMALES) 1,000 (PER RATE 12.5 BLACK 2017. Teen birth rates were 10.0 CITYWIDE 20 highest among Hispanic teens. 6.9 WHITE Reported condom use among 0 6.3 ASIAN teens remained stable at around 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 55 percent.
SOURCE: 2007-2017 Vital Statistics, PDPH 30 HEALTH OF THE CITY 2018
ACCESS TO CLINICAL & PREVENTIVE CARE
MOST RECENT POPULATIONS WITH CHANGE ESTIMATE POORER OUTCOMES IN STATUS
UNINSURED ADULTS Access to high-quality clinical 9.7%1 Hispanics; Immigrants >> IMPROVING and preventive care is critical to Philadelphians’ health. UNINSURED CHILDREN Access to care largely depends 3.6%1 Hispanics; Immigrants; >> IMPROVING on health insurance coverage, Non-Hispanic Asians affordability, and adequate availability of healthcare ADULTS WITH NO PRIMARY CARE PROVIDER
providers and facilities. 2 18.0% Uninsured; low income >> IMPROVING
ADULTS FORGOING CARE DUE TO COSTS
2 13.0% NO CHANGE
CHILDREN (19-35 MONTHS OLD) WITH UP TO DATE IMMUNIZATIONS >> IMPROVING 78.0%3
ADULTS (>50) WITH COLON CANCER SCREENING
2 68.0% NO CHANGE
WOMEN WITH MAMMOGRAPHY IN PAST 2 YEARS
2 80.0% NO CHANGE
PRIMARY CARE PHYSICIANS PER CAPITA
1:1,2434 Neighborhood clusters >> IMPROVING in Greater Northeast, West, Northwest, and Southwest regions
POTENTIALLY PREVENTABLE HOSPITALIZATIONS
1,374 Non-Hispanic blacks; >> IMPROVING per 1,0005 Hispanics
SOURCE: 1 2017 American Community Survey 1-Year Estimates, U.S. Census Bureau 2 2017 PA Behavioral Risk Factor Surveillance System 3 2017 PhilaVax Immunization Registry, PDPH 2016 Leonard Davis Institute of Health Economics, University of Pennsylvania 2016 Hospital Discharges, PA Health Care Cost Containment Council HEALTH OF THE CITY 2018 31
ACCESS TO CLINICAL & PREVENTIVE CARE
INSURANCE UNINSURED AND MEDICAID AMONG ADULTS (AGES 18 TO 64) COVERAGE
Health insurance coverage has 2009 2010 2011 2012 2013 2014 2015 2016 2017 25% improved signifi cantly for adults 20.9% 20.8% 21.1% 20.3% 20.2% 19.6% 20.5% 19.5% and children in Philadelphia. In 20% 17.8% 2017, 9.7% of adults and 3.6% of 17.7% 15% 16.9% 16.2% children did not have insurance 16.2% 15.7% 13.6% 13.7% coverage. Insurance coverage 10% 12.0% among children began improving 9.7% in 2004 and rates are lower than 5% the national average and other 0% large cities. Rates of uninsured Uninsured Medicaid adults declined signifi cantly as Medicaid enrollment increased UNINSURED AMONG ADULTS (AGES 18 TO 64) AND CHILDREN due to ACA Medicaid expansion. 25% In 2017 approximately 1 in 5 20.1 adults ages 18-64 were enrolled 20% in Medicaid. 15%
While more Philadelphians 9.7 9.9 9.6 8.0 10% have insurance coverage 4.4 4.4 overall, Hispanic adults have 3.6 3.5 3.7 5% signifi cantly higher uninsured 0% rates compared to other racial/ Child Adult Child Adult Child Adult Child Adult Child Adult ethnic groups. Citywide White Black Hispanic Asian SOURCE: 2017 American Community Survey 1-Year Estimates, U.S. Census Bureau
COST OF CARE ADULTS AVOIDING HEALTH CARE DUE TO COST
Paralleling trends in insurance 25% 20% coverage, the percent of adults 18% 19% 20% avoiding care due to cost 17% 16% 16% 13% declined in recent years. In 15% 2017, 13 percent of adults did not seek needed health care 10% because of cost. 5%
0% 2011 2012 2013 2014 2015 2016 2017
SOURCE: 2011 – 2017 PA Behavioral Risk Factor Surveillance System 32 HEALTH OF THE CITY 2018
ACCESS TO CLINICAL & PREVENTIVE CARE
PRIMARY CARE PRIMARY CARE PHYSICIAN SUPPLY | 2016 PHYSICIAN SUPPLY
Overall the availability of primary care providers in Philadelphia has improved. Yet, several clusters of areas in the Northeast, Southwest and parts of South Philadelphia have lower access to primary care. Some of these areas meet the federal criteria as primary care shortage areas. Approximately 18 percent of adults reported not having a primary care physician. Population to Primary Care Provider Ratio For more data on access to 2,920 – 11,856 (lowest supply) 1,803 – 2,919 primary care in Philadelphia, 1,248 -1,802 please visit [link to ATC report]. 757 -1,247 154-756 (highest supply) Excluded (<5th percentile population)
SOURCE: Leonard Davis Institute of Health Economics. University of Pennsylvania
PREVENTIVE CARE CHILDREN WITH RECOMMENDED VACCINATIONS
Immunizations and screenings 90% 74.7% 74.9% 79.8% 80.4% 77.7% 76.1% 76.9% 78.0% are critical public health 80% 67.3% 69.1% prevention tools. The 70% number of young children in 60% 65.2% Philadelphia with up-to-date 50% recommended vaccinations 40% has increased over the last 30% decade and has remained 20% stable in recent years. 10% 0% 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
SOURCE: 2017 PhilaVax Immunization Registry, PDPH HEALTH OF THE CITY 2018 33
ACCESS TO CLINICAL & PREVENTIVE CARE
AMBULATORY CARE HOSPITALIZATIONS FOR AMBULATORY CARE SENSITIVE CONDITIONS, 2005–2016 SENSITIVE CONDITIONS
When chronic health conditions 2,000 1867.3 1871.8 like asthma, diabetes, and 1,900 1760.1 1831.3 hypertension are managed 1,800 1762.5 adequately in primary care 1,700 1596 settings, patients can avoid 1,600 1537.5 many hospitalizations for 1,500 1418.1 1396.3 1378 complications due to these 1,400 1469.8 1374.2 conditions. For this reason, 1,300 HOSPITALIZATIONS (PER 100,000) (PER HOSPITALIZATIONS rates of hospitalizations 1,200 for these “ambulatory care- 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 sensitive conditions”, are used as an indicator of access to and quality of primary care. In Philadelphia, rates of HOSPITALIZATIONS FOR AMBULATORY CARE SENSITIVE CONDITIONS hospitalizations due to these BY RACE/ETHNICITY conditions have declined steadily over the last decade. However, in 2016, rates were All Races 1,400 nearly 2.5 times higher among non-Hispanic blacks and 2 White* 750 times higher among Hispanics than non-Hispanic whites. Black* 2,100
Asian* 200
Hispanic 1,400
0 500 1000 1500 2000 2500
*Non-Hispanic HOSPITALIZATIONS (PER 100,000)
SOURCE: 2005-2016 Hospital Discharges, PA Health Care Cost Containment Council 34 HEALTH OF THE CITY 2018
PHYSICAL ENVIRONMENT
MOST RECENT POPULATIONS WITH CHANGE IN ESTIMATE POORER OUTCOMES RECENT YEARS
DAYS WITH UNHEALTHY AIR QUALITY Clean air and water and a safe 121 NO CHANGE environment in and out of the home are essential for good WALKABILITY health. Unsafe air conditions 79 out of 1002 Far Northeast, Northwest, IMPROVING increase risk of heart disease >> South regions and exacerbate respiratory conditions like asthma and HOUSING WITH POTENTIAL LEAD RISK chronic obstructive pulmonary 7,2752 >> IMPROVING disease. Unsanitary water can spread infectious illnesses and HOUSING CODE VIOLATIONS harmful chemical compounds. 4.0%2 North region << WORSENING Unsafe home conditions can have similar impacts and increase risk for unintentional SOURCE: ¹ 2017 AMP 410 S Reports, Air Management Service, PDPH injuries and create extreme ² 2016 Walk Score® via City Health Dashboard ³ 2015 American Community Survey 5-year Estimates via City Health Dashboard stress for families. Ensuring a 2017 Philadelphia Licenses & Inspections safe environment is particularly important for children and seniors. HEALTH OF THE CITY 2018 35
PHYSICAL ENVIRONMENT
AIR QUALITY DAYS WITH GOOD, MODERATE, AND UNHEALTHY AIR QUALITY
Air quality is summarized by the Air Quality Index (AQI), which combines 250 224 information about four major air 210 203 189 190 189 190 pollutants regulated by the Clean 200 183 171 177 179 Air Act: ground-level ozone, particle 155 166 178 150 174 166 172 pollution, carbon monoxide, and sulfur 163
DAYS 136 135 132 dioxide. When the AQI is below 50, it 100 128 is considered “good” air quality. When the AQI is between 50 and 100, it is 50 40 28 28 20 28 considered “moderate” air quality 8 10 9 16 9 12 and when it is above 100 the air is 0 considered unhealthy. 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Bad Moderate Good The number of days with unhealthy air quality has declined signifi cantly in Philadelphia, while days with good air quality have increased. In 2017, Philadelphians experienced more days with good air quality than in previous years. SOURCE: 2007-2017 AMP 410 S Reports, Air Management Service, PDPH
WALKABILITY 2016 WALK SCORE
Having walkable neighborhoods encourages active transit and facilitates easy access to jobs, food, and health resources. Philadelphia’s Walk Score®, a summary scoring of walkability to neighborhood resources and amenities, is 79 out of 100. Some areas in the far Northeast, Northwest, and South have walk WALKABILITY SCORE scores that are signifi cantly lower Higher values indicate than the rest of the city. better walkability 87 - 100 72 - 86 49 - 71 24 - 48 3 - 23
SOURCE: 2016 Walk Score® via City Health Dashboard 36 HEALTH OF THE CITY 2018
PHYSICAL ENVIRONMENT
HOUSING WITH HOUSING WITH POTENTIAL LEAD RISK I 2015 POTENTIAL LEAD RISK
Most Philadelphia homes were built before 1950, and many of those in low income areas have been poorly maintained. Based on age of housing, 42.2 percent of houses in Philadelphia have a potential risk of lead exposure, which is particularly harmful for young children.
68% 6%
SOURCE: 2015 American Community Survey 5-year Estimates via City Health Dashboard
HOUSING CODE VIOLATIONS HOUSING CODE VIOLATIONS
Housing code violations occur when people living in rental properties make complaints to 250 218.9 the Department of Licenses and 199.2 181.7 182.9 190 200 180.3 187.5 Inspections, which then conducts 164.7 193.4 inspections. The number of 185.4 150 housing code violations is a proxy 164.8 for measuring housing quality in 100
the city, but it is infl uenced by the 100,000) (PER RATE staffi ng levels of the Department of 50 Licenses and Inspections. In 2017, 0 187.5 violations per 1,000 occupied 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 housing units were issued. Rates are highest in the lowest-income neighborhoods, particularly in
North Philadelphia. SOURCE: 2017 Philadelphia Licenses & Inspections HEALTH OF THE CITY 2018 37
SOCIAL AND ECONOMIC DETERMINANTS
MOST RECENT POPULATIONS WITH CHANGE IN ESTIMATE POORER OUTCOMES RECENT YEARS
POVERTY Social support, fi nancial 25.7%1 Hispanics; Non-Hispanic >> IMPROVING resources, education, blacks; North and West employment, and stable regions housing directly impact CHILDREN IN POVERTY Philadelphians’ ability to access 31.9%1 Non-Hispanic blacks; >> IMPROVING adequate health care, engage Hispanics in healthy behaviors, and live CHILDREN IN SINGLE-PARENT HOUSEHOLDS in a healthy environment. But 1 these determinants are not 55.5% Non-Hispanic blacks; >> IMPROVING Hispanics addressed in traditional clinical and preventive health care. This UNEMPLOYMENT section provides data on these 2 6.2% >> IMPROVING social determinants of health in LABOR FORCE PARTICIPATION RATE Philadelphia. 2 56.2% NO CHANGE
ON-TIME HIGH SCHOOL GRADUATION
67.2%3 Non-Hispanic blacks; >> IMPROVING Hispanics
ADULTS COMPLETING SOME COLLEGE
50.0%1 Non-Hispanic blacks; >> IMPROVING Hispanics
EXCESSIVE HOUSING COST (>30% INCOME)
1 40.2% High poverty areas NO CHANGE HOMELESSNESS
5,7884 << WORSENING VIOLENT CRIME RATE
989 per 100,0005 High poverty areas >> IMPROVING
SOURCE: ¹ 2017 American Community Survey 1-Year Estimates, U.S. Census Bureau ² 2017 Bureau of Labor Statistics ³ 2017 PA Department of Education 2018 Point in Time Count, Offi ce of Homeless Services 2017 FBI Uniform Crime Report 38 HEALTH OF THE CITY 2018
SOCIAL AND ECONOMIC DETERMINANTS
POVERTY POVERTY RATES FOR ADULTS AND CHILDREN, 2007–2017
In 2017, approximately one-fourth 45% 39.2% 36.9% 38.3% 37.3% of Philadelphians lived in a 40% 36.4% 34.8% 33.2% 31.9% household with an income below 35% 31.4% 28.4% 36.8% 36.1% 100 percent of the federal poverty 30% 25% level. Poverty rates declined in 26.7% 26.9% 23.8% 24.1% 25.0% 26.3% 26.0% 25.8% 25.7% 25.3% recent years among all racial/ 20% ethnic groups except non-Hispanic 15% whites. Increased rates of poverty 10% among non-Hispanic whites are 5% 0% likely related to the ongoing opioid 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 epidemic. Still, Hispanics and non- Hispanic blacks are still about twice Children Adults as likely to live in poverty as non- Hispanic whites. Poverty is greatest POVERTY RATES BY RACE/ETHNICITY in North and West Philadelphia. 60% 52.6 50% 45.0 40% 28.2 30% 26.7 25.4 24.7 24.5 21.1 20%
10%
0% CHILD ADULT CHILD ADULT CHILD ADULT CHILD ADULT White Black Hispanic Asian
SOURCE: 2017 American Community Survey 1-Year Estimates, U.S. Census Bureau HEALTH OF THE CITY 2018 39
SOCIAL AND ECONOMIC DETERMINANTS
Poverty is the underlying determinant for many of the racial IMPACT OF and ethnic health disparities that persist in Philadelphia. Many Philadelphians live, learn, work, shop, and play in high poverty POVERTY neighborhoods that make good health diffi cult to achieve. Neighborhoods with high rates of poverty often have lower access ON HEALTH to healthy affordable foods, safe outdoor spaces for physical activity, and clinical services, and higher rates of tobacco and alcohol DISPARITIES retailers and community violence. These contextual factors in addition to cultural norms often shape health behaviors. Ultimately, they both partially explain poor health and point toward potential solutions.
Living just a couple of miles INCOME INEQUALITY AND LIFE EXPECTANCY away can reduce life expectancy by nearly 20 years. Income HIGHEST inequality and life expectancy PROPORTION OF 72 HIGH INCOME are directly correlated – that is, neighborhoods with more individuals in the lowest income brackets have signifi cantly lower life expectancy than neighborhoods with more individuals in the highest income bracket. Neighborhoods with higher income gaps are also 0 much more likely to have higher proportions of racial/ethnic minorities.
HIGHEST PROPORTION OF -72 64 69 74 79 84 89 LOW INCOME LIFE EXPECTANCY AT BIRTH (AVERAGE)
SOURCE: 2015 ACS 5-Year Estimates, U.S. Census Bureau and U.S. Small-area Life Expectancy Estimates Project (USALEEP): Life Expectancy Estimates File, National Center for Health Statistics via City Health Dashboard 40 HEALTH OF THE CITY 2018
SOCIAL AND ECONOMIC DETERMINANTS
POVERTY AND IMPACT OF POVERTY ON BLACK-WHITE HEALTH DISPARITIES I 2015 - 2017 RACE/ETHNICITY 45% For many health outcomes and Highest Income behaviors, higher rates of poverty 40% Mid-Income among non-Hispanic blacks and Lowest Income Hispanics account for much of 35% the disparity. As an illustration, rates of several health outcomes 30% and behaviors are shown below comparing non-Hispanic blacks 25% to non-Hispanic whites by income category. Of note, the white/black 20% disparity is reduced at higher incomes and in many cases no 15% longer present. 10%
5%
0% White Black White Black White Black White Black White Black Poor or Adult Smoking Hypertension Diabetes Frequent Fair Health Prevalence Mental Stress
SOURCE: 2015-2017 PA Behavioral Risk Factor Surveillance System
UNEMPLOYMENT UNEMPLOYMENT RATES | 2007–2017
Similar to national trends, 12% unemployment has declined 10.6% 10.7% 10.9% 9.7% 10.4% signifi cantly in recent years. In 2017, 10% unemployment rates in Philadelphia 8.1% were higher than other major U.S. cities 8% 6.9% 6.8% 6.1% 7.1% 6.2% and the national average. 6%
4% Unemployment considers employment status among those working and 2%
seeking employment. Workforce 0% participation is a measure of 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 employment among all Philadelphians, including the disabled, retired, and SOURCE: U.S. Bureau of Labor Statistics those not actively seeking employment. Workforce participation has remained relatively stable since 2000. HEALTH OF THE CITY 2018 41
SOCIAL AND ECONOMIC DETERMINANTS
EDUCATION ON-TIME HIGH SCHOOL GRADUATION RATES, 2011–2017
On-time graduation rates 2011 2012 2013 2014 2015 2016 2017 increased since 2011, but 80% 70.1% 68.2% 68.6% 67.2% remained stable in recent years. 70% 60% In 2017, on-time graduation rates 61.5% 64.8% 50% were highest among non-Hispanic 55.2% whites and lowest among 40% Hispanics. 30% 20% 10% The number of adults completing 0% some college increased over the last decade but has remained 80% stable in recent years. Roughly 74.6% 70% half of Philadelphians age 25 and 68.6% 66.4% 62.9% 60% older completed at least some 50% college training. ON-TIME HIGH SCHOOL 40% GRADUATION RATES BY 30% RACE/ETHNICITY 20% 10% 0% Total Black White Hispanic
SOURCE: 2017 PA Department of Education
PHILADELPHIANS (AGE ≥25) WITH SOME COLLEGE EDUCATION
60% 51.5% 50.0% 46.2% 46.6% 47.4% 48.0% 47.9% 50.0% 50% 42.6% 43.4% 40% 44.0% 30%
20%
10%
0% 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
SOURCE: 2007-2017 1-Year Estimates American Community Survey, U.S. Census Bureau 42 HEALTH OF THE CITY 2018
SOCIAL AND ECONOMIC DETERMINANTS
EXCESSIVE HOUSING COST EXCESSIVE HOUSING COST, 2007–2017
In 2017, 43.0 percent of Philadelphia 60% 53.1% 53.2% 51.9% 52.3% 52.8% 51.9% households paid 30 percent or more 50.0% 49.6% 50.3% 48.1% 50% of their income for rental housing. Rates of housing cost-burden have 40% 43.0% declined in recent years, but remain 30% very high. The highest rates of housing cost burden occur in high 20%
poverty neighborhoods in the North, 10% Upper North and Lower Northeast 0% regions of Philadelphia. 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
SOURCE: 2007-2017 1-Year Estimates American Community Survey, U.S. Census Bureau
HOMELESSNESS HOMELESSNESS, 2015–2018
6,000 Homelessness is one indicator of 5,328 5,407 4,737 4,705 housing insecurity among a population. 5,000 The number of individuals living SHELTERED homeless without shelter in Philadelphia 4,000 increased signifi cantly over the last few 3,000 years as a direct result of the opioid 2,000 epidemic. Individuals with substance 956 1,083 670 705 use disorder, who are also living 1,000 homeless, often face barriers accessing UNSHELTERED 0 temporary housing and shelters due to 2015 2016 2017 2018 their dependency. SOURCE: Point-in-Time Count, Offi ce of Homeless Services
VIOLENT CRIMES VIOLENT CRIMES, 2007–2016
1,600 Violent crimes create unsafe 1,441.3 neighborhoods, increase 1,400 1,475.4 1,214.6 1,193.3 1,160.1 1,099.3 community stress, and may deter 1,200 1,238.2 1,021.5 1,029.0 989.0 healthy behaviors like outdoor 1,000 exercise. The violent crime rate in 800 Philadelphia decreased over 30 600 percent from 2007 to 2016. 400 200 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
SOURCE: FBI Uniform Crime Reports HEALTH OF THE CITY 2018 43 ACKNOWLEDGMENTS
REPORT CONTRIBUTORS: DATA SOURCES: Gillian Capper, MPH American Medical Association PDPH Medical Examiner’s Offi ce Thomas Farley, MD, MPH Provider Masterfi le Pennsylvania Department of Education Vibha Gujar, MS Bureau of Labor Statistics Pennsylvania Department of Health Amory Hillengas Centers for Disease Control and Prevention Cancer Registries Mahmud Iqbal, MPH City of Philadelphia Licenses and Pennsylvania Department of Health Annaka Scheeres Inspections Vital Statistics Raynard Washington, PhD, MPH County Health Rankings & Pennsylvania Department of Jessica Whitley, MPH Roadmaps Transportation FBI Uniform Crime Reports Pennsylvania Health Care Cost Containment Council Get Healthy Philly Pennsylvania National Electronic Health Indicators Warehouse Disease Offi ce of Homeless Services Surveillance System (PA-NEDSS) PA Behavioral Risk Factor Philadelphia Youth Behavioral Risk Surveillance System Behavior Survey PDPH AIDS Activities Coordinating Public Health Management Offi ce Corporation PDPH Air Management Services School District of Philadelphia PDPH Division of Disease Control US Census—American Community PDPH Environmental Health Survey Services US Environmental Protection Agency 44 HEALTH OF THE CITY 2018
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