Live Well San Diego Community Health Assessment

COMMUNITY HEALTH

ASSESSMENT

Inquiries regarding this document may be directed to: Accreditation Coordinator County of San Diego Health and Human Services Agency Public Health Services Health Services Complex 3851 Rosecrans Street, MS: P-578 San Diego, CA 92110-3652 (619) 531-5800

All materials in this document are in the public domain and may be reproduced and copied without permission. However, citation to source is appreciated. Suggested citation: County of San Diego, Health and Human Services Agency. Live Well San Diego Community Health Assessment. June 2014. This publication of the Live Well San Diego Community Health Assessment utilizes estimated data from 2009. This document is the culmination of activities that started in 2010 and ended with this publication in June 2014. This document was developed under the General Management System of the County of San Diego, and is in support of Live Well San Diego.

County of San Diego Board of Supervisors

Greg Cox Dianne Jacob Dave Roberts Ron Roberts Bill Horn

District 1 District 2 District 3 District 4 District 5 Chair

Helen N. Robbins-Meyer Chief Administrative Officer

Nick Macchione, M.S., M.P.H., F.A.C.H.E. Director, Health and Human Services Agency

Wilma J. Wooten, M.D., M.P.H.

Public Health Officer

INTRODUCTION LETTER

Dear Community Partner:

The County of San Diego launched Live Well San Diego in July 2010 and embarked upon a comprehensive community planning process shortly thereafter. The Health and Human Services Agency (HHSA) engaged community partners at the regional level to best meet the needs of San Diego’s large population and diverse communities. This process included a comprehensive community health assessment, which was conducted March through August 2012 in all six HHSA regional planning areas. For the purposes of this document, the two northern Regions combined efforts. Information collected from this assessment is found in this report along with other recently completed programmatic and partner assessments. This report summarizes the assessment data used to satisfy the public health accreditation requirements.

In collaboration with the HHSA Division of Public Health Services (PHS), the Regions utilized the Mobilizing for Action through Planning and Partnership model. This collaboration forged the path for the development of the Live Well San Diego Community Health Assessment (CHA) that would be later used for PHS to submit in its application to pursue national public health accreditation for HHSA.

Results from all the above assessments influenced the development of the Live Well San Diego Community Health Improvement Plan. Included in this document is an introduction to HHSA and the principles that guide its operations; a description of the tools and processes used to involve the community in the community health assessment process; and a summary of countywide assessments, including a section for the regional community health assessments with a brief description of each Region’s process.

The contributions and commitment from our community partners provide the basis for our community health improvement planning work within the Live Well San Diego strategic framework. HHSA has a long history of engaging in public-private partnerships to address some of the most challenging health issues, such as HIV and AIDS, infant mortality, chronic disease, and tobacco prevention, to name a few. Through the community engagement process, internal and external partnerships have strengthened, and we look to the future as we measure our progress to demonstrate the impact of this collective effort approach to winning some of the most important health battles of our time.

Your dedication and contributions to this effort are appreciated by all.

Table of Contents EXECUTIVE SUMMARY 8 EAST REGION 83 COUNTYWIDE COMMUNITY HEALTH ASSESSMENT 15 Leadership Team Members 85

INTRODUCTION 16 Community Health Improvement Process 86

MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP Community Health Assessments 87 29 (MAPP) Community Perceptions Assessment 87 DEMOGRAPHIC PROFILE OF SAN DIEGO 30 Demographics 91 COMMUNITY HEALTH STATUS ASSESSMENT 33 Health Resources Availability 91 CONTRIBUTING CAUSES OF COMMUNITY HEALTH ISSUES 47 Strengths and Risks to Health 92 FORCES OF CHANGE 49 Population Health Issues 93 COMMUNITY ASSETS AND RESOURCES (THEMES AND STRENGTHS) 54 Factors Contributing to Population Health Challenges 95 LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT 59 Community Assets and Resources (Themes and Strengths) 96 REGIONAL COMMUNITY HEALTH ASSESSMENTS 65 Forces of Change 96 CENTRAL REGION 67 Summary of Assessments 98 Leadership Team Members 69 Priority Areas Identified from Assessments 99

Community Health Improvement Process 70 NORTH CENTRAL REGION 101 Community Health Assessments 72 Leadership Team Members 103 Community Perceptions Assessment 72 Community Health Improvement Process 104 Demographics 74 Community Health Assessments 105 Health Resources Availability 75 Community Perceptions Assessment 105 Strengths and Risks to Health 76 Demographics 109 Population Health Issues 77 Health Resources Availability 109 Factors Contributing to Population Health Challenges 79 Strengths and Risks to Health 110 Community Assets and Resources (Themes and Strengths) 79 Population Health Issues 110 Forces of Change 80 Factors Contributing to Population Health Challenges 112 Priority Areas Identified from Assessments 81 Community Assets and Resources (Themes and Strengths) 113 Forces of Change 114 Summary of Assessments 115 Priority Areas Identified from Assessments 116 6

Table of Contents NORTH COUNTY REGIONS 119 SOUTH REGION 145 Leadership Team Members 121 Leadership Team Members 147 Community Health Improvement Process 122 Community Health Improvement Process 148 Community Health Assessments 123 Community Health Assessments 149 Community Perceptions Assessment — North Inland Community Perceptions Assessment 149 Region and North Coastal Region 123 Demographics 151 Demographics — North Coastal Region 127 Health Resources Availability 151 Health Resources Availability — North Coastal Region 128 Strengths and Risks to Health 152 Strengths and Risks to Health — North Coastal Region 128 Population Health Issues 153 Population Health Issues — North Coastal Region 129 Factors Contributing to Population Health Challenges 154 Demographics — North Inland Region 133 Community Assets and Resources (Themes and Strengths) 154 Health Resources Availability — North Inland Region 134 Forces of Change 156 Strengths and Risks to Health — North Inland Region 134 Priority Areas Identified from Assessments 156 Population Health Issues — North Inland Region 135 ACKNOWLEDGMENTS 159 Factors Contributing to Population Health Challenges — North Inland Region and North Coastal Region 139

Community Assets and Resources (Themes and Strengths) — North Inland Region and North Coastal 139

Forces of Change — North Inland Region and North Coastal Region 140

Summary of Assessments — North Inland Region and North Coastal Region 141 Priority Areas Identified from Assessments 143

7 EXECUTIVE SUMMARY residents with equal percentages of males and females (50%). The majority was white (50%) or Hispanic (30%). Most of the popu the of Most was betweenages of the 25 (30%). Hispanic or (50%) white was majority The (50%). females and males of percentages equal with residents 3.2 approximatelyof populationdiverse a had County Diego San 2009, In assessment. healthcommunity this develop to used was populatioEstimated 2009). (from available data current most the using 2012, in conducted was assessment health community The DemographicProfile with regionalpriorities and leadership teamsto address them. the developing for framework the provided and assessment County overall the MAPPcont Assessment)Services.assessmentEach Health EssentialPublic 10 thewithinstandards nationalsystemmeets health public local System Health as Public such (Local residents, assessment their fourth influence The that conductedat a countywidelevel inIt June2012. change. brought together67 community health members representing sectors21 evaluateto ho policy of and causes services, root health the factors, determining social by behaviors, community its of status health were the assessments assess three to first The 3) Assessment. Assessment, System Change Health Public of Local demographics,atregionalallowedlevelprocessbecause the healthvaryeachconducted culture,outcomesthem.among and This Forces 4) 2) and Assessment, Assessment, Status Strengths Health and Community Themes Community 1) included and conducted were assessments MAPP (NACC Officials Health and theCenters forDisease Controland Prevention (CDC) City called and County of Association National the from adapted model planning improvement health community a leadershi Regional lives.thriving and safe, healthy,live residents help to changes initiate to togethercommunity the bring November in formed were teams leadership regional residents, County Diego San of needs the address appropriately to order In a communities; free drug SanDiego County residents. and tobacco support as well as welland health the improve to aimsHHSA communities, strategies, these Through workforce. employeeCounty the within culture activethe changing and foods healthy to access increase that changes and policy pursuing lives; free drug and tobacco and living active eating, healthy of promotion the through choices, positive the with associated include that components the of implementation the is vision this to Integral residents. many (HHSA) Agency Services Human and Health Diego San of County The Note: FastNote: forward 2012, to when the estimated population is47% whiteand 34% Hispanic 2 1 County of Diego.San “Live Diego”.San Well Estimatedpopulation data isfrom SANDAG. For details, more please visit Building Better Health BetterBuilding ulig etr Health Better Building -

64 (53%).64 Sixty http://www.livewellsd.org EXECUTIVE SUMMARY EXECUTIVE

component: building a better system which integrates care and services; supporting healthy andhealthy supporting services;and care integrateswhich system better a buildingcomponent: - four four percent(64%) of the population ages five yearsor olderwere English , iig Safely Living . Retrieved . on October 22, 2013. http://www.sandag.org/resources/demographics_and_other_data/demographics/estimates/index.asp

and , MobilizingforAction through Planning and Partnerships

Live Well San Diego San Well Live 8

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strives to create a healthy, safe, and thriving community for its for community thriving and safe, healthy, a create to strives

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EXECUTIVE SUMMARY

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San San Diego County Community Profiles

in in July 2010 and embarked upon a comprehensive 2009, 2009, 23% of people living in San Diego County were foreign bor

- 9 tenth (11.4%) of the population was below the Federal Poverty Poverty the Federal below was the ofpopulation (11.4%) tenth - third (34.0%) of them had a Bachelor Degree or higher. or Degree a Bachelor had them of third (34.0%) -

Live Live Well San Diego, Building Better Health couple families (50%) and other families (16%). The median household income of residents was $4 was residents of income median The household (16%). families (50%) families other and couple - only only speakers, and 20% were bilingual. Between 2005 - seven percent (77%) were native, including 47% who were born in California. in born California. were who 47% including native, were (77%) percent seven - community community partners, such as Community Health Improvement Partners and the Hospital Association of San Diego and Imperial Coun key hea prioritizing and for the team context identifying planning regional HHSA each from these provided reports Information planning. improvement health for community determinants also also conducted assessments based on program or project requirements. Immunization, A summary Maternal of the and assessments conducted Child by Health, the HIV/STD, and Injury programs are included in this document along with assessment reports from each Region in identifying goals, strategies, and measurable objectives to address the health and safety needs of the communi the of needs safety and health the address to objectives measurable and strategies, goals, identifying in Region each In addition to the regional assessments conducted as part of the MAPP process, several HHSA programs and other local organiza and and included chronic disease, communicable (infectious) disease, highlight maternal key findings from each and region, including disparities, determinants of child health, health issues, community health, assets and r and injury planning community for point a starting provided data. assessments These planning. improvement health for community focus areas of Regional assessm improvement improvement plan. The HHSA Community Health Statistics Unit presented county and regional data to each of the five regional groups. The health indicators presented were derived from the Community Health Statistics Unit’s Each Each of the five HHSA regional planning groups conducted regions its as own community part health of assessment the with data community specific engagement to process its to respec assess health, determine priority areas, and develop a community healt conducted conducted March through August 2012 in all six HHSA regional efforts. combined Regions planning areas. For the purposes of this document, the two north The The County of San Diego launched nee the tomeet best level regional the at partners engaged community HHSA The thereafter. shortly process planning community Diego’s large population and diverse communities. This process included a comprehensive community health assessment, which wa Community Health Status Assessment Status Health Community 11.9% 11.9% of families with children falling below the poverty level. Of the nearly 3.2 million residents in San Diego County, app million (59%) were 25 years of age or One education. college older. some had 31.0% nearly and graduates, Of those, 14.8% had less than a high school degree. Another 20.2% were high scho percentage included married both included percentage one over A little household. persons per 2.89 of an average with Seventy In 2009, there were approximately 1 million households in San Diego County and families made up 66% of these households. Thi were were Spanish EXECUTIVE SUMMARY    underserved  to services to Severallarge other scale efforts and funding sources provided resourceshealth for improvement throughoutSanDiego County: access timely improving withinHHSA the Regions. pu on new with activities emphasis prevention health mental integrating CommunityCommunitiespreventionPuttingactivitiesPreventionperformed health(e.g., by prom Transformation to Grant) Work, an by opportunity this on with capitalized HHSA dialogue. disabling, and initiatives and severe populations. becoming from illness Innovation. and Needs, Technological Facili Capital Training, and Education Workforce Intervention, Early and Prevention Support, and Services Community Planning, services: appropriate linguistically and culturally comprehensive, to access improve to priorities and needs critical services. health mental expand to funds counties provide to designed is funding PublicHealthandFund (PPHF) thatsupports Community Transformation Grant CDC.fundingthe Mental from Health ServicesAct ( examplestwoofforces thatchanged landscape the ofprovision thehealthand healthofmental services.containsACA The the 20 of (MHSA) Act Services h Health Mental 63 impact Prop and that 2010 of (ACA) priorities Act Care politicalAffordable and inProtection Patient The transformation care. health undergone have governments state and federal the decade, past the Within Forces ofChange Assessment factors,such as educational attainment, low diseases Health The Better implications. policy and factors, social services, health of provision genetics, and biology behaviors, cause contributing These thriving. and healthy,safe, be individualsto of ability the in role important an play factors Five ContributingCauses ofCommunityHealth Issues

rvsos eae fetv, atcpns il uoaial b erle i te aiona eia Assac Porm (Medi Program Assistance Medical California the in MediCal),California's Medicaid program. enrolled be automatically will participants effective, became provisions low uninsured, certain to coverage medical primary exp optionally to counties the allowed which 2010, in launched project, demonstration a (LIHP), Program Health Income Low The 2010. adopted Supervisors of Board Diego San of County The for funding in resulting package stimulus economic an as CommunitiesPutting Prevention 2009 to (CPPW),Work administered by the CDC. in passed (ARRA) Act Reinvestment and Recovery American The developmentof the t to leading epidemic, obesity childhood the addressing with 2004 in HHSA tasked Supervisors of Board Diego San of County The

–

cancer, heart disease, type 2 diabetes, and lung disease lung and diabetes, 2 type disease, heart cancer,

Prevention programs bring mental health awareness into the lives of all members of the community through public ed public through community the of members all of lives the into awareness health mental bring programsPrevention strategy identified behaviors like smoking, poor diet, and physical inactivity as those that lead to the development of four of development the to lead that those as inactivity physical and diet, poor smoking, like behaviors identified strategy Callto Action:SanDiego CountyChildhood ObesityAction Plan

rvnin n Ery nevnin evcs uprs h dsg o porm t peet ment prevent to programs of design the supports services Intervention Early and Prevention

income,and neighborhood conditions,also influence health. - noe dls ad irrd eea cmoet o AA I 21, hn ACA when 2014, In ACA. of components several mirrored and adults, income Live Well San Diego, San Well Live

10 –

which account for over 50% of deaths in San Diego County. Diego San in deaths of 50% over for account which

Building Better Health Better Building MHSA contains six major components addressing t addressing components major six contains MHSA , published , January in 2006.

as a countywide initiative in July in initiative countywide a as ieWl Sn ig, Building Diego, San Well Live

Community s i s nclude individualnclude

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Program evention health c tie on staffon ucation - MHS h and th 04 Cal s and s Other and are he he A) or al

EXECUTIVE SUMMARY r y ss ss fo ke

ional ional stem stem dre sy rom rom the regional regional reg

ent. d f to ssm and and community

Live Live Well San Diego ™. ™. Projects sustained and/or expanded include:

Healthy Healthy Works

Ed), - 11

free lifestyles. There are several other community assets and resources: and assets community other several are There lifestyles. free -

based Care Transitions Partnership designation, Partnership Transitions Care based - Free San Diego, Free San - “Weight of the Workplace” Workplace” Forum, the of “Weight and 2013), (May Showcase Produce Local” Go “Let’s Program. (VISA) Age At Any Services Independence Veterans Safe Routes to School Coalition, to School Safe Routes Services, Center Transition Community Care, Informed Trauma Community Diego San Regional Safe Routes to School Strategic Plan, Strategic School to Routes Safe Regional Supplemental Nutrition Assistance Program and Education (SNAP Education and Program Assistance Nutrition Supplemental Housing, Public for Ban Smoking Taskforce, to School Farm County Diego San Collaborative, Beacon Diego San Campaign, Us to It’s Up Smoke Policy, Garden Community The Public Health Accreditation Board launched national, voluntary public Americans. all for outcomes health health and improving the practice standardizing accreditation in September 2011 as a vehicle

              

healthy eating, active living, and smoke living, and eating, active healthy health health improvement at the regional level. Some of the most influential programs and important assets to the community resulte work initiated with funding from the CPPW grant, known in San Diego as the Resident Leadership Academy (RLA), school wellness programs, worksite lactation policies, and a mass media campaign to ad themes, assets and resources (which aligns with Public Health Accreditation Board’s measure 1.1.2) were included in this this asse in included were 1.1.2) measure Board’s Accreditation Health Public aligns with (which resources and assets themes, Several programs throughout San Diego County contribute to the overall goals and objectives of the HHSA Regions has unique community themes, strengths, and assets available based on their geography and demographics. Some demographics. and geography based on their available assets and strengths, themes, community has unique Regions the HHSA themes identified in each Region were healthy eating, active living, safety, mental health, and substance abuse. In addition Community Assets and Resources and Assets Community Based on MAPP Themes and Strengths Assessment, information was gathered to assess the community assets and resources. Each of operate. operate. They lead to the community prioritizing plan. improvement health community certain areas of public health over others, which will be reflected in each These These legislations and programs are all forces of change that affect the context in which the community and its public health  EXECUTIVE SUMMARY community’s the ability betterto address needs.their ass resources and assets community The Regions. the Strengthsbetterleverageexist,Assessment)andwiandresourceswhile of andillustratedcoordination (MAPP that assets Themes all in priority important an is cessation) tobacco and eating, healthy prevention disease chronic that confirmed data these of Analysiscommunities. respective their for areas priority determining the up make assessments these Together, Summaryof Assessments non and limited with communicating in challenges populations. identified groups all sessions, breakout the following participants 76 was category this actuality, in bein as perceivedwas Optimal category.” “optimal the use toparticipants from reluctance includedranking the in Limitations statu included: and empower lowest(50%),research and innovation (50%), healthand mobilizing partnerships the (47%). ranking monitor Areas (69%). activity: laws enforce significant and (69%), with plans and highest policies develop the (69%), investigate ranked and diagnose services essential four that showed LPHSA the from Results volunta additionalwere13% Asian, and 10% were Latino/a. and private, three Nearly identified. public, codes zip total 42 with County, Diego included region various Participantsfrom came Participants 50. of age average programs. an with (79%), female were LPHSA services the in participated who individuals health public ma The profile. allparticipant the completed staff) County 21 and memberscommunity (67 participants 88 of from total A stakeholders. collected lists member community participa to invited were Stakeholders Services. Health Public Essential 10 the within standards national meets system health p local the well howevaluate to toolCDC a (LPHSA),AssessmentSystem HealthPublic Local a conducted HHSA2012, 29, June On LocalPublic Health System Assessment healthmental services,population educationabout risk factors forhealth, and effective methodsto make changes to improve health including health, of determinants address to partners community the implementing to integral are programs and resources these of All

- 0% Ti preto ld o oe soe ta epce fr l ctgre. uig h debrie the During categories. all for expected than scores lower to led perception This 100%.

Live Well San Diego San Well Live

- quarters (72%) of participants reported their race as white or Ca or white as race their reported participants of (72%) quarters

Community Health Assessment Health Community 12

Live Well San Diego San Well Live - related behaviors, access to care and healthy options, ac options, healthy and care to access behaviors, related

goals and objectives by enabling HHSA and HHSA enabling by objectives and goals . The Regions utilized these data to aid in aid to data these utilized Regions The . - nls spe English g 1 g hea

(a te te ucasian. An ucasian. jor 00%, when 00%, ctive living, ctive ll lth. based on based ( s ity of the of ity enhance s o s ess edu cess to cess

72%), with f f San f aking ment ubl cate ry ic EXECUTIVE SUMMARY

its that that factor factor

ss ss

h will be isk hic strategies strategies to e access and

car

Other Worksite Wellness*

Live Live Well San Diego

 

Safety/ Safety/ Violence

   

Substance Use Behavioral Health/ Behavioral Health/

Health Priority Health Areas Priority 13

provides provides a summary of priority areas selected by each region. It is noted

  

Access serves serves as a blueprint for strategic and community health planning efforts. Most Health Care

Table Table A

  

Eating Healthy Healthy

   

Living Active Areas Region Identifiedby Areas

being, which include supporting positive choices and pursuing policy and environmental changes. changes. environmental and policy pursuing and choices positive supporting include which being,

East South Region Central

North County North Central Table Priority A: Key *Includes *Includes elements that active address living, healthy eating, andbehavioral health/substance use. Live Live Well San Diego Community Health Assessment integral to achieving a healthy, safe, and thriving community in San Diego County. Diego San in community thriving and safe, healthy, a achieving to integral importantly, importantly, the community engagement process, utilized to create this document, regional community has partners. These cemented partnerships will serve relationships as the between foundation for HHSA support of and the collective impact approach, w Summary This

behavioral behavioral health/substance abuse as key priorities for their regions. These issues align well with the well and health improve led led to community identification of priority health areas. that the Regions identified many similar priority health behaviors, such as areas active living, healthy eating, and tobacco cessation. In addition, many of to the Regions identified health address chronic disease prevention that focus on positive r Regional Priority Areas Priority Regional As a result of conducting community engagement to produce this community health assessment, each Region facilitated the proce

COMMUNITY HEALTH ASSESSMENT

15 INTRODUCTION initiatives will be accomplished by using the values and guiding principles of integrity, stewardship, and commitment (to exc (tocommitment stewardship,andintegrity, principles of guiding and values the using byaccomplished be willinitiatives G Plan Strategicthe COSD of element first The public. the to accountable be to and excellence operational achieve to County the allows framework cost these deliver to order In effective andoutcome family is system se unified This a system. through services social and health integrates HHSA County. Diego San in families and individuals all for life of (see government (COSD) Diego San of County the chart organizationalof groups business five of one is (HHSA) Agency Services Human and Health The TheCounty ofSan Diego Health and Human Services Agency Toaccomplish this,HHSA utilizes the following Mission: Vision:        ). HHSA provides a broad range of health and social services, promoting wellness, selfwellness,promotingservices, social and health of rangebroad a providesHHSA ).

. The plan has three strategic initiatives: Safe Communities, Sustainable Environments, and Healthy Families. TheseFamilies. Healthy and Environments,Sustainable Communities, Safe initiatives:strategic three has plan The . Leverage opportunitywith thecommunity. Support courageouscreativity. Providecustomer focused andculturallycompetentservices. Assure fiscalintegrity. Fostercontinuous improvement in orderto maximize efficiencyand effectiveness services. of Assistemployees to reach theirpotential. full Ensure allactivities outcome are driven. - drivenfashion. Healthy,Safe, ThrivingSanDiego Communities

To To makepeople’s lives safer, healthier, and self - - effective and outcome and effective focused and community and focused Overviewof HHSA Vision, Mission,and GuidingPrinciples

I - NTRODUCTION driven services, HHSA uses the COSD the uses HHSA services, driven - based, reflective of business principles in which services are delivered in delivered are services which in principles business of reflective based,

GuidingPrinciples 16

- sufficientby delivering essential services.

General Management System Management General

- sufficiency, and a betterquality a andsufficiency,

ell

rvi ence). HHSA ence). (GMS). This (GMS). ce MS - delivery a cost a is the is - INTRODUCTION s ce ounty ounty tomer tomer errals, errals, , HHSA g public t c rces rces and ref w w income d Welfare Welfare d ncy ncy at the hroughout hroughout anizations anizations ces

hil . T . Age es. based based org based based and cus - - Aging Aging and Independen

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Figure 1: Baldrige Criteria for Performance Excellence Excellence Performance for Criteria Baldrige Figure 1: Framework

17 a system that is easy to access, treats families as a whole, integrates resou

- up, like protective custody issues. custody protective up, like - based based for assessments seniors in order to arrange for needed services; public health nurses visit lo -

private partnerships to meet the needs of families in San Diego County. Diego in San families of needs the meet to partnerships private measurement, analysis and knowledge management, workforce focus, focus, workforce management, knowledge and analysis measurement, Criteria Criteria for Performance categories: Excellence, which leadership, consists strategic of seven planning, customer focus, In In alignment with the County’s expectation of operational excellence, HHSA is pursuing the Baldrige Award, which recognizes organizations based on performance excellence. This recognition is based on the the the operational excellence mission. strategic required to accomplish the County’s role, role, providing essential financial, administrative, planning, program, and policy support to HHSA’s operational divisions and contribute to At the same time, the Support Divisions (Agency Contract Financial Support, Support Technology, and Office Services, of Strategy & Innovation) play an Human important Resources, Information Services, Services, Eligibility Operations, and Public Health Services. All Regions and Divisions carry out the important work of this level. operational HHSA HHSA is also composed of five operational (including Adult Health Older and Services, Health and Adult Children's and Services, Mental Alcohol Mental Drug C Services), Divisions, which include Aging and Independence Services, Behavioral Health Service pregnant pregnant mothers to share information about parenting practices; and outreach workers provide health education, make service follow need may that risks or identify In addition, HHSA works with local and neighborhood agencies, including cities, businesses, residents have easy access to and services. Some of HHSA’s customers are provided schools, services in their own homes to better ensure tha Services staff conduct home services, services, harnesses the power of technology, and takes advantage of economies of scale. In addition to providing direct servi County. Diego San of residents million 3.2 of population general the serves also under contract with HHSA to provide key services such as alcohol and drug treatment services, or medical care to to medical the care indigent or services, drug and such as alcohol treatment key to services HHSA provide under with contract HHSA, the focus is on a "no wrong door" approach - Customers are served in a variety of settings: County facilities, hospitals, community clinics, agencies, or community The The hallmark of HHSA is its commitment to a service delivery system that is regionalized and accessible, community community a reflects system delivery service HHSA’s regions, geographic service six into Organized oriented. uses the County GMS and Strategic Plan as guidance in its own operations, including its vision, mission, and guiding principl guiding and mission, vision, its including operations, own in its guidance as Plan Strategic and GMS County uses the INTRODUCTION rgamtc raiainl tutr t an to structure organizational programmatic a from transition a marked This synergistically. together work would they that so programs and The the departmentsmergingofthese benefits potential agency. achieve to intended services was model business human and single a health into departments County individual of merger the the approved when Supervisors of reality Board a became delivery service improve to collaboration interagency 1996, In County services. and care integrated and coordinated to and barrier clients, for organizations, employeesalike.This functional structurewasa difficult was community system delivery service the Navigating activities. and effort of duplication was there and bureaucracy, own its often silos,had department Each clients. same the serving in operated departments These       Prior to the formationof the HHSA, health and human services the in County San of Diego were provided bysixindividual depa TheFormation of HHSAand theRegional ApproachtoEngaging the Communitywith contributeto operational the excellence requiredby Baldrige. showimpact.itsAccreditPublicHealthchangesarewhile way,madeonly havealreadyto the beginning been some others Along e operationalCounty for striving in commitment its showsHHSA Award, Baldrige the pursuing By results. and focus, operations

Veteran’sService Office. SocialServices, and PublicAdministrator/Public Guardian Health Services Commissionon Children, Youth, and Families, AreaAgency Agingon

Figure 2: RegionalMap 2: Figure Diego ofSan County

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INTRODUCTION

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initiative initiative includes two

Live Live Well San Diego

year year initiative aims to improve the wellbeing of the entire San Diego - 19 sufficiency and service integration; service and sufficiency

cancer, cancer, heart disease and stroke, type 2 diabetes, and respiratory condit

– . This ambitious 10 invest in direct services; direct in invest -

clearly clearly guides individuals, organizations, and communities to take action to address chronic

3 Thriving

and

50 50 approach, - : The Initiative The : based prevention and early intervention; early and prevention based 4 - -

Living Living Safely Accessed February 7, 2013. February Accessed . on on the previous page), staff provides services in an integrated fashion, close to families and communities, in

, approved by the County of San Diego Board of Supervisors in July 2010. The Figure Figure 2 50 50 concept provided the foundation for the development of the first of three components of

- www.3four50.com 4 - A A focus on business practices and performance outcomes, led and by the in County; discipline management reinforce to 1997, in (GMS), System the General Management County of San Diego Board of Supervisors who instituted services. human and health deliver to governments local on reliance a emerging An Improve customer service; and service; customer Improve providers. contract and community, Agency, of network seamless a through integration service Promote self emphasized which reform, welfare national of passage The Reduce bureaucracy, freeing up funds to re to funds up freeing bureaucracy, Reduce community Emphasize to taxpayers; accountability Strengthen

3Four50, 3Four50, Better Better Health additional components: Region. tobacco use. tobacco use. The 3 disease. disease. Three behaviors contribute to four diseases which result in more than 50 percent of all deaths in San Diego. These three behaviors are unhealthy eating, sedentary lifest San Diego to take action. action. take to Diego San A simple message, the 3 Chronic Chronic disease is a major cause of premature demands on the care health systems. surge A delivery in and disease chronic its death impact on the health the care system prompted and disability, and it is responsible for rising health care costs and in collaboration with other public and private sector providers. providers. sector private and public other with collaboration Diego San Live Well In 1998, due to the size and diversity of the county, a new regional delivery system was created, enabling regional to communities, and partnerships their with the meet unique develop better individual themselves of needs acquaint one. each general m Regions (     the 1990s: during occurring were that events from three resulted services human and health redesigning for catalyst The     integrated, regional model. The Board’s goals for redesigning HHSA included: included: HHSA redesigning for goals The Board’s model. regional integrated, 3 INTRODUCTION     The

Changing culture the within,from encouraging County employees to become role models. choice;and is choice healthy the that so health support that environmentscreating by environment healthy a for changes policy Pursuing Supportingpositive choices,so that residents takeaction and responsibility ownfor their health; Buildinga better service deliverysystemthrough partnerships with hospitals,clinics, and other health care providers; BuildingBetterHealth

Statistics, 10/2/2013. SANDAG, Current PopulationEstimates, 10/2012. Prepared by County San of Diego(CoSD), Health & Human ServicesAgency (HHSA), Source: Death Statistical Master Files(CA CountyDPH), of San Diego, Health & Human ServicesAgency, Epidemiology & Immuniza Note: As far back the 2002, as overallCounty rate for 3 County (about deaths 20,000 total countywide each year). § Rates and Percentages not calculated for fewer than 5 events. Rates notcalculated in cases where zip codeunknown. is Perc † Table3 1: COUNTY South Inland North Coastal North Central North East Central Region

3 - 4 - 50 Deaths include Stroke, Coronary Heart Disease (CHD), Diabetes, Asthma, COPD, and Cancer.

- component calls for:

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- 50 Deaths50

3Four50, Chronicdisease and health promotion. HealthWorld Organization.

2008 Percent February2013. 7, - 4 56% 59% 55% 58% 56% 57% 55% † -

AmongSan Diego CountyResidents by Region (2008 50 Model www.3four50.com

2009 Percent - 4 - . 50 Deaths and was 61%, at some regions’ rates were as high as 63%.

AccessedFebruary 2013. 7, 56% 59% 56% 58% 55% 54% 56%

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the

easy INTRODUCTION

r at at an he he ive nde were were ed ell ell as

on based based - ns” s w is is the third Thriving Thriving based based and faith - and and serve as a roadmap to

Live WellLive San Diego’s Live Well San Diego Live Live Well San Diego

highlights highlights significant accomplishments. A more detailed

report is released. ensuring ensuring residents are protected from crime and abuse,

— Table Table 2 year year collaborative process, engaging HHSA staff at all levels, - . Oceanside paved the way for subsequent Live

launched,along with the .

was the second component developed and the was adopted was developed second by the component Board 21

involves involves engaging individuals, families, and communities in taking action

website Accomplishments

first Live Well first Live city Living Living Safely Top Ten Indicators component, component, which was ultimately approved by the Board of Supervisors on July 13,

Live Well San Diego Live Live Well San Diego 50: Chronic50: Disease in San Diego County - businesses, businesses, schools, military and veterans organizations, community 4 Live Well San Diego Diego San Well Live - The

3 First Lady Michelle Obama’s “Let’s Move” initiative recognizes school nutritionschool program.

Oceanside named as represents represents a framework for an ambitious, collaborative effort that involves the County of San Diego

. component component was developed through a two Building Building Better Health

Figure 5 Figure was was just the beginning. For residents to achieve optimum health, they must live in communities that are safe, October 8, 2010: June 29, 2011: Healthy Works™ May 2012: 3, Well and cities organizations. October 22, 2013: measurement framework the and

    Table 2: Overview of of Overview 2: Table Live Live Well San Diego

Building Building Better Health organizations, organizations, and all levels of government. Altogether, Altogether, departments and community sectors Live Well San Diego: A Collaborative Effort Diego: Live San Well achieve achieve the unified vision of a county that is healthy, safe, and thriving. in seen can be timeline creating creating neighborhoods that are safe, component, and which ensuring will communities be are about resilient development, promoting with an to anticipated release a in 2014. These disasters three components region encompass and in emergencies. which residents can enjoy the highest quality of life. It is currently u economically vital, and economically forprovide a quality of high life. of Supervisors on October 9, 2012. It focuses on achieving three outcomes 2010. Building Better Health meetings meetings and staff surveys were conducted to solicit ideas and input. Subsequently, Implementation Teams were formed and met ongoing basis to refine objectives based on action plans proposed by outline the of Design what Teams. became the An HHSA Executive Workshop finalized t representatives, representatives, developed broad strategies for action. Input was gathered from all HHSA staff and other County departments a from Advisory Boards and key stakeholders, including health care providers and community partners. Presentations were deliver convened convened in which expert speakers were invited Workshops to describe were future trends used in health to and best propose practice the innovations. HHSA overarching Execut priorities. Design Teams, comprised mostly of program and HHSA Region The community committees,advisory other departments, County and many community partners. As a first step, three Sessio “Futuring Live Well San Diego: The The Process Diego: Live San Well INTRODUCTION C, utpe optn hat cr sses a claoae o hne h clue f rcie adesn ro cue nt mer not causes root addressing practice, of culture the In change entity. to collaborate symptoms; carebestshare practices;andimprove reducecostsprovide qualitytoand An underlyingoptimal care. assumption of an can medical systems defined care health a competing to, multiple attributed ACC, or from, care Car receiving population. Accountableentire and communitybroader the include to individualslevel individual an and organizational the beyond extends accountability for of County level Diego organizational San the in at creation focused incentives the and accountability where is model (ACO) Organization strategies Care Accountable current Diego the on builds San ACC An Well (ACC). Community Live the pursuing for vehicle key Another Care CommunitiesAccountable continues be,vitalto to HHSA’scommunity health improvementplanning process. No Central, North East, Central, include AccreditationPublicHealththemeet 2 DomainRegionalpromotionstandardexistence Board’sof5,measures.health The teams Regions The team. planning leadership regional Regions, HHSA each for one sections, plan five co CHIP Diego San Well Live The (CHIP). Plan Improvement Health Community Diego San Well Live the in resulting term, long the welln and health community improve to programs implemented and projects, developed resources, of use the directed priorities, he set Regions the process, assessment health community the through identified were needs health community Region’s each Once educate and mobilizeprioritize communities, health issues,secure resources, and plan actions. sha was information process, assessment health community the Through process. entire the guide to tools planning improvement Partnerships and Planning through Together,public health officialsand community members used the community priori regional identify to partners community withdevelop addressa planto those priorities. diligently worked Regions HHSA county. the across communities diverse its uni the address best to Teams Leadership Regional HHSA five of formation the in resulting level regional the at initiated was this embraced has partne HHSAcommunity and departments County othergoal. withEngagement improvement. health commoncommunity monitor and implement ato approach addresses that agenda common a to sectors different from stakeholders of commitment the Collective Diego. San Well Live of goals ambitious the achieve to outcomes expected and efforts all manage to model best the approachcollectivewoulimpactassessment HHSA’s the of2012wasperformancedetermined it managementsystem,that a Through WellSan Live Diego: Improvement Efforts Community Health thatwill allguide those involvedtoward advancing the health andwell ha County Diego San place, in plan a with but realized, be to time take will changes These Indicators. leading ten the within by measured and influence of areas five in captured are Results strategies. 4 and components 3 the falls which below pyramid, life. of quality and health their improve to 4 Thetwo North regions, North Coastal and North Inland,joined togetherdevelop to one Community Health Improvement Plan for t 4

and South. Each regional section of the Live Well San Diego CHIP was developed to reflect individual community needs and needs community individual reflect to developed was CHIP Diego San Well Live the of section regional Each South. and

MP) MP i a rcs ta icue cmuiy elh seset n cmuiy health community and assessment health community includes that process a is MAPP (MAPP).

Figure 4 Figure illustrates how it all comes together. The together. comes all it how illustrates 22 - being ofall residents.

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23 Pyramid Live Well San Diego Diego San Well Live Figure 4: 4: Figure INTRODUCTION be achievedbe throughout one’sentire lifetime. wellselection capture welltheywashowtheir for factor Another nation. the and/or state, the communities, b other to Countyand Diego San als in understandprogress compare to availableto are data easy leaders are they Community because identified experts. were Indicators Ten national Top The and well. living be towards state, which progress Influence, County’s of local,Diego Areas five into from fit that input Indicators Ten Top with the of staff selection the regarding HHSA discussions in participated by developed were Indicators Ten als Top but The health, of measure only not of consists framework indicator the measures thataddress therootcauses of illness and disease. Therefore, wellbeing. and health overall his/her with individua an where fact, In living. is person a well how influencing factors different many are there that consideration into The Fra Indicator The thriving. and safe, vision. healthy, be to residents county sharedall helping in progress measure to instrument this necessary from resulting progress of assessment the shape will provideindicatorsleading ten The progress.collective track and effortscollective focus to partners all allows that system measured. be must progress failure, or success assess to order In WellSan Live Diego: Impact Measuring while improvingthe health ofSanDiego County’s 3.2 millionresidents. community committed is County the but formulation, of stages early the in are monitor to metrics which of determination the and model patient both be will ACC Its Communities. Care se Accountable first socialnation’s the many systems, care health regional major public all of array broad with a and organizations, collaborations successful established has Diego San of County The while improvingthe health ofSanDiego County’s 3.2 millionresidents. t committed is community County the but formulation, of stages early the in are monitor to metrics which of determination the and model patient both be will ACC Its Communities. Care se Accountable first social nation’s the many systems, care health regional major public all of array broad with a and collaborationsorganizations, successful established has Diego San of County The ad that system "health" proactive truly region a be upstream deliversocialdeterminants ofhealth to andwell system delivery can care" "sick reactive ACC current the an transforming accountability, Ultimately, h government the with local promotion system. of health role and prevention,delivery convening services, the social optimize of coordination also the can facilitate ACC and improvement An health population. population regional the of wellness and health the improving sh the around together organizations independent the all bring to requirements essential are incentives and model financial a - - wide alignment of incentives and accountability to achieve the Triple Aim: better care for the individual at lower per lower at individual the for care better Aim: Triple the achieve to accountability and incentives of alignment wide per lower individualat the for care better Aim: Triple the achieve accountabilityto and incentives of alignment wide - -

and private and private and

- being. - being across the life span of anindividualspan of life across the being - -

sector partners that will now allow us to work collectively toward becom toward collectively work to us allow now will that partners sector becom toward collectively work to us allow now will that partners sector

- ie ouain elh mrvmns hog sae ifrain and information shared through improvements health population wide 24 Live Well San Diego San Well Live

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. initiative, initiative, the development of this Assessment would indeed This commitment to operational excellence is the foundation private private partnerships, with a strong culture of coopetition (i.e.,

document. document. These elements include 1) the County expectation of

25 Live Well San Diego San Well Live

Live Live Well San Diego a a robust spirit of public

In the same year, the launch of an with HHSA integrated operations throu expanding

Indicator Framework. Indicator The Framework. measures be will maintained in an electronic management system performance where data Live Live Well San Diego Community Health Assessment for the Areas of Influence and Indicators. and Influence Areas of the for

Figure 4 4 Figure private private partnerships in this region. All these factors, and more, provided the groundwork for the evolution of - process, as well as the resulting assessments, are explained in detail in the following sessions. sessions. following the in in detail explained are assessments, resulting as the well as process, Without Without the approval by the Board of Supervisors of the be a HHSA daunting task. Regions were Operationally, prepared to sufficiently engage and work with the to community assess lo needs in development of this document. Utilizing the MAPP process was an important tool for bringing all the pieces together. vision to vision health across createand safe, emphasizing wellness the healthy, communities, lifespan tothriving reduce and healt population. diverse regions the that that San Diego does not have its own hospital and primary care clinics has served public as an advantage in this region, fostering t strategic strategic mission, serving as the formal comprehensive guide delivery of toservices to San Diego residents. planning, implementing, and monitoring all functions that geographical regions was another landmark event, County many decentralizing of the imp by provided services the then new Agency. General General Management System was approved by the Board of Supervisors. the General Management System which provides the framework for all departments and programs to consistently implement the Cou cooperation in light of known competition); and 4) the creation of of creation the 4) and competition); known of light in cooperation Operational excellence has long been a local County expectation with emphasis on results and outcomes since April 1998, when effort effort to create this operational excellence; 2) the existence of an integrated health and social services agency structure, with regional approach and wellness that address community needs; 3) Summary The County of San Diego is exceptionally poised to pursue national public health accreditation. There are many factors that s framework framework will enable County government to work with community partners to the identify most strategies toeffective improve See all. Live Live Well San Diego will be monitored and reported as “stories” that will describe the collective impact on the well improvements improvements in the lives of residents. Behind every indicator, a host of measures are identified within the HHSA programs. These measures consist of both community level indicators and measures, performance programmatic aligned withi The Top Ten Indicators are part of a larger indicator framework, connecting a wide array of programs and activities to measur INTRODUCTION Figure 5: Timeline of Timeline 5: Figure KeyMilestones 2010 2009 2008 2013 2012 2011

September September November October February December 14 December November 8 November October 31 October 30 October September November October 9 October 8 October October January October July 13 July May7 - - - - January 2010 January 2010 January December March 2010 March - April

                  

Conducted Stakeholder Briefings and 1 and Briefings Stakeholder Conducted champions prepare and to train began and meetings leadership event Off” at a “Kick Conducted sessions”) “Futuring (convened the for planning Initiated website the Released BOS) (by Approved the for planning Initiated Diego Regional HHSA the of implementation Began Plan Improvement Health Community Diego San Live Well and Assessments Health Community Regional draft Completed Approved Agenda: Safety the plan for BOS) (by Approved process MAPP Regional HHSA the Initiated Partnerships and customized Conducted staff with HHSA Orientation MAPP Conducted Approved the for planning Initiated Released funding Initiative Improvement Health Public National Received Agenda: Strategy Health [BOS]) Supervisors of Board (by Approved plan the to refined partners external internal and input from Analyzed Board

Community Health Improvement Plans Improvement Health Community

Building Better Health Better Building 3 Live Well San Diego Diego San Well Live Diego San Well Live ‐ 4 ‐ Live Well San Diego San Live Well 50: Chronic Disease in San Diego County Report County Diego San in Disease Chronic 50: (MAPP) training with each HHSA Region HHSA with each training (MAPP) Live Well San San Well Live Mobilizing for Action Through Planning Planning Through Action for Mobilizing Building BetterHealth Building Thriving Safely Living

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handout handout of PowerPoint slides, MAPP framework guide, MAPP organizational chart, timeline, and MAPP handbook from the National hour hour orientation, and held it on December 14, for2011 fifty approximately HHSA staff, from the following and Divisions Regio Independence Services (AIS), Central Region, East Region, North Central Behavioral Health Region, Services North (BHS), and Coastal South Region, Region. Each North participant at Inland the Region, orientation was PH given a MAPP binder with the agen by by the Public Health with Coordinator (PHS) support Services from Improvement Manager/Accreditation Performance a student int core team included PHS staff and staff from the Office of Strategy and Innovation. The MAPP Core Team developed and facilitat assessments by PHAB standards. PHAB by assessments To prepare regional HHSA staff for the community health assessment and planning process, a MAPP core team was formed that was MAPP MAPP also allows for the health department to meet Public Health Accreditation Board (PHAB) standards for the development of a comprehensive community health assessment.    assessments: assessments:  suggested by PHAB measure 1.1.1 (T/L 3). (T/L 1.1.1 measure PHAB by suggested The MAPP planning process is composed of four different community improve improve the efficiency, effectiveness, and ultimately the public health performance systems. MAPP is one of of the community planning local process models strategic strategic planning process for improving community health ( assists communities in selecting and identifying resources prioritizing to public address health them. issues It is while an interactive process that can Diego Diego Community Health Community Assessment Health Improvement Plan Mobilizing Mobilizing for Action through selected community Planning planning model for and the development of Partnerships the MAPP effortby conducting another assessment. duplica of instead reports those used Regions Those completed. recently were that assessments community similar alrea via availablewas information this that felt Regions other while assessments, Strengths and Themes Community and Assessment Change of conducttosurvey onlinetool an use choseto SomeRegions document. thissections ofregional the located in aredata These an countywide presented staff Statistics Health Community HHSA the presentationsregionalleadershipallfive these teams; andincluded community to data demographichealtregionalhealth data process, assessment MAPP the for staff regional prepare To Reg oftenwork closely togetherand have two many of the providers.same these because Region, County North unified a as community the engaging by efforts combine to decided Inland North and C North when modified slightly was approach This strengths. and themes community and change, of forces issues, health diverse cap accurately to basis regional a on assessments MAPPrequired the of most conduct to best be would itdetermined staff HHSA MAPP Assessments each ofthe MAPP phases. customize overvie received depth in staff more a promotion with process health planning improvement Communityhealth community Region. and assessment health HHSA community regarding each training to specific heal was community one and each engagement community of the focus in The point process. differentplanning a at was Region each because necessary were trainings tailored Thes 2012. January in AIS and Regions HHSA the of each for training MAPP detailed, more second, a provided team core MAPP The orientation,Afterthe the MAPPteam corewithmetregional theonastaff weekly/bi Association ofCounty and CityHealth Officials (NACCHO). Table 3: MAPPAssessments and PHABStandards 1.1.2 T/L (1. c.) T/L 1.1.2 (1. e.) T/L 1.1.2 PHABStandard

health issues. health address to employed and becan mobilized that resources and the assets of description or listing include a must assessment The issues, based on the analysis of data. of analysis the on based issues, health of distribution the and the population of issues the health of description A narrative PHABLanguage

- weeklyuntilendofthebasisJanuary 2012 Community Themes and Strengths Themes Community Community Health Status Assessment Status Health Community MAPP Assessment

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rovided to the tenth decimal place. Some sources may sources Some place. decimal tenth to the rovided e e p level level assessments are located in the regio -

5 provide percentages rounded to the whole number. number. whole to the rounded percentages provide Assessment data are provided from a variety of HHSA departments and community sources. To the extent possible, percentages ar percentages possible, extent the To sources. community and departments HHSA of a variety from provided are data Assessment 5 Countywide Countywide assessment data immediately follow this section while results for regional this document. of sections framework framework is used to identify areas for system improvement, strengthen state and local partnerships, and ensure that a strong place for addressing public health issues. The LPHSA examines the Services. Health Public Essential the 10 across a community within services public health system or all entities that contribute to pub health health system partners serve the entire county region. The LPHSA is part of the National Public Health Performance Standards which provides a framework to assess capacity and performance of public health systems and public health governing bodies. Th The fourth MAPP assessment, the Local Public Health System Assessment (LPHSA), was conducted because countywide many the publ DEMOGRAPHICS 6 born.Of 77% the native SanDiegans, born 47% wereCalifornia.born in 2005 between County Diego San in living people of 23% addition, Spanish were 11% speakers, Sixty ( orHispanic(50%) (30%)and betweenages theof25 females and males of percentages equal residentswith million 3.2 nearly of population diverse a of comprised was County Diego Sanestimates, 2009 (SANDAG) Governments of AssociationDiego San to According DemographicBasic Characteristics ofResidents SanDiego County. one of form profile demographic to the of together description brief come a is that following The cultures region. of geographic array diverse a to home is county the such, As miles. square 4,207 nearly spanning county diverse a is County Diego San CountyDiego,San of Health and HumanServices Agency,Public Health Services, Community Health StatisticsUnit. (2012). San DiegoSan Demographics Profile by Region and Subregional Area - four percent (64%) of the population ages five years or older were English were older or years five ages population the of (64%) percent four D EMOGRAPHIC 6

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Total Population Total TablePopulation 4: Characteristics (2009) www.SDHealthStatistics.com County.go Retrieved 07/10/13 from ticsUnit, 2013. The EconomicBurden Injuryof Die-San in Agency,HealthPublic Services,Community Health Statis- Source:County Diego,San of Health and Human Services Female Male Distribution Gender Years 65+ Years 45 64 to Years 25 44 to Years 15 24 to 145 to Years 4 0 to Years Distribution Age

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Figure 8: Language Spoken at Home by San Diego Diego San by Home at Spoken Language Figure 8: (2009) Residents County 0.0% Source: County of San Diego, Health and Human Services Agency, Services Agency, Human and Health of San Diego, County Source: San 2013. Unit, Statistics Health Community Services, Public Health Area. Subregional Region and by Profile Demographics Diego County from 07/10/13 Retrieved 80.0% 60.0% 40.0% 20.0%

Total Population: 579.151 51.6% are 25 57.6% are white below8.4% the Federal Poverty Level Total Population: 460,739 50.1% are 25 54.3% are Hispanic 13.0% below Federalthe Poverty Level Total Population: 537,059 50.7% are 25 White 58.8% are below8.7% the Federal Poverty Level

South North Inland North Coastal             

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9.0% below9.0% the Federal Poverty Level Total Population: 624,072 Ages: 56.6% are 25 Race/Ethnicity: 61.9% are White Total Population: 470,898 53.2% are 25 63.6% are white 11.3% below Federalthe Poverty Level 43.3% 43.3% are Hispanic 20.2% below Federalthe Poverty Level Total Population: 513,543 54.2% are 25

North Central East Central            

Source: County of San Diego, Health and Human Services Agency, Services Agency, Human and Health of San Diego, County Source: San 2013. Unit, Statistics Health Community Services, Public Health Area. Subregional Region and by Profile Demographics Diego County from 07/10/13 Retrieved Residents (2009) Residents Figure 7: Race/Ethnicities of San Diego County County Diego San of Race/Ethnicities Figure 7:    Table 5: Snapshot of Demographics by Region (2009) Region by Demographics of 5: Snapshot Table DEMOGRAPHICS eea Pvry ee, ih 19 o fmle with families children of falling belowpoverty the level. 11.9% with Level, Poverty Federal one ( household per persons 2.89 household of average an median with $46,797 was residents The of income (16%). families other and married both million This included County. Diego figure 1 San in households the approximately of 66% were up made Families County. Diego San there in households 2009, In EconomicStatus ofResidents 07/10/13from Profileby andRegion SubregionalArea. Retrieved StatisticsUnit, 2013. DiegoSan CountyDemographics Agency,HealthPublic Services,Community Health Source:County Diego,San of Health and Human Services HH in Person per Income HH Per Persons Income HH Median (HH) in Household Person per Income >$125,000 $125,000 to $100,000 $100,000 $75,000 to $45,000 < $45,000 Income Household Households Total Residents (2005 TableHousehold 6: Incomesof San Diego

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a sm clee r n A Apoiaey 40 hd Bceo Dge or Degree higher( Bachelor a had 34.0% Approximately AA. an or college some had 31.0% nearly and graduates, school high were 20.2% Another degree. school high a than less had14.8% those, Of older. or ageof years 25 were million 1.9 approximately 2009, in County Diego San in residents million 3.2 nearly the Of Education Figure 9:Educational AttainmentofSan Diego CountyResidents (2009) SubregionalArea. Retrieved 07/10/13 from CommunityStatisticsHealth Unit, 2013. San Diego County Demographics Profile by andRegion Source:County Diego,San of Health and Human Agency,Services HealthPublic Services, Figure9 32 Graduate School

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HEALTH STATUS ASSESSMENT

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EALTH H objectives. objectives. Health indicators, in which evidence

2010 http://www.naccho.org/topics/infrastructure/mapp/framework/phase3.cfm and and Live Well San Diego Community Health Improvement Plan Improvement Health Community Diego Well San Live being being of county residents, were highlighted. To provide more context for these indicators, survey - summarizes the key findings from each Region. This information fulfills PHAB Measure 1.1.2. Measure PHAB fulfills This information Region. each from findings key the summarizes

OMMUNITY C Table 7 Table Healthy Healthy People 2000 2011, 2011, there were 1,747 new HIV diagnoses in the county, 9% of which were female. The majority of cases (51%) reside - based based organizations. The health issues identified in each assessment include details about uninsured/low income and mi - National Association of County & City Health Officials. Officials. Health City & County of Association National 7 new new HIV cases for a rate of 11.4 cases per 100,000 individuals. Of those, 42% were white, 15% were black, and 36% were Hispan Between Between 2007 the Central Region of San Diego County, followed by South Region (17%). In 2010 (most recent data available), there were a to HHSA Department Assessments Department HHSA HIV/AIDS Assessment populations. populations. These assessments give a broad view of health issues in the in identified San issues health priority Diego County and provide background and context for Various Various programs within HHSA have roles in overview assessing of the the community’s county’s most health important status health and issues risks. community by The summarizing various following health section status provides reports from both County programs Other Local Health Assessments Health Other Local The community The health data for community assessment each of the five can be Regions found in s the Health Community Assessments Regional this document. of alignment alignment with impact on the health and well applicable. when included (CHIS) were Survey Interview Health the California For For an overall picture of severity and quantity, data were analyzed discharge at levels. These indicators the have been monitored death, since 2000 hospitalization and were selected discharge, because of and their availability, source emergency rel de derived derived from the Community Health Statistics report on d health San behavioral and injury, health, child and maternal disease, (infectious) communicable disease, (chronic) Diego communicable County Community Profiles. These health indicators included This assessment describes the health status of the countywide San Diego community, as well as at each regional level. as at regional each as well community, Diego San countywide the of status the health describes This assessment Statistics Unit staff presented county and regional data to each of the five regional leadership teams; the health indicators This section provides a general description of health issues and specific descriptions of population groups with particular h required by the Public Health Accreditation Board, or PHAB (Measure 1.1.2). The issues. life of quality and health community priority identifies Assessment Status Health Community (MAPP) HEALTH STATUS ASSESSMENT TableCommunity 7: HealthStatus: Key RegionalFindings South County North Central North East Central Region

                  

Spirit collaboration of Spirit diverse Culturally resources of array communityComprehensive regional Bayshoreregional Bikeway Regionthe is part 23South of General Plan their Element Justice Environmental to City added Health National a and a school wellness mented policy VistaDistrict School Chula imple- ordinance garden Vista adopted a Chula community general their plan to Vista a added health Chula element of medical source care has Majorityresidents usual of of Lowcommunicable diseases rate average tional mortality belowInfant rate is the na- in Increase physical activity resources of Abundance natural have source of a 91% medical care ance of residents health92% have insur- Countythe overall rates disease areChronic lower than exercisefuntransportation, or therate populationof A high walkfor the addressthe health region to of team Leadership is actively engaged declined have and hospitalization rates deaths, disease, heart strokeCoronary

Strengths

- mile mile

                          

Lack of and open of placessafe parks Lack spaces; to of toaccess Lack food healthy options mortality rates chronic of High disease, infant STDs and among youth pecially alcohol,to and tobacco Access otherdrugs, es- Stigma around around Stigma mental health and walkability Poor sidewalk conditions e to fruits fresh access Limited affordable and veg- of and safe lighting Lack street crossings spaces of centers, community Lack and open parks of toaccess Lack medical home densityliquor High of and convenience stores food densityfast High of outlets trash Graffiti and especially areas in commercial advertising Alcohol serviceshealth and ofUnderutilization lack awareness mental of abuseSubstance increasing rates overweight of High and obesity prevalence ofchronic disease High related vehicle motor injuries Alcohol the County in highest rate for the 2nd adultsSuicide 65 and over is rates high Obesity are Mentalconcerns Health of Involvementcommunity Lack of activeLack and living healthy eating rates substance abuseof High safety concernsCommunity care sensitive of quality health Lack especiallycare, culturally work andlive, play t a b

l e s

Concerns

HEALTH STATUS ASSESSMENT t ith ith 8 top top .

men t w 3% of 3% of d they 9%) The le le

HIV/AIDS Surveillance Program Epidemiology Epidemiology Program Surveillance HIV/AIDS nine nine survey respondents (8%) sai - 012). 012). (2

Needs Assessment Survey of People Living with with HIV/AIDS Living People of Survey Assessment Needs

35 Approximately Approximately 7,200 paper surveys were distributed around the County. In total,

. Figure 10: Number of New HIV Cases by Year and Race (2010) Race and Year by Cases New HIV of Number Figure 10: www.sdhivaids.org ). ). The most common mode of transmission for males was men who have sex with men (MSM) (82%), followed by intravenous positive positive individuals residing in San Diego County. - . Retrieved 07/10/2013 from from 07/10/2013 . Retrieved Figure Figure 10 (14%), transportation (14%), medical specialist other than HIV specialist (13%), and legal services (13%). (13%). services legal and (13%), specialist than HIV other specialist medical (14%), transportation (14%), respondents respondents were transgender. Approximately 26% have a history of chronic mental illness. Sixty have never been in medical care for HIV. Survey respondents were asked if there were services they needed but could not get. responses (n=828) were dental care (26%), housing/shelter: permanent or ongoing help to pay rent (20%), emergency utility pay HIV whi (78%), male were respondents of majority The online. completed surveys 129 included which responses survey 924 there were drug users (IDU) (6%). The most common mode of transmission for females was heterosexual intercourse (72%) followed by IDU (1IDU by followed (72%) intercourse heterosexual was females for transmission of mode common most The (6%). (IDU) drug users In addition to its annual epidemiology reports, the HIV/STD and Hepatitis Branch of HHSA recently conducted a needs assessmen ( County of San Diego, Health and Human Services Agency, Public Health Services, HIV/STD Hepatitis Branch. (2012). (2012). Branch. Hepatitis HIV/STD Services, Health Public Agency, Services Human and Health Diego, of San County County of San Diego, Health and Human Services Agency, Public Health Services, Epidemiology and Immunization Services Branch. Services Immunization and Epidemiology Services, Health Public Agency, Services Human and Health Diego, of San County Report 9 8 HEALTH STATUS ASSESSMENT 10 years ago and have gone a little higher since then, such as for the third dose of DTP (labeled DTP3). The vaccines protecting vaccines The DTP3). (labeled DTP of dose third the hepatitisB (HepB3)and for chickenpox(Varivax), started with lowcoverage, have but since reachedas the 2010 goal ( such then, since higher little a gone have and ago years comparabl is and year each similar stateand national rates. The coverageratesbeen each for vaccine analyzedare separately;some reached the has vaccines pneumococcal and influenza the getting over and 65 ages residents County ( vaccines the met county the that found surveys Telephone Countythatare fullyimmunized. livingseniorsandadults, children,infants, proportionof assessthenumbers phonetorandomlyselected tocalls phone make future prevent to surveys.telephone(RDD)Dialing diseases Digit Randomperiodic conductsBranch ServicesImmunization Epidemiologyand HHSA’scommon against vaccinated are individuals that ensuring is control disease of aspect important An Assessment Immunization data.html Coverage.(2009). Retrieved 07/10/2013 from Source: CountyChildren (19 Figure 11:Coverage LevelsSingle for Antigens, San Diego San DiegoSan Immunization Program,Data and Statistics,County Vaccination Coverage. (2009). Retrieved 07/10/2013 from

. SanDiego Immunization Program, Dataand Statistics, County Vaccination

Figure 11 Figure ). However, the vaccination rate dropped in 2008 in dropped rate vaccination the However, ). - 35 months)35 (1995

http://www.sdiz.org/Data - 2009)

- elh Pol 2010 People Healthy Stats/RDD - 36 - 2009 due to a Hib vaccine shortage. The percentage of San Diego San of percentage The shortage. vaccine Hib a to due 2009

vaccine;and measles,rubella vaccine; are *Thenumber in front of vaccinethe represents the number of doses needed.Thevaccines Coverage.(2009). Retrieved 07/10/2013 from Source: Varicella Immunized with: Figure 12:San Diego Count, Proportion of Children Fully 100 ol f 0 o pecol hlrn eevn al f h standard the of all receiving children preschool of 80% of goal 60 70 80 90 DTaP 1999

SanDiego Immunization Program,Data and Statistics,County Vaccination —

diphtheria,tetanus, pertussis vaccine; Varicella (1999 78 2001 81 — - http://www.sdiz.org/Data chickenpoxvaccine. 2009) Hib 4DTaP, 3 Polio, 1 MMR,3 Hib, 3 Hep B& 1 71 84 CDC RDD Survey, age 19-35 months 19-35 age Survey, RDD CDC months 19-35 age Survey, SD RDD — Haemophilusinfluenza

2003 82 75 83 74

HealthyPeople 2010 http://www.sdiz.org/Data 2005 - Stats/RDD 85 Polio Figure12 B vaccine; B Healthy People Healthy People — Polio vaccine;Polio - data.html 2007 HepB ). .

Stats/RDD 10 — MMR

hepatitis B 2009 Interviewers goal ofgoal 90%

San DiegoSan — ill 77 mumps,

nesses. ag - data.html ainst e t e

o .

HEALTH STATUS ASSESSMENT

. \

2008 - Maternal and Child Health Profile by Region by Profile Health Child and Maternal Figure 13: Proportion of Overweight Youth* by Ethnic/ by Youth* Overweight of Proportion Figure 13: 2007 Racial Background,

37 Low Low Figure Figure 19), who -

reports a continuous continuous a reports

MCFHS

San San Diego County, under the

2006, 2006, while the percent of overweight - www.SDHealthStatistics.com 19 19 increased by 46%, from 15.3% to 22.4%. – Islanders Islanders (41.1% and 44.8%) and Hispanics (36.8% and - ). ). In San Diego County, 13.3% of children under age 5 were 1.7 times higher than the overall County rate, 6.6%. County overall the than higher times 1.7 and and very low birth weight and prematurity were also Being reported. born too small or too soon puts infants at risk for illness, developmental delays, and death. San Diego’s low birth weight prevalence increased 18%, from 5.6% in 1995 to 6.6% in 2006, is which risk (11.2%), a higher displaying with Americans African Pacific a 39.1%) higher displayed percent children in of overweight both respectively. grade ninth and fifth Priority 2: Low/Very Low Birth Weight and Prematurity. have have an increased cardiovascular, orthopedic, and risk other health problems of ( 13 developing type overweight 2 during 2004 diabetes, children aged 5 Priority Priority 1: Children and Weight. rise in the proportion of overweight children (ages 0 Retrieved 07/10/2013 from from 07/10/2013 Retrieved County of San Diego, Health and Human Services Agency, Public Health Services, Community Health Statistics Unit. (2012). (2012). Unit. Statistics Health Community Services, Health Public Agency, Services Human and Health Diego, ofCounty San

  (MCFHS), (MCFHS), has prioritized the five most manifested problem areas health: child and maternal to related infants, infants, children, and adolescents. jurisdiction of Maternal, Child, and Family Health Services The The Maternal and Child Health overview needs of the assessment health provides status an of pregnant and parenting women, Maternal and Child HealthMaternal and Child

11 HEALTH STATUS ASSESSMENT

  

than 7than days of age. 2004 in (72.6% deaths infant of majority Mortality. Perinatal Fetal, Infant, 5: Priority and Asians(73.9%) ( and morbidity infant African among and lowest are maternalRates the below(90.0%). reducesignificantly is (72.7%) can care prenatal that trimester first receive measures who mothers preventative of rate andThe mortality. risks health about and Utilization interventions behavioral and Access Care Prenatal 4: Priority (72.8%)who were much less likely beto insured. Children. for Insurance 0 children for enrollment Dental and Health 3: Priority

Figure14 - 19 when comparing numbers from 2001 to 2007 (87.6% to 93.5%), with the exception of adolescents18 of exception the with 93.5%), to (87.6% 2007 to 2001 from numbers comparing when 19 ).

byEthnic/Racial Background, 2006 Figure 14:Prenatal Care DuringFirst Trimester,* www.sdhealthstatistics.com. HealthProfile by Region HealthServices, Community Health Statistics Unit. (2012). Source:County

Proportion of First Time Trimester Care - 2006) are neonatal (within the first 28 days of life), and most of those (83.4%) occur (83.4%) those of most and life), of days 28 first the (within neonatal are 2006) 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 0.0% - Americans (69.6%) and Hispanics (70.8%), but not remarkably higher for whites (73.9%) whites for higher remarkably not but (70.8%), Hispanics and (69.6%) Americans

The rate ofinfant, and fetal perinatal mortalityin SanDiego is4.97 per 1,000 births. The

ofSan Diego, Health and Human Services Agency, Public Black Drn peaa vst, elh ae rvdr ifr mtes f eia and medical of mothers inform providers care health visits, prenatal During . . Retrieved . 07/10/2013 from

Prenatal Care, First Trimester Prenatal Care, Asian/Pacific hr ae o infcn dfeecs n eia ad etl insurance dental and medical in differences significant no are There Islander 38

Hispanic

Maternal andChild White (Non- White Hispanic)

Healthy People 2010 People Healthy at less at goal - 19 19 HEALTH STATUS ASSESSMENT , se ind ind ted ted BS) or or the Uni rearms attempt attempt ), ), fi to be the be to

%) %) aged 85 and and 85 aged ear . Retrieved . Retrieved en 54 age group. group. 54 age natural natural deaths, beh - - Maternal and Child Health Profile by Region by Profile Health Child and Maternal

39 24, males more often use a firearm to commit suicide (42%), while females u - Within the female population, suicide rates are higher in the 45 the in higher are rates suicide Withinfemale population, the

Suicide Suicide rates are higher in the Central and East Regions of San Diego County and lower

). ). 2009 - Figure 15: Suicide Rates* by Age and Gender San Diego County, County, Diego San Gender and Age by Rates* Suicide Figure 15: 2000 Figure Figure 15

07/10/2013 from www.SDHealthStatistics.com from 07/10/2013 County of San Diego, Health and Human Services Agency, Public Health Services, Community Health Statistics Unit. (2012). (2012). Unit. Statistics Health Community Services, Health Public Agency, Services Human and Health Diego, ofCounty San suicide suicide more often than boys. Between the ages of 15 (43%). hanging/asphyxia (46%). (46%). Adult female suicides were predominately characterized by overdose/poisoning (42%). The Youth Risk Behavior Survey (YR administered by the Centers for Disease Control and Prevention (CDC), measured health risk behaviors, and reports girls (14.4 older have the highest suicide rate (67 per 100,000). 100,000). per (67 rate suicide highest the have older When looking at suicide characteristics of the adult male population, the most commonly used method of suicide was the use of most most affected population when compared to the black population (7 per 100,000), Asian/Other Group population (5.7 per 100,000 (4100,000). per population Hispanic m Demographically, females. that of than higher times three is that rate a at suicide by 100,000) die per (17 men general, In in in the South Region. When comparing San Diego County suicide rates (9.9 per 100,000) to app 100,000) (17 per Whites average. the national below California but average, state the are rates above the 100,000), per (9.3 (10.9 States per 100,000) and the HHSA HHSA reported that from the year 2000 to 2009, 3,368 people died by suicide, the second unintentional drug/alcohol overdose ( leading cause of non Suicide 12 HEALTH STATUS ASSESSMENT eatet icag) Te ae f et de o nnetoa ijr ws 90 e 1000 Ms ijre wr peetbe wit preventable were injuries Most 100,000. per 79.0 was important to create strategies injury to reduce the impact on SanDiegans. unintentional to due death behavioralenvironmentaland unintentionalburdenofandtheidentifyingchanges.Outlining injuriesleadingth causes the of of rate The discharge). department rates higher have (Blacks groups racial/ethnic other all to compared when rates)hospitalization higher as well (as whites do compared when death injuryunintentional for risk higher had Males 100,000). per (32.3 injuries cut/pierce and overexertion pedestrian 15 agedadultsyoung and 100,000). Teens Coun the to compared when injuries drowning/submersion and burns, poisoning, injuries, natural/environmental for risk at also (0 population younger The injuries. fall 0 children with groups, age all in injuries, unintentional of cause common fall However, fall vehicle by followed death, of cause leading the was overdose) (including Poisoning County Diego San residents3.4 billion indollars 2009. cost ( injuries unintentional discharges room emergency 149,437 100,000), and per hospitalizations (29.8 21,140 injury deaths unintentional 949 2009, for accounted in HHSA and CDC locally. and nationally both related death, of disaster causes leading the among natural are injuries) or motor accidents, falls, submersion, vehicle or drowning skin, the piercing or cutting (includes injuries Unintentional UnintentionalInjury 14 13 CentersDiseasefor Control and Prevention. National Center for Injury Prevention and Control. “Water SanCounty of Diego, Health and Human Services Agency, Public HealthServices, Community Health Statistics Unit. (2012). Unin Safety/waterinjuries www.SDHealthStatistics.com.from - eae, n pedestrian and related, - eae uitninl nuis 1. pr 0,0) Aut 25 Adults 100,000). per (18.0 injuries unintentional related - eae ijre wr te most the were injuries related - factsheet.html - iue 16 Figure 14 being at highest risk for risk highest at being 14 . Accessed . 07/17/2013.

s eotd y the by reported As - eae injuries. related . Financially, ). - 14 eae, motor related,

- 4 was 14) - 24 were at the highest risk for motor vehiclemotorhighestforrisk the at were 24

Preparedby:COSD, HHSA, PHS, EMS. 03/28/2012. Source:Patient Discharge Data. COSD: HHSA, PHS, EIS:SANDAG. Current Population Estimates.10/2010. Unintentionalinjury hospitalization refers (principal to diagnosis) ICD per*Rates 100,000. CountyResidents, 2000 Figure 16:Unintentional InjuryHospitalization Among Rates* San Diego

- 4 a a icesd ik o mtr vehicle motor for risk increased an had 64 - RelatedInjuries Fact Shee - 2009

- related injuries,overexertion,transportrelated

t.” ten http://www.cdc.gov/HomeandRecreationalSafety/Water tionalInjury in DiegoSan County. Retrieved 07/10/2013 - 9 Ecodes9 E800 - E869,E880 - eae injur related ese -

to to #929. of -

females, as females, related and related emergency injuriesare ty

(3.8 per (3.8

ies; - h HEALTH STATUS ASSESSMENT g win f San of of San

n o tus is is considered the

st out out of 57, with 16% of the

Physical Inactivity th Benchmark* (US)

California

Adult Obesity San Diego

. out of 57 ranked California counties on overall health outcomes

County Health Rankings. Retrieved on 7/10/2013 from from 7/10/2013 on Retrieved Rankings. Health County th ), 3.6% experiencing poor mental health days (CA: 3.6%, US: 2.3%), 2.3%), US: 3.6%, (CA: days health mental poor experiencing ), 3.6%

41 5% 0% out out of 57, with 5,143 deaths, premature compared to the state average

* 90th percentile, i.e., only 10% are better. are 10% only i.e., * percentile, 90th Source: http://www.countyhealthrankings.org/app/home.

30% 25% 20% 15% 10% th Figure 18: Adults Self Report of BMI and Physical Activity from from Activity Physical and BMI of Report Self Figure 18: Adults and Health Prevention Disease for Chronic Center National (2009) Promotion Figure 17 Figure

http://www.countyhealthrankings.org/app/home The lower the ranking, the healthier the county so that the county ranked 1

2010) - County Health Rankings. Retrieved on 7/10/2013 from from 7/10/2013 on Retrieved Rankings. Health County 15 and 6.6% of babies born with low birth weight (CA 6.8%, US: 6.0%). US: 6.8%, (CA birth weight low with born babies of 6.6% and of 5,570 and the national benchmark (United States) of 5,317. The overall morbidity ranking of the county is 28 ( 10%) US: (CA: 19%, fair health or poor experiencing County According According to the County Health Rankings report, San Diego County is 17 (combined morbidity and mortality). healthiest The county. mortality ranking of San Diego County is 12 County HealthCounty Rankings Diego Diego County residents. Data from these assessments were used in the community health improvement planning process. The follo section summarizes a few of those assessments, including Charting the Course, County Health Rankings, and Hospital Associatio Assessment. Needs Health Community Counties Imperial and Diego Community Partner Health Assessments Assessments Partner Health Community In addition to the HHSA assessments, other local nonprofits or statewide assessments also provide insight into the health sta (BRFSS 2005 (BRFSS Figure 17: Percent of Adults Reporting Poor or Fair Health Health Fair or Poor Reporting of Adults Percent Figure 17: HEALTH STATUS ASSESSMENT the percent the of the population who loware defin is which 1%), Benchmark:US 3%, (CA:3%, at stands foodshealthy to access limitedhave who those of percent The 27%). fast are that restaurants all of percent The options. food healthy 28 ranked is environment physical The 14%). Benchmark: N/A),the unemployment rate standsat 10% (CA: 11.7%,US Benchmark: and5.0%), the rate ofchildren in povertyis19% (CA:23 ( others amongst poverty, in ranked14 economicfactors Social and Med 1,000 per 44 of rate stay hospital enrollees(CA: 52/1,000, US:47/1,000). preventable a and 90%), US: 81%, (CA: 82% at screenings diabetic of rate the 1,067:1), 1,41 (CA: 1,330:1 at physicianscare primary to population of ratio the 11%), US: 21%, (CA: 19% of physica rate uninsured an and includes 25%) US: 24%, (CA: 23% at ( 21%) US: rate 18%, obesity(CA: County adult the of 13%),17% affecting US: inactivity 14%, (CA: population, the of 13% at rate smoking adult the which 57, of out 22 ranked are County Diego San of factorsHealth environment. physical the and factors, economic and social For

overall health factors, San Diego County ranks 19 ranks County Diego San factors, health overall

Figure 19 Figure Figure 19:Family Life, Social,and Economic Factors 10% 15% 20% 25% 30% 35% Source: percentile, * 90th 10%i.e., only are better. 0% 5% Children in Poverty (2011) Poverty in Children ). The high school graduation rate in San Diego County stands at 84% (CA: 76%, US Benchmark:US 76%, (CA: 84% at standsCounty Diego San in rate graduation school high The ). CountyHealth Rankin th

out of 57. This includes the rate of high schoolhighgraduation,of children unemployment, of includesand ratesrate 57. the ofThis out - income andnot do live close toa grocerystore. San Diego San gs.Retrieved 7/10/2013on from th

out of 57 counties. Health factors include health behaviors, clinical care rates, care clinical behaviors, health include factors Health counties. 57 of out th Figure 18 Figure

u o 5, hc icue rts o fs fo rsarns n acs to access and restaurants food fast for rates includes which 57, of out Inadequate Social Support Social Inadequate -

California food establishments in San Diego is 50% (CA: 48%, US Benchma US 48%, (CA: 50% is Diego San in establishments food 42

(2005-10)

on previous page). Clinical care is ranked 29 ranked is care Clinical page). previous on http://www.countyhealthrankings.org/app/home. Benchmark (US) Benchmark US

Children in Single Parent Single in Children

Households (2007-11) Households

out of 57, which 57, of out 7:1

in %, ed clude , US: , ica US rk: by re re l HEALTH STATUS ASSESSMENT

- Graders, 2005 Graders, - , and ,9th and - , 7th -

from 2005 to 2010 to 2005 from

. Source of Image: Babey SH, Wolstein J, Diamant AL, Bloom A, Goldstein H. A Patchwork of Patchwork A H. Goldstein A, Bloom AL, Wolstein J, Diamant SH, Babey Image: of Source 5th California Among Obesity and in Overweight Changes Progress: Advocacy, Health Public for Center California and Research Policy for Health Center UCLA 2010. 2011 Figure 20: Map of Change in Overweight and Obesity Prevalence in in Prevalence Obesity and Overweight in Change of Map 20: Figure Counties California -

grades. grades.

). th Graders, Graders, - Data Data for this

16 and and 9

Figure 20 Figure , and ,9th and - th 2010. 2010. Overall, San - 2010. , 7th , , 7 - - th

2010. UCLA Center for Health Policy Research and and Research Policy for Health Center UCLA 2010.

- H. A Patchwork of Progress: Changes in Overweight and and Overweight in Changes Progress: of Patchwork H. A 5th California Among Obesity 2005 2011. Advocacy, Health for Public Center California Babey SH, Wolstein J, Diamant AL, Bloom A, Goldstein Goldstein A, Bloom AL, Wolstein J, Diamant SH, Babey 16 children grades 5, 7 and 9 ( 9 7 and 5, grades children least least 3% between 2005 Diego County saw a 3.7% decrease prevalence in the of overweight and obesity in obesity obesity and overweight and one out counties of that 15 experience a decrease of at children children decreased 1.1% 2010. San Diego between County was one out 2005 of 26 counties that experienced a decrease in PFT. PFT. In overweight California, and obesity among the school age prevalence of school school students in 5 Body weight and calculate BMI height for were children used participating in to Physical Physical Fitness administered Test annually (PFT), to California which public is Research Research evaluated rates of overweight and obesity between 2005 study were obtained from the California The The California Center Advocacy and for the UCLA Public Center for Policy Health Trends in Obesity and Overweight in Children HEALTH STATUS ASSESSMENT 17 The Institute ofThe Institute PublicHealth at DiegoSan StateUniversity, Hospital Association of DiegoSan and ImperialCounties Needs A programdevelopment that focusedon needs the patients of ( hospital for guidance targeted regional and county 3) and research, through gathered county of availability Health NeedsAssessment (CHNA) hospital a established HASD&IC, with along hospitals district and not2012, In advocacy.representation,leadership,and providingorganization non (HASDIC) a is (HASDIC) Counties Imperial and Diego San of Association Hospital The Counties Imperial and Diego NeedsAssessment Community Health San of Association Hospital      recommendationswere made basedon the needs of patients and the community: five programs,hospital and healthcommunity improving for needs the at looking When     health other asarose the community top health needsin the county including: with together as well community as providers, internally, programs health community plan to systems care health and hospitals for designed are process this from findings The www.hasdic.org/documents/CHNASummary.pdf

Collaboration. ScreeningServices, and Education, CareManagement, Access Careto or Insurance, Obesity. Mental/BehavioralHealth,and Diabetes(type 2), CardiovascularDisease,

- ie aa 2 in 2) data, wide ae ognztos ad osmr rus Fu mi issues main Four groups. consumer and organizations, based

. .

TheCHNA highlights three main components:1) - et cmuiy n hat epr feedback expert health and community depth

Figure21

- focused Community focused 44

- for

- - profit profit Diego County,2011 Figure 21:Community Need Index forSan sse ssment.(2013). Retrieved 7/10/2013 from

http:// HEALTH STATUS ASSESSMENT

nt nt he he ich

s s t eme date for for date er er respond to

http://www.sdchip.org/

that threaten health, promote, health, and/or protect health. health. protect and/or health, promote, health, threaten that . 2011. Retrieved 7/10/2013 from from 7/10/2013 Retrieved 2011. . s This assessment fulfilled of requirements Senate Bill

and data indicators available through HHSA through available indicators data and

“Charting “Charting the Course VI.”

Healthy People 2020 2020 People Healthy

profit hospitals. In October 1994, SB 697 was signed into law, which created a new man a new created which into law, SB signed was 697 1994, October In hospitals. profit -

19 Charting the Course VI: A San Diego Community Health Needs Assessment 2010 Assessment Needs Health Community San Diego A VI: the Course Charting

vi.aspx - setting criteria: setting - course - the -

Community resources available to address the problem, and problem, tothe address available resources Community data. Outcomes Size ofthe problem, Size the problem, of Seriousness

profit, profit, private hospitals to conduct a periodic assessment of the health needs of those living in their service area to bett - Injury Violence, and Injury Fitness, and Activity Physical Weight Status, Nutrition, and Disorders, and Mental Health Mental Health. of Determinants Social Selecting priority health issues. health priority Selecting forums. community during key stakeholders from input Collecting Delivery, and Access Care Health ○ ○ identified. issues health the 17 of on each briefs issues health Creating leaders. community 379 by issues health of Scoring results. scoring on consensus Reaching Selecting health issues to investigate, based on on based investigate, to issues health Selecting priority Identifying ○ ○

initiatives/charting Note: Social determinants of health including education, economic status, living conditions, and cultural elements are factor are elements cultural and conditions, living status, economic education, including health of determinants Social Note:

Community Health Improvement Partners, Partners, Improvement Health Community       are: priorities These as priorities. selected were issues key health five this process, on Based       health health issues of critical importance to San included: Diego County residents. CHIP went through a community priority setting process wh the community’s health needs. health the community’s forums leaders 2010 August in CHIP community in with conducted toSeptember of Regions and each six San Diego discus County’s Partners Partners (CHIP), conducted a needs assessment titled, non private, for San 697 Diego’s 697) (SB non Charting the the Charting Course In addition to the various assessments conducted by HHSA Departments, a local nonprofit organization, Community Health Improv 19 18 HEALTH STATUS ASSESSMENT

Table 8 HealthIdentifiedCharting the Issues Key in Course

highlightsthe keyfindings forof four the health priorityidentifiedareas in TableKey 8: Findings forFour Health PriorityAreas 2009. PercentOverweight or ObeseCalifornia in was 61.3%in PercentOverweight or ObeseU.S. in was 63.1%in 2009. of adult the population is overweightorobese. System(BRFSS) data San Diego for County,almost 59% Accordingto 2009 Behavioral FactorRisk Surveillance WeightStatus, Nutrition, Activity and Fitness 2007(CDC Data). thoseOf under 65, 16.4% was uninsuredin the inU.S. SurveyData).[CHIS] currentlyuninsured (2007 California Health Interview thoseOf under age in64 SanDiego County, 22.9% is Health CareAccess Delivery and

MentalHealth and MentalDisorders occurredin San the Diego regionin 2009. Accordingto SANDAG, a totalof homicides75 deaths. Eachyear,California injuries causeover 17,000 Health [CDPH],2010). agedpersons 1 to 44 (California Departmentof Public intentional,is thenumber one andkiller disabler of California,In injury, including both unintentionaland Injuryand Violence SanDiego County. 2008,In suicide was the 8 of household the population San of Diego County. Countywith seriousmental illness, representing 4.9% Asof 2009, there were141,420 personsin SanDiego

Charting Course the VI

leadingcause of death in .

CONTRIBUTING CAUSES - -

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hy food, food, hy red than d d h that that low ehaviors. ehaviors. iag

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. SSUES I

2012, 2012, commun -

, determinants of health http://frac.org/initiatives/hunger being of San being of - http://ask.chis.ucla.edu/main/DQ3/ 2020

EALTH People contribute contribute to over 50% of de H

09/06/2013 from from 09/06/2013

– Live Well San Well Diego. San Live Healthy Healthy . Retrieved on 09/17/2013 from from 09/17/2013 on Retrieved . In In San Diego County, African Americans had the second highest OMMUNITY

http://www.healthypeople.gov/2020/about/DOHAbout.aspx#policymaking 21

C 47

exercise, exercise, poor diet and tobacco use OF

–

obesity/ - communities communities have greater availability of conveniences stores and fast food

to - - service grocery stores and farmers’ markets, and when they do have access to when healt and they access do have markets, farmers’ grocery service and stores - These These five factors play an important role in the ability of individuals to be healthy, safe and

AUSES 20 vulnerable ). - C 50 concept is an important focus for prevention efforts of of efforts prevention for focus an is important 50 concept -

4 - people - 12 Ask CHIS. Los Angeles, CA: UCLA Center for Health Policy Research. Retrieved on Retrieved Research. Policy for Health Center UCLA CA: Angeles, Los CHIS. Ask 12 - Income and Food Insecure People are Vulnerable to Overweight and Obesity and to Overweight Vulnerable are People Insecure Food and Income - Figure Figure 22 insecure - Why Why Low These factors are especially relevant in Central and South Regions, where 20.2% and 13% of the population food

- 22 and -

income , HealthyPeople.gov. Determinants of Health. Retrieved on 09/17/2013 from from 09/17/2013 on Retrieved Health. of Determinants HealthyPeople.gov. , -

low - . are - ONTRIBUTING C geographic.asp obesity/why California Health Interview Survey. CHIS 2011 CHIS Survey. Interview Health California Center, Action and Research Food Healthy People 2020 People Healthy respectively are at or below the federal poverty level. level. federal poverty the below are or at respectively Having access to health services is another important determinant of health, with insurance coverage being an important facto which which offer unhealthy options and lower prices. Finally, income low neighborhoods. income neighborhoods have fewer physical activity resources than Many Many of the Regions highlighted the importance of access to healthy foods and areas for families to be active. It has been sh to less full access have income neighborhoods it is often poorer quality. In addition, low income whites (9.8%), with African Americans close behind (23.7%). (23.7%). behind close Americans African with (9.8%), whites Economic and other social factors also have an important impact on health status and the ability for families to adopt health with with diabetes (16.4%). Latinos and African Americans had the highest percentage of adults in San Diego County who were overwe obese (71.5% and 69.1% respectively). Additionally, Latinos in San Diego County were nearly three times more likely to be uni color color in San Diego still faced higher rates of certain health conditions. percentage (26.7%), after whites, of adults with high blood pressure and the highest percentage of adults who had ever been d As As mentioned earlier, it is recognized that three behaviors the 3 reason, this For County. Diego Other factors that contribute to community health issues are biology and genetics. According to CHIS data from 2011 residents. residents. Because of the diversity of the regions within San Diego County, these factors may have a stronger influence in ce others. to compared fall fall into five broad categories ( and well health affect the strongly most which health of the determinants of some highlights section This thriving. This This section contains a description of contributing inequities, as required by the Public Health Accreditation Board (Measure 1.1.2). According to causes of community health issues, including health status disparities an 21 22 20 CONTRIBUTING CAUSES the importance the ofaddressing determinants of health identifying in strategies thatwould encourage positive among change thei c also they communities, their affecting issues health main the examined teams leadership regional As well residents. Countyand Diego health the on impact important an have all health of determinants the comprise that categories broad the Overall, uninsured(Latinos: 26.2% and African American: 23.7%). health. overall their serv preventive use to likely more are insurance health with Individuals health. their monitor to individuals of ability the 24 23 CaliforniaHealth InterviewSurvey. CHIS 2011 America’sUninsured Crisis: Consequences for Health and Health Care.(2009). Washington,D.C. Retrieved from geographic.asp Uninsured - Crisis . - Consequences 23

codn t CI, n 2011 in CHIS, to According - for - Health - Figure 22:Determinants ofHealth and - 12Ask CHIS. Los Angeles,CA: UCLA Center Healthfor PolicyResearch. Retrieved on - Health - Care/Americas%20Uninsured%20Crisis%202009%20Report%20Brief.pdf - 02 1.% f a Deas ee nnue, ih epe f oo mr lkl t be to likely more color of people with uninsured, were Diegans San of 15.8% 2012, 24

http://www.iom.edu/~/media/Files/Report%20Files/2009/Americas .

09/16/2013 from http://ask.chis.ucla.edu/main/DQ3/ ice s and improve and s - r being esidents. ons

- of San of idered

FORCES OF CHANGE

od and and ealthy ealthy based based health health dho - ms ms

al al an an Diego nges that that nges g h 26 leadership leadership

its its mission,

t S re. cha ill ountywide andountywide vides e c pro Live Live Well San Diego (COAP), (COAP), published in he he San Diego County based based and faith -

It It further establishes workgroups in each , Communities Putting Prevention Work,to Prevention Putting Communities , Mobilizing Mobilizing for Action through Planning and the the establishment of t

. HANGE

(ACA), Community Transformation Grant, and national public health health public national and Grant, Transformation Community (ACA),

http://www.ourcommunityourkids.org/ Prop 63 Act Prop Health Services Mental Call Call to Action: San Diego County Childhood Obesity Action Plan ORCES F school school providers, 4) childcare and preschool providers, 5) community -

. These forces of change allow HHSA and regional staff to address determinants of health, thereby a comprehensive plan for ending childhood obesity through policy and environmental changes in the seven

Patient Protection and Affordable Care Act Act Care Affordable and Protection Patient influencing San Diego County residents. County Diego San influencing

Change (MAPP) (MAPP) process, each Region conducted a Forces of Change Assessment with community members within their Region. At a

San Diego County Childhood Obesity Initiative. (2013). Retrieved on 8/20/2013 from from 8/20/2013 on Retrieved (2013). Initiative. Obesity Childhood County San Diego Ibid. 26 25 domain to develop, leverage, and replicate best practices and resources throughout San Diego County, and shape a healthy futu healthy a shape and County, Diego San throughout resources and practices best replicate and leverage, develop, to domain the COI creates, supports, and partnermobilizes relationships across multiple domains (i.e., sectors). This Initiative also and vision, as well coordinates countywide efforts to prevent and reduce childhood obesity. COI COI is a public/private partnership, whose mission is to reduce and prevent environments for all children and families childhood through advocacy, education, policy development, and environmental Tochange. obesity fulf in San Diego County, by creatin providers, providers, 3) schools and before and after organizations, 6) media outlets and the marketing industry, and 7) businesses. This effort led to COAP. the in outlined strategies the of implementation effective to assure (COI) Initiative Obesity Childhood January January 2006. This document is most influential domains in creating healthy environments. These include 1) county and city governments, 2) health care syste In 2004, the County of San Diego Board of Supervisors tasked Health and Human Services Agency (HHSA) with addressing the chil obesity epidemic. This led to the development of the services, and population education about lifestyle changes to improve health. improve to changes lifestyle about education population and services, ObesityChildhood Initiative (COI) accreditation. accreditation. All of these resources and are programs to integral the goals implementing and objectives outlined by the Community Health Improvement Plan impacting health equity. Other factors addressed include health behaviors, access to care and healthy options, access to ment County. Included in this list is the Childhood Obesity Initiative, County. Initiative, Included this Obesity in the is list Childhood Program, Income Health Low Countywide Approach Countywide There are several large scale projects and funding sources that are acting as important vehicles for healthy change throughou countywide countywide level, there are several other forcesimportant of change that are taking place. isBelow a description of both th of Forces regional The Forces of Change Assessment focuses on identifying external forces, such as legislation, technology, and other impending other and impending technology, such forces, as legislation, external focuses on identifying The Assessment Forces of Change affect the context in which the community and its public health system operate. As part of Partnerships the FORCE OF CHANGE ueos omnt, oenetl ad dctoa ognztos o sals evrnetl n sses taeis eind to designed strategies systems and environmental establish to organizations educational and governmental, HHSA, by community, Administered numerous process. grant competitive federal this through funds awarded be Putting Communities CDC’s the for create epidemic. to million $16 received obesity funding national to the address led to which program (CPPW) Act, Work Reinvestment to and Prevention Recovery American the passed Congress 2009, In PuttingPrevention (CPPW) toWork Communities Thesechanges have madeand will continue to makeeasierit forclients toaccess the services theyneedmore effectively.        meaningfulsocial relationships,and improved qualitylife.MHSA of allowed has funding Behavioral Health Services (BHS) to: community are services result, a andprogramsof development the inproviders) members,and family stakeholdersclients,(including diverse from input gather year continuous, conducts (BHS) Division Services Health Behavioral Diego San of County The Early and deta Prevention For 2) Needs. Technological Supports, and Facilities and CapitalCountySan of Diego’s MHSA programs, funded please Services see County the of 5) and Community Training, 1) and Education components: Workforce 4) key Innovation, five 3) Intervention, has MHSA The lives. productive ma and residents County Diego healthy San all that so resources, necessary to access and health, mental of importance the about education support programs MHSA thatwill effectively support this system. train and technologyinfrastructure, necessary the and needs, service and intervention prevention,early of continuum broad a innovativeexpandedMHSAcounties2005,andprograms. to Effectivethe fundinghealthprovides State for ItJanuary1, mental 2004 the called law State the became and 2004 November in voters by passed was 63 Proposition MentalHealth 63 Act Services Prop

Improve patientoutcomes, such asreduction of hospitalization and rates utilization long of Include primarycare in thecontinuum of care; and Transformthe system to a wellness Promote FullService Partnershipsto increase participation of clients and families,in the healthmental system; Increasethe use of proven, innovative, value Minimize barriersto services; Expandservices;

ie el a Diego San Well Live Healthy Works™Healthy

- ae ad utrly prpit, s el s rmt wlns ad eoey self recovery, and wellness promote as well as appropriate, culturally and based

- focusedsystem throughprevention and earlyintervention services;

, the local CPPW program. San Diego County was among 44 communities in the country tocountry the incommunities 44 among Countywas Diego program. San CPPW local the , -

driven andevidence y rvdn te omnt srie nee t ass wt bhvoa hat needs, health behavioral with assist to needed services community the providing by

50 - basedprograms;

SanDiego Network ofCare

hog a opttv gat rcs i 21, HHSA 2010, in process grant competitive a Through

- term care.term elh Works™ Healthy - round Community Program Planning to Planning Program Community round

Mental Health Services Act Services Health Mental website

. .

ates h Cut with County the partners

- empowerment,

ing ser

elements vices. Asvices. ils (MHSA). dresses

y l y about ead

FORCES OF CHANGE , - d on on nts nts cai ption ption HPs ati eligible eligible

. e o options/low - would be would a a primary

network network of

coverage website - . http://www.sdcounty.ca.gov/ options/public - outlines the outlines major steps that

Enrollees Enrollees selected

is available on the on the available is

Services Services were provided by a sition. Sacramento, CA. Retrieved 12/20/2013 from from 12/20/2013 Retrieved CA. Sacramento, sition. sition plan (Revised). Sacramento, CA. Retrieved Retrieved CA. Sacramento, (Revised). plan sition

. transition transition plan http://www.sdcounty.ca.gov/hhsa/programs/phs/ cal - www.sdhcc.org/coverage Started Started in 2010, LIHP was for designed low A

29 32 medi

- . to www.dhcs.ca.gov/provgovpart/Pages/lihp.aspx - Healthy Works™ Healthy going going medical care. Pregnancy and organ transpla - , which compiles, visualizes, and analyzes conditions . California HealthCare Foundation. August 19, 2013.Retrieved on 08/20/13 08/20/13 on 2013.Retrieved 19, August Foundation. HealthCare California . program 64 64 who reside in San Diego County, who are not - - health - Cal Cal expansion. - Statewide, Statewide, total LIHP enrollment was approximately 600,000 by

media media campaign, which promotes the overarching messages of . Retrieved on 08/20/2013 from from 08/20/2013 on . Retrieved

30 Health Health Atlas income -

51 low California Healthline California -

RevisedLIHPTransitionPlan.pdf - , Making a difference. San Diego, CA. Retrieved on 08/20/2013 from from 08/20/2013 on Retrieved CA. San Diego, a difference. , Making Cal.” Cal, Cal, while the LIHP Health Care Coverage Initiative (HCCI) population - More information about about information More -

transition 28 - Healthy Works™ Healthy to include include the -

plan . - , sustained efforts to improve school environments that encourage children to walk Healthy Healthy Works™ Healthy Works™ Healthy based procurement program acting as a conduit between growers and buyers, facilitating facilitating buyers, and growers between conduit as a acting program procurement based - outlines - Cal Cal and met residency and income requirements. In San Diego County, LIHP provided - , a web , specific campaigns. specific - LIHP LIHP covered the cost of immediate and on Income Health Programs to Medi to Programs Income Health

. desk/2013/8/state

33 .

Recent Recent accomplishments Safe Safe Routes to School 27

. Healthy Food Food Systems Healthy

, as well as intervention well , as 31 health and Human Services Agency, Department of Health Care Services. (2013). Low income health program tran program health income Low (2013). Services. Care Health of Department Agency, Services Human and health Health and Human Services Agency, Department of Health Care Services. (2013). Low income health program tran program health income Low (2013). Services. Care Health of Department Agency, Services Human and Health - - Cal was expanded for said than eligible toofficials more Cal LIHP. expanded LIHP State many was 90% individuals of enrollees cover http://www.dhcs.ca.gov/provgovpart/Documents/LIHP/Meetings/DRAFT - program/ - Cal, Cal, are citizens or legal residents for at least five years and meet income requirements. - health - http://www.californiahealthline.org/capitol income - http://www.dhcs.ca.gov/provgovpart/Pages/LIHPTransitionResource.aspx from from 08/20/2013 chronic_disease_health_disparities/CPPW.html hhsa/programs/phs/documents/ltfinalfin4.pdf San Diegans for Healthcare Coverage, A Coalition for Health. (2013). Low Income Health Program. Retrieved 08/20/2013 from from 08/20/2013 Retrieved Program. Health Income Low (2013). for Health. A Coalition Coverage, for Healthcare San Diegans of State California Low Transition to Plan Outlines “State David. Gorn, of State California California Department of Health Care Services. (2012). Low Income Health Program (LIHP). Retrieved 08/20/2013 from from 08/20/2013 Retrieved (LIHP). Program Health Income Low (2012). Services. Care Health of Department California County of San Diego, Communities Putting Prevention to work (CPPW). (2013). (2013). (CPPW). work to Prevention Putting Communities of San Diego, County County of San Diego, Communities Putting Prevention to Work. (2012). Work. (2012). to Prevention Putting Communities Diego, of San County 32 33 29 30 31 27 28 transitioned to Covered California. Covered to transitioned counties, counties, the California Health Benefit Exchange (Covered Coverage California), Expansion and (MCE) stakeholders to population implement transitioned this to plan. Medi The LIHP Medi the California Department of Health Care Services (DHCS) took to coordinate the transition of available the LIHP under enrollees the to a ACA, coverag without interruption in coverage to the maximum extent possible. DHCS collaborated with the local LI December 2013. December In 2014, Medi able to keep their primary care physician when LIHP folded into the Medi care provider who managed their care. were not covered and other services may have had limited coverage. for Medi community health centers, private physicians, public and private mental health clinics, and local hospitals. with with California stakeholders and the Centers for Medicare and Medicaid Services (CMS). income adults who were not eligible for Medi medical services and limited mental health services for uninsured adults ages 19 Low Income Program Health The Low Income Health Program (LIHP) was a demonstration project of the Department of Health Care Services (DHCS), in coordin the procurement of locally grown produce; and the Works™ Healthy related related to health and wellness; school; to bike and improve improve health and wellness. FORCE OF CHANGE   five strategicareas: policy,environmental,programmatic, and infrastructure changes to maximize public activitieshealth These impact. that willin be plans implementation transformation community of range broad a implementing by achieved be will grant the of Objectives funding,ending September2014. 10 t the by and initiated grant work important the continue to Diego San of County the allowing communityis funding CTG the of by provided opportunity networks The national six to healthier to access have millionand environments healthier from benefit willAmericans more that ensure to $4areas support to expanded nearly with CTG along a states, received HHSA 36 organizations. in organizations nonprofit and territories, and reducin effective for preventionprogramming. by communities healthier creating in country the disease rates,preventing thedevelopment of secondary conditions, addressing health disparities, acrossand developing a stronger e communities and organizations, nonprofit territories, tribes, agen governmentlocal and state support grants These CTG. theopportunity, funding ACA another announcedCDC the 2011, May In qualityimprovement. conti institutionalize and system, management performance Services Health Public HHSA improve readiness, accreditation health natio support funds These 2014). September (ending years four over $850,000 was received actual funding NPHII, of elimination t systems health public of residents. types for services coordinated all and seamless across cohesion maximizing and system; health public dissemination the improving identification, for strategies the shares fostering performance; program track departments c performanceimprovementacrossof the networkmanagers a promisingbuildingpractices;and best publichealth’s of adoption how improving by provided, services health the of impact and delivery the improve to departments health allows NPHII The awards. NPHII allocated CDC 2010, September In diet,poor and lack of physical activity. system develop and infrastructure health public support Nat the CommunityseveralInitiativeTransformationandinit Improvementthe Public(CTG).agreementsHealth fund These (NPHII) Grant agreements: cooperative two through revenue HHSA provided ACA, the in allocated Fund, Health Public in Prevention The Act Health Affordable Care Funding Public in (ThePrevention Fund) 36 35 34

"Community TransformationGrant (CTG)." County of Diego.San Health and Human Services "Community TransformationGrants (CTG)." "HHSAwards $40 Million to Boost Public Health Infrastructure, PrepareTomorrow's PublicHealth Workforce." chronic_disease_health_disparities/ctg.html www.cdc.gov/communitytransformation Retrievedon8/20/2013 from Active Livingand Healthy Eating Tobacco FreeLiving - year

Live Well San Diego San Well Live http://www.hhs.gov/news/press/2011pres/08/20110831a.html

willprotectpeople secondhandfrom smoke diverse in settings, such as work sites andschools.

CentersDiseasefor Control and Prevention

willincrease access availabilityto healthfulof foods througha regionalsystem.food

In SeptemberIn 2011, CDC the awarded $103 millionstate 61 to andlocalgovernment agencies,tribes

wr fo te D i te mut f 30373 nuly o fv yas I 21, T was CTG 2012, In years. five for annually $3,053,793 of amount the in CDC the from award

initiative. 34

HHSA was originally awarded a potential of a $1.1 million over five years. Due to the to Due years. five over million $1.1 a of potential a awarded originally was HHSA 36 Due to the elimination of CTG, San Diego only received three of the five years of yearsfive the of three received only Diego San CTG, of elimination the to Due - level interventions to tackle the root causes of chronic disease such as such disease chronic of causes root the tackle to interventions level . Centers . for DiseaseControl and Prevention,15 Nov. 2012. Retrieved on8/20/2013 from

52 . Retrieved . on8/20/2013 from

HHS .U.S.Department Health of & Human Services,31 Aug. 2011.

http://www.sdcounty.ca.gov/hhsa/programs/phs/

teg vid rated across rated oun ence base

c g nal op e o smoking, iat foc http:// tions. - try thattry CPPW

ivesto ba nuo hronic pub public us on us nsure

ion cie an sed us lic s, al 35 d

FORCES OF CHANGE

dited dited goal is Safety Safety

editation editation xpe

n State n State lic ded s i s ccr

he Public Safety Safety Public o t o

Access healthy foodsto Aging population Increasing homeless population Affordable care/healthhealth care reform Cuts in government funding Differing cultural norms customs and Federal, state,and local policies The economy

       

Table 9: Common Regional Forces of of Forces Regional 9: Common Table Change . . Regional PHAB PHAB has developed national accreditation standards to

to to the Regions to

Community Assessment Health Community

will will engage health care providers to implement standard clinical care interventions to

launched launched national, voluntary public health accreditation in September 2011 as a vehicle for

will improve community design for walking biking. and walking for design community improve will

. Additional details, including methodology, is located (PHAB) cornerstone of California’s solution for reducing the number of inmates in state prisons. prisons. state in inmates of number the reducing for solution California’s of cornerstone Diego Diego in July 2010, Regions engaged with the community will promote effective parenting by nurse home visitation to high risk new mothers. risk new to high home visitation nurse by parenting effective promote will

Table Table 9 Live Well Live San Diego

Live Live Well San Mobilizing Mobilizing for Action through Planning and Partnerships

Clinical Clinical and Community Preventive Services cholesterol. high and pressure blood high of control increase Wellness Emotional and Social Environments Physical and Safe Healthy

within each of the regional sections in this document. in sections regional the each of within standardize standardize the engagement community across process the county. A of summary the regional forces of change is presented in Health Health Statistics reports. stakeholders to identify the key forces of change Others within their region. In September 2011, PHS administered introduced surveys to community members and regions. regions. Some Regions identified external forces and community trends by that reviewing the impact Need the Assessments, health Community Health of Plans, the and Community four four months later (November 2010). This community engagement provided the elements for this the document, foundational leadership team members utilized differing strategies to assess forces of change within their Regional Approach Regional After the approval of request to contract with a community organization in order to provide services needed by offenders that reintegrates them int them reintegrates that offenders by needed services to provide in order organization a community with contract to request community. and County responsibilities for managing criminal offenders. The County of San Diego Board of Supervisors (BOS) adopted a Pub adopted (BOS) Supervisors of Board Diego San of County The offenders. criminal managing for responsibilities County and a approved the BOS 2012, May In 2011). 6, on December (amended 2011 27, September on Plan Implementation 2011 Realignment Assembly Bill 109 Public Safety Safety 109 Public Realignment Assembly Bill the to be considered is This legislation change term long and fundamental includes 2011, 1, October and effective California of the State by enacted 2011, Realignment to have 60 percent of the U.S. population served by an accredited public health department. NPHII funding has supported and 2014. e spring in be submitted will which application, HHSA’s define define the expectations for all public health departments that seek to become accredited. National public health department a has been because developed of the desire to service, improve value, and toaccountability stakeholders. By 2015, PHAB’s inten The Public Health Accreditation Board standardizing the practice and improving health outcomes for all Americans.  AccreditationNational Health Public   ASSETS AND RESOURCES Diego County.Below severalare examples:key throughout issues health community address to assets as serve that services and programs many are There abuse. substance and menta safety, eating, healthy living, active were Region each in identified themes key Some demographics. and geography their Eachof the Health and HumanServices Agency(HHSA) Regions has unique community themes, strengths,and assets available base assetsare present in the community that becan used toimprove community health?” stren community key answeringquestions:followingtheby assetsidentifies assessment This important. are feel Assessment residents Strengthsthat issues and the Themes of understanding Community deep the a (NACCHO), provides Officials Health City and County of Association National to According 1.1 the (Measure using Board accomplished Accreditation was Health This Public the by required as resources, and assets community the summarizes section This Community Garden Policy Garden Community Smoke Works™ Healthy 2010): (June Academy Leadership Resident omnt prnr, o sit h Ct o Sn ig i rvmig t cmuiy adn oiy Ti plc efr reduced effort policy This policy. garden community its commerc revamping and residential in in zones. gardens community Diego establishing support easily San more to of costs regulatory and City barriers administrative the assist to partners, community smokeas a nuisance inthe City San of Diego. declaringall indoor and commonoutdoor areas smoke Smoke Diego San schoolenvironments, improving the health of San Diego’s 500,000 publicschool children. by spearheaded empower to Regions the in model RLA the use to continuescitizens in addressing the health needsof community.their HHSA plans communities. thriving regional and execute healthy, safe, help create to to wayapproach powerful a offers Diego San of County also the of part as RLA’spartners and members community with developed These project. improvement community a implementing and plan involves also and systems for healthy foods and communities; walkable and safe principles; easier building communityas such topics it make that neighborhoods their in changes self and safe influencehealthy, be to residents to tools and knowledge with them providing by neighborhoods - Free San Diego San Free

col eles rga (ue 2010): (June Program Wellness School HealthyWorks™ C - Free Project, with the goals of adopting and implementing a comprehensive smoke comprehensivea implementing and adopting of goals the with Project, Free

OMMUNITY (October 2010): (October

(June 2011): (June Mobilizing for Action through Planning and Partnerships and Planning through Action for Mobilizing , San Diego school districts enhance and implement their school wellness policies to create healthycreate to wellnesspoliciesschool implementtheir andenhance school districtsDiego San , - sufficient. RLAs is an intensive 30 intensive an is RLAs sufficient.

In partnershipIn with SocialAdvocates forYouth (SAY)San Diego, the County has launched the The County The began working with SanDiego Association of Governments (SANDAG), and other “What is important in the community? How is quality of life perceived in the community?theperceivedWhatin life quality ofiscommunity? the importantHowin is “What

A eiet edrhp cdme (Ls cets oa laes n low in leaders local creates (RLAs) Academies Leadership Resident SSETS - free, andfree, adopting a policydeclaringnon

n atesi wt te a Deo ony fie f dcto and Education of Office County Diego San the with partnership In 54

AND - hour, 10 hour,

R - day training program with a curriculum that curriculum a with program training day ESOURCES (MAPP) Themes and Strengths Assessment. Strengths and Themes (MAPP) Live Well San Diego San Well Live

- consensualexposure secondhandto - free, multi free, Initiative, a collaborative a Initiative,

- unit housing policy,housing unit gth l h l - income covers s and s ealth, .12 d o nin San ial ). g n

ASSETS AND RSOURCES

. f ing t t o nce nce

reased reased ogy. inc ) was and nol

Public Public Safety Ed Ed project, which is a -

funded funded CalFresh food assista - San San Diego Health Connect hand smoke. hand - This program provides nutrition education and

(July (July 2011): (2004).

Ed) The County works with San Diego Unified School District (SDUSD), (SDUSD), District School Unified Diego San with works County The -

enter the community, and break out of the cycle of crime. crime. of cycle the of out break and community, the enter 55 - smoking residents from second from residents smoking - This Collaborative (now known as is is a multimedia campaign designed to empower San Diegans to talk openly

HHSA partnered with SANDAG to implement the regional Safe Routes to School School to Routes Safe regional the implement to SANDAG with partnered HHSA The County of San Diego Board of Supervisors approved a movement to contract contract to movement a approved Supervisors of Board Diego of San The County

The The San Diego Safe Routes to School Coalition is made up of educators, advocates, HHSA partnered with HHSA partnered the to department Housing County Development and Community to successfully re to successfully

– Mental Health Services Act Act Services Health Mental It’s It’s Up to Us

income income families that are potentially eligible for the federally

School School Taskforce (September 2011): - to - like housing and food food and housing like

– (AB109, 2011). People returning to local communities from prison are informed of their responsibilities and provided and their responsibilities of informed from are prison to local communities returning People 2011). (AB109,

Campaign Campaign (October 2011):

Realignment Act Realignment supports basic with parents, parents, engineers, planners, and others who are working to make walking families. their and for children option and bicycling to school a safer and more accessible with a community health organization to provide Community Transition Center services, in order to address the Funding for this campaign is supported by by supported is campaign this for Funding Regional Plan (developed under CPPW). This plan ultimately will facilitate students and routines. daily their of part as to school parents or bicycling walking incorporate as they activity their physical across the County in increas continues continues to be a tech information health using forDiegans San all delivered care of health quality the tois improve goal The organizations. partnership of health care providers, clinics, hospitals, emergency medical services, about mental illness, to and recognize symptoms of public suicide and mental health health challenges, and to use local resources and seek help the largest school district in the County, to improve nutritional quality of school food, including reduction in access sodium, to and fruits and vegetables. SDUSD partners with local farmers and growers to provide fresh, locally grown produce as par the project. As a part of implementing Communities Putting Prevention to Work (CPPW) students. 130,000 over reached cooperative agreement, this intervention with all California public health jurisdictions coordinating program efforts. program coordinating jurisdictions health public California all with protects non policy The housing. public its at smoking ban obesity obesity prevention services for low program. The County of San Diego was one of 22 counties selected to pilot the State collaborative of effort California’s SNAP between Public Health Services and CalFresh and Community Action Partners (CAP). This program continues Community Community Transition Center Services (May 2012): Safe Safe Routes to School Regional Plan (March 2012): Safe Routes to School Coalition (May 2012): It’s Up to Us San San Diego Beacon Collaborative (September 2011): Ban Ban Smoking at Public Housing (July 2011): San Diego County Farm Supplemental Supplemental Nutrition Assistance Program Education (SNAP ASSETS AND RESOURCES community clinics and health center organizations. FHCSD operates 34 locations, including 17 primary care clinics, three dent three clinics, care primary 17 includinglocations, 34 operates FHCSDorganizations. center health and clinicscommunity a Hospital Psychiatric Diego San the operateclinics100 acr overof composed CCCis Diegans, sixSanin Diego (FHCSD).oneSanServing of Family CentersHealth and (CCC) does but hospitals or clinics care primary long Edgemoor have not does Diego San of County The status for allSanDiego Countyresidents. willeffortsresult theseofcollectiveimpact anticipatedthe that is it neighborhoods. time,their inOverchange implement smoking 3 reducing in while behaviors activity physical and eating healthy increase to work programs These community. the to important is address in assets leverage to partners community withcollaborate to continues and has HHSA how portray programs these of All include the following: beenidentihavesinceSomeandresourcesassets and recognize resources.importantassets regional leadershipemerging teams original communityThe assessment processhealthOctoberAscommunity2012. Regionswasengagementincompletedtheby contin Veterans Independence Services at Any Age (VISA) Program (August 2013): (August Program (VISA) Age Any at Services Independence Veterans 2013): (May Showcase Produce Local!” Go “Let’s 2013): (February Forum Workplace” the of “Weight Community Diego San pia lvl f ucinn ad needne Wt Sn ig hvn oe f h lret iiay ouain ti i a valued a is this and population, military largest Aging the neededresource. of one by having Diego San delivered With independence. and and functioning of coordinated level optimal are provide services to community is and Thesehome VISA to of access goal and caregivers. flexibility The increased (VASDHS). System family HealthCare Diego San their Affairs Veterans the and and (AIS) Services placement Independence home nursing of risk 3 the of one eating, healthy address to vegetables and schools fruits in local implemented more espousedin strategy putting important of an goal is the with This distributors plates. and students’ growers produce local with met districts school 42 Over farmers. local as well as health, student support can thatopportunities sourcing local about districts school Diego San engage to efforts regional ignited event This wellness. workplace on community business businesses in the to resources offer and educate sessio networking and fair, health discussion, panel a featured forum The Line.” Bottom Healthy a Promoting Workplace: the of heal four from hospitals 13 includes CCTP Diego, reduc San as of well County as the systems:Palomar Health, Scripps Health, Sharp care, HealthCare,and UC San Diego withHealth System. of conjunction quality In and Aim). experience, Triple patient the care, (i.e., costs of Medicare transitions improve to program federal a is (CCTP) Program - 4 - term care facility. The San Diego region boasts two strong community clinic networks: the Council of Community Cli Community of Council the networks: clinic community strong two boasts region Diego San The facility. care term - 50. Additionally, many of these programs involve residents, not just community just not residents, involve programs these of many Additionally, 50. Live WellSan Diego Live Well SanDiego

- ae Cr Tastos atesi dsgain Jnay 2013): (January designation Partnership Transitions Care based .

This showcase was an event that focused on farm on focused that event an was showcase This HHSApartnered with theSanDiego North Chamber of Commerce to host “Weight - based services that enable a Veteran to remain in the community with an with community the in remain to Veteran a enable that services based 56

VISAserves Veteransin SanDiego County that are at -

based organizations, working dir working organizations, based The Community The

- to - school solutions to educate to solutions school - based Care Transitions Care based

- improvedhealth 4 - 0 behaviors 50 al — clinics, an clinics,

the t the 30 ing fie ectly to ectly oss

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ASSETS AND RSOURCES , to these these t, t, ome and inc - , the health care resources availability can be seen

Table Table 10 highlights some of the key themes and strengths identified by each some of the key themes by highlights each and identified strengths

Figure 23 Figure

Table 10: San Diego Health Care Facilities by HHSA Regions HHSA by Facilities Care Health Diego 10: San Table region. The detailed assessments can be found in each regional CHA document. CHA regional each found in be can assessments detailed The region. Similar Similar to the other MAPP Assessments, each region conducted its own Community Themes and Strengths Assessment (also referred by the Assessment). Regions, as the Perceptions Community Regional Assets and Resources and Assets Regional across all six HHSA Operation Regions. HHSA six all across private, private, nonprofit community clinics and health centers serve as the safety net for primary care services uninsured. to Lastly, San there Diego’s are low 21 hospitals across ten health care systems. In HIV HIV clinic, and three mobile medical units which provide health care services at approximately 70 community sites. As a resul ASSETS AND RESOURCES * Note; North County includes North Costal and North Inland HHSA Operational Regions. Operational HHSA Inland North and Costal North includes County * North Note; Figure 23:Key Themes Identified by Each Region 58

LPHSA

lth lth des hea , , their

day day - ion and and 10% . m. m. A total e e workshop ste th

The LPHSA answers the Mobilizing for Action Action for Mobilizing designed into a half into designed - SSESSMENT

A day format was re was format day

- ). ). A public health system includes all public, private, and YSTEM Figure Figure 24 S

EALTH H

Figure 24: Example of a Local Public Health System System Health Public a Local of Example Figure 24: UBLIC process. With the help from a consultant, the typical two typical the consultant, With from a the help process. P

highlights highlights the represented work sectors and key positions; respondents were able to select more than one quarter quarter (72%) of participants reported their race as white or Caucasian. An additional 13% were Asian, - OCAL Table Table 11 L “What “What are the components, activities, competencies, and capacities of our local public health system? How are the Essential

category, which is why the total percentage exceeds 100. 100. exceeds percentage the total is why which category, identified. identified. Nearly three were Latino/a. sector, and the Region(s) in which they provide services, to ensure adequate representation across sector, the in they services, toHealth theprovide Public across and Sy which Local representation Region(s) ensure adequate of 67 (out of 88) participants completed this profile. Based upon the responses, the majority of the individuals who attended were female (79%), with an average age of 50. Participants came from various regions of San Diego County with 42 total zip co website. website. On the day of the event, participants were asked to complete a participant profile inquiring about their demographic informat workshop with concurrent sessions. This was done to accommodate time constraints of members of the local public health system health public the oflocal members of constraints time accommodate done to was This sessions. concurrent with workshop Control Disease for Centers the found on materials resource other tool and the LPHSPA using developed were materials Workshop On June 29, 2012, Health and Human Services Agency (HHSA) conducted the LPHSPA workshop as part of the the of as part workshop LPHSPA the conducted (HHSA) Agency Services and Human Health 2012, 29, On June Partnerships and Planning through Services being provided to our tocommunity?” our provided being Services voluntary voluntary entities that contribute to the delivery of the Essential Public Health Services within a given jurisdiction. questions: The The National Public Health Performance Standards Program (NPHPSP) created the Local Public Health System Assessment (LPHSPA) Instrument, which is based on the framework of department the to the assess status of the entire local public health ( system 10 Essential Public Health Services. This instrument is used by the local LPHSA diagnose/investigate(2), at 69%; develop policies/plans (5), at 69%; and enforce laws at(6), 69%. statu health monitor including activity, significant with highest the ranked are services essential four that shows LPHSA The one into incorporated were provided belowshows a summary of the results foreach ES and the highlighted sections represent one the to five scoring commentsscale ( and scores average The system.entry data CDC the intoentered assessed. were LPHSAthe fromfindings The(ES). ServicesEssential 10 all servicefor report combined essential each for rating mean a obtain eachquestion to (see scaleaon rating,independently a assign to participantswereasked Areagroups, Service respectiveEssentialtheir in While ba determined was assignment Group facilitator. contractedanswers a to set of demographic questions(i.e., title/positionand sector/field) one participants completedwhen theyRSVP’d for by led were that groups 5 creating thereby Services, Essential assign each were Participants expertise. of area participant’s each on based event the to prior assigned were groups Workshop Table Percent 11: of Respondents bySectorWork and Key Position Public Health Health Public Laboratories Policy Officials Elected and Makers Officer/Public Director Health Health Media Universities/Colleges Information Officers Public Recipients Service Schools Planner Health Community ExpertEpidemiologists/Data PreparednessEmergency EducatorsHealth Providers Service OrganizationCommunity Nurse; PublicUtilities; Recovery SeniorModel; Residents; Strategy Planner) HealthNursing; Management Consultant; Military Public Health; Non Insurance;HHSA; Hospitals; IHSS/Public AuthorityAdvisory Committee; Local Government; Local PublicHealth Department and Pu Health;Community Collaborative; CountyGovernment; EnvironmentalHealth Director; Faith BasedOrganization; Government; Heal Other of HealthBoard Resources Human Foundations

(Answersprovided: Community Health Center; Health Plan; PublicMental Health; Administrator;Behavior Health; Border

Table12

). At the conclusionworkshop,Attheratingswere ofthe all ).andresponseswereentered collected analyzed and to

Response Options Response - profit PublicHealth Advocate; NPO; Prevention; PublicHealth

bli th c % Respondents of 46% 16% 21% 28% 28% 2% 2% 2% 2% 3% 3% 3% 5% 5% 6% 6% 8% 8% Figure25

s ( s of e event.

1), at 72%; at 1), one to five,to one

The ). ed

sed

to two to graph

LPHSA 80% 72% 69% 69% 69% 67% 65%

60% 100%

52% 5 - 50% 50% Activity Optimal Optimal 47% 76% 76%

75%

40% - 4 Percentage Activity

51% 51% Significant

50%

61 - 3 20% Activity Moderate 26% 26%

25%

2 - Minimal Minimal Activity 0% 1% 1% Essential ServicesEssential Scores

1 No No 0% Activity Table 12: LPHSA Ranking System 12: LPHSA Table ES 6: Enforce Laws Enforce6: ES ES 9: Evaluate Services Evaluate 9:ES ES Assure 8:ES Workforce ES Educate/Empower 3:ES ES 2:ES Diagnose/Investigate ES 4: Mobilize Partnerships Mobilize 4:ES ES 1: Monitor Health Status Monitor Health 1:ES ES 7: Link to HealthServices Link 7:to ES ES 5: Develop Develop Policies/Plans 5:ES

ES 10: Research/Innovations 10:ES

Figure 25: Essential Services Scores Services Essential Figure 25:

Essential Services Essential

LPHSA TableKey 13: Findings fromLocal Public Health SystemsAssessment               Concerns:     Strengths:

Ensure innovationsand research findingsare shared Continue fostering partnerships withresearch institutionsand universities Address lackof linkage between public health research andthe actual community health system Utilize evaluationfindings to enhance and continue to strengthen the localpublic Developleaders from the community agencies Developmoreconsistent evaluation and assessment of workforce acrosscounty Increaseopportunities for trainingand education populations Facilitateefficient client follow Increaseknowledge of existing state and lawsfederal Obtain more inclusivenessand representation Identifyconnections between partnersand where improvementsare needed speakingpopulations Limitedability forsystem providers communicateto withlimited and non Communicateand disseminate information Providemore timelycommunication Demonstratesthat regulations andordinancesare evaluated and enforced Uses regionalcommunity planning process Ensures resources effectivelyto monitor and manage health threats Maintains data relatedto health

- up andup ensure efforts are reaching underserved 62

- English

REGIONAL COMMUNITY HEALTH ASSESSMENTS

CENTRAL REGION COMMUNITY HEALTH ASSESSMENT

67 CENTRAL REGION PriorityAreas Assessments Identified from CommunityAssessmentsHealth CommunityHealth Improvement Process Leadership TeamMembers Table Contents of Forces ofChange CommunityAssets and Resources (Themes andStrengths) FactorsContributing Populationto Health Challenges Population Health Issues Strengthsand Risks Healthto Health ResourcesAvailability Demographics CommunityPerceptions Assessment Socioeconomic Demographics CommunityDemographics DataSources

(C ENTRAL

R EGION

)

14 13 12 11 10 9 8 7 7 7 5 5 5 3 2

CENTRAL REGION

Council (UAAMAC) Council Parenting & Intervention Women, Infants & Children Infants Women, San Diego Area Congregations for Change Congregations Area Diego San Associates Health Black Diego San Prevention on Gang Commission Diego San Coalition Hunger Diego San Project Organizing Diego San Department Police Diego San District School Unified Diego San Center Health Ysidro San Diego San SAY Health Scripps Strive Chance Second Plan Health Sharp Church Catholic St. Rita’s Detail Bike The Place Meeting The Tree Palavra The Communities of Asian Pan Union Action Ministerial American African United San Diego San -

)

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ENTRAL (C City CAN City - Dental Care Dental and Imperial Regions Imperial and Project San Diego Adolescent Pregnancy and Pregnancy Adolescent Diego San HHSA Aging & Independence Services Independence Aging & HHSA Region Central HHSA Metamorphosis of House Branch Hepatitis and HIV, STD Strategies Public for Institute Safeway Project Foundation Jacobs Nutrition & Stars Cooking Julia’s Clinic Family La Maestra 4Hunger Meals America Health Mental Mid Healthcare Molina Association House Neighborhood California a Healthy for Network Parenthood Planned Charities Price Produce & People’s Village New Project for Center Anderson Hospital Children Rady Harmonium Inc. Harmonium East Region Leadership Team consists of the following agencies/organizations agencies/organizations following the of Team consists Leadership Region East

- - Central Region Leadership Team Leadership Region Central

Live Well San Diego Well Diego San Live HHSA Mental Health Services Health Mental HHSA -

The current current The bers: bers: 1 San 1 San Diego Chairs: - m Ron Roberts Office Roberts Ron Office Cox Greg Dept. Diego of San Society Aid Advocacy/Legal Development Community Children's Hospital San Diego San Hospital Children's - 1 e - Harmonious Solutions Harmonious Family Health Centers of San Diego San of Centers Health Family America Feeding Mortuary Greenwood County of San Diego Parks & Rec. Parks Diego of San County of SD County County of San Diego Board of Supervisor of Board Diego of San County County of San Diego Housing and and Housing Diego of San County Supervisor of Board Diego of San County Consumer Center for Health Education and Education Health for Center Consumer City of San Diego Environmental Services Services Environmental of Diego San City Asthma Coalition Asthma Lean Project California Rady Communities Healthier for Center Alternative Healing Network Healing Alternative Association Lung American 100 Strong 100 2 Tina Emmerick, HHSA Community Health Action Team Manager Manager Team Action Health Community HHSA Emmerick, Tina M Live Well San Diego San Live Well Co Regions South & Central HHSA Director, Deputy Jiménez, Barbara CENTRAL REGION Live WellLive San Diego sus ee ot motn t te omnt ( community the to follow and groups, breakout important through administered were assessments most were issues Forces ofChange Assessment)CRLT help to the understandwhich health (also Assessment the Perceptions satisfying Community a through engaged further 50 forum, quarterly each At San Well Diego would approach formulatingplan a to address identified community concerns within the in This conducted recently Region. 25 been of had that group processes smaller planning a that monthly recommended meet participants community the 2011, 4, Diego’s San regional of County the support a in Diego San Well participate to stakeholders leadershipteam. local convened outreach established,Thiscommunityregion.collaborativethroughout themeetings staff Region Supervisors. 2010, July In members.community 100 over by attended2010, 10, June on meeting ( Agenda Strategy Health a hosted Health Better Building Diego year, same the During learn. to ready and safe, healthy, be can youth and children for development this community supports initiative 2010, in Launched Endowment. Region’s California The Central by funded locations of One communities. fourteencommunities,ofBuilding healthyCommunities HealthHeights,oneCity is to converging for were synergy resources multiple support when time pivotal a was year 2010 The engagement. community of history long a has Region Central

ulig etr Health Better Building As part of the community engagement process, the Central the process, engagement community the of part As presented oiiig o Ato truh lnig n Partnerships and Planning through Action for Mobilizing framework. Central Region Leadership Team (CRLT) Team Leadership Region Central On November 17, 2010, at a community forum, the forum, community a at 2010, 17, November On ulig etr Health Better Building

o eiw xsig seset ad strategic and assessments existing review to CentralRegion Leadership Team

5 atcpns rm ies aece were agencies diverse from participants 75 a as evolving. also was

Live Well San Diego San Well Live rvn dpiain f fot while effort of duplication prevent ulig etr Health Better Building a apoe b te or of Board the by approved was

t he dfeet already different, three at

uevsr o Roberts Ron Supervisor initiative. On May On initiative. iue 2 Figure (C was formed to formed was ie el San Well Live )

ENTRAL Stakeholder t h Central e ).These 70

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Regions Figure 1:County SanDiegoof HHSAOperational Source: Improvement Diego’s Figure 2: www.naccho.org/MAPP

Roadto Community Health

CentralRegion’s

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CENTRAL REGION d re an ned ned , faith tai ing key key ing ency ency to d d at the ld ld focus ici

ect nte ommittees. ommittees. s. wou ubc . The Central Region’s profit profit organizations - built built environment

and members members met monthly from May through August CRLT CRLT ,

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4 health, health, safety

EGION R

71 built built environment ENTRAL (C and making. making. Once regional leadership teams were formed, CRLT community forums we - agreed agreed to meet quarterly as a full team, instead of monthly. This would allow the three

health, health, safety Quarterly Forum on July 17, 2012 with the assistance of a consultant to guide the community in in guide the to community of a consultant the assistance 17, with July 2012 Forum on Quarterly

Live Well San Well Diego San Live based based agencies, city and county governments, health care systems, community residents, and youth. Meeting attendance records

work on CHIP activities. Work groups' progress towards each of the goals is reported at the Quarterly Leadership Team meeting Team Leadership Quarterly the at reported goals is the of each towards progress groups' Work activities. CHIP work on Community Community Health Improvement Plan (CHIP) goals and objectives Quarterly were Forum. presented In to March the 2013, community the at CRLT the October workgroups (Health, Safety/Built Environment, and Tobacco) to 17, meet monthly, between quarterly meetings, promoting greater eff 2012 CRLT developing goals and objectives for each core issue. The team further developed the community health improvement plans by sel by plans improvement health the community further developed team The issue. for core each objectives goals and developing activities and indicators of success to address the identified issues of Once Once the team selected the core issues of a 2012 conducted and The community health assessment process for the Central Region was a collaborative process because of the involvement and sus s related on representation sector multiple through addressed were issues Multiple stakeholders. of diverse leadership active on throughout their community health improvement planning process. Meetings were attended by community non community by attended were Meetings process. planning improvement health their community on throughout - space. shared Countywide on a are stored and meeting every for kept were minutes meeting following following quarterly forum to inform future decision held quarterly to discuss results of the review assessments, County health data and determine which health issues the region questions questions were sent via SurveyMonkey™ to all participants on the mailing list. Data were analyzed by regional staff and prese CENTRAL REGION HU eeae dmgahc eooi, eairl n hat dt ognzd y HA ein n cmuiis ihn ah HHSA each within communities and Region HHSA by organized data health and behavioral economic, demographic, generates CHSU economicfalls, burden ofdisease, health disparities,and health status), health briefs, fact sheets, and atlases.All are a ( reports specific other profiles, health community the including publications, to generates CHSU support communities. their and and data Regions Pub health public HHSA for contact in of point locatedsingle a provide (CHSU), to 2005 Unit in Statistics formed CHSU The Health Division. Services Community Health the by developed annually are reports profile community Regional RegionalProfiles (Health Status Assessment) local the public health assessment can be infound public,private, andvoluntary entities contributing thetodelivery the10Essentialof Public Health Services. JuneOn 29,2012, HHSA conducted Locala Public Health System Assessment (LPHSA) toevaluate allsectors healthina system, LocalPublic Health SystemAssessment were identified priorities health The County. nutrition Diegoand physical activity, injury and violence, and mentalhealth. San facing issues health the prioritizing of goal a with County, Diego assessment. health community Course withinDiegoleadersSan County. Forums wereheld withinHumansixHealthServices the and Agencyoperational(HHSA) Regions the commun Charting 379 with process setting triennial priority a conducted sixth they where forums community itshosted Partners Improvement Health completedCommunity Partners Improvement Health Community 2010, In Charting Course the VI DataSources Community Perceptions community setting own priority their the in conducted utilized exercisescommunity for health were improvementplanning. agencies assessments community these from same Findings below. these shown assessments, of Many issues. social health address and to decade last the over funding received have that agencies Midmany contains Diego, Region San Central of communities the includes income also region The middleareas. urban other and several and Diego lower San downtown includes mostlyregion The residents. with diverse, racially/ethnically and Central The populated priorities. densely health various is address Region to used be could that assets many the of aware are area the within work that stakeholders and agencies the of most that in unique is Region Central The CommunityHealth Assessments

theoverarching Community Health Assessmentsection of this document

- iy ad otesen a Deo Central Diego. San Southeastern and City, (C ENTRAL 72

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)

A full description of the results of results the of description full A TheHeightsCity area of madeup of immigrants theCentral Region is from 60from countries. vai lable .

egt status, weight online e.g the inc ., senior .,

of HHSA luding .

San ity lic

CENTRAL REGION t ren sensitive -

pays and - insured : - s n r e Lack places of to purchase healthy food options High unemployment rates payingLow jobs thatdo not provide health insurance Lack knowledge of and information about State insurance programs and their eligibility criteria Poor quality education Safety Disproportionate number of black children in the Child Welfare System Individuals lack health plan Individuals lack personal doctor Lack health of coverage or under Costs co of prescriptions Long wait times Lack culturally of carehealth providers Lack safe of places for physical activity

      Conc        

based -

)

6 Increased awareness/ promotion of mental health Engagement of faith organizations Effective strategies and best practices to impact childhood obesity Resources to help reduce incidence andof risks associated with unwanted pregnancies and to improve health outcomes pregnant for and parenting adolescents through programs such as Nurse Family Partnership and San Diego Adolescent Pregnancy and Parenting Program Effective breastfeeding/ lactation policies Variety community of resources Culturally diverse population Ability collaborate to effectively

      Table 1: Key Findings from Community Perceptions Perceptions Community from Findings 1: Key Table Assessment Strengths:  

EGION R

73 ENTRAL (C

These These data are

regional profiles were generated, which influenced the identification of health priorities for Central Region. for Central priorities health of identification the influenced which generated, were profiles regional children in more detail. more in children CHSU worked with the CRLT to review the above data sources. Based on this review during the community engagement process, cur Health Health Services, CHSU staff created the indicators available through population based sources. Future plans for the Community Profiles include the development of profiles that address older adults and process. process. There was an unmet need for population based information on mental health and substance abuse. Working with Behavioral The addition of Behavioral Health data members was driven by during community the community health improvement planning communities communities that comprise San Diego online by calendar County. year and Data are currently archived are back to 2000 posted time. over trends to compare to public the staff and allow discharges, discharges, and emergency department discharges. organized by race/ethnicity, age group and gender for each of the 41 communicable communicable diseases, maternal and child heath, injury and most recently expanded to include behavioral health (mental health substance and abuse). Most indicators are reported as deaths, hospital each each HHSA Region. Very quickly the list expanded to include dozens of indicators organized by noncommunicable (chronic) diseases, The Community The began Profiles Community as a short list of Healthy People 2010 objectives that were reported for the US, CA, San Diego County, and provide provide information on health status and health behaviors by HHSA Region. branches branches in Public Health Services as well as from state and databases including local Vital Records and OSHPD. CHSU incorporates selected results from the California Health Interview Survey to Demographic Demographic and economic data are from pulled the Census and the American Community Survey. CHSU pulls health data from various Region, Region, and posts this information online as the Community Profiles. CENTRAL REGION 37 food. enough afford to ability consistent a had half than less (FPL), Level Poverty Federal the of 200% than less incomes with adults Among overall. county the of that double nearly was which poverty, in lived ( Region Central the in lower were incomes household county, the of rest the to Compared Socioeconomic Demographics ages18 However,percentagethis differed by withage, oneof out five adults, programs.public or private through insured adults of 84% estimated an with services, health to access and coverage had insurance havehealth to likely less were residents Region Central county, the spokeEnglish only, while 23% were bilingual. were black, and 14%were Asian ( 13% nearly Hispanic, were population Central the of (42%)percent Forty population. County Diego San the ofrepresenting 16.1% residents, 514,000 nearly to home was Region Central the 2008, In estimates. 2009 SANDAG on based Unit, Statistics Health Community the by created were projections and estimates demographic following The CommunityDemographics Demographics Area CountySan of Diego, Health and Human Services Agency, Public HealthServices, Community Health Statistics Unit. (2012). . Retrieved . 07/10/2013 from

- 64 years64 not having any health insurance coverage. 37

al 2 Table www.SDHealthStatistics.com

. n ot f ie eta residents Central five of out One ). Figure 3 ).More than half of residents Compared to the rest of of rest the to Compared .

ENTRAL - two 74

R EGION

RegionResidents (2008) Figure 3:Racial/Ethnic Demographicsof Central

)

Services, Community Statistics Health Services, Unit. 2009. Diego,CountySan Source: of Health HHSA,Public Region TableHousehold 2: Income Centralin >$125,000 $125,000 to $100,000 $100,000 to$75,000 to$45,000 $75,000 < $45,000 Households Total

13% 14%

SanDiego Demographics Profileby Region and Subregional

4% 42%

7,307 5,833 12,228 36,274 112,408 174,050 Number 27%

4.20% 3.35% 7.03% 0.84% 64.58% 100.00% Percent

Other Asian Black Hispanic White CENTRAL REGION r k s, s, so so

that

ides ward ward ent to rov dialysis dialysis

ces.

hoi nic families. more

n four schools: s s i Health Health Resources Cal, Cal, to clients - income -

term term care facilities. Many of the FQHCs are - based based clinic in December 2010, and Monroe Clar -

)

EGION R

75 ENTRAL already already had a medical and dental clinic, which is now extended

. It also has two hospice facilities, five hospitals, and ten long based based clinic. Central Elementary School opened a school

- based clinic in October 2012. 2012. October in clinic based -

based based clinic concept. Hoover High School

- Clinic and home visiting public health services for pregnant women, new mothers, and children; children; and mothers, new women, pregnant for services health public homeand visiting Clinic and problems; health serious with adult residents eligible for program assistance Services Medical County c food healthy to access and safety environment, the built of role the on focused services promotion/education health Overall Mental health and substance abuse care. abuse and substance health Mental Well Well checkups, for illnesses, Treatment pregnancy, during care Complete children, for and checkups Immunizations and drugs, prescription and care Dental

opened their school their opened support support a school serving the entire community. The same concept applies for Rosa Parks Elementary School, which had a medical clinic and now p more services as a school example, example, one of the local organizations in the City Heights area, the Price Charities funds the full salaries of school nurse Hoover High School, Rosa Parks Elementary School, Central Elementary School, and Monroe Clark Middle School. These schools al qualify. CalFresh is also provided at these FRC’s and assists in helping to make healthier choices more feasible for low for feasible more choices make healthier to helping in assists and atFRC’s these provided also is CalFresh qualify. There are other key agencies and partners within the Central Region that serve as resources for community members in need. Fo  Each Central Region Resource Family Center (FRC) provides public assistance such benefits, as CalWORKS and Medi   The The HHSA Central Region Public Health Center provides social general services to public children, youth health and adults and living and working in the Central Region. offers: Center Health Public Region Central The       especially especially those who implementation), allowing have them to pay what they can afford based on income. Services no health include: available insurance (prior to Affordable Care Act and and Services and Administration Central Region community partners and play active roles in the CRLT forums and leadership teams. FQHCs provide care for resid Central Central Region has an incredible amount of resources focused on health, including one alternative birthing center, eight clinics, one chro free clinic, one psychology clinic, and 27 Federally Qualified Health Center (FQHC) sites, according to the Health Resources Availability Health Resources Availability CENTRAL REGION concept i found diseases chronic same very those of prevalence the including Region, Central the in health to risks several are There services. of array complex the navigating is members community for challenge resource is it that is regions this of strength Another va spiritual faith their esteem highly who faith of the people are region this in reside with that populations the of many because engaged important highly also is Region Central The chi the for communities safe and healthy creating familiesthe in region. of goal the towards together work to partners community for ability the and b that area the is co its Region for knownalso is Central Region countries. The approximatelydifferent includes immigrantsCentralfrom 60 It diversity. most the of area Heights City The diversity. is them among strengths, several has Region Central Risks and Strengths to Health services. Thereare part school Mid and Maestra La - based clinics. Undocumented students and their families are also receiving preventive services (e.g., Tdap, flu shots) an shots) flu Tdap, (e.g., services preventive receiving also are families their and students Undocumented clinics. based –

diabetes,asthma,schoolsissuessafetydiseasepertainingandthedisofinheart andtoalso cancer.are risks There - City Clinic also provide school provide also Clinic City

- time psychologiststime available the on site behavior for counseling.

- based, medical care to the students who enrolled with any of the above mentio above the of any with enrolled who students the to care medical based, - rich, with services spanning from pre from spanning services with rich, (C - based organizations, another major strength for the area. This becomes becomes This area. the for strength major another organizations, based ENTRAL 76

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)

- childbirth to senior to childbirth preventive and follow were significantly higher access and utilization of for diabetes and asthma Medical encounter rates other regions, possibly than rates for nearly all the result of poorer care - related healt related .

lla lue h issues. The The issues. h - borative spiritborative up n t n advantaged s. d medical d he 3 he ldr

oas en and en ts the ts - 4 ned - 50 CENTRAL REGION e n n Diego Sa

ows that more of of more that ows sh

sensitive health care health sensitive - places to live, work and play work and live, to places affordable to healthy, access Lack of food options other and alcohol tobacco, to Access youth among drugs especially Culturally diverse Culturally collaboration of Spirit community of array Comprehensive resources spirituality with connections Strong especially care, health quality Lack of culturally diseases, chronic of rates High and diseases, transmitted sexually mortality infant safe spaces; open and parks Lack of

 (Concerns): Risks      Table 3: Key Findings from Community Community from Findings 3: Key Table Health Assessments Strengths:    -

)

up up care. - Table 3 Table

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77 ENTRAL (C

Further strengths and risks or concerns are located in located are concerns or risks and strengths Further

on on the following page shows data on the mental health status of Central Region residents. The chart shows that compared to th Source of health status information above: County of San Diego, HHSA, Public Health Services, Community Health Statistics Uni Statistics Health Community Services, Health Public HHSA, Diego, San of County above: information status health of Source 35

these individuals these are individuals being seen by their doctor and medications are being forprescribed mental health concerns, compared to overall. County Table Table 4 it Lastly, to work. their ability affected and also lives social residents’ impaired have emotions County, Diego San of rest Central Region, unintentional injuries were the third leading cause of death for all ages, and and ages, for all of death cause leading third the were injuries unintentional Region, Central eighth. the was suicide Injuries are an important public health problem, especially given that so many are predictable predictable are many so that given especially problem, health public important an are Injuries the In adults. young and children for death of cause leading the are Injuries preventable. and States States rate of 6.8 deaths per 1,000 live births. Fetal mortality in the Central Region was the highest in the County at 4.9 deaths per 1,000 live births, compared to all regions and births. live 1,000 per 3.9 of rate the county infants. infants. Infant mortality in the Central Region was 6.4 deaths per 1,000 live births, which than the United but births, lower live per 1,000 4.4 deaths of rate the is county than higher possibly the result of poorer access and utilization of preventive and follow and preventive of utilization and access poorer of the result possibly The overall health of a community is often measured by the health of its mothers and obstructive obstructive pulmonary disease (COPD) death rates lower, were than also the either county comparable, or overall. asthma However, were significantly medical higher encounter than rates rates for for nearly all diabetes other and regions in the county, coronary coronary heart disease (CHD), and stroke were generally lower than the county overall, possibly due to the younger age of the population. Diabetes, asthma, and chronic Population Health Issues In the Central Region, chronic disease death and medical encounter rates for cancer, lack of access to healthy food options; and inability to obtain quality, affordable, lack food totoculturally of and access quality, obtain inability options; healthy affordable, care. health sensitive neighborhoods: neighborhoods: access to alcohol, tobacco and other drugs, including synthetic drugs; CENTRAL REGION *Indicatesstatistically unstable estimate. **UCLACenter Healthfor Policy Research, California Health InterviewSurvey (CHIS),2009. Tested for STD in Past 12 Months (ages 12 (ages Months in Past 12 STD for Tested 2 (ages in Past Week More Times 3 or Food Ate Fast Born Child First 25 Under When Aged Mother 18+) (ages Food Enough Afford to Unable FPL 200% Under Adults Children Who Eat Less Than 5 Servings of Fruits and Vegetables Daily (ages 2 Factors Health Related & HealthBehaviors Other 18 (ages Care Source of No Usual 18 (ages Year Part of All or Uninsured 18 (ages Coverage Drug Prescription Utilization and Access 12 (ages Year Past in Marijuana Used 12 (ages Drugs or Other Glue, Sniffing Cocaine, Marijuana, Tried Ever 18+) (ages Year Past in Binge Drinking Factors Health Related & Abuse Behaviors Health Substance 12 (ages Past Month During Distress Psychological Serious Had Likely Has 4 (ages Year Past in Counseling Emotional/Psychological Child Received 18+) (ages in Months Past 12 Impaired Work Severely Emotions Year 12 (ages Past in Counseling Psychological/Emotional Received 18+) (ages Past Month During Distress Psychological Serious Had Likely Has 18+) Year (ages Past During Distress Psychological Serious Had Likely Has 18+) (ages Suicide Committing About Thought Seriously Ever 18+) (ages Months inPast 12 Life Social Impaired Severely Emotions 18+) (ages Year Past in Issues Health Emotional/Mental for 2orMore Weeks for Medicine Prescription Taken Has Emotional for Provider care Any health Saw 18+) (ages Problems Mental to More Due 8 Days or to Unable Work Factors Health & Related Behaviors Health Mental TableCalifornia 4: Health InterviewSurvey (CHIS)Data for Central Region

- 64) - 64) -

- 17)

64)

- - 17 who have had sexual had whohave 17 Mental and/or Alcohol and/or Mental

- 17)

(C -

Drug Issues in Past Year (ages 18+) Year (ages in Past Issues Drug

ENTRAL

17) intercourse) - 17)

- 11)

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Central Region Central Region Central Region Central Region Central Region 52.0 53.3 16.0 44.6 16.3 25.4 94.8 33.6 10.3 17.6 21.0 59.4 (%) (%) (%) (%) 2.1 4.8 9.3 * * * * * * *

County (%) County (%) County (%) County (%) 35.1 52.9 36.5 15.0 38.4 13.2 23.2 94.5 10.2 34.8 10.5 11.0 13.5 56.5 6.1 2.2 4.5 4.6 2.2 5.3 8.0 6.9

CENTRAL REGION - at are ral ral and th are are non o o identify

vio at at d d t Community Community Health his information, and his information, and

h t

. Health factors listed in in listed factors Health .

TERTIARY Following Following are some highlighted

Southeastern San Diego Community Community Diego San Southeastern Injury - tiary prevention factors are specific for each for each specific are factors prevention tiary Live Live Well San Diego ter

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ENTRAL (C SECONDARY ) is an illustrative representation of how demographic and social/behavioral risk factors Figure Figure 4 received funding from the California Endowment to conduct the to conduct Endowment fromthefunding California received

The The project began in January 2010, and focused on two goals: to develop health services planning and

South South Region includes the city of San Diego and San Diego Unified School District.

. San Ysidro Health Center Health Ysidro San PRIMARY 50 as a foundational concept, specific primary and secondary risk factors were identified for Central Region. Central for identified were factors risk secondary and primary specific concept, foundational a as 50 Figure 4: Critical Pathway for Central Region (Lack of Worksite Wellness, Access to Healthy Food, Safety, the Built the Built Safety, Food, to Healthy Access Wellness, Worksite of (Lack Region for Central Pathway Critical Figure 4: Use) Tobacco and Services, Social & to Health Access Environment, *SOCIAL DETERMINANTS OF HEALTH - Note: This figure conveys the aspects of primary secondary, and tertiary prevention for chronic diseases in each Region. The The Region. each in diseases chronic for prevention tertiary and secondary, primary of the aspects conveys figure Note: This factors. prevention secondary and primary of identification in resulting Region, given 4 - strategies to improve health services access and outcomes for all community members, thus reducing health disparities. disparities. health reducing thus members, forcommunity all outcomes and access services health to improve strategies Strategic Strategic Health Plan Project. implementation for infrastructure the region that would enable improved communication and coordination of local resources; an Southeastern San Diego Community Strategic Health Plan Project Plan Health Strategic Community Diego San Southeastern the In 2009, Improvement Improvement Plan this Region. of resources and assets Community Assets or Resources (Themes and AssetsCommunity Resources Strengths) (Themes or Community assets and resources unique to Central Region are imperative to implementing the social social risk factors influence the development of health outcomes that are precursors to death due to chronic disease the tertiary prevention column were identified by Central Region during the review of health status data for this WitRegion. 3 the modifiable) modifiable) have an impact in the earliest stages of modifiable) begin to impact the health outcomes as health individuals age and develop over the lifetime. Combined, outcomes. demographic, beha From there, behavioral and social risk factors (factors The Critical Pathway for Central Region ( contribute to the development of chronic disease. At the beginning stage of the pathway, demographic risk factors (factors th Factors Contributing to Population Health Challenges PopulationFactors to Health Contributing CENTRAL REGION identified. and youth to related activity) physical (i.e., factor risk behavioral A schools. in overcrowding and resources, to cultural access and funding, care health of distrust funding, government in cuts around centered Issues youth. and refugees, prisoners, community the of healthhighlights theresults ofthe fromchange forces assessment. identifiedIssues were relatedtopopulations, specific includin the impact that trends and forces external identified CRLT the data, Unit Statistics Health Community Assessment,NeedCHIP the reviewingBy ofChangeForces Assessment t relates it community as violence. students the of perceptions the identify to helping in instrumental were surveys These survey. this completed th Approximatelyof 90% MiddleSchool. Bell studentsof thePassagescollaborationwith surveySafe the conducteda 2011, In enforcemen law counselors, school principal, probation, the HHSA, togetheryouth bringingagencies, School,and student Middle leaders. Bell at active is Passages Safe school. the socialresponsibility, and the emotional well studentswhen they arewalking andto fromschool. Thisinitiative, known as In2010, Bell Middle School along with other key community partners formeda multidisciplinary collaboration to address the i Safe Passages needed capacities and resources in the logic model. residents.Thedatagathered wasprioritizeusedto outcomes,the identify thetargeted changes, develop changestrategies, a importantis what of sensestrong traditionalaprovidedsurveys, two from data the discussions,withthesealong of results 105house meetings in 13 different languages such as Burmese, Somali, Arabic, Spanish, and Vietnamese and involved 1,550 resi in order to engage in a dialogue about Building HealthyCommunities. Between July and October 2009, 27 HouseMeeting Leaders HouseMeeting Leaders, residentswho are natural leaders among their neighbors or part of a network Mid of needs.residents community that the they ar into deeper and broader CaliforniaTheEndowment’s (TCE) Building Healthy Communities Initiative Education. identifi projectthemesas a result of thesurvey collected:data BuiltEnvironment; Youth This and Adolescents; Culture andAccess Care;to and O community. the within worked that stakeholders key 100 additional an and Diego San Southeast of members Through focus groupsand informantkey interviews conducted over the courseof six months, projectthis surveyed nearly 1,500

BuildingHealthyCommunitiesHeights CityInitiative in

- Charting the Course VI Coursethe Charting being ofstudents by deterring harassment, gang, and criminal activity within the

TCE officiallyTCE launched Building Healthy Communities across14 communities 2010. in - iy omnt Avcc Ntok CN slce a ru o rsdns o ev as serve to residents of group a selected (CAN) Network Advocacy Community City

(C ENTRAL ; the Southeastern San Diego Community Strategic Health Plan; and the the andPlan;CommunityStrategicHealth Diego SoutheasternSan the ; 80

R EGION

SafePassages

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conductedreachmeetingssurveyshousetoand , has,missiona promoteto academic excellence, g h g ssu areasurrounding adu ec to nd omelessness, eof safety for g o onnectedto, City HeightsCity lts was also also was lts utr

to ascertainto co den e s e con

t, ns and angs la . eachand mmunity Table 5 Table nguage juvenile tudents ed ts.The ducted four

CENTRAL REGION ors) ors) and ty ty Health orming orming at act uni nst ision. Below is an v

CRLT’s

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n di ENTRAL n i links links the priority areas with health outcomes unique to Central Region. The

f (C

Key Priority Areas Priority Key

cutting

s Figure Figure 4 s o r Worksite Wellness Worksite c Services Health to Access Drugs Other and Tobacco Alcohol, Food Healthy to Equity/Access Food Environment Built and Safety training, education,and other necessary enter to skills workforce -

n     

ine entry m - Cuts in government funding Distrust of systemhealth and insurance Existing healthcare facilities risk at Homelessness Lack training, of re Language and cultural access Less physical activity among youth and adults Overcrowding schoolsin Prisoner re Refugee issues locally and countryin origin of

          Table 5: Forces of Change Assessment Change of 5: Forces Table issues issues represent the pro

tified n quarterly quarterly forums and within the Leadership Team meetings. Breakout groups were formed each time at both the forums and the

ide

Improvement Improvement Plan. The critical pathway noted in pathway also outlines primary and secondary prevention factors that are related to the health outcomes (tertiary areas. prevention priority f The outline of the priorities chosen by the CRLT for Central Region. These priorities are the basis for the Central Region’s Comm CRLT period. month nine a over identified were issues strategic the sessions, those Through meetings. Team Leadership Priority Areas Identified from Assessments from Identified Areas Priority The CRLT strategic identified issues by exploring the combined results of the earlier identified assessments and also by brai

EAST REGION COMMUNITY HEALTH ASSESSMENT

83 EAST REGION PriorityAreas Assessments Identified from CommunityAssessmentsHealth CommunityHealth Improvement Process Leadership TeamMembers Table Contents of SummaryAssessments of Forces ofChange CommunityAssets and Resources (Themes andStrengths) FactorsContributing Populationto Health Challenges Population Health Issues Strengthsand Risks Healthto Health ResourcesAvailability Demographics CommunityPerceptions Assessment Injury PulmonaryDisease DiseaseHeart and Stroke Diabetes Cancer Socioeconomic Demographics CommunityDemographics DataSources

( E

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)

16 15 13 13 12 11 10 10 10 10 10 9 8 8 8 8 7 4 4 3 2

EAST REGION

San Diego, Inc. San Diego, Southern Indian Health Council Health Indian Southern Center Community Valley Spring Coalition Family & Youth Valley Spring Place St. Paul’s San Diego California, of University Government Tribal Viejas in Medicine Volunteers Care Parent Vista Hill San Diego Walk WithKirk Workout YMCA (YALLA) Actively Living Leaders Youth and San Diego Youth Services Youth San Diego Collaborative Santee Network Health Santee Coalition Solutions Santee Libraries County San Diego Sheriff County San Diego University State San Diego Anderson Joel Senator Hospital Grossmont Sharp

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San Carlos Area Council Area San Carlos Collaborative Nature and Children San Diego Initia- Obesity Childhood County San Diego Conservancy River San Diego Lakeside Community Collaborative Community Lakeside Revitalization Lakeside Sol del Tierra District School Union Lakeside School Middle Conservancy Park River Lakeside's Collaborative Grove Lemon Zone HEAL Grove Lemon Academy Leadership Resident Grove Lemon District School Grove Lemon Institute McAlister 4 Hunter Meals Baptist Church Meridian Foundation Park Regional Trails Mission Empire Collaborative Mountain District School Empire Unified Mountain Services Community & Health Mountain Advocacy for Deaf Center National Parenthood Planned Market Farmers Diego San Rancho Center Kroc Joan & Ray Army Salvation EGION

85 R

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Lakeside Chamber of Commerce of Chamber Lakeside Home Start Start Home Strategies Public for Institute Committee Rescue International District School Union Delzura Jamul Church Community Journey Architecture Landscape & Planning KTU+A Centers Health Community Maestra La Courier Mesa La Club Kiwanis Mesa La Start Healthy Valley Spring Mesa La Family Health Centers of San Diego San of Centers Family Health Safe Fire Diego San of First 5 Commission Productions It For Go School High Hills Granite College Community Cuyamaca Grossmont District Center Occupations Health Grossmont District Healthcare Grossmont District School High Union Grossmont Foundation Adventures Healthy Crossroads Family Center Family Crossroads of Commerce Chamber East County Action Network East County Center Justice Family East County Collaborative El Cajon

East Region Leadership Team Leadership East Region

Mercadel, County of San Diego, Deputy Director, East and North Central Regions Central North and East Director, Deputy Diego, San of County Mercadel, -

Chairs:

- County of San Diego, Public Guardian Public San Diego, of County Services Health Public San Diego, of County ence Services ence Health Behavioral San Diego of County Recreation and Parks San Diego, of County Community Health Improvement Partners Improvement Health Community Supervisors of Board County Independ- and Aging San Diego, of County City of Santee of City Abuse Substance Against Communities Centers for Disease Control & Prevention & Control for Disease Centers Cajon El of City Mesa La of City Cajon Valley Union School District District School Union Valley Cajon Seniors for Places Caring Birth Parent Association Parent Birth County East of Club & Girls Boys VEBA Schools California American Red Cross Cross Red American Advisors AXA American Vet Aid Vet American Society Cancer American Association Heart American Active Living Research Living Active Chamber Empire & Mountain Alpine Hospital Alvarado AARP AARP Partners: Supervisor Dianne Jacob, District 2 District Jacob, Dianne Supervisor Brown Marie Live Well San Diego San Live Well Co EAST REGION various sectorsin EastRegion. Perception Community community. a to important through most are issues engaged health which understand further team leadership the was help to Assessment community Change of Forces The a and agencies.Assessment care health and schools including sectors, private p both with partnership meaningfuland leadership regional of competency core the emphasizedand RegionEast of status health revie thoughtful a undertook group The thinking. and assumptions challenge and educate both to together came experts regional Offici Health ( (MAPP) City called and (CDC), Prevention County and of Control Disease Association for National Centers the the and from (NACCHO) adapted model planning improvement health the community formed a later followed agencies Participating lives. thriving and Leadership Team (ERLT)in February support2011to County the San of Diego's safe, healthy, live to changes initiate of series a convenedRegion East the 2011, spring to 2010 fall From Live Well San Diego Figure 1:County SanDiegoof HHSAOperationalRegions Figure 2 Figure hs assmns ee diitrd i a eetoi sre t pre to survey electronic an via administered were assessments These ). As part of the community engagement process, the ERLT began with a series of planning and innovation forums whereinnovationandforums planning ofseries a withbeganERLT theengagementprocess,community the ofpart As ). East Region Leadership Team’s Community Health Improvement Process

( E AST

R 86 EGION Live Well San Diego, Building Better Health Better Building Diego, San Well Live

3 Source:

Road Community to HealthImprovement Figure 2: )

Live WellSanDiego www.naccho.org/MAPP oiiig o Ato truh lnig n Partnerships and Planning through Action for Mobilizing

EastCounty’s - dniid tkhles n prnr representing partners and stakeholders identified

initiative.Leadershipmembers Team Live SanWell Diego’s ie el a Diego San Well Live

Forums to help residents help to Forums

at Region East ubl w o w ic and ic f the f

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EAST REGION

t h re re re re nic nic ve, ve, ent red city city tan white white hro areas. areas. us

r, r, vem embers embers 12% 12% felt alth alth care, lth issues issues lth ral , , m an an he

hea ). ). Half said that low ended ended questions a - Community Community Themes and Figure Figure 3

Pine Pine Valley, Lakeside, Lemon Gro -

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EGION 87 R

AST E (

). When ). asked what would make their community a healthier place to stated respondents live, that question question survey modified from surveys in the NACCHO MAPP Toolkit. The figures following indicate - Figure Figure 5

choice choice questions are shown in bar charts with the highest responses displayed. Open - through through an 11

Once the regional leadership team was established, meetings were held monthly to discuss results of the assessments, ). Figure 4 Figure

community community involvement, opportunities for physical activity, health education, access to healthy food, access to comprehensive factors. be important would transportation improved and opportunities, economic improved The majority of respondents felt that their community was somewhat healthy (61.7%) or healthy (22.2%), while slightly more th their community was ( unhealthy crime/safe crime/safe neighborhoods were most important, while access to health care and factors. community The involvement most were also commonly listed cited as health impor problems were ( disease drug abuse, poor diet, mental health issues, physical inactivity, and c summarized in the narrative. the in summarized Respondents were asked what they felt the three most important factors are that define a health community ( Strengths Strengths Assessment the 82 responses. Multiple Community Perceptions Assessment Perceptions Community To secure an understanding of the issues residents felt were important, the Leadership Team conducted a The The Region includes the communities of Alpine, El Cajon, Harbison Crest, Jamul, La Mesa, Laguna Region. East the in found are also Reservations Indian Several Valley. and Spring Empire, Santee Mountain The The East Region of San Diego County is a large, diverse, mostly lower and middle income Region with a adult high residents. proportion The of East olde Region is the second largest, geographically, covering 1,104 square miles of urban, suburban and ru improvement plans by selecting key activities and indicators of success to address the identified health issues. health the identified address to success of indicators and key activities selecting by plans improvement Assessments Health Community met monthly to begin developing the community health improvement plans by identifying goals and objectives for the strategic forstrategic the objectives goals and identifying by plans improvement health the community developing to begin monthly met selected by the leadership team members and the community. The regional leadership team further developed the community healt The community health assessment process for excellence, and meaningful East partnerships across different sectors. Once the health Region issues were selected by the leadership team was a collaborative process focusing on innovation, a commitment to and and County representatives, leaders administrators. of Meeting attendance records the and meeting minutes faith were kept for community, every space. meeting school and are stored administrators on a and countywide sha district representatives, and health ca planning process. review County health data, and determine which health issues the region would concentrate on. Meetings were attended by vario Data Data were compiled, analyzed, and presented by County staff to the leadership team for informing their community health impro EAST REGION h aoiy frsodnsfl tee ee ihr oe cnmc potnte o vr ltl eooi opruiis 6% in (69%) opportunities economic little very Region( or opportunities economic some either were there felt respondents of majority The wa and resources, and services closer and more transportation, accessible communities would improvecommunity the forolderadults. and affordable imp that be felt would also gangs Respondents fewer and factors. involvement, community activities, recreational for opportunities communities, walkable/bikeable placesafe to raise children(57%)( somewhat(76%)a( orplaceManycommunitythattheirold goodtofeltisgoodrespondents grow community”? mostimportant FACTORS THAT DEFINEa “healthy Figure 3: In thefollowing list, doyou what think are 3the 10% 20% 30% 40% 50% 60% 0% Figure 8 Low crime/safe neighborhoods

Access to health care/other services Community involvement

Access to Figure 7 parks/recreation

Good schools orderIn ). improvesafetyneighborhood,to the the of respondentsstated less substance abuse,

Clean environment Walkable and bikeable

(

E communities AST

R 88 EGION

5 10% 15% 20% 25% 30% 35% 40% community? three mostimportant HEALTH PROBLEMS in your Figure 4: In thefollowing list, doyou what think are the

0% 5% )

Drug abuse

Poor diet Figure 6 Figure

Mental health issues ), and felt that it is a safeveryora is itand that ), felt

Physical inactivity

Lack of access to health care

Chronic disease East e lka ort ant ble EAST REGION

Abundance of Abundance opportunities Sufficient opportunities Some opportunities opportunity Little little Very opportunity Very good Very Good good Somewhat Bad bad Very 32.9% 18.2% 40.3% 3.9% 7.6% 2.5% 9.1% 13.9% 43.0% 28.6%

)

6 Figure 6: Is your community a good place to grow old? grow to place a good community Is your 6: Figure

Figure 8: Is there economic opportunity in the community? in the opportunity economic there Is Figure 8:

EGION 89 R

AST E ( Very healthy Very Healthy Somewhat Healthy Unhealthy unhealthy Very Very safe Very Safe safe Somewhat Unsafe unsafe Very

22.2% 46.3% 11.3% 3.7% 0.0% 0.0% 5.0% 12.3% 61.8% 37.5% Figure 7: How would you rate your community as a safe community your rate would you How Figure 7: children? to raise or up to grow place Figure 5: How would you rate your community community your rate would you How 5: Figure live? place to healthy a as environment EAST REGION bycalendar year and are currently archived back to 2000 allowto andstaff public the compareto trendsover time. organizedby race/ethnicity, age groupand gendereach of for communities41 the comprise that SanDiego County. Data are pos discharges. department emergency and discharges, healt hospital deaths, (mental as health reported are behavioral indicators include Most abuse). to substance expanded recently most and injury heath, disea (chronic) child noncommunicable and by maternal organized diseases, indicators communicable of dozens include to expanded list the quickly Very Region. HHSA each C Diego CA,SanHealthywere US,ofthe Communityobjectives reportedlist People2010 that a shortas for The Profiles began informationon health status andhealth behaviors by HHSA Region. l and state from as well Interviewt asSurveyHealth California the fromresults selected incorporatesCHSU OSHPD. and RecordsServices Vitalincluding databases Health Public in branches various from data health pulls CHSU Survey. Community American HHSA each within Census the pulledfrom communitiesare dataeconomic Demographic andProfiles. Community the asonlineinformation this postsand andRegion, Region HHSA by organized data health and behavioral economic, demographic, generates CHSU economicfalls, burden ofdisease, health disparities,and health status), health briefs, fact sheets, and atlases.All are a ( reports specific other profiles, health community the including publications, generates to CHSU communities.support their and and Regions data Pub health public HHSA for contact in of point locatedsingle a provide (CHSU), to 2005 Unit in Statisticsformed CHSU The Health Division. Services Community Health the by developed annually are reports profile community Regional RegionalProfiles (Health Status Assessment) system, health a in the resultsof the local public health assessmentcan be infound theoverarching CHA document. sectors all A Services. evaluate Health Public Essential to 10 the (LPHSA) of delivery the Assessment to contributing entities System voluntary and private, Health public, including Public Local a conducted HHSA 2012, 29, June On LocalPublic Health SystemAssessment DataSources

   Strengths: TableKey 1: Findings fromCommunity Perceptions Assessments

Some economic opportunities in community the opportunities economic Some old to grow place good is a Community live to place a safe as perceived is generally Community

( E AST

90 EGION

    Concerns:

) Substance abuse Substance diet Poor inactivity Physical health Mental

vai ful lable

These data a data These l description of description l online e.g oun the ted o p o

., senior ., an

ty, andty,

HHSA rovide online a h .

d the d ses oca nd lic re , l

EAST REGION

t 13 13 ss. Cal Cal ren - harp harp

n n have include include .

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re districts in re districts in ca

20% 2025 20% in 25 age 19% under

Population Demographics 64% white 64% 20% Hispanic Cajon El Iraqi in 30% 470,898 residents 470,898 2.9 persons/household 12% seniors ○ ○

     

)

EGION 91 R

AST E ( term term care facilities, more than any other HHSA Region. Lastly, there are -

64, nearly one in seven did not have any insurance coverage, 3% of whom were eligible for either Medi -

four (24) out of 25 seniors ages 65 and older had Medicare coverage. Medicare had older and 65 ages seniors 25 of out (24) four - nine percent (89%) of East Region residents were currently insured, and 96% of those had prescription drug coverage. drug prescription had those of 96% and insured, currently were residents Region East of (89%) percent nine - Twenty sta insurance of regardless advice, health needing sick or when go to place a usual had residents Region ten East out of Nine Among those aged 18 Families. or Healthy (Medicaid) Eight overall, but less likely to have earned a college degree college earned a have to likely but less overall, Two Two thirds of employed residents worked in management and professional or sales and office occupations. A comparable percent of families with children lived in poverty as in the county homes. parent be single to likely more were they overall, but East Region residents were more likely to have completed high school than the county

    community community clinics in this Region, including Mountain Empire which serves the “backcountry.” statistics: following the by In demonstrated as care, to health access increased addition, residents in East Re East East Region is a mix of urban and rural communities, with resources concentrated Region, theis which serves one the District) entire health of three Grossmont Healthcare influential the Grossmont Hospital, mostly in the urban areas. Only one hospital San Diego County. Also, this Region is home to 32 long Health Resources Availability   Socioeconomic Demographics Socioeconomic  Region Region with a high proportion of older, white adult residents. The East Region is the second areas. rural and suburban, urban, of miles square 1,100 covering geographically, largest, Community Demographics Community The East Region of San Diego County is a large, diverse, mostly middle and lower income regional profiles were generated, which influenced the identification of health priorities for East Region. for East priorities health of identification the influenced which generated, were profiles regional Demographics the development of profiles that address older adults and children in more detail. more in children and adults older that address profiles of the development CHSU worked with the ERLT to review the above data sources. Based on this review during the community engagement process, cur There There was an unmet need for population based Services, CHSU staff information created the on indicators available through mental population based sources. health Future plans for and the Community Profil substance abuse. Working with Behavioral Health The addition of Behavioral Health data was driven by community members during the community health improvement planning proce EAST REGION       strengthand five risksare uniqueto East Region: following The rates. injury vehicle motor highest the has region this casinos, to leading two rural With injury. to related is risk RegionEast in deaths the of 58% to lead diseases Thesecancer. 3 and disease the in found diseases chronic same very those of prevalence the including Region, East the in health to risks several are There Region East of health partner the communities. community improve to from participating representation residents also stakeholder but organizations, has only not team leadership regional development.The partnership community its is strengthsRegion’s East of One Risks and Strengths to Health 

oprd o h Cut oeal Es Rgo aut wr a lkl t hv been have to likely drinkingbinge in thepast year. as were adults Region East overall, County the to Compared otherregions; morethan three out of every five adultswere overweight or obese. most in adults than overweight or obese be to likely more were adults Region East week. one than More RegionEast adults were also morelikely to smoke indoors. smokers anythan other region. current be to and smoked or ever have to likely exercise more were Region East fun, the in Adults for walking reported residents Region transportation East four of out Three go to likely overall. less and office doctor’s a to go to likely more were residents Region East

- hr o at ein eiet aefs odto rmr tms per times more or two food fast ate residents Region East of third

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R 92 EGION

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Another

to community clinic, compared to the County the to compared clinic, community to EAST REGION

64 64 in the -

fourths were taking - 64 64 compared to the -

third took daily medication to control their -

Emergency Emergency department discharge for asthma was higher blood pressure medication. pressure blood Adults ages 65 years and older died, were hospitalized, discharged or from the emergency the County. throughout adults older than rates higher department for CHD at Asthma and COPD death and medical encounter rates have remained steady since 2000, but were than most higher other regions. The COPD hospitalization rate for adults ages 25 East Region was nearly double overall. the rate for the More adults have ever been diagnosed with or currently have County More than one More than half of asthmatics ever received Asthma an hospitalization asthma rates were disproportionately high Coronary Coronary heart 2000. since declined rates have hospitalization disease (CHD), One in 20 was ever diagnosed with heart disease, and one in stroke pressure. high blood with diagnosed ever was four death, and Of those with high blood pressure, three same groups in other regions. other in groups same among blacks living in the East Region than for blacks in any region. other asthma than any other region. other any than asthma asthma. professional. health from a plan management among females and residents ages 25 )

  Disease Pulmonary       Heart Disease Stroke and Heart Disease   

EGION 93 R

AST E (

a preventable disease. a preventable

—

64 64 in the East Region, compared to

fourths fourths of adults over age 50 years have complied - third third of males over age 40 in the East Region had a - specific antigen (PSA) screening the past year. the past screening (PSA) antigen specific -

Black Black residents were hospitalized regions. other in living blacks to compared rate, higher for diabetes at noticeably Diabetes Diabetes death and hospitalization rates were disproportionately high for adults ages 25 regions. other in age the same of adults Diabetes death rates were regions. other to compared Islanders, especially high for Asian/Pacific Since Since 2000, diabetes death and hospitalization rates in the East Region have increased. However, one in 20 residents was ever diabetes. with diagnosed Among East Region adults ever diagnosed with diabetes, 85% 2 diabetes Type with diagnosed were prostate Nearly three recommendations. screening cancer colorectal with Cancer Cancer death rates were especially high among adults ages 65 regions. other to compared older, and years Women over 30 were more likely to have region. other any than years two the past within had a mammogram Only one Cancer Cancer death rates have remained steady since 2000, but were region. other any than higher

    Diabetes      Cancer  (intentional (intentional and unintentional). The following section provides issue. each for statistics key Population Population health issues identified by the diabetes, ERLT heart included disease and cancer, stroke, pulmonary disease, and injury Population Health Issues EAST REGION     UnintentionalInjuries     IntentionalInjuries follows: as Region East for provided are injuries unintentional and intentional for death ( of adults cause and young leading and the children are and ages, all drowning/submersion, for County San Diego in death of causes cuts/piercing, leading the among by/against are Injuries overexertion. struck fires/burns, falls, crashes, to vehicle events, related are motor injuries poisonings/overdoses, unintentional Most predictable are unintentional they preventable. call because intent. and not would are Some they harmful but intent. “accidents,” or harmful purpose injuries on from violent caused free not are have are and that and injuries are purpose injuries Unintentional on caused are that injuries are injuries as Intentional classified unintentional. or are intentional either Injuries preventable. and predictable are many so that given especially problem, health public important an are Injuries Injury

Hospitalizationwere rates highest among adults agesand65 over. Cou the in regions Overdose andpoisoning injuriesand deaths were inhigh East the Region, especially other among females. all nearly than injury unintentional for encounter particularlyamong older adults. medical and death of rates higher had Region East EastIn the Region, unintentional injuries were the sixth leading cause ofdeath forall ages. regions. 25 and males among emergency high disproportionately was suicide and of rate The suicide of rate highest departmentdischarge forself the had Region East assault of rates highest injuryin thecounty. the among had residents Region East County the than rate. lower was Region East in homicide of rate The

al 2 Table - inflictedinjury, compared otherto regions.

). The following facts regarding regarding facts following The ). ( E AST

R 94 EGION

11 Assault Causes) UnintentionalInjury (All Suicide Self Residence PedestrianInjuries by Occurrence PedestrianInjuries by Overdose/Poisoning Involved MVC MVC MVC Motor Vehicle Injury Homicide Firearm Fall

Diego County Table 2: Injurythe Ratesfor East Region Compared toSan - 4 year 64 )

- - RelatedInjury Inflicted Injuries — — — InjuryIndicator DrinkingDriver Alcohol Involved TotalInjuries

RelatedInjury

- l rsdns f h Es Rgo, oprd o other to compared Region, East the of residents old

EastRegion Rate*(Risk) 2273.3 6275.8 188.6 309.8 580.4 678.1 357.0 14.9 48.6 28.5 56.5 81.3 22.5 2.3

Rate*(Risk) County 2035.0 5354.9 126.4 233.8 579.5 594.2 308.6 11.5 43.0 33.1 52.9 78.8 18.7 2.8

Difference (Burden) Percent - - 29.6% 49.3% 13.0% 32.5% 14.1% 20.3% 11.7% 15.7% 17.2% 13.9% 17.9% 6.8% 3.2% 0.2%

Lowerthan Higher or County ↑ ↑ ↑ ↓ ↑ ↑ ↑ ↑ ↑ ↓ ↑ ↑ ↑ ↑

nty

, EAST REGION - d der der at at are ral and ral and

th involve are are non -

vio at at information, information, and

his

Health factors listed in in listed factors Health

tiary prevention factors are are factors prevention tiary ter TERTIARY

24, significantly higher than in any other region. other than in any higher 24, significantly -

)

EGION 95 R

AST

E ( SECONDARY 24 24 were at greatest risk for motor vehicle injury. The rate of alcohol - ) ) is an illustrative representation of how demographic and social/behavioral risk factors rates rates of motor vehicle injury hospitalization, emergency department discharge, and death

Figure Figure 9 5 injured in a motor vehicle accident were not properly restrained in a car/booster seat. car/booster in a restrained properly not accident were vehicle motor a in 5 injured -

PRIMARY related related deaths, hospitalizations and emergency department discharges were notably higher, especially among ol - Figure 9: Critical Pathway for East Region (Lack of Physical Activity, Poor Diet, Substance Abuse) Substance Diet, Poor Activity, Physical of (Lack Region for East Pathway Critical Figure 9: *SOCIAL DETERMINANTS OF HEALTH Note: This figure conveys the aspects of primary secondary, and tertiary prevention for chronic diseases in each Region. The The Region. each in diseases chronic for prevention tertiary and secondary, primary of the aspects conveys figure Note: This factors. prevention secondary and of primary identification in resulting Region, given for each specific

50 as a foundational concept, specific primary and secondary risk factors were identified for East Region. East for identified were factors risk and secondary primary specific concept, foundational a as 50 - 4 - Blacks, in particular, had high rates of death, hospitalization, and emergency department discharge for motor vehicle injury. motor vehicle for discharge department emergency and hospitalization, death, of rates high had particular, in Blacks, compared to other regions. regions. other to compared 2000 decreased since have accidents vehicle motor to due rates injury Total Residents and visitors to the East Region aged ages. other all that double of nearly was group for 15 this age drivers drinking and accidents 0 ages ten children Three in Emergency department discharge rates were highest among residents ages 15 ages residents among highest were rates discharge department Emergency Unintentional fall adults. East Region residents experienced high

the 3 the modifiable) modifiable) begin to as ageimpact the over health individuals outcomes beha and the develop Combined, demographic, lifetime. to disease to chronic precursors that death due are of outcomes health the factors development social risk influence the tertiary prevention column were identified by East Region during the review of health status data for this Region. With t contribute contribute to the development of chronic disease. At the beginning stage of the pathway, demographic risk factors (factors th modifiable) have an impact in the earliest stages of health outcomes. From there, behavioral and social risk factors (factors Factors Contributing to Population Health Challenges PopulationFactors to Health Contributing The Critical Pathway for East Region (        EAST REGION and funding/grants.Responses are displayed in s technological,environmental, political, economic, social, include categories These categories.eight in health?” impacting open the asked survey the community, the of health the affect that trends and forces external Change of Forces The ofChangeForces Assessment months,with 30 (outof 116 countywide) spots servingas pri provide to country, back the in located services. ones including clinics, health community of concentration large a has also Region CuyapaManzanita,andSycuan,LaPosta,Campo,Barona, Viejas, region:Capitan, Grande, this in located tribesmany are There entire Region,which isoneofthe three influential health care districtsin SanDiego County. Sa Cajon. El in located colleges community two ChristianDiegoCollege islocatedCajon.in El are College Community Cuyamaca and College Grossmont District). School Unified Jamul District, School Dehesa District, School Mesa La District, School Union Lakeside District, School (Al districts school nine and Grove) Lemon and Mesa, La Cajon, El (Santee, cities four includes Region East areas. desert and large Due its to areas,rural Eastern SanDiego Countyopen plentyhas space andrecreationalof opportunities nearby in park especia diverse, more becoming is region this of population servi The committed life.growing Iraqi refugee population. structure, of collaborative quality community and health strong their with improve combination to in groups volunteer officials local with engaging of history a have ImprovementPlan the implementing to imperative are Region Central to unique resources and assets Community andCommunity Assets (Themes and Resources Strengths)

Lastly, the County of San Diego Aging & Independence Services coordinates a unique resource during the sweltering summ sweltering the during resource unique a coordinates Services Independence & Aging Diego San of County the Lastly, . East Region has a small town or rural atmosphere that is home to many strong,homeatmosphererural manyorisfaith to Easthasa smalltown that Region .

assessment was included in the survey used for the Community Themes and Strengths Assessment. To identify To Assessment. Strengths and Themes Community the for used survey the in included was assessment

- Onlyhospital(Sharpone Hospital,Grossmont GrossmonttheHealthcare District)serves the Dulzura Union School District, Grossmont Union High School District, and Mountainand District, School High Union GrossmontDistrict, School Union Dulzura Table 3 .

CoolZones - Spring Valley School District, Cajon Valley Union School District, Lemo District, School Union Valley Cajon District, School Valley Spring ( E AST

R 96 EGION

throughoutEast Region.

)

- ended question, “What forces are c are forces “What question, ended Live Well San Diego San Well Live - based communities.basedresidents The

Community Health Community cie s, s, ntific, ethical, ntific, mountains, pin mar lly ces ipe n Grove n Union e urrently

Empire care y ih a with . East . and , er n EAST REGION

family housingfamily units

- based practices based fidelityon and population - job training opportunities

Health careHealth and social services issues Politics, partisanship and polarization Religious exemptions/rights Racism, classism stigmatization and Limited funding forNeed grant writers Restrictions certain on funding Sustainability Low Low jobswage No health insurance Slow economy Medical expenses Negative politics Power of insurance companies and banks Representation for unincorporated areas Uncertainty Many multi Marketing of junk food Oversaturation of alcohol outlets toSantee Sea bike/walking paths School enrollment down, schools closing or losing funding Small communities spread far apart Lack of access technology to Mobile technology mediaSocial Research and development jobs Research servedbeing Lack of infrastructure support for youth Rising need for government services resourceswhen are declining Rising sexually transmitted stigma infections, regarding addressing sexuality Substance abuse Limited

                              

)

EGION 97 R

AST E ( related -

based based prevention programs

- Easier Easier and faster access information to Increased opportunity to promote health Decreased funding for research Engagement of diverse researchers Evidenced Outside influences such as money and politics Apathy, fear and lackconsensus of on ethics Cannabis regulation Child abuse Government, media and personal ethics Funding theon community level Grants/projects narrow focus,in not big picture Extremely competitive Government restrictions on business Lack ofcare access health to Lack of government funding Lack of address to support health environmental concerns Freeway/traffic expansion cleanerLaws re: environment Limited ability to walk/bike school, to shopping, carehealth Limited access healthy to foods Limited/decreasing access safe to parks/nature Decreased activity and personal interaction customs, aging increased population, fewer younger residents, low educational attainment) Growing poverty High crime High stress Bankruptcy (businesses and Individuals) High competition for good jobs Home foreclosures Lack managementmoney of Limitedemployment Affordable Care Act/health legislation Focusfixing on verses preventing issues Changing demographics (differing cultural norm and

                                 

Grants Funding/ Ethical Scientific Technological Environmental Political Economic Social Table 3: Forces of Change Assessment Results Assessment Change of 3: Forces Table EAST REGION bycommunity. the Lastly, community the actually perceived healthmental issues beto worse than the data showed. phy diet, poor of factors four originawaswhat than worse muchthefactors showing these data thewith diseases, chronic and healthcare, for to access inactivity, showed (health data the (OSHPD)what and perception Development between discordance andmarked a was Planning There abuse. Health drug Statewide of Office and in summarized is comparison data This data. encounter) (CHIS) Survey Interview Health demonstr California data available actual using the what with results, survey community Region East the on based perception, its compared Team the of results the reviewing After ofAssessmentsSummary Source:Death StatisticalMaster Files(CDPH), County of Diego,San Health Human & Services Agency, Public Health Services, E Preparedby:County of San Diego, Health & Human Services Agency,Public Health Services,Community Health StatisticsUnit, 2 Chronic Diseases Chronic Care to Health Access Inactivity Physical Issues Mental Health Poor Diet Drug Abuse TableEast 4: Region Community Survey ResultsCompared to CHIS SurveyData (Community Perception) (Community East Region Community Community East Region PatientDischarge Database (CA OSHPD),County of San Diego, Health & Human Services Agency, PublicHealth Services, Epidemiol EmergencyDepartment Discharge Database (CAOSHPD), County of San Diego, Health Human & Services Agency, PublicHealth Servic Immunization ServicesBranch; SANDAG, Current Population Estimates,10/2012. Survey Results Survey Results

ServicesBranch; SANDAG, Current Population Estimates,10/2012. MedicalServices; SANDAG,Current Population Estimates,10/2012.

Community Perceptions Community 25% 28% 28% 29% 32% 37%

Walked for fun, recreation, recreation, fun, for Walked problems or mental emotional for help Sought or obese overweight who are Adults yearlast within the drank who binge Adults N/A insured Currently or transportation California Health Interview Survey Data Interview Health California

Table 4 Table

2009 2009 Community Health Status Health Community . As the table portrays, the only concurrence between perception and data is data and perception between concurrence only the portrays, table the As . ( E

AST N/A 89% 76% 19% County) than 63% (higher County) than 35% (higher

R 98 EGION

)

- - - All Medical care medical of Usual source N/A - - ED Discharge diabetes with diagnosed ever Adults Drug/Alcohol ED Discharge

Stroke CHD Psychoses Non Psychoses Diabetes , and ,

Forces of Change of Forces Health Encounter Data 2009 2009 Data Encounter Health

(OSHPD) 013 pid emiology & .

assessments, the Leadership the assessments,

+26% +27% +32% Co than Higher 90% N/A 461.9/100,000 323.6/100,000 5% County) (lower than 244.3/100,000

ogy

es,

& Immunization &

Emergency

lly

perceived ate sic d, al EAST REGION

nt, eart eart tively tively , , and

ronary ronary County County ac

go go The The priority areas (Active

Community Community Health Status , ). A group voting process was used Key Priority Areas Priority Key Active Living Active Eating Healthy Prevention Abuse Substance Table 5

   :

t s) n n r upon its completion, was also used as an additional

e ine Community Community Perceptions

m e h

)

f t

o 16

Access and to engagement/lack stigmatization of in comprehensive health care Physical Inactivity Lack community of involvement Community infrastructure Community safety Housing/transportation Poor diet Mental heath Substance abuse (smoking/drugs/alcohol)

s t

Risks (Conc          EGION 99 R Leadership Leadership Team’s resul

d e AST the E

in ( b

o reach

the c

sed s loring p x

y e addre b Local Public Health System Assessment, b

o t The

issues

nts. eed ic e n g links links the priority areas with health outcomes unique to East

m 50 50 health concerns were higher than most of the other Regions. The one “bright spot” was that coronary h at - rate h t 4 - s

ssess s t g A ed Figure 9 n i f di n i f

identi Coronary heart disease and stroke death and hospitalization rates have declined Leadership team is actively engaged in addressing the health theof region and hashistory a of joint success

 Table 5: Key Findings from the Community Health Assessments the Community from Findings 5: Key Table Strengths:  cutting s s o r ision, as outlined in East Region’s Community Health Improvement Plan. The critical Priority Areas Identified from Assessments from Identified Areas Priority Region. Region. The pathway also outlines primary and secondary prevention factors that are areas. priority factors) and prevention (tertiary outcomes the tohealth related c v pathway noted in lens through which to review the team’s goalsLiving, to Health confirm or Eating, adjust and the direction, Substance as Abuse deemed Prevention) appropriate. represent the pro The The ERLT Forces of Change

heart heart disease and stroke death and hospitalization rates. However, these rates are still higher in the overall. Region than in Nine San Die risks or issues. health mental and concerns issues; safety and infrastructure, were identified that include behavioral risk factors; health care access; community involveme to obtain consensus and agreement on strengths and concerns. One of the greatest strengths of East Region is that the ERLT is engaged in addressing the health of the region and has a history of joint success. An example of one success is the declining disease, stroke death and hospitalization rates had declined since 2000. since declined had rates hospitalization and death stroke disease, After the ERLT reviewed all the data, a list of strengths and risks or concerns was developed ( In East Region, the 3

NORTH CENTRAL REGION COMMUNITY HEALTH ASSESSMENT

101 NORTH CENTRAL REGION PriorityAreas Assessments Identified from CommunityAssessmentsHealth CommunityHealth Improvement Process Leadership TeamMembers Table Contents of SummaryAssessments of Forces ofChange CommunityAssets and Resources (Themes andStrengths) FactorsContributing Populationto Health Challenges Population Health Issues Strengthsand Risks Healthto Health ResourcesAvailability Demographics CommunityPerceptions Assessment Injury PulmonaryDisease DiseaseHeart and Stroke Diabetes Cancer Socioeconomic Demographics CommunityDemographics DataSources

(

N ORTH

C ENTRAL 102

R EGION

)

15 14 13 12 11 10 10 10 9 9 9 9 8 8 8 8 7 4 4 3 2

NORTH CENTRAL REGION

Positive Solutions Coalition Program UCSD DivisionUCSD Geriatrics of PreventiveUCSD Medicine Union Asian Pay Communities, of WayUnited Diegoof County San 3788 VFW Auxiliary Ladies SAY San Diego/NorthSAY Prevention City San DiegoSAY Tobacco Control WIC ResearchSDSU Foundation Care Shea Family St. Paul's PACE WeTogether Grow Diego University California, San of

San DiegoSan -

)

EGION Healthy Start Coallition Parentsfor New Program ResourceFamily Center Neighborhood Services R

SAY San Diego,SAY Clairemont North North Coast HealthHome Products Oaks & Acorns Peter Companies Stark Barron Children'sRady Hospital Health Care San Diego Family San Family Collaborative Diego Military San Physical and Diego Nutrition Activity Welcome Program:San Diego Kit Baby San Diego,SAY Inc. San Diego/ClairemontSAY Coalition San Diego, SelfSAY Sufficiency Family San Diego,SAY 5 First Steps First SanMilitary Diego, SAY Start Healthy San Diego, SAY Integrated 103 -

ENTRAL

ORTH

N (

and Control District Price's Office Advocacy San Program Diego Central Public Health Central Health Public Health Services AirEnvironmental Group/ Pollution Jewish Family Service of San Diego Serviceof JewishSan Family Linda Vista Planning Group Council Linda Vista Town HealthMental Member Board HealthcareMolina North Central Resident County of San Diego, Supervisor Slater County of Diego, Supervisor San FleetFamily Supportand Centers Health of Net California Heritage Senior Care & Health Insurance Counseling MORE Impact & Impact Adults Young County of San Diego HHSA North County of Diego HHSA North San County of Diego HHSA Public San andCounty of Diego, Land Use San

North Central Region Leadership Team Leadership Region Central North

Mercadel, County of San Diego, Deputy Director, East and North Central Regions Central North and East Director, Deputy Diego, San of County Mercadel, -

Chairs: 1 San Diego

- - Independence Services North Central Regions Central Center Family Resource Health Statistics 1 - County of San Diego HHSA North County of Diego HHSA North San County of& Diego HHSA East San County of Diego & HHSA Aging San County of Diego San County of Diego HHSA Community San Challenge Center Clairemont Coalition Beach Area Family HealthBeach Center Family Area Care1st Health Plan At Your HomeAt Your Familycare CenterBayside Community American Lung Association in CaliforniainAmerican Lung Association WIC Program American Cross Red Alvarado Parkway Institute Alvarado Parkway American Society, Inc Cancer 2 Partners: Marie Brown Marie Steps First 5 First Diego San SAY Manager, Easterly, Sheri Live Well San Diego San Live Well Co NORTH CENTRAL REGION Building Once the health issues were selected by the Leadership team, members members team, Leadership the by selected were issues health the Once the issues health assessments, on. concentrate which would region determined the and data, discussed health team County reviewed leadership The improvement process. health community planning their informing for team leadership the to staff County by presented and analyzed, compiled, were Data Region. Central North identified in sectors to various survey representing partners and electronic These stakeholders Change an communities. via Region administered of Central were North assessments the Forces to important a a most are through and engaged was Assessment Assessment community Perceptions the model, Community MAPP the private Using and public both with communities. and faith military the including sectors, partnership meaningful and leadership regional of competency core the emphasized and Region Central North of status health the of review thoughtful a took then group The thinking. and subject where forums, assumptions challenge and educate innovation both to together came experts matter and planning of Team series Leadership a the with process, began engagement community the of part As the and Partnerships and Planning through Action (NACCHO) called Officials (CDC), Prevention and Health Control Disease for City Centers and County of Association National the from adapted model planning improvement health community Diego Diego San SanWell of County the support to formed was Team Leadership Central North the 2012, June In lives. thriving and safe, healthy, Health Better Region Central North ( the 2011, of spring the through 2010 of fall the In iue 1 Figure ) community was brought together through a series of of series a through together brought was community )

Better Health in North Central County Leadership Team’s Community Health Improvement Process to help the leadership group understand which health issues issues health which understand group leadership the help to

Forums to help residents to initiative changes to live live to changes initiative to residents help to Forums

strategic initiative. Leadership Team partners followed a a followed partners Team Leadership initiative. strategic

(MAPP) ( (MAPP) Figure 2 Figure

( N ORTH ). Mobilizing for for Mobilizing

C ENTRAL Live Well Live Building Building 104 Live Live

R EGION

Figure 1:County SanDiegoof HHSAOperationalRegions CommunityHealth Improvement Figure 2:

Source: 3

)

www.naccho.org/MAPP

NorthCentral’s

Live SanWell Diego’s

Road to

NORTH CENTRAL REGION

, y lth are are lth ent Live Live cate unity unity

North North were

hea al, Central Central es e 09, th th

Live Live Well San Diego ended ended questions - Live Live Well San Diego public public health agencies, local

based based organizations, we promote policy - The The mission of the

)

4 based organization program managers, health care and

- for for the North Central Region Leadership team is to support EGION R

105 ENTRAL C

ORTH N ( being; intergenerational approaches; residents helping their neighbors; and comm -

question survey, question modified survey, from surveys in the NACCHO MAPP Toolkit. The figures following indi -

choice choice questions are shown in bar charts, with the highest responses displayed. Open changes changes that create safe, healthy, and equitable communities. - - by by fostering a North Central Region that is healthy, safe, and thriving. This is a group of

Navajo, and University City. University and Navajo, - Strengths Strengths through Assessment an 11 the 19 responses. Multiple narrative. the in summarized Community Perceptions Assessment Perceptions Community To secure an understanding of the issues residents felt were important, the Leadership Team conducted a Community Themes and communities of Del Mar, Mira Mesa, La Jolla, Tierrasanta, Serra Mesa, Clairemont, Kearny Mesa, Ocean Beach, Point Loma, Coast Loma, Point Beach, Ocean Mesa, Kearny Clairemont, Mesa, Serra Tierrasanta, La Jolla, Mesa, Mira Mar, Del of communities Elliot nearly 625,000 people resided in the Region, representing nearly 20% of the county population. Compared to other Regions, Nor Regions, other to Compared population. county the of 20% nearly representing Region, in the resided people 625,000 nearly includes The Region residents. Asian and white of proportion a large with communities, educated more and wealthier to home is Community Health Assessments Health Community 20 of As areas. and suburban urban of miles square 200 covering area, a dense is County Diego San of Region Central North The environments; environments; positive choices for optimal well wellness. environment, environment, and systems Central Region Leadership Team is to implement strategies that facilitate easy access to integrated health care; safe and hea umbrella umbrella to conduct community health improvement planning. The vision Well San Diego governments, school districts, health care organizations and professionals, and community Live Well San Diego North Central North Region Leadership Team DiegoLive San Well The North Central Region Leadership Team gained momentum in January 2012, when they came together under the kept for every meeting and are stored on a County shared space. plans by selecting key activitiesThe and indicators of success to address thecoalition identified health issues. further developed the community health improvem issues. Meetings were attended by various city behavioral representatives, health administrators, community senior service coordinators, and County staff. Meeting attendance records and meeting minut met monthly to begin developing the community health improvement plans by identifying goals and objectives for the strategic NORTH CENTRAL REGION potnte o ltl eooi opruiis 8.% i te North the in (83.3%) opportunities economic CentralRegion ( economic some either little were or there opportunities felt respondents of majority The also improve thecommunity older for adults. would at to access live have and to visit to elders seniors allow for places to More home. help would aides or workers case seniors, strengths a felt also Respondents factors. important be would prevention crime and support parenting/parenting good said respondents neighborhood, the raisechildrentoplace(54%)( ( (91.6%) old grow to place good somewhat or good a is community their that felt respondents Most wouldimportant be factors. exerciseactivities/walkwaymore and healthy paths food accessto more in engage to people disabilities,opportunitieswithpeopleservicesand healthybehaviors, for for motivation unemployment, lower economy, multi that stated respondents live, to place healthier a community their make ( unhealthy was felt community 8% nearly their while live, to place (15.4%) healthy or (76.9%) healthy somewhat a was community their that felt respondents of majority The CentralNorth ( in problems health important more the drug as diseases chronic inactivity, and abuse, physical cited Respondents important. most the were neighborhoods crime/safe low felt respondents of 45% Approximately health. defined that factor important most the was care health to access healthydefinea communitythat ( are importantfactorsmost three the felt they whatasked were Respondents - etr atesis acs t mna hat cr, improved care, health mental to access partnerships, sector - ae apoc, n pstv pbi rltos regarding relations public positive and approach, based Figure4 Figure 8 ).

Figure 6 Figure Figure7 iue 5 Figure ) and felt that it is a safe or very safeveryor safe a is it that and felt ) Figure 3 Figure ). In order to improveordersafetyInto). of the

. hn se wa would what asked When ). ). A little over half said thatsaid halfover Alittle ). ( N ORTH

C ENTRAL 106

R EGION

5 “healthycommunity”? threethe mostimportant FACTORS THAT DEFINEa Figure 3: In thefollowing list, doyou what think are 10% 15% 20% 25% 30% 35% 40% 45% yourcommunity? threethe mostimportant HEALTH PROBLEMS in Figure 4: In thefollowing list, doyou what think are

10% 20% 30% 40% 50% 60% 0% 5% ) 0%

Physical inactivity Access to health care/other services Drug abuse Low crime/safe neighborhoods Chronic disease

Mental health issues Good schools

Poor diet Good jobs and healthy economy Alcohol abuse

Lack of access to Strong family life health care NORTH CENTRAL REGION

Very good Very Good good Somewhat Bad Bad Very Little opportunity Very little opportunity Abundance of opportunities Sufficient opportunities Some opportunities 58.4% 17% 8.3% 8% 75%

)

33.3% *Note: There were 0 respondents for “Abundance of opportunities” and “Very little “Very and opportunities” of “Abundance for 0 respondents were *Note: There opportunity.” Figure 8: Is there economic opportunity in the community? in the opportunity economic there Is Figure 8: *Note: There were 0 respondents for “Very good” and “Very bad.” “Very and good” “Very for 0 respondents were *Note: There EGION Figure 6: Is your community a good place to grow old? grow to place a good community Is your 6: Figure R

107 ENTRAL C

ORTH N (

Very unsafe Very Very safe Very Safe safe Somewhat Unsafe Very unhealthy Very Very healthy Very Healthy healthy Somewhat Unhealthy

46.2%

15.4% 7.7% 7.7% 76.9% 46.2% Figure 5: How would you rate your community environment environment community your rate would you How 5: Figure live? to place as healthy a *Note: There were 0 respondents for “Very healthy” and “Very unhealthy.” “Very and healthy” “Very for 0 respondents were *Note: There place to grow up or to raise children? to raise or up to grow place Figure 7: How would you rate your community as a safe community your rate would you How Figure 7: *Note: There were 0 respondents for “Unsafe” and “Very unsafe.” “Very and “Unsafe” for 0 respondents were *Note: There NORTH CENTRAL REGION bycalendar year and are currently archived back to 2000 allowto andstaff public the compareto trendsover time. organizedby race/ethnicity, age group and gender foreach of 41 the communities thatcomprise San Diego County. Data are pos substanceabuse). Most indicators are reported as deaths, hospital discharges, and emergency department discharges. communicable diseases,maternal and child heath,injury and mostrecently expanded includeto behavioralhealth (mental healt each HHSARegion. Very quickly list the expanded to include dozensof indicators organized by noncommunicable (chronic)disea TheCommunity Profiles beganas a short listof Healthy People 2010objectives were that reported US,for the CA, SanDiego C informationon health status andhealth behaviors by HHSA Region. databasesincluding Vital Records and OSHPD.CHSU incorporates selected results from California the Health InterviewSurvey t American CommunitySurvey. CHSU pulls health data variousfrom branchesPublic in Health Services aswell stateas from and l Region,and posts informationthis onlineas the Community Profiles. Demographic and economic aredata pulled from the Census CHSUgenerates demographic, economic, behavioral and health data organizedby HHSA Regionand communities within eachHHSA economicfalls, burden ofdisease, health disparities,and health status), health briefs, fact sheets, and atlases.All are a ( reports specific other profiles, health community the including publications, generatesto CHSU support communities. theirand and data Regions Pub health public HHSA for contact in of point located single a (CHSU),provide to Unit2005 in Statistics formed CHSU Health The Division. Services Community Health the by developed annually are reports profile community Regional RegionalProfiles (Health Status Assessment) system, health a in the resultsof the local public health assessmentcan be infound theoverarching sectorsCHA document. all A Services. evaluate Health Public Essential to 10 the (LPHSA) of delivery the Assessment to contributing entities System voluntary and Healthprivate, public, including Public Local a conducted HHSA 2012, 29, June On LocalPublic Health SystemAssessment DataSources

TableKey 1: Findings fromCommunity Perceptions Assessment   Strengths:

good place to grow old grow to place good a as perceived Generally safe as perceived Generally

( N

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108

Concerns:      

Physical inactivity Physical issues health Mental Drug abuse disease Chronic care to health Access Poor diet Poor R EGION

)

vai

These dataa lable ful l description of description l online h a e.g oun o p the ted oca ses

an nd ., senior ., ty, andty, rovide

HHSA online l re d the , .

lic

NORTH CENTRAL REGION

nt nt ad ad

rre linics, linics, 6 6 h

Mesa, Mesa, ss.

ls ls and 14 include include

ita

Navajo, Navajo, Kearny - Population Population 19%2025 in 16% age 15 under

Demographics The The North Central Region 13% seniors white 62% 13% Hispanic 17% Asian/Pacific Islander 624,072 residents 2.7persons/household ○ ○

     

)

EGION R

109 ENTRAL C

ORTH N ( related related business industry. Throughout the Region, there are ten community c -

Regional Regional Area communities of Coastal, Del Mar/Mira Mesa, University, Elliot -

More More than 50% of employed residents worked in management and professional or sales and office occupations. region. other any than homes single parent have to less likely and in poverty to live likely less were children with Families Residents were generally more than educated the County overall. Over 50% held a bachelor’s degree or higher, and one out of 1 education. school a high than less

Health Resources Availability North Central Region has a strong presence of health three dialysis clinics, and two surgical clinics. There are also 39 home health agencies and ten hospices, as well as 11 hosp   Socioeconomic Demographics Socioeconomic  Pacific Pacific Beach, Point Loma, San Carlos, Serra Pines. Mesa, Torrey and City, Tierrasanta, University Scripps Ranch, Sorrento Valley, Sunset Cliffs, Clairemont Clairemont Mesa West, Clairemont Mesa East, Del Cerro, Grantville, Hidden Valley, Kearny Mesa, La Jolla Farms, La Jolla Shores, La Jolla, Linda Vista, District, Mira Loma Mesa, Portal, Mission Bay, Lower Mission Valley, Hermosa, Morena, Midtown, North Clairemont, Midway Ocean Beach, Old Town, in in terms of wealth and education, pockets of disparities and poverty communities also exist. include North Central Region Allied Gardens, Bay Ho, Bay Park, Bird Rock, Birdland, Carmel Mountain, suburban suburban areas. The region has both inland and coastal communities and includes three military bases and two major As universities. of 2009, nearly people resided 625,000 the in nearly Region, representing to Regions other fare compared better, Whileresidents the North Central’s 20% population. the county of Community Demographics Community The North Central of Region San County Diego is a 200 dense area, covering miles square of urban and Demographics regional regional profiles were generated, which influenced the identification of health priorities for North Central Region. of San Diego County includes the Sub Peninsula. and Miramar, the development of profiles that address older adults and children in more detail. more in children and adults older that address profiles of the development cu process, during the worked theengagement tothe CHSU this on review review with NCRLT community Based data sources. above There was an unmet need for population based information on mental health and substance abuse. Working with Behavioral Health Behavioral Working with abuse. substance and mental health on information based for population need an unmet was There Profil the forCommunity plans Future sources. based population through available the indicators created staff CHSU Services, The addition of Behavioral Health data was driven by community members during the community health improvement planning proce planning improvement health community the during members community by driven was data Health Behavioral of addition The NORTH CENTRAL REGION      unique Northto Central Region: at higher cancer. and 3 the diseases in chronic found same very those of Region, prevalence Central the North including the in health to risks several are There Risks and Strengths to Health     availabilityof healthkey resources: facilities. care term long

a smoker.former or exercise was five in one and smoker, current a was adults nine in One fun, for thanLess 50% ofadults wereoverweight orobese. walking reported transportation. region, other Eighty overweight adultsthan in any otherregion in the County. or obese be to likely less were adults Region Central North lowerthan mostother regions. 3 the Region, Central North the In clinic, community a to comparedto the County overall. go to likely less and office a to doctor’s go to likely more were residents Region Central North insurance status. of regardless usualadvice, health needing or sick when a go to place had residents Region Central North 10 of out Nine - Medieither whomwereeligiblefor 8%coverage, insuranceof 18 aged those Among prescription had coverage.drug those of 94% and insured, currently were Ninety Cal(Medicaid) Healthyor Families. - - three percent (83%) of adult residents, more than any than more residents, adult of (83%) percent three 55%. w pret 9% o Nrh eta Rgo residents Region Central North of (92%) percent two

n h Nrh eta Rgo, h nme i even is number the Region, Central North the In - 4

- 0 concept 50

h floig ee srnts n rss are risks and strengths seven following The

- 64 years, nearly 10% did not have anyhave not did 10% nearly years, 64 motn saitc ta rfet the reflect that statistics Important –

ibts atm, er disease heart asthma, diabetes,

- 4

- 50 health concerns wereconcerns health 50

( N ORTH

C ENTRAL 110 edrhp em nldd acr daee, umnr disease, pulmonary diabetes, Region cancer, Central included North Team the Leadership by identified issues health Population Issues Health Population       Diabetes      Cancer section following The unintentional). providesstatisticskey each for issue. and (intentional injury and

R EGION past year, past which was comparable to theCounty rateoverall. the in once least at drinking binge reported adults of third One in One five residentsate fast threefood or more pertimes week. care providerscare primaryearly for disease intervention. of use low a reflecting potentially groups, racial/ethnic other to compared blacks, for high disproportionately were rates discharge department emergency and hospitalization Diabetes Type2 diabetes with diagnosed were 65% (7.4%), diagnosed ever adults Among statisticallysignificantly less than County the overall in 2009. were ratesdischarge departmentemergency and Hospitalization relatively remained rates stable since 2000. hospitalization and death Diabetes with complied have 50 age over adults colorectalcancer screening recommendations. of 75% than Less (PSA)screening past the year. antigen specific prostate a had 40 age over males of 41% Only past the year than most otherregions. in mammogram a had have to likely more were 30 over Women Cancerdeath rateswere especially amonghigh white residents. Cancerwas theleading cause ofdeath 2009. in

)

—

a preventable disease.

NORTH CENTRAL REGION

↓ ↓ ↓ ↓ ↓ ↑ ↓ ↓ ↓ ↓ ↓ ↓ ↑ ↓ County Higher or Higher Lower than than Lower

4.5% 8.7% 6.1% 7.5%↑ 42.7% 18.6% 39.0% 60.7% 26.6% 26.9% 15.7% 31.4% 33.4% 21.1% ------Percent Percent (Burden) (Burden) Difference

2.8 18.7 78.8 52.9 33.1 43.0 11.5

308.6 594.2 579.5 233.8 126.3 1995.0 5384.9 County County Rate* (Risk) Rate*

1.1 11.4 72.9 50.5 27.9 29.5 84.1 12.2 176.7 436.4 630.2 171.0 1624.3 4249.5 Region Region N. Central N. Central Rate* (Risk) Rate*

Related Injury Related

) -

10 Injury Indicator Injury

Inflicted Injuries Inflicted

Related Injury Related - - Table 2: Injury Rates for the North Central Region Region Central North forRates the Injury 2: Table County Diego to San Compared Pedestrian Injuries by by Injuries Pedestrian Occurrence by Injuries Pedestrian Residence Self Suicide Unintentional Injury (All (All Injury Unintentional Causes) Assault Fall Firearm Homicide Injury Vehicle Motor to due Injuries Total MVC MVC Involved Alcohol Involved Driver Drinking MVC Overdose/Poisoning

EGION R

caused on purpose and are free from harmful intent. Somecall would unintentional injuries “accidents,” they but are they predictable are and not preventable. because Most unintentional injuries Injury Injuries are an important public health that problem, especially so given many classified as are either intentional or predictable unintentional. Intentional are andinjuries injuries preventable. that are Injuries harmful caused intent. are on Unintentional purpose injuries and have are violent injuries or that are not 111 ENTRAL C

ORTH N (

control their asthma. their control Less than 50% of asthmatics professional. health from a plan management ever received an asthma whites. among highest was rate hospitalization COPD The Asthma Asthma medical encounter rates residents. black high among were disproportionately One in seven adults reported ever overall. County the than higher asthma, being diagnosed with Less than four in 10 residents took daily medication to Asthma Asthma and COPD obstructive disease) pulmonary (Chronic death and hospitalization rates had fluctuated slightly since decreased. had overall 2000, but medication medication to control high blood pressure than the County overall. Compared to the other regions, the North Central had among the lowest rates of Region death and medical encounter 2009. in stroke and CHD for rates had declined significantly since 2000. since significantly declined had rates A lower percentage of adults regions. other most than disease heart were ever diagnosed with Adults were less likely to have ever been high diagnosed blood with pressure and more likely to be currently taking Coronary Coronary heart disease (CHD) and stroke were the second death. of causes leading fourth and Chronic heart disease, stroke death, and hospitalization

      Pulmonary Disease Pulmonary      Heart Disease Stroke and Heart Disease NORTH CENTRAL REGION foundational concept, specific primary and secondary factors risk were identified for North Central Region. disease. chronic informationthis With Region. this to for data status health of review the due during Region Central North byidentified were column death, to precursors are that outcomes health of development the facto risk social behavioraland demographic,Combined, lifetime. the overdevelop and age individualsas outcomeshealth the modifiable are that(factors factors risk social behavioraland there,outcomes. From health of stages earliest the in impact non are that (factorsfactors risk demographicpathway, the of stage beginning the At disease.chronic of development ( Pathway Critical The Contributing Health toFactors Population Challenges          UnintentionalInjuries     IntentionalInjuries ( drow adults follows: as young Region cuts/piercing, Central North and for le provided the fires/burns, are children and ages, events, all for for County death by/against Diego San of in struck death of cause causes crashes, leading the among vehicle are Injuries motor overexertion. and submersion, poisonings/overdoses, falls, to related are

Two in five childrenages 0 and within other regions. 15 among high disproportionately was injury crash vehicle Motor Motorvehicle injury accidentwas higher than mostother regions in the county. CentralNorth Region had lowerratesof death and medicalencounter due to motor vehicle injuries,compared to theCounty ove Unintentionalinjuries fall weredisproportionately amonghigh whites, compared otherto racial/ethnic groups. Overdose andpoisoning injuriesand deaths were lowerthan the county overall. Emergencydepartment discharge rateswere disproportionately high for0 Theregion had lower rates of death and medical encountersthan County the overall. NorthIn the Central Region, unintentional injuries were6th the leading cause ofdeath ( Thesuicide rate foradults aged 65 and over was second the highest in theCounty. Self Assaultinjury emergency departmentdischarge and hospitalization was significantlylower than the Countyoverall. Therate ofhomicide in theNorth Central Region was lower than County the overall. - inflicted injuryinflicted hospitalization andemergency departmentdischarge rates werelower than most otherregions.

iue 9 Figure

- 5 injuredin amotor vehicle were accident not properly restrained a in car/booster seat. i a ilsrtv rpeetto o hw eorpi ad oilbhvoa rs fcos otiue o the to contribute factors risk social/behavioral and demographic how of representation illustrative an is )

al 2 Table ( N ORTH ). The following facts regarding intentional and unintentional injuries are are injuries unintentional and intentional regarding facts following The ).

C ENTRAL 112 - 24 year olds, compared to all ages within the North Central Regi Central North the within ages all to compared olds, year 24

R EGION - 14 year14 olds, compared otherto ages.

)

Table2 Health factors listed in the tertiary prevention tertiary the in listed factors Health ).

- , a , modifiable nd the 3 the nd ) b ) egin to impactto egin rs rs - ) have an have ) 4 influence - ral 50 as a as 50 adi l. nin

ng on g/ NORTH CENTRAL REGION r Salk Salk are are a arene arene ss Naz ated ated in this Community Community l l Base Point

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Live Live Well San Diego tiary prevention factors are are factors prevention tiary ter TERTIARY

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EGION R

113 ENTRAL C

SECONDARY ORTH N (

. While. North Central has Region only one city (San Diego), it is made up of very and diverse areas. communities PRIMARY tech business hub. This region also has a concentration of research and higher education institutions such as - Figure 9: Critical Pathway for North Central Region (Lack of Preventive Health Care, Lack of Access to Access of Lack Care, Health Preventive (Lack of Region Central for North Pathway Critical 9: Figure Activity) Physical of Lack Services, Health Behavioral *SOCIAL DETERMINANTS OF HEALTH Note: This figure conveys the aspects of primary secondary, and tertiary prevention for chronic diseases in each Region. The The Region. each in diseases chronic for prevention tertiary and secondary, primary of the aspects conveys figure Note: This factors. prevention secondary and of primary identification in resulting Region, given for each specific Permanente’s San Diego Medical Center/Kaiser Foundation Hospital. Foundation Center/Kaiser Medical Diego San Permanente’s Loma. Loma. This region is also home to some of the most popular beaches in San Diego County, where lifestyles fornatural fit. health Lastly, and fitne this region has the highest concentration of hospitals, including Rady Children’s Hospital San Diego, Sc Hospital La Jolla, Scripps Green Hospital, Sharp Memorial Hospital, Sharp Mary Birch Hospital for Women & Newborns, and Kaise Institute, Institute, Scripps Institute of Oceanography, University of California at San Diego, College. There is a large University military presence with military installations located at the of Marine Corps Air Station Miramar and N San Diego, and Point Loma It It also includes two school districts, Del Mar Union School District and San Diego Unified School District. Sorrento Valley, region, is a high Community Community assets and resources unique to North Central Region are imperative to Health Plan Improvement implementing the Community Assets and Resources (Themes and Strengths) Resources and (Themes AssetsCommunity and NORTH CENTRAL REGION and funding/grants.Responses are displayed in s technological, environmental, political, economic, social, include categories These categories. eight in health?” impacting open the asked survey the community, the of health the affect that trends and forces external Change of Forces The ofChangeForces Assessment TableForces 3: of Change Assessment Funding/Grants Scientific Technological Environmental Political Economic Social

                           

Donor/grantordisconnect from gaps/needs Less funding/opportunities Research (increasing,lack of,and useof) Personalbehavior (acting upon knowledge) Technologicalliteracy forsenior/low income Mothersisolation whendeployed father Electronic medicalrecords Affordability/accessibility Toomany autism/Attention Deficit Disorder (ADD) diagnoses in children Lowstaffing at health facilities Limitedactive design Less moneyhigher for education Foodjustice andhealthy accessfood Decrease in teachers/specialeducation Regulations impeding job growth educationJust system Health careaccess Governmentbureaucracy Domesticviolence Service impacts ofLack affordable housing Employment Population impacts Militaryissues affordableLess housing Junk accessfood Alcohol/drugabuse Access healthto care Table 3 .

( N

ORTH

ENTRAL

114

R EGION

)

- ended question, “What forces are c are forces “What question, ended

cie ntific, ethical, ntific, urrently NORTH CENTRAL REGION

, D) D) iet SHP riginally riginally s o

es,

ogy

23% 17% 44%

128.0/100,000 207.5/100,000 N/A 91% thanLower Co - - - 170.7/100,000 7% .

emiology & emiology

assessments, assessments, the Leadership

pid 013 (OSHPD*)

Health Encounter Data 2009

Forces Forces of Change

Stroke Diabetes Psychoses Non Psychoses CHD

- - ED DischargeED Drug/ Alcohol Adults ever diagnosed with diabetes DischargeED - - N/A source Usual of medical care MedicalAll -

, and

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EGION R 35% 41%% 13% 83% 92% N/A

. . As the table portrays, the only concurrence between perception and 115

ENTRAL C

2009 Table Table 4 Community Community Health Status ORTH

, N (

California Health Interview Data Survey Adults bingewho drank within Adults are who overweight or obese Needed help for emotional or mental problems Walkedfor fun, recreation, or transportation Currently insured N/A

23% 29% 39% 31% 31% 39% Community Community Perceptions

Immunization Services Branch; SANDAG, Current Population Estimates, 10/2012. Estimates, Population Current SANDAG, Branch; Services Immunization Emergency Medical Services; SANDAG, Current Population Estimates, 10/2012. Estimates, Population Current SANDAG, Services; Medical Emergency

Immunization Services Branch; SANDAG, Current Population Estimates, 10/2012. Estimates, Population Current SANDAG, Branch; Services Immunization Patient Discharge Database (CA OSHPD), County of San Diego, Health & Human Services Agency, Public Health Services, Epidemiol Services, Health Public Agency, Services Human & Health Diego, San of County OSHPD), (CA Database Discharge Patient Servic Health Public Agency, Services & Human Health Diego, San of County OSHPD), (CA Database Discharge Department Emergency North Central Region (Community Perceptions) Table 4: North Central Region Community Survey Results Compared to CHIS Survey Data Survey to CHIS Compared Results Survey Community Region Central 4: North Table Community Survey Results Source: Death Statistical Master Files (CDPH), County of San Diego, Health & Human Services Agency, Public Health Services, E Services, Health Public Agency, Services & Human Health San Diego, of County (CDPH), Files Master Statistical Death Source: Prepared by: County of San Diego, Health & Human Services Agency, Public Health Services, Community Health Statistics Unit, 2 Unit, Statistics Health Community Services, Health Public Agency, Services Human & Health Diego, San of County by: Prepared Chronic Diseases Physical Physical Inactivity Access Health to Care Drug Abuse DietPoor HealthMental Issues perceived by the community. Lastly, the community actually perceived mental health issues to be worse than the data showed. the data than worse to be issues health mental perceived actually the community Lastly, the community. by perceived data is drug abuse. There was a marked discordance between perception physical and inactivity, access to what health care, the and chronic diseases, data with the data showed showing these for factors much worse the than what wa four factors of poor d demonstrated, demonstrated, using California Health Interview Survey (CHIS) data and Office of Statewide Health Planning and Development (O (health encounter) data. This comparison is summarized in After After reviewing the results of the Team compared its perception, based on the North Central Region community survey results, with what the actual available data SummaryAssessments of NORTH CENTRAL REGION related healthto the outcomes (tertiaryprevention andfactors) priority areas. are that factors prevention secondary and primary outlines also pathway The Region. Central in noted pathwaycritical DiegoCommunitySanHealth LiveImprovement Well Plan appropriate. b deemed as direction, the andhealth, preventive health carerepresent the pro adjust or goals, team’s confirm the review to to which through lens additional an as used also was completion, Change of Forces e Central North The Priority Areas Identifiedfrom Assessments county the adults for 65 yearsage of and older. Region this for rate suicide the unfortunately,Also, high. still are rates obesity activity),physical (i.e., behavior risk dis chroniccomp to strengthsrelated the Despitedisease population. regionalthe in chronicactivityphysical of rate highof a and overall, countyrate lower Strengt a communities. is there the Additionally, of care. health needs to andaccess and sectors insurance diversehealth to large, related are the Region to part in due Region, this in partners mobilizing is Region North of challenges greatest the of One concerns. and strengths on agreement and consensus obtain to used was process voting ( developed was concerns and strengths of list a data, the all reviewed Team Leadership Region Central North the After e addre e x p loring s

the c the sed

to o

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in Assess ie el a Diego San Well Live     Strengths: TableKey 5: Findings fromCommunity AssessmentHealth e

the

resul source of medical care care of medical source Ninety insurance health Ninety exercise or fun transportation, for walk population of the A high rate overall county the than are lower rates disease Chronic Figure 9 Figure

m leadership team’s leadership e t nts. s - -

one percent (91%) have a usual have percent (91%) one have residents of (92%) two percent o f t f

links the priority areas with health outcomes unique to North to uniqueoutcomes health with areaspriority the links The Local Public Health System Assessment, upon its its upon Assessment, System Health Public Local The h e

CommunityPerceptions,CommunityandStatus, Health

edrhp em identi Team Leadership

ision. The North Central Region’s section of the of sectionRegion’s Central North The ision.

m ine ( n N t

ORTH addressesareas.priority these c r o s

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cutting ENTRAL hscl ciiy behavioral activity, Physical 116 f   (Conc Risks i ed

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  

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NORTH COUNTY REGIONS COMMUNITY HEALTH ASSESSMENT

119 NORTH COUNTY REGIONS Assessments Health Community Process Improvement Health Community Members Team Leadership Table Contents of Region Issues Health Population Region to Health Risks and Strengths Region Availability Health Resources Demographics Region Coastal North and Inland Region Assessment Perceptions Community Maternal and Child Health Child and Maternal Disease (Infectious) Communicable Injury Disease Pulmonary Stroke and Heart Disease Diabetes Cancer Demographics Socioeconomic Demographics Community Sources Data

—

North North

Coastal Region Coastal

—

North Coastal Coastal North —

—

North Coastal Coastal North

North Coastal North Coastal

—

North North

13 13 11 11 11 10 10 10 4 4 3 2 9 9 8 8 8 7

( N ORTH

Priority Areas Identified from Assessments Areas from Identified Priority Region Availability Health Resources Demographics Summary of Assessments of Summary Region North Coastal Change of Forces Region Coastal North and Inland Region Resources and Assets Community Region Coastal Challenges Health Population to Contributing Factors Region Issues Health Population Region to Health Risks and Strengths

C OUNTY Socioeconomic Demographics Socioeconomic Demographics Community Maternal and Child Health Child and Maternal Disease (Infectious) Communicable Injury Disease Pulmonary Stroke and Heart Disease Diabetes Cancer 120

R EGIONS

—

North Inland Region and North North and Region Inland North —

North Inland Region North Inland

— 1

) North

—

Inland Region and and Inland Region North Inland Inland North —

—

North Inland Inland North

North Inland North Inland

—

North North

24 22 21 20 20 19 19 17 17 17 16 16 16 15 15 14 14 14

NORTH COUNTY REGIONS

Elder Elder

Age School -

Price

E Program -

City Medical Center Medical City - Migrant Education Migrant IV Title Work, Services Support and Access Multicultural Program Family Educations Program Program Educations Family Initiative San Diego State University, School of Social Social of School University, State San Diego Assoc. Parent Heart/Foster the from Straight Horn Bill Supervisor Roberts Dave Supervisor Slater Pam Supervisor Center Women's Resource The Tri Communities Asian Pan of Union Forum Veterans/Family Clinic Vista Community School Middle Vista Magnet District School Vista Unified Ministries Home Welcome San Dieguito Alliance for Drug Free Youth Free for Drug Alliance San Dieguito &Club Girls Boys San Marcos Center Senior San Marcos District School Unified San Marcos School/Cal High San Pasqual San Diego SAY Alliance San Diego Obesity Childhood County San Diego Education, of Office County San Diego

San Diego San

)

EGIONS and Mental Health Services Services Health Mental and Council Foundation Health Academy Health R

San Diego County Alcohol Drug Addiction Addiction Drug Alcohol County San Diego Development Economic North San Diego Project Organizing San Diego Research University State San Diego North County Gang Commission Commission Gang County North Services Health County North Coalition Trafficking Human County North Inc. Lifeline, County North House Serenity County North Change for Solutions County North First 5 Inland North Advisory Shores Ocean District School Unified Oceanside School High Oceanside Oceanside District, School Unified Oceanside Health Palomar Psychiatry Outpatient Hospital Children Rady Hospital Children's Rady (RICA) California of Innovations Recovery Youth Free for Drug Alliance San Diego County San Diego Branch Library County San Diego Education of Office County San Diego Probation County San Diego

121

OUNTY

ORTH

(

San Diego Smoke Free Free Smoke San Diego

- North County Regions Leadership Team consists of the following agencies/organizations: following the of consists Team Leadership Regions County North

City CAN CAN City - Project Behavioral Health Services Health Behavioral North County Community Services Community County North Maternal Infant Support Support Infant Maternal Inc. Systems, Health Mental Force Strike Meth Mid Services Community & Health Mountain Products Health Home Coast North Coastal North NAMI Healthcare Neighborhood Coalition Prevention Coastal North Health and Human Services Agency Agency Services Human and Health Board Advisory Service Health Coast the North of Hospice Solutions Energy Independent Inc Council, Health Indian Services Community Interfaith County San Diego of Federation Jewish Pathways Julian District School Julian Union California Southern of Foundation Life Light of Start Head Project MAAC Escondido Recreation Escondido District School Union Escondido District Healthcare Fallbrook Support Parent Foster Oak Ranch Green

North County Regions Leadership Team Leadership Regions County North

Live Well San Diego San Well Live

Deputy Director, HHSA North Coastal & North Inland Regions Inland North & Coastal North HHSA Director, Deputy

Parks and Recreation and Parks

The current current The

1 San Diego 1 San Chairs: - - Student Health & Counseling Services & Counseling Health Student Development Center Community 1 - Exceptional Family Member Program Member Family Exceptional COMPACT Education Escondido County Office of Education of Office County San Marcos Univesity, State California County of San Diego, Housing & Community Community & Housing San Diego, of County Fallbrook / Parks San Diego of County Community Resource Center Resource Community Library County City of Solana Beach Solana of City Vista of City Works Housing Community City of Oceanside of City San Marcos of City City of Carlsbad Carlsbad of City Encinitas of City Escondido of City Carlsbad Unified School District School Unified Carlsbad Amparo de Casa Physicians Children’s Cal State University San San Marcos University State Cal Project Youth Care Alta Vista High School/Teen Parent Program Program Parent School/Teen High Vista Alta ARBOR/Rescare Carlsbad of Club & Girls Boys 2 Chuck Matthews, Chuck Lifeline County North Director, Executive Stump, Don Members: Live Well San Diego San Live Well Co NORTH COUNTY REGIONS success toaddress theidentified of health issues. indicators and activities key selected and objectives and goals identified Plan Improvement Health RegionsCounty communityNorth developing thebegin and to heldwere meetings regularselected, were issues health key Once space. shared partner countywide a on stored are and meetings most key for kept were notes representing individuals organizationswithinCountyNorththe region. Meeting agendassummary and by attended were Meetings process. implementation and planning improvement health community their throughout on focus would region the issues health which to month discuss resultsof the other assessments, reviewCounty health every data, and determine approximately held were meetings team Leadership to compiledinform thecommunity health and improvement planning team process. leadership the by reviewed was surveys these Data from process. planning improvement health community was the process during collaborativeutilized true a ensuring members, community of range broad a to survey electronic an via administered were Perceptions assessments These Community community. the to important Leadership a most are issues thehealth whichunderstand Team help to through Assessment Change of Forces engaged a and Assessment further was community issues. health priority discuss to together partners community bring to forums community quarterly key identify to and strategic community,areas for North County. the in happening is what on informed and Partnerships the used region County North healthy,themodel,Leadershiptransitioning thrivingtheTeamlives.Afterand to safe, live to residents help region’s to engagement community the active facilitating guide help to 2012 January Team Leadership Community Regions County North The North County Regions Community Leadership Team Community Health Improvement Process

(MAPP) process to guide planning, to keep partners connectedpartners keep to planning,guide to process(MAPP) n diin o h qatry omnt frm, the forums, community quarterly the to addition In Te edrhp em n te community the and Team Leadership The . Between 2010 and 2012, North CountyheldNorth 2012, andBetween 2010 oiiig o Ato uig lnig and Planning using Action for Mobilizing Live Well San Diego CommunityDiegoSan WellLive ie el a Diego San Well Live

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a l choice choice questions are shown in bar charts, with the highest nin o - n r t a ment of EGIONS l Live Live Well San Diego n s p R

t Co es s 123 e en m as OUNTY e e C v question survey, modified from surveys in the NACCHO MAPP Toolkit. The The Toolkit. MAPP in from the NACCHO surveys modified question survey,

s - i o r D p is is to have a community where r ORTH m o i f N

( h s t r The The Leadership Team is composed of public health agencies, local governments, l e a t n he e C ty ty North Inland Region and North Coastal Inland North North Region Region and

e uni h

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d based based partners, operate and administer services seamlessly across both regions. Therefore, the North we - o l l ended questions are summarized in the narrative. the narrative. in summarized are questions ended o - f changes that create safe, healthy, and equitable communities. equitable and healthy, safe, create that changes

- rs e als (NACCHO) i b ic f m e Of m indicate indicate the results from the 194 respondents. Multiple

h lt the the North County Regions Leadership Team a e H

y it C

d responses displayed. Open displayed. responses secure an understanding of the issues residents feel are important, the North County Regions Community Leadership Team conduc through an 11 Assessment Strengths and Themes Community graphics below Community Perceptions Assessment Assessment Perceptions Community The Community Perceptions Assessment included input from members of North Inland Region (NIR) and North Coastal Region (NCR). square square miles of urban, suburban, rural, and remote areas. The Center. Valley and Region Poway, Marcos, San Ramona, Pauma, Julian, Palomar, Diego, San includes North Fallbrook, the communities of Anza Corps Corps Base Camp Pendleton and includes the communities of Oceanside, Carlsbad, Pendleton, San Dieguito, and Vista. The North Region is the largest geographical Region in the county, with a high proportion of white and Hispanic residents. The Region c The North County Regions Community Leadership Team serves both the regions of North Coastal and North Inland. Region consists The of both urban and North suburban areas, with wealthy coastal Coast communities and communities of varying degrees of pove Region covers 388 miles, square with a high proportion of white residents and a large Hispanic presence. North Coastal is hom Community Health Assessments Health Community school school districts, health care organizations and professionals, and systems and environment, community Live Well San Diego North County North DiegoLive San Well The vision of services are accessible, and communities are safe. strengths, assets, and needs, and formulated a Community Health Improvement Plan for North County to address. to County North for Plan Improvement Health Community a formulated and needs, and assets, strengths, community community leaders from both North Coastal and North Inland Regions. The HHSA HHSA’s North numerous Coastal and community North Inland Regions, much lik County Regions Community Leadership Team conducted a joint as an County Regions Community Leadership Team along with the regions’ Leadership team team Leadership NORTH COUNTY REGIONS findingsby identifying the topstrengths and concerns as perceived by membersof the North CountyRegionsLeadership Team. Enhancing County. North seniors. in population aging for the for conditions placeimprove would care health difficult to access improved aand safety it make support social more for need and options, limited transportation, inadequate portionAnotherofsurvey the askedrespondents provideinputto onwhether communitytheir place toisa goodgrowold. Some to access greater education, care,nutrition education, health/communityeconomic improvement, and access healthyto effective food. more using by improved be could community the of health the felt Many physical diet, inactivity, abuse,drug mentalhealth issues, and chronic diseases ( of lack abuse, drug disorders, eatinghabits/choicesand opportunity, ( health mental/behavioral overweight, being were health to factors risk important most five The felt thatthe overall health oftheir community was unhealthyveryor unhealthy ( ( schools quality and economy,healthy a jobs, availableneighborhoods, crime/safe low care, access stated greateror 50%Community,” “Healthy a for are importantfactors most five the what asked respondentswere When FIVEMOST IMPORTANT factors fora “Healthy Community?” Figure 3: In thefollowing list, general,in doyou what arethink the Clean Environment (e.g. clean air, water) Access to Community & Social Services Access to Health Care (family doctor) Access to Parks, Trails Recreation & Available Jobs & Health Economy Low Crime/Safe Neighborhoods Community/Civic Engagement Access to Healthy Foods Affordable Housing Quality Schools 0 20 21.50% 40 22.10% Figure 5 Figure 28.20% 32.80% 33.80% 60 35.90% ). The five most important health concerns identifiedimportantconcernsmost healthrespondentswereunhealthysurveybyfive The ). 80 50.80% 56.90% 100 ( N 61.00% 63.60% ORTH 120

C OUNTY

140 124

R EGIONS

Figure 4 communityyou serve? Figure 4:How youwould rate the overall health ofthe

5 Figure 6

)

37.20% 2.70% ). ). ).

Figure 3 Figure 1.60% 18.60% ). Approximately 40% of respondentsof Approximately40% ). 39.9%

Table 1 Table Very Unhealthy Very Unhealthy Healthy or Unhealthy Neither Healthy Healthy Very

summarizes these summarizes

st ec atedthat to to mmunity onomic

he health alth NORTH COUNTY REGIONS 140 59.4% 120 55.6% 51.3% 100 44.9% 39.0% 36.9% 80 35.3% 29.4%

60 22.5% 23.0% 40

20 0

Oral Health Oral Drug Abuse Drug Alcohol Abuse Alcohol

Unhealthy Diet Unhealthy

Physical Inactivity Physical Illegal Immigration Illegal

Hunger/Food Insecurity Hunger/Food

Lack of Access to Health Care Health to Access of Lack

)

Mental Health Issues (suicde & Depression & (suicde Issues Health Mental Lack of public transportation public Lack of diseases chronic of prevalence High Immigration recovery economic Slow Aging population Aging violence and Crime Funding EGIONS Chronic Disease (Cancer, COPD, diabetes,…) COPD, (Cancer, Disease Chronic Figure 6: What are the FIVE MOST IMPORTANT HEALTH HEALTH IMPORTANT MOST FIVE the are What Figure 6: serve? you the community in PROBLEMS Concerns: R

       125 OUNTY C

120 ORTH N

100

( 52.2% 50.5%

39.7% 39.1% 37.5% 37.5% 60

23.4%

20.7% 40 18.9% 17.4%

20 0 Abundance of natural resources natural of Abundance community Faith collaboration Community diversity Cultural resources community Variety of Table 1: Key Findings from Community Perceptions Assessment Perceptions Community from Findings 1: Key Table Strengths:

     Drug Abuse Drug Low Literacy Low Alcohol Abuse Alcohol Homelessness Lack of Exercise of Lack Being Overweight Being Eating Habits/Choices Eating Dropping out of High School High of out Dropping Lack of Economic Opportunity Economic of Lack Mental/Behavioral Health Disorders Health Mental/Behavioral RISK FACTORS among the community you serve? you community the among FACTORS RISK Figure 5: What do you think are the FIVE MOST IMPORTANT IMPORTANT MOST FIVE the think are you do What Figure 5: NORTH COUNTY REGIONS HU okd ih h Laesi Ta t rve te bv dt sucs Bsd n hs eiw uig h cmuiy engagement community the during review this on Based sources. data process,current regionalprofiles were generated, abovewhich influenced identification the ofhealth prioritiesNorth for County the review to Team Leadership the with worked CHSU Health Behavioral with development the of profiles address that olderadults and childrenin moredetail. Working abuse. substance Profil Community the and for plans Future health sources. based population mentalthrough available indicators the on created staff CHSU information Services, based population for need unmet an was There proce planning improvement health community the during members community by driven was data Health Behavioral of addition The bycalendar year and are currently archived back to 2000 allowto andstaff public the compareto trendsover time. organizedby race/ethnicity, age groupand gendereach for of41 the communities that comprise SanDiego County. Dataare discharges. pos department emergency and discharges, healthospital deaths, (mental as health reported are behavioral indicators include Most abuse). to substance expanded recently most and injury heath, disea (chronic) child noncommunicable and by maternal organized diseases, indicators communicable of dozens include to expanded list the quickly Very Region. HHSA each C SanDiego US,CA,the CommunityHealthyobjectiveswerereportedlist of People2010 thatshort a for The Profiles as began informationon health status andhealth behaviors by HHSA Region. l and state from as well as InterviewSurveyCaliforniat Health the fromresults selected CHSUincorporates OSHPD. and Services RecordsVitalincluding databases Health Public in branches various from data health pulls CHSU Survey. Community American HHSA each within Census the pulledfrom are communitieseconomic dataDemographicProfiles. and Communitythe as onlineinformation this postsand Region, and Region HHSA by organized data health and behavioral economic, demographic, generates CHSU economicfalls, burden ofdisease, health disparities,and health status), health briefs, fact sheets, and atlases.All are a ( reports specific other profiles, health community the including publications, generates to CHSU communities.support their andand Regions data Pub health public HHSAfor contact in of point single located a provide (CHSU), to 2005 Unit in formed Statistics CHSU The Health Division. Services Community Health the by developed annually are reports profile community Regional RegionalProfiles (Health Status Assessment) local the public health assessment can be in the overarchingdocument. public,private, andvoluntary entities contributing tothedelivery theof10Essential Public Health Services. JuneOn 29,2012, HHSA conducted Locala Public Health System Assessment (LPHSA) evaluateto allsectors inhealtha system, LocalPublic Health SystemAssessment DataSources

( N ORTH

C OUNTY

126

EGIONS

)

A full description of the results of results the of description full A

vai Reg lable

These data a data These ions. online e.g oun es the

ted o p o inc

., senior ., an include

ty, andty,

HHSA rovide online a h luding .

d thed ses oca ss. nd lic re , l

NORTH COUNTY REGIONS a in in

en ish ish

n n the ngl

s s at or f every

h h o t t o

olds olds earned

seh

Population Population 17%2025 in

Demographics* 537,059 residents 3 persons/household 11% Seniors 59% White 28% Hispanic 6% Asian 4% Black ○ Among adults with adults Among

       to afford enough food. enough afford to had a consistent ability ability a consistent had incomes below 200% of of 200% below incomes the FPL, seven out of 10 10 of out seven FPL, the third of women earning income -

)

EGIONS R

127 OUNTY C

ORTH N (

North Coastal North Region

— Population density of 1,384 persons per square mile square per persons of 1,384 density Population Has urban and suburban areas suburban and urban Has areas poorer and towns of wealthy Mix West the to Ocean Pacific the and North the to Pendleton Camp Borders Vista Beach, and Solana Oceanside, Encinitas, Carlsbad, include Cities Diegans San of to 16.9% Home Spans 388 square miles of San Diego County of Diego San miles 388 square Spans

population population density of 1,384 persons per square mile. The majority of North Coastal residents were white, but more than one ou four residents was Hispanic. Pockets of Asian communities existed within the NCR. More than seven out bilingual. were 15% of another and only, 10 residents spoke E San San Diego covers County 388 miles square of urban and from areas, suburban ranging coastal wealthy towns to bot poorer areas, coast and inland. As of 2009, 537,059 people resided in the NCR, representing 16.9% of the San Diego County population, with The The North County Community Leadership Team also looked at the most recent health and community data for NCR and NIR. The NCR (WIC) (WIC) program. Therefore, Therefore, NCR residents had better food than security poorer residents of most other Regions. One below 300% of the FPL and who were pregnant or had young children, received assistance through the Women, Infants, and Childr degree degree or higher and only 13% had less than a high school education. Nearly all NCR households had at least one vehicle available to them. Among adults with incomes below 200% of the Federal as Inland). food (same enough to afford ability (FPL), a consistent out 10 had Level seven of Poverty were also less likely than most other regions to have been single parent homes. NCR residents were were residents NCR homes. parent been single to have regions than most other less likely also were similar to San Diego County residents in their educational attainment. One in three held a bachelor Families Families residing in the NCR were less likely to live in poverty than in San Diego County overall. Nearly one out of five hou had residents of percent Nine poverty. in lived one in 11 residents and year, per than $100,000 more incomes less than the Federal Poverty Level (FPL), compared to 12% in the County overall. They Socioeconomic Demographics Socioeconomic Community Demographics Community        Demographics (NCR): Region Coastal North the of snapshot a is following The NORTH COUNTY REGIONS         (COPD)were generally lower thethan County overall ( obstructivepulmonachronicand diabetes,asthma,(CHD),stroke,disease coronary heart rates encountermedicalfor and death 3 the in found diseases chronic same very cancer and heartdiseaseasthma, diabetes, those of prevalence the including NCR, in health to risks several are There Risks and Strengths to Health          hospitals care acute Importantstatistics thatreflect theavailability keyof health resources: two are there and facilities, hospice three and agencies emergencydepartments, as well skilledas 12 nursing facilities. health home seven are There clinics. community dialys chronic four are there NCR, In services. care health utilize to or to access have to likely as just were They overall. population a impact careof directly sourceusual a as officedoctor’s a use andto currently insured be toto likely morewere NCRresidentsstatus. health shown been have services health of utilizationver and or excellent access, report coverage, three Insurance of status. out health Two regions. other most in adults than health better report region this in living Adults Availability Resources Health

Slightlyless thanthree out of fourNCR adults reported walking for fun,exercise or transportation. NCRadultswere less likely haveto drank binge in thepast year compared tothe County overall. Nearlyone NCRadultswere slightly more likely beto obese overweightor adultsthan in theCounty overall. More halfthan ofadults wereoverweight orobese. Threein 10NCR residents ate fast food two or more timesper week. NCRadultswere less likely smoketo indoors than allotherregions. out One of 10 NCR residents is a current smoker. in One sevenNCR adultssaw neededor professional help emotional for or problemsmental in the year. past NCRadultswere as likely as otherCounty adults overall haveto usual aplace to when go or sick needing health advice. out One of sevenwas disableddue to aphysical, mental, or emotional problem. Of NCR uninsured adults aged 18 NCRadultswere in verygood health, compared to countyoverall. Twoout (2) of 3 residents reported very good or excellenthealth. general Slightlymorelikely to have visiteda doctor during thepast year than County the overall. Ninety Eighty - - ninepercent (89%) ofresidents were currently insured. five percent (95%)of hadthose prescription drug coverage. - third ofthird adults 18+ years binge drankleast at once in thepast year. — — -

64 (16%), only 2.8% were eligible for Medi

North Coastal RegionNorth Coastal North Coastal RegionNorth Coastal –

that cause over 50% of deaths. In NCR, the number is even higher at 58%. Chronic di Chronic58%. at higher even isnumber the NCR, In deaths.of 50% over cause that

Table 2 ( N ORTH ).

OUNTY

128

EGIONS - Cal or Healthy Families.

)

adultsa is current NorthCoastal Oneout 10 of have any insurance Coastal residents age18 Onein six North smoker.

coverage. - 64 did64 not is -

4 tha y g y

- clinics and 15 and clinics 50 conce 50 n the countythe n ood general ood ry ’s

disease general sease pt wit h –

NORTH COUNTY REGIONS sidents sidents

re mergency mergency

d e overall

↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ the County County the among North North among due to cancer cancer to due was lower than than lower was The rate of death death of rate The Coastal residents residents Coastal Higher or LowerCounty than

9.6% 6.1% 9.3% 7.1% 22.3% 22.9% 29.3% 39.1% ------

)

Percent (Burden) DifferencePercent (Burden) EGIONS

Since Since 2000, diabetes death and hospitalization rates in the NCR

129

Specific Specific Antigen (PSA) screening the past OUNTY - C

385.1 148.6 687.9 739.4 449.8 286.3 276.6 384.1 ORTH

N ( County Rate* (Risk)

348.1 139.6 534.6 570.2 407.8 266.0 195.6 233.9 NCR Rate*NCR (Risk) North CoastalRegion North

—

Stroke Asthma Arthritis Diabetes Indicator Dorsopathy Disease (COPD) Cancer, All Causes

Chronic Obstructive Pulmonary Pulmonary Chronic Obstructive Coronary Heart Disease (CHD) Coronary Heart Disease

One in 20 residents was ever diagnosed with diabetes. with diagnosed ever was residents One 20 in Seven out of 10 adults over age 50 have complied with colorectal cancer screening recommendations. screening cancer colorectal with complied 50 have age over out10 adults of Seven Two out of three women over age 30 had a mammogram in the prior two years. two prior the in mammogram a 30 had age over women three out Two of One in four males over age 40 in the NCR had year. a Prostate

Chronic Disease Chronic Table 2: North Coastal Region Chronic Disease Rates Compared to County Rates County to Rates Compared Disease Chronic Region Coastal 2: North Table

have remained relatively stable. relatively remained have  Diabetes Diabetes death and rates hospitalization in the NCR have remained relatively stable since 2000, and death, an hospitalization department (ED) discharge rates were statistically significantly lower than the County overall in 2009. The percentage ever of diagnosed NCR with diabetes was also lower than the County overall. Diabetes   the county overall. the county  Cancer Cancer was the second leading cause of death in the NCR in 2009, the rate of which was slightly lower than stroke, stroke, injury (intentional and unintentional), pulmonary disease, communicable (infectious) issue. for each key statistics provides section following The diseases, health. child and maternal and Population Health Issues Population health issues identified by the Leadership Team included cancer, diabetes, heart disease and

NORTH COUNTY REGIONS poisonings/overdoses, motor vehicle crashes, struck by/against events, fires/burns, cuts/piercing, drowning/submersion, and and drowning/submersion, cuts/piercing, fires/burns, events, d of cause leading the are and by/against ages, all for County Diego San in struck death of causes leading related the among are crashes, are Injuries injuries overexertion. unintentional vehicle unintent Most call would preventable. motor Some and intent. predictable are harmful they poisonings/overdoses, from because free not are are and they purpose but on harm or “accidents,” caused violent not injuries have are and that purpose on injuries caused are are that injuries injuries are Unintentional injuries Intentional are unintentional. Injuries or preventable. and intentional predictable either are as many so that given especially problem, health public important an are Injuries Injury       among was rate hospitalization lowestin the County. COPD the and County, the in lowest the were rates discharge ED and hospitalization asthma NCR PulmonaryDisease      firstand fourthleading causes ofdeath in NCR the in 2009. the were (stroke) diseases cerebrovascular and disease) heart coronary (including heart the of Diseases DiseaseHeart and Stroke  

Black residentsof the regionhad higher rates of asthmahospitalization andEDdischarge than other racial/ethnic groups. 0 aged children region. among higher disproportionately was rate discharge ED COPD The Halfof asthmatics ever receivedasthmaan managementplan afrom health professional. NCRasthma and COPD hospitalization and EDdischarge rateswere among the lowest in the County. Fewer halfthan of asthmatics dailytook medication tocontrol asthma.their Asthmaand COPD death andhospitalization rateshave fluctuated since2000, butappear beto decreasing overall. was NCR the in living Islanders Asian/Pacific and whites among death disproportionately comparedhigh to other racial/ethnic groupsin Region. the stroke of rate The thoseOf with highblood pressure,only 60% were taking blood pressure medication. Aquarter was everdiagnosed with blood high pressure. One in 20 was ever diagnosed with heart disease. Coronary heart disease (CHD) and stroke death and hospitalization rates have declined since 2000. ethnic groupsin the region. other to compared NCR, the in living blacks for high disproportionately were rates discharge ED and hospitalization Diabetes NCROf adults diagnosed with diabetes,92% were diagnosed with 2 Type diabetes

( N ORTH

C OUNTY 130

R EGIONS

)

—

a preventable disease. - 14 than children living in almost every other other every almost in living children than 14

rateshave declined

stroke deathstroke and Coronaryheart disease (CHD), hospitalization since 2000.since

ful cla eat to to

ssified ssified

intent. intent. rac ion falls, falls, h for for h the ial/ al al

NORTH COUNTY REGIONS

↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ than County Higher orHigher Lower

9.6% 9.8% 24.5% 36.0% 13.7% 14.6% 32.5% 11.5% 36.4% 14.3% 26.4% 12.0% 10.7% 12.4% ------Difference Percent (Burden)

)

2.8 18.7 78.8 52.9 33.1 43.0 11.5 (Risk)

594.2 579.5 233.8 126.4 308.6 EGIONS 5354.9 2035.0 R

County Rate*County 131 OUNTY C

ORTH

N ( 2.4 11.9 70.4 47.7 25.0 27.5 10.4 (Risk) 437.4 510.0 204.7 109.1 208.4 4572.2 1800.9 NCR Rate*

). In the NCR, unintentional injuries were the sixth leading cause of death for all ages, and suicide

Table 3

Injury IndicatorInjury inflicted injury hospitalizations and ED discharges were lower in the NCR than in the County overall. overall. County the than in the in NCR lower were discharges and ED hospitalizations injury inflicted

- Related Injury

Inflicted Injuries Related Injury - - Drinking Driver Involved MVC Overdose/Poisoning Motor Vehicle Injury Total dueInjuries to MVC Alcohol InvolvedMVC Fall UnintentionalInjury (All Causes) Pedestrian Injuries Residence by Self Suicide Pedestrian Injuries Occurrence by Homicide Assault Firearm Table 3: Injury Rates for North Coastal Region Coastal forRates North Injury 3: Table NCR residents had lower rates of assault injury hospitalization and ED discharge than the County overall. the County than discharge and ED hospitalization injury assault of rates lower residents had NCR self and Suicide The rate of homicide in North Coastal was lower than the County rate. the County than lower was North Coastal in homicide of rate The

   was the eighth. The following facts regarding intentional and unintentional injuries are provided for NCR as follows: Injuries Intentional children and young adults ( NORTH COUNTY REGIONS     1,000 live births. 6. of average States United the and births, live 1,000 per deaths 4.4 of average County the than lower births, live 1,000 per was NCR the in mortality Infant infants. and mothers its of health the by measured often is community a of health overall The Maternaland Child Health       and gonorrhea, syphilischlamydia, than county the overall. C, hepatitis chronic TB, AIDS, have to likely less significantly were residents NCR County. Diego San in regions other most in than NCR the in lower was incidence disease Infectious Communicable (Infectious)Diseases      UnintentionalInjuries

NCRmotherswere as likely receiveto earlyprenatal care compared to mothersliving in theCounty overall. Countyoverall. 15 aged girls to born infants live all of proportion The Teenbirths occurred less often in the NCR than in other most regions in thecounty. Threeout of fourNCR womenhave ever givenbirth, with births most occurring to mothersbetween theages of20 and years.29 Twoof out five NCRchildren and adults had a flushot in thepast year als was Gonorrhea incidencewas lower ItamongNCR residents than residentsin nearlyall other regions. NCR. the in groups racial/ethnic other to compareddisproportionately blacks, high among among 15 high disproportionately was chlamydia of rate The However, the rate of chlamydia incidence in the NCRChlamydia was commonlymostthe was lower reported diagnosis, STD than which increased has rate ofinthe sincenearly 2000. any other region. Islander thanLess 8% of all AIDS cases reported in thecounty in 2009were in the NCR. Asian/Pacific among highest was and 2000, residents. since decreased has rate incidence TB The Unintentional fall alcohol Therate of injury total due tomotor vehicle was accidents lowerNCRin the than mostother County regions,as was the rate Overdose/poisoningdeaths/medical encounter rates werelower NCR for residents than County the overall. groups in the region. ratedeathofThedueto unintentional injury was disproportionatelyamonghighwhite residentsof compared NCR, otherrac to NCRhadresidents lower rates ofdeath/medical encounter unintentional for injury than the County overall. - involvedaccidents.

related injuryhospitalizations andEDdischarges were lower NCRin the inthan mostother regions.

24 year olds, compared to other age groups. ( N ORTH - 17 in 2009 was lower among NCR mothers than among mothers living in the in living mothers among than mothers NCR among lower was 2009 in 17

C OUNTY 132

R EGIONS

)

Chlamydiawas the mostcommonly diagnosis thein reported STD

NCR. 8 d 8

4. of eaths per eaths ial 1 deaths 1

/ethnic o

NORTH COUNTY REGIONS

Population Population 2.8 persons/ household 57% White 28% Hispanic 8% Asian 2% Black 579,000 residents Demographics

     

)

EGIONS R

133 OUNTY C

thirds of all residents spoke English only, while - ORTH

N (

In In 2009, the NIR was home to an estimated 579,000 residents,

North InlandNorth Region

—

Large population but low population density at 244 persons per square mile square per persons 244 at density population low but population Large Has urban, suburban, rural and remote areas remote and rural suburban, urban, Has Counties and Imperial Riverside Borders Valley and Marcos, Ramona, San Poway, Pauma, Julian, Palomar, Fallbrook, Escondido, Springs, Borrego include Communities Center Diegans San of to 18.2% Home Spans 2,373 square miles of San Diego County Diego San of miles square 2,373 Spans

rural or remote areas of the NIR. the of areas remote rural or Infants, and Children (WIC) program. (WIC) Children and Infants, more the in care to access limited to contributing available, vehicle had no 20 households every of One out 9% of residents were living in poverty. Among adults with Level (FPL), seven out incomes of 10had a consistent below ability to afford enough food. Half 200% of women earning incomes of the Federal Poverty at 300% Women, or below FPL, who the were pregnant through or assistance young had received children, Compared Compared to the other HHSA Regions, residents in NIR generally had higher incomes than the rest of San Diego County residents. About 20% of all households earned more than $100,000 per year, and less than 17% were bilingual. bilingual. 17% were Demographics Socioeconomic community community data for NCR and NIR. representing 18.2% of the San Diego County population. white, and more The than one majority out of of four were North Hispanic. Two Inland residents were Community Demographics Community The North County Regions Community Leadership Team also looked at the most recent health and       The following is a snapshot of the North Inland Region (NIR): Region Inland North the of snapshot a is following The Demographics NORTH COUNTY REGIONS          ( - diabetes, and pulmonary disease), which are responsible for over 50% of deathsThree nationwide. behaviors In(poor the diet,NIR, physicalthe number inactivity, is even hig and tobacco use) are major risk factors for four chronic Risks and Strengths to Health diseases (cancer, h          f The followingimportant statistics reflect thenursing availability healthkey of resources: skilled a 16 three and psychiatric, are one there department, emergency and an facilities, without hospital hospice one five departments, emergency and with agencies hospitals health home 12 are There clinics. free two and County. clinics, the community of rest the to comparable rates at services health utilized and care, health coverag insurance health had they that reported and health general excellentor good very reported residentsNIR three of out Insurancecoverage, access,andutilization healthservices of havebeen directly shown impact to population’s a healgeneral Availability Resources Health Table 4) communicable (chronic)disease death andmedical encounter rateswere generallylower than,or comparableto,San Diego Count

Twoof out threeNorth Inland Region residentsreported very good or excellent general health. Threeout of fourNIRadults reported walking for fun,exercise or transportation. NIRadults were as likely to have bingedrank in thepast year compared to theCounty overall. More halfthan ofadults wereoverweight orobese. NIRadults were as likely to obesebe or overweight adultsthan in County the overall. One NIRadults were less likely smoketo indoors than mostother regions. NIRadults were more likely be to former smokers than any otherregion. NIRadults were more likely haveto eversmoked than County the overall. out One of 10 NIR adults saw neededor professional help emotional for or problemsmental in the year. past Nearlyout ofthree 10 adults were disabled due toa physical, mental,or emotional problem. in One 25seniors ages 65+ did nothave Medicarecoverage. Eighty Nineof out 10 NIRs had a medicalhome when sickor needing health advice. adultsOf aged 18 theOf NIR adultsaged 18 Ninety Eighty - third ofthird NIR residentsate fast twofood ormore timesper week. .

- - - seven percent (87%)visited a doctor during thepast year. six(86%) percent of all adultswere insured through privateor public programs. six(96%) percent of those had prescription drug coverage. -

64, nearly 64, one in five did nothave anyinsurance coverage. - 64 who64 were uninsured (20%),24% were eligible Medi for — —

North Inland Region North Inland Region

( N ORTH

OUNTY 134

EGIONS

)

- CalHealthyor Families.

In NIR, there are four chronic dialysis clinics,15 dialysis chronic four are there NIR, In

goodexcellentor Regionresidents Two outofthree generalhealth

reportedvery

NorthInland ear t disease, type 2 her th th

at e, status.Two 56%. cut to access aci y

care e

lities. Non NORTH COUNTY REGIONS ial/ rac es key e, injury vid eas

↓ ↑ ↓ ↓ ↓ ↑ ↓ ↓

than County Higher orHigher Lower

4.9% 9.2% 5.5% 36.4% 21.0% 11.8% 13.1% 21.9% ------Difference

Percent (Burden)

)

EGIONS R 384.1 385.1 148.6 687.9 739.4 449.8 286.3 276.6

(Risk)

135 County Rate* OUNTY C

Specific Antigen (PSA) screening the past year. past the screening (PSA) Specific Antigen - ORTH N

( 244.2 304.2 162.3 607.0 642.2 427.9 302.0 215.9 (Risk) NIR Rate*

North InlandNorth Region

—

Indicator

fourths of adults over age 50 years have complied with colorectal cancer screening. screening. cancer colorectal with complied have 50 years age over adults of fourths -

Cancer, CausesAll Arthritis Dorsopathy Stroke Diabetes Asthma Chronic Obstructive Pulmonary Disease (COPD) Coronary Heart Disease (CHD)

Diabetes Diabetes hospitalization and ED discharge rates were disproportionately high for blacks living region. the in groups ethnic in the NIR, compared to other Three stable. relatively remained have NIR the in rates hospitalization and death 2000, diabetes Since overall. County the than higher slightly was (8.6%) diabetes with diagnosed residents NIR of Percentage disease. preventable a 2 diabetes, Type had 90% diabetes, with diagnosed ever adults NIR Among Cancer was the leading cause of death in the NIR in 2009. in the NIR in death of cause leading the was Cancer overall. County the than higher was residents NIR cancer among to due death of rate The years. two previous the within mammogram a 30 had age over women five of Three out a Prostate had 40 age over males 10 NIR in three Only

Disease Chronic

Table 4: North Inland Region Chronic Disease Rates Compared to County Rates County to Compared Rates Disease Chronic Region Inland 4: North Table    Diabetes      Cancer  (intentional (intentional and unintentional), communicable (infectious) diseases, and maternal and issue. each for statistics child health. The following section pro Population Health Issues Population health issues identified by the Team Leadership included cancer, heart diabetes, disease and dis stroke, pulmonary NORTH COUNTY REGIONS     and IntentionalInjuries drowning/submersion, cuts/piercing, cause ofdeath forall ages. fires/burns, d events, ( of cause adults leading the young are and and by/against ages, all children for County Diego San in struck death of related causes are leading the among crashes, injuries are Injuries unintent unintentional overexertion. call vehicle Most would preventable. Some and motor intent. predictable harmful are from they poisonings/overdoses, free because are not and are they purpose harm but or on violent caused “accidents,” have not and injuries are purpose that on caused injuries are are that injuries injuries are Unintentional injuries are Intentional Injuries unintentional. preventable. and or predictable intentional are many either so as that given especially problem, health public important an are Injuries Injury       PulmonaryDisease     DiseaseHeart and Stroke

Therate ofsuicide was highestamong males and65+year old residentsof the NIR, compared to other groups in theregion. Suiciderateswere the third lowestall of regions, while self NIRresidents had among thelowest ratesof assault injury in County. the Therate ofhomicide in North Inland was lowerthan theCounty rate. Black residentsof NIR the had higher rates ofasthma hospitalization andEDdischarge otherthan racial/ethnic groupsin the Theasthma EDdischarge rate was disproportionately amonghigh children aged 0 thanLess half of asthmatics ever receivedasthmaan managementplan afrom health professional. Theproportion of NIR adults who were ever diagnosed with asthma was lowerany inthan other region. NIRasthma and COPD hospitalization andEDdischarge rateswere among the lowest in the County. SinceAsthma2000, andCOPD death andhospitalization rateshave fluctuated,however decreasing overall. i groups racial/ethnic other to compared high, disproportionately was region. NIR the in living whites among death stroke of rate The thoseOf with highblood pressure, two in One 20adults in NIR the was everdiagnosed with heartdisease, and one in threewas everdiagnosed with blood high pressu Coronaryheart disease and stroke deathand hospitalization have rates declined since 2000.

The following facts regarding intentional and unintentional injuries are provided for NIR as follows: as NIR for provided are injuries unintentional and intentional regarding facts following The Table 5 Table ). In the NIR, unintentional injuries were the sixth leading cause of death, and suicide was the ninth the was suicide and death, of cause leading sixth the were injuries unintentional NIR, the In - thirdswere taking blood pressure medication. ( N ORTH - inflictedinjury hospitalizations werelower nearlythan all othe

C OUNTY 136

EGIONS

)

- 14, compared 14, to otherage groupsin theregion.

r r regions.

re ful

cla gion. eat to to re.

ssified ssified intent. intent.

t n ion falls, falls,

h for for h

he al al NORTH COUNTY REGIONS ared ared to

omp l. l.

↓ ↓ ↓ ↓ ↑ ↑ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ County

Higher or Lower than than Lower or Higher

7.5% 4.5% 8.7% 3.2%

20.6% 20.2% 26.9% 26.6% 15.7% 60.7% 42.7% 60.7% 42.7% 39.0% ------Difference

Percent (Burden)

)

2.8 2.8 33.1 18.7 78.8 78.8 52.9

308.6 308.6 233.8 594.2 579.5 18 (Risk)

5354.9 2035.0 County Rate*County EGIONS R

137 OUNTY

1.1 1.1 27.9 11.4 81.3 72.9 50.5 176.7 176.7 171.0 436.4 630.2 4249.5 1624.3 ORTH N ( NIR Rate* (Risk) Rate* NIR

24 were at greatest risk for motor vehicle injury. injury. vehicle motor for risk greatest at 24 were -

5 injured in a motor vehicle accident were not properly restrained in a car/booster seat. car/booster in a restrained properly not accident were motor vehicle a in 5 injured - Related Injury - Assault Suicide Homicide Related Injury Indicator - Inflicted Injuries - involved accidents and drinking drivers for this age group was nearly double that of all other ages. other all that of double nearly was group this for age drivers drinking and accidents involved Fall - Motor VehicleMotor Injury Self Overdose/Poisoning related deaths were notably higher, especially among older adults. among older adults. especially higher, notably deaths were related Alcohol MVC Involved

Firearm Total Injuries from MVC - Drinking Involved Driver MVC Pedestrian Residence Injuries by Pedestrian Occurrence Injuries by Unintentional (All Causes) Injury

Injuries Table 5: Injury Rates for North Inland Region Inland forRates North Injury 5: Table Residents and visitors to the region aged 15 aged region the to visitors and Residents alcohol of rate The 0 ages in 10 children Two injury. vehicle motor for discharge ED of rate a high had particular, in Blacks, The rate was higher among blacks living in the NIR than blacks living in most other regions. other most in living than blacks the NIR in living blacks among higher was rate The fall Unintentional NIR residents had similar rates of death and due hospitalization to motor vehicle injuries, but lower rates of ED discharge c the County. region. the in higher significantly were however, accidents, motor vehicle to due rates injury Total In the NIR, unintentional injuries were the sixth leading cause of death for all ages. all for death of cause leading sixth the were injuries unintentional the InNIR, overal County in the than injury for unintentional hospitalization death and of rates lower, or comparable, had residents NIR overall. County in the than residents for NIR lower was rate discharge ED overdose/poisoning The

           Unintentional Injuries Unintentional NORTH COUNTY REGIONS    have receivedearly prenatalcare. als were They overall. county the in than baby weight birth low or preterm a to birth given have to likely less were mothers in regions other most than higher and births,live 1,000 per deaths 4.4 average of County the thanhigher births, live 1,000 overallThehealthof communitya isoften measuredhealth theby its of mothers andinfants. Infant mortality inNIRthe wa Maternaland Child Health    likely less were residents NIR overall. County the chronichepatitis inC, AIDS, chlamydia,TB, gonorrhea,or syphilis than ofresidentsany other region. than NIR the in lower significantly was incidence disease Communicable Communicable (Infectious)Diseases

pretermor low weightbirth baby than the County overall. lowerpercentNIRAof mothers received earlyprenatalin the care Countyoverall. than However, wereslightly theylike less their firstchild was born. 2009,In 2.2% of all live in births the NIRwere agedto girls 15 20 of age the over were mothers three in two than More overall. County the in mothers than older generally were mothers NIR in SanDiego County occurred among residentsof the NIR. ever of out one nearly Region;South the but all in than NIR the in occurred births more births, County total of percent a As notablysince 2000. incr haswhich of rate commonlydiagnosedthemosttheSTD, was chlamydia Countyoverall, the than significantlylower Though 2009,In 21 new AIDS cases werereported in the lowerNIR, than any other region. Theincidence TB ratehas generallydecreased since and2000, was lowerin 2009than in anyof the previous nine years.

( N ORTH

C OUNTY 138

R EGIONS

)

- 17.

s 5 s the o l o

.1 deaths perdeaths.1

ess likely to likely ess county. NIR county. y f y ly to haveato ive births ive to to eas whe have ed n NORTH COUNTY REGIONS

to, to, and gui variety variety a

enhances enhances erships erships as

Community Community

ion

y and secondary secondary and y private private partn -

Live Live Well San Diego tiary prevention factors are specific specific are factors prevention tiary TERTIARY

Borrego Borrego Springs, Fallbrook, Palomar, ter

- . North Inland Region includes four cities

) 20

50 as a foundational concept, specific primar specific concept, foundational a as 50 - five five school districts - 4 - EGIONS North Inland Region and North Coastal and Inland North Region North Region

— twenty 139 North Inland Region and North Coastal Inland RegionNorth and Region North

OUNTY C —

SECONDARY ORTH City City and Palomar. There has been a long history of public N - (

Health factors listed in the tertiary prevention column were identified by North County Regions during the the during Regions County North by identified were column prevention tertiary inthe listed factors Health ) is an illustrative representation of how demographic and social/behavioral risk factors contribute to the to contribute riskfactors social/behavioral and demographic how of representation illustrative ) an is

. These Regions include nine cities and PRIMARY Figure 7 Figure *SOCIAL DETERMINANTS OF HEALTH Figure 7: Critical Pathway for North County Regions (Lack of Physical Activity, Poor Diet, Lack of of Ac- Lack Diet, Poor Activity, Physical (Lack of Regions County for North Pathway Critical Figure 7: Services) Health Behavioral to cess Note: This figure conveys the aspects of primary secondary, and tertiary prevention for chronic diseases in each Region. The The Region. each in diseases chronic for prevention tertiary and secondary, primary of the aspects conveys figure Note: This factors. prevention secondary and primary of identification in resulting Region, given for each a result of effective community engagement, including a diverse faith community. The cultural and ethnic diversity of the reg issues. health community addressing in participates to ensure everyone adaptability and flexibility the MiraCosta MiraCosta College. North County Regions an have abundance of resources natural promoting health and wellbeing, in addition to of community resources. This includes two hospitals, Tri (Esondido, (Esondido, Poway, San Marcos, and San Diego) and the six unincorporated communities of Anza Julian, Pauma, Ramona, and Valley Center. North Coastal Region includes the cities of Carlsbad, Oceanside, and Pendleton, San Vista. Die These Regions also includes California State University, San Marcos and the community colleges of Palomar College Community Community assets and resources unique to the North Regions County are toimperative the implementing Health Improvement Plan Community Assets and Resources (Themes and Strengths) Resources and (Themes AssetsCommunity and development of chronic disease. chronic of development 3 and the information, Withthis Regions. these for data status ofhealth review Regions. County North for identified were factors risk Factors Contributing to Population Health Challenges Population Factors to Health Contributing ( pathway critical The NORTH COUNTY REGIONS their residents. carecosts,immigration, limitedpublic transportation, increasedanand homeless population werehavingalsostrongimpacts fundingforces,felt38%andforcesstronglyweremost affecting health ( impactingNorthCountythehealthcommunity,of respondents nearlyof77% economy thatthefeltaffecting was health, while4 in presented are which health to threatsRespondents identified opportunities and County residents. The survey responses and findings are displayed in Northof County, andbrought forththe unique characteristics Northof County thatmaypose opportunities and/or threats t to CommunityThemes andStrengths Assessment. Theassessment identified which external forces andtrends arecurrently ChangeAssessmentimpactingForcesofThe disseminated was community surveyfo includedtotheusedRegions,bothwasmembers in andin ofChangeForces Assessment and/or threats to healththe of residents? Table 6: Whatare theunique characteristics of the community you serve that maypose opportunities TableKey 7: Findings: Forces ofChangeAssessment      Strengths:

     Opportunities:

Faith community resources natural of Abundance resources of community Variety diversity Cultural collaboration Community Faith Community Faith Diversity Cultural Collaboration Community/Agency Climate Housing Affordable

—

North Inland Region and North Regionand North Inland Coastal

( N

ORTH

C OUNTY Table 6 140        Conc      Threats:

Figure8

R Crime and violence and Crime Immigration diseases of chronic prevalence High transportation of public Lack Funding population Aging recovery Slow economic Transportation Immigration Population Homeless Budget Cuts Activity Crime/Gang EGIONS e below, with key findings summarized in r n s

: ). In addition,In community). membersincreasingthatfelt health

)

al 6 Table

We akd ht he fre wr currently were forces three what asked When .

Table 7 .

he on healthNorthof 4% the healththeof

th felt socialfelt e healthe r t r he NORTH COUNTY REGIONS

th eal he he data n t assessments, the assessments, Leadership

Forces Forces of Change

, and

) 22

EGIONS

141 OUNTY C

. . As the table portrays, the only concurrence between perception and data is Community Health Community Status ORTH , N ( Table Table 8 North InlandNorth Coastal Region and North Region

Community Perceptions Community — Figure 8: In general, what are the top THREE forces you believe are currently currently are believe you forces THREE top the what are In general, 8: Figure serve? you community the of health impacting

showed. encounter) encounter) data. This comparison is summarized in drug abuse. Lastly, the community actually perceived poor diet, mental health issues, and physical inactivity to be worse tha After After reviewing the results of the Team compared its perception, based on the demonstrated, North using California County Health Interview Regions Survey (CHIS) community data and survey Office of results, Statewide Health with Planning and what Development (h the actual available data Summary of Assessments Summary of Assessments NORTH COUNTY REGIONS Source:Death StatisticalMaster Files(CDPH), County of Diego,San Health Human & Services Agency, Public Health Services, E Preparedby:County of San Diego, Health & Human Services Agency,Public Health Services,Community Health StatisticsUnit, 2 Inactivity Physical Issues Health Mental Poor Diet Drug Abuse TableNorth 8: CountyRegions Community Survey Results Compared to CHIS Survey Data Community Survey Results Results Survey Community (Community Perceptions) (Community North County Regions Regions County North PatientDischarge Database (CA OSHPD),County of San Diego, Health & Human Services Agency, PublicHealth Services, Epidemiol EmergencyDepartment Discharge Database (CAOSHPD), County of San Diego, Health Human & Services Agency, PublicHealth Servic CurrentPopulation Estimates, 10/2012.

CurrentPopulation Estimates, 10/2012. CurrentPopulation Estimates, 10/2012. 56% 45% 59% 39%

or mental problems problems or mental emotional for help Needed or obese overweight who are Adults yearlast within the drank who binge Adults or transportation or transportation recreation, fun, for Walked

California Health Interview Survey Data 2009 Survey 2009 Data Interview Health California

North Coastal: 31% (lower than than 31%(lower North Coastal: county) than (higher 37.5% North Inland: North Coastal: 73.1% North Coastal: 73.6% North Inland: county)than (lower 12.4% North Coastal: county) (lower than 10.6% North Inland: county) than (higher 56.2% North Coastal: county) (lower than 49.8% North Inland: county) ( N ORTH

C OUNTY

142

EGIONS

)

Drug/Alcohol Drug/Alcohol ED Discharge N/A - - ED North Coastal - - Discharge ED North Inland diabetes with diagnosed ever Adults

Non Psychoses Psychoses Non Psychoses Psychoses Non Psychoses Discharge

013 pid

emiology & Immunization Services Branch; SANDAG,

Health Encounter Data 2009 2009 Data Encounter Health

N/A 304.0/100,000 215.6/100,000 317.8/100,000 192.4/100,000 county) than 5%(lower North Coastal: N/A North Inland: county) than (lower 158.9/100,000 North Coastal: 2006) since (increasing 138.3/100,000 North Inland: ogy es,

& Immunization & ServicesBranch; SANDAG, (OSHPD*)

EmergencyMedical Services;SANDAG,

–

Statistically Unstable Statistically

NORTH COUNTY REGIONS

e the the the ed ed to nland nland ealth/ to to re lat h I l l h ). ). A group s section of

North North County s. ion

, underutilization Table Table 9 ort ell

links links the priority areas with health

Live Live Well San Diego Figure Figure 7

: s) n r e

)

EGIONS Underutilization and lack of awareness of mental health health mental of awareness lack of and Underutilization services disease chronic of prevalence High obesity and overweight of rates High the NIR) in (particularly increasing abuse Substance injuries motor vehicle related Alcohol R

Risks (Conc Risks

     143 OUNTY The The critical pathway noted in

C .

ORTH

Key Priority Areas Priority Key N (

Behavioral Health/Substance Abuse Health/Substance Behavioral Nutrition Activity Physical

farms, trails, etc. trails, farms,

   — Key Findings from Community Health Assessment Community from Findings Key

Abundance of natural resources natural of Abundance High majority of North County residents has usual source source usual has residents County North of majority High care medical of activity physical in Report increase diseases communicable of rates Low rate the national below is rate mortality Infant Strengths:

Live Live Well San Diego Community Health Improvement Plan      Table 9: Table health health outcomes (tertiary prevention factors) and priority areas. The North County Regions Leadership Team selected behaviora eff planning improvement health community its for areas key priority as its activity physical and nutrition, abuse, substance collaborative collaborative will address to reach the vision of healthy, safe and thriving communities, as outlined in the North County Reg the outcomes unique to North County Regions. The pathway also outlines primary and secondary prevention factors that are related completion, completion, was also used to inform the team’s goals and strategic to issues confirm or that adjust their are direction, as significant deemed appropriate. challenges Below a within our North County communities that the By By analyzing the combined results of the Community Perceptions, Community Health Status, and North Forces of County Change Assessments, Community th Leadership Team identified three strategic issues. The Local Public Health System Assessment, upon its Priority Areas Identified from Assessments from Identified Areas Priority chronic chronic disease and a related risk behavior (i.e., physical activity), chronic disease and obesity rates are still high. As w noted. were to alcohol related injuries vehicle motor and increased, was abuse seen, substance was services mental health of After After the North County Regions Leadership Team reviewed all the data, a list of strengths and concerns was developed ( voting process was used to obtain consensus and agreement on and strengths concerns. Strengths of both and North Coastal Nort Regions are related to health care access, health outcomes, health behaviors, and natural resources. Despite the strengths re

SOUTH REGION COMMUNITY HEALTH ASSESSMENT

145 SOUTH REGION

PriorityAreas Assessments Identified from CommunityAssessmentsHealth CommunityHealth Improvement Process Leadership TeamMembers Table Contents of Forces ofChange CommunityAssets and Resources (Themes andStrengths) FactorsContributing Populationto Health Challenges Population Health Issues Strengthsand Risks Healthto Health ResourcesAvailability Demographics CommunityPerceptions Assessment Heart DiseaseHeart and Stroke Diabetes Cancer Socioeconomic Demographics CommunityDemographics DataSources

( S

OUTH 146

R EGION

)

11 11 9 9 8 8 8 8 7 6 6 6 6 5 4 4 3 2

SOUTH REGION

PRC) -

) 2

EGION R SanDiego

147

(SANDAPP) (AHEC) OUTH WALK WILDCOAST Nurse Family Partnership (HHSA) Operation Samahan Planned Parenthood Project Access Promotores Activos Por La Comunidad San Diego AdolescentPregnancy and Parenting Program San Diego County Dental InitiativeHealth San Diego OfficeCounty of Education San Diego Medical Society Foundation San Diego Prevention Research Center (SD San Ysidro Health Center San Ysidro School District Scripps Family Medicine and Area Health Education Center Sharp Chula VistaMedical Center South CommunityBay Services South GuidanceBay Center South UnionBay School District Sweetwater Union High School District Turning the Hearts Center S (

South Region Leadership Team consists of the following agencies/organizations: following the of Team consists Leadership Region South

South Region Leadership Team Leadership Region South

South Region -

Live Well San Diego Well Diego San Live

District 1

–

The current current The

bers: bers: Chairs: Chairs: m - Learning Center Chula VistaFamily Health Centers City of Chula Vista,Office of Recreation Mayor, the Department e National School District Maria Sardiñas Center National Children’s Study Program National City Collaborative La MaestraLa Community HealthCenters Imperial Beach HealthCenter Institutefor Public Strategies (IPS) International CommunityFoundation (ICF) Olivewood Gardenand CommunityHealth Improvement Partners (CHIP) County Diego,of San HHSA Home Start City of NationalCity, Planning Department Communities Against Substance (CASA)Abuse Chula Vista Community Collaborative (CVCC) Chula Vista Elementary School District Child WelfareChild Services Children’s Mental Health American Association of Retired Persons (AARP) Aging Independence& Services (AIS) Board of Supervisors Paulina Bobenrieth, Public Health Nurse Manager, HHSA South Region Region South HHSA Manager, Nurse Health Public Bobenrieth, Paulina M Co Regions South & Central HHSA Director, Deputy Jiménez, Barbara Live Well San Diego San Live Well

SOUTH REGION

omnt hat ipoeet ln b slcig e atvte ad niaos of indicators and activities key selecting success,to address identified the health issues. by plans improvement the developed health further team community The community. the and members team the by issues selected health strategic the and for objectives and goals Schools identifying by plans, health improvement community Systems, the developing begin Better to month other every Building met members coalition, the the by selected were as issues health the Once members. well Subcommittee Neighborhood as Committee, Leadership the on partners the from input involved it because process, collaborative a was Region South the for process assessment health community The space. shared Countywide a Meeting members. 20 onstored everyand are approximatelymeetingwere for andkept minutes meeting records attendance by attended were Meetings process. planning which determine and issuesthehealthregion onthroughout would community focus theirhealth improvement data health County review assessments, the of results to discuss month other every held were meetings leadership formed, team regional the Once and developedreports toinform future decisionmaking processes. data the analyzed consultant The strengths. partner and mapping, asset and resource The perceptions,wellas as currentconditions,of assessment an activity. includedplanning strategic recreational and food healthy affordable to access improve to strategies Healthy and Safe develop a and need of with areas identify and met planning strategic do team to Consulting Community The Region. South of all include West to area, physical Vista, project Chula HEAC the beyond and extend to and decided partners policies the transportation, ended, funding active for foods, advocating healthy to successfully physicalactivity Vista’s inschools Chula and community environments. HEAC the When access by increased that Vista improvements Chula western in Coalition (HEAC) childhoodobesity reduce to Endowment.HEACsoughtCalifornia The by funded project Communities Active Eating, Healthy Vista Chula the SRLT the process, engagement community the of part As Diego’s San of County the support to formed 2010, October In Live WellLive San Diego ie el a Diego San Well Live

SouthRegion Leadership Team ot Rgo Laesi Ta (RT was (SRLT) Team Leadership Region South Live Well San Diego San Well Live

is the second generation of generation second the is ( S OUTH

initiative ( initiative 148

R EGION

CommunityHealth Improvement Process -

3 five a

) Figure 1 Figure

- year ). Source: Improvement Diego’s Figure 2: OperationalRegions Figure 1:County SanDiegoof HHSA www.naccho.org/MAPP

Roadto Community Health

SouthRegion’s

Live SanWell

SOUTH REGION

sector strategies to address -

: Key Findings from Community Community from Findings Key s n r e do notdo provide health insurance Obesity rates Unemployment Commitment workto together ascoalition a with common mission and vision Focushigh on risk neighborhoods inChula Vista, National City, Imperial Beach,and San Ysidro, a community of the City of San Diego Implement multi chronic disease, obesity, and community safety Seek funding joint to assist the developmentin resourcesof to address needs Share resources Vulnerable populations: families, children, pregnant women,and older adults Chronic disease rates ratesCrime and safetylack of Lack access of affordable to healthy food Lack access of physical to recreationaland activity Smoking rates Lack or no of Insurance and low paying jobs

Table 1: Table   Strengths:       Conc       Perceptions Assessment Perceptions

)

EGION R

149 OUTH S

( based based organizations, promote we South South Region Leadership Team - 30 30 million vehicles and 50 million

changes changes that create safe, healthy, equitable and -

Live Live Well San Diego is is to improve community wellness and reduce health disparities

SRLT extends extends beyond west Chula Vista to serve all of South Region. South SRLT SRLT Lack of healthy food food access healthy Lack of use Tobacco violence and security Lack of Lack of access to health homes (medical, dental and mental) populations for vulnerable Lack of physical activity and active living active and activity physical Lack of

     The major needs identified are: identified needs major The members members came together to develop a mission, vision, goals, and activities. When the County’s accreditation process started, SRLT was ready to update the charter roadmap. and Public Public Health, Safe and meetings Healthy in which Communities the Consulting facilitated several Community Perceptions Assessment Perceptions Community In collaboration with Health and Human Services Agency (HHSA) South Region busiest busiest port of entry in the world, in 2009. States United the entering people with over Mesa, Mesa, Nestor Mesa, and San Ysidro. The region encompasses 155 square miles of land, and is bordered by the Pacific Ocean to the west, Otay Mountains Mexico in the to east, and the city of south, San Diego to the north. San Ysidro is the region region serves the residents of five Beach, cities: Coronado, National and City, City Chula of Vista, San Imperial Diego, including the communities of Otay Community Health Assessments Health Community The policy, policy, environment, and systems communities. public public health agencies, organizations and and professionals, community local governments, school districts, health care The goal of among the children and families of South Region San Diego. As a coalition of Live Well San Diego South Region Leadership South Team DiegoLive San Well

SOUTH REGION

regionalprofiles were generated,which influenced theidentification of health prioritiesSouth for Region. cur process, engagement community the during review this on Based sources. data above the review to SRLT the with worked CHSU Health Behavioral with development the of profiles address that olderadults and childrenin Working moredetail. abuse. substance Profil Community the and for plans Future health sources. based population mental through available indicators on the created staff information CHSU Services, based population for need unmet an was proce There planning improvement health community the during members community by driven was data Health Behavioral of addition The bycalendar year and are currently archived back to 2000 allowto andstaff public the compareto trendsover time. organizedrace/ethnicity,by age groupand gender for each of41communitiesthe thatcompriseSan Diego County.discharges.Dataare pos department emergency and discharges, healt hospital deaths, (mental as health reported behavioral are indicators include Most to abuse). substance expanded recently most and injury disea heath, (chronic) child noncommunicable and by maternal organized diseases, indicators communicable of dozens include to expanded list the quickly Very Region. HHSA each C Diego CA,SanUS, the werereported Healthy offor that objectiveslist People2010 short Community a asProfiles The began informationon health status andhealth behaviors by HHSA Region. l and state from as well as InterviewSurveyt CaliforniaHealth the from resultsselected incorporates CHSUServicesOSHPD. and RecordsVital including databases Health Public in branches various from data health pulls CHSU Survey. Community American HHSA each within Census the pulledfrom are communitieseconomic data and DemographicProfiles. Communitythe as onlineinformation this posts and and Region, Region HHSA by organized data health and behavioral economic, demographic, generates CHSU economicfalls, burden ofdisease, health disparities,and health status), health briefs, fact sheets, and atlases.All are a ( reports specific other profiles, health community the including publications, generatesto CHSU support communities. theirand and data Regions Pub health public HHSA for contact in of point located single a (CHSU),provide to Unit 2005 in Statistics formed CHSU Health The Division. CommunityServices Health the by developed annually are reports profile community Regional RegionalProfiles (Health Status Assessment) local the public health assessment can be infound theoverarching document. public,private, andvoluntary entities contributing thetodelivery theof10Essential Public Health Services. JuneOn 29,2012, HHSA conducted Locala Public Health System Assessment (LPHSA) evaluateto allsectors healthina system, LocalPublic Health SystemAssessment DataSources

( S OUTH

150

R EGION

)

A full description of the results of results the of description full A

vai lable

These data a data These online e.g oun es the ted o p o inc

., senior ., an include ty, andty,

HHSA rovide online a h . luding

d the d ses oca ren ss. nd lic re t , l

SOUTH REGION

- - lth had of of a have have f any ver ver a hat a ivate on ts ts pr t o h h (24%)

y 25% of y 25% of ral ral acute urt arl ene range range safety net

Black4.41% Asian13.40% Other 3.31% White 24.55% Hispanic 55.33% - Racial Racial - based based organizations, met o - Demographics Demographics South Region Region South

Figure 3: Racial Demographics Racial Figure 3: - -

)

Thirty ). ). Most 6

EGION R

151 Figure Figure 3

OUTH S (

South South Region’s population is made up

Hispanic Hispanic White and 13.4% Asian ( -

month period to identify major issues, trends, and priority strategies and actions in South Region. The workgroup agreed t - five comprehensive approach was necessary to address the major issues and that this approach would strengthen the South Region hea assessment assessment showed that the South Region was the most vulnerable region in San Diego County. The action plan called for creati South Region work group to address the high risk issues and trends identified in the study. The South Safety public partnership Net comprised of workgroup, members from a hospitals, clinics, physicians, consumers, and community In South Region, there are 16 community clinics and six chronic dialysis clinics. There are five home health agencies, four g care hospitals with emergency departments, and ten skilled nursing facilities. In 2006, the Abaris Group’s long of South Region’s adult population has not completed high school. school. high completed has not population adult Region’s of South Health Resources Availability children and families live below the federal poverty line. line. poverty federal the below live families and children South Region has some of the lowest rates of educational attainment and highest rates of poverty in the County. Nearly one fo household household income, according to the last census, was $70,109 (US Census Bureau (2005)). One third (33.6%) of the region’s adul ne the region, of parts In the some in County. rate the highest second (FPL), Level 200% Poverty the below of Federal incomes the next lowest median household income in the region at $31,255, but the 27% increase in median income was one of the larges jurisdiction between 1990 and 1998. The 2000 census reports Imperial Beach’s median household income as $35,882. Chula Vista the fastest growing median income at over 30% between 1990 and 1998; its median household income is $44,861. Bonita’s median income community, with income a with community, median of income household $13,000 per and year, has theof housing highest public concentration in has Diego City San County. National Socioeconomic Demographics Socioeconomic South Region represents diversity in household income. San Ysidro is a low at home. Nearly one in four residents in South younger. Region is fourteen years old or of 55.3% Hispanic, 24.6% non of the region’s cities and communities have Latino majority populations. Spanish only speak 20% residents and of bilingual is the four population of percent With nearly half a million (460,739) residents, the South and ethnically culturally diverse population. Region is home to an Community Demographics Community Demographics

SOUTH REGION

and poorsidewalk conditions as a risk or concern. Further strengths and risks are locatedin p identified SRLT the overall, Region, South of parts some in identified are resources living active Although identified. was demandf populationand growinga withcapacity, clinic shortageof a wellas departments,emergencylocalasofovercrowding at higher t of prevalence the include risks Such concerns. or risks 3 the byidentified of diseases chronic share its has also Region South strengths, these are there While regionalBayshore Bikeway,another effort which supportsactive living. part is Region South residents. Region South for lifespan the across obesity combat Distr help also will effort SchoolThis Plan. General Vista Chula the of commitment passionate the is addressingchildhood obesity. strength significant A strengths. tangible many has Region South (HHSA)Regions. the for groundwork the laid plan, implementation year develop and forums community initiated Region South 2010, July in Supervisors, of Board Diego San of County the by initiative of strengths One the South of is Regionahistory strong of public Risks and Strengths to Health wellness.The partnersof workgroupthis are nowmembers of SRLT. the 3) and capacity, 2) access, 1) were workgroup care health this for identified areas priority major three The net. safety care     Strengths: TableKey 2: Findings fromCommunity AssessmentsHealth 

Bikeway. 23 of the is part Region South Plan. its General to Element Justice Environmental and a Health added City National on city gardens community establish to ordinance garden a community adopted Vista Chula Plan. General their to Element a Health added Vista Chula districts. other for model a as served has that policy school wellness a implemented District School Elementary Vista Chula 59% o 20. h SL ietfe a ak f ces o eia hms Mr seiial, sotg o hsia bd and beds hospital of shortage a specifically, More homes. medical to access of lack a identified SRLT The 2009. for

Health Communities South Region Coalition Charter and Two and Charter Coalition Region South Communities Health ie el a Deo omnt Hat Ipoeet Plan Improvement Health Community Diego San Well Live

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- - 4 mile regional Bayshore Bayshore mile regional - 50 concept 50 - owned vacant land. vacant owned –

diabetes, asthma, heart disease, and cancer. and disease, heartasthma, diabetes, ( S OUTH - privatepartnerships. Shortly approval the after the of 152

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Stigma around mental health mental around Stigma conditions poor sidewalk Poor walkability: areas in commercial especially trash, and Graffiti vegetables and fruits fresh to affordable access Limited crossings street safe and of lighting Lack space open and parks centers, of community Lack home to medical of access Lack stores convenience and liquor of density High outlets food fast of density High advertising Alcohol

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153 OUTH S (

highest rates of coronary heart disease deaths (112/100,000) in the County. the in (112/100,000) deaths disease heart coronary of rates highest South Region’s communities of color are disproportionately affected by heart disease and stroke. South Region’s the County. Latinos of parts other in group ethnic same the to compared also death, disease heart of rate higher The The rates of diabetes death, hospitalization, and emergency department discharge in South Region residents were disproportion regions. other in counterparts their than older adults and Latinos among higher In 2007, heart disease and stroke ranked first and third as the leading causes of death in South Region. South Region has one In 2009, cancer deaths were higher among White South Region residents compared to region. any other racial or ethnic group in any oth

For these reasons, For South Region these reasons, ratehas a mortality 59% todue the 3 challenges. these health to contribute   Heart Disease and Stroke Stroke and Heart Disease Type 2 Diabetes 2 Type Diabetes   and pulmonary diseases, such as asthma. Cancer South Region is the most impacted region in the county. It specific has chronic the conditions highestaccount for percentagethe majority(59%) of ofthese high chronic death percentages;disease cancer, heart disease and stroke, type Population Health Issues

SOUTH REGION

Diego Unified School District). South Region also has the community college of Southwestern College. assetsand resourcesof Region.this Southwestern of college community the has also Region South District, D District). School School School Unified Unified CoronadoDiego Union District, Bay School High South Union Sweetwater District, District, School School Ysidro Elementary San Vista District, School Chula Dehesa District, School (National districts school eight and Beach) the Plan Improvement implementing to imperative are Region South to unique resources and assets Community andCommunity Assets (Themes and Resources Strengths) th and information, this With Region. this for data status health foundational concept, of specific primary and secondary factors risk were reviewidentified for South Region. the during Region South disease by chronic identified to were due column death to precursors are that outcomes health of development the facto risk socialdemographic,behavioralCombined, andlifetime. the overdevelopand individuals age as outcomeshealth the modifiableare(factorsthat factorsrisk social behavioraland outcomes.there,health From of earliest stages the in impact non are that(factors pathway,factorsriskdemographic the of beginning stage the At chronicdisease. of development ( Pathway Critical The Contributing Health toFactors Population Challenges specific eachfor given Region, resulting in identification primary of and secondary prevention factors. ThisNote: figure conveys aspectsthe of primary secondary,and tertiary prevention for chronicdiseases in each Region. The Access Healthto Care) Figure 4:Critical Pathway South for Region (Lack ofPhysicalActivity, Poor Diet, Lackof Safety, Lackof *SOCIAL DETERMINANTS OF HEALTH OF DETERMINANTS *SOCIAL PRIMARY . The Region includes seven cities (San Diego, Chula Vista, National City, Coronado, San Ysidro, Bonita, and Imperial and Bonita, Ysidro, San Coronado, City, National Vista, Chula Diego, (San cities seven includes Region The

iue 4 Figure ) is an illustrative representation of how demographic and social/behavioral risk factors contribute to the to contribute factors risk social/behavioral and demographic how of representation illustrative an is )

SECONDARY

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TERTIARY

Health factors listed in the tertiary prevention tertiary the in listed factors Health ie el a Diego San Well Live

ter tiaryprevention factors are Following are some highlighted some are Following -

modifiable omnt Health Community ) b ) egin to impactto egin 3 e rs rs - 4 ) have an have ) influence and - 0 s a as 50 ist

San rict, SOUTH REGION c e e al al bil that that ation ation it it munity munity healthy healthy enter in enter lts lts living e e C adu

funded clinic, Chula Vista Family Family Vista Chula clinic, funded - year plan: plan: year -

centered “medical home,” and implemented inform home,” and “medical centered implemented -

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155 A consortium of existing community clinics, led by San Ysidro Health Center, Center, Health Ysidro San by led clinics, community existing of A consortium Family Health Centers opened the federally opened Centers Health Family OUTH

S ( competent parent education on appropriate use of health care system and and system care use of health on appropriate education parent competent

Chula Vista Community Collaborative and Scripps, Area Health Education Center, trained and trained Center, Education Area Health and Scripps, Collaborative Community Vista Chula

funded community funded clinic. community -

based prevention. based prevention. - stay intensive care for babies. Additionally, their Medical Residency program teaches medical residents about com residents medical teaches program Residency their Medical care stay for intensive Additionally, babies. -

health health programs and education. The Area Health Education Center (AHEC) trains promotoras community. (community health the in workers) classes in hold to chroni management disease Sharp Chula Vista Medical Center which offers emergency care, intensive care, and comprehensive seminars. and classes health health care. They also provid Imperial Beach Health Center opened a new clinic, Nestor Community Health Center, in early 2011. early in Center, Health Community clinic, Nestor new a opened Center Health Beach Imperial Scripps Mercy Hospital in Chula Vista, which offers emergency care, intensive care services, and a neonatal short intensive provides care un health services, in addition to health education classes. education health to addition in services, health education. health and health medical offers which Center, Health Community La Maestra services. health behavioral and dental medical, offers which Clinic, Samahan Operation Car Urgent Family Bay South the and Clinics, education Family City health National as Vista, well Chula as Otay, includes services, which Center, health Health Ysidro San behavioral and dental, medical, offer clinics and center health The Vista. Chula Chula Chula Vista Family Health Centers of San Diego, which provides medical, dental and behavioral health services. They have a mo care. health accessing to barrier a is transportation where in areas families to access that provides clinic Imperial Beach Health Center, which includes the Nestor Community Health Center. Both centers offer medical, dental, and ment Increased access Increased to federally Center. Health Improved community culturally to provide workers health community employed behaviors. Enhanced capacity of capacity Enhanced South clinics. Region community the by clinic capacity expanded patient urgent care, existing expanded providing coordination. care patient improve to technology

Additionally, Additionally, the County HHSA South Region Center provides general public health and social toservices children, youth, and Center offers: Region The South Region. South in working and  The South Region hospital partners include: partners hospital Region South The        The South Region clinic partners include: partners clinic Region South The    Three efforts were initiated to address the priority issues identified by South Region in its original two original its in Region South by identified issues the priority address to initiated were efforts Three

SOUTH REGION

priorityareas. its as SanDiego a priority and preventionfactors) (tertiary outcomes health the to related are that preventionfactors secondary and primary in noted pathway critical The Priority Areas Identifiedfrom Assessments economic from range factors These community. the of health the impact cultural,and geographic, thatto health trends and forces external identified members SRLT ofChangeForces Assessment  

CountyMedical Services assistance program for eligible adult residents with serious health problems. Clinicand visiting home publichealth services throughthe Maternal and Child Health Programand Nurse the FamilyPartnershi s t rate South RegionLeadership Team g ic

issues. issues. TableExternal 3: Forces/Trends ImpactingCommunity Health       

Fluctuation in the State budget and other funding sources sources other funding and budget State the in Fluctuation high unemployment and Slow economy world the in crossing border busiest the in resulting Mexico, to Proximity obesity of Prevalence local policies and state, federal, Emerging clients dualresidency or of binational number High information and services appropriate culturally and for linguistically demand Increased The South Region’s section of the the of section Region’s South The Figure 4 Figure - relatedissues.

  

links the priority areas with health outcomes unique to South Region. The pathway also outlines also pathway The Region. South to unique outcomes health with areas priority the links PhysicalActivityand Healthy Eating ImproveSecurity and Decrease Violence Health CareAccess identi f i ed

health care access, security and violence, and physical activity and healthy eating eating healthy and activity physical and violence, and security access, care health KeyPriority Areas

Live Well San Diego Community Health Improvement Plan Improvement Health Community Diego San Well Live ( S OUTH 156

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addresses these addresses rea s. Live Well Well Live p.

ACKNOWLEDGMENTS

We would like to thank the following individuals for providing the leadership, data, and technical assistance to complete this document.

Public Health Officer Project Support HHSA Staff Jayne Reinhardt, M.P.H.

Wilma J. Wooten, M.D., M.P.H. Nora Bota, M.P.H. Ashley Barbee, M.P.H. Kathryn Rogers, M.Sc.

Giang Nguyen, M.P.H. Amelia Barile-Simon, M.P.H. Alicia Sampson, M.P.H., C.P.H. County of San Diego Health and Human Services Agency Bruce Even Dania Barroso-Conde, MA, M.P.H. Renee Sherrill (HHSA) Executive Leads Brooke Lejeune-Chanman, M.P.H. Paulina Bobenrieth, P.H.N., R.N., M.P.H. Veronica Villareal, M.D. Dale Fleming Selina Brollini, M.P.H. Ann Vilmenay, M.P.H. Marie Brown-Mercadel, M.A., East/North Central Regions Data Support Roxanne Bueltel Romalyn Watson, M.P.H. Barbara Jimenez, Central/South Regions Leslie Upledger Ray, M.P.H. Bonnie Copland, P.H.N., R.N., M.S.N. Jackie Werth, M.P.A., P.M.P. Chuck Matthews, M.B.A., M.S., North County Regions

Nina Iwanaga, M.P.H. Pam Smith (retired) HHSA Regional Lead Staff Contract Support Hanna Kite, M.P.H. Tina Emmerick, M.P.H., Central/South Regions Peter Barron Stark Companies Project Lead Jenel Lim, M.P.H. Katie Judd, M.P.A., East/North Central Regions Harder + Company Community Research Tamara Maciel Bannan, M.P.H. Curley Palmer Carey Riccitelli, M.P.H., North County Regions Elena Quintanar, M.P.H.

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