2013 Community Health Needs Assessment
Together We Can Grow A Healthier Community
Consultant
PIH Health’s 2013 Community Health Needs Assessment was conducted by Melissa Biel DPA, RN of Biel Consulting. Biel Consulting is an independent consulting firm that works with hospitals, clinics and community-based nonprofit organizations. Dr. Biel has over 10 years of experience in the field of community benefit, which includes work on hospital community health needs assessments.
The 2013 Community Health Needs Assessment (CHNA) presents data regarding PIH Health’s primary service area cities/communities. PIH Health is situated in the southeast portion of Los Angeles County, within an area referred to as Service Planning Area 7 (SPA 7). The primary service area is determined by hospital discharge data obtained through the Office of Statewide Health Planning and Development; approximately 73% of PIH Health discharges come from the nine cities/communities noted below. PIH Health’s secondary service area includes additional cities in the San Gabriel Valley and North Orange County.
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Primary Service Area Hacienda Heights 91745 La Habra 90631 La Habra Heights 90631 La Mirada 90638-90639 Montebello 90640 Norwalk 90650 Pico Rivera 90660 Santa Fe Springs 90670 Whittier 90601-90606
Secondary Service Area - West Secondary Service Area – East Bell 90201 Chino Hills 91709 Bellflower 90706 Diamond Bar 91765 Downey 90240-90242 La Puente 91744 Los Angeles 90022 La Puente 91746 Los Angeles 90040 Rowland Heights 91748 South Gate 90280 Walnut 91789 West Covina 91792 Table of Contents
CHAPTER ONE l Background and Purpose ...... page 1
CHAPTER TWO l Overview of Key Findings ...... page 2
CHAPTER THREE l Data Collection Methods...... page 12
CHAPTER FOUR l Priority Health Areas and PrioritizedHealth Needs...... page 14
CHAPTER FIVE l Demographic Profile: PIH Health Primary Service Area...... page 16
CHAPTER SIX l Social Determinants of Health ...... page 21
CHAPTER SEVEN l General Healthcare Access ...... page 29
CHAPTER EIGHT l Maternal and Infant Health ...... page 32
CHAPTER NINE l Oral Health ...... page 36
CHAPTER TEN l Mental Health ...... page 37
CHAPTER ELEVEN l Preventative Healthcare ...... page 39
CHAPTER TWELVE l Health Behaviors ...... page 40
i Table of Contents
CHAPTER THIRTEEN l Weight Status, Nutrition, and Physical Activity ...... page 42
CHAPTER FOURTEEN l Chronic Diseases ...... page 46
CHAPTER FIFTEEN l Leading Causes of Death ...... page 49
CHAPTER SIXTEEN l PIH Health Clinical Care ...... page 60
APPENDICES l Appendix A: Geographical Information System (GIS) Maps of PIH Health Primary Service Area l Appendix B: Key Stakeholder Interview and Focus Group Participants l Appendix C: Key Stakeholder Interview and Focus Group Perceptions l Appendix D: Community Survey Responses l Appendix E: Whittier Area Profile l Appendix F: Community Health Facilities and Other Resources
ii Chapter One Background and Purpose
PIH Health is a nonprofit regional healthcare delivery network that was founded in 1959 by volunteers who went door-to-door with coffee cans to raise funds to build a local healthcare facility. Over 50 years later, PIH Health has maintained that same sense of community and family-like culture where patients are the top priority, and employees and volunteers are proud to be affiliated with such an organization. PIH Health offers a wide range of services, including utilization of primary care teams to provide general medicine and preventative care; access to emergency and urgent care, home health services, and hospice; and a network of physicians and advanced practice professionals in accessible and welcoming neighborhood locations. PIH Health is committed to remaining at the forefront of healthcare advances, and its highly trained and compassionate physicians, nurses, clinicians, staff, and volunteers work tirelessly and collaboratively every day to be the communities’ health and wellness partners.
PIH Health has conducted this triennial Community Health Needs Assessment (CHNA) in fulfillment of requirements set forth by California Senate Bill 697 (SB 697) and the federal Patient Protection and Affordable Care Act (PPACA). In planning this 2013 CHNA, PIH Health took a focused approach to obtaining detailed data on its three priority health areas, while still ensuring a comprehensive assessment of community needs. These three priority health areas (noted below) were identified by PIH Health’s Community Benefit Oversight Committee (CBOC) as a result of the 2010 CHNA.
Health Access to ensure basic and preventative care access for the uninsured and underinsured via: 1) effective use of health insurance enrollment resources; 2) promotion of free and low-cost health-related resources and services; and 3) collaborative efforts to meet community needs.
Healthy Living to deliver health promotion and prevention programs that 1) enhance health-related knowledge and behavior, and 2) support policies and environmental changes, which promote healthy eating and active living with emphasis on making the healthy choice the easy choice.
Health Management to improve community health through efforts seeking to 1) enhance health-related knowledge related to prevention and management of chronic diseases; 2) increase awareness of the importance of various prevention strategies (i.e. immunizations and screenings); and 3) promote available community resources.
The data findings and community input gained through this CHNA highlight key health needs and opportunities for action. This information greatly assists PIH Health and the CBOC with the following:
1| Validation of existing priority health areas; 2| Development of PIH Health’s Implementation Strategy, which identifies priority health areas and initiatives to address significant health needs of our communities plan; and 3| Identification and design of meaningful initiatives that will prove to be an effective use of PIH Health’s charitable resources.
Next Steps The 2013 CHNA will be made widely available to the public via PIHHealth.org/chna.pdf; Assessment findings will be distributed to key stakeholders, as well as shared with the community at-large, with emphasis on providing community-based organizations with information that will support program planning and fund-development endeavors, while sparing the expense of duplicative data collection efforts; Assessment findings and Implementation Strategy initiatives will be shared and community dialogue encouraged through community events, with area agencies invited to partner on initiatives.
1 Chapter Two Overview of Key Findings
This overview section summarizes significant needs assessment findings related to PIH Health’s primary service area, drawn from an analysis of the primary and secondary data. A detailed narrative that examines each of the data sets, along with data sources, immediately follows in the next section of this report.
Demographic Profile – Primary Service Area The population is 606,484. From 2000 to 2010, the total population increased by 1.2%. Children and youth (ages 0-17) make up 25.7% of the population; 31.4% are 18-39 years of age; 30.8% are 40-64; and 12.1% of the population are seniors, 65 years of age and older. The largest population by race and ethnicity is Hispanic or Latino (67.7%). White/Caucasians make up 18.8% of the population; Asians comprise 10.4% of the population, and African Americans, Native Americans, Hawaiians, and other races combined total 3.1% of the population. Spanish is spoken in 48% of the homes; 41.2% of the residents speak English only, and 8.5% speak an Asian language.
Social Determinants of Health – Primary Service Area 10.2% of the population is at poverty level; 30% of the residents exist at 200% of the Federal Poverty Level. Montebello has the highest rates of children living in poverty (22.6%). The unemployment rate in the area is 10.2%. Unemployment has decreased since 2010. The service area has a higher high school graduation rate (91.6) than the Healthy People 2020 benchmark (82.4). There are 183,129 housing units in the area. Most of the housing units in the service area are owner occupied (62.3%). Just over one-third of the housing units (34.1%) are renter occupied. The median household income ranges from $50,881 in Montebello to $121,380 in La Habra Heights. Santa Fe Springs (449.9) and Norwalk (425.4) have the highest rate of arrests for violent crimes per 100,000 persons.
General Healthcare Access – Primary Service Area 79.3% of the total population has health insurance; 90.4% of children under age 18 have health insurance coverage. Among adults, ages 18-64, 71.3% have health insurance. Adults in SPA 7 experience a number of barriers to accessing care, including: cost of care, lack of a medical home, language barriers, and lack of transportation. Among residents of SPA 7, 9.3% of residents delayed care and 6.3% delayed obtaining prescription medications.
Maternal and Infant Health – Primary Service Area In 2011, there were 7,774 births. The number of births has decreased from 2008 to 2011. Teen births occurred at a rate of 78.7 per 1,000 births (or 7.9% of total births). Teen births have decreased from 10.5% in 2008 to 7.9% in 2011. 86.9% of pregnant women entered prenatal care within the first trimester. PIH Health breastfeeding rates show 87.5% of new mothers use some breastfeeding and 43.4% use breastfeeding exclusively. The infant mortality rate averaged 4.6 deaths per 1,000 live births over a five-year period (from 2006-2010).
2 Oral Health – Primary Service Area 10.2% of children in SPA 7 had never been to a dentist. 3.7% of teens in SPA 7 had never been to a dentist. The main reason why SPA 7 households delayed dental care for children (15.7%) and teens (10.8%) was that they were unable to afford the care or had no dental insurance coverage.
Mental Health – Primary Service Area Among adults, 5.5% in SPA 7 experienced serious psychological distress in the past year. 45.7% of adults in SPA 7 who needed help for an emotional or mental health problem did not receive treatment. 16.7% of teens in SPA 7 needed help for mental health problems. 11.1% of adults in SPA 7 had moderate to severe interference with work because of mental health issues; 14.8% had moderate to severe interference with family relationships due to mental health issues; and mental health concerns impacted the social lives of 14.3% of adults. 4.5% of adults in SPA 7 had seriously thought about committing suicide.
Preventative Healthcare – Primary Service Area Among seniors, 68.2% in SPA 7 had received a flu shot, and over half of the seniors (56.6%) had obtained a pneumonia vaccine. In SPA 7, 77% of women, age 40+, have had a mammogram, and 85% of women have had a Pap smear in the past three years. 71.1% of adults 50 and over had been screened for colorectal cancer.
Health Behaviors – Primary Service Area 11.3% of the population in Whittier smokes cigarettes. Norwalk (14.5%) has the highest rate of smoking in the service area. Among adults, 30.2% in SPA 7 had engaged in binge drinking in the past year. In SPA 7, 5.5% of teens had engaged in binge drinking.
Weight Status, Nutrition, and Physical Activity – Primary Service Area In SPA 7, over one-third of the adult population is overweight (34%); 18.8% of teens and 15.2% of children are overweight. Adult overweight and obesity by race and ethnicity indicate high rates among African American adults (78.6%) and Whites (72.1%). 64.1% of Latino adults are overweight or obese. West Whittier/Los Nietos (31.1%) and South Whittier (29%) have high rates of obesity among youth. Over one-third (33.5%) of the residents eat fast food three to four times a week. 23.5% of children and teens consume two or more sodas or sweetened drinks a day. In SPA 7, over half of the children (53.6%) consume five fruits and vegetables in a day. In SPA 7, 17% of children were sedentary during the week.
Chronic Diseases – Primary Service Area 21.8% of adults and 38.5% of seniors in SPA 7 consider themselves to be in fair/poor health. The rate of diabetes has increased from 10.5% in 2005 to 16.2% in 2011 of the adult population in SPA 7. For adults in SPA 7, 6.2% have been diagnosed with heart disease, and 26% of adults have been diagnosed with high blood pressure. The population diagnosed with asthma in SPA 7 is 11.5%, with 43% of asthmatics taking medication to control their symptoms. Among youth in SPA 7, 16.2% have been diagnosed with asthma. 28.8% of adults in SPA 7 had a physical, mental, or emotional disability.
3 Leading Causes of Death – Primary Service Area In SPA 7, the top three causes of premature death were: heart disease, homicide, and motor vehicle crash. In the service area, the top three causes of death were: heart disease, cancer, and stroke. The heart disease death rate of 169.1 per 100,000 persons exceeds the State rate (165.3) and the HP 2020 objective rate (100.8). The cancer death rate of 154.7 per 100,000 persons exceeds the State rate (154.5), but meets the HP 2020 objective by falling under 160.6 deaths per 100,000. The diabetes death rate of 25.9 per 100,000 persons exceeds the State rate (19.8), but meets the HP objective by falling under 65.8 deaths per 100,000. The influenza/pneumonia death rate of 20.6 per 100,000 persons exceeds the State rate (17.4).
PIH Health Clinical Care In 2010, Medicare served as the payer for over one-half of PIH Health patients (50.8%). PIH Health Emergency Department admissions increased from 52,801 in 2010 to 54,758 in 2011. In 2011, 1,350 patients were diagnosed with cancer or received cancer care at PIH Health. The top five cancer sites at PIH Health are: breast, digestive system, male and female genitalia, and respiratory/intrathoracic.
Community Perceptions: Interviews, Focus Groups & Survey Summary The following perceptions and/or concerns were expressed through stakeholder interviews, focus groups, or community surveys:
Access to healthcare continues to be a major health issue in the community. Access encompasses a number of issues including: insurance coverage, costs associated with healthcare, availability of specialty care, dental care and mental health care, and community resources such as transportation and information on available services.
Area residents are working to improve healthy lifestyles, including increasing physical activity and improving healthy eating—but more work needs to be done. Overweight, obesity, and chronic diseases continue to be considerable health concerns in the service area.
A key strategy recommended for making an impact was to bring services to people in the places where residents naturally congregate, and not expect people to access services at the hospital setting. A number of participants talked about the opportunities for PIH Health to partner with community organizations, which have relationships with their service population, for education, outreach, and the provision of services.
4 Data Highlights The 2013 PIH Health CHNA of our primary service area communities revealed the following statistics related to demographics, social determinants of health, and general healthcare access.
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6 Leading Health Indicators Where data are available, health and social indicators in the primary service area are compared to established leading health indicators. These leading health indicators are aligned with Healthy People 2020, an “ambitious, yet achievable 10-year agenda for improving the nation’s health,” led by the Federal Department of Health and Human Services. These are “a small set of high priority health issues that represent significant threats to the public’s health.”
Leading Health Indicator HP 2020 Objective Local Data Status Chapter Six: Social Determinants of Health
High School Graduation Rate 82.4% 169.1 per 100,000 Target Met
Proportion of students who graduate with a
regular diploma 4 years after starting 9th grade Source: CA Department of Education, 2010-2011 school year. Data represent public schools only.
Violent crime rate 469.0 per 100,000 401.9 per 100,000 Target Met
Source: California Department of Justice, Office of the Attorney General, 2010; U.S. Census 2010
Chapter Seven: General Healthcare Access
Adult health insurance rate 100% 71.3% Target Not Met
Source: U.S. Census Bureau, 2009-2011 American Community Survey
100% Target 100% 90.4% Child health insurance rate 100% 90.4% Not Met
Source: U.S. Census Bureau, 2009-2011 American Community Survey 0% HP 2020 PSA
Target Adults with a specific source of 89.4% 77.5% Not ongoing care Met
Source: California Health Interview Survey, 2009
PSA= Primary Service Area; SPA 7= Service Planning Area 7 Green Chart Background = indicates the area that achieves the Healthy People 2020 Objective Orange Chart Background = indicates the area that does not achieve the Healthy People 2020 Objective
7 Leading Health Indicator HP 2020 Objective Local Data Status Chapter Seven: General Healthcare Access (continued)
Target Adults who delay obtaining medical 4.2% 9.3% Not care Met
Source: California Health Interview Survey, 2009
Adults who delay obtaining 2.8% 6.3% Target Not prescription medications Met
Source: California Health Interview Survey, 2009
Chapter Eight: Maternal and Infant Health
Early prenatal care 78% of women 86.9% of women Target Met
Source: California Department of Public Health, 2008 + 2011
Mothers who breastfeed (ever) 81.9% 87.5% Target Met
Source: California Department of Public Health, PIH Health Hospital, 2011
Target Low-birth weight infants 7.8% of live births 6.7% of live births Met
Source: California Department of Public Health, 2008 + 2011
Target Infant death rate 6.0 per 1,000 live births 4.6 per 1,000 live births Met
Source: California Department of Health Services, 2006-2010
PSA= Primary Service Area; SPA 7= Service Planning Area 7 Green Chart Background = indicates the area that achieves the Healthy People 2020 Objective Orange Chart Background = indicates the area that does not achieve the Healthy People 2020 Objective
8 Leading Health Indicator HP 2020 Objective Local Data Status Chapter Ten: Mental Health
Suicides 10.2 per 100,000 6.4 per 100,000 Target Met
Source: CA Department of Public Health, 2008-2010, Age-adjusted using 2010 Census data
Chapter Eleven: Preventative Healthcare
Target Adults who received a colorectal 70.5% 71.1% Met cancer screening
Source: California Health Interview Survey, 2009
Target Seniors who received an annual 90% 68.2% Not influenza vaccination Met
Source: California Health Interview Survey, 2009
Target Seniors who have received a 90% 56.6% Not pneumococcal (pneumonia) Met vaccination Source: Los Angeles County Department of Public Health, Los Angeles County Health Survey 2007
Target Women who have had a screening 81.1% 77.0% Not mammogram Met
Source: Los Angeles County Department of Public Health, Los Angeles County Health Survey 2007
Target Adult women who had a Pap smear in 93% 85% Not the last three years Met
Source: Los Angeles County Department of Public Health, Los Angeles County Health Survey 2007
PSA= Primary Service Area; SPA 7= Service Planning Area 7 Green Chart Background = indicates the area that achieves the Healthy People 2020 Objective Orange Chart Background = indicates the area that does not achieve the Healthy People 2020 Objective
9 Leading Health Indicator HP 2020 Objective Local Data Status Chapter Twelve: Health Behaviors
Target Cigarette Smoking - Adults 12% Communities ranged Not from 9.4%-14.5% Met
Source: LA County Department of Public Health, Cigarette Smoking in Los Angeles County, 2010
Target Alcohol- Binge Drinking - Adults 24.3% 30.2% Not Met
Source: California Health Interview Survey, 2009
Chapter Thirteen: Weight Status, Nutrition, and Physical Activity
Adults who are obese 30.6% 30.1% Target Met
Source: Los Angeles County Department of Public Health, 2012
Childhood Obesity 14.5% Communities ranged Target Not from 17.6% - 31.1% Met
Source: Los Angeles County Department of Public Health, 2011
Chapter Fifteen: Leading Causes of Death
Target Heart disease deaths 100.8 per 100,000 169.1 per 100,000 Not Met
Source: CA Department of Public Health, 2008-2010, Age-adjusted using 2010 Census data
Target Diabetes deaths 65.8 per 100,000 25.9 per 100,000 Met
Source: CA Department of Public Health, 2008-2010, Age-adjusted using 2010 Census data
PSA= Primary Service Area; SPA 7= Service Planning Area 7 Green Chart Background = indicates the area that achieves the Healthy People 2020 Objective Orange Chart Background = indicates the area that does not achieve the Healthy People 2020 Objective
10 Leading Health Indicator HP 2020 Objective Local Data Status Chapter Fifteen: Leading Causes of Death (continued)
Cancer deaths 160.6 per 100,000 154.7 per 100,000 Target Met
Source: CA Department of Public Health, 2008-2010, Age-adjusted using 2010 Census data
Target Stroke deaths 33.8 per 100,000 35.9 per 100,000 Not Met
Source: CA Department of Public Health, 2008-2010, Age-adjusted using 2010 Census data
Unintentional injury deaths 36.0 per 100,000 20.6 per 100,000 Target Met
Source: CA Department of Public Health, 2008-2010, Age-adjusted using 2010 Census data
Target Homicides 5.5 per 100,000 5.5 per 100,000 Met
Source: CA Department of Public Health, 2008-2010, Age-adjusted using 2010 Census data
PSA= Primary Service Area; SPA 7= Service Planning Area 7 Green Chart Background = indicates the area that achieves the Healthy People 2020 Objective Orange Chart Background = indicates the area that does not achieve the Healthy People 2020 Objective
11 Chapter Three Data Collection Methods
2013 CHNA Enhancements
In conducting the 2013 CHNA, PIH Health implemented the following enhancements from the prior assessment: In preparation for primary data collection, community partners and PIH Health staff were surveyed as to desired data that would best assist with organizational planning efforts. A survey link was distributed electronically; a total of 163 responded. Responses resulted in expanded CHNA data. Those surveyed were also asked to identify potential individuals and groups to engage via interviews and focus groups. Responses were considered in primary data collection planning; Engaged community-based agencies in distributing a community survey of health needs to their clients; received 391 responses. Results can be found in Appendix D; Utilized Healthy People 2020 Leading Health Indicators as benchmarks for comparing service area data, page 7; and Included a separate profile of Whittier area community health data (Appendix E).
Primary Data Collection Primary data collection for this needs assessment consisted of targeted interviews, focus groups, a community survey, and a Photovoice project, which were used to gather information regarding perceptions and opinions from those representing the broad interests of the communities in our primary service area.
Key Stakeholder Interviews Key community stakeholders, identified by PIH Health and local partners, were contacted and asked to participate in the needs assessment through telephone interviews. Eighteen interviews were conducted in November 2012. The community stakeholders who participated in this needs assessment represented a cross-section of agencies representing a broad continuum of health and social services in the primary service area. Interview participants included leaders and representatives of medically underserved, low-income, minority, and chronic disease populations, as well as regional, state, or local health departments that have “current data or information relevant to the health needs of the community served by the hospital facility,” per IRS requirements. A list of the stakeholder interview respondents, including their titles and organizations can be found in Appendix B; a summary of interview results can be found in Appendix C.
Community Focus Groups Six focus groups were also conducted as part of the needs assessment during the months of October through December 2012. One focus group was conducted in Spanish and five in English. The Spanish group was conducted by a bilingual facilitator; responses were then translated to English and presented in a written report. Additionally, one focus group was conducted in April 2012 with the East Whittier City School District Community Advisory and Resource Education (C.A.R.E.) Council that focused on students’ perceptions on healthy eating and physical activity. Another focus group was conducted in August 2012 at the United Friends of the Children housing program. These eight focus groups engaged 106 participants. A list of the focus groups can be found in Appendix B; a summary of focus group results can be found in Appendix C.
Community Survey A web-based survey was used to collect primary data from area residents. The survey link was posted on the PIH Health website and distributed electronically throughout the community and paper copies were made available through area agencies. The survey was also translated into Spanish. The survey was available for six weeks during October to December 2012; a total of 391 people responded. A summary of results can be found in Appendix D.
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Photovoice Photovoice is a digital storytelling process that results in advocacy tools to achieve positive community change formally defined as “a process by which people can identify, represent, and enhance their community through a specific photographic technique.” Through the Activate Whittier community collaborative, of which PIH Health is a founding partner, two Photovoice projects were facilitated with 29 participants: 1) Boys & Girls Club of Whittier teen members, and 2) “Change Starts With Me” community advocacy participants. The projects were conducted by PIH Health and the Los Angeles County Department of Public Health and encouraged residents to tell their stories about healthy eating and active living in Whittier via photographs and brief captions. Secondary Data Collection Secondary data were collected from a variety of local, county, and state sources to profile PIH Health’s primary service area. Data include primary service area demographics, as well as social determinants of health; death characteristics; maternal and infant health; access to healthcare; oral health; mental health; clinical care; nutrition, physical activity and weight status; chronic disease; and health behaviors. When applicable, these data sets are presented in the context of Los Angeles County and the State in order to frame the scope of an issue as it relates to the broader community. Analyses were conducted at the most local level possible, based on data availability.
The following sources and data sets were utilized for this assessment: American Community Survey data by place/city; California Department of Education for school district data; California Department of Justice by city; California Department of Public Health data by zip code; California Employment Development Department statistics by city; California Health Interview Survey data by Service Planning Area (SPA); California Office of Statewide Health Planning and Development (OSHPD) for hospital-specific data; Gateway Connections - Vulnerability Study of the Homeless; Los Angeles County Department of Public Health data by Service Planning Area (SPA); PIH Health Cancer Registry by patient diagnosis; PIH Health Community Advice Nurse Line by call topic; U.S. Census 2010 data by zip code; and U.S. Department of Housing and Development by city.
Information Gaps and Other Limitations Information gaps that impact the ability to assess health needs were identified. Specifically, cancer incidence rates are not available at a rate more local than Los Angeles County, and the results of the most recent 2011 Los Angeles County Health Survey (a population-based telephone survey that provides information concerning the health of Los Angeles County residents) were not yet available during the time this needs assessment was conducted. Community Health Facilities and Other Resources A list of existing health facilities and resources that are available to meet identified community health needs can be found in Appendix F, which includes a Healthcare Assets Map as well as Information and Referral Resource List. Maps of the PIH Health Primary Service Area Appendix A presents eight maps depicting a variety of health characteristics of the PIH Health primary service area.
1| PIH Health Primary Service Area Low-Income Households 2| PIH Health Primary Service Area Body Composition of 5th Grade Students by School 3| PIH Health Primary Service Area Alzheimer’s Disease Deaths 4| PIH Health Primary Service Area Cancer Deaths 5| PIH Health Primary Service Area Diabetes Deaths 6| PIH Health Primary Service Area Heart Disease Deaths 7| PIH Health Primary Service Area Hypertension Deaths 8| PIH Health Primary Service Area Stroke Deaths
13 Chapter Four Priority Health Areas and Prioritized Health Needs
Process and Criteria Used for Prioritization of Health Needs Priority setting is a required step in the community benefit planning process. IRS regulations state that the Community Health Needs Assessment must prioritize community health needs identified through the assessment and include a description of the process and criteria used in the prioritization process.
Based on assessment findings, PIH Health’s community benefit consultant used the criteria below to identify health needs: The area of need was identified through secondary data analysis and: o Fared worse than County and/or CA rates; and/or o Did not meet Healthy People 2020 Leading Health Indicator objectives. The area of need was confirmed by more than one indicator or data source (either primary or secondary data); and The size or seriousness of the problem was determined to be significant.
Priority Setting Process On February 6, 2013, PIH Health convened an ad hoc subcommittee of the Community Benefit Oversight Committee (CBOC) to prioritize identified health needs. Those in attendance were provided an overview of assessment findings, identified health needs and supporting data, as well as existing assets addressing each identified need.
The subcommittee members first validated the three overarching community benefit priority health areas to serve as a framework for organizing the priority health needs. These priority health areas are health access, healthy living, and health management.
The subcommittee then engaged in a process to prioritize health needs within each priority health area using the relative worth method. The relative worth method is a ranking strategy in which participants receive a fixed number of points to assign among health needs. In this case, 100 points (four dots worth 25 points each) were allotted per person to distribute among the priority health area’s identified needs. Subcommittee members then assigned points based on the criteria below: The size of the problem (number of people per 1,000, 10,000, or 100,000 populations); The seriousness of the problem (impact at individual, family, and community levels); Available PIH Health and/or community resources to address the health need; and Alignment with the PIH Health mission.
Once subcommittee members had assigned points, each health needs’ points were totaled and ranked, as shown below.
Prioritized Health Needs Points
Health Access Priority Health Area
Mental Health 450
General Healthcare Access 375 Dental Care 350 Vision Care 100 Healthy Living Priority Health Area Overweight and Obesity 350 Nutrition and Activity 350 Preventative Practices 300 Alcohol Consumption 250 Smoking 50 Health Management Priority Health Area Diabetes 450 Cardiovascular Disease 425 Youth Asthma 250 Cancer 150
14 Priority Setting Process, continued Participants engaged in a group discussion about the results and were asked to discuss the following for each health need: What works in the community to address this issue? What is going well? What groups/organizations are already focused on this issue? Where are the gaps? What are the barriers? What/who is missing? What is the level of community readiness to effectively implement and support programs to address this priority need? What are the needs that are low priority? Why?
The prioritization process and resulting prioritized health needs were presented to the CBOC for approval at their March 7, 2013 regular meeting. CBOC members unanimously approved the recommended priority health areas.
Implementation Strategy The identified priorities and the results of the CBOC subcommittee’s discussion (related to questions noted above) will drive the development of PIH Health’s Implementation Strategy. The subcommittee, consisting of a variety of key community stakeholders, will continue to meet to develop the Implementation Strategy as well as an actionable community health improvement plan that builds on existing efforts in the community. This collaborative planning process will ensure good stewardship of PIH Health’s charitable resources, avoidance of duplicative efforts in the community, and broad awareness of the health needs of our communities. Once approved by the CBOC, the Implementation Strategy will be presented to PIH Health’s Board of Directors for review and approval by September 30, 2013, in accordance with legislative requirements.
15 Chapter Five Demographic Profile PIH Health Primary Service Area
Population Demographics The population for the service area is 606,484. From 2000 to 2010, the change in total population for the service area increased by 1.2%. This was a slower rate of growth than experienced statewide.
Change in Total Population, 2000-2010 PIH Health Primary Service Area California Total Population 2000 599,173 33,871,648 Total Population 2010 606,484 37,253,956 Change in Population 2000-2010 1.2% 10.0% Source: U.S. Census Bureau, 2010 Census of Population and Housing
Population by Zip Code Geographic Area Number
90601 - Whittier 31,974
90602 - Whittier 25,777
90603 - Whittier 20,063
90604 - Whittier 39,407
90605 - Whittier 40,331
90606 - Whittier 32,396
90631 - La Habra/La Habra Heights 67,619
90638 - La Mirada 49,012
90640 - Montebello 62,549 90650 - Norwalk 105,549 90660 - Pico Rivera 62,928 90670 - Santa Fe Springs 14,866 91745 - Hacienda Heights 54,013 PIH Health Primary Service Area 606,484 Source: U.S. Bureau of the Census, 2010
Children and youth (ages 0-17) make up 25.7% of the population; 31.4% are 18-39 years of age; 30.8% are 40-64; and 12.1% of the population are seniors 65 years of age and older. The service area has slightly higher percentages of children ages 5-17 and seniors ages 65+ than found in Los Angeles County and the State.
Population by Age PIH Health Primary Service Area Los Angeles County California
Number Percent Number Percent Number Percent Age 0-4 40,083 6.5% 645,793 6.6% 2,531,333 6.8% Age 5-17 118,305 19.2% 1,756,415 17.9% 6,763,707 18.2% Age 18-39 193,777 31.4% 3,253,904 33.1% 11,814,407 31.7% Age 40-64 190,324 30.8% 3,096,794 31.5% 11,897,995 31.9% Age 65+ 74,483 12.1% 1,065,699 10.9% 4,246,514 11.4% Total 616,972 100% 9,818,605 100% 37,253,956 100% Source: U.S. Bureau of the Census, 2010
16 Population Demographics, continued When the population is examined by zip code, areas of higher concentration of seniors can be found in Hacienda Heights (15.4%), La Mirada (15.2%), and Whittier 90603 (15.0%). High percentages of youth, ages 0-17, are found in Whittier 90605 (28.6%), Norwalk (27.6%), and Whittier 90606 (27.3%). The blue shading in the population table shows the zip code areas with the highest percentage of youth (Whittier-90605) and seniors (Hacienda Heights). The green shading shows the zip codes with the lowest percentage of youth (La Mirada) and seniors (Whittier-90602).
Age of Population by Zip Code Geographic Area Youth (Ages 0-17) Seniors (Ages 65+) 90601 - Whittier 24.3% 12.3% 90602 - Whittier 26.8% 8.8% 90603 - Whittier 23.6% 15.0% 90604 - Whittier 26.5% 10.5% 90605 - Whittier 28.6% 9.2% 90606 - Whittier 27.3% 11.2% 90631 - La Habra/La Habra Heights 25.9% 11.7% 90638 - La Mirada 21.1% 15.2% 90640 - Montebello 25.8% 13.6% 90650 - Norwalk 27.6% 9.9% 90660 - Pico Rivera 26.7% 12.1% 90670 - Santa Fe Springs 25.6% 14.1% 91745 - Hacienda Heights 22.0% 15.4% PIH Health Primary Service Area 25.7% 12.1% Los Angeles County 24.5% 10.9% California 25.0% 11.4% Source: U.S. Bureau of the Census, 2010 Blue= Highest; Green= Lowest Family Size The average family size ranges from 3.40 individuals in Whittier (90603) to 4.25 individuals in Pico Rivera.
Average Family Size Geographic Area Family Size 90601 - Whittier 3.54 90602 - Whittier 3.73 90603 - Whittier 3.40 90604 - Whittier 3.72 90605 - Whittier 4.12 90606 - Whittier 4.11 90631 - La Habra/La Habra Heights 3.70 90638 - La Mirada 3.59 90640 - Montebello 3.74 90650 - Norwalk 4.16 90660 - Pico Rivera 4.25 90670 - Santa Fe Springs 4.05 91745 - Hacienda Heights 3.77 Los Angeles County 3.65 California 3.50 Source: U.S. Bureau of the Census, 2007-2011 American Community Survey, 5-year average Blue= Highest; Green= Lowest
17 Disability In the service area, 28.8% of adults had a physical, mental or emotional disability, slightly lower than the County’s 28.9%. Adults, unable to work for at least a year due to physical or mental impairment, totaled 3.5%; lower than the County’s 5.1%.
Population with a Disability Service Planning Area 7 Los Angeles County California Adults with a disability 28.8% 28.9% 27.4% Couldn’t work due to impairment 3.5% 5.1% 4.7% Source: California Health Interview Survey, 2009
Veteran Status In the service area, 6.1% of the population 18 years and older are veterans. This is higher than the percentage of veterans found in L.A. County (5.0%).
Veterans PIH Health Primary Service Area Los Angeles County California Veteran Status 6.1% 5.0% 7.6% Source: U.S. Bureau of the Census, 2006-2010 American Community Survey, 5-year average Seniors Living Alone In the service area, 8% of seniors live alone. Santa Fe Springs (15%), La Mirada (11.4%) and Whittier 90603 (10.4%) have high rates of seniors living alone.
Seniors Living Alone Geographic Area Seniors Living Alone 90601 - Whittier 8.5% 90602 - Whittier 7.7% 90603 - Whittier 10.4% 90604 - Whittier 7.7% 90605 - Whittier 5.7% 90606 - Whittier 6.3% 90631 - La Habra/La Habra Heights 8.2% 90638 - La Mirada 11.4% 90640 - Montebello 8.9% 90650 - Norwalk 6.0% 90660 - Pico Rivera 7.7% 90670 - Santa Fe Springs 15.0% 91745 - Hacienda Heights 6.7% PIH Health Primary Service Area 8.0% Los Angeles County 7.8% California 8.3% Source: U.S. Bureau of the Census, American Community Survey, 2007-2011, 5-year average Blue= Highest; Green= Lowest Citizenship 14.7% of the population in the service area are not U.S. citizens. This is a lower percentage than found in the County (19.7%) and the State (14.9%).
Not a U.S. Citizen PIH Health Primary Service Area Los Angeles County California Not a Citizen 14.7% 19.7% 14.9% Source: U.S. Bureau of the Census, 2006-2010 American Community Survey, 5-year average
18 Race/Ethnicity The largest population by race and ethnicity in the service area is Hispanic or Latino (67.7%). White/Caucasians make up 18.8% of the population. Asians comprise 10.4% of the population, and African Americans, Native Americans, Hawaiians, and other races combined total 3.1% of the population. When compared to L.A. County, the service area has a larger percentage of Latinos and a smaller percentage of other races/ethnicities.
Population by Race and Ethnicity PIH Health Primary Race/Ethnicity Los Angeles County California Service Area Hispanic or Latino 67.7% 47.7% 37.6% White 18.8% 27.8% 40.1% Asian 10.4% 13.5% 12.8% Black or African American 1.6% 8.3% 5.8% American Indian & Alaskan 0.2% 0.2% 0.4% Native Hawaiian & Pacific Islander 0.1% 0.3% 0.3% Other or Multiple 1.2% 2.2% 3.0% Source: U.S. Bureau of the Census, 2010 Blue= Highest; Green= Lowest
Among the service area cities, Pico Rivera has the highest percentage of Latinos at 91.2%; Whittier 90603 has the highest percentage of White/Caucasians at 42.9%. Hacienda Heights has the highest percentage of Asians (36.8%) and Norwalk has the highest percentage of Black/African Americans (3.9%).
Population by Race and Ethnicity by Zip Code American Black or Indian and Native Hawaiian African Hispanic Alaska and Pacific Other or Total Geographic Area White American or Latino Native Asian Islander Multiple Population 90601 - Whittier 21.7% 1.0% 70.6% 0.3% 5.0% 0.1% 1.3% 31,974 90602 - Whittier 19.8% 1.2% 74.8% 0.3% 2.8% 0.1% 1.0% 25,777 90603 - Whittier 42.9% 0.7% 50.3% 0.2% 4.7% 0.1% 1.1% 20,063 90604 - Whittier 27.2% 1.4% 64.8% 0.3% 4.8% 0.1% 1.4% 39,407 90605 - Whittier 17.5% 0.8% 77.3% 0.2% 3.2% 0.2% 1.8% 40,331 90606 - Whittier 9.7% 0.7% 86.9% 0.3% 1.5% 0.1% 0.8% 32,396 90631 - La Habra/ 33.1% 1.3% 53.9% 0.2% 9.5% 0.1% 1.9% 67,619 La Habra Heights 90638 - La Mirada 38.0% 2.1% 39.7% 0.3% 17.6% 0.2% 2.1% 49,012 90640 - Montebello 8.5% 0.6% 79.3% 0.2% 10.6% 0.1% 0.7% 62,549 90650 - Norwalk 12.3% 3.9% 70.1% 0.3% 11.7% 0.3% 1.4% 105,549 90660 - Pico Rivera 5.2% 0.6% 91.2% 0.2% 2.3% 0.0% 0.5% 62,928 90670 - 12.5% 1.9% 80.2% 0.4% 4.0% 0.1% 0.8% 14,866 Santa Fe Springs 91745 - 54,013 Hacienda Heights 14.9% 1.2% 45.5% 0.1% 36.8% 0.1% 1.4% PIH Health Primary 18.8% 1.6% 67.7% 0.2% 10.4% 0.1% 1.2% 606,484 Service Area Los Angeles 9,519,338 County 27.8% 13.5% 47.7% 0.2% 8.3% 0.3% 2.2% California 40.1% 5.8% 37.6% 0.4% 12.8% 0.3% 3.0% 33,871,648 Source: U.S. Bureau of the Census, 2010 Blue= Highest; Green= Lowest
19 Language In the service area, Spanish is spoken in 48% of the homes; this is higher than the number of Spanish speaking households in the County (39.4%) and the State (28.5%). 41.2% of the residents speak English only, and 8.5% speak an Asian language. Pico Rivera (68.7%) has the largest percentage of Spanish speakers; Hacienda Heights (32.6%) has the largest percentage of Asian language speakers.
Language Spoken at Home for the Population 5 Years and Over Geographic Area English Only Spanish Asian Indo-European Other Hacienda Heights 35.8% 28.8% 32.6% 2.3% 0.5% La Habra 50.6% 41.5% 5.9% 1.6% 0.4% La Habra Heights 71.5% 12.9% 10.6% 4.3% 0.7% La Mirada 61.1% 23.7% 12.7% 2.3% 0.2% Montebello 25.8% 61.3% 8.1% 4.5% 0.3% Norwalk 33.3% 53.1% 10.7% 2.6% 0.3% Pico Rivera 28.4% 68.7% 2.0% 0.8% 0.1% Santa Fe Springs 46.9% 51.0% 1.6% 0.2% 0.3% South Whittier 40.1% 55.7% 3.1% 0.9% 0.2% West Whittier/Los Nietos 36.3% 62.6% 0.6% 0.5% 0.0% Whittier 56.6% 39.4% 1.8% 2.0% 0.2% PIH Health Primary Service Area 41.2% 48.0% 8.5% 2.1% 0.2% Los Angeles County 43.6% 39.4% 10.7% 5.3% 1.0% California 57.0% 28.5% 9.4% 4.3% 0.8% Source: U.S. Bureau of the Census, 2006-2010 American Community Survey, 5-year average Blue= Highest; Green= Lowest Linguistic Isolation Linguistic isolation data represents the population over age 5 who speak English “less than very well.” In the service area, 24.3% of the population is linguistically isolated. La Habra Heights has the lowest percentage of linguistic isolation (8.4%), and Montebello has the highest percentage of linguistically isolated (31.7%) residents.
Linguistic Isolation among Population over 5 Years of Age Geographic Area Linguistic Isolation Hacienda Heights 28.5% La Habra 23.5% La Habra Heights 8.4% La Mirada 15.4% Montebello 31.7% Norwalk 28.8% Pico Rivera 27.8% Santa Fe Springs 20.7% South Whittier 24.5% West Whittier/Los Nietos 24.2% Whittier 15.6% PIH Health Primary Service Area 24.3% Los Angeles County 27.0% California 19.9% Source: U.S. Bureau of the Census, 2006-2010 American Community Survey, 5-year average Blue= Highest; Green= Lowest
20 Chapter Six Social Determinants of Health
Median Household Income The median household income in the service area ranges from $50,881 in Montebello to $121,380 in La Habra Heights.
Median Household Income Geographic Area Median Household Income Hacienda Heights $69,501 La Habra $62,078 La Habra Heights $121,380 La Mirada $79,347 Montebello $50,881 Norwalk $60,488 Pico Rivera $57,594 Santa Fe Springs $54,252 South Whittier $65,043 West Whittier/Los Nietos $55,879 Whittier $65,308 Los Angeles County $55,476 California $60,883 Source: U.S. Bureau of the Census, 2006-2010 American Community Survey, 5-year average Blue= Highest; Green= Lowest
Unemployment On average, the service area has a lower unemployment rate (10.8%) compared to the County (12.3%) and the State (11.7%). Compared over three years, unemployment rates were lower in 2009, rose in 2010, and decreased in 2011. La Habra, La Mirada, Whittier, and Hacienda Heights have unemployment rates less than 10%; these balance the high rates of unemployment found in Norwalk, Montebello, and West Whittier/Los Nietos.
Unemployment Rates, Annual Average, 2009-2011 Geographic Area 2009 2010 2011
Hacienda Heights 8.6% 9.4% 9.2% La Habra Heights 4.8% 5.2% 5.1% La Mirada 7.1% 7.7% 7.5% Montebello 12.9% 14.0% 13.7% Norwalk 12.2% 13.3% 13.0% Pico Rivera 10.8% 11.8% 11.5% Santa Fe Springs 9.7% 10.5% 10.3% South Whittier 10.2% 11.1% 10.8% West Whittier/Los Nietos 13.1% 14.3% 13.9% Whittier 8.3% 9.1% 8.8% PIH Health Primary Service Area 10.2% 11.2% 10.8% Los Angeles County 11.6% 12.6% 12.3% California 11.3% 12.4% 11.7% Source: California Employment Development Department, Labor Market Information Division Blue= Highest; Green= Lowest
21 Poverty Poverty thresholds are used for calculating poverty population statistics. They are updated each year by the Census Bureau. For 2010, the Federal Poverty Level for one person was $10,830 and for a family of four $22,050.
In the service area, 10.2% of the population is at poverty level. This poverty rate is less than the County (15.7%) and State (13.7%) rates. Poverty increases for those at or below 200% of the FPL as 30% of the residents exist at 200% of the FPL.
Ratio of Income to Poverty Level Geographic Area Below 100% Poverty Below 200% Poverty Hacienda Heights 7.7% 23.0% La Habra 10.9% 30.9% La Habra Heights 2.1% 15.6% La Mirada 5.2% 20.0% Montebello 14.9% 39.4% Norwalk 11.1% 31.8% Pico Rivera 11.0% 33.7% Santa Fe Springs 8.9% 32.0% South Whittier 10.8% 31.4% West Whittier/Los Nietos 10.0% 31.1% Whittier 9.2% 27.1% PIH Health Primary Service Area 10.2% 30.0% Los Angeles County 15.7% 37.6% California 13.7% 32.8% Source: U.S. Bureau of the Census, 2006-2010 American Community Survey, 5-year average Blue= Highest; Green= Lowest Seniors in Poverty In the service area, Montebello has the highest percentage of seniors living in poverty at 13.1%. Whittier 90601 has the lowest rate of seniors in poverty at 4.9%.
Seniors in Poverty Geographic Area Seniors in Poverty 90601 - Whittier 4.9% 90602 - Whittier 12.1% 90603 - Whittier 6.7% 90604 - Whittier 10.1% 90605 - Whittier 12.0% 90606 - Whittier 11.0% 90631 - La Habra/La Habra Heights 7.3% 90638 - La Mirada 7.2% 90640 - Montebello 13.1% 90650 - Norwalk 10.8% 90660 - Pico Rivera 8.8% 90670 - Santa Fe Springs 9.8% 91745 - Hacienda Heights 7.8% Los Angeles County 11.7% California 9.1% Source: U.S. Bureau of the Census, American Community Survey, 2007-2011, 5-year average Blue= Highest; Green= Lowest
22 Children in Poverty In the service area, 14.6% of children under age 18 years are living in poverty. Montebello has a high percentage of children in poverty (22.6%). Among families with a female head of household and children under 18 years old, 34.6% in Pico Rivera live in poverty. This is equal to the County rate and higher than the State rate of 32.4%.
Poverty- Children under 18, and Female Head of Household Families with Children under 18 Years Old Children in Poverty Families with Children in Poverty Geographic Area (Under 18 Years) Female Head of Household Hacienda Heights 10.9% 18.7% La Habra 17.3% 21.7% La Habra Heights 0.0% 0.0% La Mirada 4.2% 9.7% Montebello 22.6% 29.2% Norwalk 15.3% 21.4% Pico Rivera 15.7% 34.6% Santa Fe Springs 13.1% 16.8% South Whittier 15.3% 21.4% West Whittier/Los Nietos 13.5% 15.0% Whittier 12.7% 23.9% PIH Health Primary Service Area 14.6% No Data Los Angeles County 22.4% 34.6% California 19.1% 32.8% Source: U.S. Bureau of the Census, 2006-2010 American Community Survey, 5-year average Blue= Highest; Green= Lowest
Public Program Participation In Service Planning Area 7 (SPA 7), 35.8% of residents are not able to afford food and 9.9% utilize food stamps. This indicates that a considerable percentage of residents may qualify for food stamps but do not access this resource. Women Infants and Children (WIC) Supplemental Nutrition Program benefits are more readily accessed in SPA 7 than in the County or State. 56.6% of qualified adults in SPA 7 use WIC. Among qualified children in SPA 7, 67% access WIC. Among SPA 7 residents, 4.3% are Temporary Assistance for Needy Families (TANF)/CalWorks recipients.
Public Program Participation SPA 7 Los Angeles County California Not Able to Afford Food (<200% FPL) 35.8% 38.2% 40.4% Food Stamp Recipients 9.9% 13.4% 13.4% WIC Usage among Qualified Adults 56.6% 52.5% 46.4% WIC Usage among Qualified Children (Ages 6 and Under) 67.0% 60.1% 48.7% TANF/CalWorks Recipients 4.3% 5.9% 6.2% Source: California Health Interview Survey, 2009
Free or Reduced Price Meals Among Whittier area school districts, 100% of the students in the Los Nietos school district are eligible for the free and reduced price meal program, indicating a high level of low-income families.
Free and Reduced Price Meals Eligibility School District Number Percent East Whittier City School District 4,394 49.5% Los Nietos School District 2,064 100% South Whittier School District 2,538 64.0% Whittier City School District 4,236 64.9% Whittier Union High School District 8,057 59.7% Los Angeles County 1,017,249 65.3% California 3,465,446 56.7% Source: California Department of Education, 2010-2011 school year Blue= Highest; Green= Lowest
23 Education Of the population age 25 and over, 24.6% have less than a high school diploma; this is consistent with County high school completion rates (24.1%). By comparison, the area has a higher number of high school graduates than the County or State, with 27.1% of the population having a high school diploma. In comparison, the residents show equivalent Associate degree college attainment, but lower rates of residents with Bachelor’s, graduate, or professional degrees than the County or State.
Educational Attainment PIH Health Primary Service Area Los Angeles County California Population age 25 and over 365,701 6,268,121 23,497,945 Less than 9th grade 12.8% 13.9% 10.4% 9th to 12th grade, no diploma 11.8% 10.2% 8.9% High school graduate 27.1% 21.4% 21.5% Some college, no degree 21.6% 18.8% 21.5% Associate degree 7.7% 6.8% 7.7% Bachelor's degree 13.4% 19.0% 19.2% Graduate or professional degree 5.6% 9.9% 10.8% Source: U.S. Bureau of the Census, 2006-2010 American Community Survey, 5-year average Blue= Highest; Green= Lowest
Educational attainment is considered a key driver of health status, with low levels of education linked to poverty and poor health. In the service area, 75.4% of the adult population, 25 years and older, have obtained a high school diploma or higher education. This is lower than the County rate of 75.9% and the State rate of 80.7%.
High School Graduation or Higher Education Completion - Adults, 25 Years and Older Geographic Area High School Graduate or Higher Hacienda Heights 84.8% La Habra 80.3% La Habra Heights 93.2% La Mirada 86.4% Montebello 69.2% Norwalk 71.8% Pico Rivera 65.9% Santa Fe Springs 72.0% South Whittier 68.2% West Whittier/Los Nietos 66.6% Whittier 82.2% PIH Health Primary Service Area 75.4% Los Angeles County 75.9% California 80.7% Source: U.S. Bureau of the Census, 2006-2010 American Community Survey, 5-year average Blue= Highest; Green= Lowest
24 Education, continued High school graduation rates, or the number of high school graduates that graduated four years after starting ninth grade are higher in the service area at 92%, compared to 71.5% in the County and 78.2% in the State.
High School Graduation Rates - 2010-2011 School Year High School High School Graduation Rate* California High School, Whittier, CA 96.4 El Rancho High School, Pico Rivera, CA 93.2 John H. Glenn High School, Norwalk, CA 90.7 La Habra High School, La Habra, CA 96.4 La Mirada High School, La Mirada, CA 96.3 La Serna High School, Whittier, CA 95.0 Montebello High School, Montebello, CA 83.9 Norwalk High School, Norwalk, CA 93.3 Pioneer High School, Whittier, CA 93.9 Santa Fe High School, Santa Fe Springs, CA 94.2 Whittier High School, Whittier, CA 95.4 Schurr High School, Montebello, CA 82.2 Sonora High School, La Habra, CA 94.3 PIH Health Primary Service Area** 92% Los Angeles County 71.5% California 78.2% Source: California Department of Education, 2012 *High School graduation rate was determined by taking the number of graduates for the school year divided by the number of freshman enrolled four years earlier **Hacienda Heights graduation rates not available, therefore not included in the service area rate Blue= Highest; Green= Lowest
Housing Units There are 183,129 housing units in the area. Most of the housing units in the service area are owner occupied (62.3%). Just over one-third of the housing units (34.1%) are renter occupied. The percentage of owner occupied housing exceeds the rates found in the County and the State. La Mirada has the highest percentage of owner occupied housing units (76.9%) and a corresponding low percentage of renter occupied housing (20.3%). Whittier 90602 has the highest percentage of renter occupied housing units (59.5%) and a corresponding low percentage of owner occupied housing (34.9%).
Housing Units-Owners and Renters Geographic Area Total Housing Units Owner Occupied Renter Occupied 90601 - Whittier 11,549 56.6% 38.8% 90602 - Whittier 7,007 34.9% 59.5% 90603 - Whittier 6,788 76.6% 20.3% 90604 - Whittier 12,326 62.8% 34.0% 90605 - Whittier 10,897 65.6% 31.0% 90606 - Whittier 8,931 66.0% 30.7% 90631 - La Habra/La Habra Heights 22,497 58.8% 36.5% 90638 - La Mirada ,15,236 76.9% 20.3% 90640 - Montebello 19,785 44.3% 51.8% 90650 - Norwalk 28,083 62.9% 33.7% 90660 - Pico Rivera 17,106 66.9% 29.9% 90670 - Santa Fe Springs 4,616 61.0% 34.1% 91745 - Hacienda Heights 16,645 76.4% 20.9% PIH Health Primary Service Area 183,129 62.3% 34.1% Los Angeles County 3,445,076 44.8% 49.2% California 13,680,081 51.4% 40.5% Source: U.S. Bureau of the Census, 2010 Blue= Highest; Green= Lowest
25 Section 8 Housing Section 8 is a federally-funded program that provides rental assistance in the form of vouchers to low and very-low income families, singles, senior citizens, and individuals living with disabilities. The Housing Authority of Los Angeles County handles the Section 8 program. In Whittier, there are 88 Section 8 units. Those with a Section 8 voucher wait an average of 86 months (7.2 years) to gain access to subsidized housing.
Subsidized Housing, Section 8, 2009 Geographic Area Number of Units Wait in Months Hacienda Heights 060 La Habra 56 27 La Mirada 75 28 Montebello 130 54 Norwalk 94 17 Pico Rivera 75 114 Santa Fe Springs 56 43 South Whittier No Data 74 West Whittier/Los Nietos 11 52 Whittier 88 86 Source: U.S. Department of Housing and Development, Picture of Subsidized Households, 2009 Blue= Highest; Green= Lowest Homelessness Every two years, the Los Angeles Homeless Services Authority (LAHSA) conducts the Greater Los Angeles Homeless Count as a snapshot to determine how many individuals are homeless on a given day. Data from this survey are available at the Service Planning Area (SPA) level and show a decrease in homelessness from 2009 to 2011.
According to the 2011 LAHSA count, SPA 7 had an annualized estimate of 4,759 homeless individuals. In SPA 7, 81% of the homeless are individuals, and 19% are homeless families, which is an increase from 8% in 2009.
Homeless Population Service Planning Area 7 Los Angeles County 2009 2011 Total Homeless 4,517 4,759 45,422 Single Adults 92% 81% 79% Family Members 8% 19% 20% Unaccompanied Minors (<18) <1% <1% 1% Source: Los Angeles Homeless Service Authority, 2009 + 2011 Greater Los Angeles Homeless Count Reports
Among the homeless population, approximately one-fourth are chronically homeless (23%). In SPA 7, 36% experienced substance abuse, 27% suffered from mental illness, 18% were homeless veterans, and 12% survivors of domestic violence. All categories saw an increase from 2009 to 2011.
Homeless Subpopulations Service Planning Area 7 Los Angeles County 2009 2011 Chronically Homeless 22% 23% 24% Substance Abuse 34% 36% 34% Mentally Ill 23% 27% 33% Veterans 16% 18% 18% Survivors of Domestic Violence 9% 12% 10% Source: Los Angeles Homeless Service Authority, 2009 + 2011 Greater Los Angeles Homeless Count Reports Blue= Highest; Green= Lowest
26 Whittier Connections Homeless Vulnerability Study In November 2011, community volunteer teams surveyed people living on the streets in Whittier using the Community Solutions (formerly Common Ground) Vulnerability Index, which creates a by-name list, including photos, of individuals experiencing homelessness.
Vulnerability Index Results Indicator Vulnerable Homeless (45 total) Homeless population with no health insurance 53% Homeless population that was hospitalized during the previous year 47% Homeless population that visited the ER three times or more in three months 16% Homeless population with Tri-Morbid conditions (substance abuse, mental health, and 49% physical health) Homeless population with a serious health condition 88% Homeless population living with HIV/AIDS 0% Homeless population over 60 years of age 22% Source: Homeless Vulnerability Index, Whittier First Day, 2011
Whittier Connections Homeless Vulnerability Study (continued) In addition to systematically gathering names, pictures, and dates of birth of individuals sleeping on the streets and in shelters, the teams also captured data on health status, institutional history, length of homelessness, patterns of shelter use, and previous housing situations. The Vulnerability assessments were analyzed to identify those who had been homeless the longest and those living with specific health conditions associated with a high mortality risk.
Findings included: 128 total individuals were identified and counted; 113 consented to the Vulnerability Index Interview. 40% (45) were considered “vulnerable,” defined as having health conditions associated with a high mortality risk. 12% (14) were veterans; five of the 14 veterans surveyed were considered “vulnerable.” 69% (78) were male and 31% (35) were female. 12% (13) were over 60 years old. 2% (3) were under 25 years old. The median age was 49 years old. The oldest person surveyed was 71 years old; the youngest was 20 years old. 74% (84) reported a history of substance abuse. 37% (42) reported signs or symptoms of mental illness.
Health System Impacts 66% (74) individuals reported having no health insurance. 69 separate inpatient hospital visits were reported over the previous year. 78 separate emergency room visits were reported in the last 3 months.
Length of Homelessness 76% (87) were considered “chronically homeless,” defined as a person with a disabling condition who has either been continuously homeless for a year or more, or has had at least four episodes of homelessness in the past three years. 21% (24) reported being homeless 10 years or more. The longest reported length of homelessness was 40 years. Average length of homelessness was 5.7 years. 35% (40) reported being the victim of a violent attack since becoming homeless.
Youth and Foster Care 12% (13) reported having a history of foster care.
Income Sources 34% (38) received public assistance welfare. 27% (31) earned an income from recycling. 7% (8) earned an income from panhandling. 13% (15) received Social Security income. 19% (21) received food stamps.
27 Crime and Violence Violent crimes include homicide, rape, and assault. Santa Fe Springs (449.9) and Norwalk (425.4) have the highest rate of arrests for violent crimes per 100,000 persons in the service area.
Adult Violent Crimes per 100,000 Persons, 2010 Geographic Area Number Rate La Habra Heights 7 131.5 La Mirada 74 152.5 Montebello 214 342.4 Norwalk 449 425.4 Pico Rivera 247 392.4 Santa Fe Springs 73 449.9 Whittier 343 401.9 Los Angeles County 50,223 511.5 California 163,957 440.1 Source: California Department of Justice, Office of the Attorney General, 2010; U.S. Census 2010 Blue= Highest; Green= Lowest
Whittier has the highest number of domestic violence calls in the service area. While Whittier has a large number of domestic violence calls, the majority of the calls were for incidents without a weapon.
Domestic Violence Calls, 2010 Total Without Weapon With Weapon La Habra Heights 9 1 (11%) 8 (89%) La Mirada 70 11 (16%) 59 (84%) Montebello 204 68 (33%) 136 (67%) Norwalk 243 23 (9%) 220 (91%) Pico Rivera 264 40 (15%) 224 (85%) Santa Fe Springs 164 126 (77%) 36 (4%) Whittier 903 637 (71%) 266 (29%) Los Angeles County 42,052 15,855 (38%) 26,197 (62%) California 166,361 100,496 (60%) 65,865 (40%) Source: California Department of Justice, Office of the Attorney General, 2010 Blue= Highest; Green= Lowest
13.1% of adults in SPA 7 indicated they had experienced physical or sexual violence by an intimate partner since the age of 18, and 1.8% had been the victims of intimate partner violence in the past year.
Experienced Physical or Sexual Violence Service Planning Area 7 Los Angeles County California By Intimate Partner Since Age 18 13.1% 12.7% 14.8% By Intimate Partner in Past Year 1.8% 3.1% 3.5% Source: California Health Interview Survey, 2009
28 Chapter Seven General Healthcare Access
Health Insurance Coverage Health insurance coverage is considered a key component to accessing healthcare. Of the total population, 79.3% of those in the primary service area have health insurance. La Mirada has the highest rate at 85.6%; Pico Rivera, the lowest at 74.3%.
Most (90.4%) children under age 18 have health insurance in the service area. Hacienda Heights has the highest health insurance rate at 93.8%; La Habra, the lowest at 87.3%.
Among adults, age 18-64, 71.3% in the primary service area have health insurance. La Mirada has the highest insurance rate (80.7%); Pico Rivera, the lowest at 64.1%.
Health Insurance Coverage, Total Population - Children (Under 18 Years of Age) and Adults (Ages 18-64) Geographic Area* Total Population Children Under 18 Adults Ages 18-64 Hacienda Heights 82.0% 93.8% 74.2% La Habra 77.8% 87.3% 70.9% La Mirada 85.6% 90.5% 80.7% Montebello 77.0% 92.7% 65.8% Norwalk 75.9% 90.1% 66.6% Pico Rivera 74.3% 87.9% 64.1% South Whittier 78.5% 89.9% 70.1% West Whittier/Los Nietos 79.3% 91.9% 70.6% Whittier 84.9% 91.1% 79.7% PIH Health Primary Service Area 79.3% 90.4% 71.3% Los Angeles County 77.2% 89.6% 69.2% California 81.8% 91.1% 75.1% Source: U.S. Census Bureau, 2009 - 2011 American Community Survey *Data on Santa Fe Springs and La Habra Heights not available Blue= Highest; Green= Lowest
A look at insurance coverage by Service Planning Area (SPA) shows that 44.6% of residents in SPA 7 have employment- based insurance and 18.2% are covered by Medi-Cal.
Insurance Coverage Service Planning Area 7 Los Angeles County California Medi-Cal 18.2% 17.5% 14.0% Healthy Families 2.4% 2.0% 2.0% Medicare Only 0.8% 0.9% 1.1% Medi-Cal/Medicare 3.2% 3.5% 2.8% Medicare & Others 6.2% 6.7% 7.7% Other Public 0.8% 1.6% 2.6% Employment-Based 44.6% 44.8% 49.6% Private Purchase 2.9% 6.0% 5.7% No Insurance 20.8% 17.0% 14.5% Source: California Health Interview Survey, 2009 Blue= Highest; Green= Lowest
29 Health Insurance Coverage, continued Insurance coverage for SPA 7 by age group reveals uninsured rates to be highest among adults age 18-64. Children are covered primarily through Medi-Cal and employment-based insurance. Seniors have low uninsured rates and high Medicare coverage rates. The Healthy People 2020 objective for children and adults is 100% health insurance coverage.
Insurance Coverage by Age Group, Service Planning Area 7 Ages 0-17 Ages 18-64 Ages 65+ Medi-Cal 37.0% 12.6% N/A Healthy Families 8.3% 0.2% N/A Medicare Only N/A 0.3% N/A Medi-Cal/Medicare N/A 1.3% 25.6% Medicare & Others N/A 0.2% 65.0% Other Public N/A 1.2% N/A Employment Based 41.8% 52.4% 1.5% Private Purchase 3.2% 3.1% N/A No Insurance 9.7% 28.7% 1.1% Source: California Health Interview Survey, 2009 Blue= Highest; Green= Lowest
In SPA 7, 17.3% of the population under age of 65 had no health insurance over the course of a year and 11% had insurance for part of a year. These rates are higher than the County and State rates.
No Insurance Coverage or Partial Insurance Coverage, under Age 65 Service Planning Area 7 Los Angeles County California No insurance entire past year 17.3% 13.9% 12.2% Insurance coverage only part of the year 11.0% 9.8% 9.0% Source: California Health Interview Survey, 2009
Sources of Care Residents with a medical home and access to a primary care provider improve continuity of care and decrease preventable emergency room visits. Among SPA 7 residents, over 90% of children, 77.5% of adults, and 95.4% of seniors had a usual source of care. Children and adults in SPA 7 had lower rates of usual sources of care than those in the County and State; seniors had the highest rates.
Usual Source of Care Ages 0-17 Ages 18-64 Ages 65+ Service Planning Area 7 90.5% 77.5% 95.4% Los Angeles County 91.7% 78.8% 93.8% California 92.2% 81.5% 95.0% Source: California Health Interview Survey, 2009
Physicians’ office, HMO or Kaiser were the indicated source of care for 56.3% of SPA 7 residents, a rate lower than that of the County or State. Clinics and community hospitals provide care for 25.2%; 17.1% have no regular source of care.
Sources of Care Los Angeles
Service Planning Area 7 County California Physician Office/HMO/Kaiser 56.3% 58.5% 61.2% Community or Government clinic/Community hospital 25.2% 23.1% 22.7% Emergency Room/Urgent Care 0.5% 1.3% 1.1% Other 0.9% 0.9% 0.8% No source of care 17.1% 16.2% 14.2% Source: California Health Interview Survey, 2009
30 Sources of Care, continued In SPA 7, 18% of residents visited the emergency room over the course of a year. Youth visited the emergency room at the highest rates (26.9%). Youth and seniors (19.4%) show higher rates of emergency room visits than the County and State.
Use of Emergency Room Service Planning Area 7 Los Angeles County California Visited ER in last 12 months 18.0% 16.7% 17.6% 0-17 years old 26.9% 18.3% 18.0% 18-64 years old 13.9% 15.8% 17.2% 65 and older 19.4% 18.3% 19.2% <100% of poverty level 15.3% 20.2% 21.7% <200% of poverty level 16.9% 18.5% 19.7% Source: California Health Interview Survey, 2009
Access to Primary Care Community Clinics Community clinics provide primary care (medical, dental, and mental health services) for uninsured and medically underserved populations. ZIP Code Tabulation Area (ZCTA) and Uniform Data System (UDS) data categorizes 29.7% of the service area population as low-income, living below 200% of Federal Poverty Level (FPL) and 10.1% living in poverty.
A number of Section 330-funded grantees or Federally Qualified Health Centers (FQHCs) are located in the service area including AltaMed Health Services, JWCH Institute, and East Valley Community Health Center. FQHCs have 21,793 patients, a total that includes 12.3% of low-income patients and 3.6% of the total population. From 2009 to 2011, East Valley Community Health Center providers added 4,286 patients, a 24.5% increase. Nevertheless, 155,705 of low-income residents (approximately 87.7% of the population at or below 200% FPL) are not served by a Section 330-funded grantee.
Low-Income Patients Served and Not Served by FQHCs Low-Income Patients served by Section Penetration among Penetration of Population 330 Grantees in service area low-income patients Total Population Low-Income Not Served 177,498 21,793 12.3% 3.6% 155,705 (87.7%) Source: UDS Mapper, 2011 Barriers to Care Adults in SPA 7 experience many barriers to care like cost, lack of a medical home, language, and poor transportation.
Barriers to Accessing Healthcare Service Planning Area 7 Los Angeles County Adults Unable to Afford Dental Care in the Past Year 24.0% 22.3% Adults Unable to Afford Medical Care in the Past Year 11.8% 11.8% Adults Unable to Afford Mental Health Care in the Past Year 4.4% 5.9% Adults Unable to Afford Prescription Medication in the Past Year 13.6% 12.1% Adults Who Reported Difficulty Accessing Medical Care 27.2% 27.3% Adults Who Reported Difficulty Talking to a Doctor Because of a Language Barrier in the Past Year 14.5% 15.1% Adults Who Reported Transportation Problems Prevented Obtainment of Medical Care 6.9% 7.4% Source: Los Angeles County Department of Public Health, Los Angeles County Health Survey 2007
Delayed Care Among SPA 7 residents, 9.3% delayed care and 6.3% delayed obtaining prescription medications.
Delayed Care Service Planning Area 7 Los Angeles County California Delayed or didn’t get medical care in past 12 months 9.3% 11.6% 12.5% Delayed or didn’t get prescriptions in past 12 months 6.3% 7.5% 8.2% Source: California Health Interview Survey, 2009
31 Chapter Eight Maternal and Infant Health
Prenatal Care In 2011, pregnant women in the service area began prenatal care after the first trimester at a rate of 131.0 per 1,000 live births. This late entry translates into 86.9% of women. The area rate of early entry exceeds the Healthy People 2020 objective of 78% of women entering prenatal care in the first trimester.
A decrease in early entry into prenatal care is evident from 2008 to 2011. For this measurement, a lower rate is better. Most communities in the service area saw improved access to prenatal care. Whittier 90603, Norwalk, and Santa Fe Springs saw worsening access to prenatal care.
Late Entry into Prenatal Care (After First Trimester), 2008/2011 Comparison* Rate per 1,000 Rate per 1,000 Live Live Births Births Geographic Area Late Prenatal Care Live Births^ 2008 2011 90601 - Whittier 50 409 139.4 122.2 90602 - Whittier 51 356 170.2 143.3 90603 - Whittier 22 194 127.6 127.9 90604 - Whittier 80 502 182.5 159.4 90605 - Whittier 75 562 172.2 133.5 90606 - Whittier 42 404 182.5 104.0 90631 - La Habra/La Habra Heights 107 861 145.6 124.2 90638 - La Mirada 38 446 132.3 85.2 90640 - Montebello 86 756 141.4 113.8 90650 - Norwalk 219 1,423 147.2 153.9 90660 - Pico Rivera 109 813 145.2 134.1 90670 - Santa Fe Springs 28 177 114.4 158.2 91745 - Hacienda Heights 77 606 135.2 127.1 PIH Health Primary Service Area 984 7,509 149.9 131.0 California 81,140 492,832 172.0 164.6 Source: California Department of Public Health, 2008 + 2011 ^Births in which the first month of prenatal care is unknown are not included in the tabulation. *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest; Green= Lowest
Breastfeeding Breastfeeding has considerable benefits for both baby and mother. The California Department of Public Health highly recommends babies be fed only breast milk for the first six months of life. Rates for babies born at PIH Health Hospital show 87.5% of new mothers use some breastfeeding and 43.4% use breastfeeding exclusively. These rates are lower than those of hospitals in Los Angeles County and the State.
In-Hospital Breastfeeding Any Breastfeeding Exclusive Breastfeeding Number Percent Number Percent PIH Health Hospital 2,427 87.5% 1,203 43.4% Los Angeles County 109,686 90.9% 56,478 46.8% California 481,183 91.7% 264,377 60.4%
Source: California Department of Public Health, Breastfeeding Hospital of Occurrence, 2011
32 Births In 2011, there were 7,774 births in the service area. The number of births has decreased from 2008 to 2011.
Births by Year, 2008-2011 2008 2009 2010 2011 8,785 8,311 7,987 7,774 Source: California Department of Public Health, 2008, 2009, 2010, 2011
Low Birth Weight Babies born at a low birth weight are at higher risk for disease, disability, and death. For this measurement, a lower rate is better. The service area has a lower rate (66.5) of low-birth-weight babies than the State rate of 67.8. Low birth weight in the seven zip code areas fell from 2008 to 2011. Low-weight births increased in a number of areas including Whittier 90604 and 90605, Montebello, Norwalk, Santa Fe Springs, and Hacienda Heights. Whittier 90602 had the lowest rate of low-birth-weight babies. Whittier 90604 went from the lowest to the highest rate of low-weight births from 2008 to 2011.
Low Birth Weight (Under 2,500 g) – 2008,2011 Comparison* Rate per 1,000 Rate per 1,000 Live Geographic Area Low-Weight Live Births Births Births Live Births 2008 2011 90601 - Whittier 33 423 79.6 78.0 90602 - Whittier 16 367 44.3 43.6 90603 - Whittier 10 197 56.1 50.8 90604 - Whittier 47 517 43.8 90.9 90605 - Whittier 39 575 46.3 67.8 90606 - Whittier 26 421 73.4 61.8 90631 - La Habra/La Habra Heights 56 870 67.8 64.4 90638 - La Mirada 27 453 81.7 59.6 90640 - Montebello 47 818 52.7 57.5 90650 - Norwalk 100 1,456 54.9 68.7 90660 - Pico Rivera 55 842 72.6 65.3 90670 - Santa Fe Springs 16 180 69.7 88.9 91745 - Hacienda Heights 45 655 62.4 68.7 PIH Health Primary Service Area 517 7,774 61.1 66.5 California 34,159 503,856 68.3 67.8 Source: California Department of Public Health, 2008 + 2011 *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest rate; Green= Lowest Rate
33 Teen Births In 2011, teen births occurred at a rate of 78.7 per 1,000 births, or 7.9% of total births. This rate is higher than the State rate of 77.1. Whittier 90605 has the highest teen birth rate at104.3 per 1,000 live births and Whittier 90603 has the lowest rate of teen births at 25.4 per 1,000 live births.
Births to Teenage Mothers (Under Age 20)* Geographic Area Births to Teen Mothers Live Births Rate per 1,000 Live Births 90601 - Whittier 34 423 80.4 90602 - Whittier 30 367 81.7 90603 - Whittier 5 197 25.4 90604 - Whittier 32 517 61.9 90605 - Whittier 60 575 104.3 90606 - Whittier 28 421 66.5 90631 - La Habra/La Habra Heights 73 870 83.9 90638 - La Mirada 23 453 50.8 90640 - Montebello 59 818 72.1 90650 - Norwalk 151 1,456 103.7 90660 - Pico Rivera 75 842 89.1 90670 - Santa Fe Springs 14 180 77.8 91745 - Hacienda Heights 28 655 42.7 PIH Health Primary Service Area 612 7,774 78.7 California 38,834 503,856 77.1 Source: California Department of Public Health, 2011 *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest; Green= Lowest
From 2008 to 2011, teen births as a percentage of live births decreased from 10.5% to 7.9% in the service area. All areas saw a decrease in teen births over the last four years. Norwalk and Whittier 90605 have the highest percentage of births to teenage mothers (10.4%). Whittier 90603 continues to have the lowest percentage of births (2.5%) to teenage mothers.
Births to Teenage Mothers (Under Age 20), 2008/2011 Comparison Percent of Births Percent of Births Geographic Area 2008 2011 90601 - Whittier 10.2% 8.0% 90602 - Whittier 8.9% 8.2% 90603 - Whittier 4.1% 2.5% 90604 - Whittier 9.5% 6.2% 90605 - Whittier 11.3% 10.4% 90606 - Whittier 12.9% 6.7% 90631 - La Habra/La Habra Heights 9.8% 8.4% 90638 - La Mirada 8.2% 5.1% 90640 - Montebello 10.8% 7.2% 90650 - Norwalk 12.2% 10.4% 90660 - Pico Rivera 13.4% 8.9% 90670 - Santa Fe Springs 9.5% 7.8% 91745 - Hacienda Heights 6.4% 4.3% PIH Health Primary Service Area 10.5% 7.9% California 9.5% 7.7% Source: California Department of Public Health, 2008 + 2011 Blue= Highest; Green= Lowest
34 Infant Mortality Infant mortality in the service area averaged 4.6 deaths per 1,000 live births over five years from 2006-2010. The infant death rate in the State is slightly higher at 5.0 deaths per 1,000 live births. At 8.0 deaths per 1,000 live births, Santa Fe Springs has the highest infant death rate. At 2.0 per 1,000 live births, Whittier 90603 has the lowest infant death rate.
Infant Mortality Rate, 5-Year Average, 2006-2010* Avg. Infant Deaths Live Births 5-Year Death Rate 5-Year Avg. 5-Year Avg. of Actual per 1,000 Live Geographic Area of Actual Deaths Births Births 90601 - Whittier 2.0 429.6 4.7 90602 - Whittier 3.2 407 7.9 90603 - Whittier 0.4 200.4 2.0 90604 - Whittier 1.6 557.8 2.9 90605 - Whittier 3.8 612.8 6.2 90606 - Whittier 3.2 501.2 6.4 90631 - La Habra / LH Heights 3.4 984 3.5 90638 - La Mirada 2.4 517.4 4.6 90640 - Montebello 4.4 920.2 4.8 90650 - Norwalk 5.0 1,674 3.0 90660 - Pico Rivera 4.4 965.8 4.6 90670 - Santa Fe Springs 1.6 199.2 8.0 91745 - Hacienda Heights 4.0 675.4 5.9 PIH Health Primary Service Area 39.4 8,645 4.6 California 2,717.6 543,322.8 5.0 Source: California Department of Health Services, 2006 - 2010 *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest rate; Green= Lowest Rate
35 Chapter Nine Oral Health
Dental Care In SPA 7, 10.2% of children and 3.7% of teens had never been to a dentist. Inability to pay for care or inadequate dental insurance was the main reason households delayed dental care for children and teens.
Delay of Dental Care among Children and Teens Service Planning
Area 7 Los Angeles County California Children Never Been to the Dentist 10.2% 10.9% 11.6% Main Reason Children Did Not Visit Dentist in Past Year– Could Not Afford It / Had No Insurance 15.7% 10.0% 10.4% Teens Never Been to the Dentist 3.7% 1.5% 1.2% Main Reason Teens Did Not Visit Dentist in Past Year – Could Not Afford It / Had No Insurance 10.8% 39.0% 30.6% Source: California Health Interview Survey, 2009
36 Chapter Ten Mental Health
Mental Health Indicators The 2009 California Health Interview Survey reported that 5.5% of adults in SPA 7 experienced serious psychological distress in the past year with 11.9% of adults and 16.7% of teens needing help for mental health problems. According to the report, 8.6% of adults and 7.7% of teens received help, 45.7% did not. The report also states that 7.8% of adults took a prescription medication for an emotional or mental health issue in the past year.
Mental Health Indicators Service Planning Area 7 Los Angeles County California Adults who had Serious Psychological Distress 5.5% 7.3% 6.5% During Past Year Adults who Needed Help for Emotional-Mental 11.9% 14.1% 14.3% and/or Alcohol-Drug Issues in Past Year Teens who Needed Help for Emotional-Mental 16.7% 15.3% 12.9% and/or Alcohol-Drug Issues in Past Year Adults who Saw a Healthcare Provider for Emotional/Mental Health and/or Alcohol-Drug 8.6% 10.3% 10.9% Issues in Past Year Teens who Received Psychological/ Emotional 7.7% 7.5% 9.5% Counseling in Past year Those who Took Prescription Medicine for 7.8% 9.3% 9.7% Emotional/Mental Health Issue in Past Year Those who Sought/Needed Help but Did Not 45.7% 47.3% 44.5% Receive Treatment Source: California Health Interview Survey, 2009
Among adults with moderate to severe mental issues in SPA 7, 12.1% and 14.8% said emotions interfered with work and family relationships, respectively; 14.4% said emotions interfered with social lives.
Mental Health Impairment Service Planning Area 7 Los Angeles County California Did your emotions interfere with your work? No 87.9% 84.4% 84.5% Moderate 8.1% 10.5% 10.8% Severe 4.0% 5.1% 4.7% Did your emotions interfere with your relationship with friends and family? No 85.2% 79.7% 81.0% Moderate 11.7% 14.0% 12.9% Severe 3.1% 6.3% 6.1% Did your emotions interfere with your social life? No 85.6% 79.5% 81.0% Moderate 9.9% 12.5% 11.7% Severe 4.5% 8.0% 7.3% Source: California Health Interview Survey, 2009
In SPA 7, 4.5% of adults had seriously considered suicide. This is less than the respective County and State rates of 7.6% and 8.7%.
Thought about Committing Suicide Service Planning Los Angeles County California Area 7 Adults who ever seriously thought about committing suicide 4.5% 7.6% 8.7% Source: California Health Interview Survey, 2009
37 Mental Health Indicators, continued Depression is one of the most common emotional health problems among teens. The California Healthy Kids Survey reported on seventh graders’ depression, defined as feeling sad or hopeless every day for at least two weeks to an extent they stopped doing usual activities.
In Los Angeles County, 30.7% of seventh grade females and 25.1% of seventh grade males indicated feeling sad or hopeless. Females reported depression in greater percentages. Depression in Whittier-area school districts among females was higher than for the State. Depression-related feelings among seventh grade females and males were highest at South Whittier School District.
Feeling Sad or Hopeless, by School District, 7th Grade Students, by Gender, 2008-2010 District* Female Male East Whittier City School District 28.7% 20.7% South Whittier School District 43.6% 33.3% Whittier City School District 38.5% 23.9% Los Angeles County 30.7% 25.1% Source: CA Department of Education, California Healthy Kids Survey, 2008 - 2010 *No data were available for Los Nietos School District
38 Chapter Eleven Preventative Healthcare
Colorectal Cancer Screening The 71.1% compliance rate for colorectal cancer screening in SPA 7 exceeds the 70.5% Healthy People 2020 objective. Of adults advised to obtain screening, 59.2% complied at the time of recommendation.
Colorectal Cancer Screening, Adults 50+
Service Planning Area 7 Los Angeles County California Screening Sigmoidoscopy, Colonoscopy or Fecal Occult Blood Test 71.1% 75.7% 78.0% Compliant with Screening at Time of Recommendation 59.2% 66.5% 68.1% Source: California Health Interview Survey, 2009 Flu and Pneumonia Vaccines More seniors (68.2%) received flu vaccines than adults or youth in SPA 7. Fewer adults received flu vaccine shots (23.7%) than children (38.8%). Children received vaccines at a doctor’s office, Kaiser or HMO (47.7%) or community clinic (25.2%).
Flu Vaccine Service Planning Area 7 Los Angeles County California Received Flu Vaccine, 65+ Years Old 68.2% 63.8% 65.9% Received Flu Vaccine, 18-64 23.7% 27.3% 29.4% Received Flu Vaccine, 0-17 Years Old 38.8% 45.4% 49.9% Child Received Vaccine at Dr. Office/ Kaiser/ HMO 47.7% 47.1% 47.1% Child Received Vaccine at Community Clinic 25.2% 24.5% 23.6% Child Received Vaccine at Hospital or ER 5.7% 9.0% 7.1% Child Received Vaccine Some Other Place 21.4% 19.4% 22.2% Source: California Health Interview Survey, 2009
Seniors should obtain a pneumonia vaccine. Over half (57.6%) of seniors in SPA 7 obtained a pneumonia vaccine, lower than the County rate of 60.5%.
Pneumonia Vaccine, Adults 65+ Service Planning Area 7 Los Angeles County Adults 65+, had a Pneumonia Vaccine 56.6% 60.5% Source: Los Angeles County Department of Public Health, Los Angeles County Health Survey 2007
Mammograms & Pap Smears Mammograms: The Healthy People 2020 objective is to bring to 81.1% the rate of women age 40 and older who’ve had a mammogram in the past two years. In SPA 7, 77% of women age 40 and over have had a mammogram.
Pap Smears: The Healthy People 2020 objective is to bring to 93% the rate of women age 40 and older who’ve had a Pap smear in the past three years. In SPA 7, 85% of women have had a Pap smear in the past three years.
Women Mammograms and Pap Smears Service Planning Area 7 Los Angeles County Women 40+ Years, had a Mammogram in Past Two Years 77.0% 73.7% Women had a Pap Smear in Past Three Years 85.0% 84.4% Source: Los Angeles County Department of Public Health, Los Angeles County Health Survey 2007
39 Chapter Twelve
Health Behaviors
Alcohol and Drug Use The following chart presents rates for binge drinking, defined as consuming a certain amount of alcohol in a set period of time. For males, it is five or more drinks per occasion. For females, it is four or more drinks per occasion. In SPA 7, 30.2% of adults and 5.5% of teens engaged in binge drinking in the past year; 31.8% of teens indicated they tried an alcoholic drink. These rates are higher than the County, but lower than the State rates.
Alcohol Consumption and Binge Drinking Service Planning Area 7 Los Angeles County California Adult Binge Drinking Past Year 30.2% 27.0% 31.3% Teen Binge Drinking Past Month 5.5% 4.2% 5.8% Teen Ever Had an Alcoholic Drink 31.8% 29.0% 33.4% Source: California Health Interview Survey, 2009
In SPA 7, 16% of teens have tried illegal drugs and 13.2% have used marijuana in the past year. These rates are higher than the County and State rates.
Teen Illegal Drug Use Service Planning Area 7 Los Angeles County California Ever Tried Illegal Drugs 16.0% 11.6% 13.5% Use of Marijuana in Past Year 13.2% 8.8% 8.8% Source: California Health Interview Survey, 2009 Cigarette Smoking The following chart presents the percent of smokers by community and ranks them, lowest (1) to highest (127) according to prevalence. La Habra Heights (9.4%) and Hacienda Heights (10.5%) have the lowest and Norwalk (14.5%), the highest rate of smoking in the service area.
Cigarette Smoking Geographical Area Percent of Smokers Rank (1-127) Hacienda Heights 10.5% 26 La Habra Heights 9.4% 15 La Mirada 12.1% 48 Montebello 11.7% 42 Norwalk 14.5% 91 Pico Rivera 12.7% 62 Santa Fe Springs 12.6% 61 South Whittier 13.0% 74 West Whittier – Los Nietos 12.3% 54 Whittier 11.3% 40 Los Angeles County 14.3% NA Source: LA County Department of Public Health, Cigarette Smoking in Los Angeles County, 2010 Blue= Highest rate; Green= Lowest Rate
40 Sexual Health SPA 7 rates of Chlamydia are 406.3 per 100,000 persons. Rates for Gonorrhea are 52.4; primary and secondary Syphilis 4.4, and early latent Syphilis 6.0. Females have the highest rates of Chlamydia; young adults, age 20-24, and Blacks/African Americans, the highest rates of sexually transmitted infections. All STD rates in SPA 7 are lower than the County rates.
STD Cases, Rate per 100,000 Persons, 2010 Service Planning Area 7 Los Angeles County Chlamydia 406.3 455.1 Gonorrhea 52.4 96.8 Primary & Secondary Syphilis 4.4 6.5 Early Latent Syphilis 6.0 9.2 Source: County of Los Angeles, Public Health, Sexually Transmitted Disease Morbidity Report, 2010
In SPA 7, 76.2% of teens indicated they had never had sex. Of those who had sex, only 7% had been tested for an STD.
Teen Sexual History Los Angeles
Service Planning Area 7 County California Never Had Sex 76.2% 84.2% 80.7% First Encounter Under 15 Years Old 5.7% 5.7% 7.3% First Encounter Over 15 Years Old 18.1% 10.1% 12.0% If Had Sex, Tested for STD in Past Year 7.0% 29.7% 31.9% Source: California Health Interview Survey, 2009
41 Chapter Thirteen Weight Status, Nutrition, and Physical Activity
Overweight and Obesity In SPA 7, over one-third (34%) of the adult population is overweight along with 18.8% of teens and 15.2% of children. Overweight rates in SPA 7 exceed those of the County and State.
Overweight Service Planning Area 7 Los Angeles County California Adult 34.0% 33.2% 33.6% Teen 18.8% 18.6% 16.7% Child 15.2% 12.1% 11.5% Source: California Health Interview Survey, 2009 An adult is considered overweight if 25.0 ≤ Body Mass Index (BMI) ≤ 30.0 Teen/Child Overweight is defined as a BMI at or above the 85th percentile and lower than the 95th percentile for children of the same age and sex.(CDC.gov, 2013)
In 2011, 30.1% of the adult population in SPA 7 was obese, higher than the County rate of 23.6%. Adult obesity increased 10.3% between 2005 and 2011.
Adult Obesity 2005 2007 2011 Change 2005-2011 Service Planning Area 7 27.3% 26.6% 30.1% 10.3% Los Angeles County 20.9% 22.2% 23.6% 12.9% Source: LA County Department of Public Health, 2012 An adult is considered obese if BMI ≥ 30kg/m2.
Adult overweight and obesity by race and ethnicity in SPA 7 indicate high rates among African Americans (78.6%) and Whites (72.1%) followed by Latinos (64.1%). Though lower, the Asian rate (49.3%) of overweight and obesity exceeds County and State rates.
Adult Overweight and Obesity by Race/Ethnicity Service Planning Area 7 Los Angeles County California African American 78.6% 65.0% 64.4% Asian 49.3% 34.9% 31.6% Latino 64.1% 64.0% 66.3% White 72.1% 51.5% 55.0% Source: California Health Interview Survey, 2009 An adult is considered obese if BMI ≥ 30kg/m2.
42 Overweight and Obesity, continued Los Angeles County Department of Public Health has collected data on adult and childhood obesity prevalence and established rankings to compare obesity levels across localities. Pico Rivera, Santa Fe Springs, and West Whittier/Los Nietos have the highest rates for obesity among adults; West Whittier/Los Nietos and South Whittier, the highest rates among youth. All cities in the service area, except Hacienda Heights and La Mirada, exceed the County rate of childhood obesity.
Adult and Youth Obesity Rates and Rankings Prevalence of Rank of Adult Prevalence of Rank of Adult Obesity Obesity* Childhood Obesity Childhood
Percent^ (ranked 1- Percent+ Obesity * 127) (ranked 1-119) Hacienda Heights 19.2% 44 20.0% 42 La Habra Heights 15.8% 28 No Data No Data La Mirada 20.8% 52 17.6% 36 Montebello 26.0% 77 23.3% 63 Norwalk 27.2% 86 26.0% 75 Pico Rivera 30.9% 112 25.9% 73 Santa Fe Springs 29.4% 99 24.1% 66 South Whittier 28.0% 91 29.0% 97 West Whittier/Los Nietos 29.4% 99 31.1% 111 Whittier 23.6% 65 23.4% 64 Los Angeles County 23.9% NA 23.0% N/A Source: L.A. County Department of Public Health, 2011 ^adult BMI of 30kg or above; youth +BMI for age ≥ 95th percentile *Places were ranked from lowest to highest rates of obesity with 1 indicating the lowest rate of obesity. There are fewer rankings for children since some localities were not presented due to small student group sizes. Blue= Highest rate; Green= Lowest Rate Nutrition Eating breakfast is especially important for children and adolescents. Among seventh grade students in Whittier-area school districts, males eat breakfast more than females.
Ate Breakfast in Past Day, by School District, 7th Grade Students, by Gender, 2008-2010 District* Female Male East Whittier City School District 58.2% 70.6% South Whittier School District 56.5% 69.2% Whittier City School District 49.5% 68.1% Los Angeles County 62.9% 70.3% Source: CA Department of Education, California Healthy Kids Survey, 2008-2010 *No data were available for Los Nietos School District
In SPA 7, over one-third (33.5%) of the residents eat fast food three to four times a week. Adults, age 18-64, consume fast food at a higher rate than youth or seniors. SPA 7 has higher rates for fast food consumption among all age groups than the County or State.
Fast Food Consumption, 3-4 Times a Week
Service Planning Area 7 Los Angeles County California Total Population 33.5% 21.9% 19.6% Ages 0-17 22.1% 19.0% 17.0% Ages 18-64 40.3% 25.3% 22.6% Ages 65+ 17.6% 8.7% 7.7% Source: California Health Interview Survey, 2009
43 Nutrition, continued In SPA 7, over half (53.6%) of children consume five fruits and vegetables in a day. This is higher than County or State rates. Fresh fruit and vegetable consumption decreases considerably among teens. Only 31.4% of teens consume five or more fresh fruits and vegetable a day.
Consumption of 5+ Fresh Fruits and Vegetables a Day Service Planning Area 7 Los Angeles County California Children 53.6% 50.8% 48.4% Teens 31.4% 18.4% 19.9% Source: California Health Interview Survey, 2009
In Service Planning Area 7, almost a quarter (23.5%) of children and teens consume two or more sodas or sweetened drinks a day. This rate is higher than the County (18.1%) and State (14.7%) rates.
Soda or Sweetened Drink Consumption, Two or More a Day Service Planning Area 7 Los Angeles County California Teens and Children 23.5% 18.1% 14.7% Source: California Health Interview Survey, 2009 Physical Activity In SPA 7, 64.2% of children engaged in vigorous physical activity three days per week. Over 75% of youth visited a park, playground or open space in the last month and 17% of children were sedentary during the week. Among adults, 81.4% walked for transportation, fun or exercise in the past 7 days.
Physical Activity Service Planning Los Angeles California Area 7 County Engaged in Vigorous Physical Activity 3 Days/Week – Child 64.2% 68.1% 67.1% No Physical Activity/Week – Child 17.0% 10.6% 11.8% No Physical Activity/Week – Teen 14.1% 16.9% 16.2% Teens Take PE Class During the School Year 80.1% 68.0% 65.9% Walked/Biked/Skated to School in Past Week 49.5% 49.5% 43.0% Youth Visited Park/Playground/Open Space in the Last Month 79.5% 80.0% 79.4% Adults Walked for Transportation, Fun or Exercise in Past 7 days 81.4% 79.0% 77.2% Source: California Health Interview Survey, 2009
The California Department of Education’s physical fitness test (PFT) measures the aerobic capacity of school children using run and walk tests. Children who meet established standards for aerobic capacity are categorized in the Healthy Fitness Zone. Whittier City School District ranks highest in Healthy Fitness Zone aerobic capacity.
Fifth, Seventh and Ninth Grade Students, Aerobic Capacity, Healthy Fitness Zone School District Fifth Grade Seventh Grade Ninth Grade East Whittier City School District 63.0% 62.8% N/A Los Nietos School District 25.7% 59.6% N/A South Whittier School District 52.3% 40.4% N/A Whittier City School District 65.4% 72.5% N/A Whittier Union High School District N/A N/A 61.0% Los Angeles County 58.8% 59.4% 57.6% Source: California Department of Education, FITNESSGRAM Physical Fitness Testing Results, 2011 – 2012 Blue= Highest rate; Green= Lowest Rate
44 Physical Activity, continued
Community Walkability WalkScore.com ranks the walkability of over 2,500 cities (over 10,000 neighborhoods) in the United States to determine how conducive a neighborhood is to walking. Access to amenities—such as grocery stores and parks—determines the walk score. Many locales are sampled to determine an overall score. The higher the score, the more walkable. The lower the score, the more vehicle dependent. WalkScore.com has established the range of scores as follows:
0-24: Car Dependent (Almost all errands require a car) 70-89: Very Walkable (Most errands can be accomplished on foot) 25-49: Car Dependent (A few amenities within walking distance) 90-100: Walker's Paradise (Daily errands do not require a car) 50-69: Somewhat Walkable (Some amenities within walking distance)
Based on this scoring, most communities in the service area are classified as “Somewhat Walkable.” Hacienda Heights is “Car Dependent” and Santa Fe Springs, “Very Walkable.”
Walkability Geographic Area Walk Score Hacienda Heights 45 La Habra 66 La Mirada 57 Montebello 59 Norwalk 62 Pico Rivera 55 Santa Fe Springs 75 South Whittier 50 West Whittier/Los Nietos 56 Whittier 62 Los Angeles County 66 Source: WalkScore.com, 2012 Blue= Highest rate; Green= Lowest Rate
In the service area, 1.6% of workers, age 16 and older, walk to work. Whittier 90602 has the highest rate of commuters who walk to work (3.8%).
Walked to Work Geographic Area Walked to Work 90601 - Whittier 1.8% 90602 - Whittier 3.8% 90603 - Whittier 1.4% 90604 - Whittier 0.1% 90605 - Whittier 0.7% 90606 - Whittier 1.6% 90631 - La Habra/La Habra Heights 1.5% 90638 - La Mirada 2.7% 90640 - Montebello 2.1% 90650 - Norwalk 1.8% 90660 - Pico Rivera 1.9% 90670 - Santa Fe Springs 0% 91745 - Hacienda Heights 1.1% PIH Health Primary Service Area 1.6% Los Angeles County 2.9% California 2.8% Source: U.S. Bureau of the Census, American Community Survey, 2007 - 2011 Blue= Highest rate; Green= Lowest Rate
45 Chapter Fourteen Chronic Diseases
Health Status In SPA 7, 20.1% of residents, including 21.8% of adults and 38.5% of seniors, gave themselves a fair or poor health status rating. These rates are greater than for the County and State.
Health Status, Fair or Poor Health
Service Planning Area 7 Los Angeles County California Fair or Poor Health 20.1% 18.1% 15.2% 18-64 Years Old 21.8% 19.7% 16.8% 65+ Years Old 38.5% 32.5% 27.6% Source: California Health Interview Survey, 2009
AIDS/HIV In 2011, 128 cases (9 per 100,000) of HIV/AIDS were diagnosed in SPA 7, a decrease from 167 in 2010. HIV/AIDS diagnoses are lower in SPA 7 than the County.
AIDS/HIV Diagnoses, 2010 - 2011 2010 2011
Number Rate Number Rate Service Planning Area 167 12 128 9 Los Angeles County 2,062 20 1,340 13 Source: County of Los Angeles, Public Health, 2011 Annual HIV Surveillance Report Asthma In SPA 7, 11.5% have been diagnosed with asthma with 43% taking medication to control their symptoms and 52.7% very confident they can control and manage their condition. Among youth, 16.2% have been diagnosed with asthma, a rate higher than the respective County and State rates of 13.8% and 14.2%.
Asthma Los Angeles
Service Planning Area 7 County California Diagnosed with Asthma, Total Population 11.5% 12.5% 13.7% Diagnosed with Asthma, 0-17 Years Old 16.2% 13.8% 14.2% ER Visit in Past Year Due to Asthma, Total Population 7.0% 9.5% 10.3% ER Visit in Past Year Due to Asthma, 0-17 Years Old 9.2% 15.9% 13.7% Takes Daily Medication to Control Asthma, Total Population 43.0% 45.2% 42.1% Takes Daily Medication to Control Asthma, 0-17 Years Old 47.4% 40.8% 38.1% Very Confident to Control and Manage Asthma 52.7% 73.4% 76.9% Confident to Control and Manage Asthma 40.8% 22.9% 14.8% Not Confident to Control and Manage Asthma 6.5% 3.7% 3.3% Source: California Health Interview Survey, 2009
46 Cancer Cancer incidence rates are available at the County level. In Los Angeles County, cervical cancer (9.8 per 100,000 persons) and colorectal cancer rates (45.1per 100,000 persons) exceed State rates. Breast cancer (117.8), prostate cancer (142.8) and lung cancer (45.6) occur at rates less than the State rates for these types of cancer.
Cancer Incidence, per 100,000 Persons Los Angeles County California Breast Cancer 117.8 123.2 Cervical Cancer 9.8 8.3 Colon and Rectum Cancer 45.1 43.7 Prostate Cancer 142.8 146.5 Lung Cancer 45.6 52.4 Source: The Centers for Disease Control and Prevention, National Cancer Institute, State Cancer Profiles, 2005 - 2009
PIH Health Oncology Registry Data PIH Health maintains an Oncology Registry to track cancer statistics and report them to the regional registry - Cancer Surveillance Program at the University of Southern California. In 2011, 1,350 patients—57.8% female and 42.2% male— were diagnosed with or received care for cancer at the hospital. Top five cancer sites at PIH Health are breast, digestive system, male/female genitalia, and respiratory/intrathoracic. Of note, digestive system and respiratory cancer diagnoses usually occur at stages III or IV.
Top Five Sites, Cancer Diagnoses, PIH Health Oncology Registry, 2011 Stage at Diagnosis Primary Site Cases Male Female Unknown 0 I II III IV N/A
All sites 1,350 570 780 78 274 188 136 158 198
Breast 256 2 254 48 80 62 18 5 4
Digestive System 253 139 114 9 33 38 41 59 33
Male Genitalia 142 142 0 0 18 44 12 10 3
Female Genitalia 123 0 123 1 44 13 18 12 3
Respiratory/Intrathoracic 113 58 55 0 19 7 21 41 1
Source: PIH Health Cancer Registry Statistical Database; 2012 Ruby L. Golleher Comprehensive Cancer Program Annual Report
47 Diabetes In SPA 7, 12.7% of adults have been diagnosed with diabetes. For adults with diabetes, 60% are very confident they can control the disease and 82.5% have a management plan. Among diabetics, 21.6% have never had a foot exam and 5.2% have never had an HgA1c test.
Adult Diabetes Service Planning Area 7 Los Angeles County California Diagnosed Pre/Borderline Diabetic 6.6% 7.1% 8.0% Diagnosed with Diabetes 12.7% 10.9% 8.5% Very confident to Control Diabetes 60.0% 60.9% 58.6% Somewhat confident 33.3% 30.6% 32.6% Not confident 6.7% 8.5% 8.8% Takes oral hypoglycemic medications 77.2% 73.7% 77.0% Has a diabetic management care plan 82.5% 77.8% 78.0% Has never had a foot exam 21.6% 25.7% 72.2% Number of times had an HgA1c test Never heard of this test 17.4% 19.5% 14.5% Never had the test 5.2% 9.3% 10.6% Source: California Health Interview Survey, 2009
The rate of diabetes among adults in SPA 7 increased from 10.5% in 2005 to 16.2% in 2011. Diabetes in SPA 7 is higher than the County. SPA 7 has the highest rate of diabetes and largest increase over time.
Adults Diagnosed with Diabetes, 2005-2011 2005 2007 2011 Change 2005-2011 Service Planning Area 7 10.5% 11.8% 16.2% 54.3% Los Angeles County 8.6% 9.1% 9.9% 15.1% Source: LA County Department of Public Health, 2012
Heart Disease In SPA 7, 6.2% of adults have been diagnosed with heart disease. Most (60.8%) are very confident they can manage their condition and 76.1% have a care plan developed by a healthcare professional.
Adult Heart Disease Service Planning Area 7 Los Angeles County California Diagnosed with heart disease 6.2% 5.8% 5.9% Very Confident to Control Condition 60.8% 61.4% 58.5% Somewhat Confident to Control Condition 28.1% 31.4% 32.3% Not Confident to Control Condition 11.1% 7.3% 9.2% Has a management care plan 76.1% 65.1% 70.9% Source: California Health Interview Survey, 2009
High Blood Pressure In SPA 7, 26% of adults have been diagnosed with high blood pressure (hypertension), a co-morbidity of diabetes and heart disease. Of these, 65.5% are on medication.
High Blood Pressure Service Planning Area 7 Los Angeles County California Diagnosed with High Blood Pressure 26.0% 27.6% 26.2% Takes Medication for High Blood Pressure 65.5% 70.2% 70.2% Source: California Health Interview Survey, 2009
48 Chapter Fifteen Leading Causes of Death
Leading Causes of Premature Death In Los Angeles County, 44% of people in 2008 died before they reached age 75, with deaths prior to 75 years of age determined by the Los Angeles County Department of Public Health to be premature. When premature death rates were examined for SPA 7, the top three causes of premature death were: heart disease, homicide, and motor vehicle crash.
Leading Causes of Premature Death (before age 75) by Gender, Service Planning Area 7 Male Female Overall #1 Cause Heart Disease Heart Disease Heart Disease #2 Cause Homicide Breast Cancer Homicide #3 Cause Motor Vehicle Crash Diabetes Motor Vehicle Crash Source: L.A. County Department of Public Health, Office of Health Assessment and Epidemiology. Mortality in Los Angeles County 2007: Leading causes of death and premature death with trends for 1999-2008, 2011.
Age-Adjusted Death Rates The crude death rate is a ratio of the number of deaths to the entire population. Age-adjusted death rates eliminate the bias of age in the makeup of the populations being compared. When comparing across geographic areas, age-adjusting is typically used to control for the influence that different population age distributions might have on health event rates. When adjusted for age, the death rate in the service area was 626.7 per 100,000 persons. This is lower than the State rate.
Age-Adjusted Death Rate, per 100,000 Persons, 3-Year Total (2008-2010) Geographic Area Crude Death Rate Age-Adjusted Death Rate PIH Health Primary Service Area 636.1 626.7 California 625.4 643.1 Source: California Department of Public Health, Public Health Death Statistical Master Files 2008-2010, tabulated by the University of Missouri, CARES. Age-adjustment using U.S. 2010 Decennial Census, based on the 2000 Standard Population using the methods approved by the Centers for Disease Control (CDC).
Leading Causes of Death – Age-Adjusted Death counts represent totals for the three-year period 2008-2010, whereas death rates are averages for the same three-year period. Heart disease, cancer, and stroke are the top three leading causes of death in the service area. When compared to the State, the service area has higher death rates for influenza/pneumonia, heart disease, cancer, and diabetes.
Leading Causes of Death – Age-Adjusted Death Rate per 100,000 Persons, 3-Year Total (2008-2010) PIH Health Primary Service Area California Number Rate Rate Diseases of the Heart 3,166 169.1 165.3 Cancer 2,830 154.7 154.5 Stroke 671 35.9 37.8 Chronic Lower Respiratory Disease 615 33.5 37.1 Alzheimer's Disease 500 26.1 28.3 Diabetes 476 25.9 19.8 Influenza/Pneumonia 387 20.6 17.4 Unintentional Injuries 367 20.6 27.9 Suicide 116 6.4 10.0 Homicide 92 5.5 5.5 Source: California Department of Public Health, Public Health Death Statistical Master Files 2008-2010, tabulated by the University of Missouri, CARES. Age-adjustment using U.S. 2010 Decennial Census. Mortality rates are age-adjusted based on the 2000 Standard Population using the methods approved by the CDC. Mortality rates for causes of death and area combinations based on less than 10 deaths over the study period were suppressed. Blue= Highest; Green= Lowest
49 Alzheimer’s Disease Mortality In the service area, the rate of death for Alzheimer’s disease is 26.1 per 100,000 persons. La Habra has the highest rate of death from Alzheimer’s disease at 41.3 per 100,000 persons, and La Mirada has the lowest rate of death at 20.0.
Alzheimer’s Disease Death Rates Age-Adjusted Death Rate per 100,000 Persons, 3-Year Total (2008-2010)* Geographic Area Number Rate 90601 – Whittier 26 24.2 90602 – Whittier 15 20.9 90603 – Whittier 31 30.9 90604 – Whittier 25 22.9 90605 – Whittier 21 21.0 90606 – Whittier 28 28.7 90631 – La Habra/La Habra Heights 88 41.3 90638 – La Mirada 41 20.0 90640 – Montebello 60 25.5 90650 – Norwalk 62 24.9 90660 – Pico Rivera 48 24.2 90670 – Santa Fe Springs 17 31.8 91745 – Hacienda Heights 38 20.6 PIH Health Primary Service Area 500 26.1 California 30,810 28.3 Source: California Department of Public Health, Public Health Death Statistical Master Files 2008-2010, tabulated by the University of Missouri, CARES. Age-adjustment using U.S. 2010 Decennial Census SF1. Mortality rates are age-adjusted based on the 2000 Standard Population using the methods approved by the CDC. Mortality rates for causes of death and area combinations based on less than 10 deaths over the study period were suppressed. *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest; Green= Lowest
50 Cancer Mortality The age-adjusted death rate for cancer in the service area is 154.7 per 100,000 persons. This is higher than the State rate of 154.5 for cancer deaths but below the Healthy People 2020 objective of 160.6 for the service area overall; however, a number of communities do have death rates from cancer that exceed State and Healthy People 2020 rates. La Habra has the highest rate of death by cancer (168.9). Montebello has the lowest rate of death by cancer at 128.6 per 100,000 persons.
Cancer Death Rates Age-Adjusted Death Rate per 100,000 Persons, 3-Year Total (2008-2010)* Geographic Area Number Rate 90601 - Whittier 147 146.5 90602 - Whittier 98 161.8 90603 - Whittier 126 156.1 90604 - Whittier 183 166.3 90605 - Whittier 155 156.2 90606 - Whittier 136 148.7 90631 - La Habra/La Habra Heights 341 168.9 90638 - La Mirada 290 162.1 90640 - Montebello 263 128.6 90650 - Norwalk 436 161.9 90660 - Pico Rivera 307 162.7 90670 - Santa Fe Springs 82 164.0 91745 - Hacienda Heights 266 134.2 PIH Health Primary Service Area 2,830 154.7 California 166,456 154.5 Source: California Department of Public Health, Public Health Death Statistical Master Files 2008-2010, tabulated by the University of Missouri, CARES. Age-adjustment using U.S. 2010 Decennial Census. Mortality rates are age-adjusted based on the 2000 Standard Population using the methods approved by the CDC. Mortality rates for causes of death and area combinations based on less than 10 deaths over the study period were suppressed. *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest; Green= Lowest
51 Chronic Lower Respiratory Disease (Lung Disease) Mortality In the service area, the rate of death for chronic lower respiratory (lung) disease is 33.5 per 100,000 persons. Norwalk has the highest rate of death from lung disease at 51.2 per 100,000 persons, and Whittier 90603 has the lowest rate of death for the disease at 18.2.
Lung Disease Death Rates Age-Adjusted Death Rate per 100,000 Persons, 3-Year Total (2008-2010)* Geographic Area Number Rate 90601 - Whittier 36 36.2 90602 - Whittier 27 42.6 90603 - Whittier 16 18.2 90604 - Whittier 35 34.2 90605 - Whittier 48 50.5 90606 - Whittier 29 31.9 90631 - La Habra/La Habra Heights 62 30.9 90638 - La Mirada 70 37.0 90640 - Montebello 43 19.9 90650 - Norwalk 128 51.2 90660 - Pico Rivera 64 33.5 90670 - Santa Fe Springs 17 33.3 91745 - Hacienda Heights 40 21.2 PIH Health Primary Service Area 615 33.5 California 39,179 37.1 Source: California Department of Public Health, Public Health Death Statistical Master Files 2008-2010, tabulated by the University of Missouri, CARES. Age-adjustment using U.S. 2010 Decennial Census SF1. Mortality rates are age-adjusted based on the 2000 Standard Population using the methods approved by the CDC. Mortality rates for causes of death and area combinations based on less than 10 deaths over the study period were suppressed. *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest; Green= Lowest
52 Diabetes Mortality The rate of death by diabetes per 100,000 persons is higher in the service area (25.9) than in the State (19.8). Montebello has the highest rate of death as a result of diabetes, at 34.2 per 100,000 persons. Hacienda Heights has the lowest rate of death from diabetes (17.0) in the area. The Healthy People 2020 rate for diabetes deaths is 65.8 per 100,000 persons. All PIH Health communities meet this objective.
Diabetes Death Rates Age-Adjusted Death Rate per 100,000 Persons, 3-Year Total (2008-2010)* Geographic Area Number Rate 90601 - Whittier 23 22.7 90602 - Whittier 12 21.6 90603 - Whittier 22 26.4 90604 - Whittier 27 24.4 90605 - Whittier 32 33.1 90606 - Whittier 26 28.6 90631 - La Habra / La Habra Heights 38 18.9 90638 - La Mirada 35 19.2 90640 - Montebello 71 34.2 90650 - Norwalk 83 31.8 90660 - Pico Rivera 58 30.3 90670 - Santa Fe Springs 17 32.5 91745 - Hacienda Heights 32 17.0 PIH Health Primary Service Area 476 25.9 California 21,337 19.8 Source: California Department of Public Health, Public Health Death Statistical Master Files 2008-2010, tabulated by the University of Missouri, CARES. Age-adjustment using U.S. 2010 Decennial Census SF1. Mortality rates are age-adjusted based on the 2000 Standard Population using the methods approved by the CDC. Mortality rates for causes of death and area combinations based on less than 10 deaths over the study period were suppressed. *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest; Green= Lowest
53 Heart Disease Mortality The service area has a high rate of death due to heart disease. Whittier 90602 has the highest rate of death due to heart disease (192.9). Hacienda Heights has the lowest rate of death from heart disease (140.1). The Healthy People 2020 objective for heart disease death rate is 100.8 per 100,000 persons. No PIH Health community meets this objective.
Heart Disease Death Rates Age-Adjusted Death Rate per 100,000 Persons, 3-Year Total (2008-2010)* Geographic Area Number Rate 90601 - Whittier 163 157.2 90602 - Whittier 122 192.9 90603 - Whittier 155 170.8 90604 - Whittier 198 181.7 90605 - Whittier 159 157.5 90606 - Whittier 149 157.9 90631 - La Habra/La Habra Heights 373 176.9 90638 - La Mirada 318 166.1 90640 - Montebello 365 167.9 90650 - Norwalk 474 182.7 90660 - Pico Rivera 335 174.2 90670 - Santa Fe Springs 96 185.2 91745 - Hacienda Heights 259 140.1 PIH Health Primary Service Area 3,166 169.1 California 179,934 165.3 Source: California Department of Public Health, Public Health Death Statistical Master Files 2008-2010, tabulated by the University of Missouri, CARES. Age-adjustment using U.S. 2010 Decennial Census. Mortality rates are age-adjusted based on the 2000 Standard Population using the methods approved by the CDC. Mortality rates for causes of death and area combinations based on less than 10 deaths over the study period were suppressed. *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest; Green= Lowest
54 Homicide Rate The age-adjusted rate of homicide is 5.5 per 100,000 persons in the service area. This is the same as the State and Healthy People 2020 rate. Whittier 90601 has the highest rate of homicide (10.1 per 100,000 persons), higher than the State rate; Santa Fe Springs has the lowest at 0.0 per 100,000 persons.
Homicide Death Rates Age-Adjusted Death Rate per 100,000 Persons, 3-Year Total (2008-2010)* Geographic Area Number Rate 90601 - Whittier 10 10.1 90602 - Whittier 33.5 90603 - Whittier 2 3.0 90604 - Whittier 4 3.3 90605 - Whittier 6 4.6 90606 - Whittier 8 8.0 90631 - La Habra/La Habra Heights 6 3.1 90638 - La Mirada 3 2.0 90640 - Montebello 15 8.3 90650 - Norwalk 21 5.9 90660 - Pico Rivera 11 5.8 90670 - Santa Fe Springs 0 0.0 91745 - Hacienda Heights 3 2.1 PIH Health Primary Service Area 92 5.5 California 6,281 5.5 Source: California Department of Public Health, Public Health Death Statistical Master Files 2008-2010, tabulated by the University of Missouri, CARES. Age-adjustment using U.S. 2010 Decennial Census SF1. Mortality rates are age-adjusted based on the 2000 Standard Population using the methods approved by the CDC. Mortality rates for causes of death and area combinations based on less than 10 deaths over the study period were suppressed. *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest; Green= Lowest
55 Influenza and Pneumonia Mortality The age-adjusted influenza and pneumonia mortality rate for the service area is 20.6 per 100,000 persons. Santa Fe Springs has the highest rate of death at 27.7 per 100,000 persons. Whittier 90606 has the lowest rate of death from influenza and pneumonia (13.6).
Influenza and Pneumonia Death Rates Age-Adjusted Death Rate per 100,000 Persons, 3-Year Total (2008-2010)* Geographic Area Number Rate 90601 - Whittier 20 20.0 90602 - Whittier 15 25.3 90603 - Whittier 17 16.7 90604 - Whittier 16 15.2 90605 - Whittier 22 22.5 90606 - Whittier 13 13.6 90631 - La Habra/La Habra Heights 45 21.1 90638 - La Mirada 32 16.2 90640 - Montebello 52 24.0 90650 - Norwalk 58 22.8 90660 - Pico Rivera 36 18.6 90670 - Santa Fe Springs 16 27.7 91745 - Hacienda Heights 45 25.8 PIH Health Primary Service Area 387 20.6 California 18,782 17.4 Source: California Department of Public Health, Public Health Death Statistical Master Files 2008-2010, tabulated by the University of Missouri, CARES. Age-adjustment using U.S. 2010 Decennial Census SF1. Mortality rates are age-adjusted based on the 2000 Standard Population using the methods approved by the CDC. Mortality rates for causes of death and area combinations based on less than 10 deaths over the study period were suppressed. *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest; Green= Lowest
56 Stroke Mortality The service area has a lower rate of death by stroke (35.9) than found in the State (37.8). Whittier 90601 has the highest rates of death due to stroke (44.2 per 100,000 persons). Montebello has the lowest rate of death due to stroke (27.5). The Healthy People 2020 rate for stroke deaths is 33.8 per 100,000 persons. Whittier 90604 and 90606, La Mirada, Montebello, Norwalk, Santa Fe Springs, and Hacienda Heights all meet this objective.
Stroke Death Rates Age-Adjusted Death Rate per 100,000 Persons, 3-Year Total (2008-2010)* Geographic Area Number Rate 90601 - Whittier 46 44.2 90602 - Whittier 27 38.7 90603 - Whittier 39 43.4 90604 - Whittier 37 33.8 90605 - Whittier 42 43.1 90606 - Whittier 31 33.2 90631 - La Habra/La Habra Heights 90 43.2 90638 - La Mirada 64 33.8 90640 - Montebello 60 27.5 90650 - Norwalk 81 31.7 90660 - Pico Rivera 78 40.4 90670 - Santa Fe Springs 18 33.8 91745 - Hacienda Heights 58 31.3 PIH Health Primary Service Area 671 35.9 California 40,768 37.8 Source: California Department of Public Health, Public Health Death Statistical Master Files 2008-2010, tabulated by the University of Missouri, CARES. Age-adjustment using U.S. 2010 Decennial Census. Mortality rates are age-adjusted based on the 2000 Standard Population using the methods approved by the CDC. Mortality rates for causes of death and area combinations based on less than 10 deaths over the study period were suppressed. *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest; Green= Lowest
57 Suicide Rate The age-adjusted rate of suicide is 6.4 per 100,000 persons in the service area. This is lower than the State rate of 10 and the Healthy People 2020 objective of 10.2. Whittier 90605 has a rate of suicide of 10.5 per 100,000 persons, higher than the State rate. Whittier 90603 has the lowest rate of suicide at 1.2.
Suicide Death Rates Age-Adjusted Death Rate per 100,000 Persons, 3-Year Total (2008-2010)* Geographic Area Number Rate 90601 - Whittier 11 10.4 90602 - Whittier 33.9 90603 - Whittier 1 1.2 90604 - Whittier 9 8.1 90605 - Whittier 11 10.5 90606 - Whittier 8 8.6 90631 - La Habra/La Habra Heights 13 6.4 90638 - La Mirada 11 7.1 90640 - Montebello 12 6.1 90650 - Norwalk 14 4.7 90660 - Pico Rivera 9 4.7 90670 - Santa Fe Springs 3 5.5 91745 - Hacienda Heights 11 5.5 PIH Health Primary Service Area 116 6.4 California 11,324 10.0 Source: California Department of Public Health, Public Health Death Statistical Master Files 2008-2010, tabulated by the University of Missouri, CARES. Age-adjustment using U.S. 2010 Decennial Census SF1. Mortality rates are age-adjusted based on the 2000 Standard Population using the methods approved by the CDC. Mortality rates for causes of death and area combinations based on less than 10 deaths over the study period were suppressed. *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest; Green= Lowest
58 Unintentional Injury Death Rate In the service area, the death rate per 100,000 persons as a result of unintentional injuries (20.6) is lower than the State rate (27.9), and the Healthy People 2020 rate (36.0). Whittier 90602 has the highest rate of death from unintentional injuries (28.9) and Whittier 90603 has the lowest death rate (11.9) from this cause.
Unintentional Injury Death Rates Age-Adjusted Death Rate per 100,000 Persons, 3-Year Total (2008-2010)* Geographic Area Number Rate 90601 - Whittier 25 25.0 90602 - Whittier 20 28.9 90603 - Whittier 9 11.9 90604 - Whittier 23 19.4 90605 - Whittier 20 17.6 90606 - Whittier 15 16.5 90631 - La Habra/La Habra Heights 49 23.0 90638 - La Mirada 30 19.3 90640 - Montebello 33 16.8 90650 - Norwalk 56 19.0 90660 - Pico Rivera 47 24.9 90670 - Santa Fe Springs 11 24.9 91745 - Hacienda Heights 29 18.2 PIH Health Primary Service Area 367 20.6 California 31,383 27.9 Source: California Department of Public Health, Public Health Death Statistical Master Files 2008-2010, tabulated by the University of Missouri, CARES. Age-adjustment using U.S. 2010 Decennial Census SF1. Mortality rates are age-adjusted based on the 2000 Standard Population using the methods approved by the CDC. Mortality rates for causes of death and area combinations based on less than 10 deaths over the study period were suppressed. *When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest; Green= Lowest
59 Chapter Sixteen PIH Health Clinical Care Data in this chapter pertain to PIH Health clinical data for service area residents.
PIH Health Payer Mix Between 2007 and 2010, PIH Health experienced an increase in Medicare and a decrease in Medi-Cal and private payer patients from the service area. In 2010, Medicare served as the payer for 50.8% of PIH Health’s service area patients.
PIH Health Primary Service Area Payer Source, 2007-2010 Payer Source 2007 2008 2009 2010 Medicare 42.8% 44.4% 47.4% 50.8% Medi-Cal 18.8% 18.8% 14.1% 15.7% Private 33.2% 30.8% 32.5% 27.8% Self-Pay 4.3% 4.4% 4.8% 4.5% Other 1.0% 1.5% 1.2% 1.2% Source: OSHPD, PIH Health Data, 2007-2010
PIH Health Emergency Department (ED) Admissions PIH Health ED admissions, examined over a five-year period, decreased from 50,188 in 2007 to 49,727 in 2008. Admissions increased to 55,433 in 2009, decreased to 52,801 in 2010 and increased again to 54,758 in 2011.
Emergency Department Admissions, 2007-2011 60,000 55,433 52,801 54,758 50,188 49,727 50,000
40,000
30,000
20,000
10,000
0 2007 2008 2009 2010 2011
Source: State of California, OSHPD, PIH Health Emergency Department Data, 2007-2011
The top five PIH Health ED diagnoses from service area residents for 2011 are listed in order of occurrence by age group. When compared to 2009 and 2010 ED admissions, overall diagnoses stayed consistent.
PIH Health Emergency Department Diagnoses, Top 5 by Age Group, 2011 Pediatrics (0-17 years) Adults (18-64 years) Seniors (65+ years) 1 Upper respiratory infection Abdominal Pain Head Injury 2 Fever Headache Dizziness 3 Ear Infection Urinary Tract Infection Abdominal Pain 4 Vomiting Chest Pain Malaise Fatigue 5 Head Injury Antepartum (prenatal) Condition Hypertension Source: PIH Health, 2011
60 PIH Health ED Admissions for Ambulatory Care Sensitive Conditions
Ambulatory Care Sensitive Conditions are defined as those conditions for which outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications or more severe disease.
In 2011, PIH Health data indicate there were 3,016 patients with ambulatory care sensitive conditions that were admitted to the ED. Patients most frequently presented with urinary tract/kidney infections, asthma, hypertension, dehydration, and chronic obstructive pulmonary disease (COPD).
PIH Health Emergency Department Visits by Ambulatory Care Sensitive Conditions across all ages, 2011 Rank Ambulatory Care Sensitive Condition Emergency Department Admissions 1 Urinary Tract Infection / Kidney Infection 2 Asthma 3 Hypertension 4 Dehydration 5 Chronic Obstructive Pulmonary Disease (COPD) 6 Congestive Heart Failure (CHF) 7 Pediatric Gastroenteritis 8 Related to Uncontrolled Diabetes 9 Angina 10 Perforated Appendix 11 Bacterial Pneumonia Source: PIH Health, 2011
61 Appendix A Geographical Information System Maps of PIH Health Primary Service Area
1| PIH Health Primary Service Area Low-Income Households
2| PIH Health Primary Service Area Body Composition of 5th Grade Students by School
3| PIH Health Primary Service Area Alzheimer’s Disease Deaths
4| PIH Health Primary Service Area Cancer Deaths
5| PIH Health Primary Service Area Diabetes Deaths
6| PIH Health Primary Service Area Heart Disease Deaths
7| PIH Health Primary Service Area Hypertension Deaths
8| PIH Health Primary Service Area Stroke Deaths
62 10
10 Garvey Ave e v
e E Cameron Ave A v
A e Alhambra a v
r r it A
e n Low-Income Households (<$30k/yr.)l e d Rosemead t PIH Health Hospital y E Me A rced Ave v n l e T El Monte A Rush St a e B v m t u A P a
c c n i e r t d a v R l PIH Health Primary Service Area
n S A d e a i e l f e t f r r A a u West Rd
S S G D Zip Codes r 60 V a S S Rd a Covina Am
d l Mil lle Amar Rd R y Rd an B mar k k rkm lv Freeways A Campo e c Wo d E Av e 605 A
e P urfe ma D La Puente Tem r R Montebello ple A Majord Roads d ve d R Walnut e R 90640 l e nt W B il Pue everly 19 v 39 La Blvd M A 1 Dot = 2 Households d n n h R a t te
m 7 t n S e rk u
o s P Low Income (<$30k)e a W G V l L
B a a a ev le A lley Bl lvd er v vd g ly e y B B Whittier o lvd lle e N Va 90601 Hacienda Heights v A F 91745 n Source: American Communitya i o r e s w v Survey, 2007-2011 Average m a A anyon Rd i C y ull t d d b S D l n d r S 60 e v u r i l T Co f B lima Rd r Pico Rivera a l k Beverly Blvd G a Broadway T E el 90660 rw 72 Sla eg o us d N
o r Ave n ap lv Av B f h a e s R e Pa n l t d S Whittier d hfin Ga la o n R d ge A us s a er ve o e n s Rd
A e m v a 90606 i e r l P Whittier o
G C 90602 5 ast Rd T E el F eg lor ra Whittier La Habra/ en p M West ce h Santa Fe u Rd d A Rd lb 90605 La Habra Heights R ve e n Springs rr o y y D 90631 n 90670 r e a Downey Av Whittier C lls a Telegraph Rd i re M 90603 B Florence Ave Whittier d E La Habra Blvd 605 ell R d 90604 ingw 57 d f d f lv d Le
v
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10 10 ¦¨§
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v ¦¨§ v
A
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d
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e a
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M e v GF PIH Health Hospital
T v A l l Cancer Deaths Rush St e A
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k t te r t
o 7 n S e
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|ÿ e a Ga South San l L a d Be le A lv Montebello v Whittier v g T er e Jose0.0 Hills - 100.2 y B e ly o l Bl lle e v N g 90640 d 90601 e Va r v a A p F h n 100.3 - 130.6 a i R o r d s 60 w Pico Rivera m a anyon R i ÿ C d | y ull t b S 130.7 - 150.7 90660 n D r S Tu <-- CA Avgr 150.7 d d v lv Beverly Blvd l B Broadway Hacienda Heights 150.8 - 193.1 d B k E v s l S l la n a 91745 u B o w s t r on s Ave 193.2 - 246.0 n s o A a f v u N e P Whittier a o 72 e Pa |ÿ l thfin G m 90606 n d age A a 246.1 - 37,500.0 e v S W e r R e r la ash d u e Ü 5 a s in on gto r Whittier P A n B ¨¦§ ve lvd G 90602 Source: CA Dept. of GF Diamond East Rd Public Health, 2010 M Bar Flo u re lb Whittier West d n Santa Fe er Rd lv ce ry d B d Av D R r R d e Springs r 90605 a o n lv b o B im r y Te l a n t t le 90670 o H n gr e a u ap v C C h s A La Habra/ a o Rd ill Whittier e m M r a Downey B r La Habra Heights a 90603 P Florence Ave Whittier 90631 90604 d E La Habra Blvd ell R 42 ingw d f
d f |ÿ d Le
v
R
l v l t Lam 90 B E be a a
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r 530-898-4598 Park N a W Commonwealth Ave E Commonwealth Ave
C www.cedcal.com Anaheim 10 10 ¦¨§
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v ¦¨§ v
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M e v GF
T v A Diabetes Deaths l
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D e n r rf e R u u d PIH Health Primary D P WestService Area 60 Va |ÿ ll Covina ey Rd B La Puente Freeways Amar lvd lv d B ve d E r R L llo A A a e e rfee m m m East b Du 39 ar A o e d |ÿ RMajor Roads n t d R A n ll Los i v o M e e W v Beve M n Walnut Angeles rly B a A Zip Codes d lv N d m h R
k t te r t
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W Death rate per 100,000u persons 19 s P
|ÿ e a Ga South San l L a d Be le A lv Montebello v Whittier v g T er e Jose0.0 Hills y B e ly o l Bl lle e v N g 90640 d 90601 e Va r v a A p F h n 0.1 - 11.3 a i R o r d s 60 w Pico Rivera m a anyon R i ÿ C d | y ull t b S 11.4 - 18.9 90660 n D r S Tu <-- CA Avgr 18.9 d d v lv Beverly Blvd l B Broadway Hacienda Heights 19.0 - 21.9 d B k E v s l S l la n a 91745 u B o w s t r on s Ave 22.0 - 31.7 n s o A a f v u N e P Whittier a o 72 e Pa |ÿ l thfin G m 90606 n d age A a 31.8 - 12,500.0 e v S W e r R e r la ash d u e Ü 5 a s in on gto r Whittier P A n B ¨¦§ ve lvd G 90602 Source: CA Dept. of GF Diamond East Rd Public Health, 2010 M Bar Flo u re lb Whittier West d n Santa Fe er Rd lv ce ry d B d Av D R r R d e Springs r 90605 a o n lv b o B im r y Te l a n t t le 90670 o H n gr e a u ap v C C h s A La Habra/ a o Rd ill Whittier e m M r a Downey B r La Habra Heights a 90603 P Florence Ave Whittier 90631 90604 d E La Habra Blvd ell R 42 ingw d f
d f |ÿ d Le
v
R
l v l t Lam 90 B E be a a
S rt B R |ÿ t d i
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d a M v
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B A
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V ast
i E B r l
k re Rosecrans Ave
e
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m Norwalk to Fullerton
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b ve
A m k k n
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P 0 1 2 3 4 Miles
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C i v l 5 rn A California State University, Chico c E
B n a Placentia l e ¨¦§ Buena Chico, CA 95929-0765 91 N Chapman Ave Artesia Blvd Artesia Blvd E P |ÿ m
r 530-898-4598 Park N a W Commonwealth Ave E Commonwealth Ave
C www.cedcal.com Anaheim 10 10 ¦¨§
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v ¦¨§ v
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r r El Monte R
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M e v GF
T v A l l
Heart Disease Deaths e
Rush St A A m e P e t e a
D e n r rf e R u u d PIH Health Primary D P WestService Area 60 Va |ÿ ll Covina ey Rd B La Puente Freeways Amar lvd lv d B ve d E r R L llo A A a e e rfee m m m East b Du 39 ar A o e d |ÿ RMajor Roads n t d R A n ll Los i v o M e e W v Beve M n Walnut Angeles rly B a A Zip Codes d lv N d m h R
k t te r t
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W Death rate per 100,000u persons 19 s P
|ÿ e a Ga South San l L a d Be le A lv Montebello v Whittier v g T er e Jose0.0 Hills - 94.6 y B e ly o l Bl lle e v N g 90640 d 90601 e Va r v a A p F h n 94.7 - 129.8 a i R o r d s 60 w Pico Rivera m a anyon R i ÿ C d | y ull t b S 129.9 - 155.8 90660 n D r S Tu <-- CA Avgr 155.8 d d v lv Beverly Blvd l B Broadway Hacienda Heights 155.9 - 194.9 d B k E v s l S l la n a 91745 u B o w s t r on s Ave 195.0 - 253.1 n s o A a f v u N e P Whittier a o 72 e Pa |ÿ l thfin G m 90606 n d age A a 253.2 - 2,400.0 e v S W e r R e r la ash d u e Ü 5 a s in on gto r Whittier P A n B ¨¦§ ve lvd G 90602 Source: CA Dept. of GF Diamond East Rd Public Health, 2010 M Bar Flo u re lb Whittier West d n Santa Fe er Rd lv ce ry d B d Av D R r R d e Springs r 90605 a o n lv b o B im r y Te l a n t t le 90670 o H n gr e a u ap v C C h s A La Habra/ a o Rd ill Whittier e m M r a Downey B r La Habra Heights a 90603 P Florence Ave Whittier 90631 90604 d E La Habra Blvd ell R 42 ingw d f
d f |ÿ d Le
v
R
l v l t Lam 90 B E be a a
S rt B R |ÿ t d i
k k
l a id id n Brea
a
d
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w
19 r
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r
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d 72
d a M v
S S N 90
l |ÿ v
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B A
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i d ÿ B e F | hury Rd
o c v an
V ast
i E B r l
k re Rosecrans Ave
e
y y
a B s
m Norwalk to Fullerton
e a
b ve
A m k k n
l Rosecrans
r l
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a B
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l a e l 90650 v
P 0 1 2 3 4 Miles
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l c n a a l
B v t o e e
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C i v l 5 rn A California State University, Chico c E
B n a Placentia l e ¨¦§ Buena Chico, CA 95929-0765 91 N Chapman Ave Artesia Blvd Artesia Blvd E P |ÿ m
r 530-898-4598 Park N a W Commonwealth Ave E Commonwealth Ave
C www.cedcal.com Anaheim 10 10
e e
v v
A
Alhambra A
d
r r
r r El Monte R
e a
l k k e
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c PIH Health Hospital
M e v
T v A l l Hypertension Deaths e A
Rush St A m e P e t e a
D e n r rf e R u u d PIH Health Primary D P WestService Area 60 Va ll Covina ey Rd B La Puente Freeways Amar lvd lv d B ve d E r R L llo A A a e e rfee m m m East b Du 39 ar A o e d RMajor Roads n t d R A n ll Los i v o M e e W v Beve M n Walnut Angeles rly B a A Zip Codes d lv N d m h R
k t te r t
o 7 n S e
W Death rate per 100,000u persons
19 s P e a Ga South San l L a d Be le A lv Montebello v Whittier v g T er e Jose0.0 Hills y B e ly o l Bl lle e v N g 90640 d 90601 e Va r v a A p F h n 0.1 - 6.1 a i R o r d s 60 w Pico Rivera m a anyon R i C d y ull t b S 6.2 - 10.0 90660 n D r S Tu <-- CA Avgr 10.0 d d v lv Beverly Blvd l B Broadway Hacienda Heights 10.1 - 12.9 d B k E v s l S l la n a 91745 u B o w s t r on s Ave 13.0 - 19.3 n s o A a f v u N e P Whittier a o 72 e Pa l thfin G m 90606 n d age A a 19.4 - 317.5 e v S W e r R e r la ash d u e 5 a s in on gto r Whittier P A n B ve lvd G 90602 Source: CA Dept. of Diamond East Rd Public Health, 2010 M Bar Flo u re lb Whittier West d n Santa Fe er Rd lv ce ry d B d Av D R r R d e Springs r 90605 a o n lv b o B im r y Te l a n t t le 90670 o H n gr e a u ap v C C h s A La Habra/ a o Rd ill Whittier e m M r a Downey B r La Habra Heights a 90603 P Florence Ave Whittier 90631 90604 d E La Habra Blvd ell R 42 ingw d f
d f d Le
v
R
l v l t Lam 90 B E be a a
S rt B R t d
i
k k
l a id id n Brea
a
d
e cl 605 a
w
19 r
u
r
i m E Birch St E Birch St
r
E
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d 72
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S S
N 90
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B A
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e
L
r r
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i
d B
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o c v an
V ast
i E B r l
k re Rosecrans Ave
e
y y
a B s
m Norwalk to Fullerton
e a
b ve
A m k k n
l Rosecrans
r l
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a B
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P 0 1 2 3 4 Miles
t V
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l c n a a l
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C i v l 5 rn A California State University, Chico c E
B n a Placentia l e Buena Chico, CA 95929-0765 91 N Chapman Ave Artesia Blvd Artesia Blvd E P
m
r 530-898-4598 Park N a W Commonwealth Ave E Commonwealth Ave
C www.cedcal.com Anaheim 10 10
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v v
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Alhambra A
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M e v
Stroke Deaths T v
A l l
Rush St e A A m e P e t e a
D e n r rf e R u u d PIH Health Primary D P WestService Area 60 Va ll Covina ey Rd B La Puente Freeways Amar lvd lv d B ve d E r R L llo A A a e e rfee m m m East b Du 39 ar A o e d RMajor Roads n t d R A n ll Los i v o M e e W v Beve M n Walnut Angeles rly B a A Zip Codes d lv N d m h R
k t te r t
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C www.cedcal.com Anaheim Appendix B Key Stakeholder Interview and Focus Group Participants
Key Stakeholder Interviewees # Interviewee Title Organization 1 Dottie Andersen Soup Hour Coordinator St. Matthias Episcopal Church 2 Arlie Ankerberg Parish Nurse Whittier Area Community Church 3 Michael Crook Fire Chief City of Santa Fe Springs Dept. of Fire - Rescue 4 Sue Dean President Whittier Chamber of Commerce 5 Mike Davis Captain City of Whittier Police Department 6 Bob Itatani Coordinator of Psychological Services Rio Hondo College Psychology Department 7 Joe Leal President/Founder Vet Hunters 8 Heidi Lopez Community Liaison Public Health Nurse LA County Department of Public Health - SPA 7 9 Rita Murray President, Whittier Affiliate National Alliance on Mental Illness 10 Ingrid Patsch,MD Associate Program Director PIH Health Family Medicine Residency Program 11 PIH Health Patient N/A N/A 12 Jennifer Rivera Community Liaison Public Health Nurse LA County Department of Public Health - SPA 7 13 Anita Sinha, MD Chair, Department of Pediatrics PIH Health Physicians 14 Judith Stockman, NP Nurse Practitioner St. Matthias Episcopal Church 15 Elvia Torres Executive Director SPIRITT Family Services 16 Gerald Torres Supervisor, Consumer Services Unit Eastern Los Angeles Regional Center - Whittier 17 Jonathan Vasquez Superintendent Los Nietos School District 18 Yu-Fei Wu, MD Pediatrician PIH Health Family Medicine Residency Program
Community Focus Groups Number of Language # Agency Participants of Group Population Community Advisory and Resource Education School age-children and (CARE) Coalition, East Whittier City School families; school staff and 1 District 25 English community partners Parents of children attending 2 Hacienda Heights Area Chinese School 9 English Chinese Saturday school 3 Los Angeles Centers for Alcohol & Drug Abuse 6 Spanish Parents of people in recovery Board members and 4 Meals on Wheels 9 English volunteers 5 Rio Hondo and Whittier Community Colleges 11 English College students 6 United Friends of the Children 25 English Emancipated foster youth 7 Whittier Rio Hondo AIDS Project 10 English People living with HIV School health staff (nurses, special education directors, student support services, and 8 Whittier-area school districts 11 English health aides) Total Participants 106
63 Appendix C Key Stakeholder Interview and Focus Group Perceptions
Community stakeholder interviewees and focus group participants were asked a number of questions organized around PIH Health’s three priority health areas: health access, health management, and healthy living. Generalized questions about community issues and health concerns and the impact of Health Care Reform were also asked.
Interview and focus group responses characterize the perceptions and opinions of those who participated in the data collection process.
Big Picture Questions
What are the biggest issues facing the community? What are the biggest health concerns in the community?
Responses: Stakeholder Interviews Biggest issue, not directly related to health, was the impact of the economy and the following related issues: Housing/homelessness; Unemployment and related stress/anxiety; People “just trying to survive and provide for their families”; and Hunger.
Issues specific to the homeless population, including homeless veterans: General Relief income, insufficient to meet basic needs; Homeless people, unwelcome anywhere and not allowed to sleep in parks; Hunger; Hopelessness and inability to access support; Financial problems and stress due to financial debt; and Mental health, medical, and substance abuse issues.
Significant health concerns identified in the community: Prevalence of obesity, particularly among children, identified as No. 1 with related issues that include diabetes, asthma, muscle/joint pain, hypertension, and mental health; Inadequate physical activity and good nutrition; Inadequate awareness of available healthcare and social services; Inadequate knowledge about mental health, including the side effects of medications and disease processes; Inadequate health insurance and access to low-cost healthcare for low-income, uninsured young adults, Latino families, and the undocumented with several people noting it is easier for children to obtain healthcare than adults; Access to specialty care, which often requires long wait times for approval or travel out of the area, noted by physicians; Difficult access to mental health services, including psychiatrists willing to take Medi-Cal, and medications; Apprehension about cancer screenings because of fear of results; Health issues among the homeless related to mental health, medications, medical care, and substance abuse; and Health issues among homeless veterans, including poor hygiene from living on the streets; mental health problems, including Post Traumatic Stress Disorder; drug and/or alcohol issues; needle sharing; and undiagnosed/untreated health problems, such as cancer and diabetes.
64 Big Picture Questions, continued
Responses: Focus Groups Biggest issues facing the community: School budget cuts to education among Latino and Chinese parents. Latino parents expressed concern about the reduced number of school days; and As families leave the Hacienda Heights/La Puente School District, Chinese parents fear education and property values will decline, leading them to wonder if they should move from the area. School program cuts, particularly those listed below: After-school programs, including sports programs; and Physical education, arts programs, and bilingual education. Homelessness, particularly families, and their presence in Uptown Whittier and on Norwalk Boulevard. Issues related to aging, particularly: Inadequate access to psychiatric care; Inadequate access to exercise/fitness opportunities; Isolation and/or inadequate help from family; Difficult self-care, such as eating and bathing; and Refusal to accept help when offered. Other issues, including: Graffiti and gang activity, particularly in Uptown Whittier; Limited and infrequent bus transportation around Whittier; Crumbling infrastructure, including streets and sidewalks in need of repair; Language barriers; Families unable to afford sports programs; and Extensive restrictions on park use for sports use.
Biggest health concerns: Cost of healthcare and health insurance; Differing views on the use of and access to emergency services among lower-income populations: Some felt lower-income residents use the emergency department as a clinic that provides free care and where no will be turned away rather than for emergencies. Overcrowding and families with minor issues not triaged from those with true emergencies were cited as issues. Others expressed the opposite concern – that those with limited financial resources and/or without insurance are afraid to use the emergency room because they’ll get “stuck with a bill they cannot afford.” All observed the need for access to affordable, non-emergent community medical care. Inadequate knowledge among lower-income people about available services, programs, and resources. Some parents don’t take advantage of programs they’re aware of; Issues related to nutrition and access to healthy food: Inadequate places to buy healthy food include: farmer’s markets with limited selections, ethnic markets and grocery stores that are closing; Prevalent fast food restaurants that are affordable, but unhealthy; Energy drinks replacing soda pop in vending machines seen as “just as bad” as sodas; Malnourishment among lower-income children without access to sufficient food; and Increased obesity and related problems, such as diabetes. Stigma associated with mental health services in the Asian community; Inadequate access to PIH Health for those with Medi-Cal insurance; and Need for more physicians to care for people with communicable diseases (e.g., HIV).
65 Big Picture Questions, continued
How do you project that agencies and/or community needs will change over the next three years given health care reform efforts? For any anticipated gaps, how can the hospital collaborate with community partners to fill the gaps?
Responses: Stakeholder Interviews A number of people expressed hope that Health Care Reform will extend health insurance to individuals currently uninsured or under-insured, thereby increasing access to care. They also hope that Health Care Reform will focus on prevention and wellness, resulting in a healthier population and less need for sick care and hospital services.
Issues, needs, and concerns: Increased demand for services will increase the need for primary and specialty care providers. Costs to employers, who provide employee-based insurance, will increase to pay for expanded services. Quality of services may decrease because of the increased number of people eligible for care. Healthy lifestyle changes to prevent chronic disease and keep people well will be emphasized. Strategies to motivate and support people to make healthy lifestyle changes will be critical. Role of public health will shift as healthcare providers offer services traditionally offered in the public health sector. These include immunizations, sexually transmitted disease services, and tuberculosis treatment.
Ways the hospital can fill some of the anticipated gaps: Increase service capacity through more contracts. Expand insurance accepted beyond employer-based policies. Offer a nurse help line in Spanish and Chinese to improve access to emergency care. Provide strategic support to families to address and prevent childhood obesity, prevent diabetes and other chronic conditions. Collaborate with community organizations to assess how the hospital can enhance health outside the hospital.
Health Access-Related Questions
Do you and your family have a regular source of healthcare where you go for physical exams, check-ups, immunizations, treatment for chronic diseases, etc.? If so, what is that source of care? If not, why?
Responses: Stakeholder Interviews – Physician Perspectives All participants identified cost and lack of health insurance as top barriers to care access. Fear of receiving a bill impacted preventative care, treatment for chronic disease, medications, and emergency ambulance services. Other challenges identified by physicians were: Inadequate mental health services and providers, especially for children; Limited services for depression and behavioral health for children; Cost of care, a barrier to insured and uninsured. Some insured patients limit medical visits because they can’t afford co-pays or the services they need are not covered. Uninsured patients, who may not qualify for health coverage, lack the resources to pay for care; Cost of care, which causes many to skip wellness care and only seek services when they are sick or illness becomes advanced, resulting in more expensive care;
66 Health Access-Related Questions, continued
Responses: Stakeholder Interviews – Physician Perspectives, continued Challenges to specialty care referrals, including distance the uninsured travel to Los Angeles County, which can be prohibitive, and lengthy approval processes; Inadequate childhood obesity prevention services, including nutrition counseling (counting calories), physical activity programs, and poor integration of families into the process for sustained lifestyle changes; and Inadequate staff members who speak Asian languages at PIH Health.
Responses: Stakeholder Interviews – General Interviewees echoed concerns shared by physicians, particularly about inadequate access to mental health services and difficulty accessing specialty care services for the uninsured. Additional barriers to healthcare and health/social services included: Difficulty navigating healthcare systems to determine eligibility and logistics of care, a particular problem for the elderly, homeless, mentally ill, and undocumented who often become overwhelmed and give up; Reduced and closed services, such as the Salvation Army, which provide showers and shelter for homeless; Medi-Cal care, difficult to access for those with developmental disabilities; Inexperience among professionals on how to interact with or treat people with developmental disabilities whose numbers continue to grow. These include children with autism who are now becoming adults; Stigma associated with homelessness and mental illness affecting treatment; Difficulty accessing a quick and accurate mental health diagnosis, timely mental health services or understanding insurance coverage, which can prevent people from seeking services; and Difficulty accessing services because of cultural and economic divides between the City of Whittier and South Whittier (unincorporated part of Los Angeles County).
Responses: Focus Groups Comments about their health insurance/coverage and regular source of care: Thirty-nine participants had some type of health insurance and primary care source. One participant recently registered for Healthy Way LA through PIH Health and now accesses a community clinic within walking distance of her home. Most college-age students are insured through their parents’ employer policies. Rio Hondo College students can use the school’s health services, an affordable option. Individuals with Medi-Cal use community clinics when necessary. Some use the AIDS Healthcare Foundation clinic for primary care, medications, and referrals. For most, access to specialty care depends on insurance coverage. Some access specialty care at the Los Angeles County Department of Health Services medical centers or clinics. Children with insured parents have regular access to care, say school health staff. They report parental barriers as needing to take time off work. Children without health insurance largely rely on PIH Health’s Care Force One mobile health unit. Most children only see a physician or get an exam if required, such as for sports.
Barriers to health care and/or social services include: Limited hours for Whittier’s AIDS Healthcare Foundation clinic, open two days a week. The emergency room serves as an alternative; Inadequate understanding among uninsured and undocumented about where to access services; Cost of care and insurance co-pays; and Uncertainty caused by job loss, related insurance loss and being dropped from parent’s insurance at age 26.
67 Health Access-Related Questions, continued
Do you have ideas as to what might make it easier for individuals to access or otherwise address the challenges of accessing care?
Responses: Stakeholder Interviews – Physician Perspectives Physician respondents gave the following suggestions to overcome healthcare challenges: Provide Los Angeles County Department of Health Services specialty care to local area uninsured; Develop a list of specialists willing to give volunteer services (It was noted, “if everyone pitched in [to volunteer a few hours a month], it would not be too burdensome for any one person but it would help a lot”); Provide group visits for patients with common health issues; Offer education to parents by providers other than physicians; Use physician extenders to reduce the cost of care; Provide a structure (physicians, health educators, physical activity coaches, therapists, families, and others) to address childhood obesity; and Build the knowledge, skills, and support families need to sustain lifestyle change and impact the condition.
Responses: Stakeholder Interviews – General Interviewees echoed the need for affordable specialty care in the local area with the following suggestions: Develop an easy-to-read directory of local services that includes patient eligibility requirements; Share this information in commonly frequented places, such as schools, churches, and social service agencies; Build relationship between faith-based, community, and health/social service organizations to facilitate referrals by pastors and PIH Health staff; Provide mental health— including counseling, therapy and medication services—in locations where people gather; Provide more education and support for mental illness and recovery; Provide service providers with enrollment information for Healthy Way LA, the “bridge to healthcare reform” program in Los Angeles County; Educate professionals about how to work with people with developmental disabilities and use Regional Center; Provide transportation services to those with logistical barriers; Create partnerships between schools and health education, health services, and mental health providers (A PIH Health partnership allows physician residents to provide health, nutrition, and exercise education to students, staff, and parents at Los Nietos School District on a monthly basis.); Educate the community, especially senior center residents, that the hospital won’t turn anyone away regardless of their ability to pay and will at least stabilize anyone who comes to the emergency department.
Have there been health or supportive services that you or your family needed but you were unable to access? If so, what services? What would make it easier for people to obtain care?
Responses: Focus Groups Almost all focus group participants cited dental care as a problem. o Most indicated a lack of dental insurance and that dental care is cost prohibitive except in emergencies. o Those with dental insurance said preventative care was covered, but a high co-pay or cost was required for other services. o Others had to pay out of pocket for all dental care, including preventative care. o Some accessed preventative care through a funded program for people with HIV, but had to pay for specialty procedures or periodontal work. o School health staff discussed the Big Smiles program where volunteer dentists provide services at schools, requiring students to sign up in advance with parent permission (a perceived barrier). o Lower-income families have difficulty affording orthodontia services.
68 Health Access-Related Questions, continued
Responses: Focus Groups, continued Most focus group participants noted that vision care access was a problem. A number of focus groups cited mental health as a concern because of the: o Stigma associated with accessing services; o Inadequate school resources to provide these services, which many parents expect to receive; o Inadequate and unaffordable services and/or cuts to services; and o Inadequate insurance or inability to pay for ongoing medication among some families. A number of groups identified transportation—cost of gas, lack of car, reliance on a limited public transportation—as a barrier to care. Focus group participants noted access to specialty care services as difficult because: o Uninsured people must travel to Los Angeles County Department of Health Services and wait for long periods to get appointments; and o Insured had long authorization waits from HMOs after referrals by primary care providers. College students mentioned inadequate Planned Parenthood services in the community; and Several individuals, approved for Section 8 housing, had to move from Whittier to East Los Angeles, necessitating travel (sometimes by public transportation) back to Whittier for services and related costs for gas.
The following would make healthcare and/or service access easier: Increase access to low-cost, affordable services, including dental services and mental health; Make one-stop services available to reduce transportation between different providers; Provide information in languages other than English about low-cost services; Make this information available via the media or community health fairs; Include eligibility requirements, specific costs, and places where undocumented people can seek services; Provide information to new immigrants who don’t speak English about the healthcare system and different coverage types— HMO, PPO, and Medi-Cal; Link services with patient advocates and navigators, especially for seniors and people with HIV; and Offer information about natural alternatives to prescription medications.
PIH Health has a number of programs that increase access to care such as Care Force One mobile health services; A Day Away adult day healthcare center, health enrollment assistors; and a free Community Advice Nurse Hotline. Have you heard of these services? What do you know about them? What has been the experience with any of these services? How can these programs be improved (if you are familiar with them)? What can be done so that you are more likely to use these services?
Responses: Stakeholder Interviews – Physician Perspectives PIH Health Care Force One Mobile Health Unit Services All physicians were familiar with this program and see it as beneficial for services, such as vaccines and physicals. Services that come directly to people at community locations, such as schools and parks, was a benefit. Expansion of the reach of Care Force One was suggested. Risk of providing screenings with no follow-up care was a concern.
69 Health Access-Related Questions, continued
Responses: Stakeholder Interviews – Physician Perspectives, continued PIH Health S. Mark Taper Foundation A Day Away – an adult day healthcare center Those physicians who were aware of this program did not know much about it. Two physicians were very positive about the program and refer patients to it frequently with one saying it provides “an incredible benefit for family members who are overtaxed in care for people at home and need time to balance their lives.” PIH Health Enrollment Assistors There was a general lack of awareness of this resource. Physicians recognized this service helps families navigate a complicated system and that insurance companies will promote themselves, making it difficult to obtain objective information. One physician said physicians and patients don’t know about the service because the Assistors are off-campus without a strong presence. Information should be included in take-home packets for new parents, made available via flyers in the emergency room and booths that staff set up in the hospital to reach parents. PIH Health Community Advice Nurse Hotline Most physicians were not familiar with the advice hotline in part because the pediatrics department used a separate nurse hotline (exchange). Physicians thought this service had been eliminated and/or was unavailable for promotion by independently contracted physicians. One physician called this a good resource for triaging and getting people to the appropriate level of care.
Responses: Focus Groups PIH Health Care Force One Mobile Health Unit Services Except for school health staff, only four people had heard of Care Force One. The one person to use the program reported a great experience. School health staff results follow: All knew of Care Force One; Most benefited from it; Several were very enthusiastic, saying an accommodating and helpful staff “make all the difference”; Participants suggestions included: o Provision of dental services; o Online calendar/schedule improvements; o Accessibility by families with insurance for their children’s immunizations, as a convenience to overcome barriers, such as work or transportation; and o A second mobile unit to expand service sites and frequency. PIH Health S. Mark Taper Foundation A Day Away – an adult day healthcare center Most focus group participants hadn’t heard of the program. Meals on Wheels participants had heard of the program, but had no personal experience with it. One participant said the program provided socialization and reduced isolation. PIH Health Enrollment Assistors Most participants didn’t know that PIH Health offered health enrollment assistors for Medi-Cal and other health coverage programs. One participant, enrolled in Healthy Way LA at PIH Health, was happy with how quickly it went into effect. Linked to a clinic around the corner from where she lives upon hospital discharge, she said the hospital should promote health enrollment assistors before patients get admitted and promote insurance enrollment in pamphlets in the emergency room. Some school health staff accessed health enrollment assistors via Care Force One. Others said the service wasn’t available on Care Force One at their school. All wanted assistors on Care Force One. Other suggestions included: Promoting to school health staff and counselors for parents who need insurance coverage; and Providing service in community locations outside the hospital, such as Care Force One.
70 Health Access-Related Questions, continued
Responses: Focus Groups, continued Community Nurse Advice Line Most focus group participants had not heard of the Community Nurse Advice Line, but wanted to learn about it. A suggestion from the school health staff was to publicize the line to parents via flyers in high school guidance offices.
Health Management-Related Questions
Thinking about the Health Management focus area, what issue do you think should be addressed that will have the greatest impact on community health?
Responses: Stakeholder Interviews A key strategy was to bring services to people in the places where they naturally congregate rather than expecting them to access services in the hospital setting. A number of participants suggested PIH Health partner with community organizations that have relationships with service populations in education, outreach, and care. Suggested organizations included area schools, senior centers, Whittier Area Community Church, Vet Hunters, Whittier First Day, The Whole Child, SKILLS, Boys & Girls Club, National Alliance on Mental Illness, Hispanic Outreach Task Force, and the YMCA.
Other strategies to make an impact on community health: No co-pays for wellness visits and screenings; Nutrition and physical activity opportunities; Incentivized prevention services; Promotion of breastfeeding and immunizations to keep children well; Promotion of health fairs, Care Force One and other community-based services on Channel 3, print, electronic and social media; 211 local service directory; Open houses at the hospital or fire departments to make residents aware of community resources; Outreach to businesses; and Transportation to overcome barriers.
Do you know people with a chronic health condition such as asthma, diabetes or heart disease? What barriers do people face in getting treatment for their chronic diseases? What resources do people access to manage their chronic diseases? Are there things the hospital could be doing to make it easier for you to learn how to manage your chronic health conditions?
Responses: Focus Groups Many reported these barriers to treatment for chronic diseases: Cost of services and medications, unaffordable for many; Unfamiliarity with resources for low-cost services; Inadequate information about the illness and uncontrolled disease processes; Inadequate transportation for seniors and lower-income people; Fear of medications and side effects; Difficulty changing behaviors to be healthier; and Cultural inhibitions to changing eating habits.
71 Health Management-Related Questions, continued
Responses: Focus Groups, continued School health staff identified a number of barriers to families: Finances/cost of care and medications; Paperwork required by schools for children with asthma that burdens parents to take time off work; Replacement cost of inhaler, glasses or other needed equipment that children lose and insurance doesn’t cover; Appointments for medication refills that parents don’t make or keep; Compliance for children with diabetes and/or ongoing medication needs, including mental health issues (Parents who alter doses or let children take care of themselves fail to provide the support they need. School nurses keep a close eye on children where compliance seems to be an issue); Challenges grandparents raising grandchildren face (They may not have the energy or ability to manage a child’s needs. Also challenging, when parents are in and out of the child’s picture); and Inability of parents to get help or information related to insurance coverage (This may shift and affect care of the child’s disease).
Resources to help people manage their chronic diseases: Herbal medicine and acupuncture recommended by Chinese parents in addition to traditional Western medicine (One participant also reported a very positive experience with a cancer support group at Herald Christian Health Center. Another goes to Taiwan for care); Books and information from family members and friends; Screenings and classes offered through PIH Health and senior centers; Diet, exercise and other health behavioral changes (One person talked about the benefits of exercise programs at the parks that build community and friendships in addition to physical activity); Care plans, developed by physicians and implemented by nurses and health staff, for children with chronic diseases (Care plans include education for everyone who interacts with the child); Glucometers for college students to check their blood sugar levels at home (Barriers include expensive test strips. Glucometer kits are inexpensive or free); and Technology/apps to help college students count calories and lose weight.
Ways the hospital can help people manage their chronic health conditions: Lower the cost of care and medications to be affordable; Provide information/education about coverage and eligibility for different programs; Provide access to Life Alert for seniors; Use print, electronic and social media to communicate (Platforms include newsletters, the Internet—not for seniors, and public service television Channel 6—a good way to reach seniors); Provide screenings in community settings, such as parks, schools, markets, health fairs or other social gatherings; Offer support groups to those with chronic diseases to access information and mutual support; Offer low-cost yoga or exercise classes for the community; Provide incentives and reminders; Publicize stories about how people benefit from early detection and treatment to motivate others to get screened and become informed; Make available an advocate who parents can call with questions about managing a child’s chronic disease, ideas, strategies and education to comply with and navigate the healthcare system; and Offer presentations and classes about chronic disease and management. One participant found an asthma class very helpful.
72 Health Management-Related Questions, continued
Let’s talk about getting health screenings, immunizations, and flu shots. What have been your experiences in getting these recommended preventive services? What prevents people from getting health screenings, immunizations, and flu shots? What could the hospital do to make it easier – or encourage people – to get health screenings, immunizations, and flu shots?
Responses: Stakeholder Interviews Specific recommendations: Provide immunizations at schools where children are a “captive audience”; Educate parents, reluctant to immunize, about the importance of immunizations to community health; Provide services at veteran’s organizations or partner with organizations to promote services to veterans outside of the hospital and at locations where they’ll be comfortable; Provide services at farmer’s markets at the hospital and/or community centers; Conduct community outreach and promote services at health fairs; Engage the community in solutions and strategies that address health issues and the access of comfortable care; and Expand flu vaccine drives to churches so it’s convenient for people, including those without insurance or resources.
Responses: Focus Groups Focus group participants identified the following experiences and barriers to health screenings and immunizations: Participants with health insurance reported easy access to flu shots, immunizations and screenings. College students reported easy access to affordable flu shots at locations, such as pharmacies. Cost and ignorance about the location of services were cited as barriers to other health screenings. Some participants cited transportation as a barrier for seniors. Dial-A-Ride can be helpful, but has long wait times. Many are unaware that PIH Health provides transportation services. One participant—who reserved her money for women’s health procedures, such as pap smears and mammograms—cited cost as a barrier to flu shots and screenings. Uninsured children or those with Medi-Cal utilize Care Force One for immunizations and sports physicals say school staff. Families with insurance, ineligible for Care Force One, cited difficulty taking time off work or transportation as barriers. Insured and uninsured participants don’t get flu shots or immunizations because they: o Fear the flu shot will make them sick or cause autism. o Believe that their own immune system will protect them. o Fear immunizations will prevent building up their immunities. One participant lost track of her children’s immunization and check-up schedule because of frequent switches in insurance and physicians.
The following include recommendations for easier access to health screenings and possible roles for the hospital: School health staff made the following recommendations for Care Force One immunizations and screenings: o Expand access to all school families, whether insured or not, to overcome the barriers of time off work and transportation that preclude access to services for their children. The school district, not currently visited by Care Force One, hopes services will be extended there. o Create a second Care Force One unit to make services more widely available. Address transportation barriers for seniors and improve Dial-A-Ride to be user-friendly and reduce waits for return trip pick-ups;
73
Health Management-Related Questions, continued
Responses: Focus Groups, continued Offer community education that includes: o Information about how immunizations help individuals and the community and the risks of NOT getting immunized; o Stories about how screenings helped people get diagnosed and treated early; and o Financial literacy about the importance of saving money to pay for healthcare. Screenings should be free or very low cost; Parental consent should be waived for screenings, such as pap smears, that could be sensitive for youth to obtain; Savings accounts for families to pay for healthcare services, established by the hospital; and Shots that don’t hurt or oral immunizations made available.
PIH Health offers a free chronic disease self-management workshop, “Better Choices, Better Health”? Have you heard about this program? What can be done so that you are more likely to participate (if needed) or refer friends/family?
Responses: Stakeholder Interviews Most physician respondents hadn’t heard of PIH Health’s free chronic disease self-management program “Better Choices, Better Health.” One suggested offering lower insurance premiums as an incentive.
Eleven non-physician participants hadn’t heard of the program. One suggested making it available outside the hospital at senior centers, churches, and library conference rooms since hospital parking is difficult and hard to navigate.
Strategies suggested by physician participants: Prevention and wellness outreach to schools and sick care to compensate for inadequate care, the result of cut backs in school nurses; Free services provided by the hospital to share the burden of low-income and uninsured care; and Promotion of the health enrollment assistors to PIH Health physicians and the community (Include health enrollment assistor information in newborn packets so families can access insurance for their children and place assistors at community locations).
Strategies/issues identified by non-physician participants: One-stop community-based locations where people feel safe or congregate, such as schools; Information about insurance coverage and payment requirements for seniors, many of whom don’t know whether they or Medicare pays for convalescent home services; Information about covered services for families who move on and off insurance programs, such as Medi-Cal; and Increased services for people with no insurance.
Responses: Focus Groups Most had not heard of this program. Those who had seen it in brochures or flyers knew nothing about its purpose or content. Scheduling prohibited one participant from a program for asthma, offered during the day when he was at work. Suggestions to increase awareness of and participation in the program included: Provide Healthy Living magazine to schools to ensure information gets to families; Offer the program at sites convenient to people, such as high schools, rather than at PIH Health, located in a non- residential area not easily accessed; Distribute flyers at senior centers, school districts and through agencies, such as Meals on Wheels; and Distribute a list of services and education opportunities via agencies and media channels.
74 Healthy Living-Related Questions
Thinking about the Healthy Living focus area, what issue do you think should be addressed that will have the greatest impact on community health?
Responses: Stakeholder Interviews The Healthy Living priority area was defined as “improving health knowledge and behavior and promoting healthy eating and active living – making the healthy choice the easy choice.” Strategies for maximum impact were education, easier access to healthy, affordable foods and harder access to unhealthy foods.
Suggestions for the focus of education: Correct misinformation and misconceptions about obesity; Conduct classes on cooking, nutrition, and shopping for healthy foods; Give exercise classes; Educate the public about the ease of eating healthy and preparing nutritious snacks; and Provide ideas for healthier living.
Strategies for education in the community rather than at the hospital: Education programs at schools to reach parents and students; Parish nurse programs and promotoras for neighborhood outreach to capitalize on trust between the educator and audience; and Electronic strategies, such as apps, television, and the Internet.
Vulnerable populations identified as having difficulty making healthy choices and needing special support included: Homeless with limited access to healthy food, places to cook or keep perishable foods (The St. Matthias Soup Hour provides once-daily nutritious meals); Older adults with limited access to healthy food or no food at all and with transportation barriers; and People with a mental health diagnosis, unable to care for themselves, manage their sleep, eat well or exercise (They may suffer weight gain as a side effect to medication).
Several interviewees talked about increasing access to healthy choices while reducing access to unhealthy choices. One person said that people “generally side with convenience over health,” pointing to the need for convenient healthy options. Ideas and comments: Sodas and candies at cash registers sabotage healthier choices; People need safe and interesting exercise options, especially after dark; Large quantities of food purchased at the “big box retailers” promote greater consumption; Lower-income neighborhoods lack affordable grocery stores with fresh foods, especially for people who walk to buy their groceries; and Healthier fast food options, such as Subway and Flame Broiler, are needed.
Have you heard of the Activate Whittier community collaborative?
Responses: Stakeholder Interviews Of the 16 interviewees, one is actively involved in the program and four have never heard of it. Several respondents said they were aware of the program but did not know much about it. These respondents wanted to learn more and be put on a mailing list for meetings.
One participant expressed a concern that Activate Whittier is not attracting lower-income residents, such as Latino families or those from South Whittier. This person said, “Sometimes it feels like (PIH Health) is trying to fix people rather than invite them to the table to participate in identifying what works.”
75 Healthy Living-Related Questions
Over the last year, have you or your family made any healthy lifestyle changes? If so, what changes have you made? What are some barriers or struggles you face in staying healthy?
Responses: Focus Groups Participants across all focus groups reported the following healthy lifestyle changes: Eating as a family; Growing their own food; Reading labels when shopping; Improving nutrition habits by: o Eating less red meat, lard, sugar, salt, sodas, and sugary drinks; o Consuming more fresh and/or organic food (vegetables, chicken), wheat bread; o Drinking more water; o Avoiding foods that produce allergies; o Embracing gluten-free diets to avoid allergies; o Avoiding fast and “junk” food; o Reducing carbohydrates; o Practicing portion control and moderation; o Making recipe substitutions, such as olive oil, Greek yogurt or soymilk in place for butter; and o Among children, drinking water at school instead of soda pop or Gatorade. Increasing physical activity and stress reduction through walking, cycling, Tae Kwon Do, swimming, yoga, meditation, health club, Greenway Trail or YMCA use.
Other notes and comments about healthy lifestyle changes: A community garden at their children’s elementary school, used for snacks, teaches kids how to grow food. Parents considered this very positive. Police presence on the Greenway Trail helps to “keep it safe.” A college student’s mom attending Zumba classes is happier and healthier, benefiting from the social interaction and physical activity; Keeping soda pop out of the house is quite a challenge for one mom with three children. Concern about childhood obesity by school health staff who don’t see many changes in family eating habits. School-based activities to help staff and others lose weight. On-site school activities include annual Biggest Loser competitions and Weight Watchers. YMCA provides affordable gym membership and physical activity opportunities, says one college student. Discussion about “what it means to live a healthy lifestyle.”
Barriers to healthy lifestyles for participants and children: Cost, especially for organic and fresh foods, and health club memberships; Time related to plan and prepare healthy meals and exercise (Children’s needs, such as helping with homework, and adult work requirements meant making convenient, often unhealthy, food choices); Lack of self-control or willpower coupled with laziness or lack of motivation to exercise; Physical disabilities, such as arthritis and asthma that limit activity; Sustained healthy diet changes (One person reports initial success reducing family red meat intake following his mother’s diabetes diagnosis. They have gradually added red meat back into their diets, he says); Difficulty making changes in a family or household where others don’t make the same changes);
76 Healthy Living-Related Questions, continued
Responses: Focus Groups, continued Resistance among children to healthy lifestyle changes including an unwillingness to swap “screen time” with TV, computer or gaming with outside play; Celebrations—birthdays, sports team events, pizza parties, etc.—that discourage healthy eating and require parents to bring cupcakes; and Sedentary lifestyles, where adults spend much of the day sitting at a desk (It takes significant and thoughtful effort to change, especially when busy).
Suggestions to overcome barriers to healthier lifestyles: Education about what constitutes a nutritious and healthy diet; Healthy, affordable alternatives in the community at markets/corner stores, restaurants, etc.; Technology/apps to lose weight and count calories, an option particularly relevant for young people who integrate technology in their lives; Charts or diaries to track food and avoid allergic reactions; and Incentives for participation in physical activities.
Describe the employee wellness opportunities and policies currently in place at your workplace? What types of programs/policies do you foresee your work place considering to improve/support employee wellness?
Responses: Stakeholder Interviews Overall, larger organizations and institutions have more employee wellness activities than their smaller counterparts. Some participants report the elimination of employee wellness programs.
Examples of organizational wellness activities and policies: Benefits/incentives (e.g., gym memberships, gift cards, or reductions in health insurance premiums) offered to PIH Health staff who participate in screenings or other designated health activities. Physicians are not employees and can’t participate; Health screenings and vaccinations; Health seminars and workshops; Weight loss competitions and Weight Watcher’s programs; Reduced enrollment fees to onsite fitness centers; Onsite health providers, including nurses, the parish nurse programs, and PIH Health Care Force One mobile health unit; UCLA study that promotes exercise and dance breaks at meetings and breaks; Employee wellness committees; Shared gardens; Sports teams; Wellness newsletter; No-smoking policies in city vehicles or buildings; Healthy snacks and water at community/family events; and Off-site staff days that include physical activity.
77 Healthy Living-Related Questions, continued
Responses: Stakeholder Interviews, continued Opportunities for additional support to improve employee wellness: Education for police and fire staff to prevent and manage injuries, particularly back injuries; Education to eat healthy “on the run” and reduce stress for police who sit in their patrol cars all day with no breaks for lunch; Cooking/nutrition classes for fire department staff, many of whom cook at fire houses; and Education on wellness topics, such as nutrition and exercise, at various organizations.
In your role as a physician, what is most effective in helping overweight and obese clients improve healthy eating and increase physical activity?
Responses: Stakeholder Interviews – Physician Perspectives Create a team-based approach using multiple providers for ongoing family care and support. Address each family’s unique situation to make and sustain healthy eating and active living lifestyle changes. Offer incentives to families in this program. Correlate a child’s weight gain over time with a healthy trend to help parents understand the direction their child is heading. Give families exercises and refer them to a nutritionist. Provide families with basic guidelines about what to avoid— fried foods and sugary beverages—and how to create a healthier home environment. Get services out to schools and offer group sessions for youth on nutrition and physical activity. Recommend follow-up visits every few months rather than annually for very overweight youth even if capitation doesn’t cover it. Educate Latino parents about appropriate growth patterns and the risks of too much food consumption. Connect overall health to daily lifestyles and give people small, manageable goals and tools to reach them.
Community Assets-Related Questions
An important part of the community health needs assessment process is to identify current/existing services, programs, and collaborative efforts that benefit the community. In your opinion, what services/programs/community efforts appear to be effective to address community health issues you have identified?
Responses: Stakeholder Interviews Beneficial organizations, programs, and/or collaborative efforts include: Homeless outreach and service providers, such as: o Whittier First Day; o Vet Hunters, which targets homeless veterans; o Los Angeles County Health Department assessment teams; o Soup Hour at St. Matthias Episcopal Church; o Church collaboration, which provides cold-weather shelter for homeless during winter months; o Veterans Administration services; and o Volunteers of America (El Monte).
78 Community Assets-Related Questions, continued
Responses: Stakeholder Interviews, continued Los Angeles County Department of Public Health initiatives develop sustainable policy change with cities, communities, and other organizations, such as: o Choose Less, Weigh Less campaign; o Walking clubs; o Healthy vending machines in schools and city facilities; o Smoke-free parks; o Health Advisory Committees, walking clubs, and/or health mentor programs at the Los Angeles Unified School District and Bellflower Unified School District; and o Neighborhood Action Councils, such as neighborhood-based advocacy groups. Other services/agencies identified were schools, churches, Boys & Girls Club, Hispanic Outreach Taskforce (HOT), Santa Fe Springs Social Services Department (especially for senior services), SKILLS Foundation, and the YMCA.
Responses: Focus Groups Organizations, programs, and/or collaborative efforts that benefit the community: An Asian organization that provides immigrants with domestic violence, legal, and healthcare services; Whittier YMCA; Red Cross; and Salvation Army’s domestic violence programs.
Services, information for college students: Information in Uptown Whittier on health fairs; Nutrition services; Planned Parenthood services; Quarterly health screening clinics for cholesterol, blood pressure checks, and other screenings; Assistance in reading bills; and Legal assistance.
What are the community’s strongest health care assets?
Responses: Stakeholder Interviews PIH Health is a key community health resource. Its visibility in the community was commended. Highlighted programs included: Hospitalist program, which offers high-level services to low-income people; Residency programs, which sees a lot of uninsured people; Case management and discharge planning, which helps people with resources manage their care; Breastfeeding classes; Education classes on a number of topics; Partnership with Whittier First Day; and Partnership with Los Nietos School District.
Other community healthcare services included: Friends of Family Health Center in La Habra; and Los Angeles County Health Services, such as Roybal Comprehensive Health Center and LAC+USC Medical Center.
79 Community Assets-Related Questions, continued
Responses: Stakeholder Interviews, continued Mental health service providers, included: The Whole Child; Los Angeles County Community Mental Health Centers, the safety net for severely mentally ill patients; Family Service Center, which offers a sliding fee scale, prohibitive for students or very low-income people; SPIRITT; and Intercommunity Counseling Center.
Responses: Focus Groups The strongest, most effective local healthcare services/assets included: PIH Health Care Force One mobile health unit services (noted as the community’s strongest healthcare asset); Healthy Families health insurance for affordable and accessible health services for children; WIC program resources and breastfeeding support; Herald Christian Health Center, a community clinic in San Gabriel that offers support to cancer patients, including information about treatment and a monthly survivor support group; Activate Whittier, which develops physical education programs at elementary schools; Think Together after-school program for homework assistance and physical activity opportunities for youth; L.A. CADA – loved and appreciated by focus group participants; AltaMed Community Health Center, which helps enroll families in Medi-Cal and offers a sliding fee services. School health staff note satisfaction among parents with the services; Kaiser Permanente; and PIH Health.
One participant reported consistently good experiences at PIH Health, saying the hospital treats people respectfully and “they get people in and out quickly.” She says the hospital accommodates her fear of needles by always providing the same technician to draw her blood.
Responses: Focus Groups, continued School health respondents identified effective dental care and mental health service resources for students and families.
Dental care resources included: Whittier Assistance League; frequently used by schools, it provides free services with a $10 paperwork fee; Big Smiles, a school-based dental clinic used by several schools, received mixed reports because of requirements for advanced enrollment and parental permission for dental work; and An orthodontist (possibly in Hawthorne or Hawaiian Gardens) provides free care to qualified students.
Mental health care resources included: The Whole Child, a good resource for Med-Cal families, but not uninsured (The wait list can be long. The Whole Child sometimes provides a therapist at the school, which helps to overcome transportation barriers and decrease the stigma of obtaining mental health services at the school); SPIRITT, which offers some school-based groups for students; Almanzor program, which offers a good therapist; Intercommunity Counseling Center; Pacific Clinics; Turning Point mental health interns who come to schools; and Two integrated medical/mental health service programs offered by Whittier Union High School District schools (Pacific Clinics and The Whole Child offer a grant for mental health services).
80 Community Assets-Related Questions, continued
Community partners are interested in engaging physicians in community health programs. Are there opportunities for us to work together on health access, health management or healthy living initiatives?
Responses: Stakeholder Interviews – Physician Perspectives Require physician involvement in community health. They get busy and don’t get involved; Continue to include physician input in Healthy Living magazine; and Encourage physicians’ participation in health fairs and screenings, educational seminars, and PIH Health partnerships with organizations, such as First Day and the Los Nietos School District (PIH Health has a successful curriculum for physicians to present to the community and communication strategies that work).
Additional Comments
Participants shared final thoughts and comments. Many expressed appreciation for PIH Health and the quality of its services. One participant said, “PIH Health takes its responsibility for the health of the community to an extreme, especially compared to for-profit hospitals that focus only on the bottom line.” Many requested a copy of the final needs assessment report. Other comments included: Physician information about PIH Health programs; PIH Health involvement in parish nursing programs and recognition for connecting, or bridging, the hospital and its services to the people of the community. Provider education on developmental disabilities and how to address them; Disappointment that PIH Health closed its psychiatric unit and dual recovery program since the community still needs those services; Recommendation that PIH Health reinstate well-attended monthly networking breakfasts for mental health providers to learn about each other and the services offered in the community; Excessive park regulations about when people can and cannot use the facilities, especially soccer fields; Better park lighting to support evening sports and prevent illegal activities, such as drug use; Bilingual education to help children maintain their first language and learn English; A hospital mentor program to introduce youth to healthcare-related jobs (A father said a physician and nurse encouraged his child to work in healthcare after a family member was hospitalized. The parents were moved and it sparked an interest in their child); Resources for low-cost services or insurance for young adults who lost jobs and are unemployed; Activate Whittier, a good program that promotes healthy lifestyles; Partnership between Whittier Union High School Integrated Services program—which funds mental, but not physical health—and Care Force One; and PIH Health promotion of services and resources to adults over age 26, who don’t qualify for coverage under their parents’ insurance policies.
81 Appendix D Community Survey Responses
A community survey was distributed through agencies and organizations in the PIH Health primary service area for six weeks from October 25, 2012 through December 10, 2012. Translated into Spanish, the survey link was distributed electronically. Paper copies were made available in English or Spanish upon request.
There were a total of 391 respondents, of which: 72% were female and 28% male; 64% were Hispanic or Latino, 25% White, 3% Asian, and 1% African American; 74% had a high school diploma or higher degree; and 10% were age 24 or younger, 36% 25-45, 40% 46-64, and 14% 65 or older.
The community survey responses are summarized below:
When asked about their health status, 69% indicated they were in good or excellent health.
Supporting Survey Responses: How would you rate your health today? Response Percent Excellent 17.3% Good 51.7% Fair 22.5% Poor 5.2% Don’t Know 3.4%
Respondents, who indicated their health to be better today than a year ago, totaled 29%. Only 9% indicated their health was worse than a year ago.
Supporting Survey Responses: Compared to one year ago, how is your health today? Response Percent Better 29.1% About the same 58.8% Worse 8.8% Don’t Know 3.4%
Over half (69%) of the respondents had a routine physical in the past year.
Supporting Survey Responses: When was your most recent routine check-up or physical? Response Percent Within the past year 69.1% 2-4 years ago 14.8% Over 5 years ago 9.2% Never 0.5% Don’t remember 6.3%
82 When asked, 29% of survey respondents said they or their families couldn’t access needed health services in the last six months. Lack of money or health insurance was cited as the reason 81% didn’t receive needed healthcare services.
Supporting Survey Responses: What are the reasons for not receiving healthcare services? Response Percent Lack of money/health insurance for office visits and/or prescriptions 80.9% Too long of a wait time in the office 18.2% Lack of transportation 14.5% Don't know how to find a good doctor 11.8% Inconvenient office hours 10.0% Language/cultural barriers 6.4%
When asked, 76% of survey respondents didn’t receive needed dental services in the past six months; almost 95% cited lack of money or insurance as a barrier; more than 15% didn’t know how to find a good dentist.
Supporting Survey Responses: What are the reasons for not receiving dental care services? Response Percent Lack of money/health insurance for office visits and/or prescriptions 94.5% Don't know how to find a good dentist 15.4% Too long of a wait time in the office 7.7% Language/cultural barriers 6.6% Inconvenient office hours 5.5% Lack of transportation 4.4%
What could PIH Health do to make it easier to get health screenings, immunizations and flu shots? A summary of responses follows: Offer reminders and incentives; Increase community awareness via advertisements, flyers, social media, TV, and banners; Provide information in Spanish; Offer evening and weekend hours for working adults; Offer services at schools, shopping centers, work, and health fairs; Explain benefits and consequences of not receiving prevention; and Reduce the cost of care or offer free services.
What are the biggest health-related issues facing the community? A summary of responses follows: Access to care: low-cost care, dental care, mental Chronic diseases including diabetes, asthma, arthritis, health services cancer, heart disease, depression Alcohol, drugs Violence/safety Overweight and obesity Inadequate health insurance Smoking Nutrition Sexually transmitted diseases Physical activity Mental health issues Inadequate health education
83 In the last six months, were there services you or your family needed but didn’t receive? Response Percent Health education 14.5% Healthcare preventative screenings such as mammograms, Pap 13.5% smears, colonoscopy Support with healthy eating and physical activity 13.5% Flu shots, immunizations, vaccines 12.8% Urgent care 12.2% Mental health services 11.5% Help managing chronic health conditions, such as heart disease, 10.2% diabetes or asthma Adult day health care services 9.9% Parenting classes 8.9% Food resources/assistance 7.2% Senior services – education, support or resources 5.3% Help to quit smoking 4.9% Hospice or supportive end-of-life care 3.0% Home nursing services (home health care) 2.0% None of the above 54.3% Other: dental care, vision care, housing, insurance
Which PIH Health community programs have you or your family used in the past year? Response Percent Care Force One Mobile Health Services 47.5% Community Health Education programs (including exercise classes) 23.2% Support Groups 22.0% Free 24/7 Community Nurse Advice Line 15.3% Fall Prevention Program 11.3% Enrollment Coordinators (assist with enrollment in health insurance 6.8% programs) PIH Health S. Mark Taper Foundation A Day Away Adult Day Health 4.5% Care Center
Which of the following health goals do you wish to achieve over the next 12 months? Response Percent Manage my weight 58.7% Improve my diet 53.4% Improve my fitness 51.4% Manage my stress better 41.0% Learn how to choose healthier foods 37.9% Learn how to live a healthier life 35.7% Take appropriate preventative health measures 32.0% Learn what exercise would be best for me 28.7% Learn how to manage my chronic pain 15.7% Manage my chronic health condition 12.9% Stop using tobacco 5.6% None of the above 9.0%
What could PIH Health do to make it easier for you to achieve your health goals? A summary of responses follows: Classes and health education (DVDs, Free programs for diet, exercise, stress, parenting, & diabetes books/magazines) Offer programs and classes evenings/weekends Have Care Force One increase outreach and advertise route Health plans for the uninsured Exercise opportunities at work and in the community Dental clinic Access to health insurance Health fairs More urgent care centers Affordable healthy food Work with local groups
84 Appendix E Whittier Area Profile Demographic Profile Whittier Area Zip Codes 90601-90606
Population Demographics This profile includes statistics for the City of Whittier as well as the Los Angeles County unincorporated areas of South Whittier and West Whittier.
The Whittier-area zip codes in the service area are 90601, 90602, 90603, 90604, 90605, and 90606 and include unincorporated areas of South Whittier and West Whittier. The population of Whittier, including unincorporated areas of Los Angeles County, at the 2010 census totaled 189,948. Over a quarter of the population in Whittier is made up of children, age 0-18 (26.4%) with 10.8% of the population age 65 and older.
Population by Age Whittier Los Angeles County Age 0-4 6.8% 6.6% Age 5-17 19.6% 17.9% Age 18-39 32.1% 33.1% Age 40-64 30.7% 31.5% Age 65+ 10.8% 10.9% Source: U.S. Bureau of the Census, 2010
Population by Zip Code Geographic Area Number 90601 - Whittier 31,974
90602 - Whittier 25,777
90603 - Whittier 20,063 90604 - Whittier 39,407 90605 - Whittier 40,331 90606 - Whittier 32,396
Source: U.S. Bureau of the Census, 2010
Family Size The average family size ranges from 3.40 in Whittier 90603 to 4.12 in Whittier 90605.
Average Family Size Geographic Area Family Size 90601 - Whittier 3.54 90602 - Whittier 3.73 90603 - Whittier 3.40 90604 - Whittier 3.72 90605 - Whittier 4.12 90606 - Whittier 4.11 Los Angeles County 3.65 California 3.50 Source: U.S. Bureau of the Census, American Community Survey, 2007-2011 Blue= Highest rate; Green= Lowest Rate
85 Demographic Profile, continued Whittier Area Zip Codes 90601-90606
Seniors Living Alone In Whittier, 7.6% of seniors live alone. Whittier 90605 has the fewest seniors living alone (5.7%), and Whittier 90603 has the highest rate of seniors living alone (10.4%).
Seniors Living Alone Geographic Area Seniors Living Alone 90601 - Whittier 8.5% 90602 - Whittier 7.7% 90603 - Whittier 10.4% 90604 - Whittier 7.7% 90605 - Whittier 5.7% 90606 - Whittier 6.3% Whittier 7.6% PIH Health Primary Service Area 8.0% Los Angeles County 7.8% California 8.3% Source: U.S. Bureau of the Census, American Community Survey, 2007-2011 Blue= Highest rate; Green= Lowest Rate
Race and Ethnicity In Whittier, Latinos represent 72% of the population; Caucasians 21.9%; Asians 3.7%; and African Americans 1%.
Race and Ethnicity Whittier Los Angeles County Hispanic or Latino 72.0% 47.7% White or Caucasian 21.9% 27.8% Asian 3.7% 13.5% Black or African American 1.0% 8.3% Native American & Alaskan 0.3% 0.2% Native Hawaiian & Pacific Islander 0.1% 0.3% Other or Multiple 1.0% 2.2% Source: U.S. Bureau of the Census, 2010
86 Social Determinants of Health Whittier Area Zip Codes 90601-90606
Unemployment The unemployment rate in Whittier for 2011 was 8.8%, in South Whittier it was 10.8%, and in West Whittier it was 13.9%. Unemployment rates increased from 2009 to 2010, but decreased from 2010 to 2011.
Unemployment Rates, Annual Average, 2009-2011 Geographic Area 2009 2010 2011 South Whittier 10.2% 11.1% 10.8% West Whittier/Los Nietos 13.1% 14.3% 13.9% Whittier 8.3% 9.1% 8.8% PIH Health Primary Service Area 10.2% 11.2% 10.8% Los Angeles County 11.6% 12.6% 12.3% California 11.3% 12.4% 11.7% Source: California Employment Development Department, Labor Market Information Division Blue= Highest rate; Green= Lowest Rate
Median Household Income The median household income in West Whittier is $55,879, in South Whittier $65,043, and in Whittier $65,308.
Median Household Income Geographic Area Median Household Income South Whittier $65,043 West Whittier/Los Nietos $55,879 Whittier $65,308 Los Angeles County $55,476 California $60,883 Source: U.S. Bureau of the Census, 2006-2010 American Community Survey Blue= Highest rate; Green= Lowest Rate
Poverty Poverty thresholds are used to calculate all official poverty population statistics. They are updated each year by the Census Bureau. For 2010, the Federal Poverty Level for one person was $10,830, and for a family of four $22,050. In Whittier, 27.1% of the population is considered low-income at 200% or below poverty; 31.1% of the population in West Whittier is low- income, and 31.4% is low-income in South Whittier. Whittier has 9.2% people living in poverty, West Whittier has 10%, and South Whittier has 10.8%.
Ratio of Income to Poverty Level Geographic Area Below 100% Poverty Below 200% Poverty South Whittier 10.8% 31.4% West Whittier/Los Nietos 10.0% 31.1% Whittier 9.2% 27.1% PIH Health Primary Service Area 10.2% 30.0% Los Angeles County 15.7% 37.6% California 13.7% 32.8% Source: U.S. Bureau of the Census, 2006-2010 American Community Survey Blue= Highest rate; Green= Lowest Rate
87 Social Determinants of Health, continued Whittier Area Zip Codes 90601-90606
Poverty, continued In South Whittier, 15.3% of children live in poverty; and 21.4% of households, headed by a female with children, are in poverty. In West Whittier, 13.5% of children live in poverty, and 15% of households with children headed by a female are at the poverty level. In Whittier, 12.7% of children live in poverty. Close to one-fourth (23.9%) of families with children and a female head of household live in poverty in Whittier.
Poverty, Children under 18, and Female Head of Household Families with Children under 18 Years Old Geographic Area Children in Poverty Female Head of Household Families (Under 18 Years) with Children in Poverty South Whittier 15.3% 21.4% West Whittier/Los Nietos 13.5% 15.0% Whittier 12.7% 23.9% PIH Health Primary Service Area 14.6% No Data Los Angeles County 22.4% 34.6% California 19.1% 32.8% Source: U.S. Bureau of the Census, 2006-2010 American Community Survey Blue= Highest rate; Green= Lowest Rate
Whittier 90602 has the highest percentage of seniors living in poverty at 12.1%. Whittier 90601 has the lowest rate of seniors in poverty at 4.9%.
Seniors in Poverty Geographic Area Seniors in Poverty 90601 - Whittier 4.9% 90602 - Whittier 12.1% 90603 - Whittier 6.7% 90604 - Whittier 10.1% 90605 - Whittier 12.0% 90606 - Whittier 11.0% Los Angeles County 11.7% California 9.1% Source: U.S. Bureau of the Census, American Community Survey, 2007-2011 averaged Blue= Highest rate; Green= Lowest Rate
Free or Reduced Price Meals
The percentage of students eligible for free and reduced price meal programs is one indicator of socioeconomic status. Among Whittier-area school districts, 100% of students in the Los Nietos district are eligible for the free and reduced-price meal program, indicating an extremely high rate of low-income families.
Free and Reduced Price Meals Eligibility School District Number Percent East Whittier City School District 4,394 49.5% Los Nietos School District 2,064 100% South Whittier School District 2,538 64.0% Whittier City School District 4,236 64.9% Whittier Union High School District 8,057 59.7% Los Angeles County 1,017,249 65.3% California 3,465,446 56.7% Source: California Department of Education, 2010-2011 Blue= Highest rate; Green= Lowest Rate
88 Social Determinants of Health, continued Whittier Area Zip Codes 90601-90606
Housing In Whittier zip codes 90601 and 90602, there are higher percentages of renters than owner-occupied housing units compared to the service area.
Housing Units/Owners and Renters Geographic Area Total Housing Units Owner Occupied Renter Occupied 90601 - Whittier 11,549 56.6% 38.8% 90602 - Whittier 7,007 34.9% 59.5% 90603 - Whittier 6,788 76.6% 20.3% 90604 - Whittier 12,326 62.8% 34.0% 90605 - Whittier 10,1089710110,897 65.6% 31.0% 90606 - Whittier 8,931 66.0% 30.7% PIH Health Primary Service Area 183,129 62.3% 34.1% Los Angeles County 3,445,076 44.8% 49.2% California 13,680,081 51.4% 40.5% Source: U.S. Bureau of the Census, 2010 Blue= Highest rate; Green= Lowest Rate
Section 8 is a federally funded program that provides rental assistance in the form of vouchers to low and very-low income families, singles, senior citizens, disabled, and handicapped individuals. The Housing Authority of Los Angeles County handles Section 8 program. In Whittier, there are 88 Section 8 units. Those with a Housing Choice voucher in Whittier wait an average of 86 months (7.2 years) to gain access to subsidized housing.
Subsidized Housing, Section 8 Vouchers, 2009 Geographic Area Number of Units Wait Time in Months South Whittier No Data 74 West Whittier/Los Nietos 11 52 Whittier 88 86 Source: U.S. Department of Housing and Development, Picture of Subsidized Households, 2009
Language In Whittier, English only is spoken in over half the homes (56.6%) with English only spoken in 36.3% of West Whittier homes. By comparison, the City has relatively few households where Indo-European (2%) or Asian languages (1.8%) are spoken. English only is spoken by 40.1% and 36.3% of the populations of South Whittier and West Whittier, respectively. Spanish is spoken by 55.7% and 62.6% of the populations of South Whittier and West Whittier, respectively.
Language Spoken at Home for the Population 5 Years of Age and Over Geographic Area English Only Spanish Asian Indo-European Other South Whittier 40.1% 55.7% 3.1% 0.9% 0.2% West Whittier/Los Nietos 36.3% 62.6% 0.6% 0.5% 0.0% Whittier 56.6% 39.4% 1.8% 2.0% 0.2% PIH Health Primary Service Area 41.2% 48.0% 8.5% 2.1% 0.2% Los Angeles County 43.6% 39.4% 10.7% 5.3% 1.0% California 57.0% 28.5% 9.4% 4.3% 0.8% Source: U.S. Bureau of the Census, 2006-2010 American Community Survey Blue= Highest rate; Green= Lowest Rate
89 Social Determinants of Health, continued Whittier Area Zip Codes 90601-90606
Language, continued Linguistic isolation data refers to the population over age five who speak English “less than very well.” In Whittier, 15.6% of the population are linguistically isolated, in South Whittier it’s 24.5%, and in West Whittier 24.2% of the population are linguistically isolated.
Linguistic Isolation among Population 5 Years of Age and Over Geographic Area Linguistic Isolation South Whittier 24.5% West Whittier/Los Nietos 24.2% Whittier 15.6% PIH Health Primary Service Area 24.3% Los Angeles County 27.0% California 19.9% Source: U.S. Bureau of the Census, 2006-2010 American Community Survey Blue= Highest rate; Green= Lowest Rate
Education Of the population age 25 and over in South Whittier, 68.1% have a high school diploma or higher. In West Whittier, 66.7% have a high school diploma or higher. In Whittier, 82.3% have a high school diploma or higher.
Educational Attainment PIH Health Primary South Whittier West Whittier Whittier Service Area Population age 25 and over 34,070 16,031 53,270 365,701 Less than 9th grade 16.2% 17.5% 8.0% 12.8% 9th to 12th grade, no diploma 15.7% 15.9% 9.8% 11.8% High school graduate 28.2% 32.1% 24.7% 27.1% Some college, no degree 20.9% 19.6% 26.1% 21.6% Associate degree 7.2% 6.9% 8.4% 7.7% Bachelor's degree 8.5% 5.7% 14.8% 13.4% Graduate or professional degree 3.3% 2.4% 8.3% 5.6% Source: U.S. Bureau of the Census, 2006-2010 American Community Survey
Perceived School Safety Over half of the seventh grade students in Whittier-area school districts feel safe or very safe at school.
Feels Very Safe/Safe at School, by School District, Seventh Grade Students, by Gender, 2008-2010 District* Female Male East Whittier City School District 73.2% 65.7% South Whittier School District 51.7% 56.4% Whittier City School District 58.3% 62.2% Los Angeles County 63.9% 62.6% Source: CA Department of Education, California Healthy Kids Survey, 2008-2010 *No data were available for Los Nietos Elementary School District
90 Social Determinants of Health, continued Whittier Area Zip Codes 90601-90606
Crime and Violence Violent crimes include homicide, rape, and assault. Whittier has a rate of 401.9 arrests for violent crimes per 100,000 persons in the service area.
Adult Violent Crimes, 2010, per 100,000 Persons
Geographic Area Number Rate
Whittier 343 401.9 Los Angeles County 50,223 511.5 California 163,957 440.1 Source: California Department of Justice, Office of the Attorney General, 2010; U.S. Census 2010
Whittier has the highest number of domestic violence calls in the primary service area. While Whittier has a large number of domestic violence calls, the majority of calls were for incidents without a weapon.
Domestic Violence Calls, 2010 Geographic Area Total Without Weapon With Weapon Whittier 903 637 (71%) 266 (29%) Los Angeles County 42,052 15,855 (38%) 26,197 (62%) California 166,361 100,496 (60%) 65,865 (40%) Source: California Department of Justice, Office of the Attorney General, 2010
Access to Healthcare Whittier Area Zip Codes 90601-90606
Health Insurance Coverage Health insurance coverage is considered a key component to accessing healthcare. Of the total population, 84.9% of Whittier residents and 79.3% of West Whittier and Los Nietos residents have health insurance. Over 90% of children under age 18 have health insurance coverage. In Whittier 79.7% and West Whittier 70.6% of adults age 18 to 64 carry health insurance. South Whittier has the lowest rate of health insurance among all age groups.
Health Insurance Coverage, Total Population, Children, Under 18, and Adults, 18-64 Adults Geographic Area Total Population Children Under 18 Ages 18-64 South Whittier 78.5% 89.9% 70.1% West Whittier/Los Nietos 79.3% 91.9% 70.6% Whittier 84.9% 91.1% 79.7% PIH Health Primary Service Area 79.4% 90.4% 71.3% Los Angeles County 77.2% 89.6% 69.2% California 81.8% 91.1% 75.1% Source: U.S. Census Bureau, 2009-2011 American Community Survey Blue= Highest; Green= Lowest
91 Maternal and Infant Health Whittier Area Zip Codes 90601-90606
Prenatal Care In 2011, 86.8% of pregnant women in Whittier began prenatal care during their first trimester, up from 83.3% in 2008. Whittier zip code 90604 has the lowest rate (84.1%) and 90606 the highest rate (89.6%).
Late Entry into Prenatal Care (After First Trimester), 2008 and 2011 Comparison* Late Prenatal Live Rate per 1,000 Live Births Rate per 1,000 Live Births Geographic Area Care Births^ 2008 2011 90601 - Whittier 50 409 139.4 122.2 90602 - Whittier 51 356 170.2 143.3 90603 - Whittier 22 194 127.6 127.9 90604 - Whittier 80 502 182.5 159.4 90605 - Whittier 75 562 172.2 133.5 90606 - Whittier 42 404 182.5 104.0 Whittier 320 2,427 167.3 131.9 PIH Health Primary 984 7,509 149.9 131.0 Service Area California 81,140 492,832 172.0 164.6 Source: California Department of Public Health, 2008, 2011 ^Births in which the first month of prenatal care is unknown are not included in the tabulation. * When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest rate; Green= Lowest Rate
Births In 2011, there were 2,500 births in Whittier. The majority of the births were to Latino mothers (82.8%) followed by White mothers (12%). The birth rate has decreased every year for the last four years.
Births by Year, 2008-2011 2008 2009 2010 2011 2,756 2,566 2,536 2,500 Source: California Department of Public Health, 2008, 2009, 2010, 2011
Low Birth Weight Babies born at low birth weight are at higher risk for disease, disability, and death. In Whittier, the rate of low-weight births is 68.4 per 1,000 live births. This is higher than the 2008 rate of 56.6.
Low Birth Weight (Under 2,500 g) – 2008 and 2011 Comparison* Rate per 1,000 Live Births Rate per 1,000 Live Births Geographic Area Low-Weight Births Live Births 2008 2011 90601 - Whittier 33 423 79.6 78.0 90602 - Whittier 16 367 44.3 43.6 90603 - Whittier 10 197 56.1 50.8 90604 - Whittier 47 517 43.8 90.9 90605 - Whittier 39 575 46.3 67.8 90606 - Whittier 26 421 73.4 61.8 Whittier 171 2,500 56.6 68.4 PIH Health Primary 517 7,774 61.1 66.5 Service Area California 34,159 503,856 68.3 67.8 Source: California Department of Public Health, 2008+2011 * When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest rate; Green= Lowest Rate
92 Maternal and Infant Health, continued Whittier Area Zip Codes 90601-90606
Teen Births In 2011, teen birth rates represented 7.6% of total births. Whittier 90605 has the highest percentage of teen births at 10.4%.
Births to Teenage Mothers (Under Age 20)* Geographic Area Births to Teen Mothers Live Births Rate per 1,000 Live Births 90601 - Whittier 34 423 80.4 90602 - Whittier 30 367 81.7 90603 - Whittier 5 197 25.4 90604 - Whittier 32 517 61.9 90605 - Whittier 60 575 104.3 90606 - Whittier 28 421 66.5 Whittier 189 2,500 75.6 PIH Health Primary 612 7,774 78.7 Service Area California 38,834 503,856 77.1 Source: California Department of Public Health, 2011 * When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest rate; Green= Lowest Rate
Whittier zip codes, compared for teen births from 2008 to 2011, show an overall decrease.
Births to Teenage Mothers (Under Age 20), 2008 and 2011 Comparison Percent of Births Percent of Births Geographic Area 2008 2011 90601 - Whittier 10.2% 8.0% 90602 - Whittier 8.9% 8.2% 90603 - Whittier 4.1% 2.5% 90604 - Whittier 9.5% 6.2% 90605 - Whittier 11.3% 10.4% 90606 - Whittier 12.9% 6.7% PIH Health Primary Service Area 10.5% 7.9% California 9.5% 7.7% Source: California Department of Public Health, 2008, 2011 Blue= Highest rate; Green= Lowest Rate
Infant Mortality Infant mortality in Whittier averaged 5.2 deaths per 1,000 live births over five years from 2006 to 2010. This is higher than an infant death rate of 4.6 for the service area and 5.0 for the state.
Infant Mortality Rate, 5-Year Average, 2006-2010* Infant Deaths, 5-Year Live Births, 5-Year Average 5-Year Death Rate per Geographic Area Average of Actual Deaths Average of Actual Births 1,000 Live Births 90601 - Whittier 2.0 429.6 4.7 90602 - Whittier 3.2 407 7.9 90603 - Whittier 0.4 200.4 2.0 90604 - Whittier 1.6 557.8 2.9 90605 - Whittier 3.8 612.8 6.2 90606 - Whittier 3.2 501.2 6.4 Whittier 14.2 2,708.8 5.2 PIH Health Primary 39.4 Service Area 8,645 4.6 California 2,717.6 543,322.8 5.0 Source: California Department of Health Services, 2006-2010 * When examining geographic areas with a small population, such as zip codes, it is important to use caution when drawing conclusions from data; small occurrence of a health problem may result in a high rate. Blue= Highest rate; Green= Lowest Rate
93 Weight Status, Nutrition, and Physical Activity Whittier Area Zip Codes 90601-90606
Obesity The Los Angeles County Department of Public Health collected data about adult and childhood obesity prevalence and established rankings that compare obesity levels across locales. Over one-quarter of adults and youth in South Whittier and West Whittier are obese.
Adult and Youth Obesity Rates and Rankings Rank of Adult Prevalence of Rank of Childhood Prevalence of Adult Obesity* Childhood Obesity Obesity * Obesity Percent^ (ranked 1-127) Percent^ (ranked 1-119) South Whittier 28.0% 91 29.0% 97 West Whittier/Los Nietos 29.4% 99 31.1% 111 Whittier 23.6% 65 23.4% 64 Los Angeles County 23.9% NA 23.0% N/A Source: L.A. County Department of Public Health, 2011 ^Adult BMI of 30kg or above; +Child BMI for age ≥ 95th percentile *Places were ranked from lowest to highest rates of obesity with 1 indicating the lowest rate of obesity. There are fewer rankings for children since some localities were not presented due to small student group sizes. Blue= Highest rate; Green= Lowest Rate
Nutrition Eating breakfast is especially important for children and adolescents. Among seventh grade students in Whittier-area schools, males tend to eat breakfast at higher rates than females.
Ate Breakfast in Past Day, by School District, Seventh Grade Students, by Gender, 2008-2010 District* Female Male East Whittier City School District 58.2% 70.6% South Whittier School District 56.5% 69.2% Whittier City School District 49.5% 68.1% Los Angeles County 62.9% 70.3% Source: CA Department of Education, California Healthy Kids Survey, 2008-2010 *No data were available for Los Nietos School District
Physical Activity The California Department of Education’s physical fitness test (PFT) measures the aerobic capacity of school children using run and walk tests. Children who meet established standards for aerobic capacity are categorized in the Healthy Fitness Zone. Whittier City School District students rank highest in Healthy Fitness Zone aerobic capacity.
Fifth, Seventh and Ninth Grade Students, Aerobic Capacity, Healthy Fitness Zone School District Fifth Grade Seventh Grade Ninth Grade East Whittier City School District 63.0% 62.8% N/A Los Nietos School District 25.7% 59.6% N/A South Whittier School District 52.3% 40.4% N/A Whittier City School District 65.4% 72.5% N/A Whittier Union High School District N/A N/A 61.0% Los Angeles County 58.8% 59.4% 57.6% Source: California Department of Education, FITNESSGRAM Physical Fitness Testing Results, 2011-2012 Blue= Highest rate; Green= Lowest Rate
94 Weight Status, Nutrition, and Physical Activity, continued Whittier Area Zip Codes 90601-90606
Physical Activity, continued In the service area, 1.6% of workers age 16 and older walk to work. In Whittier, 1.4% of commuters walk to work. Whittier 90602 has the highest rate (3.8%) of commuters who walk to work.
Walked to Work Geographic Area Walked to Work 90601 - Whittier 1.8% 90602 - Whittier 3.8% 90603 - Whittier 1.4% 90604 - Whittier 0.1% 90605 - Whittier 0.7% 90606 - Whittier 1.6% Whittier 1.4% PIH Health Primary Service Area 1.6% Los Angeles County 2.9% California 2.8% Source: U.S. Bureau of the Census, American Community Survey, 2007-2011 Blue= Highest rate; Green= Lowest Rate
WalkScore.com ranks the walkability of over 2,500 cities (over 10,000 neighborhoods) in the United States to determine how conducive a neighborhood is to walking. Access to amenities—such as grocery stores and parks—determines the walk score. Many locales are sampled to determine an overall score. The higher the score, the more walkable. The lower the score, the more vehicle dependent.
WalkScore.com has established the range of scores as follows: 0-24: Car Dependent (Almost all errands require a car) 70-89: Very Walkable (Most errands can be accomplished on foot) 25-49: Car Dependent (A few amenities within walking distance) 90-100: Walker's Paradise (Daily errands do not require a car) 50-69: Somewhat Walkable (Some amenities within walking distance)
Based on this scoring, South Whittier and Whittier are classified as “Somewhat Walkable.”
Community Walkability Geographical Area Walk Score South Whittier 50 West Whittier/Los Nietos 56 Whittier 62 Los Angeles County 66 Source: WalkScore.com, 2012
95 Mental Health Whittier Area Zip Codes 90601-90606
Depression is one of the most common emotional health problems among teens. The California Healthy Kids Survey reported on seventh graders’ depression, defined as feeling sad or hopeless every day for at least two weeks to the extent they stopped doing usual activities.
In Los Angeles County, 30.7% of seventh grade females and 25.1% of seventh grade males indicated feeling sad or hopeless. Females reported depression in greater percentages. Depression among females in Whittier-area schools was higher than for the state. Depression-related feelings among seventh grade females and males was the highest at South Whittier School District.
Feeling Sad or Hopeless, by School District, Seventh Grade Students, by Gender, 2008-2010 District* Female Male East Whittier City School District 28.7% 20.7% South Whittier School District 43.6% 33.3% Whittier City School District 38.5% 23.9% Los Angeles County 30.7% 25.1% Source: CA Department of Education, California Healthy Kids Survey, 2008-2010 *No data were available for Los Nietos School District
Leading Causes of Death Whittier Area Zip Codes 90601-90606
Deaths From 2008 to 2010 there were 3,545 deaths among residents of Whittier. Heart disease, cancer, stroke, and chronic lung disease were the top four causes of death.
Age-Adjusted Death Rates per 100,000 Persons, 3-Year Total (2008-2010) Flu/
Heart Cancer Stroke Lung Alzheimer’s Diabetes Pneumonia Injury Suicide Homicide 90601 157.2 146.5 44.2 36.2 24.2 22.7 20.0 25.0 10.4 10.1 90602 192.9 161.8 38.7 42.6 20.9 21.6 25.3 28.9 3.9 3.5 90603 170.8 156.1 43.4 18.2 30.9 26.4 16.7 11.9 1.2 3.0 90604 181.7 166.3 33.8 34.2 22.9 24.4 15.2 19.4 8.1 3.3 90605 157.5 156.2 43.1 50.5 21.0 33.1 22.5 17.6 10.5 4.6 90606 157.9 148.7 33.2 31.9 28.7 28.6 13.6 16.5 8.6 8.0 PIH Health Primary Service Area 169.1 154.7 35.9 33.5 26.1 25.9 20.6 20.6 6.4 5.5 Source: California Department of Public Health, Public Health Death Statistical Master Files 2008-2010, tabulated by the University of Missouri, CARES. Age-adjustment using U.S. 2010 Decennial Census SF1. Mortality rates are age-adjusted based on the 2000 Standard Population using the methods approved by the CDC. Mortality rates for causes of death and area combinations based on less than 10 deaths over the study period were suppressed. Blue= Highest rate; Green= Lowest Rate
96 Appendix F
Community Health Facilities and Other Resources
1| Community Health Facilities
Healthcare Assets Map for PIH Health Primary Service Area
2| Other Resources
Information and Referral Resources
97 10 10
Healthcare Assets PIH Health Hospital Rush St El Monte WestPIH Health Physician Offices (1-13)
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S o Lakewood N La Palma Anaheim Care Force One Health Van Sites Label Name Address A El Rancho High School 6501 Passons Blvd, Pico Rivera, CA 90660 B Pioneer High 10800 Benavon St, Whittier, CA 90606 C Sorenson Park 11419 Rosehedge Dr, Whittier, CA 90606 D Whittier High 12417 Philadelphia St, Whittier, CA 90601 E Frontier High School 9401 S. Painter Ave, Whittier, CA 90605 F Carmela Elementary School 13300 Lakeland Rd, Whittier, CA 90605 G Santa Fe High 10400 Orr and Day Rd, Santa Fe Springs, CA 90670
PIH Health Office Locations Label Name Address 1 PIH Health Physicians Pain Management 12462 Putnam St Suite 402, Whittier, CA 90602 1 PIH Health Physicians Podiatry 12463 Putnam St Suite 402, Whittier, CA 90602 1 PIH Health Physicians Spine Center 12464 Putnam St Suite 402, Whittier, CA 90602 1 PIH Health Physicians Cardiology 12465 Putnam St Suite 203, Whittier, CA 90602 1 PIH Health Physicians Women's Center 12466 Putnam St Suite 303, Whittier, CA 90602 1 PIH Health Physicians Orthopaedics & Sports Medicine 12467 Putnam St Suite 303, Whittier, CA 90602 2 PIH Health Family Practice Center - Whittier 12291 Washington Blvd, Suite 500, Whittier, CA 90606 3 PIH Health Physicians - West Whittier 12522 East Lambert Rd, Whittier, CA 90606 4 PIH Health Family Health Center - Santa Fe Springs 9251 Pioneer Blvd, Santa Fe Springs, CA 90670 5 PIH Health Physicians - Hacienda Heights - Puente Hills 1850 South Azusa Ave, Hacienda Heights, CA 91745 6 PIH Health Physicians Orthopaedics & Sports Medicine 12215 Telegraph Rd Suite A, Santa Fe Springs, CA 90670 7 PIH Health Physicians - South Whittier 10750 Laurel Ave Whittier, CA 90605 8 PIH Health Physicians Women's Center 15141 East Whittier Blvd, Suite 205, Whittier, CA 90603 9 PIH Health Physicians - Whittier 15725 East Whittier Blvd, Whittier, CA 90603 10 PIH Health Physicians - Norwalk 13330 Bloomfield Ave, Suite A, Norwalk, CA 90650 11 PIH Health Physicians - La Mirada 12675 La Mirada Blvd, Suite 201, La Mirada, CA 90638 12 PIH Health Physicians - La Mirada 15082 Imperial Highway, La Mirada, CA 90638 13 PIH Health Physicians Orthopaedics & Sports Medicine 1400 South Harbor Blvd, La Habra, CA 90631
Federally Qualified Health Centers (FQHC's) Label Name Address a Altamed Medical Group - Montebello 2321 W Whittier, Montebello, CA 90640 b Altamed ADHC: Pico Rivera 6336 Passons Blvd, Pico Rivera, CA 90660 c Altamed Danial Lara Hiv - Pico Rivera 9436 Slauson Ave, Pico Rivera, CA 90660 c Altamed Medical Group Pico Rivera - Slauson 9436 Slauson Ave, Pico Rivera, CA 90660 d Norwalk Regional Health Center 12360 Firestone Blvd, Norwalk, CA 90650
Other Health Care Clinics Label Name Address I Tavarua Medical and Mental Services 8207 Whittier Blvd, Pico Rivera, CA 90660 II Southern California Medical Center, Inc. 8825 Whittier Blvd, Pico Rivera, CA 90660 III Eldorado Community Service Center 5200 San Gabriel Pl, Pico Rivera, CA 90660 IV Planned Parenthood Los Angeles - Whittier Center 7655 Greenleaf Ave, Whittier, CA 90602 V Santa Maria's Children and Family Center 9209 Colima Rd, Whittier, CA 90605 VI Whittier Pregnancy Care Clinic 16147 E. Whittier Blvd, Whittier, CA 90603 VII Friends of Family Health Center 501 S Idaho St, La Habra, CA 90631 VIII The Gary Center 341 Hillcrest St, La Habra, CA 90631
Hospitals Label Name Address i Beverly Hospital 309 W Beverly Blvd, Montebello, CA 90640 ii Whittier Hospital Medical Center 9080 Colima Rd, Whittier, CA 90605 iii Coast Plaza Doctors Hospital 13100 S Studebaker Rd, Norwalk, CA 90650 iv Norwalk Community Hospital 13222 Bloomfield Ave, Norwalk, CA 90650 v Kindred Hospital - La Mirada 14900 E Imperial Highway, La Mirada, CA 90637
Urgent Care Sites Label Name Address aa PIH Health Physicians Urgent Care 15733 Whittier Blvd, Whittier, CA 90603 bb After-Hours Care (Imperial Primary Care) 15625 Imperial Highway, La Mirada, CA 90638 Information and Referral Resources
This is not intended to be a comprehensive list as we realize that there are many referral resources within the community available to meet the community health needs identified through the Community Health Needs Assessment.
Los Angeles County Information and Referral Line – Dial 2-1-1 Los Angeles County’s free 211 information and referral line is available 24 hours a day. This is the largest information and referral service in the nation with a variety of referral resources covering a wide range of needs. Website: www.healthycity.org
Los Angeles County Department of Mental Health Services Los Angeles County Department of Mental Health provides information and referrals to mental health resources. Website: http://dmh.lacounty.gov/wps/portal/dmh/our_services
PIH Health Information and Referral Resources PIH Health Community Advice Nurse Line - 1.888.780.1875 Free and confidential advice about your health concerns from a Registered Nurse. Available 24 hours a day to anyone in the community. Talk confidentially and receive information about minor illness and injuries, a variety of symptoms, including fever, and how and when to access urgent care or emergency care. If you believe you need emergency care, call 911 or go directly to the nearest emergency room.
PIH Health Enrollment Coordinators - 562.698.0811 Ext. 14811 or 14812 PIH Health Enrollment Coordinators are available to provide information and referral resources regarding adult, child, and family health insurance options and other needs including food, housing, childcare, and more.
PIH Health Senior Services - 562.698.0811 Ext. 18305 The PIH Health Senior Life Center maintains a variety of referrals and resources for seniors in the community from health insurance questions to caregiver resources. The Senior Life Center is open Monday thru Friday from 8:30 am – 4 pm.
PIH Health Social Services Helpline - 562.698.0811 Ext. 12453 The PIH Health Care Management Department has a free community information and referral line, offering access to a variety of referrals for food, housing, support groups and more. The helpline operates from 8 am – 4:30 pm.
Primary Service Area Communities Local communities provide information and referral on a variety of social service topics. Below is the contact information for the cities/communities in PIH Health’s Primary Service Area.
Hacienda Heights - Los Angeles County, Rowland Heights Field Office - 909.594.6561
City of La Habra Community Services Department – 562.905.9708 Website: http://www.lahabracity.com/section.cfm?id=21
City of La Habra Heights - 562.694.6302 Website: http://www.la-habra-heights.org/
City of La Mirada Community Services Department - 562.943.7277 Website: http://www.cityoflamirada.org/index.aspx?page=54
City of Montebello Parks and Recreation Department - 323.480.8000 Ext. 540 Website: http://www.cityofmontebello.com/depts/parks/about/default.asp
City of Norwalk Social Services Center - 562.929.5544 Website: http://www.ci.norwalk.ca.us/socialservices2.asp
City of Pico Rivera Public Information Line – 562.801.4217 Website: http://www.ci.pico-rivera.ca.us/
City of Santa Fe Springs Neighborhood Center - Family, Senior, and Social Services - 562.692.0261 Website: http://www.santafesprings.org/cityhall/community_serv/family_and_human_services/neighborhood_center.asp
City of Whittier Information and Referral & Social Services Directory - 562.567.9476 Website: http://www.cityofwhittier.org/depts/prcs/ss/ssi.asp
98