<<

OF NEWARK, NEW

COMMUNITY HEALTH ASSESSMENT 2017

May 2017 City of Newark, Community Health Assessment - 2017 Table of Contents Page i

CityofN ewark COMMUNITY HEALTH ASSESSMENT - 2017

T ableofContents

Introduction...... 1

I. O verview ofN ewarkP opulation...... 2 A. DemographicCharacteristics...... 2 B. N ewarkbyZIP Code...... 7

II. FactorsAffectingHealthS tatus...... 10 A. S ocialDeterminantsofHealth...... 10 B. EconomicS tability...... 11 Income ...... 11 Employment...... 12 C. Education...... 13 D. HealthCareS ystem ...... 14 L ackofHealthInsurance...... 14 L ackofHealthInsuranceAm ongAdultsAge18-64 in2014 ...... 14 ImpactoftheAffordableCareAct(ACA)...... 14 P rimaryCareR esourcesinN ewark...... 15

III. HealthBehaviorandR iskFactors...... 16 A. 500 CitiesProject...... 16 U nhealthyBehaviors– Age18andO lder...... 16 BingeDrinking...... 16 CurrentS m oking...... 16 N oL eisureT imeP hysicalActivity...... 17 O besity...... 17 L essthan7HoursofS leep...... 18 U seofP reventiveS ervices– Age18andO lder...... 19 CurrentL ackofHealthInsuranceAm ongAdultsAge18-64...... 19 VisitsToDoctorForR outineCheckupW ithinT heP astYear...... 19 VisitsToDentistO rDentalClinic...... 20 T akingM edicineforHighBloodP ressureControl...... 20 CholesterolScreening...... 21 M amm ographyU seAm ongW omenAged50-74 Years...... 21 P apanicolaou S m earU seAm ongAdultW omenAged21-65Years...... 22 FecalO ccultBloodT est,Sigmoidoscopy,orColonoscopyAm ongAdultsAged50-75Years...... 22 U p-To-DateonCoreS etofClinicalPreventiveS ervices(FluS hotP astYear, P neum ococcal S hot Ever, Colorectal Cancer S creening) Am ong M en Aged ≥65 Years...... 23 U p-To-DateonCoreS etofClinicalPreventiveS ervices(SameasM enP lusM amm ogram in P ast 2 Years) Am ong W om en Aged ≥65 Years...... 23

IV. HealthS tatus...... 25 A. HealthConditions...... 25 HealthO utcomes– Age18andO lder...... 25 Arthritis...... 25 City of Newark, New Jersey Community Health Assessment - 2017 Table of Contents Page ii

CurrentAsthmaP revalence...... 25 HighBloodP ressure...... 26 HighCholesterol...... 27 Cancer...... 29 DiagnosedDiabetes...... 29 ChronicKidneyDisease...... 30 ChronicO bstructiveP ulmonaryDisease(CO P D)...... 30 CoronaryHeartDisease...... 31 S troke...... 31 M entalHealthN otGoodfor14+ Days...... 32 P hysicalHealthN otGoodfor14+ Days...... 32 AllTeethL ost...... 33 B. M aternal,InfantandChildHealth...... 34 P renatalCare...... 34 L ow Birthweight...... 36 InfantM ortality...... 38 C. EnvironmentalHealth...... 39 ChildhoodL eadP oisoning...... 39 D. S exuallyT ransmittedDiseases...... 40 E. M ortality-LeadingCausesofDeath...... 41

V. HIV/AIDS ...... 46 A. HIV/AIDS inN ewark...... 46 B. HealthO utcomesAm ongP eoplew ithHIV/AIDS inN ewark...... 50 Background...... 50 N ewarkR esidentsServedbyR W HAP ...... 52 O utcomesofN ewarkP L W HA alongtheHIVCareContinuum ...... 52 ViralSuppression– N ewarkversusN ewarkEM A ...... 53

VI. Comm unityHealthCenters/FQ HC N eedsAssessment...... 55 A. CHC/FQ HC N eedsAssessmentR equirements...... 55 B. HealthS tatusIndicators...... 55 1. EarlyEntryIntoP renatalCare...... 55 2. ChildhoodImm unizationS tatus...... 56 3. CervicalCancerS creening...... 56 4. W eightAssessmentandCounselingforN utritionandP hysicalActivityforChildrenand Adolescents...... 56 5. BodyM assIndex(BM I)S creeningandFollow U pP lan...... 57 6. T obaccoU seS creeningandCessationIntervention...... 57 7. U seofAppropriateM edicationsforAsthma...... 57 8. CoronaryArteryDisease(CAD):L ipidT herapy...... 58 9. IschemicVascularDisease(IVD):U seofAspirinorO therAntithrombotic...... 58 10. ColorectalCancerS creening...... 58 11. S creeningforClinicalDepressionandFollow U pP lan...... 59 12. HIVL inkagetoCare...... 59 13. DentalSealantsforChildrenAge6-9Years...... 59 14. DiabetesHemoglobinA1cP oorControl...... 60 15. ControllingHighBloodP ressure...... 60 16. L ow BirthW eight...... 60 City of Newark, New Jersey Community Health Assessment - 2017 Table of Contents Page iii

VII. Comm unityP artnersandR esources...... 61 A. Comm unityP artnerships...... 61 B. AvailabilityofFundingR esources...... 62

LIST O FTABLES

T able1: P opulationinN ewark,Essex,N J,U S – 2010 and2015...... 2 T able2: P opulationbyAgeCategoryinN ewark,Essex,N J,U S – 2015...... 2 T able3: DemographicandS ocioeconomicFactorsofN ewarkR esidentsbyZIP Code(2011-2015)...... 8 T able4: IncomeinN ewark,Essex,N J,U S – 2010 and2015...... 11 T able5: HouseholdswithFoodS tamp/SN AP BenefitsintheP ast12 M onthsinN ewark,Essex,N J,U S – 2010 and2015...... 11 T able6: P ercentofR esidentsLivingBelow P overtyinN ewark,Essex,N J,U S – 2010 and2015...... 12 T able7: L aborForceandU nemploymentin2015...... 12 T able8: HealthInsuranceS tatusBeforeandAfterAffordableCareAct– 2010 and2015...... 15 T able9: N ewarkW omenR eceivingP renatalCareinFirstT rimesterbyR ace/Ethnicity– 2005,2010,2015...... 35 T able10: HealthyP eople2020 andHealthyN J2020 T argetsforP renatalCareandN ewark2015...... 35 T able11: HealthyP eople2020 andHealthyN J2020 T argetsforL ow BirthweightandN ewark2015...... 37 T able12: HealthyP eople2020 andHealthyN J2020 T argetsforInfantM ortalityandN ewark2015...... 38 T able13: S FY2015:N um berofChildren(six(6)to26 m onthsofage)byBL L forN ewarkandN ew Jersey...... 40 T able14: CasesofS exuallyT ransmittedDiseasesin2015– N ewarkandN ew Jersey...... 40 T able15: T op10 L eadingCausesofDeathin2014 – N ewark,N J,U S ...... 44 T able16: 10 L eadingCausesofDeathinN ewark(2014)byR ace/Ethnicity...... 45

L IST O FFIGU R ES

Figure1: ChangeinAgeofN ewarkR esidents– 2005,2010,2015 ...... 3 Figure2: P opulationbyR ace/Ethnicityin2015– N ewark,EssexCounty,N J,U S ...... 4 Figure3: ChangeinN ewarkP opulationbyR ace/Ethnicity– 2005,2010,2015...... 4 Figure4: L anguageS pokenAtHome(Age5+)in2015...... 5 Figure5: N ativeandForeignBornP opulation-2015...... 6 Figure6: M apofN ewarkbyZIP Code...... 7 Figure7: S ocialDeterminantsofHealthfrom KaiserFamilyFoundation,N ovember2015...... 10 Figure8: U nemploymentR atesin2015...... 13 Figure9: Education– Age25andO lder(2015)...... 13 Figure10:L ackofHealthInsuranceAm ongAdultsAged18-64 (AgeAdjusted),2014...... 14 Figure11: ImpactofACA onN ewarkR esidents2010 -2015...... 15 Figure12: BingeDrinkingP revalenceAm ongAdultsAged18+(AgeAdjusted),2014...... 16 Figure13: CurrentS m okingP revalenceAm ongAdultsAged18+(AgeAdjusted),2014 ...... 16 Figure14:N oL eisureT imeP hysicalActivityAm ongAdultsAged18+(AgeAdjusted),2014...... 17 Figure15:O besityAm ongAdultsAged18+(AgeAdjusted),2014...... 17 Figure16:S leepingL essthan7HoursAm ongAdultsAged18+(AgeAdjusted),2014...... 18 Figure17:CurrentL ackofHealthInsuranceAm ongAdultsAged18-64 (AgeAdjusted),2014...... 19 Figure18:VisitstoDoctorforR outineCheckupw ithintheP astYearAm ongAdultsAged18+(Age Adjusted),2014 ...... 19 Figure19:VisitstoaDentistorDentalClinicAm ongAdultsAged18+(AgeAdjusted),2014 ...... 20 Figure20:T akingM edicineforHighBloodP ressureAm ongAdultsAged18+w ithHighBloodP ressure (AgeAdjusted),2014...... 20 Figure21:CholesterolScreeningAm ongAdultsAged18+(AgeAdjusted),2014...... 21 Figure22:M amm ographyU seAm ongW omenAged50-74 Years(AgeAdjusted),2014 ...... 21 City of Newark, New Jersey Community Health Assessment - 2017 Table of Contents Page iv

Figure23:P apS m earU seAm ongAdultW omenAged21-65Years(AgeAdjusted),2014...... 22 Figure24:FecalO ccultBloodT est,Sigmoidoscopy,orColonoscopyAm ongAdultsAged50-75Years(Age Adjusted),2014 ...... 22 Figure25:U p-To-DateonaCoreS etofP reventiveS ervices(FluS hotP astYear,Pneum oniaShotEver, Colorectal Cancer S creening) Am ong M en Aged ≥ 65 Years (Age Adjusted), 2014 ...... 23 Figure26:U p-To-DateonaCoreS etofP reventiveS ervices(SameasM enplusM amm ograminP ast2 Years) Am ong W om en Aged ≥ 65 Years (Age Adjusted), 2014 ...... 24 Figure27:ArthritisAm ongAdultsAged18+(AgeAdjusted),2014...... 25 Figure28:CurrentAsthmaP revalenceAm ongAdultsAged18+(AgeAdjusted),2014...... 26 Figure29:HighBloodP ressureAm ongAdultsAged18+(AgeAdjusted),2014 ...... 27 Figure30:HighCholesterolAm ongAdultsAged18+W hoHaveBeenS creenedintheP ast5Years(Age Adjusted),2014 ...... 28 Figure31:CancerAm ongAdultsAged18+(AgeAdjusted),2014...... 29 Figure32:DiagnosedDiabetesAm ongAdultsAged18+(AgeAdjusted),2014...... 29 Figure33:ChronicKidneyDiseaseAm ongAdultsAged18+(AgeAdjusted),2014 ...... 30 Figure34:ChronicO bstructiveP ulmonaryDiseaseAm ongAdultsAged18+(AgeAdjusted),2014 ...... 30 Figure35:CoronaryHeartDiseaseAm ongAdultsAged18+(AgeAdjusted),2014...... 31 Figure36:S trokeAm ongAdultsAged18+(AgeAdjusted),2014 ...... 31 Figure37:M entalHealthN otGoodfor>= 14 DaysAm ongAdultsAged18+(AgeAdjusted),2014 ...... 32 Figure38:P hysicalHealthN otGoodfor>= 14 DaysAm ongAdultsAged18+(AgeAdjusted),2014...... 32 Figure39:AllTeethL ostAm ongAdultsAged18+(AgeAdjusted),2014...... 33 Figure40: N ewarkP renatalCareinFirstT rimesterbyR ace/Ethnicity– 2005,2010,2015...... 34 Figure41: P ercentBirthsofL ow Birthweightin2015 -N ewark,N JandU S ...... 36 Figure42:T rendsinN ewarkL BW andVL BW in2005,2010,2015...... 37 Figure43:T otalandBlackInfantM ortalityin2014 – N ewark,N J,U S ...... 38 Figure44: P ercentofN ew JerseyS exuallyT ransmittedDiseasesO ccurringinN ewark-2015...... 40 Figure45: L eadingCausesofDeathinN ewark-2014 ...... 42 Figure46: L eadingCausesofDeathinN ew Jersey-2014...... 43 Figure47: P eopleL ivingW ithHIV/AIDS inN ewarkasofDecember31,2015...... 46 Figure48:P ercentofN ew Jersey’sPL W HA L ivinginN ewarkasofDecember31,2015 ...... 47 Figure49: P eopleL ivingw ithHIV/AIDS -Ratesper100,000 P opulation– N ewark,N ewarkEligible M etropolitanArea(EM A)andN J(2015)andU S (2013)...... 48 Figure50: T rendsinP L W HA inN ewark– 2005,2010,2015...... 49 Figure51: DeathsDuetoHIVinN ewark– 2004 -2014 ...... 49 Figure52: O utcomesofN ewarkR W HAP ClientsalongtheHIVCareContinuum ,2016...... 52 Figure53: ViralSuppressionofR W HAP ClientsinN ewarkandN ewarkEM A,2016...... 54 City of Newark, New Jersey Community Health Assessment - 2017 Behavioral Risk Factors Page 1

Introduction

In2007,theCityofN ewarkDepartmentofHealthandComm unityW ellness(DHCW )(namedthe DepartmentofChildandFamilyW ell-Being),whichisthelocalhealthdepartment(LHD)fortheCityof N ewark,N ew Jersey,completedaComm unityHealthAssessment– February2007presentinganarray ofindicatorsofthehealthstatusofresidentsoftheCityofN ewark,includingm orbidity,mortality,and behavioralfactors.T hisassessmentw aspartofaLocalPublicHealthS ystem Assessmentrequiredofall L HDsbytheN .J.DepartmentofHealth(N JDO H).S incethen,num erousassessmentsofcomm unity healthhavebeencompletedbyanum berofentitiesincludinghospitalsandhealthcarecoalitionswhich haveinformedthisreport.T hisdocum entpresentsacompleteupdateofthe2007assessment,and includesananalysisofsignificanttrendsoverthepastfivetotenyears.

N ewarkisthelargestcityinN ew Jerseybypopulation,comprising35% ofthepopulationofEssex Countyinw hichitissituated.M ostdataforthisassessmentareavailableforN ewark.W herenot available,dataforEssexCountyareused.

AdditionalInformation. T heCityofN ewarkalongw ithpartnerorganizationsthroughouttheGreater N ewarkareawillseektoobtainadditionalinformationdirectlyfrom N ewarkresidentsabouttheir health,well-beingandaccesstohealthcareandrelatedservices.T hismaytaketheformoftownhall m eetingsineachofN ewark’sfivew ards,focusgroups,keyinformantinterviewsandothermethods.

DataSources. S ourcesofinformationforthecontentsofthisassessmentareshownineachsection. T heyaresum m arizedbelow.

N ew JerseyDepartmentofHealth.O fficeofP opulationHealth.CenterforHealthS tatisticsand Informatics.N JS tateHealthAssessmentData(N JS HAD).DivisionofComm unicableDiseases. ofHIV,ST D andT B S ervices. U .S.CensusBureau. Am ericanComm unityS urvey(ACS ). CentersforDiseaseControlandP revention(CDC).BehavioralR iskFactorS urveillanceS ystem (BR FSS ). T he500 CitiesProject– L ocalDataforBetterHealth– N ewark,N ew Jersey. T he500 CitiesProject— L ocalDataforBetterHealth— isacollaborationamongtheR obertW oodJohnsonFoundation,theCDC Foundation,andtheCentersforDiseaseControlandP revention(CDC),whosepurposeistoprovidehigh qualitysmallareaestimatesforbehavioralriskfactorsthatinfluencehealthstatus,forhealthoutcomes, andtheuseofclinicalpreventiveservices.T heseestimatescanbeusedtoidentifyemerginghealth problemsandtodevelopandimplementofeffective,targetedpublichealthpreventionactivities. N ationalInstitutesofHealth.N ationalHeart,Blood,andL ungInstitute. HealthyP eople2020. HealthyP eopleprovidesscience-based,10-yearnationalobjectivesforimproving thehealthofallAm ericans.For3 decades,HealthyP eoplehasestablishedbenchmarksandm onitored progressovertimeinorderto:Encouragecollaborationsacrosscomm unitiesandsectors,Empower individualstowardm akinginformedhealthdecisions,andM easuretheimpactofpreventionactivities. HealthyN ew Jersey2020. HealthyN ew Jersey2020 istheS tate’sHealthImprovementP lanandits healthpromotionanddiseasepreventionagendaforthedecade.ItismodeledafterthefederalHealthy P eople2020 initiativeandistheresultofamultiyearprocessthatreflectsinputfrom adiversegroupof individualsandorganizations. City of Newark, New Jersey Community Health Assessment - 2017 I. Overview of Newark Population Page 2

I. Overview of Newark Population

A. Demographic Characteristics

Population

T hepopulationofN ewarkisestimatedat281,944 asofJuly1,2015,upfrom 277,140 asofthe2010 Census.N ewarkaccountsfor35% ofEssexCounty’spopulationand3.1% ofN ew Jersey’spopulation. From 2010 to2015,thepopulationofN ewarkincreasedatthesamerateasEssexCounty(1.7%)and N ew Jersey(1.9% ),buthalfofthenationwideincrease(4.1% ).

T able1: P opulationinN ewark,Essex,N J,U S – 2010 and2015 April1,2010 July1,2015 Change2010-2015 N ewark 277,140 281,944 4,804 1.7% EssexCounty 783,969 797,434 13,465 1.7% N ew Jersey 8,791,894 8,958,013 166,119 1.9% U nitedS tates 308,745,538 321,418,820 12,673,282 4.1% S ource: U .S.CensusBureau

Gender (Sex)

Approximately49% oftheN ewarkpopulationismaleand51% female-thesameasN ew Jerseyandthe U S . (Census,2015).

Age

T hepopulationinN ewarkisyoungerthanthatofthestateornation.In2015them edianageofN ewark residentswas34.6years,comparedtotheN ew Jerseym edianageof39.6yearsandtheU nitedS tates m edianof37.8years(Census,2015).

T able2: P opulationbyAgeCategoryinN ewark,Essex,N J,U S – 2015 AgeCategory N ewark EssexCo. N ew Jersey US U nderAge18 24.3% 24.0% 22.3% 22.9% Age18-62 62.0% 60.3% 59.3% % 58.8% Age62 + 13.7% 15.7% 18.4% 18.3% T otal 100% 100% 100% 100% Age65+ 10.7% 12.6% 15.0% 14.9% M edianAge(years) 34.6 37.0 39.6 37.8 S ou rce: U. S . C ensu s B u reau , 2015A mericanC ommu nityS u rvey1 YearEstimates.

T hepopulationofN ewarkisaging,however.Althoughthem edianagew as30.1yearsoldin2005,it roseto31.8in2010 and34.6in2015– nearlyfiveyearsolderw ithinadecade.In200530.4% of residentswereunderage18,whichdeclinedby6percentagepointsto24.3% in2015.L ikewise,the City of Newark, New Jersey Community Health Assessment - 2017 I. Overview of Newark Population Page 3 populationage62 andolderincreasedfrom 11.0% in2005to13.7% in2015.T hereisaneedformore servicestoseniors.

Figure1: ChangeinAgeofN ewarkR esidents–2005,2010,2015

70%

63.0%62.0% 2005 2010 2015 60% 58.6%

50%

40%

30.4% 30% 26.3% 24.3%

20% 13.7% 11.0%10.7% 10.7% 10% 8.5% 8.4%

0% Under Age 18 Age18-62 Age 62 and Older Age 65 and Older

Race/Ethnicity

T hepopulationofN ewarkhasahighproportion(89%)ofracial/ethnicm inorities.N earlyhalfof residentsareBlack/AfricanAm erican(notHispanic)andoveronethirdareHispanic/Latino(anyrace). O verthepast10 years,thepercentofN ewark’spopulationw hichisAfricanAm ericanhasdeclined slightlyandthepercentoftheHispanic/Latinopopulationhasincreased.T hesetrendshavetobe consideredw henplanninganddeliveringservicestoresidentsofN ewark. City of Newark, New Jersey Community Health Assessment - 2017 I. Overview of Newark Population Page 4

Figure2: P opulationbyR ace/Ethnicityin2015– N ewark,EssexCounty,N J,U S

70%

61.5% 60% 56.0%

50% 48.6%

40% 38.5% 35.6% 31.4% 30%

22.4% 19.7% 20% 17.6%

12.7% 12.3% 10.8% 11.6% 10% 7.7% 8.6% 5.0%

0% Newark Essex New Jersey

Black/African American (Not Hispanic) White (Not Hispanic) Other (Not Hispanic) Hispanic/Latino (any race)

Figure3: ChangeinN ewarkP opulationbyR ace/Ethnicity– 2005,2010,2015

60%

50.6% 50.8% 48.6% Black/African American 50% (Not Hispanic)

40% 35.6% 32.9% 33.4% Hispanic/Latino (any race)

30%

20% White (Not Hispanic)

12.5% 11.8% 10.8%

10%

Other (Not Hispanic) 5.0% 0% 4.1% 4.0% 2005 2010 2015 City of Newark, New Jersey Community Health Assessment - 2017 I. Overview of Newark Population Page 5

Language

O verhalfofN ewarkresidentsage5andolderspeakonlyEnglishinthehome.N earlyonethirdspeak S panishathome,another14.3% speakotherlanguagesandlessthan1% speakAsian/P acificIslander languagesorotherlanguages.Incontrast,nearly70% ofN ew JerseyresidentsspeakonlyEnglishat home.T hismeansthatservicestoN ewarkresidentsmustconsidertheselanguagedifferences.

Justasimportant,lessthanonequarter(21.2%)ofN ewarkresidentssaidtheydidnotspeakEnglishvery w ellincludingthosew hospokeonlyEnglishathome.T hisrateisnearlytwiceashighasN ew Jersey (12.1% )andtheU S (8.6%).S ervicestoN ewarkresidentsmustalsoaddressliteracyinand understandingoftheEnglishlanguage.

Figure4: L anguageS pokenAtHome(Age5+)in2015 Newark

3.5% English only 0.7% Spanish 10.7% Other Indo-European languages Asian and languages Other languages

54.2%

30.9%

6-0-p`1/.w Jersey United States 1.0% 1.5% 3.5% 4.7% 3.7% 8.6%

13.3%

15.9%

69.2%

78.5%

S ou rce: C ensu s B u reau . 2015A mericanC ommu nityS u rvey. City of Newark, New Jersey Community Health Assessment - 2017 I. Overview of Newark Population Page 6

Foreign Born/Citizenship

N early70% ofN ewark’spopulationisnativebornintheU nitedS tatesand31% (86,250)isforeignborn. N early22% ofN ew Jersey’spopulationisforeignborn,higherthan11% acrosstheU S .

O fthenativebornN ewarkers,5% w ereborninP uertoR icoandtheU .S.islands,twiceashighas2.3% statewideand1.5% nationwide.

O fthe31% ofN ewark’sforeignbornpopulation,13% (35,700)arenaturalizedU .S.citizensand18% (50,500)arenotU .S.citizens.

Figure5: N ativeandForeignBornP opulation-2015

10 0 % 11.1% 90 % 22.1% 30.6% 8 0 %

7 0 % n o

i 60 % t a l u p

o 50 % P

l a t

o 78.6% T 40 %

% 77.9% 69.4% 30 %

20 %

10 %

0 % Newark New Jersey United States Native Born City of Newark, New Jersey Community Health Assessment - 2017 I. Overview of Newark Population Page 7

B. Newark by ZIP Code

T herearenineZIP codeareasinN ewark.T hecharacteristicsoftheresidentsofeachZIP areaare different.T hetablebelow containsdemographicsandeconomicdataforeachZIP codeandillustrates thevariations.Healthservicesmustaddressthesedifferencestohelpimprovehealthoutcomes cityw ide.

ZIP Code07105isinthe“ Ironbound” sectionofN ewark.ZIP Code07114 containsN ewarkL iberty InternationalAirportandfew residents.

Figure6: M apofN ewarkbyZIP Code

T hedatainthetablebelow areanaverageofa5yearperiod2011-2015.Fiveyearperiodsaretheonly timeframesforw hichdatabyZIP codeisavailablefrom theCensusBureau,Am ericanComm unity S urvey. Foreaseofcomparison,thetableincludesdatafortheCityofN ewarkforthesame5-year period,2011-2015.T heN ewark5-yeardataisobviouslydifferentforthe1 yeardatafor2015. City of Newark, New Jersey Community Health Assessment - 2017 I. Overview of Newark Population Page 8

T able3: DemographicandS ocioeconomicFactorsofN ewarkR esidentsbyZIP Code(2011-2015)

N ewarkZIP Code Factor 07102 07103 07104 07105 07106 07107 07108 07112 07114 N ewark P opulation 13,222 31,363 50,998 53,080 30,824 38,795 21,365 26,006 14,251 279,793 % N ewarkT otal 4.7% 11.2% 18.2% 19.0% 11.0% 13.9% 7.6% 9.3% 5.1% 100% Gender M ale 54.1% 46.8% 47.8% 56.0% 46.6% 48.7% 43.7% 45.6% 63.2% 49.8% Female 45.9% 53.2% 52.2% 44.0% 53.4% 51.3% 56.3% 54.4% 36.8% 50.2% Age U nderAge18 16.5% 27.5% 25.6% 21.9% 25.4% 30.8% 29.6% 26.1% 18.4% 25.4% Age18andO lder 83.5% 72.5% 74.4% 78.1% 74.6% 69.2% 70.4% 73.9% 81.6% 74.6% Age65andO lder 10.1% 8.8% 9.1% 7.4% 10.6% 7.7% 9.9% 10.8% 5.5% 8.8% M edianAge(Years) 30.3 29.1 32.5 34.2 33.0 31.2 30.8 34.3 34.6 32.6 Race/Ethnicity W hite,N otHispanic 15.1% 3.8% 5.6% 34.1% 2.8% 6.6% 1.8% 1.2% 11.5% 10.7% Black/AfricanAm erican 48.2% 77.2% 23.8% 8.4% 79.5% 34.7% 85.6% 92.2% 55.4% 48.3% Hispanic/Latino(AllR aces) 23.5% 15.2% 66.4% 48.9% 10.0% 54.2% 11.6% 4.5% 30.2% 35.6% O ther 13.2% 3.8% 4.2% 8.6% 7.7% 4.5% 1.0% 2.1% 2.9% 5.4% Language Spoken At Home (Age 5+) EnglishO nly 64.6% 78.6% 34.3% 18.1% 72.0% 45.5% 83.0% 87.8% 62.3% 53.5% S panish 22.2% 12.8% 59.1% 45.5% 9.2% 47.7% 9.1% 4.0% 28.7% 32.0% O therIndo-European 7.8% 3.7% 3.7% 36.0% 12.6% 4.0% 2.7% 2.6% 7.6% 11.1% Asian/P acificL anguages 2.1% 0.6% 1.3% 0.2% 1.1% 1.0% 0.0% 0.3% 0.4% 0.7% O therL anguages 3.3% 4.4% 1.6% 0.2% 5.0% 1.8% 5.1% 5.3% 1.0% 2.7% Native/Foreign Born N ative 76.9% 83.8% 73.7% 42.5% 71.2% 70.5% 88.0% 87.3% 79.2% 71.0% ForeignBorn 23.1% 16.2% 26.3% 57.5% 28.8% 29.5% 12.0% 12.7% 20.8% 29.0% Income M edianHouseholdIncome $25,238 $27,617 $32,160 $43,645 $34,659 $31,128 $25,757 $36,052 $21,102 $33,139 Income Below Poverty (%) Individuals 43.0% 36.9% 29.2% 21.5% 26.8% 29.4% 40.4% 23.7% 40.0% 29.7% Children< Age18 49.3% 48.0% 43.0% 33.9% 41.3% 37.3% 59.6% 35.3% 53.3% 42.3% City of Newark, New Jersey Community Health Assessment - 2017 I. Overview of Newark Population Page 9

N ewarkZIP Code Factor 07102 07103 07104 07105 07106 07107 07108 07112 07114 N ewark Employment U nemploymentR ate 17.4% 23.4% 16.6% 10.5% 20.6% 20.4% 27.4% 22.8% 19.4% 18.4% Educational Attainment (Age 25+) L essthan9thGrade 11.4% 8.8% 16.0% 26.6% 8.4% 15.2% 6.3% 3.5% 9.8% 14.1% N oHighS choolDiploma 28.3% 21.9% 30.0% 39.0% 18.6% 30.2% 22.0% 14.1% 31.2% 27.7% HighS choolGraduate/Higher 71.7% 78.1% 70.0% 61.0% 81.4% 69.8% 78.0% 85.9% 68.8% 72.3% Bachelor'sDegreeorHigher 22.1% 14.2% 15.3% 13.0% 13.5% 11.2% 10.3% 15.0% 5.1% 13.3% Health Insurance N oHealthInsuranceCoverage 19.6% 18.9% 25.1% 39.7% 22.3% 21.5% 17.2% 17.6% 27.7% 24.8% S ource: CensusBureau. 2011-2015Am ericanComm unityS urvey5-YearEstimates City of Newark, New Jersey Community Health Assessment - 2017 II. Factors Affecting Health Status Page 10

II. Factors Affecting Health Status

A. Social Determinants of Health

R esearchisshowingthatw hileincreasingaccesstohealthcareandtransformingthehealthcare deliverysystem areimportant,improvingpopulationhealthm ayalsorequirebroaderapproachesthat addresssocial,economic,andenvironmentalfactorsthatinfluencehealth.T hesefactorsare categorizedasthesocialdeterminantsofhealth. Althoughthereisnoconsensusonw hichfactors comprisethese“ socialdeterminants”,thissectionsetsforthaframeworkpublishedbytheKaiserFamily Foundation1 thatcanbeusedasatemplateorbenchmark.T hissectionoffersdataforN ewarkonsome ofthesedeterminants.T heCityofN ewarkandthem anypartnersinthefieldsofhealth/socialservices/ comm unityserviceshaveincorporatedthesedeterminantsintoserviceplanninganddelivery. And therearem oreopportunitiestobeidentifiedintheN ewarkComm unityHealthImprovementP lan.

Figure7: S ocialDeterminantsofHealthfrom KaiserFamilyFoundation,N ovember2015

1 KaiserFamilyFoundation.N ovember2015.IssueBrief.BeyondHealthCare: T heR oleofS ocialDeterminantsinP romotingHealth andHealthEquity. HarryJ.HeimanandS amanthaArtiga.http://files.kff.org/attachment/issue-brief-beyond-health-care City of Newark, New Jersey Community Health Assessment - 2017 II. Factors Affecting Health Status Page 11

B. Economic Stability

Income

T hem edianhouseholdincomeinN ewarkin2015w as$30,996,downslightlyfrom $32,043 in2010. However,thisincomelevelwasonly60% ofEssexCountyincome,43% ofthestatewidem edianand 56% ofthenationalmedianhouseholdincome.T hesedifferencesindicatetheneedforadditional, coordinatedservices.

T able4: IncomeinN ewark,Essex,N J,U S – 2010 and2015

Incomein2010 Incomein2015 M edian M edian M edian M edian Household Family P erCapita Household Family P erCapita

N ewark $32,043 $36,277 $15,933 $30,966 $36,567 $17,402 EssexCounty $52,394 $66,439 $29,674 $52,041 $68,965 $33,514 N ew Jersey $67,681 $82,427 $33,555 $72,222 $90,245 $37,245 U nitedS tates $50,046 $60,609 $26,059 $55,775 $68,260 $29,979 N ewarkasa% of: EssexCounty 61% 55% 54% 60% 53% 52% N ew Jersey 47% 44% 47% 43% 41% 47% U nitedS tates 64% 60% 61% 56% 54% 58% S ource: U .S.CensusBureau.2010 Am ericanComm unityS urvey1-YearEstimates.2015Am ericanComm unityS urvey1-Year Estimates.

R eceiptoffoodstamp/SN AP benefitsisoneindicatorofincomestatusandrelianceongovernment benefits.In2010 onequarterofN ewarkhouseholdreceivedFoodS tamp/SN AP benefits,nearlydouble thatofEssexCountyandtheU S andoverthreetimesthatofN ew Jersey. Followingfederalexpansion oftheS N AP programafter2010,thenum berofpeoplereceivingS N AP increasedinallgeographicareas. Asof2015,approximately27,000 N ewarkhouseholdsreceivedfoodstampbenefits,anincreaseof nearly20% over2010.

T able5: HouseholdswithFoodS tamp/S N AP BenefitsintheP ast12 M onthsinN ewark,Essex, N J,U S – 2010 and2015

2010 2015 Change2010-2015 P ercent N um ber P ercent N um ber N um ber P ercent N ewark 24.8% 22,657 27.4% 26,993 4,336 19% EssexCounty 13.7% 37,605 15.3% 42,949 5,344 14% N ew Jersey 6.8% 214,973 9.4% 301,208 86,235 40% U nitedS tates 11.9% 12.8% 11% N ewarkasa% of: EssexCounty 60% 63% N ew Jersey 11% 9% S ource: U .S.CensusBureau.2010 Am ericanComm unityS urvey1-YearEstimates.2015Am ericanComm unityS urvey1-YearEstimates. City of Newark, New Jersey Community Health Assessment - 2017 II. Factors Affecting Health Status Page 12

Consistentw ithdataonincomeandfoodstamp/SN AP benefits,ratesofpovertyarehigherinN ewark. W elloveronequarterofN ewarkresidents– andtwoinfiveofN ewark’schildren-werelivingbelow povertyin2015.T heseratesdeclinedslightlysince2010.

T able6: P ercentofR esidentsLivingBelow P overtyinN ewark,Essex,N J,U S – 2010 and2015

2010 2015 Children Children T otal < Age18 T otal < Age18

N ewark 30.2% 44.3% 29.0% 39.5% EssexCounty 16.7% 23.5% 17.1% 23.9% N ew Jersey 10.3% 14.5% 10.8% 15.6% U nitedS tates 15.3% 216.6% 14.7% 20.7% S ource: U .S.CensusBureau.2010 Am ericanComm unityS urvey1-YearEstimates.2015Am ericanComm unityS urvey1-Year Estimates.

Employment

Employmentandunemploymentratesarerelatedtothesocioeconomicfactorsofincomeand educationabove.In2015,thecivilianlaborforceinN ewarkrangedfrom 116,697to134,542. A range of8,321 to20,447N ewarkresidentsinthelaborforcew ereunemployedin2015.

T hetwosourcesofrecentemploymentdatashow thatratesofunemploymentinN ewarkw erehigher thanN ew JerseyandtheU nitedS tates.

T hisfactorisimportantforhealthplanningbecauseemploymentisthechiefsourceofhealthinsurance. Higherratesofunemployment(lowerratesofemployment)m eanrelativelylessemployer-provided healthinsurance.Individualsandfamiliesmustrelyonothersources,includinggovernmentinsurance programs,orgow ithouthealthinsurance.T hisdirectlyaffectsaccesstohealthcareandhealth.T he AffordableCareActof2010 andM edicaidExpansioninN ew Jerseyhelpedoffsetthelackofemployer- providedhealthinsuranceasdiscussedelsewhereinthisdocum ent.

T able7: L aborForceandU nemploymentin2015 U S DO L – BL S Census– 2015ACS CivilianL abor U nemployment CivilianL abor U nemployment Force N um ber R ate Force N um ber R ate

N ewark 116,697 8,321 7.1% 134,542 20,447 15.2% N ew Jersey 4,530,500 262,600 5.8% 4,684,036 309,500 6.6% U nitedS tates 157,130,000 8,296,000 5.3% 160,652,483 10,117,710 6.3% S ource: U .S.Dept.L abor.BureauofLaborS tatistics CensusBureau.2015Am ericanComm unityS urvey City of Newark, New Jersey Community Health Assessment - 2017 II. Factors Affecting Health Status Page 13

Figure8: U nemploymentR atesin2015

16% 15.2%

14%

12%

10 %

8 % 7.1% 6.6% 6.3% 5.8% 6% 5.3%

4%

2%

0 % 2015* 2015** Newark New Jersey United States

2015*= U .S.Dept.L abor,BureauofLaborS tatistics 2015**= CensusBureau. 2015Am ericanComm unityS urvey

C. Education

T hreequartersofN ewarkresidentsage25andolderarehighschoolgraduatesorhigher,and16.0% haveabachelor’sdegreeorhigher.T hepercentw ithhighereducationishalfoftheN JandU S rates.

Figure9: Education– Age25andO lder(2015)

100%

90% 89.1% 87.1%

80% 74.4%

70% + 5 2

60% e g A 50% s t l u

d 37.6%

A 40%

% 30.6% 30% 16.0% 20%

10%

0% Newark New Jersey United States

High School Graduate or Higher Bachelor's Degree or Higher City of Newark, New Jersey Community Health Assessment - 2017 II. Factors Affecting Health Status Page 14

D. Health Care System

AsshowninVII.Comm unityP artnersandR esources,thereisanadequatesupplyofhealthresources w ithinthe26squarem ilesoftheCityofN ewark.

Lack of Health Insurance

T helackofhealthinsuranceormethodtopayforhealthcareisthechiefbarrieraffectingaccessto healthcareandrelatedservices.T hisbarrierw asunderscoredinpreviouscomm unityhealth assessmentsbyresidentsinN ewark’sfivew ardsandnum erousfocusgroupsamongspecific populations.R esidentsreliedonM edicaidorcharitycare,whichm aynotcoverallneededhealth servicesorw hichprovideonlypartialpaymentforservicesrendered.Asaresult,theypostponed neededhealthcareorignoredtheproblem,untilthem edicalconditionrequiredacutecareand admissionviatheemergencydepartment.

L ackofHealthInsuranceAm ongAdultsAge18-64 in2014 In2014,nearly30% ofN ewarkadultsage18-64 reportedlackofhealthinsurance– twiceashighasN Jand U S . In2014 N ew JerseyimplementedM edicaidExpansiontoinsurelow incomeadults,anoptionavailable intheAffordableCareAct(ACA).T heuninsuredpercentageinN ewarkm aydeclinein2015.

Figure10:L ackofHealthInsuranceAm ongAdultsAged18-64 (AgeAdjusted),2014

30% 28.9% 25%

20%

15% 15.7% 14.9%

10%

5%

0% Newark NJ US S ource: CDC.500 CitiesProject

ImpactoftheAffordableCareAct(ACA) EnactmentoftheAffordableCareAct(ACA)in2010 hadapositiveimpactonN ew JerseyandN ewark, especiallyM edicaidExpansionw hichcoveredlow incomeadultsage18-64 previouslyuninsured. Implementationbeganin2014 andtheimpactonN ewarkresidentswasapparent.T hetablebelow showstheimpactin2010 beforeACA andin2015afterfullACA implementation. T herateofuninsured N ewarkresidentsdroppedby10 percentagepointsfrom 28.1% in2010 to18.1% in2015. City of Newark, New Jersey Community Health Assessment - 2017 II. Factors Affecting Health Status Page 15

T able8: HealthInsuranceS tatusBeforeandAfterAffordableCareAct– 2010 and2015 N ewark EssexCounty NJ US P ercentInsured 2010 (pre-ACA) 71.9% 81.8% 86.8% 84.5% 2015(post-ACA) 81.9% 87.0% 91.3% 90.6% P ercentU ninsured 2010 (pre-ACA) 28.1% 18.2% 13.2% 15.5% 2015(post-ACA) 18.1% 13.0% 8.7% 9.4% S ource: U .S.CensusBureau. 2010 Am ericanComm unityS urvey1-YearEstimates.2015Am ericanComm unity S urvey1-YearEstimates

Despitetheimprovementinhealthinsurancecoverageandaccesstohealthcare,thenum berofN ewark residentstelladifferentstory. Approximately50,000 N ewarkresidents(18%)remainuninsuredasof2015.

Figure11: ImpactofACA onN ewarkR esidents2010 -2015 2010 2015 Improvement T otalInsured 191,000 (72%) 224,000 (82%) +33,000 (10%) P rivateInsurance* 37% 42% +5% P ublicInsurance* 39% 47% +8% T otalU ninsured 75,000 (28%) 50,000 (18%) -25,000 (-10%)

Butstill50,000 N ewarkresidentsareuninsured!

* S omepeoplehavebothprivateandpublicinsurance,e.g.,publicM edicareplusprivateP artB S upplementalinsurance. S ource: U .S.CensusBureau. 2010 Am ericanComm unityS urvey1-YearEstimates.2015Am ericanComm unityS urvey1-YearEstimates

Primary Care Resources in Newark

N ationwidetrendsregardingprojectedshortagesofprimaryhealthcareprovidersarestartingohavean impactonN ew JerseyandN ewark.A num berofprovidersdonotacceptM edicaidw hichrestricts accessforthosenewly-insuredunderACA M edicaidExpansion(N JFamilyCare).However,recent federalfundingfrom HR S A BP HC hasexpandedtheavailabilityofprimarycareprovidersN ewark residentsespeciallyw hosew ithlow incomesunder200% FederalPovertyL evel(FP L ).In2015,this fundingcreatedtwonew S ection330 HealthCenters– alsoknownasFederallyQ ualifiedHealthCenters (FQ HCs)– inN ewark.T heseareS aintJamesHealth,Inc.locatedintheIronboundsectionofN ewark neartheS aintJamescampus,andR utgersU niversityS choolofN ursingFQ HC servingpublichousing programsbym obilem edicalvan.

A totaloffiveFQ HCsarenow inN ewark.T heseagenciesprovidecomprehensive,highqualityprimary andpreventivehealthcareservicesandarefundedtoservebothinsuredpatientsandespeciallythose w ithouthealthinsurance. City of Newark, New Jersey Community Health Assessment - 2017 III. Health Behavior and Risk Factors Page 16

III. Health Behavior and Risk Factors

A. 500 Cities Project

Unhealthy Behaviors – Age 18 and Older

BingeDrinking S elf-reportedbingedrinking,definedas5drinksina2-hourperiodformenand4 drinksina2-hour periodforw omen2,islessinN ewarkamongadultsage18+thaninN ew JerseyandtheU S .

Figure12: BingeDrinkingP revalenceAm ongAdultsAged18+(AgeAdjusted),2014

18%

16% 16.9% 16.8% 14%

12% 13.3%

10%

8%

6%

4%

2%

0% Newark NJ US

CurrentS m oking Currentsmokingprevalenceisover50% higherforN ewarkadultsthanforN ew JerseyandtheU S . T his isanareaneedingtobaccocessationcounseling.

Figure13: CurrentS m okingP revalenceAm ongAdultsAged18+(AgeAdjusted),2014

30%

25% 24.3% 20%

17.7% 15% 15.5%

10%

5%

0% Newark NJ US

2 CDC. FactS heets– BingeDrinking.https://ww w .cdc.gov/alcohol/fact-sheets/binge-drinking.htm City of Newark, New Jersey Community Health Assessment - 2017 III. Health Behavior and Risk Factors Page 17

N oL eisureT imeP hysicalActivity N earlytwoinfiveofN ewarkadultsdonotengageinleisuretimephysicalactivity,comparedtoalmost oneinfiveadultsinN JandtheU S . Exerciseisonecomponentofgoodhealthcontributingtoreduction inm orbidityandm ortalityduetoobesity,hypertensionandheartdisease,stroke,diabetes. DevelopmentofopportunitiesforleisureactivitythroughoutN ewarkisagoodpriority.

Figure14:N oL eisureT imeP hysicalActivityAm ongAdultsAged18+(AgeAdjusted),2014

40%

35% 36.1%

30%

25% 23.3% 20% 22.9%

15%

10%

5%

0% Newark NJ US O besity O besityisdefinedasaBodyM assIndex(BM I)of30 orgreaterforadultsage18-64 (and35orgreater foradultsage65andolder?).N earlytwoinfiveN ewarkadultsareobese,comparedtoslightlym ore thanonequarterofN ew Jerseyansandallresidentsnationwide.Addressingobesityandrelatedhealth problems– hypertension,cardiovasculardisease,diabetes,stroke– continuestobethefocusofhealth educationeffortsthroughoutN ewark.

Figure15:O besityAm ongAdultsAged18+(AgeAdjusted),2014

40%

35% 37.7%

30% 28.7% 25% 26.6%

20%

15%

10%

5%

0% Newark NJ US City of Newark, New Jersey Community Health Assessment - 2017 III. Health Behavior and Risk Factors Page 18

L essthan7HoursofS leep S leepplaysavitalroleingoodhealthandw ell-beingthroughoutyourlife.Gettingenoughqualitysleep attherighttimescanhelpprotectyourmentalhealth,physicalhealth,qualityoflife,andsafety.3 A m inimum of7hoursofsleeppernightisgenerallyconsideredessentialforgoodhealth.L ackof adequatesleepisamajorproblem acrosstheU S . N earlyhalfofN ewarkadultsdonotgetadequate sleep,comparedtotwoinfiveN JadultsandonethirdofadultsacrosstheU S .

Figure16:S leepingL essthan7HoursAm ongAdultsAged18+(AgeAdjusted),2014

50%

45% 48.1%

40%

35% 37.2% 35.1% 30%

25%

20%

15%

10%

5%

0% Newark NJ US

3 N ationalInstitutesofHealth.N ationalHeart,LungandBloodInstitute.https://ww w .nhlbi.nih.gov/health/health- topics/topics/sdd/why City of Newark, New Jersey Community Health Assessment - 2017 III. Health Behavior and Risk Factors Page 19

Use of Preventive Services – Age 18 and Older

CurrentL ackofHealthInsuranceAm ongAdultsAge18-64 N early30% ofN ewarkadultsage18-64 reportedlackofhealthinsurancein2014 – twiceashighasN Jand U S . In2014 N ew JerseyimplementedM edicaidExpansiontoinsurelow incomeadults,anoptionavailable intheAffordableCareAct(ACA).T heuninsuredpercentageinN ewarkm aydeclinein2015.

Figure17:CurrentL ackofHealthInsuranceAm ongAdultsAged18-64 (AgeAdjusted),2014

30% 28.9% 25%

20%

15% 15.7% 14.9%

10%

5%

0% Newark NJ US VisitsToDoctorForR outineCheckupW ithinT heP astYear T hreequartersofN ewarkadultsreportedseeingadoctorforroutinecheckup,thesameasN Jresidents andslightlyhigherthantheU S .

Figure18:VisitstoDoctorforR outineCheckupw ithintheP astYearAm ongAdultsAged18+(Age Adjusted),2014

80%

70% 74.8% 74.5% 68.7% 60%

50%

40%

30%

20%

10%

0% Newark NJ US City of Newark, New Jersey Community Health Assessment - 2017 III. Health Behavior and Risk Factors Page 20

VisitsToDentistO rDentalClinic O nlyhalfofN ewarkadultsreportedvisitingadentistordentalcliniccomparedtotwo-thirdsofadultsin N JandtheU S . T hisconfirmstheneedfororalhealtheducationandservicesinN ewark.

Figure19:VisitstoaDentistorDentalClinicAm ongAdultsAged18+(AgeAdjusted),2014

80%

70% 69.9% 60% 64.1%

50% 49.8% 40%

30%

20%

10%

0% Newark NJ US

T akingM edicineforHighBloodP ressureControl Almosttwo-thirdsofN ewarkadultswithhighbloodpressure(HBP )aretakingm edicationstocontrol HBP ,slightlyhigherthantheratesforN JandU S .

Figure20:T akingM edicineforHighBloodP ressureAm ongAdultsAged18+w ithHighBloodP ressure (AgeAdjusted),2014

70%

60% 63.1% 57.4% 58.2% 50%

40%

30%

20%

10%

0% Newark NJ US City of Newark, New Jersey Community Health Assessment - 2017 III. Health Behavior and Risk Factors Page 21

CholesterolScreening N early¾ofN ewarkadultsreporthavingcholesterolscreening,thesameastheU S andslightlylessthan N J.T hereisaneedformorecholesterolscreeninginN ewarkw hichcanbedonebythem anyhealth agenciesengagedinpreventivescreenings.

Figure21:CholesterolScreeningAm ongAdultsAged18+(AgeAdjusted),2014

90%

80% 79.0% 70% 73.9% 74.0% 60%

50%

40%

30%

20%

10%

0% Newark NJ US

M amm ographyU seAm ongW omenAged50-74Years T hreequartersofN ewarkw omenage50-74 reportedhavingamamm ogram,comparabletoN JandtheU S .

Figure22:M amm ographyU seAm ongW omenAged50-74 Years(AgeAdjusted),2014

80% 78.2% 70% 74.7% 75.5%

60%

50%

40%

30%

20%

10%

0% Newark NJ US City of Newark, New Jersey Community Health Assessment - 2017 III. Health Behavior and Risk Factors Page 22

P apanicolaou S m earU seAm ongAdultW omenAged21-65Years N early¾ofN ewarkw omenaged21-65havehadaP apsmearforcervicalcancer,slightlylessthanthe 84% forN Jand81% forU S w omen.T heseratesaregoodforN ewarkbutthereisalwaysaneedfor educationtoN ewarkw omenoncervicalcancerscreening.

Figure23:P apS m earU seAm ongAdultW omenAged21-65Years(AgeAdjusted),2014

90%

80% 83.6% 81.1% 70% 74.5%

60%

50%

40%

30%

20%

10%

0% Newark NJ US

FecalO ccultBloodT est,Sigmoidoscopy,orColonoscopyAm ongAdultsAged50-75Years S lightlym orethanhalfofN ewarkadultsage50-75yearsoldw erescreenedforcoloncancer,compared tonearlytwo-thirdsofN JandU S adultsage50-75.expandingcoloncancerscreeningisanopportunity forN ewarktoimprovehealthofitsolderadults.

Figure24:FecalO ccultBloodT est,Sigmoidoscopy,orColonoscopyAm ongAdultsAged50-75Years (AgeAdjusted),2014

70%

60% 62.6% 64.0%

50% 53.0%

40%

30%

20%

10%

0% Newark NJ US City of Newark, New Jersey Community Health Assessment - 2017 III. Health Behavior and Risk Factors Page 23

U p-To-DateonCoreS etofClinicalPreventiveS ervices(FluS hotP astYear,Pneum ococcalShot Ever, Colorectal Cancer S creening) Am ong M en Aged ≥65 Years O nlyonequarterofN ewarkm enage65andolderreportedreceivingallofthesepreventiveservices comparedtoalmostone-thirdforN JandU S m enage65andolder.T hisisanopportunityforN ewarkto improvethehealthofitsseniormales.

Figure25:U p-To-DateonaCoreS etofP reventiveS ervices(FluS hotP astYear,PneumoniaShotEver, Colorectal Cancer S creening) Am ong M en Aged ≥ 65 Years (Age Adjusted), 2014

35%

32.9% 30% 31.6%

25% 24.0% 20%

15%

10%

5%

0% Newark NJ US

U p-To-DateonCoreS etofClinicalPreventiveS ervices(SameasM enP lusM amm ogramin P ast 2 Years) Am ong W om en Aged ≥65 Years L essthan20% ofN ewarkw omenage65andolderhadtherecomm endedscreeningservicesofflushot, pneum oniashot,colorectalcancerscreeningandm amm ogram. O nly¼ofN Jw omenreceivedthese screenings,comparedto30% ofU S w omen.T hisisanareaofsignificanthealthimprovementfor N ewarksenioradultw omen. City of Newark, New Jersey Community Health Assessment - 2017 III. Health Behavior and Risk Factors Page 24

Figure26:U p-To-DateonaCoreS etofP reventiveS ervices(SameasM enplusM amm ograminP ast2 Years) Am ong W om en Aged ≥ 65 Years (Age Adjusted), 2014

35%

30% 30.7%

25% 26.5%

20%

15% 17.5%

10%

5%

0% Newark NJ US City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 25

IV. Health Status

A. Health Conditions

Health Outcomes – Age 18 and Older

Arthritis Arthritisincludesmorethan100 rheum aticdiseasesandconditionsthataffectjoints,thetissuesthat surroundthejointandotherconnectivetissue.ArthritisisaleadingcauseofdisabilityintheU nited S tatesandoneofthem ostcomm onchronicconditionsinthenation.Arthritisisacomm oncauseof chronicpain.4 ArthritisisprevalentinoneinfourN ewarkadults,whichiscomparabletotheU S andN J.

Figure27:ArthritisAm ongAdultsAged18+(AgeAdjusted),2014

30%

25% 24.9% 23.0% 20% 20.6%

15%

10%

5%

0% Newark NJ US

CurrentAsthmaP revalence Asthmaisadiseasethataffectsthelungs.Itcausesrepeatedepisodesofwheezing,breathlessness,chest tightness,andnighttimeorearlym orningcoughing.Itisoneofthem ostcomm onlong-termdiseasesof children,butadultscanhaveasthma,too.Asthmacanbecontrolledbytakingm edicine,avoidingthe triggersthatcancauseanattack,andremovingtriggersinyourenvironmentthatcanm akeasthmaworse.5

Anestimated11% ofN ewarkadultscurrentlyhaveasthma,25% higherthantherestofN JandU S .

4 CentersforDiseaseControlandP revention.https://ww w .cdc.gov/arthritis/ 5 CentersforDiseaseControlandP revention.https://ww w .cdc.gov/asthma/default.htm City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 26

Figure28:CurrentAsthmaP revalenceAm ongAdultsAged18+(AgeAdjusted),2014

12%

10% 11.0%

8% 8.8% 8.3%

6%

4%

2%

0% Newark NJ US

HighBloodP ressure Bloodpressureistheforceofbloodpushingagainstthew allsofthearteriesastheheartpum psblood. Highbloodpressureisacomm ondiseaseinw hichbloodflowsthroughbloodvessels(arteries)athigher thannormalpressures.N ormalbloodpressureforadultsisdefinedasasystolicpressurebelow 120 m m Hgandadiastolicpressurebelow 80 m m Hg.Itisnormalforbloodpressurestochangew henyou sleep,wakeup,orareexcitedornervous.W henyou areactive,itisnormalforyourbloodpressureto increase.However,oncetheactivitystops,yourbloodpressurereturnstoyournormalbaselinerange. Bloodpressurenormallyriseswithageandbodysize.6

AbnormalBloodP ressure. Abnormalincreasesinbloodpressurearedefinedashavingbloodpressures higherthan120/80 m m Hg.T hefollowingtableoutlinesanddefineshighbloodpressureseveritylevels.

S tagesofHighBloodP ressureinAdults S ystolic Diastolic S tages (topnumber) (bottom number) P rehypertension 120– 139 OR 80– 89 HighbloodpressureS tage1 140– 159 OR 90– 99 HighbloodpressureS tage2 160 orhigher OR 100 orhigher S ource:N ationalInstitutesofHealth.N ationalHeart,LungandBloodInstitute.

R iskFactors. Anyonecandevelophighbloodpressure;however,age,raceorethnicity(African- Am erican),beingoverweight,gender(menunderage55,womenoverage55),lifestylehabits(lackof physicalactivity,excesssodium oralcohol),andafamilyhistoryofhighbloodpressurecanincreasethe riskfordevelopinghighbloodpressure.

ComplicationsofHighBloodP ressure. W henbloodpressurestayshighovertime,itcandamagethe bodyandcausecomplications.S omecomm oncomplicationsandtheirsignsandsymptomsinclude:

6 N ationalInstitutesofHealth.N ationalHeart,LungandBloodInstitute.https://ww w .nhlbi.nih.gov/health/health- topics/topics/hbp. City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 27

Aneurysms,ChronicKidneyDisease,CognitiveChanges,EyeDamage,HeartAttack,HeartFailure, P eripheralArteryDisease,Stroke.

N early40% ofN ewarkadultshavehighbloodpressurecomparedto30% adultsinN Jandnationwide.

Figure29:HighBloodP ressureAm ongAdultsAged18+(AgeAdjusted),2014

45%

40% 39.0% 35%

30% 30.2% 25% 28.6%

20%

15%

10%

5%

0% Newark NJ US

HighCholesterol Bloodcholesterollevelhasalottodow iththechancesofgettingheartdisease.Highbloodcholesterol isoneofthem ajorriskfactorsforheartdisease.W henthereistoom uchcholesterol(afat-like substance)intheblood,itbuildsupinthew allsofthearteries.O vertime,thisbuildupcauses "hardeningofthearteries"sothatarteriesbecomenarrowedandbloodflow totheheartisslowed downorblocked.T hebloodcarriesoxygentotheheart,andifenoughbloodandoxygencannotreach yourheart,you m aysufferchestpain.Ifthebloodsupplytoaportionoftheheartiscompletelycutoff byablockage,theresultisaheartattack.7

Cholesterolnumbers: T otalcholesterol. L DL (bad)cholesterol--them ainsourceofcholesterolbuildup andblockageinthearteries. HDL (good)cholesterol--helpskeepcholesterolfrom buildingupinthe arteries. T riglycerides--anotherformoffatintheblood. Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.

T otalCholesterolLevel Category L essthan200 m g/dL Desirable 200-239 m g/dL BorderlineHigh 240 m g/dL andabove High

7 N ationalInstitutesofHealth.N ationalHeart,LungandBloodInstitute. https://ww w .nhlbi.nih.gov/health/resources/heart/ heart-cholesterol-hbc-what-html City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 28

L DL CholesterolLevel L DL -CholesterolCategory L essthan100 m g/dL O ptimal 100-129 m g/dL N earoptimal/aboveoptimal 130-159 m g/dL Borderlinehigh 160-189 m g/dL High 190 m g/dL andabove Veryhigh

FactorsAffectingCholesterolLevels. Diet.W eight(overweight).P hysicalActivity(lackof).Ageand Gender(olderw omenandm en).Heredity.

O ver1/3ofN ewarkadultshavehighcholesterol-thesamepercentagesasN JandtheU S .

Figure30:HighCholesterolAm ongAdultsAged18+W hoHaveBeenS creenedintheP ast5Years(Age Adjusted),2014

40%

35% 36.0% 34.8% 30% 33.2%

25%

20%

15%

10%

5%

0% Newark NJ US City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 29

Cancer T hepercentofN ewarkadultswithcancerisslightlylessthanN JandtheU S .

Figure31:CancerAm ongAdultsAged18+(AgeAdjusted),2014

7%

6% 5.9% 5% 5.3% 4.8% 4%

3%

2%

1%

0% Newark NJ US

DiagnosedDiabetes T hepercentofN ewarkadultsdiagnosedw ithdiabetesistwo-thirdshigherthantheU S and80% higher thanN J.

Figure32:DiagnosedDiabetesAm ongAdultsAged18+(AgeAdjusted),2014

18%

16% 15.7% 14%

12%

10% 9.4% 8% 8.7% 6%

4%

2%

0% Newark NJ US City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 30

ChronicKidneyDisease A higherpercentofN ewarkadultshavekidneydiseasethaninN JandtheU S . T hisisconsistentw ith higherratesofdiabetes.

Figure33:ChronicKidneyDiseaseAm ongAdultsAged18+(AgeAdjusted),2014

4%

3% 3.2%

3% 2.6%

2% 2.2%

2%

1%

1%

0% Newark NJ US

ChronicO bstructiveP ulmonaryDisease(CO P D)

Figure34:ChronicO bstructiveP ulmonaryDiseaseAm ongAdultsAged18+(AgeAdjusted),2014

9%

8% 8.4%

7%

6% 6.1% 5% 5.1% 4%

3%

2%

1%

0% Newark NJ US City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 31

CoronaryHeartDisease N early8% ofN ewarkadultsreportedhavingcoronaryheartdisease,whichis25% higherthanN JandU S percentages.

Figure35:CoronaryHeartDiseaseAm ongAdultsAged18+(AgeAdjusted),2014

8%

7% 7.6%

6% 5.8% 6.0% 5%

4%

3%

2%

1%

0% Newark NJ US

S troke T w iceasmanyN ewarkadultsreportedhavingastrokecomparedtoN JandtheU S .

Figure36:S trokeAm ongAdultsAged18+(AgeAdjusted),2014

5%

4.6% 4%

3% 2.8%

2% 2.2%

1%

0% Newark NJ US City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 32

M entalHealthN otGoodfor14+Days N earlyoneinsixN ewarkadultsreportedthattheirmentalhealthw asnotgoodfor14+ daysinthepast m onth,almost50% higherthanN JandtheU S .

Figure37:M entalHealthN otGoodfor>= 14 DaysAm ongAdultsAged18+(AgeAdjusted),2014

18%

16% 15.7% 14%

12% 11.5% 10% 10.6% 8%

6%

4%

2%

0% Newark NJ US P hysicalHealthN otGoodfor14+Days N earlyoneinfiveN ewarkadultssaidthattheirphysicalhealthw asnotgoodfor14+ daysinthepast m onth,over50% m orethanN JandtheU S .

Figure38:P hysicalHealthN otGoodfor>= 14 DaysAm ongAdultsAged18+(AgeAdjusted),2014

18% 17.5% 16%

14%

12% 11.6% 10% 9.8% 8%

6%

4%

2%

0% Newark NJ US City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 33

AllTeethL ost O nequarterofN ewarkadultsreportedthattheyhadlostalloftheirteeth,morethan60% higherthan N JandU S adults.InN ewark,thereisaneedforbotheducationontheimportanceoforalhealthand accessibleoralhealthcareservices.

Figure39:AllTeethL ostAm ongAdultsAged18+(AgeAdjusted),2014

30%

25% 25.0%

20%

15% 15.4% 13.3% 10%

5%

0% Newark NJ US City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 34

B. Maternal, Infant and Child Health

Prenatal Care

Appropriateprenatalcare,thatis,careprovidedbyahealthprofessionaltopregnantw omen,can enhancepregnancyoutcomebyassessingrisk,providinghealthcareadvice,andm anagingchronicand pregnancy-relatedhealthconditions. T hismeasureisthepercentofw omenw ithalivebirthw hose firstprenatalcarevisitw asinthefirsttrimesteroftheirpregnancy.

W omenresidinginN ewarkw hogavebirthin2015continuedtoreceivetimelyprenatalcare(first trimester)atlowerratesthantheircounterpartsintherestofN ew JerseyandacrosstheU .S.– at59.9% versus73.7% and83.9%,respectively. T heratescontinuepatternsinN ewarkshownin2005and2010.

S imilarly,thepercentofN ewarkw omengivingbirthin2015w hohadnoprenatalcare(3.1% )exceeded thestatewiderate(1.4% )andnationalrate(0.9% estimated).

Figure40: N ewarkP renatalCareinFirstT rimesterbyR ace/Ethnicity– 2005,2010,2015

80% HN J2020 79.4% HP 2020 70% 77.9%

60%

50%

40% 2005 2010

30% 2015

20%

10%

0% W hite,N ot Black,N ot Hispanic/Latino O ther,N ot T otal Hispanic Hispanic Hispanic City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 35

T able9: N ewarkW omenR eceivingP renatalCareinFirstT rimesterbyR ace/Ethnicity– 2005,2010, 2015 P renatalCare1st T rimester/ % P renatalCare1st T rimester R ace/Ethnicity L iveBirths 2005 2010 2015 2005 2010 2015 W hite,N otHispanic N um 329 167 183 76.7% 69.6% 71.2% Denom 429 240 257 Black,N otHispanic N um 1,134 1,200 1,080 50.0% 57.3% 55.2% Denom 2,266 2,094 1,958 Hispanic/Latino N um 1,018 1,078 1,149 57.6% 60.3% 63.3% Denom 1,767 1,787 1,815 O ther,N otHispanic N um 57 49 121 63.3% 64.5% 61.7% Denom 90 76 196 T otal N um 2,538 2,494 2,533 55.8% 59.4% 59.9% Denom 4,552 4,197 4,226 N um = N um erator(W omenw /prenatalcarein1st T rimester.Denom = Denominator(Totallivebirths)

N ewarkvs.HealthyP eople2020 andHealthyN ew Jersey2020. HealthyP eople2020 objective(M ICH- 10)istoincreasetheproportionofpregnantw omenw horeceiveearlyandadequateprenatalcare. M ICH-10.1 goalistoIncreasetheproportionofpregnantw omenw horeceiveprenatalcarebeginningin thefirsttrimester. HealthyN ew Jersey2020 adoptsthisobjectivebutincreasesthetargetandprovides targetsbyrace/ethnicity.

Importance: W omenw horeceiveearlyandconsistentprenatalcare(PN C)increasetheirlikelihoodof givingbirthtoahealthychild.Healthcareprovidersrecomm endthatw omenbeginprenatalcareinthe firsttrimesteroftheirpregnancy.

T able10: HealthyP eople2020 andHealthyN J2020 T argetsforP renatalCareandN ewark2015

HealthyP eople2020 HealthyN J2020 N ewark2015 Baseline(2007)– T otalPopulation 70.8% 59.9% T arget– T argetP opulation 77.9%* 79.4% 59.9% T argetO therP opulations W hites(N otHispanic) 90.7% 71.2% Blacks(N otHispanic) 67.4% 55.2% Hispanic(AllR aces) 72.1% 63.3% Asian/P acificIslanders 90.8% N /A *T arget-SettingM ethod: 10% improvement City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 36

Low Birthweight

T hew eightofthenewbornisanimportantpredictoroffuturem orbidityandm ortality. L ow birthweight -lessthan2,500 grams(5lbs.8oz.)-carriesrisks.Forverylow birthweightinfants-lessthan1,500 gramsor3 lbs.4 oz.-theriskofdyinginthefirstyearoflifeisnearly100 timesthatofnormalweight infants.T heriskformoderatelylow birthweightinfants(1,500 to2,499 grams)ismorethanfivetimes higherthanthatofheaviernewborns.

L ow birthw eight(LBW )increasestheriskforinfantm orbidityandm ortality. L BW infantsareatgreater riskofdyinginthefirstm onthoflife.L BW infantsmayrequireintensivecareatbirthandareathigher riskofdevelopmentaldisabilitiesandchronicillnessesthroughoutlife.T heyarem orelikelytorequire specialeducationservices.HealthcarecostsandlengthofhospitalstayarehigherforL BW infants.

O fthe4,244 N ewarkresidentbirthsin2015,9.8% w ereoflow birthweight.T hisrateisslightlyhigher thancomparabletotalsforN ew JerseyandtheU nitedS tatesof8.1% . By race/ethnicity,low w eight birthstoAfricanAm ericanm otherswerehigherthanthetotalrates,at12.3% oftotalAfricanAm erican birthsinN ewark,12.2% inN ew Jerseyand13.3% intheU nitedS tates.

T hepercentofverylow w eightbirthsin2015w ashigherinN ewark,at2.1% oftotallivebirthsversus 1.4% forN ew JerseyandtheU S .

T rends. T hepercentsofLBW andVL BW inN ewarkhavedeclinedoverthepast10 years.

Figure41: P ercentBirthsofLow Birthweightin2015-N ewark,N JandU S

14.0%

12.0%

10.0% HP 2020 7.8% 8.0% HNJ 2020 7.7%

6.0%

4.0%

2.0%

0.0% White Not Black Not Hispanic Total Hispanic Hispanic

Newark New Jersey United States City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 37

Figure42:T rendsinN ewarkL BW andVL BW in2005,2010,2015

14% 12.0% 12% 10.9% 9.8% 10% s h t r i B

8% e

v LBW i L

l VLBW a

t 6% o T

% 4% 2.8% 2.6% 2.1% 2%

0% 2005 2010 2015

P rogressTowardHealthyP eople2020 andHealthyN J2020. BothN JandtheU S areontargetfor m eetingthe2020 goalsforL BW – andhavealreadyachievedthetotalgoals.N ewarkhasmettheHN J 2020 goalsforN on-HispanicW hiteandBlacksandhasmadesignificantprogresstowardthetotalgoal.

T able11: HealthyP eople2020 andHealthyN J2020 T argetsforLow BirthweightandN ewark2015

HealthyP eople2020 HealthyN J2020 N ewark2015 Baseline(2007)– T otalPopulation 8.2% 9.8% T arget– T argetP opulation 7.8% 7.7% 9.8% T argetO therP opulations W hites(N otHispanic) 6.9% 5.8% Blacks(N otHispanic) 12.4% 12.3% Hispanic(AllR aces) 7.1% 7.5% Asian/P acificIslanders 7.9% N /A City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 38

Infant Mortality

T herateofinfantm ortality-deathsper1,000 livebirths-inN ewarkishigherthaninN ew Jerseyand theU nitedS tates– 11.6versus4.4and5.8in2014.

R atesofblackinfantm ortalityin2014 w erehigherinallgeographicareas– at15.1inN ewark,8.7in N ew Jersey,and11.4intheU S .

Figure43:T otalandBlackInfantM ortalityin2014 – N ewark,N J,U S

16% 15.1% 14%

12 % s

h 11.6% t

r 11.4% i 10 % B

e v i L

8 % 8.7% l a t o T

f 6% o 5.8% % 4% 4.4%

2 %

0 % Total Black

Newark New Jersey United States

P rogressTowardHealthyP eople2020 andHealthyN J2020. BothN JandtheU S havealreadyachieved thetotal2020 goals.N ewarkisfarfrom m eetingthetotalgoals.Blackinfantm ortalityisachallengeinall jurisdictionsbutespeciallyinN ewarkandtheU S .

T able12: HealthyP eople2020 andHealthyN J2020 T argetsforInfantM ortalityandN ewark2015

HealthyP eople2020 HealthyN J2020 N ewark2015 Baseline(2006)– T otalPopulation 6.7% 11.6% T arget– T argetP opulation 6.0% 4.8% 11.6% T argetO therP opulations W hites(N otHispanic) 1.9% 4.4%** Blacks(N otHispanic) 6.0% 15.1% Hispanic(AllR aces) 4.5% 5.3%** Asian/P acificIslanders 2.2% N /A *T arget-SettingM ethod: 10% improvement **AggregatedyearsbyN JSHAD duetosmallannualnum bers. City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 39

C. Environmental Health

Childhood Lead Poisoning

T hedefinitionofchildhoodleadpoisoningduetoElevatedBloodL eadL evel(EBL L )haschangedoverthe past 10 years from 20 μ g/dL (m icrogram s per deciliter) or greater in 2005 to 15 μ g/dL or greater by 2010 to 10 μ g/dL or greater in 2015. T hese changes are based on scientific findings regarding the im pact of leadexposureonchilddevelopment.

N ewarkhasahigherthanaverageincidenceofchildhoodleadpoisoningcomparedtotheentirestate permostrecentblood-leadm onitoringdataavailableforS tateFiscalYear(SFY)2015from July1,2014 throughJune30,2015. However,childreninN ewarkarescreenedforleadpoisoningathigherrates thantherestofthestate. InS FY2015,61.6% ofyoungchildrenw erescreenedforleadcomparedto 43.4% statewide– 42% higherthanstatewiderates.

T hehighestriskforchildrenremainsinhousesbuiltbefore1950,whenpaintscontainedaveryhigh percentageoflead.T hepercentofhousingunitsinN ewarkbuiltbefore1950 hasdeclinedfrom 45% in 2000 to39% in2015-versus26% inN ew Jerseyand18% intheU .S.(Census,2015).O ftheseolder units,79% inN ewarkarerenteroccupiedversus37% inN ew JerseyandtheU .S.

T heCityofN ewarkhasthegreatestnum berofchildrenw ithEBL L scomparedtoanyothermunicipality intheS tate.N ewarkcomprised13% oftheS tate’schildrenyoungerthansix(6)yearsofagew ithan EBL L duringS FY2015,whileonly3.8% oftheentireS tate’spopulationofchildreninthatagegroup residesinN ewark.Additionally,inS FY2015itcomprised18% ofthetotalnum berofchildrenyounger thansix(6)yearsofagew ithanEBL L inalllargem unicipalities.

O fallchildren*<6yearsofageresidinginN ewark,0.47% w erereportedw ithanEBL L duringS FY2015. By contrast,intwocomparablelargem unicipalities(bypopulation*)thispercentagew as0.36% (Jersey City),and0.36% ().

N ewarkaddressestheissueofelevatedbloodleadlevelsinchildrenthroughseveralmeansandhasbeen allottedandcontinuestoseekgrantsfrom governmentalandnon-governmentalsources.Inthepast decade,N ewarkestablishedandlocallyadministerstheS tate’sonlyL ead-SafeHouses,whichare m unicipally-ownedproperties.T heL ead-SafeHousesareusedtorelocateresidentswhohaveachildw ith anEBL L andw henthefamilyhasnootherlead-safehousingalternatives.T hisisagreataccomplishment thatothermunicipalitieshaveexpressedaninterestinalsoachieving.Further,N ewarkprovidesa primarypreventionfocused,comm unity-basedpresencethroughtheN ewarkP artnershipforL ead-Safe Children.T hispartnershipprovidesoutreach,educationandprofessionaldevelopmentopportunitiesto parents,propertyowners,childcareprovidersandhealth,socialservicesandhousingprofessionals.

From 2000-2010,N ewarkappliedforandreceived$16.5m illioninfederalgrantfundingfrom theU S DepartmentofHousingandU rbanDevelopment(HU D)toremediateover800 N ewarkhomesoflead hazardsandtoimplementhealthyhomesinterventionswhichhelpN ewarkresidentsmaintaintheir homesinaleadsafem annerandm inimizeotherenvironmentalfactors.M ostdwellingsreceiving interventionswererentalhomes.T heseleadsafeenvironmentswhichw erere-rentedtootherN ewark familiesassistedinreducingthenum berofchildrenw ithEBL L ,especiallyover20 and15U g/dL. City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 40

T able13: S FY2015:N um berofChildren(six(6)to26m onthsofage)byBL L forN ewarkandN ew Jersey T otal % BL L (ug/dL) T otal Children* S creened <5 5-9 10-14 15-19 20-44 ≥ 45 N ewark 8,382 61.6% 4,847 273 26 10 5 2 5,163 NJ 214,727 43.4% 90,560 2,111 268 105 79 5 93,128 * 2010 CensusData S ource: N JDept.Health.ChildhoodL eadExposureInN ew JerseyAnnualR eport-StateFiscalYear2015(July1,2014– June30,2015).

D. Sexually Transmitted Diseases

N ewarkhasmorethanitsproportionateshareofallofN ew Jersey’scasesofsexuallytransmitted diseases(ST Ds)in2015.N ewarkhasonly3.1% N ew Jersey’stotalpopulationbutamuchhigher percentageofitsST Ds.

T able14: CasesofS exuallyT ransmittedDiseasesin2015– N ewarkandN ew Jersey S yphilis P rimary+ L ateand S econdary EarlyL atent L ateL atent Congenital Gonorrhea Chlamydia

N ewark 125 31 8 23 1,056 2,983

N ew Jersey 719 219 108 263 7,228 31,446 % N ewarkofN J 17.4% 14.2% 7.4% 8.7% 14.6% 9.5% Cases

Figure44: P ercentofN ew JerseyS exuallyT ransmittedDiseasesO ccurringinN ewark-2015

20 % Newark is 3.1% of 17.4% 18 % NJ total population.

16% 14.2% 14.6% 14%

12% 9.5% 10 % 8.7%

8 % 7.4%

6%

4%

2%

0 % Primary + Early Latent Late & Late Congenital Gonorrhea Chlamydia Secondary Syphilis Latent Syphilis Syphilis Syphilis City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 41

E. Mortality - Leading Causes of Death

 T hetop10 leadingcausesofdeathforN ewarkandN ew Jerseyareshownintheattachedfigures.A tablecomparesN ewark,N ew JerseyandtheU nitedS tatesfor2014.

 T hetopthreecausesofdeathinN ewarkare#1 HeartDisease,#2 Cancer,and#3 Accidents.In contrast,thetopthreecausesofdeathinN ew Jerseyare#1 HeartDisease,#2 Cancer,and#3 S troke.

 DeathsduetoHIV/AIDS remainasignificanthealthissueinN ewarkversusstatewideatarankof#8. Forover12 yearsHIV/AIDS hasnotbeenoneofthe10 leadingcausesofdeathinN ew Jersey,andis estimatedtorank#18in2014. N ewarkaccountedfor22% ofN ew JerseydeathsduetoHIVdisease, butisonly3% ofthestate’spopulation.

 S imilarly,deathsduetohomiciderank#4 inN ewarkbut#17statewideinN ew Jersey. N ewark accountsfor23% ofN ew Jerseydeathsduetohomicide.

 T hetoptwoleadingcausesofdeathamongallpopulationsinN ewarkare#1 HeartDiseaseand#2 Cancer,althoughCancerwas#1 forW hite,N otHispanicresidents.T herearedifferencesin subsequentrankingsby race/ethnicity.

o Am ongBlack/AfricanAm ericanN ewarkresidents,Homicideisthe#3 leadingcauseofdeath. T hisisfollowedby#4 S troke,#5Accidents,and#6HIV/AIDS .

o Am ongHispanic/LatinoN ewarkresidents,Accidentsisthe#3 leadingcauseofdeath.T hisis followedby#4 Diabetes,#5S epticemiaand#6Homicide.

o Am ongw hiteN ewarkresidents,accidentsis#3 leadingcause.T hisisfollowedby#4 Diabetesand#5S epticemia. City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 42

Figure45: L eadingCausesofDeathinN ewark-2014

#1 Heart Disease 21%

Remaining Causes 29%

#10 Kidney Disease #2 Cancer 2% #9 CLRD 20% 3% #8 HIV 3%

#7 Septicemia #3 Unintentional 4% Injuries #6 Diabetes 5% #5 Stroke #4 4% 4% 5% City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 43

Figure46: L eadingCausesofDeathinN ew Jersey-2014

Remaining Causes #1 Heart Disease 26% 26%

#10 Flu/Pneumonia 2% #9 Kidney Disease 2% #8 Septicemia 2% #7 Alzheimer's 3% #6 Diabetes 3% #2 Cancer 23% #5 Accidents 4% #4 CLRD 4% #3 Stroke 5% City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 44

T able15: T op10 L eadingCausesofDeathin2014 – N ewark,N J,U S

N ewark N ew Jersey U nitedS tates

#1 HeartDisease 383 21.3% HeartDisease 18,023 25.6% HeartDisease 614,348 23.4%

#2 Cancer 369 20.5% Cancer 16,393 23.3% Cancer 591,699 22.5% #3 Accidents 90 5.0% S troke 3,363 4.8% ChronicL ower 147,101 5.6% R espiratoryDisease #4 Homicide 83 4.6% ChronicL ower 3,018 4.3% Accidents 136,053 5.2% R espiratoryDisease

#5 S troke 81 4.5% Accidents 2,882 4.1% S troke 133,103 5.1%

#6 Diabetes 79 4.4% Diabetes 2,050 2.9% Alzheimer's 93,541 3.6%

#7 S epticemia 73 4.1% Alzheimer's 1,936 2.8% Diabetes 76,488 2.9%

#8 HIV 59 3.3% S epticemia 1,747 2.5% Flu/P neum onia 55,227 2.1% #9 ChronicL ower 50 2.8% KidneyDisease 1,486 2.1% KidneyDisease 48,146 1.8% R espiratoryDisease

#10 KidneyDisease 38 2.1% Flu/P neum onia 1,219 1.7% S uicide 42,773 1.6% T otalDeaths 1,801 T otalDeaths 70,351 T otalDeaths 2,626,418 City of Newark, New Jersey Community Health Assessment - 2017 IV. Health Status Page 45

T able16: 10 L eadingCausesofDeathinN ewark(2014)byR ace/Ethnicity

Black/ Hispanic/ AfricanAm erican L atino(AllR aces) W hite,N otHispanic

#1 HeartDisease 235 20.7% HeartDisease 79 21.9% Cancer 67 26.6% #2 Cancer 215 19.0% Cancer 73 20.3% HeartDisease 60 23.8% #3 Homicide 68 6.0% Accidents 23 6.4% Accidents 16 6.3% #4 S troke 60 5.3% Diabetes 21 5.8% Diabetes 11 4.4% #5 Accidents 48 4.2% S epticemia 15 4.2% S epticemia 9 3.6% #6 HIV/AIDS 47 4.1% Homicide 15 4.2% S troke 8 3.2% #7 S epticemia 46 4.1% Flu/P neum onia 11 3.1% Alzheimer’s 6 2.4% #8 Diabetes 45 4.0% R espiratoryDisease 10 2.8% Flu/P neum onia 6 2.4% #9 R espiratoryDisease 34 3.0% KidneyDisease 10 2.8% R espiratoryDisease 4 1.6% #10 KidneyDisease 25 2.2% S troke 9 2.5% Cirrhosis 4 1.6%

S ubtotal 823 72.6% 266 73.9% 191 75.8% R emainingCauses 290 27.4% 94 26.1% 61 24.2% TOTAL 1,133 100% 360 100% 252 100% City of Newark, New Jersey Community Health Assessment - 2017 V. HIV/AIDS Page 46

V. HIV/AIDS

A. HIV/AIDS in Newark

HIV/AIDS hasaffectedtheCityofN ewarksincetheinceptionoftheepidemicinthe1980’s.O ver2% of N ewarkresidents(5,750)areP eopleL ivingW ithHIV/AIDS (PL W HA)asofDecember31,2015.T heCity ofN ewarkhasbeentheepicenterofHIV/AIDS inN ew Jersey. N ewarkisdisproportionatelyimpactedby HIV– w ith15% ofN JP L W HA butonly3% ofN Jpopulation.

HIVdisproportionatelyaffectsvariouspopulationsofN ewarkresidentsversusN ew Jersey. T hese include:w omen,thoseinfectedheterosexually,injectiondrugusers(IDU ),Black/AfricanAm erican residents,youthage13-24,andchildrenunderage13.

Figure47: P eopleL ivingW ithHIV/AIDS inN ewarkasofDecember31,2015 N um ber P ercent N EW AR K M ale Female T otal M ale Female T otal Disease Category HIV 1,720 1,121 2,841 48.7% 50.6% 49.4% AIDS 1,813 1,096 2,909 51.3% 49.4% 50.6% T otal 3,533 2,217 5,750 100.0% 100.0% 100.0% Gender 61.4% 38.6% 100.0% Current Age < 13 9 9 18 0.3% 0.4% 0.3% 13 -24 125 70 195 3.5% 3.2% 3.4% 25-34 432 178 610 12.2% 8.0% 10.6% 35-44 541 420 961 15.3% 18.9% 16.7% 45-54 1,101 802 1,903 31.2% 36.2% 33.1% 55+ 1,325 738 2,063 37.5% 33.3% 35.9% T otal 3,533 2,217 5,750 100.0% 100.0% 100.0% Age 45+ 2,426 1,540 3,966 68.7% 69.5% 69.0% Race/Ethnicity Hispanic 853 391 1,244 24.1% 17.6% 21.6% Black,N otHispanic 2,511 1,755 4,266 71.1% 79.2% 74.2% W hite,N otHispanic 148 58 206 4.2% 2.6% 3.6% O ther/U nknown 21 13 34 0.6% 0.6% 0.6% T otal 3,533 2,217 5,750 100.0% 100.0% 100.0% Racial/Ethnic Minority 3,364 2,146 5,510 95.2% 96.8% 95.8% Transmission Category MSM 1,053 0 1,053 29.8% 0.0% 18.3% IDU 800 531 1,331 22.6% 24.0% 23.1% M S M /IDU 122 0 122 3.5% 0.0% 2.1% Heterosexual 1,032 1,401 2,433 29.2% 63.2% 42.3% N otR eported/O ther 526 285 811 14.9% 12.9% 14.1% T otal 3,533 2,217 5,750 100.0% 100.0% 100.0% S ource: N JDept.Health.DivisionofHIV,ST D,TB S ervices City of Newark, New Jersey Community Health Assessment - 2017 V. HIV/AIDS Page 47

Figure48:P ercentofN ew Jersey’sPL W HA L ivinginN ewarkasofDecember31,2015

Heterosexual 16.8%

IDU 19.6%

15.4% of NJ MSM 10.4% PLWHA live in Newark in 2015 Hispanic 12.6%

Black, Not Hispanic 22.4%

Age 55+ 15.2%

Youth Age 13-24 19.1%

Children < Age 13 28.6%

Men 14.0%

Women 18.0%

0 % 5% 10 % 15% 20 % 25% 30 %

T heimpactofHIVonN ewarkresidentsisshowninagraphcomparingtheprevalenceofHIV/AIDS amongN ewarkresidentsandsurroundingm unicipalitiesandcountiescomparedw ithN ew Jerseyand theU S . City of Newark, New Jersey Community Health Assessment - 2017 V. HIV/AIDS Page 48

Figure 49: People Living with HIV/AIDS - Rates per 100,000 Population – Newark, Newark Eligible Metropolitan Area (EMA) and NJ (2015) and US (2013)

2 , 2 50

EMA's 5 Largest Cities (71% of PLWHA) 2 , 0 0 0

1 , 7 50

EMA's 5 Counties

n 1 , 50 0 o i t a l u p

o 1 , 2 50 p

0 0 0 , EMAvs NJ vs US 0 0

1 1 , 0 0 0

r e p

e t a 7 50 R

50 0

2 50

0 NJ N ewark N ew US East Total5 ou tside of Es s ex M orris S u s s ex Union W arren Irvington N ewark ElizabethP lainfield EMA Jersey (20 13) O range C ities EMA PLWHA 656. 2 417 . 9 344. 8 295. 1 1, 218 . 4 17 3. 6 120 . 4 515. 7 167 . 5 2,187.9 1,793.7 2,039.4 8 8 8 . 3 1,029.0 1,688.7 City of Newark, New Jersey Community Health Assessment - 2017 V. HIV/AIDS Page 49

T rends. T herehasbeenaveryslightdecreaseinP L W HA inN ewarkfrom 2005to2015.

Figure50: T rendsinP L W HA inN ewark– 2005,2010,2015

7 , 0 0 0

6, 0 0 0 5,872 5,830 5,750 5, 0 0 0

4, 0 0 0

3, 0 0 0

2 , 0 0 0

1 , 0 0 0

0 2005 2010 2015

DeathsDuetoHIV. HIVremainsaleadingcauseofdeathamongN ewarkresidentsdespitethe availabilityoflife-savingHIVm edications.HIVw asthethirdleadingcauseofN ewarkdeathsfrom 2004- 2009,andstartedtodeclinethereafterto#8in2014.

Figure51: DeathsDuetoHIVinN ewark– 2004 -2014

1 8 0

1 60

1 40

1 20

1 0 0

8 0

60

40

20

0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 HIV Deaths 166 169 140 125 109 88 93 78 77 64 59

% T otalDeaths 7.7% 7.5% 6.9% 6.4% 5.4% 4.7% 5.0% 4.2% 4.4% 3.4% 3.3% R ank #3 #3 #3 #3 #3 #3 #4 #6 #6 #7 #8 City of Newark, New Jersey Community Health Assessment - 2017 V. HIV/AIDS Page 50

B. Health Outcomes Among People with HIV/AIDS in Newark

Background

R yanW hiteHIV/AIDS P rogram(RW HAP ). T heR W HAP providesacomprehensivesystem ofcarethat includesprimarym edicalcareandessentialsupportservicesforpeoplelivingw ithHIVw hoareuninsured orunderinsured.T heP rogramw orkswithcities,states,andlocalcomm unity-basedorganizationsto provideHIVcareandtreatmentservicestom orethanhalfamillionpeopleeachyear.T heP rogram reachesapproximately52% ofallpeoplediagnosedw ithHIVintheU nitedS tates.8 T hem ajorityof R W HAP fundssupportprimarym edicalcareandessentialsupportservices.T heP rogramservesasan importantsourceofongoingaccesstoHIVm edicationthatcanenablepeoplelivingw ithHIVtoliveclose tonormallifespans.T heR W HAP w asestablishedin1991 byfederallaw-RyanW hiteComprehensive AIDS R esourcesEmergency(CAR E)Act-andhasbeenreauthorizedsincethen,respondingtochangesin theHIVepidemicandneedsofthosew ithHIVdisease.

T heCityofN ewarkthroughtheO fficeoftheM ayorofN ewark,theChiefElectedO fficial,hasbeena recipientofR W HAP fundingsince1991 coveringthefive-county“ EligibleM etropolitanArea(EM A)” of Essex,U nion,M orris,SussexandW arrencounties.T his“P artA” fundingisformetropolitanareasmost severelyaffectedbytheHIV/AIDS epidemic.T heN ewarkhealthdepartment,DepartmentofHealthand Comm unityW ellness(DHCW ),administerstheR W HAP .

T heR W HAP requiresrecipientsoffundingincludingN ewarktoestablishaClinicalQ ualityM anagement (CQ M )programtoimprovehealthoutcomesofP L W HA andaclientleveldata(CL D)system tocapture dataonhealthoutcomesandR W HAP servicesdelivered.T heN ewarkDHCW hasanextensiveCQ M programanditsComprehensiveHIV/AIDS M anagementP rogram(CHAM P )CL D,developedin1997asa programandfinancialmanagementIT system andextensivelym odernizedsince,isanessentialfeature oftheN ewarkR W HAP . CHAM P isthesourceofdatainthissection.

N ationalHIV/AIDS S trategy(N HAS ). T heN ationalHIV/AIDS S trategyisafive-yearplanthatdetails principles,priorities,andactionstoguideourcollectivenationalresponsetotheHIVepidemic.First releasedonJuly13,2010,theS trategyidentifiedasetofprioritiesandstrategicactionstepstiedto m easurableoutcomesformovingtheN ationforwardinaddressingthedomesticHIVepidemic.InJuly 2015,theN ationalHIV/AIDS S trategyfortheU nitedS tates:U pdatedto2020 w asreleased.T he updatedS trategyreflectsthew orkaccomplishedandthenew scientificdevelopmentssince2010 and chartsacourseforcollectiveactionacrosstheFederalgovernmentandallsectorsofsocietytom oveus closetotheS trategy’svision.9

T heS trategyGoalsare:(1)R educeN ew Infections.(2)IncreaseAccesstoCareandImproveHealth O utcomesforP eopleL ivingw ithHIV. (3)R educeHIV-RelatedHealthDisparitiesandHealthInequities. (3)AchieveaM oreCoordinatedN ationalR esponsetotheHIVEpidemic.W ithintheGoalsthereare10 IndicatorsO fP rogress. N ewarkDHCW R W HAP m easuresperformanceontheseindicatorsonan ongoingbasistoensureimprovementinthehealthofP L W HA served.

8 HealthR esourcesandS ervicesAdministration.HIV/AIDS Bureau.https://hab.hrsa.gov/about-ryan-white-hivaids- program/about-ryan-white-hivaids-program 9 AIDS .gov.https://ww w .aids.gov/federal-resources/national-hiv-aids-strategy/overview/ City of Newark, New Jersey Community Health Assessment - 2017 V. HIV/AIDS Page 51

INDICATO RS O FPRO GRESS T hefollowingindicatorsofprogressareidentifiedintheN ationalHIV/AIDS S trategy:U pdatedto2020: #1 Increasethepercentageofpeoplelivingw ithHIVw hoknow theirserostatustoatleast90 percent. #2 R educethenum berofnew diagnosesbyatleast25percent. #3 R educethepercentageofyounggayandbisexualmenw hohaveengagedinHIV-riskbehaviorsbyat least10 percent. #4 IncreasethepercentageofnewlydiagnosedpersonslinkedtoHIVm edicalcarew ithinonem onthof theirHIVdiagnosistoatleast85percent. #5 IncreasethepercentageofpersonswithdiagnosedHIVinfectionw hoareretainedinHIVm edicalcare toatleast90 percent. #6 IncreasethepercentageofpersonswithdiagnosedHIVinfectionw hoarevirallysuppressedtoatleast 80 percent. #7 R educethepercentageofpersonsinHIVm edicalcarew hoarehomelesstonom orethan5percent. #8 R educethedeathrateamongpersonswithdiagnosedHIVinfectionbyatleast33 percent. #9 R educedisparitiesintherateofnew diagnosesbyatleast15percentinthefollowinggroups:gayand bisexualmen,youngBlackgayandbisexualmen,Blackfemales,andpersonslivingintheS outhern U nitedS tates. #10 IncreasethepercentageofyouthandpersonswhoinjectdrugswithdiagnosedHIVinfectionw hoare virallysuppressedtoatleast80 percent.

AsrequiredbytheR W HAP ,in2016theCityofN ewarkpreparedandsubmitteditsN ewarkEM A 2017- 2021 IntegratedHIV/AIDS P lantoassisttheEM A inm eetingthegoalsofN HAS . T heP lanencompasses planningandservicedeliveryresourcesthroughouttheN ewarkEM A.

HIVCareContinuum (HCC). T heHIVCareContinuum — sometimesalsoreferredtoastheHIVtreatment cascade— isamodelthatoutlinesthesequentialstepsorstagesofHIVm edicalcarethatpeopleliving w ithHIVgothroughfrom initialdiagnosistoachievingthegoalofviralsuppression(averylow levelofHIV inthebody),andshowstheproportionofindividualslivingw ithHIVw hoareengagedateachstage.10

T heHCC hasthefollowingstages:(1)diagnosisofHIVinfection,(2)linkagetocare,(3)retentionin care,(4)receiptofantiretroviraltherapy,and(5)achievementofviralsuppression. Viralsuppression or“ViralLoadS uppression(VL S )” ishavingaviralloadoflessthan200 copiesoftheHIVvirusper m illiliterofblood. Atthislow VL S level,theHIVvirusisnottransmissibletoothers.U seoftheHCC helpstobetteridentifygapsinHIVservicesanddevelopstrategiestoimproveengagementincareand outcomesforpeoplelivingw ithHIV. In2013,theHIVCareContinuum Initiativew asestablishedasthe nextstepintheimplementationoftheN ationalHIV/AIDS S trategy. T heInitiativedirectedFederal departmentstoaccelerateeffortstoincreaseHIVtesting,care,andtreatmenttobetteraddressdrop- offsalongtheHIVcarecontinuum andincreasetheproportionofindividualsineachstagealongthe continuum . AnHIVCareContinuum FederalW orkingGroupw asestablishedtosupporttheInitiative andcoordinateFederalefforts,andthisW orkingGroupdevelopedaseriesofrecomm endations.T hese recomm endationswerefullyintegratedintotheS tepsandActionsoftheN ationalHIV/AIDS S trategy: U pdatedto2020.

10 AIDS .gov.https://ww w .aids.gov/federal-resources/policies/care-continuum / City of Newark, New Jersey Community Health Assessment - 2017 V. HIV/AIDS Page 52

Newark Residents Served by RWHAP

In2016,atotalof3,082 HIV+N ewarkresidentsreceivedR W HAP P artA services.O fthese,2,014 (65%) receivedR W HAP -fundedm edicalcareand1,068(35%)receivedservicesotherthanR W HAP -funded m edicalcare. N ewarkresidentsaccountedfor46% ofallR W HAP clients(6,701)inthe5-county N ewarkEM A in2016.

O utcomesofN ewarkP L W HA alongtheHIVCareContinuum

 L inkagetoCare. O fthe88newlydiagnosedP L W HA livinginN ewark,over93% (82)w erelinked tom edicalcarew ithin3 m onthsofdiagnosis.66or75% w erelinkedtocarew ithin30 days w hichismovingtowardtheN HAS 2020 goalof90% .  R etainedinCare. N early86% or1,463 ofN ewarkclientsreceivingR W HAP -fundedm edicalcare w ereretainedincarebyhavingtwoormorem edicalvisits,CD4 orviralloadm easuresatleast 90 daysapart.T hisisclosetotheN HAS 2020 goalof90% .  P rescribedAntiretroviral(AR V)m edications. N early96% or1,927ofN ewarkm edicalclients w ereprescribedAR Vs,whichexceedsnationalgoalsof95%.  ViralSuppression. N early79% or1,587ofN ewarkm edicalclientswerevirallysuppressed, approachingtheN HAS 2020 goalof80% .

Figure52: O utcomesofN ewarkR W HAP ClientsalongtheHIVCareContinuum ,2016

10 0 % 100.0% 90 % 93.2% 95.7%

8 0 % 85.9% 78.8% 7 0 %

60 %

50 %

40 %

30 %

2 0 %

1 0 %

0 % Newark RWHAP Linkage to Care Retained in Care Prescribed ARV Virally Clients Suppressed City of Newark, New Jersey Community Health Assessment - 2017 V. HIV/AIDS Page 53

ViralSuppression– N ewarkversusN ewarkEM A

T hegoalofHIVm edicalcareandservices– w hetherornotR W HAP -funded– istoachieveviral suppressionoraViralLoadof<200 copiespermilliliterofblood.T hisismeasuredbylaboratorytesting. T heN ewarkEM A R W HAP requiresbloodtestingatleasttwiceayear(everysixm onths)forclients receivingR W HAP -fundedm edicalcareandentryoflabresultsintotheCHAM P system. T heCHAM P system reportstheseresultsforallR W HAP clients.DataareaggregatedfortheCityofN ewark,N ewark EM A,subpopulation,etc.,andreportsareproducedregularlyby ViralLoadS uppression“VL S ” andall outcomesrequiredbyHR S A HAB.

(AllR W HAP clientleveldatasystemsacrosstheU S m ustcaptureVL values.T hesearereportedby R W HAP -fundedagenciesannuallytoU S DHHS ,HR S A,HAB.)

T hefigurebelow showsthepercentofR W HAP clientsinN ewarkandthefive-countyN ewarkEM A w ho haveachievedViralSuppressionasofDecember31,2016.T hesubpopulationsarethesameasthosein thefigureaboveshowingN ewarkpopulationsimpactedbyHIV. However,VL S percentsforChildren (

ForthetotalR W HAP clients,N ewarkisapproachingtheN HAS 2020 goalof80% VL S w ithnearly79% ofclientsvirallysuppressedand,at81%,theentireN ewarkEM A hasachievedtheN HAS 2020 VL S goal. Ingeneral,N ewarkVL S percentagesforeachsubpopulationarelowerthantheEM A,butfollow thesametrendsandpatterns. N ewarkclientsare45% ofthetotalEM A m edicalcareclients.

 By ExposureCategory/M odeofT ransmission,thosew hoacquiredHIVthroughheterosexual contactorInjectionDrugU se(IDU )w erevirallysuppressedforbothN ewarkandtheEM A. o However,forthoseexposedbyM enhavingS exw ithM en(M S M ),theEM A hasachieved VL S butnotN ewark.M S M outsideofN ewarkandespeciallyinsuburbanpartsofU nion County,andM orris,SussexandW arrencountiesaccessHIVcarem oreandtypicallytake bettercareoftheirhealth.M S M inN ewarkm aybedealingw ithissuesofstigmaaswell ascontinuingriskybehaviors.R W HAP m edicalcareiswidelyavailableforN ewarkM S M .  By R ace/Ethnicity,Hispanic/LatinoclientsinbothN ewarkandtheN ewarkEM A haveachieved viralsuppression. o Incontrast,Black/AfricanAm ericansinN ewarkandtheEM A havenotachievedVL S yet, althoughprogressisbeingm ade.  By AgeCategory,bothN ewarkandtheEM A follow thesamepatterns.P ersonsage35and oldergetseriousabouttheirhealth,takebettercareofthemselves,andachieveVL S goals.S o P L W HA age55andolderinbothN ewarkandtheEM A haveachievedVL S . o Incontrast,Youth(Age13-24)donothavetheseoutcomes– inN ewark,theEM A,N J, andacrosstheU S . Anditisnotduetolackofhealthcare.M anyN ewarkandEM A youth haveregularmedicalappointments,butjustdonottaketheirAR V m edications regularly. DailyAR Vsisamustw ithHIVdisease.  By Gender(Sex),wearefindingthatm eninbothN ewarkandtheN ewarkEM A havebetterVL S outcomesthanw omen.T hisiscounterintuitivebecauseitis“expected” thatw omenarem ore responsiblethanm enandw ouldtaketheirmedicationsasprescribed. City of Newark, New Jersey Community Health Assessment - 2017 V. HIV/AIDS Page 54

Figure53: ViralSuppressionofR W HAP ClientsinN ewarkandN ewarkEM A,2016

81.0% TOTAL 78.8%

81.2% Heterosexual 79.7%

84.7% IDU 82.2%

80.0% MSM 75.1%

85.2% Hispanic 83.1%

79.2% Black, Not Hispanic 77.6%

86.8% Age 55+ 83.9%

66.5% Youth Age 13-24 63.6%

81.6% Men 79.0%

80.2% Women 78.6%

50 % 55% 60 % 65% 7 0 % 7 5% 8 0 % 8 5% 90 %

Newark Newark EMA City of Newark, New Jersey Community Health Assessment - 2017 VI. Community Health Centers/FQHC Needs Assessment Page 55

VI. Community Health Centers/FQHC Needs Assessment

A. CHC/FQHC Needs Assessment Requirements

Comm unityHealthCenters(CHC)w ereestablishedbyfederallaw– S ection330 oftheP ublicHealth S ervicesAct-over50 yearsagotoprovidehealthcaretolow incomeindividuals– w ithincomesunder 200% oftheFederalPovertyL evel(FP L ).S ection330 providesfundingtoCHCstoservelow income individuals,particularlytheuninsured.Comm unityHealthCentersarem orecomm onlyknownas FederallyQ ualifiedHealthCenters(FQ HCs)w hichistheirdesignationrequiredtoreceive reimbursementfrom M edicareandM edicaid.U nderfederallaw,CHCs/FQ HCsmustm eet19 requirements.O neoftheseisaneedsassessment.

CHCs/FQ HCsarerequiredbyfederallawtoconductaneedsassessmentoftheirservicearea.T his assessmentm ustbedocum entedandisaconditionofreceivingfederalfunding.Itincludesthe informationsetforthintheN ewarkComm unityHealthAssessment2017regardingdemographics, socioeconomicstatus,behavioralriskfactorsandhealthstatusofthepopulationintheN ewarkservice .O theritemsoutsidethescopeoftheN ewarkComm unityHealthAssessmentarespecifictothe healthcenter,suchaspatientsatisfactionsurveys.CHCs/FQ HCsareessentialpartnersinthedeliveryof healthcaretoN ewarkresidents.Forthisreason,theCityofN ewarkw antstoensurethatthis Comm unityHealthAssessment2017w illprovideinformationtohelpCHCs/FQ HCsmeettheirfederal requirementforacomm unityneedsassessment.

B. Health Status Indicators

T heHealthR esourcesandS erviceAdministration(HR S A),BureauofP rimaryHealthCare(BP HC),sets forthaminimum of16healthoutcomestobetrackedaspartoftheneedsassessmentandthehealth centerQ ualityImprovement/Q ualityAssurance(Q I/Q A)program. O utcomesarealsoreportedannually toHR S A BP HC bytheU niformDataSystem (U DS )report,andareshownontheHR S A BP HC w ebsite.

T hisdocum entliststhe16healthindicatorsandw heretheneedisdemonstratedintheN ewark Comm unityHealthAssessment2017docum ent.ItishopedthatCHCs/FQ HCswillsharetheirQ IQA outcomesforthesem easuresarepartoftheirparticipationintheN ewarkComm unityHealthP artnership.

1. Early Entry Into Prenatal Care

P ercentageofprenatalcarepatientswhoenteredtreatmentduringtheirfirsttrimester N um erator:W omenenteringprenatalcareatthehealthcenterorw iththereferredproviderduring theirfirsttrimester Denominator:W omenseenforprenatalcareduringthem easurementperiod

InformationabouttheneedforprenatalcareinN ewarkisshowninthesectionregarding M aternal,InfantandChildHealth. City of Newark, New Jersey Community Health Assessment - 2017 VI. Community Health Centers/FQHC Needs Assessment Page 56

2. Childhood Immunization Status

P ercentageofchildren2 yearsofagew hohad4 diphtheria,tetanusandacellularpertussis(DT aP); threepolio(IPV),onem easles,mum psandrubella(M M R );threeH influenzatypeB (HiB);three hepatitisB(HepB);onechickenpox(VZV);4 pneumococcalconjugate(PCV);onehepatitisA (HepA); twoorthreerotavirus(RV);andtwoinfluenza(flu)vaccinesbytheirsecondbirthday N um erator:Childrenw hohaveevidenceshowingtheyreceivedrecomm endedvaccines,had docum entedhistoryoftheillness,hadaseropositivitytestresult,orhadanallergicreactiontothe vaccinebytheirsecondbirthday Denominator:Childrenw hoturn2 yearsofageduringthem easurementperiodandw hohaveavisit duringthem easurementperiod

T heComm unityHealthAssessmentdoesnothaveinformationabouttheimm unizationstatusof N ewarkchildren.T hedatahadbeenreportedyearsagobytheCDC N ationalImm unization InformationS ystem (N IIS)forN ewarkbutisnow reportedonlyforN ew Jersey.

3. Cervical Cancer Screening

P ercentageofwomen21-64 yearsofage,whoreceivedoneormoreP apteststoscreenforcervical cancer N um erator:W omenw ithoneormoreP aptestsduringthem easurementperiodorthetwoyearsprior tothem easurementperiod Denominator:W omen23-64 yearsofagew ithavisitduringthem easurementperiod

InformationaboutthereportedprevalenceofP apsmearandgapsinN ewarkareshowninthe sectiononHealthBehaviorsandR iskFactors,Papanicolaou S m earU seAm ongAdultW omen Aged21-65Years.

4. Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents.

P ercentageofpatients3-17yearsofagew hohadevidenceofBodyM assIndex(BM I)percentile documentationandw hohaddocumentationofcounselingfornutritionandw hohaddocumentation ofcounselingforphysicalactivityduringthem easurementyear N um erator:N um berofpatientsinthedenominatorwhohadtheirBM Ipercentiledocum entedduring them easurementyearandw hohaddocum entationofcounselingfornutritionandw hohad docum entationofcounselingforphysicalactivityduringthem easurementyear Denominator:P atients3through17yearsofagew ithatleastonem edicalvisitduringthe m easurementperiod

T heComm unityHealthAssessmentdoesnothaveinformationaboutthew eightstatusof childrenoradolescents.S tatewidedataforadolescentsisavailablefrom theYouthR isk BehavioralSurveyatN JDepartmentofEducationw ebsite. City of Newark, New Jersey Community Health Assessment - 2017 VI. Community Health Centers/FQHC Needs Assessment Page 57

5. Body Mass Index (BMI) Screening and Follow Up Plan

P ercentageofpatientsage18yearsandolderw ithaBM Idocum entedduringthecurrentencounter orduringtheprevioussixm onthsAN D w hentheBM Iisoutsideofnormalparameters,afollow-up planisdocum entedduringtheencounterorduringtheprevioussixm onthsofthecurrentencounter. N ormalparameters:Age18-64 yearsBM I=>18.5and<25kg/m²,andAge65yearsandolderBM I=>23 and<30 kg/m² N um erator:P atientswithadocum entedBM I(notjustheightandw eight)duringtheirmostrecentvisit orduringtheprevioussixm onthsofthem ostrecentvisit,andw hentheBM Iisoutsideofnormal parameters,afollow-upplanisdocum entedduringthevisitorduringtheprevioussixm onthsofthe currentvisit Denominator:Allpatients18yearsofageorolderw hohadatleastonem edicalvisitduringthe m easurementperiod

InformationabouttheN ewarkadultpopulationage18andolderw hoself-reportedasobeseis intheIII.BehavioralFactorssectiononobesity.

6. Tobacco Use Screening and Cessation Intervention

P ercentageofpatients18yearsandolderw how erescreenedfortobaccouseoneormoretimes w ithin24 m onthsAN D w horeceivedcessationcounselinginterventionifidentifiedasatobaccouser N um erator:P atientswhow erescreenedfortobaccouseatleastoncew ithin24 m onthsAN D w ho receivedtobaccocessationinterventionifidentifiedasatobaccouser Denominator:Allpatientsage18yearsandolderseenforatleasttwovisitsoratleastonepreventive visitduringthem easurementperiod

InformationabouttheN ewarkadultpopulationage18andolderw horeportedsmokingisin theIII.BehavioralFactorssection– U nhealthyBehaviorsAge18andolder.

7. Use of Appropriate Medications for Asthma

P ercentageofpatients5-64 yearsofagew how ereidentifiedashavingpersistentasthmaandw ere appropriatelyprescribedm edicationduringthem easurementperiod N um erator:P atientswhow eredispensedatleastoneprescriptionforapreferredtherapyduringthe m easurementperiod Denominator:P atients5-64 yearsofagew ithpersistentasthmaandavisitduringthem easurement period

InformationabouttheN ewarkadultpopulationage18andolderw ithcurrentasthmaprevalence isinsectionIV.HealthS tatus– HealthConditions– HealthO utcomesAge18andolder. City of Newark, New Jersey Community Health Assessment - 2017 VI. Community Health Centers/FQHC Needs Assessment Page 58

8. Coronary Artery Disease (CAD): Lipid Therapy

P ercentageofpatientsaged18yearsandolderw ithadiagnosisofCoronaryArteryDisease(CAD)w ho w ereprescribedalipid-loweringtherapy N um erator:N um berofpatientswhoreceivedaprescriptionfor,wereprovided,orw eretakinglipid loweringm edications Denominator:N um berofpatientswhow ereseenduringthem easurementyearaftertheir18th birthday,whohadatleastonem edicalvisitduringthem easurementyear,atleasttwom edicalvisits ever,andw hohadanactivediagnosisofcoronaryarterydisease(CAD)includinganydiagnosisfor m yocardialinfarction(M I)orw hohadhadcardiacsurgeryinthepast

InformationabouttheN ewarkadultpopulationage18andolderw ithcardiovascularhealth issuesisinsectionsIII.BehavioralFactors– U seofP reventiveS ervices(takingm edicationsfor highbloodpressure)andIV.HealthS tatus– HealthConditions– HealthO utcomesAge18and older(highbloodpressure)andM ortality– L eadingCausesofDeath.

9. Ischemic Vascular Disease (IVD): Use of Aspirin or Other Antithrombotic

P ercentageofpatients18yearsofageandolderw how eredischargedaliveforacutem yocardial infarction(AM I),coronaryarterybypassgraft(CABG)orpercutaneouscoronaryinterventions(PCI)in the12 m onthspriortothem easurementperiod,orw hohadanactivediagnosisofIVD duringthe m easurementperiod,andw hohaddocumentationofuseofaspirinoranotherantithromboticduring them easurementperiod N um erator:P atientswhohavedocum entationofuseofaspirinoranotherantithromboticduringthe m easurementperiod Denominator:P atients18yearsofageandolderw ithavisitduringthem easurementperiod,andan activediagnosisofIVD orw how eredischargedaliveforacutem yocardialinfarction(AM I),coronary arterybypassgraft(CABG)orpercutaneouscoronaryinterventions(PCI)inthe12 m onthspriortothe m easurementperiod

T heN ewarkHealthAssessmentdoesnothaveinformationaboutN ewarkresidentswithIVD. However,informationabouttheN ewarkadultpopulationage18andolderw ithcardiovascular healthissuesisinsectionsIII.BehavioralFactors– U seofP reventiveS ervices(takingm edications forhighbloodpressure)andIV.HealthS tatus– HealthConditions– HealthO utcomesAge18and older(highbloodpressure)andM ortality– L eadingCausesofDeath.

10. Colorectal Cancer Screening

P ercentageofadults50-75yearsofagew hohadappropriatescreeningforcolorectalcancer N um erator:P atientswithoneormorescreeningsforcolorectalcancer.Appropriatescreeningsare definedbyanyoneofthefollowingcriteria:fecaloccultbloodtest(FO BT )duringthem easurement period;flexiblesigmoidoscopyduringthem easurementperiodorthefouryearspriortothe m easurementperiod;orcolonoscopyduringthem easurementperiodorthenineyearspriortothe m easurementperiod Denominator:P atients50-75yearsofagew ithavisitduringthem easurementperiod City of Newark, New Jersey Community Health Assessment - 2017 VI. Community Health Centers/FQHC Needs Assessment Page 59

InformationabouttheN ewarkadultpopulationage18andolderw hohadcolorectalcancer screeningisinsectionIII.BehavioralFactors– U seofP reventiveS ervices(fecaloccultbloodtest, etc.,amongpopulationage50-75)anddataoncoresetofclinicalpreventiveservicesforboth m alesandfemales).

11. Screening for Clinical Depression and Follow Up Plan

P ercentageofpatientsage12 yearsandolderscreenedforclinicaldepressiononthedateofthe encounterusinganageappropriatestandardizeddepressionscreeningtoolAN D ifpositive,afollow- upplanisdocum entedonthedateofthepositivescreen N um erator:P atientsscreenedforclinicaldepressiononthedateoftheencounterusinganage appropriatestandardizedtoolAN D ifpositive,afollow-upplanisdocum entedonthedateofthe positivescreen Denominator:Allpatientsage12 yearsandolderbeforethebeginningofthem easurementperiodw ith atleastoneeligibleencounterduringthem easurementperiod

InformationabouttheN ewarkadultpopulationage18andolderw hohadpotentialdepressive episodesisinsectionIV.HealthS tatus– Individualswhoreportedthattheirmentalhealthw as notgoodfor14 ormoredays.

12. HIV Linkage to Care

P ercentageofnewlydiagnosedHIVpatientswhohadamedicalvisitforHIVcarew ithin90 daysof first-everHIVdiagnosis N um erator:P atientswhohadamedicalvisitforHIVcarew ithin90 daysoffirst-everHIVdiagnosis Denominator:P atientsfirstdiagnosedw ithHIVbythehealthcenterbetweenO ctober1 oftheprior yearthroughS eptember30 ofthecurrentm easurementyear

Informationaboutlinkagetocareamongpersonsnewly-diagnosedw ithHIVisintheV. HIV/AIDS section.

13. Dental Sealants for Children Age 6-9 Years

P ercentageofchildren,age6-9years,atm oderatetohighriskforcarieswhoreceivedasealantona permanentfirstm olarduringthem easurementperiod N um erator:P atientswhoreceivedasealantonapermanentfirstm olartoothinthem easurementyear Denominator:Dentalpatientsage6-9w hohadanoralassessmentorcomprehensiveorperiodicoral evaluationvisitduringthem easurementperiodanddocum entedashavingm oderatetohighriskforcaries

T heComm unityHealthAssessmentdoesnothaveinformationabouttheoralhealthstatusof childrenoradolescents. City of Newark, New Jersey Community Health Assessment - 2017 VI. Community Health Centers/FQHC Needs Assessment Page 60

14. Diabetes Hemoglobin A1c Poor Control

P ercentageofpatients18-75yearsofagew ithdiabeteswhohadhemoglobinA1c>9.0% duringthe m easurementperiod N um erator:P atientswhosem ostrecentHbA1clevel(performedduringthem easurementperiod)is >9.0% Denominator:P atients18-75yearsofagew ithdiabeteswithavisitduringthem easurementperiod

InformationabouttheN ewarkadultpopulationage18andolderw hohaddiagnoseddiabetesis insectionIV.HealthS tatus– diagnosedDiabetes.

15. Controlling High Blood Pressure

P ercentageofpatients18-85yearsofagew hohadadiagnosisofhypertensionandw hoseblood pressurew asadequatelycontrolled(lessthan140/90 mm Hg)duringthem easurementperiod N um erator:P atientswhosebloodpressureatthem ostrecentvisitisadequatelycontrolled(systolic bloodpressure<140 m m Hganddiastolicbloodpressure<90 m m Hg)duringthem easurementperiod Denominator:P atients18-85yearsofagew hohadadiagnosisofessentialhypertensionw ithinthefirst sixm onthsofthem easurementperiodoranytimepriortothem easurementperiod

InformationabouttheN ewarkadultpopulationage18andolderw ithhighbloodpressureand thosetakingm edicationisinsectionsIII.BehavioralFactors– U seofP reventiveS ervices(taking m edicationsforhighbloodpressure).

16. Low Birth Weight

P ercentageofpatientsborntohealthcenterpatientswhosebirthw eightw asbelow normal(lessthan 2,500 grams) N um erator:Childrenbornw ithabirthw eightofunder2,500 grams Denominator:L ivebirthsduringthem easurementyearforwomenw horeceivedprenatalcarefrom the healthcenterorbyareferralprovider

Informationaboutlow birthw eightinN ewarkisshowninIV.HealthS tatus– M aternal,Infantand ChildHealthandshowsLBW andVL BW comparedtoHealthyP eople2020 andHealthyN J2020 targets. City of Newark, New Jersey Community Health Assessment - 2017 VII. Community Partners and Resources Page 61

VII. Community Partners and Resources

A. Community Partnerships

T herearenum erouscomm unitypartnersandhealthcareproviderswhichareavailabletoN ewark residents.T hesearesum m arizedbelow.

 Hospitals/healthcaresystems. T herearethreeacutecarehospitalsinN ewark,withinthree m ajorstatehealthcaresystems.T hesesystemshaveinpatientandoutpatientclinicservices, includingfamilyhealthcareservices.  S ection330 Comm unityHealthCenters(CHCs)AKA “FederallyQ ualifiedHealthCenters (FQ HC)” – T herearefiveFQ HCsinN ewark– CityofN ewarkM aryElizaM ahoneyHealthCenter, N ewarkComm unityHealthCenters,RutgersU niversity– S choolofN ursing(servingpublic housingresidents),St.JamesHealth,Inc.,andJewishR enaissanceM edicalCenter(providing school-basedcare).  Comm unitybasedclinics– anum berofcomm unitybasedorganizations(CBO s)providem edical andhealthservicesatlocalsites,includingCBO sservingtheHispanic/Latinopopulation.  S choolbasedhealthservices– N ewarkP ublicS choolshasschoolbasedclinicsatallschools– elementary,middleandhighschool– throughoutN ewark.  Healthinsurers– anum berofhealthinsurancecompaniesareservingN ewarkandthestate’s largesthealthinsurancecompany,HorizonBlueCrossBlueS hield,isheadquarteredinN ewark asisPrudentialInsurance.

Inaddition,agenciesandindividualshaveparticipatedintheinitialmeetingoftheComm unityHealth ImprovementP lanningand/orhaveagreedtow orkw iththeDepartment.

AIDS R esourceFoundation Am ericanCancerS ociety/N ewarkCancerInitiative C.U .R.A.,Inc.(substanceabusetreatment)- ElClubDelBarrio EssexCountyCancerCoalition/St.M ichael’sM edicalCenter EssexCountyCollege Essex-PassaicW ellnessCoalition FocusComm unityHealthCenter GatewayN orthwestM aternal& ChildHealthN etwork GreaterN ewarkConservancy GreaterN ewarkHealthCareCoalition IntegrityHouse IsaiahHouse JewishR enaissanceHouse L aCasaDeDonP edro N ewarkBethIsraelM edicalCenter N ewarkComm unityHealthCenters,Inc. N ewarkP ublicS chools City of Newark, New Jersey Community Health Assessment - 2017 VII. Community Partners and Resources Page 62

N ew JerseyCitizenAction N ew JerseyInstituteofT echnology N ew JerseyM edicalSchool N orthernN ew JerseyM aternalChildHealthConsortium P lannedP arenthood,N ewark P rudentialInsuranceCo. R utgers-TheS tateU niversityofN ew Jersey S t.JamesHealth,Inc. S aintM ichael’sM edicalCenter T heL eaguers U nitedComm unityCorp

B. Availability of Funding Resources

A w idearrayoffundingresourcesisavailabletosupporthealthcareandrelatedservices.However, becausethecostofhealthcareissohighstate-andnationwideandhealthproblemsarecomplexand interrelatedw ithsocialandeconomicissues,theamountsareoftennotsufficienttocoverthecostof careforallresidents.

P rivatehealthinsuranceprovidedprimarilybyemployersisstillthelargestpaymentsourceforhealth care.However,theratesofsuchcoveragearelowerinN ewarkthanstatewideduetohigherratesof unemployment.N onetheless,them ajorfinancial,government,education,andhealthcareinstitutions inN ewarkprovidecoveragefortheiremployees,manyofwhom areN ewarkresidents.

M edicaidishealthinsuranceforverylow incomeindividualsandfamilieswhoare“ categorically eligible”. T hosew horeceiveT emporaryAssistancetoN eedyFamilies(TAN F)orS upplementalSecurity Income(SS I)alsoreceiveM edicaid.M edicaidisasignificantsourceofhealthcareforN ewarkresidents andrevenueforN ewarkhospitalsandotherproviders.In2014 N ew Jerseyimplemented M edicaid ExpansionavailableundertheACA w hichcoversN ewarkresidentsage18-64 w ithincomesunder138% FederalPovertyL evel,mostlysingleadultandchildlesscouplesandthosenoteligibleforcategorical M edicaid.T hishasimprovedaccesstocareincomm unityandhospitalsetting.

N ew JerseyFamilyCare(N JFC)isavailableforlowerincomechildrenw hosefamilyincomesexceed M edicaidlimitsorw hosefamiliesarenoteligibleforM edicaid.T henum berofbeneficiariesand amountofassistancetoN ewarkresidentsisunknown.However,manyhealthcareprovidersandCBO s assistfamiliesinapplyingforN JFC. In2015N ew JerseyincorporatedallofisM edicaid,M edicaid ExpansionandChildren’sHealthInsuranceP rogramsunder“N ew JerseyFamilyCare.”

M edicarepaysforhealthinsurancem ostlyforindividualsage65andolderw hohavebeenemployed andhavecontributedtotheS ocialSecuritysystem. (Itisforthisreasonthatlackofhealthinsuranceis m easuredforadultsunderage65.)

CharityCare. T heN ew JerseyHospitalCareP aymentAssistanceP rogram(CharityCareAssistance)is freeorreducedchargecarew hichisprovidedtopatientswhoreceiveinpatientandoutpatientservices atacutecarehospitalsthroughouttheS tateofN ew Jersey. Hospitalassistanceandreducedchargecare City of Newark, New Jersey Community Health Assessment - 2017 VII. Community Partners and Resources Page 63 areavailableonlyfornecessaryhospitalcare.S omeservicessuchasphysicianfees,anesthesiologyfees, radiologyinterpretation,andoutpatientprescriptionsareseparatefrom hospitalchargesandm aynot beeligibleforreduction.T hesourceoffundingforhospitalcarepaymentassistanceisthroughthe HealthCareS ubsidyFundadministeredunderP ublicL aw1997,Chapter263 (N JDO H,2017).

ForS tateFiscalYear2017(July1,2016– June30,2017),atotalof$50 m illionincharitycarew as allocatedtothethreehospitalsinN ewark.T hisis17% ofthetotal$302 m illioncharitycareallocation (N JDO H,2016).S tatecharitycarefundingfortheuninsuredhasdeclinedrecentlyduetothem anylow incomeindividualsnewly-insuredunderM edicaidExpansion(500,000 statewide).R evenuefrom M edicaidinsurancereimbursementhasreplacedsomeoftheneedforcharitycare.

O therS ources. O therfederalandstatesourcesfundhealthandm edicalprogramsforN ewark residents.O ver$6m illionisavailablethroughtheN ewarkFQ HCsformedicalcareforuninsured residents.O ver$2 m illionisavailableforhealthcareforhomelessindividuals.O ver$2 m illionofthe federalR yanW hiteHIV/AIDS P artA programfundsmedicalcareforresidentswithHIV/AIDS ,andan additional$3 m illionsupportsrelatedhealthservicesandcasem anagement.O therHIV/AIDS funding supportsmedicalcareforwomenandchildrenandforspecialservices.S tatecharitycarefundingis availabletoFQ HCsforoutpatientcarefortheuninsured,whichisreimbursedonacasebycasebasis.