Assessing Manchester’s Urban Advantage Greater Manchester Community Health Needs Assessment June 2019 For questions regarding this report, please contact the City of Manchester Health Department at 603-624-6466 or [email protected]. Table of Contents INTRODUCTION ..............................................................................................................................................................................1 REPORT AIM ...............................................................................................................................................................................................................1 REGIONAL GEOGRAPHY ......................................................................................................................................................................................1 PRIMARY DATA SOURCES AND LIMITATIONS ............................................................................................................................................2 HOW TO READ THE REPORT ............................................................................................................................................................................3 STRATEGIC FRAMEWORK FOR HEALTH IMPROVEMENT ......................................................................................................4 COUNTY HEALTH RANKINGS AND ROADMAPS .......................................................................................................................................4 HEALTHY PEOPLE 2020 ......................................................................................................................................................................................6 ADVERSE CHILDHOOD EXPERIENCES .........................................................................................................................................................6 OPPORTUNITY ATLAS .......................................................................................................................................................................................... 7 SOCIAL AND ECONOMIC FACTORS ......................................................................................................................................... 10 EDUCATION ............................................................................................................................................................................................................. 10 EMPLOYMENT .........................................................................................................................................................................................................27 INCOME .................................................................................................................................................................................................................... 30 FAMILY AND SOCIAL SUPPORT .................................................................................................................................................................... 38 COMMUNITY SAFETY ......................................................................................................................................................................................... 42 HEALTH BEHAVIORS...................................................................................................................................................................55 ALCOHOL AND DRUG USE ...............................................................................................................................................................................55 DIET AND EXERCISE...........................................................................................................................................................................................60 TOBACCO USE ...................................................................................................................................................................................................... 64 SEXUAL ACTIVITY ................................................................................................................................................................................................67 CLINICAL CARE ........................................................................................................................................................................... 75 ADEQUATE ACCESS ............................................................................................................................................................................................75 QUALITY OF CARE .............................................................................................................................................................................................. 86 PHYSICAL ENVIRONMENT .........................................................................................................................................................93 HOUSING ................................................................................................................................................................................................................. 93 TRANSPORTATION .............................................................................................................................................................................................105 HEALTH PROMOTING ASSETS ..................................................................................................................................................................... 109 HEALTH OUTCOMES & OPPORTUNITY ................................................................................................................................... 115 LENGTH OF LIFE .................................................................................................................................................................................................. 115 QUALITY OF LIFE ................................................................................................................................................................................................ 122 PERSISTENT POVERTY & LIMITED OPPORTUNITY ..............................................................................................................................126 AGING POPULATION .........................................................................................................................................................................................135 VOICES OF COMMUNITY & NEIGHBORHOOD LEADERS .................................................................................................... 138 BACKGROUND & METHODS ...........................................................................................................................................................................138 PRIORITY AREAS ................................................................................................................................................................................................139 KEY SUMMARY OF FINDINGS .......................................................................................................................................................................142 NEXT STEPS ...............................................................................................................................................................................144 REFERENCES ............................................................................................................................................................................. 146 APPENDIX................................................................................................................................................................................... 149 I. INTRODUCTION This report provides a snapshot of the health, wellbeing, and major issues facing the population in the Manchester region at various levels of geography depending on the data source – Manchester neighborhoods, City of Manchester, and Greater Manchester. Greater Manchester includes both the Greater Manchester Public Health Region (Auburn, Bedford, Candia, Deerfield, Goffstown, Manchester, and New Boston), as well as the Hospital Service Area (Public Health Region Towns plus Londonderry). Sources are noted accordingly throughout the report; including when the data is for the Hospital Service Area (HSA) specifically. The development of this report was a joint community effort spearheaded and guided by the City of Manchester Health Department in partnership with Catholic Medical Center and Elliot Health System. Among other things, this report is intended to satisfy the requirements for all Manchester area health care charitable trusts in connection with the periodic development of a community health needs assessment as required by the Affordable Care Act, as well as State law. Funding for this project was provided by all three partner organizations, including grant funding from The Kresge Foundation. Technical assistance and support to this effort, including the development and summary of all qualitative data and report design, were provided through a contract with the Community Health Institute of Bow, New Hampshire. Additionally, technical assistance was provided in