COMMUNITY HEALTH NEEDS ASSESSMENT GREATER NEW ORLEANS APRIL 2020 Methodist Health System Foundation, Inc. 360 Oak Harbor Boulevard Slidell, LA 70458 Wendy M. Beron, President Ann Clayton Chamberlain, VP-Program Management TABLE OF CONTENTS I. Summary Findings 3 II. Overview 4 III. Social Determinants of Health 6 IV. 2018 Louisiana Health Report Card – Overview 7 V. Community Description (MHSF Service Area Demographics) 12 VI. MHSF Community Partners and MHSF School Based Health Centers 14 VII. Summary Findings of Other Local Community Health Needs Assessments 16 VIII. Published Reports on Childhood Trauma and New Orleans School Partnership Study 21 IX. Economic and Political Conditions in Louisiana and Greater New Orleans 23 X. Footnotes 28 Appendices: I. MHSF Target Zip Codes 29 II. MHSF Service Area Demographics 30 III. Summary Information – MHSF Partners/School Based Health Center 31 2 Summary Findings • Unhealthy Population o Louisiana ranks at or near the bottom for the percentage of residents with a myriad of chronic diseases or conditions. Orleans Parish exhibits an even higher incidence of these conditions than the State average, with MHSF zip codes often the leader. • Lackluster Employment Opportunities for “living wage” jobs o The ongoing challenge to diversify the Greater New Orleans economy from a predominantly hospitality sector continues. Limited opportunities result in a cycle of poverty that spans multiple generations. • Continued Community Safety Concerns o The Greater New Orleans area continues to have a high rate of violent crimes – two times the State average and three times the national average. After decades of violence, there are still few solutions. The constant exposure to violence and trauma can lead to long term poor health outcomes for children. • Limited Access to Quality Social Services o As noted throughout this report, needs for social services are great in our community. Independent nonprofits attempt to fill the void for services to at risk populations that not provided by City or State agencies. While great work is accomplished, many are small nonprofits that operate on a “shoestring” budget. The New Orleans economy lacks the large corporate businesses and foundations that often fund social programs in large metropolitan cities. The result is an ongoing challenge for nonprofits to compete for support from few funding partners. • Increase in Federally Qualified Health Centers o One positive in the local healthcare landscape is the emergence of Federally Qualified Health Centers (FQHC) in the greater New Orleans area following Hurricane Katrina. The Health Resources and Services Administration (HRSA) dictates stringent licensing and quality measures and, in exchange, provides higher average reimbursement healthcare rates than for typical health centers. FQHC’s must demonstrate the need for services through an application process and with the addition of any new service sites. The result is an increase in quality, accessible, affordable care throughout the city to provide residents with a medical home for primary health visits and monitoring for chronic illnesses. 3 Overview History Methodist Health System Foundation (the “Foundation” or “MHSF”) is a health legacy foundation operating in the Greater New Orleans area. The principal assets of the Foundation were funded through the sale of Pendleton Memorial Methodist Hospital in 2003. MHSF Board of Directors adopted a mission to support, develop and manage health-related programs and provide access to services that benefit the citizens of East New Orleans and beyond. The Foundation’s primary service area contains areas of Orleans Parish that include New Orleans East and Gentilly and St. Bernard Parish. The service area mirrors the prior service area of the Hospital (see map at Appendix I). MHSF’s current programs include: • Strategic Grants – Strategic grantmaking program which seeks to improve the physical, emotional, and mental health of citizens of the metropolitan New Orleans area with an emphasis on our service area. • School-Based Health Centers – This program offers adolescents and adults access to both high quality physical and behavioral health services in a safe, secure environment. Project Goals As a 501(c)(3) non-profit, the Foundation periodically conducts a Community Health Needs Assessment to provide current, relevant data to assess the needs of our community and the existing resources and programs currently available. These facts guide and support our decisions to commit resources to community programs. The Foundation’s vision is to improve healthy, self-sustaining individuals and communities. Professional Research Consultants, Inc. conducted needs assessments for MHSF in both 2011 and 2015. MHSF staff conducted this 2019 Needs Assessment utilizing various resources, including, but not limited to: • Demographic and aggregate patient data, number of visits and primary reason for care from several New Orleans area healthcare organizations (a local hospital and several Federally Qualified Community Health Centers (“FQHC’s”) and a community service provider)1 • Recent Community Health Needs Assessments conducted for several large nonprofit New Orleans hospital organizations2 • 2018 Louisiana Health Report Card 3 • Detailed demographic and medical disease information for State, Parish and MHSF zip codes from available databases • Local and national publications on relevant topics • Other information derived from prior or current MHSF grantee organizations 4 The 2019-2020 assessment seeks to: • Outline the basic demographics of our community as primarily defined by the MHSF service area to include income levels, race/ethnicity, and age. • Identify the primary health needs of our community. We recognize that “health” can be complicated when basic needs (food, housing) are not met. • Identify organizations/public agencies that exist to address the health needs of our community. • Identify gaps in services and how could the gaps be addressed. • Review local funding sources and see how local programs are funded. The goal is to: • Collect data regarding health needs in our community. • Identify existing service gaps in our community. • Analyze investments in programs that deliver quality services in a cost-effective manner with a clear path to sustainability. 5 Social Determinants of Health4 Source: County Health Rankings model; University of Wisconsin Population Health Institute • The Health Resources and Services Organization (HRSA), a U.S. government agency, defines Social Determinants of Health as “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks”. • As illustrated on the diagram above, recent research indicates that social and economic factors in a person’s life can have a significant impact on health outcomes – up to 40% is based on education, employment, income, family and social support and community safety. 6 LOUISIANA HEALTH REPORT CARD 20185 The Louisiana Department of Health is required to issue an annual report card describing the overall health of its citizens and identified health‐related issues. In addition to informing Louisianans on the overall health circumstances in our state, the annual publication is used as a tool for health planning and evaluating the effectiveness of health programs. The Report Card summarizes overall Facts and Figures and status on health findings of major diseases including cancer, teenage pregnancy and birth rates (including low birthweight babies), suicide and violent deaths, sexually transmitted infections, incidence of drug addictions and opioid epidemic and infectious diseases. Medicaid Expansion in 2016 has significantly decreased the number of uninsured Louisiana residents from 16.6% in 2013 to approximately 8.4% in 2017 (a favorable comparison to the national uninsured rate of 8.7%). Total adults enrolled in Medicaid Expansion in Louisiana in February 2019 was 502,055. • Orleans Parish o New enrollment of 49,137 o 70% have had doctor visits in 2018 • St. Bernard Parish o New enrollment of 5,433 o 74% have had doctor visits in 2018 Louisiana Health conditions - poor ranking in three major disease categories: Death due to Heart disease and stroke Louisiana US Rank 46 -- # of deaths/100,000 320 256.8 Adult Obesity (BMI 30 or >) Louisiana US Rank 45 -- % of population 36.2 29.9 • Increase from 35.5% in 2016 Adult Diabetes Louisiana US Rank 47 -- % of population 13.6% 10.5 • Increase from 12.1% in 2016 • Region 1 (including Orleans & St. Bernard) = 16.5% 7 CANCER RATES Louisiana Rank U.S. # Deaths* Due to All Cancers 215.3 44 189.8 Rate of New Cancer* 477.5 46 438 Cancer Rate* by Race & Sex Black Women 415.4 397.8 White Women 544.8 423.1 Black Men 605.1 535.0 White Men 551.4 488.5 *Per 100,000 • Black women in Louisiana had significantly higher breast, colorectal, kidney, and cervical cancer than the national population of black women, but significantly lower rates of uterine cancer. • White women also had significantly higher rates of colorectal and kidney cancer, and lower rates of uterine cancer than their respective national populations • The three most commonly occurring cancers in all Louisianan women were breast, lung/bronchus, and colorectal • At 605.1 cases per 100,000 population, black men in Louisiana had significantly higher rates of all cancers compared to the national rates for black men (535.0 cases per 100,000). This 13.1% difference was