central new hampshire health partnership · the total population of the primary service area of the...

CentralNewHampshireHealthPartnership

CommunityHealthNeedsAssessment2017

CommunityInputonHealthIssuesandPriorities,

SelectedServiceAreaDemographicsandHealthStatusIndicators

Pleasedirectcommentsorquestionsto:

KateTarbox,MA,APRDirectorofMarketing&CommunityRelations

SpeareMemorialHospital16HospitalRoad,

Plymouth,NH03264603-238-6468

or

SaraDonahueCentralNewHampshireHealthPartnership

101BoulderPointDrive,Plymouth,NH03264

603-238-3510

CommunityHealthNeedsAssessmentPartners:CommunityActionProgramBelknap-MerrimackCounties*CommunitiesforAlcohol-andDrug-freeYouth(CADY)*GenesisBehavioralHealth*Mid-StateHealthCenter*NewfoundAreaNursingAssociation*Pemi-BakerCommunityHealth*SpeareMemorialHospitalwithadditionalassistanceoftheWholeVillageFamilyResourceCenter

andPlymouthRegionalSeniorCenter

|FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment 1

CentralNewHampshireHealthPartnershipCommunityHealthNeedsAssessment

2017ExecutiveSummary

DuringtheperiodMaythroughSeptember2017,anassessmentofCommunityHealthNeedsAssessmentoftheCentralNewHampshireregionwascompletedbytheCentralNewHampshireHealthPartnership.Thepurposeoftheassessmentwastoidentifycommunityhealthconcerns,prioritiesandopportunitiesforcommunityhealthandhealthcaredeliverysystemsimprovement.Forthepurposeoftheassessment,thegeographicareaofinterestwas18municipalitiescomprisingtheCentralNewHampshirePublicHealthRegionwithatotalresidentpopulationof30,039,andservedbythememberagenciesoftheCentralNewHampshireHealthPartnership(www.cnhhp.org).Methodsemployedintheassessmentincludedsurveysofcommunityresidentsmadeavailableon-lineandpapersurveysplacedinnumerouslocationsthroughouttheregion;adirectemailsurveyofkeystakeholdersandcommunityleadersrepresentingmultiplecommunitysectors;asetofcommunitydiscussiongroups;compilationofresultsfromassessmentactivitiesfocusedspecificallyonbehavioralhealthneedsandgaps;andareviewofavailablepopulationdemographicsandhealthstatusindicators.Allinformationcollectionactivitiesandanalysessoughttofocusassessmentactivitiesonvulnerableanddisproportionatelyservedpopulationsintheregionincludingpopulationsthatcouldexperiencelimitedaccesstohealth-relatedservicesorresourcesduetoincome,age,disability,andsocialorphysicalisolation.Thetablebelowprovidesasummaryofcommunityhealthneedsandissuesidentifiedthroughthesemethods.

2 |FY2017CentralNHHealthPartnershipCommunityHealthNeedsAssessment

SUMMARYOFCOMMUNITYHEALTHNEEDSANDISSUESBYINFORMATIONSOURCECommunityHealth

Issue CommunitySurveys CommunityDiscussionGroups

CommunityHealthStatusIndicators

Alcoholanddruguseprevention,treatment

andrecovery

Preventionofsubstancemisuse,addictionandaccesstosubstancemisusetreatmentandrecoveryserviceswerethetopissuesidentifiedbybothcommunitysurveyrespondentsandkeystakeholders

Identifiedasahighandcontinuingpriorityforcommunityhealthimprovementbyallcommunitydiscussiongroups

Theoveralloverdosemortalityrateintheregionwas24.7per100,000people;amortalityratehigherthanmosttypesofcancerexceptlungcancer

Accesstoaffordablehealthcareservicesandinsurance

Availabilityofaffordablehealthinsurancewasthenexthighestpriorityaftersubstancemisuseidentifiedbycommunityandkeystakeholdersurveyrespondents

CommunitydiscussionsnotedimprovementsininsuranceaccessincludingMedicaid,butstillidentifiedcostandhealthcareserviceavailabilitybarriers

TheestimateduninsuranceratehasdeclinedsubstantiallyintheCNHHPservicearea(from14%toabout9%),),butstillexceedstheoveralluninsurancerateestimateforNH(6.4%)

SUMMARYOFCOMMUNITYHEALTHNEEDSANDISSUESBYINFORMATIONSOURCECommunityHealth

Issue CommunityHealthIssue CommunityHealthIssue CommunityHealthIssue

Accesstomentalhealthservices

Accesstomentalhealthcarewasthefourthhighestpriorityidentifiedbycommunityandkeystakeholdersurveyrespondentswith63%consideringita‘veryhighpriority’

Identifiedasahighandcontinuingpriorityforcommunityhealthimprovementbyallcommunitydiscussiongroupsincludingconcernsforinsufficientaccesstoinpatientpsychiatriccare

Medicaidmemberswithabehavioralhealthconditionresidingintheregionwereover4timesmorelikelytohavehadfourormorevisitstoanemergencydepartmentin2015andtwiceaslikelytohavehadanunplannedinpatientreadmissioncomparedtoMedicaidmemberswithoutarecentclaimshistoryindicatingabehavioralhealthcondition.

Domesticviolenceandchildhoodtrauma

Childabuseorneglectanddomesticviolencewereidentifiedasahighpriorityorveryhighprioritybyoverathreequartersofcommunitysurveyrespondents

Communitydiscussiongroupparticipantsreportedconcernsabouttheeffectsofparentalsubstanceuseonchildreninthecommunity;alsonotedalackofaffordablechildcareoptions

Theproportionofindividualslivingnearorbelowthepovertylevel,including38%ofchildren,ishigherintheregioncomparedtothestateoverall

Accesstohealthyfoodsandopportunitiesfor

activeliving

Opportunitiesforphysicalactivity,recreation,goodnutritionandaccesstohealthfoodscitedasahighorveryhighprioritybyabouttwothirdsofcommunityandkeystakeholdersurveyrespondents

Communitydiscussiongroupsidentifiedaneedforbettercommunicationaboutavailablehealth-relatedactivitiesandresources

55%ofadultsintheserviceareaareoverweightorobese;about23%ofadultsreportbeingphysicallyinactiveinthepast30days


Seniorservicesincludingassistedliving

orlongtermcareservices

Improvedresourcesforassistedlivingorlongtermcarewasthesixthhighestpriorityidentifiedbykeystakeholders

Localaccesstoaffordableseniorhousingandassistedlivingidentifiedbyparticipantsinthepublichealthcouncilandsenioradvisorycouncil

Theserviceareapopulationhasproportionallymoreseniors(17.7%are65+)comparedtoNHoverall(15.3%)

Accesstotransportation

Lackoftransportationwasidentifiedasthefourthmostsignificantbarrierkeepingpeoplefromaccessingservicesbykeystakeholders

AccesstotransportationIdentifiedbyallcommunitydiscussiongroupsasanunderlyingandchronicissueimpactingaccesstoservicesandsocialisolation,particularlyforyouthandfamilieswithlimitedincome

4.1%ofhouseholdsintheCNHHPregionreporthavingnovehicleavailable


CentralNewHampshireHealthPartnership

2017CommunityHealthNeedsAssessment

TableofContents

EXECUTIVESUMMARY 1

A. CommunityandKeyStakeholderSurveyResults 4

1.MostImportantHealthIssuesIdentifiedbyCommunitySurveyRespondents 7

2.MostImportantCommunityHealthIssuesIdentifiedbyKeyStakeholderSurveyRespondents 11

3.ComparisonofMostImportantCommunityHealthIssues;CommunityandKeyStakeholderRespondents 13

4.AccessBarrierstoServicesIdentifiedbyCommunitySurveyRespondents 15

5.BarrierstoServicesIdentifiedbyKeyStakeholderSurveyRespondents 19

6.BehavioralHealthNeedsSurveyFindings 22

B.CommunityHealthDiscussionGroups 28

1.CommunityDiscussionGroupThemes 29

2.HighPriorityIssuesfromCommunityDiscussionGroups 31

C.CommunityHealthStatusIndicators 37

1.DemographicsandSocialDeterminantsofHealth 37

2.AccesstoCare 42

3.HealthPromotionandDiseasePreventionPractices 48

4.SelectedHealthOutcomes 53

5.ComparisonofSelectedCommunityHealthIndicatorsbetween2014and2017 63

APPENDICES(seeseparatedocument):CommunityandKeyStakeholderSurveyResults,DiscussionGroupSummaries


A.COMMUNITYANDKEYSTAKEHOLDERSURVEYRESULTSWITHSELECTEDSERVICEAREADEMOGRAPHICSThetotalpopulationoftheprimaryserviceareaoftheCentralNewHampshireHealthPartnershipin2015was30,039accordingtotheUnitedStatesCensusBureau,whichisadecreaseof-1.9%orabout600peoplesincetheyear2010.TheFY2017CommunityHealthNeedsAssessmentSurveyconductedbytheCentralNHHealthPartnershipyielded409individualresponsesofwhich88%wereresidentsoftownswithintheprimaryserviceareaorapproximately1.5%ofthetotaladultpopulation.AsshownbyTable1,surveyrespondentsfromtheserviceareaarerepresentedinrelativelycloseproportionoveralltotheserviceareapopulationbytown.ItisalsoimportanttonotethatFY2017surveyrespondentsweremorelikelytobefemale(74.8%ofrespondents)andolder(29.5%age65yearsormore)comparedtotheoveralladultpopulationintheservicearea.

Table1:ServiceAreaPopulationbyTown;

ComparisontoProportionofFY2017CommunitySurveyRespondents

2015Population ZipCode* %ServiceAreaPopulation %ofRespondents

CNNHPServiceArea 30,039 Plymouth,Bridgewater 7382 03264 24.6% 22.4%Bristol,Alexandria,Bridgewater 5520 03222 18.4% 14.8%Campton,Ellsworth 3366 03223/19 11.2% 10.6%Holderness 2174 03245 7.2% 7.4%Rumney 1611 03266 5.4% 6.9%Thornton 2104 03285 7.0% 6.3%Ashland 2196 03217 7.3% 4.7%Hebron,Groton 1259 03241 4.2% 4.7%Lincoln,Livermore 1345 03251 4.5% 4.0%Woodstock 1054 03262 3.5% 1.8%Wentworth 941 03282 3.1% 1.8%Warren 873 03279/38 2.9% 1.9%WatervilleValley 214 3215 0.7% 0.8%Other/Unknown NewHampton(2.4%),Meredith(1.1%),Danbury(1.1%),Laconia

(1.1%)11.9%

*Surveyrespondentswereaskedtoindicatethezipcodeoftheircurrentlocalresidence.


Table2belowdisplaysadditionaldemographicandeconomicinformationforthetownsoftheCNHHPServiceArea.Onthistable,municipalitiesaredisplayedinorderofmedianhouseholdincomewithcomparisontothemedianhouseholdincomeintheregionandstateoverall.Asdisplayedbythetable,alltownsintheserviceareaexceptWatervilleValleyhavelowermedianhouseholdincomesthantheStateofNewHampshireoverall.Inaddition,allexcept3townshaveahigherproportionofindividualswithhouseholdincomesat200%ofthefederalpovertylevelorlesswhencomparedtothestateoverall.Figure1followingthistabledisplaysamapoftheserviceareawithshadingdepictingthemedianhouseholdincomebytownin5categoriesfromlowtohighmedianhouseholdincome.

Table2:SelectedDemographicandEconomicInformation

Median

HouseholdIncome

%withincomeunder200%PovertyLevel

%familyhouseholdswithchildrenheadedbyasingleparent

%populationwithadisability

Ellsworth $37,000 23.2% 0.0% 14.3%Lincoln $37,095 49.6% 78.4% 20.7%Plymouth $40,745 42.9% 16.3% 9.9%Warren $40,769 47.7% 43.5% 19.0%Groton $43,846 36.2% 43.2% 17.2%Ashland $45,938 31.0% 32.8% 18.6%Woodstock $49,063 25.8% 44.8% 12.0%Bristol $50,080 29.1% 49.8% 13.8%CNNHPServiceArea $50,872 31.5% 30.1%

513.4%

Rumney $51,250 29.5% 39.4% 14.7%Wentworth $54,306 34.5% 9.6% 16.9%Alexandria $55,066 30.4% 12.6% 16.0%Bridgewater $55,500 16.8% 27.3% 17.4%Thornton $56,058 15.7% 12.8% 14.1%Campton $56,429 25.1% 29.0% 10.7%Hebron $57,222 38.7% 53.7% 13.1%Holderness $59,079 25.5% 24.0% 8.7%NewHampshire $66,779 22.3% 29.1% 12.1%WatervilleValley $87,500 7.0% 35.7% 6.5%


Figure1–MedianHouseholdIncomebyTown,CNHHPServiceArea

2009-2013AmericanCommunitySurvey;Mapsource:AmericanFactfinder

MedianHouseholdIncome($) Bridgewater

Bristol

Alexandria

LincolnLivermore


1.MostImportantCommunityHealthIssuesIdentifiedbyCommunitySurveyRespondents

Communityrespondentstothe2017CommunityHealthNeedsSurveywerepresentedwithalistof13health-relatedtopicsthathavebeenidentifiedasprioritiesinpreviouscommunityhealthassessmentsintheCentralNewHampshireregion.Foreachtopic,respondentswereaskedtoindicatetheextenttowhichtheythoughtitshouldremainapriorityforcommunityhealthimprovementworkrelativetootherpotentialpriorities.Asecondquestionpresentedrespondentswithalistof13moretopics,includingand“other’write-inoption,thatcouldbeconsideredprioritiesfortheCentralNewHampshireregion.Respondentswerethenaskedtoindicatetheextenttowhichtheythoughteachtopicshouldbecomeapriorityforcommunityhealthimprovementworkrelativetootherpotentialpriorities.

Table3onthenextpagedisplaysthetopprioritytopicsforhealthimprovementeffortsidentifiedbycommunityrespondents.Thetopicsdisplayedwithsolidcolorsaretopicsthathadbeenidentifiedinpreviousneedsassessment.Thosetopicsshownwithdottedcoloringaretopicsthatrosetoahighlevelpriorityfromthesecondsetofpotentialtopics.Thechartdisplaysthepercentageofrespondentsindicatingthetopicasahighpriorityorveryhighpriority(needsaremostlyunmet).Otherresponsechoicesweremoderatepriority,somewhatlowpriorityandlowpriority(needsaremostlymet).

Substancemisuseprevention,treatmentandrecovery,availabilityofaffordablehealthinsurance,andaccesstomentalhealthservicesareeachtopprioritiesfrompriorcommunityhealthneedsassessmentsthatremainamongthehighestpriorities.Childabuseorneglectanddomesticviolencearetwohighprioritiesnotspecificallyidentifiedinpriorneedsassessments,although‘fragilefamiliesandreductionoffamilystress’isarelatedtopicthatwaspreviouslyidentifiedasahighpriorityforcommunityhealthimprovementefforts.


Figure2:HighPriorityCommunityHealthIssues;CommunityRespondents

42%

37%

41%

40%

37%

27%

32%

31%

29%

30%

26%

33%

31%

34%

39%

53%

49%

52%

55%

55%

0% 20% 40% 60% 80% 100%

Opportunitiesforphysicalactivity,recreation

Healthcareforseniors

Accesstohealthyfoods,goodnutrition

Availabilityofprimarycareservices

Domesticviolence

Childabuseorneglect

Accesstomentalhealthcareservices

Availabilityofaffordablehealthinsurance

Accesstosubstancemisusetreatment/recoveryservices

Preventionofsubstancemisuseandaddiction

highpriority

veryhighpriority

LowPriority

SomewhatLowPriority

ModeratePriority

HighPriority

VeryHighPriority

NeedsareMostlyMet NeedsareMostlyUnmet


Thetablebelowdisplaysthetop5communityhealthimprovementprioritiesidentifiedbycommunitysurveyrespondentsbyagegroup.Thepercentagesshownarethetotalpercentageswithineachagegroupselectingthetopicasahighpriorityorveryhighpriority.Amongrespondentsage65yearsorolder,‘availabilityofprimarycareservices’and‘healthcareforseniors’werehigheronthelistcomparedtootheragegroups,while‘accesstosubstancemisusetreatmentandrecoveryservices’wasreportedasahigherpriority(relatively)byyoungeragegroups,aswas‘childabuseorneglect’.

Table3:COMMUNITYHEALTHIMPROVEMENTPRIORITIES

BYAGEGROUP;Communityrespondents

18-44years n=126 45-64years n=149 65+years n=115

Accesstosubstancemisusetreatmentandrecovery

services80.2% Preventionofsubstance

misuseandaddiction 87.7% Availabilityofaffordablehealthinsurance 90.8%

Preventionofsubstancemisuseandaddiction 77.6% Accesstomentalhealth

careservices 87.2% Availabilityofprimarycareservices 87.1%

Availabilityofaffordablehealthinsurance 75.4%

Accesstosubstancemisusetreatmentandrecoveryservices

87.1% Preventionofsubstancemisuseandaddiction 87.0%

Childabuseorneglect 74.4% Availabilityofaffordablehealthinsurance 84.5% Accesstomentalhealth

careservices 87.0%

Accesstohealthyfoods,goodnutrition 72.6% Childabuseorneglect 79.6% Healthcareforseniors 86.4%


Thetablebelowdisplaysthetop5communityhealthimprovementprioritiesidentifiedbycommunitysurveyrespondentsbyincomegroup.Aswiththeprevioustable,thepercentagesshownarethetotalpercentageswithineachagegroupselectingthetopicasahighpriorityorveryhighpriority.Amongrespondentswithhouseholdincomelessthan$25,000,‘availabilityofaffordablehealthinsurance’and‘availabilityofprimarycareservices’werehigheronthelist(relatively)comparedtootherincomegroups.Accesstomentalhealthcareandsubstanceusetreatmentserviceswereratedhigherbyrespondentsinthemiddleandupperincomegroups.

Table4:COMMUNITYHEALTHIMPROVEMENTPRIORITIES

BYINCOMECATEGORY;Communityrespondents

Lessthan$25,000 n=95 $25,000to$74,999 n=129 $75,000or more n=143

Availabilityofaffordablehealthinsurance 80.0% Accesstomentalhealth

careservices 90.3% Preventionofsubstancemisuseandaddiction 90.0%

Childabuseorneglect 77.6%Accesstosubstancemisusetreatmentandrecoveryservices

87.1%Accesstosubstancemisusetreatmentandrecoveryservices

89.3%

Availabilityofprimarycareservices 76.3% Availabilityofaffordable

healthinsurance 86.4% Accesstomentalhealthcareservices 86.6%

Preventionofsubstancemisuseandaddiction 75.8% Preventionofsubstance

misuseandaddiction 85.4% Accesstohealthyfoods,goodnutrition 80.9%

Domesticviolence 75.8% Childabuseorneglect 83.6% Availabilityofaffordablehealthinsurance 80.8%


2.MostImportantCommunityHealthIssuesIdentifiedbyKeyStakeholderSurveyRespondents

Inadditiontothesurveyofcommunityresidents,the2017CommunityHealthNeedsAssessmentincludedasimilarsurveysentbydirectemailtokeystakeholdersandcommunityleadersfromaroundtheregion.Atotalof51completedresponseswerereceived(56.7%responserate)representingthefollowingcommunitysectors.

Table5:KeyStakeholderSurveyRespondents

PercentofRespondents

CommunitySector

25.5%

19.6% Business(10)

17.6% PrimaryHealthCare(9)

15.7% Education/YouthServices(8)

13.7% Municipal/CountyGovernment

(7)

13.7% PublicHealth(7)

11.8% Faithorganization(6)

9.8% Fire/EmergencyMedical

Service(5)

9.8% PublicSafety/Law/Justice(5)

9.8% HumanService/Social

Communitymember/Volunteer(13respondents)19.6% Business(10)17.6% PrimaryHealthCare(9)15.7% Education/YouthServices(8)13.7% Municipal/CountyGovernment(7)11.8% PublicHealth(6)11.8% Faithorganization(6) 9.8% Fire/EmergencyMedicalService(5)9.8% PublicSafety/Law/Justice(5)9.8% HumanService/SocialService(5)5.9% MentalHealth/BehavioralHealth(3)3.9% HomeHealthCare(2)3.9% Civic/CulturalOrganization(2)2.0% MedicalSub-Specialty(1)

Respondentstothekeystakeholdersurveywerepresentedwiththesametwolistsofhealth-relatedtopics:thelistoftopicsidentifiedasprioritiesinpreviouscommunityhealthassessmentsintheCentralNewHampshireregion;andasecondlistoftopics(including‘other’)thatcouldbeconsideredprioritiesforhealthimprovementeffortsintheregion.Thechartonthenextpagedisplaystheresultsofthesequestionsfromkeystakeholderresponses.

Thetopfourissuesidentifiedbykeystakeholdersarethesameasthoseidentifiedbycommunityrespondents;withevenhigherpriorityratingsforsubstancemisuseprevention,treatmentandrecovery(approximately3ofevery4keystakeholderrespondents


identifiedtheseareasasveryhighpriority).Keystakeholdersweremorelikelytoidentifyassistedliving,longtermcareandhomehealthcareashighpriorities(relatively)comparedtocommunitysurveyrespondents.

Figure3:CommunityHealthImprovementPriorities KeyStakeholderSurveyRespondents

24%

33%

41%

50%

22%

37%

24%

30%

14%

26%

43%

33%

29%

22%

50%

37%

63%

58%

75%

72%

0% 20% 40% 60% 80% 100%

Reductionoffamilystress



Homehealthcareservices

Assistedlivingorlongtermcareservices

Childabuseorneglect




Accesstosubstancemisusetreatmentandrecoveryservices

highpriority

veryhighpriority

LowPriority

SomewhatLowPriority

ModeratePriority

HighPriority

VeryHighPriority

NeedsareMostlyMet NeedsareMostlyUnmet


3.ComparisonofMostImportantCommunityHealthIssues;CommunityandKeyStakeholderRespondents

Thechartbelowdisplaysacomparisonoftheresponsesbetweencommunityandkeystakeholdersurveysforthehighestprioritycommunityhealthissues.Bluebarsonthechartdisplaythepercentageofkeystakeholdersselectingthetopicashighpriorityorverypriorityandredbarsdisplaytheresultsfromcommunityrespondents(topicsarearrayedoverallhightolowaccordingtothecommunityrespondentpercentages;seecompletesurveyresultsintheAppendicesforremainingtopicsidentifiedaslowerpriorities).

Figure4:CommunityHealthImprovementPriorities ComparisonofCommunityandKeyStakeholderRespondents

0% 20% 40% 60% 80% 100%

Homehealthcareservices

Preventionandtreatmentofcancer

Assistedlivingorlongtermcareservices



Accesstohealthyfoods,goodnutrition


Domesticviolence

Childabuseorneglect



Accesstosubstancemisusetreatment/recoveryservices


Keystakeholders

Communityrespondents


Thechartbelowdisplaysthecombinedresultsfromthequestionsoncommunityhealthimprovementprioritiesfromtheperspectiveofcommunityandkeystakeholdersurveyrespondents.Theresponsepercentagesfromcommunityrespondentsweregivendoubleweightinthecomputationofcombinedresponses.Thetop10communityhealthprioritiesaredisplayed.Asinpreviouscharts,barsdepictedwithsolidcoloraretopicsthathadbeenidentifiedinpreviousneedsassessment.Thosetopicsshownwithdottedcoloring(childabuseorneglect,domesticviolence,assistedlivingorlongtermcareservices)aretopicsthatrosetoahighpriorityfromthesecondsetofpotentialtopics.

Figure5:CommunityHealthImprovementPriorities

CommunityandKeyStakeholderResponsesCombined


4.BarrierstoServicesIdentifiedbyCommunitySurveyRespondents

RespondentstotheFY2017CommunityNeedsAssessmentSurveywereasked,“Inthepastyear,haveyouorsomeoneinyourhouseholdhaddifficultygettingthehealthcareorhumanservicesyouneeded?”Overall,30.4%ofsurveyrespondentsindicatedhavingsuchdifficulty.AsFigure6displays,thereisasignificantrelationshipbetweenreportedhouseholdincomecategoryandthelikelihoodthatrespondentsreportedhavingdifficultyaccessingservices.Figure7examinesresponsestothisquestionbysub-regionwithintheCNHHPservicearea.Ingeneral,theproportionofrespondentsindicatingdifficultyaccessingserviceswassimilaracrosstheregion.

Figure6:AccesstoServices Figure7:AccesstoServicesCommunitySurveyResponses bysub-region


30.4%

45.3%

31.0%

20.6%

0%

10%

20%

30%

40%

50%

AllRespondents Lessthan$25,000 $25,000to$74,999 $75,000ormore

AnnualHouseholdIncome

Inthepastyear,haveyouorsomeoneinyourhouseholdhaddifficultygettingthehealthcareorhumanservicesyouneeded?

Percentresponding"Yes"


Thesurveyalsoaskedpeopletoindicatetheareasinwhichtheyhaddifficultygettingservicesorassistance.AsdisplayedbyChart3,themostcommonservicetypesthatpeoplehaddifficultyaccessingwere:dentalcareforadults(32%ofthoserespondentsindicatingdifficultyaccessinganyservices);specialtyhealthcare(32%);primaryhealthcare(28%)andmentalhealthcare(28%).Notethatpercentagesonthischartareofthesubsetofrespondentswhoindicatedanydifficultyaccessingservices(30%ofallrespondents;n=120).

Figure8


Inaseparatequestion,43.9%ofsurveyrespondentsindicatedthat‘theyorsomeoneintheirhouseholdhadtotraveloutsideofthelocalareatogettheservicestheyneededinthepastyear’.Inanopen-endedfollow-upquestion,orthopediccare,cancertreatment,dentalcare,dermatologyandmentalhealthcarewerethemostcommonlycitedservicesforwhichpeopleweretravelingoutsideofthearea.(SeeAppendixAforcompletesurveyresponses.)

Respondentswhoreporteddifficultyaccessingservicesinthepastyearforthemselvesorafamilymemberwerealsoaskedtoindicatethereasonswhytheyhaddifficulty.AsshownonFigure9,thetopreasonscitedwere:‘serviceIneededwasnotavailableinmyarea’(43%);‘couldnotaffordtopay’fortheservice(41%);and‘hadnodentalinsurance’(34%).Percentagesareagaincalculatedfromthesubsetofrespondentswhoindicateddifficultyaccessingservices.

Figure9:AccessBarriersPerspectivesofCommunityRespondents


FurtheranalysisofthesetwoquestionsaddressingaccesstospecifictypesofservicesisshownbyTable6.Amongrespondentsindicatingdifficultyaccessingadultdentalcare,thetopreasonindicatedfordifficultyaccessingserviceswas‘hadnodentalinsurance‘(76%),followedbycouldnotaffordtopay’(73%).Similarly,amongrespondentsindicatingdifficultyaccessingprimarycareservices,thetopreasonscitedwerealsorelatedtoaffordabilityandlackofhealthinsurance.Amongrespondentsindicatingdifficultyaccessingspecialtyhealthcareandmentalhealthcare,thetopreasoncitedforaccessdifficultieswas‘serviceIneededwasnotavailableinmyarea(74%and53%respectively)and‘waitingtimetogetanappointment’wasalsofrequentlyassociatedwithrespondentsindicatingaccessdifficultiesinthesetwoareas.Thissuggeststhatavailableservicecapacityisamoresignificantaccessbarrierformentalhealthandspecialtymedicalservices(relatively)comparedtodentalcareandprimaryhealthcarewherethetopchallengesareassociatedwithinsuranceandaffordability.

TABLE6:TOPREASONSRESPONDENTSHADDIFFICULTYACCESSINGSERVICESBYTYPEOFSERVICE(Percentageofrespondentswhoreporteddifficultyaccessingaparticulartypeofservice)


5.BarrierstoServicesIdentifiedbyKeyStakeholderSurveyRespondents

Respondentstothekeystakeholdersurveywerealsoaskedtoidentifythemostsignificantbarriersthatpreventpeopleinthecommunityfromaccessingneededhealthcareservices.Thetopissuesidentifiedbythisgroupwerealsorelatedtoaffordabilityandinsurancecoverage.Othertopissuesincluded‘inabilitytonavigatethehealthcaresystem,lackoftransportation,andreluctancetoseekoutservices.

Figure10:MostSignificantBarrierstoAccessingServicesPerspectivesofKeyStakeholders

DentalCareforAdults(n=41,10.0%ofallrespondents)

SpecialtyHealth Care(n=38,9.3%ofallrespondents)

MentalHealthCare(n=34,8.3%ofallrespondents)

PrimaryHealthCare(n=33,8.1%ofallrespondents)

75.6%ofrespondentswhohaddifficultyreceivingadultdentalcarealsoreportedtheyHadnodentalinsurance

73.7%ofrespondentswhohaddifficultyreceivingspecialty healthcarealsoreportedtheService Ineededwasnotavailableinmyarea

52.9%ofrespondentswhohaddifficultyreceivingmentalhealthcarealsoreportedtheServiceIneededwasnotavailableinmyarea

45.5%ofrespondentswhohaddifficultyreceivingprimary healthcarealsoreportedtheCouldnotaffordtopay

73.2%Couldnotaffordtopay

42.1%Waiting timetogetanappointmentwastoolong


42.4%Hadnohealthinsurance

36.6%ServiceIneeded wasnotavailableinmyarea


41.2%Waitingtimetogetanappointmentwastoolong

36.4%OfficewasnotopenwhenIcouldgo

36.6%Hadnohealthinsurance

21.1%Hadnodentalinsurance

32.4%Insurancedeductiblewastooexpensive

30.3%Insurancedeductiblewastooexpensive

29.3%Wasnoteligible fortheservice

18.4%Insurance deductiblewastooexpensive

26.5%Didnotknowwheretogotogetservices

27.3%Waitingtimetogetanappointmentwastoolong


Keystakeholderswerealsoaskediftherearespecificpopulationsinthecommunitythatarenotbeingadequatelyservedbylocalhealthservices.About56%ofrespondentsindicatedthattherearespecificunderservedpopulations(6%responded“No”and38%were“Notsure”).Figure11displaysresultsfromkeystakeholderresponsesonspecificpopulationsthoughttobecurrentlyunderserved.‘PeopleinneedofMentalHealthCare’,‘Uninsured/Underinsured”,‘Peopleinneedofsubstanceabusetreatment’and‘LowIncome/Poor’werethemostfrequentlyindicatedpopulationsperceivedtobecurrentlyunderserved.

Figure11


TheFY2017CommunityHealthNeedsAssessmentSurveyaskedpeopletorespondtothequestion,“Ifyoucouldchangeonethingthatyoubelievewouldcontributetobetterhealthinyourcommunity,whatwouldyouchange?”Atotalof255surveyrespondents(62%)providedwrittenresponsestothisquestion.Table7providesasummaryofthemostcommonresponsesbytopictheme.AllcommentdetailcanbefoundinthereportAppendixA.

TABLE7

“Ifyoucouldchangeonethingthatyoubelievewouldcontributetobetterhealthinyourcommunity,whatwouldyouchange?”

Affordabilityofhealthcare/lowcostorsubsidizedservices;insurance;healthcarepaymentreform18.4%

ofallcomments

Healthcareprovideravailabilityincludingcertainspecialties;hoursandwaittime;healthcaredeliverysystemimprovements,qualityandoptions

17.3%

Accessibility/availabilityofsubstanceusetreatmentservices;substancemisuseprevention 10.6%

Accessibility/availabilityofmentalhealthservices 8.6%

Improvedresources,programsorenvironmentforphysicalactivity,activeliving;affordablerecreationandfitness 7.1%

Improvedresources,programsorenvironmentforhealthyeating/nutrition/foodaffordability; 5.5%

Programs/servicesforyouthandfamilies;healthylifestyleeducation 5.5%

Improvedjobopportunities;housing;childcare;economy 5.1%

Affordability/availabilityofdentalservices 4.7%

Caringcommunity/culture;communityconnectionsandsupports 4.3%

Improvedtransportationservices/publictransportation 3.9%

Seniorservices/assistedliving/concernsofaging 3.5%


6.BehavioralHealthNeedsSurveyFindings

Recognizingthecontinuedimportanceofmentalhealthandsubstancemisuseascommunityidentifiedprioritiesforimprovement,inthefallof2016,CNHHPmemberagenciespartneredwithotherhealthandhumanserviceprovidersinthebroaderLakesRegiontoconductanassessmentspecificallyfocusedonbehavioralhealthneeds.TheresultsofthisassessmentarebeingusedtoinformthedevelopmentofanIntegratedDeliveryNetworkforbehavioralhealthcareservicesintheregion,aswellasCNHHP’sspecificcommunityhealthimprovementefforts.OneaspectofthisassessmentwasaconsumersurveyofarearesidentstargetedtohighneedlocationsandpopulationswithaparticularemphasisonreachingpopulationscoveredbyMedicaid.Atotalof237consumersurveyswerecompleted;32%ofrespondentswereMedicaidmemberswithinthelast12months,42%hadusedmentalhealthservicesinthepast12months,and12%hadusedsubstanceuseservicesinthepast12months.Keyfindingsofthisbehavioralhealthneedsassessmentaredescribedhere.

Asdisplayedbychart9,about51%ofbehavioralhealthneedssurveyrespondentsindicatedthattheyhadeverbeentoldbyahealthprofessionalthattheymayhaveamentalhealthcondition,includingabout66%ofrespondentswhoalsoreportedhavingbeeneligibleforMedicaidinthepast12months.About15%ofrespondentsindicatedhavingbeentoldtheymayhavesubstanceuseproblemincludingabout28%ofMedicaidmembers.

Figure12


AsdisplayedbyChart10,about42%ofbehavioralhealthneedssurveyrespondentsindicatedthattheyhadreceivedsometypeofmentalhealthservicesinthepast12monthsincludingabout58%ofrespondentswhohadbeeneligibleforMedicaidinthepast12months.About12%ofrespondentsreportedreceivingservicesforsubstanceuseinthepast12monthsincludingabout24%ofMedicaidmembers.

About23%ofbehavioralhealthsurveyrespondentsindicatedhavingdifficultygettingthementalhealthservicestheyneededinthepast12months(Chart11),includingabout32%ofMedicaidmembers;while11%indicatedtheyhaddifficultygettingthesubstanceuseservicestheyneededincludingabout24%ofMedicaideligiblerespondents.

Figure14

Figure13


Furtheranalysisoftheseresultsshowsthatofthoserespondentswhodidreceivesometypeofmentalhealthservicesinthepast12months,about29%alsoindicatedhavingdifficultygettingthementalhealthservicestheyneeded.Amongrespondentswhoreceivednomentalhealthservicesinthepast12months,nearly1in5(about19%)indicatedaneedformentalhealthservicesthattheydidnotget.Thesefindingsmayreflectdifferentchallengestoreceivingservicessuchaswaitinglists(e.g.respondentsmayhavehaddifficultygettingservicesinitially,buteventuallydidso),gapsintheappropriatenessoracceptabilityofservices,financialobstaclestocareandrespondentreadinesstoseekservices.

Similarfindingswereobservedforrespondentsindicatingdifficultyaccessingsubstanceuseserviceswherenearlyhalfofrespondents(46%)whodidreceivesubstanceuseservicesintheprior12monthsalsoindicateddifficultyingettingservicestheyneeded.Amongthoserespondentswhodidnotaccesssubstanceuseservicesintheprior12months,about6%reportedaneedforservicesthattheydidnotget.

Figure15


Chart13displaysthetopreasonsreportedfornotgettingneededmentalhealthservices.Theseare“IthoughtIcouldhandletheproblemwithouttreatment”and“Ididnothavetime(duetojob,childcare,orothercommitments”,followedby“TherewerenoopeningsorIcouldnotgetanappointment”and“Healthinsurancedidnotcovertheserviceorenoughofthecosts”.Thetopmentalhealthservicesthatpeoplereportedhavingdifficultyaccessing(Chart14)areindividualtherapyorcounseling(79%)andservicesforco-occurringmentalandsubstanceuseconditions.Takentogether,thesefindingssuggestissuesoflimitedworkforcecapacitywithrespecttocounselors/therapistsaswellastheneedforintegrationofmentalhealthandSUDservices.

Figure16 Figure17


Reportedreasonsforsubstanceuseserviceaccessdifficultiesaresimilarwiththetopreasonsbeing“Iwasnotreadytostopusingalcoholordrugs”,“IthoughtIcouldhandletheproblemwithouttreatment”,and“TherewerenoopeningsorIcouldnotgetanappointment”.However,somedifferencesareobservedforthetypeofservicesrespondentshaddifficultygetting(Chart16).While‘individualtherapyorcounseling’wasagainthetopservicementioned,itwasmentionedbyasmallerproportionofrespondentsandamorediversearrayofserviceswerementionedathigherfrequencyincludingco-occurringmentalhealthandsubstanceuseservices,peerandrecoverysupportservices,intensiveoutpatienttreatmentandopioidtreatment.

Figure18 Figure19


Thefocusedassessmentofbehavioralhealthneedsalsoincludedasurveyofareahealthandhumanserviceproviders(n=147).AsdisplayedbyChart17,respondentstotheprovidersurveyalsoreflecttheobservationthatworkforcecapacityisanimportantconcernwith‘waitinglists/lackofappointmentavailability’citedasatopbarriertoaccessingbehavioralhealthservicesintheregion.Transportationchallenges,healthinsurancecoveragelimitationsandcompetingdemandsontimewerealsonotedassubstantialbarrierstoaccessingneededbehavioralhealthservices.

Figure20


B.COMMUNITYHEALTHDISCUSSIONGROUPS

Asetofthreediscussiongroupswereconvenedinthesummerof2017aspartofaneffortbytheCentralNHHealthPartnershiptounderstandthehealth-relatedneedsofthecommunityandtoplanprogramsandservicesthataddressthoseneeds.Thepurposeofthediscussiongroupswastogetinputonhealthissuesthatmattertothecommunityandthoughtsandperceptionsaboutthehealthofthecommunity.Discussiongroupswereconvenedrepresentingavarietyofimportantcommunitysectorsandperspectives,specificallythefollowing:

• Inter-AgencyCouncilhostedbyWholeVillage(17participants)

• CentralNHPublicHealthAdvisoryCouncil(13participants)

• ParentGrouphostedbyWholeVillage(13participants)• PlymouthandBristolareaSeniorAdvisoryCouncils(10

participants)


1. CommunityDiscussionGroupThemes

Thefollowingparagraphssummarizethefindingsfromthecommunitydiscussiongroups.SeeAppendixAformoredetailednotesfromthesegroupsorganizedbytopic.

1. Discussiongroupparticipantscomprehendedanddescribedacomprehensive,holisticperspectiveonhealthandwell-being.Thecontributionsofhealthbehaviors,thephysicalenvironment,programsandservices,andunderlyingdeterminantsofhealthsuchashousing,incomeandeducationwerealldiscussedwithrespecttoindividualandcommunityhealthoutcomes.

2. Participantshadmixedfeelingsabouttheoverallhealthofthecommunity.Positivefactorscitedincludetheperceptionofincreasedparticipationinphysicalactivityandanumberofspecificcommunityresourcesthatpromotehealthandwellness.However,therewasalsodiscussionofadivideinhealthoutcomesbetweenindividualsandfamilieswithmoreresources,particularlyincomeandhousing,comparedtothosewithlimitedresources.Anumberofcommentsalsospecificallycitedsubstancemisuseasanincreasingproblem,aswellconcernsaboutmulti-generationalhealthbehaviorsthatcontributetopoorhealthoutcomes.

3. ParticipantsidentifiedawidevarietyofcommunitystrengthsandresourcesthatpromotehealthincludingSpeareMemorialHospital,GenesisBehavioralHealth,MidstateHealthCenter,‘BoulderPoint’,Pemi-BakerAquatic&Fitness,activeAAandAlAnonprograms,thePlymouthandBristolSeniorCenters,theTapply-ThompsonCommunityCenter,CADY,theALLWellCenter,theGotLunchprogram,HeadStart,WholeVillageFamilyResourceCenter,thephysicalenvironmentandoutdoorrecreationalactivities,andfarmers’markets.

4. Participantsidentifiedarangeofbarrierstopromotinggoodhealthinthecommunityincludingtheneedformoreawarenessofavailableresources(...asingleplacetogothatlinkedyouintothedifferentresourcesfordifferentissues...thatwouldbe

"Whenwe’retalkingaboutpoverty,we’renottalkingaboutthepersonwhoisstrugglingtofindfoodorshelterortransportation.Wearetalkingaboutthecommunity;thatthispersonisn’tinpoverty,weareinpoverty."InteragencyCouncilParticipant

"I’dsaythisisahealthandwellnessconsciouscommunity....ThecommunityandtheuniversityaretiedtogetherinwellnessactivitiesthroughtheALLWellCenter.Theyhaveanopentrackthatinvitespeoplein.Therearepeoplefromherethatgodownthereandwalklapsatlunchorafterlunch.Justgeneralaccesstooutdooractivitieshereisawesome."SeniorAdvisoryCouncilParticipant


reallyhelpful.”),accesstomedicalspecialists,affordabilityofhealthcareservices(“Insuranceisexpensive,butthenonceyougo,it’sjustthatmuchmore.Soyoujusttrytostayoutasmuchasyoucan.”),theneedforimprovedaccesstotransportation,andaddressingintergenerationalpoverty,substancemisuseandmentalhealth.

5. Withrespecttowhatorganizationscouldbedoingbettertosupportorimprovecommunityhealth,participantsidentifiedneedsforimprovedcoordinationbetweenlocalorganizationsandhospitals,bettercommunication,socialmediapresenceandmarketingofhealth-relatedopportunities,increasedsupportandeducationaddressingsubstancemisuse,andmoreleadershipforaddressinglongtermcommunityhealthissuesincludingstrongerconnectionswiththeuniversity.

"Idon’tthinkweworktogetherasacommunity.AndIdon’tknowwhatthat’sallabout...Ithinkit’sjustkindofthewayit’salwaysbeen.Itjustneedstochange,andwejustneedtochangeit....It’sahardareabecausewe’vegotsomanydifferentcommunitiescomingtogether...peoplethathavelivedinthesameneighborhoodformanygenerations.Andthenwe’vegotallthenewpeople,thecollegiateprofessors...we’vegotalldifferentlevels.Ithinkallgettingonthesamebustogether;wecouldbeareallystrongcommunity.Whatthattakes,Idon’tknow."ParentGroupParticipant


2. HighPriorityIssuesfromCommunityDiscussionGroups

Ineachofthecommunitydiscussiongroupsconvenedin2017,thediscussiongroupfacilitatorreadtoppriorityareasidentifiedinthe2014CommunityHealthNeedsAssessmentandthecurrentCNHHPCommunityHealthImprovementPlan.Theseprioritieswere:

1. Accesstoaffordablehealthcareservicesandinsurance2. Alcohol,anddruguseprevention,treatmentandrecovery3. Accesstomentalhealthservices4. HealthyEating,ActiveLiving,obesityprevention5. Assistancewithcarecoordinationandhealthsystemnavigation6. SupportofFragileFamilies&ReductionofFamilyStress

Participantswerethenaskediftheywere:a)awareofanyprogramsoractivitiesthathavefocusedonanyoftheseareas;b)iftheyhadnoticedanyimprovementsintheseareas;andc)iftheythoughtthesearestillthemostimportantissuesforthecommunitytoaddressforimprovinghealthoriftherearenew,differentpriorities.Discussionparticipantsidentifiedanumberofprogramsandservicesintendedtoaddress:a)addresshealthcareaffordabilityandaccessincludingtheAffordableCareActandMedicaidExpansion;b)substancemisuseandmentalhealthcapacityincludingeffortstoimprovebehavioralservicesprovidedthroughhomehealthservices;andc)physicalactivity,particularlyprogramsforpeoplewithchronicdiseasethroughGenesisandMid-State.

Withsomeadditions(seenextpage),mostparticipantsineachgroupexpressedtheoverallopinionthattheprioritiesidentifiedin2014werestillthemostimportantissuestofocusattentiononforcommunityhealthimprovement.However,someparticipantsalsosuggestedfocusingononeoracoupleareasthatarecross-cutting,withtransportationmentionedinseveralgroupsasanexampleofanissuethathasbeenalongtermchallengeandtouchesonmanyissuesassociatedwithaccesstoservicesandqualityoflife.

“Ingeneralforalltheprioritiesmentioned,therehasbeenmoredone,butthewavecomingatusissomuchbiggerthatitsortofswampstheincreasedefforts.It’snotthattherehaven’tbeenincreasedeffortsintheseareas,justnotenoughtokeepupwiththedemand.InteragencyCouncilParticipant


Thetablebelowdisplaysthetopoverallprioritiesidentifiedbyeachsetofdiscussiongroups.Asnotedonthepreviouspage,thecommunitydiscussiongroupsconvenedin2017generallyendorsedthesamesetofprioritiesasidentifiedin2014.Someadditionalthemesemergedinthesediscussionsandarenotedinthistableaswell.

TABLE8–COMMUNITYDISCUSSIONGROUPS;MAJORTHEMES&PRIORITIES

Inter-AgencyCouncil PublicHealthAdvisoryCouncil ParentGroup SeniorAdvisoryCouncil

MentalHealthandSubstanceUse

OftheclientsIseeintheWelfaredepartmentprobably75%atleasthavesomeconnectiontoeitherMHorSUorboth.Alotoftimesboth.

Ithinkthatourcommunityputsonaveryhealthyfront,butsortofbehindthescenes,notsomuch..it’sthepoverty,it’sthesubstanceabuse,it’sthementalillness,it’sthefamilydysfunction,allofthat. We’vegotpeopleinourERswaitingweekstryingtogetservices.

Professionalrecoveryresourcesiswhatwedon’thave.Like,IOPs. SomeoneIknowisinthehospitalfor(aseriousmentalhealthissue),andtheycouldn’tfind(theperson)abedintimesotheystuckherinaroomforthreedaysandjustleft(thepersonthere.

Ithinkmoreneedstobesaidtoteenagersmaybeaboutthedrugs.Theyneedmoreinformation.Theyneedtoknowthathappens.

SocialDeterminants;Socialconnectedness

It’saglobalissue.Wellbeingdependsonallofthosesupportsandfeelinglikeyouarepartofthecommunityandnotfeelinglikeyouareshamedbecauseyouareaccessingthosesupports.Povertyandaccessarethebigones.

Talkingabouttheisolationissue,it’snotjustseniors.Therearealotofyoungfamiliesthatareveryisolatedandtheydon’thavecommunityconnections,connectionswithfriends,withneighbors.

Idon’tknowhowopenweareaboutcommunication...intermsofwhat’sgoingon,orwedon’tdiscussalotofthingsthatmaybeshouldbediscussedinanopenforumforourcommunity.AndIfeellikethat’shurtingalotofpeople,health-wise.

IthinkBristoltakescareofpeople,butyouhavetoask...andalotofpeoplethatneedservices,they’resortofafraidtoask.Wouldtheyknowwhotoask? Youimprovethequalityoflifeandthentheotherthingswillfallintoplace.



Provideravailability;capacity;workforceshortages

Therearestaffingshortagesinallthoseareas.Innursing,insocialwork,inmentalhealth.There’salineoutofeverydoor.That’sthefrustration.It’snotthatwedon’thavepeoplewhowanttohelp.

Ithinkoneofthegoodthingsfromthecommunityperspectiveispeopleknowwheretogointhiscommunity.It’seasilyidentifiablewhotheprovidersare...

Ihad(several)counselors,justdifferentonesbecausetheyeitherquit,orwereletgo,orbecausetheempathyisnotthere.So,tobuildrapportwithsomeonewho’ssupposedtohelpyouiskindofdifficultwhenyouhavejustsuchalotofturnover. Inoticemy(spouse),everycoupleyears(myspouse)gotanotherdoctorbecausethey’vefulfilledtheirthreeyears.Itseemshardtokeepphysiciansinthearea.

AlmosteverythingIneedisrighthere.I’vebeenverypleasedwiththeavailabilityandqualityofthehealthcareservicethatI’vegottenatSpeare. OneofthethingsthatI’venoticed,whereIcamefromtherewasanurgentcarecenterprobablyeverysixblocks.Andthere’snotalotinthiswholeentireareagoingfromBristoltoLincoln...Arethereany?

Carecoordination;Navigation;Accesstoinformation

Alotofpeoplestillalsohaveafearof“thesystem”.Fearthattheyaregoingtogetjudged;theyknowtheyneedhelp,ortheywanthelpormaybetheydon’tknowtheyneedhelp,butit’sthefearofthesystem.

TheinsurancenavigationthingthatcamewiththeACA,basically,ACAfundedfolkstohelppatientsnavigatehowtogetinsurance.AndIthinkitwasprettysuccessful.Butthat’sallunwinding—

WholeVillagegivesyoutherightresources,whereyouneedthem.Especiallydownatthehomelessshelter.They’reprettygoodabouthelpingpeopleout...Theatmospherehere,aswellas—thehelpisgenuinewhenthey’reassistingyouwithanything.

Peoplekepttellingme,“Thereareservicesavailable.Youjusthavetoask.”AndIkeptsaying,“WhodoIask?”

Evenaconsolidatedonlinesource...Iftherewasasingleplacetogothatlinkedyouintothedifferentresourcesfordifferentissues,thenIthinkthatwouldbereallyhelpful.



Transportation Thedifficultchallengeinbeingaruralcommunityisthetransportationpiece...asgreatofaconnectionaswefeelandthatsenseofonenessinourcommunity,it’sdifficultbecauseweareruralandbecausethingsaresospreadout...

Transportationplaysasignificantroleinourruralcommunity...especiallyinthewintermonthsthetransportationpieceisahugebarrierintermsofcommunityhealthandconnection.

I’velikedtheideaoftacklingtransportation.Itcomesupyearafteryear...

Beingstuckinsubsidizedhousingwithouttransportation,especiallythatdistancedownRoute25,andtobetryingtoarrestyourownaddictionortakecareofyourmentalhealthissues,itfeelsalmosthopelessinthemsituations.It’shardtogetout,hardtofollowthrough.

Transportationgoestoallthoseissuesthatyouhadfromfouryearsago,don’tyouthink?Putsthemalltogether.

Ithinkoneofthebiggestproblemsaltogetheristransportation.Evenifthere’ssomethingrighthereintown,ifyoudon’thaveacar,it’snoteasytogetto.AndIusejustabouteveryresourcethatthereis.Ifinallybrokedownandboughtmyselfacartosavemyownsanity.

Accesstohealthcare;healthcareinsurance

AccesstohealthcarehasimprovedasaresultofMedicaidExpansion.ThisisHUGEandhasradicallyimprovedaccesstohealthcare.

We’vemadeadentinaccesstohealthinsurance.Idon’tknowifthedentwillremain.

I’vegotfriendsthatcannowaffordinsurancewithObamacare.Buttheydon’tknowwhetheritwillbeavailablenextyear.That’stheuncertainty.Thepaperworkistremendous.

Insuranceisexpensive,butthenonceyougo,it’sjustthatmuchmore.Soyoujusttrytostayoutasmuchasyoucan...It’dhavetobesomethingreallymajorformetogo.




Addcareforfraileldersasapriority.Therearealotfraileldersinourcommunity;kindofaspecialpopulation.

Alotofpeoplearedrawnherethatareretiringorareofretirementage.Andalotofyoungpeoplearedrawntoleave.Andsoourdemographicischanging.

Isolationisahugeriskfactoronmanylevelsforhealth...ourelderlypopulationstruggleparticularlyinthewintertime;andlackfamilysupportsorplansiftheyaresick.Wespendalotoftimedoingsocialservicetohelpthem

Mytopissuewouldbehandicapaccessibility.Notjustforpeoplewithobvioushandicaps.It’selderlypeople,period...Yougointosomanyandtherearestepsandnowayforthemtogetintoarestaurantorwhatever,anditmakesitdifficult.

AssistedLiving;Longtermcare

Oneofthethingsthatwearelackingisthattherearenoassistedlivingfacilities,nonursinghomesinthearea.Wedefinitelyarenotmeetingtheneedsofthosewhoaremiddleincomeorlowincomewhocouldn’taffordit,eveniftheywantedto.

Iwastryingtofigureoutwhere(arelative)couldlive.(Myrelative)didn’twanttobeaburden.AndIaskedaround.Ididn’treallyfindalotofhelp.IendedupgoingallthewaydowntoFranklintofindaplacefor(myrelative)tolive..Iwasfrustratedthattherewasn’tsomethingcloser.

Therearenoresidentiallivingplacesthatareaffordabletosomebodyonafixedincome.

HealthyEating,ActiveLiving

Ifwecouldfocusonanupstreammodelandgetintheirearlier,thenthatwillhelpuswithourchildren,whetherit’sobesity,ortheexercise,andgetfamiliesinvolved.

Ithinkitwouldbehelpfulifwehadwalkablecommunities,likewehadsidewalks,wehadbikepaths,thatparentsfeltcomfortablethattheirchildcouldbikeovertotheirfriend’shouse.

Iseeanawfullotofpeoplefrom5inthemorninguntildarkwalking,biking,pushingstrollers.There’salotofpeopleoutgettingphysicalactivityonaregularbasis.



AvailabilityofDentalCare

Westillhaveanadultaccessissueregardingoral

Dentalisavery,verybigissue.Idon’tthinkitisasmuchforchildren,butadults.It’sbad.

There’snoplaceherethathastheslidingscalefee.Youcan’tgetinsurancethroughMedicaid...youloseitwhenyou’re21.So,alotofpeopledon’thavedentalinsurance.Andit’sexpensive.

YouseealotofpeoplegoingintheERbecausetheygetinfectedteethconstantly.Theyjustsendyouhome,prettymuch.

Therearealotofdentistshereintown,butifyoulistentotheconversationaboutthem,it’slike“Well,don’tgothere,don’tgothere.”AndbythetimeIgotdoneIsaid,“Whodoyougoseethen?”

Injuryprevention Ijustthinkit’sasafetyissue(learningtoswim).There’snaturalwaterinallofourcommunitiesandwedon’thaveaneasywaytoaddressthat.It’snoteasy,it’snotaffordable...personally,Ithinkthat’sabighealthissue.

It’sreallynicetohaveallthesepoolsintownandnotbeabletogetin...therearesomanypeoplethathaven’tlearnedhowtoswimbecauseit’snoteasyto.

My(spouse)hasahardtimegettingintosomeplacesbecause(ofaphysicaldisability).Ithinkthatitwouldn’tbeabadideatohavealittlemoreemphasisonthattypeofthing...orevenmyself,I’vehadahardtime—youcouldtripreallyeasy.

TheonlythingIcanthinkthatwouldhelpmeisrailings...it’saverylittlething—evenapost,ifit’sonlyonestep,wouldhelp.

CommunityCenter I’vealwaysdreamedabouthavingarealreccenterwheretherewasachildcarefacility....Haveusallworktogetherasacommunityinthisnicelittlereccenter

Andteachkidshowtoswim,right?Ourkidsneedtoknowhowtoswim.


C.COMMUNITYHEALTHSTATUSINDICATORS

Thissectionofthe2017CommunityHealthNeedsAssessmentreportprovidesinformationonkeyindicatorsandmeasuresofcommunityhealthstatus.Somemeasuresassociatedwithhealthstatushavebeenincludedearlierinthisreport,suchasmeasuresofincomeandpoverty.Wherepossible,statisticsarepresentedspecifictothe18townserviceareaidentifiedbytheCentralNewHampshireHealthPartnership.Insomeinstances,dataareonlyavailableatthecountylevel.Intheseinstances,informationispresentedforGraftonCounty,becausetheCNHHPserviceareaisentirelywithinGraftonCountyandcomprisesabout34%ofthetotalcountypopulation.

1. DemographicsandSocialDeterminantsofHealth

Apopulation’sdemographicandsocialcharacteristics,includingsuchfactorsasprosperity,education,andhousinginfluenceitshealthstatus.Similarly,factorssuchasage,disability,languageandtransportationcaninfluencethetypesofhealthandsocialservicesneededbycommunities.

a. GeneralPopulationCharacteristics

Accordingtothe2015AmericanCommunitySurvey,thepopulationoftheCNHHPServiceAreaisolderonaveragethaninNewHampshireoverall.Theserviceareamaponthenextpagedisplaysthepercentofthepopulation65yearsofageandolderbytown.Between2010and2015,thepopulationoftheCNHHPServiceAreadeclinedbyalmost2%.

Indicators CNHHPServiceArea NewHampshirePopulationOverview TotalPopulation 30,039 1,319,171

Overageof65 17.7% 15.3%Underageof18 16.2% 20.5%

Changeinpopulation(2010to2015) -1.9% +0.6%

DataSource:U.S.CensusBureau,2011-2015AmericanCommunitySurvey5-YearEstimatesand2010USCensus.


PercentofPopulation65yearsofageandolder

CNHHPServiceAreaTowns

b.Poverty

Thecorrelationbetweeneconomicprosperityandgoodhealthstatusiswellestablished.Inversely,thelackofeconomicprosperity,orpoverty,canbeassociatedwithbarrierstoaccessinghealthservices,healthyfood,andhealthyphysicalenvironmentsthatcontributetogoodhealth.Informationdescribinghouseholdincomeandpovertystatuswasincludedinthefirstsectionofthisreport.Thetablebelowpresentstheproportionofchildrenunderage18livingbelowthe100%and200%oftheFederalPovertyLevelintheCNHHPServiceAreacomparedwithratesforNewHampshireoverall.

Area PercentofChildreninPovertyIncome<100%FPL

PercentofChildreninornearPovertyIncome<200%FPL

CNHHPServiceArea 11.0% 38.1%

NewHampshire 11.9% 27.6%

DataSource:U.S.CensusBureau,2011–2015AmericanCommunitySurvey5-YearEstimates.

Bridgewater

BristolAlexandria

LincolnLivermore


c. Education

Educationalattainmentisalsoconsideredakeydriverofhealthstatuswithlowerlevelsofeducationlinkedtobothpovertyandpoorhealth.AsimilarproportionofthepopulationoftheCNHHPServiceAreahaveearnedatleastahighschooldiplomaorequivalentcomparedtoNewHampshireoverall.Thetablebelowpresentsdataonthepercentageofthepopulationaged25andolderwithoutahighschooldiploma(orequivalent).

Area PercentofPopulationAged25+withNoHighSchoolDiploma

CNHHPServiceArea 7.5%

NewHampshire 7.7%


d. Language

AninabilitytospeakEnglishwellcancreatebarrierstoaccessingservices,communicationwithserviceproviders,andabilitytounderstandandapplyhealthinformation(healthliteracy).Thetablebelowreportsthepercentageofthepopulationaged5andolderwhospeakalanguageotherthanEnglishathomeandspeakEnglishlessthan"verywell".

Area PercentofPopulationAged5+WhoSpeakEnglishLessThan“VeryWell”


NewHampshire 0.9%



e. Housing

Housingcharacteristics,includinghousingqualityandcostburdenasaproportionofincome,caninfluencethehealthoffamiliesandcommunities.Thetablebelowpresentsdataonthepercentageofhousingunitsthatareconsideredsubstandardhousingandhousingcostburden.

“Substandard”housingunitsarehousingunitsthathaveatleastoneofthefollowingcharacteristics1)lackingcompleteplumbingfacilities,2)lackingcompletekitchenfacilities,3)anaverageofmorethanoneoccupantperroom,4)selectedmonthlyownercostsasapercentageofhouseholdincomegreaterthan30percent,and5)grossrentasapercentageofhouseholdincomegreaterthan30percent.

Acomponentofthesubstandardhousingindexistheproportionofincomethatisspentonhousingcosts.AccordingtoresearchbytheU.S.DepartmentofHousingandUrbandevelopment,householdsthatspendmorethan30percentofincomeonhousingcostsarelesslikelytohaveadequateresourcesforfood,clothing,medicalcare,orotherneeds.Thetablebelowshowstheproportionofhouseholdsintheregionforwhichthemortgageorrentalcostsexceed30%ofhouseholdincome.

AreaPercentofHousingUnitsCategorizedAs“Substandard”

PercentofHouseholdswithHousingCosts>30%ofHouseholdIncome



DataSource:2011–2015AmericanCommunitySurvey5-YearEstimates;Sub-standardHousingandHousingCostBurdendataaccessedfromCommunityCommons.


f. Transportation

Individualswithlimitedtransportationoptionsalsohavelimitedemploymentoptions,greaterdifficultyaccessingservices,andmorechallengestoleadingindependent,healthylives.Thenexttablepresentsdataonthepercentofhouseholdsthathavenovehicleavailable.

Area PercentofHouseholdswithNoVehicleAvailable


NewHampshire 5.1%


g. DisabilityStatus

Disabilityisdefinedastheproductofinteractionsamongindividuals’bodies;theirphysical,emotional,andmentalhealth;andthephysicalandsocialenvironmentinwhichtheylive,work,orplay.Disabilityexistswherethisinteractionresultsinlimitationsofactivitiesandrestrictionstofullparticipationatschool,atwork,athome,orinthecommunity.TheUSCensusBureau(AmericanCommunitySurvey)identifiespeoplereportingseriousdifficultywithfourbasicareasoffunctioning–hearing,vision,cognition,andambulation.Accordingtothe2015AmericanCommunitySurvey,13.4%ofCNHHPServiceArearesidentsreporthavingatleastonedisability,aratethatisslightlyhigherthantheoverallNewHampshirerateandmostlikelyareflectionoftheproportionallyolderpopulation.

AreaPercentofPopulationReportingSerious

DifficultyWithHearing,Vision,Cognitionand/orAmbulation


NewHampshire 12.1%



2.AccesstoCare

Accesstocarereferstotheeasewithwhichanindividualcanobtainneededservices.Accessisinfluencedbyavarietyoffactorsincludingaffordabilityofservicesandinsurancecoverage,providercapacityinrelationshiptopopulationneedanddemandforservices,andrelatedconceptsofavailability,proximityandappropriatenessofservices.

a.InsuranceCoverage

Table9onthenextpagedisplaysestimatesoftheproportionofresidentswhodonothaveanyformofhealthinsurancecoveragebymunicipality,aswellastheproportionofresidentscoveredbyMedicareorMedicaid.Itisimportanttonotethatthedatasourceforthesemunicipallevelestimatesisa5yearspanoftheAmericanCommunitySurvey.Acombinationoffiveyearsofdataisrequiredtoproducereasonablystableestimatesontheseandothermeasuresfromthesurveysamples.However,thisparticulartimeperiodspansaperiodofsignificantchangeinthehealthinsurancemarketwiththeimplementationofthefederalAffordableCareActandthebeginningofMedicaidexpansioninNewHampshire.Figures21and22followingthetabledisplay1yearestimatesofuninsuranceandMedicaidcoverage.ThisanalysisappliesgroupingsofzipcodetabulationareastoderiveestimatesattheregionalandstatelevelfromtheAmericanCommunitySurvey.Theseestimatesarelessprecise,butareincludedtoillustrateimportanttrendsininsurancecoverage

AsdisplayedbyFigures21and22,theoveralluninsuranceratehasdeclinedsubstantiallyintheCNHHPservicearea(fromalmost14%toabout9%),butstillexceedstheoveralluninsurancerateestimateforNH(6.4%).AsignificantcontributortothischangeappearstobeincreasesinMedicaidcoverage,whereestimatesofMedicaidcoverageincreasedfromabout13%ofthetotalpopulationin2013toabout17%in2015.


TABLE9

Area PercentoftheTotalPopulationwithNoHealthInsuranceCoverage

PercentwithMedicareCoverage

PercentwithMedicaidCoverage

Ellsworth 36.6% 44.6% 10.7%Groton 31.4% 22.2% 14.3%Ashland 21.0% 22.1% 13.9%Alexandria 20.0% 20.5% 16.3%Lincoln 20.0% 23.4% 19.3%Warren 19.6% 23.5% 20.5%Woodstock 18.6% 18.0% 8.6%Wentworth 18.4% 25.6% 12.1%Holderness 16.9% 18.7% 8.5%Rumney 16.4% 18.8% 15.2%Hebron 15.8% 29.9% 10.3%Thornton 14.9% 23.4% 10.7%Bristol 13.7% 22.2% 14.8%Campton 11.9% 24.2% 6.2%Bridgewater 9.6% 28.0% 14.0%Plymouth 9.4% 11.4% 8.8%WatervilleValley 2.4% 23.4% 0.0%

DataSource:U.S.CensusBureau,2011–2015AmericanCommunitySurvey5-YearEstimates


Figure21

Figure22

2013 2014 2015CNHHP 13.7% 12.4% 9.2%NH 10.8% 9.3% 6.4%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

PercentofPopulationwithNoHealthInsurance2013-2015

CNHHP

NH

2013 2014 2015CNHHP 13.1% 16.5% 17.3%NH 11.3% 11.1% 12.9%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

PercentofPopulationwithMedicaidCoverage2013-2015

CNHHP

NH


b.AdultswithaPersonalHealthCareProvider

Thisindicatorreportsthepercentageofadultsaged18andolderwhoself-reportthattheyhaveatleastonepersonwhotheythinkofasapersonaldoctororhealthcareprovider.Alowerpercentageonthisindicatormayhighlightinsufficientaccessoravailabilityofmedicalproviders,alackofawarenessorhealthknowledgeorotherbarrierspreventingformationofarelationshipwithaparticularmedicalcareprovider.

Area Percentofadultswhoreporthavingapersonaldoctororhealthcareprovider


NewHampshire 86.8%

DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2014-2015.RegionalrateisnotsignificantlydifferentthantheoverallNHratestatistically.

c.PreventableHospitalStays

PreventableHospitalStaysisthehospitaldischargeratefordiagnosespotentiallytreatableinoutpatientsetting,alsoknownasambulatorycaresensitiveconditions,suchasdiabetes,hypertension,asthmaandchronicobstructivepulmonarydisease.ThismeasureisreportedforMedicareenrollees.Ahighrateofinpatientstaysforambulatorycaresensitiveconditionsmayindicatelimitedaccess,availabilityorqualityofprimaryandoutpatientspecialtycareinacommunity.TherateofpreventablehospitalstaysinBelknapCountyissimilartotheoverallstaterate.

Area Numberofhospitalstaysforambulatorycaresensitiveconditionsper1,000Medicareenrollees

GraftonCounty 40.1

NewHampshire 44.8

DataSource:DartmouthAtlasofHealthCare,2014;accessedthroughCountyHealthRankingsRegionalrateisnotsignificantlydifferentthantheoverallNHrate


d.BehavioralHealthCare-EmergencyDepartmentUtilizationandHospitalRe-admissionforBehavioralHealthConditions

Overutilizationordependenceonemergencydepartmentsforcareofindividualswithbehavioralhealthconditionscanbeanindicationoflimitedaccesstoorcapacityofoutpatientmentalhealthservices.Similarly,unplannedhospitalre-admissionscanindicategapsinavailablecommunityandsocialsupportsystems.

AspartoftheregionalplanningworktodevelopanIntegratedDeliveryNetworkforbehavioralhealth,analyseswereconductedwithMedicaidclaimsdatatocompareemergencydepartmentutilizationandhospitalre-admissionsforMedicaidmemberswithevidenceofabehavioralhealthconditionbasedonclaimshistory.Figure23displaysthefindingthatMedicaidmembersresidingintheLakesRegionofNH(includingtheCNHHPservicearea)withabehavioralhealthconditionwereover4timesmorelikelytohavehadfourormorevisitstoanemergencydepartmentin2015(8.6%ofmemberswithevidenceofabehavioralhealthconditioncomparedto1.9%ofmemberswithout).Similarly,the30dayhospitalinpatientreadmissionrateforbehavioralhealthindicatedmembers(13.4%)wasmorethandoubletheratefornon-behavioralhealthindicatedmembers(5.9%).

Figure23 Figure24

DataSource:NHMedicaid,2015claimsdata

8.6%

1.9%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

BHIndicated NotBHIndicated

FrequentEDUsers(4+visits,anyhospital)PercentofallMedicaidMembers,2015

BehaivoralHealthIndicatedorNotIndicicated


e.DentalCareUtilization(Adult)

Thisindicatorreportsthepercentageofadultsaged18andolderwhoself-reportthattheyhavenotvisitedadentist,dentalhygienistordentalclinicwithinthepastfiveyears.AhigherproportionofadultsintheCNHHPserviceareareportnothavingseenadentistcomparedtothestate.

Area Percent of adults who have not visited a dentist or dental clinic

in the past 5 years


NewHampshire 11.4%

DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2014.RegionalrateisnotsignificantlydifferentthantheoverallNHratestatistically

f.PoorDentalHealth

Thisindicatorreportsthepercentageofadultsage18andolderwhoself-reportthatsixormoreoftheirpermanentteethhavebeenremovedduetotoothdecay,gumdisease,orinfection.Inadditiontohighlightingneededimprovementsinpreventiveoralhealthcare,thisindicatorcanalsohighlightalackofaccesstocare,alackofhealthknowledge,orsocialandeconomicbarrierspreventingutilizationofservices.

Area Percentofadultswhoreporthavingsixormoreoftheirpermanentteethremoved


NewHampshire 15.5%

DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2014.RegionalrateisnotsignificantlydifferentthantheoverallNHratestatistically.


3.HealthPromotionandDiseasePreventionPractices

Adoptinghealthylifestylepracticesandbehaviors,suchasnotsmokingandlimitingalcoholintake,canpreventorcontroltheeffectsofdiseaseandinjury.Forexample,regularphysicalactivitynotonlybuildsfitness,buthelpstomaintainbalance,promotesrelaxation,andreducestheriskofdisease.Similarly,eatingahealthydietrichinfruits,vegetablesandwholegrainscanreduceriskfordiseaseslikeheartdisease,certaincancers,diabetes,andosteoporosis.Thissectionincludesindicatorsofindividualbehaviorsinfluencingpersonalhealthandwellness.Someindicatorsofclinicalpreventionpractices,suchasscreeningforcancerandheartdisease,areincludedinalatersectionthatalsodescribespopulationhealthoutcomesinthoseareas.

a.FruitandVegetableConsumption(Adults)

Thisindicatorreportsthepercentageofadultsaged18andolderwhoself-reportconsuminglessthan5servingsoffruitsandvegetableseachday.Unhealthyeatinghabitscontributetosignificanthealthissuessuchasobesityanddiabetes.

AreaPercentofAdultsConsumingFewFruits

orVegetables

GraftonCounty 69.0%

NewHampshire 71.5%

DataSource:CentersforDiseaseControlandPrevention,BehavioralRiskFactorSurveillanceSystem,2005-2009(mostrecentavailable).AreaestimatesfromCommunityCommons;Differenceisnotstatisticallysignificant

b.PhysicalInactivity(Adults)

Thisindicatorreportsthepercentageofadultsaged18andolderwhoself-reportleisuretimephysicalactivity,basedonthequestion:"Duringthepastmonth,otherthanyourregularjob,didyouparticipateinanyphysicalactivitiesorexercisessuchasrunning,calisthenics,golf,gardening,orwalkingforexercise?".Lackofphysicalactivitycanleadtosignificanthealthissuessuch


asobesityandpoorcardiovascularhealth.About1in5adultsintheregioncanbeconsideredphysicallyinactiveonaregularbasis–aratesimilartotherestofNewHampshire.

Area Physicallyinactiveinthepast30days,%ofadults


NewHampshire 20.8%

DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2014-2015.RegionalrateisnotsignificantlydifferentthantheoverallNHratestatistically.

c.PneumoniaandInfluenzaVaccinations(Adults)

Thisindicatorreportsthepercentageofadultswhoself-reportthattheyhaveeverreceivedapneumoniavaccineorreceivedinfluenzavaccineinthepastyear.Inadditiontomeasuringthepopulationproportionreceivingpreventivevaccines,thisindicatorcanalsohighlightalackofaccesstopreventivecare,opportunitiesforhealtheducation,orotherbarrierspreventingutilizationofservices.

Area

Adultswhohavereceivedaflushotinpast12monthsandthosewhohaveeverreceivedapneumococcalvaccination

InfluenzaVaccination18yearsofageorolder

PneumococcalVaccination65yearofageorolder



DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2014-2015.RegionalratesarenotsignificantlydifferentthantheoverallNHratestatistically.


d.SubstanceMisuse

Substancemisuse,involvingalcohol,illicitdrugs,misuseofprescriptiondrugs,orcombinationsofallofthesebehaviors,isassociatedwithacomplexrangeofnegativeconsequencesforhealthandwellbeingofindividuals,familiesandcommunities.Inadditiontocontributingtobothacuteandchronicdiseaseandinjury,substancemisuseisassociatedwithdestructivesocialconditions,includingfamilydysfunction,lowerprosperity,domesticviolenceandcrime.

Excessivedrinking:Excessivealcoholuse,eitherintheformofheavydrinking(drinkingmorethantwodrinksperdayonaverageformenormorethanonedrinkperdayonaverageforwomen),orbingedrinking(drinking5ormoredrinksonanoccasionformenor4ormoredrinksonanoccasionforwomen),canleadtoincreasedriskofhealthproblemssuchasliverdiseaseorunintentionalinjuries.

AreaEngagedinBingeDrinkinginPast30days,PercentofAdults

Male Female Total

CNHHPServiceArea 18.5% 12.5% 14.7%

NewHampshire 21.7% 12.3% 16.8%DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2014-2015.RegionalrateisnotsignificantlydifferentthantheoverallNHratestatistically.

AreaHeavyAlcoholUse,PercentofAdults

Male Female Total

CNHHPServiceArea NA NA 9.8%

GraftonCounty 6.0% 9.8% 7.9%

NewHampshire 6.0% 6.9% 6.5%DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2015.

RegionalrateisnotsignificantlydifferentthantheoverallNHratestatistically.


Althoughunderagedrinkingisillegal,alcoholisthemostcommonlyusedandmisuseddrugamongyouth.Onaverage,underagedrinkersalsoconsumemoredrinksperdrinkingoccasionthanadultdrinkers.IntheCentralNHregion,therateofbingedrinkingamonghighschoolagedyouthissimilartotheoverallstaterate.

AreaEngagedinBingeDrinkinginPast30days,

PercentofHighSchoolYouthMale Female Total


NewHampshire 17.2% 16.1% 16.8%DataSource:NHYouthRiskBehaviorSurvey,2015

RegionalrateisnotsignificantlydifferentthantheoverallNHrate

Themisuseofprescriptiondrugs,particularlyprescriptionpainrelievers,posessignificantrisktoindividualhealthandcanbeacontributingfactorleadingtomisuseofotherdrugsandacauseofunintentionaloverdoseandmortality.About17%ofhighschoolyouthintheCentralNHregionreporthavingeverusedaprescriptiondrugthatwasnotprescribedtothem.

AreaEverusedprescriptiondrugs‘notprescribedtoyou’,

PercentofHighSchoolYouthMale Female Total


NewHampshire 14.0% 12.5% 13.4%DataSource:NHYouthRiskBehaviorSurvey,2015

RegionalrateisnotsignificantlydifferentthantheoverallNHrate


e.CigaretteSmoking

Tobaccouseisaprimarycontributortoleadingcausesofdeathsuchaslungcancer,respiratorydiseaseandcardiovasculardisease.Thisindicatorreportsthepercentageofadultsaged18andolderwhoself-reportcurrentlysmokingcigarettessomedaysoreveryday.Nearly1in4adults(24%)inthecommunitiesoftheCentralNHPublicHealthRegionareestimatedtobecurrentsmokers.Theestimateofthepercentofadultsstatewidewhoarecurrentsmokersis17%.

Area PercentofAdultswhoareCurrentSmokers


NewHampshire 17.0%

DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2014-2015RegionalrateisnotsignificantlydifferentthantheoverallNHratestatistically

f.TeenBirthRate

Teenpregnancyiscloselylinkedtoeconomicprosperity,educationalattainment,andoverallinfantandchildwell-being.TheteenbirthrateintheCentralNHPublicHealthregionissignificantlylowerthantherateinNewHampshireoverall.

Area Teen Birth Rate per 1,000 Women Age 15-19

CNHHPServiceArea 8.9*

New Hampshire 12.0

Datasource:NHDivisionofVitalRecordsAdministrationbirthcertificatedata;2011-2015.*RateisstatisticallydifferentandlowerthantheoverallNHrate


4. SelectedHealthOutcomes

Traditionalmeasuresofpopulationhealthstatusfocusonratesofillnessordisease(morbidity)anddeath(mortality)fromspecificcauses.Advancesinpublichealthandmedicinethroughthe20thCenturyhavereducedinfectiousdiseaseandcomplicationsofchildbirthasmajorcontributorstoorcausesofdeathanddisease.Chronicdiseases,suchasheartdisease,cancer,respiratorydiseaseanddiabetes,alongwithinjuryandviolence,arenowtheprimaryburdensonthehealthandwellbeingofindividuals,familiesandcommunities.Inadditiontoconsideringtheabsolutemagnitudeofspecificdiseaseburdensinapopulation,examinationofdisparitiesindiseaseratescanhelptoidentifyareasofneedandopportunitiesforintervention.

a.OverweightandObesity

Beingoverweightorobesecanindicateanunhealthylifestylethatputsindividualsatriskforavarietyofsignificanthealthissuesincludinghypertension,heartdiseaseanddiabetes.Theindicatorsbelowreportthepercentageofadultsaged18andolderwhoself-reportthattheyhaveaBodyMassIndex(BMI)greaterthan30.0(obese)orgreaterthan25.0(overweightorobese).ThechartonthenextpagedisplaysthetrendinGraftonCountysince2004towardincreasingprevalenceofobesityintheadultpopulation,althoughaplateauintheproportionofadultswhoareobeseappearstohavebeenachievedinmorerecentyears.

Area PercentObesePercentOverweightor

Obese

CNHHPServiceArea 19.8%* 55.2%


DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem2014-2015*RateisstatisticallydifferentandlowerthantheoverallNHrate


DataSource:CentersforDiseaseControlandPrevention,NationalDiabetesSurveillanceSystem

b.HeartDisease

HeartdiseaseisthesecondleadingcauseofdeathinNewHampshireandintheCentralNHRegionafterallformsofCancer.Heartdiseaseiscloselyrelatedtounhealthyweight,highbloodpressure,highcholesterol,andsubstanceabuseincludingtobaccouse.In2015,DiseasesoftheHeartwasthecauseof50deathsintheCentralNHPublicHealthRegion.

HeartDiseasePrevalence:Thisindicatorreportsthepercentageofadultsaged18andolderwhohaveeverbeentoldbyadoctorthattheyhavecoronaryheartdiseaseorangina.

Area PercentofAdultswithHeartDisease(self-reported)


NewHampshire 4.0%

DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem,2014-2015RateisnotstatisticallydifferentthantheoverallNHrate

20.5 21.4 22.2 22.7 22.9 23.725.3 26.5 26.3 24.9

0

5

10

15

20

25

30

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013Pe

rcen

tofA

dults;A

geAdjusted

Year

ProportionofAdultsWhoAreObeseGraftonCounty;2004- 2013


CholesterolScreening:Highlevelsoftotalcholesterolandlowdensitylipoprotein-cholesterol(LDL-C)andlowlevelsofhighdensitylipoprotein-cholesterol(HDL-C)areimportantriskfactorsforcoronaryheartdisease.Periodiccholesterolscreeningforadults,particularlythosewithotherriskfactors,isabeneficialprocedureforearlyidentificationofheartdiseasethatcanbetreatedwithpreventivetherapy.Thetablebelowdisplaystheproportionofadultswhoreportthattheyhavehadtheircholesterollevelscheckedatsomepointwithinthepast5years.

AreaPercentofadultswhohavehadtheir

cholesterollevelscheckedwithinthepast5years


NewHampshire 83.0%

DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem,2015.RateisnotstatisticallydifferentthantheoverallNHrate

HeartDiseaseandStrokeMortality:CoronaryHeartDisease,anarrowingofthesmallbloodvesselsthatsupplybloodandoxygentotheheart,isthelargestcomponentofheartdiseasemortality.TherateofdeathduetocoronaryheartdiseaseamongLakesRegionresidentswassignificantlyhigherthantheoverallrateforNewHampshireinthe2011to2015timeperiod.Cerebrovasculardisease(stroke),whichhappenswhenbloodflowtoapartofthebrainstops,isthefifthleadingcauseofdeathinNewHampshireandintheLakesRegion.

AreaCoronaryHeartDiseaseMortality(per100,000people,age-adjusted)

CerebrovascularDiseaseMortality(per100,000people,age-adjusted)

CNHHPServiceArea 90.9 27.9

NewHampshire 95.9 28.7

DataSource:NHDivisionofVitalRecordsdeathcertificatedata,2011-2015RatesarenotstatisticallydifferentthantheoverallNHrate


c.Diabetes

Diabetesisanincreasinglyprevalentchronichealthconditionthatputsindividualsatriskforfurtherhealthcomplications,butisalsoamenabletocontrolthroughdietandadequateclinicalcare.

DiabetesPrevalence:Thisindicatorreportsthepercentageofadultsaged20andolderwhohaveeverbeentoldbyadoctorthattheyhavediabetes.About8.0%ofCentralNHadultsand9.0%ofNewHampshireadultsoverallreporthavingbeentoldbyahealthprofessionalthattheyhavediabetes.

DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem,2014-2015.RegionalrateisnotstatisticallydifferentthantheoverallNHrate

DiabetesManagement:ThisindicatorreportsthepercentageofMedicarebeneficiarieswithdiabetesawhohavehadahemoglobinA1c(HbA1c)test,abloodtestwhichmeasuresbloodglucoselevels,administeredbyahealthcareprofessionalinthepastyear.RegularHbA1Ctestingisimportantfordiabetesmanagementandpreventionofdiabetes-relatedhealthcomplications.

DataSource:DartmouthAtlasofHealthCare,2014;accessedthroughCommunityCommonsRegionalrateisnotsignificantlydifferentthantheoverallNHrate

Area PercentofAdultswithDiabetes,ageadjusted


NewHampshire 8.6%

Area PercentofMedicareBeneficiarieswithDiabeteswithAnnualHemoglobinA1cTest

GraftonCounty 90.1%

NewHampshire 90.3%


Diabetes-relatedMortality:TherateofdeathduetoDiabetesMellitusamongLakesRegionresidentsissimilartotheoverallrateforNewHampshireandistheseventhleadingcauseofdeathintheregion.

DataSource:NHDHHSHospitalDischargeDataCollectionSystem,2014-2015RatesarenotsignificantlydifferentthanoverallNHrate

d.Cancer

CanceristheleadingcauseofdeathinNewHampshire.Althoughnotallcancerscanbeprevented,riskfactorsforsomecancerscanbereduced.Itisestimatedthatnearlytwo-thirdsofcancerdiagnosesanddeathsintheUScanbelinkedtobehaviors,includingtobaccouse,poornutrition,obesity,andlackofexercise.

CancerScreening:Thetableonthenextpagedisplaysscreeningratesforcolorectalcancer,breastcancerandcervicalcancer.TheUnitedStatesPreventiveServicesTaskForce(USPSTF)recommendsscreeningforcolorectalcancerusingfecaloccultbloodtesting,sigmoidoscopy,orcolonoscopy,inadults,beginningatage50yearsandcontinuinguntilage75years.Theproportionofadultsage50to75whoareincompliancewiththeUSPSTFrecommendations(self-report)inCNNHPregion(77.8%)issimilartotheoverallNHrate(74.9%).TheproportionofwomenwhoreportbeingincompliancewithbreastandcervicalcancerscreeningrecommendationsarealsosimilartotheoverallNHrate.

Area DeathsduetoDiabetesMellitus(per100,000people,ageadjusted)

CNHHPServiceArea 16.5

NewHampshire 18.1


CancerScreeningType CNHHPServiceArea NewHampshire

Percentofadultswhoareaged50+thatmetUSPSTFcolorectalcancerscreeningrecommendations*

77.9% 74.9%

Percentoffemalesaged50+whohavehadamammograminthepasttwoyears**

80.2 80.8%

Percentoffemalesaged18+whohavehadapaptestinthepast3years***

71.2% 78.6%

*DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem,2015.**DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem,2014.

***DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem,2012and2014.RegionalratesarenotstatisticallydifferentthantheoverallNHrate

CancerIncidenceandCancerMortality:Thetablebelowshowscancerincidenceratesbysitegroupforthecancertypesthataccountforthemajoritynewcancercases(incidence).

CancerIncidenceper100,000people,ageadjusted

CNHHPServiceArea NewHampshire

Overallcancerincidence(AllInvasiveCancers) 489.8 498.8

CancerIncidencebyType Breast(female) 136.9 141.8Prostate(male) 129.7 128.7

Lungandbronchus 59.8 67.7Colorectal 45.2 38.2Bladder 31.9 28.7

MelanomaofSkin 29.7 28.6DataSource:NHStateCancerRegistry,2010-2014

RatesarenotsignificantlydifferentthanoverallNHrate


CancerMortality:Thetablebelowshowstheoverallcancermortalityrateandforthecancertypesthataccountforthemajoritycancerdeaths.Theoverallcancermortalityrateandmortalityratefromspecificcancertypesaresimilartothestateoverall.Asdisplayedbythechartatthebottomofthepage,theoverallcancermortalityrateintheregionhasbeendecliningatalinearrateofabout-4%peryearsincetheyear2000.

CancerMortalityper100,000people,ageadjusted

CNHHPServiceArea NewHampshireOverallcancermortality(AllInvasiveCancers) 164.5 165.1

CancerMortalitybyType Lungandbronchus 41.1 45.8Breast(female) 15.5 19.6Prostate(male) 28.2 20.4

Colorectal 16.6 13.1Pancreas 10.8 11.1

DataSource:NHStateCancerRegistry,2011-2015RegionalratesarenotsignificantlydifferentthanoverallNHrate

259.4

228.8

181.7183.2

189.3

180.7191.7

160.8

188.6187.7

151.7

167.6166.1

185.2152.5

151.2

y=-4.4285x+220.53

0

50

100

150

200

250

300age-ad

justed

rateper100

,000

peo

ple

OverallCancerMortalityRateAllcancers;Allagesandgenders

2000-2015CentralNHPublicHealthRegion


e.Asthma

Asthmaisachroniclungdiseasethatinflamesandnarrowstheairways.Asthmacausesrecurringperiodsofwheezing,chesttightness,shortnessofbreath,andcoughing.Asthmaisanincreasinglyprevalentconditionthatcanbeexacerbatedbypoorenvironmentalconditions.

AsthmaPrevalence:Thisindicatorreportsthepercentageofadultsaged18andolderwhoself-reportthattheyhaveeverbeentoldbyadoctor,nurse,orotherhealthprofessionalthattheyhadasthma;alsodisplayedisthepercentageofchildrenwithcurrentasthmaasreportedbyaparentorguardian.Thereportedasthmarateintheregionforchildrenislowerthanthestateoverall,althoughtheobserveddifferenceisnotstatisticallysignificant.

AreaPercentofChildren(ages0to17)

withCurrentAsthma*PercentofAdults(18+)with

CurrentAsthma**


NewHampshire 7.2% 10.1%*DataSource:NHDHHS,BehavioralRiskFactorSurveillanceSystem,2015

**NHDHHS,BehavioralRiskFactorSurveillanceSystem,2014-2015RegionalratesarenotstatisticallydifferentthantheoverallNHrate


f.IntentionalandUnintentionalInjury:

Accidentsandinjuryarethethirdleadingcauseofdeathintheregionandinthestate.Ofparticularnoteinrecentyears,NewHampshirehasbeenamongthehardesthitstatesbytheepidemicofopioidmisuse,rankingsecondbehindWestVirginia,inthenumberofopioid-relateddeathspercapitaandhighestfordeathspercapitafromsyntheticopioidslikefentanyl.

DrugOverdoseMortality:Asdisplayedbythecharttotheright,theoveralloverdosemortalityrateintheregionislowerthanthestateoverall,althoughtheobserveddifferenceisnotstatisticallysignificant.

Area

AlldrugoverdosedeathsCentralNHPublicHealthRegion,2015

(prescription,illicit,other&unspecifieddrugs)Age-adjustedrateper100,000population


NewHampshire 32.6

DataSource:NHDivisionofVitalRecordsdeathcertificatedata,2015RateisnotstatisticallydifferentthantheoverallNHrate

Suicide:Thisindicatorreportstherateofdeathduetointentionalself-harm(suicide)per100,000people.Suicideratescanbeanindicatorofaccesstomentalhealthcare.Duringtheperiod2011and2015,thesuiciderateintheCentralNHregionwassimilartotheoverallNHrateofsuicidedeaths.

Area SuicideDeathsper100,000people;anycauseormechanism


NewHampshire 14.6

DataSource:NHDivisionofVitalRecordsdeathcertificatedata,2011-2015RegionalrateisnotsignificantlydifferentthantheoverallNHratestatistically.


g.PrematureMortality

Anoverallmeasureoftheburdenofpreventableinjuryanddiseaseisprematuremortality.Theindicatorbelowexpressesprematuremortalityasthetotalyearsofpotentiallifelostbeforeage75(YPLL-75).Everydeathoccurringbeforetheageof75contributestothetotalnumberofyearsofpotentiallifelost.Duringtheperiod2012to2014,940deathsinGraftonCountyoccurredbeforetheageof75andtheaverageannualtotalofYPLL-75was5,100yearsofpotentiallifelostper100,000population.

Area Yearsofpotentiallifelostbeforeage75per100,000population(age-adjusted)

GraftonCounty 5,100

NewHampshire 5,500

Datasource:NationalCenterforHealthStatistics,NationalVitalStatisticsSystemaccessedviaCountyHealthRankings,2012-2014.

RateisnotstatisticallydifferentthantheoverallNHrate


5.ComparisonofSelectedCommunityHealthIndicatorsbetween2017and2014

Thetablebelowdisplayscomparisonsofestimatedratesforkeycommunityhealthstatusindicatorsbetweenthecurrentcommunityhealthassessment(2017)andthepreviousassessmentconductedin2014,aswellasthemostrecentstatewidestatisticforeachindicator.Thiscomparisonisprovidedforinformationalpurposesanditisimportanttonotethedifferencesbetweenthe2014and2017estimatesfortheregionandthestatecomparisonestimatearenotsignificantlydifferentata95%confidencelevelformostindicators.Ininstanceswheretherearestatisticallysignificantdifferencesbetweenrecentestimates,theindicatorsarehighlightedinboldfont.

Table10:ComparisonofSelectedCommunityHealthIndicatorsbetween2017and2014withNHStateComparison

CommunityHealthIndicator GeographicArea2014CommunityHealthAssessment

2017CommunityHealthAssessment

NHStateComparison

Accesstocare Percentageofadultpopulation(age18+)

withouthealthinsurancecoverageCNHHPServiceArea 13.5% 9.2% 6.4%

Donothavingapersonaldoctororhealthcareprovider,percentofadults

CNHHPServiceArea14.1% 19.4% 13.2%

Havenotvisitedadentistordentalclinicinthepast5years,percentofadults

CNHHPServiceArea14.3% 17.7% 11.4%

HealthPromotionandDiseasePrevention

Currentsmoking,percentofadults CNHHPServiceArea 21.2% 24.2% 17.0%

Physicallyinactiveinthepast30days,%ofadults


Bingedrinking,percentofadults CNHHPServiceArea 20.7% 16.6% 16.8%

TeenBirthRate,per1,000WomenAge15-19 CNHHPServiceArea 10.6 8.9 12.0


CommunityHealthIndicator GeographicArea2014CommunityHealthAssessment

2017CommunityHealthAssessment

NHStateComparison

HealthOutcomes

Obese,percentofadults CNHHPServiceArea 25.1% 19.8% 27.0%

Evertoldhaddiabetes,percentofadults CNHHPServiceArea 9.2% 7.7% 8.6%

Currentasthma,percentofadults CNHHPServiceArea 18.3% 11.2% 10.1

CoronaryHeartDiseaseMortality,per100,000people,age-adjusted

CNHHPServiceArea 151.8 90.9 95.9

CancerIncidence,Allsites,per100,000people,age-adjusted


CancerDeaths,AllSites,per100,000people,age-adjusted


Yearsofpotentiallifelostbeforeage75per100,000population,age-adjusted

GraftonCounty 4,956 5,100 5,500

central new hampshire health partnership · the total population of the primary service area of the...

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