1. Community Health Needs Assessment Introduction and Overview Berwood Yost Franklin & Marshall College

2. Overview Data Sources Selected Highlights of CHNA Findings –Overview of Findings Health Indicators Social Context –Defining Community Need –Community Transformation Summary

3. Data Sources Demographic Change –The data in this section of the report comes from data available through the U.S. Census Bureau. Behavioral Risk Factor Survey Indicators –Most of the data presented in this section of the summary is based on a behavioral risk factor survey of 809 adult residents of Adams County and 1,004 adult residents of York County. The survey interviewing took place from September 26 through November 9, 2011. The survey sample was designed to be representative of the adult, non- institutionalized population of the two counties. –The trend data is based on the Commonwealth of Pennsylvania’s behavioral risk factor surveillance system (BRFSS) survey and includes data gathered by the state from 2001 to 2010. Vital Statistics –Vital Statistics data were provided by the Bureau of Health Statistics and Research, Pennsylvania Department of Health, through its Epidemiological Query and Mapping System (Epi-QMS). The Department specifically disclaims responsibility for any analyses, interpretations, or conclusions. All tables were created by the Center for Opinion Research, January 2012. Prevention Quality Indicators –The Prevention Quality Indicators are defined by the Agency for Healthcare Research and Quality. The data presented in this summary were compiled from Pennsylvania Health Care Cost Containment Council data by Center for Opinion Research staff with assistance from the planning department at WellSpan Health.

4. York County compares favorably to state rates on access indicators. Most notably, York County has higher rates of health insurance coverage and the trend on that indicator has improved over the past ten years. Access indicators are strongly associated with poverty and age. Residents above 55 years of age are more likely to have health care coverage and a personal physician. They are less likely to have not received health care due to cost or to have experienced one or more economic hardships during the past year. Those older than 55 are also less likely to have dental insurance. Poor and low-income respondents are much less likely to have health care coverage or a personal physician than higher income respondents. Poor respondents are most likely to have skipped health care due to costs and to have experienced one or more economic hardships in the past year. Low-income respondents are least likely to have dental insurance.

5. Adults 18 – 64 with No Health Insurance 2001 – 2010, Adams County, York County and Pennsylvania

7. York County compares favorably to state rates on behavioral indicators. The trend in York County on these indicators is mostly stable. The most striking statistic is the large number of overweight and obese individuals and the concomitantly low rates of exercise and vegetable consumption. Behavioral indicators are most strongly associated with age. Participation in strength training tends to decline with age as does the likelihood of being a daily smoker or a binge drinker. Body Mass Index tends to increase with age. Only one in four residents over the age of 55 falls in the normal weight range.

8. Overweight and Obese Adults 2001 – 2010, Adams County, York County and Pennsylvania

9. York County compares favorably to state rates on most prevention-related behaviors or conditions except for higher rates of poor mental health days. The trend in York County on these indicators is mostly stable although the trend for poor mental health days is increasing. Health prevention behaviors and conditions are most strongly associated with age and poverty. Respondents over 55 are more likely to visit the doctor for routine check ups and to get health screenings. They are also more likely to have limited health literacy. They are less likely to have poor mental health days or money worries. Poor respondents are more likely to have poor mental health days and days with depressive symptoms. Poor and low-income respondents are more likely to have money concerns and low health literacy and are less likely to have visited the dentist in the past year.

10. Poor Mental Health Days 2003 – 2010, Adams County, York County and Pennsylvania

11. York County compares favorably to state rates on the presence of specific health conditions. The trend in York County on these indicators is mostly stable. The most striking statistics here are the high prevalence of high cholesterol and high blood pressure. That one in five residents has a depressive disorder also seems striking. Health conditions are most strongly associated with age and poverty. Respondents over 55 are more likely to be diabetic and to have been diagnosed with circulatory conditions and associated high rates of high blood pressure and high cholesterol. Respondents over 55 are also more likely to have been diagnosed with respiratory conditions and cancer. Those over 55 are less likely to report an anxiety or depressive disorder. Poor and low-income respondents are more likely to have circulatory disorders. Poor respondents are more likely to have asthma and anxiety or depressive disorders. Women are more likely than men to have a depressive disorder. Blacks are most likely among the racial/ethnic groups to have high blood pressure and Hispanics are most likely to have asthma.

12. Adults with Hearth Disease, Heart Attack or Stroke 2004 – 2010, Adams County, York County and Pennsylvania

13. Age-Adjusted Cancer Death Rate per 100,000 1990 – 2009, Adams County, York County and Pennsylvania

14. Lyme Disease Incidence Rate per 100,000 2000 – 2009, Adams County, York County and Pennsylvania

15. Early Prenatal Care Rate 1990 – 2009, Adams County, York County and Pennsylvania

16. Demographic Estimates, Comparisons and Trends Performance (%, rate or value) State Average Year10-year Trend

17. Defining Need

19. Factors that Contribute to Mortality

20. Risk Factors for Chronic Disease

21. Health Disparities

22. A Community Approach to Health Source: Centers for Disease Control and Prevention. Community Health Assessment aNd Group Evaluation (CHANGE) Action Guide: Building a Foundation of Knowledge to Prioritize Community Needs. Atlanta: U.S. Department of Health and Human Services, 2010.

23. Summary Health access and the health system are local strengths as is the regional economy. Health behaviors are comparatively positive, but negative health behaviors affect a large number of county residents. Mental health problems are increasing. Health disparities related to poverty and age pose a significant challenge. The county’s physical environment may contribute to adverse health outcomes. Community-level interventions are required to drive better health outcomes.