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Kern County Community Health Needs Assessment
The 2010 Kern County Community Needs Assessment combines quantitative and qualitative information based on review of health and quality of life data and interviews with community leaders and representatives of local agencies. To assist with identifying priorities, comparisons are made to other California counties, as well as to national benchmarks such as Healthy People 2020, which is a set of key national health objectives. This report summarizes the results of the 2010 Kern County Community Needs Assessment.
The needs assessment is a collaborative effort by Bakersfield Memorial Hospital, Delano Regional Medical Center, Kaiser Permanente, Kern County Department of Public Health, Mercy Hospitals of Bakersfield, San Joaquin Community Hospital and other local partners. The 2010 assessment is a web-based, living community needs assessment, which uses the Healthy Communities Network (HCN) web tool to display health status and track progress in the community. The 2010 assessment highlights important issues in the community. The next steps will be to propose an implementation strategy for the priority areas.
The Kern County HCN website, www.HealthyKern.org, provides over 120 health and quality of life indicators for Kern County. Rather than focus on one isolated area of need, the needs assessment sought to create a comprehensive needs assessment for the county using multiple health and quality of life indicators. The needs assessment process involves assessment and understanding of demographics, health access, health care usage, health behaviors, health status, as well as social and environmental factors that ultimately affect health outcomes. The review and evaluation of this quantitative data combined with community consultation and feedback have enabled us to identify key priority areas in the community that require attention. The findings of this need assessment can be used to inform strategic planning, decision-making, and resource investments and allocations.
The Center for Healthy Aging (CHA), independent consultants, analyzed each of the indicators on the www.HealthyKern.org website. CHA presented their findings to the collaborative for their input. The top ten priority areas were agreed upon by the collaborative. Once the priorities were determined, the collaborative created a set of interview questions and obtained input from key stakeholders in the community to validate the top issues, identify gaps, and suggest evidenced-based and/or promising practices to address the issues. Next steps will be to create the strategic plan to target the top priority areas.
This summary highlights the identified county needs to focus on in order to increase the health and quality of life of residents in Kern County.
Key Findings and Themes
- Top health problems and community issues (not ranked)
Obesity increases the risk of many diseases and health conditions including heart disease, Type 2 diabetes, cancer, hypertension, stroke, liver and gallbladder disease, respiratory problems, and osteoarthritis. Losing weight and maintaining a healthy weight help to prevent and control these diseases. Being overweight or obese also carries significant economic costs due to increased healthcare spending and lost earnings. 29.3% of Kern County adults are obese and the percentage has consistently increased over the 2003 – 2007 timeframe. Latinos are leading at 34% with Whites next at 26%. Males between the ages of 45 and 65 have the highest obesity rates. Healthy People 2020 national health target is to reduce the proportion of adults who are obese to 15%. If accomplished, this would be about a 50% reduction in the rate of obesity in Kern County.
Kern County would benefit in reducing the number of diabetes deaths and related diabetes attributes by focusing their efforts on reducing obesity and increasing physical activity in the low ranking categories noted above.
Basic Needs: Poverty and Unemployment
All but one of the Kern County ‘below poverty level’ indicators are high: Based on the 2000 Census, Children Living Below Poverty Level is 28.2%, Families Living Below Poverty Level is 16.8%, and People Living Below Poverty Level is 20.8%. Only People 65+ Living Below Poverty Level is low at 10.5%. A high poverty rate indicates that local employment opportunities are not sufficient to provide for the community (which coincides with the high unemployment rate). Through decreased buying power and decreased taxes, poverty is associated with lower quality schools and decreased business survival. Children in poverty are more likely to have physical health problems like low birth weight or lead poisoning, and are also more likely to have behavioral and emotional problems. Children in poverty also tend to exhibit cognitive difficulties, as shown in achievement test scores, and are less likely to complete basic education. Seniors who live in poverty are an especially vulnerable group due to increased physical limitations, medical needs, and social isolation. Seniors often live on a fixed income from pensions or other retirement plans and social security. If this income is insufficient in the face of increasing prescription costs and other costs of living, most seniors have no way to supplement their income. Retirement plans may be vulnerable to fluctuations in the stock market as well; the increasing reliance of retirees on stock market based retirement plans may explain why more seniors nationwide are now slipping into poverty.
Kern County is experiencing high unemployment rates. The June 2010 unemployment rate rose to 15.7% compared to the State of California unemployment rate of 12.2%. During the past year, the unemployment rate ranged from 14% to 18.3% of the adult civilian population in Kern County. The unemployment rate is a key indicator of the local economy: a high unemployment rate has personal and societal effects. During periods of unemployment, individuals are likely to feel severe economic strain and mental stress. Unemployment is also related to access to health care, as many individuals receive health insurance through their employer. A high unemployment rate places strain on financial support systems, as unemployed persons qualify for unemployment benefits and food stamp programs. Families with unemployed adults face significant challenges in caring for and meeting their health needs and the health needs of their children.
Kern County schools are struggling with low assessment rates and high drop out rates. From 2005 – 2008 the number of students who completed high school decreased from 81.6% to 73.5%. The dropout rate during this period was 5.5%, placing Kern County 42nd out of 56 reporting counties. Students who do not finish high school are more likely than people who finish high school to lack the basic skills required to function in an increasingly complicated job market and society. Adults with limited education levels are more likely to be unemployed, on government assistance, or involved in crime. Completion of high school and achieving standard literacy levels align with future employment opportunities, and encourage the transition from adolescence to responsible adulthood.
In 2009, the educational indicators of 4th grade students proficient in math and reading were low at 56% and 51%, respectively. Competence in mathematics and reading are essential for functioning in everyday life. The ability to read proficiently is a fundamental skill that affects the learning experiences and school performance of children and adolescents. Students who take higher level mathematics and science courses, which require strong fundamental skills in mathematics and who are competent readers are more likely to attend and to complete college. The high Student-to-Teacher Ratio may be contributing to the low achievement levels of students in Kern County. In 2007-2008, the student-to-teacher ratio was high in Kern County at 18.3 students/teacher, with 50% of the U.S. counties having 14.4 students/teacher or less. This indicator does not take class size into consideration; however, the student-teacher ratio is often a reasonable proxy for estimates of class size. The student-teacher ratio is an indicator of how well a school or district is preparing their students to function in society.
Sexually Transmitted Infections
Kern County has exceedingly high rates of sexually transmitted infections. The major areas identified are HIV, chlamydia, and gonorrhea rates. The HIV prevalence rate 62.5 cases per 100,000 population, ranking 49th out of 58 California counties. The chlamydia incidence rate ranks 58th of 58 counties in California; the gonorrhea incidence rate ranks 55th. In 2009, Kern County had 622.8 cases per 100,000 female population of chlamydia. The cases of chlamydia have primarily increased from 2004 to 2008 with a small decline in 2006 and again in 2009. Under reporting of chlamydia is substantial, as most people with chlamydia are not aware of their infections and do not seek testing. This can lead to more serious health outcomes such as Pelvic Inflammatory Disease and infertility.
The gonorrhea incidence rate in Kern County does not meet national targets. In 2009, the gonorrhea incidence rate in Kern County was 98.8 per 100,000 population; whereas, the Healthy People 2020 target is 19 per 100,000 population. However, unlike chlamydia, gonorrhea rates have been in steady decline since 2006.
Compared to older adults, adolescents are at higher risk for acquiring sexually transmitted diseases (STDs) for a number of reasons, including limited access to preventive and regular health care and physiologically increased susceptibility to infection. Responsible sexual behavior can eliminate or reduce the chances of contracting a sexually transmitted disease and unintended pregnancies, thus reducing the number of cases of STDs and births. The Healthy People 2020 national health target is to increase the proportion of adolescents aged 17 years and younger who have never had sexual intercourse to 75%.
Access to Healthcare
Although the access to healthcare indicators are not showing in the ‘red’ for Kern County, there is still concern by Kern County healthcare experts that this is an issue that needs to be addressed. The indicators for Kern County, based on 2007 data, show that adults with private health insurance and people with a usual source of health insurance are 57% and 87.5%, respectively, and children with Health Insurance is at 91%. African American and Latinos who have health insurance are lowest at 47.9% and 36.3%. A high rate of private insurance coverage may indicate greater financial security, since it means that more businesses are able to provide insurance, and more individuals can afford to purchase it when necessary. Areas with high rates of private insurance coverage also place less strain on the public programs that are available. People with a usual source of care are more likely to go in for routine checkups and screenings, and are more likely to know where to go for treatment in acute situations. Not having a usual source of care or a usual place to go to when sick or in need of health advice can cause a delay of necessary care, leading to increased risk of complications.
Teen Birth Rate and Infant Health
The teen birth rate in Kern County has been consistently high for many years. This has lead to more low birth weight babies, and also leads to a lack of education attainment for female youth. In 2006-2008, Kern County had the highest teen birth rate of all California counties at 63.7 births per 1,000 female ages 15 – 19, compared to 36.6 per 1,000 females ages 15 – 19 in the State of California.
High teen birth rates result in a high percent of babies with a low (<2500 grams) or very low (<1500 grams) birth weight. The Healthy People 2020 national health target is to reduce the proportion of infants born with low birth weight to 5.0%. In California, 6.9% of infants have a low birth weight. Kern County ranks 50th among the 58 counties in California at 7.4%. The percentage of babies with a low birth weight has continued to increase over the past five years. While it is not trending up in high percentages, infants born with very low birth weight is also rising. The 2010 national health target is to reduce the proportion of infants born with very low birth weight to .09%. In 2009, 1.4% of babies in Kern County were born with a very low birth weight.
Babies born with a low or very low birth weight are more likely than babies of normal weight to require specialized medical care, and often must stay in the intensive care unit. Low birth weight is often associated with premature birth and babies born with very low birth weight are at the highest risk of dying in their first year. While there have been many medical advances enabling premature infants to survive, there is still risk of infant death or long-term disability.
The Infant Mortality Rate in Kern County is also exceedingly high. Kern County ranks 45th out of all 58 counties in California with an infant mortality rate of 7.2/1,000 and the trend is rising. The leading causes of death among infants are birth defects, pre-term delivery, low birth weight, Sudden Infant Death Syndrome (SIDS), and maternal complications during pregnancy. The Healthy People 2020 national health target is to reduce the infant mortality rate to 4.5 deaths per 1,000 live births.
Preterm births from 2005 to 2008 in Kern County have been rising steadily. The 2008 preterm birth rate was 13.9%. The Healthy People 2020 national health target is to reduce the proportion of infants who are born preterm to 7.6%. In all of the above cases, the most important things an expectant mother can do to prevent and/or reduce prematurity, low and very low birth weight and also preterm births are to take prenatal vitamins, stop smoking, stop drinking alcohol and using drugs, and most importantly, get prenatal care. The good news is that the trend of mothers who received early prenatal care is going up. Kern County is at 72.2%, close to meeting the State of California at 78.7%, and is rising to meet the 2010 Healthy People 2020 goal of 90%.
Disparities can be seen among indicators of teen sexual health, maternal health, and infant health such as teen birth rate, prenatal care, low birth weight, and infant mortality rates. Birth and infant health outcomes tend to be the worst for African Americans. Additionally, in Kern County, African American and Hispanic teens have a birth rate nearly 3.5 times as high as White females.
Kern County places in the bottom quartile of California counties for all diabetes-related indicators. The age-adjusted diabetes death rate averaged over 3 years (2006-2008) is nearly 34 per 100,000 compared to the State value of 21 per 100,000. Diabetes risk factors such as obesity and physical inactivity contribute to the prevalence of diabetes and diabetes-related health outcomes in the community. Age, race, and ethnicity are also important risk factors. In Kern County, Asians have the lowest diabetes death rate of 17.5 per100,000 population; whereas African Americans, Hispanics, and American Indians have death rates 3 – 4 times this rate.
Kern County ranks in the bottom ten percent for all hospital utilization rates due to diabetes-related admissions and emergency room visits. During the 2006-2008 measurement period, the hospitalization rate due to diabetes was 28.4 hospitalizations per 10,000 population and ranked 55 out of 58 California counties. The hospitalization rate due to long-term and short-term complications of diabetes was 17.2 and 8.9 hospitalizations per 10,000 population, respectively – ranking 52nd and 54th out of 58 California counties.
Persons with diabetes are at risk for ischemic heart disease, neuropathy, and stroke. Healthy People has identified 17 goals that aim to “reduce the disease and economic burden of diabetes, and improve the quality of life for all persons who have or are at risk for diabetes." Goals include improved diabetes education, improved compliance with recommended care and screening procedures, and reduced rates of serious complications such as foot ulcers, amputation, and death.
The high mortality rates in Kern County point to multiple systemic problems in the health care system. Mortality rates in Kern County rank in the bottom third of all California counties. In addition, the rates for nearly all causes of death are increasing over time. The age-adjusted death rates due to coronary heart disease, diabetes, stroke, suicide, and influenza and pneumonia all place in the bottom quartile of all California counties. The suicide death rate is more than double the Healthy People 2020 national target, and the heart disease death rate is 25% higher than the national target. Significant racial and ethnic disparities exist for many death rates, especially for African Americans.
Ozone is the primary ingredient of smog air pollution. Inhaling ozone can result in a number of health effects including induction of respiratory symptoms, inflammation of airways, and decreased lung functioning. During 2006 -2008, the annual ozone air quality was rated an “F” (a 5 in the numeric scale) in Kern County, whereas the US standard is a B or better (a 1 or a 2 in the numeric scale). Annual particle pollution is also very high, rating an “F”, or 5, during the 2006 – 2008 measurement period. Particle pollution refers to the amount of particulate matter in the atmosphere. In addition to poor air quality due to high ozone and particulate matter, the quantity (in pounds) of carcinogens released into the air is increasing over time in Kern County. All of these factors result in poor air quality in Kern County and can adversely affect health through illnesses such as asthma, cardiovascular problems, or premature death.
Public Safety and the Social Environment
Kern County is disproportionately affected by violence. In 2008, Kern County ranked 27th of 35 reporting counties in California, with a Violent Crime Rate of 562.3 crimes per 1,000 population. The violent crime rate includes homicide, assault, rape and robbery. Violence surrounds and threatens many people in their homes, schools and neighborhoods. In addition, race, ethnic and gender disparities are an issue.
In addition to a high violent crime rate, the Child Abuse Rate in Kern County ranks 52nd of the 58 California counties. From 2004-2008 child abuse in Kern County steadily increased. In 2009, the rate decreased from 22.3 cases/1,000 population to 18.5 cases/1,000 population - a step in the right direction; however, the Healthy People 2020 national health target is to reduce the child maltreatment rate to 10.3 cases per 1,000 children under 18 years of age. The current rate in Kern County is nearly two times the target value. Child abuse and neglect can have enduring physical, intellectual, and psychological repercussions into adolescence and adulthood. Abuse can affect a person’s ability to lead a healthy life at home, at work, and at school.
It is clear that Kern County has many health and quality of life areas that need attention and concerted effort to improve. This 2010 Kern County Community Needs Assessment is the beginning effort to address the most pressing needs. These needs will be addressed by the individual hospitals, health and human service organizations within the community, as well as the collaborative efforts by the organizations gathered to create the most significant needs summarized in this needs assessment.
The 2010 needs assessment provided a listing of the top ten health priority areas that the county of Kern would need to address in order to create a healthier community for its residents. Of those ten identified areas, five rose to the top of the list as critical to the immediate health crisis in our community. Our community in collaboration through public agencies, private organizations and non profit groups will work diligently to implement evidence based strategies to close the gaps for service and quality thus creating a healthier community.
The top five priority areas of the 2010 needs assessment are
Healthy Kern County