Chna

CHNA for San Bernardino County, CA
Gilberto M. Wilson Jr.

December 7, 2013
Introduction
San Bernardino County is made up of 31 cities in the Inland Empire in Southern California,
covering an area of about 20,160 square miles. Bordering the counties of Inyo, Kern, Los
Angeles, Orange, Riverside, and the state of Nevada, San Bernardino County is almost entirely a
desert area, surrounded by mountains and valleys (sbcounty.gov). The county of San Bernardino
is home to an estimated 2,035,210 people, with 28.2% of its population consisting of persons
under 18 years of age (census.gov). Most of the working adults in the population are employed
in the areas of service, retail trade, or government (sbcounty.gov).
Source: http://geology.com/county-map/california.shtml
San Bernardino County faces some daunting health challenges, such as the rate of obesity,
diabetes, cardiovascular disease. In addition to these challenges, accessing proper resources to
maintain good health is also difficult because of health care costs and availability, while food and
recreational facilities are scarce enough to add to the difficulty of maintaining healthy lifestyles
and desired outcomes. While all of these issues beg intervention, the population continues to rise
numerically, increasing the magnitude of these prevailing matters and the effects of their
persistence.
Between the years of 2000 and 2010, the population in San Bernardino County increased by
325,740, totaling a reported population of 2,035,210 (sbcounty.gov). This was a nearly 20
percent increase from the 2000 census report.
Report Area
San Bernardino
County, CA
Total
Population,
2000 Census
1,709,470
Total Population,
2010 Census
Total Population
Change, 2000-2010
2,035,210
325,740
Source: http://assessment.communitycommons.org/CHNA/Report.aspx
The percentage of increase in population for San Bernardino County was almost than twice that
of both the state of California and the US, respectively. This qualifies the growth in San
Bernardino as significant, and further indicates that additional living resources are likely needed
to accommodate such growth, and to promote and provide a healthy living environment.
Percent Population Change, 2000-2010

19.06%
9.99%
9.74%
This increase in population over time does not specifically illustrate the aging of those
represented in the prior census, which can indicate status changes such as those no longer
considered minors or adults qualifying for retirement and more importantly, medical benefits.
The following charts detail the distribution of this population by race, age, gender, and
socioeconomic status.
Gender by percentage in San Bernardino County, CA

Percent Male
50%
50%
Percent
Female
Racial/Ethnic distribution in San Bernardino County, CA

18%4%
0%
1%
6%
9%
61%
White
Black
Asian
Native American / Alaska

Native
Native Hawaiian / Pacific

Islander
Some Other Race
Multiple Races
The impact of diet is continually studied and measured in relation to health outcomes. Poor
habitual dietary practices have been linked as contributors to health issues such as obesity and
diabetes, and although these links have not been defined as necessarily causative, they hold an
important part in the determination of the status of both individual and community health. This
data shows the approximate number of persons in San Bernardino County over 18 years of age
who do not consume the recommended daily amount of five servings of fruits and vegetables.
Report Area
Total
Population
Age 18+
Estimated Population
with Inadequate Fruit /
Vegetable Consumption
Percent Population
with Inadequate Fruit /
Vegetable
Consumption
1,005,998
73%
San Bernardino
1,378,084
County, CA
California
202,015
144,441
United States
116,676,632
88,508,989
http://assessment.communitycommons.org/CHNA/Report.aspx?page=5&id=301
71.50%
75.86%
While the consumption of fruits and vegetables are reportedly lower than the state average,
reports indicate that San Bernardino County ranks 37th amongst 58 California counties in
expenditures for these essentials (chna.org).
The indicator of grocery store access shows the number of grocery stores per 100,000
population. Included in this category are supermarkets, smaller grocery stores selling canned
and frozen foods, fresh fruits and vegetables, and fresh and prepared meats, fish, and poultry.
Also included in this group are delicatessens and similar locations. Data does not include
convenience stores or large general merchandise stores that also sell food. This indicator is
important because it displays the relative ease of healthy food access, which can influence
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dietary behaviors. With little access to healthy food, citizens can be more inclined to buy and
consume fast food, which typically offers excessive calories and fat.
Report Area
Total Population
Number of
Establishments
Establishment Rate
per 100,000
Population
16.46
San Bernardino County,

2,035,210
335
CA
California
37,253,956
7,912
21.24
United States
308,745,538
64,366
20.85
Source: http://assessment.communitycommons.org/CHNA/Report.aspx?page=3&id=402
To further illustrate the condition of food access, this data was compiled to display food
insecurity, a measure of low food access. In San Bernardino County, 25.41% of the population
reports as having low access to grocery stores, or living in tracts that qualify as food deserts
(chna.org).
Report Area
Total Population
Population with
Low Food Access
Percent Population
with Low Food
Access
25.41%

2,035,210
517,111
CA
California
37,253,956
5,332,093
14.31%
United States
308,745,538
72,905,540
23.61%
Leisure behaviors are worth investigating, as quantity and type of activity can play a large part in
determining health outcomes of any individual or group. Activity and exercise have been known
to help reduce the probability of compromising health conditions, such as obesity and
substandard to poor heart health (chna.org). Outside of work related activity, reports indicated
that 280,500 (20.60%) of adults aged 20 and up found no time for exercise or physical activities
(chna.org).
Report Area
Total Population
Age 20+
Population with
no Leisure Time
Physical Activity
Percent
Population with no
Leisure Time
Physical Activity
280,500
20.60%

1,375,000
CA
California
26,873,024
4,735,335
17.56%
United States
226,142,005
53,729,295
23.41%
The following indicates the number of recreation and fitness facilities per 100,000 population of
San Bernardino County, in comparison with the state and the U.S. as a whole. Along with a
healthy diet, exercise and physical activity are promoted for healthy living. However, access to
resources, from neighborhood sidewalks to gyms and fitness centers do play a part in the
engagement of healthy practices. The numeration of area recreation and fitness facilities is an
important indicator because ease of access to these resources can encourage or limit relevant
healthy practices.
Report Area
Total Population
Number of
Establishments
Establishment
Rate per 100,000
Population
5.36

2,035,210
109
CA
California
37,253,956
3,203
8.60
United States
308,745,538
29,506
9.56
It is not just the lack of facilities and resources that is to blame for these statistics, but also the
popularity of behaviors that contribute to negative health outcomes. Despite efforts to reveal
tobacco usage as a detriment to both primary users and those subjected to its use second hand,
the use of cigarettes is still very popular practice. Cigarettes have been linked to different forms
of cancer and cardiovascular disease, but have not been proven as a direct and singular cause of
that effect. The percentage of the population of San Bernardino County that still practices the
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habit of smoking regularly is higher than the state average, but lower than the national average
(chna.org).
Report Area

CA
California
United States
Total Population
Age 18+
1,404,630
Estimated
Population
Regularly
Smoking
Cigarettes
235,978
Percent Estimated
Population
Regularly
Smoking
Cigarettes
16.80%
27,311,960
229,932,154
3,714,426
42,664,071
13.60%
18.56%
The percentage of alcohol consumers who are considered heavy consumers is 16%, decently
similar to the percentage of reported cigarette smokers (chna.org). However, this statistic is
higher than both state and national percentages. Data was gathered from those 18 and older,
although the legal age for alcohol consumption in California is 21. Alcohol consumption can
play a role in the development of negative health outcomes, such as mental health issues
(addiction/dependence), cirrhosis, and a number of cancers.
Report Area
Total Population
Age 18+
Estimated
Population
Heavily
Consuming
Alcohol
224,741
Percent
Population
Heavily
Consuming
Alcohol
16%

1,404,630
CA
California
663,410
104,155
15.70%
United States
89,135,163
13,385,866
15.02%
One of the key drivers of health status is the prevalence of poverty that affects individuals and
the community at large. Considering the distribution of wealth within a community, San
Bernardino County has a statistically higher percentage of its population living at or below
poverty than both the state of California and the U.S. Reports indicate that 317,059 individuals
are living in households with income below the Federal Poverty Level (FPL)a total of 16.03
percent of the population (chna.org). This indicator is relevant, as it can also be assumed that
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there is a greater obstacle to gain access to health services, food, and other resources that may
improve an individuals personal health status.
Report Area

CA
California
United States
Total Population
Population in
Poverty
1,977,432
317,059
Percent
Population in
Poverty
16.03%
36,211,792
5,211,481
14.39%
298,788,000
42,739,924
14.30%
In addition to this report, findings indicate that 38.42% or 759,799 individuals living with an
income that qualifies below 200% of the Federal Poverty Level (chna.org).
Report Area
Total Population
Population with
Income at or
Below 200% FPL
Percent
Population with
Income at or
Below 200% FPL
38.42%
San Bernardino
1,977,432
759,799
County, CA
California
36,211,792
12,271,379
United States
298,788,000
97,686,536
http://assessment.communitycommons.org/CHNA/Report.aspx?page=2&id=780
33.89%
32.69%
Barriers such as the lack of insurance are just one of the major obstacles that we seek to both
understand and resolve. The lack of insurance means increased cost for preventive health care,
which can increase the risk and cost of further, necessary future health care and poor health
outcomes. As indicated below, about 20.92 percent of the total civilian, non-institutionalized
population of San Bernardino County is uninsured (chna.org).
Report Area

CA
California
Total Population
Number Uninsured
(For Whom
Insurance Status is
Determined)
2,040,455
418,805
37,330,448
6,694,764
Percent Uninsured
20.92%
17.93%
7
United States
309,231,232
46,282,216
15.22%
Ambulatory care conditions such as diabetes, dehydration, pneumonia, asthma, can sometimes
be prevented if sufficient primary care resources are available and accessible to patients. This
indicator displays the rate of discharge for patients visiting ambulatory care facilities due to
incidences with these conditions that could have been preventable with sufficient primary care.
Report Area

CA
California
United States
Total Medicare
Part A Enrollees
Ambulatory Care Ambulatory Care

Sensitive
Sensitive
Condition
Condition
Hospital
Discharge Rate
Discharges
74,131
4,692
63.30
2,324,980
120,619
51.88
56,167,590
3,737,659
66.54
Source: http://assessment.communitycommons.org/CHNA/Report.aspx?page=4
There is an admitted shortage of primary health care physicians in the county of San Bernardino.
Without proper and regular primary care, preventable issues become increasingly difficult to
negotiate, and comorbidities have a greater chance of occurring. This chart shows the
distribution of primary care physicians per 100,000 persons in given categories.
Report Area
Total Population,
2011
Total Primary
Care Physicians,
2011
Primary Care
Physicians, Rate
per 100,000 Pop.

2,065,377
1,354
65.56
CA
California
37,691,912
31,674
84.03
United States
311,591,917
267,437
85.83
3.56% of adults aged 18 and older in San Bernardino report that they have been told by a doctor
that they have coronary heart disease or angina (chna.org). While it is not the highest populated
county in California, data tells us that San Bernardino has a significantly higher mortality rate
due to heart disease. This rate is important because there are other contributing factors, such as
poor health practices and lack of resources, are equally important in specifying and assessing not
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only the status of the health of San Bernardino, but also the probable causes for the overall
condition.
Report Area
Total
Population
Average
Annual
Deaths,
2006-2010
Crude Death
Rate
(Per 100,000
Pop.)
Age-Adjusted
Death Rate,
Heart Disease
Mortality
(Per 100,000
Pop.)
127.54
183.59
San Bernardino
2,003,841
2,556
County, CA
California
36,618,207
46,508
127.01
135.06
United States
303,844,430
432,552
142.36
134.65
8.70% of surveyed adults 20 and older state that they have, at least once, been diagnosed with
diabetes by a physician (chna.org). While diabetes is an increasingly major issue in the U.S., it
causes a number of concerns. One, persons reporting being told by a doctor that they have
diabetes indicates at least one visit to a physician, but secondly, may indicate that there is a larger
number who have not been told by a doctor, but have somehow experienced qualifying
symptoms. Regardless of the case, the fact is that the prevalence of diabetes is a larger issue for
residents of San Bernardino county than state average, comparatively.
Report Area
Total Population
Age 20+
Population with
Diagnosed
Diabetes
Percent
Population with
Diagnosed
Diabetes
8.70%
San Bernardino
1,370,506
116,493
County, CA
California
26,876,472
2,112,548
7.72%
United States
228,834,127
21,876,232
8.95%
27.90% of Adults 20 years and older indicated that they have a body mass index that qualifies as
obese (above 30.0) (chna.org). This measure is typically indication of unhealthy life habits,
which can lead to health issues such as diabetes, high blood pressure, and poor heart health
outcomes. This indicator is important because common causes of obesity, such as poor diet and
lack of activity, can be the effect of the lack of access to proper resources.
Report Area
Total Population
Age 20+
Population with
BMI > 30.0
(Obese)
Percent
Population with
BMI > 30.0
(Obese)
27.90%

1,376,486
388,169
CA
California
26,882,506
6,232,137
23%
United States
226,126,076
62,144,711
27.29%
Finally, the percentage of the population that states they have insufficient social or emotional
support is higher when compared to the state and national percentage. This indicator presents the
possibility of poorer mental health outcomes for the San Bernardino County population than the
state and nation. This may also point to a necessary area for attention when developing solutions
to improve health outcomes, as there is an expressed link between mental health and physical
health(Vital Signs, 2013).
Percent Population Without Adequate Social / Emotional Support

27%
25%
21%
Methods
Much of the information gathered regarding behaviors was self-reported information, meaning
that responses were given by the population surveyed, and these responses were then categorized
and grouped and turned into statistical data. Other statistics were gleaned from information
recorded on government and county websites, and health indicators reports in the community
commons sections of chna.org.
Conclusion/recommended action
In summary, the health outcomes in San Bernardino county are typically worse than
overall state statistics. Contributing factors, such as the lack of availability of proper resources,
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continue to add to the declined state of the communitys health. Though the acquisition of
resources can prove costly, the cost of providing health services because of poor outcomes can be
greater. In order to improve the condition of the state of health for the county of San Bernardino,
a program for education and more comprehensive health advocacy is in order.
San Bernardino County would greatly benefit from access to facilities and resources to
improve the health of the population, but the greatest resource is the knowledge of how to access
and maximize the benefit of current and future resources, should they become available.
Organizations such as hospitals and clinics, as well as schools and community centers, can strive
to develop concise, comprehensive information resources, such as pamphlets or website
downloads, that community members can access and navigate easily to locate resources they can
use to maintain or improve their health. Partnerships with local fitness centers and grocery stores
can prove mutually beneficial, as patients can become patrons as it relates to their health goals.
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CHNA for San Bernardino County, CA

Gilberto M. Wilson Jr.

Percent Population Change, 2000-2010

Gender by percentage in San Bernardino County, CA

Racial/Ethnic distribution in San Bernardino County, CA

Native American / Alaska

Native Hawaiian / Pacific

Some Other Race

San Bernardino County,

San Bernardino County,

San Bernardino County,

San Bernardino County,

San Bernardino County,

San Bernardino County,

San Bernardino County,

San Bernardino County,

San Bernardino County,

Ambulatory Care Ambulatory Care

San Bernardino County,

San Bernardino County,

Percent Population Without Adequate Social / Emotional Support

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