Berks County, Pennsylvania Community Health Needs Assessment

PUBLIC HEALTH
management corporation
BERKS COUNTY, PENNSYLVANIA COMMUNITY HEALTH NEEDS ASSESSMENT
PREPAREDFOR:
BERKSCOUNTYCOMMUNITYFOUNDATION ST.JOSEPHREGIONALHEALTHNETWORK READINGHEALTHSYSTEM UNITEDWAYOFBERKSCOUNTY

PREPARED BY:
THERESEARCHANDEVALUATIONGROUP PUBLICHEALTHMANAGEMENTCORPORATION
260SOUTHBROADSTREET,18THFLOOR PHILADELPHIA,PA19102
JANUARY2013

PUBLIC HEALTH
TABLEOFCONTENTS
EXECUTIVESUMMARY..........................................................................................................................i I. INTRODUCTION.............................................................................................................................1 Purpose.....................................................................................................................................1 CommunityDefinition...............................................................................................................1 CommunityDemographics.......................................................................................................3 ExistingResources ..................................................................................................................13 . II. NEEDSASSESSMENTPROCESSANDMETHODS..................................................................................19 DataAcquisitionandAnalysis.................................................................................................20 CommunityRepresentatives..................................................................................................21 . AnalyticalMethods.................................................................................................................23 InformationGaps....................................................................................................................23 III. FINDINGS...................................................................................................................................24 HealthNeedsoftheCommunity............................................................................................24 HealthNeedsofSpecialPopulations......................................................................................50 IV. UNMETHEALTHCARENEEDS........................................................................................................57 V. CONCLUSIONSANDRECOMMENDATIONS.........................................................................................59 VI.ADVISORYCOMMITTEEGUIDANCE.................................................................................................62 APPENDICES APPENDIXA:U.S.CENSUSTABLES APPENDIXB:VITALSTATISTICSTABLES APPENDIXC:HOUSEHOLDHEALTHSURVEYTABLES APPENDIXD:ASSETMAPS APPENDIXE:COMMUNITYRESOURCELIST APPENDIXF:FOCUSGROUPDISCUSSIONGUIDE APPENDIXG:KEYINFORMANTINTERVIEWGUIDE
PUBLIC HEALTH
BERKSCOUNTYCOMMUNITYHEALTHNEEDSASSESSMENT EXECUTIVESUMMARY
PURPOSE
This needs assessment was jointly sponsored by the Berks County Community Foundation, St. Joseph RegionalHealthNetwork,ReadingHealthSystem,andtheUnitedWayofBerksCounty.Thepurposeof theneedsassessmentistoidentifyandprioritizecommunityhealthneedssothattheseorganizations can develop strategies and implementation plans that benefit the public as well as satisfy the requirementsoftheAffordableCareActforthetwohospitals.Thisreportsummarizestheresultsofan assessmentofthehealthstatusandhealthcareneedsofresidentsinBerksCounty,Pennsylvania.The needsassessmentwasconductedbyPublicHealthManagementCorporation,aprivatenonprofitpublic healthinstitute.ThisneedsassessmentwascompletedbeforemanyoftheprovisionsoftheAffordable Care Act went into effect, and before the Berks Community Health Center had been in operation for morethanafewmonths.Therefore,informationontheimpactofthelegislationandtheHealthCenter on access to health care were not included in the research for this assessment. It is anticipated that bothoftheserecentchangesinthehealthcaresysteminBerksCountywillhaveanimpactontheissues raisedbythisassessment. NEEDSASSESSMENTPROCESS ThisneedsassessmentwasoverseenbyaSteeringCommitteeofrepresentativesfromeachofthefour sponsoringorganizations.AnAdvisoryCommitteeof17representativesfromBerksCountycommunity organizations was appointed by the Steering Committee to provide input from the community. The AdvisoryCommitteesuppliedguidanceatallstagesoftheneedsassessmentprocess. COMMUNITY BerksCounty(2010Pop.411,500)wasdefinedasthecommunityforthepurposesofthisassessment. BerksCountyincludesurban,suburban,andruralareaswithdistinctpopulationsandhealthresources. The population of Berks County is relatively homogeneous overall, with the exception of the City of Reading,wherethemajorityofresidentsareLatino.TheCityofReadingalsohasayoungerpopulation thantheCountyasawhole,anditsresidentsarepoorerthanthecountyasawhole.In2010,theCityof ReadinghadthelargestshareofitspopulationinpovertyamongcitiesintheU.S.withapopulationof 65,000 or more.1 The population of Berks County is not expected to greatly increase in the next few years. HEALTH Overall,BerksCountyresidentsareingoodhealth.However,heartdiseaseistheleadingcauseofdeath followedbyallformsofcancer(includingfemalebreastcancer),stroke,lungcancer,andfemalebreast
Reading,PAKnewitWasPoor.NowitKnowsJustHowPoor.NewYorkTimes,September27,2011,pageA10.
PUBLIC HEALTH
management corporation cancer. In addition, many adults suffer from obesity, high blood pressure, diabetes and untreated mentalhealthconditions.Forexample: Nearly onethird of adults (30.2%) are obese and more than onethird (35.9%) are overweight; Onethirdofadults(33.4%)havebeendiagnosedwithhighbloodpressure;thispercentage represents105,400adults; Oneinsevenadults(13.9%)hasbeendiagnosedwithdiabetes;and Although14.6%havebeendiagnosedwithamentalhealthcondition,only38.5%ofthoseare receivingtreatmentfortheircondition. Residentsof theCityofReading,Blacks,andLatinosareinpooreroverallhealth,aremore likely to be obese and are more likely to have diabetes, high blood pressure, or a mental healthconditionthanotherresidents,buttherearemanysmallersuburbanandruralareas oftheCountywherelowincomeresidents,inparticular,areinpoorhealth.
UNMETNEEDS
HealthcareisunaffordableformanyBerksCountyresidents.Fortyfourpercentofsurveyrespondents identifiedthecostofhealthcare,includinginsurancecoverage,copays,anddeductibles,asthemost commonhealthconcern.Forexample: Oneinsevenadultsaged1864(13.3%)isuninsured,representing33,000uninsuredadults; thispercentagehasincreasedfrom8.7%in2008to13.3%in2012. Among the uninsured in Berks County, onequarter (24.8%) visited an emergency room for careinthepastyearduetoalackofhealthinsurance. Many adults in Berks County are unable to get needed care due to the cost of that care: 12.0%ofadults,orabout37,000individuals,reportedthattherewasatimeinthepastyear whentheyneededhealthcare,butdidnotreceiveitduetothecost. CONCLUSIONANDRECOMMENDATIONS TheoverallhealthstatusofBerksCountyspopulationcomparesfavorablytoPennsylvaniansingeneral andHealthyPeople2020goals.Nonetheless,anumberofdisparitiesdoexistamongthesubareasand subpopulations studied. Disparities in health status are affected by a variety of factors, including, among others: poor access to health services; various sociodemographic factors, including income; insurancecoverage;andculturalconsiderations. AlthoughthesedisparitiesarenotisolatedinanyonegeographicregioncomparedtoBerksCountyasa whole, they are most likely to be statistically significant for the City of Reading, the countys largest urbanarea,wherethehighestconcentrationsofpoor,uninsured,racialminorities,andindividualswho identify their ethnicity as Hispanic or Latino reside. The following table summarizes several of the indicatorsdiscussedinthestudyandillustratesthechallengeposedbytherelativehealthstatusofthe populationoftheseparatesubareasoftheCounty.
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SelectedHealthIndicatorsfromtheBerksCountyCommunityHealthNeedsAssessment
Indicators Figure# BerksCounty Reading North Berks 10.7% 14.5% 30.5% 26.1% 13.7% 16.6% 15.4% 20.2% 11.7% 18.5% 32.8% 3.5 24.7% 692.0 8.3% 29.5% 6% South Berks 14.1% 14.0% 33.1% 30.8% 13.7% 27.3% 12.5% 19.3% 9.1% 19.3% 43.6% 5.1 24.0% 699.6 8.8% 25.5% 10% East Berks 11.6% 13.2% 34.6% 29.5% 16.9% 8.1% 7.4% 22.2% 11.9% 18.5% 37.1% NA 24.8% 720.1 15.2% 22.3% 5% West Berks 15.6% 7.4% 30.8% 30.6% 8.8% 6.8% 8.9% 14.0% 9.6% 17.6% 33.0% 2.8 23.0% 639.5 13.9% 23.8% 6% HealthStatusandBehaviorIndicators* Mentalhealthcondition 18 Healthstatusfairorpoor 15 Highbloodpressure 16 Obesity 17 Diabetes AppCTable1 ERvisitduetonoinsurance 22 Did not fill prescription due to AppCTable3 cost Nodentalcareduetocost AppCTable3 Noregularsourceofcare 24 Smoking 27 Bingedrinking AppCTable4 VitalStatistics** Adolescentbirths/1,000births 13 Late/noprenatalcare 25 Mortalityrate/100,000pop 20 Social/EconomicIndicators Uninsuredadults* 21 Lowsocialcapital* 28 Livinginpoverty*** 8
14.6% 15.9% 33.4% 30.2% 13.9% 24.8% 13.7% 21.1% 11.8% 20.4% 38.4% 9.4 32.8% 731.3 13.3% 31.0% 13%
21.3% 32.6% 40.0% 35.0% 18.9% 44.1% 23.7% 33.2% 18.9% 29.3% 47.9% 28.1 50.1% 926.6 23.7% 57.0% 34%
*Source:PHMCs2012BerksCountyHouseholdHealthSurvey(n=1,101) **Source:PADepartmentofHealth,BureauofHealthStatisticsandResearch,20052008;nottestedforsignificance ***Source:U.S.Census,2010;nottestedforsignificance Note:ShadedareasrepresentstatisticallysignificantlyworseresultscomparedtoBerksCounty(p<.05).
In addition to the results obtained from a phone survey of residents in five subareas and other third partydata,thefollowinghealthissueswerealsoraisedassignificantareasofconcernbyparticipantsin focusgroupsandkeyinformantinterviews: Costofcare,includinginsurancecoverage,copays,anddeductibles; Chronicdiseases; Accesstochildandadolescentpsychiatrists; Access to specialists by Medical Assistance beneficiaries and the uninsured or under insured; Reluctance on the part of undocumented immigrants to utilize social and health services availableinthecommunity;and Cultural and linguistic factors that lead to disparities in accessing essential health care, particularlyfortheHispanicandLatinocommunity. BerksCountyhasaconsiderableinfrastructureofsocialserviceagenciesandhealthcareprovidersthat provide care to atrisk populations. These health care providers include the new Berks Community HealthCenter,theSt.JosephRegionalHealthNetworkDowntownCampus,specialtyclinicssponsored bythecountysnonprofitacutecarehospitals,andtheWesternBerksFreeMedicalClinicinRobesonia. iii
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management corporation Nonetheless,theresultsoftheCommunityHealthNeedsAssessmentindicateaneedforanexpansion ofessentialhealthcareservices. It is also notable that Berks County lacks a public health department. In many communities such a resourceaddressesgapsinthehealthsafetynetforatriskpopulationsinadditiontorisksaffectingthe overallhealthofthelargerpopulation.Acountypublichealthdepartmentmightalsoserveasafocal point for coordinating community resources in response to significant health concerns and disparities thatariseinthecommunity. Recommendations ThefollowingrecommendationsaremadebasedinresponsetoissuesraisedbytheCommunityHealth Needs Assessment. It is worth noting that community responses to the issues will need to take into consideration provisions of the Affordable Care Act as they are implemented, particularly those that expandaccesstohealthinsurancefortheuninsuredandunderinsured. Target1:AccesstoEssentialHealthCare Increasethecapacityofexistingprovidersandaddnewproviderstoimproveaccesstoessential healthcareservicesforatriskpopulations.Theseneedsinclude: o Primarycareandspecialtycare; o Mentalhealthservices,includingpsychiatrists; o Earlyprenatalcare,particularlyforBlackandHispanic/Latinawomen;and o Patient navigators and case managers to assist atrisk populations in circumventing barrierstoaccessingessentialhealthcare. EncouragethecommunitytoworktogethertoestablishaBerksCountyHealthDepartmentto focusonsuchpopulationhealthobjectivesas: o Providingpreventivescreeningsandhealtheducationtoatrisksubpopulations; o Addressingbarriersatriskpopulationsfaceinaccessingaffordablemedications,dental careandvisioncare;and o Coordinatingcommunityresponsestoissuesaffectingpopulationhealth. Improve the social service agencies and health care providers capacity to address unique linguisticandculturalfactorsthataffectaccesstocarebylargesegmentsoftheHispanic/Latino population,specifically: o Increasing the availability of bilingual, culturally appropriate services, particularly in specialistsoffices; o Better educating atrisk populations about the value and availability of preventive services; o Improvingatriskpopulationsunderstandingofeligibilityrequirementsandapplication processesforpubliclyfundedhealthinsurance;and o Addressingconcernsofthoseatriskpopulationswhoselegalstatusrepresentsabarrier toaccessingessentialhealthservices.
Target2:EnhancePersonalHealthBehaviors Increase programs and interventions which address personal health behaviors that negatively impacthealth.Prioritiesshouldinclude:
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management corporation o o o o Developing strategies to address adolescent pregnancy, particularly in the City of Reading; Assistingsmokersinquitting; Addressingobesity,especiallyinchildren;and DevelopingaconcertedefforttoreducebingedrinkingintheCountyasawhole.
Advisory Committee Guidance

The Community Advisory Committee to the Berks County Community Health Needs Assessment reviewed the report of Public Health Management Corporation (PHMC). The Committee drew conclusionsthatwereconsistentwiththoseofPHMC,mostnotablythat: TheoverallhealthstatusofBerksCountyresidentsisreasonablygoodcomparedtonormsfor PennsylvaniaandHealthPeople2020goals; Enhancing preventive, primary, and specialty care for certain atrisk populations is the most directapproachtoadvancingthecommunityshealthstatus;and The greatest disparities in health status are concentrated among the poor, the Hispanic and Latinocommunity,andinparticularforthosewhoresideintheCityofReading. Recognizingthattheissuesraisedbythereportwillrequireconsiderabletimeandresourcestoaddress adequately,thecommitteesuggestedthateffortsbefocusedaroundasetofmoreimmediatepriorities andasetoflongertermobjectives. MoreImmediatePriorities Allofthefollowingessentialhealthcareservicesneedtobeprovidedinamannerthatissensitivetothe uniquelinguisticandculturalneedsoftheHispanicandLatinoatriskpopulationsandinvolveaccessto careissues.Thethreeprioritieschosenare: 1. PreventiveCare: o Reducingtheprevalenceofobesity;and o Providingroutinedentalcare. 2. PrenatalCare: o Increasingtheutilizationofprenatalcarewithaparticularemphasisonthedisproportionately highrateofadolescentpregnanciesintheCityofReading. 3. SpecialtyCare: o Improving the availability of specialty care, particularly for the uninsured and underinsured; and o Enhancingaccesstobehavioralhealthservices. LongerTermObjectives A more comprehensive and far reaching strategy is required to address the root causes of many disparities discussed in the needs assessment. One approach might be to organize a coalition of community leaders and stakeholders that would examine these issues in greater depth and forge a longertermstrategyforamelioratingthem.Theobjectivesofsuchaneffortmightinclude,butarenot limitedto:
PUBLIC HEALTH
management corporation Assessing how community resources might be better coordinated to provide a more effective responsetothehealthdisparitiesidentifiedintheCommunityHealthNeedsAssessment; Investigatinginitiativesundertakenbyothercommunitiesfacedwithsimilarchallenges; Defining the appropriate role of a county public health agency and examining alternative approachestofinancingandensuringthesustainabilityofsuchacapability;and Exploringhowanepidemiologicaldatabasecouldbedevelopeddrawingonexistingpublicand privateresourcesto bettermonitor population healthandthe causesofdisparitieswithinthe population.
In summary, the overall health status of Berks County residents is good and the majority of residents have access to essential health services. Nonetheless, in the interest of advancing the health of the communityfurther,aconcertedeffortonthepartofcommunityresourcesisrequiredtoaddressand minimizetotheextentfeasiblethetroublesomedisparitieshighlightedintheCommunityHealthNeeds Assessment. The report that follows provides an overview of the assessment process, the data collection methods and sources of information utilized and provides a detailed picture of the health status, health care experiences,andunmethealthcareneedsofresidentsinBerksCounty,Pennsylvania.
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I.INTRODUCTION
PURPOSE
This needs assessment was jointly sponsored by the Berks County Community Foundation, St. Joseph RegionalHealthNetwork,ReadingHealthSystem,andtheUnitedWayofBerksCounty.Thepurposeof theneedsassessmentistoidentifyandprioritizecommunityhealthneedssothattheseorganizations can develop strategies and implementation plans that benefit the public as well as satisfy the requirementsoftheAffordableCareActforthetwohospitals.Thisreportsummarizestheresultsofan assessmentofthehealthstatusandhealthcareneedsofresidentsinBerksCounty,Pennsylvania.The needs assessment was conducted by Public Health Management Corporation (PHMC), a private non profitpublichealthinstitute.Thisneedsassessmentwascompletedbeforemanyoftheprovisionsof theAffordableCareActwentintoeffect,andbeforetheBerksCommunityHealthCenterhadbeenin operationformorethanafewmonths.Therefore,informationontheimpactofthelegislationandthe Health Center on access to health care were not included in the research for this assessment. It is anticipated that both of these recent changes in the health care system in Berks County will have an impactontheissuesraisedbythisassessment. This introduction includes a definition of the community assessed in the report, the demographic and socioeconomic characteristics of the residents, and the existing health care resources followed by II. NeedsAssessmentProcessandMethods;III.Findings;IV.UnmetHealthCareNeeds;andV.Conclusion andRecommendations.TablesandmapsareincludedinAppendicesAG.
COMMUNITYDEFINITION
BerksCounty(2010Pop.411,500)wasdefinedasthecommunityforthepurposesofthisassessment. Berks County includes urban, suburban, and rural areas with distinctpopulationsandhealthresources.Forthepurposesof thisneedsassessment,fivegeographicsubareasoftheCounty, defined by ZIP code clusters, were identified: the City of ReadingandEast,West,North,andSouthBerksCounty(Map 1).Theboundariesofthesesmallerareasweredeterminedby the Needs Assessment Steering Committee in collaboration with PHMC using county geography and population demographics.TheCityofReading,consistingofonlythreeZIP codesapproximatelycontiguouswithitsmunicipalboundaries,wasassessedasaseparateareabecause oftheuniquesocioeconomicanddemographiccharacteristicsofitspopulationcomparedtootherareas ofBerksCounty.
1
The Research and Evaluation Group
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Source:U.SCensus,2010.PreparedbyPHMC.
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COMMUNITYDEMOGRAPHICS
Thisreportincludesadescriptionofthesocioeconomicanddemographiccharacteristicsoftheresidents ofBerksCountyanditsseparateregionsbecausethesecharacteristicsarestrongindicatorsofaccessto healthcareandgoodhealth.
PopulationSizeandTrends
The population of Berks County is relatively homogeneous overall, with the exception of the City of Reading,wherethemajorityofresidentsareLatino.TheCityofReadingalsohasayoungerpopulation thantheCountyasawhole,anditsresidentsarepoorerthantheCountyasawhole.In2010,theCityof ReadinghadthelargestshareofitspopulationinpovertyamongcitiesintheU.S.withapopulationof 65,000 or more.2 The population of Berks County is not expected to greatly increase in the next few years. ThetotalpopulationofBerksCountyisnearly411,500,a10%increasefrom373,600in2000(Figure1).3 ThepopulationofBerksCountyisprojectedtocontinuetoincrease,butonlyslightly,through2018(See AppendixAforU.S.CensusTables). TheSouthBerksareaoftheCountyhasthelargestpopulation(122,000),followedbytheNorthBerks area(84,400),theCityofReading(78,100),andtheWest(77,800)andEastBerks(53,400)areas. TheSouthBerksareahadthelargestincreaseinitspopulationfrom2000 to2010 (13.3%);the East Berksareahadthesmallestincrease(1.7%). The City of Reading, and North, West, and South Berks areas are projected to increase slightly in populationthrough2018,andtheEastBerksareaisexpectedtodecreaseslightly(Figure2).
Reading,PAKnewitWasPoor.NowitKnowsJustHowPoor.NewYorkTimes,September27,2011,pageA10. U.S.CensusinformationforBerksCountyandcountysubareasarebasedonpopulationtotalsforZIPcodeswithin BerksCountyandthereforemaydifferfromU.S.Censustotalsbasedoncountypoliticalboundaries.

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management corporation Figure1:
PopulationofBerksCountybyArea,2010
411,500
450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 0
122,000 84,400 78,100 77,800 53,400
BerksCounty
SouthBerksCounty
NorthBerksCounty
Reading
WestBerksCounty
EastBerksCounty
Source:2010U.S.Census.PopulationfiguresbasedonZIPcodepopulation.
Figure2:
450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 0
2000
PopulationofBerksCounty,20002018
2010
2013Estimate
2018Estimate
BerksCounty Reading
SouthBerksCounty WestBerksCounty
NorthBerksCounty EastBerksCounty
Source: NielsenClaritas PopFacts Database (2013, 2018) and 2000, 2010 U.S. Census. Population figures based on ZIP code population.
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DemographicCharacteristics
Age BerksCountyhasarelativelyhighpercentageofolderadultsaged65andover(14.5%)comparedto the United States as a whole (13.0%). This percentage is lower than the percentage for Pennsylvania (16.0%).InBerksCountynearlyonequarterofresidentsarechildrenbetweentheagesof017(23.9%), just over onethird are aged 1844 (34.3%), and over onequarter are aged 4564 (27.4%). The populationofBerksCountyisaging;therewasadecreaseinthepercentageofresidentsaged1844 between2000and2010(37.7%in2000and34.3%in2010)andanincreaseinthepercentageofthose aged 4564 (22.6% in 2000 and 27.4% in 2010). This age structure is expected to remain the same through2018. TheCityofReading,overall,hasayoungerpopulationcomparedtotherestoftheCounty;31.3%are ages 017 and 39.3% are ages 1844 compared to 23.9% and 34.3%, respectively, in Berks County overall.Conversely,only8.9%ofadultsintheCityofReadingare65oroldercomparedto14.5%for Berks County. In Reading, the percentage of residents under 65 years of age slightly increased from 2000to2010,whilethepercentageofadults65orolderdecreased. TheNorth,South,andWestBerksareasfollowapopulationtrendthatissimilartoBerksCountyasa whole; in 2010, the percentages of adults aged 1844 decreased and the percentages of adults 4564 increased.TheEastBerksareahasseenanincreaseinadultsaged4564and65orolderandadecline inthepercentagesofresidentsages017and1844;thistrendisprojectedtocontinuethrough2018. Gender InBerksCountyanequalpercentageofresidentsaremaleandfemale:49.1%ofresidentsaremale and50.9%arefemale. Race/Ethnicity In Berks County, the percentage of ethnic and racial minorities increased between 2000 and 2010 (Figure3).Between2000and2010,thepercentageofWhiteresidentsdroppedfrom84.8%to76.9% and the percentage of Latino residents increased from 9.7% to 16.4%.4 The percentages of Black, Asian, and those who identified as an other race/ethnicity increased slightly in 2010 as well. The LatinopopulationinBerksCountyisprojectedtocontinuetogrowthrough2018.
ItisimportanttonotethatracialandethnicminoritiesareoftenundercountedbytheU.S.Census.Therefore,the Asian,Black,andLatinopopulationsofBerksCountymayactuallybelargerthanreported.
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100%
Race/EthnicityofBerksCountyResidents,20002018
85% 77% 75% 72%
80%
60%
40% 16% 20% 10% 1% 1% 2% 1% 2% Other

2013Estimate 2018Estimate
20%
3%
4%
0% White Black
2000 2010
Asian
Latino
TheraceandethnicityofBerksCountyresidentsvariesbyarea.TheCityofReadinghasamuchhigher percentageofLatino(59.6%)residentsthanWhite(27.1%)orBlack(10.2%)residents.Incontrastto theCityofReading,the North,South,EastandWestBerksareasaremuchlessraciallyandethnically diverse;over85.0%ofthepopulationisWhiteand3.0%orlessofthepopulationisBlack. TheracialandethniccompositionoftheCityofReadingspopulationchangedsubstantiallyfrom2000 to 2010. The percentage of White residents decreased from 47.0% to 27.1%, and the percentage of Latinoresidentsincreasedfrom38.0%to59.6%.Thesetrendsareexpectedtocontinuethrough2018, astheWhitepopulationdecreasesandtheLatinopopulationincreases(Figure4).
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100%
Race/EthnicityofCityofReadingResidents,20002018
80% 65% 60% 47% 38% 40% 27% 23% 20% 18% 11% 10% 9% 2% 1% 2% 60%
71%
0% White
2000
Black
2010
Asian
2013Estimate
Other
2018Estimate
Latino
LatinoOrigin Approximately one in six residents of Berks County (16.4%) is Latino. The Berks County Latino populationincreasedfrom9.7%to16.4%between2000and2010,andisprojectedtoreach20.3%in 2018.LatinoresidentsmostcommonlyidentifyasPuertoRican(7.8%),followedbyotherLatinoorigin (3.9%),MexicanAmerican(2.4%),andCubanAmerican(0.3%). TheCityofReadinghasasubstantiallylargerLatinopopulationthantheotherareasofBerksCounty. The majority of the City of Reading residents are Latino (59.6%), representing 46,600 persons. In comparisontotheCityofReading,otherareasofBerksCountyarelessthan10%Latino:8.0%(South), 7.2% (North), 5.2% (West), and 1.7% (East). In the City of Reading, the most common Latino cultural group is Puerto Rican (29.3%), followed by 13.0% other, 9.8% Mexican American, and 0.8% Cuban American(Figure5).

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50% 40% 30% 23% 20% 13% 10% 0% 7% 0%
2000
CityofReadingLatinoPopulationbyCulturalOrigin,20002018
39% 36%
29% 18% 19%
10% 1%
2010
10% 1%
2013Estimate
11% 1%
2018estimate
Cuban
Mexican
PuertoRican
Other
Source:NielsenClaritasPopFactsDatabase(20013,2018)and2000,2010U.S.Census.PopulationfiguresbasedonZIPcode population.
IntheNorthandWestBerksareas,thepercentageofPuertoRicanresidents,althoughsmall,doubled between 2000 and 2010. The population of those who identified as being of other Latino origin increasedslightlyin2010intheNorth,West,andSouthBerksareas. AsianOrigin One percent of the population of Berks County is Asian (representing 5,200 individuals). This percentage is not expected to change greatly in the near future. Asian residents most commonly identify as Vietnamese American, followed by Indian and Chinese American. By 2013 it is expected that there will be more Chinese American residents than Vietnamese and Indian American residents. TheCityofReadinghasthehighestpercentageofVietnameseresidentsandtheWestBerksareahasthe highestpercentagesofIndianandChineseAmericanresidents. LanguageSpokenatHome The overwhelming majority of Berks County residents speak English at home (85.1%), about one in elevenspeaksSpanish(10.6%),3.6%speakanotherlanguage,and0.7%speakanAsianlanguage.The percentageofresidentswhospeakSpanishathomeisprojectedtoincreasetoabout12.2%in2018. IntheCityofReading,morethantwoinfiveresidents(42.5%)speakSpanishathome,althoughthe majorityspeakEnglishathome(53.3%).IntheNorth,South,EastandWestBerksareas,atleast90.0% 8
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management corporation ofresidentsspeakEnglishathome.SimilartotheCountyasawhole,thepercentageofresidentswho speakSpanishathomeisestimatedtocontinuetoincreaseslightlyinReadingto46.1%in2018.
SocioeconomicIndicators
Education InBerksCounty,threeoutoffiveresidents(60.5%)arehighschoolgraduates,andoneinfive(22.4%) has at least a college degree. Seventeen percent of residents have less than a high school degree. Whilethepercentageofhighschoolgraduatesremainedthesamein2000and2010,thepercentageof thosewhohaveacollegedegreeormoreincreasedto22.4%andthepercentageofthosewhohaveless than a high school degree decreased to 17.1%. These percentages are projected to remain relatively constantthrough2013and2018. The level of educational attainment is lower in the City of Reading than in the other Berks County areas.CityofReadingresidentsaretwiceaslikelytohavedroppedoutofhighschoolandonehalfas likely to have a college degree as County residents overall. In the City of Reading, onethird of residents(32.9%)havelessthanahighschooldegree,56.0%graduatedfromhighschool,andonlyone innine(11.1%)hasacollegeorhigherdegree.Thesepercentageshaveimprovedslightlysince2000.In contrasttotheCityofReading,approximately60.0%ofresidentsofEast,South,West,andNorthBerks areas have high school diplomas. While educational attainment in the other Berks County areas is generally projected to continue to improve, in the City of Reading the percentage of those with less thanahighschooldegreeisprojectedtoincreaseto34.4%in2018,andthepercentageofthosewith acollegedegreeormoreisexpectedtodecreaseto9.7%(Figure6). Figure6: ResidentswithLessthanaHighSchoolDegreeinBerksCounty,20002018
50% 40% 30% 20% 10% 0%
2000 2010 2013Estimate 2018estimate
BerksCounty Reading
NorthBerksCounty EastBerksCouonty
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management corporation Employment The overwhelming majority of Berks County residents age 25 and over (94.6%) were employed in 2010.By2013,however,theunemploymentrateisprojectedtodoubleto9.7%. ReadinghasthehighestunemploymentrateintheCounty:10.0%ofresidentswereunemployedin 2010.TheNorthBerksareahadaslightlylowerunemploymentrate(7.5%).IntheEast,WestandSouth Berksareas,thepercentageofthosewhowereunemployedin2010waslessthan5.0%. The unemployment rate in the City of Reading was 10.5% in November, 2012, and 7.8% in Berks County overall, according to the Pennsylvania Department of Labor. According to U.S. Census projections,unemploymentratesareprojectedtoriseto10.0%inBerksCountyoverallby2018,andto 21.0%intheCityofReadinginthenextfiveyears.(Figure7). Figure7: PercentageofUnemployedAdults25+inBerksCounty,20002018
25%
21% 21%
20% 15% 10% 5% 0%

2000
BerksCounty Reading
10% 7% 5%
3%
10% 8% 5%
3%
10% 9%
7%
10% 9% 7%
2010
2013Estimate
2018Estimate
NorthBerksCounty EastBerksCounty
Source: NielsenClaritas PopFacts Database (2013, 2018) and 2000, 2010 U.S. Census. Population figures based on ZIP codepopulation.
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management corporation PovertyStatus In Berks County, 13.3% of families with children and 8.0% of families without children are living in poverty(Figure8).The2012federalpovertylevelisanannualincomeof$23,050forafamilyoffour.5 Thefamilypovertyrateisprojectedtoincreasein2013and2018. The City of Reading has the highest percentage of families living in poverty in Berks County: more thanonethirdoffamilieswithchildren(37.2%)andmorethanonequarteroffamilieswithoutchildren (27.6%) are living in poverty. The percentage of City of Reading families without children living in poverty more than tripled from 2000 (8.0%) to 2010 (27.6%). In other areas of Berks County the percentage of families with children living in poverty ranges from 4.6%9.7%, and the percentage of familieswithoutchildreninpovertyrangesfrom3.6%to5.6%. Figure8: PercentageofFamiliesWithandWithoutChildrenLivinginPovertyinBerksCounty,2010
50%
40% 34% 30% 28%
20% 13% 10% 8% 6% 10% 5% 6% 4% 6% 4% 5%
0%
BerksCounty SouthBerksCounty NorthBerksCounty Reading WestBerksCounty EastBerksCouonty
Familiesw/ochildrenlivinginpoverty
Familieswithchildrenlivinginpoverty
Source:NielsenClaritasPopFactsDatabaseand2010U.S.Census.PopulationfiguresbasedonZIPcodepopulation.
AllareasofBerksCountyareprojectedtoseecontinuedincreasesinthepercentageoffamiliesliving in poverty. The increase is projected to be greater in the City of Reading, with nearly onehalf of families with children (48.3%), and onethird of families without children (35.3%) projected to live in povertyin2018(Figure9).
FederalRegisterVolume77,Number17(Thursday,January25,2012).
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Percentage of Families With and Without Children Living in Poverty in Reading City, 20102018
100%
80%
60% 37% 40% 31% 20% 8% 0%

2000 2010
49% 48% 35%
36% 28%
2013Estimate
2018Estimate
Familiesw/ochildrenlivinginpoverty
Familieswithchildrenlivinginpoverty
MedianHouseholdIncome ThemedianhouseholdincomeinBerksCountyis$54,800annually,anincreasefrom$45,118in2000. However,householdincomeintheCountyisprojectedtodecreaseinthefutureto$51,500annuallyin 2013and2018. ThemedianhouseholdincomeintheCityofReadingis$29,000annually,almostonehalfthecounty widemedianhouseholdincome.Thisincomelevelisprojectedtodropbelow2000levelsto$26,000in 2013. In contrast to the City of Reading, the East Berks area ($64,300) has the highest median householdincome,andtheNorthBerksareahasthelowest($59,900).Themedianhouseholdincome intheseareasincreasedby$10,000and$13,000between2000and2010(Figure10).
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management corporation Figure10: MedianHouseholdIncomeinBerksCounty,2010
$80,000 $70,000 $60,000 $50,000 $40,000 $30,000 $20,000 $10,000 $0
BerksCounty EastBerksCounty WestBerksCounty SouthBerksCounty NorthBerksCounty Reading
$64,300 $54,800
$64,100
$60,400
$59,900
$29,000
Source:NielsenClaritasPopFactsDatabaseand2010U.S.Census.PopulationfiguresbasedonZIPcodepopulation.
HomeOwnership The majority of Berks County residents own their own homes (71.7%). Just over onequarter of residents(28.3%)renttheirhome.Thesepercentagesarenotprojectedtochangethrough2018. HomeownershipismuchlesscommonintheCityofReadingthanintherestofthecounty:58.5%of residentsrenttheirhomescomparedto28.3%countywide.HousingtenureintheCityofReadingis expectedtoremainthesamein2013and2018. IntheNorth,South,EastandWestBerksareas,approximatelyonefifthofresidentsrenttheirhomes. Thispercentageisprojectedtoremainconstantthrough2018. Thenextsection,ExistingResources,summarizesthehealthandsocialserviceresourcesthatcurrently existinBerksCounty. EXISTINGRESOURCES MostofthehealthandsocialserviceresourcesinBerksCountyareclusteredinandaroundtheCityof Reading,theareawiththehighestpopulationdensity(SeeAppendixDforAssetMaps).Incomparison to the City of Reading and its suburbs, the remainder of Berks County is less densely populated and moresuburbanandrural.TheCityofReadingisalsotheCountyseat,soCountyagenciesandservices 13
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management corporation arealsoclusteredthere.Mostresourcesforthelowincomepopulationarealsolocatedinornearthe CityofReading.(Foracompletelistofservicesandlocations,pleaseseeAppendixE.)
HealthCareResources PublicHealthResources
ThereisnoCountyhealthdepartmentinBerksCounty.Pennsylvaniahasatotalofsixcountyandfour city health departments. The purpose of public health departments is to prevent disease, protect people from hazards to their health, and promote healthy living through an organized, community basedapproach.Healthdepartmentsconducthealthscreenings,ensureenvironmentalandfoodsafety, monitor and test for communicable diseases, administer immunizations, support maternal and child health,andprovidehealtheducation.Localhealthdepartmentsensurethattheseservicesareprovided to the public using an organized approach. Services are provided free or at low cost to the general publicinordertoreachasmanyresidentsaspossible.Severalkeyinformantscitedanurgentneedfora BerksCountyHealthDepartmenttoprovidetheseservicesthroughouttheCounty.Althoughmanyof thehealthandsocialserviceprovidersdiscussedinthissectionindividuallyprovidethemanyservices whichcouldbeprovidedbyacountyhealthdepartment,thereareunmetneedswhichcouldbefilledin acountywide,coordinatedmannerbyacountyhealthdepartment. AcuteCare Acute care resources in Berks County include two notforprofit acute care general hospitals (St. JosephRegionalHealthNetworkinBernTownshipandReadingHealthSysteminWestReading),Haven Behavioral Hospital of Eastern Pennsylvania (a 28bed adult inpatient unit and a 20bed older adult acute care unit located in Downtown Reading), a publiclyfunded psychiatric hospital in Wernersville, and The Surgical Institute of Reading, an inpatient surgical hospital in Wyomissing. Both acute care general hospitals are teaching hospitals that are located just outside the municipal boundaries of the City of Reading. St. Joseph Regional Health Network admitted 8,122 inpatients and reported 226,586 outpatient (emergency and nonemergency) visits in fiscal year 2012.6 St. Joseph Regional Health Networkconsistsof: A204acutecarebedfacility,locatedinBernTownship(Reading); 20 outpatient centers, including physician offices, diagnostic, and therapeutic satellite locations; 100employedphysicianandmidlevelproviders;and AcomprehensiveambulatorycarefacilityinDowntownReading. ReadingHealthSystemhas: 600acutecarebeds; 40primarycareanddiagnosticcenters;
PennsylvaniaHealthCareCostContainmentCouncil,2012.
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management corporation The Center for Mental Health including a 35bed psychiatric hospital (adult and adolescent beds);anda 110bedpostacutehospital. Therewere800and3,586birthsateachhospital,respectively,infiscalyear2011. PrimaryCare Primary care patient medical homes are an important resource in insuring continuous and comprehensivecarethatcanpreventoramelioratechronicdisease.BerksCountyhasfewerprimary carephysiciansperpersonthanPennsylvaniaasawhole.AccordingtotheCountyHealthRankings,7 theratioofprimarycarephysicianstothepopulationofBerksCountyis1,440:1.Thisisworsethanthe U.S.ratioof631:1andthePennsylvaniaratioof838:1.Inaddition,theBerksCountyMedicalSociety forecasts that, in the next decade, 440 new primary care physicians will be needed in the county to maintain the existing ratio.8 However, there are limitations in using the supply of primary care physiciansasanindicatorofoverallhealthinthecommunity.Althoughstudieshaveshownasignificant relationshipbetweenhigherprimarycarephysiciansupplyandlowermortality,longerlifeexpectancy, and better birth outcomes, the mere presence of more primary care physicians does not ensure that moreindividualsinthepopulationareexposedtoprimarycare.9 There are 12 census tracts in the City of Reading that have a relatively lower ratio of primary care physicians to population than the county as a whole (3,499:1 compared to 1,440:1). These census tracts are designated as Medically Underserved Areas by the U.S. Health Research and Services Administration.10Thelowerratioofprimarycarephysicianstothepopulationinthese12censustracts intheCityofReadingcomparedtotheCountyasawholeisrelatedtothefactthatmanyprimarycare physiciansofficesarelocatedinornearthetwoacutecarehospitals,whicharelocatedoutsidethis12 census tract area of the City. However, both the St. Joseph Regional Health Network Downtown CampusandtheBerksCommunityHealthCenter,aswellasprivatephysicians,doprovideprimarycare inthismedicallyunderservedareaoftheCityofReading. Access to primary care for low income residents of Berks County is provided at three community clinics:thenewFederallyQualifiedHealthCenter(BerksCommunityHealthCenter),whichopenedin June 2012, and the St. Joseph Regional Health Network Downtown Campus, both in the City of Reading,andtheWesternBerksFreeMedicalClinicinRobesonia.TheBerksCommunityHealthCenter, whichreplacedtheReadingDispensary,providesprimarymedicalcaretouninsuredandinsuredadults,
7
www.countyhealthrankings.org,November1,2012.Theoriginalprimarycarephysiciantopopulationratiofor BerksCountyonwhichtheCountyHealthRankingswerebasedwasincorrectbecauseGeneralPracticephysicians were counted twice in error. The corrected ratio, which is higher, is used in this report, but the Berks County HealthRankingswerenotchangedtoreflectthecorrectedphysiciantopopulationratio. 8 www.berkscms.orgaccessedOctober18,2012. 9 Shi,L.andStarfield,B.TheEffectofPrimaryCarePhysicianSupplyandIncomeInequalityonMortalityAmong BlacksandWhitesinUSMetropolitanAreas.AmericanJournalofPublicHealth.August2001,Vol.91,No.8,pp. 12461250. 10 FederallyQualifiedHealthCenterFeasibilityStudyforBerksCounty,Pennsylvania.DrexelUniversitySchoolof PublicHealth(September2010).
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management corporation accepting Medicare, Medical Assistance (also known as Medicaid), private insurance, and selfpay patientsonaslidingfeescale.Itwilleventuallyprovidedentalcareandmentalhealthservicesaswell. TheSt.JosephRegionalHealthNetworkCommunityCampus,alsoknownastheSt.JosephDowntown Campus, provides over 200,000 patient encounters annually, mostly to uninsured and underserved patients.ServicesincludetheFamilyandWomensCarepractice,adentalclinic,communitypharmacy, imaging,behavioralhealth,physicalandoccupationaltherapy,diabeteseducationandwoundcare,and many other low cost or free social and health care services. All services provided at the Downtown Campusarebilingual.TheWesternBerksFreeMedicalClinicusesvolunteerphysicianstoprovidefree primary care to uninsured adults on Wednesday evenings. It opened in 2002 and served 247 unduplicatedpatientsincalendaryear2011.FortypercentofpatientsliveinReading,whichisfifteen milesawaybycar. Other sources of health care services for specific populations are Planned Parenthood of Northeast, MidPenn, & Bucks County for reproductive health; the Keystone Farmworker Health Program for migrant workers; and CoCounty Wellness Services for persons living with HIV/AIDS. Planned Parenthood,intheDowntownareaoftheCityofReading,providesaffordablereproductivehealthcare to men and women through medical services and education. The Keystone Farmworker Health Program provides medical outreach to farms, farmworker homes, and labor camps in the county. It workswiththePennsylvaniaDepartmentofHealthandSt.JosephRegionalHealthNetworktoprovide adult primary care, adult immunizations, STD screenings and counseling, adult health screenings and referrals for hypertension and diabetes simultaneously, school physicals, domestic violence programming,andmentalhealthservicestoabout800LatinofarmworkersannuallyinBerksCounty. ServicesareprovidedintheCityofReadingandalsoonsiteatareafarms.Theprogramcollaborates with the residency program at St. Joseph Regional Health Network to bring physicians out to farm worker camps and homes. The program also acts as an essential liaison with St. Josephs outpatient clinics to reach farmworkers in the evening or at their workplace who cannot be reached by mail or phone. CoCounty Wellness Services provides services in Berks and Schuylkill Counties in sexually transmitteddiseasescreening,counseling,treatment,andeducation.TheSTDscreeningandtreatment clinicisfundedbythePennsylvaniaDepartmentofHealth.Theeducationdepartmentprovidesteaching andcounselinginthecommunityandonsite.IndividualswithHIVwhoaremedicallyindigentandneed aprimarycarephysicianarereferredtotheCenterforPublicHealth,apubliclyfundedclinicatReading HealthSystemthatprovidesprimarycareandcasemanagementservicesforpersonswithHIV/AIDSand STDscreening. Primaryepisodiccareservicesarealsoprovidedbyseveralurgentcarecenterslocatedprimarilyinthe CityofReadingssuburbs. SocialServices As shown in Map 2 in Appendix D, there are many social service agencies in Berks County, including mental health services, substance abuse treatment, homeless/emergency shelters, social work case managementandreferral,andnutritionservices.MajorsocialserviceorganizationsincludeBoyertown AreaMultiServicesCenterinBoyertownintheEastBerksareaandTheHispanicCenterofReadingand Berks County (Centro Hispano Daniel Torres) and the Berks Counseling Center in the City of Reading, which provides outpatient behavioral health treatment, and transitional and permanent housing with supportiveservicesforpersonswithbehavioralhealthdisabilities. 16
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management corporation TheBoyertownAreaMultiServicesCenterserves750olderadultspermonthattheseniorcenterand 300400individualsmonthlywithotherservices.Theyprovide185,000unitsofserviceayear.Services includemealsonwheels,acommunityfoodpantry,theseniorcenter,energyassistance,transportation tomedicalappointmentsbyvolunteers,andaseniorfarmersmarketprogram. The Hispanic Center of Reading and Berks County is the primary agency serving the rapidly growing Latino population of the area, serving over 3,000 community members through its information and referral program alone in the past year. The Hispanic Center offers social services, information and referral, and works to support other organizations in the county. Services also include two senior centers,KennedySeniorCenterandCasadelaAmistad,andtheSeniortoSeniorcasemanagement program;theOfficeofViolenceagainstWomenincollaborationwithBerksWomeninCrisis;HelpLink assistance with benefits and entitlements enrollment; and a notary public. The Centers Higher Education Program, a partnership between the Center and the Higher Education Colleges of Berks County (HECBC): Albright College, Alvernia University, Kutztown University, Penn State Berks, and the ReadingAreaCommunityCollege(RACC),offersworkshopsandotheropportunitiesforthosepursuing highereducation. The Berks Counseling Center provides supportive services and case management for person with behavioral health disabilities on an outpatient basis. They also provide transitional and permanent housing with supportive services for this population. Specific services include: case management for homeless persons and HUD housing residents; maternal intervention and supportive services; community outreach; chemical dependency treatment; mental health treatment and crisis coverage; assertivecommunitytreatmentfortransitionages1624;andastudentassistanceprogramatReading High School and Citadel Intermediate High School. Additional programs include: a satellite site at Opportunity House; family services; peer support services; services under the jurisdiction of the Drug Courts in Berks and Chester Counties; a Chester County Counseling Center; and drug and alcohol treatmentforinmatesoftheBerksCountyPrisonandReentryCenter. TherearetenseniorcentersintheCounty,whichprovidehealth,education,andfitnessprogramming; informationandreferrals;assistancewithgroceryshopping;socializationopportunities;andcommunal mealsforolderadults.TherearefiveintheCityofReading.BerksEncoreoperatessixseniorcentersin BerksCountyintheCityofReading,Birdsboro,Fleetwood,Hamburg,Mifflin,andWernersville.There are also two senior centers in the City of Reading, Kennedy Senior Center and La Casa de la Amistad, which serve the Latino older adult population. There are seven emergency shelters in the County for women in crisis, families, and homeless persons. Six are located in the City of Reading and one in Wernersville. Berks County has several agencies and organizations that provide services directed to improving nutrition. Three Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) officesinthecounty,twointheCityofReadingandoneinShillington,providesupplementalnutritious foods,informationonhealthyeating,includingbreastfeedingpromotionandsupport,andreferralsto healthcareforlowincomepregnant,postpartum,andbreastfeedingwomen,infants,andchildrenupto age5whoareatnutritionalrisk. 17
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management corporation Additional nutritional assistance is provided through the Greater Berks Food Bank, which collects, stores, and distributes food to more than 270 food pantries, soup kitchens, shelters, and after school programsinBerks,Schuylkill,andwesternMontgomeryCounties.Thefoodbankprovides1,000meals nightlytochildreninafterschoolprogramKidsCafes,foodbackpackstotakehomeontheweekends, and1,300mealstolowincomeseniorsonamonthlybasis.InBerksCountythereareatotalof27food pantriesand21soupkitchensandothermealprogramsdistributedthroughouttheCounty.Whilethe majorityofsoupkitchensandmealprogramsarelocatedintheCityofReading,foodpantrylocations aremoredispersedthroughouttheCounty.Mostfoodpantries,soupkitchens,andmealprogramsare locatedinchurches. OthernonprofitagenciesthatprovideservicestoasubstantialnumberofCountyresidentsincludethe Salvation Army, Olivet Boys and Girls Club of Reading and Berks County, and Jewish Family Service of Reading. The next section of this report describes the process for conducting this needs assessment, including methodsofdataacquisitionandanalysis,followedbyasummaryoffindingsoftheneedsassessment andconclusionandrecommendations.
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II.NEEDSASSESSMENTPROCESSANDMETHODS
ThisneedsassessmentwasoverseenbyaSteeringCommitteeofrepresentativesfromeachofthefour sponsoringorganizations.AnAdvisoryCommitteeof17representativesfromBerksCountycommunity organizations was appointed by the Steering Committee to provide input from the community. The AdvisoryCommitteesuppliedguidanceatallstagesoftheneedsassessmentprocess.Themembersof theAdvisoryCommittee,andtheirorganizationsandtitles,arelistedbelow.
BerksCountyCommunityHealthNeedsAssessment CommunityAdvisoryCommitteeMembers
NAME MikeBaxter,MD TITLE FamilyPracticePhysician;Past President,BerksCountyMedical Society ExecutiveDirector PrimaryCarePhysician DoctoralProgramStudent Pastor CountyAdministrator BoardChair President Cardiologist FamilyPracticePhysician;President Elect,BerksCountyMedicalSociety ExecutiveDirector President Manager SVP,CommunityImpact Development SVPforCommunity&Government Relations VPforGrantmaking&Communications ORGANIZATION ReadingHealthSystemFamilyHealthCareCenter
CarolynBazik DianeBonaccorsi,MD RebeccaHartman Rev.WayneHeintzelman EdMichalik,PsyD GaryRightmire KarenRightmire MikeRusso,MD PamTaffera,DO MikeToledo IvanTorres,EdD SelinaZygmunt PatGiles MaryHahn RichardMable HeidiWilliamson
CoCountyWellnessServices GreenHillsMedicalCenter AlverniaUniversity St.Daniel'sLutheranChurch MentalHealth/DevelopmentalDisabilities BerksCommunityHealthCenter WyomissingFoundation BerksCardiologists,Ltd. St.JosephRegionalHealthNetwork CentroHispano(HispanicCentroDanielTorres,Inc.) Pronto!FinancialServices KeystoneFarmworkerHealthProgram UnitedWayofBerksCounty St.JosephRegionalHealthNetwork TheReadingHealthSystem BerksCountyCommunityFoundation
Thestepsintheneedsassessmentprocesswere:definingthecommunity;identifyingexistingprimary and secondary data and data needs; collecting primary and secondary data; analyzing data; and preparationofawrittennarrativereport.Thedataacquisitionandanalysisaredescribedinmoredetail below.
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DATAACQUISITIONANDANALYSIS
Bothprimaryandsecondaryandquantitativeandqualitativedatawereobtainedandanalyzedforthis needsassessment.Obtaininginformationfrommultiplesources,knownastriangulation,helpsprovide contextforinformationandallowsresearcherstoidentifyresultswhichareconsistentacrossmorethan onedatasource. DataSourcesandDates Quantitativeinformationforthisneedsassessmentwasobtainedfromsourceslistedbelowforthemost recentyearsavailable. BerksCountyCommunityHealthNeedsAssessmentDataSources
DataSource U.S.CensusofPopulationandHousing Claritas,Inc.PopFacts PennsylvaniaDepartmentofHealth PHMCBerksCountyHouseholdHealthSurvey PennsylvaniaHealthCareCostContainmentCouncil Dates 2000,2010 2013,2018 20052008 2008,2012 2011
HouseholdHealthSurvey The Berks County Household Health Survey was modeled after previous Household Health Surveys conductedbyPHMCinSoutheasternPennsylvaniaandinBerks,Lancaster,andSchuylkillCounties.The instrument was designed by PHMC with input from the project Steering Committee. The survey was fielded by Abt/SRBI between June 20th and August 2nd 2012, and included 1,101 randomdigit dial landline (1,001) and cell phone (100) respondents using a probability sample across five areas in the county.Withineachrandomlyselectedlandlinehousehold,theselectedrespondentwaschosenusing thelastbirthdaymethod.InterviewswereconductedinEnglishandSpanish,includinganoversampleof 101householdofLatinoorigin,andaveraged17minutesinduration.TheBerksCountysurveyhadan overall AAPOR 3 response rate close to, or better than, comparable surveys at 31.0%. The final data were weighted to reflect 2011 census estimates in two weighting areas, the City of Reading and the remainderofBerksCounty,allowingforprojectionnumbers,estimatesof thepopulation represented byeachpercentage,tobecalculated. U.S.Census ThisreportincludesdataonthepopulationofBerksCountyresidentsalongwithsociodemographicand socioeconomic characteristics for the years 2000, 2010, 2013 and 2018. Data from the 2000 U.S. Census,the2010AmericanCommunitySurvey,andtheNielsenClaritasPopFactsDatabasewerealso used. The NielsenClaritas PopFacts Database uses an internal methodology to calculate and project sociodemographicandsocioeconomiccharacteristicsfornoncensusyears,relyingontheU.S.Census, theCurrentPopulationSurvey,andtheAmericanCommunitySurvey. 20
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management corporation VitalStatistics Themostrecentinformationonbirths,birthoutcomes,deaths,andreportablediseasesandconditions forBerksCountywasobtainedfromthePennsylvaniaDepartmentofHealth,BureauofHealthStatistics and Research. Four year (20052008) annualized average rates for natality and mortality were calculated by PHMC. Mortality rates were ageadjusted using the Direct Method and the 2000 U.S. standardmillionpopulation.Themostrecentmorbidityinformationfrom2010wasalsoobtainedfrom thestateDepartmentofHealth,andrateswerecalculatedbyPHMC.Morbidityinformation,including information on HIV and AIDS cases, is not available at the ZIP code level and, therefore, rates are presentedforthecountyandthestateonly.Thedenominatorsforall20052008vitalstatisticsratesfor thecountyandstatewereinterpolatedfromthe2000and2010U.S.Census.Thenumberofwomen ages1544andthenumberofadolescentsages1419werealsointerpolatedfromthe2000and2010 U.S.Census. COMMUNITYREPRESENTATIVES InadditiontoincludingcommunityrepresentativesontheprojectAdvisoryBoard,otherrepresentatives oftheBerksCountycommunitywereincludedinthisneedsassessmentthroughfocusdiscussiongroups of residents and informational interviews with service providers and community advocates knowledgeable about community health. The process for including community representatives in the focusgroupsandinformationalinterviewsisdescribedbelow. FocusGroups TherewerefivefocusgroupsofBerksCountyresidentsconductedbetweenJuneandSeptember,2012. Atotalof55residentsparticipated.FocusgroupswereusedtocollectindepthinformationfromBerks Countypopulationsubgroupsthatmightbeatriskforpoorhealthandaccesstocare:Latinos(migrant workers,1864yearolds,andthoseage65+);AfricanAmericans;andlowincomeolderadultsaged65+. All focus groups were conducted in the City of Reading, although participants were recruited from throughout Berks County. Participants were recruited by the Berks Encore Senior Center, Berks Community Health Center, Reading Area Community College ESL program, and the Keystone Migrant Farmworker Program. Transportation was provided when necessary, and participants were compensated$50eachfortheirtimeandtransportationcosts.Focusgroupslastedapproximately90 minutesandwereguidedbyasetofwrittenquestions(seeAppendixFfortheFocusGroupDiscussion Guide).ThefocusgroupsofLatinoolderadults,migrantworkers,andadultsage1864wereconducted inSpanishbyabilingual,biculturalfacilitator.Allfocusgroupswereaudiotaped.Refreshmentswere served.
FocusGroup OlderAdults65+ AfricanAmericans LatinoOlderAdults65+ LatinoMigrantWorkers LatinoAdults1864 Location BerksEncoreSeniorCenterReading BerksCommunityHealthCenter ReadingAreaCommunityCollege ElPuenteRestaurant ReadingAreaCommunityCollege NumberofParticipants 11 9 11 12 12
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management corporation InformationalInterviews Information interviews were conducted with 13 community representatives with knowledge of the healthandhealthcareneedsofBerksCountyresidents.Keyinformantswereidentifiedandrecruited by the project Steering Committee working in collaboration with PHMC. The names, titles, area of expertise,andorganizationalaffiliationofeachkeyinformantarelistedinthefollowingtable. BerksCountyCommunityHealthNeedsAssessmentKeyInformants Name Organization Title Expertise
CarolynBazik PegBianca SheilaBressler DanaEichert CoCountyWellness Services GreaterBerksFoodBank BerksCountyMH/MR BoyertownAreaMulti Service ReadingSchoolDistrict EastPennManufacturing WesternBerksFree MedicalClinic ReadingHealthSystem BerksCountyMH/MR GalenInsurance ReadingHealthSystem ReadingHealthSystem PRONTO!Financial Services KeystoneFarmworker Programs ExecutiveDirector ExecutiveDirector ChildandAdolescent ServiceSystemCoordinator ExecutiveDirector HIVandAIDS Populations FoodInsecurity ChildMentalHealth
AnnFisher BobHarrop Rev.Dr.WayneHeintzelman Dr.LouisD.Mancano EdwardMichalik,Psy.D. AnnMoll Dr.GeorgeA.Neubert Dr.PeterSchnatz IvanTorres,Ph.D. SelinaZygmunt
HealthandSocial ServiceNeedsin BoyertownArea SupervisorofSchoolHealth ChildHealthand MentalHealth VPofPersonnel Insurance Pastor,St.DanielsLutheran Uninsured Church MedicalDirector, ClinicalServicesforAt AmbulatoryServices RiskPopulations MH/MRAdministrator MentalHealthand MentalRetardation President Insurance Chair,Dept.ofOb/Gyn Obstetricsand Gynecology ResidencyProgramDirector ClinicalServicesforAt RiskPopulations President LatinoPopulation RegionalManager MigrantWorkers
KeyinformantsalsoincludedindividualswithdirectknowledgeofspecialpopulationsinBerksCounty, including:Latinos,migrantworkers,individualswithHIV/AIDS,theuninsured,pregnantwomen,older adults,andpersonswithmentalhealthconditions. The interviews were conducted by telephone and lasted approximately 45 minutes. The interviews were guided by questions developed by PHMC in collaboration with the project Steering Committee (See Appendix G for the interview guide). The interviews were conducted between June and September,2012. 22
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ANALYTICALMETHODS
Quantitative information from the U.S. Census, Pennsylvania vital statistics, and Berks County Household Health Survey was analyzed for Berks County as a whole and for the five separate areas withinthecountyusingtheStatisticalProgramforSocialSciences(SPSS).Frequencydistributionswere producedforvariablesformultipleyearsofdatasotrendsovertimecouldbeidentifiedanddescribed. Qualitativeinformationfromfocusgroupsandinformationalinterviewswasanalyzedbyidentifyingand coding themes common across groups and individual interviews, and also themes that were unique. This information was organized into major topic areas related to health status, access to care, special populationneeds,unmetneeds,andhealthcarepriorities.
INFORMATIONGAPS
There were no major gaps in information for this community health needs assessment because quantitative information for socioeconomic and demographic information, vital statistics, and health wasavailableattheZIPcodelevelfortheentirecounty.Thesesourcesalsoprovidedinformationon theLatinopopulationinBerksCounty.Informationonthesepopulations,andotherunmethealthcare needs, was also supplied in great detail by informational interviews and focus group discussions with communityrepresentatives. Thenextsection,III.Findings,summarizestheresultsoftheneedsassessmentprocess.
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III.FINDINGS
ThissectiondescribesthehealthneedsofBerksCountyspopulation,describingdifferencesbetween BerksCountyandPennsylvania,andamongindividualareasofBerksCounty,inhealthstatus,accessto care, health behaviors, use of preventive screenings, and social capital, including the health needs of Latinoresidents. HEALTHNEEDSOFTHECOMMUNITY
HEALTHOUTCOMES
TheCountyHealthRankingsprovideanimportantoverallcontextforunmethealthcareneedsofBerks CountyresidentsbecausehealthoutcomeswhicharepoorerforBerksCountythanforothercountiesin the state indicate that these health issues should be addressed in Berks County. The County Health RankingscanbeusedtomeasurethehealthoutcomesofBerksCountyresidentsrelativetotheother66 countiesinPennsylvaniainspecifichealthareas.Therankingsmeasurethehealthofnearlyallcounties inthenationandrankscountieswithinstates.TheCountyHealthRankingsinPennsylvaniarangefrom 67thto1st,withalownumericalrankingof1outof67beingassignedtotheCountyintheStatewiththe besthealthoutcomes,andahighnumericalrankingof67 outof67beingassignedtotheCountyinthe State with the worst health outcomes. The rankings arecompiled usingcountylevel measures from a variety of national and state data sources. The health outcomes rank includes the premature death rate,healthstatus,poorphysicalandmentalhealthdays,andlowbirthweight.Thehealthoutcomes rankincludesindicatorsofhealthbehavior,clinicalcare,socialandeconomicfactors,andthephysical environment.
BerksCountyranks14thofthe67countiesinthestateinhealthoutcomesand26thoutof67countiesin health factors, compared to a rank of 1st representing best in the state in health outcomes or health factors(UnionCounty),and67beingworstinthestate(Philadelphia).11
County Health Rankings & Roadmaps. www.countyhealthrankings.org. Accessed November 1, 2012. The original primary care physician to population ratio for Berks County on which the County Health Rankings were basedwasincorrectbecauseGeneralPracticephysicianswerecountedtwiceinerror.Thecorrectedratio,which ishigher,isusedinthisreport,buttheBerksCountyHealthRankingswerenotchangedtoreflectthecorrected physiciantopopulationratio.
11
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management corporation Figure11: BerksCounty,PennsylvaniaHealthRankings
PhysicalEnvironment Social&EconomicsFactors ClinicalCare HealthBehaviors Morbidity Mortality HealthFactors HealthOutcomes 0 10 14 20 30 40 50 60 15 26 14 21 16 41 44
Rank(of67)
Source:CountyHealthRankingsandRoadmaps,www.countyhealthrankings.org.
BerksCounty(overallhealthoutcomerankof14thoutof67)ranksbettercomparedtothe53other counties in Pennsylvania in health outcomes. However, it ranks worse than 46 other counties in morbidity(21st)(Figure11).BerksCountyshealthfactorsrankisworsethan41othercounties(26th out of 67), due to relatively worse rankings in the physical environment (44th) and social and economic factors (41st) that comprise the Health Factors rank. However, clinical care (16th) and healthbehaviors(14th)arebetterthan51and53countiesinthestate,respectively. Thenextsectionofthisreportdescribesthehealthstatus,accesstocare,anduseofservicesofBerks Countyresidents.
HealthStatus
The health of a community can be assessed by comparing birth outcomes, selfreported health status andhealthconditions,communicablediseaserates,selfreportedhealthconcernsandperceptions,and mortality rates to statewide indicators and Healthy People 2020 goals for the nation. Selfreported health status has been shown to be an accurate method of determining an individuals health, comparabletotheresultsofaclinicalexamination.12
12
IdlerEL,BenyaminiY.SelfRatedHealthandMortality:AReviewofTwentySevenCommunityStudies.Journalof HealthandSocialBehavior.1997;2137.
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management corporation BirthOutcomes BirthRate Thereisanaverageofnearly5,100birthsannuallytoBerksCountywomen.TheBerksCountybirth rate (64.2 per 1,000 women 1544 years of age) is slightly higher than the state rate (58.7). In Berks County as a whole, Latina women have the highest birth rate (119.8 per 1,000 women 1544), followedbyAsian(90.6)andBlack(83.9)women,womenofanotherrace(70.6),andWhitewomen (54.9)(SeeAppendixBforVitalStatisticsTables). TheCityofReadinghasthehighestbirthrate(98.0per1,000women1844)intheCounty.TheCityof Reading birth rate is higher than rates for the state (58.7), Berks County as a whole (64.2), and the surroundingBerksCountyareas,whichrangefrom61.3to42.6(Figure12).TheCityofReadingbirth raterepresentsanaverageofnearly1,700birthsannually.IncontrasttotheCityofReading,theNorth Berks area has the lowest birth rate (42.6) in the County. It is lower than the birth rate for the state (58.7),County(64.2),andthesurroundingBerksCountyareas. Figure12: AverageAnnulizedBirthRatesforBerksCountyWomen1544YearsbyArea,20052008 120 98.0 100 Rateper1,0000
80 64.2 60 42.6 40 47.6 61.3 57.7
PARate: 58.7
20
0 BerksCounty Reading NorthBerks County SouthBerks County EastBerks County WestBerks County
Source:PennsylvaniaDepartmentofHealth,BureauofHealthStatisticsandResearch.CalculationspreparedbyPHMC.
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management corporation AdolescentBirthRate Adolescentbirthsareassociatedwithanumberofnegativebirthoutcomes,includingprematurityand low birth weight. In Berks County, the adolescent birth rate (9.4) is higher than the state rate (6.9) (Figure13). The adolescent birth rate is highest for Berks County Latina women (31.5), followed by women of anotherrace(19.5)andBlackwomen(18.5);theadolescentbirthrateislowestforWhitewomen(4.8). Theseratesarecomparabletothestatewideadolescentbirthrates.Itisimportanttonotethatmany Latino cultures view women as adults at age 14, so many marry and have children during their teen years. TheCityofReadinghasthehighestadolescentbirthrate(28.1)ofalltheareasintheCounty.TheCity of Reading rate is four times the countywide rate. This rate represents an average of 134 births to adolescentsannually.TwothirdsofadolescentbirthsintheCountyaretoadolescentsintheCityof Reading(67.8%).TheCityofReadingrateismorethanfourtimesthestaterate(6.9),andthreetimes theCountyrate(9.4).IncontrasttotheCityofReading,theWestBerksareahasthelowestadolescent birthrate(2.8;representinganaverageof11birthsannually). Figure13: AverageAnnualizedAdolescentBirthRatesforBerksCountybyArea,20052008 50 40 28.1 30 20 9.4 PARate: 10 5.1 2.8 3.5 6.9
BerksCounty Reading NorthBerks SouthBerks WestBerks Note: TheadolescentbirthrateforEastBerkswasnotcalculatedanddisplayedbecausethecountwaslessthan10. Source: PennsylvaniaDepartmentofHealth,BureauofHealthStatisticsandResearch.CalculationspreparedbyPHMC.
0
Rateper1,0000
LowBirthWeight Lowbirthweightinfants(<2,500gramsor<5lbs.8oz.)areatgreaterriskfordyingwithinthefirstyear of life than infants of normal birth weight. In Berks County, 7.7% of infants are low birth weight, comparable to thestatewide average(8.3%) andthe HealthyPeople2020targetgoal(7.8%)(Figure 14). This percentage represents an annual average of almost 400 low birth weight infants. The percentage of low birth weight infants is higher among Black infants (12.1%) than Latino (8.2%) and 27
PUBLIC HEALTH
management corporation White(7.2%)infants,andinfantsofanotherrace(7.2%).Ingeneral,thesepercentagesarecomparable tostatewidepercentages. TheCityofReadinghasaslightlyhigherpercentageoflowbirthweightinfants(8.8%)thantheother areas of Berks County. This percentage represents an average of 150 births annually. The low birth weightpercentagefortheCityofReadingisslightlyhigherthantheCountyandstatepercentages,and theHealthyPeople2020target. Figure14: Average Annualized Percentage of Low Birth Weight Births in Berks County by Area, 20052008
50%
40%
30%
20%
8.3% 8.8% 8.4% 6.9% 6.3% 7.3%
10%
7.7%
Healthy People 2020Goal: 7.8%
0%
PA BerksCounty Reading NorthBerks SouthBerks EastBerks WestBerks
InfantMortalityRate The Berks County infant mortality rate is 4.9 infant deaths per 1,000 live births. This represents an averageof25infantdeathsannually.TheinfantmortalityrateforBerksCountyiscomparabletothe state rate (5.2) and both rates meet the Healthy People 2020 goal of 6.0 infant deaths per 1,000 live births.TheinfantmortalityratefortheCityofReadingis5.8infantdeathsper1,000livebirths;thisrate meetstheHealthyPeople2020goalaswell.
28
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management corporation SelfreportedHealthStatus FairorPoorHealth Selfreported health status is one of the best indicators of the population health. This measure has consistentlycorrelatedverystronglywithmortalityrates.13InBerksCountytheoverwhelmingmajority ofadultsratetheirhealthasexcellent,verygoodorgood(Figure15)(SeeAppendixCforHousehold Health Survey Tables). However, 15.9% of residents are in fair or poor health, representing 50,400 adults.Thispercentageisslightlylowerthanthestatewideaverage(16.8%)14andtheaverageforthe five counties in Southeastern Pennsylvania as a whole (Bucks, Chester, Delaware, Montgomery, and Philadelphia)(16.1%). Adultsin theCityofReading(32.6%)aremorethantwiceaslikelyto beinfairor poor health than adultsinotherareasofBerksCounty. Figure15: PercentageofAdultsinFairorPoorHealthbyArea,BerksCounty,2012
100%
80%
60%
40%
16.1% 15.9%
32.6%
20%
13.2%
14.5%
14.0% 7.4%
PA percentage: 16.8%
0%
SoutheasternPA BerksCounty Reading EastBerks County NorthBerks County SouthBerks County WestBerks County
Source:PHMC's2012BerksCountyHouseholdHealthSurvey. HealthConditions Highbloodpressure,diabetes,asthma,cancer,andmentalhealthconditionsarecommonillnessesthat require ongoing care. In Berks County, more than onethird of adults (33.4%) have been diagnosed withhighbloodpressure;thisrepresents105,400adults.Similarly,31.0%ofPennsylvaniaadultshave
IdlerEL,BenyaminiY.SelfRatedHealthandMortality:AReviewofTwentySevenCommunityStudies.Journalof HealthandSocialBehavior.1997;2137. 14 2011BehavioralRisksofPennsylvaniaAdults,PADepartmentofHealth.
13
29
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management corporation highbloodpressure.15BothofthesepercentagesdonotmeettheHealthyPeople2020goalof26.9%. The percentage of Berks County adults with high blood pressure increased from 26.8% to 33.4% between2008and2012.(Figure16) TheCityofReading(40.0%)hasthehighestpercentageofadultswithhighbloodpressure, andNorthBerks(30.5%)hasthelowestpercentage. For most of the areas, the percentage of adults with high blood pressure has slightly increasedsince2008.However,thepercentageofadultsintheCityofReadingwithhigh bloodpressurehasincreaseddramaticallysince2008,from29.3%to40.0%in2012. Figure16: PercentageofAdultswithHighBloodPressureinBerksCountybyArea,2012
50%
40.0% 33.4% 31.0% 34.6% 32.4% 27.2% 30.5% 27.2% 33.1% 30.8% 24.2%
40%
29.3%
30%
26.8%
20%
Healthy PeopleGoal 26.9%
10%
0%
SoutheasternPA BerksCounty Reading EastBerks County NorthBerks County SouthBerks County WestBerks County
2008
2012
Source:PHMC's2008and2012BerksCountyHouseholdHealthSurvey.
One in seven adults (13.9%) in Berks County has been diagnosed with diabetes; this percentage represents approximately 44,000 adults. Statewide, only 9.5% of adults have been diagnosed with diabetes.16 The percentage of adults with diabetes is highest among adults in the City of Reading (18.9%)andlowestamongadultsintheWestBerksarea(8.8%).
Diabetes among adults and children was also named as one of the top three health problems by key informants. Some key informants observed that diabetes disproportionately affects the Latino population,butothersindicateditisauniversalproblem.
15 16
2009BehavioralRisksofPennsylvaniaAdults,PADepartmentofHealth. 2011BehavioralRisksofPennsylvaniaAdults,PADepartmentofHealth.
30
PUBLIC HEALTH
management corporation Approximately 49,200 adults in Berks County have asthma (15.5%). In Pennsylvania, 12.9% of adults have asthma.17 The percentage of adults with asthma is highest in the City of Reading (18.7%) and lowestintheEastandWestBerksareas(11.4%and11.3%,respectively). Thepercentageofadultswithasthmahasdecreasedsince2008inallareasofBerksCounty except for the North and South Berks areas (13% and 17.6%, and 13.6% and 17%, respectively). Ninepercent(8.9%)ofadultsinBerksCountyhavehadcanceratsomepointintheirlives,representing 28,300adults.ThepercentageofadultswhoeverhadcancerishighestintheEastBerksarea(14%)and lowestintheNorthBerksarea(8.3%).AdultsintheCityofReadingareleastlikelytoreporteverhaving cancer(6.1%).18 Nearly onethird of adults in Berks County (30.2%) are obese and more than onethird (35.9%) are overweight(Figure17).Asimilarpercentageofadultsareobeseoroverweightstatewide(28.6%and 36.0%,respectively).19TheHealthyPeople2020goalforadultobesityis30.6%. Figure17: PercentageofObeseAdultsinBerksCountyArea,2008&2012
50% 40% 31.9% 30% 20% 10% 0%
SoutheasternPA BerksCounty Reading EastBerksCounty NorthBerks County SouthBerks County WestBerks County
32.9% 30.2% 27.4%
35.0% 29.0% 29.5% 28.5% 30.8% 26.1% 24.7% 30.6% 25.1%
Health People 2020Goal: 30.6%
2008
2012
TheCity ofReadinghasthehighestpercentage(35.0%)of obeseadultsamong allBerksareas.The North Berks area has the lowest percentage (26.1%) of obese adults and is the only area that had a decreaseinthepercentageofobeseadultsfrom2008to2012(28.5%to26.1%,respectively).
17 18
2011BehavioralRisksofPennsylvaniaAdults,PADepartmentofHealth. ThehigherproportionofyoungadultsintheCityofReadingpopulationmaybeafactorinthisresult. 19 2011BehavioralRisksofPennsylvaniaAdults,PADepartmentofHealth.
31
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management corporation According to key informants, obesity an important health factor impacting Berks County youth and adults. Among people who dont manage their diabetes well, obesity is very much a problem.Thereismoreobesityinchildrenbecausethemostaffordablefoodisthe leastappropriateforpeopletoeat,andpeopledontknowhowtocookunlessitis fastfoodortakeout,whichisveryfattening.(KeyInformant) Obesity is the simple greatest health risk in the United States, not just Berks County. It is the number one health problem related to coronary heart disease, diabetes,hypertension,andorthopedicjointdisease.Thiswillbeverycostlytothe system.(Keyinformant) Accordingtokeyinformants,obesityisalsothenumberoneproblemincaringforpregnantwomen,and is related to many maternal and infant complications, such as diabetes, pregnancy induced hypertension,shoulderdystocia,andincreasedCesareansectionrates. AcrossBerksCounty,oneinsevenadults(14.6%)hasbeendiagnosedwithamentalhealthcondition, including clinical depression, anxiety disorder or bipolar disorder. This represents 46,200 adults (Figure 18). Of these adults, less than four in ten (38.5%) are receiving treatment for their condition. Nationally, 22.6% of adults suffer from some type of mental disorder, of which 5.8% are classified as severe.20 Adults in the City of Reading are most likely to have been diagnosed with a mental health condition(21.3%),whileadultsintheNorthBerksareaareleastlikelytobediagnosedwitha mentalhealthcondition(10.7%). AmongadultsintheSouthBerksarea,nearlyonehalf(45.9%)arenotreceivingtreatment. Figure18: MentalHealthandTreatmentStatusofAdultsbyArea,BerksCounty,2012
100% 80% 60% 40% 20% 0% BerksCounty NorthBerks SouthBerks EastBerks WestBerks County County County County DiagnosedMentalHealthCondition ReceivesTreatment Reading 38.5%
14.6%
42.0%
21.3%
45.9% 27.8%
10.7% 14.1%
39.3% 25.9%
11.6% 15.6%
Source:PHMC's2012BerksCountyHouseholdHealthSurvey.
National Institute of Mental Health, http://www.nimh.nih.gov/statistics/1ANYDIS_ADULT.shtml. Accessed November1,2012.

20
32
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management corporation Severalkeyinformantsreferredtomentalhealthproblems,particularlyamongyouth,asoneofthetop issuesinBerksCounty.Onementalhealthserviceproviderreportedthatthenumberofyouthwitha mental health disorder diagnosis, and the severity of the symptoms, is increasing. Several key informants noted that many families lack parenting skills, and this contributes to a wide range of conduct disorders and mental health problems in youth. One key informant recommended that all primarycarepracticesshouldhavementalhealthprovidersonsitebecausementalhealthisrelatedto somanyotheradversehealthconditions. CommunicableDiseases TheratesofmostcommunicablediseasesinBerksCountyarebelowstatewiderates.Countywide rates for chronic Hepatitis B (6.6 per 100,000 population), Lyme disease (8.0), Varicella (chicken pox) (20.7),Chlamydia(302.6),andgonorrhea(47.6)arelowerthanstateratesforthesediseases.However, ratesforPertussis,orwhoppingcough,areslightlyhigherinBerksCounty(6.6)thanthestate(4.0). The prevalence rate of HIV/AIDS in Berks County is also below the statewide rate. There are 883 individuals currently living with HIV, including AIDS; this represents a rate of 218.7 cases per 100,000 population. This rate is below the state rate of 224.9 per 100,000 population. Among Berks County residentslivingwithHIVorAIDS,nearlytwothirdsaremen(65.1%).Inaddition,nearlyonehalf(46.3%) areLatino,onethird(33.6%)areWhite,andonefifth(19.8%)areBlack. HealthConcerns Fortyfour percent of survey respondents identified the cost of health care, including insurance coverage, copays, and deductibles, as their top health concern (Figure 19). This percentage represents nearly 138,000 adults countywide who have identified health care costs as their top concern.EastBerksarearesidentsaremostlikelytoidentifycostastheirtopconcern(51.6%),andthe CityofReadingresidentsareleastlikelytodoso(32.1%). ChronicdiseaseisthesecondmostcommonhealthconcernforBerksCountyresidents(12.9%).City ofReadingresidents(27.8%;representing15,000adults)aretwiceaslikelyasresidentscountywideto beconcernedaboutchronicdisease,whereas6.6%ofWestBerksarearesidentsareconcernedabout chronic disease. Access to care not related to insurance (8.3%), quality of care (6.7%), and physical fitness(4.6%)arelesscommon healthconcernsforBerksCountyresidentsthanthe cost ofinsurance andchronicdiseases.
33
PUBLIC HEALTH
management corporation Figure19: FiveMostCommonHealthConcernsReportedbyBerksCountyAdults,2012
100% 80% 60% 44.0% 40% 12.9% 20% 8.3% 0% InsuranceCost ChronicDisease AccesstoCare Source:PHMC's2012BerksCountyHouseholdHealthSurvey.
6.7%
4.9%
QualityofCare
PhysicalFitness
Mortality In addition to selfreported health status and disease rates, the health of a population and the communitycanbemeasuredbytheleadingcausesofdeathandbydeathratesforspecificconditions. Berks County has a lower overall death rate (731 per 100,000 population) than the state as a whole (785)(Figure20).HeartdiseaseistheleadingcauseofdeathinBerksCounty(189.3),fourofthefive BerksCountyareas,andinPennsylvaniaasawhole(203.2)(Figure20).Theotherfourleadingcauses ofdeath in theCountyare:allformsofcancer (includingfemalebreast cancer)(175.1);stroke(50.7); lungcancer(46.7);andfemalebreastcancer(24.5).Theotherfourleadingcausesofdeathinthestate aresimilar:allformsofcancer,includingfemalebreastcancer(184.7);lungcancer(50.9);stroke(42.5); andfemalebreastcancer(23.9). The City of Reading has a higher overall mortality rate than Berks County (929.6 versus 731 per 100,000 population), the four other areas of the county, and the state. Additionally, the City of ReadinghashighermortalityratesthantheotherareasoftheCountyandstateforeachoftheleading causes of death: heart disease (241.5); all forms of cancer, including female breast cancer (184.7); stroke(59.0);lungcancer(54.2);andfemalebreastcancer(27.3).TheNorthBerksareahasthelowest overalldeathrateintheCounty(692per100,000population).
34
PUBLIC HEALTH
management corporation Figure20: AverageAnnualizedOverallMortalityRatesbyArea,BerksCounty,20052008
1000 800 600 400 200 0

BerksCounty
926.6
731.3
692.0
699.6
720.1 639.5
Reading
NorthBerksCounty
SouthBerks
EastBerks
WestBerks
AccessandBarrierstoCare
TheHealthyPeople2020goalsforaccesstohealthcareinclude: Increasetheproportionofthepopulationwithhealthinsuranceto100%; Reduce the proportion of individuals who are unable to obtain, or delay in obtaining, necessarymedicalcare,dentalcareorprescriptionmedicinesto9%overall(4.2%formedical care,5%fordentalcareand2.8%forprescriptionmedications);and Increasetheproportionofpersonswithausualprimarycareproviderto83.9%. Barriers to care for Berks County residents that were identified by key informants included insurance andotherhealthcarecosts,transportation,communication,beliefsabouttheneedforhealthcare,and cultural differences. These barriers make it more difficult for individuals to receive the timely, high qualityhealthcarethattheyneed. HealthInsuranceStatus Havinghealthinsuranceandaregularplacetogowhensickareimportantinensuringcontinuityofcare overtime.TheoverwhelmingmajorityofBerksCountyadults(86.7%)havehealthinsurancecoverage. However, a sizable percentage of adults do not have any private or public health insurance; 13.3% of adults aged 1864 in Berks County are uninsured, representing 33,000 uninsured adults (Figure 21). Thepercentageofuninsuredadultsstatewide(13%)isthesameasthepercentageinBerksCounty.The percentageofuninsuredadultsinBerksCountyhasincreasedsince2008from8.7%to13.3%in2012. 35
PUBLIC HEALTH
management corporation ThepercentageofadultsinBerksCountywithoutinsurancedoesnotmeettheHealthyPeople2020goal of100%. Figure21: PercentageofUninsuredAdultsAge1864inBerksCountybyArea,2008&2012 50% 40% 30%
22.7% 23.7% 20% 12.2% 10% 8.7% 4.7% 0%
Southeastern PA BerksCounty Reading EastBerks County NorthBerks County SouthBerks County WestBerks County
13.3%
15.2% 8.3% 6.4% 6.2% 8.8%
13.9% 6.2%
PA percentage: 13.0%
2008
2012
AdultsintheCityofReading(23.7%)aremorelikelytobeuninsured.AdultsintheNorth Berksarea(8.3%)areleastlikelytobeuninsured. WhilethepercentageofadultswithouthealthinsurancehasremainedsteadyintheCityof ReadingaswellasNorthandSouthBerkssince2008,thepercentageofadultswithouthealth insurance has increased in the East and West Berks areas (4.7% to 15.3%, and 6.2% to 13.9%,respectively). UndocumentedLatinosaremorelikelytobeuninsuredbecause,underfederallaw,theyarenoteligible for publiclyfunded insurance programs. Many Latino focus group participants went without needed carebecausetheywereuninsuredandcouldnotaffordtheoutofpocketcosts. They say that we dont get screenings, but we dont get screenings because we dont havehealthinsurance.(Latinoadults1864) Information from focus group participants revealed that many Berks County residents who are uninsuredorunderinsuredlacksufficientfundstoselfpayforpreventiveorspecialtycareandtopayfor neededprescriptions,dental,orvisioncare. EmergencyRoomUtilizationamongtheUninsured AmongtheuninsuredinBerksCounty,onequarter(24.8%)visitedanemergencyroomforcaredueto lackofinsurance;thisrepresents8,100adults.UninsuredadultsintheCityofReading(44.1%)aremore 36
PUBLIC HEALTH
management corporation likelytovisitanemergencyroomduetoalackofhealthcoverage.UninsuredadultsintheWestBerks areaareleastlikelytousetheemergencyroomforcare(6.8%)(Figure22). Figure22: Percentage of Uninsured Adults who Visited an Emergency Department Due to Lack of InsurancebyArea,BerksCounty,2012
100%
80%
60%
44.1%
40%
24.8% 16.6%
27.3%
20%
8.1%
6.8%
0%
BerksCounty Reading EastBerksCounty NorthBerksCounty SouthBerksCounty WestBerksCounty
Manyuninsuredandunderinsuredfocusgroupparticipantsdescribedgoingtoemergencydepartments fornonurgentcarebecausetheycouldnotaffordtopayforprivatecareandknewtheywouldnothave to pay the emergency department charges and/or preferred to be seen as soon as possible. Several informantsmentionedthattheemergencydepartmentbecomesadefaultsourceofprimarycare,which iscostlyandlacksthecontinuityofcarethatchronicconditionsdemand. Despitefocusgroupparticipantsimpressions,bothSt.JosephRegionalHealthNetworkandtheReading Health System provide care for nonemergency selfpay patients without asking for payment at the initialpointofservice.Whenthebillisreceivedpatientscanapplyforcharitycarewhichwillwaivepart orallofthecosts.Charitycareisalsoavailabletocoverthecostsofongoingclinicvisitsforthosewith chronichealthproblems.However,focusgroupparticipantsseemedunawareofthisresource. PrescriptionDrugCoverage Oneinten(10.8%)adultsinBerksCountydoesnothaveprescriptiondrugcoverage.Thispercentage hasremainedconstantsince2008.Accordingtokeyinformants,manyolderresidentsusetheirsavings to pay for prescriptions. This is a serious problem for those who need medications for chronic conditions,particularlyforexpensivepsychiatricmedications.Patientsoftencutthemedicationdosage, whichcausesmoreserioushealthproblems,orgowithoutnecessarybasicmedications.Manypeople arereluctanttoaskforhelp. 37
PUBLIC HEALTH
management corporation I have asthma, and I couldnt afford the medications and the care. Insurance doesnt payforitall.Welfaresaysyoumaketoomuchmoney.Thenyoutrytogoelsewhereand itstooexpensivetogetadditionalinsurance.IuseaninhalerandsometimesIhaveto suckitup.Nebulizercontrolsit,buttheAdvaircontrolsitbetter.Butinsurancedoesnt pay for it [Advair]. Im working, but insurance doesnt cover everything, and theres a $700deductible.(BerksCommunityHealthCenter) Mydaughterhasmentalhealthproblemsanddoesnthaveinsurance.Thecopaysfor mentalhealthcareare$800avisit.(SeniorCenter) Peoplearetoopridefultoask[forhelp].Itsbecausetheydontthinktheyregoingto get services. They take overthecounter medications. There are also housing problems andpayingyourutilitybills.Therewasanelderlycouplethatwassittingintheirhouse withnoheat.Theypaidforthemedicationsandcouldntpayfortheirheating.Sothey wentwithout.(BerksCommunityHealthCenter) Focusgroupparticipantsfeltthatpatientsatprivateprovidershadbetterexperienceswithprescription refillsandreferralsthanpatientswhousedpublicclinics. Mygirlfriendgetsherprescriptionsfilledinanhour.Ifshecallsforanappointment,she getsonein45minutestoanhour.(BerksCommunityHealthCenter) Yes,butyouneedareferral.Iwashere2weeksagoandIwaited2weeksforpeopleto let me know. I needed an MRI. I finally got something in the mail. You have to come downhereinpersonifyouwantsomethingdone.(BerksCommunityHealthCenter) Themessage(attheclinic)istoolongnow.Ihadcalledandittooktwoweekstogeta prescription. I had to miss two doctors appointments because of the referrals. The doctortellsyoutocallinareferral,butthephoneistoolong.Youdialandwaitforaring orsomeonetopickup,butyougetamessage.Andthenyougethereandtheyremore focused on your namehas that changed; is everything the same for the form? But theyrenotpayingattentiontowhatneedstogetbacktothedoctor.(BerksCommunity HealthCenter) EconomicBarriers Withorwithouthealthinsurance,manyadultsinBerksCountyareunabletogetneededcareduetothe cost of that care; 12.0% of adults reported that there was a time in the past year when they needed healthcare,butdidnotreceiveitduetothecost(Figure23).Unemployment,andunderemployment, are often major factors in economic barriers to care because so many individuals lose their health insurancecoveragewhentheylosetheirjobs,orhavenohealthinsurancebecausetheyworkparttime. Theroleofcostasabarriertocarevariesacrossthecounty.IntheCityofReading,18.5%ofadultsdid notreceivecareduetocost.ResidentsoftheNorthBerksarea(9.8%)wereleastlikelytonotgetcare duetothecost. 38
PUBLIC HEALTH
management corporation About43,400adultsinBerksCountywereprescribedamedicationbutdidnotfilltheprescriptiondue tocostinthepastyear(13.7%).ThoselivingintheCityofReadingaremorelikelytofacecostbarriers to prescriptions, with nearly onequarter of adults in the City of Reading not receiving prescribed medicationsduetocost(23.7%). MorethanoneinfiveadultsinBerksCountydidnotgetdentalcareinthepastyearduetothecostof thatvisit(21.1%).Therewaswidevariationintheroleofcostasabarriertodentalcareindifferent partsofthecounty.OnethirdofadultsintheCityofReading(33.2%)didnotreceivedentalcaredueto thecost,comparedto14.0%ofadultsintheWestBerksarea. Figure23: CostBarrierstoCareinPastYearbyArea,BerksCounty,2012
50% 40%
33.2%
30%
24.1% 21.1% 23.7% 18.5% 13.7% 12.0% 20.2% 15.4% 9.8% 19.3% 12.5% 10.1% 12.5% 14.0% 11.0% 8.9% 22.2%
20% 10% 0%
14.7% 12.4%
7.4%
SoutheasternPA
BerksCounty
Reading
EastBerks County
NorthBerks County
SouthBerks County
WestBerks County
NoCareDuetoCost
NoRxDuetoCost
NoDentalCareDuetoCost
Source:PHMCs2012BerksCountyHouseholdHealthSurvey. Many residents have no prescription coverage or dental insurance, and many older residents do not have Medicare Part D coverage and, as a result, go without needed medication. Dental care is not coveredbyMedicare,andminimumdentalinsurancecoverage,whichisoftenallthatolderadultscan afford,hashighdeductiblesandcopays. Whenyoutrytobuydentalcare,itsminimalamount.Theyllpayforgeneralcare. Theyremakingmoneyonyou.IhaveaproblemrightnowandIneedmajorcare. Itsanimpossibleamountofmoney.Ihaveonebrokentooth,anditcostme$1,000. Why isnt dental covered by medical? If you have bad teeth, it affects your whole system.Thenyouhaveotherproblemsthatcomefromit.Dentalcareisabsolutely impossible. And I have many more problems than that [broken tooth]. (Senior Center)
39
PUBLIC HEALTH
management corporation According to key informants, a primary reason why low income adults may lack Medicaid or other insurance coverage is that this population is very transient. They often move without forwarding addressesandareunabletocomplywiththedocumentationneededtoapplyfor,orrenew,Medicaid applications. They may also ignore notices and requests from the County welfare office for more informationandbecomeuninsured.ManyoftheCountyssocialserviceandhealthcareproviderswork tirelesslytoenrollandreenrolltheseresidents.However,manynewuninsuredbuteligibleresidents areconstantlybeingdroppedfromenrollment. Transportation ManyBerksCountyresidentshavedifficultyaccessingservicesbecausetheyliveinareaswherepublic busserviceislimited.Additionally,manyservicesarelocatedintheCityofReading,whichisnotalways accessible for suburban and rural residents who dont drive. While paratransit and some volunteer transportationprogramsareavailable,theparatransitservicewillnotcrosscountylines,soaresidentin Berks County cannot see a physician in Montgomery County. The paratransit service is often inconvenient: YoucanusetheCitybus.IwasdeniedthespecialbusbecauseImnotdisabled.Ihave torelyonataxiorfriends.Thebusdoesntstopinfrontofthedoctorsoffice.Imanage togetthere,butIhavetotakeataxi.(SeniorCenter) YoucanusetheBARTAbus,butyouhavetobedisabled.Andtheywontwaitforyou. Youhavetocall24hoursinadvance.(SeniorCenter) Language Theabilitytocommunicatewithhealthcareproviderscanbeamajorbarriertohealthcare,especially forLatinos,duetoalackofSpanishspeakingstaffandpoorornonexistenttranslationservices. Languageandmanytimesalsolackofeducationandunderstandingterminology.They talktousintermsthatwedontunderstand.Instructions.Manyofusdontunderstand Englisheasily.Theyspeakintermsthataredifficultforus.(Latinoadults1864) Interpreters are available at hospitals, but often not for specialists or at private practitioners offices. MaterialsareoftenprovidedsolelyinEnglish.Sinceinterpretersaresoexpensive,Latinopatientsoften relyonchildrentointerpret,whichisaviolationofdoctor/patientconfidentialityandcanalsoresultin miscommunication. Inthehospitals,youoftenfindaninterpreter,butwhenyougotoaspecialistthatsthe biggerproblembecauseyouneedtobringyourowninterpreter,andtheyre$75dollars anhour.Thespecialiststypicallyareoutsideofthehospitals,sotheylldotranslationand transportation if you have to take a kid to King of Prussia, the interpreter and translationis$150.(Latinoadults1864) Interpreter services for Spanish speakers are thought to be unreliable. One participant felt that interpretersaresometimesrude: 40
PUBLIC HEALTH
management corporation Ifyougototheclinicandtreatthemnicely,theresnoreasonfortheirtranslatorstobe nastytoyou.Ifyourerudetothem,thenyestheyllberudetoyou,butifyourethere sickandtreatthemwell,theyshouldnttreatyoupoorly.(Latinoadults1864) You dont have to smile, but show some respect. Theyre the professional. Were not feelingwellandthenwehavetobetreatedbadly.(Latinoadults1864) CulturalDifferences Even with interpretation, some important facts are often lost due to cultural differences. Differences betweenculturescansometimespreventoptimalcareandserviceprovision. [Health care professionals] need training on the uniqueness within the Latino populationandbetween documented andundocumentedLatinos.TheyseeLatinosall thesame,butherethereareDominicans,PuertoRicans,andMexicans,whicharetotally differentcultures.Theyshouldunderstandthedifferencesbetweentheculturesthere are21differentcountriesinLatinAmerica.(KeyInformantInterview) LackofeducationisalsoabarriertocarefortheLatinopopulation: Apoorpersonheredoesntreallyhaveaccesstoanythingandbeingeducatedmakesit easiertohaveopportunities,butherethepoorpersonandthepoorlyeducated,youre goingtohaveaveryhardtimeinthiscity.(LatinoAdults1864) In addition to economic and linguistic barriers, according to key informants, many County residents do not understand the importance of preventive care, or of having a primary care physician, and do not seek health care unless they feel ill. Others share a cultural belief that theirlivesanddestiny,includingillness,arenotundertheircontrol,sothereisnoreasontoseek earlypreventivecare.Inaddition,sometypesofpreventivecare,suchasprenatalcare,arenot commonly available in their original culture, such as Latin America, so women do not understandthebenefitsofseekingoutobstetricalcareasearlyinthepregnancyaspossible. UtilizationofServices Havingaregularsourceofcareisimportantsincepeoplewhohavearegularsourceofcarearemore likely to seek care when they are sick compared with those who do not. In Berks County, 11.8% of adultsdonothavearegularsourceofcare;thispercentagerepresentsapproximately37,600adults (Figure 24). The percentage of adults in Berks County with a regular source of care (88.2%) is higher thantheHealthyPeople2020goalof83.9%. IntheCityofReading,18.9%ofadultsdonothavearegularsourceofcare;thispercentage hasremainedconstantsince2008. The percentage of adults without a regular source of care differs across the other areas of BerksCounty:itislowestintheSouthBerksarea(9.1%). 41
PUBLIC HEALTH
management corporation Figure24: Percentage of Adults without a Regular Source of Care in Berks County by Area, 2008&2012
50%
40%
30% 18.0% 11.8% 6.1% 18.9% 11.9% 17.8% 11.7% 12.9% 9.1% 15.1% 9.6%
20% 11.2% 10%
14.4%
Healthy People 2020Goal: 16.1%
0%
Southeastern PA BerksCounty Reading EastBerks NorthBerks SouthBerks WestBerks
2008
2012
In addition to a lack of primary care providers, many residents also lack sufficient access to mental health and specialty services. According to key informants, mental health needs are often unmet because there is a significant shortage of psychiatrists, particularly for children and adolescents, and manydonotacceptanytypeofinsuranceorMedicalAssistance.Evenwithinsurancecoverage,outof pocket costsfordeductiblesandcopaysandlowreimbursementratesareprohibitively expensivefor many lower income residents. The insufficient number of board certified child and adolescent psychiatrists in the County also leads to long waiting times for an appointment. Although Reading Health System operates 10 adolescent inpatient psychiatric beds, according to key informants many familiesrelyonafamilypractitionerfortreatmentwhentheyneedspecialtymentalhealthcare. AccessingspecialtycareandpreventivescreeningsisalsodifficultforMedicaidpatientsbecausesome specialistsdonotacceptMedicaid,oracceptalimitednumberofMedicaidpatients. I wanted to go [to the specialist] and they told me I couldnt go because they didnt haveanyspaceforanother[Medicaid]patient.(Latinoadults65+) KeyInformantsagreedthattheMedicaidpopulationalsolacksaccesstosubstanceabusetreatmentand dentalcareduetothelimitednumberofproviderswhoacceptMedicaid. Inaddition,sometypesofspecialtytreatment,likeelectivesurgery,arenotcoveredatallbyMedicaid, so that patients must pay out of pocket or forgo treatment. For example, many pain management specialistsandphysicianswhotreatHepatitisCwillnotseeMedicaidpatientsatall.ManyLatinosalso relyoncornerstores(bodegas)toacquiremedicationsfromtheirnativecountries;theyalsosometimes finditlessexpensivetotraveltotheirhomecountriestoreceivecareiftheycan. 42
PUBLIC HEALTH
management corporation ManykeyinformantsmentioneddifficultyinaccessingspecialtyservicesforthoseenrolledinMedical Assistance. Many specialty providers do not accept Medical Assistance, and the existing hospitals and communityclinicsdonothavethecapacitytoserveallofthepatients.Thisleadstolongwaitingtimes toseeaproviderandfrustrationforpatients. Whathappens,they[clinicstaff]makeyouwaitalongtime.Sometimeswedonthave timetowaituntiltheywanttotreatus.Italsodependsontheperson,whenIaskthem whydoyoumakemewaitalongtime,Imnotheretowasteyourtime,andthentheyll treatyou.Butsometimesitsamatterofspeakingup,becauseifyoustayquietandwait forthem,thentheyrejustgoingtocontinuetoignoreyou.(Latinomigrantworkers) Uninsuredadultsoftencannotaffordthecostofspecialtyservicesandprocedures. Iwenttoaprivateclinic,andtheysentmetotheER.WhenIgottotheERwhatthey gavemewasinformationaboutaspecialist,soobviouslyatthespecialistwehadtopay aheadoftime.Itwas$270fortheconsultandtheexam.Itwasacolonoscopythatcosts $2,700,soobviously,no,Ididntgettheprocedure.(Latinoadults1864) Thats another reason that we dont receive health care, because theres no one that willchargeyoulessorwillatleastputyouonapaymentplanandtellyouweregoingto do this [procedure] or that [one]. But theres no opportunity, theres no possibility, we donthavetheopportunitytohaveavailabledoctorsthatwillchargeuslessorhelpus. (Latinoadults1864) PreNatalCare Receivingprenatalcareduringthefirsttrimesterofpregnancycanhelpensurethathealthconcernsare identifiedandaddressedinatimelymanner.TwothirdsofBerksCountywomen(67.2%)receiveearly prenatalcare,whichisbelowthestateaverageof70.6%anddoesnotmeettheHealthyPeople2020 goalof77.9%(Figure25). BlackandLatinawomenaremorelikelytoreceivelateornoprenatalcarethanWhiteor Asianwomen.ApproximatelyonehalfofLatina(49.1%),andBlackwomen(48.7%)receive lateornoprenatalcare,comparedto30.0%ofAsianwomenand26.6%ofWhitewomen. Similarpatternsarefoundstatewide. In the City of Reading, onehalf of women (50.1%) receive late or no prenatal care, representingmorethan820womenannuallyintheCity.Thispercentageishigherthanthe percentagethatreceivelateornoprenatalcareinotherBerksCountyareas,BerksCounty asawhole(32.8%),andthestate.InReading,morethanonehalfofBlackwomen(52.7%), Latinas(52.0%)receivedprenatalcarelateornotatall.TheWestBerksareahasthelowest percentage of women who receive late or no prenatal care (23.0%). Within West Berks, morethanonethirdofLatinawomen(36.2%)didnotbeginearlyprenatalcare,compared with21.8%ofWhitewomen. 43
PUBLIC HEALTH
management corporation Figure25: AverageAnnualizedPercentageofWomenReceivingLateorNoPreNatalCareforBerks CountybyArea,20052008 100% 80% 60% 50.1% 40% 32.8% Healthy 24.0% 24.7% 24.8% 23.0% People 2020Goal: 20% 22.1% 0% BerksCounty Reading NorthBerksCounty SouthBerksCounty EastBerksCouonty WestBerksCounty
HealthScreenings
Regular health screenings can help identify health problems before they start. Early detection can improve chances for treatment and cure and help individuals to live longer, healthier lives. In Berks County, 17.5% of adults did not visit a health care provider in the past year; this percentage represents55,200adults. AdultsintheCityofReading(23.0%)werelesslikelytovisitahealthcareproviderinthepast yearthananyotherareainBerksCounty. DentalVisit Nearly onethird (30.0%) of all Berks County adults did not visit a dentist in the past year. This is similartothepercentageofadultsstatewidewithoutadentalvisitinthepastyear(29.0%).21Adultsin theCityofReading(43.0%)weremorelikelytonotvisitadentistinthepastyear. InallBerksCountyareas,thepercentageofadultswhodidnotvisitadentistinthepastyear hasincreasedfrom2008.
21
2011BehavioralRisksofPennsylvaniaAdults,PADepartmentofHealth.
44
PUBLIC HEALTH
management corporation RecommendedScreenings ThefollowingscreeningshavebeenrecommendedforpreventativehealthforadultsbytheU.S.Centers forDiseaseControl.Asdescribedbelow,manyadultsinBerksCountyarenotutilizingtheseservices. BloodPressure 13.2%ofadultsinBerksCountydidnothaveabloodpressuretestinthepastyear.Adults intheCityofReading(17.0%)aremostlikelytonotreceivethistestwithinthepastyear. Colonoscopy Regularscreeningsbeginningatage50arefundamentalinpreventingcolorectalcancer. Seveninten(69.4%)adults50yearsofageandolderinBerksCountyhavehadacolonoscopy in the past ten years. Statewide, 65.0% of adults age 50 and over have had a colon cancer screeninginthepasttenyears.22 In the North Berks area, more than four in ten (42.5%) adults did not receive this recommendedscreeninginthepasttenyears.Thispercentagerepresents16,400adultsand isanincreasesince2008(31.6%). Nearlyonethird(31.5%)ofadultsintheCityofReadingdidnotreceiveacolonoscopyinthe pasttenyears;adultsintheWestBerks(78.0%)areaweremostlikelytohavehadthistest. PapSmearTest FourintenBerksCountywomen(41.0%)didnotreceiveaPapSmeartestinthepastyear. Thispercentagerepresentsapproximately66,300women,andisanincreasefrom31.7%in 2008. TheEastBerksareahasthehighestpercentage(46.8%)ofwomennotreceivingthistestin thepastyear. TheCityofReadinghadthelowestpercentage(36.4%)ofadultwomenwhodidnotreceivea Paptestinthepastyear. Mammogram The American Cancer Society recommends annual mammograms beginning at age 40 for women in goodhealth.However,fourinten(40.6%)BerksCountywomenage40andoverarenotreceivingthis screeningannually.Thisissimilartothestatewidepercentage(42.0%).23 IntheCityofReading,45.2%ofwomenaged40andoverdidnotreceiveamammogramin thepastyear.Thispercentageincreasedsubstantiallyfrom28.6%in2008. The percentage of adult women who did not receive a mammogram in the past year is slightlylowerinotherareasoftheCounty.
22 23
2010BehavioralRisksofPennsylvaniaAdults,PADepartmentofHealth. 2011BehavioralRisksofPennsylvaniaAdults,PADepartmentofHealth.
45
PUBLIC HEALTH
management corporation Allregionssawanincreaseinthepercentageofwomennotreceivingyearlymammograms from 2008 to 2012; this may be due to recent changes by some organizations in the recommendedscreeningintervals.
RectalExamsforProstateCancer Nearly onehalf (47.4%) of men aged 45 years and over in Berks County did not have a screeningforprostatecancerinthepastyear.Statewide,53.0%ofmenage50andoverdid nothavethistest.
HealthBehaviors Nutrition AccordingtotheUSDAsMyPlatefoodguidelines,adultsshouldeat45servingsoffruitsandvegetables daily.24MostadultsinBerksCountydonotreachtheserecommendedgoals:nearly221,100residents (71.9%) do not meet these nutritional guidelines. This percentage is comparable to national data. Nationally,lessthanthreequartersofadults(74.0%)eatthreeormoreservingsoffruitsandvegetables daily.25
TheCityofReadinghasthehighestpercentageintheCountyofadultswhodonoteatenoughfruits and vegetables. More than eight in ten adults (84.8%) eat three or fewer servings of fruits and vegetables a day (Figure 26). In the other areas of the County approximately seven in ten adults eat fewerthantherecommendedfourservingsoffruitsandvegetablesaday.
Figure26: Percentage of Adults Consuming Three or Less Servings of Fruit and Vegetables/Day by Area,BerksCounty,2012
100% 74.2% 71.9% 84.8% 72.3% 69.0% 69.3%
80%
68.3%
60%
40%
20%
0%
Southeastern BerksCounty PA Reading EastBerks County NorthBerks County SouthBerks County WestBerks County
Source:PHMCs2012BerksCountyHouseholdHealthSurvey
The U.S. Departments of Agriculture, (2011). Dietary Guidelines Consumer Brochure. Retrieved online on October23,2012athttp://www.choosemyplate.gov/foodgroups/downloads/MyPlate/DG2010Brochure.pdf 25 U.S. Centers for Disease Control and Prevention. StateSpecific Trends in Fruit and Vegetable Consumption AmongAdults,20002009(2011).
24
46
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management corporation Fast foods are high in unhealthy calories, saturated fats, sugar, and salt. Currently, nearly onehalf (48.1%)ofBerksCountyresidentseatfastfoodoneormoretimesamonth. Key Informants attributed the rise in obesity to difficulty in accessing affordable healthy foods, individuals preferences for cheap, fast food, and the difficult economic times in which families focus moreoneconomicsecuritythanondietandexercise. Exercise The U.S. Department of Health and Human Services 2008 Physical Activity Guidelines for Americans recommendsthatadults(ages1864)get2.5hoursofmoderateaerobicphysicalactivityeachweek.26 ManyadultsinBerksCountydonotmeettheserecommendedguidelines. Aboutsixteenpercent(15.6%)ofadultsinBerksCountydonotparticipateinanyexercise and only 55.0% of adult residents exercise three or more days a week as recommended. The Healthy People 2020 goal is to reduce the percentage of adults who participate in no leisuretimephysicalactivityto32.6%. ExercisehabitsofBerksCountyadultdifferacrosstheCounty.TheCityofReadinghasthe highestpercentageofadults(23.6%)whodidnotexerciseatallwithinthepastmonth;the NorthandSouthBerksareashavethelowestpercentage(13.4%and13.2%,respectively). FocusgroupparticipantswerealsoaskedwhethertheyhadheardoftheReadingTrailsandiftheyhad used them. Most participants were aware of the trails, but none were currently using them due to eitherdisabilityorfearofcrime.Participantswhohadheardofthetrailswereawareofarecentattack onanolderwomanthatoccurredonthetrailsduringtheday.Thosewhostatedtheydidnotwantto usethetrails,ornolongerwantedtousethem,gavefearofcrimeastheirreason. TobaccoUse Oneinfive(20.4%)adultsinBerksCountycurrentlysmokes;thispercentageissimilartothesmoking ratestatewide(22.4%)(Figure27).ThepercentageofadultsinBerksCountywhosmokedoesnotmeet theHealthyPeople2020goalof12%.27TheCityofReadinghasthehighestpercentage(29.3%)ofadults whosmokeandtheWestBerksarea(17.6%)hasthelowestpercentageofadultsmokers.
26 27
U.S.DepartmentofHealthandHumanServices.2008PhysicalActivityGuidelinesforAmericans,2008. 2011BehavioralRisksofPennsylvaniaAdults,PADepartmentofHealth.
47
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management corporation Figure27: PercentageofAdultsWhoSmokebyArea,BerksCounty,2008&2012
50%
40% 29.3% 27.8% 18.2% 21.7% 22.2% 18.5% 18.5% 27.2% 23.8% 19.3% 17.6% 24.8% 20.4%
30%
20%
10%
Healthy People 2020Goal: 12%

SoutheasternPA Reading EastBerksCounty NorthBerks County SouthBerks County WestBerks County BerksCounty
0%
2008
2012
Source:PHMCs2008and2012BerksCountyHouseholdHealthSurveys.
Slightlymorethanonehalf(54.3%)ofadultswhosmokeinBerksCountytriedtoquitinthepastyear. Within the county, there was wide variation among smokers who tried to quit in the past year. The highest percentage of adults trying to quit was in the North Berks area (68.9%), and the lowest percentageofadultstryingtoquitwasintheWestBerksarea(27%). AlcoholConsumption AccordingtotheCentersforDiseaseControlandPrevention(CDC),bingedrinkingisacommonpattern ofexcessivealcoholuseintheU.S.Itisdefinedasfiveormoredrinksononeoccasion.28Nearlyfourin ten(38.4%)BerksCountyadultsparticipatedinbingedrinkingononeormoreoccasionsinthepast month. The Berks County binge drinking percentage is more than twice the statewide percentage of 18.3%.29 The City of Reading has the highest percentage of residents who participated in binge drinkinginthepastmonth.NearlyonehalfofReadingresidents(47.5%)consumedfiveor moredrinksononeormoreoccasionsduringthepastmonth.
28 29
U.S.CentersforDiseaseControlandPrevention.FactSheetsBingeDrinkingAlcohol(2010). 2011BehavioralRisksofPennsylvaniaAdults,PADepartmentofHealth.
48
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management corporation SocialCapitalandNeighborhood Neighborhood factors have important roles in the overall health and wellbeing of Berks County residents. Social capital is one measure used to understand an individuals neighborhood and role in that neighborhood. The social capital index used in this needs assessment was created from five questions asked in the Berks County Household Health Survey. Those questions were: 1) number of groups the respondent currently participates in; 2) respondents perception as to whether neighbors everworkedtogethertoimprovetheircommunity;3)respondentsperceptionastowhetherneighbors are willing to help each other; 4) respondents feeling of belonging to the neighborhood; and 5) respondents perception as to whether people in the neighborhood can be trusted. A social capital index,withscoresrangingfrom1to10,wascreatedwithascoreof14deemedashavingalowsocial capital,57asbeingmedium,and810ashighsocialcapital. AdultsinReadingaremorelikelythanadultsinotherpartsofBerksCountytohavelowsocialcapital. More than onehalf of adults in Reading, 57.0%, or approximately 26,500 adults, have low socialcapital,ascomparedto22.3%ofadultsintheEastBerksarea(Figure28). Figure28: SocialCapitalbyArea,BerksCounty,2012 100% 80%
60% 40% 20% 0%
65.6% 57.0% 52.5% 55.7% 55.0% 53.3%
31.0% 16.5%
33.4% 29.5% 25.5% 19.5% 14.8%
9.6%
22.3% 12.1%
23.8%
22.9%
BerksCounty
Reading
NorthBerksCounty
SouthBerksCounty
EastBerksCounty
WestBerksCounty
LowSocialCapital
MediumSocialCapital
HighSocialCapital
About threequarters of adults in Berks County (76.1%) have a park or other outdoor space in their neighborhoodthattheyarecomfortablevisiting;thisrepresents237,800adults.AdultsintheSouth Berks area are most likely to have a park or other outdoor space in their neighborhood that they are comfortablevisiting(79.4%).AdultsintheCityofReadingarelesslikely(68.7%)tohaveaneighborhood parkorotheroutdoorspacethattheyarecomfortablevisiting. 49
PUBLIC HEALTH
management corporation AboutsixintenadultsinBerksCounty(59.8%)saythereisafreeplacewheretheycanexercise.This representsapproximately163,400adults.AdultsintheCityofReadingarelesslikelythanotheradults inBerksCountytosaythereisaplacewheretheycanexerciseforfree,withonehalfofadults(50.7%), orabout23,900adults,sayingtherewasaplacewheretheycouldexercisefreeofcharge.Accesstoa freeplacetoexerciseissomewhatconsistentacrosstherestofthecounty,rangingfrom63.7%ofadults intheNorthBerksareato58.1%ofadultsintheEastBerksarea(Figure29). Figure29: OpportunitiesforPhysicalActivitybyArea,BerksCounty,2012
100% 76.1% 68.7% 77.1% 79.4% 75.5% 77.4%
80%
60%
40% 23.9% 20%
31.3% 22.9% 24.5% 20.6% 22.6%
0%
BerksCounty Reading NorthBerks County SouthBerks County EastBerksCounty WestBerksCounty
ComfortableVisitinigNeighborhoodPark
Freeplacetoexercise
HEALTHNEEDSOFSPECIALPOPULATIONS
Oneofthegoalsofthisneedsassessmentwastoidentifythehealthneedsofspecialpopulationsacross Berks County. As described earlier in this report, the Latino population of Berks County has grown rapidlyinthepasttwentyyears,andmanyLatinosareinpoorerhealthandexperiencemorebarriersto accessing health care than others in the County. However, other populations across Berks County, includingBlacksandthepoor,alsolackaccesstoaffordablehealthcare.Thefollowingsectionfocuses on the health status and health care needs of special populations across Berks County. These groups presentanareaofimmediateandgrowingneed.
HealthStatus One of the best indicators of the health of the population is their selfreported health status. This measurehasconsistentlyshowntocorrelateverystronglywithoutcomesonmedicalexaminations. 50
PUBLIC HEALTH
management corporation Across Berks County, the majority of Latino adults rate their health as good. However, slightlymorethanonethird(34.0%)ofLatinoadultsage18yearsofageorolderareinfair or poor health, representing 15,600 adults. This percentage is almost three times higher thanfornonLatinoadultsinBerksCounty(34.0%versus12.8%,respectively). Threeinten(30.9%)BlackadultsinBerksCountyareinfairorpoorhealth;thispercentage ismorethantwiceashighcomparedtoWhiteadults. Poor adults across Berks County are more than three times as likely to be in fair or poor healthcomparedtononpooradults(40.8%versus12.6%,respectively). Highbloodpressure,diabetes,asthma,cancer,andmentalhealtharefrequentlycitedhealthconditions thatrequireongoingcare. Morethanonequarter(28.0%)ofLatinoadultshavehighbloodpressure;thispercentage represents 12,900 adults. This percentage is lower than compared to nonLatino adults (34.3%).BlackadultsaremorelikelytohavehighbloodpressurecomparedtoWhiteadults (48.4%versus33.5%).Oneinfour(39.6%)pooradultshashighbloodpressurecomparedto onethird(32.6%)ofnonpooradults. Approximately 7,100 (15.5%) Latino adults in Berks County have diabetes and 18.2% has asthma. These percentages are slightly higher than compared to nonLatino adults (13.6% and 15.1%, respectively). Across Berks County, Black (28.3%) and poor adults (24.9%) are twice as likely to have diabetes compared to their counterparts (13.3% and 12.5%). Black adults are slightly more likely to have asthma compared to White adults (17.9% versus 15.7%).PooradultsinBerksCountyaremuchmorelikelytohaveasthmacomparedtonon pooradults(25.2%versus14.2%,respectively).(Figure30) Latino adults in Berks County are more likely to have a diagnosed mental health problem thannonLatinoadults(17.6%versus14.2%,respectively).Pooradultsaretwotimes(16.2%) aslikelytohaveamentalhealthproblemcomparedtononpooradults(13%). Seven in ten (71.9%) Latino adults are overweight or obese; this percentage represents 31,200 adults and is higher compared to nonLatino (65.2%) adults in Berks County. Black adults are more likely to be overweight or obese compared to White adults (69% versus 65.6%).Similarly,pooradults(74%)aremorelikelytobeoverweightorobesecomparedto nonpoor(65.1%)adults.
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management corporation Figure30: PercentageofLatinoAdultsinBerksCountywithSpecificChronicHealthConditions,2012
100%
80%
60%
40% 28.0% 20%
34.3% 15.5% 18.2% 15.1% 9.9% 3.3% 3.1% 4.7%
13.6%
0%
HighBloodPressure Diabetes Asthma Cancer CongestiveHeart Failure
Latino
NonLatino
UtilizationofServices Earlydetectionofahealthproblemcanimproveanindividualschancesfortreatmentandacureofa healthcondition. Among Latinos in Berks County, approximately three in ten (29.3%) adults did not visit a health care provider in the past year; this percentage represents 13,200 adults. The percentageofLatinoadultswhodidnotvisitahealthcareproviderinthepastyearisnearly two times as high as for nonLatino adults (15.6%). One in five Black (21.7%) and poor (21.4%)adultsdidnotvisitahealthcareproviderinthepastyearcomparedtoWhite(16.5%) andnonpoor(17.0%)adults. Fourinten(40.3%)Latinoadultsdidnotvisitadentistinthepastyear,representing18,600 adults.ThispercentageishigherthanfornonLatinoadults(28.4%).OnehalfofBlackadults did not visit a dentist in the past year; this percentage represents 7,300 adults. This percentage is higher than compared to White adults (28.4%). Similarly, nearly onehalf of pooradults(47.8%)didnotvisitadentistcomparedtononpooradults(27.6%).
52
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management corporation HealthScreenings Thefollowingscreeningshavebeenrecommendedforpreventativehealthforadults.Formanyofthese indicators, information is presented for Latinos across Berks County only. This is because for some screenings,thesamplesizewaslimitedforBlackandpooradults. As described below, many Latino adults in Berks County are not getting these important screenings. (Figure31). Figure31: UtilizationofHealthScreeningsamongLatinoAdultsinBerksCounty,2012
100%
80%
56.5% 46.2% 40.5% 40.8% 41.5% 35.1%
60%
40%
24.5%
31.3% 30.2%
20%
11.3%
0%
BloodPressureTest Colonoscopy PapSmear Mammogram ProstateScreening
Latino
NonLatino
BloodPressure Almostonequarter(24.5%)ofLatinoadultsinBerksCountydidnothaveabloodpressure testinthepastyear,representing11,100adults.Thispercentageismorethantwotimesas highascomparedtononLatinoadults(11.3%).AcrossBerksCounty,Black(14.6%)andpoor (19.4%) adults were more likely to not have a blood pressure test in the past year. These percentagesarehighercomparedtoWhite(11.6%)andnonpooradults(12.4%). Colonoscopy Approximately onethird of Latino and nonLatino adults did not receive a colonoscopy screeninginthepasttenyears(31.3%and30.2%,respectively). 53
PUBLIC HEALTH
management corporation PapSmear Four in ten (40.5%) Latina adult women did not receive a Pap smear test in the past year. Thispercentagerepresentsapproximately10,000women.Thispercentageissimilarfornon Latinawomen. Mammogram Annual mammograms are often recommended for women 40 years of age and older. However,morethanonethird(35.1%)ofLatinawomeninBerksCountyarenotgettingthis annualscreening.WhilethispercentageislowercomparedtononLatinawomen(41.5%),it represents4,500adultLatinawomennotgettingthisimportantcancerscreening. RectalExamsforProstateCancer Morethanonehalf(56.5%)ofLatinoadultmen45yearsofageorolderinBerksCountydid not have a rectal exam for prostate cancer in the past year. This percentage represents approximately3,600men.ThepercentageofLatinomenwhohavenothadarectalexamfor prostatecancerinthepastyearishighercomparedtononLatinomen(56.5%versus46.2%, respectively). AccessandBarrierstoCare MorethanaquarterofLatinosinBerksCountybetweentheagesof18and64(25.8%)havenopublic or private health insurance. This represents approximately 10,800 uninsured Latino adults in Berks County. Latino adults are more than twice as likely to be uninsured as nonLatino adults (10.8%). Similarly,morethanonequarterofBlack(27.9%)andpoor(27.3%)adults(ages1864)inBerksCounty donothaveanypublicorprivatehealthinsurance.Thesepercentagesaremorethantwotimesashigh asforWhite(10.6%)andnonpooradults(10.5%). While 8.6% of insured nonLatino adults in Berks have prescription drug coverage, more thanonequarterofinsuredLatinoadults(25.7%)donot. Adultswithoutaregularsourceofcarefaceincreasedriskofpoorhealthoutcomes.Forexample,Latino adultsinBerksCountyaremuchlesslikelytohavearegularsourceofcarethanarenonLatinoadults. OneintennonLatinoadults(9.9%)hasnoregularsourceofcare,comparedto22.9%ofLatinoadults. WhiteadultsinBerksCountyaremuchmorelikelytolackaregularsourceofcarecomparedtoBlack adults(22.9%versus9.9%).Oneinfive(20.4%)pooradultsacrossBerksCountydoesnothavearegular sourceofcare;thispercentageistwiceashighasthepercentagefornonpooradults(10.7%). Not having a regular healthcare provider is a particular burden for those without health insurance coverage. Among adults in Berks County without health coverage, nearly 8,100 visited an emergency departmentbecausetheyhadnowhereelsetogoforcare.
54
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management corporation Nearly onehalf of uninsured Latino adults in Berks County (45.2%) visited a hospital emergency department because they were uninsured. Uninsured Latinos are more than threetimesaslikelytousetheemergencydepartmentasuninsurednonLatinos(14.9%). As indicated by the research above, there are many barriers to receiving regular and timely care for Berks County residents. One frequently cited barrier is cost, including the cost of medical and dental treatmentfortheuninsured,thecostofcopaysforthosewithinsurance,andthecostofprescription medications. Many Berks County adults with health insurance still do not have coverage for prescriptionsorfordentalvisits.InBerksCounty,Latinos,Blacks,andpooradultsfaceadditionalcost relatedbarrierstohealthcare. Nearly8,000Latinoadultsneededhealthcareinthepastyearbutdidnotreceivethatcare duetocost.Thisrepresents16.8%ofallLatinoadultsinBerksCountyandishigherthanthe percentage of nonLatino adults (11.1%) who deferred necessary care due to cost. Nearly onequarter (23.6%) of Black adults did not seek healthcare due to the cost, representing 3,300 adults. Approximately 7,000 (17.8%) poor adults did not seek healthcare due to the cost. Whilemanyresidentsareabletoseekmedicaltreatment,costremainsabarriertoreceiving prescription drugs. More than one in five (21%) Latino adults in Berks County were prescribed medications in the past year but did not purchase those medications due to cost, almost two times higher than the percentage of nonLatinos (12.4%) forgoing prescriptionsduetocost.MorethanonequarterofBlack(26.3%)andpoor(28.2%)adults didnotfillaprescription duetothecostcomparedto12.1%ofWhiteadultsand11.7%of nonpooradults. Dentalcoveragecanbedifficulttoobtain,anddelayeddentalcarecanresultinextensivedamage. MorethanonethirdofLatinoadultsinBerksCounty(34.9%)werenotabletogetthedental care they needed in the past year due to the cost of that care, while 18.8% of nonLatino adultdeferreddentalcare.MorethanoneinfourBlack(46.1%)andpoor(42.1%)adultsdid not seek dental care due to the cost compared to White (18.4%) and nonpoor (18.3%) adults. PersonalHealthBehaviors TheUSDArecommendsthatadultsconsumeatleastfourtofiveservingsoffruitsandvegetablesdaily.30 RatesoffruitandvegetableconsumptionandexercisearelowerforLatinosthanfornonLatinos. The overwhelming majority of Latino adults in Berks County (86.6%) consume less than fourservingsoffruitsandvegetablesdaily,comparedto69.5%ofnonLatinoadults.
30
DietaryGuidelinesConsumerBrochure,U.S.DepartmentofAgriculture(2011)
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management corporation Eating in fast food restaurants is associated with increased consumption of high calorie, salty foods, placingindividualsatriskforobesityrelatedchronicdiseases. ThemajorityofLatinoadults(50.1%)eatatfastfoodrestaurantsatleastonceaweek. ThispercentageissimilartothatfornonLatinoadults(47.8%). Smokingisassociatedwithincreasedriskforcancer,heartdisease,andlungdisease.Latinosaremore likelythannonLatinostosmokecigarettes. Three in ten Latinos (30.4%) smoke cigarettes compared to 18.8% of nonLatinos. This represents14,000Latinoadultswhosmoke. The percentage of Latinos who smoke is more than twice the Healthy People 2020 goal (30.4%versus12.0%). Latinos smokers are more likely to have tried to quit smoking in the past year than nonLatino smokers. More than twothirds of Latino smokers (69.5%) have tried to quit compared to onehalf (50.2%)ofnonLatinos. Thispercentage(69.5%)islowerthantheHealthyPeople2020goalof80.0%. LatinosareslightlymorelikelythannonLatinostodrinkmorethanfivealcoholicdrinksononeormore daysinthepastmonth(40.8%comparedto38.4%). SocialCapitalandNeighborhood Socialcapitalincludesparticipationinclubsandgroups,feelingsofbelongingandtrustinneighborhood andneighborsandneighborhoodactivitiesandpartiesandcommunitiesworkingtogether. LatinoadultsaremorethantwiceaslikelyasnonLatinoadultstohavelowsocialcapital (59.5%ascomparedwith26.4%).Black(45.7%)andpoor(51.1%)adultsacrossBerksCounty are more likely to have low social capital compared to White (27.8%) and nonpoor adults (27.9%). In addition, Latino and poor adults in Berks County face other environmental disadvantages. While 77.3%ofnonLatinoadultshaveaparkorotheroutdoorspacetheyarecomfortablevisiting,just69.7% ofLatinoadultsreportthesameneighborhoodresources.Similarly,68.2%ofpooradultsacrossBerks County have a park or other outdoor space they are comfortable visiting compared to 77.2% of non pooradults. Slightlymorethansixinten(62.3%)nonLatinoadultshaveaplaceintheirneighborhoodwherethey can exercise for free, but less than onehalf of Latinos (46.8%) have such a place. Similarly, less than onehalf of Black (47.3%) and poor (43.3%) adults across Berks County have a place in their neighborhoodwheretheycanexerciseforfreecomparedtothreeinfiveWhite(62.1%)andnonpoor (61.9%)adults. 56
PUBLIC HEALTH
IV.UNMETHEALTHCARENEEDS
ProcessandUnmetHealthCareNeeds
UnmethealthcareneedsinBerksCountywereidentifiedafterdeterminingthehealthstatus,accessto care, health behaviors, social capital, and health care utilization of Berks County residents. This information was then compared to information on existing resources to identify unmet needs among Countyresidentsoverall,forseparateareasoftheCounty,andforspecialpopulations. TheCommunityNeedIndexscoreforBerksCountyprovidesanoverallmeasureofunmethealthcare needsintheCounty.
CommunityNeedIndex The Community Need Index31 (CNI) uses many of the socioeconomic indicators from the U.S. Census which were described in the Community Definition section of this report on pp. 12 to assign a communityneedindexscoretoeachZIPcodeintheUnitedStates.Theindicatorsaredrawnfromfive majorbarrierstogoodhealth(culture/language,education,insurance,andhousing).Theyareusedto measurethemultiplefactorswhichareknowntolimithealthcareaccess.Individualindicatorsinclude: percent of elderly, children, and single parents in poverty; percent nonCaucasian and percent with limitedEnglishproficiency;percentwithoutahighschooldiploma;percentunemployedanduninsured; andpercentrentinghousing.Ascoreof1.0to5.0isassignedtoeachcommunity,with1.0indicatinga community with the lowest need and 5.0 a community with the highest need. There is a high correlation between high CNI scores and high rates of hospital utilization, including those which are preventablewithadequateprimarycare.Ratesofhospitaluseincommunitieswiththehighestneeds (5.0) are 60% higher than those in communities with low needs (1.0). Nationally, Bucks County, Pennsylvaniahasthelowestneedindex(1.99)amongallcommunitieswithpopulationsover500,000, andMontgomeryCountyissixthlowest.TheBronx,N.Y.ishighestnationallyamonglargecommunities withaCNIscoreof4.8. BerksCountyasawholeisacommunitywithmiddlerangeneeds(2.7).WithinBerksCounty,fourZIP codes in Reading and West Reading have the highest needs (4.65.0): 19604 (Reading; 4.6); 19611 (WestReading;4.8);19601(Reading;5.0);and19602(Reading;5.0).TherearenoZIPcodeswiththe second highest needs, but six ZIP codes have midlevel needs: Bethel (3.2), Shoemakersville (3.0), Kutztown(2.8),Womelsdorf(2.6),Temple(2.6),andHamburg(2.6).ZIPcodesinBally(1.2),Kempton (1.2),Blandon(1.6),Centerport(1.6),andWernersville(1.6)havethelowestneeds. UnmetNeeds
ThereisnoCountyhealthdepartmentinBerksCounty.Pennsylvaniahasatotalofsixcountyandfour city health departments. Although many of the health and social service providers in the County individually providethemanyserviceswhich could beprovided byacounty healthdepartment,there
31
ImprovingPublicHealth&PreventingChronicDisease:CHWsCommunityNeedIndex.DignityHealth(2005).
57
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management corporation are unmet needs which could be filled in a countywide, coordinated manner by a county health department. SpecificunmetneedsintheCountywhichwereidentifiedduringthisneedsassessment,include: Access to primary and specialty care for the uninsured and underinsured, including particularlyaccesstodentalandmentalhealthcare; Accesstoaffordableprescriptionmedications; AccesstospecialtycareforthoseinsuredthroughMedicalAssistance; TransportationtomedicalcareforthelowincomeandLatinomigrantworkerpopulation; More affordable mental health and substance abuse services, particularly for children and adolescents;and Culturally competent care for the Latino population, including more affordable services for the uninsured, including more qualified, affordable interpretation services and more bilingual,biculturalstaff.
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V.CONCLUSIONSANDRECOMMENDATIONS
TheoverallhealthstatusofBerksCountyspopulationcomparesfavorablytoPennsylvaniansingeneral andHealthyPeople2020goals.Nonetheless,anumberofdisparitiesdoexistamongthesubareasand subpopulationsstudied.Disparitiesinhealthstatusareaffectedbyavarietyoffactorsincluding,among others:pooraccesstohealthservices;varioussociodemographicfactors,includingincome;insurance coverage;andculturalconsiderations. AlthoughthesedisparitiesarenotisolatedinanyonegeographicregioncomparedtoBerksCountyasa whole, they are most likely to be statistically significant for the City of Reading, the countys largest urbanarea,wherethehighestconcentrationsofpoor,uninsured,racialminoritiesandindividualswho identify their ethnicity as Hispanic or Latino reside. The following table summarizes several of the indicatorsdiscussedinthestudyandillustratesthechallengeposedbytherelativehealthstatusofthe populationoftheseparatesubareasoftheCounty.
SelectedHealthIndicatorsfromtheBerksCountyCommunityHealthNeedsAssessment
Indicators Figure# BerksCounty Reading North Berks 10.7% 14.5% 30.5% 26.1% 13.7% 16.6% 15.4% 20.2% 11.7% 18.5% 32.8% 3.5 24.7% 692.0 8.3% 29.5% 6% South Berks 14.1% 14.0% 33.1% 30.8% 13.7% 27.3% 12.5% 19.3% 9.1% 19.3% 43.6% 5.1 24.0% 699.6 8.8% 25.5% 10% East Berks 11.6% 13.2% 34.6% 29.5% 16.9% 8.1% 7.4% 22.2% 11.9% 18.5% 37.1% NA 24.8% 720.1 15.2% 22.3% 5% West Berks 15.6% 7.4% 30.8% 30.6% 8.8% 6.8% 8.9% 14.0% 9.6% 17.6% 33.0% 2.8 23.0% 639.5 13.9% 23.8% 6% HealthStatusandBehaviorIndicators* Mentalhealthcondition 18 Healthstatusfairorpoor 15 Highbloodpressure 16 Obesity 17 Diabetes AppCTable1 ERvisitduetonoinsurance 22 Did not fill prescription due to AppCTable3 cost Nodentalcareduetocost AppCTable3 Noregularsourceofcare 24 Smoking 27 Bingedrinking AppCTable4 VitalStatistics** Adolescentbirths/1,000births 13 Late/noprenatalcare 25 Mortalityrate/100,000pop 20 Social/EconomicIndicators Uninsuredadults* 21 Lowsocialcapital* 28 Livinginpoverty*** 8
14.6% 15.9% 33.4% 30.2% 13.9% 24.8% 13.7% 21.1% 11.8% 20.4% 38.4% 9.4 32.8% 731.3 13.3% 31.0% 13%
21.3% 32.6% 40.0% 35.0% 18.9% 44.1% 23.7% 33.2% 18.9% 29.3% 47.9% 28.1 50.1% 926.6 23.7% 57.0% 34%
*Source:PHMCs2012BerksCountyHouseholdHealthSurvey(n=1,101) **Source:PADepartmentofHealth,BureauofHealthStatisticsandResearch,20052008;nottestedforsignificance ***Source:U.S.Census,2010;nottestedforsignificance Note:ShadedareasrepresentstatisticallysignificantlyworseresultscomparedtoBerksCounty(p<.05).
In addition to the results obtained from a phone survey of residents in five subareas and other third partydata,thefollowinghealthissueswerealsoraisedassignificantareasofconcernbyparticipantsin focusgroupsandkeyinformantinterviews: 59
PUBLIC HEALTH
management corporation Costofcare,includinginsurancecoverage,copays,anddeductibles; Chronicdiseases; Accesstochildandadolescentpsychiatrists; Access to specialists by Medical Assistance beneficiaries and the uninsured or under insured; Reluctance on the part of undocumented immigrants to utilize social and health services availableinthecommunity;and Cultural and linguistic factors that lead to disparities in accessing essential health care, particularlyfortheHispanicandLatinocommunity. BerksCountyhasaconsiderableinfrastructureofsocialserviceagenciesandhealthcareprovidersthat provide care to atrisk populations. These health care providers include the new Berks Community HealthCenter,theSt.JosephRegionalHealthNetworkDowntownCampus,specialtyclinicssponsored bythecountysnonprofitacutecarehospitals,andtheWesternBerksFreeMedicalClinicinRobesonia. Nonetheless,theresultsoftheCommunityHealthNeedsAssessmentindicateaneedforanexpansion ofessentialhealthcareservices. It is also notable that Berks County lacks a public health department. In many communities such a resourceaddressesgapsinthehealthsafetynetforatriskpopulationsinadditiontorisksaffectingthe overallhealthofthelargerpopulation.Acountypublichealthdepartmentmightalsoserveasafocal point for coordinating community resources in response to significant health concerns and disparities thatariseinthecommunity. Recommendations ThefollowingrecommendationsaremadebasedinresponsetoissuesraisedbytheCommunityHealth Needs Assessment. It is worth noting that community responses to the issues will need to take into consideration provisions of the Affordable Care Act as they are implemented, particularly those that expandaccesstohealthinsurancefortheuninsuredandunderinsured. Target1:AccesstoEssentialHealthCare Increasethecapacityofexistingprovidersandaddnewproviderstoimproveaccesstoessential healthcareservicesforatriskpopulations.Theseneedsinclude: o Primarycareandspecialtycare; o Mentalhealthservices,includingpsychiatrists; o Earlyprenatalcare,particularlyforBlackandHispanic/Latinawomen;and o Patient navigators and case managers to assist atrisk populations in circumventing barrierstoaccessingessentialhealthcare. EncouragethecommunitytoworktogethertoestablishaBerksCountyHealthDepartmentto focusonsuchpopulationhealthobjectivesas: o Providingpreventivescreeningsandhealtheducationtoatrisksubpopulations; o Addressingbarriersatriskpopulationsfaceinaccessingaffordablemedications,dental careandvisioncare;and o Coordinatingcommunityresponsestoissuesaffectingpopulationhealth.
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management corporation Improve the social service agencies and health care providers capacity to address unique linguisticandculturalfactorsthataffectaccesstocarebylargesegmentsoftheHispanic/Latino population,specifically: o Increasing the availability of bilingual, culturally appropriate services, particularly in specialistsoffices; o Better educating atrisk populations about the value and availability of preventive services; o Improvingatriskpopulationsunderstandingofeligibilityrequirementsandapplication processesforpubliclyfundedhealthinsurance;and o Addressingconcernsofthoseatriskpopulationswhoselegalstatusrepresentsabarrier toaccessingessentialhealthservices.
Target2:EnhancePersonalHealthBehaviors Increase programs and interventions which address personal health behaviors that negatively impacthealth.Prioritiesshouldinclude: o Developing strategies to address adolescent pregnancy, particularly in the City of Reading; o Assistingsmokersinquitting; o Addressingobesity,especiallyinchildren;and o DevelopingaconcertedefforttoreducebingedrinkingintheCountyasawhole.
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VI.ADVISORYCOMMITTEEGUIDANCE
The Community Advisory Committee to the Berks County Community Health Needs Assessment reviewed the report of Public Health Management Corporation (PHMC). The Committee drew conclusionsthatwereconsistentwiththoseofPHMC,mostnotablythat: TheoverallhealthstatusofBerksCountyresidentsisreasonablygoodcomparedtonormsfor PennsylvaniaandHealthPeople2020goals; Enhancing preventive, primary, and specialty care for certain atrisk populations is the most directapproachtoadvancingthecommunityshealthstatus;and The greatest disparities in health status are concentrated among the poor, the Hispanic and Latinocommunity,andinparticularforthosewhoresideintheCityofReading. Recognizingthattheissuesraisedbythereportwillrequireconsiderabletimeandresourcestoaddress adequately,thecommitteesuggestedthateffortsbefocusedaroundasetofmoreimmediatepriorities andasetoflongertermobjectives. MoreImmediatePriorities Allofthefollowingessentialhealthcareservicesneedtobeprovidedinamannerthatissensitivetothe uniquelinguisticandculturalneedsoftheHispanicandLatinoatriskpopulationsandinvolveaccessto careissues.Thethreeprioritieschosenare: 4. PreventiveCare: o Reducingtheprevalenceofobesity;and o Providingroutinedentalcare. 5. PrenatalCare: o Increasingtheutilizationofprenatalcarewithaparticularemphasisonthedisproportionately highrateofadolescentpregnanciesintheCityofReading. 6. SpecialtyCare: o Improving the availability of specialty care particularly, for the uninsured and underinsured; and o Enhancingaccesstobehavioralhealthservices. LongerTermObjectives A more comprehensive and far reaching strategy is required to address the root causes of many disparities discussed in the needs assessment. One approach might be to organize a coalition of community leaders and stakeholders that would examine these issues in greater depth and forge a longertermstrategyforamelioratingthem.Theobjectivesofsuchaneffortmightinclude,butarenot limitedto: Assessing how community resources might be better coordinated to provide a more effective responsetothehealthdisparitiesidentifiedintheCommunityHealthNeedsAssessment; Investigatinginitiativesundertakenbyothercommunitiesfacedwithsimilarchallenges; Defining the appropriate role of a county public health agency and examining alternative approachestofinancingandensuringthesustainabilityofsuchacapability;and 62
PUBLIC HEALTH
management corporation Exploringhowanepidemiologicaldatabasecouldbedevelopeddrawingonexistingpublicand privateresourcesto bettermonitor population healthandthe causesofdisparitieswithinthe population.
In summary, the overall health status of Berks County residents is good and the majority of residents have access to essential health services. Nonetheless, in the interest of advancing the health of the communityfurther,aconcertedeffortonthepartofcommunityresourcesisrequiredtoaddressand minimizetotheextentfeasiblethetroublesomedisparitieshighlightedintheCommunityHealthNeeds Assessment.
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APPENDIXA:U.S.CENSUSTABLES
PUBLIC HEALTH
management corporation BerksCounty Table1.SocioDemographicIndicatorsofBerksCounty,U.S.Census 2000 TotalPopulation 373,638 #
017
2010 411,442 % (24.6) (37.7) (22.6) (15.0) (49.0) (51.0) (84.8) (3.3) (1.0) (1.1) (9.7) # 98,136 141,140 112,608 59,558 201,864 209,578 316,406 16,517 5,244 5,920 67,355 324,576 40,504 2,612 13,864 % (23.9) (34.3) (27.4) (14.5) (49.1) (50.9) (76.9) (4.0) (1.3) (1.4) (16.4) (85.1) (10.6) (0.7) (3.6) #
2013 414,193 % (23.3) (34.0) (27.4) (15.3) (49.0) (51.0) (75.0) (4.2) (1.3) (1.5) (18.0) (83.3) (12.3) (0.8) (3.6) #
2018 418,339 % (22.7) (33.6) (26.8) (16.9) (49.0) (51.0) (72.2) (4.4) (1.4) (1.7) (20.3) (83.4) (12.2) (0.8) (3.6)
91,909 140,980 84,559 56,190 182,956 190,682 317,025 12,478 3,713 4,065 36,357
96,516 140,705 113,592 63,380 203,159 211,034 310,624 17,267 5,527 6,323 74,452 323,776 47,785 3,165 13,865
94,880 140,718 112,180 70,561 205,129 213,210 302,093 18,475 5,904 6,937 84,930 326,764 47,940 3,180 13,940
Age
1844 4564 65+ Male
Gender
Female White Black
Race/Ethnicity* Asian
Other Latino English
Language Spoken Home
Spanish
at
Asian Language Other
*White,Black,AsianandOtherracesexcludeLatinos. Note:LanguagespokenathomewasnotprovidedbyNielsenClaritasfor2000. Source:NielsenClaritasPopFactsDatabaseand2010U.S.Census.
PUBLIC HEALTH
management corporation Table2.LatinoPopulationbySpecificOriginofBerksCounty,U.S.Census 2000 TotalPopulation #
Cuban
2010 411,442 # 1,423 10,027 32,057 16,166 % (0.3) (2.4) (7.8) (3.9) # % (0.1) (1.8) (5.9) (2.0)
2013 414,193 % (0.3) (2.9) (9.8) (5.0) #
2018 418,339 % (0.4) (3.2) (11.1) (5.6)
373,638
385 6,562 22,038 7,372
1,378 11,812 40,537 20,725
1,571 13,399 46,478 23,482
Specific Origin
Mexican Puerto Rican Other
Source:NielsenClaritasPopFactsDatabaseand2010U.S.Census.
Table3.PopulationbyDetailedAsianOriginofBerksCounty,U.S.Census 2000 TotalPopulation #

Indian Cambodian Chinese Filipino Hmong
2010 411,442 % (0.2) (0.0) (0.2) (0.1) (0.0) (0.0) (0.1) (0.0) (0.0) (0.3) (0.1) # 1,256 45 796 463 52 197 470 117 59 1,279 368 % (0.3) (0.0) (0.2) (0.1) (0.0) (0.0) (0.1) (0.0) (0.0) (0.3) (0.1) #
2013 414,193 % (0.3) (0.0) (0.4) (0.2) (0.0) (0.0) (0.1) (0.0) ND 1,387 335 (0.3) (0.1) #
2018 418,339 % (0.3) (0.0) (0.4) (0.2) (0.0) (0.0) (0.1) (0.0) ND 1,492 352 (0.4) (0.1)
373,638
871 31 569 325 45 155 330 93 37 1,066 263
1,291 59 1,527 724 21 73 212 53
1,376 60 1,642 774 25 73 233 55
Asian Origin
Japanese Korean Laotian Thai Vietnamese Other
ND=NotDisplayed.Percentagesarenotcalculatedanddisplayedwhenthecountislessthan10.
PUBLIC HEALTH
management corporation Table4.SocioEconomicIndicatorsofBerksCounty,U.S.Census TotalPopulation
LessthanHS
2000 373,638 # 54,651 148,202 46,011 180,881 9,671 1,247 4,943 36,851 104,719 % (22.0) (59.6) (18.5) (94.9) (5.1) (2.5) (10.3) (26.0) (74.0)
2010 411,442 # 46,556 165,193 61,261 206,721 11,879 8,544 6,895 43,703 110,653 % (17.1) (60.5) (22.4) (94.6) (5.4) (8.0) (13.3) (28.3) (71.7) #
2013 414,193 % (15.7) (61.9) (22.5) (90.3) (9.7) (10.2) (17.9) (28.4) (71.6) #
2018 418,339 % (15.7) (61.9) (22.4) (90.3) (9.7) (10.2) (17.9) (28.4) (71.6)
42,986 169,624 61,554 197,088 21,259 10,823 9,015 43,840 110,632
43,650 172,689 62,465 200,220 21,597 10,906 9,071 44,165 111,088
Education
HSgraduate Collegeormore Employed
Employment
Unemployed
Poverty Status Housing UnitType
Families living in povertyw/ochildren Families living in povertywithchildren Renteroccupied Owneroccupied
MedianHouseholdIncome
45,118
54,775
51,448
51,546
PUBLIC HEALTH
management corporation ReadingCity Table5.SocioDemographicIndicatorsofReadingCity,U.S.Census 2000 TotalPopulation #
017
2010 78,128 % # 24,415 30,729 15,998 6,986 38,272 39,856 21,155 7,935 845 1,617 46,576 35,492 28,257 856 1,934 % (31.3) (39.3) (20.5) (8.9) (49.0) (51.0) (27.1) (10.2) (1.1) (2.1) (59.6) (53.3) (42.5) (1.3) (2.9) #
2013 78,715 % (30.8) (38.9) (20.9) (9.4) (49.1) (50.9) (22.6) (9.7) (1.0) (2.0) (64.6) (50.0) (46.4) (1.5) (2.1) #
2018 79,673 % (30.5) (38.3) (21.0) (10.2) (49.2) (50.8) (17.7) (8.9) (0.9) (1.9) (70.6) (50.3) (46.1) (1.5) (2.1)
72,472
21,843 29,398 12,458 8,773 35,219 37,253 34,029 8,195 1,097 1,627 27,524
(30.1) (40.6) (17.2) (12.1) (48.6) (51.4) (47.0) (11.3) (1.5) (2.2) (38.0)
24,258 30,648 16,436 7,373 38,648 40,067 17,828 7,668 796 1,601 50,822 35,612 33,031 1,066 1,503
24,263 30,541 16,723 8,146 39,234 40,439 14,107 7,085 728 1,529 56,224 36,237 33,176 1,082 1,514
Age
1844 4564 65+ Male
Gender
Female White Black
Language Spoken Home
Spanish
at
Asian Language Other
PUBLIC HEALTH
management corporation Table6.LatinoPopulationbySpecificOriginofReadingCity,U.S.Census 2000 TotalPopulation #
Cuban
2010 78,128 % (0.3) (7.4) # 634 7,674 22,926 10,129 % (0.8) (9.8) (29.3) (13.0) # 773
2013 78,715 % (1.0) (10.4) (35.6) (17.6) # 836
2018 79,673 % (1.0) (11.2) (39.1) (19.1)
72,472
195 5,398 16,809 5,122
Specific Origin
8,196 28,007 13,846
8,959 31,182 15,247
(23.2) (7.1)
Table7.PopulationbyDetailedAsianOriginofReadingCity,U.S.Census 2000 TotalPopulation #

2010 78,128 % (0.2) # 149 ND (0.1) (0.1) (0.0) (0.0) (0.1) (0.0) 104 50 22 34 56 34 ND (0.9) (0.1) 722 73 (0.9) (0.1) 292 77 (0.1) (0.1) (0.0) (0.0) (0.1) (0.0) 28 25 314 42 % (0.2) # 74
2013 78,715 % (0.1) ND (0.4) (0.1) ND (0.0) (0.0) ND ND (0.4) (0.1) 257 68 26 23 299 45 # 70
2018 79,673 % (0.1) ND (0.4) (0.1) ND (0.0) (0.0) ND ND (0.3) (0.1)
72,472
131 ND 91 46 25 31 47 36 ND 671 69
Asian Origin
PUBLIC HEALTH
management corporation Table8.SocioEconomicIndicatorsofReadingCity,U.S.Census TotalPopulation
LessthanHS
2000 72,472 # 16,183 22,292 3,716 27,832 2,919 499 3,087 13,304 13,503 % (38.4) (52.8) (8.8) (90.5) (9.5) (8.0) (30.5) (49.6) (50.4) #
2010 78,128 % (32.9) (56.0) (11.1) (90.0) (10.0) (27.6) (37.2) (58.5) (41.5) #
2013 78,715 % (34.7) (55.5) (9.7) (79.0) (21.0) (35.8) (48.9) (58.5) (41.5) #
2018 79,673 % (34.4) (55.9) (9.7) (79.0) (21.0) (35.3) (48.3) (58.5) (41.5)
14,435 24,563 4,868 29,150 3,226 4,399 3,853 15,556 11,054
15,542 24,848 4,362 27,438 7,277 6,172 5,532 15,655 11,116
15,954 25,894 4,511 27,851 7,399 6,162 5,511 15,829 11,227
Education
Employment
Unemployed
26,783
29,032
26,033
26,051
PUBLIC HEALTH
management corporation NorthBerksCounty Table9.SocioDemographicIndicatorsofNorthBerksCounty,U.S.Census 2000 TotalPopulation #
017
2010 84,437 % # 16,885 31,003 23,511 13,038 41,607 42,830 74,555 2,083 756 985 6,058 73,468 3,668 376 3,464 % (20.0) (36.7) (27.8) (15.4) (49.3) (50.7) (88.3) (2.5) (0.9) (1.2) (7.2) (90.7) (4.5) (0.5) (4.3) #
2013 85,509 % (19.4) (36.6) (27.8) (16.2) (49.3) (50.7) (86.8) (2.8) (0.9) (1.3) (8.2) (90.7) (5.1) (0.5) (3.7) #
2018 86,865 % (18.6) (36.6) (27.0) (17.8) (49.2) (50.8) (84.1) (3.4) (1.0) (1.5) (10.0) (90.7) (5.1) (0.5) (3.7)
75,270
15,786 30,175 17,281 12,028 37,225 38,045 71,084 917 469 521 2,279
(21.0) (40.1) (23.0) (16.0) (49.5) (50.5) (94.4) (1.2) (0.6) (0.7) (3.0)
16,546 31,314 23,785 13,864 42,120 43,389 74,180 2,408 810 1,091 7,020 73,809 4,142 414 3,032
16,149 31,801 23,421 15,494 42,708 44,157 73,046 2,947 888 1,273 8,711 74,905 4,170 415 3,072
Age
1844 4564 65+ Male
Gender
Female White Black
Language Spokenat Home
Spanish Asian Language Other
PUBLIC HEALTH
management corporation Table10.LatinoPopulationbySpecificOriginofNorthBerksCounty,U.S.Census 2000 TotalPopulation #
Cuban
2010 84,437 % (0.1) (0.7) (1.2) (1.1) # 162 1,127 1,787 2,130 % (0.2) (1.3) (2.1) (2.5) # 64
2013 85,509 % (0.1) (2.0) (4.0) (2.1) # 75
2018 86,865 % (0.1) (2.5) (4.9) (2.6)
75,270
42 531 911 795
Specific Origin
1,710 3,423 1,823
2,142 4,234 2,260
Table11.PopulationbyDetailedAsianOriginofNorthBerksCounty,U.S.Census 2000 TotalPopulation #

2010 84,437 % (0.1) # 144 ND (0.1) (0.1) 146 65 ND (0.0) (0.1) 34 64 ND 17 (0.1) (0.1) 157 100 (0.0) (0.2) (0.1) 275 53 (0.0) (0.1) 30 45 (0.2) (0.1) 255 63 % (0.2) # 98
2013 85,509 % (0.1) ND (0.3) (0.1) ND ND (0.0) (0.1) ND (0.3) (0.1) 319 57 31 47 270 66 # 107
2018 86,865 % (0.1) ND (0.3) (0.1) ND ND (0.0) (0.1) ND (0.4) (0.1)
75,270
91 ND 95 44 ND 24 48 ND ND 98 59
Asian Origin
PUBLIC HEALTH
management corporation Table12.SocioEconomicIndicatorsofNorthBerksCounty,U.S.Census TotalPopulation
LessthanHS
2000 75,270 # 11,016 30,774 8,628 37,458 2,649 258 350 5,211 22,104 % (21.8) (61.0) (17.1) (93.4) (6.6) (2.4) (4.1) (19.1) (80.9) #
2010 84,437 % (16.4) (62.0) (21.6) (92.5) (7.5) (4.5) (6.1) (21.4) (78.6) #
2013 85,509 % (14.4) (66.2) (19.4) (91.3) (8.7) (5.9) (10.6) (21.4) (78.6) #
2018 86,865 % (14.3) (66.2) (19.5) (91.3) (8.7) (5.9) (10.8) (21.3) (78.7)
9,450 35,665 12,439 44,329 3,616 983 596 6,627 24,350
8,120 37,241 10,924 42,371 4,023 1,262 955 6,615 24,366
8,245 38,136 11,235 43,296 4,116 1,281 978 6,623 24,513
Education
Employment
Unemployed
48,032
59,907
54,438
54,597
PUBLIC HEALTH
management corporation SouthBerksCounty Table13.SocioDemographicIndicatorsofSouthBerksCounty,U.S.Census 2000 TotalPopulation #
017
2010 122,016 % # 29,179 39,857 34,469 18,511 59,422 62,594 104,831 3,783 1,739 1,869 9,794 102,035 5,263 690 4,255 % (23.9) (32.7) (28.2) (15.2) (48.7) (51.3) (85.9) (3.1) (1.4) (1.5) (8.0) (90.9) (4.7) (0.6) (3.8) #
2013 122,829 % (23.4) (32.2) (28.3) (16.1) (48.7) (51.3) (84.5) (3.4) (1.5) (1.7) (8.9) (89.5) (6.3) (1.0) (3.3) #
2018 124,135 % (22.8) (31.6) (27.8) (17.7) (48.6) (51.4) (82.1) (3.9) (1.6) (1.9) (10.5) (89.6) (6.2) (0.9) (3.3)
107,683
26,125 39,089 25,770 16,699 52,312 55,371 98,901 1,985 1,063 1,134 4,600
(24.3) (36.3) (23.9) (15.5) (48.6) (51.4) (91.8) (1.8) (1.0) (1.1) (4.3)
28,790 39,530 34,778 19,731 59,769 63,060 103,792 4,150 1,865 2,033 10,989 103,315 7,275 1,101 3,806
28,364 39,210 34,566 21,995 60,346 63,789 101,933 4,787 2,034 2,300 13,081 104,346 7,250 1,094 3,829
Age
1844 4564 65+ Male
Gender
Female White Black
PUBLIC HEALTH
management corporation Table14.LatinoPopulationbySpecificOriginofSouthBerksCounty,U.S.Census 2000 TotalPopulation #
Cuban
2010 122,016 # 424 547 5,345 2,231 % (0.3) (0.4) (4.4) (1.8) # 131 % (0.1) (0.3) (3.1) (0.8)
2013 122,829 % (0.1) (0.8) (5.5) (2.5) # 156
2018 124,135 % (0.1) (1.0) (6.5) (2.9)
107,683
105 276 3,342 877
Specific Origin
1,035 6,709 3,114
1,236 8,075 3,614
Table15.PopulationbyDetailedAsianOriginofSouthBerksCounty,U.S.Census 2000 TotalPopulation #

2010 122,016 % (0.3) # 416 17 (0.2) (0.1) (0.0) (0.0) (0.1) (0.0) (0.0) (0.2) (0.1) 232 195 22 65 168 69 21 255 90 % (0.3) (0.0) (0.2) (0.2) (0.0) (0.1) (0.1) (0.1) (0.0) (0.2) (0.1) 412 119 # 342 48 520 317 18 16 111
2013 122,829 % (0.3) (0.0) (0.4) (0.3) (0.0) (0.0) (0.1) ND ND (0.3) (0.1) 465 131 # 360 47 588 334 17 16 120
2018 124,135 % (0.3) (0.0) (0.5) (0.3) (0.0) (0.0) (0.1) ND ND (0.4) (0.1)
107,683
278 ND 164 129 15 49 111 48 13 192 59
Asian Origin
PUBLIC HEALTH
management corporation Table16.SocioEconomicIndicatorsofSouthBerksCounty,U.S.Census TotalPopulation
LessthanHS
2000 107,683 # 13,098 45,405 15,757 54,909 1,819 238 1,074 9,317 32,771 % (17.6) (61.1) (21.2) (96.8) (3.2) (1.5) (7.6) (22.1) (77.9)
2010 122,016 # 10,929 50,454 20,844 63,586 2,228 1,851 1,507 10,744 36,176 % (13.3) (61.4) (25.3) (96.6) (3.4) (5.6) (9.7) (22.9) (77.1) #
2013 122,829 % (10.5) (61.1) (28.4) (92.6) (7.4) (6.2) (10.3) (22.9) (77.1) #
2018 124,135 % (10.5) (61.1) (28.4) (92.6) (7.4) (6.3) (10.5) (22.9) (77.1)
8,843 51,226 23,827 62,722 5,018 2,050 1,588 10,755 36,180
8,916 51,832 24,126 63,821 5,083 2,094 1,623 10,805 36,406
Education
Employment
Unemployed
Families living below povertyw/ochildren Families living below povertywithchildren Renteroccupied Owneroccupied
49,890
60,411
60,234
60,640
PUBLIC HEALTH
management corporation EastBerksCounty Table17.SocioDemographicIndicatorsofEastBerksCounty,U.S.Census 2000 TotalPopulation #
017
2010 53,429 % # 11,465 16,296 17,131 8,537 26,487 26,942 51,365 369 287 498 910 49,137 999 161 2,007 % (21.5) (30.5) (32.1) (16.0) (49.6) (50.4) (96.1) (0.7) (0.5) (0.9) (1.7) (93.9) (1.9) (0.3) (3.8) #
2013 53,199 % (20.8) (30.0) (32.1) (17.1) (49.5) (50.5) (95.8) (0.7) (0.6) (1.0) (1.9) (95.5) (1.2) (0.1) (3.2) #
2018 52,941 % (19.9) (29.7) (31.3) (19.2) (49.4) (50.6) (95.2) (0.7) (0.6) (1.2) (2.3) (95.5) (1.2) (0.1) (3.2)
52,468
12,908 19,331 13,032 7,197 26,076 26,392 51,139 430 159 278 462
(24.6) (36.8) (24.8) (13.7) (49.7) (50.3) (97.5) (0.8) (0.3) (0.5) (0.9)
11,047 15,940 17,100 9,112 26,344 26,855 50,963 361 311 555 1,009 48,231 599 63 1,613
10,528 15,724 16,548 10,141 26,138 26,803 50,375 377 340 636 1,213 47,912 595 61 1,597
Age
1844 4564 65+ Male
Gender
Female White Black
PUBLIC HEALTH
management corporation Table18.LatinoPopulationbySpecificOriginofEastBerksCounty,U.S.Census 2000 TotalPopulation #
Cuban
2010 53,429 % (0.0) (0.2) (0.4) (0.2) # 67 248 366 295 % (0.1) (0.5) (0.7) (0.6) # 162 194 419 234
2013 53,199 % (0.3) (0.4) (0.8) (0.4) # 196 233 501 283
2018 52,941 % (0.4) (0.4) (0.9) (0.5)
52,468
19 129 200 114
Specific Origin
Table19.PopulationbyDetailedAsianOriginofEastBerksCounty,U.S.Census 2000 TotalPopulation #

2010 53,429 % (0.0) # 22 12 (0.1) (0.1) 45 47 ND 11 (0.1) 47 ND ND (0.0) (0.0) 22 15 (0.0) (0.0) 28 71 (0.0) (0.1) 26 26 % (0.0) (0.0) (0.1) (0.1) 80 43 # 39
2013 53,199 % (0.1) ND (0.2) (0.1) ND (0.0) (0.0) ND ND (0.1) (0.1) 31 77 28 32 88 41 # 45
2018 52,941 % (0.1) ND (0.2) (0.1) ND (0.1) (0.1) ND ND (0.1) (0.1)
52,468
17 ND 30 31 ND ND 33 ND ND 16 11
Asian Origin
PUBLIC HEALTH
management corporation Table20.SocioEconomicIndicatorsofEastBerksCounty,U.S.Census TotalPopulation
LessthanHS
2000 52,468 # 7,067 22,771 6,171 28,004 812 154 196 3,697 16,162 % (19.6) (63.2) (17.1) (97.2) (2.8) (2.0) (2.8) (18.6) (81.4) #
2010 53,429 % (14.5) (64.1) (21.3) (97.0) (3.0) (3.6) (4.6) (20.2) (79.8) #
2013 53,199 % (12.8) (64.8) (22.5) (92.6) (7.4) (2.9) (3.9) (20.2) (79.8) #
2018 52,941 % (12.7) (64.8) (22.5) (92.6) (7.4) (3.1) (4.2) (20.2) (79.8)
5,573 24,582 8,176 31,141 958 558 335 4,265 16,836
4,845 24,576 8,531 28,089 2,241 440 244 4,249 16,766
4,845 24,624 8,552 28,214 2,247 459 260 4,234 16,686
Education
Employment
Unemployed
51,556
64,298
61,122
61,501
PUBLIC HEALTH
management corporation WestBerksCounty Table21.SocioDemographicIndicatorsofWestBerksCounty,U.S.Census 2000 TotalPopulation #
017
2010 77,806 % # 17,364 24,319 22,768 13,355 38,163 39,643 68,758 2,336 1,683 996 4,033 67,763 2,362 575 2,780 % (22.3) (31.3) (29.3) (17.2) (49.0) (51.0) (88.4) (3.0) (2.2) (1.3) (5.2) (92.2) (3.2) (0.8) (3.8) #
2013 78,595 % (21.7) (31.1) (29.1) (18.1) (49.0) (51.0) (87.0) (3.4) (2.3) (1.4) (5.9) (89.9) (3.6) (0.9) (5.6) #
2018 79,767 % (20.9) (31.1) (28.1) (19.9) (49.0) (51.0) (84.6) (4.1) (2.5) (1.6) (7.2) (89.9) (3.6) (0.9) (5.6)
69,305
16,236 24,039 16,997 12,033 33,886 35,419 65,389 957 946 550 1,463
(23.4) (34.7) (24.5) (17.4) (48.9) (51.1) (94.3) (1.4) (1.4) (0.8) (2.1)
17,036 24,427 22,907 14,225 38,534 40,061 68,363 2,670 1,819 1,099 4,644 66,875 2,712 667 4,162
16,664 24,771 22,429 15,903 39,085 40,682 67,484 3,265 2,008 1,253 5,757 67,753 2,733 669 4,203
Age
1844 4564 65+ Male
Gender
Female White Black
PUBLIC HEALTH
management corporation Table22.LatinoPopulationbySpecificOriginofWestBerksCounty,U.S.Census 2000 TotalPopulation #
Cuban
2010 77,806 % (0.0) (0.3) (1.1) (0.7) # 136 391 1,609 1,353 % (0.2) (0.5) (2.1) (1.7) # 253 694
2013 78,595 % (0.3) (0.9) (2.5) (2.2) # 314 857
2018 79,767 % (0.4) (1.1) (3.1) (2.6)
69,305
32 201 770 460
Specific Origin
1,982 1,715
2,499 2,087
Table23.PopulationbyDetailedAsianOriginofWestBerksCounty,U.S.Census 2000 TotalPopulation #

2010 77,806 # 524 ND (0.3) (0.1) 277 111 ND (0.1) (0.1) 53 141 ND ND (0.1) (0.1) 134 90 (0.2) (0.1) 386 30 (0.1) (0.2) 1 24 (0.4) (0.1) 386 258 % (0.7) # 752
2013 78,595 % (1.0) ND (0.5) (0.3) ND (0.0) (0.0) ND ND (0.5) (0.0) 432 36 1 27 429 289 # 814
2018 79,767 % (1.0) ND (0.5) (0.4) ND (0.0) (0.0) ND ND (0.5) (0.0)
69,305 % 356 ND 195 74 ND 45 97 ND ND 95 64 (0.5)
Asian Origin
PUBLIC HEALTH
management corporation Table24.SocioEconomicIndicatorsofWestBerksCounty,U.S.Census TotalPopulation
LessthanHS
2000 69,305 # 7,278 28,215 12,749 34,557 1,523 104 329 5,580 21,212 % (15.1) (58.5) (26.4) (95.8) (4.2) (1.0) (3.8) (20.8) (79.2) #
2010 77,806 % (11.3) (58.3) (30.4) (95.5) (4.5) (3.7) (6.4) (22.4) (77.6) #
2013 78,595 % (10.6) (60.9) (28.5) (93.1) (6.9) (4.3) (7.7) (22.5) (77.5) #
2018 79,767 % (10.6) (61.1) (28.3) (93.0) (7.0) (4.4) (7.8) (22.7) (77.3)
6,092 31,448 16,383 40,684 1,897 797 622 6,785 23,512
5,760 33,153 15,481 38,788 2,896 907 694 6,856 23,573
5,850 33,836 15,702 39,656 2,966 936 713 6,993 23,746
Education
Employment
Unemployed
53,864
64,080
60,172
60,279
PUBLIC HEALTH
APPENDIXB:VITALSTATISTICSTABLES
PUBLIC HEALTH

Table1:AverageAnnualizedBirthRatesforWomen1544Years byRaceandEthnicity,20052008
Race/Ethnicity Total White Black Asian Other Latina* NonLatina Reading 98.0
(1,688)
North 42.6
(712)
South 61.3
(1,382)
East 47.6
(462)
West 57.7
(785)
County 64.2
(5,098)
State 58.7
(144,233)
73.4
(597)
42.0
(646)
58.8
(1,179)
47.6
(450)
56.7
(696)
54.9
(3,638)
52.6
(105,608)
88.1
(200)
35.5
(15)
67.6
(52)
ND ND ND 65.5
(10)
59.2
(28)
83.9
(297)
74.6
(21,237)
99.1
(28)
ND 29.7
(21)
70.9
(27)
74.6
(26)
90.6
(92)
78.8
(5,298)
77.6
(508)
44.6
(60)
38.7
(19)
70.6
(611)
92.6
(8,810)
118.1
(1,134)
53.4
(59)
84.3
(166)
62.3
(47)
119.8
(1,416)
110.0
(13,040)
69.2
(527)
41.6
(650)
58.5
(1,203)
46.9
(448)
57.1
(732)
53.7
(3,630)
55.4
(129,559)
Notes: Thebirthrateiscalculatedper1,000women1544yearsofage. White,Black,AsianandOtherracesincludeLatinas. *LatinabirthrateforBerksCountysubareasdoesnottotaltheCountyLatinabirthratebecausesomesubareaZipcodes includeLatinawomeninLehighandChesterCounties,increasingthedenominator. ND=NotDisplayed.Ratesarenotcalculatedanddisplayedwhenthecountislessthan10. Source:PennsylvaniaDepartmentofHealth,BureauofHealthStatisticsandResearch.CalculationspreparedbyPHMC.
Table2:AverageAnnualizedBirthRatesforAdolescentWomen1017Years,20052008
Reading 28.1
(134)
North 3.5
(14)
South 5.1
(33)
East ND
West 2.8
(11)
County 9.4
(198)
State 6.9
(4,427)
Notes: Thebirthrateiscalculatedper1,000women1017yearsofage. ND=NotDisplayed.Ratesarenotcalculatedanddisplayedwhenthecountislessthan10.Racialandethnicratesarenot calculatedanddisplayedforeachserviceareadueacountoflessthan10. Source:PennsylvaniaDepartmentofHealth,BureauofHealthStatisticsandResearch.CalculationspreparedbyPHMC.
PUBLIC HEALTH
Table3:AverageAnnualizedPercentageofWomenReceivingLateorNoPreNatalCare byArea,Race,andEthnicity,20052008
Race/Ethnicity Total White Black Asian Other Latina NonLatina Reading 50.1
(821)
North 24.7
(172)
South 24.0
(327)
East 24.8
(112)
West 23.0
(177)
County 32.8
(1,634)
State 29.4
(40,227)
45.6
(263)
23.2
(146)
21.9
(254)
24.6
(108)
21.8
(149)
26.6
(944)
24.0
(24,458)
52.7
(102)
ND ND ND 37.9
(22)
41.9
(21)
ND ND ND ND 24.7
(108)
ND ND ND 36.2
(17)
48.7
(140)
47.5
(9,051)
45.5
(13)
ND 37.2
(22)
30.0
(27)
32.7
(1,604)
57.3
(283)
54.3
(324)
45.9
(3,753)
52.0
(575)
37.7
(62)
49.1
(680)
45.4
(5,524)
45.8
(233)
23.4
(148)
21.9
(260)
22.1
(159)
26.3
(933)
27.6
(33,988)
Notes: White,Black,AsianandOtherracesincludeLatinas. ND=NotDisplayed.Percentsarenotcalculatedanddisplayedwhenthecountislessthan10. Source:PennsylvaniaDepartmentofHealth,BureauofHealthStatisticsandResearch.CalculationspreparedbyPHMC.
Table4:AverageAnnualizedPercentageofInfantsBornatLowBirthWeightbyBerks CountyArea,20052008
Reading 8.8
(150)
North 8.4
(60)
South 6.9
(96)
East 7.3
(34)
West 6.3
(49)
County 7.7
(392)
State 8.3
(12,022)
Notes: Lowbirthweightisdefinedasaninfantweighinglessthan2500grams(5.5lbs.)atbirth. ND=NotDisplayed.Ratesarenotcalculatedanddisplayedwhenthecountislessthan10.Racialandethnicratesarenot calculatedanddisplayedforeachserviceareadueacountoflessthan10. Source:PennsylvaniaDepartmentofHealth,BureauofHealthStatisticsandResearch.CalculationspreparedbyPHMC.
Table5:AverageAnnualizedInfantMortalityRate,20052008
Reading 5.8
(10)
North ND
South ND
East ND
West ND
County 4.9
(25)
State 5.2
(751)
Notes: Infantmortalityisdefinedasthedeathofaninfantwithinthefirstyearofbirthandiscalculatedper1,000liveinfantbirths. ND=Not Displayed. Rates are not calculated and displayed when the count is less than 10. Racial and ethnic rates are not calculatedanddisplayedforeachserviceareadueacountoflessthan10. Source:PennsylvaniaDepartmentofHealth,BureauofHealthStatisticsandResearch.CalculationspreparedbyPHMC.
PUBLIC HEALTH
Table6:AverageAnnualizedMortalityRates,20052008
AllCauses AllCancer FemaleBreastCancer LungCancer ColorectalCancer Prostatecancer HeartDisease Stroke HIV/AIDS Homicide Suicide MotorVehicleCrashes Reading 929.6
(601)
North 692.0
(709)
South 699.6
(1,021)
East 720.1
(464)
West 639.5
(687)
County 731.3
(3,514)
State 785.2
(124,136)
184.7
(117)
170.5
(172)
163.8
(235)
175.5
(115)
170.1
(174)
175.1
(818)
184.7
(28,616)
27.3
(10)
23.2
(13)
25.5
(21)
ND 50.5
(33)
23.5
(13)
24.5
(65)
23.9
(2,082)
54.2
(34)
49.9
(50)
42.6
(61)
39.0
(40)
46.7
(217)
50.9
(7,852)
19.4
(12)
15.7
(16)
15.1
(22)
15.1
(10)
21.3
(22)
17.6
(83)
17.8
(2,802)
ND 241.5
(154)
ND 176.5
(186)
7.6
(11)
ND 188.9
(124)
ND 164.0
(183)
6.7
(33)
8.9
(1,448)
188.5
(283)
189.3
(940)
203.2
(33,297)
59.0
(38)
53.6
(58)
47.3
(71)
42.7
(28)
50.8
(60)
50.7
(255)
42.5
(7,017)
ND ND ND ND
ND ND 11.0
(10)
ND ND 9.6
(12)
ND ND ND 19.2
(10)
ND ND ND ND
2.6
(10)
2.7
(344)
4.0
(15)
6.1
(721)
10.8
(44)
10.9
(1,404)
15.4
(13)
11.8
(14)
14.0
(57)
11.2
(1,434)
Notes: Mortalityratesarecalculatedper100,000population. ND=NotDisplayed.Ratesarenotcalculatedanddisplayedwhenthecountislessthan10. Source:PennsylvaniaDepartmentofHealth,BureauofHealthStatisticsandResearch.CalculationspreparedbyPHMC.
PUBLIC HEALTH
Table7:CurrentlyLivingwithHIV,includingAIDS(2008) byGenderandRace/Ethnicity
Total number currently living with HIV, includingAIDS Currently living with HIV, including AIDS (rateper100,000)* Gender(percentage) Male Female Race/Ethnicity(percentage) White Black Latino Asian Other County 883 218.7 65%
(575)
State 30,479 244.9 N/A N/A N/A N/A N/A N/A N/A
35%
(308)
34%
(297)
20%
(175)
46%
(409)
ND ND
Notes: ND=NotDisplayed.Percentagesarenotcalculatedanddisplayedwhenthecountislessthan10. N/A=Dataarenotavailable. *RatescalculatedbyPHMCusingHIVprevalenceestimatesprovidedbythePennsylvaniaDepartmentof Healthdividedbypopulationestimatesfromthe2008AmericanCommunitySurvey. Source: Pennsylvania Department of Health, HIV/AIDS InvestigationsBureau of Epidemiology and AmericanCommunitySurvey.

PUBLIC HEALTH
Table8:CommunicableDiseaseRates,2010
HepatitisB,Chronic LymeDisease Pertussis* Varicella* Chlamydia Gonorrhea County 6.6
(27)
State 11.6
(1,470)
8.0
(33)
30.0
(3,805)
6.6
(123)
4.0
(1,496)
20.7
(387)
23.1
(8,671)
302.6
(1,245)
374.1
(47,518)
47.6
(196)
101.4
(12,883)
Notes: Communicablediseaseratesarecalculatedper100,000population. *Indicatesinformationisfrom20072009. Source:PennsylvaniaDepartmentofHealth,BureauofHealthStatisticsandResearch,EpiQMS.
PUBLIC HEALTH
APPENDIXC:HOUSEHOLDHEALTHSURVEYTABLES
PUBLIC HEALTH

Table1:HealthStatusofAdults18+ Reading 2008 N (%) Excellent VeryGood Health Status Good Fair Poor Mental Health Diagnosed with mental healthcondition Received treatment for mentalhealthcondition
Overweight 9,700 (20.3) N/A 22,600 (47.3) 11,500 (24.2) 3,900 (8.2) N/A N/A 16,000 (32.9) 16,000 (32.9) N/A 11,000 (23.0) 6,900 (14.5) 14,000 (29.3)
EastBerks 2008 N (%)

11,000 (28.3) N/A 19,400 (50.3) 6,400 (16.6) 1,900 (4.8) N/A N/A 14,900 (39.3) 11,000 (29.0) N/A 5,900 (15.2) 6,300 (16.2) 12,500 (32.4)
NorthBerks 2008 N (%)

20,100 (31.9) N/A 33,600 (53.2) 7,700 (12.3) 1,700 (2.6) N/A N/A 23,700 (37.8) 17,900 (28.5) N/A 8,200 (13.0) 7,500 (11.9) 17,000 (27.2) N/A
SouthBerks 2008 N (%)

27,600 (31.7) N/A 42,500 (48.8) 14,200 (16.3) 2,800 (3.3) N/A N/A 33,300 938.7) 21,200 (24.7) N/A 12,000 (13.6) 7,500 (8.6) 21,400 (27.2) N/A
WestBerks 2008 N (%)

20,600 (28.0) N/A 42,000 (57.1) 9,800 (13.3) 1,100 (1.6) N/A N/A 21,400 (29.7) 18,000 (25.1) N/A 11,500 (15.6) 6,000 (8.2) 21,400 (24.4) N/A
BerksCounty 2008 N (%)

89,000 (28.7) N/A 160,100 (51.6) 49,700 (16.0) 11,400 (3.7) N/A N/A 109,200 (35.7) 83,700 (27.4) N/A 48,500 (15.6) 34,200 (11.0) 82,900 (26.8) N/A
2012 N (%)
7,300 (13.3) 9,900 (18.2) 19,200 (35.3) 15,100 (27.2) 3,000 (5.4) 11,600 (21.3) 6,800 (58.0) 18,500 (35.3) 18,300 (35.0) 3,300 (6.1) 10,200 (18.7) 10,300 (18.9) 21,800 (40.0)
2012 N (%)
5,800 (14.9) 16,700 (43.1) 11,200 (28.8) 3,400 (8.7) 1,700 (4.5) 4,500 (11.6) 3,400 (74.1) 12,700 (33.9) 11,000 (29.5) 5,400 (14.0) 4,400 (11.4) 6,600 (16.9) 13,300 (34.6) 1,300 (3.3)
2012 N (%)
15,000 (21.1) 25,600 (36.1) 20,000 (28.2) 7,800 (10.9) 2,600 (3.6) 7,600 (10.7) 5,500 (72.2) 25,100 (35.6) 18,400 (26.1) 5,900 (8.3) 12,500 (17.6) 9,600 (13.7) 21,700 (30.5) 3,000 (4.2)
2012 N (%)
22,000 (25.8) 29,800 (35.0) 21,500 (25.2) 8,900 (10.4) 3,100 (3.6) 12,000 (14.1) 6,500 (54.1) 28,800 (35.4) 25,100 (30.8) 7,400 (8.7) 14,400 (17.0) 11,600 (13.7) 28,100 (33.1) 3,500 (4.1)
2012 N (%)
16,900 (25.0) 18,000 (26.6) 27,800 (41.0) 4,000 (6.0) 900 (1.4) 10,500 (15.6) 6,400 (60.7) 25,500 (38.7) 20,200 (30.6) 6,200 (9.2) 7,700 (11.3) 5,900 (8.8) 20,500 (30.8) 2,600 (3.8)
2012 N (%)
67,000 (21.1) 100,100 (31.5) 99,700 (31.4) 39,100 (12.3) 11,300 (3.6) 46,200 (14.6) 28,400 (61.5) 110,600 (35.9) 93,100 (30.2) 28,300 (8.9) 49,200 (15.5) 44000 (13.9) 105,400 (33.4) 14,100 (4.4)
Body Mass Index Obese
Everhadcancer Everhadasthma Chronic Health Conditions Everhaddiabetes
Ever had high blood pressure Ever had congestive heart 3,700 N/A N/A (6.7) failure Note:N/A=notaskedin2008 Source:PHMCs2008and2012BerksCountyHouseholdHealthSurvey
PUBLIC HEALTH
Table2:HealthInsuranceStatusofAdults18+ Reading 2008 N (%) 9,100 (22.7) 7,000 (18.2) 8,600 (18.0) 2012 N (%) 11,100 (23.7) 6,500 (15.1) 10,400 (18.9) 4,900 (44.1) EastBerks 2008 N (%) 1,436 (4.7) 2,100 (5.7) 2,300 (6.1) 2012 N (%) 4,300 (15.2) 3,100 (9.6) 4,600 (11.9) 300 (8.1) NorthBerks 2008 N (%) 3,200 (6.4) 7,300 (12.4) 11,300 (17.8) N/A 2012 N (%) 4,600 (8.3) 6,600 (10.1) 8,300 (11.7) 800 (16.6) SouthBerks 2008 N (%) 4,700 (6.2) 7,800 (9.3) 11,300 (12.9) N/A 2012 N (%) 5,700 (8.8) 7,500 (9.5) 7,800 (9.1) 1,600 (27.3) WestBerks 2008 N (%) 3,600 (6.2) 6,300 (9.2) 11,000 (15.1) N/A 2012 N (%) 7,200 (13.9) 6,500 (10.7) 6,500 (9.6) 500 (6.8) BerksCounty 2008 N (%) 22,000 (8.7) 30,600 (10.7) 44,600 (14.4) N/A 2012 N (%) 33,000 (13.3) 30,200 (10.8) 37,500 (11.8) 8,100 (24.8)
Uninsured(1864) Noprescriptiondrugcoverage Noregularsourceofcare
Visited ER in past year due to lack of N/A N/A insurance Note:N/A=notaskedin2008 Source:PHMCs2008and2012BerksCountyHouseholdHealthSurvey

PUBLIC HEALTH
Table3:CostBarrierstoCare Reading 2008 N (%) N/A N/A N/A 2012 N (%) 10,100 (18.5) 18,100 (33.2) 12,900 (23.7) EastBerks 2008 N (%) N/A N/A N/A 2012 N (%) 4,800 (12.5) 8,600 (22.2) 2,900 (7.4) NorthBerks 2008 N (%) N/A N/A N/A 2012 N (%) 7,000 (9.8) 14,300 (20.2) 11,000 (15.4) SouthBerks 2008 N (%) N/A N/A N/A 2012 N (%) 8,600 (10.1) 16,500 (19.3) 10,600 (12.5) WestBerks 2008 N (%) N/A N/A N/A 2012 N (%) 7,400 (11.0) 9,500 (14.0) 6,000 (8.9) BerksCounty 2008 N (%) N/A N/A N/A 2012 N (%) 37,900 (12.0) 67,000 (21.1) 43,400 (13.7)
Didnotseekhealthcareduetocost Didnotseekdentalcareduetocost Didnotfillprescriptionduetocost
Note:N/A=notaskedin2008 Source:PHMCs2008and2012BerksCountyHouseholdHealthSurvey

PUBLIC HEALTH
Table4:PersonalHealthBehaviorsofAdults18+ Reading 2008 N (%) 40,900 (88.3) 5,400 (11.7) N/A 9,600 (19.9) 15,200 (31.7) 23,300 (48.4) 13,300 (27.8) 6,538 (49.2) 2012 N (%) 43,300 (84.8) 7,700 (15.2) 26,800 (48.9) 12,900 (23.6) 16,800 (31.0) 24,700 (45.4) 15,900 (29.3) 10,000 (62.6) EastBerks 2008 N (%) 23,600 (63.5) 13,600 (36.5) N/A 4,900 (12.7) 14,500 (37.5) 19,300 (49.9) 8,300 (21.7) 3,900 (46.5) N/A 2012 N (%) 26,800 (72.3) 10,300 (27.7) 21,800 (43.5) 5,600 (15.0) 13,000 (34,9) 18,600 (50.1) 7,100 (18.5) 4,400 (62.3) 6,000 (37.1) NorthBerks 2008 2012 N N (%) (%) 39,700 48,000 (63.5) (69.0) 22,800 21,600 (36.5) (31.0) N/A 30,900 (43.5) SouthBerks 2008 N (%) 56,500 (65.9) 29,300 (34.1) N/A 8,800 (10.1) 23,000 (26.3) 55,600 (63.6) 23,900 (27.2) 14,144 (59.3) N/A 2012 N (%) 57,300 (69.3) 25,400 (30.7) 40,800 (48.0) 11,100 (13.2) 22,100 (26.3) 51,000 (60.6) 16,400 (19.3) 8,300 (50.5) 19,500 (43.6) WestBerks 2008 N (%) 51,000 (71.3) 20,500 (28.7) N/A 4,900 (6.7) 25,000 (34.3) 43,000 (59.0) 17,500 (23.8) 9,600 (55.4) N/A 2012 N (%) 45,700 (68.3) 21,200 (31.7) 32,200 (47.6) 9,900 (14.6) 19,800 (29.2) 38,000 (56.2) 11,900 (17.6) 3,200 (27.0) 12,000 (33.0) BerksCounty 2008 N (%) 211,800 (69.8) 91,600 (30.2) N/A 32,100 (10.3) 97,300 (31.4) 180,800 (58.3) 77,000 (24.8) 43,200 (56.3) N/A 2012 N (%) 221,100 (71.9) 86,200 (28.1) 152,600 (48.1) 49,000 (15.6) 92,400 (29.4) 172,800 (55.0) 64,500 (20.4) 34,900 (54.3) 55,000 (38.4)
Numberoffruitsand vegetablesconsumedin normalday Howmanytimeseaten atfastfoodrestaurantin pastweek
03servings 4+servings 1ormoretimes None
Numberoftimes exercisedinpastmonth
12daysperweek 3ormoredaysperweek
SmokesCigarettes Havetriedquittinginpastyear
3,900 9,500 (6.2) (13.4) 19,500 20,700 (30.9) (29.3) 39,600 40,400 (62.8) (57.2) 14,000 13,000 (22.2) (18.5) 9,100 9,000 (64.9) (68.9) N/A 10,100 (32.8)
Numberofdays 7,500 consumed5ormore 1ormoredays N/A (47.9) drinksinpastmonth Note:N/A=notaskedin2008 Source:PHMCs2008and2012BerksCountyHouseholdHealthSurvey

PUBLIC HEALTH
Table5:UtilizationofServicesbyAdults18+ Reading 2008 InpastyearDIDNOT Visitahealthcareprovider Visitadentist N (%) 12,600 (26.2) 18,900 (39.4) 6,300 (13.2) 6,300 (40.2) 8,800 (39.6) 3,900 (28.6) 5,400 (53.5) 2012 N (%) 12,300 (23.0) 23,600 (43.0) 9,100 (17.0) 6,100 (31.5) 10,400 (36.4) 7,500 (45.2) 6,200 (55.9) EastBerks 2008 N (%) 5,500 (14.2) 8,400 (21.7) 2,800 (7.2) 8,400 (40.5) 8,800 (42.3) 4,800 (31.4) 7,100 (49.9) 2012 N (%) 6,200 (16.3) 12,400 (31.8) 4,900 (13.3) 5,300 (25.2) 9,300 (46.8) 6,500 (40.4) 6,900 (52.6) NorthBerks 2008 N (%) 9,000 (14.3) 14,000 (22.2) 8,400 (13.6) 8,200 (31.6) 8,100 (22.8) 6,700 (31.5) 6,200 (44.6) 2012 N (%) 12,400 (17.5) 19,800 (27.9) 10,100 (14.3) 16,400 (42.5) 17,700 (42.8) 12,400 (42.2) 8,700 (45.7) SouthBerks 2008 N (%) 15,600 (17.8) 24,200 (27.7) 11,000 (12.6) 13,600 (37.0) 14,500 (31.4) 9,900 (31.6) 11,200 (50.2) 2012 N (%) 11,800 (13.9) 24,300 (28.8) 9,800 (11.6) 11,700 (28.8) 14,000 (36.8) 9,600 (35.7) 13,100 (50.9) WestBerks 2008 N (%) 8,900 (12.1) 16,100 (21.9) 5,800 (8.0) 9,000 (28.1) 10,000 (29.6) 6,300 (30.6) 7,900 (40.5) 2012 N (%) 12,400 (18.4) 15,100 (22.4) 7,400 (11.0) 7,400 (22.0) 14,700 (43.9) 8,900 (41.0) 8,300 (37.4)
BerksCounty
2008 N (%) 51,600 (16.6) 81,600 (26.3) 34,300 (11.1) 45,500 (34.7) 50,200 (31.7) 31,600 (31.0) 37,700 (47.2) 2012 N (%) 55,200 (17.5) 95,100 (30.0) 41,400 (13.2) 46,900 (30.6) 66,300 (41.0) 44,800 (40.6) 43,200 (47.4)
DIDNOThavetherecommendedscreening Bloodpressuretestinthepastyear Colonoscopyinpast10years (adults50+) Papsmearinthepastyear
Mammograminthepastyear (women40+) Rectalexamforprostatecancerinpast year(males45+) Note:N/A=notaskedin2008 Source:PHMCs2008and2012BerksCountyHouseholdHealthSurvey
PUBLIC HEALTH

Table6:SocialCapitalandNeighborhoodofAdults18+ Reading EastBerks 2008 2012 2008 2012 N N N N (%) (%) (%) (%) 26,500 7,900 Lowsocialcapital N/A N/A (57.0) (22.3) Medium social 15,600 23,200 N/A N/A SocialCapital capital (33.4) (65.6) 4,500 4,300 Highsocialcapital N/A N/A (9.6) (12.1) Comfortablevisitingpark/outdoor 37,500 28,400 N/A N/A spaceinneighborhood (68.7) (75.5) 23,900 20,000 Freeplacetoexercise N/A N/A (50.7) (58.1) Note:N/A=notaskedin2008 Source:PHMCs2008and2012BerksCountyHouseholdHealthSurvey NorthBerks 2008 2012 N N (%) (%) 18,600 N/A (29.5) 35,000 N/A (55.7) 9,300 N/A (14.8) 53,700 N/A 977.1) 39,300 N/A (63.7) SouthBerks 2008 2012 N N (%) (%) 18,600 N/A (25.5) 40,100 N/A (55.5) 14,200 N/A (19.5) 66,900 N/A (79.4) 45,400 N/A (60.8) WestBerks 2008 2012 N N (%) (%) 13,900 N/A (23.8) 31,100 N/A (53.3) 13,300 N/A (22.9) 51,400 N/A (77.4) 34,700 N/A (63.0) BerksCounty 2008 2012 N N (%) (%) 85,500 N/A (31.0) 145,000 N/A (52.5) 45,600 N/A (16.5) 237,800 N/A (76.1) 163,400 N/A (59.8)
PUBLIC HEALTH
Table7:CostBarrierstoCarebyLatinoOrigin LatinoOrigin Latino N (%) 7,700 (16.8) 15,900 (34.9) 9,700 (21.0) NonLatino N (%) 29,800 (11.1) 50,700 (18.8) 33,300 (12.4) Total N (%) 37,900 (12.0) 67,000 (21.1) 43,400 (13.7)
Didnotseekhealthcareduetocost Didnotseekdentalcareduetocost Didnotfillprescriptionduetocost
PUBLIC HEALTH
Table8:InsuranceStatusandSourceofCarebyLatinoOrigin LatinoOrigin Non Latino Latino N N (%) (%) 10,800 22,200 (25.8) (10.8) 9,100 21,000 (25.7) (8.6) 10,600 26,600 (22.9) (9.9) 4,900 (45.2) 3,200 (14.9) Total N (%) 33,000 (13.3) 30,200 (10.8) 37,500 (11.8) 8,100 (24.8)
Uninsured(1864) Noprescriptiondrugcoverage(among insured) Noregularsourceofcare VisitedERinpastyearduetolack of insurance(amongthoseuninsuredinpast year)
PUBLIC HEALTH
Table9:HealthStatusbyLatinoOrigin
LatinoOrigin Latino N (%) 6,100 (13.2) 6,700 (14.6) 17,600 (38.2) 12,000 (26.1) 3,600 (7.9) with health 8,100 (17.6) 16,600 (38.2) 14,600 (33.7) 1,500 (3.3) 8,400 (18.2) 7,100 (15.5) 12,900 (28.0) 1,400 (3.1) NonLatino N (%) 60,300 (22.4) 92,800 (34.5) 81,300 (30.2) 26,900 (10.0) 7,700 (2.8) 38,100 (14.2) 93,000 (35.5) 77,800 (29.7) 26,600 (9.9) 40,500 (15.1) 36,500 (13.6) 91,800 (34.3) 12,500 (4.7) Total N (%) 67,000 (21.1) 100,100 (31.5) 99,700 (31.4) 39,100 (12.3) 11,300 (3.6) 46,200 (14.6) 110,600 (35.9) 93,100 (30.2) 28,300 (8.9) 49,200 (15.5) 44,000 (13.9) 105,400 (33.4) 14,100 (4.5)
Excellent VeryGood HealthStatus Good Fair Poor MentalHealth Diagnosed mental condition Overweight BodyMassIndex Obese Everhadcancer Everhadasthma ChronicHealthConditions Everhaddiabetes Ever had high blood pressure Ever had congestive heartfailure Source:PHMCs2012BerksCountyHouseholdHealthSurvey
PUBLIC HEALTH
Table10:PersonalHealthBehaviorsbyLatinoOrigin LatinoOrigin Latino N (%) 37,200 (86.6) 5,700 (13.4) 23,100 (50.1) 12,100 (26.2) 14,100 (30.6) 19,900 (43.2) 14,000 (30.4) 9,500 (69.5) 4,900 (40.8) NonLatino N (%) 182,300 (69.5) 79,900 (30.5) 128,600 (47.8) 36,500 (13.7) 77,800 (29.3) 151,600 (57.0) 50,500 (18.8) 25,400 (50.2) 50,200 (38.4) Total N (%) 221,100 (71.9) 86,200 (28.1) 152,600 (48.1) 49,000 (15.6) 92,400 (29.4) 172,800 (55.0) 64,500 (20.4) 34,900 (54.3) 55,000 (38.4)
Numberoffruitsand vegetablesconsumedin normalday Howmanytimeseaten atfastfoodrestaurantin pastweek
03servings 4+servings 1ormoretimes None
Numberoftimes exercisedinpastmonth
12daysperweek 3ormoredaysperweek
SmokesCigarettes Havetriedquittinginpastyear Numberofdays consumed5ormore drinksinpastmonth 1ormoredays

PUBLIC HEALTH
Table11:SocialCapitalandNeighborhoodbyLatinoOrigin LatinoOrigin Total Latino N (%) 22,400 (59.5) 12,300 (32.8) 7,400 (7.7) 31,700 (69.7) 19,300 (46.8) Non Latino N (%) 62,400 (26.4) 131,700 (55.6) 40,700 (18.0) 204,900 (77.3) 143,300 (62.3)
low social capital mediumsocial SocialCapital capital high social capital Comfortable visiting park/outdoor space inneighborhood Freeplacetoexercise
N (%) 85,500 (31.0) 145,000 (52.5) 45,600 (16.5) 237,800 (76.1) 163,400 (59.8)
PUBLIC HEALTH

Table12:UtilizationofServicesbyLatinoOrigin Latino N (%) 13,200 (29.3) 18,600 (40.3) 11,100 (24.5) 3,300 (31.3) 10,000 (40.5) 4,500 (35.1) 3,600 (56.5) LatinoOrigin NonLatino N (%) 41,700 (15.6) 76,100 (28.4) 29,900 (11.3) 42,800 (30.2) 55,400 (40,8) 40,200 (41.5) 38,700 (46.2) Total N (%) 55,200 (17.5) 95,100 (30.0) 41,400 (13.2) 46,900 (30.6) 66,300 (41.0) 44,800 (40.6) 43,200 (47.4)
InpastyearDIDNOT Visitahealthcareprovider Visitadentist Bloodpressuretestinthepastyear Colonoscopyinpast10years (adults50+) Papsmearinthepastyear
Mammograminthepastyear (women40+) Rectalexamforprostatecancerinpastyear(males 45+)

PUBLIC HEALTH
Table13.HealthStatus,MentalHealthStatus,BodyMassIndex,andChronicHealthConditions byRaceandPovertyStatus Race White Black N (%) 3,100 (21.2) 2,100 (14.3) 4,900 (33.7) 3,700 (25.6) 800 (5.3) 2,900 (19.6) 4,800 (35.5) 4,500 (33.5) 2,600 (17.9) 4,100 (28.3) 7,000 (48.4) N (%) 58,200 (21.7) 91,500 (34.1) 81,400 (30.3) 29,300 (10.9) 8,200 (3.0) 38,400 (14.3) PovertyStatus* Poor N (%) 4,400 (12.0) 4,000 (10.8) 13,500 (36.4) 12,000 (32.2) 3,200 (8.6) 9,800 (26.2) 11,700 (33.0) 14,500 (41.0) 9,500 (25.2) 9,200 (24.9) 14,900 (39.6) NonPoor N (%) 62,500 (22.3) 96,000 (34.3) 86,100 (30.8) 27,100 (9.7) 8,100 (2.9) 36,400 (13.0) 98,900 (36.3) 78,500 (28.8) 39,700 (14.2) 34,800 (12.5) 90,500 (32.6) Total N (%) 67,000 (21.1) 100,100 (31.5) 99,700 (31.4) 39,100 (12.3) 11,300 (3.6) 46,200 (14.6) 110,600 (35.9) 93,100 (30.2) 49,200 (15.5) 44,000 (13.9) 105,400 (33.4)
Excellent VeryGood Health Status Good Fair Poor Mental Health Body Mass Index Diagnosedwithmentalhealth condition Overweight
94,100 (36.0) 77,400 Obese (29.6) 42,100 Everhadasthma (15.7) Chronic 35,600 Everhaddiabetes Health (13.3) Conditions 89,500 Everhadhighbloodpressure (33.5) Source:PHMCs2012BerksCountyHouseholdHealthSurvey
PUBLIC HEALTH

Table14.InsuranceStatusandSourceofCarebyRaceandPovertyStatus Poverty Race White N (%) 21,800 (10.6) 10,600 (22.9) Black N (%) 3,400 (27.9) 26,600 (9.9) Poor* N (%) 10,200 (32.5) 7,700 (20.4) Non Poor N (%) 22,700 (10.5) 29,900 (10.7) Total N (%) 33,000 (13.3) 37,500 (11.8)
Uninsured(1864) Noregularsourceofcare
Source:PHMCs2012BerksCountyHouseholdHealthSurvey *Below100%ofFederalPovertyLevel
PUBLIC HEALTH

Table15:SocialCapitalandNeighborhoodbyPopulationSubgroups Race White N (%) 66,000 (27.8) 129,900 (54.8) 41,200 (17.4) 202,900 (76.8) 143,600 (62.1) Black N (%) 5,600 (45.7) 4,800 (39.6) 1,800 (14.7) 10,600 (73.3) 5,800 (47.3) PovertyStatus Poor N (%) 16,800 (51.1) 10,400 (34.7) 2,800 (9.3) 25,100 (68.2) 13,400 (43.3) NonPoor N (%) 68,600 (27.9) 134,600 (54.7) 42,800 (17.4) 212,600 (77.2) 150,000 (61.9) Total N (%) 85,500 (31.0) 145,000 (52.5) 45,600 (16.5) 237,800 (76.1) 163,400 (59.8)
low social capital mediumsocial SocialCapital capital high social capital Comfortable visiting park/outdoor space inneighborhood Freeplacetoexercise
PUBLIC HEALTH
APPENDIXD:ASSETMAPS
PUBLIC HEALTH
PUBLIC HEALTH
PUBLIC HEALTH
PUBLIC HEALTH
APPENDIXE:COMMUNITYRESOURCELIST
PUBLIC HEALTH
Name
Town
State
Zip
Type
BERKS COUNTY HOSPITALS Name Haven Behavioral Hospital of Eastern PA Wernersville State Hospital St. Joseph Regional Health Network Reading Health System Surgical Institute of Reading
Town Reading Wernersville Reading West Reading Wyomissing
State PA PA PA PA PA
Zip 19601 19565 19605 19611 19610
Type of Hospital Behavioral Health Hospital Psychiatric Hospital Hospital Hospital Surgical Hospital
BERKS COUNTY HEALTH CENTERS AND CLINICS Name Town

St. Joseph Regional Health Network Downtown Campus
State
PA
Zip
19601
Type of Center
Health Center
Western Berks Free Medical Clinic Berks Community Health Center Keystone Farmworker Health Program Planned Parenthood of Northeast Pennsylvania Co-County Wellness Services/Berks AIDS Network Mercy Community Crisis Pregnancy Center St. Joseph Regional Health Network at Maidencreek Premier Immediate Medical Care Concentra Urgent Care Reading Convenient Care MedExpress Urgent Care - Muhlenberg Advance Urgent Care Name
Reading Robesonia Reading Reading Reading Reading Reading Blandon Douglassville Reading Reading Reading Reading Town
PA PA PA PA PA PA PA PA PA PA PA PA State
19551 19601 19601 19602 19603 19601 19510 19518 19605 19605 19605 19608 Zip
Health Center Health Center Health Center Health Center HIV/AIDS services Pregnancy Crisis Center Urgent Care Center Urgent Care Center Urgent Care Center Urgent Care Center Urgent Care Center Urgent Care Center Type
Abilities In Motion ADAPPT Alternative Consulting Enterprises, Inc. American Cancer Socviety American Diabetes Association American Red Cross Arc Advocacy Services Autism Society of Berks Bailey, Diane, L.P.C. BCC Satellite Office BCC/ACT Program Berks Advocates Against Violence Berks Coalition to End Homelessness Berks Counseling Center Berks Counseling Center, Inc. Berks County Associate for the Blind Berks County Children and Youth Berks County Community Foundation The Research Management Berks County Emergency and Evaluation Group
Reading Reading Reading Reading Reading Reading Reading Wyomissing West Lawn Reading Reading Reading Reading Reading Reading Reading Reading Reading Leesport
PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA
19601 19601 19601 19605 18017 19601 19607 19610 19609 19601 19601 19601 19602 19601 19601 19604 19601 19601 19533
Social Service Agency Substance Abuse Treatment Mental Health/Medicaid Provider Social Service Agency Social Service Agency Social Service Agency Social Service Agency Social Service Agency Mental Health/Medicaid Provider Social Service Agency Social Service Agency Social Service Agency Social Service Agency Social Service Agency Mental Health/Medicaid Provider Social Service Agency Social Service Agency Foundation Emergency Services
PUBLIC HEALTH
Reading Birdsboro Fleetwood Hamburg Shillington Reading Wernersville Reading Reading Reading Reading Wyomissing Reading Boyertown Boyertown Reading Reading Reading Reading Reading Reading Reading Reading Reading Reading Wyomissing Reading Wyomissing Reading Reading Birdsboro Birdsboro Wernersville Reading Reading Wyomissing Reading Leesport Reading Reading Reading Wyomissing PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA 19601 19508 19522 19526 19607 19601 19565 19601 19602 19601 19601 19610 19601 19512 19512 19601 19601 19601 19602 19601 19601 19601 19601 19601 19601 19610 19601 19610 19602 19601 19508 19508 19565 19611 19601 19610 19611 19533 19601 19601 19602 19610 Social Service Agency Senior Center Senior Center Senior Center Senior Center Senior Center Senior Center Senior Center Mental Health/Medicaid Provider Homeless/Emergency Shelter Mental Health/Medicaid Provider Mental Health/Medicaid Provider Social Service Agency Social Service Agency Social Service Agency Mental Health/Medicaid Provider Mental Health Social Service Agency Mental Health/Medicaid Provider Social Service Agency Substance Abuse Treatment Drug & Alcohol/Medicaid Provider Mental Health/Medicaid Provider Mental Health/Medicaid Provider Social Service Agency Social Service Agency Mental Health/Medicaid Provider Mental Health/Medicaid Provider Mental Health Substance Abuse Treatment Substance Abuse Treatment Mental Health/Medicaid Provider Homeless/Emergency Shelter Homeless/Emergency Shelter Government agency Mental Health/Medicaid Provider Social Service Agency Drug & Alcohol/Medicaid Provider Mental Health/Medicaid Provider Mental Health/Medicaid Provider Senior Center Drug & Alcohol/Medicaid Provider Berks County Services Center Berks Encore- Birdsboro Berks Encore- Fleetwood Berks Encore- Hamburg Berks Encore- Mifflin Berks Encore- Providence House Berks Encore- Wernersville Berks Encore-Reading Center Berks Psychiatry, Inc. Berks Women in Crisis Berkshire Psychiatric & Behavioral Health Services, P.C. Beveridge, Lisa, L.S.W. Berks Counseling Associates, P.C. Big Brothers/Big Sister Boyertown Area Multi-Services Center Boyertown Salvation Army Cammarano, Denise, L.S.W. Berks Advocates Against Violence Center for Mental Health Centro Hispano (Hispanic Center) Child & Family Support Services, Inc. Children's Allicance Center Children's Home of Reading CHOR Youth & Family Services, Inc. CHOR Youth & Family Services, Inc. Commonwealth Clinical Group, Inc. Community Prevention Partnership Community Skills Program and Rehab, Inc. Community Solutions of Pennsylvania CONCERN Professional Services for Children, Youth & Families Concern of Reading Council on Chemical Abuse Creative Health Services, Inc. Creative Health Services, Inc. Danken House Dayspring Homes, Inc. Department of Public Welfare County Assistance Office DeSantis, Denise, L.C.S.W. Berks Counseling Associates, P.C. Easter Seals of Eastern PA Easy Does It, Inc. Ercole, Mario, M.D. Familicare Counseling Center Family First Resource Center Family Guidance Center
PUBLIC HEALTH
Family Guidance Center Family Life Services Family Promise of Berks Fischetto, Anthony, Ed.D Freedom Gate Ministries Gaulin, Ann, M.S., L.M.F.T. Goodwill Greater Reading Mental Health Alliance, The Haven Behavioral Hospital of Eastern Pennsylvania Here and Now Group Hill, Alison, Ph.D. Berks Counseling Associates, P.C. Holcomb Behavioral Health Systems Hope Rescue Mission Infante, Olga, M.D. Janjua, Mohammad, M.D. Horizonz, LLC Jewish Community Center of Reading Kennedy Senior Center KidsPeace National Centers, Inc. La Casa De la Amistad Laureldale Center Lesniak-Karpiak, Katarzyna, Ph.D. Mary's Shelter McConaghay, Dean, M.S. Berks Counseling Associates, P.C. Mental Health Association Milestones Community Healthcare, Inc. Nagle, Robert, Ph.D. Berks Counseling Associates, P.C. Namiotka, Mary, L.C.S.W. National Mentor Healthcare, Inc. dba PA Mentor New Directions Treatment Services New Directions Treatment Services New Life Cognitive Behavioral Services, Inc. New Person Center NHS Pennsylvania Nicodemus, David, M.A. Office of Mental Health/Developmental Disabilities Olivet Boy and Girls Club Opportunity House Orr, Gerald, M.A. - Berks Counseling Associates, P.C. Pennsylvania Counseling Services, Inc. Pennsylvania Counseling Services, Inc. Perez Bentancourt, Mirta, L.P.C.
Reading Topton Reading Shillington Reading Shillington Reading Shillington Reading Reading Wyomissing Reading Reading Reading Reading Reading Reading Temple Reading Reading Douglassville Reading Wyomissing West Reading Wyomissing Wyomissing Leesport Fleetwood West Reading West Reading Reading Reading Wyomissing Reading Reading Reading Reading Wyomissing Reading Reading Shillington PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA 19601 19562 19601 19607 19602 19607 19605 19607 19601 19602 19610 19604 19601 19601 19601 19604 19602 19560 19601 19605 19518 19602 19610 19611 19610 19610 19533 19522 19611 19611 19601 19601 19610 19607 19601 19611 19601 19610 19602 19602 19607 Mental Health/Medicaid Provider Substance Abuse Treatment Homeless/Emergency Shelter Mental Health/Medicaid Provider Substance Abuse Treatment Mental Health/Medicaid Provider Social Service Agency Mental Health/Medicaid Provider Mental Health/Medicaid Provider Social Service Agency Mental Health/Medicaid Provider Mental Health/Medicaid Provider Homeless/Emergency Shelter Mental Health/Medicaid Provider Mental Health/Medicaid Provider Social Service Agency Senior Center Mental Health/Medicaid Provider Senior Center WIC Office Mental Health/Medicaid Provider Homeless/Emergency Shelter Mental Health/Medicaid Provider Mental Health Mental Health/Medicaid Provider Mental Health/Medicaid Provider Mental Health/Medicaid Provider Mental Health/Medicaid Provider Drug & Alcohol/Medicaid Provider Mental Health/Medicaid Provider Mental Health/Medicaid Provider Substance Abuse Treatment Mental Health/Medicaid Provider Mental Health/Medicaid Provider Mental Health Social Service Agency Substance Abuse Treatment Mental Health/Medicaid Provider Drug & Alcohol/Medicaid Provider Mental Health/Medicaid Provider Mental Health/Medicaid Provider
PUBLIC HEALTH
Reading Reading Reading Reading West Reading West Reading West Reading Wyomissing Reading Reading Reading Boyertown Wyomissing Reading Shillington West Reading Reading Wyomissing Tamaqua Reading Reading Reading Reading Reading Leesport Wyomissing Reading Reading Reading PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA 19601 19601 19602 19601 19611 19611 19601 19610 19601 19601 19602 19512 19610 19601 19607 19611 19601 19610 18252 19607 19607 19601 19601 19603 19533 19610 19601 19601 19605 Mental Health Mental Health/Medicaid Provider Mental Health/Medicaid Provider WIC Office Mental Health/Medicaid Provider Drug & Alcohol/Medicaid Provider Pregnancy Crisis Center Drug & Alcohol/Medicaid Provider Mental Health/Medicaid Provider Mental Health/Medicaid Provider Social Services Social Services Mental Health/Medicaid Provider Mental Health/Medicaid Provider WIC Office Social Service Agency Mental Health/Medicaid Provider Mental Health/Medicaid Provider Social Service Agency Behavioral Health Services Mental Health/Medicaid Provider Mental Health/Medicaid Provider Drug & Alcohol/Medicaid Provider Community agency Government agency Foundation Mental Health/Medicaid Provider YMCA Mental Health/Medicaid Provider Progressions Progressions Companies, Inc., The Reading Behavioral Health Center Inc. Reading Center Reading Health System - Ctr. for MH Reading Health System - Ctr. for MH Real Alternatives Richard J. Caron Foundation Rijo, Ana, L.P.C. Seed of Hope, Inc. Royall, Carmen, L.P.C. Horizonz, LLC. Salvation Army Salvation Army - Boyertown Corps Schollenberger, Craig, L.C.S.W. Service Access & Management, Inc. Shillington Center Signature Family Services Spellman, Pamela, L.C.S.W. Stufflet, Kathryn, L.C.S.W. Tamaqua Salvation Army Threshold Rehabilitation Services, Inc. Threshold Rehabilitation Services, Inc. Treatment Access & Services Center, Inc. Treatment Access & Services Center, Inc. United Way of Berks County Veterans Affairs of Berks Wyomissing Foundation Yasmeen, Nikhat, M.D. - Reading Psaychiatry YMCA Youth Advocate Programs, Inc.
BERKS COUNTY FOOD PANTRIES AND SOUP KITCHENS Name Town St. Luke's Lutheran Church Pottsville Area Food Pantry Schuylkill Community Action Program Hope Lutheran Church Mahanoy Area Food Pantry Minersville Area Food Cupboard Schuylkill Valley Food Pantry New Ringgold Area Food Pantry Pine Grove Area Food Pantry Shenandoah Area Food Pantry Williams Valley Food Pantry Tremont Food Pantry Tri Valley Food Pantry Bloomsburg Pottsville Pottsville Ashland Mahonoy City Minersville New Philadelphia New Ringgold Pine Grove Shenandoah Tower City Tremont Valley View
State PA PA PA PA PA PA PA PA PA PA PA PA PA
Zip 17815 17901 17901 17921 17948 17954 17959 17960 17963 17976 17980 17981 17983
Type Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry
PUBLIC HEALTH
McAdoo Nuremberg Tamaqua Tamaqua Hamburg Kutztown Mohnton Oley Temple Reading Reading Reading Reading Reading Reading Ashland Kutztown Boyertown Hamburg Robesonia Temple Reading Reading Reading Reading Reading Reading Reading Reading Reading Reading Reading Reading Reading West Reading Reading Temple PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA 18237 18241 18252 18252 19526 19530 19540 19547 19560 19601 19601 19602 19604 19606 17921 19350 19512 19526 19551 19560 19601 19601 19601 19601 19601 19601 19601 19601 19602 19602 19605 19606 19606 19611 19611 19560 Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Food Pantry Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program Soup Kitchen/Meal Program McAdoo Area Food Pantry Nuremberg Area Food Pantry Tamaqua Area Food Pantry Tamaqua Primitive Methodist Church Northern Berks Food Pantry The Rodale Institute St. Benedict's RCC Oley Valley Food Pantry Spring Valley Church of God Iglesia Bautista Betania St. Paul's Lutheran Church St. James Chapel Hub of Hope at Reading Moravian Church St. Ignatius Loyola RCC Ringtown Valley Food Pantry Ashland Food Pantry Friend, Inc. Harvest Fellowship of Colebrookdale Hamburg SDA Church Conrad Weiser Pantry Hampden Heights SDA Church Bethel AME Church Christ Lutheran Church Circle of Friends Drop In Center City Light Ministry Grace and Hope Mission Holy Cross Memorial Church Holy Spirit Lutheran Church Holy Trinity Church of God Evangelical Mennonite Church First Unitarian Universalist Greater Berks Food Bank Catholic Charities, Diocese of Allentown Central Park United Methodist Food Ministry Bethany Lutheran Church Calvary Community Center Cluster Outreach Center
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APPENDIXF:FOCUSGROUPDISCUSSIONGUIDE
PUBLIC HEALTH
Berks County Community Health Needs Assessment
Older Adults Focus Group Questions Introduction You have been asked to participate in this discussion group because you are residents of Berks County. The St. Joseph Regional Health Network, The Reading Hospital and Medical Center, Berks County Community Foundation, and the United Way of Berks County have asked the Philadelphia Health Management Corporation to collect information on the health and social service needs of residents of Berks County. Public Health Management Corporation, or PHMC, is a private, non-profit public health organization. There are three other discussion groups being conducted for this project. The information from these discussion groups will be combined with other information we are collecting into a report. The results of the needs assessment will be made available to the public. Our conversation tonight will be recorded by a tape recorder because we do not want to miss anything you say. I want to assure you that everything you say here is confidential and your name will never be used in connection with anything you say in any written report that comes out of this group. My job is to act as moderator of the discussion and ask the questions. Since we have a lot of questions to get through today/tonight, I may have to cut short discussion of some questions to make sure we finish on time. Also, in order to make sure that everyone gets a chance to be heard, I ask that only one person talk at a time. Please feel free to leave and use rest rooms at any time during the discussion or to get up and help yourself to the refreshments. In order to introduce everyone, lets go around the table. Please tell everyone your first name and what part of Berks County you live in.
Questions
As I mentioned earlier, we are very interested in learning if there are any unmet health care needs for people who live in Berks County. This includes care for health problems a person might have, as well as screenings and check ups to maintain good health, and mental health care. I am going to ask you some questions about how people get to the doctor, and where they go for care. 1. How many people here have a doctor or other health care professional they can go to if they have a question about their health or are sick? Do other people in your family have a doctor or other health care professional? What type of provider do you use: private practice doctor, clinic, emergency room, etc.? If you or your family dont have a health care professional you can go to, why not? Now I am going to ask you some questions about any problems getting health care you or your family might have had in the past year.
PUBLIC HEALTH
management corporation 2. Have you or anyone in your family had a problem getting any health care and related services that you needed or thought you needed in the past year? This includes primary care, check ups for adults, emergency services, mental health (inpatient or outpatient), substance abuse treatment (inpatient or outpatient), specialty care, dental care, prescriptions, eyeglasses, diagnostic tests, such as mammograms and prostate cancer screening. 3. If so, what type of services could you not get, and what was the problem? Probe for type of service: Primary care for adults Specialty care for adults Services for adults with special needs Dental care Eyeglasses Dentures Urgent care Preventive screenings Diagnostic testing Mental health care in patient or outpatient Substance abuse treatment inpatient or outpatient What was the reason you or your family could not get health care? Probe for: Insurance does not take my type of insurance Cost no insurance or cost of co-pays and deductibles No providers in my area Care after hours and on weekends Long waiting time for appointment Cost of prescriptions Transportation/location Handicap access Language barrier Cultural barriers Now I would like to ask you to think a little about what types of unmet health care needs there are in Berks County. 4. Nutrition is very important for health. Do older adults in Berks County experience any barriers in getting fresh fruits and vegetables? If so, what are they? Probe for: markets with fresh fruit and vegetables in their community, transportation barriers, cost, oral health, medical conditions, likes/dislikes, lack of knowledge of importance of eating f/vegs, culture. 5. Physical exercise is also very important for health. Are there any barriers to physical exercise for older adults in Berks County? If so, what are they? Probe for: chronic condition, cost, lack of facility in neighborhood/transportation, fears of going outside, dont want to, lack of knowledge of importance of exercise, culture. 6. Have you heard of the Greater Reading Trails? If so, how did you hear about it? Do you use it? If not, why not? How likely would you be to use it in the future? Probe for: safety reasons, health problems, transportation, dont have someone to go with them, dont want to. 7. Based on your own experience, what are the top health care needs of adults in Berks County? 8. Many health problems are impacted by social conditions, such as lack of education, poverty, poor housing conditions, unemployment, and culture and language. What, in your opinion, are the top social conditions that have a negative impact on the health of the community in Berks County?
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management corporation 9. What is the best way to reach people in Berks County with information about health and health care resources? Probe for: local newspapers, radio, cable TV, internet, word of mouth, churches, other organizations.
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APPENDIXG:KEYINFORMANTINTERVIEWGUIDE
PUBLIC HEALTH
BERKS COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT KEY INFORMANT INTERVIEW GUIDE
INTERVIEWER:________________________ KEY INFORMANT:______________________
DATE:___/___/____ TITLE:_____________
ORGANIZATION:___________________________________________________
Introduction: The St. Joseph Regional Health Network, The Reading Hospital and Medical Center, Berks County Community Foundation, and the United Way of Berks County are conducting an assessment of the community assets and unmet health care needs of residents of Berks County. As part of the assessment, we are interviewing leaders in the community who are knowledgeable about these issues. We would like to know your opinions, based on your experience serving the community.
First, I would like to ask you some questions about your experiences working in Berks County.
I would like to ask you some questions about the health of residents of Berks County, based on your experiences. Based on your experience, what types of health problems both physical and mental health problems do you observe in adults and children in Berks County? Are there different problems in different regions of the County? Overweight Diabetes Arthritis Heart disease High Blood pressure Cancer High cholesterol Poor oral health Poor nutrition STDs Depression Serious mental illness schizophrenia, bi-polar, etc. ADHD Anorexia/bulimia Communicable diseases including those of childhood Lead poisoning/elevated lead levels Limitations of mobility Alzheimers/dementia
Based on your experience, have you observed any health behaviors in Berks County residents that can have a negative impact on health? (Probe for smoking, drinking, substance abuse, obesity, food insecurity, poor nutrition, high risk sexual behavior, lack of physical exercise) Are these behaviors more common among different population subgroups or different geographic areas of the county?
PUBLIC HEALTH
Do Berks County residents have access to the health care services they need? Do different groups of residents have access? Adults Children Uninsured persons, underinsured Persons without prescription insurance, dental insurance Pregnant women Older adults Persons with special needs children and adults Ethnic and racial minorities African American, Latino Undocumented persons Persons with limited English proficiency Urban residents Rural residents Homeless Persons with Medical Assistance or Medicare If no, why not?? Probe for transportation, eligibility rules, cost, lack of information, culture, language, immigration status, insurance type, provider shortages Are there barriers to accessing specific types of health care services? If so, what types of services? Primary care for adults Prescriptions Dental care Obstetrical care Womens health gyn care/prenatal care, mammograms, other Acute inpatient care Outpatient care Rehabilitation care Home health care Respite care Pediatric primary care or specialty care Adult specialty care Substance abuse treatment inpatient and outpatient Mental health treatment inpatient and outpatient What are the barriers? Probe for provider shortages, cost, transportation, eligibility rules, lack of information, culture, language, immigration status, insurance type What are the top five health and social service needs of the people you serve? Are these needs being met? If not, why not? Are there any gaps in services? What are they? Which are some exemplary services/programs? Why are they exemplary? Are there services/programs that need improvement? Why? Which of the needs not being met should have the highest priority for being met? Do you have any further comments?

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PUBLIC HEALTH

BERKS COUNTY, PENNSYLVANIA COMMUNITY HEALTH NEEDS ASSESSMENT

BERKSCOUNTYCOMMUNITYFOUNDATION ST.JOSEPHREGIONALHEALTHNETWORK READINGHEALTHSYSTEM UNITEDWAYOFBERKSCOUNTY

Advisory Committee Guidance

Reading,PAKnewitWasPoor.NowitKnowsJustHowPoor.NewYorkTimes,September27,2011,pageA10. U.S.CensusinformationforBerksCountyandcountysubareasarebasedonpopulationtotalsforZIPcodeswithin BerksCountyandthereforemaydifferfromU.S.Censustotalsbasedoncountypoliticalboundaries.

The Research and Evaluation Group

450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 0

122,000 84,400 78,100 77,800 53,400

The Research and Evaluation Group

85% 77% 75% 72%

40% 16% 20% 10% 1% 1% 2% 1% 2% Other

29% 18% 19%

20% 15% 10% 5% 0%

40% 34% 30% 28%

20% 13% 10% 8% 6% 10% 5% 6% 4% 6% 4% 5%

The Research and Evaluation Group

60% 37% 40% 31% 20% 8% 0%

49% 48% 35%

The Research and Evaluation Group

The Research and Evaluation Group

The Research and Evaluation Group

The Research and Evaluation Group

80 64.2 60 42.6 40 47.6 61.3 57.7

Healthy People 2020Goal: 7.8%

IdlerEL,BenyaminiY.SelfRatedHealthandMortality:AReviewofTwentySevenCommunityStudies.Journalof HealthandSocialBehavior.1997;2137. 14 2011BehavioralRisksofPennsylvaniaAdults,PADepartmentofHealth.

The Research and Evaluation Group

Healthy PeopleGoal 26.9%

The Research and Evaluation Group

32.9% 30.2% 27.4%

35.0% 29.0% 29.5% 28.5% 30.8% 26.1% 24.7% 30.6% 25.1%

Health People 2020Goal: 30.6%

2011BehavioralRisksofPennsylvaniaAdults,PADepartmentofHealth. ThehigherproportionofyoungadultsintheCityofReadingpopulationmaybeafactorinthisresult. 19 2011BehavioralRisksofPennsylvaniaAdults,PADepartmentofHealth.

The Research and Evaluation Group

National Institute of Mental Health, http://www.nimh.nih.gov/statistics/1ANYDIS_ADULT.shtml. Accessed November1,2012.

The Research and Evaluation Group

1000 800 600 400 200 0

15.2% 8.3% 6.4% 6.2% 8.8%

20% 11.2% 10%

Healthy People 2020Goal: 16.1%

The Research and Evaluation Group

The Research and Evaluation Group

The Research and Evaluation Group

The Research and Evaluation Group

Healthy People 2020Goal: 12%

The Research and Evaluation Group

33.4% 29.5% 25.5% 19.5% 14.8%

40% 23.9% 20%

31.3% 22.9% 24.5% 20.6% 22.6%

40% 28.0% 20%

34.3% 15.5% 18.2% 15.1% 9.9% 3.3% 3.1% 4.7%

The Research and Evaluation Group

The Research and Evaluation Group

The Research and Evaluation Group

1844 4564 65+ Male

Language Spoken Home

Asian Language Other

*White,Black,AsianandOtherracesexcludeLatinos. Note:LanguagespokenathomewasnotprovidedbyNielsenClaritasfor2000. Source:NielsenClaritasPopFactsDatabaseand2010U.S.Census.

The Research and Evaluation Group

2013 414,193 % (0.3) (2.9) (9.8) (5.0) #

2018 418,339 % (0.4) (3.2) (11.1) (5.6)

385 6,562 22,038 7,372

1,378 11,812 40,537 20,725

1,571 13,399 46,478 23,482

Mexican Puerto Rican Other