Community Health Needs Assessment
HSS routinely assesses the health needs of its diverse community. A comprehensive Community Health Needs Assessment (CHNA) is conducted every three years. The results of this assessment will be used to initiate and improve community healthcare programs. This report provides a snapshot of the CHNA assessment process, results, and program implementation.
Goals
- Assess the needs of our diverse communities
- Identify health disparities
- Develop and implement programs to address community health needs
Service Areas
HSS’s primary service area consists of the five boroughs of New York City, while its secondary service area is comprised of Hudson Valley, New York; Northern and Central New Jersey; Connecticut; Long Island, New York; and Palm Beach County, Florida.
Approach
- Collect data: Collect and analyze data from community surveys, community partner interviews, and local, state, and federal systems to highlight the community’s health needs
- Obtain input: Establish a collaborative environment to obtain community input from HSS stakeholders, community partners, and health agencies serving diverse populations
- Prioritize health needs: Identify and prioritize health needs through community forums
- Implement action plan: Develop and implement an action plan to address identified health needs and disparities
Interviews were conducted virtually with 22 community partners serving diverse communities in the five boroughs of New York City; Westchester, NY; and Connecticut. Themes from the interviews are presented below:
A community survey was conducted with a total of 18,248 responses received from patients and community members, which was given online and in-person in English, Spanish, Chinese, and Russian. The results below provide a snapshot of our respondents and their reported musculoskeletal health needs.
+ Socio-Demographics
Age
- 20% < 20 years
- 30% 20-39 years
- 23% 40-59 years
- 38% 60-79 years
- 6% 80+ years
Gender Identity
- 66% Female
- 32% Male
- 1% Other
Race
- 57% White
- 23% Black/African American
- 8% Asian
- 7% Other
- 2% American Indian/Alaska Native
- 1% Native Hawaiian/Other Pacific Islander
Hispanic Origin
- 74% Non-Hispanic/Latino
- 23% Hispanic/Latino
Annual Household Income
- 28% < $35,000
- 28% $35,000-$99,999
- 27% ≥ $100,000
+ Health Status and Quality of Life
- Top three most common musculoskeletal health conditions reported:
- Osteoarthritis
- Chronic pain
- Some other form of arthritis
- Almost half (45%) reported low confidence in managing their condition
- < 20% reported poor physical or mental health
- 3 in 10 fell in the past year
- 4 in 10 rated their sleep quality terrible or poor
+ Health Behaviors and Lifestyle
- 3 in 4 lack physical activity
- Top barriers to eating healthy
- Eating habits of friends/family
- Taste
- Cost
- More than one-third report using prescription pain medicine or opioids
- 75% report not using complementary alternatives to manage pain
+ Access to Care
- Top issues affecting health/wellbeing
- COVID-19 related issues
- Social isolation/loneliness
- Limited places to exercise
- 42% could not access healthcare when needed in the past year
- Top barriers to accessing care
- Getting an appointment
- Cost of care
- Over 60% were interested in using telehealth
- Top barriers to telehealth use
- Lack of knowledge
- Concerns about medical errors/confidentiality
- Top barriers to following medical advice
- Over half respondents reported experiencing discrimination to care where clinicians did not listen to them
+ Health Education
- 7 in 10 did not participate in health education last year
- Preferred health education activities
- Virtual exercises classes
- Virtual lectures
- On-demand videos
- Preferred health education topics
- Exercise
- Healthy eating
- Mental health
Community Profile
In addition to the interviews and community survey, local, state and federal data were reviewed to create a community profile to provide essential information and insight on a broad range of health issues in our community.
+ Demographics
Race/Ethnicity1
- 41% White
- 29% Hispanic/Latino
- 24% Black/African American
- 14% Asian
Immigrant-Population2
- More than 1 in 3 are foreign-born
Sex3
Age
- 15% of the population is aged 65+ years1
- This is expected to grow to 21% in 20403
+ Health and Social Indicators
- 8% do not have health insurance3
- 1 in 10 could not access healthcare when needed in the past year4
- 77% self-report good health5
- Over 2 in 10 drink more than one sugary beverage per day6
- Spanish is the most widely spoken language at home other than English3
- 18% live in poverty6
- More than 8 in 10 have a high school diploma or higher1
References
- United States Census Bureau. (2021, July 1). QuickFacts. Retrieved from United States Census Bureau: https://www.census.gov/quickfacts/newyorkcitynewyork
- NYC Health. (2018, January 19). New York City Neighborhood Health Atlas. Retrieved from Tableau: https://public.tableau.com/app/profile/nyc.health/viz/NewYorkCityNeighborhoodHealthAtlas/Home
- Cortés-Vázquez, L. (2020). Annual Plan Summary. New York: New York City Department for the Aging. Retrieved from https://www1.nyc.gov/assets/dfta/downloads/pdf/reports/AnnualPlanSummary111820.pdf
- NYC Health. (2019). Health Care Access and Use - Subtopic: Health Care Use. Retrieved from EpiQuery: https://a816-health.nyc.gov/hdi/epiquery/visualizations?PageType=ts&PopulationSource=CHS&Topic=2&Subtopic=17
- New York City Department of Health and Mental Hygiene. Community Health Survey [2019]; public use dataset accessed on [29 August 2022].
- Shin, J., Krampner, J., Virgin, V., & Hill, A. (2021). New York City Government Poverty Measure 2019. New York: The City of New York. Retrieved from https://www1.nyc.gov/assets/opportunity/pdf/21_poverty_measure_report.pdf
Throughout the CHNA process, HSS engaged various constituents in data collection and to guide the selection of the health needs and services to address in its community programming. Input was obtained from the following groups:
- HSS CHNA Steering Committee
- HSS internal stakeholders
- Public Health Departments and other experts
- Community partners
- General public
The results of the CHNA were shared with community members and stakeholders through a series of 8 virtual forums reaching 131 community members. At the forums, community members engaged in an open discussion about the CHNA results, then were asked to rank seven health indicators in order of importance.
Top 7 Health Needs
- Osteoarthritis
- Stress
- Stiffness
- Fatigue
- Chronic pain
- Lupus
- Injury prevention
To address the health needs identified through community forums, HSS offers a diverse range of targeted, culturally-relevant, evidence-based programming. Please click on each program below for more information.
- Support groups and creative workshops to target social isolation and improve coping skills
- Health Needs Addressed: Stress, chronic pain
- Community-based exercise and education program to help Asian older adults manage their chronic musculoskeletal conditions and increase access to care
- Health Needs Addressed: OA, stiffness, fatigue, chronic pain
- A free national peer health education and support program to increase knowledge of lupus among Hispanic/Latino and African American communities
- Health Needs Addressed: Lupus
- Exercise and education programs to raise awareness, educate and reduce the impact of musculoskeletal conditions
- Health Needs Addressed: OA, stiffness, fatigue, chronic pain
- A free national bilingual peer support and education program for Asian Americans with lupus and their families
- Health Needs Addressed: Lupus
- A community-based screening and education program to detect, treat, and prevent sports related injuries in young athletes
- Health Needs Addressed: Injury prevention
- A support and education program for community members and families living with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA) and gout
- Health Needs Addressed: Lupus, stiffness, fatigue
- A primary and secondary sports injury prevention program for young adults, coaches, teachers, and parents
- Health Needs Addressed: Injury prevention
- An advocacy program to help low income, culturally diverse patients aged 60+ years, with arthritis and related chronic illnesses, with accessing services and support to improve quality of life
- Health Needs Addressed: OA, stiffness, fatigue
Past Community Health Needs Assessment
For more information, please contact us at communityed@hss.edu.
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