Los Angeles County 2017 Community Health Needs Assessment

Melissa Acuna, B.S., MPH (c)

Caress Baltimore, B.S., MPH (c)
California State University, San Bernardino
 Table of Contents

I. COMMUNITY SERVED...... 2

A. Map of Los Angeles County... 2

B. Description of Los Angeles County 2

C. Service Planning Areas of Los Angeles County......... 2

II. PROCESS AND METHODS TO CONDUCT THE CHNA.... 3

A. Secondary Data... 3

III. DETERMINANTS OF HEALTH... 3

A. Demographic Determinants........ 3

i. Total Population Health Indicator..........4

ii. Population with Limited English Proficiency Health Indicator.... 4

B. Social and Economic Determinants.... 5

i. Student Reading Proficiency (4th Grade) Health Indicator 5

ii. Population with No High School Diploma Health Indicator..... 6

C. Physical Environment Determinants... 7

i. Housing Overcrowded Housing Health Indicator.. 7

D. Clinical Care Determinants. 8

i. Lack of a Consistent Source of Primary Care Health Indicator 8

E. Health Behavior Determinants 9

i. Walking or Biking to Work Health Indicator 9

IV. RECOMMENDATIONS. 10

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I. COMMUNITY SERVED

A. Map of Los Angeles County1

B. Description of Los Angeles County2

Surrounded by Ventura, Kern, San Bernardino, and Orange Counties, Los Angeles County is

a densely populated county. Over 25% of Californias population resides within Los Angeles

County, a 4,058 square mile stretch of land with a population of 10,038,388 people.

Compared to the national average population density of 89.61 persons per square mile, Los

Angeles County is nearly 27 times that with an estimated 2,473 persons per square mile.

C. Service Planning Areas of Los Angeles County3

Divided into eight distinct geographic areas referred to as Service

Planning Areas (SPAs), these regions allow the Los Angeles

County Department of Public Health to provide services relevant

to the specific health needs of each area. The eight regions

depicted are SPA 1: Antelope Valley; SPA 2: San Fernando

Valley; SPA 3: San Gabriel Valley; SPA 4: Metro LA; SPA 5:

West; SPA 6: South; SPA 7: East; SPA 8: South Bay.

1
World Atlas. (2017). Where is Los Angeles County, California? Retrieved October 30, 2017 from
http://www.worldatlas.com/na/us/ca/c-los-angeles-county-california.html
2
Community Health Needs Assessment (CHNA). (2017). Health indicators report. Retrieved October 30, 2017 from
https://assessment.communitycommons.org/CHNA/report?reporttype=libraryCHNA
3
Los Angeles County Public Health Department (2017). Service planning areas. Retrieved October 30, 2017 from
http://publichealth.lacounty.gov/chs/SPAMain/ServicePlanningAreas.htm

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II. PROCESS AND METHODS TO CONDUCT THE CHNA

A. Secondary Data

An initial graphic representation of Los Angeles County was obtained through the World

Atlas website, http://www.worldatlas.com/na/us/ca/c-los-angeles-county-california.html. A

map of the SPAs was retrieved from the Los Angeles County Department of Public Healths

website, http://publichealth.lacounty.gov/chs/SPAMain/ServicePlanningAreas.htm. Finally,

utilizing the Community Commons website, https://www.communitycommons.org/chna/, the

option to Run an Indicator Report was selected in order to initiate the process to retrieve

data. After selecting California as the State, and Los Angeles County, CA as the county,

the View Report option was selected. Within the Health Indicator Report generated, the

various data categories were evaluated as determinants of health and were perused to evaluate

different associated health indicators.

III. DETERMINANTS OF HEALTH4

A. Demographic Determinants

Within a given population, the population composition and demographics can affect the

communitys availability of resources and public health services available to overcome

negative health outcomes. The population demographics within a community play a

significant role in identifying target populations driving health care needs. Additionally,

population demographics provide insight into populations more at risk for certain health

behaviors or health outcomes. A communitys demographics provides insight into whether a

4
Community Health Needs Assessment (CHNA). (2017). Health indicators report. Retrieved October 30, 2017 from
https://assessment.communitycommons.org/CHNA/report?reporttype=libraryCHNA

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 communitys infrastructure can provide adequate and appropriate resources for a diverse

population.

i. Total Population Health Indicator

As a densely populated area, Los Angeles County requires unique approaches to ensure

there are positive health outcomes within the community. With over of the states

population residing in this county, the total population is a key indicator for demographic

determinants of health. Understanding the countys population size provides insight into

the populations at risk for health disparities and provides an indication of required

resources needed to accommodate the different populations being served within the

community. As depicted in Figure 1, the countys age population is nearly evenly

distributed among the different age groups with the exception of children in the Age 0-4

group.5 The age distribution within the Los Angeles County provides an indication of

how to distribute resources within the community, such as having equal amounts of

seniors centers and youth activity centers. There is also a nearly 50:50 ratio of Hispanic

population to Non-Hispanic population within Los Angeles County, which can provide

context in understanding primary language spoken and whether language barriers result in

negative health outcomes.

Figure 1: In this figure, the Los Angeles County total population is broken down by age groups
(CHNA, 2017).
5
Ibid

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 ii. Population with Limited English Proficiency Health Indicator

As a key indicator to the demographic determinants of health, populations with limited

English proficiency are at risk for health illiteracy, limited education, income disparity,

and healthcare barriers.6 In Los Angeles County, over 25% of the population over the age

of 5-years-old is with limited English proficiency. This is nearly 7% over the state level

and nearly three times the national level.7 As can be seen in Figure 2, various other

languages aside from English are prominent in Los Angeles County such as Spanish or

other Asian and Pacific Island languages.

Figure 2: In this figure, the Los Angeles County population with limited English proficiency is depicted
by primary languages spoken at home (CHNA, 2017).

B. Social and Economic Determinants

The social and economic determinants have a significant impact on health outcomes. Within

the realm of social and economic determinants of health, a communitys infrastructure and

available resources affect the extent of positive and negative health outcomes within a

communitys population. This includes a communitys ability to offer quality education,

accessible healthcare, affordable housing, and opportune employment to its population.

6
Ibid
7
Ibid

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 i. Student Reading Proficiency (4th Grade) Health Indicator

Reading proficiency is a key indicator within social and economic determinants of health

because of the associations between poor reading proficiency and poor health literacy,

communication barriers, poverty, and unemployment.8 Public health campaigns and

attempts to improve health outcomes often generate materials with the average person in

mind who is assumed to read at a minimum of a fifth-grade reading level. Poor reading

proficiency encompasses poor comprehension of read materials, regardless of content such

as intervention pamphlets or work manuals, thus affecting not only health outcomes, but

also employment opportunities. As can be seen in Table 1, the majority of students in Los

Angeles County score Not Proficient or worse on state standardized tests.

Table 1. Based upon the English Language Arts portion of California standardized tests, this table
depicts the reading proficiency level of students in Los Angeles Count as compared to the state and
nation (CHNA, 2017).

ii. Population with No High School Diploma Health Indicator

The population without a high school diploma is a key health indicator within the social

and economic determinants of health based upon the associated factors education has on

quality of life for individuals. Typically, individuals with lower levels of education are at

risk for poorer health outcomes. Education itself is linked to other aspects of quality of

life such as employment, health literacy, or income. Each of these aspects can affect an

individuals health status such as inability to work a professional level occupation,

8
Ibid

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 inability to comprehend medical diagnosis or treatment, or inability to make sufficient

wages in order to afford health insurance or medical treatment. In Los Angeles County,

over 22% of the population over the age of 25-years-old do not have a high school

diploma.9 This exceeds both Californias percentage of 18% and the national percentage

of 13%.10 As can be seen in Figure 3, the population without a high school diploma in

Los Angeles County is also higher than that of surrounding counties.

Figure 3. The representation in this figure identifies the population of individuals over the age of 25-
years-old without a high school diploma in Los Angeles County and surrounding areas (CHNA, 2017).

C. Physical Environment Determinants

The physical environment determinants of health incorporate important factors affecting

health status such as physical activity or safety. The built environment encompasses aspects

of whether a community possesses resources such as parks, fitness centers, bicycle lanes, or

sidewalks for community members to engage in physical activity. Physical environment has

a role in the safety of community members, particularly in a community with a large

population with increased risk for criminal activities.

i. Housing Overcrowded Housing Health Indicator

Within Los Angeles County, overcrowded housing is an important health indicator as it

relates to the safety of the population from the concept of communicable disease, criminal

9
Ibid
10
Ibid

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 activity, and mental wellness. As depicted in Table 2, the percentage of housing units that

are considered overcrowded (more than one occupant per room) in Los Angeles County, is

nearly twice the percentage reported by the state and nearly five times the percentage of

the national level.11

Table 2. The table above depicts the percentage of housing units that are overcrowded (CHNA, 2017)

D. Clinical Care Determinants

Clinical care determinants of health are largely related to access to healthcare. Multiple

barriers exist preventing access to care for individuals such as lack of insurance, language

barriers, geographic location, or provider shortages. With limited access to care, community

health is affected as there are fewer positive health outcomes available with the lack of

resources.

i. Lack of a Consistent Source of Primary Care Health Indicator

The lack of a consistent source of primary care is a significant health indicator as it relates

to clinical care determinants of health because it is a contributing factor to barriers

preventing access to care. The lack of a consistent source of primary care has the

community implication of increased utilization of emergency departments or urgent care

services among the population. Additionally, individuals without a consistent source of

primary care are at risk for having preventable diseases remaining untreated. Consistent

primary care provides a community with primary, secondary, and tertiary interventions to

11
Ibid

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 positively impact overall community health. As can be seen in Figure 4, the percentage of

adults over the age of 18-years-old without a regular doctor in Los Angeles County

exceeds the percentage of the population without a regular doctor in both California and

the United States.12

Figure 4. This figure displays the comparison between Los Angeles Count,
California, and the United States regarding the percentage of adults without a
regular doctor (CHNA, 2017).

E. Health Behavior Determinants

Overall health status can be attributed to a variety of health behaviors such as consuming

alcohol, using tobacco, exercising, or eating properly. With regards to health behaviors,

these are the individual actions affecting health status.

i. Walking or Biking to Work Health Indicator

The majority of Los Angeles County is urbanized and developed. With the significant

population, there are more vehicles on the road and more traffic to contend with than other

less populated regions. For some individuals, the alternative to driving is to utilize public

transportation systems or to engage in physical activities such as walking or biking to

work. Within the Los Angeles community, the percentage of individuals walking or

biking to work is 3.75% and exceeds the national percentage of 3.38%; however, the

12
Ibid

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 percentage population is lower than Californias walking or biking to work population of

3.84%.13 As a key health indicator to health behaviors as a determinant of health, walking

or biking to work identifies level of physical activity within a population, particularly in

crowded county. This activity can also be used as an indicator of the built environment or

motivation of the population to engage in physical activity.

IV. RECOMMENDATIONS

Los Angeles county has several obstacles when it comes to addressing the needs of its diverse

population. To combat language barriers in public health and healthcare settings, hospitals, or

clinics, policy changes should be implemented to require all clinical settings to have literature

produced in multiple languages, as well as have a translating system on-site for Los Angeless

most common languages spoken at home such as Spanish or other Asian languages. This can

help decrease the issue of poor health literacy and simultaneously improve health care

communication between patients and providers for the nearly 25% of the population with limited

English proficiency. Additionally, private and non-profit organizations could also receive

incentives from the government for providing comprehensive language inclusion for patients and

community members. Incentives could include tax breaks, additional funding, or grant awards.

Another significant issue in Los Angeles County is the large percentage of adults without

reading proficiency or a high school diploma. Because education is a determining factor for

several health outcomes, such as obtainable health insurance, health literacy, and food security, it

is vital to establish a well-educated society that has the means to navigate and better their living

situation. Recommendations to improve reading comprehension and high school completion

13
Ibid

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rates encompasses offering little-to-no cost courses that may help an individual complete their

G.E.D, or perhaps improve their English language proficiency. Schools could be incentive to

better prepare students for standardized testing with end-of-the-year technology grants. Students

could be incentivized with job placement programs guaranteed after graduation to ensure

students have a path to sustainable employment after obtaining their education.

Finally, housing is a major issue that is an immediate need that has to be addressed. A lack of

affordable and available housing is leaving families without a safe living environment. Los

Angeles County needs to prioritize its housing needs and development to ensure families of all

incomes can afford and live in an environmentally safe housing unit without overcrowding. This

must be accomplished through policy implementation and regulation to institute a rental cap in

order to decrease rising housing costs and improve neighborhood infrastructure by means of

providing adequate housing space.

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