berks county, pennsylvania community health needs assessment

7/29/2019 Berks County, Pennsylvania Community Health Needs Assessment

1/129

PUBLICHEALTHmana ement cor oration

BERKS COUNTY,PENNSYLVANIACOMMUNITY HEALTH NEEDS ASSESSMENT

PREPAREDFOR:BERKSCOUNTYCOMMUNITYFOUNDATIONST.JOSEPHREGIONALHEALTHNETWORK

READINGHEALTHSYSTEMUNITEDWAYOFBERKSCOUNTY

PREPARED BY:

THERESEARCHANDEVALUATIONGROUPPUBLICHEALTHMANAGEMENTCORPORATION

260SOUTHBROADSTREET,18THFLOORPHILADELPHIA,PA19102

JANUARY2013


2/129


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

APPENDIX A: U.S.CENSUSTABLES

APPENDIX B: VITALSTATISTICSTABLES

APPENDIXC: HOUSEHOLDHEALTHSURVEYTABLES

APPENDIXD: ASSETMAPS

APPENDIXE: COMMUNITYRESOURCELIST

APPENDIXF: FOCUSGROUPDISCUSSIONGUIDE

APPENDIXG: KEYINFORMANTINTERVIEWGUIDE


3/129

i


BERKSCOUNTYCOMMUNITYHEALTHNEEDSASSESSMENT

EXECUTIVESUMMARY

PURPOSE

This needs assessment wasjointly sponsored by the Berks County Community Foundation, St. Joseph

RegionalHealthNetwork,ReadingHealthSystem,andtheUnitedWayofBerksCounty. Thepurposeof

theneedsassessment isto identifyandprioritizecommunityhealthneedssothattheseorganizations

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

morethan

a

few

months.

Therefore,

information

on

the

impact

of

the

legislation

and

the

Health

Center

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

1Reading,PAKnewitWasPoor. NowitKnowsJustHowPoor. NewYorkTimes,September27,2011,pageA10.


4/129

ii


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,andLatinosare inpooreroverallhealth,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

identifiedthe costofhealthcare, including insurancecoverage,copays,and deductibles,asthemost

commonhealthconcern. Forexample:

One insevenadultsaged1864(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%of

adults,

or

about

37,000

individuals,

reported

that

there

was

a

time

in

the

past

year

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.

Althoughthese

disparities

are

not

isolated

in

any

one

geographic

region

compared

to

Berks

County

as

a

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.


5/129

iii


SelectedHealthIndicatorsfromtheBerksCountyCommunityHealthNeedsAssessment

IndicatorsFigure# BerksCounty Reading North

Berks

South

Berks

East

Berks

West

Berks

HealthStatusandBehaviorIndicators*

Mentalhealth

condition

18

14.6% 21.3% 10.7% 14.1%

11.6% 15.6%

Healthstatusfairorpoor 15 15.9% 32.6% 14.5% 14.0% 13.2% 7.4%

Highbloodpressure 16 33.4% 40.0% 30.5% 33.1% 34.6% 30.8%

Obesity 17 30.2% 35.0% 26.1% 30.8% 29.5% 30.6%

Diabetes AppCTable1 13.9% 18.9% 13.7% 13.7% 16.9% 8.8%

ERvisitduetonoinsurance 22 24.8% 44.1% 16.6% 27.3% 8.1% 6.8%

Did not fill prescription due to

cost

AppCTable3 13.7% 23.7% 15.4% 12.5% 7.4% 8.9%

Nodentalcareduetocost AppCTable3 21.1% 33.2% 20.2% 19.3% 22.2% 14.0%

Noregularsourceofcare 24 11.8% 18.9% 11.7% 9.1% 11.9% 9.6%

Smoking 27 20.4% 29.3% 18.5% 19.3% 18.5% 17.6%

Bingedrinking AppCTable4 38.4% 47.9% 32.8% 43.6% 37.1% 33.0%

VitalStatistics**

Adolescentbirths/1,000births 13 9.4 28.1 3.5 5.1 NA 2.8

Late/noprenatalcare 25 32.8% 50.1% 24.7% 24.0% 24.8% 23.0%

Mortalityrate/100,000pop 20 731.3 926.6 692.0 699.6 720.1 639.5

Social/EconomicIndicators

Uninsuredadults* 21 13.3% 23.7% 8.3% 8.8% 15.2% 13.9%

Lowsocialcapital* 28 31.0% 57.0% 29.5% 25.5% 22.3% 23.8%

Livinginpoverty*** 8 13% 34% 6% 10% 5% 6%

*Source: PHMCs2012BerksCountyHouseholdHealthSurvey(n=1,101)

**Source: PADepartmentofHealth,BureauofHealthStatisticsandResearch,20052008;nottestedforsignificance

***Source: U.S.Census,2010;nottestedforsignificance

Note: ShadedareasrepresentstatisticallysignificantlyworseresultscomparedtoBerksCounty(p


6/129

iv


Nonetheless,theresultsoftheCommunityHealthNeedsAssessment indicateaneedforanexpansion

ofessentialhealthcareservices.

It is also notable that Berks County lacks a public health department. In many communities such a

resourceaddresses

gaps

in

the

health

safety

net

for

at

risk

populations

in

addition

to

risks

affecting

the

overallhealthofthe largerpopulation. 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

Providing

preventive

screenings

and

health

education

to

at

risk

subpopulations;

o Addressingbarriersatriskpopulationsface inaccessingaffordablemedications,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

processesfor

publicly

funded

health

insurance;

and

o Addressingconcernsofthoseatriskpopulationswhoselegalstatusrepresentsabarrier

toaccessingessentialhealthservices.

Target2: EnhancePersonalHealthBehaviors

Increase programs and interventions which address personal health behaviors that negatively

impacthealth.Prioritiesshouldinclude:


7/129

v


o Developing strategies to address adolescent pregnancy, particularly in the City of

Reading;

o Assistingsmokersinquitting;

o Addressingobesity,especiallyinchildren;and

o Developinga

concerted

effort

to

reduce

binge

drinking

in

the

County

as

a

whole.

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:

TheoverallhealthstatusofBerksCountyresidents isreasonablygoodcomparedtonormsfor

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

care

issues.

The

three

priorities

chosen

are:

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.

LongerTerm

Objectives

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:


8/129

vi


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

approachesto

financing

and

ensuring

the

sustainability

of

such

a

capability;

and

Exploringhowanepidemiologicaldatabasecouldbedevelopeddrawingonexistingpublicand

private resourcesto bettermonitor population healthandthecausesofdisparitieswithinthe

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,aconcertedeffortonthepartofcommunityresources isrequiredtoaddressand

minimizetotheextentfeasiblethetroublesomedisparitieshighlightedintheCommunityHealthNeeds

Assessment.

Thereport

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.


9/129

The Research and Evaluation Group


1

I. INTRODUCTIONPURPOSEThisneedsassessmentwasjointly sponsoredby theBerksCountyCommunityFoundation,St. Joseph

RegionalHealthNetwork,ReadingHealthSystem,andtheUnitedWayofBerksCounty. Thepurposeof

theneedsassessment isto identifyandprioritizecommunityhealthneedssothattheseorganizations

can develop strategies and implementation plans that benefit the public as well as satisfy the

requirementsoftheAffordableCareActforthetwohospitals. Thisreportsummarizestheresultsofan

assessmentofthehealthstatusandhealthcareneedsofresidentsinBerksCounty,Pennsylvania. The

needs assessmentwas conductedby PublicHealthManagementCorporation (PHMC),aprivatenon

profitpublichealth institute. Thisneedsassessmentwascompletedbeforemanyoftheprovisionsof

theAffordableCareActwent intoeffect,andbeforetheBerksCommunityHealthCenterhadbeen in

operationformorethanafewmonths. Therefore,informationontheimpactofthelegislationandthe

Health

Center

on

access

to

health

care

were

not

included

in

the

research

for

this

assessment.

It

is

anticipated thatbothof these recentchanges in thehealthcare system inBerksCountywillhavean

impactontheissuesraisedbythisassessment.

This introduction includesadefinitionofthecommunityassessed in thereport,thedemographicand

socioeconomic characteristicsof the residents, and the existinghealth care resources followedby II.

NeedsAssessmentProcessandMethods;III.Findings;IV.UnmetHealthCareNeeds;andV.Conclusion

andRecommendations. TablesandmapsareincludedinAppendicesAG.COMMUNITYDEFINITIONBerks

County

(2010

Pop.

411,500)

was

defined

as

the

community

for

the

purposes

of

this

assessment.

BerksCounty includesurban, suburban, and rural areaswith

distinctpopulationsandhealthresources. Forthepurposesof

thisneedsassessment,fivegeographicsubareasoftheCounty,

defined by ZIP code clusters, were identified: the City ofReadingandEast,West,North,andSouthBerksCounty(Map1). Theboundariesofthesesmallerareasweredeterminedby

the Needs Assessment Steering Committee in collaboration

with PHMC using county geography and population

demographics.TheCityofReading,consistingofonlythreeZIP

codesapproximatelycontiguouswithitsmunicipalboundaries,wasassessedasaseparateareabecause

oftheuniquesocioeconomicanddemographiccharacteristicsofitspopulationcomparedtootherareas

ofBerks

County.


10/129



2

Source: U.SCensus,2010. PreparedbyPHMC.


11/129



3

COMMUNITYDEMOGRAPHICS

Thisreportincludesadescriptionofthesocioeconomicanddemographiccharacteristicsoftheresidents

ofBerksCountyanditsseparateregionsbecausethesecharacteristicsarestrongindicatorsofaccessto

healthcareandgoodhealth.

PopulationSizeandTrendsThe 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.

Thetotal

population

of

Berks

County

is

nearly

411,500,

a

10%

increase

from

373,600

in

2000

(Figure

1).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.

TheSouthBerksareahadthe largest increase in itspopulation from2000to2010 (13.3%);the East

Berksareahadthesmallestincrease(1.7%).

The City of Reading, and North, West, and South Berks areas are projected to increase slightly in

populationthrough

2018,

and

the

East

Berks

area

is

expected

to

decrease

slightly

(Figure

2).

2Reading,PAKnewitWasPoor. NowitKnowsJustHowPoor. NewYorkTimes,September27,2011,pageA10.

3U.S.CensusinformationforBerksCountyandcountysubareasarebasedonpopulationtotalsforZIPcodeswithin

BerksCountyandthereforemaydifferfromU.S.Censustotalsbasedoncountypoliticalboundaries.


12/129



4

Figure1: PopulationofBerksCountybyArea,2010

Source:2010U.S.Census. PopulationfiguresbasedonZIPcodepopulation.

Figure2: PopulationofBerksCounty,20002018

Source: NielsenClaritas PopFacts Database (2013, 2018) and 2000, 2010 U.S. Census. Population figures based on ZIP code

population.

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

2000 2010 2013Estimate 2018Estimate

BerksCounty SouthBerksCounty NorthBerksCounty

Reading WestBerksCounty EastBerksCounty

411,500

122,000

84,40078,100 77,800

53,400

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

BerksC ou nty Sout hBerksCounty NorthBerksCounty Reading WestBerksCounty EastBerksCounty


13/129



5

DemographicCharacteristicsAge

BerksCounty

has

arelatively

high

percentage

of

older

adults

aged

65

and

over

(14.5%)

compared

to

the UnitedStates as awhole (13.0%). This percentage is lower than thepercentage for Pennsylvania

(16.0%). InBerksCountynearlyonequarterofresidentsarechildrenbetweentheagesof017(23.9%),

just over onethird are aged 1844 (34.3%), and over onequarter are aged 4564 (27.4%). The

populationofBerksCounty isaging;therewasadecrease inthepercentageofresidentsaged1844

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,only

8.9%

of

adults

in

the

City

of

Reading

are

65

or

older

compared

to

14.5%

for

Berks County. In Reading, the percentage of residents under 65 years of age slightly increased from

2000to2010,whilethepercentageofadults65orolderdecreased.

TheNorth,South,andWestBerksareasfollowapopulationtrendthat issimilartoBerksCountyasa

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.

4ItisimportanttonotethatracialandethnicminoritiesareoftenundercountedbytheU.S.Census. Therefore,the

Asian,Black,andLatinopopulationsofBerksCountymayactuallybelargerthanreported.


14/129



6

Figure3: Race/EthnicityofBerksCountyResidents,20002018


population.

TheraceandethnicityofBerksCountyresidentsvariesbyarea. TheCityofReadinghasamuchhigher

percentageofLatino(59.6%)residentsthanWhite(27.1%)orBlack(10.2%)residents. Incontrastto

theCityofReading,theNorth,South,EastandWestBerksareasaremuch less raciallyandethnically

diverse;over

85.0%

of

the

population

is

White

and

3.0%

or

less

of

the

population

is

Black.

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).

85%

3% 1% 1%

10%

77%

4%2%

16%

75%

1%

72%

2%

20%

0%

20%

40%

60%

80%

100%

White Black Asian Other Latino



15/129



7

Figure4: Race/EthnicityofCityofReadingResidents,20002018


population.

LatinoOrigin

Approximately one in six residents of Berks County (16.4%) is Latino. The Berks County Latino

population increasedfrom9.7%to16.4%between2000and2010,and isprojectedtoreach20.3% in

2018.

Latinoresidents

most

commonly

identify

as

Puerto

Rican

(7.8%),

followed

by

other

Latino

origin

(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).

47%

11%2%

2%

38%

27%

10%

60%

23%

1%

65%

18%

9%

71%

0%

20%

40%

60%

80%

100%

White Black Asian Other Latino



16/129



8

Figure5: CityofReadingLatinoPopulationbyCulturalOrigin,20002018

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

originincreasedslightlyin2010intheNorth,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 VietnameseAmerican, followedby 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.

LanguageSpoken

at

Home

The overwhelming majority of Berks County residents speak English at home (85.1%), about one in

elevenspeaksSpanish(10.6%),3.6%speakanother language,and0.7%speakanAsian language. The

percentageofresidentswhospeakSpanishathomeisprojectedtoincreasetoabout12.2%in2018.

IntheCityofReading,morethantwoinfiveresidents(42.5%)speakSpanishathome,althoughthe

majorityspeakEnglishathome(53.3%). IntheNorth,South,EastandWestBerksareas,atleast90.0%

0% 1%1% 1%

10% 10%11%

23%

29%

36%

39%

7%

13%

18% 19%

0%

10%

20%

30%

40%

50%

2000 2010 2013Estimate 2018estimate

Cuban Mexican PuertoRican Other


17/129



9

ofresidentsspeakEnglishathome. SimilartotheCountyasawhole,thepercentageofresidentswho

speakSpanishathomeisestimatedtocontinuetoincreaseslightlyinReadingto46.1%in2018.

SocioeconomicIndicatorsEducation

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.

Cityof

Reading

residents

are

twice

as

likely

to

have

dropped

out

of

high

school

and

one

half

as

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 theCityofReading thepercentage ofthosewith less

thanahighschooldegreeisprojectedtoincreaseto34.4%in2018,andthepercentageofthosewith

acollegedegreeormoreisexpectedtodecreaseto9.7%(Figure6).

Figure6: ResidentswithLessthanaHighSchoolDegreeinBerksCounty,20002018


population.

0%

10%

20%

30%

40%

50%

2000 2010 2013Estimate 2018estimate


Reading WestBerksCounty EastBerksCouonty


18/129



10

Employment

The overwhelming majority of Berks County residents age 25 and over (94.6%) were employed in

2010.

By2013,

however,

the

unemployment

rate

is

projected

to

double

to

9.7%.

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:

Percentage

of

Unemployed

Adults

25+

in

Berks

County,

2000

2018

Source: NielsenClaritas PopFacts Database (2013, 2018) and 2000, 2010 U.S. Census. Population figures based on ZIP

codepopulation.

5%5%

10% 10%

3%3%

7%7%7%

8% 9% 9%

10% 10%

21% 21%

0%

5%

10%

15%

20%

25%



Reading WestBerksCounty EastBerksCounty


19/129



11

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

Thefamily

poverty

rate

is

projected

to

increase

in

2013

and

2018.

The City ofReading 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

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

poverty

in

2018

(Figure

9).

5FederalRegisterVolume77,Number17(Thursday,January25,2012).

8%

6% 5%

28%

4% 4%

13%10%

6%

34%

6% 5%

0%

10%

20%

30%

40%

50%

BerksCounty SouthBerksCounty NorthBerksCounty Reading WestBerksCounty EastBerksCouonty

Familiesw/ochildrenlivinginpoverty Familieswithchildrenlivinginpoverty


20/129



12

Figure9: Percentage of Families With and Without Children Living in Poverty in Reading City,

20102018


population.

MedianHouseholdIncome

ThemedianhouseholdincomeinBerksCountyis$54,800annually,anincreasefrom$45,118in2000.

However,household

income

in

the

County

is

projected

to

decrease

in

the

future

to

$51,500

annually

in

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).

8%

28%

36%35%

31%

37%

49%

48%

0%

20%

40%

60%

80%

100%


Familiesw/ochildrenlivinginpoverty Familieswithchildrenlivinginpoverty


21/129



13

Figure10: MedianHouseholdIncomeinBerksCounty,2010

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%)

rent

their

home.

These

percentages

are

not

projected

to

change

through

2018.

HomeownershipismuchlesscommonintheCityofReadingthanintherestofthecounty: 58.5%of

residentsrenttheirhomescomparedto28.3%countywide. Housingtenure intheCityofReading is

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

$54,800

$64,300 $64,100$60,400 $59,900

$29,000

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

BerksCounty EastBerksCou nty WestBerksCounty SouthBerksCounty NorthBerksCounty Reading


22/129



14

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

BerksCounty

Health

Department

to

provide

these

services

throughout

the

County.

Although

many

of

thehealthandsocialserviceprovidersdiscussed inthissection individually providethemanyservices

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

caregeneral hospitals are teaching hospitals that are locatedjust outside the municipal boundaries of the

CityofReading. St. Joseph RegionalHealth Network admitted 8,122 inpatients andreported 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;

6PennsylvaniaHealthCareCostContainmentCouncil,2012.


23/129



15

The Center for Mental Health including a 35bed psychiatric hospital (adult and adolescent

beds);anda

110bedpostacutehospital.

Therewere

800

and

3,586

births

at

each

hospital,

respectively,

in

fiscal

year

2011.

PrimaryCare

Primary care patient medical homes are an important resource in insuring continuous and

comprehensivecarethatcanpreventoramelioratechronicdisease. BerksCountyhas fewerprimary

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

physiciansas

an

indicator

of

overall

health

in

the

community.

Although

studies

have

shown

a

significant

relationshipbetweenhigherprimarycarephysiciansupplyand lowermortality, longer lifeexpectancy,

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 topopulation than thecounty 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.10 Thelowerratioofprimarycarephysicianstothepopulationinthese12censustracts

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),whichopened in

June 2012, and the St. Joseph Regional Health Network Downtown Campus, both in the City of

Reading,andtheWesternBerksFreeMedicalClinicinRobesonia. TheBerksCommunityHealthCenter,

whichreplacedtheReadingDispensary,providesprimarymedicalcaretouninsuredandinsuredadults,

7www.countyhealthrankings.org ,November 1,2012. Theoriginalprimary carephysician topopulation ratio for

BerksCounty

on

which

the

County

Health

Rankings

were

based

was

incorrect

because

General

Practice

physicians

were counted twice in error. The corrected ratio, which is higher, is used in this report, but the Berks County

HealthRankingswerenotchangedtoreflectthecorrectedphysiciantopopulationratio.8www.berkscms.org accessedOctober18,2012.

9Shi, L. and Starfield, B. The Effect ofPrimary Care PhysicianSupplyand Income Inequality on Mortality Among

BlacksandWhites inUSMetropolitanAreas.AmericanJournalofPublicHealth. August2001,Vol.91,No.8,pp.

12461250.10

Federally Qualified HealthCenter Feasibility Study for Berks County, Pennsylvania. Drexel University Schoolof

PublicHealth(September2010).


24/129



16

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.

Servicesinclude

the

Family

and

Womens

Care

practice,

a

dental

clinic,

community

pharmacy,

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

unduplicatedpatients incalendaryear2011. Fortypercentofpatients live inReading,which isfifteen

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,in

the

Downtown

area

of

the

City

of

Reading,

provides

affordable

reproductive

health

care

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,andmentalhealthservicestoabout800Latinofarmworkersannually inBerksCounty.

Servicesareprovided intheCityofReadingandalsoonsiteatarea farms. 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

transmitteddisease

screening,

counseling,

treatment,

and

education.

The

STD

screening

and

treatment

clinicisfundedbythePennsylvaniaDepartmentofHealth.Theeducationdepartmentprovidesteaching

andcounselinginthecommunityandonsite. IndividualswithHIVwhoaremedicallyindigentandneed

aprimarycarephysicianarereferredtotheCenterforPublicHealth,apubliclyfundedclinicatReading

HealthSystemthatprovidesprimarycareandcasemanagementservicesforpersonswithHIV/AIDSand

STDscreening.

Primaryepisodiccareservicesarealsoprovidedbyseveralurgentcarecenterslocatedprimarilyinthe

CityofReadingssuburbs.

SocialServicesAs 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

BerksCounty (CentroHispano Daniel Torres)and theBerksCounselingCenter in the CityofReading,

which provides outpatient behavioral health treatment, and transitional and permanent housing with

supportiveservicesforpersonswithbehavioralhealthdisabilities.


25/129



17

TheBoyertownAreaMultiServicesCenterserves750olderadultspermonthattheseniorcenterand

300400individualsmonthlywithotherservices. Theyprovide185,000unitsofserviceayear. Services

includemealsonwheels,acommunityfoodpantry,theseniorcenter,energyassistance,transportation

tomedical

appointments

by

volunteers,

and

a

senior

farmers

market

program.

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,KennedySeniorCenterandCasade laAmistad,andtheSeniortoSeniorcasemanagement

program;theOfficeofViolenceagainstWomen incollaborationwithBerksWomen inCrisis;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

ReadingArea

Community

College

(RACC),

offers

workshops

and

other

opportunities

for

those

pursuing

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 thejurisdiction of the Drug

Courts in Berks and Chester Counties; a Chester County Counseling Center; and drug and alcohol

treatmentfor

inmates

of

the

Berks

County

Prison

and

Reentry

Center.

TherearetenseniorcentersintheCounty,whichprovidehealth,education,andfitnessprogramming;

informationandreferrals;assistancewithgroceryshopping;socializationopportunities;andcommunal

mealsforolderadults. TherearefiveintheCityofReading. BerksEncoreoperatessixseniorcentersin

BerksCounty intheCityofReading,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 theLatinoolderadultpopulation. There are sevenemergency shelters intheCounty 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, includingbreastfeedingpromotion andsupport,andreferralsto

healthcareforlowincomepregnant,postpartum,andbreastfeedingwomen,infants,andchildrenupto

age5whoareatnutritionalrisk.


26/129



18

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,

and1,300

meals

to

low

income

seniors

on

a

monthly

basis.

In

Berks

County

there

are

a

total

of

27

food

pantriesand21soupkitchensandothermealprogramsdistributedthroughouttheCounty. Whilethe

majorityofsoupkitchensandmealprogramsare located intheCityofReading,foodpantry locations

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

methodsof

data

acquisition

and

analysis,

followed

by

a

summary

of

findings

of

the

needs

assessment

andconclusionandrecommendations.


27/129



19

II.NEEDSASSESSMENTPROCESSANDMETHODS

ThisneedsassessmentwasoverseenbyaSteeringCommitteeofrepresentativesfromeachofthefour

sponsoring

organizations.

An

Advisory

Committee

of

17

representatives

from

Berks

County

community

organizations was appointed by the Steering Committee to provide input from the community. The

AdvisoryCommitteesuppliedguidanceatallstagesoftheneedsassessmentprocess. Themembersof

theAdvisoryCommittee,andtheirorganizationsandtitles,arelistedbelow.

BerksCountyCommunityHealthNeedsAssessment

CommunityAdvisoryCommitteeMembersNAME TITLE ORGANIZATION

MikeBaxter,MD FamilyPracticePhysician;Past

President,BerksCountyMedical

Society

ReadingHealthSystemFamilyHealthCareCenter

CarolynBazik ExecutiveDirector CoCountyWellnessServices

DianeBonaccorsi,MD PrimaryCarePhysician GreenHillsMedicalCenter

RebeccaHartman DoctoralProgramStudent AlverniaUniversity

Rev.WayneHeintzelman Pastor St.Daniel'sLutheranChurch

EdMichalik,PsyD CountyAdministrator MentalHealth/DevelopmentalDisabilities

GaryRightmire BoardChair BerksCommunityHealthCenter

KarenRightmire President WyomissingFoundation

MikeRusso,MD Cardiologist BerksCardiologists,Ltd.

PamTaffera,DO FamilyPracticePhysician;President

Elect,BerksCountyMedicalSociety

St.Joseph RegionalHealthNetwork

MikeToledo ExecutiveDirector CentroHispano(HispanicCentroDanielTorres,Inc.)

IvanTorres,EdD President Pronto!FinancialServices

SelinaZygmunt Manager KeystoneFarmworkerHealthProgram

PatGiles SVP,CommunityImpact UnitedWayofBerksCounty

MaryHahn Development St.JosephRegionalHealthNetwork

RichardMable

SVPforCommunity&Government

Relations TheReadingHealthSystem

HeidiWilliamson VPforGrantmaking&Communications BerksCountyCommunityFoundation

Thesteps intheneedsassessmentprocesswere: definingthecommunity;identifyingexistingprimary

and secondary data and data needs; collecting primary and secondary data; analyzing data; and

preparationofawrittennarrativereport. Thedataacquisitionandanalysisaredescribedinmoredetail

below.


28/129



20

DATAACQUISITIONANDANALYSIS

Bothprimaryandsecondaryandquantitativeandqualitativedatawereobtainedandanalyzedforthis

needsassessment. Obtaininginformationfrommultiplesources,knownastriangulation,helpsprovide

contextforinformationandallowsresearcherstoidentifyresultswhichareconsistentacrossmorethanonedatasource.

DataSourcesandDatesQuantitativeinformationforthisneedsassessmentwasobtainedfromsourceslistedbelowforthemost

recentyearsavailable.

BerksCountyCommunityHealthNeedsAssessmentDataSources

DataSource Dates

U.S.Census

of

Population

and

Housing

2000,

2010

Claritas,Inc.PopFacts 2013,2018

PennsylvaniaDepartmentofHealth 20052008

PHMCBerksCountyHouseholdHealthSurvey 2008,2012

PennsylvaniaHealthCareCostContainmentCouncil 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,andaveraged17minutes induration. 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,allowing forprojectionnumbers,estimatesof thepopulationrepresented

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.


29/129



21

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

thecountyandstatewere interpolated fromthe2000and2010U.S.Census. Thenumberofwomen

ages1544andthenumberofadolescentsages1419werealso interpolatedfromthe2000and2010

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

County

population

subgroups

that

might

be

at

risk

for

poor

health

and

access

to

care:

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. Focusgroups lastedapproximately90

minutesandwereguidedbyasetofwrittenquestions(seeAppendixFfortheFocusGroupDiscussion

Guide). ThefocusgroupsofLatinoolderadults,migrantworkers,andadultsage1864wereconducted

inSpanishbyabilingual,bicultural facilitator. All focusgroupswereaudiotaped. Refreshmentswere

served.

FocusGroup Location NumberofParticipants

OlderAdults65+ BerksEncoreSeniorCenterReading 11

AfricanAmericans BerksCommunityHealthCenter 9

LatinoOlderAdults65+ ReadingAreaCommunityCollege 11

LatinoMigrantWorkers ElPuenteRestaurant 12

LatinoAdults1864 ReadingAreaCommunityCollege 12


30/129



22

InformationalInterviews

Information interviews were conducted with 13 community representatives with knowledge of the

healthand

health

care

needs

of

Berks

County

residents.

Key

informants

were

identified

and

recruited

by the project Steering Committee working in collaboration with PHMC. The names, titles, area of

expertise,andorganizationalaffiliationofeachkeyinformantarelistedinthefollowingtable.

BerksCountyCommunityHealthNeedsAssessmentKeyInformants

Name Organization Title Expertise

CarolynBazik CoCountyWellness

Services

ExecutiveDirector HIVandAIDS

Populations

PegBianca GreaterBerksFoodBank ExecutiveDirector FoodInsecurity

SheilaBressler BerksCountyMH/MR ChildandAdolescent

Service

System

Coordinator

ChildMentalHealth

DanaEichert BoyertownAreaMulti

Service

ExecutiveDirector HealthandSocial

ServiceNeedsin

BoyertownArea

AnnFisher ReadingSchoolDistrict SupervisorofSchoolHealth ChildHealthand

MentalHealth

BobHarrop EastPennManufacturing VPofPersonnel Insurance

Rev.Dr.WayneHeintzelman WesternBerksFree

MedicalClinic

Pastor,St.DanielsLutheran

Church

Uninsured

Dr.LouisD.Mancano ReadingHealthSystem MedicalDirector,

AmbulatoryServices

ClinicalServicesforAt

RiskPopulations

EdwardMichalik,Psy.D. BerksCountyMH/MR MH/MRAdministrator MentalHealthand

MentalRetardation

AnnMoll

Galen

Insurance President Insurance

Dr.GeorgeA.Neubert ReadingHealthSystem Chair,Dept.ofOb/Gyn Obstetricsand

Gynecology

Dr.PeterSchnatz ReadingHealthSystem ResidencyProgramDirector ClinicalServicesforAt

RiskPopulations

IvanTorres,Ph.D. PRONTO!Financial

Services

President LatinoPopulation

SelinaZygmunt KeystoneFarmworker

Programs

RegionalManager MigrantWorkers

Key informantsalso included individualswithdirectknowledgeofspecialpopulations inBerksCounty,

including: Latinos,migrantworkers, individualswithHIV/AIDS,theuninsured,pregnantwomen,older

adults,and

persons

with

mental

health

conditions.

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.


31/129



23

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). Frequencydistributionswereproducedforvariablesformultipleyearsofdatasotrendsovertimecouldbeidentifiedanddescribed.

Qualitativeinformationfromfocusgroupsandinformationalinterviewswasanalyzedbyidentifyingand

coding themes common across groups and individual interviews, and also themes that were unique.

This informationwasorganized into major topicareasrelated to health status, accesstocare,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

wasavailableattheZIP code levelfortheentirecounty. Thesesourcesalsoprovided informationon

theLatinopopulationinBerksCounty. Informationonthesepopulations,andotherunmethealthcare

needs, was also supplied in great detail by informational interviews and focus group discussions with

communityrepresentatives.

Thenextsection,III.Findings,summarizestheresultsoftheneedsassessmentprocess.


32/129



24

III.FINDINGS

ThissectiondescribesthehealthneedsofBerksCountyspopulation,describingdifferencesbetween

Berks

County

and

Pennsylvania,

and

among

individual

areas

of

Berks

County,

in

health

status,

access

to

care, health behaviors, use of preventive screenings, and social capital, including the health needs of

Latinoresidents.

HEALTHNEEDSOFTHECOMMUNITY

HEALTHOUTCOMESTheCountyHealthRankingsprovideanimportantoverallcontextforunmethealthcareneedsofBerks

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,andahighnumericalrankingof67outof67beingassignedtotheCountyinthe

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,and lowbirthweight. Thehealthoutcomes

rank includes indicatorsofhealthbehavior,clinicalcare,socialandeconomic factors,andthephysical

environment.

BerksCountyranks14thofthe67countiesinthestateinhealthoutcomesand26thoutof67countiesin

healthfactors,

compared

to

a

rank

of

1st

representing

best

in

the

state

in

health

outcomes

or

health

factors(UnionCounty),and67beingworstinthestate(Philadelphia).11

11County 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, isused inthisreport,buttheBerksCountyHealthRankingswerenotchangedtoreflectthecorrected

physiciantopopulationratio.


33/129



25

Source: CountyHealthRankingsandRoadmaps,www.countyhealthrankings.org.

Figure11: BerksCounty,PennsylvaniaHealthRankings

BerksCounty(overallhealthoutcomerankof14thoutof67)ranksbettercomparedtothe53other

counties in Pennsylvania in health outcomes. However, it ranks worse than 46 other counties in

morbidity(21st)(Figure11). BerksCountyshealthfactorsrank isworsethan41othercounties(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)

are

better

than

51

and

53

counties

in

the

state,

respectively.

Thenextsectionofthisreportdescribesthehealthstatus,accesstocare,anduseofservicesofBerks

Countyresidents.

HealthStatusThe healthofa community can beassessed by comparingbirthoutcomes, 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,

comparableto

the

results

of

a

clinical

examination.

12

12IdlerEL,BenyaminiY.SelfRatedHealthandMortality:AReviewofTwentySevenCommunityStudies.Journalof

HealthandSocialBehavior.1997;2137.

Rank(of67)

14

26

15

21

14

16

41

44

0 10 20 30 40 50 60

HealthOutcomes

HealthFactors

Mortality

Morbidity

HealthBehaviors

ClinicalCare

Social&

Economics

Factors

PhysicalEnvironment


34/129



26

64.2

98.0

42.6

61.3

47.6

57.7

0

20

40

60

80

100

120

BerksCounty Reading NorthBerks

County

SouthBerks

County

EastBerks

County

WestBerks

County

BirthOutcomes

BirthRate

Thereis

an

average

of

nearly

5,100

births

annually

to

Berks

County

women.

The

Berks

County

birth

rate (64.2 per 1,000 women 1544 years of age) isslightly higher than the state rate (58.7). InBerks

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 hasthe lowestbirthrate (42.6) intheCounty. It is lowerthan thebirth rate forthe state

(58.7),County

(64.2),

and

the

surrounding

Berks

County

areas.

Figure12: AverageAnnulizedBirthRatesforBerksCountyWomen1544YearsbyArea,20052008

Source:PennsylvaniaDepartmentofHealth,BureauofHealthStatisticsandResearch.CalculationspreparedbyPHMC.

Rate

per1,0

000

PARate:

58.7


35/129



27

9.4

28.1

3.5 5.1 2.8

0

10

20

30

40

50

BerksCounty Reading NorthBerks SouthBerks WestBerks

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. It isimportanttonotethatmany

Latino cultures view women as adults at age 14, so many marry and have children during their teen

years.

TheCityofReadinghasthehighestadolescentbirthrate(28.1)ofalltheareasintheCounty. TheCity

ofReading rate is four times thecountywide rate. This rate represents an average of134 births to

adolescentsannually. TwothirdsofadolescentbirthsintheCountyaretoadolescents intheCityof

Reading(67.8%).

The

City

of

Reading

rate

is

more

than

four

times

the

state

rate

(6.9),

and

three

times

theCountyrate(9.4). IncontrasttotheCityofReading,theWestBerksareahasthelowestadolescent

birthrate(2.8;representinganaverageof11birthsannually).

Figure13: AverageAnnualizedAdolescentBirthRatesforBerksCountybyArea,20052008

Note: TheadolescentbirthrateforEastBerkswasnotcalculatedanddisplayedbecausethecountwaslessthan10.

Source: PennsylvaniaDepartmentofHealth,BureauofHealthStatisticsandResearch.CalculationspreparedbyPHMC.

LowBirth

Weight

Lowbirthweightinfants(


36/129



28

8.3%7.7%

8.8% 8.4%

6.9%7.3%

6.3%

0%

10%

20%

30%

40%

50%

PA BerksCounty Reading NorthBerks SouthBerks EastBerks WestBerks

White(7.2%)infants,andinfantsofanotherrace(7.2%). Ingeneral,thesepercentagesarecomparable

tostatewidepercentages.

TheCityofReadinghasaslightlyhigherpercentageoflowbirthweightinfants(8.8%)thantheother

areasof

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

Source:PennsylvaniaDepartmentofHealth,BureauofHealthStatisticsandResearch.CalculationspreparedbyPHMC.

InfantMortalityRate

TheBerksCounty infant mortality rate is4.9 infantdeathsper 1,000 livebirths. This represents an

averageof25 infantdeathsannually. The infantmortalityrateforBerksCounty iscomparabletothe

state rate (5.2) and both rates meet theHealthyPeople2020 goal of 6.0 infant deaths per 1,000 live

births. TheinfantmortalityratefortheCityofReadingis5.8infantdeathsper1,000livebirths;thisrate

meetstheHealthyPeople2020goalaswell.

Healthy

People

2020Goal:

7.8%


37/129



29

SelfreportedHealthStatus

FairorPoorHealth

Selfreported

health

status

is

one

of

the

best

indicators

of

the

population

health.

This

measure

has

consistentlycorrelatedverystronglywithmortalityrates.13 InBerksCountytheoverwhelmingmajority

ofadultsratetheirhealthasexcellent,verygoodorgood(Figure15)(SeeAppendixCforHousehold

Health Survey Tables). However, 15.9% of residents are in fair or poor health, representing 50,400

adults. Thispercentage isslightly lowerthanthestatewideaverage(16.8%)14andtheaverageforthe

five counties in Southeastern Pennsylvania as a whole (Bucks, Chester, Delaware, Montgomery, and

Philadelphia)(16.1%).

Adults intheCityofReading (32.6%)aremorethantwiceas likelytobe in fairorpoorhealth than

adultsinotherareasofBerksCounty.

Figure15:

Percentage

of

Adults

in

Fair

or

Poor

Health

by

Area,

Berks

County,

2012

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

13IdlerEL,BenyaminiY.SelfRatedHealthandMortality:AReviewofTwentySevenCommunityStudies.Journalof

HealthandSocialBehavior.1997;2137.14

2011BehavioralRisksofPennsylvaniaAdults,PADepartmentofHealth.

16.1% 15.9%

32.6%

13.2% 14.5% 14.0%

7.4%

0%

20%

40%

60%

80%

100%

SoutheasternPA BerksCounty Reading EastBerks

County

NorthBerks

County

SouthBerks

County

WestBerks

County

PA

percentage:

16.8%


38/129



30

highbloodpressure.15 BothofthesepercentagesdonotmeettheHealthyPeople2020goalof26.9%.

The percentage of Berks County adults with high blood pressure increased from 26.8% to 33.4%

between2008and2012. (Figure16)

TheCity

of

Reading

(40.0%)

has

the

highest

percentage

of

adults

with

high

blood

pressure,

andNorthBerks(30.5%)hasthelowestpercentage.

For most of the areas, the percentage of adults with high blood pressure has slightly

increasedsince2008. However,thepercentageofadults intheCityofReadingwithhigh

bloodpressurehasincreaseddramaticallysince2008,from29.3%to40.0%in2012.

Figure16: PercentageofAdultswithHighBloodPressureinBerksCountybyArea,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.



26.8%29.3%

32.4%

27.2% 27.2%24.2%

31.0%33.4%

40.0%

34.6%30.5%

33.1%30.8%

0%

10%

20%

30%

40%

50%

SoutheasternPA BerksCounty Reading EastBerks

County

NorthBerks

County

SouthBerks

County

WestBerks

County

2008 2012

Healthy

PeopleGoal

26.9%


39/129



31

Approximately49,200adults 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).19 TheHealthyPeople2020goalforadultobesityis30.6%.

Figure17: PercentageofObeseAdultsinBerksCountyArea,2008&2012

Source:PHMC's2008and2012BerksCountyHouseholdHealthSurvey.

TheCityofReadinghasthehighestpercentage (35.0%)ofobeseadultsamongallBerksareas. The

NorthBerks

area

has

the

lowest

percentage

(26.1%)

of

obese

adults

and

is

the

only

area

that

had

a

decreaseinthepercentageofobeseadultsfrom2008to2012(28.5%to26.1%,respectively).


18ThehigherproportionofyoungadultsintheCityofReadingpopulationmaybeafactorinthisresult.


27.4%

32.9%29.0%

28.5%

24.7% 25.1%

31.9%30.2%

35.0%

29.5%26.1%

30.8% 30.6%

0%

10%

20%

30%

40%

50%

SoutheasternPA BerksCounty Reading EastBerksCounty NorthBerks

County

SouthBerks

County

WestBerks

County

2008 2012

Health

People

2020Goal:

30.6%


40/129



32

According to key informants, obesity an important health factor impacting Berks County youth and

adult

berks county, pennsylvania community health needs assessment

Documents