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Community Health Needs Assessment: Imperial County

Doris Buezo

Alexa Reyes

HSCI 617

Dr. Becerra

30 October 2017

CSUSB- Master of Public Health


Table of Contents

Defining the Community: Imperial County ....3











Imperial County is located in Southern California near the Mexican border east of San

Diego County. According to U.S. Census Bureau American Community Survey or 2011-2015

Imperial County has 178,206 residents compared 38,421,464 residents in California. Imperial

County is composed of 14 cities which include Brawley, Calexico, Calipatria, etc. This county

was established in California in 1907 and it is the ninth largest California County encompassing

155,787.96 square miles.

Figure 1: Imperial County Geographic Border



Data information on Imperial County was obtained from the following website: website. Here a CHNA account was made using

general information from the user. On the link Community Health Needs Assessment which

was under the Maps and Data tab, the central tab Run an Indicator Report was selected. Then

the state California and Imperial County was selected as the intended cohort. This lead to

Imperial Counties Health Indicators Report which included social & economic factors, physical

environment, clinical care, health behavior, and health outcomes.


Indicators chosen for Imperial County demographics were females (sex), and age (25-

34). For the purpose of this study women between the ages of 25-34 were the main focus due to

life changing experiences they phase during this time. We wanted to analyze how life choices,

education, and employment play a role in womens health outcomes and quality of life. It is

believed that these years are critical for women largely because some are graduating from

college during this time, are looking for employment or changing careers/jobs. Having that said

we wanted to look at Imperial County women population in order to better understand their

health outcomes, life style, life expectancy, quality of life etc. based on career choices.

According to CHNA database it was found that Imperial County has a total of 178,206 residents

of which 87,039 of them are females. Of these women, 50.3% are White, 20.1% are Black,

46.7% are Native American/Alaskan Native, 48.5% are Asian, 34.5% are Native

Hawaiian/Pacific Islander, 46.3% are of some other race, and 54.8% are multiple races as shown

on Figure 2. In the age category 24,762 individuals in Imperial County within the ages 25-34 of

which 10,994 (12.63%) are females.


Figure 2: Imperial County Female Population by Race

For our Social Indicators Population with Bachelors Degree or Higher and

Unemployment were evaluated. It is expected that individuals with higher education of at least a

Bachelor's degree have less financial burdens and higher quality of life which includes physical,

mental and social aspects of life. A study done by Tavakoli-Fard states that there is a close

association between work ability and health-related quality of life (HRQoL). In other words,

educated women with a higher education have better health outcomes compared to those that

dont have a higher education. According to CHNA data 15,102 Imperial County residents have

a Bachelors degree or higher over the age of 25. This means that 14.08 percent of all residents

have at least a bachelors compared to 31.43 percent for the State of California and 29.77 percent

in the U.S as shown in Figure 3. This goes to show that the number of individuals living in

Imperial County without at least a bachelors degree outweigh those that do have a career.

Unfortunately CHNA did not have data on the number of women that have a bachelor's degree or

higher and only provided the total amount of residents that have a bachelors degree or higher. I

would say this is a limitation largely because it does not allow us to fully analyze how many

women in this county have at least a four year degree or higher as well as have a better

understanding on their quality of life.

Figure 3: Population with Bachelors Degree or Higher

When looking at unemployment it was found that 27.3 percent of Imperial County

residents are unemployed. This means that out of 77,398 individuals in the labor force 21,160 are

unemployed in this county alone. Comparing that with the State of California which is 5.8

percent (Unemployed) and the nation at 5.2 percent, Imperial County clearly has a high

unemployment rate as shown in figure 4. This could possibly mean that Imperial County has a

high poverty rate, lower education, lower health outcomes, lower health care, and possibly low

life expectancy. Interestingly a study done by Singh et al. that looked at unemployment and life

expectancy found that there is a close association between the two. The author further stated

that unemployment is an important social determinant of health and is strongly linked to a

number of health outcomes such as all-cause mortality, self-assessed health,

cardiovascular diseases, liver cirrhosis, suicide, and mental health problems in a number

of countries (Singh & Siahpush, 2016). Having that said one can conclude that Imperial

County Imperial population may have a lower health outcomes due to their high

unemployment rate. Unfortunately, the CHNA database was not able to show how many

women in Imperial County are unemployed. Singhs study however, allows us to better

understand how unemployment can drastically affect women's life quality and life


Figure 4: Unemployment Rate


The indicator chosen for the physical determinant is assisted housing. Within Imperial

County there are 56,067 total housing units as of 2010 and 3,156 total Housing and Urban

Development (HUD)- assisted housing units. The rate per 10,000 housing units is 562.9. This

figure demonstrates a significantly higher rate when compared to California and the United

States, 352.4 and 375.41, respectively. Housing is an important physical indicator because a safe

home in a safe location ensures adequate for health for an individual or family. Fenelon et al.

(2016) describes how housing assistance is correlated with improved health outcomes, including

psychological well-being. The high rate within Imperial County demonstrates how displacement

is a greater physical and even mental threat to people within this county as compared to the

nation. Physical indicators, such as how many people are in use of assisted housing units,

provide insight to understanding socioeconomic status and ways for public health intervention.

Figure 5: Housing and Urban Development-Assisted Housing Units


Lack of prenatal care is the healthcare indicator chosen for this community health needs

assessment. It is through access to the healthcare system that individuals may participate in

preventative care such as prenatal care. Without private or public health care coverage, many

individuals are put at risk for increased death, cancer, and chronic diseases (Bittoni et al., 2015).

Total births within Imperial County is 12,619 and mothers starting prenatal care in the first

semester accounts for 6,542 mother. Mothers with late or no prenatal care is 4,886 and prenatal

care not reported within the county consists of 1,191 cases. The total percentage of mothers with

late or no prenatal care is 38,72%. Compared to California (18.1%) and the United States

(17.3%), it is evident that Imperial County severely lacks in preventative measures such as

prenatal care for birth defects and malnutrition among infants and mothers.

This is an important indicator relevant to females especially within the ages of 25-34

because this is the age group when most women become pregnant. Analyzing these

demographics and females access to prenatal care can help determine the reasons for lack of

use. Finding ways in which education can be raised can be a potential public health intervention

to decrease the lack of prenatal care rate. With educational resources, women will learn the value

of prenatal care, and with it, help combat many health issues that may arise when the infant is


Figure 6: Percentage of Mothers with Late or No Prenatal Care


Physical inactivity is the behavioral indicator chosen with the greatest threat to public

health within Imperial County. The total population (age 20+) within Imperial County is

121,163 and the population with no leisure time for physical activity accounts for 25,323

individuals. This means that 20.8% of the population is with no leisure time for physical activity.

Compared to California (17.3%) and the United States (21.8%) , Imperial County has more

individuals with less time for physical activity compared to the state level but less compared to

the national level.

This indicator is a critical measure of how behavioral determinants can impact long-term

health outcomes. For example, a study by Johnson and Johnson (2015) evaluated childhood

obesity rates compared to rural and urban areas and found that children from rural areas are more

likely to be obese. The population size for Imperial County encompasses only 178,206 residents,

indicating that it is a rural area. Therefore, it can be inferred that obesity rates would be higher

among these rural children compared to larger counties within the state. This is due to inadequate

resources and funding for physical activity programs and resources.

Figure 7: Percent Population with no Leisure Time for Physical Activity


If physical inactivity is separated by gender, females lack more in physical activity than

males within Imperial County. Compared to the national and state level, females are also noted

to be with higher rates for physical inactivity. This demonstrates the need for public health

intervention to focus on females education regarding physical activity and the health benefits

associated with it.

Figure 8: Adults with no Leisure Time for Physical Activity By Gender



This community health needs assessment for Imperial County demonstrates many

opportunities for public health intervention and support. Based on the indicators provided some

of the most concerning issues for Imperial County are lack of education, unemployment rates,

use of assisted housing, and access to preventative health. As mentioned within the social

indicators report, the unemployment rate within Imperial County is nearly five times greater

when compared to the state and national levels. Educational level with bachelors degree or

higher is less than half the rate when compared to state and national levels. Access to prenatal

care and no leisure time for physical activity is also significantly substandard when compared to

state and national levels. In order to help improve health outcomes and ensure access to

healthcare services within this county, public health professionals must work to influence policy

makers and key informants. Through this, realistic public health policies that support community

well-being and health can be implemented.

Policy suggestions to help alleviate some of the issues mentioned consist of

implementing policies that support behavioral health. By developing health education programs

that support physical activity and educate females on the benefits of prenatal care into

motherhood, many chronic diseases and comorbidities can be prevented. Policies that improve

economic job opportunities are imperative for this county in order to increase access to health

care services and adequate housing. It is through economic development that poverty and

unemployment rates can decrease, and subsequently increase education attainment. Policies that

ensure access to social and educational resources will help alleviate Imperial Countys needs

while improving health risks and promoting positive health outcomes.



Bittoni et al. (2015), Lack of private health insurance is associated with higher mortality from

cancer and other chronic disease, poor diet quality, and inflammatory biomarkers in the

United States. Prev Med. 81. 420-426.

Fenelon et al. (2017). Housing Assistance Programs and Adult health in the United States.

American Journal of Public Health. 107 (4). 571-578.

Johnson and Johnson. (2015). Urban-Rural Differences in Childhood and Adolescent Obesity in

the United States: A Systematic Review and Meta-Analysis. Childhood Obesity. 11(3).


Singh GK, Siahpush M. Inequalities in US Life Expectancy by Area Unemployment Level, 19902010

[Internet]. Scientifica. 2016 [cited 2017 Oct 27]. Available from:

Tavakoli-Fard N, Mortazavi S-A, Kuhpayehzadeh J, Nojomi M. Quality of life, work ability and other

important indicators of womens occupational health. Int J Occup Med Environ Health.