Community Health

Needs Assessment
Fresno County

Sarah Alkejek & Maylen Jackson

HSCI 617 Quiz 1
California State University of San Bernardino
 Table of Contents
DEFINE YOUR COMMUNITY 3

METHODS 4

KEY INDICATORS 4
DEMOGRAPHIC 4
HISPANIC POPULATION & POPULATION WITH LIMITED ENGLISH PROFICIENCY 4
SOCIAL 5
HIGH SCHOOL GRADUATION RATE (NCES) 5
INCOME – MEDIAN FAMILY INCOME 6
PHYSICAL ENVIRONMENTS 7
FOOD ACCESS MODIFIED RETAIL FOOD & AIR QUALITY 7
HEALTHCARE 8
ACCESS TO PRIMARY CARE 8
BEHAVIOR 9
TOBACCO USAGE- CURRENT SMOKERS 9
PHYSICAL INACTIVITY 9

RECOMMENDATIONS 11

REFERENCES 12

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 Define Your Community

The County of Fresno is in the northern part of California. Fresno County is located in the San

Joaquin Valley north of Bakersfield and South of Stockton. Fresno is considered the fifth largest

city in California. The county has an area of 6,011 square miles of which 53 square miles is

water. Fresno County is known as an area of cultivation; it is one of the principal agricultural

regions in the United States. Fresno is well-known for growing and harvesting grapes, cotton,

Almonds, tomatoes, plums, oranges, peaches, and nectarines. In addition, to being a leading

region in agriculture Fresno County is known as the eighth in the nation to produce oil in

Coalinga one of Fresno Counties town near the coastal ranges.

Fresno County has a population of 956,749 which accounts for 48.89% of males and 50.11% of

females. Fresno County is very diverse in that is accounts for many different races. Whites

account for 59.62%, blacks account for 5.07%, Asians account for 9.77%, Native American/

Alaska Native account for 1.02%, Native Hawaiian/ Pacific Islander account for 0.21%, and

Some other race account for 20.29%.

Consequently, due to this diversity Fresno County accounts for a large population of a Hispanic,

Latinos, and Spanish ethnicities, they account for 51.64% half of the population in Fresno

County. Thus, the constant changing demographic in Fresno County have a big influence in the

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types of social services, and health needs this community has. Fresno County’s climate is very

different than the rest of California it averages about 267 sunny days and temperatures in July

range between 95-98 degrees. Overall Fresno county is also known for its proximity of the

numerous national parks such as Yosemite, Kings Canyon, and Sequoia National park.

Methods
Information for this assessment was gathered from two different online sources, (CHNA)

Community Health Needs Assessment website and the U.S. Census Bureau. Most of the county

data was collected through the Community Heath Needs Assessment website by running an

indicator report and searching for the county by selecting the state “California” first and then

selecting “Fresno” from the list of counties and clicking on view report. The report had several

information about the county including population demographics such as gender, race, and age.

The report also included health indicators for the county such as social and economic factors,

health behaviors, and physical environment.

Key Indicators
Demographic
Hispanic Population & Population with limited English Proficiency

Upon analyzing Fresno County’s population Hispanics, Latino, and Spanish origin account for

494,077 of the total population in this county, about 51.64% a key indicator of this county. This

is more than California’s and U.S. average rate of 38.39%, 17.13% respectively. Consequently,

such a large population has many implications for this community’s needs, since over half of the

population
Fresno County, CA Population
is of one
PERCENT POPULATION HISPANIC OR
LATINO
51.64%
ethnicity
PERCENT POPULATION NON-HISPANIC 48.36%

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and a variation of different races. As such, this key indicator was chosen, because it is important

to find out if there are well established resources, programs, and interventions that are culturally

adaptable for the well-being of this population. Such a large population like this needs more

social care services to reduce health inequalities, as such a detailed investigation of this

community is needed. Our second demographic key indicator was chosen, because this same

ethnicity is also burdened with limited English proficiency, therefore making this key indicator

Population with Limited English Proficiency by Ethnicity Alone

200,000 127,590 Fresno County, CA

39,428
0
28.82%
9.07%
TOTAL HISPANIC / LATINO
TOTAL NOT HISPANIC / LATINO
PERCENT HISPANIC / LATINO
PERCENT NOT HISPANIC / LATINO
extremely important for this community, because communication is extremely important in day

to day life activities. Lack of speaking, writing, and understanding the English language can

bring unintended consequences such as lack of medication adherence, or misunderstanding

directions on how to take medications.

Social

High School
Graduation Rate
(NCES)

According to

CHNA website,

within the area of

Fresno County 66.9% of students are receiving their high school diploma within four years,

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which is less than the Healthy People 2020 target of 82.4%. This is a social key indicator of the

county because research suggest education is one of the strongest predictors of health. The table

below compares the on-time graduation rates for each of the United States, California, and

Fresno County. The on-time graduation rate for Fresno County was only 66.9% which is less

than both the U.S. and California. The on- time graduation rate for California was 71% while the

rate for the U.S. was 75.5%.

High school rates is an important key indicator because education is critical to social and

economic development and can impact the population’s health. Education can bring health

benefits to the individual level and the community level. Health benefit at an individual level is

having access to resources and high quality care. At a community level, education can affect the

health-related characteristics of the environments within the area.

Income – Median Family Income

The second social key indicator is income. According to the CHNA website, a family household

is defined as any housing unit in which the householder is living with one or more individuals

related to him/her by birth, marriage, or adoption. Family income includes the incomes of all

family members age 15 and older. Based on the latest 5-year American Community survey, the

median family income for Fresno County was $49,999 as shown in the table below. Fresno

County had the lowest median family income when compared to California and the United

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States. Income is an important key indicator for the county since the rate for individuals who are

below poverty level in Fresno County is 26.8% (U.S. Census Bureau, 2017). People with low

incomes tend to have less resources and limited access to health care, are more likely to be

uninsured, and have financial barriers to afford health care expenses. On the other hand, wealthy

people will have access to better resources that can protect and improve their health.

Physical Environments

Food access Modified Retail Food & Air Quality

Modified Retail Food Environmental Index Score by Tract, DNPAO 2011

Index Score Over 30 (High Access)

Index Score 15 - 30 (Moderate Access)
Index Score 5 - 15 (Low Access)
Index Score Under 5 (Poor Access)
No Healthy Retail Food Outlet (No Access)
No Retail Food Outlets Present (Food
Desert)

The physical environment plays a big part in a community’s health. It is important to include a

secure, clean surrounding community that can provide access to healthy food, recreational

options, transportation, and clean air quality. Yet, the County of Fresno accounts for 33.64% of
Food Access- Modified Retail Food Environment Index
Percent Population in Tracts with High Healthy Food
Access
1.67% 3.29% 5.02%

Percent Population in Tracts with Moderate Healthy

Food Access
52.10% 52.48% 43.28%

Percent Population in Tracts with Low Healthy Food

Access
33.64% 33.51% 30.89%

Percent Population in Tracts with No Healthy Food Outlet 12.35% 9.93% 18.63%

Percent Population in Tracts with No Food Outlet 0.25% 0.78% 0.99%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Fresno County, CA California United States

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its residents with low healthy food access and only 1.67% of its residents have high healthy food

access. As a result, of this we have chosen this key indicator to be important, since having

healthy access to food is a key component to good health, and overall well-being in any

community. Likewise, quality of air is a key indicator in Fresno County, since Fresno County

accounts for 5.01% of particulate matter, it exceeds the percent of days compared to California

and U.S. average of only 0.46%, and 0.10% respectively. We have chosen this key indicator,

because having low quality of good air or too much particulate matter or ozone has shown to be

Air Quality- Particulate Matter In Fresno County

20 18.34 6.0%
5.01% 5.0%
Number of days

15 12.05
4.0%
9.79 9.1

Percent of Days
10 3.0%
2.0%
5 1.6
0.35 1.0%
0.46%
0 0.10% 0.0%
Fresno County, CA California United States
Average Daily Ambient Particulate Matter 2.5
Number of Days Exceeding Emissions Standards
Percentage of Days Exceeding Standards, Pop. Adjusted Average

detrimental to children and a family’s health. It is important to decrease bad air quality, because

if the air has too much pollution the community can suffer from lung diseases,

asthma, and other related disease, making it hard for the community to do outdoor activities

without having long term healthy effects.

Healthcare

Access to Primary Care

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The graph below reports rates for primary care physicians per 100,000 populations. Primary care

physicians include: General Family Medicine MDs and Dos, General Internal Medicine MDs

and General Pediatrics MDs.

This indicator was compared with the state average “California” as well as the United States

average. Fresno County had the lowest rate 70.29% compared to California 86.7% and the U.S.

87.8%. Access to primary health care is an important key indicator because a shortage of health

professionals contributes to access and health disparities.

Behavior
Tobacco Usage- Current Smokers

Percent Population Smoking Cigarettes(Age-Adjusted)

13.50%
18.10%

12.80%
Fresno County, CA California United States

Health behaviors such as lack of physical activity, alcohol consumption, and tobacco use are

some of the contributing factors to poor health. As such, we have chosen this key indicator,

because the County of Fresno accounts for 13.5% of people that smoke cigarettes which is higher

when compared to California which accounts for 12.8%. Therefore, it is important to focus on

reducing this health behavior in this county to decrease the burden of disease that smoking brings

to the community such as lung cancer, and emphysema, and other related illnesses.

Physical Inactivity

Physical inactivity was another key indicator that we chose for Fresno County. According the

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CHNA website, 135,712 or 20% of adults aged 20 and older self-report no leisure time for

physical activity based on the question: ‘During the past month, other than your regular job did

you participate in any physical activities or exercises such as running, calisthenics, golf,

gardening, or walking for exercise?”. The table below shows a comparison of the percent

population with no leisure time physical activity between Fresno County, California state, and

the United States. The percentage for Fresno County was 20.9% which was higher than the

state’s average by 3.6%.

This is an important key indicator because current behaviors such as “physical inactivity” are

determinants of future health that can illustrate a cause of significant health issues, such as

obesity and poor cardiovascular

health. The graph below also shows a comparison of no leisure-time physical activity by gender.

Adults with No Leisure- Time Physical Activity by

Gender
0.30 21.80% 23.22%
20% 20.13%
0.20 16.34% 18.21%

0.10
0.00
Fresno County, CA California United States

Percent Males with No Leisure-Time Physical Activity

Percent Females with No Leisure-Time Physical Activity
Recommendations

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 Recommendation

Fresno County has many needs, first over 50% of the population is of Hispanic, Latino or

Spanish ethnicity. Second, the population has limited English Proficiency, low income, low

education rates, low healthy food access, high polluted air, a high prevalence of individuals who

smoke and are physically inactive, and shortage in health professionals. One of the best plans of

actions to find the true needs of a large population of Hispanics in Fresno County would be to

conduct a public forum, needs assessment survey, and a community-based participatory

research. By doing this the public health sector will hear the community’s ideas, important

health issues, and understand their needs. Using such tools as a survey allows for the public

sector to plan interventions, and programs that can be culturally adaptable by this county. As

such, it is also recommended that Fresno county improve their air quality policies, prioritizes on

how to expand more efforts of healthy access to foods, establish English classes for their

citizens and promotes tobacco cessation programs. Suggestions for physical inactivity can

include, informational/educational approaches to increase physical activity which can motivate

and enable individuals to change their behavior and maintain physical activity over time. This

can be done through community campaigns, mass media, and health education classes. In

addition, it is very important to find ways for promoting educational attainment, and reducing

the number of high school and college drop outs, as well as partnering with all sectors of the

community to support the success of each individual. It is also important to find ways of

improving the overall economic performance of the region and growing economy by having

workforce development and training. In terms of the gap between the contribution of health

professionals in the county and the need for healthcare services, policy makers should seek

effective means to recruit and retain staff by developing and implementing incentives.

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 References
Community Health Needs Assessment
https://www.communitycommons.org/chna/

United States Census Bureau

https://www.census.gov/

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