Counting Communities: A Unique Approach to Community Health Assessment of a Large Suburban County, Nassau County NY

Background:  Nassau County, with over 1.3 million residents and the 12^th wealthiest in the nation, is considered healthy with low rates of disease. Yet, the affluence of the county masks the needs of underserved communities. We launched a unique health assessment that would portray the county accurately.

Methods:   To properly reflect the epidemiology, each zip code was scored based on an index comprised of socioeconomic and health related factors.  The score determined which communities were designated as underserved.  This data was aggregated and compared to the rest of the county.  The process included a quantitative analysis using morbidity and mortality rates and qualitative evaluations of community perception.

Results:  Twenty percent of Nassau County’s population lives in the underserved communities. For example, diabetes and asthma rates were more than doubled among the underserved compared to the rest of the county. Underserved communities displayed a significant higher incidence of STDs, HIV and tuberculosis.  In these communities, the rate of hospital visits due to assaults was more than double and teen pregnancy rates were quadruple than those of the rest of the county. Qualitative analysis supported these findings.

Conclusion:  Two disparate health profiles emerged from this stratified analysis.  Nassau County has pockets of residents with low social and economic status, a lack of access to care, who display riskier behaviors and suffer significantly more from disease morbidity and mortality.  We used the community health assessment to identify regions of health inequity, focus our attention and designate priorities for health initiatives.