NYC Health + Hospitals 2019 Community Health Needs Assessment Survey

NYC Health + Hospitals is conducting a Community Health Needs Assessment (CHNA) to identify, understand and respond to your communities’ health needs. The assessment is conducted every three years. During the fall, there will be an opportunity to share your ideas for how we can work together to improve health in your community.

Share this survey with your community! If you have any questions, please contact Chris Philippou (phone: 646-694-7128; email: philippc1@nychhc.org) or Dolores Wigfall (phone: 646-694-7020; email: wigfalld@nychhc.org).

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* 1. Where is your community located?

A community is where you work, live, and play. It could also be where you spend most of your time with your family, neighbors, and friends, or where your clients live.

Zip code(s) or H+H site clients use

Type of organization (social service, health care, housing, etc)

Population(s) served

Name (optional)

Email (optional)

Question Title

* 2. A health need is anything that makes it hard to manage health in your community.

The tables below list common health needs. When scoring these health needs, think of how your neighbors, family, friends, and clients feel about these health needs.

What are the top causes of poor health status and death in your community? Score each cause from 1 to 5, where 1 is not a significant problem and 5 is a significant problem. You can write in any health needs that you think are missing.

	1	2	3	4	5
Alcohol use	Alcohol use 1	Alcohol use 2	Alcohol use 3	Alcohol use 4	Alcohol use 5
Asthma	Asthma 1	Asthma 2	Asthma 3	Asthma 4	Asthma 5
Back problems and low back pain	Back problems and low back pain 1	Back problems and low back pain 2	Back problems and low back pain 3	Back problems and low back pain 4	Back problems and low back pain 5
Cancer	Cancer 1	Cancer 2	Cancer 3	Cancer 4	Cancer 5
COPD and other lung diseases	COPD and other lung diseases 1	COPD and other lung diseases 2	COPD and other lung diseases 3	COPD and other lung diseases 4	COPD and other lung diseases 5
Dementia and Alzheimer's Disease	Dementia and Alzheimer's Disease 1	Dementia and Alzheimer's Disease 2	Dementia and Alzheimer's Disease 3	Dementia and Alzheimer's Disease 4	Dementia and Alzheimer's Disease 5
Diabetes	Diabetes 1	Diabetes 2	Diabetes 3	Diabetes 4	Diabetes 5
Drug use, including opioids	Drug use, including opioids 1	Drug use, including opioids 2	Drug use, including opioids 3	Drug use, including opioids 4	Drug use, including opioids 5
Heart Disease and high blood pressure	Heart Disease and high blood pressure 1	Heart Disease and high blood pressure 2	Heart Disease and high blood pressure 3	Heart Disease and high blood pressure 4	Heart Disease and high blood pressure 5
HIV, STIs, and Hepatitis C	HIV, STIs, and Hepatitis C 1	HIV, STIs, and Hepatitis C 2	HIV, STIs, and Hepatitis C 3	HIV, STIs, and Hepatitis C 4	HIV, STIs, and Hepatitis C 5
Injuries due to falls, accidents, and violence	Injuries due to falls, accidents, and violence 1	Injuries due to falls, accidents, and violence 2	Injuries due to falls, accidents, and violence 3	Injuries due to falls, accidents, and violence 4	Injuries due to falls, accidents, and violence 5
Kidney disease	Kidney disease 1	Kidney disease 2	Kidney disease 3	Kidney disease 4	Kidney disease 5
Maternal and women's health	Maternal and women's health 1	Maternal and women's health 2	Maternal and women's health 3	Maternal and women's health 4	Maternal and women's health 5
Mental health disorders, including depression	Mental health disorders, including depression 1	Mental health disorders, including depression 2	Mental health disorders, including depression 3	Mental health disorders, including depression 4	Mental health disorders, including depression 5
Obesity and high BMI	Obesity and high BMI 1	Obesity and high BMI 2	Obesity and high BMI 3	Obesity and high BMI 4	Obesity and high BMI 5
Stroke	Stroke 1	Stroke 2	Stroke 3	Stroke 4	Stroke 5
Suicide and self-harm	Suicide and self-harm 1	Suicide and self-harm 2	Suicide and self-harm 3	Suicide and self-harm 4	Suicide and self-harm 5

Other (please specify)

Question Title

* 3. What are the top risk factors of poor health status and death in your community?
Score each cause from 1 to 5, where 1 is not a significant problem and 5 is a significant problem. You can write in any health needs that you think are missing.

	1	2	3	4	5
Access to palliative care and hospice	Access to palliative care and hospice 1	Access to palliative care and hospice 2	Access to palliative care and hospice 3	Access to palliative care and hospice 4	Access to palliative care and hospice 5
Access to primary care	Access to primary care 1	Access to primary care 2	Access to primary care 3	Access to primary care 4	Access to primary care 5
Access to health insurance	Access to health insurance 1	Access to health insurance 2	Access to health insurance 3	Access to health insurance 4	Access to health insurance 5
Access to home and community based long-term care	Access to home and community based long-term care 1	Access to home and community based long-term care 2	Access to home and community based long-term care 3	Access to home and community based long-term care 4	Access to home and community based long-term care 5
Access to mental and behavioral health care	Access to mental and behavioral health care 1	Access to mental and behavioral health care 2	Access to mental and behavioral health care 3	Access to mental and behavioral health care 4	Access to mental and behavioral health care 5
Access to specialty care	Access to specialty care 1	Access to specialty care 2	Access to specialty care 3	Access to specialty care 4	Access to specialty care 5
Access to transportation	Access to transportation 1	Access to transportation 2	Access to transportation 3	Access to transportation 4	Access to transportation 5
Aging and frailty	Aging and frailty 1	Aging and frailty 2	Aging and frailty 3	Aging and frailty 4	Aging and frailty 5
Child and adolescent development	Child and adolescent development 1	Child and adolescent development 2	Child and adolescent development 3	Child and adolescent development 4	Child and adolescent development 5
Chronic pain and arthritis	Chronic pain and arthritis 1	Chronic pain and arthritis 2	Chronic pain and arthritis 3	Chronic pain and arthritis 4	Chronic pain and arthritis 5
Community safety and violence	Community safety and violence 1	Community safety and violence 2	Community safety and violence 3	Community safety and violence 4	Community safety and violence 5
Decent work conditions and economic opportunity	Decent work conditions and economic opportunity 1	Decent work conditions and economic opportunity 2	Decent work conditions and economic opportunity 3	Decent work conditions and economic opportunity 4	Decent work conditions and economic opportunity 5
Disability and access to care for people with disabilities	Disability and access to care for people with disabilities 1	Disability and access to care for people with disabilities 2	Disability and access to care for people with disabilities 3	Disability and access to care for people with disabilities 4	Disability and access to care for people with disabilities 5
Domestic and sexual abuse	Domestic and sexual abuse 1	Domestic and sexual abuse 2	Domestic and sexual abuse 3	Domestic and sexual abuse 4	Domestic and sexual abuse 5
Exercise and physical activity	Exercise and physical activity 1	Exercise and physical activity 2	Exercise and physical activity 3	Exercise and physical activity 4	Exercise and physical activity 5
Green space and park access	Green space and park access 1	Green space and park access 2	Green space and park access 3	Green space and park access 4	Green space and park access 5
Health care literacy (understanding how to use health care & advice from caregivers)	Health care literacy (understanding how to use health care & advice from caregivers) 1	Health care literacy (understanding how to use health care & advice from caregivers) 2	Health care literacy (understanding how to use health care & advice from caregivers) 3	Health care literacy (understanding how to use health care & advice from caregivers) 4	Health care literacy (understanding how to use health care & advice from caregivers) 5
Higher education completion	Higher education completion 1	Higher education completion 2	Higher education completion 3	Higher education completion 4	Higher education completion 5
Housing access, affordability, and quality	Housing access, affordability, and quality 1	Housing access, affordability, and quality 2	Housing access, affordability, and quality 3	Housing access, affordability, and quality 4	Housing access, affordability, and quality 5
Hunger, food access, and poor nutrition	Hunger, food access, and poor nutrition 1	Hunger, food access, and poor nutrition 2	Hunger, food access, and poor nutrition 3	Hunger, food access, and poor nutrition 4	Hunger, food access, and poor nutrition 5
Immigration and citizenship status	Immigration and citizenship status 1	Immigration and citizenship status 2	Immigration and citizenship status 3	Immigration and citizenship status 4	Immigration and citizenship status 5
Indoor and outdoor air quality	Indoor and outdoor air quality 1	Indoor and outdoor air quality 2	Indoor and outdoor air quality 3	Indoor and outdoor air quality 4	Indoor and outdoor air quality 5
Jail and criminal justice	Jail and criminal justice 1	Jail and criminal justice 2	Jail and criminal justice 3	Jail and criminal justice 4	Jail and criminal justice 5
Language and language access services	Language and language access services 1	Language and language access services 2	Language and language access services 3	Language and language access services 4	Language and language access services 5
Obesity and high BMI	Obesity and high BMI 1	Obesity and high BMI 2	Obesity and high BMI 3	Obesity and high BMI 4	Obesity and high BMI 5
Poverty and low-income status	Poverty and low-income status 1	Poverty and low-income status 2	Poverty and low-income status 3	Poverty and low-income status 4	Poverty and low-income status 5
Social isolation and connection	Social isolation and connection 1	Social isolation and connection 2	Social isolation and connection 3	Social isolation and connection 4	Social isolation and connection 5
Stress and emotional wellbeing	Stress and emotional wellbeing 1	Stress and emotional wellbeing 2	Stress and emotional wellbeing 3	Stress and emotional wellbeing 4	Stress and emotional wellbeing 5
Tobacco and e-cigarettes	Tobacco and e-cigarettes 1	Tobacco and e-cigarettes 2	Tobacco and e-cigarettes 3	Tobacco and e-cigarettes 4	Tobacco and e-cigarettes 5
Water quality	Water quality 1	Water quality 2	Water quality 3	Water quality 4	Water quality 5

Other (please specify)

Question Title

* 1. Where is your community located? A community is where you work, live, and play. It could also be where you spend most of your time with your family, neighbors, and friends, or where your clients live.

Question Title

Question Title

* 3. What are the top risk factors of poor health status and death in your community? Score each cause from 1 to 5, where 1 is not a significant problem and 5 is a significant problem. You can write in any health needs that you think are missing.

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* 4. Any other comments (optional):

* 1. Where is your community located?

A community is where you work, live, and play. It could also be where you spend most of your time with your family, neighbors, and friends, or where your clients live.

* 3. What are the top risk factors of poor health status and death in your community?
Score each cause from 1 to 5, where 1 is not a significant problem and 5 is a significant problem. You can write in any health needs that you think are missing.