Berkshire County Community
Health Needs Assessment
Berkshire Health Systems
October 2015
TABLE OF CONTENTS
INTRODUCTION (p. 3)
EXECUTIVE SUMMARY (p. 4)
Priority Health Needs CHNA REPORT (p.5)
METHODOLOGY
Organization and approach Analytic Methods Prioritization Process and Criteria Collaborating Organizations Target population CHNA priorities Summary of themes DATA ASSESSMENT (p. 12)
Demographics and economic indicators (p. 12) People in Poverty Household Income Unemployment Rates Educational Profile Health Reform in Massachusetts Healthcare disparities Local Health Status and Access Indicators (p.24) County Health Rankings Community Health Status Morbidity and Mortality Indicators Behavioral Risk Factors Social and Economic Factors Additional Community Input, surveys, and interviews (p.91) Life enhancement formative research Age Friendly Survey 2015 Northern Berkshire Community Health Needs (Stroudwater Report)
Latino Patient Family Advisory Committee Southern Berkshire Healthcare Survey APPENDIX
Healthcare Facilities Sources 2 Introduction:
Berkshire Health Systems (BHS) regularly assess the health needs of Berkshire County residents
as part of the strategic planning process and community benefits programming for Berkshire
Medical Center and Fairview Hospital. Berkshire Health Systems has compiled the Berkshire
County Health Needs Assessment Report in collaboration with the County Health Initiative
Steering committee comprised of Berkshire Medical Center, Fairview Hospital, and Berkshire
County Boards of Health Association, Tri-Town Health Department, Berkshire Public
Health Alliance, Pittsfield Health Department, Berkshire United Way, Berkshire Regional
Planning Commission, and Northern Berkshire Community Coalition.
The intent is to broadly identify the major trends in health status and our community's health
needs with an understanding of the factors that are likely to affect the population of Berkshire
County. The objectives of the CHNA were:

To gather statistically valid information on the health status of the residents of Berkshire
County,

To develop accurate comparisons to state and national benchmarks of health and quality
of life measures to provide trending information for the future,

To capture input from the community about health needs,

To identify key areas of significant community needs and vulnerable populations,

To utilize findings for community benefit and hospital planning activities and

To meet MA Attorney General and IRS requirements related to the needs assessment.
This report contains the most recent available date collected through September 2015 and
serves as a valuable resource to help guide Berkshire Health Systems along with our
community at large on the best ways to improve the health of the people living in our
service area.
Improving the health of our population is best accomplished when we all work together
to improve our lifestyle and how we live, work and play. Together, we can help make
individual, family, organizational and environmental changes to improve the health of our
community. Our view of need encompasses the needs that influence the healthcare
system but also include community based, socio-economic, physical environment and
lifestyle issues that influence the creation of health as well as the incidence of illness and
disease.
It should be noted that this type of study has limitations. While demographic,
socioeconomic and health status indicators provide an effective means of identifying
potential needs and/or problems, such a broad-based view cannot identify all of the health
and human service problems facing a community. This is rather one step of many in an ongoing process of collecting and disseminating health status information so that, working
together, we can address the health needs of our community and help to ensure better
outcomes for all the people living in Berkshire County.
3 Suggesstions or add
ditional info
ormation maay be requessted by conttacting the O
Office of
Commu
unity Relatiions and Dev
velopment at
a Berkshiree Health Sysstems at 413
3-447-2060.
ve Summarry
Executiv
Over thee past decadee, mortality rates for mo
ost of the m
major diseasee categories have been
trending downward.. Incidence and
a mortalitty from infecctious diseaases have beeen declining
g.
Serious communicab
c
ble diseasess are relativeely uncomm
mon. The cap
pacity of thee community
y to
respond to natural, man-made
m
and
a public heealth emerg encies has b
been substan
ntially
enhanced
d. Despite many
m
challeenges, accesss to and avaailability of h
health care services, haas
for the most
m part improved. Thee quality of healthcare ooutcomes att BHS has ccontinued to
o
improve, as validateed by multip
ple external sources.
Berkshirre residents still are beset by health challenges that affect ttheir daily liives and theiir
overall well-being.
w
Many
M
of theese challeng
ges are relateed in some w
way or anoth
her to the So
ocial
Determin
nants of Heaalth
The Soccial Determiinants of Heealth are "th
he condition
ns and envirronments in
n which peo
ople
are born
n, grow, livee, eat, work and
a age, as well as their
ir access to tthe care sysstem" (CDC
C).
onomic statu
us, education, employmen
nt, housing, food securitty, transportaation and soccial
Socioeco
protectiv
ve factors, all have an im
mpact on the physical
p
andd mental welllbeing of thee population
n,
including
g the circumsstances peop
ple find them
mselves, and in many casses the life ch
hoices they m
make
or are forrced to makee.
This Com
mmunity Heaalth Assessm
ment, develo
oped by a parrtnership of llocal public h
health and
4 health care delivery advocates, attempts to profile the state of population health in the
Berkshires within the context of the social determinants of health. We have utilized the county
Health Rankings developed by Robert Wood Johnson and the University of Wisconsin as a
framework for understanding as well as addressing health needs.
While the Community Health Needs Assessment focuses on the health of the population,
access to care and gaps in health care services can also influence health and health status.
In March of 2014 North Adams Regional Hospital closed with seventy-two (72) hoursnotice, dramatically changing the challenges and approach to meeting the healthcare needs
of this community. Berkshire Health systems first stabilized access to critical services and
then proceeded to add additional services to meet community need. This effort has been
supported with the help of many local organizations, elected officials and government
agencies.
The Berkshires is a community that willingly collaborates to address challenges and
opportunities, which combined with the power of lifestyle and self-care strategies to
improve health gives us optimism of our ability to work together to create a healthier
community where everyone can thrive.
Identifying Health Needs- Our approach:
Berkshire Health Systems utilizes a formal approach to understand as well as address the health
needs of our community.
Berkshire Health Systems Community Benefits Mission Statement
Furthering our charitable purpose, the Berkshire Medical Center (BMC) and Fairview Hospital
(FVH) Community Benefit Mission is to identify, prioritize and invest in our community's health
needs by pursuing needed initiatives and programs. The Community Benefit goals include satisfying
unmet needs in the Berkshires and improving the health status of our community with a particular
focus on access to healthcare and "at risk" populations. Recognizing the value of BMC's partnership
with our community, BMC will seek input and meaningful collaboration in our effort to meet
community need. BMC will outline in an annual Community Benefit Plan, the priorities to be
addressed and the initiatives to be funded.
BMC and Fairview hospital are both part of Berkshire Health Systems and therefore work together to
meet community need.
Community Benefit and Access Committee
As a standing committee of the Board of Trustees - itself made up of community volunteers, this
committee is responsible for understanding the health needs and barriers to care in our service area.
The Committee oversees the Community Benefit process of the organization, including health needs
assessments, determining target populations and priorities, development of the Community Benefits
plan and evaluating performance against goals and objectives. The committee is comprised of people
from the Board of Trustees and the community at large, and meets monthly though out the year.
Community Benefits Leadership/Team
Ruth Blodgett, BHS Senior Vice President, Planning and Development; Michael Leary, BHS
5 Director of Media Relations; Cathie McHugh, Planning Analyst; Karen Benzie, RN VP Integrated
Care; Kim Kelly, Manager of Community and Public Health; Lauren smith, Director of Community
Relations and development, Fairview hospital, and Lee Santos, BHS Fiscal Administration; Program
Directors of Community Benefit programs.
Community Benefits Team Meetings
The BHS Community Benefits and Access Committee meets monthly to discuss community benefit
programs, potential new initiatives, community needs and outcomes. Throughout the year, internal
community benefit and program leaders meet to coordinate the Community Benefit Plan and
programs.
Using the CHNA to identify priorities and gaps in service
BHS has utilized an active community needs assessment as part of its community Benefit Process
since 1996. The Community Health Needs Assessment is updated annually, and the update directs
our efforts to improve community health. BHS utilized all available clinical, health status,
demographic, and socio-economic data available to form the foundation of our needs assessment. In
addition we gathered available qualitative data from our many advisory groups, community forums,
surveys, and focus groups. The wellness and outreach programs also supplement our understanding
of the health status of our community, health risk factors, and barriers to health and health care, in
collaboration with our Public Health colleagues from across Berkshire County. We also host an
annual community wide meeting to review the health needs of our community, engage stakeholders,
and solicit additional feedback from over 70 community based organizations. The feedback gathers
input on specific actions that could be taken at an individual, family and organizational level as well
as identifying gaps in service in addition to prioritizing the most important needs for the community
as a whole. We have convened this community group at least annually to review data, confirm
priorities, and discuss needs and work together to address the identified priories and needs.
The needs data, along with state priorities are used to determine our annual community benefit
priorities, which are established by the Community Benefit and Access Committee of the Board of
Trustees. In its planning, BMC and Fairview Hospital look for opportunities to make better and
more effective use of existing resources and providers, as well as to identify gaps in service. BMC
and Fairview work with internal resources and community and regional partners, with the help of
evidenced based or best practice programs, to develop and implement programs and initiatives to
meet community need and improve the health of the population we serve.
The priorities identified in the last CHNA remain important and relevant for Berkshire County.
Continuing to focus on the critical priorities identified and prioritized over the last couple of years
will enhance the chance that we can make more meaningful change. The priorities were selected with
much community discussion and were driven by the potential to create and improve health as well as
reduce or reverse existing health problems. In addition, current issues in opioid and heroin overdoses
and deaths warrant a greater focus and attention. Recent trends and feedback also suggest an added
attention to community safety, whether to allow people to feel safer to get exercise or to address
more serious violence and danger.
In addition, we recognize there have been new gaps in service caused by the closing of a health
system and this will continue to be a focus as services to meet the needs of the northern part of the
county are restored as well as new services that were not previously present are added by BHS/BMC
in order to serve the population. The Stroudwater report (excerpt contained later in this report)
continues to provide a blue print for planning and implementation. In addition, the Northern
6 Berkshire Community Coalition, in conjunction with BHS, The Brien Center, Community Health
Programs, DPH office of Rural Health, and many local government and community organizations,
secured a Rural Health planning grant in 2015 to further enhance the process of the understanding
community need and creating a community-based plan to address the needs.
County Health Initiative:
In 2012 we formalized the County Health Initiative (CHI) with the goal of working together to
improve community Health. The leadership team of the CHI included Berkshire Medical
Center, Fairview Hospital, and Berkshire County Boards of Health Association, Berkshire
Public Health Alliance, Tri-Town Health Department, Pittsfield Health Department, Berkshire
Regional Planning Commission, Berkshire United Way, Northern Berkshire Community
Coalition, and in the past, North Adams Regional Hospital.
Goal:

To improve the health status of people in Berkshire County by fostering a healthy
lifestyle environment.
Vision:

To become the healthiest county in MA and the Nation, where individuals and
families can thrive. We believe we can promote healthier lifestyles, resulting in less
disease and illness, a better quality of life, reduce costs to individuals, businesses,
government and society.
Guiding Principles:

Use best available science and information to guide us in healthcare, public health,
health literacy, social science and behavioral economics.

Utilize and deploy evidence-based approach whenever possible.

Engage the community to incorporate and support healthy choices into individual
choices and our collective environment. Empower individuals, families and
neighborhoods as co-producer. Asset-based approach.
Pursue holistic approach to health, embracing an integrated health approach
to a healthy lifestyle and community.

Data Sources
Community Focus Groups, Hospital data, Consumer and Advisory Groups, Interviews, MassCHIP,
Public Health Personnel, Surveys, Other - Healthy People 2020; Department of Public Health Bureau
of Family and Community Health Injury Report; Department of Public Health Prescription
Monitoring Program data; physician manpower data; workforce needs data; wellness data;
Emergency Department/Trauma Registry; Berkshire United Way; Berkshire Regional Planning
Commission; and Chamber of Commerce Blueprint Study
Goals: Statewide Priorities:
As part of our planning process, BHS also incorporates the MA statewide priorities as part of our
local assessment, priorities and initiatives. The Commonwealth's priorities are:
Address Unmet Health Needs of the Uninsured
7 Chronic Disease Management in Disadvantage Populations
Promoting Wellness of Vulnerable Populations
Reducing Health Disparity, Supporting Healthcare Reform
Target Populations
The target populations we address emanate from the needs of the people of the Berkshires and our
health status. Given the prevalence of chronic health issues and access to care that affects the whole
community, we start with the aggregate population to understand and address need. In addition, the
CHNA identifies further focus for the following target populations.
 Medically underserved - Berkshire County has one of the highest number of medically
underserved residents in Massachusetts.
 Uninsured - Due to its economic and employment status, Berkshire County has a significant
number of individuals and families who are uninsured or underinsured.
 Aging population - Berkshire County has one of the largest elderly populations in the state.
 Racial and ethnic populations - The Berkshires is experiencing a steady rise in immigrant
population, particularly Latin American and Russian immigrants. Entire geographic
population of Berkshire County - Berkshire County is the most rural county in the state and is
geographically isolated from larger communities. As a result, BMC is the primary provider of
healthcare services to the region.
 Economically vulnerable - Berkshire County has one of the highest unemployment and
underemployment rates in the state and low median income.
 Youth - Local healthcare statistics on youth at risk.
 Pregnancy and Childbirth - Local healthcare statistics on Maternal Child Health.
 Populations with health disparities - Local health data.
Community Benefit Priorities
The following table highlights the major priorities that have emerged from the community
Health Needs Assessment process.
Clinical Care



Access to Medical professionals
Access for Under and Uninsured
Healthcare Disparities
Health Behaviors





Adolescent and Youth
o Teen Pregnancy
Infectious Disease
Obesity
Smoking
Substance Abuse
8 Morbidity and Mortality







Cancer
Cardiovascular Health
Diabetes
Infectious Disease
Maternal/Child Health
Mental Health
o Depression
Stroke /Blood Pressure
Physical Environment

Emergency Preparedness
Social Economic


Community Development
Safety (new)
The following represents the list of priorities identified by the County Health Initiative based on
Healthy People 2020 Objectives and/or County Health Rankings.
County Health Initiative Priorities 





Healthy Weight, Nutrition, Exercise
Mental Health/Depression
Motor Vehicle Accidents
Substance Abuse/Excessive Drinking
Teen Pregnancy
Tobacco Use
There is also an overarching goal to improve the health status of the community through
integrative health and prevention.
Community Partners
Some of the formal partners include: Berkshire Regional Pittsfield Public Schools, Pittsfield
Board of Health, Head Start, Berkshire Community Action Council, Center for Ecological
Technology, Teen Parent Program, Brien Center for Mental Health and Substance Abuse
Services, Pittsfield Police, Massachusetts Coalition for Suicide Prevention, Massachusetts
Department of Public Health, local community pharmacists, Elder Services, Pittsfield Senior
Center, Greylock Federal Credit Union, Boxcar Media, Tri-Town Health Department, SHINE
program, Berkshire Immigrant Center, Berkshire Community College, Berkshire County
Sheriff's Department, local ambulance companies, Berkshire Breast Health Team, Community
Health Program, Berkshire District Attorney, Berkshire United Way, Berkshire Youth
Development Project, CHNA(Community Health Network Association), Berkshire YMCA,
Berkshire South, Volunteers in Medicine, Berkshire Healthcare, physician practices, home care
and additional community based organizations and the local business community.
9 Other resources and organizations include:
Massachusetts Department of Public Health; University of Wisconsin Population Health
Institute; Berkshire County Boards of Health; local school districts; Berkshire County Regional
Planning Commission; Berkshire United Way; Berkshire, American Heart Association,
American Stroke Association, American Diabetes Association, American Cancer Society,
Chamber of Commerce; Massachusetts Medical Society; Regional Pain collaborative; Berkshire
County Regional Emergency Operations Planning Committee.
Program Planning and evaluation
The Community Health Needs Assessment is used to focus our community benefit program and
initiative planning as well as to monitor results and reprioritize for future efforts.
10 Summary Themes from Community Health Needs Data: Demographics








Characteristic of many rural areas, growth in population is not anticipated
Population is aging
Population is predominately white with a growing Latino cohort.
Family and personal income measures lag behind other areas of the state
Population educational attainment is on par nationally but trails statewide benchmarks
in terms of individuals with college degrees
Area population is very dependent on public sources of financing for health care
services
Unemployment is currently on par with the state average at 6%.
Relatively low rates of violent crime, although on the rise in certain areas.
Most significant Health Risk Issues:








Smoking
Obesity (Nutrition and Exercise)
Substance Abuse (Excessive Drinking)
o Opioid and heroin use and overdose
Motor vehicle accidents
Teen pregnancy
Depression
Diabetes
Hypertension
Negative Socio-economic issues:





High percentage of persons at 200% of the poverty limit (working poor)
Domestic behavior issues
Children in Poverty
Children in single parent households
Public safety is becoming an issue with an increase in crime
Physical environment:




Lower population density reflects rural nature of the county
Physical beauty of the county is a major tourist/vacation/recreation attraction
Transportation to employment and services is a major issue
Safety
Clinical /Health services:


Ranked #3 in the state for Access and Quality
Prevalence of chronic diseases
11 Data
a Assessm
ment
Histo
ory, Envirronment, Demograp
D
phics and Socio-ecoonomics*
Berksh
hire County, Massachussetts is the most
m western of the 14 couunties in Maassachusetts.. With aboutt
12% of
o the landmaass and only 2% of the po
opulation, B
Berkshire County is the seecond most rrural county
in the state (Censu
us, 2010). Figure I shows the locatioon of Berkshiire County aand its neigh
hboring
countiies and statess. The Berksshires run alo
ong the New
w York bordeer from Verm
mont in the n
north to
Conneecticut in thee south and encompasses
e
s most of thee mountain rridge that sep
parates the H
Hudson and
Conneecticut Riverr Valleys. Ellevations ran
nge from 5000 feet in the rriver valleyss to 3500 feeet at Mount
Greylo
ock (Child, 1884).
1
Fig
gure I.
By traditio
on and practice the county is divided
d into three aareas: north, central and south. Each
h area is
serviced by
b a Regionaal Emergency
y Planning Committee
C
(R
onal Emergn
necy Services
REPC), withh three regio
offered by
y BHS. Therre are multip
ple healthcarre sites throuughout the ccounty, and C
Central and south county
y
have locall hospitals. There
T
is no county
c
goverrnment. Thee Commonw
wealth funds a County Sh
heriff's
Department, District Attorney's
A
Office,
O
court system and R
Registrar off Deeds. All local servicees are the
responsibiility of each of the countty's towns an
nd cities.
With sceniic hills and multiple
m
river plains, Berksshire Countyy is composedd of thirty sm
mall towns and
d two small
cities with a total of abo
out 129,000. The city of Pittsfield
P
has 43,697 residdents and the city of North
h Adams
13,305. (20
015 city dataa) All populat
ation numberss are likely uunderstated ddue to the substantial numb
ber of second
d
homeowneers. For exam
mple, the 2010
0 the census lists the popuulation of the Town of Otiis as 1,612 bu
ut the
summertim
me population
n soars to ov
ver 20,000 du
ue to the largee number of ccottages arou
und the Otis R
Reservoir
(SBREPC, 2007). Larg
ge condomin
nium develop
pments in thee four commuunities with sski slopes mean this
visitor-bassed populatio
on surge occu
urs throughou
ut much of th e year. Mudd season in M
March experiences the
lowest visiitor levels.
12 The Berkshires have been a holiday destination for Boston and New York residents for hundreds of
years. The area is promoted now as the "cultural" Berkshires with multiple lectures, plays, musicals
and art offerings throughout the years.
It takes about two hours to drive from the Town of Sheffield in the south to Williamstown in the north
and the fastest route is through New York. Trains once used to be the major method of intercity travel.
Now it is mostly cars with very little public transportation other than a commuter bus that runs
sporadically from Great Barrington to Williamstown and seasonal tourist buses from Boston and New
York. This lack of public transportation makes access to jobs and health care a problem for residents
without private cars. Albany, New York is the closest international airport and major television
provider. In fact Berkshire County media is provided by four states and satellite, making local
newspapers important in disseminating local public information.
Climate
For centuries the county has been known for its dry, cool weather, but this is changing. Average
temperatures have risen about 1°C over the last 100 years (Global Change, 2002). Figure 2 from the
NERA (2010) project displays the regional weighted change in historic temperature changes in New
England from 1895 to 1999. The regional weighted temperature rise was 0.74° F (NERA, 2010).
The county enjoys an average of 44.7 inches of rain per year, 66.1 inches of snow, an average July high
of 79.9 degrees and a January low of 11.2 degrees (Sperling, 2015).
13 Berkshire Health Systems community is comprised of 38 ZIP codes in 32 cities and towns
which essentially is Berkshire County. Berkshire Medical Center is located in Pittsfield, and
Fairview Hospital is located in Great Barrington.
Community Population, 2013
Town
Adams
Alford
Becket
Cheshire
Clarksburg
Dalton
Egremont
Florida
Great Barrington
Hancock
Hinsdale
Lanesboro
Lee
Lenox
Monterey
Mount Washington
New Ashford
New Marlborough
North Adams
Otis
Peru
Pittsfield
Richmond
Sandisfield
Savoy
Sheffield
Stockbridge
Tyringham
Washington
West Stockbridge
Williamstown
Windsor
Population
Estimate
2013
8,418
474
1,868
3,227
1,670
6,744
1,097
774
7,052
714
2,317
3,062
5,932
5,014
695
129
220
1,544
13,657
1,421
872
44,431
1,489
930
675
3,245
1,990
410
478
1,376
7,699
921
130,545
% of Total
Population
6.4%
0.4%
1.4%
2.5%
1.3%
5.2%
0.8%
0.6%
5.4%
0.5%
1.8%
2.3%
4.5%
3.8%
0.5%
0.1%
0.2%
1.2%
10.5%
1.1%
0.7%
34.0%
1.1%
0.7%
0.5%
2.5%
1.5%
0.3%
0.4%
1.1%
5.9%
0.7%
100.0%
Data Source: US Census Bureau 2009-2013 ACS Estimates
In the 12 months ending September 2014, 92.7% of BHS Inpatients originated from
these towns
14 Geogrraphic Profiile:
The 32
2 communitties of Berksshire Countty cover nearrly 950 sq. m
miles of areaa and has an
overalll population density off 140 persons per sq. mille compared
d to 835 perso
ons per sq.
mile for
f the Comm
monwealth.
B
Berkshire C
County, Ma
assachusetts





15 38 Zip Co
odes represeenting all off
Berkshiree County
Populatio
on (2014): 128,715
Project po
opulation ch
hanges 2014
42020:
o Inccrease in the 65+
po
opulation
o Deecrease in th
he 19 yrs. an
nd
un
nder populattions
Growing diversity
Grrowing Asiaa, Black,
Ru
ussian, and H
Hispanic (o
or
Laatino) popullations
Disparitiees for Black
k and Hispan
nic
(or Latino
o) residents
o More likely to
o be living iin
overty
po
o Hiigher rates o
of stroke, heeart
dissease, diabeetes, and can
ncer
mo
ortality
Berkshire County’s Changing Population” Berkshire County is currently experiencing a continued decline in population that traces back to the 1970’s
when the county hit its peak population. As mills and manufacturing began closing throughout the county,
young adults left the region to pursue employment in other areas of the country. This departure, which
continues today, combined with the global trend of increased urbanization, has led to the state of continual
decline in Berkshire County.
Berkshire County Population Trend
200,000
150,000
100,000
50,000
Hisotric 2050
2020
2010
1990
1970
1950
1930
1910
1890
1870
1850
1830
1810
1790
0
Projected
The decline in the region’s population today is based on the discrepancy between births and deaths and in- and
out- migration. For the last 10 years, Berkshire County has been experiencing an average of 280 more deaths
then births each year. As a region, it is projected to continue to decline in the number of births and an increase in
the number of deaths, which will accelerate the decline, especially as the baby boomers, the largest sector of the
population, age. In addition, the county has been experiencing an average net loss of another 250 people a year
due to migration. This is projected to decline slightly, but stay as a net loss over the coming decades. Berkshire
County is the only county in the state that is experiencing a decline in both vital events and net migration. Over
the last 40 years, the population of the region has become imbalanced based on age. As a region, the Berkshires
has a significantly smaller percentage
of young adults and fewer children than the state or nation, while having more older adults than the state and
nation. This imbalance is the leading reason why the population will continue to decline over the coming
decades. The lack of young adults, and the lack of children they have, leads to a continuous decline in the
population.
Source: Berkshire Regional Planning Commission
16 Berkshire County Births and Deaths 2000-2012
Berkshire County Births vs Deaths
2000‐2013
2000
1500
1000
500
Births
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
0
Deaths
3. Age Distribution
The age stratification of the county is older compared to state and national
distributions. On a percentage basis, Berkshire County has few children (4.5% of
the population is under the age of five), a small proportion (31.0%) of young
adults (20-44yrs), and larger proportions of older adults and elderly 19.2 >65
years). In fact, residents of ages 50-70 years currently make up the largest
portion of the population with 30%. This trend is accentuated in South County,
which has a median age of 48.4 years compared to Berkshire County (45.1) and
the state as a whole (39.2 years).
Population by Age Groups Mass, Berkshire County and Major Towns
50%
40%
30%
20%
10%
0%
19 and under
21.3%
Berkshire
County
19.0%
20.1%
17.0%
16.1%
20-44 years
36.8%
31.0%
31.7%
33.9%
40.8%
45-64 years
27.8%
30.9%
29.6%
30.0%
25.8%
65-84 years
11.9%
15.9%
15.2%
14.7%
14.8%
85 and older
2.2%
3.3%
3.4%
4.3%
2.6%
Mass
17 Pittsfield
Gt Barrington
North Adams
Berkshire County Population by Race
The population of Berkshire County is predominately White (93% vs. 83%
statewide) with smaller percentages of Hispanics (3.8%), Blacks (3.1%) and
Asian (1.4%) persons. County-wide, South County has the greater percentage
of Hispanics/Latinos of Any Race (11.1%) compared to North County (3.5%).
Central County has the largest percentage of the Black population (5.4%)
compared to North County (2.3%) and South County (3.0%).
2010‐2013 Population Percentage by Race Mass, Berkshire County and Major Towns
100.0%
75.0%
50.0%
25.0%
0.0%
Massachusett
s
Berkshire
County
Pittsfield
Great
Barrington
North Adams
White Persons
83.2%
93.1%
89.2%
84.9%
93.0%
Hispanic or Latino of any
10.5%
3.8%
5.0%
11.1%
3.5%
Black Persons
8.1%
3.1%
5.4%
3.0%
2.3%
Asian Persons
6.0%
1.4%
1.0%
2.1%
0.7%
Two or more races
2.1%
2.2%
3.2%
5.6%
2.6%
2013 Population Percentage by Race (excluding White) Berkshire County vs. Mass
20.0%
Berkshire County
Massachusetts
15.0%
10.0%
5.0%
0.0%
Hispanic
Black
Asian
or Latino
Persons Persons
of any
American
Two or
Indian
more
and
Races
Alaska
American
Two or
Indian
more
and
Races
Alaska
2010
3.5%
2.7%
1.2%
0.2%
2.1%
9.6%
6.6%
5.3%
0.3%
2.6%
2013
3.8%
3.1%
1.4%
0.3%
2.2%
10.5%
8.1%
6.0%
0.5%
2.1%
Data Source: US Census Bureau ACS Estimates 2009‐2013
18 Hispanic
Black
Asian
or Latino
Persons Persons
of any
Economic Profile:
While the unemployment rate for Berkshire County has generally trended slightly above
the statewide rate with a current 6.5% of its population unemployed compared to 5.8% in
the state as whole. Similarly, per capita income in the Berkshires ($29,294) is
substantially lower (18%lower) than the state per capita ($35,763). Median household
income ($65,216) also compares much less favorably (23% lower) to the statewide
median income ($84,900). Berkshire County has a larger percentage of Persons living
below the poverty level (9.8%) compared to Massachusetts as a whole (8.1%). A large
percentage of children and young families in Berkshire County are vulnerable to
economic distress as approximately 25.9% of the children 0-5yrs of age live below the
poverty level, and 49.9% of mothers delivering babies receive publicly funded pre-natal
care compared to 36.1% statewide.
Unemployment Rates 2001 ‐ 2014
10
8
6
4
2
0
2002
2004
2006
2008
2010
2012
2014
Mass
5.3
5.1
4.9
5.5
8.3
6.7
5.8
Berkshire
County
4.6
4.7
4.3
5.2
8.7
7.2
6.5
Data Source: US Bureau of Labor Statistics
Median and Per Capita Income Berkshire County and Major Towns
vs. Mass
90,000
80,000
70,000
60,000
50,000
40,000
30,000
20,000
10,000
-
Median Income
84,900
Berkshire
County
65,216
Per Capita Income
35,763
29,294
Mass
Data Source: US Census Bureau ACS 2009-2013
19 Pittsfield
Gt Barrington
North Adams
42,114
50,137
38,317
26,304
32,963
21,263
Educational Profile:
The residents of Berkshire County are generally as educated as the rest of the state in
terms of attainment of high school diploma, with 90.6% of its population graduating
compared to the statewide 89.4%. When it comes to those who are ≥25 years old
and have attained a Bachelor’s degree or higher, Berkshire County is about 23%
below the state average (39.4%) with only 30.3% of its population receiving higher
education. Possible explanations include lower economic capability of residents to
attain higher education, fewer young families, and outmigration of young adults
once they have attained higher education.
Degree of educational attainment varies by region in the county with residents of
South County having higher levels of educational attainment compared to the
county as a whole. Of note, in Massachusetts, if 5% more people attended some
college and 3% more had an income higher than twice the federal poverty level we
could expect to save 1,700 lives, prevent 26,400 cases of diabetes, and eliminate
$197 Million in diabetes costs every year.
Educational Attainment Mass, Berkshire County and Major Towns
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
USA
Mass
Berkshire
County
Pittsfield
Gt
Barrington
North
Adams
High School or Higher
86.0%
89.4%
90.6%
89.8%
89.4%
84.3%
Bachelor's or higher
28.8%
39.4%
30.3%
25.0%
40.7%
19.2%
Data Source: US Census Bureau ACS 2009‐2013
20 Health Reform in Berkshire County: Ecu-Health Care and Advocacy for Access
In the mid-1990s, Massachusetts began a concerted effort to increase access to publicly
sponsored health coverage by expanding eligibility for the Massachusetts Medicaid program,
known as Mass Health. Income guidelines were modified, and specific high-risk groups were
identified to increase enrollment into the program, with the intent of improving financial access
to health care services. Financial access to health care services is a major issue in Berkshire
County, given the economic demographic of the population. In 2014, the implementation of the
Patient Protection and Affordable Care Act expanded eligibility for the Mass Health program to
all qualified low-income individuals. Changes to the way income was counted would also allow
more individuals to qualify for Mass Health. However, due to major system issues,
implementation of these new eligibility rules had to be postponed. As a result, in early 2014,
Mass Health suspended member renewals, protected current members under their existing
coverage, and placed new applicants in a temporary Mass Health benefit until a functional
eligibility system could be developed and deployed, which occurred at the end of 2014.
Because of the structure of the Mass Health program at its onset, enrollment into the program
was complicated and confusing for residents. In many areas, grassroots organizations were
developed through a combination of public, private, and foundation support to facilitate
enrollment of eligible residents into health care plans. Ecu-Health Care, founded in 1995, and
Advocacy for Access, a program of Berkshire Health Systems, founded in 1997, focused on
removing financial and systemic barriers to health care for residents of Berkshire County by
providing enrollment assistance into state sponsored programs and advocacy in navigating the
health care systems. The failed implementation of Mass Health’s new eligibility system in 2014
caused significant systemic barriers to enrollment and the Advocacy for Access and Ecu-Health
Care programs were relied on heavily to overcome these barriers, which they were successfully
able to do.
Advocacy for Access and Ecu-Health Care cover the county with offices in Pittsfield, Great
Barrington, and North Adams. Currently, the programs employ approximately 14 FTE
counselors who have experience in Mass Health, Health Safety Net, Qualified Health Plans,
outreach, and related programs. The program staff has particular expertise in addressing the
needs of “high risk” clients, including those persons requiring assistance with disability
determinations, spend downs or deductibles, and behavioral health issues. For example, services
are provided on the inpatient substance abuse and psychiatric units at Berkshire Medical Center
and integrated into care planning and discharge orders, to address issues of continuity of care and
reduction of recidivism. Strong referral networks have been established with the Berkshire
County House of Correction, Community Corrections, Barton’s Crossing (homeless shelter),
Soldier On, and the Brien Center for Mental Health, to address appropriate access to health care
services.
The target populations for this effort are uninsured working adults, persons with Spanish as a
primary language, individuals requiring assistance with Mass Health disability determinations,
individuals with substance abuse and behavioral health issues, the homeless, and individuals in
the community corrections system.
The deployment of the new eligibility system in November 2014 is expected to increase
enrollment in state’s Mass Health program due to the new eligibility rules created by
Massachusetts’ adoption of the Affordable Care Act’s Medicaid expansion provision. The
enrollment in subsidized plans available through the Massachusetts Health Connector is also
expected to increase thanks to the availability of federal premium tax credits that can applied
towards the purchase of a Qualified Health Plan.
21 Health Disparity:
Disparity has been defined* as a "condition or fact of being unequal ..."
With respect to health status and health care services, disparity can result from:
• Economic status
• Level of education
• Financial access to health care
• Transportation issues in rural areas
• Language barriers
• Racial, ethnic, cultural and religious differences
These factors directly impact the choices and life options available for people in attaining and
managing health and become apparent when benchmarking the health indicators of Berkshire
County residents against the state benchmarks.
Given the age and economic demographic of the county, Berkshire residents are heavily reliant
on public sources of financing for access to health care. This makes the providers of health
care services dependent on government- reimbursed services and can have a direct influence on
what services are available locally.
The connection between education and income can be a significant determinant in health
status, as it can relate to food security, housing, behavioral health choices, and general feeling
of well-being.
In a rural area, with limited public transportation, physical access to health care services,
educational opportunities, access to healthy foods and community services, directly impact on
health status.
22 Language barriers are an emerging issue in Berkshire County, especially in the access to
healthcare services. For example, the Berkshire Medical Center In-Person Interpreter
Program experienced a 59% increase in use from FY2012-FY2014 to primarily for Latino
clients. To ta l In te rp re te r S e r v ic e s E n c o u n te rs
(in c lu d in g s ig n la n g u a g e )
FY12
2676
5512
To ta l R e q u e sts
To ta l E n c o u n te rs
FY13
3236
6501
FY14
4109
8754
12 00
10 00
800
F Y 2 0 1 4
600
F Y 2 0 1 3
F Y 2 0 1 2
400
200
0
O ct
Nov
D ec
Ja n
Feb
M ar
Apr
M ay
Ju n
Ju l
A ug
Sep
Berkshire Health Systems developed their Language Link Program to help Non English speaking patients navigate the health‐care system by: Booking appointments Helping filling up forms Insurance and billing ( to name a few) Providing Community Resources information •
•
•
•
To ta l L in k L in e E n c o u n te rs
(F Y 2 0 1 4 )
100
86
90
80
65
70
60
56
52
54
57
49
49
O TH ER
49
44
50
S P A N IS H
35
40
30
20
10
2
0
O ct
Nov
D ec
Ja n
Feb
M ar
Apr
M ay
23 Ju n
Ju l
Aug
Sep
R U S S IA N
Services Provided for all Link Line Calls
APPOINTMENT BOOKED
4%
2% 4%
APPOINTMENT CANCELLATION
4%
APPOINTMENT CANCELLATION AND NEW
APPOINTMENT BOOKED
4%
36%
6%
PHONE INTERPRETATION
MEDICAL REFERRAL
NON‐MEDICAL REFERRAL
BILLING/FINANCIAL
16%
6%
7%
11%
MEDICAL REFERRAL AND APPOINTMENT
BOOKED
INSURANCE REFERRAL
COMMUNITY RESOURCE
OTHER COMBINATIONS
Local Health Status and Access Indicators
County Health Rankings One of the basic underlying premises of Public Health is "that where we live matters to our
health".
The health of a community depends on many different factors ranging from health behaviors,
education, employment and environment, to access and quality of health care.
The University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation,
have developed County Health Rankings to help communities understand what influences how
healthy residents are and how long they will live. The Rankings look at a variety of measures that
affect health such as the rate of people dying before age 75, high school graduation rates, access to
healthier foods, air pollution levels, income, rates of smoking, obesity and teen births.
"The Rankings really show us with solid data that there is a lot more to health than health care.
Where we live, learn, work and play affect our health... according to Patrick Remington, MD, MPH,
director of the County Health Rankings project and Associate Dean for Public Health at the
24 University of Wisconsin School of Medicine and Public Health.
"It's hard to lead a healthy life if you don't live in a healthy community," (Risa Lavizzo- Mourey,
M.D., M.B.A. president and CEO of the Robert Wood Johnson Foundation)."The County Health
Rankings are an annual check-up for communities to know how healthy they are and where they can
improve.
Counties in each of the 50 states are ranked according to summaries of a variety of health measures.
Those having high ranks, e.g. 1or 2, are considered to be the "healthiest." Counties are ranked
relative to the health of other counties in the same state on the following summary measures:
Health Outcomes--rankings are based on an equal weighting of one length of life measure
(mortality) and four quality of life measures (morbidity).
For purposes of the County Health Rankings, Mortality is measured in terms of premature mortality;
deaths that occur before a person reaches an expected age e.g. age 75. Many of these deaths are
considered to be preventable.
In Community Health Rankings, Morbidity refers to how healthy people feel (their overall health:
physical and mental) and birth outcomes.
Health Factors--rankings are based on weighted scores of four types of factors:
• Health behaviors
• Clinical care
• Social and economic
• Physical environment
25 26
6 2015 Berkshire County Health 2015 Rankings
Health Outcomes
Length of Life
Premature death
Quality of Life
Poor or fair health
Poor physical health days
Poor mental health days
Low birth weight
Health Factors
Health Behaviors
Adult smoking
Adult obesity
Food environment index
Physical inactivity
Access to exercise opportunities
Excessive drinking
Alcohol-impaired driving deaths
Sexually transmitted infections
Teen births
Clinical Care
Uninsured
Primary care physicians
Dentists
Mental health providers
Preventable hospital stays
Diabetic monitoring
Mammography screening
Social & Economic Factors
High school graduation
Some college
Unemployment
Children in poverty
Income inequality
Children in single-parent households
Social associations
Violent crime
Injury deaths
Physical Environment
Air pollution - particulate matter
Drinking water violations
Severe housing problems
Driving alone to work
Long commute - driving alone
Error
Margin
Top U.S.
Performers*
5,773
5,265-6,281
5,200
12%
3.7
3.6
8.00%
10-15%
3.3-4.2
3.1-4.1
7.4-8.6%
10%
2.5
2.3
5.90%
17%
23%
8.2
19%
89%
21%
25%
259
22
15-19%
20-25%
14%
25%
8.4
20%
92%
10%
14%
138
20
4%
897:01:00
1,336:1
163:01:00
47
91%
72.60%
4-5%
87%
61.80%
7.10%
19%
5
35%
11.7
403
55
10.8
20%
17%
79%
23%
http://www.countyhealthrankings.or
27 Berkshire
County
17-21%
19-24%
20-23
44-50
87-95%
68.5-76.7%
58.3-65.3%
11%
1,045:1
1,377:1
386:01:00
41
90%
70.70%
49-61
71.00%
4.00%
13%
3.7
20%
22
59
50
16-19%
78-81%
21-24%
9.5
0%
9%
71%
15%
15-23%
4.7-5.3
31-39%
Health Status Indicators: Adult
Among adults, conditions related to high blood pressure, high cholesterol, low physical activity and diabetes
are significant.
The leading causes of death to Berkshire County residents are:
•
•
•
•
•
Circulatory Diseases (All Cardiovascular)
Cancer: All Types
Respiratory Diseases (Diseases of the lung other than lung cancer)
Nervous System Diseases
Mental Disorders: All
Since 2010, the top three disease categories (Circulatory, Cancer and Respiratory) have shown declines in
age adjusted mortality rates much like the overall rate for the state during this period. It is interesting to
note that each of these disease categories can be significantly affected by Health Behaviors (life style
choices), Social and Economic Factors, and Physical Environment. These are areas that Berkshire County
did not score particularly well in the County Health Rankings. That Berkshire County did Rank #3
statewide in clinical care and has a different population make-up, are possible explanations for this trend.
Lung cancer is still the leading cause of cancer deaths in Berkshire County (28%).
Of note, the incidence rate of lung cancer since 2008 has been decreasing for men (-1.8%) while the incidence
rate for women has been increasing (+1.0%).
The mortality rates of breast, prostate, and colon cancer have continued to decline since 2008. Vigorous early
screening and detection programs in combination with treatment advances are thought to be contributing factors.
Within the respiratory therapy disease category, death rates from pneumonia and Influenza have declined by
almost one-half compared to a one-third decline statewide. Much of the decline is believed to be attributed to
aggressive countywide public health initiatives.
Alzheimer's disease has emerged as a major cause of death, with rates increasing over the past ten years. In
Berkshire County, death rates from Alzheimer's disease (27.8/100,000) are higher than death rates from
diabetes, breast, prostate, and colon cancer.
Motor vehicle related injury deaths are higher than the state (BC: 10%, MA: 6%) experience possibly due to a
combination of behavioral (DUI), environmental issues and the significant number of visitors to the County.
Suicide death rates are higher than expected (10.02) adjusting for age compared the rest of the state (9.1).
National is 12.94/100,000.
Adult residents of Berkshire County experience lower rates of infectious disease and sexually transmitted
disease compared to the state benchmarks.
The Berkshire County mortality rates for diseases of the nervous system and the rates for injuries and
poisonings similarly track with statewide rates.
Health Outcomes and Mortality
Below is the summary of health outcomes and mortality, which will be used as a framework to organize
additionally available local data.
28 Health Outccomes: Co
ounty He
ealth Rankings Me
easure (Ran
nk of 14
Co
ounties)
2015 BERKSHIRE
B
E COUNTY HEALTH RA
ANKINGS S
SNAPSHOT
T
He
ealth Outcom
mes (11)
Length of Life
e (11)
Pre
emature death
h
Qu
uality of Life
e (11)
BC
vs.
Berkshiire County
5,773
5
Mass
BC
vs.
5,118
BC
vs.
Berkshiire County
Mass
U.S. To
op
Perform
mer
5,200
BC
vs.
U.S. To
op
Perform
mer
12%
1
12%
10%
Poo
or physical he
ealth days
3.7
3.1
2.5
Poo
or mental hea
alth days
3.6
3.2
2.3
8..00%
7.80%
5.90%
Poo
or or fair heallth
Low
w birth weightt
Worse than Mass/U.S
Similar to Ma
ass/U.S.
29 Be
etter than Mass/U
U.S.
County Health Rankings Reports 2010‐2015: Berkshire County Premature Death (Age Adjusted Rate of Years of Potential life lost < Age75)
2004‐2012
9,000
8,000
7,000
6,000
5,000
4,000
3,000
Measure: Health Outcomes - Mortality; Weight 50%
2010 YPLL Rate
2011 YPLL Rate
2012 YPLL Rate
2013 YPLL Rate
2014 YPLL Rate
2015 YPLL Rate
Berkshire
6,068
5,882
6,122
5,915
5,915
5,773
Mass State
5,681
5,577
5,441
5,295
5,295
5,118
Target 90th %tile
4,573
5,564
5,466
5,317
5,317
5,200
Data Source: National Center for Health Statistics
Massachusetts Counties
Premature Death vs. Per Capita Income
Average 2010 - 2012
7,500
7,000
Hampden
Age Adj. Rate per 100,000
6,500
Bristol
6,000
Suffolk
Berkshire
Barnstable
Worcester
5,500
Plymouth
5,000
Franklin
Essex
Hampshire
Norfolk
4,500
Nantucket
3,500
$20,000
Middlesex
Dukes
4,000
$25,000
$30,000
$35,000
Per Capita Income
30 $40,000
$45,000
BERK
KSHIRE COU
UNTY vs MAS
SSACHUSET
TTS
PREMATUR
RE DEATHS (POTENTIAL
(
L LIFE LOST A
AGE <75)
AGE SPECIFIC RATE
R
- AVERA
AGE 2010-20
012
2,5
500
2,0
000
1,5
500
1,0
000
500
5
-
00 05 30 35 40 45 50 55 60 10 15 20 25 65 70 04
34
39
44
49
54
59
64
14
19
24
29
69
09
0
9
7
74
Years Ye
ears Years Yea
ars Years Years
s Years Years Years Years Years Years Y
Years Years Ye
ears
BC Avg 2010-20
0012 130.7 15
5.11 13.30 26.5
55 48.28 124.0
0 70.13 134.9 182.7 343.0 387.1 611.6 8
826.7 1,365 1,9
972
MA Avg 201020
012
97.52
8..35
8.03
30.3
32 64.68 72.67
7 86.16 103.9 161.8 244.8 384.1 557.7 8
813.8 1,287 2,0
030
Da
ata Source: Ma
assCHIP
Berks
shire Countty Top 5 Ca
auses of Death
Age Adjustted Rates 1999-2012
8
800
7
700
6
600
5
500
4
400
3
300
2
200
100
0
1999 2000
2
2001 2002 200
03 2004 2005 2006
Mental Diso
orders: All
Nervo
ous System Disea
ases: All
Cancer: All Types
Circulatory System Disseases: All
31 2007 2008
8 2009 20
010 2011 2012
Respiratory Sysstem Diseases: A
All
32 33 County Health Rankings Reports 2010-2015: Berkshire County
Poor Physical Health Days
Avg. # Days in Past 30 Adults Responded Their Health Was Not Good
2002-2012
5.0
4.5
4.0
3.5
3.0
2.5
Measure: Health Outcomes - Morbidity; Weight 10%
2.0
2010
Physically
Unhealthy
Days
2011
Physically
Unhealthy
Days
2012
Physically
Unhealthy
Days
2013
Physically
Unhealthy
Days
2014
Physically
Unhealthy
Days
2015
Physically
Unhealthy
Days
Berkshire
4.0
4.0
3.9
3.8
3.7
3.7
Mass State
3.2
3.2
3.2
3.2
3.1
3.1
Target 90th %tile
2.8
2.6
2.6
2.6
2.5
2.5
Data Source: BRFSS
County Health Rankings Reports 2010-2015: Berkshire County
Poor Mental Health Days
(Avg. # Days in Past 30 Adults Responded Their Mental Health Not Good)
2002-2012
5.0
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
Measure: Health Outcomes - Morbidity; Weight 10%
0.5
-
2010
Mentally
Unhealthy
Days
2011
Mentally
Unhealthy
Days
2012
Mentally
Unhealthy
Days
2013
Mentally
Unhealthy
Days
2014
Mentally
Unhealthy
Days
2015
Mentally
Unhealthy
Days
Berkshire
3.5
3.6
3.5
3.4
3.6
3.6
Mass State
3.3
3.3
3.2
3.2
3.2
3.2
Target 90th %tile
2.8
2.3
2.3
2.3
2.4
2.3
Data Source: BRFSS
34 CMS: Chronic Conditions among Medicare Beneficiaries
Medicare Beneficiaries < 65 years of 65+ years of All
age age
Berkshire County Massachusetts 2012 8.99 24.40 4.54 9.58 0.19 10.32 9.81 14.35 17.35 23.05 12.25 44.35 53.55 23.26 9.08 3.67 4.19 Alzheimer's Disease/Dementia Arthritis Asthma Atrial Fibrillation Autism Spectrum Disorders COPD Cancer Chronic Kidney Disease Depression Diabetes Heart Failure Hyperlipidemia Hypertension Ischemic Heart Disease Osteoporosis Schizophrenia and Other Psychotic Disorders Stroke 2.38 17.55 8.75 2.12 0.87 10.11 3.11 9.40 32.96 19.82 5.79 27.71 30.55 11.44 2.79 8.81 1.79 10.47 25.94 3.60 11.25 10.37 11.31 15.46 13.85 23.77 13.70 48.08 58.70 25.91 10.49 2.51 4.73 The data used in the chronic condition reports are based upon CMS administrative enrollment and claims
data for Medicare beneficiaries enrolled in the fee-for-service program
35 Cardiovascular Mortality Since 1995, Cardiovascular Mortality Age Adjusted Death Rates have been declining. Currently, the annual
death rate per 100,000 in Berkshire County (180.8) is above both the state (141.5) and national (169.8)
average.
Despite rate decreases experienced in Berkshire County, death rates for Acute Myocardial Infarction and
Stroke in particular are higher for residents of the Berkshires than the statewide average. The difference is
possibly attributable to the rural nature of the county and increased length of time to treatment.
Berkshire County vs Massachusetts
Cardiovascular Mortality Age Adjusted Rates
1999 - 2012
350.00
300.00
250.00
200.00
150.00
100.00
50.00
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
BC Major CVD Deaths
MA Major CVD Deaths
Data Source: MassCHIP
Hypertension (High Blood Pressure)
Hypertension is a major risk factor for cardiovascular disease and diabetes and is associated with
overweight/obesity. The American Heart Association estimates that up to one in three adults suffer from
hypertension.
In Berkshire County working populations, blood pressure (BP) data on > 2000 employees in the health care,
manufacturing, defense, education and banking industries illustrate that 17% have a BP greater than 140/90.
Another 40% are at risk for hypertension.
Of employees in that cohort that have the diagnosis and are being treated, 26% continue to have blood
pressures "not at goal" (greater or equal to 140/90).
In Diabetes population of 365 patients seen through the BHS Diabetes Education Program 37% did not have
a blood pressure at goal (less than 130/80)
For patients seen at Berkshire Medical Center with stroke, 63% have a primary diagnosis of Hypertension.
36 Berksh
hire County v
vs Massachu
usetts
Other Cardiova
ascular Morttality Age Ad
djusted Rates
s
1999 - 2012
12.00
10.00
8.00
6.00
4.00
2.00
99
199
2000
2001
1
2002
2003
3
2004
2005
2006
2007
2008
2009
2010
2011
BC Athe
erosclerosis
BC Hypertension
BC Hypertensive Heart Dise
ease
MA Athe
erosclerosis
MA Hypertension
MA Hype
ertensive Heart Dise
ease
Data Source: MassCHIP
P
Cardiovasculaar Mortalityy by Race: Pittsfield
d, Berkshire County, and
d Massachusetts
3 Ye
Year (2008‐20
010) Age Ad
dusted Rate
427.5 450.0
358.1 400.0
343
3.0 350.0
300.0
250.0
244.1 204.0 198.3 200.8 200.0
157.2 142.4 1136.5 150.0
1110.7 99.9 100.0
50.0
‐
White, non
n‐Hispanic
Data Source: Mass D
DPH/ Mass CHIP
Black, non‐Hisspanic
Pittsfield
Hispanic
Berkshire C
County
37 2012
Asiian/OI,
non==Hispanic
State
Carrdiovascularr Hospitalization by Racee
Pittsfielld, Berkshire
e County and
d Massachu
usetts
3 Y
Year (2008‐2
2010) Age Ad
dusted Ratee
2,889.4 3,000.0
0
2,750.2 2,500.0
0
2,107.5 2,195.9 2,012.7 2,000.0
0
1,604.4
4 1,500.0
0
1,6698.8 1,456.4
4 1,347.4 1,020.8 1,000.0
0
723.4 500.0
0
‐
White, no
on‐Hispanic
Black, non‐Hiispanic
Pittsfield
Hispanic
Assian/OI,
non==Hispanic
Data Source: Mass D
DPH/ Mass CHIP
Cardiovvascular Ho
ospitalizatiion by Racce: Pittsfield vs. Masss
3 Year (2008‐2010)) Age Adussted Rate
2,889.4 2
3,000.0
0
2,1195.9 2,500.0
0
2,000.0
0
1,604.4 22,012.7 698.8 1,6
456.4 1,4
1,500.0
0
1,000.0
0
500.0
0
‐
White,, non‐Hispanic
Data Source: Mass D
DPH/ Mass CHIP
Black,, non‐Hispanicc
Pittsffield
State
38 Hispanic
Diabetes Mortality
Diabetes is one of the multiple conditions considered to be related to cardiovascular disease. Since
1994, death rates from diabetes have declined by 24% in Berkshire County. Statewide, over the same
period of time, rates of diabetes fell by 33%. According to 2013 data, 7.3% of Berkshire County adults
had diabetes, similar to the state’s proportion of 7.5%. Berkshire County’s death rate of 20.0/100,000
is above the state average death rate of 14.1 but below the national average of 21.1.
Berkshire County vs Massachusetts
Diabetes Mortality
Age Adjusted Rates 1999 - 2012
50.00
45.00
40.00
35.00
30.00
25.00
20.00
15.00
10.00
5.00
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
BC Diabetes Mellitus Deaths
MA Diabetes Mellitus Deaths
Massachusetts Diabetes
Age Adjusted Death Rate per 100,00
21.18
United States
Massachusetts
14.08
20.57
20.16
19.96
18.63
18.11
Suffolk 1.
Worcester 2.
Berkshire 3.
Hampden 4.
Bristol 5.
Plymouth 6.
Essex 7.
16.43
16.35
15.96
15.38
14.49
14.42
14.31
13.79
13.25
Hampshire 8.
Franklin 9.
Norfolk 10.
Barnstable 11.
Middlesex 12.
Nantucket 13.
Dukes 14.
0
5
10
15
Data Source: CDC 1999‐2013 Final Data
39 20
25
Diabetess Incidence
e Berkshiree County 2004‐‐2012
10.00
8.00
6.00
4.00
2.00
0.00
200
04 per
1000
1
2005 per
1000
2006 per
1000
20
007 per
1000
2008 pper
1000
2009 per
1000
22010 per
1000
2011 per
10000
2012 per
1000
Rate
7.1
7
8.4
8.5
8.5
8.2
7.4
6.9
9
6.8
Age Ad
djusted Rate
6.4
6.3
7.6
7.7
7.7
7.3
6.7
6.2
2
6.1
Data Sou
urce: CDC
Diagnosed
D
d Diabetes in Berkshiire Countyy
Numbe
er of New C
Cases 20044‐2012
2012
2011
2010
2009
2008
2007
2006
2005
2004
0
100
200
300
400
4
500
Data Source
e: CDC
40 600
700
800
Cancer Deaths
The leading causes of cancer deaths in Berkshire County:
Lung Cancer
Breast Cancer
Colorectal Cancer
Pancreatic Cancer
Prostate Cancer
Overall, cancer death rates in Berkshire County have been declining since 2000 and the total cancer age
adjusted death rate is lower than the state average in 2012 of 162.86
Berkshire County vs. Massachusetts
Cancer Mortality
Age Adjusted Rates 1999 - 2012
240
220
200
180
160
140
120
100
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
BC CA All Types
208.11 190.32 188.19 196.66 207.5 193.65 184.21 185.34 187.14 173.1 166.85 156.07 157.92 150.35
MA CA All Types
205.95 205.71 199.35 199.67 192.42 187.98 184.17 186.1 178.87 177.4 173.69 170.32 165.65 162.86
Major decreases have been observed in the death rates from Prostate Cancer, Uterine and Leukemia. In
general, death rates for Breast Cancer, Ovarian Cancer and Colorectal Cancer have declined while death
rates for Lung Cancer, Pancreatic Cancer and Bladder cancer have remained fairly steady.
Berkshire County vs Massacusetts
Change in Cancer Site Mortality
Age Adjusted 1999 - 2012
10.0%
0.0%
-10.0%
-20.0%
-30.0%
-40.0%
-50.0%
-60.0%
-70.0%
Cancer: All
Types
Cancer:
Lung
Cancer:
Breast
(Female)
Cancer:
Pancreas
Cancer:
Cancer:
Colo rectal Esophagus
Cancer:
Ovary
Cancer:
Uterine
Cancer:
Leukemia
BC 1999-2012
-27.8%
-4.3%
-47.0%
-1.7%
-56.3%
4.1%
-65.1%
-4.1%
-52.6%
-25.4%
MA 1999-2012
-20.9%
-17.9%
-29.3%
-0.4%
-40.8%
-8.9%
-42.3%
-18.1%
5.0%
-14.7%
41 Cancer:
Prostate
Chart: Berkshire County Female Deaths from 7 Most Common Cancers
as a Percent of all Causes of Death among Women in Berkshire County
140.00
120.00
100.00
80.00
60.00
40.00
20.00
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Lung
Breast (Female)
Colo rectal
Pancreas
Ovary
Lymphoma, Non Hodgkin
Leukemia
Data Source: MasCHIP
250.00
Chart: Berkshire County Male Deaths from 7 Most Common Cancers
as a Percent of all Causes of Death among Male in Berkshire County
200.00
150.00
100.00
50.00
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Lung
Prostate
Colo rectal
Pancreas
Esophagus
42 Lymphoma, Non Hodgkin
Leukemia
Data Source: MasCHIP
Lung Cancer
Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. Lung
cancer accounts for more deaths than any other cancer in both men and women. Newly available screening
and early diagnosis are essential to treatment and survival.
The incidence of Lung Cancer in the Berkshires has remained fairly steady for the population as a
whole for the 2008-2013 time period, although there are differences in the sex specific rates.
Historically, death rates for Lung Cancer in the male population were much higher than for women.
That gap appears to be narrowing with lung cancer accounting for 29% of all cancer-related deaths in
men and 27% in women.
Lung Cancer Incidence by Sex, Berkshire County vs. Massachusetts
Age Adjusted Rate per 100,000
140
120
100
80
60
40
20
0
1999
2000
2001
BC Female
2002
2003
2004
2005
BC Male
2006
2007
2008
2009
MA Female
Data Source: MassCHIP
Lung Cancer Mortality by Sex, Berkshire County vs. Massachusetts
Age Adjusted Rate per 100,000
90
80
70
60
50
40
30
20
10
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
BC Female
Data Source: MassCHIP
BC Male
MA Female
Age Adjusted Rate per 100,000 Population
43 2010
MA Male
MA Male
Massachusetts County Health Rankings Report 2015 (s/a 2014)
Adult Smoking (Estimated Current % of Adult Smokers)
2006-2012
25
20
15
10
5
Measure: Health Behaviors - Tobacco Use 100%
2012 Perc Smokers
2013 Perc Smokers
2014 Perc Smokers
2015 Perc Smokers
2015 Target 90th %tile
2015 Mass State
Middlesex
Norfolk
Hampshire
Dukes
Essex
Barnstable
Nantucket
Suffolk
Berkshire
Plymouth
Worcester
Franklin
Hampden
Bristol
0
Data Source: BRFSS
Low Dose CT Scan Lung Screenings
At this time, most private insurers and the Centers for Medicare & Medicaid Services (CMS) do not
reimburse for LDCT lung screening. Recognizing the importance of this test, and in order to increase
accessibility of lung screening to all people at high risk, Berkshire Health Systems has provided free LDCT
screenings to individuals who meet the established NCCN high-risk criteria, since November 1, 2013
Berkshire Health System LD CT Lung Screening Volume by Month 1/14-8/15
Volume of LDCT Cases
80
70
60
Volume of LDCT's
50
40
30
20
10
0
Month
44 Breast Cancer The incidence rate of Breast Cancer in Berkshire County has remained stable ( w i t h i n a 3 %
d e v i a t i o n ) from 2008-2015. The county rate is lower than the state average incidence of 136.5
but is still the leading cause of cancer related deaths among women, accounting for 27%. Of major note
are the higher rates of breast cancer mortality and breast cancer incidence presenting in minority/ethnic
populations in Berkshire County in comparison to the overall rate for the county and additionally when
compared to rates for minority/ethnic populations statewide.
Incidence Female Invasive Breast Cancer Berkshire County vs. Massachusetts
Age Adjusted Rate per 100,000
190
170
150
130
110
90
70
50
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
BC CA Breast (Female)
MA CA Breast (Female)
Data Source: MassCHIP
Female Invasive Breast Cancer Mortality Berkshire County vs. Massachusetts
Age Adjusted Rate per 100,000
40
35
30
25
20
15
10
5
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
BC CA Breast (Female)
MA CA Breast (Female)
Data Source: Mass CHIP
45 Early diagnosis is very important to patient outcome. Major efforts to improve screening rates, and
public education and awareness have been initiated, as well as technological and clinical advances in
the diagnosis and treatment options available.
Screening Mammography Women Age 40+
Berkshire County vs Massachusetts
2000 - 2012
95
90
Percenta
85
80
75
70
65
60
55
50
2000
2002
2004
2006
Berkshire County
2008
2010
2012
Massachusetts Total
Data Source: MassCHIP
46 Prostate Cancer
In 2012, the death rate from Prostate Cancer for Berkshire County men For the 2008-2012 period, the
mortality rate from Prostate cancer in the state was 24.6/100,000 cases with an annual incidence rate of
135.6/100,000. Berkshire County’s rate was slightly above the state average for incidence at 136.0/100,000.
Prostate cancer was also the leading cause of cancer-related deaths in Berkshire County accounting for 29%.
Incidence Male Prostate Cancer Berkshire County vs. Massachusetts Age Adjusted Rate per 100,000
250
200
150
100
50
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
BC CA Prostate
MA CA Prostate
Data Source: MassCHIP
Prostate Cancer Mortality Berkshire County vs. Massachusetts
Age Adjusted Rate per 100,000
50
40
30
20
10
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
BC CA Prostate
MA CA Prostate
47 Colorectal Cancer Death rates in Berkshire County from Colorectal cancer declined from 1999-2008 and have continued to fall
between 2008-2012 both statewide (-5.2%) and locally (-12.5%). If colorectal cancer is detected early,
patient survivability is greatly enhanced. Major emphasis has been placed on age-appropriate colorectal
screening in the county as well as statewide. From 2000-2010, the percentage of adults over 50 who were
screened in Berkshire county almost doubled
Incidence Colorectal Cancer by Sex, Berkshire County vs. Massachusetts
Age Adjusted Rate per 100,000
100
80
60
40
20
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
BC Female
BC Male
MA Female
MA Male
Data Soure: MassCHIP
Colorectal Cancer Mortality by Sex, Berkshire County vs. Massachusetts
Age Adjusted Rate per 100,000
35
30
25
20
15
10
5
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
BC Female
BC Male
MA Female
Data Source: MassCHIP
48 MA Male
Percentage of Adults Aged 50+ who had a Sigmoidoscopy/Colonoscopy within 5 Years 100.00
80.00
60.00
40.00
20.00
-
2000
2002
2004
2006
2008
2010
2012
2013
Berkshire County
31.6
35.4
60.8
63
66
60.3
61.1
43.9
Massachusetts
38.7
46.7
54.1
57.6
63.6
63.3
61.5
53
Data Source: MassCHIP
49 Respiratory Disease
The third leading cause of death for Berkshire county residents is Respiratory Disease including pneumonia,
asthma, and chronic and acute lower respiratory diseases. In general, over the time period
1999-2008,
death rates from respiratory disease in Berkshire County declined similar to the downward trend statewide,
but as of 2013, have remained higher .
It is interesting to note that in Berkshire County, within the Respiratory Disease category, death rates from
Pneumonia and Influenza deaths declined by nearly half between 1999-2013, while the state experienced a
one third decline during the same time period. The 2012 age-adjusted death rate for the Influenza and
Pneumonia in Massachusetts was 15.94 persons compared to Berkshire County 11.96 persons .
Berkshire County residents are less likely to be hospitalized with respiratory disease than residents
statewide. A review of the hospitalization experience by sex reveals that males tend to be hospitalized more
frequently than females both in the County and statewide, with the experience by for each sex in Berkshire
County being lower than the statewide experience.
Respiratory Disease Mortality Berkshire County vs. Massachusetts
Age Adjusted per 100,000
60.00
50.00
40.00
30.00
20.00
10.00
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
BC Pneumonia and Influenza Deaths
BC Chronic Lower Respiratory Disease Deaths
MA Pneumonia and Influenza Deaths
MA Chronic Lower Respiratory Disease Deaths
Data Source: MassCHIP
50 Chronic Ob
bstructive Pulmonary D
Disease 51 Asthma
Asthma is a chronic lung disease affecting people of all ages and races. Research has shown an increase in
the incidence of asthma in the elderly and young children in recent years due to possible genetic factors,
allergies, and environmental pollutants. There are currently over 598,000 cases of asthma in Massachusetts,
making up 11.4% of the state’s population. This is higher than the national prevalence occurring in7.3% of
the population. Contrastingly, the death rate due to asthma in Massachusetts is 8.5/1 million about 20%
lower than the national death rate of 10.7/1 million. Berkshire County tends to parallel the national trend
with a mortality of 1.1/100,000 almost double the death rate of the rest of the commonwealth at 0.6/100,000
persons.
MassCHIP Asthma Report: Berkshire County, MA (2013)
Mortality Total
Area 3
Year
Count
6
Area Age
Adjusted Rate
per 100,000
1.1
Area 95% Confidence
Interval
State Age Adjusted
Rate
(0.2 - 2.0)
0.6
Area Age
Adjusted Rate
per 100,000
Area 95%
Confidence
Interval
357
92.1
(82.1 - 102.1)
155.5
Male
153
85.5
(71.5 - 99.5)
133.9
Female
204
97.9
(83.6 112.2)
173.4
White Non-Hispanic
323
87.2
(77.1 - 97.3)
117.2
Black Non-Hispanic
26
270.5
(161.8 - 379.2)
392.0
Hispanic
7
78.0
(14.6 - 141.3)
341.8
Asian/Pacific Islander NonHispanic
0
0.0
(0.0 - 0.0)
77.8
Area 3 Year
Count
Total Inpatient
Hospitalizations (2008-2013
Emergency Room Visits
Total
Male
Female
White Non-Hispanic
Black Non-Hispanic
Hispanic
Age
0 to 4 yrs.
5 to 14 yrs.
15 to 34 yrs.
35 to 64 yrs.
65 and older
1,003
826.4
(774.5 - 878.3)
580.5
384
619
827
91
61
642.3
1013.1
735.7
2717.3
1799.3
(577.0 - 707.7)
(932.1 - 1094.0)
(684.6 - 786.9)
(2114.5 - 3320.1)
(1307.8 - 2290.9)
542.7
614.1
418.8
1352.1
1322.3
66
83
446
364
44
1076.4
550.1
1372.1
663.8
188.0
(818.1 - 1334.7)
(432.1 - 668.1)
(1245.6 - 1498.6)
(595.8 - 731.8)
(132.5 - 243.5)
1209.5
710.3
697.9
449.2
160.3
52 State Age
Adjusted
Rate
Nervous System Disease Mortality
In Berkshire County, since 2000, the death rates from Nervous System Disorders have been
increasing. Included in this category are death rates from Alzheimer's disease (AD) and
Parkinson's disease (PD). While the death rates for Parkinson's disease in Berkshire County has
remained generally consistent at around 8.0/100,000 cases, the death rates from Alzheimer's
Disease have continued to steadily increase from since the early 2000’s now at a rate of
26.8/100,000, making it the highest county in the state. Both Parkinson’s and Alzheimer’s local
death rates are higher than the rest of the state at 6.8 for PD and 19.4 for AD and national
averages of 7.28 (PD) and 23.52 (AD). In addition, the Berkshire County death rate from
Alzheimer's disease specifically, is now higher than the death rates from heart failure, diabetes,
breast cancer, prostate cancer and colorectal cancer.
Alzheimer’s Disease Mortality: Berkshire County, MA (2013)
Massachusetts Alzheimer's
Age Adjusted Death Rate per 100,000
United States
23.52
Massachusetts
19.4
Berkshire 1.
27.9
Barnstable 2.
25.58
Plymouth 3.
25.45
Worcester 4.
23.26
Essex 5.
22.89
Franklin 6..
22.13
Hampshire 7.
20.86
Middlesex 8.
19.4
Nantucket 9.
18.68
Norfolk 10.
18.47
Suffolk 11.
16.91
Hampden 12.
16.84
Bristol 13.
16.81
Dukes 14.
10.66
0
5
10
15
Data Source: CDC 1999‐2013 Final Data
53 20
25
30
Mental Health
H
Suicide is the third leeading causee of death am
mong 15-24 yyear olds and more thann 8 million addults
in the Un
nited States had
h serious thoughts
t
of suicide
s
withiin the past 12 months.
SUICIDE
S
TRE
ENDS
BERKSHIRE COUNTY
C
vs M
MASSACHUSETTS
AGE ADJ
JUSTED RAT
TE 1999 - 201
12
14
12
10
8
6
4
2
B
Berkshire
Cou
unty
Massachusetts Total
Data Source: MassCHIP
Suicide
Suicide rates
r
in Berkshire County
y have trackeed lower thann the statewiide experien
nce when
measured
d from 2008-2013 occurrring in 8.4/1
100,000 deatths. The national suicide rate hovers
around 12
2.6/100,000.
Suicide
a Count
Area
11
Area Crrude Rate
8.4
*MassCH
HIP
54 State Crude Ratte
99.0
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
0
Perinatal, and Child Health Indicators
Given the risk factors of income, education, and negative health behaviors, perinatal and child health outcomes
are surprisingly good compared to statewide benchmarks
In 2014, there were 1,174 births in Berkshire County, making up about 2% of all births in Massachusetts.
Characteristics of the Birth Profile for Berkshire County are consistent with the general demographic and
economic profile of the county.
The fertility rate in Berkshire County is lower than the state as a whole. Ethnic variances include slightly
above the state average fertility rates for White non-Hispanic and Black non-Hispanic women while
Hispanic and Asian mothers had significantly lower rates. The majority of women ( 5 1 . 1 % ) having babies
are in the lower income categories (as measured by the percentage of women receiving publicly funded prenatal care.) compared to an average statewide assistance rate of 35.8%.
The educational profile of Berkshire mothers is also revealing:
• Close to 38% of the women giving birth had attained a high school diploma or less 33% statewide.
• 30.4% of the women were college graduates compared to 46% statewide. About 30% of the women in
Berkshire County were in the category including “some college” compared to 21% statewide.
The Women, Infants and Children's program (WIC) program is a significant source of nutrition/education
assistance to pregnant women and families with children under the age of 5yrs. 36% of the children 0-5 yrs.
of age in Berkshire County are eligible for the WIC. And it is estimated that 90% of the eligible children are
being served.
County Health Rankings Reports 2010-2015: Berkshire County
Low Birth Weight
(% of Live Births with Weight < 2500 grams)
2000-2012
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
-
Measure: Health Outcomes - Morbidity; Weight 20%
2010 Perc LBW
2011 Perc LBW
2012 Perc LBW
2013 Perc LBW
2014 Perc LBW
2015 Perc LBW
Berkshire
7.5
7.9
8.0
7.9
8.1
8.0
Mass State
7.6
7.7
7.8
7.8
7.8
7.8
Target 90th %tile
6.4
6.0
6.0
6.0
6.0
5.9
Data Source: National Center for Health Statistics
55 Births are predominately to white mothers (87% in Berkshire County, 62% statewide)
Total Births
White, non-Hispanic
Black, non-Hispanic
Hispanic
Asian/Pacific Islander
Adequate prenatal care (b)
White, non-Hispanic
Black, non-Hispanic
Hispanic
Asian/Pacific Islander
Inadequate or no prenatal care (b)
Publicly-financed prenatal care (c)
White, non-Hispanic
Black, non-Hispanic
Hispanic
Asian/Pacific Islander
Smoking during pregnancy
Smoked
Never smoked
Breast feeding (at hospital discharge or
planning to)
Education of mother (age greater than
18)
Less than high school
High school graduate
Some college
College graduate
Area
Births
1,174
1,019
49
62
24
62
50
NA
6
0
19
75
59
6
7
0
Area
%
86.9
4.2
5.3
2.0
64.6
66.7
NA
66.7
0.0
19.8
78.9
79.7
75.0
77.8
0.0
State Count
or %
n= 72,835
66.6
9.3
14.6
8.0
73.5
75.0
72.6
72.5
67.2
17.5
76.3
65.8
76.8
86.8
82.9
256
916
878
21.8
78.2
75.2
6.3
93.7
82.9
92
349
339
340
8.2
31.2
30.3
30.4
8.2
24.8
21.0
46.0
Major perinatal/child health risk factors risk factors are:
Smoking during pregnancy
• Pregnant women in Berkshire County had a smoking rate more than three times that of
women statewide, at 21.8%
Adequate prenatal care
• Adequate prenatal care lags behind the state experience with 11.1% of Berkshire County
women receiving zero to little care compared to the state’s smaller proportion of 8.5%
Rates of Breast feeding
• Rates of women indicating they are planning to breast feed (75.2%) upon discharge from the
hospital are lower than the statewide experience 82.9%
Teen Pregnancy
 In Berkshire County (2013), there were 96 births to teen women representing 8.2% of the total
births in the county. Statewide, teen births were approximately 5.4 % of total births.
56 Adequacy of Prenatal Care 2005-2012
Kotelchuck Index
(2012 Rates Shown)
52.13
41.17
37.28
26.15
9.56
Unknown
None
Inadequate
Intermediate
Adequate
Unknown
None
Inadequate
Intermediate
Adequate
0.33
Berkshire County
2007
5.94
0.61
0.52
2006
8.06
7.22
Adequate Plus
11.03
Adequate Plus
55
50
45
40
35
30
25
20
15
10
5
0
Massachusetts Total
2008
2009
2010
2011
2012
Data Source: Mass Chip
2013 Berkshire County, MA: Tobacco Use in Expectant Mothers, County Rankings Total
White, Non-Hispanic
Black, Non-Hispanic
Hispanic
Asian
Other
# Who
Smoked
256
233
12
6
NA
0
% of Births to
Smokers
21.8
22.9
24.5
9.7
NA
0.0
Total Births
1,174
1,019
49
62
24
19
Health Factors:
The second section of the County Health Rankings compiles the health factors,
comprised of health behaviors, clinical care, socio-economic and physical
environment rankings.
57 He
ealth Fac
ctors: Co
ounty Hea
alth Rankings
Measure (Rank of 14
Co
ounties)
20
015 BERKS
SHIRE COUN
NTY HEALT
TH RANKINGS SNAPSHOT
He
ealth Factors (7)
He
ealth Behav
viors (8)
Adult smokin
ng
Adult obesity
y
Food environ
nment index
Physical inac
ctivity
Access to ex
xercise opporttunities
Excessive drrinking
Alcohol-impa
aired driving deaths
d
Sexually tran
nsmitted infec
ctions
Teen births
Wors
se than Mass/U.S
S
Berkshire
e
County
BC
vs.
Mass
s
BC
vs.
U.S. Top
Perform
mer
17%
15%
%
14%
%
23%
24%
%
25%
%
8.2
8.4
8.4
19%
21%
%
20%
%
89%
95%
%
92%
%
21%
20%
%
10%
%
25%
28%
%
14%
%
259
354
138
22
18
20
Similar
S
to Mass/U
U.S.
58 Better than Mass/U.S.
Tobacco Use
Tobacco use is a significant risk factor for cardio-vascular disease and lung cancer, the two highest causes of
death in Berkshire County. Approximately 17.2% of the population smoke compared to 15% statewide. In
Berkshire County there also appears to be a specific gender component to smoking, with a higher proportion of
smoking men than women in addition to a higher percentage of individuals of low income status. Smoking is a
significant issue for expectant mothers and with nearly 22% of expectant mothers in Berkshire County smoking,
local tobacco use is much higher than the state’s 6.8% for expectant mothers. The death rates for smoking related
cancers in Berkshire Count are higher than expected when measured by Standardized Mortality Ratios (SMR) and
Standardized Incidence Ratio (SIR). Of particular note are the SMR and SIR for men with the most prevalent
smoking related cancers of the Trachea, Lung and Bronchus.
2013 Berkshire County, MA Tobacco Use, BRFSS
Current Smokers
Berkshire County %
17.2
(13.6 - 20.7)
19.2
(13.1 - 25.4)
15.5
(11.5 - 19.5)
Total
Male
Female
State %
15.0
(14.5 - 15.6)
15.9
(15.1 - 16.8)
14.2
(13.6 - 14.9)
Age
NA
20.6
17.6
(11.7 - 23.5)
19.9
(15.4 - 24.4)
7.7
(4.4 - 11.1)
16.8
(15.8 - 17.7)
15.4
(14.7 - 16.0)
7.7
(7.1 - 8.3)
17.2
(13.4 - 21.0)
NA
15.1
(14.5 - 15.6)
17.5
NA
14.8
29.8
(20.6 - 39.1)
21.0
(13.6 - 28.4)
10.4
(5.4 - 15.4)
25.1
(23.6 - 26.6)
18.9
(17.5 - 20.2)
10.9
(10.3 - 11.6)
18 to 24
25 to 44
45 to 64
65 plus
Race/Hispanic Ethnicity
White Non-Hispanic
Black Non-Hispanic
Hispanic
Income
less than $25,000
$25,000 to $49,999
$50,000 plus
59 County Health Rankings Reports 2010-2015: Berkshire County
Adult Smoking
(Estimated Current % of Adult Smokers)
2002-2012
25.0
20.0
15.0
10.0
5.0
Measure: Health Behaviors - Tobacco Use 10%
-
2010 Perc
Smokers
2011 Perc
Smokers
2012 Perc
Smokers
2013 Perc
Smokers
2014 Perc
Smokers
2015 Perc
Smokers
Berkshire
19.5
19.7
19.0
17.5
17.0
17.0
Mass State
18.0
17.0
17.0
16.0
15.0
15.0
Target 90th %tile
14.0
15.0
14.0
13.0
14.0
14.0
Data Source: BRFSS
Overweight/Obesity
Obesity is a leading preventable cause of death worldwide, with increasing rates in adults and children. Authorities
view it as one of the most serious public health problems of the 21st century. Obesity is stigmatized in much of the
modern world (particularly in the Western world), though it was widely seen as a symbol of wealth and fertility at
other times in history and still is in some parts of the world. In 2013, the American Medical Association classified
obesity as a disease.

Non-Hispanic blacks have the highest age-adjusted rates of obesity (47.8%) followed by Hispanics (42.5%), nonHispanic whites (32.6%), and non-Hispanic Asians (10.8%)

Obesity is higher among middle age adults, 40-59 years old (39.5%) than among younger adults, age 20-39 (30.3%)
or adults over 60 or above (35.4%) adults.
Maintaining a healthy weight is a key protective factor for cardiovascular disease and diabetes. Up to 65% of
American adults are classified as overweight or obese. Massachusetts has a lower prevalence of overweight/obesity
with a statewide average of 57.6% with approximately 24% of that number categorized as obese. Berkshire County
has statistics comparable to the state. The figures have been relatively constant over time and tend to track slightly
lower than experience statewide over the 2000-2013 time periods.
60 % OF ADULT OBESE
BERKSHIRE COUNTY vs MASSACHUSETTS
30
25
20
15
10
5
Berkshire County
2010
2009
2008
2007
2006
2005
2004
2002
2000
1998
0
Massachusetts
Data Source: MassCHIP BRFSS
Substance Abuse
Alcohol use/abuse is an important issue in Berkshire County. Approximately 19% of adults report binge plus
heavy drinking; this rate is consistent with the statewide experience, with a similar percentage reporting binge
drinking within the past 30 days, indicating it is both an acute and chronic problem. Supporting this issue is a
liquor store density rate approximately 50% higher than the statewide experience (32/100,000 in Berkshire
County vs. 21/100,000 statewide)
SUBSTANCE ABUSE
Admission Rate per 100,000
(2013 Rate Shown)
3000
2698.15
BERKSHIRE COUNTY
MASSACHUSETTS
2500
2000
1500
1590.82
1210.36
973.32
790.7
1000
506.93
310.21
500
41.92
32.01
29.27
129.92
24.5
0
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Indicators of Drug Use: Berkshire County, MA (2011),
*MassCHIP
Area
61 Area
State
Cou
unt Crude R
Rate Crude Rate
R
2,6662
2017.2
15
532.4
Adm
missions to DP
PH funded treattment program
ms
Injeection drug useer admissions to
o DPH funded treatment prog
gram
Alcohol and otherr drug related hospital
h
discharrges
4469
1,363
355.4
1032.9
621.2
6
344.7
Maassachusettss Departmeent of Publicc Health Bu
ureau of Inffectious Dissease Officee of Integraated
Surrveillance and
a Informaatics Servicces Confirm
med and Proobable Past//Present Heppatitis C Evvents Reporrted
in B
Berkshire County,
C
Maassachusettss by Year, 2010-2015
2
tto date These data are current as oof 8/31/2015
andd are subjecct to changee 2015 data are consideered prelim
minary
Berkshire County Heepatitis C Events
E
Rep
ported to D
DPH
Year
2010
2011
2012
2013
2014
2015 (to
o
date)
Frequency
mulative
Cum
Freequency
168
121
149
122
156
86
168
289
438
560
716
802
.
Ovver the past seeveral years, abuse of oth
her drugs, parrticularly opiooids and presscription druugs has emergged as a grow
wing
behhavioral healtth issue.
62 umber of Unintentional Opioid
O
Overrdose Deaths by Countyy, MA Residents, 2000-22014, Mass DPH
Nu
63 Prrescriptio
on Opioid
d Overdoses
Year
Y
BMC
B
(pt/enc)
FVH (pt/en
nc)
SEF
2015 (Jan-J
June)
Admitted
A
53/56
28
2-Feb
N/A
In
ncl
CY
C 2014
Admitted
A
51/55
36/37
6-Jun
1-Jan
N
N/A
CY
C 2013
Admitted
A
44/47
37/40
6-Jun
1-Jan
CY
C 2012
Admitted
A
56/60
42/45
4-Apr
1-Jan
N/A wh
hen data too
t small to report
64 Adolescents/Youth
Given the risk factors of income, education, and negative health behaviors, perinatal and child health
outcomes are surprisingly good compared to statewide benchmarks
Overall, a large number of children are impacted by both issues of food security (16.6% of Berkshire
county children are food insecure) and obesity (30.4%).
Among adolescents, alcohol, marijuana, and tobacco appear to be the most prevalent substances being
used.
In Berkshire County the teen pregnancy rate was 13.67/1000 births, compare to Massachusetts
State rate 14.05/1000. Teen birth rates to mothers 15-19 years old in the Pittsfield was 25.39
substantially higher compared to county and statewide rates .
The specter of youth suicide/suicidal behavior (9.8%) is more prevalent than expected compared to the
state (7%), in which it is the second leading cause of death among ages 15-24.
In Berkshire County (2013), there were 96 births to teen women representing 8.2% of the total births in
the county. Statewide, teen births were approximately 5.4 % of total births.
The teen birth rate in Berkshire County 2013 was 22/1000 live births (women ages 15-19). The state rate
was 12.1.
The state teen birth rate has declined by 14% since the previous year’s data and has continued to drop an
additional 11.9% each year.
Since 2010, the Berkshire County teen birth rate has decreased by 36%. The communities of North
Adams (15 teen births) and Pittsfield (37 teen births) account for 54% of the teen births in Berkshire
County (2013).
In Berkshire County, 78% of the teen births were to White, non-Hispanic mothers while 8% were to
Black non-Hispanic mothers, and 9.4% to Hispanic mothers.
Birth rates for White non-Hispanic and Black non-Hispanic teens in Berkshire County were over
double the state averages while Hispanic mothers in the county and state had the same birth rate.
Smoking during pregnancy is a major risk factor with Berkshire teens smoking during pregnancy at rates
of between 2-3 times the statewide experience.
65 County Adolescents' Sexual Behavior Based on 2015 PNAS Data
70
65.5
60
% of Grade
50
40
35.2
30
18.3
20
7.7
7.2
6.5
10
0
Grade 8
Grade 10
Has Had Sexual Intercourse
400
Grade 12
Has Had a Positive Pregancy Test
County Health Rankings Reports 2010-2015: Berkshire Count
Sexually Transmitted Infections
(Chlamydia Rate per 100K Population)
2007-2012
350
300
250
200
150
100
50
0
Measure: Health Factors - Behaviors; Weight 2.5%
2010 Rates
2011 Rates
2012 Rates
2013 Rates
2014 Rates
2015 Rates
Berkshire
218.9
223.3
240.0
282.0
275.2
259.2
Mass State
251.0
271.0
297.0
322.0
346.0
354.0
Target 90th %tile
136.0
83.0
84.0
92.0
123.0
138.0
Data Source: National Center for Hepatitis, HIV, STD,
66 Berkshire County Teen Birth Rate per 1,000 1996‐2013
60.0
50.0
40.0
30.0
20.0
10.0
‐
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Berkshire County 23.0
23.2
22.4
24.6
25.9
23.0
27.9
27.2
27.5
29.0
24.5
27.0
26.1
27.2
20.6
18.6
14.0
15.8
Pittsfield
39.0
40.6
46.9
34.1
42.9
37.3
47.1
56.0
46.7
52.7
49.6
52.7
47.2
55.1
34.4
33.6
25.4
27.6
North Adams
40.2
33.5
26.0
41.2
51.3
46.2
34.7
36.7
35.6
49.5
35.4
40.7
28.3
51.3
25.1
28.5
16.7
22.1
Massachusetts
28.5
28.5
28.1
26.7
25.9
24.9
23.3
23.0
22.2
21.7
21.3
22.0
20.1
19.5
17.1
15.4
14.0
12.0
US
53.5
Data Source: MassCHIP
51.3
50.3
48.8
47.7
45.0
42.6
41.1
40.5
39.7
41.1
41.5
40.2
37.9
34.3
31.3
29.4
26.6
30.0
County Health Rankings Reports 2010‐2015: Berkshire County
Teen Birth Rate (# Births per 1K Female Population Ages 15‐19)
25.0
20.0
15.0
10.0
5.0
Measure: Health Factors - Behaviors; Weight 2.5%
-
2010 Teen Birth
Rate
2011 Teen Birth
Rate
2012 Teen Birth
Rate
2013 Teen Birth
Rate
2014 Teen Birth
Rate
2015 Teen Birth
Rate
Berkshire
25.1
25.2
27.0
24.4
23.5
21.8
Mass State
22.0
22.0
22.0
20.0
19.0
18.0
Target 90th %tile
8.0
22.0
22.0
21.0
20.0
20.0
Data Source: CDC National Vital Statistics System (NVSS)
67 Sexually Transmitted
d Diseases (ST
TDs) Rates of STDs
S
includiing Chlamyd
dia and Gono
orrhea amongg Berkshire C
County Youthh are on par w
with those off
teens stattewide while Berkshire County has a much
m
lower iincidence of Primary andd Secondary S
Syphilis in
our youth
h (ages 15-19
9) with a rate of <2.2casess/100,000 co mpared to thhe state rate oof 6.4/100,0000. There has
also been
n an all-aroun
nd decrease in
n all STDs am
mong teens ssince 2012 inn both Berkshhire County aand
Massachu
usetts as a wh
hole.
Alcohol, Tobacco, Other
O
Drugss (ATODs)
y
(2009, 2011,
2
2013, 2015)
2
the Beerkshire Youuth Developm
ment Project has
For the paast several years
sponsored
d the Preven
ntion Needs Assessment Survey for B
Berkshire Coounty. In 20015 2,686 stuudents in
grades 8, 10, and 12 in
i Berkshire County partiicipated in thhe survey. Thhe results arre compared to national
benchmarrks (Monitorring the Futu
ure Survey and
a the Bachh Harrison Noorm).
Listed beelow are Datta Tables illu
ustrating the percentage
p
oof Students w
who used AT
TODs within
n the past 30
0
days and
d a second representing use
u during th
heir lifetime. Alcohol, Ciigarettes, and
d marijuana appear the
most prev
valent substaances used with
w chewing
g tobacco (annd other relatted tobacco p
products gaiining
popularitty).
68 69 Berkshire United Way Summary of Substance Abuse
8th + 10th grade substance use is broadly DECREASING
 Lifetime and 30 day rates are decreasing for 8th and 10th graders. Almost all 8th and 10thgrade rates
remain below national average, except for 10th grade alcohol/marijuana use and binge drinking.
Berkshire County Wide 8th Graders
30 Day Use
20
18
17.4
16
13.5
14
11
12
10
8.6
8
8
8.5
9
6.5
6.1
6
6
4
4
4
2
0
2011
2013
Alcohol
2015
Mariuana
Cigarettes
MTF 2014
Data Source: 2015 Mass Prevention Needs Assessment Survey results fo Berkshire County MTF = Monitoring the Future Survey
Berkshire County Wide 10th Graders
30 Day Use
45
40
39.8
34.1
35
29.6
30
26.1
25.9
25
22.3
23.5
20
15
16.6
12.2
13.7
8.8
10
7.2
5
0
2011
2013
Alcohol
Cigarettes
2015
Mariuana
Data Source: 2015 Mass Prevention Needs Assessment Survey results fo Berkshire County MTF = Monitoring the Future Survey
70 MTF 2014
th
12 grade substance use remains HIGH
 Good news – rates are continuing downward trend since 2011. However, rates remain above national
average. Rates to focus on:
– Alcohol, chewing tobacco, marijuana, Amphetamines, binge drinking, drunk or high at
school, gambling over the past year, and playing the lottery.
th
•
About 24% of 12 graders indicated that they had been drunk or high at school.
Berkshire County Wide 12th Graders
30 Day Use
60
55.5
49.4
48.8
50
40
36.1
37.3
35.8
37.4
30
20
21.2
19.8
16.3
13.9
13.6
2015
MTF 2014
10
0
2011
2013
Alcohol
Cigarettes
Mariuana
Data Source: 2015 Mass Prevention Needs Assessment Survey results fo Berkshire County MTF = Monitoring the Future Survey
71 Youth Suicide
In Massachusetts, the risk for suicide mortality and morbidity varies significantly by region. Mass DPH
identified Berkshire County as a region with youth suicide rates/suicidal behaviors including rates of non-fatal
self-- inflicted injury higher than those in the state and nation.
The most current available information found in the 2013 Prevention Needs Assessment for Berkshire County
(pg.30-32) illustrates the following youth self-reported suicidal thoughts and attempts.
Question
During the past 12 months, did you
ever take any of the following steps
regarding suicide?
If you considered and/or attempted
suicide, did you tell someone?
Response
I did not consider suicide.
I seriously considered
committing suicide.
I made a plan about how I
would attempt suicide.
I actually attempted suicide.
I did not consider suicide.
I told a friend.
I told a family member.
I told a school adult.
I told a medical personnel
(doctor, nurse, counselor)I
I called a suicide hotline.
Total
Grades 8 thru 12
2011
2013
Num. Perc. Num. Perc.
1492 83.3 1429
82.5
166
9.3
163
9.4
89
5.0
90
5.2
44
n/a
n/a
n/a
n/a
2.5
n/a
n/a
n/a
n/a
51
1412
205
55
23
2.9
82.3
11.9
3.2
1.3
n/a
n/a
18
1.0
n/a
n/a
3
.2
Child/adolescent nutrition
Good nutrition is one of the key protective factors ensuring proper child and adolescent growth and development.
Many young people are developmentally at-risk because of food insecurity and/or lack of proper nutrition.
•
26% of Berkshire County children overall, are eligible (defined by income) for free or reduced lunch.
Although this rate compares favorably to the state wide rate of 29%, there are certain communities in
Berkshire County where the rate exceeds 50%. 36% of Berkshire County children (ages 0-5 yrs.) are
eligible for nutritional support/counseling through the Women, Infants and Children program (WIC)
Almost paradoxically, childhood overweight/obesity is also a major problem, primarily because of economic
issues relating to nutrition quality and/or lack of parental education/awareness.
For example, at Berkshire County Head Start, for the 2014-2015 school year, 36.6% of the children were
overweight/obese by BMI definition. (OBS)
Overweight/obesity continues to be a risk factor throughout the school experience. Rates of 34% of students with
overweight/obesity have been reported by school districts in the county.
72 Soccio-econ
nomic Fa
actors: County
C
Health Rankin
ngs
Mea
asure (Rank
k of 14 Cou
unties)
Soc
cial & Economic Facto
ors (10)
H
High school grraduation
S
Some college
U
Unemploymen
nt
C
Children in pov
verty
In
ncome inequa
ality
C
Children in single-parent ho
ouseholds
S
Social associa
ations
V
Violent crime
In
njury deaths
Worse th
han Mass/U.S
2015 BERKSHIRE
B
E COUNTY HEALTH RA
ANKINGS
SNAPSHO
OT
Berkshire
County
y
BC
C
vs..
BC
vs.
Mass
s
U.S. To
op
Perform
mer
87%
85%
%
61.80%
%
71.00%
%
71.00%
%
7.10%
%
7.10%
%
4.00%
19%
16%
%
13%
5
5.3
3.7
35%
31%
%
20%
11.7
9.3
22
403
434
59
55
45
50
Similar to Mass/U.S..
Better than Ma
ass/U.S.
Educcation In 20012, 32 perceent of people 25 years and
d over had a high school ddiploma or eequivalency aand 32 percennt had a
bachhelor’s degreee or higher. Nine
N percentt were dropou
uts; they werre not enrolleed in school aand had not ggraduated fro
om
high school.
ensus Bureau AC
CS
US Ce
73 Education
Adults Age 25+
With at least a
high school
diploma
With at least a 4-year
degree
Adams
Alford
Becket
Cheshire
Clarksburg
Dalton
Egremont
Florida
Great Barrington
Hancock
Hinsdale
Lanesboro
Lee
Lenox
Monterey
Mount Washington
New Ashford
New Marlborough
North Adams
Otis
Peru
Pittsfield
Richmond
Sandisfield
Savoy
Sheffield
Stockbridge
Tyringham
Washington
West Stockbridge
Williamstown
Windsor
Berkshire County
85.4
95.5
93.1
93.3
90.3
93.6
92.5
87.3
89.4
95.1
92.8
92.8
93.8
94.9
96.8
98.1
91.8
93.4
84.3
94.7
92.3
89.8
97.4
84.1
86.7
90.6
95.4
97.7
91.1
97.1
94.5
94.9
90.6
19.5
50.3
37.7
21.1
18.5
32.4
46.3
18.7
40.7
27.3
24.4
32.7
36.7
47
41.2
46.3
44.3
43.1
19.2
27.7
23
25
49.1
30.4
18.4
31.5
40.3
61
27.8
48.7
58
32.1
30.3
Massachusetts
89.4
39.4
Town
Poverty and Participation in Government Programs
In 2014, 13 percent of people in Berkshire County were in poverty compared to 11 percent in Massachusetts..
Twenty-two percent of related children under 18 were below the poverty level compared with 7 percent of people 65
years old and over. Ten percent of all families and 34 percent of families with a female household and no husband
present had incomes below the poverty level.
74 Married Couple
Families
All Families
FAMILY POVERTY
Total
% Below
poverty
level
Female householder, no
husband present
% Below
poverty
level
Total
% Below
poverty
level
Total
FAMILIES
Total Families
Received Social Security Income in past 12 months
Received Social Security Income and/or Cash/Public Assistance
31,197
11,316
3,495
10
3.8
31.6
22,543
9,210
1,573
2.1
2
6.4
6,212
1,544
1,737
33.8
9.7
52.3
NUMBER OF PEOPLE IN FAMILY
2 people
3 or 4 people
5 or 6 people
7 or more people
17,381
11,817
1,783
216
6.6
16.4
2
0
12,784
8,042
1,501
216
1.9
2.3
2.4
0
3,051
2,938
223
-
19.2
51.5
0
0
WITH RELATED CHILDREN UNDER 18 YEARS
No child
1 or 2 children
3 or 4 children
5 or more children
12,656
18,541
10,872
1,642
142
21
2.4
19.3
34.6
0
6,972
15,571
6,017
813
142
3
1.7
2.9
4.4
0
4,424
1,788
3,595
829
-
45.2
5.6
40.8
64.2
0
HOUSEHOLDER
Worked
Worked full-time year-round in past 12 months
Educational attainment - Less than high school graduate
Educational attainment - High school graduate (includes equivalency)
Educational attainment - Some college, associate's degree
Educational attainment - Bachelor's degree or higher
22,414
13,925
1,782
8,253
10,478
10,684
6.9
2.8
15.7
16.1
12.2
2.2
16,460
9,790
1,218
4,881
7,171
9,273
1.9
1.1
3.3
2.9
3.5
0.4
4,134
2,865
379
2,603
2,179
1,051
23.4
9.3
38.5
41.3
37.7
5.6
US Census Bureau: 2014 ACS Estimates
Massachusetts County Health Rankings Report 2015
Income Inequity (new 2015)
(Gap between lower and upper end of income spectrom)
2009-2013
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
Measure: Health Factors - Social & Economic; Weight 2.5%
1.0
2015 Inequity Gap
75 2015 Mass State
Nantucket
Dukes
Franklin
Plymouth
Barnstable
Hampshire
2015 Target 90th %tile
Data Source: American Community Survey
Norfolk
Worcester
Middlesex
Berkshire
Essex
Bristol
Hampden
Suffolk
0.0
County Health Rankings Reports 2010-2015: Berkshire County
% of Children Under Age 18 Living Below Federal Poverty Line
2007-2013
50.0
45.0
Measure: Health Factors - Social & Economic; Weight 7.5%
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
-
2010 Perc
Children in
Poverty
2011 Perc
Children in
Poverty
2012 Perc
Children in
Poverty
2013 Perc
Children in
Poverty
2014 Perc
Children in
Poverty
2015 Perc
Children in
Poverty
Berkshire
14.8
15.2
19.0
20.2
21.1
18.8
Mass State
13.0
12.0
14.0
15.0
15.0
16.0
Target 90th %tile
6.0
11.0
13.0
14.0
13.0
13.0
Data Source: Small Area Income & Poverty Estimates (SAIPE) Program
County Health Rankings Reports 2011-2015: Berkshire County
Percent of Children in Households Run by Single Parents
2005-2013
70.0
60.0
50.0
40.0
30.0
20.0
10.0
Measure: Health Factors - Social & Economic; Weight 2.5%
-
2011 Perc
Children in
Single-Parent
Households
2012 Perc
Children in
Single-Parent
Households
2013 Perc
Children in
Single-Parent
Households
2014 Perc
Children in
Single-Parent
Households
2015 Perc
Children in
Single-Parent
Households
Berkshire
35.8
35.0
34.5
35.1
35.0
Mass State
29.0
30.0
30.0
30.0
31.0
Target 90th %tile
20.0
20.0
20.0
20.0
20.0
Data Source: American Community Survey, 5-year estimates
76 Massachusetts County Health Rankings Report 2015
Social Associations (new 2015)
(Web of Social Support available through associations in a community)
2012
30.0
25.0
20.0
15.0
10.0
5.0
Measure: Health Factors - Social & Economic;
2015 Social Support
2015 Target 90th %tile
Dukes
Nantucket
Franklin
Barnstable
Berkshire
Suffolk
Norfolk
Middlesex
Hampshire
Hampden
Essex
Worcester
Plymouth
Bristol
0.0
2015 Mass State
Data Source: County business Partners
Injury Indicators:
The death rate from unintentional injuries including Motor Vehicle Deaths in Berkshire County has been running
consistently higher than the state experience at 33.8/100,000 compared to 28.6/100,000.
Injury deaths by MA County
Massachusetts County Health Rankings Report 2015
Injury Mortality per 100K
2008-2012
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
Measure: Health Factors - Social Econmic;; Weight 2.5%
10.0
2014 Injury Deaths
2015 Injury Deaths
77 2015 Mass State
Hampshire
Middlesex
Dukes
Norfolk
Essex
Worcester
2015 Target 90th %tile
Data Source: CDC WONDER morality data
Suffolk
Franklin
Plymouth
Hampden
Nantucket
Bristol
Berkshire
Barnstable
0.0
Crud
de death ratees for motor--vehicle inju
uries are also
o 36% higherr in the Berkkshires than the rest of th
he state,
indiccated by the table below
w. Possible ex
xplanations include
i
pers ons operatinng under the influence, ru
ural roads,
harsh
h seasonal drriving condiitions and lon
nger EMS reesponse timees.
Area
ount
Co
12
Mottor vehicle reelated injury
y deaths
Area
Crrude Rate
9.1
Staate
Crudee Rate
5.8
Berkkshire County
y has experie
enced variattions in its crime rates. P
Physical viollence such a
as murder, ra
ape, and assault have deccreased in th
he past few yyears while crimes of th
heft, burglary and robbe
ery have bee
en increasing
g. This may be rela
ated to the in
ncrease in unemployme
ent and the sstruggling lo
ocal econom
my. e, Berkshire County
y
Viollent Crime
mingly rare, death rates due
d to Homicide tend to occur at aboout half the rrate of the rest of the statte.
Seem
Hom
micide Death
h Rate: Berk
kshire Countty, MA (2013
3)
Area Co
ount
Homicid
de
2
Area
A
Crudee Rate
1.5
78 State Cru
ude Rate
3.1
Weaspons Related Injuries Percent 2008‐2010
Mass, Berkshire County, Pittsfield, and North Adams
100
90
80
70
60
Massachusetts
50
Berkshire County
40
Pittsfield
North Adams
30
20
10
0
Assault
Unintential
Self‐Inflicted
Data Source: MassCHIP
Data represents only Mass residents treated in Mass Emergency Depts.
79 Unspeciied Intent
Clinical Care: County Health Rankings
Measure (Rank of 14
Counties)
2015 BERKSHIRE COUNTY HEALTH RANKINGS SNAPSHOT
Clinical Care (3)
BC
vs.
Berkshire County
Uninsured
Primary care physicians
Dentists
Mental health providers
Preventable hospital
stays
Diabetic monitoring
Mammography screening
Worse than Mass/U.S
Mass
BC
vs.
U.S. Top
Performer
4%
4%
11%
897:01:00
974:01:00
1,045:1
1,336:1
1,096:1
1,377:1
163:01:00
216:01:00
386:01:00
47
63
41
91%
90%
90%
72.60%
73.80%
70.70%
Similar to Mass/U.S.
Better than Mass/U.S.
Berkshire County Primary Care Provider Supply and Demand
Current
Supply
Berkshire
County
Sg2 Demand
Above Median
Productivity
Current Net
(Need)/
Oversupply
Potential
Retirements
(Ages 62+)
Potential Net
FTE (Need)/
Oversupply
Adult PCPs*
68.5
80.1
(2.94)
21.4
(33.0)
OB/GYN**
18.7
20.2
(1.50)
4.3
(5.85)
Pediatrics
19.8
20.4
(0.60)
2.8
(3.4)
TOTALS
112.1
118.3
(6.24)
28.6
(34.8)
Specialty
Notes: Projections based on 2013 Defined SP Market Area
*Data includes 23.25 Hospitalists equal to 7.75 FTE PCPs
** Data includes 4.4 FTE Midwives
80 Massachusetts County Health Rankings Report 2015
Ratio of Population to Primary Care Physicians
2012
2450
Measure: Health Factors - Clinical Care; Weight 3%
2300
2150
2000
1850
1700
1550
1400
1250
1100
950
800
650
2013 PCP Ratio
2014 PCP Ratio
2015 PCP Ratio
Data Source: Area Health Resource File/American Medical Association
81 2015 Target 90th %tile
2015 Mass State
Suffolk
Hampshire
Norfolk
Middlesex
Berkshire
Dukes
Worcester
Barnstable
Essex
Hampden
Franklin
Plymouth
Nantucket
Bristol
500
Massachusetts County Health Rankings Report 2015
Ratio of Population to Dentists
2013
2500
2000
1500
1000
Measure: Health Factors - Clinical Care; Weight 1%
2013 Dentist Ratio
2014 Dentist Ratio
2015 Target 90th %tile
2015 Mass State
Data Source: Area Resource File/National Provider Identification file
82 2015 Dentist Ratio
Suffolk
Norfolk
Barnstable
Middlesex
Essex
Nantucket
Hampden
Berkshire
Plymouth
Worcester
Hampshire
Franklin
Bristol
Dukes
500
Avoid
ding readmissions to thee hospital iss another waay to improv
ve health. R
Readmission
ns
are afffected by cllinical condiitions, socio
o-economic influences and commu
unity based
accesss to coordin
nation of carre and servicces.
Admissions to thee hospital th
hat fall into the category
ry of “Preveentable admiissions”
provid
de another assessment
a
of
o care that could be m
managed in th
he commun
nity to avoid
d
hospittalization.
83 Berk
kshire Medical Cen
nter
84 Fa
airveiiw Hospitall
85 Fairv
veiw Hosp
pital
86 Berkshire County was Ranked #1 in the state by County Health Rankings 2015
Report for :
% of Medicare Diabetic Patient Blood Sugar Screening Past Year (2012)
Massachusetts County Rankings
1. Berkshire
2. Bristol
3. Norfolk
4. Franklin
5. Suffolk
6. Plymouth
7. Barnstable
8. Dukes
9. Essex
10. Hampshire
11. Middlesex
12. Worcester
13. Hampden
14. Nantucket
# Diabetics
% Receiving HbA1c
2127
8175
6188
769
6601
6281
3734
243
7888
1395
12117
6002
5295
76
91
90
90
90
90
90
90
90
89
89
89
89
88
80
County Health Rankings Reports 2011-2015: Berkshire County
Mammography Screening
2008--2012
100.0
95.0
90.0
85.0
80.0
75.0
70.0
65.0
60.0
Measure: Health Factors - Clinical Care; Weight 2.5%
55.0
50.0
Mammography Mammography Mammography Mammography Mammography Mammography
Rate 2010
Rate 2011
Rate 2012
Rate 2013
Rate 2014
Rate 2015
Berkshire
76.5
75.1
74.7
72.4
72.6
Mass State
72.4
76.0
75.7
73.2
73.8
Target 90th %tile
74.2
74.5
73.0
70.7
70.7
Data Source: Dartmouth Atlas of Health Care using Medicare Claims data
87 Work
ksite Wellnesss:
The Beerkshire Health Systems (BHS)
(
Worksite Wellnesss Program is a comprehen
nsive program
m
develo
oped for area businesses and BHS emp
ployees, whicch provides hhealth risk anaalyses and
screen
nings and a raange of prograams to suppo
ort healthier llifestyles to iimprove heallth and
wellbeeing and help
p reduce heallth costs for employees
e
annd employerss. In 2015 B
BHS provided
d
wellneess services to 11 compan
nies, reaching
g 10,000 empployees and pprovided screeenings to
3,500 people. The majority of Berkshire Co
ounty residennts work, so tthe workplacce is a great
on to identify
y risk and imp
prove our heaalth status.
locatio
88 Immunizations for Influenza
Influenza (the Flu) is a significant public health issue that can be addressed through primary
prevention efforts, most notably proper personal hygiene and behaviors (hand washing,
proper coughing, sneezing, etc.) and Flu vaccination programs.
In Berkshire County, Flu shots are available to area residents through physician offices,
pharmacies, worksites and community flu shot programs. Priority populations identified for
flu vaccinations are people age 65+, disabled individuals, persons with chronic conditions,
health care workers, public servants including teachers, police, and fire-fighters. Healthcare
providers apart of Berkshire Medical Center a lower vaccination rate per population at
only 82% compared to the statewide median of 86%.
Additionally, in Massachusetts during 2013-2014, 53.3% of people we vaccinated against
Influenza as compared to the national average of 46.2%. Berkshire County 69.6% of the
adults age 65+ reported having had a Flu vaccine in the past 12 months (11/13-11/14). The
statewide average is 74.6%
Physical environment: County Health Rankings
Measure (Rank of 14
Counties)
2015 BERKSHIRE COUNTY HEALTH RANKINGS SNAPSHOT
10.8
10.5
9.5
20%
10%
0%
17%
19%
9%
79%
72%
71%
23%
40%
15%
Driving alone to work
Long commute - driving
alone
Worse than Mass/U.S
Similar to Mass/U.S.
89 U.S. Top
Performer
Air pollution - particulate
matter
Severe housing problems
Mass
BC
vs.
Berkshire County
Drinking water violations
BC
vs.
Physical Environment
Better than Mass/U.S.
Lyme Disease The maap below illusstrates Lyme disease incidence rates peer 100,000 peeople by city and town in Massachusetts from
m 2009‐2013. It includes b
both probablee and confirm
med cases. Th
he darker the shading, the higher the incident.. Lyme diseasse is considerred endemic iin all of Masssachusetts. Areas o
of high incide
ence include m
much of the e
eastern half oof the state. R
Regions of paarticularly high inciden
nce include Plymouth, Cap
pe Code and tthe Islands, soome areas in Middlesex, EEssex and Southe
ern Berkshire Counties. Numb
ber and inciidence ratess of Lyme Disease
D
– Berrkshire Cou
unty vs. Massachusetts
Geography
G
Berksh
hire County
Massa
achusetts
2013 Confirmed # of
Cases
84
4080
2013 Probable # o
of
Cases
46
1585
Mass CH
HIP, MA Departtment of publicc Health 2010 ddata 90 Combiined Incidenc
ce
rate fo
or Confirmed
d
and Prrobable Case
es
99.0
65.09
Additional Community Input:
Surveys, Focus Groups and Interviews
BHS Canyon Ranch Institute Life Enhancement Program
As part of understanding Community Health Needs and perceptions as a precursor to
improving health status through lifestyle change and health literacy, BHS and Canyon Ranch
Institute collaborated on seeking input to understand needs and then implement a new program
to meet these needs.
Central Berkshire
Formative Research Background
The CRI LEP is an evidence-based, integrative health program that transfers the best practices
of Canyon Ranch and CRI’s partners, such as BHS, to underserved communities in order to
better prevent, diagnose, and address chronic diseases and eliminate health disparities. The CRI
LEP uses an integrative approach to health and is grounded in the best practices of health
literacy. This evidence-based program has demonstrated significant outcomes in health and
well-being across a diverse range of locations and cultures within the United States.
All CRI LEP partnerships share a common set of core foundational and program elements
related to integrative health, nutrition, physical activity, behavior change, sense of purpose,
stress management, and social support. However, each CRI LEP is unique and adapted to meet
the cultural, geographic, linguistic, environmental, and health realities of each community.
These adaptations are informed through a rigorous formative research process that includes
gathering socio-economic and demographic data, as well as the facilitation of a series of focus
groups and interviews with a diverse range of people who reflect the population(s) of interest.
A team of three CRI researchers (Newberg, Palm, and Pleasant) conducted a total of 33
individual interviews and focus groups across Berkshire County from July 15 through July 21,
2013. For the most part, the interviews and focus groups were arranged by BHS staff.
However, BHS staff was not present for any of the interviews or focus groups.
In these interviews and focus groups, participants were asked questions about health and
wellness, community resources, and program logistics. The formative research served the
following purposes:
o To identify existing resources and social norms of the community related to health and
wellness,
o To identify barriers to health and wellness in the community,
o To identify possible barriers to participant recruitment and develop methods to
overcome those barriers, and
o To understand the needs and interests of the population so as to better tailor the
program to fit the community.
91 Formative Research Methods
CRI performed a scan of all available data on socio-economic, health and well-being, and
demographic information relating to residents of Berkshire County. This effort created a broad
quantitative overview of the county. Data sources included the U.S. Census Bureau, County
Health Rankings, U.S. Centers for Disease Control and Prevention, Berkshire County Regional
Employment Board, the Federal Reserve Bank of Boston, and Berkshire Health Systems.
CRI then conducted in-depth formative research in Berkshire County. The purpose of the
formative research was to learn more about the community in order to tailor the CRI LEP to
best fit the communities and diversity across Berkshire County.
The in-person formative research, conducted by three CRI researchers, employed a
triangulation approach that incorporates multiple methods, researchers, audiences, and data
sources. BHS and CRI staff coordinated the scheduling of focus groups and interviews. CRI
wrote tailored protocols for each targeted population for focus groups and individual
interviews. These protocols consisted of questions inquiring about individual and community
health and wellness behaviors, beliefs, knowledge, and attitudes. The focus groups and
interviews took place throughout Berkshire County – south Berkshire County in Lee and Great
Barrington; north Berkshire County in North Adams; and central Berkshire County in
Pittsfield. Interviews were all one-on-one between a participant and a researcher, and each
focus group had two researchers present with between five and 12 participants.
Individual interviews were conducted with working professionals. By the nature of their
professional positions, many of the interviewees (all selected by BHS) have a deep
understanding of the entirety of Berkshire County. The professionals interviewed came from
BHS, as well as governmental, non-profit, and private sectors. Although local leaders from
government, private companies, neighborhood organizations, and the police department were
interviewed, a majority of interviewees had a primary role in social service organizations or
health care.
Focus groups targeted potential participants in the BHS-CRI LEP and were also representative
of the overall BHS patient population. Focus groups brought together individuals who shared a
common perspective on Berkshire County. These groups included BHS employees; general
public groups in south, central, and northern portions of Berkshire County; veterans; an African
American group; residents of affordable housing developments; immigrants; Hispanic and
Latino individuals; and volunteers for social service organizations.
In-person Interviews and Focus Groups
Given the history, health status, diversity of issues, and perspectives across Berkshire County, a
robust formative research effort was required to effectively tailor the CRI LEP for diverse
populations. In this section, we report the eight themes that emerged from this formative
research effort. We identify and explore areas of common agreement as well as unique
perspectives discovered through the formative research.
Highlights of the report are reflected below, with a greater recounting of the sections reflecting
community health needs.
1. Areas of Resilience
2. Areas of Need
Both professionals and general public participants expressed strong agreement that the greatest
needs of the community are related to health, jobs and poverty, transportation, and education.
Both interview and focus group participants stated that obesity, diabetes, mental health,
92 substance abuse, alcoholism, smoking, and cancer are the major health issues affecting the
community. Interview participants also listed oral health, heart health, high blood pressure, leg
problems, and teen pregnancy. Focus group participants also listed asthma. Most participants
spoke of a need for affordable preventive dental care. Participants in the individual interviews
also spoke of a lack of primary care physicians.
One interview participant said there is a racial divide and that there are perceptions among
some of the youth that racism will impact their ability to get a job. Among focus group
participants, racial issues were rarely raised as a significant issue.
Overall, interview participants expressed a view that there should be more advocacy for
parents, that youth engagement with gangs was an issue, and that the elderly face many issues
that need to be addressed. Participants in focus groups often mentioned a lack of things to do
and a lack of green spaces for children and teens.
In southern Berkshire County, all participants broadly agreed that poverty was a significant
issue. Focus group participants expressed this by discussing the need for affordable housing
and affordable recreation venues for adults, teens, and youth. Interview participants highlighted
issues related to needs to advance health literacy, address the physician shortage, and provide
adequate transportation.
A distinction for northern Berkshire County participants is that they identified mental health
and substance abuse as the biggest health issues facing residents. Interview participants also
listed smoking and tobacco use, and obesity. Focus group participants also mentioned child
abuse, disability, and cancer.
3. Challenges to Living a Happy and Healthy Life
Economics and transportation, in that order, were the most significant challenges to living a
healthy and happy life, as mentioned by both focus group and interview participants.
Poverty and the overall economy were consistently described as a main cause of poor health in
Berkshire County. Specific references included a lack of jobs, underemployment, and lowpaying jobs. Participants attributed much of this situation to General Electric (in Pittsfield) and
Sprague Electric (in North Adams) leaving, and the resulting lack of industrial jobs.
The Berkshire County economy was hit hard when major manufacturing centers (i.e. General
Electric and Sprague Electric) essentially closed for business in Berkshire County. Although
tourism has picked up following these closures, the county has yet to fully recover
economically, socially, or psychologically. Referring to Sprague Electric closing in North
Adams, one participant in this formative research said, “Generations of families had people that
worked for [Sprague Electric]. My grandparents on both sides worked there, and it was like
somebody pulled the plug in the bathtub.”
Another participant said, “If you were to talk to people who lived here a long time ago, this
was a community that was full of pride and possibility. I do think it has been a degenerative
situation. Support for this community decreased because of a lack of funds (and)
unemployment. You have a greater sense of hopelessness because people don’t see a way out
of the situation. So many people are barely making ends meet…they can’t pull their finger out
of the plug.”
A current and growing strength is the fairly seasonal tourist and service industries; however
that economic effort mainly creates lower-paying jobs, especially in southern Berkshire
County. Residents throughout the county continue to struggle to find sufficient full-time work
to support themselves and their families year-round.
93 One participant estimated that half of the population in northern Berkshire County is on public
assistance and struggling. The long-standing economic challenges have clearly had a negative
impact on many people who have turned to a fatalistic outlook that crosses multiple
generations. One participant described it: “This fatalistic sort of view clearly drives some of the
adverse health that we are seeing, and so much of that is a consequence of the disruptive nature
of the local economy.”
Regarding transportation challenges, participants reported there is limited public transportation
and taxi services, so many people who cannot afford automobiles must walk to do daily tasks,
such as going to work or shopping. However, participants quite often reported feeling it is
unsafe to walk, especially at night in certain neighborhoods. Outside of major population areas,
sidewalks and bike lanes are not common. One participant reported a perception that as many
as 20 percent of residents don’t have personal transportation, such as a car. The perception of a
long journey is another barrier. Participants report it is considered a major trip, for example, to
travel to Pittsfield from the southern or northern portions of Berkshire County. There is also a
concern regarding disability accessibility specifically raised by focus group participants in
North Adams.
Poor economics, a challenge to living a healthy and happy lifestyle that was mentioned by all
participants, often emerged through stories of people working multiple jobs and yet struggling
to make ends meet. This struggle was described as ongoing and subject to seasonal swings
based on tourism.
Participants in this formative research also identified several other significant challenges to
living a happy and healthy life in Berkshire County. For example, many participants stated that
time management was an issue when working two or three jobs, which made it difficult to
exercise, eat healthfully, and enjoy life in general.
Focus group participants also expressed a belief that they and their friends and neighbors are
not able to exercise much of the year due to weather, and that there were not affordable workout spaces and gyms. Many participants did note that while there are gyms, yoga studios, and
similar facilities, as well as an extensive trail system in Berkshire County, people must have
transportation and sufficient funds to access those facilities. As a result, many participants
viewed physical activity as beyond the reach of many Berkshire County residents.
Many participants reported that they want to know how to exercise correctly and how to use
exercise equipment and facilities. Individuals in one focus group reported having access to
exercise equipment in their affordable housing complex, but stated that they didn’t know how
to use the equipment. Another participant reported that exercise was not promoted throughout
the county.
Interview participants also saw generational and cultural causes along with a lack of awareness
of healthy living and the negative consequences of unhealthy living as contributors to the
inability to live a happy and healthy life in Berkshire County. Drug and alcohol abuse were
frequently described as contributors to poor health. Additionally, falls among the elderly was
described as a significant issue. Other unhealthy behaviors mentioned by interview and focus
group participants included poor diet, smoking, alcohol abuse, and substance abuse.
Participants reported that alcoholism is prevalent and drug abuse is particularly high among
teens. The interview participants added inactivity, poor mental health, crime, and domestic
issues.
Focus group participants also indicated food was a challenge of living a happy and healthy life
94 in Berkshire County. Some said healthy food was too expensive and others said, “Fast food is
omnipresent and easy to get.” Additionally, a focus group participant expressed an underlying
theme by describing a lack of sufficient nutritional resources. “Not everybody can get WIC
vouchers, after your child is five you can’t get anything.” Interview participants felt that
nutrition should be taught in schools starting in kindergarten.
A recurring theme appears in the answers of both focus groups and individual interviews to the
question: “What do people typically eat?” The dominant response was that people eat what is
“quick, convenient, and cheap.” That often lacks vegetables. One participant said, “The reality
is (we eat) whatever is cheap and easy. If you have to shop at Convenience Plus, you are going
to be buying what’s there and what’s available. Might be a bag of potato chips and bologna.”
An interview participant stated that portion control was also an issue. “Even if you serve
healthy food, they will eat two or three servings.” Pasta was mentioned, and it was noted that
young people eat burgers and hot dogs. Other foods spoken of included “fried foods, high
sodium foods, really yummy chicken and ribs and greens and macaroni and cheese.”
One person spoke of stress from the social environment: “Social environment, you are always
stressed with the peer pressure, and people that you work with you know that are always
putting pressure on you, to do certain tasks.” There was a variety of other responses from focus
group and interview participants, including describing challenges to health and well-being that
included mold in houses, depression, change in climate, boredom, lack of access to medical
care, closed detox centers, allergies, and a concern that school budgets have been cut and as a
result there is not enough physical education in schools.
In southern Berkshire County, interview participants identified challenges to a living a happy
and healthy life as poverty, lack of education, Lyme disease, and shortage of medical facilities
and dentists. Focus group participants stated that poverty was a significant challenge and
specifically pointed out the high costs of healthy food and health care. Focus group participants
also mentioned a lack of gyms or community centers in southern Berkshire County.
In northern Berkshire County, all participants identified transportation as a major need.
Interview participants focused on public transportation, while focus group participants
discussed the need for better streets and disability access. Both groups also mentioned jobs and
economics, echoing a county-wide challenge to living a healthy and happy life in Berkshire
County.
A focus group participant in northern Berkshire County said, “I am diabetic and I am supposed
to eat a certain way, and I can’t afford to do that. There is absolutely no way I can afford to eat
the way I am supposed to and feed my children. It is just not going to happen, and I know I am
not the only one out there facing those circumstances.”
Interview participants in northern Berkshire County also identified smoking, poor nutrition,
transportation, mental health, and obesity as challenges to a healthy life. Focus group
participants in northern Berkshire County identified poverty, disability, and lack of sense of
purpose as significant challenges. A focus group participant said that without a sense of
purpose, “You don’t have a stake in the outcome and it is so much easier to slip in your life
…because nobody is really expecting you to be disciplined.”
Participants in northern Berkshire County raised numerous other issues that create challenges
to living a happy and healthy life. These included a trend of young people leaving the area
because of a lack of opportunities, the challenges of living on disability, the expense of healthy
food, a primary care physician shortage, substance abuse, depression leading to a very passive
community, low education attainment, and lack of transportation to health care. Focus group
95 participants particularly addressed a common perception among themselves, their families,
neighbors, and communities that they did not “deserve to be healthy” and that hunger was a
given reality in their lives.
4. Fresh Produce
In regard to nutrition, the formative research included specific inquiries about the availability
of fresh produce. The overwhelming response from both interview and focus group participants
was that produce was available, but was expensive. The opportunities to buy unhealthy food in
Berkshire County were described as plentiful.
Both interview and focus group participants also stated a feeling that difficult economic
circumstances and the frequent and easy opportunities for eating unhealthy at a perceived low
price were a constant challenge.
5. Personal Safety while Walking Outdoors
There were mixed responses when it came to whether or not it was safe to walk around
Pittsfield. Slightly more than half of the focus group and the individual interview participants
indicated that it was unsafe to walk the neighborhoods in Pittsfield for exercise. Daytime
walking as well as walking in outlying areas (not downtown) were often deemed safer, with
downtown described as a higher-risk area. Participants reported walking to get places, but
doing less walking at night.
There was a mixed response among the southern Berkshire County participants when it came
to whether or not it is safe to walk in neighborhoods. Outside of the main population areas,
participants reported that there are no sidewalks and people must walk along unsafe busy
routes. Focus group participants expressed a perception it was safe to walk everywhere except
in Sheffield.
In northern Berkshire County, both focus group and interview participants expressed a shared
and strong belief that for the most part it was unsafe to walk around the community, with the
exception being that interview participants generally felt that there was safety near major
services (e.g. downtown during day, shopping plazas). Drug activity, crime, and violence were
mentioned by interview participants as causes of a lack of safety. People reported being afraid
to let their kids walk or ride bikes to school, or be out past a certain time of day.
6. Availability of Medical Care
Both focus group and interview participants stated feelings that health care was available and
that people can access health care when they need it. However, many challenges to obtaining
health care were also raised by participants. Overall, interview participants reported a broader
list of issues accessing health care than did focus group participants.
A shortage of primary care physicians and, as a result, a lack of continuity of care, long waits
to receive care, and a general perception of dissatisfaction with the overall health care system
were broadly reported. Participants repeatedly noted access is most difficult for people with
mental illness and poor physical health
7. How Can Berkshire County Residents Change Unhealthy Behaviors?
Across focus group and interview participants, the need for social support to allow individuals
to change behaviors was clearly expressed. Families, support groups, and the development of
role models were all themes within responses.
Specifically in regard to healthy behavior changes related to obesity and overweight, interview
participants discussed that Berkshire County residents, across cultural backgrounds, associated
96 food with “love, reward, and attention” and generally see people as healthy even if they are
overweight – until a trigger goes off. Focus group participants agreed that the perception of
what is and is not healthy in regard to weight is an issue that challenges behavior change
efforts. For example, the overall impression reported for the dominant culture in Berkshire
County is that being obese is considered overweight and being overweight is considered
normal.
While BHS and CRI agreed that the initial emphasis of the formative research should be
Pittsfield, many of the individual interviews conducted were with officials responsible for the
entire county. In Pittsfield, 18 interviews and seven focus groups were conducted. In the
southern portion of Berkshire County, three interviews and one focus group were conducted. In
the northern portion of Berkshire County, three interviews and one focus group were
conducted. In total, 24 interviews and nine focus groups were conducted. The focus groups
averaged approximately eight people per group, totaling approximately 72 individuals.
Conclusions
This formative research effort has provided an in-depth look at the reality of health and wellbeing for some, but not all, residents of Berkshire County. While perceptions of Berkshire
County residents gathered through this formative research process may, at times, be deemed
factually incorrect or subject to different interpretation by differing individuals with differing
perspectives, the important consideration for program design is that the perceptions are ‘real’
(i.e. true) for the people who hold them. Thus, these perceptions must be taken into
consideration when designing a public health intervention to improve health literacy and
change knowledge, attitudes, beliefs, and behaviors relating to health.
Perhaps most significantly, this formative research has encountered an unhealthy trinity that
seems to be experienced by a majority of Berkshire County residents. This negative experience
seems to be most intense for people at the lowest socio-economic levels. The unhealthy trinity
is a cyclical reinforcement among the economy, transportation, and food that reinforces
negative perceptions of an individual’s ability and capacity to change for the better. This
unhealthy trinity always affords people another reason to explain to themselves and others why
change is not possible in their lives. These three factors – poor economy, transportation, and
food – are the creators of despair and destroyers of hope. While to some perspectives, nothing
could be further from the truth– this is nonetheless a strongly held self-reinforcing reality in the
lives of many residents of Berkshire County, and was freely discussed by the research
participants.
In addition, low income and a lack of jobs that live up to past expectations combine to
eliminate hope in many people’s perceptions, and thus in their lives. This relationship has
become inter-generationally entrenched for roughly 30 years since General Electric and
Sprague Electric significantly reduced their presence in Berkshire County. However, that
perception is malleable and can be redirected given sufficient energy, intention, and
collaboration across individuals and organizations in Berkshire County. As a result, BHS
should seriously consider taking up an even more active leadership role in creating an effort to
redress this perception of economic failure within Berkshire County. This effort is, in reality,
well within the portfolio of health services Berkshire County already offers to the residents of
Berkshire County.
97 South Berkshire
BHS Canyon Ranch Institute Life Enhancement Program
This report summarizes the findings from the formative research component of the Berkshire
Health Systems-Canyon Ranch Institute Life Enhancement Program (BHS-CRI LEP) effort in
southern Berkshire County. As is always true, the first step of launching a new CRI LEP is to
conduct formative research in the community. This effort creates an evidence base upon which
the partnership can center all efforts to design and tailor the CRI LEP to be the most effective
in the targeted community.
The formative research described in this report consisted of a series of interviews and focus
groups conducted in southern Berkshire County. The first interviews and focus groups took
place in July 2013 as part of the initial formative research conducted by CRI throughout
Berkshire County, which was used to inform the tailoring of the CRI LEP to participant groups
that meet in Pittsfield. The research that was conducted in the southern section of Berkshire
County in July 2013 has been combined with research collected by CRI team members during
visits in August, November, and December 2014. A total of 53 people participated in the
interviews and focus groups in southern Berkshire County. CRI team members interviewed a
total of 22 people and facilitated six focus groups that included a total of 31 people. CRI team
members interviewed 9 males and 13 females. The six focus groups (totaling 31 participants)
included six males and 25 females.
Findings include themes related to participants’ impressions of southern Berkshire County in
regard to:
o Overall impressions of life
o Economic perspectives
o Areas of strength
o Areas of need
o Challenges to living a happy, healthy life
o Quality and access to medical care in southern Berkshire County
o Biggest health issues
o Causes of poor health – common unhealthy behaviors
o Incentives and barriers to physical activity
o Role of spirituality
o Health and wellness programs and perspectives
o Program logistics
Overall, this report concludes:
o There is a strong sense of loyalty to and happiness with Fairview Hospital – despite a
well-recognized shortage of specialty care in particular. There is not the same level of
antipathy toward Berkshire Health Systems as encountered in some parts of the central
county area.
o While nutrition and general health and well-being information may be available in the
county, it seems to not be packaged or distributed in a way that is used by residents.
o There are many structural and environmental determinants of health that are not aligned
with a healthy and happy population.
o The perceived gap between the ‘haves’ and ‘have-nots’ in southern Berkshire County is
large and considered to be growing. This poses a threat to sustainable social cohesion.
o Pride of community is strong, but also promotes a sense of resentment toward and
isolationism from the rest of Berkshire County.
o Broadly speaking, residents are very aware of health concerns – but that awareness
often fails to survive the competition with needs of daily survival and other demands of
life. That is especially true as incomes are lower.
98 o Teens are seen as being at particular risk – especially in regard to illegal drug use,
alcohol use, depression, and dropping out of the educational system.
Overall, there seems to be no doubt that the CRI LEP can be successfully tailored to the
communities of southern Berkshire County and the effort, with the support and leadership of
Berkshire Health Systems, is sure to produce a growing number of healthier individuals who
will help lead the way toward making a healthier southern Berkshire County.
Age Friendly Community Survey
During the summer of 2015, The Berkshire County Age Friendly Task Force, the Berkshire
Regional Planning commission in conjunction with other local organizations, conducted an age
friendly survey. An excerpt from the report is included below. The full report can be accessed
online at
The United States is currently undergoing an unprecedented change in the aging of the
population. Baby boomers began turning 65 in 2011, and every day for the next 20 years
10,000 Americans will celebrate their 65th birthday.1 Already one in three Americans is aged
50 or older; by 2030, one in five will be over the age of 65. 2 In Berkshire County this shift is
happening sooner and faster than in other parts of the state and the country. The population of
those over age 65 in the United States is expected to overtake the number of those under 18 in
2030. However, in Berkshire County this shift occurred in 2010. This is a permanent change,
with the number of adults over 65 continuing to increase, while the percentage of children
continues to decline.
Berkshire County is older, with a median age of 44, compared to a median age of 39 in the
state of Massachusetts overall and a median age of less than 37 in the country as a whole.
Projections show that both the absolute numbers and the proportion of older adults in Berkshire
County will continue to increase, while the number of younger adults and children continues to
decrease. By 2010, the populations of adults over the age of 50 already made up 40% or more
of most Berkshire County municipalities. By 2030, fifteen years from now, the majority of
Berkshire County municipalities will have populations that are 60% or more residents aged 50
or over, and all but North Adams and Williamstown (probably due to college populations) will
be over 40%.
99 Comparison of Children to Older Adults ‐
Berkshire County
45000
40000
Population
35000
30000
25000
20000
15000
10000
5000
2060
2058
2056
2054
2052
2050
2048
2046
2044
2042
2040
2038
2036
2034
2032
2030
2028
2026
2024
2022
2020
2018
2016
2014
2012
2010
0
Year
Children (Under 18)
Older Adults (Age 65+)
Berkshire County is older, with a median age of 44, compared to a median age of 39 in the
state of Massachusetts overall and a median age of less than 37 in the country as a whole.
Projections show that both the absolute numbers and the proportion of older adults in Berkshire
County will continue to increase, while the number of younger adults and children continues to
decrease. By 2010, the populations of adults over the age of 50 already made up 40% or more
of most Berkshire County municipalities. By 2030, fifteen years from now, the majority of
Berkshire County municipalities will have populations that are 60% or more residents aged 50
or over, and all but North Adams and Williamstown (probably due to college populations) will
be over 40%.
100 With these
t
demogrraphic changes, the needss of the comm
munity also cchange in draamatic ways, in
areas such
s
as health
h care, emplo
oyment, houssing and sociial inclusion and respect.
Age Friendly
F
Com
mmunities
Age Friendly Com
mmunities are communities that are livaable and incllusive for all ages.
Admin
nistered interrnationally by
y the World Health
H
Organnization (WH
HO) and in thhe United
States through AAR
RP, the Age--Friendly Communities m
movement ennables people of all ages too
activelly participatee in communiity activities and treats evveryone withh respect, regaardless of theeir
age. Itt is a place th
hat makes it easy
e
for olderr people to sttay connectedd to people thhat are
importtant to them. It helps peop
ple stay healtthy and activve even at thee oldest ages and providess
approp
priate supporrt to those wh
ho can no lon
nger look afteer themselvess. An Age-Frriendly
Comm
munity is both
h a great placce to grow up
p and a great place to grow
w old.
In mid
d-2014, a group of interessted Berkshire County proofessionals began to meett and exploree
how to
o make Berksshire County
y a more age-friendly placce to live, woork and play. A formal
Task Force
F
was im
mplemented in
n late 2014, with
w represenntatives from
m numerous sectors of the
comm
munity such ass planning, health
h
care, ho
ome care, hoousing, educaation, councills on aging,
municipalities, boaards of health
h, business an
nd others. Asssessment waas one of the first needs foor
the Taask Force, and
d the Berkshire Age-Frien
ndly Survey,, based on thee AARP Livability Surveey,
was deesigned and launched
l
by Berkshire
B
Reegional Plannning Commisssion (BRPC
C) and the Tassk
Force in March 2015. Overall 2,479
2
responsses were regiistered to thee survey and the results arre
describ
bed in the rep
port below.
The Taask Force continues to mo
ove forward.. On June 1, 22015, at the ffirst Berkshirre County
Seniorr Summit, thee County wass formally acccepted into tthe Age-Frienndly Commuunities
Prograam, with a ceertificate pressentation from
m Michael Feesta, AARP, Massachuseetts. Also in
June, Berkshires
B
Tomorrow, In
nc., a non-pro
ofit subsidiaryy of Berkshirre Regional P
Planning
Comm
mission, was awarded
a
a tw
wo year, $179
9,000 grant, tto enable the hire of a Prooject Manageer
to overrsee the Berk
kshire Age-F
Friendly projeect. Additionnal assessmennt continues, including
101 review of available data sources, focus groups in conjunction with several Councils on Aging,
and a planned “dashboard survey” of existing infrastructure. Once the Project Manager is hired,
working groups around each of the eight Domains of Livability, as well as an Active Agers
Advisory Group of local seniors, will be formed. The ultimate goal of the planning process is a
three year action plan for creating a more age-friendly Berkshire County
Domains of Livability
The report is organized around eight domains of livability as described by the AARP, including
Community Health and Services, as described below.







Outdoor Spaces and Buildings – public places, indoors and out, where people gather.
Green spaces, safe streets, sidewalks, outdoor seating and accessible buildings
(elevators, stairs with railings, etc.) that can be used and enjoyed by people of all ages.
Transportation – safe roads, public transportation, special transportation services and
innovative transportation options such as a taxi service that provides non-drivers with
rides to and from a doctor's office.
Housing – Most people want to remain in their own home and community as they age.
Doing so is possible if a housing is designed or modified for aging in place and a
community has affordable housing options for varying life stages.
Social Participation - Regardless of a person's age, loneliness is often as debilitating a
health condition as having a chronic illness or disease. Sadness and isolation can be
combatted by the availability of accessible, affordable and fun social activities.
Respect and Social Inclusion – Ways to make everyone feel valued. Intergenerational
Communication and Information
Communication and Information - Age-friendly communities recognize that not
everyone has a smartphone or Internet access and that information needs to be
disseminated through a variety of means.
Community and Health Services - At some point, every person of every age gets hurt,
becomes ill or simply needs some help. While it's important that care be available
nearby, it's essential that residents are able to access and afford the services required.
Geographic Location
Survey respondents came from every municipality in Berkshire County, and for the most part,
the percentage of surveys received from a given municipality reflected the percentage of
county population over the age of 50.
Similarly, the percentage of surveys received from the three major sections of the county –
North, South and Central County, roughly mirrored the population. North County was slightly
overrepresented, while South County was slightly underrepresented. This was probably due to
more small municipalities in South County, where responses were overall slightly lower.
Given the focus on the Community Needs Assessment, the section of the Age Friendly report
related specifically to health is reflected below.
Health and Community Services
Respondents in the Age-Friendly Survey rated their health compared to their peers fairly high –
36% rated it as excellent, with another 49% rating it as good. Only 3% rated their health as
poor or very poor compared to people their own age. These numbers are similar to those
reported on the Behavioral Risk Factor Surveillance System (BRFSS), a phone survey
102 conducted yearly by the Centers for Disease Control (CDC) where annually about 14% of
Berkshire County residents report their health as fair or poor. However, these numbers are
worse than those reported by Massachusetts residents as a whole; roughly 12% of
Massachusetts residents report their health to be fair or poor on the BRFSS.
Those in the 50-59 and 60-69 age groups were most likely to report their health as excellent (40
and 41% respectively) and those over 80 were least likely (21%). Less than 1% of those aged
50-59 reported their health as poor or very poor, while 6% of those over 80 did so. Overall
90% of those in their 50’s reported their health to be excellent or good compared to their peers,
as did 74% of those over 80.
Age-Friendly respondents claimed to exercise often – a third of them claimed to exercise every
day or almost every day, while another 38% said they exercised several times per week.
Overall, 84% of respondents claimed to exercise at least once a week. Only 11% claimed to
exercise less than once a month (7% of those said they never exercise). These numbers peaked
for those in their 60’s and 70’s; 35% of 60-69 year olds and 36% of 70-79 year olds claimed to
exercise every day or almost every day, compared to 32% of 50-59 year olds and 22% of those
over 80. Even in the oldest age group, however, over two-thirds of respondents claimed to be
exercising at least once a week. This number was 89% of respondents in their 50’s.
By far the most common form of exercise was walking, stated by 81% of respondents.
Numbers were similar for all age groups (slightly above 80%) except for those over 80, where
71% claimed they walked for exercise. Other popular choices overall were gardening (40%),
hiking (30%), gym or health club (28%), strength training (23%), biking (19%), yoga (16%),
swimming (15%) and kayaking/canoeing (15%). Again, these preferences held fairly steady
across the age groups, although fewer of those in the older age groups participated.
Health care priorities rated the highest of any of the domains when respondents were asked
about their importance. Topping the list were a supportive primary care physician,
conveniently located emergency centers, a variety of health care professionals, including
specialists, and respectful and helpful clinic and hospital staff. However, more than a quarter of
respondents said they had had trouble making an appointment or finding a doctor or other
needed health care services near by.
Respondents were asked several questions to ascertain information related to health conditions
of interest to the local health systems and other social service agencies. When asked about falls,
28% of total respondents said they had fallen at least once in the past 12 months. This number
was higher among older respondents; 39% of those over 80 had fallen at least once, compared
to 25% of those aged 50-59. More than 4% of respondents overall had fallen three or more
times; among those in the over 80 group 8% had fallen three or more times, as had 7% of those
aged 70-79. Of those who had fallen and answered the following question, 23% overall had had
an injury related to a fall that resulted in a doctor’s visit or a restriction of daily activities for a
time. Again, differences were seen by age – of those over 80 and those in the 70-79 age group,
30% reported an injury, while 19% of the 60-69 age group and 20% of the 50-59 age group
reported an injury.
When asked about disability or chronic disease that interfered with full participation in work,
school, housework or other activities, 17% of respondents said they had such a disability, 9%
have a spouse or partner with a disability and in another 3% of cases both the respondent and
his or her spouse do. The numbers climb with age, 8% of those 50-59 have a disability, 13% of
those 60-69, 23% of those 70-79 and 39% of those over 80. Seventeen percent of respondents
are providing caregiver services to someone. This number falls significantly after age 70, and is
lowest for those in their eighties or older (7%).
103 Smoking rates are quite low among the respondents; only 10% have smoked within the past
year. Forty-six have never smoked. Current smokers are more likely to be in the younger age
groups; 15% of those aged 50-59 have smoked in the past year (11% current), compared to 5%
of those over 80.
When asked how often they have felt down, depressed or hopeless in the past month, 73%
replied not at all. However, 4% said they had more than half the days and another 3% had been
depressed nearly every day. These percentages were fairly consistent across age ranges. In
addition, 7% said that poor physical or mental health had kept them from their usual activities
at least several times per week over the past month (13% among those over 80). Depressed
older adults are less likely to eat well, exercise or participate in social activities, and are
therefore more likely to become disabled or develop chronic diseases.
When asked if they were concerned about their memory more than a quarter of survey
respondents claimed they were. Older respondents were slightly more worried; 32% of those
over 80 expressed concern over their memory, compared to 25% of those 50-59 and 22% of
those 60-69. Approximately 15% of those who responded had spoken to their health care
provider about their memory concerns. These numbers are somewhat higher than those
reported by the CDC in a study where approximately 13% of respondents in 2011 reported
“increased confusion or memory loss” in the past 12 months. Memory problems typically are
one of the first warning signs of cognitive decline; some, but not all, persons with mild
cognitive impairment will develop Alzheimer's disease. Others can recover from mild cognitive
impairment if certain causes (e.g., medication side effects or depression) are detected and
treated.
Respondents were asked where they would seek information about needed services such as
caregiving, home delivered meals, medical transport or social activities. Elder Services of the
Berkshires (78%) was the most popular answer among all age groups, followed by the local
council on aging (68%), and the local senior center (60%). Approximately 30% of respondents
said they would seek help from their church, synagogue or other faith-based group, with
slightly smaller number of respondents saying they would seek help from another social
services agency or from the AARP. Open responses stated that many respondents would turn to
friends or family for recommendations or information. Mass 211 received the lowest number of
responses in all age groups; open responses suggested that a number of respondents had never
heard of Mass 211.
Healthcare Market Assessment: Northern Berkshire County
Stroudwater Report
The following excerpt highlighting health needs was pulled from the 102 page report. The full
report is available on the BHS website at berkshirehealthsystems.org.
As a result of the closure of North Adams Regional Hospital (NARH) in March 2014, the
Massachusetts Department of Public Health, Office of Rural Health engaged Stroudwater
Associates (Stroudwater) in May 2014 to provide an independent and objective third-party
assessment of the healthcare market in the North Adams region.
At just under 37,000 people, the North County region’s population is relatively stable. Small
declines are expected in the overall population, and what growth is seen comes from the 65+ age
cohort. The North Adams market has historically experienced challenges with access to healthcare,
particularly primary care, despite the fact that the federal government previously designated areas
of North County as health professional shortage areas. The region is worse off than the state and
104 national average for a number of health status indicators. Asthma, most cancers, and heart disease
incidences are all higher than the state average, and high percentages of the population are
overweight, have a disability, and report poor general health. Combined, these factors create a
vulnerable population for healthcare services. This health status data is from 2010-2012, indicating
that the problems existed when NARH was in full operation, and have persisted.
Given the age and economic demographic of the county, Berkshire residents rely heavily on public
sources of financing for health care. This makes the providers of healthcare services dependent on
government reimbursement, and can directly influence what services are viable for provision
locally.
Over 100 stakeholders from the North County region provided input for this study. They
represented a broad spectrum, from consumers to leaders of local organizations and from social
service agencies to healthcare professionals formerly practicing at NARH.
Participants commonly cited social and environmental issues in the community such as
 Substance abuse
 Mental health
 General economic problems such as low income and poor transportation systems within
Berkshire County. Transportation within the North County region itself was also stated as a
barrier to accessing services.
Access to physicians was also a top concern raised by the consumers in the focus group.
Participants cited a wait of up to six months to see a primary care provider, regardless of insurance
provider. They indicated health needs within the region that are primarily prevention and lifestyle
issues, such as
 Access to primary care
 High smoking rates
 Drug abuse
 Teen pregnancy.
Physicians interviewed noted the difficulties in attracting other physicians to practice in Northern
Berkshire County, and strongly recommended considering this factor in the study. Physicians
practicing in the community recommended evaluating the determination of needs from the ‘patient
point of view,’ focusing on making care accessible to the population by delivering services locally
only when it can be done safely, affordably, and with adequate availability of physicians.
A number of the interviewees noted that the costs of healthcare can be prohibitive for many in the
region, and that challenges exist in following through on care plans put in place by their providers.
Consumer advocates asserted that the models for North County need to facilitate access to
insurance and ensure that enough healthcare providers are available to the population. Common
roadblocks to accessing existing programs included lack of awareness, uncertainty about eligibility,
administrative complexity, and/or the stigma associated with seeking some types of care.
Many recognized the work of the Northern Berkshire Community Coalition in helping to improve
inter-agency communication. Other perceived assets of the community included:
• Great place to raise a family
• Colleges
• Workforce readiness
• Loyalty
• People willing to help each other
• Leadership and involvement in the community
A number of the physicians noted the importance of offering diagnostic services (imaging, lab, and
other procedures that are referred to by primary care physicians) in North County. Some physicians
105 reported that patients are forgoing low-acuity and routine care because they cannot access those
services locally. The consumer focus group supported this observation, and commonly cited
transportation as a major barrier to accessing services. This was true for both North Adams
(consumers reported difficulty in getting “up the hill” to the BMC North site) and for Pittsfield,
which lacks a regular public transportation option for North County residents seeking care there.
Major Findings Observed in the NARH 20012/13 Community Health Needs Assessment
Community Health Needs Assessments provide information vital to evaluating a community’s
particular health needs and challenges, and recent assessments highlighted some of the existing
conditions and roadblocks to wellness for Northern Berkshire residents.
The top 5 leading causes of death in Berkshire County are as follows:
o Cardiovascular Disease
o Cancer
o Respiratory Disease
o Nervous System Disease (Alzheimer’s)
o Genitourinary System Disease (nephritis, renal failure)
The top 5 leading causes of hospitalizations are:
o Cardiovascular Disease
o Mental Disorder
o Digestive System Disease
o Respiratory System Disease
o Injury (falls, hip fractures)
2012 and 2013 Needs Assessment Survey results for the residents/consumers group showed that the
vast majority of Northern Berkshire County residents report “good” or “very good” health and are
able to obtain regular physical exams and checkups. Although most residents indicated that they
were able to see the doctor for routine physical exams, one-third of respondents said that, “there are
times when they cannot go to the doctor when they are sick or need a checkup.” When asked why,
half of those respondents indicated the need for transportation as the major obstacle; cost and
availability of appointments were also barriers for a significant number of people.
Alcohol, substance abuse, overweight and obesity, smoking, and mental health are the disease and
health risks of greatest concern among members of Northern Berkshire County. Data from the
community health status assessments are from 2010-2012, which predates the closure of the
hospital and supports the conclusion that hospital-based services do not guarantee a high
community health status.
Latino population ChallengesFeedback provided by Interpreter Services, Community Outreach Program & Care
Coordination 8/27/15
Based on patients feedback and comments
 Language barrier: Most of the Latino patients served are Limited English proficiency
(LEP). Sometimes, an interpreter is not requested in a timely fashion. This makes it
difficult to get a last minute face to face interpretation. Some appointments are lengthy and
using an iPad or phone for interpreting is not the best fit.
 Wait time can be an issue because interpreter not booked appropriately or not at the last
minute. Sometimes the provider is delayed and interpreters have to go to a next assignment.
106  Latinos have a difficult time disclosing their condition being in a small community and
most fear a stigma.
 Berkshire county is rural making it challenging for interpreters and patients to trust that
confidentially is 100% a top priority
 Spanish resources:

- Informational material in Spanish
 Cancer education is needed in Spanish. Many patients do not understand their
condition, prevention or resources.
- Support groups for Latinas.
- Other community resources
Outreach and education to the community has been less challenging however is sometimes
difficult to gather bigger groups of people.
o Not all events include a medical interpreter
o Need for peer to peer outreach
 Transportation is challenging as many of the Latino patients rely on their family members
to get to appointments.

Spanish speaking therapist for behavioral and emotional support.
Southern Berkshire Healthcare Survey
The Southern Berkshire Healthcare Questionnaire was conducted in 2014 in an effort to gain
perspective of the South County community on the status of health and healthcare, access to
services and information, points of influence and decision-making, and opinions of the major
health issues facing the southern region of the Berkshires. The survey was sent by email to 150
individuals who work with or represent vulnerable groups in the community. This includes
teachers, social service workers, community organizations and members of Fairview
committees, including its Patient Family Advisory Committee. Eighty six of 150 surveys were
returned in English. The survey was also translated into Spanish and distributed in hard copy
in an ESL class. Six surveys were filled out and returned by the teacher. The results of the
Spanish version mirrored the responses received in the English version.
The results of the survey showed for people whose health had declined in the past year, the role
of stress was significant. In addition to physicians, healthcare workers are considered major
sources of credible information for health information. The survey showed our community was
open to use online tools for education. Leading health problems were identified in order as
alcohol and substance abuse, aging, heart disease/stroke and mental health. Obesity, alcohol
and drug abuse, lack of exercise, poor nutrition and tobacco use were viewed as the top risky
behaviors. Three quarters of the respondents had used services at Fairview Hospital in the past
year, primarily out-patient and emergency. Sixty-eight percent of respondents provided
answers in an open comment on the role of Fairview Hospital in our community.
To view the survey results, visit the following website:
www.berkshirehealthsystems.org/documents/Health%20Needs%20Assessment/South%20Berkshire%20Health%20Survey.pdf.
107 108 VII . Appendix
109 Berkshire County Healthcare Facilities:
Hospitals
•
Berkshire Medical Center
• Berkshire Medical Center North Campus
• Hillcrest Campus
•
Fairview Hospital
Home Health Care
•
Berkshire Home Care
•
Berkshire Place at Home
•
Berkshire VNA
•
Home Instead Senior Care
•
Gentiva Health Care Services
•
Guardian Hospice of Ma.
•
Hospice Care in the Berkshires
•
Hospice Services of Western Ma.
•
Molari Employment and Health Care
•
Porch Light VNA (Lee VNA)premier Horne Care
•
Rosewood Home Health Care
•
VNA and Hospice of Northern Berkshire
Inc. Nursing Homes and Nursing Care
Communities
•
Berkshire Place
•
Berkshire Rehabilitation
•
Curtis Manor Retirement Home and Cottages
•
Fairview Commons and Rehabilitation Center
•
Great Barrington Rehabilitation and Nursing
•
Hillcrest Commons
•
Kimball Farms
•
Mt. Greylock Extended Care Facility
•
North Adams Commons
110 •
Providence Care Center of Lenox
•
Springside of Pittsfield
•
Sweet Brook Care Centers
Community Services (primary focus related to healthcare)
•
Berkshire Area Health Education Resources
•
Berkshire County Board of Health Assoc.
•
Berkshire County Emergency Planning Council
•
Berkshire County Red Cross
Berkshire Community Health Network
Berkshire Immigrant Center
Berkshire Public Health Alliance
Berkshire WIC North
Berkshire WIC South
Elder Services of Berkshire County
Family Planning Services (Tapestry Health)
Pregnancy Support Services
Rape Crisis Center
United Way
•
•
•
•
•
•
•
•
•
•
Dental, Medical and Mental Health Professional Services
•
Berkshire District Dental Society
•
Berkshire District Medical Society
•
Berkshire Medical Reserve Corps
•
Brien Center (Community Mental Health Center)
•
Community Health Center of the Berkshires
•
Volunteers in Medicine
•
Spectrum Health
Berkshire County has broad and rich resource to meet community needs. This list is not
comprehensive of all related resource and programs but reflects the primary resources
related to health care.
111 SOURCES:
Age Friendly Survey 2015
Berkshire Benchmarks
Berkshire Health Systems
Berkshire Health Systems Community Benefit Committee
Berkshire Health Systems Wellness Data
Berkshire Medical Center Operation Better Start Data
Berkshire Regional Planning Commission
Berkshire United Way Impact 2015
Berkshire United Way Prevention Needs Assessment 2013
Canyon Ranch Institute 2013 and 2015 County Research
Community Health Initiative
Community Health Initiative Steering Committee
County Health Rankings: 2015 University of Wisconsin Public Health Institute and Robert
Wood Johnson Foundation
Elder Services of Berkshire County
Internal Revenue Service. (2012). Instructions for Schedule H (Form 990)
Life Enhancement Formative Research
Mass.Gov/Stopaddition: Recommendations of the Governor’s Opioid Working Group
Massachusetts Community Health Information Profile (MassCHIP).
Massachusetts Department of Mental Health.
Massachusetts Department of Public Health.
Massachusetts Medical Society: 2013 Patient Access to Care Study
Massachusetts Medical Society: Physician Workforce Study
National Center for Education Statistics
Northern Berkshire Coalition North County Assessment
Northern Berkshire Community Health Needs (Stroudwater Report)
Patient Family Advisory Committees (Spanish, North County, BMC, FVH, Cancer)
U.S. Bureau of Labor Statistics. . Unemployment Rates.
U.S. Census Bureau. (2011). Demographic Data. 2010; 2009-2013,
U.S. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance
System.
U.S. Health Resources and Services Administration. Guidelines for Medically Underserved
112