Community Health Assessment Final Draft mph 602

Community Health Assessment-Cuyahoga County, Ohio spring 2015

Community Health AssessmentMPH 602

Cuyahoga County, OH, Community Health Needs Assessment spring 2015

Prepared by: Steven Banjoff

Image source nationalatlas.gov

1


Cuyahoga County, Ohio Community Health Needs Assessment

Part I

Project Overview, Methodology, Population, Demographics, Socioeconomic, and Overall Health Status

Including an individual examination of separate neighborhoods within the high priority area of the City of Cleveland

Map from Cuyahoga County Public Safety and Justice Services.

2


This community health and needs assessment is being prepared by Steven C. Banjoff to gain a

deeper understanding of the diverse communities that comprise Cuyahoga County, Ohio. The assessment

aim is to give a demographic, social, and economic overview of the area while identifying key

stakeholders to encourage community members to form collaborative partnerships to recognize; who is

most vulnerable, what are their needs, where they reside, and why the problems exist.

Cuyahoga County, Ohio, is located in the northeast portion of the state, and is home to 1,280,122

residents, making it the most populous county in Ohio. There are 607,362 males with a median age of

38.4 years, and 672,760 females with a median age of 41.7 years (U.S. Census Bureau, 2014). The

county seat of Cuyahoga County is Cleveland , surrounding the city are inner and outer ring suburbs with

23 western suburbs and 35 eastern suburbs that comprise the county. Much of the poverty, poor living

conditions, older housing stock, and lack of transportation occur within the city and inner ring suburbs.

Since these areas will most likely have the greatest amount of health disparities it is important to examine

the demographic information found in the neighborhoods that make up the City of Cleveland.

The City of Cleveland is divided into 34 different neighborhoods each with different racial make-

ups, poverty rates and challenges. The following is a break-down of the population, diversity, poverty

rate, key economic indicators, median household income and education of the neighborhoods that

comprise the city. If the Child Poverty rate is in red the number of children living in poverty is greater

than the Ohio average of 23% (County Health Rankings, 2014), if green the number of children living in

poverty is less than the Ohio average. Household Median Income green when greater than Ohio Avg. of

$48,308 (U.S. Census Bureau, 2014) red when less than the average. Occupied Homes green when

greater than Ohio Avg of 89% (rounded) occupied, red when less than average.

Source: Cleveland City Planning Commission

3


Area Pop. Diversity Poverty Income Economic Education

Bellaire-Puritas 13,365

White 48%

Latino 13%

Black 26%

Asian 3%

Native American

1%

Other 5%

2+/Mixed Races

4%

% of Population in poverty

21%

% of Children in

poverty29%

% of Elderly 65+ in

Poverty12%

% of Households Receiving

Social Security Income

29%

% of Households

Supplemental Security Income

8%

Median House-

holdIncome$32,900

Unemployed16%

Occupied Homes

89%

ReceivePublic Asst.

Income7%

ReceiveFood

Stamps15%

No H.S. 5%

Some H.S. 19%

High School 42%

Some College

21%

Associates 6%

BA 5%

Grad/Prof 3%

BroadwaySlavic Village

22,432

White 36%

Latino 5%

Black 52%

Asian 0.3%

Native American

0.2%

Other 2%

2+/Mixed Races

3%

% of Population in Poverty

35%

% of Children in

Poverty45%

% ofElderly 65+ in poverty

28%



26%

% of Households


11%

Median House-

holdIncome$26,604

Unemployed23%

Occupied Homes

72%

ReceivePublic Asst.

Income5%

ReceiveFood

Stamps32%

No H.S. 8%

Some H.S. 22%

High School 36%

Some College

21%

Associates 5%

BA 5%

Grad/Prof 3%

Source: Chart compiled using data from Cleveland City Planning Commission 2014 neighborhood data report

Source: Chart compiled using data from Cleveland City Planning Commission 2014 neighborhood data report.

4


Community Pop. Diversity Poverty Income Economic Education

Brooklyn Centre

8,954

White 25%

Latino 32%

Black 21%

Asian 1%

Native American

1%

Other 16%

2+/Mixed Race 5%


29%

% of Children in

Poverty40%

% of Elderly 65+ in Poverty

19%



26%

% of Households


11%

Median House-

holdIncome$28,049

Unemployed16%

Occupied Homes

82%

ReceivePublic Asst.

Income7%

Food Stamps

31%

No H.S. 10%

Some H.S. 25%

High School 35%

Some College

17%

Associates 5%

BA 5%

Grad/Prof 3%


Buckeye-Shaker Square

12,470

White 12%

Latino 1%

Black 81%

Asian 3%

Native American

0.2%

Other 1%

2+/Mixed Races

2%


29%

% of Children in

Poverty40%

% ofElderly 65+ in Poverty

15%



24%

% of Households


6%

Median House-

holdIncome $25,917

Unemployed14%

Occupied Homes

81%

ReceivePublic Asst.

Income4%

Food Stamps25%

No H.S. 3%

Some H.S. 15%

High School 29%

Some College

22%

Associates 6%

BA 13%

Grad/Prof 12%


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Buckeye-Woodhill 6,657

White 1.2%

Latino 0.8%

Black 96%

Asian 0.0%

Native American

0.1%

Other 0.2%

2+/Mixed Races

1%


51%

% of Children in

Poverty66%


36%



24%

% of Households


16%

Median House-

holdIncome$14,491

Unemployed31%

Occupied Homes

79%

ReceivePublic Asst.

Income9%

Food Stamps

42%

No H.S. 4%

Some H.S. 30%

High School 29%

Some College

25%

Associates 7%

BA 2%

Grad/Prof 3%

Source: Charts compiled from Cleveland City Planning Commission 2014 neighborhood data report

Central 12,306

White 2%

Latino 2%

Black 94%

Asian 0.2%

Native American

0.2%

Other 0.5%

2+/Mixed Races

1%

% of Population in

Poverty70%

% of Children in

Poverty79%


40%



20%

% of Households Supplemental Security

Income16%

Median House-

holdIncome$9,418

Unemployed36%

Occupied Homes

87%

ReceivePublic Asst.

Income16%

ReceiveFood

Stamps64%

No H.S. 5%

Some H.S. 28%

High School 39%

Some College

19%

Associates 3%

BA 3%

Grad/Prof 2%

Source: Charts compiled from Cleveland City Planning Commission neighborhood data report

6



Clark-Fulton 8,548

White 4%

Latino 47%

Black 19%

Asian 1%

Native American

1%

Other 24%

2+/Mixed Races

5%


38%

% of Children in

Poverty52%


24%



30%

% of Households


15%

Median House-

holdIncome $24,485

Unemployed17%

Occupied Homes

78%

Public Asst. Income

9%

Food Stamps

35%

No H.S. 13%

Some H.S. 22%

High School 37%

Some College

19%

Associates 5%

BA 3%

Grad/Prof 1%


Collinwood-Nottingham

11,542

White 9%

Latino 1%

Black 87%

Asian 0.1%

Native American

0.1%

Other 1%

2+/Mixed Races

2%


33%

% of Children in

Poverty47%


27%



30%

% of Households


6%

Median House-

holdIncome $24,955

Unemployed17%

Occupied Homes

74%

Public Asst. Income

5%

Food Stamps

26%

No H.S. 10%

Some H.S. 17%

High School 38%

Some College

26%

Associates 4%

BA 3%

Grad/Prof 1%


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Community Pop Diversity Poverty Income Economic Education

Cudell 9,288

White 29%

Latino 19%

Black 34%

Asian 3%

Native American

1%

Other 9%

2+/Mixed Races

5%


39%

% of Children in

Poverty47%

% of Elderly 65+in

Poverty15%



18%

% of Households


15%

Median House-

holdIncome $21,392

Unemployed20%

Occupied Homes

82%

Public Asst. Income

12%

Food Stamps

34%

No H.S. 8%

Some H.S. 22%

High School 40%

Some College

19%

Associates 3%

BA 5%

Grad/Prof 3%


Cuyahoga Valley

969

White 9%

Latino 1%

Black 87%

Asian 0.1%

Native American

0.1%

Other 1%

2+/Mixed Races

2%


27%

% of Children in

Poverty62%

% of Elderly 65+in

Poverty32%



24%

% of Households


11%

Median House-

holdIncome $26,002

Unemployed33%

Occupied Homes

81%

Public Asst. Income

15%

Food Stamps

59%

No H.S. 9%

Some H.S. 23%

High School 34%

Some College

19%

Associates 4%

BA 8%

Grad/Prof 3%


8



Detroit-Shoreway 11,567

White 32%

Latino 25%

Black 21%

Asian 1%

Native American

1%

Other 16%

2+/Mixed Races

5%


43%

% ofChildren in

Poverty59%


42%



25%

% of Households


12%

Median House-

holdIncome $23,476

Unemployed20%

Occupied Homes

80%

Public Asst. Income

8%

Food Stamps

38%

No H.S. 9%

Some H.S. 22%

High School 30%

Some College

19%

Associates 5%

BA 9%

Grad/Prof 7%


Downtown 9,464

White 41%

Latino 3%

Black 44%

Asian 8%

Native American

0.2%

Other 2%

2+/MixedRaces

2%


24%

% of Children in

Poverty78%


30%



12%

% of Households


7%

Median House-

holdIncome $36,760

Unemployed12%

Occupied Homes

77%

Public Asst. Income

2%

Food Stamps

16%

No H.S. 4%

Some H.S. 12%

High School 19%

Some College

13%

Associates 5%

BA 25%

Grad/Prof 22%


9



Edgewater 5,850

White 61%

Latino 9%

Black 21%

Asian 2%

Native American

0.5%

Other 3%

2+/Mixed Races

3%


21%

% of Children in

Poverty31%


30%



19%

% of Households


6%

Median House-

holdIncome $39,353

Unemployed12%

Occupied Homes

85%

Public Asst. Income

1%

Food Stamps

12%

No H.S. 3%

Some H.S. 13%

High School 17%

Some College

26%

Associates 8%

BA 21%

Grad/Prof 12%


Euclid-Green 5,533

White 5%

Latino 1%

Black 92%

Asian 0.1%

Native American

0.3%

Other 0.2%

2+/Mixed Races

1%


28%

% of Children in

Poverty43%


15%



25%

% of Households


4%

Median House-

holdIncome $33,948

Unemployed11%

Occupied Homes

79%

Public Asst. Income

6%

Food Stamps

20%

No H.S. 8%

Some H.S. 9%

High School 38%

Some College

26%

Associates 8%

BA 6%

Grad/Prof 5%


10



Fairfax 6,239

White 1%

Latino 1%

Black 95%

Asian 1%

Native American

0.2%

Other 0.3%

2+/Mixed Races

1%


38%

% of Children in

Poverty68%


22%



41%

% of Households


14%

Median House-

holdIncome $20,449

Unemployed24%

Occupied Homes

74%

Public Asst. Income

10%

Food Stamps

34%

No H.S. 10%

Some H.S. 18%

High School 37%

Some College

19%

Associates 6%

BA 7%

Grad/Prof 3%


Glenville 27,268

White 0.5%

Latino 1%

Black 97%

Asian 0.1%

Native American

0.2%

Other 0.2%

2+/Mixed Races

1%


35%

% of Children in

Poverty51%


24%



35%

% of Households


8%

Median House-

holdIncome $22,067

Unemployed25%

Occupied Homes

70%

Public Asst. Income

8%

Food Stamps

30%

No H.S. 4%

Some H.S. 20%

High School 39%

Some College

24%

Associates 6%

BA 5%

Grad/Prof 2%


11



Goodrich-Kirtland

Park4,238

White 29%

Latino 10%

Black 24%

Asian 30%

Native American

0.4%

Other 5%

2+/Mixed Races

2%


32%% of

Children in Poverty

56%


39%



26%

% of Households


8%

Median House-

holdIncome $24,418

Unemployed18%

Occupied Homes

79%

Public Asst. Income

3%

Food Stamps

21%

No H.S. 6%

Some H.S. 18%

High School 35%

Some College

15%

Associates 6%

BA 8%

Grad/Prof 9%


Hopkins 283

White 51%

Latino 11%

Black 24%

Asian 5%

Native American

1%

Other 6%

2+/Mixed Races

2%


18%

% of Children in

Poverty38%


11%



34%

% of Households


10%

Median House-

holdIncome $48,152

Unemployed15%

Occupied Homes95%

Public Asst. Income

4%

Food Stamps

16%

No H.S. 5%

Some H.S. 11%

High School 39%

Some College

22%

Associates 3%

BA 15%

Grad/Prof 5%


12



Hough 11,475

White 1%

Latino 1%

Black 96%

Asian 0%

Native American

0.3%

Other 1%

2+/MixedRaces

1%


40%

% of Children in

Poverty66%


25%



33%

% of Households


18%

Median House-

holdIncome $18,906

Unemployed25%

Occupied Homes

76%

Public Asst. Income

15%

Food Stamps

38%

No H.S. 6%

Some H.S. 24%

High School 33%

Some College

21%

Associates 6%

BA 6%

Grad/Prof 3%


Jefferson 16,548

White 52%

Latino 18%

Black 17%

Asian 2%

Native American

0.4%

Other 8%

2+/Mixed Races

4%


20%

% of Children in

Poverty28%


12%



27%

% of Households


5%

Median House-

holdIncome $41,130

Unemployed13%

Occupied Homes

89%

Public Asst. Income

4%

Food Stamps

16%

No H.S. 4%

Some H.S. 15%

High School 39%

Some College

22%

Associates 8%

BA 8%

Grad/Prof 4%


13



Kamm’s Corner

25,170

White 74%

Latino 7%

Black 11%

Asian 3%

Native American

0.3%

Other 3%

2+/Mixed Races

2%


11%

% of Children in

Poverty16%


13%



26%

% of Households


5%

Median House-

holdIncome $48,811

Unemployed10%

Occupied Homes

92%

Public Asst. Income

2%

Food Stamps

9%

No H.S. 2%

Some H.S. 8%

High School 32%

Some College

25%

Associates 7%

BA 17%

Grad/Prof 9%


Kinsman 6987

White 0.2%

Latino 0.8%

Black 97%

Asian 0.1%

Native American

0.1%

Other 0%

2+/Mixed Races

1%


52%

% of Children in

Poverty70%


20%



29%

% of Households


10%

Median House-

holdIncome $15,788

Unemployed26%

Occupied Homes

78%

Public Asst. Income

10%

Food Stamps

46%

No H.S. 6%

Some H.S. 25%

High School 38%

Some College

22%

Associates 5%

BA 2%

Grad/Prof 2%


14



Lee-Harvard 10,326

White 0.1%

Latino 0.8%

Black 97%

Asian 0.1%

Native American

0.2%

Other 0.3%

2+/Mixed Races

1%


14%

% of Children in

Poverty25%


10%



41%

% of Households


6%

Median House-

holdIncome$40,547

Unemployed14%

Occupied Homes

92%

Public Asst. Income

3%

Food Stamps

11%

No H.S. 3%

Some H.S. 15%

High School 34%

Some College

29%

Associates 7%

BA 8%

Grad/Prof 4%


Lee-Seville 4,496

White 0.3%

Latino 0.7%

Black 97%

Asian 0%

Native American

1%

Other 0.4%

2+/Mixed Races

1%


23%

% of Children in

Poverty34%


11%



42%

% of Households


6%

Median House-

holdIncome$33,090

Unemployed22%

Occupied Homes

86%

Public Asst. Income

3%

Food Stamps

22%

No H.S. 2%

Some H.S. 18%

High School 35%

Some College

29%

Associates 7%

BA 8%

Grad/Prof 1%


15



Mount Pleasant 17,320

White 0.2%

Latino 0.8%

Black 98%

Asian 0%

Native American

0.1%

Other 0.2%

2+/Mixed Races 0.7%


30%

% of Children in

Poverty48%


12%



31%

% of Households


9%

Median House-

holdIncome$23,646

Unemployed21%

Occupied Homes

73%

Public Asst. Income

8%

Food Stamps

28%

No H.S. 5%

Some H.S. 19%

High School 37%

Some College

22%

Associates 8%

BA 7%

Grad/Prof 2%


North Shore Collinwood 15,768

White 29%

Latino 1%

Black 66%

Asian 0.2%

Native American

0.3%

Other 0.4%

2+/Mixed Races

2%


29%

% of Children in

Poverty35%


23%



23%

% of Households


9%

Median House-

holdIncome$27,648

Unemployed15%

Occupied Homes

84%

Public Asst. Income

5%

Food Stamps

22%

No H.S. 5%

Some H.S. 19%

High School 37%

Some College

22%

Associates 8%

BA 7%

Grad/Prof 2%


16



Ohio City 8,736

White 31%

Latino 20%

Black 35%

Asian 1%

Native American

1%

Other 9%

2+/Mixed Races

4%


39%

% of Children in

Poverty53%


48%



21%

% of Households


10%

Median House-

holdIncome$26,324

Unemployed17%

Occupied Homes

83%

Public Asst. Income

10%

Food Stamps

31%

No H.S. 7%

Some H.S. 19%

High School 21%

Some College

17%

Associates 6%

BA 17%

Grad/Prof 12%


Old Brooklyn 32,009

White 68%

Latino 14%

Black 8%

Asian 1%

Native American

0.3%

Other 5%

2+/Mixed Races

3%


18%

% of Children in

Poverty25%


15%



27%

% of Households


6%

Median House-

holdIncome$39,282

Unemployed10%

Occupied Homes

90%

Public Asst. Income

3%

Food Stamps

15%

No H.S. 6%

Some H.S. 14%

High School 41%

Some College

21%

Associates 6%

BA 8%

Grad/Prof 4%


17



Saint-Clair Superior 6,876

White 11%

Latino 5%

Black 79%

Asian 0.2%

Native American

0.4%

Other 2%

2+/Mixed Races

2%


45%

% of Children in

Poverty57%


24%



26%

% of Households


13%

Median House-

holdIncome$19,444

Unemployed34%

Occupied Homes

63%

Public Asst. Income

10%

Food Stamps

40%

No H.S. 7%

Some H.S. 24%

High School 35%

Some College

22%

Associates 8%

BA 4%

Grad/Prof 0.5%


Stockyards 10,372

White 21%

Latino 35%

Black 19%

Asian 1%

Native American

1%

Other 18%

2+/Mixed Races

5%


47%

% of Children in

Poverty64%


24%



27%

% of Households


20%

Median House-

holdIncome$19,658

Unemployed23%

Occupied Homes

80%

Public Asst. Income

11%

Food Stamps

39%

No H.S. 17%

Some H.S. 31%

High School 31%

Some College

16%

Associates 2%

BA 1%

Grad/Prof 1%


18



Tremont 7,948

White 37%

Latino 23%

Black 23%

Asian 1%

Native American

0.5%

Other 12%

2+/Mixed Races

4%


38%

% of Children in

Poverty59%


22%



21%

% of Households


10%

Median House-

holdIncome$24,175

Unemployed11%

Occupied Homes

83%

Public Asst. Income

7%

Food Stamps

30%

No H.S. 10%

Some H.S. 19%

High School 28%

Some College

18%

Associates 5%

BA 12%

Grad/Prof 8%


Union-Miles 19,004

White 0.4%

Latino 0.6%

Black 97%

Asian 0.1%

Native American

0.2%

Other 0.2%

2+/Mixed Races

1%


31%

% of Children in

Poverty53%


15%



35%

% of Households


8%

Median House-

holdIncome$27,111

Unemployed22%

Occupied Homes

78%

Public Asst. Income

5%

Food Stamps

30%

No H.S. 5%

Some H.S. 19%

High School 41%

Some College

24%

Associates 5%

BA 5%

Grad/Prof 2%


19



University 7,920

White 53%

Latino 2%

Black 23%

Asian 18%

Native American

0.1%

Other 1%

2+/Mixed Races

2%


43%

% of Children in

Poverty36%


24%



27%

% of Households


7%

Median House-

holdIncome$14,632

Unemployed20%

Occupied Homes

89%

Public Asst.Income

6%

Food Stamps

12%

No H.S. 2%

Some H.S. 12%

High School 25%

Some College

17%

Associates 4%

BA 19%

Grad/Prof 21%


West Boulevard 18,888

White 31%

Latino 27%

Black 21%

Asian 2%

Native American

1%

Other 13%

2+/Mixed Races

6%


25%

% of Children in

Poverty34%


21%



31%

% of Households


11%

Median House-

holdIncome$32,223

Unemployed17%

Occupied Homes

85%

Public Asst. Income

9%

Food Stamps

29%

No H.S. 9%

Some H.S. 22%

High School 36%

Some College

21%

Associates 3%

BA 6%

Grad/Prof 3%


20



Cleveland Total 396,815

White 37%

Latino 10%

Black 53%

Asian 2%

Native American

0.3%

Other 5%

2+/Mixed Races

3%


31%

% of Children in

Poverty46%


20%



28%

% of Households


9%

Median House-

holdIncome$27,349

Unemployed18%

Occupied Homes

81%

Public Asst.Income

6%

Food Stamps

26%

No H.S. 6%

Some H.S. 18%

High School 35%

Some College

22%

Associates 6%

BA 8%

Grad/Prof 5%


Cuyahoga County Total

1,280,122

White64%

Latino5%

Black30%

Asian2.7%

Native American

0.2%

Other1.14%

2+/Mixed Races2.2%


18.8%

% of Children in

Poverty29%


10.8%


Social Security Income29.9%

% of Households


6.3%

Median House-

holdIncome$43,804

Unemployed7.4%

Occupied Homes

86%

Public Asst.Income4.24%

Food Stamps17.2%

No H.S. 3.3%

Some H.S. 9.1%

High School 28.6%

Some College 22.2%

Associates 6.9%

BA 17.7%

Grad/Prof 12%

Source: Charts compiled U.S. Census Bureau quick facts, Community Commons health indicator report

21


The City of Cleveland is an urban area with many brown-fields, industrial areas, and dense

population; older ring suburbs are very similar to the city demographics. As one travels further out into

the county the suburbs become higher-end housing developments with a few small farms and the ethnicity

of the communities is mostly white. Only 1% of Cuyahoga County is considered rural (County Health

Rankings, 2014). Cuyahoga County covers 457.19 square miles, of that Cleveland encompasses 82.47

square miles (U.S. Census Bureau, 2010). The higher poverty rate, lower household median income, and

fewer residents attaining higher education indicates the City of Cleveland should be a health improvement

priority area, though there are wide disparities of these indicators throughout the county as well. For

example: The City of East Cleveland has 22% of its residents over the age of 25 without a high-school

diploma, 29.5% of the population makes less than $10,000 a year, nearly 20% without health insurance,

and is 91% African American. Rocky River, a suburb on the west side of the county, 55% of the

residents over the age of 25 hold a Bachelors Degree or higher, 70% of residents make more than $50,000

a year, and is 95.5% White (U.S. Census Bureau, 2010).

The years of potential life lost before the age of 75 in Cuyahoga County, Ohio is 7,975 (County

Health Rankings, 2014). Infant mortality rates in Cuyahoga County show an overall decreasing trend in

two suburban rings and an increase in Cleveland with none of the three reaching Healthy People 2010

goal, and a disparity between black and white babies (Cuyahoga County Board of Health, 2014).

Cuyahoga County rates well with available caregivers with 162.8 primary caregivers per 100,000, but the

average Cuyahoga County adult feels mentally or physically unhealthy 6.4 day a month (Ohio Dept. of

Health, 2015). Cuyahoga County performs poorly on the number of farm markets, fast food density,

liquor store density, particle pollution and Ozone quality (Ohio Dept. of Health, 2015). Cuyahoga

County, like many counties in the United States, is having a hard time meeting Healthy People 2010

goals, and a concerted community effort, especially in the greater economical and environmental

challenges of the county seat, The City of Cleveland. Greater collaboration and community

empowerment may be the sustainable answer to help reach the Healthy People 2020 goals.

22


Cuyahoga County and the City of Cleveland have many rich resources and history to inspire

greater collaboration and empowerment of community to build capacity for system change. Through the

formation of coalitions the content of the community’s wants, needs, and fears can be identified, and with

the technical support of key partners can work to take the lead in solving the problems they face. There

are numerous data sources available and include The Cleveland City Planning Commission which

provides an array of demographic, housing, and social economic factors. The commission also has

information on the many advocacy and community groups already present (Cleveland City Planning

Commission, 2015). The Ohio Department of Health, Cuyahoga County Department of Health, and

Cleveland Department of Public Health can provide a wealth of epidemiological and health program

knowledge. The recently completed community health assessment undertaken by Health Improvement

Partnership-Cuyahoga (HIP-C) through partnerships with area hospitals, learning institutions, and health

departments is also a valuable resource of already compiled data that can be used (Health Improvement

Partnership, 2013). The local colleges such as Cleveland State University, Case-Western Reserve and

others could also be a rich source of information and grant writing skills.

Incorporating key stakeholders that form lasting partnerships will be essential in empowering

communities to take greater control of the health environment. First understanding the context in which

people act that may bring them together to form a partnership is crucial (Community Tool Box, 2014).

One of the key stakeholders would be the heads of the seventeen wards that make up Cleveland. Some

questions that could be asked of these leaders; what are your Ward’s greatest concerns? Do your

residents feel they have adequate access to primary healthcare? What are your Ward’s greatest assets?

Religious leaders, community institutions such as barbershops could provide the opportunity to identify

influential community members and the general tone of the community. Questions that could be asked

include; do you feel safe in your community? What do you believe are the biggest challenges facing your

community? Given the opportunity, how likely would you be to become involved to make a positive

change within your community? Do you feel your voice is heard? Do you feel your political leadership

has concern for the health status of the community? Local institutions of higher learning are also key 23


stakeholders, and identifying key members in schools of Urban Development, Environmental Science,

and Public Health can be key contributors of logistical support. Questions that could be posed to these

individuals include; would the institution be willing to form partnerships to aid community groups in

grant writing? Can the school provide logistical support in research technique? What are the current

resources available, and partnerships that have already been initiated? Local professional sports teams

and media outlets can also be an important partner to spread the word and encourage participation.

Identifying and engaging these individuals can be accomplished through discovering common goals,

fears, and needs, which can then facilitate greater cooperation and generate trust between them. This will

be an ever-evolving process that strives to empower communities through the development of strong

collaborations lead by the community.

24



Part II

Data AnalysisMortality, Chronic Disease, Accidental Death, Obesity,

Food Environment, Physical Activity, Access to Healthcare,

Crime and Violence

Map from Cuyahoga County Public Safety and Justice Services.

25


Cuyahoga County is a densely populated area with much of the county having greater than 2,500

residents per square mile. The majority of the African American Population resides in the eastern portion

of the county and within the City of Cleveland (NEOSCC, 2015), (Northern Ohio Data & Information

Service, 2012). The population change in Cuyahoga County from 2000-2010 is a loss of 8.2% of its

residents.

Population Density

Source: (Northern Ohio Data & Information Service, 2012)

According to County Health Rankings and Roadmaps, Cuyahoga County ranks 65 th out of 88 counties in

health outcomes, 50th in health factors, 78th in social and economic factors, 68th in physical environment,

and 6th in clinical care (County Health Rankings, 2014). Chronic disease is a major worry of all

communities across the Nation, and is the main cause of death in Cuyahoga County.

26


An Aging Population

Age Cuyahoga County

Population % ofWhite

Population

% of Afr. American

Population

% of Total

Females

% ofTotal Males

0-4 years 05.81% 73,898 04.72% 07.07% 05.46% 06.49%5 - 17 16.49% 209,902 14.21% 19.95% 15.46% 17.64%

18 - 24 08.95% 113,844 07.95% 10.80% 09.36% 08.57%25 - 34 12.58% 160,082 12.34% 12.15% 12.38% 12.80%35 - 44 12.17% 154,857 12.20% 11.89% 12.04% 12.31%45 - 54 15.00% 190,856 15.83% 14.21% 14.90% 15.11%55 - 64 13.28% 168,959 14.46% 11.87% 13.31% 13.24%

65+ 15.73% 200,135 18.28% 12.06% 17.88% 11.60%Source: Data for chart compiled using Community Commons health indicators report generator.

Causes of Death

All Deaths in Cuyahoga County for the years 1999-2013: Crude Rateper 100,000 all ages

Age African -American

Male

White Male African- American

Female

White Female

Hispanic Male

Hispanic Female

<1 years 1,886.1 614.0 1,550.6 539.4 718.9 553.1

1-4 53.9 21.2 44.6 21.3 * unreliable

5-14 23.5 12.0 18.6 10.0 unreliable *

15-24 164.6 75.2 38.8 32.6 78.6 35.7

25-34 271.9 123.0 106.4 59.3 127.0 46.6

35-44 419.2 233.1 223.0 125.1 245.8 108.0

45-54 967.0 517.7 572.0 292.4 494.4 268.6

55-64 2,066.6 1,137.1 1,166.8 660.6 914.6 529.4

65-74 3,803.9 2,590.0 2,423.2 1,715.3 2,190.7 1,279.5

75-84 7,551.9 6,529.3 5,177.8 4,591.1 4,435.6 3,219.2

85+ 15,985.4 16,842.0 13,394.3 14,364.7 10,740.4 8317.1Source: Data compiled using CDC Wonder online database National Center for Health Statistics, unreliable = numerator less than 20, * indicates

suppressed data.

27


Cardiovascular Disease Related Deaths in Cuyahoga County for the years 1999-2013: Crude Rate per 100,000 all ages


Male


Female

White Female

Hispanic Male

Hispanic Female

15-24 8.3 2.7 * unreliable * *

25-34 37.7 9.8 15.7 6.3 * *

35-44 110.4 51.7 57.9 20.9 unreliable *

45-54 355.1 163.7 176.6 59.4 85.7 64.5

55-64 779.3 407.8 394.5 157.4 314.6 140.0

65-74 1,468.6 928.0 865.1 524.6 760.6 375.8

75-84 2,894.7 2,548.3 2,025.1 1,816.9 1,441.6 1,221.1

85+ 6,301.2 7,663.9 5,775.3 7,048.9 4,637.9 4,037.0Source: Data compiled using CDC Wonder online database National Center for Health Statistics, unreliable = numerator less than 20, * indicates

suppressed data.

Cancer Related Deaths in Cuyahoga County for the years 1999-2013: Crude Rate per 100,000 all ages


Male


Female

White Female Hispanic Male

Hispanic Female

5-14 unreliable 2.7 unreliable unreliable * *

15-24 5.5 5.2 unreliable 3.9 * *

25-34 8.3 10.3 13.2 9.6 * *

35-44 45.6 30.1 48.7 39.8 unreliable unreliable

45-54 207.5 120.2 177.5 120.4 113.4 64.5

55-64 622.3 368.5 413.5 295.8 222.6 161.9

65-74 1,260.4 905.4 792.1 633.6 588.2 351.9

75-84 2142.3 1,752.5 1,218.8 1,072.9 1,197.6 586.7

85+ 3,172.2 2,619.4 1,564.8 1,513.3 1,790.1 unreliableSource: Data compiled using CDC Wonder online database National Center for Health Statistics, unreliable = numerator less than 20, * indicates

suppressed data.

28


Cerebrovascular Disease Related Deaths in Cuyahoga County for the years 1999-2013: Crude Rate per 100,000 all ages

Age Afr. /Amer.Male

White Male Afr./Amer. Female

White Female

Hispanic Male

Hispanic Female

<1 years 7.5 2.8 5.6 2.2 2.5 2.4

1-4 0.6 0.3 0.5 0.3 0.2 0.3

5-14 0.3 0.2 0.3 0.2 0.2 0.2

15-24 0.7 0.4 0.7 0.4 0.6 0.4

25-34 3.0 1.1 2.7 1.1 1.6 1.1

35-44 12.7 4.0 11.5 3.8 5.5 3.8

45-54 41.4 11.9 31.7 9.7 17.1 11.3

55-64 96.0 31.0 60.5 23.2 40.8 25.7

65-74 214.8 99.4 149.8 80.8 105.1 75.1

75-84 502.6 395.5 436.9 345.7 310.5 268.3

85+ 1,104.5 1,096.3 1,225.1 1,275.4 817.6 889.8Source: Data compiled using CDC Wonder online database National Center for Health Statistics. unreliable= numerator less than 20, * indicates

suppressed data.

Diabetes Related Deaths in Cuyahoga County for the years 1999-2013: Crude Rate all ages per 100,000

Age Afr. /Amer.Male

White Male Afr. /Amer.Female

White Female

Hispanic Male

Hispanic Female

25-34 unreliable unreliable unreliable * * *

35-44 11.4 4.3 6.2 unreliable * *

45-54 25.1 11.2 17.2 6.2 * *

55-64 69.0 35.4 44.6 19.3 * *



85+ 383.3 356.4 468.7 266.5 * 266.5

29


Chronic Lower Respiratory Related Deaths in Cuyahoga County for the years 1999-2013: Crude Rate per 100,000 all ages

Age Afr./ Amer. Male

White Male Afr./ Amer.Female

White Female

Hispanic Male

Hispanic Female

25-34 unreliable * unreliable * * *

35-44 unreliable 2.6 5.3 2.4 * *

45-54 16.3 8.2 15.6 8.9 * *

55-64 48.2 37.5 31.6 31.1 * *

65-74 137.2 144.3 106.2 129.8 * *

75-84 351.3 382.1 193.3 314.9 unreliable *

85+ 805.0 839.0 384.5 616.2 * *Source: Data compiled using CDC Wonder online database National Center for Health Statistics. unreliable= numerator less than 20, * indicates

suppressed data.

According to County Rankings and Roadmaps 15% of the age adjusted population considered themselves

to be in poor or fair health, had an average of 3.3 poor physical health days a month, and 4.1 poor mental

health days per month. The county ranked 72nd out of 88 for quality of life (County Health Rankings,

2014). Death due to unintentional accident is also a leading cause of death in the county.

Accidental Death

Accident (unintentional) Related Deaths in Cuyahoga County for the years 1999-2013: Crude Rate per 100,000 all ages

Age Afr. /Amer.Male

White Male Afr./Amer. Female

White Female

Hispanic Male

Hispanic Female

<1 years 58.9 * unreliable * * *

1-4 13.5 unreliable unreliable * * *

5-14 7.2 3.0 unreliable unreliable * *

15-24 28.1 31.7 6.0 11.4 unreliable *

25-34 36.0 44.7 12.9 15.3 40.6 *

30


Accident (unintentional) Related Deaths continued

35-44 50.4 49.0 16.8 15.6 59.8 *

45-54 78.8 60.4 30.1 22.7 74.6 *

55-64 90.6 42.0 30.1 14.3 unreliable *

65-74 68.3 41.7 20.6 23.9 * *

75-84 102.1 106.4 54.6 63.5 * *

85+ 177.3 295.1 120.5 168.1 * *Source: Data compiled using CDC Wonder online database National Center for Health Statistics, unreliable = numerator less than 20

Obesity a growing epidemic

Green= Better than U.S. and Oh avg. Orange= Better than Ohio avg. worse than U.S. avg. Red= worse than both avg.

Area Total Population of Adults 20+

Adults 20+ With BMI > 30

% of Adults With BMI > 30

Cuyahoga County 952,713 272,476 28.10%

Ohio 8,561,233 2,609,704 30.08%

USA 231,417,834 63,336,403 27.14%Source: Data for charts compiled using Community Commons health indicators report generator

Obesity Gender and Historical data

Area Total Males Obese

Total % of Males Obese

Total Females Obese

Total % of Females Obese

2004Obesity

Rate

2012 Obesity

RateCuyahoga

County 122,466 27.0% 150,010 29.00% 26.40% 28.10%

Ohio 1,271,375 30.4% 1,337,891 29.74% 25.67% 30.08%United States 31,423,437 27.7% 31,912,963 26.59% 23.07% 27.14%

Source: Data for charts compiled using Community Commons health indicators report generator.

31


Food Security

Source:

Case Western Reserve Mandel School of Applied Science NEO-CANDO system, blue outline = City of Cleveland

Food insecurity is the economic and social condition of having limited or inadequate access to sufficient

food at least some of the time. Food security conditions in Cuyahoga County are worse than the State or

National level, and are at disturbing levels.

Food Security


Area Total Population Food Insecure Population

Food Insecure Population %

Cuyahoga County 1,278,024 238,530 18.66%

Ohio 11,544,255 1,982,170 17.17%

United States 313,281,717 49,943,940 15.94%Source: Data for chart compiled using Community Commons health indicators report generator.

32


Food Environment

Food Environment Cuyahoga County Ohio USA

Number of fast-food establishments 1,060 8,931 224,877

Fast-food establishments per 100,000 82.8 77.4 71.97

Number of grocery stores 299 2,079 66,047

Grocery stores per 100,000 23.36 18.02 21.14

Low Income population with low food access 49,504 732,289 19,347,047

% of Low Income Pop. with low food access 3.87% 6.35% 6.27%

Population with low food access 258,506 2,880,993 72,905,540

% of population with low food access 20.19% 24.97% 23.61

SNAP authorized food store retailers 1,199 8,981 243,113

SNAP authorized per 100,000 of population 93.66 77.85 78.44

Number of WIC authorized stores 237 1,788 50,042

WIC authorized per 100,000 of population 18.66 15.4 15.6Source: Data for chart compiled using Community Commons health indicators report generator.

Food Behavior

Behavior Cuyahoga County Ohio United States

Total Adults (18+) with inadequate fruit and vegetable consumption

759,459 6,869,511 171,972,118

% of Adults (18+) with inadequate fruit and vegetable consumption

76.7% 78.5% 75.67

Soda Expenditures as % of Total Household expenditures

Suppressed -State rank 82nd 4.51% 4.02%

% of food at home expenditures for Fruits and Vegetables

Suppressed-State rank 32nd 11.74% 12.68%

Source: Data compiled using Community Commons’ health indicator report

33


Physical Activity Green= Better than U.S. and Oh avg. Orange= Better than Ohio avg. worse than U.S. avg. Red= worse than both avg.

Behavior Cuyahoga County Ohio United States

Population with no leisure time physical activity 20+ years old 244,400 2,254,246 53,415,737

% of Population with no leisure time physical activity 20+ years old 24.7% 25.48% 22.64%

Females with no leisure time physical Activity 20+ years old 139,200 1,233,900 29,343,293

% of Females with no leisure time physical activity 20+ years old 26.1% 26.63% 23.94%

Males with no leisure time physical activity 20+ years old 105,200 1,020,030 24,071,561

% of Males with no leisure time physical activity 20+ years old 23.1% 24.13% 21.2%


Access to Healthcare


Cuyahoga County Ohio United States

Total Uninsured Population 144,984 1,317,960

45,569,668

% of Population Uninsured 11.54% 11.59% 14.87%

Total Number Females Uninsured 64,372 597,389 21,069,298

% of Females Uninsured 9.75% 10.23% 13.43%

Total Number of Males Uninsured 80,612 750,578 24,500,364

% of Males Uninsured 13.51% 13.02% 16.38%

% Uninsured White 9.4% 10.73% 13.13%

% Uninsured African American 15.93% 16.04% 17.52%

% Population under 18 Uninsured 4.09% 5.69% 7.61%Source: Data compiled using Community Commons’ health indicator report

34


Concentrations of population that lack health insurance.

Map created by Community Commons map building application.

35


Number of Health Care Professionals


Healthcare Professionals Cuyahoga County Ohio United States

Primary Care Physicians 1,407 8,642 233,862

Primary Care Physicians per 100,000 pop. 111.22 74.86 74.5

Dentists 1,191 6,626 199,743

Dentists per 100,000 pop. 94.29 57.26 63.18

Adults without a regular Doctor 172,030 1,624,401 52,290,932

% of Adults without a regular Doctor 19.52% 18.65% 22.07%

% Population living in a Health Professional Shortage Area 16.7% 12% 34.07%


County Health Rankings and Roadmaps rates Cuyahoga County 6th out of 88 counties for

clinical care. Eighty-three percent of residents enrolled in Medicare enrollees aged 65-75 partake in

regular diabetic monitoring, and sixty-five percent of female Medicare enrollees aged 67-69 regularly

receive a Mammography Exam. Cuyahoga County also has 445: 1 individual to mental health provider

ratio, easily bettering the 716: 1 average in the State of Ohio, but falling short of the 386: 1 ratio of the

Nation’s top performers (County Health Rankings, 2014).

36


Environment

Source: Cuyahoga County Board of Health

Source: Cleveland.com. A Northeast Ohio Media Group

37


Air Quality Cuyahoga County Ohio United States

Avg. Daily Particulate Matter 2.5 X above National Standard per year

12.36 11.80 10.65

% of Days Particulate Matter exceeds standards per year, Pop. adjusted

1.30% 0.75% 1.19%

Number of Day exceeding Ozone emission standards

1.24 1.16 1.59

% of Days exceeding Ozone Standards, Pop. adjusted

0.33% 0.31% 0.47%


Source: Obtained from Cleveland Plain Dealer online Northeast Ohio Media Group of map made by Smith Group JJR showing the eastside of Cuyahoga County and the existing park access problem there.

38


Violence and Crime Green= Better than U.S. and Oh avg. Orange= Better than Ohio avg. worse than U.S. avg. Red= worse than both avg.

Cuyahoga County Ohio United States

Violent Crimes 6,530 34,148 1,213,859

Violent Crimes per 100,000 of Pop. 559.75 312.8 395.5Source: County Health Rankings and Roadmaps

Source: Case Western Reserve Mandel School of Applied Social Science

39


Source: Graphs obtained from Cuyahoga County Prosecutor benchmarks and data

Region 1: Cleveland, Lakewood, Rocky River, Bay Village, Westlake, North Olmsted, Olmsted Township, Olmsted Falls, Fairview Park, Brook Park, Middleburg Heights, Berea, Strongsville.

Region 2: Cleveland, Brecksville, Broadview Heights, Brooklyn, Brooklyn Heights, Cuyahoga Heights, Garfield Heights, Independence, Maple Heights, Newburgh Heights, North Royalton, Parma, Parma Heights, Seven Hills, Valley View, Walton Hills

Region 3: Cleveland, Bedford, Bedford Heights, Bentleyville, Chagrin Falls, Glenwillow, Highland Hills, Moreland Hills, North Randall, Oakwood, Orange, Solon, Warrensville Heights, Woodmere.

Region 4: Cleveland, Beachwood, Gates Mills, Highland Heights, Hunting Valley, Mayfield, Mayfield Heights, Pepper Pike, Richmond Heights, Shaker Heights, South Euclid, University Heights (Cuyahoga County Prosecutor, 2014).

40


Source: graphs obtained from Cuyahoga County Prosecutor benchmarks and data, chart mislabeled as Region 3

Region 5: Cleveland, Bratenahl, Cleveland Heights, East Cleveland, Euclid

Map obtained from Cleveland.com

41



Part IIIData Limitations, Opportunity and Prioritization, Resources,

Strengths and Weaknesses

Map obtained from Cuyahoga County Public Safety and Justice Services.

42


Data Limitations

The data used to compile the preceding charts and graphs is up to date, reliable, and widely

available. Much of the information is based on U.S. Census data using data derived from Population

Estimates, American Community Survey, Census of Population, State and County Population and

Housing estimates, County Business Patterns, Nonemployer Statistics, Economic Census, Survey of

Business Owners, and Building Permits (U.S. Census Bureau, 2014), Center for Disease Control and

Prevention, National Center for Health Statistics and Division of Behavioral Surveillence, Dartmouth

Institute for Health Policy and Clinical Practice (County Health Rankings, 2014), (Center for Disease

Control and Prevention, 2015). Much of the data is an average over a wide area which fails to recognize

the unique challenges and limitations of the individual neighborhoods and cities that comprise the

Cuyahog County. Greater detail on how the data is concentrated is needed, and it is reccommended that

further GIS mapping be conducted in subsequent assements to help identify areas of critical need more

precisely. It is also reccommended that the individual demographic information of the cities that

comprise the county be broken down to the same level that the neighborhoods of Cleveland have been to

aid in more accurate comparisons to a more refined area. Though the data is reliable and from credible,

respected sources it lacks context, and is a snapshot of estimates from the recent past, not a real time

sharply focused picture. There is the possibility of bias in the method health indicators were chosen,

which may not necessarily reflect the true concerns of the community. Bias in health indicators chosen

may have also contributed in missing a significant yet limited health issue that could be affecting a

subgroup of the community not recognized in the data. The information does serve as a good benchmark

and comparison tool of other communities, counties, and states but the additional level of social/cultural,

economic, environmental, and political context must accompany the data to guard against

misinterpretation or out-of-context use of the information. The level of trust and cooperation from the

community also remains unknown and is not revealed by the data. Recent police shootings of citizens

such as Tamir Rice, a 12 year old African American boy (Shaffer, 2015), or unarmed African Americans

Timothy Russel and Malissa Williams (Lieszkovszky, 2015) may have greatly affected the level of trust,

willingness to participate and collaborate in many neighborhoods of concern. To gain better perspective

team members, especially (but not limited to) those unfamiliar with the area should take a predetermined

time period to experience the individual geographic and cultural areas on multiple levels (i.e. attending

council meetings, browse businesses, parks, and entertainment options, talk to community members and

advocates) to have a more tangibe and holistic understanding of the community, the challenges they face,

and resources available beyond what the data can provide.

43


Opportunity

The following health topics have been identified by this Community Health Assessment that are in need

of improvement through intervention, policy change, and raising awareness. The Community Health

Assessment further indicates The City of Cleveland and the inner ring suburbs are areas of greatest

critical need and the health of the county as a whole may be best served by having initial focus on these

communities.

Poverty

Cardiovasucular disease

Cerebrovascular disease

Cancer

Diabetes

Respiratory disease

Accidental death/disability

Obesity

Food environment/behavior/security

Physical environment/behavior

Crime

Access to healthcare

Geriatrics

Mental Health

Substance abuse

The prioritization process for these health issues should be established by a predetermined

member work group that is comprised of the participating stakeholders. To make sure the process is as

democratic as possible, use of the National Association of County & City Health Officials guidelines for

Nominal Group Technique should be employed (NACCHO, 2011). This method is particular usefull in

the early phases of prioritization that helps to determine group structure, generate ideas, and allows all to

have equal say in the process (NACCHO, 2011). Step by step guidelines for this process can be found

44


here http://www.naccho.org/topics/infrastructure/accreditation/upload/Prioritization-Summaries-and-

Examples.pdf to facillitate the proper use of this process.

Available Resources

Cuyahoga County Board of Health

Cleveland Department of Health

Cleveland City Planning Commission

Cuyahoga County Prosecutors Office

Ohio Department of Health

Northeast Ohio Sewer District

Ohio Department of Treasury

Cleveland Clinc Foundation care network

University Hospitals care network

Case Western Reserve Mandell School of Applied Social Science

Cleveland State University Maxine Goodman Levin College of Urban Affairs

Cleveland State University Howard A. Mims African American Cultural Center

Cleveland Restoration Society

Cuyahoga County Children and Family Services

The American Heart Association greater Cleveland chapter

American Cancer Society greater Cleveland chapter

National Alliance for the Mentally Ill, greater Cleveland chapter

Cleveland Food Bank

Northeast Ohio Sustainable Communities Consortium

Cuyahoga County Land Reutilization Corporation

The Urban Agriculture working group

The National Organization of Homebuilders Cuyahoga County chapter

The Environmental Protection Agency Cuyahoga County Office

Cleveland City Mission

Salvation Army

Regional Transit Authority

Cleveland Professional sport teams, Brown’s, Indians, Cavaliers charity foundations

Cleveland Metropark System

Northeast Ohio Areawide Coordination Agency

Green energy Ohio

45

http://www.naccho.org/topics/infrastructure/accreditation/upload/Prioritization-Summaries-and-Examples.pdf

http://www.naccho.org/topics/infrastructure/accreditation/upload/Prioritization-Summaries-and-Examples.pdf


Cleveland Museum of Natural History

Central Community Food Co-op

Gund Foundation

Cleveland Public Art

Cleveland Industrial Retention Initiative

State of Ohio

Center for Disease Control and Prevention

Various non-profit Religious and other Charitable Organizations in the area not mentioned

directly

Strengths and Weaknesses

Some of the areas’ greatest strengths are also some of the areas’ greatest weaknesses. The World

class medical facilities help to ensure adequate numbers of primary care officials in the area and world

class treatment, they can also foster a feeling of over-reliance on medical professionals to manage health

issues. The diverse population provides a large pool of far ranging experiences and cultural information

in which to draw, but also sets the stage for segregation and isolation to occur as each group views

differing community members as “the Other”. The large population supplies better opportunity for

revenue streams, larger pool of people to try and recruit from, and more advocacy groups, but the

potential for dissent on how to prioritize, implement, and fund intiatives and issues is also larger. The

large number of advocacy groups provide pathways to greater awareness, collaboration opportunities, and

more programs and initiatives to be implemented, but they also may lead to information overload and

volunteerism burnout or redundancy to occur wasting dollars that could be better spent elsewhere. The

good news is there are strong movements forward across the area, initiatives like the Heritage Home

Program that help homeowners with home improvement and maintenance for homes over 50 years old,

Cleveland Lakefront Development, Northeast Ohio Sustainable Communities Initiative, Bikeway Master

Plan, and others (Cleveland City Planning Commission, 2015) reveals there is a strong commitment to

improving the enviroment and health of the community. By further encouraging and identifying areas of

collaboration and community empowerment between Cuyahoga County and the City of Cleveland,

commitment and community awareness will continue to grow, and its citizens will have greater

opportunity to take greater ownership and control of their health.

Works Cited

46


Center for Disease Control and Prevention. (2015). CDC WONDER. Retrieved from Center for Disease Control and Prevention, National Center For Health Statistics, Underlying Cause of Death1999-2013, CDC Wonder online database, Data from the cause of death files: http://wonder.cdc.gov/

Cleveland City Planning. (2014). 2014 Neighborhood Fact Sheets. Retrieved from Cleveland City Planning Commission: http://planning.city.cleveland.oh.us/2010census/factsheets.php

Cleveland City Planning Commission. (2015). Current Activities. Retrieved from Cleveland City Planning Commission: http://planning.city.cleveland.oh.us/cpc.html

Community Commons. (2015). Community Health Needs Assessment Full Health Indicators Report. Retrieved from Community Commons, date accessed 4/3/15: http://assessment.communitycommons.org/CHNA/report.aspx?page=1&id=710

Community Tool Box. (2014). Chapter 1 section 3, Chapter 2 section 1-4, 6-10, 12-15. Retrieved from Work Group for Community Health and Development at the University of Kansas.: http://ctb.ku.edu/en/table-of-contents/overview/models-for-community-health-and-development

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Documents

Community Health Assessment Final Draft mph 602