99_11092023%20City%20Council%20Packet%20page%20numbers — Newark City Council, November 9, 2023 (part 1 of 3)

AGENDA
Thursday, November 9, 2023
7:00 P.M.

A. ROLL CALL
B. PRESENTATIONS

1. Introduction of employee(s)

2. Presentation on Newark Library

3. Washington Hospital Healthcare System presentation of Community Health Needs Assessment

4. AC Transit Realign bus service network plan presentation C. PUBLIC COMMENT
The public is invited to address the City Council on any item not listed on the agenda.

Public Comments are generally limited to 5 minutes per speaker. Please note that State law prohibits the Council from acting on non-agenda items.

D. CONSENT CALENDAR
Consent Calendar items are considered to be routine and may be approved by one motion. There will be no separate discussion on these items unless there is a request by a Council Member, a staff member, or a member of the public to remove an item for separate discussion and action.

1. Approval of Audited Demands

2. Approval of October 26, 2023 minutes

3. Waive full reading, conduct second reading by title only, and adopt an ordinance repealing and replacing Title 16 "Subdivisions" of the Newark Municipal Code

4. Adopt resolutions establishing the City Council meeting calendar for 2024 and authorizing the City Manager to take administrative actions during the August Recess

5. Adopt a resolution reappointing William Fitts to the Planning Commission

6. Adopt a resolution approving a Contractual Equipment and Services Agreement with RJMS Corporation dba Toyota Material Handling of Northern California for the purchase of a sub-compact sweeper

7. Adopt a resolution accepting the work with American Asphalt Repair and Resurfacing Co., Inc. for FY 2021-2022 Citywide Park Pathways Resurfacing for ADA Access, Project 1297

8. Adopt a resolution approving an agreement with Applied Landscape Materials, Inc. to apply composted mulch to landscaped areas in City parks and to amend the 2022-2024 Biennial Budget and Capital Improvement Plan to reappropriate the remaining $44,813 of CalRecycle Local Assistance Grant funding to Fiscal Year 2024

9. Adopt a resolution approving a lease agreement with Viola Blythe Community Service Center of Newark, Inc.

10. Adopt a resolution approving an amendment to the Contractual Services Agreement with Cal West Lighting & Signal Maintenance for additional traffic signal and street light maintenance services

11. Adopt a resolution approving a lease agreement with Second Chance, Inc.

12. Adopt a resolution amending the Biennial Budget and Capital Improvement Plan to consolidate the three Traffic Signal Interconnect Projects, Project 1307, 1308, and 1309 into newly identified Project 1361, and approving a Contractual Services Agreement with Iteris, Inc. for Professional Engineering Services for the Traffic Signal Interconnect Project

13. Adopt a resolution approving a side letter with the Newark Police Management Association and approving an amendment to the salary schedule for the classification of Community Engagement Manager

14. Adopt a resolution approving a compensation plan for certain positions in the exempt service employee group to amend the Temporary Classifications Schedule of Hourly Wage Rates, and revoking the previous resolution in conformance with California Code of Regulations, Title 2, Section 570.5

15. Adopt a resolution approving Amendment No. 1 to the Contractual Services Agreement with Lance, Soll & Lunghard, LLP (LSL), Certified Public Accountants, for professional auditing services

16. Adopt a resolution approving a Project Specific Funding Agreement with Alameda County Transportation Commission for the design and construction phases of Central Avenue Overpass, Project 1014
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17. Adopt a resolution authorizing a 5.0% increase to the solid waste collection, recycling and organics services maximum rates for Calendar Year 2024
E. PUBLIC HEARINGS
F. OTHER BUSINESS

1. Presentation of the draft Public Art Master Plan update and Council input G. CITY COUNCIL MATTERS
City Council Members report on attendance at intergovernmental agency meetings, conferences, and seminars since the last meeting. City Council Members may also announce upcoming events and coordinate attendance; report on local events attended since the last meeting; and make brief comments on issues of concern.

H. CITY MANAGER UPDATES
I. CLOSED SESSION
J. ADJOURNMENT

MEETING INFORMATION
Members of the public may attend the meeting in person, watch online, or watch on Cable Channel 26. The ability to observe online or Cable Channel 26 is predicated on those technologies being available and functioning without technical difficulties. Should those platforms not be available, or become non-functioning, or should the City Council otherwise encounter technical difficulties that make those platforms unavailable, the City Council will proceed with business in person unless otherwise prohibited by law.

How to view the meeting remotely:

Livestream online at YouTube: https://www.youtube.com/@cityofnewark3077/streams Copy/paste the YouTube URL into your browser if the link does not automatically open.

Cable Channel 26 - if the meeting does not broadcast live, please contact your service provider and request the City of Newark channel lineup.

Zoom will no longer be available for public participation unless required by Assembly Bill 2449. Should a Council Member or the Mayor attend the meeting via Zoom pursuant to Assembly Bill 2249, then the Webinar ID https://us06web.zoom.us/j/85808270278 will be activated. The Mayor will make an announcement at the beginning of the meeting that the City will be allowing public comment via Zoom. Raise your virtual hand to notify the City Clerk that you would like to speak during the item that you wish to speak on.

How to submit written Public Comment:

Send an email to City Clerk by 3:00 p.m. the day of the meeting. Please identify the agenda item number in the subject line of your email. Emails will be compiled into one file and will be distributed to the City Council before the meeting.

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No question shall be asked of a council member, city staff, or an audience member except through the Mayor. No person shall interrupt the meeting. Any person who refuses to carry out instructions given by the Mayor for the purpose of maintaining order may be guilty of an infraction and may result in removal from the meeting.

Council Meeting Access/Materials:

The agenda packet is available for review at Agendas and Minutes. The packet is typically posted to the City website the Friday before the meeting, but no later than 72 hours before the meeting.

Pursuant to Government Code 54957.5, supplemental materials distributed less than 72 hours before this meeting, to a majority of the City Council, will be made available for public inspection at this meeting and will be posted at https://www.newark.org/departments/city-manager-s-office/agendas-minutes and will concurrently be made available for public inspection during regular business hours at the David W. Smith City Hall, 37101 Newark Boulevard, Newark CA. Materials prepared by City staff and distributed during the meeting are available for public inspection at the meeting or after the meeting if prepared by some other person. Documents related to closed session items or are exempt from disclosure will not be made available for public inspection. For those persons who require special accommodations, please contact the City Clerk at least two days prior to the meeting at City Clerk or 510-578-4266.

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Item B. 1.

DATE 11/09/2023
TO Honorable Mayor and City Council Members
FROM Sheila Harrington, City Clerk
SUBJECT Introduction of employee(s)
The following employees will be introduced at the City Council meeting:

Janelle Mensinger, Aquatics Coordinator
Albert Medina, Police Officer
Daniel Williams, Police Officer
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Item B. 2.

DATE 11/09/2023
TO Honorable Mayor and City Council Members
FROM Sheila Harrington, City Clerk
SUBJECT Presentation on Newark Library
Branch Manager Joe Stoner will provide the annual report at the City Council meeting covering statistics and special programs at the Newark Library. A copy of the presentation is attached.

Attachments
Presentation
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NEWARK LIBRARY
Annual report
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1 st time this national workshop held in California. Newark Library was the only other location participants visited. Library Directors from 7 states represented.

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Dr. Milo Buitrago-Casas, UC Berkeley Space Sciences Lab Solar Eclipse preview program in Spanish & English
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Saturday, October 14 – Solar Eclipse viewing event
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September 5, 2024
160 people registered to attend
New York Times Bestselling Author
Tiffany Hammond
#1 bestselling picture book
“ A Day With No Words”
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FY 2023-2024 to date:

July – September:

Sundays: 291 average, 73 visitors / hour
Sundays total: 2,907
Total visits to ACL, FY 2022-2023
Quarterly and total visits to Newark Library, FY 2022-2023 Packet Page 12
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Diwali Festival
Concert:

The Alaya Project,
led by Dr. Rohan
Krishnamurthy
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Average 60 PC sessions per day, plus 2,000 laptop sessions for the year.

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Remote work / Adult study area
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Item B. 3.

DATE 11/09/2023
TO Honorable Mayor and City Council Members
FROM Sheila Harrington, City Clerk
SUBJECT Washington Hospital Healthcare System presentation of Community Health Needs Assessment
Every three years, the Washington Hospital Healthcare System conducts a comprehensive health needs assessment. The study helps identify crucial health issues affecting residents in the Washington Township Health Care District, including Newark. By using this data, Washington Hospital can target services and education programs that help improve the health of our community.

Angus Cochran, Chief of Community Support Services will give a presentation on the 2023 Community Needs Assessment for Newark.

Attachments
Presentation
2023 CHNA Report
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Angus Cochran
Chief of Community Support Services
[email protected]
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510-818-6713
What is a Community Health Needs Assessment?
• Developed by nonprofit hospitals every
three years
• Provides insight into the health of the
community
• Prioritizes local health needs
• Identifies areas of focus
• Used to develop outreach and education
strategies to improve well-being of
community members
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Focus
Groups and
Interviews
Statistical
Analysis
Data
Synthesis
Health Needs
List Prioritization Report Writing
CHNA: A Qualitative and Quantitative Process
50 participants
provided input
125 health
indicators
analyzed
District to County and
State Comparisons
Based on health indicators
worse than Alameda County
average
Community Members
ranked health needs
Washington Hospital worked with consultant group Actionable Insights, LLC to create 2023 CHNA Packet Page 24
Using a Broader View of Health
• Community thinks about healthcare beyond
disease status
• CHNA includes the:
“Social Determinants of Health”
The conditions in which people are born, grow,
work, live, and age, and the wider set of forces
and systems shaping the conditions of daily life
that influence health outcomes
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Health is Influenced Outside the Hospital
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Washington Township Health Care District
• Service Area Total Population: 350,145
• Fremont: 231,502
• Newark: 47,815
• Union City: 70,828
• Language Barriers:
• Limited English Proficiency
• Greater than 15 percent of Fremont’s population
• Greater than 20 percent of Union City’s
population*
• Most Common Languages Spoken:
• Spanish
• Chinese (Cantonese and Mandarin)
• Hindi
• Tagalog
*data not available for Newark
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Race/Ethnicity of the Health Care District
• WTHCD has much larger
Asian population than
Alameda County and
California overall
• Hispanic/Latino population
highest in Newark
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2023 Community Health Needs

1. Behavioral Health

2. Housing & Homelessness

3. Economic Security

4. Diabetes & Obesity

5. Heart Disease/Stroke

6. Healthcare Access & Delivery

7. Respiratory Health

8. Cancer
Prioritized health needs either
showed statistically significant
differences in comparison to
Alameda County, OR showed
racial/ethnic inequalities
within the district.

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1. Behavioral Health
• Emotional and psychological wellbeing; includes substance use (alcohol, tobacco, etc.)
• Mentioned in every focus group
and interview
• Highest concern: Lack of access to
Behavioral Health services
• Racial inequities:
• White, Black, and Hispanic/Latino
students have highest rates of alcohol
and drug use
• Multiracial and White adults have
higher rates of serious psychological
distress
If I need mental healthcare, I can call and I’ll
get an appointment eight, 10 weeks out.
[Somebody] who is on the street or in a harmful
situation, they don’t have eight to 10 weeks.

Asking somebody to hold on that long to get
care is like asking a fish to ride a bicycle, it’s
just not going to happen.
– South County Partnership member
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Behavioral Health (continued)
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2. Housing & Homelessness
• Number of homeless people in
Alameda County increased by 22%
in the last two years
• Number of homeless people in the
District increased by 95% in the last
three years
• COVID-19 decreased emergency
shelter capacity
• Racial inequities:
• Black residents are overrepresented
in the homeless population
Our city just pushed out $15 million in rental
assistance for folks... eventually we’re going to see
a lot of evictions and potentially more people
ending up either having to leave the area or ending
up in the homeless category.
– South County Partnership member
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Housing & Homelessness (continued)
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3. Economic Security
• Topic mentioned in every
community focus group
• Sharp rise in food insecurity in
summer of 2022
• Overall fear of losing housing due
to economic difficulties
• Racial inequities:
• Black, indigenous, and people of color
(BIPOC) populations have lower
incomes and a larger proportion of
individuals living in poverty than
other racial groups
For Alameda County, there’s an index for what it
actually costs to live in our county. If you look at
that and you look at the incomes of our
population, about 20 percent of people are kind of
hanging on by their toenails to stay housed, and
that’s not counting things like saving for a college
education for your kid or taking a vacation. It’s just
the basics for a family to survive.
– South County Partnership member
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Economic Security (continued)
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4. Diabetes & Obesity
• Community members asking for
more recreation programs and
increased access to healthy
foods
• Racial inequities:
• BIPOC populations have higher
rates of diabetes and obesity
I’m someone who has diabetes… It’s very
difficult to find affordable organic food, food
classes, nutrition classes… That’s something
that’s very important because there’s a large
percentage of us who are suffering from this
illness.
– Southern Alameda County resident
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Diabetes & Obesity (continued)
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5. Heart Disease/Stroke
• Cerebrovascular conditions
(stroke, heart disease, and
cardiac arrest) among top causes
of death in Alameda County
• Stroke mortality decreasing in
Fremont and Newark
• Union City disproportionally
impacted by cardiac disease
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Heart Disease/Stroke (continued)
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6. Healthcare Access & Delivery
• Mentioned often in focus groups and key
informant interviews
• Communication challenges for monolingual
non-English speakers and non-verbal
residents (Deaf/Hard of Hearing)
• Call for increased cultural competency
• Offering care in native language
• Involving family members in joint decision
making around care
• Using appropriate language with lesbian, gay,
bisexual, transgender, queer, intersex, and
asexual (LGBTQIA+) community
• Racial/Gender inequities:
• Pacific Islanders have lower rates of adult health
insurance
Even though those people have a degree, they
have a full-time job, and they work in a hightech company, but they still want a physician or provider that speaks their own language. I think
that when they become sick, they really want
people to speak their own language. They feel
much more comfortable.
– BIPOC Southern Alameda County resident
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7. Respiratory Health
• Respiratory disorders affect the ability to breathe
• Examples: Asthma, Chronic Obstructive Pulmonary Disorder (COPD), pneumonia, and lung cancer
• Union City affected more than other district cities
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8. Cancer
• Cancer is the second leading cause of death in the US • Qualifies as a health need for CHNA due to racial/ethnic disparities Packet Page 42
Health Snapshot: Newark
Disease Incidence compared to Alameda County Rate, per 100,000 pop.

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• CHNA published on WHHS website for
community to read
• Presentations for District cities and
community partners
• Hospital creates Community Health
Improvement Plan to guide
programming for next three years
• Implementation of Community
Outreach Programs
How is this Information Used?
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Questions?
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2023 Community Health
Needs Assessment
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TABLE OF CONTENTS

1. EXECUTIVE SUMMARY ............................................................................................................................................. 5 COMMUNITY HEALTH NEEDS ASSESSMENT BACKGROUND ................................................................. 5 PROCESS AND METHODS ...................................................................................................................................... 5 PRIORITIZED HEALTH NEEDS ............................................................................................................................... 6 NEXT STEPS .................................................................................................................................................................. 7

2. BACKGROUND ........................................................................................................................................................... 8 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT PURPOSE ............................................................. 8 AFFORDABLE CARE ACT REQUIREMENTS....................................................................................................... 8 SB 697 AND CALIFORNIA’S HISTORY OF ASSESSMENTS ............................................................................ 9 BRIEF SUMMARY OF THE PRIOR (2020) CHNA CONDUCTED ................................................................ 9 EVALUATION FINDINGS FROM 2021–2023 IMPLEMENTED STRATEGIES ............................................. 9 Behavioral Health ................................................................................................................................................... 10 Housing and Homelessness .................................................................................................................................. 10 Healthy Eating/Active Living ................................................................................................................................. 11 Healthcare Access and Delivery ......................................................................................................................... 11 Social Determinants of Health ............................................................................................................................ 12 Diabetes, Heart Disease, Hypertension, and Stroke ..................................................................................... 12 Respiratory Health ................................................................................................................................................. 13 Cancer ....................................................................................................................................................................... 14 WRITTEN PUBLIC COMMENTS ........................................................................................................................... 15

3. ABOUT WASHINGTON HOSPITAL ................................................................................................................... 16 MISSION STATEMENT ............................................................................................................................................. 16 VISION .......................................................................................................................................................................... 16 VALUES STATEMENT ............................................................................................................................................... 16 COMMUNITY BENEFIT PROGRAMS .................................................................................................................. 17 COMMUNITY SERVED ............................................................................................................................................ 17 Demographics .......................................................................................................................................................... 18

4. ASSESSMENT TEAM .................................................................................................................................................. 20 HOSPITALS, OTHER PARTNER ORGANIZATIONS, AND CONSULTANTS ....................................... 20

5. PROCESS AND METHODS .................................................................................................................................... 21 SECONDARY DATA COLLECTION ................................................................................................................... 21 INFORMATION GAPS AND LIMITATIONS...................................................................................................... 21 Packet Page 47
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COMMUNITY INPUT ............................................................................................................................................... 22 Key Informant Interviews ..................................................................................................................................... 22 Focus Groups .......................................................................................................................................................... 23 CHNA Participant Demographics ...................................................................................................................... 24 IDENTIFICATION OF COMMUNITY HEALTH NEEDS ................................................................................ 24 PRIORITIZATION OF HEALTH NEEDS ............................................................................................................. 25 Health Disparities and Inequities ........................................................................................................................ 25

6. 2023 PRIORITIZED COMMUNITY HEALTH NEEDS ...................................................................................... 30 SUMMARIZED DESCRIPTIONS OF PRIORITIZED NEEDS ........................................................................... 30 ❶ Behavioral Health ............................................................................................................................................. 30 What Is the Issue? .............................................................................................................................................. 30 Why Is It a Health Need? ................................................................................................................................. 30 ❷ Housing & Homelessness ............................................................................................................................... 32 What Is the Issue? .............................................................................................................................................. 32 Why Is It a Health Need? ................................................................................................................................. 32 ❸ Economic Security ........................................................................................................................................... 34 What Is the Issue? .............................................................................................................................................. 34 Why Is It a Health Need? ................................................................................................................................. 34 ❹ Diabetes & Obesity ......................................................................................................................................... 35 What Is the Issue? .............................................................................................................................................. 35 Why Is It a Health Need? ................................................................................................................................. 35 ❹ Heart/Stroke ..................................................................................................................................................... 37 What Is the Issue? .............................................................................................................................................. 37 Why Is It a Health Need? ................................................................................................................................. 37 ❻ Healthcare Access & Delivery ...................................................................................................................... 38 What Is the Issue? .............................................................................................................................................. 38 Why Is It a Health Need? ................................................................................................................................. 39 ❼ Respiratory Health (including COVID-19) ................................................................................................ 40 What Is the Issue? .............................................................................................................................................. 40 Why Is It a Health Need? ................................................................................................................................. 40 ❽ Cancer ................................................................................................................................................................ 41 What Is the Issue? .............................................................................................................................................. 41 Why Is It a Health Need? ................................................................................................................................. 41 COMPARISON OF SERVICE AREA CITIES TO ALAMEDA COUNTY ...................................................... 42 Packet Page 48
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7. COMMUNITY RESOURCES ................................................................................................................................... 45 HOSPITALS .................................................................................................................................................................. 45 FEDERALLY QUALIFIED HEALTH CENTERS ................................................................................................... 45 OTHER HEALTH CLINICS ...................................................................................................................................... 45

8. CONCLUSION ........................................................................................................................................................... 46

9. LIST OF ATTACHMENTS ........................................................................................................................................ 47 ATTACHMENT 1: COMMUNITY LEADERS, REPRESENTATIVES, AND MEMBERS CONSULTED . 48 ATTACHMENT 2: SECONDARY DATA TABLES ............................................................................................ 53 Demographics .......................................................................................................................................................... 53 Behavioral Health ................................................................................................................................................... 56 Housing and Homelessness .................................................................................................................................. 61 Economic Security .................................................................................................................................................. 63 Diabetes & Obesity ................................................................................................................................................ 66 Heart Disease, Hypertension, and Stroke ........................................................................................................ 68 Healthcare Access & Delivery ............................................................................................................................. 73 Respiratory Health ................................................................................................................................................. 75 Cancer ....................................................................................................................................................................... 78 General Health & Mortality .................................................................................................................................. 80 ATTACHMENT 3: COMMUNITY ASSETS AND RESOURCES .................................................................... 82 Behavioral Health ................................................................................................................................................... 82 Cancer ....................................................................................................................................................................... 83 Diabetes & Obesity ................................................................................................................................................ 83 Economic Security (includes food security, employment, education) ....................................................... 83 Healthcare Access & Delivery ............................................................................................................................. 84 Heart/Stroke ............................................................................................................................................................ 85 Housing & Homelessness ..................................................................................................................................... 85 Respiratory Health ................................................................................................................................................. 86 ATTACHMENT 4: QUALITATIVE RESEARCH PROTOCOLS ..................................................................... 87 ATTACHMENT 5: IRS CHECKLIST ...................................................................................................................... 96 Packet Page 49
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1. EXECUTIVE SUMMARY

COMMUNITY HEALTH NEEDS ASSESSMENT BACKGROUND
The Patient Protection and Affordable Care Act (ACA) enacted March 23, 2010, includes requirements for nonprofit hospitals that wish to maintain their tax-exempt status. Regulations finalized December 31, 2014, also provide guidance related to section 501(r) of the Internal Revenue Code. These regulations mandate that all nonprofit hospitals conduct a Community Health Needs Assessment (CHNA) every three years. The CHNA must be done by the last day of a hospital’s taxable year, and hospitals must make the CHNA report widely available to the public. The CHNA must also gather input from experts in public health, local health departments, and the community. The community must include representatives of minority, low-income, medically underserved, and other vulnerable populations.

California Senate Bill 697, enacted in 1994, stipulates that private nonprofit hospitals submit an annual report to the Department of Health Care Access and Information (HCAI), formerly the Office of Statewide Health Planning and Development (OSHPD), that shall include, but not be limited to, a description of the activities that the hospital has undertaken to address identified community needs within its mission and financial capacity. Additionally, hospitals shall describe the process by which they involved community groups and local government officials in helping identify and prioritize the needs to be addressed. This community needs assessment shall be updated at least once every three years.1 Per California Assembly Bill 1204, enacted in 2021, the community must include vulnerable populations, including the unhoused, people with disabilities, LGBTQ, medically underserved, low-income, of a minority population, or those with limited English proficiency.2 The 2023 CHNA is the fourth such assessment completed since the ACA was enacted. It builds upon the information and understanding that resulted from previous assessments. The latest CHNA process, completed in fiscal year 2023 and described in this report, was conducted by Washington Hospital Healthcare System (“Washington Hospital”) in compliance with current legal requirements. This report was adopted by Washington Hospital’s governing body, the Washington Township Health Care District Board of Directors, on May 10, 2023.

PROCESS AND METHODS
Washington Hospital began the current CHNA cycle in 2022. The hospital’s goal was to gather community feedback, understand existing data about health status, and prioritize local health needs.

Community input was obtained during the summer and fall of 2022 through key informant interviews with local health and community experts, focus groups with community leaders and representatives, and focus groups with community residents.
1 California Office of Statewide Health Planning and Development. (1998). Not-for-profit hospital community benefit legislation (Senate Bill 697), Report to the Legislature. Retrieved November 2019 from https://oshpd.ca.gov/wp-content/uploads/2018/07/SB-697-Report-to-the-Legislature-Community-Benefit.pdf 2 California Legislative Information. (2021). AB-1204 Hospital equity reporting. Retrieved from https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220AB1204 Packet Page 50
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Secondary data were obtained from a variety of sources. Secondary data were available for Alameda County and for the three separate major cities in Washington Hospital’s primary service area: Fremont, Newark, and Union City. The service area also includes unincorporated Sunol and a small part of southern Hayward, for which data were not available. Secondary data were gathered in fall and winter of 2022–2023.

In early 2023, community health needs were identified by synthesizing primary qualitative research and secondary data, and then filtering those needs against a set of criteria. The results of the prioritization appear below.

For the purposes of this assessment, Washington Hospital did not limit the definition of “community health” to traditional measures of health. Instead, the definition included indicators about the physical health of the area’s residents, as well as the broader social and environmental determinants of health, such as access to healthcare, affordable housing, child care, education, and employment. This more inclusive definition reflects Washington Hospital’s view that many factors affect community health, and it is essential to consider these factors to adequately understand and address community health needs.

PRIORITIZED HEALTH NEEDS
The previously described prioritization process produced a ranked list of the most pressing community health needs for the hospital’s primary service area. Two needs, Diabetes & Obesity, and Heart/Stroke, tied for fourth place. All eight needs, listed in priority order (from highest to lowest), are:
● Behavioral Health. The community considered behavioral health a strong priority. The lack of access to behavioral health services and facilities was cited, pandemic isolation was a big concern, and parents expressed concern about alcohol and drug use. Statistics support CHNA participants’ concerns: Depression-related feelings and alcohol/drug use are higher than the county among most Union City students as well as some Fremont and Newark students. Adult binge drinking and 7th grade binge drinking are both worse in Newark than the county overall. ● Housing & Homelessness. The cost of housing in the Bay Area is extremely expensive, and the community identified this as one of the most pressing health needs. Because housing is difficult to afford, community members described seeing more people struggling with other living expenses. The number of homeless people in Alameda County has increased in the last two years, a trend also seen in Fremont and Union City. In Fremont and Union City, the proportion of the population that is unsheltered is worse than in the county. We also know that some populations, especially Black residents, are overrepresented in the homeless population. ● Economic Security. Community input about economic security made up the highest proportion of discussion after healthcare access and delivery. The community described the high cost of living, and difficulty securing employment for individuals with health issues, disabilities, or those experiencing homelessness. The community described a sharp rise in food insecurity in summer 2022. While most data indicators, including multiple measures of poverty and income, were favorable for service area cities, data showed inequities by race. Overall, most BIPOC populations have lower incomes than their counterparts and higher proportions of their populations who are living in poverty.
● Diabetes & Obesity. The community expressed the need for access to healthy food and nutrition education. They also called out the need for recreation/fitness programs and more safe Packet Page 51
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spaces to recreate in their neighborhoods. This category met the threshold for a health need because of the statistical data; the proportions of children who are overweight are higher in Newark and Union City than in the county and state overall. Notably, the rates of adults with diabetes are worse in all three service area cities, and rates of diabetes ED visits and hospitalization are an issue in Fremont and Newark. Also, there are inequities by race for adult obesity and adults with diabetes.
● Heart/Stroke. Cerebrovascular issues such as stroke, heart disease, and heart attack are among the top causes of death in the county. The community did not discuss heart and stroke issues specifically, but did call out the need for recreation programs and nutritional education.

Statistical data shows that service area cities fare worse than the county overall. In Union City, residents have worse rates than other service area cities and the county for emergency department visits (stroke, hypertension, and heart failure), hospitalizations (heart disease, hypertension), and mortality (acute myocardial infarction, heart disease, and ischemic heart diseases).
● Healthcare Access & Delivery. Access to healthcare and the experiences of receiving care were dominant in community input. Residents described difficulties affording health care, even for those who are insured, and a lack of adequate health care facilities in the service area. In terms of data, local statistics fare well compared to the county, including the proportion of insured residents, recent physical and dental visits, and access to internet at home. However, there are notable inequities: Pacific Islanders have lower rates of adult health insurance than their peers. Several populations have more difficulty obtaining care compared to all county residents: Native American, white, and multiracial.
● Respiratory Health. Statistical data for adult asthma and COPD both indicate that Union City does worse than the county overall in respiratory health. While COVID-19 is an undeniable respiratory health condition that has impacted service area cities, the community did not prioritize it over other needs.
● Cancer. Cancer qualifies as a health need because of racial and ethnic disparities. The overall cancer incidence rate in Assembly District 20 (AD20, an area analogous to Washington Hospital’s service area) is worse than that of Alameda County overall. Overall cancer incidence is also higher for white, Black, and Latina/o residents of AD20 than residents of the county overall. Compared to the county, colorectal cancer incidence is worse for most AD20 residents except Asian/Pacific Islanders. Black residents of AD20 have a higher incidence of prostate cancer than county residents. Latina/o residents of AD20 have a higher incidence of pancreatic cancer than county residents. Finally, white residents of AD20 have higher incidence of female breast cancer, lung cancer, and melanoma than county residents.

For additional details, including statistical data and citations, see Section 6: 2023 Prioritized Community Health Needs and Attachment 2: Secondary Data Tables.

NEXT STEPS
After making this CHNA report publicly available by July 1, 2023, Washington Hospital will solicit feedback and comments about the report until two subsequent CHNA reports have been posted.3 The hospital will also develop an implementation plan based on the CHNA results. 3 https://www.whhs.com/about-us/community-connection/community-health-needs-assessment/ Packet Page 52
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2. BACKGROUND

COMMUNITY HEALTH NEEDS ASSESSMENT REPORT PURPOSE
The goals of the 2023 Community Health Needs Assessment (CHNA) are to provide insight into the health of the community, prioritize local health needs, and identify areas for improvement. With this information, Washington Hospital Healthcare System (“Washington Hospital”) will develop strategies to tackle critical health needs as well as improve the health and well-being of community members. The assessment findings may also be used as a guideline for funding, policy, and advocacy efforts.

The 2023 CHNA builds upon the findings of the 2020 CHNA (see below for evaluation of 2021–2023 implemented strategies) and previous assessments conducted by Washington Hospital. The 2023 report documents how the current CHNA was conducted and describes the related findings. As with prior CHNAs, this assessment also highlights the district’s assets and resources (see Section 7: Community Resources).

Note that, for the purposes of this assessment, “community health” was not limited to traditional health measures. Washington Hospital considered indicators relating to the quality of life (e.g., access to healthcare, affordable housing, food security, education, and employment) and to the physical, environmental, and social factors that influence the health of the county’s residents. This broader definition reflects the hospital’s philosophy that many factors affect community health and that community health cannot be adequately understood without consideration of trends outside the realm of healthcare.

In addition to helping generate shared priorities around community health, Washington Hospital also used the 2023 CHNA to fulfill key state and federal mandates.

AFFORDABLE CARE ACT REQUIREMENTS
Enacted on March 23, 2010, the Affordable Care Act (ACA) provides guidance at a national level for CHNAs for the first time. Federal requirements included in the ACA stipulate that hospital organizations under 501(c)(3) status must adhere to new 501(r) regulations, one of which is conducting a community health needs assessment every three years. The CHNA report must document how the assessment was done, including the community served, who was involved in the assessment, the process and methods used to conduct the assessment, and the community’s health needs that were identified and prioritized as a result of the assessment. Final requirements were published in December 2014.

The federal definition of community health needs comprises the social determinants of health and morbidity and mortality. This broad definition is indicative of a wider focus on both upstream and downstream factors that contribute to health. Such an expanded view presents opportunities for nonprofit hospitals to look beyond immediate presenting factors to identify and take action on the larger constellation of influences on health, including social determinants.

Beyond providing a national set of standards and definitions related to community health needs, the ACA has had an impact on upstream factors. For example, the ACA created more incentives for healthcare providers to focus on prevention of disease by including lower or no co-payments for Packet Page 53
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preventative screenings. Also, funding has been established to support community-based primary and secondary prevention efforts.

SB 697 AND CALIFORNIA’S HISTORY OF ASSESSMENTS
California Senate Bill 697, enacted in 1994, requires private nonprofit hospitals to conduct a community needs assessment and to consult with the community on a plan to address their identified needs. An assessment must be conducted every three years. Hospitals are also required to submit an annual report to the California Department of Health Care Access and Information, HCAI (formerly the Office of Statewide Health Planning and Development, OSHPD) that describes the strategies that hospitals have engaged in to address the identified community needs. Per California Assembly Bill 1204, enacted in 2021, the community must include vulnerable populations, including people with disabilities, those with limited English proficiency, or those who are unhoused, LGBTQ, medically underserved, low-income, or of a minority population.4
The 2023 CHNA meets both state and federal requirements.

BRIEF SUMMARY OF THE PRIOR (2020) CHNA CONDUCTED
In 2018–2019, Washington Hospital collaborated with 14 local hospitals in Alameda and Contra Costa counties to assess community health needs. The 2020 CHNA report is posted on the Community Health Needs Assessment page of the hospital’s website.5 The community health needs identified and prioritized through the 2020 CHNA process were:
● Behavioral Health
● Housing and Homelessness
● Healthy Eating/Active Living
● Healthcare Access and Delivery
● Social Determinants of Health
● Diabetes, Heart Disease, Hypertension, and Stroke
● Respiratory Health
EVALUATION FINDINGS FROM 2021–2023 IMPLEMENTED STRATEGIES Washington Hospital addressed all of these critical community health needs in subsequent years through targeted programs and community partnerships. It also addressed cancer, which was not one of the identified needs from the 2020 CHNA but which is one of the top causes of death in Alameda County.6 At the time this report was completed, Washington Hospital had impact results for fiscal years 2021 and 2022. Although not reflected herein, the hospital will continue to monitor and report the impact of strategies implemented in 2023.
4 California Legislative Information. (2021). AB-1204 Hospital equity reporting. Retrieved from https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220AB1204 5 https://www.whhs.com/about-us/community-connection/community-health-needs-assessment/ 6 California Department of Public Health. (2019). Alameda County Health Status Profile.

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Behavioral Health
 The Washington Hospital Wellness Center hosted a monthly women’s support group, Women Empowering Women. Three of these support group meetings focused on behavioral health topics, with an average of 14 participants at each meeting.  Washington Township Medical Foundation provided onsite presentations at Ardenwood Elementary School for National Mental Health Awareness Month. Presentations were given to 10 classrooms of students in grades 1-6.
 Washington Hospital provided two in-person seminars on “Grief, Loss and Self Care” to local retirement communities. 40 adults attended.
 Washington Hospital’s Maternal and Child Health Department hosted the BlueDot Walk to help raise awareness for Maternal Mental Health. 71 individuals participated.  Washington Hospital hosted a virtual Health & Wellness Seminar on “Self-Care and Compassion”. This presentation received 656 virtual views on Facebook and YouTube.  Since 2021, Washington Hospital convenes a monthly “South County Partnership” meeting with representatives from healthcare organizations, city and county services, and non-profit organizations. These meetings focus on local mental health challenges and encourage collaboration between sectors to address community needs.  Working in collaboration with Fremont Police Department and Fremont Human Services Department, Washington Hospital provides a social worker as part of a multidisciplinary team that brings comprehensive and compassionate care to community members with mental illness where they live. The Mobile Evaluation Team (MET) responds to calls for service in the field by offering case management services that connect clients with resources and educate them on programs and services.
 Washington Hospital collaborated with City of Fremont on Cities for Opportunity, a pilot project to identify frequent users of Emergency Department resources that could benefit from connection to county behavioral health services. Washington Hospital is currently exploring how to fully integrate this program after the end of the pilot period.  Washington Township Medical Foundation expanded outpatient and inpatient behavioral health services. For outpatient care, staff expanded to two psychiatrists and one Licensed Marriage and Family Therapist. For inpatient care, one of our psychiatrists provided inpatient psychiatric consults for admitted patients and those with emergency needs.  Washington Hospital is currently working with the Alameda County Behavioral Health Services Department to host space for a new behavioral health clinic. This clinic is set to open in late 2023/early 2024.

Housing and Homelessness
 Washington Hospital participates in the Tri-City Collaborative on Homelessness. The task force tracks community concerns, focuses efforts on the greater needs of the community, facilitates collaboration of homeless services and resources throughout the area. Meetings occur quarterly.
 Washington Hospital provides general grant funding to Abode Services, the largest homeless housing and service provider in the Bay Area. In addition, Washington Hospital has a staff representative on Abode Services Board of Directors.

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Healthy Eating/Active Living
 Washington Hospital hosted two sports safety presentations for local youth athletic teams and coaches. 103 individuals attended.
 Washington Hospital hosted 19 free, virtual seminars focused on healthy eating and active living.

These presentations included cooking and fitness demonstrations. More than 11,726 community members viewed these seminars on Facebook and YouTube.
 Washington Hospital presented 7 on-site health seminars on Healthy Eating and Active Living to local senior living communities. Topics included fall prevention, joint replacement, and easy ways to stay active as you age. 178 adults attended these presentations.  Washington Sports Medicine athletic trainers hosted first aid stations during 4 Special Olympics tournaments. The mission of Special Olympics is to provide athletic competition in a variety of Olympic-type sports for youth with intellectual disabilities. 986 student athletes attended these events.
 Washington Hospital’s Sports Medicine program offered onsite sports physicals to 324 local student athletes.
 The Washington Hospital Wellness Center hosted a monthly women’s support group, Women Empowering Women. Three of the support group meetings focused on healthy eating and active living topics, with an average of 18 participants at each meeting.  The Washington Wellness Center promotes active living through exercise classes and services designed for people of all ages and fitness levels.

Healthcare Access and Delivery
 Washington Hospital provided 98,859 COVID-19 vaccinations for 44,329 unique individuals.

Washington Hospital also provided 87,829 COVID-19 tests.  Washington Hospital provided COVID-19 vaccinations and tests at a variety of community locations. Some of our community clinics included: Washington Hospital Healthcare System (ongoing), BACS, Masonic Homes of California, Little Apples Learning Center, City of Newark Library, City of Newark Tree Lighting Ceremony, Newark Unified School District (multiple facilities) and the Tesla manufacturing plant.
 Washington Hospital was selected by Alameda County as a trauma center and is progressing towards designation in 2027.
 Washington Hospital continued providing grants for mammograms to uninsured clients referred by community clinics such as Tiburcio Vasquez Health Center. These clients include women ages 40 to 70, or women ages 30 to 40 who are considered at high risk for breast cancer as defined by the Medicare program.
 Washington Hospital hosted three free, virtual seminars focused on healthcare access, including information on Medicare and Medi-Cal enrollment. 1,064 community members viewed these seminars on Facebook and YouTube.
 Washington Hospital presented three on-site health seminars on Medicare enrollment to local senior living communities. 66 adults attended these presentations.  Washington Hospital entered into a contract with Canopy Health to support the establishment of a lower cost and geographically customizable health plan option for employers and residents of the Bay Area.

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 Washington Hospital entered into a three-year agreement with Alameda Alliance to broaden access to health care for MediCal members.
 Washington Hospital provides free Health Insurance Information Services (HIIS) to community members in the Tri-City Area. This service helps answer insurance questions about individual plans, group plans and government-sponsored programs such as Medicare, Medi-Cal and Covered California. It also specializes in understanding Advance Health Care Directives or Physicians Orders for Life Sustaining Treatments (POLSTs).  Washington Hospital collaborates with ReCare and the City of Fremont to distribute free durable medical equipment to low-income community members.  Washington Hospital operates a Lymphedema Garment program that offers free garments to low-income patients. 15 patients were served.

Social Determinants of Health
 Washington Hospital continued collaborating with a local drug rehabilitation center to provide tattoo removal. The program is designed to help young adults make positive changes in their lives by removing symbols of past negative behaviors and actions associated with gang and drug activities.
 Washington Hospital welcomed 12 students from Mission Valley Regional Occupational Program for a job shadowing program. The students were given the opportunity to spend eight hours in a specific operational area. Students were hosted for job shadowing in the Washington Special Care Nursery, 4W, 5W, 6W, the Sandy Amos Outpatient Infusion Center and the clinical laboratory.
 Washington Hospital hosted a Community Forum on Anti-Asian Hate. This event featured a panel of speakers as well as resource fair with community organizations sharing important information on maintaining safety and health in the Tri-City Area. 100 individuals attended.  Washington Hospital hosted a tour for a Future Health Professionals clubs at a local high school in the Tri-City Area.
 Washington Hospital provides general grant funding to Avanzando, an organization dedicated to the advancement and empowerment of Latino youth and their families through education and leadership.
 Washington Hospital provides general grant funding to local educational foundations, including the New Haven Schools Foundation and The Fremont Education Foundation. They also provide two scholarships to high school graduates pursuing healthcare related careers.  Washington Hospital created a Diversity, Equity and Inclusion taskforce to develop strategies that improve diversity and inclusion for staff and patients of the healthcare system.

Diabetes, Heart Disease, Hypertension, and Stroke
 Washington Hospital participated in 12 health fairs hosted by community organizations and local schools to provide health information, including free blood pressure checks and information about stroke prevention.
 Washington Hospital offers free monthly diabetes support group meetings and educational Diabetes Matters sessions to community members with diabetes.

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 Washington Hospital hosted five free, virtual seminars focused on diabetes education. These presentations included information on managing diabetes during the pandemic and technology to monitor blood glucose levels. 1,909 community members viewed these seminars on Facebook and YouTube.
 Washington Hospital hosted six free, virtual seminars focused on heart disease and hypertension. These presentations included information on heart attack symptoms and prevention. 2,378 community members viewed these seminars on Facebook and YouTube.  Washington Hospital presented one on-site health seminar on Carotid Artery Disease to a local senior living residence. 34 adults attended this presentation.  Washington Hospital hosted two free, virtual seminars focused on risk factors, warning signs and prevention of stroke. 812 community members viewed these seminars on Facebook and YouTube.
 Washington Hospital presented four on-site health seminars on Stroke Awareness to local senior living communities. 107 adults attended these presentations.  Washington Hospital reviewed their stroke protocols to be in line with the updated Clinical Practice Guidelines. These protocols ensure and encourage the increased use of “RAPID” software for identifying strokes and expediting decision on appropriate therapies for stroke patients. To facilitate with rapid administration of IV thrombolytic Therapy to eligible patients, WHHS switched to Tenectaplase (TNKase) as recommended in the recent clinical practice guidelines. TNKase is an IV thrombolytic, which is administered over five seconds as an IV push, thus enabling our hospital to meet a shorter door to drug time.  Washington Hospital progresses towards Joint Commission Thrombectomy Capable Stroke Center (TSC) certification. We are currently working to build required volumes to attain this certification by extending our neurosciences services to the central valley and northern California.
 Washington Hospital’s Stroke Program received the American Heart Association/ American Stroke Association’s Get With the Guidelines®-Stroke Gold Plus Quality Achievement Award.

The award recognizes the hospital’s commitment to ensuring that stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence. Washington Hospital earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. These measures include evaluation of the proper use of medications and other stroke treatments, with the goal of speeding recovery and reducing death and disability for stroke patients.
 Washington Hospital also received the associations’ Target: Stroke Elite Plus award. To qualify for this recognition, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with a clot-buster tissue plasminogen activator used to treat ischemic stroke.

Respiratory Health
 Washington Hospital hosts a monthly Better Breathing for Life support group for people with chronic lung conditions such as chronic asthma, bronchitis, emphysema, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis or other restricted lung disease. Currently there are 74 active members of the support group.

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 Washington Hospital engaged in community education during the COVID-19 pandemic with educational articles in the Tri-City Voice on Post COVID Breathing Problems.  Washington Hospital hosted 4 free, virtual seminars focused on respiratory health. These presentations included information about asthma and pulmonary rehab. 2,621 community members viewed these seminars on Facebook and YouTube.
 Washington Hospital’s pulmonary rehab team attended local health fairs to share information about lung health.
 Washington Hospital hosted 5 virtual seminars in response to COVID-19. 1,355 community members viewed these seminars on Facebook and YouTube.

Cancer
 Washington Hospital hosted four free, virtual seminars focused on prevention, screening, and early detection for various cancers (e.g., breast, lung, and skin). 2,815 community members viewed these seminars on Facebook and YouTube.
 Washington Hospital presented two on-site health seminars on breast cancer prevention and detection to local senior living communities. 51 adults attended these presentations.  Washington Hospital hosted four special events to educate and honor cancer patients and survivors. 729 community members attended these special events.  Washington Hospital acquired a new linear accelerator for Washington Hospital’s Radiation Oncology Center. This treatment modality increases the hospital’s ability to provide advanced radiation therapy to patients.
 Washington Hospital continued offering a lung cancer screening tool to patients to identify those who may be at high risk for developing lung cancer. A total of 115 new patients were identified as high risk and underwent low-dose computed tomography (LDCT).  Washington Hospital was awarded a three-year accreditation from the Commission on Cancer.

The Commission on Cancer is a program of the American College of Surgeons recognizing cancer care programs for their commitment to providing comprehensive, high-quality, and multidisciplinary patient-centered care.
 Washington Hospital was awarded a three-year accreditation from the American College of Surgeons National Accreditation Program for Breast Centers.  Both accreditations were received without any deficiencies, demonstrating Washington Hospital’s commitment to quality care based on national standards.  Washington Hospital was also designated as a Breast Imaging Center of Excellence by the American College of Radiology (ACR).
 Washington Hospital hosted a skin cancer screening event at the Nakamura Clinic in Union City. A total of 22 people were screened. Of those, two were recommended for biopsy.  In fall of 2022, Washington Hospital established a cancer survivorship program built on the coordination of services between care providers and specialists to provide an assessment of late psychosocial and physical effects of cancer. Through this program, a referral system with social work was established. The program also hosts a monthly general cancer survivor support group.  The Washington Hospital Survivorship Committee meets quarterly. These meetings help coordinate efforts across oncology services and include representation from clinical staff, social work, nursing, community outreach, cancer registry program, physical therapy, lymphedema, and radiation oncology.

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WRITTEN PUBLIC COMMENTS
Washington Hospital welcomes and encourages written public comments about its CHNA and implementation strategy reports. Feedback may be submitted through the Contact form on its website7 or emailed directly to [email protected].

At the time this CHNA report was completed, Washington Hospital had not received any written comments about the (previous) 2020 CHNA report.8 The hospital will continue to track submissions and ensure that all relevant comments are reviewed and addressed by appropriate staff members. 7 https://www.whhs.com/contact-us/
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3. ABOUT WASHINGTON HOSPITAL
Washington Hospital Healthcare System is a District hospital, opened in 1958. It is governed by an elected Board of Directors consisting of five members. Washington Hospital serves the residents of Fremont, Newark, Union City, and part of southern Hayward and unincorporated Sunol, and it encompasses approximately 124 square miles of Southern Alameda County. The District's population is approximately 350,145.9

MISSION STATEMENT
As the local Healthcare District, our mission is to meet the healthcare needs of the District residents through medical services, education, and research.

Within this scope, Washington Township Healthcare District is committed to assuming the leadership role in improving and maintaining the health status of its residents by:
● Identifying and assessing community healthcare needs. ● Developing mechanisms to respond to the identified need within the financial capabilities of the District.
● Committing to a culture of patient safety and accountability. ● Adopting identified best practices.
● Providing access to high quality, cost-effective health services through an integrated delivery system.
● Partnering with a diverse medical staff and other providers to meet the healthcare needs of district residents.
● Providing appropriate employee, professional, and community educational resources to enhance patient care and health promotion throughout the District.

VISION
To support the fulfillment of the mission, the District's strategic vision is to be the regional medical center of choice in Southern Alameda County offering quality services that span the full range of care within the available financial resources.

VALUES STATEMENT
● Our organizational values stem directly from the origins of the Hospital District in 1948. The District was formed to provide access to patient care services for the residents of the Township, at a time when people had to leave their community and travel significant distances to find hospital care. The District serves its community by providing high quality, affordable, and convenient care. We are committed not only in law, but in spirit to local accountability. ● Healthcare is an intensely personal service. Underlying all that we offer is the recognition that healthcare is not a commodity. Our essential purpose is to improve the human condition. Our reason for being begins and ends with our patients and our community, and we are committed to a "patient first" ethic. To our patients we owe comfort, compassion, and whenever possible, a 9 Sum of the populations of the three major cities: Fremont, Newark, and Union City. Data from U.S. Census Bureau, 5-year Estimates, 2017-2021.

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cure. Our efforts are focused not just on individuals and families, but also on the overall health of the community.
● It is our obligation to provide responsible stewardship of our resources, acting in all areas of our healthcare system with integrity, professionalism, and with respect for a patient's right to choice. ● To our fellow employees, volunteers, and members of our medical staff we owe a commitment to perform all of our responsibilities with loyalty, perseverance, self-discipline, and dependability.

We achieve these goals through our organizational commitment to innovation, process improvements, and pursuit of excellence.

COMMUNITY BENEFIT PROGRAMS
Each year, Washington Hospital provides a host of innovative and impactful community benefit programs and services to underserved and underinsured residents. The hospital’s community benefit programs and activities are designed to:
● Meet the specific healthcare needs of targeted populations; ● Expand availability of healthcare to those who need it most; ● Provide health information and education resources; and ● Teach participants about healthier lifestyles and the importance of staying healthy.

These programs are developed to meet the needs of the community.

COMMUNITY SERVED
The IRS defines the “community served” by a hospital as those individuals residing within its hospital service area. A hospital service area includes all residents in a defined geographic area and does not Figure 1. Map of Washington Township Healthcare District Packet Page 62
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exclude low-income or underserved populations. Although Washington Hospital patients come from all around Alameda County, the majority reside in the southern part of Alameda County. Washington Hospital’s primary service area comprises the cities of Fremont, Newark, Union City, and a portion of southern Hayward, as well as unincorporated Sunol (see map on previous page).

Demographics
In 2021, the estimated population of the major cities included in the primary service area was approximately 350,145.10 Fremont is the largest city in the primary service area and the fourth-largest city in the San Francisco Bay Area. Washington Hospital’s primary service area also includes portions of unincorporated Sunol and southern Hayward, for which population data are not available.

Figure 2. Race/Ethnicity Proportions, Major District Cities Source: U.S. Census Bureau, Decennial Census, 2020. Notes: U.S. Census race/ethnicity estimates for 2017–2021 not available at time of report publication. Proportions are for race “alone” (single race) and non-Hispanic. * Purple segment is those of all other races combined (Pacific Islander/native Hawaiian, Native American, and “Other” race). Native American residents make up 0.2% of the city populations (not labeled in the chart). Those of “Other” race alone (not multi-racial) make up 1% or less of the cities’ populations (not labeled in the chart). Pacific Islander/native Hawaiian make up 1% or less of the cities’ populations (not labeled in the chart). 10 U.S. Census Bureau, 5-year Estimates, 2017-2021.

Asian
33%
Asian
65%
Asian
42%
Asian
59%
Asian
61%
Asian
15%
Hispanic/
Latino
24%
Hispanic/
Latino
13%
Hispanic/
Latino
31%
Hispanic/
Latino
22%
Hispanic/
Latino
17%
Hispanic/
Latino
40%
White
29%
White
17% White
19%
White
11%
White
16%
White
35%
Black, 10%
Black, 2%
Black, 3% Black, 4% Black, 3%
Black, 5%
Multiple, 3% Multiple, 2% Multiple, 3% Multiple, 2% Multiple, 2% Multiple, 3% All other*, 4% All other*, 3% All other*, 4% All other*, 3% All other*, 3% All other*, 4% Alameda County Fremont Newark Union City Washington District Cities Subtotal
California
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The largest racial/ethnic group in Washington Hospital’s primary service area cities is Asian, comprising at least one-third of the population in each city and two-thirds in Fremont. The service area cities have a larger proportion of Asian residents than the county and the state. Newark has a much higher proportion of Hispanic/Latino residents (30%) compared to the other two cities, the county, and the state.

The residents of Washington Hospital’s primary service area speak a variety of languages. The most common languages include Spanish, Chinese (Cantonese and Mandarin), Hindi, and Tagalog. More than 15% of Fremont’s population and more than 20% of Union City’s population speak limited English.11 Speaking limited English can be a barrier to an individual’s economic security and access to healthcare.

Washington Hospital’s primary service area cities’ proportions of residents by age are displayed in the chart below. Union City’s population skews a bit older than the other two cities.

Figure 3. Population by Age Range and City, Washington Hospital Primary Service Area Source: U.S. Census Bureau, American Community Survey, 5-Year Estimates 2017-2021. Notes: CA stands for California; AC stands for Alameda County; UC stands for Union City.
11 Limited English is defined as those who are over five years of age and speak English less than “very well.” U.S.

Census Bureau. (2023). Data on Limited English is not available for Newark. 70 and over
10%
70 and over
9%
70 and over
8%
70 and over
9%
70 and over
11%
60-69
11%
60-69
11%
60-69
10%
60-69
10%
60-69
13%
50-59
13%
50-59
13% 50-59
13%
50-59
14%
50-59
14%
40-49
13%
40-49
14%
40-49
16%
40-49
13%
40-49
14%
30-39
15%
30-39
17%
30-39
17%
30-39
18%
30-39
15%
20-29
14%
20-29
14%
20-29
11%
20-29
14%
20-29
13%
15 to 19 years, 7% 15 to 19 years, 6% 15 to 19 years, 5% 15 to 19 years, 6% 15 to 19 years, 5%
5 to 14 years
13%
5 to 14 years
12%
5 to 14 years
14%
5 to 14 years
10%
5 to 14 years
11%
Under 5 years, 6% Under 5 years, 6% Under 5 years, 6% Under 5 years, 7% Under 5 years, 5% CA AC Fremont Newark UC
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4. ASSESSMENT TEAM

HOSPITALS, OTHER PARTNER ORGANIZATIONS, AND CONSULTANTS Washington Hospital’s 2023 CHNA involved input from the following individuals:
● Angus Cochran, PhD, Chief, Community Support Services ● Kayla Gupta, MPH, Community Outreach Manager
● Alisa Curry, PT, DPT, Coordinator of Rehab Clinical Programs ● Donald Pipkin, MHA, Chief of Strategic Management
● Christine Nunez, MPH, Vice President of Ambulatory Care and Administrative Services ● Kimberly Hartz, Chief Executive Officer
Washington Hospital’s conducted the CHNA with the support of consultants from Actionable Insights (AI), LLC, an independent local research firm. AI assisted with primary and secondary data collection and synthesis, as well as facilitation and documentation of key findings.

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5. PROCESS AND METHODS
Washington Hospital Healthcare System directed the research firm Actionable Insights (AI) to collect data specific to the three cities in the hospital’s primary service area. The CHNA data collection process took place over five months and culminated in a report written for Washington Hospital in the winter of 2022–2023. The phases of the process are depicted below (Figure 4).

Figure 4. CHNA Process

SECONDARY DATA COLLECTION
AI analyzed over 125 quantitative health indicators to assist Washington Hospital in understanding the health needs and in assessing its priorities in the community. AI collected data from existing sources using the Alameda County Public Health Department’s data platform, https://www.healthyalamedacounty.org/, and other online data platforms, such as the Healthy Alameda County data platform and the U.S. Census Bureau. For the CNHA, each city’s data were compared to regional benchmarks (Alameda County averages and rates) to help determine the severity of a health problem and to identify disparities. When trend data and/or data by ethnicity were available, they were reviewed to enhance understanding of the issue(s).

For details on specific sources and dates of the data referenced in this report, see Attachment 2:

Secondary Data Tables.

INFORMATION GAPS AND LIMITATIONS
A lack of secondary data limited Washington Hospital in its ability to assess some health issues. Timely, reliable statistical information related to these topics was unavailable:
● Alzheimer’s disease and dementia diagnoses
● Data for the part of southern Hayward in Washington Hospital’s primary service area ● Data for unincorporated Sunol
● Diabetes among children
● Experiences of discrimination among vulnerable populations ● Health of undocumented immigrants (who do not qualify for subsidized health insurance and may be underrepresented in survey data)
● Hepatitis C
● Oral/dental health
● Suicide among LGBTQI youth
Secondary
Data
Collection
Primary Data
Collection
Data
Synthesis
Health
Needs List Prioritization Report Writing
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COMMUNITY INPUT
AI conducted the primary research for this assessment. AI used three strategies for collecting community input: key informant interviews with health experts and community service experts, focus groups with professionals who represent and/or serve the community or residents, and focus groups with residents. Individuals representing vulnerable populations, including low-income, minority, LGBTQ, individuals with disabilities, limited English-proficient, and medically underserved, were included.12 AI, in collaboration with the hospital, generated primary research protocols based on facilitated discussion among the CHNA team’s members about what they wanted to learn during the 2021–2023 CHNA. The study team sought to build upon prior CHNAs by focusing the primary research on topics and subpopulations that are less well understood by the statistical data. For example, the experiences of the population of disabled individuals in the hospital’s primary service area are often obscured by statistics that represent the entire county’s population. The 2023 study team specifically convened a focus group of professionals who serve disabled individuals and older adults to better understand this population through primary qualitative research.

Actionable Insights conducted the key informant interviews and focus groups for this assessment. AI recorded each interview and focus group as a standalone piece of data. Recordings were transcribed, and then AI used qualitative research software tools to analyze the transcripts for common themes. AI also tabulated how many times health needs were prioritized by each of the focus groups or described as a priority in a key informant interview. Washington Hospital used this tabulation to assess community health priorities.

Across the key informant interviews and focus groups, AI solicited input from 27 community leaders and representatives of various organizations and sectors.13 These representatives either work in the health field or in community-based organizations focused on improving health and quality of life conditions by serving those from IRS- and California HCAI-identified vulnerable populations.

See Attachment 1: Community Leaders, Representatives, and Members Consulted for the names, titles, and expertise of these leaders and representatives, as well as the date and mode of consultation (focus group or key informant interview). See Attachment 4: Qualitative Research Protocols for details on the protocols and questions used.

Key Informant Interviews
In October 2022, Actionable Insights spoke with seven experts from Alameda County Public Health and various organizations in Southern Alameda County. Interviews were conducted virtually via Zoom for approximately one hour. Prior to each interview, participants were asked to complete a short online survey, in which they were asked to identify the health needs they felt were the most pressing among the people they serve. Interviewees could choose up to three needs from the list of needs presented to 12 The IRS requires that community input include the low-income, minority, and medically underserved populations. California’s HCAI requires that community input include the IRS-identified populations as well as vulnerable populations such as LGBTQ, unhoused individuals, individuals with disabilities, and individuals with limited English proficiency.
13 Note that one of these individuals was both a key informant interviewee and a focus group attendee. This individual is counted only once in the total of 27, but is listed in both sections.

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them, which had been identified in the hospital’s service area in 2020, or could write in needs that were not on the 2020 list. Also in the survey, participants were advised of how their interview data would be used and were asked to consent to be recorded. Finally, participants were offered to be listed in the report and were asked to provide some optional basic demographic information.

Discussions centered around four questions for each health need prioritized by interviewees:
● How do you see the need playing out?
● Which populations are experiencing inequities with respect to this need? ● How have things changed in the last few years, related to this need? ● What is needed (including models/best practices) to better address this need? AI sent a similar survey to focus group participants and asked focus groups the same questions during discussion. These questions were modified appropriately for each audience. Focus group discussions centered on the needs that had received the most votes from prospective participants in the online presurvey.

See Attachment 4: Qualitative Research Protocols for complete protocols and questions, including presurveys. See Attachment 1: Community Leaders, Representatives, and Members Consulted for a list of key informants and focus group or interview details.

Focus Groups
AI conducted four focus groups in Southern Alameda County with a total of 21 professionals and 22 residents between September and November 2022. CHNA team members and/or nonprofit hosts recruited participants for the groups. To provide a voice to the community it serves, and in alignment with IRS regulations and California AB1204 (2021), the groups focused on vulnerable residents, including the unhoused, people with disabilities, LGBTQ, medically underserved, low-income, of a minority population, or those with limited English proficiency. Focus groups were asked the same questions as key informants, modified appropriately for each audience.

Table 1. List of Focus Groups Conducted for CHNA 2023
Topic or Population Focus Group Host/Partner Date
Number of
Participants
Southern Alameda County South County Partnership 9/20/2022 8 Disability community & older adults Washington Hospital 10/7/2022 13 Spanish-speaking community
members*
Newark Promotores Network 10/14/2022 15
English-speaking BIPOC community
members*
Washington Hospital 11/8/2022 7
* Indicates resident/community member group.

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CHNA Participant Demographics
A total of 49 people participated in focus groups or interviews for the CHNA. Thirty-nine participants (80%) provided demographic data.

The charts below show the age ranges of participants (N=39), as well as their race (N=38); note that individuals could choose more than one race. More than two in five (41%) participants were of Hispanic/Latino ethnicity (N=39). Most participants (90%) identified as female, with almost all of the rest identifying as male. On average, participants were aged 48 years.

Figure 5. Participant Age Groups Figure 6. Participant Racial/Ethnic Groups

IDENTIFICATION OF COMMUNITY HEALTH NEEDS
In the analysis of quantitative and qualitative data, many health issues surfaced. To be identified as a community health need, an issue had to meet certain criteria, listed below Figure 7. See the Definitions box on the next page for additional terms and definitions.

Figure 7. Washington Hospital 2023 Health Needs Rubric
8%
28%
33%
26%
5%
Age 25-34 Age 35-44 Age 45-54 Age 55-64 Age 65+
White,
63%
Asian,
21%
Black,
5%
Native
American/
Alaskan
Native, 5%
Other,
5%
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Health Needs Identification Criteria

1. Meets the definition of a health need (see the Definitions box, below).

2. At least two indicators for the health issue are available for the subcounty area.14

3. Meets the statistical data criteria:14
a. Multiple indicators are worse than the county by 5% or more, or b. Multiple inequities by race/ethnicity are a concern.

4. Meets the community priority criterion: Prioritized (i.e., voted in as top three to discuss) by at least one-half of all community input cases (interviews or focus groups).

In 2023, this process led to the identification of eight community health needs that fit the criteria. That list of needs, in descending order of priority, appears below.

PRIORITIZATION OF HEALTH NEEDS
The IRS CHNA requirements state that hospital facilities must identify and prioritize the significant health needs of the community. As described previously, Actionable
Insights solicited qualitative input from focus group and interview participants about which needs they thought
were the highest priority (i.e., most pressing).

The hospital used this feedback to identify and rank the significant health needs as follows:
● Behavioral Health
● Housing & Homelessness
● Economic Security
● Diabetes & Obesity (tied)
● Heart/Stroke (tied)
● Healthcare Access & Delivery
● Respiratory Health
● Cancer
See Section 6: 2023 Prioritized Community Health Needs
(pages 30-41) for a summarized description of each need.

For further details, including statistical data, see Attachment 2: Secondary Data Tables.

Health Disparities and Inequities
Washington Hospital acknowledges the health impacts that come from racial/ethnic disparities. It is clear that inequitable health and economic outcomes can be attributed in part to structural and institutional 14 For any Southern Alameda city (Fremont, Newark, and Union City) or Assembly District 20 (2019).

Health indicator: A characteristic
of an individual, a population, or an
environment that can be measured
(directly or indirectly) and used to
describe one or more aspects of the
health of an individual or population.

Health need: A poor health
outcome and its associated risk(s), or
a risk that may lead to a poor health
outcome.

Health outcome: A snapshot of a
disease/health event in a community
that can be described in terms of
both morbidity (illness or quality of
life) and mortality (death).

Health risk: A behavioral, social,
environmental, economic, or clinical
care factor that impacts health. May
be a social determinant of health.

DEFINITIONS
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racism.15 For example, BIPOC community members may
cope with toxic stress due to their experiences of
discrimination. The physical toll this can take on their bodies has no equivalent among white Americans.

Additionally, inflammation from toxic stress contributes to greater comorbidities among the BIPOC population in the U.S. compared to whites.16 BIPOC individuals are also
more likely to work higher-risk and/or low-wage jobs, in part due to employment discrimination17, and to live in crowded or substandard conditions and impoverished
neighborhoods, in part due to historical red-lining policies and present-day housing discrimination.18 All of these
issues contribute to poorer health outcomes for BIPOC
community members than white people for nearly all
health conditions, including COVID-19 infection.

With regard to economic outcomes, people of color are
more likely to have less formal schooling than whites, in part due to education discrimination19 and in part because they are more likely to attend segregated, underperforming schools.20 This, combined with possible employment discrimination, makes it more likely that
they’ll earn less, too.21
15 Garcia, M. A., Homan, P. A., García, C., & Brown, T. H. (2020). The color of COVID-19: structural racism and the pandemic’s disproportionate impact on older racial and ethnic minorities. The Journals of Gerontology: Series B.

Retrieved from https://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1735&context=sociologyfacpub 16 Adler, N. E., & Rehkopf, D. H. (2008). U.S. disparities in health: descriptions, causes and mechanisms. Annual Review of Public Health, 29:235–252.
17 See meta-analysis: Neumark, D. (2018). Experimental research on labor market discrimination. Journal of Economic Literature, 56(3), 799-866. Retrieved from
https://www.nber.org/system/files/working_papers/w22022/w22022.pdf 18 Acevedo-Garcia, D., Noelke, C., & McArdle, N. (2020). The Geography of Child Opportunity: Why Neighborhoods Matter for Equity. Diversitydatakids.org, Institute for Child, Youth and Family Policy, The Heller School for Social Policy and Management, Brandeis University: Waltham, MA. Retrieved from https://www.diversitydatakids.org/sites/default/files/file/ddk_the-geography-of-child-opportunity_2020v2.pdf 19 Adair, J. K. (2015). The impact of discrimination on the early schooling experiences of children from immigrant families. Washington, DC: Migration Policy Institute. Retrieved from https://www.migrationpolicy.org/research/impact-discrimination-early-schooling-experienceschildren-Immigrantfamilies 20 Reardon, S.F., Weathers, E.S., Fahle, E.M., Jang, H., & Kalogrides, D. (2019). Is separate still unequal? New evidence on school segregation and racial academic achievement gaps. Retrieved from https://cepa.stanford.edu/content/separate-still-unequal-new-evidence-school-segregationand-Racial-academicachievement-gaps 21 Noymer, A., & Garenne, M. (2000). The 1918 influenza epidemic’s effects on sex differentials in mortality in the United States. Population and Development Review, 26(3), 565–581. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740912/. And Centers for Disease Control and Prevention. (2019).

In late 2019, a new coronavirus
(SARS-CoV-2) appeared. It causes a
respiratory illness that is now called
COVID-19. The ensuing pandemic has
been a health event of historic
proportions. In absolute terms, the
COVID-19 pandemic has surpassed
the 1918 influenza (H1N1) pandemic,
which killed 550,000 Americans (0.5%
of the U.S. population at that time).21
The COVID-19 pandemic shows signs
of continuing for the foreseeable
future. In Alameda County, the
numbers of COVID-19 cases and
deaths peaked several times in 2020,
2021, and 2022. However,
vaccinations—which began in early
2021—appear to be mitigating local
hospitalizations and deaths.

See the next page for more
information and statistics on COVID19 infections, vaccinations, and deaths as of March 2023.

COVID-19
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These issues drove Washington Hospital to incorporate racial/ethnic disparities in the CHNA in the following ways, including as a key health need criterion:
● Compared data by race/ethnicity when available (see Attachment 2: Secondary Data Tables). ● Compared data by sub-county geographies when available (see Attachment 2: Secondary Data Tables).
● Asked every single key informant and focus group to identify local populations they felt were experiencing inequities related to each need that the informant or focus group prioritized (see Attachment 4: Qualitative Research Protocols).
● Among other criteria, identified an issue as a health need if multiple inequities by race/ethnicity were a concern (see Identification of Community Health Needs sub-section above).

Because COVID-19 is a new virus, many health
effects and healthcare needs are still emerging.

This CHNA report summarizes what the
participating hospitals know so far about the
health condition and its social determinants. The
hospital will continue to monitor and address
health effects, trends, and healthcare needs of
COVID-19 as it learns more about the disease, its
progression, and its short- and long-term impacts.

Women in particular left the workforce in large
numbers in 2020 and 2021, The pandemic has
exacerbated existing inequities in the health and
welfare of vulnerable populations in the U.S.,
when school closures created a need for child
care, a responsibility much more likely to fall on
their shoulders than men’s. While Washington
Hospital acknowledges the negative health effects
of COVID-19 itself, this CHNA report focuses on
identifying the broader health inequities and
socioeconomic consequences of COVID-19 in its
service area causing disproportionate illness and
mortality for people in minority racial and ethnic
groups (i.e., Black, Indigenous, and people of
color: BIPOC), people with certain pre-existing
1918 Pandemic (H1N1 virus). Retrieved from https://www.cdc.gov/flu/pandemic-resources/1918-pandemich1n1.html 22 Campbell, J. (2020). What are essential services and jobs during the coronavirus crisis? Huffington Post. Retrieved from: https://www.huffpost.com/entry/what-are-essential-services-jobs_l_5e74eaacc5b6f5b7c543370c 23 Data: Burns, A. (2023). Long COVID: What Do the Latest Data Show? Kaiser Family Foundation. Retrieved from https://www.kff.org/policy-watch/long-covid-what-do-latest-data-show/ health conditions, people living in crowded
conditions, and people who are classified as
“essential workers” (at higher risk of workplace
exposure).22 More than one in four people (28%)
who were infected experience “long COVID,” a
set of lingering symptoms including “fatigue, body
aches, shortness of breath, difficulty
concentrating” that lasts a year or more.23 And a
small but not insignificant percentage (5%) of the
U.S. adult population reports “struggling with
activity limitations from long COVID.”23
Perhaps the most far-reaching impacts of COVID19 are socioeconomic. The government mandates shutting down or limiting activities in major
industries (tourism, hospitality, brick-and-mortar
retail and services, etc.) exacerbated the inequities
experienced by many of the vulnerable
populations identified above. Women, BIPOC,
young people (ages 16–24), and those with low
income (usually defined as less than 80% of the
area median income) or without college degrees
have also been impacted by job loss, housing
insecurity, food insecurity, and other difficulties,
all of which are likely to persist.

COVID-19 continued
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6. 2023 PRIORITIZED COMMUNITY HEALTH NEEDS

SUMMARIZED DESCRIPTIONS OF PRIORITIZED NEEDS
❶ Behavioral Health
What Is the Issue?
Mental health—emotional and psychological well-being—is key to personal well-being, healthy relationships, and the ability to function in society.24 According to the U.S. Substance Abuse and Mental Health Services Administration, 21% of the adult U.S. population was coping with a mental illness in 2020, and rates were highest among young adults (over 30% among people ages 18 to 25).25 Mental and physical health are often closely related. For example, depression and anxiety can affect one’s ability for self-care. Likewise, chronic diseases can lead to negative impacts on an individual’s mental health.26 Additionally, the use of substances such as alcohol, tobacco, and legal and illegal drugs can lead or contribute to many social, physical, mental, and public health problems, both for the individual using them and also their families and communities. Increasingly, substance use is seen as a disorder that can develop into a chronic illness requiring lifelong treatment and monitoring.27 Why Is It a Health Need?
The community considered behavioral health a strong priority, as evidenced by the fact that it was discussed at length in almost all key informant interviews and focus groups. The lack of access to behavioral health services and facilities was cited, including information about how to access existing resources. Not surprisingly, pandemic isolation was a big concern, especially for older adults, those with medical vulnerabilities, and LGBTQIA+ residents who may already have felt disconnected from their families at home and seek connection in community centers. Parents expressed concern about alcohol and drug use, which is supported by the data below. Students also report depression-related feelings at higher rates in some cities than in the county. Also, adult binge drinking and 7th grade binge drinking are both higher in Newark than in the county.

In terms of racial inequity, white, Black, and Hispanic/Latino students usually have highest rates of alcohol and drug use (see charts in Figure 8) but the only group that is worse than the county is in Newark Unified School District; 18% of Black youth use drugs and alcohol compared to 16% of Black youth in Alameda County overall. Also, multiracial adults and white adults have higher rates of likely serious psychological distress (24% and 13% respectively) than in the county overall (10%). 24 Office of Disease Prevention and Health Promotion. (2018). Mental Health and Mental Disorders. 25 U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). (2021). Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. U.S. Department of Health and Human Services, SAMHSA. Retrieved from https://www.samhsa.gov/data/sites/default/files/reports/rpt35325/NSDUHFFRPDFWHTMLFiles2020/2020NS DUHFFR1PDFW102121.pdf
26 Lando, J., & Williams, S. (2006). A logic model for the integration of mental health into chronic disease prevention and health promotion. Preventing Chronic Disease. 2006 Apr. 3(2): A61. 27 Office of Disease Prevention and Health Promotion. (2018). Substance Abuse.

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Figure 8. Student Alcohol and Drug Use by Race/Ethnicity for School Districts in Washington Hospital Service Area (Percentage)
Note: Nat Am=American Indian/Alaskan native; Pac Isl=Pacific Islander/native Hawaiian; Multi=Two or more races; Latino= Hispanic/Latina/o. Source: California Healthy Kids Survey. 2017-2019.

If I need mental healthcare, I can call and I’ll get an appointment eight, 10 weeks out. [Somebody] who is on the street or in a harmful situation, they don’t have eight to 10 weeks. Asking somebody to hold on that long to get care is like asking a fish to ride a bicycle, it’s just not going to happen. So having access [for] somebody who is like, “In this moment, I would accept care right now.” Cool. How do we connect? And I suspect it’s a whole workforce issue, that there’s just not enough people. Being able to move quickly to [provide] culturally responsive, appropriate care, it’s just a giant gap. It’s this giant, giant gap that we’re facing. – South County Partnership member
Table 2. Concerning Indicators for Behavioral Health
Indicator Name Fremont Newark UC AC
Alcohol: Binge Drinking, Adults (percent) 15.1 16.7 14.3 15.8 Alcohol/Drug Use in Past Month: 7th Grade (percent) 3.2 6.7 6.4 5.1 Alcohol/Drug Use in Past Month: 9th Grade (percent) 7.1 10.8 18.3 13.3 Alcohol/Drug Use in Past Month: NT (percent) 48.6 31.9 28.6 42.3 Alcohol: Binge Drinking: 7th Grade (percent) 0.2 0.8 0.1 0.2 Depression-Related Feelings: 7th Grade (percent) 22.1 28.6 34.7 25.6 Depression-Related Feelings: 9th Grade (percent) 27.6 34.5 41.5 29.9 Depression-Related Feelings: 11th Grade (percent) 36.9 36.0 41.4 35.2 Depression-Related Feelings: NT (percent) 42.9 32.4 47.1 37.4 Notes: Binge drinking is two or more occasions where five or more drinks of alcohol within a couple of hours were consumed. Brown shading indicates a statistic is worse than the county by 5% or more. UC stands for Union City; AC stands for Alameda County. NT stands for students in non-traditional schools. See Attachment 2: Secondary Data Tables for all sources.

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❷ Housing & Homelessness
What Is the Issue?
The physical condition of a home, its neighborhood, and the cost of rent or mortgage are strongly associated with the health, well-being, educational achievement, and economic success of those who live inside.28 Even when housed, if that housing is not affordable and exceeds 30 percent of a household’s annual income, a family is often unable to afford other necessities, such as food, clothing, transportation, and medical care.29 The U.S. Department of Health and Human Services also notes that “people with the lowest incomes may be forced to rent substandard housing that exposes them to health and safety risks.”30 Further, people who are experiencing homelessness have been shown to have more healthcare issues than people who aren’t, to suffer from preventable illnesses at a greater rate, to require longer hospital stays, and face a greater risk of premature death.31 Healthcare systems must monitor the local homeless population and identify the population’s health needs. Additionally, remaining aware of housing conditions and affordability for all populations helps to inform a hospital’s related efforts in the community.

Why Is It a Health Need?
The cost of housing in the Bay Area is extremely expensive, and the community identified this as one of the most pressing health needs. Because housing is difficult to afford, community members described seeing more people struggling with other living expenses. The number of homeless people in Alameda County has increased in the last two years (by 22%), a trend also seen in Fremont and Union City. In Fremont and Union City, the proportions of people who are unsheltered are worse than in the county.

Figure 9. Total Homeless Population by City and Year
Source: Applied Survey Research. Alameda County Point-in-Time Count. 2022. 28 Pew Trusts/Partnership for America’s Economic Success. (2008). The Hidden Costs of the Housing Crisis. See also:

The California Endowment. (2015). Zip Code or Genetic Code: Which Is a Better Predictor of Health? 29 U.S. Department of Housing and Urban Development. (2018). Affordable Housing. 30 U.S. Department of Health and Human Services. (Undated). Housing Instability. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Healthy People 2030. 31 O’Connell, J.J. (2005). Premature Mortality in Homeless Populations: A Review of the Literature. Nashville, TN: National Health Care for the Homeless Council.
608
89 106
1026 58 489
Fremont Newark Union City
2019 2022
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Community members have taken note of the increase in people living in cars and encampments. In addition, emergency shelter space has been more limited because of COVID restrictions; this reduction in the number of beds impacts those who are escaping domestic abuse. We also know that some populations, especially Black residents, are overrepresented in the homeless population (i.e., the percent of homeless who are Black residents is much larger than the proportion of the overall population who are Black). (See Figure 9, previous page.)
Figure 10. Populations Overrepresented in the Alameda County Homeless Population Source: Applied Survey Research. Alameda County Point-in-Time Count. 2022.

Table 3. Concerning Indicators for Housing & Homelessness Indicator Name Fremont Newark UC AC
Total Homeless Count 1,026 58 489 9,747
Unsheltered homeless (percent of total count) 84 55 100 73 Chronically homeless (percent of total count) 27 48 -- 28 Notes: HUD defines sheltered homeless persons as adults, children, and unaccompanied children who, on the night of the count, are living in shelters for the homeless. Brown shading indicates a statistic is worse than the county by 5% or more. UC stands for Union City; AC stands for Alameda County. See Attachment 2: Secondary Data Tables for all sources.

Our city just pushed out $15 million in rental assistance for folks, so right now we’re still under an eviction moratorium for Alameda County... And so, I think when that moratorium is lifted, eventually we’re going to see a lot of evictions and potentially more people ending up either having to leave the area or ending up in the homeless category.
– South County Partnership member
23% 1% 25% 1% 34% 10%
3% 4%
39% 43%
Latino Pac Isl Nat Am White Black
Percent of Pop. Percent of AC Homeless Pop.

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❸ Economic Security
What Is the Issue?
Social and economic environments are the greatest determinants of a population’s health,32 with a strong link between higher income and/or social status and better health. Childhood poverty has lasting effects: Even when economic and social environments later improve, childhood poverty still results in poorer long-term health outcomes.33 Numerous studies have found that access to economic security programs (i.e., SNAP—formerly referred to as food stamps) and policies that positively influence economic conditions result in better long-term health and social outcomes.34 Additionally, the National Poverty Center reports that increased education is associated with decreased rates of most acute and chronic diseases.35 It is well established that educational attainment, employment rates, and household income are key indicators that show the economic vitality of an area and the buying power of individuals, including their ability to afford basic needs such as housing and healthcare.

Why Is It a Health Need?
Community input about economic security was dominant in every case; this input made up the highest proportion of the discussion after healthcare access and delivery. The community described the high cost of living, and difficulty securing employment for individuals with health issues, disabilities, or those experiencing homelessness. The community described a sharp rise in food insecurity in summer 2022.

Overall, people were worried about an increase of residents losing their housing due to economic difficulties. In Newark and Union City per capita income is lower (6% and 13% respectively) than Alameda County. However, most data indicators, including measures of poverty, are favorable for Washington Hospital’s service area cities. Data also show inequities by race (see table). Overall, most BIPOC populations have lower incomes than their counterparts and higher proportions of their populations who are living in poverty. Also, the proportions of youth not in school nor working are higher in Newark (1.7%) and Union City (1.8%) than in the county overall (0.7%).

Table 4. Concerning Indicators for Economic Security by Race/Ethnicity Indicator Name Latino
Nat
Am Asian Pac Isl Black White Multi AC
Median Household Income $83.0k $82.7k $130.2k $97.5k $56.7k $120.5k $99,712 $104.9k Per Capita Income $28.7k $34.2k $51.5k $32.5k $37.3k $70.2k $33,147 $49.9k Children Living Below FPL 14.6% 15.3% 5.1% 13.5% 27.0% 5.0% 8.1% 10.2% 32 County of Los Angeles Public Health. (2013). Social Determinants of Health: How Social and Economic Factors Affect Health.
33 World Health Organization. (2018). The Determinants of Health. 34 Center on Budget and Policy Priorities. (2018). Economic Security, Health Programs Reduce Poverty and Hardship, With Long-Term Benefits.
35 Cutler, D.M., & Lleras‐Muney, A. (2006). National Bureau of Economic Research. Education and Health: Evaluating Theories and Evidence (No. w12352).

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Indicator Name Latino
Nat
Am Asian Pac Isl Black White Multi AC
Families Living Below FPL 9.0% 12.4% 4.7% 8.5% 13.5% 2.6% 6.4% 5.8% Aged 65+ Living Below FPL 9.9% 22.4% 12.4% 10.6% 15.8% 6.3% 9.3% 9.8% Notes: Brown shading indicates a statistic is worse than the county by 5% or more. Latino stands for Hispanic/Latina/o. Nat Am stands for Native American/Alaskan native. Pac Isl stands for Pacific Islander/native Hawaiian. Multi stands for multiple races/ethnicities. AC stands for Alameda County. FPL stands for Federal Poverty Limit. See Attachment 2: Secondary Data Tables for all sources.

For Alameda County, there’s an index for what it actually costs to live in our county. If you look at that and you look at the incomes of our population, about 20 percent of people are kind of hanging on by their toenails to stay housed, and that’s not counting things like saving for a college education for your kid or taking a vacation. It’s just the basics for a family to survive. – South County Partnership member
❹ Diabetes & Obesity
What Is the Issue?
Nutrition and exercise are important aspects of a healthy lifestyle. The benefits of a healthy diet include preventing high cholesterol and high blood pressure, reducing the risks of developing diseases including cancer and diabetes, and helping to reduce the risks of obesity, osteoporosis, and dental cavities.36 Getting regular exercise can reduce the risk of cardiovascular disease, type 2 diabetes, some cancers, and other physical issues,37 while also strengthening bones and muscles, preventing falls for older adults, and increasing lifespan.38 Despite the well-known benefits, most people do not follow recommended healthy food and exercise guidelines. Most significantly, a poor diet and lack of regular exercise can lead to adult and childhood obesity, a serious and costly health concern in the U.S. that often results in some of the leading causes of preventable death,39 including type 2 diabetes.40 Why Is It a Health Need?
The community expressed the need for not only access to healthy food in grocery stores, but also to nutrition education in schools and communities. They also called out the need for recreation programs to prevent diabetes and more safe spaces to recreate/walk in their neighborhoods. This category met the threshold for a health need because of the statistical data; the proportions of children who are overweight are higher in Newark and Union City than in the county and state overall. Notably, the rates 36 United States Department of Agriculture. (2016). Why Is It Important to Eat Vegetables? 37 The Mayo Clinic. (2016). Exercise: 7 Benefits of Regular Physical Activity. 38 Harvard Health Publishing/Harvard Medical School. (2013). Balance Training Seems to Prevent Falls, Injuries in Seniors.
39 Centers for Disease Control and Prevention. (2016). Childhood Obesity Causes & Consequences. See also: Centers for Disease Control and Prevention. (2018). Adult Obesity Causes & Consequences. 40 Centers for Disease Control and Prevention (2018). Diabetes Quick Facts.

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of adults with diabetes are worse in all three service area cities, and rates of diabetes ED visits and hospitalization are issues in Fremont and Newark. Also, there are inequities by race for adult obesity and diabetes. (See tables.)
Table 5. Concerning Indicators for Diabetes & Obesity
Indicator Name Fremont Newark UC AC
Adults with Diabetes (percent) 11.4 13.6 13.7 10.3
Diabetes ED Visits Rate 1396 2053.8 2280.7 1541
Diabetes Hospitalization Rate 1307.9 1592.1 1831.7 1512 Adults who are Obese (percent) 19.0 24.6 21.2  25.4
Children who are Overweight for Age (Ages 2-11)
(percent) 13.3 15.0 15.2  14.3
Workers who Walk to Work (percent) 1.2 2.6 0.8  3.3
Notes: Brown shading indicates a statistic is worse than the county by 5% or more. Where trends were available, color-coded arrows are used to show directionality (green marks positive trends, and red marks negative trends.) UC stands for Union City; AC stands for Alameda County. See Attachment 2: Secondary Data Tables for all sources.

Table 6. Concerning Indicators for Diabetes & Obesity by Race/Ethnicity Indicator Name Latino
Nat
Am Asian Pac Isl Black White Multi AC
Adults with Diabetes 10.1% 11.5% 13.8% 9.6% 2.1% 10.3%
Adults who are Obese 29.2% 10.9% 43.8% 28.0% 38.5% 25.4% Workers who Walk to Work 3.3% 6.8% 3.1% 3.6% 2.3% 3.8% 3.7% 3.3% Notes: Brown shading indicates a statistic is worse than the county by 5% or more. Latino stands for Hispanic/Latina/o. Nat Am stands for Native American/Alaskan native. Pac Isl stands for Pacific Islander/native Hawaiian. Multi stands for multiple races/ethnicities. AC stands for Alameda County. See Attachment 2: Secondary Data Tables for all sources.

I’m someone who has diabetes… It’s very difficult to find affordable organic food, food classes, nutrition classes… That’s something that’s very important because there’s a large percentage of us who are suffering from this illness. – Southern Alameda County resident
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❹ Heart/Stroke
What Is the Issue?
Nationally, some 84 million people suffer from a form of cardiovascular disease.41 Heart disease is the #1 killer of both men and women,42 and stroke is the fifth leading cause of death and a significant cause of serious disability for adults.43 Recent research has established that disparities exist between minority and non-minority cardiovascular health outcomes across the U.S.44 Although some risk factors for heart disease and stroke are not controllable (age, race/ethnicity, gender), some risk factors can be controlled (high blood pressure, high cholesterol, obesity, excessive alcohol consumption, smoking, an unhealthy diet, lack of physical activity). Left untreated, these risk factors can lead to changes in the heart and blood vessels. Over time, those changes can lead to heart attacks, heart failure, strokes, and other forms of cardiovascular disease.45 Addressing risk factors early in life can help in preventing chronic cardiovascular disease.46, 47
Why Is It a Health Need?
Cerebrovascular issues such as stroke, heart disease, and heart attack are among the top causes of death in the county. Statistical data shows that service area cities fare worse than the county overall.

The community did not discuss heart and stroke issues specifically, but they did call out the need for recreation programs to prevent heart problems and for nutritional education for older adults. Heart and stroke issues are considered a health need because of the statistical data. Notably, in Union City, residents have worse rates than other service area cities and the county for emergency department visits (stroke, hypertension, and heart failure), hospitalizations (heart disease, hypertension), and mortality (acute myocardial infarction, heart disease, and ischemic heart diseases). Stroke mortality has been decreasing in Fremont and Newark but increasing in Union City, and it is higher there than the Healthy People 2030 benchmark. No data are available by race/ethnicity.

Table 7. Concerning Indicators for Heart/Stroke
Indicator Name Fremont Newark UC AC
Stroke ED Visits Rate 45.1 54.0 68.9 56.2
Hypertension ED Visits Rate 2311.1 2994.1 3517.9 2827.2 Heart Failure Emergency Dept Visit Rate 339.4 423.5 481.5 413.9 41 Johns Hopkins Medicine. (2018). Cardiovascular Disease Statistics. 42 Centers for Disease Control and Prevention. (2017). Heart Disease Facts. 43 Centers for Disease Control and Prevention. (2018). Stroke. 44 Graham, G. (2015). Disparities in cardiovascular disease risk in the United States. Current Cardiology Reviews, 11(3):
238–245.
45 American Heart Association. (2017). What Is Cardiovascular Disease? 46 The Mayo Clinic. (2016). Strategies to Prevent Heart Disease. 47 Centers for Disease Control and Prevention. (2017). Leading Causes of Death.

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Indicator Name Fremont Newark UC AC
Heart Disease Hospitalization Rate 464.6 534.4 622.2 565.7 Hypertension Hospitalizations Rate 1936.8 2264.3 2736.9 2520.5 Acute Myocardial Infarction Mortality Rate 14.3 14.7 27.8 19.9 Heart Disease Mortality Rate 86.9 90.9 120.1 109.0
Ischemic Heart Diseases Mortality Rate 49.9 48.7 75.6 56.0 Notes: Brown shading indicates a statistic is worse than the county by 5% or more. Bold text indicates that an indicator is worse than the county but by less than 5%. UC stands for Union City; AC stands for Alameda County. ED stands for Emergency Department. See Attachment 2: Secondary Data Tables for all sources.

Figure 6: Stroke Mortality (Age-adjusted Rate per 100,000 pop.) Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from with data from Alameda County vital statistics files, 2009–2020. ICD-10 codes I60-I69. ❻ Healthcare Access & Delivery
What Is the Issue?
Access to comprehensive healthcare is important to everyone’s health and quality of life.48 Components of access to care include insurance coverage and adequate numbers of primary and specialty care providers. Components of delivery of care include quality, transparency, timeliness, and cultural competence/cultural humility. Limited access to healthcare and compromised delivery can hinder people’s ability to reach their full potential. As reflected in statistical and qualitative data, barriers to receiving quality care include high costs and a lack of availability, insurance coverage, and/or cultural competence on the part of providers. These barriers lead to unmet health needs, delays in receiving appropriate care, and an inability to attain preventive services. 48 Office of Disease Prevention and Health Promotion. (2015). http://www.healthypeople.gov 0 10
20 30
40 50
2011 2012 2013 2014 2015 2016 2017 2018 2020
Fremont Newark
Union City Alameda County
HP2020 Benchmark
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Why Is It a Health Need?
Access to healthcare and the experiences of receiving care were dominant in the community input.

Costs of insurance and healthcare services are still unaffordable, even for those who have insurance.

Also, some community members who are employed but have trouble making ends meet find it difficult to qualify for Medi-Cal.

Residents perceive that there is a relative lack of facilities in southern Alameda County compared to other areas of the county. Monolingual Spanish-speaking residents described problems communicating with doctors and being unable to participate in some community health programs. Communication is also difficult for non-verbal residents, including those who are Deaf/Hard of Hearing. LGBTQ+ community members described recent improvements in health care delivery, and also stressed that more health professionals need to become culturally competent to serve this population. Cultural competency in healthcare is also important for those in the service area from non-Western cultures; for example, some families make health decisions together, but clinicians often do not include family members or communicate with them. Professionals who gave input described the ongoing difficulty in retaining healthcare staff due to cost of living and outmigration, creating a lack of capacity to serve residents, particularly in non-English languages.

In terms of statistics, local data fare well compared to the county, including the proportion of insured residents, those who had recent physical and dental visits, and access to internet at home. However, there are notable inequities. Pacific Islanders have lower rates of adult health insurance than their peers (66.7%). Several subpopulations have more difficulty obtaining care compared to the county population overall (13.1%): Native American (94%), white (17.1%), and multiracial (29.7%), as well as women overall (16% compared to 10% for men).

Table 8. Concerning Indicators for Healthcare Access & Delivery by Race/Ethnicity Indicator Name Latino
Nat
Am Asian Pac Isl Black White Multi AC
Adults with Health
Insurance (18-64) 90.3% 93.4% 66.7% 89.5% 96.3% 90.0% 93.2% People Delayed or Had
Difficulty Obtaining Care 6.9% 94.0% 11.1% 10.6% 17.1% 29.7% 13.1% Notes: Brown shading indicates a statistic is worse than the county by 5% or more. Latino stands for Hispanic/Latina/o. Nat Am stands for Native American/Alaskan native. Pac Isl stands for Pacific Islander/native Hawaiian. Multi stands for multiple races/ethnicities. AC stands for Alameda County. See Attachment 2: Secondary Data Tables for all sources.

Even though those people are – they have a degree, they have a full-time job, and they work in a high-tech company, but they still want a physician or provider that speaks their own language. I think that when they become sick, they really want people to speak their own language. They feel much more comfortable. – BIPOC Southern Alameda County resident
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❼ Respiratory Health (including COVID-19)
What Is the Issue?
Respiratory disorders affect the ability of the individual to breathe. Asthma, chronic obstructive pulmonary disorder (COPD), pneumonia, and lung cancer—each of which is chronic—are among the most common of respiratory disorders.49 Asthma is an inflammation of the airways that causes them to swell and narrow, characterized by episodes of reversible breathing problems.50 Symptoms range from mild to life-threatening. Asthma attacks can cause a range of issues from simple wheezing to extreme breathlessness.51 According to the American Lung Association, “the most common risk factors for developing asthma [are] having a parent with asthma, having a severe respiratory infection as a child, having an allergic condition, or being exposed to certain chemical irritants or industrial dusts in the workplace.”52 In late 2019, a new coronavirus (SARS-CoV-2) appeared. It causes a respiratory illness that is now called COVID-19. The ensuing pandemic has been a health event of historic proportions.

COVID-19 was one of the top three causes of death in the U.S. in 2021, while chronic lower respiratory disease was the sixth.53
Why Is It a Health Need?
Statistical data for Union City (below) qualified respiratory health as a need in the service area. Rates of visits to emergency departments for COPD and asthma hospitalizations among adults were both higher in Union City than in Alameda County. (Note that respiratory data by race are unavailable.) While COVID-19 is an undeniable health condition that has impacted service area cities, the community did not prioritize it over other needs. Professionals did identify southern Hayward as a part of southern Alameda County that was hardest hit by COVID-19 infections. (See data about COVID-19 infections in the area in Attachment 2: Secondary Data Tables.)
Table 9. Concerning Indicators for Respiratory Health
Indicator Name Fremont Newark UC AC
Asthma Hospitalizations Rate (Adults 18+) 18.6 18.8 29.2 27.8 COPD Emergency Dept Visits Rate 355.3 417.2 437.1 413.5 Notes: Brown shading indicates a statistic is worse than the county by 5% or more. UC stands for Union City; AC stands for Alameda County. COPD stands for Chronic Obstructive Pulmonary Disease. See Attachment 2: Secondary Data Tables for all sources. 49 U.S. National Library of Medicine. (2018). Lung Disease. 50 The Mayo Clinic. (2018). Asthma Overview.
51 Centers for Disease Control and Prevention. (2018). Asthma. 52 American Lung Association. (2018). Asthma Risk Factors. 53 Centers for Disease Control and Prevention (CDC). (2021). Leading Causes of Death. CDC, National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm Packet Page 83
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❽ Cancer
What Is the Issue?
Cancer is a generic term used to describe more than 100 conditions54 in which abnormal cells divide uncontrollably, invading and killing healthy tissue. These abnormal cells can metastasize to other parts of the body via the blood and lymph systems. Cancer in all of its forms is the second leading cause of death in the U.S., following heart disease.55 High-quality screening can serve to reduce cancer rates; however, complex factors contribute to disparities in cancer incidence and death rates among different ethnic, socioeconomic, and otherwise vulnerable groups. While personal, behavioral, and environmental factors are significant (e.g., smoking, exposure to known carcinogens), the key risk factors for cancer are social determinants of health, including lack of access to healthcare, low socioeconomic status, the natural and built environment where people live, and “institutional racism and the chronic stress it causes.”56 Why Is It a Health Need?
Cancer qualifies as a health need because of the racial/ethnic disparities that are evident. Local cancer data are for Assembly District 20 (as defined in 2010 and displayed in Table 10 below), an analogous area to Washington Hospital’s service area. The overall cancer incidence rate (418.6) in Assembly District 20 is worse than that of Alameda County overall (371.0). The table below displays the most common cancers and rates for racial/ethnic populations where the population fares worse than Alameda County overall, and overall cancer incidence, which is higher for white, Black, and Latina/o residents than for residents of the county overall.

Table 10. Concerning Indicators for Cancer, Assembly District 20 (2019) Indicator Name Latino
Asian/
Pac Isl Black White AC
Incidence Rate: Breast (female) 119.9 105.8 106.0 156.0 121.6 Incidence Rate: Prostate (male) 90.4 61.9 134.9 90.2 86.9 Incidence Rate: Colorectal 36.6 26.5 47.7 34.3 32.3
Incidence Rate: Melanoma 7.1 -- -- 39.1 18.9
Incidence Rate: Pancreatic 14.5 9.6 -- 11.4 11.8
Incidence Rate: Lung 33.7 33.0 31.2 42.0 38.7
Incidence Rate: All Sites 440.5 320.5 454.5 559.3 380.1 Notes: Brown shading indicates a statistic is worse than the county by 5% or more. AC stands for Alameda County. See Attachment 2:

Secondary Data Tables for all sources.
54 Centers for Disease Control and Prevention. (2018). How to Prevent Cancer or Find It Early. 55 Centers for Disease Control and Prevention. (2021). Leading Causes of Death. 56 National Cancer Institute. (2022). Cancer Disparities. Retrieved from https://www.cancer.gov/aboutcancer/understanding/disparities Packet Page 84
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COMPARISON OF SERVICE AREA CITIES TO ALAMEDA COUNTY
In looking at key statistics, it is clear that certain cities in Washington Hospital’s service area generally do better in comparison to Alameda County overall, while others do worse. The following charts compare each city’s statistics to county statistics on 25 indicators related to four major health needs (Behavioral Health, Diabetes & Obesity, Heart/Stroke, and Respiratory Health).

Fremont does better than the county on all 25 indicators. Two of the city’s three worst indicators are related to Diabetes (ED visits and hospitalizations), and the third is ischemic heart disease mortality.

Figure 11. Fremont Comparison to Alameda County
Substance Use ED Visits, 37%
Asthma ED Visits (Adults), 53%
Severe Mental Illness Hospitalizations, 54%
Asthma Hospitalizations (Children), 60%
Self-Harm ED Visits, 62%
Self-Harm Hospitalizations, 64%
Asthma Hospitalizations (Adults) , 67%
COPD Hospitalizations, 68%
Heart Failure Hospitalizations , 69%
Stroke Hospitalization, 72%
Acute Myocardial Infarction Mortality, 72%
Stroke Mortality, 75%
Severe Mental Illness Related ED Visits, 75%
Hypertension Hospitalizations, 77%
Heart Disease ED Visits, 77%
Heart Disease Mortality, 80%
Stroke ED Visits, 80%
Suicide Mortality, 81%
Hypertension ED Visits, 82%
Heart Disease Hospitalization, 82%
Hypertension Mortality, 84%
COPD ED Visits, 86%
Diabetes Hospitalization, 87%
Ischemic Heart Diseases Mortality, 89%
Diabetes ED Visits, 91%
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Newark does better than the county on all but six of the 25 statistics. One of five Behavioral Health indicators (severe mental illness-related ED visits) is worse for Newark than the county.57 Both Diabetes indicators (ED visits and hospitalizations) are worse. For Heart/Stroke, two of 12 indicators, hypertension and heart disease ED visits, are worse. Finally, one of five Respiratory Health indicators, COPD ED visits, is worse for Newark than the county.

Figure 12. Newark Comparison to Alameda County
57 For the sixth indicator, suicide mortality, there were too few suicides in Newark to generate a stable mortality rate that could be compared to the county.

Suicide Mortality, N/A
Asthma Hospitalizations (Children), 48%
Self-Harm ED Visits, 50%
Self-Harm Hospitalizations, 52%
Substance Use ED Visits, 52%
Stroke Mortality, 59%
Severe Mental Illness Hospitalizations, 62%
Asthma Hospitalizations (Adults) , 68%
Acute Myocardial Infarction Mortality, 74%
Hypertension Mortality, 78%
COPD Hospitalizations, 80%
Asthma ED Visits (Adults), 80%
Heart Failure Hospitalizations , 82%
Heart Disease Mortality, 83%
Stroke Hospitalization, 84%
Ischemic Heart Diseases Mortality, 87%
Hypertension Hospitalizations, 90%
Heart Disease Hospitalization, 94%
Stroke ED Visits, 96%
Heart Disease ED Visits, 100%
Severe Mental Illness Related ED Visits, 100%
COPD ED Visits, 101%
Diabetes Hospitalization, 105%
Hypertension ED Visits, 106%
Diabetes ED Visits, 133%
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Union City does better than the county on about half (12) of the 25 statistics, including all three Behavioral Health indicators. The city does worse on both Diabetes indicators (ED visits and hospitalizations). For Heart/Stroke, nine of the city’s 12 indicators are worse; only stroke and heart failure hospitalizations and heart disease ED visits are better than the county’s rates. Finally, two of five Respiratory Health indicators, COPD ED visits and adult asthma hospitalizations, are worse for Union City than the county.

Figure 13. Union City Comparison to Alameda County
Self-Harm Hospitalizations, 56%
Severe Mental Illness Hospitalizations, 65%
Substance Use ED Visits, 65%
Self-Harm ED Visits, 66%
Asthma ED Visits (Adults), 79%
Asthma Hospitalizations (Children), 83%
Suicide Mortality, 86%
COPD Hospitalizations, 96%
Heart Failure Hospitalizations , 96%
Stroke Hospitalization, 97%
Heart Disease ED Visits, 98%
Severe Mental Illness Related ED Visits, 98%
Hypertension Mortality, 101%
Stroke Mortality, 103%
Asthma Hospitalizations (Adults) , 105%
COPD ED Visits, 106%
Hypertension Hospitalizations, 109%
Heart Disease Hospitalization, 110%
Heart Disease Mortality, 110%
Diabetes Hospitalization, 121%
Stroke ED Visits, 123%
Hypertension ED Visits, 124%
Ischemic Heart Diseases Mortality, 135%
Acute Myocardial Infarction Mortality, 140%
Diabetes ED Visits, 148%
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7. COMMUNITY RESOURCES
Various hospitals and clinics, community-based organizations, government departments and agencies, and other resources in Southern Alameda County are engaged in addressing many of the community health needs identified by this assessment. Hospitals and clinics are listed below. For additional resources available to respond to the identified health needs of the local community, see Attachment 3:

Community Assets and Resources.

HOSPITALS
● Alameda Health System, John George Psychiatric Hospital ● Fremont Hospital
● Kaiser Foundation Hospital-Fremont
● St. Rose Hospital
● Sutter Health Eden Medical Center
● Washington Hospital Healthcare System

FEDERALLY QUALIFIED HEALTH CENTERS
● Bay Area Community Health (multiple sites, incl. mobile clinics) ● Tiburcio Vasquez Health Center (multiple sites)

OTHER HEALTH CLINICS
● Alameda Health System (Hayward Wellness, Newark Wellness) ● Sutter Health Palo Alto Medical Foundation, Fremont Center ● Washington Township Medical Foundation (multiple sites) Packet Page 88
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8. CONCLUSION
Washington Hospital Healthcare System worked with its consultants, Actionable Insights, to complete the 2023 Community Health Needs Assessment. The 2023 CHNA meets federal and state requirements. By gathering secondary data and conducting new primary research, the hospital was able to understand the community’s perception of health needs as well as prioritize health needs with consideration for how each compares against benchmarks.

The CHNA report was adopted by the Washington Township Health Care District Board of Directors on May 10, 2023.

Next steps for Washington Hospital Healthcare System:
● Make CHNA report publicly available on the Community Benefit page of the hospital’s website by June 30, 2023.58
● Monitor community comments on the CHNA report (ongoing). ● Select priority health needs to address using a set of criteria. ● Develop strategies to address priority health needs (independently and/or with local partners). ● Ensure strategies are adopted by the hospital.
58 https://www.whhs.com/about-us/community-connection/community-health-needs-assessment/ Packet Page 89
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9. LIST OF ATTACHMENTS

1. Community Leaders, Representatives, and Members Consulted

2. Secondary Data Tables

3. Community Assets and Resources

4. Qualitative Research Protocols

5. IRS Checklist
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ATTACHMENT 1: COMMUNITY LEADERS, REPRESENTATIVES, AND MEMBERS CONSULTED The list below contains the names of leaders, representatives, and members who were consulted for their expertise in the community. Leaders were identified based on their professional expertise and knowledge of target groups including low-income populations, minorities, and the medically underserved.

ID
#
Data Collection
Method Name, Title, Agency Topic
# of
People
Target
Group(s)
Represented
Role in Target
Group
Date Input
Was
Gathered
Organizations
1 Interview James Wagner, Deputy Director of
Clinical Operations, Alameda County
Behavioral Health
Behavioral
health
1 Low-income,
medically
underserved
Leader 10/11/2022
2 Interview Alameda County Behavioral Health Behavioral health
1 Low-income,
medically
underserved
Leader 10/11/2022
3 Interview Yugi Albior, TransVision Supervisor, Bay
Area Community Health (BACH)
LGBTQIA+
community
1 Medically
underserved,
minority groups
Leader,
member
10/12/2022
4 Interview Padmaja Magadala, HIV/TransVision
Program Director, Bay Area Community
Health (BACH)
LGBTQIA+
community
1 Medically
underserved,
minority groups
Leader 10/12/2022
5 Interview Suzanne Shenfil, Director of Human
Services, City of Fremont
Housing/
homelessness
1 Low-income,
medically
underserved
Leader 10/17/2022
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ID
#
Data Collection
Method Name, Title, Agency Topic
# of
People
Target
Group(s)
Represented
Role in Target
Group
Date Input
Was
Gathered
6 Interview Kimi Watkins-Tartt, Public Director,
Alameda County Health Care Services
Agency
Public health 1 Low-income,
medically
underserved,
minority groups
Leader 10/24/2022
7 Interview Evette Brandon, QIA Director, Alameda
County Health Care Services Agency
Public health 1 Low-income,
medically
underserved,
minority groups
Leader,
member
10/24/2022
8 Focus Group Host: South County Partnership Southern
Alameda
County
Health
8 Low-income,
medically
underserved,
minority groups
(see below) 9/20/2022
Attendees:

Annie Bailey, Administrator, City of
Fremont, Human Services Department,
Youth & Family Services Division
Leader
Angus Cochran, Chief, Community
Support Services, Washington Hospital
Healthcare System
Leader
Nick Cuevas, Recreation & Community
Services Manager, City of Newark
Leader
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ID
#
Data Collection
Method Name, Title, Agency Topic
# of
People
Target
Group(s)
Represented
Role in Target
Group
Date Input
Was
Gathered
Jennifer Dow-Rowell, Executive
Director, Safe Alternatives to Violent
Environments (SAVE)
Leader
Lucy Hernandez, Director of
Development, Community Relations, Bay
Area Community Health (BACH)
Leader
Preet Kaur Sabharwal, Community
Program Manager, The Hume Center
Leader
Director of Strategic Partnerships,
Tiburcio Vasquez Health Center
Leader
Human Services Director, City of
Fremont
Leader
9 Focus Group Host: Washington Hospital Disability
community &
older adults
13 Medically
underserved
(see below) 10/7/2022
Attendees:

Marly Beck, Program Manager, Tri-City
Volunteers Food Bank and Mobile Pantry
Leader
David Bible, Resident Experience
Coordinator, Masonic Homes of
California, Union City
Leader
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ID
#
Data Collection
Method Name, Title, Agency Topic
# of
People
Target
Group(s)
Represented
Role in Target
Group
Date Input
Was
Gathered
Shawn Fong, Ride-On Tri-City Program
Manager, City of Fremont Human
Services Department
Leader
Karen Grimsich, Administrator, City of
Fremont
Leader
Patricia Osage, Executive Director, LIFE
Eldercare
Leader
Lucy Rivello, Clinical Director, Regional
Center of the East Bay (RCEB)
Leader
Anna Wang, Vice President of Local
Programs and Community Relations,
Friends of Children with Special Needs
(FCSN)
Leader
Acacia Creek Retirement Community Leader
Alameda County Behavioral Health Care
Services
Leader
Deaf Counseling Advocacy & Referral
Agency (DCARA)
Leader,
member
Health and Wellness Coach, Union City
Senior Commission
Leader
Recreation Supervisor, City of Newark Leader
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ID
#
Data Collection
Method Name, Title, Agency Topic
# of
People
Target
Group(s)
Represented
Role in Target
Group
Date Input
Was
Gathered
Union City Family Center Leader
Community Members
10 Focus Group Host: Newark Promotores Network Spanishspeaking community
members
15 Minority
groups,
medically
underserved
Members,
representative
s
10/14/2022
11 Focus Group Host: Washington Hospital Englishspeaking minority
community
members
7 Minority groups Members 11/8/2022
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ATTACHMENT 2: SECONDARY DATA TABLES
Data Table Notes
Data Tables are presented in health need prioritization order.

Emergency Department visits data and hospitalizations data: The International Classification of Diseases, Clinical Modification (ICD-CM) is a system used by healthcare providers to classify and code all diagnoses, symptoms, and procedures recorded by hospitals in the United States. In California, these data are then submitted to California’s Office of Statewide Health Planning and Development. Beginning October 1, 2015, medical coding changed from ICD-9-CM to ICD-10-CM. Due to the change, one cannot make comparisons or establish trends for hospitalization and emergency department visits between data before and after that point in time. For example, ICD-10-CM added 65,000 new codes that are now used to more precisely describe different illnesses and ailments. Because those codes did not exist in ICD-9-CM, newly coded data cannot be compared with older data.

Trends: Where trends were available, color-coded arrows are used to show directionality (green marks positive trends, and red marks negative trends.) Where the trend is unclear, or the rates were substantially similar in previous years, no arrow is used. Also, black arrows are used (without shading) for data that are neither positive nor negative (such as socio-demographic indicators).

Demographics
Table 11. Total Population (Count and Percentage of County) Fremont Newark Union City Alameda County
2007–2011 211,748 (14.2%) 42,322 (2.8%) 68,830 (4.6%) 1,494,876 2010–2014 221,654 (14.2%) 43,635 (2.8%) 71,675 (4.6%) 1,559,308 2013–2017 230,964 (14.2%) 45,554 (2.8%) 74,354 (4.6%) 1,629,615 2014–2018 233,083 (14.2%) 46,276 (2.8%) 74,601 (4.5%) 1,643,700 2017–2021a  231,502 (13.8%)  47,815 (2.9%)  70,828 (4.2%)  1,673,133 Source: U.S. Census Bureau, 5-Year Estimates. Table S0101. Note: a Estimates that contain the year 2020 are not comparable to other five-year estimates due to methodology differences that may exist between different data sources. See https://www.census.gov/programs-surveys/acs/guidance/comparing-acs-data/2021/5-year-comparison.html for more information.

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Figure 14: Population by Age Range and City, 2017–2021
Source: U.S. Census Bureau, American Community Survey, 5-Year Estimates, 2017-2021. Notes: CA stands for California; AC stands for Alameda County; UC stands for Union City.

Table 12. Race/Ethnicity (Percentage), 2020
Race/Ethnicity Fremont Newark Union City Alameda County Latino 13 31 22 24
White 17 19 11 29
Asian 65 42 59 33
Black 2 3 4 10
Two or More 2 3 2 3
Other 0.6 0.5 0.4 0.6
Pacific Islander 0.4 1.4 1.1 0.8
Source: U.S. Census Bureau Decennial Census, 2020. U.S. Census race/ethnicity estimates for 2017–2021 not available at time of report publication. Proportions
70 and over
10%
70 and over
9%
70 and over
8%
70 and over
9%
70 and over
11%
60-69
11%
60-69
11%
60-69
10%
60-69
10%
60-69
13%
50-59
13%
50-59
13% 50-59
13%
50-59
14%
50-59
14%
40-49
13%
40-49
14%
40-49
16%
40-49
13%
40-49
14%
30-39
15%
30-39
17%
30-39
17%
30-39
18%
30-39
15%
20-29
14%
20-29
14%
20-29
11%
20-29
14%
20-29
13%
15 to 19 years, 7% 15 to 19 years, 6% 15 to 19 years, 5% 15 to 19 years, 6% 15 to 19 years, 5%
5 to 14 years
13%
5 to 14 years
12%
5 to 14 years
14%
5 to 14 years
10%
5 to 14 years
11%
Under 5 years, 6% Under 5 years, 6% Under 5 years, 6% Under 5 years, 7% Under 5 years, 5% CA AC Fremont Newark UC
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Figure 15: Population by Race/Ethnicity, 2020
Source: U.S. Census Bureau, Decennial Census, 2020. Notes: U.S. Census race/ethnicity estimates for 2017–2021 not available at time of report publication. Proportions are for race “alone” (single race) and non-Hispanic. * Purple segment is those of all other races combined (Pacific Islander/native Hawaiian, Native American, and “Other” race). Native American residents make up 0.2% of the city populations (not labeled in the chart). Those of “Other” race alone (not multi-racial) make up 1% or less of the cities’ populations (not labeled in the chart). Pacific Islander/native Hawaiian make up 1% or less of the cities’ populations (not labeled in the chart).

Table 13. Severe Mental Illness Related ED Visits (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2016–2017 1,840.1 2,436.4 2,323.2 2,265.5
2018–2020  1,716.4  2,294.4  2,249.3  2,285.9
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020. Notes: Brown shading indicates that the data are worse than the county by 5% or more. Bold indicates that the data are worse than the county, but by less than 5%.

Table 14. Severe Mental Illness Hospitalization (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2016–2017 869.9 1,130.1 1,007.9 1,452.2
2018–2020  755.1  876.5  906.0  1403.4
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020.

Table 15. Self-inflicted Injury ED Visits (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2016–2017
Adult 53.9 69.0 40.5 93.6
Child 179.6 137.2 140.6 197.0
All ages 57.6 52.8 42.9 76.6
2022 All ages  32.0  25.5  34.0  51.4
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2022. For self-harm codes, see the CSTE definition at https://resources.cste.org/Injury-Surveillance-Methods-Toolkit/Home/GeneralInjuryIndicators. Note: Adults are 18 years old and older; children are under 18 years old.

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Table 16. Self-Inflicted Injury Hospitalization (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2016–2017 12.7 17.7 16.6 17.3
2018–2020  17.2  14.0  15.0  26.8
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020. For self-harm codes, see the CSTE definition at https://resources.cste.org/Injury-Surveillance-Methods-Toolkit/Home/GeneralInjuryIndicators. Note: Bold indicates that the data are worse than the county, but by less than 5%.

Table 17. Suicide Mortality (Rate per 100,000 Pop.)
Fremont Newark Union City Alameda County
2009–2011 7.5 7.1 8.9 9.0
2010–2012 7.3 6.6 7.3 8.6
2011–2013 6.3 5.0 4.2 8.6
2012–2014 6.5 7.2 4.0 9.1
2013–2015 6.0 5.8 7.3 9.4
2014–2016 5.9 8.6 9.4 9.3
2015–2017 6.7 5.3 8.3 8.7
2016–2018 7.3 6.9 6.5 8.7
2018–2020  6.7
(N=49)
--
(N<10)
 7.1
(N=17)
 8.3
(N=437)
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Alameda County vital statistics files, 2009–2020. ICD-10 codes U03, X60-X84, Y87.0. Note: N=Number (count).

Table 18. Depression-Related Feelings (Percentage)
Fremont Newark Union City Alameda
County
2017–2019
7th Grade 22.1 28.6 34.7 25.6
9th Grade 27.6 34.5 41.5 29.9
11th Grade 36.9 36.0 41.4 35.2
NT Schools 42.9 32.4 47.1 37.4
Source: California Healthy Kids Survey, 2017–2019. Notes: NT is “non-traditional.” Brown shading indicates that the data are worse than the county by 5% or more. Bold indicates that the data are worse than the county, but by less than 5%.

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Table 19. Adults Ever Diagnosed with Depression (Percentage) Fremont Newark Union City Alameda County
2019 13.1 15.3 12.8 14.8
Source: U.S. Centers for Disease Control and Prevention PLACES data. 2019. Note: Bold indicates that the data are worse than the county, but by less than 5%.

Table 20. Adults with Likely Serious Psychological Distress (Percentage) Fremont Newark Union City Alameda County
2019–2020 9.6 9.9 9.5 10.4
Source: California Health Interview Survey. UCLA Center for Health Policy Research, Los Angeles, CA. 2019–2020.

Table 21. Severe Mental Illness Related ED Visits (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2018–2020 1,048.9 1,336.5 1,485.3 1,703.1
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020. ICD-10 codes F2[0-9]|F30[1-3,8-9]| F31[0-6]|F317[0-1,3,5,7]|F31[8- 9]|F32[2-4]|F32[8-9]|F33[1-3]|F334[0-1]|F33[8-9]|F34|F39|F400|F4[1–2]|F431|F4[4-5]|F48[1–2]|F60|F50|F53|F91.

Table 22. Severe Mental Illness Related to Drugs and Alcohol ED Visits (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2018–2020 6.0 9.1 8.4 19.0
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020. ICD-10 codes F101[4-5]|F10180|F102[4-5]|F10280|F109[4- 5]|F10980|F111[4-5]|F112[4-5]|F119[4-5]|F12150|F12180|F1225|F12280|F1295|F12980|F131[4-5]|F13180|F132[4- 5]|F13280|F139[4-5]|F13980|F141[4-5]|F14180|F142[4-5]|F14280|F149[4-5]|F14980|F151[4-5]|F15180|F152[4-5]|F15280|F159[4- 5]|F15980|F161[4-5]|F16180|F162[4-5]|F16280|F169[4-5]|F16980|F181[4-5]|F18180|F182[4-5]|F18280|F189[4-5]|F18980|F191[4- 5]|F19180|F192[4-5]|F19280|F199[4-5]|F19980
Table 23. Severe Mental Illness Related to Drugs and Alcohol Hospitalizations (Age-Adjusted Rate per 100,000 Pop.)
Fremont Newark Union City Alameda County
2018–2020 9.3 11.0 11.0 36.4
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020. See Table 18 for ICD-10 codes.

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Table 24. Substance Use ED Visits (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2016–2017 856.9 1,249.1 1,184.2 1,584.6
2018–2020  406.9  570.6  708.5  1,090.3
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020. ICD-10 codes F1[0-6,8-9]|T40[0-9]..(A|$|\b).

Table 25. Substance Abuse, Dependence, and Overdose Related Hospitalizations (Age-Adjusted Rate per 100,000 Pop.)
Fremont Newark Union City Alameda County
2018–2020 273.5 339.7 378.9 825.7
Source: Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020. ICD-10 codes F1[0-6,8-9]|T40[0-9]..(A|$|\b).

Table 26. Alcohol: Binge Drinking, Adults (Percentage)
Fremont Newark Union City Alameda County
2019 15.1 16.7 14.3 15.8
Source: U.S. Centers for Disease Control and Prevention PLACES data. 2019. Note: Binge drinking is consuming five or more drinks of alcohol within a couple of hours in the previous 30 days. Brown shading indicates that the data are worse than the county by 5% or more.

Table 27. Alcohol: Binge Drinking on Two Occasions in Past Month, Students (Percentage) Grade Fremont
Unified SD
Newark
Unified SD
Union City
New Haven USD Alameda County
2017–
2019
7th 0.2 0.8 0.1 0.2
9th 0.4 0.0 0.6 0.7
11th 0.8 2.0 1.5 2.0
NT schools 4.3 2.6 0.0 4.5
Source: California Healthy Kids Survey. 2018–2019. Notes: Binge drinking is consuming five or more drinks of alcohol within a couple of hours. (For example, an estimated 0.2% of Fremont Unified 7th graders had binge drunk on 2 occasions (days) in the previous month). NT is “non-traditional.” Brown shading indicates that the data are worse than the county by 5% or more.

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Table 28. Alcohol/ Drug Use in the Past Month (Percentage) Grade Fremont
Unified SD
Newark
Unified SD
Union City
New Haven USD Alameda County
2018–
2020
7th 3.2 6.7 6.4 5.1
9th 7.1 10.8 18.3 13.3
11th 12.9 20.6 22.6 23.4
NT schools 48.6 31.9 28.6 42.3
Source: California Healthy Kids Survey. 2018–2020. Notes: NT is “non-traditional.” Brown shading indicates that the data are worse than the county by 5% or more.

Table 29. Population 65 and Over Living Alone
Fremont Newark Union City Alameda County
2016–2020 16.0 11.6 11.5 22.8
Source: U.S. Census Bureau Factfinder. American Community Survey 5-Year Estimates.

Table 30. Domestic Violence Calls
Fremont Newark Union City Alameda County
Calls (Count) (2020) 416 136 132 5,183
Crude Rate per 1,000
(2014–2016) 4.9 9.7 6.9 11.3
Sources: Calls: California Dept. of Justice Criminal Justice Statistics Center, Domestic Violence-Related Calls for Assistance. July 2021.; California Dept. of Finance, Population Estimates and Projections. May 2021. Retrieved December 2022 from census.gov/programs-surveys/cbp.html; Rate: Alameda County Domestic Violence Review Team, Domestic Violence in Alameda County. June 2018.

Table 31. Behavioral Health Data by Race/Ethnicity
Latino Nat Am Asian Pac Isl Black White Multi Other
Adults Serious Psychological
Distress 4.9 9.7 10.3 12.9 23.9
Student AOD use, Alameda
County 19.8 8.9 6.5 16.3 16.4 17.3 15.5 10.3
Student AOD use, Fremont
Unified SD 17.1 5.1 4.5 13.3 7.1 10.9 10.2 5.2
Student AOD use, New
Haven SD 12.7 2.2 4.1 8.3 9.6 4.5 8.2 2.6
Student AOD use, Newark
Unified SD 13.8 0 3.7 9.9 18.4 17 13.4 7.7
Sources: Serious Psychological Distress: California Health Interview Survey. UCLA Center for Health Policy Research, Los Angeles, CA. 2019–2020; Student AOD use: California Healthy Kids Survey. 2018–2020. Note: AOD is “alcohol or drug.” Brown shading indicates that the data are worse than the county by 5% or more. “Nat Am”= Native American/Alaskan native; “Pac Isl”=Pacific Islander/native Hawaiian; “Multi”=Two or more races.

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Housing and Homelessness
Table 32. Owner-Occupied Housing Units (Percentage of All Units) Fremont Newark Union City Alameda County
2007–2011 64.3 72.2 69.4 54.5
2010–2014 63.2 69.0 65.1 52.9
2013–2017 62.4 69.2 65.7 53.0
2016–2020  58.6  65.8  62.6  50.7
Source: U.S. Census Bureau Factfinder. American Community Survey 5-Year Estimates.

Table 33. Rent-Burdened Households (Percentage)
Fremont Newark Union City Alameda County
2007–2011 38.8 44.7 51.0 49.3
2010–2014 39.9 48.6 50.4 50.2
2013–2017 39.7 49.9 47.3 48.9
2016–2020  39.0  44.8  42.8  48.4
Source: U.S. Census Bureau Factfinder. Notes: A rent-burdened household is defined as a household in which the monthly rent is 30% or more of the household income. Bold indicates that the data are worse than the county, but by less than 5%.

Table 34. Individuals Experiencing Homelessness (Count) Fremont Newark Union City Alameda County
2017
Sheltered 197 42 0 1,766
Unsheltered 282 28 40 3,863
Total 479 70 40 5,629
2019
Sheltered 123 30 0 1,710
Unsheltered 485 59 106 6,312
Total 608 89 106 8,022
2022
Sheltered  160
(16% of all homeless)
 26
(45% of all
homeless)
0 (0% of all homeless)
 2,612
(27% of all homeless)
Unsheltered 866
(84% of all homeless)
32 (55% of all
homeless)
489
(100% of all
homeless)
7,135
(73% of all homeless)
Total  1,026
Crude rate 451.0
 58
Crude rate 122.3
 489
Crude rate 712.0
 9,747
Crude rate 591.2
Source: Applied Survey Research. Alameda County Homeless Count. 2017, 2019, and 2022. Additional calculations by Actionable Insights, LLC based on July 2022 population estimates. Notes: HUD defines sheltered homeless persons as adults, children, and unaccompanied children who, on the night of the count, are living in shelters for the homeless. Data not available by city prior to 2017. Brown shading indicates that the data are worse than the county by 5% or more.

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Figure 16. Individuals Experiencing Homelessness, 2022 (Count) Source: Applied Survey Research. Alameda County Homeless Count. 2022.

Table 35. Alameda County Homeless Population by City (Percentage of County) Fremont Newark Union City Alameda County
2022 5% 2% 2% 100%
Source: Applied Survey Research. Alameda County Homeless Count. 2022.

Figure 17. Proportion of Homeless Population by Race/Ethnicity Source: Applied Survey Research. Alameda County Homeless Count. 2022.

Table 36. Homeless who are Chronically Homeless (Percentage) Fremont Newark Union City Alameda County
2016–2020 27 48 -- 28
Source: Applied Survey Research. Alameda County Homeless Count. 2022. Note: Brown shading indicates that the data are worse than the county by 5% or more.
160 26 0
186
866
32 489
1387
Fremont Newark Union City Total
Sheltered Unsheltered
23% 1% 25% 1% 34% 10%
3% 4%
39% 43%
Latino Pac Isl Nat Am White Black
Percent of Pop. Percent of AC Homeless Pop.

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Economic Security
Please see the Housing & Homelessness section for data related to housing costs and numbers of persons experiencing homelessness. The last table in this section presents available data by race/ethnicity.

Table 37. Median Household Income (Dollars)
Fremont Newark Union City Alameda County
2007–2011 98,513 81,777 82,634 70,821
2010–2014 103,591 86,521 82,564 73,775
2013–2017 122,191 96,817 95,625 85,743
2016–2020  142,374  127,619  120,772  104,888
Source: U.S. Census Bureau; American Community Survey 5-Year Estimates, 2007–2020. Table B19013.

Table 38. Per-Capita Income (Dollars)
Fremont Newark Union City Alameda County
2016–2020 55,950 47,136 43,336 49,883
Source: U.S. Census Bureau; American Community Survey, 2016–2020 American Community Survey 5-Year Estimates. Note:

Brown shading indicates that the data are worse than the county by 5% or more.

Table 39. Poverty, Children Below 100% FPL (Percentage) Fremont Newark Union City Alameda County
2010–2014 7.1 11.7 10.1 15.8
2011–2015 6.2 12.2 9.8 15.2
2012–2016 4.8 10.7 9.1 14.4
2013–2017 3.9 9.2 8.3 13.0
2016–2020  3.5  4.0  5.3  10.2
Source: U.S. Census Bureau; American Community Survey, American Community Survey 5-Year Estimates. 2010–2020. Note:

FPL=Federal Poverty Limit.

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Table 40. Poverty, Families Living Below 100% FPL (Percentage) Fremont Newark Union City Alameda County
2016–2020 2.8 1.9 3.3 5.8
Source: U.S. Census Bureau; American Community Survey, 2016–2020 American Community Survey 5-Year Estimates. Note:

FPL=Federal Poverty Limit.

Table 41. Poverty, People Aged 65 and Over Living Below 100% FPL (Percentage) Fremont Newark Union City Alameda County
2010–2014 6.7 6.8 8.5 9.7
2011–2015 6.8 8.2 8.1 9.2
2012–2016 6.3 7.1 8.1 9.5
2014–2018 7.3 5.4 6.4 9.7
2016–2020  7.1  5.1  7.6  9.8
Source: U.S. Census Bureau; American Community Survey, American Community Survey 5-Year Estimates, 2010–2020. Table S1701. Note: FPL=Federal Poverty Limit.

Table 42. Youth Ages 16–19 Not in School nor Working (Percentage) Fremont Newark Union City Alameda County
2016–2020 0.3 1.7 1.8 0.7
Source: U.S. Census Bureau; American Community Survey, 2016–2020 American Community Survey 5-Year Estimates. Note:

Brown shading indicates that the data are worse than the county by 5% or more.

Table 43. People 25 and Over with a Bachelor’s Degree or Higher (Percentage) Fremont Newark Union City Alameda County
2011–2014 51.7 28.9 35.0 42.1*
2012–2016 54.0 30.3 36.2 43.9
2016–2020  58.7  37.8  41.4  48.7
Source: U.S. Census Bureau, American Community Survey. *2011–2014 Alameda County rate is for 2010–2020. Note: Brown shading indicates that the data are worse than the county by 5% or more.

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Table 44. Economic Security Data by Race/Ethnicity
Latino Nat Am Asian
Pac Isl/
Hawaiian Black White Multi
AC
Overall
Median Household Income 83.0k 82.7k 130.2k 97.5k 56.7k 120.5k 99.7k 104.9k Per Capita Income 28.7k 34.2k 51.5k 32.5k 37.4k 70.2k 33.1k 49.9k Children Living Below FPL 14.6 15.3 5.1 13.5 27.0 5.0 8.1 10.2 Families Living Below FPL 9.0 12.4 4.7 8.5 13.5 2.6 6.4 5.8 People 65+ Living Below FPL 9.9 22.4 12.4 10.6 15.8 6.3 9.3 9.8 High School Graduation Rate 79.3 80.9 95.4 79.8 91.8 89.7 86.9 People 25+ with a Bachelor's
Degree or Higher 21.0 20.5 59.3 20.1 31.3 59.3 46.7 48.7 Source for High School Graduation Rate: California Department of Education. 2020–2021. Notes: For other year and source data, see corresponding tables above. Brown shading indicates that the data are worse than the county by 5% or more. Bold indicates that the data are worse than the county, but by less than 5%. “Nat Am”= Native American/Alaskan native; “Pac Isl”=Pacific Islander/native Hawaiian; “Multi”=Two or more races. AC stands for Alameda County. High School Graduation Rate data not available by city.

Table 45. Arrests (Rate per 1,000) by Age, Race/Ethnicity Latino Nat Am Asian
Pac Isl/
Hawaiian Black White
AC
Overall
Juvenile Arrests 3.0 10.4 0.6 2.3
Adult Arrests 26.4 64.3 15.2 20.8
Source: California Department of Justice Criminal Justice Statistics Center. 2020. Notes: Brown shading indicates that the data are worse than the county by 5% or more. “Nat Am”= Native American/Alaskan native; “Pac Isl”=Pacific Islander/native Hawaiian; “Multi”=Two or more races. AC stands for Alameda County. These data were not available by city.

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Diabetes & Obesity
The last table in this section presents available data by race/ethnicity.

Table 46. Adults with Diabetes (Percentage)
Fremont Newark Union City Alameda County
2019–2020 11.4 13.6 13.7 10.3
Source: California Health Interview Survey. UCLA Center for Health Policy Research, Los Angeles, CA. 2019–2020. Note: Brown shading indicates that the data are worse than the county by 5% or more.

Table 47. Diabetes ED Visits (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2016–2017 2,008.2 2,890.0 3,191.6 2,674.7
2018–2020  1,396  2,053.8  2,280.7  1,541.0
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2017. ICD-10 codes E10, E11, E13. Note: Brown shading indicates that the data are worse than the county by 5% or more.

Table 48. Diabetes Hospitalization (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2016–2017 1,494.1 1,844.8 2,054.1 1,702.8
2018–2020  1,307.9  1,592.1  1,831.7  1,512.0
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020. Note: Brown shading indicates that the data are worse than the county by 5% or more.

Table 49. Adults who are Obese
Fremont Newark Union City Alameda County
2020 19.0 24.6 21.2 25.4
Source: California Health Interview Survey. UCLA Center for Health Policy Research, Los Angeles, CA. 2020.

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Table 50. Children who are Overweight for Age (Ages 2–11) (Percentage) Fremont Newark Union City Alameda County
2019–2020 13.3 15.0 15.2 14.3
Source: California Health Interview Survey. UCLA Center for Health Policy Research, Los Angeles, CA. 2019–2020. Note: Brown shading indicates that the data are worse than the county by 5% or more.

Table 51. Workers who Walk to Work
Fremont Newark Union City Alameda County
2016–2020 1.2 2.6 0.8 3.3
Source: U.S Census Bureau, 5-Year Estimates, American Community Survey. 2016–2020. Table DP02. Note: Brown shading indicates that the data are worse than the county by 5% or more.

Table 52. Diabetes & Obesity Data by Race/Ethnicity
Latino Nat Am Asian Pac Isl Black White Multi
AC
Overall
Adults with Diabetes 10.1 11.5 13.8 9.6 2.1 10.3
Adults who are Obese 29.2 10.9 43.8 28 38.5 25.4
Workers who Walk to Work 3.3 6.8 3.1 3.6 2.3 3.8 3.7 3.3 Notes: For year and source, see corresponding tables above. Brown shading indicates that the data are worse than the county by 5% or more. “Nat Am”= Native American/Alaskan native; “Pac Isl”=Pacific Islander/native Hawaiian; “Multi”=Two or more races.

AC stands for Alameda County.

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Heart Disease, Hypertension, and Stroke
Table 53. Adults with Heart Disease (Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2011–2012 5.7 5.8 5.9 5.8
2013–2014 5.4 5.2 5.5 5.5
2018–2019  5.8  5.5  5.8  5.9
Source: California Health Interview Survey (Neighborhood Edition). UCLA Center for Health Policy Research, Los Angeles, CA. 2019. Note: Bold indicates that the data are worse than the county, but by less than 5%.

Table 54. Heart Disease ED Visits (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2016–2017 372.3 384.3 459.3 481.2
2018–2020  236.5  307.2  301.1  306.4
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020. Note: Bold indicates that the data are worse than the county, but by less than 5%.

Table 55. Heart Disease Hospitalization (Age-Adjusted Rates per 100,000 Pop.) Fremont Newark Union City Alameda County
2016–2017 469.8 518.6 593.6 559.7
2018–2020  464.6  534.4  622.2  565.7
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020 (Codes I0[1,2,5-9], I11, I2[0-7], I3[0-5], I[4-5], I97[0,1], R001). Note:

Brown shading indicates that the data are worse than the county by 5% or more.

Table 56. Heart Failure ED Visits and Hospitalizations (Age-Adjusted Rates per 100,000 Pop.) Fremont Newark Union City Alameda County
ED Visits
2018–2020 339.4 423.5 481.5 413.9
Hospitalizations
2018–2020 641.0 757.0 888.5 924.0
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020. Notes: Brown shading indicates that the data are worse than the county by 5% or more. Bold indicates that the data are worse than the county, but by less than 5%.

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Table 57. Heart Disease Mortality (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda
County
2009–2011 126.1 126.6 124.7 133.8
2010–2012 121.7 120.7 125.0 130.4
2011–2013 118.8 111.4 135.6 128.1
2012–2014 107.9 106.1 127.1 123.1
2013–2015 102.7 101.3 109.7 121.0
2014–2016 97.2 105.2 122.4 119.5
2015–2017 100.8 117.9 133.4 116.5
2016–2018 95.6 114.1 140.5 111.6
2018–2020  86.9  90.9  120.1  109.0
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Alameda County vital statistics files, 2009–2020. ICD-10 codes I00-I09, I11, I13, I20-I51. Notes: Brown shading indicates that the data are worse than the county by 5% or more. Bold indicates that the data are worse than the county, but by less than 5%.

Table 58. Ischemic Heart Disease Mortality (Rate per 100,000 Pop.) Fremont Newark Union City Alameda
County
2009–2011 80.8 83.8 92.4 84.1
2010–2012 76.6 71.9 91.2 80.6
2011–2013 76.8 65.2 88.9 77.6
2012–2014 69.4 63.1 77.0 72.3
2013–2015 65.0 60.9 65.7 69.8
2014–2016 58.6 63.0 76.3 67.0
2015–2017 58.3 77.7 82.3 63.4
2016–2018 53.0 73.4 83.9 57.6
2018–2020  49.9  48.7  75.6  56.0
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Alameda County vital statistics files, 2009–2020. ICD-10 codes I20-I25. Note: Brown shading indicates that the data are worse than the county by 5% or more.

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Table 59. Acute Myocardial Infarction Mortality (Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2009–2011 19.4 24.9 25.9 25.8
2010–2012 16.9 19.2 23.8 24.8
2011–2013 17.8 19.3 23.0 23.9
2012–2014 16.7 16.0 17.6 22.1
2013–2015 14.9 15.1 17.5 20.7
2014–2016 15.1 11.9 21.0 21.0
2015–2017 15.8 14.8 23.5 20.4
2016–2018 15.4 17.6 25.8 19.5
2018–2020  14.3  14.7  27.8  19.9
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Alameda County vital statistics files, 2009–2020. ICD-10 codes I21-I22. Notes: Brown shading indicates that the data are worse than the county by 5% or more. Bold indicates that the data are worse than the county, but by less than 5%.

Table 60. Hypertension ED Visits (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2016–2017 4,092.7 5,421.0 5,874.8 5,405.0
2018–2020  2,311.1  2,994.1  3,517.9  2,827.2
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020. ICD-10 code I10. Notes: Brown shading indicates that the data are worse than the county by 5% or more. Bold indicates that the data are worse than the county, but by less than 5%.

Table 61. Hypertension Hospitalization (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2016–2017 2,430.9 3,007.0 3,172.7 3,058.0
2018–2020 1,936.8 2,264.3 2,736.9 2,520.2
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020. ICD-10 codes I10-I13. Notes: Brown shading indicates that the data are worse than the county by 5% or more. Bold indicates that the data are worse than the county, but by less than 5%.

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Table 62. Hypertension Mortality (Rate per 100,000 Pop.) Fremont Newark Union City Alameda
County
2009–2011 10.3 3.8 12.1 12.4
2010–2012 11.7 8.6 15.3 13.9
2011–2013 11.7 14.0 13.5 14.0
2012–2014 12.0 13.3 13.7 14.1
2013–2015 13.0 7.7 8.6 13.1
2014–2016 12.2 7.4 10.4 13.0
2015–2017 14.1 11.5 8.4 13.8
2016–2018 10.9 14.9 11.2 13.8
2018–2020  11.6  10.8  14.0 13.8
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Alameda County vital statistics files, 2009–2020. ICD-10 codes I10, I12, I15. Notes: Brown shading indicates that the data are worse than the county by 5% or more. Bold indicates that the data are worse than the county, but by less than 5%.

Table 63. Stroke ED Visits (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2016–2017 71.9 119.0 83.9 87.9
2018–2020  45.1  54.0  68.9  56.2
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020. ICD-10 codes G45, G46, I6. Note: Brown shading indicates that the data are worse than the county by 5% or more.

Table 64. Stroke Hospitalization (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2016–2017 158.5 249.4 223.8 220.9
2018–2020  152.4  178.2  205.8  212.5
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020. ICD-10 codes G45, G46, I6. Notes: Brown shading indicates that the data are worse than the county by 5% or more. Bold indicates that the data are worse than the county, but by less than 5%.

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Table 65. Stroke Mortality (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2009–2011 25.0 37.1 38.0 37.9
2010–2012 26.5 38.9 36.3 37.9
2011–2013 27.0 38.2 34.2 37.4
2012–2014 27.5 30.5 31.1 35.9
2013–2015 29.5 29.7 30.9 37.4
2014–2016 31.4 34.4 35.0 38.6
2015–2017 37.8 36.4 37.8 42.3
2016–2018 36.4 26.5 37.4 40.4
2018–2020  29.2  22.9  40.2  39.0
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Alameda County vital statistics files, 2009–2020. ICD-10 codes I60-I69. Notes: Bold indicates that the data are worse than the county, but by less than 5%. See chart below.

Figure 18. Stroke Mortality (Age-Adjusted Rate per 100,000 Pop.), by Year Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Alameda County vital statistics files, 2009–2020. ICD-10 codes I60-I69. 0 10
20 30
40 50
2011 2012 2013 2014 2015 2016 2017 2018 2020
Fremont Newark
Union City Alameda County
HP2020 Benchmark
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Healthcare Access & Delivery
The last table in this section presents available data by race/ethnicity.

Table 66. Adults With Health Insurance Aged 18–64 (Percentage) Fremont Newark Union City Alameda County
2010–2014 92.4 90.1 89.5 88.2
2011–2015 93.3 90.4 91.4 89.9
2012–2016 94.9 92.5 93.4 91.6
2013–2017 96.6 94.4 95.0 93.1
2018–2020  92.8  91.9  92.2 93.2
Source: California Health Interview Survey. UCLA Center for Health Policy Research, Los Angeles, CA. 2019. Note: Bold indicates that the data are worse than the county, but by less than 5%.

Table 67. Adults Without Health Insurance Aged 18–64 (Percentage) Fremont Newark Union City Alameda County
2019 9.2 13.3 11.9 12.8
Source: U.S. Centers for Disease Control and Prevention PLACES data. 2019. Note: Bold indicates that the data are worse than the county, but by less than 5%.

Table 68. Adults Who Have Had a Recent Routine Checkup
Fremont Newark Union City Alameda County
2018–2020 69.7 68.4 69.8 69.4
Source: U.S. Centers for Disease Control and Prevention PLACES data. 2019. Note: A recent checkup is defined as taking place within the past year. Note: Bold indicates that the data are worse than the county, but by less than 5%.

Table 69. Households with Internet Subscription (Percentage) Fremont Newark Union City Alameda County
2016–2020 94.5 95.2 92.9 91.2
Source: U.S. Census Bureau; American Community Survey, 2016–2020 American Community Survey 5-Year Estimates, Table S2802.

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Table 70. Recent Dentist Visit (Past Year) (Percentage) Fremont Newark Union City Alameda County
Adults 2018 70.9 65.9 66.1 66.0
Children
2019–2020 88.2 89.2 89.3 89.7
Source: California Health Interview Survey. UCLA Center for Health Policy Research, Los Angeles, CA. Children: 2019–20.

Adults: U.S. Centers for Disease Control and Prevention PLACES data. 2019. Note: Bold indicates that the data are worse than the county, but by less than 5%.

Table 71. Healthcare Access Data by Race/Ethnicity
Latino Nat Am Asian
Pac Isl/
Hawaiian Black White Multi
AC
Overall
Adults with Health
Insurance (18-64)
(percent) (2018–2020) 90.3 93.4 66.7 89.5 96.3 90.0 93.2 People Delayed or Had
Difficulty Obtaining Care
(percent) (2019–2020) 6.9 94.0 11.1 10.6 17.1 29.7 13.1 Source: California Health Interview Survey. UCLA Center for Health Policy Research, Los Angeles, CA. Notes: No city-level data were available for People Delayed or Had Difficulty Obtaining Care. “Nat Am”= Native American/Alaskan native; “Pac Isl”=Pacific Islander/native Hawaiian; “Multi”=Two or more races. AC stands for Alameda County. Brown shading indicates that the data are worse than the county by 5% or more. Bold indicates that the data are worse than the county, but by less than 5%.

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Respiratory Health
Table 72. Asthma ED Visits (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda
County
2016–2017
Adult 180.7 315.4 273.3 355.7
Child 244.8 423.3 411.1 516.1
All 263.2 440.4 400.9 512.4
2018–2020 Adult 115.9 173.7 171.9 218.0
Child 143.7 177.6 211.1 261.2
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020 (Asthma codes: J45[2-9]). Note: Adults are 18 years and older; children are under 18 years old.

Figure 19. Asthma ED Visits by Age Group and City (Age-Adjusted per 100,000 Pop.) Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2018–2020.

Table 73. Asthma Hospitalization (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2016–2017
Adult 59.6 91.2 70.3 66.6
Child 45.9 27.0 70.7 131.0
2018–2020
Adult 18.6 18.8 29.2 27.8
Child 38.7 30.9 53.8 64.5
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020. ICD-10 code J45. Note: Adults are 18 years and older; children are under 18 years old. Brown shading indicates that the data are worse than the county by 5% or more. 0 50
100
150
200
250
300
Fremont Newark Union City Alameda County
Children ED Adults ED Children Hosp Adults Hosp
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Table 74. COPD ED Visits (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2016–2017 221.4 352.2 300.9 249.9
2018–2020 355.3 417.2 437.1 413.5
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020 (codes J44[0-4]). Notes: Brown shading indicates that the data are worse than the county by 5% or more. Bold indicates that the data are worse than the county, but by less than 5%.

Table 75. COPD Hospitalization (Age-Adjusted Rate per 100,000 Pop.) Fremont Newark Union City Alameda County
2016–2017 490.9 646.8 624.8 674.3
2018–2020 363.5 428.6 515.7 538.0
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020. ICD-10 code J44.

Table 76. COVID-19 Data
Washington
Service Area AC
Average daily COVID-19 hospital admissions (rate per
100,000 pop.) 3.6 27
Cases, Infections, and Tests
Number of weekly cases 184 1,073
Cumulative total cases 23,033 405,321
Cumulative case rate (per 100,000 pop.) 6,578 24,127
Current rate of spread (R-eff)59 — 1.03*
14-day average test positivity rate — 6.7%
Deaths
Number of weekly deaths 0 2
Cumulative total deaths 315 2,205
Cumulative death rate (per 100,000 pop.) 90 131
59 “The effective reproductive number (R-eff) is the average number of secondary infected persons resulting from an infected person. If R-eff > 1, the number of infected persons will increase. If R-eff < 1, the number of infected persons will decrease. At R-eff = 1, the number of infected persons remains constant.” California Communicable Diseases Assessment Tool. Retrieved from https://calcat.covid19.ca.gov/cacovidmodels.

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Washington
Service Area AC
Vaccinations60
Vaccinated, primary series (all ages) — 86%
Vaccinated, primary series (age 65+) — 95%
Vaccinated, bivalent booster — 32%
Vaccinated, bivalent booster (age 65+) — 61%
Sources: Alameda County: The New York Times. (2023). California Coronavirus Tracker. The New York Times. Data retrieved from https://www.nytimes.com/interactive/2023/us/california-covid-cases.html. Washington Service Area: Washington Hospital Healthcare System. (2023). Rates per 100,000 in Washington Service Area calculated by Actionable Insights. Notes: AC stands for Alameda County. — indicates data not available for Washington Hospital’s primary service area. * Current rate of spread (R-eff) in California is 0.99. Current rate of spread is as of March 30, 2023. Average daily hospital admissions, 14-day test positivity rate, number of weekly cases, and number of weekly deaths are for the week of March 24-30, 2023. Vaccination percentages and all cumulative data represent the period from January 2020 to March 30, 2023. 60 Vaccination data for Washington Hospital Healthcare System represent number of doses, not proportion of the population vaccinated. As of April 6, 2023, Washington Hospital had administered 103,695 doses of a COVID-19 vaccine, including 926 doses to children ages 6 months to four years and 3,873 doses to children ages 5–11 years.

The hospital had also administered 27,655 COVID-19 boosters, include 160 to children ages 5–11 years.

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Cancer
The last table in this section presents available data by race/ethnicity.

Table 77. Cancer Incidence (Age-Adjusted Rate per 100,000 Pop.), 2015–2019 Cancer Site
Assembly District
20 (2019) Alameda County
All 418.6 371.0
Breast (Female) 122.3 121.6
Prostate (Male) 78.1 86.9
Colorectal 31.3 32.3
Melanoma 13.8 18.9
Pancreatic 10.8 11.8
Lung 36.4 38.7
Source: University of California, San Francisco. California Health Maps website. https://www.californiahealthmaps.org. Note:

Brown shading indicates that the data are worse than the county by 5% or more.

Table 78. Cancer Screenings (Percentage)
Year Fremont Newark Union City Alameda
County
Cervical (Ages 21–65) 2018 81.6 82.0 78.8 81.6
Colon (Ages 50–75) 2018–2020 68.1 66.2 65.3 67.7
Mammogram in the Past 2
Years (Ages 50–74) 2018 77.2 75.8 76.6 75.0
Notes: Colon screening measures those who have had fecal occult blood test in the past year, a sigmoidoscopy in the past five years and a fecal occult blood test in the past three years or colonoscopy in the past year. Bold indicates that the data are worse than the county, but by less than 5%.

Table 79. Cancer Deaths: Greater Bay Area (Age-Adjusted Rate per 100,000 Pop.) Greater Bay Area Alameda County
2019 115.5 157.1
Source: Greater Bay Area Cancer Registry.

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Table 80. Adults who Smoke (Percentage)
Fremont Newark Union City Alameda County
2019 4.7 4.9 5.0 5.7
2020 2.3 2.4 2.3 2.5
Source: California Health Interview Survey. UCLA Center for Health Policy Research, Los Angeles, CA. 2019.

Table 81. Cancer Incidence Data by Race/Ethnicity
Latino
Asian/
Pac Isl Black White AC Overall
Incidence: breast (female) a 119.9 105.8 106.0 156.0 121.6 Incidence: prostate (male) a 90.4 61.9 134.9 90.2 86.9
Incidence: colorectal a 36.6 26.5 47.7 34.3 32.3
Incidence: melanoma a 7.1 -- -- 39.1 18.9
Incidence: pancreatic a 14.5 9.6 -- 11.4 11.8
Incidence: lung a 33.7 33.0 31.2 42.0 38.7
Incidence: all sites a 440.5 320.5 454.5 559.3 380.1
Source: University of California, San Francisco. California Health Maps website. 2015–2019. https://www.californiahealthmaps.org.

Notes: a Data is for Assembly District 20 (as of 2019). Brown shading indicates that the data are worse than the county by 5% or more. Bold indicates that the data are worse than the county, but by less than 5%. “Pac Isl”=Pacific Islander/native Hawaiian. AC stands for Alameda County.

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General Health & Mortality
Table 82. Life Expectancy at Birth (Years)
Fremont Newark Union
City
Alameda
County
2009–2011 83.7 82.7 83.3 81.8
2010–2012 83.7 82.6 83.1 81.8
2011–2013 83.9 82.5 82.5 81.8
2012–2014 84.4 82.6 82.6 81.9
2013–2015 84.6 82.9 83.0 81.9
2014–2016 84.8 83.2 82.4 82.1
2015–2017 84.6 83.1 82.3 82.3
2016–2018 85.3 83.6 82.5 82.9
2018–2020  85.7  85.1  83.2 82.9
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2009–2020. Note: Life expectancy at birth is defined as the average number of years that a newborn can expect to live if he or she passes through life subject to the age-specific mortality rates of a given period. Bold indicates that the data are worse than the county, but by less than 5%.

Table 83. Life Expectancy at Birth (Years), by Race/Ethnicity Latino Nat Am Asian Pac Isl Black White Multi AC

83.7 81.8 88.6 74.6 81.9 82.8
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2018–2020. Notes: Life expectancy at birth is defined as the average number of years that a newborn can expect to live if he or she passes through life subject to the age-specific mortality rates of a given period. “Nat Am”= Native American/Alaskan native; “Pac Isl”=Pacific Islander/native Hawaiian; “Multi”=Two or more races.

Brown shading indicates that the data are worse than the county by 5% or more. Bold indicates that the data are worse than the county, but by less than 5%.

Table 84. Children with a Disability (Percentage)
Fremont Newark Union City Alameda County
2016–2020 1.6 2.0 1.6 2.8
Source: U.S Census Bureau, 5-Year Estimates, American Community Survey. 2016–2020.

Fremont Newark
Union City Alameda County
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Table 85. Poor Physical Health: 14+ Days in the Past Month (Percentage) Fremont Newark Union City Alameda County
2019 8.1 10.0 9.1 10.1
Source: U.S. Centers for Disease Control and Prevention PLACES data. 2019.

Table 86. Deaths: All Causes, 2018–2020
Fremont Newark Union City Alameda County
Count 3,207 734 1,332 30,311
Rate 449.6 476.9 562.6 558.7
Source: Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Office of Statewide Health Planning and Development, 2016–2020.

Table 87. Mortality Rate, All Causes (Age-Adjusted per 100,000 Pop.) Fremont Newark Union
City
Alameda
County
2009–2011 535.0 570.0 548.9 607.1
2010–2012 533.5 580.2 568.1 606.4
2011–2013 527.3 602.0 591.5 610.0
2012–2014 501.4 594.3 585.7 601.3
2013–2015 496.2 574.6 564.2 601.1
2014–2016 486.1 555.0 594.6 595.3
2015–2017 496.9 558.3 605.2 586.2
2016–2018 468.0 535.3 598.7 560.3
2018–2020  449.6  476.9  562.6  558.7
Source: Alameda County Public Health Community Assessment Planning & Evaluation (CAPE) Unit, with data from Alameda County vital statistics files, 2009–2020. Note: Bold indicates that the data are worse than the county, but by less than 5%.

Fremont Newark
Union City Alameda County
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ATTACHMENT 3: COMMUNITY ASSETS AND RESOURCES
Behavioral Health
● 12-Step programs (Alcoholics Anonymous, Narcotics Anonymous, Al-Anon/Alateen) ● Afghan Coalition
● Alameda County Tri-City Children and Youth Service
● Alameda Health System John George Psychiatric Hospital ● Bay Area Community Services (BACS)
● Boldly Me
● Building Futures
● Calico Center
● California Smoker’s Helpline
● Cherry Hill Detox
● Citizens for Better Community
● Crisis Support Services of Alameda County 24-Hour Crisis Line ● CURA
● DeafPlus
● East Bay Agency for Children
● Family Education and Resource Center (FERC)
● Family Paths 24-Hour Parent Support Hotline
● Fremont Family Resource Center
● Friends of Children with Special Needs
● First 5 Alameda County
● HOPE Project Mobile Health Clinic
● Kaiser Behavioral Health classes (available to public) ● LIFE Eldercare Friendly Visitors
● Narika
● National Alliance on Mental Illness Alameda County South ● Rubicon Programs
● Ruby’s Place (Casa de Ruby, Betty’s Village)
● Safe Alternative to Violent Environments (SAVE)
● Second Chance, Inc.
● Seneca Center
● South Hayward Parish - Hayward Community Action Network ● Special Need Children Center
● Tobacco Control Coalition of Alameda County
● Union City Family Center
● Victory Outreach - Prison Counseling and Services; Residential Rehab Program, Hayward Packet Page 125
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Cancer
● American Cancer Society
● HERS Breast Cancer Foundation
● Tobacco Control Coalition of Alameda County
Diabetes & Obesity
● Alameda County Community Food Bank (multiple sites)
● Alameda County Nutrition Services - Women, Infants, and Children (WIC) ● Alameda County Public Health Department
● Alameda County Social Services Agency
● American Diabetes Association
● California State University, East Bay, Hayward Promise Neighborhood ● Centro de Servicios
● City of Fremont Parks & Recreation Division
● East Bay Regional Parks District
● Family Resource Center, Fremont
● Hayward Area Recreation & Park District
● LIFE Eldercare, Inc.
● Meals on Wheels of Alameda County
● Newark Recreation & Community Services Department
● Solid Rock Community Services, Newark
● Special Need Children Center
● Tri-City Volunteers Food Bank and Thrift Store
● Union City Community & Recreation Services Department ● Union City Family Center
● Viola Blythe Community Service Center of Newark
● Washington Hospital Healthcare System, Diabetes Education Center Economic Security (includes food security, employment, education) ● Abode Services
● Alameda County Community Food Bank (searchable list)
● Alameda County Early Head Start and Head Start
● Alameda County Library
● Alameda County Nutrition Services - Women, Infants, and Children (WIC) ● Alameda County Social Services Agency
● Avanzado
● Bay Area Community Services (BACS)
● California State University, East Bay, Hayward Promise Neighborhood ● Centro de Servicios
● Citizens for Better Community
● Community Resources for Independent Living (CRIL)
● DeafPlus
● Eden I&R, Inc.

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● First 5 Alameda County
● Fremont Education Foundation
● Fremont Family Resource Center
● Fremont Unified School District
● Friends of Children with Special Needs
● Give Teens 20/NavZ
● HOPE Project Mobile Health Clinic
● LIFE Eldercare Meals on Wheels
● Mission Valley ROP
● Narika, SEED Program
● New Haven Schools Foundation
● New Haven Unified School District
● Newark Education Foundation
● Newark Unified School District
● Ohlone Community College
● Rubicon Programs
● Solid Rock Community Services
● South Hayward Parish: Emergency Food Pantry
● Tri-City One-Stop Career Center (Employment Development Department) ● Tri-City Volunteers Food Bank & Thrift Store
● Union City Family Center
Healthcare Access & Delivery
HOSPITALS:
● Alameda Health System, John George Psychiatric Hospital ● Fremont Hospital
● Kaiser Foundation Hospital-Fremont
● St. Rose Hospital
● Sutter Health Eden Medical Center
● Washington Hospital Healthcare System
FEDERALLY QUALIFIED HEALTH CENTERS:
● Bay Area Community Health (multiple sites, incl. mobile clinics) ● Tiburcio Vasquez Health Center (multiple sites)
OTHER HEALTH CLINICS:
● Alameda Health System (Hayward Wellness, Newark Wellness) ● Sutter Health Palo Alto Medical Foundation, Fremont Center ● Washington Township Medical Foundation (multiple sites) OTHER ORGANIZATIONS:
● Alameda-Contra Costa Transit District (AC Transit)
● Alameda County Health Care Services: HealthPAC
● Alameda County Social Services Agency
● Bay Area Rapid Transit (BART)
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● East Bay Agency for Children
● Eden I & R, Inc.
● Family Resource Center, Fremont
● George Mark Children’s House
● LIFE Eldercare Transportation Program
● Operation Access
● Paratransit
● Rubicon Programs Wellness Services
● Special Need Children Center
● Union City Family Center
● Union City Transit
● Washington Women’s Center
Heart/Stroke
● American Heart Association
● Alameda County Community Food Bank (multiple sites)
● Alameda County Nutrition Services - Women, Infants, and Children (WIC) ● Alameda County Public Health Department
● Alameda County Social Services Agency
● California State University, East Bay, Hayward Promise Neighborhood ● Centro de Servicios
● City of Fremont Parks & Recreation Division
● East Bay Regional Parks District
● Family Resource Center, Fremont
● Hayward Area Recreation & Park District
● LIFE Eldercare, Inc.
● Meals on Wheels of Alameda County
● Newark Recreation & Community Services Department
● Solid Rock Community Services, Newark
● Tri-City Volunteers Food Bank and Thrift Store
● Union City Community & Recreation Services Department ● Union City Family Center
● Viola Blythe Community Service Center of Newark
Housing & Homelessness
● Abode Services
● Alameda County Homeless Project - Hayward (incl. Special Needs Housing) ● Alameda County Housing & Community Development
● Alameda County Social Services Agency
● Bay Area Community Services (BACS)
● Building Futures
● DeafPlus
● Everyone Home
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● Fremont Family Resource Center
● HOPE Project Mobile Health Clinic
● Union City Family Center
Respiratory Health
● Alameda County Asthma Coalition
● Alameda County Public Health Department, Asthma Start Program ● Alameda County Healthy Homes Alliance
● American Lung Association
● Bay Area Healthy 880 Communities
● Breathe California
● Tobacco Control Coalition of Alameda County
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ATTACHMENT 4: QUALITATIVE RESEARCH PROTOCOLS
WHHS CHNA Key Informant Interview (KII) Protocol (60 min.) PREP
● Schedule, call, send survey and main questions [minimum: 1 week ahead of time] ● 48 hours before, prepare:
○ Review the individuals’ backgrounds on LinkedIn and/or their organizations’ websites; review their survey responses (health needs they identified). ○ Send reminder email; if any didn’t respond to the survey (most pressing needs among those they serve), include the link and ask them to respond ASAP before the focus group.
○ Ensure you have slides of agenda/questions/identified needs ready.

INTRODUCTION (10 MIN.)
[Start recording from the beginning of the session. Remember, do not admit anyone who has not consented to recording.]
● Welcome and thanks.
● What the project is about:
○ Identifying health needs in our community here in the Washington service area, southern Alameda County, including social determinants of health (called the Community Health Needs Assessment or CHNA)
○ The report based on this assessment will be a snapshot in time, required of all nonprofit hospitals in the U.S. every three years; this report will be published next year (in 2023) and consulted through 2026
○ Will inform investments that hospitals make to address community needs ● Our interview is scheduled for sixty minutes – does that still work for you? ● Today’s questions:
○ Better understand the needs you identified as most pressing in southern Alameda County
○ Which populations are experiencing inequities related to the needs ○ How things may have changed recently (trends)
○ Any models or best practices you know of for addressing the needs ○ Areas of concern
○ [If not one of the needs identified:] Your expertise as it relates to the community’s needs ○ [If not one of the needs identified:] Your comments on how the pandemic has affected the people you serve
● What we’ll do with the information you tell us today:
○ Will record so that we can get the most accurate record possible. ○ Will not share the audio itself; transcript will go to hospital ○ We will read all of the transcripts and summarize the things we learn. We will also use some quotes so that the hospital can read your own words. We will not use your name when we give them those quotes.
○ Hospitals will make decisions about which needs they can best address ○ We can keep anything confidential, even the whole interview. Let me know at any time.

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○ [First half depends on their survey response:] Plan to name you/your organization in the report where we list all the experts we consulted, but will not attach your name to any quotes we might use.
● Any questions before I begin? [If we don’t have the answer, commit to finding it and sending later via email]
● [Make sure that recording is in progress.]
HEALTH NEEDS DISCUSSION (35 MIN.)
You identified [read list] as the most pressing needs for the people you serve. For each of these needs, I’ll ask you four things [read only bold text to introduce this section]:

1. Please describe how you see the need playing out, including how well the need is being addressed right now and what barriers might exist to seeing better outcomes. Probe: Who is addressing the need?
[Prompts for barriers if they are having trouble thinking of any: Income/economic issues, language, culture/stigma, lack of awareness/education, policies/laws, budget cuts, lack of community resources, geographic location, transportation, housing, addiction, stress, being victims of abuse/bullying/crime]

2. This may overlap the previous question, but I’ll ask you to identify which populations are experiencing inequities with respect to the need (that is, who are better or worse off than others) and explain their situation.
[Prompts for populations if they are having trouble thinking of any: income/education level, housing status, language, immigration status, age/generation, ethnicity, sexual orientation, gender identity, disability status, geographic location]

3. Third, to say how things may have changed in the last few years (since we know that the data always lags what is happening now). What emerging trends or areas of concern do you see? Think about how things were going prior to the emergence of COVID-19, and also how they are now, with the impact of the pandemic.

4. Finally, I’ll ask you to explain what you feel is needed to better address this need, including any models or best practices for addressing the need. Probe: What resources would you like to see Washington offer? [Prompts if needed: Practices you have observed within your organization, in our county agencies, national practices you have heard about, or practices you have read about in literature.]
OK, let’s get started. For [name first need], [start at Q1; address all four questions, then go back to Q1- 4 with second need, again with third need, then go on to the questions below.] Packet Page 131
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Only if their expertise was not related to one or more of the needs chosen:

FURTHER DISCUSSION: THEIR EXPERTISE (5 min.)
You were invited to share your expertise/experience about [e.g., substance use disorder, senior health, or homelessness]. Let’s talk a little about that; how does it relate to the community’s health needs? Only if COVID was not chosen as a need/was not discussed in the context of other needs:

FURTHER DISCUSSION: CORONAVIRUS PANDEMIC (5 min.)
I know you didn’t identify the coronavirus as a specific need; would you mind... ● Telling me about the effects of the pandemic you may be seeing among the people you serve (not just among those who were ill with COVID)?
● What inequities are you seeing?
● How have things changed in the last few years (both prior to COVID, and since COVID began)? ADDITIONAL COMMENTS (time permitting)
We have a few minutes left; is there anything else you would like to add regarding community health needs? Anything else we can convey to the hospital?
REQUEST FOR ASSISTANCE WITH ASSETS LIST (2 min.)
The IRS requires that we get feedback from the community on potential resources available to address these health needs. We are compiling a list of resources by health need later this year, which will be based on 2-1-1’s list. Would you be willing to review a list at that time, related to your area of expertise, and give us feedback? For example, we may ask whether the resources seem sufficient or if there are resources available that we have missed. [Make a note as to whether they agree or not.] CLOSING (1 min.)
Thank you for contributing your expertise and experience to the CHNA. You can look for Washington’s CHNA report to be made publicly available on its website in the second half of 2023.

If anything occurs to you later that you would like to add to this discussion, please feel free to send me an email.

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Washington Hospital CHNA FG Protocol - Professionals (60 min.) PREP
● Schedule or work with host to schedule a group of 8-12 participants. If needed, create recruitment email/flier for hospital rep. Ahead of time, send participants:
○ Pre-focus group survey and main questions [minimum: 1 week ahead of time]. ○ FG date, time, and Zoom login information
○ Advise that the session will be recorded
● 48 hours before, prepare:
○ Review the individuals’ backgrounds on LinkedIn and/or their organizations’ websites; review their survey responses (health needs they identified). ○ Send reminder email; if any didn’t respond to the survey, include the link and ask them to respond ASAP before the focus group.
○ Ensure you have slides of agenda/questions/identified needs ready.

INTRODUCTION (10 MIN.)
[Start recording from the beginning of the session.]
● Hello everyone. Today we are hosting a focus group about health here in the Washington service area, southern Alameda County. This session will run until [time]. ● My name is ____ and I’m with Actionable Insights, a local consulting firm. When we start our discussion in a few minutes, we will call ask you to say your name before speaking. ● What the project is about:
○ Identifying health needs in our community, including social determinants of health (called the Community Health Needs Assessment or CHNA)
○ The report based on this assessment will be a snapshot in time, required of all nonprofit hospitals in the U.S. every three years; this report will be published next year (in 2023) and consulted through 2026
○ Will inform investments that hospitals make to address community needs ● Today’s questions: show slide/poster
○ We’ll go over them more in a minute.
■ Better understand the needs you identified as most pressing in southern Alameda County
■ Which populations are experiencing inequities related to the needs ■ Trends (How things may have changed recently)
■ Models or best practices you know of for addressing the needs ■ Areas of concern
■ [If not one of the needs identified:] Your expertise as it relates to the community’s needs
■ [If not one of the needs identified:] Your comments on how the pandemic has affected the people you serve
● What we’ll do with the information you tell us today:
○ We are recording this group so that we can make sure to get your words right. ○ Will not share the audio itself; transcript or notes will go to hospital ○ When we are finished with all of the focus groups, we will summarize the things we learn.
○ We will also use some quotes in our reports, which we will keep anonymous.

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○ If for any reason you are deciding that you do not want to participate, it is OK to leave the meeting now. No hard feelings!
● Guidelines:
○ We know you have other commitments and we really appreciate you taking the time out of your day to be here. It is my job to move us along to keep us on time. I may interrupt you; I don’t mean any disrespect, but it is important to get to all of the questions so we can finish on time.
○ For Zoom: We understand that you may have distractions on your end; we ask that you do the best you can to remain present, and let us know through the chat if you absolutely need to step away.
○ In-person: If you need to take an emergency call, please step outside so that we can continue the discussion here in the room.
○ It’s OK to disagree, but please be respectful. We want to hear from everyone. Really want your personal opinions and perspectives, even – especially! – if they aren’t the same as everyone else’s.
● Any questions before I begin? [If we don’t have the answer, commit to finding it and sending later via email.]
HEALTH NEEDS DISCUSSION (35 MIN.)
As a group, you identified [read list] as the most pressing needs for the people you serve -- these are the needs that were ranked the highest in the pre-survey. For each of these needs, I’ll ask you four things [read only bold text to introduce this section]:

1. [Facilitators call on participants one by one.] “Please say your first name, and then describe how you see the need playing out, including how well the need is being addressed right now and what barriers might exist to seeing better outcomes. You can choose to pass if you didn’t rank the need highly or don’t have anything to say about it.” [Prompts for barriers if they are having trouble thinking of any: Income/economic issues, language, culture/stigma, lack of awareness/education, policies/laws, budget cuts, lack of community resources, geographic location, transportation, housing, addiction, stress, being victims of abuse/bullying/crime]

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4. Finally, I’ll ask you to explain what you feel is needed to better address this topic, including any models or best practices. Probe: What resources would you like to see Washington offer? [Prompts if needed: Practices you have observed within your organization, in our county agencies, national practices you have heard about, or practices you have read about in literature.]
OK, let’s get started. For [name first need], [start at Q1; address all four questions, then go back to Q1- 4 with second need, again with third need, then go on to the questions below.] Only if their expertise was not related to one or more of the needs chosen:

If anything occurs to you later that you would like to add to this discussion, please feel free to send me an email.

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WHHS CHNA FG Protocol - Community Members (60 min.)
PREP
● Work with host to schedule a group of 8-12 participants. If needed, create a recruitment email/flier for hospital rep. Ahead of time, have host send participants:
○ Pre-focus group health needs survey and main questions ○ FG date, time, and Zoom login information
○ Advise that the session will be recorded
● 48 hours before, prepare:
○ PDF of agenda/questions
○ Review pre-survey responses (if not everyone who’s expected responses, let host know to send reminders)
○ Ensure you have slides of agenda/questions/identified needs ready.

INTRODUCTION (10 MIN.)
[Start recording from the beginning of the session. Remember, do not admit anyone who has not consented to recording.]
● Hello everyone. Today we are hosting a focus group about health here in Southern Alameda County. This session will run until [time].
● My name is ____ and I’m with Actionable Insights, a local consulting firm. When we start our discussion in a few minutes, we will call on you and ask you to say your name before speaking. ● Purpose:
○ You are here today to let nonprofit hospitals know what the biggest health needs are in our county.
○ This is called the Community Health Needs Assessment (CHNA), which is required every three years by the IRS, so it is an official, public report. ○ Hospitals will use this to plan how they will use their resources to improve health and wellness in our county.
● Today’s questions: show slide
○ What are the needs?
■ Which groups of people are doing better or worse when it comes to the needs? ■ What can hospitals/health systems do to improve health in the community? ○ We will also talk about your pandemic experience and what you think the long-term effects will be (not just on health, but overall).
○ Lastly, we will get your perspective about equity and cultural competence when it comes to healthcare.
● Confidentiality:
○ We are recording this group so that we can make sure to get your words right. ○ We will only use first names here -- you will be anonymous. (If you want to use a fake name that’s OK, too!)
○ Will not share the video itself; transcript will go to hospital. ○ When we are finished with all of the focus groups, we will read all of the transcripts and summarize the things we learn. We will also use some quotes so that the hospital can read your own words. We will not use your name when we give them those quotes.

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○ If for any reason you are deciding that you do not want to participate, it is OK to leave the meeting now. No hard feelings!
● Guidelines:
○ We know you have other commitments and we really appreciate you taking the time out of your day to be here. It is my job to move us along to keep us on time. I may interrupt you; I don’t mean any disrespect, but it is important to get to all of the questions so we can finish on time.
○ We understand that you may have distractions on your end; we ask that you do the best you can to remain present, and let us know through the chat if you absolutely need to step away.
○ You have a choice of a $40 gift card to Amazon or Target. Please chat your email address to my colleague [name] now, along with your choice. If you don’t tell her which one you prefer, we’ll send you an Amazon gift card.
○ It’s OK to disagree, but please be respectful. We want to hear from everyone. Really want your personal opinions and perspectives, even – especially! – if they aren’t the same as everyone else’s.
● Any questions before I begin? [If we don’t have the answer, commit to finding it and sending later via email]
● Make sure that recording is in progress.

HEALTH NEEDS DISCUSSION (45 MIN.)
● To start off, we would like to know: when you imagine a healthy community, what does it look like? How does this compare/differ to any specific health concerns you have about your own community?
● As a group, you identified [read list] as the most pressing needs for the people you serve – these are the needs that got the most votes in the pre-survey. For each of these needs, I’ll ask you four things [read only bold text to introduce this section]:

1. [Facilitators call on participants one by one.] “Please describe how you see the need playing out, including how well the need is being addressed right now and what barriers might exist to seeing better outcomes. You can choose to pass if you didn’t vote for the need and don’t have anything to say about it.” [Prompts for barriers if they are having trouble thinking of any:

Income/economic issues, language, culture/stigma, lack of awareness/education, policies/laws, budget cuts, lack of community resources, geographic location, transportation, housing, addiction, stress, being victims of abuse/bullying/crime]

3. Finally, I’ll ask you to describe, for that need, what you think the people in charge should do to support, enhance, facilitate, or fund to help communities become healthier. This may include resources you wish to see offered by the hospital, or services that you think are important to your health or improving everyone’s well-being.

OK, let’s get started. For [name first need], [start at Q1; address all four questions, then go back to Q1- 3 with second need, again with third need, then go on to the questions below.] YOUR PANDEMIC EXPERIENCE (15 min.)
We all know that the coronavirus has been really disruptive to our normal lives since March of 2020.

Specifically, we want to hear about your experience with getting health care since then. ● [Facilitators call on participants one by one.] Tell us about how the pandemic affected your ability to access healthcare.
[Potential probes] Tell us more about your reasons for putting off a regular appointment or not seeing a provider for something that went wrong. Tell us your opinion of virtual appointments.

How did you like them? What was good about them (maybe even better than an in-person appointment)? What about them could be improved?
● Not only thinking about healthcare, but more generally: What do you think the longterm impact of the pandemic will be on you, your family, and your friends and neighbors? YOUR PERCEPTION OF EQUITY ISSUES (20 min.)
As you probably know, people have been talking about issues of equity much more than ever before. “Equity” means fairness and unbiased treatment. When it comes to health care, what’s your perspective about equity and cultural competence? For example:
● What do you think are the barriers to everyone having the same access to healthcare? ● What do you think are the barriers to everyone getting the same quality of healthcare? ● We know how important it is that healthcare providers care for people in a respectful and culturally competent way. How can local providers do better in this area? Can you share any examples of something that’s worked well in your experience? ● What can hospitals and health systems do to best address equity for you and the people in your community?
CLOSING (1 min.)
Thank you for contributing your ideas and experience to the CHNA.

You can contact us if you want any more information about the assessment. If anything occurs to you later that you would like to add, please feel free to send me an email.

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ATTACHMENT 5: IRS CHECKLIST
Section §1.501(r)(3) of the Internal Revenue Service code describes the requirements of the CHNA.

Federal Requirements Checklist
Regulation
Section
Number
Report
Reference
A. Activities Since Previous CHNA(s)
Describes the written comments received on the hospital’s most recently conducted CHNA and most recently adopted implementation strategy. (b)(5)(C) Section #2
Describes an evaluation of the impact of any actions that were taken, since the hospital facility finished conducting its immediately preceding CHNA, to address the significant health needs identified in the hospital facility’s prior CHNA(s).
(b)(6)(F) Section #2
B. Process & Methods
Background Information
Identifies any parties with whom the facility collaborated in preparing the CHNA(s).
(b)(6)(F)(ii) Section #4
Identifies any third parties contracted to assist in conducting a CHNA. (b)(6)(F)(ii) Section #4 Defines the community it serves, which:
 Must take into account all patients without regard to whether (or how much) they or their insurers pay for care or whether they are eligible for assistance.
 May take into account all relevant circumstances including the geographic area served by the hospital, target population(s), and principal functions.
 May not exclude medically underserved, low-income, or minority populations who live in the geographic areas from which the hospital draws its patients.
(b)(i)
(b)(3)
(b)(6)(i)(A)
Section #3
Describes how the community was determined. (b)(6)(i)(A) Section #3 Describes demographics and other descriptors of the hospital service area.

Section #3
Health Needs Data Collection
Describes data and other information used in the assessment: (b)(6)(ii) a. Cites external source material (rather than describe the method of collecting the data).
(b)(6)(F)(ii) Attachments 1
& 2
b. Describes methods of collecting and analyzing the data and information.
(b)(6)(ii) Section #5
CHNA describes how it took into account input from persons who represent the broad interests of the community it serves in order to identify and prioritize health needs and identify resources potentially available to address those health needs.
(b)(1)(iii)
(b)(5)(i)
(b)(6)(F)(iii)
Section #5
Describes the medically underserved, low-income, or minority populations being represented by organizations or individuals that provide input.
(b)(6)(F)(iii) Section #5
a. At least one state, local, tribal, or regional governmental public health department (or equivalent department or
agency) or a State Office of Rural Health.
(b)(5)(i)(A) Section #5 &
Attachment 1
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Federal Requirements Checklist
Regulation
Section
Number
Report
Reference
b. Members of the following populations, or individuals serving or representing the interests of populations listed below. (Report includes the names of any organizations - names or other identifiers not required.)
(b)(5)(i)(B) Section #5 &
Attachment 1
I. Medically underserved populations (b)(5)(i)(B) Section #5 & Attachment 1
II. Low-income populations (b)(5)(i)(B) Section #5 &
Attachment 1
III. Minority populations (b)(5)(i)(B) Section #5 &
Attachment 1
c. Additional sources (optional) – (e.g., healthcare consumers, advocates, nonprofit and community-based organizations, elected officials, school districts, healthcare providers and community health centers).
(b)(5)(ii) Section #5 &
Attachment 1
Describes how such input was provided (e.g., through focus groups, interviews or surveys).
(b)(6)(F)(iii) Section #5 &
Attachment 1
Describes over what time period such input was provided and between what approximate dates.
(b)(6)(F)(iii) Section #5 &
Attachment 1
Summarizes the nature and extent of the organizations’ input. (b)(6)(F)(iii) Sections #5, #6, & Attachment 1
C. CHNA Needs Description & Prioritization
Health needs of a community include requisites for the improvement or maintenance of health status both in the community at large and in particular parts of the community (such as particular neighborhoods or populations experiencing health disparities).
(b)(4) Section #6
Prioritized description of significant health needs identified. (b)(6)(i)(D) Section #6 Description of process and criteria used to identify certain health needs as significant and prioritizing those significant health needs. (b)(6)(i)(D) Section #5
Description of the resources potentially available to address the significant health needs (such as organizations, facilities, and programs in the community, including those of the hospital facility. (b)(4)
(b)(6)(E)
Section #7 &
Attachment 3
D. Finalizing the CHNA
CHNA is conducted in such taxable year or in either of the two taxable years immediately preceding such taxable year.
(a)1 Sections #1 &
#5
CHNA is a written report that is adopted for the hospital facility by an authorized body of the hospital facility (authorized body defined in §1.501(r)-1(b)(4)).
(b)(iv) Section #8
Final, complete, and current CHNA report has been made widely available to the public until the subsequent two CHNAs are made widely available to the public. “Widely available on a web site” is defined in §1.501(r)-1(b)(29).
(b)(7)(i)(A) By 6/30/2023
a. May not be a copy marked “Draft”. (b)(7)(i)(A) By 6/30/2023 Packet Page 140
Actionable Insights, LLC 98
Federal Requirements Checklist
Regulation
Section
Number
Report
Reference
b. Posted conspicuously on website (either the hospital facility’s website or a conspicuously-located link to a web site established by another entity).
(b)(7)(i)(A) By 6/30/2023
c. Instructions for accessing CHNA report are clear. (b)(7)(i)(A) By 6/30/2023 d. Individuals with Internet access can access and print reports without special software, without payment of a fee, and without creating an account.
(b)(7)(i)(A) By 6/30/2023
e. Individuals requesting a copy of the report(s) are provided the URL.
(b)(7)(i)(A) By 6/30/2023
f. Makes a paper copy available for public inspection upon request and without charge at the hospital facility.
(b)(7)(i)(B) By 6/30/2023
Further IRS requirements not applicable to this report:
 §1.501(r)-3(b)(iv) and (v): separate and joint CHNA reports  §1.501(r)-3(d): requirements that apply to new hospital facilities, transferred or terminated hospital facilities, and newly acquired hospital facilities  §1.501(r)-3(a)(2) and (c): implementation strategy requirements Packet Page 141
Item B. 4.

DATE 11/09/2023
TO Honorable Mayor and City Council Members
FROM Sheila Harrington, City Clerk
SUBJECT AC Transit Realign bus service network plan presentation AC Transit has embarked on Realign, a comprehensive planning process to better match their service to peoples’ transit needs. A representative from AC Transit will present preliminary bus service plan scenarios at the City Council meeting. They plan to implement the service changes in August 2024.

For more information on the project, please visit: Realign Attachments
Presentation
Packet Page 142
THURSDAY, NOVEMBER 9, 2023
1 Realign Draft Service Scenarios
INFORMATIONAL ITEM: AC Transit Realign Bus Service Network Plan Update Newark City Council
Check out our
proposals
online!
Packet Page 143
AC Transit At-a-Glance
Rider Demographics:
•65% low income
•75% people of color
•29% Limited English Proficiency
•27% of riders are traveling to work
•30,000 student trips to and from school every school day Riders During Pandemic:
•40% of riders made an essential trip
•15% of riders identified as an essential worker
•43% riders do not have access to a car
We serve
Essential workers, students, low-income, seniors,
commuters, individuals with disabilities, and anyone wishing to reduce their carbon footprint. 2
Packet Page 144
3 Transit Service in Newark Today
24 mins
60 mins
Line Serving Wkdy
Frequency
200
Union City BART - Decoto -
Newark Blvd - NewPark Mall
– Mowry – Fremont BART
Every 24 min
216
Union City BART - Niles -
Mowry - Fremont BART -
Stevenson - NewPark Mall -
Silliman Center
Every 60 min
232
Fremont BART - Mission –
Union City BART - Decoto –
Paseo Padre - Lido Faire -
NewPark Mall
Every 60 min
251
Fremont BART - Paseo Padre
- Thornton – Ohlone College
Newark Campus
Every 60 min
Packet Page 145
1 2 3 4 5
Develop Plans
+
Learn Rider
Needs
Aligning
Guiding
Principles with
Community
Assessment
Develop
Service
Scenarios
and Gather
Feedback
Draft Final
Service Plan
and Plan
Adoption
Develop
Service
Standards
and Inform
Riders about
Service
Changes
Mar-Jun 2023 Jul-Aug 2023 Sep-Dec 2023 Jan-Apr 2024 Apr-Sep 2024 Realign Project Phasing
On 4 -going emphasis on equity and transparency in all project phases and communications Packet Page 146
Equity
Provide a network
that prioritizes
mobility for
communities who
need it the most.

Frequency
Provide frequent
service to the most
people; frequency’s
importance will vary by
location and be
balanced against
geographic coverage
and community needs.

Reliability
Provide bus
service that is
reliable and
predictable.

Guiding
Principles
Packet Page 147
Service Scenarios Overview
6 Stay the Course Balanced Coverage Scenario
More Frequency,
Less Coverage Frequent Service Scenario
Unconstrained More Frequency,
More Coverage
Unconstrained Vision
Scenario
Cost-Neutral
(Pending funding availability)
Packet Page 148
Balanced Coverage Scenario
• Keeps today’s balance between core service
and providing network coverage.
• Improves access to many destinations
• New coverage to areas with high transit
demand
• Simplifies routes to improve
reliability and travel time
• Better matches service frequency to
customer demand
7 Packet Page 149
• Focuses more frequent service in denser
areas at the cost of network coverage.
• All local routes provide weekday service
at least every 30 minutes
• Better frequency on busier trunk routes
• Simplifies routes to improve
reliability and travel times
• Eliminates less productive local lines and
route segments.
8 Frequent Service Scenario
Packet Page 150
• Expanded frequent service, expanded
coverage, more revenue, operators, buses,
bus garages needed.
• Restores pandemic suspensions, with some
changes to support equity and reflect new
travel patterns.
• Proposed on-demand microtransit zones
where fixed route service expansion is less
practical.
9 Unconstrained Vision Scenario
Packet Page 151
Key Highlights
10 Consistent between
Balanced Coverage and
Frequent Service scenarios
Packet Page 152
Redesigned Line 200 expands
coverage in western Newark,
with service along Enterprise Dr,
Willow St, and Central Ave
11 Packet Page 153
12 Redesigned Line 216 serves Mission Blvd,
provides later service, and improves
weekday frequency to 30 mins.

Packet Page 154
13 Redesigned Line 232 operates
between Union City BART and New
Park Mall with weekday frequency
improved to 30 mins.

Packet Page 155
14 Line 251 includes service to Ohlone
College – Newark everyday, provides
later service, and improves weekday
frequency to 30 mins
Packet Page 156
System-wide Summary
15 Existing
Network
Balanced
Coverage
Scenario
Frequent Service
Scenario
Unconstrained
Vision
Scenario
10 minutes or less 2 routes 3 routes 4 routes 20 routes 10 - 15 minutes 9 routes 8 routes 10 routes 17 routes
15 – 30 minutes 28 routes 34 routes 39 routes 26 routes Over 30 minutes 23 routes 14 routes 0 routes 0 routes
Total 62 routes 59 routes 53 routes 63 routes
Packet Page 157
16 Review and comment on
bus service proposals
online, in person, or at a
local library.

Shape the
future of
AC Transit’s
bus
network
November 1 – December 13, 2023
Public Engagement: Phase 3
Packet Page 158
Visit: actransit.org/realign
17 Staff Contacts
Diann Castleberry
External Affairs Representative
(510) 891-4801
[email protected]
Crystal Wang
Transportation Planner
(510) 891-4735
[email protected]
more info at
Actransit.org/realign
Email us at
[email protected]
Check out our
proposals
online!
Packet Page 159
Item D. 1.

DATE 11/09/2023
TO Honorable Mayor and City Council Members
FROM Krysten Lee, Finance Director
SUBJECT Approval of Audited Demands
Attachments
Audited Demands 10.12.23
Audited Demands 10.19.23
Packet Page 160

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Item D. 2.

DATE 11/09/2023
TO Honorable Mayor and City Council Members
FROM Sheila Harrington, City Clerk
SUBJECT Approval of October 26, 2023 minutes
Attachments
Minutes
Packet Page 172
City of Newark | Newark City Council
Mayor Michael K. Hannon | Vice Mayor Maria “Sucy” Collazo | Council Members: Luis L. Freitas, Mike Bucci, and Matthew Jorgens

Draft
Thursday, October 26, 2023
7:00 P.M.

A. ROLL CALL
Mayor Hannon called the meeting to order at 7:11 p.m. Vice Mayor Collazo, Council Members Bucci, Freitas, and Jorgens were present.

B. PRESENTATIONS

1. Introduction of employee(s)
Mayor Hannon introduced Senior Parks and Landscape Maintenance Worker Thomas Curtis and Senior Streets Maintenance Worker Jason Avery who were each recently promoted.

2. Proclaim October as Promotores Month
Mayor Hannon presented the proclamation to Administrative Assistant Edda Rivera, Special Assistant Adriana Lopez, Special Assistant Veronica Torres and members of the Newark Promotores.

3. Proclaim October as Filipino American History Month
Mayor Hannon presented the proclamation to Rosalinda Canlas.

4. Senator Aisha Wahab California legislative update
Senator Wahab provided a California legislative update (presentation on file with City Clerk).

Packet Page 173
Page No. 2
City of Newark City Council Minutes October 26, 2023
C. PUBLIC COMMENT
No one requested to speak.

D. CONSENT CALENDAR
Council Member Jorgens moved, Council Member Bucci seconded, to approve Consent Calendar Items D.1 through D.7, that the resolutions and ordinances be numbered consecutively, and that reading of the titles suffice for adoption. The motion passed, 5 AYES.

1. Approval of Audited Demands

2. Approval of October 12, 2023 minutes

3. Resolution for acceptance of work with Sposeto Engineering, Inc. for Safe Routes to School Improvements, Project 1280
Resolution No. 11570

4. Adopt a resolution authorizing the City Manager to execute a Contractual Equipment and Services Agreement with PB Loader Corporation for the purchase of a dump truck and authorization for outfitting by Classic Graphics and amend the 2022-2024 Biennial Budget and Capital Improvement Plan Resolution No. 11571
Contract No. 23075

5. Adopt a resolution accepting public subdivision improvements for Tract 8459 – Compass Bay, a 138-unit residential subdivision generally located in Bayside Newark on the southeast corner of Enterprise Drive and Hickory Street Resolution No. 11572

6. Adopt a resolution authorizing the City Manager to execute a Contractual Services Agreement with Joseph Chow & Associates, Inc. for on-call architectural services
Resolution No. 11573
Contract No. 23076
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7. Adopt a resolution authorizing an amendment to the agreement with Stantec Consulting Inc. for environmental services for the Mowry Village project Resolution No. 11574
Contract No. 21025
E. PUBLIC HEARINGS

1. Public Hearing to consider adoption of the 2023-2031 Housing Element and Safety Element of the City of Newark General Plan
Resolution No. 11575
Mayor Hannon announced that Vice Mayor Collazo and Council Member Freitas would need to recuse themselves from certain approvals due to real property/business interests.

The City Council would consider those locations first and then review the remaining Housing Element sites.

Community Development Director Turner provided an overview of the General Plan, Housing and Safety Elements. He noted that Newark’s Regional Housing Needs Allocation(RHNA) is 1,874 housing units, a 70% increase over the previous RHNA.

Vice Mayor Collazo stated that she would recuse from Site Inventory List A which included Site 9 6781 Thornton Avenue and Site 28 APN 92-24-10 Neighborhood Infill Lots due to a conflict of interest.

Vice Mayor Collazo exited the City Council Chambers.

Mayor Hannon opened the public hearing for List A at 8:30 p.m.

No one requested to speak.

Mayor Hannon closed the public hearing for List A at 8:31 p.m.

Moved by Council Member Bucci, seconded by Council Member Jorgens to approve Site 9 and Site 28 (APN 92-24-10) in the Sites Inventory (Table C-1) of the 2023-2031 Housing Element. The Motion passed 4 AYES, 1 RECUSED.

Vice Mayor Collazo returned to the City Council Chambers.

Council Member Freitas stated that he would recuse from Site Inventory List B which included Site 12 37280 Magnolia Street, Site 21 Sycamore Vacant Lot and Site 28 APN 92-125-2-2 Neighborhood Infill Lots due to a conflict of interest.

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Council Member Freitas exited the City Council Chambers.

Mayor Hannon opened the public hearing for List B at 8:33 p.m.

No one requested to speak
Mayor Hannon closed the public hearing for List B at 8:34 p.m.

Moved by Council Member Bucci, seconded by Vice Mayor Collazo to approve Sites 12,21, 28 APN 92-125-2-2 in the Sites Inventory (Table C-1) of the 2023-2031 Housing Element. The motion passed 4 AYES, 1 RECUSED.

Council Member Freitas returned to the City Council Chambers.

Kristy Wang, Planning Collaborative, reviewed the 2023-2031 Housing Element:

Community Engagement, Constraints, Goals and Policies (preserve and improve existing housing; facilitate the development of more homes for more people; reduce and remove constraints to affordable housing development; help people stay in their homes and communities; increase access to affordable housing; enhance quality of life/equity and environmental justice; further fair housing throughout the city.

Paul Peninger, Bay Area Economics reviewed programs: Preservation - create housing rehabilitation and repair programs and a rental inspection program; Missing Middle Housing develop housing options close to services, support ADU production, encourage middle-density housing types; Special Needs Housing local response to homelessness, support development of single room occupancy units, identify housing opportunities for those with developmental disabilities; Addressing Government Constraints streamline ministerial permit procedures, design standards for housing, update impact fees, adjust zoning to allow mixed uses in commercial zones, parking study; Partnerships/Public Lands collaborate for the redevelopment of school district owned sites, develop programs and policies to increase the utilization of public land for affordable housing; Antidisplacement and Tenant Support develop anti-displacement programs for the Old-Town Newark Specific Plan, develop a Just Cause Eviction Ordinance, connect residents to existing shared housing programs, support tenant stability; Affordable Housing Development ensure an adequate amount of affordable housing through programs; First Time Homebuyer Program. He briefly reviewed the sites inventory Community Development Director Turner reviewed the Housing Element Revisions requested by the State of California Department of Housing and Community Development (HCD). He recommended that the City Council incorporate the revisions to ADUS Program H2.2, Four Corners Program H2.3, Parking Standards Program H3.5, Definitions and process review Program 4.10, incentive program for small lot consolidation and Packet Page 176
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development H2.11, achievable maximum residential densities H2.12, and monitor progress and residential development potential H7.6 (October 26, 2023 memorandum to City Council detailed the proposed revisions on file with the City Clerk).

A discussion ensued on Homeowner Association fees.

Grace Nelson Environmental Science Associates (via Zoom) presented the Safety Element She highlighted Air Quality, Drought and Water Quality, Flooding Hazards, Hazardous Materials, Emergency Preparedness and new requirements from the State related to evacuation routes.

Community Development Director Turner stated that the Planning Commission held a public hearing on October 24, 2023 and voted 4-0-1 (Commissioner Fitts absent) to recommend that the City Council adopt a General Plan amendment to repeal the Fifth Cycle Housing Element for the period of 2015-2023 and adopt the Housing Element of the General Plan for the period of 2023-2031 and adopt the Safety Element of the General Plan, in compliance with State Housing Element Law.

Mayor Hannon opened the public hearing at 10:00 p.m.

No one requested to speak.

Mayor Hannon closed the public hearing at 10:01 p.m.

Council Member Jorgens stated that bicycle storage was needed at businesses for public convenience.

Council Member Bucci suggested including preapproved plans for Accessory Dwelling Units to help people save money on architectural design fees.

Mayor Hannon stated that he would like to see a higher percentage of lower income standards for housing. He requested that Echo Housing provide a presentation of their services in 2024.

Council Member Bucci moved, Council Member Jorgens seconded to adopt a resolution for a General Plan Amendment to repeal the Fifth Cycle Housing Element for the period of 2015- 2023 and adopt the Housing Element of the General Plan for the Period 2023-2031 and repeal the existing Natural Hazards Element and adopt the Safety Element of the General Plan, in compliance with State Housing Element Law. The motion included the Housing Element Revisions as outlined by Community Development Director Turner and in the October 26 memorandum to the City Council (on file with City Clerk). The motion passed, 5 AYES.

Mayor Hannon called for a recess at 10:14 p.m. The meeting resumed at 10:26 p.m.

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F. OTHER BUSINESS

1. Waive full reading and, by title only, introduce an ordinance to repeal and replace Title 16 “Subdivisions” of the Newark Municipal Code Introduction of Ordinance
Principal Civil Engineer Cangco gave the presentation recommending introduction of the Ordinance. Presentation on file with City Clerk.

No one from the public requested to speak.

Principal Civil Engineer Cangco and City Engineer Imai responded to Council Member Bucci’s questions and concerns regarding the security release process.

Vice Mayor Collazo moved, Council Member Freitas seconded to waive full reading and, by title only, introduce an ordinance to repeal and replace Title 16 “Subdivisions” of the City of Newark Municipal Code In its entirety. The motion passed, 5 AYES.

G. CITY COUNCIL MATTERS
Council Member Jorgens stated that the East Bay Community Energy has rebranded as Ava Community Energy.

Council Member Freitas extended his sympathy to former Council Member Ana Apodaca and her family on her mother’s death. He complimented the Maintenance Division for the wellorganized Community Clean up event. He stated that the corner of Mayhews Landing Road and Newark Boulevard and a property on Thornton and Mulberry Street were blight and needed attention. He suggested requiring a covered fence for future infill property approvals.

Council Member Bucci congratulated the Newark Memorial High School football team for winning the homecoming game. He requested drivers to slow down on Halloween and that he would give away full size candy bars on Halloween.

Vice Mayor Collazo extended her condolences to the Apodaca family. She stated that the Dia de las Muertos event has grown in size and they may need to close Thornton Avenue next year. Shop Newark.

Mayor Hannon stated he would adjourn the meeting in recognition of the mass shooting event in Maine.

H. CITY MANAGER UPDATES
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I. CLOSED SESSION
J. ADJOURNMENT
Mayor Hannon adjourned the meeting at 10:55 p.m. in tribute to the Lewiston, Maine’s mass shooting victims.

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Item D. 3.

DATE 11/09/2023
TO Honorable Mayor and City Council Members
FROM Diana Cangco, Principal Civil Engineer
SUBJECT Waive full reading, conduct second reading by title only, and adopt an ordinance repealing and replacing Title 16 "Subdivisions" of the Newark Municipal Code At its October 26, 2023 meeting, the City Council introduced an ordinance repealing and replacing Title 16 “Subdivisions” of the Newark Municipal Code. A second reading of the ordinance is required prior to adoption. The proposed ordinance will result in a comprehensive update of Title 16 to clarify decision-making processes, streamline procedures, and ensure consistency with the Subdivision Map Act. The ordinance will take effect 30 days after the second reading.

Attachments
Subdivision Ordinance
Subdivision Ordinance Exhibit A
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ORDINANCE NO. ______

AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF NEWARK
REPEALING AND REPLACING TITLE 16 “SUBDIVISIONS” OF

OF THE CITY OF NEWARK MUNICIPAL CODE IN ITS ENTIRETY
WHEREAS, the California Constitution, Article XI, Section 7, provides cities and counties with the authority to enact ordinances and regulations not in conflict with general laws; and WHEREAS, the Subdivision Map Act, Sections 66411 et. seq. of the Government Code, allows cities with flexibility in enacting local subdivision ordinances; and WHEREAS, Title 16 “Subdivisions” of the City of Newark Municipal Code (“NMC”) regulates and control the division of land and each part thereof within the City, supplements the provisions of the Subdivision Map Act, and sets forth the procedure to be followed in securing the official approval of the planning director, city engineer, public works director, city manager, planning commission and city council regarding divisions of land; and
WHEREAS, Title 16 was last significantly updated in 1977 pursuant to Ordinance No. 143; and WHEREAS, the City Council, on the recommendation of the City Manager and the City Attorney, desires to repeal and replace Title 16 to update and revise the local subdivision ordinance; and WHEREAS, the amendments to the Municipal Code propose to repeal and replace Title 16 “Subdivisions” of the NMC in its entirety, as shown in Exhibit A, which is attached hereto and incorporated herein by reference.

NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF NEWARK DOES ORDAIN AS FOLLOWS:

SECTION 1. Recitals. The above recitals are true and correct and made a part of this Ordinance.

SECTION 2. CEQA. The subdivision ordinance update is exempt from environmental review under the general exemption in California Environmental Quality Act (CEQA) Guidelines section 15061(b)(3) for projects where it can be seen with certainty that there is no potential for significant environmental effects. The subdivision ordinance update does not approve any development project or other physical activity; nor does it change any land use or density designations that would affect development potential.

Instead it updates the policies, standards and procedures through which subdivision applications for development would be considered. Any future development application would be reviewed for compliance with CEQA.

SECTION 3. Municipal Code Amendment. The City Council hereby approves the amendments to the NMC, more particularly, repealing Title 16 “Subdivisions” of the NMC in its entirety, and replacing it with the text shown in attached Exhibit A, which is attached hereto and incorporated herein by reference and available for review in the City Clerk’s office during normal business hours.

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SECTION 4. Severability. If any provision of this Ordinance or the application thereof to any person or circumstance is held invalid, the remainder of the Ordinance, including the application of such part or provision to other persons or circumstances shall not be affected thereby and shall continue in full force and effect. To this end, provisions of this Ordinance are severable. The City Council hereby declares that it would have passed each section, subsection, subdivision, paragraph, sentence, clause, or phrase hereof irrespective of the fact that any one or more sections, subsections, subdivisions, paragraphs, sentences, clauses, or phrases be held unconstitutional, invalid, or unenforceable.

SECTION 5. Publication and effective date. Within fifteen (15) days from and after adoption, this Ordinance shall be published once in the Tri-City Voice, a newspaper of general circulation printed and published in Alameda County and circulated in the City of Newark, in accordance with California Government Code Section 36933. This Ordinance shall take effect and be enforced thirty (30) days after its adoption.

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EXHIBIT A
Title 16 SUBDIVISIONS
Chapter 16.04 General Provisions

16.04.010 Title

16.04.020 Purpose and Authority

16.04.030 Intent

16.04.004 Consistency

16.04.050 Application of Chapter

16.04.060 Exclusions

16.04.070 Fees and Deposits

16.04.080 General Responsibilities

16.04.090 Definitions

16.04.100 Authority for Subdivision Decisions
Chapter 16.06 Maps Required

16.06.010 General

16.06.020 Division of Land – Five (5) or More Parcels

16.06.030 Division of Land – Four (4) or Fewer Parcels
Chapter 16.08 Tentative Tract and Tentative Parcel Maps

16.08.010 General.

16.08.020 Persons Authorized to Prepare

16.08.030 Tentative Map Number

16.08.040 Filing

16.08.050 Form and Contents

16.08.060 Accompanying Data and Reports

16.08.070 Noticed Public Hearing

16.08.080 Public Notice

16.08.090 Action -Tentative Tract Maps

16.08.100 Action -Tentative Parcel Maps

16.08.110 Appeals

16.08.120 Extension of Time for Action or Report

16.08.130 Effective Period of Approved Tentative Map
Chapter 16.12 Design

16.12.010 General Requirements

16.12.020 Street Alignment

16.12.030 Street and Alley Grades and Widths
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16.12.040 Blocks

16.12.050 Parcels

16.12.060 Grading

16.12.070 Erosion and Siltation Control

16.12.080 Flood Hazards

16.12.090 Exceptions
Chapter 16.16 Improvements

16.16.010 Duty of Subdivider to Improve Streets

16.16.020 Required Improvements

16.16.030 Standards for Improvements

16.16.040 Improvement Plans

16.16.050 Inspection by City Engineer

16.16.060 Cost of Inspection

16.16.070 Completion of Improvements
Chapter 16.20 Surveys and Monuments

16.20.010 Field Survey

16.20.020 Discrepancy

16.20.030 Compiled Map

16.20.040 Accuracy Required

16.20.050 Remainder

16.20.060 Ties to Centerlines

16.20.070 Boundary Monuments

16.20.080 Street Monuments

16.20.090 Monuments - Interior Lots

16.20.100 Monuments -Time for Setting

16.20.110 Monuments -Inspection and Approval

16.20.120 California Coordinate System
Chapter 16.24 Final Maps and Parcel Maps

16.24.010 General

16.24.020 Phasing of Final Maps or Parcel Maps

16.24.030 Form

16.24.040 Contents

16.24.050 Procedure

16.24.060 Data and Material to Accompany Final Map or Parcel Map Submittal

16.24.070 Improvement Agreements

16.24.080 Action on Final Map

16.24.090 Action on Parcel Map

16.24.100 Appeal to City Council
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16.24.110 Action on Final Map or Parcel Map Appeal by City Council Chapter 16.28 Reserved
Chapter 16.32 Underground Utilities

16.32.010 Intent

16.32.020 Utility Distribution Facilities to be Placed Underground

16.32.030 Duty of Subdivider

16.32.040 Request for Exception
Chapter 16.40 Vesting Tentative Map

16.40.010 Authority and Purpose

16.40.020 Consistency

16.40.030 Application

16.40.040 Filing and Processing

16.40.050 Vesting of Development Rights

16.40.060 Development Inconsistent with Zoning – Conditional Approval

16.40.070 Applications inconsistent with Applicable Ordinances, Policies and Standards

16.40.080 Amendment to Vesting Tentative Map

16.40.090 Findings Required for Vesting Tentative Map Approval Chapter 16.44 Map Amendments and Certificates of Correction

16.44.010 Map Amendments and Certificates of Correction Chapter 16.48 Reversion to Acreage and Resubdivision

16.48.010 Reversion to Acreage

16.48.020 Resubdivision
Chapter 16.52 Lot Line Adjustments

16.52.010 Lot Line Adjustments

Chapter 16.56 Enforcement

16.56.010 Enforcement

16.56.020 Effect of Approval or Conditional Approval of Map Packet Page 185

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Chapter 16.04 General Provisions

16.04.010 Title
This title shall be known as the Subdivision Ordinance of the city of Newark.

16.04.020 Purpose and Authority
This title shall regulate and control the design and improvement of subdivisions of land within the city and supplement the provisions of the Subdivision Map Act of the State of California set forth at Government Code Sections 66410 et seq. concerning the design, improvement and survey data of subdivisions, the form and content of all maps provided for by the Subdivision Map Act, and the procedure to be followed in securing the official approval of the city regarding the maps.

16.04.030 Intent
The intent of this title is to promote the public health, safety and general welfare; to promote orderly growth and development within the city; to coordinate lot design, street patterns, rightsof-way, traffic circulation, utilities and public facilities with the general plan and any specific plans; to assure that areas dedicated for public purposes will be properly improved initially so as not to be a future burden upon the community; to preserve natural resources and prevent environmental damage; to maintain suitable standards to ensure adequate, safe building sites; and to prevent hazard to life and property.

16.04.040 Consistency
No land shall be subdivided for any purpose that is inconsistent with the city’s general plan or any applicable specific plan of the city or that is not permitted by the zoning ordinance (Title 17) or other applicable provisions of this Code. It is the intent of this title to comply in every regard to the latest edition of the Subdivision Map Act. If any provision of this title is in conflict with the Subdivision Map Act, the provisions in the Subdivision Map Act shall prevail.

The type and intensity of land use as shown on the general plan and any applicable specific plan shall determine the type of streets, roads, highways, utilities and public services, and other public improvements that shall be provided by the subdivider.

16.04.050 Application of Title
The regulations set forth in this title shall apply to all or parts of subdivisions within the city and to the preparation of subdivision maps and to other maps provided for by the Subdivision Map Act and this title. All subdivisions and any part thereof lying within the city shall be made and all subdivision maps shall be prepared and presented for approval in accordance with this title.

16.04.060 Exclusions
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This title shall not apply to actions exempted by Government Code Section 66412 and any others specifically exempted by the State Subdivision Map Act, except that the procedures for the application, review and approval of lot line adjustments shall be as outlined in Chapter 16.52.

16.04.070 Fees and Deposits
All applicants for the approval of maps or for other approvals as required by this title shall pay all fees and/or deposits as established by City Council resolution.

16.04.080 General Responsibilities
In addition to the specific responsibilities set forth elsewhere in this title, the following agencies and officers, or their duly authorized representatives, shall have the general responsibilities hereby designated.

A. City Attorney. The City Attorney is responsible for approving as to form all subdivision improvement agreements and security and governing documents for a common interest development.

B. City Clerk. The City Clerk is responsible for filing and maintaining all official documents.

C. City Council. The City Council responsibilities shall be as follows:

1. The City Council shall act as the appeal board for subdivision decisions or actions of the Planning Commission.

2. The City Council shall act as the appeal board for subdivision decisions or actions of the City Engineer on final maps, parcel maps, improvement agreements and/or dedications.

3. When tentative maps are processed concurrently with other land use applications requiring City Council action, the City Council shall have authority for approval, conditional approval, or disapproval of the tentative map application.

D. City Engineer. The City Engineer or their designated representative, as specified in the Subdivision Map Act, shall have the following responsibilities:

1. The City Engineer shall have final approval or disapproval authority for final maps, parcel maps, improvement agreements, and the acceptance or rejection by the city of lands, easements, and/or improvements as may be offered for dedication to the city under Government Code Sections 66458, 66463, 66477.1, 66477.2 and 66477.3. The City Engineer shall sign the City Engineer’s certificate, and release the map to the county clerk or a title insurance company for transmittal to the county recorder for recordation.

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2. The City Engineer is responsible for determining if proposed subdivisions comply with provisions of the Subdivision Map Act and this title.

3. The City Engineer is responsible for the approval or disapproval of requests for parcel map waivers under Section 16.06.030.

4. The City Engineer is responsible for determining whether the proposed improvements are consistent with the design and improvement standards specified or referred to in this title, and for the inspection and approval of all such improvements, and for making recommendations on granting exceptions requested under Section 16.12.090.

5. The City Engineer shall, on a regular basis, report to the City Council on consideration and action on final maps, parcel maps, improvement agreements, and the acceptance or rejection by the City Engineer of lands and/or improvements offered for dedication.

E. Community Development Director. The Community Development Director responsibilities shall be as follows:

1. The Community Development Director is responsible for the approval, conditional approval or disapproval of tentative parcel maps and lot line adjustments, except for tentative parcel maps subject to concurrent processing under subsection (C)(3) of this section.

2. Reviewing, distributing, and processing tentative tract, tentative parcel map and tentative parcel map waiver applications and making a recommendation on compliance with the California Environmental Quality Act (CEQA).

3. The Community Development Director shall have the power to direct the issuance of citations, cease and desist orders and other appropriate orders involving violations of provisions of this title.

4. At any point in the review process and at their sole discretion, the Community Development Director may transfer original hearing jurisdiction to the Planning Commission because of policy implications, unique or unusual circumstances, or the magnitude of the project.

F. Planning Commission. The Planning Commission responsibilities shall be as follows:

1. The Planning Commission is responsible for the approval, conditional approval, or disapproval of tentative tract maps and discretionary extensions.

2. At any point in the review process and at its sole discretion, the Planning Commission may transfer original hearing jurisdiction to the City Council because of policy implications, unique or unusual circumstances, or the magnitude of the project.

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3. The Planning Commission shall act as the appeal board for decisions of the Community Development Director.

4. When tentative maps are processed concurrently with other land use applications requiring City Council action, the Planning Commission shall make a recommendation on the maps to the City Council.

16.04.090 Definitions
All words and terms used in this title shall have the same meaning as defined in the Subdivision Map Act, except as expressly defined in this section.
“Advisory agency” means a designated official or an official body charged with the duty of reviewing the design and improvement of proposed divisions of real property, the imposing of requirements or conditions thereon, or having the authority under this title to approve, conditionally approve or disapprove maps.
“Final map” means a map showing a subdivision prepared in accordance with the provisions of this title and the Subdivision Map Act and designed to be recorded in the office of the Alameda County Recorder.
“Parcel map” means a map showing a subdivision of four or fewer parcels, prepared in accordance with the provisions of this title and the Subdivision Map Act and designed to be recorded in the office of the Alameda County Recorder. A parcel map also means a map showing a subdivision of five (5) or more parcels under the final map exemption in Government Code Sections 66426(a) through (e).
“Subdivider” means a person, firm, corporation, partnership, or association, who proposes to divide, divides or causes to be divided real property into a subdivision for him or herself or for others except that employees and consultants of such persons or entities, acting in such capacity, are not “subdividers.”
“Subdivision” means the division, by any subdivider, of any unit or units of improved or unimproved land, or any portion thereof, as shown on the latest equalized county assessment roll as a unit or as contiguous units, for the purpose of sale, lease or financing, whether immediate or future, and as further defined in Government Code Section 66424. “Tentative map” means a map made for the purpose of showing the design and improvement of a proposed subdivision and the existing conditions in and around it. “Tentative map” includes a tentative parcel map and a tentative tract map.
“Tentative parcel map” means a tentative map prepared in connection with a subdivision of four (4) or fewer parcels.

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“Tentative tract map” means a tentative map prepared in connection with a subdivision of five (5) or more lots.
“Vesting tentative map” means a tentative map that meets the requirements set forth in Chapter

16.40. 16.04.100 Authority for Subdivision Decisions
Table 16-1 (Subdivision Review Authority) identifies the city official or authority responsible for reviewing and making decisions on each type of subdivision application or other decision required by this title.

Table 16-1 Subdivision Review Authority
Issue/Document
Applicable
Code
Chapter
Role of Review Authority(1)
Community
Development
Director
City
Engineer
Planning
Commission
City
Council
Tentative parcel map 16.08 Decision(2)(3) Appeal
Tentative parcel map
waiver

16.06 Decision(2) Appeal
Parcel map 16.24 Decision(2) Appeal
Tentative tract map 16.08 Decision(2)(3) Appeal
Final map 16.24 Decision(2) Appeal
Certificate of
compliance

16.56 Decision(2) Appeal
Lot line adjustment 16.52 Decision(2) Appeal
Parcel map waiver 16.06 Decision(2) Appeal
Reversion to acreage 16.48 Decision
Time extension 16.40 Decision(2) Appeal
Notes:
(1) “Decision” means that the review authority makes the final decision on the matter; “Appeal” means that the review authority may consider and decide upon appeals of the decision of an earlier decision-making body in accordance with Government Code Section 66452.5. (2) At its sole discretion, the review authority may transfer original hearing jurisdiction to a higher body.
(3) For tentative maps subject to concurrent processing, the Planning Commission makes a recommendation to the City Council.

Chapter 16.06 Maps Required

16.06.010 General
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The necessity for tentative, final, and parcel maps shall be governed by the provisions of this chapter.

16.06.020 Division of Land – Five (5) or More Parcels
A tentative tract map and final map shall be required for all divisions of land creating five (5) or more parcels, five (5) or more condominiums as defined in Section 783 of the Civil Code, a community apartment project containing five (5) or more parcels, or for the conversion of a dwelling to a stock cooperative containing five (5) or more dwelling units, except where any one (1) of the following occurs:

A. The land before division contains less than five (5) acres, each parcel created by the division abuts upon a maintained public street or highway, and no dedications or improvements are required by the Planning Commission or City Council.

B. Each parcel created by the division has a gross area of twenty (20) acres or more and has an approved access to a maintained public street or highway.

C. The land consists of a parcel or parcels of land having approved access to a public street or highway, which comprises part of a tract of land zoned for industrial or commercial development, and which has the approval of the Planning Commission or City Council as to street alignments and widths.

D. Each parcel created by the division has a gross area of not less than forty (40) acres or is not less than a quarter of a quarter section.

E. The land is being subdivided solely for the creation of an environmental subdivision pursuant to Government Code Section 66418.2.

F. A tentative parcel map shall be required for the subdivisions described in subsections A through E of this section, and a parcel map shall be required rather than a final map unless the parcel map is waived by the City Engineer in accordance with Section 16.06.030(C).

16.06.030 Division of Land – Four (4) or Fewer Parcels
A. General. A tentative parcel map and parcel map shall be required for all divisions of land into four (4) or fewer parcels, except as provided below.

B. No Parcel Map Required. No parcel map shall be required for the following:

1. Subdivisions of a portion of the operating right-of-way of a railroad corporation, defined by Public Utilities Code Section 230, that are created by short-term leases (terminable by either party on not more than thirty (30) days’ notice in writing).

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Newark City CouncilNovember 9, 2023

Newark City Council
November 9, 2023