The health and well-being of individuals, families, and neighborhoods depends on access to educational opportunities, health services, and social services that meet their social, cultural, and linguistic needs. Integrated and comprehensive health and social services, including primary care providers, mental health, substance use prevention and treatment programs, and nutrition and other assistance programs can improve health outcomes and provide the support children need to become school ready. Educational attainment can lead to healthier and longer lives through increased earning power, better access to health insurance, and reduced levels of chronic stress. When residents are healthy and supported, they are more likely to maintain personal independence, age in place, and engage in the community's civic, economic and social life.
Health insurance safeguards our community's health by increasing access to medical care and reducing the burden of costly medical bills. Access to care increases the use of preventive health services including routine physical exams, immunizations, cholesterol testing and other screenings and improves the treatment and management of acute and chronic diseases.
For the 2013-2015 time period, approximately 1 in 15 (6.5%) Napa County residents did not have health insurance, which is below the state level of 1 in 10 (9.8%).
Napa County fell short of the Healthy People 2020 target of 100% health insurance coverage, a goal that was established based on the increase in coverage provided through the 2010 Patient Protection and Affordable Care Act (ACA). In California, the ACA expanded Medi-Cal coverage to previously ineligible adults with incomes below 138% of the federal poverty level. For higher income individuals and families without employer coverage, a private health insurance marketplace was established, Covered California. Under Covered California, lower income, but Medi-Cal ineligible, households receive health plan premium subsidies. ACA also allowed young adults to stay on their parent’s plan longer (until 26 years of age) and prevented insurance companies from denying coverage to those with pre-existing conditions. Since its roll out of ACA in 2012, there has been a considerable decline in the number of uninsured. Despite this achievement, the future of the law is uncertain, as attempts to modify or repeal the law and replace it with alternative reforms have been underway.
Delays in care prevents timely diagnosis, referrals to specialists and effective management of diseases, resulting in more serious complications, poorer prognosis, and higher health care costs. For children, the lack of access to care not only contributes to poorer health outcomes but poorer school performance, educational attainment and economic success in the future.
Common reasons for delaying care are costs, lack of insurance, language and cultural differences between the patient and the provider, scarcity of providers, lack of transportation to the providers, limited hours of operation, and other access to care issues. Residents living in rural areas are most impacted by lack of access; they tend to use less preventative care and are more likely to use emergency departments as primary care services.
For the 2015-2017 time period, 8.0% of Napa County residents delayed or did not receive any medical care, which was better than the state level of 10.5%. This was a dramatic shift from the 2012-2014 time period when 14.3% of Napa County residents delayed or did not receive care. This decrease is largely attributed to the implementation of the ACA.
Preventable hospitalizations are the hospital admissions that could have been prevented if the disease condition had been identified and effectively managed in an outpatient care setting. Preventable hospitalizations can lead to 1) higher healthcare costs, especially with conditions such as diabetes and asthma that can generally be managed through routine primary care and, 2) disease complications and more severe health outcomes as a result of under-utilization and delays in seeking screenings, treatment, and other primary care services.
In 2016, there were 948 preventable hospitalizations per 100,000 residents in Napa County. Almost a third of those hospitalizations were due to respiratory conditions in older adults and diabetes in the general population; about 174 hospitalizations per 100,000 were attributable to chronic obstructive pulmonary disease (COPD) and asthma in older adults and 132 per 100,000 were attributable to diabetes. All three rates in Napa County were slightly below the state levels.
Although data is not available for Napa County, the following populations in the US experience higher rates of preventative hospitalization: racial/ethnic minorities (e.g. Hispanics and Blacks), older adults, lower income households, and the uninsured. There are several reasons for this disparity, including poor access to care (e.g. hours of operation and location), lack of usual source of care, deficiencies in coordination and quality of care, and financial constraints. Strategies to reduce preventable hospitalization include increasing access to primary care services, closer monitoring and improving the culturally competency of care for high-risk populations, and enhancing the continuity of care.
Oral health is an important component of a person's overall health. Regular visits to a dentist are a necessary component of the prevention of both tooth decay and gum disease in children and adults. Dentists also play an important role in the early detection of oral cancers. Untreated tooth decay and gum disease not only cause pain and difficulties with eating, but they can also lead to social stigma and a decreased ability to show emotions through facial expressions. The ability to access dental care is linked to factors such as race, ethnicity, education, and income. Because cost is often a barrier to accessing care, rates of dental insurance and timely visits are used as two possible indicators of oral health in populations. Among adults age 55 and older in Napa County, only 54% of those surveyed in 2016-2017 indicated that they currently had dental insurance. Among children in Napa County, 88% were estimated to have visited a dentist in the past year (2014). That was slightly lower than the statewide average of 92%.
An advanced healthcare directive is a legal document that ensures that a person's wishes regarding healthcare are carried out in the event they are incapacitated and unable to speak for themselves.
Since a medical crisis can happen at any age, both younger as well as older adults are highly encouraged to have an advanced care directive. It is a living document that can be adjusted as one's situation changes because of new information or a change in health. Decisions that may be included in the directive relate to CPR, ventilator use, placement of feeding tubes, and comfort care.
At the Queen of the Valley Medical Center, 31% of patients hospitalized between 2017 and 2019 had an existing advanced healthcare directive.
For more information on advanced care planning, visit Honoring Choices Napa Valley.
*Note that you can see adults overall with the filter.
Adopted from CDPH's Healthy Communities Data and Indicators Project (HCI) - (C) Child Development, Education, and Literacy
For more information on health care, visit the following links — CA OSHPD Data and AskCHIS(NE)
Education and health are interconnected over the lifetime of individuals, families and communities.
More education brings with it opportunities that promote health, such as higher income, access to healthcare, healthy behaviors, more sense of control over life and reduced levels of chronic stress. Health issues can influence educational attainment, too. Asthma is a major cause of absenteeism for students. Physical and psychological stresses at home can make it difficult for children to concentrate during lessons. Students may struggle in school because of difficulties with vision, hearing, or learning.
Furthermore, several leading health organizations now recognize a healthy brain as an important part of overall health. Education provides the brain with skills and experiences that help keep it fit, like physical activity helps keep the body fit.
Image from the Center on Society and Health (https://societyhealth.vcu.edu/work/the-projects/why-education-matters-to-health-exploring-the-causes.html)
The experiences of early childhood shape behavior, learning, and health into adolescence and beyond. High quality early childcare, research shows, is linked to favorable outcomes, such as less aggressive behavior in their first 3 years of life, higher vocabulary scores in 5th grade, higher academic achievement at age 15 and fewer risk factors for heart disease in one’s mid-30s. Access to affordable, high quality childcare can be especially beneficial for low-income and single parent families by allowing parents to work and freeing family income that was spent on child care for other needs.
How many child care slots are enough? According to Child Care Aware of America’s working definition, a census tract is considered a child care desert if there are at least 50 children under age five living there, and there is either no child care providers in the area or the ratio of young children to child care slots is more than 3 to 1. When this definition is applied in Napa County, many census tracks lack sufficient child care availability. The ratio of young children to child care slots countywide is about 4.5:1, meaning that Napa County, with an estimated 7,035 children under 5 years old in 2017, is itself a child care desert. Napa County is not alone in this; in 2018, 60% of California residents lived in a child care desert. Click on the link to explore an interactive map of child care deserts in America: https://childcaredeserts.org/index.html. Currently, there are more licensed day care slots available across all types of care for children ages 0-5 years in Napa County compared with California overall, with about 13% more slots in infant care centers and 18% more in preschools. Although Napa County compares favorably to the state, there is still unmet need with regard to affordable childcare. According to a recent report, California was the least affordable state for center-based infant care, where 60% of the average median income for a single-parent family would be needed to pay for care.
Preschools make up the majority of child care slots available for children aged 5 and under. Although the percentage of 3- and 4-year-olds enrolled in preschools in California has changed little in recent years, the rates of preschool enrollment appear to have declined between 2013 and 2017 in Napa County. In 2017, 43.8% of 3- and 4-year-olds in Napa County were enrolled in pre-primary school compared to 48.7% statewide.
Please note, interactive filters are available to see additional data.
Public school enrollment in middle and high schools has changed little during the 5-year period from 2013 to 2018, while elementary public school enrollment declined by over 600 students, nearly a 9% change. Over that same period, the total population in Napa County increased. However, the birth rate in Napa County has been dropping, from a 2-year average of 10.3 per 1,000 residents in 2012-2013 to 9.5 per 1,000 residents in 2016-2017. In that same 5-year period, the percent of the population aged 65+ continued to increase.
Public school enrollment among Filipino students increased some from 2013-2014 to 2017-2018, and decreased somewhat among White students over the same period. Enrollment among Hispanic or Latino students changed little. Please note that not all Races/Ethnicities are shown due to low numbers.
For the 2017-2018 school year, Napa County has a slightly higher percentage of English language learners than the state average (23.1% compared with 20.4%), with nearly a quarter of all students enrolled in public schools being classified as English learners based on objective assessments of listening, speaking, reading and writing proficiency in English. Schools are required to administer these assessments upon enrollment and annually for all students whose primary language is not English.
See Also: Demographics and Housing and Health
Reading proficiency in the third and fourth grades is a predictor of future academic success, with one study of almost 4,000 students finding that children with low reading proficiency are four times less likely to graduate with a high school diploma than proficient readers. Third grade reading proficiency is a predictor of academic future success, because that is the time when students transition from “learning to read to reading to learn.” Many factors have been identified as contributors to reading proficiency, including readiness for school, chronic absence, summer learning loss, family-related stressors, and quality of teaching.
Although reading proficiency among third and fourth graders appears to be increasing over time, fewer than half of students in Napa County are meeting California Assessment of Student Performance and Progress standardized test English Language Arts standards, also known as Smarter Balanced tests.
Math proficiency test scores among third and fourth grade students in Napa County have mirrored state scores from 2014 to 2018. Nearly half of third grade students met California Assessment of Student Performance and Progress standardized test math standards in 2017-2018. Closer to 40% of fourth grade students met grade-level standards in 2017-2018.
Math skills also affect health outcomes, both directly and indirectly. Math is an important part of many health-related prevention and treatment activities, such as reading nutrition labels, understanding when and how to take prescription medication, and managing blood glucose levels. Additionally, math skills impact socioeconomic factors that also influence health, such as financial literacy and employment opportunities.
School years prior to 2016-2017 have not been included on this chart because changes made to the methods used in calculating graduation rates mean they are not directly comparable. For more information, see Ed-Data.
High School Education: How does education have such broad and long-lasting effects on health? Education influences health in many ways, which researchers believe can be broadly categorized into three main routes: the mental and social environment, work, and health knowledge and behaviors. In other words, education provides people with a sense of control over their lives, increases social standing and social support, which in turn can reduce stress and support healthy behaviors. With regard to work, education can lead to better working conditions, as well as higher income and benefits, such as health insurance. The educational setting also provides a place for people to learn about nutrition and healthy behaviors, like exercising and avoiding tobacco.
The high school graduation rate in Napa County is 4% higher than the statewide rate, 87% and 83% respectively. Although Hispanic or Latino students had a slightly higher graduation rate than California as a whole (84.8% compared to 83%), this is the group in Napa County with the lowest graduation rate. In 2017-2018, Hispanic or Latino students were also the largest group of graduates, making up 745 of 1,466 graduates countywide. Smaller in number at 117 of all graduates, Filipino students had the highest graduation rate at 94.4%, about 7.5% higher than the county average.
See Also: Social Vulnerability
A high school diploma is associated with increased health over a lifetime, and that boost in health continues with increased education. University of California (UC) and the California State University (CSU) schools require incoming students to have taken a minimum number of years of study in various core subjects, such as 2 years of History/Social Science, 3 years of Mathematics, and so on. (Please visit https://hs-articulation.ucop.edu/guide/a-g-subject-requirements/g-college-preparatory-elective/ for more information about UC/CSU course requirements.) About half of Napa County students graduated with all the courses required for entry into the California public university systems in 2017-2018. Calistoga Joint Unified graduated 48 students in 2017-2018, 19 of which had taken the minimum required courses. Saint Helena Unified graduated 95 students, with 54 meeting minimum course requirements. Napa Valley Unified graduated 1,269, of which 667 met minimum course requirements.
In both Napa County and California, about half of all high school graduates in 2017-2018 met course requirements for admission to California’s public universities. That percentage is significantly smaller for graduates who are English language learners. While statewide, college readiness among English language learner graduates is about half of that for all students, the percentage drops to 3.9% in Napa County. In other words, 5 of the 740 English language learner high school graduates in Napa County in 2017-2018 met admission requirements for UC/CSU schools.
Higher Education: Across the country, adults with more education tend to have a higher life expectancy, on average living 9 years longer than those without a college degree. As a group, adults with more education also live with better overall health, reporting lower rates of diabetes and heart disease.
From 2013 through 2017, slightly more Napa County residents held a higher education degree than the state’s average, with a small upward trend over the five-year period. Although about a third of Napa County residents hold a Bachelor’s Degree or higher, those degrees are not distributed evenly among racial/ethnic groups. In Napa County in 2017, over 45% of Asian residents had a college degree or higher, followed by 43.7% of Non-Hispanic White residents, 38.1% of residents reporting two or more races, 27.8% of Black residents, and 11% of Hispanic residents. Only 6.3% of residents reporting their race/ethnicity as ‘Some other race’ held a higher degree.
Social services can provide eligible families and individuals with the resources they need to lead healthy lives. Programs such as WIC, CalFresh, CalWORKs and Medi-Cal, provide health care coverage, healthy food and other aid to Napa County residents in need.
The Social Services page is currently in development and will be linked here when available.
Billings, J. Recent Findings on Preventable Hospitalizations. Health Affairs 15, no. 3 (1996): 239-49. Retrieved on July 8, 2019 from https://doi.org/10.1377/hlthaff.15.3.239
Carman KG., Eibner C. Paddock, SM. Trends in Health Insurance Enrollment, 2013-2015. Health Affairs. 34. no.6 (2015):1044–1048. Retrieved on July 8, 2019 from https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2015.0266
Diamant, A. L., Hays, R. D., Morales, L. S., Ford, W., Calmes, D., Asch, S., … Gelberg, L. (2004). Delays and unmet need for health care among adult primary care patients in a restructured urban public health system. American journal of public health, 94(5), 783–789. doi:10.2105/ajph.94.5.783.
Kaiser Family Foundation. Key Issues in Children's Health Coverage (2017). Retrieved on July 8, 2019 from https://www.kff.org/medicaid/issue-brief/key-issues-in-childrens-health-coverage/
Loftus, J., Allen, E. M., Call, K. T., & Everson-Rose, S. A. (2018). Rural-Urban Differences in Access to Preventive Health Care Among Publicly Insured Minnesotans. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 34 Suppl 1(Suppl 1), s48–s55. doi:10.1111/jrh.12235
Pezzin LE, Bogner HR, Kurichi JE, et al. Preventable hospitalizations, barriers to care, and disability. Medicine (Baltimore). ;97(19):e0691. Retrieved on July 8, 2019 from doi:10.1097/MD.0000000000010691
Rand Corporation. Healthcare Reform. Retrieved on July 8, 2019 from https://www.rand.org/health-care/key-topics/health-policy/in-depth.html
Richardson, AK. Investing in Public Health: Barriers and Possible Solutions. Journal of Public Health (Oxford) 34, no. 3 (2012): 322-27. Retrieved on July 8 from https://doi.org/10.1093/pubmed/fds039
Vogenberg FR, Santilli J. Healthcare Trends for 2018. Am Health Drug Benefits. 2018;11(1):48–54.
Education and Health
Center on Society and Health (2015). Why Education Matters to Health: Exploring the Causes. Retrieved August 5, 2019 from https://societyhealth.vcu.edu/work/the-projects/why-education-matters-to-health-exploring-the-causes.html
Hahn, Robert A., and Truman, Benedict I. (2015). Education Improves Public Health and Promotes Health Equity. Retrieved on August 2, 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691207/
Early Childhood Education
California Department of Public Health, Office of Health Equity (2017). Healthy Communities Data and Indicators Project: Educational Attainment. Retrieved July 25, 2019 from
Child Care Aware of America (2018). The US and the High Cost of Child Care: A Review of Prices and Proposed Solutions for a Broken System. Retrieved July 25, 2019 from https://cdn2.hubspot.net/hubfs/3957809/COCreport2018_1.pdf
Council of Economic Advisers, White House (2015). The Economics of Early Childhood Investments. Retrieved July 25, 2019 from https://obamawhitehouse.archives.gov/sites/default/files/docs/early_childhood_report_update_final_non-embargo.pdf
Center for American Progress (2018). America’s Child Care Deserts in 2018. Retrieved August 6, 2019 from https://www.americanprogress.org/issues/early-childhood/reports/2018/12/06/461643/americas-child-care-deserts-2018/
For more information on licensed day care in California, visit the Department of Social Services' facilities search tool. https://secure.dss.ca.gov/CareFacilitySearch/Search/ChildCare
Public School Enrollment
For more data on enrollment, visit the following databases — CA Department of Education & US Census Bureau's American Fact Finder. https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml and http://www.ed-data.org/
Math and Reading Proficiency
California Assessment of Student Performance and Progress (CAASPP)
California requires all school districts to administer the Smarter Balanced Summative Assessments. These assessments are comprehensive end of year assessments in English Language Arts/Literacy and Mathematics. The Smarter Balanced Assessment System utilizes computer-adaptive tests and performance tasks that allow students to show what they know and are able to do. This system is based on the Common Core State Standards (CCSS) for English language arts/literacy (ELA) and mathematics.
Students in grades 3-8 and 11 participate in the Smarter Balanced assessments for English Language Arts and Math. Students in grades 5, 8, 11 and 12 will be participating in the Smarter Balanced assessment for Science field test for 2018.
Fiester, Leila, The Annie E. Casey Foundation (2013). Early Warning Confirmed: A Research Update on Third-Grade Reading. Retrieved July 29, 2019 from https://www.aecf.org/m/resourcedoc/AECF-EarlyWarningConfirmed-2013.pdf#page=3
Hernandez, Donald J., The Annie E. Casey Foundation (2011). Double Jeopardy: How Third-Grade Reading Skills and Poverty Influence High School Graduation. Retrieved July 29, 2019 from https://files.eric.ed.gov/fulltext/ED518818.pdf
Fiester, Leila, The Annie E. Casey Foundation (2010). Early Warning!: Why Reading by the End of Third Grade Matters. Retrieved July 29, 2019 from https://www.ccf.ny.gov/files/9013/8262/2751/AECFReporReadingGrade3.pdf
Rothman, Russell L et al. Journal of Health Communication (2008) Author Manuscript. Perspective: The Role of Numeracy in Health Care. Retrieved September 23, 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2767457/
High School Graduation
Center on Society and Health (2015). Education: It Matters More to Health than Ever Before. Retrieved July 29, 2019 from https://societyhealth.vcu.edu/work/the-projects/education-it-matters-more-to-health-than-ever-before.html
Visit https://hs-articulation.ucop.edu/guide/a-g-subject-requirements/g-college-preparatory-elective/ for more information about UC/CSU course requirements.
California Department of Public Health, Office of Health Equity (2017). Healthy Communities Data and Indicators Project: Licensed daycare center slots. Retrieved July 25, 2019 from https://www.cdph.ca.gov/Programs/OHE/CDPH%20Document%20Library/HCI/ADA%20Compliant%20Documents/HCI_Licensed%20Daycare%20Center_760_Narrative_11-13-15-ADA.pdf