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14  County Health Summaries

14.1 Dutchess County Health Summary

14.1.1 Demographics

Dutchess County is in the center of the Hudson Valley, midway between New York City (NYC) and New York State’s (NYS) capital, Albany. The western border includes 30 miles of Hudson River shoreline with Connecticut forming the eastern border. Dutchess County is 825 square miles, made up of 30 municipalities, consisting of 20 towns, 8 villages, and two cities, Poughkeepsie (the county seat) and the city of Beacon. The southwestern region of Dutchess County is the most densely populated part of the county and includes the cities of Beacon and Poughkeepsie. The rest of the county is predominantly suburban and rural. Dutchess County has a population of almost 300,000 with a majority of residents between 35 and 64 years old. In Dutchess County 8.3% of adults report having poor physical health and 11.7% of adults report having poor mental health (1).

14.1.2 Community Survey Findings

14.1.2.1 Mid-Hudson Regional Community Health Survey 2025

As a primary data collection method, Dutchess County collaborated with Putnam County on the third iteration of the Mid-Hudson Regional Community Health Survey Section 15.12. The 66-question survey, administered by Siena Research Institute (SRI), asked 500 Dutchess County residents about overall quality of life, social determinants of health, perceptions of health and well-being, health behaviors, and access to and utilization of health services. By administering a revised version of the 2018 and 2022 iterations of the Mid-Hudson Regional Community Health Survey (2), Dutchess and Putnam Counties were able to analyze changes in responses over time.

The survey was fielded from May 1 to June 3, 2025, and was open to residents of Dutchess and Putnam Counties aged 18 years and older. Respondents were contacted via landline and cell phone. Telephone sampling was conducted via a stratified dual-frame probability sample of landline and cell phone numbers. County samples were weighted by age, gender, reported race and ethnicity, and income using American Community Survey population estimates to ensure statistical representativeness. A total of 500 residents of Dutchess County completed the survey. The margin of error (MOE), including design effects resulting from weighting, with a 95% confidence interval for the Dutchess County sample, was +/- 6.4%.

The self-reported physical health status of Dutchess County residents increased from 2022 to 2025, with 73% and 78% reporting excellent or good physical health, respectively. In 2025, individuals who rent their home, are unemployed, live in households with disabled persons, or are low-income reported poorer overall physical health compared to their peers. Residents of the western portion of Dutchess County also reported poorer overall physical health compared to those residing in the eastern portion of the county.

Similarly, the self-reported mental health status of Dutchess County residents increased from 2022 to 2025, with 69% and 75% reporting excellent or good mental health, respectively. In 2025, individuals who are non-White, rent their home, and live in households without children or households with disabled persons reported poorer overall mental health compared to their peers. Self-reported mental health status also appeared to correlate with age, with individuals 18–34 years old having poorer mental health compared to those 35–54 and 55+.

Respondents were asked a series of questions regarding psychological distress. According to the Kessler Score, the summation of responses to those questions, 46% of Dutchess County residents reported moderate or severe mental distress. Moderate or severe mental distress was more commonly reported by individuals residing in the eastern portion of the county, residents aged 18–54 years, non-White individuals, those who rent their home, employed residents, and households with disabled persons.

When asked about their ability to get basic necessities, such as food, housing, utilities, transportation, and access to a phone and internet, Dutchess County residents reported having less trouble accessing these necessities in 2025 compared to 2022. In 2025, some groups more frequently reported trouble accessing these necessities compared to their peers. In general, this included those residing in the western portion of the county, non-White residents, households with disabled persons, individuals who rent their home, and lower-income individuals.

Self-reported ability to get health care, including physical, mental, and dental care, varied by demographic group. Individuals residing in the eastern portion of the county reported worse access to physical and mental health care, but better access to dental care, compared to those residing in the western portion. Non-White individuals, those who rent their home, and households with disabled persons reported more trouble accessing all health care compared to their counterparts.

Twenty-five percent of Dutchess County residents said they had not been to a primary care physician for a routine physical checkup in the last 12 months. This is an increase from 2022 and 2018, when 22% and 16%, respectively, reported not visiting a primary care physician in the last year. The most common reasons for not visiting a primary care provider in the past year included not having time (37%), choosing not to go for another reason (31%), not having enough money (24%), or not having insurance (23%).

In 2025, 6% of Dutchess County residents reported visiting the emergency room in the last year for a non-emergent issue. This is similar to 2022 (8%) and 2018 (7%). The most common reason for visiting the emergency room for a non-emergency issue was the convenience of emergency room operating hours, accounting for nearly 50% of responses in 2025.

More information regarding the methodology, design, and results is available in Dutchess County’s report.

14.1.2.2 Dutchess County Resident Priority Voting

In addition to the phone-based survey, DCDOH also gathered input from residents at community events. Attendees were given two stones and asked to place them in a flowerpot labeled with the Prevention Agenda 2025–2030 priority areas. A total of 830 Dutchess County residents participated in six events during summer 2025. As shown in Figure 14.1, the most common priority area selected was Mental Wellbeing and Substance Use, followed by Health Insurance Coverage and Access to Care and Healthy Children.

Figure 14.1: Dutchess County Resident Prevention Agenda Priority Area Voting, 2025

Table 14.1: Dutchess County Resident Prevention Agenda Priority Area Voting, 2025

Mental Wellbeing & Substance Use	Health Insurance Coverage & Access to Care	Safe & Healthy Communities	Healthy Children	Student Success & Educational Attainment	Economic Wellbeing
412	324.0	265.0	286.0	206.0	167.0

14.1.3 Areas of Focus

In Dutchess County, there is a strong need to focus on chronic disease factors and mental and behavioral health. Cardiovascular disease is the leading cause of death in Dutchess County, and other chronic health conditions, such as hypertension, diabetes, and obesity, can contribute to and exacerbate cardiovascular disease. Those with a mental health condition, including but not limited to depression, anxiety, other mood disorders, or substance or alcohol use disorder, are also more likely to have a chronic health condition than those without one.

Due to the interrelatedness of physical and mental well-being, it is important to focus not only on physical health but on mental health as well. Within both sectors, disparities exist between the more urban-suburban western side of the county and the rural eastern side; between White non-Hispanic residents and Black non-Hispanic and Hispanic residents; and between those with disabilities and those without disabilities. These disparities can be seen in rates of preventable hospitalizations, premature death, opioid overdose, participation in primary care, and provision of mental health services. To combat these issues, residents of Dutchess County need access to and support from sufficient, competent health providers to manage their health.

Areas of focus should include, though not be limited to: - Cardiovascular disease, the leading cause of death in the county - Cancer, including screening rates - Respiratory diseases, including asthma and chronic lower respiratory disease (CLRD) - Other chronic diseases, such as diabetes, hypertension, and obesity - Childhood immunizations - Mental health and well-being - Suicide and self-harm - Opioid overdose - Behavioral health, including diet and exercise, smoking, and alcohol and drug use

14.1.4 Assets and Resources

Dutchess County Department of Health (DCDOH) works closely with a variety of organizations, including academic institutions (public schools and colleges), community-based organizations (CBOs), hospitals and other medical facilities, federally qualified health centers, and governmental departments. DCDOH also has a Mobile Health Unit that is deployed to community events and areas of high need to provide clinical services (immunizations, sexual health) and public health education.

Additionally, Department of Health employees participate in an array of coalitions and workgroups aimed at improving Dutchess County residents’ health, including Eastern Dutchess Rural Health Network, Bringing Agencies Together, Poughkeepsie Healthy Black and LatinX Coalition, Fit Dutchess, the Dutchess County Food Security Council, and Vassar Brothers and Northern Dutchess Hospital’s Community Health Committee Meetings, fostering collaboration between DCDOH and other participating organizations.

14.2 Orange County Health Summary

14.2.1 Demographics

Orange County is in the southeastern area of NYS, bounded on the east by the Hudson River and on the west by the Delaware River. It is located approximately 40 miles north of NYC with 43 municipalities. Orange County is the second most populous in the M-H Region with approximately 403,840 residents Table 6.1. Of Orange County residents, 50.1% are male, 59.2% are non-Hispanic White, 10.5% are non-Hispanic Black, and 23.2% are Hispanic Table 6.2, Table 6.4, Table 6.5. Orange County is both racially and ethnically diverse, with the second highest percentage of Hispanic persons in the M-H Region and 17.5% of individuals identifying as a race other than non-Hispanic White [Table 5]. Twenty-nine percent of people living in Orange County speak a language other than English at home, third highest in the M-H Region next to Westchester and Rockland counties [Table 6]. Nearly 30% of Orange County residents are 19 years or younger, the second highest percentage among M-H counties Table 6.3. Nearly half (49.5%) of Orange County students are considered economically disadvantaged, which ranks second in the M-H region Figure 7.12 and Table 7.15. Although 89% of students graduate with a high school diploma, third highest in M-H Region, only 14.1% of residents hold a graduate or professional degree, the second worst among M-H Region counties Figure 7.13 and Table 7.16. Unemployment has remained steady in the last three years of data available around 5.4% Figure 7.2 and Table 7.2 and the percentage of the population under poverty has been 13% since 2022 Figure 7.7 and Table 7.9. In Orange County, 20% of households spent half or more of their income on housing, which is the second highest in the M-H Region and higher than the NYS average of 19% Figure 7.6 and Table 7.6.

Orange County is a mix of urban, suburban, farmland, and rural areas. Agriculture is a leading industry in Orange County and constitutes more than half of the county’s open space. The availability of multiple modes of transportation, including bus, train, and major highways, allows residents to travel to NYC, New Jersey, and Southern NYS for employment. Orange County also contains New York Stewart International Airport in Newburgh, NY, West Point Military Academy in Highland Falls, NY, and major tourist attractions such as LEGOLAND New York and the Woodbury Commons Premium Outlets.

14.2.2 Community Survey Findings

14.2.2.1 Orange County Community Health Survey

As part of the CHA process, the Orange County Department of Health (OCDOH), in partnership with Siena Research Institute, collected primary data through the Orange County Community Health Survey Section 15.13 to better characterize community needs. The 63-question survey, administered by Siena Research Institute (SRI), asked residents about overall quality of life, social determinants of health, perceptions of health and well-being, health behaviors, and access to and utilization of health services.

Orange County conducted this survey in coordination with the M-H Region in 2018 and 2022 and unilaterally in 2023 and 2024. By administering the survey over time, OCDOH was able to analyze response changes. The survey was fielded from May 20 to June 26, 2024, and was open to Orange County residents aged 18 years and older. Respondents were contacted via landline and cell phone. There were 800 respondents who completed the survey through a dual-frame (landline and cell phone) mode and 100 who completed the survey via the online panel (Lucid). The county-wide sample of 900 was weighted by age, gender, reported race and ethnicity, income, and county using the 2015–2020 American Community Survey 5-year estimates to ensure statistical representativeness. The margin of error (MOE), including design effects resulting from weighting with a 95% confidence interval for the sample, was +/- 3.8%.

More information regarding the methodology, design, and results is available in the Orange County Community Health Survey Report (3) on the OCDOH website. Overall, Orange County residents with an income under $25,000 ($25K) had worse health outcomes and reported struggling to obtain basic needs such as food, housing, and transportation.

Below are several data points of note:

• Overall, 74% of respondents rated their physical health as excellent or good, compared to 79% in 2018. By comparison, only 60% of those making <$25K per year reported excellent or good physical health.
• The percentage of respondents reporting excellent mental health declined significantly since 2018 (52% vs. 37% in 2024).
• Forty-seven percent of Orange County respondents aged 18–34 reported moderate or serious mental (psychological) distress, compared to 25% of those aged 55 and over.
• Eighty-nine percent of Orange County respondents aged 55 and older reported visiting a primary care physician for a routine physical or checkup in the last 12 months, compared to 69% of those aged 18–34.
• Nineteen percent of Orange County respondents aged 18–34 reported that they, or a member of their household, had trouble obtaining housing when it was really needed at some point in the last 12 months. This compares to 10% of Orange County respondents aged 55+.
• Over 20% of respondents reported being unable to get any health care (including dental or vision) when it was really needed, compared to 14.7% in 2018.
• Fifteen-point-three percent of respondents reported being unable to access food when needed in 2024, which is similar to 2023 (15.5%) but significantly higher than in 2018 and 2022 (9.8% and 12.4%, respectively).
• Thirty percent of respondents with <$25K yearly income were unable to get transportation when needed in the previous 12 months, compared to 17% of all Orange County respondents.
• Twenty-seven percent of Orange County respondents making <$25K per year reported they were unable to access the internet, compared to 18% of all respondents.

14.2.2.2 Orange County Community Asset Survey

In addition to the Orange County Community Health Survey conducted in 2024, OCDOH conducted the Community Asset Survey Section 15.14 from April 25 to September 4, 2025. This convenience sample survey asked residents about the community’s greatest strengths, where efforts should be focused to improve quality of life, and the most important health issues. Over 800 residents participated in the convenience sample survey.

The greatest strengths of the community were identified as:

• Access to good education
• Parks and recreation
• Access to basic health care

The top three areas identified to improve quality of life were:

• More affordable housing
• Better jobs and economy
• Improving public transportation

The top three important health issues identified by respondents were:

• Mental health, including depression and anxiety
• Drug use
• Aging problems (Alzheimer’s disease, arthritis, hearing/vision loss, etc.)

14.2.3 Areas of Focus

Premature death for those less than 65 years is the 2nd worst in the M-H Region and worse than the NYS rate Figure 10.1 and Table 10.2. Heart disease and cancer are the leading causes of death and premature death (death before age 75) by a large margin. These margins are larger for those among racial and ethnic lines, with Orange County have the second highest percentage difference between Black Non-Hispanics and White Non-Hispanics, in the M-H Region Figure 10.2. Obesity is a leading contributor to these top causes of death, as well as cancer, diabetes, stroke, and hypertension, all of which can lead to premature death. Orange County’s percentage of adults overweight or obese is the highest in the M-H Region 75% Figure 10.33 and Table 10.34. Over the past ten years, the rates of obesity have continually grown, as well as the subsequent morbidity of cardiovascular disease, prediabetes, and hypertension. Orange County’s age-adjusted all cancer mortality is the highest in the M-H Region at 155.5 per 100,000 residents, and 1.4 times higher than the NYS rate based on the latest available data Figure 10.38 and Table 10.39. Within these preventable causes of death, there are disparities among racial and ethnic minorities. These disparities can be seen in the rates of premature deaths, food insecurity, infant mortality, asthma hospitalizations, hospitalizations and mortality due to heart disease, breast cancer mortality, colorectal cancer mortality, and premature births. Many of these health outcomes are influenced by the social determinants of health, conditions where systems and policies determine the environments in which people live. Given the connectivity between physical health and mental health, it is important to focus on both physical health and mental health. In 2024, 36% of Orange County adults 18 years and older reported they experience either moderate or serious psychological distress. However, 47% of adults with income less than $25K per year reported moderate or serious psychological distress. This highlights the role poverty plays in impacting residents’ well-being.

Where data are available across the M-H Region from 2019–22, Orange County ranks fourth in the M-H Region in overdose deaths involving any opioid and is higher than the NYS excluding NYC rate. However, strides have been made in addressing substance use in Orange County, including a 45.5% reduction in overdose deaths from 2021 to 2024 (4).

Other health areas where Orange County falls behind NYS or has worsened since the last assessment include:

• Food insecurity
• Severely cost-burdened households
• Cardiovascular disease hospitalization rate
• Adults with prediabetes
• Asthma hospitalization rate among adults
• Emergency department visits for asthma in children 17 years and younger
• Stroke hospitalization rate
• Cancer mortality, including all cancer, female breast cancer, lung and bronchus, and colorectal cancer
• Childhood immunization rates among children 24–35 months of age
• Percentage of births with late or no prenatal care
• Percentage of women age 50–74 years receiving breast cancer screening based on recent guidelines
• Early syphilis case rate

14.2.4 Assets and Resources

OCDOH has strong community partnerships with hundreds of organizations serving residents, including five area hospitals, federally qualified health centers (FQHCs), private medical providers, school districts, two-year and four-year colleges, a medical school, community-based organizations (CBOs), and governmental departments serving a broad variety of community needs.

OCDOH has established multiple coalitions, including Chronic Disease Coalition (Healthy Orange), Orange County Breastfeeding Coalition, Food Insecurity Workgroup, Orange County Cancer Screening Collaborative, Orange County Infection Control Committee, the Healthcare Coalition, and the Hudson Valley Public Health Collaborative.

OCDOH also co-leads and participates in many countywide coalitions aimed at improving residents’ health, including Changing the Orange County Addiction Treatment Ecosystem, Orange County Community Alliance for Prevention, Middletown Cares Coalition, Perinatal Infant Family Health Collaborative, Newburgh Healthy Black and LatinX Coalition, Hudson Valley Health Coalition, Head Start Health Advisory Committee, RECAP Health Services Advisory Committee, System of Care 0–5 Infant and Early Childhood Mental Health Collaborative, System of Care Children Youth and Families, Orange County Suicide Task Force, Hudson Valley Waterworks Conference, Orange County Water Authority, Team Newburgh, Child Fatality Review Board, WELCOME Orange, and the Orange County Resilience Project.

14.3 Putnam County Health Summary

14.3.1 Demographics

Putnam County is located approximately 60 miles north of NYC and is bordered by the Hudson River to the west, Connecticut to the east, Dutchess County to the north, and Westchester County to the south. NYC is accessible by Metro-North rail lines running on the eastern and western sides of the county. With just 230 square miles of land area, Putnam is the third smallest county in NY, excluding the five boroughs of NYC (5). Putnam’s terrain includes a mix of rural and suburban areas with numerous lake communities, parklands, and reservoirs. The county is divided into six towns with three villages and no urban centers (6). More than a third of the population resides in the town of Carmel (7), which occupies the southern-central portion of the county (5).

With an estimated 2023 population of 97,988, Putnam is the second least populous county in the M-H Region, constituting 4.1% of the region’s population and 0.5% of the population of NYS Table 6.1. The county’s population decreased by 2% between the 2010 and 2020 census, but American Community Survey population estimates have been relatively stable from 2021–2023 (8), and the three-year average birth rate is trending up (9).

Putnam’s age distribution, with 19.6% under age 18 years and 26.5% age 60 and older, is slightly older than that of the M-H Region (22.6% < 18 and 24.1% >= 60), and more similar to NYS excluding NYC (20.9% < 18 and 25.6% >= 60) Table 6.3. By race and ethnicity, the county is comparatively homogenous, with a greater majority non-Hispanic White population (72.4%) than both the M-H Region (58.5%) and NYS (53.4%). Approximately 19% of the population is Hispanic, and all other racial and ethnic groups combined make up only 8.6% of the population Table 6.1,Table 6.5. The majority of the population (79%) speaks only English at home, with Spanish (12.6%) being the most common non-English language spoken at home Table 6.6. A little more than 4% of Putnam’s population are veterans, slightly higher than that for the M-H Region (3.9%), but lower than that for NYS excluding NYC (5.3%) Table 6.10. Putnam has a slightly lower disabled population (9.6%) compared to the M-H Region (10.2%) and NYS (11.6%). Ambulatory difficulty is the most common type of disability in Putnam (5.4%), as well as in the M-H Region (5.2%) and NYS (6.6%) Table 6.11.

Putnam is a well-educated and affluent county. Over 90% of the population has a high school degree or higher, and nearly 44% have a bachelor’s degree or higher Table 6.7. The median annual household income has trended up in the last decade and in 2022 was the third highest in the state (8); however, median household income is lower in Asian and Hispanic populations (10).

14.3.2 Community Survey Findings

14.3.2.1 Mid-Hudson Regional Community Health Survey

Alongside Dutchess, Putnam County participated in the third iteration of the Mid-Hudson Regional Community Health Survey (MHRCHS) (11), a broad-based assessment designed to enhance understanding of local health status, quality of life, and factors that impact health for Putnam County residents. As in 2018 and 2022, when all seven M-H Region counties were able to participate, the MHRCHS was administered by Siena Research Institute (SRI). In 2025, the 50+ question survey instrument included both new questions and many of the same questions offered in previous surveys to allow for assessment of change over time Section 15.12.

The survey was fielded from May 1 to June 3, 2025, and was open to residents of Dutchess and Putnam counties aged 18 years and older. Respondents were contacted via landline telephone and cell phone. Telephone sampling was conducted via a stratified dual-frame probability sample of landline and cell phone numbers. County samples were weighted by age, gender, reported race and ethnicity, and income using American Community Survey population estimates to ensure statistical representativeness. A total of 602 residents of Putnam County completed the survey. The margin of error (MOE), including the design effects resulting from weighting with a 95% confidence interval for the Putnam County sample, was +/- 5.5%.

Notable findings include:

• Overall, Putnam County performed similarly or favorably compared to Dutchess County, and there were few differences outside the MOE when comparing Putnam results from previous surveys.
• The vast majority of Putnam residents have a positive impression of overall quality of life (84%) and safety (97%) in their communities. About two-thirds think their communities are good places to live as they age and that there are safe places to walk or bike. However, residents with a disabled household member have a lower opinion of their community as a place to age and of safety for walking and biking. Women and residents of the western side of the county also have a lower opinion of safety for walking and biking in their communities.
• Compared to previous surveys, overall improvement was seen in the ability of Putnam County residents to access needed resources such as housing, childcare, and transportation in the last year. Notably, inability to maintain employment that pays a living wage, a new addition in the series of questions, emerged as the most commonly unmet need at 19% of the population. For all other resources, the proportion of the population with an unmet need in the last year ranged from 4%-9%.
• Difficulties accessing health care in the last year were similar across different types of care, ranging from 10% having difficulty getting mental health care to 14% having difficulty getting dental care and physical health care. Inability to get care to meet the needs of household members with disabilities was more common (29% of those with a disabled household member).
• Similar to past surveys, utilization rates were high for routine physical exams (82%) and dental check-ups (80%), and inappropriate use of emergency departments for non-emergencies was low (6%). Outside of being too busy and choosing not to go, lack of money and insurance were the common barriers to getting routine dental care, and inability to get an appointment was the most common barrier to getting a routine physical.
• The K6 Index, a series of questions that provides a standardized measure of prevalence of mental distress in the population, was added to the 2025 survey. The K6 Index proved to be more sensitive than self-reported ratings of mental health, with K6 scores of 9% for severe mental distress and 29% for moderate mental distress, as compared to self-reported mental health ratings of 5% poor and 18% fair. K6 and self-reported ratings yielded similar results in distribution of mental health concerns in the population, with higher distress/poorer ratings seen in younger adults, renters, those with a disabled household member, and those with household income less than $50,000 per year.
• The most notable finding related to potentially harmful behaviors is the decreasing proportion of residents who never use drugs for non-medical purposes (75% in 2025 as compared to 80% in 2022 and 90% in 2018), alongside a cannabis consumption rate of 26%. Frequency of cannabis consumption was newly added to the 2025 survey to facilitate tracking of cannabis utilization rates since legalization in New York State, so we can only hypothesize that increasing cannabis consumption may be contributing to the overall rise in drug use for non-medicinal purposes.

14.3.2.2 Community Health Experience Survey

Putnam also participated in the Community Health Experience Survey (CHES) (12), a public survey conducted by Nuvance Health in support of its Community Health Needs Assessment. The survey instrument was designed to collect information to assess resident perception of health and well-being, health behaviors, health concerns, and community needs [see Appendix O]. Promotion of this self-administered online survey in the community and through local partners resulted in 267 responses from adult residents of Putnam County. The survey population skewed heavily toward female and older age groups, and results were not considered generalizable to the entire population of Putnam County.

Nonetheless, consistent with MHRCHS findings, mental health and health care access (particularly primary care) emerged as top concerns in this survey. Affordable housing was also a chief concern, with the highest proportion of respondents selecting affordable housing as an area of need to improve health in the community, and more than half of respondents anticipating that housing affordability will be worse in five years. Concern regarding health care access, mental health, and affordable housing was also supported by findings of the Community-based Organization Survey, detailed earlier in the M-H Regional CHA.

14.3.3 Areas of Focus

Areas of focus were identified through a systematic review of primary data collected in community surveys and secondary data indicators included in the M-H Regional CHA, the 2025–2030 NYSPA (13), and/or the NYS County Health Indicators by Race/Ethnicity (CHIRE) Dashboard. Indicators were flagged if they met any of the following criteria: prevention agenda objective not met; performance worse than the M-H Region, NYS, or five or more counties in the M-H Region; indicator performance worsening over time; or disparities between sub-groups within the county. Flagged indicators were then examined for patterns, and determinants of health or health issues with two or more flags were given consideration as an area of focus. On this basis, areas of focus include decreasing economic stability; access to healthy food and healthy eating; mental health and suicide; alcohol and tobacco use; health care access; childhood preventive services; maternal-child health; and tick-borne disease. Data points in this summary are linked and/or footnoted if they are not otherwise found in the M-H Regional CHA.

While Putnam is a comparatively affluent county, CHA data show signs of decreasing economic stability and disparities that could have downstream impacts on health and well-being. Putnam has the lowest poverty rate in the M-H Region, but the percentage of the population in poverty ticked up from 2021 (6.0%) to 2022 (6.3%) and again in 2023 (6.5%) Figure 7.7, with higher rates seen in the Hispanic population Table 6.7. Similarly, in the 2023–2024 school year, Putnam had the lowest proportion of economically disadvantaged students enrolled in schools in the M-H Region (32.5%), but this too rose from 2021–2022 (28.5%) and 2022–2023 (32.1%) Table 6.8. Putnam enjoys a low and decreasing unemployment rate (4.1% in 2023) Table 6.2, but at 6.6%, rates are higher in the Black population (10). In spite of high employment rates, income may not be sufficient for the cost of living, as evidenced by 19% of MHRCHS respondents stating they were unable to maintain employment that pays a living wage in the past year. Imbalance between income and the cost of living, in particular the cost of housing, is further reflected in an increasing percentage of cost-burdened renter-occupied units (56.5% in 2023) Table 6.5 and severely cost-burdened households (17% in 2019–2023) Table 6.6. These findings are reinforced by high levels of concern regarding the cost of housing seen in both the Community Health Experience Survey and the Community-based Organization Survey.

Access to healthy food is essential to healthy eating habits, which in turn are essential to maintaining overall health. While in 2023 Putnam County had the lowest rates among M-H Region counties of food insecurity in both the overall population (8.9%) and in children 18 years and younger (6.6%), rates have increased since 2021 Figure 7.3 and Table 7.4. In 2019, 6.7% of Putnam’s population was considered to have limited access to healthy foods (low income and do not live close to a grocery store). Although there was improvement from 2015 to 2019, Putnam’s rate was still the highest among M-H Region counties Table 7.32. Difficulties accessing healthy foods may contribute to an increasing percentage of Putnam adults consuming less than one fruit and less than one vegetable daily (30.1% in 2021) Figure 9.2, and increasing proportions of both children (34.7% from 2021–2023) and adults (65.1% in 2021) who are overweight or obese Figure 10.33,Figure 10.34, and Figure 10.35. Obesity puts individuals at greater risk of developing a whole host of chronic diseases (14), including heart disease and cancer, which were the top two leading causes of death in Putnam County in all years from 2013–2022 (15).

There is consistent evidence across component CHA assessments for a need to focus on mental health and suicide prevention in Putnam County. In 2021, Putnam had the highest proportion of adults reporting poor mental health for 14 or more days in the last month among M-H Region counties (17.4%), a considerable jump from 10% in 2018 Figure 11.1. The percentage of adults reporting a depressive disorder also increased sequentially from 2016 to 2018 and 2021 Figure 11.2. While the rate of suicide in Putnam County is lower than most other counties in the region and NYS, the three-year average suicide mortality rate increased from 4.6 per 100,000 population for 2019–2021 to 7.3 per 100,000 for 2020–2022 Table 11.17. These secondary data indicators are supported by findings of high levels of community concern about mental health in both the Community Health Experience Survey and the Community-based Organization Survey, as well as K6 index scores of 9% for severe mental distress and 29% for moderate mental distress on the MHRCHS, with higher distress/poorer ratings seen in younger adults, renters, those with a disabled household member, and those with household income less than $50,000 per year.

CHA data reveal comparatively high rates of smoking and binge drinking in Putnam County adults. The percentage of adults who are current smokers jumped from 9% in 2018 to 16.7% in 2021, exceeding rates in the M-H Region (11.1%) and NYS excluding NYC (14.1%) Figure 11.4. High prevalence of smoking could be contributing to Putnam 2018–2022 lung and bronchus cancer incidence (57.6 per 100,000 population) and mortality (27.7 per 100,000) rates that exceed those of NYS (52.4 and 26.5 per 100,000 population, respectively) Figure 10.44. Similarly, the percentage of adults binge drinking during the past month increased from 14.1% in 2018 to 18.7% in 2021, exceeding rates in the M-H Region (13.1%) and NYS excluding NYC (16.1%), and giving Putnam the highest rate among M-H Region counties Figure 11.5.

Excessive use of alcohol could be contributing to mortality from cirrhosis, which is trending up and, at 8.3 per 100,000 population in 2021, exceeded the NYS rate of 8.2 per 100,000 population Figure 10.37. Unfortunately, there is evidence that high prevalence of smoking and drinking is continuing in younger residents of Putnam County. The Prevention Needs Assessment (PNA), a survey administered every other year to Putnam public school students in 8th, 10th, and 12th grades, demonstrates a downward trend in the percentage of survey respondents who have used alcohol in the last month (18.9% in 2024), and the percentage who have engaged in binge drinking (7.8% in 2024); however, both of these numbers still exceed the national benchmark (14.3% and 5.7%, respectively). PNA results also show increasing proportions of students engaging in drinking and driving (1.7% in 2024) and riding with a drinking driver (13.4%), with both rates exceeding national benchmarks (1.5% and 11.4%, respectively). PNA results are mixed for tobacco use, with cigarette (1.5% in 2024) and e-cigarette (7.7% in 2024) use in the last thirty days decreasing and below the national benchmark (2.1% and 11.8%, respectively), but an increasing proportion of students smoking 1/2 pack of cigarettes daily (0.4% in 2024), which is just below the national benchmark of 0.5% (16).

Access to health care services plays a critical role in achieving optimal health outcomes through disease prevention, timely diagnosis and treatment, and appropriate management of chronic conditions. Secondary data indicators related to health care access are mixed for Putnam County. Compared to other counties in the M-H Region, Putnam has the lowest rate of uninsured children (2.4% in 2023) and the highest rate of insured adults (94.9% in 2023) (17) Figure 7.18 and Figure 7.19, but health insurance may not always alleviate cost barriers to getting care. Among the M-H Region counties in 2021, Putnam had the highest proportion of adults who were not able to receive medical care due to cost (9.9%) Table 7.20. Access to care may also be impacted by deficits in providers per capita. While Putnam had the second-best ratio of residents to mental health providers among the M-H Region counties in 2024 (210:1), it had the second-worst ratio of residents to dentists in 2022 (1610:1) and the second-worst ratio of residents to primary care providers in 2021 (1880:1)Figure 7.20,Figure 7.21,Figure 7.22. In spite of concerning per capita ratios, Putnam had the highest percentage of adults with a regular primary care provider (90.5%) among the M-H Region counties in 2021 Figure 7.23. MHRCHS 2025 findings are also mixed for health care access in Putnam County. A high proportion of residents received routine annual dental (80%) and primary care (82%); however, substantial proportions of the population report difficulty getting mental (10%), dental (14%), and physical (14%) health care in the past year when it was really needed. Inability to meet care needs for family members with disabilities was even more common (29% of those with a disabled household member). MHRCHS data indicate cost is a bigger limiting factor for dental care, while availability of providers is a bigger limiting factor for routine primary care. Community Health Experience and Community-based Organization Survey results corroborate high levels of community concern about access to health care.

Prenatal and infant health are the foundation for a healthy future in Putnam County. Although Putnam County performs well in both the percentage of births with early prenatal care (84%, 2020–2022 three-year average) and the percentage of births with late or no prenatal care (3.1%, 2020–2022 three-year average) as compared to other counties in the M-H Region Figure 10.66 and Figure 10.67, disparities can be seen when these indicators are examined by race and ethnicity. As compared to births to non-Hispanic White Putnam residents (89%), lower proportions of births to Hispanic (74.6%), non-Hispanic Asian/Pacific Islander (79.2%), and non-Hispanic Black (86.4%) residents had early prenatal care Figure 10.68. Findings are similar for birth outcomes, with both the 2020–2022 three-year average percentages for preterm births (9.1%) Figure 10.74 and babies born at a low birthweight (7.3%) Figure 10.75 in Putnam falling below those for NYS excluding NYC, but disparities are seen by race and ethnicity. A higher proportion of births to Hispanic residents were premature (10.0%), as compared to births to non-Hispanic White residents (8.7%) (10). When looking at birthweight outcomes, there was a higher percentage of low-birthweight births in Hispanic (7.6%) and non-Hispanic Black (10.2%, unstable rate) populations as compared to non-Hispanic White (7.1%) Figure 10.76. Similar to NYS excluding NYC, and all other M-H Region counties besides Ulster, Putnam has seen a concerning downtrend in babies who are exclusively breastfed in the hospital. In 2022, only 38.5% of Putnam infants were exclusively breastfed in the hospital, well below the 2025–2030 NYSPA objective of 48.2% Figure 10.78

Preventive services for children, including immunizations and health care screenings, are key to ensuring that Putnam’s youngest residents have the opportunity to achieve optimal health. While improvements have been made in early childhood vaccination rates, and Putnam now performs well in comparison to both NYS and other M-H Region counties Figure 10.52, the same cannot be said for HPV vaccination rates or lead screening. The percentage of 13-year-olds with a completed HPV vaccine series has trended down in Putnam since 2019, and in 2024 Putnam joined Ulster County in having the lowest percentage (14.5%) among M-H Region counties. This is considerably lower than the percentage in NYS excluding NYC (24.4%) and the 2025–2030 NYSPA objective of 28.7% Figure 10.54. Regarding lead screening, data included in the M-H Regional CHA demonstrates a decline in the percentage of children tested at least twice for lead before 36 months of age from 2013 (61.3%) to 2019 (58%) Figure 7.31. This finding is supported by data included in the 2025–2030 NYSPA, which demonstrates a decline in four-year averages of the percentage of Putnam children with two lead tests before 36 months of age from 62.5% for 2014–2017 to 59.4% for 2018–2021, which is well below the NYSPA objective of 70% (13).

Putnam County bears a disproportionately high burden of tick-borne disease. The geographic distribution of tick-borne disease in the United States is highly concentrated in Upper Midwestern and Northeastern states, and within NYS some of the highest concentrations of disease are seen in the M-H Region (18). The most common tick-borne diseases seen in Putnam County are Lyme disease, anaplasmosis, and babesiosis. Increases were seen in all three of these diseases in Putnam County from 2020 to 2023 Figure 10.62,Figure 10.63, and Figure 10.64. Lyme disease rates rose each year, and the 2023 rate (351.9 cases per 100,000 population) was higher than that of NYS (109 cases per 100,000 population) and the fourth highest among M-H Region counties [see Figure 147]. Rates of anaplasmosis and babesiosis were more volatile, and displayed alternating year peaks and troughs related to the two-year lifecycle of the blacklegged tick vector (19). Putnam’s 2023 anaplasmosis (96.6 cases per 100,000 population) and babesiosis (61 cases per 100,000 population) were by far the highest in the M-H Region, and approximately ten times higher than those for NYS (10.3 and 5.9 cases per 100,000 population, respectively)Figure 10.63 and Figure 10.64. ### Assets and Resources The Putnam County Department of Health (PCDOH) has strong community partnerships that operate through a variety of channels:

• Live Healthy Putnam (LHP) is a coalition of community organizations whose mission is to improve individual and community health and well-being for all residents by addressing social determinants of health through education, advocacy, and collaboration. LHP meets quarterly and works to achieve its mission by acting as the primary forum for collaborative development and implementation of a comprehensive Community Health Improvement Plan (CHIP). NYS Prevention Agenda priorities are well represented within the coalition, with eight organizations working on priorities within the Economic Stability Domain; 14 working within the Social and Community Context Domain; 10 working within the Neighborhood and Built Environment Domain; and nine working within the Education Access and Quality Domain.
• PCDOH participates in a variety of other coalitions and task forces, including the Communities that Care Coalition (adolescent substance misuse prevention), Suicide Prevention Task Force, the Co-Occurring System of Care Coalition, the BR;DGE Alliance (harm reduction and overdose prevention), the Putnam Hospital Community Health Committee, Tri-County Steering Committee (HIV prevention), and the Mid-Hudson Adult Immunization Coalition.
• PCDOH partners closely with Putnam-Westchester Board of Cooperative Educational Services (BOCES) on various school-based initiatives, as well as directly with school districts and The Prevention Council of Putnam on harm reduction programming.
• Restaurants, camps, and recreational areas work closely with the Environmental Health Services Division to distribute health information and maintain safe environments.
• Putnam County has a robust Medical Reserve Corps (MRC) with over 100 volunteers and an active partnership with Putnam County Bureau of Emergency Services.
• Putnam County’s bilingual health education team has an active presence in Spanish-speaking communities throughout the county. Community connections are maintained through strong partnerships with community leaders and delivery of person-centered, culturally informed health education and communication.

The Putnam Community Resource Guide, a publication of the Putnam Community Action Partnership (CAP), provides a central location for residents to find local resources to meet their needs. The guide includes 191 service listings from approximately 120 unique organizations. Organizations listed in the guide serve a broad range of populations, including children and youth, senior citizens, veterans, immigrants, and people with disabilities. A wide variety of services are offered in areas such as housing, food and nutrition, legal aid, mental health, alcohol and substance use, educational resources, and youth services. Language support is common, with more than half of listed organizations specifying services offered in Spanish, and another 15 organizations offering translation in languages such as Italian, Portuguese, Hungarian, and Chinese (20).

14.4 Rockland County Health Summary

14.4.1 Demographics

Rockland is the sixth smallest county by land area in NYS and the smallest in the M-H Region. Despite its size, Rockland County has the third-highest population in the M-H Region, and its population is growing at the fastest rate of any county in the region Table 6.1. Rockland County’s population is also the youngest in the region, with the highest percentage of residents below age 20 (32%) Table 6.3.

Rockland County is among the most diverse counties in the region regarding race and ethnicity, with the third-highest percentage of Hispanic residents in the region, the third-highest percentage of non-Hispanic Black residents in the region, and the second-highest percentage of non-Hispanic Asian residents in the region Table 6.4 and Table 6.5. Linguistically, Rockland County is also very diverse, with the highest percentage of languages other than English spoken in the region, at 43.6% Table 6.6.

Educational attainment for people aged 25 or older is highly variable in Rockland County. For those with degrees beyond high school, Rockland County has the second-lowest percentage of those achieving an Associate degree in the region (7.8%), the third-highest percentage of those achieving a Bachelor’s degree in the region (23.2%), and the third-highest percentage of those achieving a graduate or professional degree in the region (18.9%). Rockland County also has a relatively high percentage of residents with low educational attainment, with the highest percentage of people with less than a 9th grade education in the region (5.7%), the second-highest percentage of those with 9th-12th grade education without a diploma in the region (6.6%), and the second-lowest percentage of those achieving a high school degree or equivalent in the region (21.6%) Table 6.7.

Household income, like educational attainment, is also relatively variable in Rockland County. Rockland County has the second-highest percentage of households with an income greater than $200,000 at 24.6%, as well as the second-lowest percentage of households with an income less than $10,000 and between $10,000 and $14,999 in the region (3.7% and 2.1%, respectively). For the remaining Census income ranges, Rockland County occupies a relative middle position with regard to the other counties and differs from the regional average by no more than a few tenths of a percent, with the exception of the $75,000-$99,999 income range, where Rockland is third lowest in the region (10.0%) and eight tenths of a percent below the regional average (10.8%) Table 6.9.

14.4.2 Community Survey Findings

The main source of primary data for Rockland County was the inaugural Rockland County Community Health Assessment Survey Section 15.16. The survey was held from May 28, 2025, through July 31, 2025, and was made available digitally via Jotform in English, Spanish, and Creole (paper versions were also made available). The survey was extensive and encompassed each of the five domains of the 2025–2030 NYSPA.

Limitations: This survey format qualifies as a convenience sample. Therefore, conclusions derived from this data cannot be generalized to the population of Rockland County as a whole. Rather, the conclusions based on the data collected from the survey are confined to the pool of survey respondents.

Methods: The survey consisted of a maximum of 50 questions. The survey was only available to people who were aged 18 years or older and who resided in Rockland County during the survey period. The specific type and number of questions available to be answered varied depending on the demographics of the survey-taker (such as zip code, sex, child < 6 years old in household, and pregnant or planning to become pregnant), as well as their choices for the top three Priorities for Community Health and Wellbeing question [see Appendix P].

The survey’s primary format was digital, but paper versions in all three languages were made available at multiple publicly accessible locations throughout the county (three public libraries, a town hall, a community center, and a church). Paper versions had directions that differed slightly from those of the Jotform version of the survey, due to logical differences between digital and paper formats. Paper surveys were hand-entered by RCDOH staff. When the answers on a paper survey came into conflict with the logic of the Jotform version, the Jotform logic was adhered to.

The survey was promoted via Rockland County’s social media accounts, the county website, the placement of flyers and palm cards throughout the county, and promotion by county agencies (such as the Office of the Aging, Department of Social Services, and Department of Mental Health), town governments, and community partners (such as the Haverstraw, Spring Valley, and Western Ramapo Collaboratives, WMC Health, Montefiore Nyack, and individual community leaders). The survey was also promoted at public events by RCDOH staff and by an outreach worker in zip codes where survey response rates were relatively low.

Incentives for the survey included the ability to enter a sweepstakes for one of several $50 gift cards upon completion of the survey. An additional limited promotion was vouchers for free NY Boulders tickets. This promotion was organized with the help of the Town of Ramapo and NY Boulders Baseball. Vouchers were made available (to those who completed the survey) at four Boulders games during the survey period and by the RCDOH outreach worker in the aforementioned zip codes.

Results of Note: > - The RCDOH received 603 responses to the survey. Sixty-eight percent of respondents were female, compared to 29.9% male (and 2.2% prefer not to answer). The majority of respondents identified as White/Caucasian (55.2%), followed by Hispanic/Latino (14.1%) and Black/African American (12.7%) Table 14.2. > - The three most well-represented zip codes among survey responses were 10977, 10956, and 10901 (at 14.43%, 12.44%, and 11.44% of total survey responses, respectively) Figure 14.2. > - A majority of survey respondents rated their quality of life in Rockland County as either good (51.2%) or excellent (21.6%) Figure 14.3. > - Safe neighborhoods (61.5%), opportunities for outdoor recreation/physical activity (41%), and good schools (35%) were selected as the top three factors that make a positive contribution to healthy living in Rockland County Figure 14.4. > - The vast majority of respondents found that the top three areas that need improvement in Rockland County are Economic Wellbeing (73.3%), Safe and Healthy Communities (71.5%), and Education (49.8) Figure 14.5. > - According to survey respondents, the area most in need of improvement in the category of Economic Wellbeing was Affordable Housing Figure 14.6. > - According to survey respondents, Traffic Safety was the area most in need of improvement in the category of Safe and Healthy Communities [@ > - For the category of Educational Priorities, survey respondents selected the three sub-categories Vocational Programs, Options for Continuing Education, and Health and Wellness Programs in Schools with relative parity in terms of what needs the most improvement Figure 14.8.

Table 14.2: Rockland County Community Health Assessment Demographics

	Count	Percent
Sex
Male	180	29.90
Female	410	68.00
Age
18-29	90	14.90
30-39	122	20.20
40-49	104	17.20
50-59	102	16.90
60+	185	30.70
Race and Ethnicity
White or Caucasian	344	55.20
Black or African American	79	12.70
Hispanic or Latino or Latinx	88	14.10
Asian or Asian American 25	25	4.00
American Indian or Alaskan Native	2	0.30
Native Hawaiian or Other Pacific Islander	0	0.00
2 or more selected	10	1.60
Other	16	2.60
Income
0-29,999	71	11.80
30,000-69,999	98	0.16
70,000-109,999	116	0.19
110,000-140,999	86	0.14
150,000-189,999	46	0.08
190,000-229,999	37	0.06
230,000+	50	0.08
Household Size
1	75	0.12
2	164	0.27
3	107	0.18
4	126	0.21
5+	117	0.19

Figure 14.2: Respondents by Zip Code

Figure 14.3: Respondents’ Ratings of Quality of Life in Rockand County

Figure 14.4: Top 3 Factors that Make a Positive Contribution to Healthy Living in Rockland County

Figure 14.5: Top Selected Areas the Need Improvement

Figure 14.6: Economic Priorities that Need Improvement

Figure 14.7: Safe and Healthy Communties Priorities that Need Improvement

Figure 14.8: Education Priorities the Need Improvement

14.4.3 Areas of Focus

Rockland continues to struggle with chronic diseases as previously reported in prior community health assessments. This can be seen in the 2022 top five leading causes of death for Rockland County, which include three chronic conditions: heart disease, cancer, and cerebrovascular disease. During the previous cycle, it was an expressed goal to look at the core issues driving these trends. While progress was made, this issue requires continued attention and adaptation to changing populations and needs. Specifically, disparities across racial and ethnic lines continue to be reflected in chronic disease outcomes. For example, between 2020–2022, cerebrovascular disease mortality for non-Hispanic Black and Hispanic populations was higher than for the non-Hispanic White population. Culturally competent programs and interventions are key to helping address this issue.

In addition to chronic disease, communicable disease prevention is also a key issue. Specifically, vaccine-preventable diseases continue to be a concern in Rockland County. In 2022, a polio outbreak was declared in Rockland County after a case of paralytic polio was reported. Rockland County has also struggled with other vaccine-preventable diseases such as measles and pertussis. A contributing factor to the prevalence of these diseases in Rockland is low childhood vaccination rates. Rockland has the lowest on-time childhood vaccination rates in the region. This low rate leaves the population more vulnerable to the spread of these diseases. Continuous work has been devoted to improving these numbers, but more needs to be done to appropriately address this complex, ongoing issue.

Poor socioeconomic conditions continue to be a significant barrier to health for a number of Rockland County communities. Many communities in Rockland County are poor or otherwise struggle to meet basic needs such as food and housing. Additionally, lower educational achievement and language barriers mean that individuals who may be struggling to meet basic needs may not be aware of, or may otherwise have trouble accessing, available services to help them meet those needs. Poor socioeconomic conditions (such as those mentioned above) are not evenly distributed throughout the population of Rockland County. Communities in Rockland County that experience limitations in education, language, wealth, and housing (among other factors) are sharply contrasted by other communities in Rockland that experience little or no limitations in those factors. The causes of poor socioeconomic conditions, as well as their unequal distribution across local communities, exist largely upstream of the interventions that are typically employed by local health departments. As such, the actions of any particular local health department are limited in their ability to improve these factors. That said, the RCDOH is committed to utilizing its own resources and to working with partners in the community to mitigate the effects that poor socioeconomic conditions have on local health outcomes.

The following are areas that the RCDOH is committed to improving by its own means and through collaboration with partners: > - The lowest childhood immunization rates in the region, increasing the risk of outbreaks of vaccine-preventable diseases. > - Some of the most severe housing problems in the region, both in terms of housing quality and cost; residential segregation rates are among the highest in region. > - Racial and ethnic disparities in mortality from diabetes and cardiovascular disease. > - A recent increase in both overall food insecurity and childhood food insecurity. > - Screening rates for colorectal cancer and cervix uteri cancer remain low. > - The highest suicide mortality rate in the region. > - Decreasing percentage of adults with health insurance in recent years. > - The incidence of gonorrhea has been steadily increasing since 2020. > - Lead screening rates for children younger than 36 months have decreased. > - An increase in the percentage of adults who are current smokers in recent years. > - Linguistic, cultural, and educational barriers to health care, and a need for improved health literacy among the population.

14.4.4 Assets and Resources

Rockland is a resource-rich county, considering that it is dense and in the heart of the New York Metropolitan Area. Local stakeholders in the county have historically been eager, focused, and engaged. This was clearly demonstrated in the assessment process for this document. The RCDOH was able to work with established and new partners to complete this assessment. Plans are in place to reestablish the Public Health Priorities Group, which is a partnership between the RCDOH and various stakeholders to highlight different areas of health that may be of concern or need. This group will be utilized to help establish priorities for community health improvement interventions and strategies.

Rockland County has an abundance of partners and facilities to provide assistance and resources to accomplish community health improvement goals. Good Samaritan Hospital and Montefiore Nyack Hospital are the county’s hospital partners that help support community health improvement strategies. Support in these efforts is also expected from the FQHCs (Sun River Health and Refuah Health), other county departments (Mental Health, Youth Bureau, Office of the Aging, Social Services, and Planning), as well as from the various CBOs that have assisted in developing this assessment. Several active village collectives (notably the Spring Valley Collaborative, the Haverstraw Collaborative, and the Western Ramapo Collaborative) meet regularly in Rockland and provide opportunities for community-based networking, intervention deployment, and resident-level feedback. A variety of smaller cultural associations also exist in the county. Increasing inclusivity of these groups to better support the health needs of the entire population is an expressed goal in this improvement cycle. In addition to supporting previous community health improvement interventions, these partners have provided assistance in times when urgent response is needed, such as disease outbreaks.

All of the organizations and collaborative groups mentioned above were critical in conducting this assessment, as they were the partners who provided critical input during the community health partner survey. Their feedback on the factors most influencing health and the leading barriers to care at the neighborhood level allowed for a unique health perspective tailored to the local community. Soliciting survey responses from the groups listed above provided a means of gathering information on subpopulations that otherwise may not have been captured in the Community Health Assessment Survey. It is expected that the partners engaged during the assessment process will contribute a portion of their assets and resources to countywide community health improvement efforts as needed.

14.5 Sullivan County Health Summary

14.5.1 Demographics

Sullivan County is a geographically large, rural county located in the northwestern part of the M-H Region, approximately 90 miles northwest of New York City in the Catskill Mountains. Bordered by Delaware County to the north, Ulster County to the east, Orange County to the south, and Pennsylvania to the west, the county covers 997 square miles and includes 15 towns, seven incorporated villages, seven public school districts, and one two-year college (SUNY Sullivan).

Home to approximately 80,000 residents, Sullivan County has one of the lowest population densities in the region. The area is characterized by small rural communities, agricultural land, and seasonal tourism tied to its natural beauty, including lakes, rivers, and mountains. The county has a rich history in recreation and tourism as a Catskills vacation destination and contains more than 100 summer camps that draw tens of thousands of visitors. During the summer months, the year-round population increases to nearly 300,000 as seasonal residents, visitors, and members of the Orthodox Jewish community temporarily reside in the area. Because many are not year-round residents, their associated health needs may not be fully reflected in county-level data.

The majority of Sullivan County residents are non-Hispanic White (67.1%), followed by Hispanic (18.4%) and non-Hispanic Black or African American (7.9%) populations. About 20 percent of residents speak a language other than English at home [see Table 6]. Sullivan County also has the highest percentages of civilian veterans (6.0%) and residents with disabilities (15.9%) among the M-H counties [see Tables 11 and 12]. Health indicators reflect rural disparities, including higher rates of chronic disease, maternal and child health challenges, transportation barriers, and limited access to specialty care. These characteristics shape the county’s public health priorities and emphasize the importance of community-based outreach, education, and preventive services.

14.5.2 Community Survey Findings

Sullivan County participated in primary data collection through participation in the Greater New York Hospital Association 2025 Community Health Needs Assessment Survey Section 15.17. Input was also collected from residents and health care providers at various events within the county, where attendees voted for two Prevention Agenda 2025–2030 priority areas. The results were used to inform the Community Health Improvement Plan and can also be found in the Sullivan County Community Health Assessment on the Sullivan County Department of Public Health website.

14.5.3 Areas of Focus

Sullivan County residents are greatly affected by chronic illness and unintentional injury. The leading causes of death in 2022 were heart disease, cancer, unintentional injury, COVID-19, and chronic lower respiratory disease (CLRD) Table 10.1. In general, Sullivan County had the highest overall mortality rate in the M-H Region, as well as the highest mortality rates of CLRD, congestive heart failure, and cardiovascular disease. Despite having a lower rate of physician-diagnosed diabetes than NYS, Sullivan County had the highest diabetes hospitalization rate in the region in 2021 Figure 10.27 and Figure 10.28. Overweight and obesity remain common; the percentage of school-aged children and adolescents who were overweight or obese was 41.6% in 2021–2023 Figure 10.35. Additionally, the rate of asthma emergency department visits among individuals aged 0–17 years old more than doubled from 2021 to 2023, surpassing pre-COVID-19 rates Figure 10.11.

Economic wellbeing factors were identified in the provider survey as impactful on the health of Sullivan County residents. The unemployment rate has been decreasing since 2021, falling to 6.1% in 2023 Figure 7.2. However, there has also been an increase in food insecurity and poverty, a decreasing high school graduation rate, and an increase in the percent of disconnected youth. Regarding housing, the percent of cost burdened renter occupied units was 48.7 (2023) and the percent of households with severe housing problems was 16% (2017-2021) Figure 7.5 and Figure 7.32. These rates are lower than other M-H counties and NYS but represent a sizeable percent of the population. The rural landscape is another factor that influences the health factors and outcomes in Sullivan County. Large areas of the county are remote and lack access to public transportation, and in 2023, 8.8% of households in Sullivan County had no vehicles available Figure 7.33.

Health care access is another major issue in Sullivan County. Sullivan County has higher ratios of residents to primary care providers, residents to dentists, and residents to mental health providers when compared to other M-H counties and the state Figure 7.20 through Figure 7.22. There are also low rates of preventive care and screenings:

• Sullivan County had the lowest percentage of children tested for lead before 36 months of age (36.6% in 2019) compared to other M-H counties and New York Figure 7.20.
• Sullivan County has the lowest rate of prenatal care (61.3%) and highest rate of late or no prenatal care (8.0%) in the region Figure 10.66 and Figure 10.67
• Only 29.1% of Medicaid enrollees had at least one dental visit in the last year (2021–2023) Figure 10.80.
• Screening rates for colorectal cancer, cervical cancer, and breast cancer remain below the rates of NYS and some other M-H counties Figure 10.80,Figure 10.49, Figure 10.50.

Other noted concerns are rising rates of reported poor mental health, early syphilis incidence, rabies treatments, and Lyme disease and other tick-borne illnesses.

These data reinforce the county’s priority areas of chronic disease prevention, maternal and child health, behavioral health, and access to care, while emphasizing the importance of addressing the underlying social determinants that shape health outcomes. Addressing these issues will require cross-sector collaboration to improve access to care, strengthen prevention and early intervention efforts, and expand community-based resources that promote health equity and well-being across all populations.

14.5.4 Assets and Resources

Sullivan County Department of Public Health has strong community partnerships with organizations serving residents across the county. These include the local hospital, Federally Qualified Health Centers (FQHCs), urgent care centers, schools, and numerous community-based organizations. The Department also leads the Sullivan County Rural Health Network and participates in the Sullivan County Substance Use Task Force. In addition, the county collaborates with Unite Us Sullivan, a coordinated care network that connects health and social service providers to better address residents’ social determinants of health. Sullivan County government continues to expand the Move Sullivan program, improving access to affordable public transportation for residents.

Together, these partnerships are leveraged to address priority health areas and emerging public health needs identified through the Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP).

14.6 Ulster County Health Summary

14.6.1 Demographics

Ulster County is located in the southeastern part of NYS, south of Albany and immediately west of the Hudson River. According to the US Census Bureau, the county has a total area of 1,161 square miles, which is approximately the size of Rhode Island. Much of Ulster County can be characterized as suburban and semi-rural, with only one major urban area, the city of Kingston, which is in the east-central portion of the county and encompasses just 7.4 square miles of the county’s total area. Ulster County is part of the Kingston Metropolitan Statistical Area.

According to the latest estimates available from the US Census Bureau, Ulster County’s population was 182,109 in 2023. The total number of households was 73,105, and the household median income was approximately $85,878.

14.6.2 Areas of Focus

The data analyzed point to several areas of focus for Ulster County. Ulster County has an exceptionally high suicide mortality rate Figure 11.16, including among teens and older adults; a high percentage of children and adolescents who are overweight or obese Figure 10.35; and opioid fatality Figure 11.9 and emergency department visit rates Figure 11.6 that are well above the M-H Region and NYS averages.

Other areas of concern include the following:

• The leading cause of death is heart disease Table 10.1; Ulster County has the second-highest rate in the region for cardiovascular disease mortality Figure 10.12.
• Ulster County is among the counties in the region with the highest percentages reporting food insecurity Figure 7.31, as well as population at poverty level or below Figure 7.7. In addition, a high percentage of people report living with a disability Table 6.11.
• The Community Partner Survey indicated that access to mental health providers is a challenge Figure 8.34, which aligns with the high percentage of adults reporting poor mental health for 14 or more days in the last month Figure 11.1, as well as those reporting a depressive disorder Figure 11.2.
• Ulster County has the highest three-year average rate for alcohol-related motor vehicle injury and fatality in the region Figure 13.5.
• Disparities persist among all indicators where data is available, especially among the non-Hispanic Black population.

Finally, the housing crisis in Ulster County continues to persist. The Community Partner Survey reported that access to affordable, decent, and safe housing is the leading issue that affects health in Ulster County Figure 8.34. This problem can be attributed to the limited construction of new, affordable rental and ownership units and the associated inflated costs of building materials and labor. In addition, the post-pandemic influx of NYC Metropolitan area individuals and families seeking weekend and permanent residences has increased demand and prices for affordable housing. The expanding tourism industry in Ulster County has also resulted in many previously available and affordable housing units being converted into short-term rentals. Affordable, healthy, and safe housing is the foundation upon which individuals, families, and the community build their strength, wellness, and resiliency, and county leadership from every sector has recognized the urgency of immediate action in this area.

14.6.3 Assets and Resources

UCDOH has strong community partnerships with hundreds of organizations serving its residents, including two area hospitals, FQHCs, private medical providers, local two-year and four-year colleges, CBOs, and regional organizations serving a broad variety of community needs. UCDOH and the Ulster County Department of Mental Health have established multiple coalitions, including Healthy Ulster Council, Integrated Ulster, Ulster County Human Services Coalition, Ulster County Suicide Prevention Coalition, Ulster County Opioid Prevention Strategic Action Leadership Team, and Ulster County Public Health Preparedness Task Force. In addition to participating in numerous public health-focused coalitions, UCDOH serves with Live Well Kingston, Ellenville Rural Health Network, Mano-a-Mano, Bringing Agencies Together, Ulster County Healthy Families, Maternal Infant Services Network, Ulster Prevention Council, and Tobacco Free Action Communities, among others. The coalitions’ partners and others are mobilized to address the health areas of focus and emerging issues of the 2025–2030 CHA/CHIP cycle.

14.6.4 Efforts Moving Forward

• Ulster County continues to make significant improvements in the built environment through a combination of federal, state, and local funds. These include ongoing development of a world-class rail trail system throughout the county, pedestrian- and bike-friendly complete street initiatives, safe routes to schools, and others. All are designed to encourage physical activity, improve access to fresh and healthier foods, and increase social engagement to help prevent chronic diseases. This will also continue to reduce carbon footprint while reducing air pollution.
• Ulster County will continue to build on a strong foundation of tobacco prevention policy change by updating legislation to further strengthen regulations designed to protect youth and low-income and minority populations from the impacts of tobacco marketing and increasing awareness of the risks of tobacco and vaping products.
• Ulster County has strengthened the availability of and access to mental health services with the establishment of a walk-in mental health clinic and a crisis stabilization center.
• There are many other health initiatives that Ulster County will be involved with to monitor and enhance public health progress.

More details are available in the Ulster County CHIP (21).

14.7 Westchester County Health Summary

14.7.1 Demographics

With an area of about 450 square miles, Westchester County is located just north of New York City. It is bordered on the west by the Hudson River, on the north by Putnam County, and on the east by the Long Island Sound and Connecticut’s Fairfield County. With its six cities, 19 towns, and 23 villages, Westchester is home to a mix of urban and suburban communities.

According to the 2023 American Community Survey, the total population residing in Westchester is 996,888, with 48.4% males and 51.6% females. Among them, 50% are non-Hispanic White, 12.9% non-Hispanic Black, 6.0% non-Hispanic Asian or Pacific Islander, and 11.7% are of some other race. Just under a quarter of the population is of Hispanic origin, and 25.4% of the population is foreign born. About one-third of residents speak a non-English language at home.

The majority of Westchester residents over the age of 25 have received a high school diploma/GED, and almost a quarter have obtained a college and/or beyond-college education. The median household income is estimated at $118,411.

While an affluent county in general, there are pockets of communities living in less desirable conditions. About 8.88% of the population lives in poverty, with higher poverty rates among non-Hispanic Black and Hispanic populations. About 4.98% of the population are uninsured, and about 3.9% of residents are living in overcrowded housing.

Rather than driving alone, 48.6% of the population uses an alternative mode of transportation for the commute to work, including carpooling, public transportation, walking, bicycling, or telecommuting.

In summary, Westchester is a diverse and prosperous county, yet socioeconomic and health disparities continue to impact segments of its population. The data point toward an ongoing need for targeted interventions to address disparities and ensure that all residents benefit from the county’s overall affluence.

14.7.2 Area of Focus and Efforts Moving Forward

Given the complexity of Westchester County’s geographic, demographic, and socioeconomic composition, and based on the Mid-Hudson Regional Community Partner Survey, Westchester County will work to improve communication about existing resources and help residents navigate complex health insurance plans. Addressing health literacy through plain language will be one of the county’s priorities. Information gathered by the survey will help guide the Health Department and its partners in focusing services on the county’s current and emerging health issues to enhance community wellness.

Based on the striking findings from the regional community survey, the need for increased mental health services, specialty services, and access to affordable and safe housing were generally top concerns of providers in the community.

14.7.3 Assets and Resources

Westchester County has a rich supply of assets and resources that support the health and well-being of its residents. Some examples include:

• Ample green spaces as well as county and state parks provide about 98% of the population with access to outdoor recreation and exercise opportunities.
• Extensive health care systems, including hospitals, federally qualified health cares, urgent care centers, and laboratories operating within the county, provide timely and state-of-art direct health care.
• Healthcare facilities Dashboard Westchester (22).
• A large number of colleges and universities located within the county provide opportunities for health education.
• The extensive Bee-Line bus system serves over 27 million passengers annually, providing transportation services to over 65% of all Westchester County residents and workplaces within walking distance to a Bee-Line bus route, making the bus both close and convenient.
• United Way’s 211 information and referral system contains information on non-profit organizations for many communities in Westchester.
• A variety of community organizations, task forces, coalitions, and other agencies work on providing direct services as well as policy and structural change within the county.

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