TOWNSHIP OF HAMILTON - Hamilton ...
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Jeffrey S. Martin Kathleen Fitzgerald, Director
Mayor Chris Hellwig, Health Officer
TOWNSHIP OF HAMILTON
DEPARTMENT OF HEALTH, RECREATION, SENIORS, AND VETERANS SERVICES
DIVISION OF HEALTH – 2100 Greenwood Avenue, Hamilton, NJ 08609 *Office (609) 890-3828 *Fax (609) 890-6093
COVID-19 Vulnerable Population Assessment
Funded by the NJDOH Strengthening Local Public Health Capacity 2021 Grant
1
Contents
Background ............................................................................................................................................................................. 3
COVID-19 Vulnerable Population Assessment Goal ............................................................................................................... 3
Underlying Medical Conditions and Increased Risk ................................................................................................................ 4
Table 1. Conditions that Increase a Person’s Risk of Severe COVID-19 Illness, CDC (2020) ........................................... 4
Defining Vulnerable Populations in the Community .............................................................................................................. 4
Table 2. Vulnerable Populations within Hamilton Township ......................................................................................... 5
Community Demographic Profile............................................................................................................................................ 8
Table 3. Hamilton Township, NJ Demographic Profile, US Census Bureau, 2019 .......................................................... 8
Vulnerability, Health Disparities and Community Impacts of COVID-19 .............................................................................. 11
Vulnerability of the Community........................................................................................................................................ 11
Health ................................................................................................................................................................................ 11
Economic Stability and Employment ................................................................................................................................ 11
Figure 1. Unemployment in Hamilton Township, 2020 ................................................................................................ 12
Education .......................................................................................................................................................................... 12
Food Insecurity.................................................................................................................................................................. 12
Provision of Community Resources .................................................................................................................................. 13
Geographic Disparities .......................................................................................................................................................... 13
Figure 2. Community Need Index (CNI) for Hamilton Township, NJ from Dignity Health ............................................ 14
Figure 3. COVID-19 Vulnerability Footprint .................................................................................................................. 14
Figure 4. Percent of the Population over the Age of 65, Mercer County ..................................................................... 15
Disparities in Cases and Deaths from COVID-19 ................................................................................................................... 15
Community Impacts from COVID-19..................................................................................................................................... 16
Health Impacts .............................................................................................................................................................. 16
Employment impacts .................................................................................................................................................... 17
Educational impacts ...................................................................................................................................................... 17
Impacts on Human Services Provision .......................................................................................................................... 17
Community Resource Impacts ...................................................................................................................................... 18
Prolonged employment issues ...................................................................................................................................... 18
Prolonged community resource/coordination issues ................................................................................................... 18
Community Agencies Supporting Vulnerable Populations ................................................................................................... 19
Table 4. Community Agencies Supporting Vulnerable Populations in Hamilton Township ......................................... 19
COVID-19 Vaccination Considerations .................................................................................................................................. 19
Conclusion ............................................................................................................................................................................. 20
References ............................................................................................................................................................................ 21
2
Background
In New Jersey, local health departments (LHDs) are the boots on the ground for public health services. Through the
statutory authority granted to municipalities, local boards of health are responsible for providing essential services in
emergency response and disaster resiliency, communicable disease investigation and outbreak response, environmental
and sanitation inspections, chronic disease prevention, and health promotion. These LHDs have varied infrastructures,
where some agencies may provide services to an entire county, some to a single city or municipality, and some to multiple
municipalities. As such, it is critical that LHDs build communicable disease capacity in contact tracing and containment to
ensure rapid response to and recovery from COVID-19 and other emergent pathogens.
To support COVID-19 response, the New Jersey Department of Health (NJDOH) Office of Local Public Health (OLPH)
received federal funding from the Centers for Disease Control and Prevention (CDC) that was awarded to county and local
health departments to support COVID-19 response and mitigation. Throughout COVID-19, LHDs have worked around the
clock to prepare, respond to, and contain the spread of COVID-19 in the state, and these funds have provided LHDs with
resources to identify, track and address local outbreaks rapidly.
$9.3 million in CDC funds (ELC Strategy 5 Use Laboratory Data to Enhance Investigation, Response, and Prevention) was
made available through a non-competitive Strengthening Local Public Health Capacity 2021 Grant made available to 77
non-LINCS Agency LHDs to hire full-time Vulnerable Population Outreach Coordinators (VPOCs) to assess, mitigate and
respond to the social and health impacts of COVID-19 through targeted outreach to at-risk, vulnerable populations.
Specifically, the purpose of this funding is to ensure that at-risk residents in their communities have access to testing,
vaccination, and support services such as housing, primary medical care, insurance coverage, and unemployment
compensation to allow them to quarantine effectively. Additionally, a total of $1.7 million in Strengthening Local Public
Health Capacity funds earmarked through the State's 2021 Budget was also allocated to assist non-LINCS Agency LHDs to
strengthen communicable disease outbreak preparedness and boost COVID-19 response capacity. The Hamilton Township
Division of Health (HTHD) received a Strengthening Local Public Health Capacity 2021 Grant in the amount of $142,236.
The above funding was made available in addition to $5 million in federal funding allocated to support LHDs statewide
through the New Jersey Association of County and City Health Officials (NJACCHO) to carry out critical local public health
efforts such as case contact tracing, providing guidance to long-term care facilities, standing up community testing and
vaccination sites, ensuring individuals have a safe place to quarantine and a variety of other COVID-19 related activities.
HTHD received $40,906 in funding from NJACCHO.
COVID-19 Vulnerable Population Assessment Goal
From the beginning of the pandemic through the date of this report, public health response has evolved daily through
testing, contact tracing, quarantine, isolation, and vaccination to prevent the spread of disease and protect the public’s
health. As part of the Strengthening Local Public Health Capacity 2021 Grant, and in response to this unprecedented
COVID-19 public health pandemic, the HTHD prepared this COVID-19 Vulnerable Population Assessment, to be referenced
as the Assessment going forward in this document. The goal of this rapid assessment is to:
Define and categorize vulnerable populations within Hamilton Township;
Detail the community demographics of Hamilton Township;
Describe the vulnerability, health disparities, and community impacts of COVID-19;
List community agencies that provide support to these vulnerable populations; and
Summarize key findings and priorities.
The data referenced within this Assessment applies to the Township of Hamilton, Mercer County, NJ, served by the
Hamilton Township Division of Health. The Assessment is to be presented by the VPOCs to the HTHD Director, Health
3
Officer, Mayor and Board of Health. Completing this rapid Assessment will inform the development or update of a
community resource directory of social support agencies by the VPOC. The forming of connections with support services
providers and other community stakeholders will enable VPOCs to effectively provide targeted outreach within the
community in the areas of COVID-19 prevention, testing, contact tracing, containment, isolation, quarantine, vaccination.
Underlying Medical Conditions and Increased Risk
CDC updated the list of underlying medical conditions that increase the risk of severe illness after reviewing published
reports, pre-print studies, and various other data sources. CDC experts then determined if there was clear, mixed, or
limited evidence that the condition increased a person's risk for severe illness, regardless of age. There was consistent
evidence (from multiple small studies or a strong association from a large study) that specific conditions increase a
person's risk of severe COVID-19 illness, as seen in Table 1 below.
Table 1. Conditions that Increase a Person’s Risk of Severe COVID-19 Illness, CDC (2020)
Chronic kidney disease Smoking
Cancer Type 2 diabetes
COPD (chronic obstructive pulmonary HIV/AIDS
disease)
Obesity (BMI of 30 or higher) Sickle cell disease
Immunocompromised state (weakened Serious heart conditions, such as heart
immune system) from solid organ failure, coronary artery disease, or
transplant cardiomyopathies
Down Syndrome Pregnancy and Breastfeeding
Defining Vulnerable Populations in the Community
Vulnerable populations are defined as those at greater risk for poor health status and health outcomes, experience
significant disparities in life expectancy, often lack access to healthcare and social supports, and experience increased
morbidity and mortality. The health needs of vulnerable populations are complex and intersect with the social and
economic conditions they experience. These populations are also more likely to have one or more physical and/or mental
health conditions (AJMC, 2006). Additionally, the disparities in health and environmental risk factors that vulnerable
populations experience put them at greater risk for COVID-19 related morbidity and mortality. To reduce the number of
poor health outcomes due to COVID-19 in vulnerable populations, it is imperative that the HTHD identify vulnerable
populations in the community and work closely with the social support agencies to connect them to COVID-19 prevention
measures, testing, contact tracing, containment, isolation, quarantine, vaccination, primary care, and other social supports
(AJMC, 2006).
Several groups are vulnerable to experiencing extra challenges related to COVID-19, including immediate medical risks
and broader social and economic factors. Challenges vulnerable populations may face concerning COVID-19 include;
difficulty accessing care (including insurance coverage, testing, and vaccination), being at risk for contracting and
experiencing more severe complications of COVID-19, difficulty completing quarantine or isolation periods,
unemployment, financial struggles, food insecurity, and mental health conditions. It is important to note that the
following categories are not independent of one another. Individuals may identify with one or more of these populations,
stressing the importance of interdisciplinary upstream policies and programs to improve community health. In Hamilton
Township some of the most vulnerable populations include; individuals at high risk for COVID-19 (those with pre-existing
chronic conditions as identified by phase 1B/1C), older adults, Long Term Care (LTC) residents and staff, racial and ethnic
4minorities, low-income households, isolated individuals and those with new or pre-existing mental health conditions.
These are just some of the vulnerable populations, Table 2 contains additional categories of vulnerable populations that
may be present within the community.
Table 2. Vulnerable Populations within Hamilton Township
Economic Disadvantage
Low-income persons and those living at or under the poverty line, including those who have been in
poverty for at least two generations; Ethnic and racial minorities; Homeless; Medicaid recipients;
Working poor with limited resources, often working multiple jobs; Single mothers and sole caregivers;
Low wage workers in multiple jobs
Difficulty Accessing Information or Technology (Language, Literacy, Cultural Barriers)
Persons with limited English language proficiency (read, write) in native language; low literacy or non-
English speaking groups:
o Spanish Asian and Pacific Island languages (Chinese, Korean, Japanese, Vietnamese, Hmong,
Khmer, Lao, Thai, Tagalog, Dravidian, Polynesian, and Micronesian languages)
o Other Indo-European languages (Germanic, Scandinavian, Slavic, Romance French, Italian), Indic,
Celtic, Baltic, Iranian, and Greek languages)
o All other languages (Creole, Uralic and Semitic languages as well as indigenous languages of the
Americas); Sign Languages/American Sign Language (ASL)
Foreign visitors; Undocumented immigrants; Immigrants; Refugees
Age
Elderly with limited strength, but not disabled; Senior citizens; Infants; Mothers with newborns;
Teens, school-age children; Families with children who have health care needs
People living in Congregate, Crowded, Sub-Standard Living Situations:
People experiencing Homelessness; People living in: Shelters/Temporary Housing; LTC/Assisted Living
Facilities or Other Long-Term Care Settings; Intellectual and Developmental Disabilities (IDD) group
Homes; Group Homes; Mental Health Group Homes; Schools, Migrant Workers/ Undocumented
Immigrants; Other Congregate Settings
Isolation (cultural, geographic, or social)
Persons in the LGBTQ community; Homeless people; People living in shelters (homeless, runaways, or
battered persons); Homebound elderly; People living alone; Sole caregivers; Single individuals without
extended family; Low-income persons; Persons experiencing mental illness; Undocumented
immigrants; Persons unable to afford transportation; People dependent on public transportation;
Persons living in temporary living conditions/ locations; Commuters
Hospitalized persons
Persons that are hospitalized; Persons living in congregate Long-Term Care Facilities/Assisted Living
Facilities/Veteran’s Homes; Blind and visually impaired; Deaf and hard of hearing; Developmentally
disabled; Mobility impaired; Medically dependent (persons dependent on life support/medical
equipment); Chronic disease/infirm; Drug and/or alcohol dependent (perhaps not in treatment);
Persons with a history of drug overdose; Diagnosed with mental illness; Drug use and substance use
disorder; Mentally ill or having brain disorders/injuries; Persons with chronic pain
Non-hospitalized patients
Require renal dialysis; Require supplemental oxygen; Require daily medication (insulin,
antihypertensive agents, narcotics, antipsychotics); Persons receiving chemotherapy or cancer
treatment; Clinically depressed individuals who may be unable to follow directions; Stroke patients
with limited mobility and additional care requirements; Pregnant women; People recuperating at
home from an acute injury (e.g., broken bones, recent surgery, back injury, burns)
5Challenges with Accessing Healthcare
Persons uninsured or uninsured; Persons who have reduced access to medical care; Persons who are
fearful of seeking care due to ability to pay, fear of prejudice or stigma; Persons with behavioral health
issues that prevent them from seeking care
Individuals at High Risk for COVID-19 (Phase 1B/Phase 1C Combined)
Individuals aged 65 and older, and individuals ages 16-64 with medical conditions, as defined by the
CDC, that increase the risk of severe illness from the virus. These conditions include:
o Cancer
o Chronic kidney disease
o COPD (chronic obstructive pulmonary disease)
o Down Syndrome
o Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
o Immunocompromised state (weakened immune system) from solid organ transplant
o Obesity (body mass index [BMI] of 30 kg/m2 or higher but < 40 kg/m2)
o Severe Obesity (BMI ≥ 40 kg/m2)
o Sickle cell disease
o Smoking
o Type 2 diabetes mellitus
o Pregnant/Breastfeeding
People aged 75 years and older because they are at high risk of hospitalization, illness, and death
from COVID-19.
Frontline Essential Workers
First Responders (Phase 1B) At-Risk for COVID-19
o Sworn law enforcement, firefighters, and other first responders, including:
o New Jersey State Police troopers
o Municipal and county police officers
o Detectives in prosecutors' offices and state agencies
o State agency/authority law enforcement officers (e.g., State Park Police and Conservation
Officers, Palisades Interstate Parkway Officers, Human Services police, and NJ Transit police)
o Investigator, Parole, and Secured Facilities Officers
o Aeronautical Operations Specialists
o Sworn Federal Law Enforcement Officers and Special Agents
o Bi-State law enforcement officers (e.g., Port Authority)
o Court Security Officers
o Paid and unpaid members of firefighting services (structural and wildland)
o Paid and unpaid members of Search and Rescue Units including technical rescue units and
HAZMAT teams
o Paid and unpaid firefighters who provide emergency medical services
o Paid and unpaid members of Industrial units that perform Fire, Rescue, and HAZMAT services
o Members of State Fire Marshal's Offices
o Bi-State Fire Service Personnel (e.g., Port Authority)
Other Frontline essential workers: food and agricultural workers, United States Postal Service workers,
manufacturing workers, grocery store workers, public transit workers, and those who work in the
educational sector (teachers, support staff, and daycare workers.)
Other essential workers, such as people who work in transportation and logistics, food service,
housing construction and finance, information technology, communications, energy, law, media,
public safety, and public health.
6Healthcare Personnel (Phase 1A) At-Risk for COVID-19
Paid and unpaid persons serving in health care settings who have the potential for direct or indirect
exposure to patients or infectious materials, including, but not limited to:
Licensed healthcare professionals like doctors, nurses, pharmacists, and dentists
Staff like receptionists, janitors, mortuary services, laboratory technicians
Consultants, per diem, and contractors who are not directly employed by the facility
Unpaid workers like health professional students, trainees, volunteers, and essential caregivers
Community health workers, doulas, and public health professionals like Medical Reserve Corps
Personnel with variable venues like EMS, paramedics, funeral staff, and autopsy workers
All workers in acute, pediatric, and behavioral health hospitals and ambulatory surgical centers
All workers in health facilities like psychiatric facilities, Federally Qualified Health Centers, and
rehabs
All workers in clinic-based settings like urgent care clinics, dialysis centers, and family planning sites
All workers in long-term care settings like nursing homes, assisted living facilities, group homes, etc.
All workers in occupational-based healthcare settings like health clinics within workplaces, shelters,
jails, colleges, and universities, and K-12 schools
All workers in community-based healthcare settings like PACE and Adult Living Community Nursing
All workers in home-based settings like hospice, home care, and visiting nurse services
All workers in office-based healthcare settings like physician and dental offices
All workers in public health settings like local health departments, LINCS agencies, harm reduction
centers, and medicinal marijuana programs
All workers in retail, independent, and institutional pharmacies
Other paid or unpaid people who work in a healthcare setting, who may have direct or indirect
contact with infectious persons or materials, and who cannot work from home.
Long-Term Care Residents and Staff (Phase 1A) At-Risk for COVID-19
All residents and workers of long-term care and high-risk congregate-care facilities, including:
Skilled nursing facilities
Veterans homes
Assisted living facilities, continuing care retirement communities, and personal care homes
Group homes like residential care homes, adult family homes, adult foster homes, and intellectual
and developmental disabilities group homes
HUD 202 Supportive Housing for the Elderly Program residences
Institutional settings like psychiatric hospitals, correctional institutions, county jails, and juvenile
detention facilities (for eligible minors, e.g., 16+ years of age may be eligible for Pfizer vaccine under
the emergency use authorization)
Other vulnerable, congregate, long-term settings
(OPHPR, n.d.; NJDOH, 2021)
7Community Demographic Profile
This section of the Assessment contains information about the age, sex, race, and socioeconomic composition of
the population within Hamilton Township obtained from the US Census Bureau (2019).
Table 3. Hamilton Township, NJ Demographic Profile, US Census Bureau, 2019
Demographic Characteristic Hamilton Township
Population estimates, July 1, 2019, (V2019) 87,065
People
Population
Population estimates, July 1, 2019, (V2019) 87,065
Population estimates base, April 1, 2010, (V2019) 88,442
Population, percent change - April 1, 2010 (estimates base) to July 1, 2019, (V2019) -1.6%
Population, Census, April 1, 2010 88,464
Age and Sex
Persons under 5 years, percent 5.9%
Persons under 18 years, percent 18.9%
Persons 65 years and over, percent 18.0%
Female persons, percent 51.7%
Male persons, percent 48.3%
Race and Hispanic Origin
White alone, percent 75.2%
Black or African American alone, percent 14.9%
American Indian and Alaska Native alone, percent 0.1%
Asian alone, percent 4.4%
Native Hawaiian and Other Pacific Islander alone, percent 0.1%
Two or More Races, percent 2.1%
Hispanic or Latino, percent 15.8%
White alone, not Hispanic or Latino, percent 63.7%
Population Characteristics
Veterans, 2015-2019 4,389
Foreign-born persons, percent, 2015-2019 16.6%
Housing
Housing units, July 1, 2019, (V2019) X
Owner-occupied housing unit rate, 2015-2019 71.1%
Median value of owner-occupied housing units, 2015-2019 $248,000
8Demographic Characteristic Hamilton Township
Median selected monthly owner costs -with a mortgage, 2015-2019 $2,040
Median selected monthly owner costs -without a mortgage, 2015-2019 $901
Median gross rent, 2015-2019 $1,267
Building permits, 2019 X
Families & Living Arrangements
Households, 2015-2019 32,936
Persons per household, 2015-2019 2.64
Living in same house 1 year ago, percent of persons age 1 year+, 2015-2019 89.8%
Language other than English spoken at home, percent of persons age 5 years+, 2015-2019 22.7%
Computer and Internet Use
Households with a computer, percent, 2015-2019 91.8%
Households with a broadband Internet subscription, percent, 2015-2019 86.8%
Education
High school graduate or higher, percent of persons age 25 years+, 2015-2019 91.0%
Bachelor's degree or higher, percent of persons age 25 years+, 2015-2019 30.6%
Health
With a disability, under age 65 years, percent, 2015-2019 7.3%
Persons without health insurance, under age 65 years, percent 7.5%
Economy
In civilian labor force, total, percent of population age 16 years+, 2015-2019 67.3%
In civilian labor force, female, percent of population age 16 years+, 2015-2019 62.1%
Total accommodation and food services sales, 2012 ($1,000) X
Total health care and social assistance receipts/revenue, 2012 ($1,000) 774,176
Total manufacturers’ shipments, 2012 ($1,000) 842,833
Total merchant wholesaler sales, 2012 ($1,000) 457,572
Total retail sales, 2012 ($1,000) 1,233,455
Total retail sales per capita, 2012 $13,891
Transportation
Mean travel time to work (minutes), workers age 16 years+, 2015-2019 25.2
Income & Poverty
Median household income (in 2019 dollars), 2015-2019 $78,177
Per capita income in past 12 months (in 2019 dollars), 2015-2019 $37,862
Persons in poverty, percent 7.9%
Households living in poverty or below basic cost of living in the county, ALICE Threshold estimate,
30%
percent*
9Business
Total employer establishments, 2018 X
Total employment, 2018 X
Total annual payroll, 2018 ($1,000) X
Total employment, percent change, 2017-2018 X
Total non-employer establishments, 2018 X
All firms, 2012 7,119
Men-owned firms, 2012 4,672
Women-owned firms, 2012 1,734
Minority-owned firms, 2012 1,438
Nonminority-owned firms, 2012 5,447
Veteran-owned firms, 2012 492
Nonveteran-owned firms, 2012 6,212
Geography
Population per square mile, 2010 2,240.2
Land area in square miles, 2010 39.49
(US Census Bureau, 2019; United Way of Northern NJ, 2020)
*The ALICE Threshold (Asset Limited, Income Constrained, Employed) provides estimates regarding poverty status and those
who earn more than the Federal Poverty Level but less than the cost of living within the county. For Hamilton Township
specifically, the ALICE Threshold for 2018 indicates 8% of the population are in poverty, and 22% are living below the ALICE
Threshold, for a total of 30% struggling to meet basic needs (United Way of Northern New Jersey, 2020)
10Vulnerability, Health Disparities and Community Impacts of COVID-19
Vulnerability of the Community
There have been a significant number of emerging impacts on the community served by the HTHD that are categorized
below. Some of the greatest vulnerable population impacts observed have been in physical and mental health,
employment (economic stability), education, food insecurity, and provision of community resources.
Within Hamilton Township, the following vulnerable population impacts have been observed in the following categories:
Health (physical and mental)
Employment (economic stability)
Education
Food Insecurity
Provision of community resources
Health
The vulnerable populations identified for Hamilton Township are among those most at risk for suffering physical health
complications from COVID-19, including severe complications, hospitalization, and death (CDC, 2020). Public health
efforts should aim to mitigate the disease burden from COVID-19 while also preventing the spread through testing, contact
tracing, and vaccination.
In addition to physical health complications, the pandemic also exacerbates mental health conditions. Interactions with
community members indicate feelings of worry, fear, frustration, and isolation all surrounding the happenings of the
pandemic (CDC, 2021). Various stressors are in place within the community, including economic hardships, job loss, the
passing of loved ones, social isolation, challenges surrounding remote learning, and the disruption of everyday tasks once
considered normal.
Economic Stability and Employment
As mentioned in the demographic profile (Table 3) 30% of Hamilton Township residents live in poverty or under the ALICE
Threshold, meaning they struggle financially to provide basic needs based on the cost of living in the county (United Way
of Northern NJ, 2020). This data is from 2018, so it is unknown how the pandemic has impacted this estimate. The
pandemic has caused economic stress for families, particularly affecting low-income, Black and Hispanic households
(Parker et al., 2020). Unemployment spikes as a result of the pandemic can also cause economic hardships. As seen in
Figure 1, unemployment at the start of 2020 was around 3% but increased starting in April 2020, spiking to a high of 14.4%
in June of 2020. Unemployment has declined, ending 2020 at 6.2%. However, this is still double what it was in March of
2020 (NJ Department of Labor and Workforce Development, 2020). Unemployment, reduction in hours or pay can all
contribute to individuals and families experiencing worsening or new financial hardships due to COVID-19.
11Figure 1. Unemployment in Hamilton Township, 2020
Hamilton Township Unemployment Rate, 2020
14.4
13.6
Unemployment Rate (%)
12.6 12.7
9.6
8.1
6.2 6.2
5.4
3.7 3.6 3.1
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Month, 2020
(NJ Dept. of Labor and Workforce Development, 2020)
Education
The COVID-19 pandemic has caused many changes to the education system. Remote learning is one of the most significant
impacts students, teachers, and school administrators have had to adjust to over the past year. Some of the challenges
include students receiving meals in school now not being in school to get those meals, technological access and difficulties,
and the disruption of the traditional classroom settings. Parents and caregivers have had to become teachers at home
and make arrangements if the parents need to leave home to work. In Hamilton, the YMCA and CYO organizations both
have full-day remote learning camps providing a valuable resource for parents who cannot supervise children during the
day. Additional impacts on the students include the disruption in social interaction with classmates, canceling of school
events many students look forward to, and disruption to the classroom setting, making learning difficult for some students.
Food Insecurity
The United States Department of Agriculture (USDA) defines food insecurity as "household-level economic and social
condition of limited or uncertain access to adequate food" (USDA, 2019). Food insecurity can be families not having
enough money to purchase food, the food they are buying not lasting before they can buy more, and reducing the amount
eaten to make food last longer.
Although food insecurity can happen to anyone, living in poverty, families with children, single-parent households, Black
and Hispanic households, and those that live alone are particularly vulnerable populations (ERS, 2019). Food insecurity
may put adults at risk for poor health outcomes such as obesity and chronic diseases. Adults with food insecurity have a
greater prevalence of obesity, likely due to lower consumption of fruits and vegetables and overconsumption of cheaper
energy-dense low nutrient foods (Pan et al., 2012). Food insecure children may experience adverse health outcomes,
including obesity, developmental delays, adverse childhood experiences, and mental health problems (ODPHP, 2020;
FRAC, 2017).
A COVID-19 Community Impact Survey was administered at the township level at public flu clinics in September and
October of 2020. Although responses were limited (n =101) to generalize the findings, preliminary results did indicate
20% of respondents reported some level of food insecurity was present in their household. Projections for the food
insecurity rate in Mercer County from Feeding America (2020) indicate that the overall food insecurity rate had increased
12from 8.9% in 2018 to a projected 13.6% in 2020. For children specifically in 2018, the food insecurity rate was 11% and is
projected at 19.2% for 2020 (Feeding America, 2020).
Understanding how food insecurity impacts Hamilton Township residents is essential to ensuring services and programs
are mobilized appropriately to assist the most vulnerable populations. The township and county has an existing network
of food assistance resources available to support residents experiencing long-term food insecurity and newly food-
insecure families due to COVID-19 (See Appendix A). Food insecure households may also experience stigma to seek out
or ask for help, especially among newly food insecure from the pandemic.
Provision of Community Resources
Residents and community organizations have experienced the impact of the disruption of programs, services, and
resources community members utilize. This includes but is not limited to; community centers closing to the public, meal
service programs and food banks shifting to a grab-and-go format, group fitness and wellness classes being canceled or
moved remotely, increase in telemedicine visits for health, remote, and hybrid learning in schools and faith-based
organizations canceling or moving services and events remotely. All of these changes have caused changes in the way we
live our daily lives, and for vulnerable families may have impacted how they access essential services.
Geographic Disparities
Unfortunately, zip code is a great predictor of health and life expectancy, knowing where disparities are can help with
public health action (RWJF, 2020). Hamilton Township contains several different zip codes within its jurisdiction, some of
which overlap with neighboring areas (Trenton City and Robbinsville Township). When examined as a whole, it may be
difficult to see where disparities exist; however, disparities become evident when looked at from the zip code level. The
Community Need Index (CNI) from Dignity Health considers several barriers to determine a score of the need within a
certain community, with 1 being the lowest need and 5 being the highest need (Dignity Health, 2020). These barriers
include culture, income, education, insurance, and housing, all important determinants of health. Within Hamilton
Township alone, the CNI ranges from 1.6 to 4.8, as seen in Figure 2. Additionally, the most recent Community Health
Assessment data shows areas with the greatest CNI's also have lower median incomes and a greater percentage of non-
White residents (CHA, 2018).
Further examination of the location of COVID-19 cases and deaths will provide insight into the hardest hit areas
geographically within the township. The COVID-19 Vulnerability Footprint from the SparkMap by CARES Engagement
Network (2021) also provides an interactive and useful data tool at the census tract level. As seen in Figure 3, this image
is a snapshot of the vulnerability of the community taking into consideration population density (>=1000 persons per sq.
mile), uninsured persons (>= 8%) and percent of the population over the age of 65 (>= 15%). Census tracts in orange meet
at least two of these thresholds and areas in darker red meet all three. Additionally, areas showing in purple just meet
the threshold for adults over 65 and areas in blue meet population density thresholds. Threshold markers on this tool can
be modified as needed by using the SparkMap platform.
Figure 4 gives a closer look at the population over 65 years by census tract for Mercer County. Individuals over 65 are one
of the most vulnerable groups in the township and one of the most vulnerable to morbidity and mortality from COVID-19.
Focusing on the south east portion of the county where Hamilton Township falls we can see that many of the census tracts
in Hamilton have an older adult population at or over 20%. These geographic maps showcase how the community differs
within the township to help us identify areas with the greatest vulnerability through a multitude of determinants that
contribute to health outcomes.
13Figure 2. Community Need Index (CNI) for Hamilton Township, NJ from Dignity Health
(Dignity Health, 2020)
Figure 3. COVID-19 Vulnerability Footprint
(SparkMap, 2021)
14Figure 4. Percent of the Population over the Age of 65, Mercer County
(SparkMap, 2021)
Disparities in Cases and Deaths from COVID-19
Conditions known as social determinants of health based on the places where people live, work, learn, play, and worship
affect a great variety of health risks and outcomes, such as COVID-19 infection, severe illness, and death. Systemic social
and health inequities have placed many people from racial and ethnic minority groups at increased risk of dying from
COVID-19. However, CDC data shows that the highest percentage of COVID-19 cases have affected non-Hispanic White
persons; ethnic and racial minority populations are disproportionally represented among COVID-19 cases (CDC, 2020).
Nationwide, according to the CDC (2020), data shows that the following vulnerable groups have experienced
disproportionately higher rates of infection and/or complications/death as a result of the COVID-19 pandemic:
People with underlying health conditions (especially lung disease, asthma, diabetes, cardiovascular disease, kidney
disease, liver disease, severe obesity, and individuals with immunocompromised conditions)
o Hamilton Township data from the most recent New Jersey Behavioral Risk Factor Survey (NJBRFS) survey
indicated that 12.3% of adults have at least one chronic condition (NJBRFS, 2017).
Older persons
o Older adults are at a considerably higher risk for severe complications, hospitalization, and death from COVID-
19. In the US, 8 out of 10 deaths from COVID-19 have been in individuals over 65. Additionally, older adults
with pre-existing chronic conditions are also at risk for severe illness (CDC, 2020). In Hamilton Township, 92%
of deaths have been in those over the age of 60.
People of color, particularly African Americans and persons of Hispanic ethnicity.
o Compared to non-Hispanic Whites, Blacks or African Americans are 1.4 times as likely to be diagnosed with
COVID-19, 3.7 times as likely to be hospitalized, and 2.8 times as likely to die from COVID-19 (CDC, 2020).
15o Compared to non-Hispanic Whites, Hispanic or Latinx persons are 1.7 times as likely to be diagnosed with
COVID-19, 4.1 times as likely to be hospitalized, and 2.8 times as likely to die from COVID-19 (CDC, 2020).
o Racial and ethnic minority groups may be disproportionately affected by the pandemic's economic and social
impacts and underlying factors affecting health and virus exposure (CDC, 2020).
o State-level statistics for NJ show Hispanic/Latinx persons were most likely to contract COVID-19, and
Black/African American persons are most likely to die from COVID-19 (The COVID Tracking Project, 2021).
Community Impacts from COVID-19
The following outlines the variety of possible impacts of COVID-19 on the Hamilton Township Community thus far
(National Community Action Partnership, 2020).
Health Impacts
Individuals over 65, especially those with underlying health conditions, are at risk for severe health implications
from COVID-19.
o Older adults are especially vulnerable to increased morbidity and mortality from COVID-19. Hamilton has
a higher percentage of adults over 65 compared to the county overall, and many of the deaths from
COVID-19 have been in older adults. In Hamilton Township, approximately 92% of all deaths were in
residents over the age of 60.
Mental health resources will need to be available in new and increased ways to deal with the many different
stressors/traumas caused by the pandemic, especially its impact over an extended time period.
o National data shows 4 in 10 adults have reported feelings of anxiety or depression during the pandemic,
compared to January 2019- June 2019 where this estimate was 1 in 10 (KFF, 2021). Interactions with
community members indicate feelings of worry, fear, frustration, and isolation all surrounding the
happenings of the pandemic. Various stressors are in place within the community, including economic
hardships, job loss, the passing of loved ones, social isolation, challenges surrounding remote learning,
and the disruption of everyday tasks once considered normal. Those with pre-existing mental health
conditions or living alone may be especially vulnerable.
Nutrition for school-aged children previously accessing free/reduced breakfast, lunch and snacks is impacted as
many are now removed from that food source due to school closures.
o The Hamilton Township School District has made sure students who were receiving school meals will still
be able to despite the remote and hybrid learning schedules. Families can pick up seven meals (breakfast
and lunch) once a week.
Long Term Care (LTC) facilities have been particularly affected by COVID-19 in terms of cases and deaths.
o In Hamilton Township, approximately 70% of all deaths were connected to an LTC facility. Of the COVID-
19 cases identified in LTC’s 29% of residents with a confirmed case passed away.
Food insecurity among community members during COVID-19. Many of whom may have been food insecure
before the pandemic and others newly food insecure.
o A township-level survey conducted in Sept. and Oct of 2020 indicated food insecurity is present within the
community. County-level projections from Feeding America also show the food insecurity rate to increase
from 8.9% in 2018 to an estimated 13.6% in 2020 (Feeding America, 2020). Food insecurity can happen
to anyone, especially vulnerable populations in the community, including those living in poverty, families
with children, single-parent households, Black and Hispanic households, and those who live alone (ERS,
2019).
16Employment impacts
Individuals in the health care field are at high risk of exposure to COVID-19 and are under tremendous stress due
to additional work hours and challenging work conditions. In particular, many of those workers with close,
frequent contact with vulnerable individuals are lower-wage individuals.
o Healthcare workers working long hours and faced with the increased stress from the pandemic may suffer
from burnout. These individuals are on the frontlines of the pandemic and are at risk for contracting
COVID-19: especially home health aides and employees in LTCs. As of March 12, 2021 there are currently
COVID-19 outbreaks in four LTC’s in Hamilton Township, these outbreaks affect residents as well as staff
(NJDOH, 2021).
Individuals in many sectors of the economy – but particularly the service sector, the retail sector, gig economy,
and others most affected by quarantine policies – are currently experiencing sudden and unexpected
unemployment. Some are unaware of resources available to them and their families as they experience
unemployment for the first time.
o During 2020 there were spikes in the unemployment rate in Hamilton, going from 3.1% in March to 14.4%
in June. The township community impact survey conducted in September and October 2020 also found
23% of respondents reported a change in employment due to the pandemic, either through job loss,
furlough, layoffs, or a reduction in hours or pay. Many are experiencing this for the first time and have
had difficulty finding employment after the pandemic. Especially for those working in lower-wage jobs,
jobs that cannot be remote, and jobs reliant on tip wages.
Educational impacts
The closing of public schools in Hamilton Township has impacted children’s education. Children with less access
to resources (broadband internet, computers/tablets, technology expertise, language barriers, etc.) are most at
risk for suffering learning loss during a protracted period of school closure.
o The school district has made strides to ensure students can access the technology needed by providing
students with Chromebooks to use for school. However, according to census data, about 13% of
households do not have broadband internet subscriptions.
Caregivers of school-age children must secure daycare arrangements for their children or sacrifice employment
to care for their children. These same caregivers are also expected to be primary teachers for their children during
the closure period. Parents with limited resources face numerous challenges as a result of this situation.
o Having a school-aged child has posed challenges for working parents and caregivers—especially those
who work in essential jobs that cannot be conducted remotely. Remote learning day programs are
available through the YMCA and CYO; however, they cost money which may be a potential barrier to
access this service.
Impacts on Human Services Provision
Services to vulnerable populations have been curtailed or drastically changed. Some service providers are not
operating, operating at reduced hours, or are not allowing walk-up services to clients, leaving gaps in services to
the community. This includes the Hamilton Township Senior Center (closed to the public and operating remotely),
food banks shifting to grab-and-go, and faith-based services moving to a virtual format. Other service providers
have altered their service provision in significant ways, leaving some family needs unmet. Finally, for those service
providers continuing to operate, the changed circumstances have required significant, immediate adaptations
that will require additional resources to support over a longer period of time:
o Organizations that provide direct support to the community and vulnerable populations cannot interact
with their members as they once did. Community members who would once walk in to find assistance
now do not have that option, leaving needs unmet and unknown.
17Community Resource Impacts
The impacts of COVID-19 on community resources are numerous and include a reduction in the availability of
resources (access to group activities, commercial services), a scarcity of some resources (health care, food, and
emergency supplies), and/or needs for resources that have not previously been required in this community in any
significant capacity.
o Community centers and faith-based organizations have had to change their programming, services, and
events to follow virtual or social distancing models. Organizations providing food to residents indicate
the need is high, and pre-packaged food bags are distributed quickly.
The broad impacts of COVID-19 on this community have created an even more urgent need for coordination and
collaboration of resources among the public sector, the public health sector, first responders, educators, the
business community, the faith community, and many others. The Hamilton Township Division of Health plays an
important role in convening organizations, people, and resources to support families.
o Serving as a central liaison, the HTHD is in a unique position to facilitate connections between various
resources and sectors of the community.
Prolonged employment issues
Sudden layoffs and other employment disruptions are being addressed by emergency response measures;
however, it is anticipated that long-term recovery efforts will be required to help customers reconnect to the
workforce, particularly those for whom employment assistance has not previously been required.
o Unemployment in Hamilton Township has improved since the Summer of 2020, yet as of December 2020
remained at 6.2%. This is about twice as high as the average unemployment from 2018 (3.5%) and 2019
(3.0%) (New Jersey Department of Labor and Workforce Development, 2020).
Prolonged community resource/coordination issues
With COVID-19 impacting the community for almost one-year, the need for community resource/coordination
will continue long-term until the community begins to recover from the widespread effects of the pandemic.
Recovery efforts will require coordination. Ongoing community preparedness to guard against a future outbreak
will also require ongoing convening and new community readiness strategies based on what is shown to be
effective during the current crisis.
o The COVID-19 pandemic has brought to light the need for upstream approaches to address the social
determinants of health. Many lessons have been learned while dealing with the pandemic and can fuel
decision-making and collaboration moving forward.
18Community Agencies Supporting Vulnerable Populations
Below are select agencies and organizations that support vulnerable populations in Hamilton Township, NJ. Please see
Appendix A for a complete inventory of services available to residents at the county, state, and national levels.
Table 4. Community Agencies Supporting Vulnerable Populations in Hamilton Township
Agency Types of Services Provided
Hamilton Township Division of Health Local health department, referrals and support to the
community, VFC site
CYO Bromley Center Community center, childcare, food pantry, and computer
lab
John O. Wilson Community Center Social support referrals, food pantry, homeless prevention
services, Senior Nutrition Program site
Hamilton Township Senior Center Community center, social and wellness activities, Senior
Nutrition Program site
Mercer County WIC Nutrition and breastfeeding support for low-income
pregnant and post-partum women and children up to 5
years
Interfaith Caregivers of Greater Mercer County Companionship and non-medical care for older adults
Hamilton Area YMCA Community Center, fitness and wellness support,
childcare, and remote learning services
Faith-Based Organizations Food pantries, community support
Food Banks and Meal Service Programs Food and meal assistance services
School District Education, meal distribution for students, remote learning
support (technology access)
Henry J. Austin Health Center Local area FQHC, affordable healthcare access for
uninsured, low-income, and vulnerable populations
COVID-19 Vaccination Considerations
A critical step currently underway to help control the spread of COVID-19 is vaccination. At the HTHD, we have seen high
demand from the community wanting to be vaccinated. Limited supply, confusion on scheduling an appointment, and
the limited availability of appointments have shown understandable frustration from the public. Despite supply issues,
other barriers to vaccination include hesitation and fear of the vaccine, technological and transportation issues.
Addressing these barriers and easing concerns regarding vaccination is critical to decreasing morbidity and mortality from
COVID-19 and getting one step closer to recovering the community. The addition of the one dose Johnson & Johnson
(J&J/Janssen) vaccine is critical for reaching vulnerable populations that may be experiencing some of these barriers to
vaccination. The HTHD has completed successful COVID-19 vaccine clinics with the Moderna vaccine at the Nottingham
Fire Department and Hamilton Township Senior Center and with the J&J vaccine at the Alvin E. Gershen/Pond Run
apartment complex (affordable independent living for older adults and persons with disabilities). These clinics made
getting vaccinated easy and convenient for residents especially those facing technology, transportation or other mobility
barriers.
19Conclusion
The COVID-19 pandemic has caused great disruption to the Hamilton Township community. Within Hamilton Township,
some of the most vulnerable populations include, but are not limited to; individuals at high risk for COVID-19 (those with
pre-existing chronic conditions as identified by phase 1B/1C), older adults, Long Term Care (LTC) residents and staff, racial
and ethnic minorities, low-income households, isolated individuals and those with new or pre-existing mental health
conditions. These groups and other vulnerable populations identified in this Assessment are most at risk for increased
morbidity and mortality related to COVID-19. In Hamilton Township, areas particularly impacted by COVID-19 include
physical and mental health, economic stability and employment, food insecurity, and the disruption of community
resources. Geographic disparities are also present within the community, highlighting areas of disparities and health
inequities.
The next steps in mitigating the burden caused by COVID-19 on vulnerable populations include first controlling the spread
of COVID-19 and addressing root causes of health inequities that are preventing residents, especially the most vulnerable,
from achieving their fullest health potential. The Robert Wood Johnson Foundation (2017) defines health equity as:
“Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing
obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to
good jobs with fair pay, quality education and housing, safe environments, and health care.”
This Assessment serves as a guide for the HTHD to utilize when working with vulnerable populations. It is the goal of the
HTHD to mitigate the immediate and long-term impacts of the COVID-19 pandemic, especially among the most vulnerable.
Knowing which populations are the most vulnerable and where the greatest unmet health needs are can help direct
resources to address the impacts of COVID-19 and promote health equity.
For more information please contact:
Veronica Eisenmann
Vulnerable Populations Outreach Coordinator (VPOC) for the Hamilton Township Division of Health
veisenmann@hamiltonnj.com
609-890-3647
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