Plan for Collaborating on a Harford County Community Health Improvement Plan Community Health Improvement Plan (CHIP) Coalition Steering Committee November 2011

Today’s Agenda Rationale for a community health needs assessment and improvement plan Proposed approach for the planning process Broad-brush review of Harford County health data and priorities Next steps 2

Who Says We Need a Plan for Improving the Community’s Health? CHNA – For Hospitals – Federal health care reform, as well as Federal and State requirements, mandate community health needs assessment (CHNA). SHIP – For State Health Departments – Maryland’s Health Care Reform Coordinating Council reaffirms the importance of a State Health Improvement Process (SHIP). LHIP – For Local Health Departments – National public health accreditation requires a Local Health Improvement Plan (LHIP). 3

What’s Required? Local Health Departments State Health Improvement Process (SHIP) obligations requiring a Local Health Improvement Coalition (LHIC) and Action Plan Obesity Prevention Task Force report due to the County Council Public Health Accreditation Board (PHAB) prerequisite Hospitals State community benefits report to HSCRC Federal IRS Form 990 Schedule H New federal health care reform requirements for Community Health Needs Assessment (CHNA) 4

Are We Duplicating or Streamlining Efforts? 5

Can We Build on Harford County Efforts? 6 Federal Health Care Reform Requirements LHD SHIP Mandates Hospital CHNA Mandates Healthy Harford Activities COMMUNITY HEALTH IMPROVEMENT PLAN

A Common Vision and Mission? VISION To make Harford County the healthiest community in Maryland MISSION To protect, promote and improve the health, safety and environment of the residents of Harford County through community assessment, education, collaboration and assurance of services 7

What is a Public Health Planning Process? MAPP = Mobilizing for Action through Planning & Partnerships Developed by NACCHO & CDC in 2001 Consists of 4 assessments: – Quantitative data review – Qualitative data review – Internal review – External review 8 MAPP

How Can We Get Started? Present the quantitative data we currently have to community audiences Then solicit reaction, including qualitative feedback In order to engage in a discussion about strengths, weaknesses, opportunities & threats To gain consensus on priorities, goals, strategies & action steps 9 One Approach

First, Quick Facts About Our Community Demographic IndicatorsHarford CountyMaryland Population (2010)244,8265,773,552 Population % change ( )12%9% White population % (2010)81.2%58.2% Black population % (2010)12.7%29.4% Hispanic population % (2010)3.5%8.2% High school graduates ( )90.8%87.5% Bachelor’s degree or higher ( )30.3%35.2% Homeownership rate ( )81.3%69.6% Median household income (2009)$75,364$69,193 Persons below poverty level (2009)6.2%9.2% Persons per square mile (2010)

Let’s start at the beginning... PREGNANCY DATA 11

Infant Mortality Rates Harford County & Maryland to Source: Maryland Vital Statistics 12

Infant Mortality Rates Harford County, By Race to Source: Maryland Vital Statistics 13

Top 7 Leading Causes of Infant Death Maryland,

Low Birthweight Rates Harford County & Maryland to Source: Maryland Vital Statistics 15

Low Birthweight Rates Harford County, By Race 2004 vs Source: Maryland Vital Statistics 16

Teen Birth Rates Harford County & Maryland 2004 vs Source: Maryland Vital Statistics 17

Teen Birth Rates Harford County, By Race 2004 vs Source: Maryland Vital Statistics 18

1 st Trimester Prenatal Care Rates Harford County & Maryland to Source: Maryland Vital Statistics 19

1 st Trimester Prenatal Care Rates Harford County, By Race 2004 vs Source: Maryland Vital Statistics 20

For pregnancy outcomes, Harford County ranks better than the State, but health disparities exist IndicatorHarfordMarylandComparisonDisparity Infant Mortality Rate 5.7/ /1000 Low Birthweight Rate 7.8%9.3% Teen Birth Rate 19.7/ /1000 Early Prenatal Care Rate 84.8%80.0% 21

Let’s move on to conditions that affect us over the years... CHRONIC DISEASE DATA 22

Top 10 Causes of Death Maryland,

Top 7 Causes of Death Harford County,

Heart Disease Mortality Rates Harford County & Maryland to Source: Maryland Vital Statistics 25

Heart Disease Mortality Rates Harford County, By Race to Source: Maryland Vital Statistics 26

Cancer Mortality Rates Harford County & Maryland to Source: Maryland Vital Statistics 27

Cancer Mortality Rates Harford County, By Race to Source: Maryland Vital Statistics 28

Stroke Mortality Rates Harford County & Maryland to Source: Maryland Vital Statistics 29

Stroke Mortality Rates Harford County, By Race to Source: Maryland Vital Statistics 30

COPD Mortality Rates Harford County & Maryland to Source: Maryland Vital Statistics 31

COPD Mortality Rates Harford County, By Race to Source: Maryland Vital Statistics 32

For chronic disease outcomes, Harford County ranks worse than the State IndicatorHarfordMarylandComparisonDisparity Heart Disease Mortality Cancer Mortality Stroke Mortality COPD Mortality Note: Rates are deaths per 100,000 population

Now let’s look at lifestyle choices... LIFESTYLE DATA 34

Leading Actual Causes of Death United States, Source: Mokdad AH, et al, JAMA, Mar 2004

Adult Smoking Rates Harford County & Maryland to Source: CDC Behavioral Risk Factor Surveillance System 36

Adult Smoking Rates Harford County 2010 CHAP & BRFSS Data 37

Adult Cigarette Smoking Rates Harford County & Maryland 2000 to Source: CDC Behavioral Risk Factor Surveillance System

Youth Tobacco Use Rates Harford County & Maryland 2000 to 2010 Source: Maryland Youth Tobacco Survey 39

Secondhand Smoke Exposure Rates Harford County & Maryland, 2008 Source: CDC Behavioral Risk Factor Surveillance System 40

Adult Obesity/Overweight Rates Harford County & Maryland to Source: CDC Behavioral Risk Factor Surveillance System 41

Adult Obesity/Overweight Rates Harford County 2010 CHAP & BRFSS Data 42

Physical Activity Rates* Harford County & Maryland to * NOTE: Moderate activity 30 minutes/day, 5 days/week 43 Source: CDC Behavioral Risk Factor Surveillance System

Physical Activity Rates Harford County 2010 CHAP & BRFSS Data 44 NOTE: Moderate activity 30 minutes/day, 5 days/weekNOTE: Moderate activity 30 minutes/day, 3 days/week

Fruits & Vegetables Intake Rates* Harford County & Maryland to Source: CDC Behavioral Risk Factor Surveillance System * NOTE: 5 or more daily servings of fruits or vegetables

Fruits & Vegetables Intake Rates Harford County 2010 CHAP & BRFSS Data 46 NOTE: 3 more daily servings of fruit and 3 more daily servings of vegetables Fruits, 18.3% Fruits/Vegetables, 37.1%

In lifestyle choices, Harford County ranks worse than or even with the State IndicatorHarfordMarylandComparison Tobacco Use 20.3%15.1% Obesity/ Overweight 63.5%64.1% Physical Activity 37.1%33.9% Fruits/ Vegetables 25.2%27.3% 47

And what about access to health care... ACCESS DATA 48

% Who Could Not Afford to See M.D. Harford County & Maryland to Source: CDC Behavioral Risk Factor Surveillance System 49

Adult Influenza Vaccination Rates Harford County & Maryland to Source: CDC Behavioral Risk Factor Surveillance System 50

Childhood Influenza Vaccination Rates County Leaders, 2010 Source: CDC Behavioral Risk Factor Surveillance System 51

Anxiety Disorder Rates Harford County & Maryland to Source: CDC Behavioral Risk Factor Surveillance System 52

Binge Drinking Rates Harford County & Maryland to Source: CDC Behavioral Risk Factor Surveillance System 53

Population to Provider Ratios Harford County & Maryland 54 Source: Maryland Primary Care Office, DHMH

Primary Care & Dental Care Shortage Areas in Harford County,

With access to care, Harford County has specialty area needs IndicatorHarfordMarylandComparison Afford to See M.D. 10.4%12.0% Adult Flu Vaccine 38.7%41.2% Child Flu Vaccine 63.3%53.7% Anxiety19.0%12.8% Binge Drink16.0%13.7% Pop:Provider Ratio (MH) 44,354:112,253:1 56

Now, putting the pieces together... COMPOSITE DATA 57

SHIP 58

Which of the 39 SHIP objectives does Harford County rank worse than the State? 1.Seasonal flu vaccination rate 2.Heart disease death rate 3.Cancer death rate 4.Adult tobacco use 5.Youth tobacco use 6.Behavioral health-related admissions to E.R. 7.Alzheimer’s-related admissions to the E.R. 59

County Health Rankings 60

Which of the 27 County Health Rankings objectives does Harford County rank worse than the State? 1.Adult smoking 2.Adult obesity 3.Access to recreational facilities 4.Air pollution ozone days 5.Mammography screening 6.Motor vehicle crash death rate 7.Primary care physician availability 8.Preventable hospital stays 9.Poor mental health days 10.Poor physical health days 11.Unemployment 61

Do the data suggest common themes for determining Harford County health priorities? 62

Next Steps? Agree that the Community Health Improvement Plan (CHIP) Coalition will serve as the unifying framework for Community Health Needs Assessment, Local Health Improvement Plan, and the Obesity Task Force efforts. Finalize membership of the CHIP Steering Committee and the larger Coalition. Preliminarily select 3 to 5 priority areas of focus and identify partners for leading those improvement efforts. Solicit feedback from others in the community – via meetings, website communications, and other avenues. Other thoughts? 63