THE COUNTY HEALTH RANKINGS & ROADMAPS: FROM DATA TO ACTION Julie A. Willems Van Dijk RN, PhD Deputy Director, County Health Roadmaps University of Wisconsin Population Health Institute December 4, 2013

County Health Rankings & Roadmaps is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

3 ACKNOWLEDGEMENTS ‣ Robert Wood Johnson Foundation – Including Abbey Cofsky, Joe Marx, Michelle Larkin, Jim Marks, Naima Wong ‣ Wisconsin County Health Rankings & Roadmaps Team – Including Bridget Catlin, Patrick Remington, Amanda Jovaag, Kitty Jerome, Alison Bergum, Kate Konkle, Karen Odegaard, Jan O’Neill, Kirstin Siemering ‣ Our Partners – Including Burness Communications, Community Catalyst, United Way Worldwide, NACo, NBCH, ASTHO, NACCHO, NNPHI, Dartmouth Institute, CDC, NCHS 3

4 TODAY’S OUTLINE ‣ What Creates Health? ‣ Exploring the County Health Rankings & Detroit’s State of Population Health Report ‣ Moving to Action ‣ Discussion

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6 TWO VIEWPOINTS Today’s Health Health Outcomes Tomorrow’s Health Health Factors 6

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8 ‣ Reflect important aspects of population health that can be improved ‣ Valid, reliable, recognized and used by others ‣ Available at the county-level ‣ Available for free or low cost ‣ As up-to-date as possible ‣ Fewer measures better than more HOW ARE MEASURES SELECTED?

9 FOCUS AREAMEASUREDATA SOURCE MORTALITY (50%)Premature Death (50%) (Years of Potential Life Lost) National Center for Health Statistics MORBIDITY (50%)Low Birthweight (20%) Poor or Fair Health (10%) Poor Physical Health Days (10%) Poor Mental Health Days (10%) National Center for Health Statistics Behavioral Risk Factor Surveillance System HEALTH OUTCOMES

10 FOCUS AREAMEASUREDATA SOURCE TOBACCO USE (10%) Adult Smoking (10%)Behavioral Risk Factor Surveillance System DIET AND EXERCISE (10%) Obesity (7.5%) Physical Inactivity (2.5%) National Center for Chronic Disease Prevention and Health Promotion ALCOHOL USE (5%) Excessive Drinking (2.5%) Motor Vehicle Crash Death Rate (2.5%) Behavioral Risk Factor Surveillance System National Center for Health Statistics SEXUAL ACTIVITY (5%) Teen Birth Rate (2.5%) Sexually Transmitted Infections (Chlamydia Rate) (2.5%) National Center for Health Statistics National Center for Hepatitis, HIV, STD, and TB Prevention HEALTH BEHAVIORS

11 FOCUS AREAMEASUREDATA SOURCE ACCESS TO CARE (10%) Uninsured (5%) Primary Care Physicians (3%) Dentists (2%) Small Area Health Insurance Estimates Health Resources & Services Administration QUALITY OF CARE (10%) Preventable Hospital Stays (5%) Diabetic Screening (2.5%) Mammography Screening (2.5%) Dartmouth Institute: Dartmouth Atlas Project, Medicare Claims Data CLINICAL CARE

12 FOCUS AREAMEASUREDATA SOURCE EDUCATION (10%) High School Graduation (5%) Some College (5%) States provided H.S. graduation data American Community Survey EMPLOYMENT (10%) Unemployment (10%)US Bureau of Labor Statistics INCOME (10%)Children in Poverty (10%)Small Area Income and Poverty Estimates FAMILY AND SOCIAL SUPPORT (5%) Inadequate Social Support (2.5%) Single-Parent Households (2.5%) Behavioral Risk Factor Surveillance System American Community Survey COMMUNITY SAFETY (5%)Violent Crime (5%) Uniform Crime Reporting, Federal Bureau of Investigation SOCIAL AND ECONOMIC FACTORS

13 PHYSICAL ENVIRONMENT Focus AreaMeasureData Source ENVIRONMENTAL QUALITY (4%) Daily Fine Particulate Matter (2%) Drinking Water Safety (2%) CDC WONDER Environmental data, NASA Applied Sciences Program/Public Health Program Safe Drinking Water Information System BUILT ENVIRONMENT (6%) Limited Access to Healthy Foods (2%) Fast Food Restaurants (2%) Access to Recreational Facilities (2%) Food Environment Atlas County Business Patterns

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26 State of Population Health Report, Page 9

27 State of Population Health Report, Page 8

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29 State of Population Health Report, Page 15

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35 SOCIAL ECOLOGICAL MODEL (MCELROY, BIBEAU, STECKLER, & GLANZ, 1988)

36 Obesity IndividualWeight reduction Exercise programs Family/InterpersonalFamily nutrition classes Active family challenge InstitutionalHealthy nutritional choices Competitive pricing Activity challenges Point of decision prompts CommunityBike and walking trails Safe Routes to School PolicyTaxes on sugar-sweetened beverages Community development financing for healthy food outlets

37 ‣ A model of health and action to guide your process ‣ Tools and guidance that can be used by both public health and hospitals to work together ‣ Community of learning ‣ Stories and examples of how other communities have advanced their journey towards health HOW CAN THIS BE HELPFUL TO MY COMMUNITY?

DRAFT Health Driver Diagram (High Level) Key Outcome Primary Drivers Central to our Mission and Capabilities, High Control Central to our Mission & Shared Capabilities, & Control Aligned with our Mission & Limited Capabilities & Control Improved Health (As Measured by a Summary Measure of Health) Healthy Lifestyles Preventive Services Acute Care Chronic Disease End of Life Cross Cutting Issues Tobacco Non-use Activity Diet/Nutrition Appropriate Alcohol Use Advocacy Other Community Projects Advocacy Other Community Projects Environmental Factors Health Behaviors Health Care Socio-economic Factors

Adult/Family Literacy Early Childhood Development Physical Activity Nutritious Food/Drink Livable Communities Physical Environment Socioeconomic Lead and Other Chemicals Health Literacy Built Environments Environmental Quality Trained Workforce Income Family/Social Support Family Stability Aging Population Services and Caregiver Support Parenting Skills Safe Areas for Activity Access to Healthy Food/Drink Social Cohesion Affordability Dental Health Housing English Proficiency 2 nd Hand Smoke Employer/Employee Awareness Utilities Worker Availability/Readiness Cultural Competence April 16, Version 4.0 Driver Diagram: Partial Inventory of Related HealthPartners Initiatives Reduced Toxic Exposures Financial Management Mental Health Anti-Stigma Efforts for Mental Health and Chemical Dependency Improved Work-Health Linkage Cultural Understanding Community Engagement Provider Outreach to Community Community Safety Reduced Violence Ready Transportation Green Building Initiatives Itasca Project efforts Food Shelf programs Pirates of Carrot Bean: SHIP support Breastfeeding video Health Literacy workshops Project Read Speaking Together Itasca Project efforts Tech Prep Consortium Youth Volunteer Program EBAN Experience Employee education Health Career Scholarships Teachers in Healthcare Setting Financial Fitness Program Itasca Project efforts Food Shelf programs SPPS Health & Wellness Homes for All 2010 EMACS SHIP support Regions Financial Counseling Project Read Baby Safety program Baby Clothes Breastfeeding video: Cell phone drives Shelter/Clinics partners Cornerstone conference Itasca Project efforts Data/Research projects Employee education EBAN Experience Power to End Stroke EMACS: Hovander House SHIP support NAMI partnership East Metro Roundtable Itasca Project efforts Food Shelf programs CSAs Farmers Market promo Complete Streets SHIP support MN Environmental Fund County Volunteer Drivers Smoke-Free Worksites SHIP support MN Environmental Fund Environment Conservation Related HealthPartners Initiatives Employment Education

40 ‣ Annual prize ‣ Honoring outstanding community efforts and partnerships ‣ Winning communities receive a $25,000 cash prize ‣ 2014 winners will be announced and next round of applications will be released in June, 2014 ROADMAPS TO HEALTH PRIZE Meet the six inaugural winners and learn more about how your community can apply at

41 NEW ORLEANS content/2013/02/new-orleans--louisiana roadmaps-to-health-prize.html

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43 DISCUSSION Julie Willems Van Dijk RN PhD Deputy Director, County Health Rankings & Roadmaps University of Wisconsin Population Health Institute