1. 1 Marissa J. Levine, MD, MPH, FAAFP Virginia State Health Commissioner February 16, 2016 Designing Healthy Communities

2. 2 Educational Objectives By the end of this session, participants will be able to: Identify the current health status of the people of Virginia, and Describe approaches to creating the conditions in which all Virginians will have a greater opportunity for health and well-being

3. 3 Outline 1.Presentation of population health metrics for Virginia 2.Review of Virginia’s Plan for Well-Being 3.Discussion of the role of nurses in implementing Virginia’s Plan for Well- Being

4. 4 IMAGINE: What would our communities look like if they were intentionally designed to ensure health and well-being for all?

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6. 6 Data Source: Presentation to Joint Commission on Health Care, September 6, 2014 6

7. 7 Source: http://ucatlas.ucsc.edu/health.php Year - 2000

8. 8 *Potentially unnecessary visits include primary care treatable, preventable/avoidable and non-emergent Potentially Avoidable* Emergency Department Visits in Virginia Data Source: Virginia Health Information, Potentially Avoidable Emergency Department Visits in Virginia 2013.

9. 9 Increasing the Opportunity for Health for All People in Virginia 1.Factor health into policy decisions related to education, employment, housing, transportation, land use, economic development, and public safety 2.Invest in the health, education, and development of Virginia’s children 3.Promote a culture of health through preventive actions 4.Create a connected system of health care

10. 10 The Health of the People in Virginia

11. Source: American Health Rankings by United Health Foundation Released 12/10/15 Virginia Compared to Other States, 2014 Overall Ranking = 21 st

12. 12 Virginia Population Health Metrics Highest Ranking Indicators: Children in Poverty Violent Crime Drug Deaths Infectious Disease Poor Mental Health Days Teen Birth Rate

13. 13 Virginia Population Health Metrics Lowest Ranking Indicators: Disparity in Health Status Smoking High Blood Pressure Physical Inactivity Infant Mortality

14. 14 Health Opportunity Index A composite measure comprised of 13 indices that reflect a broad array of social determinants of health Disparity in Health Status

15. 15 Fairfax County

16. 16 Richmond City

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18. 18 Smoking Virginian Adults Report Smoking Data Source: Virginia Department of Health, BRFSS 2013

19. 19 Virginia’s Youth Who Smoke… 7,300 youth become new, regular smokers each year 9.7 million packs of cigarettes are bought or smoked by kids each year 150,000 youth who are alive today will die prematurely from smoking Source: Campaign for Tobacco Free Kids, “The Toll of Tobacco in Virginia Fact Sheet”, January 8, 2015. Available at: http://www.tobaccofreekids.org/facts_issues/toll_us/virginia

20. 20 In Virginia… The prevalence of households with smoke-free rules increased from 39% during 1992-1993 to 85.6% in 2010-2011  The prevalence of households with smoke- free rules increased from 53.8% to 93.2% among households with no adult smokers, and  from 7.4% to 46.1% among households with at least one smoker Source: Exposure to Secondhand Smoke in the U.S. and Virginia, VDH, http://www.vdh.virginia.gov/livewell/programs/tobacco/documents/SecondhandSmokeExposureintheUSandinVirginia.pdf

21. 21 Infant Mortality Source: VDH Division of Health Statistics, compiled by the Division of Policy & Evaluation, Office of Family Health Services

22. 22 Virginia’s Infant Mortality Rate by Hospital Region, 2012 Source: VDH Division of Health Statistics, compiled by the Division of Policy & Evaluation, Office of Family Health Services

23. 23 Source: VDH Division of Health Statistics, compiled by the Division of Policy & Evaluation, Office of Family Health Services

24. 24 Source: Virginia Department of Health, Pregnancy Risk Assessment Monitoring System, 2007-2011

25. Preterm (<37wks Gestation) Births by Race/Ethnicity, Virginia, 2002-13* * Data for birth year 2013 is provisional as of July 1, 2014. Final data for birth year 2013 should be available Late September/Early October. Source: VDH Division of Health Statistics, compiled by the Division of Policy & Evaluation, Office of Family Health Services

26. Preterm (<37wks Gestation) Births by Maternal Smoking Status, Virginia, 2002-13* * Data for birth year 2013 is provisional as of July 1, 2014. Final data for birth year 2013 should be available Late September/Early October. Source: VDH Division of Health Statistics, compiled by the Division of Policy & Evaluation, Office of Family Health Services

27. 27 If These Conditions Are Prevented Among Pregnant Women This Number of Infants Could Be Born at Full-term Smoking1,548 Diabetes275 Chronic Hypertension190 Anemia103 Source: VDH Division of Health Statistics, compiled by the Division of Policy & Evaluation, Office of Family Health Services

28. Goal: Close the Gap to Give All Infants the Chance to Thrive

29. 29 Emerging Public Health Issue

30. Years of Potential Life Lost Before Age 65 Virginia, 2013 Data Source: National Center for Health Statistics Vital Statistics System for Virginia 2013. Data includes all races, both sexes, all deaths.

31. Years of Potential Life Lost Before Age 65 Virginia, 2014 Data Source: National Center for Health Statistics Vital Statistics System for Virginia 2014. Data includes all races, both sexes, all deaths.

32. 32 Average Annual Drug Overdose Death Rate, Virginia, 2011-13 Data Source: Virginia Health Information, Average Annual Drug Overdose Rate 2011-2013.

33. Mental Health and Substance Use Disorder Hospitalization Rate, Virginia, 2008-13 Data Source: Virginia Health Information 2008-2013. The metric measures the hospitalization rate of Virginia adults identified by primary diagnosis. Mental health and substance use hospitalization cases were selected based on criteria developed by the Healthcare Cost and Utilization Project (HCUP). Hospitalization data derived from inpatient discharge dataset provided by Virginia Health Information (VHI). Population denominators derived from midyear Census estimates provided by the National Center for Health Statistics. The case definition used excluded discharges related to maternity stays.

34. 34 Road to Becoming the Healthiest State in the Nation: Assessment, Planning (Alignment/Focus), Feedback

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36. 36 An Approach Manage the burden of disease  Assure that people have access to the right care at the right time at a reasonable cost Break the cycle  Prevention everwhere/Culture of Health Think about health differently  Not just something we restore when we lose it, but rather something we retain and maintain while we have it

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39. Metrics HEALTHY, CONNECTED COMMUNITIES H.S. Grads Enrolled in Higher Ed Cost-Burdened Households Consumer Opportunity Index Economic Opportunity Index Districts with Collaborative Improvement Processes PREVENTIVE ACTIONS Adults Not Participating In Physical Activity Adults Who Are Overweight or Obese Households That Are Food Insecure Adults Using Tobacco Adults Vaccinated Against Influenza Adolescents Vaccinated Against HPV Adults Screened for Colorectal Cancer Percent of Adults With Adverse Childhood Experiences Disability-free Life Expectancy STRONG START FOR CHILDREN Teen Pregnancy Rate Kindergarteners Not Meeting PALS-K Benchmark Third Graders Passing Reading SOL Infant Mortality Rate by Race SYSTEMS OF HEALTH CARE Adults With A Regular Health-care Provider Avoidable Cardiovascular Disease Deaths Mental Health and Substance Abuse Hospitalizations Avoidable Hospital Stays Adults Whose Poor Health Kept Them from Usual Activities Providers With Electronic Health Records Health Districts With EHRs Entities Connected to the Health Information Exchange Hospitals Meeting State Goal for Prevention of C. difficile Infections Percent of Adults Who Report Positive Well-Being

40. 40 AIM 1: Healthy, Connected Communities Goals 1.Virginia’s Families Maintain Economic Stability 2.Virginia’s Communities Collaborate to Improve the Population’s Health

41. 41 Drivers of Healthy, Connected Communities Social and economic environment Built environment/ physical conditions Policy and governance Sense of community Civic engagement Investment in cross-sector collaboration Adapted from Robert Wood Johnson Foundation: From Vision to Action: A Framework to Mobilize a Culture of Health

42. 42 AIM 2: Strong Start for Children Goals 1.Virginians Plan Their Pregnancies 2.Virginia’s Children are Prepared to Succeed in Kindergarten 3.The Racial Disparity in Virginia’s Infant Mortality Rate is Eliminated

43. 43 AIM 3: Preventive Actions Goals 1.Virginians Follow a Healthy Diet and Live Actively 2.Virginia Prevents Nicotine Dependency 3.Virginians are Protected Against Vaccine Preventable Diseases 4.In Virginia, Cancers Are Prevented or Diagnosed at the Earliest Stage Possible 5.Virginians Have Lifelong Wellness

44. 44 AIM 4: System of Health Care Goals 1.Virginia Has a Strong Primary Care System Linked to Behavioral Health Care, Oral Health Care, and Community Support Systems 2.Virginia’s Health IT System Connects People, Services and Information to Support Optimal Health Outcomes 3.Health Care-Associated Infections in Virginia are Prevented and Controlled

45. 45 How Can You Help Shape the Future Health of Virginians?

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47. The Public Health System

48. 48 Isolated Health Improvement Activities Aligned Efforts and Resources

49. 49 Community Health Improvement Process

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51. 51 Focus on Key Community Issue

52. 52 Community Health Services Network of Health Districts & Local Health Departments www.vdh.virginia.gov

53. 53 Questions? Thank you for all you do and what we will do… together!