1. The County Health Rankings: Mobilizing Action Toward Community Health A collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Key Slides – January 2010 Provided by The University of Wisconsin Population Health Institute

2. Building on America’s Health Rankings which ranks the health of the 50 states, the University of Wisconsin began ranking the health of Wisconsin’s counties in 2003. What? The County Health Rankings

3. Why County Health Rankings? Where we live matters to our health “Geography is destiny” One of the greatest disparities in the U.S. is the variation of health between communities There is relatively little attention in the public or among policy makers to these disparities

4. What is unique about the County Health Rankings? Provides a measure of the overall health of each county in the United States Each county will: –get a snapshot of their overall health and the factors (i.e., determinants) that influence their health –be able to see how its health compares to that of other counties in their state, so they can see where they are doing well and where they could improve

5. Health Factors Programs and Policies Health Outcomes

6. Community safety Education Family & social support Employment Built environment Environmental quality Income Unsafe sex Alcohol use Diet & exercise Tobacco use Access to care Quality of care Physical environment (10%) Social & economic factors (40%) Health behaviors (30%) Clinical care (20%) Health Factors Programs and Policies Health Outcomes Mortality (length of life): 50% Morbidity (quality of life): 50% County Health Rankings model © 2010 UWPHI

7. How are measures selected for the County Health Rankings? Reflect important aspects of population health that can be improved Valid, reliable, recognized and used by others Available at the county-level As up-to-date as possible Fewer measures better than more

8. Health Outcomes Mortality (length of life) (50%) Morbidity (quality of life) (50%) Focus AreaMeasureSource Mortality (50%) Premature death —years of life lost before age 75 Vital Statistics, National Center for Health Statistics (NCHS) Morbidity (50%) Self-reported poor or fair health Behavioral Risk Factor Surveillance System (BRFSS) Physically unhealthy daysBRFSS Mentally unhealthy daysBRFSS Low birthweightVital Statistics, NCHS

9. Focus AreaMeasureSource Tobacco use (10%) Smoking rateBRFSS Diet & exercise (10%) Obesity rateBRFSS Alcohol use (5%) Binge drinking rate Deaths due to motor vehicle crashes BRFSS Vital Statistics, NCHS Sexual behavior (5%) Sexually transmitted disease rate Centers for Disease Control and Prevention (CDC), National Center for Hepatitis, HIV, STD, and TB Prevention Teen birth rateVital Statistics, NCHS Unsafe sex Alcohol use Diet & exercise Tobacco use Health behaviors (30%)

10. Access to care Quality of care Clinical care (20%) Focus AreaMeasureSource Access to Care (10%) People without health insuranceCensus/Current Population Survey (CPS)—Small Area Health Insurance Estimates (SAHIE) Primary care providersHealth Resources and Services Administration, Area Resource File (ARF) Quality of Care (10%) Hospital stays for ambulatory-care sensitive conditions Medicare claims/Dartmouth Atlas Diabetics that receive HbA1c screeningMedicare claims/Dartmouth Atlas Hospice care in last 6 months of lifeMedicare claims/Dartmouth Atlas

11. Focus AreaMeasureSource Education (10%)High school graduation rateNational Center for Education Statistics Adults with college degreeDecennial Census, American Community Survey (ACS) Employment (10%)Unemployment rateLocal Area Unemployment Statistics, Income (10%)Children in poverty Income inequality Census/CPS, Small Area Income and Poverty Estimates (SAIPE) Bureau of Labor Statistics Decennial Census, ACS Family & social support (5%) Social/emotional support Single-parent households BRFSS Decennial Census, ACS Community safety (5%) Violent crime rate or Homicide death rate Uniform Crime Reporting, FBI NCHS Community safety Education Family & social support Employment Income Social and economic factors (40%)

12. Built environment Environmental Quality Physical environment (10%) Focus AreaMeasureSource Environmental Quality (5%) Unhealthy air quality days due to ozone U nhealthy air quality days due to fine particulate matter CDC-Environmental Protection Agency (EPA) Collaboration Built Environment (5%) Zip codes without healthy food outletsCensus Zip Code Business Patterns Liquor store densityCensus County Business Patterns and Census 2006 Population Estimates

13. Why rank? Easy to understand one’s rank Draws attention to all the factors that affect community health Draws members of the new “public health system” into discussions about how to improve health:

14. Health Outcomes Rank #9 Mortality (length of life) (50%) Rank #13 Morbidity (quality of life) (50%) Rank #6 Marquette County

15. Unsafe sex 52% lower rate than State Chlamydia rate; 56% lower rate than State Teen Pregnancy rate Alcohol use 21% Binge Drink Target: 12% Diet & exercise 29% obese Tobacco use 18% Health behaviors Rank #10 Marquette County

16. Access to care 11% uninsured Target: 10% or less Quality of care 86% Diabetic Screening - Target: 88% 88% higher rate of Primary Care Physicians than Michigan target 37% Terminally ill utilization of Hospice Care Target – 45 % 32% lower Preventable Hospitalizations than state value Clinical care Rank #1 Marquette County

17. Community safety - 73% lower rate of violence than State Education 88% High School Grad 30% College Degree Target: 88% and 30% respectively Family & social support - 12% inadequate social support Target: 12% or lower Unemployment - 7% (2008 data) Income - 16% Child Poverty Rate Target: 11% or lower Social and economic factors Rank #8 Marquette County

18. Built environment 31% access to healthy foods Target: 71% 54% lower rate of liquor store density than state avg. Environmental Quality 0 ozone days 0 particulate matter days Physical environment Rank #31 Marquette County

19. Mobilizing Action Toward Community Health

20. Mobilize through County Health Rankings ç ç

21. Action

22. Action depends on stage of readiness in the county

23. Toward Community Health

24. Toward Community Health by setting goals and monitoring progress over time Setting goals and objectives for overall health Keeping track of progress

25. MobilizingActionToward Community Health through County Health Rankings Setting goals and objectives for overall health Keeping track of progress MATCH model © 2010 UWPHI

26. Action Communities for Health, Innovation, and EnVironmental ChangE (ACHIEVE) Initiative The goal of the program is to bring together local leaders and stakeholders to build healthier communities by promoting policy and environmental change strategies with a focus on obesity, diabetes, heart disease, healthy eating, physical activity, and preventing tobacco use, as well as promoting disease management for Cardiovascular Disease and Diabetes.

27. Learn more at www.countyhealthrankings.org www.mqthealth.org Join the Marquette County Active Living Task Force: Lisa Coombs-Gerow, YMCA 227-9622 George Sedlacek, MCHD 475-7848