1. County Health Rankings & Roadmaps: From data to action
We’re going to spend about half an hour today talking about how to find strategies that can work in your communities and exploring a resource called WWFH
May 16, 2017
Aliana Havrilla Community Coach County Health Rankings & Roadmaps

2. We work with the County Health Rankings & Roadmaps program
Rankings & Roadmaps is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute (where I work).
My day-to-day is leading the WWFH team
County Health Rankings & Roadmaps is a partnership of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

3. Today’s Roadmap Quick Overview: County Health Rankings & Roadmaps
Exploring What Works for Health
Strategy Selection and Tools for Action

4. County Health Rankings Logic MOdel
Broad community engagement
Media attention
This picture or logic model helps to show the thinking behind the Rankings & Roadmaps program.
I like to think of the horizontal piece as WHAT we do in the Rankings and the vertical piece as the HOW in the Roadmaps to Health. To break that down
In the Rankings
We seek out population-based data
We use that data to rank the health of almost every county in the US
We release the Rankings annually. Release often receives media attention nationally & locally
That serves as a call to action for communities to leverage existing efforts or start new efforts to improve health
and transitions us to the Roadmaps
where we see communities using release to gather momentum or build on existing efforts to improve health
engage a broad set of stakeholders
and use evidence to inform their actions
Population based data collected
County Health Rankings
Community leaders use Rankings release
Evidence-informed strategies implemented
Improved health outcomes
Increased health equity

5. This is an image we often refer to
This is an image we often refer to. It is the model underpinning the County Health Rankings. It shows:
how we think about health (more than doctor’s office)
what we use to determine the County Health Rankings
Starting from the bottom (orange box), we believe …
Effective policies and programs (at various levels) can improve a variety of factors (blue box) that, in turn, shape the health of communities (green).
We measure two types of health outcomes to show how healthy each county is:
Length of life
Quality of life
Many health factors shape our communities' health outcomes. We look at health behaviors, clinical care, social and economic factors, and the physical environment.

6. This is another important image to the CHR&R program – Take Action Cycle. You’ve probably seen images like this before.
It helps demonstrate the HOW and the WHO in community health improvement.
In the middle of the cycle, we see the many different stakeholders that can be involved
You’ll notice some of the usual suspects (health care and public health) but also less traditional players such as educators, businesses & community development professionals
We believe that health is everyone’s business, and people from a wide variety of sectors have a role to play – also important role for comm members themselves
The orange arrows outline steps towards improving community health [read]
On the outside of the image, you see dotted lines – we sometimes refer to these as ‘hugging steps’
Throughout this work, it’s important to continually communicate and work together with partners, policy makers, and others.
Model – gateway to many resources and tools on our live web site
Today we’re going to focus on choosing effective policies & programs

7. a community is in “Choose” when:
They have selected priorities but not strategies.
They have been implementing strategies to address an issue but want to do more (maybe move to policy work).
Communities and organizations often find themselves ‘in choose’ in two ways:
(read)
IF you a sitting around a table, hear questions like these, Signs you are ready to select a strategy and WWFH might be a good tool.

8. helping communities make decisions
We could do what most other communities are doing, but maybe not consider how well it works.
We could invent something from scratch, building on what we learned from our stakeholders in assessment and planning.
We could look for policies and programs that are in use elsewhere that seem to be successful in ways that might work for us.
At its core, WWFH is a tool to help communities make decisions about the strategies they can use to address their health priorities
This slide shows 3 stereotypical ways communities make decisions about health improvement
1 - Look to what others are doing, with less emphasis on effectiveness
2 - Create something new, based on feedback from the community
3 - Look for strategies that are effective in a way that matters locally
WWFH makes 3rd approach easier for communities. We know that many local organizations don’t have access to academic literature or, if they do have access, don’t the skillsets or the time to review critically.
Adapted from the Community Tool Box University of Kansas

9. evidence matters Smart investments Inform decisions Inform innovation
So, why take the time to consider evidence?
As a program, we believe that evidence matters.
It can help
Drive smart investments and stretch the impact of scarce dollars
[CLICK 1] Help inform decisions about when to adopt ‘tried & true’ and when to be more innovative.
[CLICK 2] Inform innovation. Knowing what has been shown to work – and what hasn’t –can help to ensure that innovative solutions are effective.
Photo credit: Sky Noir, Flickr Creative Commons

10. WWFH is our database of evidence-informed policies, programs, and system changes that can improve the many factors that affect health.

11. What works for health: scope
In WWFH, We work across the factors in the Rankings model. You can find strategies to support efforts to ‘move the needle’ on health behaviors (such as tobacco use, diet & exercise) and clinical care, but also,
More upstream factors such as education, employment & income that we know have a greater impact on health over time
WWFH is a living resource. Just shy of 370, continually updating and adding

12. A menu of ideas Evidence rating Literature summary Disparity rating
Who
What
Cost
Disparity rating
Implementation examples & tools
For each strategy in WWFH (by that, I mean policy, program, systems, environmental change) we include
-An evidence rating
A short literature summary that highlights WHO a strategy can benefit, WHAT it can do, and as we have it, information about cost.
We also include disparity ratings, to help communities use an equity lens as they explore strategies
And, implementation resources to move from idea to action

13. Example: School breakfast programs
Here’s an example of what this looks like
For those of us who like to read the details, this is tough slide. Please bear with me as I walk through.
-Top left, you see a thermometer with the evidence rating (likelihood the strategy will work, based on best available evidence). This strategy is rated SS.
You also see the health factors we are thinking about as we assign that rating, and decision makers who could implement the strategy
The paragraph on the right describes the intervention
Below that, you see the outcomes we have in mind when we assign that rating (e.g., SS for effects on cognitive function)
And other potential benefits that pop up in our literature review
Before moving forward, I’ll call your attention to the picture of the girl on the bottom left – this is what we call a Community in Action. A short vignette describing one community’s work implementing the strategy, along with their contact information. These are fairly new, and growing throughout our site.

14. Imagine scrolling down
EE – meat (very truncated)
Disparities
Impl examples & resources
The blue text throughout are links to the underlying resources we reviewed when compiling this summary

15. Evidence ratings
Evidence Ratings
Scientifically Supported
Some Evidence
Expert Opinion
Insufficient Evidence
Mixed Evidence
Evidence of Ineffectiveness
Seek out, assess, and summarize best available research
What has been shown to work
What might work
What does not work
I’d like to dive a little more deeply into the ER mentioned on last slide (core to what we do, and how this resource can be useful for you)
To assign these ratings, our team of analysts seek out, assess, and summarize best available research to share:
- What has been shown to work
- What might work
- What does not work
You see that continuum in our evidence ratings (right):
-SS, at the top, is assigned to strategies with the strongest evidence – these have been shown to work
- Strategies rated SE also appear to work
- Strategies rated EO/IE might work. These are often the newest ideas, or strategies that have been implemented for a long time but not studied in a robust way.
EI at bottom (not to work or cause harm)
Remember Outcomes

16. finding strategies in WWFH
So now you have a sense of what you’ll find in WWFH. We’ll spend a few minutes now thinking about how you can use it.
There are three main ways to find strategies in WWFH.
Browse all (don’t recommend)
Search by KW
Strategy in mind (e.g., drug courts, suicide prevention programs, EITC)
Topic in mind (e.g., maternal & child health, mental health, obesity)
Caution: may need multiple tries
If you know the broad topic you want to address, but aren’t sure which avenue to take (WHAT not HOW)
Search by HF
Pretend you are interested in moving the needle on employment

17. You’ll see
- We’ve assessed 13 strategies in this area to date
By clicking on a title, you can get to the detailed information we saw in SBP
If the list is longer than you’d like, you can filter by
- Approach - how you want to move the needle or what you want to achieve
- DM – stakeholder group that can implement a specific strategy; folks you want in your coalitions moving forward, if they aren’t there already, or maybe who is there to date

18. New this summer – we also created ‘What Works
New this summer – we also created ‘What Works? Strategies to Improve Rural Health’
This hard copy report can help ‘jumpstart’ search for those of you working with rural communities
It outlines about 60 strategies from WWFH that can make sense in rural or low density areas, and is a great starting point

19. Communities use wwfh in many ways
Learn about policies and programs
Inventory current approaches
Formulate an action strategy
However accessed (web site, printed materials, partners, coaches). Communities can use WWFH in a variety of ways. We hear:
Introduction – to get a sense of what strategies they might want to consider to address a particular problem
Others use WWFH to inventory current approaches – in budgeting or strategic planning, id what to scale up or scale back.
Other communities take a step beyond general learning and use WWFH to really help narrow down to the best strategies for them.

20. Strategy selection: Evidence plus
Evidence “fit”
Strength of evidence
Priority outcome
Community “fit”
Capacity
Resources
Readiness
Values
When you are using evidence to find strategies to address your priorities, we encourage an approach we call ‘Evidence plus.’ This means thinking about
Whether a strategy works (evidence fit)
Whether it works for you (community fit)
Evidence ‘fit’
– how strong is the evidence? (evidence of effectiveness rating)
- has the strategy been shown to address an outcome of interest to you?
And community ‘fit’ -- How well would a strategy work in your community?
Political will? Buy-in? Does is fit with Comm values

21. This is another important image to the CHR&R program – Take Action Cycle. You’ve probably seen images like this before.
It helps demonstrate the HOW and the WHO in community health improvement.
In the middle of the cycle, we see the many different stakeholders that can be involved
You’ll notice some of the usual suspects (health care and public health) but also less traditional players such as educators, businesses & community development professionals
We believe that health is everyone’s business, and people from a wide variety of sectors have a role to play – also important role for comm members themselves
The orange arrows outline steps towards improving community health [read]
On the outside of the image, you see dotted lines – we sometimes refer to these as ‘hugging steps’
Throughout this work, it’s important to continually communicate and work together with partners, policy makers, and others.
Model – gateway to many resources and tools on our live web site
Today we’re going to focus on choosing effective policies & programs

23. 3 Questions for advocacy
What do you want?
Why do you want it?
Who has the power to give it to you?

24. Key takeaways
Evidence is an important part of decision making, but not the only part
Think strategically about when you are ready to find evidence-informed strategies and how you will use them
WWFH provides information about what works, what doesn’t work & what might work
The Roadmaps to Health Action Center provides more guidance around choosing strategies and moving to action
We’ve covered a lot of ground today. A few key takeaways before we move into questions
Evidence is an important part of decision making, but not the only part
Think also about your local culture & context
Think strategically about when you are ready to find evidence-informed strategies and how you will use them
This means knowing what you want to accomplish
Thinking carefully about adaptation
3. There are a lot of resources that can help you find strategies that can work locally
They are all different
Be sure to read the fine print
4. You can find data, evidence-informed strategy ideas, tools and other practical help at
WWFH
Roadmaps to Health Action Center
Coaches

25. questions now let’s see if we can answer some more of your questions.
Time – 10 min.
questions

26. Thank you! Aliana Havrilla, Community Coach
University of Wisconsin Population Health Institute
Madison, WI
(608)

27. acknowledgements Robert Wood Johnson Foundation
Including Abbey Cofsky, Andrea Ducas, Michelle Larkin, Jim Marks, Joe Marx, Don Schwarz, Amy Slonim, Katie Wehr
Wisconsin County Health Rankings & Roadmaps Team
Including Julie Willems Van Dijk, Kitty Jerome, Kate Konkle, Carrie Carroll, Amanda Jovaag, Astra Iheukumere, Marjory Givens, Lael Grigg, Bomi Kim Hirsch, Jessica Rubenstein, Kiersten Frobom
Our Partners
Including Active Living by Design, Burness, CDC, Dartmouth Institute, Local Initiatives Support Corporation, National Association of Counties, United Way Worldwide
This program is the result of the contributions of many partners, including those listed here.

28. Assigning evidence Ratings
Key considerations
Type of studies
Quality of studies
Number of studies
We think about type of studies, but also
how well they were conducted
how many studies we found
From Public Health Law Research (PHLR)

29. an equity lens Rating based on Disparities among
What is known about design and implementation
What literature says about differences in effects
Disparities among
Socio-economic, racial or ethnic groups
Geographic areas
Disparity ratings
Likely to decrease disparities
No impact on disparities likely
Likely to increase disparities
In addition to the evidence rating, we assign a disparity rating
This is intended to help communities use an equity lens as they think about what strategies might work for them
These ratings reflect both that we know about how strategies are designed & implemented (literature says this has bearing on disparities) and what the literature says about differences in effects
When we assign this rating, we consider disparities or gaps among groups of different socio-economic status, or race or ethnic groups. And among different geographic areas (urban vs. rural).
Look to the right, see ratings. You’ll notice the word LIKELY
This is an area where evidence is still emerging; more to learn

30. Outline County Health Rankings & Roadmaps overview Using evidence
What Works for Health introduction
Strategy selection
Q & A
We’re going to start with an introduction to the CHR&R program – scope of work and how we think about health
We’ll focus in on the idea of using evidence and what that means
We’ll explore What Works for Health
And wrap up with some discussion about strategy selection and next steps