County Health Rankings & Roadmaps 101

County Health Rankings & Roadmaps 101
KEY POINTS County Health Rankings & Roadmaps is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The County Health Rankings show us where we live matters to our health. The Rankings motivate community leaders and citizens to work together in new and creative ways to build a culture of health. The Roadmaps offer communities practical help to move from awareness to action. The purpose of this presentation is to provide you with an general overview of County Health Rankings & Roadmaps. ________________________ NOTE TO PRESENTER: The most important takeaway from this presentation is that Rankings are a starting point for mobilizing community ACTION toward health improvement. Presenter name Title

Rankings: Understanding the Data Roadmaps: Moving Forward with Action
OUTLINE Why this matters Rankings: Understanding the Data Roadmaps: Moving Forward with Action KEY POINTS By the end of this presentation you will know: Why this work matters What we rank, and how to understand your data How to use Roadmaps to move from awareness to action ____________________________________

County Health Rankings logic model
Transition: Let’s look at the thinking behind the County Health Rankings & Roadmaps program. KEY POINTS At the County Health Rankings & Roadmaps, we’re building a culture of health, county by county. This logic model helps us explain WHY we create the Rankings. We gather population based data. All data for Rankings are already collected somewhere else. We compute County Health Rankings & release them. The release attracts media attention. Local public health officers and other community leaders use County Health Rankings as call to action for community. They bring together community members from wide variety of sectors to look further at community’s needs. Community members identify evidence-informed health policies and programs that can be implemented locally. As a result, ultimately the health of the community improves.

1. Health Outcomes: “Today’s health” (the green boxes)
KEY POINTS Rankings model shows: 1. Health Outcomes: “Today’s health” (the green boxes) Length of life – tells whether people are dying too early Quality of life – tells how well people feel while living 2. Health Factors: “Tomorrow’s health” (the blue boxes) Health behaviors Clinical care Social and economic factors Physical environment These are factors that determine how long people live and quality of their lives. The blue boxes are things communities can work on now to help improve their future health. 3. Policies and Programs impact health factors and ultimately health outcomes. (orange box) Alternative: WALK THROUGH THE MODEL Starting from the bottom, we believe … Effective local, state, and federal Policies and Programs (orange box) can improve a variety of factors that, in turn, shape the health of communities. Many Health Factors (the blue boxes) shape our communities' health outcomes. We specifically look at health behaviors, clinical care, social and economic factors, and the physical environment. We measure two types of Health Outcomes (the green boxes) to show how healthy each county is: length of life and quality of life. Example: a clean indoor air policy is a policy that can influence health factors, such as tobacco use, which in turn influences health outcomes. We often point to this image as one of our most important, because it outlines what we use to determine the County Health Rankings and what influences health in a community. Because much of what affects our health happens beyond medical care, the Rankings underscore how important it is to build a culture of health where getting healthy, staying healthy, and making sure our kids grow up healthy are top priorities. -As an example, expanding early childhood education improves academic achievement. Higher levels of education lead to higher levels of income which then influence other health factors such as access to healthy foods, clinical care, and quality housing, which in turn influence health outcomes. -Stepping back, you’ll note that we don’t include race or ethnicity in our health factors. We’ve selected health factors that reflect aspects that communities can improve. Race and ethnicity are not modifiable while poverty is something we can take action on, so you will see “income” as a key health factor. We do provide data, tools and resources that can help communities address health disparities, and we’ll show you later where to find these on our site. The bottom line is that factors such as one’s race, ethnicity and socioeconomic status should not play a role in how healthy we are or how long we live, but unfortunately, for many people across the nation, they do . If we are going to build a Culture of Health in every community, reducing health disparities needs to be a top priority - because everyone in our society deserves an equal opportunity to pursue a healthier life. ___________________________________________ NOTE TO PRESENTER: This is THE MOST IMPORTANT SLIDE in the deck. It’s as important as the numbers that go into the Rankings. It helps people tell important story about the many factors that determine health.

Health equity Attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities. (Healthy People 2020) KEY POINTS: To create a Culture of Health county by county, everyone in a community needs to have an equal opportunity to enjoy good health--in other words, health equity. Health equity includes a shared commitment to identifying and addressing gaps in opportunity that tend to disproportionately and negatively affect certain populations . Health equity is a basic principle that all people, despite race/ethnicity, limited English skills, gender, age, religion, income, educational level, geographic location, sexual orientation, or ability have equal opportunity to lead healthy lives. It also means creating a sense of community where all individuals, especially those most affected by poor health outcomes, feel they have a voice and a role to play in creating and implementing solutions. Healthy People 2020 calls for “valuing everyone equally,” “addressing avoidable inequalities,” and “eliminating health and health care disparities.” Durham Public Schools Farm Hub, Durham County, NC – 2014 RWJF Culture of Health Prize winner

housing KEY POINTS: Here is one example of how inequities developed in our nation. Access to affordable housing is key to health. Generations ago, during President Franklin Roosevelt's New Deal, the federal government started subsidizing a lot of housing. But they funded programs that allowed whites to move into new suburbs like Levittown, N.Y. while the options for black people were public housing apartments in the same city centers where they already lived. Over the generations the suburban homes greatly increased in value, creating wealth for the white families there. Meanwhile, even though laws have changed allowing African Americans to have the right to buy into places like Levittown, many of these homes are now selling for $500K—out of range for many people. In 2016, we added residential segregation as an additional measure in the County Health Rankings to help people see where residential segregation exists in their community. Data such as this provides an opportunity for people to see how this issue affects their own county. Although most overtly discriminatory policies and practices promoting segregation, such as separate schools or seating on public transportation or in restaurants based on race have been illegal for decades, segregation caused by structural, institutional, and interpersonal racism still exists in many parts of the country. Segregation continues to have lasting implications for both personal and community well-being. NOTE TO PRESENTER: To learn more about the impact of historical housing segregation listen to the NPR interview with Richard Rothstein of the Economic Policy Institute -

OUTLINE Why this matters Rankings: Understanding the Data Roadmaps: Moving Forward with Action KEY POINTS Transition slide. ____________________________________ NOTE TO PRESENTER: The Rankings : Understanding the data section includes: example of a county’s snapshot from the website Tools to help you further explore and understand your data

County Health Rankings: 2 Rankings
Today’s Health Health Outcomes Tomorrow’s Health Health Factors KEY POINTS The County Health Rankings ranks the health of nearly every county in every state. For each county, you will find two Rankings, one for Health Outcomes and one for Health Factors. There are two separate sets of messages to convey. How healthy a county currently is (Health Outcomes) How healthy a county might be in the future based on the many factors that influence health (Health Factors).

www.countyhealthrankings.org KEY POINT
Transition: Having looked at the model, now we will take brief look at a county example – what does it look like on our website? KEY POINT For purposes of this presentation, we will go to Wisconsin and then to Dane County, WI (UW Population Health Institute is in Madison, WI which is in Dane County). _____________________________________ NOTE TO PRESENTER: The following slides are screenshots taken from the website. You may want to create your own slides with a different state/county or use the hyperlink in the title of this slide to go directly the website.

KEY POINT You can find information for your state and county clicking on your state on the map, by entering your county name in the search bar below “How Healthy is Your Community?” or in the main website search bar. _____________________________________ NOTE TO PRESENTER: There are three different ways to find your county snapshot (two search bars and the map).

Tips for presenting your county’s data
Start with your county’s Health Outcomes and Health Factors ranks. Discuss the context of those ranks. Look at your county’s ranks for each Health Factor. Examine the measures

Health outcomes Ranking
Daviess County ranks out of 120 counties KEY POINTS Daviess County, KY ranks 13th out of 120 counties for Health Outcomes. POTENTIAL DISCUSSION QUESTIONS What do you notice about our county’s rank compared with the state? ______________________________________ NOTES TO PRESENTER: If your overall rank for health outcomes is better than your rank for health factors, this suggests if you take no further action, your health outcomes rank may decline in the future. If your health outcomes rank is worse than your health factors rank, your health outcomes rank may improve in the future. People can also find archived webinars on the site at County Health Rankings & Roadmaps 101 Take Action (features communities working to improve health, often focused on specific steps in the Take Action Cycle) CUSTOMIZE FOR YOUR COMMUNITY Replace the state map with your state. You can find a downloadable map on your state’s page. Enter your county’s name, rank, and the number of counties in your state.

Health Factors Ranking
Daviess County ranks out of 120 counties KEY POINTS Daviess County, KY ranks 9th out of 120 counties for Health Factors POTENTIAL DISCUSSION QUESTIONS What do you notice about our county’s rank compared with the state? ______________________________________ NOTES TO PRESENTER: If your overall rank for health outcomes is better than your rank for health factors, this suggests if you take no further action, your health outcomes rank may decline in the future. If your health outcomes rank is worse than your health factors rank, your health outcomes rank may improve in the future. CUSTOMIZE FOR YOUR COMMUNITY Replace the state map with your state. You can find a downloadable map on your state’s page. Enter your county’s name, rank, and the number of counties in your state.

Health behaviors Ranking
Daviess County ranks out of 120 counties KEY POINTS Health behaviors includes things like diet & exercise, alcohol & drug use, tobacco use, and sexual activity. Daviess County, KY ranks 10th out of 120 counties for Health Behaviors. POTENTIAL DISCUSSION QUESTIONS What do you notice about our county’s rank compared with the state? What surprises you about this rank? What are you curious about? ______________________________________ NOTES TO PRESENTER: If your overall rank for health outcomes is better than your rank for health factors, this suggests if you take no further action, your health outcomes rank may decline in the future. If your health outcomes rank is worse than your health factors rank, your health outcomes rank may improve in the future. CUSTOMIZE FOR YOUR COMMUNITY Enter your county’s name, rank, and the number of counties in your state.

Daviess County ranks 2 out of 120 counties
Clinical care Ranking Daviess County ranks out of 120 counties KEY POINTS Clinical Care includes things like access to care and quality of care. Daviess County, KY ranks 2nd out of 120 counties for Health Behaviors. POTENTIAL DISCUSSION QUESTIONS What do you notice about our county’s rank compared with the state? What surprises you about this rank? What are you curious about? ______________________________________ NOTES TO PRESENTER: If your overall rank for health outcomes is better than your rank for health factors, this suggests if you take no further action, your health outcomes rank may decline in the future. If your health outcomes rank is worse than your health factors rank, your health outcomes rank may improve in the future. CUSTOMIZE FOR YOUR COMMUNITY Enter your county’s name, rank, and the number of counties in your state.

Social & economic factors Ranking
Daviess County ranks out of 120 counties KEY POINTS Social and economic includes things like education, employment, income, family & social support, and community safety. Daviess County, KY ranks 13th out of 120 counties for Health Behaviors. POTENTIAL DISCUSSION QUESTIONS What do you notice about our county’s rank compared with the state? What surprises you about this rank? What are you curious about? ______________________________________ NOTES TO PRESENTER: If your overall rank for health outcomes is better than your rank for health factors, this suggests if you take no further action, your health outcomes rank may decline in the future. If your health outcomes rank is worse than your health factors rank, your health outcomes rank may improve in the future. CUSTOMIZE FOR YOUR COMMUNITY Enter your county’s name, rank, and the number of counties in your state.

Physical environment Ranking
Daviess County ranks out of 120 counties KEY POINTS Physical environment includes things like air & water quality and housing & transit. Daviess County, KY ranks 119th out of 120 counties for physical environment. POTENTIAL DISCUSSION QUESTIONS What do you notice about our county’s rank compared with the state? What surprises you about this rank? What are you curious about? ______________________________________ NOTES TO PRESENTER: If your overall rank for health outcomes is better than your rank for health factors, this suggests if you take no further action, your health outcomes rank may decline in the future. If your health outcomes rank is worse than your health factors rank, your health outcomes rank may improve in the future. CUSTOMIZE FOR YOUR COMMUNITY Enter your county’s name, rank, and the number of counties in your state.

Examine the measures Look at the trends.
Compare county values to the state average. Look at the error margins. Compare county values to the Top U.S. Performers. KEY POINTS First, examine your measures to understand how you are doing compared to previous years and other places. Looking at changes in individual measures over time can help you measure your progress. Look at the trends. We include trend graphs for several measures (click on the graph icon in the Trend column of your county's snapshot). The color of the line in the icon shows the direction of the measures in your county: Red - Your county is getting worse for this measure Yellow - Your county is staying the same for this measure Green - Your county is getting better for this measure Compare county values to the state average. Which measures are better than the state average? Which are worse? Look at the error margins. Among those measures that are worse, for which is the state average beyond the margin of error for your county? (If so, this suggests that this might be a problem area for your county.) Among those measures that are better in your county, does the value for the state average sit outside of the margin of error for your county's measure? (If so, this suggests that this is an area of strength in your county.) Compare county values to the Top U.S. Performers. If your county is doing relatively well compared to the state average, how does it compare to the Top U.S. Performers? Only 10% of counties in the nation do better than the value in this column. POTENTIAL DISCUSSION QUESTIONS Where are we doing better than the state average? Where are we doing worse? Is anything surprising about these measures? What are you curious about? ______________________________________ NOTES TO PRESENTER: You can find more information on interpreting and using your trend graphs in Measuring Progress.

Examine the measures Show areas to explore and areas of strength.
Dive deeper. KEY POINTS Show areas to explore and areas of strength. On the upper right corner of your county snapshot, you can click on Areas to Explore. This feature can serve as a double-check of the work you’ve just done. Highlighted in orange are specific measures that, based on the value and its relative weight in the Rankings model of population health, are likely to have a greater impact on your community’s health. You can also click on Areas of Strength. Highlighted in purple are specific measures that are likely to be areas where your community is already doing well. Dive deeper. We know that health factors and outcomes can differ by age, gender, race, ethnicity, ability, and sexual orientation among many other characteristics. Within counties, differences can also exist from one neighborhood or ZIP code to the next. These differences are not captured in the County Health Rankings data. More detailed data for subgroups and for many other measures of health may exist at the state, county, and even city level. POTENTIAL DISCUSSION QUESTIONS How do the areas to explore and areas of strength compare with experience in the community? Based on your experience, what other areas should your community explore? Based on your experience, what additional areas of strength have you observed? As your community dives deeper, what are you curious about? Additional County Health Rankings & Roadmaps resources Measure Detail Pages. Our measure detail pages can be especially helpful as you start. To dive deeper into any measure simply click on the measure name on your snapshot. You can learn more about how your county compares with others in your state, where the data comes from, and what it means. You can also click on Learn more about this measure on the measure detail page to understand how you can use this data in your community and to find additional resources to explore the measure more deeply. Digging Deeper. This section of Using the Rankings Data helps you think through what other information would help you further understand the health of your community. You can find it here:

Using the rankings data
KEY POINTS: The County Health Rankings provide a snapshot of a community’s health and a starting point for investigating and discussing ways to improve health. Using the Rankings Data – found under the Rankings tab on the main navigation bar – will help you find and understand the data in this site and beyond as you begin to assess your needs and resources and focus on what's important. To learn more about the Rankings, explore these sections on your own, particularly the “Communities Using the Rankings Data,” “Broaden Your View” and “Visualize the Data” sections. _____________________________ NOTE TO PRESENTER: The three sections called out for further exploration provide snapshots of community engagement in the Rankings, background for understanding the broad definition of “health” the Rankings model describes, and links to other websites with visual mapping of data similar to the County Health Rankings. Learn more about data in this site and beyond at

Measuring progress Use ranks as tool Change and data take time
Learn more about what you can do measure progress at measuring-progress KEY POINTS: Many communities around the nation are working to improve their health. But how can they measure progress? There are many ways to do this and one size may not fit all. We’ve included some guidance on our site to help you see if you’re on the right track. Use ranks as a tool Ranks are great for garnering attention, simplifying a lot of complex data, and making comparisons between one community and another at a point in time -- but they shouldn’t be used alone to measure a single community’s progress. Rather, look at them as one tool among many. Because ranks are relative, they aren’t as helpful in isolation -- your county’s rank depends not only on what is happening in your county, but also on what happens in all the other counties in your state. In fact, if every county in a state improved its health, their ranks would all stay the same. So look for ranks to inform you progress measurement, not drive it. Change and data take time Be realistic about how quickly you can move the needle—it will take time for your efforts to improve your health outcomes. For example: When you reduce your adult smoking rates significantly, it will still take some time before this positive change reduces the number of preventable deaths due to smoking. When you increase high school graduation rates, some effects will be immediate but it will be years before premature deaths are reduced. Also, most data collection (via census or survey) has lag times. For example, the County Health Rankings premature death rates represent a lag of more than three years, and to be sure that we have reliable data for communities of all sizes, we use three years of data. So, the premature death rates you see for the current Rankings reflect premature deaths from 4-6 years ago.

What are health gaps? KEY POINTS: We also have resources to help communities start or continue work around health equity. One of these resources is the County Health Rankings Health Gaps Reports. The reports were released in November of These reports reveal that in each state, not everybody has the opportunity to be the healthiest they can be. Since 2010 CHR has provided a snapshot of the health of nearly every county in the U.S. We have ranked counties within each state on the factors that are important to health such as health behaviors, clinical care, social and economic factors, and the physical environment. The Health Gaps Reports add to the County Health Rankings by illustrating the size of the gap between healthier counties and unhealthier counties. To develop the reports, County Health Rankings & Roadmaps researchers asked: how big are the opportunities for health improvement within states and how could states work to make sure that everyone has a fair chance to be the healthiest they can be? Each report details how well the healthiest counties in each state do; what could happen if residents of all counties had the same opportunities for health; and statewide strategies to help close the gaps between the healthiest and unhealthiest places. We know many state policymakers and leaders are taking important steps to shape our communities so that everyone can live longer, healthier lives. With these reports, we intended to provide this information to support these efforts. When we think about closing health gaps, it is not just about offering everyone the same opportunities to be healthy, but rather the resources necessary to realize the same health outcomes. This image of the three children can illustrate the point. Consider these three children of different heights. Offering them all the same size bench to stand on would mean that the shorter children will not have a fair chance to see over the fence. Offering each child a bench to stand on that is the right size for his/her height gives all children a fair chance to see over the fence. Giving everyone a fair chance to be healthy does not necessarily mean offering the same resources to all, rather offering resources necessary for their good health.

OUTLINE Why this matters Rankings: Understanding the Data Roadmaps: Moving Forward with Action KEY POINTS Transition slide ____________________________________ NOTE TO PRESENTER: The Roadmaps: Moving Forward with Action section includes: The Roadmaps to Health Action Center Community examples Policies & programs examples

KEY POINTS Transition: The County Health Rankings are intended to serve as a call to action, to ignite action in communities across the country. Our primary goal is to build a culture of health, county-by-county. We do that by taking action. The Roadmaps offer communities resources to move from awareness to action. This is our Take Action Cycle. The Take Action Cycle is the HOW within County Health Rankings & Roadmaps. We know solving issues like low high school graduations rates, excessive drinking, or poor healthcare requires the wisdom and resources of people from all walks of life. You’ll see several potential community partners in the blue circles in the center of the cycle. The Take Action Cycle lays out a series of steps that communities take to work together to create healthier places to live, learn, work, and play, but this series of steps isn’t always as clear and simple as they appear in this graphic. Making changes to improve health in communities is messy and complicated and building relationships across sectors can be challenging. We’ve designed a series of guides to help communities take the next step, where ever they might be in the Take Action Cycle. Communities can improve health by using the steps of the cycle – assessing needs and resources, focusing on what’s important, choosing effective policies and programs, acting on what’s important, and being sure to evaluate those actions. At the core of this model are people working together to improve health in a community. Health is everyone’s business, and we believe people from a wide variety of sectors have a role to play in improving a community’s health. Throughout this work, it’s important to continually communicate with partners, policy makers, your community, and know how to use media effectively to tell your story.

Foundation of roadmaps
It takes everyone Move from data to evidence- informed action Focus across the health factors—including social and economic factors Policy, systems, and environmental change KEY POINTS The Roadmaps offer communities resources to move from awareness to action. There are 4 foundations of Roadmaps It takes everyone – all of us working together – to improve the health of a community. [click] We need to move as quickly as possible from data to action– not get stuck in analysis paralysis or drowning in data. We encourage communities to look to the evidence to inform these actions—and if you innovate, be sure to evaluate [click] Keep focused across the health factors—including social and economic factors [click] And don’t be afraid to take on policy, systems, and environmental change which will in the long run create the greatest long term change in health for the children and adults in your community [click] _____________________________ NOTE TO PRESENTER: Slide Note: This slide is animated

www.countyhealthrankings.org/roadmaps/action-center KEY POINTS
From Working Together to Evaluating your efforts, the Action Center provides a variety of tools and guidance to assist communities in taking action. The Roadmaps to Health Action Center is an online platform which provides practical help for communities working collectively to improve their health. It provides guidance and tools to understand the data and strategies that communities can use to take action. The Action Center also provides access to community coaches. _____________________________ NOTE TO PRESENTER: If you’re demonstrating on the website, you may want to open one of the Action Center guides to further show what is available there. ( You can also use the our Action Center walk through video to provide a brief (2:39) tour:

KEY POINTS You can learn more about the Roadmaps to Health Coaching under the Roadmaps to Health section. Roadmaps to Health Coaching provides local leaders anywhere in the country with direct support from community coaches to strengthen their capacity to advance health in their communities. Thanks to the support of the Robert Wood Johnson Foundation, coaching is available at no cost to communities. This service provides guidance in how best to strengthen partnerships, enhance skills in a strategic manner, or navigate challenging policy advocacy choices. Nearly a dozen community coaches will work with communities in short (one phone call) to long-term (one year of monthly coaching contact) coaching agreements. Most, if not all, coaching is provided through distance learning technology or phone contact. Coaching may be requested through the Contact Us or “Get Help” box on the website. _____________________________ NOTE TO PRESENTER: If you’re demonstrating on the website, you may want to navigate to this page using the Roadmaps to Health dropdown menu on the orange navigation bar and then clicking on Roadmaps to Health Coaching.

Transition Going back to our model, let’s talk a little more about the policies and programs that impact health factors. KEY POINTS The model shows us that we all have a stake in creating a healthier community. Using the County Health Rankings & Roadmaps, leaders from public health and health care, business, education, and government can work together to create policies and programs to improve people’s health, reduce health care costs, and increase productivity.

evidence matters Smart investments Inform decisions Inform innovation
Photo Credit: Sky Noir KEY POINTS When it comes to selecting, developing, and implementing solutions to problems that affect our communities, evidence matters. Using what has been shown to work can drive smart investments. None of us have a lot of time, money or resources, so choosing strategies that have been shown to work can help you stretch the impact of scarce dollars and resources. Knowing whether there are strategies that effectively address your community’s priorities can help inform decisions about when to adopt existing strategies and when to take more innovative approaches. It is important to understand what has been shown to work – and what hasn’t – when creating new solutions. Explicitly considering what works can help to ensure that your innovative solutions are effective.

What Works for Health Find effective programs and policies at countyhealthrankings.org/whatworks KEY POINTS To help you look for policies and programs that could help move health forward in your community, visit What Works for Health, an easy-to-use, searchable menu of solutions for the specific problem you are targeting. It includes evidence ratings, literature summaries, and implementation resources for over 380 strategies. _____________________________________ NOTE TO PRESENTER To get to What Works for Health from our home page, pull down the menu under Roadmaps to Health and select What Works for Health. You can also access relevant What Works for Health strategies from county snapshots and partner guides For each strategy included in What Works for Health, experts at the University of Wisconsin Population Health Institute search published and unpublished literature as well as the findings of credible organizations that assess evidence of effectiveness. Learn more about our methods here:

A menu of ideas Evidence rating Literature summary Disparity rating
Who What Cost Disparity rating Implementation examples & tools KEY POINTS Each strategy in WWFH includes: An evidence rating. Evidence ratings convey the likelihood a strategy will work, based on best available evidence A short literature summary that highlights the populations a strategy can benefit, the outcomes it can achieve, and when possible, information about cost. Disparity ratings that help communities use an equity lens as they explore strategies Implementation resources to move from idea to action

Example: School breakfast programs
KEY POINTS This slide gives an idea of the information provided for each strategy: Thermometer with the evidence rating (likelihood the strategy will work, based on best available evidence). This strategy is rated Scientifically Supported. Health factors Decision makers—those that can implement the strategy A description of the intervention Expected Beneficial Outcomes (Rated) Other potential benefits noted in our team’s literature review Community in Action. These short vignettes describe one community’s work implementing the strategy, along with their contact information. These are a fairly new feature, growing throughout our site.

KEY POINTS - Evidence of Effectiveness summarizes the evidence we‘ve found - Likely impact on disparities - Examples & Resources to help move towards implementation The blue text throughout are links to the underlying resources we reviewed when compiling this summary _____________________________________ NOTE TO PRESENTER These slides show only partial text, full entry is available here: Strategies are updated regularly. These screenshots reflect text as of 3/1/17.

Evidence ratings Scientifically Supported Some Evidence Expert Opinion
Insufficient Evidence Mixed Evidence Evidence of Ineffectiveness KEY POINTS There are six evidence ratings, ranging from Scientifically Supported, assigned to strategies with the strongest evidence, to Evidence of Ineffectiveness, assigned to strategies that have been shown consistently to be ineffective or cause harm. Scientifically Supported: Strategies with this rating are most likely to make a difference. Strategies with this rating are most likely to make a difference. These strategies have been tested in multiple robust studies with consistently favorable results. Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend favorable overall. Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects. Insufficient Evidence: Strategies with this rating have been tested more than once and results are inconsistent; further research is needed to confirm effects. Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects. Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in multiple studies with consistently unfavorable or harmful results. Evidence ratings are assigned based on the quality, quantity, and overall findings of relevant research. ______________________________________ NOTE TO PRESENTER Review ALL definitions or just give a few examples. Learn more about our ratings here:

KEY POINTS This is an image of our landing page. _____________________________________ NOTE TO PRESENTER Strategies are updated regularly. This screenshot reflects strategies added or updated as of 3/29/17.

finding strategies in WWFH
KEY POINTS There are three main ways to find strategies in WWFH. Browse all Search by Key word. This can be helpful when you have: Strategy in mind (e.g., drug courts, suicide prevention programs, EITC) Topic in mind (e.g., maternal & child health, mental health, obesity) 3. Select a health factor from the Rankings model. This can be helpful if you know the broad topic you want to address, but aren’t sure which avenue to take _____________________________________ NOTE TO PRESENTER This slide is animated.

KEY POINTS This slide indicates what you will see if you filter by employment, as suggested on the last slide. - 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 Decision maker _____________________________________ NOTES TO PRESENTER New strategies are added and ratings are revisited over time. This slide reflects content as of 3/29/17. This slide is animated

Example policies and programs
KEY POINTS Here are examples of three programs that can be found in WWFH that are being implemented in communities. Clinton County, IA is rolling out the Nurse Family Partnership (NFP) program, an evidence-based initiative that pairs nurses with new mothers to provide more than just medical care. The nurses meet regularly with mothers and provide them with support and resources to strengthen their parenting, lifestyle, and financial choices, including referrals for nutrition, physical activity, birth control, financial planning, and stress management. In Columbia, MO, Walking School Buses an organized mode of active transportation for students walking to school. Walking school buses have a fixed route, with designated stops and pick up times when children can join adult chaperones to walk to school. By getting kids moving, walking school buses help compensate for reductions in physical education and recess time. Community Services Society of New York worked with community residents to pass a Paid Sick Leave Ordinance in New York City which requires employers to provide paid time off to employees for use when ill or injured. Sick employees may use the time to see a physician or stay home until they are healthy enough to work again, without concern for lost wages. The law passed in June, 2013 and went into effect in April, 2014.

RWJF Culture of Health Prize
Defining health in the broadest possible terms. Committing to sustainable systems changes and policy-oriented long- term solutions. Cultivating a shared and deeply held belief in the importance of equal opportunity for health. Harnessing the collective power of leaders, partners, and community members. Securing and making the most of available resources. Measuring and sharing progress and results. KEY POINTS The Robert Wood Johnson Foundation Culture of Health Prize recognizes communities that have placed a priority on health and are creating powerful partnerships and deep commitments that will enable everyone, especially those facing the greatest challenges, with the opportunity to live well. The six criteria displayed on this slide drive the selection of Prize winners. We are looking for communities who are able to bring these criteria to life. _____________________________ NOTE TO PRESENTER: The next call for applications for the 2018 RWJF Culture of Health Prize will be released in the summer of You can find the Prize call for applications and additional information about the Prize program and past Prize winners at Potential discussion questions: How does our community reflect these criteria? Which criteria does our community most embody? Which criteria is our community still working toward? What are we most proud of in our community?

RWJF Culture of Health Prize Winners
KEY POINTS: There are 27 Prize winning communities to date. The winners span 19 states, including 4 tribes, and represent communities of many different sizes and geographical characteristics. The 2017 Prize winners will be announced this fall. _______________________________________________________________________________________________________________ BACKGROUND: In 2013 six communities were awarded the first RWJF Culture of Health Prize: -Cambridge, MA -Minneapolis, MN -Fall River, MA -Manistique, MI -New Orleans, LA -Santa Cruz, CA The 2014 Prize winners are: -Brownsville, TX -Spokane, WA -Buncombe, NC -Taos Pueblo (NM) -Durham, NC -Williamson, WV The 2015 Prize winners are: -Bridgeport, CT -Lawrence, MA -Bronx, NY -Menominee Nation (WI) -Everett, MA -Kansas City, MO -Spartanburg County, SC -Waaswaaganing Anishinaabeg (Lac du Flambeau Tribe) (WI) The 2016 Prize winners are: 24:1 Community, MO - Miami-Dade County, FL Columbia Gorge Region, OR & WA - Santa Monica, CA Louisville, KY - Shoalwater Bay Indian Tribe (WI) Manchester, NH Learn more about each winning community at:

The Value for Prize Winners
$25,000 cash prize Stories and successes celebrated broadly Engage with other leaders as ambassadors for building a Culture of Health Join a Prize Alumni Network to learn with other Prize winners KEY POINTS: Prize winning communities receive a $25,000 cash prize in recognition of their accomplishments. The purpose of the Prize goes far beyond the dollar amount, however. It is a designation and an honor. Prize winners have their stories and successes celebrated broadly to inspire others toward locally-driven change. They engage with other national and community leaders as ambassadors for building a Culture of Health across the nation. And they become part of a national network to engage and learn with other Prize winners and to network locally, regionally, and nationally.

Learn about the Prize Winners
Visit for: Written profiles and brief video features on each community Prize criteria Information about the Prize competition KEY POINTS: Stories and instructional content about each Prize winning community can be found at The extensive site includes written profiles and brief video features on each community, as well as information about the six Prize criteria and applying for the Prize competition.

2016 Prize Winner Thematic videos
24:1 Community, MO Collective Impact on Health & Education Columbia Gorge Region, OR & WA Bringing Food Security to the Chronically Hungry Louisville, KY Preventing Youth Violence Manchester, NH Addressing the Opioid Crisis Miami-Dade County, FL Revitalizing Neighborhoods through Community Engagement Santa Monica, CA Addressing Homelessness Shoalwater Bay Indian Tribe (WA) Preparing for Climate-related Threats KEY POINTS: What does it take to build a Culture of Health? Prize winning communities offer strong, inspiring examples of how communities are working across multiple health factors and collaborating across sectors to improve health for all in their communities. These links feature specific work from the 2016 Prize winners – through brief, 30-second videos accompanied by written text – organized by theme for communities across the country to learn from. _____________________________ NOTE TO PRESENTER: Consider using one of these short videos as an opening to your presentation or as an a discussion activity. Potential discussion questions: How is our community similar to the Prize-winning community shown here? What can we learn from this Prize-winning community? What are we most proud of in our community?

Staying Connected Follow @CHRankings
Like Facebook.com/ CountyHealthRankings e-Newsletter, to subscribe KEY POINTS Use social media to stay in touch with and communicate about County Health Rankings & Roadmaps program. Twitter Facebook E-Newsletter

Summary Where we live matters to our health.
There are great disparities in health based on where we live. Health is more than health care. Many factors contribute to health. We’re all in this together. It takes all of us working together to improve the health of a community. You can find data and practical help at KEY POINTS The County Health Rankings help us see how where we live, learn, work and play influences how healthy we are and how long we live. The Rankings are an annual check-up of the health of each county. They show us that some places are doing very well and other places have a lot of work to do. Everyone can improve. Having health insurance is important – but much of what affects our health occurs outside of the doctor’s office. It’s hard to live a healthy life if you live in an unhealthy place. Improving community health is not something solved by a local health department, hospital, or physician. We need everyone to improve health in community. All of us need to work together and take action together. You can find practical guidance through on-line resources in the Action Center and using the “Get Help” button to reach a Community Coach for consultation on your community efforts to improve health.

University of Wisconsin Population Health Institute
Thank you! University of Wisconsin Population Health Institute Madison, WI

County Health Rankings & Roadmaps 101

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County Health Rankings & Roadmaps 101

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