1. How we use Roadmaps to Health in Durham County Mel Downey-Piper MPH CHES Erika Samoff MPH PhD

2. County Health Rankings http://www.countyhealthrankings.org/app/north-carolina/2014/overview

3. NC County Rankings 2013 – 1 st : Wake County – 2 nd : Orange County – 3 rd : Watauga County Durham County – 2010: 11 th – 2011: 9 th – 2012: 8 th – 2013: 17 th

4. Durham County Rankings 2010-2013 2010201120122013 Health Outcomes119817 Quality of life (50%) Mortality (50%) Health Factors89815 Behaviors (30%) Clinical Care (20% Socioeconomic (40%) Physical environment (10%)

5. Durham County Rankings 2010-2013 2010201120122013 Health Outcomes119817 Quality of life (50%)25201821 Mortality (50%)881016 Health Factors89815 Behaviors (30%)191711 Clinical Care (20%2227 Socioeconomic (40%)24211231 Physical environment (10%)66606215

6. Durham County Rankings 2010-2013 2010201120122013 Health Outcomes119817 Quality of life (50%)25201821 Mortality (50%)881016 Health Factors89815 Behaviors (30%)191711 Clinical Care (20%2227 Socioeconomic (40%)24211231 Physical environment (10%)66606215

7. Durham County Rankings 2010-2013 2010201120122013 Health Outcomes119817 Quality of life (50%)25201821 Mortality (50%)881016 Health Factors89815 Behaviors (30%)191711 Clinical Care (20%2227 Socioeconomic (40%)24211231 Physical environment (10%)66606215 …a lot here we need to understand

8. Wait - did the measures change? 2010201120122013 Health Outcomes119817 Quality of life (50%)25201821 Mortality (50%)881016 Health Factors89815 Behaviors (30%)191711 Clinical Care (20%2227 Socioeconomic (40%)24211231 Physical environment (10%)66606215 There was no change in the mortality measure

9. If there wasn’t a change, what happened? Mortality Mortality ranking 8 8 10 16 Overall ranking 11 9 8 17! …some other counties changed

10. Did the measures change? 2010201120122013 Health Outcomes119817 Quality of life (50%)25201821 Mortality (50%)881016 Health Factors89815 Behaviors (30%)191711 Clinical Care (20%2227 Socioeconomic (40%)24211231 Physical environment (10%)66606215 Primary care physician measure: Weighting decreased from 5% to 3%; included D.O.s, excluded obstetricians Added dentist measure

11. If there was a change, what happened? Clinical Care 2010201120122013 Clinical Care ranking2227 Measures % Uninsured17%21%18%19% Preventable hospital stays (ambulatory care sensitive rate) 58575049 Mammography rate69.469.870.6 Population per dentist1564:1 Population per primary care physician 401:1 844:1 …the changed measures made a difference

12. Did the measures change? 2010201120122013 Health Outcomes119817 Quality of life (50%)25201821 Mortality (50%)881016 Health Factors89815 Behaviors (30%)191711 Clinical Care (20%2227 Socioeconomic (40%)24211231 Physical environment (10%)66606215 No change in social and economic measures

13. So what happened? 2010201120122013 Socioeconomic ranking24211231 Measures High school graduation rate (AFGR) 69758077 % Some college42%70% 71% % Unemployed5.0%7.9%8.0%8.5% % Children in poverty19%18%24%27% % No social-emotional support 21%23%22% Single-parent households 11%39%40%42% Violent crime rate---664 …probably both

14. So … but … It can take a lot of explaining to use the Roadmaps well Don’t let that scare you away! – The way they put environmental, social, and health data together is really great

15. Indicators of poverty in Durham and surrounding counties from Roadmaps

16. Health outcomes in Durham and surrounding counties Low birthweight Obesity Heart disease mortality

17. Press information sheet

18. U SING THE DATA

19. Durham County Community Listening Sessions 2011

20. Short list Healthy NC 2020 Objectives Top community-ranked issuesTop mortality Access to medical and dental care Uninsured / Oral healthHealthcare: Access Cancer Cancer - colorectalCancerAll Cancer Diabetes Diabetes Mellitus Drug / alcohol abuse Substance abuse / useAddiction to alcohol, drugs, pills/medsAssault / Homicide Healthy eating and exercise Obesity/PA/Nutrition Obesity/overweight; Nutrition/Exercise; Transportation Maintenance & Safety Diseases of the Heart; Diabetes Heart Disease Cardiovascular diseaseHeart disease/heart attacks Diseases of the Heart; Cerebrovascular Disease HIV/ STIs Having unsafe sex Infant deaths Infant mortalityInfant Mortality Mental health Mental health / ED and mental health / suicide Mental health Intentional self-harm (suicide); Alzheimer's Neighborhood safety: Violence, gangs, homicide Homicide Violent Behavior; Reduced Crime/ Neighborhood Watch; Gang Involvement Assault / Homicide Poverty and Education: Housing, Poverty, High school graduation Housing, Poverty, High school graduation Homelessness; Gang involvement; Community Unity; Unemployment Teen health Unintended pregnancies Having unsafe sex; Population growth; positive teen activities Unintentional injuries: car crashes, work-related, falls, poisonings Motor vehicle crashes, falls, poisonings; work-related injuries Alcohol abuse; Reckless/drunk driving Motor vehicle injuries

21. Final Community Health Priorities (2012-2014) 1.Obesity and chronic illness* 2.Access to health and dental care* 3.Poverty+ 4.Education*+ 5.Mental health & substance abuse 6.HIV and sexually transmitted infections These were unanimously approved by the full Partnership for a Healthy Durham at their October 2011 Quarterly meeting. *Durham County Health Department priority +Durham County priority

22. What Works for Health

23. http://www.countyhealthrankings.org/roadmaps/what-works-for-health

24. What Works for Health - ratings The ratings include: Scientifically Supported Some Evidence Expert Opinion Insufficient Evidence Mixed Evidence Evidence of Ineffectiveness

25. What Works for Health - employment

27. RWJF Culture of Health Prize Harnessing the collective power of leaders, partners, and community members Implementing a strategic approach to improving health that focuses on the multiple factors that influence health Addressing problems that disproportionately affect vulnerable populations Developing sustainable, long-term solutions to shared community priorities Securing and making the most of available resources Measuring and sharing results Link to video:

28. RWJF Culture of Health Prize 12 Finalists: Bexar County, Texas Brownsville, Texas Buncombe County, North Carolina Canton, Ohio Durham County, North Carolina East Baton Rouge Parish, Louisiana Franklin County, Maine Sitka, Alaska Spokane County, Washington Taos Pueblo Tribal Community, New Mexico Van Buren County, Iowa Williamson, West Virginia The six winning communities will be announced June 25, 2014.

29. RWJF Culture of Health Prize Benefits of applying: – Community conversation on successes – Historical document of collaborations – Good energy Winners receive: – Professional video highlighting accomplishments – $25,000 prize – National recognition

30. Contact Erika Samoff esamoff@dconc.gov 919-560-7833esamoff@dconc.gov Mel Downey-Piper mpiper@dconc.gov 919-560-7761mpiper@dconc.gov

31. Group activity

32. Physical Environment (10%) 2010201120122013 Physical Environment ranking 66606215 Airborne particulate matter per cubic meter (micrograms) 21112.6 % of population getting drinking water from public system with violation 0 % with limited access to healthy foods 76 Recreational facilities per 100,000 pop 1413.714.5 % Fast food restaurants5453 Change in physical environment measures – Change in source of air quality data – Addition of measure of drinking water safety