1. The County Health Rankings: How We Got Here Together We Can Summit April 14, 2011 Brenda Henry, PhD, MPH Robert Wood Johnson Foundation Julie A. Willems Van Dijk, RN, PhD University of Wisconsin

2. Multiple Determinants of Health Exploring the Rankings model MATCH: Next Steps Action: Resources & ExamplesDiscussion Outline 2

3. Robert Wood Johnson Foundation

5. Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Stockholm: Institute of Futures Studies, 1991.

6. Independent Inquiry into Inequalities in Health Report (1998) chaired by Sir Donald Acheson

7. 'The system of influences on Scotland’s health and wellbeing that can be affected by Scottish public policy' Scottish Council Foundation, The Wellbeing Project. Accessed online at http://www.thewellbeingproject.org/system.htm 8/24/2007.http://www.thewellbeingproject.org/system.htm

8. Influences on Health: Broadening the Focus RWJF Commission to Build a Healthier America. Overcoming Obstacles to Health, 2008

9. Building on the Commission’s work, the County Health Rankings story begins in early 2008…

10. Wisconsin County Health Rankings 2003-2008

11. America’s Health Rankings Ranks the overall health of all 50 states, from healthiest to least healthy. First published in 1990 and annually thereafter. Uses a model that summarizes the overall health of each state. 11

12.  Fifty-state, county-by-county ranking reports  Health Outcomes  Health Factors  First report of its kind  Standardized measures of overall health for almost every county in U.S.  Every state can see how its counties compare  County-level snapshot on health outcomes and factors that influence health  Partnership between RWJF and UWPHI  Reports for 3 years  First report released February 17, 2010  Second report released March 30, 2011

13. Where we live, learn, work and play influence how healthy we are and how long we live. Many factors contribute to health. Health is more than health care. The County Health Rankings is one of many tools for communities to figure out where they are doing well and where they are not - - so they can work together to make changes. Moving to Action: Key Messages 13

14. Change begins by bringing together community leaders to identify what steps need to be taken to build a healthier community. The Rankings are not about a race to the top. They are a tool for advocating for improvement. Moving to Action: Key Messages 14

15. Multiple Determinants of Health Exploring the Rankings model MATCH: Next Steps Action: Resources & ExamplesDiscussion Outline 15

16. Logic Model 16

17. 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

18. Do we know how much each of the major determinants contributes to health? 18 a.Historical perspective b.Literature review c.Analysis of ability to predict health outcomes

19. Historical Perspective 1930-1950: Sanitary revolution and improvements in environmental health 1950-1970: Increasing role of health care 1970-1990: Contribution of health behaviors (smoking/diet/exercise) increases 1990-present: Social and economic determinants

20. Review of the Literature

21. The oft cited McGinnis et al (2002) paper states: "...using the best available estimates, the impacts of various domains on early deaths in the US distribute roughly as follows: – genetic predispositions, about 30%; – social circumstances, 15%; – environmental exposures, 5%; – behavioral patterns, 40%; and – shortfalls in medical care, 10%.”

22. a.Based on historical perspective b.Based on a review of the literature c.Based on ability to predict health outcomes d.Based on need to engage stakeholders e.None of the above f.All of the above Determining Weights for the County Health Rankings

23. Central Michigan Health Factors County Health Behaviors 30% Clinical Care 20% Social & Economic 40% Physical Environment 10% Arenac 31776716 Clare 6772786 Gladwin 77797325 Isabella 16781340 Osceola 34455734 Roscommon 6821761 23

24. Central Michigan Overall Rankings County Health Outcomes Health Factors Arenac 6365 Clare 8276 Gladwin 7680 Isabella 3319 Osceola 4746 Roscommon 7566 24

25. MobilizingActionToward Community Health through County Health Rankings Setting goals and objectives for overall health Keeping track of progress

26. Multiple Determinants of Health Exploring the Rankings model MATCH: Next Steps Action: Resources & ExamplesDiscussion Outline 26

27. 27

28. 28 Mobilizing Action Toward Community Health February 2010: Inaugural release of County Health Rankings October 2010: RWJF Board of Trustees approves new MATCH initiative March 2011: 2 nd release of County Health Rankings & Community Grants Call for Proposals Throughout 2011: More to come!

29. MATCH Center Online Solutions Strategy Training/Technical Assistance National Population Health Award UWPHI MATCH Center Lead To be Announced MATCH Policy Advocacy Lead National MATCH Strategy National Partner Grants MATCH Initiative County Health Rankings MATCH Advisory Group Community Grants Program Policy and Advocacy Training/Technical Assistance Evaluation

30. Multiple Determinants of Health Exploring the Rankings model MATCH: Next Steps Action: Resources & ExamplesDiscussion Outline 30

31. 31

32. 32

33. 33

34. 34

35. 35

36. 36

37. 37

38. 38

39. 39

40. 40

41. 41

42. 42

43. 43

44. 44

45. MICHIGAN

46. KANSAS 46

47. WISCONSIN 47

48. www.countyhealthrankings.org 48

49. 49 Taxes, Clean Indoor Air Policies Menu labeling, School Food Policies Work force development Minimum wage, Paid family/medical leave Reduce alcohol outlet density Partner referral services Expand early childhood programs Nurse home visiting programs Zoning/incentives for mixed use development Reducing bus emissions Pedestrian/cycling in master plans Coverage, medical homes EHRs, Public Reporting, Payment Reform

50. The MATCH Project and the County Health Rankings The Wisconsin MATCH Team – Patrick Remington, Bridget Booske, David Kindig, Julie Willems Van Dijk, Jessica Athens, Angela Russell Robert Wood Johnson Foundation – Brenda Henry, Michelle Larkin, Jim Marks, Joe Marx, Pamela Russo, Abbey Cofsky Our Partners – CDC, NCHS, ASTHO, NACCHO, NNPHI, Leah Devlin, Dartmouth Institute, 11-member Metrics Advisory Group

51. For More Information www.countyhealthrankings.org Julie Willems Van Dijk University of WI Population Health Institute Madison, WI willemsvandi@wisc.edu 608-263-6731

52. Multiple Determinants of Health Exploring the Rankings model MATCH: Next Steps Action: Resources & ExamplesDiscussion Outline 52