Transcript Quality of life (50%) - North Carolina Public Health Association

How we use Roadmaps to Health
in Durham County
Mel Downey-Piper MPH CHES
Erika Samoff MPH PhD
County Health Rankings
http://www.countyhealthrankings.org/app/north-carolina/2014/overview
NC County Rankings
• 2013
– 1st: Wake County
– 2nd: Orange County
– 3rd: Watauga County
• Durham County
–
–
–
–
2010: 11th
2011: 9th
2012: 8th
2013: 17th
Durham County Rankings 2010-2013
Health Outcomes
2010
2011
2012
2013
11
9
8
17
8
9
8
15
Quality of life (50%)
Mortality (50%)
Health Factors
Behaviors (30%)
Clinical Care (20%
Socioeconomic (40%)
Physical environment (10%)
Durham County Rankings 2010-2013
2010
2011
2012
2013
11
9
8
17
Quality of life (50%)
25
20
18
21
Mortality (50%)
8
8
10
16
8
9
8
15
Behaviors (30%)
19
17
11
11
Clinical Care (20%
2
2
2
7
Socioeconomic (40%)
24
21
12
31
Physical environment (10%)
66
60
62
15
Health Outcomes
Health Factors
Durham County Rankings 2010-2013
2010
2011
2012
2013
11
9
8
17
Quality of life (50%)
25
20
18
21
Mortality (50%)
8
8
10
16
8
9
8
15
Behaviors (30%)
19
17
11
11
Clinical Care (20%
2
2
2
7
Socioeconomic (40%)
24
21
12
31
Physical environment (10%)
66
60
62
15
Health Outcomes
Health Factors
Durham County Rankings 2010-2013
2010
2011
2012
2013
11
9
8
17
Quality of life (50%)
25
20
18
21
Mortality (50%)
8
8
10
16
8
9
8
15
Behaviors (30%)
19
17
11
11
Clinical Care (20%
2
2
2
7
Socioeconomic (40%)
24
21
12
31
Physical environment (10%)
66
60
62
15
Health Outcomes
Health Factors
…a lot here we need to understand
Wait - did the measures change?
2010
2011
2012
2013
11
9
8
17
Quality of life (50%)
25
20
18
21
Mortality (50%)
8
8
10
16
8
9
8
15
Behaviors (30%)
19
17
11
11
Clinical Care (20%
2
2
2
7
Socioeconomic (40%)
24
21
12
31
Physical environment (10%)
66
60
62
15
Health Outcomes
Health Factors
There was no change in the mortality measure
Years of potential life lost
If there wasn’t a change, what happened?
Mortality
7200
7150
7100
7050
7000
6950
6900
6850
Mortality ranking
Overall ranking
7170
7005
6969
6979
2010
2011
2012
2013
8
11
8
9
10
8
16
17!
…some other counties changed
Did the measures change?
2010
2011
2012
2013
11
9
8
17
Quality of life (50%)
25
20
18
21
Mortality (50%)
8
8
10
16
8
9
8
15
Behaviors (30%)
19
17
11
11
Clinical Care (20%
2
2
2
7
Socioeconomic (40%)
24
21
12
31
Physical environment (10%)
66
60
62
15
Health Outcomes
Health Factors
• Primary care physician measure: Weighting decreased
from 5% to 3%; included D.O.s, excluded obstetricians
• Added dentist measure
If there was a change, what happened?
Clinical Care
Clinical Care ranking
2010
2011
2012
2013
2
2
2
7
17%
21%
18%
19%
58
57
50
49
69.4
69.8
70.6
Measures
% Uninsured
Preventable hospital
stays (ambulatory care
sensitive rate)
Mammography rate
Population per dentist
Population per primary
care physician
1564:1
401:1
401:1
844:1
…the changed measures made a difference
Did the measures change?
2010
2011
2012
2013
11
9
8
17
Quality of life (50%)
25
20
18
21
Mortality (50%)
8
8
10
16
8
9
8
15
Behaviors (30%)
19
17
11
11
Clinical Care (20%
2
2
2
7
Socioeconomic (40%)
24
21
12
31
Physical environment (10%)
66
60
62
15
Health Outcomes
Health Factors
No change in social and economic measures
So what happened?
2010
2011
2012
2013
24
21
12
31
69
75
80
77
% Some college
42%
70%
70%
71%
% Unemployed
5.0%
7.9%
8.0%
8.5%
% Children in poverty
19%
18%
24%
27%
% No social-emotional
support
21%
23%
22%
22%
Single-parent
households
11%
39%
40%
42%
-
-
-
664
Socioeconomic ranking
Measures
High school
graduation rate (AFGR)
Violent crime rate
…probably both
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
Indicators of poverty in Durham and
surrounding counties from Roadmaps
60%
Unemployment
57%
Children in single-parent households
50%
Children in poverty
42%
40%
30%
28%
28%
26%
20%
10%
40%
37%
24%
15%
6.2%
15%
7.5%
7.6%
9.7%
13.2%
0%
Orange
Wake
Durham
Person
Vance
Health outcomes in Durham and
surrounding counties
Obesity
14%
35%
8%
6%
8% 8%
25%
25%
Percent obese
Percent of live births
9%
10%
21%
20%
15%
4%
10%
2%
5%
0%
0%
232 228
29%
30%
10%
250
33%33%
12%
12%
Heart disease
mortality
Deaths per 100,000 residents
Low birthweight
200
150
117
100
50
0
87
98
Press information sheet
USING THE DATA
Durham County
Community Listening
Sessions 2011
Short list
Healthy NC 2020
Objectives
Top community-ranked issues
Access to medical and
dental care
Uninsured / Oral health
Healthcare: Access
Cancer
Cancer - colorectal
Cancer
All Cancer
Diabetes
Diabetes
Diabetes
Diabetes Mellitus
Drug / alcohol abuse
Substance abuse / use
Addiction to alcohol, drugs, pills/meds
Assault / Homicide
Healthy eating and exercise
Obesity/PA/Nutrition
Obesity/overweight; Nutrition/Exercise;
Transportation Maintenance & Safety
Diseases of the Heart; Diabetes
Heart Disease
Cardiovascular disease
Heart disease/heart attacks
Diseases of the Heart;
Cerebrovascular Disease
HIV/ STIs
HIV / STIs
Having unsafe sex
Infant deaths
Infant mortality
Mental health
Mental health / ED and mental health
/ suicide
Mental health
Intentional self-harm (suicide);
Alzheimer's
Homicide
Violent Behavior; Reduced Crime/ Neighborhood
Watch; Gang Involvement
Assault / Homicide
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
Neighborhood safety:
Violence, gangs, homicide
Poverty and Education:
Housing, Poverty, High
school graduation
Top mortality
Infant Mortality
Motor vehicle injuries
Final Community Health Priorities (2012-2014)
1.
2.
3.
4.
5.
6.
Obesity and chronic illness*
Access to health and dental care*
Poverty+
Education*+
Mental health & substance abuse
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
What Works for Health
What Works for Health
http://www.countyhealthrankings.org/roadmaps/what-works-for-health
What Works for Health - ratings
The ratings include:
•Scientifically Supported
•Some Evidence
•Expert Opinion
•Insufficient Evidence
•Mixed Evidence
•Evidence of Ineffectiveness
What Works for Health - employment
What Works for Health - employment
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:
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.
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
Contact
Erika Samoff [email protected] 919-560-7833
Mel Downey-Piper [email protected] 919-560-7761
Group activity
Physical Environment (10%)
• Change in physical environment measures
– Change in source of air quality data
– Addition of measure of drinking water safety
Physical Environment
ranking
Airborne particulate matter
per cubic meter (micrograms)
2010
2011
2012
2013
66
60
62
15
2
1
1
12.6
% of population getting
drinking water from public
system with violation
0
% with limited access to
healthy foods
Recreational facilities per
100,000 pop
% Fast food restaurants
14
7
6
13.7
14.5
54
53