health disparities in hawaii county japanese chamber of commerce january 25, 2012 sharon h....

Health Disparities in Hawaii County

Japanese Chamber of Commerce January 25, 2012

Sharon H. Vitousek, M.D.North Hawaii Outcomes Project, www.nhop.org

Hawaii Island Healthcare Alliance www.hawaiihealthcarealliance.org

http://www.nhop.org/

Health Disparities in Hawaii County

• What impact on business?

• What is the role of business ?

• Benefits of improvement to business

Health Disparities - Hawaii County

Population Health Outcomes

• Higher Death rates– All causes– Heart disease– Stroke– Overall cancer– Infant Mortality– Suicide– Traffic-related

• Lower life expectancy• Higher teen birth rates• Higher confirmed child abuse rates

764.0

670.8

668.4

603.8

0

100

200

300

400

500

600

700

800

900

1000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Age

-Adj

ust

ed

Dea

th R

ate

per

100

,000

pop

ula

tion

All Causes - Age-Adjusted Death RateHawaii County Compared to the State

Chart: North Hawaii Outcomes Project - April 2011 Source: Office of Health Status Monitoring, 1999-2011

Hawaii County

State

153.4

Hawaii CountyHawaii County

93.4HP 2020 - 100.8

124.3

State 77.6

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Age

-adj

uste

d ra

te p

er 1

00,0

00 p

opul

atio

nCoronary Heart Disease - Death RatesHawaii County compared to State (1999-2009)

Chart: North Hawaii Outcomes Project - May 27, 2011 Source: Hawaii State Department of Health - Office of Health Status Monitoring 1999 - 2009

75.5

Hawaii County

42.7

61.9

State39.1

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Ag

e-a

dju

ste

d r

ate

pe

r 10

0,0

00

po

pu

lati

on

Chart: North Hawaii Outcomes Project - May 31, 2011

Cerebrovascular(Stroke) Disease - Death RatesHawaii County compared to State (1999-2009)

Source: Department of Health - Office of Health Status Monitoring, 1999 - 2009

Healthy People 2020 Target - (33.8)

172.7

156.3151.9

140.7

0

20

40

60

80

100

120

140

160

180

200

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Dea

ths

per 1

00,0

00 a

ge-a

djus

ted

popu

latio

nOverall Cancer - Death Rate

Hawaii County Compared to the State - (1999-2009)

Chart: North Hawaii Outcomes Project - May 31, 2011 Source: Office of Health Status Monitoring, 1999-2009

State

Hawaii CountyHealthy People 2020 Target - 160.6

10.3

6.9

7.7

5.9

0.0

2.0

4.0

6.0

8.0

10.0

12.0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Ra

te o

f In

fan

t d

ea

ths

pe

r 1

,00

0 li

ve b

irth

sInfant Mortality Rate

(Place of residence)

HP 2020

HC

St

Source: State of Hawaii Health Department, Vital StatisticsChart: North Hawaii Outcomes Project - September 2011

HP 2020 Target - 6.0

12.6

20.7

11.1

12.8

HP 2020 - 10.2

0.0

5.0

10.0

15.0

20.0

25.0

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Dea

th r

ate

per

100,

000

popu

latio

n

Hawaii County

State

HP2020

Suicide - Death Rate (1999 - 2009)

Chart: North Hawaii Outcomes Project - January 2011Source: Office of Health Status Monitoring, 1999-2009

Source: Denominator from U.S. Census

10.9 11.5

9.710.8 11.4 11.1

12.7

10.9

8.4 8.5 8.7

7.48.9

7.69.0

7.9 8.49.8

7.5

4.85.9

6.6

25.5

19.9

18.3

21.1

25.624.2

23.021.9

16.515.2

17.3

0.0

5.0

10.0

15.0

20.0

25.0

30.0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Ra

te o

f tr

aff

ic -r

ela

ted

fa

talit

ies

pe

r 10

0,0

00

po

pu

latio

n,

no

t a

ge-

ad

just

edFatalitiesRelated -Rate of Traffic

Chart: North Hawaii Outcomes Project - April 2011Traffic fatalities include; motor vehicle occupants, pedestrians, motorcyclists,

Source: Numerator from Department of TransportationDenominator-Source: U.S. Census Bureau, Population

Division, "CO-PEST2010-totalsJuly 1, 2000 to July 1, 2010(CO-EST2009-01-15)

Hawaii County

State

City & County of Honolulu

79.7 80.9 80.7 80.6

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Hawaii County City & County of Honolulu Kauai County Maui/Kalawao County

Average Life Expectancy at Birth, by County (2004-2006)

Chart: North Hawaii Outcomes Project - March 2010 Source: Hawaii State Data Book 2008

Hawaii County

52.1

State

42.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

2000 2001 2002 2003 2004 2005 2006 2007 2008

HP 2010 - 5.0

Source: Department of Health, Office of Health Status Monitoring, 2008Chart: North Hawaii Outcomes Project - March 2010

Teen Birth Rates per 1,000 females15 - 19 years old

Hawaii County

State

0.0

5.0

10.0

15.0

20.0

25.0

30.0

2000 2002 2003 2005 2006 2007 2008

Per

1,0

00 c

hild

ren

Chart: North Hawaii Outcomes Project - August 2010

Rate Confirmed-Child Abuse and Neglect

Source: Hawaii State Data BookNote: No data was available for years 2001 and 2004.


Why?

Institute of MedicineFramework for Population Health

Social and Physical Environment

Social, Economic & Physical Environment

(Socioeconomic Determinants)

Health-Related Behaviors

Health Systems

(Access to Care)

Population

Health Outcomes

9.8%

5.6%

8.3% 8.7%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

Hawaii County City & County of Honolulu Maui County Kauai County

Average Percent Unemployed 2010

Chart: North Hawaii Outcomes Project - January 2012 Source: American Community Survey 2010

$22,713

$28,629 $27,767

$24,774

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000


Per Capita Income - 2010

Chart: North Hawaii Outcomes Project - October 2011 Source: U.S. Census, ACS 2010

$57,308

$81,177$73,916

$59,020

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000


Median Income - 2010


35.0%

21.9%

28.4% 26.5%State - 24.6%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

Hawaii County City & County of Honolulu Kauai County Maui County

Population at or Below 200% Federal Poverty - 2010

Chart: North Hawaii Outcomes Project - October 2010 Source: U.S. Census Bureau, ACS 2010

25.0%

18.0%

12.5%11.0%

State - 13.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Hawaii County Maui County Kauai County C & C of Honolulu

Youth Below 100% Federal Poverty Level 2010


0.451

0.422

0.4410.447

State - 0.433

U.S. - 0.469

0.39

0.4

0.41

0.42

0.43

0.44

0.45

0.46

0.47

0.48


Gini Ratio of Income Inequality - 2010



Health Related Behaviors

Smoking- 15 % vs 10% state

• Obesity-

• (Binge drinking)

• (Adults no exercise)

19.7%

10.7%

23.1%

15.7%

HP 2020 - 12.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Perc

ent

of c

urre

nt s

moke

rs

State Hawaii County HP 2010

Chart: North Hawaii Outcomes Project - May 27, 2011 Source: Behavioral Risk Factor Surveillance Survey, 2000-2010

Current Adult SmokerHawaii County compared to State (2000-2010)

Hawaii County

State

15.7%

23.1%

15.2%

26.3%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

State

Hawaii County

HP 2020

Chart: North Hawaii Outcomes Project - January 2012 Source: Behavioral Risk Factor Surveillance Survey, 2000 - 2010

HP 2020 Target- 30.6%

Obesity-(Body Mass Index > 30)Hawaii County Compared to State (2000-2010)

10.4%

17.9%

12.2%

17.7%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

State Hawaii County

Hawaii County Compared to State - *Binge Drinking Adults 18 years and older (2001- 2010)

Source: Behavioral Risk Factor Surveillance Survey 2001- 2010*"five or more alcoholic beverages on at least one occasion, in the past month."

Chart: North Hawaii Outcomes Project May 27, 2011

22.4%20.2%

18.9% 19.2%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Adults with no Leisure Time Exercise or Physical Activity within last 30 days

Chart: North Hawaii Outcomes Project - September 2011 Source: State of Hawaii Behavioral Risk Factor Surveillance Survey, 2001-2010

Hawaii County

State

HP 2020 Target - 32.6%


Health Systems

Access to care:• Higher uninsured Lower ratio of physicians per 1,000 population• Higher percent of population without a personal doctor• Lower percent mothers receiving prenatal care

Utilization & Cost:• Higher acute care hospitalizations per 1,000 population

Quality:

2.1

3.4

2.22.4

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Hawaii County City & County Of Honolulu

Maui County Kauai County

Lic

en

sed

ph

ysic

ian

s p

er 1

,000 p

op

ula

tio

n

Licensed Physicians with a Hawaii Primary Address per 1,000 Population by County (2011)

Chart: North Hawaii Outcomes Project - September 2011 Source: Numerator from Department of Commerce and Consumer Affairs –July 27, 2011

*Denominator from U.S. Census 2010 .may or may not be active** Licensed physicians

Consequences of Primary Care Shortage

Source: Institute of Health Improvement, John Wasson, M.D.

Consequences of Primary Care Shortage

• Delayed Care & Increased suffering

• Higher ER utilization

• Higher hospital utilization

• Increased costs

• Less focus on Prevention- Life style

• Less screening- Cancer & Depression

• Poorer outcomes

76%

76%

83%84%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

HP 2020

Hawaii County

State

Mothers Receiving Prenatal Care in First Trimester

Chart: North Hawaii Outcomes Project - September 4, 2011 Source: Department of Health - Office of Health Status Monitoring, 2000 - 2009

Healthy People 2020 Target 77.9%

Improving Population Health -- How?

Socioeconomic DeterminantsEconomic Development

•Health sector: policy change & planning•Education & Science sectors- TMT•Energy sector

Health-Related BehaviorsEnvironmental AND Individual Strategies

•Smoking cessation, physical activity, • Identifying and addressing problem drinking, & depression

Health SystemsPrimary Care Workforce Development

•Grow our own docs, Policy change, •BEACON: Redesign care through Collaboration, Technology & Engagement

Improved

Population

Health Outcomes

Economic Development of the Healthcare Sector

• Why – 3rd largest employer in Hawaii County – Largest employer in many rural communities– Economic Multiplier effect of physicians~ 5 to 1– Good for business & community

• How– Work force development & policy change

• What Business can do

Hawaii County EmployeesDBED Nov 2011

Employment sector # of Employees

1. Government 12,0002. Retail trade 8,0003. Healthcare/social assistance 6,900

4. Accommodations 5,5005. Food service and drinking places

5,200

Hawaii Island Healthcare Alliance• Island wide, voluntary, collaborative group of

stakeholders• Goal: Improve health & healthcare in Hawaii County

by increasing healthcare workforce & improving financial sustainability of providers

• Endorses:– Growing own providers - Residency Hilo, – Broader primary care team– Collaboration to align policy efforts,

• Friends of the Future is 501(c )(3) Fiscal Agent

What Business Can Do

• Engage Employees in Healthy Lifestyles• Advocate for:

– Development of the Health Sector/Workforce– Funding UH Family Practice Residency - Hilo

• Technical Assistance for planning, finance– Serve on healthcare boards or committees– Join Hawaii Island Healthcare Alliance

• Demonstrate for Residency Program - Hilo– Small donations to show community support

Benefits of Health Workforce Development

• Improved Access– Timely Care & Decreased suffering– Lower hospital/ER utilization

• More prevention & life style improvements• More recommended screenings• Decreased costs• Economic stimulation- job creation• Better outcomes & Quality of Life• Improved productivity/business environment

Hawaii Island Healthcare Alliance

www.hawaiihealthcarealliance.org

[email protected]

http://www.hawaiihealthcarealliance.org/

mailto:[email protected]

health disparities in hawaii county japanese chamber of commerce january 25, 2012 sharon h....

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