Cheryl Wold, MPHWold and Associates

for the National Library of

Medicine

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Module 4: Health Indicators in Action

(Examples of Indicator Projects)

Review of Modules in the Health Indicator Series

• Module 1: Overview of Health Indicators• Module 2 – Community Health Status Indicators

(CHSI)• Module 3 - Case study of librarian involvement in

indicators• Module 4 – Look in-depth at examples of health

indicator sets available on-line• Future Modules?

Health Indicators, Part 42

Goals• Further your understanding of health indicator resources and

their uses at the national and local level• Feature two indicator sets with some interesting similarities

and differences: • County Health Rankings – general health report for the

nation that provides rankings, targets, and comparative information at the state and county level on health indicators

• Boston Indicators Project-- comprehensive indicator system that assesses the overall quality of life in a region across ten sectors

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Health Indicators vs. Sets

• Comparable measures of health over time, between groups of people, and across geographic areas

• Informed by conceptual models of health• Created using high quality data• Communicate well• Relevant to important health issues• Reflect PREVENTION opportunities

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Core Qualities of Indicator Sets• Transparency • Quality of data sources and methods• How frequently updated• Stated purposes, who is involved, intended

audiences, and uses• How is the effort financed and what is the

commitment to updating and funding in the future?• Are indicators attached to an agenda, set of

measureable objectives, or intended to broadly inform?

• Who is accountable to act?

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Credible Data Sources • Health and Human Services (NCHS, CDC)• Census (American Community Survey,

Current Population Survey) • Education Department• Environmental Protection Agency• Federal sources are supplemented on the

state and local level with administrative data from e.g., health, human services, educational, and justice systems.

Health Indicators, Part 4

Uses of Health Indicators Sets

Health indicator sets are used to: • raise awareness• identify priorities• draw people/organizations together to

collectively take action• target or redirect resources• promote accountability• monitor progress

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Problem Identification and Prioritization Cycle

e.g., CHSI, County Health Rankings, are used here in combination w/local data.

Source: http//books.nap.edu/openbook.php?record_id=5298&page=31

County Health Rankings

• http://www.countyhealthrankings.org• Developed by the University of Wisconsin’s

Population Health Institute, the Robert Wood Johnson Foundation, and broad group of technical advisors.

• MATCH (Mobilizing Action Toward Community Health) goals: call to action; engage policy makers and community leaders; develop incentive models to stimulate improvement.

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Why Rankings?Why Rankings?

• Based upon America’s Health Rankings and previous work in Wisconsin http://uwphi.pophealth.wisc.edu/

• Peppard, PE, et al. Ranking community health status to stimulate discussion of local public health issues: the Wisconsin County Health Rankings. Am J Public Health. 2008 Feb;98(2):209-12. Epub 2008 Jan 2.

• Rohan, AMK, Booske, BC, and Remington, PL. Using the Wisconsin County Health Rankings to catalyze community health improvement. J Public Health Manag Pract. 2009 Jan-Feb;15(1):24-32.

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County Health Rankings Home Page with an interactive map of the U.S.

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County Health Rankings Home Page - California

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County Health Rankings Home Page – Snapshot 2010: Los Angeles

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County Health Rankings Home Page – Health Factors Rankings

Health Factors Map

Health Factors

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Snapshot of 2010 Health Outcomes data for Los Angeles

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Premature Death Ranking for the State of California.

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Los Angeles County – Health Behaviors Ranking

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Health Outcomes

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Health Factors

Health Factors Health factors in the County Health Rankings

represent what influences the health of a county.

Health Behaviors (30%)Tobacco Use Diet and Exercise Unsafe Sex Alcohol Use

Clinical Care (20%)Access to Care Quality of Care

A fifth set of factors that influence health (genetics and biology) is not included in the Rankings.

Social and Economic Factors (40%)Education Employment Income Family and Social Support Community Safety

Physical Environment (10%)Environmental Quality Built Environment

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Health Behavior: Tobacco

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Detailed Information provided for all Indicators

• What is it?• Why do we measure it? • Measurement strategies• County Health Ranking measurement• Measure strengths and limitations• References

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Weighted Rankings for Each County/State

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Health Outcome Weights for the 2010 County Health Rankings

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Examples of the Measures for Health Behaviors and for Clinical Care

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Examples of the Measures for Health Behaviors and for Clinical Care (cont.)

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Take Action

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Take Action Model

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Take Action Model: Work Together to Find Programs and Policies that Work.

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Find Programs and Policies that Work

• General sources of evidence• The Guide to Community Preventive Services • Cochrane Public Health Group - Finding Public Health Revie

ws• The Cochrane Library• The Campbell Collaboration Library of Systematic Reviews• Health-Evidence.ca -- Promoting Evidence-Informed

Decision Making• Canadian Best Practices Portal (from the

Public Health Agency of Canada)--Community and population health interventions related to chronic disease prevention and health promotion.

Source: County HealthSource: County Health Rankings, accessed April 26, 201030

Complementary Approaches of CHR and BIP

• Common to both: • Rich resource for health improvement - offers high quality,

accessible information. • Links to practical information.• Seeks to activate a base within local communities to take

action; engage users.• Pushes innovations, and new ways of working (e.g. more

informed approaches and tools, vehicle for collaboration, sharing).

• How current these resources will be maintained going forward is not known – CHR is designed as a snapshot while BIP is more trend-oriented.

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The Boston Indicators Project Home Page

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10 sectors comprising the Boston Indicators Project

Ten Sectors:• Civic Vitality • Cultural Life and the Arts • Economy • Education • Environment & Energy

• Health • Housing• Public Safety • Technology • Transportation

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The civic agenda for the Boston Indicators Project

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Health Indicators, Part 435

The Boston Indicators Project: 8 Health Indicators

The Boston Indicator Project: 10 Indicators for the Environment and Energy.

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Key Features

1. Framing of the indicators2. Rich contextual information3. Incorporation of national and local data4. Sector Cross Cut (filters)5. Hub of innovation

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1. Framing the indicators

• Competitive Edge in the Health Sector

• 7.1.1 Research funding, Massachusetts and Metro Boston Massachusetts has been consistently ahead of all other Leading Technology States in the capture of research and development funds. In 2007, per capita National Institute of Health (NIH) funding was $656. By comparison, Connecticut’s funding per capita was $252, North Carolina’s was $206 and California’s was $174.

• 7.1.2 "Right Start" rank in child health outcomes, Boston vs. 50 largest US cities Boston ranked in the top 10 among 50 cities on 5 of 8 measures of healthy births; the rankings are designed so that a higher rank is a better outcome for newborn health.

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2. Contextual Information

• Revised data for trends through 2009

• Contextual information: Local civic agenda and leadership.

• Links to multiple other local and national reports.

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3. Incorporation of National and

Local Data

3. Incorporation of National and

Local Data

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Sector Crosscuts

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4. Sector Cross Cuts - Filters

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Civic Vitality

Housing; Health

Cultural Life and the Arts

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Percentage of Bostonians who Feel they can Rely on their Neighbors

(2008)

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Map and Data from the Boston Police Department

Boston Police Department; Boston Public Safety Survey 2006

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5. Hub of Innovation

• For each of the ten sectors, information about innovative strategies--proven or promising – are featured with links for further information.

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Health Innovations

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Community Health Data Initiative

• Community Health Data Initiative [Internet]. Washington (DC): U.S. Department of Health & Human Services; 2010. [cited 2010 May 4]. Available from: http://www.hhs.gov/open/datasets/communityhealthdata.html

• Community Health Data Initiative Interim Work Page [Internet]. Atlanta: Centers for Disease Control and Prevention, National Center for Health Statistics; 2010 Mar 19 [revised 2010 May 3; cited 2010 May 4]. Available from: http://www.cdc.gov/nchs/data_access/chdi.htm (links specifically to the County Heath Rankings data as well as to data from other indicator sets).

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Community Health Data Initiative (cont.)

More information about the Open Government Initiative: • Open Government Initiative: Transparency, Participation,

Collaboration [Internet]. Washington (DC): The White House; 2009. [cited 2010 May 4]. Available from: http://www.whitehouse.gov/open/around

• HHS.gov/OPEN [Internet]. Washington (DC): U.S. Department of Health & Human Services; 2010. [cited 2010 May 4]. Available from: http://www.hhs.gov/open/index.html

Health Indicators, Part 4

Design Framework for Community Health Data Initiative

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Resources on Related Opportunities

• Kaiser Family Foundation – Health Reform Summary http://www.kff.org/healthreform/upload/8061.pdf• Partners in Information Access for the Public Health

Workforce. NLM has section on funding opportunities. http://phpartners.org/grants.html

• HSR Information Central (NLM portal on HSR information resources) that has section on grants http://www.nlm.nih.gov/hsrinfo/grantsites.html

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Resources for Community Planning• Task Force on Community Preventive Services. The

Guide to Community Preventive Services (or “The Community Guide”) [Internet]. Atlanta: Centers for Disease Control and Prevention; [revised 2010 Feb 10; cited 2010 May 4] Available from: http://www.thecommunityguide.org/index.html

• Community Health Assessment aNd Group Evaluation (CHANGE): Building a Foundation of Knowledge to Prioritize Community Health Needs—An Action Guide. [Internet]. Atlanta: Centers for Disease Control and Prevention; Forthcoming 2010. [cited 2010 May 4]. Available from: http://www.cdc.gov/healthycommunitiesprogram/tools/index.htm

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Resources for Community Planning (cont.)

• The Prevention Institute [homepage on the Internet]. Oakland (CA): The Institute; 2010. [cited 2010 May 4]. Available from: http://www.preventioninstitute.org

• Health Impact Assessment/Human Impact Assessment [Internet]. Atlanta: Centers for Disease Control and Prevention; 2009 Oct 15 [revised 2010 Mar 1; cited 2010 May 4]. Available from: http://www.cdc.gov/healthyplaces/hia.htm

• Brownson RC, Fielding JE, Maylahn CM. Evidence-based public health: a fundamental concept for public health practice. Annu Rev Public Health. 2009 Apr 29;30:175-201.

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Community Health Improvement Models

• Institute of Medicine (U.S.). Committee on Assuring the Health of the Public in the 21st Century. The future of the public’s health in the 21st century. [Internet] Washington, DC: National Academy Press ; 2002. [cited 2010 May 4]. Available from: http://www.iom.edu/Reports/2002/The-Future-of-the-Publics-Health-in-the-21st-Century.aspx

• Public Health Functions Steering Committee. Public Health in America. 10 Essential Public Health Services . [Internet] Washington, DC: The Committee; Fall 1994. [cited 2010 May 4]. Available from: http://www.health.gov/phfunctions/public.htm or http://www.cdc.gov/od/ocphp/nphpsp/essentialphservices.htm

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Community Health Improvement Models (cont.)

• Institute of Medicine (U.S.). Committee on Using Performance Monitoring to Improve Community Health. Improving health in the community; a role for performance monitoring. [Internet] Washington, DC: National Academy Press; 2007. [cited 2010 May 4]. Available from: http://www.nap.edu/catalog.php?record_id=5298#toc.

• University of Kansas. Work Group for Community Health and Development. The Community Tool Box. [Internet]. Lawrence, KS: The Work Group; [cited 2010 May 4]. Available from: http://ctb.ku.edu/en/

• Healthy People 2020. Phase I report: recommendations for the framework and format of Healthy People 2020. Action model to achieve Healthy People 2020 overarching goals. [Internet] Washington, DC: Last revised: 2008 Dec 11. [cited 2010 May 4]. Available from: http://www.healthypeople.gov/hp2020/advisory/PhaseI/summary.htm#_Toc211942896

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Thank you for attending!

for more information contact me atcheryl@cherylwold.com

or Ione Auston at

Ione_auston@nlm.nih.gov

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