how we use roadmaps to health in durham county mel downey-piper mph ches erika samoff mph phd
TRANSCRIPT
How we use Roadmaps to Health in Durham County
Mel Downey-Piper MPH CHESErika 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
2010 2011 2012 2013Health Outcomes 11 9 8 17
Quality of life (50%)
Mortality (50%)
Health Factors 8 9 8 15
Behaviors (30%)
Clinical Care (20%
Socioeconomic (40%)
Physical environment (10%)
Durham County Rankings 2010-2013
2010 2011 2012 2013Health Outcomes 11 9 8 17
Quality of life (50%) 25 20 18 21
Mortality (50%) 8 8 10 16
Health Factors 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
Durham County Rankings 2010-2013
2010 2011 2012 2013Health Outcomes 11 9 8 17
Quality of life (50%) 25 20 18 21
Mortality (50%) 8 8 10 16
Health Factors 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
Durham County Rankings 2010-2013
2010 2011 2012 2013Health Outcomes 11 9 8 17
Quality of life (50%) 25 20 18 21
Mortality (50%) 8 8 10 16
Health Factors 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
…a lot here we need to understand
Wait - did the measures change?
2010 2011 2012 2013Health Outcomes 11 9 8 17
Quality of life (50%) 25 20 18 21
Mortality (50%) 8 8 10 16
Health Factors 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
There was no change in the mortality measure
If there wasn’t a change, what happened?Mortality
2010 2011 2012 201368506900695070007050710071507200 7170
70056969 6979
Year
s of
pot
entia
l life
lost
Mortality ranking 8 8 10 16Overall ranking 11 9 8 17!
…some other counties changed
Did the measures change?
2010 2011 2012 2013Health Outcomes 11 9 8 17
Quality of life (50%) 25 20 18 21
Mortality (50%) 8 8 10 16
Health Factors 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
• 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
2010 2011 2012 2013
Clinical Care ranking 2 2 2 7
Measures
% Uninsured 17% 21% 18% 19%
Preventable hospital stays (ambulatory care sensitive rate)
58 57 50 49
Mammography rate 69.4 69.8 70.6
Population per dentist 1564:1
Population per primary care physician
401:1 401:1 844:1
…the changed measures made a difference
Did the measures change?
2010 2011 2012 2013Health Outcomes 11 9 8 17
Quality of life (50%) 25 20 18 21
Mortality (50%) 8 8 10 16
Health Factors 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
No change in social and economic measures
So what happened?2010 2011 2012 2013
Socioeconomic ranking 24 21 12 31
Measures
High school graduation rate (AFGR)
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%
Violent crime rate - - - 664
…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
Orange Wake Durham Person Vance0%
10%
20%
30%
40%
50%
60%
6.2% 7.5% 7.6%9.7%
13.2%
26% 28%
42%37%
57%
15% 15%
28%24%
40%
Unemployment
Children in single-parent households
Children in poverty
Health outcomes in Durham and surrounding counties
Orange
Wak
e
Durham
Person
Vance
0%
5%
10%
15%
20%
25%
30%
35%
21%
25%
29%
33%33%
Perc
ent o
bese
Orange
Wak
e
Durham
Person
Vance
0%
2%
4%
6%
8%
10%
12%
14%
8% 8%
9% 10%
12%
Perc
ent o
f liv
e bi
rths
Orange
Wak
e
Durham
Person
Vance
0
50
100
150
200
250
8798
117
232 228
Deat
hs p
er 1
00,0
00 re
siden
ts
Low birthweight Obesity Heart disease mortality
Press information sheet
USING THE DATA
Durham County Community Listening
Sessions 2011
Short list Healthy NC 2020 Objectives Top community-ranked issues Top mortality
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 Infant 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
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 abuse6. 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 Prize12 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
Group activity
Physical Environment (10%)
2010 2011 2012 2013
Physical Environment ranking
66 60 62 15
Airborne particulate matter per cubic meter (micrograms)
2 1 1 12.6
% of population getting drinking water from public system with violation
0
% with limited access to healthy foods
7 6
Recreational facilities per 100,000 pop
14 13.7 14.5
% Fast food restaurants 54 53
• Change in physical environment measures– Change in source of air quality data– Addition of measure of drinking water safety