Rural NH County Health Rankings

Mobilizing Action Toward Community Health (MATCH)

• County Health Rankings – catalyst or cornerstone of a bigger effort– “Call to Action”

• Collaboration between Robert Wood Johnson Foundation and University of Wisconsin Population Health Department

• Results in actions to improve overall community health

Data Sources• Centers for Disease Control and Prevention (CDC):

– Behavioral Risk Factor Surveillance System (BRFSS), – National Center for Health Statistics, – National Center for Chronic Disease Prevention and Health

Promotion (Division of Diabetes Translation), – National Center for Hepatitis, HIV, STD, and TB Prevention

• Environmental Protection Agency (EPA) Collaboration • Health Resources and Services Administration (Area Resource File) • Decennial Census and American Community Survey,

Census/Current Population Survey: – Small Area Health Insurance Estimates and Income and Poverty

Estimates, and – Census County and Zip Code Business Patterns

• Federal Bureau of Investigation (Uniform Crime Reporting) • Medicare claims/The Dartmouth Institute • National Center for Education Statistics

Population Health Model

• Health outcomes - measures of length and quality of life

• Health factors - behaviors, clinical care, social and economic factors, and the physical environment.   

Health Outcomes

• Mortality– Premature Death

• Morbidity– Health-related Quality of Life– Birth Outcomes

Health Factors

• Health Behaviors– Tobacco Use– Diet and Exercise– Unsafe Sex Alcohol

Use

• Physical Environment– Environmental

Quality– Built Environment

• Clinical Care– Access to Care– Quality of Care

• Social and Economic Factors– Education– Employment– Income– Family and Social

Support– Community Safety

State Rankings

United States

National State Rankings

1 Vermont 41 Kentucky

2 Utah 42 West Virginia

3 Massachusetts 43 Georgia

4 Hawaii 44 Tennessee

5 New Hampshire 45 Nevada

6 Minnesota 46 South Carolina

7 Connecticut 47 Louisiana

8 Colorado 48 Alabama

9 Maine 49 Oklahoma

10 Rhode Island 50 Mississippi

Prominent Finding

• Healthier counties are urban/suburban, whereas least health counties are mostly rural– About half (48%) of the 50 healthiest

counties are urban or suburban counties– Most (84%) of the 50 least healthy

counties are rural.

New Hampshire Health Rankings

Health Outcomes

Health Factors

New Hampshire Summary

Rank Health Outcomes Rank Health Factors

1 Grafton 1 Grafton

2 Rockingham 2 Rockingham

3 Merrimack 3 Merrimack

4 Cheshire 4 Hillsborough

5 Hillsborough 5 Carroll

6 Belknap 6 Cheshire

7 Strafford 7 Strafford

8 Carroll 8 Belknap

9 Sullivan 9 Sullivan

10 Coos 10 Coos

Health Outcomes

Rank Mortality Morbidity

1 Rockingham Merrimack

2 Grafton Grafton

3 Hillsborough Cheshire

4 Cheshire Carroll

5 Merrimack Hillsborough

6 Strafford Rockingham

7 Belknap Belknap

8 Sullivan Strafford

9 Carroll Sullivan

10 Coos Coos

Health Factors

Rank Health Behaviors Clinical Care Social & Economic

Factors Physical

Environment

1 Grafton Grafton Grafton Carroll

2 Carroll Merrimack Rockingham Strafford

3 Merrimack Rockingham Hillsborough Belknap

4 Rockingham Sullivan Merrimack Merrimack

5 Hillsborough Hillsborough Cheshire Grafton

6 Belknap Strafford Strafford Hillsborough

7 Cheshire Belknap Belknap Cheshire

8 Strafford Cheshire Carroll Rockingham

9 Sullivan Coos Sullivan Sullivan

10 Coos Carroll Coos Coos

Coos County Rank

Coos Health Outcomes

 

Coos Error Target NH Rank

County Margin Value* Value (of 10)

Health Outcomes 10

Mortality 10

Premature death 7,980 6,800-9,159 5,209 5,604  

Morbidity 10

Poor or fair health 17% 15-19% 10% 11%  

Poor physical health days 4.2 3.6-4.8 3.1 3.3  

Poor mental health days 3.9 3.3-4.6 2.8 3.2  

Low birthweight 7.20% 6.1-8.3% 5.70% 6.60%  

* 90th percentile, i.e., only 10% are betterNote: Blank values reflect unreliable or missing data

Coos Health Factors: Health Behaviors

 

Coos Error Target NH Rank

County Margin Value* Value (of 10)

Health Factors 10

Health Behaviors 10

Adult smoking 26% 23-29% 18% 20%  

Adult obesity 27% 24-30% 22% 25%  

Binge drinking 17% 14-20% 14% 16%  

Motor vehicle crash death rate 19 13-25 9 11  

Chlamydia rate 100   98 156  

Teen birth rate 33 29-37 15 20  

* 90th percentile, i.e., only 10% are betterNote: Blank values reflect unreliable or missing data

Coos Health Factors: Clinical Care

 

Coos Error Target NH Rank

County Margin Value* Value (of 10)

Health Factors  

Clinical Care 9

Uninsured adults 12% 10-14% 11% 12%  

Primary care provider rate 164   246 128  

Preventable hospital stays 95 89-100 52 63  

Diabetic screening 86% 83-89% 89% 86%  

Hospice use 15% 12-21% 30% 24%  

* 90th percentile, i.e., only 10% are betterNote: Blank values reflect unreliable or missing data

Coos Health Factors: Social & Economic Factors

 

Coos Error Target NH Rank

County Margin Value* Value (of 10)

Health Factors  

Social & Economic Factors 10

High school graduation 76%   89% 84%  

College degrees 17% 15-19% 35% 32%  

Unemployment 5% 5-6% 3% 4%  

Children in poverty 17% 13-21% 7% 9%  

Income inequality 40   40 41  

Inadequate social support 24% 21-27% 16% 17%  

Single-parent households 9% 6-12% 7% 8%  

Homicide rate     1 2  

* 90th percentile, i.e., only 10% are betterNote: Blank values reflect unreliable or missing data

Coos Health Factors: Physical Environment

 

Coos Error Target NH Rank

County Margin Value* Value (of 10)

Health Factors  

Physical Environment 10

Air pollution-particulate matter days 1   1 1  

Air pollution-ozone days 8   0 4  

Access to healthy foods 56%   61% 42%  

Liquor store density 1.8   0.5 0.7  

* 90th percentile, i.e., only 10% are betterNote: Blank values reflect unreliable or missing data

Economic Impact On Health & Health Impact on the

Economy

Health As An ‘Economic Engine’

• Health Becomes A Form Of Capital

• Health Expenditures Become Investments

Microeconomics of Health

• Directly increases – the number of working years– the productivity of each year of work,

• Indirectly enhances – education,– personal, family, and business income

Economic Loss To Business From Illness

• Absenteeism – 2 million FTEs per year– ¼ of workers – 1 workday/month either absent from work

or exhibit reduced productivity at work

• Depression – average of 5.6 lost hours productivity/week– Cost to employers of $44 billion per year

• Pain – productivity loss of over $61 billion per year• Employee Turnover – pre-employment history of a

single hospitalization due to a chronic illness is associated with a 20% increase – high replacement costs– loss of the benefits of long-term experience

Overall Economic Impact

• Chronic conditions cost to employers– exceeded $1 trillion in 2003 – may reach $5.7 trillion by 2030

• Improvements in survival and health in the United States from 1970 to 1999 increased the value from the output of the formal labor force by as much as 8%.

Macroeconomic

• Increase – Internal investment– External investment

• Alter the long-term demographics of a population

Investments

• Internal – Increasing savings that provide financial

capital for investment

• External – Better population health encourages

outside investment, technology transfer, and access to global markets

– Poor health conditions raise concerns about the capability of the local workforce to meet the needs of investors

Non-healthcare Determinants Of Health

• Medical care is a relatively minor contributor to overall health• More potent influences on health include:

– increasing health-promoting personal behaviors, – reducing environmental health hazards, and – improving basic social systems that facilitate health.

• Education– Link between health and economic development– Unhealthy children

• Not prepared for school• Miss more school• Attend school fewer years• Learn less when in school

• Community-based and participatory processes– directly involve the region's citizens in the debate, research,

policy design, and evaluation of any interventions

Health = Economic Growth

Historical studies have found that half of the overall economic growth in the United States during the last century may be associated with improvements in population health.

New Hampshire Health Employment

• 3rd in average annual employment (12.8% of total) - 2008– 27.7% (14,999 jobs) average annual

increase 2000 - 2008

• 2nd in average annual wages

(13.8% of total) 2008– 82.1% ($1.5 billion) average annual

health care wage increase 2000 – 2008

Impact of New Hampshire Hospital Systems on Coos County

EconomicIndicator

DirectImpact Multiplier

Secondary Impact

Total Impact

Employment 1,031 1.51 526 1,557

Income $58,127,882 1.30 $17,438,365 $75,566,247

SOURCES: 2008 Audited Financial Statements, New Hampshire Hospital Association; mutilpliers from IMPLAN, Minnesota IMPLAN Group, Inc.

Next Steps

• Pick Priorities

• Implement Strategies

• Evaluate Efforts

• Assess Needs and Resources

• Find Programs and Policies that Work

Thank You

Detailed Information on Weighting of Indicators

Health Outcome Weights

OutcomeFocusArea

Measure

Mortality (50%)

Prematuredeath

Years of potential life lost before age 75 (50%)

Morbidity (50%) 

Quality of life

Percent reporting poor or fair health (10%)

Physically unhealthy days (10%)Mentally unhealthy days (10%)

Poor birthoutcomes

Low birthweight live births (20%)

Health Factor Weights: Health Behaviors

   Health Factor

Focus Area Measure

Health Behaviors

(30%)

Smoking (10%) Adult smoking rate (10%)

Diet and exercise (10%)

Adult obesity rate (10%)

Alcohol use (5%)Binge drinking (2.5%)

Motor vehicle crash death rate (2.5%)

Unsafe sex (5%)Chlamydia rate (2.5%)

Teen birth rate (2.5%)

Health Factor Weights: Clinical Care

    Health Factor

Focus Area Measure

Clinical Care

(20%)

Access to care (10%)

Adult uninsured rate (5%)

Primary care provider rate (5%)

Quality of care (10%)

Hospitalization rates for ambulatory-sensitive conditions (5%)

Diabetic screening rate (2.5%)

Hospice use rate (2.5%)

Health Factor Weights: Social and Economic

   Health Factor

Focus Area Measure

Social and Economic Factors

(40%)

Education (10%) High school graduation rate (5%)

Adults with college degrees (5%)

Employment (10%) Unemployment rate (10%)

Income (10%)Children in poverty (7.5%)

Income inequality (2.5%)

Family and social support (5%)

Social and emotional support (2.5%)

Single-parent households (2.5%)

Community safety (5%)

Violent crime or homicide rate (5%)

Health Factor Weights: Physical Environment

   Health Factor

Focus Area Measure

Physical Environme

nt (10%)

Environmental quality (5%)

Unhealthy air quality due to particulate matter (2.5%)

Unhealthy air quality due to ozone (2.5%)

Built environment

(5%)

Access to healthy foods (2.5%)

Liquor store density (2.5%)

County Health Rankings

• Where we live, learn, work, and play influences how healthy we are and how long we live.

• Purpose - “Call to action” for state and local health departments to develop broad-based solutions with others in their community so all residents can be healthy.