Community Health Assessment and Public Health Improvement Plan for Larimer County

1. Community Health Assessment and Public Health Improvement Plan for Larimer County HAPPI Leadership Team Meeting January 17, 2012

2. Acronyms! • CHAPS- Community Health Assessment and Planning System. Term used by state health department (CDPHE) • HAPPI - Health Assessment and Planning Partnership Initiative - the name of our local initiative • CHA - Community Health Assessment • PHIP- Public Health Improvement Plan • CHA/IP = CHA/PHIP

3. Why are we here today? We hope participants will want to collaborate to: • meet mutual needs & requirements • improve the health of the people of Larimer County

4. Health Department perspective • LCDHE is kicking off a CHA/PHIP effort over the next nine months, to comply with new state public health statutes. • Today is the initial meeting of the Leadership Team, which will guide a community effort to identify 1-5 priority health issues to improve health in Larimer County • We will be discussing the process/timeline, roles, and asking you to commit to the role(s) you select

5. Potential hospital benefits Beginning 3/23/2012, each non-profit hospital will have to comply with new “community benefit” IRS regulations that require: • A Community Health Needs Assessment (CHNA) done at least every three years • Strategies to address needs identified through CHNA • Input from persons representing the broad interests of the community, including public health experts

6. Relevance to other organizations Other local organizations, including: • Health District of Northern Larimer County • Community Health Centers (Salud, Loveland Community Health Center/Sunrise) • Larimer Co. Department of Human Services • Area Agency on Aging …and others, have Board requirements or legal mandates to periodically assess the health or other needs of the community

7. State Process – CHAPSCommunity Health Assessment and Planning System Guidance • Required by SB08-194 • Within 5 years of creation of state plan (Dec ‘09), and at least every 5 years thereafter, counties must do a CHA and create a PHIP based on the assessment that is “not inconsistent” with the state plan • 2009 State plan is currently focused on improving the public health system rather than improving public health • Future state plans will use the content of county/regional plans to help focus the state’s public health priorities

8. Overall process • Use Community Health Assessment findings to concentrate on 10-15 issues for larger stakeholder group to consider in a prioritization process, with a goal to select a smaller number (perhaps 1-5 issues) to focus on in a health improvement plan • Plan is not a local health department plan, but a community plan for the jurisdiction boundaries (Larimer County)

10. Timeline • Two phase process: • Phase 1: Community Health Assessment ~ January – March/April • Phase 2: Prioritization and Planning ~ April – July/August

11. What is Community Health Assessment? • Dynamic and ongoing process • Identifies dimensions of health status to be described • Acquires, summarizes, and interprets relevant data in order to reveal the health status of a community and groups within the community

12. Why do a CHA/IP? • Basis for decision making about where to focus resources and interventions – (prioritization) • Ensure that all members of partnership have an understanding of the issues • Ensure that interventions will be designed, planned, and carried out in a way that maximizes benefit to the community

13. Why do a CHA/IP? (cont.) • Influence others in the community and enlist support and resources for efforts • Understand where partnership is starting, and what kinds of things we want to track along the way in order to determine our efforts are contributing to change

14. Community Health Assessment Components • Engage community partners (we’re here!) • Describe the community and its health status • Collect existing data and reports • Identify gaps in existing data • Integrate and interpret the data to identify top issue areas • Research strategies for top issue areas • Can they be measured for progress? • Prioritize top issue areas • Assess capacity to intervene effectively, interest, resources, lead agencies or champions • Develop an action plan and implement

15. Larimer County CHA/IP approach • Utilize secondary data (already collected) • Identify data gaps that might be addressed in future • Avoid duplicating existing efforts • Provide a useful resource for the entire community • Help fulfill other mandates or requirements

16. HAPPI Organization Chart Core Planning Team Leadership Team Data subcommittee Prioritization and Planning Stakeholders Group

17. HAPPI Team Roles • Core Planning Team – Internal to LCDHE; provides guidance and direction to Project Manager • Leadership Team – Develops guiding principles for data subcommittee when selecting indicators; selects 10-15 topic areas/indicators for consideration by Prioritization and Planning Stakeholders Group • Data subcommittee – Reviews data sources and recommends subset of ~30-40 indicators for consideration by Leadership Team • Prioritization and Planning Stakeholders Group – Selects 1-5 priority issues and works on action plan

18. HAPPI Leadership Team • Responsible for selecting 10-15 high priority issue areas/indicators for consideration by Prioritization and Planning Stakeholders Group • Develops guiding principles for the data subcommittee to use when selecting potential indicators

19. HAPPI Leadership Team (cont.) • Individuals from key organizations who: • hold a leadership position within their organization which is key to the successful creation and implementation of a comprehensive, county-wide health improvement plan; and/or • have expertise in the area of health data and statistics • Meets monthly, January – July/August

21. Potential models • We want your input about how to frame the approach to CHA • Most of the other larger counties/regions who are further along in the process have completed the majority of CHA internally, asking for community input at prioritization – we want to know what YOU want the CHA to look like • We can adopt an existing framework, modify an existing one for our purpose, or come up with something new (within our limited timeframe)

22. Examples of existing models • Colorado’s 10 Winnable Battles • Health Equity Model • National Prevention Strategy • Healthy People 2020 Leading Indicators • County Health Rankings • UHF - State Health Rankings • CO Health Foundation – Report Card • Community Health Status Rankings • Other suggestions?

23. Colorado’s 10 Winnable Battles • Clean Air • Clean Water • Infectious Disease Prev. • Injury Prevention • Mental Health and Substance Abuse • Obesity • Oral Health • Safe Food • Tobacco • Unintended Pregnancy • These were selected because: • They are important • Can be impacted • There is a capacity to improve

24. Colorado’s 10 Winnable Battles - Features • Addresses ten broad issue areas • Aligned with CDC Winnable Battles and Seven Priorities for EPA’s future • Chosen because: 1) important; 2) have ability to impact; 3) there is capacity to improve • No graphic representation of framework

25. INSERT HEALTH EQUITY MODEL

26. Health Equity Model - Features • Incorporates life stages, social/economic/environmental determinants of health, and individual health factors into overall population health outcomes • Describes Public Health’s role in addressing social determinants of health • CDPHE used this framework to develop Colorado Health Data indicators website

27. 1 Overarching Goal 4 Strategic Directions 7 Health Priorities

28. National Prevention Strategy - Features • Focus is on solutions/strategies rather than problems • 1 Overarching goal, 4 Strategic Directions, 7 Priorities

29. Healthy People 2020 Leading Indicators • Conceptual framework combined two models: • life course model • health determinants and health outcomes • 12 issue areas = 12 indicators (one indicator for each high-priority issue area) • 24 objectives

30. HP 2020 Leading Indicators - Features • Incorporated the life course health model in selecting indicators • 12 Topics – Topic is defined as a general category relevant to health • 12 Leading Health Indicators – Defined as measurement of health-related concepts that reflect major public health concerns • 24 Objectives – 1-4 for each Indicator; defined as a statement of movement in an indicator toward a quantitative target

31. County Health Rankings

32. County Health Rankings - Features • Ranks Colorado counties according to summary measures of health outcomes and health factors • Four health factors (health behaviors, clinical care, social and economic factors, physical environment) • Two health outcomes (morbidity and mortality) • Comparison with National and State benchmarks

33. United Health Foundation – America’s Health Rankings

34. UHF America’s Health Rankings - Features • Considers four groups of health determinants (behaviors, community and environment, public and health policy, and clinical care)\ • Combines measures to determine overall rank

35. CO Health Foundation – Health Report Card • Describes how Colorado compares to other states on 38 indicators • Organized by five life stages—Healthy Beginnings, Healthy Children, Healthy Adolescents, Healthy Adults and Healthy Aging • Assigns letter grade (A-F) to each life stage

36. Community Health Status Indicators (CHSI) • www.communityhealth.hhs.gov • Community health profile of key health indicators (county level) • Birth and death statistics, leading causes of death, infectious disease cases, air quality, preventive services use, access to care, etc. • Compares to peer counties

37. Reaction? • What do you like/not like about the various approaches? • Strengths/weaknesses of each approach • Are there any “must include” concepts?

38. Possible guiding principles for selecting important health issues (slide 1 of 2) • Severity of problem • Number of people affected • Greatest impact on quality of life • Highest disease burden • Worsening (or not improving) trends over time • Greatest disparities between population groups • Greatest impact on health care costs • Most amenable to evidence-based interventions • Matches priorities/goals adopted by state, national efforts

39. Possible guiding principles for selecting important health issues (slide 2 of 2) • Broad-based strategy that impacts numerous health issues • Focus on at least one issue for each broad age group • Most supported by public? By policy makers? By funders? • Largest gaps between current status and state/national goals • Worse than “peer counties” • Worse than state, national measures • Others?

40. Next Steps… • Establish Leadership Team meeting schedule through August • Convene Data Subcommittee meeting (late January) • Begin compiling data for Community Health Assessment phase • Begin thinking about who should be included in Phase 2/Prioritization and Planning • Wiki page for updates

41. General Meeting Schedule