Module 4: Health Indicators in Action (Examples of Indicator Projects)

1. Module 4: Health Indicators in Action (Examples of Indicator Projects) Cheryl Wold, MPH Wold and Associates for the National Library of Medicine

2. 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 4

3. 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 Health Indicators, Part 4

4. 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 Health Indicators, Part 4

5. 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?

6. 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

7. 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 Health Indicators, Part 4

8. 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

9. 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. Health Indicators, Part 4

10. 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 ManagPract. 2009 Jan-Feb;15(1):24-32. Health Indicators, Part 4

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

12. County Health Rankings Home Page - California

13. County Health Rankings Home Page – Snapshot 2010: Los Angeles

14. County Health Rankings Home Page – Health Factors Rankings

15. Health Factors Map Health Factors

16. Snapshot of 2010 Health Outcomes data for Los Angeles

17. Premature Death Ranking for the State of California.

18. Los Angeles County – Health Behaviors Ranking

19. Health Outcomes Healh Indicators, art 4

20. 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

21. Health Behavior: Tobacco

22. 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

23. Weighted Rankings for Each County/State

24. Health Outcome Weights for the 2010 County Health Rankings Health Indicators, Part 4

25. Examples of the Measures for Health Behaviors and for Clinical Care Health Indicators, Part 4

26. Examples of the Measures for Health Behaviors and for Clinical Care (cont.) Health Indicators, Part 4

27. Take Action

28. Take Action Model

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

30. Find Programs and Policies that Work • General sources of evidence • The Guide to Community Preventive Services • Cochrane Public Health Group - Finding Public Health Reviews • 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, 2010

31. 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. Health Indicators, Part 4

32. The Boston Indicators Project Home Page

33. 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 Health Indicators, Part 4

34. The civic agenda for the Boston Indicators Project

35. The Boston Indicators Project: 8 Health Indicators Health Indicators, Part 4

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

37. Key Features • Framing of the indicators • Rich contextual information • Incorporation of national and local data • Sector Cross Cut (filters) • Hub of innovation Health Indicators, Part 4

38. 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. 

39. 2. Contextual Information • Revised data for trends through 2009 • Contextual information: Local civic agenda and leadership. • Links to multiple other local and national reports.

40. 3. Incorporation of National and Local Data 3. Incorporation of National and Local Data

41. Sector Crosscuts

42. 4. Sector Cross Cuts - Filters

43. Civic Vitality Cultural Life and the Arts Housing; Health

44. Percentage of Bostonians who Feel they can Rely on their Neighbors (2008)

45. Map and Data from the Boston Police Department Boston Police Department; Boston Public Safety Survey 2006 Health Indicators, Part 4

46. 5. Hub of Innovation • For each of the ten sectors, information about innovative strategies--proven or promising – are featured with links for further information. Health Indicators, Part 4

47. Health Innovations Health Indicators, Part 4

48. 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). Health Indicators, Part 4

49. 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

50. Design Framework for Community Health Data Initiative