Improving Health
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This document summarizes a presentation given by Karen Timberlake on improving health at the Wisconsin Women's Health Foundation Gathering. It discusses how the US spends more on healthcare than other countries but has poorer health outcomes. It highlights factors outside of clinical care like behaviors, social and economic factors, and the physical environment that influence health. The presentation provides examples of collaborative community efforts in Brown and Menominee counties to improve early childhood development and reduce childhood obesity. It encourages participants to think about how they can influence health through their work and leadership in their communities.
Improving Health
- 1. Wisconsin Women’s Health Foundation The Gathering November 13, 2012 Karen Timberlake Director, UW Population Health Institute
- 3. How healthy are we as a country and as a state? What matters to improving health? What’s working to improve the health of individuals and communities? What can you do?
- 4. Thegoal: “Everyone living better longer.” ◦ Length of life, quality of life, health disparities Prevention (when possible) is better than cure It’s easier to be healthy when you live, work, learn, play in a “healthy place” 4
- 5. Country Rankings 1.00–2.33 2.34–4.66 4.67–7.00 AUS CAN GER NETH NZ UK US OVERALL RANKING (2010) 3 6 4 1 5 2 7 Quality Care 4 7 5 2 1 3 6 Effective Care 2 7 6 3 5 1 4 Safe Care 6 5 3 1 4 2 7 Coordinated Care 4 5 7 2 1 3 6 Patient-Centered Care 2 5 3 6 1 7 4 Access 6.5 5 3 1 4 2 6.5 Cost-Related Problem 6 3.5 3.5 2 5 1 7 Timeliness of Care 6 7 2 1 3 4 5 Efficiency 2 6 5 3 4 1 7 Equity 4 5 3 1 6 2 7 Long, Healthy, Productive Lives 1 2 3 4 5 6 7 Health Expenditures/Capita, 2007 $3,357 $3,895 $3,588 $3,837* $2,454 $2,992 $7,290 Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity). Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).
- 6. Source: Muennig and Glied, Health Affairs 29, No. 11 (2010)
- 7. US spends more on health care than any other industrialized nation and yet we trail all developed nations in length and healthiness of life What should we do to improve health? Co-chairs: ◦ Mark McClellan, former head of CMS under President George W. Bush ◦ Alice Rivlin, former head of OMB under President Bill Clinton http://www.commissiononhealth.org/AboutUs.aspx
- 8. Become a smoke-free nation Ensure that all children have high quality early developmental support Create public-private partnerships to open and sustain full-service grocery stores in communities without access to healthful foods Require all schools (K-12) to include time for all children to by physically active every day http://www.commissiononhealth.org/AboutUs.aspx
- 9. Develop a “health impact” rating for housing and infrastructure projects; create incentives for healthier infrastructure development Ensure that decision-makers in all sectors have the evidence they need to build health into public and private policies and practices http://www.commissiononhealth.org/AboutUs.aspx
- 10. 4 of 5 physicians say unmet social needs are directly leading to worse health 4 of 5 physicians say patients’ social needs are as important as their medical conditions 4 of 5 physicians are not confident of their ability to address social needs Physicians would like to write prescriptions for fitness, nutrition, transportation assistance, employment, adult education, housing http://www.rwjf.org/files/research/RWJFPhysiciansSurveyExecutiveSummary.pdf
- 12. HEALTH MORTALITY (LENGTH OF LIFE): 50% OUTCOMES MORBIDITY (QUALITY OF LIFE): 50% Tobacco use Diet & exercise HEALTH BEHAVIORS (30%) Alcohol use Sexual activity Access to care CLINICAL CARE (20%) Quality of care HEALTH FACTORS Education Employment SOCIAL & ECONOMIC FACTORS Income (40%) Family & social support Community safety POLICIES & Environmental quality PROGRAMS PHYSICAL ENVIRONMENT (10%) Built environment County Health Rankings model © 2012 UWPHI
- 13. Where you live matters to your health. There are many factors that influence health. Improving health is everyone’s responsibility and we all -- businesses, health care providers, government, consumers, and community leaders -- need to work together to find solutions.
- 14. Because health depends upon, and is influenced by, the entire community, all sectors need each other’s participation and expertise to make progress. While personal responsibility is important when it comes to health, it must also be linked to a larger discussion about how policy change can make healthy choices easy choices.
- 15. www.countyhealthrankings.org 15 HEALTH OUTCOMES – MORBIDITY AND MORTALITY ‣ Top 5 – St. Croix – Ozaukee – Taylor – Iowa – Vernon ‣ Bottom 5 – Jackson – Adams – Milwaukee – Marquette – Menominee 15
- 16. www.countyhealthrankings.org 16 HEALTH FACTORS – BEHAVIORS, CLINICAL CARE, SOCIAL/ECONOMIC FACTORS, PHYSICAL ENVIRONMENT ‣ Top 5 – Ozaukee – Waukesha – Dane – La Crosse – Pierce ‣ Bottom 5 – Racine – Juneau – Adams – Milwaukee – Menominee
- 17. Which states have the best adult smoking rates? Some counties in WI are as low as 13% - others as high as 29% - what’s the difference?
- 18. Binge + heavy drinking 4 drinks for women, 5 drinks for men on a single occasion 1 drink for women, two drinks per day for men, on average
- 19. For how many days during the past 30 was your mental health not good? Considering: stress, depression, problems with emotions
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- 37. What aspects of life outside of a hospital or clinic support or hinder health? ◦ Health begins where we live, learn, work, worship, play What can you do to support improvement in those conditions? Who else can have an impact? How can you help get others to the table?
- 39. Health care Public health Foundations (including community foundations) United Way Chambers of Commerce Rotary/Civic organizations Large employers Churches/faith organizations Schools City planning/local government Community non-profits ______________________?
- 42. What’s the goal? ◦ School readiness for all Brown County children, starting with at-risk families Who’s involved? ◦ United Way ◦ Hospitals ◦ Early childhood ◦ County human services ◦ Elected officials ◦ Private sector business leaders
- 43. What have they accomplished? ◦ Last year, over 1100 first time parents received Welcome Baby Visits in the hospital, and 320 families were connected with further services How have they done it? ◦ Central coordinating agency ◦ Clear metrics and means of tracking ◦ Commitment among participants to common strategies ◦ Found an evidence-based model and adapted it slightly to their needs
- 44. What’s the Goal? ◦ Improve success for Menominee children in school ◦ Address health challenges for Menominee children and families, starting with childhood obesity
- 45. Who’s Involved? ◦ Schools ◦ Health clinic ◦ College of Menominee Nation ◦ Local health department What have they accomplished? ◦ Mapped community assets against County Health Rankings indicators ◦ Chose childhood obesity as a priority ◦ Developed 90 day action plans to improve physical environment to promote health
- 46. How have they done it? ◦ Created a shared understanding that neither health nor school performance can be improved in a vacuum—root causes are common to both ◦ Leadership ◦ Data ◦ Models of action
- 47. Opportunities to improve health, not just healthcare, exist in your “day jobs” and in your communities Tools, resources, models exist to help Your experiences, networks, connections are important Think of yourselves as leaders with important knowledge and social capital who can make a real difference
- 48. From the Juneau County Community Health Needs Assessment: Everyone needs to make a concerted effort to help populations become healthier. Efforts to change people’s behavior cannot be viewed as “oh it’s just the doctors, or health department’s or etc., responsibility.” We all need to put our reputations and names on the line and support one another to increase the credibility of what we are trying to do and help support the change we hope to accomplish with our population. In addition, we cannot rely on others totally for making referrals for residents who need services and resources; we need to educate and empower the consumer. 48
- 49. Wisconsin Partnership Program, UW School of Medicine and Public Health The Robert Wood Johnson Foundation and the County Health Rankings & Roadmaps team
- 50. ktimberlake@wisc.edu County Health Rankings & Roadmaps http://www.countyhealthrankings.org/ UW Population Health Institute http://uwphi.pophealth.wisc.edu/
Editor's Notes
- #12: Transition: Having looked at model and measures, now we will take brief look at county example – what does it look like on our website?KEY POINTFor purposes of this presentation, will go to Wisconsin and then to Dane County (UW Population Health Institute is in Madison, which is in Dane County).Note to Presenter: The following slides are screenshots taken from the website. You may want to create your own slides with a different state/county or use the hyperlink in the title of this slide to go directly the website.
- #13: Introduce CHR. Discuss model (including its simplicity) and how rankings can add context to the conversation.Reflect important aspects of population health that can be improvedValid, reliable, recognized and used by othersAvailable at the county-level Available for free or low costAs up-to-date as possibleFewer measures better than more24 measures of health factors
- #19: Alcohol is associate with not just accidents and injury, but HypertensionHeart attackUnintended pregnancy and STIsInterpersonal violence including domestic violence
- #39: Long term commitmentBy a group of important actorsFrom different sectorsTo a common agendaFor solving a specific problemWith shared measurementMutually reinforcing activitiesSupported by an independent backbone organization
- #41: Evidence of effectiveness is one of many factors to consider when choosing a strategy to solve a community health challenge. Community ‘fit,’ readiness, priorities, capacity, and resources are also important considerations.