in health matters, place matters -the health opportunity ......dec 15, 2016  · to identify hoi...

In Health Matters, Place Matters -The Health Opportunity Index

(HOI)

Virginia Department of HealthOffice of Health Equity

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Identifying the Problem

0

5

10

15

20

25

30

35

40

45

50

Teen

Bir

th R

ate

Hig

h Bl

ood

Pres

sure

Vege

tabl

es

Disp

arit

y in

Hea

lth

Stat

us

Diab

etes

Stro

ke

Lack

of

Hea

lth

Insu

ranc

e

Card

iova

scul

ar D

eath

s

Infa

nt M

orta

lity

Frui

ts

Prim

ary

Care

Phy

sici

ans

Canc

er D

eath

s

Chol

este

rol C

heck

Low

Bir

thw

eigh

t

Obe

sity

Phys

ical

Inac

tivi

ty

Exce

ssiv

e Dr

inki

ng

Hig

h Sc

hool

Gra

duat

ion

Smok

ing

Air

Pollu

tion

Une

mpl

oym

ent

Annu

al

Hig

h Ch

oles

tero

l

Prem

atur

e De

ath

Suic

ide

Hig

h H

ealt

h St

atus

Prev

enta

ble

Hos

pita

lizat

ions

Infe

ctio

us D

isea

se

Child

ren

in P

over

ty

Drug

Dea

ths

Poor

Phy

sica

l Hea

lth

Days

Poor

Men

tal H

ealt

h Da

ys

Viol

ent

Crim

e

Source: American Health Rankings by United Health Foundation Released 12/15/16

America’s Health RankingsUnited Health Foundation Scorecard

Overall Ranking = 19th

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HEALTH OUTPUT – RACIAL/ETHNIC

The State of Population Health

Source: Dr. Edward Ehlinger, Minnesota Commissioner of Health2016 President’s Challenge for the Association of State and Territorial Health Officials (ASTHO)

Opportunity Differences Geographic

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

Poverty Below 50 Poverty Below 100Poverty Below 125Poverty Below 150Poverty Below 185Poverty Below 200

Rural

Urban

Virgina

Gap @ 200

Gap @ 150 FPL

Gap @ 125 FPL

Gap @ 100 FPL

Poverty Gradient (Rural & Urban) in Virginia

Opportunity Differences Racial/Ethnic

All White Black

Hispanic or Latino Origin Asian

American Indian and Alaska Native

Native Hawaiian and Other Pacific Islander

Unemployment Rate (2015 Q3) 4.5% 3.4% 8.3% 5.2% NR NR NR

Education: On-Time Graduation Rate (2015) 90.5% 92.9% 86.3% 84% 95.6% 87.9% 94.4%Poverty: Less than 50% FPL 5.2% 4.2% 9.2% 6.4% 3.8% 7% 7.4%Poverty: Less than 100% FPL 11.4% 9.2% 20.1% 15.8% 8.3% 13.9% 11%Poverty: Less than 125% FPL 15.2% 12.3% 25.7% 21.4% 11.3% 18.7% 13.6%

Source: EPI analysis of Bureau of Labor Statistics Local Area Unemployment Statistics (LAUS) data and Current Population Survey (CPS) data;Virginia Department of Education State-level Cohort Report, Class of 2015; U.S. Census Bureau, 2010-2014 American Community Survey 5-Year Estimates.

Identifying the Means to a Solution

0

5

10

15

20

25

30

35

40

45

50

Teen

Bir

th R

ate

Hig

h Bl

ood

Pres

sure

Vege

tabl

es

Disp

arit

y in

Hea

lth

Stat

us

Diab

etes

Stro

ke

Lack

of

Hea

lth

Insu

ranc

e

Card

iova

scul

ar D

eath

s

Infa

nt M

orta

lity

Frui

ts

Prim

ary

Care

Phy

sici

ans

Canc

er D

eath

s

Chol

este

rol C

heck

Low

Bir

thw

eigh

t

Obe

sity

Phys

ical

Inac

tivi

ty

Exce

ssiv

e Dr

inki

ng

Hig

h Sc

hool

Gra

duat

ion

Smok

ing

Air

Pollu

tion

Une

mpl

oym

ent

Annu

al

Hig

h Ch

oles

tero

l

Prem

atur

e De

ath

Suic

ide

Hig

h H

ealt

h St

atus

Prev

enta

ble

Hos

pita

lizat

ions

Infe

ctio

us D

isea

se

Child

ren

in P

over

ty

Drug

Dea

ths

Poor

Phy

sica

l Hea

lth

Days

Poor

Men

tal H

ealt

h Da

ys

Viol

ent

Crim

e

Source: Adapted from American Health Rankings by United Health Foundation Released 12/15/16

America’s Health RankingsUnited Health Foundation Scorecard

Overall Ranking = 1st

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VIRGINIA STATE HEALTH IMPROVEMENT PLAN

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Source: King County (WA) Equity and Social Justice Annual Report December 2015

DESIGN AND METHODS

Health Opportunity Index

Identifies areas and populations that are most vulnerable to adverse health outcomes based on the Social

Determinants of Health

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Healthy People 2020:Five Elements of SDOH

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Educational Attainment

Population Density

Spatial Segregation

Material Deprivation

Population Churning

Job Participation

Income Diversity

Affordability of Housing and

Transportation

EPA Environmental

Hazards

Food Access

Walkability

Access to Care

Employment Access

HOI

Health Opportunity Index

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19

Geographic Level Can Mask Detail

Structure

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30+ Variables

13 Indicators

4 Profiles

1 Health Opportunity Index

Selecting Indicators

1. Identified by Local Health Departments & Stakeholders as important.

2. Linked to health outcomes in academic literature.

3. “Actionable” (e.g., segregation vs race)

4. Consistent, quality data for all Census Tracts in Virginia.

Health Opportunity Index

Community Environmental Profile

Economic Opportunity Profile

Consumer Opportunity Profile

Wellness Disparity Profile

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Air Quality Index (EPA)

Neurological Risk

Cancer Risk

Respiration Risk

On-road Pollution

Non-road

Non-point

Population Churning Index

Inflow Mobility

Outflow Mobility

Population-WeightedDensity

Walkability Index

Density

Diversity (Land-use)

Design (Connecti

vity)

Distance to Transit

Community Environmental Profile

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Consumer Opportunity Profile

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Affordability Index

Housing Cost

Transportation Costs

Average Income

Education Index

Avg. Years of Schooling

Food Accessibility

Index

% Low Income

% Low Access to Major Grocery Store

Distance to Grocery Store

Material Deprivation

Index

Unemployment

Autoless Homes

Home Ownership

Overcrowding

Economic Opportunity Profile

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Employment Access Index

Number of Jobs

Distance to Jobs

Income Inequality Index

Gini Coefficient

Job Participation Index

% of Working Age Population in the

Labor Force

Wellness Disparity Profile

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Access to Care Index

% Uninsured

Primary Care Physician FTEs within 30 miles

Segregation Index

Race/Ethnicity

Population

Spatial Influence Weighting

Uses of the HOI

To show that place matters when it comes to health To identify the impact of social determinants of health

on statewide health landscape To identify HOI indicators that are most influential on

local health To learn from communities with good health despite

adverse HOI indicators To build collaboration across all sectors to promote

health equity

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DISPARITIES & THE HOI

Monotonicity of HOI

Life Expectancy at BirthDisability Free Life

Expectancy

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Monotonicity of HOI

Infant Mortality Low Birth Weight

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Predictive Analytics for Low Birth Weight (Low HOI)

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Predictive Analytics for Low Birth Weight (High HOI)

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0.000 5.000 10.000 15.000 20.000 25.000 30.000

Employment Accessibility

Job Participation

IncomeEquality

Townsend Deprivation

PopDensity

PopChurning

AirQuality

HealthCare Accessibility

Walkability

Education

RacialDissimilarities

FoodAccess

Affordability

Three River Health District HOI

Rural/Urban Disparities

Rural-Urban Commuting Areas

Health Opportunity IndexUrban Areas Rural Areas

Profiles

For more informationplease contact:

Adrienne McFadden, MD, JDAdrienne.mcfadden@vdh.virginia.gov

Justin Crow, MPAJustin.crow@vdh.virginia.gov

Rexford Anson-Dwamena, MPHRexford.Dwamena@vdh.virginia.gov

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