The County Health Rankings:How We Got Here

Together We Can SummitApril 14, 2011

Brenda Henry, PhD, MPHRobert Wood Johnson Foundation

Julie A. Willems Van Dijk, RN, PhDUniversity of Wisconsin

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Robert Wood Johnson Foundation

Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Stockholm: Institute of Futures Studies, 1991.

Independent Inquiry into Inequalities in Health Report (1998) chaired by Sir Donald Acheson

'The system of influences on Scotland’s health and wellbeing that can be affected by Scottish public policy'

Scottish Council Foundation, The Wellbeing Project. Accessed online at http://www.thewellbeingproject.org/system.htm 8/24/2007.

Influences on Health: Broadening the Focus

RWJF Commission to Build a Healthier America. Overcoming Obstacles to Health, 2008

Building on the Commission’s work, the County Health Rankings story

begins in early 2008…

Wisconsin County Health Rankings

2003-2008

America’s Health Rankings

• Ranks the overall health of all 50 states, from healthiest to least healthy.

• First published in 1990 and annually thereafter.

• Uses a model that summarizes the overall health of each state.

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Fifty-state, county-by-county ranking reports Health Outcomes Health Factors

First report of its kind Standardized measures of overall health for almost every county in U.S.

Every state can see how its counties compare

County-level snapshot on health outcomes and factors that influence health

Partnership between RWJF and UWPHI Reports for 3 years First report released February 17, 2010 Second report released March 30, 2011

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

• Many factors contribute to health. Health is more than health care.

• The County Health Rankings is one of many tools for communities to figure out where they are doing well and where they are not -- so they can work together to make changes.

Moving to Action: Key Messages

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• Change begins by bringing together community leaders to identify what steps need to be taken to build a healthier community.

• The Rankings are not about a race to the top. They are a tool for advocating for improvement.

Moving to Action: Key Messages

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Outline

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Logic Model

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Community safety

Education

Family & social support

Employment

Built environment

Environmental quality

Income

Unsafe sex

Alcohol use

Diet & exercise

Tobacco use

Access to care

Quality of care

Physical environment(10%)

Social & economic factors(40%)

Health behaviors(30%)

Clinical care(20%)

Health Factors

Programs and Policies

Health OutcomesMortality (length of life): 50%

Morbidity (quality of life): 50%

County Health Rankings model © 2010 UWPHI

Do we know how much each of the major determinants contributes to health?

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a. Historical perspectiveb. Literature reviewc. Analysis of ability to predict health outcomes

Historical Perspective

• 1930-1950: Sanitary revolution and improvements in environmental health

• 1950-1970: Increasing role of health care• 1970-1990: Contribution of health behaviors

(smoking/diet/exercise) increases• 1990-present: Social and economic

determinants

Review of the Literature

Review of the Literature

• The oft cited McGinnis et al (2002) paper states: "...using the best available estimates, the impacts of various domains on early deaths in the US distribute roughly as follows:

– genetic predispositions, about 30%; – social circumstances, 15%; – environmental exposures, 5%; – behavioral patterns, 40%; and – shortfalls in medical care, 10%.”

a. Based on historical perspectiveb. Based on a review of the literaturec. Based on ability to predict health outcomesd. Based on need to engage stakeholderse. None of the abovef. All of the above

Determining Weights for the County Health Rankings

Central Michigan Health Factors

CountyHealth

Behaviors30%

Clinical Care20%

Social & Economic

40%

Physical Environment

10%

Arenac 31 77 67 16

Clare 67 72 78 6

Gladwin 77 79 73 25

Isabella 16 78 13 40

Osceola 34 45 57 34

Roscommon 68 21 76 1

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Central Michigan Overall Rankings

CountyHealth

OutcomesHealth Factors

Arenac 63 65Clare 82 76Gladwin 76 80Isabella 33 19Osceola 47 46Roscommon

75 66

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throughCounty Health Rankings

Setting goals and objectives for overall health

Keeping track of progress

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Mobilizing Action Toward Community Health

February 2010: Inaugural release of County Health Rankings

October 2010: RWJF Board of Trustees approves new MATCH initiative

March 2011: 2nd release of County Health Rankings & Community Grants Call for Proposals

Throughout 2011: More to come!

MATCH Center

Online Solutions Strategy

Training/Technical Assistance

National Population Health Award

UWPHIMATCH Center Lead

To be AnnouncedMATCH Policy Advocacy Lead

National MATCH Strategy

National Partner Grants

MATCH Initiative

County Health Rankings

MA

TC

H A

dvis

ory

Gro

up

Community Grants Program

Policy and Advocacy Training/Technical Assistance

Evaluation

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MICHIGAN

KANSAS

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WISCONSIN

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www.countyhealthrankings.org

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Taxes, Clean Indoor Air Policies

Menu labeling, School Food Policies

Work force development

Minimum wage, Paid family/medical leave

Reduce alcohol outlet density

Partner referral services

Expand early childhood programs

Nurse home visiting programs

Zoning/incentives for mixed use development

Reducing bus emissions

Pedestrian/cycling in master plans

Coverage, medical homes

EHRs, Public Reporting, Payment Reform

The MATCH Projectand the County Health Rankings

• The Wisconsin MATCH Team– Patrick Remington, Bridget Booske, David Kindig,

Julie Willems Van Dijk, Jessica Athens, Angela Russell• Robert Wood Johnson Foundation

– Brenda Henry, Michelle Larkin, Jim Marks, Joe Marx, Pamela Russo, Abbey Cofsky

• Our Partners– CDC, NCHS, ASTHO, NACCHO, NNPHI, Leah Devlin,

Dartmouth Institute, 11-member Metrics Advisory Group

For More Information

www.countyhealthrankings.org

Julie Willems Van DijkUniversity of WI Population Health Institute

Madison, WIwillemsvandi@wisc.edu

608-263-6731

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