Creating Conditions In Which People Can Be Healthy

National Public Health Week Celebration

April 11, 2014

Vision: Healthy people in a healthy community without health disparities

Current Context

The Affordable are Act has created new opportunities for public health and primary care

Major causes of morbidity and mortality have shifted

Understanding of health and what makes people healthy or ill changed.

Advantages of community-based interventions

Economic wellbeing is connected to the health of all of our residents

In Search of Better Value The US lags behind its peers on health status while

outspending every country in the world on health, largely in clinical care costs.

Rising spending on medical care diverts funds from education, business development, and other systems that keep nations globally competitive.

We need to make our health dollars buy more. Eliminating inappropriate and unnecessary care Limiting administrative costs Achieving universal access Implementing population-based health improvement

strategies Developing integrated delivery systems

Source: IOM, Primary Care and Public Health: Exploring Integration to Improve Population Health, March 2012

Health Care Spending Paradox Life Expectancy at Birth (yrs), Health Spending by Country

INTEGRATED CARE Reliable and effective care delivery system with a focus on prevention

ONLINE ENGAGEMENT Online resources, health coaching,

mobile apps

ENVIRONMENTAL & COMMUNITY STRATEGIES Support healthy choices

where we live, work, learn and play

Connecting Medical Care With Public Health and Social Services

Integrated Local Health Delivery System

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 Outcomes

Mortality (length of life): 50%

Morbidity (quality of life): 50%

County Health Rankings model © 2014 UWPHI

County Health Rankings Model for Population Health Improvement

2010 2011 2012 2013 2014

Rank Z- Score

Rank Z- Score

Rank Z- Score

Rank Z- Score

Rank Z- Score

Health Outcomes 77 0.37 72 0.35 73 0.32 82 0.53 79 0.44

Mortality 54 0.00 56 0.02 51 -0.02 70 0.17 70 0.17

Morbidity 86 0.37 86 0.33 89 0.34 88 0.35 81 0.27

Health Factors 83 0.29 95 0.55 98 0.66 101 0.85 97 0.63

Health Behavior 53 0.00 88 0.15 76 0.09 75 0.09 66 0.03

Clinical Care 12 -0.11 11 -0.12 32 -0.06 39 -0.02 52 0.00

Social and Economic

94 0.42 100 0.55 101 0.60 101 0.67 97 0.43

Physical Environment

42 -0.01 22 -0.04 90 0.03 101 0.12 102 0.16

2014 Winnebago County Summary Health Rankings Four Year Comparison (2010 – 2014)

Healthy Community Study Health Priorities (2011 – 2015)

Priority Issue Problem Identification Access to Care Improve availability of access to health care, including behavioral

health and oral health care services

Maternal and

Child Health

Develop a coordinated system of intervention services for prenatal,

early childhood and maternal care and support services

Chronic Disease Reduce the burden of morbidity and premature mortality from the

major chronic diseases (i.e. cardiovascular disease, diabetes,

cancer, and chronic lower respiratory disease) by focusing the

contributing factors of obesity and tobacco use

Crime and

Violence

Reduce the incidence of domestic violence and crimes committed

with guns

Healthy Equity Increase awareness of the burden of health disparities and assure

health inequities are a focus of each of the health priorities above.

Maternal Child Health Outcomes

WIC/FCM – 13,923 births (2010-2013), WCHD served 6816 or 49%

LBW has declined for the last seven years by 20% to 8.2% of births (2005-2011) reversing a 25 year increasing trend

Better Birth Outcomes - intensive prenatal home visiting demonstrated inverse relationship with reduced LBW

Teen births for last four years (2008-2011) declined by 22% to an all-time low of 10.8% of births

Family Planning – (2013) served 3,235 unduplicated patients averting an estimated 465 unintended pregnancies, 39% would have been teen pregnancies

Communicable Disease Outcomes Established first in Illinois, long-term Rental

Assistance (LTRA) Program – HIV / AIDS

Successfully diagnosed and treated 31% of all reported STI’s through WCHD’s Sexual Health Clinic, representing some ~ 5000 visits

Chlamydia, gonorrhea and syphilis cases combined have been reduced by 24% since 2007 (2007 – 2011), 2505 to 1902, 854/100,000 to 649/100,000. Illinois at the same time reduced their rate by 16%

Other Outcomes EHI - Increased number of blood lead tests by 33% and

decreased elevated blood lead levels by 53% (from 4.5% to 2.1%, 2005-2009)

IPC - Access to Care (IPC) partnership grant successfully enrolled 3885, assisted 4873, provided 474 community presentation reaching 12,114 since Nov. 2013 (through Mar. 31, 2014)

Preparedness - Pandemic Influenza (2009-2010) vaccinated >46,000/100,000 in 0 – 17 years of age group, almost twice as much as next closest county in urban areas of Illinois

Finance - Funding over the past decade has brought in almost $78M in grant support for population-based prevention health services representing 60% of WCHD’s total funding

Return on Investment (ROI) Primary Prevention Interventions

Intervention Savings/$1 Investment

Prenatal Care $ 3.38 Family Planning $ 4.40 WIC Nutrition $ 2.45 STD Control $ 3.00 HIV Counseling and Testing $ 4.97 MMR Vaccine $14.40 Influenza Vaccine $ 2.27 Community-based Prevention (physical activity, improve nutrition, tobacco use/exposure)*

$ 5.60

* TFAH, NYAM, RWJF, TCE

WCHD Service Summary by Type (2011)

Clients Visits

Clinical Services (Women’s health, Breast/Cervical, STI’s School-based Clinic)

8,126 14,548

Maternal/Child Services (WIC/FCM, Intensive Prenatal Case Management, HealthWorks, TPS)

25,522 54,844

Health Promotion Services (Vision & Hearing, Oral Health, CVD screening, Adult Immunizations)

42,217 50,157

Environmental Health (Neighborhood Environ., Food Protection, Sewage/Water, Soil, Wells

8,149 20,840

TOTAL 84,014 140,389 Samples Tests

Laboratory (Private and Public Water, Microbacterial and Chem., Clinical)

6,126 12,252

Originals Total

Vital Statistics (Birth and Death Certificates)

7,483 31,692

“Public health is purchasable…within natural limitations a community can determine its own death rate by how funding is allocated.”

Dr. H. Biggs NYC Health Commissioner

1914

Defining Success Commitment to evidence-based, informed

practice Reliable funding Continuous quality improvement Competent workforce (e.g. policy

development, administration / management, communication, collaboration, core programs

Transparency Culture of health