improving health
DESCRIPTION
Karen Timberlake, Director, UW Population Health InstituteTRANSCRIPT
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The 80/20 Rule:Improving Health, Not Just
HealthcareWisconsin Women’s Health Foundation
The Gathering November 13, 2012
Karen TimberlakeDirector, UW Population Health Institute
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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?
Overview
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The goal: “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”
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Assumptions
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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).
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
Country Rankings
1.00–2.33
2.34–4.66
4.67–7.00
US v. Industrialized World: Poor Return on Our Healthcare Investment
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Source: Muennig and Glied, Health Affairs 29, No. 11 (2010)
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Robert Wood Johnson FoundationCommission to Build a Healthier America, 2009 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
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Robert Wood Johnson FoundationCommission to Build a Healthier America, 2009
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
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Robert Wood Johnson FoundationCommission to Build a Healthier America, 2009
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
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http://www.rwjf.org/files/research/RWJFPhysiciansSurveyExecutiveSummary.pdf
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
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www.countyhealthrankings.org
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Tobacco use
HEALTH BEHAVIORS (30%)Diet & exercise
Alcohol use
Sexual activity
CLINICAL CARE (20%)Access to care
Quality of care
SOCIAL & ECONOMIC FACTORS (40%)
Education
Employment
Income
Family & social support
Community safety
PHYSICAL ENVIRONMENT (10%)
Environmental quality
Built environment
HEALTH OUTCOMES
MORTALITY (LENGTH OF LIFE): 50%
MORBIDITY (QUALITY OF LIFE): 50%
HEALTH FACTORS
POLICIES & PROGRAMS
County Health Rankings model © 2012 UWPHI
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What the County Health Rankings are teaching us:
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.
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What the County Health Rankings are teaching us: 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.
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15www.countyhealthrankings.org
‣ Top 5
– St. Croix
– Ozaukee
– Taylor
– Iowa
– Vernon
‣ Bottom 5
– Jackson
– Adams
– Milwaukee
– Marquette
– Menominee
HEALTH OUTCOMES – MORBIDITY AND MORTALITY
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16www.countyhealthrankings.org
‣ Top 5
– Ozaukee
– Waukesha
– Dane
– La Crosse
– Pierce
‣ Bottom 5
– Racine
– Juneau
– Adams
– Milwaukee
– Menominee
HEALTH FACTORS – BEHAVIORS, CLINICAL CARE, SOCIAL/ECONOMIC FACTORS, PHYSICAL ENVIRONMENT
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Adult Smoking In Wisconsin 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?
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Excessive Drinking in Wisconsin 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
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Self-Reported Mental Health For how
many days during the past 30 was your mental health not good?
Considering: stress, depression, problems with emotions
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High School Age Girls: Less Healthy Than Boys
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What Matters, and What Works?
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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?
Consider…
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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 ______________________?
Who Has a Role to Play?
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http://whatworksforhealth.wisc.edu/index.asp
www.countyhealthrankings.org/what-works-for-health
Find Policies and Programs that Work
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Two Examples
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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
Brown County Community Partnership for Children
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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
Brown County Community Partnership for Children
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What’s the Goal?◦ Improve success for Menominee children in school◦ Address health challenges for Menominee children
and families, starting with childhood obesity
Menominee Nation Community Collaboration
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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
Menominee Nation Community Collaboration
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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
Menominee Nation Community Collaboration
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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
What This Means To You
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What Will It Take To Succeed?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.
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Wisconsin Partnership Program, UW School of Medicine and Public Health
The Robert Wood Johnson Foundation and the County Health Rankings & Roadmaps team
Acknowledgements
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Thank [email protected]
County Health Rankings & Roadmaps
http://www.countyhealthrankings.org/
UW Population Health Institute
http://uwphi.pophealth.wisc.edu/