Wisconsin County Health Rankings

1
Wisconsin County Health Rankings
UW Population Health Institute
CATCH Project June 2, 2008
2
The Public Health Surveillance Model
Data Collection
Source Remington and Goodman Chronic Disease
Surveillance, 1999
3
(No Transcript)
4
(No Transcript)
5
Wisconsin County Health Rankings

• Measures and ranks the health of Wisconsins 72
  counties and the City of Milwaukee
• Modeled after United Health Foundation Americas
  Health Rankings
• Uses population-based measure of healthbroadly
  defined
• Summarizes the health into summary measures

6
Purpose of the Rankings

• Provide an annual overview of health outcomes and
  health determinants across Wisconsin
• Spark discussion of health issues
• Stress that there are multiple broad determinants
  of health
• Draw insights from high-performing counties
  additional resources for improvement to less
  healthy counties

7
Why Rank?

• Allows comparison of one or more attributes for a
  select group of entitieshospitals, counties, law
  schools, etc.
• Rankings reduce data to a form that consumers and
  policy-makers can easily use
• Rankings draw attention and can be used
• to help target interventions
• help consumers select high-performers for
  services (schools, hospitals, clinics)
• reward high-ranking entities and penalize
  low-ranking ones

8
(No Transcript)
9
Data sources

• Behavioral Risk Factor Surveillance System
• CDC WONDER
• Metastar
• US Census Bureau
• US Environmental Protection Agency
• Wisconsin Crash Outcomes Data Evaluation System
• Wisconsin Dept of Health and Family Services

• Wisconsin Dept of Natural Resources
• Wisconsin Dept of Public Instruction
• Wisconsin Family Health Survey
• Wisconsin Interactive Statistics on Health
• Wisconsin Office of Justice Assistance

10
(No Transcript)
11
Methods

• For each measure of local health we calculated
• Mean value of all counties
• Standard deviation of all counties
• Z-Score for each place
• The number of standard deviations from the mean
  of all counties
• To prevent any one measure from dominating
  summary scores, Z-scores were truncated at 3
• When needed, multiple years of data were used to
  improve reliability of estimates and reduce
  random error.

12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
Major Finding

• Significant variation in health outcomes and
  determinants exists in Wisconsin
• Least healthy places include
• Menominee County
• City of Milwaukee
• Central and Northern rural counties

27
Selection of measures

• Reflect important aspect of population health
• Unit of analysis (e.g., city, county, MSA)
• Validity/reliability
• Availability of data
• Free or low cost
• Publicly accessible if possible
• Timeliness/consistency over time
• WDQS preferred!

28
Surveillance Methods

• Census versus survey
• Confidence intervals
• How to handle small numbers
• Combine data from neighboring counties
• Multiple years
• Suppression
• Etc.
• Changes in measurement

29
Planning teleconferences

• Monthly teleconferences are held with health
  officers and others interested in the Rankings
• Allowed for user feedback to be promptly
  incorporated into the design and release
• Keep local health officers updated and helped
  them to be more adequately prepared to handle
  media inquiries when released

30
Evaluation Annual Survey

• Survey health officers across the state regarding
  their experiences with and feedback on the
  Rankings
• The majority of health officers
• find the Rankings useful to their work
• plan to use Rankings in the community
• Annual feedback incorporated into the planning
  for the next Rankings edition

31
Uses of the Rankings

• Needs assessments and evaluations
• Program planning
• Presentation to others
• County health boards
• Public health staff
• Community partners
• Spark for coalition building

32
Focus on key messages

• Broad determinants of health
• Importance of a community approach to public
  health
• There are things that can be done to affect
  health of individuals and communities in every
  county in Wisconsin

33
?
?
?
?
34
Problems with Rankings

• Tendency to infer too much from minor differences
  in ranks
• Incorrect assumptions about distance between
  items
• Reactivity
• Low morale for low-ranked entities
• Competing interests
• Stability of model vs. model of improvement
• Focuses pressure on local health departments for
  poor rank