Rural NH County Health Rankings

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Rural NH County Health Rankings
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Mobilizing Action Toward Community Health (MATCH)

• County Health Rankings catalyst or cornerstone
  of a bigger effort
• Call to Action
• Collaboration between Robert Wood Johnson
  Foundation and University of Wisconsin Population
  Health Department
• Results in actions to improve overall community
  health

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Data Sources

• Centers for Disease Control and Prevention (CDC)
  
• Behavioral Risk Factor Surveillance System
  (BRFSS),
• National Center for Health Statistics,
• National Center for Chronic Disease Prevention
  and Health Promotion (Division of Diabetes
  Translation),
• National Center for Hepatitis, HIV, STD, and TB
  Prevention
• Environmental Protection Agency (EPA)
  Collaboration
• Health Resources and Services Administration
  (Area Resource File)
• Decennial Census and American Community Survey,
  Census/Current Population Survey
• Small Area Health Insurance Estimates and Income
  and Poverty Estimates, and
• Census County and Zip Code Business Patterns
• Federal Bureau of Investigation (Uniform Crime
  Reporting)
• Medicare claims/The Dartmouth Institute
• National Center for Education Statistics

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Population Health Model

• Health outcomes - measures of length and quality
  of life
• Health factors - behaviors, clinical care, social
  and economic factors, and the physical
  environment.   

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Health Outcomes

• Mortality
• Premature Death
• Morbidity
• Health-related Quality of Life
• Birth Outcomes

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Health Factors

• Health Behaviors
• Tobacco Use
• Diet and Exercise
• Unsafe Sex Alcohol Use
• Physical Environment
• Environmental Quality
• Built Environment

• Clinical Care
• Access to Care
• Quality of Care
• Social and Economic Factors
• Education
• Employment
• Income
• Family and Social Support
• Community Safety

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State Rankings

• United States

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National State Rankings
1 Vermont 41 Kentucky
2 Utah 42 West Virginia
3 Massachusetts 43 Georgia
4 Hawaii 44 Tennessee
5 New Hampshire 45 Nevada
6 Minnesota 46 South Carolina
7 Connecticut 47 Louisiana
8 Colorado 48 Alabama
9 Maine 49 Oklahoma
10 Rhode Island 50 Mississippi
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Prominent Finding

• Healthier counties are urban/suburban, whereas
  least health counties are mostly rural
• About half (48) of the 50 healthiest counties
  are urban or suburban counties
• Most (84) of the 50 least healthy counties are
  rural.

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New Hampshire Health Rankings
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Health Outcomes
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Health Factors
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New Hampshire Summary
Rank Health Outcomes Rank Health Factors
1 Grafton 1 Grafton
2 Rockingham 2 Rockingham
3 Merrimack 3 Merrimack
4 Cheshire 4 Hillsborough
5 Hillsborough 5 Carroll
6 Belknap 6 Cheshire
7 Strafford 7 Strafford
8 Carroll 8 Belknap
9 Sullivan 9 Sullivan
10 Coos 10 Coos
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Health Outcomes
Rank Mortality Morbidity
1 Rockingham Merrimack
2 Grafton Grafton
3 Hillsborough Cheshire
4 Cheshire Carroll
5 Merrimack Hillsborough
6 Strafford Rockingham
7 Belknap Belknap
8 Sullivan Strafford
9 Carroll Sullivan
10 Coos Coos
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Health Factors
Rank Health Behaviors Clinical Care Social Economic Factors Physical Environment
1 Grafton Grafton Grafton Carroll
2 Carroll Merrimack Rockingham Strafford
3 Merrimack Rockingham Hillsborough Belknap
4 Rockingham Sullivan Merrimack Merrimack
5 Hillsborough Hillsborough Cheshire Grafton
6 Belknap Strafford Strafford Hillsborough
7 Cheshire Belknap Belknap Cheshire
8 Strafford Cheshire Carroll Rockingham
9 Sullivan Coos Sullivan Sullivan
10 Coos Carroll Coos Coos
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Coos County Rank
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Coos Health Outcomes
  Coos Error Target NH Rank
  County Margin Value Value (of 10)
Health Outcomes Health Outcomes Health Outcomes Health Outcomes Health Outcomes 10
Mortality Mortality Mortality Mortality Mortality 10
Premature death 7,980 6,800-9,159 5,209 5,604  
Morbidity Morbidity Morbidity Morbidity Morbidity 10
Poor or fair health 17 15-19 10 11  
Poor physical health days 4.2 3.6-4.8 3.1 3.3  
Poor mental health days 3.9 3.3-4.6 2.8 3.2  
Low birthweight 7.20 6.1-8.3 5.70 6.60  
90th percentile, i.e., only 10 are
betterNote Blank values reflect unreliable or
missing data
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Coos Health Factors Health Behaviors
  Coos Error Target NH Rank
  County Margin Value Value (of 10)
Health Factors Health Factors Health Factors Health Factors Health Factors 10
Health Behaviors Health Behaviors Health Behaviors Health Behaviors Health Behaviors 10
Adult smoking 26 23-29 18 20  
Adult obesity 27 24-30 22 25  
Binge drinking 17 14-20 14 16  
Motor vehicle crash death rate 19 13-25 9 11  
Chlamydia rate 100   98 156  
Teen birth rate 33 29-37 15 20  
90th percentile, i.e., only 10 are
betterNote Blank values reflect unreliable or
missing data
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Coos Health Factors Clinical Care
  Coos Error Target NH Rank
  County Margin Value Value (of 10)
Health Factors Health Factors Health Factors Health Factors Health Factors  
Clinical Care Clinical Care Clinical Care Clinical Care Clinical Care 9
Uninsured adults 12 10-14 11 12  
Primary care provider rate 164   246 128  
Preventable hospital stays 95 89-100 52 63  
Diabetic screening 86 83-89 89 86  
Hospice use 15 12-21 30 24  
90th percentile, i.e., only 10 are
betterNote Blank values reflect unreliable or
missing data
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Coos Health Factors Social Economic Factors
  Coos Error Target NH Rank
  County Margin Value Value (of 10)
Health Factors Health Factors Health Factors Health Factors Health Factors  
Social Economic Factors Social Economic Factors Social Economic Factors Social Economic Factors Social Economic Factors 10
High school graduation 76   89 84  
College degrees 17 15-19 35 32  
Unemployment 5 5-6 3 4  
Children in poverty 17 13-21 7 9  
Income inequality 40   40 41  
Inadequate social support 24 21-27 16 17  
Single-parent households 9 6-12 7 8  
Homicide rate     1 2  
90th percentile, i.e., only 10 are
betterNote Blank values reflect unreliable or
missing data
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Coos Health Factors Physical Environment
  Coos Error Target NH Rank
  County Margin Value Value (of 10)
Health Factors Health Factors Health Factors Health Factors Health Factors  
Physical Environment Physical Environment Physical Environment Physical Environment Physical Environment 10
Air pollution-particulate matter days 1   1 1  
Air pollution-ozone days 8   0 4  
Access to healthy foods 56   61 42  
Liquor store density 1.8   0.5 0.7  
90th percentile, i.e., only 10 are
betterNote Blank values reflect unreliable or
missing data
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Economic Impact On Health Health Impact on the
Economy
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Health As An Economic Engine

• Health Becomes A Form Of Capital
• Health Expenditures Become Investments

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Microeconomics of Health

• Directly increases
• the number of working years
• the productivity of each year of work,
• Indirectly enhances
• education,
• personal, family, and business income

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Economic Loss To Business From Illness

• Absenteeism 2 million FTEs per year
• ¼ of workers 1 workday/month either absent
  from work or exhibit reduced productivity at work
  
• Depression average of 5.6 lost hours
  productivity/week
• Cost to employers of 44 billion per year
• Pain productivity loss of over 61 billion per
  year
• Employee Turnover pre-employment history of a
  single hospitalization due to a chronic illness
  is associated with a 20 increase
• high replacement costs
• loss of the benefits of long-term experience

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Overall Economic Impact

• Chronic conditions cost to employers
• exceeded 1 trillion in 2003
• may reach 5.7 trillion by 2030
• Improvements in survival and health in the United
  States from 1970 to 1999 increased the value from
  the output of the formal labor force by as much
  as 8.

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Macroeconomic

• Increase
• Internal investment
• External investment
• Alter the long-term demographics of a population

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Investments

• Internal
• Increasing savings that provide financial capital
  for investment
• External
• Better population health encourages outside
  investment, technology transfer, and access to
  global markets
• Poor health conditions raise concerns about the
  capability of the local workforce to meet the
  needs of investors

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Non-healthcare Determinants Of Health

• Medical care is a relatively minor contributor to
  overall health
• More potent influences on health include
• increasing health-promoting personal behaviors,
• reducing environmental health hazards, and
• improving basic social systems that facilitate
  health.
• Education
• Link between health and economic development
• Unhealthy children
• Not prepared for school
• Miss more school
• Attend school fewer years
• Learn less when in school
• Community-based and participatory processes
• directly involve the region's citizens in the
  debate, research, policy design, and evaluation
  of any interventions

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Health Economic Growth

• Historical studies have found that half of the
  overall economic growth in the United States
  during the last century may be associated with
  improvements in population health.

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New Hampshire Health Employment

• 3rd in average annual employment (12.8 of total)
  - 2008
• 27.7 (14,999 jobs) average annual increase 2000
  - 2008
• 2nd in average annual wages
• (13.8 of total) 2008
• 82.1 (1.5 billion) average annual health care
  wage increase 2000 2008

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Impact of New Hampshire Hospital Systems on Coos County Impact of New Hampshire Hospital Systems on Coos County Impact of New Hampshire Hospital Systems on Coos County Impact of New Hampshire Hospital Systems on Coos County Impact of New Hampshire Hospital Systems on Coos County Impact of New Hampshire Hospital Systems on Coos County
Economic Indicator Direct Impact Multiplier Secondary Impact Total Impact Total Impact
Employment 1,031 1.51 526 1,557 1,557
Income 58,127,882 1.30 17,438,365 75,566,247 75,566,247
SOURCES 2008 Audited Financial Statements, New Hampshire Hospital Association mutilpliers from IMPLAN, Minnesota IMPLAN Group, Inc. SOURCES 2008 Audited Financial Statements, New Hampshire Hospital Association mutilpliers from IMPLAN, Minnesota IMPLAN Group, Inc. SOURCES 2008 Audited Financial Statements, New Hampshire Hospital Association mutilpliers from IMPLAN, Minnesota IMPLAN Group, Inc. SOURCES 2008 Audited Financial Statements, New Hampshire Hospital Association mutilpliers from IMPLAN, Minnesota IMPLAN Group, Inc. SOURCES 2008 Audited Financial Statements, New Hampshire Hospital Association mutilpliers from IMPLAN, Minnesota IMPLAN Group, Inc.
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Next Steps

• Pick Priorities
• Implement Strategies
• Evaluate Efforts
• Assess Needs and Resources
• Find Programs and Policies that Work

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Thank You
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Detailed Information on Weighting of Indicators
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Health Outcome Weights
Outcome Focus Area Measure
Mortality (50) Premature death Years of potential life lost before age 75 (50)
Morbidity (50)   Quality of life Percent reporting poor or fair health (10) Physically unhealthy days (10) Mentally unhealthy days (10)
Morbidity (50)   Poor birth outcomes Low birthweight live births (20)
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Health Factor Weights Health Behaviors

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Health Factor Focus Area Measure
Health Behaviors (30) Smoking (10) Adult smoking rate (10)
Health Behaviors (30) Diet and exercise (10) Adult obesity rate (10)
Health Behaviors (30) Alcohol use (5) Binge drinking (2.5)
Health Behaviors (30) Alcohol use (5) Motor vehicle crash death rate (2.5)
Health Behaviors (30) Unsafe sex (5) Chlamydia rate (2.5)
Health Behaviors (30) Unsafe sex (5) Teen birth rate (2.5)
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Health Factor Weights Clinical Care

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Health Factor Focus Area Measure
Clinical Care (20) Access to care (10) Adult uninsured rate (5)
Clinical Care (20) Access to care (10) Primary care provider rate (5)
Clinical Care (20) Quality of care (10) Hospitalization rates for ambulatory-sensitive conditions (5)
Clinical Care (20) Quality of care (10) Diabetic screening rate (2.5)
Clinical Care (20) Quality of care (10) Hospice use rate (2.5)
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Health Factor Weights Social and Economic

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Health Factor Focus Area Measure
Social and Economic Factors (40) Education (10) High school graduation rate (5)
Social and Economic Factors (40) Education (10) Adults with college degrees (5)
Social and Economic Factors (40) Employment (10) Unemployment rate (10)
Social and Economic Factors (40) Income (10) Children in poverty (7.5)
Social and Economic Factors (40) Income (10) Income inequality (2.5)
Social and Economic Factors (40) Family and social support (5) Social and emotional support (2.5)
Social and Economic Factors (40) Family and social support (5) Single-parent households (2.5)
Social and Economic Factors (40) Community safety (5) Violent crime or homicide rate (5)
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Health Factor Weights Physical Environment

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Health Factor Focus Area Measure
Physical Environment (10) Environmental quality (5) Unhealthy air quality due to particulate matter (2.5)
Physical Environment (10) Environmental quality (5) Unhealthy air quality due to ozone (2.5)
Physical Environment (10) Built environment (5) Access to healthy foods (2.5)
Physical Environment (10) Built environment (5) Liquor store density (2.5)
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County Health Rankings

• Where we live, learn, work, and play influences
  how healthy we are and how long we live.
• Purpose - Call to action for state and local
  health departments to develop broad-based
  solutions with others in their community so all
  residents can be healthy.