Improving Health

The 80/20 Rule:Improving Health, Not Just

HealthcareWisconsin Women’s Health Foundation

The Gathering November 13, 2012

Karen TimberlakeDirector, UW Population Health Institute

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

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”

4

Assumptions

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

Source: Muennig and Glied, Health Affairs 29, No. 11 (2010)

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

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

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

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

www.countyhealthrankings.org

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

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.

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.

15www.countyhealthrankings.org

‣ Top 5

– St. Croix

– Ozaukee

– Taylor

– Iowa

– Vernon

‣ Bottom 5

– Jackson

– Adams

– Milwaukee

– Marquette

– Menominee

HEALTH OUTCOMES – MORBIDITY AND MORTALITY

15

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

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?

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

Self-Reported Mental Health For how

many days during the past 30 was your mental health not good?

Considering: stress, depression, problems with emotions

20

21

22

23

25

26

27

28

29

30

High School Age Girls: Less Healthy Than Boys

What Matters, and What Works?

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…

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?

http://whatworksforhealth.wisc.edu/index.asp

www.countyhealthrankings.org/what-works-for-health

Find Policies and Programs that Work

Two Examples

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

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

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

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

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

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

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.

48

Wisconsin Partnership Program, UW School of Medicine and Public Health

The Robert Wood Johnson Foundation and the County Health Rankings & Roadmaps team

Acknowledgements

Thank [email protected]

County Health Rankings & Roadmaps

http://www.countyhealthrankings.org/

UW Population Health Institute

http://uwphi.pophealth.wisc.edu/