Category Archives: County Health Rankings
How healthy is your county? Answers are out today in the 2013 County Health Rankings, which examine the health and well-being of people living in nearly every county in the United States and show that how long and well people live depends on multiple factors beyond just their access to medical care. The Rankings allow counties to see what’s making residents sick or healthy and how they compare to other counties in the same state. The County Health Rankings, now in its fourth year, is a joint project of the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute.
“The County Health Rankings can be put to use right away by leaders in government, business, health care, and every citizen motivated to work together to create a culture of health in their community,” said Dr. Risa Lavizzo-Mourey, RWJF president and CEO. “The Rankings are driving innovation, unleashing creativity, and inspiring big changes to improve health in communities large and small throughout the country.”
The Rankings examine 25 factors that influence health, including rates of childhood poverty and smoking, obesity levels, teen birth rates, access to physicians and dentists, rates of high school graduation and college attendance, access to healthy foods, levels of physical inactivity, and percentages of children living in single parent households.
Although the Rankings only allow for county-to-county comparisons of ranks within a state, this year’s Rankings show significant new national trends:
To mark the launch of the 2013 County Health Rankings, Risa Lavizzo-Mourey, MD, MBA, President and CEO of the Robert Wood Johnson Foundation will be taking questions and leading a group discussion via Twitter on March 20, from 2:00 p.m. to 3:00 p.m.
The Q&A will focusing on what's new in the 2013 County Health Rankings and how individuals and organizations can make use of the Rankings to create change for better health in their communities. Submit your questions to: @RWJF_PubHealth or @CHRankings and make sure to use the hashtag #healthrankings.
You can follow the County Health Rankings & Roadmaps on Facebook and Twitter to learn about the new data, find stories about how the project has improved health in communities like yours and get ideas for taking action where you live. The Facebook page will be posting useful new infographics, videos, quotes and images all week. On Twitter, join the Q&A, share your #healthrankings to fill in the “Race to 50” map, and ask an expert for help by tweeting your county to #myrankings.
The new issue of Frontiers in Public Health Services and Systems Research (PHSSR), an online journal that looks at early research on issues related to public health services and delivery, focuses on quality improvement in practice-based research networks.
This issue’s commentary, from the journal’s editor, Glen Mays, PhD, MPH, is about a series of studies sponsored by the Robert Wood Johnson Foundation that look at how public health decision-makers are responding to accreditation, quality improvement, and public reporting initiatives during ongoing fiscal problems. Mays is co-principal Investigator of the National Coordinating Center on PHSSR, Director of the Public Health Practice-Based Research Networks and the F. Douglas Scutchfield Endowed Professor at the University of Kentucky College of Public Health. Mays says that, overall, the current evidence shows that “these initiatives represent promising strategies for strengthening evidence-based decision-making and expanding the delivery of evidence-tested programs and policies in local public health settings.”
Mays adds that continued comparative research and evaluation activities are needed to provide more definitive evidence about which combination of strategies work best, for which population groups, in which community and organizational settings, and why.
The Robert Wood Johnson Foundation (RWJF) has announced a second round of grant winners for the Roadmaps to Health Community Grants. The grants support two-year state and local collaborative efforts among policymakers, business, education, health care, public health and community organizations, and are managed by Community Catalyst, a national consumer health advocacy organization. The goal of the grants is to create positive policy or systems changes that address the social and economic factors that impact the health of people in their community.
The grants build on the model of the County Health Rankings & Roadmaps program, which highlights the critical role that factors such as education, jobs, income and the environment play in influencing how healthy people are and how long they live. County Health Rankings & Roadmaps is a collaboration of RWJF and the University of Wisconsin Population Health Institute.
Four of the new grants have been awarded to projects spearheaded by United Way organizations in several states.
The Roadmaps to Health Community Grants are:
- Demonstrating how a range of partners from multiple sectors in a community can work together to take actionable data such as the County Health Rankings and begin addressing the multiple social or economic determinants of health in a community.
- Focusing on collaboration and action at the policy or system-change level.
- Getting grant partners in fields such as education, employment or community safety to think of themselves as part of the work of the public health community.
The County Health Rankings & Roadmaps show how every county in the United States ranks on critical measures that impact health, in comparison to all the counties in a state. The program helps communities create solutions that make it easier for people to be healthy in their own communities, focusing on specific factors that affect health, such as education and income.
Now headed into its fourth year, the Rankings are spurring communities to action. In Scioto County, Ohio, which was ranked last among all 88 Ohio counties last year, the Rankings motivated community leaders to convene two recent meetings. One held last spring gathered stakeholders at the table to set the agenda for helping to improve the county’s health. And a summit held this fall brought engaged county partners together with leaders from counties in both Ohio and Kentucky who shared ideas and initiatives that are already working to help improve health and lives.
NewPublicHealth spoke with two conveners of the summit, Ed Hughes, CEO of Compass Community Health, a local mental health and substance abuse provider, and Ohio State Representative Terry Johnson.
NewPublicHealth: What did the 2012 County Health Rankings reveal for your region?
Ed Hughes: We slipped this year from 87 to 88—last place. So, it became a rallying point for us as a community to be able to actually see those numbers, and to understand what the rates for the measures mean. We probably knew about a lot of it, but didn’t have the information available in a comprehensive way, like the number of people who smoke in our region, the number of folks who are struggling with obesity and the percentage of children who do not have their immunizations. We were surprised that we were one of the most struggling counties in the country.
When it comes to solving problems that affect the health of our communities, knowing what works matters. Using programs, policies and innovations that are based on solid evidence offers a better chance to improve public health.
What Works for Health, the latest release from County Health Rankings & Roadmaps, is an online, searchable menu of policies and programs—each with a rating based on strength of evidence for factors that can help make communities healthier places to live, learn, work and play. Policies, such as sobriety checkpoints, and programs, such as early childhood interventions, included in What Works for Health are rated on their level of evidence to help guide users toward choosing proven strategies. The County Health Rankings & Roadmaps team also hopes this tool will help spur a dialogue, and encourage those in the field to weigh in on other possible evidence-based programs.
NewPublicHealth spoke with Bridget Catlin, PhD, MHSA, director of the County Health Rankings & Roadmaps about the new tool and how she expects it to be used.
NewPublicHealth: Who is the primary audience for What Works for Health?
Bridget Catlin: There are a number of audiences for What Works for Health. Key audiences are people who are leading community health improvement planning processes such as public health officials. Hospitals are also getting involved in this area due to requirements from the ACA and from the IRS. They’re doing community health needs assessments to identify needs in communities and then what they can do to address those needs. Other audiences include employers who want to make their communities healthier for their employees and dependents, as well as grant-makers and policy-makers who are interested in spending their resources in areas that they know will work.
NPH: What’s new about this resource? How is it different from some of the other evidence guides that are out there like The Community Guide?
More than $2.5 trillion is spent on U.S. health care annually. Yet only a small fraction of that goes toward funding public health and prevention programs — programs that could stop people from getting sick in the first place, helping people and communities while saving money in the long run.
In a new op-ed in Roll Call, Hernando Mayor Chip Johnson and Wyandotte Mayor Joe Reardon discuss how their communities have been working to improve public health. Both community prevention efforts were featured as examples of success by County Health Rankings & Roadmaps, a program of the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation that measures the health of counties across the country.
Highlights of these efforts include a comprehensive wellness program for municipal workers in Hernando, Miss., and the utilization of tax incentives to bring grocery stores to underserved areas in Wyandotte County, Kan.
“Replicated on a national scale, these kinds of investments in health can yield significant dividends. Spending just $10 per person in programs aimed at smoking cessation, improved nutrition and better physical fitness could save the nation more than $16 billion a year, according to the Trust for America’s Health. That’s a nearly $6 return for every $1 spent. The bottom line is that policies aimed at better health are a smart investment, regardless of where our counties rank.”
>>Watch videos from Hernando Mayor Chip Johnson and Wyandotte Mayor Joe Reardon about improving public health in their communities.
At the Health Data Initiative III: The Health Datapalooza this summer, which looked at the role health data plays in transforming health and health care, the Robert Wood Johnson Foundation (RWJF) announced the three winners of an app challenge calling for developers to create applications that would allow consumers to easily access and make use of comparative information about the quality of care provided in various regions of the country. The data behind the apps came from Aligning Forces for Quality, the Foundation’s initiative to improve the quality of health care in 16 targeted communities.
John Lumpkin, MD, MPH, senior vice president and director of the Health Care Group at RWJF, presented the awards to the top three winners of the challenge. Recently, NewPublicHealth spoke with Dr. Lumpkin about the explosion of health care data, and how to find the strongest data and use it well.
NewPublicHealth: Quantities of health data are increasing at a speedy clip. What kind of challenge does that pose in order to make sense of the numbers?
Dr. Lumpkin: In a single day there are over 300 million photos that are being posted on Facebook, and 3.2 billion likes and comments. We have 115,000 people participating in web sites such as Patients Like Me and about 9 million tweets each day. So we have all this data, but how do we access it in ways that make it meaningful? Kerr White, MD, the chairman for the U.S. National Committee on Vital and Health Statistics once said: “With the advent of new technology, data can be collected in any format, aggregated by the computer and arrayed in any desired output…untouched by human thought.” And so our challenge is to present it in a way that we actually have it touched by human thought.
Some good examples of this would include the County Health Rankings and the Aligning Forces for Quality Initiative where we have coalitions of consumers, purchasers and providers who, through public reporting of quality and price information and consumer engagement, we encourage to adopt quality improvement methods and use the data in ways that move that process forward.
NPH: Does everyone mean the same thing when they talk about “evidence-based” data?
North Little Rock Mayor: It's About Giving People a Reason to Want to Live Here; Health is Added Inspiration
Pulaski County, Ark., home to the city of North Little Rock, ranked 21st out of 75 counties in the state in the 2012 County Health Rankings. North Little Rock Mayor Patrick Hays recognized need to take action to improve the health of his residents, so he and his colleagues began an employee wellness program in earnest. As Mayor Hays and Alderman Beth White wrote in a recent blog post, “The benefits of employee wellness programs are clear: reduced healthcare costs, increased productivity and healthier employees. With those benefits in mind, the City of North Little Rock is an example of how a city government’s commitment to health and fitness benefits both employer and employee The city’s Fit 2 Work program offers employees healthier workplaces that offer greater options for getting and staying healthy, including healthier vending machines and discounts at community centers that offer physical fitness programs.
Fit 2 Work is just one component of the overall Fit 2 Live program, which aims to create an environment that empowers the community to adopt healthy life choices. This initiative, supported by grants from the National League of Cities’ Institute for Youth, Education & Families, which is funded by the Robert Wood Johnson Foundation, and a CDC Communities Putting Prevention to Work (CPPW) grant, includes safe routes to school efforts, joint use agreements, built environment improvements such as walking and biking trails, and school wellness improvements.
NewPublicHealth spoke with Mayor Hays and Fit 2 Live Coordinator for the City of North Little Rock, Bernadette Rhodes, about their efforts to create a healthier city.
NewPublicHealth: Tell us about the Fit 2 Work program for the City of North Little Rock.
Mayor Hays: I have been here at City Hall about 23.5 years. I’m very proud of a lot of things we’ve done, but this has to be pretty much at the top of the list. These are things we’ve long understood to be a priority. I’ll give you a little bit of background—75 percent of my budget goes toward employee benefit costs. The old adage of “follow the money” is absolutely true. I’ve got 900 folks who work directly for me. We, like many in the country, are experiencing fairly significant increases in premiums in our medical costs. We tried to be as sensitive to preventive efforts to keep our employees healthy as we could be. About eight years ago, the city wrote a check for $300,000 to form its own health clinic. We wanted to have health screenings, and options for our employees with a great deal of accessibility to annual physical exams, screenings, blood work and more.
We are focusing on our workforce to give them the options to be healthy. We’re also trying to be a little creative with our employees to allow them to join a 10-week Weight Watchers program—that was 16 pounds ago that I was a beneficiary of that program—as well as discounts at our excellent community and senior centers.
NPH: The Fit2Live initiative includes a broad set of programs to create a healthier city. Why is it critical for a growing city to make health a priority?
Mayor Hays: We are serious about both our employees as well as our community having healthy options at vending machines, through the use of walking paths and in other aspects throughout the community. About 20 years ago I started building trails in North Little Rock because I wanted to make sure it was a place people wanted to live. We had been flat in population since the 1960s. People were moving to the suburbs, not unlike what was happening all over the country, but I made the decision that I wanted to do things to make people want to live here. We started out with trails, improving our parks and building sidewalks. I’m proud to say some of the dirt paths I walked through as a kid are now sidewalks and trails. We felt that competing for young people’s time was something we need to do, and what better way to do it than creating options for recreation—so we put a basketball court under an interstate overpass. We lit it, and sometimes we have midnight basketball.
Our inspiration was more geared toward wanting people to live in the community and giving them reasons to do it than it was because of the health epidemic. Now the health side of things has certainly taken on an added inspiration over the last five to 10 years. We like to think we were ahead of the game. We’re excited about what’s happened and where we are.
We received a $1.5 million Communities Putting Prevention to Work (CPPW) grant from the CDC to fight obesity and other health-related issues. We of course are partnering with our high schools and other organizations throughout the community to make this happen.
>>Read more on the North Little Rock CPPW grant.
NPH: What changes are you hoping to see in six months or a year?
Mayor Hays: The thing I want to ensure is that what’s in my head has been institutionalized so it’s not up to any one person. We need to ensure the foundation has been laid, and we do feel we’re there. We’ve got a built environment committee when it comes to utilization of trails and buildings and other things that together create a healthier community. We’ve got the Fit2Live leadership team.
All of this will be carried on in this city after my term is up because of the foundation we’ve laid and the enthusiasm of the staff and leadership. That together with the funding we secured has laid the groundwork to make healthier lifestyles and choices an institutionalized part of the way our city works.
NPH: Who were some of your important partners, and what is the overall role of partnerships in your work?
Mayor Hays: We formed a coalition of teams, and collectively if you’re at the table you have more likelihood to buy in to the outcome, and that’s been a big part of the success of our programs. I would include our employees themselves as one of our key partners, as well as the state, the Department of Health, Chamber of Commerce, Department of Parks and Recreation and others.
Bernadette Rhodes: The neighborhood associations have also been critical in getting the word out about what we’re doing. For example, the built environment committee organized a tour and discussion of a new bike and pedestrian trail that’s going to be paved and built in an abandoned railroad spur.
Hays: These pedestrian trails are not only good for physical activity, they also promote interaction. Social integration is absolutely critical. People need to see each other in ways other than hollering at each other through a car window.
NPH: What are some of the milestones in what has been achieved with the CPPW grant?
Rhodes: We’ve had the grant for almost two years now. In our community action plan we identified quite a few ways in which we wanted to combat obesity. The first one is in schools. We partnered with the school health coordinator for the district and worked with her to revise the school district wellness policy and to draft a district employee policy. Those policies have been drafted and reviewed by the superintendent and approved to go on to the school board for a vote. It strengthens the existing wellness policies a lot. Schools were required to have a wellness policy, but a lot of times they were just bare bones. For example, vending machines would have to be at least half healthier options, and the signage on the front of the machine has to be water or 100% fruit juice and not a soft drink. It also says food is not to be used as a reward with the kids. Another big thing is implementing SPARK PE, a national evidence-based program that incorporates physical activity and nutrition education, and that was implemented across the board with all PE teachers as well as city community after-school programs.
The second thing is healthy food options. We passed guidelines through the City Council to encourage all departments within the city to change the way they offer food, whether it’s in meetings or catered events and of course vending machines. We adopted a model called “Go, Slow, Whoa” and per the guidelines, half of those foods offered should be “Go” or “Slow.”
The third thing is joint use agreements. We had some money to renovate existing facilities around the city—community centers, parks and schools. For example, a lot of elementary schools had basketball courts but the nets were gone and there was no way to play on them. We went through and refurbished all of those so they’re usable. We’ve also been ordering signs to put up in the parks and around walking trails to say they’re open for use to the public at certain times, and one lap equals a quarter of a mile—to ensure people know these facilities are available to them for use.
NPH: How do you measure progress?
Rhodes: We have an evaluator who’s been working on getting hard numbers on all of our vending machines. He created a baseline and went around and categorized existing foods in the vending machine using go, slow, whoa. After these guidelines are implemented, he’ll go around and measure the changes that have taken place.
With joint use agreements, the evaluator will measure the quality of those facilities and the usage both before and after. They have a tool that allows you to observe the usage of the facility and the type of physical activity they’re engaging in.
The 2012 Health Data Initiative Forum (also known as the "Health Datapalooza") has double the registrations since last year's Forum, and registrations two years ago were a mere fraction (3 percent, to be exact) of this year's number of attendees. That rapid growth mirrors the growth in the field of "data liberación"—the push to make data public, accessible and usable so it's available to support innovative new technology in the marketplace—a term coined by U.S. Chief Technology Officer Todd Park.
At this year's Forum, Matt Miller, columnist for the Washington Post and senior fellow at the Center for American Progress, said health data initiatives particularly in the past year have exemplified the kind of public-private partnerships that will be critical to move the field forward. So far, the model has largely been for government to collect, curate and release data and create opportunities for private companies to use it to fuel innovative new apps, products and technologies that can further individual or community health.
To that end, the Department of Health and Human Services today released a revamped version of HealthData.gov, including improved search capabilities, links to more than 400 free data resources, and more easily accessible data sets. The hope, said Park, is that more data will equal more innovation, and eventually better health.
Todd Park is considered a health data "rock star" in many circles, but this year's Forum also introduced a different kind of rock star—Jon Bon Jovi, chairman of the Jon Bon Jovi Soul Foundation and partner on the Project REACH Challenge, an app challenge aimed at simplifying access to resources available to the homeless and the caregivers and caseworkers who serve them. The finalists for the challenge were announced today at the Forum. Bon Jovi shared his vision for the project: an app that would empower community members to help homeless people on the spot, for example by pressing a smartphone button and in real-time, finding out how many beds were open at the nearest homeless shelter. "The power of 'we' allows us to truly make a difference—to not just talk the talk, but also to walk the walk," said Bon Jovi.
The morning kicked off with demonstrations of apps that support community health, with a theme of data to spur community action. Some of the programs highlighted included:
- County Health Rankings & Roadmaps (University of Wisconsin Population Health Institute and Robert Wood Johnson Foundation): Creates solutions that make it easier for people to be healthy in their own communities, focusing on specific factors that we know affect health, such as education, income and behaviors. The methodology and data are both open-source and provided free on the website. But, the data is just the first step. The County Health Roadmaps project offers a concrete plan of action, including tools, self-assessments and guidance to help groups working to make their communities healthier places.
- Health Insights in Real Time (University of Rochester): Answers public health questions in real time by culling and integrating both public health data and fine-grained social media data. This work includes "heat maps" of illness reported on Twitter and other projects.
- Community Health Dashboard (New York City Department of Health and Mental Hygiene): Offers a community health dashboard that takes tons of health data and makes it public, friendly and useful. The Department also integrated an existing blood pressure intervention in 44 churches that had volunteer community health workers track and reporting blood pressure. The new online system allowed them to track the data online, and see the impact of their work over time among their community or congregation. For example, it would allow a group to track the percentage of their congregation that has uncontrolled blood pressure, and see if that percentage drops after introducing walking groups or nutrition classes.
- Healthy Communities Network (Healthy Communities Institute) and Community Indicators Data Portal (HealthLandscape): Both offer fee-based, hyper-local, customizable portals to communities to allow them to organize, track and display community health indicators for public health officials, policymakers and other stakeholders. The dashboards often serve as a jumping-off point for collaboration in the communities, said presenters.
>>Read a Q&A with Todd Park about the benefit of app challenges to spur innovation.