Mobilizing for Action through Planning and Partnerships (MAPP)


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Presentation by Lillian Peake, MD, MPH at the 2009 Virginia Health Equity Conference, outlining steps for completing health impact assessments using Mobilizing for Action through Planning and Partnerships (MAPP) 2008 data from Charlottesville, VA

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  • Assessment is a significant phase of the MAPP process. The four MAPP Assessments form the core of the MAPP process. Only intense community attention to these activities can assure appropriate community ownership of the entire MAPP effort. Results of the assessments will drive the identification of strategic issues and activities of the local public health system and the community for years to come. Therefore, although they may appear to be time-consuming, it is important to take great care in implementing the assessments and ensuring that they are done effectively and with broad participation. The Essential Services most associated with the Core function of Assessment are: Monitor health status to identify and solve community health problems. - This service includes accurate diagnosis of the community’s health status; identification of threats to health; and determination of health service needs. Diagnose and investigate health problems and health hazards in the community. - This service includes epidemiological investigations of disease outbreaks and patterns of infectious and chronic diseases and injuries, environmental hazards, and other health threats. Inform educate and Empower People about Health Issues - This service includes providing health information, health education, and health promotion activities designed to reduce health risk and promote better health; implementing health communication plans and activities such as media advocacy and social marketing; making health information and educational resources accessible to the community; and fostering health education and health promotion program partnerships with schools, faith communities, worksites, personal care providers, and others to implement and reinforce health promotion programs and messages. The Four MAPP Assessments provide the foundation for achieving the three Essential Services most associated with the Core Function of Assessment. The four MAPP Assessments — the third phase of MAPP — and the issues they address are described below: The Community Themes and Strengths A ssessment provides a deep understanding of the issues residents feel are important by answering the questions, "What is important to our community?" "How is quality of life perceived in our community?" and "What assets do we have that can be used to improve community health?" The Local Public Health System Assessment focuses on all of the organizations and entities that contribute to the public's health. The Local Public Health System Assessment answers the questions, "What are the components, activities, competencies and capacities of our local public health system?" and "How are the Essential Services being provided to our community?" The Community Health Status Assessment identifies priority community health and quality of life issues. Questions answered here include, "How healthy are our residents?" and "What does the health status of our community look like?" The Forces of Change Assessment focuses on identifying forces such as legislation, technology and other impending changes that affect the context in which the community and its public health system operate. This answers the questions, "What is occurring or might occur that affects the health of our community or the local public health system?" and "What specific threats or opportunities are generated by these occurrences?" Why are the four MAPP Assessments important? While each of the assessments alone will yield important information for improving community health, the value of the four MAPP Assessments is multiplied by considering the findings of each individual assessment together. Disregarding any of the four assessments will leave participants with an incomplete understanding of the factors that affect the local public health system and, ultimately, the health of the community. Collectively, the four MAPP Assessments have several purposes, including: Providing insight on the gaps between current circumstances and a community's vision (as determined in the Visioning phase); Providing information to use in identifying the strategic issues that must be addressed to achieve the vision; Serving as the source of information from which the strategic issues, strategies, and goals are built. After the four MAPP assessments are completed and the results are compiled, the local public health system partners can move on to the next phase of MAPP- Identifying Strategic Issues and Formulating Goals and Strategies. It is during this phase that the services related to the Core Function of Policy Development can be accomplished. Each of the four MAPP assessments will be described in the following slides of this module.
  • Changing demographics Fastest growing segment of C/A are those 45 years old and up
  • Our community is seeing an increasingly diverse population due to the influx of immigrants and refugees
  • While over 80 percent of City and 90 percent of County residents are above the poverty level, children and the elderly are the most affected groups by poverty.
  • An estimated 17,000 individuals have no health insurance in the City and County. Nearly 60 percent of County and 35 percent of City households without insurance are above 200 percent of poverty. Methodology: Uninsured estimates were derived by applying income-specific uninsured rate estimates to population estimates at the city, county, and zip code level. Uninsured rate estimates were calculated using multiple national and state surveys to derive an estimated uninsured rate for people above and below 200 percent of poverty. Population estimates for each income group were derived by applying 200-percent-of-poverty rates from the 2000 Census to total population estimates for 2005. The uninsured rates estimates were then applied to the population estimates to derive an estimated number of uninsured individuals above and below 200 percent of poverty in 2005. This method is obviously subject to error and CHRC does not guarantee the accuracy of the estimates. Estimates should be used for program and policy planning only, and should not be used to compare uninsured rates across geographic areas.
  • Overall death rates are declining in both the City and County, but they are higher among African-Americans than their white counterparts, especially for heart disease stroke, and cancer.
  • Local childhood obesity data indicate that childhood overweight and obesity increased between 2003 and 2007, likely reflecting changes in physical activity and nutrition.
  • The infant mortality rate in the City is increasing with racial disparities in both the City and County: i.e., more African-American babies are dying within the first year of life as compared to whites and more are born at a low birthweight (i.e., < 2500 grams).
  • Mobilizing for Action through Planning and Partnerships (MAPP)

    1. 1. MAPP Mobilizing for Action Through Planning and Partnerships Lilian Peake, MD, MPH
    2. 2. PUBLIC HEALTH TODAY: PARTNERSHIPS TO ASSURE THE CONDITIONS FOR POPULATION HEALTH Communities Academia The Media Employers and Business Health Care Delivery System Governmental Public Health Infrastructure Adapted from “The Future of the Public’s Health, 2003
    3. 3. What is MAPP? <ul><li>A community-wide strategic planning tool for improving health </li></ul><ul><li>A method to help communities: </li></ul><ul><ul><li>1. Prioritize community health issues </li></ul></ul><ul><ul><li>2. Identify resources to address </li></ul></ul><ul><ul><li>3. Take action </li></ul></ul><ul><li>National model </li></ul><ul><ul><li>Developed by National Association of County and City Health Officials and Centers for Disease Control and Prevention </li></ul></ul>
    4. 4. Purpose <ul><li>Develop a system to collect, analyze and interpret data to prioritize and address community health issues </li></ul><ul><li>Determine whether there are disturbing or unexpected health trends in the City and/or County </li></ul><ul><li>Identify health disparities </li></ul>
    5. 5. The MAPP Model
    6. 6. Community Health Status Assessment <ul><li>Collect and analyze existing quantitative data about health status and issues that affect it </li></ul><ul><li>Focus on trends, comparisons, and Healthy People 2010 Goals </li></ul>
    7. 7. Questions Addressed <ul><li>Who are we? </li></ul><ul><li>Are there health risks specific to our environment? </li></ul><ul><li>What strengths and risks does our community contribute to health? </li></ul><ul><li>What is our health status? </li></ul>
    8. 8. Change in Age Distribution Albemarle and Charlottesville, 1990, 2005
    9. 9. Limited English Proficient Student Enrollment Albemarle and Charlottesville Public Schools 2001-2006
    10. 10. Cost of Living Relative to Charlottesville Hampton Roads, Richmond, Alexandria/Arlington, Roanoke, 2007 Source: - ACCRA Average of past four quarters ending first quarter 2007 ACCRA calculates the index for each category by measuring the cost of a select group of goods and services, then calculates the ratio of an area’s price for an item to the average price of that item nationwide. The amount that individual item ratios contribute to the category index is based on proportion of expenditures on that item *Charlottesville = 100% 87% 78% 82% $ 17,812 Roanoke 102% 197% 102% $ 27,480 NoVa 95% 106% 87% $ 21,133 Richmond 89% 106% 87% $ 20,518 Hampt Rds Cost of Healthcare Cost of Housing Cost of Groceries Comparable Salary to $21,000 in Charlottesville
    11. 11. Percent of Children Below 100% Poverty Albemarle, Charlottesville, Virginia, U.S. 2000-2004
    12. 12. Lightest = Richest Darkest = Poorest
    13. 13. Average Medicaid Participation Rate Albemarle and Charlottesville, 2002-2006 (4198) (4307) (4491) (4527) (4585) (3878) (4476) (4865) (5155) (6069) *Parentheses indicate actual number served Sources: Charlottesville and Albemarle Departments of Social Services
    14. 14. Estimated Uninsured Residents Albemarle and Charlottesville, 2005
    15. 15. United States – Emergency Room Visits by Type of Insurance - 2004 Source: CDC/NCHS, 2004 National Hospital Ambulatory Medical Care Survey
    16. 16. Five Leading Causes of Death TJHD and Virginia, 2005 Source: Center for Health Statistics, Virginia Department of Health 5. Unintentional Injuries 4. Chronic Respiratory Disease (COPD and Asthma) 3. Stroke 2. Cancer 1. Heart Disease
    17. 17. Age-Adjusted Mortality By Race TJHD and Virginia, 2001-2004
    18. 18. Combined Incidence of All Cancers by Race Albemarle, Charlottesville, Virginia, 2000-2004
    19. 19. Stroke-Related Deaths by Race: Three-Year Rolling Averages TJHD, Virginia, 2001-2005
    20. 20. Diabetes-Related Deaths by Race: Three-Year Rolling Averages TJHD, Virginia, 2001-2005
    21. 21. Actual Causes of Death Behavioral factors that contribute to leading killers
    22. 22. Current Smokers by Income, Virginia 1997, 2000, 2003, 2006
    23. 23. Overweight* and Obese** Prevalence Among Fifth Graders Albemarle and Charlottesville, 1998, 2003, 2007 Source: Thomas Jefferson Health District; Childhood Obesity Task Force
    24. 24. Infant Mortality (<1 Year) Albemarle, Charlottesville, and Virginia 5-Year Rolling Averages 1995-2005
    25. 25. Infant* Mortality Rate by Race: Five-Year Rolling Averages Albemarle and Charlottesville, 1995-2005 *< 1 year old
    26. 26. % of Infant Deaths by Number of Prenatal Visits Thomas Jefferson Health District, 2002-2006 Source: Division of Women’s and Infant’s Health, Virginia Department of Health
    27. 27. No 1 st Trimester Prenatal Care and Low Birth Weight City of Charlottesville, 1990-2006 The Meadows North Downtown Rose Hill 10 th & Page Locust Grove Greenbrier Barracks Rugby Barracks Road Lewis Mountain Venable Belmont Woolen Mills Martha Jefferson Ridge St. Fifeville Johnson Village Fry’s Spring Jefferson Park Ave. Starr Hill
    28. 28. Fry’s Spring Ridge St. Belmont Barracks/ Rugby Greenbrier 10 th & Page Venable Locust Grove Ridge St. Belmont 10 th & Page Greenbrier Barracks/ Rugby
    29. 29. Federally qualified medically underserved area
    30. 30. Questions