Final florida 2013 county health rankings
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This is the presentation I prepared for a Webinar releasing Florida's 2013 County Health Rankings. I started with a template provided by national County Health Rankings and Roadmaps team that I believe was designed by Burness Communications.
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Final florida 2013 county health rankings
- 1. HOW HEALTHY IS OUR STATE 2013 FLORIDA COUNTY HEALTH RANKINGS Presenter: Dr. Roderick K. King Executive Director, Florida Public Health Institute Moderator: Martha Kurth Harbin Consultant, Florida Public Health Institute www.flphi.org
- 2. www.countyhealthrankings.org 2 GOTOWEBINAR ATTENDEE INTERFACE 1. Viewer Window 2. Control Panel Be sure to select the Audio Mode that corresponds to the method you are using to hear the webinar. Telephone users: Select “telephone” and enter the Audio Pin provided in your chat box. Computer headset users: Select “Mic & Speakers” www.flphi.org
- 3. www.countyhealthrankings.org 3 DR. RODERICK K. KING EXECUTIVE DIRECTOR, FLORIDA PUBLIC HEALTH INSTITUTE ‣ Executive Director, Florida Public Health Institute ‣ Faculty in the Department of Epidemiology and Public Health, University of Miami Miller School of Medicine ‣ Faculty appointments at the Massachusetts General Hospital Disparities Solutions Center, Harvard Medical School, and Harvard School of Public Health ‣ Former Senior Advisor to the Bureau of Primary Health Care, & Region 1 Director for the Health Resources and Services Administration, US Dept of Health and Human Services ‣ 10+ years supporting multi-stakeholder collaborations to build healthy communities domestically and internationally www.flphi.org
- 4. www.countyhealthrankings.org 4 THE FLORIDA PUBLIC HEALTH INSTITUTE ‣Freestanding 501c 3 corporation incorporated in 2001 ‣ Mission: “Advance the knowledge and practice of public health to promote, protect and improve the health of all.” ‣Promotes improvements in health by: – Providing information and knowledge to inform health policy – Supporting multi-stakeholder collaborations to support leaders in taking aligned actions for measurable results www.flphi.org
- 5. www.countyhealthrankings.org 5 OUTLINE Rankings Background Rankings: What are the Rankings? Roadmaps: Moving to Action Moving Forward: Local Action www.flphi.org
- 6. www.countyhealthrankings.org 6 COUNTY HEALTH RANKINGS: BACKGROUND ► What? State-by-state rankings of the health of each county in the United States ► Who? ► Nationally: The Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute (UWPHI) ► Florida: The Florida Public Health Institute ► When? Annually – 2013 Data Released March 20th ► Where? www.countyhealthrankings.org or www.flphi.org www.flphi.org
- 7. www.countyhealthrankings.org 7 WHY COUNTY HEALTH RANKINGS? ‣ Where we live matters to our health ‣ The Rankings helps counties see where they are doing well and where they are not, so they can make changes to improve health. ‣ Health is everyone’s responsibility. www.flphi.org
- 8. www.countyhealthrankings.org 8 WHY RANK? ‣Call to action ‣Simplify complex data ‣Media coverage ‣Add context ‣Starting point www.flphi.org
- 9. www.countyhealthrankings.org 9 COUNTY HEALTH RANKINGS ARE NOT… ‣ The single-best source for the most current health data about Florida counties – Florida CHARTS – The Florida Department of Health – The Florida Agency for Health Care Administration – Regional Health Planning Councils – Local County Health Departments – Florida Public Health Institute – Oral Health Florida www.flphi.org
- 10. www.countyhealthrankings.org 10 LOGIC MODEL www.flphi.org
- 11. www.countyhealthrankings.org 11 LOGIC MODEL www.flphi.org
- 12. www.countyhealthrankings.org 12 OUTLINE Rankings Background Rankings: What are the Rankings? Roadmaps: Moving to Action Moving Forward: Local Action www.flphi.org
- 13. www.countyhealthrankings.org 13 COUNTY HEALTH RANKINGS: 2 RANKINGS Health Health Outcomes Factors Today’s Tomorrow’s Health Health www.flphi.org
- 14. www.countyhealthrankings.org 14 HEALTH OUTCOMES ‣ Mortality (50%): – Measures of how long we live Health ‣ Morbidity (50%): Outcomes Today’s – Measures of how well we live Health ‣ Poor or fair physical health days ‣ Poor or fair mental health days ‣ Low birthweight rates www.flphi.org
- 15. www.countyhealthrankings.org 15 HEALTH FACTORS ‣ Health behaviors (30%) Health ‣ Clinical care (20%) Factors Tomorrow’s ‣ Social and economic factors (40%) Health ‣ Physical environment (10%) www.flphi.org
- 16. www.countyhealthrankings.org 16 www.flphi.org
- 17. www.countyhealthrankings.org 17 CHANGES FOR 2013 2012 2013 Data Source Years Rationale for Change Measure Measure Health Outcomes – No changes Health Behaviors Motor vehicle Motor vehicle National Center for 2004- A slight change in the definition of motor vehicle crash rates crash rates Health Statistics 2010 crashes to align with Health People 2020 Clinical Care No measure Dentists HRSA Area 2011- Oral health care is a key indicator for the health of Resource File 2012 communities Primary care Primary care HRSA Area 2011- Now includes dentists and doctors of osteopathy and physicians physicians Resource File 2012 excludes obstetricians Social and Economic Factors - No changes Physical Environment Air pollution Daily fine CDC WONDER 2008 This new measure of the average daily fine particulate- particulate environmental data particulate matter offers several advantages over the matter days matter prior measures of air quality including recency and precision Air pollution ozone days No measure Drinking water Safe drinking water FY This new measure estimates the proportion of the safety information system 2012 county’s population whose water system has been www.flphi.org past year. least one health-related violation in affected by at the
- 18. www.countyhealthrankings.org 18 FLORIDA’S 2013 RANKINGS www.flphi.org
- 19. www.countyhealthrankings.org 19 TOP & BOTTOM FIVE COUNTIES Health Health Factors Outcomes • St. Johns • St. Johns • Martin • Martin • Collier • Sarasota Health Health Factors • Seminole • Alachua Outcomes • Sarasota • Seminole • Gadsden • Hendry • Hamilton • Dixie • Washington • Okeechobee • Putnam • Putnam • Union • Hamilton www.flphi.org
- 20. www.countyhealthrankings.org 20 PREMATURE DEATH RATE AT 20-YEAR LOW TRENDS 2,153 • National Minimum 5,317 • 10th Percentile (National Benchmark 5,876 • Florida Minimum (Collier) 7,310 • Florida Average 8,025 • National Average • Florida’s 66th Ranked 11,114 (Putnam) • Florida’s Maximum 16,608 (Union) 24,668 www.flphi.org National Maximum •
- 21. www.countyhealthrankings.org 21 OBESITY AND PHYSICAL ACTIVITY TRENDS Adult Obesity 26 percent – Florida 24 percent – Florida Average Average 38 percent – Hamilton 34 percent – Three counties 36 percent – Two counties 33 percent – Two counties Percentage Physically 35 percent – Seven counties Inactive www.flphi.org
- 22. www.countyhealthrankings.org 22 CHILD POVERTY CLIMBING (FLORIDA AVERAGE) TRENDS 2013 2012 • 25 Percent 2011 • 24 Percent 2010 • 18 Percent • 17 Percent • Nationally one-in-five children in poverty • In Florida, one-in four children in poverty • Clay County: 15 percent of children in poverty • Hardee County: 45 percent of children in poverty www.flphi.org
- 23. www.countyhealthrankings.org 23 VIOLENT CRIME RATES DECREASING 2010 TRENDS National Average = 274 per 100,000 • 714 Florida’s Highest = 1,117 per 100,000 (Jefferson) 2011 Jefferson County Actual • 706 Number = 163 Florida’s Lowest = 157 per 2012 100,000 (Washington) • 674 Washington County Actual Number = 37 Nation’s Highest = 2,062 per 100,000 2013 www.flphi.org • 614
- 24. www.countyhealthrankings.org 24 RANKINGS FEATURES www.flphi.org
- 25. www.countyhealthrankings.org 25 www.flphi.org
- 26. www.countyhealthrankings.org 26 www.flphi.org
- 27. www.countyhealthrankings.org 27 www.flphi.org
- 28. www.countyhealthrankings.org 28 www.flphi.org
- 29. www.countyhealthrankings.org 29 www.flphi.org
- 30. www.countyhealthrankings.org 30 www.flphi.org
- 31. www.countyhealthrankings.org 31 WHAT THE DATA TELLS US ‣ The County Health Rankings continue to show us that where we live matters to our health. ‣ The Rankings serve as an easy-to-use health snapshot of the many factors that influence health and help community leaders identify areas where improvement is needed. ‣ Improving health is everyone’s business. www.flphi.org
- 32. www.countyhealthrankings.org 32 OUTLINE Rankings Background Rankings: What are the Rankings? Roadmaps: Moving to Action Moving Forward: Local Action www.flphi.org
- 33. www.countyhealthrankings.org 33 LOGIC MODEL www.flphi.org
- 34. www.countyhealthrankings.org 34 LOGIC MODEL www.flphi.org
- 35. www.countyhealthrankings.org 35 www.flphi.org
- 36. www.countyhealthrankings.org 36 ROADMAPS: MOVING TO ACTION: ‣ Communities are coming together to create a culture of health. ‣ The Roadmaps to Health Action Center offers an expansive portfolio of information, tools, and guidance supporting action to improve the health of your community. ‣ Communities investing in health will want to be sure they are focused on the most effective strategies. Information to guide leaders about what works to improve health can be found at www.countyhealthrankings.org www.flphi.org
- 37. www.countyhealthrankings.org 37 www.flphi.org
- 38. www.countyhealthrankings.org 38 OUTLINE Rankings Background Rankings: What are the Rankings? Roadmaps: Moving to Action Moving Forward: Local Action www.flphi.org
- 39. www.countyhealthrankings.org 39 HEALTH FACTORS & POTENTIAL PARTNERS Tobacco use • Addiction specialists • Wellness coordinators Diet & exercise • Educators • Bar owners/tenders HEALTH BEHAVIORS • Advocacy groups • Healthcare providers Alcohol use • Policymakers • Community members Sexual activity • Faith leaders Access to care • Healthcare providers • Community members CLINICAL CARE Quality of care • Ombudsmen • Advocacy groups Education • Business owners • Labor unions Employment • Educators • Neighborhood • Advocacy groups organizations SOCIAL & ECONOMIC Income • Economic development FACTORS • Policymakers Family & social support • United Way • Community members Community safety • Law enforcement Environmental quality • Planning/zoning • Community members PHYSICAL ENVIRONMENT www.flphi.org Built environment • Transportation • Foresters
- 40. www.countyhealthrankings.org 40 RWJF ROADMAPS TO HEALTH PRIZE ‣$25,000 Award ‣www.rwjf.org/goto/prize ‣2013 Prize Timeline & Key Dates – March 20, 2013: RWJF Roadmaps to Health Prize Call for Applications released. – April 2, 2013 (1-2 p.m. Eastern Time): Informational webinar. – May 23, 2013 (3 p.m. Eastern Time): Phase I Applications due. – 2014: Winners announced. www.flphi.org
- 41. www.countyhealthrankings.org 41 GOTOWEBINAR ATTENDEE INTERFACE 2. Control Panel www.flphi.org
- 42. www.countyhealthrankings.org 42 FOR MORE INFORMATION: Dr. Roderick King rking@flphi.org (561) 561-533-7909 www.flphi.org www.countyhealthrankings.org www.flphi.org
Editor's Notes
- Martha introduces Dr. King:Dr. Roderick K. King is currently Executive Director of the Florida Public Health Institutes and is on faculty at the University of Miami Miller School of Medicine Department of Epidemiology and Public Health, the Department of Global Health and Social Medicine at Harvard Medical School, and Senior Faculty at the Massachusetts General Hospital Disparities Solutions.Martha mutes her microphone and unmutes Dr. King.
- Thank you, Martha and welcome everyone to the fourth annual release of the County Health Rankings for Florida. Before we get started, I want to share with you what we do at the Florida Public Health InstituteAbout the Florida Public Health InstituteThe Florida Public Health Institute (FPHI) is a freestanding 501c 3 corporation incorporated in 2001, that conducts action-oriented research and promotes leadership, partnerships and collaborations to build capacity for strong public health policy, programs, systems and practices. The mission of the Institute is to “advance the knowledge and practice of public health to promote, protect and improve the health of all.” FPHI accomplishes this by promoting improvements in health by providing information and knowledge to inform health policy, conducting applied research and supporting multi-stakeholder collaborations to support leaders in taking aligned actions for measurable results in order to build healthy communities.
- Dr. King: Welcome to the release of the Florida’s 2013 County Health Rankings. Over the next 30 minutes or so, we’re going to review:A little about the background of the County Health Rankings: For those of you who have participated in previous year’s releases, tuned in to the national teleconference this morning, or attended some of the webinars offered by the University of Wisconsin Center for Population Health Studies in the run-up to this year’s release, you will already have heard some of the information we will review this morning. For that reason, we are going to move quickly through some of the background information. If this is new to you, I encourage you to spend a little time on the County Health Rankings website where you can view recordings of previous webinars such as County Health Rankings and Roadmaps 101. On that website, you may also sign up to be notified of future Webinars and other events. An quick overview of how the Rankings are calculated and some observation and highlights of this year’s Rankings for FloridaA review of the Roadmaps portion of the County Health Rankings website and how it may be used as a tool for your new and existing community initiativesFinally we’ll review some ways the Rankings might be used to make a difference in your communityAnd then we’ll try to answer your questions
- Just quickly this is the fourth year that the University of Wisconsin Population Health Institute has calculated the Rankings with the support of the Robert Wood Johnson Foundation. The Florida Public Health Institute, with the support of the RWJF and University of Wisconsin releases the Rankings here in Florida. You can find all of the data and a lot of other resources at the county health rankings website and you may link to it from the Institute website. At the FLPHI website you may also download one page data summaries for each of Florida’s counties.
- County Health Rankings shows us that where we live, learn, work, and play matters to our health. The Rankings shows us that much of what influences our health happens outside of the doctors’ office. People from public health and health care, business, education, and government sectors must work together to create programs and policies to help people lead healthier lives and build healthier communities.
- NOTE to Presenter: The most important takeaway from this slide is that Rankings are a starting pointfor mobilizing community ACTION toward health improvement.Why Rank? KEY POINTSThe Rankings are way to take number of different pieces data andsimplify for people to show quick and easy snapshot of their community’s health. The Rankings serve as hook to get our attention. We’re competitive, like to know who’s winning, who’s not, and who’s doing better than others. The Rankings generate media coverage. This is good because will help people understand health status of their community. It’s an opportunity for people to tell the story of many factors affecting health in a community.TheRankings add context.A number by itself doesn’t tell much. TheCounty Health Rankings allow communities to compare themselves with others within their state, and they can also compare to national benchmarks on individual measures.The Rankings provide an opportunity to ignite discussion and action at local level with many diverse members of community from multiple sectors.The Rankings report is a starting point for discussion in communities, not anending point. Communities will want to dig into local data to further understand what’s going on in order to know where and how to take action.
- What the Rankings are not is a replacement for a community health needs assessment.For the County Health Rankings to create a database that can generate an apples-to-apples comparison of every county in the entire United States, they must only use indicators available for all 3,000 plus counties. So they don’t provide all of the information about what’s going on in a community. More local data is needed, and there are often more current sources for information specific to Florida or to an individual county than the indicator used by the Rankings.The single best starting point for detailed data specific to Florida or to an individual county is Florida CHARTS, which is housed within the Florida Department of Health. AHCA also tracks a great deal of clinical care information and each of Florida’s 11 Regional Health Planning Councils produce a number of reports and assessments of the counties within their regions, some with interactive health information dashboards.Oral Health Florida has created several county-level data compilations and links to many of the resources may be found at the Florida Public Health Institute website.(Note to Dr. King: It’s up to you but considering the politics, if you want to make a little remark about the slide not containing the logos of all 11 local health councils – only those whose logos were easy to grab in jpeg format from their websites – it might prevent mild drama)
- So if there are these Florida-based sources of health information, why Rank? This is the logic model on which the County Health Rankings and Roadmaps project is based…
- …and here’s where we are today – the release of the 2013 Rankings. Our ultimate goal is not just to issue a report card on the counties. The ultimate goal is to improve health outcomes by gaining attention to the areas of the health that may be improved, building community engagement to implement evidence-based community projects, programs and policies.
- So what are the Rankings and what are Florida’s 2013 Rankings?
- With the County Health Rankings nearly each county across the nation receives two rankings: health outcomes (current health of the community as compared to other counties within a particular state) and health factors (estimate of future health of your community as compared to other counties within a particular state.Counties are only ranked in comparison/relative to other counties within a particular state. This is a particularly important distinction because it means that sometimes – even if every county in the state has improved its health measurements over the past year – a particular county may maintain the same ranking that it had the previous year or even decline because another county has experienced greater improvements in some areas.
- The Health Outcome Measure is calculated by combining mortality and morbidity rates. Mortality rates are determined solely on a county’s premature death rates. This can sometimes skew a county’s data, such as for Union County, which has ranked 67th in Health Outcomes for each of the past four years that the County Health Rankings has been released because of the death rate among the prison population in that county.The morbidity rate is calculated using the numbers of poor of fair physical health days and poor or fair mental health days, and the rate of low birthweight babies. The source of this data is available on the county health rankings website.
- The second of the two overall rankings is the Health-Factors ranking. To those of us working to improve the health of our communities, this is probably the more relevant of the two rankings because it is a snapshot of our current lives and it portends our future health outcomes. As you can see from the weighting of the factors, much of what influences our health happens outside of the doctor’s office. We can have the best back-end care in the world, but without addressing issues like obesity, primary care, dental care, the quality of our educational systems, access to healthy food and safe drinking water, the rates of chronic disease will continue climbing and the amount we pay for healthcare will keep rising.
- This graphic shows how it all comes together. Starting from the bottomThe Orange Box, Policies and Programs drive outcomes around health factors. (orange box) The programs and policies in place determines whether people are more or less likely to engage in risky behaviors, their access to & quality of clinical care, their economic & education status, how socially connected they feel, and important elements in physical environment. Policies and programs are not ranked by the County Health Rankings but rather are what a community should look at to see why their county ranks where it does or where changes may be made to improve their health factors and outcomes. And these do not necessarily mean laws and ordinances or any type of government involvement. An example might be a business’s policy to provide on-site exercise opportunities for their employees, or a PTA launching a walking school bus or developing safe routes to school. Next come the Health Factors (the blue boxes): Health behaviors; this like whether we get enough exercise, smoke or drink too much, or practice safe sexClinical care; our ability to see a primary care provider for check-ups, whether or not we’re keeping our mouth healthy and getting proper screenings for early detection of disease, and whether we are ending up in the hospital for conditions that could have been prevented with proper primary careSocio-economic conditions, which is given the most weight of all of the factors because of the overwhelming evidence tying education and a decent income to better health, and because the healthiest people in the world can still have their lives cut short by violence.The quality of our physical environment; whether we have access to healthy food, clean air and safe drinking waterThese are factors that determine how long people live and quality of their lives. The blue boxes are things communities can work on now to help improve their future. And at the top of the list is the Health Outcomes measure, how healthy we are today. (the green boxes) Length of life – tells whether people are dying too early Quality of life – tells how well people feel while living
- Every year since the Rankings were first calculated on a national basis, the University of Wisconsin Population Health Institute has tweaked the formula for calculating the Rankings. This is because more relevant data becomes available that was not previously available for every county in the nation.Data Updates: This is the first year that the Rankings have been calculated with Census data based on the 2010 Census rather than 2000.Change:Motor vehicle crash rates: A slight change in the definition of motor vehicle crashes to align with Health People 2020 objectives. The new definition excludes crashes that happen off of roadways.New:Dentists: Oral health care is a key indicator for the health of communities. Dentist shortages are widespread, and affect the quality of dental care provision in the communities.Change: Primary care physicians: The weighting was changed to accommodate the inclusion of dentists. In addition, the definition of primary care Physicians which changed slightly to include doctors of osteopathy and to exclude obstetricians, bringing the definition in alignment with the Health Resources & Services administration Change: Air pollution particulate-matter days and air pollution ozone days – These measures used in past years were replaced with daily fine particulate matter From the CDC wonder environmental data. This updated measure of air quality became available this year. This new measure of the average daily fine particulate matter offers several advantages over the prior measures of care quality including the recency and precision. Change:Drinking Water Safety - Tainted drinking water is estimated to sick and over one million Americans each year. This new measure estimates the proportion of the county’s population whose water system has been affected by at least one health-related violation in the past year.Of all of the changes to the calculations, the changes to the how the Physical Environment rankings are calculated seems to have had the biggest impact on where the counties rank.
- And here is where Florida is today. The lightest colored counties are in the top 25 percent in rank moving down to the darkest, which are in the bottom quartile.If you’ve followed the Rankings over the past few years, one thing you may notice is that the colors don’t change much. Counties’ specific rankings may shift from year-to-year based on individual variables, but whether they are in the top, bottom or one of the middle quartiles doesn’t seem to change much. In general, the rural counties with fewer resources and less vibrant economies have poorer health.
- Looking at the top and bottom five counties reinforces the connection between health and the resources of a county. (Just a note that Union probably would not be in the bottom five of Health Outcomes if not for its large prison population.)
- But just because we’re living longer, doesn’t necessarily mean that we’re living better. Obesity rates are climbing and the amount of exercise we’re getting is dropping. This does not bode well for our future quality of life or for how much money we will need to spend to treat the chronic diseases caused by these issues
- I want to show you a couple of features of the County Health Rankings website. What you’re seeing here is a screenshot of the home page where you can click on your state to bring up the rankings
- Here is a screen shot of Florida and it is in green because we are seeing the Health Outcome rankings. If we were to click on the blue Health Factors button, the image would change to show the health-factor rankings in blue
- If you click on a county you will bring up a screen like this. In this case we have selected St. Johns County. Here you can see the where the county ranks on each of the components of the Health Outcomes and Health Factors. If you want to learn more about the individual factors and see the data sources, you can click right on the indicator and it will provide you with a great deal of detail.
- I want to call your attention to a helpful feature. At the top of each county page, there is an “Areas to Explore” button that can be toggled on and off. If you click it on…
- …You will see various Rankings highlighted. These indicate critical areas to be addressed. On the county data sheets that FPHI has distributed and that we will soon have available for download on the FPHI website, we have highlighted those indicators for each county.
- Also on the page you can see additional measures that are not uniform enough across all counties in the country to be used in the Rankings but is nevertheless very useful information.
- So here’s a look at just some of the additional data available.We have included some of these indicators on the county one-pagers FPHI has prepared.
- All of this data lets us see how where we live, learn, work, and play influences how healthy we are and how long we live. The County HealthRankings & Roadmaps show us what is making residents sick, where we need to improve, and what communities can do to create a culture of health. Having health insurance is important–but much of what affects our health happens outside of the doctor’s office. It’s hard to live a healthy life if you live in an unhealthy place.
- The Rankings raise multifaceted challenges that require all-hands-on-deck solutions
- The ultimate goal of the County Health Rankings is not just to issue a report card on the counties. It’s ultimate goal is to improve health outcomes by gaining attention to the areas of the health that may be improved, building community engagement to implement evidence-based community projects, programs and policies. So how do we get from where we are today to our goal of improved health outcomes?
- By publicizing the Rankings we hope to spark the kind of broad community engagement necessary to implement some of the evidence-based health program and policies that will improve long-term health outcomes and hold down the cost of healthcare.
- This is what it looks like when a community comes together to take action.
- Acknowledging where your community is doing well and identifying health problems is the first step—taking action is the second and most important step and here is where the County Health Roadmaps can be an important tool for local health improvement coalition.
- Unfortunately, we don’t have time today to take you through a tour of the Roadmaps to Health section of the County Health Rankings & Roadmaps website, but I strongly encourage you to spend some time exploring it on your own. You will find tools for community organizing, a variety of evidence-based health policies and programs to consider for your community, sources of funding to help support your community health improvement initiative, and a whole lot more. On the website you can also register for upcoming training Webinars that delve deeper into these topics.
- Moving forward it’s up to each of us move our communities to take action.
- So who are the types of community leaders you should approach to get something started? This chart shows just an example of the many sectors of the local community who have a role to play in the policies and programs that impact health. We encourage you to meet with these groups and share the Rankings data.
- Martha: I want to thank everyone who has taken the time to attend today’s webinar, and thank Dr. King for his time and professional insights. The slides for today’s webinar will be available on the Florida Public Health Institute website at www.flphi.org and as soon as possible we will have a recording of the webinar posted there also. Have a great day and be well!