JOINING HANDS: SHARING RESOURCES AND DATA ACROSS SECTORS TO IMPROVE POPULATION HEALTH Virginia Population Health Summit Charlottesville, Virginia March 29, 2017 Steven H. Woolf, MD, MPH Director, Center on Society and Health Department of Family Medicine and Population Health Center on Society and Health Virginia Commonwealth University swoolf@vcu.edu
2013 Metro Map
WHO Conceptual Model From: A Conceptual Model for Taking Action on the Social Determinants of Health. Geneva: World Health Organization, 2010
The Built Environment
Health in All Policies Transportation Land use Built environment Taxes Housing Agriculture Environmental justice Etc. Health and illness
Region Forward 8
The Problem of Silos
Connecting the Dots 10
The Health of the States Supplemental reports Supplement 1: The Health of the States: Spotlight on methods Supplement 2: The Health of the States: Spotlight on life expectancy and mortality Supplement 3: The Health of the States: Spotlight on birth outcomes Supplement 4: The Health of the States: Spotlight on child and adolescent health Supplement 5: The Health of the States: Spotlight on sexually transmitted infections Supplement 6: The Health of the States: Spotlight on injury fatalities Supplement 7: The Health of the States: Spotlight on adult health status Supplement 8: The Health of the States: Spotlight on overweight/obesity, diabetes, and cardiovascular conditions Supplement 9: The Health of the States: Spotlight on cancer, lower respiratory disease, influenza and pneumonia, and Alzheimer s disease
Data sources considered (N = 56) AFL-CIO Air Quality System form EPA American Community Survey Annual Parole Survey Annual Probation Survey Area Health Resource File Behavioral Risk Factor Surveillance Survey Bureau of Justice Statistics Bureau of Labor Statistics CCW and Medicare Administrative Data from Health Indicators Warehouse CDC CDC 2012 Water Fluoridation Statistics CDC Breastfeeding Report Card CDC Morbidity and Mortality Weekly Report CDC National Program of Cancer Registries CDC State Indicator Report on Fruits and Vegetables CDC State Tobacco Activities and Evaluation (STATE) System CDC WISQARS CDC Wonder CDC s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Atlas Census of Juveniles in Residential Placement, Office of Juvenile Justice and Delinquency Prevention Center for Housing Policy s Housing Landscape 2013 CMS Hospital Compare data from Health Indicators Warehouse Community Development Financial Institutions Fund s data on persistent poverty in counties Corporation of Enterprise Development Assets and Opportunity Scorecard Current Population Survey Dartmouth Atlas of Healthcare DHHS Title X Family Planning Annual Report Food Research and Action Center s Mapping School Breakfast: Participation, Funding and Growth Health Indicators Warehouse Immunization Information Systems Annual Report Juvenile Offenders and Victims: National Report Series Kaiser Family Foundation Kids Count National and State Healthcare-Associated Infections Standardized Infection Ratio Report National Center for Children in Poverty National Center for Education Statistic s National Assessment of Educational Progress Mathematics Assessment Report Card National Center for Education Statistic s National Assessment of Educational Progress Reading Assessment Report Card National Center for Education Statistics National Crime Victimization Survey National Environmental Public Health Tracking Program National Immunization Survey National Immunization Survey data from Health Indicators Warehouse National Survey of Children s Health National Survey of Drug Use and Health NHTSA Traffic Safety Facts Crash Stats NHTSA Traffic Safety Facts Research Note SAMHSA annual SYNAR report (retailer violations rate FY 2012) School Health Policies and Practices Study The 2013 Annual Homeless Assessment Report (AHAR) to Congress Uniform Crime Reporting Statistics US Census Bureau US Census Bureau- Yale USDA Food Environment Atlas Various CDC/NCHS data Youth Risk Behavior Surveillance Survey
Health measures (N=39) Life expectancy and premature death Newborn life expectancy Life expectancy at age 65 All-cause mortality Years of potential life lost before age 75 Birth outcomes Infant mortality Low birth weight Child and adolescent health Child health status Overweight and obesity Dental problems Asthma Teen births Injuries Unintentional injuries Motor vehicle fatalities Drug overdose fatalities Intentional injuries Homicide Suicide Sexually transmitted infections Chlamydia and gonorrhea HIV Adult health status Self-rated health Activity limitations Unhealthy days Physical Mental Chronic diseases Adult overweight and obesity Diabetes (prevalence and mortality) Cardiovascular disease (prevalence and mortality) Cerebrovascular disease (prevalence and mortality) Cancer (prevalence and mortality) Lower respiratory mortality Kidney mortality Influenza mortality Alzheimer s mortality
Determinants of health by domain HEALTH SYSTEMS Access to care Private insurance Mental health care shortages Dental visits Quality of care Unmet pediatric needs Pediatric immunization Colorectal cancer screening Discharges for ACS conditions Diabetes management 30-day hospital readmissions Ambulatory EMR HEALTH BEHAVIORS Smoking Diet Exclusive breastfeeding Physical activity Children activity Adult inactivity Teen contraception Prescription drug use Injurious behavior Seat belts Teens with intoxicated driver Teen violence SOCIOECONOMIC Demographics Married Minority majority Homeless Education Parent education > high school 8th grade reading proficiency College education Household economic status Median household income Poverty Concentrated poverty Minority + concentrated poverty Income inequality Employment Food insecurity Housing cost burdens Severe housing problems Overcrowding Crime and incarceration Adult incarceration Parole PHYSICAL/SOCIAL ENVIORNMENT Physical environment Smoke-free homes Air (particulate matter) pollution Water fluoridation Built environment Motor vehicle transportation Social environment Reading to children Social support for children ACE exposure Mentoring for teens Neighborhood social support Social capital Violent crime School safety Children s exposure to violence Neighborhood safety Witnessed violence Sexual assault (intimate partner violence) PUBLIC POLICIES AND SPENDING Public policies Tobacco tax per pack Medicaid eligibility Public spending Education spending (per capita & per poor) Income support Health spending (per capita & per poor) Medicaid (per poor) Medicare (per capita and per older adults)
Library of HOTS geospatial maps, by health outcome (N=40)
Virginia Ranking in United States Quintile Child and adolescent health Adult health 1 st quintile (N = 5) 2 nd quintile (N = 13) 3 rd quintile (N = 14) 4 th quintile (N = 6) 5 th quintile (N =1 ) 7. Child health status 6. Colorectal cancer mortality 8. Drug overdose mortality 9. Unintentional injury mortality 10. Diabetes mortality 11. Children s dental problems 12. Teen births 23. Child/adolescent overweight and obesity 24. Low birth weight 30. Child and adolescent asthma 15. Physically unhealthy days 17. Activity limitations 20. Years of potential life lost 21. Adult health status 24. Life expectancy 25. All-cause mortality 33. Infant mortality 32. Mentally unhealthy days 33. Life expectancy at age 65 11. Adult overweight and obesity 11. Prostate cancer mortality 12. Lower respiratory mortality 14. Alzheimer s mortality 16. Motor vehicle mortality 16. Suicides 16. Lung cancer mortality 18. Homicides 21. Breast cancer mortality 22. Cancer (overall) mortality 23. Gonorrhea infection 24. Cardiovascular disease (prevalence) 25. Cardiovascular mortality 25. Stroke (prevalence) 25. Chlamydia infection 27. Diabetes (prevalence) 32. Influenza mortality 33. HIV infection 35. Cerebrovascular mortality 42. Renal mortality Note: From Health of the States, Virginia Commonwealth University, 2016. Most data from 2011-2013.
Public policies and spending
Data resources across five domains
An example: Spending on infrastructure r s = -0.78 r s = -0.66 Spending on mass transit (per capita) r s = -0.50 r s = -0.51 All-cause mortality
Health Opportunity Index
Life expectancy, Fairfax County, by census tract
Seminary Hill vs. Beauregard, Alexandria
The determinants of wellbeing
The Return on Investment
Collective Impact Kania and Kramer, Stanford Social Innovation Review, Jan 21, 2013
Live Well San Diego
The Era of Big Data
Contact Information Steven H. Woolf, MD, MPH Center on Society and Health Department of Family Medicine and Population Health Virginia Commonwealth University 804-628-2462 swoolf@vcu.edu societyhealth.vcu.edu @VCUSocHealth