Health Disparities for Hawaii County

Health ConferenceAugust 13, 2010

Sharon H. Vitousek, M.D.North Hawaii Outcomes Project

www.nhop.org

Health Disparities - Hawaii County 

Health Outcomes

• Higher Death rates– All causes– Heart disease– Stroke– Overall cancer– Infant Mortality– Traffic-related– Suicide

• Lower life expectancy• Higher teen birth rates• Higher confirmed child abuse rates• Higher self-reported fair/poor health status

Health Disparities - Hawaii CountyHealth Outcomes

0

100

200

300

400

500

600

700

800

900

1000

1999 2000 2001 2002 2003 2004 2005 2006 2007

Ag

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nAll Causes - Age-Adjusted Death RateHawaii County Compared to the State

Chart: North Hawaii Outcomes Project - February 2010 Source: Office of Health Status Monitoring, 1999-2007

Hawaii County

State

Hawaii County

State

HP 2010 - 166.0

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

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Coronary Heart Disease - Death RateHawaii County Compared to State

Chart: North Hawaii Outcomes Project - July 2010 Source: Hawaii State Department of Health - Office of Health Status Monitoring 1999 - 2008

Hawaii County

State

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Ag

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Chart: North Hawaii Outcomes Project - August 2010Source: Department of Health - Office of Health Status

Monitoring, 1999 - 2008

Cerebrovascular(Stroke) Disease - Death RatesAll Counties

Chart: North Hawaii Outcomes Project - August 2010Source: Department of Health - Office of Health Status

Monitoring, 1999 - 2008

Cerebrovascular(Stroke) Disease - Death RatesAll Counties

0

20

40

60

80

100

120

140

160

180

200

1999 2000 2001 2002 2003 2004 2005 2006 2007

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Overall Cancer - Death RateHawaii County Compared to the State

Chart: North Hawaii Outcomes Project - February 2010 Source: Office of Health Status Monitoring, 1999-2007

State

Hawaii County

10.911.5

9.710.7

11.3 11.112.6

10.8

8.3 8.4

25.5

19.918.3

21.1

25.6

24.323.1

22.0

16.5

15.2

7.48.9

7.68.9

7.8 8.39.7

7.4

4.85.8

0.0

5.0

10.0

15.0

20.0

25.0

30.0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Rat

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dFatalitiesRelated -Rate of Traffic

Chart: North Hawaii Outcomes Project - April 2010Traffic fatalities include; motor vehicle occupants, pedestrians, motorcyclists, moped operators, ATV operators, and bicyclists.

Source: Numerator from Department of TransportationDenominator-Table 1: Annual Estimates of the Population for Counties of Hawaii:

April 1, 2000 to July 1, 2009(CO-EST2009-01-15)Source: Population Division, U.S. Census Bureau

Release Date: March 20, 2010

Hawaii County

State

City & County of Honolulu

4.6

5.3

0

2

4

6

8

10

12

2000 2001 2002 2003 2004 2005 2006 2007 2008

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f In

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t de

ath

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,00

0 li

ve b

irth

sInfant Mortality Rate

(Place of residence)

HP 2010

HC

St

Source: State of Hawaii Health Department, Vital StatisticsChart: North Hawaii Outcomes Project - March 2010

HP 2010 Goal - 4.5

15.4

12.6 12.4

16.0

10.6

6.7

10.111.0

15.9

11.6 11.09.7

10.49.2

8.3

9.410.1 10.2

HP 2010, 5.05.0

0.0

5.0

10.0

15.0

20.0

25.0

2000 2001 2002 2003 2004 2005 2006 2007 2008

Dea

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ted Hawaii County

State

HP 2010

Suicide - Death Rate (not age-adjusted)

Chart: North Hawaii Outcomes Project - March 2010 Source: Office of Health Status Monitoring, 1999-2006Source: Denominator from U.S. Census

79.7 80.9 80.7 80.6

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Hawaii County City & County of Honolulu Kauai County Maui/Kalawao County

Average Life Expectancy at Birth, by County (2004-2006)

Chart: North Hawaii Outcomes Project - March 2010 Source: Hawaii State Data Book 2008

Hawaii County

52.1

State

42.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

2000 2001 2002 2003 2004 2005 2006 2007 2008

HP 2010 - 5.0

Source: Department of Health, Office of Health Status Monitoring, 2008Chart: North Hawaii Outcomes Project - March 2010

Teen Birth Rates per 1,000 females15 - 19 years old

Hawaii County

State

0.0

5.0

10.0

15.0

20.0

25.0

30.0

2000 2002 2003 2005 2006 2007 2008

Per

1,0

00 c

hild

ren

Chart: North Hawaii Outcomes Project - August 2010

Rate Confirmed-Child Abuse and Neglect

Source: Hawaii State Data BookNote: No data was available for years 2001 and 2004.

15.5%

13.6% 13.4%

17.2%

18.2%

16.8%

18.1%

15.5% 15.3%

12.4%

11.5%12.1%

14.4%13.7%

14.7% 14.6% 14.8%

13.8%

0%

5%

10%

15%

20%

25%

2001 2002 2003 2004 2005 2006 2007 2008 2009

Per

cent

repo

rting

fair

to p

oor g

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al h

ealth

sta

tus

Self-Reported General Health Status - Fair / Poor

Source: Behavioral Risk Factor Surveillance Survey 2001-2009Chart: North Hawaii Outcomes Project - August 2010

Hawaii County

State

Health Disparities - Hawaii County• Geographic

– Hawaii County

• Economic – higher death rates with lower income

• Education– Higher death rates with lower education

• Ethnic: Genetic & Cultural, Socioeconomic

– Higher CVD death rates --Hawaiian, Filipino– Lower cancer screening rates– Hawaiian– Lower rates of control - diabetes & blood pressure

Health Disparities - Hawaii County

Why?

Framework for Population Health Institute of Medicine

Social and Physical Environment

Social, Economic & Physical Environment

(Socioeconomic Determinants)

Health-Related Behaviors

Health Systems

(Access to Care & Quality)

Population

Health Outcomes

Health Disparities - Hawaii County

Social and Economic Determinants

• Higher unemployment• Lower income per capita• Higher % population living under 200%

of federal poverty• More children living in poverty• Higher income inequality

5.1%

4.3% 4.2% 4.1%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

Hawaii County Maui County City & County of Honolulu Kauai County

Average Percemt Unemployed by Counties2006 - 2008

Chart: North Hawaii Outcomes Project - August 2010Source: American Community Survey 2006-2008

$25,070

$30,205$29,128

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

Hawaii County City & County of Honolulu Maui

Average Per Capita Income by County - 2008

Chart: North Hawaii Outcomes Project - December 2009 Source: American Community Survey, 2008

Higher % population living under 200% of federal poverty

29.6%

20.7%

9.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

Hawaii County City & County of Honolulu Maui County

Population for Whom Poverty Status is Determined at or Below 200% Federal Poverty Level - 2008

Source: U.S. Census, ACS 2008Chart: North Hawaii Outcomes Project - February 2010

17.2%

9.7%9.0% 9.1%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

Hawaii County City & County of Honolulu Maui County Kauai County

Average Percent of Population Under 18 years old living below poverty

Chart: North Hawaii Outcomes Project - August 2010 Source: American Community Survey, 2006 -2008

0.4330.425

0.406

State - 0.428

U.S. - 0.469

0.37

0.38

0.39

0.4

0.41

0.42

0.43

0.44

0.45

0.46

0.47

0.48

Hawaii County City & County of Honolulu Maui County

Gini Index of Income Inequality - 2008

Chart: North Hawaii Outcomes Project - January 2010 Source: U.S. Census, ACS 2008

Health Disparities - Hawaii County

Health Related Behaviors

Smoking

• Binge drinking

• (Obesity)

• (Adults getting no exercise)

Smoking

HP 2010 - 12.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Per

cent

of c

urre

nt s

mok

ers

State Hawaii County HP 2010

Chart: North Hawaii Outcomes Project - July 2010Source: Behavioral Risk Factor Surveillance Survey, 2000-2008

Current Adult Smoker

Hawaii County

State

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

2001 2002 2003 2004 2005 2006 2007 2008 2009

State Hawaii County

Hawaii County Compared to State - *Binge Drinking Adults 18 years and older (2001- 2009)

Source: Behavioral Risk Factor Surveillance Survey 2001-2009*"five or more alcoholic beverages on at least one occasion, in the past month."

Chart: North Hawaii Outcomes Project July 2010

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

State

Hawaii County

HP 2010

ObesityBody Mass Index > 30

Chart: North Hawaii Outcomes Project - August 2010 Source: Behavioral Risk Factor Surveillance Survey, 2000 - 2009

HP 2010 Goal

Activity

HP 2010 - 20.0%

0.0%

10.0%

20.0%

30.0%

2001 2002 2003 2004 2005 2006 2007 2008 2009

Adults Getting No Exercise

Chart: North Hawaii Outcomes Project - July 2010 Source: State of Hawaii Behavioral Risk Factor Surveillance Survey, 2001-2009

Hawaii County

State

Health Disparities - Hawaii County

 Health Systems

Access:• Higher uninsured Lower ratio of physicians per 1,000 population• Higher percent of population without a personal doctor• Lower percent of female population receiving prenatal

careUtilization & Cost:• Higher acute care hospitalizations per 1,000 population

Quality:

 

2.1

3.4

2.32.4

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Hawaii County City & County Of Honolulu Maui County Kauai County

Access to Physicians - 2009**Current licenses as of April 1, 2009

Chart: North Hawaii Outcomes Project - January 2010 Source: Numerator from Department of Commerce and Consumer Affairs –April 1, 2009

*Denominator from U.S. Census March 19, 2009 population estimate.may or may not be active** Licensed physicians

136137

146 146

150151

136

125

130

135

140

145

150

155

2001 2002 2003 2004 2005 2006 2007

7 %

1 %

3 %

1 %

-10%

Number of Hawaii CountyPhysicians Offices (2001- 2007)

Chart: North Hawaii Outcomes Project - February 2010Source: U.S. Census, Economic Census 2007

Consequences of Inadequate Access to Primary Healthcare

Source: Institute of Health Improvement, John Wasson, M.D.

78%

65%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2000 2001 2002 2003 2004 2005 2006 2007

State

Hawaii County

HP 2010

Mothers Receiving Prenatal Care in First Trimester

Chart: North Hawaii Outcomes Project - June 2008 Source: Department of Health - Office ofHealth Status Monitoring, 2000 - 2007

Healthy People 2010 Goal

Consequences of Inadequate Access

• Delayed Care & Increased suffering

• Higher ER utilization

• Higher hospital utilization

• Increased costs

• Less focus on Prevention- Life style

• Less recommended screening

• Poorer outcomes

Improving Population Health -- How?

Socioeconomic Determinants1.Economic Development

•Health sector: policy change & planning•Education/ Science sectors•Energy sector

Health-Related Behaviors1.Environmental AND Individual Strategies

•Smoking cessation, physical activity, improved access to fruits & vegetables

• Identifying and addressing problem drinking

Health Systems1.Primary Care Workforce Development

•Grow our own, Policy, Broader Team, Redesign care delivery, Engage community

Improved

Population

Health Outcomes

Consequences of Improved Access

• Timely Care & Decreased suffering• Lower ER utilization• Lower hospital utilization• Decreased costs• More focus on prevention & life style• More recommended screening• Better outcomes & Quality of Life• Improved productivity/business environment• Improved community wellbeing

Hawaii Island Healthcare Alliance• Island wide, voluntary, collaborative group of

stakeholders• Goal to improve health & health care in Hawaii County

by increasing healthcare workforce & financial sustainability of providers

• Endorses:– Growing own providers, – Broader primary care team– Collaboration to align policy efforts,

• Friends of the Future is 501(c )(3) Fiscal Agent