Joanne Rinker MS, RD, CDE, LDNDirector of Training and Technical Assistance

Center for Healthy North Carolina

NCIOM Prevention Task Force

• Prevention for the Health of North Carolina released on October 8, 2009

• At the release, Gov. Beverly Perdue voiced her desire for NC to be the healthiest state in the nation by 2020. 

• Goal - a Better State of Health!

http://www.nciom.org/projects/prevention/prevention_report.shtml

America’s Health Rankingshttp://www.americashealthrankings.org/

North Carolina: A Better State of Health

North Carolina: A Better State of HealthThe Next Step in the Journey...

• We have the Prevention Action Plan, now what?

• Healthy North Carolina 2020 Objectives• Governor’s Task Force for Healthy

Carolinians asked NCIOM to help develop NC’s 2020 objectives and targets.

Healthy North Carolina 2020• Three primary steps in setting Healthy North Carolina

2020 objectives:– 1) Identify appropriate focus (priority) areas,

building off Prevention Action Plan.– 2) Identify limited number of objectives – 3) Identify appropriate targets

Healthy NC 2020 Focus Areas

1. Tobacco use

2. Nutrition and physical activity

3. Sexually transmitted infections/Unintended pregnancy

4. Substance abuse

5. Environmental risks

6. Injury

7. Mental health

8. Infectious disease/ Food-borne illness

9. Social determinants of health

10.Dental health

11. Maternal and infant health

12.Chronic disease

13.Cross-area measures

Healthy North Carolina 2020:Moving Ahead

• Focus on prevention and reducing risk factors that contribute to the leading causes of death in North Carolina

• We cannot measure everything that is important in public health work

• Identify a limited number of health objectives to work toward across the state– 40 objectives: limited, manageable, concise – Allow for meaningful impact – Pull together to make progress

Healthy North Carolina 2020:2013 Annual Report Results

• The NC Division of Public Health/NC State Center for Health Statistics produces annual reports measuring progress towards the targets of improving population health.

• For 2013, of the 31* objectives for which we have updated data, 7 are not comparable.

• Of the 31 that are comparable to the baseline, trends may indicate:– 15 (48%) are moving in the right direction – 1 (3%) stayed the same– 15 (48%) are moving in the wrong direction

All data provided by the NC State Center for Health Statistics

*Not all data are available every year.

Note: Total does not equal 100% due to rounding

Healthy North Carolina 2020

Tobacco Use   Baseline CurrentHNC2020

Target US

1. Decrease the percentage of adults who are current smokers¹

20.3% (2009)

20.9% (2012)

13.0% 21.2%(2011)

2. Decrease the percentage of high school students reporting current use of any tobacco product

25.8% (2009)

22.5% (2011)

15.0% 23.4%(2011)

3. Decrease the percentage of people exposed to secondhand smoke in the workplace in the past seven days¹

14.6% (2008)

8.6% (2012)

0% Not available

* Data for this indicator is collected only in odd numbered years.¹ In 2011, the BRFSS methodology changed, so results are not directly comparable to

previous years’ results.

Healthy North Carolina 2020Physical Activity and Nutrition

 Baseline Current HNC2020Target

US

1. Increase the percentage of high school students who are neither overweight nor obese

72.0% (2009)

71.2%(2011)

79.2% 71.8%(2011)

2. Increase the percentage of adults getting the recommended amount of physical activity ²

46.4% (2009)

No update²

60.6% 51.0%(2009)

3. Increase the percentage of adults who report they consume five or more servings of fruits and vegetables per day²

20.6% (2009)

No update²

29.3% 23.4%(2009)

* Data for this indicator is collected only in odd numbered years. ² In 2011, the definition for recommended amount of physical activity and fruit and

vegetable consumption changed. Therefore, comparable data for these measures are not available at this time.

Healthy North Carolina 2020

Injury  Baseline CurrentHNC2020

Target US

1. Reduce the unintentional poisoning mortality rate (per 100,000 population)

11.0(2008)

11.7 (2012)

9.9 10.6(2010)

2. Reduce the unintentional falls mortality rate (per 100,000 population)

8.1(2008)

9.6 (2012)

5.3 7.9(2010)

3. Reduce the homicide rate (per 100,000 population)

7.5 (2008)

6.0 (2012)

6.7 5.3(2010)

Healthy North Carolina 2020Maternal and Infant Health Baseline Current HNC2020

TargetUS

1. Reduce the infant mortality racial disparity between whites and African Americans

2.45(2008)

2.50 (2012)

1.92 2.35(2010)

2. Reduce the infant mortality rate (per 1,000 live births)

8.2 (2008)

7.4 (2012)

6.3 6.1(2010)

3. Reduce the percentage of women who smoke during pregnancy³

10.4%(2008)

10.6% (2012)

6.8% Not available

³ North Carolina implemented the revised U.S. Standard birth certificate in 2011. The methodology for collecting smoking data was modified, therefore values presented for

2011 are not comparable to prior years.

Healthy North Carolina 2020Sexually Transmitted Diseases andUnintended Pregnancy  Baseline Current

HNC2020Target US

1. Decrease the percentage of pregnancies that are unintended

39.8%(2007)

42.7% (2011)

30.9% Not available

2. Reduce the percentage of positive results among individuals aged 15 to 24 tested for Chlamydia

9.7%(2009)

10.8% (2012)

8.7% Not available

3. Reduce the rate of new HIV infection diagnoses (per 100,000 population)

24.7 (2008)

17.3 (2011)

22.2 16.3(2010)

Healthy North Carolina 2020Substance Abuse Baseline Current

HNC2020 Target US

1. Reduce the percentage of high school students who had alcohol on one or more of the past 30 days

35.0%(2009)

34.3% (2011)

26.4% 38.7%(2011)

2. Reduce the percentage of traffic crashes that are alcohol-related

5.7%(2008)

5.3% (2012)

4.7% Not available

3. Reduce the percentage of individuals aged 12 years and older reporting any illicit drug use in the past 30 days

7.8%(2007-2008)

7.9% (2010-

11)

6.6% 8.8%(2010-2011)

* Data for this indicator is collected only in odd numbered years.

Healthy North Carolina 2020

Mental Health Baseline CurrentHNC2020

Target US

1. Reduce the suicide rate (per 100,000 population)

12.4(2008)

12.9 (2012)

8.3 12.1(2010)

2. Decrease the average number of poor mental health days among adults in the past 30 days¹

3.4(2008)

3.9 (2012)

2.8 Not available

3. Reduce the rate of mental health-related visits to emergency departments (per 10,000 population)

92.0(2008)

104.5 (2012)

82.8 Not available

¹ In 2011, the BRFSS methodology changed, so results are not directly comparable to previous years’ results.

Healthy North Carolina 2020Oral Health  Baseline Current

HNC2020Target US

1. Increase the percentage of children aged 1-5 years enrolled in Medicaid who received any dental service during the previous 12 months

46.9% (2008)

57.3% (2012)

56.4% 40.3%(2011)

2. Decrease the average number of decayed, missing, or filled teeth among kindergartners

1.5(2008-2009)

1.5 (2009-

10)

1.1 Not available

3. Decrease the percentage of adults who have had permanent teeth removed due to tooth decay or gum disease

47.8% (2008)

48.3% (2012)

38.4% 43.6%(2010)

Healthy North Carolina 2020Environmental Health Baseline Current

HNC2020Target US

1. Increase the percentage of air monitor sites meeting the current ozone standard of 0.075 ppm

62.5%(2007-2009)

80.5% (2010-

12)

100% Not available

2. Increase the percentage of the population being served by community water systems (CWS) with no maximum contaminant level violations (among persons on CWS)

92.2%(2009)

97.4% (2012)

95.0% Not available

3. Reduce the mortality rate from work-related injuries (per 100,000 equivalent full time workers)

3.9 (2008)

3.7 (2011)

3.5 3.6%(2010)

Healthy North Carolina 2020Infectious DiseaseFoodborne Illness Baseline Current

HNC2020 Target US

1. Increase the percentage of children aged 19-35 months who receive the recommended vaccines

77.3%(2007)

76.2%(2012)

91.3% 77.0%(2011)

2. Reduce the pneumonia and influenza mortality rate (per 100,000 population)

19.5(2008)

19.6 (2012)

13.5 15.1(2010)

3. Decrease the average number of critical violations per restaurant/food stand

6.1(2009)

6.5 (2011)

5.5 Not available

**Data update not available

Healthy North Carolina 2020

Social Determinants of Health Baseline Current

HNC2020Target US

1. Decrease the percentage of individuals living in poverty

16.9%(2009)

17.2% (2012)

12.5% 15.0%(2011)

2. Increase the four-year high school graduation rate

71.8%(2008-9)

82.5% (2012-

13)

94.6% Not available

3. Decrease the percentage of people spending more than 30% of their income on rental housing

41.8%(2008)

44.8% (2012)

36.1% 49.3%(2011)

Healthy North Carolina 2020

Chronic Disease Baseline CurrentHNC2020

Target US

1. Reduce the cardiovascular disease mortality rate (per 100,000 population)

256.6(2008)

237.2 (2012)

161.5 234.2(2010)

2. Decrease the percentage of adults with diabetes¹

9.6%(2009)

10.4% (2012)

8.6% 9.5%(2011)

3. Reduce the colorectal cancer mortality rate (per 100,000 population)

15.7(2008)

15.1 (2012)

10.1 15.6(2010)

¹ In 2011, the BRFSS methodology changed, so results are not directly comparable to previous years’ results.

Healthy North Carolina 2020Cross-cutting Baseline Current

HNC2020Target US

1. Increase average life expectancy (years)

77.5 (2008)

78.2 (2012)

79.5 78.7(2010)

2. Increase the percentage of adults reporting good, very good, or excellent health¹

81.9%(2009)

80.7% (2012)

90.1% 83.1%(2011)

3. Reduce the percentage of non-elderly uninsured individuals (aged less than 65 years)

20.4%(2009)

18.9% (2011)

8.0% 17.9%(2011)

4. Increase the percentage of adults who are neither overweight nor obese¹

34.6%(2009)

34.2% (2012)

38.1% 36.3%(2011)

¹ In 2011, the BRFSS methodology changed, so results are not directly comparable to previous years’ results.

County Health Rankings: 2014North Carolina

1 Wake

2 Watauga

3 Orange

4 Union

5 Camden

6 Mecklenburg

7 Davie

8 Dare

9 Cabarrus

10 New Hanover

91 Bladen

92 Lenoir

93 Martin

94 Swain

95 Bertie

96 Vance

97 Robeson

98 Scotland

99 Halifax

100 Columbus

Source: County Health Rankings and Roadmaps, 2014. http://www.countyhealthrankings.org/

Healthy North Carolina 2020:Moving Forward

Where would we be if we met our HNC 2020 Goals?

Objective Current Ranking Rank if 2020 Goal Met

Diabetes Prevalence 33 13

Immunization Rates 22 1

High School Graduation 32 1

Adult Tobacco Use 33 13

Cardiovascular Mortality 32 3

Infant Mortality 40 25

The individual state’s ranking and score was determined for each of these measures using the 2013 America’s Health Rankings. The Healthy NC 2020 goal for each measure was then compared to the current ranking and a new ranking was determined based on the goal score.

Source: Personal email, Kelly Kimple, MD, MPH, UNC Preventive Medicine, Chief Resident, June 18, 2014.

Healthy North Carolina 2020:Moving Forward

• The Prevention Action Plan and the Healthy North Carolina 2020 objectives form the basis of a larger campaign to promote a “Better State of Health” in North Carolina.

• Community engagement• Locally implemented, community

appropriate, evidence based strategies

Establish CHA Team

Collect Primary

Data

Collect Secondary

Data

Analyze and Interpret

Data

Determine Health

Priorities

Create CHA Documents

Disseminate CHA

Documents

Develop Community Action Plan

The Center for Healthy North Carolina can provide technical assistance related to the identification, selection, implementation, evaluation and sustainability of evidence based strategies for community identified health priorities that relate to the Healthy North Carolina 2020 objectives.

Adapted from North Carolina Division of Public Health Community Health Assessment http://publichealth.nc.gov/lhd/cha/

Community Health Assessment and Technical Assistance Continuum

Technical Assistance from NC DPH

Technical Assistance from CHNC

Stage Ikey partners form

workgroup

Stage IIcommon priorities

formal commitment to action

Stage IIIstrategic plan

defined purpose/vision

Stage IVactive projects

established structure

Stage Vprojects maintained or

transitionedQI/Evaluation component

multiple sources of funding/support

CHAImplementation

plan with priorities

Identify & select EBS Implement & evaluate EBS

CoalitionDevelopment

PopulationHealthInitiatives

IMPROVED POPULATION HEALTH

Evaluation

Sustainability

Implementation

Technical Assistance

Action Plan

EBS Awareness

Healthy North Carolina 2020:The Campaign

• Working to improve individual, environmental and policy changes that will have a meaningful impact on health in NC

• Increase public awareness and community support

• Increase community capacity• Engage boards, organizations and

community groups

Healthy North Carolina 2020:What Can You Do Today?

• Sign the Resolution in Support of Making NC a Healthier State: http://www.publichealth.nc.gov/hnc2020/resolution.asp – Commit as an individual– Commit as an organization

• Ask for an HNC2020 presentation to your organization, board or community group

Credits/Thanks

• Thanks to the NC State Center for Health Statistics for providing the HNC2020 data

• Thanks to CHNC’s funder - The Duke Endowment

Healthy North Carolina 2020:How Can You Find Out More?

Visit the HNC2020 websitehttp://publichealth.nc.gov/hnc2020

Contact: Joanne Rinker 919-699-5886

Joanne.rinker@centerforhealthync.org