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

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)

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

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

1st quintile (N = 5)

7. Child health status 6. Colorectal cancer mortality 8. Drug overdose mortality 9. Unintentional injury mortality 10. Diabetes mortality

2nd quintile (N = 13)

11. Children’s dental problems 12. Teen births

15. Physically unhealthy days 17. Activity limitations 20. Years of potential life lost

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

3rd quintile (N = 14)

23. Child/adolescent overweight and obesity 24. Low birth weight 30. Child and adolescent asthma

21. Adult health status 24. Life expectancy 25. All-cause mortality

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)

4th quintile (N = 6)

33. Infant mortality 32. Mentally unhealthy days 33. Life expectancy at age 65

32. Influenza mortality 33. HIV infection 35. Cerebrovascular mortality

5th quintile (N =1 )

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

Spending on mass transit (per capita)

rs= -0.78

rs= -0.51

All-cause mortality

rs= -0.50

rs= -0.66

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