Population Health and Its Role in Our Community

Virginia A. Caine, MDDirector,

Marion County Public Health Departmentvcaine@marionhealth.org

317-221-2301

Population Health is:

The health outcomes of a group of individuals, including the distribution of such outcomes within the group.

Aren’t Population Health and Public Health the Same?

Public Health focuses on the critical functions of state and local health departments such as preventing epidemics, containing environmental hazards, and encouraging health behaviors.

Population health concerns the determinants of health like health care, education, and income inequality to name a few, which remain outside the traditional public health authority and its responsibility.

The Future of the Public’s Health in the 21st Century

• Significant movement in “building a new generation of intersectoral partnerships that drawn on the perspectives and resources of diverse communities and actively engage them in health action.”

But What About Population Medicine?

• Considers the specific activities of the medical care system that promote population health beyond the goals of care of the individuals treated

• Requires the medical care system to collaborate and partner with other organizations

• Acknowledgement that individual health and clinical outcomes greatly influenced by population factors, such as education

Population Health Provides the Best Definitional Framework

• It focuses on measurable outcomes from multiple sectors– Clinical outcomes– Education levels– Poverty rates– Environmental factors

• Creating a holistic picture of a community’s health

So…How Do We Measure Population Health Outcomes?

MCPHD initiated a Community Health Assessment to create a baseline of these factors.

Inputs:• Health Care• Individual Behavior• Social Environment• Physical Environment• Genetics

Population Health in the Affordable Care Act

• Provisions to expand insurance coverage by improving access to the health care delivery system (Medicaid expansions, state insurance exchanges, support for community health centers)

• Improving the quality of the care delivered (National Strategy for Quality Improvement, CMS Center for Medicare and Medicaid Innovation, and establishment of the Patient-Centered Outcomes Research Institute)

Population Health in the Affordable Care Act

• Promotion and implementation of ACOs to incentivize providers to take responsibility for population health outcomes

• Expansion of primary health care training, requirements that private health plans and Medicare provide specific services recommended by U.S. Preventive Services Task Force without cost sharing

Population Health in the Affordable Care Act

• Promoting community-and population-based activities

• The establishment of the National Prevention, Health Promotion and Public Health Council

• A new Prevention and Public Health Fund (authorized $1 billion in fiscal year 2012)

• Funding for Community Transformation Grants

What is a Community Health Assessment (CHA)?

Quantifies prevalent or impactful health issues

Detects health trends that merit attention

Identifies health inequities

Compares Marion County to peer cities and the nation, to provide context

Why do a Community Health Assessment?

Increases community awareness of health issues Prioritizes community health needs Identifies health disparities Provides an evidence base for MCPHD’s

Community Health Improvement Plan (CHIP)

Improves the health status of our community

Top Priorities

Unhealthy Weight Poor Mental Health Increasing Poverty Rates Chronic Disease Prevention and Management

Chief contributing factor: SMOKING Violence

Key Data Sources

National Sources• 2010 Census, American Community Survey• Bureau of Labor Statistics• County Health Rankings www.countyhealthrankings.org • Behavioral Risk Factor Surveillance System (BRFSS)

Local Sources• Birth and Death Certificates• Hospital Discharges, ED visit data• CHA 2012 Telephone Survey

Community Health Assessment 2012 Telephone Survey

• 5013 total respondents• 100 survey questions: health status, behavioral

risk factors, family, local resources• Survey is a SAMPLE of whole-county population

(928,281), randomly selected to represent county as a whole.

• Called cell phones as well as in-house phones to reach a more diverse group

Survey Process7 workgroups identified priority issues– Workgroups: Ages 0-4, 5-11, 12-17, 18-34, 35-64, 65+, &

Environment– Content experts, service providers, & community members– 3 to 5 meetings, reviewed data, discussed issues

Steering Committee selected overall priorities– Reviewed workgroup’s output– Synthesized that output into the overall priorities

What Did We Learn and What Did We Find?

Increasing Poverty Rate

County Poverty Rates DOUBLED Between 2000 and 2012: Now 19%

100% Federal Poverty Level (FPL) Definition: Family of 4 with annual household income less than $23,496 (2012)

County residents meeting 100% FPL includes:1 in 5 individuals 1 in 3 households with children

(up from 1 in 5, 2007)

High Poverty Concentration in 6 Central Marion County Zip Codes

These zip codes have over 25% of their populations living at or below 100%FPL

They exceed County rates of….Poverty

7 times Unemployment rate 3

times Violent Crime rate 5

times

Zip Codes % FPL

46201 36.946204 33.646218 33.446225 32.546202 29.846208 28.8

More Than 1 in 4 Young Adults (18-34) Met 100% Federal Poverty Guidelines

Chronic Disease Prevention and Management

County Children:High Prevalence of Chronic Disease

Asthma*

ADHD

Depression/Anxiety

High BP

Diabetes

0 5 10 15 20 25

20

15

9

2

2

% Youth 5-17 ever diagnosed with….

* Twice the national rate

County Adult Chronic Disease, 2012 (%) compared to U.S.

High BP

High Cholesterol

Depression

Diabetes

Current Asthma

Heart Attack/CHD

0 5 10 15 20 25 30 35 40

31

24

21

14

11

7.7

US 2010-12MC 2012

SmokingMarion County Adults – 2005 & 2012

2005 20120%

5%

10%

15%

20%

25%

30%

35%

27% 29%

95% CI: 2005 (24.4%-29.6%); 2012 (26.5% - 30.7%)

Prevalence of Smoking by RaceAdults Over 18 Years Old

Marion County – 2005 & 2012White

Black

Latino

2005

NaN

NaN

NaN

2012

3%

8%

13%

20052012

Unhealthy Weight

50% of County Youth 5-17 Were Above Normal Weight

2012

2005

0% 20% 40% 60% 80% 100%

31

22

19

18

44

58

6

1

Obese Overweight Normal Underweight

Overweight and Obesity Continue to Increase in Marion County

• Obese Children– 2005: 2 out of 10– 2012: 3 out of 10

• Obese Adults– 2005: 3 out of 12– 2012: 4 out of 12

Adult Outcomes Marion County1 US2

Diabetes 14.0% 9.5%CHD/Stroke 7.7% 7.0%

1 2012 CHA Telephone Survey 2 2011 BRFSS

Obesity Related Health Outcomes

Adults Marion County1 US2

Diabetes 14.0% 9.5%CHD/Stroke 7.7% 7.0%

1 2012 CHA Telephone Survey 2 2011 BRFSS

Poor Mental Health

Major Depressive Disorder is the Leading Cause of U.S. Disability, Ages 15-44

Depression is prevalent in all County age groups, including:

1 in 5 AdultsU.S. 17.5% (2011)

1 in 10 Children (5-17)U.S. 3.9% (2007)

Depression in Young Adults

Young Adults: A high prevalence of depression and poor mental

health days. High rates of abuse of prescription painkillers.

47% of Marion County 18- to 25-year-olds reported having 14+

days in the past month of poor mental health – four times the U.S.

rate. (CDC 2011 BRFSS Survey)

Diagnosed Depression in County Adolescents

County adolescents are diagnosed with depression (12.8%) and their suicide risk is high

• 8.3% U.S. major depressive episode(2010-11)2

2011 Indiana Teens: Youth Risk Behavior Study4

• 25% had been bullied at school • 18.9% seriously considered suicide• 11% had one or more attempts at suicide

Suicide: A Leading Cause of Deaths

• Among the 5 leading causes for ages 12-64• (Nationally, the second leading cause for

ages 12-17)• Third leading cause for ages 15-24 (30%

higher than U.S.)• Fifth leading cause for ages 10-14

Increasing Dementia in Senior Adults

6-10% of persons over 65 develop dementia• Alzheimer’s makes up 75% of dementia

cases• 8 in 10 dementia cases are never clinically

diagnosed

In past decade, Alzheimer’s Disease was the only leading cause of death to increase among seniors (up 20%)

Violent Deaths and Prevention

Homicide Deaths

Deaths per 100,000Age Rank* MC (2008-2010) US (2010)10-14 3rd 2 0.915-24 1st 31 10.933-44 5th 16 645-54 9th 13 4.4

* among all causes of death in Marion County

Community Health Assessment & Health Improvement Plan (2015)• Identify short–term, evidence

based intervention strategies, and action steps

• Find committed partners to take substantial roles for each issue

• Assure process and outcome monitoring occurs for each specific action area to document change.

Where Do We Go from Here?:The Next Steps

Community Health Improvement Plan

• A community health improvement plan is a long-term, systematic effort to address public health problems on the basis of the results of community health assessment activities and the community health improvement process. This plan is used by health and other governmental education and human service agencies, in collaboration with community partners, to set priorities and coordinate and target resources.

• A community health improvement plan is critical for developing policies and defining actions to target efforts that promote health. It should define the vision for the health of the community through a collaborative process and should address the gamut of strengths, weaknesses, challenges, and opportunities that exist in the community to improve the health status of that community.

Source: NACCHO, http://www.naccho.org/topics/infrastructure/CHAIP/upload/CHIP-Basics.pdf

Source: Population Health in the Affordable Care Act Era. Academy Health. Michael A. Stoto, Ph.D., February 13, 2013.

Questions?