A snapshot of the New Hampshire ’ s Health profile Jose Thier Montero, MD Director Division of...
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Transcript of A snapshot of the New Hampshire ’ s Health profile Jose Thier Montero, MD Director Division of...
A snapshot of the New Hampshire’s Health profile
Jose Thier Montero, MDDirector
Division of Public Health ServicesNH-DHHS
Today’s Presentation
Current use of dataHow do we measure?Report structure“Responding” to present and future needs
NH Health Ranking
Source: http://www.americashealthrankings.org/SiteFiles/Reports/AHR%202011Edition.pdf
NH Determinants
Source: http://www.americashealthrankings.org/SiteFiles/Reports/AHR%202011Edition.pdf
NH Health Outcomes
Source: http://www.americashealthrankings.org/SiteFiles/Reports/AHR%202011Edition.pdf
So…. How do we measure?
What do we measure?Health? Disease? Access to services? Cost? Who? What? When?
Who is measuring?Who is reporting?
Who Lives here? Who are we supposed to serve?
General demographicsPopulation segmentsMarket segmentation
County
Age Adjusted Percent (PERCENT)
Age Adjusted Percent Standard Deviation (PERSD)
Age Adjusted Percent Lower 95% CL (PER95L)
Age Adjusted Percent Upper 95% CL (PER95U)
Belknap County 7.5 0.6 6.3 8.8Carroll County 7.3 0.7 6.1 8.8Cheshire County 7.6 0.6 6.4 8.8Coos County 8.1 0.7 6.9 9.5Grafton County 6.5 0.5 5.6 7.5Hillsborough County 6.6 0.3 6 7.3Merrimack County 6.9 0.5 6 7.9Rockingham County 7.1 0.4 6.3 8Strafford County 8.8 0.6 7.7 10.1Sullivan County 7 0.7 5.8 8.4
2007 Age-Adjusted Estimates of the Percentage of Adults† with Diagnosed Diabetes in New Hampshire
What should we do ?
Why do we need to talk about health equality?
Do we all have an equal chance to health?Health is seen in modern societies as a universal human aspiration as well as a basic human need. In the XXI century we compare and judge societies, rich or poor, by the quality of its population's health, how fairly health is distributed across the social spectrum, and the degree of protection provided from disadvantage due to ill-health. Health equity is central to this premise To improve health equity we need to go beyond the immediate causes of diseaseSocial Determinants of HealthSeveral groups have attempted to look at the “What to do” and others at “How to do it”WHO Commission on Social Determinants of Health
What is Health equity?Equity is an ethical principle; it also is consonant with and closely related to human rights principles. The definition of equity shall support operationalisation of the right to the highest attainable standard of health as indicated by the health status of the most socially advantaged group. Assessing health equity requires comparing health and its social determinants between more and less advantaged social groups. These comparisons are essential to assess whether national and international policies are leading toward or away from greater social justice in health
Source: Braveman P & Gruskin S. acll J Epidemiol Community Health 2003;57:254-258 doi:10.1136/jech.57.4.254
How to define Health Equity?For the purposes of measurement and operationalisation, equity in health is the absence of systematic disparities in health (or in the major social determinants of health) between groups with different levels of underlying social advantage/disadvantage—that is, wealth, power, or prestige. Inequities in health systematically put groups of people who are already socially disadvantaged (for example, by virtue of being poor, female, and/or members of a disenfranchised racial, ethnic, or religious group) at further disadvantage with respect to their health; health is essential to wellbeing and to overcoming other effects of social disadvantage.
Source: B Braveman, et acll J Epidemiol Community Health 2003;57:254-258 doi:10.1136/jech.57.4.254
The average life expectancy in the US rose 30 years in the last century25 of these years are due to advances in public health (not in medical care)
Value of Public Health
DPHS Vision
The New Hampshire Division of Public Health Services is committed to being a responsive, expert, leadership organization that promotes optimal health and well being for all people in New Hampshire and protects them from illness and injury. Our first responsibility is to serve the public – individuals, families, communities and organizations – by delivering high quality, evidence-based services. We believe that quality health services should be available, accessible, affordable and culturally competent
10 Essential
Public Health Services
Improvement work with public health systems partners
2005 Conducted the NPHPSDeveloped Strategic PrioritiesWorkgroups Public Health Improvement Services Council –enacted in statute 2007 to oversee public health improvement
New Hampshire Division of Public Health ServicesStrategic Map: 2011-2013
Position DPHS asExpert on Approachesto Population Health:Policy, Data, Practices
Focus on ChronicDisease Prevention,Diagnosis, Treatment
and Intervention
Prepare forAccreditationof the State
Health Department
Implement a Regional
Public Health System
Develop KeyCommunicationsPartnerships toIncrease Impact
Ensure OptimalWorkforceCapacity
Optimize thePerformance of Key Business Processes
StrengthenApproaches to
Population Health
Demonstrate Measurable Improvementsin Health and Well Being
StrengthenPublic HealthInfrastructure
Improve theEffectiveness of Resource
Allocation
ExpandPublic HealthEducation and
Messaging
StrengthenOrganizational
Effectiveness andAdaptability
Develop and Implement a Public Health Performance Management System
Make Strategic Use of Partnerships to
Implement PopulationHealth Approaches
StrengthenOrganizational and
Staff Resilience
Continue toPrepare for and
Respond toPublic Health Threats
Evaluate MessageEffectiveness and
Make NeededAdjustments
Develop andImplement a
Health MessagingStrategy
Align InternalResources to
SupportStrategic Goals
Improve Intra-agencyCommunication at
All Levels
Implement Cross-Program Integrationto Increase Population
Health Impact
Ensure Accessto Healthcare and
Public Health Services
Implement theTechnology Required
For FutureEffectiveness
Integrate Data Systems to
Monitor PopulationHealth Status
Develop the Capacityto Meet the FutureHealth Workforce
Needs
Redesign InternalContracting Process
and FinancialManagement Structure
Build an InternalSocial Marketing
Capacity
Allocate ResourcesExternally to
SupportStrategic Goals
Build the InternalCapacity to SupportStrategic Resource
Allocation
A B DC
F
E
1
3
2
4
5
6
7
Color boxes denote priority tracks of work for year one. Similar colors are related focus areas and would be worked on together.
Expected OutcomesHealthier population as defined by:
Lower rates of obesity (currently at 35% in children)Lower rates of smoking (currently at 15% in adults, 19% in teens)Increased access to preventive health careHigher rates of immunizationsBetter health care quality (Evidence based, no adverse events)Disease care cost avoidance
Population Informed and educated on health promotion and disease preventionCompliance with state and federal laws, rules and/or guidelines governing the terms and conditions of federal grantors, optimizes the federal revenue brought into the State
Evidence-based Public Health
DPHS promotes evidence-based public health, particularly through adoption of the Community Guide to form state health policy.NH worked with small businesses to implement employee-driven worksite wellness programs.Partnered with the Business & Industry Association, Health insurance companies to increase employer awareness of their workers’ health concerns and implement policy changes.
34
Collaboration is Key
In its recent report, the Institute of Medicine (IOM) makes a clear statement that
“collaboration between government and public private entities is critical for assuring the future health of the public.”
Thus, the work of public health is everyone's work as defined by “what we as a society do collectively to assure the conditions in which people can be healthy.”
HP 2020LHI
National Prevention
Strategy
National Health Equity
Strategy
National Tobacco Control Strategy
Prescription Drug Abuse
Prevention Plan
National Physical Activity Strategy
National Quality Strategy
LHI is a framework to Support National Strategies
Leading Health Indicators
1. Access to Health Services
2. Clinical Preventive Services
3. Environmental Quality
4. Injury and Violence
5. Maternal, Infant, and Child Health
6. Mental Health
7. Nutrition, Physical Activity, and Obesity
8. Oral Health
9. Reproductive and Sexual Health
10. Social Determinants
11. Substance Abuse
12. Tobacco
37
New Hampshire DPHS direction
Aim
People
Staff
Leadership
ResourcesInformation
ProcessesDemonstrate Measurable
Improvements in the Health and Well Being of
NH Population
DPHS direction – how does it all fit?
Aim
DPHS direction – how does it all fit?
Mission, vision, values
Goals and
objectives
SHIP
DPHS direction – how does it all fit?
Aim
People
Staff
Leadership
ResourcesInformation
Processes
Div
isio
n go
als
DPHS objective: Reduce youth smoking prevalence to X% by 20YY
DPHS 2015 goal
2000 2010
%Youth media campaigns School outreach
Activities and performance indicators
2000 2010
#
DPHS 2012 target
Television ads Radio ads Internet ads
2000 2010
#
2010 target
2000 2010
#
2008 target
2000 2010
#
2008 target
DPHS objective: Reduce maternal smoking prevalence to X% by 20YY
DPHS 2015 goal
2000 2010
%
Provider education Direct outreach
Activities and performance indicators
2000 2010
#
DPHS 2012 target
Providers with edu materials
2000 2010
#2010 target
$ spent in 2009: $23,000
Helpline
Div
isio
n go
als $ spent in 2010: $12,000
Broad Goal: Reduce burden of chronic disease Specific goal: Reduce tobacco consumption
We need to Work Together to Assure a Healthy Population
Questions........