Michigan’s Rural Health Priorities: Community Health Needs Assessment Analysis A county based review of health needs within the rural counties of Michigan

Douglas Snow Michigan State University

Department of Public Health

Objective

Determine county level health priorities based on the analysis of community health needs assessments (CHNA) submitted by non-profit hospitals

Analysis will only be done on the 61 counties in Michigan that are designated rural

Determine any trends or geographic constraints that could possibly be addressed through program intervention or funding

Community Health Needs Assessment

Introduced through the passing of the Patient Protection and Affordable Care Act (PPACA) in 2010

Submitted by hospitals every three years with non-profit 501(c)(3) designation

Regulated under the Internal Revenue Service Hospitals that fail to report are subject to a

$50,000 tax penalty

Rural Counties in Michigan

62 rural counties were included in the study 54 counties were analyzed within the CHNA project

• 11 counties do not have a hospital located within their geographic region

– Antrim – Leelanau – Missaukee – Alcona – Montmorency – Oscoda – Presque Isle – Roscommon – Lake – Menominee – Cheboygan

Regional Stratification

Determined by the Michigan Department of Management and Budget Prosperity Regions

Categorization of Health Priorities

Grouped health priorities into separate distinct categories* Access to Care Maternal and Child Health Obesity Infectious/Chronic Disease Substance Abuse/Behavioral Health Socioeconomic Factors

*The complete list of health priorities for each county are available. The list is not confined to the categories listed above. The list is also not confined to a set number, the health priorities listed by the county can list as many health priorities as they believe necessary.

Categorization Data

Ratios are based upon analysis of 54 rural counties in Michigan* Access to Care- 98% Substance Abuse/Behavioral Health- 77% Infectious/Chronic Disease- 70% Socioeconomic Factors- 66% Obesity- 51% Maternal and Child Health- 40%

*53 of the 61 rural counties in Michigan were used. The remaining counties either did not conduct a CHNA due to no health facility or the CHNA was not located.

Category- Access to Care- 98%

Category- Substance Abuse/Behavioral Health- 77%

Category- Infectious/Chronic Disease-70%

Category- Socio-Economic Factors- 66%

Category- Obesity- 51%

Category- Maternal and Child Health-40%

County Health Rankings

The County Health Rankings & Roadmap Program is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute

Goals of Program Build awareness of the multiple factors that influence health Provide a reliable, sustainable source of local data and evidence

to communities Encourage and activate local leaders from many sectors in

creating sustainable community change Connect and empower community leaders working to improve

health

County Health Rankings Description

Rankings are determined through a weighted system

Based upon a variety of health and demographic data for each county

2017 Michigan County Health Ranking for Health Factors 4 Grand Traverse 33 Antrim 58 Tuscola 5 Clinton 34 Presque Isle 59 Isabella 8 Leelanau 35 Gratiot 60 Mackinac 9 Emmet 37 Keweenaw 61 St. Joseph 10 Marquette 38 Alger 63 Oscoda 11 Charlevoix 39 Menominee 65 Van Buren 12 Dickinson 40 Iron 66 Montcalm 14 Otsego 41 Cass 67 Mecosta 15 Eaton 42 Missaukee 68 Osceola 16 Allegan 44 Wexford 70 Oceana 18 Delta 45 Gogebic 71 Kalkaska 19 Alpena 46 Iosco 72 Schoolcraft 20 Houghton 47 Sanilac 74 Gladwin 21 Huron 48 Ontonagon 75 Arenac 22 Benzie 49 Hillsdale 76 Baraga 24 Shiawassee 50 Newaygo 77 Ogemaw 25 Mason 51 Luce 78 Chippewa 26 Lenawee 53 Manistee 81 Clare 28 Crawford 54 Cheboygan 80 Roscommon 31 Alcona 55 Montmorency 82 Lake 32 Ionia 56 Branch

2017 County Health Factors Rankings for Michigan

Trend of Health Factors 2014-2017 for Rural Counties of Michigan

2017 Michigan County Health Ranking for Health Outcomes 2 Clinton 30 Shiawassee 57 Mecosta

4 Grand Traverse 31 Alger 58 Alpena 5 Leelanau 32 Montcalm 60 Baraga 6 Emmet 33 Manistee 61 Van Buren 11 Charlevoix 35 Osceola 62 Luce 12 Houghton 36 Cass 63 St. Joseph 13 Allegan 38 Gratiot 65 Wexford 14 Marquette 39 Alcona 66 Gladwin 16 Eaton 40 Tuscola 67 Ogemaw 18 Schoolcraft 41 Presque Isle 70 Montmorency 19 Ionia 42 Delta 71 Crawford 20 Dickinson 43 Keweenaw 72 Clare 21 Missaukee 45 Sanilac 73 Oscoda 22 Gogebic 46 Mason 75 Kalkaska 23 Antrim 47 Newaygo 76 Roscommon 24 Iron 48 Lenawee 77 Ontonagon 25 Mackinac 49 Menominee 78 Oceana 26 Benzie 50 Isabella 79 Iosco 27 Hillsdale 51 Huron 80 Arenac 28 Cheboygan 52 Otsego 81 Lake 29 Chippewa 54 Branch

2017 County Health Outcomes Ranking for Michigan

Trend of Health Outcomes 2014-2017 for Rural Counties of Michigan

Median Age as a Function of Health Rankings

Median Household Income as a Function of Health Rankings

Kids Count Ranking KIDS COUNT is a project of the Annie E. Casey

Foundation to track the well-being of children in the United States

Provide high-quality data and trend analysis through its KIDS COUNT Data Center

Goals for the Foundation Seek to enrich local, state and national discussions concerning

ways to secure better futures for all children Raise the visibility of children's issues through a nonpartisan,

evidence-based lens

Michigan KIDS COUNT Data

The Annie E. Casey Foundation partnered with The Michigan League for Public Policy (MLPP) to collect and interpret data

List of indicators that go into the determination of KIDS COUNT ranking is vast

For full list of indicators provided by the National KIDS COUNT and MLPP refer to this link

2017 Michigan KIDS COUNT Rankings 2 Clinton 32 Tuscola 61 Gladwin

7 Grand Traverse 35 Antrim 62 Hillsdale

9 Emmet 36 Benzie 63 Osceola

11 Marquette 37 Otsego 64 Cass

12 Leelanau 39 Schoolcraft 65 Manistee

15 Houghton 39 Chippewa 67 Alcona

16 Charlevoix 39 Montcalm 68 Baraga

17 Huron 42 Gogebic 71 Montmorency

18 Allegan 43 Ontonagon 72 Luce

19 Dickinson 44 Mason 73 Ogemaw

20 Lenawee 45 Newaygo 74 Roscommon

21 Eaton 48 Mackinac 75 St. Joseph

22 Shiawassee 49 Arenac 76 Iron

23 Ionia 50 Crawford 77 Kalkaska

24 Isabella 51 Missaukee 78 Clare

26 Sanilac 52 Alpena 79 Oscoda

28 Delta 53 Mecosta 80 Oceana

29 Alger 54 Cheboygan 81 Iosco

30 Presque Isle 54 Van Buren 82 Lake

30 Gratiot 57 Branch NR Keweenaw

32 Menominee 60 Wexford

2017 Michigan KIDS COUNT Rankings

Trend of Kids Count Ranking 2015-2017 for Rural Counties of Michigan

Limitations • Data that was provided by the hospitals can be

somewhat subjective and incongruent • Quality of the Community Health Needs Assessment is

not regulated. Variance between different assessments is easily recognized

• Counties, although contiguous and similar in rurality, differ in many aspects of health and human services

• Health systems and regional areas performed assessments together and provided priorities for the entire region/system instead of the individual community

Trend Analysis Infographic • For a complete trend analysis of each county for County

Health Factor, Outcome, and Kids Count Rankings please utilize the following link

• https://public.tableau.com/profile/douglas.snow#!/

References University of Wisconsin Population Health Institute (2014). County Health Rankings: Michigan 2014 University of Wisconsin Population Health Institute (2015). County Health Rankings: Michigan 2015 University of Wisconsin Population Health Institute (2016). County Health Rankings: Michigan 2016 University of Wisconsin Population Health Institute (2017). County Health Rankings: Michigan 2017 Michigan League for Public Policy (2015). Kids Count in Michigan Data Book 2015 Michigan League for Public Policy (2016). Kids Count in Michigan Data Book 2016 Michigan League for Public Policy (2017). Kids Count in Michigan Data Book 2017 Michigan Department of Technology, Budget, and Management (n.d.). Regional Prosperity Initiative. Empowering Locals to Drive Economic Prosperity.