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.

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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

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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........

Thank You

Contact Info

Jose Thier Montero603-271-4617

jmontero@dhhs.state.nh.us

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