Plan for Collaborating on a Harford County Community Health Improvement Plan

Community Health Improvement Plan (CHIP) Coalition Steering Committee

November 2011

Today’s Agenda

• Rationale for a community health needs assessment and improvement plan

• Proposed approach for the planning process

• Broad-brush review of Harford County health data and priorities

• Next steps

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Who Says We Need a Plan for Improving the Community’s Health?

• CHNA – For Hospitals– Federal health care reform, as well as Federal and

State requirements, mandate community health needs assessment (CHNA).

• SHIP – For State Health Departments– Maryland’s Health Care Reform Coordinating Council

reaffirms the importance of a State Health Improvement Process (SHIP).

• LHIP – For Local Health Departments– National public health accreditation requires a Local

Health Improvement Plan (LHIP).3

What’s Required?Local Health Departments

State Health Improvement Process (SHIP) obligations

requiring a Local Health Improvement Coalition (LHIC) and Action Plan

Obesity Prevention Task Force report due to the

County Council

Public Health Accreditation Board (PHAB) prerequisite

Hospitals

State community benefits report to HSCRC

Federal IRS Form 990 Schedule H

New federal health care reform requirements for Community Health Needs

Assessment (CHNA)

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Are We Duplicating or Streamlining Efforts?

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Can We Build on Harford County Efforts?

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Federal Health Care Reform

Requirements

LHD SHIP Mandates

Hospital CHNA Mandates

Healthy Harford Activities

COMMUNITY HEALTH IMPROVEMENT PLAN

A Common Vision and Mission?

VISIONTo make Harford County the healthiest community in Maryland

MISSIONTo protect, promote and improve the health, safety and environment of the residents of Harford County through community assessment, education, collaboration and assurance of services

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What is a Public Health Planning Process?

• MAPP = Mobilizing for Action through Planning & Partnerships

• Developed by NACCHO & CDC in 2001

• Consists of 4 assessments:– Quantitative data review– Qualitative data review– Internal review– External review

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MAPP

How Can We Get Started?

• Present the quantitative data we currently have to community audiences

• Then solicit reaction, including qualitative feedback

• In order to engage in a discussion about strengths, weaknesses, opportunities & threats

• To gain consensus on priorities, goals, strategies & action steps

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One Approach

First, Quick Facts About Our Community

Demographic Indicators Harford County Maryland

Population (2010) 244,826 5,773,552

Population % change (2000-2010) 12% 9%

White population % (2010) 81.2% 58.2%

Black population % (2010) 12.7% 29.4%

Hispanic population % (2010) 3.5% 8.2%

High school graduates (2005-09) 90.8% 87.5%

Bachelor’s degree or higher (2005-09) 30.3% 35.2%

Homeownership rate (2005-09) 81.3% 69.6%

Median household income (2009) $75,364 $69,193

Persons below poverty level (2009) 6.2% 9.2%

Persons per square mile (2010) 560.1 594.8

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Let’s start at the beginning . . . PREGNANCY DATA

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Infant Mortality RatesHarford County & Maryland

2001-05 to 2006-10

Source: Maryland Vital Statistics12

Infant Mortality RatesHarford County, By Race

2000-04 to 2005-09

Source: Maryland Vital Statistics13

Top 7 Leading Causes of Infant DeathMaryland, 2010

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Low Birthweight RatesHarford County & Maryland

2000-04 to 2005-09

Source: Maryland Vital Statistics15

Low Birthweight RatesHarford County, By Race

2004 vs. 2009

Source: Maryland Vital Statistics16

Teen Birth RatesHarford County & Maryland

2004 vs. 2009

Source: Maryland Vital Statistics17

Teen Birth RatesHarford County, By Race

2004 vs. 2009

Source: Maryland Vital Statistics18

1st Trimester Prenatal Care RatesHarford County & Maryland

2004-06 to 2007-09

Source: Maryland Vital Statistics19

1st Trimester Prenatal Care RatesHarford County, By Race

2004 vs. 2009

Source: Maryland Vital Statistics20

For pregnancy outcomes, Harford County ranks better than the State, but health disparities exist

Indicator Harford Maryland Comparison DisparityInfant

Mortality Rate

5.7/1000 7.6/1000

Low Birthweight

Rate

7.8% 9.3%

Teen Birth Rate

19.7/1000 31.2/1000

Early Prenatal

Care Rate

84.8% 80.0%

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Let’s move on to conditions that affect us over the years . . .CHRONIC DISEASE DATA

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Top 10 Causes of DeathMaryland, 2010

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Top 7 Causes of DeathHarford County, 2009

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450433

136

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99

5941

Heart Disease Mortality RatesHarford County & Maryland

2004-06 to 2007-09

Source: Maryland Vital Statistics25

Heart Disease Mortality RatesHarford County, By Race

2004-06 to 2007-09

Source: Maryland Vital Statistics26

Cancer Mortality RatesHarford County & Maryland

2004-06 to 2007-09

Source: Maryland Vital Statistics27

Cancer Mortality RatesHarford County, By Race

2004-06 to 2007-09

Source: Maryland Vital Statistics28

Stroke Mortality RatesHarford County & Maryland

2004-06 to 2007-09

Source: Maryland Vital Statistics29

Stroke Mortality RatesHarford County, By Race

2004-06 to 2007-09

Source: Maryland Vital Statistics30

COPD Mortality RatesHarford County & Maryland

2004-06 to 2007-09

Source: Maryland Vital Statistics31

COPD Mortality RatesHarford County, By Race

2000-07 to 2004-09

Source: Maryland Vital Statistics32

For chronic disease outcomes, Harford County ranks worse than the State

Indicator Harford Maryland Comparison DisparityHeart

Disease Mortality

210 197.8

Cancer Mortality

185.8 177.7

Stroke Mortality

57.3 55.7

COPD Mortality

45.7 35.6

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Note: Rates are deaths per 100,000 population

Now let’s look at lifestyle choices . . .LIFESTYLE DATA

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Leading Actual Causes of DeathUnited States, 2000

35Source: Mokdad AH, et al, JAMA, Mar 2004

Adult Smoking RatesHarford County & Maryland

2005-07 to 2008-10

Source: CDC Behavioral Risk Factor Surveillance System36

Adult Smoking RatesHarford County

2010 CHAP & BRFSS Data

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Adult Cigarette Smoking RatesHarford County & Maryland

2000 to 2010

38Source: CDC Behavioral Risk Factor Surveillance System

Youth Tobacco Use RatesHarford County & Maryland

2000 to 2010

Source: Maryland Youth Tobacco Survey 39

Secondhand Smoke Exposure RatesHarford County & Maryland, 2008

Source: CDC Behavioral Risk Factor Surveillance System40

Adult Obesity/Overweight RatesHarford County & Maryland

2005-07 to 2008-10

Source: CDC Behavioral Risk Factor Surveillance System41

Adult Obesity/Overweight RatesHarford County

2010 CHAP & BRFSS Data

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Physical Activity Rates*Harford County & Maryland

2005-07 to 2008-10

* NOTE: Moderate activity 30 minutes/day, 5 days/week43

Source: CDC Behavioral Risk Factor Surveillance System

Physical Activity RatesHarford County

2010 CHAP & BRFSS Data

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NOTE: Moderate activity 30 minutes/day, 5 days/weekNOTE: Moderate activity 30 minutes/day, 3 days/week

Fruits & Vegetables Intake Rates*Harford County & Maryland

2005-07 to 2008-10

45Source: CDC Behavioral Risk Factor Surveillance System* NOTE: 5 or more daily servings of fruits or vegetables

Fruits & Vegetables Intake RatesHarford County

2010 CHAP & BRFSS Data

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NOTE: 3 more daily servings of fruit and 3 more daily servings of vegetables

Fruits, 18.3%

Fruits/Vegetables, 37.1%

In lifestyle choices, Harford County ranks worse than or even with the State

Indicator Harford Maryland ComparisonTobacco

Use20.3% 15.1%

Obesity/ Overweight

63.5% 64.1%

Physical Activity

37.1% 33.9%

Fruits/ Vegetables

25.2% 27.3%

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And what about access to health care . . .ACCESS DATA

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% Who Could Not Afford to See M.D.Harford County & Maryland

2005-07 to 2008-10

Source: CDC Behavioral Risk Factor Surveillance System49

Adult Influenza Vaccination RatesHarford County & Maryland

2005-07 to 2008-10

Source: CDC Behavioral Risk Factor Surveillance System50

Childhood Influenza Vaccination Rates

County Leaders, 2010

Source: CDC Behavioral Risk Factor Surveillance System51

Anxiety Disorder RatesHarford County & Maryland

2005-07 to 2008-10

Source: CDC Behavioral Risk Factor Surveillance System52

Binge Drinking RatesHarford County & Maryland

2005-07 to 2008-10

Source: CDC Behavioral Risk Factor Surveillance System53

Population to Provider RatiosHarford County & Maryland

54Source: Maryland Primary Care Office, DHMH

Primary Care & Dental Care Shortage Areas in Harford County, 2010

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With access to care, Harford County has specialty area needs

Indicator Harford Maryland ComparisonAfford to See

M.D.10.4% 12.0%

Adult Flu Vaccine

38.7% 41.2%

Child Flu Vaccine

63.3% 53.7%

Anxiety 19.0% 12.8%Binge Drink 16.0% 13.7%

Pop:Provider Ratio (MH)

44,354:1 12,253:1

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Now, putting the pieces together . . .COMPOSITE DATA

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SHIP

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Which of the 39 SHIP objectives does Harford County rank worse than the State?

1. Seasonal flu vaccination rate2. Heart disease death rate3. Cancer death rate4. Adult tobacco use5. Youth tobacco use6. Behavioral health-related admissions to E.R.7. Alzheimer’s-related admissions to the E.R.

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County Health Rankings

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Which of the 27 County Health Rankings objectives does Harford County rank worse

than the State?1. Adult smoking2. Adult obesity3. Access to recreational facilities4. Air pollution ozone days5. Mammography screening6. Motor vehicle crash death rate7. Primary care physician availability8. Preventable hospital stays9. Poor mental health days10. Poor physical health days11. Unemployment

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Do the data suggest common themes for determining Harford County health

priorities?

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Next Steps?

• Agree that the Community Health Improvement Plan (CHIP) Coalition will serve as the unifying framework for Community Health Needs Assessment, Local Health Improvement Plan, and the Obesity Task Force efforts.

• Finalize membership of the CHIP Steering Committee and the larger Coalition.

• Preliminarily select 3 to 5 priority areas of focus and identify partners for leading those improvement efforts.

• Solicit feedback from others in the community – via meetings, website communications, and other avenues.

• Other thoughts?

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