Report Card on Washingtons Health

1
Report Card on Washingtons Health

• Key Health Indicators
• Steering Committee
• November, 2003

2
Report Card on Health

• Origin
• Development to date
• Next Steps

3
Origin

• 1995 Public Health Improvement Implementation Act
  directed the Department of Health to
• identify, as part of the public health
  improvement plan, the key health outcomes sought
  for the population.
• Basic question
• How healthy are we?

4
Development

• Two Stages
• Stage 1 (2000) Initial design and selection of
  indicators
• Stage 2 (2001 - 2002) Collection of data and
  refinement of indicators
• Process
• Multidisciplinary steering committee guiding
  work
• Public health, healthcare (hospitals, health
  plans, clinicians), community service, academia,
  legislative, general public.
• Consultant and DOH staff gathering information

5
Stage 1- 2000

• General principles
• Try not to create new indicators-use existing
  data
• Short list of key health issues
  (meta-indicators)
• Focus on health, not disease
• Targeted at the general public and policy-makers
• Purpose focus attention on and engage the
  public around key health issues

6
Initial Design Process

• Comprehensive review of existing lists of
  indicators (local, state, national,
  international)
• Decision to focus on determinants of health over
  disease, where possible
• Decision to include both individual factors and
  social/economic/community factors

7
Review of Previous Work

• National level
• Healthy People 2010
• The Health of Canadians
• State Level
• The Health of Washington State
• Oregon Benchmarks
• Healthier New York
• Healthy Minnesotans

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Review of Previous Work

• Local Level
• Health Status of Thurston County
• Health of King County
• Other
• Washington Kids Count
• The Pulse Indicators Taking the Pulse of
  Washingtons Health System

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Review of Previous Work

• Conclusion There has been a proliferation of
  indicator sets, at the national, state and local
  level
• Indicator sets vary considerably
• No one set is best
• Indicator sets must be tailored to the objectives
  under consideration

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Primary Purpose of the Washington State Report
Card

• Engage and focus people around key health issues
• Create understanding that will lead to
  mobilization that will lead to improvement in
  health status

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Report Card Ownership

• Not the Department of Healths report card
• Not governmental public healths report card
• Washington States Report Card

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Basic Framework Actual Determinants of Health
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Basic Parameters of Report Card - 2000

• Ten to twenty indicators (not too many)
• Include both health status and causal factors
• Include both individual factors and
  social/economic/community factors
• Science-based
• Favor robust indicators - metaindicators

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Existing and New Data

• Strong inclination to include indicators created
  from existing data
• For very important, but hard to measure
  indicators, new data should be sought

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Application of Framework
Meta-indicators
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Initial Draft Report Card - 2000

• Safe/supportive surroundings
• Food, water, air
• Injuries
• Social connections
• Economic status
• Violence - child abuse, homicide, suicide
• Healthcare system

• Behaviors
• Tobacco
• Nutrition
• Physical activity
• Drug/alcohol abuse

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Stage 2 2001 - 2002

• Reconstitution of Steering Committee
• Some members carried forward from first round,
  and some new members
• Focus on broad representation, within and
  outside of public health

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Stage 2 2001 - 2002

• Technical review of potential data sets
• Are data readily available?
• Are the data valid, reliable, responsive,
  understandable and available?
• What do the data tell us about the current
  status of these indicators in Washington?

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Stage 2 - Key Informant Interviews

• Key Informant Interviews - June and Sept
• Employers, public health, health care, policy
  makers, teachers, community leaders. N19
• Eastern and western Washington
• Purpose
• Explain the report card
• Get feedback on indicators and measures
• Ask if the report card would be useful to them

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Stage 2 - Key Informant Interviews

• Readiness-to-learn/child health development a
  difficult concept to measure
• Keep it simple
• Talk about relationships among indicators
• Market to business/show relevance to business -
  good health is good business
• Message needs to be developed by marketing
  professionals and repeated often
• Disaggregate data geographically when possible

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Stage 2 - Key Informant Interviews

• Overall, key informants found draft report card
  easy to understand, with about the right number
  and type of indicators.
• The health determinants framework was especially
  powerful and appreciated (but proportion
  attributable to health care was surprising to
  many).
• Many informants felt that they could use this
  report card in their communities.

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Stage 2 Changes were made in initial Report Card
(examples)

• Readiness to Learn changed to Healthy Child
  Development
• Perceived Mental Health changed to Emotional
  Well-Being
• High School Graduation rates changed to School
  Retention rates
• Homicides/suicides dropped Violent Crimes instead

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Next Steps 2003-2005

• The Report Card alone is not enough to encourage
  action
• Steering Committee has recommended development of
  an Action Guide
• Current data for each indicator
• Example of research-based interventions for each
  indicator
• Guidance on setting targets and doing evaluations

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Next Steps 2003-2005

• Publication of Action Guide (hard copy and on
  internet)
• Distribution of Guide and Report Card to key
  opinion leaders
• Identification of change advocates at state and
  local level - engage in process
• Distribute the Report Card and Action Guide widely

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Next Steps 2003-2005

• Work to develop and sustain availability of
  community-level data
• Develop report cards with county level data and
  data for other subgroups
• Develop a systematic process for compiling and
  publishing the Report Card data and examples of
  research-based interventions
• Educate and encourage organizations and
  communities to use the Report Card

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Next Steps 2004-2005

• Set targets and timelines for improvement
• How healthy do we want to be?