Transcript ID Emergencies - North Country Health Consortium

A snapshot of the New Hampshire’s
Health profile
Jose Thier Montero, MD
Director
Division of Public Health Services
NH-DHHS
Today’s Presentation
Current use of data
How 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 demographics
Population segments
Market segmentation
2007 Age-Adjusted Estimates of the Percentage of
Adults† with Diagnosed Diabetes in New Hampshire
Age
Adjusted
Percent
(PERCEN
County
T)
Belknap County
7.5
Carroll County
7.3
Cheshire County
7.6
Coos County
8.1
Grafton County
6.5
Hillsborough County
6.6
Merrimack County
6.9
Rockingham County
7.1
Strafford County
8.8
Sullivan County
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Age
Adjusted
Percent
Standard
Deviation
(PERSD)
0.6
0.7
0.6
0.7
0.5
0.3
0.5
0.4
0.6
0.7
Age
Adjusted
Percent
Lower
95% CL
(PER95L)
6.3
6.1
6.4
6.9
5.6
6
6
6.3
7.7
5.8
Age
Adjusted
Percent
Upper
95% CL
(PER95U)
8.8
8.8
8.8
9.5
7.5
7.3
7.9
8
10.1
8.4
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
disease
Social Determinants of Health
Several 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
Value of Public Health
The average life
expectancy in the US
rose 30 years in the last
century
25 of these years are due
to advances in public
health (not in medical
care)
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 NPHPS
Developed Strategic Priorities
Workgroups
Public Health Improvement
Services Council –enacted in
statute 2007 to oversee
public health improvement
New Hampshire Division of Public Health Services
Strategic Map: 2011-2013
Demonstrate
Measurable Improvements
in Health and Well Being
A
B
C
D
E
Strengthen
Approaches to
Population Health
Expand
Public Health
Education and
Messaging
Strengthen
Public Health
Infrastructure
Improve the
Effectiveness
of Resource
Allocation
Strengthen
Organizational
Effectiveness and
Adaptability
Develop and
Implement a
Health Messaging
Strategy
Ensure Access
to Healthcare and
Public Health Services
Improve Intra-agency
Communication at
All Levels
Build an Internal
Social Marketing
Capacity
Develop the Capacity
to Meet the Future
Health Workforce
Needs
Focus on Chronic
Disease Prevention,
Diagnosis, Treatment
and Intervention
Continue to
Prepare for and
Respond to
Public Health Threats
Align Internal
Resources to
Support
Strategic Goals
Allocate Resources
Externally to
Support
Strategic Goals
Build the Internal
Capacity to Support
Strategic Resource
Allocation
Implement Cross-
1
Program Integration
to Increase Population
Health Impact
Integrate
2
3
Data Systems to
Monitor Population
Health Status
Position DPHS as
Expert on Approaches
to Population Health:
Policy, Data, Practices
Make Strategic Use of
4
Partnerships to
Implement Population
Health Approaches
Develop Key
Communications
Partnerships to
Increase Impact
Evaluate Message
Effectiveness and
Make Needed
Adjustments
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.
Implement a
Regional
Public Health System
Prepare for
Accreditation
of the State
Health Department
Implement the
Technology Required
For Future
Effectiveness
Develop and Implement a Public Health Performance Management System
F
Redesign Internal
Contracting Process
and Financial
Management Structure
Ensure Optimal
Workforce
Capacity
Strengthen
Organizational and
Staff Resilience
Optimize the
Performance of Key
Business Processes
Expected Outcomes
Healthier 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 care
Higher rates of immunizations
Better health care quality (Evidence based, no adverse events)
Disease care cost avoidance
Population Informed and educated on health promotion
and disease prevention
Compliance 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
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.”
National
Prevention
Strategy
National
Health
Equity
Strategy
National
Quality
Strategy
HP 2020
LHI
National
Physical
Activity
Strategy
National
Tobacco
Control
Strategy
Prescription
Drug Abuse
Prevention Plan
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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Processes
People
Leadership
Demonstrate Measurable
Improvements in theStaff
Aim
Health and Well Being of
Information
NH Population
Resources
Aim
Goals
Mission,
and
vision, values
objectives
SHIP
Processes
People
Leadership
Aim
Information
Staff
Resources
Broad Goal: Reduce burden of chronic disease
Specific goal: Reduce tobacco consumption
DPHS objective: Reduce youth smoking prevalence to X%
by 20YY
Activities and performance indicators
School outreach
Helpline
$ spent in 2009: $23,000
Television ads
%
Radio ads
Internet ads
DPHS 2012 target
2008 tar
#
#
DPHS 2015 goal
#
Division goals
Youth media campaigns
2010 target
2000
2000
2000
2010
2010
2000
2010
DPHS objective: Reduce maternal smoking prevalence to X% by 20YY
Activities and performance indicators
Direct outreach
$ spent in 2010: $12,000
Providers with edu materials
%
DPHS 2012 target
#
#
Division goals
Provider education
DPHS 2015 goal
2010 target
2000
2000
2010
2010
2000
2010
We need to Work Together to Assure a Healthy Population
Questions........
Thank You
Contact Info
Jose Thier Montero
603-271-4617
[email protected]
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