Population Health and Its
Role in Our Community
Virginia A. Caine, MD
Director,
Marion County Public Health Department
vcaine@marionhealth.org
317-221-2301
Population Health is:
The health outcomes of a group of individuals, including
the distribution of such outcomes within the group.
Aren’t Population Health and Public
Health the Same?
Public Health focuses on the critical
functions of state and local health
departments such as preventing
epidemics, containing environmental
hazards, and encouraging health
behaviors.
Population health concerns the
determinants of health like health
care, education, and income inequality
to name a few, which remain outside
the traditional public health authority
and its responsibility.
The Future of the Public’s Health in
the 21st Century
• Significant movement in “building a new
generation of intersectoral partnerships that
drawn on the perspectives and resources of
diverse communities and actively engage
them in health action.”
But What About Population Medicine?
• Considers the specific activities
of the medical care system that
promote population health
beyond the goals of care of the
individuals treated
• Requires the medical care
system to collaborate and
partner with other organizations
• Acknowledgement that
individual health and clinical
outcomes greatly influenced by
population factors, such as
education
Population Health Provides the Best
Definitional Framework
• It focuses on measurable outcomes from
multiple sectors
– Clinical outcomes
– Education levels
– Poverty rates
– Environmental factors
• Creating a holistic picture of a community’s
health
So…How Do We Measure Population
Health Outcomes?
MCPHD initiated a Community
Health Assessment to create a
baseline of these factors.
Inputs:
• Health Care
• Individual Behavior
• Social Environment
• Physical Environment
• Genetics
Population Health in the
Affordable Care Act
• Provisions to expand insurance coverage by
improving access to the health care delivery
system (Medicaid expansions, state insurance
exchanges, support for community health
centers)
• Improving the quality of the care delivered
(National Strategy for Quality Improvement, CMS
Center for Medicare and Medicaid Innovation,
and establishment of the Patient-Centered
Outcomes Research Institute)
Population Health in the
Affordable Care Act
• Promotion and implementation of ACOs to
incentivize providers to take responsibility for
population health outcomes
• Expansion of primary health care training,
requirements that private health plans and
Medicare provide specific services
recommended by U.S. Preventive Services
Task Force without cost sharing
Population Health in the
Affordable Care Act
• Promoting community-and population-based
activities
• The establishment of the National Prevention,
Health Promotion and Public Health Council
• A new Prevention and Public Health Fund
(authorized $1 billion in fiscal year 2012)
• Funding for Community Transformation
Grants
What is a Community Health Assessment (CHA)?
Quantifies prevalent or impactful health issues
Detects health trends that merit attention
Identifies health inequities
Compares Marion County to peer cities and the
nation, to provide context
Why do a Community Health Assessment?




Increases community awareness of health issues
Prioritizes community health needs
Identifies health disparities
Provides an evidence base for MCPHD’s Community
Health Improvement Plan (CHIP)
Improves the health status of our community
Top Priorities




Unhealthy Weight
Poor Mental Health
Increasing Poverty Rates
Chronic Disease Prevention and Management
 Chief contributing factor: SMOKING
 Violence
Key Data Sources
National Sources
•
•
•
•
2010 Census, American Community Survey
Bureau of Labor Statistics
County Health Rankings www.countyhealthrankings.org
Behavioral Risk Factor Surveillance System (BRFSS)
Local Sources
•
•
•
Birth and Death Certificates
Hospital Discharges, ED visit data
CHA 2012 Telephone Survey
Community Health Assessment
2012 Telephone Survey
• 5013 total respondents
• 100 survey questions: health status, behavioral
risk factors, family, local resources
• Survey is a SAMPLE of whole-county population
(928,281), randomly selected to represent county
as a whole.
• Called cell phones as well as in-house phones to
reach a more diverse group
Survey Process
7 workgroups identified priority issues
– Workgroups: Ages 0-4, 5-11, 12-17, 18-34, 35-64, 65+,
& Environment
– Content experts, service providers, & community
members
– 3 to 5 meetings, reviewed data, discussed issues
Steering Committee selected overall priorities
– Reviewed workgroup’s output
– Synthesized that output into the overall priorities
What Did We Learn and
What Did We Find?
Increasing Poverty Rate
County Poverty Rates DOUBLED
Between 2000 and 2012: Now 19%
100% Federal Poverty Level (FPL) Definition:
Family of 4 with annual household income less than
$23,496 (2012)
County residents meeting 100% FPL includes:
1 in 5 individuals
1 in 3 households with children
(up from 1 in 5, 2007)
High Poverty Concentration in 6
Central Marion County Zip Codes
 These zip codes have over
25% of their populations
living at or below 100%FPL
 They exceed County rates
of….
Poverty
7 times
Unemployment rate
times
Violent Crime rate
times
3
5
Zip Codes
% FPL
46201
46204
46218
46225
46202
46208
36.9
33.6
33.4
32.5
29.8
28.8
More Than 1 in 4 Young Adults (18-34)
Met 100% Federal Poverty Guidelines
Chronic Disease
Prevention and Management
County Children:
High Prevalence of Chronic Disease
% Youth 5-17 ever diagnosed with….
Diabetes
2
High BP
2
Depression/Anxiety
9
ADHD
15
Asthma*
* Twice the national rate
20
0
5
10
15
20
25
County Adult Chronic Disease, 2012
(%) compared to U.S.
Heart Attack/CHD
7.7
Current Asthma
11
Diabetes
14
US 2010-12
Depression
21
High Cholesterol
MC 2012
24
High BP
31
0
10
20
30
40
Smoking
Marion County Adults – 2005 & 2012
35%
30%
27%
29%
25%
20%
15%
10%
5%
0%
2005
95% CI: 2005 (24.4%-29.6%); 2012 (26.5% - 30.7%)
2012
35%
Prevalence of Smoking by Race
Adults Over 18 Years Old
Marion County – 2005 & 2012
30%
25%
20%
2005
15%
2012
10%
5%
0%
White
Black
Latino
2005
25%
27%
18%
2012
30%
29%
16%
Unhealthy Weight
50% of County Youth 5-17 Were
Above Normal Weight
2005
22
2012
18
31
0%
20%
Obese
58
19
40%
Overweight
1
44
60%
Normal
6
80%
Underweight
100%
Overweight and Obesity Continue to
Increase in Marion County
• Obese Children
– 2005: 2 out of 10
– 2012: 3 out of 10
• Obese Adults
– 2005: 3 out of 12
– 2012: 4 out of 12
Adult Outcomes
Diabetes
CHD/Stroke
1 2012
CHA Telephone Survey
Marion County1
14.0%
7.7%
2
2011 BRFSS
US2
9.5%
7.0%
Obesity Related Health Outcomes
Adults
Marion County1
Diabetes
14.0%
CHD/Stroke
7.7%
1 2012
CHA Telephone Survey
2
2011 BRFSS
US2
9.5%
7.0%
Poor Mental Health
Major Depressive Disorder is the Leading
Cause of U.S. Disability, Ages 15-44
Depression is prevalent in all County age groups,
including:
1 in 5
Adults
U.S. 17.5% (2011)
1 in 10
Children (5-17)
U.S. 3.9% (2007)
Depression in Young Adults
Young Adults: A high prevalence of depression and poor
mental health days. High rates of abuse of prescription
painkillers.
47% of Marion County 18- to 25-year-olds reported having
14+ days in the past month of poor mental health – four
times the U.S. rate. (CDC 2011 BRFSS Survey)
Diagnosed Depression in
County Adolescents
County adolescents are diagnosed with depression
(12.8%) and their suicide risk is high
• 8.3%
U.S. major depressive episode(2010-11)2
2011 Indiana Teens: Youth Risk Behavior Study4
• 25%
• 18.9%
• 11%
had been bullied at school
seriously considered suicide
had one or more attempts at suicide
Suicide: A Leading Cause of Deaths
• Among the 5 leading causes for ages 12-64
• (Nationally, the second leading cause for
ages 12-17)
• Third leading cause for ages 15-24 (30%
higher than U.S.)
• Fifth leading cause for ages 10-14
Increasing Dementia in Senior Adults
6-10% of persons over 65 develop dementia
•
Alzheimer’s makes up 75% of dementia
cases
•
8 in 10 dementia cases are never clinically
diagnosed
In past decade, Alzheimer’s Disease was the only
leading cause of death to increase among seniors (up
20%)
Violent Deaths and
Prevention
Homicide Deaths
Age
10-14
15-24
33-44
45-54
Rank*
3rd
1st
5th
9th
Deaths per 100,000
MC (2008-2010) US (2010)
2
0.9
31
10.9
16
6
13
4.4
* among all causes of death in Marion County
Where Do We Go from Here?:
The Next Steps
Community Health Assessment &
Health Improvement Plan (2015)
• Identify short–term,
evidence based intervention
strategies, and action steps
• Find committed partners to
take substantial roles for
each issue
• Assure process and outcome
monitoring occurs for each
specific action area to
document change.
Community Health Improvement Plan
• A community health improvement plan is a long-term, systematic effort
to address public health problems on the basis of the results of
community health assessment activities and the community health
improvement process. This plan is used by health and other governmental
education and human service agencies, in collaboration with community
partners, to set priorities and coordinate and target resources.
• A community health improvement plan is critical for developing policies
and defining actions to target efforts that promote health. It should
define the vision for the health of the community through a collaborative
process and should address the gamut of strengths, weaknesses,
challenges, and opportunities that exist in the community to improve the
health status of that community.
Source: NACCHO, http://www.naccho.org/topics/infrastructure/CHAIP/upload/CHIP-Basics.pdf
Source: Population Health in the Affordable Care Act Era. Academy Health. Michael A. Stoto, Ph.D., February 13, 2013.
Questions?