Data Counts Healthy King County Coalition April 9, 2015 Marguerite Ro, DrPH, MPH Nadine Chan, PhD, MPH 1 Purpose Using data effectively Determining what data you need Finding data on the populations we care about Q&A 2 Using data effectively 3 Why are you looking for data and who is your audience? 4 Why? Who? Grant proposal Funders Advocacy Elected officials, policymakers, media, general public Monitoring / Performance management Agency heads, program and service staff, governing boards or committees Research Subject matter experts 100% of applicants (n=11) who were funded used data effectively: • Demographic characteristics • Data articulate need • Link data to proposed project Based on analysis of 54 applications from community organizations for funding for policy/system change projects. 5 From a grant reviewer’s perspective Comparisons are important Tying data to your logic model/theory of change Need to link data to strategies Use forecasting - what would the curve look like if you 6 didn’t do anything? Have you done a recent literature search? Evidence-based? Are there supporting studies? Cost per person Use appendices – not too much! From a policymaker’s perspective Is the data compelling, reliable, and understandable? Do: Present information in a short, easily digestible form. Use language that a non-specialist can understand. Summarize the information, and present clear arguments for a particular course of action. Don’t: Oversell your data (e.g. don’t imply causality without proof) 7 How much data do your audiences need? 8 What data do you need 9 What do you need the data to do? Demonstrating need Showing that you have a solution Forecasting what will happen if a problem is not addressed Measuring progress, impact, or outcomes 10 What message will the data deliver? Scope – what is the magnitude of the problem? what is the 11 landscape? Cost – what is the cost of the problem to the community and various sectors? Quality – are there issues of accessibility, availability, or affordability? Equity – are there disparities or inequities in resources or outcomes? Impact – what is the impact of an applied strategy or intervention? Telling your story 12 13 Credit: Tiffany Manuel, PhD, Vice President for Knowledge, Impact & Strategy Start with the basic elements of good storytelling: not always the data points. 14 Credit: Credit:Tiffany TiffanyManuel, Manuel,PhD, PhD,Vice VicePresident Presidentfor forKnowledge, Knowledge,Impact Impact&&Strategy Strategy 15 Credit: Tiffany Manuel, PhD, Vice President for Knowledge, Impact & Strategy Social Math 16 17 Credit: Tiffany Manuel, PhD, Vice President for Knowledge, Impact & Strategy 18 Credit: Tiffany Manuel, PhD, Vice President for Knowledge, Impact & Strategy Social Math in Action Over 100,000 adults live with diabetes in King County. That’s enough to fill CentuyLink Football Stadium 1.5 times. 19 Social Math with Solutions Over 300,000 adults are obese in King County. That’s enough players for 5 soccer matches a day in each of the 1000 King County soccer fields (if they were safe and accessible) and an additional 200 soccer fields. 20 Measuring Progress: Result, indicator, strategy, and performance measure Guidance by Mark Friedman, author of “Trying Hard is Not Good Enough: how to produce measurable improvements for customers and communities” 21 Result (or outcome or goal) Population condition of well-being For children, adults, families and communities Stated in plain language Results are conditions that voters and tax-payers can understand Examples: healthy children, children ready for school, children succeeding in school, strong families, elders living in the community with dignity, a safe community, clean environment 22 Indicator (or benchmark) A measure that helps quantify the achievement of a result 23 Strategy A coherent collection of actions that has a reasoned chance of improving results Made of the best thinking of what works or likely to work Can operate at both the population and performance levels 24 Performance measure A measure of how well the program, agency, or service system is working How much did we do? How well did we do it? Is anyone better off? 25 Examples of population accountability: community, city, county, state, nation Population: all WA residents Population result: clean environment Indicators: percent of days below air quality standards, percent of contaminated stream-miles Population: entire King County population Population result: vibrant economy Indicators: percent of adults unemployed Population: All Auburn residents Population result: safe community Indicators: violent crime rate, percent of residents who feel safe 26 Examples of performance accountability: program, agency, service system Program: The Peace Corps Performance measures: percent of countries accepting/requesting volunteers, percent of volunteers who complete the program Program: Pennsylvania Dept of Environmental Protection Performance measures: percent of cited industries that fully implement clean up orders Program: Philadelphia Police Dept Performance measures: Avg response time, percent of crimes with successful prosecution 27 Steps for selecting indicators For each result, get input from stakeholders on indicators to consider Rank indicator (high, medium, low) on three criteria: Podium Power (communication power): is it common sense and compelling? Proxy power: can it stand as a proxy for the result of interest? If this changes, will several other related indicators change in the same way? Data power: is the data reliable, consistent, timely, available at the geographic/demographic level needed? Specify three buckets of indicators: Primary/headline indicators: For each result, select 3 or 4 measures that rise to the top in the rating process Secondary indicators: Include any other measures for which there is good data Data development bucket: Include items ranking high in communication and proxy power, but low in data power 28 Measuring progress: Try it What’s the connection? • Poverty, health, and housing? • Health and education? 29 Finding the data 30 Where does the data come from? Surveys Assessments Research / special studies Services / programs Other ??? 31 Healthy Youth Survey Time: 2014 latest year, collected every other year Who: students in grades 6, 8, 10, and 12 Topics: safety and violence, physical activity and diet, alcohol, tobacco and other drug use, and related risk and protective factors. Data availability: state, county, and some cities http://www.doh.wa.gov/DataandStatisticalReports/DataSyst ems/HealthyYouthSurvey 32 Healthy Youth Survey – Alcohol questions Questions about the neighborhood and environment 33 Healthy Youth Survey – Alcohol questions Questions about issues related to alcohol 34 Healthy Youth Survey – Alcohol questions Questions about their individual behaviors 35 Behavioral Risk Factor Surveillance Survey (aka BRFSS) Time: collected each year Who: representative telephone survey collected in English and Spanish Topics: health-related risk behaviors, chronic health conditions, and use of preventive surveys Data availability: state, county, and health reporting areas http://www.cdc.gov/brfss/index.html 36 BRFSS Core Health Status Immunization Quality of Life Falls Health Care Access Seatbelt Use Exercise Drinking and Driving Inadequate Sleep Breast and Cervical Cancer Chronic Health Conditions Oral Health Demographics Tobacco Use Alcohol consumption 37 Screening Prostate Cancer Screening Colorectal Cancer Screening HIV/AIDS 2013 BRFSS Modules (WA) Cardiovascular health Childhood asthma prevalence Mental illness & stigma Pre-diabetes Random child selection Sodium or Salt-related behavior Sugar drinks 38 Pregnancy Risk Assessment Monitoring System (PRAMS) Time: collected monthly via mail, with phone follow-up Who: new moms sampled from birth certificates to assure adequate data in higher risk pops, administered in English and Spanish Topics: data to improve the health of mothers and infants Data availability: state and county http://www.cdc.gov/prams/aboutprams.htm http://www.doh.wa.gov/DataandStatisticalReports/HealthBehaviors/PregnancyRiskAsses smentMonitoringSystem/ForResearchers 39 PRAMS Core Attitudes and feelings about the most recent pregnancy. Access, content, source, and quality of prenatal care. Maternal alcohol and tobacco consumption. Physical abuse before and during pregnancy. Pregnancy-related morbidity. Infant health care. Contraceptive use. Mother's knowledge of pregnancy-related health issues, such as adverse effects of tobacco and alcohol; benefits of folic acid; and risks of HIV. 40 The Geography of Diabetes by Census Tract in a Large Sample of Insured Adults in King County, Washington, 2005–2006 Adam Drewnowski, PhD, Colin D. Rehm, PhD, MPH, Anne V. Moudon, Dr es Sc, and David Arterburn, MD, MPH Prev Chronic Dis. 2014; 11: E125. Published online 2014 Jul 24. doi: 10.5888/pcd11.140135PMCID: PMC4112927 Results In this population of insured adults: Diabetes was concentrated in south and southeast King County Diabetes prevalence ranging from 6.9% to 21.2% For each 50% increase in median home value, diabetes prevalence was 1.2 percentage points lower, 41 42 What to do if quantitative data are not available Proxies Extrapolating national or state data Use of qualitative data 43 Extrapolating data: What is the number of Latinos with diabetes in the community? National data: The diabetes rate for Latinos nationally is 0.02 for age 1844, 0.143 for age 45-64, and 0.204 for age 65+ Number of Latinos with diabetes in the community = National rates x population in your community (by the different ages) .02 x 30,000 (ages 18-44) = 600 .143 x 11,000 (ages 45-64) = 1,573 .203 x 2,000 (ages 65+) = 410 Next add up the various populations with diabetes: 600 + 1,573 + 410 = 2,583 There are an estimated 2,500 Latinos with diabetes in this community 44 Qualitative data What information can context experts provide? What might explain the quantitative data we are seeing? What else is important to know that the data aren’t showing? What are the attitudes and beliefs of the community? What can we learn about why something is working or not working? 45 Sources: Qualitative Data Focus groups, interviews, photo voice, video, observations, content analyses, neighborhood assessments Literature review Reports Mapping Our Voices for Equity http://www.mappingvoices.org/ Communitiescount.org Reports from local initiatives http://www.kingcounty.gov/healthservices/health/partnerships.aspx http://www.kingcounty.gov/healthservices/health/partnerships/CPPW.aspx 46 Policy landscape: King County K-12 Tobacco Related Policies, 2014 47 http://www.kingcounty.gov/healthservices/health/data/PolicyTracker.aspx Data Power or Critiquing the Data Credibility –Who produced the data? Specificity – Is the data precise for a particular population? Generalizability – Can you apply data from one population to another population? Reliability – How was the data collected? Timeliness –When was it collected? 48 Good or bad data? According to the Community Research Initiative on AIDS, 21 of 1,000 male prisoners and 35 of 1,000 female prisoners were known to be HIV positive at the end of 1997. The rate of confirmed AIDS was 51⁄2 times higher in the prisons than in the general population. A study of infectious diseases among people passing through correctional facilities in 1996 found that 17% of those released from prison were HIV positive. Available at: http://www.thebody.com/cria/summer00/prison.html 49 Local Data Sources Community Health Indicators http://www.kingcounty.gov/healthservices/health/data/indicators.aspx School district health profiles http://www.kingcounty.gov/healthservices/health/data/SchoolProfiles.aspx City health profiles http://www.kingcounty.gov/healthservices/health/data/CityProfiles.aspx Data Maps http://www.kingcounty.gov/healthservices/health/data/maps.aspx Data and Reports http://www.kingcounty.gov/healthservices/health/data.aspx Communities Count www.communitiescount.org King County CHNA http://www.kingcounty.gov/healthservices/health/data/kchhc.aspx King County Policy Tracker: Law Atlas 50 http://www.kingcounty.gov/healthservices/health/data/PolicyTracker.aspx