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
2
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?
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)
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
4
Are We Duplicating or Streamlining
Efforts?
5
Can We Build on Harford County Efforts?
Federal Health Care
Reform
Requirements
Hospital CHNA
Mandates
COMMUNITY HEALTH
IMPROVEMENT PLAN
LHD SHIP
Mandates
Healthy Harford
Activities
6
A Common Vision and Mission?
VISION
To make Harford County the healthiest
community in Maryland
MISSION
To protect, promote and improve the health,
safety and environment of the residents of
Harford County through community
assessment, education, collaboration and
assurance of services
7
What is a Public Health Planning Process?
MAPP
• 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
8
How Can We Get Started?
One Approach
• 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
9
First, Quick Facts About Our Community
Demographic Indicators
Harford County
Maryland
244,826
5,773,552
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
Population (2010)
Population % change (2000-2010)
10
Let’s start at the
beginning . . .
PREGNANCY
DATA
11
Infant Mortality Rates
Harford County & Maryland
2001-05 to 2006-10
Source: Maryland Vital Statistics
12
Infant Mortality Rates
Harford County, By Race
2000-04 to 2005-09
Source: Maryland Vital Statistics
13
Top 7 Leading Causes of Infant Death
Maryland, 2010
14
Low Birthweight Rates
Harford County & Maryland
2000-04 to 2005-09
Source: Maryland Vital Statistics
15
Low Birthweight Rates
Harford County, By Race
2004 vs. 2009
Source: Maryland Vital Statistics
16
Teen Birth Rates
Harford County & Maryland
2004 vs. 2009
Source: Maryland Vital Statistics
17
Teen Birth Rates
Harford County, By Race
2004 vs. 2009
Source: Maryland Vital Statistics
18
1st Trimester Prenatal Care Rates
Harford County & Maryland
2004-06 to 2007-09
Source: Maryland Vital Statistics
19
1st Trimester Prenatal Care Rates
Harford County, By Race
2004 vs. 2009
Source: Maryland Vital Statistics
20
For pregnancy outcomes, Harford County ranks
better than the State, but health disparities exist
Indicator
Harford
Maryland Comparison
Infant
Mortality
Rate
5.7/1000
7.6/1000
Low
Birthweight
Rate
7.8%
9.3%
Teen Birth
Rate
Early
Prenatal
Care Rate
Disparity
19.7/1000 31.2/1000
84.8%
80.0%
21
Let’s move on to
conditions that
affect us over
the years . . .
CHRONIC
DISEASE DATA
22
Top 10 Causes of Death
Maryland, 2010
23
Top 7 Causes of Death
Harford County, 2009
450
433
136
99
59
43
41
24
Heart Disease Mortality Rates
Harford County & Maryland
2004-06 to 2007-09
Source: Maryland Vital Statistics
25
Heart Disease Mortality Rates
Harford County, By Race
2004-06 to 2007-09
Source: Maryland Vital Statistics
26
Cancer Mortality Rates
Harford County & Maryland
2004-06 to 2007-09
Source: Maryland Vital Statistics
27
Cancer Mortality Rates
Harford County, By Race
2004-06 to 2007-09
Source: Maryland Vital Statistics
28
Stroke Mortality Rates
Harford County & Maryland
2004-06 to 2007-09
Source: Maryland Vital Statistics
29
Stroke Mortality Rates
Harford County, By Race
2004-06 to 2007-09
Source: Maryland Vital Statistics
30
COPD Mortality Rates
Harford County & Maryland
2004-06 to 2007-09
Source: Maryland Vital Statistics
31
COPD Mortality Rates
Harford County, By Race
2000-07 to 2004-09
Source: Maryland Vital Statistics
32
For chronic disease outcomes, Harford
County ranks worse than the State
Indicator
Harford
Maryland Comparison
Heart
Disease
Mortality
Cancer
Mortality
Stroke
Mortality
COPD
Mortality
210
197.8
185.8
177.7
57.3
55.7
45.7
35.6
Disparity
Note: Rates are deaths per 100,000 population
33
Now let’s look
at lifestyle
choices . . .
LIFESTYLE
DATA
34
Leading Actual Causes of Death
United States, 2000
Source: Mokdad AH, et al, JAMA, Mar 2004
35
Adult Smoking Rates
Harford County & Maryland
2005-07 to 2008-10
Source: CDC Behavioral Risk Factor Surveillance System
36
Adult Smoking Rates
Harford County
2010 CHAP & BRFSS Data
37
Adult Cigarette Smoking Rates
Harford County & Maryland
2000 to 2010
Source: CDC Behavioral Risk Factor Surveillance System
38
Youth Tobacco Use Rates
Harford County & Maryland
2000 to 2010
Source: Maryland Youth Tobacco Survey
39
Secondhand Smoke Exposure Rates
Harford County & Maryland, 2008
Source: CDC Behavioral Risk Factor Surveillance System
40
Adult Obesity/Overweight Rates
Harford County & Maryland
2005-07 to 2008-10
Source: CDC Behavioral Risk Factor Surveillance System
41
Adult Obesity/Overweight Rates
Harford County
2010 CHAP & BRFSS Data
42
Physical Activity Rates*
Harford County & Maryland
2005-07 to 2008-10
* NOTE: Moderate activity 30 minutes/day, 5 days/week
Source: CDC Behavioral Risk Factor Surveillance System
43
Physical Activity Rates
Harford County
2010 CHAP & BRFSS Data
NOTE: Moderate activity 30 minutes/day, 3 days/week
NOTE: Moderate activity 30 minutes/day, 5 days/week
44
Fruits & Vegetables Intake Rates*
Harford County & Maryland
2005-07 to 2008-10
* NOTE: 5 or more daily servings of fruits or vegetables
Source: CDC Behavioral Risk Factor Surveillance System
45
Fruits & Vegetables Intake Rates
Harford County
2010 CHAP & BRFSS Data
Fruits/Vegetables, 37.1%
Fruits, 18.3%
NOTE: 3 more daily servings of fruit and 3 more daily
servings of vegetables
46
In lifestyle choices, Harford County ranks
worse than or even with the State
Indicator
Harford
Maryland Comparison
Tobacco
Use
20.3%
15.1%
Obesity/
Overweight
63.5%
64.1%
Physical
Activity
37.1%
33.9%
Fruits/
Vegetables
25.2%
27.3%
47
And what about
access to
health care . . .
ACCESS DATA
48
% Who Could Not Afford to See M.D.
Harford County & Maryland
2005-07 to 2008-10
Source: CDC Behavioral Risk Factor Surveillance System
49
Adult Influenza Vaccination Rates
Harford County & Maryland
2005-07 to 2008-10
Source: CDC Behavioral Risk Factor Surveillance System
50
Childhood Influenza Vaccination Rates
County Leaders, 2010
Source: CDC Behavioral Risk Factor Surveillance System
51
Anxiety Disorder Rates
Harford County & Maryland
2005-07 to 2008-10
Source: CDC Behavioral Risk Factor Surveillance System
52
Binge Drinking Rates
Harford County & Maryland
2005-07 to 2008-10
Source: CDC Behavioral Risk Factor Surveillance System
53
Population to Provider Ratios
Harford County & Maryland
Source: Maryland Primary Care Office, DHMH
54
Primary Care & Dental Care Shortage
Areas in Harford County, 2010
55
With access to care, Harford County has
specialty area needs
Indicator
Harford
Maryland
Afford to See
M.D.
10.4%
12.0%
Adult Flu
Vaccine
Child Flu
Vaccine
Anxiety
Binge Drink
38.7%
41.2%
63.3%
53.7%
19.0%
16.0%
12.8%
13.7%
Pop:Provider 44,354:1
Ratio (MH)
Comparison
12,253:1
56
Now, putting
the pieces
together . . .
COMPOSITE
DATA
57
SHIP
58
Which of the 39 SHIP objectives does
Harford County rank worse than the State?
1.
2.
3.
4.
5.
6.
7.
Seasonal flu vaccination rate
Heart disease death rate
Cancer death rate
Adult tobacco use
Youth tobacco use
Behavioral health-related admissions to E.R.
Alzheimer’s-related admissions to the E.R.
59
County Health Rankings
60
Which of the 27 County Health Rankings
objectives does Harford County rank worse
than the State?
1. Adult smoking
2. Adult obesity
3. Access to recreational facilities
4. Air pollution ozone days
5. Mammography screening
6. Motor vehicle crash death rate
7. Primary care physician availability
8. Preventable hospital stays
9. Poor mental health days
10. Poor physical health days
11. Unemployment
61
Do the data suggest common themes for
determining Harford County health
priorities?
62
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?
63