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A snapshot of the New Hampshire ’ s Health profile Jose Thier Montero, MD Director Division of Public Health Services NH-DHHS.

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Presentation on theme: "A snapshot of the New Hampshire ’ s Health profile Jose Thier Montero, MD Director Division of Public Health Services NH-DHHS."— Presentation transcript:

1 A snapshot of the New Hampshire ’ s Health profile Jose Thier Montero, MD Director Division of Public Health Services NH-DHHS







8 Today’s Presentation Current use of data How do we measure? Report structure “Responding” to present and future needs


10 NH Health Ranking Source:

11 NH Determinants Source:

12 NH Health Outcomes Source:

13 So…. How do we measure? What do we measure? Health? Disease? Access to services? Cost? Who? What? When? Who is measuring? Who is reporting?

14 Who Lives here? Who are we supposed to serve? General demographics Population segments Market segmentation





19 2007 Age-Adjusted Estimates of the Percentage of Adults † with Diagnosed Diabetes in New Hampshire



22 What should we do ?

23 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

24 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

25 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

26 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) Value of Public Health

27 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

28 10 Essential Public Health Services


30 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


32 New Hampshire Division of Public Health Services Strategic Map: 2011-2013 Position DPHS as Expert on Approaches to Population Health: Policy, Data, Practices Focus on Chronic Disease Prevention, Diagnosis, Treatment and Intervention Prepare for Accreditation of the State Health Department Implement a Regional Public Health System Develop Key Communications Partnerships to Increase Impact Ensure Optimal Workforce Capacity Optimize the Performance of Key Business Processes Strengthen Approaches to Population Health Demonstrate Measurable Improvements in Health and Well Being Strengthen Public Health Infrastructure Improve the Effectiveness of Resource Allocation Expand Public Health Education and Messaging Strengthen Organizational Effectiveness and Adaptability Develop and Implement a Public Health Performance Management System Make Strategic Use of Partnerships to Implement Population Health Approaches Strengthen Organizational and Staff Resilience Continue to Prepare for and Respond to Public Health Threats Evaluate Message Effectiveness and Make Needed Adjustments Develop and Implement a Health Messaging Strategy Align Internal Resources to Support Strategic Goals Improve Intra-agency Communication at All Levels Implement Cross- Program Integration to Increase Population Health Impact Ensure Access to Healthcare and Public Health Services Implement the Technology Required For Future Effectiveness Integrate Data Systems to Monitor Population Health Status Develop the Capacity to Meet the Future Health Workforce Needs Redesign Internal Contracting Process and Financial Management Structure Build an Internal Social Marketing Capacity Allocate Resources Externally to Support Strategic Goals Build the Internal Capacity to Support Strategic Resource Allocation ABD C F E 1 3 2 4 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.

33 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

34 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. 34

35 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.”


37 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 37

38 National National Public Health Performance Standards Accreditation Healthy People 2020 State PHIAP State Health Profile 2011 State Health Improvement Plan TBD DPHS Strategic Plan Agency targets Staff training Staff mentoring WISDOM/PMS Programs and Individuals Project focus Individual performance Process evaluation DPHS Performance Management Model

39 Aim People Staff Leadership Resources Information Processes Demonstrate Measurable Improvements in the Health and Well Being of NH Population

40 Aim

41 Mission, vision, values Goals and objectives SHIP

42 Aim People Staff Leadership Resources Information Processes







49 Division goals DPHS objective: Reduce youth smoking prevalence to X% by 20YY DPHS 2015 goal 2000 2010 % Youth media campaignsSchool outreach Activities and performance indicators 2000 2010 # DPHS 2012 target Television adsRadio adsInternet ads 2000 2010 # 2010 target DPHS objective: Reduce maternal smoking prevalence to X% by 20YY DPHS 2015 goal 2000 2010 % Provider educationDirect outreach Activities and performance indicators 2000 2010 # DPHS 2012 target Providers with edu materials 2000 2010 # 2010 target $ spent in 2009: $23,000 Helpline Division goals $ spent in 2010: $12,000 Broad Goal: Reduce burden of chronic disease Specific goal: Reduce tobacco consumption

50 We need to Work Together to Assure a Healthy Population

51 Questions........

52 Contact Info Jose Thier Montero 603-271-4617 52

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