1. Health Disparities for Hawaii County Health Conference August 13, 2010 Sharon H. Vitousek, M.D. North Hawaii Outcomes Project www.nhop.org www.nhop.org

2. Health Disparities - Hawaii Count y Health Outcomes Higher Death rates –All causes –Heart disease –Stroke –Overall cancer –Infant Mortality –Traffic-related –Suicide Lower life expectancy Higher teen birth rates Higher confirmed child abuse rates Higher self-reported fair/poor health status

3. Health Disparities - Hawaii Count y Health Outcomes

14. Health Disparities - Hawaii County Geographic – Hawaii County Economic –higher death rates with lower income Education –Higher death rates with lower education Ethnic: Genetic & Cultural, Socioeconomic –Higher CVD death rates --Hawaiian, Filipino –Lower cancer screening rates– Hawaiian –Lower rates of control - diabetes & blood pressure

15. Health Disparities - Hawaii County Why?

16. Framework for Population Health Institute of Medicine Social and Physical Environment Social, Economic & Physical Environment (Socioeconomic Determinants) Health-Related Behaviors Health Systems (Access to Care & Quality) Population Health Outcomes

17. Health Disparities - Hawaii County Social and Economic Determinants Higher unemployment Lower income per capita Higher % population living under 200% of federal poverty More children living in poverty Higher income inequality

20. Higher % population living under 200% of federal poverty

23. Health Disparities - Hawaii County Health Related Behaviors  Smoking Binge drinking (Obesity) (Adults getting no exercise)

24. Smoking

27. Activity

28. Health Disparities - Hawaii County Health Systems Access: Higher uninsured  Lower ratio of physicians per 1,000 population Higher percent of population without a personal doctor Lower percent of female population receiving prenatal care Utilization & Cost: Higher acute care hospitalizations per 1,000 population Quality:

31. Consequences of Inadequate Access to Primary Healthcare Source: Institute of Health Improvement, John Wasson, M.D.

33. Consequences of Inadequate Access Delayed Care & Increased suffering Higher ER utilization Higher hospital utilization Increased costs Less focus on Prevention- Life style Less recommended screening Poorer outcomes

34. Improving Population Health -- How? Socioeconomic Determinants 1.Economic Development Health sector: policy change & planning Education/ Science sectors Energy sector Health-Related Behaviors 1.Environmental AND Individual Strategies Smoking cessation, physical activity, improved access to fruits & vegetables Identifying and addressing problem drinking Health Systems 1.Primary Care Workforce Development Grow our own, Policy, Broader Team, Redesign care delivery, Engage community Improved Population Health Outcomes

35. Consequences of Improved Access Timely Care & Decreased suffering Lower ER utilization Lower hospital utilization Decreased costs More focus on prevention & life style More recommended screening Better outcomes & Quality of Life Improved productivity/business environment Improved community wellbeing

36. Hawaii Island Healthcare Alliance Island wide, voluntary, collaborative group of stakeholders Goal to improve health & health care in Hawaii County by increasing healthcare workforce & financial sustainability of providers Endorses: –Growing own providers, –Broader primary care team –Collaboration to align policy efforts, Friends of the Future is 501(c )(3) Fiscal Agent