1. Spring Conference May 5, 2016 County Health Rankings and Roadmaps: The North Carolina Experience

2. Laura Emerson Edwards RN, MPA Senior Vice President for Strategic Initiatives Mission: To build community and organizational capacity to improve and sustain population health.

3. Review of the Rankings… Why Are We Doing This Again? The NC Experience… The Good, the Bad and the Ugly Next Steps…or How Can I Make the Rankings Work for Me?

4. Review of the Rankings… Why Are We Doing This Again?

5. Review of the Rankings (Remind me what they are and why I should care) The County Health Rankings show us where we live matters to our health. The Rankings motivate community leaders and citizens to work together in new and creative ways to build a culture of health. The Rankings are a starting point for mobilizing community ACTION toward health improvement. County Health Rankings and Roadmaps http://www.countyhealthrankings.org/

6. Review of the Take Action Cycle (Remind me what that is and why I should care) The Take Action Cycle lays out a series of steps that communities take to work together to create healthier places to live, learn, work, and play. Making changes to improve health in communities is messy and complicated and building relationships across sectors can be challenging! It’s important to continually communicate with partners, policy makers, your community, and know how to use media effectively to tell your story. County Health Rankings and Roadmaps http://www.countyhealthrankings.org/

7. The NC Experience… The Good, the Bad and the Ugly

8. Healthy North Carolina 2020 Healthy NC 2020 is our state's health improvement plan, to address and improve our state's most pressing health priorities. HNC 2020 health objectives address all aspects of health with the aim of improving the health status of every North Carolinian.

9. Healthy North Carolina 2020 Social Determinants of Health Poverty Education level Housing

10. Healthy North Carolina 2020 Decrease the percentage of individuals living in poverty 16.9% (2009) 17.1% (2014) 12.5% Increase the four-year high school graduation rate 71.8% (2008-09) 85.4% (2014-15) 94.6% Decrease the percentage of people spending more than 30% of their income on rental housing 41.8% (2008)46.3% (2014) 36.1% Social Determinants of Health Baseline Current Target Healthy North Carolina 2020 Annual Data Update January 2016

11. HNC 2020: Social Determinants of Health People with higher incomes, more years of education, and a healthy and safe environment to live in have better health outcomes and longer life expectancies. People in poverty are more likely to engage in risky health behaviors, and are less likely to have affordable housing. Families with difficulties in paying rent and utilities are more likely to report barriers to accessing health care, higher use of the emergency department, and more hospitalizations. http://publichealth.nc.gov/hnc2020/

12. Health Equity County Health Rankings & Roadmaps 101 Attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities. (Healthy People 2020)

13. Health Equity County Health Rankings & Roadmaps 101 Giving everyone a fair chance to be healthy does not necessarily mean offering the same resources to all, rather offering resources necessary for their good health.

14. Equality, equity, reality Dr. Soma Stout, Institute for Healthcare Improvement

15. Next Steps…or How Can I Make the Rankings Work for Me?

16. NC and the Rankings: Through the Years 2010 –What the…?? I am going to get fired! How do I explain this to the County Commissioners and my Board of Health? 2011 – Much confusion! Why did my county’s rank change by 20 places (or more)? Where does this data come from? I am going to get fired - again! 2012 –Why does the data keep changing? (Hello…CHR&R??) 2013 – We’re getting the hang of these…we got this. 2014 – Again, already? 2015 – Yawn….not a single media call to the state team. 2016 – WHAT??? Where did this data come from?

17. Things that Make You Go Hmmm… Ranks should inform your progress measurement, not drive it. Because ranks are relative, they aren’t helpful in isolation Ranks are great for garnering attention, simplifying a lot of complex data, and making comparisons between one community and another at a point in time. But they should not be used alone to measure a single community’s progress. Your county’s rank depends not only on what is happening in your county, but also on what happens in all the other counties in your state. In fact, if every county in a state improved its health equally, their ranks would all stay the same. Personal email communication from Jan O’Neill, County Health Rankings & Roadmaps. April 8, 2016.

18. You Spoke, They Listened Because of concerns raised this year by NCALHD, this summer CHR&R Senior Staff will bring NCALHD’s recommendations (below) to their Scientific Advisory Group for review. a) stop reporting individual county ranks and, instead, only report the quartile that counties fall into, and b) work with NACCHO to do a survey of reactions of local health departments to the County Health Rankings Personal email communication from Jan O’Neill, County Health Rankings & Roadmaps. April 8, 2016.

19. Inquiring Minds Want to Know The Rankings aren’t going away…not anytime soon, anyway. So…. As an Association – how can you support counties who need it? As a County – how can you use the Rankings to your advantage and make them work FOR you rather than against you? Based on personal email communication from Jan O’Neill, County Health Rankings & Roadmaps. April 8, 2016.

20. Final Thoughts How can you and CHR&R work together so you are better supported when the rankings come out next year? How can CHR&R and your state team help you switch the focus from the rankings to the good work happening in your communities? At the end of the day, we all want the same thing: for each and every person to live as long and with the highest quality of life as possible. Based on personal email communication from Jan O’Neill, County Health Rankings & Roadmaps. April 8, 2016.

21. Thank you! Laura Emerson Edwards, RN, MPA ledwards@improvepartners.org (919) 802- 6611