2. 2008 Wisconsin County Health Rankings Online Webinar Available November 14, 2008 Kyla Taylor

3. Outline Summary of the Wisconsin County Health Rankings, 2008 –Overview –Methods –Changes Interpreting the Rankings Communicating findings of the Rankings

4. Overview

5. Background Launched in 2003, the Rankings is an annual publication Compilation of publicly available data for Wisconsin counties Modeled after the United Health Foundation’s America’s Health Rankings Focuses on both health outcomes and determinants

6. Purpose of the Rankings Provide an annual overview of health outcomes and health determinants across Wisconsin Spark discussion of health issues Stress that there are multiple broad determinants of health Draw insights from high-performing counties Draw additional resources for improvement to less healthy counties

7. Uses of the Rankings Based on feedback received from county and local health officers and other users of the Rankings, some of the most common uses of the Rankings include: –Needs assessments and evaluations –Program planning –Presentation to others County health boards Public health staff Community partners

8. Methods

10. The Health Outcomes dimension equally weights length and quality of life. The Health Determinants dimension weights the four subgroups based upon a review of the literature and expert opinion of how these subgroups contribute to health –10% Health Care –40% Health Behaviors –40% Socioeconomic Factors –10% Physical Environment

12. Methods – data sources Behavioral Risk Factor Surveillance System Metastar US Census Bureau US Environmental Protection Agency Wisconsin Crash Outcomes Data Evaluation System Wisconsin Dept of Health and Family Services Small Area Income and Poverty Estimates Wisconsin Dept of Natural Resources Wisconsin Dept of Public Instruction Wisconsin Dept of Workforce Development Wisconsin Family Health Survey Wisconsin Office of Justice Assistance Wisconsin Interactive Statistics on Health US Dept. of Health and Human Services Hospital Compare

13. Methods For each measure of local health we calculated: –Mean value of all counties –Standard deviation of all counties –Z-Score for each place The number of standard deviations from the mean of all counties To prevent any one measure from dominating summary scores, Z-scores were truncated at +3 When needed, multiple years of data were used to improve reliability of estimates and reduce random error.

14. Methods – special features This year, the Rankings includes a special feature to highlight aspects of community health that are not captured in the calculation of the annual rankings 2008 special feature –The five leading causes of death in Wisconsin

15. Special feature Five leading causes of death in Wisconsin –While the Rankings examine overall premature mortality at the county level, this special feature analyzes mortality rates by cause among people under age 75 –There is considerable variation in cause-specific mortality rates among counties –Inspection of causes of death by county can provide important information for setting health priorities at the county level

16. Methods A detailed and comprehensive description of all of the 2008 Wisconsin County Health Rankings methods can be found in the 2008 Wisconsin County Health Rankings Full Report. www.pophealth.wisc.edu/uwphi/research/rankings_2008/rankings_2008.htm

17. Changes

18. Three changes were made for 2008. We added a new indicator called Inpatient Quality of Care. It is a composite score based on two measures of appropriateness of care provided to hospitalized patients: no pneumococcal vaccination and inadequate instructions for heart failure patients. We created a new composite score for air quality called Air Quality Risk by combining four indicators: Cancer Risk, Respiratory Hazard Index, Fine Particulate Matter in Air, and Ozone. For the Children in Poverty measure we used more current data from the Small Area Income and Poverty Estimates (SAIPE), instead of Census data.

19. Changes In an effort to make the Wisconsin County Health Rankings as useful as possible for policymakers and public health officers, we continue to refine our methods Some measures have been discontinued in favor of more complete health indicators Other measures have been added as they become available to enhance the Rankings

20. Changes For a full list of changes to the Rankings since its inception in 2003 see the 2008 Wisconsin County Health Rankings Full Report www.pophealth.wisc.edu/uwphi/research/rankings_2008/rankings_2008.htm

21. Interpretation

22. Interpreting the Rankings Primary focus should be on … –the overall health outcomes ranking –the overall health determinants ranking –the comparisons among counties Minor differences in the rankings among the 73 places should be interpreted with caution. For example, the data used for these rankings are not precise enough to indicate that a place ranked 40 th is meaningfully healthier than a place ranked 45 th.

23. Interpreting the Rankings Small changes or differences in rank (even for summary components) should not be over interpreted, because of changes in methods from year to year and the impact of random variation and sampling on some values. The County Snapshots contain a summary of the outcomes and determinants ranks for each county for 2004-2008.

24. Communication

25. Communicating findings Key messages of the Rankings –Broad determinants of health –Importance of a community approach to public health –There are things that can be done to affect health of individuals and communities in every county in Wisconsin

26. Communicating findings Additional Rankings resources –Annual glossy report –County Snapshots –Full Report –& more Available at: www.pophealth.wisc.edu/uwphi/research/rankings_2008/rankings_2008.htm

27. Questions University of Wisconsin Population Health Institute website http://www.pophealth.wisc.edu/uwphi Wisconsin County Health Rankings website http://www.pophealth.wisc.edu/uwphi/research/wi_county_rankings.htm

28. Questions Further inquiries may be addressed to: –Kyla Taylor Email: kwtaylor2@wisc.edukwtaylor2@wisc.edu Phone: (608) 263-0352 –Jessica Athens Email: jkathens@wisc.edujkathens@wisc.edu Phone: (608) 265-8924 –Bridget Booske Email: bbooske@wisc.edubbooske@wisc.edu Phone: (608) 263-1947 –Patrick Remington Email: plreming@wisc.eduplreming@wisc.edu Phone: (608) 263-6294