EOA2016: Taking Stock: 2016 Health Profile & Well-Being Reports

• Equity

• Empathy

• Resilience

• Empowerment

Taking Stock:The Health District’s Profile of Health in Snohomish County and the Results of the PIHC Health & Well-Being Monitor

Elizabeth Parker, PhD, MHS Epidemiologist, Snohomish Health District

Jody Early, PhD, MS, MCHES Associate Professor, UW Bothell School of Nursing &

Health Studies Co-Chair, PIHC, AimWell/Center for Health Priorities &

Progress

Stuart Elway, PhD, Elway Research, Inc.

The Changing Picture of

Health in Snohomish County

Today’s Agenda

Big picture

of health

Little picture

of health

versus

Objectives

• Overview of health

• Health disparities and social

determinants of health

• Brief data presentation

• Questions

Health in Snohomish County

• A measure of differences in outcomes between populations.

• Health disparities exist in relation to:

– Income

– Race/ethnicity

– Education-level (among many others)

• Do not provide an explanation for the origin of these differences in health.

Health Disparities

• Conditions in which we live, learn, work, and play are significant factors that impact our health.

• Life enhancing resources whose distribution across populations determines length and quality of life.

• Responsible for unfair and avoidable differences in health seen within and between communities in Snohomish County.

• Root causes of health disparities

Social Determinants of Health

Let’s Look at the Big Picture

Big PictureDemographics & Socioeconomic Characteristics

SnohomishCounty

Washington

Population size 757,600 7,061,410

Median household income $69,443 $60,294

Unemployment rate 9% 9%

Residents with bachelor’s degree or

more 29% 32%

Sources: (1) U.S. Census Bureau, 2010-2014 5-Year American Community Survey(2) Washington State Office of Financial Management, Forecasting Division, single year ntercensal estimates 2001-2015, June 2015.

Big Picture

General Health (2015)Snohomish

CountyWashington

Life expectancy at birth (in years) 80.3 80.4

Mortality rate*

(per 100,000 people)708 692

Infant mortality rate

(per 1,000 live births)4.1 4.8

Years of potential life lost before age 65

(per 100,000 people)3,407 3,536

* Age-adjusted rate Sources: (1) Washington State Department of Health, Center for Health Statistics, Birth Certificate Data, 1990–2014, August 2015.(2) Washington State Department of Health, Center for Health Statistics, Death Certificate Data, 1990–2014, August 2015.

Big Picture

Health Outcomes, 2011-2015Snohomish

CountyWashington

Self-report health as good or excellent 84% 84%

Serious mental illness 4% 3%

Current smoker 16% 16%

Diabetes 9% 9%

Heart disease 4% 4%Source: Washington State Department of Health, Center for Health Statistics, Behavioral Risk Factor Surveillance System 2011-2015, supported in part by Centers for Disease Control and Prevention

Let’s Look at the Little Picture

Snohomish Health

Reporting Areas

Snohomish Health Reporting Areas

Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey

North EverettTulalip Bay &

the North Coast

South Everett

Edmonds, Mountlake Terrace &

West Lynnwood

Arlington, Stanwood & Darrington

Snohomish County

MarysvilleGranite Falls, Lake Stevens & Snohomish

Mukilteo & North

Lynnwood

Sultan, Skykomish &

MonroeBothell & Brier

Mill Creek & Silver Firs

$55,757 $63,271 $64,055 $66,096 $66,397 $68,381 $70,698 $75,298 $76,548 $81,659 $88,600 $100,390

Mill Creek & Silver Firs

Edmonds, Mountlake Terrace &

West Lynnwood

Bothell & BrierMukilteo &

North Lynnwood

Granite Falls, Lake Stevens & Snohomish

Snohomish County

Sultan, Skykomish &

Monroe

Arlington, Stanwood & Darrington

Marysville South Everett North EverettTulalip Bay &

the North Coast

6.6% 7.5% 8.3% 8.6% 9.1% 9.3% 9.4% 9.7% 9.8% 10.3% 11.5% 13.3%

Average median household income

Unemployment rate

Snohomish Health Reporting Areas

Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey

Tulalip Bay & the North

Coast Marysville

Arlington, Stanwood & Darrington

Granite Falls, Lake Stevens & Snohomish

North Everett South EverettSultan,

Skykomish & Monroe

Snohomish County

Mukilteo & North

Lynnwood

Edmonds, Mountlake Terrace &

West Lynnwood

Bothell & BrierMill Creek &

Silver Firs

17% 19% 19% 23% 24% 25% 26% 29% 35% 38% 43% 45%

Resident’s with a bachelor’s degree or more

Snohomish Health Reporting Areas

Source: Washington State Department of Health, Center for Health Statistics, Death Certificate Data, 1990–2014, August 2015.

Tulalip Bay & the North

Coast North Everett

Arlington, Stanwood & Darrington

Granite Falls, Lake Stevens & Snohomish

South EverettSnohomish

County Marysville

Mukilteo & North

Lynnwood

Sultan, Skykomish &

Monroe

Mill Creek & Silver Firs

Edmonds,

Mountlake Terrace &

West Lynnwood

Bothell & Brier

73.3 78.7 78.8 79.7 79.8 80.3 80.4 81.2 82.1 82.2 82.3 82.7

Edmonds, Mountlake Terrace &

West Lynnwood

Bothell & Brier

Sultan, Skykomish &

Monroe

Mill Creek & Silver Firs

MarysvilleSnohomish

County

Mukilteo & North

LynnwoodSouth Everett North Everett

Granite Falls, Lake Stevens & Snohomish

Arlington, Stanwood & Darrington

Tulalip Bay & the North

Coast

586 594 599 605 689 691 692 716 756 758 782 970

Life expectancy

Mortality rate rate

Snohomish Health Reporting Areas

Source: Washington State Department of Health, Center for Health Statistics, Death Certificate Data, 1990–2014, August 2015.

Mukilteo & North

Lynnwood

Granite Falls, Lake Stevens & Snohomish

Arlington, Stanwood & Darrington

Bothell & BrierSultan,

Skykomish & Monroe

Snohomish County

Mill Creek & Silver Firs

South Everett North Everett

Edmonds, Mountlake Terrace &

West Lynnwood

MarysvilleTulalip Bay &

the North Coast

0 1.2 1.3 1.3 1.5 4.1 4.3 5.2 6.1 6.2 6.6 8.3

Mill Creek & Silver Firs

Bothell & BrierMukilteo &

North Lynnwood

Sultan, Skykomish &

Monroe

Granite Falls, Lake Stevens & Snohomish

Marysville

Edmonds, Mountlake Terrace &

West Lynnwood

Snohomish County

South EverettArlington,

Stanwood & Darrington

North EverettTulalip Bay &

the North Coast

2,178 2,220 2,471 2,629 2,908 3,057 3,136 3,259 3,650 3,922 4,361 8,538

Infant mortality rate

Years of potential life lost relative to age 65

Health by Race/Ethnicity

White Black

American

Indian/

Alaska

Native

Asian/

Pacific

Islander

Hispanic

(of any

race)

Self-reported health 85% 82% 89% 64%

Serious mental illness 5% 10% 4% 3%

Diabetes 10% 6% 7% 8%

Current smoker 17% 25% 9% 14%

Heart disease 4% 3% 1% 3%Sources: Washington State Department of Health, Center for Health Statistics, Behavioral Risk Factor Surveillance System 2011-2014, supported in part by Centers for Disease Control and Prevention

Source: Washington State Department of Health, Center for Health Statistics, Behavioral Risk Factor Surveillance System 2011-2014, supported in part by Centers for Disease Control and Prevention

Health by Education-Level

Did not

graduate HS

Graduated

HS

Attended

some

college/

technical

school

College/

technical

school

graduate

Self-reported health 53% 81% 86% 93%

Serious mental illness 14% 4% 5% 1%

Diabetes 11% 8% 11% 8%

Current smoker 36% 21% 17% 7%

Heart disease 5% 4% 4% 3%

Source: Washington State Department of Health, Center for Health Statistics, Behavioral Risk Factor Surveillance System 2011-2014, supported in part by Centers for Disease Control and Prevention

Health by Income-Level

<$25,000$25,000-

$49,999>$50,000

Self-reported health 64% 83% 91%

Serious mental illness 14% 4% 5%

Diabetes 12% 11% 8%

Current smoker 36% 21% 17%

Heart disease 6% 5% 3%

What Does This Mean?

• Progress has been made in improving the health of Snohomish

County residents, but not all groups have benefited equally.

• Health Reporting Areas and sociodemographic groups have

distinct health issues that must be addressed.

• Full participation of affected communities is needed to begin

tackling the disparities.

Local Resources

What Data Are Presented?

Demographics

• Age and race

Socioeconomic Characteristics

• Income, unemployment, education, etc.

Health Outcomes

• Life expectancy

• Leading causes of death

• Mortality by age

• Birth outcomes

• To support community health improvement efforts.

• To help the Health District, elected officials, and community members identify priority health issues as well as underlying conditions that are more immediately actionable.

• To help community groups interested in prioritizing and improving health outcomes.

Why Create These Reports?

• Knowledge is power.

• Information will enable communities to understand the major health challenges facing their residents and take action.

• The Health District wants to be closely connected with your community as we work in partnership to reduce the impact of your health concerns.

How Do You Use the Reports?

How the District is Addressing Disparities

Community Health Improvement Plan (one example)

• Youth physical abuse • Have a Plan: Social marketing campaign targeting parents

• Youth and adult suicide• Mental Health First Aid: Course that provides people skills to help someone

developing a mental health problem or in crisis

• Youth and adult obesity • 5210 Campaign: 5 fruits/vegetables, 2 hours or less of screen time, 1 hour or

more of physical activity, 0 sugary drinks

Highlights from the

PIHC Snohomish County Health &

Well-Being Monitor

31

Source: Centers for Disease Control and Prevention (CDC), 2008

32

• There are numerous data sources at the national, state, and local level that focus on medical care and health-related outcomes.

• Most measure health indicators and variables are selected for study by researchers and “experts.”

Sources of Health Data

33

1) To provide a periodic measure of county residents’ perceptions about their health status and overall satisfaction with their health and well-being.

2) To guide practical action by providing an additional source of data that organizations can use for planning purposes.

3) To offer strategic guidance to PIHC to help direct where it focuses its attention and resources to create positive change.

Why Develop a Health & Wellness Monitor for Snohomish County?

Central Questions of the HWBM:

What factors do residents of Snohomish County think are important to health and well-being?

How satisfied are they with their own health and well-being?

34

35

Creating a More Complete Picture

of Health:Using the Social Ecological Model of Health as a Framework for Community Conversations and the Health & Well-Being Monitor

Groundwork in 2015:

Listening to the Community

• How are health & well-being defined?

• What social ecological factors impact people’s ability to be healthy?

• What makes a healthy community?

Why are understanding perceptions important?*Decades of research have established that perceptions and behaviors are related.

2015 Focus Groups & Community

Conversations

• Everett + North / <$65,000

• Everett + South / >$65,000

• Arlington Area /Age 25-45

• Monroe Area / Age 45-65

UW Bothell | Lutheran Community Services NWElway Research, Inc. | EvCC | Housing Hope

•College Youth from first gen. and ethnic minority groups/EVCC [Everett]

•Tribal Communities (Tulalip Tribe) / Marysville-Tulalip

•Adults in low income housing or transition housing [Lynnwood]

• Latina mothers/(all non-native U.S.) [Everett]

• Latina female lay health workers/Promotoras/ [Lynnwood]

•Women/lower SES/mixed ethnicities/ [Lake Stevens]

•Rural adults/most middle age/ all Caucasian and most lower income [Granite Falls]

•Rural adults/lower-income senior citizens(10/12); mostly Caucasian/female/ lower income [Arlington]

• Relationships with others

• Outlook on life

• Sense of purpose/meaning

• Treatment by others

• Opportunities for learning & growth

• Ability to control life events

• Sense of belonging to community

• Participation in cmty events

• Access to healthy food

• Access to medical care

• Access transportation

• Access to health information

• Quality of my housing

• Safety of my neighborhood

• Community environment

• Condition of neighborhood

• State of my physical health

• My mental/emotional health

• Level of physical activity

• My eating patterns

• Having meaningful work

• Workplace atmosphere

• Level of financial security

• Feelings of racial and ethnic discrimination

Emergent Themes (Factors) from

Community Conversations & Focus Groups

…Formed Measures for the HWBM…

Survey Information

• PIHC Advisory committee looked at other population surveys

• Quantitative Survey based on 24 attributes

• 75 questions/inquiries • Combination of question types

• Bi-polar scales [-5] to [+5]• Unipolar scales 0-10• Multiple choice• Open-end• Attitudinal questions• Behavior questions• Demographic items

Sample and Methods

• Participants: 751 adults (18 years +)

• Administered by Elway Research

• Systematic random sample of Snohomish county households

• Data collection January 7th – 30th

2016

• Margin of Error: + 3.6% at the 95th

percent confidence interval

• Multiple methods of data collection:• 500 completed phone

interviews by live interviewers (27% on cell phones)

• 251 residents completed the questionnaire online

Respondent

Characteristics

Repondent Characteristics Cont’d

Respondent Characteristics Cont’d

Respondent Characteristics Cont’d

46

38

21

20

7

7

5

2

Split w Employer

Employer Paid

Medi-care/caid

Self Paid

Other

No Coverage

No Ans

% of

Sample

with Health

Insurance

89% had at least one scheduled appointment with a health care professional in the last year.

Key Findings

Four Primary Index Measures

N = 751

ITEM AVERAGE +4 or +5

Overall satisfaction with the way things are going in your life +2.66 45%

Current mental or emotional health +2.96 52%

Overall health rating +2.46 38%

Satisfaction with your physical health +1.97 33%

Rating Scale = -5 to 5

Combined Scores on 4 Measures

Rating Scale = - 5 to + 5

Differences by Demographics

•Age

• Education *

• Employment

• Income*

• Ethnicity

•Gender

•Number of chronic conditions*

• Significant demographic factors: Satisfaction scores went up with education level and income

• There were significant differences by age, but relationship was not linear

• Scores were more strongly related to health conditions than demographics. Scores went down with the presence of a health condition, number of bad health days, and number of healthcare visits.

Linking Health Monitor Scores to

Underlying Health

Also tested for:• Poor physical

health days• Poor mental

health days• Presence of

medical condition

FACTORS THAT INFLUENCE

HEALTH & WELL-BEING

Perceptions of Factors that

Influence Health & Well-Being

Survey respondents were asked to rate each factor on two criteria:

1) The importance of each factor on a person’s well-being in general;

2) The personal influence each factor is having on “your own life these days.”

• Relationships with others

• Outlook on life

• Sense of purpose/meaning

• Treatment by others

• Opportunities for learning & growth

• Ability to control life events

• Sense of belonging to community

• Participation in community events

• Access to healthy food

• Access to medical care

• Access transportation

• Access to health information

• Quality of my housing

• Safety of my neighborhood

• Community environment

• Condition of neighborhood

• State of my physical health

• My mental/emotional health

• Level of physical activity

• My eating patterns

• Having meaningful work

• Workplace atmosphere

• Level of financial security

• One’s ethnicity/race

23 OF THE 24 FACTORS WERE PERCEIVED AS

IMPORTANT TO HEALTH AND WELL-BEING

(ON A SCALE OF 0 – 10)

…… all except for one factor was rated (at 5.0

+) as having a positive impact on their lives.

How would you rank these 10

factors by importance to overall

health and well-being?

• Access to Medical Care• Financial Security• Level of Physical Exercise• Treatment by Others• Personal Safety• Access to Healthy Food• Outlook on Life

• Mental and Emotional Health

• Sense of Purpose• Opportunities for

Learning and Growth

• How do you think these factors ranked in order of perceived importance?• Which one do you

think was ranked highest?

#1 Factor of Perceived Importance:

Mental and Emotional Health

Top 10 Factors of Health & Well-

Being Ranked by Importance

• Rated highest (on a scale of 0 -10):

1. Mental or emotional health

(mean = 8.8)

2. Access to medical care(mean = 8.7)

3. Outlook on life (mean = 8.7)

4. Sense of purpose (mean = 8.6)

5. Access to healthy food (mean = 8.6)

6. A person’s physical health

(mean = 8.4)

7. Safety of a person’s neighborhood (mean = 8.3)

8. Financial Security (mean = 8.1)

9. Opportunities for learning and

growth (mean = 8.0)

10. Treatment by Others (mean = 8.0)

& Level of Physical Activity(mean = 8.0)

Components of Health & Well

Being by Personal Impact

• Access to Transportation

• Quality of Housing• Emotional or

Mental Health• Ability to Access

Health Information• Relationships with

Family and Friends

• Outlook on Life• Access to Healthy

Food• Access to Medical

Care• Treatment by

Others• Sense of Purpose

• How do you think these factors ranked on perceived impact on personal health?

(-5 to 5)?

• Which one was perceived to have the most positive impact?

#1 Factor- Personal Impact:

Relationships with Family and Friends

Top Ranked Factors by

Personal Impact

Rated highest (on a scale of -5 to 5 with zero at midpoint)

1. Relationships with friends and family

(mean = +3.7)

2. Outlook on life (mean = +3.4)

3. Ability to get healthy food

(mean = +3.3)

4. Access to medical care

(mean = +3.3)

5. Access to transportation

(mean = +3.1)

6. Sense of purpose (mean = +3.1)

7. Emotional and mental health

(mean = +3.0)

8. Quality of housing (mean = +2.9)

9. Treatment by others (mean = +2.9)

10. Ability to get health information

(mean = +2.8)

Factor Analysis: Categories for PIHC

HBWM Mapped to & 6

Dimensions of Wellness

Sense of community

Perceived Health of Community

• 86% reported they lived in a healthy or very healthy community

• However, there were differences by area: • More positive ratings of “very

healthy” and “healthy” were from those in Snohomish (96%) & Lake Stevens/Granite Falls (93%) areas.

• Everett (75%) and Monroe -East (83%) had less positive ratings but still majority indicating “healthy” or “very healthy”

17

69

112

VERY HEALTHY

HEALTHY

NO OPIN

UNHEALTHY

VERY UNHEALTHY86%

N = 751

Composite Scores Based on Four

Components of Health & Well Being

Based on composite

scores for

satisfaction with:

• Overall life;

• Overall health;

• Physical health; &

• Mental/emotional

health

64

• Research shows that data tilts positively on surveys such as this.

• For those individuals who rated very negative on all items:

• Feelings of discrimination were significantly related to the overall HWBM score:

• Those who most felt discriminated against were less likely to report satisfaction with components of well-being (42% ) than those who felt little or no discrimination (64%).

• The “Treatment by Others” came up as a significant factor impacting health and well being. Ethnic/Racial discrimination may be captured in this measure as well.

• Most who were less satisfied reported at least one health condition (51%).

• More analyses such as a gap analyses and factor analyses included in full report which is available at http://www.pihc.org or emailing Scott.Forslund@pihc..org

A Few More Points of Discussion

• Refine Health & Well-Being Monitor 2.0 for 2017.

• Facilitate ongoing community conversations to collect qualitative information from groups and/or people who are not best reached through quantitative surveys.

• Pilot and validate tailored versions for specific groups within Snohomish County (e.g. Spanish version).

• Share data with community groups and organizations.

Next Steps

How is This Data Applied?

Community Examples

•Health-education resources & events co-created with community partners•Referral services to community partners •Lifestyle change programs designed with population health objectives

PIHC'S LIVEWELL / CENTER FOR

HEALTH EDUCATION & HEALING

Pathways to Health

Get Connected

Example 2: Edge of Amazing

Theme and Focal Areas for 2016

Thank you!

Elizabeth Parker, PhD, MHS

Epidemiologist

Healthy Communities & Assessment

Snohomish Health District

For more information visit: www.snohd.org\assessment

Jody Early, PhD, M.S., MCHES

Associate Professor

UW Bothell, School of Nursing & Health Studies

Co-Chair

Providence Institute, AimWell/Center for Health Priorities & Progress

JEarly3@UW.edu

Stuart Elway, PhD

Elway Research, Inc.hstuart@elwayresearch.com

For more information on the HWBM, visit http://www.pihc.org