Wisconsin County Health Rankings

UW Population Health Institute

CATCH Project

June 2, 2008

Program Implementation

Data Analysis

Data Interpretation

Information Dissemination

Data Collection

Program Planning

Program Evaluation

Source: Remington and Goodman; Chronic Disease Surveillance, 1999

The Public Health Surveillance Model

Wisconsin County Health Rankings

• Measures and ranks the ‘health’ of Wisconsin’s 72 counties and the City of Milwaukee

• Modeled after United Health Foundation America’s Health Rankings

• Uses population-based measure of health—broadly defined

• Summarizes the ‘health’ into summary measures

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 additional resources for improvement to less healthy counties

Why Rank?

• Allows comparison of one or more attributes for a select group of entities—hospitals, counties, law schools, etc.

• Rankings reduce data to a form that consumers and policy-makers can easily use

• Rankings draw attention and can be used – to help target interventions; – help consumers select high-performers for services

(schools, hospitals, clinics); – reward high-ranking entities and penalize low-ranking

ones

Data sources

• Behavioral Risk Factor Surveillance System

• CDC WONDER • Metastar• US Census Bureau• US Environmental

Protection Agency• Wisconsin Crash

Outcomes Data Evaluation System

• Wisconsin Dept of Health and Family Services

• Wisconsin Dept of Natural Resources

• Wisconsin Dept of Public Instruction

• Wisconsin Family Health Survey

• Wisconsin Interactive Statistics on Health

• Wisconsin Office of Justice Assistance

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.

Major Finding:

• Significant variation in health outcomes and determinants exists in Wisconsin

• Least healthy places include:– Menominee County– City of Milwaukee– Central and Northern rural counties

Selection of measures

• Reflect important aspect of population health

• Unit of analysis (e.g., city, county, MSA)• Validity/reliability • Availability of data

– Free or low cost– Publicly accessible if possible

• Timeliness/consistency over time• WDQS preferred!

Surveillance Methods

• Census versus survey – Confidence intervals

• How to handle small numbers– Combine data from neighboring counties– Multiple years– Suppression– Etc.

• Changes in measurement

Planning teleconferences

• Monthly teleconferences are held with health officers and others interested in the Rankings

• Allowed for user feedback to be promptly incorporated into the design and release

• Keep local health officers updated and helped them to be more adequately prepared to handle media inquiries when released

Evaluation: Annual Survey

• Survey health officers across the state regarding their experiences with and feedback on the Rankings

• The majority of health officers– find the Rankings useful to their work– plan to use Rankings in the community

• Annual feedback incorporated into the planning for the next Rankings edition

Uses of the Rankings

• Needs assessments and evaluations

• Program planning

• Presentation to others– County health boards– Public health staff– Community partners

• Spark for coalition building

Focus on key messages

• 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

Population-based data collected

Media attention

County Health Rankings Local health

officers use report

Broad community engagement

Evidence-based health programs and policies implemented

Improved health outcomes

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Problems with Rankings• Tendency to infer too much from minor

differences in ranks• Incorrect assumptions about “distance” between

items• Reactivity

– Low morale for low-ranked entities

• Competing interests– Stability of model vs. model of improvement

• Focuses pressure on local health departments for poor rank