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