# Presentation: 561251

## Developing Key Health Indicators for Island County 

- Presented By:  Carrie McLachlan, MPA
- Island County Health Department
**Acknowledgement: CHAB Key Indicators Task Force**
**--Sharon Little, MS, Chair****	****   --Mary Anderson, MPH**
**--David Macys, ****MS, CIH, DABT**** --Kathryn Stevens, PhD**
**  ****--Judy Moore, MSN****	****      --Marie Piper, MPH**

## Island County Community Health Advisory Board (CHAB)

- Advise Board of Health
- Listen to and represent the public’s health concerns
- Develop Action Plans
- Recommend Policy
- Write Letters of Support
- Form and/or Participate in Coalitions
- Inform/Educate the Public
- Develop Partnerships
- Make Project/Program Recommendations

## What Does CHAB Try to Do?

**Use engaged & knowledgeable community members, data, and a community process to determine our top health issues**
**Document & communicate Island County health issues**
**Target limited health department and community resources to areas of highest needs**
**Nurture community partnerships and incent community leaders/agencies to address issues **
**Develop new policies and/or programs **

## CHAB Community Health Process Model

**Inventory Resources**

**Identify Effective Interventions**

**Develop Health Improvement Strategy**

**Identify  Indicators &/or Outcomes**

**Identify Accountability**

**CHAB Community Health Process Model**

**Notes:**
Adapted from the Missouri Department of Health CHART Manual 
(Community Health Assessment Resource Team)

## History of CHAB Data Explorations

- Data Task Force in 2002-2003
- Published *The Health of Island County, 2003*
- Very labor/staff intensive—to collect, analyze, and monitor
- Developed a CHAB Key Indicator Task Force
- Committed to tracking 36 indicators and reporting back to the BOH/ICHD/ Community

## CHAB Key Indicator Task Force: Purpose 

- To develop key indicators of health for Island County to:
- Raise awareness of health status
- Monitor trends in health status
- Identify emerging issues
- Focus CHAB planning and actions
- Make policy, program & project recommendations to BOH and HD

##   Why We Need Indicators for our Community

- Every community is different
- Communities are always changing
- Each community has a unique set of health problems
- Each community has unique assets and locally structured resources
- Communities must be able to reallocate resources according to changing needs and health priorities
- Local responsiveness is key

## “The indicators a society chooses to report to itself about itself are surprisingly powerful.  They reflect collective values and inform collective decisions.  A nation that keeps a watchful eye on its salmon runs or the safety of its streets makes different choices than does a nation that is only paying attention to its GNP.  The idea of citizens choosing their own indicators is something new under the sun - something intensely democratic.”
Donella Meadows 

- Donella Meadows

## Definition of Key Indicators 

- Community indicators are measuring systems, designed, developed and researched by the community members themselves.  Indicators are small bits of information that reflect the status of larger systems.”
***The Community Indicators Handbook*****, 1997**
- Indicators are specific items measured to depict the status of a condition of interest
- Indicators are measures for which data are available, which help quantify the achievement of the desired result for community-wide populations

## Indicators/Outcomes

**Indicators-component that must be changed or conditions that must be achieved by the actions the community undertakes in order to claim that progress has been made.  **
**Indicators are usually put in terms of an outcome or output.**
**Outcomes include both outcome objectives (measurable, e.g. by 2005, 95% of children by age 4 will have seen a dentist) and process objectives (describe the action to be taken to reach the outcome objective, e.g. a physical coalition will be in place and active)  **

##   Why Develop a Key Indicator Report?

**Measures local trends in a specified geographic area**
**Provide snapshots of community's health & quality of life**
**Help decision-makers understand key issues and set priorities**
**Increase community members' understanding of issues**
**Mobilize resources**
**Fosters collaborations to address health issues**
**Target community interventions with community-level outcomes (evaluation)**
**Identify where additional effort or resources may be needed**
**Create and work toward a community vision for health**

## Characteristics of Our Indicators

- Ideally we wanted data-based indicators
**To come from a reputable data source**
**Actual local data**
- Data is available over time to use as a baseline, monitor trends, set targets/ outcomes, and track progress
- Comparable to the nation and the state
- Associated with a HP 2010 goal or another national or state-level goal (we created our own goals for several key indicators, usually using our best year of data)

## Criteria for Indicators

- Simple
- Understandable
- Acceptable
- Measurable
- Defensible
- Others include:  Validity, Availability & timeliness, stability & reliability, responsiveness, policy relevance, representativeness

##    How We Began...

- Used the 13 categories from *The Health of Island County*
- Determined 2-4 indicators per module to represent the module or specific conditions of interest (issue identified earlier, something we wanted to highlight (good/bad))
- Determined whether good data on the selected indicator was available and made recommendations on future data collection
- Compiled and synthesized the data into the final product

## Scoring of Key Indicators

- Compared local data to state/nation
- Reviewed data trends, using 1996 as a baseline when possible
- Assessed how we were meeting Healthy People 2010 goals (or other national/ state goals or our own goal)

## Health Module Composite Score

- Formula:
- State+Nation/2+Trend+Goal/#of Indicators

**Health Module Composite Score**

## Island County and Its People: Demographic & Economic Factors

**Education Level**
**Poverty **
**Employment**

## Poverty Status (1999)

## Quality of Life & Social Context

**Hunger & Food Insecurity**
**Social & Emotional Support**

## Emotional & Social Support

## Health Access, Satisfaction, and Care 

**Provider Availability**
**Adults with Health Insurance**
**Usual Source of Care**

## Provider Availability

**Goal: 2.2 physicians per 1000 residents.**
**How are we meeting our goal?  Not meeting**
**IC 1.2 per 1000 in 2001; .84 per 1000 residents in 1996**
**Military-based physicians not included**
**State 2.2 per 1000 residents**
**Nation 2.2 per 1000 residents**

**Notes:**
Satisfaction was very important to us as our health system has improved over the past 5 years, at least in terms of numbers of providers

Those with the highest percentage reporting fair or poor satisfaction were in the 25-34  and 45-54 age ranges

We had much higher percentages of our population report having a particular place to for for health care  (only 3.4% do not have a place to go vs. 14.1% for WA State)

Cost barriers was not the same as in 1996--in 1996 we asked about not able to see a doctor because of cost
and in 2000 we asked about unable to fill a prescription

## Adults with Health Insurance

**HP2010: 100% health care insurance coverage.   **
**How are we meeting our goal?  Not meeting**
**94% of IC adults under age 65 had health coverage: a slight increase from 92-93% in 1996**
**Military coverage positively impacts Island County’s insurance rates**
**State: 90%**
**Nation: 88.2%**

## Health Coverage: IC compared to WA

## Usual Source of Care

**HP2010: 96% with a specific source of ongoing care.  **
**How are we meeting our goal?  Not meeting**
**IC 86%; slight decrease from 87% in 1996**
**State also continues to decrease from 85% in 2000 to 80% in 2002**
**Island County needs to be closely monitored for a similar trend (e.g. survey in BRFSS)**

**Notes:**
IC 86%; slight decrease from 87% in 1996
State also continues to decrease from 85% in 2000 to 80% in 2002
Island County needs to be closely monitored for a similar trend (e.g. survey in BRFS).  

## Unintentional Injury

**Falls**
**Firearms**

## Falls

**HP2010: Reduce the falls age adjusted mortality rate to 3.0 per 100,000.**
**How are we meeting our goal?  Not meeting**
**IC: 14.08 per 100,000; significant increase from 6.42 per 100,000 in 1996**
**State: 8.87 per 100,000**
**Nation: 4.8 per 100,000 **
** **

## Mental Health

**Days of Good Mental Health**
**Mental Health Professional Shortage Area Designation**

## Mental Health Professional Shortage Area

**Goal: Not to be a MHPSA**
**How are we meeting our goal?  **
**	****Not meeting**
**In 2004 Island County received HPSA designation for mental health **

## Chronic Disease & Physical Activity

**Overweight & Obesity (adult and child)**
**Physical Activity (adult and youth)**

## Overweight & Obese Adults

- HP2010: 60% of adults at a healthy weight.
- How are we meeting our goal?  Not Meeting
-  IC increased: 26% in 1996 to 53.9% in 2000 (might be partially attributed to new definitions)
- State: 55.1%
- Nation: 57.5%
- Note:  ICHD got grant to develop an Island County Plan for Physical Activity & Healthy Eating

## Infectious Disease

**Immunizations (adult and children)**
**Sexually Transmitted Diseases**

## Adult ImmunizationsHP2010 Goal: 90% adults > 65 immunized for flu & pneumonia.How are we meeting our goal?  Not meeting

**Notes:**
IC 67% adults aged 65 and older are immunized for flu and 70.6% are immunized for pneumonia.  
Flu:  State (72.5%) & Nation (66.2%)
Pneumonia:  State (66.8%) & Nation (61.3%)

## Children Immunized at School Entry

**HP2010: 95% immunized at school entry level**
**How are we meeting our goal?  Not meeting**
**81.1% of IC children had received all vaccines  recommended by school entry, increase from 63.4% in 1996-97; State 89.3%**
**Exempt children is a concern (10.1%), up dramatically from 3.5% in 1997-98; State level is 4.2% exemption**
**Need to collect data on children’s immunization ages 19-35 months **

## Sexually Transmitted DiseasesHP2010: Decrease the STD  rate to 189.2 per 100,000 for gonorrhea, syphilis and chlamydia. How are we meeting our goal?  Not meeting

## Maternal-Child Health

- Prenatal Care Access
- Child Care
- Tobacco & Alcohol Use During Pregnancy

## Childcare Choices & Quality

**Goal: 25% or less will report few or no childcare choices.  95% will rate childcare quality as good or very good. **
**How are we meeting our goal?  Not meeting**
**45% IC parents report few/no choices for childcare, higher than the state (34%)**
**80% IC parents rate their child’s childcare quality as good or very good; compared to 95% state**
**Recommend continue asking on BRFSS  **

**Notes:**
Goals are to match the state

## CHAB’s Early Childhood Health Action Team

**Early Childhood Education/Parental Support is CHAB’s #1 Issue**
**The EC-HAT is actively working on a number of items, including:**
**Early Childhood Survey**
**Exploring Children’s Commission Models**
**Children & Family Fund**
**Key Indicators for Island County Children**

## Environmental Health 

- Rates of Food, Water & Airborne Diseases
- Illegal Dumping
- Drinking Water Quality

## Disease Composite Rate

**HP2010: A composite incident rate of 20.35 or less for 4 diseases.**
**How are we meeting our goal?  Exceeding  **
**IC rate of 1.74 per 100,000 for 9 diseases**
**Considerably lower than the state rate of 4.93 per 100,000**
**Improved since 1996 when rate was 2.46**

## Illegal Dumping (EHAT’s #1 Issue)

**Goal: Reduce the number of illegal dumping sites and littering complaints in Island County.  **
**How are we meeting our goal?  Didn’t score as new data and are monitoring complaints closely. **
**Results are variable for Island County**
**Increased incidents of improper storage**
**Illegal dump complaints have decreased over the last ten years, this is primarily due to a decrease in the number of illegal burning complaints coming to ICHD (now go to Fire Warden)**

## Oral Health 

- Access to Dental Care (adults and children)
- Caries Rate in Children

## Adult Dental Visits

**Goal: National target is for 83% of adults to visit a dentist within the last year.**
**How are we meeting our goal?  Meeting**
**IC 82%; up from 73% in 1996**
**State 70% in 2002; 67% in 1999**
**Indicator needs to be closely monitored with Island County’s only low-cost clinic closing in 2003**

## Substance Abuse

- Smoking (adults and youth)
- Adult Binge-Drinking
- Youth Alcohol Use

## Crime & Violence

- Child Abuse or Neglect
- Domestic Violence
- Violent Crime Rate

## Child Abuse & Neglect

**Goal: 1.5% of Child Protective Services (CPS) referrals merit***** *****investigation. **
**How are we meeting our goal?  Not meeting**
**IC 3.8% of children referred to CPS as victims of maltreatment were judged to merit investigation**
**State 3.8%**
**Trend of lower reported cases from 1996 (1540 cases) to 2001 (1399 cases)  **
**CPS staffing might impact numbers  **

## Violent Crime Rate

**Goal: Less than 3 violent crimes per 100,000 population  **
**How are we meeting our goal?  Exceeding**
**IC: 1 per 10,000 population**
**State:  35 per 10,000**
**Nation:  50 per 10,000  **

## How Are Key Indicators Being Used?

- By local boards/agencies to make funding decisions and programmatic decisions, e.g. Whidbey General Hospital, United Way
- To search for new grants for new programs
- Other local health departments using as a model to develop their own Key Indicators
- Our community “owns” our Key Indicators

## Challenges to Using Health Status Indicators (CHS Planning Guide)

- Timing—between intervention and change in health status (8-10 years +)
- Complexity-Complex and related to societal problems, e.g. poverty, housing, employment, education
- Societal factors are difficult to measure
- Quantitative versus qualitative indicators

##    Future Work 

- Broad diffusion of Key Indicators
- Continue to support and promote the Island County BRFSS as a key source for local data
- Make recommendations on future indicators and data we would like to have (childhood immunizations, child care, prevalence of mental health conditions)
- Make policy and program recommendations as conditions change

## “Our plans miscarry because they have no aim.  When a man does not know what harbor he is making for, no wind is the right wind.”
Lucius Annaeus Seneca

**Lucius Annaeus Seneca**

## THE END!