Population Health and Its

Role in Our Community

Virginia A. Caine, MD
Director,
Marion County Public Health Department
vcaine@marionhealth.org
317-221-2301
Population Health is:
The health outcomes of a group of individuals, including
the distribution of such outcomes within the group.
 Aren’t Population Health and Public
Health the Same?

Public Health focuses on the critical

functions of state and local health
departments such as preventing
epidemics, containing environmental
hazards, and encouraging health
behaviors.

Population health concerns the

determinants of health like health
care, education, and income inequality
to name a few, which remain outside
the traditional public health authority
and its responsibility.
 The Future of the Public’s Health in
the 21st Century

• Significant movement in “building a new

generation of intersectoral partnerships that
drawn on the perspectives and resources of
diverse communities and actively engage
them in health action.”
 But What About Population Medicine?
• Considers the specific activities
of the medical care system that
promote population health
beyond the goals of care of the
individuals treated
• Requires the medical care
system to collaborate and
partner with other organizations
• Acknowledgement that
individual health and clinical
outcomes greatly influenced by
population factors, such as
education
 Population Health Provides the Best
Definitional Framework
• It focuses on measurable outcomes from
multiple sectors
– Clinical outcomes
– Education levels
– Poverty rates
– Environmental factors
• Creating a holistic picture of a community’s
health
So…How Do We Measure Population
Health Outcomes?
MCPHD initiated a Community
Health Assessment to create a
baseline of these factors.
Inputs:
• Health Care
• Individual Behavior
• Social Environment
• Physical Environment
• Genetics
 Population Health in the
Affordable Care Act
• Provisions to expand insurance coverage by
improving access to the health care delivery
system (Medicaid expansions, state insurance
exchanges, support for community health
centers)
• Improving the quality of the care delivered
(National Strategy for Quality Improvement, CMS
Center for Medicare and Medicaid Innovation,
and establishment of the Patient-Centered
Outcomes Research Institute)
 Population Health in the
Affordable Care Act
• Promotion and implementation of ACOs to
incentivize providers to take responsibility for
population health outcomes
• Expansion of primary health care training,
requirements that private health plans and
Medicare provide specific services
recommended by U.S. Preventive Services
Task Force without cost sharing
 Population Health in the
Affordable Care Act
• Promoting community-and population-based
activities
• The establishment of the National Prevention,
Health Promotion and Public Health Council
• A new Prevention and Public Health Fund
(authorized $1 billion in fiscal year 2012)
• Funding for Community Transformation
Grants
What is a Community Health Assessment (CHA)?

Quantifies prevalent or impactful health issues

Detects health trends that merit attention

Identifies health inequities

Compares Marion County to peer cities and the

nation, to provide context
Why do a Community Health Assessment?

 Increases community awareness of health issues

 Prioritizes community health needs
 Identifies health disparities
 Provides an evidence base for MCPHD’s Community
Health Improvement Plan (CHIP)

Improves the health status of our community

 Top Priorities
 Unhealthy Weight
 Poor Mental Health
 Increasing Poverty Rates
 Chronic Disease Prevention and Management
 Chief contributing factor: SMOKING
 Violence
 Key Data Sources
National Sources
• 2010 Census, American Community Survey
• Bureau of Labor Statistics
• County Health Rankings www.countyhealthrankings.org
• Behavioral Risk Factor Surveillance System (BRFSS)

Local Sources
• Birth and Death Certificates
• Hospital Discharges, ED visit data
• CHA 2012 Telephone Survey
 Community Health Assessment
2012 Telephone Survey
• 5013 total respondents
• 100 survey questions: health status, behavioral
risk factors, family, local resources
• Survey is a SAMPLE of whole-county population
(928,281), randomly selected to represent county
as a whole.
• Called cell phones as well as in-house phones to
reach a more diverse group
 Survey Process
7 workgroups identified priority issues
– Workgroups: Ages 0-4, 5-11, 12-17, 18-34, 35-64, 65+,
& Environment
– Content experts, service providers, & community
members
– 3 to 5 meetings, reviewed data, discussed issues

Steering Committee selected overall priorities

– Reviewed workgroup’s output
– Synthesized that output into the overall priorities
What Did We Learn and
What Did We Find?
Increasing Poverty Rate
 County Poverty Rates DOUBLED
Between 2000 and 2012: Now 19%
100% Federal Poverty Level (FPL) Definition:
Family of 4 with annual household income less than
$23,496 (2012)

County residents meeting 100% FPL includes:

1 in 5 individuals
1 in 3 households with children
(up from 1 in 5, 2007)
 High Poverty Concentration in 6
Central Marion County Zip Codes
 These zip codes have over
25% of their populations Zip Codes % FPL
living at or below 100%FPL
46201 36.9
 They exceed County rates 46204 33.6
of…. 46218 33.4
Poverty 46225 32.5
7 times
Unemployment rate 3 46202 29.8
times 46208 28.8
Violent Crime rate 5
times
More Than 1 in 4 Young Adults (18-34)
Met 100% Federal Poverty Guidelines
 Chronic Disease
Prevention and Management
 County Children:
High Prevalence of Chronic Disease
% Youth 5-17 ever diagnosed with….

Diabetes 2

High BP 2

Depression/Anxiety 9

ADHD 15

Asthma* 20

* Twice the national rate 0 5 10 15 20 25

 County Adult Chronic Disease, 2012
(%) compared to U.S.
Heart Attack/CHD 7.7
Current Asthma 11
Diabetes
14
US 2010-12
Depression
21 MC 2012
High Cholesterol
24
High BP 31
0 10 20 30 40
 Smoking
Marion County Adults – 2005 & 2012
35%
29%
30% 27%
25%
20%
15%
10%
5%
0%

2005 2012
95% CI: 2005 (24.4%-29.6%); 2012 (26.5% - 30.7%)
 Prevalence of Smoking by Race
Adults Over 18 Years Old
35% Marion County – 2005 & 2012
30%

25%

20%

2005
15%
2012

10%

5%

0%
White Black Latino
2005 25% 27% 18%
2012 30% 29% 16%
Unhealthy Weight
 50% of County Youth 5-17 Were
Above Normal Weight

2005 22 18 58 1

2012 31 19 44 6

0% 20% 40% 60% 80% 100%

Obese Overweight Normal Underweight
 Overweight and Obesity Continue to
Increase in Marion County
• Obese Children
– 2005: 2 out of 10
– 2012: 3 out of 10
• Obese Adults
– 2005: 3 out of 12
– 2012: 4 out of 12

Adult Outcomes Marion County1 US2

Diabetes 14.0% 9.5%
CHD/Stroke 7.7% 7.0%

1 2012 CHA Telephone Survey 2 2011 BRFSS

 Obesity Related Health Outcomes
Adults Marion County1 US2
Diabetes 14.0% 9.5%
CHD/Stroke 7.7% 7.0%

1 2012 CHA Telephone Survey 2 2011 BRFSS

Poor Mental Health
Major Depressive Disorder is the Leading
Cause of U.S. Disability, Ages 15-44

Depression is prevalent in all County age groups,

including:
1 in 5 Adults
U.S. 17.5% (2011)

1 in 10 Children (5-17)
U.S. 3.9% (2007)
 Depression in Young Adults
Young Adults: A high prevalence of depression and poor
mental health days. High rates of abuse of prescription
painkillers.

47% of Marion County 18- to 25-year-olds reported having

14+ days in the past month of poor mental health – four
times the U.S. rate. (CDC 2011 BRFSS Survey)
 Diagnosed Depression in
County Adolescents

County adolescents are diagnosed with depression

(12.8%) and their suicide risk is high
• 8.3% U.S. major depressive episode(2010-11)2

2011 Indiana Teens: Youth Risk Behavior Study4

• 25% had been bullied at school
• 18.9% seriously considered suicide
• 11% had one or more attempts at suicide
Suicide: A Leading Cause of Deaths
• Among the 5 leading causes for ages 12-64
• (Nationally, the second leading cause for
ages 12-17)
• Third leading cause for ages 15-24 (30%
higher than U.S.)
• Fifth leading cause for ages 10-14
 Increasing Dementia in Senior Adults
6-10% of persons over 65 develop dementia
• Alzheimer’s makes up 75% of dementia
cases
• 8 in 10 dementia cases are never clinically
diagnosed

In past decade, Alzheimer’s Disease was the only

leading cause of death to increase among seniors (up
20%)
Violent Deaths and
Prevention
 Homicide Deaths
Deaths per 100,000
Age Rank* MC (2008-2010) US (2010)
10-14 3rd 2 0.9
15-24 1st 31 10.9
33-44 5th 16 6
45-54 9th 13 4.4

* among all causes of death in Marion County

 Where Do We Go from Here?:
The Next Steps
Community Health Assessment &
Health Improvement Plan (2015)
• Identify short–term,
evidence based intervention
strategies, and action steps
• Find committed partners to
take substantial roles for
each issue
• Assure process and outcome
monitoring occurs for each
specific action area to
document change.
Community Health Improvement Plan
• A community health improvement plan is a long-term, systematic effort
to address public health problems on the basis of the results of
community health assessment activities and the community health
improvement process. This plan is used by health and other governmental
education and human service agencies, in collaboration with community
partners, to set priorities and coordinate and target resources.
• A community health improvement plan is critical for developing policies
and defining actions to target efforts that promote health. It should
define the vision for the health of the community through a collaborative
process and should address the gamut of strengths, weaknesses,
challenges, and opportunities that exist in the community to improve the
health status of that community.

Source: NACCHO, http://www.naccho.org/topics/infrastructure/CHAIP/upload/CHIP-Basics.pdf

Source: Population Health in the Affordable Care Act Era. Academy Health. Michael A. Stoto, Ph.D., February 13, 2013.
Questions?