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CHNA Dane County, Wisconsin
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Community Assessment
Dane County, Wisconsin
By: Teagen JohnsonMPH602
Outline Introduction Community defined Community health assessment model Community Stakeholders Prioritizing methodology Population and demographics of Dane County Secondary data collection and analysis Health indicator limitations Main areas for opportunity Top high needs / high priorities identified Ten organizations that can help Conclusion References
Community Health Needs Assessment Introduction
A Community Health Needs Assessment (CHNA) looks at the health of a community by using data and collecting community input. The CHNA provides a broad-ranging view of health, and encompasses more than vital statics. The assessment also includes information on social determinants of health, such as the local economy, education, and social environment. The CHNA can then be used to assist in evaluating community health programming.
Subjective term
Public Perspective: ◦ World Health Organization (WHO) definition:
People within a fixed geographical location Share social relationships Identify with each other on a common
interest or goal
Community Defined
Public Health Perspective: ◦Initial declaration of an agenda◦Describing intent◦Recognizes influencing stakeholders◦Identifies resources◦Optimizes data collection
Community Defined
Mobilizing for Action through Planning and Partnership: MAPP
(NACCHO.org)
Role:Engage the community in strategic planning for improving health.
Concept: When a community is provided with the opportunity to take ownership of their health planning the population’s strengths needs and desires drive the process. Leading to: Collective thinking, resulting in effective sustainable solutions to complex problems.
Community Health Assessment Model
MAPP: Phases
Phase one: Organize for success/partnership developmentLead organizations in the community begin by organizing themselves and preparing to implement community wide strategic planning. This requires a high level of commitment from stakeholders and the community residents who are recruited to participate. By systematically identifying them it can be easier to utilize their skill sets.
Phase two: VisionA shared common vision provides framework for pursing long range community goalsWhat would our community to look like in ten years?
Community themes and strengths assessments: Provides a deeper understanding of the issues residents feel are important (playing into where will we be in ten years?)
What is important in our community?How is the quality of life in our community?What assets do we have that can be used to improve community health?
Local public health assessment: Comprehensive assessment of all of the organizations and entities that contribute to the public’s health
What are the activities competencies and capacities of our local public health system? How are the essential services being provided to our community?
Community health status assessment:
How healthy are the residents?What does the health status of our community look like?
Force of change assessment:
What is occurring or might be occurring that affects the health of our community or the local public health system?What specific threats or opportunist are generated by these occurrences?
Phase four: Identify strategic issuesAnalyze the data gathered during the four assessments to identify critical issues.
Phase five: Formulate goals and strategiesThe fifth and sixth phases are key in laying the groundwork for implementing change. By taking the time to adequately plan, educate, and align goals so the final action phase will have a higher rate of return. During this phase, collaborative and directive thinking occurs.
Phase six: The action cycleCounty of Dane.comTo further emphasize the importance of streamlining the implementation of information, phase six cyclically juggles planning, implementing, and evaluating. By constantly going through these steps the initiative can continuously develop through checks and balances. (NACCHO.org)
Phase three: Four MAPP assessments
Questions to ask stakeholders are presented throughout the phases.
Community stakeholdersMajor hospital and clinic systems
Public Services Local insurance
Centers for physical activity
Community clubs
UW HealthVA HospitalsMeriter Health SystemsSt. Mary’s HospitalDean CareEPIC software systems
LibrariesReligious groups/ worship centersCivil services:Police, fire department, safety department, health department, public instruction,Governing bodies: Capital is located in . The city is a hub of state and local officials.
WPSWEAPhysician’s PlusGroup healthCuna MutualAmerican FamilyDean Care
Locally owned gymsCommercial gymsYMCA (none-profit recreational facilities)Indoor/outdoor recreational facilities
Big Brothers Big SistersBoy Scouts and Girl Scouts4HCommunity recreationSpecial interest groups-Urban League
Have first hand interaction with influencing the physical and mental health of the community. Collectively, these are the largest employers in and contain the majority of doctors and nurses.
The community leaders who have an influencing voice over policy and reform, its regulation, and its development.
These companies represent large employer groups and the affordability of health care. Without strong ties to the community their ability to create adequate coverage will be compromised.
They can be evaluated to see what tools and resources individuals and families have for physical activities.
Small communities where people can develop hobbies and special interests to create ties with others.
Prioritizing Methodology
Grid Strategy Nominal Group Technique
When addressing health and wellbeing of an entire group of individuals narrowing down the focus is optimal for efficiency. To achieve efficiency, representatives from different pockets of the community will be integral in organizing thoughts and prioritizing interests. Roundtable discussions and voting will be helpful deciding methods.
The strategy grid will be useful in pinpointing specific areas that will have the opportunity for the greatest impact , further narrowing down group discussions.
(NACCHO)
Grid Strategy
Low HighNeed
Low
Hig
h
Feasib
ilit
y
Low Need/High Feasibility – Often politically important and difficult to eliminate, these items may need to be re-designed to reduce investment while maintaining impact.
Low Need/Low Feasibility – With minimal return on investment, these are the lowest priority items and should be phased out allowing for resources to be reallocated to higher priority items.
High Need/High Feasibility – With high demand and high return on investment, these are the highest priority items and should be given sufficient resources to maintain and continuously improve.
High Need/Low Feasibility – These are long term projects which have a great deal of potential but will require significant investment. Focusing on too many of these items can overwhelm an agency.(NACCHO)
Nominal Group TechniqueEstablish a group of, ideally, 6-20 people
Designate a moderator to take the
lead in implementin
g the process
Silent brainstorming
Generate list in round-
robin fashion
Simplify & clarify
Group discussion
Anonymous
ranking
Repeat if
needed
(NACCHO)
Welcome to Dane CountyHome of the Badgers
County of Dane.com
Established: December 7th, 1836
Home to the capital city: Madison
Area: 1,197 square miles of land,41 square miles (3.3% of total 1,238 square miles) of water
Out of 72 Counties
Dane County is ranked:
• 3rd in Health Factors (social and economic factors)
•15th in Health Outcomes(CommunityCommons.org)
6.16%
15.45%
13.29%
15.97%13.28%
13.96%
11.50%
10.40%
Age of Population by Percentage
Age 0-4
Age 5-17
Age 18-24
Age 25-34
Age 35-44
Age 45-54
Age 55-64
Age 65+
Population & demographics
64.15%Ages: 0-44 years old
13.96%
11.50%
10.40%
Age of Population by Percentage
Age 0-4
Age 5-17
Age 18-24
Age 25-34
Age 35-44
Age 45-54
Age 55-64
Age 65+
Note that the majority of the population is below the age of 44
(CountyHealthRankings.org)
State population: 5,687,219
Dane population:
488,073
Ethnic and racial populationbreakdown by percentage
Population & demographics
Population & demographics
Having a diverse population is a valuable asset to any community. To understand how to balance needs and be culturally sensitive projecting race and ethnicity of a population is important. This encourages diversification and establishes opportunities within the community for resources development .
CommunityCommons.org)
Population & demographics:Change by location from: 2000 - 2010
Note the population movement away from the downtown region. This is an issue because public transportation routs are having a difficult time keeping up with urban sprawl. The downtown area is the only region that provides easy access to public transportation services such as bus, bicycle, quick access cabs, and continuous, well lit trails or sidewalks options. Housing is also more expensive downtown, yet some of the lowest income neighborhoods are established there (CommunityCommons.org)
(CommunityCommons.org)
Poverty can result in an increased risk of mortality, prevalence of medical conditions and disease incidence, depression, intimate partner violence, and poor health behaviors.
While negative health effects resulting from poverty are present at all ages, children and older adults in poverty experience greater morbidity and mortality than younger individuals due to increased risk of accidental injury and lack of health care access.
Risk of poor health and premature mortality may also be increased due to the poor educational achievement associated with poverty. As it is often difficult to escape from poverty, these groups captures an upstream measurement of current and future poverty rate and health risk (CountyHealthRankings.org).
Population & demographics: Income
Dane County has a large amount of individuals who have attained secondary education or higher. This is helpful in that individuals who have achieved higher education generally have better health. However, there is a large gap between the population size of those who do not have additional education, indicating a vulnerable group. Currently 86% of kids are initially graduating high school. This is low in comparison to other counties (PHMD).
Population & demographics: Education
Individuals who have a secondary education or higher is the majority in Dane County.
This is most likely due to the location of the University of Wisconsin-Madison and large
employer groups such as UW Health, Deancare, Meriter Hospital systems, and Epic Systems
Software Development. All of which recruit a large number of highly educated employees
(PHMDC).
(Wonder.cdc.org)
Population & demographics: Education
Secondary health indicators for change
Access to health care Health insurance coverage Available providers Heath care cost Birth rate
Chronic disease Obesity Diabetes Heart Disease Cancer
When individuals go underinsured or uninsured they are more likely to suffer financial hardship, less likely to seek timely care, have a lower health status and run the risk of early death (HealthyPeople2020). With mandates set forth by the Affordable Care Act, data collection and insurance rates will be changing in 2014 (Countyhealthranking.org) .
Health insurance coverage
(CountyHealthRanking.org)
(Communitycommons.org)
Available providersPeople with a fluid source of care have better health outcomes, fewer disparities and lower costs. (HealthyPeople2020) In Dane county there is no shortage of health care professionals; there is currently 159.6 physicians per 100 thousand people (DHHS).
The Health Services Research Administration projects that the primary care nurse practitioners and physicians assistance workforce will also grow substantially over the next ten years.
Dane County has an exceptional population to physician presence.
(CDC)
Health care cost Establishing prevention and early care is
reflective in accrued cost in an aging population. The ability to cover the cost of maintaining health and quality of life for this population is in question. In Dane County the percentage of individuals over the age of 65 has risen from 10% to 11% in the last three years and the cost of providing health care is fluctuating as well. Health care costs are an important measure of the efficiency of a health care system.
(CountyHealthRanking..org)
Cost to see doctor
It is important to note that even with insurance the cost of receiving care can be limiting for some individuals. This problem is gradually increasing both in Dane County and state wide. He graph below quantitatively compares the percentage of population in Dane County that could not see a doctor due to excesive cost between the years 2012 and 2014.
(CountyHealthRanking.org)
categories of health factors, including her health behaviors, access to health care, the social and economic environment she inhabits, and environmental risks to which she is exposed. In terms of the infant’s health outcomes, LBW serves as a predictor of premature mortality and/or morbidity over the life course and for potential cognitive development problems. (CountyHealthRanking.org)
Birth weight
Low birth weight (LBW) represents two factors: maternal exposure to health risks and an infant’s current and future morbidity, as well as premature mortality risk. From the perspective of maternal health outcomes, LBW indicates maternal exposure to health risks in all
Age of Mother
(Wonder.CDC.gov)
Pregnant teens are more likely than older women to receive late or no prenatal care, have gestational hypertension and anemia, and achieve poor maternal weight gain. Teens are also more likely than older women to have a pre-term delivery and low birth weight babies, increasing the risk of child developmental delay, illness, and mortality (CountyHealthRanking.org). Dane County has a reasonably low teen pregnancy rate and shows high rates of pregnancies between the ages of 20-34 years.
Dane County shows signs of healthy birth weights across all age categories. Reviewing the age of the mother is expressive of at risk pregnancies, family planning/abstinence practices, and risky behaviors among the population. Teen pregnancy significantly increases the risk of repeat pregnancy and of contracting sexually transmitted diseases.
Birth weight
Chronic diseases
Chronic diseases including heart disease, stroke, diabetes , lung disease and cancer are the leading causes of death and disability in Dane County, in Wisconsin and the entire United States. To a large degree, these diseases can be prevented, delayed and controlled, allowing for longer and healthier lives (PHMDC). Dominant risk factors include smoking, obesity, and lack of preventive screenings.
(PHMDC)
Obesity
Obesity is a complex measure that is affected through several different pathways: genetics, metabolic processes, education, built environment, behavioral choices, socioeconomic status and education(CDC).
In comparison to county rankings in Wisconsin, obesity rates in Dane are among the lowest, however, that does not mean the rate of prevalence is acceptable. With 20.1% of adults in Dane County having a BMI of 30 or greater serious concerns
about future health and the costs of obesity-related diseases are being raised. A current limitation is that childhood obesity rates are not available to provide a more comprehensive measure of the current and future health risks of a county (CountyHealthRanking.org).
Diabetes can lower life expectancy up to 15 years and increase the risk of heart disease by 2 to 4 times. It is also the leading cause of kidney failure, lower limb amputations, and adult-onset blindness in the United States. (HealthyPeople2020) Encouraging regular preventive screenings and maintenance is key in reducing these human and financial costs. In Dane County, 4.2% (FindtheBest.com) of the population has been diagnosed with a form of diabetes. With prevention in mind, the county has a high performance of diabetic screenings, with a 92% participation rate; higher than the top U.S. performers (90%) (CountyHealthRanking.org).
Heart disease Currently heart disease is the
number one killer and stroke is the third killer in both the United States and Wisconsin (HealthyPeople2020, PHMDC).
Cardiovascular health is significantly influenced by the physical, social, and political environment. In Dane County its rate of occurrence is high but lower than the national and state average with a prevalence of 136 deaths per 100,000 people (PHMDC).
Cancer
Continued advances in cancer research, detection, and treatment have resulted in a decline in both incidence and death rates for all cancers. Among people who develop cancer, more than half will be alive in 5 years. Yet, cancer remains a leading cause of death in the United States and in Wisconsin, second only to heart disease. In Dane County it is the number one cause of mortality with a prevalence of 138 deaths per 100,000 people. From 2001 to 2004, on average, 1,780 people in Dane County were newly diagnosed with cancers. That is a rate of 454 per 100,000, which is lower than Wisconsin’s (471 per 100,000). The leading cancer types are prostate, breast, lung and colorectal, together representing 54% of the new cases of cancers and 49% of the deaths by cancer (PHMDC).
(PHMDC)
Cancer and heart diseases are the two leading causes of death, representing almost half of all deaths in Dane County. While in Dane County the white population has a lower death rate than the statewide white population for the leading causes of death, Dane County black populations have death rates comparable to the black population statewide. This creates a larger disparity in death rates between Blacks and Whites in Dane County compared to the rest of Wisconsin. Dane County Asians had lower death rates than Dane County Whites for cancer, heart disease, and chronic lower respiratory disease, and higher death rates than Dane County Whites for cerebrovascular diseases and kidney disease, both of which are related to hypertension. Dane County Hispanics’ death rates from the top 3 causes of death - cancer, heart disease and cerebrovascular disease - were the lowest of all racial and ethnic groups examined (PHMDC).
(PHMDC)
Health indicator limitations
Childhood obesity rates not available◦ Important to determine if intervention is needed.
Lacking primary source information◦Though the sources used are reputable only
secondary sources were used. To strengthen the assessment, additional primary source such as interviews, surveys, group discussions, and observations should also be used.
Drawing comparisons to other counties◦Dane county is unique in its size, political bodies,
business operations, and layout. In comparing it to other counties with much different climates, information can appear skewed.
Health Care Reform◦ The Affordable Care Act will change many health
outcomes, data collection, and sample sizes. Being aware of the time of data collection will be important in future information interpretation and comparison.
Sample Group◦ In using reputable secondary sources, sample
group selection is easier to be confident in. In smaller group sizes ensuring that the group selected accurately represents the population is hugely important and difficult to assess purely from the data consumer position.
Health indicator limitations
To evaluate the needs of Dane County, access to health care services,
chronic diseases conditions, nutrition and weight status, and physical
activity indicators were examined. These indicators qualitatively and
quantitative give a big picture view of the past experiences, current
trends, and future needs of the communities within Dane County and
how the population compares against Wisconsin and in some
instances, the top U.S. performers. As Dane County is ranked 15 th out
of the 72 counties in Wisconsin in overall health status,
(CommunityCommons.org) based on the information discussed
throughout, there are many current health assets for the population to
build upon and advance with. However, there are five major
indicators that stood out, of those, two were identified as specific
areas for improvement.
CHNA needs identified
Main areas for opportunityBased on the health indicators listed the main areas for opportunity include:
Integrating the younger and older populations together
The African American population is showing signs of struggling in prevalence of younger pregnancy ages, lower income, lower educational achievements. Focus on increasing opportunity and access to resources for the given population.
Obesity prevention to alleviate the effects of chronic health conditions.
Increase high school graduation rates to increase opportunities later in life.
Heart disease and stroke rates are high. Focus on preventive care and community climate towards heart disease instigators such as food options and physical activity.
High School Graduation Rate
Obesity
Two high need / high priority areas:
High school graduation rate
By focusing additional attention to educational achievement of youth future opportunities will become more easily attainable as they age. These benefits are often seen in the form of better health and self-sustainable economic security both of which lead to a higher quality of life and longevity.
Obesity
Obesity, like education, statistically compares well to other locations in Wisconsin and the United States. However, that doesn’t mean that the statistical values are effective for maintenance and prevention throughout the population. As mentioned Obesity is complex in its measurements and effects on the individual and the population. By decreasing its prevalence the impact of many additional chronic health conditions can be alleviated.
Ten organizations that can help
Planned Parent Hood
Urban League of Madison Area
YMCA of Dane County
School Districts of Dane County
Big Brother’s Big Sisters of Dane County
Literacy network
Hospital/clinics in Dane County
MSCR Madison School & Community Recreation
United Way of Dane County
Options in Community Living Inc.
“Data is used to create information.
Information is used to create knowledge.
Knowledge is used to create
understanding. Understanding is used to
create wisdom to make good decisions.”
Bill Schrum
UW Medical Foundation
Human Resources Vice President
Mr. Schrum’s words emphasize the snowball effect that efficient data collection can have and its potential to impact a community. In comparison to Wisconsin and the United States Dane County is in good health standings but there will always be room for improvement.
Conclusion
See notes for reference information
