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Community Health Status Indicators 2015 Video Transcript

 

Lisa Lang: On behalf of the National Library of Medicine, and the Centers for Disease Control and Prevention, I would like to welcome you and thank you for joining us today for our webinar on the newly released Community Health Status Indicators CHSI 2015 web application.

 

My name is Lisa Lang. I am Assistant Director at NLM for Health Services Research Information and also Head of the National Information Center on Health Services Research and Healthcare Technology.

 

We are very pleased to be co-hosting this webinar with the CDC. We've been involved with the CHSI project since 2004 recognizing the importance to improving public health of linking research and evidence to data and measures.

 

NLM collaborates with CDC in many venues to improve information access for public health.

 

For example, CDC, HRSA, the Public Health Foundation, NACCHO, ASTHO, the National   Network of Libraries of Medicine and many others are members of our long standing collaboration, Partners and Information Access for the Public Health Workforce at PHPartners.org.

 

Resources relevant to community health assessment and improvement from across our diverse organizations can be found at that web site. We are particularly pleased by the diversity of the audience that's registered for this event.

 

Public health workers, librarians, academics, and researchers at the very least.

 

Improving population health, and the quality of the public health systems and services that

contribute to it will require our utmost collaboration.

 

CHSI 2015 comes at a perfect time to inform efforts to identify and address community

health needs, as a result of growing health department accreditation movement, and the need for not-

for-profit hospitals to demonstrate their community benefit through collaboration with

public health and progressive improvement in their communities' health.

 

So before we begin today's presentation, a bit of housekeeping.

 

The webinar is being recorded. You can see it's also being closed-captioned.

 

Today's moderators are Liz Amos and Basheer Kareem.

 

And we have in-meeting technical support from Damon Watson and Felice Harper.

 

You may have noticed that all the phones have been muted upon your joining us.

 

If you have questions during the meeting, we ask that you please submit them in the

chat box on your screen selecting everyone in the drop down menu.

 

The webinar will be comprised of a presentation, a live demonstration, and a question and answer period.

 

After each of the first two segments, we will open up a brief poll that will appear on your

screens, but more about them later.

 

During the Q and A period, we will address the questions that you've submitted through the

chat box.

 

We will post answers to all the questions that we receive in the document that will

accompany the recording of this webinar.

 

And we'll be notifying you after the meeting with the URL for both the recording and the Q's and

A's.

 

So presenting today are Teresa Daub and Vickie Boothe, both of the CDC.

 

Teresa Daub works as the lead public health advisor with the Health Department and Systems Development Branch in CDC's Office for State, Tribal, Local and Territorial Support (OSTLTS), Division of Public Health Performance Improvement.

 

Vickie Boothe is a health scientist and environmental engineer with more than 27 years of experience working in the public and environmental health fields.

 

Currently, she serves as the Lead for the Population Health Metrics Team at The

Centers for Disease Control and Prevention.

 

Her team participates with CDC and other federal and non-federal partners in developing epidemiologic resources tools and guidance for assessing, monitoring and improving the health of communities.

 

And now Teresa Daub.

 

Teresa Daub: Thank you, Lisa. It really is a pleasure to be with you all today.

 

Thank you for hosting this webinar for us to get together today.

 

I am Teresa Daub, with the Office for State, Tribal, Local, and Territorial Support.

 

We in OSTLTS view a big part of our job as connecting health departments with information, tools, and resources that they can use to do their work better and more easily.

 

So we're especially excited about the CHSI tool because we know it helps health departments, especially those working on community health assessment, access local data, which helps them do their work and to partner with others in their community.

 

So at this moment, I want to review the learning objectives for today's call. Following this session in which you hear from Vickie Boothe on CHSI, you'll be better able to describe the history and new features of CHSI; Use CHSI to better assess community health status, and identify potential health disparities; Understand health status within the context of the wide range of factors that drive health; And use CHSI to engage multi-sector partners and working collaboratively to improve population health.

 

So there are many drivers for community health assessment improvement plans currently.

 

They're all driving us toward institutionalizing community health assessment and improvement planning.

 

So, Lisa mentioned at the top of the hour the National Voluntary Public Health Department accreditation that's occurring through FAB. Affecting about 2,400 local health departments around the country.

 

There's also a requirement, an IRS requirement that came about as a result of ACA, that all tax exempt hospitals conduct a community health needs assessment and develop an implementation strategy to satisfy their tax exempt requirements.

 

Federally qualified health centers have similar requirements, community health assessment and improvement planning is a part of Healthy People 2020, and the National Prevention Strategy.

 

There are many states that have requirements for local health departments or states themselves to assess community health status. It's a requirement in many grants and increasingly in planning led by other sectors.

 

So, all of these things are pushing us toward more thorough consistent community health assessment and collaboration with other sectors.

 

So while there are many different frameworks and models for conducting community health assessment, there's some common elements that we think it's helpful to ground our discussion in.

 

And that's a system, or process of preparing and organizing and gauging with the community of broad representation of community...Developing a goal or vision for the process...

 

Conducting the community health assessment itself...Prioritizing health issues, then developing and implementing a community health improvement plan.

 

And evaluating and monitoring outcomes. So what I'm going to do now is turn to Basheer for the poll, but let me just give you the heads up that Vickie, who will present on CHSI, following, will focus on the fourth bullet on this list -- Conducting the community health assessment and how CHSI can assist with that particular step of the process.

 

Basheer are you ready to open our first pole?

 

Basheer Kareem: Yes.

 

Teresa Daub: Thank you.

 

Basheer Kareem: You're welcome.

 

Vickie Boothe: Ok, this is Vickie. Hopefully all of you can see the poll on this screen.

 

And we just would like to get a sense of -- And especially since it's a diverse audience, as

Lisa mentioned.

 

We'd like to get a sense of how many of you have, or are planning in the near future, to participate in the community health improvement process, which of course includes the Community Health Assessments.

 

And if you'd just answer "yes" or "no". And if "yes", which of those drivers is your main motivation for participation?

 

We have a few options there for you to choose among.

 

And then also if "yes," which of the following frameworks were you going to use to guide the health improvement process?

 

And the first option, of course, is if you weren't thinking of a specific framework.

 

So, Basheer, are we pretty close to having all of our answers?

 

Basheer Kareem: Yeah, I don't see any more movement. I think we can stop at 76%.

 

Vickie Boothe: Okay, great.

 

Thank you so much for providing that information to us.

 

The responses to this poll, as well as the short one we have at the end, will help us understand which features, and what part of the content that you think is especially useful, and help us prioritize some potential improvements to the content and functionality as we move forward.

 

Okay, I'm picking up just for where Teresa left off, and this is another way to view those seven common steps that Teresa went over.

 

And we particularly like to use this one for training, since it is more of a process diagram.

 

And so as Teresa mentioned, here is where you organize, and you first engage your partners and your communities, and you come up with a shared vision and objective for the community health assessment andimprovement process.

 

This second step here, that is the assessment part, and that's where a lot of the focus has been.

 

And, indeed, as Teresa mentioned, this is the step that CHSI 2015 was primarily designed to facilitate assistant with.

 

And there are four products that come out of the assessment of phase and I'll go over them in a little more detail in a minute.

 

But just really briefly, in the assessment phase, you are going to analyze secondary data on your health outcomes, as well as on the factors that might be driving those health outcomes.

 

And you are going to collect information on what the community thinks is important.

 

And the third thing that you're going to do is identify potential important health disparities within the community.

 

And then finally, you're going to want to identify the assets, not only of the health system but that the community has itself so that they become empowered and take ownership, which is going to lead to more sustainable health improvement.

 

The next step of the process is an open and transparent process for taking the list of potential priorities that come out of assessment, and coming up with your three to five priorities that you're actually going to take actions on.

 

And I say three to five because out of the literature, that's best practices, recognizing that some of the communities are only going to identify one or two, and we've seen as many as fifteen come out of that process.

 

Of course you're then going to do all of the necessary things to come up with a plan for your intervention.

 

And that's going to identify roles and responsibilities of all of the key players.

 

Then you're going to begin to implement your intervention, and that kicks off this little "Do" loop of monitoring.

 

And this is monitoring of the process and asking, continually, you know, how faithful are we being to the evidence based intervention, or to our plan. And you're also going to monitor those short term and, perhaps, intermediate outcomes.

 

Because you don't want to get down here, three or five or seven years when you're doing--down the road--when you're doing your evaluation, and find out that something went wrong in month two of year two.

 

So all of this is organized in a continuous improvement, diagram, and for shared learning.

 

And the underlying principle, as Teresa mentioned, includes shared ownership among all the stakeholders, and meaningful engagement involvement of the community members.

 

So just a little bit more about those four products.

 

So as I mentioned, one of the products--and most of you guys know this--but it's the analysis of secondary data, which is already collected and analyzed data, or is already collected and sometimes pre-analyzed like CHSI and the county health rankings.

 

And within this analysis, you're going to compare those indicators against communities that are similar to yours...national and state averages, healthy people 2020 benchmarks, or perhaps to the best performing counties in the country.

 

You're going to examine trends in the data.

 

So is the heart disease rate, is it going in the right direction? Is it moving in the wrong direction?

 

And through this analysis, you're going to come up with this subset of the most prevalent, severe, and important outcomes and determinants. This is going to be examined together with primary and qualitative and quantitative data that captures what the community opinions are of what the priorities should be.

 

And, of course, you can capture that information through sessions such as interviews, town halls...

 

And if you have a very large community that prohibits accurately capturing and representing all of the opinions of the community with interviews and town halls, you're going to think about conducting a community opinion survey.

 

And the third thing is identifying, going back through that secondary data and examining it based on sex, race, ethnicity, socioeconomic status and geography to identify potential health disparities.

 

And then finally the assets of the health system.

 

And the identification of the health disparities and the secondary data analysis is in yellow here because those are the two steps within the assessment process that CHSI was designed to support.

 

Ok, so before I talk about CHSI and some of our other products and resources, I just want to introduce this Population Health Framework.

 

All of our products and resources are organized using a population health framwork.

 

And we selected this one because it allows us to think and talk about that population health is the result of these modifiable factors.

 

So healthcare quality and access, personal behaviors, social factors, and the physical environment, which combined in somewhat mysterious and not well understood ways with genetics and individual biology to create population health outcomes.

 

And typically we measure these with mortality, morbidity, and quality of life.

 

Now the reason that we selected this model, which was adapted by one developed by Dave Kindig and colleagues--it was at the University of Wisconsin--is it also allows us to talk about when these upstream factors are unequally and inequitably distributed by race, ethnicity, socioeconomic status, geography and/or gender.

 

Then you get population level health disparities.

 

And as I mentioned...or I didn't mention, but I will now. So I work in the Division of Public Health Information Dissemination.

 

And it's located within the Center for Surveillance Epidemiology and Laboratory Services.

 

So, as such, our team is responsible for development of the epi and scientific tools and resources for the data driven steps of the community health improvement process. And we have been working on these tools and resources, and with our colleagues in OSTLTS, and other parts of the agencies, since early in 2012.

 

And one of the first questions that our stakeholders asked was, “What data do you start with? What health outcome data, what factors do you look at?"

 

And, typically, the health departments would say, "There are so many indicator, and indicator systems out there. You've got environmental health indicators."

 

"You've got chronic disease. You've got specific indicator systems for heart disease and stroke."

 

And they said, "We don't even know where to start." And many of the non-profit hospitals we engage with very early on said, "The only data that we have is information onthe populations that walk through our door."

 

"We don't know what information is out there, over the entire community."

 

So to answer that question, we did a systematic review and an analysis of all of the

guidance documents that have been widely used and developed on how to conduct the community health improvement process.

 

And based on the criteria we set, we ended up with these ten seminal sources, and they include two IOM reports.

 

They include NAACHO's Map process, for those of you that are familiar with that.

 

Three State Health Department's web based guidance systems.

 

And we went through that and we pulled out all of the recommendations for the health outcomes and factors to look at.

 

And synthesized that information and came up with this 42 most frequently recommended health outcomes and determinants, or health factors that should be...that have been recommended to be addressed.

 

And you can find this monograph with information on the background or methods and sensitivity analysis on the CHSI web site.

 

And this was the results of that analysis. These are the forty-two most commonly recommended health outcomes and factors.

 

And these numbers behind each one of these is how many of those ten seminal documents recommended them.

 

And this is not a "Thou Must" look at this.

 

We did this as a service so each and every organization conducting a community health improvement process wouldn't have to do their own reviews.

 

And so if you have a lot of resources, and you have a lot of time, you might look at all forty-two of these, plus many more.

 

Or you might take into account the ones that were most recommended among the ten documents, and then think about the ones that are particularly important to your community.

 

So that is the information also that we use to identify which indicators to put in CHSI.

 

And I'm going to spend just a couple minutes going over the background and history of CHSI, and a brief overview of the new features before we launch into the demo.

 

So, just by way of background, CHSI has been around for a long time, and I'm sure many of you have used CHSI in the past.

 

It produces health profiles for what use to be 3,143 counties, and now we've added two, so now it's the three thousand and ...I mean, 3,143. It used to be 3,141.

 

And it was originally developed by a collaboration led by HRSA. And it was released in 2000 in individual, hard copy format.

 

The Public Health Foundation, ASTHO, and NAACHO were the original partners that came up with the first paper versions of CHSI.

 

And, of course, by 2004, the data in those original brochures were getting kind of old and so they retired the brochures.

 

But it was such a popular tool, that this steering committee, here, that you see, listed with the original partners plus many more including CDC, was heavily engaged at this part.

 

They reconvened in 2004 to evaluate the original hard copy formats, update them and expand them.

 

And so, based on all of the work of all of these organizations, CHSI was converted to an online format in 2008, and updated in 2009. In 2010, after the Affordable Care

Act came along, CHSI kind of fell to the back burners for HRSA.

 

But they still wanted to see it live on. And so, in conjunction with the partners and with us, the primary decision was made to have the primary responsibility transferred to

CDC, and we received it in 2012.

 

So CHSI 2015, its primary goals are to improve the ability of stakeholders, to assess health status and identify disparities;

 

Promote a shared understanding of all of the factors that drive health, so health is more than just access to medical care and access to insurance. And also to mobilize multi-sector partners, and that includes folks like Transportation, Education, Social Services...

 

All of those entities and organizations that share responsibilities for creating healthy communities.

 

And most importantly, I want to draw your attention--I'll say a little bit more about this in a few minutes--that when the County Health Rankings and Roadmaps was designed, CHSI has been around, oh, seven or eight years.

 

And so, the County Health Rankings and Roadmaps were designed to complement

CHSI.

 

And then as we redesigned the CHSI application, we, in-turn, kept that going, and it's designed specifically to complement the County Health Rankings and Roadmaps.

 

The primary stakeholders for CHSI, of course, are the health departments for accreditation, the non-profit hospitals for the IRS requirements, and then other organizations that are heavily engaged in the community health improvement process like the Federally Qualified Health

Centers, United Ways, and others.

 

But we also designed it to be user friendly, and organized in such a way that it would also be useful in helping to engage those multisector partners that I was just speaking of, for legislatures, policymakers and business leaders.

 

And then as a tool for...to increase the knowledge of the general public that health is more than just healthcare access and insurance.

 

A quick overview of the new and updated features so...We came up with--And I'll talk just a little bit more about this as well because it's an important feature of CHSI--So we came up with new sets of peer counties.

 

It's reorganized in that population health framework I talked about a few minutes ago.

 

Has all new and updated indicators, and we also have information by subpopulation, so the mortality data is available for race, ethnicity, age-group and gender. Wherever that data is available.

 

And we have census track maps to identify vulnerable populations and potential health disparities.

 

Each indicator is benchmarked against the group of peer counties, Healthy People 2020 targets, and the median of all counties.

 

And we have a summary comparison page, and new look, and new visualization tools.

 

And right now our strategy is, every other year, update the indicators and, potentially, add new indicators, and then--I always say that before the ink was dry on the wire frames, people were asking for increased functionality.

 

And, so, we are trying to look at those potential improvements as well.

 

But just a minute on the peer counties. So we spent almost a year and engaged with many internal and external SME's, and we had a regular working group that had both some of the original architects of CHSI involved--And I'll send a shout-out to Norm McCannarack and to Ron Bialek that's been with CHSI since the very, very beginning.

 

Ron's from the Public Health Foundation, and Norm's with Johns Hopkins University.

 

And we examined seven different methods for developing the peers.

 

And the one we finally settled on was an adaptation of the method used by Health Canada to develop their peer health regions.

 

And what Health Canada wanted was living, ongoing peers, such that when they instituted a health region wide policy, or intervention, they had ongoing other health regions that they could examine to help them understand what the impact of those interventions or policies were.

 

And that was kind of what we were thinking about for CHSI 2015.

 

And so we used their method, they actually--and which is a k-means clustering analysis.

 

And they actually had 24 variables. We identified the U.S. equivalent.

 

And, so as a clustering analysis, based on all of these 19 variables that you see here.

 

And, you see, we captured demographic information, as well as things such as education, housing, housing stress, income and income equality, poverty, employment...

 

So, the peers are set up such that they are matched on all 19 of those variables, recognizing that, you know, there will be some differences across peers into the extent that each peer is matched on each one of those.

 

Ok, and then one other thing I wanted to talk about is...This is another look at the forty-two most frequently recommended health outcomes and determinants.

 

We did use this as our guide, also building on what the indicators that was in the original CHSI.

 

I am very happy to report that for each one of these indicators in black, we have at least one, or each one of these topics in black, we have at least one indicator.

 

And for some, such as educational attainment, we have three indicators.

 

I wanted to point out for these items in purple here. We had an inclusion rule of, "Data must be available for two-thirds of the counties in the country for the initial launch."

 

So infant mortality, suicide, and homicides available for about half the counties in the country. So these aren't in CHSI, but we do link to the Health Indicators Warehouse.

 

So for those counties that are looking for this county-level data, we will link you to a source of those. For these indicators in red, we were unable to find reliable, valid, county-level rates and comparable county-level rates for these things.

 

That is not to say that these things aren't important. They are very important.

Homelessness is important.

 

Population health, domestic violence and child abuse, motor vehicle injury, as oppose toyou know, motor vehicle accidents that end in fatalities.

 

So, one of the advantages of CHSI is we're bringing together all of this information in one place.

 

So that will, hopefully, free up time for health departments, hospitals, and others to look for alternatives state data or local data, or even think about collecting their own data for these indicators that we weren't able to find.

 

And then the other note is that we're continuing to look for that information, and we will include it when we meet...when we find indicators that meet our criteria.

 

The last thing I want to note is that access to healthy food, and access to places for recreation, did not meet our systematic review-driven criteria.

 

And I'll note that that systematic review was done back in 2011 and 12.

 

And during the time that we were completing the review, there was a growing body of literature--a large body of literature--that indeed identified that there was a strong link between access to healthy food and people actually consuming the healthy food.

 

And same thing for access to recreation. So...And our criteria was that there was a large body of literature.

 

It, typically, always went in the same direction for the link with population health outcomes.

 

And it suggested the...a plausible biological pathway.

 

So these met all those criteria and, so, we actually have indicators for those as well.

 

The last thing that I want to talk about before I show you...leave you with some resources, and we go to the live demo... is that...reinforce that CHSI was designed to not duplicate the County Health Rankings and Roadmaps but to complement it.

 

And I just want to point out that between the two resources, which were designed to work together, you will find a comprehensive set of health outcomes and determinant indicators, benchmarked against peer counties, and from county health rankings, the best 10% of counties, the U.S. and state averages and healthy people target.

 

You'll also identify resources that will help you identify potential health disparities, graphs and historical trends, data for select indicators, which is has been the county health rankings.

 

And then maybe most important of all, over 200 rated strategies for...of interventions and policies that are rated everywhere from evidence base to...scientific, and I think they have four different categories.

 

But it's a wealth of resources on what actions you might think about taking once you have your focus areas.

 

And, finally, a note that we both use the same population health framework to help reinforce the shift from disease treatment to understanding and addressing some of the upstream modifiable factors.

 

The last thing before we move to the demo is some resources and, you know, by now if you weren't familiar with the CHI process, I think you get a good sense that it's quite complex with lots of moving parts.

 

So you'll find more resources that can help you understand those processes and identify frameworks from these links.

 

And then the National Library of Medicine has provided links to specific areas that we feel that will be very useful to you, including Healthy People 2020, Evidence Queries, the ToxNet and ToxMap, which I've used myself and found to be very useful in terms of understanding and identifying chemical and environmental hazards.

 

And then you'll find some case studies and training materials on these resources.

 

Okay, so that's it. We will go to the live demo.

 

Okay, so this is the CHSI home page. Hopefully, most of you have had a chance to look at it.

 

I'll just point out that there are links to...There's summary information that I just went over on the home page, and links to information about how we selected the indicators, the history of the project, how to use the project, Partners and some additional resources.

 

And I'm actually going to do a little case study here of how you might use CHSI to understand more about the health status and the factors driving the health status.

 

For Fulton County, Georgia, I think probably most of you know but that's the county that

Atlanta's located in.

 

So, this is the first page you're going to see, and this is our summary comparison page.

 

And over here on the left, you’re going to see those categories of organization out of the population health framework.

 

So your health outcomes and here are those factors that drive health outcomes.

 

The "Better" column represents the best performing cortile compared to your peer counties.

 

So these are potential areas of strength for a county.

 

The right-hand colum is the "Worse" performing cortile compared to indicators in your peers.

 

And I'll just note here that, especially, if you're involved in the Community Health Improvement Process that you need to investigate all of the indicators. But the data is layered and so this gives you some idea of those things for which you perform not as well as your peers. And then, of course, in the yellow, here, would be the two middle quartiles.

 

So I want to talk about the value of having all of this on one page, and I'll do it with the smoking rates here.

 

So compared to the peers, Fulton County smoking rates are in the best quartile compared to the smoking rates of all the peers.

 

And so if you think about that, so if all we had were these health factors, I would think, "Hmmm...What's related to smoking?"

 

So, immediately, I would think of cancer and, especially, lung cancer, and we'll examine...we can examine that using our cancer morbidity indicator.

 

I would also think about cardiovascular disease, stroke, respiratory diseases, exacerbations of asthma, COPD...

 

And, so, because we have this here, we can look and see if the things that we think also might go along with that, appear to do so.

 

And so, we see that Fulton Counties in the best performing quartile for older adult asthma.

 

For coronary heart disease, yes, we would expect that...perhaps?

 

Chronic lower respiratory disease. Well, maybe not so much, but perhaps.

 

I think the one surprise, and we'll come back to this, is that although coronary heart disease deaths are low compared to those of the peers, stroke disease aren't. And so, you know, this might be giving me some hints that there are other factors at work in...with stroke.

 

And like I said, will come back to that. So, now I probably want to know more about this smoking indicator. So I select that, and from this information here, first thing that it tells me is, it's not quite but almost...So, so the smoking rate in Fulton County is 13.2% based on the data in CHSI.

 

And it almost meets the Healthy People target of 12%, but not quite.

 

And this is the median of all counties and so it's well below that.

 

And I want you to note that we've designed CHSI so that, at a glance, you can compare the county of interest rates, or indicators, to all of the peers as a group, or to each one individually.

 

And you can see as I roll over that the name of each one appears.

 

Now I know for all of the epidemiologists that are listening to this, you're sitting there and you're going, "Well that's point estimates and depending on the confidence intervals, there may not be any differences between any of the two of these."

 

And so to address that concern, we have all of the data here.

 

And it's downloadable into an excel spreadsheet.

 

And this also helps you understand who your peers are, and look at those ones that you think are most like the county that you're interested in.

 

One other thing to provide you information is this "Show Peer Counties."

 

And this is going to tell you something about the geographic distribution of the indicator values among the peers.

 

And as I would expect on the west coast, smoking rates are fairly low, especially compared to some of these in the south and up the Appalachians.

 

So by now, if you're like me, you're going, "Well, this does appear to be a strength but I really need to understand more about this indicator."

 

And so we have a description page, and for each one of these factors we've got a statement of significance for why this is important for population health.

 

And then we've got the description.

 

And, you know, one of the things I might think of is, "Well, is this one year data?

 

Are we looking at an aberration? Some problem with the data?"

 

And what you find out here is that this particular indicator comes from a seven year rolling average of BRFSS, which, of course, is a self-report data but it's a very validated BRFSSquestion.

 

And so, you might take away from that, that it seems to be a fairly stable rate.

 

Especially for a county as large as this, but I still would go to another source and get trend data.

 

So, I want to go back...There's two ways that you can get back to that...or get to other indicators, or back to that summary comparison. You can come here to the indicators tab, and this will tell you all the indicators that are available for the county you're interested in.

 

And the ones with the asterisk by them are the associated indicators.

 

An associated indicator measures the same construct as the primary indicators but in a different way, perhaps for a subpopulation.

 

And a good example of that, is for educational attainment. We have on-time graduation rates...

 

But also important is associate level degrees or higher, the percent of the population that has those.

 

And the percent of "High School/No-High School Diploma" or high school drop-outs after the age of 25.

 

And so, we can get at a stroke page here, and I will do that because I promised that we would go back and revisit that.

 

And...I'm going to have to...I see that we only have 13 minutes.

 

One of the reasons that I usually go back using the semi-comparison is although this gives you access to all the indicators...

 

As you noticed, it took a little bit more time than some of the other moving around in this site.

 

And so the age-adjusted stroke rate for Fulton County, Georgia is 47.2. You see it here.

 

It's fairly high compared to those rates of some of its peers. But what do we know?

 

So we know that stroke is not equally distributed in the population, so that's where this population's information...

 

And I think if we look in here, we can see, yes, the rate for African-Americans is almost twice the rate for the White population.

 

And so this gives you some hint that, yes, it does look like there's some disparities among populations.

 

The other thing that we know about strokes...And just before this call, I went and pulled some information from the Million Hearts web page. And, what the Million Hearts says is that stroke is also, of course, related to diabetes, unhealthy diet, obesity, and I think we know that.

 

One of the things I didn't know is that it was related to depression and mental health issues, that I learned from that web site.

 

And, so, if we come back here and look, we can see that violent crime.

 

Oh! And it's also very related...and the rates are much higher among low income population than they are among the middle class or more wealthy populations. So we can come back here and see that, compared to the peers, you have violent crime, unemployment, poverty, on-time graduation, children and single parent households that have issues, limited access to healthy food...

 

And then the last feature I'm going to demonstrate today...Well, actually I'm going to demonstrate two more real quick.

 

So is poverty...And what I want to direct your attention to are these census track maps.

 

And based on a very rapidly growing body of literature, we know that for census tracks that have greater than 20% of its population in poverty, you're very likely to see health disparities. Because a confluence of environmental and social factors, and that are influencing behaviors in those particular areas, so now you have these geographic areas of focus to work with.

 

The last thing I want to talk about before we do our poll and open it for questions is this county demographics.

 

So not only do you have your demographics but you also have information about the range of each one of these demographic factors of your peers. And this will give you a good idea of, you know, how close the peers match on each one of these.

 

And, so, age groups looks fairly close.

 

And I will note, just up front, that we didn't--after many, many months of healthy, open debate about whether or not to include race or ethnicity in the peer county methodology--we actually decided not to.

 

And primarily because the race related differences are, for the most part, not biologic.

 

And we didn't want to end up where we were just comparing minority communities against minority communities.

 

And I think I'm going to end with that.

 

And back over to you, Basheer.

 

Basheer Kareem: Okay, would you like for us to present the second poll?

 

Vickie Boothe: I think that would be great.

Basheer Kareem: Okay.

 

Vickie Boothe: Just briefly, with the instructions...In summary, CHSI 2015 is targeted primarily to health departments, hospitals and others engaged in the community health improvement process.

 

We have scales here from "very helpful,""somewhat helpful," and "not helpful at all."

 

If you will just take a minute or two to provide your opinion on whether or not CHSI will be helpful for understanding the current health status of populations. Identifying the modifiable extreme factors that may be contributing to health status.

 

Identifying the vulnerable populations and potential health disparities.

 

Raising awareness of all the factors that can influence health.

 

And, finally, mobilizing the partners with those other sectors that share a responsibility for community health.

 

So, Basheer, are we doing okay there? Because I do want to have some time for questions and answers.

 

Basheer Kareem: Alright, we're at 70%.

I'll go ahead and close it. Is that okay?

 

Vickie Boothe: That sounds great. Thank you so much, Basheer.

 

Basheer Kareem: You're very welcome.

 

Vickie Boothe: So was someone going to moderate the questions?

 

Liz Amos: Sure. Hi, Vicki, this is Liz. We had one question in the chat box: "Can you choose your own peer counties?

 

For example, if you want to look at all the counties within your own state."

 

Vickie Boothe: So, I have two responses to that and the first one is...The County Health Rankings is where you go to get more Information than you ever even thought of asking with respect to how your county compares to counties within your state.

 

So, most of the time, there are some peers in our groupings that are within the states but they're also across all those states.

 

So, first we would send you the County Health Rankings and then we would say that we talked about giving people the ability to choose your own peers.

 

And we decide that that would be something that we would entertain in the future.

 

But we were going to keep with the CHSI policies on peers that have been there since the first release in 2000.

 

And that, for our release, they're going to be those ones that are socially, economically and demographically like the county of interest.

 

Liz Amos: Great! We also have another question: "If you could please define peer counties and I would also be interested in how often you are updating the variables that you choose for determining peer counties."

 

Vickie Boothe: So the peer counties, so we ran the k-means cluster analysis and got the sets of peer counties, and that's what we used for the ones you see in CHSI.

 

It was based on the 2010 census. So we recognize that around...

 

No, depending on which one of those variables there are, that we will have to look at the peers again.

 

We're hoping that it won't be for a few more years but that is something that we'll be checking as we go forward.

 

Was there another part of that question I didn't get to?

 

Liz Amos: No, I think you answered it.

 

And we actually just got another one here, too.

 

From Cindy Reed...

 

"It's hard for smaller states, like Hawaii, that only have four counties total, not to be able to compare within the state.

 

So I look forward to having this individual capacity included within this tool."

 

Vickie Boothe: Oh, great (chuckling)!

 

Yeah so, you know, and that's why, you know, comparing within your counties, especially the way that public health planning is done makes perfect sense.

 

And also comparing to counties that are like yours but, you know, are in other states make sense.

 

If you think about Atlanta and Fulton County, there isn't another county like Atlanta.

 

So I would not expect the cardiovascular mortality rates to be similar or even rates among some of the factors.

 

Liz Amos: Okay, and, let's see...It's almost four o'clock but this last question here from Joanna

Ramos....

 

"What is the source for the data on language spoken in the home in L.A.P. status? Census only?"

 

Vickie Boothe: So that's the American Community Survey, from the census.

 

Liz Amos: Okay.

 

Vickie Boothe: And each indicator that's within CHSI identifies the years of the data the source of the data and actually links you back to the source of the data so that you can look at other things that they have, as well as download the original data.

 

Liz Amos: Okay, and we have a comment from Kelly Hamm that she typed in

"www.cdc.gov/communityhealth"

 

She missed the "n" after the "www" and it brought up a different web site.

 

Vickie Boothe: That is correct, and we're aware of that.

 

And the "n" in the "www" is because we're a dot net application.

 

But, yes, we're aware that without the "n" you go somewhere else.

 

And they're putting a link on CHSI to CHSI on their web site.

 

And we're going to link to theirs while we get it straightened out. But thank you for also bringing that to our attention.

 

Lisa Lang: This is Lisa Lang and I wanted to thank you again for joining us today.

 

The goal is to get as much information out about CHSI new web application as possible.

 

And to engage partners in active conversation to improve population health.

 

So thank you very much for joining us at this wonderful opportunity to share information and to see the new CHSI site that CDC and Partners have developed.

 

Thank you again, take care, and we will let you know where we are posting the recording.

 

We'll send you an email based on the registration that you've sent us.

 

Thank you so much.