Intentionally Designing Health and Well-Being in Virginia

1. Intentionally Designing Health and Well-Being in Virginia Marissa J. Levine, MD, MPH, FAAFP Virginia State Health Commissioner The Virginia Department of Health

2. Objectives • Define factors that affect health • Describe Virginia’s health status • Outline an Approach to Population Health Improvement • Identify the Virginia State Health Improvement Plan Framework (Virginia Plan for Well-Being) • Discuss opportunities for intentional and aligned health improvement efforts

3. AMONG ALL STATES, Virginia RaNKS 21STIN HEALTH STATUS Data Source: America’s Health Rankings, United Health Foundation Scorecard-2015 • 3

5. Relative Contribution of Factors that Affect Health • Genetics • Clinical • Care • Social and • Economic • Factors • Environment • Health • Behaviors • Source: McGinnis et al, The Case for More active Policy Attention to Health Promotion, Health Affairs, 21, no. 2 (2002): 78-93

6. County Health Rankings

7. Health Factor Rankings for Virginia Counties (2016)

8. Health Outcome Rankings for Virginia Counties (2016)

9. Annual Cost of Chronic Diseases in Virginia • Total cost estimate of these conditions $41 billion • Data Source: CDC Cost Calculator for Virginia 2015. Includes costs only for diseases that are selected and have cost values available. The projections: 1) are medical costs only, including nursing home costs but excluding absenteeism costs; 2) are based on default inputs; 3) are reported in 2010 $ and do not project inflation; and 4) assume no changes in policy or technology and exclude changes due to the Affordable Care Act. • 9

10. Years of Potential Life Lost Before Age 65 Virginia, 2013 • Data Source: National Center for Health Statistics Vital Statistics System for Virginia 2013. Data includes all races, both sexes, all deaths • 10

11. Years of Potential Life Lost Before Age 65 Virginia, 2014 • Data Source: National Center for Health Statistics Vital Statistics System for Virginia 2014. Data includes all races, both sexes, all deaths • 11

12. Number of ED Visits for Heroin Overdose among Virginia Residents by Month, 2015-2016

13. Number of ED Visits for Heroin Overdose among Virginia Residents by Month and Age (Years), Previous 12 Months • *0-8 year olds excluded from graph because no visits

14. Number of ED Visits for Heroin Overdose among Virginia Residents by Month and Sex, Previous 12 Months

15. Rate of ED Visits for Heroin Overdose among Virginia Residents by Month and Health Region, Previous 12 Months

16. Cancer Death Rate • Data Source: Virginia Department of Health , Office of Information Management, Division of Health Statistics, 2012: Cancer Deaths • 16

17. Heart Disease Death Rate • Data Source: Virginia Health Information, Office of Information Management, Division of Health Statistics: Heart Disease Deaths, 2012 • 17

18. Question: What would it take for Virginia to be the healthiest state?

19. Health Opportunity Index HOI

20. Virginia Health Opportunity Index • A composite measure comprised of 13 indices that reflect a • broad array of social determinants of health • Air Quality ● Population Density ● Population Churning ● Walkability ● Affordability ● Education ● Food Access ● Material Deprivation ● Employment ● Income Inequality ● Job Participation ● Segregation ● Access to Health Care

21. Health Outcome Rankings for Virginia Counties (2016)

22. Intentional Design: A Population Health Approach A population is a collection of individuals • 22

23. Key Points/Assumptions • Health and well-being matter to all people in Virginia • Dealing with the burden of disease and breaking the cycle of debilitating disease must be addressed simultaneously • Community-led, data-driven, focused solutions are the ideal • Leadership efforts should intentionally facilitate the development and/or maintenance of these community efforts and be aligned for efficiency and impact

24. Strong Start for All Children HEALTHY CONNECTED COMMUNITY

25. http://www.virginiawellbeing.com

26. Virginia’s Plan for Well Being Metrics • Percent of Adults Who Report Positive Well-Being

27. Population Health Data Framework State Data • Virginia’s Plan • for Well-Being Regional Data Regional Data Regional Data Regional Data • Community Health Assessment in Every District Local Data Local Data Local Data Local Data Local Data Local Data Local Data Local Data Drivers Drivers Drivers Drivers

28. Aim 1: Healthy, Connected Communities

29. Community Health Services • Network of Health Districts & Local Health Departments • Data Source: Virginia Department of Health, Health Planning Districts. • 29

31. Aim 2: Strong Start for Children

32. Life Course Theory HEALTH OUTCOMES • PGY= Pregnancy • Source: William Hollinshead, Trajectories and MCH Checkpoints, 2007

35. Quintiles • Page 35

36. Aim 3: Preventive Actions

38. Aim 4: System of Health Care

40. Patients With Undiagnosed Hypertension: Hiding in Plain Sight JAMA November 19, 2014 Volume 312, No 19

42. * Per 100,000 Population ages 18 years and older

43. * Per 100,000 Population ages 18 years and older

44. Health Impact Assessment (HIA) A systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or projecton the health of a population and the distribution of those effects within the population. HIA provides recommendations on monitoring and managing those effects. National Research Council, Improving Health in the United States: The Role of Health Impact Assessment, 2011.

45. HIA Answers the Question... • “How would this new development/project affect people’s health?’. • HIA Toolkit Available at: http://www.vdh.virginia.gov/healthpolicy/healthequity/hia/index.htm

46. Different Types of HIAs

47. Virginia HIA Examples • Proposed poultry litter-to-energy facility in the Shenandoah Valley of Virginia. • http://societyhealth.vcu.edu/work/the-projects/health-impact-assessment-poultry-litter-to-energy-facility-in-the-shenandoah-va.html • Building a new transit center along Richmond Highway Corridor in Northern Virginia • http://www.naccho.org/topics/environmental/health-impact-assessment/project-locations/va.cfm

48. Model Process for Developing Public Health Policy Proposal – Define The Issue In Collaboration With Stakeholders And Appropriate Data Stage 1- Foundation Stage 2- Action Assumptions Not A Linear Process No Fixed Time Table DATA Analyze Existing Data Including ROI Key Principles Data Driven Stakeholder Engagement Thorough Vetting Broad Based Benefit LAW & Legislative Activity Analyze Existing Laws, Prior Legislative Activity Bills & Fiscal Impact Statements Stage 3- Consolidation & Decisions Stage 4- Evaluate STAKEHOLDER Analyze & Identify Existing and Future Stakeholders Consolidate All Analyses & Input Develop Proposal, Alternative or Stop Resulting Policy Changes Evaluated For Effectiveness Implementation Challenges Political Will Emotional Constituents How Much is Enough? Evaluations & Analyses Review articles, studies and reports Best Practices

50. References • Virginia’s Plan for Well-Being • http://virginiawellbeing.com/ • Virginia Health Opportunity Index • https://www.vdh.virginia.gov/omhhe/hoi/ • Health in All Policies - NCSL • http://www.ncsl.org/research/environment-and-natural-resources/health-in-all-policies.aspx • Page 50