Community Health Status
Indicators (CHSI)
Module 2
Nancy Allee, MLS, MPH, AHIP
Deputy Director, Health
Sciences Libraries
University of Michigan
Webinar, January 27, 2010
Health Indicators, Part II
Health indicators: 4-part series
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Part I: “Health Indicators: Overview”
Wednesday, January 20th, 1:00pm EST
– Understand the variety of health indicators, their data sources, their key attributes, context and use
– Presenter: Cheryl Wold, Wold & Associates
Part II: “Community Health Status Indicators (CHSI)”
Wednesday, January 27th, 1:00pm EST
– Learn to navigate and use the Community Health Status Indicators (CHSI) effectively to find county-level
data
– Presenter: Nancy Allee, Deputy Director, Health Sciences Libraries, University of Michigan
Part III: “Practical Approaches for Using Health Indicators”
Wednesday, February 3rd, 1:00pm EST
– Discover ways in which librarians can become more engaged with others in improving the health of their
communities and become knowledgeable about ways in which CHSI data can be used in working with the
public health practice community
– Presenter: Nancy Allee, Deputy Director, Health Sciences Libraries, University of Michigan
Part IV: “Examples of Important New Indicator Projects”
Date/Time: To Be Announced
– Become familiar with several important indicator efforts including State of the USA, MATCH, and two local
level examples
– Presenter: Cheryl Wold, Wold & Associates
Registration: http://www.nlm.nih.gov/nichsr/healthindicators/
Health Indicators, Part II
Today’s presentation
Focus on: the Community Health Status Indicators
Goal: Learn to navigate and use the Community Health Status
Indicators effectively to find local data
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accessing
searching
mapping
generating county-level reports
Question: How can librarians engage with the public health workforce
and local communities in using health indicator resources for quality
improvement?
Health Indicators, Part II
Presenter’s background
Nancy Allee ([email protected])
Degrees in Library Science & Public Health
MLA CE’s
–Community Health Status Indicators
–Evidence Based Public Health
–Public Health 2.0 (Social Media)
NLM & Partners in Information Access
–Chair: Public Health Training Subcommittee
–Project Director: Public Health Information & Data Tutorials project
& developer of Evidence Based Public Health Module
Past chair of the Public Health / Health Administration
Section of the Medical Library Association
Health Indicators, Part II
What is public health?
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Prevents epidemics and the spread of disease
Protects against environmental hazards
Prevents injuries
Promotes and encourages healthy behaviors
Responds to disasters and assists communities in recovery
Assures the quality and accessibility of health services
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Source: Public Health Functions Steering Committee, Fall 1994.
Health Indicators, Part II
10 Essential Public Health Services
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Monitor health status to identify community health problems
Diagnose and investigate health problems and health hazards in the
community
Inform, educate, and empower people about health issues
Mobilize community partnerships to identify and solve health problems
Develop policies and plans that support individual and community health
efforts
Enforce laws and regulations that protect health and ensure safety
Link people to needed personal health services and assure the provision of
health care when otherwise unavailable
Assure a competent public health and personal health care workforce
Evaluate effectiveness, accessibility, and quality of personal and populationbased health services
Research for new insights and innovative solutions to health problems
Source: Public Health Functions Steering Committee, Fall 1994.
http://www.health.gov/phfunctions/public.htm
Health Indicators, Part II
What is CHSI (Community Health
Status Indicators)?
A collection of nationally available health indicators for
counties, helping to present a “total picture” of local
health.
A resource for monitoring and analyzing community health
status and its determinants at the county level.
The goal of CHSI is to give local public health agencies
another tool for improving their community’s health by
identifying data resources and facilitating the setting of
priorities.
CHSI supports the mission and goals of public health, the
10 essential public health services, Healthy People 2010
initiatives, and evidence-based policy and research.
Partners
• Federal partners
– Agency for Toxic Substances and Disease Registry (ATSDR)
– Centers for Disease Control and Prevention (CDC)
– Health Resources Services Administration (HRSA)
– National Library of Medicine (NLM)
• Private partners
– Association of State and Territorial Health Officials (ASTHO)
– Johns Hopkins University Bloomberg School of Public Health
– National Association of County and City Health Officials
(NACCHO)
– National Association of Local Boards of Health (NALBOH)
– Public Health Foundation (PHF)
– Robert Wood Johnson Foundation (RWJF)
Health Indicators, Part II
Uses of & users of CHSI and health
indicators
• Uses of
– Public policy
– Public health
programs
– Interventions
– Partnerships
– Research
– Grants
– Publications
• Users of
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Public health officials
Public health workers
Librarians
Academics
Government agencies
Nonprofit
organizations
– General public
– Anyone with an
interest in local public
health data
Health Indicators, Part II
CHSI data sources
• Air Quality Reporting System & Toxic Release Inventory
(EPA)
• Behavioral Risk Factor Surveillance System (BRFSS)
• Centers for Medicare & Medicaid Services
• Harvard Initiative on Global Health
• Infectious Diseases Reporting System (CDC)
• National Vital Statistics System (CDC)
• Substance Abuse and Mental Health Services
Administration (SAMHSA)
• U.S. Census Bureau & Bureau of Labor Statistics Current Population Survey
Health Indicators, Part II
CHSI & evidence-based
decision-making
• Comparison to peer and other U.S. counties
• Symbols
– Apple = favorable status
– Magnifying glass = unfavorable status
Health Indicators, Part II
What are indicators?
• An indicator is “a summary measure that
aims to describe in a few numbers as
much detail as possible about a system to
help understand, compare, predict,
improve, and innovate.”
• Source:
– The Good Indicators Guide
http://www.apho.org.uk/resource/item.aspx?RID=44584
Health Indicators, Part II
What are health indicators?
• A health indicator is “a characteristic of an
individual, population, or environment which is
subject to measurement and can be used to
describe one or more aspects of the health of an
individual or population.”
• Source:
– Definition of Wellness web site
http://www.definitionofwellness.com/dictionary/healthindicator.html
Health Indicators, Part II
What is the “community” in
Community Health Status Indicators?
• Individual counties
– data for 3,141 U.S. counties
• Peer counties
– counties similar in population size and other
selected characteristics (e.g. poverty level,
age distribution, density)
Health Indicators, Part II
Some myths about health indicators
• Only local indicators are relevant for local
people.
• Unless the data are perfect, the indicator is
useless.
• Measurement eliminates uncertainty and
argument.
• Only a few indicators are needed to understand
how a system is working.
• Source:
– The Good Indicators Guide
http://www.apho.org.uk/resource/item.aspx?RID=44584
Health Indicators, Part II
Some truths about health indicators
• Indicators only indicate – they are not the whole
story.
• Indicators are ideally linked to quality
improvement.
– “Measurement is necessary for improvement but is
not sufficient on its own.”
• David Pencheon, The Good Indicators Guide
– “I am not interested in measurement per se. I am
obsessed by improvement and the role measurement
has in that process.”
• Don Berwick, Institute for Healthcare Improvement
• Source:
– The Good Indicators Guide
http://www.apho.org.uk/resource/item.aspx?RID=44584
Health Indicators, Part II
CHSI health indicators
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Demographics
Summary measures of health
National leading causes of death
Measures of birth and death
Relative health importance
Vulnerable populations
Environmental health
Preventive services use
Risk factors for premature death
Access to care
Source: http://www.communityhealth.hhs.gov/Companion_Document/CHSIData_Sources_Definitions_And_Notes.pdf
Health Indicators, Part II
CHSI health indicators
• Demographics
– Population size
– Poverty level
– Population by age
– Population by race/ethnicity
Health Indicators, Part II
CHSI health indicators
• Summary measures of health
– Average life expectancy
– Rates of death
– Self-rated health status
– Average unhealthy days
Health Indicators, Part II
CHSI health indicators
• National leading causes of death
– Complications of pregnancy/birth
– Birth defects
– Injuries
– Homicide
– Cancer
– Suicide
– Heart disease
– HIV/AIDS
Health Indicators, Part II
CHSI health indicators
• Measures of birth and death
– Birth
• Low birth weight, very low birth weight, premature
births
– Death
• Infant mortality, breast cancer, colon cancer,
coronary heart disease, homicide, stroke
Health Indicators, Part II
CHSI health indicators
• Relative health importance
– Highlights favorable and unfavorable health
status between peer counties and the U.S. in
general
Health Indicators, Part II
CHSI health indicators
• Vulnerable populations
– Have no high school diploma
– Unemployed
– Severe work disability
– Major depression
– Recent drug use
Health Indicators, Part II
CHSI health indicators
• Environmental health
– Clean air, water, land, waste disposal
– Data on infectious diseases
– Standards for pollutants and toxic chemicals
Health Indicators, Part II
CHSI health indicators
• Preventive services use
– Pap tests, mammograms, colonoscopy,
vaccines
Health Indicators, Part II
CHSI health indicators
• Risk factors for premature death
– Lack of exercise
– Poor nutrition
– Obesity
– High blood pressure
– Smoking
– Diabetes
Health Indicators, Part II
CHSI health indicators
• Access to care
– Number of uninsured
– Number of Medicare enrollees
– Number of primary care physicians
– Health professional shortage areas
Health Indicators, Part II
Peer counties
88 strata or peer groups defined in CHSI,
using 5 factors:
• Frontier status
• Population size
• Poverty quartiles
• Median age
• Population density
Health Indicators, Part II
How can I access the CHSI web site?
http://www.communityhealth.hhs.gov/
CHSI: “Home”
Health Indicators, Part II
CHSI: “About the data”
Health Indicators, Part II
CHSI: “Data details”
Health Indicators, Part II
CHSI: “About the project”
Health Indicators, Part II
CHSI: “How to use your county’s report”
Health Indicators, Part II
CHSI: “Partners”
Health Indicators, Part II
CHSI: “Resources”
Health Indicators, Part II
CHSI: “Resources” cont’d
Health Indicators, Part II
CHSI: “NLM resources”
CHSI: Mapping & reports
Health Indicators, Part II
CHSI sample search
Health Indicators, Part II
Focus on Wayne County, MI
Health Indicators, Part II
Demographics:
Wayne County, MI
Health Indicators, Part II
Summary measures of health:
Wayne County, MI
National leading causes of death: Wayne County, MI
Measures of birth and death:
Wayne County, MI
Health Indicators, Part II
Relative health importance:
Wayne County, MI
Unfavorable health indicators – both Peers and U.S.
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Low Birth Wt. (<2500 g)
Very Low Birth Wt. (<1500 g)
Premature Births (<37 weeks)
Births to Women under 18
Births to Unmarried Women
No Care in First Trimester
Infant Mortality
White non Hispanic Infant
Mortality
• Black non Hispanic Infant
Mortality
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Hispanic Infant Mortality
Neonatal Infant Mortality
Post-neonatal Infant Mortality
Breast Cancer (Female)
Colon Cancer
Coronary Heart Disease
Homicide
Lung Cancer
Stroke
Health Indicators, Part II
Vulnerable populations:
Wayne County, MI
Health Indicators, Part II
Environmental health:
Wayne County, MI
Health Indicators, Part II
Preventive services use:
Wayne County, MI
Health Indicators, Part II
Preventive services use: infectious
disease cases: Wayne County, MI
Risk factors for premature death:
Wayne County, MI
Access to care:
Wayne County, MI
Health Indicators, Part II
CHSI reports
Each CHSI report includes data
on access and utilization of
healthcare services, birth and
death measures, Healthy
People 2010 targets and U.S.
birth and death rates,
vulnerable populations, riskfactors for premature deaths,
communicable diseases and
environmental health.
In addition, the presentation of the
data allows for comparisons of
a county to its peer counties as
well as U.S. rates and Healthy
People 2010 targets.
Health Indicators, Part II
Mapping
Health Indicators, Part II
Mapping: major depression indicator
Peer counties:
Wayne County, MI
• California
– Los Angeles County
– Orange County
– San Diego County
• Florida
– Miami-Dade County
– Palm Beach County
• Illinois
– Cook County
• New York
– Bronx County
– Queens County
• Texas
– Bexar County
– Dallas County
Health Indicators, Part II
Peer county comparison: major depression
Wayne County, MI and Cook County, IL
Another mapping example
Health Indicators, Part II
Additional resources
The July 2008 issue of Preventing Chronic Disease contains the
following articles that provide additional information about the
Community Health Status Indicators project:
Kanarek N, Bialek R, Stanley J. Use of peer groupings to assess
county public health status. Prev Chronic Dis 2008;5(3).
http://www.cdc.gov/pcd/issues/2008/jul/07_0145.htm.
Metzler M, Kanarek N, Highsmith K, Bialek R, Straw R, Auston I, et
al. Community Health Status Indicators Project: the development of
a national approach to community health. Prev Chronic Dis
2008;5(3). http://www.cdc.gov/pcd/issues/2008/jul/07_0225.htm.
Heitgerd JL, Dent AL, Holt JB, Elmore KA, Melfi K, Stanley JM, et al.
Community health status indicators: adding a geospatial component.
Prev Chronic Dis 2008;5(3).
http://www.cdc.gov/pcd/issues/2008/jul/07_0077.htm.
Sondik EJ. The goal of adequate data. Prev Chronic Dis 2008;5(3).
http://www.cdc.gov/pcd/issues/2008/jul/07_0175.htm.
Additional resources
Community Health Status Indicators Project Working Group. Data
Sources, Definitions, and Notes for CHSI 2008. Department of
Health and Human Services, Washington, DC: 2008.
http://www.communityhealth.hhs.gov/Companion_Document/CHSIData_Sources_Definitions_And_Notes.pdf
CHSI GIS Analyst User Documentation
October 8, 2009
http://gis.cdc.gov/chsi/chsi_help.pdf
Health Indicators, Part II
Upcoming webinars
•
•
“Practical Approaches for Using Health Indicators”
Wednesday, February 3rd, 1:00pm EST
–
–
•
•
“Examples of Important New Indicator Projects”
Date/Time: To Be Announced
–
–
•
Discover ways in which librarians can become more engaged with others in improving the
health of their communities and become knowledgeable about ways in which CHSI data can
be used in working with the public health practice community
Presenter: Nancy Allee, Deputy Director, Health Sciences Libraries, University of Michigan
Become familiar with several important indicator efforts including State of the USA, MATCH,
and two local level examples
Presenter: Cheryl Wold, Wold & Associates
Registration: http://www.nlm.nih.gov/nichsr/healthindicators/
Health Indicators, Part II
Topic for February 3rd webinar
• How can librarians engage with the public health
workforce and local communities in using health
indicator resources for quality improvement?
• If you’d like to share your library’s experiences and
project efforts successfully partnering with the public
health community to improve health status:
– send to [email protected]
– include name & contact information and brief project
description
– send by January 30 to be highlighted in upcoming
webinar
Health Indicators, Part II
Contact information
Nancy Allee
Health Sciences Libraries
University of Michigan
[email protected]
Health Indicators, Part II