Covering Kids and Families Annual Fall Conference Health Care on the Horizon:

1. It Takes a Healthy Village to Raise a Healthy Child Covering Kids and Families Annual Fall Conference Health Care on the Horizon: Considering our roles as voices for consumers Patrick Remington, MD, MPH University of Wisconsin School of Medicine and Public Health

2. Objective: Who’s Accountable for Public Health? • RWJ-funded County Health Rankings • The role of the Wisconsin Partnership Program • A vision for future support of health communities efforts

4. 1. Determinants of Population Health Social Environment Physical Environment Genetic Endowment Individual Response: -Behavior -Biology Disease Health Care Health & Function Prosperity Well-Being (Evans and Stoddart, 1994)

6. 2. Action Model to Achieve Healthy People 2020 Goals Determinants of Health Outcomes Interventions • Behavioral outcomes • Specific risk factors, • diseases, and conditions • Injuries • Well-being and health- • related Quality of Life • Health equity • Policies • Programs • Information Assessment, Monitoring, Evaluation & Dissemination

7. 3. Health Communication Framework Individuals Policy Makers Inform a b Persuade c d Source: Communicating Public Health Information Effectively: A Guide for Practitioners. Nelson, Brownson, Remington and Parvanta Eds. APHA, 2002

8. 4. Old Public Health System Other Partners Governmental Public Health Infrastructure

9. 4. New IOM Public Health “System” THE FUTURE OF THE PUBLIC’S HEALTH in the 21st Century INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Other Partners Governmental Public Health Infrastructure

10. 5. A Life Course Approach Before birth Infancy &Childhood Adolescence Adult: Young……Older Increase in body fat with aging Age-related declines in activity Established adult risky behaviours Nutrition Pregnancy Environment Disparities Adiposity rebound* Growth* Obesity* Growth* Inactivity Nutrition Smoking Mother’s Nutrition IU Growth* Breast Feeding Physical Activity Nutrition Environment Environment Environment Parental Disparities Parental Disparities Parental Disparities Biological risk Atherosclerosis, hypertension, insulin resistance Disease Time

11. Data Interpretation Program Evaluation Data Analysis Information Dissemination Program Implementation Program Planning 6. Public Reporting of Data Data Collection Source: Remington and Goodman; Chronic Disease Surveillance, 1999

12. Wisconsin County Health Rankings • Published first in 2003 • Ranks health in all 72 counties in WI

13. Health Outcomes Health Factors Source: Kindig D, Stoddart G. Models for Population Health. What Is Population Health? American Journal of Public Health. 2003;93(3 ):380-383 Programs and Policies

14. 50% 50% Mortality YPLL Health Outcomes 10% 50% Self-reported health Morbidity 10% Physical unhealthy days 10% Mental unhealthy days 20% Low birth weight 10% Tobacco use 10% 30% Health behaviors Diet & exercise 5% Alcohol use 5% Unsafe sex 10% Access to care 20% Clinical care 10% Quality of care Health Factors 10% Education 10% Employment 10% 40% Social/econ. factors Income 5% Family & social support 5% Community safety 5% Environmental quality 10% Physical env. Programs and Policies 5% Built environment

15. The MATCH “Logic Model”

16. Released on February 17, 2010

19. State and National Media Coverage • National print, wire, online stories • Regional/local print and online: over 800 stories in first 3 mos.

20. Conclusions ✔ ✔ ✔ ? ✔

21. Advantages • The Rankings focus the discussion on the multiple determinants of the health of populations • Draws in members of the new “public health system”

22. Academia:WPP Awards: 2004-2010 by Grant Type

25. Conclusion • It takes a “healthy village” to raise a healthy child • But who’s accountable for assuring conditions for population health (aka public health)? • Everybody…and nobody