Opportunities to Make Wisconsin the Healthiest State

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1 Opportunities to Make Wisconsin the Healthiest State JANUARY 2013 University of Wisconsin Population Health Institute Department of Population Health Sciences

2 Table of Contents Introduction 1 Overview of Report 2 Key Findings 3 Health Behaviors 4 Clinical Care 7 Social and Economic Factors 9 Physical Environment 11 References 12 Data Sources 13 Funding for this report is provided by the Wisconsin Partnership Program, UW School of Medicine and Public Health (UW SMPH). Graphic design was provided by Lois Bergerson of the University of Wisconsin School of Medicine and Public Health, Media Solutions. Suggested citation: Roubal AM, Catlin BB, Timberlake K. Identifying Opportunities to Make Wisconsin the Healthiest State, University of Wisconsin Population Health Institute, Anne Roubal is a graduate student; Bridget Booske Catlin is a senior scientist; and Karen Timberlake is the director of the University of Wisconsin Population Health Institute.

3 Introduction Improving broad health outcomes in Wisconsin how long and how well people live - requires improvement in specific health indicators spanning several health factor areas. The model below, from the County Health Rankings, shows four modifiable categories, or health factor areas, that influence health outcomes. These areas are: health behaviors, clinical care, social and economic factors and the physical environment. Each area, and the specific indicators within that area, contributes to the health and well-being of individuals and the community overall. In general, improvements by Wisconsin in each of the health factor areas will produce better health outcomes for all Wisconsin residents. In this report, the Making Wisconsin the Healthiest State team examines multiple interrelated indicators within the four health factor areas. We use this compilation of data to identify opportunities to improve Wisconsin s health and make progress towards the goal of becoming the healthiest state. This report is part of a series produced by the University of Wisconsin Population Health Institute. It brings attention to how Wisconsin compares to other states and the nation overall on leading health indicators. In addition to this report, information regarding health disparities in Wisconsin is available in the Health of Wisconsin Report Card. To see how Wisconsin health trends have changed in the past ten years on 20 leading health indicators, the Wisconsin Health Trends: Progress Report is available. For information regarding programs and policies that have been used to address key health indicators, see What Works? Policies and Programs to Improve Wisconsin s Health and -1-

4 In this report, the most current data available is presented for selected indicators in the four health factor areas: health behaviors, clinical care, social and economic factors, and the physical environment. Data is reported on between four and seventeen indicators within each health factor area. Each indicator is presented in a consistent format, comparing the results for: Wisconsin the United States the best and worst states Overview of Report and our healthier neighboring state Minnesota For example, here is a graphic depicting an example of a possible indicator: HI $40 $60 $80 $100 $120 $140 $160 $180 $200 $220 $240 Goverment public health spending per capita More annual public health spending per capita is linked to increased availability of resources for prevention and health improvement. The state with the highest amount of spending per capita is classified as the best. Hawaii spends the most at $244 per capita while Wisconsin spends the least at $40 per capita, making it the worst state for this indicator. Spending $45 per capita, Minnesota performs just slightly better than Wisconsin. However, Wisconsin and Minnesota are both below the average of $95 per capita. One important caveat is that the results presented in this report focus on Wisconsin overall: they do not indicate the extent of differences in health determinants between population subgroups (e.g., subgroups defined by race/ ethnicity, education, income, geographic location, or age). Consideration of such differences is important. Several of these differences are highlighted in the Health of Wisconsin Report Card. This information is a useful guide when examining opportunities for improving the health of Wisconsin. Wisconsin s greatest opportunities may be found where Wisconsin s current results are below the average or where Wisconsin is performing better than the average but worse than Minnesota. To identify ways to improve Wisconsin s health and reduce health disparities, the What Works? Policies and Programs to Improve Wisconsin s Health report and online database highlight what we know about the success of policies and programs that have been implemented. -2-

5 Key Findings Wisconsin has some important strengths such as a good high school graduation rate, a low percentage of cost burdened renters, a small percentage of individuals living in overcrowded housing, a high number of children covered by immunizations, and a low number of children without health insurance. However, Wisconsin clearly has room to improve in many other areas such as alcohol use, tobacco use, and employment. Because no state is the best in all factors, even the healthiest can still get healthier. Even being among the best performing states (better than the and Minnesota), may not be good enough. For example, Wisconsin ranks 7th among all states for the percentage of adults meeting physical activity guidelines, yet a large number of Wisconsin adults (43%) do not engage in regular physical activity. The table below summarizes Wisconsin s strengths and challenges across the four health factor areas: = One indicator = Better than Minnesota Health Factor Area Factors (# of indicators) Number of Indicators better than Number of Indicators worse than Health Behaviors Tobacco Use (2) Diet and Exercise (6) Alcohol and Substance Use (2) Sexual Activity (4) Personal Safety (3) Clinical Care Access to Care (9) Quality of Care (3) Social and Economic Factors Education (5) Employment (1) Income (3) Family and Social Support (3) Community Safety (2) Physical Environment Environmental Quality (3) Built Environment (5) -3-

6 Health Behaviors Individual health behaviors such as smoking, diet and nutrition, physical activity, and alcohol and drug use, are important determinants of health. Nearly half of all preventable deaths in Wisconsin each year have been attributed to a handful of health-compromising behaviors. 1 Tobacco Use Smoking is a frequent cause of preventable deaths. Its negative impact is not only well established for those who smoke but also for those who breathe secondhand smoke. KY 30% 2 1 Percent of adults that currently smoke UT WV UT 60% 6 70% 7 80% 8 90% 9 WV Percent of homes with a smoke ban HI (two-parent household in which both parents reported a ban or a single-parent household in which the parent reported a ban) 70% 6 60% 5 WV Percent of adults that are obese or overweight HI Diet and Exercise A nutrient poor diet, excess consumption of calories, and low levels of physical activity are major causes of obesity, premature death and a range of chronic conditions. Healthy behaviors while young are important for later health outcomes. Breastfeeding provides essential nutrients for infants, has been shown to reduce childhood obesity, and improves the health of mothers. 70% WV 70% 6 60% 5 Percent of adults that are obese or overweight HI 6 60% Percent of adults that are obese or overweight 2 UT % 3 30% 2 Percent of children (10-17) that are obese or overweight UT 4 40% 3 30% UT Percent of children (10-17) that are obese or overweight 4 40% 3 30% 2 LA WA Percent of children (10-17) that are obese or overweight 40% 4 50% 5 60% 6 70% 7 80% 8 90% 9 LA Percent of children that are breastfed WA 40% 4 50% 5 60% 6 70% 7 80% 8 90% 9 Percent of children that are breastfed LA WA 40% 4 50% 5 60% 6 70% 7 80% 8 90% 9-4- Percent of children that are breastfed

7 CO Opportunities to Make Wisconsin the Healthiest State 64% 69% 74% 79% 84% Percent of adults that participated in any physical activity in past month CO 64% 69% 74% 79% CO 84% Health Behaviors (continued) Diet and Exercise (continued) 64% 69% 74% 79% 84% Percent of adults that participated in any physical activity in past month Percent of adults that participated in any physical activity in past month CO 64% TN 69% 74% 79% CO 84% Percent of adults that participated in any physical activity in past month 3 40% 4 50% 5 60% 6 Percent of adults participating in recommended levels of physical activity (150 minutes or more of moderate to vigorous physical activity weekly) TN TN CO CO % 40% % 5 60% 60% 6 6 Percent Percent of adults of adults participating in in recommended levels of of physical activity (150 minutes or more of moderate to vigorous physical activity weekly) TN (150 minutes or more of moderate to vigorous physical activity weekly) CO 3 40% 4 50% 5 60% 6 Percent of adults OK participating in recommended levels of physical VT activity (150 minutes or more of moderate to vigorous physical activity weekly) 12% 18% 24% Percent of adults eating 5 servings of fruit or vegetables per day Alcohol and Substance Use Heavy consumption of alcohol and illegal substances can lead to violence, injury, liver disease, cancer, and premature death. OK OK 12% 18% 24% 12% 18% 24% 2 1 OK 12% (>1 drink per 18% day for women, >2 drinks per 24% day for men) VT VT TN Percent of adults eating 5 servings of fruit or vegetables per day VT Percent of adults eating 5 servings of fruit or vegetables per day Percent of adults that are excessive drinkers Percent of adults eating 5 servings of fruit or vegetables per day AK IA 14% 12% 8% 6% 4% Percent age 12 and older that used illicit drugs in past month Sexual Activity High risk sexual practices, e.g., without the use of condoms, leads to increased risk for transmission of a number of sexually transmitted diseases (STDs). STDs can affect the health of men, women, and unborn children. Risky sexual behavior also leads to unwanted pregnancies (which can have long term negative consequences especially for teenage mothers and their children). NH Teen birth rate (per 1, year olds) NH Chlamydia rate (per 100,000 population) LA MT Syphilis rate (per 100,000 population)

8 NH Health Behaviors (continued) Chlamydia rate (per 100,000 population) 150 Sexual Activity (continued) LA MT Syphilis rate (per 100,000 population) WY Gonorrhea rate (per 100,000 population) Personal Safety Other health behaviors are known to impact health outcomes but do not fit neatly into the previous categories. Accidents are a leading cause of injury and death. Seatbelt use is known to reduce fatality rates in motor vehicle accidents. Deaths from falls measures injury rates in older adults, a leading cause of death. 1.8 MT NH Traffic fatalities per 100,000 miles driven MA 0.6 HI WA 70% 7 80% 8 90% 9 100% 0.4 Percent of total population that uses seatbelts VT AL NJ Deaths from falls (per 100,000 population) -6-

9 Clinical Care Although experts do not agree about the importance of health care relative to the preceding factors in terms of its ability to improve health, they all agree that health care matters. Health care can both save lives and improve quality of life. Governmental public health also plays an important role in promoting, protecting, and restoring health. Access to Care A prerequisite for access to health care means having adequate coverage for preventive, acute, and chronic care. In addition to having affordable health insurance, access to health care means that the full range of health care services, including medical, dental, mental health, and long-term care, are available. Being available means that care is offered when and where it is needed. Note: Some of these measures have question marks after the best and worst values since there is conflicting evidence suggesting that the highest and lowest values for these indicators may not necessarily represent the best and worst values for states. TX TX 3 30% 3 30% 2 2 MA MA 1 1 Percent of adults (18-64) without health insurance Percent of adults (18-64) without health insurance NV NV 2 18% 1 13% 8% HI MA HI MA 3% Percent of children (0-18) without health insurance Percent of children (0-18) without health insurance 2 1 ND ND Percent of adults not receiving care in the last year due to cost Percent of adults not receiving care in the last year due to cost? OK? OK 18% % Ratio of total population to primary care physician Ratio of total population to primary care physician 8% 900 3%? VT? VT ?? NV SD?? NV SD Nurses per 100,000 population Nurses per 100,000 population OK MA OK 5 60% 6 70% 7 MA 80% % 6 70% 7 80% 8 Percent of adults that had a dental visit in the last year Percent of adults that had a dental visit in the last year -7-

10 Clinical Care (continued) Access to Care (continued) KY HI Preventable hospitalizations per 1,000 Medicare enrollees? MA? UT $10,000 $9,000 $8,000 $7,000 $6,000 $5,000 Personal health spending per capita MT CT 82% 84% 86% 88% 90% 92% 94% 96% Percent of children (19-35 months) that received recommended vaccines Quality of Care Having access to health care will only improve health if the care provided is safe, effective, patient-centered, and timely. * Median value for states used in place of average. TX * 30 TX * Agency for Healthcare Reform and Quality Meter Score for Overall Quality of Care Agency for Healthcare Reform and Quality Meter Score for Overall Quality of Care TX * CT 5 60% 6 70% 7 80% 8 90% Percent Percent of pregnant of pregnant women women receiving receiving prenatal prenatal care during care during first trimester first trimester Percent of pregnant women receiving prenatal care during first trimester AK MA 5 AK 60% 6 70% 7 MA 80% Percent of female Medicare enrollees (67-69) that receive mammography screening 5 60% 6 70% 7 80% Percent of female Medicare enrollees (67-69) that receive mammography screening TX CT 5 TX 60% 7 70% 7 80% 8 CT 90% Percent of pregnant women receiving prenatal 70% care during first trimester 5 60% % 8 90% Percent of pregnant women receiving prenatal care during first trimester -8-

11 Social and Economic Factors Research regarding the social and economic factors of individuals and communities is continually growing. Although the magnitude of these effects on health is unknown, it is generally accepted that they have important health influences. Social and economic factors have a bidirectional relationship with health. For example, healthier individuals are able to work, and working individuals generally have better health outcomes due to increased income and access to health insurance. Education There is a well-known relationship between increased education and positive health outcomes. This occurs through several mechanisms such as higher income, better knowledge regarding health behaviors, higher health literacy, and increased access to health care. NV NJ 2 30% 3 40% 4 50% 5 60% 6 70% Percent of children age 3-4 enrolled in preschool NM HI 7 80% 8 90% 9 Percent of adults (18-24) with a high school degree TX CA WY 80% 82% 84% 86% 88% 90% 92% 94% Percent of adults (25 and older) with a high school degree WV MA % 3 40% Percent of adults (25 and older) with a college degree CA NH 24% 22% 18% 16% 14% 12% 8% 6% Percent of the population age 16 and older that lack basic literacy skills Employment Employment impacts health through income, health benefits, pension plans, and other pathways to financial security. Higher levels of health are associated with more job control; more security, less stress, and safer work environments (lower exposures to danger or toxins). NV 14% ND 12% 8% 6% 4% Percent of workforce that is unemployed 2% -9-

12 Social and Economic Factors (continued) Income Income and health have a well-established reciprocal relationship that operates in both directions: higher income leads to better health and better health leads to higher income. Children who grow up in poverty are more likely to suffer from injuries, physical inactivity and chronic diseases such as asthma. MD $35,000 $40,000 $45,000 $50,000 $55,000 $60,000 $65,000 $70,000 Median household income NH 3 30% 2 1 Percent of children (0-17) in poverty NE WY 9% 8% 7% 6% 4% 3% 2% 1% Percent of children (0-17) living in low-income households where no adult worked in past year Family and Social Support Research has shown that people with greater social support, less isolation, and greater interpersonal trust live longer and healthier lives. Those with greater social support experience lower levels of anxiety and depression and show reduced tendencies towards stress-related behaviors such as overeating and smoking. MT NJ Suicide rate per 100,000 population NY UT 2 30% 3 40% 4 Percent of population (age 16 and older) that volunteered last year ND UT 13% 11% 9% 7% Percent of total population living alone -10-

13 Social and Economic Factors (continued) Community Safety Violence and abuse not only have a physical impact on health with the injuries and fatalities that they cause but they also have a significant psychological impact on the victims and other residents of high crime areas. NV Violent crime rate per 100,000 population LA ME 100 NH Homicide rate per 100,000 population Physical Environment Where we live is important to our health throughout our lives. Environments can act as facilitators or barriers to healthy behaviors: it s easier to be physically active in a neighborhood with parks or sidewalks. Additionally, when known toxins such as lead, bacteria, and ozone exist above recommended limits in homes, water or air supplies, there can be serious negative impacts on health. Environmental Quality Air and water pollution are the two most common environmental factors that can impair health. They have been linked to increased respiratory disease, gastrointestinal disorders, and other forms of illness. OR 12 DE Air quality (number of days per year above PM 2.5 limit), FL, KS, MO, NE, NM, ND, OK, SC, SD 2 0 WA 2 1 0% Water quality (percent of total population exposed over health-based limits)? AL? NY 8 80% 7 70% 6 60% 5 50% Percent of workers (16 and older) that drive to work alone -11-

14 Physical Environment (continued) Built Environment Health factors including access to healthy foods and participation in physical activity are directly related to features of the physical environment in which we live, learn, work and play. Additionally, the cost and quality of housing are important in terms of financial security and overall well-being. NM NY NM NY 1 13% 11% 9% 7% 3% 1 13% 11% 9% 7% 3% Percent of total population with limited access to healthy foods Percent (Percent of total of population population who are with low-income limited and access live further to healthy than 1 mile foods (Percent from of a population grocery store who in are urban low-income areas or 10 and miles live further in rural than areas) 1 mile from a grocery store in urban areas or 10 miles in rural areas) MD MD 60% 60% VT VT 5 50% 4 40% 3 30% 5 50% 4 40% 3 Percent of restaurants classified as fast food Percent of restaurants classified as fast food CA CA 9% 7% 3% 9% 7% 3% 30% ND PA ND WV PA WV 1% Percent of total population living in overcrowded housing Percent of total population (>1.00 occupants living per in room) overcrowded housing (>1.00 occupants per room) 1% CA ND 5 50% 4 40% 3 30% 2 1 FL FL 60% Cost-burdened Cost-burdened homeowners (housing costs more than 30% of income) Cost-burdened homeowners (housing costs more than 30% of income) (housing costs more than 30% of income) 5 50% 4 WY 40% WY 60% 5 50% 4 Cost-burdened renters (rent costs more than 30% of income) Cost-burdened renters (rent costs more than 30% of income) 40% References 1 Vilas PM, Booske BC, Wegner MV, and Remington PL. Preventable Causes of death in Wisconsin, Wisconsin Medical Journal, 106(7): , Zhang X, Martinez-Donate AP, and Kuo D. Trends in home smoking bans in in the A : prevalence, discrepancies and disparities. Tobacco Control, Published Online First: 3 August

15 Data Sources MEASURE SOURCE Percent of adults that currently smoke 2011 Behavioral Risk Factor Surveillance System Percent of homes with a smoke ban 2007 Trends in home smoking bans in the A, Percent of adults that are obese or overweight 2011 Behavioral Risk Factor Surveillance System Percent of children (0-17) that are obese or overweight 2007 National Survey of Children s Health Percent of children that are breastfed National Immunization Survey, CDC Percent of adults that participated in any physical activity in past month 2011 Behavioral Risk Factor Surveillance System Percent of adults participating in recommended levels of physical activity 2011 Behavioral Risk Factor Surveillance System Percent of adults eating 5 servings of fruit or vegetables per day 2009 Behavioral Risk Factor Surveillance System Percent of adults that are excessive drinkers 2010 Behavioral Risk Factor Surveillance System Percent age 12 and older that used illicit drugs in past month 2009 SAHA, National Survey on drug use and health Teen birth rate (per 1, year olds) 2009 National Vital Statistics Reports, 60:1, Nov 3, 2011 Chlamydia rate (per 100,000 population) 2010 STD Surveillance, CDC Syphilis rate (per 100,000 population) 2010 STD Surveillance, CDC Gonorrhea rate (per 100,000 population) 2010 STD Surveillance, CDC Traffic fatalities per 100,000 miles driven 2010 Fatal Analysis Reporting System Percent of total population that uses seatbelts 2010 NHTSA s National Center for Statistics and Analysis Deaths from falls (per 100,000 population) 2009 CDC Wonder Percent of adults (18-64) without health insurance 2010 wmerican Community Survey Percent of children (0-18) without health insurance 2011 American Community Survey Percent of adults not receiving care in the last year due to cost 2010 Behavioral Risk Factor Surveillance System Ratio of total population to primary care physician 2009 Health Resources and Services Administration s Area Resource File Nurses per 100,000 population 2011 Bureau of Labor Statistics Percent of adults that had a dental visit in the last year 2011 Behavioral Risk Factor Surveillance System Preventable hospitalizations per 1,000 Medicare enrollees 2009 Dartmouth Atlas of Health Care Personal health spending per capita 2009 Centers for Medicare & Medicaid Services Percent of children (19-35 months) that received recommended vaccines 2010 U.S. National Immunization Survey Agency for Healthcare Reform and Quality Meter Score for Overall Quality of Care 2011 Agency for Healthcare Research and Quality Percent of pregnant women receiving prenatal care during first trimester 2011 National Center for Health Statistics Percent of female Medicare enrollees (67-69) that receive mammography screening 2009 Dartmouth Atlas of Health Care Percent of children age 3-4 enrolled in preschool 2010 Education Counts. Editorial Projects in Education. Edcounts.org Percent of adults (18-24) with a high school degree 2010 American Community Survey Percent of adults (25 and older) with a high school degree 2010 American Community Survey Percent of adults (25 and older) with a college degree 2010 American Community Survey Percent of the population age 16 and older that lack basic literacy skills 2003 National Center for Education Statistics Percent of workforce that is unemployed 2011 Bureau of Labor Statistics Median household income 2010 American Community Survey Percent of children (0-17) in poverty 2010 Small Area Income and Poverty Estimates Percent of children (0-17) living in low-income households where no adult worked in past year 2010 American Community Survey Suicide rate per 100,000 population 2009 CDC Wonder Percent of the population (age 16 and older) that volunteered last year 2010 Corporation for National and Community Service Percent of total population living alone 2010 Census Violent crime rate per 100,000 population 2010 Department of Justice Homicide rate per 100,000 population 2009 CDC Wonder Air quality 2011 U.S. Environmental Protection Agency Water quality 2011 Safe Drinking Water Information System Percent of workers (16 and older) that drive to work alone 2010 American Community Survey Percent of total population with limited access to healthy foods 2006 County Health Rankings Percent of restaurants classified as fast food 2009 County Business Patterns Percent of total population living in overcrowded housing 2010 American Community Survey Cost-burdened homeowners 2010 American Community Survey Cost-burdened renters 2010 American Community Survey Government public health spending per capita 2011 Trust for America s Health -13-

16 POPULATION Health Sciences University of Wisconsin M A D I S O N CONTACT University of Wisconsin Population Health Institute Department of Population Health Sciences University of Wisconsin School of Medicine and Public Health 575 WARF Building 610 Walnut Street Madison, Phone: (608) Fax: (608)

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