PHRUC 2015: County Health Rankings Assignment Due Friday, February 13, 2015 by 4:00 pm, via the Dropbox

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1 PHRUC 2015: County Health Rankings Assignment Due Friday, February 13, 2015 by 4:00 pm, via the Dropbox Introduction In this assignment, you ll explore publicly available data (via the County Health Rankings [CHR] database and website) to assess the health of a United States county. I know this is a long, long set of instructions. Don t panic Much of the material that follows provides basic but detailed (perhaps painfully detailed) information on the assignment and/or instructions on how to access various facets of the CHR website. Those instructions are in plain text. Passages in italics that is, in this sentence s typeface are prompts for the writing of the paper. You might be able to skim the plain-text instructions, but please pay close attention to the italicized passages Paper format and mechanics Your report should be 3-4 double-spaced pages (see below), and should give the reader a basic overview of the health status of people who live in the county you have selected. Imagine that you re writing for an audience of public officials or community activists folks with limited time and/or background in public health. A general overview of the paper (the details of will become clear as you read on): 1. First, you ll provide an introduction to the county you ve chosen. You re free to choose a county at random, or one in which you have a personal connection or interest Then you ll detail the (at least) five indicators your report covers one assigned, four of your choice and explain their significance as measures of public health including illustration of how your county compares to other counties in its state. 4. After analyzing these data, you ll review available resources and recommend an action relevant to one of the (at least) four indicators you chose in (3). 5. You ll finish by drawing your own conclusions about the overall public health status in the county you have chosen. If you don t feel you can deliver complete (or even thorough) assessment of these issues, you ll specify what additional data might be useful for completing such an assessment. While I ve listed numbered components and provided specific questions and criteria for you to address, your report should be in a fluid, narrative format. You should include headings and subheadings to organize the report and make it user-friendly for your reader. Be sure to include an introductory paragraph describing the community, and a short final paragraph that summarizes your findings. You are welcome to create tables or figures to summarize the data, but it s not required. Another note: if the county you choose is one with which you re familiar, feel free to use your insider knowledge in analyzing the public health issues in the county. Although you submit papers through Learn@UW, I return them either in class or via individual . To help me out, please make sure your name appears on the first page of your report. Papers without names will receive a score of zero for this assignment. Your report should be typed, double-spaced, using a 12-point font of common use (e.g., Times New Roman, Garamond) and one-inch margins. Please include page numbers. Proofread your work carefully Papers with frequent misspellings and grammatical errors will be marked down by a half grade. Yet while grammar and mechanics are important, it s most important that you communicate your findings clearly and accurately, and support your discussion with relevant data. I urge you to make use of the University s writing center at 6171 Helen C. White Hall. Graduate students and professional staff are available to help you develop your writing. For best results, make an appointment for an individual consultation well in advance of the due date of the assignment. 1

2 Introduction to the County Health Rankings Webpage Point your browser to the CHR website: You should see this webpage: If you know the name of the county you d like to explore, type it in the search bar. As you can see (in the red circle below), I ve typed Tarrant which is my home county in Texas into the bar. Click the blue compass pin or the gray box to continue. 2

3 That brings us, appropriately enough, to the page for Tarrant County, Texas. If you know which county you re going to choose, follow the above instructions, and click this to continue. Still undecided about your county? You can click a state on the U.S. map. (I ve chosen Texas): That will bring up a map of the state, with all of its counties listed and clickable: 3

4 As seen below, you can pick a county from the left-side list (red box). Browse the list by clicking the boxes at the bottom (orange box). Or click a county on the map (the blue box is around Tarrant): 4

5 Selecting Tarrant County brings us to the same Tarrant County page that we reached via the first set of instructions above. Now that we re all on the same page, literally and figuratively, let s continue the details of the assignment. Keep in mind throughout these instructions: Don t panic And if in doubt, click Measures. 5

6 Once you ve reached your county s page, there s a County Snapshot table with a first row titled Health Outcomes (red square). In that row, under Rank (of [n]) (where n is a number), is the overall CHR ranking for your selected county, relative to the state s other counties: As an initial step, click the Additional Measures tab in the orange box above the one next to County Snapshot. The page now displays selected indicators for the county and state as a whole: 6

7 As you scroll down, you ll see statistics on the county s demographics, health outcomes and care, social and economic factors, and physical environment. 1. The demographic statistics should play a role in your introduction, which should give an overview of your county. Consider what these data suggest about the population of the county, both in and of itself and relative to the state. Notice that all of the indicators are blue links. (This is also true of the indicators on the County Snapshot table, as we ll see below.) Each indicator s home page is an alphabetical county listing; if you click the blue indicator link on that page (in the case below, Hispanic ; blue box), you ll get a list sorted using that indicator either from lowest to highest, or vice-versa. Just as importantly (at least for this paper), there are Description and Data Source tabs (red box in the screen shot below) that give you more information on the indicator: If you click Description : If you click Data Source : 7

8 Now, go back to the County Snapshot tab: Within the table, look at the row titled Premature death (under Mortality ; blue square). Again, the data listed are for your county. Click the Premature death link. You ll see something like this: 8

9 The red box highlights summary information about the listed indicator (again, in this case Premature Death, under the heading of Health Outcomes ) and its use in the overall rankings. While the default indicator home page is now a map, notice that the tabs (in the blue box) still include the county listing ( Data ) and the Description and Data Source links. Use these tabs 2(a). Summarize in one or two sentences what the indicator listed means, where the data used to create the indicator come from, and the time period those data cover. 2(b). Also address how important this measure is in the overall health rankings for your county. Is that weight is appropriate, or would you weigh it differently and in either case, why? 2(c). Going back to the previous screen, compare the premature death statistic in your county with those for the state as a whole and the national overall. Is your county worse or better off than most other counties within your state? Explain your basis for this comparison. Substantiate your assessment by citing the relevant quantitative data. 2(d). Also, assess the quality of the data for this indicator for your county, considering (at least) the following questions: Do you think it s a reliable source of data for this outcome? What do you make of the error margin? A note for the curious: the Z-Score column is explained at: We re almost done with the screen shots. Just one more tip a shortcut for making the next steps more efficient. Go back to the County Snapshot one more time: Note the purple box. 9

10 If you click on the down-arrow in that box, it will give you options: you can choose Health Outcomes or Health Factors. Under the former category, you ll see Overall Rank (the default that we ve already seen), Mortality, and Morbidity. Under the latter, you ll see Overall Rank again, along with Health Behaviors, Clinical Care, Social and Economic Factors, and Physical Environment : No prize for noticing that this is the same list of main categories from the Additional Measures screen discussed above. When you select one of these categories, the county list below it re-sorts into rank order, from top to bottom. This is useful, but it might also be a little misleading. Because if you actually select an indicator in the table to the right say, Poor or fair health, under Morbidity you get what appears to be a familiar page: BUT 10

11 Now, if you click on the down-arrow (in the purple box), you get a drop-down list of all the other indicators in the main category (again, in this case, Morbidity, under Health Outcomes as we see in the red box below): Better still, if you click on another category say, by clicking on Additional Measures, all the way to the left bottom, you get a list of all of those categories, again: And, when you click one of those categories to the right, you get a complete list of the relevant indicators for example, for Social & Economic Factors (again, below in the red box): When you select one of those indicators on the right-hand side say, High housing costs you re taken directly to that indicator s page. And from there, you can access all of the indicators via the same drop-down options, without having to go back to the County Snapshot and/or Additional Measures pages. 11

12 OK: on with the show. Here s a table of all of the indicators available in the database, with the exception of the Demographics category: HEALTH OUTCOMES HEALTH FACTORS ADDITIONAL MEASURES Length of life Quality of life Health Behaviors Clinical Care Social & Economic Factors Physical Environment Health Outcomes Health Behaviors Health Care Social & Economic Factors Premature death Poor or fair health Poor physical health days Poor mental health days Adult smoking Adult obesity Food environment index Uninsured Primary care physicians High school graduation Some college Air pollution: particulate matter Drinking water violations Physical inactivity Dentists Unemployment Severe housing Access to exercise problems opportunities Excessive drinking Alcohol-impaired driving deaths STIs Diabetes HIV prevalence rate Preventable hospital stays Diabetic screening Inadequate social support Children in singleparent households Violent crime Driving alone to work Mental health providers Children in poverty Premature ageadjusted mortality Infant mortality Food insecurity Limited access to healthy foods Motor vehicle crash deaths Drug poisoning deaths Uninsured adults Uninsured children Could not see doctor due to cost Median household income Children eligible for free lunch Homicide rate Low birthweight Teen births Mammography screening Injury Deaths Long commute Child mortality Health care costs Other primary care provider 3(a). Choose four (or more) indicators, with no more than one indicator from each of the second-row columns. The pink-shaded boxes are off limits. That is, you can choose only one indicator from each column except Length of life Quality of life (under Health Outcomes ); Health Behaviors, Clinical Care, Social & Economic Factors, and Physical Environment (under Health Factors ); and Health Outcomes, Health Behaviors, Health Care, and Social & Economic Factors (under Additional Measures ) and you may not choose Premature age-adjusted mortality under Health Outcomes. For each indicator you ve chosen, summarize in one or two sentences what the indicator listed means, where the data used to create the indicator come from, and the time period those data cover. In one more sentence, explain why you chose this indicator. 3(b). Now, use the map and ranking lists that we ve covered above to compare data for each of your chosen indicators in your county with comparable data for your state overall. For each measure, answer the following: Is your county worse or better off than most other counties within your state? Explain your basis for this comparison. Substantiate your assessment by citing the relevant quantitative data. Next, assess the quality of the data for each chosen indicator for your county. Do you think it s a reliable source of data for this outcome? If not, what additional data would you seek? How important is this measure in the overall health rankings for your county? Do you think that s appropriate, or would you weight it differently? If so, why? PHRUC 2013 County Health Rankings Assessment 12

13 I know I said we were done with screen shots, but for the last facet of the paper, we should loo just a few more (sorry). Go back to the CHR home page: The red box in the screen-shot above has two tabs: Rankings and Roadmaps. Rankings is the default, and that s the one we ve been using until now. Mouse over on Roadmaps and click on Action Center. 13

14 On the page that loads next, you ll be prompted to click links that identify your role in the community (e.g., Community Development ; Business ; Government ; Public Health ), or take action for a specific goal (e.g., Assess Needs and Resources ; Choose Effective Policies and Programs ; Evaluate Actions ): The pages to which these links lead have a wealth of resources, many of which link to external websites with information on community organizing or developing and evaluating public health interventions. 4a. Skim these materials and write a short paragraph, alerting your audience to the resources available on the web. In one or two sentences, explain to your audience how these web resources may be useful in developing programs that could improve public health, at least with respect to the indicators you have explored in parts 1, 2, and 3 of this exercise. 4b. For any one of the health indicators you have described, give one specific idea for an action that a community leader, elected official, or health professional might do to improve the health of this community. 5. Conclude your paper by summarizing your interpretation of what the indicator reports mean for the overall public health profile of your county and the likely health concerns of its citizens. What implications might your findings have for activists, policy-makers, healthcare providers, and regulatory officials for devising ways to improve community health? What additional data would be helpful in profiling this community? 14

15 Grading Rubric Section Points 1. Introduction 15 Overview of county 2. Health Outcome: Premature Death 15 Summary (definition data source, time period, choice) County-state comparison Quality of data assessed Weight of statistic in overall ranking considered 3.1 Chosen Indicator One 10 Summary (definition data source, time period covered) County-state comparison Quality of data assessed Weight of statistic in overall ranking considered 3.2 Chosen Indicator Two 10 Summary (definition data source, time period, choice) County-state comparison Quality of data assessed Weight of statistic in overall ranking considered 3.3 Chosen Indicator 3 10 Summary (definition data source, time period, choice) County-state comparison Quality of data assessed Weight of statistic in overall ranking considered 3.4 Chosen Indicator 4 10 Summary (definition data source, time period, choice) County-state comparison Quality of data assessed Weight in overall ranking 4. Action Center Exploration 15 Summary Action idea 5. Conclusion: 15 Implications Additional data needed? TOTAL 100 points 15