2. Individual view: Healthcare spikes just before death
Source: Robert Fogel, U. Chicago / AEI Forecasting the Cost of U.S. Healthcare, 2009
3. Source: Paul Fishbeck, Carnegie Mellon University, 2009
But others don’t experience the U.S. pattern.
4. AND most “high-cost patients” are not at end of life.
• They come in waves.
• In any given year,
only 11% of highest-
cost patients are in
their final year of life.
• 49% are having a
discrete high-cost
medical episode.
• 62% won’t be in the
top 5% next year.*
Source: AHRQ/HHS, 2011; adjusted to include nursing home population (NCHS, 2013); *NIHCM Foundation 2012.
5. These cycles of healthcare & cost repeat many times over a lifetime.
8. Central Questions of PIHC’s Health & Well-being Monitor™
How do our county residents define their health & well-
being? What resonates for them?
What factors do residents find important to health &
well-being?
How satisfied are they with their own health &well-
being?
8
9. Physical Health
Emotional
Health
Learning &
Growth
Financial
Security
Relationships
Community
Access:
Health Information
Access:
Medical Care
Access:
Transportation
Eating Patterns
Physical Activity Neighborhood
Safety
Housing
Quality
Access:
Healthy Food
Neighborhood:
Physical Condition
Meaningful
Work
Sense of Belonging
to a Community
Participation:
Community Events
Workplace
Atmosphere
Control Over
Life Events
Outlook on Life
Sense of Purpose
& Meaning
Treatment by
Others
Racial or Ethnic
Discrimination
Our community defined health/wellbeing 24 ways
10. Security & Basic Needs: from the TotalHEALTH™ 7
30% of county
respondents
lack at least 1
basic need.
Education
accounted for
about half.
12. 24 attributes map to Six Dimensions of Health & Well-being…
…creating our roadmap to population health
13. Tailored Community HWB Monitor™
• A snapshot of your own community health
& well-being
• Benchmarks to compare to the county or
similar communities
• Insights into focus areas for improvement
• Access to hyperlocal tools & resources
• A way to monitor progress over time
Countywide HWB Monitor Goal:
• A standard measure of health & well-
being for our county
• Defined by our residents
• Monitor & report changes annually
• Unprecedented local insights
• Help Snohomish County flourish
A standard for health & well-being available to all
25. Measuring ‘Can Do’: Getting BY: BETTY
Bandura
SeeToplineQuestionsQ18,Q8c
Getting By: 100K
Struggling to Challenged Good to Flourishing
NO
MORE
CAN
DO
MORE
26. Measuring ‘Can Do’: Getting By / “Betty”
HWB Index: 47% (F) “Struggling”
Age: 57 years old (62% >55)
Race: Caucasian (10% POC vs. 19% pop)
Gender: 57% female
Relationships:
• Single, living alone (87% no kids)
• Relationship difficulties (40%)
• Isolated, not part of community (52%)
• No sense of community efficacy (55%)
Mental/emotional/spiritual:
• Struggling emotionally (52%)
• 3+ poor mental health days/mo (53%)
Neighborhood & Environment
• Very dissatisfied (41%, 2x population)
• 0 exercise days/week (30%, 2x pop)
Work/Learning & Growth:
• Education: High School (77% no college)
• Low income, $ insecure (66% <$25k/pc)
• Part-time job, troubles (46%)
• No sense of opps for growth (40%)
Security/Basic Needs:
• Housing concerns, Food insecurity (42%)
• Social Needs (42% with 1+ SDOH needs)
Physical Health:
• Not happy with physical health (65%)
• Chronic medical condition (55%)
• 3+ poor health days/month
• Sedentary; no exercise
• <7 hours sleep most days (4x pop avg)
“Just Getting By”: 100K people (12% of county), predominantly Everett, Marysville, Arlington/northeast
27. Measuring ‘Can Do’: Getting Traction: TRACY
Bandura
SeeToplineQuestionsQ18,Q8c
Getting Traction
305K
Struggling to Challenged Good to Flourishing
NO
MORE
CAN
DO
MORE
28. Measuring ‘Can Do’: Getting Traction/ “Tracy”
HWB Index: 64% “D” Challenged
Age: 29 (#2nd Millennials cohort @ 30%)
Race: Caucasian (13% POC vs. 19% pop)
Gender: 57% female
Relationships:
• Married, 2 kids (35% couples/kids)
• Relationship OK (25% excel vs. 45%)
• Not community connected - yet (56%)
• Lowest community efficacy (63% no)
Mental/emotional/spiritual:
• Emotional challenges (41%)
• Struggle w/ purpose (72% “no/some”)
• 3+ poor mental health days/mo (52%)
Neighborhood & Environment
• OK (41% Unhappy, 2x population)
Work/Learning & Growth:
• Education: HS, college (like pop overall)
• Low income, $ insecure (44% <$25k/pc)
• Risk of job loss (17%; 2x population)
• Sees opps for growth (43% positive)
Security/Basic Needs:
• High Social Needs (40%; @ 2x overall
population)
• ~Education, transportation, job
Physical Health:
• Highest phys hlth dissatisfaction (70%)
• Risk of Chronic medical condition (42%)
• 1+ poor health days/month (63%)
• Workout 1-3 days/wk (53%)
• <7 hours sleep 1-3 days/wk (39%)
“Getting Traction”: 305K people (37% of county), predominantly Everett, Monroe-east, Lake Stevens/Granite, Marysville
29. Measuring ‘Can Do’: Getting There: TED
Bandura
SeeToplineQuestionsQ18,Q8c
Getting There
316K
Struggling to Challenged Good to Flourishing
NO
MORE
CAN
DO
MORE
30. Measuring ‘Can Do’: Getting There/ “Ted”
HWB Index: 86% “B” Good
Age: 39 (Highest Millennials cohort @ 32%)
Race: African Amer (32% POC)
Gender: 55% male
Relationships:
• Married, 1 child (73% couples/kids)
• Excellent relationships (68% v. 45% pop)
• Community connected - yet (65%)
• Solid community efficacy (61%)
Mental/emotional/spiritual:
• Mental/emotionally stable (98% pos.)
• Hi purpose/meaning (55% “fits exact”)
• 0-1 poor mental health day/mo (56%=0)
Neighborhood & Environment
• Good (11% Unhappy, half county rate)
Work/Learning & Growth:
• Education: college grad (highest
college/grad school rate @ 43%)
• Good income, $ secure (48%
>$100K/HH; 3% job worries)
• Strong job satis (85% positive)
• Strong learning/growth (56% “excell”)
Security/Basic Needs:
• Rare social needs (97% 0-1)
Physical Health:
• Satisfied (55% moderate; 45% highly)
• No medical condition (80%)
• Rare poor health days/mo (60%=0)
• Workout 4-6+ days/wk (68%=4+)
• <7 hours sleep most days/wk (70%)
“Getting There”: 316K people (37% of county), predominantly Bothell, Edmonds, Snohomish
31. Measuring ‘Can Do’: Getting Kudos: KURT
Bandura
SeeToplineQuestionsQ18,Q8c
Struggling to Challenged Good to Flourishing
NO
MORE
CAN
DO
MORE
Getting Kudos: 109K
32. Measuring ‘Can Do’: Getting Kudos/ “Kurt”
HWB Index: 91% “A-” Flourishing
Age: 54 (66% 35-64)
Race: Caucasian (7% POC vs. 19% pop)
Gender: 59% male
Relationships:
• Couple no kids home (49% - highest)
• Relations thriving (76% excel vs. 45%)
• Deep community (57% “exactly”)
• Highest community efficacy (75% yes)
Mental/emotional/spiritual:
• Emotionally thriving (72%; 2x pop)
• Hi life purpose/meaning (88% “exact”)
• 0 poor mental health days/mo (71%)
Neighborhood & Environment
• Loves it (71%, 1.7x avg population)
Work/Learning & Growth:
• Education: Some college (44%, highest)
• Income, $ insecure (49% >100k/PC)
• No job fears (99%)
• Hi growth potential (91% positive)
Security/Basic Needs:
• No basic/social Needs (98%)
• Excellent healthcare access (87%)
Physical Health:
• Highly satisfied (64% ‘excel’)
• No chronic medical condition (78%)
• Fewest poor health days/mo (75%=0)
• Workout near daily (45% daily; highest)
• Most sleep (49%=7+ hrs daily;
75%=most days)
“Getting Kudos”: 109K people (13% of county), predominantly Arlington, Lynnwood, Snohomish
37. Discrimination, Well-being, and Health
“A threatening childhood and adolescent milieu indicates
a need to be vigilant and on guard…
…fosters calibration of the immune system
to a hypersensitive mode.
This early programming is predicted to:
• foster vigilance and elevated inflammation through-out the life course.
• amplify the effects of adult exposure to potentially racist events.”
Source: Simons, Barr, Gibbons, October 2018
38. Discrimination, Well-being, and Health
“A medical/public health model that
restricts its focus to increasing socio-economic
status and reducing health risk behaviors
is likely to have little impact
on the ill health
of Black Americans.”
Source: Simons, Barr, Gibbons, October 2018
39. • National Association for the
Advancement of Colored People (NAACP)
• Greater Trinity Academy & Church
• Forest Park SDA Church
• Latino Educational Training Institute
• Community Health Center of Snohomish
County
• United Way Collaborative: Improving
School Attendance for Families in
Transition
• Everett AMEN Clinic (medical &
community)
• Cascade Valley Health Foundation
(Stilly Valley)
• Interfaith
• Everett Housing Authority
• Providence Northwest Service Area
Community HWBM – underway & exploring in 2018
