During the 2nd breakout session at Edge of Amazing 2016, Jody Early, PhD (UW Bothell School of Nursing & Health Services) and Elizabeth Parker, PhD (Snohomish Health District) discussed results from the PIHC Health & Well-Being Monitor & the Health Districts latest profile of health in Snohomish County.
2. Taking Stock:
The Health District’s Profile of
Health in Snohomish County
and the Results of the PIHC
Health & Well-Being Monitor
Elizabeth Parker, PhD, MHS
Epidemiologist, Snohomish Health District
Jody Early, PhD, MS, MCHES
Associate Professor, UW Bothell School of Nursing &
Health Studies
Co-Chair, PIHC, AimWell/Center for Health Priorities &
Progress
Stuart Elway, PhD, Elway Research, Inc.
9. • A measure of differences in outcomes between
populations.
• Health disparities exist in relation to:
–Income
–Race/ethnicity
–Education-level (among many others)
• Do not provide an explanation for the origin of these
differences in health.
Health Disparities
10. • Conditions in which we live, learn, work, and play are
significant factors that impact our health.
• Life enhancing resources whose distribution across
populations determines length and quality of life.
• Responsible for unfair and avoidable differences in
health seen within and between communities in
Snohomish County.
• Root causes of health disparities
Social Determinants of Health
12. Big Picture
Demographics & Socioeconomic
Characteristics
Snohomish
County
Washington
Population size 757,600 7,061,410
Median household income $69,443 $60,294
Unemployment rate 9% 9%
Residents with bachelor’s degree or
more 29% 32%
Sources:
(1) U.S. Census Bureau, 2010-2014 5-Year American Community Survey
(2) Washington State Office of Financial Management, Forecasting Division, single year ntercensal estimates 2001-2015, June 2015.
13. Big Picture
General Health (2015)
Snohomish
County
Washington
Life expectancy at birth (in years) 80.3 80.4
Mortality rate*
(per 100,000 people)
708 692
Infant mortality rate
(per 1,000 live births)
4.1 4.8
Years of potential life lost before age 65
(per 100,000 people)
3,407 3,536
* Age-adjusted rate
Sources:
(1) Washington State Department of Health, Center for Health Statistics, Birth Certificate Data, 1990–2014, August 2015.
(2) Washington State Department of Health, Center for Health Statistics, Death Certificate Data, 1990–2014, August 2015.
14. Big Picture
Health Outcomes, 2011-2015
Snohomish
County
Washington
Self-report health as good or excellent 84% 84%
Serious mental illness 4% 3%
Current smoker 16% 16%
Diabetes 9% 9%
Heart disease 4% 4%
Source:
Washington State Department of Health, Center for Health Statistics, Behavioral Risk Factor Surveillance System 2011-2015, supported in part by Centers for
Disease Control and Prevention
17. Snohomish Health Reporting Areas
Source:
U.S. Census Bureau, 2009-2013 5-Year American Community Survey
North Everett
Tulalip Bay &
the North
Coast
South Everett
Edmonds,
Mountlake
Terrace &
West
Lynnwood
Arlington,
Stanwood &
Darrington
Snohomish
County
Marysville
Granite Falls,
Lake Stevens
& Snohomish
Mukilteo &
North
Lynnwood
Sultan,
Skykomish &
Monroe
Bothell & Brier
Mill Creek &
Silver Firs
$55,757 $63,271 $64,055 $66,096 $66,397 $68,381 $70,698 $75,298 $76,548 $81,659 $88,600 $100,390
Mill Creek &
Silver Firs
Edmonds,
Mountlake
Terrace &
West
Lynnwood
Bothell & Brier
Mukilteo &
North
Lynnwood
Granite Falls,
Lake Stevens
& Snohomish
Snohomish
County
Sultan,
Skykomish &
Monroe
Arlington,
Stanwood &
Darrington
Marysville South Everett North Everett
Tulalip Bay &
the North
Coast
6.6% 7.5% 8.3% 8.6% 9.1% 9.3% 9.4% 9.7% 9.8% 10.3% 11.5% 13.3%
Average median household income
Unemployment rate
18. Snohomish Health Reporting Areas
Source:
U.S. Census Bureau, 2009-2013 5-Year American Community Survey
Tulalip Bay &
the North
Coast
Marysville
Arlington,
Stanwood &
Darrington
Granite Falls,
Lake Stevens
& Snohomish
North Everett South Everett
Sultan,
Skykomish &
Monroe
Snohomish
County
Mukilteo &
North
Lynnwood
Edmonds,
Mountlake
Terrace &
West
Lynnwood
Bothell & Brier
Mill Creek &
Silver Firs
17% 19% 19% 23% 24% 25% 26% 29% 35% 38% 43% 45%
Resident’s with a bachelor’s degree or more
19. Snohomish Health Reporting Areas
Source:
Washington State Department of Health, Center for Health Statistics, Death Certificate Data, 1990–2014, August 2015.
Tulalip Bay &
the North
Coast
North Everett
Arlington,
Stanwood &
Darrington
Granite Falls,
Lake Stevens
& Snohomish
South Everett
Snohomish
County
Marysville
Mukilteo &
North
Lynnwood
Sultan,
Skykomish &
Monroe
Mill Creek &
Silver Firs
Edmonds,
Mountlake
Terrace &
West
Lynnwood
Bothell &
Brier
73.3 78.7 78.8 79.7 79.8 80.3 80.4 81.2 82.1 82.2 82.3 82.7
Edmonds,
Mountlake
Terrace &
West
Lynnwood
Bothell &
Brier
Sultan,
Skykomish &
Monroe
Mill Creek &
Silver Firs
Marysville
Snohomish
County
Mukilteo &
North
Lynnwood
South Everett North Everett
Granite Falls,
Lake Stevens
& Snohomish
Arlington,
Stanwood &
Darrington
Tulalip Bay &
the North
Coast
586 594 599 605 689 691 692 716 756 758 782 970
Life expectancy
Mortality rate rate
20. Snohomish Health Reporting Areas
Source:
Washington State Department of Health, Center for Health Statistics, Death Certificate Data, 1990–2014, August 2015.
Mukilteo &
North
Lynnwood
Granite Falls,
Lake Stevens
& Snohomish
Arlington,
Stanwood &
Darrington
Bothell & Brier
Sultan,
Skykomish &
Monroe
Snohomish
County
Mill Creek &
Silver Firs
South Everett North Everett
Edmonds,
Mountlake
Terrace &
West
Lynnwood
Marysville
Tulalip Bay &
the North
Coast
0 1.2 1.3 1.3 1.5 4.1 4.3 5.2 6.1 6.2 6.6 8.3
Mill Creek &
Silver Firs
Bothell & Brier
Mukilteo &
North
Lynnwood
Sultan,
Skykomish &
Monroe
Granite Falls,
Lake Stevens
& Snohomish
Marysville
Edmonds,
Mountlake
Terrace &
West
Lynnwood
Snohomish
County
South Everett
Arlington,
Stanwood &
Darrington
North Everett
Tulalip Bay &
the North
Coast
2,178 2,220 2,471 2,629 2,908 3,057 3,136 3,259 3,650 3,922 4,361 8,538
Infant mortality rate
Years of potential life lost relative to age 65
21. Health by Race/Ethnicity
White Black
American
Indian/
Alaska
Native
Asian/
Pacific
Islander
Hispanic
(of any
race)
Self-reported health 85% 82% 89% 64%
Serious mental illness 5% 10% 4% 3%
Diabetes 10% 6% 7% 8%
Current smoker 17% 25% 9% 14%
Heart disease 4% 3% 1% 3%
Sources:
Washington State Department of Health, Center for Health Statistics, Behavioral Risk Factor Surveillance System 2011-2014, supported in part by Centers for Disease Control and Prevention
22. Source:
Washington State Department of Health, Center for Health Statistics, Behavioral Risk Factor Surveillance System 2011-2014, supported in part by Centers for Disease Control and Prevention
Health by Education-Level
Did not
graduate HS
Graduated
HS
Attended
some
college/
technical
school
College/
technical
school
graduate
Self-reported health 53% 81% 86% 93%
Serious mental illness 14% 4% 5% 1%
Diabetes 11% 8% 11% 8%
Current smoker 36% 21% 17% 7%
Heart disease 5% 4% 4% 3%
23. Source:
Washington State Department of Health, Center for Health Statistics, Behavioral Risk Factor Surveillance System 2011-2014, supported in part by Centers for Disease Control
and Prevention
Health by Income-Level
<$25,000
$25,000-
$49,999
>$50,000
Self-reported health 64% 83% 91%
Serious mental illness 14% 4% 5%
Diabetes 12% 11% 8%
Current smoker 36% 21% 17%
Heart disease 6% 5% 3%
24. What Does This Mean?
• Progress has been made in improving the health of Snohomish
County residents, but not all groups have benefited equally.
• Health Reporting Areas and sociodemographic groups have
distinct health issues that must be addressed.
• Full participation of affected communities is needed to begin
tackling the disparities.
26. What Data Are Presented?
Demographics
• Age and race
Socioeconomic Characteristics
• Income, unemployment, education, etc.
Health Outcomes
• Life expectancy
• Leading causes of death
• Mortality by age
• Birth outcomes
27. • To support community health improvement efforts.
• To help the Health District, elected officials, and
community members identify priority health issues as well
as underlying conditions that are more immediately
actionable.
• To help community groups interested in prioritizing and
improving health outcomes.
Why Create These Reports?
28. • Knowledge is power.
• Information will enable communities to understand the
major health challenges facing their residents and take
action.
• The Health District wants to be closely connected with
your community as we work in partnership to reduce the
impact of your health concerns.
How Do You Use the Reports?
29. How the District is Addressing Disparities
Community Health Improvement Plan (one example)
• Youth physical abuse
• Have a Plan: Social marketing campaign targeting parents
• Youth and adult suicide
• Mental Health First Aid: Course that provides people skills to help someone
developing a mental health problem or in crisis
• Youth and adult obesity
• 5210 Campaign: 5 fruits/vegetables, 2 hours or less of screen time, 1 hour or
more of physical activity, 0 sugary drinks
32. 32
• There are numerous data
sources at the national, state,
and local level that focus on
medical care and health-related
outcomes.
• Most measure health indicators
and variables are selected for
study by researchers and
“experts.”
Sources of Health Data
33. 33
1) To provide a periodic measure of county residents’
perceptions about their health status and overall
satisfaction with their health and well-being.
2) To guide practical action by providing an additional
source of data that organizations can use for planning
purposes.
3) To offer strategic guidance to PIHC to help direct
where it focuses its attention and resources to create
positive change.
Why Develop a Health & Wellness
Monitor for Snohomish County?
34. Central Questions of the HWBM:
What factors do residents of Snohomish
County think are important to health and
well-being?
How satisfied are they with their own
health and well-being?
34
35. 35
Creating a More Complete Picture
of Health:
Using the Social Ecological Model of Health as a Framework for
Community Conversations and the Health & Well-Being Monitor
36. Groundwork in 2015:
Listening to the Community
• How are health & well-
being defined?
• What social ecological
factors impact people’s
ability to be healthy?
• What makes a healthy
community?
37. Why are understanding perceptions important?
*Decades of research have established that perceptions and behaviors are related.
38. 2015 Focus
Groups & Community
Conversations
• Everett + North / <$65,000
• Everett + South / >$65,000
• Arlington Area /Age 25-45
• Monroe Area / Age 45-65
UW Bothell | Lutheran Community Services NW
Elway Research, Inc. | EvCC | Housing Hope
•College Youth from first gen. and ethnic minority
groups/EVCC [Everett]
•Tribal Communities (Tulalip Tribe) / Marysville-Tulalip
•Adults in low income housing or transition housing
[Lynnwood]
•Latina mothers/(all non-native U.S.) [Everett]
•Latina female lay health workers/Promotoras/
[Lynnwood]
•Women/lower SES/mixed ethnicities/ [Lake Stevens]
•Rural adults/most middle age/ all Caucasian and most
lower income [Granite Falls]
•Rural adults/lower-income senior citizens(10/12); mostly
Caucasian/female/ lower income [Arlington]
39. • Relationships with others
• Outlook on life
• Sense of purpose/meaning
• Treatment by others
• Opportunities for learning &
growth
• Ability to control life events
• Sense of belonging to
community
• Participation in cmty events
• Access to healthy food
• Access to medical care
• Access transportation
• Access to health information
• Quality of my housing
• Safety of my neighborhood
• Community environment
• Condition of neighborhood
• State of my physical health
• My mental/emotional health
• Level of physical activity
• My eating patterns
• Having meaningful work
• Workplace atmosphere
• Level of financial security
• Feelings of racial and ethnic
discrimination
Emergent Themes (Factors) from
Community Conversations & Focus Groups
…Formed Measures for the HWBM…
40. Survey Information
• PIHC Advisory committee
looked at other population
surveys
• Quantitative Survey based on
24 attributes
• 75 questions/inquiries
• Combination of question types
• Bi-polar scales [-5] to [+5]
• Unipolar scales 0-10
• Multiple choice
• Open-end
• Attitudinal questions
• Behavior questions
• Demographic items
41. Sample and Methods
• Participants: 751 adults (18 years +)
• Administered by Elway Research
• Systematic random sample of
Snohomish county households
• Data collection January 7th – 30th
2016
• Margin of Error: + 3.6% at the 95th
percent confidence interval
• Multiple methods of data
collection:
• 500 completed phone
interviews by live
interviewers (27% on cell
phones)
• 251 residents completed
the questionnaire online
46. 46
38
21
20
7
7
5
2
Split w Employer
Employer Paid
Medi-care/caid
Self Paid
Other
No Coverage
No Ans
% of
Sample
with Health
Insurance
89% had at least
one scheduled
appointment
with a health
care
professional in
the last year.
48. Four Primary Index Measures
N = 751
ITEM AVERAGE +4 or +5
Overall satisfaction with the way things are going in your life +2.66 45%
Current mental or emotional health +2.96 52%
Overall health rating +2.46 38%
Satisfaction with your physical health +1.97 33%
Rating Scale = -5 to 5
50. Differences by Demographics
•Age
•Education *
•Employment
•Income*
•Ethnicity
•Gender
•Number of chronic
conditions*
• Significant demographic factors:
Satisfaction scores went up with
education level and income
• There were significant differences by
age, but relationship was not linear
• Scores were more strongly related to
health conditions than demographics.
Scores went down with the presence of
a health condition, number of bad health
days, and number of healthcare visits.
51. Linking Health Monitor Scores to
Underlying Health
Also tested for:
• Poor physical
health days
• Poor mental
health days
• Presence of
medical
condition
53. Perceptions of Factors that
Influence Health & Well-Being
Survey respondents were asked to rate each factor on two criteria:
1) The importance of each factor on a person’s well-being in general;
2) The personal influence each factor is having on “your own life
these days.”
54. • Relationships with others
• Outlook on life
• Sense of purpose/meaning
• Treatment by others
• Opportunities for learning &
growth
• Ability to control life events
• Sense of belonging to
community
• Participation in community
events
• Access to healthy food
• Access to medical care
• Access transportation
• Access to health information
• Quality of my housing
• Safety of my neighborhood
• Community environment
• Condition of neighborhood
• State of my physical health
• My mental/emotional health
• Level of physical activity
• My eating patterns
• Having meaningful work
• Workplace atmosphere
• Level of financial security
• One’s ethnicity/race
23 OF THE 24 FACTORS WERE PERCEIVED AS
IMPORTANT TO HEALTH AND WELL-BEING
(ON A SCALE OF 0 – 10)
…… all except for one factor was rated (at 5.0
+) as having a positive impact on their lives.
55. How would you rank these 10
factors by importance to overall
health and well-being?
• Access to Medical Care
• Financial Security
• Level of Physical Exercise
• Treatment by Others
• Personal Safety
• Access to Healthy Food
• Outlook on Life
• Mental and Emotional
Health
• Sense of Purpose
• Opportunities for
Learning and Growth
• How do you think
these factors ranked
in order of perceived
importance?
• Which one do you
think was ranked
highest?
56. #1 Factor of Perceived
Importance:
Mental and
Emotional
Health
57. Top 10 Factors of Health & Well-
Being Ranked by Importance
• Rated highest (on a scale of 0 -10):
1. Mental or emotional health
(mean = 8.8)
2. Access to medical care(mean = 8.7)
3. Outlook on life (mean = 8.7)
4. Sense of purpose (mean = 8.6)
5. Access to healthy food (mean = 8.6)
6. A person’s physical health
(mean = 8.4)
7. Safety of a person’s neighborhood
(mean = 8.3)
8. Financial Security (mean = 8.1)
9. Opportunities for learning and
growth (mean = 8.0)
10. Treatment by Others (mean = 8.0)
& Level of Physical Activity
(mean = 8.0)
58. Components of Health & Well
Being by Personal Impact
• Access to
Transportation
• Quality of Housing
• Emotional or
Mental Health
• Ability to Access
Health Information
• Relationships with
Family and Friends
• Outlook on Life
• Access to Healthy
Food
• Access to Medical
Care
• Treatment by
Others
• Sense of Purpose
• How do you think
these factors ranked
on perceived impact
on personal health?
(-5 to 5)?
• Which one was
perceived to have the
most positive
impact?
60. Top Ranked Factors by
Personal Impact
Rated highest (on a scale of -5 to 5 with zero at midpoint)
1. Relationships with friends and family
(mean = +3.7)
2. Outlook on life (mean = +3.4)
3. Ability to get healthy food
(mean = +3.3)
4. Access to medical care
(mean = +3.3)
5. Access to transportation
(mean = +3.1)
6. Sense of purpose (mean = +3.1)
7. Emotional and mental health
(mean = +3.0)
8. Quality of housing (mean = +2.9)
9. Treatment by others (mean = +2.9)
10. Ability to get health information
(mean = +2.8)
62. Perceived Health of Community
• 86% reported they lived in a
healthy or very healthy
community
• However, there were differences by
area:
• More positive ratings of “very
healthy” and “healthy” were from
those in Snohomish (96%) & Lake
Stevens/Granite Falls (93%) areas.
• Everett (75%) and Monroe -East
(83%) had less positive ratings but
still majority indicating “healthy” or
“very healthy”
17
69
11 2
VERY HEALTHY
HEALTHY
NO OPIN
UNHEALTHY
VERY UNHEALTHY
86%
N = 751
63. Composite Scores Based on Four
Components of Health & Well Being
Based on composite
scores for
satisfaction with:
• Overall life;
• Overall health;
• Physical health; &
• Mental/emotional
health
64. 64
• Research shows that data tilts positively on surveys such as this.
• For those individuals who rated very negative on all items:
• Feelings of discrimination were significantly related to the overall HWBM score:
• Those who most felt discriminated against were less likely to report
satisfaction with components of well-being (42% ) than those who felt little or
no discrimination (64%).
• The “Treatment by Others” came up as a significant factor impacting health
and well being. Ethnic/Racial discrimination may be captured in this measure
as well.
• Most who were less satisfied reported at least one health condition (51%).
• More analyses such as a gap analyses and factor analyses included in full
report which is available at http://www.pihc.org or emailing
Scott.Forslund@pihc..org
A Few More Points of Discussion
65. • Refine Health & Well-Being Monitor 2.0 for 2017.
• Facilitate ongoing community conversations to
collect qualitative information from groups and/or
people who are not best reached through
quantitative surveys.
• Pilot and validate tailored versions for specific
groups within Snohomish County (e.g. Spanish
version).
• Share data with community groups and
organizations.
Next Steps
67. •Health-education resources & events
co-created with community partners
•Referral services to community
partners
•Lifestyle change programs designed
with population health objectives
PIHC'S LIVEWELL / CENTER FOR
HEALTH EDUCATION & HEALING
74. Thank you!
Elizabeth Parker, PhD, MHS
Epidemiologist
Healthy Communities & Assessment
Snohomish Health District
For more information visit: www.snohd.orgassessment
Jody Early, PhD, M.S., MCHES
Associate Professor
UW Bothell, School of Nursing & Health Studies
Co-Chair
Providence Institute, AimWell/Center for Health Priorities & Progress
JEarly3@UW.edu
Stuart Elway, PhD
Elway Research, Inc.
hstuart@elwayresearch.com
For more information on the HWBM, visit http://www.pihc.org
