CHNA Dane County, Wisconsin

1. Community Assessment
Dane County, Wisconsin
By: Teagen Johnson
MPH602

2. Outline
 Introduction
 Community defined
 Community health assessment model
 Community Stakeholders
 Prioritizing methodology
 Population and demographics of Dane County
 Secondary data collection and analysis
 Health indicator limitations
 Main areas for opportunity
 Top high needs / high priorities identified
 Ten organizations that can help
 Conclusion
 References

3. Community Health Needs
Assessment
Introduction
 A Community Health Needs Assessment
(CHNA) looks at the health of a community
by using data and collecting community
input. The CHNA provides a broad-ranging
view of health, and encompasses more
than vital statics. The assessment also
includes information on social
determinants of health, such as the local
economy, education, and social
environment. The CHNA can then be
used to assist in evaluating community

4.  Subjective term
 Public Perspective:
◦ World Health Organization (WHO) definition:
 People within a fixed geographical location
 Share social relationships
 Identify with each other on a common interest or
goal
Community Defined

5.  Public Health Perspective:
◦ Initial declaration of an agenda
◦ Describing intent
◦ Recognizes influencing stakeholders
◦ Identifies resources
◦ Optimizes data collection
Community Defined

6. Mobilizing for Action through Planning and
Partnership: MAPP
(NACCHO.org)
Role:
Engage the community in strategic
planning for improving health.
Concept:
When a community is provided with
the opportunity to take ownership of
their health planning the population’s
strengths needs and desires drive the
process.
Leading to:
Collective thinking, resulting in effective
sustainable solutions to complex
problems.
Community Health Assessment
Model

7. MAPP: Phases
Phase one: Organize for
success/partnership development
Lead organizations in the community begin
by organizing themselves and preparing to
implement community wide strategic
planning. This requires a high level of
commitment from stakeholders and the
community residents who are recruited to
participate. By systematically identifying
them it can be easier to utilize their skill sets.
Phase two: Vision
A shared common vision
provides framework for
pursing long range
community goals
What would our
community to look like in
ten years?
Community themes and strengths assessments: Provides a
deeper understanding of the issues residents feel are important
(playing into where will we be in ten years?)
What is important in our community?
How is the quality of life in our community?
What assets do we have that can be used to improve
community health?
Local public health
assessment:
Comprehensive
assessment of all of the
organizations and entities
that contribute to the
public’s health
What are the
activities
competencies and
capacities of our
local public health
system?
How are the
essential services
being provided to
our community?
Community health status assessment:
How healthy are the residents?
What does the health status of our
community look like?
Force of change
assessment:
What is occurring or
might be occurring that
affects the health of
our community or the
local public health
system?
What specific threats
or opportunist are
generated by these
occurrences?
Phase four: Identify strategic issues
Analyze the data gathered during the
four assessments to identify critical
issues.
Phase five: Formulate goals
and strategies
The fifth and sixth phases are
key in laying the groundwork
for implementing change. By
taking the time to adequately
plan, educate, and align goals
so the final action phase will
have a higher rate of return.
During this phase,
collaborative and directive
thinking occurs.
Phase six: The action cycle
County of Dane.com
To further emphasize the importance
of streamlining the implementation of
information, phase six cyclically
juggles planning, implementing, and
evaluating. By constantly going
through these steps the initiative can
continuously develop through
checks and balances.
(NACCHO.org)
Phase three: Four MAPP
assessments
Questions to ask stakeholders are
presented throughout the phases.

8. Community stakeholders
Major hospital and
clinic systems
Public Services Local insurance Centers for
physical activity
Community clubs
UW Health
VA Hospitals
Meriter Health
Systems
St. Mary’s Hospital
Dean Care
EPIC software
systems
Libraries
Religious groups/
worship centers
Civil services:
Police, fire
department, safety
department, health
department, public
instruction,
Governing bodies:
Capital is located in
. The city is a hub of
state and local
officials.
WPS
WEA
Physician’s Plus
Group health
Cuna Mutual
American Family
Dean Care
Locally owned
gyms
Commercial gyms
YMCA (none-profit
recreational
facilities)
Indoor/outdoor
recreational
facilities
Big Brothers Big Sisters
Boy Scouts and Girl
Scouts
4H
Community recreation
Special interest groups
-Urban League
Have first hand
interaction with
influencing the
physical and mental
health of the
community.
Collectively, these are
the largest employers
in and contain the
majority of doctors
and nurses.
The community
leaders who have an
influencing voice
over policy and
reform, its regulation,
and its development.
These companies
represent large
employer groups
and the
affordability of
health care.
Without strong
ties to the
community their
ability to create
adequate
coverage will be
They can be
evaluated to see
what tools and
resources
individuals and
families have for
physical activities.
Small communities
where people can
develop hobbies and
special interests to
create ties with others.

9. Prioritizing Methodology
 Grid Strategy
 Nominal Group Technique
When addressing health and wellbeing of an entire group of
individuals narrowing down the focus is optimal for efficiency. To
achieve efficiency, representatives from different pockets of the
community will be integral in organizing thoughts and prioritizing
interests. Roundtable discussions and voting will be helpful deciding
methods.
The strategy grid will be useful in pinpointing specific areas that will
have the opportunity for the greatest impact , further narrowing down
group discussions.
(NACCHO)

10. Grid Strategy
Low Need/High Feasibility
– Often politically
important and difficult to
eliminate, these items
may need to be re-
designed to reduce
investment while
maintaining impact.
Low Need/Low Feasibility
– With minimal return on
investment, these are the
lowest priority items and
should be phased out
allowing for resources to
be reallocated to higher
priority items.
High Need/High
Feasibility – With high
demand and high return on
investment, these are the
highest priority items and
should be given sufficient
resources to maintain and
continuously improve.
High Need/Low Feasibility
– These are long term
projects which have a great
deal of potential but will
require significant
investment. Focusing on too
many of these items can
overwhelm an agency.
(NACCHO)

11. Nominal Group Technique
Establish a
group of,
ideally, 6-20
people
Designate a
moderator to
take the lead
in
implementing
the process
Silent
brainstorming
Generate list
in round-robin
fashion
Simplify &
clarify
Group
discussion
Anonymou
s ranking
Repeat if
needed
(NACCHO)

12. Welcome to Dane County
Home of the Badgers
County of Dane.com
Established: December 7th, 1836
Home to the capital city: Madison
Area: 1,197 square miles of land,
41 square miles (3.3% of total
1,238 square miles) of water

13. Out of 72 Counties
Dane County is ranked:
• 3rd in Health Factors
(social and economic
factors)
•15th in Health Outcomes(CommunityCommons.org)

14. 6.16%
15.45%
13.29%
15.97%13.28%
13.96%
11.50%
10.40%
Age of Population by Percentage
Age 0-4
Age 5-17
Age 18-24
Age 25-34
Age 35-44
Age 45-54
Age 55-64
Age 65+
Population & demographics
64.15%
Ages: 0-44 years
old
13.96%
11.50%
10.40%
Age of Population by Percentage
Age 0-4
Age 5-17
Age 18-24
Age 25-34
Age 35-44
Age 45-54
Age 55-64
Age 65+
Note that the majority of the population is below the age of 44
(CountyHealthRankings.org)

15. State population: 5,687,219
Dane population:
488,073
Population & demographics

16. Population &
demographics
Having a diverse population is a valuable asset to any
community. To understand how to balance needs and be
culturally sensitive projecting race and ethnicity of a
population is important. This encourages diversification
and establishes opportunities within the community for
resources development .
CommunityCommons.org)

17. Population & demographics:
Change by location from: 2000 - 2010
Note the population movement away from the downtown region. This is an
issue because public transportation routs are having a difficult time keeping up
with urban sprawl. The downtown area is the only region that provides easy
access to public transportation services such as bus, bicycle, quick access
cabs, and continuous, well lit trails or sidewalks options. Housing is also more
expensive downtown, yet some of the lowest income neighborhoods are
(CommunityCommons.org)

18. Poverty can result in an increased risk of mortality, prevalence of medical
conditions and disease incidence, depression, intimate partner violence, and
poor health behaviors.
While negative health effects resulting from poverty are present at all
ages, children and older adults in poverty experience greater morbidity and
mortality than younger individuals due to increased risk of accidental injury
and lack of health care access.
Risk of poor health and premature mortality may also be increased due to the
poor educational achievement associated with poverty. As it is often difficult to
escape from poverty, these groups captures an upstream measurement of
current and future poverty rate and health risk (CountyHealthRankings.org).
Population & demographics:
Income

19. Dane County has a large amount of individuals
who have attained secondary education or higher.
This is helpful in that individuals who have
achieved higher education generally have better
health. However, there is a large gap between
the population size of those who do not have
additional education, indicating a vulnerable
group. Currently 86% of kids are initially
graduating high school. This is low in comparison
to other counties (PHMD).
Population & demographics:
Education

20. Individuals who have a secondary education or higher is
the majority in Dane County.
This is most likely due to the location of the University of
Wisconsin-Madison and large employer groups such as
UW Health, Deancare, Meriter Hospital systems, and
Epic Systems Software Development. All of which
recruit a large number of highly educated employees
(PHMDC).
(Wonder.cdc.org)
Population & demographics:
Education

21. Secondary health indicators for
change
 Access to health care
 Health insurance coverage
 Available providers
 Heath care cost
 Birth rate
 Chronic disease
 Obesity
 Diabetes
 Heart Disease
 Cancer

22. When individuals go underinsured or uninsured they are more likely
to suffer financial hardship, less likely to seek timely care, have a
lower health status and run the risk of early death
(HealthyPeople2020). With mandates set forth by the Affordable
Care Act, data collection and insurance rates will be changing in
2014 (Countyhealthranking.org) .
Health insurance coverage
(CountyHealthRanking.org)
(Communitycommons.org)

23. Available providers
People with a fluid source of care have better health outcomes, fewer
disparities and lower costs. (HealthyPeople2020) In Dane county there is no
shortage of health care professionals; there is currently 159.6 physicians per
100 thousand people (DHHS).
The Health Services Research Administration projects that the primary care
nurse practitioners and physicians assistance workforce will also grow
substantially over the next ten years.
Dane County has an exceptional population to physician presence.
(CDC)

24. Health care cost
 Establishing prevention and early care is
reflective in accrued cost in an aging population.
The ability to cover the cost of maintaining health
and quality of life for this population is in
question. In Dane County the percentage of
individuals over the age of 65 has risen from 10%
to 11% in the last three years and the cost of
providing health care is fluctuating as well. Health
care costs are an important measure of the
efficiency of a health care system.
(CountyHealthRanking..org)

25. Cost to see doctor
 It is important to note that even with insurance the cost of receiving
care can be limiting for some individuals. This problem is gradually
increasing both in Dane County and state wide. He graph below
quantitatively compares the percentage of population in Dane
County that could not see a doctor due to excesive cost between the
years 2012 and 2014.
(CountyHealthRanking.org)

26. categories of health factors, including her health
behaviors, access to health care, the social and economic
environment she inhabits, and environmental risks to which
she is exposed. In terms of the infant’s health
outcomes, LBW serves as a predictor of premature mortality
and/or morbidity over the life course and for potential
cognitive development problems.
(CountyHealthRanking.org)
Birth weight
Low birth weight (LBW) represents two
factors: maternal exposure to health risks
and an infant’s current and future
morbidity, as well as premature mortality
risk. From the perspective of maternal health
outcomes, LBW indicates maternal exposure
to health risks in all

27. Age of
Mother
(Wonder.CDC.gov)

28.  Pregnant teens are more likely than older women to receive late or
no prenatal care, have gestational hypertension and anemia, and
achieve poor maternal weight gain. Teens are also more likely than
older women to have a pre-term delivery and low birth weight
babies, increasing the risk of child developmental delay, illness, and
mortality (CountyHealthRanking.org). Dane County has a
reasonably low teen pregnancy rate and shows high rates of
pregnancies between the ages of 20-34 years.
Dane County shows signs of healthy
birth weights across all age categories.
Reviewing the age of the mother is
expressive of at risk pregnancies, family
planning/abstinence practices, and risky
behaviors among the population. Teen
pregnancy significantly increases the
risk of repeat pregnancy and of
contracting sexually transmitted
diseases.
Birth weight

29. Chronic diseases
Chronic diseases including
heart
disease, stroke, diabetes
, lung disease and cancer
are the leading causes of
death and disability in Dane
County, in Wisconsin and
the entire United States. To
a large degree, these
diseases can be
prevented, delayed and
controlled, allowing for
longer and healthier lives
(PHMDC). Dominant risk
factors include
smoking, obesity, and lack
of preventive screenings.
(PHMDC)

30. Obesity
Obesity is a complex measure that is affected through several different
pathways: genetics, metabolic processes, education, built
environment, behavioral choices, socioeconomic status and
education(CDC).
In comparison to county rankings in Wisconsin, obesity rates in Dane are
among the lowest, however, that does not mean the rate of prevalence is
acceptable. With 20.1% of adults in Dane County having a BMI of 30 or
greater serious concerns
about future health and the costs
of obesity-related diseases are
being raised. A current limitation
is that childhood obesity rates
are not available to provide a
more comprehensive measure of
the current and future health
risks of a county
(CountyHealthRanking.org).

31. Diabetes can lower life expectancy up to 15 years and increase the risk of
heart disease by 2 to 4 times. It is also the leading cause of kidney
failure, lower limb amputations, and adult-onset blindness in the United States.
(HealthyPeople2020) Encouraging regular preventive screenings and
maintenance is key in reducing these human and financial costs. In Dane
County, 4.2% (FindtheBest.com) of the population has been diagnosed with a
form of diabetes. With prevention in mind, the county has a high performance
of diabetic screenings, with a 92% participation rate; higher than the top U.S.
performers (90%) (CountyHealthRanking.org).

32. Heart disease
 Currently heart disease is the
number one killer and stroke is
the third killer in both the United
States and Wisconsin
(HealthyPeople2020, PHMDC).
 Cardiovascular health is
significantly influenced by the
physical, social, and political
environment. In Dane County its
rate of occurrence is high but
lower than the national and state
average with a prevalence of 136
deaths per 100,000 people
(PHMDC).

33. Cancer
Continued advances in cancer
research, detection, and treatment have
resulted in a decline in both incidence and
death rates for all cancers. Among people
who develop cancer, more than half will be
alive in 5 years. Yet, cancer remains a
leading cause of death in the United States
and in Wisconsin, second only to heart
disease. In Dane County it is the number
one cause of mortality with a prevalence of
138 deaths per 100,000 people. From
2001 to 2004, on average, 1,780 people in
Dane County were newly diagnosed with
cancers. That is a rate of 454 per
100,000, which is lower than Wisconsin’s
(471 per 100,000). The leading cancer
types are prostate, breast, lung and
colorectal, together representing 54% of
the new cases of cancers and 49% of the
(PHMDC)

34.  Cancer and heart diseases are the two leading causes of
death, representing almost half of all deaths in Dane County. While in
Dane County the white population has a lower death rate than the
statewide white population for the leading causes of death, Dane County
black populations have death rates comparable to the black population
statewide. This creates a larger disparity in death rates between Blacks
and Whites in Dane County compared to the rest of Wisconsin. Dane
County Asians had lower death rates than Dane County Whites for
cancer, heart disease, and chronic lower respiratory disease, and higher
death rates than Dane County Whites for cerebrovascular diseases and
kidney disease, both of which are related to hypertension. Dane County
Hispanics’ death rates from the top 3 causes of death - cancer, heart
(PHMDC)

35. Health indicator limitations
 Childhood obesity rates not available
◦ Important to determine if intervention is
needed.
 Lacking primary source information
◦ Though the sources used are reputable only
secondary sources were used. To strengthen
the assessment, additional primary source
such as interviews, surveys, group
discussions, and observations should also be
used.
 Drawing comparisons to other counties
◦ Dane county is unique in its size, political
bodies, business operations, and layout. In
comparing it to other counties with much

36.  Health Care Reform
◦ The Affordable Care Act will change many health
outcomes, data collection, and sample sizes.
Being aware of the time of data collection will be
important in future information interpretation and
comparison.
 Sample Group
◦ In using reputable secondary sources, sample
group selection is easier to be confident in. In
smaller group sizes ensuring that the group
selected accurately represents the population is
hugely important and difficult to assess purely from
the data consumer position.
Health indicator limitations

37. To evaluate the needs of Dane County, access to health care
services, chronic diseases conditions, nutrition and weight
status, and physical activity indicators were examined. These
indicators qualitatively and quantitative give a big picture view of
the past experiences, current trends, and future needs of the
communities within Dane County and how the population compares
against Wisconsin and in some instances, the top U.S. performers.
As Dane County is ranked 15th out of the 72 counties in Wisconsin
in overall health status, (CommunityCommons.org) based on the
information discussed throughout, there are many current health
assets for the population to build upon and advance with.
However, there are five major indicators that stood out, of
those, two were identified as specific areas for improvement.
CHNA needs identified

38. Main areas for opportunity
Based on the health indicators listed the
main areas for opportunity include:
 Integrating the younger and older
populations together
 The African American population is
showing signs of struggling in prevalence
of younger pregnancy ages, lower
income, lower educational
achievements. Focus on increasing
opportunity and access to resources for
the given population.

39.  Obesity prevention to alleviate the
effects of chronic health conditions.
 Increase high school graduation rates to
increase opportunities later in life.
 Heart disease and stroke rates are high.
Focus on preventive care and
community climate towards heart
disease instigators such as food options
and physical activity.

40. High School Graduation Rate
Obesity
Two high need / high priority areas:

41. High school graduation rate
 By focusing additional attention to
educational achievement of youth
future opportunities will become more
easily attainable as they age. These
benefits are often seen in the form of
better health and self-sustainable
economic security both of which lead
to a higher quality of life and longevity.

42. Obesity
 Obesity, like education, statistically
compares well to other locations in
Wisconsin and the United States.
However, that doesn’t mean that the
statistical values are effective for
maintenance and prevention throughout
the population. As mentioned Obesity is
complex in its measurements and effects
on the individual and the population. By
decreasing its prevalence the impact of
many additional chronic health

43. Ten organizations that can
help
 Planned Parent Hood
 Urban League of Madison Area
 YMCA of Dane County
 School Districts of Dane County
 Big Brother’s Big Sisters of Dane County
 Literacy network
 Hospital/clinics in Dane County
 MSCR Madison School & Community Recreation
 United Way of Dane County
 Options in Community Living Inc.

44. “Data is used to create information.
Information is used to create knowledge.
Knowledge is used to create
understanding. Understanding is used to
create wisdom to make good decisions.”
Bill Schrum
UW Medical Foundation
Human Resources Vice President

45. Mr. Schrum’s words emphasize the
snowball effect that efficient data
collection can have and its potential to
impact a community. In comparison to
Wisconsin and the United States Dane
County is in good health standings but
there will always be room for
improvement.
Conclusion

47. See notes for reference
information