Middle Tennessee Rural Healthcare Leadership Forum May 6, 2019 What - - PowerPoint PPT Presentation

Middle Tennessee Rural Healthcare Leadership Forum

May 6, 2019

How are we doing? What influences our health? What is The Sycamore Institute? What does it cost?

WHAT IS THE SYCAMORE INSTITUTE?

An An i indepe pend nden ent, t, nonpa partisan rtisan public ic policy icy resea earc rch h center ter for Te Tennesse ssee. e.

To To help policym cymak aker ers, s, the media, a, and the public ic unders rstan and d complex lex issu sues es that affect and connect Tennesseans’ health and prosperity. OU OUR P PUR URPO POSE SE

To To help policym cymak aker ers, s, the media, a, and the public ic unders rstan and d complex lex issu sues es that t affect t and connect ect Tennesseans’ health and prosperity. OU OUR P PUR URPO POSE SE

A RANGE OF COMPLEXITY AND DEPTH ANA NALYTI TIC C BLOG OG POSTS TS POLIC LICY Y 101 PRIMER MERS PO POLICY LICY BR BRIEFS EFS & & PAPERS PAPERS FOUN UNDATIO DATIONAL NAL PUB UBLIC ICATI ATIONS ONS

RESEARCH ARCH TO D O DATE

DA DATA VISUALIZATI UALIZATION ON

HOW ARE WE DOING?

TN

TOP 10 LEADING CAUSES OF DEATH

2016 age-adjusted mortality rate per 100K population | Source: CDC WONDER (2016)

200 160 120 80 40

• Heart

Diseases Cancers Accidents COPD, Emphysema, Bronchitis Stroke Alzheimer’s Disease Diabetes Flu & Pneumonia Suicide Kidney Diseases

US

18% 30% 19% 11% 21% 33% 23% 13%

Sources: 2017 Behavioral Health Risk Factor Surveillance System (2017)

US US TN TN Fair/P ir/Poo

• or Health

lth Obesity esity Depre ressi sion

• n

Diabetes abetes

HEALTH INDICATORS

FAIR/POOR HEALTH

Lauderdale Co: 26% Williamson Co: 12%

Sources: 2017 Behavioral Health Risk Factor Surveillance System (2017)

HEALTH DISPARITIES

Percent of adults diagnosed with diabetes (2017), infant mortality (2017), prostate cancer mortality (2017) | Sources: BRFSS, CDC WONDER

13.1% 13.0% 15.7% White Diabetes TN Black 7.4 5.9 12.9 White Infant Mortality

deaths per 1K live births

TN Black 20.0 17.6 44.8 White Prostate Cancer Mortality

age-adjusted deaths per 100K pop

TN Black

WHAT INFLUENCES OUR HEALTH?

Clinical Care Health Behaviors $

Social & Economic Environment Physical Environment Clinical Care Health Behaviors

20% 30% 40% 10%

Excludes genetics. Source: McGovern, Miller, and Hughes-Cromwick. Health Policy Brief: The Relative Contribution of Multiple Determinants to Health Outcomes. Health Affairs. August 21, 2014.

Health Behaviors Social & Economic Environment Clinical Care

THE DRIVERS OF HEALTH

Physical Environment

Source: Sycamore Institute analysis of Tennessee Department of Health’s Behavioral Risk Factor Surveillance System 2014 – 2017 data, provided by Office of Surveillance, Epidemiology, and Evaluation , Division of Policy, Planning, and Assessment

As the number of ACEs increases, so does the risk of long-term health and social problems.

No ACEs 40% 1 ACE 22% 2 ACEs 13% 3 ACEs 8% 4+ ACEs 17%

ADVERSE CHILDHOOD EXPERIENCES

ADVERSE CHILDHOOD EXPERIENCES

Depre ressi sion

• n

49% 49% Attr

trib ibutable utable to ACEs Es Smoki king

32% 32%

Asthm thma

24% 24%

COPD PD

21% 21%

Source: Sycamore Institute analysis of Tennessee Department of Health’s Behavioral Risk Factor Surveillance System 2014 – 2017 data, provided by Office of Surveillance, Epidemiology, and Evaluation , Division of Policy, Planning, and Assessment

40%

Social & Economic Environment

THE DRIVERS OF HEALTH

80% 55% 68% 74% 87% 92%

All Income Levels <$15k $15K-$25K $25K-$35K $35K-$50K >$50K

Percent of adults in Tennessee who rate their status as “good” or better by household income | Source: CDC BRFSS (2016)

HEALTH & INCOME

Source: American Community Survey (2017)

13% 32%

15% 27%

Pov

• verty

ty Bachelor’s or More US US TN TN

SOCIAL & ECONOMIC

Percent of individuals living in poverty (2013-2017) | Source: 2013-2017 American Community Survey 5-year estimates

Williamson Co: 5% Scott Co: 26%

POVERTY RATE

≥ 4-YEAR DEGREE

All Tennesseans

27% 19% 14%

White Non-Hispanic Black

Percent of adults ages 25+ with at least a bachelor’s degree (2012-2016) | Sources: American Community Survey (2012-2016)

Hispanic/ Latino

25%

30%

Health Behaviors

THE DRIVERS OF HEALTH

Percent of adults who currently smoke | Source: CDC BRFSS (2017)

ADULT SMOKING

23% 16%

TN US

Percent of adults who currently smoke | Source: CDC BRFSS (2016) via 2018 County Health Rankings

Williamson Co: 15% Lake Co: 27%

ADULT SMOKING

Percent of adults in who currently smoke by TN county (pink) and in the US (green) | Source: CDC BRFSS (2016)

Only 1 TN county’s smoking rate was better than the national rate. ADULT SMOKING

Mostly Urban (25 counties) Mostly Rural (50 counties) Completely Rural (20 counties)

21% 22% 24% 5% 10% 15% 20% 25%

Percent of adults who currently smoke | Source: CDC BRFSS (2016) via 2018 County Health Rankings

ADULT SMOKING

20%

Clinical Care

THE DRIVERS OF HEALTH

Percent of Tennesseans without health insurance | Source: 2009-2017 American Community Survey 1-year estimates

14.3% 14.4% 14.6% 13.9% 13.9% 12.0% 10.3% 9.0% 9.5% 2009 2010 2011 2012 2013 2014 2015 2016 2017

UNINSURED

Percent of individuals without health insurance (2013-2017) | Source: 2013-2017 American Community Survey 5-year estimates

Williamson Co: 5% Grundy Co: 19%

UNINSURED

Number of general service hospitals by county | Source: The Sycamore Institute’s analysis of data from the TN Dept. of Health

HOSPITALS

10% THE DRIVERS OF HEALTH

Physical Environment

Percent of people who experience a severe housing problem (2011-2015) | Source: 2011-2015 U.S. Dept. of Housing and Urban Development

Lewis Co: 9% Shelby Co: 21%

HOUSING PROBLEMS

20% 30% 40% 10%

Health Behaviors Social & Economic Environment Clinical Care Physical Environment

Clinical Care Health Behaviors $

Social & Economic Environment Physical Environment Clinical Care Health Behaviors

$

$

Percent of adults in Tennessee who currently smoke by household income | Source: CDC BRFSS (2017)

SMOKING & INCOME

23% 12% 20% 30% 30% 47%

All >$50K $35K-$50K $25K-$35K $15K-$25K < $15K

TN

Percent of adults in Tennessee who are uninsured by household income | Source: American Community Survey (2017)

UNINSURED & INCOME

14% 5% 12% 22% 27%

All Ages 19-64 >400% FPL 200-400% FPL 138-200% FPL <138% FPL

Percent of adults in Tennessee who currently smoke by number of adverse childhood experiences (ACEs) | Source: CDC BRFSS (2014-2017) provided by the TN Dept. of Health, Division of Policy, Planning and Assessment, Office of Health Statistics

SMOKING & ACEs

15% 22% 25% 27% 37%

No ACEs 1 ACE 2 ACEs 3 ACEs 4+ ACEs

WHAT DOES IT COST?

9% 39% 13%

US US TN TN

6% 6%

US US TN TN

10% 10%

US US TN TN

31% 31%

10% 31% 6% Diabetes Hypertension Cardiovascular Disease

Source: Behavioral Risk Factor Surveillance System (2015)

ECONOMIC IMPACT

6% 6% 10% 10% 31% 31%

Source: Behavioral Risk Factor Surveillance System (2015)

Diabetes Hypertension Cardiovascular Disease

ECONOMIC IMPACT

460,000 TENNESSEANS $5.3 BILLION

Diabetes $1.0B Hypertension $0.5B CVD $3.9B

Estimated 2015 impact of TN’s excess burden of diabetes, hypertension, and cardiovascular disease | Source: The Sycamore Institute

$2.1B $923M $730M $532M $371M $197M $196M $162M

$5.2B

ANNUAL IMPACT ADVERSE CHILDHOOD EXPERIENCES

Estimated 2017 ACEs-related medical and worker absenteeism costs of select health outcomes and behaviors | Source: Sycamore Institute analysis of Tennessee Department of Health’s Behavioral Risk Factor Surveillance System 2014 – 2017 data, provided by Office of Surveillance, Epidemiology, and Evaluation , Division of Policy, Planning, and Assessment

Prett tty y Picture cture

MANDY PELLEGRIN

Policy Director MPellegrin@SycamoreinstituteTN.org @sycamoreTN thesycamoreinstitute

SycamoreInstituteTN.org