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

Middle Tennessee Rural Healthcare Leadership Forum May 6, 2019

What is The Sycamore Institute? How are we doing? What influences our health? 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.

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

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HOW ARE WE DOING?

TOP 10 LEADING CAUSES OF DEATH 200 TN 160 US 120 80 40 -- Kidney Diabetes Flu & Pneumonia Suicide COPD, Stroke Alzheimer’s Heart Cancers Accidents Diseases Emphysema, Disease Diseases Bronchitis 2016 age-adjusted mortality rate per 100K population | Source: CDC WONDER (2016)

HEALTH INDICATORS 33% 30% 23% 21% 19% 18% 13% 11% US US TN TN Fair/P ir/Poo oor Health lth Obesity esity Depre ressi sion on Diabetes abetes Sources: 2017 Behavioral Health Risk Factor Surveillance System (2017)

FAIR/POOR HEALTH Williamson Co: 12% Lauderdale Co: 26% Sources: 2017 Behavioral Health Risk Factor Surveillance System (2017)

HEALTH DISPARITIES Infant Mortality Prostate Cancer Mortality Diabetes deaths per 1K live births age-adjusted deaths per 100K pop 12.9 44.8 15.7% 13.0% 13.1% 7.4 5.9 20.0 17.6 TN White Black TN White Black TN White Black Percent of adults diagnosed with diabetes (2017), infant mortality (2017), prostate cancer mortality (2017) | Sources: BRFSS, CDC WONDER

WHAT INFLUENCES OUR HEALTH?

Health Social & Economic Health Behaviors Behaviors Environment $ Clinical Care Clinical Care Physical Environment

THE DRIVERS OF HEALTH Health Social & Economic Behaviors Environment 30% 40% 20% Clinical Care 10% Physical Environment 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.

ADVERSE CHILDHOOD EXPERIENCES 4+ ACEs 17% 3 ACEs No ACEs As the number of ACEs increases, so does the 8% 40% risk of long-term health and social problems. 2 ACEs 13% 1 ACE 22% 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

ADVERSE CHILDHOOD EXPERIENCES 49% Attr trib ibutable utable to Depre ressi sion on 49% Smoki king 32% 32% Asthm thma 24% 24% COPD PD 21% 21% ACEs Es 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

THE DRIVERS OF HEALTH Social & Economic Environment 40%

HEALTH & INCOME 92% 87% 80% 74% 68% 55% 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)

SOCIAL & ECONOMIC 32% 27% 15% 13% TN TN US US Pov overty ty Bachelor’s or More Source: American Community Survey (2017)

POVERTY RATE Williamson Co: 5% Scott Co: 26% Percent of individuals living in poverty (2013-2017) | Source: 2013-2017 American Community Survey 5-year estimates

≥ 4 -YEAR DEGREE 27% 25% 19% 14% All White Hispanic/ Black Tennesseans Latino Non-Hispanic Percent of adults ages 25+ with at least a bachelor’s degree (2012 -2016) | Sources: American Community Survey (2012-2016)

THE DRIVERS OF HEALTH Health Behaviors 30%

ADULT SMOKING 23% 16% TN US Percent of adults who currently smoke | Source: CDC BRFSS (2017)

ADULT SMOKING Lake Co: 27% Williamson Co: 15% Percent of adults who currently smoke | Source: CDC BRFSS (2016) via 2018 County Health Rankings

ADULT SMOKING Only 1 TN county’s smoking rate was better than the national rate. Percent of adults in who currently smoke by TN county (pink) and in the US (green) | Source: CDC BRFSS (2016)

ADULT SMOKING 25% 24% 22% 20% 21% 15% 10% 5% Mostly Urban Mostly Rural Completely Rural (25 counties) (50 counties) (20 counties) Percent of adults who currently smoke | Source: CDC BRFSS (2016) via 2018 County Health Rankings

THE DRIVERS OF HEALTH 20% Clinical Care

UNINSURED 14.6% 14.4% 14.3% 13.9% 13.9% 12.0% 10.3% 9.5% 9.0% 2009 2010 2011 2012 2013 2014 2015 2016 2017 Percent of Tennesseans without health insurance | Source: 2009-2017 American Community Survey 1-year estimates

UNINSURED Williamson Co: 5% Grundy Co: 19% Percent of individuals without health insurance (2013-2017) | Source: 2013-2017 American Community Survey 5-year estimates

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

THE DRIVERS OF HEALTH 10% Physical Environment

HOUSING PROBLEMS Lewis Co: 9% Shelby Co: 21% Percent of people who experience a severe housing problem (2011-2015) | Source: 2011-2015 U.S. Dept. of Housing and Urban Development

Health Social & Economic Behaviors Environment 30% 40% 20% Clinical Care 10% Physical Environment

Health Social & Economic Health Behaviors Behaviors Environment $ Clinical Care Clinical Care Physical Environment

$ $

SMOKING & INCOME 47% 30% 30% 23% 20% 12% TN All >$50K $35K-$50K $25K-$35K $15K-$25K < $15K Percent of adults in Tennessee who currently smoke by household income | Source: CDC BRFSS (2017)

UNINSURED & INCOME 27% 22% 14% 12% 5% All Ages 19-64 >400% FPL 200-400% FPL 138-200% FPL <138% FPL Percent of adults in Tennessee who are uninsured by household income | Source: American Community Survey (2017)

SMOKING & ACEs 37% 27% 25% 22% 15% No ACEs 1 ACE 2 ACEs 3 ACEs 4+ ACEs 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

WHAT DOES IT COST?

TN TN ECONOMIC IMPACT US US TN TN US US TN TN US US 6% 6% 31% 31% 10% 10% 6% 9% 31% 39% 10% 13% Diabetes Hypertension Cardiovascular Disease Source: Behavioral Risk Factor Surveillance System (2015)

ECONOMIC IMPACT 6% 6% 31% 31% 10% 10% Diabetes Hypertension Cardiovascular Disease Source: Behavioral Risk Factor Surveillance System (2015)

$5.3 BILLION Diabetes Hypertension CVD 460,000 TENNESSEANS $1.0B $0.5B $3.9B Estimated 2015 impact of TN’s excess burden of diabetes, hypertension, and cardiovascular disease | Source: The Sycamore Inst itute

ADVERSE CHILDHOOD EXPERIENCES $2.1B $5.2B ANNUAL IMPACT $923M $730M $532M $371M $197M $196M $162M 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

SycamoreInstituteTN.org @sycamoreTN thesycamoreinstitute MANDY PELLEGRIN Policy Director MPellegrin@SycamoreinstituteTN.org