Community Health Indicators
for the
Washington Metropolitan
Region
Michael A. Stoto, PhD, RAND
Jane Durch, MA, IOM
Susan Allan, MD, JD, MPH, Arlington
County Health Department
The Washington Region
• The region covered
by the report
includes
– the District of
Columbia
– 3 counties in
Maryland
– 5 health districts in
Virginia
Frederick
Montgomery
Loudoun
DC
#
Fairfax
#
Prince George's
Prince William
Ale xandria
Arlington
The Washington Region
• The Washington region is diverse
– almost half the area’s residents are Black,
Asian, multiracial, or of Hispanic origin
– 14% of the region’s adult residents had
less than a high-school education (1990)
– growing and multicultural immigrant
population throughout the region
– per capita income ranges from $30,000 in
Prince George’s County to almost $47,000
in Arlington (1998)
Metropolitan Washington Public
Health Assessment Center
• Established in 1999 to provide a base for
regional development and analysis of public
health data
• Collaborative activity of
–
–
–
–
COG and COG health officers committee
MD, VA, and DC state health departments
Metro Washington Public Health Association
The George Washington University School of
Public Health and Health Services
• Based and staffed at GW
Origins of the Project
• 1995 MWPHA indicators report focusing on
six jurisdictions
– need for continuing reports of this kind led to the
development of the MWPHAC
• Healthy People 2010 at the national level
– State versions in DC, Maryland and Virginia
• Community Health Status Indicators (CHSI)
project and generally a growing interest in
health data for local areas
The Determinants of Health
• Good health for individuals and communities
depends not only on health care for the sick,
but on opportunities to prevent health
problems and improve basic health and wellbeing
• To assess the region’s “health,” the MWPHAC
has assembled 29 community health
indicators for nine jurisdictions
– health promotion/disease prevention focus
– NOT a “report card” on public health agencies
Choosing the Indicators
• Technical advisory committee with representatives
from state and local health departments
• Support from GW faculty and students
• Considerations
– desire for a mix of health measures
• behavioral risks: smoking
• health outcomes: lung cancer death rate
– availability of effective preventive interventions
– manageable number of indicators
– availability of data (only at the end)
Choosing the Indicators
• “Leading health
indicators”
framework from
Healthy People
2010
• At least two
measures with local
data for each of the
ten indicator
categories
1.
2.
Physical activity
Overweight and
obesity
3. Tobacco use
4. Substance abuse
5. Responsible sexual
behavior
6. Mental health
7. Injury and violence
8. Environmental quality
9. Immunization
10. Access to health care
Healthy People 2010
Leading health indicators
• Purpose: Communicate and motivate
– create a national identity for HP2010
– small set of health indicators of interest, importance,
and relevance to the general public, non-health
organizations, as well as traditional public and private
health organizations
– focus on a small number (10) of key health and social
issues
• bring to public attention
• motivate actions towards achievement
• provide feedback about progress
Healthy People 2010
Leading health indicators
• Criteria for choice of indicators
– worth measuring: important and salient
– can be measured
• at the community level
• for diverse populations
– understood by people who need to act
– information will galvanize action
– actions that can lead to improvement are anticipated
and feasible
– measurement over time will reflect results of actions
Healthy People 2010
Leading Health Indicators
Indicator
Physical activity
Overweight and obesity
Tobacco use
Substance abuse
Responsible sexual behavior
Mental health
Injury and violence
Environmental quality
Immunization
Access to health care
Healthy People 2010 Measure
% engaging in physical activity
% overweight or obese
% who smoke cigarettes
% who use substances
% who use condoms
% with depression getting treatment
Motor vehicle deaths, homicides
Meeting EPA standards, ETS exposure
Immunization coverage rates
Insurance coverage, prenatal care
Data for Healthy People 2010
leading indicators
Physical activity
Overweight and obesity
Tobacco use
Substance abuse
Responsible sexual
behavior
Mental health
Injury and violence
Environmental quality
Immunization
Access to health care
TOTAL
Survey
2
2
2
3
2
Vital stats
Other
1
2
1
2
2
17
1
1
3
1
HP2010 Leading Health Indicators
Possible local data
Indicator
Physical activity
Overweight and obesity
Tobacco use
Substance abuse
Responsible sexual behavior
Possible local measures
% engaging in physical activity (BRFSS)
Coronary heart disease death rate
% overweight or obese (BRFSS)
Diabetes death rate
% who smoke cigarettes (BRFSS)
Lung cancer death rate
Adult binge drinking (BRFSS)
Drug-induced death rate
AIDS incidence
Gonorrhea incidence
Birth rate for girls aged 15-17
HP2010 Leading Health Indicators
Possible local data
Mental health
Injury and violence
Environmental quality
Immunization
Access to health care
Suicide rate
Mental health "not good" days (BRFSS)
Motor vehicle crash death rate
Firearm-related death rate
Reported rape or attempted rape
Days ozone standards exceeded
Cases of foodborne pathogens (E.
Coli 0157:H7, Salmonella )
% children 19-35 months who have
received recommended vaccines
% of adults 65+ with flu vaccine
% adults w/ health insurance (BRFSS)
Infant mortality rate
Cervical cancer death rate
Results
• Overall, the adult population of the
Washington metropolitan area is healthier
than the nation as a whole
• On some measures, however, the region
appears less healthy than the nation
• The region is diverse; every jurisdiction
shows some strengths and weaknesses
• There are several key regional data needs
The adult population of the
Washington area is healthier
than the nation as a whole
• For 19 of 27 indicators, the Washington
region is doing as well or better than the
national average
• For coronary heart disease deaths and
mammography rates, our region already
more than meets national targets for 2010
• The estimated rate of adult obesity in the
region is almost at the national target
Coronary Heart Disease: Age-Adjusted Death Rate per
100,000, 1996-1998 Average
250
227.5
215.9
213.4
197.1
200
Healthy People 2010
Target
Deaths per 100,000
Frederick
Montgomery
161.7
157.5
150
141.8
129.2
111.7
125.5
106.6
100
Coronary Heart
Disease
Loudoun
DC
Fairfax
Prince George's
Prince William
106.6
111.7
125.5
50 129.2
141.8
157.5
197.1
213.4
227.5
e
M
on rick
tg
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0
Women, 40 and Older, Having a Mammogram
in the Past 2 Years, 1997-1999 Average
100
Healthy People
2010 Target
82.6
78.7
76.91
80
Frederick
75.5
69.54
67
61.1
Percent
60
Montgomery
Vi
rg
in
ia
eo
G
No
rth
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n
rg
e
's
er
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m
Pr
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on
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C
61.1
69.5
75.5
78.7
82.6
D
Prince George's
20
Mammogram
US
as
hi
ng
to
n
Ar
ea
DC
W
Northern Virginia
40
Percentage of Adults Who Are Obese
1997-1999 Average
30
23.3
23
Frederick
Healthy People 2010
Target
20
17.7
Loudoun
16.5
15.59
12.2
11.1
Obesity
DC
17.5
16.8
Percent
Montgomery
19.8
11.5
10
11.1
11.5
12.2
16.5
16.8
17.5
17.7
19.8
23.3
Fairfax
Prince George's
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Alexandria
On some measures the region
is less healthy than the nation
• AIDS
• Gonorrhea, and other sexually
transmitted infections
• Tuberculosis
• Binge drinking
• Firearm-related deaths
• Infant mortality
• Low birth weight
Annual Incidence of AIDS, New Cases per 100,000
population, 1997-1999 Average
200
179.3
150
Cases per 100,000
Frederick
Montgomery
Loudoun
100
AIDS
3.5
12.1
4.6
31.9
8
11.7
3.5
e
M
on rick
tg
Pr
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G
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Alexandria
W
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Prince William
29.7
C
Prince George's
37.3
D
8.0
11.7
12.1
17.4
29.7
31.9
43.7
0 179.3
Fairfax
Healthy People
2010 Target
43.7
Fr
ed
DC
50 4.6
Adults Having 5+ Drinks on an Occasion in the Past
Month, 1997, 1999 Average
30
27
25.4
Healthy People
2010 Target
23.3
Frederick
21.5
20
16.6
Percent
Montgomery
Loudoun
19.6
19.08
15.8
11.6
Drinks
10
DC
Fairfax
Prince George's
Prince William
19.8
11.6
15.8
19.6
19.8
21.5
23.0
23.3
25.4
27.0
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23
Low Birth Weight: Percentage of Births <2500
Grams, 1997-1999 Average
15
13.2
Frederick
10.1
Percent
10
Montgomery
Loudoun
7.6
Healthy People
2010 Target
8.0
6.9
7.3
7.5
7.0
6.3
6.4
5.5
Birth Weight
5
Alexandria
W
Arlington
as
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Ar
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e
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Fairfax
5.5
6.3
6.4
6.9
7.0
7.3
7.5
10.1
13.2
Fr
ed
DC
The region is diverse
• Every jurisdiction shows some strengths and
weaknesses
• Jurisdictions with higher average
socioeconomic status still face challenges in
promoting health and preventing disease
– in pockets of poverty
– among growing immigrant communities
with varying cultural and linguistic
characteristics
The region is diverse
• Rates better than the national average
– Whites: 17 of 19 indicators
– Blacks: 5 of the 19 indicators
• smoking, suicide, motor vehicle deaths,
dental care, mammography
• For 10 indicators more healthful
behaviors among people with
– more education
– higher household incomes
Key regional data needs
• Data comparable across jurisdictions on
behavioral risk factors for adolescents
– MD: adolescent survey
– DC: Youth Risk Behavior Survey
– VA: some local adolescent surveys
• Data on risk factors for younger children
– overweight
– physical activity
Key regional data needs
• Data on the use of hospital and
emergency department services
– visits for asthma, injury, or mental
health care
– in forms suitable for regional analysis
• More data on differentials by race,
ethnicity, socioeconomic status, and
education
Key regional data needs
• Data on behavioral risk factors for adults in
Virginia jurisdictions
– no longer available because of changes in the size
and design of Virginia’s BRFSS
• Some data are inadequate for their intended
purpose
– blood-alcohol level is tested for only a small
percentage of drivers in fatal crashes
– Retrospective immunization coverage data for
children at age 2
Conclusions
• On the whole, the region is healthy, yet there
are health problems that require attention
• The indicators may point to opportunities for
jurisdictions in the region to
– collaborate on common concerns
– learn from the work of neighbors
• Need to invest in better data as an investment
in the community’s health
• We hope that the report will spur further
analysis and action to advance health
promotion and disease prevention
Reference
• Community Health Indicators for the Washington
Metropolitan Region, A regional report from the
Metropolitan Washington Public Health Assessment
Center, June, 2001.
http://www.mwcog.org/healthindicators.pdf
• Healthy People 2010, U.S. Department of Health and
Human Services, 200.
http://www.health.gov/healthypeople/document/
• Improving Health in the Community: A Role for
Performance Monitoring, L. A. Bailey, J. S. Durch, and M.
A. Stoto, eds., National Academy Press, 1997.
http://www.nap.edu/catalog/5298.html