Slide presentations delivered during the afternoon sessions of Day One of the California Statewide Health and Human Services Open DataFest - March 14 - 15, 2016, Sacramento, CA

1. Join the conversation now: #HHSDataFest
Advancing Social Determinants of Health with Let’s Get Healthy California
and California Open Data Intiatives
Karen L. Smith, Director and State Health Officer, CDPH
Matt Willis, Rx Safe Marin
Debra S. Oto-Kent, Walk with Friends
Eric G. Handler, WasteNotOC

2. Rethinking Health

3. Rank state/territory Overall
1 Japan 82.73
2 Switzerland 81.81
3 Hong Kong 81.61
4 Australia 81.44
5 Italy 81.37
6 Iceland 81.28
7 France (metropol.) 80.95
8 Sweden 80.88
9 Israel 80.69
10 Singapore 80.60
11 Canada 80.54
12 Spain 80.48
13 Norway 80.45
14 Austria 80.24
15 Netherlands 80.20
16 New Zealand 80.13
17 Martinique ( France) 80.07
18 Macau 80.03
19 South Korea 80.00
20 Germany 79.85
Rank state/territory Overall
21 Belgium 79.77
22 Ireland 79.68
23 United Kingdom 79.53
24 Greece 79.52
25 Channel Islands ( UK) 79.51
26= Luxembourg 79.39
26= Guadeloupe ( France) 79.39
28 Finland 79.34
29= Cyprus 78.94
29= U.S. Virgin Islands ( US) 78.94
31 Costa Rica 78.87
32 Malta 78.80
33 Puerto Rico ( US) 78.70
34 Chile 78.65
35= Portugal 78.59
35= Slovenia 78.59
37 Cuba 78.50
38 Denmark 78.25
39 Taiwan 78.19
40 United States 77.97
41 Qatar 77.88
What do we know?
Overall health isn’t determined by
how much we spend.

4. Life expectancy in
California
by race/ethnicity
2006-2008
What do we know?
Health is not distributed evenly in
US.

5. Health
Behaviors
30-40%
Underlying
Determinants
of Health
20-50%
Medical
Care
10-20%

6. “Behavioral risk factors”
People’s behavior is shaped by the real life choices and
opportunities available to them where they live, work,
learn, and play.

7. Choices?

9. Neighborhood Conditions

11. “It is necessary that properties shall continue to
be occupied by the same social and racial
groups”- Federal Housing Administration
Underwriting Manual 1938 in recommending racially
restrictive covenants.

12. Social Determinates of Health
Conditions in the social, physical, and economic environment in which
people are born, live, work, and age. They consist of policies, programs
and institutions and other aspects of the social structure, including the
government and private sectors, as well as community factors.”
Healthy People 2020: An Opportunity to Address Societal Determinants of Health in the U.S., Objectives for 2020, July 11, 2010

13. “Health equity is achieving the highest level of health for all
people.”
Everyone should have the opportunity to make the
choices that allow them to live a long, healthy life,
regardless of their income, education or ethnic
background.
Sources: Virginia Department of Public Health RWJF: Vulnerable Populations Portfolio

14. Measuring health

15. Indicators of Health
• Mortality rates
• Diseases
• Disability
• Medical care
• DALYs
• QALY
• Risk behaviors
• Poverty rates
• Educational attainment
• Incarceration rates
• Environmental toxins
• Built environment
• Food insecurity
• etc

16. Infant Mortality
Data Source
birth certificate

17. New tools
• Open data
• Geocoding
• Mapping

18. Recipients as of Oct 2006.

24. High school grads: 90%
Unemployment: 4%
Poverty: 7%
Home ownership: 64%
Non-White: 49%

25. High school grads: 81%
Unemployment: 6%
Poverty: 10%
Home ownership: 52%
Non-White: 59%

26. High school grads: 65%
Unemployment: 12%
Poverty: 25%
Home ownership: 38%
Non-White: 89%

28. Life Expectancy—
Oakland Flats and Hills (2000-2003)

29. Alameda County
50
55
60
65
70
75
80
85
90
95
100
0% 10% 20% 30% 40% 50% 60%
Poverty Rate
LifeExpectancy(Years)
San Francisco County
50
55
60
65
70
75
80
85
90
95
100
0% 10% 20% 30% 40% 50% 60%
Poverty Rate
LifeExpectancy(Years)
Contra Costa County
50
55
60
65
70
75
80
85
90
95
100
0% 10% 20% 30% 40% 50% 60%
Poverty Rate
LifeExpectancy(Years)
Tract Poverty vs. Life
Expectancy

31. Let’s get Healthy California

32. The Guiding Questions
What will it look
like if California is
the healthiest
State in the
Nation?

33. Better Care for
Individuals
Better Health for
Populations
Lower Costs
National Strategy for Quality (2011), National Prevention Strategy (2011), California
County Health Rankings,
Commonwealth Fund on Local Health System Performance
Reviewed National and State Reports
Informed Development of
Priorities, Goals and Targets
Health Equity Focus
Foundation to the Process

34. Indicators
• 39 Indicators
• 10 Year targets
Report Issued December 2012

35. Data
Innovation
&
Communication
Website
- Public reporting
- Interaction & collaborative engagement
- Promising interventions
- Moving the needle
- Stakeholder participation
LGHC: Three Core Components
- Data structure
& visualization
- Data stories
& analysis

36. Let’s Get Healthy California
Website

39. Let’s Get Healthy California
Innovation Conference

41. Innovations Finalists
• Rx Safe Marin
Matt Willis, MD, MPH, Public Health Officer,
Marin County
• Walk with Friends
Debra S. Oto-Kent, MPH, Founder, Executive
Director, Health Education Council
• WasteNotOC
Eric G. Handler MD, MPH, Health Officer,
Deputy Agency Director,
Health Care Agency
2016 Innovations Conference

42. RxSafe Marin:
Using Data to Mobilize a
Community Coalition
Matt Willis, MD MPH
Public Health Officer
Marin County

43. What can we do as a community to
prevent prescription drug misuse and
abuse and save lives?

44. Comprehensive Approach
Prevention
Education
Surveillance
Monitoring
Diversion
Control
Law
Enforcement
Treatment
Recovery

45. Community Based
Prevention
Action Team
Data Collection and
Monitoring
Action Team
Law Enforcement Action
Team
Intervention, Treatment and
Recovery
Action Team
Steering Committee:
Data, Messaging, Policy
Representatives from:
Marin County Office of Education, Marin County
Prescription Drug Abuse Task Force, Healthy
Marin Partnerships
Backbone Support: HHS
Prescribers and Pharmacists
Action Team

46. Strategic Goal for Data Action Team
• Problem: An Epidemic Without a Surveillance System
• Vision: Marin County will have county-wide relevant
data on prescription drug misuse and abuse
• Develop a report card with 5-10 key data elements to track
prospectively
• Engage community in selection of indicators of greatest
relevance

47. 1. Consulted with federal, state, and other local jurisdictions
2. Contacted local agencies to determine available county-specific
data
3. Compiled data and presented potential indicators
• “Why this matters”
• Results
• Data source
4. Stakeholders voted on which indicators to include in the report card
Steps for Choosing Report Card Indicators

48. Resources

49. Example of Potential Indicator: Opioid-Related Emergency
Department Visits
Why this matters:
The Centers for Disease Control and Prevention (CDC) reports that drug misuse and abuse causes almost three million
emergency department (ED) visits annually. More than half of these are related to pharmaceuticals. Compared to
deaths, non fatal ED visits are a more frequent and more sensitive indicator of community burden of opioid related
harm.
Results:
Indicator 2006 2007 2008 2009 2010 2011 2012 2013
Non-Fatal Opioid-
Related Emergency
Department Visits
198 222 289 300 295 344 471 352
Data Source:
Office of Statewide Health Planning & Development (OSHPD). Emergency Department Data. Prepared by California
Department of Public Health, Safe and Active Communities Branch

50. State Data Sources
• Emergency Department
visits
• Hospitalizations
Office of Statewide Health Planning
and Development (OSHPD)
• Controlled substance
Prescription
California Department of Justice/
Controlled Substance Utilization
Review and Evaluation System
(CURES)
• Drug poisoningsVital Statistics
• Treatment admissions
California Outcomes Measurement
System (CalOMS) Treatment
Agency Type

51. Local Data Sources
• Drug possessionsOffice of the District Attorney (DA)
• Safely disposed
Prescription
Medications
Environmental Health Services
(EHS)/
Drug Enforcement Agency (DEA)
• Naloxone doses
administered
Emergency Medical Services (EMS)
Agency Type

52. Report Card Draft

53. Beyond the PDF: Livestories

54. • The Public as Data
Consumers
• Infographics
• Social Math
• Website
• Social Media

55. Stay connected!
www.RxSafeMarin.org
Facebook.com/RxSafeMarin
RxSafeMarin@gmail.com
THANK YOU!

56. “There is nothing new about poverty. What
is new is that we now have the techniques
and the resources to get rid of poverty. The
real question is whether we have the will.”
-Martin Luther King Jr.

58. • 12.7% of households are food insecure
• There are 349,690 people living with food
insecurity
• 1 in 5 children face food insecurity
Source: (Feeding America. Map the Meal Gap 2013.)
Food Insecurity Statistics
Orange County

59. Child Poverty Rates in California Counties
County or County Group Child Poverty Rate (%) County or County Group Child Poverty Rate (%)
Merced 40.6 Colusa, Glenn, Tehama, Trinity 21.7
Fresno 36.4 Shasta 21.7
Tulare 36.3 Yolo 21.3
Lake, Mendocino 35.2 Solano 20.8
Kern 35 San Diego 19.6
Imperial 32.7 San Luis Obispo 19.2
Stanislaus 32.4 Santa Barbara 19
Madera 30.7 Orange 18.4
Del Norte, Lassen, Modoc, Siskiyou, 29 Ventura 16.8
Kings 28.7 Sonoma 16.1
Butte 26,4 Alameda 15.8
Los Angeles 26.3 Contra Costa 15.6
Sutter, Yubs 26 San Francisco 15.4
San Joaquin 25.2 Santa Cruz 14.3
Sacramento 25.2 El Dorado 14.2
Humboldt 24.7 Nevada, Plumas, Sierra 12.7
San Bernardino 24.6 Santa Clara 12.2
Alpine, Amador, Calaveras, Inyo, Mariposa, Mono, Tuolumne 22.6 Marin 10.5
Riverside 22.1 Placer 9.7
Monterey, San Benito 22 San Mateo 8.6
Napa 21.9

60. Food Recovery
Educate restaurants and grocery stores on the
Good Samaritan Act to increase food
donations.
Food Distribution
Connect those in need with
pantries that provide wholesome
food.
Identify those in need
Start asking the questions if individuals are facing
food insecurity.
3-Pronged Approach

61. Targeting the cities of Anaheim and Orange
253 tons (390,000 meals)
of newly recovered food
Updated 10/31/15

62. Screening Tool to Determine
Level of Food Insecurity
• “Within the past 12 months we worried whether our food would run
out before we got money to buy more”
Often True Sometimes True Never True
• “Within the past 12 months the food we bought just didn’t last and we
didn’t have money to get more.”
Often True Sometimes True Never True
Development and Validity of a 2-Item Screen to Identify Families at Risk: Pediatrics 2010;126;e26

63. Interactive Google Pantry Map of Orange County

64. Join the conversation now: #HHSDataFest
Interactive Activity: Enhancing Incentives for State and Local
Government to Use Data More Effectively
Facilitator: Shell Culp, Chief Innovation Officer, Stewards of Change Institute

65. Creating Person Centered Services
and Coordinating the San Diego Region
Achieving Community Health
John Ohanian, President & CEO, 2-1-1 San Diego/Imperial

73. The Complex Community that We Live in…
• 4,261 square miles (larger than 21 U.S.
States; same size as Connecticut)
• 5th largest U.S. County, 2nd largest in
CA
• 18 municipalities; 36 unincorporated
towns
• 18 tribal nations
• 42 school districts
• 2013 Estimates - 3.1 million population
• 48% White
• 32% Latino
• 11% Asian/PI
• 4.7% African American
• 0.5% American Indian
• Region is very diverse
• Over 100 languages
• Large military presence
• Largest refugee resettlement site in CA
• Busiest international border crossing in
the world (San Ysidro/MX)

74. Building
Better
Health
Living
Safely
Thriving

75. BEHAVIORS DISEASES PERCENT
Leadto
Resultin
Morethan
No Physical Activity
Poor Diet
Tobacco Use
Cancer
Heart Disease & Stroke
Type 2 Diabetes
Lung Disease
of Deaths
in San Diego

76. Areas of
Influence
Definition Top 10 Indicators
Enjoying good health and
expecting to live a full life
• Life Expectancy
• Quality of Life
Learning throughout the
lifespan
• Education
Having enough resources
for a quality life
• Unemployment Rate
• Income
Living in a clean and safe
neighborhood
• Security
• Physical Environment
• Built Environment
Helping each other to live
well
• Vulnerable Population
• Community Involvement
N
G
R
E
S
U
L
T
S
7
6

77. The County of San Diego’s ConnectWellSD will enrich the lives of individuals and families
through collaboration.
ConnectWellSD is implementing a person-centered service approach and a new technology
system to link enterprise-wide customer data and service information.

78. It all begins with one person, one family
Housing/Shelter
TransportationHealthcare
Food
Assistance
Financial
Assistance

79. Connecting San Diego Healthcare
Lab Companies
Health Plans
Home Health
Nursing Homes
EMS
Public Health
Agencies
Behavioral Health
Providers
Schools
Patients and
Caregivers
Community Health
Centers
Pharmacies
Physician Practices
Hospitals

80. Connecting Service Providers
Public Benefits
Housing
Health Benefits
Military / Veteran
Services
Meals
Community Services
Utility Assistance
Financial Literacy
Programs
Crisis Services
Disaster
Coordination
Aging Services
Childcare Transportation

81. Regional Information Exchange
Cross-Sector –
Vertical insights across social,
health and government
sectors
Community-wide
Holistic
Easily Accessible
High volume
Community
Backbone
Efficient

82. Regional Information Exchange virtually integrates with its participants to enable the automation of secure,
private, flow of information between regional service and healthcare providers to:
Greatly Enhance Care
Coordination
Reduce the Cost to provide
services
Improve the
Quality of care
Achieve Improved
Population Health
Regional Information Exchange Partnership

83. Without restrictions
from copyright,
patents or other
mechanisms
Freely available for
everyone
to use
Movement towards Open Data
Interoperability denotes the ability of diverse systems and organizations to work together
(inter-operate). In this case, it is the ability to interoperate - or intermix - different datasets.
Open Data

85. Challenges and Roadmap to Success
Trust and Relationships
Interoperability
Privacy and Consent
Training and
Re-training

86. What do you think?
Achieving Community Health
John Ohanian, President & CEO, 2-1-1 San Diego/Imperial