Wednesday, June 26, 2019

National HIV Testing Day



HIV testing day is June 27. On this day, organizations throughout the U.S. sponsor a wide variety of events, including free testing and education.  As HRSA’s Health Center Program funds 10,000 health center sites, serving over 24 million people, it is uniquely situated to address the HIV crisis. In fact, the health center program focuses on care for underserved and vulnerable populations, the same populations disproportionately affected by HIV.  One way the health center program is leveraging this is by participating in the Department of Human Services’ “Ending the Epidemic: A Plan for America.” This new 10-year initiative aims to virtually eliminate new HIV infections in the U.S. by focusing on early diagnosis, rapid treatment, proven prevention, and rapid outbreak response among areas most at risk. When the initiative begins next year, health centers in target areas will expand outreach as well as both routine and risk-based HIV testing opportunities.

As a geographer, I was curious about the communities targeted by the Ending the Epidemic initiative and the health centers located within them. I wanted to visualize the service areas of these health centers in relation to other community resources and overlay some population health data. To get started, I created a series of maps of Franklin County, Ohio, one of the initiative’s 48 target counties, using the UDS Mapper.

The UDS Mapper is ideal for this type of project as it is an online mapping and decision-support tool driven primarily by patient location data within the Uniform Data System (UDS). It allows easy visualization of health center service areas, along with patient data, population health data, and health related facilities. Within the UDS Mapper, I started by navigating to Franklin County, Ohio, then activating the By Patient Origin mode of the Explore Service Area tool.

UDS Mapper with Explore Service Area tool set to By Patient Origin mode

I could see right away that there are five organizations located within Franklin County. I wanted to see how large their service areas are and where they overlap.

I clicked on each organization which added its core, in this case 75%, patient origin service area to the map. I could see that these organizations serve many Franklin County ZIP Code Tabulation Areas (ZCTAs), especially those in and adjacent to the city of Columbus.
Patient origin service areas





I turned on service access points and saw that they are also mostly concentrated in central Franklin County.
Patient origin service areas with health center service access points


For demonstration purposes, I chose Columbus Neighborhood Health Center (CNHC) to examine further. I de-selected the other health centers so my map only showed CNHC’s patient origin service area, then I opened the Data Table. Studies show that people with health insurance have greater access to HIV testing, and that early knowledge of one’s HIV status reduces HIV-related morbidity and mortality and reduces the risk of transmission (KFF, 2019). To assess population insurance status and access to care for CNHC’s service area, I added uninsurance and no usual source of care data to my table. I could see at a glance that in the ZCTAs that comprise CNHC’s core service area, 9% of the population are uninsured and 19% have no usual source of care.

Data table and summary row



I then used the Population Indicators tool to see which ZCTAs are at or above these service area benchmarks.

ZCTAs with relatively high rates of uninsurance and no usual source of care

Twelve ZCTAs within the health center’s service area have uninsured rates above 9% and more than 19% of the population without a usual source of care. These ZCTAs might be ideal areas in which to focus the initiative’s early outreach efforts.

I also wanted to see what other health resources are nearby. There are four opioid treatment programs which could serve as ideal partners throughout the initiative. This is important as intravenous drug use is a major risk factor for HIV transmission, and drug use in persons with HIV could exacerbate the progression of the virus (NIDA, 2018). Additionally, there are several hospitals and public housing facilities within CNHC’s service area which could serve as potential HIV care collaborators.
Health centers, hospitals and public housing sites added to map



Using the UDS Mapper, I was able to quickly and effectively visualize population health and resource data for a health center located within an Ending the Epidemic target county. If you’re interested in trying the UDS Mapper, go to www.udsmapper.org, and don’t miss the Tutorials page for details on each of the tools I used and more. And finally, take advantage of National HIV Testing Day – attend a HRSA webinar, read up on the CDC website, get tested, or just spread the word using the #DoingItMyWay hashtag on social.

Jessica McCann
User Engagement Specialist, HealthLandscape


References
KFF. June 25, 2019. HIV Testing in the United States





Monday, June 10, 2019

HealthLandscape and Men’s Health Week


Since 1994, the week leading up to Father’s Day has been officially recognized as Men’s Health Week. This advocacy campaign, hosted by Men's Health Network, promotes men’s health improvement measures during the entire month of June. During Men’s Health Week and throughout the month, men in the United States are encouraged to schedule appointments with their primary care physician (PCP), get more exercise, get screened for prostate health, eat healthy foods, and consider prevention as a way of life.

Outreach conducted by local and national groups focuses on disseminating statistics to bolster awareness related to men’s health. For example, according to Men’s Health Month, women are 100% more likely than men to seek out an annual visit to their PCP. Data from Health.gov show that men live shorter lives, die at higher rates from the top 10 causes of death in the U.S., and are less likely to have health insurance. According to the Men’s Health Network, men are much more likely than women to die by homicide with some variation by race (1 in 30 for black males versus 1 in 132 for black females; 1 in 179 for white males versus 1 in 495 for white females). Equally alarming is the risk for suicide among men. In 2015, the CDC reported that men are four times more likely to commit suicide than women and that the rate of suicide among men 65 and over is 31.5% compared to 5% for women.

In honor of Men’s Health Week, HealthLandscape has added some exciting new county-level data related to men’s health to the Community HealthView data library. From the National Cancer Institute, we’ve added three datasets describing annual prostate cancer incidence, average prostate cancer cases per year, and prostate cancer incidence five-year trends from 2010 to 2014. From the U.S. Census American Community Survey, users can turn on a layer showing the percent of the population that are male for 2011-2015. Lastly, from the Centers for Disease Control and Prevention’s Diabetes Surveillance System, we’ve added measures on diabetes and obesity prevalence among men, as well as the percentage of physical inactivity among men. All three of these measures are from 2015, the most recent year for which data are available.



During Men’s Health Week and beyond, advocacy groups like the Men’s Health Network and local and state health departments can use tools like HealthLandscape’s Community HealthView to explore data on men’s health, identify geographic variation or overlap, and/or target resources to improve men’s health.

Dave Grolling
GIS Strategist, HealthLandscape


Friday, June 7, 2019

Family Health and Fitness Day and Park Exploration

Family Health and Fitness Day, created by the National Recreation and Park Association (NRPA), is celebrated annually on the second Saturday of June. Intended to show how important parks and recreation are to keeping their communities active and healthy, people are encouraged to visit their local parks to explore the recreational options available in their backyards. According to the Department of Health and Human Services, only one in three children are physically active every day and only one in three adults receive the recommended amount of physical activity each week. Parks can serve as local outlets for individual and community activities.


NRPA’s vision is that everyone has easy access to park and recreation opportunities in sustainable communities. To that end, they’ve partnered with the Trust for Public Land (TPL) in a nationwide movement called The 10-Minute Walk Campaign - ensuring that every person has a great park within a 10-minute walk. 

By visiting their site, www.tpl.org/10minutewalk, you can learn more about park access in your community. Seattle, for example, has a ParkScore ranking of 11. The TPL ParkScore rating is based on the following measures; access - the portion of residents within a 10-minute walk to a park, acreage - the median park size and percent of area dedicated to parks, community investment - park spending per resident, and available amenities - features like basketball hoops, playgrounds, and dog parks. 


In the interest of exploring issues of equity in access to parks and recreation, TPL takes their analysis even further by delving into park access by age, income, and race/ethnicity. All of these data points are available at the aggregate level, by city, and for each individual park.




Further, they use the data collected to make recommendations about where new parks might be best located, based on how many additional residents could be covered by the 10-minute walk radius, highlighting areas highest in need of funding and attention.







Clicking on an individual park polygon on the map will give you information about the service area within a 10-minute walk as well as a detailed report on the population being served by that location.






Want to quickly find the parks in your neighborhood? Check out the ParkServe webmap, created using TPL’s database of collected and user-added park locations, to find public parks near you. Click on any park location to find information about the name, owner, and address, where available. 






Jene Grandmont
Senior Manager, Application Development and Data Services, HealthLandscape

Tuesday, May 28, 2019

Data Lovers Unite!

One thing the team at HealthLandscape believes in pretty consistently is the power of data visualization. We do it daily by building mapping and graphing tools, we teach it, we research it. We live it, we breathe it. That’s why it’s always great to go out to conferences and interact with our fellow data-philes (as you may have read earlier this week in our ACS Users Conference blog).

I try to live by the maxim don’t let the perfect get in the way of the good, particularly when it comes to health data. Health data are robust and fragile. They are comprehensive and limited. They are universal and unique. Since my role at HealthLandscape is primarily to teach people how to use our mapping tools, I try to gauge from an audience how much they care about the nuances and limitations of the datasets we use. Usually I get blank stares; after all, it’s not as fun listening to a list of datasets as it is to see a dynamic mapping tool in action and witness the power of those datasets.

This week, I represented the UDS Mapper at two conferences - the Northwest Regional Primary Care Association Spring Summit in Anchorage, Alaska, and the 2019 National Health Care for the Homeless Conference & Policy Symposium in Washington, DC. I had the opportunity to present in Anchorage and interact with attendees as an exhibitor in Washington. Aside from trying to sort out “when” I am after spanning so many time zones, I was surprised by how many people had deep questions about the data. Many people confessed to being closet data-philes and told me they want more. Their thirst for knowledge pushed me to really think about how these data could be used to answer their unique questions. They seemed to understand the data are not perfect and never will be, but are still useful and can help them continue to do the good work they are already engaged in.

Let the HealthLandscape team know about your data questions. Give us suggestions for new datasets we can add to our tools. Confess to us you are a data-phile. This is an inclusive, data-loving community and all are welcome!

P.S. I met one huge fan of the UDS Mapper this week, and I want to assure you all that if the future of public health data is up to her, we are in good hands.

Tuesday, May 21, 2019

2019 American Community Survey (ACS) Data Users Conference




The ACS Data Users Group is a partnership between the U.S. Bureau of the Census and the Population Reference Bureau, to promote the effective use and dissemination of ACS data, as well as educate users on data issues and best practices.

The annual ACS Data Users Conference, held May 14 and 15 this year, was a great opportunity to learn how others use ACS data, how the data can be used in concert with other federal and non-federal data sources, and how to keep up with the great data exploration and visualization tools people use (and develop) to get the maximum utility from this detailed demographic and economic data resource.

For me it was great to be introduced (actually, reintroduced) to the IPUMS data library at https://www.ipums.org/. I hadn’t visited their collection for the better part of five or more years, and they have really expanded their offerings. By focusing on data curation and dissemination, and NOT analysis and visualization, they have been able to create wide ranging and still detailed collections of census (lower case c) and administrative survey records. It’s very much worth a visit to their site if you’ve never been (or like me, have been away too long).


Our Contribution at the 2019 ACS Data Users Conference

For my part, I was able to give two well-received presentations, including one that I delivered with Annu Jetty of the Robert Graham Center.
Zhang et al., Am J Epidemiol. 2014;179: 1025–1033 

Both papers focused on our use of an innovative modeling technique developed by researchers from the Centers for Disease Control and Prevention (CDC) to create small (sub-county) area estimates for specific health behaviors and health outcomes. These estimates are derived from sub-county ACS population measures 
(diagram shown above). In the first presentation, we showed how the Health Resources and Services Administration (HRSA) and the UDS Mapper enable you to do cold spot analysis to find high-need areas. My second presentation showed how our Population Health Profiler can help health care providers learn more about the health of the community (“Community Vital Signs”) that matches their actual patient-derived service area. 

Try the tools mentioned above, find support resources, or contact us today for more information.

Mark Carrozza
Director, HealthLandscape

Friday, May 17, 2019

National Mental Health Month and the Mental Health Explorer


The World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” While we have shifted our societal views on what we define as “healthy” and have molded programs to meet the needs of individuals, mental health stigma remains. Meanwhile, several figures in popular culture and other platforms have begun a crusade to de-stigmatize mental health issues. For example, President Obama championed and signed the 21st Century Cures Act in 2016 which took steps to ensure insurance companies treat mental health and substance use disorders more equitably. Mental Health America (MHA) has declared May National Mental Health Month. Additionally, many leaders around the world are encouraging safe spaces to discuss issues that millions of people struggle with daily.  


Background

Research confirms extensive mental health stigma and unmet need. Multiple studies from RAND state that mental health stigma is rampant in places like correctional facilities, professional work environments, and in the military. According to the CDC, 50% of Americans are diagnosed with a mental illness or disorder, and the third most common cause for hospitalization is mental illness, especially in the 18-44 age group. Mental Health America (MHA) fact sheets state 1 in 5, or in other words 9 million, American adults reported not having their mental health needs met. MHA reports that, compared to states with a large mental health provider workforce, “states with the lowest workforce [have] almost 4 times the number individuals to only 1 mental health provider.” In 2018, the Health Resources and Services Administration (HRSA) published a report projecting supply and demand for behavioral health occupations in 2030. Utilizing 2016 baseline data, the findings revealed behavioral health workforce variations by state and projected an overall shortage across 37 states, reaffirming the need for these services. As we become more cognizant about mental health issues and workforce deficits, policy makers must be careful to match limited resources and appropriate mental health supports to existing needs.  To assist policy makers, practitioners, and communities in these efforts, the team at HealthLandscape developed a tool which provides data illustrating mental health services and need across the nation.  




In May 2019, in conjunction with National Mental Health Month, HealthLandscape launched the Mental Health Explorer. The Mental Health Explorer (shown above) is a free, online tool based primarily on data available from the Robert Wood Johnson Foundation’s County Health Rankings. The County Health Ranking model uses over 30 data measures which leaders can use to advocate for health policy and program improvements in their communities.  The Mental Health Explorer features the Mental Health Mapper (shown below), which consolidates relevant County Health Rankings data, other mortality data, and workforce data in one tool for users to view their specific county level data pertaining to mental health and wellness.


Three additional capabilities are also available through the Mental Health Explorer: Mapping the mental health workforce, mapping community health data, and uploading other data sets for geocoding or analysis. The Mental Health Workforce Mapper (shown below) allows the user to view point and rate data on the mental health workforce. 


Community HealthView (shown below) is an extensive library of social, behavioral, and health measures. Finally, users can upload data to add to the map via the Map My Data feature.


Please refer to the Mental Health Explorer Quick Start Guide as you get started. The guide will help navigate the Mapper and its various tools, and help you examine mental health need in your community. If you have questions, contact us anytime.

Karin Natalie Pivaral for HealthLandscape
Dartmouth College Intern at the Robert Graham Center

Karin Pivaral is an MPH candidate at The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College. As an intern with the Robert Graham Center, Karin conducted research in Primary Care Spend in the U.S. Karin’s Public Health research interests also include global health and health policy finance.







Monday, May 13, 2019

Maternal Mortality in the United States


Thanks in part to a recent surge in research, better data collection methods, and media attention, maternal mortality is once again on the minds of researchers, policy makers, and providers.  Previously considered a problem only in the developing world, the U.S. is now the most dangerous high-income country in which to give birth. In honor of National Women’s Health Week, we created a Story Map to further explore maternal mortality in the U.S., including contributing factors, geographic distribution, and potential solutions.


Background

Though disparate definitions of maternal mortality exist, it is defined by the CDC as the death of a pregnant woman or a woman within one year of giving birth ”from any cause related to or aggravated by the pregnancy or its management.” While many countries have made great strides in reducing maternal mortality, the United States has seen major setbacks. According to the CDC, between 1987 and 2014, the maternal mortality rate increased from 7.2/100,000 live births to 18.0/100,000 live births, more than doubling. 
Image source: CDC Pregnancy Mortality Surveillance System


A Story Map

Researchers site many factors that contribute to these statistics. In a 2017 series entitled “Lost Mothers: Maternal Mortality in the U.S.,” Martin and Montagne explore several of these factors, including racial disparities in health and access to health care. In the article “Black Mothers Keep Dying After Giving Birth,” as noted in Panel 4, the authors state that black women die at nearly four times the rate of white women, and these disparities persist across all income and education levels.  Martin and Montagne cite systemic social inequalities, poor access to care, and unconscious provider bias as contributing factors. In National Geographic, Jones expands on this concept by attributing maternal mortality racial disparities, in part, to “weathering,” the concept that the constant stress placed on racial and ethnic minorities by racism and bias leads to poor health outcomes.

Researchers also blame health care inequality and unequal access to care, explored in Panel 5. The U.S. is the only highly-developed county in the world without some form of universal health coverage, leading to women delaying or forgoing care they cannot afford. Additionally, uninsured women are more likely to suffer from chronic conditions which can lead to pregnancy complications. In fact, “women who lack health insurance are four times more likely to die of a pregnancy-related complication compared to their insured counterparts,” states Barone in Berkeley Wellness.

As Panel 6, also shown below, shows the geographic variation in maternal mortality is strongly correlated with other indicators of health and well being. The southern U.S. has the highest rates, with a maximum in Georgia at 46.2 deaths/100,000 live births.



The map in Panel 7 (left) shows county-level data following the same distribution as state-level data; however, county data are only available using 100,000 population as the rate denominator. So, while the state of Georgia has the highest maternal mortality ratio at 46.2 deaths/100,000 live births, county-level data for Jefferson County, for example, are reported as 1.14 deaths/100,000 population. Also noteworthy in Panel 7 is the ability to view mortality trends. Again, using Jefferson County as an example, we see maternal mortality has increased between 1985-2014 from 0.62 to 1.14/100,000 population, up 84%.

Next Steps

So what’s being done about this crisis in our midst? Organizations and initiatives are stepping up to create change. The American Academy of Family Physicians has implemented awareness campaigns, legislative initiatives, provider training, and innovative partnerships. The Health Resources and Services Administration (HRSA) convened a maternal mortality summit last year and has pledged to increase action via implementing best practices, increasing access to care via the Health Center Program, supporting providers, and more.  In California, the California Maternal Quality Care Collaborative (CMQCC) is being credited with reducing state maternal mortality rates by 55% using data-driven quality improvement initiatives.

Learn more about this issue, its geographic distribution, and improvement efforts in Maternal Mortality in the United States, and let us know if you have questions or feedback.



Jessica McCann
User Engagement Specialist, HealthLandscape