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Report Methodology

Why did the Greater Louisville Project decide to publish a report on health?

At 2011 Retreat, the GLP Policy Board made a commitment to developing Health at the level of a Deep Driver and to identifying the best indicators to measure Health.

In 2012, the Project team conducted a series of 25+ local interviews with health experts and completed an extensive review of national health research.

The Project Team conducted a series of interviews in early 2012, talking to leaders from across sectors including government, nonprofit, healthcare providers, health plans, major employers, and education.

In these meetings, the GLP heard there was a need for a more comprehensive understanding of community-wide health and that GLP is well positioned to provide a perspective on health that could inspire action.

What literature was reviewed?
  • Trust for America’s Health, “Healthy Americans for Healthier Economy”, 2011. http://healthyamericans.org/assets/files/TFAH2011PreventEconomy05.pdf
  • Louisville Metro Public Health and Wellness, “Louisville Metro Health Status Report,” 2012. http://www.louisvilleky.gov/NR/rdonlyres/D83AC3D6-0C08-440C-B993-50BB258C573F/0/HealthreportFINAL_12712.pdf
  • Center for Health Equity, a division of Louisville Metro Public Health & Wellness, “The Social Determinants of Health in Louisville Metro Neighborhoods,” 2011.  http://www.louisvilleky.gov/NR/rdonlyres/29925903-E77F-46E5-8ACF-B801520B5BD2/0/HERFINALJAN23.pdf
  • County Health Rankings and Roadmaps, http://www.countyhealthrankings.org
  • NEHI, “The Boston Paradox:  Lots of Health Care, Not Enough Health” http://www.nehi.net/publications/22/the_boston_paradox_lots_of_health_care_not_enough_health
  • Mayo Clinic Health Solutions, “The True Cost of Poor Health,” 2008.  http://www.tcyh.org/employers/downloads/Extra_MayoCostOfHealth.pdf
  • Healthy Hartford, March 2012
  • America’s Health Rankings. http://www.americashealthrankings.org
  • Centers for Disease Control and Prevention, “Healthy People 2020,” “http://www.cdc.gov/nchs/healthy_people/hp2020.htm
  • National Bureau of Economic Research, “Healthy, Wealthy and Wise:  Socioeconomic Status, Poor Health in Childhood and Human Capital Development,” May 2008. http://www.nber.org/papers/w13987
  • National Bureau of Economic Research, “Estimating Interdependence between Health and Education in a Dynamic Model,” January 2007. http://www.nber.org/papers/w12830

From this review, the Greater Louisville Project discovered the County Health Rankings model, developed by a team of researchers, epidemiologists, and statisticians at the University of Wisconsin and funded by the Robert Wood Johnson Foundation.

They choose their data points similar to the way the GLP does – actionable measures, free or low-cost, and comparable across communities.

The GLP believes this is the best representation of health data available today that meets these criteria.

The County Health Rankings provides measures and rankings for factors within one state. The Greater Louisville Project has used these measures to rank Louisville against its peer cities, which are in many different states. How did it do this?

The county health rankings use lots of indicators, measured by a wide range of scales (percents, per 100,000, ratios, etc.) The use of “z-scores” accomplished two objectives:

  • All indicators are converted to the same scale, (and thus may be more easy to use in composite indices).
  • Z-scores are calculated relative to a specific group of cases (or counties). Z-scores based on counties within states are provided in the County Health Rankings, and their interpretation is limited to comparing counties relative to others within the same state. GLP has calculated the z-scores (and the health indicators) based on the Jefferson County and the 14 “competitive city” core counties, showing how we stack up to our competitors.
How did the GLP select “strategic indicators” that are presented in the health report?

In April 2013, the GLP convened the ad-hoc Health Advisory Group for two three-hour meetings. The GLP asked the group to contribute thought and perspective on health from a macro-community, rather than organizational, perspective.

The Ad Hoc group consisted of local health experts, representing various sectors in the community, and included Gabriela Alcade, MPH, DrPH and Susan G. Zepeda, PhD – Foundation for a Healthy Kentucky; Donna Church and Diana Han, MD – GE; Lelan K. Woodmansee CAE – Greater Louisville Medical Society; Erik Anderson, Stuart Mushala and John Schriber – Humana; Bonnie Ciarroccki, MAT, MCHES and Dewey Hensley – Jefferson County Public Schools; Teresa Campbell and Randa Deaton – Kentuckiana Health Collaborative; Alice Bridges and Tom Walton – KentuckyOne Health; Dana Jackson – Network Center for Community Change (NC3); LaQuandra S. Nesbitt, MD, MPH – Louisville Metro Public Health & Wellness; Sandra E. Brooks, MD, MBA, Norton Healthcare; Rob Steiner, MD, PhD  and Craig Blakely, PhD, MPH– University of Louisville.

Kate Konkle of County Health Rankings presented the model and the group had the opportunity to ask questions.  This group first confirmed the County Health Rankings as a valid and effective model for the GLP.

The Advisory Group worked to rank the health factors and to help narrow the factors to the most strategic challenges in each of the areas. They identified which factors had substantial community activity or stakeholder buy-in around them, and which would have the greatest consequence for inaction. The GLP team then synthesized their comments and input for developing the content of the Special Report on Health.

What about the other factors not identified as strategic challenges in the GLP health report?

The GLP compiled data and rankings on every factor tracked by the County Health Rankings.