To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera, 707-565-4774
Vote Requirement: Informational Only
Supervisorial District(s): Countywide
Title:
Title
Community Health Dashboard
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Recommended Action:
Recommended action
Receive a report on the Community Health Dashboard.
end
Executive Summary:
The Department of Health Services (hereinafter, “DHS” or “the Department”) is launching a publicly accessible online-only Community Health Dashboard with data from 2016 to the present. This dashboard will serve as a regularly updated resource to make data more accessible and highlight changing health needs and health equity concerns in Sonoma County following the 2017-2019 fire events, the COVID-19 pandemic and beyond.
Discussion:
Project Goals
The Department is seeking to make data on the health of our community more accessible through the launch of a Community Health Dashboard. The goals of implementing this dashboard are to:
1) Monitor changing health needs and impacts of multiple disasters: Over the past six years, Sonoma County residents have experienced loss and trauma associated with multiple wildfires and a pandemic. By displaying regularly updated from 2016-present, users can view trends in how health care access, utilization, physical and mental health needs have changed over time.
2) Understand disproportional access to resources for support of health and well-being: The 2021 update to the Portrait of Sonoma highlighted racial/ethnic inequities in access to resources to support health, well-being and longevity. The Community Health Dashboard centers equity-focused analyses to understand where health disparities exist by race/ethnicity, age, gender, geography, and income-status.
3) Increase accessibility of data to inform awareness and action: This bilingual (English/Spanish), interactive dashboard is designed to serve as a resource for the Board of Supervisors, city leadership, health professionals, community-based organizations, public, and DHS staff and leadership to increase awareness of emerging health trends and facilitate resource planning, evaluation, and data informed decision-making to address health inequities in the community.
4) Align with State community health assessment requirements: This dashboard will also help meet Future of Public Health grant and Public Health accreditation community health assessment requirements. The Future of Public Health grant requires that the Department conduct a community health assessment every three years.
Methodology
The following describes the process the Department used to determine what data to highlight on the dashboard and how the necessary staff and technical capacity was developed to build and design this new tool.
• Establishing dashboard focus:
In summer and fall of 2022, the DHS Health Data and Epidemiology (HDE) Unit conducted research and engaged multiple stakeholders to identify priority indicators for inclusion on the initial draft of the dashboard.
- Literature review: The HDE Unit reviewed local, state, and national research on potential impacts of COVID-19 on community health to develop an initial list of possible indicators.
- Stakeholder feedback: The HDE Unit conducted multiple meetings with over 60 stakeholders from health services, human services, hospital and clinic health systems, behavioral health programs, health equity advocacy groups, community health worker initiatives, and the County Office of Education to gather input on the highest priority indicators to track.
- Data access: Data source availability, recency and disaggregation options for potential indicators were reviewed and ranked by HDE staff according to their research foundation, stakeholder interest, and data viability. In some cases, HDE established new data sharing agreements to access previously inaccessible data from health partners.
- Indicator selection: The initial set of indicators selected focused on prevention and resiliency, health access, physical health, mental health and longevity. Additional indicators will be added as data becomes available and staff capacity allows.
• Designing equity-informed and visually effective data displays and framing:
In designing the dashboard, HDE Unit staff sought feedback on how to best display health equity data through the following:
- Literature review: The HDE Unit conducted a review of multiple dashboards focused on health equity and studied written resources including the Do No Harm Guide: Applying Equity Awareness in Data Visualization <https://www.urban.org/research/publication/do-no-harm-guide-applying-equity-awareness-data-visualization> and the Racial Equity in Public Policy Message Guide <https://www.nationalforum.org/wp-content/uploads/2022/10/vhk_racialequitymessageguide_feb252021.pdf>.
- Staff trainings: The HDE Unit attended several webinars on equity in data display and an Epidemiologist and a Program Planning and Evaluation Analyst within the unit applied and were accepted to be part of the DHS Equity Circle to receive more in-depth training.
- Qualitative data capacity: To better represent the experiences of people in smaller racial ethnic groups for whom statistical analyses may not be feasible, the HDE Unit plans to partner with ongoing work to collect qualitative data in the community and share stories.
- Equity feedback: The HDE Unit met with the DHS equity manager and the local NAACP (National Association for the Advancement of Colored People) to get feedback on principles to incorporate in data display. Staff will continue to seek feedback on the dashboard displays from key health equity stakeholders and community groups to refine the dashboard and will update the dashboard with qualitative data as it becomes available.
• Staff capacity and technical resources:
In order to build the dashboard, it was necessary to first modernize HDE unit software to facilitate maintaining large quantities of data and building interactive, user friendly, interactive online displays.
- Statistical capacity: The HDE Unit staff participated in an intensive training to transition to R statistical software. This software is free and more versatile for automating processes and managing large quantities of data. The transition to this free software will result in approximately $18,000 of cost savings to the county per year ongoing because the HDE Unit was able to cancel its other paid statistical licensing packages used previously.
- Visualization tools: Stakeholders asked for easy-to-use interactive displays that would allow them to find the data and demographic breakdowns they needed. Utilizing Future of Public Health funds, the HDE Unit purchased Tableau licenses which permit the team to create interactive displays including trend and geospatial data with equity centered breakdowns and analyses.
- Data platform: The HDE Unit partnered with the County GIS team to build out the dashboard and Tableau displays within ArcGIS. This platform allows for translation of text to multiple languages using Google translate. The platform is mobile phone and desktop compatible. The GIS-based Community Health Dashboard site will be linked from the County DHS homepage.
Resulting Dashboard and Ongoing Development
The following outlines the initial iteration of the DHS Community and plans for continual improvement.
• Initial iteration
- The Community Health Dashboard will be launched on August 16, 2023 and available online at https:/gis-community-health.sonomacounty.ca.gov/ <https://gis-community-health.sonomacounty.ca.gov/>. This initial iteration will include data on:
• Prevention and Resiliency
• Health screenings
• Childhood immunizations
• Adverse Childhood Experiences
• Youth Connectedness
• Healthy Eating
• Active Living
• Healthy pre-pregnancy weight
• Health Care Access and Utilization
• Health insurance coverage
• Emergency department visits
• EMS (Emergency Medical Services) transport trends
• Preventable hospitalizations
• Physical Well-Being
• Chronic diseases
• Heart disease
• Diabetes
• Obesity
• Hypertension
• Cancer
• Communicable diseases
• Tuberculosis
• HIV
• Sexually Transmitted Infections
• Enterics
• COVID-19
• Mpox (formerly called Monkeypox)
• Emotional Well-Being
• Youth mental health
• Adult/teen mental health
• Prenatal and postpartum depression
• Alcohol/tobacco use
• Other substance use
• Longevity
• Life expectancy
• Leading causes of death
• Mental health related deaths
• Injury related deaths
• Future Development
• Addition of Social Determinants of Health indicators: Additional data will be added to the dashboard related to Social Determinants of Health and the root causes of disparities seen in health outcomes. These indicators are important to add because the social determinants of health-the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life-have been shown to account for 80-90% of health outcomes. Structural and systemic racism impact social determinants of health and the resources and opportunities available to individuals to support their health and well-being.
• Other dashboard content updates and revisions: The Community Health Dashboard will continue to be updated and refined based on community feedback and as new/improved data sources become available. These updates will occur on an ongoing basis as new information becomes available and staff capacity allows.
• Data update frequency for existing displays: Some data points will be updated weekly while others will be updated annually depending on the frequency with which new data becomes available.
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 2: Develop and implement dashboard tracking tools to collect data on common outcome measures across Safety Net departments by 2026
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
Yes
The Community Health Dashboard is being launched as a tool for public and County staff use in understanding areas of strength and challenge in local community health. Within each health indicator, disaggregation by race/ethnicity, Healthy Places Index quartile, geography, sex, age, and sexual orientation are provided wherever statistically feasible. The desired results and outcomes of making this interactive, bilingual dashboard available are to elevate areas of health inequity to help inform awareness and action around structural racism and unequal access to resources to support health and well-being. Data will be regularly updated to provide an ongoing indication of how Sonoma County is doing in addressing these health inequities.
The data highlighted on the dashboard at launch detail multiple areas of disproportionality by race/ethnicity. Some examples are as follows:
• Prevention and Resiliency
• Health Care Access
• Physical Well-Being
• Emotional Well-Being
• Longevity
In upcoming updates to the dashboard, additional indicators related to Social Determinants of Health (i.e., economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context) will be added to better monitor systemic inequities that impact opportunity and resource access and contribute to health outcomes. In addition, qualitative data will be incorporated as it becomes available to better represent community voice and perspectives (particularly among people in smaller racial/ethnic groups whose experiences are often not well captured through quantitative data alone due to sample size/statistical limitations).
Prior Board Actions:
None
Fiscal Summary
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Narrative Explanation of Fiscal Impacts:
There are no fiscal impacts associated with this item.
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Narrative Explanation of Staffing Impacts (If Required):
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Attachments:
Attachment 1 - Racial Equity Analysis
Related Items “On File” with the Clerk of the Board:
None