Wisconsin Department of Health Services
January 2014 P-00522H
Healthiest Wisconsin 2020 Baseline and Health Disparities Report
Healthy Growth and Development
HEALTHY GROWTH AND DEVELOPMENT
Background• Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities
Report • Healthiest Wisconsin 2020 objectives and indicators• Rationale• Key points
Data• Infant mortality and low birthweight• Risk factors• Health care access and utilization
References
Links to additional reports and resources
Contacts
Chapter Outline
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Chapter outline
HEALTHY GROWTH AND DEVELOPMENT
Report Overview
• This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf
• The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included.
• Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations.
• Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf
Report overview
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HEALTHY GROWTH AND DEVELOPMENT
Report Format
Full Report• Format: PDF • Intended use: reference document
Chapters• Format: Annotated PowerPoint slide set• Intended uses: presentations to
– Decision-makers– Service providers– Community leaders– The public
Sample annotated slide
Report overview
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HEALTHY GROWTH AND DEVELOPMENT
Report Outline
Executive Summary
Section 1: Introduction
Section 2: Demographic overview
Section 3: Health focus areas
Section 4: Infrastructure focus areas
Section 5: Data summaries by population
Section 6: Technical notes
Report overview
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HEALTHY GROWTH AND DEVELOPMENT
Report Outline: Detail
Section 3: Health focus areas
• Alcohol and other drug use• Chronic disease prevention and management• Communicable diseases• Environmental and occupational health• Healthy growth and development• Injury and violence• Mental health• Nutrition and healthy foods• Oral health• Physical activity• Reproductive and sexual health• Tobacco use and exposure
Section 4: Infrastructure focus areas• Access to health care
Report overview
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HEALTHY GROWTH AND DEVELOPMENT
Report Outline: Detail
Section 5: Data summaries by population
Racial/ethnic minority populationso American Indianso Asianso Blackso Hispanics
People of lower socioeconomic status People with disabilities Lesbian, gay, bisexual, and transgender populations Geography
Report overview
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HEALTHY GROWTH AND DEVELOPMENT
Data notes
• Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf
• The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution.
• Population estimates that are considered unreliable are excluded.
• Misclassification of racial/ethnic groups may affect the accuracy of rates.
• Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non-Hispanic.
Report overview
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HEALTHY GROWTH AND DEVELOPMENT
Factors that influence health
Social determinants
of health
Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach
Report overview
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HEALTHY GROWTH AND DEVELOPMENT
Objective 1 By 2020, increase the proportion of children who receive periodic developmental screening and individualized intervention.
Objective 1 Indicators
• Proportion of parents reporting that a health provider assessed their child’s learning, development, communication, or social behavior.
• Number of children who received services from the Birth to Three program during the first year of life.
Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Healthy Growth and Development Profile.
Healthiest Wisconsin 2020 objectives and indicators
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HW2020 objectives
HEALTHY GROWTH AND DEVELOPMENT
Objective 2
By 2020, provide pre-conception and inter-conception care to Wisconsin women in population groups disproportionately affected by poor birth outcomes.
Objective 2 Indicators
• Rates of avoidable infant and fetal death.
• Percentage of births to women with avoidable risks for poor birth outcomes.
Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Healthy Growth and Development Profile.11
Healthiest Wisconsin 2020 objectives and indicators
HW2020 objectives
HEALTHY GROWTH AND DEVELOPMENT
Objective 3
By 2020, reduce the racial and ethnic disparities in poor birth outcomes, including infant mortality.
Objective 3 Indicators
• Disparity ratios for infant mortality, low birthweight, prematurity, and timing of entry into the Women, Infants and Children (WIC) program.
Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Healthy Growth and Development Profile.
Healthiest Wisconsin 2020 objectives and indicators
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HW2020 objectives
HEALTHY GROWTH AND DEVELOPMENT
Rationale
• Healthy growth and development in early life have a profound effect on health across the life span.
• Research demonstrates a link between early life events and adult chronic diseases. Babies born at lower birthweights have an increased risk of developing heart disease, diabetes, and high blood pressure in later life.
• Infants with poor birth outcomes begin life with multiple risk factors that may prevent them from reaching their full health and development potential.
Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Healthy Growth and Development Profile.13
Rationale
HEALTHY GROWTH AND DEVELOPMENT
Key points
• While Wisconsin’s infant mortality rate has declined over the past 10 years, notable racial disparities remain. In 2010, the Black infant mortality rate (13.9 deaths per 1,000 live births) was approximately three times greater than for Whites (4.9 per1,000).
• During 2009-2010, nearly two out of three births to Black mothers in Wisconsin were the result of unintended pregnancy.
• Smoking during pregnancy is much more common than drinking during pregnancy. An estimated one out of five Black women who recently gave birth smoked during pregnancy.
• In more than one-third of Laotian/Hmong births, the mother did not receive first-trimester care, nearly three times the rate among White births.
• Rates of drinking during pregnancy were similar by race/ethnicity. Among the racial and ethnic groups reported here, Hispanic women were the least likely to smoke or drink during a recent pregnancy.
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Key points
HEALTHY GROWTH AND DEVELOPMENT
Infant mortality and low birthweight
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HEALTHY GROWTH AND DEVELOPMENT
Infant mortality by race/ethnicity, rate per 1,000 births, Wisconsin, 2001-2010
Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.
Infant mortality and low birthweight
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
5
10
15
20
25 BlackAmerican IndianLaotian/HmongHispanicWhite
Rate
per
1,0
00 b
irths
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HEALTHY GROWTH AND DEVELOPMENT
Percentage of low birthweight (<5.5 pounds) births, by maternal race/ethnicity, Wisconsin, 2008-2010
Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident birth certificates.
Infant mortality and low birthweight
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Low birthweight0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
6.0% 13.7% 6.1% 7.1% 6.8%
WhiteBlackHispanicLaotian/HmongAmerican Indian
HEALTHY GROWTH AND DEVELOPMENT
Percentage of low birthweight (<5.5 pounds) births, by maternal education level, Wisconsin, 2008-2010
Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident birth certificates.
Low birthweight0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
10.0% 8.1% 6.6% 5.5%
Some high schoolHigh school graduateSome collegeCollege graduate
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Infant mortality and low birthweight
HEALTHY GROWTH AND DEVELOPMENT
Risk factors
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HEALTHY GROWTH AND DEVELOPMENT
Unintended pregnancy as a percent of births, by race/ethnicity, Wisconsin, 2009-2011
Risk factors
Source: Wisconsin Department of Health Services, Division of Public Health, PRAMS, 2009-2011. 20
Percent of births in which pregnancy was unintended0%
10%
20%
30%
40%
50%
60%
70%
32% 65% 43%
White Black
Hispanic
HEALTHY GROWTH AND DEVELOPMENT
Percentage of new mothers who drank alcohol during the last three months of pregnancy, by race/ethnicity, Wisconsin, 2009-2011
Risk factors
Drank alcohol during last three months of pregnancy0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
8% 6% 6%
White Black
Hispanic
Source: Wisconsin PRAMS, 2009-2011. Division of Public Health, Department of Health Services.Note: “Other” includes Asians and American Indians.
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HEALTHY GROWTH AND DEVELOPMENT
Percentage of new mothers who smoked during the last three months of pregnancy, by race/ethnicity, Wisconsin, 2009-2011
Risk factors
Source: Wisconsin PRAMS, 2009-2011. Division of Public Health, Department of Health Services.Note: “Other” includes Asians and American Indians.
Smoked during last three months of pregnancy0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
13% 18% 7%
White Black
Hispanic
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HEALTHY GROWTH AND DEVELOPMENT
Percentage of new mothers who smoked postpartum, by race/ethnicity, Wisconsin, 2009-2011
Risk factors
Source: Wisconsin PRAMS, 2009-2011. Division of Public Health, Department of Health Services.Note: “Other” includes Asians and American Indians.
Smoked postpartum0%
5%
10%
15%
20%
25%
17% 23% 9%
White Black
Hispanic
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HEALTHY GROWTH AND DEVELOPMENT
Health care access and utilization
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HEALTHY GROWTH AND DEVELOPMENT
Percentage of births to mothers who received prenatal care during the first trimester, by race/ethnicity, Wisconsin, 2010
Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident birth certificates.
Prenatal care during first trimester0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
88% 74% 75% 66% 72%
WhiteBlackHispanicLaotian/HmongAmerican Indian
Health care access and utilization
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HEALTHY GROWTH AND DEVELOPMENT
Percentage of births to mothers who received prenatal care during the first trimester, by maternal education level, Wisconsin, 2010
Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident birth certificates.
Prenatal care during first trimester0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
70% 80% 88% 93%
Some high schoolHigh school graduateSome collegeCollege graduate
Health care access and utilization
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HEALTHY GROWTH AND DEVELOPMENTPercentage of children ages 10 months to 5 years who did not receive screening for developmental, behavioral, and social delays, Wisconsin and United States, 2011-2012
Source: National Survey of Children’s Health, 2011-2012.
Did not receive developmental screening in past 12 months0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
66% 69%
WisconsinU.S.
Health care access and utilization
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HEALTHY GROWTH AND DEVELOPMENT
References
1. University of Wisconsin Population Health Institute. County Health Rankings, 2013. http://www.countyhealthrankings.org/our-approach
2. Center for Urban Population Health. Milwaukee Health Report, 2011. http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf
3. LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
4. Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/
5. Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf
6. National Survey for Health Statistics. National Vital Statistics Reports. Deaths: Preliminary Data for 2010. http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf
7. U.S. Department of Health and Human Services. Infant Mortality Fact Sheet. http://www.hhs.gov/news/factsheet/infant.html
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References
HEALTHY GROWTH AND DEVELOPMENT
8. Centers for Disease Control and Prevention (CDC). Is low birthweight a health problem? http://www.cdc.gov/pednss/how_to/interpret_data/case_studies/low_birthweight/what.htm
9. CDC. Unintended Pregnancies. http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/
10. CDC. PNSS Health Indicators. http://www.cdc.gov/pednss/what_is/pnss_health_indicators.htm#Smoking/Drinking Indicators
11. CDC. Health Effects of Secondhand Smoke. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/
12. CDC. During Prgnancy. http://www.cdc.gov/pregnancy/during.html 13. American Academy of Pediatrics. Developmental Surveillance and Screening of
Infants and Young Children. http://pediatrics.aappublications.org/content/108/1/192.full
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References
HEALTHY GROWTH AND DEVELOPMENT
Links to additional reports and resources
• Wisconsin Births and Infant Deaths, 2010: http://www.dhs.wisconsin.gov/publications/P4/P45364-10.pdf
• Wisconsin Pregnancy Risk Assessment Monitoring System (PRAMS):http://www.dhs.wisconsin.gov/births/prams/index.htm
• Children and Youth with Special Health Care Needs Program:http://www.dhs.wisconsin.gov/health/children/
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Links
HEALTHY GROWTH AND DEVELOPMENT
Liz OftedahlEpidemiologistChildren and Youth with Special Health Care Needs (CYSHCN) Program / Maternal and Child Health ProgramBureau of Community Health PromotionDivision of Public Health Wisconsin Department of Health ServicesEmail: [email protected]
Contact
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Contacts