HEALTH INDICATORS

Healthy People

Determinants of Health

The progress toward achieving our community's health improvement goals is monitored through the measurement of objectives in numerous focus areas. Many of the objectives focus on interventions designed to reduce or eliminate illness, disability, and premature death among individuals in the community. Local objectives are adopted from national objectives established by the U.S. Department of Health and Human Services' Healthy People Initiatives. Objectives to measure our past performance for the 90's decade are outlined in Healthy People 2000 National Health Promotion and Disease Prevention Objectives. Objectives to strive for future improvements are presented in Healthy People 2010 Understanding and Improving Health. In the past we have focused on direct measurements of disease, death, and disability to gauge progress. Healthy People 2010 leads us to focus on the causes or determinants of health outcomes, including issues such as smoking, diet, physical activity, and individual behaviors.

Healthy People

The local community health initiative is an extension of the national plan to achieve the vision of Healthy People in Healthy Communities. It represents an opportunity for individuals to make healthy lifestyle choices for themselves and their families. A great deal of progress in public health and medicine has been made since the United States first embarked on the national planning process for the Healthy People initiative in 1979 with The Surgeon General's Report on Health Promotion and Disease Prevention, which followed in 1990 by Healthy People 2000.

Healthy People 2010 represents the third time that the U.S. Department of Health and Human Services has developed ten-year health objectives for the nation (US DHHS, September 2000, Healthy People 2010).

Healthy People 2010 outlines a comprehensive, nationwide health promotion and disease prevention agenda. It is designed to serve as a roadmap for improving the health of all people in the United States during the first decade of the 21st century. Like the preceding Healthy People 2000 initiative-which was driven by an ambitious, yet achievable, ten-year strategy for improving the nation's health by the end of the 20th century-Healthy People 2010 is committed to a single, overarching purpose: promoting health and preventing illness, disability, and premature death.

Healthy People 2010 is designed to achieve two primary goals:

• Increase quality and years of healthy life.
• Eliminate health disparities.

Healthy People 2010 is designed to achieve two primary goals:

• Increase quality and years of healthy life.
• Eliminate health disparities.

Quality of life reflects a general sense of happiness and satisfaction with our lives and environment. General quality of life encompasses all aspects of life including health, recreation, culture, rights, values, beliefs, aspirations, and the conditions that support a life containing these elements. Health-related quality of life reflects a personal sense of physical and mental health and the ability to react positively to factors in the physical and social environments.

Health disparities are the differences in health outcomes among different segments of the population. These include differences that occur by gender, race, ethnicity, education, income, disability, distance from services, population density, or sexual orientation. Disparities in health are very apparent in the local environment.

The underlying premise of Healthy People 2010 is that the health of the individual is almost inseparable from the health of the larger community and that the health of every community in every state and territory determines the overall health status of the nation. That is why the vision for Healthy People 2010 is "Healthy People in Healthy Communities" (US DHHS, September 2000, Healthy People 2010).

Travis County met or exceeded most of the Healthy People 2000 national health indicator objectives. A review of local health indicators shows that the health of most residents is good when compared to state and national health trends.

In July of 2000, the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services released Community Health Status Reports for all counties across the United States. The Travis County Report compared Travis County with 38 peer counties with similar population sizes and poverty rates. The Relative Health Importance table creates four categories of relative concern by simply comparing Travis County to its peers and to the US In most areas, Travis County was rated among the most favorable. In many areas, Travis County was rated higher than all other peer counties. The only exception to this most favorable rating was the incidence of stroke (Health Resources and Services Administration, September 2000).

Determinants of Health

Many factors directly and indirectly influence the level of health outcomes. For example, tobacco use is linked with heart disease and lung cancer and early prenatal care is inversely associated with infant mortality. Since these factors are part of the chain of causation for health outcomes, tracking their levels provides an early indication as to the direction in which the health outcome is likely to change. These factors increase the likelihood or risk of particular health outcomes occurring and can be broadly characterized as risk factors.

• Depending on how these factors are grouped, traditional categories of risk factors include:
• Biological factors (from genetic endowment to aging)
• Environmental factors (from food, air, and water to microbial agents)
• Lifestyles factors (from diet to injury avoidance and sexual behaviors)
• Psychosocial factors (from poverty to stress, personality, and cultural factors)
• Use of and access to health services (United States Department of Health and Human Services [US DHHS], September 2000, Healthy People 2010: Understanding and Improving Health).

Individual behaviors and environmental factors are responsible for about 70 percent of all premature deaths in the United States (US DHHS, September 2000, Healthy People 2010: Understanding and Improving Health). Developing and implementing policies and preventive interventions that effectively address these determinants of health can reduce the burden of illness, enhance quality of life, and increase longevity.

Socioeconomic status and access to medical care are important contributors to mortality. However, the most prominent contributors in the United States during the past decade were:

• Tobacco (an estimated 400,000 deaths annually)
• Diet and activity patterns (300,000 deaths annually)
• Alcohol use (100,000 deaths annually)
• Microbial agents (90,000 deaths annually)
• Toxic agents (60,000 deaths annually)
• Firearms (35,000 deaths annually)
• Sexual behavior (30,000 deaths annually)
• Motor vehicles (25,000 deaths annually)
• Illicit use of drugs (20,000 deaths annually) (McGinnis & Foege, 1993).

As the most prominent contributor to mortality, tobacco has been the target of much research and local attention. According to the Texas Risk Factor Report published in March of 1997, each year tobacco kills more Texans (26,427 in 1995) than AIDS, crack, heroin, cocaine, alcohol, car accidents, suicides, fire, and murder combined. The report goes on to say that tobacco use is associated with increased mortality from heart disease, stroke, cancer (including cancer of the lung, lip, oral cavity, pharynx, esophagus, pancreas, larynx, cervix uteri, urinary bladder, and kidney), chronic lung disease, low birth weight, respiratory distress syndrome, and sudden infant death syndrome (Office of Tobacco Prevention and Control, September 20, 2000).

The Behavioral Risk Factor Surveillance System (BRFSS), initiated in 1987, is a federal telephone survey conducted randomly to collect data on lifestyle risk factors contributing to the leading causes of death and chronic diseases. The State of Texas participates in this surveillance system telephone survey on a monthly basis surveying 1500 randomly selected adult Texans to collect lifestyle and risk factor data. The local community Health Partnership conducted similar telephone surveys in 1993, 1995 and the latest in 1998. These surveys are the only means of assessing some risk factors on a large population and are a valuable tool for predicting future needs in health services and providing strategies for preventing illness.

Tobacco use (and its related health problems) affects a significant number of Texans in all age groups. In 1998, 22 percent of Travis County residents sampled in the Health Partnership Community Survey reported that they used tobacco. In the other MSA counties, 33 percent of the Bastrop County residents sampled report using tobacco, 16 percent in Caldwell County, 28 percent in Hays County, and 21 percent in Williamson County (Health Partnership 2010, 1998). The 1998 Texas Youth Tobacco Survey reports that 31 percent of Texas public middle school students and 43 percent of Texas public high school students use some form of tobacco (Bureau of Disease and Injury Prevention, September 20, 2000).

According to the Health Partnership Community Survey, tobacco use in Travis County decreased from 30 percent in 1993 to 22 percent in 1995 and 1998 (Health Partnership 2010, 1998).

In Texas, smoking prevalence has remained essentially unchanged since 1987 with a shift in smoking prevalence from the older age groups to the 18-24 year old age group (Bureau of Disease and Injury Prevention, September 20, 2000). Nationally, smoking among adults has decreased dramatically from 42 percent in 1965 to 26 percent in 1994 (Tobacco Information and Prevention Source, September 21, 2000, Smoking Prevalence Among US Adults), however adult smoking has remained unchanged in the 1990s (25 percent in 1993, 25.5 percent in 1994, 24.7 percent in 1995, and 24.7 percent in 1997) (Tobacco Information and Prevention Source, September 21, 2000, Cigarette Smoking Among Adults - United States 1997 Fact Sheet).

Due to increasing concerns about the effects of environmental tobacco smoke (ETS) on public health, the Austin City Council adopted the Smoking in Public Places Ordinance in February of 1994. The ordinance placed strict requirements on when and where smoking could occur and required some businesses to install separate heating, ventilation, and air conditioning systems as well as have air-filtering equipment (Austin City Connection, September 20, 2000). Data are not available to enable determination of the impact of the smoking ordinance on the public health of Austin, although it is assumed that since the ordinance was more restrictive than its predecessor, there is less exposure to ETS.

Poor diet and lack of physical activity are the second most commonly linked factors to illness and premature death. US Agriculture Secretary Dan Glickman predicted that obesity will soon rival smoking as a cause of preventable death (Geofferey, 2000).

Obesity, particularly among children, has become an alarming health issue. By the national government's estimate, some six million American children are now fat enough to endanger their health. An additional five million are on the threshold, and the problem is growing. Obese individuals, including children suffer both physically and emotionally. Resulting illnesses diabetes, heart disease, high blood pressure, and several cancers--now claim half-million American lives each year, costing $100 billion in medical expenses and lost productivity annually (Geofferey, 2000).

Young people can build healthy bodies and establish healthy lifestyles by including physical activity in their daily lives. However, many young people are not physically active on a regular basis, and physical activity declines dramatically during adolescence. School and community programs can help young people get active and stay active. In addition to programs directed towards youth, workplace wellness programs for adults that offer incentives for participation have demonstrated their cost effectiveness (Centers for Disease Control, October 27, 2000).