D A Kindig

University of Wisconsin–Madison, Madison, Wisconsin, United States

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Publications (86)554.06 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Achieving meaningful population health improvements has become a priority for many healthcare and public health organizations, yet funding to sustain multi-sector initiatives is frequently not available. One potential source of funding for population health initiatives is the community benefit expenditures that are required of nonprofit hospitals to maintain their tax-exempt status. In this paper, we used data from nonprofit hospitals’ tax filings (IRS Form 990 Schedule H) combined with expenditure information for state and local health departments to explore the importance of hospitals’ community benefit dollars as a funding source for population health. We found that across all 50 states nonprofit hospitals spent an average of $133 per capita on community benefit activities, of which $13 went toward community health initiatives (CHI). State and local health department spent an average of $110 and $50 per capita, respectively. Hospitals’ spending on CHI thus contributed an additional eight percent to the financial resources available for public health activities, with further increases expected as health reform takes full effect. CHI spending, however, varied widely among hospitals and, based on our analyses, was unrelated to state and local health department spending Adding CHI dollars to the financial resources available to public health agencies, however, reduced existing inequalities in governmental public health spending across states as shown by a drop in the Gini coefficient from 0.36 for CHI spending alone to 0.21 for CHI and governmental public health spending combined. Hospitals’ CHI dollars thus play an important role in funding the larger public health system.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
  • David Kindig, Karen Anderson, Alina Baciu
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    ABSTRACT: The phrase “movement-building” and “we need a movement” arise frequently in gatherings on the topic of population health improvement, in recognition of the fact that healthier communities and healthier, longer lives for all will require collective and transformative action. After all, the public health field emerged in part from the history of the labor movement, and has been both beneficiary of or a partner to other movements over the years. Frameworks, insights, and vocabulary drawn from both sociology and community organizing provide some of the tools needed to determine how social movements can inform individuals, groups, and organizations that strive to alter the social and environmental conditions that shape health in U.S. communities. A June 2013 workshop of the Institute of Medicine Roundtable on Population Health Improvement provided these tools, along with several powerful perspectives from movement experts and movement leaders. The themes that arose from presentations and discussion included: the key ingredients of successful movements; essential distinctions or dichotomies (connect vs. direct); the challenge of movement-building in the absence of a well-defined antagonist and the available alternatives; the history of policies that have led to health inequities and the transformative power of movements in addressing inequity. Specific examples examined for their lessons and impact included: the Healthy Communities movement, the climate change and “green” movement(s), and the tobacco control movement.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
  • George R. Flores, David Kindig, Alina Baciu
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    ABSTRACT: The Affordable Care Act has created opportunities for health care delivery and public health practice to collaborate in new ways to improve population health, and some of the law’s provisions offer concrete platforms for better interaction between the two fields. These opportunities complement system transformation already undertaken by a number of communities often in partnerships involving health care organizations and one or more of the following: state or local public health agencies, academic institutions, and community or other non-profit organizations. In a June 2013 workshop of the IOM Roundtable on Population Health Improvement, presenters and participants discussed: the emergence of variants of the accountable care organization concept, such as accountable care communities in Ohio and coordinated care communities in Oregon, and the need to create markets for health, drawing investments that keep people from entering the care system. Workshop participants also learned about and discussed: the role of communities in shaping the health system broadly conceived (and not merely health care systems); the ACA-driven or reinforced efforts to change the health care payment system and incentivize primary prevention and a population focus; and the increased involvement of non-profit hospitals in partnership with public health agencies and others to tackle some of the place-based factors (housing quality, educational attainment) that powerfully influence the health of their communities.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Regular reporting of health inequalities is essential to monitoring progress of efforts to reduce health inequalities. While reporting of population health became increasingly common, reporting of a subpopulation group breakdown of each indicator of the health of the population is rarely a standard practice. This study reports education-, sex-, and race-related inequalities in four health outcomes in each of the selected 93 counties in the United States in a systematic and comparable manner.
    International Journal for Equity in Health 06/2014; 13(1):47. · 1.71 Impact Factor
  • Erik Bakken, David Kindig
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    ABSTRACT: The initial analysis of the revised Internal Revenue Service Schedule H community benefit report revealed that only about 5% of these dollars are allocated for community health improvement activities. These results have prompted suggestions for improved community health via community benefit reform, given the poor performance of the US population health system. However, if such a reform were enacted, it would have differential impacts across states due to variation in nonprofit hospitals, expenditures, and community benefit allocations. We model this variation, indicating that the range in per capita benefit across states would approximately range from $46 to $309. This variation should be taken into account as community benefit reform is considered.
    Journal of public health management and practice: JPHMP 03/2014; · 1.47 Impact Factor
  • Erik Bakken, David Kindig
    WMJ: official publication of the State Medical Society of Wisconsin 02/2014; 113(1):9-10.
  • David A Kindig, Erika R Cheng
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    ABSTRACT: Researchers increasingly track variations in health outcomes across counties in the United States, but current ranking methods do not reflect changes in health outcomes over time. We examined trends in male and female mortality rates from 1992-96 to 2002-06 in 3,140 US counties. We found that female mortality rates increased in 42.8 percent of counties, while male mortality rates increased in only 3.4 percent. Several factors, including higher education levels, not being in the South or West, and low smoking rates, were associated with lower mortality rates. Medical care variables, such as proportions of primary care providers, were not associated with lower rates. These findings suggest that improving health outcomes across the United States will require increased public and private investment in the social and environmental determinants of health-beyond an exclusive focus on access to care or individual health behavior.
    Health Affairs 03/2013; 32(3):451-8. · 4.64 Impact Factor
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    ABSTRACT: Trends in population health outcomes can be monitored to evaluate the performance of population health systems at the national, state, and local levels. The objective of this study was to compare and contrast 4 measures for assessing progress in population health improvement by using age-adjusted premature death rates as a summary measure of the overall health outcomes in the United States and in all 50 states. To evaluate the performance of statewide population health systems during the past 20 years, we used 4 measures of age-adjusted premature (<75 years of age) death rates: current rates (2009), baseline trends (1990s), follow-up trends (2000s), and changes in trends from baseline to the follow-up periods (ie, "bending the curve"). Current premature death rates varied by approximately twofold, with the lowest rate in Minnesota (268 deaths per 100,000) and the highest rate in Mississippi (482 deaths per 100,000). Rates improved the most in New York during the baseline period (-3.05% per year) and in New Jersey during the follow-up period (-2.87% per year), whereas Oklahoma ranked last in trends during both periods (-0.30%/y, baseline; +0.18%/y, follow-up). Trends improved the most in Connecticut, bending the curve downward by -1.03%; trends worsened the most in New Mexico, bending the curve upward by 1.21%. Current premature death rates, recent trends, and changes in trends vary by state in the United States. Policy makers can use these measures to evaluate the long-term population health impact of broad health care, behavioral, social, and economic investments in population health.
    Preventing chronic disease 01/2013; 10:E214. · 1.82 Impact Factor
  • Erik Bakken, David A Kindig
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    ABSTRACT: The Affordable Care Act is drawing increased attention to the Internal Revenue Service (IRS) Community Benefit policy. To qualify for tax exemption, the IRS requires nonprofit hospitals to allocate a portion of their operating expenses to certain "charitable" activities, such as providing free or reduced care to the indigent. To determine the total amount of community benefit reported by Wisconsin hospitals using official IRS tax return forms (Form 990), and examine the level of allocation across allowable activities. Primary data collection from IRS 990 forms submitted by Wisconsin hospitals for 2009. Community benefit reported in absolute dollars and as percent of overall hospital expenditures, both overall and by activity category. For 2009, Wisconsin hospitals reported $1.064 billion in community benefits, or 7.52% of total hospital expenditures. Of this amount, 9.1% was for charity care, 50% for Medicaid subsidies, 11.4% for other subsidized services, and 4.4% for Community Health Improvement Services. Charity care is not the primary reported activity by Wisconsin hospitals under the IRS Community Benefit requirement. Opportunities may exist for devoting increasing amounts to broader community health improvement activities.
    WMJ: official publication of the State Medical Society of Wisconsin 10/2012; 111(5):215-9.
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    Tim Casper, David A Kindig
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    ABSTRACT: The variation in health outcomes among communities results largely from different levels of financial and nonfinancial policy investments over time; these natural experiments should offer investment and policy guidance for a business model on population health. However, little such guidance exists. We examined the availability of data in a sample of Wisconsin counties for expenditures in selected categories of health care, public health, human services, income support, job development, and education. We found, as predicted by the National Committee on Vital and Health Statistics in 2002, that availability is often limited by the challenges of difficulty in locating useable data, a lack of resources among public agencies to upgrade information technology systems for making data more usable and accessible to the public, and a lack of enterprise-wide coordination and geographic detail in data collection efforts. These challenges must be overcome to provide policy-relevant information for optimal population health resource allocation.
    Preventing chronic disease 08/2012; 9:E136. · 1.82 Impact Factor
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    Erika R Cheng, David A Kindig
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    ABSTRACT: Several well-established determinants of health are associated with premature mortality. Using data from the 2010 County Health Rankings, we describe the association of selected determinants of health with premature mortality among counties with broadly differing levels of income. County-level data on 3,139 US counties from the 2010 County Health Rankings were linked to county mortality data from the Centers for Disease Control and Prevention Compressed Mortality database. We divided counties into 3 groups, defined by sample median household income levels: low-income (≤25th percentile, $29,631), mid-income (25th-75th percentile, $29,631-$39,401), and high-income (≥75th percentile, ≥$39,401). We analyzed group differences in geographic, sociodemographic, racial/ethnic, health care, social, and behavioral factors. Stratified multivariable linear regression explored the associations of these health determinants with premature mortality for high- and low-income groups. The association between income and premature mortality was stronger among low-income counties than high-income counties. We found differences in the pattern of risk factors between high- and low-income groups. Significant geographic, sociodemographic, racial/ethnic, health care, social, and behavioral disparities exist among income groups. Geographic location and the percentages of adult smokers and adults with a college education were associated with premature mortality rates in US counties. These relationships varied in magnitude and significance across income groups. Our findings suggest that population health policies aimed at reducing mortality disparities require an understanding of the socioeconomic context within which modifiable variables exist.
    Preventing chronic disease 03/2012; 9:E75. · 1.82 Impact Factor
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    ABSTRACT: Successful efforts to reduce obesity will require public policy strategies that target both individuals and external factors such as social conditions, economic circumstances, and physical environments. Public opinion data suggest that many policy changes to reduce obesity are likely to face public resistance. We conducted 4 focus groups involving 33 adults living in or near a midsized Midwestern city in July 2008. Participants were assigned to the focus groups on the basis of self-reported political ideology. We used a semistructured discussion guide to 1) better understand public perceptions of obesity and 2) assess the promise of narratives as a strategy to stimulate meaningful discussion about obesity-related policy change. Participants viewed internal factors as primary causes of obesity. Despite substantial acknowledgment of external causes of obesity, many participants - particularly political conservatives - were resistant to external policy solutions for the problem. Across the political spectrum, participants responded more favorably to a short narrative emphasizing barriers to reducing adult obesity than a story emphasizing barriers to reducing childhood obesity. This study provides a deeper context for understanding public perceptions about obesity. Some types of narratives appear promising for promoting support for policy solutions to reduce obesity.
    Preventing chronic disease 03/2011; 8(2):A39. · 1.82 Impact Factor
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    ABSTRACT: In October 2009, authors, staff, and guest experts from the Mobilizing Action Toward Community Health (MATCH) project and the Robert Wood Johnson Foundation, the project's funder, met in Madison, Wisconsin to discuss metrics, incentives, and partnerships for population health improvement. Their essays were published in this and the previous 2 issues of Preventing Chronic Disease (www.cdc.gov/pcd/issues/2010/jul/toc.htm and www.cdc.gov/pcd/issues/2010/sep/toc.htm). The plenary and small-group discussions were provocative and wide ranging. The purpose of this commentary is to 1) summarize key themes from the essays and meeting discussion and 2) present recommendations for future practice and research regarding metrics, incentives, and partnerships to improve population health.
    Preventing chronic disease 11/2010; 7(6):A124. · 1.82 Impact Factor
  • David Kindig, John Mullahy
    JAMA The Journal of the American Medical Association 08/2010; 304(8):901-2. · 29.98 Impact Factor
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    Preventing chronic disease 07/2010; 7(4):A68. · 1.82 Impact Factor
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    ABSTRACT: Report cards are widely used in health for drawing attention to performance indicators. We developed a state health report card with separate grades for health and health disparities to generate interest in and awareness of differences in health across different population subgroups and to identify opportunities to improve health. We established grading curves from data for all 50 states for 2 outcomes (mortality and unhealthy days) and 4 life stages (infants, children and young adults, working-age adults, and older adults). We assigned grades for health within each life stage by sex, race/ethnicity, socioeconomics, and geography. We also assigned a health disparity grade to each life stage. Report cards can simplify complex information for lay audiences and garner media and policy maker attention. However, their development requires methodologic and value choices that may limit their interpretation.
    Preventing chronic disease 01/2010; 7(1):A16. · 1.82 Impact Factor
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    David Kindig, Paul Peppard, Bridget Booske
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    ABSTRACT: We predicted the amount of health outcome improvement any state might achieve if it could reach the highest level of key health determinants any individual state has already achieved. Using secondary county-level data on modifiable and nonmodifiable health determinants from 1994 to 2003, we used regression analysis to predict state age-adjusted mortality rates in 2000 for those younger than age 75, under the scenario of each state's "ideal" predicted mortality if that state had the best observed level among all states of modifiable determinants. We found considerable variation in predicted improvement across the states. The state with the lowest baseline mortality, New Hampshire, was predicted to improve by 23% to a mortality rate of 250 per 100,000 population if New Hampshire had the most favorable profile of modifiable health determinants. However, West Virginia, with a much higher baseline, would be predicted to improve the most-by 46% to 254 per 100,000 population. Individual states varied in the pattern of specific modifiable variables associated with their predicted improvement. The results support the contention that health improvement requires investment in three major categories: health care, behavioral change, and socioeconomic factors. Different states will require different investment portfolios depending on their pattern of modifiable and nonmodifiable determinants.
    Public Health Reports 01/2010; 125(2):160-7. · 1.42 Impact Factor
  • David A Kindig, John Mullahy, Stephanie Robert
    WMJ: official publication of the State Medical Society of Wisconsin 09/2009; 108(5):275.
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    ABSTRACT: Despite significant accomplishments in basic, clinical, and population health research, a wide gap persists between research discoveries (ie, what we know) and actual practice (ie, what we do). The University of Wisconsin Population Health Institute (Institute) researchers study the process and outcomes of disseminating evidence-based public health programs and policies into practice. This paper briefly describes the approach and experience of the Institute's programs in population health assessment, health policy, program evaluation, and education and training. An essential component of this dissemination research program is the active engagement of the practitioners and policymakers. Each of the Institute's programs conducts data collection, analysis, education, and dialogue with practitioners that is closely tied to the planning, implementation, and evaluation of programs and policies. Our approach involves a reciprocal exchange of knowledge with non-academic partners, such that research informs practice and practice informs research. Dissemination research serves an important role along the continuum of research and is increasingly recognized as an important way to improve population health by accelerating the translation of research into practice.
    WMJ: official publication of the State Medical Society of Wisconsin 09/2009; 108(5):236-9, 255.
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    ABSTRACT: Raising public awareness of the importance of social determinants of health (SDH) and health disparities presents formidable communication challenges. This article reviews three message strategies that could be used to raise awareness of SDH and health disparities: message framing, narratives, and visual imagery. Although few studies have directly tested message strategies for raising awareness of SDH and health disparities, the accumulated evidence from other domains suggests that population health advocates should frame messages to acknowledge a role for individual decisions about behavior but emphasize SDH. These messages might use narratives to provide examples of individuals facing structural barriers (unsafe working conditions, neighborhood safety concerns, lack of civic opportunities) in efforts to avoid poverty, unemployment, racial discrimination, and other social determinants. Evocative visual images that invite generalizations, suggest causal interpretations, highlight contrasts, and create analogies could accompany these narratives. These narratives and images should not distract attention from SDH and population health disparities, activate negative stereotypes, or provoke counterproductive emotional responses directed at the source of the message. The field of communication science offers valuable insights into ways that population health advocates and researchers might develop better messages to shape public opinion and debate about the social conditions that shape the health and well-being of populations. The time has arrived to begin thinking systematically about issues in communicating about SDH and health disparities. This article offers a broad framework for these efforts and concludes with an agenda for future research to refine message strategies to raise awareness of SDH and health disparities.
    Milbank Quarterly 10/2008; 86(3):481-513. · 4.64 Impact Factor

Publication Stats

746 Citations
554.06 Total Impact Points

Institutions

  • 1991–2014
    • University of Wisconsin–Madison
      • • Department of Population Health Sciences
      • • School of Medicine and Public Health
      • • Department of Medicine
      Madison, Wisconsin, United States
  • 2012
    • Madison College
      Madison, Wisconsin, United States
  • 2011
    • Cornell University
      • Department of Communication
      Ithaca, NY, United States
  • 2006
    • Emory University
      • School of Medicine
      Atlanta, GA, United States
    • Utah State University
      Logan, Ohio, United States
  • 2004
    • Wisconsin Policy Research Institute
      Hartland, Wisconsin, United States