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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
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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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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. · 5.62 Impact Factor
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JAMA The Journal of the American Medical Association 06/2008; 299(17):2081-3. · 30.03 Impact Factor
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ABSTRACT: United Health Foundation's America's Health Rankings, which ranks the states from "least healthy" to "healthiest," receives wide press coverage and promotes discussion of public health issues. The University of Wisconsin Population Health Institute used the United Health Foundation's model to develop the Wisconsin County Health Rankings ("Health Rankings") from existing county-level data. The institute first released the rankings in 2004. A survey of the Wisconsin county health officers indicated that they intend to use the rankings for needs assessment, program planning, and discussion with county health boards. The institute implemented many of the health officers' suggestions for improvement of the rankings in subsequent editions. The methods employed to create the rankings should be applicable in other states.
American Journal of Public Health 03/2008; 98(2):209-12. · 3.93 Impact Factor
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David A Kindig
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ABSTRACT: Population health is a relatively new term, with no agreement about whether it refers to a concept of health or a field of study of health determinants. There is debate, sometimes heated, about whether population health and public health are identical or different. Discussions of population health involve many terms, such as outcomes, disparities, determinants, and risk factors, which may be used imprecisely, particularly across different disciplines, such as medicine, epidemiology, economics, and sociology. Nonetheless, thinking and communicating clearly about population health concepts are essential for public and private policymakers to improve the population's health and reduce disparities. This article defines and discusses many of the terms and concepts characterizing this emerging field.
Milbank Quarterly 02/2007; 85(1):139-61. · 5.62 Impact Factor
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David A Kindig
JAMA The Journal of the American Medical Association 01/2007; 296(21):2611-3. · 30.03 Impact Factor
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ABSTRACT: Public health agencies have identified the elimination of health disparities as a major policy objective.
The primary objective of this study is to assess changes in the association between education and premature adult mortality in Wisconsin, 1990-2000.
Wisconsin death records (numerators) and US Census data (denominators) were compiled to estimate mortality rates among adults (25-64 years) in 1990 and 2000. Information on the educational status, sex, racial identification, and age of subjects was gathered from these sources.
The effect of education on mortality rate ratios in 1990 and 2000 was assessed while adjusting for age, sex, and racial identification.
Education exhibited a graded effect on mortality rates, which declined most among college graduates from 1990 to 2000. The relative rate of mortality among persons with less than a high school education compared to persons with a college degree increased from 2.4 to 3.1 from 1990-2000-an increase of 29%. Mortality disparities also increased, although to a lesser extent, among other educational groups.
Despite renewed calls for the elimination of health disparities, evidence suggests that educational disparities in mortality increased from 1990 to 2000.
WMJ: official publication of the State Medical Society of Wisconsin 11/2006; 105(7):38-41.
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Journal of General Internal Medicine 09/2006; 21(8):891-2. · 2.83 Impact Factor
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ABSTRACT: The purpose of this study is to measure Chinese population health related quality of life (HRQoL) using European quality of life (EQ-5D) instrument, to examine the validity of EQ-5D in measuring Chinese population HRQoL, to explore the relationships between EQ-5D and other health determinants, and to display the similarities and differences of HRQoL between the Chinese population and the populations of other countries. The data used in this study includes 2994 respondents whose age are 12 years and older, which is from the 2000 Beijing Household Health Survey. Univariate and bivariate analyses have been used to examine the level of HRQoL and the relationships between HRQoL and other variables. Multi-variate analyses have been used to explore the relationships between the EQ-5D Visual Analogue Scale (VAS) and the EQ-5D five dimension indicators. There are four principal findings from this study. First, the EQ-5D instrument is a valid measure for Chinese HRQoL, but with a significant ceiling effect. Second, Pain/ Discomfort and Anxiety/Depression are the major Chinese HRQoL problems and the extents of these problems differ in subgroup populations. Third, typically mean scores are lower for older age group; this is observed at lower ages in the Chinese population than in populations from developed countries. Fourth, Chinese HRQoL has strong association relationship with population socio-economic status (SES), which might imply that issues brought on by the rapid economic transition have both positive and negative impacts on Chinese HRQoL.
Quality of Life Research 03/2005; 14(1):119-32. · 2.30 Impact Factor
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ABSTRACT: To account for variations in death rates in population subgroups of the USA.
Factors associated with age-adjusted death rates in 366 metropolitan and non- metropolitan areas of the United States were examined for 1990-92. The rates ranged from 690 to 1108 per 100 000 population (mean = 885 +/- 78 per 100 000).
Least squares regression analysis explained 71% of this variance. Factors with the strongest independent positive association were ethnicity (African-American), less than a high school education, high Medicare expenditures, and location in western or southern regions. Factors with the strongest independent negative associations were employment in agriculture and forestry, ethnicity (Hispanic) and per capita income.
Additional research at the individual level is needed to determine if these associations are causal, since some of the factors with the strongest associations, such as education, have long latency periods.
Bulletin of the World Health Organisation 02/2002; 80(1):9-15. · 4.64 Impact Factor
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ABSTRACT: Objective.
—To determine alternate combinations for reductions in US medical school graduates (USMGs), international medical graduate (IMG) immigration, and graduate medical education (GME) residencies, based on future physician supply targets.
JAMA The Journal of the American Medical Association 276(12):978-982. · 30.03 Impact Factor
