Indiana State Health Gaps Report

Every year, nearly 4,500 deaths in Indiana could be avoided if all residents in the state had a fair chance to be healthy.

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How big are the health gaps?

If residents of all counties in Indiana had the same opportunities for health, there would be:

242,000
fewer adult smokers
146,000
fewer adults who are obese
181,000
fewer people who are uninsured
118,000
more adults ages 25-44 with some education beyond high school
44,000
fewer people who are unemployed
131,000
fewer children in poverty
18,000
fewer violent crimes
118,000
fewer households with severe housing problems

Most of Indiana’s 4,500 excess deaths tend to occur in counties with higher populations (such as Marion and Lake). However, some counties with smaller populations also have a disproportionate share of avoidable lives lost. For example, over 41 percent of premature deaths in Scott County could be avoided if Scott residents had the opportunities of those in healthier counties (no shading).

Of course, population size is not the only factor that state leaders should take into account when selecting strategies to solve health gaps. We know that there are many factors that shape health. Highlighted below are factors state leaders may want to pay particular attention to as they work to improve health for all.

Highlighted Health Gaps in Indiana

Highlighted measures indicate meaningful gaps that policymakers and leaders may want to examine more closely. We define meaningful gaps as those that are noteworthy or statistically different from a state or U.S. value for factors that have the greatest influence on health (e.g., social and economic factors have a greater influence than clinical care). The best and worst counties represent the top and bottom 10% of county-level values for a given measure, respectively.

Learn how we identified health factors to improve

County Health Rankings data can help to identify factors with meaningful differences across counties. Accounting for the relative influence of various factors on health outcomes, a range of techniques were used to identify those factors that seem to have the greatest potential opportunity for improvement. We identified measures where there are meaningful differences between the state’s or poor performing counties’ value and that of a U.S. or state reference value for the factor. Meaningful differences indicate that for a given state, the magnitude of the difference is consequential and/or statistically significant compared to this reference value.

Health Behaviors
Health FactorsBest IN CountiesWorst IN CountiesMean IN Best US Counties
Adult smoking: adults who are current smokers18%30%23%14%
Adult obesity: adults that report a BMI of 30 or more29%35%31%25%
Food environment index: access to healthy food and food insecurity8.36.77.28.4
Physical inactivity: adults reporting no leisure-time physical activity25%32%27%20%
Access to exercise opportunities: adequate access to locations for physical activity83%41%75%92%
Excessive drinking: adults reporting binge or heavy drinking11%20%16%10%
Alcohol-impaired driving deaths: driving deaths with alcohol involvement9%37%26%14%
Sexually transmitted infections: newly diagnosed chlamydia cases per 100,000 population138423451138
Teen births: births per 1,000 females ages 15-1926503920
Clinical Care
Health FactorsBest IN CountiesWorst IN CountiesMean IN Best US Counties
Uninsured: population under age 65 without health insurance14%19%17%11%
Primary care physicians: ratio of population to primary care physicians1,214:14,622:11,518:11,039:1
Dentists: ratio of population to dentists1,739:17,060:11,973:11,362:1
Mental health providers: ratio of population to mental health providers611:14,590:1750:1383:1
Preventable hospital stays: hospital stays for ambulatory-care sensitive conditions per 1,000 Medicare enrollees54927041
Diabetic monitoring: diabetic Medicare enrollees, ages 65-75, that receive HbA1c monitoring89%81%84%90%
Mammography screening: female Medicare enrollees, ages 67-69, that receive mammography screening67%52%61%71%
Social & Economic Factors
Health FactorsBest IN CountiesWorst IN CountiesMean IN Best US Counties
High school graduation: ninth-grade cohort that graduates in 4 years93%83%87%93%
Some college: adults ages 25-44 with some post-secondary education66%44%60%71%
Unemployment: population 16+ that are unemployed but seeking work6%9%8%4%
Children in poverty: children under age 18 living in poverty15%29%22%13%
Income inequality: ratio of 80th/20th percentile of income3.64.64.33.7
Children in single-parent households: children that live in a household headed by a single parent21%38%33%20%
Social associations: social associations per 10,000 population19101322
Violent crime: violent crime offenses per 100,000 population4428333459
Injury deaths: deaths due to injury per 100,000 population51866250
Physical Environment
Health FactorsBest IN CountiesWorst IN CountiesMean IN Best US Counties
Air pollution: average daily density (µg/m3) of fine particulate matter (2.5)13.213.913.59.5
Drinking water violations: population potentially exposed to water exceeding violation limit during past year0%6%4%0%
Severe housing problems: households with ≥ 1 of 4 housing problems: overcrowding, high housing costs, lack of kitchen or plumbing facilities9%15%14%9%
Driving alone to work: workforce that drives alone to work79%86%83%71%
Long commute - driving alone: among workers who commute in their car alone, those that commute more than 30 minutes20%46%30%15%

What can be done to help close gaps in Indiana?

Here are some examples of evidence-informed strategies to improve the above highlighted health factors:

Tobacco Use (Adult smoking)

Deliver phone-based behavioral counseling and follow-up for tobacco users who want to quit

Implement private sector rules or public sector regulations that prohibit smoking or restrict it to designated areas

Limit the pricing, flavoring, placement, or promotion of tobacco products via regulation

Increase tobacco per unit prices through taxes or point-of-sale fees

Diet and Exercise (Adult obesity)

Modify local environments to support physical activity, increase access to new or existing facilities for physical activity, or build new facilities

Encourage convenience stores, corner stores, or gas station markets to carry fresh produce and other healthier food options

Use zoning regulations to address elements important to physical activity such as street continuity and connectivity, residential density, and proximity of residential areas to businesses, schools, and recreation

Support programs to provide students with a nutritious breakfast, in the cafeteria, from grab and go carts in hallways, or in classrooms

Access to Care (Uninsured)

Increase support for non-profit health care organizations that receive federal funding and deliver comprehensive care to uninsured, underinsured, and vulnerable patients regardless of ability to pay

Provide health insurance outreach and support to assist individuals whose employers do not offer affordable coverage, who are self-employed, or who are unemployed

Quality of Care (Preventable hospital stays)

Revise health care processes and provider roles to integrate mental health and substance abuse treatment into primary care

Provide education and behavioral interventions that support patients’ ability to actively manage their condition(s) in everyday life

Offer outreach and education with enhanced written materials and other approaches to increase patients' health-related knowledge

Provide continuous, comprehensive, whole person primary care that uses a coordinated team of medical providers across the healthcare system

Education (Some college)

Combine academics, physical health, mental health, and social service resources for students and families through partnerships with community organizations

Provide services such as remedial education, vocational training, case management, health care, and transportation assistance, to help students complete high school

Help students prepare academically for college, complete applications, and enroll, especially first generation applicants and students from low income families

Employment (Unemployment)

Extend or raise the compensation provided to eligible, unemployed workers looking for jobs

Support acquisition of job-specific skills through education, certification programs, or on-the-job training

Income (Children in poverty)

Look for ways to expand various earned income tax credits for low to moderate income working individuals and families

Increase financial assistance to working parents or parents attending school to pay for  center-based or certified in-home child care

Establish locally or state mandated wages that are higher than federal minimum wage levels

Provide employees with paid time off for circumstances such as a recent birth or adoption, a parent or spouse with a serious medical condition, or a sick child

Community Safety (Violent crime)

Coordinate law enforcement and community agencies' implementation of focused deterrence strategies (pulling levers) to target particular crimes

Support the efforts of neighborhood residents  to work together in addressing local crime and reporting suspicious or potentially criminal behavior

Develop interventions for victims and offenders focused on repairing the harm a crime caused and collectively determining offender reparations

Choosing strategies that work

Taking time to choose policies and programs that have been shown to work in real life and that are a good fit for your state will maximize the chances of success. Focusing on policy, systems, and environmental changes – or implementing programs in a broad, systematic way – can lead to the most substantial improvements over time. The strategies listed above are among many resources in What Works for Health, a searchable database of policies or programs that have worked in other places or are recommended by unbiased experts.

Visit What Works For Health

How have states and local communities taken action?

The approach to reducing health gaps is not ‘one size fits all.’ Each state and community has different assets and opportunities they can use. Many communities across the U.S. are already addressing health gaps and building a Culture of Health. States and local communities have improved health by taking action and making changes. Just look at community revitalization efforts, the expansion of education programs that empower young people, and local and state economic development. For more detailed tools and guidance on how to improve health for all:

Visit the Action Center

Robert Wood Johnson Foundation Culture of Health Prize

State and local efforts can harness the collective power of leaders, partners, and community members to provide everyone with opportunities for better health. The 2015 RWJF Culture of Health Prize winners are prime examples of making this a reality. Here are links to examples of how these communities are cultivating a shared belief in good health for all:

See All The Prize Winners

Find out more about health gaps in another state:

Credits

Recommended citation

University of Wisconsin Population Health Institute. County Health Rankings Health Gaps Report 2015.

Lead Authors

Bridget Catlin, PhD, MHSA
Marjory Givens, PhD, MSPH
Julie Willems Van Dijk, PhD, RN

This publication would not have been possible without the following contributions:

Research Assistance

Alison Bergum, MPA
Kathryn Hatchell
Amanda Jovaag, MS
Hyojun Park, MS
Elizabeth Pollock
Matthew Rodock, MPH

Outreach Assistance

Mary Bennett, MFA
Kitty Jerome, MA
Stephanie Johnson, MSW
Jan O’Neill, MPA

Communications and Website Development

Burness
Forum One

Data

Centers for Disease Control and Prevention: National Center for Health Statistics
Dartmouth Institute for Health Policy & Clinical Practice

Robert Wood Johnson Foundation

Abbey Cofsky, MPH
Andrea Ducas, MPH
Michelle Larkin, JD, MS, RN
James Marks, MD, MPH
Joe Marx
Donald Schwarz, MD, MPH
Amy Slonim, PhD
Kathryn Wehr, MPH

Scientific Advisory Group

Patrick Remington, MD, MPH, Chair
Maureen Bisognano, MS
Bridget Catlin, PhD, MHSA
Tom Eckstein, MBA
Elizabeth Mitchell
C. Tracy Orleans, PhD
Maggie Super Church, MSc, MCP
Renée Canady, PhD, MPA
Ana Diez Roux, MD, PhD
Wayne Giles, MD, MS
Ali Mokdad, PhD
Steven Teutsch, MD, MPH