Guest Post: Dr. Craig Blakely – “The Greater Louisville Project—Bringing the community together for its own good”

November 20, 2013
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This is a great time to live in Louisville as hundreds of public, private and community-based non-profit groups share a vision to improve the conditions in which we all work, eat, sleep and play. From Mayor Fisher’s office and President Ramsey’s desk to local foundations and our large and small employers, there is an interest in making Louisville a better place. GE is undertaking data driven workplace safety and wellness projects. The Health Enterprise Network is generating ideas and supporting health related innovation. The Kentuckiana Health Collaborative, a Ford/UAW supported initiative is seeking to improve health systems in the region.

The University of Louisville health sciences students, faculty and students are active in the community – informing the public about proper eating and exercise, providing dental education and screenings to school children and vaccinating the community against influenza and other communicable diseases. UofL health science researchers are seeking to understand the complexities of diseases such as cardiovascular disease, cancer and diabetes in hopes of finding a cure. At the School of Public Health and Information Sciences (SPHIS), we promote prevention of disease through initiatives like the Gray Street Farmers Market where vendors sell fresh fruits, vegetables and homemade products in an area considered a ‘food desert.’ As an employer, UofL encourages staff and faculty to bike to work or use city transportation, and to take part in Get Healthy Now – an effort to promote healthy lifestyles through better choices. These are just a few of the ways UofL is seeking to create a healthier community.

SPHIS recently achieved a great milestone, approval by the Kentucky Council on Postsecondary Education to begin an undergraduate degree program in fall 2014. The two degree options, a bachelor of science in public health (BSPH) for students focused on public health practice and a bachelor of arts in public health (BAPH) for liberal arts studies will help meet the national shortage of trained public health professionals for positions in specific sectors of public health, health services and public policy, with career opportunities in policy change, community engagement, global health, maternal and child health, disease surveillance, non-profit management, health promotion, health care administration, health services research and environmental health.

As a public health educator, I have endeavored to improve conditions under which people can be healthy. The vast strides we have made in the developed world have come from cleaning up the environment (water quality, food security, minimize toxic exposures) and encouraging people to engage in healthier behaviors (eat appropriately, exercise, don’t smoke, minimize risk taking behaviors). We also know health status is linked to the zip code in which you live along with other factors (known as social determinants) including poverty, environmental influences and unemployment. The GLP Special Report on Health is a simple but timely compilation of relevant community data. It provides a foundation for collaboration and a prod to achieve better education and employment opportunities and quality of place that will define the health status of Louisville residents for the next decade. One of the greatest challenges is getting people to alter behavior. Health habits are deeply rooted in culture and it can be very difficult for people to understand the benefit of change. It will take great effort on the part of Louisville businesses, non-profit entities and government agencies to work together to solve the health disparity problem in our city.

Let’s document the appropriateness of the marketed label—the compassionate city—and not waste this opportunity.

Craig H. Blakely, PhD, MPH
Dean and Professor, UofL School of Public Health and Information Sciences
Member, Greater Louisville Project Special Report Health Advisory Group

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Natural Breaks Algorithm

For each indicator, Greater Louisville Project assigns cities into one of three groups (high-performing, middle-of-the-pack, and low-performing) based on how they compare to other cities. The assignment is based on how cities naturally cluster on that indicator. Sometimes, the differences between cities are very small, and the difference between a city ranked 5th and 6th could simply be a matter of the sampling error that arises from using survey data. Thus, rather than always make a division that declares the top 5 to be the top tier, we use a natural breaks algorithm to look for a cluster of cities that is outperforming the rest, a cluster that is about average, and a cluster that is lagging. This clustering gives us a better indication of where Louisville is thriving and where Louisville has room to learn from cities that are doing better.

Z-Scores

Z-scores (or standardization) is a way to combine data with different units of measurement into a single index. The z-score is a measure of how far away a city (or census tract, etc.) is from the average city. In order to be comparable across different units of measurement, the z-score is the distance from the mean measured in standard deviations (e.g. if Louisville has a z-score of 1 it means Louisville is 1 standard deviation above the mean of its peer cities).

Data from the Robert Wood Johnson Foundation's County Health Rankings use z-scores and all z-scores are relative to the mean of Louisville's peer cities. (On the County Health Rankings site z-scores are relative to all the counties in each state - thus z-scores reported by GLP will be different, because we are using a different reference group). The Greater Louisville Project also uses z-scores in our multidimensional poverty index, which compares each census tract to the mean of all census tracts in Louisville.