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Research Questions

  1. What are the health and well-being outcomes of residents of Prince George's County, Maryland, and does health differ by group?
  2. What are the key drivers of health and well-being within the county, inclusive of the social, economic, built, natural, and health service environments?
  3. What strategies can the county pursue to align and integrate planning and budgeting to promote health and well-being?

With evolving demographics and a changing health system landscape, the Prince George's County Council, acting as the County Board of Health, is considering its future policy approaches and resource allocations related to health and well-being. To inform this path forward, the authors of this report used primary and secondary data to describe both the health needs of county residents and drivers of health within the county, inclusive of the social, economic, built, natural, and health service environments. This report integrates these findings, an analysis of budget documents, and a review of promising practices from other communities to situate recommendations in a Health in All Policies framework to foster aligned and integrated planning and budgeting across the county to promote health and well-being.

Findings from the assessment indicate a shared interest among leaders and residents to embrace a holistic strategy for health and well-being in the county. Inefficient uses of the health care system are identified, highlighting a need to rebalance investments in health care use and drivers of health. Additionally, challenges in navigating health and human services and inequities in drivers of health across communities are noted, signaling broader concerns related to residents' access to health and human services that influence health and well-being outcomes.

Recommendations are provided for several paths forward for the county to pursue a more integrated policy approach to influence health and well-being outcomes.

Key Findings

Inefficient uses of the health care system remain despite improvements

  • One in four emergency calls for medical services were for nonurgent needs.
  • Emergency departments continue to be used for preventable issues, such as asthma and dental care.

Residents encounter challenges in navigating health and human services

  • There is a lack of health insurance for some groups, including noncitizen immigrants, and there is insufficient funding to support the needs of these groups.
  • Residents are often unaware of available services and resources or might not know how to access or navigate known services and resources.
  • Shortages of primary care providers, behavioral health providers, and dentists affect access, as does the cultural competency of providers.

Spending on health and human services is low

  • Estimated county spending on health and human services departments is $39 per person, about one-third to one-seventh the per-person spending of surrounding Maryland counties.

Systemic inequities in drivers of health place some communities farther behind in building healthy futures

  • Districts are differentially affected by drivers of health and thus encounter different health challenges.
  • District 2 has high rates of uninsurance and is predominantly Hispanic, a population with a teen birth rate more than double the county rate.
  • District 3 has the highest poverty rate and numerous community "hot spots" of low-income individuals with poor access to healthy food.
  • District 7 is predominantly black and has low health literacy and the highest emergency department visit rates for adults and children in the county.

Recommendations

  • Create a Health in All Policies system by (1) developing a coordinated Health in All Policies system that creates guidelines for governance; (2) creating a strategic plan for all health and human services agencies; (3) implementing policies that promote health equity, including design and economic environment decisions; (4) improving the delivery and coordination of health services, including better screening for social needs; and (5) improving the accessibility, clarity, and usability of health and human services promoting resources and related civic engagement opportunities among county residents.
  • Align investments by (1) breaking down silos between funding streams for health and human services, particularly in ways that can better leverage and coordinate grant funding; (2) engaging the nontraditional health sector (e.g., fire/EMS, police) to participate in "health mapping" and analysis; (3) better coordinating the nongovernmental organizations that address health and human services needs in the county, and (4) employing high-capacity nonprofits strategically.
  • Implement new measurement and data systems by (1) identifying data gaps and implement systems to address gaps and (2) improving structures that support health and well-being data transparency and stewardship.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Demographic Profile

  • Chapter Three

    Health and Well-being

  • Chapter Four

    Drivers of Health: Health Care Service Environment

  • Chapter Five

    Drivers of Health: Social and Economic Environment

  • Chapter Six

    Drivers of Health: Built and Natural Environments

  • Chapter Seven

    Connecting Drivers of Health with Health Outcomes: Examples for Children and Noncitizen Immigrants

  • Chapter Eight

    Exploring Prince George's County Budget for Health

  • Chapter Nine

    Conclusions and Recommendations

  • Appendix A

    Overview of Focus Groups and Key Informant Interviews

  • Appendix B

    Data Sources

  • Appendix C

    Maps Illustrating Variation in ED Visits and Inpatient Hospitalizations Among Prince George's County Residents, 2017

  • Appendix D

    Sample Integrated Health in All Policies Budget Planning Template

  • Appendix E

    Guidance for Implementing Health in All Policies in Prince George's County

Research conducted by

This research was sponsored by the Prince George's County Council, acting as the County Board of Health, and conducted by the Community Health and Environmental Policy Program within RAND Social and Economic Well-Being.

This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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