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HEALTHY COMMUNITIES OBESITY SUMMIT SERIES NOVEMBER 2, 2016 HEALTHY CITY CAMPAIGNS: IDENTIFYING REGIONAL PRIORITIES
HEALTHY COMMUNITIES OBESITY SUMMIT SERIESN O V E M B E R 2 , 2 0 1 6
H E A L T H Y C I T Y C A M P A I G N S :
I D E N T I F Y I N G R E G I O N A L P R I O R I T I E S
Intentionally Designing
Health & Well-Being in
Eastern Virginia
Marissa J. Levine, MD MPH
State Health Commissioner
Intentional Design:
A Population Health
Approach
3
Key Points/Assumptions
• Health and well-being matter to all people in Virginia
• Dealing with the burden of disease and breaking the cycle of debilitating disease must be addressed simultaneously
• Community-led, data-driven, focused solutions are the ideal
• Leadership efforts should intentionally facilitate the development and/or maintenance of these community efforts and be aligned for efficiency and impact
Relative Contribution of Factors that Affect Health
Social and
Economic
Factors
Health
Behaviors
Clinical
Care
Genetics
Environment
Source: McGinnis et al, The Case for More active Policy Attention to Health Promotion, Health Affairs, 21, no. 2 (2002): 78-93
Health Status Assessment
Data-driven decision
making and feedback
Create a System of Healthcare
Build Prevention Everywhere
Redefine Health
Strong Start
for All
Children
HEALTHY CONNECTED COMMUNITY
HEALTHY, CONNECTED COMMUNITIES
• H.S. Grads Enrolled in Higher Ed
• Cost-Burdened Households
• Consumer Opportunity Index
• Economic Opportunity Index
• Districts with Collaborative Improvement
Processes
PREVENTIVE ACTIONS
• Adults Not Participating In Physical Activity
• Adults Who Are Overweight or Obese
• Households That Are Food Insecure
• Adults Using Tobacco
• Adults Vaccinated Against Influenza
• Adolescents Vaccinated Against HPV
• Adults Screened for Colorectal Cancer
• Percent of Adults With Adverse Childhood
Experiences
• Disability-free Life Expectancy
STRONG START FOR CHILDREN
• Teen Pregnancy Rate
• Kindergarteners Not Meeting PALS-K Benchmark
• Third Graders Passing Reading SOL
• Infant Mortality Rate by Race
SYSTEM OF HEALTH CARE
• Adults With A Regular Health-care Provider
• Avoidable Cardiovascular Disease Deaths
• Mental Health and Substance Abuse
Hospitalizations
• Avoidable Hospital Stays
• Adults Whose Poor Health Kept Them from Usual
Activities
• Providers With Electronic Health Records
• Health Districts With EHRs
• Entities Connected to the Health Information
Exchange
• Hospitals Meeting State Goal for Prevention of C.
difficile Infections
Virginia’s Plan for Well Being MetricsPercent of Adults Who Report Positive Well-Being
Population Health Data Framework
Drivers Drivers
State
Data
Regional
DataRegional
DataRegional
Data
Regional
Data
Local
Data
Local
DataLocal
Data
Local
DataLocal
Data
Local
Data
Local
Data
Local
Data
Drivers Drivers
Community
Health
Assessment
in Every
District
Virginia’s Plan
for Well-Being
Aim 1: Healthy, Connected
Communities
Educational Attainment
Population Density
Spatial Segregation
Material Deprivation
Population Churning
Job Participation
Income DiversityAffordability of Housing and
Transportation
EPA Environmental
Hazards
Food Access
Walkability
Access to Care
Employment Access
HOI
Health Opportunity Index
Community Health Services• Network of Health Districts & Local Health Departments
14
Data Source: Virginia Department of Health, Health Planning Districts.
Aim 2:Strong Start for
Children
Source: William Hollinshead, Trajectories and MCH Checkpoints, 2007
Life Course Theory
PGY= Pregnancy
HE
ALT
H O
UT
CO
ME
S
Page 18
Quintiles
Aim 3:Preventive Actions
Health Impact Assessment
(HIA)
A systematic process that uses an array of data sources and analytic methods and considers input from
stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. HIA provides recommendations on monitoring
and managing those effects.
National Research Council, Improving Health in the United States: The Role of Health Impact Assessment, 2011.
HIA Answers the Question...
• “How would this new
development/project
affect people’s health?’.
HIA Toolkit Available at:
http://www.vdh.virginia.gov/healthpolicy/healthequity
/hia/index.htm
Aim 4:System of Health Care
* Per 100,000 Population ages 18 years and older
* Per 100,000 Population ages 18 years and
older
Summary and Questions
Healthy Communities Obesity Summit Series:
Healthy Community Framework –What Works
EVMS Lester HallNovember 2, 2016
Amy Paulson, MPH, AE-CEastern Virginia Medical School
How does it work?
Multi-level Impact:
• Creating healthy environments
• Developing community support
• Influencing social norms• Facilitating healthy
behaviors• Implementing high impact
policies
Making the healthy choice the easy choice
Behavior is Complicated
“It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change.”
-Smedly and Syme (2000) Institute of Medicine
The Drivers of Healthier Communities
http://www.cultureofhealth.org/en/healthier-communities.html
How do our physical spaces support our
well-being?
What are the social and communal
factors that contribute to well-
being?
Do we have policies that support
everyone to live their healthiest life
possible?
HHR Model for Taking Action
Social Norms
Health Outcomes
Policy, Systems &
Environmental Change
Community
Action
Socio-Ecological Model
Social Determinants of Health
• Economic Stability– Poverty
– Employment
– Food Security
– Housing Stability
• Education– High School Graduation
– Enrollment in Higher Education
– Language and Literacy
– Early Childhood Education and Development
• Social and Community Context– Social Cohesion
– Civic Participation
– Perceptions of Discrimination and Equity
– Incarceration/Institutionalization
http://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health
• Health and Health Care̶ Access to Health Care̶ Access to Primary Care̶ Health Literacy
• Neighborhood and Built Environment̶ Access to Healthy Foods̶ Quality of Housing̶ Crime and Violence̶ Environmental Conditions
Healthy Communities ApproachA Framework for Action on the Determinants of Health
What is Policy Change?
• Policy interventions may be a
law, ordinance, resolution, or
rule (formal – in writing,
binding, broad application)
• Example: Organizational
policies that provide time off
during work hours for physical
activity. Cities may adopt
resolutions to support healthy
behaviors or activities.
What is Systems Change?
Systems interventions are changes that impact all elements of an organization, institution or system.
Types of systems include: School, transportation, parks and rec, etc.
Example: System changes might include changing bus routes, increasing police patrols to decrease crime around parks, including lunch offerings in day-camps, etc.
What is Environmental Change?
• Environmental interventions involve physical or material change to the economic, social or physical environment.
• Example: Incorporating bike lanes, sidewalks, paths and recreation areas into community design.
Case Study – Vending Machines
• Policy – create policy to guide product type or percentage meeting nutritional standards
• System – work with vendors to change product mix
• Environment – product placement, marketing materials, product inclusion
You see this newly installed
on the corner of your street.
What type of change is it?
• Policy?
• System?
• Environmental?
Pop Quiz!
• Community Fluoridation of Water
– 1945, safe & cost effective policy to prevent tooth decay for more than 184 million (CDC 2009)
Examples in History of PSE
Did Social Norms Shift?
Even Fido wears a seat belt now!
30 years ago we didn’t even use Booster Seats
HHR Model for Taking Action
Social Norms
Health Outcomes
Policy, Systems &
Environmental Change
Community
Action
Make the healthy choice the easy choice
Healthy Communities Obesity Summit Series:GHR Connects
Community Indicators DashboardEVMS Lester Hall
November 2, 2016
Luciano Ramos
United Way of South Hampton Roads
Healthy Communities Obesity Summit Series:
What’s Currently Happening in Hampton Roads & Best Practices
EVMS Lester HallNovember 2, 2016
Amy Paulson, MPH, AE-CEastern Virginia Medical School
Mobilize key individuals and organizationsPhase 1
Phase 2
Phase 3
Phase 4
Phase 5
Assess community needs, strengths, & resources
Plan for action
Implement action plan
Track progress & outcomes
McKenzie, J.F., Neiger, B.L., & Smeltzer, J.L. (2005). Planning, Implementing & Evaluating Health Promotion ProgramsCDC CHANGE Tool: http://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/change/pdf/changeactionguide.pdf
Healthy Community Process
Use Evidence-based ApproachesLeadership for Healthy Communities
http://www.leadershipforhealthycommunities.org/
Active Living by Design
http://www.activelivingbydesign.org
RWJF Healthy Eating Research
http://healthyeatingresearch.org/
The Community Guide
http://www.thecommunityguide.org
CDC http://www.cdc.gov/nccdphp/dch/index.htmhttp://www.cdc.gov/healthyplaces/factsheets.htm
RWJF County Health Rankings – Roadmapshttp://www.countyhealthrankings.org/
Virginia Plan for Well Beinghttp://virginiawellbeing.com
ChangeLabhttp://www.changelabsolutions.org/
National Prevention StrategyThe Goal
• Increase the number of Americans who are healthy at every stage of life.
Four Strategic Directions
• Healthy and Safe Community Environments
• Clinical and Community Preventive Services
• Empowered People
• Elimination of Health Disparities
The Priorities
• Tobacco Free Living
• Preventing Drug Abuse &Excessive Alcohol Use
• Healthy Eating
• Active Living
• Injury and Violence Free Living
• Reproductive and Sexual Health
• Mental and Emotional Well-Being http://www.surgeongeneral.gov/priorities/prevention/strategy/
Events/Programs vs. PSE Change
• One time
• Additive: often results in only short-term behavior
• Individual level
• Not part of ongoing plan
• Short term
• Non-sustaining
• Ongoing
• Foundational: often produces behavior change over time
• Policy level
• Part of an ongoing plan
• Long term
• Sustaining
Characteristics of Events/Programs
Characteristics of PSE Change
Programs versus PSEAn Example from Schools
Programs/EventsPolicy, Systems, and Environmental
Change
Celebrate National Nutrition Month Add fruits & vegetables to a la carte
Host a Family Fitness Night Make school athletic facilities regularly
available to families
Participate in Walk to School Day Establish a Safe Routes to School Policy
Provide healthy snacks or breakfast Adopt a Healthy Food & Beverage Policy
Participate in Kick Butts Day Establish a tobacco-free school taskforce
Provide health screenings for staff Establish a building-sponsored wellness team
Obesity Prevention – What Works
• Recreational screen time interventions for children
• Worksite weight, healthy eating & physical activity interventions
• School based interventions generally have insufficient evidence, except for increasing recess & physical education
• Business Case for Breastfeeding– Adopt lactation policies that provide space and break time
for breastfeeding employees (in accordance with the Affordable Care Act) and offer lactation management services and support (e.g., breastfeeding peer support programs
• Work with hospitals, early learning centers, health care providers, and community-based organizations to implement breastfeeding policies and programs– Breastfeeding Welcome Here– Breastfeeding Friendly Early Childcare Centers– Baby Friendly Hospitals
Breastfeeding
• Creating Healthy Meeting Policies• Limiting sugary beverages
– RevYourBev, ReThink Your Drink
• Increasing fresh fruits & veggies– Farm to School– Community Gardens– Farmer’s Markets– EBT/SNAP at Farmer’s Markets– Corner Store initiatives– Early childhood (http://www.colormehealthy.com/ ,
http://www.eatsmartmovemorenc.com/ )
Healthy Eating
• Wellness Policies – work, school, childcare• Instant Recess “breaks”• Stairwell Promotion Programs• Community Walking Promotion • Walk to School Programs
– Safe Route to School– Walking School Bus
• Joint Use Agreements • School based physical activity• Social support Programs• Community wide campaigns
Physical Activity
• Complete Streets
• Walking Routes
• Bike Lanes, Racks, Shares
• Traffic Calming
• Parks, Benches
• Park & Walk Development
• Connected Neighborhoods
Built Environment
• Transportation Routes
– Increased access to food
– Increased physical activity among those taking public transit
– Increased access to services, jobs, & educational resources = impacts social determinants
• Location of Grocery Stores versus Corner Stores
• Location of Parks & Recreation Resources
• Joint Use Agreements
Example: Transportation, Proximity & Access
• Complete Street Policies– Traffic calming measures
– Infrastructure building
• Increased policing/crime reduction
• Safe Routes to School– Increased academic performance
– Improved air quality
– Increased alertness
– Increased physical activity
Example: Walkability & Bikeability
Complete Streets?• Where do you want to walk??
• Where would you rather cross the road?
Leaders Matters. Policy Matters.
Tobacco
• Smoke Free Policies banning or limiting exposure• Tobacco pricing strategies• Mass media campaigns• Cessation programs specifically
– Incentive based cessation programs– Mobile phone based cessation programs
• Community mobilization for youth initiation– community mobilization combined with additional
interventions —such as stronger local laws directed at retailers, active enforcement of retailer sales laws, and retailer education with reinforcement
Mental Health
• Collaborative Care
• Home and clinical services
• Promote positive early childhood development, including positive parenting and violence-free homes
• Facilitate social connectedness and community engagement across the lifespan
• Provide individuals and families with the support necessary to maintain positive mental well-being
• Promote early identification of mental health needs and access to quality services
Drug & Alcohol Use
• Support implementation and enforcement of alcohol control policies
• Create environments that empower young people not to drink or use other drugs
• Identify alcohol and other drug abuse disorders early and provide brief intervention, referral and treatment
• Reduce inappropriate access to and use of prescription drugs
Injuries & Violence
• Implement and strengthen policies and programs to enhance transportation safety
• Support community and streetscape design that promotes safety and prevents injuries
• Promote and strengthen policies and programs to prevent falls, especially among older adults
• Promote and enhance policies and programs to increase safety and prevent injury in the workplace
• Strengthen policies and programs to prevent violence• Provide individuals and families with the knowledge,
skills, and tools to make safe choices that prevent violence and injuries
Access to Care
• Use payment and reimbursement mechanisms to encourage delivery of clinical preventive services
• Expand use of interoperable health information technology
• Support implementation of community-based preventive services and enhance linkages with clinical care
• Reduce barriers to accessing clinical and community preventive services, especially among populations at greatest risk
• Enhance coordination and integration of clinical, behavioral, and complementary health strategies
Healthy Chesapeake
Priorities:
• Healthy Eating
• Behavioral Health
• Active Lifestyles
• Clinical Linkages/Ambassador Program
http://healthychesapeake.org/
Healthy Norfolk
Priorities:
• Healthy Eating
• Active Living
• Workplace Wellness
• Smoking Cessation
http://www.norfolk.gov/index.aspx?NID=1149
Healthy Portsmouth
Priorities:• Active Communities/Physical Activity• Healthy Eating• Tobacco Use• Mental Health Literacy
http://www.healthyportsmouthva.org/
Priorities:• Healthy People/Healthy Suffolk
– Healthy Eating– Active Living
• Suffolk on the Move• Community Gardens• Healthy Youth Ambassadors
http://suffolkpartnership.com/http://healthypeoplehealthysuffolk.com/
Healthy VB
Priorities:
• Access to care
• Health Behaviors – Physical/Mental
• Mental Health – Substance Abuse, Suicide & Stigma
• Aging – Health Issues/Elderly
Eastern Shore Healthy Communities
Priorities:• Partnership Building• Improve Nutrition Environments• Increase Opportunites for Active Living• Expand Tobacco Free Environments• Encourage & Support Business & Faith Community
Wellness Efforts• Encourage & Support School Wellness Efforts
http://www.eshealthycommunities.org/
Consortium for Infant & Child Health (CINCH)
Priorities:• Obesity Prevention
– Healthy Eating– Physical Activity– Breastfeeding
• Respiratory Health– Clean Air– Asthma– Tobacco Use
• Healthy Hampton Roads– Healthy Eating/Active Living
www.cinchcoalition.org
Eastern Regional Accountable Care Community Working Group
Priorities:
• Advance the Triple Aim– Better care
– Better health
– Lower cost
• Shared responsibility for community health
• Greater Hampton Roads Population Health Initiative
http://www.evms.edu/community/brock_institute/programs/greater_hampton_roads_population_health_summit/
http://www.vahealthinnovation.org/what-we-do/the-virginia-health-innovation-plan/regional-accountable-care-communities-information/
United for Children
Priorities:
• Break cycle of poverty
• Holistic approach to whole child –individual, family, neighborhood and school interventions
http://www.unitedwayshr.org/united-for-children
Hampton Roads Early Care & Education Initiative
Priorities:
• Focus on families/children, prenatal through through age 5
• Create an integrated system for families to provide opportunities for cross-city collaboration and learning that leads to greater advocacy on behalf of area children
• Help economically disadvantaged families and the working poor while creating an improved system for all
• Emphasize a holistic range of positive outcomes for children
• Center on improving skills, support and the well-being of parents and the provider community
http://www.hamptonroadscf.org/about/earlyCareEduInit.html
Other Area Initiatives
• Virginia Beach Youth & Community Action Team
• DriveSafe Hampton Roads
• Coming Soon: Hampton/Newport News/Peninsula Healthy Community Initiative
• Hospital based community health needs assessments
• Bon Secours Healthy Community Initiative(https://bonsecours.com/hampton-roads/community-commitment/healthy-community-initiative)
• The Planning Council (http://www.theplanningcouncil.org/ )
Remember: All Policy is Health Policy
"A principle is a principle and in no case can it be watered down because of our incapacity to live it in practice. We have to strive to achieve it, and the striving
should be conscious, deliberate and hard."
~ Mahatma Ghandi
How to get a Healthy Hampton Roads?
Impacting PolicyEducation vs. Lobbying
• Awareness activities
• Facts
• Balanced
• No call to action (position not taken)
• Activities defend, support or maintain cause
• Usually broad issues
Education
• Influencing legislation, regulation, funding
• Actions aimed at influencing public officials to promote or secure passage of specific bill or funding
• A paid representative for a particular organization
Lobbying
• Influence
• Decision making power
• Opportunity to incorporate health into broad-based decisions
• Leadership works to create healthy communities
Why You?
““That some achieve great success, is proof to all that
others can achieve it as well.”
~Abraham Lincoln
What can you do now?
• Promote stairwells
• Implement Healthy Meeting Policies– Activity breaks
– Healthy food
• Support community gardens
• Support breastfeeding
Organizational Commitment
Leadership Pledge
As a leader in Hampton Roads,
I pledge to make decisions for my
community with health in mind.
Will You Champion Healthy Communities in
Hampton Roads??
We couldn’t do this without YOU!
Questions?Contact us at
757-446-6039
Healthy Communities Obesity Summit Series:
Identifying Regional Priorities: Small Group Discussion
EVMS Lester HallNovember 2, 2016
Healthy Communities Obesity Summit Series:
Small Group Report Out & Common Agenda
EVMS Lester HallNovember 2, 2016
Cynthia Romero, MD, FAAFP
Director, Brock InstituteEastern Virginia Medical School
