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North Dakota State Health Improvement Plan 2016
State Health Improvement Plan 1
North DakotaState Health Improvement Plan
2016
North DakotaState Health Improvement Plan
Jack DalrympleGovernor of North Dakota
Terry Dwelle, M.D., M.P.H.T.M.State Health Officer
Kelly Nagel, MS, RD, LRDDirector, Office of Public Health Systems and PerformanceNorth Dakota Department of Health
Acknowledgements:Thank you to the following people for their help in the development of this document.
Karen K. Ehrens, RD, LRDHealthy North Dakota Coordinator
Kelly Nagel, MS, RD, LRDDirector, Office of Public Health Systems and PerformanceNorth Dakota Department of Health
State Health Improvement Plan2
Table of Contents
Background ........................................................................................................3
Strategic Mapping Process ..............................................................................5
Statewide Vision and Strategy Group, Strategic Map ................................6
Further Development of SHIP .........................................................................7
SHIP Framework Diagram ................................................................................9
SHIP Principles .................................................................................................10 Strategic Priorities ...........................................................................................11
Policy Change ...................................................................................................14
SHIP Alignment ................................................................................................14
State Health Improvement Plan 3
Background
In January 2002, Governor John Hoeven announced a new public health initiative, Healthy North Dakota:
“Today, I am announcing a new public health initiative for our state, Healthy North Dakota, and I am challenging each school child, each businessperson, each senior citizen to take control of his or her life – to exercise more, to eat a healthy diet, to examine their use of tobacco and alcohol. These must be individual choices, but we can provide the support structure, education and encouragement to each North Dakotan who wants to adopt a healthier lifestyle. Knowing North Dakotans, I have no doubt that they will meet the challenge.”
The launch of Healthy North Dakota stemmed from discussions between the North Dakota Department of Health, the University of North Dakota, and the Governor’s office, with all entities realizing the need for a realistic and kinetic state health improvement plan. There were more than 100 health organizations/agencies represented at the Healthy North Dakota (HND) Summit. From this Summit, more than 20 HND workgroups were organized to encourage enhanced collaboration and partnerships to accomplish common goals. The members of these HND workgroups were primarily program level personnel.
Healthy North Dakota works through an established framework, supporting North Dakotans in their efforts to make healthy choices – in schools, workplaces, senior centers, homes and anywhere people live, learn, work, and play. This work is further expanded through the networks, memberships, and professional relationships each individual and organization brings to the table.
One part of Healthy North Dakota is the Coordinating Committee (HND CC), a dynamic, statewide partnership with over 25 organizations and 20 state agency organizational units joining to find solutions for healthier living. The HND CC’s vision is Healthy North Dakota – Healthy People, Healthy Communities with a mission to inspire and support North Dakotans to improve physical, mental and emotional health for all by building innovative statewide partnerships.
The HND CC works to identify and fill gaps in prevention efforts in areas including worksite wellness, hunger and food insecurity, and increasing health equity. The HND CC facilitates integration among prevention groups with consistent messaging, collaborative planning, and strategic alliances. The HND CC is the place for establishing connections and collaborating with state and local government agencies, voluntary health groups and advocacy organizations statewide.
State Health Improvement Plan4
Another part of Healthy North Dakota is the Statewide and Vision Strategy for a Healthier North Dakota Group (SVS). The SVS Coordinating Committee, a steering group, was organized in 2006. These leaders from both the private and public sectors initiated a voluntary, self-funded collaborative effort to explore innovative, statewide approaches to improving the health status of North Dakotans. This initiative focused on the development of a Vision and Strategy for the Health-Care System in North Dakota, which is accepted as the State Health Improvement Plan (SHIP).
Groups and organizations represented in the development of the SHIP include:Office of the Governor of North Dakota and other agenciesNorth Dakota Department of Health and local public healthGreater North Dakota Chamber and other businessesUND School of Medicine and Health SciencesNorth Dakota State UniversityNorth Dakota Medical AssociationNorth Dakota Long Term Care Association and other care facilitiesAmerican Indian education and service providersNorth Dakota Healthcare Association and medical centersBlue Cross Blue Shield of North Dakota (the insurer covering most people in the state)
State Health Improvement Plan 5
Strategic Mapping Process
The original strategic mapping process was led by the Statewide Vision and Strategy (SVS) Coordinating Committee and took place in 2007. The SVS Coordinating Committee brought in additional input from local public health, long term care, health systems, businesses, and emergency medical systems to develop a long term plan. SVS planning activities included a situational analysis of the state’s health care system, setting a future direction for the system, and creating a strategic map moving from the present into the future.
The strategic mapping process resulted in a formulation of a map that summarizes and defines the direction SVS has set for state health improvement. The map sets a vision for the health care system in North Dakota up to the year 2020. The map also outlines key initiatives or priorities to be addressed between 2007-2011. The SVS group’s health improvement planning process is fluid and dynamic. The priorities and goals were re-examined and the map updated in 2014 and 2016. The SVS Coordinating Team continues to function to provide direction in mapping and carrying out the plans. The most recent version of the strategic map is shown on the following page.
State Health Improvement Plan 5
State Health Improvement Plan6
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State Health Improvement Plan 7
Further Development of SHIP
The Statewide Vision and Strategy (SVS) Coordinating Team is an independent, voluntary group of “key” representatives from the public, private, and nonprofit sectors who share a concern for the overall health and well-being of all the citizens of North Dakota – infants through seniors. They have joined to identify and address the health care needs of our state. In its 2016 strategic planning session, SVS determined that its primary function is the development of a comprehensive, congruent, research-based, relevant and dynamic plan (State Health Improvement Plan - SHIP) to address the health and well-being of all North Dakotan to achieve its vision. SVS convenes at least quarterly to discuss progress towards their vision and mission.
Vision: A North Dakota whose citizens are the healthiest people in the nation.
Mission: To work collaboratively with stakeholders and partners statewide to build, implement and maintain a dynamic State Health Improvement Plan (SHIP) that supports and improves the health of all our citizens.
State Health Improvement Plan8
SVS conducts a biennial strategic planning process to renew and update the SHIP map. The planning sessions are initiated by a review of: 1. State health assessment data 2. Population health survey findings and priorities.
Along with the state health assessment, other statewide initiatives and plans inform the SHIP. (See Framework Diagram on page 10.)
SVS sets long-term (5+ years) and short-term (2 years) priorities based on the health issues and concerns and strategic opportunities identified by health system partners. The number of short-term priorities identified is based on ownership, focused attention, and resources available for greater impact within the two years.
Following adoption of the short-term focus area(s), agencies and organizations that are part of the HND network identify goals, measurable objectives, and strategies around each priority and are responsible for strategy implementation. SHIP strategies are identified through communication and coordination with the HND Coordinating Committee. The HND Coordinating Committee members represent various statewide health prevention groups and facilitate integration among the groups with consistent messaging, collaborative planning, and strategic alliances.
State Health Improvement Plan 9
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State Health Improvement Plan10
SHIP Principles
The SHIP embodies the following principles:
➤ Broad, cultural factors that bring about change – longer term➤ Research-based/supported initiatives➤ Best practices➤ Consumer needs and concerns➤ Prevention/wellness/personal responsibility ➤ Advocacy, systems, and policies
10 State Health Improvement Plan
State Health Improvement Plan 11
Strategic Priorities
The SHIP consists of two sets of strategic priorities; long-term and short-term.
Long-Term Impact:
Priorities identified for long-term impact are continually monitored through health indicators but do not have targeted statewide strategies. After review of the health indicators and other data, SVS may choose to target the long-term priorities for more immediate attention. New priorities may also be identified during the planning interim.
Priority 1: Promote healthy weight for all North DakotansObesity has become an increasing problem for North Dakota; however, American Indians are at substantially higher risk of obesity than the state as a whole. Even the combined percentage of children overweight or obese has been rising steadily. Obesity is a major risk factor for many other conditions including heart disease, high blood pressure, depression, and arthritis. The reasons for obesity are complex. Trends in rising obesity are likely to continue until the underlying risk factors are altered. Therefore, stakeholders will pursue research and integration strategies to address the risk factors.
Priority 2: Collaborate for data and researchIn 2012, North Dakota developed a collaborative Masters of Public Health program between the University of North Dakota and North Dakota State University. Not only did the program build capacity for education but also for research initiatives which stress an ecological understanding of health problems and a systems approach to developing innovative solutions. The public health program also provided an opportunity for the North Dakota Department of Health to collaborate with the universities in data gathering and in becoming an academic health department. Stakeholders will pursue establishing training programs that will further the capacity for data collection, research, and public health workforce development.
State Health Improvement Plan12
Priority 3: Support children, families, and caregivers for improved behavioral healthThe North Dakota Department of Human Services conducted the North Dakota Behavioral Health Assessment to identify priority recommendations to enhance the foundation of the state’s behavioral health system, with the goal of supporting North Dakota’s children, adults, families, and communities in health and wellness, to reach their full potential. Prevention is a cost-effective and common-sense way to avoid the consequences of behavioral health disorders. Prevention efforts are effective when approaches are comprehensive, address risk and protective factors, and focus on a community’s unique challenges. All promotion and prevention efforts should recognize and address the interrelated impact of behavioral health on overall well-being. However, the assessment results indicated that even though general stakeholders valued the importance of promotion and prevention, they were not aware of prevention efforts occurring in the state or what evidence-based promotion and prevention services should look like. Stakeholders will identify and support strategies for development of good behavioral health. Promotion and prevention activities will be targeted to children and their families and childcare givers.
12 State Health Improvement Plan
State Health Improvement Plan 13
Short-Term Impact:
Priorities identified for short-term impact have targeted statewide attention, focus, and resources. Therefore, multiple goals, measurable objectives, and strategies are implemented for the two-year timeline. SVS continually monitors progress towards the set goals. Short term goals, measurable objectives and activities can be found in the supplemental State Health Improvement Implementation Plan.
Priority 1: Promote health through worksite wellnessNorth Dakota businesses initially identified worksite wellness interest and desire to learn more in a Healthy North Dakota (HND) 2001 statewide survey. HND served as an incubator, bringing together partners and resources to implement a statewide worksite wellness initiative. HND worked with groups in the state, including SVS, to identify funding and a home for providing technical assistance to businesses to carry out wellness programs. The Dakota Medical Foundation and Blue Cross Blue Shield of North Dakota initially provided funding and a home for the worksite wellness initiative. Currently Blue Cross Blue Shield of North Dakota supports a full-time position, training resources, and travel to serve worksites implementing wellness activities throughout the state.
Comprehensive worksite wellness programs provide a sustainable channel to reach people with integrated public health and primary care to improve health outcomes. North Dakota is estimated to have the lowest unemployment rate in the nation for all age ranges younger than 65 (American Community Survey), and so worksites are a prime location for reaching a majority of residents.
Increasing productivity and controlling health insurance rates are two reasons businesses are supportive of worksite wellness initiatives. Healthy workers are more productive and contribute to healthy and productive businesses. The costs of health insurance premiums to businesses who provide insurance for employees have increased substantially, with up to 50 percent of company profits spent on employee health care costs.
Comprehensive worksite wellness programs that address many aspects, including safety, are encouraged in the state. Stakeholders will implement integrated strategies to impact multiple life influences and behaviors and utilize community engagement models that can be beneficial for both large and small businesses.
State Health Improvement Plan14
Priority 2: Increase immunization rates in school childrenNorth Dakota state law (23-07-17.1) stipulates that children receive a schedule of immunizations before entry into school. All Advisory Committee on Immunization Practices (ACIP) recommendations are required for school entry, except influenza and HPV vaccines. However, some North Dakota school entry immunization rates are below the national average and the Healthy People 2020 Objective. Stakeholders will work to increase immunization rates through process changes. The Boosting Immunization Rate through Process Change (BIRP) pilot project will help identify a process for school personnel, working with local public health unit staff, to identify gaps and barriers that prevent families from obtaining required immunizations to prevent disease and be able to attend school. The SVS has received grant funding to pilot this project out in at least one region of the state.
State Health Improvement Plan14
State Health Improvement Plan 15
Policy Change
North Dakota public health system partners have been working for some time to influence policymakers and third-party payers to provide incentives to worksites who implement employee wellness programs. As a result, the Public Employees Retirement System health insurance program now offers a 1 percent rebate in premiums for government entities who plan and participate in multiple worksite wellness activities.
SHIP stakeholders’ efforts directly encourage worksites to implement policy, environmental, and system change. Many of the objectives include developing, providing and implementing policies to improve employee health. The American Heart Association Midwest Affiliate has been helping to train worksites on improving nutrition in worksites including via policy change around food served at meetings. Some private organizations and state agencies, including the North Dakota Department of Health, have implemented policies that allow flexible break time for physical activity.
Effective policy change can help wellness become the norm and sustain systems and environment modifications.
SHIP Alignment
The SHIP sets the direction for statewide health system planners and decision makers. It provides a common ground from which to plan for action and to leverage knowledge, relationships, and resources to create a culture of health.
The SHIP is informed by local health priorities and those of the sovereign Indian nations of North Dakota. To ensure that the voices of tribal people are included in decision-making, the SVS includes representation from the American Indian Public Health Resource Center (AIPHRC) at NDSU. The AIPHRC works with tribal nations to assess the health of the population and to identify health concerns and priorities.
The NDDoH collaborates with the University of North Dakota Center for Rural Health to ensure that local health priorities are included in the SHIP. They consult with local public health units and critical access hospitals to identify community health needs and gather their health priorities.
For more information, contact:Kelly Nagel, MS, RD, LRDDirector, Office of Public Health Systems and PerformanceNorth Dakota Department of [email protected]
