Community Health Improvement: National and Local Approaches CHIC 2006

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Community Health Improvement National and Local
ApproachesCHIC 2006

• Nancy M. Bennett, MD, MS
• Center for Community Health
• University of Rochester

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Outline

• Background
• Healthy People 2010
• Health Action
• Monroe County Department of Public Health
• Center for Community Health

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What is the problem?

• Poor health status compared to other
  industrialized nations
• Health Care Costs more than 1,300,000,000,000
  per year - 2002
• Racial and socioeconomic disparities in health
  status
• Less than 5 of budget for prevention

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Actual Causes of Death In the US
From Mokdad et al, JAMA, 2004
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The Determinants of Health

• COMMUNITY
• Physical environment
• Community-based organizations
• Schools
• Work-sites
• Churches
• Individual behavior

• HEALTH CARE SYSTEM
• Ambulatory care
• Long term care
• Home care

HOSPITAL CARE
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BIOMEDICAL MODEL vs. PUBLIC HEALTH
MODEL

• Biomedical Model
• Individual Focus
• Disease Orientation
• Cure
• Basic Sciences
• Medical Care

• Public Health Model
• Population Focus
• Health Orientation
• Prevention
• Epidemiology and Behavioral Science
• Public Health Interventions

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What is community health improvement?

• Goal is improvement of health of entire community
  or sub-populations
• Each individuals health may improve but success
  measured by improvement overall
• Requires agreed upon measures
• Requires a plan
• Requires consistency of goals and approaches
  across very diverse organizations

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The Challenge
PUBLIC HEALTH

• COMMUNITY BASED
• ORGANIZATIONS
• SCHOOLS/CHURCHES
• WORKSITES
• LOCAL/STATE/FEDERAL
• HEALTH AGENCIES

HEALTH CARE SYSTEM
ACADEMIC COMMUNITY

• INSURERS
• HOSPITALS
• HEALTH CENTERS
• PROVIDERS

• UNIVERSITY MEDICAL CENTERS
• OTHER COLLEGES/UNIVERSITIES

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The Solution
PUBLIC HEALTH

• COMMUNITY BASED
• ORGANIZATIONS
• SCHOOLS/CHURCHES
• WORKSITES
• LOCAL/STATE/FEDERAL
• HEALTH AGENCIES

ACADEMIC COMMUNITY
HEALTH CARE SYSTEM

• INSURERS
• HOSPITALS
• HEALTH CENTERS
• PROVIDERS

• UNIVERSITY MEDICAL CENTERS
• OTHER COLLEGES/UNIVERSITIES

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Healthy PeopleEntering its Third Decade

• 1974 - Lalonde Report - Canada
• 1979 - Healthy People The Surgeon Generals
  Report on Health Promotion and Disease
  Prevention
• 1980 - Promoting Health/Preventing
  Disease Objectives for the Nation - 1990
• 1990 - Healthy People 2000 National Health
• Promotion and Disease Prevention Objectives
• 2000 - Healthy People 2010

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Healthy People 2010

• Two overarching goals
• 10 Leading Health Indicators
• 28 focus areas
• 467 specific objectives

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Overarching Goals ofHealthy People 2010

• Increase quality and years of healthy life
• Eliminate health disparities

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Leading Health Indicators

• Physical activity
• Overweight and obesity
• Tobacco use
• Substance abuse
• Responsible sexual behavior

• Mental health
• Injury and violence
• Environmental quality
• Immunization
• Access to health care

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Public Health Approaches

• Planned
• Approach
• To
• Community
• Health

• Mobilize
• Assess
• Plan
• Implement
• Track

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STEERING COMMITTEE
BLUE CROSS/BLUE SHIELD OF THE ROCHESTER
AREA CENTER FOR GOVERNMENTAL RESEARCH FINGER
LAKES HEALTH SYSTEMS AGENCY LAKESIDE HEALTH
SYSTEM MONROE COUNTY DEPARTMENT OF PUBLIC
HEALTH MONROE COUNTY MEDICAL SOCIETY PREFERRED
CARE ROCHESTER BUSINESS ALLIANCE STRONG
HEALTH UNITY UNIVERSITY OF ROCHESTER VIA HEALTH
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Health Action Process
Problem Identification and Prioritization Repo
rt cards Measures
Community input to choose priorities
Health Priority
Health Priority
Health Action Partnership
Health Action Partnership
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Report Cards/Priorities

• www.healthaction.org
• Maternal Child Health Report Card
• Adolescent Health Report Card
• Adult Health Report Card
• Older Adult Report Card
• Environmental Health Report Card
• 6-8 goals per age group - all supported by data
• Public release of report card
• 20-30 diverse focus groups
• Revision of goals and selection of 2 priority
  goals
• Board of Health approval and final report

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Maternal / Child and Adolescent Priorities

• Maternal Child Priorities
• Improve nutrition and physical activity
• Improve social and emotional well-being
• Adolescent Priorities (under review)
• Reduce use of tobacco
• Build youth competencies to promote a healthy
  life

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Adult and Older Adult Priorities

• Adult Priorities
• Promote Healthy Behaviors that Reduce the Risk of
  Chronic Disease
• Promote Optimal Use of Preventive Health Services
• Older Adult Priorities
• Promote Behaviors that Prevent or Delay
  Complications and Disability from Chronic Disease
  
• Promote Use of Preventive Health Services

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Health Action Partnerships Activities

• Analyze health issue and relevant data
• Inventory community resources
• Review best practices from other communities
• Develop strategic plan to improve health
• Develop evaluation plan
• Implement interventions
• Monitor process and outcomes

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Monroe County Fitness Campaign
Adult Health Improvement Strategy
Preventive Health Services Campaign

• Diet
• Physical Activity
• Smoking
• Use of Preventive Health Services
• Mental Health

• BeActiveRochester.com
• Worksite Health Action Team
• Healthy Living Program
• Rochester Walking Challenge

• Insurance Coverage
• (Access Benefits)
• Access to Care
• Provider Knowledge,
• Attitudes and Practices
• Individual Education

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Public Health in AmericaCore Functions

• Prevents epidemics and the spread of disease
• Protects against environmental hazards
• Prevents injuries
• Promotes and encourages healthy behaviors
• Responds to disasters and assists communities in
  recovery
• Assures the quality and accessibility of health
  services

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Department of Public Health Divisions

• Communicable Disease
• Environmental Health
• Maternal Child Health
• Medical Examiner
• Administration

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Communicable Disease

• Disease Control Unit
• Immunization
• Tuberculosis
• Sexually Transmitted Diseases / HIV
• Foster Care Pediatric Clinic

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Environmental Health

• Environmental Quality
• Stormwater management
• Environmental Management Council
• Environmental Quality Monitoring
• General Sanitation
• Public Health Engineering

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Maternal Child Health

• Child and Family Health
• Community Health worker program
• Women, Infants and Children Nutrition Program
• Early Intervention Program
• Safe Start Grant
• Physically handicapped childrens program

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Administration

• Office of the Director / Deputy Director
• Vital Records
• Health Education
• Public Health Emergency Management
• Data Analysis and Information
• Emergency Medical Services
• Budget, contracts, HR, IS
• Health Action/Center for Rochesters Health

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The University of Rochesters Role
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URMC Community Health Goals

• Through community based activities and
  partnerships, improve health and quality of life,
  and reduce health disparities
• Continue to promote community health as a fourth
  mission fully integrated with research,
  education, and patient care
• Enhance the URMCs recognition as a national
  leader in community health

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Center for Community HealthPurposes

• Organizational structure to support the community
  health mission
• Conduit for community concerns, needs and access
  to medical center resources including students,
  faculty, and staff
• Assistance to departments and centers in
  identifying community partners
• Research in key areas of community and public
  health
• Infrastructure to help pursue new sources of
  funding to address community priorities
• Support for HEALTHACTION

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Center for Community HealthCurrent Programs

• Womens Health Partnership
• Office for the Aging Health Program
• Finger Lakes Office of Surveillance and
  Epidemiology
• Emerging Infections Program
• Racial and Ethnic Adult Disparities in
  Immunization Initiative (READII)
• Greater Rochester Area Smoking Prevention Program
  (GRASP)
• Healthy Living Program

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Public Health is neither a discipline nor a
profession it is the goal.
From Alfred Sommer, M.D. , Dean
Johns Hopkins School of Public Health
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Useful web sites

• healthaction.org
• urmc.rochester.edu/crh/
• cdc.gov
• healthypeople.gov
• BeActiveRochester.com

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Extra slides

• Example of HA approach applied to heart disease
  prevention

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Ischemic Heart Disease MortalityMonroe County
1995-1998, Age lt75
Age-adjusted to the 1980 US population
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Cardiovascular Risk FactorsMonroe County, 2000,
Ages 18-64
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Cardiovascular Risk FactorsMonroe County, 2000,
Ages 18-64
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Healthy Living Program

• Community-based program delivered through network
  of African American churches
• Physical Activity Intervention
• Center for Lifetime Wellness
• Health Promotion / Behavior Change Counseling
• Healthy Living Partnership Staff
• Individual Care Coordination
• HLP-Net

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HLP Participants 1/02 5/06, n1323

• Mean Age 51 years (18-95)
• African-American 89
• Female 89
• Education
• HS or less 38
• Some college 40
• College graduate 20
• Insurance
• Uninsured 6
• Medicaid/Medicare 21
• Private 68

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Risk Factor Profile

• Hypertension 42
• High Cholesterol 27
• Diabetes 16
• Overweight/Obese (BMI25) 81
• Current Smoking 6
• Heart Disease 5

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HLP Physical Fitness Level
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HLP Exercise Participation
Meets 2010 Goal Moderate 5x weekly for 30
minutes Aerobic 3x Weekly for 20 minutes
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HLP Dietary Guideline Compliance
Self-reported compliance with USDA
recommendations, measured through dietary
patterns survey.