Transcript Policy Scan - Bernalillo County

This event is jointly sponsored by the HealthInsight New Mexico and
NMPHA & NM CARES Health Disparities Center.
In compliance with the ACCME/NMMS Standards for Commercial Support
of CME,
Theresa Cruz, PhD
Lorna Marchand, MA, MPH
Danielle Reed, MA
Angelica Solares, MCRP
have asked to advise the audience that they have no relevant financial
relationships to disclose.
This activity has been planned and implemented in accordance with the Essential Areas and polices of
the New Mexico Medical Society (NMMS) through the joint sponsorship of HealthInsight New Mexico
and New Mexico Public Health Association and NM CARES Health Dipartites Center]. HealthInsight
New Mexico is accredited by the NMMS to provide Continuing Medical Education for physicians.
HealthInsight New Mexico designates this live event for a maximum of 10.75 AMA PRA Category 1
Credit(s) tm. Physicians should claim only the credit commensurate with the extent of their participation
in the activity.
Transforming Communities Through
Prevention of Chronic Disease:
Early Lessons Learned from the
Bernalillo County Community Transformation Grant
Theresa Cruz, PhD
Lorna Marchand, MA, MPH
Danielle Reed, MA
Angelica Solares, MCRP
April 19, 2013
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Collective Impact for Neighborhood
and County Health (CINCH)
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Background
• Authorized by Affordable Care Act of 2010
 Administered and supported by CDC
• Awarded $103 million to 61 states and communities
 Reaching 120 million Americans
 36 states, 7 tribal organizations, Republic of Palau
• Bernalillo County received 1 of 26 Capacity-Building
Awards
 Two-year capacity-building award with potential to
apply for a three-year implementation award
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Purpose
• To create healthier communities by focusing on
capacity building and implementation of broad,
evidence-based and practice-based policy,
environmental, programmatic, and infrastructure
changes.
• Emphasis on Equity “...specific measures to achieve
health equity, eliminate health disparities, and
improve the health of the population and population
subgroups.”
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Goal
• Create a healthier community by achieving positive changes
in:






nutrition/weight
physical activity
tobacco-use
the built environment
clinical preventive services
emotional well-being/overall mental health
• CTG concentrates on the causes of chronic disease, by
improving health and wellness of county residents
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How?
• Reduction in deaths and illnesses from heart disease, diabetes, cancer,
and asthma through policies that increase opportunities for:
 physical activity and healthy eating
 healthy neighborhoods, and
 living environments free of tobacco smoke.
• Participatory Planning Approach
 Leadership, advisory teams and community input
• Research
 Policy Scan, Health Assessment, qualitative data gathering
• Communication and Training
 Communication assessment, and strategic communications plan
 Training Academy
Health Assessment Key Findings
• Hispanics in Bernalillo County:
 Have disproportionately high rates of death from
Heart disease (men)
Stroke (men and women)
High blood pressure
 Have high rates of obesity (2)
 Lowest educational attainment of any group – 56% HS education or
less
 High rates of poverty – 21.2%
 Have second highest rates of smoking among high school students
Health Assessment Key Findings
• African Americans in Bernalillo County:
 Have disproportionately high rates of death from
Lung cancer
Heart disease
Stroke
 See higher rates of obesity than any other population group
 Are most likely to encounter financial barriers to obtaining
health care
Health Assessment Key Findings
• American Indians in Bernalillo County:
 Have disproportionately high rates of death from
Cancer
Diabetes
 See higher rates of overweight than any other population
group
 Are most likely to have no health insurance than any other
group
 Have highest rates of smoking among high school students
(25.2%) and adults (24%)
Areas with highest concentration of families living in
poverty have the highest rates of chronic disease
CINCH Community Engagement
• Focus group-style community meetings
 Six communities identified in health assessment
 Geographic – International District, South Valley, I-25
Corridor
 Racial/Ethnic – African American, Native American,
Hispanic
•
Recruitment efforts led by members of leadership
and planning teams
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CINCH Community Engagement
• Key informant interviews
 Fill in the gaps from community meetings
 Who was not represented?
 Community health workers, youth advocates,
community center leaders
 CINCH leadership team provided links when needed
CINCH Community Engagement
• Two hour semi-structured meetings
• Key questions
 What makes a healthy community?
 What are barriers to healthy eating, active living,
preventive screening?
 What are your ideas about reducing chronic disease?
CINCH Community Engagement
• Key findings - Healthy eating
 Need increased access to affordable, quality fresh
food
 Need education about healthy food preparation
 Wanted more fresh food in schools and at summer
programs
 Low price and easy access to fast food makes it
difficult to eat well when time and money are
constraints
CINCH Community Engagement
• Key findings – Active Living
 South Valley – need for safer streets and sidewalks
 International District – concerns about crime
 Supported increased access to school yards after
hours
 Expressed need for increased utilization of
community centers for recreation opportunities
CINCH Community Engagement
• Key findings - Tobacco
 Difficult for smokers to quit – become defensive
when regulations are proposed
 Enforcement is lacking – smoking in public places as
well as sales of tobacco to minors
 Need to deal with larger issues of why people are
smoking – stress, poverty
 Living in a smoke-free environment is important,
especially for children
CINCH Community Engagement
• Key findings – Clinical Preventive Services
 Hesitation to go for screening because costs are
often unclear
 Need more providers similar to the race and
ethnicity of the communities they serve
 Would like to see community health workers in nonclinical settings
Schools, community centers
 Need to make people aware of free clinics and
screening services
Policy Scan
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Purpose of Policy Scan
1. Identify and classify policies addressing chronic
disease prevention
2. Detect policy gaps
3. Report on findings
4. Develop a database
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Scope of the Policy Scan
• Written policies
• Includes legislative, regulatory, and organizational
policies that promote population health
• Focus on prevention of heart disease, cancer, stroke,
and diabetes
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Examples of Evidence-Based Policies
• Tobacco-free school policies
• Policies that increase opportunities for physical
activity in communities (e.g., joint use)
• Policies that support breast-feeding
• Mixed-use zoning policies
• Complete Streets policies
• Training and technical assistance to improve delivery
of clinical preventive services
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Data Collection Methods
• Database and internet policy
searches
• Stakeholder meetings
• Collaboration with non-profits
and policy implementers
• Healthcare provider interviews
• Employer wellness policy
surveys
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Policy Levels
•
•
•
•
•
•
State – New Mexico
County - Bernalillo
City – Albuquerque
Employers/Organizations
Healthcare Providers
School District –
 Albuquerque Public Schools
 University of New Mexico
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Model Policies
Policy Area
Tobacco
Healthy Eating/
Active Living
Clinical Preventive
Services
Built Environment
Reviewed
Included
14
6
34
15
1
1
7
2
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Policies Analyzed
Strategic
Direction
Tobacco-free
Living
State County City Employer APS UNM Total
14
1
3
3
5
1
27
Active Living
12
3
3
5
6
3
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Healthy Eating
Clinical Preventive
Services
18
1
1
4
5
1
30
7
0
0
0
0
0
7
Built Environment
Social/Emotional
Wellness
5
2
4
2
2
0
15
8
0
0
2
2
0
12
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Interviews and Surveys
• 7 primary care medical directors
• 25 eligible employer survey respondents
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CINCH Policy Database
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Searches – Active Living and City
Results
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Early Lessons Learned
• Need for a dynamic, flexible, sustainable database to allow for
on-going analysis and assessment
• Multiple policies addressing one topic make it more difficult
to understand and assess
• Many plans, programs, and practices exist but they aren’t
formalized as policies
• Employers often don’t have written policies
• The majority of policies had exemptions
• Translating policies into multiple languages would improve
access and understanding
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Key Findings – Tobacco
The community may wish to improve population
health by focusing on:
• Clean indoor air policies
• Policies that promote tobacco-free outdoor public
places and outdoor workplaces not controlled by
Bernalillo County
• Smoke-free multi-unit housing policy
• Consolidated policies
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Key Findings - Healthy Eating and
Active Living
The community may wish to improve population health by
focusing on:
• Competitive food policies in schools to apply to
fund-raising and foods available to staff
• Enrollment policies for students in free- and
reduced-lunch programs
• Revised vending policies to include healthier food
options
• Policies that address location and density of fast
food outlets
• Incentives on the sale of healthy foods at retail
outlets
• Policies that address accessibility and availability of
healthy foods through zoning laws that allow for
community gardens on vacant land
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Key Findings – Healthy and Safe
Physical Environment
The community may wish to improve population health by
focusing on:
• Policies to create and sustain
safety/walkability programs
• Policies that incorporate Complete Streets
principles
• Policies that incorporate Transit-Oriented
Development principles
• Policies supporting health impact
assessments prior to changes to the built
environment
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Key Findings - Clinical Preventive
Services
The community may wish to improve population health by
focusing on:
• Polices that promote training and technical assistance to health
care providers to effectively implement systems to improve
delivery of clinical preventive services
• Policies that promote the use of chronic disease selfmanagement programs
• Regular review and revision of policies on eligibility for
preventive services
• Policies for use of EHRs for patient reminders about
recommended preventive services
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The Community Transformation
Implementation Plan
• CINCH’s two-year long capacity-building and
planning process has informed the development of a
comprehensive, three-year implementation plan for
Bernalillo County that focuses on prevention of
chronic disease.
• The CINCH Planning Team met for six months to
review results of the Health Assessment, Policy Scan,
and focus groups, and to prioritize implementation
activities.
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The Community Transformation
Implementation Plan
• Implementation awardees will implement policy,
environmental, programmatic, and infrastructure changes
consistent with CDC’s strategic directions.
• Implementation activities must impact the entire
population of Bernalillo County, as well as specific
population subgroups with disproportionately high rates
of health and social disparities, and pockets of high
burden with increased intensity tailored to the specific
barriers and needs of populations suffering from
disparities.
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The Community Transformation
Implementation Plan
• The proposed CTIP and funding request
application will be submitted to CDC for
consideration.
• Implementation project period: October
1, 2013 – September 30, 2016.
• If funded, activities will be carried out
through contractual agreements with
community partners.
• CTIP includes project period objectives
(PPO), annual/multiyear objectives
(AMO), and specific activities.
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The Community Transformation
Implementation Plan
Active Living
PPO:
Increase the number of schools that are
authorized to provide safe, inviting, accessible
places for physical activity opportunities during
non-school hours.
AMOs:
1. Increase the number of district-wide joint
use agreements that facilitate the shared use
of school property for physical activity
purposes.
2.
Increase the number of schools that employ
joint-use and shared-use practices.
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The Community Transformation
Implementation Plan
Healthy Eating
PPO:
Increase the number of people in identified priority neighborhoods
who have access to healthy, affordable food.
AMOs:
1. Increase the number of people served by mobile produce vending
programs that link consumers with fresh, locally grown fruits and
vegetables.
2. Increase the number of people served by healthy corner stores
initiatives that facilitate access to fresh fruits and vegetables in
USDA-designated food deserts.
3. increase the number of students served by initiatives that provide
schools with locally grown fruits and vegetables.
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The Community Transformation
Implementation Plan
Tobacco-Free Living
PPO:
Increase the number of people living in smoke-free multi-unit housing
in Bernalillo County's International District.
AMOs:
1. Increase the number of property owners/managers who receive
education, training, and outreach related to smoke-free housing.
2. Increase the number of people exposed to smoke-free multi-unit
housing messages.
3. Increase the number of tenants receiving education and outreach
related to smoke-free multi-unit housing in the International
District
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The Community Transformation
Implementation Plan
Tobacco-Free Living
PPO:
Decrease the number of middle and high school students in priority
neighborhoods with access to tobacco products.
AMOs:
1. Increase the number of community-based youth tobacco
compliance task forces.
2. Increase the number of tobacco merchants in priority
neighborhoods receiving education about tobacco sales to
minors.
3. Increase the number of community members in priority
neighborhoods receiving education about enforcement and
reporting of tobacco sales to minors.
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The Community Transformation
Implementation Plan
Healthy and Safe Physical Environments
PPO:
Increase the number of adopted land use/transportation plans,
policies, or funded projects that incorporate Complete Streets design
principles.
AMOs:
1. Increase the number of transportation engineers, planners, and
other stakeholders in Bernalillo County that are familiar with
Complete Streets principles and proficient in applying Complete
Streets design standards.
2. Increase the number of adopted land use/transportation plans,
policies, or funded projects that incorporate Complete Streets
design principles.
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The Community Transformation
Implementation Plan
Clinical Preventive Services
PPO:
Increase the number of people who receive health education and preventive
services from community health workers who are representative of the
target populations.
AMOs:
1. Increase the number of community health worker programs that have
sustainable funding sources.
2. Increase the number of Bernalillo County-based community health
workers participating in a formal learning collaborative.
3. Increase the number of certification programs that incorporate
community health worker core competency curriculum modules that
focus on chronic disease, social determinants of health, and CTG
strategies.
4. Increase the number of community health workers placed in community
settings.
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Acknowledgments
Courtney FitzGerald, MSSW, LMSW, UNM Prevention Research Center
Marsha McMurray-Avila, MCRP, and the Bernalillo County Community Health Council
George Schroeder, MPH, (PI) Bernalillo County Office of Health and Social Services
Shiraz Mishra, MBBS, PhD, UNM Prevention Research Center
Leona Woelk, MA, UNM Prevention Research Center
Participating colleagues, students, and staff that made this project a success
Physicians and employers who took time to respond to our interview questions and
surveys
• Members of the CINCH advisory teams
• Members of the community
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The policy scan and presentation were supported by Cooperative Agreement Number 1U58DP003595-01. The findings and conclusions in this presentation are those of the authors and
do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Thank you!
Questions?