health in arizona policy initiative...health and wellness for all arizonans azdhs.gov health in all...

Health and Wellness for all Arizonans

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Health in Arizona Policy Initiative

Addressing Population Health Needs in Arizona

Arizona Rural & Public Health Policy Forum Thursday, January 24, 2012

Tim Vaske, Prevention Services Policy Manager Bureau of Health Systems Development

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Overview

• Health in Arizona Policy Initiative (HAPI) utilizes evidence-based approaches to address population health needs including the:

– Health in All Policy Framework

– Health Impact Pyramid

– National Prevention Strategy








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Health in All Policy • Identifies the underlying factors which are drivers of health

costs in society including, but not limited to the: – Conditions in which people are born, grow, live, work and age,

including the current health system focus on treatment vs. prevention.

– Growing number of individuals with chronic disease yet who do not utilize health systems to better control and manage conditions.

– Isolation of “health” to the environment of health systems, not recognizing the impact other environments have on health outcomes.

– Other determinants which impact health including race, income, safety, community design, and access to basic necessities.








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Health in All Policy

• Focus on innovative solutions which address these drivers of health costs including: – Identifying the role of governments and communities

to create environments more conducive to health.

– Establishing partnerships between “nontraditional” health partners such as business, city planning & zoning, military, etc.

– Exploring opportunities to incorporate health concepts into new policy areas, even if health isn’t the central focus, such as housing, economic development, etc.








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Frieden, Thomas R. “A Framework for Public Health Action: The Health Impact Pyramid.” Am J Public Health. 2010 April; 100(4): 590–595.

Promote Healthy Eating & Active Living

Prescribe Rx for high blood pressure, diabetes control

Immunizations, cessation treatment, CRC screening

Safe Routes to School, complete streets, wellness policy

Poverty, Education, Housing, Inequalities, Age, Gender, Disability

The Health Impact Pyramid








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Frieden, Thomas R. “A Framework for Public Health Action: The Health Impact Pyramid.” Am J Public Health. 2010 April; 100(4): 590–595.

Health in Arizona Policy Initiative

The Health Impact Pyramid








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National Prevention Strategy








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Health in Arizona Policy Partners

Coconino County Cochise County

Gila Graham

Greenlee La Paz

Maricopa Mohave

Navajo Pima

Pinal Yavapai

Yuma








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Health in Arizona Policy Initiative Focus Areas

• Healthy Worksites

• School Health

• Community Design / Healthy Communities

• Clinical Care

• Procurement








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Healthy Worksites








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Healthy Worksites • People spend more awake hours at work than any other place. U.S. Bureau of Labor Statistics, 2010 American Time Use Survey, Table II.

• The average return on investment (ROI) is nearly $3.27 in medical

costs per $1 spent and $2.73 in absentee day costs per $1 spent. Baiker K., Culter D., Song Z. Workplace wellness programs can generate savings. Health Affairs. 2010;29(2):304-311.

• A 1% reduction in excess weight, elevated blood pressure, glucose,

and cholesterol has been shown to save $83 to $103 annually in medical costs per person. Henke, R.M., Carls, G.S., Short, M.E., Pei, X., Wang, S., Moley, S., Sullivan, M., and Goetzel, R.Z. (2010) The Relationship between Health Risks and Health and Productivity Costs Among Employees at Pepsi Bottling Group. Journal of Occupational & Environmental Medicine, 52(5), 519–527.








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Healthy Worksites

• HAPI ADHS & County Activities: – Connect Arizona businesses with efforts impacting employee

wellness, including the Healthy Arizona Worksites Program. – Work with employers to increase incentive programs, such as

flex time, rewarding or recognizing employee healthy behaviors. – Help employers connect their employees with community

partners offering disease self-management programs. – Assist employers as implement policies and practices supporting

breastfeeding in the workplace. – Help Arizona employers navigate the wellness components of

the Affordable Care Act. – Incorporate healthy vending machines into work environments.








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School Health

Poverty

Health Education

Number of children under the age of 18 in Arizona living in poverty increased from 15.2% to 35% since 2003. - 2010 U.S. Census

Health-related factors such as hunger, physical and emotional abuse, and chronic illness can lead to poor school performance.

- Dunkle MC, Nash MA. Beyond the Health Room. Washington, DC:

Council of Chief State School Officers, Resource Center on Educational Equity; 1991.

Health-risk behaviors such as early sexual initiation, violence, and physical inactivity are consistently linked to poor grades and test scores and lower educational attainment. - Carlson SA, Fulton JE, Lee SM, Maynard M, Drown DR, Kohl III HW, Dietz WH. Physical education and academic achievement in elementary school: data from the Early Childhood Longitudinal Study. American Journal of Public Health

2008;98(4):721–727.








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School Health

Scientific reviews have documented that school health programs can have positive effects on educational outcomes, as well as health-risk behaviors and health outcomes.

- Basch CE. Healthier Students Are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap. Equity Matters: Research Review No. 6. New York: Columbia University; 2010.

Similarly, programs that are primarily designed to improve academic performance are increasingly recognized as important public health interventions.

- Freudenberg N, Ruglis J. Reframing school dropout as a public health issue. Preventing Chronic Disease 2007;4(4):A107.

Students who perform better on physical capacity tests are more likely to receive higher reading and math scores even when the added time for physical activity takes away from time in the classroom. - Rampey, B. Dio, G and Donahue, P. Trends in Academic Progress, NAEP, Washington D.C., 2008







http://www.cdc.gov/pcd/issues/2007/oct/07_0063.htm


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HAPI ADHS & County School Health Activities








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Community Design – Healthy Eating

23.5 million Americans, including 6.5 million children live within food deserts – neighborhoods that lack access to stores where affordable, health food is readily available. - United States Department of Agriculture. Access to Affordable and Nutritious Foods: Measuring and Understanding Food Deserts and Their Consequences, June 2009

Almost 15% of households experience food insecurity at least occasionally during the year, meaning there access to food is limited due to lack of money and other resources. - Wilde PE, Peterman JN. Individual Weight Change is Associated with Household Food Security Status. Journal of Nutrition 2006,

136(5): 1395-1400.

Over 2/3 of the adult population is overweight or obese; approximately 1 in 5 children are overweight or obese by the time they reach their sixth birthday. - Ogden CL, Carroll MD. Prevalence of Obesity Among Children and Adolescents: United States., Trends 1963-1965 Through 2007-

2008. Journal of the American Medical Association 303(3), 242-9. 2010.








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Community Design – Active Living Only 13% of children walk or bike to school, compared with 44% a generation ago - Centers for Disease Control and Prevention. The Association Between School Based Physical Activity, Including Physical Education and Academic Performance. U.S. Department of Health and Human Services, 2010.

Physical activity levels are lower in low-income communities and among racial/ethnic minority children due in part to people feeling unsafe in their communities. -Sallis JF. Procheaska JJ. Taylor WC. A Review of Correlates of Physical Activity of Children and Adolescents. Med Sci Sports

Exerc. 2000; 32: 963-75

Engaging in regular physical activity is one of the most important things that people of all ages can do to improve their health. - U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. 2008 Physical activity guidelines for Americans.








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HAPI ADHS & HAPI Community Design Activities








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Clinical Care Structural barriers are non-economic burdens or obstacles that make it difficult for people to access cancer screenings. Interventions designed to reduce these barriers may facilitate greater access to screenings by populations. - Guide to Community Preventive Services. Increasing cancer screening: reducing structural barriers for clients. www.thecommunityguide.org/cancer/screening/client-oriented/ReducingStructuralBarriers.html. Last updated: March 2010.

Nearly 9 out of 10 adults have difficulty using the everyday health information that is routinely available in our healthcare facilities, retail outlets, media and communications. - Kutner, M., Greenberg, E., Jin , Y., & Paulsen, C. ( 2006

). The health literacy of America's adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483).

For nearly all infants breastfeeding is the best source of nutrition and immunologic protection and also provides benefits to mothers - U.S. Department of Health and Human Services. Executive Summary: The Surgeon General’s Call to Action to Support Breastfeeding: U.S. Department of Health and Human Services, Office of the Surgeon General; January 20, 2011.







http://www.thecommunityguide.org/cancer/screening/client-oriented/ReducingStructuralBarriers.html




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ADHS & County HAPI Clinical Care Activities

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HAPI Contractor Activities

• HAPI Contractors are encouraged:

– To leverage resources to maximize impact.

– Use burden data to identify & drive activities.

– Engage community leaders in the process.

– Document the process for evaluation purposes.








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HAPI ADHS Activities

• HAPI ADHS Staff are creating:

– Online resources and training opportunities for partners on evidence-based population health policy.

– Virtual forums for continued discussion and collaboration across Arizona.

– A Statewide Taskforce tasked with identifying additional opportunities to incorporate “health in all policy” in Arizona.








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Contact Information Sheila Sjolander, Assistant Director Division of Public Health, Prevention Services 602-542-2818 [email protected]

Tim Vaske, Prevention Services Policy Manager Division of Public Health, Prevention Services Bureau of Health Systems Development 602-364-0606 [email protected]








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Questions







health in arizona policy initiative...health and wellness for all arizonans azdhs.gov health in all...

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