May 4, 2015 - NDSU MPH-Health Promotion ClassKaren Nitzkorski

PartnerSHIP 4 Health - School and Worksite Coordinator 

The Problem Factors that influence Health The Minnesota Solution

Statewide Health Improvement Program PartnerSHIP 4 Health

The Federal Solution CDC 1422 Community Wellness Grant

Life in the Grant World

Tonight’s Roadmap

The Problem: Chronic illness accounts for four of the top seven causes of death in MN…

The Problem: The “real” causes of these deaths are behaviors that are preventable, such as tobacco use/exposure, poor diet, and sedentary living…

Obesity is epidemic in Minnesota.

• Nearly 2/3 of adults are overweight or obese

• Only one out of four adults eats enough fruits and vegetables

• Only slightly more than half of Minnesota adults get at least a moderate level of exercise

Percent of Minnesota Adults Obese

Tobacco continues to be a problem in Minnesota.• 14.4% of adults

smoke, and many others are subjected to secondhand smoke.

• Over a quarter of high school students used tobacco in the past 30 days.

www.mnadulttobaccosurvey.org

All contributing to rising health care costs…

What Influences Our Health?

• Socio-Ecological Model: – Individual: knowledge, attitudes,

beliefs– Interpersonal: family, peers, social

networks– Organizational: employers, schools,

etc.– Community: social norms and

standards– Policy: a law, rule at an employer,

college, or multi-unit housingWhe

re w

e’ve

trad

ition

ally

spe

nt o

ur e

fforts

What Influences Our Health?

• Socio-Ecological Model: – Individual: knowledge, attitudes,

beliefs– Interpersonal: family, peers, social

networks– Organizational: employers, schools,

etc.– Community: social norms and

standards– Policy: a law, rule at an employer,

college, or multi-unit housingWhe

re w

e’ve

trad

ition

ally

spe

nt o

ur e

fforts

What is m

ost effective

2009 - present day

https://www.youtube.com/watch?v=SMymFKsix6A

Making the Healthy Choice the Easy Choice

Statewide Health Improvement Program (SHIP)

The Policy, Systems and Environmental Approach• Support social norm changes• Support individual behavior

change• Widespread results• Long-term impact

What is Policy Change?• Policies include laws,

ordinances, resolutions, mandates, regulations, or rules (both formal and informal)– Policy change includes the passing

of laws, ordinances, resolutions, mandates, regulations, or rules

– Example: organizational policy that allows the use of flex-time to accommodate physical activity

What is System Change?• Systems impact all elements of

an organization, institution, or system– Systems change impacts all elements

of an organization and often focuses on changing infrastructure within a school, park, worksite or healthcare setting

– Example: Implementation of the WHO 10 Steps to Successful Breastfeeding and becoming a baby-friendly hospital system

What is Environmental Change?

• The environment involves physical or material elements of the economic, social, or physical environment– Environmental change is a change

made to the physical or material elements

– Example: Incorporating sidewalks, paths, and/or recreation areas into community design

Policy, systems, and environmental changes… supporting healthy individual behaviors…

How it works

•work with schools to serve more locally grown produceRather than just telling kids about good

nutrition•help employers build

opportunities into the dayRather than just telling people to get more

physical activity

•help college campuses become smoke-freeRather than just telling

students to avoid second-hand smoke

PartnerSHIP 4 Health Community and public health partners in Becker,

Clay, Otter Tail and Wilkin counties working together to create an environment that supports improved health for all

Anchored in the Statewide Health Improvement Program (SHIP)

Our Goals• Improve population health

• Increase healthy weight adults by 9%

• Reduce young adult tobacco use by 9%

• Decrease medical costs

Our Objectives

Increase Healthy

Eating

Increase Physical Activity

DecreaseTobacco Use And Exposure

Walking Alongside Our Partners…• Human Service Organizations• Schools• Worksites• Communities• Healthcare• Childcare

Impacting Policies, Systems, and the Environment to Create Sustainable Changes

Environment

Policy

System

It Takes a Team

• Multi-agency, multi-county, multi-disciplinary staff• The right people doing the right work• Supported by decision-makers• Multiple funding partners

Complete Streets Active Transportation Safe Routes to School

Active School Day:Active Recess andActive Classrooms

Comprehensive School Physical Activity Programs:

Bike FleetWorksite Wellness

INCREASING PHYSICAL ACTIVITY FOR ALL

Worksite Wellness: Lactation Room Farmers Markets Fresh Connect Food Hub

and Farm to School

Human Service Organizations Community Gardens Healthy Food Pantry

Donations

INCREASING HEALTHY FOOD ACCESS FOR ALL

Smoke-Free Multi-Housing Units

Clinical Guideline Implementation

Tobacco-Free Worksites and Secondary Campuses

Counter Marketing and Point of Sale

Increase Access to Tobacco Cessation Services

Smoke-free Childcare and Foster Care

DECREASING TOBACCO USE AND EXPOSURE

Encourage Clinical

Obesity and Tobacco

Guidelines

Encourage Worksite

Wellness to Foster

Healthy Role Models

HEALTH CARE STRATEGY #1

ELEVEN PARTNERS Community Health

Service, Inc. (Migrant Health)

Family HealthCare Center (FQHC)

Orthopedic and Sports Physical Therapy, Inc.

Lake Region Healthcare, Essentia Health, Sanford Health, and Perham Health Clinics

Local Public Health Departments

HEALTH CARE STRATEGY

Five Partners• Essentia Health St.

Mary’s in Detroit Lakes• Lake Region Healthcare

in Fergus Falls• Perham Health in

Perham• St. Francis in

Breckenridge• Essentia Health and

Sanford Health in Fargo-Moorhead

Participate with Local Hospitals in their

Community Health Needs Assessment and

Strategic Planning Process

Health Care Strategy #2

Multiple funding partners• Statewide Health Improvement Program - SHIP• SHIP Innovation• CTG, CDC 1422 Community Wellness Grant• ClearWay • UCare• Otto Bremer Foundation• BCBS Foundation• MN GreenCorps• BCBS Center for Prevention• NW Regional Sustainable Development

Sustaining the work in the future

Worksites

Healthcare

Human Service Organizations

Community Active

Transportation

Community Healthy Foods

Childcare

School

Population Health

• Minnesota has outperformed nearby states by being the only one of its neighbors to bend the curve on obesity rates, according to a recent MDH analysis of CDC data.

• Significant health care savings linked to 60,000 more Minnesotans at a healthy weight

U.S. and Regional Obesity Rates

Data source: CDC Behavioral Risk Factor Surveillance System

http://www.health.state.mn.us/news/pressrel/2015/ship042015.html

Minnesota Alone Trims Obesity Rates Among Upper Midwest States

CDC 1422 Community Wellness Grant (2015)

Healthcare Reform: A vision for MinnesotaSHIP, CTG, and CWG

FUNDING TO PREVENT OBESITY, DIABETES, AND HEART DISEASE AND STROKE

The Minnesota Department of Health (MDH) has received new Centers for Disease Control & Prevention (CDC) funding to support local communities to improve health. This grant builds on current work to prevent and better manage obesity, diabetes, heart disease, and stroke, at the same time focusing on reducing health disparities.

With this funding, FOUR selected communities in Minnesota will engage in cross-cutting, creative approaches that can positively impact the health of your residents, especially those with the greatest health needs.

The key components and strategies of this grant will also enhance communities’ current efforts through the Statewide Health Improvement Program (SHIP), The Minnesota Accountable Health Model or SIM, and Health Care Homes.

Promote Health and Support and Reinforce Healthy Behavior through Environmental Change

1.1 Implement food and beverage guidelines including sodium standards (i.e., food service guidelines for cafeterias and vending) in public institutions, worksites and other key locations such as hospitals

1.2 Strengthen healthier food access and sales in retail venues (e.g., grocery stores, supermarkets, chain restaurants, and markets) and community venues (e.g., food banks) through increased availability (e.g., fruit and vegetables and more low/no sodium options) improved pricing, placement and promotion

1.3 Strengthen community promotion of physical activity through signage, worksite policies, social support and joint-use agreements

1.4 Develop and/or implement transportation and community plans that promote walking

Build Support for Healthy Lifestyle Changes, especially for those at high risk for Type 2 Diabetes

1.5 Plan and execute strategic data-driven actions through a network of partners and local organizations to build support for lifestyle change

1.6 Implement evidence–based engagement strategies (e.g., tailored communications, incentives, etc.) to build support for lifestyle change

1.7 Increase coverage for evidence-based supports for lifestyle change by working with network partners

Improve the Quality of Health Systems, Care Systems, and Care Delivery for People w/Hypertension and Pre-Diabetes Disparities

2.1 Increase electronic health records (EHR) adoption and the use of health information technology (HIT) to improve performance (e.g., implement advanced Meaningful Use data strategies to identify patient populations who experience CVD-related disparities)

2.2 Increase the institutionalization and monitoring of aggregated/standardized quality measures at the provider level (e.g., use dashboard measures to monitor healthcare disparities and implement activities to eliminate healthcare disparities)

2.3 Increase engagement of non-physician team members (i.e., nurses, pharmacists, nutritionists, physical therapists and patient navigators/community health workers) in hypertension management in community health care systems

2.4 Increase use of self-measured blood pressure monitoring tied with clinical support

2.5 Implement systems to facilitate identification of patients with undiagnosed hypertension and people with prediabetes

Link Clinical and Community Resources to Support Heart Disease, Stroke and Type 2 Diabetes Prevention

2.6 Increase engagement of CHW’s (such as Community Paramedics) to promote linkages between health systems and community resources for adults with high blood pressure and adults with prediabetes or at high risk for type 2 diabetes

2.7 Increase engagement of community pharmacists in the provision of medication-self management for adults with high blood pressure

2.8 Implement systems to facilitate bi-directional referral between community resources and health systems, including lifestyle change programs (e.g., EHRs, 800 numbers, 211 referral systems, etc.)

Life in the Grant World

Questions?