TOWARD TOTAL COMMUNITY HEALTH

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TOWARD TOTAL COMMUNITY HEALTH

• KAISER PERMANENTES
• HEALTHY EATING, ACTIVE LIVING INITIATIVE
• Loel Solomon, Ph.D., National Director
• Community Health Initiatives and Evaluation
• National Academy of State Health Policy
• Nashville, TN
• August 8, 2005

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About Kaiser Permanente

• Founded in 1945
• Americas oldest and largest private, nonprofit,
  integrated health care delivery and financing
  system
• 8.2 million members 6.1 million members in
  California
• Over 12,000 physicians representing all
  specialties and 130,000 additional employees
• Operations in 9 states and Washington, D.C. with
  29 Medical Centers and 423 Clinics
• KP Research Centers - 100,000,000 in external
  funding in 2003 for Health Systems Research

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Community Health Part of Our Mission for 60 Years

• ..to improve the health of our members
• and the communities we serve...

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Elements of KPs Comprehensive Approach to
Healthy Eating, Active Living

• Clinical initiatives
• BMI as a vital sign
• Brief negotiation
• Weight management classes
• Internet-based programs
• Organizational policies and practices
• Policy advocacy
• Community efforts
• HEAL grants
• Farmers markets
• TV Turnoff Campaign
• Educational theatre
• Regional and national partnerships
• Community Health Initiatives

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KPs Community Health Initiatives Strategy
A program-wide initiative to create scale and
impact through intensive, place-based
interventions Elements of our Framework

• A common thematic focus -- Healthy Eating, Active
  Living (HEAL)
• Key design principles
• Common outcomes and core metrics
• We seek to move the needle on
• community health outcomes

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Why HEAL Anatomy of an Epidemic

• Obesity is the 2 cause of preventable deaths in
  America
• Excellent medical care alone is insufficient
• Major drivers of the obesity epidemic are
  environmental
• A built environment and economy that promote
  physical inactivity
• Increased access to and marketing of cheap,
  calorically dense food
• Biological evolution
• Consensus Comprehensive environmental and social
  change is required to turn down the epidemic
• Our Members Cant be Healthy if They Live and
  Work in
• Unhealthy Communities

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The Epidemic of Overweight Children

• The steady rise in life expectancy during the
  past two centuries may soon come to an end
• -- N Engl J Med 2005 3521138-1145

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Key Elements of KP Community Health Initiatives

• Multi-level interventions including environmental
  and policy change
• A geographic, place-based focus
• Multi-sectoral collaboration
• Community engagement
• Leveraging the assets and strengths of
  communities and our own organization
• Long-term partnerships (7-10 years)
• A focus on racial and ethnic health disparities
• Evaluation and evidence-informed public health

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Why a Disparities Framework

• Social equity
• Mathematics
• Critical pathways and the power of place

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Community Factors Lay on the Pathway to
Disparities Elimination
BEHAVIORAL ENVIRONMENTAL FACTORS
ROOT FACTORS
HEALTH PROBLEMS
Built Environment
Social Capital
Community Factors
Services and Institutions
Macro Factors
Source Prevention Institute, 2004
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An Evidence-Informed Approach

• Collaborate with our communities to establish
  specific, short-term health related goals
  (community data, needs assessment)
• Identify evidence-based best practice(s) for
  achieving shared goal (Medline, Community Guide)
• Collaborate with our communities to adapt this
  best practice to the communitys unique assets
  and constraints
• Evaluate the project by using appropriate
  expertise
• Disseminate results

Pediatrics April 20051151142-1147
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The Evidence on Community-Level Interventions
Strong Evidence Insufficient
Evidence

• Community-wide campaigns
• Point-of-decision prompts
• School-based physical education
• Non-family social support
• Individually-adapted health behavior change
• Enhanced access to places for physical activity
  informational outreach

• Classroom-based health education focused on
  information provision
• Mass media campaigns
• Health education w/ TV/video game turnoff
  component
• College-age physical education/health education
• Family-based social support

Source http//www.thecommunityguide.org
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KAISER PERMANENTES INITIATIVE-LEVEL LOGIC MODEL
FOR CHIs
PROCESS
OUTCOMES
INPUTS
Short-term
Intermediate
Long-term
EFFECTIVE INTERVENTIONSTRATEGIES
BASELINE CONDITIONS
IMPROVED BIOMETRIC (E.G. BMI) PHYSIOLOGIC
MEASURES
HEALTH
EXISTING COMMUNITY ASSETS
HEALTH PROMOTING SYSTEM CHANGES
KP ASSETS
COMMUNITY CAPACITY BUILDING STRATEGIES
DESIGN PRINCIPLES
SUSTAINABILITY
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What HEAL Looks Like in California

• Partnership with The California Endowment on
  Healthy Eating, Active Communities (HEAC)
• Financial support
• Health sector leadership
• Participation in local collaboratives
• Additional elements
• Steps partnerships
• Focused HEAL grants
• Educational Theatre Programs
• Regional and local partnerships
• Farmers markets

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What HEAL Looks Like in Denver

• Thriving Communities Partnership launched 3/14/05
• Seed grants ? deep intervention strategy
• Major partners
• CO State Department of Health
• America/Colorado on the Move
• Kroenke Sports

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What HEAL Looks Like in Portland

• Interstate Farmers Market
• Farm to facility
• Strong community board
• Steps grants to state, county partnerships
• 10 Toe Express with Portland City Dept of
  Transportation
• Potential deep intervention TVTO, built
  environment change w/ local preschools

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One Year Out What Weve Learned

• Asset-based approaches begin at home
• Providers can be strong and effective change
  champions
• Staying focused on environmental and policy
  change is challenging
• Power of organizational practice change
• For education
• As a model
• As an intervention strategy

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Engaging the Healthcare Sector in Healthy Eating,
Active Living Efforts

• Opportunities
• Invoke power of the White Coat
• Exploit frustration with toxic environment
• Reframe transportation and land use issues
• Enlist institutions as partners in organizational
  practice change
• Challenges
• Reimbursement for prevention
• Access to weight management programs
• Making the connection to health
• Physician time
• Critical supports
• ID of key decision-points, venues
• Advocacy training
• Translation

The normal physician treats the problem the
good physician treats the person the best
physician treats the community. -
Chinese proverb
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Beyond Personal Responsibility vs. Government
Solutions

• Framing a new conversation
• Creating Opportunities for People to Thrive
• What does it mean?
• Making the right thing easier
• Creating meaningful choices
• Shared ownership across sectors
• Personal ownership and accountability

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Why it Matters
Be the change you want to see In the world
-- M. Ghandi
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For More Information

• http//xnet.kp.org/communitybenefit/chi
• Loel Solomon
• loel.solomon_at_kp.org
• 510-271-6401