Local Health Officials: Chief Health Strategists Transforming Communities

By Rahul Gupta, Health Officer and Executive Director, Kanawha-Charleston Health Department

Just like the rest of the country, West Virginia and Kanawha County has been battling the obesity epidemic for decades. Across the state, there have been a myriad of physical activity, nutrition and other initiatives focused on helping people get to and remain at a healthy weight.

However, when these obesity prevention programs came in, there was a huge problem with sustainability so after a few years a program would lose funding and disappear. Quickly, residents saw these programs as fads or simply flashes in the pan. A lot of communities around the state felt kind of used, they were put into a program and researched and when the grant was up, the program was gone and, with it, the support, incentives and staffing. There was nothing built into the infrastructure of the community so there was no capacity left to sustain the process.

Clearly, as obesity rates and chronic conditions like diabetes continue to increase, this incremental, start and stop approach has failed. Realizing this early on, our community created an independent Health Coalition in Kanawha County that included the local hospitals, K-12 education systems, higher education, business and other people who had a stake and roots in our community. While health and wellbeing is a personal responsibility, it is the local, state and national government’s job to provide easy outlets for citizens to reach their goals.

The founding idea of the coalition was that if there are challenges facing the community, they will be brought to the coalition and they will be solved and resources will be dedicated by partner agencies.

As the coalition’s benefits to the community became apparent, it was obvious that the state needed more of these county-level coalitions across West Virginia.

Transforming Communities

When the CTG program was launched in May, 2011, we saw this as an opportunity to obtain the kind of resources and support that could stand up programs and capacity which would then remain in place after grant dollars disappeared.

The CTGs made it even easier to bring stakeholders and institutions to a common table to talk about health. At the outset, we had over 100 organizations interested in being part of transforming the state and local communities.

As we learned our lesson from past grants and programs, we weren’t going to let everyone get their piece of the CTG pie and go home in a silo. We wanted to ensure that each community worked with each other as well as across the traditional silos, so efforts were complimentary, not duplicative. It became evident that the best conduit for the grant money and ideas to flow was through Local Health Departments (LHDs). Our plan was to position the LHDs from all 55 counties as wellness or healthy living hubs for their communities. They would work with the local and state Departments of Education, West Virginia’s Universities and the Osteopathic School to ensure plans would work and were research driven and connected to clinical settings.

While it might not seem like a huge shift, this was a culture change in how resources and grants were distributed across the state. Instead of each LHD getting their money and going home, it was clear the funding was to build capacity, i.e., the resources and ability to do things — sort of how it’s better to teach a man to fish than simply give him a fish. LHDs were also the natural lead because they were trusted voices in the community and, quite simply, they weren’t going anywhere. Every day, in each community across West Virginia (and across the nation, for that matter) local health employees serve to carry out and accomplish the basic public health needs of their jurisdictions.

As a result, our communities are safer, healthier and protected from deadly diseases. Once we had the framework in place, we went back to communities to understand their needs.

Every three years, our county coalition conducts a needs assessment, which includes telephone surveys, focus groups, and key informant surveys.

A community forum, which is open to the public, is held to prioritize the top three health concerns in the county. Once identified, work groups are formed to address these health concerns over the next three years within the county after which the process recommences with a new needs assessment. Examples of health concerns that our community has asked to address in the past have included high rates of tobacco use including second hand smoke, poor nutritional standard, lack of physical activity and prevalence of substance abuse.

While we haven’t been able to create a statewide Comprehensive Clean Indoor Air Regulation (CIAR), that hasn’t stopped LHDs like Kanawha-Charleston Health Department (KCHD) from creating their own ordinances and enforcing them — it’s great to enact a policy, but the enforcement has to be just as good 

In Kanawha County, our Sanitarians conduct close to 5,000 inspections annually to ensure our CIAR ordinance is enforced and we have a near 100 percent compliance rate. To build support in our community for the ordinance, we took not only a policy approach (discussing the medical benefits of clean air), but also a social/media approach, business approach (showing that it would not hurt bars or restaurants but actually could increase business), and a science and research approach (we demonstrated a 37 percent reduction in heart attack related hospital admission rate in presence of CIAR over eight years — published in CDC’s Preventing Chronic Diseases, July 2011 issue). Every facet of our community became advocates for clean air for different reasons — a one-time tobacco-reliant community transformed into one with clean air.

Meanwhile, at a state level, we continue to work toward enacting a statewide comprehensive law. While it has happened incrementally, the capacity and know-how is there across the state. In fact, our local ordinance has been utilized by the state’s Division of Personnel to implement a state employee policy against second hand smoke. Consequently, the state government, without legislation, has adopted a comprehensive clean indoor air regulation for all state employees, which reaches and benefits thousands of West Virginians.

In addition, in doing our needs assessment, it became clear that people simply didn’t have access to safe places to work out and play. There was a huge barrier on the environmental side in our community: there were no sidewalks and the areas with the largest populations had no options for physical activity. We needed to connect those who wanted to work out with safe places to do so.

In Kanawha County, we built a Physical Activity Sites Google Map (http://www.kchdwv.org/Home/Health-Promotion.aspx). It includes a Google map of all physical activity opportunities in the County as well as tools such as walk score, Everytrail and Gmaps pedometer which can be used on mobile devices. The map empowers people to seek out nearby physical activity outlets. We hope to replicate this model in other counties across the state through CTG.

In addition, we’re looking to improve nutrition and physical activity in school and after-school settings, by, most notably:

• Farm-to-School Initiatives: We have developed blueprints and guides for county Food Service Directors and farmers, giving them the capacity and knowledge to stand up their own  sustainable programs.
• Child and Day Care Center Nutrition Programs: We implemented the “Be Choosy, Be Healthy” program, which educates and empowers children to choose healthy lifestyles. We have also expanded the “I am Moving, I am Learning” curriculum, which increases physical activity and promotes healthy food choices.

Lastly, our state is supporting the development of community coordinated care systems that link and build referral networks between the clinical system and community-based lifestyle programs that can help people overcome disease and disability and manage their health. We’ve linked clinicians with programs like Dining with Diabetes, Patient Centered Medical Home pilot initiatives, the National Diabetes Program and Chronic Disease Self-Management Program.

We want programs to be complimentary to clinical practice. If a physician is seeing 30 patients a day that need diabetes/weight loss resources, we need to provide these clinicians with the capacity and information to direct their patients to a referral network outside the doctor’s office. This approach is both time and cost effective and has the potential for healthier outcomes for patients.

West Virginia has worked long and hard to reverse the obesity epidemic. We’ve learned what doesn’t work and we’re beginning to transform our state, community by community. It’s become clear that we need to provide people with the resources to create their own programs and that positioning LHDs as chief health strategists will ensure capacity is maintained and programs continue if grant funding disappears. By ensuring that education, health, commerce and other key stakeholders are responsible for setting and enforcing policy, the entire community truly has a stake in the health and wellbeing of everyone.

Access a PDF of the story here.