Stories Archive - Page 10 of 18

3 WINS Fitness: Free Exercise Classes get Communities Moving

Regular physical activity promotes good health and well-being. Yet, about 80 percent of American adults do not meet the minimum recommended levels for cardiovascular activity and strength training needed to support optimal health and prevent the risk of chronic diseases.

3 WINS Fitness seeks to improve community health by increasing people’s physical activity levels. Launched in 2011 as 100 Citizens by California State University, Northridge’s (CSUN) Department of Kinesiology in partnership with Recreation Park in San Fernando, CA, 3 WINS Fitness offers a tailored and comprehensive free exercise intervention that is sustainable and replicable through its delivery by university kinesiology students. Programs are provided at public parks, faith-based institutions, and public schools, and currently they operate at six sites across Los Angeles County serving over 300 participants.

In 2013 the White House recognized and gave an award to the program through First Lady Michelle Obama’s “Let’s Move!” campaign. Since then, the program has scaled to three other universities within the California State University system.

Their program’s “3 WINS” reflects their social impact priorities: community health, participant fitness, and student professional development.

WIN 1: Community Health

Access and affordability to safe places to engage in physical activity promotes optimal community health. However, many low-income communities do not have affordable access to safe places for physical activity, and thus have a disproportionate burden of disease compared to wealthier communities.

Steven Loy, Ph.D., professor of kinesiology at CSUN and founder/faculty advisor for 3 WINS Fitness says the program focuses on those underserved communities which are at high risk for diabetes, cardiovascular disease, obesity and other chronic diseases related to physical inactivity.

“Having a program in their neighborhood park, school, and church where they can easily walk to and exercise, especially where there are no other physical activity programs is important,” said Loy. “We are holding it in communities that county public health has identified as areas where health inequities exist, and we are helping to address the social determinants of health by improving the physical activity conditions of those communities.”

Loy says through their research with RAND Corporation and the data they have collected, they observed a greater use of park facilities with the introduction of structured physical activity, in particular for the senior population reflecting a sense of safety and community among themselves and their students.

WIN 2: Participant Health

*Program Coordinator, Josh Carlos with 3 WINS Fitness participant Maria Ortiz-Rojas.*

3 WINS Fitness provides participants with a dynamic 60-minute exercise routine three times per week for adults of all ages and fitness abilities, including a falls prevention group, and free diabetes prevention program modified from the National Diabetes Prevention Program.

Loy noted, “participants who attend the three classes per week exceed the minimum recommended levels for cardiovascular activity and strength training cited in the 2018 Physical Activity Guidelines. Throughout the years, our 3 WINS Fitness participants have had many success stories.”

“Doctors said I would need surgery for a back injury, I was in constant pain, I couldn’t even lift my arms to brush my hair” said 3 WINS participant of two years Balvina Nuño. “Since joining 3 WINS, the injury has healed without surgery. I can now lift my arms over my head, and I have lost 30 pounds! I am thankful to God and the instructors for giving me my life back.”

Other participants of the program have also reported improved health.

“I started 3 WINS Fitness last summer and have lost over 40 pounds,” said Andrea Veronica. “I am diabetic and was required to inject insulin 6 times a day. Because of this program, today I am no longer required to inject myself or take any medication. I am happy and feel more energetic than ever!”

“I started this program in October 2017 as a pre-diabetic,” added Candy Lopez. “I have lost 24 pounds, and I feel happier and have more energy. I love coming here because the participants and instructors create such a strong family-like community that I feel motivated to come workout every time.”

WIN 3: Student Professional Development

The kinesiology students involved in the program include both undergraduate and graduate students trained and educated in exercise and human movement. For them, 3 WINS Fitness is an opportunity to apply their education, gain job-related experience, and grow in leadership skills and self-empowerment.

“Noting the constant changes happening in health care reform, I realized what we are doing through 3 WINS Fitness is so special and is soon, if not already, to become the face of preventative health care methods that is efficient, cost-effective, and helps not only me as a healthcare provider, but most importantly, the individuals in the communities around us attain their best level of health and fitness,” said Angelica Alberto, a former 3 WINS Fitness student volunteer who is now pursuing a Doctor of Physical Therapy and Master of Public Health dual degree at Northwestern University.

Loy says it is also an opportunity to show communities what those educated in kinesiology can do for public health.

“We have found that there are few opportunities created for kinesiology and public health to work together. We are trying to change that with upstream solutions to the ideas promoted by Public Health 3.0,” said Loy. “We have recruited students to create an ongoing army of individuals trained in physical activity who are pursuing additional public health education opportunities, and, are motivated and enthusiastic to deliver programming that reaches the whole community to improve health.”

Where is the Program Going?

3 WINS Fitness participants receive exercise programming from 3 WINS Fitness kinesiology students during a 3 WINS
Fitness Summit held in April 2018.

Throughout 3 WINS Fitness’ journey, partnerships have been critical. The program has teamed with public and private sector partnerships with parks and recreation, public health, universities and research institutions, hospitals, and health and fitness organizations to sustain, scale, and provide accessible physical activity programming to communities.

One of those partners is the American Council on Exercise (ACE). Cedric Bryant, Ph.D., ACE President and Chief Science Officer says “ACE’s partnership with 3 WINS Fitness helps us fulfill our mission to get people moving, regardless of age, gender, race, or socioeconomic background.”

In the spring of 2018, ACE partnered with 3 WIN Fitness to hold a Summit to demonstrate the program to stakeholders. One of the attendees included Loretta DiPietro, Ph.D., professor of exercise and nutrition sciences at the Milken Institute School of Public Health at George Washington University in Washington, D.C. She was also a committee member of the 2018 Physical Activity Guidelines Advisory Committee which reviewed the scientific evidence and prepared a report about physical activity and health for the second edition of the Physical Activity Guidelines for Americans.

She said, “I’ve been waiting my entire public health career to see the science of exercise and physical activity translated and scaled up to the community level so elegantly and effectively. The cultural wave of change in how communities adopt an active lifestyle begins now with 3WINS Fitness!”

According to a study done by the Centers for Disease Control and Prevention, 11.1 percent in total health care expenditures were associated with inadequate levels of physical activity. However, if programs were in place to help adults meet current guidelines for physical activity, the country could avert up to an estimated $117 billion in preventable health care spending.

Loy said 3 WINS Fitness is part of that solution, and their next goal is to scale 3 WINS Fitness through universities across the country by training staff to develop and sustain their own program specific to their community.

“There are over 700 universities with kinesiology programs,” said Loy. “Our experience in replicating our program, as well as scaling it to other universities has identified the challenges existing for collaboration among public health, kinesiology, parks and recreation, and faith-based organizations, but it has also been an 8-year demonstration that an affordable sustainable solution is possible if we work together. The university kinesiology model can drive community wide disease prevention programs which can be customized for the needs of the community.”

*3 WINS Fitness Banner Photo Credit: Carmen Anthony

Minority Mental Health Awareness Month

Health is a combination of physical and mental wellness. According to the National Alliance on Mental Illness, one in five U.S. adults will experience a mental illness this year. Dealing with stereotypes, bias, discrimination, and racism creates unique stressors in the lives of people of color and other marginalized groups including immigrants and members of the LGBTQ community – stressors that can have negative impacts on mental, emotional and physical health. Additionally, poverty and lack of health insurance – two realities in many minority communities – create substantial barriers to care when people need help with a mental health or substance misuse issue. While overall rates of mental disorders for most communities of color are largely similar to those for Whites, numerous studies have found that racial and ethnic minorities are less likely than Whites to seek mental health treatment, often due to factors such as lack of health insurance and sometimes due to stigma. People of color are also more likely to face barriers such as lack of available mental health services, poorer quality of care, and lack of culturally and linguistically appropriate care within treatment settings.

There is overwhelming evidence that inequitable social, economic and environmental factors— such as, poverty, discrimination, and lack of access to educational opportunities, jobs and affordable housing —contribute to disparities in health including mental health.

For Minority Mental Health Awareness Month, Trust for America’s Health (TFAH) is sharing the following information on what communities can do to support the mental and emotional health of all residents and to reverse the inequities that often lead to poorer health outcomes in communities of color.

Pain in the Nation Update: While Deaths from Alcohol, Drugs, and Suicide Slowed Slightly in 2017, Rates Are Still at Historic Highs: More than 150,000 Americans died from alcohol- and drug-induced causes and suicide in 2017—more than twice as many as in 1999—according to analysis by TFAH and Well Being Trust of mortality data from the U.S. Centers for Disease Control and Prevention. In 2017, synthetic-opioid deaths were highest among males, Blacks, Whites, adults ages 18–54, and those living in urban areas. Between 2007 and 2017, drug deaths among Blacks increased by 101 percent and alcohol deaths were up 49 percent. For Latinos during the same period, drug deaths were up 78 percent and alcohol deaths were up 48 percent. Over the past decade (2008–2017), suicide increased in nearly every state. However, there were substantial variations by demographics —with larger proportional increases among younger people and racial and ethnic minorities.

Pain in the Nation Issue Brief – Alcohol and Drug Misuse and Suicide and the Millennial Generation – a Devastating Impact: The impact of the national epidemics of alcohol, drug and suicide deaths has been especially pronounced amongst Millennials. Millennials, people born between 1981 and 1996, faced and continue to face a mix of challenges unique to their generation including the opioid crisis, the skyrocketing costs of education and housing, and entering the job market during the great recession. Between 1999 and 2017, opioid overdose death rates among 18- to 34-year-olds increased by more than 500 percent. During the same period, the increase in synthetic opioid death rates among young adults increased by a staggering 6,000 percent.

The millennial generation is a more diverse generation than are baby boomers, therefore the need for culturally and linguistically appropriate mental and substance misuse treatment services for today’s young adults has grown significantly. This report includes policy recommendations on ways to prevent substance misuse and suicide among Millennials.

Racial Healing and Achieving Health Equity in the United States: Health equity is the opportunity for everyone to have a fair chance of achieving optimal health. This 2018 issue brief highlights and acknowledges health inequities, the factors that influences them and highlights policy recommendations that can help the nation achieve health equity.

Advancing Health Equity: What We Have Learned from Community-based Health Equity Initiatives: On March 1, 2018, TFAH, with support from The California Endowment, held a convening Advancing Health Equity: What We Have Learned from Community-based Health Equity Initiatives in to identify and examine promising practices from existing initiatives. The resulting convening summary outlines core strategies of successful community-based health equity initiatives and recommendations for next steps in creating and advancing a policy agenda to promote community-based health equity.

Taking Action to Promote Health Equity – Using the Lessons from Cutting-Edge Practices to Improve Health and Well Being: TFAH’s Fall 2018 4-part health equity webinar series features public health practitioners and community leaders sharing their experiences shaping and implementing programs to advance health equity in their communities. The webinar series informed a broad, national audience about compelling and replicable health equity initiatives and how to address the grass roots issues that will impact their success.

Age-Friendly Public Health Case Studies

Trust for America’s Health (TFAH) is prioritizing the role of public health to improve the health and well-being of our nation’s growing older adult population. We are committed to sharing great examples and models of public health collaborations with the aging sector and have developed case studies to highlight these efforts.

Cultivating Collaborations – A Case Study of the Successful Partnership Between Public Health and the Aging Sector in Los Angeles

The creation of the Los Angeles Alliance for Community Health and Aging (LAACHA) is an example of how the public health and aging sectors can collaborate to identify needs and challenges, coordinate supports and services, and leverage funding and other resources to best serve the health and social needs of LA’s older adults. This case study explores the creation of LAACHA and examines the roles it plays in improving older adult health in Los Angeles. Read more.

Adding Years to Life and Life to Years – A Case Study of Public Health’s Contribution to Healthy Aging in Oregon

Oregon has taken a unique and cost-effective approach to addressing the health needs and opportunities of its older adult population by co-locating the State Unit on Aging’s Long-Term Care Program Analyst within the Public Health Division offices. This case study describes this innovative co-location that creates efficiencies, eliminates silos, and enhances coordination and collaboration between the two Oregon state agencies that provide health supports to older Oregonians. Read more.

May is National Physical Fitness & Sports Month

Physical activity across the lifespan supports good health and well-being and is a key health behavior for healthy aging. For National Physical Fitness & Sports Month Trust for America’s Health (TFAH) is sharing the following reports and resources with a focus on evidence-based programs and policies that if enacted or expanded will help all residents be physically active and enjoy optimal health and well-being.

The State of Obesity: Better Policies for a Healthier America, 2018: This report highlights the latest obesity trends, policies, programs, and practices that can reverse the obesity epidemic, and includes key recommendations for specific actions. New studies documenting national obesity rates and trends reinforce what we already know: obesity rates are alarmingly high; sustained, meaningful reductions have not yet been achieved nationally; and racial, ethnic, and geographic disparities persist. Policies and programs like the National Diabetes Prevention Program, community-based programs, safe routes to school, school-based physical education and physical activity, and complete streets policies play a key role in increasing physical activity and reversing the obesity epidemic.

Promoting Health and Cost Control: How States Can Improve Community Health and Well-Being Through Policy Change: This new report considers the important ways life circumstances outside the healthcare sector impact health. It recommends 13 policy actions that data show if enacted by states would improve health and well-being for community residents. Complete street polices are one way to promote physical activity and connectedness. Complete streets are streets that provide safe and comfortable means of transport for all users including walkers, bikers and people driving cars. Moreover, enacting complete streets and other complementary streetscape design policies can not only improve the physical well-being of individuals, but also help avoid costs for public (Medicaid and Medicare) and private payers.

Countering Childhood Obesity in Georgia: Georgia Shape, a statewide multifaceted initiative, seeks to advance the health and well-being of children by utilizing a cross-sectors approach to tackle childhood obesity in the state. Through the development of community-wide interventions, particularly Georgia Shapes’ ‘Power Up for 30’ program, rates of childhood obesity in Georgia have started to decrease. The Center for Disease Control and Prevention recognizes school-based programs to increase physical activity, such as ‘Power Up for 30’, as one of fourteen non-clinical community-wide interventions that can lead to cost-effective and cost-saving health outcomes within five years.

May is Mental Health Month

Mental Health Month is an appropriate time to talk about programs and policies that support the health and well-being of Americans throughout the year. TFAH reports focus on evidence-based programs and policies that, if enacted or expanded, will help all residents enjoy optimal health and well-being.

Pain in the Nation is a series of reports created by TFAH and the Well Being Trust to call attention to the tragic epidemics of alcohol, drug and suicide deaths – and suggest solutions. More than 150,000 Americans died from alcohol- and drug-induced causes and suicide in 2017—more than twice as many as in 1999 – including sharp increases in synthetic opioid deaths. Policy action on these deaths of despair epidemics is imperative. Read more.

Promoting Health and Cost Control in States. This new report considers the important ways life circumstances outside the healthcare sector impact health. It recommends 13 policy actions that data show if enacted by states would improve health and well-being for all residents. Read more.

Health Equity is the equal opportunity for everyone to enjoy optimal health. TFAH has identified programs and policy recommendations that if enacted in more communities would help address the disparities that are barriers to healthy living for too many people. Read more.

April is Minority Health Month – Resources for Addressing Minority Health Issues

Being healthy requires more than access to healthcare. Numerous aspects of where we live, work and go to school – often called the social determinants of health – impact our overall well-being. For Minority Health Month, TFAH is sharing the following information on what communities can do to reverse the inequities that often lead to poorer health outcomes in minority communities.

	*Racial Healing and Achieving Health Equity in the United States:* This 2018 issue brief highlights and acknowledges health inequities, the factors that influences them and highlights policy recommendations that can help the nation achieve health equity. TFAH issued the brief in conjunction with The Truth, Racial Healing & Transformation’s second annual National Day of Racial Healing, which is intended to identify key steps toward collective action to promote positive and lasting change across issues.
	*Advancing Health Equity: What We Have Learned from Community-based Health Equity Initiatives*: This convening identified and examined promising practices and outlines core strategies of successful community-based health equity initiatives and recommendations for next steps in creating and advancing a policy agenda to promote community-based health equity.
	*Taking Action to Promote Health Equity – Using the Lessons from Cutting-Edge Practices to Improve Health and Well Being:* TFAH’s Fall 2018 4-part health equity webinar series features national public health practitioners and community leaders sharing their experiences shaping and executing programs to increase health equity in their communities. The webinar series is designed to inform a broad, national audience about compelling and replicable health equity initiatives and how to address the grass roots issues that will impact their success.
	The State of Obesity: Better Policies for a Healthier America, 2018: This report highlights the latest obesity trends, policies, programs, and practices that can reverse the obesity epidemic, and Includes key recommendations for specific actions. New studies documenting national obesity rates and trends reinforce what we already know: obesity rates are alarmingly high; sustained, meaningful reductions have not yet been achieved nationally and racial, ethnic, and geographic disparities persist. For example, Black and Latino children and adults continue to have higher obesity rates than Whites and Asians.
	Building a Community Roadmap to Health and Equity in Jackson, Mississippi: The health indicators for the Black population of Mississippi are significantly worse than for the White population. Black residents live on average 4 years less than Whites and have more deaths from cancer, heart disease, HIV and many other chronic conditions. The Mississippi Roadmap to Health Equity, Inc., a community-based organization in Jackson, is actively engaged in improving those statistics with its focus on changing the conditions in the lives of the low-income Black population.
	*Pain in the Nation Update: While Deaths from Alcohol, Drugs, and Suicide Slowed Slightly in 2017, Rates Are Still at Historic Highs:* Deaths from synthetic opioids continue to rise sharply and suicides are growing at the fastest pace in years. More than 150,000 Americans died from alcohol- and drug-induced causes and suicide in 2017—more than twice as many as in 1999—according to a new analysis by Trust TFAH and Well Being Trust (WBT) of mortality data from the U.S. Centers for Disease Control and Prevention. In 2017, synthetic-opioid deaths were highest among males, Blacks, Whites, adults ages 18–54, and those living in urban areas. Additionally, over the past decade, suicide increased in nearly every state. However, there were substantial variations by demographics —with larger proportional increases among younger people and racial and ethnic minorities.
	*Promoting Health and Cost Control: How States Can Improve Community Health and Well-Being Through Policy Change:* Prevention starts with people leading a healthy lifestyle. Yet certain populations, including racial and ethnic minorities have worse health outcomes than other groups. These inequities in health can often be attributed to differences in living conditions, exposure to traumatic events, and the lack of access to needed resources in their community, which in many cases are a result of discriminatory policies and practices. There are several evidence-based policies that can be implemented to address these hurdles and close health disparities. TFAH’s new report, Promoting Health and Cost Control: How States Can Improve Community Health and Well-being Through Policy Change highlights 13 policies, all outside the healthcare sector, that if adopted by states can improve the health and well-being of their residents.
	*Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, 2019:* Ready or Not provides an annual snapshot of states’ public health and emergency response preparedness. Many communities of color can suffer disproportionately during a disaster due to unequal access to services before and after an event. Community resilience and preparedness planning must recognize health inequities, address systemic barriers to services and ensure inclusive planning, especially for populations that may face a disproportionate impact of disasters.

Countering Childhood Obesity in Georgia

Countering Childhood Obesity in Georgia

Georgia Shape, a statewide multifaceted initiative, seeks to advance the health and well-being of children by utilizing a cross-sectors approach to tackle childhood obesity in the state.

By cultivating strong relationships with institutions throughout the State, Georgia Shape has been able to focus on upstream interventions, namely providing time in each students’ day for physical activity. Upstream interventions refer to programs and policies that impact the root causes of health or social conditions.

Through the development of community-wide interventions, particularly Georgia Shapes’ ‘Power Up for 30’ program, rates of childhood obesity in Georgia have started to decrease. The Center for Disease Control and Prevention recognizes school based programs to increase physical activity, such as ‘Power Up for 30’, as one of fourteen non-clinical community-wide interventions that can lead to cost-effective and cost-saving health outcomes within five years.

How It Took ‘Shape’

After the implementation of the 2009 Georgia Student Health and Physical Education Act (SHAPE), Georgia Shape was created to end the increasing rates of obesity among children in the state. In 2011, the Governor declared childhood obesity prevention as the number one public health priority and state leaders understood the importance of bridging the efforts of multi-sector partners to bolster the goals set forth by SHAPE. A governing council comprised of experts from a variety of disciplines was established to ensure that multiple perspectives were considered. Through the utilization of an obesity systems modelling program, factors contributing to obesity were identified, including a substantial lack of physical activity.

The overall goal of Power Up for 30 is to promote and protect the health of all children by incorporating 30 minutes of physical activity before, during, or after each school day. In collaboration with researchers, the Georgia Department of Public Health developed a comprehensive model to strategically focus and measure the health and economic impacts of school-based programs to increase physical activity.

The Power Up for 30 Model

Implementation of ‘Power Up for 30’ in schools relied on the support and acceptance of school superintendents and educators. Georgia Shape was promoted throughout elementary schools with messaging tailored to the interests of teachers and administrators to help garner support and establish applicability for the intervention. Tailored messages emphasized the benefits school principals, physical education teachers, and classroom teachers each prioritized including improved attendance and discipline, improved health, and improved academic performance. By identifying perceived barriers in each school, program developers were able to mold ‘Power Up For 30’ to fit each school’s specific environment and/or needs and assist teachers and administrators in achieving their respective goals.

School Based Activity Programs Increase

School Based Activity Programs Decrease

● School attendance

● Academic performance

● Concentration and attention in the classroom

● Scores on State competency tests

● Physically activity in the classroom

● Childhood Obesity

● Number of students receiving discipline

● Negative health outcomes

Shape encouraged the utilization of physically active academic lessons as both a supplement to physical education in schools and to complement student learning. Former teachers served as subject matter experts to ensure the design of the program incorporated the realities of what would work in the classroom. Furthermore, the former teachers lent their knowledge of the unique needs of specific communities, which helped increase the programs ability to fit the diverse norms of different school environments.

In order to measure the effects of the intervention, the program assessed health knowledge, classroom physical activity time, time spent doing moderate to vigorous activity during physical education, availability of before school activity programs, and student aerobic capacity and BMI. For each school, data was compiled to discern the best available strategies for increasing physical activity within their individual environments. Buy-in and engagement was created at the individual school levels by training at least one administrator, one physical education teacher, and one classroom teacher to lead the ‘Power Up for 30’ program in their respective schools. Cultivating within-the-school leaders for the Power Up 30 program was a key to its success.

Success and Sustainability

At the beginning of 2012 the Power Up for 30 program launched across 40 Georgia elementary schools. ‘Power Up for 30’ expanded from a 5-county pilot program to a statewide approach by the 2013-2014 school year. As of 2016, more than 880 schools enlisted in Power Up for 30. Initially an elementary school pilot, ‘Power Up for 30’ is now embedded into Georgia’s elementary school educational curriculum and augmented to incorporate a middle school pilot.

Georgia Shape’s success in large part is due to its more than 120 partnerships and its sustainable and adaptable practices. Through utilizing evidence-based and sustainable models such as online training modules, low or no cost resources, free training, and continuous technical support, the Power Up for 30 program supports the implementation needs of all schools and educators. Assistance from public and private sector partners, such as the Georgia Department of Education, Department of Child and Family Services, the CDC, and corporate sponsors have been vital to Georgia Shapes’ achievements in tackling childhood obesity and protecting the health of every child.

For more information visit:

http://georgiashape.org/

(December 2018)

Adding Years to Life, and Life to Years: A Case Study of Public Health’s Contribution to Healthy Aging in Oregon

Life expectancy at birth in the U.S. has doubled over the past one-and-a-half centuries jumping from 40 years in 1850 to 80 years in 2000. In 1950 approximately eight percent of the U.S. population (12 million people) was over 65 years of age. In 2015, that percent had almost doubled to 15 percent (45 million people). Today, Americans reaching the age of 65 can expect, on average, to live an additional 19 years.

Our country can significantly benefit from the contributions and experiences of older Americans, but we also must recognize and meet the challenges commensurate with the growing population of Americans 65 and older. All sectors should be engaged in promoting healthy aging, but public health – in particular – has a very distinct role to play to ensure that our older citizens experience a full life for as long as possible. After all, the public health sector has played a significant role in helping Americans to live longer, so we also have an important role to play to ensure those longer lives are full and productive.

What is Healthy Aging?

Healthy aging is defined as: 1) promoting health, preventing injury and managing chronic conditions; 2) optimizing physical, cognitive and mental health; and 3) facilitating social engagement. This definition intentionally does not equate healthy aging with the absence of disease and disability. Instead, it portrays healthy aging as both an adaptive process in response to the challenges that can occur as we age and a proactive process to reduce the likelihood, intensity, or impact of future challenges. It calls for maximizing physical, mental, emotional, and social wellbeing, while recognizing that aging often is accompanied by chronic illnesses and functional limitations, including lifelong conditions. While the public health sector has experience and skill in addressing these components of health for some populations, it has not traditionally focused such attention on older adults.

The Role of Public Health in Healthy Aging

Trust for America’s Health (TFAH), in partnership with The John A. Hartford Foundation, held
a convening called A Public Health Framework to Support the Improvement of the Health and
Wellbeing of Older Adults, in Tampa, Florida on October 27, 2017. National, state, and local
public health officials; aging experts, advocates, and service providers; and healthcare officials came together to discuss how public health could contribute to an age-friendly society and improve the health and wellbeing of older Americans. The result is a Framework for an Age-Friendly Public Health System that includes five potent roles for public health in the healthy
aging effort:

Connecting and convening multiple sectors and professions that provide the
supports, services, and infrastructure to promote healthy aging.
Coordinating existing supports and services to avoid duplication of efforts, identify gaps, and increase access to services and supports.
Collecting data to assess community health status (including inequities) and aging population needs to inform the development of interventions.
Conducting, communicating, and disseminating research findings and best practices to support healthy aging.
Complementing and supplementing existing supports and services, particularly in
terms of integrating clinical and population health approaches.

The Framework outlines the functions that public health could fulfill, in collaboration with aging services, to address the challenges and opportunities of an aging society. Not every community will have the capacity to fulfill all these roles, and some roles are already being filled by other entities. Advancing the public health sector’s involvement in healthy aging needs to be guided by, and in partnership with, such organizations. Furthermore, public health organizations may lack sufficient capacity to undertake such activities and will need to carefully and thoughtfully determine how and where to focus their limited resources (e.g., braiding current streams of funding for public health activities). The emerging challenges associated with an aging population in the context of serious fiscal limitations within our communities means that we must find efficient models of supports and services that align with the framework’s approach. Oregon provides just such a model.

The Oregon Model

Oregon has taken a unique and cost-effective approach to addressing the needs and opportunities of its more than 660,000 people older than 65 years by co-locating the State Unit on Aging’s Long-Term Care Program Analyst (Program Analyst) within the Public Health Division offices. Although this was not always the case, this nontraditional co-location creates efficiencies, eliminates silos, and enhances coordination and collaboration between the two Oregon state agencies that provide health supports to Oregonians.

Like other states, Oregon’s public health and aging services are separate and distinct in funding, personnel, location, and services provided. The Department of Human Services State Unit on Aging (SUA) is responsible for overseeing implementation of the Older Americans Act,

Medicaid long-term care supports and services, Adult Protective Services (APS), and Oregon Project Independence. It works with the 17 Area Agencies on Aging which help to administer all the services and supports for older Oregonians. The Program Analyst works with Oregon’s aging services network to promote community implementation of evidence-based health promotion strategies addressing chronic disease self-management, falls prevention, physical activity and healthy eating, Alzheimer’s caregiving, and other preventive services.

Although Oregon’s public health division has not historically included healthy aging in its portfolio of programs, its Cross-Agency Systems Manager now devotes part of her time to healthy aging and collaborates frequently with the Program Analyst. The co-location in the public health division offices enhances opportunities for working together, limits redundancies, enables the sharing of key data, leverages funding between the divisions, and overall, helps to
create an age-friendly public health system in Oregon.

The Roles of the Program Analyst and Alignment with the Framework

When aligned with the five roles of public health within the Framework, the Oregon model provides an informative and, importantly, doable model for other public health systems across the country.

1. Connecting and convening

Healthy aging requires the active contribution of a variety of stakeholders. Indeed, many different organizations and professionals are working to support healthy aging and public health can help to connect and convene the multiple sectors and professions that provide the supports, services, policies and infrastructure to promote healthy aging.

Oregon’s Long-Term Care Program Analyst provides a link between the health department and the state’s 17 agencies on aging – a significant alignment as they are primarily responsible for providing information and services to seniors and people with disabilities across Oregon. Engaging public health with the agencies on aging provides a crucial connection between the two entities, particularly as local public health grantees are required to work with those agencies to ensure that seniors benefit from public health programs and services. The Program Analyst also facilitates partnerships with other statewide aging services, aging advocacy, and long-term care entities. These public-private partnerships are critical in addressing issues including the need for expanded respite services, the growing impact of Alzheimer’s disease and other dementias, and housing and transportation needs.

Oregon’s State Plan on Aging (developed every four years to guide SUA programs and activities) requires SUA staff to collaborate across programs and work to include positive approaches and practices across the elder services delivery networks. The Program Analyst supports these efforts by bringing the needs of older adults into this planning process.

2. Coordinating existing supports and services

Navigating the wide variety of supports and services for older adults can be confusing and overwhelming for older adults, their families, and other professionals. A second possible role for public health is therefore to coordinate existing supports and services to avoid duplication of efforts, identify gaps, increase access to services and supports, and ensure that older adults are not overlooked in any other public health programming or research.

Together health department staff and the Program Analyst help to ensure that programs run between the two agencies are complementary and not duplicative. They work closely with the Oregon Health Authority (Oregon’s single state Medicaid agency) regarding older adult mental and behavioral health and public health efforts impacting older adults. The Oregon Health Authority received state funding in 2015 to develop a statewide network of older adult behavioral health specialists. These individuals are working closely with elder services offices, community mental health agencies and others to develop closer coordination and support for older adults dealing with mental health needs. Oregon’s Program Analyst provides technical assistance to the area agencies on aging to aid in the implementation of the Older American’s Act and other federally-funded initiatives. Finally, the state public health division and Aging and People with Disabilities office partner on various initiatives to address chronic disease prevention and management, falls prevention, immunizations, and a new focus on oral health. ^iv

3. Collecting data

An important role of public health is to gather, analyze and disseminate demographic and health information. Such core public health activities can call attention to the needs and assets of a community’s aging population, inform the development of interventions and help set goals (and define measures) for health improvement. The Behavioral Risk Factor Surveillance System (BRFSS) administered by the CDC includes two modules that states have the option of using to assess and track two issues crucial to the health and well-being of older adults: the cognitive decline module and the caregiver module. The Oregon chapter of the Alzheimer’s Association encouraged the state legislature to fund these aging modules, making Oregon one of only seven states to collect data for both modules. Oregon utilizes additional BRFSS measures to cross walk multiple risk factors to better tune and align their efforts, such as the general physical and mental health indicators. In addition, Oregon created a healthy aging index in 2015 to prioritize and monitor key data indicators that inform investments in infrastructure to support health across the life span. Ensuring the use of public health data galvanizes partners toward common goals and objectives. And Oregon’s State Health Improvement Plan 2015-2019 identified oral health in older adults as a focus area for improvement and is using the BRFSS to track this data. The Program Analyst helps to oversee the collection and analysis of these data.

4. Conducting, communicating, disseminating research/best practices

Public health researchers, policymakers, and practitioners can play key roles in supporting healthy aging by conducting, communicating, and disseminating research findings and best practices to empower individuals to engage in healthy behaviors, support the provision of effective services, and contribute to the create of safe and healthy community environments. Indeed, there is a large body of research concerning healthy aging, yet limited clearinghouses for interested parties to find best practices or resources. Public health organizations could provide central locations for information on healthy aging, including best practices, toolkits, and research. The ready availability of such a site would enhance the capacity of other sectors and professions to address the needs of older adults.

Despite a lack of funding for communication, Oregon’s Public Health Division works with their aging partners to promote messaging directed toward older adults. Using the Public Health Division’s communication infrastructure to develop a story arc on Place Matters Oregon, the health department has been successful at accelerating and raising the civic conversation in Oregon. Place Matters Oregon now shares the lived experiences of older adults, reinforcing the importance of place and space on one’s ability to thrive as we age. Additionally, the department published the Health Within Reach Blog and Data Within Reach Webinar. This webinar outperformed all previous webinars and the Healthy Aging blog was the second most reviewed Health Within Reach blog post since it began; both demonstrating the opportunity and the need for public health to be informing conversations about aging in Oregon.

5. Complementing and supplementing existing supports

The fifth possible role for public health is complementing and supplementing existing supports and services, particularly in terms of integrating clinical and population health approaches. Existing public health programs address a wide range of health issues, from infectious disease to chronic disease; from education campaigns that reach the general public to targeted and focused home visits by educators; from the enforcement of environmental regulations addressing longterm health risks like clean air and water to the response to rare and catastrophic events. Furthermore, public health is focused on the entire life course, providing programs and policies such as maternal and child health, workplace safety, and tobacco-free initiatives, that ultimately support healthy aging later in life. Each of these current activities could be assessed to determine if they are adequately meeting the needs of older adults and, when not, modified to better do so.

In Oregon, as the aging sector works primarily at the individual level, the Cross Agency Systems Manager provides focus for the public health division and coordination with other statewide partners such as AARP and the Alzheimer’s Association on policy, systems and environmental change issues, such as tobacco policy, residential and in-home care settings, caregiving and worksite wellness policies, including paid sick leave and healthy meetings and events, agefriendly communities, and increasingly on dementia-friendly communities.

Conclusion

There are many ways for a public health department to become engaged in the promotion of the health and wellbeing of older adults. The current work in Oregon provides an innovative example particularly with the co-location of its Long-Term Care Program Analyst within its public health department. This approach enhances the state’s capacity to include healthy aging in its planning, data collection, communication, and program implementation. The Oregon model illustrates the potential for public health to effectively collaborate with the other sectors providing older adult services to promote optimal health.

Acknowledgements

TFAH wishes to acknowledge the contributions of Kirsten Aird, Cross Agency Systems Manager in Oregon’s Public Health Division, and Jennifer Mead, Program Analyst in the Oregon Department of Human Services State Unit on Aging, to make this case study possible. We are grateful for their expertise and commitment to ensure the effective collaboration between Oregon’s public health and aging services sectors.

Building a Community Roadmap to Health and Equity in Jackson, Mississippi

By Beneta D. Burt, Executive Director, Mississippi Roadmap to Health Equity

The Mississippi Roadmap to Health Equity, a community-run organization that seeks to generate and mobilize resources, utilizes our expertise to improve how community institutions operate and, at the same time, protect and promote the health of community members.

By working with everyday institutions that touch everyone’s life, we can advocate for changes that are good for the bottom line and promote better health equity in Jackson. By building important relationships, we can ensure community institutions support the community’s efforts to be healthy—and are true partners in making the healthy choice the easy choice.

How we started

With primary support from the W.K. Kellogg Foundation, Mississippi Roadmap’s work began in 2003 with a series of sessions aimed at addressing why African-Americans are sicker and die sooner than their peers.

Through concept mapping, we identified the many factors that contribute to poor health. And, just one year later, nearly 200 community residents, members of the Mississippi Roadmap Community Steering Committee (CSC) and National Advisory Board members created ideas to improve community health outcomes. Participants laid out a “roadmap” for a healthy present and an even healthier future, especially for the economically-disadvantaged citizens of Jackson. While the state of affairs regarding the health of African-Americans was central to the purpose of the conference, the overall goal was to develop a community-driven health movement that fostered equity, justice and respect for all people.

Initially we set out to improve access to fresh and affordable produce and safe and affordable places for people to exercise – there were simply no grocery stores or farmers’ markets in the area and no price-conscious fitness centers.

To solve these problems, we re-purposed a shuttered grocery store to include:

A state-of-the-art adult fitness center;
An indoor farmers’ market;
A children’ fitness area that accommodates pre-school through teens;
Space for healthy cooking classes, in partnership with dietitians from The University of Mississippi Medical Center;
A venue for senior citizens to congregate;
An affordable rental facility for community events and a venue to convene community conversations; and
A Technology Learning Lab that serves 4^th and 5^th grade students who participate in our afterschool program.

Additionally—in an effort to promote healthy eating habits, to demonstrate to city kids where good food comes from, and to encourage them to eat more fruits and vegetables—we developed 15 garden-based projects in elementary/middle schools in the Mississippi Delta, in Jackson, and on the Gulf Coast.

How we do it

A Community Steering Committee guides our work. An executive director, together with a staff of six, provides day-to-day management. CSC members each have their own “community constituents” who they work with and/or advocate for. These community constituents range from neighborhood associations to church groups to social justice and advocacy organizations—they run the full gamut of the community.

The diversity of ages, backgrounds, interests, professions, and community connections of the CSC members provide access to the pulse of each segment of Jackson and provides a voice for their issues, ideas, needs and concerns.

Going Forward

We are scaling up our work to focus even more on promoting the health and well-being of children by creating job training programs targeted to non-college bound high school graduates and other out of- school youth.

To do so, we began the process of becoming an affiliate of the National Urban League—this vital partnership, which was fully formed in February 2018, will promote employment equity.

Unemployment among teenagers and young adults are major issues in Jackson, especially during the summer, while unemployment among out-of-school youth is equally concerning. In 2016, approximately 600 Jackson high school graduates did not attend college and most had no plans or employment prospects.

In an effort to close this gap, Roadmap entered into a Memorandum of Understanding (MOU) with the City of Jackson in to acquire a city-owned, soon-to-be-shuttered golf course and club house that we will now use to develop a job training program in golf course management designed to develop landscaping-related employment opportunities.

Out-of-school youth will be recruited during the course of the year and enrolled in a GED program provided by Hinds Community College prior to enrolling in the job training program. We will incentivize participant training to encourage consistent attendance and attainment of GEDs prior to transitioning to the program. Additionally, a job developer will work with non-college bound high school seniors in March of each year to prepare them for entering the training program.

Upon completion of classroom and on-the-job training activities, and with Roadmap’s oversight, some participants will bid on landscaping management contracts with local public school districts. Successful bids will result in permanent, unsubsidized employment for participants.

To leverage these relationships and also improve physical fitness, golf pros will develop a program for integration into the curriculum of the local elementary school, which is located next to the golf course. And, a concurrent physical fitness program will be incorporated into the program. Eventually, we hope these plans and resources can benefit the health of the entire community.

Partnerships are Vital

Any measure of success that we have achieved can be attributed to the long-term support from the W. K. Kellogg Foundation, and to the large group of public and private sector members whose actions demonstrate that community partnerships play an integral part in achieving improved health outcomes. We have the good fortune to have local chefs, hospitals and health professionals, church ministries, and community-academic partners involved.

Just one partnership example: we are the grant recipient in partnership with the Mississippi State Department of Health and the University of Mississippi Medical Center (UMMC). For this grant, the Department of Health provides staff resources and UMMC provides the required match for the project, which allows us to create a culture of breastfeeding among young women in Jackson.

Mental Health is Vital to Preparedness and Response

By Dr. Octavio N. Martinez, Jr., MD, MPH, MBA, FAPA, Executive Director, the Hogg Foundation for Mental Health at The University of Texas at Austin

This story was published in Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism.

The health effects from a public health emergency go way beyond the physical, taking an enormous mental toll in the immediate aftermath and the years following—and often can harm our children the most.

We must do more to know how to ensure mental health and physical health go hand-in-hand in response planning and efforts. We must also do a far better job of increasing our mental health workforce and ensuring and increasing access to mental health services both during and after an emergency.

Using Data to Plan for Maintaining Access to Mental Health Services

To prepare for any type of emergency, communities must be aware of vulnerable populations—typically children, the elderly and those who have an underlying medical condition or are mentally ill. We have gotten better at identifying where groups of these populations live.

And, we should also be able to access databases to predict what portion of a certain population might have substance use disorders, for example—and then understand what kind of continued treatment and medication are needed and where they might best be distributed.

Paired with this, we should be able to identify geographically which communities will have the hardest time bouncing back from an emergency and will need more resources.

While some neighborhoods might have good infrastructure and better access to transportation and physical and mental health services, others will struggle. The neighborhoods that will struggle should be identified in advance and plans created to help them. And, we can create plans based on any number of scenarios: fires, floods, wind damage, loss of power, etc. If you combine all the knowledge and data together, you can then coordinate resources and everyone has a chance to be healthy.

Long-term Strategies to Improve Responses to Emergencies

We also must acknowledge that human connections are incredibly important. In-between disasters, preparedness work should focus on strengthening families and communities so they are resilient enough to weather an emergency.

For example, after Hurricane Katrina, New Orleans developed community leaders specifically focused on mental wellness, resilience and recovery. The gains in improved access to care and lessened stigma were noticeable—and these should help ensure responders and communities can work together to forge a better response during the next emergency.

While this is by no means a quick fix, taking a long-term approach to emergency preparedness and community health will pay dividends in improved health of the entire population. We should bring this research to other cities and communities that will likely face similar events.

Additionally, psychological effects can take years to manifest and get under control—especially if there isn’t access to mental health services. We learned from Hurricanes Katrina and Sandy that PTSD and suicidal ideation increased dramatically after these events. However, if we were able to step in earlier and connect individuals with mental health professionals, it’s likely these issues and potentially other health issues (substance use disorders, increased anxiety, depression, etc.) could have been prevented or lessened.

Further, while we are getting better at recognizing that mental health is a key component to physical health, the workforce in this area is inadequate—and we’ve known this for a while, especially as the opioid epidemic has continued. By increasing our workforce and ensure they have the right skill sets; we could help tackle the opioid epidemic and better prepare our communities to bounce back from a disaster.

Additional Research is Needed

The devil is often in the details and coordination among the various federal, state and local agencies, organizations and others must be improved. To do so, the nation has to prioritize funding into research and assessments post emergencies—so we can truly understand how these events affect the mental health and stability of a community at a population level.

While the National Institutes of Health has a Disaster Research Response Project, it needs to better include measures on mental health and substance use disorders. We must take each disaster as a learning opportunity that can prepare us for the next one and enable us to save more lives. Increasing research would also help build a network of behavioral health disaster experts.

First Responders

Our first responders and volunteers must be trained to identify and assist people who exhibit psychiatric symptoms, i.e., in “psychological first aid.” And, going beyond this training, we know that mental health must be better integrated with the traditional health services.

Responders and volunteers must also be cared for—they are at risk for suffering secondary psychiatric distress themselves. We need better ways to monitor them during but also after the crisis to ensure they are receiving the appropriate interventions and care.

Part of the solution is increased mental health providers, which would serve many roles: keeping our first responders in good shape, filling gaps in mental health services and, by increasing access to care, hopefully preventing someone from developing a serious and chronic mental health illness.

Quite simply, if we intentionally make mental health part of our preparedness and response systems it will have untold benefits for communities before, during and after an emergency—we will build resiliency and improve well-being.