Sullivan County Sullivan County Regional Health Regional Health Council OverviewCouncil Overview

Stephen MayStephen May

November 15, 2011November 15, 2011

Health Council Health Council CompositionComposition

Approximately 30 members of the Approximately 30 members of the communitycommunity

Cross all spectrums: Business and Cross all spectrums: Business and Industry, Hospitals, Private Health Care Industry, Hospitals, Private Health Care Providers, Religious, Insurance providers, Providers, Religious, Insurance providers,

Health department provides support, Health department provides support, program structure, epidemiology.program structure, epidemiology.

CDC MAPP Model (Mobilizing for Action CDC MAPP Model (Mobilizing for Action through Planning and Partnerships)through Planning and Partnerships)

Our Vision and Value StatementsOur Vision and Value Statements

VisionVision: : A safe, healthy, and educated Sullivan County.A safe, healthy, and educated Sullivan County.

Value Statements: Value Statements: ~~EducationEducation:: We value community health education.We value community health education.

~~AccessAccess:: We value access to community resources.We value access to community resources.

~~CollaborationCollaboration:: We value partnerships and We value partnerships and collaborative efforts.collaborative efforts.

~~Compassionate CommitmentCompassionate Commitment:: We value a caring We value a caring holistic approach to community health.holistic approach to community health.

~~CultureCulture:: We value the various cultures and the We value the various cultures and the diversity they bring to our communitydiversity they bring to our community

~ ~ AccountabilityAccountability:: We value a commitment from both We value a commitment from both individuals and the community to take ownership for a individuals and the community to take ownership for a healthier Sullivan County.healthier Sullivan County.

MAPP PrincipalsMAPP Principals The following principals are integral to the successful The following principals are integral to the successful

implementation of MAPP:implementation of MAPP: Systems thinkingSystems thinking — to promote an appreciation for — to promote an appreciation for

the dynamic interrelationship of all components of the dynamic interrelationship of all components of the local health system required to develop a vision of the local health system required to develop a vision of a healthy community.a healthy community.

DialogueDialogue — to ensure respect for diverse voices and — to ensure respect for diverse voices and perspectives during the collaborative process.perspectives during the collaborative process.

Shared visionShared vision — to form the foundation for building a — to form the foundation for building a healthy future.healthy future.

DataData — to provide factual information during each — to provide factual information during each step of the process.step of the process.

Partnerships and collaborationPartnerships and collaboration — to optimize — to optimize performance through shared resources and performance through shared resources and responsibility.responsibility.

Strategic thinkingStrategic thinking — to foster a proactive response to — to foster a proactive response to the issues and opportunities facing the system.the issues and opportunities facing the system.

Celebration of successesCelebration of successes — to ensure that — to ensure that contributions are recognized and to sustain contributions are recognized and to sustain excitement for the processexcitement for the process

Where Are We ??

4 MAPP Assessments4 MAPP Assessments

Community Themes and StrengthsCommunity Themes and Strengths Local Public Health SystemLocal Public Health System Forces of ChangeForces of Change Community Health StatusCommunity Health Status

Community Health StatusCommunity Health Status

Data Sources: Data Sources: Death 1990 – 2004 added 2005-2006Death 1990 – 2004 added 2005-2006 Hospitalizations (Outpatient and Inpatient )Hospitalizations (Outpatient and Inpatient ) Outpatient 1998 - 2004Outpatient 1998 - 2004 Inpatient 1997 – 2004Inpatient 1997 – 2004 Infectious Disease – Tennessee Dept of HealthInfectious Disease – Tennessee Dept of Health Census 2000 and American Community Census 2000 and American Community

SurveySurvey Births – Teen pregnancyBirths – Teen pregnancy Behavioral Risk Factor Surveillance Survey Behavioral Risk Factor Surveillance Survey

20052005

Matrix Weighting and Matrix Weighting and ScoringScoring

Percent deathsPercent deaths Percent Hosp ERPercent Hosp ER Percent Hospital InpatientPercent Hospital Inpatient Severity of ConsequencesSeverity of Consequences TrendsTrends High incidence or prevalenceHigh incidence or prevalence Healthy People 2010Healthy People 2010 Instate priorityInstate priority Acceptability to citizensAcceptability to citizens

Chronic Rhinitis+Sinusitis 29.3 22

Anxiety 29.2 23

Nephritis 29.1 24

Alzheimer's 27.5 25

Mood 27.6 26

Ulcer/Gastritis 27.2 27

Other Intestinal Dis 24.6 28

Other Resp. Diseases 24.2 29

Cirrhosis of the Liver 23.9 30

Other Urinary Diseases 15.1 31

Gallbladder 13.3 32

   

Lead Poisoningdata soon to be

analyzed  

Hearing and Sightdata not

collected  

Alternative Assisted Living

data not collected  

* Chlamydia and Gonorrhea

** Vancomycin Resistant Enterococcus and Streptococcus pneumoniae Drug Resistant

Preliminary Ranking:Sullivan County Health Problems

Health Problem    

Score Rank

Upper Resp Infection 47.5 1

Motor Vehicle Accidents 47.1 2

Heart 46 3

Infant Mortality 45.8 4

Lung Cancer 45.8 5

Chronic Lower Resp Dis 44.4 6

Colon Cancer 42.8 7

Falls 41.6 8

Stroke 35.5 9

Prostate Cancer 35.3 10

Diabetes 34.8 11

Primary HPN 34.7 12

Drug + Alcohol 34.4 13

Pneumonia 34.2 14

Sexually Transmitted Dis* 32.6 15

Drug Resistant Bacteria** 32.4 16

Suicide 32.1 17

Oral Health 32 18

Breast Cancer 30.7 19

NonInfect.Colitis/Enteritis 29.7 20

Assault 29.6 21

Disease DiagramsDisease Diagrams

Literature Searches for each health Literature Searches for each health outcomeoutcome

Identified: PrecursorsIdentified: Precursors

ConsequencesConsequences

LinkagesLinkages Health Council Members localized Health Council Members localized

diagramsdiagrams

Chronic O

bstructiveP

ulmonary D

isease

Smoker, PreviousSmoker, long-standing

Victim of 2nd Hand Smoke

SC 26% Smoke

Indoor Air Pollution (mold, air handling unit)

Occupational Exposure (asbestosis, silicosis)

Genetic Deficiency (α1antitrypsin deficiency)

Lack of Regular Physical Exercise

Lack of Effective Smoking Cessation

Education

Lack of Social Support

Recurrent Respiratory Infections Lack of

vaccination

Outdoor AirPollution

Age ≥ 40 yrs Low Income

Incomplete Education

DirectSecondaryTertiary

Learning DisabilityNo Incentive to Complete

School

Poverty

Smoking Family Members and

Friends

Morbidity

Mortality

6th Cause InPatient Hospitalization SC

3rd Cause of ER Visits in SC

Inappropriate Perception of

Disease

Less Physical Activity

Limits Ability to Perform

Household Chores

Not Picked Up by MD

Grief

↓ Family Activities

Dependency

Work AbsenteeismAbility to work

limited

Inappropriate Perception of

Disease

↓ Sleep

Potential Years of Life

Lost

Chronic ObstructivePulmonary Disease

ConsequencesPrecursors

Direct Secondary Tertiary

Smoking causes80-90% COPD

SC 31%No Exercise

SC 75%No Flu Vaccine

RR women 1.35RR men 2.12

1% of all COPDcases

% of COPD Patients Surveyed

70%

56%

46%

50%

51%

3rd Leading Cause of Death in SC, 4th in US

Tallied Risk Factors + Tallied Risk Factors + ConsequencesConsequences

5 risk factors affected all 28 diseases5 risk factors affected all 28 diseases Less than High School EducationLess than High School Education Lack of Resources/PovertyLack of Resources/Poverty Access Barriers (lack of health Access Barriers (lack of health

insurance, lack of transportation, insurance, lack of transportation, absence of childcare, etc)absence of childcare, etc)

Limited Employment OpportunitiesLimited Employment Opportunities Health Literacy/Hygiene Knowledge + Health Literacy/Hygiene Knowledge +

PracticePractice

Community Themes & Community Themes & Strengths AssessmentStrengths Assessment

Convenience Sample Survey – Convenience Sample Survey – captures thoughts of individual captures thoughts of individual citizencitizen

- public libraries, grocery stores, - public libraries, grocery stores, malls, beauty salonsmalls, beauty salons

Produced a ranking of the top 15 Produced a ranking of the top 15 causescauses

Sullivan County Health Problems:Community Themes & Strengths Survey

Health Problem    Rank

Alcohol and Drugs 1

Obesity 2

Cancer 3

Heart Disease/Stroke 4

Diabetes 5

Cigarette Smoking 6

Depression 7

Teen Pregnancy 8

Child Abuse + Neglect 9

High Blood Pressure 10

Forces of Change Forces of Change AssessmentAssessment

2 Focus Group sessions consisting of 2 Focus Group sessions consisting of community leaders:community leaders:

- legislators, police, local government, - legislators, police, local government, non-profit health care agencies, schools, non-profit health care agencies, schools, United Way, various agencies representing United Way, various agencies representing child + youth services, individual citizenschild + youth services, individual citizens

Goal was to identify forces and/or themes Goal was to identify forces and/or themes in the community that has or would cause in the community that has or would cause an affect on the health of Sullivan County an affect on the health of Sullivan County citizenscitizens

Discussions were guided around topics of Discussions were guided around topics of politics, environment, technology, socio-politics, environment, technology, socio-

cultural changes and legalcultural changes and legal

Top Issues: Focus Group Top Issues: Focus Group AssessmentAssessment

1.1. Lack of Affordable, safe housingLack of Affordable, safe housing

2.2. Poor Air QualityPoor Air Quality

3.3. Steady use of fast food restaurantsSteady use of fast food restaurants

4.4. Sub-optimal level of prenatal education for Sub-optimal level of prenatal education for teensteens

5.5. Sub-optimal level of high school completion Sub-optimal level of high school completion rate relating to lack of educated workforcerate relating to lack of educated workforce

6.6. Lack of political lobbying: local and state Lack of political lobbying: local and state levellevel

7.7. Increased drug useIncreased drug use

8.8. Increase in family violenceIncrease in family violence

9.9. Increase in depressionIncrease in depression

10.10. Aging PopulationAging Population

Local Public Health System Local Public Health System AssessmentAssessment

Evaluated Sullivan County’s total Evaluated Sullivan County’s total health system is doing in providing health system is doing in providing the 10 Essential Public Health the 10 Essential Public Health Services as identified by the CDCServices as identified by the CDC

5 areas surfaced as being areas with 5 areas surfaced as being areas with opportunity for improvementopportunity for improvement

Local Public Health System Local Public Health System Assessment’s Areas with Assessment’s Areas with

Opportunity for Opportunity for ImprovementImprovement

#3 Inform, educate and empower #3 Inform, educate and empower people about health issuespeople about health issues

#5 Develop policies and plans that #5 Develop policies and plans that support individual and community support individual and community effortsefforts

#6 Enforce laws and regulations #6 Enforce laws and regulations that protect health and ensure safetythat protect health and ensure safety

All together, what do the 4 All together, what do the 4 assessments say?assessments say?

All 4 assessments offered a consistent All 4 assessments offered a consistent list of the top causes of health concerns list of the top causes of health concerns and precursors within Sullivan Countyand precursors within Sullivan County

2 important disease precursors 2 important disease precursors

surfaced from all 4 assessments':surfaced from all 4 assessments':

- Less than a high school education- Less than a high school education - Lack of political lobbying: local and - Lack of political lobbying: local and

state levelstate level

Phase 1 ResultsPhase 1 Results

Data Summary ReferenceData Summary Reference Compilation of common risk factorsCompilation of common risk factors Resource utilization, morbidity, Resource utilization, morbidity,

mortality matrixmortality matrix Preliminary rankings of diseases Preliminary rankings of diseases

with most impact on community. with most impact on community.

Overview Phase 2Overview Phase 2Expanded StructureExpanded Structure

HC is transitioning…HC is transitioning… from planning to from planning to operational phaseoperational phase

MAPP Builds local health leadership, MAPP Builds local health leadership, but also promotes community but also promotes community responsibility for the health of the responsibility for the health of the publicpublic

Steps to SuccessSteps to Success Community-driven HCCommunity-driven HC Strategic planning and evaluation from HCStrategic planning and evaluation from HC Engaging community partners (external to Engaging community partners (external to

HC)HC)

OverviewOverviewExpanded Structure RecommendationsExpanded Structure Recommendations

Preparing for Action CyclePreparing for Action Cycle Evaluate – Plan – ImplementEvaluate – Plan – Implement

Based on HC best practices:Based on HC best practices:1.1. Establish Establish Steering GroupSteering Group (HC) (HC)

2.2. Establish Health Priority Establish Health Priority Task Task Forces &Forces & WorkgroupsWorkgroups

Goal: Engagement of Community Goal: Engagement of Community PartnersPartners

Expand operational structure for Expand operational structure for “implement”“implement”

Steering GroupSteering Group(Proposed)(Proposed)

Purpose: Purpose: Strategic direction for HC & MAPPStrategic direction for HC & MAPP Planning for short term Planning for short term

(e.g., HC meeting objectives and agendas)(e.g., HC meeting objectives and agendas) Planning for long term Planning for long term

(e.g., annual goals for MAPP)(e.g., annual goals for MAPP)

Membership: Membership: 3 HC members + HC Coordinator (SCRHD)3 HC members + HC Coordinator (SCRHD) Advisor: Dr. May (SCRHD)Advisor: Dr. May (SCRHD)

Frequency:Frequency: Meet 1-2 weeks after each HC mtgMeet 1-2 weeks after each HC mtg

Task Force Logic Model Task Force Logic Model StepsSteps

Why is the disease a problem? Target groups?Why is the disease a problem? Target groups? Who are our stakeholders and partners?Who are our stakeholders and partners? What processes or programs currently exist?What processes or programs currently exist? What are the best practices and best programs in What are the best practices and best programs in

other areas?other areas? Bench marking Bench marking Gap analysisGap analysis Design Custom community action plan to target Design Custom community action plan to target

issue.issue. Design appropriate measures for programDesign appropriate measures for program Measure resultsMeasure results Plan, do, check, act cyclePlan, do, check, act cycle

Community Partners Community Partners

Healing Hands and Friends in Need Healing Hands and Friends in Need REACHREACH CHIP – more regionalCHIP – more regional Project AccessProject Access NE TN Regional Health CouncilNE TN Regional Health Council TN Dept of Health and CDCTN Dept of Health and CDC

Questions?Questions?