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Thriving Cities: Building Skills to Create a Culture of Health Where We Live, Learn, Work & Play2016 City Summit
Trainer(s):
Rex Archer, MD, MPH, Director of Health City of Kansas City, Missouri
Sue Pechilo PolisDirector, Health & Wellness [email protected]
Stacy WegleyCommunity InitiativesLori FresinaSenior Vice President and New England Office Director M+R [email protected]
Thriving Cities: Building Skills to Create a Culture of Health Where We Live, Learn, Work & Play
NLCU Culture of Health SeminarNovember 16, 20161:30 PM – 4:30 PM
Culture of Health: The core of this work is at the intersection of where we live, learn, work & play and our health.Goal: Lift-up and further inform city efforts, models, policies, practices & programs that improve health and well-being of city residents.
Welcome/Introductions
• Data• Equity• Financing• Civic Engagement• Sustainability
Welcome/Introductions
What has more to do with influencing health: Genetic codes or Zip codes?
Welcome/Introductions
At your table, select a partner and discuss following question: What factors create significant differences in health outcomes (e.g. life expectancy) in neighboring communities and why?
Experience/Reflection Question
https://www.youtube.com/watch?v=DUfccUJoZhE
Video Presentation
Cultivating a “Culture of Health” Equity
Through Promoting
Interdependence and IngenuityRex Archer, MD, MPH, Director of Health
City of Kansas City, Missouri NLC, 11/16/2016
Saving Lives, Protecting People from Health Threats, $aving Money through Prevention
A Tale of Two Zip Codeshttps://www.youtube.com/watch?v=DUfccUJoZhE
We are Kansas City,
We Lead!
Robert Wood Johnson Foundation’s Culture of Health Prize
http://www.rwjf.org/en/library/articles-and-news/2015/10/coh-prize-kansas-city-mo.html
Saving Lives, Protecting People from Health Threats,
Saving Money through Prevention
10
Kansas City, MissouriHealth Department
“Public health is what we, as a society, do collectively through organized actions*to assure the conditions in
which all* people can be healthy.”
-Institute of Medicine (1988), Future of Public Health
*The blue italic font has been added to emphasisour partnership with community organizers
79.274.5 74.2
66.0
80.577.1 75.7
68.7
0
10
20
30
40
50
60
70
80
White female Black female White male Black male
Life
exp
ecta
ncy
(yea
r)
Life expectancy, KCMO 2000-2004 vs. 2010-20142000-2004 2010-2014
*Non-Hispanic white male and female and non-Hispanic black male and female.
+1.3 years +2.6 years +2.7 years+1.5 years
Life expectancy by zip code, Kansas City, MO 2010-2014
Life expectancy Nonwhite
Below poverty@
Median family@
(year) % % income ($)81-83 years 16.2 5.8 97,38273-79 years 34.7 10.6 59,70170-72 years 83.6 37.5 30,470
*Too small population to calculate life expectancy
@ 2010-2014 American Community Survey 5-Year Estimates
64153 64154 64156
64163
64155
6411964151
64134
64129
64120
64157
64161
64132
64138
64149
64131
64116
64130
64137
64117
64136
64118
64160
64164
64139
64133
64127
64165
64133
64108
64133
64128
64147
64111
64158
64109
64126
64118
64124
64114
6414664145
64110
64113
64152
64079
64106
64166
64112
6412364125
64012
64152
6410564101
64102
64167
6403064081
64152
Life expectancy70-72 years
73-79 years
80-83 years
Too small pop.*
Check out YouTube: tale of two zip codes
United Nations: “Surveys on Crime Trends and the Operations of Criminal Justice Systems, 2000”
WHO Perspective
Death rate by education among persons 25 -34 years KCMO 2009 - 2013
17.5X
Dea
th ra
te p
er 1
00,0
00 p
opul
atio
n
Social and
Economic Factors…Health
Behaviors30%
Clinical Care10%
PhysicalEnvironment10%
Genes and Biology
10%
Tarlov AR. Public policy frameworks for improving population health. Ann N Y Acad Sci 1999; 896: 281-93. Icons designed by Freepik
WHAT CREATES HEALTH? what are the Determinants of Health?
Disease&
Injury
UnhealthyBehavior
& Risk Factors
NeglectedCommunities
HarmfulPolicies
&Practices
DeathBiased Beliefs (Isms)
Medical Model (individuals)
Socio-Ecological (society)
Emergency Rooms
ClinicsHealth Education
PeoplePower
&Leadership
Policy & Partnerships
Change the
Narrative
Drivers of Change
Inclusion&
Sustainability
Health In All
Policies
Resilient&
TransformedCommunities
WORLDVIEWMental Models
AXIS OF JUSTICE
AXIS OF JUSTICE
Retributive Justice(Punishment)
Contributive/Distributive And Restorative(Social) Justice
AXIS OF POWER/INFLUENCE
Violent Force
AXIS OF POWER/INFLUENCE
Nonviolent Persuasion
Normalcy of Civilization*
RadicalityOf God**
*History/Cultural Norms, Political/Military/Industrial
Economic Complex
**Values, Philosophy, orReligious Wisdom
Improving Service. Protecting People. Saving Lives.
2400 Troost Ave. │ Suite 4400 │ Kansas City, MO 64108Phone: 555.555.5555 │ KCMO.GOV │ [email protected]
CONNECT!
Dr. Rex Archer, MD MPH
Ave. │ Suite 4400 │ Kansas City, MO 64108Phone: 816.513.6252 │ KCMO.GOV │ [email protected]
Dr. Rex Archer, MD MPH
QUESTIONS/COMMENTS?
Your Nationally Accredited . . .
2400 Troost Ave. │ Suite 4400 │ Kansas City, MO 64108Phone: 816.513.6252 │ KCMO.GOV │ [email protected]
11/11/16Saving Lives, Protecting People, Improving Services
Lives.
Themes of the
Alternate Worldview Narrative: Interdependence(compassion for the other/no other)
Individuals needsupport
Structural inequities
are still present
Government Solutions
Free MarketChecks & Balances
Science is essential
Education is for critical thinking
and citizenship
Themes of the
Dominant Worldview (US) Narrative: Independence (primary motivation - fear of other)
Boot StrapsIndividualism
StructuralDiscrimination is a thing of the Past
Free MarketSolutions
Small Government
Science is suspect
Education is for job
training
The “Stream”Societal Level
Community& Policy Level
Individual &Family Level
Services for individuals and families to treat problems
Social, economic, & physical conditions that allow people to reach their full potential
Political structures & institutional practices that assure fairness & opportunity for all
Pro-Equity Policies
Affordable Housing
Safeneighborhoods
Good paying jobs
Qualityeducation
Incarceration
Obesity
Homelessness
Address Structural
Racism and Privilege
Healthy Environment Access to
Transportation
Access to Healthcare
Low Birth Weight
Untreated Mental Illness
Access to healthy food
Access toPhysical
Activity
Social Structure
Power/Influence & Wealth ImbalanceLABOR
MARKETS
GLOBALIZATION&
DEREGULATIONHOUSINGPOLICY
EDUCATIONSYSTEMS
TAXPOLICY
Social Determinants of Health
Disparity in the Distribution of Disease, Illness, and Wellbeing
Structural & Institutional
Racism
Income & Class Inequality
Gender/Sexual Orientation
Bias
SOCIAL NETWORKS
SOCIALSAFETY
NET
SafeAffordable
Housing
SocialConnection
& Safety
QualityEducation
Job Security
LivingWage
Transportation Availabilityof Food
Psychosocial Stress / Unhealthy Behaviors
Definitions
Social Justice Health Equity
The absence of unfair, unjust advantage or privilege based on race, class, gender, or other forms of difference.
A fair, just distribution of the social resources and social opportunities needed to achieve well-being.
Health Disparity
“A disproportionate difference in health between groups of people.”
By itself, disparity does not address the chain of events that produces it.
Health Inequity“Differences in population health status and mortality rates that are systemic, patterned, unfair, unjust, and actionable, as opposed to random or caused by those who become ill.” Margaret Whitehead
Fam
ily &
C
ultu
reHealth
InequitiesHealth
Disparities
Fam
ily &
C
ultu
re
PlacePolicyNarrative
240226
66 58 53 52 51 46 41 37
126108
328 24 29 34 28
12 100
50
100
150
200
250
Rate
per
100
,000
pop
ulat
ion
Shortest life expectancy Longest life expectancy
Leading Causes/Symptoms Crude Mortality Rates in Two Areas, KCMO 2008-2012 (Root Causes underlie all of these)
6 zipcodes include zip code 64109, 64126, 64127, 64128, 64130, and 64132, which are the shortest life expectancy
11 zipcodes include zip code 64112, 64113, 64116, 64118, 64151, 64152, 64153, 64154, 64156, 64157, and 64158, which are the longest life expectancy.
A “Culture of Health” starts in our homes, schools, workplaces, neighborhoods, and communities.
Overview
Risa Lavizzo-Mourey, President and CEO. Robert Wood Johnson Foundation.
Achieving Health Equity by Addressing the Social Determinants of Health
• It is time to stop thinking of health as something we get at the doctor’s office
• Health starts—long before illness-- in our homes, neighborhoods, schools and jobs.
• All residents should have the opportunity to make the choices that allow them to live a long, healthy life, regardless of their income, education or ethnic background.
• Your neighborhood or job shouldn’t be hazardous to your health.
• The more we see the problem of health this way, the more opportunities we have to improve it. 33
Aligned Campaigns (PH&CO)2012: Cap the Rate, Raise the Wage2013: Ban the Box2013-2014: Low Wage Worker Actions/Living Wage
2014 70% Voter Approval 22 mil health levy 9yr ext.
2014: Ban the Ban2014: Raising of America Kansas City 2014: Advance KC Development Scoring2015: Council Approved (12:1) Raise Living WageOther Ongoing: Medicaid Expansion, Early Voting,
Violence/Homicide Prevention
Hennekens’ Criteria
•Is there a valid statistical association?–Chance–Bias–Confounding
•Can this valid association be causal?–Strong association–Biologic credibility–Consistency with other studies–Time sequence/Temporality–Dose-response
37
When is an association causal?
• Types of causal relationships(i) necessary and sufficient (ii) necessary but not sufficient (iii) sufficient but not necessary (iv) neither sufficient nor necessary
38
Where to Start: Mapping the Social Determinants in Your City
Stacy WegleyCommunity InitiativesNLCU Culture of Health SeminarNovember 16, 2016
Community Commons
To spur actions and investments that lead to healthier, more equitable, and more sustainable communities…
Providing change makers with public access to meaningful data, maps, & reporting capability & featured stories/guest voices
Providing cross-sector collaboratives with digital tools to support collective action: data integration, shared measures, strategy and message alignment
BUILDREPORTS
COLLABORATIVESPACES
ACCESS DATA
CREATEMAPS
VOICES ofTHOUGHTLEADERS
Access to 1,000’s GIS Data layers
&Ability to Upload &
ContextualizeLocal Data
Education
Civic
Economic/Income
Political
Demographic
Environment
Housing
Food
Poverty
Transportation
Health
Emergency Management
Robust “Relational” Database
Investing In The Commons
WK Kellogg:Building Next Generation Dashboards for the KelloggBoard & Grantees
CDC: Developed “Vulnerable Population Footprint Tool” &tools to develop stronger grant proposals
RWJF: Built Childhood Obesity GIS, Tutorial Videos andaugmenting County Health Rankings (sub countyestimates)
Kaiser Permanente: Built their Community Health Needs Assessment (CHNA),partner on Everybody Walk! And Weight of the NationCampaigns
CDC
RWJF
WKKF
KP
United Ways
CDC
RWJF
USAID
WKKFKP
PHI
New HubSpaces
Leveraging Shared Investments for the Common Good!Growing A Shared Database
Generating Stories Across Networks
Innovating Together & Sharing Functionality
Co-Investing to Ensure Sustainability
We Will Resume at 2:40 PM
10 Minute Break
Connecting the Dots: Cross-Sector Strategies to Improve Health
Lori Fresina
Senior Vice President and New England
Office Director M+R Strategies
Early Childhood & Health Katie Whitehouse, Senior Associate, NLC YEF Nick Wallace, Associate, NLC YEF
Education & Health Miles Sandler, Senior Associate, NLC YEF Andrew Moore, Program Director, NLC YEF
Family Economic Success & Health Sue Pechilio Polis, Director of Health and Wellness, NLC YEF Dawn Schluckebier, Senior Associate, NLC YEF
Housing & Health Alyia Gaskins, Senior Associate, NLC YEF Anthony Santiago, Senior Fellow, NLC YEF
Table Facilitators
MODERATOR:CLIFFORD M. JOHNSON Executive Director, Institute for Youth, Education & Families,
National League of [email protected]
PANELISTS:JAMES W. MCGEE Mayor, City of Vinita Park, MO
REX D. ARCHER, MD, MPH Director of Health, Health Department, Kansas City, [email protected]
JOHN LOVELACE President, University of Pittsburgh Medical Center (UPMC) for You [email protected]
Operationalizing the Culture of Health
Reflections and Key Takeaways
Core Components• Mayors’ Institute Series: Launching in December on
Housing/Health with 5 to follow. Technical assistance amongother resources provided as part of the effort.
• Culture of Health Monthly Web Forum: On-going monthlyweb series that initially explores key themes and builds withan emphasis on key issues and their connection to health(e.g. Housing & Health, Education & Health, etc).
What’s Ahead/How to Engage?
• CoH CitiesSpeak Blog: Augments web forum and meant to lift upcity engagement around key themes and issue intersectionsfrom a variety of multi-sector perspectives.
• LMCTC/All-Stars: Pivot to city policy, program & practice arounda Culture of Health framework and guided by solid foundation inwork addressing childhood obesity.
• On-going opportunities: NLC March Conference in Washington –look for further session(s)
What’s Ahead/How to Engage?
SUE PECHILO POLIS Director, Health & [email protected]
ALYIA GASKINS Senior Associate, Health & [email protected]
NICK WALLACE Associate, Health & [email protected]
*To learn more about our work, check out http://www.nlc.org/find-city-solutions/institute-for-youth-education-and-families/healthy-communities.
NLC Contact Information
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