Kaiser Permanente Community Health Initiative - Rails-to-Trails ...
Kaiser Permanente Community Health Initiative - Rails-to-Trails ...
Kaiser Permanente Community Health Initiative - Rails-to-Trails ...
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<strong>Kaiser</strong> <strong>Permanente</strong><br />
<strong>Community</strong> <strong>Health</strong> <strong>Initiative</strong><br />
Philip Wu, MD<br />
Northwest <strong>Permanente</strong><br />
Department of Pediatrics<br />
TrailLink 2007<br />
Public <strong>Health</strong>—designing communities with physical activity and<br />
active transportation in mind as a positive way <strong>to</strong> improve public c health.<br />
1
The “check-up”<br />
• 45-year old gentleman comes in for a check-up<br />
– Heterosexual relationship with two children<br />
– Spouse works part-time out of the home<br />
• Commutes 90 minutes <strong>to</strong> work each way—on a good<br />
day<br />
• Complains of “being tired all the time”<br />
2
The Stats…<br />
• 50 pounds overweight<br />
• Blood pressure 145/92<br />
• Elevated blood sugar<br />
• Cholesterol 270<br />
– HDL 25<br />
• Appears depressed<br />
3
His doc<strong>to</strong>r recommends…<br />
• Consultation with a<br />
nutritionist<br />
• Referral <strong>to</strong> the Severe<br />
Obesity Treatment Program<br />
• Mental <strong>Health</strong> referral for<br />
counseling<br />
• Pedometer—encouraged <strong>to</strong><br />
get 10,000 steps a day<br />
• <strong>Health</strong> Club membership<br />
• Better balance between work<br />
and home life<br />
4
Three months later…<br />
• 3 visits with the nutritionist<br />
• 6 mental health visits<br />
• Not a candidate for bariatric surgery<br />
• No time <strong>to</strong> exercise<br />
• No place <strong>to</strong> walk<br />
• Day is already <strong>to</strong>o full<br />
• Marriage and family life are on the rocks—he’s<br />
feeling worse than ever<br />
5
What’s s next?<br />
• Antihypertensive agent<br />
• Antidepressant agent<br />
• Anticholesterol agent<br />
• Antiglucose (AKA oral glucose lowering) agent<br />
• And a FAMILY THERAPY AGENT…<br />
6
Total monthly cost…<br />
$210<br />
7
But, what’s wrong with this picture?<br />
8
The power of partnerships<br />
• Improving our health<br />
requires more than just<br />
building bike lanes and<br />
walking paths or prescribing<br />
expensive drugs. It calls for<br />
multi-sec<strong>to</strong>r partnerships <strong>to</strong><br />
create thriving communities<br />
where…<br />
9
…making the HEALTHY CHOICE is the<br />
EASY CHOICE<br />
10
Why is <strong>Kaiser</strong> <strong>Permanente</strong> involved?<br />
• <strong>Health</strong> care is more than<br />
what happens in the exam<br />
room<br />
• Clinical interventions have<br />
limited impact<br />
• Physical activity should be a<br />
part of everyday life<br />
• We believe in “<strong>Community</strong><br />
<strong>Health</strong>”—neighbors<br />
engaging with each other <strong>to</strong><br />
create liveable communities<br />
11
Environmental barriers <strong>to</strong> walking and<br />
active transportation<br />
12
Why should physical activity be a part<br />
of everyday life?<br />
• It’s organic.<br />
• It’s cost effective.<br />
• It’s evidence-based.<br />
13
Physical activity is cost effective—<br />
relative benefits of cardiovascular<br />
interventions<br />
• Mediterranean diet<br />
• 65%<br />
• Smoking cessation<br />
• 60%<br />
• Physical activity<br />
• 50%<br />
• Blood pressure control<br />
• 42%<br />
• Lipid control<br />
• 25%<br />
• Aspirin for CAD<br />
• 25%<br />
• ACE inhibi<strong>to</strong>r for CHF/MI • 22%<br />
• Beta-blockers for MI<br />
• 18%<br />
• Tight blood sugar in DM2 • ?<br />
• Triglyceride/HDL control • ?<br />
• Vitamins<br />
• 0<br />
• Hormone replacement<br />
• 0<br />
14
Increasing physical activity in<br />
communities<br />
• Creation of places for<br />
physical activity with<br />
information outreach.<br />
• Urban design and land use<br />
changes.<br />
– <strong>Community</strong> scale.<br />
– Street scale.<br />
• Strong evidence.<br />
• Sufficient evidence.<br />
<strong>Community</strong> Guide <strong>to</strong> Preventive<br />
Services, CDC, 2006<br />
15
• What is <strong>Community</strong> <strong>Health</strong><br />
and why do we need multisec<strong>to</strong>r<br />
partnerships?<br />
16
An Expansive View of <strong>Health</strong><br />
<strong>Community</strong> <strong>Health</strong><br />
(<strong>Health</strong>y Behaviors)<br />
Medical Access<br />
<strong>Health</strong><br />
Outcomes<br />
Source: Prevention Institute<br />
17
Opportunity and the environment<br />
shape individual behavior<br />
Equitable opportunity<br />
•Racial justice<br />
•Jobs and local ownership<br />
•Education<br />
The people<br />
•Social networks and trust<br />
•Participation and willingness <strong>to</strong> act for<br />
the common good<br />
•Acceptable behaviors and<br />
attitudes<br />
The place<br />
•What’s sold and how<br />
it’s promised<br />
•Look, feel, and safety<br />
•Parks and open space<br />
•Getting around<br />
•Housing<br />
•Air, water, and soil<br />
•Arts and culture<br />
Source: Prevention Institute<br />
18
What is <strong>Kaiser</strong> <strong>Permanente</strong> doing?<br />
• Support physical<br />
environmental solutions and<br />
public policies and practices<br />
that encourage healthy<br />
eating and activity, and can<br />
result in shaping health<br />
behaviors<br />
19
<strong>Kaiser</strong> <strong>Permanente</strong> Northwest<br />
• <strong>Community</strong> Walkability <strong>Initiative</strong>, Clark County, WA<br />
– Awareness Campaign<br />
– Policy Team<br />
• Ten Toe Express, Portland Metro, Portland, OR<br />
– 2004 North Portland<br />
– 2005 East Portland<br />
– 2007 Southeast Portland<br />
– 2008 Southwest Portland<br />
• Metro Walking Guide, Portland Metro, Portland, OR<br />
– 2007+<br />
20
<strong>Community</strong> Walkability <strong>Initiative</strong><br />
Awareness campaign<br />
• Co-chaired by <strong>Kaiser</strong> <strong>Permanente</strong><br />
• What is community walkability?<br />
• Make the connection between a walkable<br />
environment and health<br />
• How <strong>to</strong> bring walkability ideas <strong>to</strong> family, workplace,<br />
and community<br />
• Walkability Guide<br />
• Provides maps for 25 trails, health information, and<br />
activity log—free of charge<br />
21
Awareness Campaign Team Members<br />
• <strong>Kaiser</strong> <strong>Permanente</strong> Northwest<br />
• City of Vancouver Department of Transportation<br />
• City of Vancouver Parks and Recreation<br />
• Clark County Public <strong>Health</strong><br />
• Legacy Salmon Creek Foundation<br />
• Vancouver Housing Authority<br />
• YMCA of Clark County, WA<br />
• <strong>Community</strong> Advocates<br />
22
<strong>Community</strong> Walkability <strong>Initiative</strong><br />
Policy Team<br />
• Understand current policies<br />
and how they are<br />
implemented<br />
• Focus on specific policy for<br />
further improvement and<br />
support<br />
• Active <strong>Community</strong><br />
Environments (ACE)<br />
assessment<br />
• Public opinion survey on<br />
bicycle and pedestrianrelated<br />
issues<br />
23
Policy Team members<br />
• <strong>Kaiser</strong> <strong>Permanente</strong><br />
• City of Vancouver <strong>Trails</strong><br />
• City of Vancouver Transportation Department<br />
• City of Washougal<br />
• Clark County Public <strong>Health</strong><br />
• <strong>Community</strong> Advocates<br />
• Regional Transportation Council<br />
• Sea-Mar <strong>Community</strong> <strong>Health</strong> Center<br />
• Vancouver School District<br />
• Washing<strong>to</strong>n Department of <strong>Health</strong>, Physical Activity Program<br />
• Washing<strong>to</strong>n State Department of Transportation, Southwest<br />
region<br />
24
Ten Toe Express<br />
• Neighborhood targeted<br />
walking campaign<br />
• Pedometer<br />
• Neighborhood walking map<br />
• Schedule of guided walks<br />
• Coupon book for local<br />
businesses<br />
• City of Portland measures<br />
outcomes<br />
– Drive alone time<br />
– Walking and biking trips<br />
25
Ten Toe Express Walking Campaign kit<br />
26
Ten Toe Express Outcomes<br />
• 2004<br />
– 27% increase in walking<br />
trips<br />
– 9% decrease in drive<br />
alone trips<br />
– 40% increase in bike<br />
trips<br />
Source: Social Data<br />
• 2005<br />
– 7% increase in walking<br />
trips<br />
– 8.5% decrease in drive<br />
alone trips<br />
– 23% increase in bike<br />
trips<br />
Source: Davis and Hibbits<br />
27
Springwater Corridor Trail<br />
28
Metro Walking Guide, 2007<br />
• Multnomah, Clackamas, Washing<strong>to</strong>n,<br />
and Clark counties<br />
• Increase the number of people walking<br />
for health and transportation<br />
• Walking guidebook destination-focused<br />
maps of walking route, including<br />
down<strong>to</strong>wns, main streets,<br />
neighborhoods, and parks<br />
– Patterned after Clark County<br />
Walkaround Guide<br />
– Each route begins and ends at a<br />
transit s<strong>to</strong>p<br />
• Walking campaigns in selected<br />
neighborhoods<br />
• Target date: Fall, 2008<br />
29
Metro Walking Guide Partners<br />
• <strong>Kaiser</strong> <strong>Permanente</strong><br />
• City of Gresham Transportation<br />
Management Association<br />
• City of Portland Transportation<br />
Options Division<br />
• City of Vancouver Department<br />
of Transportation<br />
• City of Wilsonville SMART<br />
• <strong>Community</strong> Choices 2010, Clark<br />
County, WA<br />
• <strong>Health</strong>y Eating Active Living<br />
Partnership<br />
30
Metro Walking Guide Partners<br />
• Metro Department of Parks<br />
and Greenspaces<br />
• Metro Department of<br />
Planning<br />
• Rose City Roamers<br />
• TriMet<br />
• Tualatin Hills Parks and<br />
Recreation District<br />
31
<strong>Kaiser</strong> <strong>Permanente</strong> Northwest<br />
• Oregon House Bill 3141—<br />
school physical education<br />
requirements<br />
• “HIA Action Team”<br />
• Regional Equity Atlas<br />
32
<strong>Kaiser</strong> <strong>Permanente</strong><br />
Nationwide<br />
• Metro Branch Trail, Washing<strong>to</strong>n, DC<br />
– <strong>Rails</strong> <strong>to</strong> <strong>Trails</strong> partnership<br />
• Bellflower Greenway Project, Bellflower, CA<br />
• Baldwin Park Walking Audit, Baldwin Park, CA<br />
33
Metro Branch Trail, Washing<strong>to</strong>n, DC<br />
• 8-mile walking trail from DC <strong>to</strong> Silver Spring, MD<br />
• <strong>Rails</strong>-<strong>to</strong>-<strong>Trails</strong>, DC Department of Transportation, and <strong>Kaiser</strong><br />
<strong>Permanente</strong> partnership<br />
• One-mile segment between two Metro s<strong>to</strong>ps<br />
– Recreational use<br />
– Active transport connecting neighborhoods<br />
• Needs assessment research and community engagement<br />
– Recreational and physical activities resources, needs, and<br />
opportunities<br />
– Strategies <strong>to</strong> increase physical activity for members of target<br />
communities<br />
34
Metro Branch <strong>Trails</strong>, Washing<strong>to</strong>n, DC<br />
35
Bellflower Greenway Project<br />
Bellflower, CA<br />
• Former Pacific-Electric right-of-way owned by Metro<br />
Transportation Authority<br />
• Bicycle and pedestrian trail, landscape<br />
improvements, rest s<strong>to</strong>p at Civic Center Gateway<br />
• Eventually continue in<strong>to</strong> and complete four-cities<br />
greenway<br />
– Connect <strong>to</strong> Los Angeles County Trail system<br />
36
Baldwin Park Walking Audit, 2006<br />
• Walking audit conducted by<br />
teens<br />
• “Walk Baldwin Park Event”<br />
– Facilitated presentation of<br />
teen audit results<br />
– What makes a walkable<br />
community?<br />
– Participants repeated a<br />
“mini-audit” with report-out<br />
• Final report <strong>to</strong> Baldwin Park City<br />
Council with specific<br />
recommendations<br />
37
Baldwin Park Walking Audit, 2006<br />
• Sponsors: <strong>Kaiser</strong><br />
<strong>Permanente</strong> and California<br />
Center for Public <strong>Health</strong><br />
Advocacy<br />
• Facilita<strong>to</strong>rs: Prevention<br />
Institute and RSA<br />
Transportation and Policy<br />
Analysis<br />
38
What makes an effective partnership?<br />
• Shared and individual, but complementary goals<br />
• Clear understanding of each partner’s values (and language)<br />
• Mutual respect, trust, gratitude—and support of partner’s<br />
particular goals<br />
39
The Power of Partnerships…<br />
40