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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

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