Healthy Connections Network...

ISSUES THAT IMPACT HEALTH EQUITY

 

  • FOOD EQUITY
  • TRANSPORTATION
  • HEALTH CARE ACCESS
  • HEALTHY HOUSING

Food Equity

The Need….

In 2010, a Community Health Assessment was commissioned by Akron Children’s Hospital, Akron General Medical Center, and Summa Health System.  The results of the assessment pointed to the need to increase access to affordable fresh foods for our county’s residents. Over 1,500 Summit County residents participated in the Community Health Assessment and dozens of organizations partnered to distribute surveys and convene focus groups. The primary data collection portion of the assessment intentionally oversampled underserved populations.

Residents indicated a desire for a culture of health promotion and disease prevention, expressing the need to eat more fresh vegetables and fruits.  Many participants said that  they have received the directive from health care providers to eat healthier foods, but need  support accomplish that goal.  A significant percentage of those living in urban areas said that they do not have access to affordable fresh foods and that they need to learn how to prepare healthy nutritious meals. Participants also indicated the desire to transform family cultures and traditions that favor unhealthy foods. Many focus group participants expressed a deep desire to empower families and educate/support parents to help their children transform their diets. Immigrant populations shared deep concern about increasing levels of obesity and diabetes within their communities due to inability to read nutritional labels and decreased access to affordable traditional fresh foods. They also indicated the introduction of affordable American fast foods as a major influence.

The assessment also revealed a relationship between household income, race and chronic conditions such as obesity and diabetes. Both conditions are significantly impacted by diet. Generally, obesity rates go down as income rises. In Summit County, Black adults show obesity percentages above the national rate and higher than the other races. Hispanic adults show overweight percentages above national levels and higher than the other races. Similar to obesity, diabetes rates are higher than the national rate in Summit County and highest in those residents with the lowest incomes. Black adults are impacted at higher levels than other races.


Community Response…

Summit County Food Policy Coalition

 

Growing Hope Food Summit  
The Growing Hope Food Summit was held in April, 2011 “to create a shared awareness of our local food system and its gaps, launch a movement to increase access to healthy food, explore ways to strengthen the local food economy, and connect and begin to empower Summit County residents to act collectively.”  The Growing Hope Food Summit engaged 250 very diverse participants, included interpretation for 3 language groups and demonstrated a high level of interest around healthy and local food resources in Summit County.

The Summit resulted in several recommendations and post-Summit goals:

  • Change our collective mindset that will lead to eating more healthy food
  • Build local demand for local produce/food (i.e. restaurants, schools, grocers, and corner stores)
  • Launch a process to develop a Food Charter that will become a tool for public officials, businesses and organizations to create policy and make decisions
  • Create businesses to support the local food economy
  • Encourage individuals, organizations and communities to start growing food
  • Coordinate existing resources to fill existing needs (i.e. connect farmers/gardeners to food desert areas; generate more farm to school partnerships)
  • Identify gaps and begin to strategize to act and fill (i.e. develop tools such as Healthy Bucks to leverage dollars)
  • Build a movement (i.e. Grow & Buy Local; more people shopping at farmer’s markets; more food being grown in family yards/vacant lots; new businesses being created)
  • GROWING HOPE FOOD SUMMIT OUTCOMES REPORT

Summit Food Policy Steering Committee currently includes:

Chris Norman, Crown Point Jerry Egan
Beth Knorr, Countryside Conservancy Tom Lukes
Bob Howard Oscar BaAye, Karen Community
Malcolm Costa, Akron Summit Community Action Ms. Julie Wandling Costell, Ms. Julie's Kitchen and Cafe
Veronica Sims, Akron Summit Community Action Sue Lacy and Katie Fry, Round River Consulting, LLC
Sarah Vradenburg, Summit County Master Gardeners  


Summit County Food Policy Coalition

Summit Food Policy Coalition works to improve healthy food access for all Summit County residents and spur economic opportunities for existing and beginning farmers.  Anyone in the community who feels strongly about these issues and wants to get involved is welcome.  Goals and objectives include:

  • Policy Development: At local and regional level to  encourage preservation and support of agricultural lands, raising of food and farm animals on private property, enable reuse of vacant lands within municipalities food growing (community gardens and urban farming)
  • Advocacy for Healthy Food Access: Encourage the distribution of healthy foods throughout all segments of the community, support the ability of households of all economic levels to purchase healthy foods, identify the distribution of food access throughout the County for the purpose of determining where gaps exist,  support the expansion of the availability of local foods within the mainstream food market, including convenience stores, corner stores and public or private institutions, and encourage the growth of personal gardening on private property and in community gardens.
  • Entrepreneurial and Market Development:  Encourage the development and growth of new and existing farmers, including small microenterprise or niche activities, develop financial and technical assistance to support the development of new agricultural activities including use of the waste stream, promote buy local food campaigns and the development of alternative food outlets, and encourage the purchase of local foods by institutions with large food delivery opportunities such as schools and hospitals.
  • Education: Educate the public on lifelong healthy food choices, promote the benefits of local food purchases, provide a clearinghouse of information and contacts that link the public to opportunities to grow, purchase, and consume local foods.

Organizers of the group include Jerry Egan, Local Food Networking Specialist, and Coalition Tri-Conveners Denise Ellsworth (OSU Extension), Beth Knorr (Countryside Conservancy), and Chris Norman (Crown Point Ecology Center).

 

Mapping of Food Market Distribution

Mapping of food market distribution in Summit County: grocery stores: size and market areas, supplementary grocery store food options, driving time to groceries, distribution in below poverty areas, accessibility by METRO bus routes/stops, and distribution by density of persons under 18 years.  Mapping determined that all residents of Summit County are no more than 10 minutes by car from a grocery and 85% are within a one mile radius of a food store.

 

Summit County Food Charter

The Charter is designed to guide individual and community actions that support local food systems.  The Charter addresses these ideas:

      • Making sure nutritious food is available and within reasonable distance to all
      • Actively encouraging growing food for personal use
      • Providing education on growing, preparing and eating nutritious food
      • Supporting regional agriculture as a business by encouraging the sale, distribution and purchase of locally grown food in area markets, grocery stores, restaurants, schools and other institutions directly from farmers
      • Developing policies that preserve farm land, encouraging the use of vacant urban land for agriculture and permitting the raising of animals for food production
      • Supporting farming by training new farmers and an agricultural workforce, supporting the sale of existing farms to new farmers, enacting prudent farming regulations and encouraging best farming practice
      • Supporting existing local food businesses and new food-related entrepreneurial opportunities through investment, incubators, micro-credit and other financial incentives

Summit County Council and Akron City Council have approved the Charter.  The Charter will be presented for endorsement to Cuyahoga Falls and Bath Councils.  Some organizations will also be asked to endorse the charter. 

 

“Talking in the Garden”

Akron Summit Community Action Inc. (ASCA) has a long history of being concerned with access to food. ASCA is currently supporting local community gardening is the Summit Lake area and has an upcoming program “Talking in the Garden Series 2012.”  The program will include presentations and demonstrations in the gardens: how to grow things and how to use items grown. “For every $1 spent on gardening, there is a $6 return.”  ASCA is also working with the “corner store” program in Summit County along with the Summit County Food Policy Coalition.  A program titled “Taste it and Make It” will be conducted in stores: a food dish will be provided for tasting, along with ingredients and recipes. ASCA will also be doing a collaboration with AMHA to add a greenhouse and chickens to gardens at Summit Lake. 

 

Special Food Needs of Ethnic Populations in Summit County

The Burmese population in Summit County is an example of these special needs.  Representing this community, Oscar BaAye has shared these ideas:

“The Koren people, from East Burma, have been forced from Burma as refugees due to ethnic cleansing by the Burmese government. About 40,000 have come and have come to the United States since 2001, from five different refugee camps. Over 1000 have settled in the Akron/Cleveland area. The culture of this group is subsistence farming and, when able to purchase homes, they will begin to till the land. Access to grocery stores is necessary in the U.S. The Koren eat lots of vegetables, but have developed a taste for white rice in the U.S.  The incidence of diabetes is increasing in this opulation group. The City of Akron has helped by providing land in community gardens and opening hydrants to water gardens to grow vegetables they are used to. The Koren need education on how to use local resources and need mentors to assist them. This is a population that tends to stay “under the radar.” There is another Burmese ethnic population, the Mon, on the south side of Akron.”

 

“Let’s Move, Summit County!”

Let’s Move! is a comprehensive initiative, launched by the First Lady Michelle Obama. The program is dedicated to solving the problem of obesity within a generation, so that children born today will grow up healthier.  Combining comprehensive strategies with common sense, Let’s Move! is about putting children on the path to a healthy future during their earliest months and years. Giving parents helpful information and fostering environments that support healthy choices, providing healthier foods in our schools, ensuring that every family has access to healthy, affordable food, and, helping children become more physically active. In Summit County, Paula Prentice (Summit County Council) has spearheaded “Let’s Move, Summit County!” The local program will address food and activity in neighborhoods, sponsoring four walks scheduled to begin in June, 2012. The intention is for the program to be on-going.

Achieving Transportation Equity in Summit County
Images_transportation

The Need….

Transportation impacts health directly.  It affects air quality, injury risk, physical activity levels, and access to necessities such as grocery stores. Transportation is also one of the largest drivers of land use patterns. It determines whether communities have sidewalks and areas to play and be physically active, as well as whether communities are connected to or isolated from economic and social opportunities.

Research shows that low-income communities and communities of color often do not have access to the benefits our transportation system can provide, yet they bear the burdens of that system. For example, many low-income neighborhoods have little or no efficient, reliable public transportation to get them to jobs and essential goods and services.  But these communities are often situated near bus depots, highways, and truck routes, where pollution levels are high—and not coincidentally, asthma rates are high as well.  Many of these
same communities live without safe, complete sidewalks or bike paths, making walking and biking difficult and often dangerous. As a result these neighborhoods have low levels of physical activity and high rates of chronic diseases.

Creating a more equitable transportation system must lie at the core of any analysis of transportation or health, and it must guide reform. Leaders, experts,and advocates from many spheres—public health, environmental justice, food policy, agriculture, labor, equity, community economic development, business, and government—must join in partnership to push for broad reform. Collectively, we can build support for creating transportation systems that nourish healthy communities.

 “The Transportation Prescription,” published by Policy Institute www.policylink.org, The Prevention Institute www.preventioninstitute.org, and the Convergence Partnership www.convergencepartnership.org, outlines the relationship between health and transportation policy, defining policy and program priorities to improve health and health equity.   Click for Transportation RX report.

 

Community Responses…

Transportation and Health: Place Making and Parking 
Jerry Egan, Consultant

Mr. Egan described local context regarding transportation with emphasis on efforts to create walkability and encourage walking in local communities.  “Walking is the simplest, easiest form of physical activity. It should be a part of lifestyle, not a form of exercise.” It is important to design our communities to enhance the walk appeal.
Click for Place Making and Parking presentation.

Complete Streets Project  
Christopher Alvarado, Associate Senior Planner, Cuyahoga Planning Commission and Bike Cleveland

“The streets of our cities and towns are an important part of the livability of our communities. They ought to be for everyone, whether young or old, motorist or bicyclist, walker or wheelchair user, bus rider or shopkeeper. But too many of our streets are designed only for speeding cars, or worse, creeping traffic jams. Now, in communities across the country, a movement is growing to complete the streets. States, cities and towns are asking their planners and engineers to build road networks that are safer, more livable, and welcoming to everyone. Instituting a Complete Streets policy ensures that transportation planners and engineers consistently design and operate the entire roadway with all users in mind - including bicyclists, public transportation vehicles and riders, and pedestrians of all ages and abilities.” http://www.completestreets.org/

Cuyahoga County is participating in the National Complete Streets Coalition.  The goal of Cuyahoga County’s project is “better urban design to active living.” A Complete Street is safe, comfortable and convenient for travel via automobile, foot, bicycle, and transit. Mr. Alvarado described different types of Complete Streets, noting that about 1/3 of Americans do not drive, physical inactivity is a problem, and streets that incomplete streets are inadequate and not safe, especially for pedestrians and cyclists.  The Built Environment can promote or deter positive health choices and motivation. A complete streets policy ensures that the entire right of way is routinely designed and operated to enable safe access for all users.
Click for Complete Streets presentation.



Local Biking Initiatives: Andy Davis, Traffic Engineering, City of Akron

Mr. Davis described Akron biking initiatives, noting that active transportation is a major key in battling obesity. There needs to be a change in the frame of mind to incorporate active transportation such as bicycling or walking).  Mr. Davis said that a range of 2-5 miles is considered very “bikeable” and this range incorporates most of the City of Akron.  He noted that many Akron buses now have bike rakes, enabling bikers to extend the feasible range for bike transportation.  The Akron Bike Club (http://akronbike.org/) provides resources for persons interested in bike transportation.



Regional Policy, Connecting Communities Initiative, and Regional Bike Plan   

Curtis Baker, Planning Administrator, AMATS

Mr. Baker participates in a regional planning group that includes representatives of 42 communities in Northeast Ohio.  An abundance of information regarding local transportation planning is available at http://www.amatsplanning.org/. AMATS is currently involved in a Connecting Communities initiative. The purpose of “Connecting Communities – A Guide to Integrating Land Use and Transportation” is to promote a region that balances environmental, social and economic concerns by improving coordination between land use and transportation, including a regional bike plan. A Bike User Map is available on request via the AMATS web site and at http://switching-gears.org/, another resource for local bikers.

 

Health Care Access

The Issue….Affordable Care Act (ACA): Local Implications

On November 2, 2012, HCN held a panel discussion to examine local implications in the implementation of the Affordable Care Act. Moderators for the panel discussion were Marie Curry, Health Policy Advocate, Community Legal Aid and Tracy Carter, Director, Government Affairs and Health Policy, Summa Health System. Panelists included Dottie Achmoody, CEO, OPEN-M (Free Clinic), Kris Drummond: CEO, Akron Community Health Resources (FQHC), Dr. Thomas L. “Tim” Stover: President and CEO, Akron General Health System       (Hospital), Anne Armao, Vice-President of Marketing and Product Development, Summa Care (Insurance Provider) and Kerry Kernen: Assistant Director, Community Health, Summit County Public Health (Public Health).

Panelists examined the following questions:

1. What do you see as the most important challenges facing organizations like yours (hospitals, payers, FQHC, free clinic, health department) in preparing for full implementation of the ACA?
2. What does the concept of “Patient Centered Medical Home” mean for local providers in the future?
3. What priority policy changes should be considered to improve access and care quality while controlling costs?

 

Panelist Responses…

A.        Major challenges include:

  • Major institutional changes resulting from ACA are happening at extremely fast pace, stressing systems.
  • Balancing of reimbursement:  The focus will have to change.
    • Providers will do what is incentivized through reimbursement.
    • Medicare reductions will impact, with no added dollars for service provision enhancements.
    • Providers will be place in competition for shrinking resources by value-based purchasing. Any bonuses for one will be taken from another.
  • Workforce concerns:
    • Shortage of primary care and other physicians. There is uncertainty and discouragement among physicians concerning potentially cumbersome reimbursement processes.
    • Medical malpractice issues were not addressed by the ACA.
    • Potential need for increased mid-level providers.
    • Providing health insurance access does not mean a provider will be available.
  • New methods are needed to help people newly enrolled to navigate insurance options, make    decisions, and obtain needed social services such as transportation, housing. There will be an increased need for enabling services, i.e. translation, social service.
  • Impact of insurance exchange regulations: It appears that Ohio will have a federal exchange.
  • Increased need for accurate and best information for those who need to understand community resources: there is a need to build data capacity and develop strategies for community-wide sharing of information.
  • There will be continued need for providers like free clinics, though the landscape may change. It is not yet clear which care gaps will emerge that safety net providers will need to address. Community donors will need information to understand the need for continued support of safety net services.

B.        What does the concept of “Patient Centered Medical Home” mean for local providers in the future?

  • Public Health: Direct care services of public health will continue to focus on statute-driven services such as tuberculosis and STD control. Provision of medical homes is not a mission of public health, but public health can help with population-based linkages.
  • Free Clinic: Not currently a patient centered medical home, but will need to strive over time to address what is required.
  • Federally Qualified Health Center: Provides open access and linked services. Has many elements of a patient centered medical home, but will be challenged to develop electronic information exchange with other providers.
  • Insurance Provider: Summa Care is a proponent of the medical home concept and has connected with some pilot programs for this. Has seen a reduction in readmissions for some conditions such as congestive heart failure.
  • Hospital: The patient has always been seen as “at the center.” The Patient Centered Medical Home concept does stimulate the primary care physician to teach, but payment for such services is needed. A population-based approach can help, but will require a culture shift, i.e. changes in both expectations by patients and in types of providers.

C.        What priority policy changes should be considered to improve access and care quality while controlling costs?

  • Timelines should be considered.  The rapid pace for states to respond to required changes is “murderous.”
  • The ACA did not address support of free clinics which serve gaps in care to and provide prevention services for the uninsured.
  • Care coordination by public health should be reimbursed. 
  • Policies addressing social determinants of health are needed. Public health can connect with organizations such as DJFS for needs analysis focused on policy change.
  • Increased support (centralized and decentralized) for FQHC can increase access:
    • Expansion of telehealth strategies
    • Increased support for professional education, e.g. student loan forgiveness for service
  • Change from current focus on sick care and move toward wellness care: how can this be incentivized?  The sick care focus is unsustainable. Policy can impact change, especially through youth.
  • Currently Medicare reimbursement does not cover costs. If, in 3 years, 70% of hospital patients are government insured, hospitals will be losing money. Currently the average physician spends 90 minutes daily on paper work, adding up to a national bill of $780 billion per year for reporting. Implementation of new ICD 10 codes will cost millions locally. The key is to deliver value and this must occur. Early detection of chronic diseases such as diabetes can significantly reduce costs. For example, early detection of metabolic syndrome, a precursor of diabetes, could take $800 billion in care costs out of the system. The private market, business, and policy makers must collaborate to find answers.
  • Behavioral health services need enhancement. There is a critical need to address the relationships between behavioral and physical health. Persons with behavioral health conditions who are seen in Emergency Departments often have 4-5 physical health comorbidities (illnesses).
  • Care continuity is another critical element that must be addressed. Life style changes must be part of chronic disease treatment, control and prevention.
  • The health impact of community policies needs to be overt. Each personal decision can be the “default” healthy decision in a community environment that promotes this. 

Image_houses Healthy Housing

 

The Issue…

There is strong evidence that links social circumstances to health, but little guidance for health care practitioners and institutions on addressing social needs in clinical settings. Current approaches to social determinants generally focus on population-level and policy interventions and often overlook individual and clinical innovations within health care that can address patients' social circumstances. Social determinants can be addressed by interventions in the health care system at the patient, institution, and broader population level.

 

Perspectives…

At its April 26, 2013 meeting, HCN initiated discussion of Healthy Housing with a showing of the PBS documentary film: “Unnatural Causes: Place Matters” (www.unnaturalcauses.org). The film examines neighborhoods in several communities, focusing on three themes:

  • Built space and the social environment have a direct impact on residents’ health.
  • Neighborhood conditions can have an indirect impact on health by making healthy choices easy, difficult or impossible.
  • Public policy choices and private investment decisions shape neighborhood conditions.

P. Cooper White, M.D., addressed the meeting, discussing the impact of poor housing environments on health. Dr. White is currently Director, Locust Pediatric Care Group, Akron Children’s Hospital, Akron, Ohio. In 2011, he received the Legendary Service Award from Akron Children’s Hospital, Department of Pediatrics. He is a Physician leader, Ohio Chapter AAP, Chapter Quality Network Asthma Collaborative and a Clinical Associate Professor of Pediatrics, NEOMED.  Dr. White high-lighted medical legal partnerships as a method of helping families improve housing and address issues such as absentee ownership and keeping resources in a community to improve housing. Medical Legal Partnerships integrate lawyers as a vital component of the health care team. (http://www.medical-legalpartnership.org/center)

Dr. White noted the Cincinnati Children’s Hospital Medical Center Child Health-Law Partnership (Child HeLP) program as one successful program.  Child HeLP is an innovative medical-legal partnership between the Cincinnati Children’s primary care centers and the Legal Aid Society of Greater Cincinnati to help patient families resolve legal and social issues that often undermine the health and well-being of their children. (http://www.cincinnatichildrens.org/service/g/gen-pediatrics/services/child-help/)

At its July 26, 2013 Community Meeting, HCN will continue the focus on Healthy Housing with a panel of experts representing local individuals and organizations that are working to address the issue of Healthy Housing in our own community. Local concerns and potential approaches to solutions will be discussed.