1. Healthy Anne Arundel Coalition “A Ripple Effect” May 16, 2012 1 Healthy Anne Arundel Coalition

2. Healthy Anne Arundel Coalition VISION Healthy County, Healthy People! May 16, 20122Healthy Anne Arundel Coalition

3. Healthy Anne Arundel Coalition MISSION Working together as a community to promote the health and wellness of Anne Arundel County residents May 16, 20123Healthy Anne Arundel Coalition

4. Anne Arundel County ~ Who Are We? Area: 416 square miles Population 537,656 (2010) § Geography: Rural south county Rural south county Urban/suburban northern and mid-county Urban/suburban northern and mid-county Anne ArundelMarylandU.S. Racial/Ethnic Breakdown: White72.4%54.7%63.7% Black15.2%29.0%12.2% Hispanic6.1%8.2%16.3% Asian3.4%5.5%4.7% Median Household Income (2010) *$79,843$69,193$50,221 Unemployment (January 2011) † 6.5%7.5%9.8% Uninsured Adults (2010) ¶ 10.3%12.9%17.8% Individuals Below Poverty (2010)6.8 %9.2%14.3% § US Census, 2010; * American Community Survey, 2010; ¶ BRFSS, 2010; † Bureau of Labor Statistics, January 2011 May 16, 20124Healthy Anne Arundel Coalition

5. Public Health Context  Reductions in federal, state and local funding for public health has required a collaborative approach to leveraging local resources to improve the public’s health  Economic and policy incentives (inc. Health Care Reform) will require public and private sector providers to promote: Prevention and wellness Prevention and wellness Health equity and reduction in health disparities Health equity and reduction in health disparities Patient satisfaction Patient satisfaction May 16, 20125Healthy Anne Arundel Coalition

6. Background to the SHIP  Maryland’s Health Reform Coordinating Council has recognized the importance of local health improvement coalitions (LHICs)  The Maryland Governor and Legislature have committed State support to LHICs in SFY 2012 budget  The Maryland Hospital Association provided start-up funds to LHICs  The Maryland Community Health Resources Commission provided implementation funding to LHICs  Local health improvement plans are a prerequisite for local health department accreditation May 16, 20126Healthy Anne Arundel Coalition

7. State Health Improvement Process (SHIP)  Provides a framework for accountability, local action, and public engagement  Identifies 39 critical health measures  Requires each County to develop a Local Health Improvement Coalition (LHIC)  Requires each LHIC to develop and implement a Local Health Improvement Action Plan May 16, 20127Healthy Anne Arundel Coalition

8. Rationale for SHIP and LHICs  Federal goals related to Healthy People 2020  Reductions in federal, state and local funding for public health  Increased health care costs related to preventable health conditions  Increased focus on prevention and wellness  Increased focus on health equity and reduction of health disparities  Increased demand for public health accreditation May 16, 20128Healthy Anne Arundel Coalition

9. What Affects “Good Health?” Environment Lifestyle Human Biology Management of Illness Source: Presentation by Rodney B. Glotfelty, RS, MPH, Garrett County Health Officer. "Public Health 101 - A Maryland Perspective." Maryland Association of Counties Winter Conference, January 4, 2007 May 16, 20129Healthy Anne Arundel Coalition

10. Public Monies Spent on “Good Health” May 16, 201210 Management of Illness Human Biology Lifestyle Environment Source: Presentation by Rodney B. Glotfelty, RS, MPH, Garrett County Health Officer. "Public Health 101 - A Maryland Perspective." Maryland Association of Counties Winter Conference, January 4, 2007 Healthy Anne Arundel Coalition

11. Pay Now for PREVENTION Instead of Paying Later for Care and Treatment A Paradigm Shift “From Treatment To Prevention” May 16, 201211Healthy Anne Arundel Coalition

12. Anne Arundel County SHIP Data Anne Arundel County High Impact Objectives  High Morbidity Impact Reduce ED visits from: Reduce ED visits from: AsthmaAsthma DiabetesDiabetes HypertensionHypertension Behavioral health conditions (mental health and substance abuse)Behavioral health conditions (mental health and substance abuse)  High Mortality Impact Reduce deaths from cancer and heart disease Reduce deaths from cancer and heart disease  Multiple Impact Reduce overweight/obesity Reduce overweight/obesity Improve maternal and infant health Improve maternal and infant health Reduce tobacco use Reduce tobacco use Increase access to health care Increase access to health care May 16, 201212Healthy Anne Arundel Coalition

13. Leading Causes of Death Anne Arundel County, 2010 1. Heart Disease 2. Cancer 3. Stroke 4. Chronic Lower Respiratory Diseases 5. Diabetes 6. Unintentional Injuries 7. Influenza and Pneumonia 8. Septicemia 9. Alzheimer’s Disease 10. Suicide Anne Arundel County Report Card available at www.aahealth.org/statistics May 16, 201213Healthy Anne Arundel Coalition

14. Rank Health Outcomes Rank Health Factor 1 Howard 2 Montgomery 3 Queen Anne's 3 Frederick 4 Frederick 4 Talbot 5 Carroll 6 Calvert 7 St. Mary's 7 Anne Arundel 8 Talbot 8 Harford 9 Harford 9 Queen Anne's 10 Anne Arundel 10 Baltimore 11 Charles 12 Washington 12 St. Mary's 13 Baltimore 13 Kent 14 Worcester 14 Garrett 15 Prince George's 15 Worcester 16 Garrett 16 Washington 17 Kent 17 Prince George's 18 Cecil 18 Allegany 19 Wicomico 20 Caroline 20 Cecil 21 Somerset 21 Caroline 22 Dorchester 23 Allegany 23 Somerset 24 Baltimore City Source: County Health Rankings 2012, available at www.countyhealthrankings.org May 16, 201214Healthy Anne Arundel Coalition

15. Source: County Health Rankings 2012, available at www.countyhealthrankings.org May 16, 201215Healthy Anne Arundel Coalition

16. Public Health Partnerships 1. Public Sector 2. Health Care Providers/Payers ** 3. Community Based Partners 4. Employers/Business Community 5. Academic Partners **Health Care Providers/Payers HospitalsHospitals FQHCsFQHCs PharmaciesPharmacies InsurersInsurers Community Health CentersCommunity Health Centers Health Care ProfessionalsHealth Care Professionals Successful public health initiatives often have multiple and diverse partners including: May 16, 201216Healthy Anne Arundel Coalition

17. Structure of the Healthy Anne Arundel Coalition May 16, 2012Healthy Anne Arundel Coalition 17

18. Healthy Anne Arundel Coalition Structure Coalition Steering Committee Coalition Network Partnership for Children, Youth, & Families CBOs/FBOs/ Volunteers/ Community Reps School Health Advisory Council Drug and Alcohol Abuse Council County Board of Education County Detention and Corrections Facilities Department of Social Services Department of Aging and Disabilities County and City Recreation and Parks Mental Health Agency Arundel Community Development Services Anne Arundel County Public Schools County Agencies, Offices, Departments and Partners Examples Boards, Coalitions, Councils and Committees Examples Conquer Cancer Coalition FIMR and CFR Committees City Housing Authority & County Housing Commission County and City Police and Fire Department Large Employers & Businesses American Heart Association May 16, 201218Healthy Anne Arundel Coalition

19. Steering Committee Promotion and Publicity Subcommittee Co-Occurring Disorders Steering Committee Community Health Needs Assessment Workgroup Community Outreach Subcommittee Obesity Prevention Workgroup Leadership and Finance Team Healthy Anne Arundel Coalition Implementation Structure May 16, 201219Healthy Anne Arundel Coalition

20. Healthy Anne Arundel Coalition Levels of Engagement  Steering Committee Member  Network Group Member  Network-Steering Committee Liaison  Special Invitee to Steering Committee Meetings  Expert Consultant  Project/Initiative Leader  Resource Partner  Consumer/Client/ Former Patient  Community Representative  Observer  Volunteer May 16, 201220Healthy Anne Arundel Coalition

21. Healthy Anne Arundel Coalition Management and Staffing  Chair and Chair Designees  Vice Chairs  Steering Committee  Network Members  Staffing Support  Implementing Organizations May 16, 201221Healthy Anne Arundel Coalition

22. Healthy Anne Arundel Coalition Guiding Principles  Utilize Existing Groups  Flexibility  Inclusive and Welcoming  Embrace Change  Transparent May 16, 201222Healthy Anne Arundel Coalition

23. Healthy Anne Arundel Coalition Collaborative Process – Values 1. COMMUNICATING - exchanging information through networking for mutual benefit and to achieve a common purpose 2. COORDINATING - exchanging information and altering activities for mutual benefit and to achieve a common purpose 3. COOPERATING - exchanging information, altering activities, & sharing resources for mutual benefit and to achieve a common purpose 4. COLLABORATING - exchanging information, altering activities, sharing resources, and enhancing the capacity of another for mutual benefit and to achieve a common purpose May 16, 201223Healthy Anne Arundel Coalition

24. Healthy Anne Arundel Coalition Intervention Framework  Individual/Group level  Community/Societal  Structural/Policy May 16, 201224Healthy Anne Arundel Coalition

25. Healthy Anne Arundel Coalition Social-Ecological Model Source: Marjorie Buchanan, RN, MS, CPH, Clinical Director, Community and Public Health Nursing, University of Health School of Nursing May 16, 201225Healthy Anne Arundel Coalition

26. Healthy Anne Arundel Coalition Measures of Success  Decreased emergency department visits  Decreased preventable hospitalizations  Decreased hospital readmissions  Decreased pharmaceutical costs  Increased quality of life Joint Community Needs Assessment to gain a baseline and monitor success May 16, 201226Healthy Anne Arundel Coalition

27. Coalition Influence and Reach (1) May 16, 201227 OrganizationEmployeesReachWellness Program A.A. Co. Dept. of Health710All Co. residentsYes Anne Arundel Health System 3,60080,000+ ED visits; 25,000+ inpatient Yes Baltimore Washington Medical Center 2,600100,000+ ED visits; 30,000 in outreach Yes A.A. Co. Public Schools8,000+76,000+ studentsYes A.A. Community College1,000+15,000+ studentsYes Preliminary Data – Healthy Anne Arundel Coalition May 2012 Healthy Anne Arundel Coalition

28. Coalition Influence and Reach (2) May 16, 201228 OrganizationEmployeesReachWellness Program A.A. Co. Dept. of Aging & Disabilities 100Older and disabled Co. residents Yes A.A. Co. Dept. of Detention Facilities 4007,800 inmates/yearYes A.A. Co. Dept. of Recreation & Parks 300500,000+ County residents & visitors Yes A.A. Co. Dept. of Social Services 35060,000+ familiesYes A.A. Co. Executive’s Office/County Employees 19/TBD500,000+ County residents Yes City of Annapolis60038000Yes Preliminary Data – Healthy Anne Arundel Coalition May 2012 Healthy Anne Arundel Coalition

29. Coalition Influence and Reach (3) May 16, 201229 OrganizationEmployeesReach Wellness Program MedStar Harbor Hospital1,400Approx. 185,000 County residents Yes Rite Aid Corporation150 (in Co.)15,000 customers per week in County Yes CareFirst BlueCross BlueShield 5,000 (in Baltimore/ DC area) 3.4 million in MD Yes People’s Community Health Centers, Inc. 12114,600 unduplicated clients/ year Yes TOTAL ~ 20,000 ~ 300,000+ ALL! Preliminary Data – Healthy Anne Arundel Coalition May 2012 Healthy Anne Arundel Coalition

30. Healthy Anne Arundel Coalition Health Improvement Focus Areas  Obesity*  Mental Health & Substance Abuse as Co-Occurring Disorders*  Cancer and Tobacco Use  Dental Care  Sexual Health  Housing and Environmental Conditions *Designated Priority Areas May 16, 201230Healthy Anne Arundel Coalition

31. Priority # 1 Obesity Prevention May 16, 2012Healthy Anne Arundel Coalition 31

32. Adult Obesity – Not Sustainable! May 16, 2012Healthy Anne Arundel Coalition32 Percent of Obese Adults By Year for Anne Arundel County, Maryland, and the US Data source: National BRFSS Bend the obesity curve ~ a call to action!

33. Adult Obesity May 16, 2012Healthy Anne Arundel Coalition33 Weight Status by Race for Anne Arundel County, 2007 Data source: Anne Arundel County Behavioral Risk Factor Survey, 2007

34. Childhood Obesity May 16, 2012Healthy Anne Arundel Coalition34 Weight Distribution by Age Group for Children and Adolescents, 2006 Data source: Anne Arundel County Department of Health Provider-based County Survey of Children and Adolescents, 2006

35. disparities Source: Maryland Health Services Cost Review Commission Health Disparities May 16, 201235Healthy Anne Arundel Coalition

36. disparities Source: Maryland Health Services Cost Review Commission Health Disparities May 16, 201236Healthy Anne Arundel Coalition

37. Six Target Behaviors: Eat Healthier… 1. 1.Increase consumption of fruits and vegetables 2. 2.Increase breastfeeding initiation, duration, and exclusivity 3. 3.Decrease consumption of sugar sweetened beverages 4. 4.Decrease consumption of high energy dense, nutrient poor, foods Move More… 5. 5.Increase physical activity 6. 6.Decrease television viewing Source: CDC Obesity Prevention: Individual Level May 16, 201237Healthy Anne Arundel Coalition

38. Worksite Wellness Programs  Resources for starting or strengthening worksite wellness programs include: Benefit Administration Human Resources Departments Workplace Wellness Initiatives Centers for Disease Control and Prevention State Health Departments Local Health Departments Local Health Improvement Coalitions May 16, 201238Healthy Anne Arundel Coalition

39. Obesity Prevention: Workplace Level Eat Healthier!  Increase Access to Healthy Foods Healthy food options at meetings and events Healthy food options at meetings and events Healthy vending options Healthy vending options Move More!  Promote Physical Activity Walking programs/courses Walking programs/courses Onsite fitness classes/ equipment Onsite fitness classes/ equipment Subsidized gym memberships Subsidized gym memberships May 16, 201239Healthy Anne Arundel Coalition

40. http://www.aahealth.org/ltl_healthybus.asp Anne Arundel County DOH Healthy Business Resources May 16, 201240Healthy Anne Arundel Coalition

41. http://www.aahealth.org/ltl_50ways.asp Anne Arundel County DOH Healthy Business Resources May 16, 201241Healthy Anne Arundel Coalition

42.  Based on the DOH’s Fitness Challenge available at www.aahealth.org/fitnesschallenge Anne Arundel County DOH Healthy Ways to Fitness Challenge! May 16, 201242Healthy Anne Arundel Coalition

43. Anne Arundel County DOH Healthy Ways to Fitness Challenge!  6 week program to increase healthy eating and physical activity  47 teams of 5; total of 235 participants (1/3 of DOH employees)  Complemented by other activities: healthy eating class healthy eating class introduction to container gardening introduction to container gardening stress reduction workshop stress reduction workshop Department-wide potluck at a local park Department-wide potluck at a local park May 16, 201243Healthy Anne Arundel Coalition

44. Anne Arundel County DOH Healthy Meetings & Events Policy May 16, 201244Healthy Anne Arundel Coalition

45. Anne Arundel County DOH Healthy Business Resources Learn to Live Healthy Living Resources: http://www.learntolivehealthy.org http://www.learntolivehealthy.org 410-222-7979 Available resources include Healthy Eating, Cancer Prevention and Smoking Cessation Information Kits and other materials Anyone can download materials, but Learn to Live can only mail materials to Anne Arundel County addresses May 16, 201245Healthy Anne Arundel Coalition

46. Obesity Prevention Federal Initiatives May 16, 2012Healthy Anne Arundel Coalition 46

47.  President’s Challenge www.presidentschallenge.org www.presidentschallenge.org Presidential Active Lifestyle Award (PALA+) Presidential Active Lifestyle Award (PALA+) PALA+ is for people who want to better their health by making healthier choices related to eating and physical activityPALA+ is for people who want to better their health by making healthier choices related to eating and physical activity Good for beginnersGood for beginners Presidential Champions Presidential Champions Aimed at individuals who are already physically activeAimed at individuals who are already physically active Good for people who already get regular exercise or a next step for people who complete PALA+.Good for people who already get regular exercise or a next step for people who complete PALA+. President’s Initiative May 16, 201247Healthy Anne Arundel Coalition

48.  President’s Challenge (cont.) Online tracker allows groups to take the President’s Challenge together Online tracker allows groups to take the President’s Challenge together Can register a group together and access progress reports Can register a group together and access progress reports Can also register individually Can also register individually President’s Initiative May 16, 201248Healthy Anne Arundel Coalition

49. http://www.letsmove.gov/ First Lady’s Initiative May 16, 201249Healthy Anne Arundel Coalition

50.  MyPlate SuperTracker  MyPlate SuperTracker https://www.choosemyplate.gov/ SuperTracker/default.aspx https://www.choosemyplate.gov/ SuperTracker/default.aspx Get a personalized nutrition and physical activity plan Get a personalized nutrition and physical activity plan Track foods and physical activities to see how they stack up Track foods and physical activities to see how they stack up Get tips and support Get tips and support My Plate May 16, 201250Healthy Anne Arundel Coalition

51. Priority # 2 Mental Health and Substance Abuse as Co-Occurring Disorders May 16, 2012Healthy Anne Arundel Coalition 51

52. Rate of Emergency Department Visits for Substance Abuse* by ZIP Code of Residence, Anne Arundel County, July 2010 – June 2011 *Includes alcohol, illegal drugs and nonmedical use of prescription drugs. Data Source: Rates calculated based on 2010 U.S. Census; MD Health Services Cost Review Commission. Substance Abuse May 16, 2012Healthy Anne Arundel Coalition52

53. Suicide May 16, 2012Healthy Anne Arundel Coalition53 R ate per 100,000 persons Rate* of Suicide-related Emergency Department Visits by Age Group. Anne Arundel County, July 2010 – June 2011 * Crude rate calculated based on 2010 U.S. Census. Data Source: Maryland Vital Statistics Annual Report, Division of Health Statistics, Maryland DHMH; Injury Center, CDC; MD Health Services Cost Review Commission

54. Suicide May 16, 2012Healthy Anne Arundel Coalition54 Rate per 100,000 persons Age-Adjusted Suicide Death Rates, Anne Arundel and Maryland, 2005-2010 Data Source: Maryland Vital Statistics Annual Report, Division of Health Statistics, Maryland DHMH; Injury Center, CDC; MD Health Services Cost Review Commission

55. disparities Source: Maryland Health Services Cost Review Commission Health Disparities May 16, 201255Healthy Anne Arundel Coalition

56. What Can You Do?  Step 1: Determine your healthy weight and make weekly goals to reach it  Step 2: “Eat healthier” by choosing healthier foods for you and your family  Step 3: “Move more” during your leisure time or through workplace initiatives  Step 4: Get a mental health screening for depression or post-traumatic stress  Step 5: Get screened for alcohol, opioid or prescription drug abuse May 16, 201256Healthy Anne Arundel Coalition

57. What Can You Do?  Step 6: Review your family history and get screened for cancer  Step 7: Visit your dental health provider every six months  Step 8: Get tested for sexually transmitted infections and HIV  Step 9: Schedule your annual health visit with your primary care doctor  Step 10: Keep your home, community and work space free of clutter May 16, 201257Healthy Anne Arundel Coalition

58. Healthy Anne Arundel Coalition Contacts Laurie Fetterman, MSW Phone: 410-222-7203 Email: HDFETT00@aacounty.org Charis Jones, MPH Phone: 410-222-4495 Email: HDJONE11@aacounty.org www.HealthyAnneArundel.org May 16, 201258Healthy Anne Arundel Coalition

59. County Executive John R. Leopold Department of Health J. Howard Beard Health Services Building 3 Harry S. Truman Parkway Annapolis, Maryland 21401 Phone: 410-222-7375 Fax: 410-222-4433 Maryland Relay (TTY): 1-800-735-2258 www.aahealth.org Anne Arundel County Department of Health Representatives: Angela M. Wakhweya, M.D., MSc.Econ., Health Officer Jinlene Chan, M.D., M.P.H., Deputy Health Officer, Healthy Families Administration Kelly Russo, M.D., M.P.H., Deputy Health Officer, Healthy Communities Administration Ronna Gotthainer, Deputy Health Officer, Operations Antigone Vickery, M.P.H., Director, Office of Assessment, Planning and Response Laurie Fetterman, M.S.W., Health Planner, Office of Assessment, Planning and Response Charis Jones, M.P.H., Technical Advisor, Office of Assessment, Planning and Response Steering Committee Member Organizations: A.A. Co. Office of the County Executive A.A. Co. Dept. of Aging and Disabilities A.A. Co. Dept. of Detention Facilities A.A. Co. Dept. of Health A.A. Co. Dept. of Recreation & Parks A.A. Co. Dept. of Social Services A.A. Co. Public Schools A.A. Co. Mental Health Agency, Inc. Anne Arundel Community College Anne Arundel Economic Development Corporation Anne Arundel Health System Arundel Community Development Services, Inc. Baltimore Washington Medical Center CareFirst BlueCross BlueShield City of Annapolis Mayor’s Office Johns Hopkins Bloomberg School of Public Health MedStar Harbor Hospital Northrop Grumman People’s Community Health Centers, Inc. Rite Aid Corporation School of Public Heath, University of Maryland Walmart May 16, 201259Healthy Anne Arundel Coalition