Community Health Improvement Plan Mobilizing for Action through Planning and Partnerships

Purpose: Improving Health in the Thomas Jefferson Health District

The Thomas Jefferson Health District (TJHD) Virginia’s Planning District 10 Population: 234,702 –Urban, suburban and rural environments –8% (19,302) live in rural census tracts Source: The Oak Hill Fund

Source: Centers for Disease Control and Prevention; National Association of County and City Health Officials MAPP Model

Big Picture of Community Health Compiles existing local data Trends Comparisons –State –Benchmarks

1.Locality CHA Councils Review, discuss and determine need for additional quantitative and qualitative data Prioritize health issues Charlottesville-AlbemarleFluvannaGreeneLouisaNelson 2.TJHD MAPP 2 Health Leadership Council Decide health questions for TJHD phone survey Complete Community Health Improvement Plan for TJHD 1-2 reps per CHA locality council District-wide agencies serving TJHD Local government Schools Colleges Community agencies Healthcare organizations Non-profits Source: Thomas Jefferson Health District MAPP 2 Health

M2H Organizational Partners 2012 Source: TJHD

M2H Steps and Timeline Sept '11 Oct '11 Nov '11 Dec '11 Jan '12 Feb '12 Mar '12 Apr '12 May '12 June '12 July '12 Aug '12 Sept '12 Oct '12 Nov '12 Dec '12 Jan ‘13 Feb ‘13 Hold initial locality council meetings Continue locality CHA meetings Collect/present quantitative data Plan for qualitative research Conduct qualitative research Determine health priorities Write community profile(s) Hold TJHD M2H meetings Complete CHIP and M2H Report Disseminate profile and CHIP Source: Thomas Jefferson Health District

Problem Importance Worksheet Complete a separate form for each health issue identified by the CHA Team Health Issue: ________________________________________________ Check the Appropriate Box for each item and record the score under subtotal 10 High Low Sub- total Magnitude/Impact How many people does the problem affect, actually or potentially, directly or indirectly? What is the cost to society and the economy? Seriousness of the Consequences What degree of disability or premature death occurs because of the problem? What are the potential burdens to the community, such as economic or social burdens? What happens if we do not address this problem? Feasibility of Correcting Is the problem amenable to interventions (i.e., is the intervention feasible scientifically as well as acceptable to the community?). What technology, knowledge, or resources are necessary to effect a change? Is the problem preventable? Can we affect this problem at the local level? Problem Importance Index (Sum of Subtotals)

District Priority Issues Source: Thomas Jefferson Health District

The Community Health Improvement Plan: MAPP 2 Health

Community Health Issue #1: An Increasing Rate of Obesity

Obesity Trends Among U.S. Adults 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Obesity Trends Among U.S. Adults 1990 Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System

No Data <10% 10%–14% 15%–19% Obesity Trends Among U.S. Adults 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System

No Data <10% 10%–14% 15%–19% ≥20% (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends Among U.S. Adults 2000 Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends Among U.S. Adults 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends Among U.S. Adults 2010 Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System

Percentage of Adults Who Are Obese TJHD and Virginia, Source: Virginia Department of Health, Virginia Behavioral Risk Factor Surveillance Survey

Percentage of Adults Who Are Obese TJHD by Locality, 2009 Greene County 30.5% Albemarle County 27.1% Charlottesville 26.9% Fluvanna County 29.6% Nelson County 26.4% Louisa County 31.7% Source: Centers for Disease Control and Prevention: National Diabetes Surveillance System **Body mass was derived from self-report of height and weight from adults 20 and Over. *Obese = Body Mass Index (BMI) ≥30, or ~ 30 lbs. overweight for 5’ 4” person

Percentage of 5 th Graders Who Are Overweight or Obese Albemarle and Charlottesville Public Schools, Source: Community Action on Obesity

Percentage of 5 th &10 th Graders Who Are Overweight or Obese Nelson County Public Schools, Source: Blue Ridge Medical Center

Deaths (in thousands) Source: Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, et al. (2009) The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors. PLoS Med 6(4): Heron, M., Tejada-Vera, B. (2009). Deaths: Leading Causes for National Vital Statistics Reports. 58(8) Leading Causes of DeathDeaths Attributable to Individual Risk Factors Leading vs. Actual Causes of Death

Source: Virginia Department of Health, Virginia Behavioral Risk Factor Surveillance System Percent of Adults Diagnosed with Diabetes (Self-Reported), TJHD and Virginia,

Physical Inactivity TJHD by Locality and Virginia, 2009 Source: Behavioral Risk Factor Surveillance System; County Health Rankings*Numbers are self-reported

Recreational Facilities TJHD by Locality and Virginia, 2009 Source: County Health Rankings

Food Stores by Type TJHD, 2009 Source: U.S. Department of Agriculture

Food Stores by Type TJHD by Locality, 2009 Source: U.S. Department of Agriculture

Food Stores by Type TJHD by Locality, 2009 Source: U.S. Department of Agriculture

Qualitative Data Thomas Jefferson Community Survey –Obesity most frequently identified as the most important public health concern to which the district needs to give more attention Feedback during MAPP 2 Health Focus Groups –Charlottesville and Albemarle: Lack of knowledge surrounding already existing programs. –Fluvanna County: Parents do not have enough time and knowledge to prepare nutritious food for their families. –Nelson County: Education is the key to ameliorating the problem.

Goal 1 Decrease the percentage of persons who are overweight or obese in TJHD by promoting school and corporate wellness programs and by engaging residents in a Move2Health campaign. LEAD COALITION: Community Action on Obesity

Objectives 1.By 2017, reduce the percentage of adults living in TJHD who are physically inactive from 24% to 20%. 2.By 2017, stop the trend of the percentage of TJHD residents who are overweight or obese from increasing.

Strategies 1.Encourage and support schools to implement comprehensive wellness policies. 2.Encourage and support employers to implement comprehensive wellness programs. 3.Organize and launch a district-wide Move2Health campaign to encourage TJHD residents to be more active.

Community Health Issue #2: Insufficient Access to Mental Health and Substance Abuse Services

Average Number of Poor Physical/Mental Health in the Last 30 Days (Self-reported) TJHD by Locality, TJHD and Virginia, Source: County Health Rankings *Numbers are self-reported

Hospital Discharge Rates for Neurotic Disorders, Personality Disorders, and other Nonpsychotic Mental Disorders TJHD and Virginia, Source: VDH Data Warehouse; Virginia Hospital Information Systems

Hospital Discharge Rates for Psychoses TJHD and Virginia, Source: VDH Data Warehouse; Virginia Hospital Information Systems

Number of Emergency Services Delivered by Region 10 Community Services Board by Type of Service Source: Region Ten Community Services Board

Source: Substance Abuse and Mental Health Services Administration Percent of Persons Served though State Mental Health Agencies with Co-Occurring Mental Health and Substance Abuse Disorders, Virginia and U.S., 2010 MH = Mental Health; AOD = Alcohol and Other Drug

Qualitative Data Thomas Jefferson Community Survey –Mental health issues identified by 20% of residents as the most important public health concern to which the district needs to give more attention Feedback during MAPP 2 Health Focus Groups –A lack of access to mental health services was cited as a problem –Stigma associated with mental health issues deters people from getting assistance

Goal 2 Decrease the number of poor mental health days among TJHD residents by increasing access to mental health services and decreasing stigmas and fear surrounding mental health issues. LEAD COALITION: Community Mental Health & Wellness Coalition

Objectives 1.By 2017, increase access to mental health services in TJHD by increasing the number of mental health service hours provided by Community mental Health and Wellness Coalition (CMHWC) member agencies. 2.By 2017, among TJHD residents decrease stigma and fears associated with mental health, as demonstrated through pre/post surveys from educational programs.

Strategies 1.Establish a system to collect and track the number of CMHWC agencies’ service hours. 2.Promote the integration of behavioral health services into primary care settings. 3.Develop, conduct and promote culturally competent educational programs, such as Mental Health First Aid USA, to reduce stigma and fears that prevent individuals from seeking mental health services.

Community Health Issue #3: Late and Insufficient Prenatal Care and Racial Disparities in Pregnancy Outcomes

Percentage of Mothers Entering Prenatal Care in the 1 st Trimester TJHD and Virginia, Source: Virginia Department of Health, Division of Health Statistics *Percentage of Total Live Births to mothers with Prenatal Care Beginning in the First 13 Weeks

Percentage of Mothers Entering Prenatal Care in the 1 st Trimester TJHD by Locality, Source: Virginia Department of Health, Division of Health Statistics *Percentage of Total Live Births to mothers with Prenatal Care Beginning in the First 13 Weeks

Percentage of Mothers Who had 10 or More Prenatal Care Visits TJHD and Virginia, Source: Virginia Department of Health, Division of Health Statistics

Percentage of Mothers Who had 10 or More Prenatal Care Visits TJHD by Locality, Source: Virginia Department of Health, Division of Health Statistics

Infant Mortality Rates* TJHD and Virginia, Source: Virginia Department of Health, Division of Health Statistics *Deaths among infants <1year of age

Infant Mortality Rates* by Race TJHD, Virginia, and U.S., Source: Virginia Department of Health, Division of Health Statistics *Deaths among infants <1year of age

Percentage of Low-Weight* Births TJHD, Virginia, and U.S., Source: Virginia Department of Health, Division of Health Statistics *Low Birth Weight = Live Births Weighing <2500 grams

Percentage of Low-Weight* Births TJHD by Locality, Source: Virginia Department of Health, Division of Health Statistics *Low Birth Weight = Live Births Weighing <2500 grams

Percentage of Low-Weight Births* by Race, TJHD and Virginia, Source: Virginia Department of Health, Division of Health Statistics *Low Birth Weight = Live Births Weighing <2500 grams

Percentage of Low-Weight Births* by Race, TJHD by Locality, Source: Virginia Department of Health, Division of Health Statistics *Low Birth Weight = Live Births Weighing <2500 grams

Reported Substance Exposed Infants* TJHD, FY Source: Virginia Department of Social Services *Newborn infants that may have been exposed to controlled substances prior to birth (as indicated by a positive drug toxicology of the mother with presence of a controlled substance or by the child being born dependent on a controlled substance and demonstrating withdrawal symptoms) or have a diagnosis of fetal alcohol syndrome

Goal 3 Improve pregnancy outcomes in TJHD by increasing the percentage of women who plan pregnancies and receive adequate prenatal care; by targeting interventions towards vulnerable populations; and by promoting clinical smoking cessation interventions. LEAD COALITION: Improving Pregnancy Outcome Workgroup

Objectives 1.By 2017, increase the percentage of pregnant women who receive 10 or more prenatal care visits from 66% to 75% of TJHD pregnant women. 2.By 2017, decrease the percentage of low birth weight black infants from 12.5% to 10% of TJHD black births. 3.By 2017, increase enrollment in Plan First, a Medicaid program that covers family planning services, in TJHD by 5%.

Strategies 1.Conduct research to better understand why vulnerable populations of women are not receiving/accessing available prenatal care services. 2.Work with TJHD prenatal care providers to overcome barriers identified in research. 3.Increase awareness among vulnerable women of childbearing age about the importance of taking steps to improve health before becoming pregnant and steps to take to improve the likelihood of having a healthy pregnancy. 4.Develop and/or promote peer-based health navigator services for vulnerable pregnant women. 5.Increase awareness among clinical providers and eligible populations about the availability of Plan First benefits

Community Health Issue #4: Tobacco Use Above the Healthy People 2020 Goal

Self-Reported Adult Smokers TJHD and Virginia, Source: Virginia Department of Health, Virginia Behavioral Risk Factor Surveillance Survey

Percentage of Mothers Who Report Smoking during Pregnancy TJHD and Virginia, Source: Virginia Department of Health, Division of Health Statistics

Percentage of Mothers Who Report Smoking during Pregnancy TJHD by Locality, Source: Virginia Department of Health, Division of Health Statistics

Tobacco Facts Virginia, 2012 VirginiaUnited States Adult Smoking Rank (1 st = low smoking rates) 31stN/A Cigarette Tax (per pack) $0.30 ($0.35 local tax for Cville) $1.46 Cigarette Tax Rank (1 st = high taxes) 50thN/A FY 2012 Funding for State TC Programs (millions) $8.4$456.7 Tobacco Prevention Spending % of CDC Target 8.1%12.5% Tobacco Prevention Spending Rank (1 st =high spending rates) 30thN/A Source: Campaign for Tobacco-Free Kids; City of Charlottesville City Treasurer Website

Goal 4 Decrease the percent of persons who use tobacco in TJHD. LEAD COALITION: Tobacco Use Control Coalition

Objectives 1.By 2017, decrease the percentage of adults who smoke from 18% to 16% of TJHD adults. 2.By 2017, decrease the percentage of pregnant women who report smoking during pregnancy from 7.5% to 6% of TJHD pregnant women.

Strategies 1.Collect data to better understand the attitudes and behaviors that encourage young people to start smoking. 2.Evaluate current smoking cessation programs for effectiveness in decreasing tobacco use. 3.Develop and/or promote more smoking cessation classes for TJHD residents. 4.Educate clinical providers in TJHD about evidence- based patient interventions that were shown to increase tobacco cessation and promote their use.