The Current Situation The Washington Post reports that the width of a standard movie seat used to be 19 inches…. It is now 23 inches.. Journal of Pediatrics, 2006, reported that 1 percent of all American infants and children – more than 283,000 children – are too big to fit in a car seat…. Susan Combs, Texas Comptroller of Public Accounts

The Current Situation Since 1970, the prevalence of obesity has doubled for preschool children And tripled for school-aged children Currently, 37% of school aged children are obese or overweight. Strauss RS, Pollack HA. JAMA, 2001;286:2845-8 Ogden et al JAMA 2006;295:1549-55 Margellos-Anast et al; Public Health Reports. 123;117-125

The Current Situation With a focus on obesity alone, 19% of school aged children are obese. Disproportionate numbers nationally: African Americans 22% Mexican Americans 23% Non-Hispanic white 18% Ogden et al JAMA 2006;295:1549-55 Margellos-Anast et al; Public Health Reports. 123;117-125

The Current Situation The Prevalence of Obesity Among Children in Six Chicago Communities Sinai Improving Community Health Survey Door to door, population based health survey 501 randomly selected children aged 2-12 years Humboldt Park Roseland North Lawndale South Lawndale Norwood Park West Town Margellos-Anast H, Shah AM, Whitman S. Public Health Reports. 123;117-125.

The Prevalence of Obesity Among Children in Six Chicago Communities Three stage sample design Communities by probability proportionate to size (PPS) sampling Households selected at random Household screen survey to an adult and a child/caretaker. Survey methodology: Survey Research Laboratory of UIC Margellos-Anast H, Shah AM, Whitman S. Public Health Reports. 123;117-125.

The Prevalence of Obesity Among Children in Six Chicago Communities Percent Margellos-Anast H, Shah AM, Whitman S. Public Health Reports. 123;117-125.

The Prevalence of Obesity Among Children in Six Chicago Communities Major findings: Nearly half the children (aged 2 – 12) in five of six communities were obese compared to 16.8% nationally. Prior community-level evaluations have found only 23-25% of school children were obese. The prevalence of obesity exceeded the prevalence of overweight by a factor of four in Humboldt Park and a five in Roseland. Contrary to what would be expected. Margellos-Anast H, Shah AM, Whitman S. Public Health Reports. 123;117-125.

The Decline in Cardiovascular Mortality Men Age Adjusted All Races; Out of hospital mortality per 100,000; NEJM, McGovern,et al, 334, 1996

The Decline in Cardiovascular Mortality Women Age Adjusted All Races; Out of hospital mortality per 100,000; NEJM, McGovern,et al, 334, 1996

The Current Situation - CVD While dramatic improvements in CVD mortality declines for over 40 years have been praised as one of the major health accomplishments of the twentieth century, recent data suggests that CVD mortality rate declines are slowing to 1.5% per year Despite significant and notable declines in stroke mortality for over 60 years, stroke mortality is no longer falling. R Cooper et al. Circulation, 102, no. 25 (2000):3137-3147

The Current Situation - CVD Two well-designed population based studies Worchester, Mass Olmstead County, Minnesota have found that the rates of new cases of heart disease have not fallen from 1990 forward, and for women, may have actually risen. More recent concerns of potentially increasing incidence of CVD and CVD mortality in men and women. Goldberg RJ et al. JACC, 33 #6 (1999); 1533-1539. Roger VL et al. Annals of Internal Med.136;#5 (2002): 34-348. Anciero et al. American J of Med;117:4 (2004):228-233. Pearson TA. Health Affairs 26;12007): 49-60

The Current Situation – Life Expectancy The Reversal of Fortunes: Trends in County Mortality and Cross County Mortality Disparities in the US NCHS data used to calculate life expectancy for all US counties between 1961 and 1999. Between 1961 and 1982, life expectancy improved. From 1983 to 1999, life expectancy declined significantly by 1.3 years for men and women in 48 counties (men) and 783 counties (women) Ezzati M, Friendman AB, et al. PLoS Med (5)4;e66, April 2008

The Current Situation – Life Expectancy Of note, the higher disparity partly resulted from stagnation or an increase in mortality among the worst-off segment of the population, with life expectancy for approximately 4% of the male population and 19% of the female population having either had statistically significant decline or stagnation. Ezzati M, Friendman AB, et al. PLoS Med (5)4;e66, April 2008

The Decline in Cardiovascular Mortality Men Age Adjusted All Races; Out of hospital mortality per 100,000; NEJM, McGovern,et al, 334, 1996

The Apache Heart Study Incidence of Confirmed CAD Cases per 100,000. Ages 45 to 79. Arch Intern Med 2002;162:1368-1372.C.

ACUTE MYOCARDIAL INFARCTION AMONG NAVAJO MEN Klain, Coulehan, Arena, & Janett, AJPH, 1988 Hospitalization rates per 1000

Acute MI and USA among the Hopi: The Hopi Heart Study

Acute Myocardial Infarctions Hopi Tribal Members Average values 1957-66 from Seivers and average for 1975-78 taken from Sievers and Fisher; p,0.001

INCIDENCE OF CVD The Strong Heart Study Fatal and Nonfatal Rates per 1000 person years. The Rising Tide of CVD in AI: The SHS, Circulation, 1999

American Indian/Alaska Native Mortality Rates Trends in Indian Health, 1997; Age-adjusted data

Carotid Atherosclerosis in Native Americans Roman MJ, Fabsitz RR, Crawford A, Lee ET, Fishman D, Howard BV. Circulation 1998;98(suppl):I-516

Prevalence of CVD Among American Indians Compared with other Groups MMWR, Vol 52, Number 47, REACH Data, Nov. 28, 2003. p 1148-1152

MMWR, Vol 52, Number 47, REACH Data, Nov. 28, 2003. p 1148-1152 MMWR: The REACH Survey Among men and women in these four groups, American Indians had the highest prevalence of Cardiovascular disease… as well as obesity, current smoking and diabetes. Men had the highest rates of hypertension and high blood cholesterol levels. MMWR, Vol 52, Number 47, REACH Data, Nov. 28, 2003. p 1148-1152

Alice K. Jacobs, M.D., President American Heart Association “American Indians and Alaska Natives appear to have developed the highest rates of cardiovascular disease within the US.”

Percentage of Premature Heart Disease Deaths by Ethnicity MMWR, February 28, 2004

Percent of Death from Strokes in Those < 65 years MMWR, May 20, 2005

Disparity in Average Age of Death from Strokes MMWR, May 20, 2005

Disparities AI/AN US Gap MDs 73.9 220.6 66% lower Health Staff/100,000 people AI/AN US Gap MDs 73.9 220.6 66% lower DDS 24.0 61.8 61% lower Nurses 229.0 849.9 73% lower RPh 42.8 71.3 40% lower

Pathways into Health Issues of Health & Health Education Disparities Quality of care improved when patient and provider of same ethnicity IOM’s study, ‘Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care’ provided a clear connection between poorer health outcomes for minorities and the shortage of minority health care providers.

Pathways into Health Issues of Health Education Disparities Within Arizona, only 31 American Indian students have graduated from medical school over the past two decades Very low enrollment rates Very high drop out rates (3 to 5 x higher)

Pathways into Health Issues of Health Education Disparities Native students represent only 0.3% of medical students Only 98 Native students graduating from medical school in 2004 among 125 Medical Schools. Only 9 Medical Schools across the nation have more than two American Indians in their graduating class. Sequist, TD. Journal of Interprofessional Care 21;(S2): 20-30

Pathways into Health Issues of Health Education Disparities AI/AN physicians make up only 0.002% of the total US physician workforce, compared to 4.4% African American, 5.1% Hispanic, 73.8% White and 14.9% Asian/Native Hawaiian/Pacific Islander. Sequist, TD. Journal of Interprofessional Care 21;(S2): 20-30

Pathways into Health Issues of Health Education Disparities “Native American students are frequently forced to endure educational environments that violate their rights to equal educational opportunity and ignore their cultural identities.” U.S. Commission on Civil Rights, “A Quiet Crisis”

Pathways into Health Issues of Health Education Disparities Issues related to consideration of college Issues related to leaving reservations Cultural requirements Absenteeism

Pathways into Health A focus on professional healthcare education for Native Americans Built upon Academic – Tribal – Indian health collaborations Regionalized centers of varied educational strengths Arizona & the Southwest Northern Rockies Great Plains Alaska

Pathways into Health Objectives To recruit and educate Native American students in health career professions initially focusing on clinical laboratory science, followed by nursing and public health, radiology technology and subsequently pharmacy and medicine, among others. To create an inter-professional and culturally reinforcing educational environment using traditional and innovative curricular methods. To improve the health and health care of Native American communities by producing high quality graduates who remain in their home communities.

A collaborative & integrated approach to an issue of Pathways into Health A collaborative & integrated approach to an issue of national importance Academic collaborators: University of Arizona Northern Arizona University University of Alaska– Anchorage and Fairbanks University of North Dakota University of New Mexico Arizona State University Georgetown University University of South Dakota Montana State University Harvard

Pathways into Health Tribal collaborators: The Hopi Tribe The Navajo Nation The White Mountain Apache Tribe The Ute Mountain Ute Tribe Pasqua Yaqui Tribe Tohono O’odham Nation InterTribal Council of Arizona

Pathways into Health Southcentral Foundation, Alaska Further Tribal and Indian health collaborators: Southcentral Foundation, Alaska Ute Mountain Ute Tribe Southern Ute Tribe Pueblo of Zuni Mescalero Apache Tribe Seattle Indian Health Board

Pathways into Health National Congress of American Indians A collaborative & integrated approach to an issue of national importance… A Resolution from the National Congress of American Indians

Pathways into Health Current Directions: National Advisory Council Everett Rhodes, MD, Former Director IHS (U of OK) Bette Keltner, RN, Ph.D., Dean, Nursing, Georgetown University H. Sally Smith, Chair, National Indian Health Board Margaret Knght, Executive Director, Association of American Indian Physicians John Lowe, RN, PhD, Associate Professor, Florida Atlantic University Judy Sherman, Friends of Indian Health George Blue Spruce, DDS, MPH, Asst Dean, Indian Affairs, Arizona School of Dentistry & Oral Health Don Davis, MPH, Director, Phoenix Area HIS Wayne Taylor, Chairman, Hopi Tribe Jenny Joe, Ph.D., University of Arizona

Pathways into Health Organizational Structure Chairperson: Michael Allison (Navajo) Vice Chair: Carl Fox, PhD (Montana State) Secretary: Fred Kopacz (Alaska) Treasurer: Sean Clendaniel, MPH (Arizona) Executive Board Membership Subcommittees

Pathways into Health Current Directions: Development of Laboratory Science Program (Med Tech) UND, NAU, IHS, e-HealthU Collaboration On-site Lab Science Bachelors and Certification Front End Workers Program Nursing and Public Health Radiology Technicians

Pathways into Health Laboratory Sciences Program: IHS and Tribal employees in multiple states Currently employed in the laboratory Long Term Training approval by IHS Small Foundation Funding for Tribal Scholarships

Ms. Begay (top far right) is joined by Atlanta Begay, featured in the North Dakota Medicine, Pathways Into Health article of the Fall 2006 issue is the first student to train in CLS at UND under Pathways Into Health. Ms. Begay (top far right) is joined by other AI/AN students pursuing Health Professions education.

Nursing and Public Health Committee Pathways into Health Native Interprofessional Development in Health Initiative Nursing and Public Health Committee

Activating the Pipeline: New Horizons in Accredited Work-Based Learning In collaboration with the Robert Wood Johnson Foundation Cruz Begay, PhD Good Morning. It's good to be back in Bisbee and Cochise county among friends and colleagues. I have a lot a great memories in this area. As Jennie said, I now work with the IHS in Flagstaff. I have a question for you. Imagine that you are a member of a Native nation living on a remote rural reservation. Your daughter has had a pain in her abdomin for a week now, and you are starting to get concerned. The clinic closest to you has a really nice young doctor with the IHS. She just arrived from Boston where she grew up. They say she got her medical degree from Harvard. She doesn't know anything about the tribe, but she seems eager to learn. The IHS clinic two hours away has Kateri. You grew up with Kateri. She is member of your clan. She is the daughter of a well respected medicine man. She got her medical degree from U. of North Dakota and went to Johns Hopkins for her residency in pediatrics. Those places sound good. Where are you going to take your daughter? Most American Indian people living on the reservation do not have the luxary of making this choice. The research shows that trust between provider and patient is higher when the provider is of the same cultural background as the patient. Qualitiy of care is better, as is patient satistifaction. We can imagine that committment to prevention and communitiy wellbeing is better when the provider comes from the same community. In Indian Country, tribal sovereignty and self-determination is advanced when members of the tribe are the care providers. What I often hear working with tribal leaders is a real longing for their young people to become the professionals who provide care to the tribe. But what is the situtation right now?

Native Interprofessional Development in Health Initiative Initial Focus: Frontline workers CHRs, EMTs, Health Educators, Nurses, etc. Forefront of Indian health system Important pipeline Interprofessional Education Frontline workers need to be empowered to confidently contribute to Interprofessional teams. Students in nursing, public health, and other disciplines need preparation to work with frontline workers.

Pathways into Health Frontline workers are an important pipeline. AWBL may address many needs: Place-bound adult learners. Need for collaborative, experiential learning. Learning that improves organizational performance. Orientation and preparation for additional degree programs. Credit toward degree completion or new degree. Setting for interprofessional training Provide Stimulus for Systems Change

Learning Circles for Health Technicians: The Robert Wood Johnson Foundation Systems Change Learning Circles is the project I'm involved with. As Dine College and the University of Arizona recognized in the development of their ph certiciate and two year degree, the pipline leading to professional careers in health care and public health does not primary go directly from high school, to college, to university, to graduate or medical school. Instead, the pipeline meanders through the existing workforce to pick up paraprofessionals and move them into professional careers. Learning Circles is a work-based learning program that will start with two service units and focus on health technicians. Who are they? They are healthcare paraprofessionals who generally have a little more educational background than CHRs, but are not yet nurses, nutritionists, health educators, doctors, dentists, or pharmacists. So what is work-based learning? It is a trend taking off throughout many countries. It is partnership between community colleges, university and employers. It is meant to advance the careers of employees and improve the performance of their organizations. It involves giving credit for learning on the job. And finally, it is teaching Shakespere through the act of delivering food to patients. At least it is close to that. It is facilitating learning on the job to meet standard learning objectives in areas like clincial practice, public health practice, leadership, and communication. Now how in the world are we going to do that? Let me share with you the heart and soul of our proposal, which is not yet funded but very close. We will know in three weeks. Our approach utilizes three tools in three settings. We have all used some of them before. First, a team of four employees is formed. Employer approved projects, work-based critical incident/task review, and participant learning portfolios are the tools we will use. These tools will be applied in three settings: individual work, small group tutorials, and individual multmedia teleconsultation. Before learners begin work-based learning, they will attend a three day retreat to learn how to engage in work-based learning, to use the technology, and also to learn about how to move on from work-based learning to distance education degree programs and other career-advancing options. This program also involves serious systems changes for both the employer and the academic institution. Let's go in for a closer look. With the agreement and full, enthusiastic support of her employer, a health technician named Marie may be assigned a project to lead a rapid cycle quality improvement initiative to reduce waiting times in the pediatric clinic. Marie will work individually to get the project going and in an interprofessional team that she is empowered by the supervisor to convene. In the weekly small group tutorial, a faculty member beams into the conference room where Marie and three other employees are learning as a team. Marie shares progress on her project and challenges of the project. The group brainstorms solutions. The faculty member connects the challenges faced with background and solutions in the literature. As our employee encounters additional challenges, she checks into the online public health clinic about twice a week, essentially online office hours. The faculty member in charge of these office hours beams into the very PC that the learner is using with video conferencing and application sharing. This will be demonstrated in a minute. During individual multimedia teleconsultation, a lot of work happens accross all three tools. Marie's routine job is to check in patients and do follow-up with them. And she notes in her portfolio that she has identified a critical task. How do I motivate parents of newborns to install a car seat after their first visit, if they haven't already done so? She brings this critical task up in her next weekly small group tutorial. The group discusses and the tutor connects the group with principles in the literature, checking off the learning objectives addressed. OUr learner's portfolio is getting bigger. She is documenting critical tasks, her progress toward meeting learning objectives, the results of her project, and she is writing reflections on lessons learned, future applications, and career plans. In addition to using her porfolio extensively in the small group tutorials, it is being reviewed during the individual multimedia teleconsultation by the faculty mentor. Indeed, the tutor and the faculty mentor have developed university-approved rubrics to evaluate the student's perforance mostly in the portfolio as a basis for assigning grades and conferring credit. Well, I've covered most of the boxes in this matrix, and I hope you sort of catch the vision.

Pathways into Health Initial sites: Chinle Comprehensive Health Care Center (IHS) Winslow Indian Health Care Center (Tribal) Future plans: Expand to Alaska Expand to Great Plains Expand to other sites in the southwest Good Morning. It's good to be back in Bisbee and Cochise county among friends and colleagues. I have a lot a great memories in this area. As Jennie said, I now work with the IHS in Flagstaff. I have a question for you. Imagine that you are a member of a Native nation living on a remote rural reservation. Your daughter has had a pain in her abdomin for a week now, and you are starting to get concerned. The clinic closest to you has a really nice young doctor with the IHS. She just arrived from Boston where she grew up. They say she got her medical degree from Harvard. She doesn't know anything about the tribe, but she seems eager to learn. The IHS clinic two hours away has Kateri. You grew up with Kateri. She is member of your clan. She is the daughter of a well respected medicine man. She got her medical degree from U. of North Dakota and went to Johns Hopkins for her residency in pediatrics. Those places sound good. Where are you going to take your daughter? Most American Indian people living on the reservation do not have the luxary of making this choice. The research shows that trust between provider and patient is higher when the provider is of the same cultural background as the patient. Qualitiy of care is better, as is patient satistifaction. We can imagine that committment to prevention and communitiy wellbeing is better when the provider comes from the same community. In Indian Country, tribal sovereignty and self-determination is advanced when members of the tribe are the care providers. What I often hear working with tribal leaders is a real longing for their young people to become the professionals who provide care to the tribe. But what is the situtation right now?

Examples of Building Blocks… Settings: Methods: Apprenticeships Internships Residency/Field Work On Site courses OJT Service Learning Collaborative Learning Problem-based Learning Experiential Learning Reflective Practice Activity-based Learning Community of Practice

Learning Circles for Health Technicians What are we teaching? Learning Circles is the project I'm involved with. As Dine College and the University of Arizona recognized in the development of their ph certiciate and two year degree, the pipline leading to professional careers in health care and public health does not primary go directly from high school, to college, to university, to graduate or medical school. Instead, the pipeline meanders through the existing workforce to pick up paraprofessionals and move them into professional careers. Learning Circles is a work-based learning program that will start with two service units and focus on health technicians. Who are they? They are healthcare paraprofessionals who generally have a little more educational background than CHRs, but are not yet nurses, nutritionists, health educators, doctors, dentists, or pharmacists. So what is work-based learning? It is a trend taking off throughout many countries. It is partnership between community colleges, university and employers. It is meant to advance the careers of employees and improve the performance of their organizations. It involves giving credit for learning on the job. And finally, it is teaching Shakespere through the act of delivering food to patients. At least it is close to that. It is facilitating learning on the job to meet standard learning objectives in areas like clincial practice, public health practice, leadership, and communication. Now how in the world are we going to do that? Let me share with you the heart and soul of our proposal, which is not yet funded but very close. We will know in three weeks. Our approach utilizes three tools in three settings. We have all used some of them before. First, a team of four employees is formed. Employer approved projects, work-based critical incident/task review, and participant learning portfolios are the tools we will use. These tools will be applied in three settings: individual work, small group tutorials, and individual multmedia teleconsultation. Before learners begin work-based learning, they will attend a three day retreat to learn how to engage in work-based learning, to use the technology, and also to learn about how to move on from work-based learning to distance education degree programs and other career-advancing options. This program also involves serious systems changes for both the employer and the academic institution. Let's go in for a closer look. With the agreement and full, enthusiastic support of her employer, a health technician named Marie may be assigned a project to lead a rapid cycle quality improvement initiative to reduce waiting times in the pediatric clinic. Marie will work individually to get the project going and in an interprofessional team that she is empowered by the supervisor to convene. In the weekly small group tutorial, a faculty member beams into the conference room where Marie and three other employees are learning as a team. Marie shares progress on her project and challenges of the project. The group brainstorms solutions. The faculty member connects the challenges faced with background and solutions in the literature. As our employee encounters additional challenges, she checks into the online public health clinic about twice a week, essentially online office hours. The faculty member in charge of these office hours beams into the very PC that the learner is using with video conferencing and application sharing. This will be demonstrated in a minute. During individual multimedia teleconsultation, a lot of work happens accross all three tools. Marie's routine job is to check in patients and do follow-up with them. And she notes in her portfolio that she has identified a critical task. How do I motivate parents of newborns to install a car seat after their first visit, if they haven't already done so? She brings this critical task up in her next weekly small group tutorial. The group discusses and the tutor connects the group with principles in the literature, checking off the learning objectives addressed. OUr learner's portfolio is getting bigger. She is documenting critical tasks, her progress toward meeting learning objectives, the results of her project, and she is writing reflections on lessons learned, future applications, and career plans. In addition to using her porfolio extensively in the small group tutorials, it is being reviewed during the individual multimedia teleconsultation by the faculty mentor. Indeed, the tutor and the faculty mentor have developed university-approved rubrics to evaluate the student's perforance mostly in the portfolio as a basis for assigning grades and conferring credit. Well, I've covered most of the boxes in this matrix, and I hope you sort of catch the vision.

Learning Experiences Summer/Winter Institute at THealth Center. Problem-based learning sets in health promotion and disease control. Collaborative proposal development Summer/Winter Institute at THealth Center.

Native Interprofessional Development in Health Initiative Existing Existing Nursing Courses CHR, ANHA Training Employees Students Teams Existing Existing Health Education Courses Students Employees Others Interprofessional Learning Experiences

Interprofessional Teams Workers CHR, Community Health Aides (Alaska) Pre-baccalaureate Nurses Nursing Students Health Education Students Others Students Ad Hoc members, mentors from across the country, can be brought into Teams.

Additional Successes Pathwaysintohealth.org Description, Information on Partners Mentorship Availability Educational Opportunities A searchable national registry of successful ‘pipeline’ activities underway in Indian communities Pathways Into Health Professional Development Conference Denver, Sept 2006 Supplemental issue of Journal of Interprofessional Care Chicago, September 14, 2007 Alaska, September 9 & 10, 2008

Additional Successes Interprofessional Education in Nursing & Public Health Disciplines Followed by Dental, Pharmacy and Medicine integration Regional Collaborative Grants Regional Collaborative Conferences Business Plan Development Further expansion of Clinical Laboratory Sciences training opportunities nationally

Community HeAlth Mobilization Projects Building a Healthier Chicago CHAMPS Community HeAlth Mobilization ProjectS  Community Health Assessment and Mobilization ProjectS  Community Health And Mobiliation ProjectS Community HeAlth Mobilization Projects

VISION Building a Healthier Chicago CHAMPS Building a Healthier Chicago VISION Build model community-wide partnerships for health promotion that can be replicated nationwide

GOAL Building a Healthier Chicago CHAMPS Building a Healthier Chicago GOAL To improve the health of Chicago’s residents and employees through integration of existing public health, medicine and community health promotion activities

Building a Healthier Chicago CHAMPS Building a Healthier Chicago Our Objectives: Convene a model collaboration of local and national stakeholders dedicated to building a Healthier Chicago. Strengthen and sustain our partners’ current and new efforts to promote health in Chicago.

Building a Healthier Chicago CHAMPS Building a Healthier Chicago Our Objectives: (cont.) Promote and track the adoption of selected programs, practices, policies, and supportive environments throughout the health care organizations, worksites, schools, and neighborhoods of Chicago.

Building a Healthier Chicago CHAMPS Building a Healthier Chicago Our Objectives: (cont.) Create a system of interventions that complement and reinforce each other to maximize reach and effectiveness Build Synergy!

Community Level Interventions Issues of organization: Collaborative Community leadership Trust Commitment to each other and the intervention Culturally appropriate

Stages of Intervention Utilization Research Development Stage 1 Dissemination Stage 2 Intent to Adopt Decision to Adopt Stage 3a Implementation Stage 3b Adaptation Source: Davis SM et al. Introduction and Conceptual Model for Utilization of Prevention Research. Am J Prev Med. 2007; 33(1S):S1-S5. Stage 4 Institutionalization Stage 5 Diffusion

Building a Healthier Chicago CHAMPS Building a Healthier Chicago Partners City of Chicago (DPH, Parks & Rec, etc.) American Medical Association American Diabetes Association American Heart Association Midwest Business Group on Health Shaping America’s Health American Cancer Society American College of Cardiology Multiple Academic Institutions and Community Organizations

Building a Healthier Chicago CHAMPS Building a Healthier Chicago Our Federal Partners: Federal Occupational Health – Health Risk Appraisal The President’s Council on Physical Fitness – The President’s Challenge The Surgeon General’s initiative on Obesity We see our roles as providing strong support for, collaboration with and aggressive integration with several leading national efforts. First, the President’s Council on Physical Fitness – and the President’s Challenge. Indeed, a partnership between the council leadership and the national Road Runners Club of America has been created and the local chapter in Chicago is currently assuming a leadership role and discussing engagement endeavors. The use of the President’s Challenge Web based log in system will be utilized as an important component of this program. In addition, we plan to integrate and promote the American Medical and the American Academy of Sports Medicine ‘Exercise is Medicine’ initiative. Secondly, we are planning on using metrics from the 2010 and the developing 2020 as produced by The Office of Health Promotion and Disease Prevention. Third, The Surgeon General’s ‘Childhood Obesity’ Program efforts will be integrated into our efforts related to increasing physical activity and dietary modification. In addition, current tools and programs of the National Institutes of Health and the Centers for Disease Prevention and Control will be incorporated and utilized in our population based approach.

Building a Healthier Chicago CHAMPS Building a Healthier Chicago Our Federal Partners (continued): The Office of Health Promotion and Disease Prevention – Metrics from Healthy People 2010/2020 Centers For Disease Control and Prevention The Office of Public Health and Science Regional Health Administrators We see our roles as providing strong support for, collaboration with and aggressive integration with several leading national efforts. First, the President’s Council on Physical Fitness – and the President’s Challenge. Indeed, a partnership between the council leadership and the national Road Runners Club of America has been created and the local chapter in Chicago is currently assuming a leadership role and discussing engagement endeavors. The use of the President’s Challenge Web based log in system will be utilized as an important component of this program. In addition, we plan to integrate and promote the American Medical and the American Academy of Sports Medicine ‘Exercise is Medicine’ initiative. Secondly, we are planning on using metrics from the 2010 and the developing 2020 as produced by The Office of Health Promotion and Disease Prevention. Third, The Surgeon General’s ‘Childhood Obesity’ Program efforts will be integrated into our efforts related to increasing physical activity and dietary modification. In addition, current tools and programs of the National Institutes of Health and the Centers for Disease Prevention and Control will be incorporated and utilized in our population based approach.

Building a Healthier Chicago CHAMPS Building a Healthier Chicago Source: CDPH

Building a Healthier Chicago CHAMPS Building a Healthier Chicago Source: CDPH

Building a Healthier Chicago CHAMPS Building a Healthier Chicago Source: CDPH

Building a Healthier Chicago CHAMPS Building a Healthier Chicago

The idea that individual health choices and personal behaviors are the most important determinants of chronic disease is an idea whose time has come and gone. We need to reassess our effectiveness for ourselves and for others… our patients, our families George Mensah, MD.

Individual choices are important… However, it is unlikely that individually attempted changes in lifestyles and behaviors alone can avert the growing epidemic of chronic disease that we are witnessing. Other comment related to support

Environmental, System & Policy Changes are extremely important… Based on our messages, will people choose to change their lifestyle when we have not corrected the issues that make that choice difficult? When there have no safe place to walk? When there is no produce in the local grocery store? When the health care provider is only financed for fixing the current illness? When the worksite is a place to sit, stress - and gain weight? When their school has no physical education? Other comment related to support

“It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change” Institute of Medicine, 2003

The Social Ecological Model “The aim must be to establish a health promoting environment in the social space in which persons make significant health decisions. The struggle is for the relevant space that various forces, some unconcerned with health ad some actually detrimental to it, have thus far too loosely preempted. Social ecology for health means deliberately occupying more of that social space and using it in the interest of health.” Breslow L. Am J Health Promotion 10:253-257.

The choices we make are shaped by the choices we have

How can we most effectively address these issues ? CHAMPS Building a Healthier Chicago How can we most effectively address these issues ?

Environmental Change: Policies Practices Programs Healthy Chicago Healthy Behavior Less Illness & Death Collaborative Partnership Changing Individual Behaviors

Environmental Change: Policies Practices Programs Healthy Chicago Healthy Behavior Less Illness & Death Collaborative Partnership Although partnerships have affected change in community-wide behavior, the strongest evidence shows that coalitions most effectively contribute to changes in programs, services and practices. Butterfloss FD & Francisco VT. (2004) Health Promotion Practice 5(2):108-114. Roussos ST and Fawcett SB (2000) Annu Rev of Public Health 21:369-402.

The Social Ecological Model The Social Ecological Model cuts across disciplinary lenses and integrates multiple perspectives and theories. This framework recognizes that behavior is affected by multiple levels of influence, including interpersonal factors, interpersonal processes, institutional factors, community factors, environmental factors, social factors and public policy.

CHAMPS Healthy Chicago Partnership Functions Build Awareness of What Works Joint Projects Widely Adopted, Strengthened & Sustained Prevention Measures Information Sharing, Training, & Collaborative Learning Market Effective Prevention & Provide Incentives Healthy Chicago Effective Health Promotion Interventions Healthy Places & Environments Partnership functions such as building awareness of what works,  sharing information, training, collaborative learning, identifying and tackling barriers to implementation, mobilizing assets, building synergies between successful programs, marketing effective interventions, and engaging in joint prevention initiatives will lead to widespread adoption of prevention measures—prevention measures such as healthy places and environments, evidence-based preventive care, and effective health promotion interventions.  If these measures are widely adopted, strengthened and sustained, we have every reason to believe that Chicago will be a healthier city. Evidence-Based Preventive Care Build Synergies Between Prevention Initiatives Tackle Barriers Mobilize Assets

The Social Ecological Model We must “ignite and build a social movement” at private, public and policy levels in order to change broad scale social norms and create a social envionment supportive of health. Sorenson G et al. Ann Rev Public Health; 1998.19:379-416

Building a Healthier Chicago Community HeAlth Mobilization ProjectS  Community Health Assessment and Mobilization ProjectS  Community Health And Mobiliation ProjectS

Building a Healthier Chicago james.galloway@hhs.gov 312-353-1358 Community Health Assessment and Mobilization ProjectS  Community Health Assessment and Mobilization ProjectS  Community Health And Mobiliation ProjectS