In compliance with the ACCME/NMMS Standards for Commercial Support of CME, Theresa Cruz, PhD

1. This event is jointly sponsored by the HealthInsight New Mexico and NMPHA & NM CARES Health Disparities Center. In compliance with the ACCME/NMMS Standards for Commercial Support of CME, Theresa Cruz, PhD Lorna Marchand, MA, MPH Danielle Reed, MA Angelica Solares, MCRP have asked to advise the audience that they have no relevant financial relationships to disclose. This activity has been planned and implemented in accordance with the Essential Areas and polices of the New Mexico Medical Society (NMMS) through the joint sponsorship of HealthInsight New Mexico and New Mexico Public Health Association and NM CARES Health Dipartites Center]. HealthInsight New Mexico is accredited by the NMMS to provide Continuing Medical Education for physicians. HealthInsight New Mexico designates this live event for a maximum of 10.75 AMA PRA Category 1 Credit(s) tm. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

2. Transforming Communities Through Prevention of Chronic Disease: Early Lessons Learned from the Bernalillo County Community Transformation Grant Theresa Cruz, PhD Lorna Marchand, MA, MPH Danielle Reed, MA Angelica Solares, MCRP April 19, 2013

3. Collective Impact for Neighborhood and County Health (CINCH)

4. Background • Authorized by Affordable Care Act of 2010 • Administered and supported by CDC • Awarded $103 million to 61 states and communities • Reaching 120 million Americans • 36 states, 7 tribal organizations, Republic of Palau • Bernalillo County received 1 of 26 Capacity-Building Awards • Two-year capacity-building award with potential to apply for a three-year implementation award

5. Purpose • To create healthier communities by focusing on capacity building and implementation of broad, evidence-based and practice-based policy, environmental, programmatic, and infrastructure changes. • Emphasis on Equity “...specific measures to achieve health equity, eliminate health disparities, and improve the health of the population and population subgroups.”

6. Goal • Create a healthier community by achieving positive changes in: • nutrition/weight • physical activity • tobacco-use • the built environment • clinical preventive services • emotional well-being/overall mental health • CTG concentrates on the causes of chronic disease, by improving health and wellness of county residents

7. How? • Reduction in deaths and illnesses from heart disease, diabetes, cancer, and asthma through policies that increase opportunities for: • physical activity and healthy eating • healthyneighborhoods, and • living environments free of tobacco smoke. • Participatory Planning Approach • Leadership, advisory teams and community input • Research • Policy Scan, Health Assessment, qualitative data gathering • Communication and Training • Communication assessment, and strategic communications plan • Training Academy

8. Health Assessment Key Findings • Hispanics in Bernalillo County: • Have disproportionately high rates of death from • Heart disease (men) • Stroke (men and women) • High blood pressure • Have high rates of obesity (2) • Lowest educational attainment of any group – 56% HS education or less • High rates of poverty – 21.2% • Have second highest rates of smoking among high school students

9. Health Assessment Key Findings • African Americans in Bernalillo County: • Have disproportionately high rates of death from • Lung cancer • Heart disease • Stroke • See higher rates of obesity than any other population group • Are most likely to encounter financial barriers to obtaining health care

10. Health Assessment Key Findings • American Indians in Bernalillo County: • Have disproportionately high rates of death from • Cancer • Diabetes • See higher rates of overweightthan any other population group • Are most likely to have no health insurance than any other group • Have highest rates of smoking among high school students (25.2%)and adults (24%)

11. Areas with highest concentration of families living in poverty have the highest rates of chronic disease

12. CINCH Community Engagement • Focus group-style community meetings • Six communities identified in health assessment • Geographic – International District, South Valley, I-25 Corridor • Racial/Ethnic – African American, Native American, Hispanic • Recruitment efforts led by members of leadership and planning teams

14. CINCH Community Engagement • Key informant interviews • Fill in the gaps from community meetings • Who was not represented? • Community health workers, youth advocates, community center leaders • CINCH leadership team provided links when needed

15. CINCH Community Engagement • Two hour semi-structured meetings • Key questions • What makes a healthy community? • What are barriers to healthy eating, active living, preventive screening? • What are your ideas about reducing chronic disease?

16. CINCH Community Engagement • Key findings - Healthy eating • Need increased access to affordable, quality fresh food • Need education about healthy food preparation • Wanted more fresh food in schools and at summer programs • Low price and easy access to fast food makes it difficult to eat well when time and money are constraints

17. CINCH Community Engagement • Key findings – Active Living • South Valley – need for safer streets and sidewalks • International District – concerns about crime • Supported increased access to school yards after hours • Expressed need for increased utilization of community centers for recreation opportunities

18. CINCH Community Engagement • Key findings - Tobacco • Difficult for smokers to quit – become defensive when regulations are proposed • Enforcement is lacking – smoking in public places as well as sales of tobacco to minors • Need to deal with larger issues of why people are smoking – stress, poverty • Living in a smoke-free environment is important, especially for children

19. CINCH Community Engagement • Key findings – Clinical Preventive Services • Hesitation to go for screening because costs are often unclear • Need more providers similar to the race and ethnicity of the communities they serve • Would like to see community health workers in non-clinical settings • Schools, community centers • Need to make people aware of free clinics and screening services

20. Policy Scan

21. Purpose of Policy Scan • Identify and classify policies addressing chronic disease prevention • Detect policy gaps • Report on findings • Develop a database

22. Scope of the Policy Scan • Written policies • Includes legislative, regulatory, and organizational policies that promote population health • Focus on prevention of heart disease, cancer, stroke, and diabetes

23. Examples of Evidence-Based Policies • Tobacco-free school policies • Policies that increase opportunities for physical activity in communities (e.g., joint use) • Policies that support breast-feeding • Mixed-use zoning policies • Complete Streets policies • Training and technical assistance to improve delivery of clinical preventive services

24. Data Collection Methods • Database and internet policy searches • Stakeholder meetings • Collaboration with non-profits and policy implementers • Healthcare provider interviews • Employer wellness policy surveys

25. Policy Levels • State – New Mexico • County - Bernalillo • City – Albuquerque • Employers/Organizations • Healthcare Providers • School District – • Albuquerque Public Schools • University of New Mexico

26. Model Policies

27. Policies Analyzed

28. Interviews and Surveys • 7 primary care medical directors • 25 eligible employer survey respondents

29. CINCH Policy Database

30. Searches – Active Living and City

31. Results

32. Early Lessons Learned • Need for a dynamic, flexible, sustainable database to allow for on-going analysis and assessment • Multiple policies addressing one topic make it more difficult to understand and assess • Many plans, programs, and practices exist but they aren’t formalized as policies • Employers often don’t have written policies • The majority of policies had exemptions • Translating policies into multiple languages would improve access and understanding

33. Key Findings – Tobacco The community may wish to improve population health by focusing on: • Clean indoor air policies • Policies that promote tobacco-free outdoor public places and outdoor workplaces not controlled by Bernalillo County • Smoke-free multi-unit housing policy • Consolidated policies

34. Key Findings - Healthy Eating and Active Living • Competitive food policies in schools to apply to fund-raising and foods available to staff • Enrollment policies for students in free- and reduced-lunch programs • Revised vending policies to include healthier food options • Policies that address location and density of fast food outlets • Incentives on the sale of healthy foods at retail outlets • Policies that address accessibility and availability of healthy foods through zoning laws that allow for community gardens on vacant land The community may wish to improve population health by focusing on:

35. Key Findings – Healthy and Safe Physical Environment The community may wish to improve population health by focusing on: • Policies to create and sustain safety/walkability programs • Policies that incorporate Complete Streets principles • Policies that incorporate Transit-Oriented Development principles • Policies supporting health impact assessments prior to changes to the built environment

36. Key Findings - Clinical Preventive Services The community may wish to improve population health by focusing on: • Polices that promote training and technical assistance to health care providers to effectively implement systems to improve delivery of clinical preventive services • Policies that promote the use of chronic disease self-management programs • Regular review and revision of policies on eligibility for preventive services • Policies for use of EHRs for patient reminders about recommended preventive services

37. The Community Transformation Implementation Plan • CINCH’s two-year long capacity-building and planning process has informed the development of a comprehensive, three-year implementation plan for Bernalillo County that focuses on prevention of chronic disease. • The CINCH Planning Team met for six months to review results of the Health Assessment, Policy Scan, and focus groups, and to prioritize implementation activities.

38. The Community Transformation Implementation Plan • Implementation awardees will implement policy, environmental, programmatic, and infrastructure changes consistent with CDC’s strategic directions. • Implementation activities must impact the entire population of Bernalillo County, as well as specific population subgroups with disproportionately high rates of health and social disparities, and pockets of high burden with increased intensity tailored to the specific barriers and needs of populations suffering from disparities.

39. The Community Transformation Implementation Plan • The proposed CTIP and funding request application will be submitted to CDC for consideration. • Implementation project period: October 1, 2013 – September 30, 2016. • If funded, activities will be carried out through contractual agreements with community partners. • CTIP includes project period objectives (PPO), annual/multiyear objectives (AMO), and specific activities.

40. The Community Transformation Implementation Plan Active Living PPO: Increase the number of schools that are authorized to provide safe, inviting, accessible places for physical activity opportunities during non-school hours. AMOs: • Increase the number of district-wide joint use agreements that facilitate the shared use of school property for physical activity purposes. • Increase the number of schools that employ joint-use and shared-use practices.

41. The Community Transformation Implementation Plan Healthy Eating PPO: Increase the number of people in identified priority neighborhoods who have access to healthy, affordable food. AMOs: • Increase the number of people served by mobile produce vending programs that link consumers with fresh, locally grown fruits and vegetables. • Increase the number of people served by healthy corner stores initiatives that facilitate access to fresh fruits and vegetables in USDA-designated food deserts. • increase the number of students served by initiatives that provide schools with locally grown fruits and vegetables.

42. The Community Transformation Implementation Plan Tobacco-Free Living PPO: Increase the number of people living in smoke-free multi-unit housing in Bernalillo County's International District. AMOs: • Increase the number of property owners/managers who receive education, training, and outreach related to smoke-free housing. • Increase the number of people exposed to smoke-free multi-unit housing messages. • Increase the number of tenants receiving education and outreach related to smoke-free multi-unit housing in the International District

44. The Community Transformation Implementation Plan Tobacco-Free Living PPO: Decrease the number of middle and high school students in priority neighborhoods with access to tobacco products. AMOs: • Increase the number of community-based youth tobacco compliance task forces. • Increase the number of tobacco merchants in priority neighborhoods receiving education about tobacco sales to minors. • Increase the number of community members in priority neighborhoods receiving education about enforcement and reporting of tobacco sales to minors.

45. The Community Transformation Implementation Plan Healthy and Safe Physical Environments PPO: Increase the number of adopted land use/transportation plans, policies, or funded projects that incorporate Complete Streets design principles. AMOs: • Increase the number of transportation engineers, planners, and other stakeholders in Bernalillo County that are familiar with Complete Streets principles and proficient in applying Complete Streets design standards. • Increase the number of adopted land use/transportation plans, policies, or funded projects that incorporate Complete Streets design principles.

46. The Community Transformation Implementation Plan Clinical Preventive Services PPO: Increase the number of people who receive health education and preventive services from community health workers who are representative of the target populations. AMOs: • Increase the number of community health worker programs that have sustainable funding sources. • Increase the number of Bernalillo County-based community health workers participating in a formal learning collaborative. • Increase the number of certification programs that incorporate community health worker core competency curriculum modules that focus on chronic disease, social determinants of health, and CTG strategies. • Increase the number of community health workers placed in community settings.

47. Acknowledgments • Courtney FitzGerald, MSSW, LMSW, UNM Prevention Research Center • Marsha McMurray-Avila, MCRP, and the Bernalillo County Community Health Council • George Schroeder, MPH, (PI) Bernalillo County Office of Health and Social Services • Shiraz Mishra, MBBS, PhD, UNM Prevention Research Center • Leona Woelk, MA, UNM Prevention Research Center • Participating colleagues, students, and staff that made this project a success • Physicians and employers who took time to respond to our interview questions and surveys • Members of the CINCH advisory teams • Members of the community The policy scan and presentation were supported by Cooperative Agreement Number 1-U58DP003595-01. The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

48. Thank you! Questions?