Hunterdon County. Community Health Improvement Plan

Transcription

1 Hunterdon County Community Health Improvement Plan September 2013

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3 Hunterdon County Community Health Improvement Plan Prepared by: Joanna Chua, MPH, CHES Program Coordinator Hunterdon Regional Community Health And Adopted: September 13, 2013

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5 Dear Hunterdon County Community, It is with much excitement and pride that we present the Community Health Improvement Plan (CHIP) for Hunterdon County. This plan serves as an updated document to our community s 2007 CHIP. A considerable amount of research, planning, and thoughtful consideration went into this document and we encourage area agencies, organizations, community members, and elected officials to support our health priorities. Specifically, the Partnership for Health will formally focus on four key priority areas - obesity, substance abuse, aging-related issues and the unique health needs of the Latino population in Hunterdon County. Many individuals contributed to the development of this CHIP. We acknowledge their support and commitment. We also encourage other agencies and concerned individuals to embrace the charge set forth in this CHIP. A formal work plan will be developed to implement the proposed strategies and move toward fulfilling our goals. We encourage residents and other community organizations to join the CHIP process as it enters the Action Phase. If you are interested in participating in this work and becoming a member of an action team or the Partnership for Health, we encourage you to reach out to one of our Partnership members or to contact Joanna Chua at or hunterdonpfh@gmail.com. In closing, we look forward to working together to make Hunterdon County a healthy place to live, work and play. Our collective efforts and our individual knowledge and passion can garner greater change than any one of us working alone. Thank you in advance for your commitment and support! Regards, Hunterdon County Partnership for Health Members

6 Table of Contents PARTNERSHIP FOR HEALTH... 1 BACKGROUND... 1 COMMUNITY HEALTH NEEDS ASSESSMENT OVERVIEW... 1 SELECTION OF COMMUNITY HEALTH PRIORITIES... 2 Master List of Community Priorities... 3 Priority Health Issues... 5 ACTION TEAMS AND ADDRESSING IDENTIFIED PRIORITY ISSUES CHIP... 6 OBESITY/OVERWEIGHT... 7 Goal Statement and Objectives... 8 Action Team Members... 9 Other Community Resources/Assets... 9 Strategy Map SUBSTANCE ABUSE Goal Statement and Objectives Action Team Members Other Community Resources/Assets Strategy Map LATINO HEALTH DISPARITY Goal Statement and Objectives Action Team Members Other Community Resources/Assets Strategy Map AGING-RELATED ISSUES Goal Statement and Objectives Action Team Members Other Community Resources/Assets Strategy Map MOVING FORWARD USING THE CHIP PARTNERSHIP FOR HEALTH MEMBERS REFERENCES... 26

7 Partnership for Health The Partnership for Health, Hunterdon s healthier community initiative, was cofounded in 1995 by Robert Wise, President and CEO of Hunterdon Healthcare System, John Beckley, former Director of the Hunterdon County Department of Health and Bernadette West, PhD, then Executive Director of Local Advisory Board III (a central NJ regional health planning organization). The Partnership for Health is a county-wide initiative that involves more than 30 community service providers, agencies and organizations sharing a common interest in promoting and improving the health, well-being and quality of life of Hunterdon County residents. Each agency represented in the Partnership plays a vital role in improving the health of the Hunterdon community. Background Community health needs assessment (CHNA) and community health improvement planning work has been a commitment of the Partnership for Health since its inception in In 2007, a county-wide Community Health Improvement Plan (CHIP) was developed to guide the initiatives of the Partnership. [The 2007 CHIP is available at: The CHIP is a planning document that outlines the community health priorities. It also includes the goals, objectives and strategies that will be implemented to address the identified priority issue. The CHIP is community-driven and community-owned. The current document is an updated CHIP, developed by the members of the Partnership for Health and the four Action Teams, for 2013 through From this point forward, the Partnership plans to conduct a CHNA/CHIP process every three years in alignment with other health improvement initiatives. Community Health Needs Assessment Overview Using the Mobilizing for Action through Planning and Partnerships (MAPP) framework, the Partnership for Health used a variety of quantitative and qualitative research components as part of the CHNA process. These components included the following: 2013 Hunterdon County CHIP - 1 -

8 1. Community Themes and Strengths Assessment (CTSA) Conducted 6 focus groups with different sectors of the community members to identify factors affecting quality of life of residents of Hunterdon County 2. Local Public Health System Assessment (LPHSA) Surveyed 18 representatives of Hunterdon County s Public Health System to identify its strengths, limitations, gaps and needs 3. Forces of Change Assessment (FOCA) Facilitated a brainstorming session with 14 community stakeholders to identify factors, events and trends that influence or will influence the community s health and the delivery and operation of public health services 4. Community Health Status Assessment (CHSA) Analyzed 13 primary and secondary data sources to develop a comprehensive quantitative data-based Hunterdon County health profile Primary data included: i. Hunterdon County Behavioral Risk Factor Surveillance System (BRFSS) a statistical household survey completed with roughly 1,100 Hunterdon County adults. The survey has been conducted approximately every five years throughout Hunterdon County and largely aligns with the BRFSS study promoted by the Centers for Disease Control and Prevention (CDC). The survey assessed indicators such as general health status, prevention activities and risky behaviors. The results were also examined by a variety of demographic indicators such as age and gender. ii. Hunterdon County Youth Risk Behavior Survey (YRBS) a survey conducted with 9 th through 12 th grade students in Hunterdon County high schools. Of more than 5,100 surveys completed, a sample of approximately 500 surveys from each grade level was randomly selected, resulting in a total sample size of 2,002 surveys. Similar to the BRFSS study, the YRBS is a CDC promoted assessment. It examines health behaviors such as substance use/abuse, bullying and sexual activity. The findings were analyzed by gender and grade. Selection of Community Health Priorities In July 2012, approximately 30 members of the Partnership for Health gathered to review the results of the Community Health Assessment data. The community assessment and strategic planning meeting was held to discuss and prioritize key findings and to lay the groundwork for an updated CHIP. Agencies represented at the one-day retreat included: 2013 Hunterdon County CHIP - 2 -

9 Central Jersey Family Health Consortium Delaware Valley Family Health Center Family Support Organization of Hunterdon, Sussex and Warren Counties Flemington Jewish Community Center Hunterdon County Chamber of Commerce Hunterdon County Resident Hunterdon County Division of Senior, Disabilities and Veterans Services Hunterdon County Office of the Prosecutor Hunterdon County Superintendent of Schools Hunterdon County YMCA Hunterdon County Cancer Coalition (now the Hunterdon/Mercer County Regional Chronic Disease Coalition) Hunterdon Helpline Hunterdon HealthCare Partners Hunterdon Medical Center o Center for Healthy Aging o Center for Nutrition and Diabetes Management o Hunterdon Behavioral Health Hunterdon County Cancer Coalition (now the Hunterdon/Mercer County Regional Chronic Disease Coalition) Hunterdon Pediatric Associates Hunterdon Regional Cancer Center Hunterdon Regional Community Health Hunterdon Prevention Resources Phillips Barber Family Health Center Readington Township Board of Health Rutgers Cooperative Extension Services Safe Communities Coalition of Hunterdon and Somerset County United Way of Hunterdon County Following a discussion of expectations for the meeting, a research overview was presented by John Beckley and Joanna Chua. Subsequent to the research overview, participants were asked to share openly what they perceived to be the health needs and areas of opportunity in the county. The intent was to develop a master list of potential health priorities for inclusion in the updated CHIP. The following is the list developed by the attendees along with relevant notes of mention related to each priority issue. Master List of Community Priorities (in no particular order): 1. Obesity/Overweight Relationship with heart disease, diabetes, hypertension, and other chronic diseases Role of nutrition and exercise 2. Integration of Physical and Mental Health This is a system issue as well as an individual one Recognizing the comorbidity with mental illness and health outcomes 3. Substance Abuse Specific concerns with underage users/abusers Increase abuse of prescription medication Limited funding in law enforcement to address this issue Relationship between drug use and gang activity 4. Disparities with Hispanic/Latino Population Poorer health outcomes 2013 Hunterdon County CHIP - 3 -

10 5. Gang Activity Closely related to drug use; responding to local demand for drugs Increase in recent years 6. Prenatal Care 7. Dental Care Cost as a major barrier No dental providers for the uninsured in the county 8. Aging-related Issues Needs of caregivers are significant as well Access to assisted living Aging-in-place services and support End of life issues A number of cross-cutting issues were identified as well. These issues were perceived to be present regardless of the key health issue. They included barriers to accessing care, transportation, funding shortages, and cultural competency. The future work of the Partnership for Health will consider each of these cross-cutting issues when identifying potential interventions and community improvement activities. Once the master list was compiled, participants were then asked to rate each need based on two criteria. The two criteria included seriousness and ability to impact the issue. Respondents were asked to rate each issue on a 1 (not at all serious; no ability to impact) through 5 (very serious; great ability to impact) scale. The ratings were gathered instantly and anonymously through a wireless audience response system. Each attendee received a keypad to register their vote. The following reveal the results of the voting exercise. TABLE 1: Voting Results of the Master List MASTER LIST SIGNIFICANCE (average rating) IMPACT (average rating) 1) Obesity/overweight ) Integration of physical & mental health ) Substance abuse ) Disparities with Hispanic/Latino population ) Gang activity ) Prenatal care ) Dental care ) Aging-related issues Hunterdon County CHIP - 4 -

11 FIGURE 1: Prioritization of Community Issues Voting Results 5 Impact Seriousness Obesity/Overweight Integration of Phys. & Mental Health Substance Abuse Latino Health Disparity Gang Activity Prenatal Care Dental Care Aging-Related Issues The Quadrant Map above outlines the intersection of the average seriousness and ability to impact ratings. The issues that are in the upper right side of the map are those that have the highest ratings across the two criteria. During the meeting, the attendees stated interest in selecting a limited set of priority issues by focusing on areas that foster collaboration and on issues where an impact can be made. It was also reiterated that individual agencies or groups may elect to focus or continue to focus on particular areas, regardless of priority ranking, related their respective areas of expertise. Priority Health Issues The Partnership for Health members reviewed the findings from the strategic planning voting and discussed approaches to reducing the master list. Following an open discussion and review of the mission of the Partnership and resources available, there were several issues that were eliminated from consideration, given their associated ratings or the fact that other agencies had already begun addressing the priority area. Members of the Partnership in attendance adopted four priority areas, which are listed below Hunterdon County CHIP - 5 -

12 Obesity/Overweight Substance Abuse Latino Health Disparities Aging-related Issues While these are the key areas of focus for the Partnership for Health, the coalition will continue to acknowledge other needs that exist in Hunterdon County and will support initiatives and outreach to improve the health of all residents in the county CHIP The 2007 CHIP identified five priority health issues: (1) Mental Health, (2) Weight/Physical Activity, (3) Cardiovascular Disease, (4) Drugs, Alcohol and Tobacco, and (5) Access to Healthcare. Members of the Partnership for Health want ensured that the previous Action Teams and the work they initiated and accomplished were not left hanging. Two of the five Weight/Physical Activity (Obesity/Overweight) and Drugs, Alcohol and Tobacco (Substance Abuse) are still recognized as key issues in the 2013 CHIP. Mental health will be partly addressed under the umbrella of Substance Abuse as they are often co-occurring disorders. The issue of access to healthcare has been identified as a cross-cutting issue which all four Action Teams will consider as they develop initiatives to address their respective health issue. Cardiovascular disease was not identified as a priority issue in this round of CHNA. Although individual efforts are ongoing in the area of cardiovascular disease, the Action Team has completed its work and their efforts and accomplishments were acknowledged at the July 2012 strategic planning meeting. Action Teams and Addressing the Identified Priority Health Issues The four Action Teams (1) Obesity/Overweight, (2) Substance Abuse, (3) Latino Health Disparity, and (4) Aging-related Issues which include community members and professionals who have interest in any of the four identified priority health issues were created in late Members have been meeting regularly, discussing the extent and nature of the need around the priority health issues, and generating ideas to address them. During their strategic planning meetings, Action Teams defined clear goals and objectives and developed strategy maps to visually represent their overall strategy. The following sections outline the goals and outcome objectives, and include the strategy maps for each of the four identified priority health issues. The strategy map illustrates how each of the Action Teams plans to achieve the goal of a healthier Hunterdon community by means of a linked cause-and-effect chain of strategic objectives Hunterdon County CHIP - 6 -

13 Obesity and Overweight Based on the results from the 2010 Hunterdon County Behavioral Risk Factor Surveillance System (BRFSS), more than half of Hunterdon County adults (55%) are overweight or obese. This translates into approximately 54,300 adults. Additionally, the percentage of overweight and obese adults has steadily increased in Hunterdon since Figure 2 shows the trends in Body Mass Index (BMI) of Hunterdon County adults over the past 15 years. FIGURE 2: Body Mass Index in Hunterdon County % 37% 19% % 33% 18% % 33% 17% % 34% 9% 0% 20% 40% 60% 80% 100% 120% Normal Overweight Obese Source: Hunterdon County Behavioral Risk Factor Surveillance System, 2010 Note: BMI Categories: Underweight (Below 18.5), Normal ( ), Overweight ( ), Obese (30.0 and above). BMI is a widely used and fairly reliable measure of an adult s body fat based on height and weight. On average, people who are considered obese are estimated to pay $1,429 more in health care cost than someone with a BMI less than 25 (42% higher per individual). [1] Obesity also increases the risk of developing a number of health conditions including diabetes, cardiovascular disease, hypertension, arthritis, and some cancers, and reduces the life span. [2] As outlined in Healthy People 2020, [3] individuals who are at a healthy weight are less likely to: Develop chronic disease risk factors, such as high blood pressure and dyslipidemia Develop chronic diseases, such as type 2 diabetes, heart disease, osteoarthritis, and some cancers Experience complications during pregnancy Die at an earlier age 2013 Hunterdon County CHIP - 7 -

14 Given the alarming rise in obesity and its connections with a host of health problems, it is imperative that we address this important public health crisis. ShapingNJ is a statewide public private partnership of more than 200 organizations that is committed to curbing obesity in NJ through policy and environmental change. It is coordinated by the NJ Department of Health with support from the US Centers for Disease Control and prevention. ShapingNJ is focused on addressing six specific behaviors that have been identified to play the biggest role in maintaining weight. Breastfeeding Physical Activity Fruits and Vegetable Consumption High Calorie Food Intake Sugar-Sweetened Beverage Consumption TV Viewing Goal Statement and Objectives Understanding that obesity is a pervasive problem, the Action Team will target the whole Hunterdon community residents, workforce, students, preschoolers and infants. The six behaviors listed above will be considered as the Action Team develops specific strategies and initiatives. Goal: Reduce the prevalence of obesity in Hunterdon County. Outcome Objectives: 1. Increase the proportion of residents who are at a healthy weight by 5% by January Increase the proportion of mothers who breastfeed exclusively at hospital discharge by 5% by January Reduce the proportion of adults who engage in no physical activity by 5% by January Increase the proportion of adults who eat fruits and vegetables at least once a day by 5% by January There are numerous evidence-based strategies and programs available relating to prevention and reversal of the obesity epidemic. In addition, the Action Team members also recognize that Hunterdon County has a lot of resources and services that encourage physical activity and healthy eating, but are underutilized. Therefore, the focus of their work will be to develop relationships and collaborate with the different sectors of the community, such as businesses, 2013 Hunterdon County CHIP - 8 -

15 schools and health care providers in order to promote and to maximize the use and impact of existing resources. Current Obesity/Overweight Action Team Members: YMCA Grow-A-Row Francis Desmares Elementary School Hunterdon Land Trust Rutgers Cooperative Extension Hunterdon and Mercer Chronic Disease Coalition Hunterdon County Chamber of Commerce Center for Nutrition and Diabetes Management Center for Advanced Weight Loss Hunterdon Health and Wellness Centers, Clinton and Whitehouse Other Existing Community Resources and Assets: School Nurses Local Supermarkets Parks and Recreation Local Gyms Registered Dieticians in private practice Food Pantries Faith-based Organizations Healthcare Providers School Parent-Teacher Organizations Hunterdon County Division of Health Local Media School Wellness Councils Senior Groups Local Businesses/Employers Hunterdon County Chamber of Commerce Because of the increasing rates of obesity, unhealthy eating habits and physical inactivity, we may see the first generation that will be less healthy and have a shorter life expectancy than their parents. ~ Richard Carmona Former US Surgeon General 2013 Hunterdon County CHIP - 9 -

16 Below is the strategy map of the Obesity/Overweight Action Team developed as it envisions working to address the issue of obesity in Hunterdon County.

17 Substance Abuse In 2011, 21.6 million Americans aged 12 and above struggled with a drug or alcohol problem. Of those who required treatment, 98.6% were either unaware that they needed it or made no effort to seek treatment. [4] However, addiction is a treatable disease. In the latest survey by New York State Office of Alcoholism and Substance Abuse Services (OASAS), 23 million adult Americans reported having had substance abuse problems but are now in recovery. [5] These statistics stress the need and importance for increasing prevention efforts and improving access to treatment for substance abuse and co-occurring disorders. FIGURE 3: Percentage of Adults who have had at least One Drink in the Past 30 Days 100.0% 80.0% 78.3% 60.0% 57.6% 51.9% 40.0% 20.0% 0.0% Hunterdon County 2010 New Jersey 2009 US 2009 Source: Hunterdon County Behavioral Risk Factor Surveillance System, 2010 Alcohol consumption has been a consistent issue in Hunterdon County for many years, as evidenced by the results of the county-wide BRFSS going back to In 2010, 78.3% of the adults in Hunterdon County reported having at least one drink of an alcoholic beverage in the past 30 days, with 6.8% reporting drinking on a daily basis. This is a 27.4% increase from 2005 and is also more than 20% above statewide averages and 26% above national figures. While males in the county are generally reporting higher alcohol consumption, the figures for both males and females are quite high. Additionally, consumption does not appear to decrease with age, as elevated alcohol consumption was reported by all adult age groups in Hunterdon County Hunterdon County CHIP

18 TABLE 2: Alcohol Consumption, by Gender (2010) Gender Yes, had alcohol in past 30 days Males 80.6% Females 75.6% Source: Hunterdon County Behavioral Risk Factor Surveillance System, 2010 TABLE 3: Alcohol Consumption, by Age (2010) Age Yes, had alcohol in past 30 days % % % % % % In addition to alcohol, illicit drug use is also a concern among Hunterdon adults. According to the 2009 NJ Household Survey on Drug Use and Health, 8.2% of adults reported using any illicit drug one or more times during the past year compared to the statewide average of 6.5%. TABLE 4: Adult Illicit Drug Use (2009) Hunterdon County % New Jersey % Lifetime use of marijuana Lifetime use of any drug other than marijuana Source: NJ Household Survey on Drug Use and Health, 2009 Substance abuse is also a growing problem among Hunterdon County youths. Similar to adults, alcohol is the drug of choice among Hunterdon high school students, with 33.1% reporting they had at least 1 alcoholic drink in the past 30 days and 19.6% reporting having engaged in binge drinking in the past 30 days. Aside from alcohol, Hunterdon youths also have experimented with other illicit drugs such as marijuana, cocaine, heroin and prescription drugs Hunterdon County CHIP

19 FIGURE 4: High School Students Lifetime Use of Drugs 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Alcohol Marijuana Cocaine Heroin Meth Ecstasy Rx Drugs w/o Prescription Source: Hunterdon County Youth Risk Behavior Survey, 2012 Substance abuse affects not only the individual, but also families and communities. And similar to obesity, it poses a significant burden on society through higher healthcare costs, loss of productivity at work and engagement in risky behaviors leading to a host of public health problems, such as crime and injury, teenage pregnancy, and sexually transmitted diseases (STDs). TheNational Institute on Drug Abuse breaksdown the cost of substance abuse as follows: [6] Health Care Overall Tobacco $96 billion $193 billion Alcohol $30 billion $235 billion Illicit Drugs $11 billion $193 billion Goal Statement and Objectives Hunterdon County 2012 New Jersey 2011 US 2011 The Substance Abuse Action Team is aware of the scope of the problem and recognizes that there are multiple agencies and organizations working to address this issue in Hunterdon. Therefore, to avoid duplicating efforts, the Action Team decided to target the age-specific populations believed to be underserved in county young adults aged years old and older adults aged 55 years and older. The Action Team will address substance abuse to these target age groups en masse. However, it will place particular focus on heroin and opiate use among young adults and alcohol consumption and prescription drug misuse and abuse among older adults Hunterdon County CHIP

20 Goals: Reduce the prevalence and incidence of substance abuse among Hunterdon County residents. Outcome Objectives: 1. Reduce the prevalence of heroin and opiate abuse among young adults by 5% by January Reduce the prevalence of prescription drug abuse among adults 55 years and older by 5% by January Reduce excessive drinking among adults 55 years and older 5% by January Increase the number of admissions into substance abuse treatment 5% by January Current Action Team Members: Hunterdon Medical Center Behavioral Health Hunterdon County s NJ CEED Hunterdon Lifeline Hunterdon County Division of Health Hunterdon County Department of Human Services Readington Township Board of Health Hunterdon Drug Awareness Program Freedom House Anderson House Other Existing Community Resources and Assets: Daytop Hunterdon Prevention Resources Safe Communities Coalition Hunterdon County Prosecutor s Office and other Law Enforcement Agencies Faith-based Organizations "It is time for America to deal with our Nation's number one public health problem: substance abuse and addiction. While we must provide treatment for those in need, the best cure is prevention." ~ Jim Ramstad, Former Member of Congress (MN-3) 2013 Hunterdon County CHIP

21 Below is the strategy map of the Substance Abuse Action Team developed as it envisions working to address substance abuse among young and older adults in Hunterdon County.

22 Latino Health Disparity According to the 2010 United States Census Bureau, 5.2% of residents within Hunterdon County are of Hispanic or Latino origin. That is approximately 6,600 individuals. However, it is perceived by area providers and agencies that these figures are less than the actual number of Latino residents in the county. In 2010, the United States Office of Minority Health noted that Hispanics have the highest uninsured rates of any racial or ethnic group within the US. [7] This is not surprising and is reflective of the current situation in Hunterdon, wherein only 37.9% Latinos reported having some form of health care coverage. This is significantly lower than the county and statewide averages of 93.2% and 87.2%, respectively. Latinos in Hunterdon County face more barriers in seeking care compared to the general Hunterdon population, making them less likely to get needed care and more likely to have poorer health outcomes. In addition to not having health insurance, other barriers they face include healthcare affordability, transportation and language and cultural differences. According to the 2011 Hunterdon County Latino Health Risk Behavior Survey, 34.9% of Latinos did not see a doctor for needed care in the past year due to cost while 45.2% reported never having seen a doctor for routine care. Furthermore, 31.3% of Hunterdon Latinos surveyed said they could not get needed health care in the past year because of language barriers. FIGURE 5: Barriers to Care, Hunterdon County and Hunterdon Latinos 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 5.0% 34.9% Did not see doctor due to cost 31.3% *N/A 0.6% Experienced language barrier 45.2% Never had a routine checkup Hunterdon County 2010 Hunterdon Latinos % 37.9% Has health insurance coverage *Question not asked in the 2010 Hunterdon County BRFSS Source: Hunterdon County Behavioral Risk Factor Surveillance System, 2010; Hunterdon County Latino Health Risk Behavior Survey, Hunterdon County CHIP

23 Anecdotal stories shared by some community members suggest that health beliefs and attitudes towards healthcare, and in particular preventive care, may be another reason why Latinos are less likely to utilize preventive services such as cancer screenings and are more reluctant to seek medical care unless absolutely necessary. In Hunterdon, disparity in prenatal care utilization based on race exists. Generally speaking, a higher rate of pregnant women in Hunterdon County receives first trimester prenatal care compared to state average. However, this is not the case among the county s Latina population. Educating the Latino population on the importance of utilizing preventive healthcare, including early prenatal care, in attaining and maintaining good health is essential. FIGURE 6: Access to Care, Hunterdon County and Hunterdon Latinos 100.0% 88.7% 80.0% 71.2% 71.8% 68.2% 60.0% 86.1% 57.3% 40.0% 20.0% 28.0% 34.6% 0.0% Screen Blood Cholesterol Mammography Colonoscopy / Sigmoidoscopy Hunterdon County 2010 Hunterdon Latinos st Trimester Prenatal Care Source: Hunterdon County Behavioral Risk Factor Surveillance System, 2010; Hunterdon County Latino Health Risk Behavior Survey, 2011 Goal Statement and Objectives Due to the complexity and extent of the issues experienced by the Latino community in Hunterdon County, the Latino Health Disparity Action Team and the Latino Healthcare Access Committee decided to focus on three main areas, of which one is targeted towards a specific health outcome while the other two attempt to address broader issues that have the potential to affect multiple health outcomes: 1. Health Literacy 2. Cultural Competency 3. Prenatal Care The focus of the Action Team s efforts will be on promoting health and wellness among the Hunterdon Latino community, encouraging adoption of healthy behaviors, and emphasizing the importance of cultural competence among healthcare professionals. Goal: Reduce health disparities among the Latino population in Hunterdon County Hunterdon County CHIP

24 Measurable Objectives: 1. Increase the proportion of Latino women receiving first trimester prenatal care by 5% by January Develop and conduct health education workshops targeting the Latino population. 3. Develop a training guide to cultural competence for providers. Current Action Team Members: United Way of Hunterdon County Hunterdon Medical Center Phillips Barber Family Health Center Public Health Nursing and Education Family Success Center Hunterdon County YMCA HART Commuter Services Norwescap Hunterdon Helpline Hunterdon and Mercer County Regional Chronic Disease Coalition Francis Desmares Elementary School Johnson and Johnson Other Existing Community Resources and Assets: Local Businesses Faith-Based Organizations "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being..." ~ WHO Constitution Hunterdon County CHIP

25 Below is the strategy map of the Latino Health Disparity Action Team developed as it envisions working to address the issue of health disparity among the Latino population living in Hunterdon County.

26 Aging-related Issues In Hunterdon County, approximately 13% (about 17,000 seniors) of the population is 65 years or older. It is projected that by 2030, they will make up 24% of the county s population. The growing senior population and their higher and more complex demand for services pose a significant challenge to Hunterdon s social service and healthcare delivery systems. Prevalence of chronic conditions and related disabilities increases with age. This is evident in Hunterdon wherein 59.3% of its residents aged 65 years and older reported having been diagnosed as having a chronic health condition such as diabetes, high blood pressure or heart disease compared to only 22.7% of all of Hunterdon adults. In addition, 22.7% of seniors reported having poor physical and mental health days in the past month which kept them from performing their usual activities. This is more than double the percentage of all of Hunterdon adults (9.7%). And as stated in Healthy People 2020, many seniors experience hospitalizations, nursing home admissions and low-quality care. In addition, many lose their ability to live independently at home. FIGURE 7: Chronic Disease, Hunterdon County and Hunterdon County (2010) Stroke Angina or Heart Disease Heart Attack 5.2% 1.6% 9.7% 2.0% 7.8% 1.8% High Blood Pressure Diabetes 15.0% 5.7% 25.2% 90.0% Has Chronic Health Condition 22.7% 59.3% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Hunterdon Seniors Hunterdon County Source: Hunterdon County Behavioral Risk Factor Surveillance System, 2010 Almost all of the seniors (99.1%) interviewed for the 2010 BRFSS reported having some form of health insurance, most likely through Medicare. Hence it is not surprising that according to the 2013 Hunterdon County CHIP

27 2010 BRFSS, 83% reported having seen a doctor for a routine checkup within the past year. Although this rate is high, it is significantly lower than the state average of 91%. Goal Statement and Objectives Like the other three priority health issues, there are multiple factors that affect the health, function and quality of life of seniors. The Aging-related Issues Action Team decided to focus on the following two issues believe to be key factors: 1. Adult Wellness 2. End of Life Care Goal: Improve the health, function and quality of life of seniors living in Hunterdon County. Outcome Objectives: 1. Increase the percentage of seniors who receive an Annual Wellness Visit or a traditional physical exam at least once a year by 10% by January Increase hospice utilization by 10% by January Increase the proportion of seniors who have a completed Advanced Directive by 10% by January Current Action Team Members: Hunterdon Regional Community Health Hunterdon HealthCare Partners Hunterdon Hospice Hunterdon Medical Center, Center for Healthy Aging Delaware Valley Family Health Center Public Health Nursing and Education Hunterdon Care Center Hunterdon Helpline Division of Senior, Disabilities and Veterans Services Hunterdon Medical Center Foundation United Way of Hunterdon County Briteside Adult Day Center Other Existing Community Resources and Assets: Hunterdon County YMCA Meals on Wheels Assisted Living and Nursing Homes Faith-based Organizations Municipal Liaisons Arc of Hunterdon County Hunterdon Developmental Center Media The aging of the country s population and the rise in healthcare costs will continue to be the nations most significant economic challenges moving forward. ~ Congressional Budget Office, February Hunterdon County CHIP

28 Below is the strategy map of the Aging-related Issues Action Team developed as it envisions working to address the issue of health disparity among the Latino population living in Hunterdon County.

29 Moving Forward In addition to the strategy maps, a more detailed work plan will be developed by the Partnership for Health and its four action teams to serve as the road map for addressing the four priority health issues. Action plans as they unfold will be available at Specific strategies and tactics will be outlined along with detailed plans for timelines and responsible parties. Again, all area agencies and organizations and community members are encouraged to participate in this work. The CHIP is not intended to be a static report. The progress of the work will be evaluated on an ongoing basis, not simply at the three-year mark. Strategies and tactics that do not yield the intended outcomes will be revised. What will remain consistent throughout the life of the CHIP is the commitment to fulfilling the vision of optimal health for the Hunterdon community. Thank you to all the Partnership for Health and action team members who contributed to the development and production of the CHIP. For more information on how to be involved with the Hunterdon County Partnership for Health, please contact Joanna Chua at (908) or hunterdonpfh@gmail.com. By working together to address the priority health issues identified, community members will help realize the vision of making Hunterdon a healthier place to live, learn, work and play. Using the CHIP Each of us in Hunterdon County can play an important role in community health. Whether in our homes, schools, worksites, recreational areas or places of worship, there are some simple strategies to improve the health of your community. Employers Use the CHIP to improve the health of your employees and the community in which you work Understand priority health issues that affect the health of your community Use objectives to talk with employees about health issues that affect their well-being, productivity and health care costs Develop worksite wellness programs Educators Because life-long habits are often developed in childhood, understand that you are key partners in improving the long-term health of the community Use the CHIP to integrate prevention into education, starting from the earliest ages Align the school district s wellness policy with CHIP initiatives, if and when possible Identify opportunities for youth and offer to get involved 2013 Hunterdon County CHIP

30 Government Officials Identify barriers to good health in your communities and mobilize community leaders to take action investing in programs and policy changes that help residents lead healthier lives Health Care Professionals Offer your time and expertise to local improvement efforts Offer patients relevant counseling, education and other preventive services in alignment with identified needs in Hunterdon County Faith-based and Other Community Organizations Talk with parishioners or congregations and service consumers about the importance of overall wellness (mind, body and spirit) and the local community health initiatives that support wellness Identify opportunities that your organization or individual members can help support and encourage participation Community Residents Understand how health issues are changing in your community over time Use information to talk with community leaders about the health issues that are important to you and your family Get involved join a task force, volunteer your time or expertise for an event or activity or financially help support initiatives planned 2013 Hunterdon County CHIP

31 Partnership for Health Members Cancer Coalition of Hunterdon and Mercer Central Jersey Family Health Consortium Delaware Valley Family Health Center Flemington Jewish Community Center Francis Desmares Elementary School HART Commuter Information Services Hunterdon Care Center Hunterdon County Chamber of Commerce Hunterdon County Resident Hunterdon County Division of Health Hunterdon County Division of Senior, Disabilities and Veterans Services Hunterdon County Office of the Prosecutor Hunterdon County Public Health Nursing and Education Hunterdon County Superintendent of Schools Hunterdon County YMCA Hunterdon Drug Awareness Program Hunterdon Helpline Hunterdon HealthCare Partners Hunterdon Medical Center o Center for Healthy Aging o Center for Nutrition and Diabetes Management o Hunterdon Behavioral Health Hunterdon Pediatric Associates Hunterdon Regional Cancer Center Hunterdon Regional Community Health Hunterdon and Mercer County Regional Chronic Disease Coalition Hunterdon Prevention Resources Latino Healthcare Access Committee Phillips Barber Family Health Center Readington Township Board of Health Rutgers Cooperative Extension Services Safe Communities Coalition of Hunterdon and Somerset County United Way of Hunterdon County 2013 Hunterdon County CHIP

32 REFERENCES 1. Finkelstein, E.A., Trogdon, J.G., Cohen, J.W., & Dietz, W. (2009). Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Affairs 28(5). doi: /hlthaff.28.5.w Trust for America s Health & Robert Wood Johnson Foundation. (2012) F as in Fat: Howe Obesity Threatens America s Future Accessible at: 3. U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People Washington, DC. Available at 4. US Department of Health and Human Services. (2011). Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings. Retrieved from: 5. Feliz, M. (2012, March 6). Survey: Ten percent of American adults report being in recovery from substance abuse or addiction. Newsroom. Retrieved from: 6. National Institute on Drug Abuse. (n.d.) Trends and Statistics (Costs of Substance Abuse). Retrieved from: 7. US Department of Health and Human Services. (2010). Data and Statistics (Hispanic/Latino Profile). Retrieved from: Hunterdon County CHIP

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