Environmental, Scan,

HEROEmployer-CommunityCollaborationCommittee Environmental, Scan, RoleofCorporateAmericainCommunity HealthandWellness Submittedto: TheInstituteofMedicineRoundtableonPopulationHealthImprovement January,2014

AboutThisReport ThisreportwassponsoredbytheRoundtableonPopulationHealthImprovementattheInstituteof Medicine(IOM).TheconvenerofthisprojectwastheHealthEnhancementResearchOrganization (HERO),anationalleaderinemployeehealthmanagement,research,education,policy,strategy, leadership,andinfrastructure(www.the-hero.org).denise,e.stevens,ph.d.,ofmatrixpublichealth Solutions,Inc.(www.matrixphs.com),anindependentconsultancy,conductedtheenvironmentalscan andtooktheleadinwritingthisreport.healthpartnersmanagedtheiomgrant. ThisreportwaswrittenwithfeedbackandinputfromtheHEROEmployer-CommunityCollaboration (HECC)withspecialthanksextendedtocommitteecochairs: CathyBaase,M.D.,ChiefHealthOfficer,TheDowChemicalCompany NicoPronk,Ph.D.,VicePresidentandChiefScienceOfficer,HealthPartners JerryNoyce,PresidentandCEO,HERO Theviewspresentedinthisreportdonotreflectanyspecificindividualorindustryposition,norarethey representativeoftheviewsoftheiomorofthenationalresearchcouncil.ithasbeenpreparedto generatediscussionandinformfuturework. 1

TABLEOFCONTENTS Introduction PurposeandScopeofThisReport 3 EnvironmentalScanMethods LiteratureReviewSummary StakeholderInterviews CaseStudies 9 EnvironmentalScanResults LiteratureReviewSummary OverviewofKeyPlayers StakeholderInterviews CaseStudies 10 BusinessCase NaturalExtensionofCurrentWorkin WorkplaceWellness CostSavings BusinessesasKnowledgeBase RoleofBusinessofPopulationHealth PopulationHealthStrategies 19 Summary 26 References 28 Appendices A.SnapshotsofFoundationsWorkingin Employer-CommunityHealth B.SnapshotsofMultistakeholderCoalitions InvolvedinCommunityHealth C.SnapshotsofBusinessesWorkingin CommunityHealth D.HEROEmployer-CommunityCollaboration CommitteeMembership 30 2

INTRODUCTION AlthoughtheUnitedStatesspendsmoreonhealthcarethananyothernation,17.7%of itsgdp(grossdomesticproduct),theunitedstatescontinuestolagbehindothercountriesin termsoflifeexpectancy(ranking27 th ),andotherhealthindicators(oecd,2013).theinequities withintheu.s.healthcaresystemareevenmorestartlingthanthosebetweennations,asthe socialdeterminantsofhealth neighborhoodandbuilt-environment,economicstability, education,andculturalcommunitycontext aredirectlyaffectinghealthaccessandoutcomes. Approximately162millionadultAmericansreporthavingatleastoneofthefollowingchronic diseases:cancer,diabetes,hypertension,stroke,heartdisease,pulmonaryconditions,and mentaldisorders.thetotaleffectofthesediseasesontheeconomyis$1.3trillionannually(de Voletal.,2013).Partoftheproblemisthatthecurrenthealthcaresystemispredominantly reactive,ratherthanproactive,focusingonthetreatmentofindividualillnessanddisease, ratherthanfosteringmultisectoralcommunitypreventioninitiatives,focusingonwellness,that wouldaddressthewholeperson wheretheylive,learn,workandplay(commonhealth ACTION,2013).Thereisagrowingconsensusthatfundamentalpublichealthimprovementswill requiremultisectoralpartnerships,andbusinesseshaveacoreroletoplayinthese(fawcettet al.,2010).thebusinesscommunityitselfagrees(u.s.chamberofcommerce,2013).one couldarguethatitmaybeimpossibletoachievepublichealthobjectiveswithoutthe involvementofthebusinesscommunityonseveralfronts.studieshavealreadydemonstrated thepositivereturnoninvestmentofworkplacehealthprograms(partnershipforprevention, 2013).Businesseshaveadefinableeconomicrationaletobeinvolvedandareuniquely positionedincommunitiesandhavethecapacitytoprovideleadership,directtheir philanthropy,advocateforeffectivepolicy,facilitatevolunteerism,andpromotehealththrough theirengagementwithcross-sectororganizationsofthesociety. Chronicdiseasesaccountfor7ofthe10leadingcausesofmortalityintheUnitedStates andaffectalmost50%ofamericans(cdc,2012).theseconditionsarenotlimitedtoadults since1980ratesofobesityhavedoubledin2 5yearolds,quadrupledin6 11yearolds,and tripledin12 19yearolds(ChildObesity180,2013). TheCountyHealthRankingsandRoadmaps program,whichisacollaborationbetweentherobertwoodjohnsonfoundationandthe UniversityofWisconsin,havecreatedamodelthatidentifiesvariousaspectsofthesocial determinantsofhealththatneedtobeaffectedinordertoimproveoverallpopulationhealth. Policiesandprogramswithsufficientlystrongevidenceofeffectivenessareoutlinedandwill needtobeimplementedinordertodrivetowardimprovedshort-termhealthfactorsandlongtermhealthoutcomes,resultinginhealthiercommunities(seefigure1). 3

TheCountyHealthRankingsisacollaborationoftheRobertWoodJohnsonFoundationandtheUniversityofWisconsinPopulationHealth Institute. Source:CountyHealthRankings,2012 Figure1:CountyHealthRankingsandRoadmapsModel Thenonclinicaldeterminantsofhealthareestimatedtoaccountforapproximately80% ofthehealthofapopulation,andthesearetheareasthatcanbeaffectedbyevidence-based communitypublichealthinitiatives(rwjf,2013). Currently,theUnitedStatesonlyspends3% ofitshealthcarebudgetonpreventingdiseases(asopposedtotreatingthem),while75%of healthcareexpendituresarerelatedtopreventableconditions(apha,2012). 4

Evidence-basedcommunity-levelpublichealthiniativescanhaveasignificantreturnon investmentthroughsavingmoneyandsavinglives.accordingtotheamericanpublichealth Association (2013): Every$1investedinbikingandwalkingcanreturnbenefitsupto$11.80 Forevery$1investedinfoodandnutritioneducationthereisa$10returninreduced healthcarecosts Forevery$1investedintobaccocessationprograms,thepotentialROIis$1.26 If10%ofadultsbeganwalkingonaregularbasis,$5.6billioninheartdiseasecosts wouldbeaverted. Childhoodimmunizationssave$9.9millionindirecthealthcarecosts,save33,000lives, andprevent14millioncasesofdisease Every$1investedinfluorinatedwatersaved$40indentalcare Theprivatesectorisburdenedbydirectandindirecthealthcarecosts,includinghealth benefitplans,worker scompensation,disability,absenteeism,presenteeism(reduced employeeperformanceduetopoorhealth),employeeretentionandturnover,andlower morale.asmuchas50%ofcompanyprofitsgotowardshealthcarecosts(phi,2013).currently, morethan90%oflargeremployersandmorethan60%ofsmallbusinessesofferatleastone wellnessbenefittotheiremployees(thehenryj.kaiserfamilyfoundation,2013). WorksiteHealth:Facts Theindirectcosts(e.g.,absenteeism,presenteeism)ofpoorhealthcanbetwotothreetimesthe directmedicalcosts. ProductivitylossesrelatedtopersonalandfamilyhealthproblemscostU.S.employers$1,685 peremployeeperyear,or$225.8billionannually. Areviewof73publishedstudiesofworksitehealthpromotionprogramsshowsanaverage $3.50-to-$1savings-to-costrationinreducedabsenteeismandhealthcarecost. Ameta-reviewof42publishedstudiesofworksitehealthpromotionprogramsshows: o Average28%reductioninsickleaveabsenteeism o Average26%reductioninhealthcosts o Average30%reductioninworkerscompensationanddisabilitymanagementclaims costs o Average$5.93-to-$1savings-to-costratio Source:PartnershipforPrevention,2013 TheNationalBusinessCoalitiononHealth(refertoAppendixBformoreinformation) listedthefollowing EmployerIncentivesforBuildingHealthyCommunities (NBCH,2013): Improvethehealthstatusandproductivityofanemployer scurrentandfuture workforce. 5

Controldirect(healthcare)andindirect(absenteeism,disability,presenteeism)coststo theemployer. Createboththeimageandtherealityofahealthycommunitythatmayhelp recruitmentandretentionofworkforcetalentintightlabormarkets. Increasethebuyingpowerandconsumptionlevelforbusinessproducts,inparticular nonmedicalgoodsandservicesbyimprovingthehealthandwealthofacommunity. Channelcorporatephilanthropyinadirectionthatwillimprovecommunityrelations, goodwill,orbrandingwiththepotentialforapositivereturnforthebusinessenterprise itself. Helpcreatepublicandprivatepartnershipsandamultistakeholdercommunity leadershipteamthatcanbecomethefoundationforcollaboration,cooperation,and community-basedproblemsolvingformanyotherissuesaffectingthebusiness community,suchaseconomicdevelopmentandeducation Studiesareemerginglinkingcorporatebottom-lineperformancewithcorporatesocial responsibility.thereisagrowingunderstandingthatearlychildhood,elementary,andhigh schooleducationprogramswithincommunitiescontributetobusinessprofitability(kindiget al.,2013).schoolsprovideanexcellent environmentofavarietyofcommunityhealth initiatives. AHarvardBusinessSchoolstudyof18yearsof dataintheunitedstatesfoundstrong evidencethatfirmsthatemphasizedcorporate socialresponsibilityandsustainable significantlyoutperformedsimilarfirmsthat didnot,asmeasuredbybothfinancialand stockmarketreturns(ecclesetal.,2012). Justastherearemultipledeterminants ofhealth,nosinglesectorissolelyresponsible Businessleadersmustcometounderstandthat theycandoeverythingrighttoinfluencethe healthandproductivityoftheircaptured workforceattheworksite,butifthatsame workforcelivesinunhealthycommunities employerinvestmentscanbelostorcertainly weakened. AndrewWebber,PastPresident& CEO,NBCH forhealthimprovement.businessesandcommunitymultisectoralpartnershipsandcoalitions haveacrucialroletoplayinpopulationhealthimprovement. TheNationalPreventionStrategy,publishedbytheSurgeonGeneralin2011,identifies fourstrategicdirectionsandseventargetedprioritiesthatprioritizepreventionandare focusedonimprovingthehealthofcommunities(figure2)., 6

Source:NationalPreventionCouncil,2011 Figure2:NationalPreventionStrategies Thesestrategiesandprioritiestakentogetherprovideausefulframeworkforthose consideringengaginginpopulationhealthactivities. PurposeandScopeofThisReport HEROhasestablishedacommitteeknownastheHEROEmployer-Community Collaboration(HECC)Committeecomposedof25membersrepresentingavarietyofbusiness andfoundationstakeholders.thepurposeofthiscommitteeistodevelopaframeworkand reportthatpresentsarationaleforbusinessestobeinvolvedinaddressingpopulationhealthat thecommunitylevelandtherolethatthebusinesscommunityplaysorcanplayinthisarena. 7

TheInstituteofMedicine sroundtableonpopulationhealthimprovementisthesponsorofthe firstphaseofthisproject,whichcallsforanenvironmentalscanofactivitiesbeingconductedin thisspacearoundthenation.thisenvironmentalscanincludesthefollowing: 1. Whoorwhichorganizationsmayberecognizedasthemajorplayersinthis landscapefocusingonbusinesses,coalitions/associations,andfoundations? 2. Keydocumentsandresourcesidentifiedduringthereview 3. Asummarythatprovidesanoveralldescriptionofthecurrentstateofaffairs 4. Aninitialstatementofthebusinesscase/logicmodelforcorporateinvestmentin communityhealthimprovement Itisimportanttonotethisenvironmentalscandoesnotfocusonworkplacehealth initiatives.itisfocusedonestablishingabaselineregardingcurrentknowledgeregardingthe roleandextentofinvolvementthatcorporateamericahasinpopulationhealthefforts.toour knowledge,thisisthefirstsystematicattempttodocumenttheseefforts. ThedefinitionofpopulationhealththatweareusingisbasedonKindigandStoddart (2003)viewthatitisafieldofinquirythatencompasses healthoutcomes,patternsofhealth determinants,andpoliciesandinterventionsthatlinkthesetwo. Inthisdefinition,they furtheremphasizedthatpopulationhealthrefersto thehealthoutcomesofagroupof individuals,includingthedistributionofsuchoutcomeswithinthegroup. Notethatthis definitionismuchbroaderthanpublichealthinthatitgoesbeyondtheroleoftraditional governmentsystems(e.g.,healthdepartments).italsogoesbeyondourhospitalsandclinical caresystemstoincludecommunityandsocietalinfluences(e.g.,socialdeterminantsofhealth). Thisbroaderdefinitionwearereferringtohereaspopulationhealthisacompositeof community,publichealth,andclinicalcaresystems. 8

ENVIRONMENTALSCANMETHODS LiteratureReview Anextensivereviewofgreyaswellaspeer-reviewedscientificjournalswasundertakento determinethedepthandbreadthofinformationcurrentlyavailable. StakeholderInterviews Aseriesofeightkeyinformantinterviewswereconductedtoprovideamorein-depth understandingoftherolethatbusinessescurrentlyplayinaddressingpopulationhealthissuesaswellas togainperspectivesonthebusinesscase.thoseinterviewedrepresentedthoughtleadersfrom business,associations,andfoundations.theywereaskedwhethertheyknewofanybusiness exemplars,includingthosethathaddemonstratedmeasurableimpact,whattheyperceivedtheroleof businesscouldbeinpopulationhealth,whatthebestwaywouldbetomakethebusinesscase,among otherquestions. CaseStudies Akeycomponentoftheenvironmentalscanwastoidentifybusinessesthatareaddressing populationhealththroughtheirdirect(throughsupportedprogramming)orindirectparticipation (throughassociationsand/orpartnerships).thescanassessedthosethatarecurrentlyconducting,or havepreviouslyconducted,programsorinitiativesthathadthepotentialtoimprove,orhadalready demonstratedimprovements,onpopulationhealth.thecriterionusedtoidentifyasetofbusiness exemplarsincludesprogram/initiativesthat: Specificallyaddresspopulationhealth Extendbeyondtheworkplacesettingtoreachemployeefamiliesandcommunityparticipants Includemetricsthatallowdemonstrableimpact(eitherorbothshortandlongterm) 9

ENVIRONMENTALSCANRESULTS LiteratureReviewSummary Theresultsofthepeer-reviewedscientificliteraturerevealedfewpublishedarticles (Table1).Themajorityofthesearticleswerepositionpapersontherole(orpotentialrole)of businessinaddressingpopulationhealthissues.theextensivereviewofthegreyliteratureled todetailedreviewofseveralhundredwebsitesofcorporations,foundations,andassociations. Onclosereview,manybusinessesthatinitiallyemphasizedpopulationhealthactivitiesdidnot meetthedefinitionofaffectingthehealthofcommunitiesbeyondtheworkplaceenvironment. Theappendicesincludeoverviewsoftheprogramsandaccomplishmentsofbusiness-led communitycoalitions,individualbusinesses,andfoundationswhosemissionistoimprove communitypopulationhealth. Table1:ReviewofLiterature BSR.(2013).AnewCSRfrontier:Businessandpopulationhealth. http://www.bsr.org/reports/bsr_a_new_csr_frontier_business_and_population_health.pdf Cardelo,H.&Wolfson,J.(2013).Lower-caloriefoodsandbeveragesdriveHealthyWeightCommitment FoundationCompanies SalesGrowth.HudsonInstitute. http://www.hudson.org/files/publications/lowercalhealthyweightcommitment--may2013.pdf CanterburyM,HedlundS.Thepotentialofcommunity-wideinitiativesinthepreventionofchildhoodobesity. DiabetesSpectrum2013;26(3):165-170. HudsonInstitute.(2013).Lower-caloriefoods.It sjustgoodbusiness. http://www.hudson.org/files/publications/lower_calorie_foods.pdf Kindig,D.A.,Isham,G.J.,&Siemering,K.Q.(2013).Thebusinessroleinimprovinghealth:Beyondsocial responsibility.iomroundtableonpopulationhealth,discussionpaper. Isham,G.J.,Zimmerman,D.J.,Kindig,D.A.,Hornseth,G.W.HealthPartnersadoptscommunitybusinessmodel todeepenfocusonnonclinicalfactorsofhealthoutcomes.healthaffairs2013,aug:32(8):1446-52 Nash,D.B.,Reifsynder,J.,Fabius,R.J.,Pracilio,V.P.,PopulationHealth:Creatingacultureofwellness.Jones BartlettLearning. NBCH.(April2013). NBCHactionbrief:Communityhealth. http://www.nbch.org/nbch-action-briefs NBCH.(2009).Buildinghealthycommunities:Shouldemployerscare? http://www.nbch.org/nbch/files/cclibraryfiles/filename/000000000798/nhlc%20white%20paper%20july% 202009%20V2.pdf PartnershipforPrevention.(2011). Leadingbyexample:Creatinghealthycommunitiesthroughcorporate engagement. http://www.prevent.org/data/files/initiatives/lbe_community_final.pdf Simon,P.A.,&Fielding,J.E.(2006).Publichealthandbusiness:Apartnershipthatmakescents.Health Affairs,25(4),1029-1039. Sturchio,J.L.,&Goel,A.(2012).Theprivate-sectorroleinpublichealth:Reflectionsonthenewglobal architectureinhealth.csis.http://csis.org/files/publication/120131_sturchio_privatesectorrole_web.pdf Webber,A.(2011).Businessesaspartnerstoimprovecommunityhealth.AmericanJournalofPreventive Medicine,40(1),S84-S85. Webber,A.,&Mercure,S.(2010).ImprovingPopulationHealth:TheBusinessCommunity Imperative.PreventingChronicDisease,7(6):1-6 10

OverviewofKeyPlayers Thepopulationhealthlandscapeinvolvesadiversearrayofpublic,private,andnonprofit stakeholders.figure3belowidentifiesthesekeyplayers.althoughthefocusofthisenvironmentalscan istoexaminetheroleofcorporateamericanincommunityhealthandwellness,itisimportanttotouch ontheactivitiesofthepublicandnonprofitsectorsaswell,astheyarepartofthelandscape.the literaturereviewhasdemonstratedthatmanyofthesestakeholdersarepartnersinbusiness-led coalitions/associations.moreimportantly,manyofthesestakeholderscanprovideresources,tools,and partnershipopportunitiesforbusinessesdesiringtoinvestinpopulationhealthinitiatives.forthe purposesofthisreviewwewillfocusongovernment,corporate,andprivatefoundations;coalitionsand associations;andindustry(presentedinthecaseexamples). Government) Nationally,thegovernment sroleincommunitypublichealthhasincludedtheprovision ofhealthinsurancetolow-incomeindividualsandseniorpopulationsthroughthemedicaidand Medicaresocialprograms.RecentlythisrolehasexpandedthroughtheAffordableCareAct (ACA)toprovidinghealthinsuranceregulationsandstandardsaimedtoincreaseaccess, affordability,andqualityofcoverageforallamericans.overthecomingmonthsandyears,as therolloutoftheacaprogresses,thiswillcontributetochangingthelandscapeofcommunity health,asfundingbecomesavailableforcommunityneedsassessments,andstricter regulationscomeintoeffectsurroundingworkplacewellnessprograms.althoughadetailed analysisofthegovernment sroleincommunityhealthimprovementisbeyondthescopeofthis environmentalscan,thecenterfordiseasecontrol sdivisionofcommunityhealth(cdc-dch) Programsareworthnoting.FourofthemainCDC-DCHprogramsinclude: CommunitiesPuttingPreventiontoWork(CPPW) 1 o (CPPW)isalocallydriveninitiativesupporting50communitiestotackleobesity andtobaccouse. o Communities includingurban,small,rural,andtribalareas areimplementing environmentalchangestomakehealthylivingeasier,suchasimprovingmeans forsafeactivetransportationforpedestrians,bicyclists,andmasstransitusers; ensuringprovisionofhealthyfoodandbeverageoptionsinschools;limiting exposuretosecondhandsmoke;andincreasingavailabletobaccocessation resources. 1 FormoreinformationonCDC-CPPW,pleasevisit http://www.cdc.gov/nccdphp/dch/programs/communitiesputtingpreventiontowork/index.htm 11

o Morethan50millionpeopleliveinacommunitythatwillbenefitfromthis initiative. Nonprofits& AssociaPons (ResearchInsPtutes, Taskforces, Professional AssociaPons) Government NaPonal (CDC,NIH) FoundaPons Corporate (HealthInsurance, PhysicalAcrvity, Food&Beverage) Government City,County,& StateHealth Departments Health FoundaPons Private (RWJ,Kellogg, Community,other) UnversiPes Hospitals& Federally QualifiedHealth Centers Industry (Individual businesses& businesscoalirons) Figure3:OverviewofPopulationHealthKeyPlayers 12

CommunityTransformationGrants(CTG) 2 o In2011theCDCawarded$103millionto61stateandlocalgovernmententities, tribes,andterritoriesaswellasnonprofitorganizationsin36statestosupport community-levelprogramsthatpreventchronicdiseases. o Inadditiontheyawardedapproximately$4millionto6nationalnetworksof community-basedorganizationstoengageinmultistakeholderpartnerships (e.g.,education,transportation,business,faith-basedorganizations)inorderto improvethehealthoftheirlarge-sizedcommunities(greaterthan1.5million). o In2012,theCTGwasexpandedtosupportareaswithfewerthan500,000people inneighborhoods,schooldistricts,villages,towns,cities,andapproximately$70 millionwasawardedto40communitiestoimplementbroad,sustainable strategiesthatwillreducehealthdisparitiesandexpandclinicalandcommunity preventiveservicesthatwilldirectlyimpactabout9.2millionamericans. HealthyCommunitiesProgram 3 o CDCsHealthyCommunitiesProgramworkswithcommunitiesthroughlocal, stateandterritory,andnationalpartnershipstoimprovecommunityleadersand stakeholdersskillsandcommitmentsforestablishing,advancing,and maintainingeffectivepopulation-basedstrategiesthatreducetheburdenof chronicdiseaseandachievehealthequity o Resourcesinclude:ActionInstitutesforTraining,ToolsforCommunityAction, NationalNetworksforCommunityChange,andtheSuccessStorieswebsite RacialandEthnicApproachestoCommunityHealth(REACH) 4 o REACHisanationalinitiativevitaltotheCDC seffortstoeliminateracialand ethnicdisparitiesinhealth.throughreach,cdcsupportsawardeepartnersthat establishcommunity-basedprogramsandculturallytailoredinterventionsto eliminatehealthdisparitiesamongafricanamericans,americanindians, Hispanics/Latinos,AsianAmericans,AlaskaNatives,andPacificIslanders. Atalocallevel,state,city,andcountyhealthdepartmentsalsoplayacrucialrolein shapingcommunityhealthoutcomesthroughpolicyinitiatives,research,andserviceprovision. 2 FormoreinformationonCDC-CTG,pleasevisit http://www.cdc.gov/nccdphp/dch/programs/communitytransformation/index.htm 3 FormoreinformationonCDC shealthycommunitiesprogram,pleasevisit http://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/index.htm 4 FormoreinformationonCDC sreachprogram,pleasevisit http://www.cdc.gov/nccdphp/dch/programs/reach/index.htm 13

Corporate)and)Private)Foundations) Foundationsplayapivotalroleincommunityhealthimprovement.First,private foundationsprovideessentialfundingtopopulationhealthinitiatives,andthelargescaleofthis fundinghastheabilitytoshapethedirectionofpopulationhealthpolicyandcommunity development.secondly,corporatefoundationsprovideanavenueforlargebusinessestofocus theirphilanthropicactivityandcorporatesocialresponsibilityintoareasthatcomplementtheir businessstrategy.foundationsareoftenmembersofmultistakeholdercoalitions,andtheymay fundtheresearchthatleadstothebestpracticesandevidence-basedinitiativesthatare implementedbydiversestakeholdersatthecommunitylevel.asnapshotoftheactivitiesofthe followingfoundationscanbefoundinappendixa: AetnaFoundation TheCaliforniaEndowment GENYOUthFoundation W.K.KelloggFoundation RobertWoodJohnsonFoundation StakeholderInterviews Theresultsofthestakeholderinterviewsbythoughtleadersrepresentingbusiness, associations,andfoundationsrevealedarewoventhroughouttheresultssection,particularlyin thesectiononbusinesscaseandrationaleforinvolvement.thekeythemesthatemergedfrom theinterviewsincluded: 1. Businessesbenefitfromengagingincommunity/populationhealthactivitiesbeyond theworkplacesettinginavarietyofways(selectexamples). Increasestiestocommunityandenhancesreputationofbusiness Increasesbusinessesawarenessoffactorsthatcaninfluencebusiness throughincreasedknowledgeofcommunityandstakeholders 2. Elementsofaneffectivebusinesscaseforengaginginpopulationhealthactivities include(selectexamples): Costsavings Increasedhealth,safety,andproductivityofworkforce Investinginvibrantlivablecommunitiesattractsnewtalent,newbusinesses, andretainscurrentworkforce. 14

CaseStudies MultistakeholderBusinessCoalitions Multistakeholdercoalitions,composedofpublic,private,andgovernmentplayersare oneofthekeywaysthatbusinessesarebecominginvolvedinpopulationhealthinitiatives. Thesecoalitionscanbeorganizedatastateorcitylevel,ortheycanbelargernationalalliances workinginmultiplegeographiclocationswithamissiontotargetaspecificpublichealthrisk factor,suchasobesity.thenationalbusinesscoalitiononhealth(nbch)andthecommunity CoalitionsHealthInstitute(CCHI)developedadocument, CommunityHealthPartnerships ToolsandInformationforDevelopmentandSupport, thatliststheprimarybenefitsof partnershipas (NBCHandCCHI,2012): Leveragingandmaximizingresourcesbypoolingtalent,expertise,andresources Improvingoutreachtostakeholders(employers,employees,providers,vendors,public healthofficials,policymakers,etc.)withenhancedvisibilityandmessaging Minimizingduplicationofefforts Generatingbroad-basedsupport includingotherstakeholdersfrombothprivateand publicsectors Increasingcredibilitybeyondthescopeoftheindividualorganization Beingmoreappealingtootherpotentialresourcesincludingfundingsources Co-brandingopportunity Creatingbetterwaystoreachaudienceswheretheyspendtime live,work,play Realizingthatnoonestakeholdercansolvetheproblem Buildingonpublichealth sexpertiseandevidence-basedtoolsandinformationto improvethehealthofthecommunity Accesstothepublicsectorasamajoremployerandpurchaserofhealthprograms Reductionincosts bothdirectandindirect relatedtohealth Improvinghealthstatus Improvingcommunitylife Inaddition,thisvaluableresourceprovidesgeneralguidelinesforsuccessful partnerships,suggestionsforcoalitionsandbusinessrelatedtooutreachtopublichealth officials,andsuggestionsforpublichealthofficialsrelatedtooutreachtobusinessand coalitions.table2illustratesadditionaltoolsandresourcesidentifiedduringtheliterature reviewthatmaybenefitfutureworkinthisarea. Theroleofbusinessinmultistakeholdercoalitionsrangesfrompassivelyfunding programstoactivelytakingaleadershiproleincreatingcommunitychange.thefederal DepartmentofHealthandHumanServices(HHS)alongwiththeAgencyforHealthCare 15

ImprovementhavefacilitatedtheCharteredValueExchangeswheremultistakeholder coalitionscanbecomedesignatedascommunityleadersforvalue-drivenhealthcare. Participantsarebecomingpartofanationalcommunityofpracticewherecoalitionscanlearn fromoneanother.overtimethesecoalitionsmaybeavaluableresourcefortrackingand monitoringlong-termchangesinpopulationhealth. Theresultsoftheliteraturereviewandkeyinformantinterviewsrevealedanumberof coalitionsthathavebeenstrivingtoimprovepopulationhealthusingdata-drivenapproaches. Thesearelistedbelow,andadetailedsnapshotofthesemultistakeholdercoalitionsthatare illustrativeexemplarscanbefoundinappendixb: BlueZonesProject ChildObesity180 CommunityCoalitionsHealthInstitute HealthiestStateInitiative HealthyWeightCommitmentFoundation LakeNonaProject LiveWellOmaha MichiganHealthInformationAlliance Mid-AmericaCoalitiononHealthcare NationalBusinessCoalitiononHealth PartnershipforaHealthierAmerica ByfartheBlueZonesProjectisfurtheraheadwhencomparedtoothersintermsofdata trackingandmonitoring.ofnoteistherecentworkofthehudsoninstitutewhichexamined thesalesfrom2007to2011oflower-caloriefoodsmadeby16membersofthehealthyweight CommitmentFoundation(HWCF)andfoundevidencethatpromotinghealthyproductsisgood forthebusinessbottomline.lower-calorieproductsdrove82%ofthesalesgrowthamongthe foodandbeveragecompaniesstudied,whichwasfourtimestherateofhighercalorieitems.in addition,salesoflower-calorieproductsincreasedbyover$1.25billioncomparedtolessthan $300millionforhigher-calorieitems(HealthWeightCommitmentFoundation,2013). Inadditiontotheseexamplestherearemanymoreoccurringthatmaynotbeeasily obtainedthroughliteraturesearchesand/orhaverecentlybeenlaunchedbutareworth followingovertime.afewnoteworthyexamplesmentionedduringthekeyinformant interviewsand/orfromthecommitteeinclude: HealthierTennessee http://healthiertn.com HeartsBeatBackMinnesota www.heartsbeatback.org 16

Table2:ResourcesandTools CommunityCoalitionHealthInstitute. CommunityHealthPlanningResources. http://www.nbch.org/community-health-planning-resources Butterfoss,F.D.(2007).Coalitionsandpartnershipsincommunityhealth.Wiley.com. Canterbury,Marna,etal., ThePotentialofCommunity-WideInitiativesinthePreventionofChildhood Obesity, DiabetesSpectrum,2012,Volume26,Number3. CaseInPointMagazine,AnneLlewellyn,RN-BC,MS,BHSA,CCM,CRRN,EditorinChief,DorlandHealth, 954-476-7143,ALlewellyn@decisionhealth.com Corporatesustainabilityandhealth(SHINE):HarvardSchoolofPublicHealth,CenterforHealthandthe GlobalEnvironment.http://http://chge.med.harvard.edu/category/corporate-sustainability-andhealth-shine Fawcett,Stephen,JerrySchultz,JomellaWatson-Thompson,MichaelFoxandRoderickBremby."Peer Reviewed:BuildingMultisectoralPartnershipsforPopulationHealthandHealthEquity."Preventing chronicdisease7,no.6(2010). MobilizingActionTowardCommunityHealth(MATCH). (2010).SpecialfocusofPreventingChronic Disease:PublicHealthResearch,Practice,andPolicy,7(6). http://www.cdc.gov/pcd/issues/2010/nov/toc.htm NationalBusinessCoalitiononHealth. Aguidetobuildingabusinesscoalitiononhealth. http://nbch.kma.net/nbch/files/cclibraryfiles/filename/000000000041/guide_to_building_bus_coaliti on_on_health.pdf NationalBusinessCoalitiononHealthandUnitedHealthFoundation. Communityhealthevaluation: Technicalactionguide. http://www.nbch.org/nbch/files/cclibraryfiles/filename/000000002659/evaluation%20tag.pdf NationalBusinessCoalitiononHealthandUnitedHealthFoundation. Communityhealth implementation:technicalactionguide. http://www.nbch.org/nbch/files/cclibraryfiles/filename/000000002660/implemenation%20tag.pdf NationalBusinessCoalitiononHealthandUnitedHealthFoundation. Communityhealthplanning: Technicalactionguide. http://www.nbch.org/nbch/files/cclibraryfiles/filename/000000002331/nbch_tag_f.pdf Roussos,S.T.,&Fawcett,S.B.(2000).Areviewofcollaborativepartnershipsasastrategyforimproving communityhealth.annualreviewofpublichealth,21(1),369-402. Shortell,Stephen,M.etal.(2002).Evaluatingpartnershipsforcommunityhealthimprovement:Tracking thefootprints.journalofhealthpolitics,policyandlaw,(27)1. Theartofhealthpromotion,ideasforimprovinghealthoutcomes(newsletter) BusinessExemplars Althoughtherearenumerousexamplesofbusinessesengagedinactivitiesthatextendbeyond theworkplacesetting,therearefewerinvolvedinlarger-scalepopulationhealthapproacheswhere informationontheeffortsaresystematicallydocumentedandmonitoredwithclearindicatorsand outcomesforsuccess.kaiserpermanenteisaleaderinthefieldforengaginginabroadrangeofhealth activitiesandscientificstudies;however,longer-termhealthoutcomestudieswerenotidentified.both DowChemicalandHealthwaysintheirBlueZoneProject(referencedabove)havetakenleadershiproles indevelopingframeworksandtemplatesforgatheringshort-andlong-termoutcomedatathatmay serveasmodelsformovingforward.healthwaysintheircollaborationwithgalluphavetakenthisone 17

stepfurtherandhavedevelopedstatisticalmodelsandaninteractivesoftwareplatformthatpredicts changesinpopulationhealth(gallup-healthwayswell-beingindex ). Snapshotsofthefollowingprogramsandinitiativesthatbusinessesareengagedincanbefound intheappendixc.thesearecompanieshighlighted: BlueCrossBlueShieldofOmaha DowChemical DTEEnergy GeneralElectric HealthPartners KaiserPermanente Nike Target WaltDisney Walmart Wellmark 18

19 Improvehealthof familymembersto furtherreducehealth carecosts Influenceotherlevers anddriversofhealth carecostsbeyond workplacesetting(e.g. quality,accountability, cost) Enhancereputation Engageineconomic developmentthat stimulatesnew businessandincreases salesforcurrent business Createavibrant,safe communitytodraw newtalentandretain currentworkforce WHY$INVEST$ BUSINESSCASE Improvinghealthisabusinessimperativethatisinalignmentwithcorporatepriorities forcompetitivebusinessestoday.thehighcostofhealthcarehasledtosocialcapitalerosion wherebyfewerdollarsareabletobespentonothersocietal prioritiessuchaseducation,infrastructure,andlivable wages,amongothers.businesscanplayapivotalrolein reshapingthecurrenteconomiclandscapethroughstrategic partnershipsandleveragingofresources. Theresultsoftheenvironmentalscanrevealthat therearemanybusinessesalreadyengagedinprogramsand initiativesthataddresspopulationhealth.theliterature reviewandkeyinformantinterviewswereabletouncovera numberofkeyleversanddriversthatareimportantto makingthebusinesscaseforengaginginpopulationhealth efforts.commonlystatedreasonsinclude:(a)enhanced reputationinthecommunityasgoodcorporatecitizens;(b) costsavingsthatwouldincreaseovertime;(c)job satisfaction;(d)healthier,happierandmoreproductive employees;and(e)healthyvibrantcommunitiesthatdraw newtalentandretaincurrentstaff(refertosidebarformore examples).afewofthesefactorsarehighlightedand discussedinmoredetailbelow. NaturalExtensionofCurrentWorkinWorkplace Wellness Thevaluepropositionforbusinessinvestmentin populationhealthisthat investmenttodaywillleadtoeconomicbenefitsandacompetitive edgetomorrow (Webber,2011).Inhisarticleontheroleofbusinessinhealth,Andrew Webber(2011)furtherpointsoutthatwherewearetodayisafunctionofhistoricalfactorsthat begandecadesagowithoccupationalhealthandsafetyoccurringfirst,whenbusinesseshadto invest,aspartofaregulatoryrequirementtomeetminimumstandardsforsafeworking environments,inthehealthoftheirworkforceduetothehighdirectcostsofsickorinjured employees.oncetheyrecognizedtheadvantagesofthisinvestment,theybegantocreate culturesofworkplacehealth. Workplacesafetyremainsakeyissuetodayinworkplace healthprograms.

Inresponsetogrowinghealthcare costs,coalitionsofbusinessesbegantoform overthelastseveraldecades,andcollectively theywereabletobargainandengagein value-basedpurchasing.todaywiththeaca, weareinapositiontoreevaluate,giventhata majorcomponentofthehealthcaresystem (e.g.,hospitals,clinics)havebeenmandated THECRITICALELEMENTINTHESE EFFORTSISENGAGEMENTATTHECEO LEVEL.ITISALEADERSHIPCALL. - THOUGHTLEADER toreachandengagetheircommunitiesandtomonitorprogress.thetimingisrighttomerge theseefforts.therearealreadyexamplesofthisunderwayinmanypartsofthecountry,partly drivenbytheexistingeffortsofthebusinesscoalitions.thestrengthsthatabusinesscoalition canbringtoaplanningtableonaddressingpopulationhealthareenormous,farbeyondtheir abilitytoprovidefunding.businessesinvolvedinthesecoalitionscanbringtothetablethe wealthofknowledgegainedfromengaginginworkplacehealthinitiativesthathavethe potentialtoextendtopopulationhealthefforts.asoneprominentbusinessthoughtleader noted,whosecompanyisinvolvedinlarge-scalepopulationhealthinitiativesthatreachoutand engageotherbusinessestobecomeinvolvedincommunitypartnerships,acriticalelementis theengagementofc-suite.withoutbuy-infromtheceolevelmanyoftheseeffortsfade,are notfunded,and/ortherearenomeasuresofaccountability. CostSavings Ageneralviewthathasbeenarticulatedinthisreviewisthatinvestmentinpopulation healthactivitiestodayleadtocostsavingstobusinessestomorrow.thewayinwhichthese costsavingsmaymanifestwillvarybybusiness.itisusefultothisdiscussiontothinkofthree typesofbusinessesthatmightbeimpacted:(1)thosethataddresshealth(e.g.,healthcare industry);(2)non-healthcare/healthrelated(e.g.,musicindustry);and(3)thosethatinfluence health(e.g.,foodandbeverage,tobacco).thelargestcostsavingsmayoccurforbusinesses thatprovideproductsorservicesdirectlylinkedtopositivehealthoutcomes(e.g.,healthcare industry).businessesthatarenotwithinthehealthcare/health-relatedlandscapewillmost likelybenefitovertimeiftheycurrentlyhavehighhealthcarecostsduetotheiremployee healthstatus.howeverbusinessesthatpotentiallynegativelyaffecthealthhavethebiggest challengesahead.therationaleforbusinesstoinvestinpopulationhealthmustincludea thoughtfulanalysisofthepotentialbenefitsandrisks.keytothisisanunderstandingofthe relationshipbetweentheinvestmentinhealthandtheviabilityandsustainabilityofcorporate businessmodels(figure4).anyshiftsinthevaluechain(r&d manufacturing sales productuse disposal)maygenerateanimbalanceandreconsiderationofrisktocost.for example,ifafoodcompanyinvestsinhealthierproductswithshortenedshelftimebuthasto usenewpackagingmaterialsthataremorecostlytoensureitisbiodegradable,theymayriska financialloss., 20

EmployerHealth Drivers Improveemployee producrvity Ayractandretain employees Reducehealthcarecosts EmployerBusiness Drivers Protectorstrengthen reputaron Reduceregulatoryrisks Reduceoperaronalrisks Expandproductline throughr&d Expandsalesand customerbase Increaseormaintain profitmargin Figure4:Relationshipbetweenhealthandbusinessdrivers Thecostsavingstobusinesseswillincreaseovertimeastheyextendbeyondtheworkplaceto includeprogramsandservicesforfamilies(spouses,children)iftheyarenotalreadydoingso. Theleveragingofcommunitypartnershipsthroughbusinessandcommunitycoalitionsisan importantcost-effectivestrategythatwillmaximizegains. BusinessesasKnowledgeBase Beyondconsiderationofprofitmarginandvaluechain,therearemanywaysinwhich businessescanbeengagedinpopulationhealthefforts.bydesign,largebusinessesfunctionas smallcommunitieswithecosystems.theyhaveinternalandexternalfunctionsthatallowthem tointerfacewiththebroadercommunitiesthatsurroundthem.forexample,thereare divisionsordepartmentsthatfocusoninternalfunctioning(strategy,r&d,finance,hr, facilities).takentogether,thesedepartmentsprovidedirection,policy,management, structure,fundingandhousing somethinglikeafamilyhousehold.thedepartmentsand divisionsthataddressexternalrelations(e.g.,communityrelations,corporatefoundations, governmentrelations,marketing/communications)areanalogoustohowafamilyinterfaces withsociety.itisanaturalextensiontothinkabouthowthestructure,function,and 21

knowledgebasewithinthecorporateworldmightbebeneficialtoimprovingpopulationhealth. Withrespecttointernalfunctions,itmakessensethatworkplacehealthshouldbewoveninto thegoals,objectives,andoveralldivision/departmentstrategy.theroleofexternalrelations maybemoreimportantasthesedepartmentsarealreadyskilledatworkingwithdiverse stakeholders.aswillbediscussednext,asbusinessesshifttowardsaddressingpopulation health,thereisthepotentialforengagementbybothinternalfunctionsandexternalrelations throughavarietyofactivities,beyondservingasafundingstream. RoleofBusinessinPopulationHealth Thesocioecologicalmodelofhealththatincorporatesbehavioral,social,and environmentaldeterminantsisthepreeminentmodelforaddressingpublichealth.whenit incorporatesatheoryofchangeitistheidealframeworkforaddressingriskfactorsanddisease thatarehighlyprevalentinthepopulation(refertofigure5).businesses,throughtheir workplacewellnessinitiatives,areaddressingthesameriskfactorsanddiseasesthatarehighly prevalentinsocietytoday(withmentalhealthandmusculoskeletaldiseaseemphasized).the underlyingpremiseofthesocioecologicalmodelisthatindividualsandtheirsusceptibilities (intrapersonalfactorsincludinggeneticandenvironmentalsusceptibilities)areatthecoreof healthstatus.individualsliveinfamiliesthatinfluencetheirbehaviorssuchasfoodsthatare purchasedandeaten(interpersonalfactors)aswellasaccesstohealthcareandpreventive services.individualsandtheirfamilymembersliveincommunitiesthatareinfluencedby externalfactorssuchastheinstitutionstheyinterfacewith(e.g.,schools,workplaces,health care).institutions,individuals,andfamiliesareallinfluencedbypoliciesthatshapethe functioningofsociety.takentogether,allofthesefactorsinfluencehealthstatus.whilemany oftheseriskfactorsanddiseasesareaddressedbythepublichealthandhealthcaresystems, incorporatingbusinessesintoapopulationhealthframeworkwherethesesystemsinteractand worktogethermakessense. Primary Risk Factors Unhealthydiets Physicalinacrvity Tobaccouse Alcohol/druguse Major Disease Diabetes Obesity CVD Asthma Cancer Mentalhealth Musculoskelatal Figure5:Riskfactorsanddiseasehighlyprevalentinthepopulation 22

PopulationHealthStrategies Thetypesofhealthinterventionsthatbusinessesandcommunitiescouldinvestin include,butarenotlimitedto,thosethataddresshealthbehaviorsaswellassocialand environmentaldeterminants.theseexamplescanalsobemappedbackontothe socioecologicalmodelofhealth(figure6andtable3). AgencyforToxicSubstancesandDiseaseRegistry,2010 Figure6:Factorsimportantforimprovingpopulationhealth Examplesofpopulationhealthstrategiesinclude: A. HealthBehaviors(promoting) Immunization Promotingresponsiblealcoholuse Createtobacco-freecommunities Promotingphysicalactivity Promotinghealthyeating B. SocialDeterminants(investing) Economicdevelopment Education Jobs Financialstability Crimeandsafety Familysocialsupport C. EnvironmentalDeterminants(addressing) 23

Urbanrevitalization(e.g.,parks,gardens,bikelanes) D. Pollution/airquality,trafficcongestion,waterquality,noise E. Psychosocialfactors(e.g.,culturaland/orlinguisticbarriers,socialnorms) Table3:SocioecologicalModelofHealthandtheRoleofBusiness SocioecologicalModel PotentialBusinessRole IntrapersonalFactors Individualcharacteristicsthatinfluencebehavior Routinescreeningand assessmentsforthoseatrisk (e.g.,knowledge,attitudes,beliefs,personality traits) Evidence-basedworkplacehealth programs InterpersonalFactors Family,friends,andpeersthatprovidesocial identity,support,androledefinitions InstitutionalFactors Rules,regulations,policies,informalstructures CommunityFactors Socialnetworks,norms,standardsthatexist amongindividuals,groups,organizations PolicyFactors Local,state,andfederalpoliciesandlawsthat regulateorsupporthealthyactionsandpractices fordiseaseprevention,earlydetection, treatment,andcontrol Evidence-basedworkplacehealth programsextendedtofamily membersandtocommunity(if feasible) Workplacesafetyandhealth Knowledgeandexpertisemade availabletocommunity Provideexpertiseon customersandconsumers Workwithcommunity partnerstoidentifypolicies, practices,andinnovationto addresscontinuumofdisease Thedefinitionofpopulationhealthusedinthisreportincludestheinteractionbetween thecommunityandpublichealthandhealthcaresystems.tomeetthedefinitionusedby KindigandStoddard(2003),itisimportanttoalsoconsiderhealthoutcomesofpopulations. Whiletherearemanyexamplesofbusinessesengagedinpopulationhealthactivities,itisonly recentlythatattentionhasbeendirectedtowardsoutcomeassessment.intheenvironmental scandowchemicalandhealthways(bluezonesproject)wereusedexemplarsofcommunity engagementandplanningusingdata-drivenapproaches.throughastrategythatuses partnershipconsensusbuilding,strategicplanscanbedevelopedthatincludecoordinated effortstoaddressmajorpublichealthissues.thisisanimportantcomponentofaplantomove forwardtosystematicallyassesstheroleandeffectivenessofbusinessinvolvementin populationhealth.thelogicmodelbelowpresentsthekeyinputs,outputs,activities,and outcomesnecessarytotrackandmonitorthebenefitsofthisstrategy. 24

# ################### Inputs What#Businesses#Invest# Outputs Activities#####################Participants# What#they#can#do########Who#they#impact# Staff# Employees# Expertise# Resources#(e.g.#IT,# marketing)# Research#&#Development# Funding# Partnerships# Volunteerism# Provide#funding# Provide#expertise#and# brainpower# Partner#to#guide# strategic#planning# Facilitate#innovation# Facilitate#economic# development# Families# CommunityObased# organizations# Government# O Health# O Urban#planning# O Transportation# Customers# Suppliers# Community# # # *Address#the#most#salient#risk#factors#and#disease#in#the#community# # # Figure7:Logicmodelforbusinessinvestmentinpopulationhealth # # # Outcomes Impact Short#term# # # Long#term# Families#engage# Business O Partnerships# created# O Strategic# plans# developed# with# stakeholders# with#emphasis# on#ebps# O Community# improvements# implemented# O Data#systems# to#track# strategies#and# participation# established# O Enhanced#reputation# O Job#savings# O Healthier,#happier,# productive#employees## O Job#retention# O Increased#safety# # HealthofCommunity O Improved#risk#factors*# O Improved#quality#of#life# O Improved#social# connectedness# O Vibrant#communities# that#attract#and#retain# employees# O Improved#environment# O Decreased#morbidity*# O Decreased#mortality*# 25#

SUMMARY Theresultsoftheenvironmentalscanhaverevealedthattherearemanystakeholders engagedinpopulationhealtheffortsreflectingabroadrangeofsectorsincludingthe government,nongovernmentalorganizationsandassociations,universities,foundations,and business/industry(beyondhealthcare).thereisasubstantialplatformtobuilduponwith respecttounderstandingtherolethatbusinessmaytakeinaddressingpopulationhealth. Businesseshaveahistoryofaddressingthecomplexityofhealthcarebyrespondingthrough thelensofcostsavingsandcorporatebottomline.businesseshavehadtocreatestrategic partnershipstoengageinvaluepurchasing.moreover,businessesrecognizethevalueof investinginthehealthoftheircommunitiesandworkforcetoprotecttheirfuture. Correspondingly,thereisagreatdealthatpublichealthandthehealthcareindustrycanlearn frombusinessthatwillavoidduplicationofeffortsandredundancy,reinforceresultsebased accountability,andleadtocostsavings.strategicpartnershipsbetweenbusinessesandthose engagedinpopulationhealtharenowparticularlyimportantgiventherampupofactivities relatedtotheacaandtriplebottomline(i.e.,economic,social,andenvironmentalsuccess). Theliteraturereviewrevealedapaucityofscientificliteraturedemonstratingtheroleor impactofbusinessonpopulationhealth.anyliteraturethatdoesexistfocusesprimarilyonthe returnontheinvestmentforemployeehealthprograms.overthelastdecadetherehavebeen enormousstrideswithinthebusinesscommunitydirectedtowardsimprovingemployeehealth through:(1)developingstrategiestoengageleadershipincludingcesuiteandacrossthevalue chain;(2)identifyingandimplementingevidenceebasedworkplaceinterventions;3)developing andtrackingmetricstoassessefficacyandutilization;and4)testingperformanceincentives. RAND(Mattkeetal.,2013)recentlypublishedaWorkplaceWellnessProgramsStudythat presentedonavarietyofworkplacehealthprograms.whileitisconceivablethatsomeof theseprogramsmightbeusefultopopulationhealthefforts,additionalstrategiesare warrantedthatextendbeyondindividualhealthmanagementprograms(e.g.,targeted interventionsintheworkplace)tomorebroadscalegroupbasedprogramsinthecommunity (e.g.,universalinterventions). Thekeyinformantinterviewswiththoughtleadersprovidedafoundationforthe developmentofthebusinesscaseandlogicmodel.acriticalpointemphasizedwasthe importanceofengagingcesuiteinordertoensuresuccess.theinterviewsprovidedinsightand examplesintothechallengesthatlayahead.interestingly,bythefinalinterview,thepatterns ofresponsesweresosimilar,thatnofurtherknowledgewasgained. Thecasestudiespresentedareonlysnapshotsofthecurrentworkinthefield.They haveillustratedthatbusinesscanplayaleadershiproleprovidinginputandguidanceonthe design,implementation,anddevelopmentofmetricsforpopulationhealthefforts.however, thereremainseveralweaknessesinourknowledgebasethatneedtobeaddressedbefore designingandengaginginshorteorlongtermresearchstudiesontheroleandeffectivenessof businessinimprovingpopulationhealth.in2008anewschoolofpopulationhealthemerged 26

atthomasjeffersonuniversity,thefirstofitskindtofocusonpopulationhealthspecifically, fillingagapwithrespecttotrainingnewleadersinthisareaandengaginginlongtermresearch studies. Thescanalsorevealedthatthereisaneedtounderstandthebreadthanddepthof activitiesthatcorporateamericaiscurrentlyengagedinoutsideoftheworkplacegiventhat theseactivitiesarenotalwayssystematicallydocumented.thisisjustthebeginning.while thereareseverallargerescalecommunityinitiativespresentedinthisreport,asraisedduring thekeyinformant/thoughtleaderinterviews,therearemanyothersthathavenotbeen identifiedthroughtraditionalinternetebasedinformationchannels.thismayincludethetype ofworkcurrentlydonebytheexternalinfluencerssuchascsr,foundations,government relations,andmarketing/communicationdepartmentswithincompanies.thisinformation needstobecollatedonanationalbasisandbestcaseexamplesidentified.anotherpotential gapisanunderstandingoftheintellectualcapitalthatiscontainedwithinthebusinesssector andhowthatmightbeharnessedtoaddresspopulationhealth.asraisedinthisreviewthere areseveralexamplesoflargecompanieswithhighlyskilledmedicalstaffthatarethought leadersinthisfieldwhoseknowledgeneedstobeconsolidated.finally,thereisaneedto developacommonlanguageandframeworkthatcanbesharedwiththebusinesscommunity thatwillprovidecleardefinitionsofpopulationhealth,whatevidenceebasedstrategiesexist,as wellasthecorrespondingmetricstotrack,sothattheyareinabetterpositiontodetermine howtobestusetheirresources. 27

28 REFERENCES AgencyforToxicSubstancesandDiseaseRegistry.2010.Orientationsessionsummary:Tribalconsultationadvisory committee(tcac)meeting.washington,dc:departmentofhealthandhumanservices. APHA(AmericanPublicHealthAssociation).2012.The$Prevention$and$Public$Health$Fund:$A$critical$investment$in$our$ nation s$physical$and$fiscal$health.washington,dc:americanpublichealthassociationcenterforpublichealth Policy. APHA.2013.National$public$health$week@public$health$is$ROI:$Save$lives,$save$money. http://www.youtube.com/watch?v=b5m9jefyxji(accessedjanuary28,2014). CDC(CentersforDiseaseControlandPrevention).2013.Healthy$communities$program$overview. http://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/overview/index.htm(accessed January28,2014). ChildObesity180.2013.The$epidemic.http://www.childobesity180.org/epidemic(accessedJanuary28,2014). CommonHealthACTION.2012.The$Well$Community$Project:$Moving$beyond$health.$Addressing$the$missing$dimension. Washington,DC:CommonHealthACTION. CountyHealthRankings.2012.Countyhealthrankingsmodel.http://www.countyhealthrankings.org/resources/countyE healtherankingsemodel(accessedjanuary28,2014) DeVol,R.,A.Bedourssian,A.Charuworn,A.Chatterjee,K.Kim,andK.Klowden.2007.An$unhealthy$America:$The$ economic$burden$of$chronic$disease$@@$charting$a$new$course$to$save$lives$and$increase$productivity$and$economic$ growth.santamonica,ca:milkeninstitute. Eccles,R.G.,I.Ioannou,andG.Serafeim.2012.ThedollarpayofffromCSRandsustainability.Strategy$+$Business, January13,2012. Fawcett,S.,J.Schultz,J.WatsonEThompson,M.Fox,andR.Bremby.2010.Buildingmultisectoralpartnershipsfor populationhealthandhealthequity.preventing$chronic$disease7(6):a118. HealthyWeightCommitmentFoundation.2013.Lower$calorie$foods$drive$sales:$Infographic. http://www.healthyweightcommit.org/news/lower_calorie_food_drive_sales_infographic(accessedjanuary28, 2014). Kindig,D.,andG.Stoddart.2003.Whatispopulationhealth?American$Journal$of$Public$Health93(3):380E383. Kindig,D.A.,G.J.Isham,andK.Q.Slemering.2013.The$business$role$in$improving$health:$Beyond$social$responsibility. Washington,DC:InstituteofMedicine. Mattke,S.,H.Liu,J.Caloyeras,C.Y.Huang,K.R.VanBusum,D.Khodyakov,andV.Sheir.2013.Workplace$wellness$ programs$study.santamonica,ca:randcorporation. NBCH(NationalBusinessCoalitiononHealth).2013.NBCH$action$brief:$Community$health.Washington,DC:National BusinessCoalitiononHealth. NBCHandCCHI(NationalBusinessCoalitiononHealth,andCommunityCoalitionsHealthInstitute).2012.Tools$and$ information$for$community$health$partnerships.washington,dc:nationalbusinesscoalitiononhealth. NationalPreventionCouncil.2011.Nationalpreventionstrategy:America splanforbetterhealthandwellness. Rockville,MD:OfficeoftheSurgeonGeneral. OECD(OrganisationforEconomicCoEoperationandDevelopment).2013.Health$data$2013. http://www.oecd.org/health/healthesystems/oecdhealthdata2013efrequentlyrequesteddata.htm(accessed January28,2014). PartnershipforPrevention.2013.Worksite$health.http://www.prevent.org/Topics/WorksiteEHealth.aspx(accessed January28,2014). PHI(PublicHealthInstitute).2013.Prevention$means$business.http://www.phi.org/resources/?resource=preventionE meansebusiness(accessedjanuary28,2014). RWJF(RobertWoodJohnsonFoundation).2013.Our$approach.http://www.countyhealthrankings.org/ourEapproach (accessedjanuary28,2014).

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AppendixA SNAPSHOTSOFFOUNDATIONSWORKINGINEMPLOYER<COMMUNITYHEALTH AetnaFoundation Overview PrimaryGoal/Mission Programs/Campaigns Establishedin1972,theAetnaFoundationhasalongtraditionofgivingandcommunity supportandhascontributedmorethan$427millioningrantsandsponsorships.the AetnaFoundation scorefocusareasareobesity,racialandethnichealthcareequity, andintegratedhealthcare. Topromotewellness,health,andaccesstohighEqualityhealthcareforeveryone,while supportingthecommunitiesweserve ExamplesofgrantsAetnaFoundationwouldsupportinclude: Projectsandstudiesthatidentifycausesofobesityandpotentialbestpracticesforaddressingobesity, suchas: o Domesticfoodpoliciesandtheirimpactonindividualfoodchoices o Theimpactofourneighborhoodsandthe builtenvironment onpromotingpopulationhealth andweightloss o Assessmentsofwhycommunitieswithhighratesoffoodinsecurityalsoaremorelikelyto experiencehighratesofobesity o Howchildrenuserecreationtime o Howschoollunchandfoodpoliciesaffectourchildren Explorehowastrongerprimarycaremodelandrelationshipswithproviderscouldbenefitminority populationsandclosethepersistenthealthcaregap. HelpproviderswhotreatlargeminoritypopulationsbecomeleadersindeliveringhighEqualitycare. DeterminewhatcanbedonetoreducethenumbersoflowEbirthweightbabiesborntomothersatrisk. Examine,throughobservationalstudies,thecorrelationbetweenamother shealth,stresslevel,and socialsupports,andthelikelihoodofhavingahealthybabywholivesthroughitsfirstyearoflife. Determine,throughinterventionalstudies,whetherstressEreductionprograms(includingyogaand meditation)canimprovehealthoutcomesforminoritypatientswithchronicconditions,aswellas postnataloutcomesformothersandpregnantwomen. Developstandardsandmetricsofcarecoordinationinambulatorycaresettings. Evaluatemodelsofcarecoordinationthatenhanceproviders communicationwitheachotherandwith theirpatientsandleadtoimprovedpatientoutcomesandexperienceswiththeircare. Evaluatemethodsofcarecoordinationforengagingpatientsaspartnersintheircare,particularlyinthe managementofchronicconditions. IdentifybestpracticestoalignfinancialandotherincentivesforachievingwellEcoordinatedcare. Identifyandassessmodelsofcarecoordinationthatreducethecostofcarewhileimprovingpatient healthoutcomes. Impact Reports/CaseStudies Linkstoreports http://www.aetnaefoundation.org/foundation/aetnaefoundationeprograms/programe impact/index.html Recentgrantrecipients http://www.aetnaefoundation.org/foundation/recentegrants/index.html 30

SocialMediaSites WebsiteandContact Information RecentcommunityEbasedgrants http://www.aetnaefoundation.org/foundation/recentegrants/projectsebyeprograme area/obesity.html N/A http://www.aetnaefoundation.org/foundation/index.html 31

TheCaliforniaEndowment Overview TheCaliforniaEndowmentisaprivate,statewidehealthfoundationthatwasestablishedin1996. PrimaryGoal/ Toexpandaccesstoaffordable,qualityhealthcareforunderservedindividualsandcommunities, Mission andtopromotefundamentalimprovementsinthehealthstatusofallcalifornians Programs/Campaigns HealthHappensinNeighborhoods(JunkDrinksandJunkFoods,PlacestoWalkandPlay,SafeStreets) HealthHappenswithPrevention(EncouragingEnrollmentThroughtheACA,HelpingSmallBusinesses ImplementtheACA,GivingRisetoHealthierCommunities) HealthHappensinSchools(HealthierSchoolFoodsandBeverages,AllAboardtheSchoolSuccessExpress, ExerciseDuringtheSchoolDay,SocialEEmotionalHealthforStudents) HealthHappenswithAction HealthHappenswithallOurSonsandBrothers BuildingHealthyCommunities Impact Reports/ CaseStudies SocialMedia Sites Websiteand Contact Information A10Eyear,$1billioncomprehensivecommunityinitiativethatiscreatingarevolutionintheway Californiansthinkaboutandsupporthealthintheircommunities.In14placesacrossCalifornia,residents areprovingtheyhavethepowertomakehealthhappenintheirneighborhoodsandschoolsthrough prevention andindoingso,theyarecreatingabrighterfuturefortheirchildrenandfortheirstate. OutcomesforEvaluationBHCImpact http://www.calendow.org/uploadedfiles/health_happends_here/fourbigresultsupdate8_06_09.pd f BHCProfileofAdvocacyProgress http://www.calendow.org/uploadedfiles/learning/profile%20of%20advocacy%20progress_tce%20 Board%20Report%20FINAL%204E18E13%20(2).pdf BHCYouthProgramIndicatorSurvey http://www.calendow.org/uploadedfiles/bhc%20youth%20program%20inventory%20report%2020 13.pdf CaseStudiesandLearningBriefs http://www.calendow.org/case_studies.aspx Samuels, S. E., Craypo, L., Boyle, M., Crawford, P. B., Yancey, A., & Flores, G. (2010). The California Endowments healthy eating, active communities program: A midpoint review. American Journal of Public Health, 100(11), 2114-2123. https://www.facebook.com/calendow https://twitter.com/calendow_here https://www.pinterest.com/calendow/ https://www.youtube.com/healthhappenshere http://www.calendow.org/ GrantInquiriesEmail:tcegrantreports@calendow.org 32

GENYOUthFoundation Overview GENYOUthwasfoundedthroughanunprecedentedpublicEprivatepartnershipwiththe NationalDairyCouncil(NDC)andtheNationalFootballLeague(NFL)committedtochild healthandwellness PrimaryGoal/Mission Inspireandeducateyouthtoimprovetheirnutritionandincreasephysicalactivity Programs/Campaigns FuelUptoPlay60 o Inschoolphysicalactivityandnutritionprogram TownHalls o LocaleventsconceivedasgrassrootsextensionsofGENYOUth snational LeadershipRoundtablestoidentifyandactivateideasandsolutionsona locallevel AdVentureCapital o Inspire,empower,andfundyouthEdriveninitiativesthatimprove nutrition,physicalactivity,andstudentachievementinschoolsand communities.byapplyingtheprinciplesofentrepreneurialinvestmentto thechallengeofschoolwellness,students pitch theirideastobusiness leadersforpotentialfundingandimplementation CitizenYOUth o Hubforstudents,andtheoverallcommunitytotakeanactiverolein creatingchange Impact FuelUptoPlay60iscurrentlyactiveinmorethan70,000schoolswiththe potentialtoreach36.6millionstudentsnationwide LinktoWellnessImpactReport http://www.genyouthfoundation.org/wpe content/uploads/2013/02/the_wellness_impact_report.pdf Reports/CaseStudies http://fueluptoplay60.com/successoverview/ SocialMediaSites https://www.facebook.com/genyouthfoundation?sk=wall https://twitter.com/genyouthnow http://www.youtube.com/genyouthfoundation http://www.pinterest.com/genyouth/ WebsiteandContact Information http://www.genyouthfoundation.org/ INFO@GENYOUTHFOUNDATION.ORG 33

34 W.K.KelloggFoundation Overview TheW.K.KelloggFoundation(WKKF),foundedin1930asanindependent,private foundationbybreakfastcerealpioneerwillkeithkellogg,isamongthelargest philanthropicfoundationsintheunitedstates.guidedbythebeliefthatallchildren shouldhaveanequalopportunitytothrive,wkkfworkswithcommunitiestocreate conditionsforvulnerablechildrensotheycanrealizetheirfullpotentialinschool,work, andlife. PrimaryGoal/Mission TheW.K.KelloggFoundationsupportschildren,families,andcommunitiesasthey strengthenandcreateconditionsthatpropelvulnerablechildrentoachievesuccessas individualsandascontributorstothelargercommunityandsociety. Programs/Campaigns TheW.K.KelloggFoundationorganizestheirworkandinvestmentstowardattainingthree strategicgoals: EducatedKids:IncreasethenumberofchildrenwhoarereadingEandEmath proficientbythirdgrade. HealthyKids:Increasethenumberofchildrenbornatahealthybirthweightand whoreceivethecareandhealthyfoodtheyneedforoptimaldevelopment. SecureFamilies:Increasethenumberofchildrenandfamilieslivingatleast200 percentabovethepovertylevel. WithinandaroundeachgoalarecommitmentstoCommunity&CivicEngagementand RacialEquity. In2008,thefoundationbeganconcentratinguptotwoEthirdsofitsgrantsinseveral priorityplaces,intheunitedstatestheseare: Michigan,Mississippi,NewMexicoandNewOrleans Impact N/A Reports/CaseStudies 2012AnnualReport http://www.wkkf.org/resourceedirectory/resource/annualereports/2012ewekekellogge foundationeannualereport Databaseofgrantsawardedhttp://www.wkkf.org/grants SocialMediaSites https://www.facebook.com/wkkelloggfoundation https://www.facebook.com/foodandcommunity https://www.youtube.com/kelloggfoundation https://twitter.com/wk_kellogg_fdn WebsiteandContact Information http://www.wkkf.org/grantseekers

RobertWoodJohnsonFoundation(RWJF) Overview Mission Program Areas Impact Examplesof Relevant RWJFH Funded Resources SocialMedia Sites Websiteand Contact Information TheRWJFisthenation slargestphilanthropydevotedexclusivelytohealthandhealthcare.the foundationworkswithadiversegroupoforganizationsandindividualstoidentifysolutionsand achievecomprehensive,measurable,andtimelychange. ToimprovethehealthandhealthcareofallAmericans Obesity o Schoolfoodsandbeverages o Physicalactivityatschool o Pricingstrategies o Healthyaffordablefood o Physicalactivityincommunities o Marketingtokids Coverage Humancapital Pioneer Publichealth Quality/equality Vulnerablepopulations RWJFinvests$20millionperyearonevaluationoftheirprograms.Theirdatabasecanbesearched herehttp://www.rwjf.org/en/researchepublications/assessingeoureimpact/programeresults.html SignsofProgressinChildhoodObesityhttp://www.rwjf.org/content/rwjf/en/researchE publications/finderwjferesearch/2013/09/signseofeprogress.html ANewCSRFrontier:BusinessandPopulationHealthMobilizingCSRtoStrengthenCorporate EngagementonHealthandWellnessacrosstheValueChain http://www.bsr.org/reports/bsr_a_new_csr_frontier_business_and_population_health.pdf MillerW,SimonP,MalequeS,eds.(2009)Beyondhealthcare:Newdirectionstoahealthier America.WashingtonDC:RobertWoodJohnsonFoundationCommissiontoBuildaHealthier America.http://www.commissiononhealth.org/Report.aspx?Publication=64498 Includes ActionStepsforEmployersandBusinesses p.106 AdditionalCommissiontoBuildaHealthierAmericapublications http://www.commissiononhealth.org/publications.aspx CountyHealthRankings&RoadMapswww.countyhealthrankings.org. HealthyKids,HealthyCommunitieshttp://www.healthykidshealthycommunities.org/ https://www.facebook.com/robertwoodjohnsonfoundation https://twitter.com/@rwjf https://www.youtube.com/user/rwjfvideo http://www.rwjf.org/en/rss.html http://www.rwjf.org/en/blogs.html http://www.rwjf.org/ 35

AppendixB SnapshotsofMultistakeholderCoalitionsInvolvedinCommunityHealth BlueZonesProject Overview TheBlueZonesProjectbyHealthwaysisacommunitywellEbeingimprovementinitiativedesigned tomakehealthychoiceseasierthroughpermanentchangestoenvironment,policy,andsocial networks.thebluezonesprojectisinspiredbyresearchabouttheregionsoftheworldwiththe highestconcentrationsofcentenarians(peoplewholivetobe100yearsorolder).therearefive BlueZonesregions:LomaLinda,California;Okinawa,Japan;Nicoya,CostaRica;Sardinia,Italy;and Ikaria,Greece.TheBlueZonesProjectenvironmentalapproachtowellEbeingimprovementuses toolsbasedonninehealthylifestylehabitssharedbythepeoplelivingintheoriginalbluezones areas. Primary ToleadandignitecommunityEbyEcommunitywellEbeingtransformation,wherepeopleliveand Goal/Mission worktogetherinbluezonescommunitiesforabetterlife. Programs/Campaigns BlueZones hasselected12communitiesasdemonstrationsitesiniowa.theinitiativeisnowexpandinginto California,Texas,andHawaii.TobecomeacertifiedBlueZonesCommunity: Atleast20%ofcitizensmustsignthePersonalPledgeandcompleteoneaction, Atleast25%ofpublicschoolsmustbecomeaBlueZonesSchool, Atleast50%ofthetop20communityEidentifiedemployersmustbecomeaBlueZonesWorksite, Atleast25%ofindependentlyorlocallyownedrestaurantsmustbecomeaBlueZonesRestaurant, Atleast25%ofgrocerystoresmustbecomeaBlueZonesGroceryStore,and ThecommunitymustcompletetheBlueZonesCommunityPolicyPledge. Impact Theresultsofa1EyearpilotprojectinAlbertLea,Minnesota,include: Anaverageweightlossof2poundsforparticipatingresidents Anincreaseinaveragelifeexpectancyof2.9years A20%reductioninabsenteeismfortoplocalemployers Activeparticipationfrom60%ofthecity slocalrestaurants,51%ofitslargestemployers,100%ofits schools,and27%ofitscitizens InIowa,theBlueZonesProjectwillnowinclude10demonstrationsiteswithpopulationsgreaterthan10,000 citizens,andatleast20additionalcommunitieswithpopulationslessthan10,000.communityprogresswillbe trackedbythegallupehealthwayswellebeingindex,ameasureofu.s.residentsdailyhealthandwellebeing.for moreinformation,pleasevisithttp://www.healthways.com/solution/default.aspx?id=1125. 36

SeveralcommunitiesinIowaare1 2yearsintotheireffortsandhavemeasureablechangesdocumented. BlueZonesStatisticsintheUnitedStates: 173,013peoplejoined 1,141businessesjoined 109schoolsjoined 203,431citizenactions 424eventsheld Reports/Case Studies SocialMedia Sites Websiteand Contact Information Buettner, D. (2012). The Blue Zones: 9 Lessons for Living Longer from the People Whove Lived the Longest. National Geographic Books. https://www.youtube.com/user/bluezonesproject *ThereareFacebookandTwittersitesaswell,butyoumustberegistered. https://www.bluezonesproject.com/ JohnWerger CommunityOperationsDirectorIowa Email:jon.werger@healthways.com Phone:515.645.5212 37

ChildObesity180 Overview Expertsandleadersfrombusiness,academia,nonprofit,andsciencearecomingtogether, generatingurgency,andfindingsolutionstothechildhoodobesityepidemic. PrimaryGoal/Mission Reach80%ofU.S.childrenbetweentheagesof5and12andreversethetrend ofthechildhoodobesityepidemicinageneration stime. CoalitionMembers DavidM.Cordani,PresidentandCEO,CignaCorporation JosephA.Curtatone,Mayor,CityofSomerville,Massachusetts,NationalLeagueofCities WilliamH.Dietz,M.D.,Ph.D.,RetiredDirector,DivisionofNutrition,PhysicalActivity,andObesity,Centers fordiseasecontrolandprevention DavidDillon,ChairmanandCEO,TheKrogerCompany PeterR.Dolan,Chair,ChildObesity180 ChristinaD.Economos,Ph.D.,ViceEChairandDirectorofChildObesity180,NewBalanceChairinChildhood Nutrition,andAssociateProfessorattheFriedmanSchoolofNutritionScienceandPolicyatTuftsUniversity BobKocher,M.D.,Partner,Venrock;FormerSpecialAssistanttothePresident,NationalEconomicCouncil A.D.DavidMackay,RetiredPresidentandCEO,KelloggCompany;ChairEmeritus,HealthyWeight CommitmentFoundation AnneC.MacMillan,DeputyChiefofStaff,UnitedStatesDepartmentofAgriculture JamesS.Marks,M.D.,M.P.H.,SeniorVicePresidentandDirector,HealthGroup,RobertWoodJohnson Foundation H.MelvinMing,PresidentandChiefExecutiveOfficer,SesameWorkshop DeniseMorrison,PresidentandChiefExecutiveOfficer,CampbellSoupCompany MiriamE.Nelson,Ph.D.,Professor,FriedmanSchoolofNutrition,TuftsUniversity;CoEFounderandSenior Advisor,ChildObesity180 NeilNicoll,PresidentandCEO,YMCAoftheUSA DwayneProctor,Ph.D.,MA,Director,ChildhoodObesityTeamDirectorandSeniorProgramOfficer,Robert WoodJohnsonFoundation MayaRockeymoore,Ph.D.,PresidentandCEO,GlobalPolicySolutions MaryStory,Ph.D.,RD,Professor,DivisionofEpidemiologyandCommunityHealth;AssociateDean,Schoolof PublicHealth,UniversityofMinnesota;AdjunctProfessor,DepartmentofPediatrics,UniversityofMinnesota DawnSweeney,PresidentandCEO,NationalRestaurantAssociationandNationalRestaurantAssociation EducationalFoundation ArturoVargas,ExecutiveDirector,NationalAssociationofLatinoElectedandAppointedOfficials JakeWinebaum,FounderandCEO,Brighter.com MatthewYale,VicePresident,CorporateCommunications,LaureateEducation;FormerDeputyChiefof Staff,UnitedStatesDepartmentofEducation Programs/Campaigns Multisectoralleadershipandcollaboration,withbusinessesdirectlyinvolvedinthefunding andimplementationofchildobesity180 s: BreakfastInitiative ActiveSchoolsAccelerationProject RestaurantInitiative HealthyKidsOutofSchool Impact BreakfastInitiative: o 450,000childrenparticipatinginbreakfastintheclassroom ActiveSchoolsAccelerationProject: o $1Mingrantsawardedto1,000schoolsnationwide,andeachschoolwill launchanewphysicalactivityprogramnextyear 38

Reports/CaseStudies SocialMediaSites WebsiteandContact Information o 400,000childrenparticipatinginschoolphysicalactivityprograms RestaurantsInitiative: o 20industryleadersconvenedtodevelopandexecutestrategiessothe restaurantindustrycanbepartofthesolutiontochildhoodobesity. CommittedtoevidenceEbasedapproach,libraryincludeslinkstopeerEreviewedjournals andvideos http://www.childobesity180.org/library https://twitter.com/childobesity180 http://www.childobesity180.org/ Phone: 617.636.3563 39

CommunityCoalitionsHealthInstitute Overview (CCHI)isanonprofitaffiliateorganizationoftheNationalBusinessCoalitiononHealth (NBCH). PrimaryGoal/Mission Improvinghealthandtransforminghealthcare,communitybycommunity Programs/Campaigns CoalitionSeedGrantProgram CCHI has issued seed grants to nearly half of the NBCH coalition members. Grant areas include adult immunization, diabetes programs, community health planning, and community health partnership Community Health Partnerships Project 5-year grant from the CDC seeks to strengthen existing relationships and catalyze new partnerships between NBCH member coalitions and state and local public health agencies across the United States Community Health Planning Seed Grant Six NBCH communities received grants funded by United Health Foundation and the lessons learned and best practices were developed into a library of Community Health Planning Resources (see gray literature table for document descriptions) Impact N/A Reports/CaseStudies CommunityHealthPlanningResources http://www.nbch.org/communityehealtheplanningeresources CaseStudieshttp://www.nbch.org/CaseEStudies SocialMediaSites N/A WebsiteandContact Information Community Coalitions Health Institute 1015 18th Street, NW Suite 730 Washington, DC 20036 202.775.9300 (p) www.nbch.org/cchi Karen Linscott Chief Operating Officer, NBCH 202.775.9300 x17 Alejandra Herr Director of Grants and Programs, NBCH 202.775.9300 x15 aherr@nbch.org 40

41 HealthiestStateInitiative Overview TheHealthiestStateInitiativeisaprivatelyledpublicinitiativeintendedtoinspireIowans andtheircommunitiesthroughoutthestatetoimprovetheirhealthandhappiness.to achieveourgoal,individuals,families,businesses,faithebasedorganizations,notefore profits,andthepublicsectorwilluniteinacommunityefocusedefforttomakeiowathe healthieststateinthenationby2016.tomeasureprogress,thegallupehealthwayswelle BeingIndexwillbeused,whichtracksixareas,or domains, thatcomprisewellebeing. PrimaryGoal/Mission TomakeIowathehealthieststateinthenationby2016. BusinessesActively InvolvedinHSI HyEVeeInc.andWellmark,Inc. Programs/Campaigns Healthyfortheholidays Toolsandresourcestofacilitatehealthychoicesathomeandattheworkplaceduringtheholidayseason Healthieststatewalk Individualandorganizedwalkcommitments,includingcontests BlueZonesProject Focus5 TheHSIhasidentifiedfiveprioritiesforIowatofocusonoverthenextfewyears. o DecreasingthenumberofIowanswhosmoke o Increasingconsumptionoffruitsandvegetables o IncreasingthenumberofIowanswhoarelearningordoingsomethinginterestingdaily o IncreasingthenumberofIowanswhohavevisitedthedentistinthelastyear o IncreasingthenumberofIowanswhofeeltheirbosstreatsthemlikeapartneratwork FiveworkgroupschairedbyleadingIowanshavebeenestablishedtohelpachievethesegoals. Impact Tomeasureprogress,theGallupEHealthwaysWellEBeingIndexwillbeused,whichtracks sixareas,or domains, thatcomprisewellebeing. Formoreinformation,pleasevisit http://www.healthways.com/solution/default.aspx?id=1125 SuccessStorieshttp://blog.iowahealthieststate.com/ Reports/CaseStudies HSIWebinarhttps://www.youtube.com/watch?v=e416hVJmBVM SocialMediaSites https://www.facebook.com/healthiestiowa https://www.youtube.com/user/healthieststateia https://twitter.com/healthiestiowa WebsiteandContact Information http://www.iowahealthieststate.com/ LizCox Email:lcox@hyEvee.comPhone:515E246E3079

HealthyWeightCommitmentFoundation(HWCF) Overview TheHWCFisaCEOEledorganizationthatisacoalitionofmorethan245retailers,foodand beveragemanufacturers,restaurants,sportinggoodsandinsurancecompanies,tradeassociations andnongovernmentalorganizations(ngos),andprofessionalsportsorganizations. PrimaryGoal/ Reducingobesity,especiallychildobesity,by2015 Mission CoalitionCorporateMembers AnytimeFitness,BioVittoria,BrookshireGroceryCompany,BumbleBeeFoods,LLC,CampbellSoupCompany,ConAgraFoods, DardenRestaurants,Inc,FestivalFoods(Minnesota),FoodCity,FoodMarketingInstitute,GeneralMills,Inc.,GeorgeForman, Gladson,GonzalezNorthgateMarket,GroceryManufacturersAssociation,H&HProductsCompany,HarrisTeeter,Hillshire Brands,HyEVee,Inc.,IGA,Inc.,JaxMarkets,KelloggCompany,KraftFoods,Inc.,Mars,Inc.,Martin ssupermarkets,mccain, McCormick&Company,Inc.,NestléUSA,PepsiCo,Inc.,RalstonFoods/PostFoods,LLC,Redner smarkets,inc.,schnuck Markets,Inc.,ShopRite,Inc.,Tate&Lyle,TheCocaEColaCompany,TheHersheyCompany,TheJ.M.SmuckerCompany,The SportsAuthority,TriWestHealthcareAlliance,Unilever,WakefernFoodCorporation,Wegmans Forafulllistofassociatememberspleasevisithttp://www.healthyweightcommit.org/supporters/partners/ Programs/ Campaigns Committedtoreducing1.5trillioncaloriesinthemarketplaceby2015 TogetherCountsCampaign(http://www.togethercounts.com/) promotestheadvantagesoffamilymealsandphysicalactivity.thecampaignprovides participationadvice,toolstotrackprogress,andawardsandincentives. Impact TogetherCountsbrandconsumerreach573,000,000 PartneredwiththenumberEoneUScurriculumprovider,DiscoveryEducation Reaching22,000PTAscomprising4.3millionmembers 2,885,816totalwebsitepageviews 1,591,795totaluniquewebsitevisits FacebookFans:132,475 TwitterFollowers:10,802 GirlScoutpartnershipreachesover1.7milliongirlsandapproximately700,000mom volunteers Reports/ CaseStudies Social MediaSites Websiteand Contact Information http://www.healthyweightcommit.org/about/reports_and_case_studies/ Elementaryschoolcasestudiesfocusingoninnovativewaystoincreasestudentandfamily physicalactivityandimprovefruitandvegetableconsumption Workplacewellnessscorecards Annualreports http://blog.togethercounts.com/ https://www.facebook.com/togethercounts https://twitter.com/togethercounts https://plus.google.com/u/0/115811366885803739126/posts http://www.pinterest.com/togethercounts/ http://feeds.feedburner.com/togethercounts/axdv http://www.healthyweightcommit.org/ BeckyJohnson,SeniorDirector,StrategicOperations Phone:202.558.4660Email:bjohnson@healthyweightcommit.org LisaGuillerminGable,President 42

LakeNonaLifeProject(LNLP) Overview TheLakeNonaLifeProject Mission Tounderstandthelinksbetweenhealth,wellness,longevity,andqualityoflife LakeNonaMedicalCityResidentsandPartners Wellness&Prevention,Inc.,aJohnson&JohnsonCompany(http://wellnessandpreventioninc.com/) LakeNonaInstitute(http://www.lakenonainstitute.org/) CiscoHealthSystems GHealthcare UniversityofCentralFlorida UniversityofFlorida FloridaBlue SanfordBurnhamMedicalResearchInstitute NemoursChildren shospital OrlandoVAMC Programs/Campaigns TheLakeNonaLifeProjectisaregistrystudythatwillbeopentoallmembersoftheLakeNona,FL, community,includingresidents,students,andemployeesthatlive,study,andworkwithinthelakenona community. TheLakeNonaLifeProjectwillbeanaturalisticprospectivecommunityepidemiologicstudythatevaluates thehealthandwellnessofparticipantsoverthecourseofmultipleyears,focusingonthelinksoflife experienceswithhealth,wellness,longevity,qualityoflife,andhumanperformance.thedatagathered throughthisvaluablenaturalisticcommunityresearchwillprovidearichfoundationforadditionalstudies thatmightsubsequentlybedevelopedinthepopulationtolearnaboutinterventionsthatcaninfluencethe healthandwellebeingoffuturegenerations. ThestudywillhaveatitscoreanannualdeEidentifiedselfEreportcommunitysurvey.Consentingrespondents willalsohavetheirdeeidentifiedsurveydatalinkedtodeeidentifiedmedicalandpharmacyclaimsdata obtainedbasedonsignedinformedconsentfromtheirhealthplan. Althoughtherewillbenopaymenttorespondentsforparticipatinginthestudy,weplantoofferanumber ofthankeyougiftstorespondentsasawayofhelpingbuildandmaintainrapport.threetypesofgiftsare currentlyenvisioned,althoughothersmaybeaddedovertime.thefirstwillbeexclusiveaccesstothe members@onlypartofthelakenonalifeprojectwebsite,whichwillcontaindiversekindsofhealtherelated informationthatparticipantsmightfindvaluable.thesecondwillbethehealthmediasnapshotofthe individual shealthstatusanddigitalhealthcoachingprogramstohelppeoplechangetheirbehaviors(e.g., exercise,weightreduction,smokingcessation).thethirdwillbeaseriesoftbdtests,freemedicaltests,and monitoringsystems,theresultsofwhichwewillmakeavailabletotheindividualand/ortotheindividual s physician.althoughnofinaldeterminationhasyetbeenmade,includedheremightbepedometers,smart wristbandsthatmonitorheartrateandsleep,andpossiblyevenbasicbloodandurinetests. Theoverarchinggoaloftheresearchistogatherinformationthatcanbeusedbyresearcherstohelp optimizethehealthandwellebeingonpeopleinthegeneralpopulation. 43

Impact Expected launch Scientific Advisory Board Members Social MediaSites Websiteand Contact Information Questionstobeassessedincludesuchareasas: Sociodemographicsandroles Lifeexperiences(ongoingroleexperiences,lifeevents) Personalityandlifestylepreferencesandbehaviors(e.g.,religiosity,physicalactivity, smoking) SymptomEbasedphysicalandbehavioralhealthproblems(e.g.,insomnia,migraine, depression) Roleperformanceandqualityoflife Researchquestionswillincludeinvestigationsofsuchtopicsas: Theassociationsbetweenlifeexperiencesandhealth Theeffectsofspecifichealthproblemsonroleperformanceandqualityoflife Theextenttowhichtheadverseeffectsofhealthproblemsaremitigatedbypersonality, lifestylepreferences,andlifestylebehaviors. Q22014 GloriaCaulfield,LakeNonaInstitute ThomasS.Ells,Ph.D.,Johnson&JohnsonConsumer SteveGardell,Ph.D.,SanfordBurnhamMedicalResearchInstitute KennethGoldberg,M.D.,OrlandoVAMedicalCenter RonaldKessler,Ph.D.,HarvardMedicalSchool JimLoehr,Ph.D.,HumanPerformanceInstituteandWellness&Prevention,Inc. ShawnMason,Ph.D.,Wellness&Prevention,Inc. VelmaMonteiroETribble,BlueCrossBlueShieldofFloridaFoundation ChristopherMosunic,Ph.D.,Wellness&Prevention,Inc. MarcoPahor,M.D.,UniversityofFlorida SurendraSaxena,MBA,CiscoSystems JimRoycroft,HomeownersAssociationofNorthLakePark,LakeNona CarmellaSebastian,M.D.,BlueCrossBlueShieldofFlorida PeterSerpentino,Ph.D.,GEGlobalResearch GEHealthcare ThaddeusSeymour,Jr.,Ph.D.,LakeNonaInstitute PaulStang,Ph.D.,JanssenPharmaceuticals KimberlyThompson,Sc.D.,UniversityofCentralFlorida EdwardUrdaneta,M.D.,McNeilConsumerHealthcare LloydWerk,M.D.,M.P.H.,NemoursChildren shospital BenWiegand,Ph.D..Johnson&JohnsonConsumer N/A http://lakenonalifeproject.com/ Principalinvestigator: ShawnMason,Ph.D. Wellness&Prevention,Inc. 130SouthFirstStreet,AnnArbor,MI48104 734369E9047;Smason5@its.jnj.com 44

45 LiveWellOmaha Overview LiveWellOmahaisthelongEtermcollaborativeefforttoimprovetheoverallhealthofarearesidents andpositionomahaasathrivingcommunitynowandwellintothefuture.membersareindividuals, organizations,andinstitutions includingschools,healthcareprofessionals,faithebasedand communityebasedorganizations,privateesectorcompanies,andofficialsfromalllevelsof government whoarecommittedtocultivatingaphysicalandculturalenvironmentthatencourages everyoneinomahaanddouglascountytomakethehealthychoice,atanytime,inanyplace,every time. PrimaryGoal/ Mission Improvetheoverallhealthofarearesidents CoalitionMembers AlegentHealth,AmericanRedCross,AON,BairdHolmLaw,LLP,BlandandAssociates,BlueCrossandBlueShieldofNebraska,Boys TownNationalResearchHospital,CatholicCharities,CarolRussell,CenterforHumanDiversity,Inc.,CharlesDrewHealthCenter, Children shospital&medicalcenter,conagra,coventryhealthcare,creightonuniversity,douglascountyhealthdepartment,dr. LauraJana,PPC/PrimroseSchoolofLegacy,Gallup,GreaterOmahaChamberofCommerce,Healthways,MethodistHealthSystem, MetroOmahaMedicalSociety,MutualofOmaha,NationalSafetyCouncil,GreaterOmahaChapter,NebraskaCenterforHealthy Families,NebraskaOrthopedicHospital,NonprofitAssociationoftheMidlands,OmahaPublicSchools,OmahaCommunity Foundation,OneWorldCommunityHealthCenter,Inc.,PRIDEEOmaha,Inc.,PrimroseSchoolofLegacy,RDGPlanningandDesign, Sarpy/CassDepartmentofHealthandWellness,SMStevensandAssociates,LLC,TheNebraskaMedicalCenter,TheTrekStoreof Omaha,UnionPacificRailroad,UnitedHealthcareoftheMidlandsInc.,UniversityofNebraskaatOmaha,UniversityofNebraska MedicalCenter,UnitedWayoftheMidlands,UrbanLeagueofNebraska,ValmontIndustries,Inc.,VisitingNurseAssociation, WellnessCounciloftheMidlands,Women scenterforadvancement,ymcaofgreateromaha Programs/Campaigns PuttingPreventiontoWorkisanefforttoreducetheincidenceobesityandchronicdiseaseandmakeour communitythehealthiestinthenation.activitiesinclude: ESmokeEfreeoptionsforapartmentcomplexes EHealthyNeighborhoodStores EFarmtoInstitution EPartnersforaHealthyCity EPartnersforaHealthyCity Schools EPharmacistsandPhysicians LiveWellOmahaKidsisacommunitycoalitionofover40communityorganizationsworkingtoachieve measurableimprovementsinnutritionandphysicalactivity.activitiesinclude: EHealthyFamilies EChildCareCenterLearningCollaborative ESchoolWellnessNetwork EYouthAdvisoryCouncil EBreastfeeding EFamilyDiningPledge EActiveCommunities ActivateOmahaestablishesinnovativeapproachestoincreasephysicalactivitythroughcommunitydesignand communitystrategies.itsupportsactivelivingbypromotingchangesinurbandesign,landuse,and transportationplanning.activitiesinclude: ESafeRoutestoSchool EBoltageprogram(abike/walktoschoolincentive) ESummerbikerideprogram ESummercamphealthyeating/physicalactivitymoduleforlowEincomechildren EAssistsmayor sofficeinactivetransportationsummit

ECommunityGardens Impact Onlinehealthindicatorsitewww.douglascohealth.org PuttingPreventiontoWork: InitiatingFarmEtoESchoolprogramsinthreeschoolsandonlineFarmEtoESchooltoolkit SevennewschoolgardensinOmahaPublicSchools Facilitatingpolicythatallowsforhealthyfoodoptionsinnearly350businesses,faithEbasedorganizations, schools,physiciansoffices,andcommunityorganizations Partneringwitheightneighborhoodstoreownerstoenhancetheirbusinessmodelsbycarryinghealthyoptions forarearesidents DevelopingOmaha sfirsteeverfarmetoeinstitutionprograms Supportingareacommunitygardensandfarmers markets Workingwithpharmacistsandphysicianstohelpmorethan7,000individualscontroltheirhighbloodpressure and/orhighcholesterol IncreasingthenumberofsmokeEfreehomes,apartments,andenvironments CreatingSafeRoutestoSchooltoover30areaschoolsformorethan3,000children BringingMovin AfterSchoolprogramsto2,000childrenin40areaafterEschoolprogramlocations Facilitatingpolicychangesthatallowsforincreaseddailyphysicalactivityinmorethan350businesses,schools, andfaithebasedorganizationsthroughoutdouglascounty CollaboratingonandsupportingapedestrianandbicycleEfriendlycommunitythroughinfrastructure,safety,and sharingprograms ActivateOmaha: Bicycletransportationmap Bicyclepedestrianadvisorycommitteetothemayor 20milesofbikelanes,trailexpansion Reports/Case ActivateOmahaisfeaturedinPartnershipforPrevention: CreatingHealthyCommunitiesthrough Studies CorporateEngagement. http://www.prevent.org/initiatives/leadingebyeexample.aspx http://livewellomaha.org/resources/ SocialMedia Sites Websiteand Contact Information http://livewellomaha.org/blog/ https://www.facebook.com/livewellomaha https://www.facebook.com/livewellomahakids https://www.facebook.com/activateomaha http://livewellomaha.org/ http://www.activateomaha.org/ LiveWellOmaha,Phone:(402)934E5886 ActivateOmaha,Phone:(402)934E5923 46

47 MichiganHealthInformationAlliance(MiHIA) Overview MiHIAisaformal,multistakeholder,communitycollaborationworkingtoachieveacommunityof healthexcellenceforthe14ecountyregionitserves. MiHIA sworkvaries,butitallfallsunderwhatisknownas TheTripleAim, whichtargetshealth andsystemsbroadlyattheregionallevelthroughfocusingonthreefacetsofhealthdelivery populationhealth,patientexperience,andcostofcare. Primary Goal/Mission Toimprovethehealthofpeoplewithinourregionthrougheffectiveuseofinformationand collaborationtoestablishourregionasacommunityofhealthexcellencethrougha comprehensivefocusonpopulationhealth,patientexperience,andcostofcare. Supporters CentralMichiganUniversity,ChemicalBank/ChemicalBankTrust,CovenantHealthCare,DowChemicalCompany,Dow ChemicalCompanyFoundation,DowCorningCorporation,HealthPlusofMichigan,McLarenBayRegion,MidMichiganHealth, SaginawCountyCommunityMentalHealthAuthority Programs/Campaigns ChoosingWisely Tohelpphysiciansandpatientsengageinconversationstoreduceoveruseoftestsandprocedures SaginawPathwaystoBetterHealth PathwaysCommunityHubsprovidetoolsandstrategiesforservingatEriskpersonsinatimely,coordinated mannerinordertoavoidduplicationofeffortandkeepingpersonsontracktoimprovetheirhealth. CommunityTransformations:TogetherWeCan TheCentralMichiganDistrictHealthDepartment(CMDHD)wasawardedagrantof$1.6milliontoimplement programsthataimtoreduceobesityandreducedeathanddisabilityduetoheartdisease,stroke,and tobacco.byfocusingonwherepeoplelive,work,learn,andplay,thecommunitytransformationprogramis expectedtoimprovethehealthofmorethanfouroutof10u.s.citizens about130millionamericans. AdvancingYouth sfutures AserviceprovidedbytheLegacyCenterforCommunitySuccessinMidlandthathelpstobuildpositive developmentalattributesinyouthingrades6 12. ChildhoodDevelopmentalScreenings PromotingChildDevelopmentalScreening,forchildrenages0 8,isonecomponentofProjectLAUNCH (LinkingActionsforUnmetNeedsinChildren shealth),anationalinitiativefundedbythesubstanceabuse andmentalhealthservicesadministration Impact TheMiHIAHealthDashboardisanInternetEaccessiblereportingandmonitoringtoolwherepeoplecan seehowacommunityisdoingrelativetokeyhealthmeasuresandassociatedhealthindicators.itislaid outinawaythatprovideseasyetoeunderstandtablesandgraphicsthatfollowpopulationhealthforthe region,costsofcare,andpatientexperience allofwhichcanbeclickedtorevealmoredetail.under thepopulationhealthtabyouwillfinddetaileddemographicinformationoneachcounty(undercounty Details),selectedindicatorsofhealthorhealthbehaviorssuchassmoking,activity,andobesity(under HealthFactors),andselectedindicatorsofillnessanddeath(underHealthOutcomes). http://www.mihia.org/dashboard/ Reports/Case Studies N/A$ SocialMediaSites N/A

Websiteand Contact Information http://www.mihia.org/ Kimberly Morley Chief Executive Officer (CEO) Email:k.morley@mihia.org Phone: (989) 275-4106 Beth Pomranky Operations Manager Email:b.pomranky@mihia.org Phone: (989) 430-8637 48

49 Mid<AmericaCoalitiononHealthcare (MACHC) Overview TheMidEAmericaCoalitiononHealthCareisa30Eyearnonprofitcollaborationof employersandallcomponentsofthebiestatekansascityregionshealthcaredelivery system.ithas60members,representingover500,000livesandleveragestheexpertise, experience,andresourcesofitsmultidisciplinarymembershiptopromotehealthand wellebeinginthegreaterkansascityarea. PrimaryGoal/Mission DecreasingtherateofobesityinthepopulationintheKansasCityregion CoalitionMembersandContributors Abbvie/Abbott,Aetna,ALRTechnologies,AmericanAcademyofFamilyPhysicians,AmericanCenturyInvestments, BenefitFocus,BlueCrossBlueShieldofKansasCity,BlueScopeSteel,NA,BoehringerIngelheimPharmaceuticals,Cartwright International,CBIZBenefits&InsuranceKansasCity,CernerCorporation,Children smercyhospitalsandclinics,cigna HealthCareofKansas/Missouri,CityofKansasCity,Missouri,ClayEPlatteFamilyMedicine,ClinicalReferenceLaboratory, Fresh2desk,GenentechUSA,GreaterKansasCityMedicalManagersAssociation,HallmarkCards,Inc.,HCAMidwestHealth System,Hellman&RosenEndocrineAssociatesH&RBlock,Inc.,HuschBlackwell,LLP,J.E.DunnConstruction,KansasCity InternalMedicine,KansasCityMetropolitanHealthcareCouncil,KansasCityMetropolitanPhysicianAssociation,Lockton Companies,LLC,MedicalSocietyofJohnson&WyandotteCounties,MedTrakServices,Mercer,Merck&Company,Inc., MetropolitanMedicalSocietyofGreaterKansasCity,MosaicLifeCare,NorthKansasCityHospital,NovoNordisk,Inc.,Pfizer, PhysiciansReferenceLaboratoryLLC,QuestDiagnostics,SaintLuke shealthsystem,shawneemissionmedicalcenter, SignatureMedicalGroupofKansasCity,Sprint,StinsonMorrisonHeckerLLP,TheUniversityofKansasHospital,Towers Watson,TriaHealth,UMKCSchoolofMedicine,UnitedHealthcareHeartlandStates,WellnessInnovations&NursingServices, YourWellnessConnection Programs/ Campaigns CurrentPrograms: NCQADiabetesRecognitionProgramProject o Programenablesphysicianstoaudittheirownperformanceon10evidenceEbased measuresofdiabetescare.clinicianswhoachievedrprecognitionshowtheirpeers, patients,andpayersinthecommunitythattheyarepartofanelitegroupthatis recognizedfortheirskillinprovidingthehighesteleveldiabetescare. KCFitVendingPledge o Increasehealthyvendingoptionsintheworkplace PastInitiatives(seeNBCHlinkbelowformoreinformation)$ CommunityInitiativeonDepression$ CommunityInitiativeonCardiovascularHealthandDisease$ http://nbch.kma.net/index.asp?bid=222 Impact N/A Reports/Case Studies FeaturedinPartnershipforPrevention: CreatingHealthyCommunitiesthroughCorporate Engagement. http://www.prevent.org/initiatives/leadingebyeexample.aspx TheCommunityCoalitionsHealthInstitutedidacasestudyontheMidAmericaCoalitionon Healthcare:http://nbch.kma.net/index.asp?bid=222 SocialMedia Sites N/A Websiteand Contact Information http://machc.org Phone:(913)671E7122 Email:bstanley@machc.org

NationalBusinessCoalitiononHealth(NBCH) Overview TheNBCHisanational,nonprofitmembershiporganizationof52purchaserEledhealthcarecoalitions acrosstheunitedstatesrepresentingover7,000employersandapproximately25millionemployees andtheirdependents.thesebusinesscoalitionsarecomposedofmostlymideandlargeesized employersinboththeprivateandpublicsectorsinaparticularcity,county,orregion. Mission NBCHexiststohelpmembercoalitionsleadinimprovinghealthandthevalueofhealthcareservices intheircommunities. CoalitionMembersLinkstodetailedinformationoneachmemberhttp://www.nbch.org/index.asp?bid=67 EmployersHealthAllianceofArizona,ArkansasEmployersHealthCoalition,PacificBusinessGrouponHealth SiliconValleyEmployersForum,ColoradoBusinessGrouponHealth,FloridaHealthCareCoalition,SavannahBusinessGroup onhealth,employerscoalitiononhealth,heartlandhealthcarecoalition,midwestbusinessgrouponhealthtriestatehealth CareCoalition,IndianaEmployersQualityHealthAlliance,TriEStateBusinessGrouponHealth,WichitaBusinessCoalitionon HealthCare,MidEAmericaCoalitiononHealthCare,LouisianaBusinessGrouponHealth,MaineHealthManagementCoalition, MidAtlanticBusinessGrouponHealth,MichiganPurchasersHealthAlliance,MinnesotaHealthActionGroup, Labor/ManagementHealthCareCoalitionoftheUpperMidwest,St.LouisAreaBusinessHealthCoalition,MontanaAssociation ofhealthcarepurchasers,healthservicescoalition,nevadabusinessgrouponhealth,newjerseyhealthcarequality Institute,NortheastBusinessGrouponHealth,NiagaraHealthQualityCoalition,NorthCarolinaBusinessGrouponHealth, PiedmontHealthCoalition,Inc.,OhioEmployersHealth,FrontPathHealthCoalition,HealthActionCouncilOhio,Oregon CoalitionofHealthCarePurchasers,GreaterPhiladelphiaBusinessCoalitiononHealth,LancasterCountyBusinessGroupon Health,LehighValleyBusinessCoalitiononHealthCare,PittsburghBusinessGrouponHealth,RhodeIslandBusinessGroupon Health,SouthCarolinaBusinessCoalitiononHealth,Healthcare21BusinessCoalition,MemphisBusinessGrouponHealth, Dallas/FortWorthBusinessGrouponHealth,TexasBusinessGrouponHealth,VirginiaBusinessCoalitiononHealth,Puget SoundHealthAlliance,TheAlliance,BusinessHealthCareGroup,FondDuLacAreaBusinessesonHealth,GreaterMilwaukee BusinessFoundationonHealth,Inc.,WisconsinRxandNationalCooperativeRx,WyomingBusinessCoalitiononHealth Programs/ Campaigns Reports/ Case Studies Social MediaSites Websiteand Contact Information NBCHisa coalitionofcoalitions thatprovidesexpertise,resources,andavoicetoitsmember coalitionsacrossthecountryandrepresentseachcommunitycoalitionatthenationallevel. NBCHprovidesActionBriefs,ActionGuides,andwhitepapersontopicspertainingtotheroleof businessinimprovingpublichealth TheCommunityCoalitionsHealthInstitute(CCHI)isanonprofitaffiliateorganizationofNBCH dedicatedtoimprovinghealthandtransforminghealthcare,communitybycommunity(see separatetable) http://www.nbch.org/library CommunityHealthEvaluationTechnicalActionGuide CommunityHealthImplementationTechnicalActionGuide CommunityHealthPlanningTechnicalActionGuide AGuidetoBuildingaBusinessCoalitiononHealth April2013NBCHActionBrief:CommunityHealthhttp://www.nbch.org/NBCHEActionEBriefs https://www.facebook.com/pages/nationalebusinessecoalitioneonehealth/140725316615 https://twitter.com/nbch http://www.nbch.org/ AlejandraHerr DirectorofGrantsandPrograms Email:aherr@nbch.orgPhone:(202)775E9300x15 50

51 PartnershipforaHealthierAmerica Overview PHAbringstogetherpublic,private,andnonprofitleaderstobrokermeaningfulcommitmentsand developstrategiestoendchildhoodobesity.phaensuresthatcommitmentsmadearecommitments keptbyworkingwithunbiased,thirdpartiestomonitorandpubliclyreportontheprogresspartners aremakingtoshoweveryonewhatcanbeachievedwhenweallworktogether.foundedin2010in conjunctionwith butindependentfrom Let smove,phaisanonpartisan,nonprofitthatisledby someofthenation smostrespectedhealthandchildhoodobesityadvocates,includinghonorarychair FirstLadyMichelleObama. Mission Toensurethehealthofournation syouthbysolvingthechildhoodobesitycrisis. CoalitionMembers LinktocommitmentsofprivateEsectorpartnershttp://ahealthieramerica.org/ourEpartners/ AllEClad,Ann&RobertH.LurieChildren shospital,birdseye,bluecrossandblueshieldassociation,brighthorizons,brown s Superstores,CalhounEnterprises,CatholicHealthInitiatives,CenturaHealth,Cerner,ChildObesity180,Children smercy Hospitals,ClevelandClinicFoundation,Darden,GEHealthcare,GundersonHealthSystem,HenryFordHealthSystem,Hyatt Hotels,IndianaUniversityHealth,KaiserPermanente,Klein sfamilymarkets,lucilepackardchildrenshospitalatstanford, MaineHealth,MorrisonHealthcareFoodServices,MushroomCouncil,Nemours,NewHorizonAcademy,NewYorkRoad Runners,Nike,OhioStateUniversity,WexnerMedicalCenter,OregonHealthandScienceUniversity,PCC,Reebok&BoksKids, ShareOurStrength,SUPERVALU,TheCaliforniaEndowmentsFreshWorksFund,TheFreshGrocer,TheHealthWeight CommitmentFoundation,TheLinks,UniversityofColoradoHealth,UniversityofIowaHospitalsandClinics,USOlympic Committee,USTA,VarsityBrands,Walgreens,Walmart,WashingtonAdventistHospital,YMCA Programs/Campaigns Partnersareworkinginfivebroadareas: 1) Childcare/earlychildhood Example:Eliminatingsugarsweetenedbeverages,increasingconsumptionoffruitsandvegetablesatevery meal,1 2hoursofdailyphysicalactivity,eliminatingfriedfoods,eliminatingtelevisionandvideogame time,limitingcomputerusetoeducationalactivities,andsupportingbreastfeeding, 2) Foodaccess Example:Buildgrocerystoresandsupermarketsinfooddeserts,andexpandaccesstofruitsandvegetables inpharmacies 3) Marketplacechoices Example:Marketingandadvertisingpromotingfreshandfrozenvegetables,enhancerestaurantmenu optionsbyofferinghealthiermealsandsidedishesforchildren,reducecalorieandsodiumlevelsofmenu offerings,reformulatepackagedfoodswithreducedsaltandsugar,anddevelopcriteriaforsimplefronteofe packagesealtohelpconsumersidentifyhealthierfoodoptions 4) Physicalactivity Example:Launchanationwidecompetition,theActiveSchoolsAccelerationProject,torewardcreative, effectiveschoolebasedprogramsandtechnologicalinnovationspromotingphysicalactivityforchildren duringtheschoolday;$1millioninvestmentintenniscourts,coaches,andequipmentforschoolandyouth facilities;engage15,000childreninbeginnerfieldhockey;freewalkingeventsincommunities;engage approximately25,000physicallydisabledchildreninbeginnerelevelprogramming;engageapproximately 12,000childreninbeginnerElevelsoccer;engageapproximately88,000lowEincomeandunderserved childreninbeginnerelevelcycling;introduce40,000individualstogymnastics;engage600,000childrenin

beginnerelevelswimming;engage120,000childreninbeginnereleveltrackandfield;andengage30,000 childreninbeginnerelevelvolleyball, 5) Engagement/verification: Example:Matchchefstoschools,donate$2millionincookwaretoschoolkitchens,andhireindependent contractortodositevisitsandevaluatepartnercommitments AdditionalProgramsinclude: DrinkUp(toencourageeveryonetodrinkmorewater) SongsforaHealthierAmerica(togetfamiliesdancingtosongswithlyricsthatpromotehealth) PlayStreets(closesstreetstotrafficforspecialeventstopromotephysicalactivity) Olympics(Olympicorganizationsofferingprogramsgearedtoget1.7millionchildrenmoving) Impact 2.95millionkidsgotmovingin2012. 650,000childrenwillbeprovidedwithhealthierchildcareenvironmentsby2015. Overthenextdecade,changeswillreducecalories,fat,andsodiumandtoofferhealthier choicesforbillionsofcustomers. 10,000,000Americanswillbegivenaccesstohealthierfoodsby2016. 1,500grocerystoresandfoodretailerswillbebuilt. Reports/Cas 2012AnnualProgressReport estudies http://ahealthieramerica.org/about/annualeprogressereports/ Linkstovideoshttp://ahealthieramerica.org/media/videos/ Newslettershttp://ahealthieramerica.org/media/newsletters/ Newsreleaseshttp://ahealthieramerica.org/media/newsEreleases/ Social MediaSites Websiteand Contact Information https://twitter.com/phanews https://www.facebook.com/pha https://plus.google.com/+phanews/posts http://www.youtube.com/ahealthieramerica https://www.pinterest.com/phanews/ http://ahealthieramerica.org/ Email:info@ahealthieramerica.org 52

AppendixC SnapshotsofBusinessesWorkinginCommunityHealth BlueCrossandBlueShieldofOmaha Overview Handsonelementaryeducationcampaignaboutthedangersoftobaccouse PrimaryGoal/Mission Preventingchildrenfromstartingsmoking Programs/Campaigns BeSmartEDon tstart DrawingandwritingcontestopentoOklahomastudentsinkindergartenthrough fifthgrade,wherestudentscreateapublicserviceannouncement(psa) storyboardaboutthedangersofsmoking WinningstoryboardsareproducedasaPSAandairedonthemedia. Interactive,SmartBoardcompatiblecurriculum Impact Sincetheprogrambeganin2004,morethan500,000storyboardshavebeen distributedtooklahomachildren. In2010morethan2,600studentsparticipatedinthecontest. Reports/CaseStudies http://tinyurl.com/nfyootg SocialMediaSites N/A WebsiteandContact Information http://www.bcbsok.com/company_info/community/tobacco_prevention.html BertMarshall,President 53

TheDowChemicalCompany Overview TheDowChemicalCompanyisamemberoftheMichiganHealthInformationAlliance(see separateappendixb.$inaddition,thecompanyhasdevelopedacommunityhealthneeds AssessmentToolkit. PrimaryGoal/Mission Toprovideacommunityhealthscorecard,alongwithrecommendedactions,thatcanbe usedbydowtomoreeffectivelyuseourresourcestosupportkeycommunityhealth needs.oneoftheprimaryobjectivesofthedowhealthstrategyistoimprovethehealth andcostsofcarefordowfamilymembers.thisnecessitatesaclearunderstandingofthe communityhealthneeds. Programs/Campaigns CommunityHealthNeedsAssessmentToolkit AtoolthatDowhasdevelopedandbeguntousewithrelationshiptocommunitieswith highpopulationcounts.itisanexcelworkbookthathelpstoprofilethehealthparameters ofthecommunitiesandhotlinktoevidenceebasedinterventions.thisworkisusedto selectthetopfivegapsorneedsforeachcommunity.thisdataispresentedtoeachofthe Dowpartieswhohasapotentialroleoractivitywherethismightberelevant the corporategivinggroup,publicaffairs,governmentaffairs,localleadershipteams,people whositonvariouscommunityboards,andhealthstaff.thedataisalsosharedwithlocal communityorganizationsandagencies. MichiganHealthInformationAlliance(seeseparatetable) Impact N/A Reports/CaseStudies SocialMediaSites WebsiteandContact Information http://prevent.org/data/files/initiatives/andrew%20n.%20liveris.pdf N/A http://www.dow.com/ CathyBaase GlobalDirector,HealthServices Email: CMBaase@dow.com 54

DTEEnergy Overview TheDTEEnergyFarmisdedicatedtoprovidingfresh,localfruitsandvegetablesto ourcommunityshungrypeople.throughthecombinedeffortsofgleaners CommunityFoodBank,DTEEnergy,anddedicatedvolunteers,theDTEEnergy Farmworkstofillthatgap.Thefarmisdividedintoninegardensthroughout southeastmichigan Primary Providingfresh,healthyproducetohungrypeople Goal/Mission Programs/Campaigns DTEEnergyFarmProject o Ninegardenson4acresdevotedtofeedingthehungry o Farmedbyvolunteers Impact Thegardensproduceover23,000poundsoffreshproduce,whichis turnedovertogleanersandthevariousfoodpantriesitservesinthe metrodetroitarea. 400+volunteersworkinthegardens Reports/CaseStudies FeaturedinPartnershipforPrevention: CreatingHealthyCommunities throughcorporateengagement. http://www.prevent.org/initiatives/leadingebyeexample.aspx SocialMediaSites https://www.facebook.com/dteenergygardens?fref=ts WebsiteandContact Information http://www.gcfb.org/site/pageserver?pagename=pg_volunteer_dteenergygarden AnthonyF.Earley,Jr. ChairmanandCEO KateLong Phone:(734)545E2758Email:dteenergyfarmproject@gcfb.org. 55

56 GEandGEFoundation Overview GEisamultinationaltechnologycorporationwithacorefocusoncitizenship.TheGE Foundation,thephilanthropicorganizationofGE,focusesitseffortsintheareasof health,education,theenvironmentanddisasterrelief. Primary Goal/Mission GEiscommittedtofindingsustainablesolutionstobenefittheplanet,itspeople,and theeconomy. Community Health Programsin theusa GE Healthyimaginationisa6Eyear,$6billionstrategytotackleglobalhealththrough increasingquality,access,andaffordabilityofhealthby: o Investingmorethan$3millioninR&Danddevelopingmorethan65 Healthyimaginationproducts o PartnerforInnovation:Cities GEcreatedacollaborativeeffortinCincinnatiwithemployers,hospitals, physicians,andcommunityofficialstoimprovehealth.theprogramexpanded tolouisville,ky,anderie,pa. o MobilebreastcancerscreeningsinWY GEFoundation sdevelopinghealthus Launchedin2009,thismultiyear,$50millionprogramaimstoincreaseaccess toprimarycareforunderservedpopulationsbypartneringwithindependent, nonprofithealthcentersincommunitiesacrosstheunitedstates. Impact GEFoundation sdevelopinghealthus AsofJanuary2013,theprogramhasreached32citiesandincludesmorethan 100healthcenters,withatotalof$37.4millioncommittedtodatetoindividual organizations. Reports/Case Studies 2012HealthyimaginationGlobalImpactReport http://www.ge.com/globalimpact/healthymagination.html#report=top DevelopingHealthFactsheet http://static.foundation.gecitizenship.com.s3.amazonaws.com/foundation/files/2013/0 2/DevelopingEHealthEfactEsheetEJanE20131.pdf BuildingBetterHealthcareValueinCincinnati http://www.ge.com/globalimpact/pdf/building_better_healthcare_value_in_cincinnati.pdf SocialMedia Sites https://www.facebook.com/healthymagination https://twitter.com/gehealthy https://www.youtube.com/user/healthymagination?feature=watch Websiteand Contact Information http://www.ge.com/ http://www.healthymagination.com/ http://www.gecitizenship.com/focuseareas/people/communityeengagement/ http://www.gefoundation.com/increasingeaccessetoehealthcare/developingehealtheus/

HealthPartners Overview ThelargestconsumerEgoverned,nonprofithealthcareorganizationinthenation,HealthPartners providescare,coverage,research,andeducationtoimprovethehealthofourmembers,patients, andthecommunity.healthpartners,adoptedacommunitybusinessmodelaspartofitsstrategic businessplantoimprovepublichealthinthetwincitiesarea.workingwithschools,foundations, nonprofits,stateandlocalgovernments,andotherorganizations sometimesastheleaderand sometimesasasupportingplayer HealthPartnershasparticipatedinapproximately20multisectoral healthinitiatives. Primary ToimprovehealthandwellEbeinginpartnershipwithourmembers,patients.andcommunity. Goal/Mission Programs/Campaigns HealthPartnersInstituteforEducation&Research Anonprofitorganizationdedicatedtoimprovinghealththroughdiscovery,thetranslationofresearch,and healthprofessionaleducation yumpower o Fruitandvegetabletrackingprogramforelementarystudents o Outtoeat searchesrestaurantswithina20emileradiusofazipcodeandidentifieshealthymenu optionsforavarietyofneeds(e.g.,diabetes,lowesodium,lowcalorie) o MyKitchen healthymealplanning/recipetool ExamplesofCommunityPartnerships: o PedalMinnesotatoencouragebicycleuse o AmericanHeartAssociationHeartWalk o NationalAllianceonMentalIllnessAntiEStigmaCampaign o StatewideHealthImprovementProgram(SHIP) Impact o o o Reports/Case Studies RenewingtheCountryside(supportlocalfood) HonoringChoicesMinnesota (collaborative,communityewidepublichealthinitiativethatpromotesdiscussionsaboutendeofelife choicesandadvancecareplanning) St.PaulPromiseNeighborhoodInitiative Duringthe2011 12schoolyear,76%ofstudentsvoluntarilytrackedtheirfruitandvegetableintake intheyumpowerschoolchallenge,andstudents fruitandvegetableconsumptionincreasedby11% atschooland22%onweekends.15,000studentsin32elementaryschools,including19innerecity schoolsinthetwincities.theprogramwasexpandedto60additionalschoolsinthe2012 13school year. Isham,G.J.,Zimmerman,D.J.,Kindig,D.A.,&Hornseth,G.W.(2013).HealthPartnersAdopts CommunityBusinessModelToDeepenFocusOnNonclinicalFactorsOfHealthOutcomes.Health$ Affairs,32(8),1446E1452.http://content.healthaffairs.org/content/32/8/1446.short CanterburyM,etal.ThepotentialofcommunityEwideinitiativesinthepreventionofchildhood obesity.diabetesspectrum2012;26(3). PronkNP,KottkeTE,IshamGJ.Leveraginglifestylemedicineandsocialpolicytoextendthetriple aimfromtheclinicintothecommunity.americanjournaloflifestylemedicine;$first$published$on$ April$2,$2013$as$doi:10.1177/1559827613483433$$ KottkeTE,PronkNP.AprimarycareEworksitehealthpromotioncollaborationmightfacilitate behaviorchange[eletter].http://www.annfammed.org/cgi/eletters/7/6/504#11387,17nov 2009. Kottke,T.E.,&Pronk,N.P.Takingonthesocialdeterminantsofhealth.Aframeworkforaction. MinnesotaMedicine,February2009,36E39. 57

Websiteand Contact Information Pronk,N.P.&Kottke,T.Socialdeterminantsofhealth.Acalltoactionfortheemployer community.acsm shealth&fitnessjournal,2010,14(1),44e47. Pronk,N.P.Communitiesofemployeesandemployeeswithincommunities.ACSM shealth& FitnessJournal,2003,7(1),33E35. Pronk,N.P.,&Kottke,T.E.HealthPromotioninHealthSystems.In:Rippe,J.,Editor.Lifestyle Medicine,2 nd Edition.TaylorandFrancis,BocaRaton,FL;2013,Chapter111. Yancey,A.K.,Pronk,N.P.,&Cole,B.L.WorkplaceApproachestoObesityPrevention.In: Kumanyika,S.&Brownson,R.C.Eds.HandbookofObesityPrevention:AResourceforHealth Professionals.Springer,NewYork,NY,2007.Chapter15,p.317E347. Pronk,NP.Populationhealthmanagementandahealthyworkplaceculture:Aprimer.In: EngagingWellness.CorporateHealthandWellnessAssociation.2012. (www.wellnessassociation.com). http://www.healthpartners.com/institute/ http://www.healthpartners.com/yumpower NicoPronk VicePresident&ChiefScienceOfficer Nico.P.Pronk@HealthPartners.com 58

KaiserPermanente Overview KaiserPermanente(KP)supportsinnovativeeffortstobringnutritiousfoodsandsafe,physicalactivity tolocalschools,workplaces,andneighborhood. Primary Kaisersupportspoliciesandenvironmentalchangesthatpromotehealthyeatingandactiveliving Goal/ (HEAL),aswellascommunityeconomicdevelopment,environmentalsustainability,and Mission neighborhoodsafety keyfactorsinpromotinghealthycommunities. Programs/Campaigns PrimarysponsororcoEfunderofover40communityhealthinitiativesacrosstheUnitedStatesaspartoftheir HealthyEating/ActiveLivingprogram. In2006KPcoEfoundedtheConvergencePartnershipwiththeaimofstrengtheningandacceleratingcollaborative effortsamongpractitioners,policymakers,funders,andadvocatesfromdifferentfields.thepartnershipprovides financialassistance,throughleadership,andcoordinationneededtosupportcommunitypartnersincreating environmentsthatencouragehealthyeatingandactiveliving. KPThrivingSchoolsprogram Otherfocusareas: Deliveringhealthyfood(supportingcreationoffarmer smarketsandencouragingconveniencestorestocarry fruitsandvegetables) Encouragingresidentstogetactive(establishwalkingandbikingtrails,aswellas saferoutestoschool program) Makingschoolshealthier(improvephysicalactivityprograms,healthiervendingmachinesandcafeterias) Guidinglocalgovernmentlanduseandtransportationpoliciesthatsupportcommunityhealth Creatinghealthyworkenvironments Providinggrantstofoodbanks,foodpantries,andsoupkitchenstoimprovenutritionalqualityoffoodthey distribute Impact ExcellentevidencebaseandevaluationmetricsforsuccessofHEAL.KPhasaCommunityHealthInitiativesEvaluation teamthatusestoolssuchassurveys,interviews,storytelling,andphotographytogatherdatathathelpstoinformthe workofhealcollaboratives.http://share.kaiserpermanente.org/article/evaluationeandelearning/ Someofthefindingsinclude: 510distinctcommunitychangestrategieswerebeingimplemented(e.g.,schoolandworksitewellnesspolicies, bodymassindexscreeningsincommunityclinics,creatingcommunitygardensthatsupplylocalfoodpantries withfreshfruitandvegetables,andimprovinginfrastructuretopromotewalkingandbikingtoschool) 500,000peopleaffectedthroughcommunityEbasedinterventionsinneighborhoods,worksites,andhealthclinics andanother148,000childrenthroughschoolebasedinterventions 59%ofstrategiesarefocusedonneighborhoods(e.g.,refurbishmentofparks,groceryEstoreimprovement),21% onschools(e.g.,cafeteriareforms),11%onworkplaces(e.g.,campaignstopromotestairwelluse),and9%onthe healthsector(e.g.,bodymassindexscreenings) http://share.kaiserpermanente.org/article/healingecommunitiesemeasuringetheeimpacteofecommunitye interventions/ PartialListofReports&CaseStudies CommunityHealthInitiativesFactSheet http://share.kaiserpermanente.org/media_assets/pdf/communitybenefit/assets/pdf/our_work/global/chi/chie OverviewE10152011_FINAL.pdf HEALingCommunitiesSupportfromAllSideshttp://share.kaiserpermanente.org/article/healingEcommunitiesE supportefromeallesides/(includesvideoclip) 59

CommunityHealthInitiativeInterimReport http://share.kaiserpermanente.org/media_assets/pdf/communitybenefit/assets/pdf/our_work/global/chi/chi%2 0Interim%20Report%20FINAL%203E6E09.pdf NorthernCaliforniaHEALECHIInitiativeSummary http://share.kaiserpermanente.org/media_assets/pdf/communitybenefit/assets/pdf/our_work/global/chi/heale CHI%20overall%20results%20summary%2011E14E11.pdf CommerceCitySummaryCaseStudy http://share.kaiserpermanente.org/media_assets/pdf/communitybenefit/assets/pdf/our_work/global/chi/lw%2 0Commerce%20City%20Final%20Summary%20Report_CCHE_2012.pdf ParkHillSummaryCaseStudy http://share.kaiserpermanente.org/media_assets/pdf/communitybenefit/assets/pdf/our_work/global/chi/lw%2 0Park%20Hill%20Final%20Summary%20Report_CCHE_2012.pdf RichmondSummaryCaseStudy http://share.kaiserpermanente.org/media_assets/pdf/communitybenefit/assets/pdf/our_work/global/chi/richm ond_healechi_summaryreport_2006e2010_final_6e20e11.pdf ModestoSummaryCaseStudy http://share.kaiserpermanente.org/media_assets/pdf/communitybenefit/assets/pdf/our_work/global/chi/modes to_healechi_summaryreport_2006e2010_final_6e21e11.pdf DenverUrbanGardensCaseStudy http://share.kaiserpermanente.org/media_assets/pdf/communitybenefit/assets/pdf/our_work/global/chi/chi%2 0Case%20Study%20Draft%20DUG%2002E28E11.pdf HEALingCommunities:SpotlightingTransformationinSantaRosa,Calif(includesvideoclip) http://share.kaiserpermanente.org/article/healingecommunitiesespotlightingetransformationeinesantaerosaecalif/ SantaRosaSummaryReport http://share.kaiserpermanente.org/media_assets/pdf/communitybenefit/assets/pdf/our_work/global/chi/santar osahealechi_summaryreport_2006e2010_final_6e22e11.pdf HEALingCommunities:CreatingaSafeHaveninDenver(includesvideoclip) http://share.kaiserpermanente.org/article/healingecommunitiesecreatingeaesafeehaveneinedenver/ HEALingCommunities:BuildingWellnessZonesinthePortTownsofMaryland(includesvideoclip) http://share.kaiserpermanente.org/article/healingecommunitiesebuildingewellnessezoneseinetheeportetownseofe maryland/ CaliforniaHEAL http://www.healcitiescampaign.org/ PartialListofPeerReviewedPublications Baxter,RJ. Makingbetteruseofthepoliciesandfundingwealreadyhave. PrevChronicDisease.Sep2010 CheadleA,SchwartzPM,RauzonS,BourcierE,SenterS,SpringR, UsingtheConceptofPopulationDosein PlanningandEvaluatingCommunityElevelObesityPreventionInitiatives AmJofEvaluation2012 CheadleA,SchwartzPM,RauzonS,BeeryWL,GeeS,SolomonL.TheKaiserPermanenteCommunityHealth Initiative:OverviewandEvaluationDesign.AmJPublicHealth2010100:2111E2113. CheadleA,SamuelsS,RauzonS,YoshidaSC,SchwartzPM,BoyleM,BeeryWL,CraypoL,SolomonL.Approaches tomeasuringtheextentandimpactofenvironmentalchangeinthreecaliforniacommunityelevelobesity PreventionInitiativesAmJPublicHealth2010100:2129E2136. CheadleA,SchwartzPM,EdmistonJ,JohnsonS,DavisL.EngagingYouthinLearningAboutHealthyEatingand ActiveLiving:EvaluationResultsfromKaiserPermanente seducationaltheatreprograms.jnuteducand Behavior. Cheadleetal., Aqualitativeexplorationofalternativestrategiesforbuildingcommunityhealthpartnerships: collaboration versusissueeorientedapproaches. JournalofUrbanHealth.Oct2005. CheadleA,SchwartzPM,RauzonS,BeeryWL,GeeS,SolomonL.TheKaiserPermanenteCommunityHealth Initiative:OverviewandEvaluationDesign.AmJPublicHealth2010100:2111E2113.[Presentsthedesign 60

frameworkkpusesfortheirplaceebasedcommunityhealthinitiatives,withfindingsfromnortherncalifornia sites] CheadleA,SamuelsS,RauzonS,YoshidaSC,SchwartzPM,BoyleM,BeeryWL,CraypoL,SolomonL.Approaches tomeasuringtheextentandimpactofenvironmentalchangeinthreecaliforniacommunityelevelobesity PreventionInitiativesAmJPublicHealth2010100:2129E2136.[Presentsmethodologywithfindingsfrom NorthernCaliforniasites.] 2010SummaryofEvaluationApproach[Highlightstheoverarchingstrategyanddesignframeworkfor40+ collaborativeswithresultsfor26sitesacrosscaliforniaandcolorado] CrompD,CheadleA,SolomonL,MaringP,WongE.KaiserPermanente sfarmersmarketprogram:description, impact,andlessonslearned.forthcominginjournalofagriculture,foodsystems,andcommunitydevelopment (2011E0321). Cohenetal., Discretionarycalorieintakeapriorityforobesityprevention:resultsofrapidparticipatory approachesinloweincomeuscommunities. AmericanJournalofPublicHealthJan2010. Dietz,etal., HealthPlans RoleInPreventingOverweightInChildrenAndAdolescents, HealthAffairs.Mar/Apr 2007. Kingetal., ReaimingREEREAIM:UsingtheModeltoPlan,Implement,andEvaluatetheEffectsofEnvironmental ChangeApproachestoEnhancingPopulationHealth. AmericanJournalofPublicHealth.Oct2010. Koplanetal., ProgressinPreventingChildhoodObesity:HowDoWeMeasureUp? InstituteofMedicine.2007. Koplanetal., PreventingChildhoodObesity:HealthintheBalance. InstituteofMedicine.2005. KramerL,SchwartzP,CheadleA,BortonJE,WrightM,ChaseC,LindleyC.Promotingpolicyandenvironmental changeusingphotovoiceinthekaiserpermanentecommunityhealthinitiative.healthpromotpract2010;11(3): 332E339 Ross,RK,Baxter,RJ,etal, CommunityApproachestoPreventingChildhoodObesityinCalifornia. American JournalofPublicHealth.Vol20:11,November2010.ESeemoreat: http://share.kaiserpermanente.org/article/evaluationeandelearning/#sthash.eawv9kuz.dpuf SocialMediaSites https://www.facebook.com/kpthrive Websiteand http://share.kaiserpermanente.org/article/communityehealtheinitiativese3/ Contact http://thrivingschools.kaiserpermanente.org/ Information Pamela.M.Schwartz@kp.org Peggy.E.Agron@kp.org 61

Nike Overview Overthenext5years,NIKE,Inc.willinvest$50millionintheUnitedStatestoincrease thephysicalactivityofkidsinschoolsandcommunitiesaswellastargetadvocacyefforts toinspirekidsanddrawadditionalresourcestotheeffort. PrimaryGoal/Mission Createearly,positiveexperiencesforkidsinsports,physicaleducation,and activeplay. Integratephysicalactivityintoeverydaylife. Programs/Campaigns Let smovepartnership Let smoveactiveschoolswillprovidefreeresourcestoteachers,parents,and administratorstoenablecommunitiestoincorporatephysicalactivityexperiences before,during,andaftertheschoolday.therewillalsobeopportunitiesforschoolsto applyforgrantsthatsupportactiveschoolsefforts,whichwillbefundedbychildhood Obesity180,GenYouth,andothers. Impact Seecasestudies Reports/CaseStudies http://letsmoveschools.org/successestories/ SocialMediaSites WebsiteandContact Information Siemers, Erik, Nike s Investment in Physical Activity Starts in U.S., Will Spread Elsewhere, Portland Business Journal, February 2013, www.bizjournals.com/portland/blog/threads_and_laces/2013/02/nikes-investment-inphysical-activity.html?page=all. N/A http://nikeinc.com/news/nikeeannouncese50emillionecommitmentetoegetekidsemoving http://letsmoveschools.org/ 62

TargetCorporation Overview Targetdonates5%oftheirprofitstocommunities,whichequalsmorethan4million USDeachweek.HealthyCommunitiesisacorecomponentofTarget ssocial responsibilityplatform. PrimaryGoal/Mission Corporateresponsibilityareasofcommitment:education,environment,health andwellebeing,teammembers,responsiblesourcing,safetyandpreparedness, volunteerism Targetsupportspublichealthobjectivesincludingfoodsecurity,physical fitness,andsupportforchildrenwithspecialhealthcareneeds Programs/Campaigns FoundingmemberoftheAlliancetoMakeUSHealthiest,aworkplacewellness coalition Trackteammember(employee)volunteerhours,withgoalofattaining700,000 by2015 NovemberCelebrateSmokeEFreecampaign SupportsNiceRideMinnesota thelargestbikeshareprogramintheunited States PartnerwithFeedingAmericatofighttoendhungerintheUnitedStates Communitybreastcancerscreenings Impact N/A Reports/CaseStudies WebinarslidesfromCountyHealthRankings&Roadmaps:AdvancingHealthin CommunitiesThroughBuildingSuccessfulPartnershipswithBusiness,guest speakercaramcnulty,seniorgroupmanagerepreventionandwellnessat TargetCorporation Linktoslides: http://www.countyhealthrankings.org/webinars/advancingehealthecommunitiese throughebuildingesuccessfulepartnershipsebusiness Linktovideo: http://www.youtube.com/watch?v=iyqbkd_yesu SocialMediaSites N/A WebsiteandContact Information https://corporate.target.com/corporateeresponsibility/healthewellebeing/community CaraMcNulty SeniorGroupManager,PreventionandWellness 63

TheWaltDisneyCompany Overview Disneyprogramshelpkidsandfamiliestakeactionontopicstheycareabout,fromfitness andtheenvironmenttonutritionandvolunteerism. Primary Goal/Mission Focusingonthepowerandingenuityofyouthtomakepositivechangesinthe world Reinforcingkidsactionsthroughstrategicphilanthropyfocusedonlocal communities ProvidingresourcesandtoolsforkidsandfamiliesthroughDisneyonline Buildinguponglobalmedianetworks,includingDisneyChannel,DisneyXD,and RadioDisney Programs/Campaigns DisneyMagicofHealthyLiving Anationalmultimediainitiative(PSAs,onlinevideos,andresourcesfor parentsandkids)designedtomakehealthylivingfunforkidsandfamilies by: 1) UsingDisneycreativitytomakenutritiousfoodsthemostappealingchoice 2) Encouraging60minutesofdailyphysicalactivityandmakingexercisemore broadlyappealing 3) Providinginformationforparentsandkidstomakehealthychoicessimpler Impact ParksandGardens $1millioncontributionfromDisneywillhelptobuildplayspacesandgardensin 12underservedcommunitiesnationwide N/A Reports/CaseStudies N/A SocialMediaSites N/A WebsiteandContact http://corporate.disney.go.com/citizenship2010/inspiringkidsandcommunities/overview/ Information mohl/ http://citizenship.disney.com/tryeit 64

Walmart Overview In2011,Walmartcommittedtomakingfoodhealthier,affordable,andaccessiblethrougha programwithfivekeyelements. Goal Makinghealthierfoodarealityforall Commitments 1.Reformulatingthousandsofeverydaypackagedfooditemsby2015. Reducingsodiumby25%,reducingaddedsugarsby10%,andremovingallremaining industriallyproducedtransfats. 2.Makinghealthierchoicesmoreaffordable. Savecustomersapproximately$1billionperyearonfreshfruitsandvegetables throughavarietyofsourcing,pricing,andtransportationandlogisticsinitiativesthat willdriveunnecessarycostsoutofthesupplychain. 3.DevelopingstrongcriteriaforasimplefrontEofEpackageseal. Walmart s GreatforYou Iconfornutritiousfoodchoices Formoreinformation,pleasevisithttp://corporate.walmart.com/globalE responsibility/hungerenutrition/greateforeyou 4.Providingsolutionstoaddressfooddesertsbybuildingstoresinunderservedcommunities. Pledgetoprovidemorethan1.3millionpeoplelivinginmorethan700USDAE designatedfooddesertswithaccesstofresh,healthierfoodbyopeningbetween275 and300storesinareasservingfooddesertsby2016. 5.Increasingcharitablesupportfornutritionprograms $26millionoftotalgiving,includingthefundingofimportantprogramsfromShareOur Strength,theAmericanHeartAssociation,theNational4EHCouncilandAlliancefora HealthierGeneration. Impact Between2008and2011,decreasedsodiumby13%acrossthecommercialbread category. Since2008sugarshavedeclinedbymorethan10%. Since2008,industriallyproducedtransfatshavebeenreducedby50%. Morethan4,000privateEbrandproductswereevaluatedagainstthe GreatForYou nutritioncriteria,withapproximately32%offreshproduce,meats,andpackageditems receivingtheicon. Opened86storesinfooddesertsbringinghealthierfoodoptionstomorethan264,000 people Reports/Case Studies N/A SocialMedia N/A Sites Websiteand http://corporate.walmart.com/globaleresponsibility/hungerenutrition/healthierefood Contact Information 65

Wellmark Overview Wellmarkpartnerswithsportsteams,keynonprofits,andcivicgroupsinIowa andsouthdakotatoworkhandinhand,enrichinghealththroughanarrayof uniqueprojectsandprograms PrimaryGoal/Mission CreatingahealthiertomorrowforIowansandSouthDakotans Programs/Campaigns Wellmark3EPointPlay o Whenauniversitysportsteamscores 3s, Wellmarkmakes contributionstosupportcommunityhealthprojectsinthe university shometown.3epointplay encouragingfanstoeat right,movemore,andfeelbetter WellmarkistheprimarysponsorofTheBlueZonesProject(see AppendixB) Impact Since2010,theWellmark3EPointPlayhasraisedmorethan$278,000to supporthealthprojectsincommunitiesacrossiowaandsouthdakota. Reports/CaseStudies N/A SocialMediaSites N/A WebsiteandContact http://www.wellmark3pointplay.com/ Information 66

AppendixD HEROEmployer<CommunityCollaborationCommitteeMembership Cochairs CathyBaase,M.D.,ChiefHealthOfficerDowChemicalCompany NicoPronk,Ph.D.,VicePresident&ChiefScienceOfficer,HealthPartners JerryNoyce,ExecutiveDirector,HERO Committee: MarleneAbels,Coordinator,MembershipServices,HERO PatriciaBenson,Director,GetHealthyNow,UniversityofLouisville MelondieCarter,DSN,RN,AssociateProfessor,SchoolofNursing,UniversityofLouisville AlexChan,OrfaleaFellow,ClintonFoundation JenDaniel,Director,BenefitAdvisoryServices,BusinessSolver,Inc. TomDowning,M.B.A.,Director,MMCLifelineWorkplaceWellnessProgram,MaineMedicalCenter GeorgeEngland,Director,ClientDevelopmentandServices,BioIQ RayFabius,M.D.,President,HealthNext TiffanyFinly,Manager,AdvisoryServices,BSR KimberlyFirth,Ph.D.,DirectorofResearch,OptimalHealingEnvironments,SamueliInstitute VickiGeorge,NationalExecutiveDirector,ProgramEvaluationHealthWorks&ProductInnovation,Kaiser Permanente AndrewGray,M.D.,HRAssociate,CapitalOne HilaryHeishman,ProgramOfficer,Quality/EqualityTeam,RobertWoodJohnsonFoundation LynnHipp,IntegratedHealthandWellnessManager,EastmanChemicalCo. YvonneIngramERankin,Director,GlobalWellnessStrategy,HewlettPackardCompany AnnKent,ManagingDirector,SVP,BlueZonesProject JasonLang,TeamLead,WorksiteHealthPromotion,CDC ShawnMason,Ph.D.,AssociateDirector,ResearchOutcomes&DataAnalytics,Johnson&Johnson ElisaMendel,VPHealthWorks&ProductInnovation,KaiserPermanente LesMeyer,VPandChiefMarketingOfficer,HealthNext SusanMueller,M.D.,SeniorMedicalDirector,NationalAccounts,Aetna JanetNardo,M.S.,GlobalDirector,Wellness,Covidien BrendaNeuhoff,DirectorofCompensation&Benefits,MasterBrandCabinets KarenOberle,VPTotalRewards,TheSchwanFoodCompany BonnieSakallaris,Ph.D.,RN,VPOptimalHealingEnvironments,SamueliInstitute JenniferSargent,M.S.,M.B.A.,SeniorVPBusinessDevelopment,PlusOneHealthManagement ErinSeaverson,M.P.H.,DirectorofResearch,StayWellHealthManagement StewardSill,HumanResourcesManager,GlobalHealth&Vitality,IBM ElizabethSobelEBlum,SeniorCommunityDevelopmentResearchAssociate,FederalReserveBankofDallas AndySpaulding,Director,ViridianCenterforCommunityandWorksiteHealth,ViridianHealthManagement 67

JenniferTurgiss,Ph.D.,M.S.,VPHealthSolutions,VirginHealthMiles MelissaVaughn,M.S.,WellnessManager,Schwan sfoods JanelleWaldock,M.S.,M.P.A.,BlueCrossBlueShieldMN JeffWarren,M.P.A.,SeniorAdvisor,GardentGlobal BrianWeber,MarketingManager,BusinessSolver,Inc. BurtWolder,SeniorVP,ChiefMarketingOfficer,HooperHolmes 68