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WELCOME
DOUG JACKSONVIRGINIA DEPARTMENT OF HOUSING
& COMMUNITY DEVELOPMENT
Explore how NRV Community Health
Assessment findings relate to your work.
Learn how other communities are making
strategic investments to address identified
needs
Contribute ideas, experiences, and energy to
improve health and well being in the NRV.
TODAY WE’LL
BILL FLATTERYCARILION CLINIC
WELCOME +INTRODUCTION
STEPHEN CHANDLER
LEWIS GALE
WELCOME +INTRODUCTION
ASHLEY HASHCARILION NEW RIVER VALLEY
MEDICAL CENTER
COMMUNITY HEALTH ASSESSMENT
MICHELLE BRAUNSCOMMUNITY HEALTH CENTER OF THE
NEW RIVER VALLEY
COMMUNITY HEALTH ASSESSMENT
SYSTEMS AT WORK
DOUG JACKSONVA DHCD
SYSTEMS AT WORK
TAKEAWAYS
SYSTEMS AT WORK
JESSICA WIRGAUCOMMUNITY FOUNDATION OF THE
NEW RIVER VALLEY
SYSTEMS AT WORK
DOUG JACKSONVA DHCD
SYSTEMS AT WORK
TAKEAWAYS
WEIGHING IN BYMOVING ABOUT
WEIGHING IN BYMOVING ABOUT
Which of the CHA priorities do you perceive to be the greatest barrier for your clients/citizens?
1
A. Access to Care
B. Affordable, Safe Housing
C. Child Abuse / Domestic Violence
D. Culture: Healthy behaviors not a priority
E. Lack of knowledge of resources
F. Poverty / low avg. household income
G. Substance Use
H. Transportation
GREATEST BARRIER
WEIGHING IN BYMOVING ABOUT
If we could address one priority area, which one do you think would have the greatest impact on
our region?
2
A. Access to Care
B. Affordable, Safe Housing
C. Child Abuse / Domestic Violence
D. Culture: Healthy behaviors not a priority
E. Lack of knowledge of resources
F. Poverty / low avg. household income
G. Substance Use
H. Transportation
GREATEST IMPACT
WEIGHING IN BYMOVING ABOUT
Which priority do you think there is the greatest energy
to work on?
3
A. Access to Care
B. Affordable, Safe Housing
C. Child Abuse / Domestic Violence
D. Culture: Healthy behaviors not a priority
E. Lack of knowledge of resources
F. Poverty / low avg. household income
G. Substance Use
H. Transportation
GREATEST ENERGY
SYSTEMS AT WORK
JEFF DINGERGILES COUNTY
SYSTEMS AT WORK
JEFF DINGERGILES COUNTY
SYSTEMS AT WORK
TAKEAWAYS
SYSTEMS THINKING
SYSTEMSTHINKING
mycorrhizal
networks
SYSTEMSTHINKING
SYSTEMSTHINKING
SYSTEMS SYSTEMS THINKING SEEING
The glaringly obvious only glares at you
after you see it.
First Steps Information Sharing NetworkShared ResourcesService DeliveryJoint Planning
2016 2019
SYSTEMS SYSTEMS THINKING SEEING
SYSTEMSTHINKING
The network as part of a system, actively engaging in the system by
understanding it.
LEARNING TOGETHER
SYSTEMSTHINKING
The network as part of a system, actively engaging in the system by
understanding it.
LEARNING TOGETHER
SYSTEMS SYSTEMS THINKING SEEING
SYSTEMIC
SYSTEMSTHINKING
SYSTEMSTHINKING
Get it at
donnellameadows.org
SYSTEMSTHINKING
Learn to read causal loops at
systemsandus.com
SYSTEMSTHINKING
But what are we trying to identify in the system?• Overlooked resources
• Missed perspectives
• Nontraditional partners
• Norms
• Patterns
• Synthesis over analysis
• New frames of reference
• Complexity!
• Feedback patterns
• Environmental inputs
• Leverage points
• Policy implications
SYSTEMSTHINKING
Learn to read causal loops at
systemsandus.com
“We’re disrupting how we think about the community.”
Jessica Wirgau
“Then we get them all together.
Chris McKlarney
BARRIERS & LEAPS
LUNCH
DR. NOELLE BISSELL, M.D.
NEW RIVER HEALTH DISTRICT
DR. NANCY WELCH, M.D.CHESAPEAKE HEALTH DEPARTMENT
DANIELLE PORZIGHEALTHY CHEASAPEAKE
KEYNOTE SPEAKERS
12/18/2019
Healthy ChesapeakeA Unique Partnership for Addressing Population Health Needs
New River Presentation| November 2019
Danielle Porzig, MPH, Healthy Chesapeake CARE Program Manager
Nancy Welch, MD, MHA, MBA, Chesapeake Health District Director
• Chesapeake City had declined to 44th per the
annual Virginia RWJF County Health Rankings
• Recent joint Community Needs Assessment
conducted by the health department and hospital
indicated specific focus areas for improvement
• Data analysis showed large disparities in segments
of our community
• Now it is 37
Declining community health status drove
the formation
What are the most important HEALTH-RELATED ISSUES for our entire community?
Options Response
Count
Percent
Mental health (depression, anxiety, stress) 92 60.9
Aging 73 48.3
Clean & healthy environment 65 43.0
Nutrition (healthy food and eating habits) 59 39.1
Obesity 58 38.4
Disabilities (physical, intellectual, sensory,
developmental)
53 35.1
Chronic Diseases (such as heart disease or diabetes) 52 34.4
Alcohol and drug abuse 50 33.1
Infectious diseases (such as flu or tuberculosis) 40 26.5
Healthy babies and mothers 36 23.8
Dental health (healthy teeth) 36 23.8
Immunizations 31 20.5
Tobacco Use 29 19.2
Sexually transmitted diseases 25 16.6
Accidental injuries 14 9.3
7
7
Data Shows Large Disparity Gaps
within the city
Low Health Opportunity = BAD
Health Opportunity Index (HOI) Factors
also show big differences
VDH calculates a Health
Opportunity Index, or
HOI, which is a composite
measure comprised of 13
indices that reflect a broad
array of social determinants
of health affecting the
community.
We are electing to work in
low HOI areas initially
where the impact
opportunity is the greatest.
Population Health Issues in
Chesapeake
• Food InsecurityThere are an estimated 26,630 food insecure individuals in
Chesapeake1
• Diabetes PrevalenceAt 15%, Chesapeake is 1.5 times the state average2
• Adult Obesity Prevalence1 in 3 Chesapeake adults are obese3
• AgingThere is an expected 114 percent increase in the population
65 years + projected by 20404
Source:1 Feeding America: Map the Meal Gap 20182,3 Virginia Department of Health, 20154 Welden Cooper Population Center for Public Service, UVA
A small working group with two representatives
from the City and two from Chesapeake Regional
Medical Center, under the leadership of the Health
Director strategized the development of a unique
concept that eventually became Healthy
Chesapeake, Inc.
How to address these community health
needs?
• Inaugural interest meeting for development of Coalition led by Mayor
Krasnoff and Health Director, Dr. Nancy Welch
Community leadership buy-in critical
Broad Group of Initial Stakeholders
Internal and External Focus Group
Meetings = Initial Direction
Harbour North Focus Group Meeting Cambridge Square Focus Group Meeting
Coalition Strategic Planning
• The Health Director serves as the public health advisor for the Board
Decision to establish a unique hybrid
operating relationship
Chesapeake Health
Department
Director serves as
Public Health
Advisor
The Healthy Chesapeake Executive Director is contracted and
participates in strategic planning and liaisons with other Health
Department units for integration opportunities
Mission – Healthy Chesapeake is committed to building a culture of wellness that
supports, sustains, and advocates for a healthier Chesapeake
Vision – To be ranked the healthiest community in Virginia per the Robert Wood Johnson
County Health Ranking
Board – Board of Directors that provide the guidance and financial oversight of our
program initiatives
Coalition – Voluntary group of citizens, community agencies, city
departments, faith-based organizations, health care providers, and
others that collaborate on direct service delivery
501(c)(3) – Established and operational with an Executive Director reporting to the Board
and administrative and programmatic staff that support the Coalition
Strategy – Facilitate and provide support for population health
programs and services developed and delivered by the Coalition in
response to priorities identified by Community Needs Assessment,
Chesapeake Neighborhood Quality of Life Study, Chesapeake
Comprehensive Plans for Youth and 55 and Better, etc.
Chesapeake Responds: Healthy
Chesapeake
85
• Healthy Chesapeake, Inc. is designated by the Chesapeake Health District and approved by VDH as the population health manager to lead the response to Virginia’s Plan for Well Being.
• Healthy Chesapeake, Inc. is charged with providing and ensuring: “…coordination and collaboration of all sectors of the community government, health care, education, businesses and community organizations including the faith based .. in working together to improve the conditions needed for people to be healthy.”
Unique Contractual Relationship
with The Chesapeake Health District
Plan created by statewide multi-
faceted taskforce to address
population health issues in Virginia.
• This Memorandum of Agreement between Chesapeake Health Department (CHD), and Healthy Chesapeake, Inc. (HCI), for the purpose of cooperation and coordination related to the implementation of strategic initiatives related to improvement of the population health of Chesapeake.
• WHEREAS, in 2017 HCI was designated the population health manager for CHD with responsibility to implement the Plan for Wellbeing in Chesapeake.
• CHD Responsibilities1. Subject to appropriation for CHD budget and contingent on
available non-designated funding, the CHD agrees to disburse funds in support for the operation of HCI and the delivery of population health programs and services.
2. The CHD Health Director shall serve as a non-voting Public Health Advisor to the board and coalition.
MOU with Healthy Chesapeake
A unique hybrid/lateral structure is established by the corporate
bylaws and outlines the operating process.
Important Roles
Shared MissionHealthy Chesapeake
Board
Healthy Chesapeake
Coalition
Collective Impact Premise
• The Coalition is a separate entity with its own chair
and operating structure that includes work teams
consisting of internal and external stakeholders
• The Coalition is lateral to the Board and drives the
direction of the programs that are then financially
supported by the Board
• The Board has two voting members from the Coalition
that reinforce program priorities
• The Executive Director is an experienced community
and economic development professional that
facilitates the relationship between the two entities
Uses the Collective Impact Model
1. Expanded the knowledge base of partners and community officials to focus on population health.
2. Expands population health response capacity with a 40+ member coalition instead of a single staff member.
3. Brings broad breadth of expertise to bear via coalition participation.
4. Extends the ability for leveraging resources
5. Reduces administrative processes and restrictive purchasing.
6. Improves the ability for resource gathering via in-kind, tax deductible giving and grant-writing eligibility.
7. Better able to serve as a neutral facilitator.
8. Allows the external contractual relationships of the Health District be extended to Healthy Chesapeake via MOU’s.
Benefits of a Nonprofit as a Health District
Population Health Manager
Public Health is a Community Value
Two years after establishment and extensive community
collaboration and projects, the city was approached for
financial support.
City Council approved 15 cent per pack increase in cigarette tax
and earmarked it for public health projects with
6 cents directed for Healthy Chesapeake, Inc.
This unique allocation for community-led health initiatives and
provides Healthy Chesapeake on-going organizational stability.
Chesapeake… the city that cares!
City of Chesapeake Support
As a founding partner of Healthy Chesapeake, Chesapeake Regional Healthcare has
been a linchpin for this city-wide effort. With a focused commitment to addressing
population health, this regional hospital has continued to provide resources,
guidance, and engagement in all facets of Healthy Chesapeake. It has leveraged
both financial and in-kind resources to enable this effort to develop.
Chesapeake Regional Healthcare
• Program Support:
❖ Diabetes and Hypertension Community-based Response HUB in high
risk area with staffing and supplies
❖ Purchase and renovation of Community Food Farmacy projected at
$375,000 when completed Fall 2018
• Participation of Staff on Board and Coalition in-kind donation of
$75,000 annually
❖ Board: Vice President of Operations
❖ Coalition: Vice-chair of Coalition
❖ Coalition: Mental Health & Community Ambassador work
team leadership
• Space and Webhosting in-kind donation of over $40,000 annually
❖ Provision of Healthy Chesapeake Office Space, usage of board
and training space, and on-going web hosting
CRH Engagement with
Healthy Chesapeake
ODU through an MOU assumed the leadership role in gathering and
performing the external review and evaluation for all Healthy
Chesapeake projects.
Old Dominion University
• Volunteer Management Policy
initial draft
• Financial Management Policy
initial draft
• Program Policies and
Procedures initial draft
• Administrative Data Analysis
• Coordination of the SPARK Pilot
Project
• IRB development for Cooking
Class Program evaluation
• Individual gardening project
evaluation
• Youth employment program
development and evaluation
• An overview of evidence-based
chronic diseases prevention
programs in Virginia and
descriptions
• Healthy Chesapeake Program
Evaluation (assistance w/
instrument research)
• Active Lifestyle Phone Surveys
and compilation of data
• Baby Care Project Evaluation
• HUB Medical Intervention Data
Collection
• Family Planning Program
Evaluation
• Functional Food Project
Development
• Assessment of transportation
services provided by free clinics
• FAMIS project with DVH
through Chesapeake Health
Department
Healthy Chesapeake & ODU
Academic Evaluations/Research
FREE Diabetes prevention and management program
within high risk communitiesIncludes: Transportation, Testing, Cooking School, Social Work, and Food
distribution through Food Farmacy
PARTNERS: CRH, Health Department, Fire Department, Liberty Street Clinic,
Chesapeake Care Clinic, Cooperative Extension, Foodbank, American Diabetes
Association, Norfolk State University, Community Churches
Plan for VA
Well-being
Aims 3 & 4
The HUB
Diabetes and Hypertension Center
Need Providers
Client referrals Southeastern Virginia Health System
Chesapeake Care Clinic
Free, frequent medical checks at site
location
Chesapeake Regional Healthcare
EMS, City of Chesapeake
Medical supplies and equipment
provided
Access Partnership
Chesapeake Care Clinic
Social work referral assistance Norfolk State University
Kin and Kids Consulting
Wellness coaching Chesapeake Health Department
Fresh food access Healthy Chesapeake
Education Chesapeake Health Department
American Diabetes Association
Transportation assistance To be contracted
99
Case Study: Diabetes and
Hypertension Management (HUB)
Services and service providers confirmed
100
Case Study: Diabetes and
Hypertension Management (HUB)
• Healthy Chesapeake sought and received funding from Hampton Roads Community Foundation: $147,750 over 3 years
• HUB program launched
• External evaluation performed during pilot phase by the ODU Center for Global Health
101
Case Study: Diabetes and
Hypertension Management (HUB)
Outcome: Decrease in hospitalizations and ER visits
0% 10% 20% 30% 40% 50% 60% 70% 80%
Any Hospitalization in the past 12
months before starting Hub
Any ER Visit in the past 12 months
before starting Hub
Any ER Visit in the past 9 months
since starting Hub
Any Hospitalization in the past 9
months since starting Hub
Source:
Healthy Chesapeake, Summary of Findings, ODU Center for Global Health, April 2019
Case Study: Diabetes and
Hypertension Management (HUB)
102
Source:
Healthy Chesapeake, Summary of Findings, ODU Center for Global Health, April 2019
Outcome: Decrease in mean A1C
Outcome: Decrease in mean arterial pressure
103
Case Study: Diabetes and
Hypertension Management (HUB)
Source:
Healthy Chesapeake, Summary of Findings, ODU Center for Global Health, April 2019
Outcome: Improved healthy eating and active lifestyle
behaviors
104
Case Study: Diabetes and
Hypertension Management (HUB)
0% 20% 40% 60% 80% 100% 120%
Daily Fruits and Vegetables
Consumption
Daily moderate sport for at least
10 minutes
Daily water consumption
At 9 Months Baseline
Source:
Healthy Chesapeake, Summary of Findings, ODU Center for Global Health, April 2019
105
Active Coalition Partners and Program
EngagementActive Coalition Partners and Program
Engagement
Active Coalition Partners and Program Engagement
• Volunteer Management Policy
• Financial Management Policy
• Program Policies and Procedures
• Administrative Data
• Coordination of the SPARK Pilot Project
• IRB development for Cooking Class
Program evaluation
• Individual gardening project
development
• Youth employment program
development
• An overview of evidence-based chronic
diseases prevention programs in
Virginia and descriptions
• Healthy Chesapeake Program Evaluation
(assistance w/ instrument research)
• Active Lifestyle Phone Surveys
• Baby Care Project
• HUB Data Collection
• Family Planning
• Functional Food
• Assessment of transportation services
provided by free clinics
• FAMIS project with DVH through Chesapeake
Health Department
Healthy Chesapeake ODU Projects
Opportunities for individuals to grow their own food or have access to healthy foods. Sites at
community and senior locations managed by the residents and production sites at churches and
schools.
Pending Project : 22 Acre research, teaching and production site
Healthy Food Access
Goal: Provide the knowledge and
skills on how to eat healthier
❖ Healthy Chef is a multi-part cooking school on how to cook healthier.
❖ Use mobile cooking stations
❖ Grant PARTNERS:
✓ Hampton Roads Community Foundation
✓ The City of Chesapeake Social Services
✓ Southeast Virginia Community Foundation.
AIM 3
Utilization of Healthy Foods
Extension Agent teaching Healthy Chef class for seniors
Healthy Chesapeake convenes and
facilitates, but the Coalition partners take
ownership!
See the Concept in Action
Strategy: Utilize the VA Plan for Well-Being Goals and Strategies as the
operational framework:
• AIM 1: Healthy Connected Communities
– Expand training and work-linked learning opportunities
– Virginia adolescents choose not to engage in behaviors that put their well-being at risk
• AIM 2: Strong Start for Children
– Form neighborhood collaborative co-led by community members in under-resourced
communities to identify obstacles and develop plans to address the root causes of
health inequities
• AIM 3: Preventative Actions
– Virginians follow a healthy diet and live actively
– Virginians have lifelong wellness
– Expand opportunities during and after school for children to get healthy meals and the
recommended amount of daily physical activity
– Increase access to healthy and affordable foods in all neighborhoods
– Expand programs and services eliminate childhood hunger
– Help people recognize and make healthy food and beverage choices
– Increase access to internet usage for aging Virginians
• AIM 4: System of Health Care
– Virginia has a strong primary care system lined to behavioral health care, oral health
care and community support systems
– Virginians obtain, process, and understand basic health information and services
needed to make appropriate health decisions
VA Plan for Well-Being as a
Healthy Chesapeake Action Guide
• County Health Rankings are used as directional benchmarks.
• Virginia Plan for Well-Being correlated with the County
Health Rankings.
• The Chesapeake Community Action Plan and Community
Health Needs Assessment currently conducted in
conjunction with hospital.
• The RU Ready comprehensive plan, the 55Plus
comprehensive plan and the cities 2030 plan are also
integrated.
Melding of local, state & national priorities
striving for goal of health in all policies
*A Food Farmacy in a low HOI area with Chesapeake Regional
Hospital.
PARTNERS:• Foodbank
• Farmers Market
• Local Farmers
• Healthy Chef Cooking School
• Youth Employment
• Non-profit Buffalow Family and Friends
• Health Department
Healthy Foods Access Site Plan for VA
Well-being
Aim 1
Concept drawings
*in process
Health Ambassadors and Support of
Neighborhoods
Voices for the community and serve on our
work-teams
This Fall initiate Diabetes and Hypertension
Pilot
PARTNERS:
• African American Churches in low HOI
• NC State Faithful Families curriculum
Engaging with
the community
is vitally
important!
Peer-to-peer is a long-proven effective strategy
VOICES from the community
Plan for VA
Well-being
Aim 1
Goal: Virginians Follow a Healthy Diet and Live Actively
SPARK senior and youth do and learn program-expands free meal program, social engagement, and wellness activities.
PARTNERS:
▪ Chesapeake Libraries
▪ School Nutrition Program
▪ Senior Services of Southeast VA
▪ 15 other service providers
of various activities
Active Lifestyles - SPARK
1. Continue to build Coalition
2. Improve internal and external communications
3. Enhance advocacy role
4. Adjust to evaluation findings
115
Next Steps
5. Determine need and role in addressing other social determinant
issues; i.e.., transportation, housing, etc.
6. Expand beyond pilot areas
116
Next Steps
Buying Motivation: Do You Actually Buy
Products?
• Fashion: Purchased to look better, feel more valued, have
greater confidence, fit in/stand out.
•Books/Information: Bought to further education, feel
more intellectual, gain understanding, escape reality.
•Furniture: Purchased for comfort, security, greater self-
esteem and aesthetics.
•Food: Bought for the experience, self-esteem, body-
consciousness (e.g. diet food).
The Pepsi Generation Story
Lets go back to 1960’s America for a few minutes.
Set The Stage
1.The youth of the day were fighting for liberation, equality and
battling against the restrictions put in place by the previous generation.
…Afros, bell-bottom jeans, mini-skirts, lava lamps and tie dye t-shirts
were all the rage.
…Things were getting- how can I put this- groovy.
2. And there was one company dominating the soft-drink industry, Coca-
Cola. They were outselling their nearest competitor, Pepsi, by almost 6 to
1.
3. They’d used branding and advertising to promote themselves as a representative of everything that made American’s proud to be American- wholesome values, tradition and national pride.
Advertising
• Alan Pottasch, decided that the brand should stop talking about
their product and instead, start talking about the user
• …and more specifically, those who saw themselves as different to the previous generation.
The Pepsi Generation
In 1963 Pepsi launched an ad campaign named The Pepsi Generation.
• Pepsi took a huge chunk of Coca-Cola’s market share. The campaign had successfully advertised the type of person who bought their
product, INSTEAD of their product (which was almost identical to their
biggest rivals).
Buying Motivation: Anybody Can Harness It
• Social media offers brands the perfect opportunity to target their
ideal market for very low costs…
• The key selling point of your product, is not actually your product, it’s what it can help your customer achieve.
• …and all these things add up to one thing: a better version of
themselves.
• People don’t buy products, they buy what the product will do TO them.
Shift Your Focus
The first thing you need to do is shift your advertising focus away from
your product and put the spotlight on your target market.
Whilst a beginner would spend all their time and focus
advertising the second step (the product), an experienced
advertiser would primarily focus their efforts on the difference
between step 1 and step 3.
Coalition Workteams
124
Current and developing programs
Health Behaviors
Diet and Exercise
Healthy ChefElizabeth Gorimani-Mundoma
Garden2Table Mike Andruczyk
Food Farmacy
FITBenjamin Camras
Clinical Care
Access to Care
HUBMary Trosien
Mental Health
Social and Economic
Education
Employment
Family and Social Support
SPARKKathryn Jesse
Volunteer (MRC)Thomas Johnson
Faithful Families
County Health Rankings
0
10
20
30
40
50
60
2014 2015 2016 2017 2018
RA
NK
ING
WIT
HIN
ST
AT
E
Chesapeake Trend Depictions
Health Outcomes Health Factors Quality of Life
Health Factor/Behaviors
Adult Obesity
Physical Inactivity
Access to Exercise
Opportunity
Alcohol Related Deaths
STD
Teen Births
Drug Overdose Deaths
County Health Rankings
0
10
20
30
40
50
60
2014 2015 2016 2017 2018
RA
NK
ING
WIT
HIN
ST
AT
E
Chesapeake Trend Depictions
Health Behaviors Clinical Care Soc & Econ. Factors Length of Life
Clinical Care
Social & Economic Factors
Uninsured
Primary Care Physician Ratio
Dentist Ratio
Mental Health Provider Ratio
Mammogram Screening
Violent Crime
Injury Deaths
Median Household Income
Children reduced lunch
Strategic Plan Development
Healthy Chesapeake Programs
• 11 community, production or learning gardens,
including a garden and training program for
Chesapeake Correctional Center female inmates
• 50 individual grow box projects for low-income
individuals
• Seedbank launched to provide community
gardens and individuals with free supplies
129
Year One Highlights: Garden2Table
• Launched faith-based wellness program (Faithful
Families)
• Sponsored 10 youth and 2 senior stipends to
support community programming
• Supported community events, trainings, and
learning activities for more than 1500 individuals
130
Year One Highlights: CARE
Public health is not a department but rather a community value
For More Information:
Dr. Nancy Welch, Health Director
Chesapeake Health District
Nancy.Welch@vdh.virginia.gov
Dr. Wendy Schofer, Coalition Co-Chair
wschofer@gmail.com
SYSTEMS AT WORK
DOUG JACKSONVA DHCD
SYSTEMS AT WORK
TAKEAWAYS
SYSTEMS AT WORK
TINA KINGNEW RIVER VALLEYAGENCY ON AGING
SYSTEMS AT WORK
TAKEAWAYS
SYSTEMS AT WORK
DOUG JACKSONVA DHCD
NEXT STEPS
DOUG JACKSONVA DHCD
NEXTSTEPS
NEXT STEPS
What key institutions or organizations (or type of
institutions or organizations) do you believe are critical in
providing stewardship for our collective next steps?
1
NEXT STEPS
What are the two top things you’d ask the
steering team to pursue as initial steps?
1
KEVIN BYRDNEW RIVER VALLEY
REGIONAL COMMISSION
WRAPUP
DR. NOELLE BISSELL, M.D.
NEW RIVER HEALTH DISTRICT
CLOSING
THANK YOU
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