CIBER Healthy Community Model

8/8/2019 CIBER Healthy Community Model

1/84


2/84

Small businesses and unemployed or self employed are left out no money forfancy health plans or gyms or expensive fruits and vegetables we can make adifference here most have TVs and cell phones broadband exercise classeson demand watch TV and use treadmill

Give coupons (travel for losing weight and keeping it off) = QTN travel cards -$99 cards for vacation to show off the weight you lost or walk on tours where youcould not do so before.

In the 20th annual Americas Health Rankings study, Tennessee ranked 44th among states inoverall health, up four spots from 2008.

The report, by the United Health Foundation, the American Public Health Association andPartnership for Prevention, highlighted the need to change unhealthy behaviors that contribute topreventable, chronic diseases as the key to improving the nations health.

Tennessee excelled in a number of areas reported. The prevalence of binge drinking in Tennessee isthe third lowest in the nation at 9.8 percent. Tennessee is also the fourth highest state inimmunization coverage with 83 percent of children ages 19 to 35 months receiving complete

immunizations.

Smoking and obesity are still challenges for the state, although Tennessee's rates are consistentwith national numbers. The state's smoker rate is high, but is consistently decreasing. Since 1990,the prevalence of smoking decreased from 30.8 percent to 23.1 percent of the population, accordingto the report.

The opposite has occurred with obesity. In the past ten years, the prevalence of obesity increasedfrom 19.2 percent to 31.2 percent of Tennessee's population, according to the report.

Nearly one third of the population of Tennessee is obese, earning the state the 47th rank in thecountry, the same ranking as 2008. However, with the help of programs such as Get Fit Tennessee,the prevalence of obesity is expected decrease in the years to come.

Vermont was named the healthiest state, followed by Utah (2) and Massachusetts (3). Mississippi

was named the least healthy state, with Oklahoma (49) and Louisiana (48) next in line.

The annual Americas Health Rankings reports have tracked state-by-state statistics for 20 years.United Health Foundation was established by UnitedHealth Group (NYSE: UNH) in 1993 as anonprofit private foundation. The American Public Health Association has been working to improvepublic health since 1872, focusing on community-based health promotion and disease prevention.The Partnership for Prevention is a membership group linking businesses, nonprofits andgovernment agencies to prevent disease and improve Americans health.

Get Fit Tennessee urges everyone in the state to utilize the free health and fitness tools availablehere on GetFitTN.com to benefit their health.

Great website to model w.ediets.com

The statistics paint a grim picture: Tennessee is 48th for children's overall health, has among the

highest rates of infant mortality and is ranked in the top 10 for teen deaths. About 17 percent of

the state's teens are obese, with many more at risk. 2/26/10

Nashville Community Health Improvement Model R.Taylor 01-15-10 2


3/84

Nashville Opportunity

Former Nashville CIO Richard McKinley X is part of MicrosoftGovernment

Mary Miller Newton still at City

09-06-10-

09-06-10Michael GaloContact Info Update | Aug 27, 2010Company Microsoft CorporationJob Title Technical Account Manager

Work Address 2555 Meridian Blvd, Suite...Work Email [email protected] company Principal Consultant, The Consultant Workshop (2010-2010)Business leaders want to get things done. TCW uses smart planning, clearcommunications, and daily execution to get business IT projects ... more>done.

New company Technical Account Manager

Partners

Civic Health and CareScope

Healthy TeacherPlumgood Founder in Nashville now investor distribution model to keydelivery points

Organic local farms and farmers markets Amish model

Myhealthmaster.com Blender $200 healthy smoothiesGreen vegetables and fruits blended disguise healthy food with tasty food blend it together lettuce, spinach, celery, strawberries, bananas, apples,blueberries,

Edlets.comLearn more about meal deliveryHealthy delicious meals delivered to your doorRecommended for maximum weight-loss fast!



4/84

No calorie counting, no cooking, no dishesOver 100 meals freshly prepared by our chefsEasy to follow, easy to stay disciplinedSee How Meal Delivery Works

Buy up used treadmills (ebay and Craigss list) and loan them out keep them aslong as they are losing weight high school students and unemployed repair andrenovate the threadmills lots of used parts in a school district inventory

Build green houses with solar panels and back up stove with refuse and woodburning in really cold days high school students build them and unemployed

Online counselors and health coaches unemployed

Mayor Dean has a vision of Nashville as a green city = and now as a blue city to build an environment that promotes healthy well being.

Well being defined as

Gallup and Healthways Well Being Index

Every county in America will get a health scorecard in February 2010 by CDC

Green city = promotes sustainable use of natural resources around us.

Key partners

Eric Satz Plumgood Foods Founder

JC Bowman and Angel Food Ministries

Organic Farms in Nashville area

CIBER = WIC and CDC connections grant funding

Mike Smerling and Jim Amos Jr. Tasti d Lite

A Blue Ocean Strategy for Creating Blue Zones in America

Venture Capital Proposal for NashvilleCreating Jobs and Reducing Costs by Creating Healthier Citizens in Nashville



5/84

Nutrition vs Exercise impact analysis

ESRI mapping for food distribution and farmers market s see Research GISfile

Data Futures Lunch Box

How it will workCommunity Health Model for Nashville

Draft RGT 02-16-10

This document outlines a proposed strategy for reducing indigent care costs and

improving the overall health of Nashville citizens that could serve as a national model.This strategy consists of four parts:

1. Reduce Nashville Indigent Care Costs

One of Mayor Dean's top priorities for 2010 is to find a way to reduce indigent care costswhich in 2008 cost the city approximately $66 million dollars. In 2009, the City hiredJohn Snow Inc. to develop recommendations to reduce costs. CIBER and Data Futurespresented the CareScope model to John Snow Inc. as part of this study. Based on thedocumented CareScope assisted savings in Minneapolis/St. Paul and Escambia County,we believe the use of the CareScope model could save Nashville up to $5 million a year

in indigent care costs (after a $1.5 million investment (the net gain would be $3.5 millionfor Nashville). The non profit Bridges to Care and the Nashville Health Dept operate theCareScope system on an ongoing basis to generate annual savings of $ 5 million (whichin turn could be used to fund the other 3 proposals below).

2. Improve Health Outcomes In Nashville

At the Health and Well-Being: Keys to Transformation Conference in Nashville onNovember 2, Mayor Dean said he would like to see Nashville become a Blue Zone City(Healthy City). Newt Gingrich said his Center for Health Transformation is looking for acity that would be willing to become a national model city for improving communityhealth. To accomplish this goal, CIBER has developed a high level plan based on

successful models in other cities that could be implemented in Nashville. This plan callsfor the State of Tennessee Health Planning, the Health Info Partnership of Tennessee,Vanderbilt University, Meharry Medical College, CIBER, Bridges to Care, MetroNashville, the Nashville Area Chamber of Commerce, the Nashville Healthcare Council,and other key Nashville based private companies (Healthways and others) to developand implement this proposed community health improvement system. Thissystem would use the Gallup/Healthways Well Being Index and/or the upcoming CDCNationwide County Health Rankings report (out in February 2010) as the benchmark tomeasure progress (the Center for Health Transformation) loves benchmarks and



6/84

progress reports). We could then utilize an analytics solution (Microsoft and SASbased) to provide analytical reports). The Metropolitan Nashville Dept of Health andHealthways would assist in the analytical solution.

This proposed solution could be paid for with grant funds from the CDC (part of theirHealthy America 2020 program (CIBER has a close relationship with the CDC), cost

savings from the Indigent Care Solution described above (take $1.5 million from the $3.5million in savings), and/or money from Newt's Center for Health Transformation andpossibly the State of Tennessee. In addition, the participating private companies couldoffer their services at cost or for free.

3. Implement a new health information exchange in Nashville that would capturethe data needed for managing the health improvement program (item # 2 above)and to facilitate the sharing of medical data to improve the quality of healthcareand reduce costs.

The Nashville based Middle Tennessee eHealth Connect RHIO has been created toimplement a regional health information exchange network in the greater Nashville area.

This HIE solution could be used to help coordinate the collection and analysis of data forcommunity health.

4. Implement a community wellness outreach system and portal for informationon health programs in the Nashville area.

Reach out to increase Medicaid well child screenings and immunizations via a portal and311/211 service (CareScope extension). This would include a portal for seniors andparents of K-12 children. Content could be provided by Nashville based HealthTeacher. This could also include access to a personal health record for citizens thatwould be updated by the Nashville HIE. An analytics solution could also be includedfrom Healthways, Meharry Medical College, and the Nashville Metro Health Department.

How this Proposed Solution Will Generate new jobs for Nashville area companies .

Implementing the four proposed solutions above using technology solutions from mostlyNashville based companies would help generate new high tech jobs for the Nashvillearea. It would also help attract new small businesses where their healthcare costswould be less than in other Southern cities. In addition, the exportation of the NashvilleCommunity Health solution could generate additional jobs as the Nashville basedcompanies the sell and implement their respective software/services to othercommunities in America and the world. The planned Nashville based HealthCare TradeMarts would be a great place to advertise Nashvilles Community Health Solution to theworld.

In summary, the proposed Nashville Community Health solution could:1. Save the City of Nashville millions of dollars in reduced indigent care costs -freeingdollars that could be reinvested for improving the overall community health which willover time further reduce indigent care costs.

2. Significantly improve the health of Nashvillians - in turn reducing healthcare costs forarea employers and making Nashville a more attractive city in which to base a business



7/84

(e.g. to help counter the negative image of Tennessee's current health outcomes rankingof 45th in America).

3. Generate new healthcare IT jobs for Nashville based companies which in turn wouldincrease tax revenue for the City of Nashville and help attract more healthcarecompanies to potentially locate in Nashville which in turn would help generate more

health related conferences for the new Nashville Convention Center which would againgenerate more revenue for Nashville (visitor dollars).

GetFit Tennessee Model

ww.getfittn.com/

GetFitTN is a statewide awareness program developed by Governor Phil Bredesen to address therising epidemic of Type 2 diabetes and risk factors that lead to diabetes, like obesity. This initiativeis aimed at educating both adults and children that Type 2 diabetes can be delayed or evenprevented with modest lifestyle changes like increasing physical activity and a healthier diet.

How do I join Get Fit Tennessee?This is your Get Fit Tennessee! Everyone can log onto our Web site and officially become a memberof Team Tennessee by committing to make healthy food choices and exercise daily. We're here toencourage you to plan creative community events promoting health and fitness in your hometown,school, or organization and support your efforts. The Get Fit Tennessee Web site is your resource tohelp you with ideas, answer questions about nutrition and fitness, and to promote your events.We're here to rally Tennesseans to think about moving more and eating healthier. You can postyour events on www.getfittn.com where it says submit your event. You can sign up to become aTeam Tennessee member by clicking on submit your organization. And you can use the Get FitTennessee logo to create your own t-shirts, banners or promotional items for your events.Remember, this if your Get Fit Tennessee! We're excited to see what you can do with it!

Can Get Fit Tennessee come to my event? What will you do at the event?The Get Fit Tennessee Team is based out of the Commissioner of Health's office in Nashville, withTeam members spread out across the state in each Health Department. The Team makes severalstops each month across the state to help promote events involving healthy living and spread the

news about Get Fit Tennessee. You can see where we're headed next on the calendar page, whereyou see the Get Fit symbol. If we're available, we'll make every effort to attend events that involvehealth promotion. We tailor our plans for each stop based on the each event. We're happy todiscuss options with you once a time and date of your event has been confirmed and we've agreedto attend. If you think Get Fit Tennessee would be a valuable addition to your event, please postyour event on the calendar and send us an email.

Can Eddie George come to my event?In our inaugural year, Eddie George was very instrumental in helping spread the word about Get FitTennessee. However, due to his busy schedule, Get Fit Tennessee is no longer booking events withEddie George. He remains our number one supporter and a member of Team Tennessee!

Can a Get Fit representative speak at my event?Please post your event on our Web site and send us an email with the details. Several members ofthe Get Fit Tennessee Team are available to speak at events involving health, nutrition or fitness.

How can I work for Get Fit Tennessee?Get Fit Tennessee is Governor Bredesen's program, led by Commissioner of Health, Susan Cooper,M.S.N., R.N. Get Fit Tennessee is fully staffed and operated by the Department of Health, and is notcurrently hiring employees. Volunteer opportunities are available. If you are interested involunteering at Get Fit events across the state, please send us an email with your resume,background, and availability. A brief screening process is required.

How do I apply to receive a grant from Get Fit Tennessee?At this time, Get Fit Tennessee does not have funding to offer grant assistance. Please check theDepartment of Health's Web site, where you will find a link on the home page to any availablefunding opportunities, or click here: http://health.state.tn.us/vendors.htm.

How can I get in shape?



8/84

This Web site is full of useful information to help you get started on your journey to better health.Our new, interactive Fitness Tracker allows you to develop health and fitness goals and track yourprogress. You can even start a competition and challenge your friends or co-workers to Get Fit! Ifyou have a specific question about diet or exercise, please visit our "Ask an Expert" section, whichwill be reviewed and answered by a trained professional from the Get Fit Tennessee Team.

What is Team Tennessee?Team Tennessee is a group of Tennesseans committed to living a healthy lifestyle through regular

exercise, healthy eating, avoiding tobacco and risky alcohol use. By joining Team Tennessee, youare pledging to help yourself and your community Get Fit!

On the Fitness Tracker, I am trying to set up a personal fitness goal, but I don't seemy fitness activity listed. What do I do?

If you don't see your fitness activity listed, please choose any activity or other. If you choose any

activity you will be given the option to measure times per week you perform that activity. If you

choose other activity, you will be given the option to measure minutes per week you perform the

activity.

I am having trouble getting in to the Fitness Tracker. I registered and received myconfirmation link. I clicked on the link to activate my account, but it keeps telling me

my account is not active and I need to re-click the activate my account link. I'vedone this already, several times, and I waited as long as it said. What do I do?

If you continue receiving an error message or the Fitness Tracker site continues to ask you to

activate your account or retry the link, please follow these steps:

Go to tools (just below your internet browser)

Go to internet options

Click browsing history

Click delete all

Close the Web site and reopen. This should solve the problem.

The Department of Health urges Tennessee smokers to take part in this years Great AmericanSmokeout on November 19, 2009. The goal of this annual health observance is to encouragesmokers to quit for one day in the hope they may quit for good. In Tennessee, tobacco users cancall the Tennessee Tobacco QuitLine free of charge at1-800-QUIT-NOW or 1-800-784-8669 1-800-784-8669 to set a plan for how to quit.

Tennesseans who want to start the process of quitting smoking have a powerful tool available tohelp them in the QuitLine, said Health Commissioner Susan R. Cooper, MSN, RN. Research showsthat smokers who have a cessation plan and a support system have a much better chance of

success with their quit attempt.

The Tennessee Tobacco QuitLine offers personalized support for Tennessee residents who want toquit smoking by connecting them with trained coaches to guide them through the quitting process.Callers will receive ongoing professional coaching via individually scheduled calls with a quit coachpersonally assigned to them. This convenient and confidential service is free and available toTennessee residents in both English and Spanish. The service is also available for the deaf andhard-of-hearing at TTY 1-877-559-3816 1-877-559-3816 .

Since the launch of the Tennessee Tobacco QuitLine in August 2006, more than 33,000Tennesseans have called the service. More than 10,800 callers completed the intake process and



9/84

were assigned to a quit coach, and more than 7,450 people have enrolled in the "iCanQuit" tobaccocessation program. QuitLine callers have complimentary access to relapse prevention techniques,printed resource materials, information on nicotine replacement therapies and other services to aidin the quitting process.

Smoking cessation services are also available at Tennessees county health department clinics. Allpatients are screened for tobacco use and asked if they are interested in quitting. Those who want

to quit are evaluated by medical professionals to determine the best course of treatment to helpthem stop smoking. These services are offered on a sliding fee scale based on income.

Smoking is responsible for almost one in five deaths in the United States, and according to theCenters for Disease Control and Prevention, smoking accounts for approximately 9,400 deaths inTennessee every year, nearly half of which are due to lung cancer. Secondhand smoke is anotherserious problem in Tennessee. An estimated 1,730 Tennesseans die every year due to exposure tosecondhand smoke.

The healing process begins almost immediately after quitting smoking. Within 20 minutes of givingup tobacco, elevated heart rate and blood pressure decrease; in 12 hours, the carbon monoxidelevel in your blood drops to normal; within two weeks to three months, circulation improves andlung function increases; and in one year after quitting, the risk of coronary heart disease is cut inhalf.

The Tennessee Tobacco QuitLine (1-800-QUIT-NOW 1-800-QUIT-NOW or 1-800-784-8669 1-800-784-8669 ) is a statewide toll-free telephone tobacco cessation treatmentprogram made possible through the Tennessee Department of Health. There is no charge to callersfor services and callers have unlimited access to a quit coach through the QuitLine. Hours areMonday through Friday, 7 a.m. to 10 p.m., Saturday 9 a.m. to 6 p.m. and Sunday 10 a.m. to 4p.m. Central time.

Article provided by: www.clarksvilleonline.com

Team Tennessee enjoyed spending the day with the Mount Zion Baptist Church community for theirfirst health and wellness day on Saturday, Sept. 26, at the Old Hickory Blvd. location.

More than 300 members of the church congregation came out to participate in the fun-filled daywith a focus on healthy living practices. Many families entered the fitness 5K, along with receivingfree health and dental screenings on site. Local health vendors included Centennial Pediatrics,Matthew Walker Health Care Center, Meharry School of Dentistry and the Mount Zion Health andWellness Ministry.

Get Fit Tennessee hosted a booth at the event, providing educational material on healthy lifestylechoices and free pedometers to the participants. Each visitor to the Get Fit Tennessee booth wasalso given an introduction to the free tools and features available on GetFitTN.com and told howthey could personally benefit from a free membership on the Health and Fitness Tracker. The Get FitTennessee team also played fitness games with the children and reminded them to get 60 minutesof physical activity each day.

NASHVILLE, Tenn. - Commissioner of Health Susan R. Cooper, MSN, RN, spent today

at Camp Widjiwagan, a YMCA of Middle Tennessee day and overnight camp, where she

spoke to more than 300 campers about the importance of making healthy choices and

being active. Cooper and the Get Fit Tennessee team ate breakfast with the campers,

discussed steps the children and their families can take to make Tennessee a healthier



10/84

state, and led the campers in an obstacle course designed to showcase fun fitness

activities.

"A recent study ranked Tennessee fifth in the nation for childhood obesity, and that is a

number I am on a mission to change," said Cooper. "We need to teach our children at a

young age that nutrition and exercise are important so they can grow up to be healthy

adults living in a healthy Tennessee."

Get Fit Tennessee organized the event at Camp Widjiwagan to continue raising

awareness about the importance of moving more and eating healthier in an effort toreduce health problems in Tennessee associated with obesity. Cooper was pleased with

the activities and healthy food options offered at the YMCA camp.

"Camp Widjiwagan is a good example of adults understanding the health needs of

children and putting them first," said Cooper. "They do a great job of offering healthy

foods and plenty of physical activities for their campers."

The YMCA of Middle Tennessee is committed to helping improve the overall health

and wellness of Tennesseans, and we know teaching our children healthy habits is one of

the best ways we can do that, said YMCA Communications Director Jessica Fain.

Were delighted to welcome Commissioner Cooper to this session of Camp Widjiwagan

to join with us in helping kids have fun with fitness and develop good habits that will last

a lifetime.

Get Fit Tennessee is a statewide awareness program developed by Gov. Phil Bredesen to address

the rising epidemic of Type 2 diabetes and risk factors that lead to diabetes, like obesity. This

initiative is aimed at educating both adults and children that Type 2 diabetes can be delayed or

even prevented with modest lifestyle changes like increasing physical activity and eating healthier.



11/84

For more information on Get Fit Tennessee, including free fitness and nutrition tools, visit

www.GetFitTN.com.

Hospitals across Tennessee are working to make the state a healthier place by banning tobacco useamong employees.

Chattanoogas Memorial Hospital is leading the charge by announcing it will no longer hire anyonewho uses tobacco products. Potential hires will be subject to a nicotine test in addition to requireddrug testing.

Knoxvilles University of Tennessee Medical Center, Covenant Health, Mercy Health Partners, BlountMemorial Hospital and East Tennessee Childrens Hospital are expected to announce a similar banon tobacco use soon. These hospitals are among a growing number of companies that will no longerhire tobacco users.

The new regulations make this the perfect time to quit. Regardless of how long you have smoked orused tobacco, studies show quitting has immediate benefits. Within 20 minutes of giving uptobacco, elevated blood pressure and pulse decrease; in two days, nerve endings regenerate; in twoweeks, circulation improves; in one to nine months fatigue and shortness of breath decrease; and inone year, the risk of a heart attack is cut in half.

The Get Fit Tennessee web site offers several tools designed to motivate smokers to quit. TheSmoking Life Span Effect calculator estimates how many years will be added to your life and theSmoking Savings calculator totals up the money you could save if you quit smoking today. Thereare also links and resources to help you on your journey to stop smoking including the TennesseeTobacco QuitLine (1-800-784-8669 1-800-784-8669 ).

Get Fit Tennessee was developed by Gov. Phil Bredesen to address the rising epidemic of Type 2diabetes and risk factors that lead to diabetes, such as obesity. The initiative is aimed at educatingboth adults and children that Type 2 diabetes can be delayed or even prevented with modestlifestyle changes like increasing physical activity and eating healthier. For more information on GetFit Tennessee, including free fitness and nutrition tools, visit www.GetFitTN.

The sixth annual Walk Across Tennessee kicked off Saturday with a ceremonial lap around theDyersburg Mall, a Zumba demonstration and free health screenings.

Walk Across Tennessee officially begins Monday when teams of eight persons exercise to accrueenough mileage to take an imaginary walk across the state. Mileage is earned by walking, running,bicycling, lifting weights and other forms of exercise. The contest lasts for eight weeks. Actualmileage is used for walking and a conversion chart is used for other forms of exercise. For example,14 minutes of weight lifting is equivalent to 1 mile.

The top teams will be announced during an awards ceremony at 5:30 p.m. April 15, all in the mall'scenter court. Gold, silver and bronze medals are awarded to the teams with the most mileage. Eachteam also receives one gold medal that the team may award as it chooses. Every participantreceives a certificate.

A traveling trophy also is awarded to the top team.

A new award this year will be given to the person who packs his or her fitness regimen with the

biggest variety of activities. WAT Coordinator Beth Bell said she's looking for someone who pursuessix or seven different kinds of fitness activities each week.

Forty-eight teams had signed up by Saturday. Bell said she will continue accepting registrationpackets until Friday. She said the wintry weather had prevented some teams - particularly thosebased in schools - from registering yet.

Registration packets for the sixth-annual Walk Across Tennessee are now available at the DyerCounty Extension Office, the Dyersburg Mall customer service desk, the YMCA, Dyersburg ActivityCenter and First United Methodist Church. Forms may also be downloaded from the Walk AcrossTennessee Web site: www.watdyer.org.

http://www.getfittn.com/http://www.getfittn.com/


12/84

During Saturday's kickoff, Bell told participants that more than 35 percent of the people whoparticipate in WAT achieve one or more of their goals to lose weight, reduce stress, lower bloodpressure levels and improve sleep.

For those interested in weight loss, Bell said a realistic goal is to lose 1 to 2 pounds a week, orabout 16 pounds during WAT.

To help people envision a skinnier version of themselves, Sheila Jacobi, coordinator of the Deltaregional health grant and employee of Le Bonheur Children's Medical Center, took photos ofparticipants. The photos will be e-mailed to the participants. Then, they may use the digitalphotographs on the Weight Mirror Web site: weightmirror.com. The Web site allows users to seewhat they'd look like if they lost or gained weight. Participants may print the photos and use themfor inspiration.

WAT participants also received free screenings for blood pressure levels and body mass index.

A number of organizations also set up educational booths during the kickoff. These included:

* The McIver's Grant Public Library, which featured a number of books on exercise, sports, nutritionand weight-loss plans.

* Dyersburg Parks and Recreation, which featured exercise and sports opportunities.

* The Coordinated School Health Programs for city and county schools.

* Tennessee Trails Association.

* Curves.

* Weight Watchers.

Story and images from Dyersburg State Gazette:http://www.stategazette.com/story/1608993.html

My child doesn't get enough physical education or activity in school. Can you doanything about this problem?

Tennessee schools are required to provide children with 90 minutes of physical activity each week,

according to Chapter 1001 Public Acts, 2006 House Bill 3750.

It is mandated that each local education agency will integrate a minimum of 90 minutes of physical

activity per week into the instructional school day for elementary and secondary school students.

Opportunities to engage in physical activity may include walking, jumping rope, playing volleyball,

or other forms of physical activities that promote fitness and well-being.

If you would like your child to have more physical activity in school, it is important to take the issue

up with your Local Education Agency, School Board, Principal or other school and community

leaders.

NASHVILLE, Tenn. - Commissioner of Health Susan R. Cooper, MSN, RN, announced today theaddition of new sections for young people and their teachers on the Get Fit Tennessee websitewww.getfittn.com/kids to help the next generation of Tennesseans get fit. The new site presentsfitness and nutrition information for middle school students with bold graphics and engagingactivities. Interactive games and trivia encourage kids to learn more about nutrition, properportion sizes and new ways to move more throughout the day.

http://www.getfittn.com/kidshttp://www.getfittn.com/kids


13/84

"Kids and teens are so technology-savvy, it was time we created a space for them to learn

relevant health and fitness information through a medium they are already using," Cooper said.

"As obesity rates among children are on the rise nationally, we want to provide a fun and

interactive resource for them to learn how to make better food choices and how to get the

recommended 60 minutes of movement a day.

The site also includes a section dedicated to teachers who want to incorporate fitness and

nutrition information into the classroom. Sample lesson plans are provided, as well as online

forums for teachers to discuss lessons, activities and initiatives that work to promote better health

among students.

Get Fit Tennessee is a statewide awareness program developed by Gov. Phil Bredesen to

address the rising epidemic of Type 2 diabetes and risk factors that lead to diabetes, like obesity.

This initiative is aimed at educating both adults and children that Type 2 diabetes can be delayed

or even prevented with modest lifestyle changes like increasing physical activity and eating

healthier. For more information on Get Fit Tennessee, including free fitness and nutrition tools,

visit www.GetFitTN.com

Have you ever eaten a pluot?

Would you be more likely to eat one if someone called it a "dinosaur egg?"

Gov. Phil Bredesen and state Education Commissioner Timothy Webb on Thursday

announced 121 elementary schools in Tennessee have been chosen to participate in

the Fresh Fruit and Vegetable Program for the 2010-11 school year. The program

allows students to newly experience fresh fruits and veggies in hopes their

consumption will increase throughout their lives.

These funds are provided to the state through the U.S. Department of Agriculture as

part of the National School Lunch Program. Schools applied and were selected based

on factors such as staff commitment, efficient use of resources and innovative

promotional efforts. Schools with the greatest percentage of economically

disadvantaged students were given the highest level of consideration.

Janet Clarkson, child nutrition supervisor for Bedford County Schools, said she

applies each year for all of the schools that meet the economic requirements in

terms of percentage of students on free or reduced price lunches. This is the third

year for the fresh fruit and vegetable program, she said, and Bedford County has

had participating schools all three years.

Clarkson said the fresh fruits and veggies are generally presented as snacks. Each

school implements the program very differently. She had particular praise for

http://www.getfittn.com/http://www.getfittn.com/


14/84

Beverly Ward at East Side Elementary, who exposes children to unexpected items

like dragonfruit.

Ward says she offers the students two snacks a week plus monthly "taste testing"

event at which they tray a small portion of some new kind of fruit. She's introduced

the kids to mangoes, figs, dragonfruit, pomegranate, avocados, raspberries, fresh

pineapples and coconut. When she introduced them to the pluot, a cross between a

plum and an apricot, she sparked their interest by calling the fruit by its nickname,

"dinosaur egg."

"It was a huge hit," she said.

"I've tasted fruit that I didn't think I would ever taste," said Ward. But the real

pleasure is seeing the children introduced to new fruit and vegetable choices.

"As much fresh fruit that they can eat," she said, "it's that much that they're not

eating chips or anything else."

Sometimes, she introduces an activity along with the fruit. For example, she

researched avocados on the Internet and found the directions for starting an

avocado tree from a pit.

"We can't do enough to encourage healthy eating and living habits in our children,"

Bredesen said in a news release. "Programs like the School Nutrition Program are

vital to the continued success of our students during the school day and throughout

their lives.

"I've very encouraged that we have a large number of schools participate in this

grant process every year," Webb said in a news release. "Our teacher and

administrators know the key to educational success is healthy students and healthy

meal options."

The program allows schools to provide approved fruits and vegetables at no charge

to students during the school day. For examples, fruits and vegetables must be

fresh, not canned, frozen, or vacuum packed.

The program is effective from July 1 through June 30, 2011.

Original story from Shelbyville Times-Gazette:

http://www.t-g.com/story/1639412.html



15/84

The Benwood Foundation will put nearly $100,000 into five Hamilton County elementary schoolsto help combat childhood obesity and expose more low-income students to fruits and vegetables.

Brown Academy, Calvin Donaldson, Orchard Knob, Eastside, Hardy, Rivermont and Clifton Hillselementary schools are the first group to receive funding under Gaining Ground, Benwood's newinitiative to promote local foods.

"All of this is a win-win," said Russell Cliche, coordinator of school health for the Hamilton CountyDepartment of Education. "These students are from a lower socioeconomic background, and theyaren't exposed to local growers. ... We need to increase consumption of fruits and vegetables.There is a very low percentage of our population living a healthy lifestyle."

Issues of school nutrition and diet-related disease among students have taken front and center inrecent months. The White House announced the Let's Move campaign in February to establishcommunity support for addressing childhood obesity.

Fifteen percent of elementary students in Hamilton County are classified as obese, schooldocuments show. One in three children in the United States are either overweight or obese,according to figures from Benwood Foundation.

"This is a great project because it touches the family and community in many different ways," saidJeff Pfitzer, program director for Gaining Ground.

With the investment in school nutrition, Gaining Ground will provide one serving of fresh fruit andvegetables to students three or four days a week outside of the cafeteria. The produce will beused by teachers to educate students about healthy eating, said Mr. Cliche.

The money also will help create training programs for cafeteria staff and parents to increase thenumber of fruits and vegetables in students' diets.

The "Farm to School" program will increase cafeteria staff's knowledge of how to prepare andserve fresh fruits and vegetables, and "Healthy Home Kitchen" will provide cooking lessons fromlocal chefs to parents in targeted schools.

Local growers will be encouraged to come to schools and sell produce since many families don'thave access to regional foods, officials said.

"With this grant, we will be creating more opportunities for school leadership and staff, students,and families to understand, practice, and incorporate healthy eating habits," said Carolyn K.Childs, director of school nutrition in Hamilton County schools, in a statement.

Story from Chattanooga Times Free Presshttp://www.timesfreepress.com/news/2010/apr/16/benwood-improves-student-access-to-produce/Someone in the United States is diagnosed with diabetes every 20 seconds, according to theAmerican Diabetes Association. Get Fit Tennessee is working to reduce the burden of diabetes inthe state by urging all Tennesseans to know their risk factors for the disease as part of the

observance of Diabetes Alert Day March 23. This annual health observance is dedicated toraising awareness of Type 2 diabetes and encouraging those who are at risk to take steps towardprevention.

I encourage all Tennesseans to take this day to learn

more about the risk factors for diabetes and make small changes to eat better and increase

physical activity to help reduce those factors in their lives, said Health Commissioner Susan R.

Cooper, MSN, RN. Contact your health care provider to talk about your personal risk factors and

ways to lower your risk for diabetes.



16/84

More than 10 percent of adult Tennesseans

participating in the 2008 Behavioral Risk Factor Surveillance System responded they had been

told by a health professional that they have diabetes. That ranks Tennessee 46th in the nation for

diabetes incidence, with only four other states having a higher percentage of cases. The

American Diabetes Association estimates 530,000 children and adults are living with diabetes in

Tennessee, and an additional 50,000 people in the state are living with pre-diabetes. Nationwide,more than 20 million children and adults are living with diabetes, according to the ADA.

Get Fit Tennessee has a number of resources available to help those managing diabetes or pre-

diabetes. The free health and fitness tools found online at www.getfittn.com include a nutrition

tracker based on the United States Department of Agricultures database of more than 7,500 food

items. The nutrition tracker allows users to keep track of calories, fat grams and carbohydrates

consumed each day in a virtual food journal. Users can also accumulate fitness points by

logging physical activity in the fitness tracker, as well as set fitness and nutrition goals.

To learn more about diabetes and how to prevent it,

visit www.getfittn.com or the American Diabetes Association Web site, www.diabetes.org. Visitors

to the ADA Web site can also determine their risk for developing diabetes by taking the online

Diabetes Risk Test.

Get Fit Tennessee is a statewide awareness program developed

by Governor Phil to address the rising epidemic of Type 2 diabetes and risk factors that lead to

diabetes, like obesity. This initiative is aimed at educating both adults and children that Type 2

diabetes can be delayed or even prevented with modest lifestyle changes like increasing physical

activity and eating a healthier diet.

NASHVILLE, Tenn. First Lady Andrea Conte and Health Commissioner Susan R.Cooper, MSN, RN, recognized state agencies and acknowledged National Public Health

Week today during announcement of results of the March to the Moon fitness challenge

for state employees. The top three placing state departments and agencies were

honored with a presentation at Bicentennial Capitol Mall State Park.

"This years results could not have come at a more appropriate time than during National

Public Health Week," said First Lady Conte. "We hope this event will continue to inspire

small actions in our state workers that can have big impacts toward making Tennessee a

healthier state.

The March to the Moon fitness challenge was open to all state employees, and was

designed as a fun way to help promote and improve health and fitness. Throughout the

month of March, participants logged physical activity and earned fitness points using Get

Fit Tennessees Fitness Tracker at www.getfittn.com, while competing as members of

their departments team. At the end of the month, departments were ranked by the

http://www.getfittn.com/http://www.getfittn.com/http://www.diabetes.org/http://www.diabetes.org/http://www.getfittn.com/http://www.getfittn.com/http://www.getfittn.com/http://www.diabetes.org/http://www.getfittn.com/


17/84

average number of fitness points in hopes of claiming the Health Commissioners

Challenge Trophy. The top five teams and their average fitness points are as follows:

Department/Agency Point

Average

1. Tennessee Wildlife Resources Agency 4189.34

2. Bureau of TennCare 2735.30

3. Commission on Children and Youth 2706.80

4. Department of General Services 2422.44

5. Governors Office on Childrens Care Coordination 2401.18

There were 756 participants in this years March to the Moon Challenge. These state

employees walked the equivalent of a total of 60,200.89 miles, took 120,401,777 steps

and earned 1,204,017.77 fitness points toward the grand prize of better health.

We spend just as much time in our workplaces as at home, and health and safety of

employees are a priority, said Cooper. Research shows more employers are offering

programs to support a healthier lifestyle than ever before. A commitment to improving

the health status of all employees promotes a comprehensive culture of well being as

well as a more productive work environment.

Get Fit Tennessee offers free fitness and nutrition tools that individuals and employers

can take advantage of online. Users can design their own fitness challenges for family,

friends or coworkers, or simply track their own progress as they work to improve health

and fitness. All Tennesseans are urged to visit the Get Fit Tennessee Web site to

receive free daily tips via e-mail, and to access features including a food diary and a

cookbook of simple, healthy and economical recipes.

Get Fit Tennessee is a statewide awareness program developed by Governor Phil Bredesen witha focus on educating and empowering Tennesseans to move more and eat healthier to combat

health risks facing the state, such as obesity, Type 2 diabetes, heart disease and stroke.

Odds are slim that a Tennessee child will be in good health, advocates say.



18/84

The statistics paint a grim picture: Tennessee is 48th for children's overall health, has among the

highest rates of infant mortality and is ranked in the top 10 for teen deaths. About 17 percent of

the state's teens are obese, with many more at risk.

Behind the numbers are the real children like Faith Apperson, who struggles with being

overweight; like Donovan Cotton, who was born prematurely at 23 weeks; and like April Alonzo,

who at 16 suffers from bipolar disorder and has attempted suicide.

Faith, Donovan and April and their families share their stories as faces behind Tennessee's

health issues in a new seven-part series that will air over the next three years on Nashville Public

Television.

"I wanted to be a part of this to let other parents know they are not alone and there are resources

for their children," said Tammy O'Rourke, who is Faith's mother. "I was lost too."

The first episode of the documentary series, NPT Report: Children's Health Crisis, in February to

start driving conversation and change in the community. The second episode is expected to runin June, with each new part airing every few months.

Kimberly Williams-Paisley, an actress and mother of two, hosts the documentaries. The

installments also feature experts who dissect the problems on film, including local and state

health officials, doctors, professors, advocates and school officials.

Faith and her mom were referred to Vanderbilt University Medical Center's Dayani Center, which

focuses on health and wellness. They learned how to eat healthier meals.



19/84


20/84

BOLIVAR, Tenn. Carolyn Stewart looked over the contents of her grocery cart

and let out a rueful chuckle at the inventory three cases of Faygo soda, some

gummy candy and a box of Froot Loops.

It's an unhealthy shopping list for an unhealthy woman living in one of the

unhealthiest places in Tennessee.

"I'm diabetic and on a kidney machine," said Stewart,

a Hardeman County native who is hoping for a kidney transplant, as soon as one of

her daughters loses enough weight to qualify as a donor. In the meantime, she

knows she needs to watch what she eats and drinks. "I try to eat right and

everything."

Stewart lives in the county with the highest obesity rate in Tennessee, but there's

nothing in her community, or her grocery cart, that you won't also find everywhere

else in the state. Tennessee consistently ranks as one of the most obese states in

the nation, and weight-related health problems feed into sky-high rates of diabetes,

cancer, hypertension and infant mortality.

"Hardeman County does not look that much different from 20 or 30 other counties in

this state and no different than what you'd find in the rest of the nation," said

Tennessee Department of Health Commissioner Susan Cooper.

Hardeman, a county of rolling green hills, small farms and lovingly restored Civil

War-era town squares, lies east of Memphis, north of the Mississippi line and at the

rock bottom of the state health rankings. The county is working to improve public

health, and finding out just how hard that can be.

This is not a story about a county with a weight problem. This is a story about a

county trying to get its people healthy again. Helping Hardeman County get fit won't

be a simple matter of putting in a few salad bars or bike paths. The county has

parks, ball fields, tennis courts, a golf course, a pool, two private gyms, a few

walking paths and three grocery stores with decent produce sections.

Three years ago, the county seat of Bolivar launched a farmers' market that brings

heaps of farm-fresh produce downtown three times a week. Roadside stands groan

under the weight of ripe watermelons, tomatoes and summer squash.

The schools took out the vending machines, brought in salads and baked potato bars

and stepped up nutrition counseling. Joe's Restaurant in Bolivar installed a salad bar

to give customers an alternative to the six deep fryers bubbling in a row back in the

kitchen.



21/84

Fresh new sidewalks are all over downtown Bolivar, thanks to a redevelopment grant

the city obtained a few years ago, and whimsical painted pianos lean on the street

corners, beckoning people to come stroll the city square and listen to the live music

performances every Friday.

The facilities may not be as large or as nice as those in the metro areas, but there

are options for people seeking a healthier lifestyle. But the healthy choice is not

always the easy choice.

"It's hard to get people to come," said Mary Heinzen, executive director of the

Hardeman County Community Health Center, which has received multiple grants that

allowed its staff to offer free nutrition counseling and exercise classes to low-income

residents with weight problems. But few signed up.

"Many of our clients feel very depressed and hopeless," Heinzen said. "When you're

living what you feel is a hopeless life, it's hard to get people to come and listen to

someone talk about what they should be doing with food choices."

Hardeman is a rural, relatively poor county, where the median household income is

$36,000, only 7 percent of the population has a college degree, the unemployment

rate hovers around 13 percent, and those who work must often commute outside the

county now that most of the factories here have shuttered their operations.

"Our health-care costs are out the roof; we have unmotivated, depressed people;

and I don't think the average person in the county recognizes that we have a

problem with obesity," Heinzen said.

When you're working long hours, or two jobs to make ends meet, finding the time or

the energy to work in a brisk morning jog or to whip up a healthy dinner from

scratch isn't high on your priority list.

"I'm just trying to budget the best way I can," said Angela Lambert of Middleton,

piling three frozen pizzas into her cart at Maxwell's Big Star, a locally owned grocery

store in Bolivar that has survived the arrival of a Walmart grocery a few miles down

the road.

Lambert, who works at the county prison, gets paid twice a month and must stretch

her $200-a-week food budget to make sure her three children ages 2, 10 and 12

have enough to eat as moneygets tight and payday is still half a week away.



22/84

Her children enjoy fruits and healthy foods, and she tries to walk two miles a day

with a friend or she did, before the temperatures outside started hitting the triple

digits.

The Robert Wood Johnson Foundation and the University of Wisconsin rank U.S.

counties by health. When the latest survey came out in February, Hardeman County

ranked worst in Tennessee 95th out of 95 counties for obesity. According to

statistics gathered by the Centers for Disease Control and Prevention, an estimated

38 percent of Hardeman residents are obese, with body mass indexes of 30 or

higher.

Even for trained health workers, making healthy choices isn't always easy. The

Curves gym shut down recently, leaving Carol Gill searching for a new workout

routine.

"I'm 59 years old, and I have battled with my weight all my life," said Gill, the new

patient coordinator for the county health department. Over the years, she has tried

everything from Weight Watchers to hypnotism to try to keep weight off her tiny 5-

foot frame.

Like many of her neighbors, Gill is diabetic, which makes the battle with her weight

all the more urgent.

"Why we're so fat here, I don't know," she said with a smile. "It could be as simple

as, if it's fried, we think it tastes good. The economy has a lot to do with it, too."

Hardeman County has fallen on hard times in recent decades. Once, cotton was king.

Then manufacturing moved in, bringing good jobs and good wages.

Bill Strope followed one of those jobs south from Indiana to Bolivar 50 years ago and

stayed, long after the auto partsplant where he worked pulled up stakes and moved

out of state, along with most of the county's other manufacturing jobs.

"They used to say this was a cotton town, but all the

old farm people are dead and gone," said Strope, who survived a stroke and now

devotes himself to regular exercise with a group of fellow die-hards at the Bolivar

municipal gymnasium.

"It keeps my sugar down," said Strope, who has been living with diabetes for 22

years. To stay fit, he plays golf and walks three or four times a week.



23/84

Last week was the hottest of the year, 103 degrees outside with a heat index closer

to 116 degrees. Hardeman County has no malls for walkers to stroll in air-

conditioned comfort, but there is the small municipal gym, where regulars circle the

court, around and around, day after day, getting their miles in. It takes 14 laps of

the gym to make a mile. Bolivar neighbors Jo Butler and Earline Cox wear

pedometers and keep each other company as they make their circuit.

Butler, who moved to Bolivar from Austin, Texas, two years ago, drives 70 miles

west to Memphis to grocery shop at Whole Foods and pick up the vitamins and

holistic supplements she credits for her continued good health at the age of 77. "It

makes it hard," she said of healthy living in a small town. But her daily walks with a

friend help.

"I feel better when I do," said Cox, who was born and raised in Hardeman County, in

a family where money was scarce but the food was always home-cooked, hearty and

healthy.

Danny Cheshier used to walk the mile from his home to his barbershop on Bolivar's

square. The place looks a lot like it did when he opened for business in 1958 the

striped pole outside, the penny gumball machine inside and the sturdy antique chairs

with their view onto the street outside. When a back injury made walking painful,

Cheshier said he switched to riding his recumbent bike to stay fit.

"I see a lot of obesity out there," said Cheshier, who runs the shop with his brother,

Jerry. The daily exercised has helped him drop about 5 pounds off his already fit

frame in recent months, but he knows a lot of his neighbors don't have the option of

walking to work, or cycling to stay fit. "It's really sad. You have to understand, these

people, they don't want to be like that. They just don't know what they need to do."

Hardeman County Mayor Willie Spencer knows what people need to do. Getting them

to do it is another matter. A physical education major in college, he eggs his staffers

into taking the stairs to his third-floor office in the century-old courthouse and

sometimes slips away to do pushups or jog in place in an empty meeting room.

"We need to start strategizing," he said. "Poverty is our biggest issue. We do not

have a lot of industry, we do not have a lot of good-paying jobs. Education has to

be the foundation."

Down the street, Bolivar Mayor Barrett Stevens Sr. offers municipal employees 30

minutes a day to exercise, and the city offers quarterly competitions for workers who

walk the farthest.



24/84

The biggest changes are probably happening in the schools, which have been

stripped of their vending machines and had their cafeterias greened with salads and

baked potato bars.

"When you work with younger kids, it makes the longest-term impact," said Dr.

Karen Codjoe, a pediatrician who is seeing rising numbers of overweight and obese

children, including many who have developed Type II diabetes.

Last year, she said, the county schools hosted a fitness challenge for second-

graders, and "it took some of those kids 30 minutes to walk one mile." Alarmed, the

county is organizing an obesity task force that hopes, among other things, to send

adult mentors into the schools to encourage children to become more active and to

make smarter meal choices.

"The reality is, it's going to take a lot to make changes. We're not going to see

results for a number of years."

Slow progress is not necessarily a bad thing. At the state health department, Cooper

repeats the advice the state gives to people trying to lose weight and get fit: The

way to go is with little changes, gradual changes, slow improvement.

"Weight is the last thing people want to talk about. If you told me I had to lose 100

pounds, I wouldn't hear another word you said, because it would sound so

unattainable," she said. But if you encourage people to be active for five minutes in

the privacy of their home, or to bake the chicken for dinner instead of fry it, those

small changes can add up, she said.

Original story from The Tennessean:

http://www.tennessean.com/apps/pbcs.dll/article?

AID=/201008080210/NEWS01/8080380

Bredesen Signs Executive Order Promoting Healthy Options for State Vending

Machines8/10/2010



25/84

NASHVILLE Governor Phil Bredesen signed Executive Order No. 69 promotinghealthy options for food and beverages sold through vending facilities on properties

within the executive branch of state government. The order directs that guidelines bedeveloped establishing minimum nutritional standards and standards for labeling and

placement of food and beverages along with pricing and other incentives toencourage the purchase of items that meet these nutritional standards.

Many of the health issues that face Tennesseans today are things that a prescription

or a doctors appointment or health insurance cant fix, Bredesen said. The statehas spent the past several years investing in prevention strategies like GetFitTN to

raise awareness and address behaviors that lead to chronic disease, including

physical inactivity, nutrition and tobacco use. State employees deserve healthier foodchoices and ought to be the leaders in moving toward a healthier Tennessee."

The executive order applies to all vending machines on public properties within theexecutive branch of state government that are serviced by licensed blind vendors,

private third party vendors and private vending companies that operate on publicproperties under the authority of the Department of Human Services.

The departments of Finance and Administration, Health and Human Services, as wellas appropriate blind vendor representatives, will develop and publish the nutritional

guidelines. The Department of Human Services will amend written agreements with

property management officials and existing vendors to incorporate the newguidelines and standards by January 1, 2011. All permits issued after January 1,

2011 will include the guidelines and minimum standards.

The Department of Health will also publish recommendations for nutritional food andbeverages provided to state employees at breaks, meetings, conferences and other

work-related events held on public property.



26/84

Robert Wood Johnson Foundation

w.countyhealthrankings.org/

The County Health Rankings

The County Health Rankings are being developed by the University of Wisconsin PopulationHealth Institute through a grant from the Robert Wood Johnson Foundation and will be released

in February 2010. This Web site will serve as a focal point for information about the CountyHealth Rankings, a project developed to:

Increase awareness of the many factorsclinical care access and quality, health-

promoting behaviors, social and economic factors, and the physical environmentthatcontribute to the health of communities

Foster engagement among public and private decision makers to improve community

health and

Develop incentives to encourage coordination across sectors for community health

improvement.

The project builds on the University of Wisconsin Population Health Institute's experience inproducing the Wisconsin County Health Rankings annually since 2003.

The Robert Wood Johnson Foundation

The Robert Wood Johnson Foundation focuses on the pressing health and health care issuesfacing our country. As the nation's largest philanthropy devoted exclusively to improving thehealth and health care of all Americans, we work with a diverse group of organizations and

individuals to identify solutions and achieve comprehensive, meaningful and timely change. Formore than 35 years we've brought experience, commitment and a rigorous, balanced approach

to the problems that affect the health and health care of those we serve. When it comes tohelping Americans lead healthier lives and get the care they need, we expect to make adifference in your lifetime. For more information visit RWJF.org.

The University of Wisconsin Population Health Institute

The University of Wisconsin Population Health Institute is the focal point within the University ofWisconsin School of Medicine and Public Health for translating public health and health policy

research into policy and practice. The Institute strives to:

Address a broad range of real world problems of topical importance to government,

business, providers, and the public;

Promote partnerships of inquiry between researchers and users of research, breakingdown barriers between the academic community and public and private sector policymakers;

Advance the development of interdisciplinary research, along the spectrum from public

health to health care;

Provide continuing education for practitioners and opportunities for applied learning for

graduate and medical students; and

Make useful contributions to public health and health policy decisions that improve thehealth of the public.

1. Why rank counties' health?

http://www.rwjf.org/http://uwphi.pophealth.wisc.edu/http://www.rwjf.org/http://uwphi.pophealth.wisc.edu/


27/84

To serve as a call to action for communities to

o Understand the health problems in their community

o Get more people involved in improving the health of communities

o Recognize that factors outside medical care influence health

Ranking the health of counties using not only traditional health outcomes, but also thebroad range of health determinants, can mobilize action, not only on the part of

governmental public health, but also of the many other sectors that can influence andare affected by health.

return to top

2. Is there a model underlying the County Health Rankings?

The County Health Rankings are based upon the model of population health

improvement in which health outcomes are the result of a set of health determinants(see diagram). These determining factors and their outcomes are also affected by

policies or programs in the community. Once communities understand their currenthealth (health outcomes) and the factors likely to impact their future health (healthdeterminants), they can improve health by adopting effective programs and policiesthat address these key determining factors.

3. How will you rank counties' health?

We will rank counties' health on two sets of measures:

1. Health outcomes (length and quality of life)

http://www.countyhealthrankings.org/FAQsGene-1948-list0.html#top%23tophttp://www.countyhealthrankings.org/FAQsGene-1948-list0.html#top%23top


28/84

2. Health determinants (health behaviors, access to and quality of clinical care,

social and economic factors, and the physical environment).

More details are provided in the Ranking Methods section.

2. Do some states already rank the health of their counties?

Yes, building on the work ofAmerica's Health Rankings, the University of WisconsinPopulation Health Institute has been ranking the health of Wisconsin counties for the

past six years:o Wisconsin County Health Rankings

Other states have developed their own rankings:o Tennessee*

o Kansas*

o Kentucky

o New Mexico*

*Based on the Wisconsin model.

4. Our state already publishes county-level indicators what is the value-added ofthe County Health Rankings?

The County Health Rankings are designed as a call to action the use of ranks canoften serve as a more effective tool for drawing attention to community health issuesthan lengthy listings of indicators. We encourage any community that has not already

done so to use the Rankings as a stimulus to engage community members in a moredetailed community health assessment, using whatever additional data sources theyhave available.

1. There is a major city in our state will this city be included in the County HealthRankings?

The County Health Rankings will be based on counties and county equivalents. Anyentity that has its own Federal Information Processing Standard (FIPS) county code will

be included in the Rankings. The FIPS county code is a five-digit code where the first 2digits represent the state and the remaining 3 digits designate county or county

equivalents. Certain major cities, such as the cities of Baltimore and St. Louis areconsidered county equivalents and have their own FIPS county code whereas othercities, such as the City of Milwaukee, do not.

2. How do the County Health Rankings address the fact that the availability andquality of information for the various elements in the Rankings varies across states?

The County Health Rankings will be presented by state with no comparisons across

states.

3. Our state department of health provides county-level data for many moreindicators than are likely to be included in the County Health Rankingswhy arecomposite scores and rankings helpful?

The County Health Rankings use composite scores and rankings as a means to draw

attention to the fact that health varies by place, that there are multiple factors that

contribute to healthy communities, and that health is everybody's business (not justthat of the state or local health department). Communities wishing to dig deeper and

understand what can be done within their community should be encouraged to useadditional more detailed data sources available within a state to conduct an indicator-specific analysis. The Rankings can be used as a pointer to suggest areas where more

in-depth analysis might be helpful.

http://www.countyhealthrankings.org/Rank-7304.htmlhttp://www.americashealthrankings.org/2008/index.htmlhttp://uwphi.pophealth.wisc.edu/pha/wchr.htmhttp://www.tn.gov/tniph/countyprofiles.htmlhttp://www.khi.org/s/index.cfm?aid=2193http://www.kyiom.org/pdf/healthy2007a.pdfhttp://www.health.state.nm.us/phd/dist3/documents/NMCountyHealthRankings2008.pdfhttp://www.countyhealthrankings.org/Rank-7304.htmlhttp://www.americashealthrankings.org/2008/index.htmlhttp://uwphi.pophealth.wisc.edu/pha/wchr.htmhttp://www.tn.gov/tniph/countyprofiles.htmlhttp://www.khi.org/s/index.cfm?aid=2193http://www.kyiom.org/pdf/healthy2007a.pdfhttp://www.health.state.nm.us/phd/dist3/documents/NMCountyHealthRankings2008.pdf


29/84

4. How will the weights be assigned across and within the four health determinantcategories in the County Health Rankings?

For the past six years, the Wisconsin County Health Rankings have used a 40-10-40-10

weighting for the relative contribution of health behaviors, clinical care, social andeconomic factors, and the physical environment toward overall health. The exact

weighting for the components of the forthcoming County Health Rankings has not yet

been finalized. There is no "correct" weighting formula, but we are conductingadditional literature reviews and having discussions with experts to determine an

appropriate allocation of weights. Within each component, we will assign weights toconstructs and individual indicators based on a combination of available information onthe contribution of that construct and on the reliability of specific indicators.

5. How should/can state departments of health respond when counties believethat the County Health Rankings may not accurately reflect their county and thus

question their findings?

We suggest that state departments use the release of the County Health Rankings asan opportunity to encourage communities to conduct more in-depth community health

assessment using whatever additional more detailed county-level data are availablewithin the state. If and when questions are raised by results in the County Health

Rankings, the objective is to generate discussion about how healthy a county is and

what can be done to improve its health, rather than focusing on whether or not itsranking is "correct."

Engaging Partners

Healthy communities are good for everyone. Public health agencies alone can only makeincremental improvements in healthto achieve major improvements in health requiresinvolvement from everyone.



30/84

IOM. The of the Public's Health in the 21st Century. Washington, DC: National Academies Press,2002.

The February 2010 release of the County Health Rankings in every state in the U.S. is anopportunity for each state to:

call attention to the need for health improvement and

get more people involved in improving the health of communities.

Finding Solutions

What happens once the County Health Rankings are released? There are a number of steps that

communities can take as a result of this "call to action" to improve health. This page highlightsthree steps communities can take and lists some resources to get you started.

Step 1: Get people involved: see Engaging Partners

Step 2: Use the County Health Rankings as a starting point for a more thorough

community health assessment

Mobilizing for Action through Planning and Partnerships (MAPP)

The Community Toolbox Assessing Community Needs and Resources

PRECEDE/PROCEED

State tools:

o Florida COMPASS (Comprehensive Assessment, Strategic Success)

o Minnesota Community Health Assessment and Action Planning

o North Carolina Community Assessment Guidebook

o New York--10 Steps in Community Assessment Development Process

o Washington State Assessment Initiative Web Site

Step 3: Identify and implement evidence-based policies and programs to improvehealth

Evidence databaseso The Guide to Community Preventive Services

o The Cochrane Library

o Cochrane Reviews of Relevance to Health Promotion and Public Health

o Health-Evidence.ca

o The Campbell Collaboration Library of Systematic Reviews

Action guides

o Partnership for Prevention Community Health Promotion Handbook

ww.thecommunityguide.org/index.htmlThe Community Health Promotion Handbook

Action Guides to Improve Community Health

Partnership for Prevention and the Centers for Disease Control and Prevention have workedtogether to bridge the gap between research and practice by developing The Community HealthPromotion Handbook: Action Guides to Improve Community Health.

The Community Health Promotion Handbook is an evidence-based tool that consists of anIntroduction and five Action Guides. Each Action Guides translates a specific recommendationfrom The Guide to Community Preventive Services (Community Guide) into how to guidanceto help public health practitioners and others interested in promoting health implement effective

http://www.countyhealthrankings.org/Enga-7305.htmlhttp://www.naccho.org/topics/infrastructure/MAPP/index.cfmhttp://ctb.ku.edu/en/tablecontents/chapter_1003.htmhttp://ctb.ku.edu/en/tablecontents/chapter_1003.htmhttp://ctb.ku.edu/en/tablecontents/section_1008.htmhttp://www.doh.state.fl.us/planning_eval/CHAI/index.htmhttp://www.health.state.mn.us/divs/cfh/ophp/system/planning/chaap/index.htmlhttp://www.healthycarolinians.org/assess.htmhttp://www.health.state.ny.us/statistics/chac/10steps.htmhttp://www.assessnow.info/http://www.thecommunityguide.org/index.htmlhttp://www.cochrane.org/http://www.ph.cochrane.org/en/localrevs.htmlhttp://health-evidence.ca/http://www.campbellcollaboration.org/library.phphttp://www.prevent.org/content/view/142/173/http://www.countyhealthrankings.org/Enga-7305.htmlhttp://www.naccho.org/topics/infrastructure/MAPP/index.cfmhttp://ctb.ku.edu/en/tablecontents/chapter_1003.htmhttp://ctb.ku.edu/en/tablecontents/section_1008.htmhttp://www.doh.state.fl.us/planning_eval/CHAI/index.htmhttp://www.health.state.mn.us/divs/cfh/ophp/system/planning/chaap/index.htmlhttp://www.healthycarolinians.org/assess.htmhttp://www.health.state.ny.us/statistics/chac/10steps.htmhttp://www.assessnow.info/http://www.thecommunityguide.org/index.htmlhttp://www.cochrane.org/http://www.ph.cochrane.org/en/localrevs.htmlhttp://health-evidence.ca/http://www.campbellcollaboration.org/library.phphttp://www.prevent.org/content/view/142/173/


31/84

community-level health promotion strategies. The five Action Guides address diabetesmanagement, physical activity, and tobacco-use treatment.

Order (Click here to order The Community Health Promotion Handbook in its entirety). To orderor download an individual Action Guide, click on its title below.

Diabetes Management

Diabetes Self-Management Education: Establishing a Community-Based DSME Program forAdults with Type 2 Diabetes to Improve Glycemic ControlAn Action Guide

Physical Activity

Places for Physical Activity: Facilitating Development of a Community Trail and Promoting ItsUse to Increase Physical Activity Among Youth and AdultsAn Action Guide

School-Based Physical Education: Working with Schools to Increase Physical Activity AmongChildren and Adolescents in Physical Education ClassesAn Action Guide

Social Support for Physical Activity: Establishing a Community-Based Walking Group to IncreasePhysical Activity Among Youth and AdultsAn Action Guide

Tobacco-Use Treatment

Healthcare Provider Reminder Systems, Provider Education, and Patient Education: Workingwith Healthcare Delivery Systems to Improve the Delivery of Tobacco-Use Treatment to PatientsAn Action Guide

Each Action Guide contains an overview of the recommendation and supporting evidence, linksto tools and resources for planning and implementation, tips for implementation and overcomingpotential obstacles, suggested resource needs, and questions and potential data sources forevaluation planning.

In order to maximize the benefit of this "call to action," teams comprised of individuals from thepublic and private sectors will be forming in each state. These teams will serve as key projectparticipants before, during, and after the release of the County Health Rankings.

This page will serve as a source of information for people invited to join one of these teams aswell as others who are interested in the communications and community engagement activitiesthat will surround the upcoming release of the County Health Rankings.



32/84

In order to maximize the benefit of this "call to action," teams comprised of individuals from thepublic and private sectors will be forming in each state. These teams will serve as key project

participants before, during, and after the release of the County Health Rankings.

This page will serve as a source of information for people invited to join one of these teams aswell as others who are interested in the communications and community engagement activities

that will surround the upcoming release of the County Health Rankings.

FOR MORE ABOUT JOINING YOUR STATE'S RANKINGS ROLLOUT TEAM, PLEASE

CONTACT US.

The Model for Integrated Community Care

Leading states = Vermont, North Carolina (Medicaid only), Colorado

Aug 2009

http://www.countyhealthrankings.org/Cont-7303.htmlhttp://www.countyhealthrankings.org/Cont-7303.htmlhttp://www.countyhealthrankings.org/Cont-7303.html


33/84

Health and Human Services Secretary Kathleen SebeliusWASHINGTON Health andHuman Services Secretary Kathleen Sebelius released a report Thursday on howinformation technology can improve healthcare for Americans living in rural communities.

The report examines how the Columbia Basin Health Association in Othello, Wash.,uses IT to improve healthcare quality and patient safety as well as promote care

coordination and continuity.

"The Columbia Basin Health Association is just one place in America where healthinformation technology and electronic health records have helped ensure patients getbetter care," said Sebelius. "Health information technology can reduce paperwork, makecare more efficient and let doctors spend more time practicing medicine and less timefilling out forms."

The CBHA provides 25,000 patients with access to a variety of medical, dental,prescription and other services at four sites and was one of the first health centers in theUnited States to fully transition from paper-based charts to an electronic health recordsystem.

In response to the growing prevalence of diabetes in rural communities, the CBHA usedits EHR system to track 1,302 diabetic patients, monitoring whether they receivedrecommended exams and providing feedback to healthcare providers on theirperformance.

In January 2008, 31 percent of patients at the CBHA had received a foot exam and 37percent had received an eye exam during the previous year. By June 2008, 86 percentof patients had received a foot exam and 63 percent had received an eye exam over theprevious year.

According to the report, since the CBHA's implementation of EHRs, the community

health center has consistently ranked above the 95th percentile nationally in totalmedical and dental team productivity.

Approximately 65 million Americans live in communities with shortages of primary careproviders and nearly 50 million live in rural areas. Sebelius said health informationtechnology, and specifically EHRs, can improve care for patients and assist in clinicaldecision-making and the use of evidence-based guidelines. EHRs can also decreaseadministrative hassle, increasing workplace satisfaction and productivity.

The American Recovery and Reinvestment Act encourages greater use of healthinformation technology through significant new investments, Sebelius said. Throughincentive payments to providers and hospitals, she said, the ARRA will accelerate the

adoption of health information technology and creation of an interoperable, nationwidenetwork, and health insurance reform will build on this investment by simplifying andstreamlining administrative procedures, investing in telehealth and improving the qualityof healthcare

Secretary Siebelis



34/84

Secretary's Corner

Regional Framework: Introduction

It helps to have a System

Recent evidence indicates that some Americans benefit from better care. Largehealth systems such as the Veterans Health Administration and Kaiser

Permanente have significantly improved the quality of their care for their millionsof patients (ref). How did they do it and, more importantly, is their experience

relevant to the rest of American medical care? Studies of these high performinghealth systems tend to agree on the following predictors of success:

Strong leadership committed to quality improvement;

Shared vision among clinicians and business folks;

Routine measurement of the quality and costs of care;

Emphasis on primary care and its integration with specialty care;

Evidence-based guidelines integrated into performance measurement andclinical decision-making;



35/84

Information technology that facilitates performance measurement, andprovides decision support for clinical care; and

Organized quality improvement activities.

Of course, this raises the question of what can be done for those people who are

not part of a large, high performing system? A growing number of places in theUnited States, are exploring broad-based, geographically focused improvementsto the communitys healthcare infrastructure. We have been examining the

success stories among these coalitions, and seeing what common lessons canbe drawn about how they are formed and the work they do. Detailed reports on

what we have found to date can be read here, what follows is a brief and generaloverview of the constituent parts of successful healthcare coalitions.

The Framework for Creating a Regional Healthcare System

The experience of community-based efforts to improve health and healthcare,

complemented by that of successful large organizations, leads us to propose aframework for improving the quality and efficiency of healthcare for a

geographically defined population. The proposed Framework and its specificcomponents are not evidence-based, as rigorous research evaluating theimpacts of regional initiatives and the proposed components on regional

quality, health outcomes, and costs has been very limited. In fact, some of theelements mentioned in the Framework - such as public disclosure of

performance data - remain controversial, at best. Therefore, the proposedFramework is descriptive and heuristic, a compendium of important local

responses to the major problems and trends in current American healthcare

The Framework might be best explained from the bottom up. The overall goalsof the structure and activities described in the Framework are to:

improve the quality of care and outcomes across a population,especially for those with a chronic illness; and

reduce the costs of care for that population through waste reduction,outcome improvement, and greater administrative efficiency.

These ambitious goals will not be achieved without major redesign of ourcurrent care delivery systems, small and large. So, transformation or redesign

of healthcare delivery in accord with the Quality Chasm aims is an essentialintermediate outcome. Such broad scale delivery system changes are unlikelywithout direct support of practices and active programs of practice change,

and changes to benefits and provider payment to make them more conduciveto system change. It is also entirely possible that consumer encouragement ofcost-effective care through advocacy and purchasing will accelerate change.

All three strategies benefit from the pooling of clinical and cost data to supportclinical care and for performance measurement. In most communities, data on

http://www.iom.edu/CMS/8089.aspxhttp://www.iom.edu/CMS/8089.aspx


36/84


37/84

healthcare systems to improve and become more efficient. Public disclosure ofperformance data is widely recommended although there has been little if anydemonstration of impact on consumer behavior. Purchasers are clearly shifting

costs to consumers. While we lament the increased financial burden onconsumers, cost-sharing strategies that increase consumer involvement in

decisions about their care may encourage more cost-effective care and reduceunwarranted, supply-driven demand. Strategies to increase the use ofeffective generic drugs are a prime example.

Removing some of the disincentives, redund

Documents

CIBER Healthy Community Model