Issue Category: Environmental Health

Corporation for Supportive Housing

The Corporation for Supportive Housing (CSH) provides capital, expertise, information, and innovation to transform how communities use housing solutions to improve lives of vulnerable populations. Founded in 1991 and headquartered in New York City with staff stationed in more than 20 locations throughout the country, CSH’s work focuses on capacity-building, policy and advocacy, supportive housing technical assistance and housing development, and demonstrating pilot initiatives to build evidence. One of CSH’s most effective pilots is the Frequent Users of Health Services Initiative, a six-year, $10 million pilot that sought to deliver innovative, integrated approaches to meet the health, housing, and social service needs of frequent users of emergency departments and inpatient hospitalization. Program results included a 27 percent drop in inpatient hospitalization versus a 26 percent increase for those not connected to housing. In addition, those in supportive housing experienced a 34 percent drop in emergency room visits compared to only a 12 percent drop among those not in supportive housing. In 2011, CSH was awarded $2.3 million over two years by the federal Corporation for National and Community Service and is using these funds to invest in supportive housing models that provide cost-effective solutions for people with complex health needs and facing housing crises. CSH funding comes from a mix of roughly 150 foundations, corporations, public agencies, investment income, and gifts from individual donors. Read the summary brief to learn more about this innovative program.

Register today for the July 10 webinar,  Advancing Health Equity During and Beyond COVID-19: Addressing Housing and Homelessness

Community Benefit Web Tool Prototype

The Department of Health Policy in the Milken Institute School of Public Health at The George Washington University was awarded a contract by the Robert Wood Johnson Foundation to develop a prototype Web Tool that provides easy access to the community benefit investment information that all nonprofit hospitals must submit annually to the Internal Revenue Service (IRS). The Web Tool will make hospital community benefit investment information easily available to public health experts, community stakeholders, hospital, and policymakers, among others. The Web Tool (to be completed in 2015) will enable users to compare hospital investments in their communities on the basis of factors such as geographic location, community economic status, and hospital characteristics such as size. To read more about this innovative program, see this brief summary [link].

Community Assessment Project

The Community Assessment Project (CAP) is a broad-based collaborative of the United Way of Santa Cruz County, California that jointly conducts community health needs assessments and publishes an annual countywide community indicators report. The report, first introduced 20 years ago, serves as the community health needs assessment for local nonprofit hospitals and includes indicators in six domains: economy, education, health, public safety, natural environment, and social environment. The CAP also conducts a bi-annual quality-of-life survey of the County’s households. A sampling of the goals in 2015 include: improvement in access to primary care; comprehensive health care coverage for children; and a decrease in the prevalence of childhood obesity. Annually, CAP measures and reports progress toward its goals. For example, in 2007, the Healthy Kids Insurance Program achieved 98 percent insurance coverage for children in Santa Cruz County. CAP is funded by local hospitals, city and county governments, utility companies, colleges, and non-profit organizations. To read more about this innovative program, see this brief summary [link].

Common Table Health Alliance: Backbone for the Healthy Shelby Partnership

The Common Table Health Alliance is a regional health improvement collaborative and an Aligning Forces for Quality Community. In 2011, the Shelby County Mayor, Memphis City Mayor, and the four major health systems engaged the Common Table Health Alliance as the backbone organization for the Healthy Shelby Partnership, which is one of the key pillars of Memphis Fast Forward, a broad-based collective impact initiative. Healthy Shelby connects social service agencies with the health care system to jointly address the social determinants of health. Common Table Health Alliance has implemented evidence-based and best practices, used social media, employed education programs, coordinated partner engagement, and is tracking 12 measures. Successful programs include a safe sleep campaign and a community hypertension registry. The goal is to improve the health rankings of Memphis and Shelby County. Healthy Shelby has received core funding from the Baptist Memorial Health Care, Methodist LeBonheur Healthcare, Region One Health and Saint Francis Hospital, city and county governments, and grants from the United Way and Medtronic. To read more about this innovative program, see this brief summary [link].

Changing the Narrative About What Creates Health—Essential Steps in Improving Population Health in Minnesota

The goal of Changing the Narrative about What Creates Health— Essential Steps in Improving Population Health is to bring about critical change to effectively address the social determinants of health and achieve health equity. Launched in 2011 by the Minnesota Health Department, this initiative shifts the responsibility for health to a community level to address the conditions in which all people can be healthy through policy, systems, and environmental changes. Key strategies include: the creation of a Healthy Minnesota 2020 framework that engages partners in all sectors; community engagement via the Healthy Minnesota Partnership, establishment of cabinet-level committee on Health in All Policies; a State Health Improvement Program that outlines policy, systems, and environmental changes; and creation of Accountable Communities for Health. By focusing the narrative on what creates health (beyond the health system), community agencies and groups have become involved in health policies contributing to policy changes including: anti-bullying law; minimum wage increase; smoke-free campuses and apartments; and complete street ordinances. Minnesota has also shown decreasing rates of childhood obesity and youth tobacco use, and increasing rates of breastfeeding. This initiative is funded by State Health Department grants. To read more about this innovative program, see this brief summary [link].

Women-Inspired Neighborhood Network (WIN Network): Detroit

In 2008, the CEOs of Detroit Medical Center, Henry Ford Health System, Oakwood Healthcare System, and St. John Providence Health System commissioned the Detroit Regional Infant Mortality Reduction Task Force to develop a plan of action to help more babies reach their first birthdays. The Task Force addresses Detroit’s infant mortality rate, which is nearly 15/1000 live births, among the highest in the nation. Working through a public-private partnership of Detroit’s major health systems, public health, academic, and community partners, the Task Force seeks to tighten the disconnected medical and social services for women. The Task Force and its WIN Network have realized a number of accomplishments as of August 2014 including zero infant deaths among more than 200 babies born to date and the enrollment of 364 pregnant women in the program. Funding for this project comes from a variety of foundations, organizations, and institutions. To read more about this innovative program, see this brief summary [link].

Communities That Care Coalition

The Communities That Care Coalition began in 2000 in Western Massachusetts to reduce youth substance abuse and improve youth health. The program brought together and coordinated the efforts of various local stakeholders including schools, youth and parent groups, law enforcement, health care providers, and the local hospitals. By implementing its Community Action Plan—which includes an annual Teen Health Survey, anti-substance curricula in local schools, social marketing, and forming strategic partnerships within the community—the Coalition has been successful in identifying several underlying risk factors of youth substance use in the area and priorities for improvement. During the 12 years of its work, the Coalition has measured substantial improvements in youth substance abuse, as well as a reduction in the underlying factors causing it. The Coalition is supported by state and federal grants. To read more about this innovative program, see this brief summary [link].

Increasing Access to Breastfeeding Friendly Hospitals: The Iowa Experience

By Jane Stockton, Community Health Consultant, Bureau of Nutrition and Health Promotion, Iowa Department of Public Health & Catherine Lillehoj, Ph.D. Research Analyst, Iowa Department of Public Health

The Iowa Department of Public Health (IDPH) has a long tradition of striving to improve the health and wellness of all residents. Because breastfeeding is a key strategy to preventing obesity among children and youth, IDPH has worked for the past several years to increase rates of breastfeeding initiation and duration.

Five years ago, Iowa ranked 31 out of 53 states and territories on a national survey, the Maternity Practices in Infant Nutrition and Care (mPINC). When we looked a little deeper, we realized that the rural nature of our state made maternal nutrition and care somewhat difficult.

For instance, 89 percent of Iowa counties are considered rural, with hospitals in rural counties having a higher proportion of Medicaid births (40 to 60 percent of births). Sadly, these hospitals often don’t have the necessary resources to truly improve breastfeeding education and provide the appropriate technical assistance. In general, rural hospitals experience unique barriers due to distance between hospitals, patients and other facilities, plus staff are often not dedicated to working in maternity care units.

To get over these hurdles, IDPH targeted hospitals in rural counties with significant numbers of Medicaid births. One of the preliminary activities to improve breastfeeding was to meet with key hospital partners (e.g., OB managers, Chief Nursing Officers, Directors of Nursing, Educators). Along with key partners, hospital policies related to breastfeeding were reviewed and results of the mPINC survey were discussed. Following these initial meetings, 53 hospitals voluntarily completed a pre-assessment using a self-appraisal tool. Subsequently, the IDPH hosted a training, called 6 Steps 4 Success, which we developed specifically to address the Ten Steps to Successful Breastfeeding, a set of evidence-based practices that have been shown to increase breastfeeding initiation and duration.

After receiving technical assistance, resources and staff education, 37 of the 53 hospitals completed a post-assessment. The majority of the hospitals implemented at least three of the Ten Steps and the most widely adopted policy, encouraging breastfeeding on demand, was implemented by 83 percent of the hospitals. After attending the 6 Steps 4 Success training, one nurse stated, “This gave me a lot to think about. I have changed my position and going to change my ideas, way I promote breastfeeding.” Hospitals frequently express their gratitude for the technical assistance and education being brought to them in their rural setting, rather than having to go to the larger cities for these services.

To further enhance statewide breastfeeding initiatives, efforts for the past two years have focused on improving maternity practice in four or five hospitals each year that meet three criteria: rural location, Medicaid birth rate higher than statewide average and an mPINC score of less than the statewide composite score. Using their mPINC survey data, hospitals are given assistance in reviewing the results, determining where the greatest opportunities for improvement are, and developing an improvement plan to address at least two of the dimensions of care. Over the course of one year, hospitals are offered:

  1. Technical assistance related to breastfeeding policy – telephone, face-to-face, electronic messaging;
  2. Resources – desk references such as Hale’s Medications and Mother’s Milk, Continuity of care in Breastfeeding: Best Practices in the Maternity setting; model breastfeeding policy, and a Self Attachment video;
  3. Educational opportunities – funding to send one staff nurse to Certified Lactation Counselor (or comparable) training, Breastfeeding Education for Iowa Communities, a four hour training developed by the Iowa Breastfeeding Coalition, and/or 6 Steps 4 Success training; and
  4. Networking opportunities – Iowa’s Annual Breastfeeding Conference and networking call for all participating hospitals.

The most recent data indicate all participating hospitals demonstrated improvement in several areas including: Labor and delivery practice (an improvement ranging from 3 to 230 percent), Staff Training (63 percent improvement), Breastfeeding Assistance (18 percent improvement), and Structural and Organizational Aspects of Care (94 percent improvement). In addition, staff who became Certified Lactation Counselors are now educating other nurses in their hospital.

To truly make these activities pervasive and sustainable, the IDPH knew it was important to collaborate with key partners with valuable expertise, including:

  • University of Iowa Statewide Perinatal Team – Breastfeeding Guidelines were written and incorporated into the Guidelines for Perinatal Services published by IDPH and distributed by the University of Iowa’s Perinatal Care Program. The Guidelines for Perinatal Services provides the framework to be used in defining and evaluating the level of perinatal services being offered by hospitals.
  • Iowa Breastfeeding Coalition – Breastfeeding Education for Iowa Communities, a four hour training curriculum, is being presented to healthcare communities throughout the state. The training curriculum, based on WIC’s Grow and Glow curriculum, was written as a collaborative effort by IDPH staff and ICBLC members of the coalition.

Over the past five years Iowa hospitals have gone from understanding what the term “Baby Friendly” meant and about the significance of the Ten Steps to Successful Breastfeeding, to having one hospital designated as Baby Friendly and many other hospitals in the process of achieving that designation

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References

Lillehoj, C. & Dobson, B. (2012). Implementation of the Baby-Friendly Hospital Initiative Steps in Iowa Hospitals. http://authorservices.wiley.com/bauthor/onlineLibraryTPS.asp?DOI=10.1111/j.1552-6909.2012.01411.x&ArticleID=1043603.

TFAH Supports the EPA and Obama Administration in Beginning to Address the Serious Health Consequences of Ground-level Ozone

Washington, D.C., October 1, 2015 – The Trust for America’s Health (TFAH) is pleased that the Environmental Protection Agency (EPA) has announced it will finalize an update to the National Ambient Air Quality Standard (NAAQS) for Ground-level Ozone. The following is a statement by Jeffrey Levi, PhD, executive director of TFAH.

“Today the EPA and Obama Administration announced they will finalize a long overdue update to the ground-level ozone standard. TFAH commends EPA for meeting the latest deadline and finalizing a ground-level ozone standard of 70 parts-per-billion (ppb)—far more in line with the current scientific evidence and an important improvement over the flawed 2008 standard.

However, as we have made clear in public statements to EPA, TFAH strongly believes that a standard of 60 ppb would best meet the expectations of the Clean Air Act and would give our nation’s families an ozone standard that protects their health.

EPA’s own science is clear that even healthy adults can experience adverse health effects from ozone at 65 ppb. And, research has told us for years that elevated levels of smog can cause asthma attacks, shortness of breath, trips to the emergency room and even premature death. Now, we are beginning to see research link low birth weight babies, negative neurological effects, and many additional health hazards to ozone.

At a time when obesity levels are stabilizing at an unspeakably high level and we are encouraging more and more Americans to be active, we aren’t providing clean air to breathe. In reality, the Americans—young children, the elderly, and those who already suffer from certain chronic diseases—who are most likely to benefit from being active outdoors are unfortunately those who are most vulnerable to the dangers of dirty air and ground-level ozone.

Improving the standard to 70 ppb is undoubtedly progress towards cleaner air and a healthier nation – however it also represents a missed opportunity for EPA to act on the best available science and truly protect the public’s health.”

 

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

Trust for America’s Health Releases Letter Detailing Strong Opposition to the Reconciliation Instructions Proposed by the House Energy and Commerce Committee

Eliminating the Prevention and Public Health Fund—which has the support of more than 900 organizations—would set Public Health back by a Decade

 

Washington, D.C., September 29, 2015 – Trust for America’s Health (TFAH) released a letter detailing strong opposition to the Reconciliation Instructions proposed for consideration by the House Energy and Commerce Committee, stating that eliminating funding for the Prevention and Public Health Fund would set public health back by a decade.

The letter also notes that more than 900 state and national organizations have already pledged their support for the Prevention Fund and details the successes of the Fund.

The letter, in part, reads:

“In the first six years since its inception, the Prevention Fund has invested nearly $5.25 billion in resources to states, communities, tribal and community organizations in support of community-based prevention, including tobacco use prevention, healthy eating and active living, as well as childhood immunizations and clinical prevention. Decimating the Prevention Fund in this manner would dramatically impede efforts underway to improve health, including:

  • The Preventive Health and Health Services Block Grant, which was doubled under the Prevention Fund and provides all 50 states, the District of Columbia, two American Indian tribes, and eight U.S. territories with flexible funding to address their unique public health issues at the state and community level.
  • Expanding Access to Cancer Screenings: In FY 2015, the Fund provided $104 million for the National Breast and Cervical Cancer Early Detection Program, which is helping states across the country provide cancer screenings to high risk women who are uninsured or underinsured.
  • The successful Tips from Former Smokers campaign, which in just its first three months inspired more than 1.6 million people to try to quit smoking, and more than 100,000 smokers have quit for good.
  • Funding for the section 317 childhood immunization program, which has been vital to preventing and responding to measles outbreaks, and epidemiology and laboratory capacity in all states, which are key to preventing and containing infectious disease outbreaks.

“These are just a few examples of the work underway thanks to the Prevention Fund. Massively reducing the Fund would set back public health by a decade, and would slash life-saving investments in every state that are desperately needed. For example, chronic diseases such as cancer, diabetes, lung disease, heart disease, and stroke are now responsible for seven out of 10 deaths and account for 86 percent of health care spending in America. An approach to deficit reconciliation that cuts prevention may in fact have the opposite effect – less prevention of illness and disease and increased future health care spending.”

 

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.