Stories Archive - Page 18 of 18

Teledentistry: Reducing Absenteeism by Supporting Student Health

The full version of this story, published by Healthy Schools Campaign, is available at https://healthyschoolscampaign.org/policy/teledentistry-reducing-absenteeism-by-supporting-student-health/. Below is just an introduction.

A terrible toothache is virtually impossible to ignore. For millions of children across the nation, the consequences of untreated tooth decay extend far beyond momentary pain to include potentially devastating effects on their long-term learning and opportunity.

Now, a new approach called teledentistry offers the promise of addressing this issue and relieving the lifelong burden it places on young children.

Fostering Community Resilience: How one Indiana Community Meshed its Resources to Improve Preparedness

By Justin Mast, RN, BSN, CEN, FAWM, Senior Crisis and Continuity Advisor, MESH

Seven years ago, Wishard Memorial Hospital, now Eskenazi Health, was one of five organizations to receive a $5 million grant from the Assistant Secretary for Preparedness and Response to create innovative public health and healthcare emergency response and management models.

To try something new, Dr. Charles Miramonti, an emergency department physician, looked at relationships, policy and technology. Ultimately, he created a team of healthcare leaders from all of the area’s major hospitals, known as the M anaged Emergency Surge for Healthcare (MESH) Coalition, based in Indianapolis.

Initially, MESH created a framework for sharing resources, a centralized cache of supplies, protocols for coordinated emergency response efforts and training opportunities. All these efforts better centralized preparedness functions across the Central Indiana region.

After building the coalition, marshalling resources and creating efficiencies in public health preparedness, to continue our work, we hosted a work group to focus on disaster planning for children, mothers and expecting mothers.

Quickly, we realized that we had to build community resiliency and that there was a significant vulnerable population that hadn’t been fully addressed when it comes to preparing for emergencies: children who are dependent on electric equipment, most notably ventilators.

During weather events, we found that families with children on ventilators were coming to the emergency room to ensure they would have electricity. They often brought other family members and stayed for the duration of the storm.

To look at the problem, we took three steps:

Fact finding and research;
Creating a registry of children in the state who are dependent on ventilators; and
Writing an educational toolkit for families and providers (also in Spanish).

First, we wanted to see if there were places other than hospitals that would be able to maintain a power supply during an emergency. It would be beneficial to the entire community to keep people out of the hospital if they didn’t need urgent care at that moment—as long as we could safeguard their health.

We spoke with emergency personal in every county to get a sense of what resources existed and what needs there were—we needed to know if it was possible to give families another location they could go to during an emergency. Ultimately, we developed a database that includes 181 power safe facilities with nearly two locations for every county.

While having the alternate locations mapped was great, they would only be helpful if we could identify and inform the families that would need to use them. So, we built a HIPAA compliant registry that parents can use to register their ventilator-dependent children.

The third piece of the puzzle was informing and educating families and responders. We wanted to give families tools to connect with local resources because it’s far easier—in more rural areas—to get to those places during an emergency. We also wanted to empower families to reach out to these services and personnel, which would make the connections even stronger.

So, we created tools, including a video (also in Spanish), to educate families on how weather could impact the power supply their children depended on. The toolkit includes draft letters families can send to authorities—such as EMS and fire—to let them know in advance there is an electrically dependent patient in the household.

We then gave the toolkit to hospital nurses to pass along to families at discharge. And, throughout the development, we partnered with the Indiana Emergency Medical Services for Children (IEMSC), Indiana State Department of Health and other partners whom were instrumental in creating the toolkit and spreading the resources across the state.

We also worked with medical equipment providers and let them know that there are resources for families. They were extremely happy to provide information on the toolkit and registry to their patients.

It’s hard to believe that just five years ago each individual Central Indiana hospital and healthcare facility prepared to face a public health emergency on its own—completely apart from the other resources, infrastructure and partners, just down the road.

Now, the MESH Coalition is helping providers prepare for and respond to emergency events and communities remain viable and resilient through recovery.

We know that, by forging these innovative partners, we have saved millions of dollars on redundant equipment and emergency supplies. Through all of these efforts, the MESH Coalition is building resilience in the healthcare sector and improving everyday life for Hoosiers.

Improving the Health of Communities by Increasing Access to Affordable, Locally Grown Foods

BY MICHEL NISCHAN, CEO and Founder, Wholesome Wave

When my son was diagnosed with type 1 diabetes, I became painfully aware of the direct connection between food and health. As a chef, this realization caused me to transform the way I fed my family and customers. Fresh, nutrient-dense, locally grown foods became the foundation for the type of diet that would give my son and restaurant guests the best long-term health.

Quickly, though, I recognized that not every family can afford to purchase healthy foods. As a result, I founded Wholesome Wave in 2007.

Wholesome Wave is a 501(c)(3) nonprofit dedicated to making healthy, locally and regionally grown food affordable to everyone, regardless of income. We work collaboratively with underserved communities, nonprofits, farmers, farmers’ markets, healthcare providers, and government entities to form networks that improve health, increase fruit and vegetable consumption and generate revenue for small and mid-sized farms.

Double Value Coupon Program

In 2008, we launched the Double Value Coupon Program (DVCP), a network of more than 50 nutrition incentive programs operated at 305 farmers markets in 24 states and DC. The program provides customers with a monetary incentive when they spend their federal nutrition benefits at participating farmers markets. The incentive matches the amount spent and can be used to purchase healthy, fresh, locally grown fruits and vegetables.

Farmers and farmers’ markets benefit from this approach, and have been key allies as we work towards federal and local policy change. In 2013, federal nutrition benefits and DVCP incentives accounted for $2.45 million in sales at farmers’ markets.

Communities also see an increase in economic activity. The $2.45 million spent at local farmers’ markets creates a significant ripple effect. In addition to the dollars spent at markets, almost one-third of DVCP consumers said they planned to spend an average of nearly $30 at nearby businesses on market day, resulting in more than $1 million spent at local businesses. We also see that the demographics of market participants are more diverse – our approach breaks down social barriers and allows consumers who receive federal benefits to be seen as critical participants in local economies.

Equally as important, people are eating healthier. Our 2011 Diet and Behavior Shopping Study indicated 90 percent of DVCP consumers increased or greatly increased their consumption of fresh fruit and vegetables – a behavior change that continues well after market season ends.

Today, the program reaches more than 35,800 participants and their families and impacts more than 3,500 farmers. Combined with the new Food Insecurity Nutrition Incentives Program in the latest Farm Bill, this approach is now being scaled up with $100 million allocated for nutrition incentives over five years.

Fruit and Vegetable Prescription Program

We developed the Fruit and Vegetable Prescription Program (FVRx) to measure health outcomes linked to fruit and vegetable consumption. The four to six month program is designed to provide assistance to overweight and obese children who are affected by diet-related diseases such as type 2 diabetes. In 2013, the program impacted 1,288 children and adults in 5 states and DC. Nearly two-thirds of the participants are enrolled in SNAP and roughly a quarter receive WIC benefits.

The model works within the normal doctor-patient relationship. During the visit, the doctor writes a prescription for produce that the patient’s family can redeem at participating farmers’ markets. The prescription includes at least one serving of produce per day for each patient and each family member – i.e., a family of four would receive $28 per week to spend on produce. In addition to the prescription, there are follow-up monthly meetings with the practitioner and a nutritionist to provide guidance and support for healthy eating, and to measure fruit and vegetable consumption. Other medical follow-ups are performed, including tracking body mass index (BMI).

FVRx improves the health of participants. Forty-two percent of child participants saw a decrease in their BMI and 55 percent of participants increased their fruit and vegetable consumption by an average of two cups. In addition, families reported a significant increase in household food security.

Each dollar invested in the program provides healthier foods for participants, boosts income for small and mid-sized farms and supports the overall health of the community. As with the DVCP, there are benefits for producers and communities. In 2012 alone, FVRx brought in $120,000 in additional revenue for the 26 participating markets.

In less than seven years, Wholesome Wave has extended its reach to 25 states and DC and is working with more than 60 community-based organizations, community healthcare centers in six states, two hospital systems, and many others. Our work proves that increasing access to affordable healthy food is a powerful social equalizer, health improver, economic driver and community builder.

Wholesome Wave is working to change the world we eat in. As the number of on-the-ground partners increases, we get closer to a more equitable food system for everyone. This means healthier citizens and communities, and a more vibrant economy nationwide.

Connecting Diabetes Care from the Clinic to the Community

BY JOHNNA REED, vice president, business development, Bon Secours Health System

In 2011, the Bon Secours St. Francis Health System in Greenville, South Carolina created a Diabetes Integrated Practice Unit (IPU) to foster a new environment that improves the health of patients with, or at risk of developing, type 2 diabetes.

Since most of the factors that influence health exist outside of the doctor’s office, we’ve learned the importance of connecting our patients to resources in their communities. This helps them in their daily lives and better supports their ongoing medical care.

The goal of the Diabetes IPU is to connect patients with community resources that can help benefit their health through improved nutrition, increased physical activity and support to manage their condition. The program also ensures that physicians and other caregivers have sufficient time to focus on their patient’s needed care. This added time also allows providers and patients to work together to understand how obesity, prediabetes and diabetes can affect health and daily life and to set goals that work for each patient’s unique circumstances.

The program also emphasizes the importance of prevention, to avoid developing additional health risks or problems in the future. We help prediabetics avoid the progression to diabetes and help diabetics avoid developing additional conditions.

The program is designed around a network of community and clinical resources, providers and technology. While the program hub is at St. Francis Millennium, the programs themselves are delivered where patients are—at work, home, and throughout the community.

The Diabetes IPU includes an extensive coordinated team of care givers, including a primary care physician, ophthalmology, cardiology, nephrology and podiatry services, and an endocrinologist who consults with the primary care physicians regarding innovations in diabetes care and assists with the care of patients facing particular medical challenges.

The medical care is managed by a registered nurse care coordinator. It’s also important to note that our care team includes a psychologist, social worker, registered dietician, diabetes educator, pharmacist, and an exercise physiologist to help patients get to a healthy weight. It is not just a clinicalcentered approach — it’s a total community health approach.

HOW THE IPU WORKS:

A patient’s initial visit with the diabetes team begins with a fasting blood draw to determine blood glucose, HbA1c, cholesterol, and other relevant lab values. Following the blood draw, patients are provided a diabetes-appropriate breakfast. Next, the patient is asked to participate in a small group discussion about issues they have in dealing with diabetes, led by a diabetes educator and nurse. Facilitators are continually surprised at the level of engagement in these groups — patients tend to share readily and openly.

The group discussion not only introduces patients to others who share similar health and lifestyle challenges—including being overweight or obese and struggling to engage in physical activity and eat healthy—but also enables the nurse facilitator to determine the best match for the patient with individual caregivers. After the discussion, the entire group receives an introduction to exercise with an exercise physiologist who provides an easy, low stress overview of exercise options.

In the course of this first morning, the patient sees the primary physician, psychologist, diabetes educator, and registered dietitian. Each patient also receives a retinal scan and foot exam. Finally, patients are served a diabetes friendly lunch with the clinical team present to answer questions about the food or anything else related to diabetes.

However, our work doesn’t stop when the patient leaves the clinic. Because the needs of patients with type 2 diabetes require support and resources in the community, our diabetes program provides worksite and home services. After their visit, a team member meets with patients in their home to assess the support network available and to identify areas where patients will face particular challenges. Our teams then work with family and employers to inform and facilitate improvements in the home and work environments and sometimes in the local grocery stores and pharmacies.

Often, the care team conducts a thorough workplace assessment to determine how each patient’s work setting impacts his or her health. For example, if there is no access to healthy foods, we work with the employer to improve the food options at a worksite. It might be surprising that employers have been incredibly supportive, however they fully understand the importance of having a healthy, happy, and productive workforce.

From the patient perspective, the most important measure is improvement in the ability to live (i.e., to work, participate in family life, attend important events, and enjoy daily activities). With each patient, the care team identifies capabilities that are motivating and meaningful and track their improvement. While these measures require greater effort to quantify, they are often the drivers of people’s long-term commitment to lifestyle change and health.

Patients have responded incredibly well. A recent patient entered the program hoping to improve his health, get off regular insulin and lose about 60 lbs. With the diabetes team’s help, he understood the need to deny barriers and stressors, such as fast food and sugary drinks, and was very successful.

Through the program, he increased glucose monitoring from to three to four times daily; went from not exercising at all to exercising four times a week at the facility we recommended to him; attended all prescribed education opportunities and shared medical group appointments; and engaged often with our dietician. While he hasn’t yet reached all his top-level goals, he lost more than 45 lbs., reduced his BMI from 33.7 to 27.5 and his waist size from 44 to 36, and no longer needs mealtime insulin coverage.

The most successful patients are the ones who receive a continuum of care from the clinic to their community. Our model improves a physician’s capability by bringing all of the necessary community resources together. Research shows that what happens outside the doctor’s office can have a major impact—either positive or negative—on our health. That’s why we began the Diabetes IPU model and why we’ll continue using it to fight obesity and improve the care of individuals with prediabetes or diabetes.

A Menu Approach to Public Health: Empowering People to Take Responsibility for their Health Choices

By Tracy Neary, Director of Mission Outreach and Community Benefit, St. Vincent Healthcare

For nearly twenty years, St. Vincent Healthcare, a care site operated by the Sisters of Charity of Leavenworth Health System (SCL Health System), the Billings Health Clinic and RiverStone Health, our local health department, have been working together to address complex community wide health issues by adopting intervention strategies identified through a recurring CHNA.

A significant early collaboration came in 1994 when the CHNA showed access to prescription medications was a major issue for our community. We created a medication assistance program (MAP) that helped patients who couldn’t afford prescriptions obtain them.

Last year, MAP advocates, funded in part by St. Vincent Healthcare, assisted approximately 1,200 people with accessing medication worth more than four million dollars. What began as a single access point has expanded to a dozen locations across our community.

The initial collaboration, which began in the early 1990s, between the three organizations became more formal with a Memorandum of Understanding in 2001 to create “The Alliance”. Chief executives of our two competing hospitals and the public health department committed organizational expertise in planning, communication, advocacy, community benefit and clinical services to help lead community efforts to improve health.

Through a CHNA, we found there was a significant need for mental health services, as hospital emergency departments were being inundated with people who didn’t really need medical care but were admitted because of a mental health crisis. Knowing that emergency rooms are not typically the best place for mental health interventions, we created a joint partnership with the two hospitals to build the Community Crisis Center (CCC), the first licensed out-patient crisis management program in Montana.

Now, the CCC is staffed 24 hours per day, seven days per week with a combination of registered nurses, licensed mental health therapists, and mental health technicians. During an outpatient visit, clients are stabilized and assessed to facilitate the development of a crisis management plan.

The CCC has successfully reduced inappropriate utilization of local emergency departments, decreased the number of short-term inpatient hospital admissions, and has been a driving force in reducing the inmate population at the Yellowstone County Detention Facility.

Additionally, the CCC offers crisis intervention training to law enforcement officers in the region. Officers learn how to recognize mental health distress and de-escalate individuals rather than interacting with people in a way that escalates anxiety. Law enforcement officers credit the training with helping them more effectively respond to situations involving individuals with mental health disorders, especially those in suicidal situations.

One of our crisis intervention program officers, off duty at the time, was driving across a bridge and a man was on it threatening suicide. The officer was able to talk the person down without anyone getting hurt.

This is one example of how a community program has a wide-reaching public health benefit. Instead of the individual hurting himself and/or others, no one was hurt and the appropriate part of our community’s medical system (the mental health portion versus an emergency department) was involved.

In 2005, RiverStone Health underwent an assessment of the public health system’s performance in the 10 Essential Public Health Services established by CDC. The assessment was conducted using the National Public Health Performance Standards Program (NPHPSP), also established by the CDC. A key outcome of that assessment was an understanding of the need to perform a community health assessment and develop a community plan. The Alliance then sponsored the 2006 CHNA where childhood and adult obesity, heart disease, diabetes, nutritional intake, unintentional injury, and chronic depression were identified areas of weakness. Physical activity, nutrition, and well-being were selected as the areas of improvement because of their inter-connectedness and their collective benefit on our community’s health. The results moved us to thinking about longer term population health improvements through policy, system and environmental change strategies. We began by creating an operational work plan, “The PITCH.” The Plan to Improve the Community’s Health (PITCH) focuses on physical activity, nutrition, and well-being. PITCH is intended to increase awareness and knowledge of, as well as access to, healthier lifestyles in Yellowstone County.

This plan was developed with a broad variety of community stakeholders who participate in achieving the identified goals as part of a broad coalition. With the support of the Robert Wood Johnson Foundation, one of the most impactful early Health Impact Assessments (HIA) we completed was with our city/county master growth plan. Results of the HIA led to the adoption of a new health section within the plan in 2008, which set the foundation for later success in adopting a complete streets policy for Billings. This accomplishment was supported in large part by our work with Action Communities for Health, Innovation, and EnVironmental ChangE (ACHIEVE).

As one of the ten original participants in the Healthy Weight Collaborative, a project of the National Initiative for Children’s Healthcare Quality (NICHQ) and HRSA, we partnered with primary care providers to better document body mass index (BMI) in medical records and, if a BMI was too high, offer a patient-directed healthy weight plan. The efforts have created new collaboration between providers and community organizations.

The partnership has also launched an effort into the worksite by developing physical activity and nutrition guidelines. We found that it is important to create a menu approach of evidenced-based practices that have been shown to increase physical activity (i.e., promoting use of stairwells, on-site exercise classes, etc.). The menu option allows businesses to pick and choose which policies are appropriate in their environment and also empowers employers. A similar project, the “Healthy By Design” (HBD) endorsement, was developed as a way of promoting events in Billings that are designed with health in mind. This endorsement is done through an application process and each application is reviewed and evaluated by a team of experts. There are five criteria: safety; nutrition; physical activity; prevention and wellness; and environmental stewardship.

As we look to the future and our interconnected health system, we see a community that is Healthy By Design with active people working to improve their own health and the health of those around them. It is a dream we plan to realize by continuing our work to identify unmet health needs and leading efforts to coordinate a community based response. We recognize the critical importance of key stakeholders in economic development, private business, city government, education, strategic planners in addition to traditional health partners. Our website, www.healthybydesginyellowstone.org includes our CHNA, work plans, accomplishments and a variety of tools we have developed to achieve our vision.

Local Health Officials: Chief Health Strategists Transforming Communities

By Rahul Gupta, Health Officer and Executive Director, Kanawha-Charleston Health Department

Just like the rest of the country, West Virginia and Kanawha County has been battling the obesity epidemic for decades. Across the state, there have been a myriad of physical activity, nutrition and other initiatives focused on helping people get to and remain at a healthy weight.

However, when these obesity prevention programs came in, there was a huge problem with sustainability so after a few years a program would lose funding and disappear. Quickly, residents saw these programs as fads or simply flashes in the pan. A lot of communities around the state felt kind of used, they were put into a program and researched and when the grant was up, the program was gone and, with it, the support, incentives and staffing. There was nothing built into the infrastructure of the community so there was no capacity left to sustain the process.

Clearly, as obesity rates and chronic conditions like diabetes continue to increase, this incremental, start and stop approach has failed. Realizing this early on, our community created an independent Health Coalition in Kanawha County that included the local hospitals, K-12 education systems, higher education, business and other people who had a stake and roots in our community. While health and wellbeing is a personal responsibility, it is the local, state and national government’s job to provide easy outlets for citizens to reach their goals.

The founding idea of the coalition was that if there are challenges facing the community, they will be brought to the coalition and they will be solved and resources will be dedicated by partner agencies.

As the coalition’s benefits to the community became apparent, it was obvious that the state needed more of these county-level coalitions across West Virginia.

Transforming Communities

When the CTG program was launched in May, 2011, we saw this as an opportunity to obtain the kind of resources and support that could stand up programs and capacity which would then remain in place after grant dollars disappeared.

The CTGs made it even easier to bring stakeholders and institutions to a common table to talk about health. At the outset, we had over 100 organizations interested in being part of transforming the state and local communities.

As we learned our lesson from past grants and programs, we weren’t going to let everyone get their piece of the CTG pie and go home in a silo. We wanted to ensure that each community worked with each other as well as across the traditional silos, so efforts were complimentary, not duplicative. It became evident that the best conduit for the grant money and ideas to flow was through Local Health Departments (LHDs). Our plan was to position the LHDs from all 55 counties as wellness or healthy living hubs for their communities. They would work with the local and state Departments of Education, West Virginia’s Universities and the Osteopathic School to ensure plans would work and were research driven and connected to clinical settings.

While it might not seem like a huge shift, this was a culture change in how resources and grants were distributed across the state. Instead of each LHD getting their money and going home, it was clear the funding was to build capacity, i.e., the resources and ability to do things — sort of how it’s better to teach a man to fish than simply give him a fish. LHDs were also the natural lead because they were trusted voices in the community and, quite simply, they weren’t going anywhere. Every day, in each community across West Virginia (and across the nation, for that matter) local health employees serve to carry out and accomplish the basic public health needs of their jurisdictions.

As a result, our communities are safer, healthier and protected from deadly diseases. Once we had the framework in place, we went back to communities to understand their needs.

Every three years, our county coalition conducts a needs assessment, which includes telephone surveys, focus groups, and key informant surveys.

A community forum, which is open to the public, is held to prioritize the top three health concerns in the county. Once identified, work groups are formed to address these health concerns over the next three years within the county after which the process recommences with a new needs assessment. Examples of health concerns that our community has asked to address in the past have included high rates of tobacco use including second hand smoke, poor nutritional standard, lack of physical activity and prevalence of substance abuse.

While we haven’t been able to create a statewide Comprehensive Clean Indoor Air Regulation (CIAR), that hasn’t stopped LHDs like Kanawha-Charleston Health Department (KCHD) from creating their own ordinances and enforcing them — it’s great to enact a policy, but the enforcement has to be just as good

In Kanawha County, our Sanitarians conduct close to 5,000 inspections annually to ensure our CIAR ordinance is enforced and we have a near 100 percent compliance rate. To build support in our community for the ordinance, we took not only a policy approach (discussing the medical benefits of clean air), but also a social/media approach, business approach (showing that it would not hurt bars or restaurants but actually could increase business), and a science and research approach (we demonstrated a 37 percent reduction in heart attack related hospital admission rate in presence of CIAR over eight years — published in CDC’s Preventing Chronic Diseases, July 2011 issue). Every facet of our community became advocates for clean air for different reasons — a one-time tobacco-reliant community transformed into one with clean air.

Meanwhile, at a state level, we continue to work toward enacting a statewide comprehensive law. While it has happened incrementally, the capacity and know-how is there across the state. In fact, our local ordinance has been utilized by the state’s Division of Personnel to implement a state employee policy against second hand smoke. Consequently, the state government, without legislation, has adopted a comprehensive clean indoor air regulation for all state employees, which reaches and benefits thousands of West Virginians.

In addition, in doing our needs assessment, it became clear that people simply didn’t have access to safe places to work out and play. There was a huge barrier on the environmental side in our community: there were no sidewalks and the areas with the largest populations had no options for physical activity. We needed to connect those who wanted to work out with safe places to do so.

In Kanawha County, we built a Physical Activity Sites Google Map (http://www.kchdwv.org/Home/Health-Promotion.aspx). It includes a Google map of all physical activity opportunities in the County as well as tools such as walk score, Everytrail and Gmaps pedometer which can be used on mobile devices. The map empowers people to seek out nearby physical activity outlets. We hope to replicate this model in other counties across the state through CTG.

In addition, we’re looking to improve nutrition and physical activity in school and after-school settings, by, most notably:

Farm-to-School Initiatives: We have developed blueprints and guides for county Food Service Directors and farmers, giving them the capacity and knowledge to stand up their own sustainable programs.
Child and Day Care Center Nutrition Programs: We implemented the “Be Choosy, Be Healthy” program, which educates and empowers children to choose healthy lifestyles. We have also expanded the “I am Moving, I am Learning” curriculum, which increases physical activity and promotes healthy food choices.

Lastly, our state is supporting the development of community coordinated care systems that link and build referral networks between the clinical system and community-based lifestyle programs that can help people overcome disease and disability and manage their health. We’ve linked clinicians with programs like Dining with Diabetes, Patient Centered Medical Home pilot initiatives, the National Diabetes Program and Chronic Disease Self-Management Program.

We want programs to be complimentary to clinical practice. If a physician is seeing 30 patients a day that need diabetes/weight loss resources, we need to provide these clinicians with the capacity and information to direct their patients to a referral network outside the doctor’s office. This approach is both time and cost effective and has the potential for healthier outcomes for patients.

West Virginia has worked long and hard to reverse the obesity epidemic. We’ve learned what doesn’t work and we’re beginning to transform our state, community by community. It’s become clear that we need to provide people with the resources to create their own programs and that positioning LHDs as chief health strategists will ensure capacity is maintained and programs continue if grant funding disappears. By ensuring that education, health, commerce and other key stakeholders are responsible for setting and enforcing policy, the entire community truly has a stake in the health and wellbeing of everyone.

Access a PDF of the story here.

The Salt Lake Metropolitan Area: Both Sprawling and Walkable, Depending On Where You Look

Salt Lake City has a reputation as a city whose residents are physically active. Many people there hike, bike, ski, walk, and run in the hills, canyons, and mountains surrounding the city.

Last year, Men’s Health magazine chose Salt Lake City as the “fittest city in the country.”

Even so, the Salt Lake City area has not escaped the obesity epidemic that has swept the country over the past few decades. Almost a quarter of all residents are obese.

One reason for this contradictory mix of fit and fat is the area’s physical environment. It offers ample outdoor recreation options, it has a robust mass transit system, and several neighborhoods that encourage people to walk and bike.

At the same time, it also includes a good number of sprawling, disconnected suburbs that make it difficult for residents to be active.

Many American cities face similar issues. But in Salt Lake City the contrast between the two kinds of environments — those that encourage physical activity, and those that discourage it — is particularly striking.

Overall, the Salt Lake area has several features that increase opportunities for everyday walking. The region has a growing transit system that includes commuter rail, light rail, and buses. More than 143,000 trips are taken on the system each day.

That number will soon grow. The Utah Transit Authority (UTA), the state agency in charge of rail transportation, is now in the middle of a $2.6 billion project that will add four more light rail lines and another commuter line, more than doubling the current 64 miles of track.

In addition, Salt Lake City will soon begin building a $55 million streetcar line, that will extend over two miles through the downtown Sugar House neighborhood. The project has received significant support from Salt Lake City Mayor Ralph Becker, who sees it as a cornerstone of downtown revitalization. The city is working on plans for two additional streetcar lines.

A former city planner who rides his bike to work nearly every day, Becker has played a major role supporting policies that encourage physical activity.

Under Becker, Salt Lake City has increased its budget for bicycling from $50,000 to $500,000, and hired a bicycle coordinator. The city now has 170 miles of bike lanes, 47 miles of bike trails, and 26 miles of walking trails. This

year it will add another 65 miles of bike lanes. “We are taking a comprehensive approach,” said Becker. “We want to increase biking, walking, and transit service. We’ve got a long way to go, but we’re making good progress.”

Last year, the mayor initiated a review of all city ordinances to identify those that impede active living. So far, officials have identified more than 300 that they hope to change, including laws that discourage urban agriculture, and mixed use zoning. Blending retail and residential use can help increase walking and biking; when stores are close to homes, people don’t have to drive to go shopping.

The city also boasts several areas specifically designed to encourage physical activity. Gateway, a decade-old development west of downtown, features apartments built above a range of stores, as well as a nearby supermarket.

In recent decades, another neighborhood near downtown, The Avenues, has been revitalized. Built more than a century ago, the area has small lots, gridded street design and sidewalks— all of which make walking easier. And next spring, a new development will open, also downtown: City Creek will encompass 20 acres, and will include condominiums, department stores, and a 50,000-square-foot supermarket. Funded by the Mormon Church, it will cost $1.6 billion. Fifteen miles south of the city, another community is also emphasizing active living. Daybreak, a planned suburb, opened in 2005 and will eventually encompass 4,000 acres. Building will continue for another two decades; eventually Daybreak will include more than 162,000 houses.

Planners specifically overseeing the development specifically designed Daybreak so that residents can easily walk or bike. Houses are close together, and residential areas are close to shopping areas and schools. Streets are narrow and include sidewalks, which makes it easier to cross and slows vehicle speed. All houses will be a short walk to a park, and the development will eventually have nearly 40 miles of trails. In addition, Daybreak is linked by light rail to downtown Salt Lake City.

“It’s a more compact community, and that seems to produce more walking,” says University of Utah professor Barbara Brown, who studies the link between obesity and neighborhood layout. “It’s a nice example of how a city can be designed to produce more walkability.”

She and her colleagues found that children in Daybreak are much more likely to walk to school than kids in a more typical suburban community nearby. According to their research, more than 80 percent of Daybreak students walked to school at least some of the time, compared with about 20 percent in the other neighborhood.

“Judging from this, kids in Daybreak get significantly more physical activity from walking to school than kids in surrounding communities,” Brown said.

In another study, Brown looked at how the layout of different Salt Lake area neighborhoods affected the weight of residents. She rated the levels of sprawl in various neighborhoods throughout the area; among other measures, she looked at the density of homes; the mixture of homes and retail businesses; number of streets with sidewalks and crosswalks; the number of stores with ground-floor windows (makes being on foot more appealing); residents’ sense of safety from crime and traffic problems; and the degree to which a neighborhood had a central area that residents could reach by walking or biking.

According to her calculations, many Salt Lake area communities had high levels of sprawl. Among the most spread-out were large suburbs south of the city, such as Draper, Sandy, South Jordan, and Herriman.

These communities were part of the sweeping national trend that started in the 1940s and continues with the McMansions of today: “After World War II, the whole development business changed,” says Reid Ewing, a professor of planning at the University of Utah who studies environment and obesity. “Spreading out became much more important.”

Brown found that people who live in more compact, and hence more walkable, neighborhoods tended to weigh significantly less than those who lived in more sprawling neighborhoods. On average, a typical six-foot-tall male in a sprawling area weighs ten pounds more.

Overall, Ewing says, the Salt Lake area epitomizes what’s happening all over the country. As cities and counties begin to engineer and re-engineer communities to promote movement and exercise, they must also deal with the legacy of older areas that in many ways hinder activity.

“There’s now a lot of evidence that the built environment affects people’s weight,” Ewing says. “Sprawling communities produce heavier people.”