Access and Barriers to Health Care: Findings from Arizona...U.S. Obesity Trends 1985-2010 Clearly,...
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USING A MULTI-SECTOR APPROACH TO CREATE HEALTHY COMMUNITIES Joan Serviss, Arizona Housing Coalition Serena Unrein, Arizona Partnership for Healthy Communities
Transcript of Access and Barriers to Health Care: Findings from Arizona...U.S. Obesity Trends 1985-2010 Clearly,...
USING A MULTI-SECTOR APPROACH TO CREATE HEALTHY COMMUNITIES
Joan Serviss, Arizona Housing CoalitionSerena Unrein, Arizona Partnership for Healthy Communities
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Last year more than 25 Arizona-based nonprofits, foundations, businesses, and government agencies joined to launch the Arizona Partnership for Healthy Communities. Our vision is an Arizona where all communities are a healthy place to live.
Arizona Partnership for Healthy Communities
Role: Convene different sectors, foster healthy community development projects through: Technical resources Capacity Building Communications
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Our vision is that all communities in Arizona are healthy places to live. Our goal is to be the catalyst for 25 multi-sector projects in low-income communities by 2020. To get the work of the Partnership done, we have three working groups that meet monthly and they focus on the biggest barriers to healthy communities: capital, capacity, and connection. Capital thinks about how to increase the public and private funders understanding of an integrated approach to healthy communities. Capacity thinks about how to build capacity within Arizona to support integrated healthy communities activities. And the Connection Working Group implements communication strategies that healthy communities activities.
U.S. Obesity Trends 1985-2010
What is “health”?
“Health is a state of complete physical, mental
and social well-beingand not merely the
absence of disease or infirmity.”
Preamble to the Constitution of the World Health Organization, June 1946
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When we say we want Arizona’s communities to be healthy, we think it’s important to start by sharing what we mean by health. We like the World Health Organization’s definition of health: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
U.S. Obesity Trends 1985-2010
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Clearly, we’re facing some daunting health challenges. Look at the obesity trends from 1985-2010
2000
Obesity Trends* Among U.S. AdultsBRFSS, 1990, 2000, 2010
(*BMI ≥30, or about 30 lbs. overweight for 5’4” person)
2010
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Chronic Conditions
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And the news for chronic diseases isn’t good, either. Chronic diseases are long-lasting illnesses that generally can be controlled, but not cured completely. Examples of common chronic diseases include heart disease, cancer, and diabetes. Among the most common, costly and preventable of all health problems in the U.S. Can be disabling and reduce a person’s quality of life, especially if left undiagnosed or untreated.
What influences our healthMedical Care
10%Physical
Environment5%
Social Circumstances
15%
Behavioral Choices
40%
Genetics30%
Health Affairs: “The Case For More Active Policy Attention To Health Promotion”
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So what does impact health? Certainly genetics and medical care have a big impact on how healthy we are. But so do our behavioral choices as well as the physical environment and our social circumstances – which are often influence our behavioral choices.
HEALTH ≠ HEALTHCARE
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If the amount of healthcare you received determined how healthy you were, the United States would be the healthiest country in the world. Your health is not equal to the amount of healthcare you get. Paradoxically, as medical science has advanced, we’ve become less healthy. How do we create health if improving medical science doesn’t help?
Life Expectancy vs. Health Spending
AUS AUT
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ISRITA JPN
KOR LUX
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0 2000 4000 6000 8000 10000
LIFE EXPECTANCY IN YEARS
HEALTH SPENDING PER CAPITA (USD)
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Back in the 1970s, Americans typically lived longer than residents of other countries. United States' average lifespan has fallen one year behind the international average, lower than Canada and Germany, more akin to Slovenia and Chile. We’ve tried to spend more money on health care. What that’s gotten us - by far - the highest per-capita healthcare spending in the world, but one of the lowest life expectancies of any of the world's richest countries. Centers for Medicare and Medicaid Services (CMS) report http://thehill.com/policy/healthcare/225882-healthcare-spending-growth-at-53-year-low
Why Everyone is Affected
• Total U.S. spending on public and private health care =
$3.35 trillion in 2016• About 75% went toward
treatment of chronic disease• Increased demand for health
care
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WE ARE COSTING EVERYONE & EVERYTHING ELSE BY SPENDING SO MUCH MONEY ON HEALTH CARE. Health spending per person was $10,345, up $1,430 from 2012 Health care premiums for employer-sponsored coverage have increased by 87% since 2000 Total medical expenditures in the United States reached $2.9 trillion in 2013. Health spending per person was $9,255, up $340 from 2012. Health care spending is about 5x higher for people with a chronic disease U.S. employers and employees are paying for the high costs of chronic disease through the increase in health costs associated with greater demand for and use of health care services. Estimated annual medical cost of obesity was $147 billion in 2008 Medical costs for people who are obese were $1,429 higher than those of normal weight Data from Partnership to Fight Chronic Disease: http://www.fightchronicdisease.org/sites/fightchronicdisease.org/files/docs/GrowingCrisisofChronicDiseaseintheUSfactsheet_81009.pdf
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The Arizona Healthy Communities Opportunity Index (Opportunity Index) is made up of a set of indicators grouped into five dimensions and four themes. The dimensions include the built environment, public health, economics, vulnerable demographics, and multi-sector opportunities. The themes include public health, transportation, housing, and socio-economics. The Opportunity Index includes 15 indicators selected in connection with the dimensions and themes mentioned above. If asked about methodology: The methodology for calculating and mapping the Opportunity Index requires four steps. First, normalizing the indicators to put them all on a common scale. Second, averaging the rescaled scores together for all of the 15 indicators. Third, normalizing the averaged scores to reach a final composite score. Finally, mapping the calculated Index to provide a visual representation of the Index. All of the indicators in the Opportunity Index are weighted equally within each dimension, and each of the five dimensions makes up one-fifth of the final Index value.
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The Arizona Healthy Communities Opportunity Index (Opportunity Index) is made up of a set of indicators grouped into five dimensions and four themes. The dimensions include the built environment, public health, economics, vulnerable demographics, and multi-sector opportunities. The themes include public health, transportation, housing, and socio-economics. The Opportunity Index includes 15 indicators selected in connection with the dimensions and themes mentioned above. If asked about methodology: The methodology for calculating and mapping the Opportunity Index requires four steps. First, normalizing the indicators to put them all on a common scale. Second, averaging the rescaled scores together for all of the 15 indicators. Third, normalizing the averaged scores to reach a final composite score. Finally, mapping the calculated Index to provide a visual representation of the Index. All of the indicators in the Opportunity Index are weighted equally within each dimension, and each of the five dimensions makes up one-fifth of the final Index value.
Presenter
Presentation Notes
The Arizona Healthy Communities Opportunity Index (Opportunity Index) is made up of a set of indicators grouped into five dimensions and four themes. The dimensions include the built environment, public health, economics, vulnerable demographics, and multi-sector opportunities. The themes include public health, transportation, housing, and socio-economics. The Opportunity Index includes 15 indicators selected in connection with the dimensions and themes mentioned above. If asked about methodology: The methodology for calculating and mapping the Opportunity Index requires four steps. First, normalizing the indicators to put them all on a common scale. Second, averaging the rescaled scores together for all of the 15 indicators. Third, normalizing the averaged scores to reach a final composite score. Finally, mapping the calculated Index to provide a visual representation of the Index. All of the indicators in the Opportunity Index are weighted equally within each dimension, and each of the five dimensions makes up one-fifth of the final Index value.
OUR ZIP CODE IS MORE IMPORTANT TO OUR HEALTH THAN OUR GENETIC CODE.
Health Occurs Where You Live, Work, and Play
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Health doesn’t just take place in the doctor’s office. It also is impacted by other things in our communities. The design of many low-income communities makes it challenging for residents to be healthy and active. Healthy communities provide quality housing at affordable rates, transportation choices, opportunities for physical activity, and access to healthy foods. Affordable, healthy homes Transportation options Places to be physically active Fresh food retailers To improve health, we have to pay attention to built environment and how different sectors impact health. Walkability and the ability to be active are vital to our health One reason that we care about activity is that sedentary lifestyles contribute to cardiovascular disease, stroke, and diabetes. If we want a community to be healthy, it needs to be designed in a way that allows people to be active. When Charlotte, North Carolina first opened their light rail line, they found that people who regularly rode light rail lost 6 pounds on average and reduced their obesity risk by 81%. The National Household Travel Survey indicates that people who use public transportation spend a median of 19 minutes daily walking to and from transit, and 29% achieve 30 minutes of physical activity during transit access trips—much higher than the rates by non-transit users. *MacDonald, J., Stokes, R., Cohen, D., Kofner, A. Ridgeway, G. The Effect of Light Rail Transit on Body Mass Index and Physical Activity. American Journal of Preventative Medicine. (2010) 39(2): 105–112. Public Transit Users: Spend a median of 19 minutes daily walking to and from transit 29 percent achieve 30 minutes of physical activity during transit access trips Tend to weigh 3-7 lbs less than non-transit users
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If it can’t just be one sector working to change health, but how creating healthy communities has to be a multi-sector approach. We created the Arizona Partnership for Healthy Communities to be the independent third party bringing the key players to the table and inspiring collaboration among them. We engage partners throughout the state to foster and support multi-sector projects that make our communities healthier by design. Here’s a snapshot of some of the Partners involved with our efforts. We’re about partnership rather than “membership.” We are a collaborative organization striving to enact tangible, quantifiable change. To make sure that we can achieve a radical transformation of our communities, we’ve included the private sector at the table to ensure that banks, health insurers, and health care providers are active partners alongside the government and nonprofit sectors.
Intersection of Housing & Health
• Health inextricably tied to where we live
• “Our zip code is more important to our health than our genetic code”
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Where we live is at the very core of healthy lives. Why? We spend 2/3 of our time in our homes. Our home is the base of our life-physical, social, spiritual. Most everything emulates from where we live.
How Housing Affects Health
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Physical condition within the homes Neighborhood conditions Housing affordability
• Lead exposure• Cold and heat exposure• Accessibility and
accommodations• Substandard conditions:
water, ventilation, pests, mold, allergens
• Radon, asbestos, tobacco smoke
• Structural factors leading to injuries
Physical Condition of Home
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Asthma, lung cancer, and other respiratory illnesses can be caused by substandard conditions Exposure is a particular concern for the elderly Housing Conditions can cause psychological distress Structural factors leading to injuries: staircases, balconies, smoke detectors, windows
Neighborhood Conditions
Safety Transportation Access to healthy foods Access to employment opportunities Schools
Residents of the most walkable communities are more likely to meet the U.S. Surgeon General recommended 30 minutes per day of moderate activity
Neighborhood Conditions
Housing Affordability/Instability
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Financial burden. Overcrowding. Eviction spiral
Housing Affordability/Instability
Only 1 out of every 4 extremely low-income renters can find an affordable apartment in AZ
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Financial burden. Overcrowding. Eviction spiral 1 out of every 4 extremely low-income renters can find an affordable apartment in AZ
High housing costs affect health
Families who have trouble paying for housing are more 84% likely to delay medical care and 116% more likely to postpone buying medications
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Financial burden. Overcrowding. Eviction spiral 1 out of every 4 extremely low-income renters can find an affordable apartment in AZ Families who have trouble paying for housing are 84% more likely to delay medical care, 116% more likely to postpone buying medications
Housing Inequity=Health Inequity
Low income communities
Poor quality housing
Poor neighborhood conditions
Paying too much for rent
Poor health outcomes
Housing Stress Impacts Health
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Frees up financial resources for food, health care. Provides platform for health care delivery. Provides age in place opportunities. Reduces toxic stress.
Bridge to Permanency Housing Program: Tempe Housing Authority and MMIC
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Examples of Health & Housing projects: Tempe Housing Authority partners with Mercy Maricopa Integrated Care for rental assistance and supportive services for 25 Tempe residents with serious mental illness experiencing homelessness.
Estancia de Sol Apartment Community: CPLC and UnitedHealthcare
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United Healthcare provides $20 million in capital to Chicanos Por La Causa to buy and renovate a 351-unit affordable multifamily housing complex and deliver support services to the residents
Estancia de Sol Apartment Community: CPLC and UnitedHealthcare
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United Healthcare provides $20 million in capital to Chicanos Por La Causa to buy and renovate a 351-unit affordable multifamily housing complex and deliver support services to the residents
Cedar Crossing and Patina Wellness Center: Native American Connections
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Native American Connections develops Patina Wellness Center, a residential substance use treatment and recovery center, with Cedar Crossing, 74 affordable apartments
Cedar Crossing and Patina Wellness Center: Native American Connections
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Native American Connections develops Patina Wellness Center, a residential substance use treatment and recovery center, with Cedar Crossing, 74 affordable apartments
Housing + Health Collaboration
Permanent Supportive Housing NOFA: Arizona Department of Housing and AHCCCS
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Arizona Department of Housing coordinates with AHCCCS to develop a request for proposal for 60 affordable apartments with services for people experiencing chronic homelessness
Supportive housing helps vulnerable people
Allows people to live stably in communities People with disabilities in supportive housing
reduce their use of costly systems Seniors also benefit
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Allows people to live stably in communities Housing First program in Seattle showed health care costs savings of $43K/yr People with disabilities in supportive housing reduce their use of costly systems NYC program combines independent housing with case mgmt services 90% of the costs covered by reductions in use of public services (jails, ERs) Seniors also benefit Seniors in supportive housing were half as likely to enter nursing homes
How You Can Help
Work across silos Advocate for affordable housing funding: Department of Housing and Urban Development
(HUD) Low Income Tax Credit Program Housing Trust Funds
Partner with affordable housing developers Oppose NIMBYism (Not In My Back Yard) Connect housing and services
Engage in community planning activities City community plans HUD funding recipients’ housing plans
Subscribe to our e-newsletters:www.arizonahealthycommunities.orgwww.azhousingcoalition.org
Email us with questions:[email protected]@azhousingcoalition.org
