2013 SAINT LOUIS COUNTY HEALTH ASSESSMENT. Mobilizing for Action through Planning and Partnerships (MAPP) Forces of Change Assessment

Transcription

1 2013 SAINT LOUIS COUNTY HEALTH ASSESSMENT Mobilizing for Action through Planning and Partnerships (MAPP) Forces of Change Assessment Prepared by: Sponsored by:

2 Table of Contents Introduction...1 Assessment Methodology...2 Executive Summary...3 Priority Forces of Change...4 Collection of Results from the Forces of Change Assessment Prioritization of the Forces of Change: Voting of the Steering Committee Conclusion List of Partners SAINT LOUIS COMMUNITY FORCES OF CHANGE SAINT ASSESSMENT LOUIS COMMUNITY FORCES OF CHANGE ASSESSMENT

3 Introduction Introduction: The Overall MAPP Process and the Forces of In 2013, a broad array of public health stakeholders from St. Louis County convened as the Partnership for a Change Assessment Healthy. In the following months, the St. Louis County Partnership for a Healthy worked towards its mission to join forces to improve the health of St. Louis County residents through comprehensive As of the overall approach to strategic community health improvement planning, the St. Louis andpart accountable assessment, planning, programming and measurement by conducting a Mobilizing for Action County Partnership for a Healthy has embarked on a community-based approach called through Planning and Partnerships (MAPP) process. MAPP, which stands for Mobilizing for Action through Planning and Partnerships. MAPP is a tool which MAPP is a community-driven strategic planning framework that assists communities in developing and helps communities improve health and quality of life through community-wide and community-driven implementing efforts around the prioritization of public health issues and the identification of resources to strategic planning. By following this approach, collaboration is sought by a broad representation of address them as defined by the 10 Essential Public Health Services. The MAPP process includes four assessment people who share the commitment to and have a role in the community s health and overall well-being. tools, including the Forces of Change Assessment. Organize Partnership for Success Development Visioning Four MAPP Assessments Identify Strategic Issues Formulate Goals and Strategies Evaluate al Public He Loc m Assess alth men te t Sys es of Cha Forc ssm nge ent s A se munity Themes Com gths Assessm & ent en St r Plan Action Implement Com alt h S t a m u nity H e n t tus Assess m e MAPP Model, Achieving through MAPP MAPPUser s User s Handbook MAPP Model, AchievingHealthier HealthierCommunities Communities through Handbook Within the process, there are are fourfour mainmain assessment tools. tools. One ofone theseofassessment tools is called Within the overall overallmapp MAPP process, there assessment these assessment toolsthe Forces of Change Assessment (FOCA). The FOCA is aimed at identifying forces such as trends, factors, or events is called the Forces of Change Assessment (FOCA). The FOCA is aimed at identifying forces such as that are or will be theare health andbequality of life of thehealth community and the thecommunity local public trends, factors, or influencing events that or will influencing the and quality of work life ofofthe health system. and the work of the local public health system. Trends are patterns over time, such as migration in and out of a community or a growing disillusionment Trends are patterns over time, such as migration in and out of a community or a growing with government. withelements, government. disillusionment Factors are discrete such as a community s large ethnic population, an urban setting, or the Factors are discrete elements, as a community s large ethnic population, an urban setting, jurisdiction s proximity to a major such waterway. the jurisdiction s to such a major or Events are one-time proximity occurrences, as awaterway. hospital closure, a natural disaster, or the passage of new Events are one-time occurrences, such as a hospital closure, a natural disaster, or the passage legislation. of new legislation. During the FOCA, participants answer the following questions: What is occurring or mightanswer occur that the health of our community or the local public During the FOCA, participants theaffects following questions: health system? What is occurring or might occur that affects the health of our community or the local public health What specific threats or opportunities are generated by these occurrences? system? What specific threats or opportunities are generated by these occurrences? Forces to be considered should include the following categories of influence: (1) Social, (2) Economic, (3) Political, (4) Legal/Ethical, (5) Environmental, (6) Technological, (7) Scientific, and (8) Population. Forces to be considered should include the following categories of influence: (1) Social, The group is also able to add other categories that may be influential. (2) Economic, (3) Political, (4) Legal/Ethical, (5) Environmental, (6) Technological, (7) Scientific, (8) Population, and other categories that the group decides are influential. 1 2

4 Assessment Methodology On March 5th, 2013, the St. Louis County Partnership for a Healthy Stakeholder Advisory Committee participated in the FOCA. A neutral facilitator walked the Stakeholder Advisory Committee through the following process: 1. The components of the FOCA were reviewed. 2. Flip charts for each category of influence were placed around the room. 3. The Stakeholder Advisory Committee divided into small groups and each group was assigned an initial category of influence and writing utensils for their flipcharts. 4. Each small group brainstormed and listed relevant forces of influence and accompanying threats and opportunities. 5. After a specified period of time, the small groups moved clockwise around the room to the next category of influence flip chart, where they added to the previous group s ideas. 6. This process of review and expansion of notes was repeated until every small group had the chance to contribute ideas for each category of influence. 7. The Stakeholder Advisory Committee came back together as one large group to discuss each of the categories of influence and to review all of the forces, threats, and opportunities listed. 8. Each member of the Stakeholder Advisory Committee received five voting stickers which they were instructed to place next to the most prominent forces of change. 9. The forces with the most stickers yielded through the multi-voting process were ranked as the most prominent forces of change. 2

5 Executive Summary The analysis of the cross-cutting themes from all categories within the Forces of Change Assessment and their prioritization by the Stakeholder Advisory Committee produced six core issues. These six priority issues include: Aging and End of Life Issues Health Care Reform Inequality and Health Disparities Violence and Crime Food Insecurity and Food Deserts Mental Illness These six priority issues will be described in detail on the following pages. For each priority issue, the related threats and opportunities identified by the Stakeholder Advisory Committee are listed. Additionally, the Stakeholder Advisory Committee often identified additional information needed to better understand each issue and its implications for influencing health in St. Louis County. These six core issues arose as priorities through the multi-voting process described above in the assessment methodology and are listed in order of the votes they received. Votes for each discrete Force of Change ranged from 0 to 17 votes. Similar issues across the Forces of Change categories were combined to create the six core issues listed above. Following the descriptions of the priority Forces of Change that arose through the multi-voting process, a summary is provided for each Force of Change identified by the Stakeholder Advisory Committee, along with associated threats, opportunities, and additional information needed to fully understand each force. The votes allocated to each discrete force are also listed, both within these summary charts and in a table on page 17. 3

6 Priority Forces of Change Aging and End of Life Issues Under this heading, participants specifically mentioned the aging of baby boomers under the heading of Population Forces, which received the highest ranking of any force of change with seventeen votes. Living longer was also included as a leading Population Force with five votes. End of life choices, under the heading of Legal and Ethical Forces, received four votes. End of life care, listed among Scientific Forces, is also included in this category, but did not receive any votes as a priority issue. Threats Opportunities Questions/ Information Needed Current health services do not match their needs Increased chronic conditions and medically complex conditions Increased aging/disability More individuals wanting to be involved with volunteer opportunities, desire walkable communities to age in place More intergenerational sharing Continued high cost to keep aging individuals alive Improving medical technology Compassionate care Increased awareness of palliative care services 4

7 Health Care Reform Under this heading, participants specifically mentioned health care costs under Economic Forces, which received five votes, Medicaid expansion under Political Forces, which received sixteen votes, and electronic health records, which received four votes. Threats Opportunities Questions/ Information Needed Decreased access to care Increased costs of Medicare/Medicaid Decreased funding and services Increased number of uninsured people Increased unemployment Decreased access Potential for health exchanges to be effective Increased access to care Increased innovation increased prevention Increased advocacy Increased coverage Improvement in health status How can the Saint Louis County Department of Health prepare for and support the implementation of the Affordable Care Act? Need more information about specific impact, legislative process, and potential benefit Decreased health status Loss of privacy and identity theft Increased awareness Greater data sharing and collaboration Cost savings 5

8 Inequality and Health Disparities Under this heading, participants specifically mentioned income inequality, segmented communities, geographic inequality, and racial inequality. In addition to falling under the heading of Social Forces with ten votes as a priority issue, population segregation across economical and racial lines was listed under Economic Forces, and received nine votes. Threats Opportunities Questions/ Information Needed Decreased access to services and opportunities Reinforcement of prejudice Exacerbation of health disparities and inequity Divisiveness Difficult to collaborate and communicate Working in silos Lack of consensus regarding priorities Educate community members about the health consequences of inequity Opportunities to create new partnerships What partners can we engage with to address these inequities? 6

9 Violence and Crime Under this heading, participants mentioned crime and violence as both a Social and Environmental Force, receiving a combined total of twelve votes. Also included in this category is narcotics and substance abuse, listed as an additional Environmental Force and receiving one vote as a priority issue. Threats Opportunities Questions/ Information Needed Unsafe neighborhoods Lack of physical activity and outdoor recreation Stress and poor mental health Overburdened correctional system Create neighborhood watch groups Create partnerships and strengthen relationships with law enforcement Disseminate messaging about personal safety and crime prevention How can we address the root causes of violence? What data do we need to collect/gain access to? Increased crime Increased morbidity Detrimental impact on mental health Co-morbidities associated with substance abuse Advocate for justice system reform collaboration Opportunity to engage with nontraditional partners Create more rehabilitation services Address through mental health services 7

10 Food Insecurity and Food Deserts Participants listed food insecurity and food deserts as an Environmental Force, which received thirteen votes as a priority issue. This issue thus arrived as a core Force of Change despite having limited specific threats and opportunities identified by the Stakeholder Advisory Committee. Threats Opportunities Questions Obesity and malnutrition gardens Can healthy food sales be profitable? 8

11 Mental Illness Under this heading, participants mentioned mental illness stigma as a Social Force, receiving seven votes, and the highly restricted number of involuntary commit beds for those with mental illness, receiving one vote as a priority issue. Threats Opportunities Questions/ Information Needed Insufficient preventative services and access to care Fear of treatment Offer prevention and treatment services Potential opportunities for early treatment What are the resources available to us to address mental health issues? Harm to self and others What legislative action can be taken to address mental health needs? 9

12 Collection of Results from the Forces of Change Assessment The following table provides the overall collection of comments generated from the assessment process, with the full compilation of notes recorded on each Force of Change identified and corresponding threats and opportunities to the local public health system (LPHS), additional information needed, and the score assigned by the Stakeholder Advisory Committee. Forces of Change (Trend, Events, Factors) Threats Posed to the LPHS or Opportunities Created to the LPHS or Questions/More Info Needed Score Social Income inequality, segmented communities, geographic inequality, racial inequality Decreased access to services and opportunities Reinforcement of prejudice Educate community members about the health consequences of inequity What partners can we engage with to address these inequities? 10 Exacerbation of health disparities and inequity Provider shortage Inadequate access to services Partner with local medical schools to create incentives for students to remain in the St. Louis area 6 Mental illness stigma Insufficient preventative services and access to care Fear of treatment Offer prevention and treatment services What are the resources available to us to address mental health issues? 7 Access to education Decreasing health literacy Ensure that health messaging is accessible and understandable for individuals with low educational attainment 1 Technology Inadequate access Disparities in access to information Abundance of misinformation about health exists on the internet Create programs to increase access to information Increase web literacy Information sharing Health messages can be disseminated through social media How can we use technology to more effectively communicate with the community? 0 10

13 Forces of Change (Trend, Events, Factors) Threats Posed to the LPHS or Opportunities Created to the LPHS or Questions/More Info Needed Score Social (Continued) Public transportation Inadequate access Reliance on cars Advocate for more walkable, livable, and bikeable areas Which communities are most underserved and in need of public transit? 2 Advocate for further investment in public transit Strengthen partnerships with county planners Crime and violence Unsafe neighborhoods Lack of physical activity and outdoor recreation Stress and poor mental health Overburdened correctional system Create neighborhood watch groups Strengthen relationships with law enforcement Disseminate messaging about personal safety and crime prevention How can we address the root causes of violence? 5 Unhealthy lifestyles Strain on health delivery system Advocate for policy, systems, and environmental change strategies to increase access to healthy choices 3 Housing for those in the margins Inadequate public and affordable housing Unsafe housing Advocate for housing access as a key social determinant of health Who is responsible? Environmental Barriers 0 Economic Funding Decreased funding and grants available Build on/create partnerships to share resources. 2 Increase organizational/ institutional alignment to create a bigger impact Weak economy Increased poverty 3 11

14 Forces of Change (Trend, Events, Factors) Threats Posed to the LPHS or Opportunities Created to the LPHS or Questions/More Info Needed Score Economic (Continued) Poor job growth Income stagnation High unemployment High rates of uninsured individuals Advocate for living wages and benefits Provide safety net services for low income/ uninsured individuals 0 Population separation across economic and racial lines Divisiveness Difficult to collaborate and communicate Opportunities to create new partnerships 9 Working in silos Lack of consensus regarding priorities Health care costs (Affordable Care Act) Decreased access to care Increased costs of Medicare Potential for health exchanges to work Increased access to care Increased innovation How can the Saint Louis County Department of Health prepare for and support implementation of the Affordable Care Act? 5 Increased prevention Political Federal, state, and local Medicaid expansion Decreased funding and services Increased number of uninsured people Increased unemployment Decreased access Increased advocacy Increased coverage Improvement in health status Increased awareness Need more information about: specific impact, legislative process, potential benefit 16 Decreased health status Electoral process Term limits 0 12

15 Forces of Change (Trend, Events, Factors) Threats Posed to the LPHS or Opportunities Created to the LPHS or Questions/ More Info Needed Score Political (Continued) Lack of political will Lack of action to improve public health Lack of investment in public health Lack of action that is intentionally detrimental to the public health system To what extent will new legislators act to promote or divest in public health? 2 Unease with taking a position on controversial issues The Saint Louis County Department of Highways and Traffic will not accommodate bicycles Injury/death Obesity Advocate for policy change Work with department to create bike lane project 1 Large number of local governing bodies Possible fragmentation Increasing desire to collaborate 1 City/county cooperation Loss of fidelity Reduction in workforce Reduce duplication and increase impact 2 Unequal resources Technological Increased access to technology Inactivity Increased obesity Increased access to education and information 3 New ways to engage and communicate with the public Health information technology (HIT) Potential for privacy to be compromised Shared information Efficiency and cost savings 2 Increased access to environmental management systems Security and cost Communicate with other agencies, trend analysis 0 13

16 Forces of Change (Trend, Events, Factors) Threats Posed to the LPHS or Opportunities Created to the LPHS or Questions/ More Info Needed Score Technological (Continued) Increased medical technology Cost and unnecessary treatments Faster results, increased access 0 Universal Electronic Health Records (UEHR/ EHR) Exposure and identity theft Greater data sharing and collaboration Cost savings 4 Environmental Extreme weather Increased asthma Destruction of infrastructure Property damage and displacement Funding opportunities for emergency preparedness Increased collaboration with partners to create preparedness plan 4 Decrease in agricultural production and increase in food prices Shortage of natural resources Communicate with public about household preparedness and prevention Violence Increased crime Increased morbidity collaboration Opportunity to engage with nontraditional partners What data do we need to collect/gain access to? 7 Policies limiting tobacco exposure Perceived economic damage Increased health Decreased secondhand smoke exposure Policy threats/changes FDA regulations 0 Increased awareness about harmful effects of smoking Potential to encourage reduction/cessation of tobacco use Human-made disasters (Bridgeton landfill, Coldwater Creek) Decreased air quality Detrimental economic impact Opportunity to demonstrate transparency Opportunity to advocate for increased environmental protection Need for frequent updates and dissemination of information 2 14

17 Forces of Change (Trend, Events, Factors) Threats Posed to the LPHS or Opportunities Created to the LPHS or Questions/ More Info Needed Score Environmental (Continued) Lack of access to safe walking, biking, and public transit Death Injury Obesity Isolation Advocate for improved access to alternative transportation Enforcement of pedestrian/biker right of way How can we integrate safe alternative transit into community improvement plans? 5 Decreased economic opportunities Education about pedestrian, biker, and driver safety Narcotics and substance abuse Detrimental impact on mental health, co-morbidities, crime, and violence Create partnerships with law enforcement Create more rehabilitation services 1 Address through mental health services Food insecurity/food deserts Obesity and malnutrition gardens Are healthy food sales profitable in all areas? 13 Population Aging of Baby Boomers Current health services do not match their needs More want to be involved with volunteer opportunities, desire walkable communities to age in place 17 Living longer Increased chronic conditions and medically complex More intergenerational sharing 5 Changed traditional family dynamics Smaller families/less family support (aging), single parent households, less in-home support Greater visibility/ recognition of non-traditional families 2 Geographic concentrations of poverty, segregation, and income disparities Health and social inequity 3 Millennials Insured by parents or not insured Increase coverage through implementation of the Affordable Care Act 1 Increasing minority populations Power struggle Embrace other cultures How is it changing needs of population? 2 15

18 Forces of Change (Trend, Events, Factors) Threats Posed to the LPHS or Opportunities Created to the LPHS or Questions/ More Info Needed Score Scientific Portable technolology devices Lack of knowledge, lack of access and availability Mainstream in schools and workforce Cost/benefit ratio 0 Evidence-based practices Time lag Decreased time lag 0 May not be place based Standardized care Research funding/medical advances No new treatment Increased costs, no cap New treatment 0 End of life care Increase aging/disability Improving medical 0 technology Cloning Fear Life-saving opportunities 0 Innovation Confidentiality and security Medical advancement 0 Legal/Ethical Health care reform Reduced reimbursement Fewer doctors Increased access, increased reimbursement inefficiency Outcome of implementing 15 Lack of involuntary commit beds available (mental health) Harm to self/others Potential opportunities for early treatment Legislative action 1 Government finance Increased debt and decreased money to priorities Restructuring of priorities 0 End of life choices Continued high cost to keep person alive Compassionate care Increased awareness of palliative care services 4 16

19 Prioritization of the Forces of Change: Voting of the Stakeholder Advisory Committee After the forces, threats, and opportunities had been reviewed and discussed by the group, each Stakeholder Advisory Committee member reflected and voted for what he or she deemed to be the five most influential forces of change in St. Louis County. The table below summarizes the voting results. Social Inequality 10 Mental Illness Stigma 7 Provider Shortage 6 Crime and Violence 5 Lifestyle Behavior 3 Transportation 2 Education 1 Economic Population Segregation Across Economic and Racial Lines 9 Health Care Costs (Affordable Care Act) 5 Weak Economy 3 Funding 2 Political Federal/State/Local/Municipal Medicaid Expansion 16 Lack of Political Will 2 City/County Cooperation and Regional Cooperation 2 Saint Louis County Highways and Traffic Department Will Not Accommodate Bicycles 1 Large Number of Local Governing Bodies 1 Legal/Ethical Health Care Reform (Affordable Care Act) 15 End of Life Choices 4 Lack of Involuntary Commit Beds Available (Mental Health) 1 Environmental Food Security/Quality and Food Deserts 13 Violence 7 Lack of Access to Safe Walking, Biking, and Public Transit 5 Drought, Tornado, Flooding, Earthquake, Climate Change 4 Human-made Disasters (Bridgeton Landfill, Coldwater Creek) 2 Narcotics and Substance Abuse 1 17

20 Technological Universal Electronic Health Records (UEHR/EHR) 4 Increased Access to Technology 3 Health Information Technology (HIT) 2 Population Aging of Baby Boomers 17 Living Longer 5 Geographic Concentrations of Povery, Segregation, and Income Disparities 3 Increasing Minority Populations 2 Changed Traditional Family Dynamics 2 Millennials 1 Scientific Alternative Remedies/Practices 1 18

21 Conclusion The Forces of Change identified by Stakeholder Advisory Committee Members in this assessment represent important issues affecting the local public health system in St. Louis County, and their potential implications on the health and quality of life of county residents and on the public health system. The core issues that emerged as priorities in this assessment include: Aging and End of Life Issues Health Care Reform Inequality and Health Disparities Violence and Crime Food Insecurity and Food Deserts Mental Illness Social determinants of health* were frequently cited throughout the Forces of Change Assessment and arose as some of the mostly highly ranked priority issues to address. Stakeholder Advisory Committee members noted that social and economic forces, including poverty, racism, and other structural disadvantages have a profound impact on the wellbeing and quality of life of all community members in St. Louis County. Special consideration should be given to addressing these disparities to improve health and wellbeing for the most vulnerable residents to achieve greater health equity in St. Louis County. *The Centers for Disease Control and Prevention defines social determinants of health as the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics. 19

22 Partners Animal Protective Association of Missouri Barnes-Jewish Hospital Barnes-Jewish West County Hospital Campus Beyond Housing BJC HealthCare City of St. Louis Department of Health Cooperating School Districts Daughters of Charity Foundation of St. Louis Housing Authority of St. Louis County International Institute of St. Louis Jewish Center Maternal Child and Family Health Coalition Mercy Hospital St. Louis Missouri Baptist Medical Center Missouri Department of Corrections Division of Probation and Parole Missouri Department of Health and Senior Services Eastern District Office St. Louis Missouri Foundation for Health National Alliance of Mental Illness Operation Food Search Ranken Jordan St. Anthony Medical Center St. Louis Area Business Health Coalition St. Louis County Children s Service Fund Saint Louis County Council Saint Louis County Department of Health Saint Louis County Department of Human Services Saint Louis County Health Advisory Committee St. Louis County Municipal League Saint Louis County Parks and Recreation Saint Louis County Department of Planning Saint Louis County Police Department North County (1st) Precinct St. Louis Integrated Health Network St. Louis Regional Health Commission Saint Louis University s College for Public Health and Social Justice St. Luke s Medical Center Shriners Hospital for Children Special School District of St. Louis County SSM DePaul Medical Center SSM Health Care SSM St. Mary s Health Center Trailnet United Way of Greater St. Louis University of Missouri Extension YMCA of Greater St. Louis 20

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24 For more information about this report or about the St. Louis Partnership for a Healthy, please contact: SAINT LOUIS COUNTY DEPARTMENT OF HEALTH 6121 North Hanley Road, Berkeley, MO (314)