A. BACKGROUND AND NEED 1. Current Capacity to Support the Activities Identified in the CTIP

Transcription

1 A. BACKGROUND AND NEED 1. Current Capacity to Support the Activities Identified in the CTIP Contra Costa Health Services (CCHS), a comprehensive Public Health Care Agency with a demonstrated record of building civic and community partnerships that affect policy, systemic, and environmental transformations of the community health landscape, is the lead agency of Healthy Contra Costa ( HCC ). This collaborative initiative will implement policy and environmental strategies that reduce chronic disease rates countywide and within specific neighborhoods and cities with the greatest health disparities/inequities. CCHS operates a hospital, Contra Costa Regional Medical Center, and eight associated Federally Qualified Health Center (FQHC) primary care clinics, providing the majority of care received by low-income and Medicaid populations in the County. Additionally, the Federally Qualified Contra Costa Health Plan (CCHP), part of CCHS, manages care for over 100,000 residents, almost all of whom are concentrated in the areas with greatest health disparities. CCHS together with three Community FQHC clinics and Planned Parenthood forms the Safety Net Council, which provides over 80% of primary health care received by low-income County residents. As a leader, convener, or participant of many of the community coalitions that are part of HCC, CCHS is well positioned to ensure success of this initiative. The CCHS Public Health Division and its Community Wellness and Prevention Program lead CCHS efforts to improve community health through community prevention activities to address the environmental determinants of health, and will guide the HCC initiative. The Health Data, Planning and Evaluation unit in Public Health will rigorously evaluate both clinical and environmental strategies of HCC and inform ongoing strategic refinement. CCHS, the Community Clinics, and CCHP members will share their clinical outcome data with the HCC Evaluation Team, providing a rare opportunity to measure changes in population health. July 13,

2 Finally, HCC also includes the partnership and endorsement of dozens of individual and institutional collaborators from the State, County, and community level, who will serve critical functions in the management and execution of HCC implementation strategies. This includes political support from the State department of Public Health, County Board of Supervisors, and local jurisdictions; technical support from Kaiser Permanente Group, The Prevention Institute, the California Center for Public Health Advocacy, and Public Health Law and Policy; institutional support from the University of California and local agencies; and community-based support from School districts, community organizations, and key resident stakeholders involved in HCC. With this established infrastructure and experience, Contra Costa County provides a rare opportunity to effectively address chronic disease disparities and demonstrate measurable improvement in population health. 2. Past Policy, Environmental, Programmatic, and Infrastructure Successes CCHS is a recognized leader in building community coalitions to implement policy and environmental strategies that address the social determinants of chronic disease, create community norm change around health behaviors, promote environments where the healthy choice is the easy choice and improve the usage and quality of preventive services for the most disadvantaged populations. With the CTG support, HCC will expand upon past successes including: Promoting tobacco-free policies: In 1984 CCHS and the Tobacco Prevention Coalition led Contra Costa to become the first multijurisdictional county in the country to adopt ordinances by the county and all cities restricting smoking in public places and the workplace. CCHS has worked with the county and 19 cities to pass more than 50 tobacco policies. Facilitating a Health in All Policies (HiAP) approach in County and City agencies: In 2007, CCHS worked with the Board of Supervisors to pass a Board Order directing CCHS July 13,

3 and the Departments of Community Development and Public Works to collaborate to integrate health into planning and public works. This resulted in the creation of a Planning Integration Team for Community Health (PITCH), which has collaborated on a complete streets amendment to the County s general plan, school siting efforts and sustainable development projects. CCHS is now working with Richmond to include HiAP in all City Departments. Using Health Impact Assessments (HIA) to inform policymaking: CCHS has conducted HIA s on an urban casino, a major development plan in Concord, and is conducting a citywide HIA to assess health ordinances regulating street food vendors in Richmond. Incorporating health into Built Environment planning and implementation: CCHS worked with the cities of Richmond and San Pablo to develop some of the first stand-alone Health Elements included in City General Plans nationwide. Collaborating with school districts to improve youth nutrition and physical activity: CCHS has worked with three of the largest school districts to improve nutrition standards in school cafeterias and after school programs, and enhance opportunities for youth physical activity. Using data-driven clinical decision-making to improve the impact and quality of care: CCRMC was recognized in 2011 in a press conference with national leaders from HRSA as the model health system for health care reform in using data for improving patient outcome. 3. Description of the Target Area Contra Costa County (CCC) is a diverse, San Francisco Bay Area jurisdiction of 1,049,025 residents (2010 census). Contra Costa totals 720 square miles, including agricultural land in the East, a number of wealthy suburbs in the Central and South, and an arc of cities fronting the San Francisco Bay and Sacramento River that contain high concentrations of minorities, poverty, unemployment, and low educational attainment. The ethnic composition of Contra Costa County July 13,

4 is 52% non-hispanic White, 22% Hispanic, 14% Asian/PI and 9% African American. Latinos, the largest minority group, are both the youngest and fastest growing cohort in the County. Located across the Bay from San Francisco and just north of the Silicon Valley, Contra Costa s economy is a mix of corporate headquarters, decaying industry, new economic growth and farmlands increasingly transformed into sprawling subdivisions. Within the county, there are intense intra-county socioeconomic disparities with low-income communities concentrated in specific cities and sub regions. Overall, Contra Costa compares favorably with the state and nation on income ($75k, $59k, $50k per household, respectively) and education (38%, 30%, 28% college graduate, respectively); however, a census tract analysis shows many cities and sub-city neighborhoods with intense poverty and low educational attainment. These clusters what we have defined as hotspots comprise more than 280,000 residents from the cities of Richmond, San Pablo, Pittsburg, Antioch, Concord s Monument Corridor, and unincorporated North Richmond and Bay Point. Each hotspot is characterized by levels 1) Richmond, San Pablo 2) Monument Corridor 3) Bay Point, Pittsburg, Antioch Poverty Heat Map Contra Costa County by Census Tract Source: 2000 US Census July 13,

5 of poverty and educational attainment significantly worse than national averages, as shown at right. 4. Health Disparities The strong link between socioeconomic status, ethnicity and health inequities has been clearly documented on a national level. 1 Those living in poverty, with low-educational attainment, or who are African American have significantly worse health outcomes than the population overall. Contra Costa County is no exception to these patterns. A study conducted by CCHS found that children born into high-poverty areas in the County where more than 30% of households live below 200% of the federal poverty level will live six years less than children born in lowpoverty areas. Similarly, children born in a high-education area - where less than 5% of residents have less than a high school diploma live seven years longer than children born in a low-education area where 25% or more residents have less than a high school diploma. African Americans in Contra Costa had the shortest life expectancy (73.1 years) of any racial/ethnic group: by contrast, an Asian baby born between 2005 and 2007 in Contra Costa could expect to live more than 12 years longer than an African American baby born at the same time. 2 Latinos are also clustered in many areas with low education and high poverty; African Americans and Latinos combined comprise more than 50% of residents in all target locales except Antioch. While Latinos overall exhibit mortalities now comparable to non-hispanic whites, they have extremely high documented rates of obesity, diabetes, and other clinical factors that will lead to chronic disease and increased medical costs if not addressed now. 3 In fact, the rates of overweight and obesity for both African American adults (69.0%) and Latino adults (68.2%) are significantly higher than the Bay Area overall (53.3%). This disparity 1 Braverman P, Egerter S. et al (2008) Overcoming Obstacles to Health. Robert Wood Johnson Foundation. 2 Community Health Indicators for Contra Costa County, December 2010, pp L Franzini, JC Ribble, AM Keddie. Understanding the Hispanic paradox Ethnicity and Disease, 11(3), July 13,

6 is equally pronounced in youth and children in our target areas. Latino fifth graders in the county have a 36.6% obesity rate, and African American fifth graders a 34.2% rate, alarmingly high when compared with Contra Costa or California as a whole (26.5% and 31.6%, respectively). The overweight and obesity rate among fifth graders in Antioch Unified School District is 36.6%, in West Contra Costa Unified School District - serving San Pablo and Richmond it is 36.5%, and in the Pittsburg Unified School District the rate is 36.2%. Of the 37 elementary schools in Contra Costa with obesity rates in the highest county quartile ( %), all but four are in the target area; none of the 32 schools in the lowest quartile (0-15.5%) are in the target area. Analysis at the elementary school level shows even greater childhood obesity in hotspots. HCC s priority target areas exhibit significant documented health disparities. Cancer, heart disease, stroke, and lower respiratory disease are the four leading causes of death in Contra Costa, with lung cancer accounting for 23.7% of all cancer deaths in the county. Though Contra Costa as a whole almost meets or exceeds Healthy People 2010 targets for management of these chronic diseases, residents in our target locales have significantly higher death rates from these causes than the county as a whole; African American death rates are even higher. The table below summarizes age-adjusted death rates per 100,000 residents, with asterisks indicating rates significantly above the county norm. Despite overall positive health outcomes countywide, as HCC Target Population (mortalities per 100,000) Cancer Lung Cancer Heart Disease Stroke Diabetes Richmond * 62* 32* Antioch 201* * 56 35* Pittsburg * 72* 37* San Pablo 270* 73* 338* 100* 50* Afr.-Amer. 218* 52* 259* 80* 47* CCC Baseline July 13,

7 these local data show, disparities within specific cities and populations are substantial. In large part, this is due to environmental factors and deficits. In absolute terms, the County contains fewer grocery stores per capita than all but four of the state s more rural counties. A recent study by the California Center for Public Health Advocacy (CCPHA) found more than four times as many fast-food restaurants and convenience stores in Contra Costa vs. supermarkets and produce vendors. Research also finds a strong, direct relationship between the Retail Food Environment Index (RFEI) of the area in which someone lives and their likelihood of being obese or having diabetes. California adults living in high RFEI areas, such as the hot spots in Richmond and Pittsburg, had 20% higher obesity prevalence and 23% percent higher diabetes prevalence than counterparts living in lower RFEI areas. 4 With CTG funding, HCC will target a host of policy and environmental factors contributing to the leading causes of death cancer, stroke, heart and lower respiratory disease and for each propose a targeted strategy to improve outcomes, both at the community level and among highrisk populations. B. PROGRAM INFRASTRUCTURE Healthy Contra Costa will be staffed by a comprehensive Operational Team to manage dayto-day implementation activities, provide technical support to partners, and monitor and evaluate program progress against milestones and outcome objectives. The team will draw extensively on in-kind personnel and institutional resources of CCHS divisions, including the Public Health Division, Community Wellness & Prevention Program, and Health Data, Planning, and Evaluation Unit, as well as a full-time program director hired with CTG funds. In total, Healthy Contra Costa will be staffed by 10 individuals from CCHS. Evaluation activities have 1.5 FTEs 4 Designed for Disease: The Link Between Local Food Environments and Obesity and Diabetes (2008) July 13,

8 allocated. Operation Team members - constituting 4.9 FTEs in service of HCC each bring on average more than 15 years experience in implementing effective community health initiatives. Healthy Contra Costa Operational Staffing Staff Title HCC Role Tracey Rattray, MPH, MSW Dr. Wendel Brunner, MD, PhD, MPH Manager, Community Wellness & Prevention Program, CCHS FTE Allocation Program Director (first 90 days) 0.50 Director of Public Health, CCHS Senior Coalition Leadership 0.10 TBD HCC Program Director, CCHS Program Director 1.00 Jennifer Lifshay MPH, MBA Health Planner-Evaluator Evaluator 0.50 Lisa Diemoz, MPH Health Planner-Evaluator Evaluator 0.50 Abigail Kroch, PhD, MPH Epidemiologist Evaluator 0.50 Bill Sorrell Public Health Administrator Lead Fiscal Manager 0.20 Fay Ny Program Administrator Operational staff support 0.10 Nancy Baer, MSW Denice Dennis, MPH Dr. Bonnie Zell MD, MPH Jason Corburn, PhD Manager, Injury Prevention and Physical Activity, CCHS Tobacco Prevention Project Manager, CCHS Community and Clinical Prevention Consultant Associate Professor, UC-Berkeley TA for ALHE & Safe Phys. Environment strategies 0.75 TA for Tobacco-Free Living 0.50 TA for Community and Clinical Prevention strategies TA for Healthy and Safe Phys. Envirnmt, Evaluation Total Operational FTEs Project Staffing Tracey Rattray, MPH, MSW, will be the full-time Program Director for the first 90 days and will continue to oversee the project when the permanent full time Director is hired. She currently manages the Community Wellness & Prevention Program of CCHS. She directs countywide programs in the areas of tobacco control, built environment, and nutrition and physical activity, focusing on policy, systems, and environmental change and community engagement. She is the author of The New Spectrum of Prevention: A Model for Public Health Practice and July 13,

9 co-author of Planning Communities: What Health Has to Do With It. 5 Ms. Rattray s time will be devoted full-time to HCC until hiring the Program Director, and 50% thereafter in-kind. Dr. Wendel Brunner, MD, PhD, MPH, Director of Public Health for Contra Costa since 1983, will provide Senior CCHS Coalition Leadership for Healthy Contra Costa (see organizational chart, Appendix D). Dr. Brunner has 28 years experience working with communities, city and county policy makers, and state legislators to promote successful initiatives on tobacco control, environmental justice, health care access, policies limiting access to unhealthy foods, and the built environment. He is on the Governing Board of Doctors Medical Center in San Pablo and a founding co-chair of the Bay Area Health Inequities Initiative. With a Leadership Committee of Public Health Directors and Health Officers from across California, he directs a state-wide Chronic Disease Project to develop and promote best practices for chronic disease control through local health departments in California. A Full-time Program Director will be hired within 90 days of award notification. The Director will assume responsibility for managing day-to-day activities of HCC and facilitating collaboration between the Leadership Team, Evaluation Team, and HCC partners. The Director and appropriate staff will participate in CDC convened meetings as required. 2. Project Evaluation Robust evaluation support will be provided on a full-time basis through CCHS s Health Data, Planning, and Evaluation unit, which is already involved in regular monitoring and reporting of community health disparities and program evaluation. The team members include: Jennifer Lifshay, MPH, MBA is a Health Planner-Evaluator at CCHS. She received her MPH (with a focus on Health Behavior) from UC-Berkeley, and her MBA from Columbia 5 All CCHS articles described in this application are available on the CCHS website at July 13,

10 University. She will provide.50 FTE for HCC. Lisa Diemoz, MPH is a Health Planner-Evaluator at CCHS. She holds an MPH and will provide.50 FTE for HCC. Abigail Kroch, PhD, MPH is a Health Planner-Evaluator at CCHS. She received her PhD in Biophysics from the Johns Hopkins University and her MPH (with a focus on Epidemiology) from UC-Berkeley. She will provide.50 FTE for HCC. 3. Fiscal Operations Fiscal management for HCC will be provided through current CCHS fiscal management systems, overseen by the CCHS CFO, Pat Godley, MBA. Bill Sorrell, Public Health Administrator, will act as the Lead Fiscal Manager for Healthy Contra Costa, ensuring accurate and timely disbursal of CTG funding in alignment with HCC strategies and reporting to the CDC per the reporting guidelines described. He will provide.20 FTE in-kind for HCC. Fay Ny will provide Operational Staff Management Support, and will provide.10 FTE in-kind for HCC. 4. Technical Support and Clinical Expertise Nancy Baer, MPH will provide oversight and technical support for the HCC Active Living / Healthy Eating and Safe Physical Environment strategies. She is the Manager of the Injury Prevention and Physical Activity Promotion Program at CCHS. She managed the creation of the West Contra Costa County Safe Communities Coalition. She served on the Technical Advisory Group that developed a health element for the Richmond General Plan update. Ms. Baer will provide.75 FTE in-kind. Denice Dennis, MPH will provide oversight and technical support for the HCC Tobacco- Free Living strategies. She is the Tobacco Prevention Project Manager in the Community Wellness and Prevention Program at CCHS. Ms. Dennis will provide.50 FTE in-kind for HCC July 13,

11 Bonnie Zell, MD, MS, MPH will provide technical clinical support to the HCC community prevention strategies. Dr Zell has been the Senior Director, Population Health for National Quality Forum, the Health Care Sector Partnership Lead for the CDC and is Faculty at the Institute for Healthcare Improvement (IHI). Dr Zell is now with CCHS and will provide TA and program assistance for Clinical Preventive Services strategies. Dr Zell will provide.20 FTE in-kind. Jason Corburn, PhD, MCP will provide technical support and planning assistance for HCC efforts to incorporate wellness elements in General Plans, and will serve on the Evaluation Committee. Dr. Corburn is a professor in the Department of City and Regional Planning at UC Berkeley. He co-directs the joint Master of City Planning/Master of Public Health degree program at UCB. He will provide.05 FTE in-kind through foundation funding (TCE). C. FISCAL MANAGEMENT 1. Community Partner Allocations Healthy Contra Costa includes numerous partners who will be involved in the implementation of project strategies. 52.6% of funding will be distributed to these sub-recipients. HCC partners, including community organizations and broadbased coalitions, will be coordinated by CCHS Public Health Administrator, Bill Sorrell, who will work with each partner s fiscal staff to ensure timely contracting, and effective monitoring of funds and deliverables. Each sub-recipient has unique expertise in Community Partner Year One Allocation Monument Corridor Partnership $99,000 Contra Costa Child Care Council $65,000 La Clinica $50,000 Local Government commission $40,000 23rd Street Merchants Association $20,000 Play Works $20,000 Building Blocks for Kids $15,000 Public Health Law and Policy $15,000 Center for Human Development $15,000 Rainbow Community Center $15,000 Opportunity West $10,000 CA Center for Public Health Advocacy $10,000 The Prevention Institute $5,000 Afterschool for All $5,000 East Bay Bicycle Coalition $5,000 UC Center for Weight and Health $5,000 Resource Development Associates $3,800 reducing health disparities in the communities they serve. Sub-recipients will leverage their July 13,

12 current resources while expanding their capacity. This will enable Healthy Contra Costa to achieve maximum impact across multiple strategic directions. The table above identifies the subrecipients of Healthy Contra Costa funding, along with their expertise and representativeness. 2. Fiscal Management Procedures and Reporting Systems CCHS will negotiate all subcontracts, subject to the normal county review processes. Each contract will contain a clear specification of activities, milestones, deliverables and resources contributed in-kind or otherwise used to leverage CDC funds. Each contract will be assigned a Contract Monitor, who will monitor deliverables on a quarterly basis and provide feedback to the contractor to ensure continuous improvement. The Program Director will ensure that organizations failing to meet their milestones will receive support to improve in future activities. Reports on project deliverables will be presented to the Leadership Team by the Evaluation Committee. Program funding will be distributed to sub-recipients in accordance with the CTIP (Appendix I) and the Budget Narrative (Appendix B). The Leadership Team will provide general oversight of the allocation of HCC funds and ensure that sub-recipients achieve agreed-upon objectives. The Finance Division of CCHS and the Public Health Division Administrator, working closely with the Program Director, will provide day-to-day fiscal management of HCC. They will track and monitor program expenditures, and prepare required reports. Patrick Godley, MBA, COO/CFO of CCHS, will provide general financial oversight for HCC. 3. Sustainability Assurance that HCC will be sustained past the 5 years of CDC funding will be accomplished as a result of the following strategies: 1. All of the proposed strategies will be integrated into the health department s strategic goals which are geared to implementing Health Care Reform and the Triple Aim of improving patient and population health and reducing cost. As such, HCC will become part of doing July 13,

13 business as usual. 2. The evaluation will identify cost savings that occur as a result of the successful implementation of these prevention strategies. Kaiser Permanente, a leader in reducing health care costs by emphasizing wellness and prevention is a member of the Leadership Team and has pledged to share their expertise in how to maximize prevention efforts that are woven into health care delivery. Cost savings from reducing high end care over time will be reinvested into prevention to ensure expansion of HCC strategies and activities. 3. HCC is also fortunate to have one of the best endowed foundations in California represented on the Leadership Team (The California Endowment) and the Kaiser Community Benefits Program. 4. The Contra Costa County Board of Supervisors will continue to receive updates and information regarding the prevalence of these health issues. California is poised for a major change in the way the State allocates funds to counties through Health Care Reform thus providing the Board of Supervisors and CCHS with increased latitude and fiscal incentive to utilize funds for cost-saving prevention. 5. Community partners in CCC are demonstrating strong commitment to the goals of HCC and will continue to utilize their resources in this effort. We anticipate ongoing support from partners to integrate this model into ongoing activities of these community programs. D. LEADERSHIP TEAM AND COALITIONS 1. Healthy Contra Costa Leadership and Coordination Structure The Leadership Team for Healthy Contra Costa was initially formed in 2009 and comprises members who are committed to advancing the selected broad-based policy, environmental, programmatic and infrastructure changes described in this proposal. Each member has signed a letter of support and/or MOU (Appendix G and F, respectively) to participate in the July 13,

14 collaborative. As a result of their experience, their demonstrated commitment to advancing healthy communities and their positions within key organizations, these individuals have been chosen to oversee the strategic direction of project activities and ensure adoption of policy, environmental, programmatic and infrastructure changes. They are representative of the entire geographic span of the county and the multi-sectoral components necessary to succeed. This existing Leadership team has been expanded for HCC. It includes a mayor, a vice-mayor, the County Superintendent of Schools, the California Endowment, Kaiser Permanente, the Local Government Commission, public health advocates and health system leaders, as well as clinical providers and the California Department of Public Health. The Team is supported by two working groups, the HCC Steering Committee and HCC Evaluation Committee. Additionally, HCC is implemented by a number of active coalitions whose efforts in the County already reflect alignment with the HCC. These coalitions meet regularly and have a long history of partnering effectively with CCHS. The Committees and supporting coalitions comprise an experienced and knowledgeable organization, which, along with staff, are capable of leading and successfully implementing HCC. Please see Appendix D for a graphical description of this leadership structure. The full Leadership Team will convene within two weeks of funding notification in order to commence Healthy Contra Costa, and will meet monthly until the program is fully underway. Following commencement of CTIP activities, the Leadership Team will continue to meet quarterly to provide overall strategic direction, guidance, and oversight to HCC. The Program Director will staff the Leadership Team and work with both committees. The Leadership Team will also draw on the expertise and assistance of the CCHS Director, Dr William Walker. During the first two months of launching HCC, the Leadership Team will participate in a half July 13,

15 day training and facilitated discussion on how shared leadership will be successfully managed and implemented. The group will come to consensus on ground rules for meetings and will develop written leadership principles that they will agree to live by. Agreements regarding communication protocols and ongoing self-evaluation tools for the Leadership Team and its committees will be adopted. Minutes of all meetings will be kept and provided to all members. Meetings will be open to the public and times for public comment will be scheduled. 2. Leadership Team Members In addition to the Interim Program Director (Tracey Rattray) the Leadership Team includes: Wendel Brunner PhD, MD, MPH is the Director of Public Health for Contra Costa County and a member of the CCHS Senior Management Team. Dr Brunner is designated by the Health Services Director to represent CCHS on the Leadership Team. Honorable Federal Glover of the Contra Costa County Board of Supervisors: representing the East County communities of Antioch, Pittsburg and Bay Point he serves on the Board s Ad Hoc Committees on Environmental Justice, Smart Growth and Violence Prevention and has worked extensively with CCHS on nutrition policy, environmental justice, community violence prevention, and the built environment. Joseph Ovick, EdD, County Superintendent of Schools, works with all 19 school districts on curriculum and policy and convenes a monthly meeting of all 19 Superintendents from which he can inform and mobilize the school districts around TCC strategies. Leonard McNeil, Mayor of San Pablo, is promoting a Health Element for the City s General plan and a city tax on sweetened beverages. He has worked with CCHS as a leader of the Kaiser- funded Healthy Eating Active Living (HEAL) project in West County. Mary Rocha, Vice-Mayor of Antioch, is a leader of the Healthy and Active Before Five July 13,

16 Coalition, a member of the CCHS Public and Environmental Health Advisory Board, and works with the broad diversity of East County residents and organizations. Richard Mitchell, Planning Director for the City of Richmond, works with CCHS on implementing the Richmond Health Element. Judith Corbett, MS, Executive Director of the Local Government Commission, spearheaded the Ahwahnee Land Use Principles and convenes the nationally recognized Smart Growth conference which brings together planners and public health professionals to share experiences and insights, tools and strategies. Marianne Balin, oversees Community Benefits for the Kaiser Health Plan, and has a 10- year history of working with CCHS on nutrition and food policy, built environment, and tobacco control. Ms. Bailin brings the experience of Kaiser s state-wide HEAL initiatives, and connects TCC with the Kaiser Health System, covering one-third of county residents. Rosemary Cameron is General Manager, Public Affairs for the East Bay Regional Parks District. The District includes over 96,000 acres of open space in 65 regional parks. Diane Aranda, Senior Program Officer with The California Endowment (TCE). Ms. Aranda works closely with CCHS, the City of Richmond and West county Community in the development, implementation and evaluation of the Richmond Health and Wellness Element of the General Plan. She is also the TCE Program Officer for Healthy Richmond, a ten-year TCEfunded project to improve health, education and access to health care in Richmond. Charlotte Dickson, MPH is the Director of the California Center for Public Health Advocacy s (CCPHA) Healthy Eating Active Living Cities Campaign, which is working with the League of California Cities and California s 485 municipalities to enact policies to increase access to healthy food and opportunities for physical activity. CCPHA led the successful July 13,

17 legislative campaigns to remove sodas and junk food from California schools and to mandate menu labeling for calories in restaurants. Dr Linda Rudolph, MD, MPH, is the Director of the Center for Chronic Disease Prevention and Health Promotion for the California Department of Public Health. She is the senior leader at the CDPH for chronic disease control, and leads the CDPH participation in the CTG initiative state-wide. Dr Rudolph will coordinate Healthy Contra Costa with state-wide efforts, and facilitate the dissemination of best practices from Contra Costa around the state and country. Dr. Christopher Farnitano, MD is the Ambulatory Care Medical Director for CCHS and oversees the eight Ambulatory Care clinics for CCRMC. He will coordinate the integration of the HCC clinical strategies with the over-all strategic direction of HCC. Members of the Leadership Team were selected from among many qualified and interested individuals based on their demonstrated history of leadership in policy and systems change on the county-wide, city, and community levels in the areas of wellness and prevention. 3. Leadership Team Steering Committee A working group of the Leadership Committee, the HCC Steering Committee will serve as the operational body of Healthy Contra Costa, responsible for coordinating activities across the strategies, regions and partners, and working with staff to implement the strategic directions of the Leadership Team. The Steering Committee of ten members will be comprised of at least five representatives of the Coalitions along with members of the Leadership Team. The Steering committee will meet monthly, and the HCC Project Director and Project Manager will participate in the Committee and work closely with its members. CCHS will provide additional staff support as needed for both the Leadership Team and Steering Committee. The Steering July 13,

18 Committee will: 1) plan for meetings of the Leadership Team, 2) coordinate activities among the coalition partners and across strategies, 3) identify opportunities for collaboration between coalitions and organizations and plan smaller, focused meetings as needed between agencies working in the same area, 4) work closely with the HCC Project Evaluation Team to ensure that data is collected to evaluate progress and impact of the initiative, 5) plan for three meetings per year of all coalition partners, and 6) work with the CCHS Communications Officer and HCC social media consultant to establish a Web Page, Facebook account and online collaboration platform for project stakeholders. See job descriptions for the Leadership Team and Steering Committee in Appendix E. 4. Evaluation Committee Members of the Evaluation Committee will be comprised of selected members of the Leadership Team as well as coalition members. The purpose of this committee is to ensure that the evaluation plan is being implemented and that the information derived is being reviewed by the Leadership team and coalition members. It will contain both professionals and community members to ensure that data is considered through multiple lenses and the resulting analysis is useful to those who are implementing strategies. Dr Jason Corburn from UC Berkeley and Pamela Schwartz from Kaiser National HEAL Evaluation Team, have agreed to participate. (See job description in Appendix E) 5. Healthy Contra Costa Coalition HCC includes the Healthy Contra Costa Coalition, which utilizes the expertise of diverse and established organizations located throughout the county to provide necessary coordination across sectors for a focused impact on key populations. Healthy Contra Costa Coalition includes the following existing coalitions with long ties to CCHS (see Appendix H for membership rosters and Appendix G for letters of support): July 13,

19 The Tobacco Prevention Coalition has operated since 1984 and includes the American Cancer Society, American Lung and Heart Associations, labor, members of the medical community and clinical providers, children s advocates and other stakeholders. They promote policy and education to reduce tobacco use and second hand smoke. CCHS provides staff support. Healthy and Active before Five (HAB45) was formed in 2007 to address childhood obesity in Contra Costa County. Bringing together the Contra Costa Child Care Council, First Five, Kaiser, WIC, and other stakeholders, the goal of HAB45 is to create food and activity environments in neighborhoods and key children s institutions that support children and families to adopt healthy behaviors. The HAB45 Leadership Council includes 44 individuals representing government, schools, foundations, health care providers, and community organizations. Much of the successful policy and environmental change advocated by the Healthy and Active Before Five: Action Plan to Reduce Childhood Obesity is implemented by partner organizations. The Monument Community Partnership (MCP) Central County Healthy Eating, Active Living (HEAL) is focused on increasing access to healthy food, improving the built environment, engaging the community, and building community capacity in the Monument Corridor hotspot in Central County. MCP has a resident driven philosophy with an extensive network of Neighborhood Action Teams (NATs). Its board includes the City Manager of Concord, the Mt. Diablo Unified School District, the Community Benefits CEO for the John Muir Health System, a Contra Costa Kaiser Community Benefits Manager and the CCHS Public Health Director. The majority of the Board members are community residents. MCP manages a Healthy Eating, Active Living (HEAL) project in Central County. It has had major successes in improving the built environment, advocating for the inclusion of the Monument region of Concord as a Redevelopment Area, and ensuring that the General Plan included bicycle and July 13,

20 pedestrian facileties, complete streets provisions, parks, and street lighting. Neighborhood Action Teams trained by CCHS staff and working through MCP local businesses work to improve the food environment in the small stores and restaurants serving the community. The Public and Environmental Health Advisory Board (PEHAB), established in 1986, is a 19-member advisory board appointed by the Board of Supervisors to advise CCHS on emerging public and environmental health issues and to advocate for systems and policy change to promote community health. It advocates for more effective tobacco policy in Contra Costa County and was a strong advocate for California s menu labeling law to inform healthier eating choices. PEHAB members represent consumers, voluntary organizations, schools, youth, seniors, industry, environmental organizations and health care providers. West County Healthy Eating, Active Living (HEAL) works across the business, education, community and health sectors to address nutrition and physical activity in low-income communities. Members include local businesses, parks and recreation departments, city governments, community agencies, CCHS, health care providers, and schools. In Richmond, HEAL conducted a community resident survey of the safety and usability of city parks, and used the results to work on the Parks Master Plan, addressing issues concerning lighting, drug use, and adequate staff presence to make the parks safe for physical activity. HEAL and CCHS have also used the State of California s USDA CX3 data collection instrument to map the local food landscape, identifying assets as well as food deserts. HEAL signed up new WIC stores and recruited local merchants to be part of the Network for a Healthy California, which provides for in-store marketing for healthy food. Working with the West Contra Costa Unified School District, HEAL successfully advocated for district-wide universal breakfast and funded a staff position to train elementary teachers in a curriculum-based physical education program. That program, which July 13,

21 included tracking BMI measurements of 27,000 students, is now district-wide; BMIs at some schools are beginning to show declines. The Health Care Sector Committee, chaired by the HCC Program Director, has worked to promote breast-feeding through peer counseling, home visitation, and efforts to make the CC Regional Medical Center a baby-friendly hospital. Building Blocks for Kids Collaborative (BBK) was established in 2007 and comprises 27 non profit and government agencies working in Richmond and West County and focusing on the high risk Iron Triangle neighborhood of Richmond. The vision of BBK is healthy, educated children living in safe communities and self-sufficient families. BBK s goal is to improve and, if needed, change service systems to better serve children and families with multiple issues. Bay Point Community Collaborative/Center for Human Development is a communitybased organization that actively provides a range of services to at-risk youth, individuals, and families within HCC s target implementation area. The Bay Point Community Collaborative is currently engaged in promoting the Health Conductors model of community health outreach. Contra Costa Clinic Consortium. This Consortium represents the three FQHC Community Clinics in Contra Costa and also the Planned Parenthood affiliates in the county. The Consortium is a key partner in the HCC clinical strategy. 6. Healthy Contra Costa Initiative Summits and Special Events HCC will convene a Summit of all the Coalition Partners three times per year. At each Summit meeting, Coalition partners will report on project activities and share best practices and lessons-learned and identify areas for collaboration both across strategies and within regions. They will participate in training sessions organized by national leaders focused on reducing and eliminating health disparities. These sessions will be led by organizations including the nationally recognized Prevention Institute and Public Health Law and Policy, as well as the July 13,

22 California Center for Public Health Advocacy, the UC Center for Weight and Health, Rainbow Community Center and others. In order to cultivate cross region and cross sector relationships, the Social Media Consultant will customize an online wiki or similar platform with a secure environment for Coalition and Leadership Team members to develop, share and discuss ideas. The Consultant will conduct a series of online trainings for Leadership Team and Coalition members about how to use GoTo Meeting, WebEx or shared desktop so participants can see and understand technical capabilities and provide technical support to participants. HCC will send a mixture of Initiative staff and community stakeholders to CDC meetings and learning summits as needed. E. COMMUNITY TRANSFORMATION IMPLEMENTATION PLAN Healthy Contra Costa includes 21 strategies that will be integrated across four overarching strategic themes, i) Health in All Policies (HiAP), ii) Pledge the Practice, Pass the Policy, iii) Community Health Messaging, and iv) Residents Voices. Health in All Policies components stress that health lenses are utilized in public and private-sector decision-making, with the objective of facilitating policies and procedures that promote health by addressing the social and environmental determinants of health. This means integrating consideration of health impacts into the decision-making apparatuses of organizations at all levels, from land use and housing policies, to the organizational practices of neighborhood store owners, to the business policies of day care providers. Pledge the Practice, Pass the Policy supports HiAP by responding to the often-slow nature of policy transformation by holding that voluntary commitment by community partners to practicing a policy s principles even before it has been formally adopted by Boards and legislatures can help build momentum for policy promulgation. Pledge the Practice strategies are about July 13,

23 enlisting organizations and groups to model pro-health practices, while simultaneously mobilizing bottom-up support for policy transformation. Community Health Messaging involves retooling messaging strategies and delivery mechanisms so that all residents are aware and engaged in promoting positive community health campaigns. Through the use of media consultants, Community Health Messaging will use social marketing and media to promote good nutrition and physical activity for youth, while expanding existing campaigns to target a broad range of age groups, communities, and health conditions. Residents Voices will provide the underlying direction to ensure that all strategies, organizational practices, and policies developed through the initiative are driven by - and continuously relevant to - residents health needs. This theme emerges from CCHS s long history of building participatory relationships with community groups and residents to better direct their communities healthcare service delivery. Healthy Contra Costa is a residents initiative, and as such, residents play a critical part in both framing and supporting its implementation. In addition to these themes, the strategies described below have been selected because each supports an integrated effort spanning multiple strategic directions, sectors, and jurisdictions. 1. Strategic Direction: Tobacco-free Living Overview: The Tobacco-free Living (TFL) Strategic Direction is an integrated package of evidence-based initiatives aimed to prevent adoption of tobacco use by young adults, facilitate cessation of use by current users, and prevent exposure to secondhand smoke both in public venues and private homes. Long-term Objective: Reduce death/disability due to tobacco use by 5% in Contra Costa County. POLICY STRATEGY: Support the adoption and implementation of legislative policies that create smoke free multiunit housing; prohibit smoking within 20 feet of building doorways, windows, and ventilation units; within all indoor workplaces including childcare centers; and July 13,

24 prohibit smoking in parks in 5 jurisdictions of greatest need within the County. ACTIVITIES The Tobacco Prevention Project (TPP) will work with the Tobacco Prevention Coalition to develop advocacy campaigns in each of the target jurisdictions of Concord, San Pablo, Pittsburg and Antioch. Campaigns will engage Coalition members and community partners that represent those populations most targeted by the tobacco industry, to develop strategy advocacy skills. Advocacy will include presentations to community groups, letters to the editor, meetings with policy makers, and testimony at public meetings on the importance of smoke free policies. Staff will provide consultation and technical assistance to city officials and staff, and will link city staff with the Technical Assistance Legal Center (TALC). TALC provides California communities with technical assistance on tobacco control issues, including model policies and fact sheets. After adopting policies, each city will receive technical assistance by the Tobacco Prevention Project on implementation. MILESTONES A community stakeholder strategy session for each city will be conducted with attendance by TPC members and community partners (Jan 2012-Dec 2014); A total of 5 jurisdictions will adopt and implement comprehensive secondhand smoke protections policies that include prohibiting smoking within 20 feet of building doorways, windows and ventilation units; prohibiting smoking in childcare provider sites 24/7; prohibiting smoking in parks and public trails; and prohibiting smoking in any workplace or building open to the public. At least one of these jurisdictions will adopt and implement comprehensive secondhand smoke protections that includes 100% smoke free multiunit housing for existing and new housing (Jan 2015). Adoption and implementation of legislated policies will be sought in Concord, San Pablo, Pittsburg, Antioch and County BOS (Dec 2015). POLICY STRATEGY: Encourage at least two jurisdictions in the County to strengthen their July 13,

25 tobacco retailer licensing policies to restrict the location and density of tobacco retailers. ACTIVITIES The Tobacco Prevention Coalition (TPC) will work with the County Board of Supervisors and at least one city to strengthen existing Tobacco Retailer Licensing policies to restrict the location and density of tobacco retailers. As best practices recommend, restricting the location and density of tobacco retailers contributes to reducing youth smoking, specifically by prohibiting retailers from operating within 1000 feet of youth-sensitive areas or within 500 feet of one another. Staff will coordinate outreach and media activities to educate the community and policymakers on the importance of considering tobacco retailer zoning restrictions as part of their community s total-health landscape. By working to establish model policies within the County s unincorporated regions first, the TPC will demonstrate the economic feasibility and public health benefit of such policies for cities. MILESTONES Identify all tobacco retailers operating within 1000 feet of youth-sensitive areas or within 500 feet of one another in the unincorporated regions, and the city of San Pablo (Jun 2012); seek adoption of tobacco retailer restrictions in unincorporated areas (Dec 2012); seek adoption of tobacco retailer restrictions by San Pablo City Council (Mar 2012). 2. Strategic Direction: Active Living and Healthy Eating Overview: The Active Living and Healthy Eating Strategic (HEAL) Direction includes an integrated set of policy, environmental, and programmatic initiatives aimed at fostering public and private environments that are conducive to making the healthy choice the easy choice. This includes efforts to create legislative environments friendly to Health in All Policies, bridging access to healthy food options, especially for low-income populations, and ensuring that youth have opportunities to learn and practice healthy eating and physical activity both at school and at home. It includes policy initiatives to promote Baby Friendly environments for breast feeding, especially in public facilities, health centers, child care facilities, and businesses. July 13,

26 Long-term Objectives: Reduce the rate of obesity by 5% in Contra Costa County. Eliminate USDA-identified food deserts throughout the County. POLICY STRATEGY: Establish local food policy councils in East, Central and County to assess local food systems and develop projects/policies that get healthy and locally-produced food to residents, especially those living in food deserts. ACTIVITIES Food Policy Councils will convene residents, stakeholders, and government officials to assess the local food system and develop policy recommendations. Three regional food assessment and GIS mapping activities will be conducted, which will provide residents, producers, and suppliers with information about where and how they can reach healthier food options. The assessment will also educate policymakers about which areas of their community are most in need of additional attention. The Councils will identify and resolve barriers that families face in procuring healthy foods for their families. Financial barriers will be addressed by expanding USDA outreach efforts to enroll families in CalFresh (foodstamps) and WIC and supporting EBT acceptance at local farmer s markets. HCC will assist individual farmers at markets to accept EBT through Pledge the Practice, Pass the Policy!, setting an example for other farmers to follow suit and encouraging the farmer s market association to adopt a policy that requires all sellers to accept EBT. Contra Costa s agricultural community will be connected to food deserts via farm to community programs which will include WIC, child care, neighborhood stores and schools. This is another Pass the Practice, Pass the Policy! opportunity as community programs establish relationships with local food producers, setting an example for other similar programs. MILESTONES Develop assessment tool and develop partners (Jan 2012); conduct 3 regional assessment and mapping (Oct 2012, 2013, 2014); introduce policy or programmatic July 13,