Creating Equal Opportunities for a Healthy Weight: The Role of Total Health together WE BUILD A BRIGHTER FUTURE Institute of Medicine Standing Committee on Childhood Obesity Prevention June 6, 2013 Raymond J. Baxter, PhD Senior Vice President, Community Benefit, Research and Health Policy
Kaiser Permanente s History & Mission To provide high quality affordable healthcare and to improve the health of our members and the communities we serve. A legacy of equity and prevention Page 2
Health and Health Outcomes are Not Equitably Distributed Page 3
Obesity Varies Among Kaiser Permanente Members KP Member Rates of Obesity (%) by Race 100% 80% Percent 60% 40% obese overweight normal underweight 20% 0% AIAN Asian Black Hispanic Multi White Ethnicity Page 4
Health is About More Than Access to Care Health is driven by multiple factors that are intricately linked of which medical care is one component. Drivers of Health Personal Behaviors 40% Family History and Genetics 30% Environmental and Social Factors 20% 10% Medical Care Page 5 Source: Determinants of Health and Their Contribution to Premature Death, JAMA 1993
An Integrated Approach to Diseases and Risk Factors 4 Diseases, 4 Risk Factors* 4 Kaiser Permanente Actions Support Individuals Cardiovascular Disease Encourage Groups Diabetes Cancer Change Communities Chronic Respiratory Disease Track Outcomes Page 6 *Aligns with World Health Organization s framework for monitoring non-communicable diseases
What We re Up Against Page 7
We Have to Deploy All Our Assets for Total Health Deploying Kaiser Permanente Assets for Total Health Clinical Prevention Physical and Mental Health Care Health Education Research Purchasing and Employment Practices Community Health Initiatives 1 Individual / Family Home / School / Worksite Neighborhood / Community Access to Social and Economic Supports Walking Promotion Worksite Wellness Environmental Stewardship Society Public Policy Public Education Page 8
Behavior Change: A Total Health Perspective Health and costs hinge on addressing modifiable risk factors. CLINICAL EXECUTION Reliable and effective delivery system interventions to: screen, advise, assist, refer ONLINE ENGAGEMENT Optimal use of: online resources, health coaching, mobile apps, social media, etc ENVIRONMENTAL AND COMMUNITY STRATEGIES Support healthy choices Total health requires us to systematically identify members behavior change goals, connect members to optimal resources/supports and create optimal defaults. Page 9
Obesity Prevention and Treatment: Initial Focus Exercise as a Vital Sign (EVS) Program-wide implementation Clinical scripts regarding community environments Referrals to community-based physical activity providers Healthy Pregnancy/0-2 Hospital breastfeeding commitment Post-discharge support for breastfeeding Healthy childcare and workplace environments Pre- Diabetes Pilot Diabetes Prevention Program Explore online and other modes Our goal Total Health Navigation Systematic assessment of members healthy eating and active living goals, readiness to change and support preferences Referral to appropriate KP and community resources Page 10
Obesity Prevention and Treatment Must Be Culturally and Linguistically Appropriate Culturally grounded health education and approaches to behavior change Cut the Fat Keep the Soul cooking classes, Spanish language health ed materials, interpretation vs literal translation Interventions grounded in research and evaluated for effectiveness in diverse populations KPNW study of a culturally tailored program, including a traditional diet, to help Mexican American women lose weight Journal of Immigrant and Minority Health Inclusiveness in program design and acknowledgment of weight bias Scales and terminology around weight Community partners bring competencies and models we may not have. Promotoras in SCal, Su Salud diabetes prevention in CO, faithbased partnerships The real challenge is scaling up solutions. Page 11
Kaiser Permanente's Commitment to Healthy Food Improve food offerings for patients and staff in all our facilities: More than 50 farmers markets and farm stands Healthy Picks is standard for healthy eating Food Guidelines ensure affordable, healthy, on-site food; menu labeling and catered food. Healthy Eating programs, educational tools and resources Page 12 12
Kaiser Permanente's Breastfeeding Commitment In April 2013, launched breastfeeding toolkit designed to provide hospitals and health care systems with information and resources to promote exclusive breastfeeding when moms leave the hospital. It includes: Evidence-based practices Processes used by Kaiser Permanente improvement teams to meet the needs of their patients Strategies around leadership engagement, measurement, planning and ongoing improvement, patient-centeredness, and sustainability Additional templates, tools, and videos Page 13
Workforce Wellness: National Labor Agreement Landmark provisions Incentives to bring down healthcare costs Reward collective group achievement of lowered risk factors Goal: Achieve 5% improvement in key biometric risk indicators - BMI, smoking, blood pressure and cholesterol - for 100,000 represented employees by the end of 2016. http://www.lmpartnership.org/tools/2012-national-agreement-overview Page 14
KP Interventions: Employers We have begun to offer a portfolio of services to help KP customers and other organizations improve the health of their workforce. Analytics & Reporting Communications Lifestyle Health Coaching by Phone HealthMedia reporting Exercise reporting Rewards reports Kp.org activity reports Standard & customizable print/web communications HealthWorks workbook Inbound coaching Page 15
Cities for Workforce Health A partnership brought together through the League of California Cities' League Partner Program at the end of 2012 Brings workforce health resources, in various levels of engagement, to 482 cities in California. Page 16
Community Health Strategies Focus on individuals and communities with the least access to healthy foods and activities Engage them in the design of solutions Page 17
A Total Health Strategy Healthcare BMI as a vital sign Breastfeeding promotion Hospital cafeterias Schools Cafeteria reforms PE standards, after school programs Joint Use Agreements Safe routes to school Worksites Stairwell prompts Lactation support Worksite wellness programs Neighborhoods Parks, trails and other active public spaces General Plan amendments Corner store conversion efforts Farmers markets and community gardens Healthcare Neighborhoods Schools Worksites Page 18
We Have to Activate Individuals & Communities Weight of the Nation http://theweightofthenation.hbo.com/ Every Body Walk http://everybodywalk.org Page 19 Thriving Schools www.thrivingschools.kaiserpermanente.org
Health and Health Outcomes are Not Equitably Distributed Page 20
The Road Ahead is Challenging But We Can Find a Way. Page 21