Transforming Health and Health Care Through Nurses in Tennessee

Transforming Health and Health Care Through Nurses in Tennessee

Nursing Leadership Workshop I: Building a Culture of Health in Tennessee Carole R. Myers, PhD, RN Nursing Lead-Tennessee Action Coalition Transforming Health and Health Care Through Nurses in Tennessee

Learner outcomes Describe health outcomes of Tennesseans Review the many factors that impact health outcomes & select health determinants of Tennesseans Discuss what a Culture of Health entails Describe the RWJF Culture of Health Action Framework

Before we get started: What does a Culture of Health mean to you?

Health is more than health care & personal choices. To measurably improve health status & reduce inequities, we must address social determinants of health.

Tennessee: Overall Rank 46 45 45 44 43 42 41 41 42 42 43 40 39 2011 2012 2013 2014 2015 Source: America s Health Rankings (United Health Foundation, 2015)

America s Health Rankings Determinants Outcomes 25% 75% Behaviors Community & environment Policy Clinical care Source: America s Health Rankings (United Health Foundation, 2015)

Health determinants: Behaviors Metric Rank Smoking 47 Excessive drinking 2 Drug deaths 40 Obesity 36 Physical inactivity 42 High school graduation 11 OVERALL 37 Source: America s Health Rankings (United Health Foundation, 2015)

Health determinants: Community & environment Metric Rank Violent crime 47 Occupational fatalities 32 Children in poverty 45 Infectious disease 18 Air pollution 30 OVERALL 40 Source: America s Health Rankings (United Health Foundation, 2015)

Health determinants: Policy Metric Rank Lack of health insurance 31 Public health funding 21 Immunization-Children 25 Immunization-Adolescents 38 OVERALL 31 Source: America s Health Rankings (United Health Foundation, 2015)

Health determinants: Clinical care Metric Rank Low birth weight 44 Primary care physicians 18 Dentists 39 Preventable hospitalizations 43 OVERALL 41 Source: America s Health Rankings (United Health Foundation, 2015)

Metric Health outcomes Rank Diabetes 48 Poor mental health days 50 Poor physical health days 46 Disparity in health status 6 Infant mortality 36 Cardiovascular deaths 44 Cancer deaths 44 Premature deaths 43 OVERALL 45 Source: America s Health Rankings (United Health Foundation, 2015)

Poor Health Outcomes $2.8 trillion BETTER Health care HEALTH Health CARE = BETTER HEALTH

Improving health requires a broadbased cross-sectoral view & collaboration.

Key ideas Factors at multiple levels affect human behavior Essential to understand and address barriers and constraints to behavior change at multiple levels Unrealistic to expect individuals to change behavior if barriers at higher levels are insurmountable

Implications for practice Interventions for planned change should address all four levels to be effective: Individual Social network Community Societal

If social change supports individual change, more self-sustaining.

Population health focuses: Wellness, prevention & health promotion Upstream causes of health problems Social determinants of health Community conditions All people Partnerships between health & other sectors

Enrollment Population Health Characteristic Geographic

Why does population health matter? Least Healthy Counties More infants die More children live in poverty Higher crime rates Higher unemployment Higher drop out and teen pregnancy rates Most Healthy Counties Better access to healthy foods, parks and exercise venues Better access to health care Less likely to end up in hospital for preventative reasons Source: RWJF County Health Rankings and Roadmaps, 2015

CREATING OPPORTUNITY FOR ALL

Culture of Health A social movement with an aim to boldly work in community to improve equity across diverse populations and the health and well-being of everyone in America.

Culture of Health Good health flourishes across geographic, demographic, & social sectors. Attaining the best health possible is valued by our entire society. Individuals & families have the means & the opportunity to make choices that lead to the healthiest lives possible. Business, government, individuals, & organizations work together to build healthy communities & lifestyles. Everyone has access to affordable, quality health care because it is essential to maintain, or reclaim, health. No one is excluded. Health care is efficient & equitable. The economy is less burdened by excessive & unwarranted health care spending.

https://www.youtube.com/watch?v=rs4qsf6mxug

Address all factors that affect health The choices we make are based on the choices we have.

Vision We, as a nation, will strive together to build a Culture of Health enabling all in our diverse society to lead healthy lives, now and for generations to come

Nurses crucial to building a Culture of Health Nurses make up the largest segment of the health and health care workforce and spend most time with people. They: Promote prevention and wellness Provide population-focused services to entire communities

ACTION AREA 1 MAKING HEALTH A SHARED VALUE DRIVERS MINDSET AND EXPECTATIONS SENSE OF COMMUNITY CIVIC ENGAGEMENT Value on health interdependence Value on well-being Public discussion on health promotion and well-being Sense of community Social support Voter participation Volunteer engagement

ACTION AREA 1 2 FOSTERING CROSS- SECTOR COLLABORATION TO IMPROVE WELL-BEING DRIVERS NUMBER AND QUALITY OF PARTNERSHIPS INVESTMENT IN CROSS-SECTOR COLLABORATION POLICIES THAT SUPPORT COLLABORATION Local health department collaboration Opportunities to improve health for youth at schools Business support for workplace health promotion and Culture of Health U.S. corporate giving Federal allocations for health investments related to nutrition and indoor and outdoor physical activity Community relations and policing Youth exposure to advertising for healthy and unhealthy food and beverage products Climate adaptation and mitigation Health in all policies (support for working families)

ACTION AREA 3 CREATING HEALTHIER, MORE EQUITABLE COMMUNITIES DRIVERS BUILT ENVIRONMENT/ PHYSICAL CONDITIONS SOCIAL AND ECONOMIC ENVIRONMENT POLICY AND GOVERNANCE Housing affordability Access to healthy foods Youth safety Residential segregation Early childhood education Public libraries Complete Streets policies Air quality

Auerbach J., The 3 Buckets of Prevention. Journal of Public Health Management and Practice 2016. h6p://journals.lww.com/jphmp/cita>on/publishahead/the_3_buckets_of_preven>on_.99695.asp

www.cdc.gov

ACTION AREA 4 STRENGTHENING INTEGRATION OF HEALTH SERVICES AND SYSTEMS DRIVERS ACCESS CONSUMER EXPERIENCE AND QUALITY BALANCE AND INTEGRATION Access to public health Access to stable health insurance Access to mental health services Routine dental care Consumer experience Population covered by an Accountable Care Organization Electronic medical record linkages Hospital partnerships Practice laws for nurse practitioners Social spending relative to health expenditure

Building a Culture of Health in Tennessee: Exemplars Tomorrow 8:00-9:00 am MODERATOR: Victoria Niederhauser, DrPH, RN, PCPNP-BC, FAAN, Dean, College of Nursing, University of Tennessee, Knoxville PANELISTS: Lisa Davenport, PhD, CEN, RN, Clinical Assistant Professor, College of Nursing, University of Tennessee, Knoxville Meghan H. Hayes, MPH, RN, Clinical Instructor, College of Nursing, University of Tennessee Knoxville Laurie L. Meschke, PhD, Associate Professor, Department of Public Health, University of Tennessee, Knoxville This is the second session of the two-part workshop

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