Overview

Our Strategic Program aims to create long-term, measurable, sustainable change in the health of our seven-county region. The key themes running through all the strategic priorities will be tackling any issue with a multi-faceted, community-based approach. The initiatives may last three to seven years with continual evaluation and measurement of success.

Strategic Priorities

Empire Health Foundation's first two strategic issue areas are:  1) Obesity Prevention, and 2) Mental Health.  To the extent possible, the team will look for opportunities to complement these two programs with each other and with our other efforts.

Obesity Prevention

The obesity epidemic is a national crisis. In fact, 68% of our population is overweight and obese. We know that we need a complex solution to a complex problem. One that is multi-faceted, crossing many silos and sectors, and is adaptive. In order to be successful as a region at addressing the obesity crisis, we need to develop strong community partnerships and leverage that to foster community change and encourage healthy living.  

In early 2011, the Foundation began the obesity prevention initiative with an evaluation of several rural communities in our region to understand the healthy living initiatives that were already taking place and meet the local leadership championing these efforts. Through that initial exploration, the Foundation is currently working with the community of Cheney to implement a significant pilot project with several multi-pronged, community-based interventions. In addition, five other rural school districts are participating in the obesity prevention initiative through significant reform of their school food programs. In 2013 and over the next 12-18 months, the Foundation will work together with these communities to support existing efforts in each community and assist in expanding the scope of involvement these groups have in creating healthier communities. A critical component of this work will be ongoing commitment of time, energy and resources from local leaders in each community. Our hope is to take this learning and apply it regionally, partnering with as many communities as we can in our seven counties over the next few years. 

Systems, Policy & Environmental Changes

It is clear that the most effective, sustainable solutions to combat the obesity epidemic are systems and policy changes that ultimately affect the environment in which we live, work, and play. Programmatic and/or individual behavior changes are important to improving and individual’s health, but are not effective by themselves to change the health of a population. 

Examples of evidence-based practices that contribute toward obesity prevention

SCHOOLS

• School Food Reform (improve the nutritional quality of foods served to children in school, and reduce availability of processed foods with low-nutritional content available to kids and staff) 
• Recess Before Lunch
• Increased physical activity requirements in school and after-school (target: minimum of 60 minutes per day of moderate to heavy physical activity)
• Physical activity/movement integrated into existing curriculum for all subjects
• Policies against bake sales and unhealthy snack foods distributed to classes or at after school programs
• Policies against marketing of unhealthy foods in schools
• Increased parent communication about nutrition and physical activity (provide healthy, affordable recipes for home cooking, etc.)
• Increased communication about Body Mass Index (BMI) to parents with children who are overweight or obese (or who are at risk)
• Limit hours of operation and contents of vending machines and competitive food outlets on school property
• Hire Wellness Coordinator to work within the school to help develop healthier school environments for kids 
• Develop formal “Wellness Council” within school to make policy and governance decisions about healthy school environments

COMMUNITY/CITY/WORKSITES/HEALTHCARE

• Increased built environment accessible for walking/biking
• Support access to safe outdoor recreation areas (parks, playgrounds and trails)
• Pricing strategies (both incentives and disincentives) to promote purchase of healthier foods
• Institute smaller portion sizes and healthier options in public service venues
• Promote required menu labeling at restaurants and public service venues
• Institute worksite wellness policies promoting healthy habits by employees (has long-term financial gain for employers in the form of reduced health premiums)
• Community joint-use agreements of local physical activity space (school gyms, community centers, etc.)
• Develop and support a local food system (farmers markets, local grocery stores with fresh produce, healthy food options)
• Worksites – conduct annual health screenings, on-site behavior change programs (biggest looser competitions, walking clubs, etc.), incentives for meeting health goals
• Make BMI screening and education opportunities part of regular healthcare examinations
• Pre-pregnancy, during pregnancy and after birth, promote physical exercise and proper nutrition for the mother as well as and a minimum of 6 months of breastfeeding for the child
• Promote nutrition and physical activity policies within early learning centers

Highlight: School Food Reform

Since fall of 2011, Cheney and Othello school districts have been working hard to completely reformulate their school food systems. In the summer of 2012, the school districts of Davenport, East Valley, Newport, and Wellpinit, along with the Community School of Spokane Public Schools, joined this effort. Ninety to 95% of all highly-processed foods that include unwanted ingredients such as high fructose corn syrup, preservatives and other chemicals are being removed, and instead wholesome, scratch-cooked food is being served for breakfast and lunch everyday. Nearly 15,000 K-12 students are enrolled in these school districts and will be positively affected by this change. This new model fits within the existing financial structure of the school food program, and some schools are even able to achieve a positive financial return on investment over time. Nutrition education integration is beginning to occur in the classroom and throughout the communities as well. We have partnered with consultants to conduct the training, technical assistance, and hands-on guidance through the change. 

NEWS

The Alliance for a Healthier Generation: "Eastern Washington Schools Tackle Obesity Head On"

Spokesman Review: "Old-School Lunches: more East Side districts are changing back from pre-processed to made-from-scratch meals"

Action for Healthy Kids: "Cheney School District Tackles Student Wellness Head-On"

Cheney Free Press: "Going further than federal and state requirements makes before and after school and summer camp programs health policy uniquely Cheney's"

InHealth Healthy Living in the Northwest: "Selling Healthy: Remaking school lunches to be healthier is a big challenge, but small victories are starting to emerge"

Mental Health

Working on the spectrum from prevention to treatment, the Foundation is currently focused on designing and promoting strategies to reduce Adverse Childhood Experiences (ACEs) as well as build resiliency among youth and adults who have experienced multiple ACEs throughout the course of their childhood. In addition, the team is working with local health providers to better integrate the behavioral health and primary care delivery systems and bridge gaps between the various other agencies that serve overlapping populations.

Bi-Lateral Integration between Primary Care and Behavioral Healthcare

The team is currently working with a group of local providers to help initiate a pilot that successfully integrates primary care and behavioral health care for a specific target population. The work is in the early formative stage, and we are continually learning on a daily basis. Some of the strategic principles and goals for this work include: 

• Reflecting the bi-lateral integration and team approach of the "person-centered health home" model
• Addressing links to pain specialists, medication management, social service supports, pharmacy, transportation, etc.
• Build towards creating sustainable reimbursement models to pay for portions of the wrap-around services that are not covered by traditional payers
• Reduce unnecessary Emergency Department use
• Reduce hospital readmissions
• Reduce recidivism in the criminal justice system
• Increase connection and show-up rate to a usual source of primary care (the "medical home")
• Improve self-reported patient health status
• Improve provider satisfaction
• Increase percent of patients managing their medication/chronic conditions appropriately

Reducing the prevalence and mitigating the effects of Adverse Childhood Experiences (ACEs)

The team is currently working to better understand the research relating to Adverse Childhood Experiences (ACEs) and the powerful relationships between life stressors during the first eighteen years of life, and the physical, emotional and behavioral health issues across a person’s life span. ACE-related health outcomes with substantial public costs include: depression, chronic illness, substance abuse, and teen pregnancy (Anda et al, 2006). We are currently in the early stages of developing a strategy for our role in helping take this powerful research and turn it into tangible interventions in our region aimed at reducing the prevalence of ACEs as well as building resiliency among individuals who have experienced childhood trauma. 

Reference: Anda, R.F., Felitti, V.J., Bremner, J.D., Walker, J.D., Whitfield, C., Perry, B.D., Dube, S.R., & Giles, W.H. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256, 174-186. 

NEWS

Spokesman Review Editorial: "We need to nuture young brains"

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* New Report Available!: Complex Trauma: Key Informant Perspectives, prepared for Empire Health Foundation by Clegg & Associates.

Click here for full report [pdf]