San Diego County's 10-Year Public Health Initiative Shows Early Progress

by Lisa Zamosky, California Healthline Regional Correspondent

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SAN DIEGO – Three years into a 10-year plan to alter the landscape of public health, the county Health & Human Services Agency is preparing to present its third annual report to the County Board of Supervisors about the progress of Live Well, San Diego!

Live Well, San Diego! is a comprehensive public health initiative that involves widespread community partnerships to address the root causes of illness and rising health care costs.

"We knew we had to do more than just health," said Nick Macchione, director of the San Diego County Health & Human Services Agency. Macchione said that evaluating and making changes to the social determinants of chronic illness -- safety, jobs, housing and education -- is critical to improving the overall health of the community. "They are completely dependent upon one another," he said.

As such, the plan calls for participation and coordination among those in the health care community, faith-based organizations, the business community, schools, law enforcement, cities and tribal governments.

In all, the program involves 52 county departments coming together with community partners. "That collective impact -- we knew we had to achieve that, and that's really what separates, I think, our population base from most others," Macchione said.

Live Well, San Diego! has three distinct phases, the first two of which are already underway.

Phase 1: Building Better Health

Building Better Health, the first phase of Live Well, San Diego! was adopted in July 2010. The program builds on the principle of 3-4-50, or that three behaviors (a lack of physical activity, tobacco use and poor diet) -- lead to four diseases: heart disease and stroke, lung disease, cancer and Type 2 diabetes. Those four diseases contribute to more than 50% of all deaths in the San Diego region.

The goal of the program is to reduce childhood obesity and preventable deaths resulting from heart and respiratory conditions, diabetes and cancer. A big part of the effort also incorporates strengthening the connections between physical health and behavioral health services.

Regional health systems, such as Palomar Health participate on one of the six Live Well, San Diego! teams that function within each of the HHSA regions throughout San Diego County. These teams provide a central point for planning and prioritizing collaborative action that occurs among a large number of health care partners.

Nancy Roy, community outreach liaison with Palomar Health, said the collaborative approach to the Live Well, San Diego! program has enabled her organization to foster partnerships that have led to the expansion of health care services. In all, according to Roy, Palomar has more than 72 community partners.

"I work in some rural areas, and the needs are different than in central San Diego. But still, substance abuse is everywhere. Mental health is everywhere. Obesity and diabetes are everywhere. We get together with best practices for the whole county."

Topping the list of health issues her system tackles through the Live Well, San Diego! program are obesity and diabetes.

The system offers various programs, such as classes to educate children and families about healthier eating habits and exercise, sponsoring running clubs in several school districts to promote physical fitness and increasing community awareness about access to medical and behavioral health services, including no- and low-cost sources of care.

"We bring together all these different partners from all these different organizations, and some community volunteers, to do these projects that we're passionate about, and develop it without a whole lot of money, really," Roy said.

Phase 2: Living Safely

The second phase of Live Well, San Diego! was adopted October 2012 and focuses its efforts on protecting residents from crime or abuse and preparing communities for disasters and emergencies.

According to Macchione, as with the Building Better Health initiative, the program is wide-ranging in its efforts to create safer communities. However, he pointed to the great importance of addressing childhood abuse and trauma and looking at the various ways a lack of safety negatively affects health.

Phase 3: Thriving

The third and final phase of Live Well, San Diego! has yet to roll out but is expected sometime in 2014. Part of its focus will be to help residents develop financial literacy and bring people out of poverty. "We know that understanding the importance of financial management and personal finances, has a direct impact on health," Macchione said.

Like the other phases, Thriving will involve a wide range of stakeholders, including local businesses that understand the implications of employee health and providing adequate and affordable housing for all San Diegans.

An Early Success Story

Chula Vista's school district is a prime example of the impact focused programs can have on the growing epidemic of obesity among children.

The district kicked off a program in 2010 as part of the Building Better Health initiative. It measured the body mass indexes of more than 25,000 students from kindergarten through 6th grade.

"We found out that we had a problem in Chula Vista with obesity," said Francisco Escobedo, the district's superintendent. "One out of three of our kids were leaving 6th grade at an obese level."

The Chula Vista School District's efforts, along with all other programs within the Live Well, San Diego! initiative, are guided by U.S. Census data used to identify the schools where obesity rates were highest and interventions most needed.

In response to the findings, the school district adopted a host of new policies. "Obviously, measurement is important for awareness, but measurement in itself is not going to make a difference," Escobedo said.

Every school in the district renewed its commitment to physical education by getting kids to run more frequently and to participate in programs, such as the American Heart Association's Jump Rope for Heart while at school. Schools also emphasized movement throughout the day.

"What we're doing is embedding movement and kinesthetic activity as part of our new common course standards," Escobedo explained. For example, a classroom of kids engaged in a math activity may be asked to stand up and do three jumping jacks. "Just trying to incorporate some of that during the school day I think is very critical," Escobedo said.

The district also has altered its food policies. Some examples include celebrating students' birthdays with stickers and games instead of cupcakes. Cafeterias display messaging that encourages healthy eating and exercise habits, and fruits and vegetables are center stage in visually appealing ways to entice kids to eat more of them.

"We used to have our salad bar at the end in a corner. Guess what? Kids aren't going to be choosing that. You just change where it's at, make it look welcoming, cut them up, and we were able to see consumption increase about 30%," Escobedo said.

As a demonstration of the broad-reaching effort embodied by Live Well, San Diego!, the Chula Vista School District reached out to neighboring farms to find ways to make fresh produce more available in communities with the highest rates of obesity.

In areas identified as unsafe and with high obesity rates, the school district worked with the city to deploy police officers so that kids could play in public parks. And as a result of its partnership with Scripps Health, parents have access to cooking lessons that help them prepare healthier versions of the traditional foods by substituting ingredients.

In just two years, the obesity rate in the district has been reduced by a little more than 3%, which represents more than 800 students. "If you think about it, that's a whole school that went from the obesity range to a healthy weight. That was great," Escobedo said.

The Chula Vista story is but one of a number of successes the program has had thus far. The Live Well, San Diego! Building Better Health 2011-2012 annual report highlights the establishment of many others, including relationships between mental health and primary care providers; increasing participation in California's nutrition assistance program, Cal-Fresh, by nearly 9%; and bolstering access to behavioral health screenings for prison parolees.

With the Affordable Care Act's emphasis on wellness and prevention, Macchione feels the Live Well, San Diego! initiative has prepared the county well for the future. And he's happy that some big changes were set in motion before the law was at his door step.

"We've been building the groundwork to prepare for it," he said. "I think it's exciting because we will see with the ACA resetting the playing field what potentials will come."


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