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Section 15. The County Health Rankings & Roadmaps Take Action Cycle

Numerous counties across the nation are already sharing stories of how the County Health Rankings have spurred cross-sector collaboration to improve community health. Below are a few of the stories from the County Health Rankings website, and you can view more or contribute your own.

Example 1: Never Giving Up: Addressing Drug Addiction in Scott County, Indiana

Carolyn King, Scott County Health Outcomes Task Chair for the Scott County Partnership Scott, Indiana - Snapshot

What would you do if the county you’d lived in and loved for many decades was ranked the least healthy county in your state for three years running? What if just days after this year’s Rankings release Reuter News Service began investigating why your county has the highest rate of prescription drug deaths in a six county area? This is the situation faced by the people of Scott County, Indiana. It would be understandable if their response was to give up in frustration, but that’s far from the reality.

Located in the beautiful rolling hills of southeastern Indiana, Scott County has suffered from decades of generational poverty with all its associated problems: isolation, depression, poor diet, tobacco use, colorectal cancer, child abuse, teen pregnancy. According to the 2012 County Health Rankings the rate of premature death in Scott County is much higher than the state average. “We die too young here and people don’t feel well,” says Carolyn King, Scott County Health Outcomes Task Chair for the Scott County Partnership. But a passionate group of people from every sector has been working together to turn things around and they’re in it for the long haul. According to Ms. King, “People care deeply here. The level of partnership and collaboration is exceptional.”

Today, besides the Scott County Partnership, a 40 member coalition called CEASe (Coalition to Eliminate Abuse of Substances of Scott County), a local coordinating council for drug prevention, which includes law enforcement, healthcare, education, community leaders, and others, is addressing the prescription drug abuse problem. CEASe worked with the local hospital and doctors to change prescribing practices. Formerly, people coming to the emergency room could get 10 day prescriptions for pain medication. Now, narcotic prescriptions are only written for 3 days at a time, and doctors are committed to blood level checks and reviewing patients’ prescription use history. Ms. King says, “We’re all on board together around this."

Much has been accomplished in spite of limited state and local funding. To promote positive health, the Health Outcomes Task Force started a Facebook site and published “Feeling Good Scott County” describing their numerous health initiatives, including colorectal cancer screening, a community garden, enhancements to the local Farmer’s Market, and replacing deep fat fryers at local schools with healthy options.

CEASe is addressing strategies around tobacco prevention, underage drinking and the new narcotic prescription policies at the local ER. For example, a local faith-based leader began “New Creation Addiction Ministry” to help former addicts find employment and stay sober. Fortunately, because there is so much activity around these and other issues, some funds are beginning to flow into the community. For example, a local not-for-profit recently received a large grant to address health and educational issues for pregnant and parenting teens. “Because we’re stirring the pot,” says Ms. King, “many agencies are getting grants.” It isn’t going far enough yet, but in the meantime, much has been accomplished simply through the power of people working together on a common vision of a healthier community. “We have much to do to address health disparity due to high poverty, but we are willing to tackle all issues in a creative fashion,” affirms Ms. King. Though change takes time and the annual Rankings results don’t reflect results quickly, Ms. King and the others on her team are encouraged by the way the community is pulling together around health in a positive way.

Example 2: In San Bernardino, CA, County Health Department Takes Lead to Improve Area's Poor Health Ranking

Evelyn Trevino, program coordinator for San Bernardino County Healthy Communities | San Bernardino, California - Snapshot

The 2011 County Health Rankings ranked San Bernardino County—which spans more than 20,000 square miles and a population of more than 2 million—50th out of 56 California counties in health factors like physical environment, social and economic factors, health behaviors and clinical care. The city of San Bernardino alone faces significant public health challenges, with a lower life expectancy, a higher homicide rate, and fewer parks and healthy food options than the rest of the state. Many other communities throughout the county share similar challenges associated with the county’s high poverty and unemployment levels, and its vast geography makes it difficult for many residents to reach centralized services.

But initial disappointment over its low ranking didn’t prevent the San Bernardino County Health Department from seeing the County Health Rankings as an opportunity to strengthen its current health improvement initiatives and persuade policymakers of the need for change. In fact, by clearly showing where the county ranks on various health measures, the Rankings have helped inform the health department’s six-year drive to get every community in the county to launch a Healthy Communities initiative aimed at ensuring that all residents have the opportunity to live a healthy life.

“The County Health Rankings are a terrific tool for us to take to policymakers because we can show that the status quo isn’t sufficient,” said Evelyn Trevino, program coordinator for San Bernardino County Healthy Communities. “It motivates support and action. We use it to get the message out.”

To date, 17 of the county’s 24 jurisdictions are at some stage of implementing a Healthy City initiative locally. Three partner cities have updated their general plans to include health as a guiding principle. Others have enacted healthy city resolutions; changed zoning policies to allow community gardens and farmers markets to flourish; improved safe routes to schools and campus vending machine standards; and established after-school programs, walking clubs and cooking classes for local residents.

The health department jump starts this engagement by offering $100,000 annually in seed grants to communities that want to join the effort. Among this year’s four grant recipients is a small group of unincorporated mountain towns that applied together through a local non-profit to create new and more attractive places for walking, biking and playing. Although many children ride buses to school, getting safely to and from bus stops is an issue. A Safe Routes to School program addressing the unique needs in these mountain communities could greatly impact the safety of children and drivers.

“City and county leaders have accepted the challenge to improve the county’s health ranking,” Trevino said. “The movement in San Bernardino County for cities to become partners in community health is amazing and inspiring. Thanks to the tremendous political will for creating healthier environments and choices for our residents, I am very hopeful that we will see our ranking improve.”

Example 3: Detroit, MI: Joy-Southfield Neighborhood Unites to Tackle Chronic Disease, Poverty, and Other Barriers to Health

Dr. David Law, executive director of the Joy-Southfield Community Development Corporation | Wayne, Michigan - Snapshot

Detroit, MI, is one of the most racially segregated cities in the country, with high crime, poverty and unemployment; poor public transportation; and vast food deserts that prevent residents from easily accessing healthy foods. In 2011, the County Health Rankings ranked Wayne County—where Detroit is located—81 out of 82 counties in Michigan for health outcomes and dead last for health factors.

But Detroit is also a very resilient city, where people know how to tackle complex challenges. For example, residents of the Joy-Southfield neighborhood have drawn upon the Rankings to help transform their corner of Detroit into a hub of activities aimed at improving community health.

“Once I got over the shock and anger of the County Health Rankings, I said ‘thank you’ because now we have a rational argument for obtaining grants and resources for addressing the root causes of poor health,” said Dr. David Law, executive director of the Joy-Southfield Community Development Corporation.

The Joy-Southfield Community Development Corporation (JSCDC) has operated in the neighborhood since 2001, initially offering sorely needed healthcare services to low-income, uninsured residents. However, after treating a number of common medical problems stemming from high rates of chronic disease, like diabetes and high blood pressure, the organization decided to expand its work to include more programs aimed at preventing community members from getting sick in the first place.

“Poor health in this country isn’t for lack of resources; it’s about investing in prevention,” Law said. “If we do a better job of preventing disease, health system reform will pay for itself. And preventing disease requires more than providing universal access to healthcare - we also need to address social and environmental factors that limit healthy options.”

The JSCDC has developed what Law calls an “ecological approach to promoting health equity,” that addresses each of the four factors measured by the County Health Rankings: health behaviors, clinical care, social and economic factors and physical environment. For example, several community groups and funders have already collaborated to empower youth through mentoring and community garden projects; renovate vacant properties to attract new businesses; improve community safety; provide job training and foreclosure prevention services; and educate the community about prevention and chronic disease management.

Law says the County Health Rankings data allows JSCDC and their numerous collaborators to focus their resources and engage local residents. Since 2010, JSCDC has used the County Health Rankings to leverage more than $500,000 in grant support, while also acquiring more strategic partners.

“Detroiters are not naïve about the complexity and depth of the challenges they face,” Law said. “At the same time, Detroit residents are extremely resilient and resourceful. Systematic and incremental transformation of this community is underway. It may take time, but when it comes to the Rankings, we’ll be ‘movin’ on up.’”

Example 4: PedNet Coalition Works to Improve Health Through Public Transit

Michelle Windmoeller, assistant director of the PedNet Coalition and Roadmaps Grant manager | Boone, Missouri - Snapshot

Home to the University of Missouri, Columbia is considered one of the state’s most livable cities, with a number of educational, economic and cultural opportunities available. It is also the seat of Boone County, which ranked well according to the 2011 County Health Rankings—10th out of 114 counties in Missouri for health outcomes and 2nd for health factors.

But with an eye toward further improvement, a local coalition has started to tackle one of Columbia’s greatest obstacles to health: reliable public transportation. Recent budget cuts have forced the city to raise bus fares and reduce routes, making it harder for many low-income residents to get to work and school, to grocery stores selling healthy foods and to health clinics located across town.

Education, employment, and access to healthy foods and health care services are all important determinants of health. That’s why PedNet—a coalition of community members, business representatives, schools and agencies seeking to increase active living in Columbia—and its partners, including the Central Missouri Community Action and the Columbia/Boone County Department of Public Health and Human Services, are using a Roadmaps to Health Community Grant from the Robert Wood Johnson Foundation to raise public awareness about the economic and health tolls of cutting bus services.

In addition to supporting a campaign that has engaged local university students to advocate for better transportation options, the partnership will use a tool called a health impact assessment to demonstrate to decision makers the connection between expanded public transit options, employment and health. The long-term goal is to create a transit authority with a dedicated tax base that ultimately triples public transportation services in Columbia by 2014, helping all residents lead healthier lives.

“A reliable, efficient public transportation system makes it easier for low-income workers to obtain and keep employment,” said Michelle Windmoeller, assistant director of the PedNet Coalition and Roadmaps Grant manager. “Studies have shown that improvement in employment and economic factors has a positive impact on health.”

Example 5: Rockingham County, North Carolina establishes task force to identify the root causes of its poor health rankings, develops recommendations

Rockingham, North Carolina - Snapshot

Rockingham County, dubbed as North Carolina’s North Star, is nestled at the tip of the Northern Piedmont Triad region and cradled by the foothills of the Blue Ridge Mountains. Though Rockingham County is mostly rural (county size – 572 square miles with a population of approximately 93,063), its communities still offer small-town living balanced with 21st century amenities.

The 2010 County Health Rankings revealed that Rockingham County ranked in the lower half of the state except for the area of physical environment where it ranked 48th out of 100 counties. Rockingham County ranked 71st out of 100 North Carolina counties in health outcomes and 85th out of 100 counties in the area of health factors.

In response to the 2010 County Health Rankings, the Rockingham County Department of Public Health in North Carolina immediately began to identify ways that the community could mobilize to address the issues facing their citizens. On April 26, 2010, the Rockingham County Board of County Commissioners officially appointed members to the Rockingham County Community Health Task Force, including community leaders from education, business, health, human services, as well as elected city and county officials.

The charge to the Health Task Force was to examine the 2010 County Health Rankings, identify the root causes of the poor health rankings, and develop recommendations for community action directed at improving health outcomes and health factors affecting Rockingham County residents.

The Task Force identified several common themes for action: health behaviors, education, jobs, and access to health care. The Task Force then developed recommendations related to these themes to improve the health of Rockingham County and presented a summary report to the Board of County Commissioners. In their report they state that, “the health status of Rockingham County residents is directly impacted by individual behavior, education and economic status, the physical and social environment, and access to quality healthcare. It is the position of the Rockingham County Community Health Task Force that positive improvements in these critical areas will result in the improved health status of county residents.”

Rockingham County is working hard to improve the health of county residents.

A great deal of effort has taken place to respond to the themes and actions recommended. These efforts include but are not limited to the following activities:

  • Introduction of new health department website – Rockingham County, North Carolina Department of Public Health: Not only is the new website more user-friendly and aesthetically appealing, it provides a wealth of up-to-date health information and resources. Through the aid of social media, health and wellness information is right at the resident’s fingertips.
  • Creation of the Rockingham County Healthcare Alliance: Funding pursuit for a new Federally Qualified Health Center.
  • Recipient of the Project Connect -- Communities Supporting Young Families Grant: Increase access to health care for uninsured pregnant or parenting females between the ages of 13-24.
  • Recipient of the Susan G. Komen for the Cure Community Grant: Eliminate breast cancer and medical isolation encountered by women who live in rural counties. Increase breast cancer awareness and education for African American women and increase visibility of free services for women who are medically-underserved.
  • Rockingham County Healthy Carolinians Partnership: Working with the Cooperative Extension, WIC/Nutrition Program and the Local Food Coalition by providing a farmer’s market located at the health department during the days WIC vouchers are distributed (providing access to local fresh fruits and vegetables for WIC clients); collaborating with the Rockingham County School System to reduce childhood obesity through the In-School Prevention of Obesity & Disease program; working with the Rockingham County Public Libraries by providing county-wide presentations to promote and raise the awareness of healthy lifestyles and behaviors; and offering Zumba fitness sessions to county employees and family members to increase structured weekly physical activity.
  • Recently conducted competitiveness survey: Provided through collaboration between Rockingham County Partnership for Economic & Tourism Development and UNC-Kenan-Flagler Business School to evaluate Rockingham County’s ability to compete in the new economy by assessing the strengths, weaknesses, opportunities, and threats inherent in its existing stock of polity, financial, physical, human, cultural, and social capital.
  • Community Health Assessment: Rockingham County Department of Public Health is preparing to conduct a Community Health Assessment which will provide a wealth of county health, education, employment and overall needs/resource information.

According to Glenn L. Martin, Rockingham County Health Director, "The County Health Rankings allowed Rockingham County leaders the ability to clearly see and understand the connection between the population’s level of education, economic status and their health status. We learned that while the challenges facing our county were inter-related, so were the solutions."