Panelist

Jody Early, Associate Professor, UW Bothell School of

Nursing & Health Studies

Stuart Elway, President, Elway Research, Inc.

2015 Snohomish CountyHealth & Well-being Index

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Providence Institute statement of purpose: Healthier body,Healthier relationships,Healthier communities.Created together.

It takes a village

Providence Institute for a Healthier Community

The PIHC will affect health behavior changes through partnerships in four areas:

Center for Health

Priorities & Progress

Center for Health

Education & Healing

Center for Workforce

Health & Productivity

Center for Community

Health Transformation

Focus: Targeted, innovative community partnerships

based on a common agenda & shared metrics to

improve population health.

Focus: productivity & competitiveness through

innovative employer wellness tools and resources,

and best business practices.

Focus: Listening deeply. Allow individuals

(not health systems) to define health &

wellbeing on their own terms. Track progress.

Focus: co-creating with community

partners a clearinghouse of relevant

tools and resources to optimize health.

• Focus:

• Create /promote a community-based view of vibrant health & well being

• Drive a common agenda for better health and well-being

• Consumer information to improve healthcare literacy and informed healthcare decisions (Year 2+)

• Measurement/evaluation of Institute program efficacy

Center for Health Priorities & Progress

• 2015 Initiatives:

–Community Voices listening campaign

–Vital Signs: The Snohomish County Health & Well-being Index

–Collaboration with The Daily Herald – online and print platform for reporting results

–LiveHealthy2020 campaign – support for countywide shared measurement

Building our capacity to “see” community health

A concept for GIS mapping capabilities for Health & Well-being Index results and other purposes (in this case, LiveHealthy2020 signatory locations) being explored through the Providence Institute for a Healthier Community.

Digital home & clearinghouse

A concept for online, searchable community assets with a broad array of resources, being explored through the Providence Institute for a Healthier Community.

Community co-creation

A concept for “gold-card” access allowing community partners to self-submit content, being explored through the Providence Institute for a Healthier Community.

Snohomish County Vital Signs

Toward a County Wellbeing Index

Jody Early, Ph.D., M.S., MCHESAssociate ProfessorSchool of Nursing and Health StudiesUniversity of Washington-Bothell

H. Stuart Elway, Ph.D.PresidentElway Research, Inc.

Vital Signs Index • Systematic, representative measure of behaviors

and opinions

• Visible and owned by our community

• Used as a means to build common agenda and set priorities

• Track and report changes and progress

Framework: Existing Paradigms• Build on existing models

• Ground the models in the here and now

• What works for Snohomish County in 2015?

Public Health:Socioecological Model

Social Determinants of Health• Economic Stability

• Poverty• Employment• Food Security• Housing Stability

• Education• High School Graduation• Enrollment in Higher Education• Language and Literacy• Early Childhood Education and Development

• Social and Community Context• Social Cohesion• Civic Participation• Perceptions of Discrimination and Equity• Incarceration/Institutionalization

• Health and Health Care• Access to Health Care• Access to Primary Care• Health Literacy

• Neighborhood and Built Environment• Access to Healthy Foods• Quality of Housing• Crime and Violence• Environmental Conditions

WA Behavioral Risk Factor Surveillance System

• Centers for Disease Control and Prevention

• WA Department of Health

• Snohomish Health District

Community Roadmaps

University of WisconsinRobert Wood Johnson

Gallup / Healthways• PURPOSE: Motivated; I like what I do

• SOCIAL: Supportive relationships

• FINANCIAL: Security; Degree of stress

• COMMUNITY: Like where you live; Safety; Pride

• PHYSICAL: Energy, Nutrition, Exercise

Seattle Foundation

Community-Based Participatory Research

• Collaborative approach to research

• Cyclical and iterative Process

• Equitably involves community members in the research process

• Covers issues important to the community involved

•Recognizes the unique strengths that each partner brings. •Fosters colearning and capacity building among partners•Includes multiple sources of knowledge and methods of discovery•Based on guiding principle of reciprocity•Goal of taking action for social change

Community-Based Participatory Research

Why Participatory Research?• Involves the community in the process

• More complete and accurate information

• Better chance of addressing community needs

• Changes people’s sense of efficacy

• Builds community capacity to address issues

Who is The Community?• Encompasses a variety of social organizations that

operate at a number of levels of size and complexity. • Members share a common interest or identity.• Examples:

• Arlington, Edmonds Residents• Latino Community• Facebook Friends• Soccer Leagues

First steps• Person on the street interviews

• Pictures of Health

• Daily Herald poll

• Focus groups• Non-random/purposeful • Random recruitment

• County-wide representative sample survey

“Lake Stevens schools rate so high… people try to move their kids there.”Rich community, youth drug use, need youth outreach.

The lake, swimming, year round funDon’t let the weather determine your activity

Our group as recruited to interview outlying towns in Snohomish County

Providence Institute approachedthe University of Washington, BothellFor help with their community health

needs assessment.

By: Devyn Nixon, Charlotte Jordan, Ana Burcheci, Gagan Kaur and Katrina Carpenter

We completed a windshield survey of Arlington and through this process chose other small communities to visit

“Homeless are the most vulnerable”“People are using [drugs] to cope”

“Your health can be undermined by the exposure that comes with street life…

Exposure to crime… communicable diseases…

“People slept by the river, they made that illegal.”“We have homeless here [the library] who are coming to sleep…

Where else are they going to go?”“Do not have the same access to the healthcare”

“I worry about qualifications people have to have to get access”

Walking has done more good than anything.“It’s a pretty health operation…

we would know if there was an impact of sickness.”People’s occupations contribute to their health.

Intercept Interview & Windshield Survey

Social Media Photo Contest

• Health and well-being are perceived in a variety of ways.• Photography and art can be a common language• How do people “picture” health and wellbeing? • Photo contest open to all• Collection of images of health and well-being• To see the #PicturesOfHealth challenge on Facebook login to the

PIHC Page at www.facebook.com/PIHCSnohomish.

Recent Photo Entries

Daily Herald Poll

• State of your health• Satisfaction with health• Impacts on your health• Behaviors• Health of community

• What is important from the point of view of the individual?

• How are factors are related to each other in people’s view of their own health?

Focus Group DiscussionsPicturing Health & Wellness

Through the Eyes of Residents

Focus Groups

• Listen to a cross section of Snohomish voices

• Let people discuss health and wellness in their own words

• Hear voices not typically heard

• Deepen our understanding of health through the eyes of residents

Focus Groups

Focus Groups• Everett + North / <$65,000

• Everett + South / >$65,000

• Arlington Area /Age 25-45

• Monroe Area / Age 45-65

•College Youth from ethnic minority groups/EVCC [Everett]

•Adults in low income housing or transition housing [Lynnwood]

• Latina mothers/(all non-native U.S.) [Everett]

• Latina female lay health workers/Promotoras/ [Lynnwood]

• Low income females/mixed ethnicities/ [Lake Stevens]

•Adults/most middle age/ all Caucasian and most lower income (2 under $65K; 9 under $40K) [Granite Falls]

•Primarily Senior citizens(10/12); mostly Caucasian/female/ lower income (3 under $65K; 9 under $40K) [Arlington]

UW BothellLutheran Community Services NWElway Research, Inc.

What is important in your life?

What is important in your life?

•Family #1: 41 of 43 mentions

•Health #2: 23 of 43

•19 of 23 who listed Health were 45+

Definitions of Health

Definitions of Health• Not sick /Lack of Disease/

Free from addiction

• Medical insurance / Access to regular medical and dental check ups

• Having an active family

• Pollution/ Clean water

• Living in a safe environment

• Staying alive

• You feel good • Energy• Independence• Mental health• Lack of pain• Genetics• Prevention• Attitude• Diet & Exercise• Social Connections

Definitions of Wellness

Definitions of WellnessMore all-encompassing than “health”

• Don’t they usually say ‘health and wellness?’ It’s almost separate. I feel that when you’re thinking about wellness, you’re thinking outside of the box of what you’ve normally done.

• Whole body/holistic approach• To me it’s more like a proactive approach to feeling

better, being better, for wellness.

Definitions of Wellness• Health is maintenance and wellness is

extracurricular activities almost. • I would consider if you're happy with the way you are,

you think, you live, your health, your life, your family, your church. That's wellness to me.

• Do you remember that show, “The Waltons”? That’s kind of what I picture.

• Some type of peace; serenity with one’s self.

Definitions of WellnessHaving Resources

Definitions of WellnessHaving Resources

• Having enough food …When I think of wellness, I think of a world where there isn’t hunger.

• I cannot afford dieticians, hypnosis and holistic approaches to my health…I am barely surviving!

• When I envision wellness, I think: “ She gets to eat salads and it doesn’t matter if meat is $13 a chunk.”

Optimal Health & Wellness•Self awareness / Maturity•Acceptance of limitations

• I think you have to know yourself because what is right for someone else may not work for you. You have to be in tune with your mental and physical well-being and know when something needs a change.

• You could have my body and be happy with it, or this tofu person would think I’m absolutely disgusting. It’s perspective, it’s what’s important to you.

• It's not comparing myself to somebody who's 10, 20 or 30 years younger than me, it's being conscious of who I am now at this stage in my life. And being active with what I know I can do.

• I put nutrition ahead of medicine and other things. I accepted that I needed to spend the money to feel better, to make that choice.

Optimal Health & Wellness•Self awareness / Maturity•Acceptance of limitations•Being active•Access: food, information, services•Participate more in community activities

• If you want to do something there's nothing stopping you from doing it, physically or mentally.

• I asked my surgeon, ‘Why is it people walk funny after surgery?’ She said, “Because they didn't do the physical therapy.” I never wanted to walk funny, so I've accomplished that too, just by keeping moving.

•Being able to eat more fruits and vegetables when they are more affordable.”

•People having more secure housing.

•Having access to health information and preventative services.

Optimal Health & Wellness•Self awareness / Maturity•Acceptance of limitations•Being active•Access: food, information, services•Participate more in community activities•Mental health•Attitude

• I think healthy may be a mental state where if you're mentally healthy then everything else will probably just work. If it wasn't working, your mental health could keep you locked down and not concentrating on healthy things.”

• Being spiritual. “I’m spiritual. I believe this has a lot to do with wellness.”

Barriers to HealthWhat prevents you from being as healthy as you want to be?

•Immediate gratification(vs. delayed, indefinite price or payoff)

•Time / Schedule / Convenience

•Attitude / motivation

• [After work],The last thing I want to do is go to the gym and stand more. All I want to do is sit down.

• Families are splintered, too busy running to soccer, grab a burger, this and that, rather than sitting around with the family. Everything is out of the freezer, prepared meals, or processed, which is generally less healthy.

• I don’t know if I want to live to 120.

Barriers to HealthWhat prevents you from being as healthy as you want to be?

•Resources

•It cost more to eat healthy

•Access: Information, Services

•Not knowing where to go for health information

• It is getting more costly to eat healthy. Sometimes you look at the food, it’s so much money to eat good but you've got to make that choice.

• I eat frozen meals like Lean Cuisine not to lose weight but because they are on sale and the only thing that looks healthy that I can buy.

• I can’t afford a gym and it’s not safe to exercise in neighborhood. I want to join a social group of some kind and exercise, but I cannot afford what’s available.

• I think food is probably the last thing people go to buy because everything else is so demanding. Food is not demanding, food is a luxury.

Barriers to HealthWhat prevents you from being as healthy as you want to be?

•Cost of medical care/ insurance•Food options•Lack of transportation•Lack of affordable housing

• I have insurance, but I cannot afford to pay the deductible so I don’t go to the doctor to avoid having to pay.

•There have been times where [food bank] clients have gone through and they couldn’t get near the food that they were offered because they said I’m on foot, which was super sad because they couldn’t take anything that was heavy.

• I want to experience the community and cannot because of my health and transportation issues. I have a lot to give still.

Barriers to HealthWhat prevents you from being as healthy as you want to be?

•Cultural misunderstanding

•Racial/Ethnic discrimination

•Immigration status

•Language barriers

• There is chronic stress of constantly living in anonymity.• I am Columbian. When I go to school, I don’t see people like

me. I have been discriminated against because I speak Spanish. I have had to form my own sense of community and find people who accept me. When people say, “Go back to your country, I’m like…’Where would you like me to go? This is my country!”

• At a certain level, I want to be accepted by the larger society, but if people are haters, I want to give up.

• If I go see a doctor, I am fearful that I’ll be sent back and taken away from my family.

• Even though I have credentials in another country, I cannot get hired here with those same credentials. That gives me limited options.

• I was a little bit angry when I found out that the Timberline was built on Indian burial ground. That could be bad for your health physically, mentally.

• Actually I never been to any hospital after I moved here, because …..I feel like I can’t really communicate with doctors because of the language, you know?”

Barriers to HealthWhat prevents you from being as healthy as you want to be?

• Drugs & Addiction• Crime and Violence• Lack of jobs• Lack of education• Lack of mental health

resources• Not feeling connected to

anyone or to the community

• This county has a severe heroin problem. Four youth this year alone have died from heroin overdoses.

• We need more full-time job opportunities in Snohomish County.

• We will never be healthy until we as a community take care of our children’s safety. We have to address the crime in our area.

• …I don’t know any of my neighbors, I don’t even know like who they are…I don’t know anything about them, I just know we all live in the same place, and that we stop by at night, and we leave and that’s it you know ?

ResourcesWhere do you go for health information, help?• Family members – Mother

• Friends/ Peers

• Healthcare Provider

• Nutritionist

• Internet

• Pharmacist

• 2-1-1

• Social services and non-profits

• Theme of people not knowing where in the community to go for reliable health information outside of family, doctor or clinic.

• My mother. She has helped me through a lot. I see her before the doctor.

• The realm of information that we got 10 years ago compared to now. Now it's readily available and you can just go, I'll read this about this doctor. Ten doctors said this.

• Yes, the information is incredible.

• In Everett, they have really good resources. I just feel like they’re spread out. Right here is DSHS and Child Support Enforcement, but Pregnancy Research Center and Planned Parenthood are way in the other direction. The men’s shelters are way over there. It’s like they’re not in a centralized area, where if they were I think more people would have access to them.

What makes a healthy community?• People

• Relationships/ Engagement

• Infrastructure/ Access

• Safety/ Security

• Community activities

• Affordable youth sports programs

• Health/ Healthcare

• Parks and trails

• Good public transportation

• Affordable healthy food options

•You don’t have the vice of anonymity.

• I’ve been playing soccer since I was 13 and a lot of the people I have played with since I was at that age I still come across them… you just find familiar faces everywhere you go basically.

•We will never be healthy until we as a community take care of our children’s safety. We have to address the crime in our area.

What makes a healthy community?• People

• Relationships/ Engagement

• Community activities

• Infrastructure/ Access

• Safety/ Security

• Affordable youth sports programs

• Health/ Healthcare

• Parks and trails

• Good public transportation

• Affordable healthy food options

•Being able to hang out with your neighbors…everybody watches everybody’s house. Everybody watches everybody’s kids, so we make sure nothing happens in our neighborhood. That's the community I like.

• I'm going to say village, when I think of community. Everybody in the village is responsible for the community. Everybody needs to be responsible.

•A healthy community has a lot of outlets. It also produces healthier activities and minds. There's just more of a variety of things to do.

What can we, as a community, doto make our community healthier?• Improve transportation

• Sidewalks/ Bike paths

• Grocery stores

• More jobs

• Information/ Education about Resources

• Community Activities

• Mental health services

•Every community should have a family center! Anything you need, you can come to the family center for resources.

•We need a Boys and Girls Club up here. Some place they have to go in case they need to talk to somebody other than their parents.

•I'd love to see the Centennial Trail go through. Honestly we'd probably ride our bikes to Snohomish then.

What can we, as a community, do tocreate a healthier community?• Create more full-time jobs

• Help people become aware of community resources

• Affordable dental

• Organize more community events

• Create more safe places for people to walk and exercise

• Address ongoing ethnic discrimination and build cultural understanding

•More local food sources / Community gardens

•Connect seniors to the community—beyond the senior centers

•Parenting classes

•Make sports affordable to all.

When we are on the field….we are all just players.

2035: What will success look like?• More food options

• Less Crime/ Drug use

• Better transportation/Less driving

• People getting outside

• Stable economy

• More engagement in the community /Volunteering

• More housing/ Housing options

• Community P-Patches, where people grow their own food, and get out there and till the earth, and feel good about it. Sharing with the food banks.

• After-school programs for the kids, accessibility to them. Even if they’re low-income, let them go to the Y.

• Reward businesses…if you let your employees volunteer for a half day, maybe they should be able to get some sort of tax credit for that.

• Aren’t we supposed to be on Mars by then?

Next Steps• Pictures of Health

• Compile and publish the Daily Herald Poll

• On-going community conversations

• Design and test survey questionnaire

• Conduct baseline Vital Signs Index

Snohomish County Vital Signs

Toward a County Wellbeing Index