WE BUILD A BRIGHTER FUTURE

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together

2011 Open Space Conference Raymond J. Baxter, PhDSenior Vice President, Community Benefit, Research and Health PolicyMay 12, 2011

Open Spaces, Healthy Places

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The Epidemic of Overweight and Obesity

“Unless effective population-

level interventions to reduce

obesity are developed, the steady

rise in life expectancy observed in

the modern era may soon come

to an end and the youth of today

may, on average, live less

healthy and possibly even shorter

lives than their parents”S. Jay Olshansky, Ph.D., Douglas J. Passaro, M.D., Ronald C.

Hershow, M.D., Jennifer Layden, M.P.H., Bruce A. Carnes, Ph.D., Jacob Brody, M.D., Leonard Hayflick, Ph.D., Robert N. Butler, M.D., David B. Allison, Ph.D., and David S. Ludwig, M.D., Ph.D. New England Journal of Medicine 2005

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Obesity Trends Among U.S. Adults

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

1999

2009

1989

*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” personSource: CDC

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Rising Obesity Rates Could Eat Our Lunch

Total Obesity-Related Direct Health Care Spending, U.S. (2008-2018)

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

$350,000

$400,000

2008 2013 2018

(Millio

ns)

ProjectedHolding Obesity Rates Constant

Source: Thorpe, 2009

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Many Factors Drive and Shape Health

Family History and Genetics

30%

Environmentaland Social

Factors20%

Personal Behaviors 40%

Source: Determinants of Health and Their Contribution to Premature Death, JAMA 1993

Health is driven by multiple factors that are intricately linked – of which medical care is one component.

Medical Care

10%

Drivers of Health

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Behaviors Shape Health

Actual Causes of Death in the U.S. in 1990 and 2000Actual Causes of Death in the U.S. in 1990 and 2000

*Data are from McGinnis and Foege. Percentages are for all deaths.*Data are from McGinnis and Foege. Percentages are for all deaths.

Actual CauseNumber (and %)

1990*Number (and %)

2000

Tobacco 400,000 (19%) 435,000 (18.1%)

Poor diet and physical inactivity 300,000 (14%) 400,000 (16.6%)

Alcohol consumption 100,000 (5%) 85,000 (3.5%)

Microbial agents 90,000 (4%) 75,000 (3.1%)

Toxic agents 60,000 (3%) 55,000 (2.3%)

Motor vehicle 25,000 (1%) 43,000 (1.8%)

Firearms 35,000 (2%) 29,000 (1.2%)

Sexual behavior 30,000 (1%) 20,000 (0.8%)

Illicit drug use 20,000 (<1%) 17,000 (0/7%)

Total 1,060,000 (50%) 1,159.000 (48.2%)

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Social and Economic Factors Drive Health• Education/Literacy• Employment• Income• Family and social support

San Francisco Bay Area – Kaiser Permanente MembersPoverty, Diabetes and Obesity (2010)

• Community Safety• Early Childhood• Race and Ethnicity

Social and Economic

Factors

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The Environment Shapes Health

San Francisco Bay Area Kaiser Permanente

Childhood Obesity and Park Space

(2010)

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What We’re Up Against

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What We’re Up Against

Slide courtesy of Richard Jackson, MD

0

0.1

0.2

0.3

0.4

0 100 200 300 400 500

Minutes Spent in Car Per Day

Pro

ba

bil

ity

of

Ob

es

ity

White Male White Female

Black Male Black Female

7% of Americans’ urban trips arebiking/walking:46% in Holland

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What We’re Up Against

Change in price of items since 1978, relative to overall inflation, as measured by the Consumer Price Index. The price of carbonated drinks, for example, has fallen 34 percent relative to all other prices.

Source: Leonhardt, 2010                                                                          

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We Must Address Health at All Levels

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Neighborhood /Community

Society

Individual / Family

Home / School /Worksite

Physical and Mental Health Care

Deploying Kaiser Permanente Assets for Total Health

Growing evidence indicates we must take on the issues at multiple levels.

Community Health Initiatives

Environmental Stewardship

Clinical Prevention

Access to Social and Economical Supports

Health Education

Public Education

WorksiteWellness

Public Policy

Research

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Kaiser Permanente’s Community Health Strategies

Neighborhoods Parks, trails and other active public spaces General Plan amendments Corner store conversion efforts Farmers markets and community gardens

Schools Cafeteria reforms PE standards, after school programs Joint Use Agreements Safe routes to school

Healthcare BMI as a vital sign Breastfeeding promotion Hospital cafeterias

Worksites Stairwell prompts Lactation support Worksite wellness programs

NeighborhoodSchools

Work Site Healthcare

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Kaiser Permanente’s Healthy Eating Active Living Intervention Sites

Atlanta, GA

Prince George’s County, MD

Cleveland, OH

Denver, CO

Commerce City, Park Hill, Lincoln Park

21 LiveWell Colorado

(statewide)

6 HEAC Sites

Santa Rosa

Portland, OR

Clark County, WA

Modesto

Richmond

We Support 40+ Communities

Community Health Initiative sites

Joint initiatives with other funders

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The Environment Matters

Climate/Energy

Waste Reduction Water

Safe Chemicals

Sustainable Food

Kaiser Permanente Environmental Strategy Priority Areas

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The Road Ahead is Challenging

But we can find the way…But we can find the way…

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Regular walking can prevent

misery of colds

Raises HDL

Aerobic exercise helps strengthen the heart, lungs,

and muscles

Helps people with diabetes to control their blood sugar

Reduces risk of oseteoporosis

and broken bones

Reduces the pain and swelling from arthritis

Improves mood and energy

Gain 1.3-1.5 healthy years

of life

Evidence of Short and Long Term Benefits

Example: Making the Healthy Choice the Easy Choice

Benefits of walking can be expressed in terms of improved environmental and personal health, enhanced quality of life, economic rewards, and more.Benefits of walking can be expressed in terms of improved environmental and personal health, enhanced quality of life, economic rewards, and more.

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Example: East Bay Regional Park District

Trails Challenge for up to 5,000 participants/year in East Bay Regional Parks

Camp-related efforts (e.g., scholarships for underserved youth, Healthy meals at camp, organic garden at Camp Arroyo in Livermore)

Increase use of parks and outdoor space to promote health

GOAL

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Example: Trust for Public Land

Increase/enhance more outdoors space for safe physical activity

GOAL

Advocacy for park deficient communities to benefit from state infrastructure bonds

Expansion of Fitness Zones in Southern CA

Analysis of benefits of parks in City/County of Denver

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Example: Rails to Trails Conservancy

Needs assessment/research and community engagement to identify:Recreational and physical activities resources, needs, and opportunities.

Strategies to increase physical activity for members of target communities.

Trail tours and bike rides for community members

Assess recreational & health needs of communities adjacent to 1-mile stretch of the Metropolitan Branch Trail that can be used for recreation and active transport

GOAL

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Example: Land Use

Advocated for adding health elements to the Richmond General PlanGOAL

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Example: Walk There!

Development of walking guidebook with 50 walks in 4-county region

Series of 20 guided walks in Portland area

Increase the number of people walking for short trips rather than using car for both health and environmental benefits

GOAL

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Example: Organizational Endorsement

Portland Metro Bond Measure 26-80 for Natural Areas, Parks and Streams

(2006, passed)

Oregon House Bill 3141 (2007, signed by Gov)

Opposition to California Prop 23 (to suspend AB 32)

(2010, defeated)

Acquiring natural areas for protecting wildlife habitat, preserving water quality, and enhancing public access to nature

Minimum physical education minutes during school

Data collection on number of physical education minutes provided

AB 32 requires that greenhouse emission levels in the state be cut to 1990 levels by 2020

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Example: Engaging Organizational Assets

National Get Outdoors Day in Denver

Colorado employees built playground in underserved neighborhood in partnership with KaBoom!

Southern CA facilities services employees adopted Pasadena city parks with baseball facilities

To leverage the assets of the total organization to make a difference in communities.

GOAL

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How We Partner

Kaiser Permanente looks for:In the last 5 years, we have given over $6M in grants related to open space

Efforts that target underserved communities Creative, multi-faceted partnerships that incorporate “nexus” strategies Opportunities to leverage multiple resources/assets at Kaiser Permanente Efforts that are sustainable and have long-term impact Target healthy eating and active living (primarily)

Health partners care about….health outcomes, and more!

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