The Community Transformation Initiative in One Rural California County Where We Stand and What s Ahead: Public Health and the Prevention Fund S. Todd Stolp MD November 14, 2012 Dialogue4Health
A CTG proposal was submitted on behalf of the 42 California counties under 500,000 population by the Public Health Institute and the California Department of Public Health. Twelve Intensive Counties were identified in the proposal. Tuolumne County
Tuolumne County Population: 54,953 (2010 Census) Industries: Government and Government Enterprises (Forest, Park and Fire Services) and Tourism (US Department of Commerce, 2012) Demographics: 87% White, 9% Hispanic, 2% African American, 2% Native American, 1% Asian American (2010 Census)
The Community Transformation Grant Program: Authorized by Section 4201 of the Affordable Care Act Four Strategic Directions Proposed by CA4Health: 1. Implementing smoke-free policies in multi-unit housing 2. Limiting access to sugar-supplemented beverages 3. Improve chronic disease management and prevention by providing evidence-based interventions, promoted by community health workers (CHW) 4. Promote safe routes to school and nearby neighborhoods
Procuring the support of the Public, the Board of Supervisors and County Administration
Leadership Committee: Seeking broad representation County Office of Education Tuolumne Me WukIndian Health Center Public Health Department City of Sonora County Administration County Chamber of Commerce Tuolumne County Transportation Council Community Resources Agency Sonora Regional Medical Center Columbia Community College University of California Extension Citizen Representatives
Rural Burden of Chronic Disease Urban/Rural Prevalence of Chronic Disease in California* Percent of Population Affected 35 30 25 20 15 10 5 0 Diagnosed with Diabetes Diagnosed with Heart Disease Diagnosed with Lung Disease Other Than Asthma Physically or Mentally Disabled Ever Diagnosed with Arthritis, Gout, Lupus or Fibromyalgia Urban Second City Suburban Town and Rural Chronic Disease Category *Source: California Health Interview Survey, 2009 data
21% of the Tuolumne County Population is over 65 years of age, compared to 12% of the California Population Percent of Population 10 9 8 7 6 5 4 3 2 1 0 Population Age Distribution Population Age Distribution, Tuolumne County and California, 2010 Census Tuolumne California Age 8
1. Implementing smoke-free policies in multi-unit housing A Case Statement for Strategic Direction #1: Breathing other people s smoke contributes to heart disease, cancer and stroke. Tuolumne County has one of the highest rates of smoking in the state. People who live in apartments and other types of multi-unit housing often don t have a choice about their exposure to tobacco smoke coming from nearby sources. We want to improve apartment dwellers health and prevent disease by limiting their exposure to tobacco smoke when they are in their homes.
1. Implementing smoke-free policies in multi-unit housing Percentage of California children age 5 to <20 years who live in households with smokers who smoke inside the home, by county 0 - < 4 4 - < 11 11 - < 18 18 + No Data PedNSS, 2006 Year 2010 target: reduce the proportion of children who are regularly exposed to tobacco smoke at home to 10%.
Tuolumne County Tobacco Consumption Survey Key Findings of a Survey Conducted October 13-16, 2012 320-528
The rate is lower among those residing in singlefamily homes. Household Cigarette Consumption Rate by Type of Residence Smoker in Household No Smoker in Household 80% 60% 40% 20% 0% Unattached House Mobile Home Apartment/Condo/Townhome (% of Sample) (75%) (9%) (14%) 4. Do you currently smoke cigarettes? 7. Does anyone else in your household currently smoke cigarettes? 12
Proposal to Limit Smoking in Apartment Buildings Some people have proposed a law limiting smoking in outdoor common areas of apartment buildings, such as entry ways, swimming pools and courtyards. In general, would you support or oppose this type of law? 13
A solid majority support the proposal. In general, would you support or oppose this type of law? Strongly support Somewhat support 19% 38% Total Support 57% Somewhat oppose Strongly oppose 11% 24% Total Oppose 35% Undecided 8% 0% 15% 30% 45% 60% 75% Q17. 14
1. Implementing smoke-free policies in multi-unit housing
2. Limiting access to sugar-supplemented beverages and increasing access to non-sugar-supplemented beverages
2. Limiting access to sugar-supplemented beverages and increasing access to non-sugar-supplemented beverages
The new county vending machine contract solicitation is seeking vendors who have experience with non-sugar-supplemented beverage products
2. Limiting access to sugar-supplemented beverages and increasing access to non-sugar supplemented beverages 20
3. Reduce environmental risk factors and improve chronic disease management by providing evidence-based interventions, promoted by community health workers (CHW)
3. Reduce environmental risk factors and improve chronic disease management by providing evidence-based interventions, promoted by community health workers (CHW)
Youth engagement: A Mobile Health Van for Schools Health Literacy
4. Promote safe routes to school and nearby neighborhoods
4. Promote safe, active transportation, active play, and recreation through adoption of institutional land use and transportation policies. Disparity, in Tuolumne County with roots in socioeconomic disadvantage and mental or behavioral illness, is a primary target of the entire Community Transformation effort
Transformation is happening, but it is often hard to see in action 28