Hi! My name is Hilary Jauregui. I am a nurse and I am half way through the Master’s in Psychiatric Nursing. This presentation covers the rural county of Klickitat in Washington State.
Klickitat County is a medium-sized rural county that lies along the Oregon border in central Washington. As you can see, the primary RUCA for the county is small town/isolated rural.
The average resident of Klickitat is white, aged 18-64. A large proportion of the community, however, is either under 18 or over 65. After Whites, Latinos are the next largest ethnic group in Klickitat, at 10% of the population. Many residents have a low socioeconomic status, with 17% living below the federal poverty level.
In rural communities, access to care is always a big issue. In Klickitat, 10% of residents are more than a 30 minute drive from acute care or OB care. The OB care that is available in the county is just basic care – if a woman has any complications during pregnancy or birth, there is not a facility available in the county equipped to provide more than basic OB care. Klickitat has shortages in primary care, mental health care and dental care. There are no MUAs or MUPs for Klickitat.
Nearly half of the population of Klickitat County has public insurance coverage or no coverage at all. A full quarter is on Medicaid.
There are not many healthcare facilities in Klickitat, as shown above. Note also that the two hospitals and all the rural health clinics are all in the two largest cities: Goldendale and White Salmon. Both hospitals have a low trauma level (level IV). Surprisingly, there are no community health or migrant health centers in the county.
Klickitat County has several health areas in which they exceed the state as a whole. These strengths are important to recognize and build upon to foster a healthy community. Especially encouraging are the rates of teen physical activity and teen overweight – an impressive trend in the face of nationwide increasing rates of childhood and teen obesity. Additionally, binge drinking among adults is lower in Klickitat.
There are also several areas in which the community is doing worse than the state as a whole. Most surprising in this table is the dramatic difference between Washington State and Klickitat County in access to healthy foods. In spite of ample farm lands in the county, resident’s access to those healthy foods is limited.
From the outsider’s perspective, adult obesity is one of the priority health issues for the county. The obesity rate is 10% higher in Klickitat than in the state and it is a major public and personal health issue. Many chronic health problems are associated with obesity, including many types of cancer. Several cancers associated with obesity, including stomach, colorectal, endometrial and pancreatic, are disproportionately high in Klickitat county.
To address the obesity rates in Klickitat, I recommend the evidence-based intervention, Healthy U of Delmarva, developed in Maryland. This program serves 3 counties and over a million people. It is a comprehensive, community-based incentive program, which provides awards for healthy behaviors.
Partnerships with the community has been integral to the program’s success. To date, the program has partnered with more than 170 different community businesses and organizations to provide deeply discounted health and exercise services to members. For members that are still unable to afford services such as a fitness club membership, fitness scholarships are available. Members also receive complementary diet and exercise software to compliment the services available.
The program is designed to provide incentives for both individuals and organizations. By participating in healthy behaviors, such as participating in a walking club, exercise classes or attending a health lecture, members earn entries into monthly raffle drawings. An annual grand prize raffle entry is available to participants who return after one year of participation in the program to have their BMI measured. The grand prizes are truly that – grand. In years past, a new car and a new motorcycle were given away.
Community groups are also rewarded for healthy choices – this includes faith-based organizations, governmental agencies, schools and non-profit organizations. When groups implement changes that promote long-term healthy lifestyles, they are eligible to compete for prizes or cash awards.
In it’s first year, Healthy U of Delmarva was quite successful in increasing the health among participants. The participants had significant losses in weight, BMI and waist circumference. Another success was the return of participants at one year to be reevaluated – more than half of those that originally signed up to participate showed up. And, at that time, another 1000 people joined the program!
As illustrated by the Healthy U of Delmarva program, community partnerships are crucial to any program’s success. Even more important, is collaborating with the community in the identification of priority issues and strategies for resolving them. I think the community strength of relatively more healthy weight teens and teens getting adequate physical exercise is a great place to start: are there strategies that can be tapped and applied to the adult population? I am also very interested to learn about the level of health literacy in the community. This is an important consideration when developing an intervention program. Similarly, I think it’s critical to determine why people aren’t exercising or eating healthfully – are there safe places to participate in outdoor physical activity? Are there indoor facilities available or other programs? Do people know how to find and prepare healthy foods for themselves and their families? All of these things (and many more) are essential things to find out before implementing any type of program to address the obesity rates in Klickitat County.
And here you have my many references. I hope you enjoyed my presentation!
Where is Klickitat County?<br />Primary RUCA: Small town/isolated rural2<br />
WhoisKlickitatCounty?6<br />17% live below the federal poverty level<br />
Access to Care<br />10% of county residents are more than 30 minutes from OB care11<br />10% of county residents are more than 30 minutes from acute care152<br />HPSAs9<br />Primary Care <br />Mental Health Care <br />Dental Care<br />No MUAs or MUPs8<br />
The obesity rate in Klickitat County is 10% higher than Washington state13<br />Obesity is a personal and public health issue<br />Obesity leads to a variety of health issues, including diabetes, hypertension and many cancers<br />Stomach, colorectal, endometrial and pancreatic cancer rates are disproportionately high in Klickitat<br />Obesity is a risk factor for all of the above cancers <br />Priority Health Issue: Adult Obesity<br />
Healthy U of Delmarva<br />Comprehensive, community-based program to holistically address obesity<br />Serves 3 counties in Maryland<br />More than 170 community partners<br />Incentive-based program that provides awards for healthy behaviors<br />Evidence-Based Intervention5<br />
Community Partnerships are critical for the program’s success<br />Program negotiated deep discounts with community providers of health & exercise services for members<br />Fitness scholarships are provided for members unable to afford the services<br />Members receive complementary diet & exercise software<br />Program Design<br />
Individual Incentives<br />Participants earn entries into monthly raffles<br />Entries earned through participation in exercise classes, walking clubs or health lectures<br />Annual grand prize drawings (car or motorcycle) <br />Earned through program participation for 1 year, with baseline and 1 year BMI measurements<br />Program Design<br />
Community Incentives<br />Recognizes community settings that work to promote long-term healthy lifestyle changes<br />Schools<br />Faith-based organizations<br />Non-profits<br />Governmental agencies<br />Organizations are eligible to compete for prizes <br />Program Design<br />
Program shows significant health gains for participants<br />Participants lost an average:<br />5% weight loss<br />6% BMI reduction<br />7% of their waist circumference<br />6000 community members signed up at the initiation of the program<br />At 1 year, more than half of the participants returned to have their weight and measurements reassessed<br />Another 1000 community members joined the program after the first year<br />Program Outcomes<br />
Is lack of physical activity impacting obesity rates?<br />Is it safe to participate in outdoor physical activity?<br />Are exercise facilities or programs available for community members?<br />Is the lack of access to healthy foods impacting obesity rates?<br />Are healthy eating educational programs available?<br />What is the level of health literacy in the community?<br />The teen obesity rate is much lower than the rate in Washington State. Are there interventions in place with teens that can be incorporated into a program for adults?<br />Questions for Community Partners<br />
References<br />County Health Rankings. (2010). Snapshot 2010: Klickitat, WA. Retrieved 06 30, 2010, from County Health Rankings: http://www.countyhealthrankings.org/washington/klickitat<br />Ginther, G. (2001, 07 25). Dominant RUCA County Code. Retrieved 06 25, 2010, from Washington State Department of Health, Office of Environmental Assessments: http://www.doh.wa.gov/Data/Guidelines/RuralUrban_images/figure6.gif<br />Northwest Portland Area Indian Health Board. (n.d.). Yakama Indian Nation. Retrieved 07 03, 2010, from Northwest Portland Area Indian Health Board: http://www.npaihb.org/member_tribes/tribe/yakama_indian_nation/<br />Olexa, L. (2009, 07 01). Federally Designated Rural Health Clinics By County as of July 1, 2009. Retrieved 07 03, 2010, from Washington State Department of Health: http://www.doh.wa.gov/hsqa/ocrh/RHC/Fed_DesignRHCs.pdf<br />Southwest Rural Health Research Center. (n.d.). Healthy U Delmarva. Retrieved 08 04, 2010 from RHP2010: Models for Practice: http://www.srph.tamhsc.edu/centers/rhp2010/html/education/delmarva.htm<br />U.S. Census Bureau. (2010, 04 22). Klickitat County, Washington. Retrieved 06 24, 2010, from State & County Facts: http://quickfacts.census.gov/qfd/states/53/53039.html<br />U.S. Department of Health & Human Services. (n.d.). Access to Care: Klickitat County. Retrieved 07 03, 2010, from Community Health Status Indicators: http://communityhealth.hhs.gov/AccessToCare.aspx?GeogCD=53039&PeerStrat=42&state=Washington&county=Klickitat<br />
References<br />U.S. Department of Health and Human Services, Health Resources and Services Administration. (n.d.). Find Shortage Areas: MUA/P by State and County. Retrieved 06 25, 2010, from http://muafind.hrsa.gov/index.aspx<br />U.S. Department of Health and Human Services, Health Resources and Services Administration. (n.d.). Find Shortage Areas: HPSA by State & County. Retrieved 06 24, 2010, from http://hpsafind.hrsa.gov/HPSASearch.aspx<br />Washington Association of Community and Migrant Health Centers. (n.d.). CHCs in Washington. Retrieved 07 03, 2010, from Washington Association of Community and Migrant Health Centers: http://wacmhc.org/find-care/chcs-in-washington. <br />Washington State Department of Health. (2006, 09 07). Access of Hospital-Based Perinatal and Neonatal Care, 2006. Retrieved 06 25, 2010, from Geographic Information Systems: http://ww4.doh.wa.gov/gis/pdf.neon)tt.pdf<br />Washington State Department of Health. (2006, 07 28). Access to the Nearest Acute Care Hospital in Washington, 2006. Retrieved 06 24, 2010, from Geographic Information Systems: http://ww4.doh.wa.gov/gis/pdf/acute_tt.pdf<br />Washington State Department of Health. (2009). Klickitat County Public Health. Retrieved 06 30, 2010, from Washington State Local Public Health Indicators: http://www.doh.wa.gov/PHIP/khi/lphi/lhj/klickitat/hp/hp1.htm<br />Washington State Department of Health, Office of Community Health Systems. (2010, 05 04). Directory: Washington State Trauma Services. Retrieved 06 25, 2010, from www.doh.wa.gov/hsqa/emstrauma/download/atcf_directory.pdf<br />