Open Spaces, Healthy Places

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Ray Baxter from Kaiser Permanente's Community Benefit presented at the Bay Area Open Space Council's 2011 conference. More about the conference here: http://openspacecouncil.org/upload/page.php?pageid=53

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Open Spaces, Healthy Places

  1. 1. Open Spaces, Healthy Places together WE BUILD A BRIGHTER FUTURE2011 Open Space ConferenceRaymond J. Baxter, PhDSenior Vice President, Community Benefit, Research and Health PolicyMay 12, 2011 kp.org/communitybenefit
  2. 2. 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 2
  3. 3. Obesity Trends Among U.S. Adults 1989 1999 2009 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” personSource: CDC 3
  4. 4. Rising Obesity Rates Could Eat Our Lunch Total Obesity-Related Direct Health Care Spending, U.S. (2008-2018) Projected $400,000 Holding Obesity Rates Constant $350,000 $300,000 $250,000 (Millions) $200,000 $150,000 $100,000 $50,000 $0 2008 2013 2018 Source: Thorpe, 2009 4
  5. 5. Many Factors Drive and Shape HealthHealth is driven by multiple factors that are intricately linked – of whichmedical care is one component. Drivers of Health Personal Behaviors 40% Family History and Genetics 30% Environmental and Social 10% Factors Medical Care 20% Source: Determinants of Health and Their Contribution to Premature Death, JAMA 1993 5
  6. 6. Behaviors Shape Health Actual Causes of Death in the U.S. in 1990 and 2000 Number (and %) Number (and %) Actual Cause 1990* 2000Tobacco 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%)*Data are from McGinnis and Foege. Percentages are for all deaths. 6
  7. 7. Social and Economic Factors Drive Health • Education/Literacy • Community SafetySocial and • Employment • Early ChildhoodEconomic • Income • Race and Ethnicity Factors • Family and social support San Francisco Bay Area – Kaiser Permanente Members Poverty, Diabetes and Obesity (2010) 7
  8. 8. The Environment Shapes HealthSan Francisco Bay Area Kaiser PermanenteChildhood Obesity and Park Space (2010) 8
  9. 9. What We’re Up Against 9
  10. 10. What We’re Up Against 7% of Americans’ urban trips are biking/walking: 46% in Holland 0.4 White Male White Female Black Male Black FemaleProbability of Obesity 0.3 0.2 0.1 0 0 100 200 300 400 500 Minutes Spent in Car Per Day 10 Slide courtesy of Richard Jackson, MD
  11. 11. What We’re Up AgainstChange in price of items since 1978, relative to overall inflation, as measured by theConsumer Price Index. The price of carbonated drinks, for example, has fallen 34 percentrelative to all other prices.Source: Leonhardt, 2010 11
  12. 12. We Must Address Health at All Levels Growing evidence indicates we must take on the issues at multiple levels. Deploying Kaiser Permanente Assets for Total Health Physical and Mental Health Care Clinical Prevention Health Education Research Individual / Access to Social and Family Economical Supports Home / School / WorksiteCommunity Health 1 Worksite Initiatives Wellness Neighborhood / Community Environmental Stewardship Public Policy Society Public Education 12
  13. 13. Kaiser Permanente’s Community Health Strategies Neighborhoods  Parks, trails and other active public spaces  General Plan amendments Schools Neighborhood  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 Work Site Healthcare  Breastfeeding promotion  Hospital cafeterias Worksites  Stairwell prompts  Lactation support  Worksite wellness programs 13
  14. 14. Kaiser Permanente’s Healthy Eating Active Living Intervention Sites We Support 40+ Communities Clark County, WA  Cleveland, OH Portland, OR  Santa Rosa   Richmond       Modesto Prince George’s  County, MD 6 HEAC Sites  21 LiveWell Colorado (statewide) Atlanta, GA Denver, CO Community Health Initiative sites Commerce City, Park Hill, Joint initiatives with other funders Lincoln Park 14
  15. 15. The Environment Matters Kaiser Permanente Environmental Strategy Priority Areas Safe Chemicals Climate/Energy Waste Reduction Water Sustainable Food 15
  16. 16. The Road Ahead is Challenging But we can find the way… 16
  17. 17. Example: Making the Healthy Choice the Easy ChoiceBenefits of walking can be expressed in terms of improved environmentaland personal health, enhanced quality of life, economic rewards, and more. Evidence of Short and Long Term Benefits Aerobic exercise Gain 1.3-1.5 helps strengthen healthy years Helps people with the heart, lungs, of life diabetes to control and muscles their blood sugar Reduces risk of Improves mood oseteoporosis Raises and energy and broken HDL bones Reduces the Regular walking pain and can prevent swelling from misery of colds arthritis 17
  18. 18. Example: East Bay Regional Park District Increase use of parks and outdoor space to GOAL promote health  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) 18
  19. 19. Example: Trust for Public Land Increase/enhance more outdoors space for GOAL safe physical activity  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 19
  20. 20. Example: Rails to Trails Conservancy Assess recreational & health needs of communities GOAL adjacent to 1-mile stretch of the Metropolitan Branch Trail that can be used for recreation and active transport  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 20
  21. 21. Example: Land Use Advocated for adding health elements to the GOAL Richmond General Plan 21
  22. 22. Example: Walk There! Increase the number of GOAL people walking for short trips rather than using car for both health and environmental benefits Development of walking guidebook with 50 walks in 4-county region Series of 20 guided walks in Portland area 22
  23. 23. Example: Organizational Endorsement Portland Metro Bond  Acquiring natural areas for protecting Measure 26-80 for Natural wildlife habitat, preserving water quality, Areas, Parks and Streams and enhancing public access to nature (2006, passed)  Minimum physical education minutes Oregon House Bill 3141 during school (2007, signed by Gov)  Data collection on number of physical education minutes provided  AB 32 requires that greenhouse emission Opposition to California levels in the state be cut to 1990 levels byProp 23 (to suspend AB 32) 2020 (2010, defeated) 23
  24. 24. Example: Engaging Organizational Assets To leverage the assets of the total organization GOAL to make a difference in communities.  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 24
  25. 25. 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! 25
  26. 26. kp.org/communitybenefit 26

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