Blog & Bloggers

Connecting Health With Place

Artistic rendering of 11th Street Bridge Park courtesy of Ed Estes, Washington, DC Office of Planning

Artistic rendering of 11th Street Bridge Park courtesy of Ed Estes, Washington, DC Office of Planning

Editor’s Note:  We often write pieces on the Center for Total Health blog about how important our surroundings can be to our health.  We’ve covered passionate discussions around built environments, and we’ve highlighted success stories.  What we haven’t been able to capture so far is the process.  We have invited Scott Kratz, director of 11th Street Bridge Park – a newly launched project – to share with us some of his experiences as he takes this vision of a shared community space that supports health from concept to reality.  This is his first post with us.

Can your zip code determine your health? Epidemiologists tell us that place – where we live and work – is one of the greatest factors in health outcomes. Urban planning decisions afect people’s health. We know there is a strong link between regular physical activity and lowered risk of obesity and chronic diseases. But what if there is no safe place to play? What if one’s home is located in a food desert, as it has been for many residents in Washington, DC, without access to healthy meal choices?

Linking place and health is a key goal of the 11th Street Bridge Park – an innovative project in the nation’s capital to transform an old freeway bridge into a new civic space. As the 11th Street bridges across the Anacostia River have reached the end of their lifespan, the DC Office of Planning and a local non-profit, Building Bridges Across the River, will use part of the remaining infrastructure to build the 11th Street Bridge Park, a new park above the river.

We have led an extensive public outreach campaign asking local residents for their programming suggestions and have received many inspired ideas and wonderful support. The community has suggested innovative play spaces, urban agriculture, an environmental education center and kayak / canoe launches on the river below.

Community outreach continues with a brainstorming session on Tuesday, March 25 at Kaiser Permanente’s Center for Total Health with presentations by 11th Street Bridge Park’s team. All of these ideas will inform a nationwide design competition launched in March to imagine the new park.

But we need to be more than aspirational. We need results. To understand the ways that access to green space, farmers markets, planting festivals and kayak launches may improve health outcomes, we are implementing a Health Impact Assessment. This baseline data of residential health will enable a comparative analysis after the 11th Street Bridge Park opens in 2017/2018. If we’re successful, we can make a solid link between health and place — and build a bridge to a healthier Washington, DC.

A Healthy Beginning for Babies and Their Moms

CEX12d041Last week’s annual “Building a Healthier Future” Summit put on by the Partnership for a Healthier America provided an opportunity to highlight what many organizations across the country are doing to address the underlying causes of childhood obesity.

For Kaiser Permanente, that meant not only a chance to show that we could and did deliver on our commitment to the highest levels of exclusive breastfeeding within our hospitals, but also the opportunity to showcase how Kaiser Permanente is building upon those successes by rolling out a comprehensive “Healthy Beginnings” effort to address the health of mother and child throughout the first years of life.

Robert Riewerts, MD, regional chief of pediatrics for Southern California Permanente Medical Group and clinical lead for childhood obesity for Kaiser Permanente presented an overview of the Healthy Beginnings work at a breakout session at the Summit. We had the opportunity to interview Dr. Riewerts alongside Jocelyn Audelo, RN, senior consultant at Kaiser Permanente’s Care Management Institute who coordinates Kaiser Permanente’s interregional work around Healthy Beginnings.

CTH Blog: Why is Kaiser Permanente focused on supporting a program of “Healthy Beginnings?”

Dr. Robert Riewerts: As an integrated health care system, Kaiser Permanente has been very interested in providing the best support we can to breastfeeding mothers. In our system, we deliver nearly 90,000 babies each year, so we have an incredible opportunity to make an impact on the lives of those babies.

Childhood obesity is a serious problem in America, and we’ve learned from research and from the care of our own patients, that if we support breastfeeding effectively, we’re going to produce a population of children that start out healthy. With effective breastfeeding support, those babies will get the important nutrients they need as young babies and they’ll be more likely to be healthy children later on.

Jocelyn Audelo, RN: Pregnancy is also a critical time in the development of healthy habits. As a new family is coming into being, we have the opportunity as a health care system to help support some of the habits – like breastfeeding, healthy diet patterns, and plenty of movement – that can translate to a pattern of well being over time for a family.

CTH: What can you tell us about the recent research showing trends in obesity reduction in children age 2 – 5?

RR: There’s been a lot of excitement around the recent article in the in the Journal of the American Medical Association that showed a 43% reduction in obesity in early childhood, ages 2 – 5, range. This research gives us hope that the work that we’re doing is effectively reducing the rate of childhood obesity. One of the factors quoted in the article is the fact that early breastfeeding and the support of breastfeeding may be an effective reason why we are seeing this reduction in obesity.

Although we are hopeful that this is a trend for the future, we still have a whole lot of work to do. And Kaiser Permanente’s relationship with the Partnership for a Healthier America and our commitment to the Partnership represents a road that we will be staying the course on, in order to make greater progress in addressing childhood obesity.

CTH: What would a comprehensive Healthy Beginnings program look like?

JA: At Kaiser Permanente, we feel that there is an opportunity to broaden our approach beyond just breastfeeding in support of a healthy weight trajectory throughout life, that really has its beginning in the pregnancy and early childhood time frame. Healthy Beginnings is our Kaiser Permanente approach to support healthy weight, active living and good nutrition from the time before a woman becomes pregnant, throughout her pregnancy and throughout the early life of the child. Examples might include things like helping women to get healthy and fit before conceiving, supporting women and families in emotional and behavioral health, helping pregnant women to stop using tobacco and other harmful substances, and teaching how families can incorporate a pattern of healthy foods – with plenty of vegetables and fruits – for babies and young children.

RR: Kaiser Permanente has a wealth of employees involved in all sectors of health care. We want all of our physicians, our nursing staff, our doctors who are delivering babies and caring for mothers during pregnancy to be aware of the importance of breastfeeding and to really start that infant out on a good healthy lifestyle.

JA: We know there are lots of things that we can do clinically to support a healthy beginning, but we know it needs to be much bigger than that. It needs to involve our community partners, our built environment to support physical activity and good nutrition, and numerous areas that we need to continually develop capacity in.

Since we know that what happens during pregnancy and the early childhood timeframe is critically important for a life course of Total Health, we’re focusing intensely on this Healthy Beginnings work. We are very excited about the journey we’re on, to support women and children and their families on a trajectory of Total Health from the beginning.

The Way to Healthy Living: ‘Collective Resolve’ for a ‘Global Revolution’

The World Economic Forum today published a powerful blog post authored by Raymond J. Baxter, senior vice president for Community Benefit, Research and Health Policy at Kaiser Permanente.  In it, he talks about the obesity and inactivity epidemics in the United States and the chronic conditions they can cause – as well as what they cost us at home and across the globe.

“Indeed, we know that chronic conditions such as diabetes, obesity, coronary artery disease and depression account for 75% of the nearly $3 trillion we spend on healthcare every year in the United States alone,” Baxter writes in his blog post.  “Worldwide, these conditions are projected to cost our global economy a staggering $47 trillion per year.”

While acknowledging the role of personal responsibility in improving an individual’s health, Baxter points out that chronic conditions hit minorities and the poor the hardest.  These are communities where fresh, healthy food options aren’t available, and where safety determines whether or not someone chooses to go for a walk or if kids can play outside.  He writes:

“When high-fat, high-sodium, high-sugar, low-nutrition, cheap, packaged snacks from a tiny corner store are convenient; when watching television behind locked doors is the safest, easiest choice; when cheap tobacco and alcohol are readily available to “ease” the stress of a toxic environment, that becomes an infectious lifestyle that breeds chronic health conditions.”

Luckily, change is afoot.  Baxter describes the Healthy Eating, Active Living (HEAL) Cities Campaign – a partnership between the California Center for Public Health Advocacy and the League of California Cities to increase the availability of healthy food and encourage physical activity.  The goal of the campaign is simple, yet profound:  Make the healthy choice the easy choice.

“Personal responsibility is certainly central to improving individual health,” says Baxter. “But collective resolve can be the catalyst that sparks a global revolution to place healthy living at the heart of every individual, family and community…”

Read Baxter’s post in its entirety at the WEF blog.

New Years Resolutions from the CTH Team

Like many people around the world, members of the Center for Total Health team have set a few total health resolutions for 2014:

Ted Eytan, MD, Medical Director
1. Connect the health care system to health even more in 2014
2. Make #activetransportation hashtag of the year
3. DRINK MORE WATER

Erin Meade, Meeting & Event Consultant
1. Continue to bike to work, including on less-than-ideal weather days
2. Spend more time with family

Trish Doherty, Editor for the Center for Total Health Blog
1. Take classes in things I love learning about and doing, like drawing, painting and dancing.
2. Spend more time in nature.
3. Learn to meditate, and then do it regularly.

We would love to hear about your own resolutions — please share in the comments.  Here’s to a happy, healthy year!

Photo of the Day: Danish HealthBridge Visits the Center for Total Health

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On Monday, December 9, Kaiser Permanente International (KPI) welcomed a Danish delegation to the Center for Total Health to learn about Kaiser Permanente. The group included leaders from local and regional government, hospitals, Ministry of Health, leading research organizations and other company executives.

Kaiser Permanente was one stop for the delegation, which is touring sites in the U.S. to learn about how health systems are leveraging technology and telemedicine to improve quality of and access to care for patients.

The group learned about Kaiser Permanente from Joy Lewis (KP International), Yevgeniy Gincherman, MD (Mid-Atlantic Permanente Medical Group), Joan Grand, RN (Capitol Hill Medical Center Administrator), and the Center for Total Health Staff.

Kaiser Permanente International offers a forum for sharing Kaiser Permanente’s knowledge and experience with the global health care community. For more information about KPI offerings visit www.kp.org/international.

Celebrating Diversity and Inclusion

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In June, Kaiser Permanente and the Center for Total Health welcomed members of the transgender community to share their experiences with care and help Kaiser Permanente understand how we could better promote the health and well being of the entire LGBT community. This event furthered a dialogue with the community that continues today.

Last month, Kaiser Permanente of the Mid-Atlantic states recognized the team that orchestrated this event with a diversity award as part of its annual KP Honors celebration.

Pictured, left to right, representing the larger team:

  • Keith Montgomery, Executive Director of the Center for Total Health
  • Melanie Hiller, Proposal Management Consultant, Kaiser Permanente Mid-Atlantic States
  • Bianca Rey, Project Coordinator, Kaiser Permanente Mid-Atlantic States
  • Jeffrey Hart, Principal Consultant, Kaiser Permanente Mid-Atlantic States
  • Erin Meade, Senior Consultant at the Center for Total Health
  • Beth Jaeger, Vice President for Human Resources, Kaiser Permanente Mid-Atlantic States

You can see more photos from the event here.

The Newest Vital Sign? Exercise.

We’ve landed in those muddy weeks between Thanksgiving and the end-of-year holidays when indulgence in food seems to be on lots of people’s minds. Whether talking with friends, family or work colleagues, food, recipes and festivities where we might enjoy food or showcase our recipes become common threads.

These conversations are inevitably followed in the new year by concern about how to shed any pounds we may have accumulated during the holidays. Diets are evaluated and exercise plans discussed. Now, thanks to a Kaiser Permanente program started in 2009, routine medical office visits are another place members can talk about exercise. The program is called Exercise as a Vital Sign and it involves medical assistants — along with checking heart rate, blood pressure, and weight — asking patients about their physical activity and recording this information in their electronic medial records.

Since its launch a few years ago, the program has spread across all Kaiser Permanente regions. A recent Kaiser Permanente study found that the simple act of asking patients about their exercise habits is linked to making small but significant improvements in their health. That one question helps bring awareness to the importance of physical activity. During the eighteen-month period of the study, researchers found an association between the implementation of the program and loss of weight for some patients and improved glucose control for patients with diabetes.

Read more.

Disaster Response: One Health Organization’s Perspective

Dinah Dittman

Dinah Dittman

As the details quickly spread in the aftermath of Typhoon Haiyan in the central Philippines, governments and organizations worldwide began looking for the best avenues to provide relief and support to survivors. As a non-profit organization with a humanitarian social mission, we tracked down Dinah Dittman, national director for community engagement and philanthropy at Kaiser Permanente, to help explain the assessment process that Kaiser Permanente undertakes following news of a major natural disaster.

Does Kaiser Permanente have a philosophy about how to respond financially or otherwise following natural disasters?

Yes, our approach has been informed by years of experience and a rational, multi-phased approach. While we are quick to pull together the appropriate folks within Kaiser Permanente to begin this assessment, we follow a process of working with our community partners about how Kaiser Permanente can be the most helpful. We are fortunate to have a team of experts in areas of philanthropy, disaster response and community engagement, to begin this assessment process following a disaster.

Immediately following a disaster, it’s human nature to want to quickly respond and do something, especially when news reports are filled with photos and stories of people who clearly need help. So many of us want to rush to the site of the disaster and provide immediate assistance – clothing, food and comfort. However, that’s not practical. The people who need to do those things are trained professionals and trained volunteers who know how to organize and cope in austere environments.  At Kaiser Permanente, our communications to our workforce emphasizes that disasters have stages of relief, recovery and rebuilding. And we reinforce best practices in philanthropy and community service — one being that during the relief phase, the best thing to do is give funding to the first responder, trained and connected relief agencies, who are working with governments and networks in the place that’s experiencing the disaster. Resources, such as how to be a “wise” donor and how to contact friends and family in disaster areas, are posted on our disaster relief website, which we make available for our employees.

Because our workforce includes many physicians, nurses, and logistics experts who are trained in disaster relief, the people with those skills are often asked by the aid organizations with whom they are affiliated, to volunteer to serve in the affected areas. We do have a website for our employees and physicians to provide their clinical or logistics skills and language abilities that would be suitable for helping in a disaster area, either in the relief or the recovery and rebuilding phases. This is the system that Kaiser Permanente’s clinical and community volunteer managers use to connect with the people of Kaiser Permanente who are ready, willing and able to serve.

Has Kaiser Permanente made any decisions on how they might support people in the Philippines?

As far as what Kaiser Permanente will be doing to help people affected by this storm, we are now gathering information and connecting with our first responder partners on the ground in the Philippines. They have told us that they now are in the “assessment” phase to find out what the local needs are, including medical and logistics skills, and how best to organize skilled volunteers to coordinate with local responders in the relief phase.

The charitable giving/nonprofit community is also in the process of assessing where the short and longer-term needs are, especially for the “recovery” phase which will be so important to people getting back to their way of life in their home villages and towns. We also don’t advise employees where to make their personal charitable contributions, but we do encourage them to be informed about a charitable organization before making a donation. The Charity Navigator site is a very useful one. They do a “quality control” assessment of nonprofit organizations and provide details on their website, which they have updated for Typhoon Haiyan.

As recovery begins for the people affected by the storm, Kaiser Permanente will stay in touch to learn how volunteers from our workforce would be needed and could serve.

That is an interesting point you’ve made about relief vs. recovery. Can you give an example of how Kaiser Permanente does that?

One example of our long-term thinking and partnership approach is the earthquake in Haiti. In January 2010, Haiti suffered a devastating earthquake that killed thousands of people, left millions homeless, and significantly damaged the country’s already fragile infrastructure, including its health system.

Among many of the buildings that were destroyed was the administrative headquarters for the Ministry of Health. This is the government agency that looks out for the public’s health in Haiti, similar to the Health and Human Service Department in the United States. Kaiser Permanente partnered with the Centers for Disease Control and Prevention, which has a large contingent of staff in the country, in its drive to support public health department assistance in Haiti. Kaiser Permanente’s donation provided a new building with offices for Haiti’s Ministry of Public Health and Population (Ministère de la Santé Publique et de la Population or MSPP). Everyone agreed that, without a decent place to work, it would be extremely difficult to coordinate efforts to rebuild Haiti’s public health infrastructure and respond to the country’s ongoing health needs. We knew this project would help the communities of Haiti for years to come.  We were pleased to join the CDC delegation that traveled to Haiti in February of this year, for the dedication of the new MSPP building and laboratories in Haiti.

In addition to the CDC Foundation donation, Kaiser Permanente supported four nonprofit agencies in 2010 that were first responders, providing much-needed relief aid to the people of Haiti. Kaiser Permanente physicians and nurses trained in disaster relief volunteered in Haiti with aid organizations they were affiliated with. To help share their experiences with other employees at Kaiser Permanente and beyond, the “Dispatches from Haiti” blog was created, which featured at least 28 posts from 11 different caregivers, among them surgeons, emergency room physicians, a nurse and a psychologist.

Read first-person accounts of on-the-ground relief aid from Kaiser Permanente clinicians on the Dispatches From… blog.

IOM Meeting Addresses the Science of Family Violence

The Institute of Medicine (IOM) held its 43rd annual meeting on The Science of Violence: Causation, Mitigation, and Prevention on Monday, Oct. 21, 2013, in Washington, DC. The meeting served as a catalyst to bring attention to this issue.

Mark Rosenberg, MD delivered the keynote address.  Dr. Rosenberg has devoted his career to approaching violence as a public health issue and in 1994 started the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention.

The concept that violence is preventable is a paradigm shift that has occurred during the last 40 years. Throughout the day, participants heard about the extent of the problem and the extraordinary impact of violence on families, communities, and its contribution to health disparities.

Dr. Rosenberg raised the questions: “What is the problem?” “What are the causes?” “What works?” and “How do you it?”

Brigid McCaw, MD

Brigid McCaw, MD

There are answers: Brigid McCaw, MD, medical director for Kaiser Permanente’s Family Violence Prevention Program and member of the IOM Forum on Global Violence Prevention, participated in a panel discussion and offered an example of a successful approach to family violence prevention in a large health care delivery organization. Read on to hear what she has to say.

Dr. McCaw, your contribution focused on answering the question, “what works and how do you do it?” What were you hoping to communicate to the audience about the health care system’s role in responding to family violence?

Health care has a unique and important role in violence prevention. For instance, over the past decade Kaiser Permanente has transformed the clinical practice in the area of family violence prevention, specifically intimate partner violence (IPV). Using an evidence-based “systems model” approach that has been widely implemented in our medical centers, we have shown a 7-fold increase in IPV identification. And this approach is being used in other health care settings in the U.S and abroad. The “systems model” approach serves as an example of practice-based evidence that provides valuable “learnings” for the field of violence prevention and offers a very powerful message to the clinicians and scientists who are members of the IOM, and who have a unique opportunity to promote research and funding to move the field forward.

Who else besides health care systems should be paying attention to this topic of family violence?

The response to family violence is going to require a collaborative approach from a variety of stakeholders – schools, criminal justice, public health, elected officials, patient and family advocacy groups – to name a few. Effective investments in preventing violence must recognize and address violence within the family, strengthen social norms that promote healthy relationships, and reduce community-level risk factors.

For more information on this topic, check out Kaiser Permanente Institute for Health Policy’s “Transforming the Health Care Response to Domestic Violence,” – one of the Kaiser Permanente Policy Stories (Vol 1, no.10 , 2012).

American Heart Association Recommends Creating Healthier Communities by Sharing Places to Play

Deborah Rohm Young, PhD

Deborah Rohm Young, PhD

This month, the American Heart Association published a policy statement in the American Journal of Public Health recommending that federal, state, and local decision-makers support and expand opportunities for physical activity through shared use of school facilities and playgrounds. For example, a youth soccer league with an evening practice schedule could arrange to use the facilities of a nearby school when the grounds would be otherwise unoccupied. According to the authors, opening up school recreational facilities to neighboring communities could help improve the health of Americans by providing increased opportunities for physical activity, particularly for neighborhoods that lack easy access to public parks or other facilities.

Deborah Rohm Young, PhD, a research scientist studying physical activity interventions with the Kaiser Permanente Department of Research & Evaluation, is the lead author of the policy statement and a member of American Heart Association’s Council on Lifestyle and Cardiometabolic Health. We caught up with her to discuss the statement and find out what she and the other subcommittee members learned about the benefits and challenges of increasing shared use of school facilities.

Why did you decide to study this topic?

Most Americans are not sufficiently physically active, even though regular physical activity improves health and reduces risk of many chronic diseases such as coronary heart disease, stroke, hypertension, obesity, and some types of cancers. Facilities like parks, gyms and recreational centers are provided by local governments as a great way for community members to stay active. Many rural, non-white, and lower-income communities, however, do not have the density of community recreational facilities as higher-income neighborhoods. In addition, privately owned facilities such as health clubs typically require memberships or fees that limit the accessibility for lower-income populations. Therefore, we believe that it is important to have convenient access to affordable physical activity spaces within all communities.

Why focus on schools as a way to increase physical activity?

We’ve decided to focus on public schools because they are in so many communities, and they are important centers for physical activity. Public schools have an estimated 6.6 billion square feet of indoor space and more than 1 million acres of land.  They also often have spaces, including ball fields, courts, gymnasiums, and playgrounds that can be used by the broader community. The School Health Policies and Programs Study, conducted in 2000 and 2006, found that virtually all schools reported at least one outdoor physical activity facility. In addition, several studies have found that opening school grounds to neighboring communities results in increased physical activity for those living nearby.

We’ve found that there are many benefits to schools sharing recreational facilities with their local communities including increased opportunities for physical activity and creating community good will. However, as of 2010, only eight states require schools facilities be made available for community use.

What are some of the challenges of opening up school facilities to communities?

Funding is always a challenge as there are expenses associated with keeping facilities open more often, including maintenance fees, staff compensation, and lighting and other utilities. Communities also have to address liabilities in case someone is injured while participating in recreational or sport activities while on school property. Sharing space could also be a challenge for schools and school districts who do not have a decision-making process to help easily identify eligible users and activities as well as manage scheduling for the facility. A lack of a standardized process may lead to confusion and result in some individuals or groups being excluded from shared space opportunities.

What are your recommendations to encourage the use of shared space?

We’ve found that legislative or regulatory policies are particularly important because they enable, incentivize and, in some cases, require shared use. We recommend states encourage or mandate school districts to allow community recreational use of school property and that school board policy be required to address shared use. Liability protection for shared use of school property also needs to be clarified, and states should have clear laws that provide appropriate legal protections for school districts.

Where do we go from here?

We definitely need to learn more about how and where shared use is being implemented from state to state and what is working in these communities. I also think that we should identify and examine perceived barriers and motivators to shared use. Also, we need to understand the best ways to inform community members about how to get involved in this process. For instance, do they reach out to their local government representatives or their school districts? There needs to be a better process in place to encourage these conversations.

What do you personally hope to achieve through your work on developing these recommendations?

I would like to be able to drive by a school at 6pm on a weeknight and see community members using the space for physical activity purposes like soccer or baseball. I believe that when more people are visibly physically active, they become role models and encourage others to do the same. This is why I believe that sharing school facilities with the surrounding neighborhood is a great way to encourage a healthy community.

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