Montana Local Public Health?

1. Montana Local Public Health? Minnesota Department of Health Cara McNulty, M.S. OSHII Director Cara.McNulty@state.mn.us

2. Overview • Initial legislation & plan for statewide health improvement • Description of SHIP • Model for SHIP • Policy, Systems, & Environmental Change • Interventions and early successes • Next steps

3. Initial Legislation and Plan • Legislation passed in 2007 called for creation of plan to fund and implement comprehensive statewide health improvement • Plan developed in consultation with State Community Health Services Advisory Committee (SCHSAC) and MDH Executive Office • Addresses risk factors for preventable deaths, decreased quality of life and financial costs from chronic diseases in four settings: • Community • Worksites • Schools • Health care • Incorporates expert knowledge from the state and local level • Based on Steps to a Healthier MN

4. Signed into Law – May 2008 • Senate and House passed revised bill • Governor Pawlenty signed historic health reform bill into law May 2008 • Bill is comprehensive health reform package making significant advances for Minnesotans that includes: • Statewide Health Improvement Program (public health component • Health care coverage/affordability • Chronic care management • Payment reform and price/quality transparency • Administrative efficiency • Health care cost containment

5. Description of SHIP • Program intended to reduce obesity and tobacco use in Minnesota • $47 million appropriated for SHIP for fiscal years 2010 and 2011 • Competitive grants to Community Health Boards and tribal governments rolled out beginning July 1, 2009 • SHIP funding will not supplant other funds

6. Description of SHIP Community Health Boards and Tribal Governments required to: • Match 10% of funding • Submit community action plans, establish partnerships, and develop community leadership team • Develop policy, systems, and environmental changes in four settings • Work with MDH to evaluate programs MDH required to: • Set outcomes to support obesity and tobacco goals • Measure current status (baseline) • Provide content expertise, technical expertise, and training • Conduct comprehensive biennial evaluation • Provide biennial reports to legislature

7. SHIP Applications and Grant Awards • Request for Proposals (RFP) released February 2009 • Applications due April 2009 • Applications received from all 53 CHBs and 8/11 tribes, including many counties collaborating on policy, systems, and environmental change • 41 grant covering all 87 Minnesota counties and 9 of 11 tribes awarded based on $47 million • Grant agreements signed July 2009

8. Community input into planning, implementation and evaluation Adherence to socio-ecological model Health promotion in four settings Local program advocates Informed by evidence-based interventions Focus on common risk factors Extensive and comprehensive evaluation linked to program planning Policy, systems, and environmental change Accountability and oversight Model for Statewide Health Improvement

9. Why Focus on Policy, Systems, and Environmental Change? “It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change.” -Smedly and Syme (2000), Institute of Medicine

10. What is Policy, Systems and Environmental Change? • Policy interventions may be a law, ordinance, resolution, mandate, regulation, or rule (both formal and informal). • Systems interventions are changes that impact all elements of an organization, institution, or system. • Environmental interventions involve physical or material changes to the economic, social, or physical environment.

11. SHIP Menu of Interventions • Address at least one SHIP risk factor (tobacco, physical activity, nutrition, or all three); • Occur in at least one SHIP setting (school, community, worksite or health care); • Are population-based versus individual-based; • Emphasize prevention versus individual treatment; • Address policy, systems, or environmental change; • Are evidence-based or practice-based; and • Have associated evaluation outcomes.

12. What are Examples of Policy, Systems, and Environmental Changes to Reduce Obesity? Physical Activity • Active schools and child care such (safe routes to school) • Worksite wellness policies support physical activity in workplace • Active living in communities like promoting biking and walking through community design (complete streets)

13. What are Examples of Policy, Systems, and Environmental Changes to Reduce Obesity? Nutrition • Healthy breakfast, lunch, and vending in schools and child care • Healthy vending and catering policies in worksites • Access to healthy foods in communities through farmers’ markets, community gardens, and fruits and vegetables in corner stores • Support maternity care practices in health care setting

14. What are PSE Changes to Reduce Tobacco Use and Exposure? Tobacco • Tobacco-free post-secondary campuses • Tobacco-free parks and recreation • Referral to cessation services in health care, worksites, and on post-secondary campuses

15. Early Successes in Nutrition Increasing healthy eating in communities – Farmers’ Markets • City of Minneapolis – EBT Accepted for Healthy Fresh Foods • Collaboration between stakeholders led to an expansion of EBT acceptance to include the Minneapolis Farmer’s Market and the Northeast Minneapolis Farmer’s Market • City of Edina - Ordinance Changed • A city ordinance that prohibited sale of produce in city parks was changed to allow sale of produce and a new Farmer’s Market is now open

16. Early Successes in Schools Increasing healthy eating in Schools – School Gardens • Anoka County - “Edible Schoolyard” • 200 students participated in planting a fruit, vegetable, and herb garden for Columbia Heights School District • Produce is being incorporated into high school family and consumer science classes • Figuring how to work in the “Edible Schoolyard” into K-12 curriculum Increasing physical activity in schools – SRTS • Dakota County – Safe Routes to School • 10 schools conducted school assessments of non-motorized transportation and recreation policies, practices and facilities • Developed a SRTS comprehensive plan in Spring and will implement SRTS in Fall 2010 • 12,634 students attend a school participating in SRTS in Dakota; these students will have increased opportunities to walk and bike to school

17. Early Successes in Tobacco • At least 28 post-secondary institutions across the state are actively engaged in passing tobacco-free campus policies • Reach would be at least 143,000 students, faculty, and staff. • At least 6 campuses across state have passed tobacco-free policies since SHIP began

18. Early Successes in Tribal Communities • Community garden expansion for youth and families – three sisters (corn, beans, and squash) • New partnerships (college students, Forestry and Trustlands Dept., • Youth mentorship and photovoice projects

19. SHIP Next Steps for MDH • Continue planning and implementation with our partners • Provide technical assistance to grantees to ensure successful implementation • Secure future funding to achieve goals of reducing obesity and tobacco use and exposure in Minnesota • Reduce the burden of chronic disease to generate future health care-related cost savings

20. Lessons Learned Integrate with other Health Reform Initiative components to support overall health reform transformation Build on existing prevention efforts to expand and not duplicate work that is already being done Make efforts to help grantees succeed, even before funds are awarded including developing list of evidence-based strategies Enhance capacity of local public health and tribal governments to implement policy, systems, and environmental changes

21. Lessons Learned, Continued • Language matters • Hearing concrete evidence of community readiness for SHIP was important to decision-makers • Health improvement champions cannot back down • Public-private partnerships are critical • Data can drive decision-making • Develop a statewide system to demonstrate that reductions in risk factors  decreases in chronic disease  substantial health care savings!

22. Questions? Contact Information: Cara McNulty, MS Director, Office of Statewide Health Improvement Initiatives Cara.mcnulty@state.mn.us (651) 201-5438 SHIP Website: http://www.health.state.mn.us/healthreform/ship.html