Moving Upstream: Working to Create Healthier Communities October 26, 2006

1. Moving Upstream: Working to Create Healthier Communities October 26, 2006

2. Presentation Outline: • Blue Cross and Blue Shield of Minnesota Foundation Overview • Growing Up Healthy: Kids and Communities • Project Profile: National Center for Healthy Housing project • Final Remarks

3. 1. Overview of the Blue Cross and Blue Shield of Minnesota Foundation

4. Who We Are • Philanthropic arm of Blue Cross and Blue Shield of Minnesota • State’s largest health grantmaker with assets dedicated to improving the health of Minnesota communities • Governed by a board of community leaders and Blue Cross representatives

5. Our Purpose “Looking beyond health care today for ideas that create healthier communities tomorrow.”

6. Blue Cross Health Continuum Social Economic Environmental Change Prevention Disease Screening Treatment Disease Management Foundation Center for Prevention Health Plan “Interventions to improve access to medical care and reduce behavioral risks have only limited potential for success if the larger societal and economic context in which people live is not improved.” - Institute of Medicine

7. Definition of Health Health is the state of physical, mental and social well-being and not merely the absence of disease or infirmity. -World Health Organization

8. Blue Cross Foundation focuses on social determinants of health • A 10 year commitment • Social connectedness • Early childhood development • Housing • Environment

9. Understanding Social Determinants of Health: • Health is not just the result of genes, lifestyle, access to care • It’s also determined by the day-to-day conditions in which we work and live

10. Tips for Staying Healthy -A Lifestyle Approach • Don’t smoke. If you do, stop. If you can’t, cut back. • Eat a balanced diet, eat plenty of fruits and vegetables. • Keep physically active. • If you drink, do so in moderation. • Cover up in the sun and protect your children.

11. Tips for Staying Healthy -A Lifestyle Approach (continued) • Practice safe sex. • Participate in appropriate health screening. • Drive defensively; don’t drink and drive. • Manage your stress. • Maintain social ties.

12. Tips for Staying Healthy -A Social Determinants Approach • Don’t be poor. If you can, stop. If you can’t, try not to be poor for too long. • Don’t have poor parents. • Don’t live in a poor neighborhood. • Own a car - but use only for weekend outings. Walk to work.

13. Tips for Staying Healthy -A Social Determinants Approach (continued) • Practice not losing your job and don’t become unemployed. • Don’t be illiterate. • Avoid social isolation. ─Ichiro Kawachi, MD, 12/2004

14. Our Goal Improve the health of Minnesota communities long term and close the health gap that affects many Minnesotans.

15. Four Strategic Initiatives: Grantmaking: • Healthy Together • Growing Up Healthy: Kids and Communities Operating Programs: • Public Awareness and Policy Support ( Fall 2006) • Leadership Institute ( Spring 2007)

16. Grantmaking Initiatives Include: • Healthy Together: Creating Community with New Americans • Growing Up Healthy: Kids and Communities

17. 2.Growing Up Healthy: Kids and Communities

18. Early Childhood Care and Education is a Health Determinant: • Quality early childhood care and education helps improve resilience, social competence and confidence, but less than half of the incoming kindergartners in Minnesota have early literacy skills necessary for learning success • Children with quality early learning experiences are 40 percent less likely to need special education or to be held back a grade • A recent study published in the journal Pediatrics found that of children born prematurely those involved in early education programs in the first three years of life had higher math and reading scores and fewer behavioral problems than similar children who didn’t get the educational boost

19. Stable Housing is Important to the Health and Well-being of Children • Stable, affordable housing is important to health, but nearly 300,000 low-income Minnesota households are currently “cost burdened” or paying more than 30 percent of their incomes for housing costs • According to the Department of Health, in rural Minnesota, as much as 90% of the low-income/affordable housing stock was built before 1978, with 25 percent of the units being built before 1940 • Minnesota has 41,000 housing units with high risk for lead hazard

20. Chronic Diseases of Environmental Origin are Increasing Problem Amongst Minnesota’s Children: • 5-10% of Minnesota children are affected by mental retardation, autism, or ADHD and researchers increasingly suspect environmental links to these chronic diseases. • According to the Minnesota Department of Health, in 2000, birth defects and cancer were among the leading causes of death for children under 9 years of age • Minnesota has issued a statewide advisory limiting the number of walleyes and other game fish that people should eat from Minnesota lakes. Even low level exposure over time, such as from maternal fish consumption during pregnancy, can affect a child’s learning and abilities, including reduced intelligence, impaired hearing and memory, poor coordination or delayed motor and verbal skills

21. Core Premises for Growing Up Healthy: Kids and Communities • The definition of health goes beyond the absence of disease to include the day-to-day conditions in which we live and work • In order to create communities that support and nurture the healthy growth and development of children, holistic approaches that link cultural, environmental, and physical factors rather than narrowly focused programs must be employed • The entire community should be engaged in conversations and in action plans

22. Core Premises for Growing Up Healthy: Kids and Communities (continued) • Building healthy communities that nurture the healthy development of children is an ongoing process, not one specific outcome • As communities learn to vision, work, and act together they are better able to use these skills to attain other community goals • Long-term investment is needed to foster the leadership, community development, and partnerships that will create sustainable models

23. The Goal of Growing Up Healthy: Kids and Communities: • To strengthen the capacity of communities to work across sectors to create an environment that nurtures the healthy growth and development of children

24. Underlying Assumptions: • Healthy children are the product of healthy communities • Healthy communities are the places where people have a stake in one another’s lives • Share a common vision for their children’s future • Work collaboratively, across sectors to achieve that vision

26. Phase I - Building the Vision: (Individual communities create their own vision, goals and strategies) • Place-based • Organizational or broad based community partnerships • Cross-sectoral collaborations connecting across at least two of the focus areas: early childhood, affordable housing, environment • Must engage the health sector • Other community stake holders • Focus on children of color, children in poverty, American Indian communities • Community-based decision making and shared goals

27. Growing Up Healthy: Kids and Communities • Planning Grants (up to $25,000) to support grantees in engaging diverse partners and developing shared strategies that will lead to improved health for the most vulnerable children

28. Examples of Planning Projects funded (fall 2006): • Expand existing early childhood collaborative to address housing and environmental safety issues on a county-wide level • Engage Native American and greater Bemidji communities in collaborative planning process around early childhood development and stable housing issues • Build strategies to improve access to and physical environment of early childhood development programs for American Indian families in public housing complex • Work with high risk communities and stakeholders in the Red River Valley to design a plan to reduce exposure to pesticides for children and pregnant women

29. Project/Implementation Grants (up to 3 years, up to $150,000) • Must have completed a written plan that describes the planning step, the partners, the community vision and goal, and an evaluation of the planning process. • The health related outcomes they will measure.

30. Evaluation and Shared Learning: • Grantees evaluation of their own projects • Grantees participate in initiative level evaluation • Annual grantee convening to share challenges and successes, best practices • Web-based resource center • Grantee Web Portal (under design)

31. 3. Project Profile: National Center for Healthy Housing

32. National Center for Healthy Housing Viking Terrace,Worthington, MN: Demonstrate how incorporating green building principles into low income housing rehabilitation improve resident health status. • Product of an extensive planning process engaging multiple sectors • The nation’s first longitudinal evaluation of the health impacts of incorporating green building principles into the rehabilitation of affordable housing • Help shape policy around affordable housing design

33. National Center for Healthy Housing Outcome Measures: • Reduced asthma symptom days among children residing in the green building units • Residents report improved quality of life as a result of healthier housing • Increased availability of and measured improvements in physical and environmental conditions of affordable housing with quantified changes in occupant health status

34. National Center for Healthy Housing Process measures: • Improved coordination between affordable housing, community action, and health service organizations to address multi-disciplinary issues affecting children’s health; • Increased understanding among residents, property managers, builders, community development organizations, and public officials of both health and economic impacts of incorporating building principles into affordable housing development.

35. National Center for Healthy Housing Key Partners in this Project: • Southwest Minnesota Housing Partnership • Minnesota Green Communities • Greater Minnesota Housing Fund • Enterprise Community Partners • Center for Sustainable Building Research (U of M) • City of Worthington • Nobles County Health Department • Residents of Viking Terrace

36. For More Information on this Project: David Jacobs, Phd,CIH—Director of Research National Center for Healthy Housing Djacobs@centerforhealthyhousing.org (410) 772-2794

37. 4. Final Remarks

38. “Health status should be of concern to all policy makers, not merely those within the health sector. . . Wider social policy will be crucial to reduction of inequalities in health.” ─ Michael Marmot Chair, World Health Organization’s Commission on the Social Determinants of Health

39. For More Information Please e-mail: joan_cleary@bluecrossmn.com Or visit our website: www.bluecrossmn.com/foundation