Piedmont Health Foundation

1. GREENVILLE COUNTY HEALTH ASSESSMENT A FIFTEEN YEAR STUDY TRACKING GREENVILLE’S HEALTH AND THE MEDICALLY UNDERSERVED Piedmont Health Foundation

2. GREENVILLE COUNTY HEALTH ASSESSMENT BACKGROUND Piedmont Health Foundation

4. Summary of Findings and Recommendations

5. Summary and Recommendations

7. Thank You… Thank you to each organization that sponsored this study.

8. Thank You… Also to the sponsors of the Greenville Forward Health and Wellness Vision.

9. Health and Wellness Task Force Lillie Hall, Task Force ChairmanDHEC Robin Scott BlackburnGreenville Medical Society Doug BrownRealtiCorp Lori CenterBon Secours St. Francis Health System Regina CookNew Horizon Family Health Services Natalie DoughertyBon Secours St. Francis Health System Marsha DowellUSC – Upstate Eleanor DunlapSE Consulting Steve EppsCorporate Benefits Phil FeisalBon Secours St. Francis Health System Suzie FoleyGreenville Free Medical Clinic Kim MahaffeyHealthy Connections Maya PackSC Business Coalition on Health Bill PierceFurman University Alicia PowersFurman University Jane Earle PresslyFAVOR – Greenville Liz SemanMeals On Wheels Andrea SmithSenior Action Katy SmithPiedmont Health Foundation Cathy StoreyGreenville County Schools Mike TeacheyGreenville County Recreation District About Greenville Forward Greenville Forward was created in 2006 to enhance the quality of life for greater Greenville by engaging citizens in continually updating, promoting, and facilitating a community vision for 2025 and beyond. Greenville Forward is the organization that “wakes up every morning thinking about where Greenville County is going.” Prior to forming Greenville Forward, Executive Director Russell Stall was the lead consultant of the two previous Greenville Health Assessment Studies.

10. Vision for Health and Wellness “In 2025, Greenville County ranks among the healthiest places to live in the country. Residents reversed the trend in obesity, in part due to the supportive environment for recreation, exercise, and healthy lifestyles. Through active disease prevention and intervention strategies, Greenville residents live longer with less chronic disease, injury, or accidental or premature death. When disease occurs, the Greenville health care system is the first choiceto provide the full continuum of quality medical care for individuals of all ages and resources.”

11. Overarching Goal: Advance the vision for Health and Wellness in Greenville County • Track progress toward the Health and Wellness vision. • Engage in advocacy efforts to influence policies and practices that advance the Health and Wellness vision. • Promote and facilitate collaborative initiatives that advance the Health and Wellness vision.

12. Vision for Health and Wellness – HEALTHY PEOPLE GOAL 1: Increase proportion of children, adolescents, and adults at a healthy weight. • People are living at a healthy weight. • Improve health, fitness, and quality of life through daily physical activity. GOAL 2: Reduce tobacco use by persons of all ages. • Adolescents live tobacco free. • Adults, 18 and older, live tobacco free. GOAL 3: Reduce proportion of persons engaging in risky behaviors relating to alcohol and other drug use. • Adolescents are alcohol and drug free. • Adults are not using illicit drugs. • Adults are not engaging in risky behaviors relating to alcohol. Vision for Health and Wellness

13. Vision for Health and Wellness – HEALTH SERVICES AND SYSTEMS OF CARE Goal 1: Improve access to and utilization of a high quality, comprehensive system of care addressing medical, mental, and wellness care. • All persons have access to a medical home. • All persons have access to a comprehensive set of services, including addiction and mental health treatment. Goal 2: Provide the benefits of national research and medical care innovation and training in Greenville County. Goal 3: Greenville is recognized locally and nationally for healthcare excellence, quality, and innovation. Vision for Health and Wellness

14. Successes in the Health and Wellness Vision Smoking Ban. In 2007, Greenville became the first county in South Carolina with a city-wide no smoking ordinance. This ordinance was quickly followed by other cities across the state. In 2011, City Council expanded the ban to include public spaces and outdoor events. Health Reassessment Study. Released in 2008 by Greenville Forward, and sponsored by Bon Secours St. Francis Health System, Greenville Hospital System, the United Way, and Piedmont Health Care Foundation, the third health reassessment determined that 37% of Greenvillians are medically underserved. Over the last ten years, the study has provided information from over 4,200 telephone interviews with Greenville County residents. We have started the next installment to be completed by July 2012. LiveWell Greenville. Formed as a partnership of dozens of public and private organizations, LiveWell aims to make Greenville County a healthier place to live, work, and play. Created by the Piedmont Health Care Foundation and the YMCA, LiveWell initially focused on obesity rates, specifically in our youth, and has expanded to include over 100 partners to make living well easier in Greenville. 211 Health Help Line. Greenville County’s comprehensive source for information regarding human service agencies and community resources went live in March 2009. The 211 system fields thousands of calls and provides a wealth of information about human services. AccessHealth. A proposal for a three-year grant was recently funded by The Duke Endowment to create a collaborative effort to better coordinate and streamline safety-net health care resources for the uninsured in Greenville County. Vision for Health and Wellness

15. Successes in the Health and Wellness Vision Healthy School Lunch Program. Greenville County schools are piloting a program in eleven elementary schools where the menu includes veggie burgers, fresh fruits, and other low-fat, vegetarian and whole grain foods. Through the program, food service also staff attended a 40-hour course to learn about healthy cooking. The healthy lunch program has won a 2011 Golden Carrot Award from the Physicians Committee for Responsible Medicine. The District is planning on adding 20 more elementary schools to the program in the next school year. Gardening for Good. As the number of and interest in community gardens has grown, Greenville Forward and partners created Gardening for Good as a resource for Greenville’s network of community gardens USC School of Medicine-Greenville. To help address a nationwide physician shortage that will only worsen as more physicians retire and baby boomers age, Greenville Hospital System University Medical Center (GHS) and the University of South Carolina are expanding the existing USC School of Medicine program in Greenville to include first- and second-year medical students. This expansion will increase the number of care providers who can help improve the overall health of our citizens – as well as increase access to the latest medical research and most advances technology for diagnosis and treatment. Vision for Health and Wellness

16. Prior studies have inspired significant change. • Expanded Neighborhood-Based Medical and Community Health Centers for the Medically Underserved. • Dental Services for Medically Underserved Adults and Children are Created. • The South Carolina Business Coalition on Health Was Developed • Opened New Greenville Hospital System Eastside and Greer Campuses and announced the Building of the Bon Secours St. Francis Millenium Campus. • FAVOR – Faces and Voices of Recovery • Activate Upstate Kicks-Off and Encourages Active Lifestyles. • Greenville City Creates a Plan for Greenways and Trails, and Development of the Swamp Rabbit Trail and a County-wide Greenways Master Plan Begins. • Through Medverse, increased awareness and local partnerships to address language barriers to care • The City of Greenville unveiled its Breathe Easy campaign was implemented and a no-smoking ordinance was passed. • Opened Three Neighborhood Based Medical Centers. • Created MedWell Access and Linked with Commun-I-Care. • Linked New Horizon with Medical Centers. • Distributed “Health at Home” Self Help Books. • Created Healthy Connections. • Improved Medical Transportation.

17. Successes in the Health Vision

18. Successes in the Health Vision Health Reassessment Study. Released in 2012 by Greenville Forward, and sponsored by the United Way, Greenville Hospital System, Bon Secours St. Francis Health System, and Piedmont Health Foundation, the fourth health reassessment determined that 48% of Greenvillians are medically underserved. Over the last ten years, the study has provided information from over 5,500 telephone interviews with Greenville County residents.

19. Successes in the Health Vision

20. Successes in the Health Vision LiveWell Greenville. Formed as a partnership of dozens of public and private organizations, LiveWell aims to make Greenville County a healthier place to live, work, and play. Created by the Piedmont Health Foundation and the YMCA, LiveWell initially focused on obesity rates, specifically in our youth, and has expanded to include over 100 partners to make living well easier in Greenville.

21. Successes in the Health Vision

22. Successes in the Health Vision GHS Swamp Rabbit Trail. Greenville County purchased an abandoned rail line and have converted into a walking, running, and biking trail. So far, many people are using the trail for transportation and recreation.

23. Successes in the Health Vision

24. Successes in the Health Vision Building Healthy Communities Initiative. Bon Secours St. Francis builds healthy communities by addressing the root cause of the problems in our community that directly impact both residents and stakeholders.  Additionally, Bon Secours St. Francis embraces ecological stewardship as a key component of our healing ministry which extends into the communities we serve. Programs and projects that mirror these commitments include one of Greenville’s first Community Gardens, the Bon Secours St. Francis AgriCulture Exchange, Seniors on the Go, and the creation of the first community land trust in South Carolina.   

25. Successes in the Health Vision

26. Successes in the Health Vision Smoking Ban. In 2006, Greenville became the first county in South Carolina with a city-wide no smoking ordinance. This ordinance was quickly followed by other cities across the state. In 2011, City Council expanded the ban extending the ban to include patios and outdoor eating areas, private clubs and city parks near play grounds.

27. Successes in the Health Vision

28. Successes in the Health Vision AccessHealth. A proposal for a three-year grant was recently funded by The Duke Endowment to create a collaborative effort to better coordinate and streamline safety-net health care resources for the uninsured in Greenville County.

29. Successes in the Health Vision

30. Successes in the Health Vision 211 Health Help Line. Greenville County’s comprehensive source for information regarding human service agencies and community resources went live in March 2009. The 211 system fields thousands of calls and provides a wealth of information about human services.

31. Successes in the Health Vision

32. Successes in the Health Vision Oral Health, Bon Secours St. Francis Health System. Through partnerships with the Medical University of South Carolina, the Greenville Free Medical Clinic, and Greenville Technical College, Bon Secours St. Francis Health System provides improved access to oral health services for low-income and underserved clients through the Bon Secours St. Francis Oral Health Program and the Mobile Dental Unit. These initiatives have provided oral health education and restorative dental services to over 6,000 individuals in the Greenville community.

33. Successes in the Health Vision

34. Successes in the Health Vision Healthy School Lunch Program. Greenville County schools created a program in eleven elementary schools where the menu includes veggie burgers, fresh fruits, and other low-fat, vegetarian and whole grain foods. Through the “Culinary Creations” program, food service also staff attended a 40-hour course to learn about healthy cooking. The healthy lunch program won a 2011 Golden Carrot Award from the Physicians Committee for Responsible Medicine. The District has added 20 more elementary schools to the program in the next school year.

35. Successes in the Health Vision

36. Successes in the Health Vision University of South Carolina School of Medicine Greenville. To help address a nationwide physician shortage that will only worsen as more physicians retire and baby boomers age, Greenville Hospital System University Medical Center (GHS) and the University of South Carolina are expanding the existing USC School of Medicine program in Greenville to include first- and second-year medical students. This expansion will increase the number of care providers who can help improve the overall health of our citizens – as well as increase access to the latest medical research and most advances technology for diagnosis and treatment.

37. Successes in the Health Vision

38. Successes in the Health Vision Gardening for Good. As the number of and interest in community gardens has grown, Greenville Forward and partners created Gardening for Good as a resource for Greenville’s network of community gardens. Currently 70 gardens are participating in the network. A new web presence was launched in August.

39. Study Process and Methodology

40. Indicators Data Scan Employer Insurance Survey • Revisited issues explored in 1998, 2003, and 2008 with more emphasis of changes over time. • Deeper analysis including census tract level reporting. • More emphasis of health and wellness, less on the underserved. • Some benchmarks against other similar and aspirant communities. • Online survey distributed to Chamber members and the Greenville Forward database. • Replication of 2008 survey. • 407 Surveys; 206 surveys in 2012 to add to 201 in 2008 Citizen Telephone Survey • 802 telephone interviews with over-sampling of ZIP codes with higher levels of poverty to supplement 4,700 surveys from prior efforts. • 18 minute survey focusing on the uninsured. • Precision of +/-3% at 95% confidence interval.. Assessment Study Tools

41. Some Numbers from the Health Assessment 330 Focus Group Participants 5,510 Telephone Surveys 100,000 minutes on the phone 48 Personal One on One Interviews 60 Focus Groups 407 Employer Survey Responses

42. Numbers from Five Health Assessments 5,510 Telephone Surveys 100,000 minutes on the phone 48 Personal One on One Interviews 60 Focus Groups 330 Focus Group Participants 407 Employer Survey Responses

43. 2012 Health Assessment Research Objectives • Reevaluate Greenville County trends in health status and health and wellness indicators. • Reevaluate access to health care and assess the status of the medically underservedin Greenville County. • Document the progress (or lack of progress) in closing the underserved gap. • Prioritize where key resources should be focused. • Assist local providers with data needed for Community Health Improvement Plans (CHNA).

44. Primary Research Areas • Population • Age • Race/Ethnicity • Education • Household Income • Economic Climate • Recreation Infrastructure • Obesity • Nutrition • Exercise • Substance Abuse • Family Abuse • Teen Pregnancy • Oral Health • Behavioral Health • Disease Rates • Death Rates • Infant Mortality • Cancer • Insurance/Uninsured • Healthcare Spending • Medicaid Spending • Medicare Spending • Healthcare Policy • Facilities • Uninsured • Low Income • Hispanic • Neighborhood

45. Primary Research Areas • Population • Age • Race/Ethnicity • Education • Household Income • Economic Climate • Recreation Infrastructure • Why look beyond “health” data? • Health is not measured just by the healthcare system, but also issues with the community and quality of life. • The scan is extensive, looking at a variety of sources. The primary reason is to look at as much as possible to get a complete picture of Greenville’s health. • However, not everything found is shown; just the most “relevant.” • Obesity • Nutrition • Exercise • Substance Abuse • Family Abuse • Teen Pregnancy • Oral Health • Behavioral Health • Disease Rates • Death Rates • Infant Mortality • Cancer • Insurance/Uninsured • Healthcare Spending • Medicaid Spending • Medicare Spending • Healthcare Policy • Facilities • Uninsured • Low Income • Hispanic • Neighborhood

46. The Telephone Survey

47. The Telephone Survey • 18 minute telephone survey completed with 803 Greenville County residents. • Sample split among a random sample of residents and a lower income group of respondents (incomes under $30,000). • Responses weighted to appropriately reflect trends over study periods. • Results added to previous waves to give 5,500 interviews.

48. The Power of Numbers By combining surveys from multiple years, we can develop an analysis of the uninsured using over 5,500 surveys. Note: The profile of the under-insured has not changed dramatically in the last fifteen years.

49. Statistical Police For 2012 data, 800 interviews yieldsa confidence interval of 3.5% For all years’ data, 5,500 interviews yieldsa confidence interval of 1.3%

50. Building on Prior Efforts • Comparable base of knowledge and consistency of collection modalities insuring data comparability. • Understanding from past effort on the geographic areas with the greatest needs, and thus the ability to focus even deeper into geographies. • Understanding that the data represents individuals, and the face of individuals is what differentiates and inspires change.