Prevention Agenda 2013-2017: New York State ’ s Health Improvement Plan

1. Prevention Agenda 2013-2017:New York State’s Health Improvement Plan Presentation to the Council of Environmental Health Directors by the New York State Department of Health May 2013

2. Prevention Agenda 2013-2017: Ad Hoc Leadership Group • Six members of Public Health Committee and other leaders from Healthcare, Business, Academia, Community-based & Local Health Departments.

3. Vision New York is the Healthiest State

4. How Health Improvement is Produced Dahlgren G, Whitehead M. 1991. Policies and Strategies to Promote Social Equity in Health. Stockholm, Sweden: Institute for Futures Studies.

5. The Public Health System Adapted from : The Future of the Public’s Health in the 21st Century. IOM 2003

6. Framework for Improving Health Increasing Individual Effort Needed Increasing Population Impact Frieden T., A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health. 2010; 100(4): 590-595

7. Prevention Agenda 2013-17 Goals • Improve the health status of all New Yorkers and close health disparities. • Advance a “Health in All Policies” approach that addresses the broader determinants of health • Strengthen public health infrastructure • Create and strengthen sustainable public-private and multi-sector partnerships   • Further strengthen and promote the case for investment in prevention and public health

8. Five Prevention Agenda Priorities • Prevent chronic diseases • Promote a healthy and safe environment • Promote healthy women, infants and children • Promote mental health and prevent substance abuse • Prevent HIV, sexually transmitted diseases, vaccine-preventable diseases and healthcare associated infections

9. Cross-Cutting Priorities • Access to quality health services and early identification of health problems • Health disparities (including population specific strategies where applicable) • Social Determinants of Health • Life course Perspective (including attention to the aging population) • Oral Health • Gender perspective (male and female specific strategies where applicable)

10. Prevent Chronic DiseasesFocus Areas • Reduce obesity in children and adults • Reduce illness, disability and death related to tobacco use and secondhand smoke exposure • Increase access the high quality chronic disease preventive care and management in both clinical and community settings

11. Promoting Healthy Women, Infants, and ChildrenFocus Areas • Maternal and infant health • Child health • Reproductive, preconception, and inter-conception health

12. Promote Mental Health and Prevent Substance AbuseFocus Areas • Promote mental, emotional and behavioral well-being in communities • Prevent substance abuse and other mental emotional behavioral disorders • Strengthen infrastructure across systems

13. Prevent HIV/STDs, Vaccine-Preventable Disease and Health Care-Associated InfectionsFocus Areas • Prevent HIV and STDs • Prevent vaccine-preventable diseases • Prevent health care-associated infections

14. Promote a Healthy and Safe Environment (PHSE)

15. PHSE Scope and Charge • Focus on factors in the natural and built environments that influence human health and disease in order to create health supportive environments in NYS • Scope: chemical, physical and biological exposures; and injury and violence prevention • Membership – representing diverse sectors of the public health system • Charge • Primarily, complete priority-specific action plan • Action plan should include recommendations on interventions that can be implemented by other sectors (i.e. beyond DOH and other governmental PH) • 3-month timeline

16. PHSE Committee Sector Distribution Philanthropy • Aaron Wernham, Pew Charitable Trusts Clinical Care Delivery System • Rosemary Anthony, Arnot Health • Michael Lax, Occupational Health Clinic Center Business • Darren Suarez, NYS Business Council • Steve Rosario, American Chem. Council Non-profit • Ana Garcia/Elyse Powell, NY Academy of Medicine • Rebecca Morley, Natl. Center for Healthy Housing • Sheila Bushkin, Med. Soc. State of NY • James Melius, NYS Laborers’ Health & Safety Fund • Peggy Shepard WE ACT for Env. Justice • Joyce Hyatt, Chemung Valley Rural Health Network • Patricia Scalera, NY Rural Water Association Government Public Health • Nancy Clark/Thomas Matte, NYCDOHMH • Eric Faisst/Geoff Snyder Madison County HD • Daniel Luttinger (Co-Chair), NYSDOH • John Wilson, Neil Muscatiello, Ken Aldous, NYSDOH Staff Government, Other than Public Health • Ellen Burkhard, NYSERDA • Pam Hadad-Hurst, NYSDEC • Maureen O’Neill, US EPA • Carl Thurnau/Tom Roberts, NYSED • Tony Perez, DCJS Education Sector • Susan Klitzman (CO-Chair), CUNY SPH • Blanca Ramos/Bonita Sanchez, SUNY Albany

17. Four Focus Areas • Air Quality • Water Quality • Built Environment (including indoor and community-scale environments) • Injuries (unintentional and intentional)

18. ClimateChange Climate change is cross cutting issue, not related to just one specific goal.

19. Focus Area Action Plan • Define the Problem and Scope • Identify Goals and Objectives • Identify Interventions (evidenced-based where possible) • Identify Key Sectors/Organizations by Intervention • Objectives/Tracking Indicators

20. Selecting Interventions • Identified evidence based, promising and next policies, programs, and practices for action • Assessed potential to address health disparities, ability to measure success, potential reach, and potential for broad partner support and collaboration. • Finalized by committees • Selection serves as starting point.

21. Focus Area: Outdoor Air Quality • Problem/Scope • Outdoor air quality leads to increase illness and death • 11 counties out of compliance with the NAAQS • People with respiratory or cardiovascular disease are particularly at risk due to poor air quality • Approx. 10 % of NYers have asthma • Rates of hospitalizations due to asthma higher among low-income and minorities • Cardiovascular disease leading cause of death • Goal • Reduce exposure to outdoor air pollutants with a particular focus on burdened communities

22. Focus Area: Outdoor Air QualityInterventions • Develop a media campaign to provide information on public health effects of air pollutants and their sources • Consider implementing EPA’s Air Quality Flag program at schools and other community organizations • Assess and reduce emissions from sources that may contribute to local air pollutant levels (e.g., residential wood boilers, residential boilers using high sulfur fuels) • Support transportation options that reduce air pollution from mobile sources (e.g., support public transportation, community planning incorporating enhanced walkability or cycling, pricing strategies, greater diversification of transportation fuels)

23. Focus Area: Water Quality • Problem/Scope • Fluoridated drinking water considered by CDC as one of 10 great public health achievements of the 20th century • Number of water systems that fluoridate in NYS is decreasing • Many rural areas are not served by public water supplies, approximately 20% of population on private wells • Aging drinking water infrastructure • Abandonment of small privately owned community water systems • Climate change places additional stressors on NY water and water supplies (e.g., nutrient loading, decreased quantity of water, algal blooms, beach water quality) • Goals • Increase the percentage of State residents that receive fluoridated drinking water • Reduce potential health risks associated with drinking and recreational water

24. Focus Area: Water QualityInterventions • Provide communities interested in implementing fluoridation with outreach materials and resources to promote fluoridation as a significant health intervention (Goal 1) • Develop and promote existing strategies that provide the benefits of fluoridation to people with private drinking water wells, e.g., fluoride tablets; obstetricians, pediatricians, WIC programs and others are likely partners (Goal 1) • Promote or require long-range local level planning, including asset management planning for the long-term sustainability of water utilities infrastructure (Goal 2) • Develop enforceable codes for water conservation during extended periods of drought. Consider model codes adoptable at local levels, or a Statewide approach that local governments can use for enforcement (Goal 2) • Work with the real estate industry to promote well testing when a house is bought or sold (Goal 2)

25. Focus Area: Built Environment Quality • Problem/Scope • Includes homes, schools, workplaces, transit systems, roadways, parks, etc. • Can affect health through products/materials used and/or land use, zoning, infrastructure decisions • Land use that encourages physical activity and access to nutritious food is one component to reducing obesity and concomitant health problems • Many low-income communities and communities of color have disproportionately less access to public transportation, green space, safe streets and healthy foods • Many housing-related issues can pose a threat to human health (e.g., carbon monoxide, peeling lead paint, fire and electrical hazards, mold, radon, pests and pesticides, poor indoor air quality) • Climate change (e.g., extreme weather episodes, increased coastal flooding and storms) contribute to adverse health impacts of the built environment • Goals • Improve the design and maintenance of the built environment to promote healthy lifestyles, sustainability and adaptation to climate change • Improve the design and maintenance of home environments to promote health and reduce related illness

26. Focus Area: Built Environment QualityInterventions • Implement Smart Growth Public Infrastructure Policy Act, which requires consideration of smart growth principles when planning and funding investments, as well as the Complete Streets Law, which requires focused consideration of bicycle and pedestrian elements in street design (Goal 1) • Provide accessible, neighborhood cooling centers (Goal 1) • Provide incentives for sustainable and climate smart planning, zoning and development, including transportation, e.g., increase the amount and mix of development within 1/2 mile of commuter rail and bus stations (Goal 1) • Enhance mechanisms for referrals to support services, such as the Healthy Neighborhood Program (Goal 2) • Encourage home and building modifications, such as weatherization, CO alarms, smoke detectors, fire alarms, and other safety mechanisms (Goal 2) • Enforce compliance with existing property maintenance, building, fire and related codes, e.g., boilers, lead paint (Goal 2)

27. Focus Area: Injuries, Violence & Occupational Health • Problem/Scope • Injuries are a leading cause of death and disability (in NY 20/day die, 453/day are hospitalized and another 4,295/day are treated and released from ERs) • Falls are the leading cause of unintentional injury death and disability in people 65 or older, and a leading cause of injury in children up to age 4 • Violence accounts for approximately 847 deaths, 9,392 hospitalizations and 91,740 emergency visits in NY/year • In the US, more than 4,000 occupational fatalities, 3 million occupational injuries and 160,000 cases of occupational illness occur each year • About 53,000 youth go to the ER each year for job-related injuries • Climate change has potential to impact workers health (e.g., extreme temperatures, solar ultra-violet radiation, vector-borne diseases) • Goals • Reduce fall risks among the most vulnerable populations • Reduce violence • Reduce occupational injury and illness

28. Focus Area: Injuries, Violence & Occupational HealthInterventions • Train community workers in evidence-based programs for older adults (Goal 1) • Conduct in-home assessments and interventions to identify and reduce slip and fall hazards (Goal 1) • Improve walkability and safety in community and public spaces (Goal 1) • Expand access to and availability of exercise and information programs in community venues (Goal 1) • Develop multi-sector violence prevention programs (e.g., LHDs, criminal justice, social services, job training, CBOs) such as SNUG, Cure Violence or CEASEFIRE in high-risk communities (Goal 2) • Reduce neighborhood environmental risks, e.g., abandoned buildings, no lighting, deserted street (Goal 2) • Outreach effort targeting vocational school programs and industries hiring large numbers of young workers (Goal 3)

29. Indicator Development • Support “Promote a Healthy and Safe Environment” goals and objectives • Basis for measuring intervention progress • Primary tracking indicators and supplemental indicators • Where possible, consistent with HP2020 • Worked with program staff to develop measures and, assess data availability (spatially and temporally) • Tracking indicators available at: http://www.health.ny.gov/prevention/prevention_agenda/2013-2017/indicators/2013/nys.htm

30. Tracking Indicators • Outdoor Air Quality • Reduce the annual number of days with unhealthy air as measured by the Air Quality Index (AQI)>100 to 0(Goal 1) (Baseline: New York City annual average days 5 for ozone and 6 for PM; Rest of State annual average days 5 for ozone and 3 for PM) • Water Quality • Increase the percentage of NYS residents served by community water systems that receive optimally fluoridated water by 10% from 71.4% (2012) to 78.5% (Goal 1)

31. Tracking Indicators • Built Environment • Increase the percentage of the population that lives in a jurisdiction that adopted the Climate Smart Communities pledge by 20% from 26.7% to 32.0% (Goal 1) • Increase the proportion of people who commute using alternate modes of transportation, i.e., public transportation, carpool, bike/walk, telecommute, by 10% from 44.7% to 49.2% (Goal 1) • Improve access to affordable fruits and vegetables among low-income NYS residents by decreasing the percentage who live greater than 1 mile from a supermarket or grocery store in urban areas, or greater than 10 miles from a supermarket or grocery store in rural areas, by 10% from 2.49% to 2.24% (Goal 1) • Increase the percentage of homes in vulnerable neighborhoods that have fewer asthma triggers during Healthy Neighborhood Program home revisits by 55% from 12.9% to 20% (Goal 2)

32. Tracking Indicators • Injuries, Violence, and Occupational Health • Stop the annual increase of the rate of hospitalizations due to falls among residents ages 65 and over by maintaining the rate at 204.6 per 10,000 residents (Goal 1) • Reduce ED visits due to falls among children ages 1 to 4 from 476.8 to 429.1 per 10,000 residents (Goal 1) • Reduce the rate of assault-related hospitalizations from 4.8 to 4.3 per 10,000 (Goal 2) • Reduce the rate of emergency room visits for occupational injuries among adolescents 15-19 years of age from 36.7 to 33.0 per 10,000 (Goal 3)

33. Supplemental Indicators • Outdoor Air Quality • Implement policies that target vulnerable groups to reduce exposure to short-term increases in pollutant levels (e.g., policies for schools, day cares, children’s camps) (Goal 1) • Reduce releases of pollutants from stationary sources (e.g., outdoor wood boilers, residential boilers using high sulfur fuel, fast food char-broilers) (Goal 1)

34. Supplemental Indicators • Water Quality • Upgrade physical infrastructure (source, treatment, and delivery systems) in 15% of community water systems (Goal 2) • Develop strategies to address the abandonment of small community drinking water systems (Goal 2) • Improve capacity and develop strategies to identify and assess sources of pollution that potentially affect regulated beaches (Goal 2)

35. Supplemental Indicators • Built Environment • Improve pedestrian and bicycling infrastructure by addressing financial and other barriers to investing in pedestrian and bicycling networks, especially in low-income communities (Goal 1) • Reduce health impacts associated with extreme weather incidents, especially among vulnerable populations (Goal 1) • Integrate active transportation network to increase accessibility to destinations, such as grocery stores, schools, shops, and restaurants (Goal 1) • Reduce the incidence of elevated blood lead levels among children in high-risk neighborhoods (Goal 2) • Increase the number of housing units that contain at least one functional smoke and one functional CO detector (Goal 2)

36. Supplemental Indicators • Injuries, Violence, and Occupational Health • Stop the annual increase in the rate of ED visits due to falls among residents ages 65 and over (Goal 1) • Reduce ED visits due to falls among children under 1 year of age (Goal 1) • Reduce the rate of ED visits due to assault (Goal 2) • Reduce the impact of climate change on outdoor workers (Goal 3)

37. CHAs & CSPs • Local (County) Health Department Community Health Assessment (CHA) & Community Health Improvement Plan • Due November 15, 2013; covers years 2014-2017 • HospitalCommunity Service Plans (CSPs) • Due November 15, 2013, covers years 2013-15 • Plans need to choose two Prevention Agenda priorities and at least one needs to address a disparity

38. Local Community Health Planning Guidance 2013 • Informed by: • NYS PHL Article 6 and Article 28 Requirements • Experience with Prevention Agenda 2008-12 • Public Health Accreditation Standards • Affordable Care Act • Guidance intended to facilitate responses to these requirements and promote collaboration.

39. Local Health Department CHA-CHIPBlue = new Community Health Assessment • Description of Community (i.e. Demographics, Health issues) • Identification of major health challenges • Succinct summary of assets and resources • Documentation of collaborative process and methods Community Health Improvement Plan • Identification of at least two community priorities. At least one must address a disparity. 2,4,5 For each priority – goals, objectives, strategies and practices, performance measures (process, outcome) 3. Community stakeholder roles and responsibilities 6. Process used to sustain engagement

40. Hospital CSP Mission Statement Definition of community served Public Participation (i.e. participants, dates, process) Assessment and selection of at least two community priorities. At least one must address a disparity. 3-year plan of action Dissemination of plan to the public Process to sustain engagement

41. Community Health Assessment and Improvement Process

42. For More Information on the NYSPrevention Agenda 2013-17 and Local Community Health Planning Guidance http://www.health.ny.gov/prevention/prevention_agenda/2013-2017/index.htm prevention@health.state.ny.us