Travis County Commissioners Court
January 31, 2012 (Agenda)
Item 15
>> Let me indicate my intention to call up item 15 now.
and then we'll call up 13.
15, receive update from city of Austin and Travis County staff regarding communities putting prevention to work, cppw, initiative and joint city/county implementation of community transformational grant, ctg, program and take appropriate action.
>> good morning, judge Biscoe, Commissioners.
sherri fleming, county executive for health and human services and veterans services.
as you know, we have an interlocal agreement with the city of Austin to meet our public health responsibilities and as such work collaboratively with the city of Austin as relates to public health initiatives for our community.
today we have for you dr. Phil wong who is our Travis County health authority and he is here to talk to you not only about the transition from the cppw grant which is communities putting prevention to work, which has been sort of the impetus for a lot of tobacco cessation work we've been doing, so he will talk about the transition from that grant into a new grant that the community has received and tell you a little about the planned implementation.
so dr. Wong.
>> good morning.
thank you for allowing me to be here.
following up on some of the discussions last week even, when we look at the data for Travis County, the leading causes of death, cancer is number one, heart disease number two, then stroke and chronic lung disease 4 and 5.
these are preventable connick diseases.
when we look at the actual causes related to some of those deaths, tobacco is in number 1 preventable cause of death and disease in our community, but then overweight and obesity is another one that is a growing problem in our community.
you know, we have been working with you closely on the communities putting prevention to work grant from cdc and we've had just tremendous wins in terms of the policy and environmental changes already.
some of the just the most recent wins that Austin community college is going 100% smoke free campus on all campuses starting this month.
the city of Austin libraries are implementing 100% to tobacco free policies effective February 1.
we did a survey of all the city department directors.
over 31 city departments and officers are ready to move forward with tobacco free campuses.
cap metro, cap metro board has smoke free bus stops.
back in November of last year.
and then as you probably know also parks and recreation, the city council voted on December 15th that all parks are smoke free in the city of Austin.
and this is just a list of some of the almost -- of the partners that have adopted these 100% smoke free and tobacco free policies, which again are the interventions that really help change the social norms, help people to support their efforts to live tobacco free lifestyles.
and the success we've had with the communities putting prevention to work grant has really positioned us well to implement this community transformation grant.
and the community transformation grant, this is authorized under the form care act or the health care reform bill.
the purpose is to create healthier communities by building capacity to implement evidence and other practice based policy environmental, programmatic and infrastructure changes or policy systems and environmental changes and support implementation of interventions in five main strategies.
tobacco free living, active living and healthy eating, physical activity to address obesity.
high impact evidence based clinical and other preventive services to address hypertension and high cholesterol.
social and emotional wellness and healthy and safe physical environment.
the guiding principles of this grant are to maximize the health impact, to used and spanned the evidence base for local changes or system changes of improved health.
again, when they talk about these policy environmental infrastructure changes what they are trying to do is overcome the stickiness problem.
for so long we've been doing a lot of interventions where we just educate people and this is an example.
this was a study in jama that looked at trying to increase exercise participation.
in this study there were three different arms. One was people get long bouts, the second is short bouts of exercise and the third one short bouts and treadmills.
during the first six months they all go up.
we were successful during that first six months.
where do you think it goes after that first six months?
again, what happens is -- what you typically see in so many of the types of interventions, exercise participates lags off.
you have success for a little bit but it doesn't have the long-lasting change.
here's another study.
there was a study also looking at self-help for commercial weight loss programs. During that first six months, you see some effectiveness.
but after that period of time then things start reverting back to norm a what this grant is trying to do is that after the funds are over to have that long-term effect, changing really the social norms, changing the environment, changing policies that after the funds are gone will have -- will still remain and still make an impact.
and so for the community transformation grant we were out of 244 applicants Austin was one of 35 communities selected for implementational level funding which is the higher level of funding.
there were an additional 26 communities receiving smaller levels of funding.
the city is receiving $1,026,000.
for the year one budget of a five-year grant.
funding for years 2 through 5 is dependent on continuing the health care reform.
the core principles of this grant to use and expand the evidence based, using proven strategies, enhancing community efforts and filling gaps to maximize the health impacts so impacting all members of the community t core activities fall into three buckets.
the first is poll sane environmental changes.
for instance, improving nutrition and physical activity in schools and work sites and schools and communities.
health system changes, improving delivery and use of selected clinical preventive services.
we've been partnering closely with all the icc members that serve some of the underserved patients in our community.
supporting self-management and improving quality of life.
again, the efforts are jurisdiction wide meaning all of Travis County including outside the city of Austin with the focus on health equity across the sectors.
you know, health care work sites, school or child care or higher learning and community.
and collaborating with community partners to leverage these resources.
again, this builds on these same sort of partnerships, the same interventions we've been implementing with the communities putting work together.
some of the things Austin county can do and this is guidelines from cdc that in schools and child wear, requiring or improving physical activity programs, reducing screen time, increasing walk organize cycling to school, reducing calories or beverages by promoting water and reducing sugar sweetened bev ragees.
work sites we've been working with the mayor's fitness council, works like wellness programs using physical activities promoting stair use instead of elevatorrers, health care benefits, changing the benefit plans to improve lifestyle and management councils he will, increasing availability of healthier food at the work site and changing standards for food procurement or vending machines.
and communities, eliminating healthy food deserts.
expanding purchase of locally developed food and safe active transportation.
making more connections between neighborhoods, making more walkable streets and things like that.
then in health care again there are some clinical system changes.
increasing support for breast feeding.
and also referring to structured lifestyle change programs. Some of the specific things in Austin-Travis County that sort of fall under those areas of strategy include working with the planning and development review department with city of Austin on their 30-year comprehensive imagine Austin plan and develop a implement to healthful city code and transfer some of the best practices to county levels.
working a change the streets to promote active walken appear making more connection between neighborhoods.
shorter cul-de-sacs, things like.
that addressing
>> [indiscernible] and trying to incorporate those into future building codes so future developments have those things that promote physical activities in all areas of the community.
increasing the number of neighborhoods with access to grocery stores or markets selling high quality fruits and vegetables, urban gardens, farmers markets.
promotion of tobacco free living and protection from secondhand smoke.
increasing availability of healthy foods sold and used by restaurants, schools and health care facilities and clinical systems to improve outcomes related to high blood pressure and cholesterol.
we've had a lot of success working with some of the partners working to change electronic medical records so every patient is assessed for tobacco use and referred to cessation.
similarly to address hypertension and high cholesterol.
building some of the same system changes that people are compliant with their medications.
working with other community partners, perhaps pharmacists or others to help people stay on track with their treatment reason mens and things like that.
-- regimens and things like that.
it build on what we've done with the great successes and I think it's a tremendous opportunity for all of us in the entire county.
>> that's a great idea.
>> let me ask you this question.
you brought up a good point especially with the healthy food.
all of it really, I don't want to just say healthy food.
the reason I brought up healthy food is because there's been a person speaking that has contacted me and, of course, they want to look at a possible situation where be Travis County and the city of Austin through some kind of collaborative effort could basically get involved in maybe producing food through a garden or some type of farm, some type of outreach where low-income persons would be able to participate in acquiring affordable, healthy food.
especially with your fresh fruit and vegetables.
and, of course, I hear and I heard you mention a couple of those aspects in the particular conversation we're having today.
is there any way possible that the collaboration you have now will be able to address low-income persons in the community who sometimes some of these things are out of reach for some folks, and in fact the person even brought up the residents within a public housing configuration where you have several low-income persons within that type of housing configuration that do not have access to a community garden, some type of sustainable healthy food and vegetables where you raise your own and from an experience of exposure to that.
is there any aspect of any of this could be directed there or how would you look toward that in the future especially if it's dealing with health?
and of course I'm concerned about that because the -- the resident I talked with pretty adamant about it and, of course, I'm just as adamant as that person is.
how can we reach the low-income, how can we reach the poor to address some of their health concern issues, especially if they would like to do a community garden to raise some of these particular products.
is any -- can you maybe talk to me a little bit about that.
>> absolutely.
that is exactly what this grant, part of this type of activities we're planning on doing and working with community partners to support community gardens in the areas that don't have it, in the neediest areas.
>> this is what I want you to do.
call my office and I'm going to give that person's name and telephone number so he can maybe lock into this what we're talking about today because I think the person has some great vehicle ideas to take it forward especially when we're addressing the poor.
those that aren't able to participate maybe at another level and maybe can't even afford these things that we've been talking about here today.
so I want you to do that whenever you get an opportunity and we'll give you that information when you call my office.
>> sure, absolutely.
again, there's several partners that are already doing things like farm to school programs, you know, they get the kids active and learning about the fresh fruits and vegetables, seeing them grow, get their parents and it's some of the areas that have that greatest need.
we're also looking at healthy neighborhood stores.
we would like for some of the larger grocery chains to go to some of the areas where the food deserts are but as that is being developed, we hear communities in the neighborhood, they still trust their neighborhood community stores and working with those actual community partners to get them to offer healthier options so they can make healthier choices.
>> okie-doke.
thank you.
>> I was wondering if there was an opportunity to utilize any of this grant money with regard to -- I do know that there's a need for the jail to connect their icc information to the health information exchange.
and I was wondering if there was any possibility of working that connection between this effort and the jail's effort to be more integrated with the health information exchange.
>> we're certainly supporting and looking to use the health information exchange to get some important quality improvement efforts especially related to hypertension and high cholesterol.
I don't know that it can specifically support that, you know, the connection of that, but it's certainly something that we hope to use and we hope to, you know, have those networks in place as part of this.
>> because there have been some very good innovations in the jail in terms of providing -- providing programs inside the jail that could perhaps create stickiness for the population moving out the door and back into the community.
>> absolutely.
again, you know, policy changes in jail settings in Texas prisons, smoke free or tobacco free, those policies changing some of the -- perhaps working on the type of food that's offered or served in --
>> and I know both of those things are true of our jail, that it's smoke free.
it also has a community garden.
and compost.
>> definitely we would be interested in, you know, looking at that population to try to include in these activities.
>> thanks.
>> on the first two pages after the cover sheet of the presentation, leading causes of death in Travis County, cancer, heart disease, accidents, stroke, others.
actual causes of death in Texas, tobacco, obesity, overweight, alcohol.
the lists are remarkably different.
why is that?
>> the first slide is the actual by disease category how it's on the death certificate which diseases listed.
the second one is sort of a synthesis.
for instance in the first one where cancer, heart disease are the top two killers.
well, tobacco is a contributing cause and a significant cause for many of those cancer and heart disease deaths.
so there's a way and actually in Texas we have on a check box on our death certificate that says did tobacco use contribute to this death as well as epidemiologic estimation of the number of deaths related to, for instance, tobacco or overweight and obesity and that's where those other estimates come.
they are consistent but that's breaking it down by risk factors as opposed to these categories.
does that make sense?
>> okay.
and so for Texas in the second chart here the latest information is 2001?
>> that's the latest we could find for statewide estimates.
>> okay.
so when I see smoke free, tobacco free, the language used here, I should think cigarettes, chewing tobacco and snuff?
all three.
>> yes.
>> okay.
there must be, what, 22, 23 other cities in Travis County.
this grant covers them too?
>> all of Travis County.
>> and what efforts are we making to spread the news to them?
>> well, again, you know, we're working together.
we we applied for this grant we went on sort of a field trip to look at some of the different areas and some of the unincorporated areas, but, you know, we are trying to work with all of the partners within Travis County to promote these same policies and environmental changes.
and we actually will have some r.f.p.s coming out shortly in the next month that will be available to community partners to also participate.
>> what's the plan for spending that $1,026,000?
>> well, it's to implement, you know, to work with community partners on this.
we're also working with some of the other departments like the planning and development review and parks and rec within the city.
we're partnering together on our efforts.
you know, this actually a significantly less amount of money than we had with communities putting prevention to work.
$5 million over two years to address one issue with tobacco.
with the community transformation act we're getting just 1 million per year to address five issues.
so we are, again, trying to leverage those resources and make them so we get these long-term changes.
>> so at the end of the grant period, what are we expected to show to justify the the the the the grant funds?
>> similarly to communities putting prevention to work.
really successes in the policy system environmental changes.
so that again if we can get changes to some of the different city codes and things that promote future development of neighborhoods and streets to promote connectiveness with parks and trails that promote walking and physical activity.
if the county had policies, for instance, that only healthy food options are in the vending machines, things like.
that I think your efforts in looking at countywide smoke free, tobacco free policies, those sort of things are all consistent.
getting more employers in Travis County that are adopting these same policies.
you know, again, we know work site policies really help employees make these healthier choices.
that schools and other settings adopting these similar things.
and that more community gardens that are established in the areas of need and more opportunity for people to get healthy food options.
>> what I would add too is that I think the the overarching goal in a lot of the funding that the city has received both for the city and on our behalf is sort of a nationwide change for us to look at health in all policies.
so how do the everyday actions that we take in public policy actually affect the health of our community.
so when we think about everything from, you know, subdivision plats and things of that nature, how we spend our dollars to have vending machines in our break rooms for our employees, where does health fit, you know, and how does health fit and do we consider healthy options and healthy community options like sidewalks and community gardens and things as we make those decisions.
and so I think if we look at what the big goal is, that certainly would be health in all policies.
>> what if anything do you need from us today?
>> again, it's to get your continued support.
it's been a continuous partnership we've already had with cppw.
we want to partner and continue to work together and if you see opportunities, again, we'll follow up on the constituents you mentioned and, again, any other ideas to make this work.
we're all in this together and however we can, you know, have these successes that we can take back to cdc and show how much we've done in Travis County.
>> and to have you vocalize support for healthy choices and healthy considerations as you move forward in developing policy for the community.
>> request granted.
>> thanks so much.
>> thank you all very much and we'll be getting in touch with you on that question we discussed earlier.
we will exchange information.
thank you.
>> so do we have a point person at the county to assist in this effort?
>> absolutely.
you are looking at your point person.
and, of course, miss alma gail.
>> thanks.
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