Travis County Commissioners Court

July 24, 2012 - Item 5
Agenda

5 is to receive update on Community Health Assessment from Austin-Travis County Health and Human Services Department and take appropriate action.
And we'll go to 17 after this item.

>> Joining us is deputy director of the Austin-Travis County health and human services department, shannon jones.

>> Thank you, judge and the court.
I'm here to give you an update on the Austin-Travis County community health assessment.
You will recall about a year ago we came forth to you and indicated that we were undertaking this community health assessment and community health improvement plan.
So my goal today is to give you an update on that.
First of all let me thank on behalf of our director carlos rivera I would like to thank sherri for her support certainly in getting through this process.
It's been very detailed, very long process.
What we'd like to thank you for opportunity to share with you the key findings from the 2012 Austin Travis County community health assessment.
This asecession.
Is in part a larger community health planning effort undertaken by Austin Travis County.
The data that was talked about early constituted this health assessment.
This was undertaken with the support of Travis County health and human services, central health, st.
David's foundation, seton health care family, and the university of Texas health science center at houston school of public health, Austin regional campus as service agencies in and around the Austin-Travis County area.
Some background to remind you, Austin-Travis County received funding to complete a model health assessment.
We were one of 12 selected nationwide participate in the local health department community health assessment to set a model for the nation.
We were the only health department to apply under what's called a general approach, and that is a unique community, strong intergovernmental collaboration between public and partners to conduct the assessment for our community.
This was also part of our accreditation process as we've kept you aware, we're in the process of going through accreditation.
Our goal is to apply in 2014 with hopefully the accreditation completed by the end of that year.
The reason we're doing this particularly is to make sure we're meeting national standards tox signify excellence in what we're doing in public health, to identify issues that were identified here today in terms of health inequities and health problems and to also result in better health outcomes for our community as a whole.
Today's presentation will focus on three things.
One, a little background of how we got here.
Two, the key themes that came out of the of the community health assessment.
And then finally the priority issue areas and focus areas that we will develop in development of the chip, which is the community health improvement process.
Which is what we'll do about the findings that have indicated.
First a reminder that in order to do this we had to come up with a vision and the vision of the collaboration was that we would have healthy people of the foundations of our thriving community.
As you see around the community and will see in the series of our die logs both in community and in the -- in various organizations that vision.
Our mission was that our community, individuals and organizations, public, private, nonprofit works together to build a sustainable, healthy Austin-Travis County.
A little bit about the goals of the assessment were the 2012 assessment was conducted to fulfill several overarches goals, one to examine the current health status across Austin-Travis County and compare local indicators with at a time state and local indicators.
You've heard early he will today if the credit debt health indicators some of the data, but we look not only at health status, but also at social service and social behavioral data.
Two, to identify not only the needs of the community, but also the strengths, resources as well as external factors that impact the health and gaps in our community.
So not only what we saw, but also where we saw it and what was going on in those communities, which relates to the problems that we've identified.
And then with the ultimate goal of informing funding and programmatic priorities to improve the health of Austin and Travis County.
So how do we get more funding into those target areas where we see deficiencies to improve the health.
The method we used in terms of the report was to look at a variety of different data.
To develop a social, economic and health portrait of Austin-Travis County, we used existing data that was drawn from the state, the county, local sources as well as the u.s.
Census and the Texas department of state health services data so measure a range of indicators.
Types of data include self-report of health behaviors from large population surveys such as behavioral risk surveillance.
Public health disease surveillance data as well as vital statistics both of birth, death and other sources of data.
In addition to the quantitative data that was developed as indicated through the critical health indicators and others, this provided the best issues.
We collected qualitative data to provide depth to the issues through stories, life experiences such as numbers don't always tell the whole story, but what's going on in the communities where we see these datas.
Qualitative datas helped the numbers to come to light and represent the void of the community that is critical to the process.
You should know that over 300 participants were engaged in conversations about health through community forums. Not only county wide, but in specific quadrants and precincts of the county.
We also used focus groups and we used key in forming interviews to gather the data.
These discussions flor the perceptions of the community, both the strength and challenges.
The health concerns and ways to improve the health of the community.
When we look at the priorities that we focus in discussions were conducted with staff from a wide range of organizations.
Community stakeholders and residents representing a variety of sectors.
For example, focus groups were conducted with senior citizens, public housing residents, refuge s, economic businesses, philanthropic organizations, behavioral health.
We also looked at health emotional activities, education, demographic groups such as african-american, asian americans, latinos, aging parents, immigrants and a variety.
So we looked at a variety of interviewees in terms of the sectors.
Interviews were also conducted with governmental officials, educational leaders, social service providers and health care providers among others.
From our report key things have come out and our report will be available at the end of the month to give you an overview of our findings, but some of the key themes that are identified, as were indicated earlier, disparities and wide variation in demographic and socioeconomic status.
The needs of a growing latino-hispanic population.
Limited transportation options including walkability.
Insufficient mental health services to meet the increasing needs of the community.
Chronic conditions and related health behaviors such as lack of physical activity.
Location for healthy eating options and obesity.
Access to primary care, especially among vulnerable populations.

>> The last one, especially the location situations.
I thought about that when I looked at that a little earlier, and part of the problem I know -- I didn't mean to interrupt you, but I'm just bubbling over about saying something about it.
You know, in the other assessment looking at the health indicators and the assessment that we're looking at here now, part of the problem, you had the cancer, you had the heart disease and you had a lot of these things that we discussed earlier.
And from an economic standpoint of view, having healthy choices.
Trying to eat healthy is an expensive endeavor.
When you want to buy -- an for example, like salmon or something like that which has a natural type of fat that is healthy for you.
Along with olive oils and a whole lot of other ingredients that are very expensive.
You get a its bottle of olive oil and then you compare that to a cheaper way of preparing your meal, it's very expensive.
And economically there are a lot of poor folks in this community.
My question is how can we bring an affordable, healthy menu for persons in this community that can't afford to pay those exorbitant prices for healthy foods?
Can somebody answer me that question, please?
Because I think -- and I know that educationalwise we want to educate folks as much as we can.
You know you've got to cut down on smoking.
Those are choices and stuff like that.
But there are some things like obesity, there are some things like heart disease.
It could be attributed to smoking, but it also could be attributed to an unhealthy diet.
And the question still begs me to point out is with the poor folks in this community in Travis County who cannot afford the salmon or cannot afford the olive oil, to stay away from those types of saturated fats and things like that which is harmful to the body, what are we doing to bring an affordable array of healthy choices?
And I said affordable because we talked about some economically stressed out people who are poor and can't afford it.
What are we doing about bringing affordability healthwise to affordable menu for those folks that can't afford the other healthy life-style foods?

>> Commissioner, I think the best answer we can give you today is first and foremost education.
I think we have to educate our community that food choices matter.
That there are options for them to prepare meals, plan meals for their family that will have -- will lead to much better health outcomes.
But as mr. Rivera has said many times today, it is a community issue that is going to -- that is going to require a community solution.
We get down to the basics of where grocery stores are located.
It is much cheaper to purchase fresh fruits from a large grocery store versus a corner convenience store, for example, but we know we have residents in our community that is their only access to do their grocery shopping to make sure that they have food for their families for any given day.
And so we have to start there.
We have to look at where our grocery stores are located.
Then we have to look at what information do we provide people and what incentives are there.
We are a community and a nation of choice, and so the best that we can do is educate our residents about choices.

>> All right.
And saying that, you brought up a good point.
Thank you, sherri, for that.
But when we look at our fruits and vegetables, which is good.
Got to eat a lot of fruits, a lot of vegetables.
And of course those things that don't contain saturated fats, especially the olive oil, eating poultry, fish and stuff like that, my question is how do we get this type of healthy diet to persons -- some of this stuff is very expensive where a person maybe can't afford it.
Now, I don't really know, but I do know that it is an exorbitant expense if you would like to eat that healthy choice consistently.
How do we get that to the persons in the community who are suffering because of the fact that the life-style they're in and also the unhealthy disposition that they're in currently.
How do we turn this thing around?
I'm looking tow try to turn this thing around.
That's what I'm looking for.

>> I'm not trying to be ava sieve, but it comes down to eliminate education, simple things like energy in, energy out.
The food that we consume are full of calories and if we don't burn them off, then the body accumulates the excess energy as fat.
But our kids need to be more active.
It's a societal thing.
It's a big shift.
Kids are spending too much time in front of the tv's.
They're not biking.
Parents are not engaging their kids.
Our communities are not walkable.
There are a lot of steps we can take in that right direction.
The issue of affordability of food is a complicated one.
It's not something that can be easily addressed.
But we can improve the health status of our residents starting today.
There's always been poverty.
In fact, I grew up poor, but we weren't overweight because of the food choices that we made and we were always outside running around.
Our communities aren't as safe as they should be or used to be, which makes parents keep the kids inside too.
So there are a number of factors that we can address.
Again, the high hanging fruit is making food affordable for everyone, healthy options, but there are intear mediate steps we can take to improve the health of our population.

>> Very true.

>> Well, I think it's a holistic approach to it all.
Look at dove strings.
You can look at that community as a study area, I guess.
And the parks are not safe.
The kids can't go out and play.
I'm sure they stay indoors.
So how does the governmental entity deal with making that park safe?
You have to think about the resources you're going to put in there.
So kids can go out and wide their bicycles.
And maybe is that the park where there's a swimming pool as well?
They can use the swimming pool instead of the wrong element taking over that park.
And so it's just a holistic approach.
It's not just the health, although it's a part of it.
But it's not in isolation with everything else.
Brand and then that whole area is a food desert.
There aren't any eating places that are healthy.
They're all fast food that add to obesity.
And so -- and then the dropout rate.
And then the pregnancy rate.
And then all of this other stuff.
And so it's -- we could start with dove springs and show that that can be -- can be really improved, really fast.
And it's been there a long time and it's waiting for some solutions.

>> We do have other community partners that are trying to address this.
We are partnering with like the sustainability food center.
There are efforts to do community gardens, farm to school and getting to schools in some of east Austin where the kids are actually involved in their own community garden and getting excited about the foods and fruits and vegetables and actually see them grow and get those and get farm to work and farm access in some of those ways.
And also even partnering with some of the -- we're trying to again address the food deserts but even working with the corner stores and have the healthy corner stores or some of the other models.
And I think michelle obama's effort to partner with wal-mart and get some of those affordable fruits and vegetables and things is a major accomplishment in trying to increase access to some of these things.

>> Mr. Jones has a few more minutes before he concludes, right?

>> Thank you, judge.
In addition to those, there is access to primary hair, especially among vulnerable population was identified in our report.
Prevention focused on health care services and programs as opposed to just health care.
In other words, collaborative in terms of how we provide services that was identified as a finding.
Strategic coordinated and collaborative approaches to health issues were also identified as key themes from the report.
And let me remind you that the report was an assessment from the community.
This is what the community is telling us is the problem.
So our goal now is now that we have the community's perspective as these are the key things, what are we going to do about it?
And that goes into the chip, which is the community health improvement plan.
And first of all, we have defined -- we identified priorities based on the review of the data.
We are in the process of establishing work groups for each priority areas.
The goals of those priority areas to create action plans, I put emphasis on action plans, including goals, objectives, evidence-based strategies and key indicators to be able to accomplish.
We are to engage community partners for feedback and partnership in plan adoption.
With regards to the chip quality areas, those that have been identified, recognizing that we had some 12 to 13 different priority areas identified, we recognize there's no way for us to do all of them.
So we've narrowed them down to three what we call health improvement priorities.
Chronic disease, the built environment and access could to primary care and access to primary care and mental health.
The chronic care would be obesity.
We've heard here today you will factors of obesity on diseases.
Obesity will be that focus area within chronic disease that we will focus on.
Two, built environment.
Two major focus areas came out.
One, as we've already talked, Commissioner, you eluded to, access to healthy food.
Certainly that is one of the critical focus areas we're going to focus on.
The second one is transportation.
One of the big issues we hear particularly as the community grows, the lack of access to transportation.
So people are forced to go to the corner grocery stores or what's available in the area.
So transportation is the other area.
How do we tie transportation to health care, transportation to access to food and transportation to healthy environment.
And then the third area is access to primary care and mental and behavioral health.
One of the major focus area there is how does the population navigate the health care system both the behavioral as well as the primary care.
A lot of the public tells us they just do not understand the health care system and how to utilize it.
So one of the focus areas there is how do we help them to understand that?
And across all of these areas, health education and health literacy was selected as a cost-cutting strategy for all priorities.
We talk a lot about health disparities, health inequities, chronic disease and the like, but most of the public does not understand that.
So helping them to understand what we're talking about is critical for them to take ownership in helping to address this themselves.
In terms of time lines, we're looking at completing our chip by the end of the year.
In order to do that our cha, the community health assessment report, the report we aincluded to, will be available at the end of July.
And that report will be available from the county and the city website.
We are presenting to the public this Thursday, July the 26th, from 3:30 to 4:30, and from 6:30 to 7:30 at Austin city hall so that the findings of this presentation, and we've encouraged the public to come out and hear the overall results as we're sharing with you today the findings.
We then begin our issue area work groups.
Those are the groups that will take these findings and work on implementing strategies.
We're going to have a series of meetings at the learning resource center and throughout the county in various other locations.
Those meetings will occur in August, September and October.
We plan to have the draft action plan for the chip, that is the community health improvement plan, by the end of December -- by the end of November.
We hope to bring that back to you and share with you that action plan that we have to plan.
And then we hope to have the final chip presentation by the beginning of January of 2013.
Our goal has been to develop a plan that looked at the problem that we've identified from the community's point of view and not just from the health and human services point of view.
And we've done that and that report will be available.
Our next step as I said now is to begin to develop plan and strategies to implement in the community to address the problems we find.
That's sort of an overview of the update of where we are with the cha.
I'll be happy to answer any additional questions you may have.

>> You alluded to something as far as where you will house the information.
You also mentioned those persons that have challenges because of a lack of affordability to do from one point to another point, in other words, the need for transportation to keep them from those places where they are purchasing maybe unhealthy food.
So my question, though, is this: I just assume that those poor persons may not have access to computers.
And because of the fact that they can't even -- transportation is not available to them, making it available.
So I'm looking at those persons who are not computer literate, who do not have computers, the poor folks out there that can't afford it.
How do we get them involved in this process because they are -- because of the economic challenges that they have just trying to make it day-to-day?
How do we get this information to them to let them know yes, we do have a community health plan that we're trying to assess with Travis County.
Yes, you're a part of it.
This is what we're trying to do.
How do we include those persons?

>> Well, first of all, I'll just remind thaw in the assessment piece when we first tried to get the problems identified we went out into the county.
We health four community forums. We had over a 14 focus groups.
And these were held in their community.
So we went to the communities.
We went to churches.
We went to community organizations to get the data.
Now that we are v that we plan to do the same thing in terms of sharing the data out.
We're going to host them in a variety of locations.
We're going to go back out and get their feedback in terms of strategic plans what are we going to do to address those.
Then in addition to not only the website, we're going to provide it to social service organizations, group, churches, a variety of organizations that interact with the public that we're talking about.
So our goal is to make it available as universal throughout the county and to get the feedback universal throughout the county and not just to the traditional means.

>> Okay.
Thank you.

>> Plan implementation typically requires resources.
So what partners do we believe we'll have available when it's time to implement?

>> The county, we certainly look forward to their support.
But in addition, if you're seeing -- on the profile that we have, all of our partners, the major partners are of course the city of Austin, seton and st.
David's have committed to this.
One of the things about seton and st.
David's is part of their i.r.s.
Requirement they are asked to do a community health assessment.
Instead of doing an independent one for Austin-Travis County, they have agreed to work with us on this.
So they will be a part in terms of helping to identify resources.
Central health has been very critical in assisting us in doing this assess.
And their agreement is to -- based upon the findings to work to implement the recommendations that we have.
And of course, the university of Texas health science center at houston school, Austin regional campus, is working with us to implement those.
But in addition to those we're looking to -- to the social service agencies who are going to be assisting us and we've had a variety of community and business private sector organizations have indicated the interest in our findings and how how they maybe able to is assist us in implementing what we want to do.
We're looking at a variety of partners.
But once again we have to see the plan and that's what we're in the process of developing.
Based upon that we will identify those resources that we need based upon the plan that we come up with.

>> Judge, I think the partners are optimistic that not only will we receive this plan, but it will give us an opportunity to better align our resources to ensure that there's no duplication so we would in effect use our resources more wisely.
And then of course be mortar getted in how we use our resources to impact the areas that the community has told us that they care about.
And then finally, this is an ongoing process.
So we will be revisiting these questions on an annual basis and hope that the community will continue to be engaged with us to ensure that we are on target but also as new needs arise we will also have that opportunity to hear from our community what they would like us to focus on.

>> The plan will be drafted in November and December.
So who would in fact put the plan together?

>> The department is in collaboration with all the partners, will be putting it together, but the department is responsible for putting the plan together in terms of presenting it, but it a collaborative effort.
It's not just a department doing t but we're ultimately responsible for assembling it and presenting it.

>> Okay.
And the department is...

>> Austin-Travis County health and human services department.

>> Okay.
Thank y'all very much.

>> Pardon me, judge.
Can I echo dr. Wong's words that he just said.
I appreciate that.
But -- and also I wanted to answer that question, again, from I guess ms. Gomez and mr. Davis about the unhealthy diet.
How can we do that?
And again, we just need to ban the poison or at least stop buying it.
All fried chicken outlets, church's, pop eyes, kentucky fried chicken, they all put msg in everything, in the potatoes.
They're poisoning.
So we have to stop buying commercially available fried chicken.
That's one way.
And that's again speaks to the wide variation among ethnic groups.
They're targeting you.
They're targeting both of you, the black community, you're being targeted with msg.
And you mentioned, mr. Davis, about olive oil.
Everyone can't afford olive oil and it goes to that need to educate and we just need to avoid corn oil and soybean oil.
Corn oil has fructose in it.
A lot of fructose.
And soybean oil is all gmo now, which is something people aren't aware of.
And to stay indoors, just turn off the tv.
Read.
That's something that you can -- it's not going to make you obese or anything necessarily or give you -- stop that as much as exercise would.
So the body mass index over 30 is because these foods, these chemicals, msg, gmo crops.
This is all badness, all being done on purpose.
They're marketed, they're targeting you and that's why -- it's out of love, judge.
And I'm trying to help share information.
That's one thing I think we can all do among ourselves, educate each other about what's healthy to eat and what what to avoid.

>> Thank you very much.

>> Thank you, sir.

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