Community Community Assets to Assets to

Support Healthy Support Healthy EatingEating

www.preventioninstitute.orgwww.preventioninstitute.org

Leslie MikkelsenLeslie MikkelsenManaging DirectorManaging Director

Health-Wealth Health-Wealth Connection Connection SymposiumSymposium

June 23, 2010June 23, 2010

““A Holistic View of A Holistic View of Assets: Family, Assets: Family, Community, Equity”Community, Equity”

What’s Health Got What’s Health Got To Do With It?To Do With It?

Photo Courtesy of: http://www.chrisstroud.net/blog/fremont-union-city-farmers-markets/ Photo Courtesy of: http://www.chrisstroud.net/blog/fremont-union-city-farmers-markets/

Photo Courtesy of Google ImagesPhoto Courtesy of Google Images

Photo Courtesy of: Don Dommer Associates at http://www.flickr.com/photos/dondommerassociates/3254703816//

HEALTH HEALTH & &

SAFETYSAFETYBEHAVIORBEHAVIORBEHAVIORBEHAVIOR

ENVIRONMENTENVIRONMENT

It is unreasonable to expect It is unreasonable to expect

that people will change their that people will change their

behavior behavior easilyeasily when so many when so many

forces in the social, cultural, forces in the social, cultural,

and physical environment and physical environment

conspire against such change.conspire against such change.

““

””Institute of MedicineInstitute of Medicine

70%70%

10%10%

20%20%

$2.2 Trillion$2.2 Trillion

Current Health Care SpendingCurrent Health Care Spending

Factors InfluencingHealth

National Health Expenditures

SOURCE: SOURCE: Centers for Disease Control and Prevention, Blue Sky Initiative, Centers for Disease Control and Prevention, Blue Sky Initiative, University of California at San Francisco, Institute of the Future, 2000University of California at San Francisco, Institute of the Future, 2000

Behaviors & Behaviors & EnvironmentEnvironment

GeneticsGenetics

Medical CareMedical Care

Behaviors & Behaviors & EnvironmentEnvironment

70%70%

Medical Care, 10%Medical Care, 10%

GeneticsGenetics20%20%

$2.2 Trillion$2.2 Trillion

Current Health Care SpendingCurrent Health Care Spending

Factors InfluencingHealth

National Health Expenditures

SOURCE: SOURCE: Centers for Disease Control and Prevention, Blue Sky Initiative, Centers for Disease Control and Prevention, Blue Sky Initiative, University of California at San Francisco, Institute of the Future, 2000University of California at San Francisco, Institute of the Future, 2000

Behaviors & Behaviors & EnvironmentEnvironment

70%70%

Medical Care, 10%Medical Care, 10%

GeneticsGenetics20%20%

Prevention, 4%Prevention, 4%

Medical ServicesMedical Services96%96%

$2.2 Trillion$2.2 Trillion

Current Health Care SpendingCurrent Health Care Spending

Factors InfluencingHealth

National Health Expenditures

SOURCE: SOURCE: Centers for Disease Control and Prevention, Blue Sky Initiative, Centers for Disease Control and Prevention, Blue Sky Initiative, University of California at San Francisco, Institute of the Future, 2000University of California at San Francisco, Institute of the Future, 2000

$1$1

Return on Investment with PreventionReturn on Investment with Prevention

Investment

SOURCE: SOURCE: Prevention for A Healthy America: Investments in Disease Prevention Yield Significant Savings, Prevention for A Healthy America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, Trust for America’s Health, July 2008Stronger Communities, Trust for America’s Health, July 2008

$5.60$5.60

Return on Investment

Savings at 5 years

$16 Billion $16 Billion Annual SavingsAnnual Savings

In 5 YearsIn 5 Years

QUALITYQUALITYPreventionPrevention

is the Prescriptionis the Prescription ComprehensiveComprehensive

Aimed at the community Aimed at the community environmentenvironment

Changes norms: Changes norms: makes the healthy choice the makes the healthy choice the easy choiceeasy choice

TwoTwo Steps to Steps to PreventionPrevention

Medical Care

Exposures &

BehaviorsEnvironment

Source:Source: Actual Causes of Deaths in the US, 2000, Centers for Disease Control and Prevention, Actual Causes of Deaths in the US, 2000, Centers for Disease Control and Prevention, 20042004

Leading Causes of DeathLeading Causes of Death

Heart Heart DiseaseDisease

CancerCancer

StrokeStroke

DiabetesDiabetes

Injuries & ViolenceInjuries & Violence

Medical care, costs, and Medical care, costs, and inequitiesinequities

Photo courtesy of http://tycohealth-ece.com/files/d0003/ty_rn33d7.jpgPhoto courtesy of http://tycohealth-ece.com/files/d0003/ty_rn33d7.jpg

Not the primary determinant of healthNot the primary determinant of health

Treats one person at a timeTreats one person at a time

Often comes late; can’t always restore Often comes late; can’t always restore healthhealth

Medical Care Alone CannotMedical Care Alone Cannot Reduce Injuries and InequitiesReduce Injuries and Inequities

Let’s take a step... Medical

CareExposures

& Behaviors

Environment

Let’s take anotherstep...

Exposures &

Behaviors

What’s Sold and PromotedWhat’s Sold and Promoted

VS.VS.

Industry Low-Wealth High-Wealth Group Neighborhood Neighborhood

Bars/Taverns

7 27

26 24

35 11

SupermarketsCarry-out eating places

SOURCE: Morland K, Wing S, Diez Roux A, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002;22:23-9.

What’s Sold and PromotedWhat’s Sold and Promoted

VS.VS.

Industry Low-Wealth High-Wealth Group Neighborhood Neighborhood

Bars/Taverns

7 27

26 24

35 11

SupermarketsCarry-out eating places

SOURCE: Morland K, Wing S, Diez Roux A, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002;22:23-9.

What’s sold & how What’s sold & how it’s promotedit’s promoted

Elements of Community HealthElements of Community Health

PLACEPLACE

Social networks & trustSocial networks & trust Participation & willingness to act Participation & willingness to act

for the common goodfor the common good Acceptable behaviors & attitudesAcceptable behaviors & attitudes

Racial justiceRacial justice Jobs & local ownershipJobs & local ownership EducationEducation

What’s sold & how What’s sold & how it’s promotedit’s promoted

Look, feel & safety Look, feel & safety Parks & open spaceParks & open space Getting aroundGetting around Housing Housing Air, water, soil Air, water, soil Arts & cultureArts & culture

Elements of Community HealthElements of Community Health

PEOPLEPEOPLE

PLACEPLACE

EQUITABLE EQUITABLE OPPORTUNITYOPPORTUNITY

Social networks & trustSocial networks & trust Participation & willingness to act Participation & willingness to act

for the common goodfor the common good Acceptable behaviors & attitudesAcceptable behaviors & attitudes

Racial justiceRacial justice Jobs & local ownershipJobs & local ownership EducationEducation

What’s sold & how What’s sold & how it’s promotedit’s promoted

Look, feel & safety Look, feel & safety Parks & open spaceParks & open space Getting aroundGetting around Housing Housing Air, water, soil Air, water, soil Arts & cultureArts & culture

Elements of Community HealthElements of Community Health

PEOPLEPEOPLE

PLACEPLACE

EQUITABLE EQUITABLE OPPORTUNITYOPPORTUNITY

Preventative servicesPreventative services AccessAccess Treatment quality, disease Treatment quality, disease

management, in-patient management, in-patient services, & alternative medicineservices, & alternative medicine

Cultural competenceCultural competence Emergency responseEmergency response

MEDICAL MEDICAL SERVICESSERVICES

Complete StreetsComplete StreetsOakland, CAOakland, CA

Source: Partners Through FoodSource: Partners Through Food

Healthy Food Retail and AccessHealthy Food Retail and Access

Rochester, NYRochester, NY

““Life was there Life was there again. again.

It transformed the It transformed the neighborhood.”neighborhood.”

Hank Herrera, President/CEOHank Herrera, President/CEOCenter for Popular Research Education and PolicyCenter for Popular Research Education and Policy

Increasing Access to Healthy FoodIncreasing Access to Healthy FoodUpper Falls Community: Rochester, New YorkUpper Falls Community: Rochester, New York

Fresh Food FinancingFresh Food Financing

Alameda County CCNIAlameda County CCNI

West Oakland – Hoover DistrictWest Oakland – Hoover District

Alameda County CCNIAlameda County CCNI

Sobrante ParkSobrante Park

Photo courtesy of: http://www.acphd.org/healthequity/ccni/docs/youth/SP_keeping_it_real_final_rpt.pdf Photo courtesy of: http://www.acphd.org/healthequity/ccni/docs/youth/SP_keeping_it_real_final_rpt.pdf

“Violence is not the problem of one neighborhood or group…Coming together and owning this problem and the solutions are central.”

 -Dr. Deborah Prothrow-Stith, Harvard School of Public Health, UNITY Co-

Chair

Focus on SafetyFocus on Safety

Health Reform LegislationHealth Reform Legislation

Community Transformation GrantsCommunity Transformation Grants

Prevention and Wellness Fund Prevention and Wellness Fund

Health Empowerment ZonesHealth Empowerment Zones

Workforce training in community Workforce training in community preventionprevention

National strategy and inter-agency effortsNational strategy and inter-agency efforts

Stimulus (ARRA)Stimulus (ARRA) Health Equity and Accountability Act of Health Equity and Accountability Act of

2009 (H.R. 3090)2009 (H.R. 3090) Transportation ReauthorizationTransportation Reauthorization Child Nutrition ReauthorizationChild Nutrition Reauthorization Preventing violencePreventing violence The next Farm BillThe next Farm Bill

Federal Funding: Other OpportunitiesFederal Funding: Other Opportunities

““It wouldn't have happened except for the It wouldn't have happened except for the fact that people worked to make it happen. fact that people worked to make it happen. Every time I go by that corner, I remember Every time I go by that corner, I remember people saying ‘Face reality. There will people saying ‘Face reality. There will never be a grocery store there,’ and I never be a grocery store there,’ and I smile.”smile.”

- Hank Herrera - Hank Herrera

President/CEO, Center for Popular Research, Education, and PolicyPresident/CEO, Center for Popular Research, Education, and Policy

www.preventioninstitute.orgwww.preventioninstitute.org

www.eatbettermovemore.orgwww.eatbettermovemore.org

TOOLSTOOLS

THRIVETHRIVETool for Tool for Health and Health and Resilience Resilience In Vulnerable In Vulnerable EnvironmentsEnvironments

http://preventioninstitute.org/thrive/index.phphttp://preventioninstitute.org/thrive/index.php

ENACTENACTEEnvironmental nvironmental NNutrition & utrition & AActivityctivityCCommunity ommunity TToolool

www.eatbettermovemore.org

221 Oak Street221 Oak StreetOakland, California 94607Oakland, California 94607

phone: 510-444-7738 fax: 510-663-1280phone: 510-444-7738 fax: 510-663-1280

www.preventioninstitute.org