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2019-2024 Napa County

Community Health Improvement Plan A Napa County Public Health publication based on collaboration with Live Healthy Napa County community partners and our local community.

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Our Vision for a Livable Napa County

A livable Napa County will be diverse, inclusive, equitable, and safe for

community members across cultures and generations. It will have

affordable and appropriate housing, multiple transportation options,

and supportive community features and services. Once in place, these

resources will enhance both personal independence and

interdependence, effectively engaging residents in the area’s civic,

economic, and social life.

Livable Communities Framework

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Table of Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Community Health Improvement Plan - Development Process . . . . . . . . . . . . . . . . . . . 6

Population Health Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Priority 1: Respect and Social Inclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Priority 2: Food Insecurity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Priority 3: Housing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Priority 4: Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

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Introduction

Live Healthy Napa County (LHNC) is a unique public-private partnership focused on realizing a shared

vision of a healthier Napa County. LHNC members include representatives from healthcare

organizations, non-profit and social services organizations, education, local government – including

cities and county departments, transportation-focused organizations, local funders, and the community

at large. Napa County Public Health is the backbone organization for LHNC and provides technical and

administrative support, including leading the development of the Community Health Assessment (CHA)

and Community Health Improvement Plan (CHIP).

In addition to Live Healthy Napa County, Napa has several initiatives that are working to address social

determinants of health (SDoH). These groups include the Community Leaders Coalition, the Child Abuse

Prevention Council, the Citizenship Legal Services Initiative, the Healthy Aging Population Initiative

(HAPI), Resilient Napa, and the First 5 Napa Network, among others. There is substantial overlap

between membership in these initiatives and membership in LHNC and this CHIP reflects our shared

commitment to improving health equity in Napa County.

Live Healthy Napa County partners, through the 2018 CHA process facilitated by Napa County Public Health, identified four priority areas. These areas are directly from, or are related to, the Livable Communities framework. The Livable Communities1 framework was adapted from the World Health Organization and American Association of Retired Persons’ Age-Friendly Communities models, which outline eight domains of community life affecting health and well-being. These areas also align with several of the priorities identified by community members during the County of Napa’s Strategic Planning process.

Respect and Social Inclusion

Food Insecurity

Housing

Transportation

The purpose of a CHIP is to outline a long-term, systematic effort to improve the health of a community. In Napa County, we will strive to have CHIP strategies and proposed solutions be community-driven and designed with Napa County Public Health staff as support and LHNC partners providing direction and leadership. While there are multiple goals and objectives within each of the identified priority areas, in order for the process to be community driven, we will focus our efforts on a smaller number of impactful strategies and activities in order to maintain capacity to do the work. Each of the four priority areas within the CHIP has or will have goals, objectives, and strategies. Goals are broad measures that are tied to long-term outcomes and reflect changes in population health or community conditions. Objectives are mid-range outcomes and processes that will help achieve the goals. In addition to reflecting meaningful change within the priority areas, the goals and objectives were selected based on the availability of population level data that can be used to measure change over time. Strategies encompass the different specific activities undertaken by partners and community members; strategies help to achieve the objectives and will have short-term measurable outcomes.

1 Livable Communities framework, showing eight domains that address social determinants of health. Source: http://msaphase.org/theme/age-friendly-cities/ Accessed November 26, 2018.

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Since the completion of the first Napa County CHA and CHIP in 2013/2014, LHNC has increasingly

focused on addressing social determinants of health to decrease health inequities among Napa County

residents. Access to (and quality of) medical care and personal health behaviors, such as alcohol and

tobacco use, play a role in determining the length and quality of our life. However, the social

determinants of health, including economic, social, physical, and environmental factors, are the

strongest predictors of morbidity and mortality. Health inequities are systematic differences in the

opportunities that groups have to achieve optimal health, leading to unfair and avoidable differences in

health outcomes. According to The National Academies of Sciences, Engineering, and Medicine, “Health

inequity is costly for the United States with respect to health care expenditures, security, economic

productivity and business viability2.” For these reasons, strategies in the 2019 CHIP focus on the social

determinants of health in order to achieve a longer-term impact on health outcomes and improve

health equity.

Community Health Improvement Plan - Development Process

The Community Health Improvement Plan was developed over a series of four meetings with

community partners that led to the adopted framework:

Meeting 1: February 2019, prioritization of issues identified in the Community Health Assessment; identification of underrepresented population groups.

Meeting 2: May 2019, measures for CHIP goals and objectives proposed; asset based community development exercise.

Meeting 3: August 2019, Open Space Technology used to identify populations and topic areas for development of strategies within the CHIP.

Meeting 4: November 2019, subcommittee established for final review of CHIP; further development of action items after review of results from learning conversations with community members.

The Livable Communities portion of the Community Health Assessment was launched in May of 2018

and published in early January 2019. Quantitative and qualitative data was collected and reviewed for

each of the eight domains within the Livable Communities framework. Forty community stakeholders

identified Respect and Social Inclusion, Housing, and Transportation as domains needing the most

improvement in Napa County. Food insecurity was also identified as an area for improvement through

the 2018 Emergency Food System Study, which included collection of survey data (n=351) and focus

group data (three groups, n=31) from community residents.

Our first LHNC meeting of 2019, on February 11, kicked off the Community Health Improvement

Planning process. LHNC members were asked to prioritize which of the priority areas from the

Community Health Assessment to focus on first. Prioritization was based on the following questions:

How many people are impacted?

Are some groups of people impacted more than others?

2 http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=24624

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What is the volume of work happening already (e.g. are other groups already focused in a

particular area?)?

Do local organizations have capacity and resource availability to address the health factor?

After identifying Respect and Social Inclusion (RSI) as the most urgent priority, coalition members were

then asked to identify the groups in Napa County experiencing the most challenges related to this issue.

Each group shared out their top three most critical groups, and then coalition members collectively

voted for their top choices. Mixed status immigrant households, people living in poverty, the LGBTQ

community (with a focus on older adults and Spanish speaking community members), and people with

physical and mental health disabilities were identified as groups potentially experiencing the most

challenges related to this priority area. Of note is the group consensus that Respect and Social Inclusion

is also a lens through which the collaborative can analyze the three remaining priority areas from the

Community Health Assessment.

During the May 2019 LHNC meeting participants went over the timeline and objectives of our current

Community Health Improvement Plan process and were presented with proposed RSI measures,

objectives and goals. Attendees then participated in an Asset Based Community Development (ABCD)

workshop. The results from asset mapping activities is described in more depth in the section on

Respect and Social Inclusion. Through the ABCD workshop, Associations were identified as particular

groups of interest. Associations are groups where most members are there in an unpaid status and

participate based on common interests. Many LHNC partners felt that these were groups that we may

not be engaging with or fully understanding their interests.

Following the May LHNC meeting, Public Health staff and LHNC partners conducted more than 20

learning conversations with identified associations to learn more about their interests and thoughts

around RSI. These learning conversations, which engaged over 225 individuals, are not only a strategy

to increase respect and social inclusion, but will be used to help further develop the strategies identified

in this improvement plan and to start to deepen relationships with community members directly

impacted by issues LHNC is working to address.

The August 2019 LHNC convening then focused on sharing the content from completed learning

conversations and identifying RSI activities/outputs and measures for the CHIP. After reviewing the

learning conversation content, partners used Open Space Technology (OST)3 to identify populations or

topics for the purpose of further developing strategies and activities tied to improvement plan goals and

objectives. The outcomes from this process will form the basis of the action plan to help us achieve the

goals and objectives identified in this document.

The final LHNC meeting of 2019 was held on November 12, 2019. During this meeting, a subcommittee

was established to oversee finalization of the CHIP. Participants in each OST group were given notes

from community learning conversations with feedback that was pertinent to their OST group topic in

order to further develop action items. Ron Dwyer-Voss of Pacific Community Solutions then led LHNC

participants through an Asset Based Community Development exercise called the “Resident Power

3 Open Space Technology is a method of organizing a meeting that is participant driven and relies on attendees to determine topics of discussion, as well as how and where to engage in these discussions.

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Ladder”. As we create systems that place residents in positions that control goal setting, planning and

implementation, we empower our community to identify and enact their own solutions.

LHNC members view this CHIP as a living document that will likely change as we work to authentically

engage and share power with the community members most impacted by our identified issues.

Although our partner agencies are skilled at gathering input from community members, those most

impacted by an issue are often missing when it comes to the design and implementation of solutions.

The act of involving more community members in the work of LHNC can itself be a strategy for

increasing respect and social inclusion.

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Population Health Goals:

Goals are broad measures that are tied to long-term outcomes and reflect changes in

population health or community conditions. They primarily represent the downstream impacts

of social determinants of health. Outcomes, such as ischemic heart disease for example, are

complex and multi-factorial. For this reason, this CHIP has one set of long-term goals across the

four upstream priority areas of work.

1. By 2029, decrease premature mortality from ischemic heart disease by 20% (from 548 Years of Life

Lost (YLL) in 2015-2017 to 438 YLL in 2025-2027). Source: Napa County Public Health, Vital Statistics

2. By 2029, decrease premature mortality resulting from substance use disorders by 20% (from 568

Years of Life Lost (YLL) in 2015-2017 to 454 YLL in 2025-2027). Source: Napa County Public Health,

Vital Statistics

3. By 2029, decrease the age-adjusted death rate from suicide from 13/100,000 (2015-2017) to

10/100,000. Source: Napa County Public Health, Vital Statistics

4. By 2029, reduce the percentage of adults who are obese from 29% to 23%. Source: CHIS, 3 year

pooled

5. By 2029, reduce the percentage of students with an unhealthy body composition from 17% to 14%.

Source CDE

6. By 2029, reduce the percentage of adults reporting fair or poor health from 14% to 11%. Source:

County Health Rankings

7. By 2029, increase reading proficiency among 3rd graders from 43% (2017-2018) to 52%. Source:

California Department of Education

8. By 2029, decrease substantiated cases of child abuse and neglect from 9.1/1000 (2016-2018) to

7.3/1,000 (2026-2028). Source: California Child Welfare Indicators Project

9. By 2029, decrease substantiated cases of elder abuse from 38 cases per 10,000 adults 65 and older

(93/24,521) to 30/10,000.4 Source: HHSA, CSOA Division

10. By 2029, increase the proportion of students who are College/Career prepared from

o 43% (2018) to 52% at NVUSD

o 55% to 66% at CJUSD

o 71% to 85% at SHUSD

Source: California Department of Education

4 There were 93 cases of abuse by others substantiated in 2018. American Community Survey (5 yr estimates, 2013-2017) estimates 24,521

adults 65 and older in Napa County

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Priority 1

Social inclusion means that people:

Experience a sense of belonging

Are accepted (for who they are) within their communities

Have valued roles in the community

Are actively participating in the community

Are involved in activities based on their personal preferences

Have social relationships with others whom they chose and share common interests

Have friends

Are civically engaged*

*Civic engagement means working to make a difference in the civic life of our communities and

developing the combination of knowledge, skills, values and motivation to make that difference. It

means promoting the quality of life in a community, through both political and non-political processes.

Having strong social connections benefits both physical and mental health across the life course.5

Research increasingly suggests that quality social relationships protect people against chronic diseases

as they age and may increase longevity. For example, the harmful effects of social isolation among

adults have been estimated to exceed those of obesity6, a well-known risk factor for other chronic

diseases. Social relationships have also been linked to both the development7,8 and progression9 of

cardiovascular disease.

In contrast, societies that are more socially cohesive are typically healthier and have lower mortality

rates than those that are less so.10,11 Experiencing discrimination based on age, race, sexual orientation

or other attributes decreases feelings of safety and increases stress and the risk for poor health

5 http://ccare.stanford.edu/uncategorized/connectedness-health-the-science-of-social-connection-infographic/ 6 J. Holt-Lunstad, T. B. Smith, M. Baker, T. Harris, D. Stephenson. Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic

Review. Perspectives on Psychological Science, 2015; 10 (2): 227 DOI: 10.1177/1745691614568352 7 Knox SS, Adelman A, Ellison RC, Arnett DK, Siegmund K, et al. Hostility, social support, and carotid artery atherosclerosis in the National Heart,

Lung, and Blood Institute Family Heart Study. Am J Cardiol. 2000;86:1086–1089. https://www.ncbi.nlm.nih.gov/pubmed/11074204 8 Kop WJ, Berman DS, Gransar H, Wong ND, Miranda-Peats R, et al. Social network and coronary artery calcification in asymptomatic

individuals. Psychosom Med. 2005;67:343–352 https://www.ncbi.nlm.nih.gov/pubmed/15911895 9 Brummett BH, Barefoot JC, Siegler IC, Clapp-Channing NE, Lytle BL, et al. Characteristics of socially isolated patients with coronary artery

disease who are at elevated risk for mortality. Psychosom Med. 2001;63:267–272. https://www.ncbi.nlm.nih.gov/pubmed/11292274 10 Umberson, D., & Karas Montez, J. (2010). Social relationships and health: A flashpoint for health policy. Journal of Health and Social Behavior, 51(1_suppl), S54-S66 11 Yang, Y. C., Boen, C., Gerken, K., Li, T., Schorpp, K., & Harris, K. M. (2016). Social relationships and physiological determinants of longevity across the human life span. Proceedings of the National Academy of Sciences, 113(3), 578-583.

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outcomes among affected groups.12,13 The toxic stress of racism, along with differences in access to

resources and opportunities that result from racism, has resulted in people of color experiencing poorer

health outcomes across a wide range of conditions.14 Negative age stereotypes also predict adverse

outcomes among older adults, including possible effects on cognition.15 These differences in health,

which are unjust and avoidable, are known as health inequities.

In addition to being identified as a priority in the Community Health Assessment, themes related to

respect and social inclusion were also identified by community members in the Napa County Strategic

Planning process. Through a variety of public input sessions, Napa County residents collectively

expressed that they have the following vision for the future of Napa County: Napa County is inclusive of

its diverse, growing populations and provides opportunities to build community and for everyone to feel

safe. The table below identifies specific issues related to respect and social inclusion that were raised in

strategic plan input meetings.

The graphic on the following page gives examples of physical, social and emotional impacts of having

high levels of social connection and belonging vs. lower levels.

12 Ranji U, Beamesderfer A, Kates J, Salganicoff A. (2014). Health and access to care and coverage for lesbian, gay, bisexual, and transgender

individuals in the U.S. Menlo Park, CA: Kaiser Family Foundation. 13 Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., Gupta, A., Kelaher, M., & Gee, G. (2015) Racism as a Determinant of Health:

A Systematic Review and Meta-Analysis. PLoS One, 10(9): e0138511. 14 https://www.rwjf.org/en/library/collections/racism-and-health.html 15 https://www.ncbi.nlm.nih.gov/pubmed/26641877

Area of Opportunity identified by LHNC Major Issues Identified in County Strategic Plan

Respect & Social Inclusion

Need to improve senior services (mentions isolation)

Children and teens lack out-of-school and afterschool activities (mentions isolation)

Lack of safe spaces to build community and be active for all ages

Lack of events and activities to build community in Napa County

Community members wish to see more equitable treatment and inclusivity

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Respect and Social Inclusion Objectives and Strategies:

The objectives in this section are mid-range outcomes and processes that will assist with measuring

progress toward increasing respect and social inclusion in Napa County, with the overall goal of

impacting the population health outcomes listed on page 9. In addition to reflecting meaningful change

within the priority areas, the objectives were selected based on the availability of population level data

that can be used to measure change over time. Strategies encompass the different specific activities

undertaken by partners and community members and will have short-term measurable outcomes.

Objectives:

By 2024, increase the rate of social associations from 7.5/100,000 to 8.3/100,000 (10%

increase). Source: County Health Rankings

By 2024, increase the percentage of older adults who report seeing friends and family either

daily or weekly from 77% to 85%. Source: HAPI survey

By 2024, increase the percent of LGBTQ students who report feeling safe at school from 55%

(2017) to 61%. (10% increase) Source: California Healthy Kids Survey

Strategies16:

Increase community engagement and inclusion through activities that are jointly designed with

and led by community members.

LHNC partners voted to prioritize outreach to four groups in the community – 1) mixed status

immigrant households, 2) people living in poverty, 3) LGBTQ community (with a focus on older

adults and Spanish speaking community members), and 4) people with physical and mental

health disabilities. Specific topics or projects that LHNC partners are already planning for or

engaged with include:

o Learning conversations

o Civic engagement training

o Census 2020 outreach

o Voter registration and participation

o Youth career pipeline project

o Promoting LGBTQ inclusion

Partner with HAPI and the Commission on Aging to hold an Ageism summit in order to raise

awareness about the impact of ageism and develop strategies to counter ageism in our

community.

16 Strategies may shift or evolve as community members become more engaged with this work.

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Partner with Resilient Napa, the Child Abuse Prevention Council, and First 5 Napa County to

continue to expand awareness and resources related to Adverse Childhood/Community Events

(ACEs) and Resilience.

Partner with Napa Opioid Safety Coalition, Advisory Board on Alcohol and Drug Programs, and

Tobacco Free Napa to raise awareness and reduce stigma around substance use disorders.

Partner with Parks and Recreation Departments to make access to classes economically viable

for those who want to participate and to increase access to parks and open spaces.

Work with organizations to complete a policy scan to determine if organizational

polices/practices create barriers for certain groups of people.

Partner with Suicide Prevention Coalition, Rainbow Action Network and others to reduce stigma

and provide supports that decrease risk of suicide.

Pursue “Livable Community” designation through AARP.

Strategies to address RSI are based on community engagement activities including asset based

community development workshops and a community town hall. The two asset maps and the graphic

recording on the following pages show community member input on Respect and Social Inclusion. Asset

mapping is a process for identifying and connecting resources to achieve goals based on what we

already have and/or have access to. Participants looked at community assets (Individuals, Associations,

Institutions, Physical, Exchange, Culture)17, and how they can be connected and aligned for increasing

RSI. A second ABCD workshop was also held with Spanish-speaking residents in the city of Napa in

November 2019; the Individuals category was not included in this workshop due to smaller group size

and time limitations. On November 21, 2019, the Up Valley Family Center, the Calistoga Community

Schools Initiative, and Public Health collaborated to hold a bilingual community conversation around the

theme of respect and social inclusion. Ninety-four people attended the meeting and a graphic recorder

captured the outcomes of the evening. Evident in the outcomes of the meeting is the overlap between

Respect and Social Inclusion and the other priority areas within this improvement plan.

17 https://resources.depaul.edu/abcd-institute/resources/Documents/WhatisAssetBasedCommunityDevelopment.pdf

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Priority 2

Being food insecure means being without reliable access to affordable, nutritious foods, with or without

reduced food intake. Access and ability to utilize healthy, nutritious food is a social determinant of

health, with food insecurity being linked to type 2 diabetes, cardiovascular disease and a host of other

health conditions. Food insecurity is paradoxically linked to obesity, which is a risk factor for many

chronic diseases.18 The connection between obesity and food insecurity occurs because processed foods

and foods high in sugar and fat are often more affordable and more readily available than healthier

alternatives. Food insecurity also makes it difficult to control chronic conditions that require nutritional

management, such as diabetes. The graphic on the following page describes factors that contribute to

food (in)security and the health, social, and emotional benefits of food security.

Approximately one in 10 people in Napa County struggles with hunger; among children, the prevalence

of food insecurity is even higher and affects one in five children. Ending food insecurity in Napa County

will require significant community engagement and sustained commitment by a diverse array of

stakeholder groups working in partnership to achieve collective impact. Strategies to address food

insecurity are based on recommendations from the 2018 Napa County Emergency Food System Study.

18 Pan, L., Sherry, B., Njai, R., and Blanck, H.M. Food Insecurity Is Associated with Obesity among US Adults in 12 States. J Acad Nutr Diet. 2012

Sep; 112(9): 1403–1409. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4584410/

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Food Insecurity Objectives and Strategies:

The objectives below are the mid-range outcomes and processes that will help to measure progress in addressing food insecurity and improving long-term health outcomes included in the population health goals outlined on page 9. In addition to reflecting meaningful change within the priority areas, the objectives were selected based on the availability of population level data that can be used to measure change over time. Strategies encompass the different specific activities undertaken by partners and community members and will have short-term measurable outcomes.

Objectives:

By 2024, reduce the food insecure population from 11% to 8%. Source: SNAP

By 2024, reduce the food insecurity rate among children from 19% to 15%. Source: SNAP

By 2024, increase the percentage of adults who always have access to fresh fruits and

vegetables from 84% to 88%. Source: Let’s Get Healthy CA indicator

By 2024, increase the percent of children (age 2-11) consuming 5+ serving of fruits and

vegetables in last day from 34% to 37%. Source: CHIS 2011-2016

Strategies:

Develop easily accessible, multi-lingual, multi-media regular communication about available

emergency food assistance programs and services, eligibility criteria and location-date-time

information.

Develop a human-centered story-telling campaign designed to decrease the stigma of food

insecurity and serve as a platform for potential donors to experience empathy for fellow

residents who are experiencing food insecurity.

Expand food access locations and minimize transportation barriers by leveraging existing place-

based service locations and operations to include food distribution within the scope of services

offered.

Large economic anchor institutions in the community (such as healthcare, education and

government institutions) should include supporting access to healthy food for all residents as an

essential part of future policy and planning activities.

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Priority 3

Where we live matters for our health. Housing affordability, neighborhood conditions, and conditions

within the home impact the ability of individuals and families to make healthy choices. Excessive

housing costs are associated with a spectrum of health issues including food insecurity, psychological

stress, under-utilization of health care, and developmental and behavioral problems in children. As

households spend a larger proportion of their income on housing, they have less money to spend on

nutrition, health care, and other essential needs19.

When housing is not affordable, households may double up with other families or otherwise live in

overcrowded conditions. Residential overcrowding can negatively affect physical health and induce

elevated stress levels, depression and behavioral problems in children. The associated stress and the

quality of housing (e.g. presence of mold, lead paint, etc.) often associated with overcrowding have

been linked with certain chronic diseases, including asthma and cardiovascular diseases. While adults

may suffer from these negative effects, the impact of overcrowding on children and adolescents can be

extensive and long lasting20. Finally, lack of affordable housing is a major contributor to California’s

homelessness crisis. People experiencing homelessness are at increased risk of adverse health

outcomes, including premature death; homeless individuals have more emergency department visits

and inpatient admissions as those who are not homeless.

19 Maqbool, N., Ault, M., & Viveiros, J. (2015). The impacts of affordable housing on health: A research summary. Center for Housing Policy

20 Krieger, J., & Higgins, D. L. (2002). Housing and health: time again for public health action. American journal of public health, 92(5), 758-768

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Housing Objectives and Strategies:

Objectives are mid-range outcomes and processes that will help achieve the goals. In addition to reflecting meaningful change within the priority areas, the objectives were selected based on the availability of population level data that can be used to measure change over time. Strategies encompass the different specific activities undertaken by partners and community members and will have short-term measurable outcomes.

Objectives:

By 2024, reduce the homelessness rate from 22.8/10,000 to 20.5/10,000. (10% decrease)

Source: National Alliance to End Homelessness (uses PIT count data)

By 2024, decrease overcrowding by 10% or more in the most impacted Census tracts (7 Census

Tracts in the County have overcrowding occurring in 10% or more of the households). Source:

American Community Survey.

By 2024, reduce the percent of renters who are housing cost burdened from 50% to 45%.

Source: American Community Survey.

Strategies:

Provide education on the connection between health outcomes and the built environment.

Promote a Health in All Policies approach when local jurisdictions are revising their general

plans.

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Priority 4

Public transportation that is timely, convenient, and affordable gives residents who either cannot or

choose not to drive personal vehicles opportunities to access employment, healthcare and other

resources in the community. Safe and convenient active transportation (e.g., walking, biking, etc.) allows

people to naturally build physical activity into their daily routines and is recommended by The Centers

for Disease Control and Prevention as one strategy to improve health and prevent disease. Moreover,

when people increasingly choose transportation options other than personal vehicles, heavy vehicle

traffic in a region can decrease, reducing the likelihood of injuries from motor vehicle crashes, air

pollution, and commuter stress.21 The more time a person spends commuting (particularly while

sedentary), the more likely they are to experience or report adverse physical and mental health

outcomes. In addition, daily work commutes are responsible for the majority of daily traffic in a region.22

21 Maizlish, N. (2016). Increasing walking, cycling, and transit: Improving Californians’ health, saving costs, and reducing greenhouse gases.

Office of Health Equity, CA Department of Public Health. Retrieved from https://www.cdph.ca.gov/Programs/OHE/CDPH Document

Library/Maizlish-2016-Increasing-Walking-Cycling-Transit-Technical-Report-rev8-17-ADA.pdf. 22 Crabtree, S. (2010). Well-being lower among workers with long commutes. Retrieved October 31, 2018,

from https://news.gallup.com/poll/142142/wellbeing-lower-among-workers-long-commutes.aspx

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Transportation Objectives and Strategies:

The objectives are mid-range outcomes and processes that will help achieve long term population health goals. In addition to reflecting meaningful change within the priority areas, the objectives were selected based on the availability of population level data that can be used to measure change over time. The objectives here focus specifically on measures related to alternate transportation and improvements in physical activity levels. Strategies encompass the different specific activities undertaken by partners and community members and will have short-term measurable outcomes.

Objectives:

By 2024, increase the percent of Napa County residents who regularly walk for transportation,

fun or exercise from 39% to 43%.

By 2024, reduce the percentage of people driving alone to work from 79% to 71%.

By 2024, increase the percentage of 5th, 7th and 9th grade students meeting fitness standards for

aerobic capacity from 65% (2017) to 72%. Source: California Department of Education.

Strategies:

Provide education on the connection between health outcomes and the built environment.

Promote a Health in All Policies approach when local jurisdictions are revising their general

plans.

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Appendix

Community Partners

Abode Services

Area Agency on Aging

Catholic Charities of Santa Rosa

City of American Canyon

City of Calistoga

City of Napa

City of St. Helena

Coalition for a Tobacco Free Napa

Collabria Care

Commission on Aging

Community Action Napa Valley

Community Health Initiative (CHI)

Community Leaders Coalition (CLC)

Community Organizations Active in Disaster (COAD)

Cope Family Center

Disability Services and Legal Center

First 5 Napa County

Girls on the Run Napa-Solano

Healthy Aging Population Initiative (HAPI)

Individual Community Members from the Napa

County Community

Innovations Community Center

Innovative Health Solutions

Kaiser Permanente-Napa/Solano

Legacy Youth Project

LGBTQ Connection

Local Food Advisory Council

Mentis

Napa County HHSA - Administration

Napa County HHSA - Alcohol and Drug Services

Napa County HHSA - Comprehensive Services for

Older Adults

Napa County HHSA - Mental Health

Napa County HHSA - Public Health

Napa County HHSA - Self Sufficiency

Napa County Housing and Homeless Services

Napa County Library

Napa County Regional Park and Open Space District

Napa Farmer’s Market

Napa Valley Community Foundation

Napa Valley Community Housing

Napa County Mental Health Board

Napa Valley Transportation Agency

Napa Valley Unified School District

Napa Senior Center

NEWS

On the Move (OTM)

Ole Health

Opioid Safety Coalition

ParentsCAN

Partnership Health Plan of California

Puertas Abiertas Community Resource Center

Rainbow Action Network

Rianda House-Upper Valley Senior Activity Center

Resilient Napa

St. Helena Hospital

St. Joseph Health Queen of the Valley

St. Joseph Health Queen of the Valley-Community

Outreach

Suicide Prevention Council

Suscol Intertribal Council

Teens Connect

Up Valley Family Center