Health 360°: Obesity Agency Stakeholder Meeting August 23, 2017 Oklahoma Department of Mental Health and Substance Abuse Services Hope Room 1 &2 1
Terry Cline, PhD Secretary of Health and Human Services WE WELCOME OME AND ND INT NTROD ODUCTION UCTION 2
Julie Cox-Kain Deputy Secretary of Health and Human Services SE SESS SSION ON 1: 1: RE REVIE VIEW W OF OF HE HEALTH TH 36 360° 3
Meeting Agenda • Welcome and Introduction • Review of Health 360° • Presentation of Compendium, Scoring Process, and Expert Panel Recommendations • Discussion of Statewide Considerations • Time/Resource Allocation Activity • Small Group Discussion: Recommendations for Improvement • Small Group Report-Out • Agency Packets and Next Steps 4
Meeting Objectives • Review the Health 360° project efforts • Review the Health 360° compendium and evidence base • Review statewide inventories for obesity • Identify high level recommendations • Facilitate discussion around addressing recommendations 5
What is Health 360°? • Governor’s health improvement initiative • Requires a multi-agency collaborative approach Wealth Health • Works toward common set of health outcomes Justice • Uses Health in All Policies Approach (HiAP) 6
Health in All Policies • Health in All Policies is a collaborative approach to improving the health of all people by incorporating health considerations into decision making across sectors and policy areas • Recognizes health is created by a multitude of factors beyond healthcare and beyond the scope of traditional public health activities 7
Sectors (Factors) that Impact Health • Transportation • Food and Agriculture • Housing • Economic Development • Education • Workplaces • City Planning & Development • Water • Tourism & Recreation • Nutrition and Health 8
Top Global Social Burden Generated by Humans 9
Phases of Work Phase se 1 Phase se 2 Phase se 3 Phase se 4 Phase se 5 • Establish • Create • Compare • Recommend • Action Plan Priority Health Program and Inventory to Improvements through HiAP Topics Policy Evidence or Existing Inventory Base Process 10 10
Oklahoma Health 360 Healthy Citizens and Strong Families Julie Cox-Kain Deputy Secretary of Health and Human Services Healthy Life Years of Potential Life expectancy Expectancy Life Loss Process for Evaluation of Health Priority Areas Refer to Health 1) MEASURE: Burden, Investment, Performance In All Policies/ 2) SYNTHESIZE: Evidence-based Practice Access 3) ASSESS: Inventory State Assets HIA Team: 4) ANALYZE: Review Program Fidelity HHS Team Education Correction Transportation Public Safety 1) MEASURE: Burden, Investment, Performance OMES 2) SYNTHESIZE: Evidence-based Practice Workforce Wellness Recommendations HEALTH 3) ASSESS: Inventory State Assets 4) ANALYZE: Review Program Fidelity PRIORITY Refer to OHIP AREA(S) and/or Other What is the best TBD Workgroup investment to 1) MEASURE: Burden, Investment, Performance 2) SYNTHESIZE: Evidence-based Practice Prevention improve health? 3) ASSESS: Inventory State Assets Refer to 4) ANALYZE: Review Program Fidelity Quality Improvement 1) MEASURE: Burden, Investment, Performance Social Agency 2) SYNTHESIZE: Evidence-based Practice 3) ASSESS: Inventory State Assets Stability Collaboration 4) ANALYZE: Review Program Fidelity or New Action
John Friedl Manager of Physical Activity and Nutrition SESSION N 2: : COMPE PEND NDIUM, IUM, SCORING ING TOOL, OL, AND D EXPERT RT PANEL L RECOMMEND OMMENDATIO TIONS NS 12 12
Evaluation Process for Obesity Efforts Compendium of Evidence Evaluation of Oklahoma Efforts -Identify obesity-related programs and policies Subject Matter Expert Input -Inventory obesity-related -Evaluate existing efforts in Oklahoma state evidence base and best -Receive input on agencies practices statewide efforts from -Assess based on obesity subject matter compendium findings experts -Evaluate on fidelity and -Develop internal evaluation recommendations to measures improve obesity outcomes based on evidence base and existing efforts 13 13
Evaluation Process for Obesity Efforts Compendium of Evidence Evaluation of Oklahoma Efforts -Identify entify obesity sity-rel relat ated ed prog ogram rams s and poli licies cies Subject Matter Expert Input -Inventory obesity-related -Eval aluat uate e existi ting ng efforts in Oklahoma state evidence ence base e and best st -Receive input on agencies prac acti tices ces statewide efforts from -Assess based on obesity subject matter compendium findings experts -Evaluate on fidelity and -Develop internal evaluation recommendations to measures improve obesity outcomes based on evidence base and existing efforts 14 14
Compendium of Evidence-Based Obesity Efforts • Review of existing literature on obesity- related programs and policies • Identified programs and policies were evaluated using a scoring matrix – Adapted from the Missouri Foundation for Health • Each compendium item was categorized and received an overall score based on several scoring categories 15 15
Descriptive Compendium Categories • Bu Buck cket – topic area assignment – Access, Wellness, Prevention, or Social Stability • Age – Infant – Child – Adolescent – Adult – Older Adult – Combination of age groups 16 16
Descriptive Compendium Categories • Social Ecological Level – Where is the impact? 17 17
Compendium Scoring • Recommendation Score Based on the body of evidence, how highly recommended is this program/policy? Is there consensus on the recommendation? • Evidence Score Based on type and quality of the study, replication of the study with consistent results, and additional support from other types of studies 18 18
Compendium Scoring • Disparity Score Based on how the program/intervention is likely to increase, decrease, or provide no change in disparities related to obesity • Reach Score Percentage of the population that is being served by the program/intervention 19 19
Evaluation Process for Obesity Efforts Compendium of Evidence Evaluation of Oklahoma Efforts -Identify obesity-related programs and policies Subject Matter Expert Input -Invent entory y obesi esity-re relat lated ed -Evaluate existing effor orts ts in Oklah lahom oma a stat ate e evidence base and best -Receive input on agencies encies practices statewide efforts from -Asse ssess ss based sed on obesity subject matter compe pend ndium um find ndings gs experts -Eval aluat uate e on fidel elity ty and -Develop internal rnal eva valu luati ation n recommendations to measur asures es improve obesity outcomes based on evidence base and existing efforts 20 20
Statewide Inventory Scoring • Each state agency provided an inventory of all of their programmatic and policy initiatives related to obesity • Each initiative/program was assessed for alignment with the evidence-based programs and best practices for addressing obesity identified in the compendium • Inventories were scored based on their alignment to each category in the compendium 21 21
Inventory Scoring Categories • Fidelity Score Based on the degree of exactness with which a program/policy/intervention is copied or reproduced, and how closely the design aligns with the evidence base. • Internal Evaluation Score Based on how and with what frequency an agency examines the worth, merit, or significance of the inventory item. 22 22
Inventory Scoring Categories • Project Effectiveness Measures Score Based on the direction of effect on public health outcomes, evidence source, and context. Ineffective interventions or programs are those that consistently show null or adverse effects; show evidence of effectiveness but lack plausibility across one or more of the following criteria: reach, feasibility, sustainability, benefits, and costs. 23 23
Findings from State Agency Inventory Evaluation 24 24
A majority of the inventories align with evidence based obesity programs. Evidence Based Not Evidence Based Percent of 87% 13% Inventories The largest portion of the budget is spent on the evidence based obesity programs. Evidence Based Not Evidence Based Budget $75.8 $1.2 Invested (millions) 25 25
Public policy level A majority of the inventories programs use the largest are focused on the portion of the budget. individual level. 44% $8.9 Individual Individual 0% $0.0 Interpersonal Interpersonal 26% $25.1 Organizational Organizational 29% $1.0 Community Community $42.1 2% Public Policy Public Policy 26 26 26 26
The average scores of the inventories by area are displayed below. Level of Recommendation Composite 2.8 (Range:1-4) Scores Strength of Evidence 4.7 Average (Range:1-6) statewide Disparities 2.0 inventory score (Range:1-3) 68% Reach 1.6 (Range:1-3) Fidelity 2.2 Range of (Range:1-3) statewide Project Effectiveness Measures scores 1.6 (Range:1-3) 25%-92% Internal Evaluation 1.2 (Range:1-3) 27 27 27 27
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