BUILDING BRIDGES Community-University Partnerships for Health - PowerPoint PPT Presentation

BUILDING BRIDGES Community-University Partnerships for Health

OBJECTIVES 1. Provide overview of CARE: Community Alliance for Research and Engagement at Yale, and our flagship initiative, Community Interventions for Health. • Global health initiative with focus on chronic disease 2. Document current health status of New Haven children and adults based on >2400 surveys conducted this fall, including mental and physical health. 3. Invite collaborative research.

CARE Mission To improve the health of New Haven residents through visionary leadership, community engagement, collaborative community-based research, and dissemination of findings. Yale Center for Clinical Investigation Schools of Public Health, Medicine, Nursing

CARE‟S UNIQUE STRENGTHS C OMMUNITY A LLIANCE R ESEARCH E NGAGEMENT

CARE‟S UNIQUE STRENGTHS COMMUNITY

COMMUNITY New Haven • Rich historical and cultural traditions • Vital to economy of south central CT • Ideal population size (130,000 people): – small enough to create close partnerships – Large and diverse enough for robust engagement, research, and action

New Haven: Community Challenges • Wealth disparity – CT is one of the richest states – New Haven is one of poorest US cities • Food insecurity : 163 of 169 towns/cities in CT • Economic insecurity : 78% NHPS eligible for free/reduced price meals • Health disparity – From birth to death, New Haven residents face risk of illness and disability 1.5 to 7 times higher than others in the state

OUR RESPONSE • Unacceptable poor health status in New Haven • We can prevent or reduce many adverse health outcomes • Revitalize our community by promoting health of our citizens

CARE‟S UNIQUE STRENGTHS ALLIANCE

ALLIANCE CREATE/STRENGTHEN PARTNERSHIPS • Take action with many partners to improve health in New Haven • Create programs and policies to prevent disease and promote health . • Evaluate impact

ALLIANCE DIVERSE CITYWIDE COALITION o Residents and grass roots coalitions o City of New Haven officials o New Haven Public Schools o Health centers/health providers o Business community . o Leadership of community-based organizations o Faith-based communities o Organized philanthropy o Senior leadership and faculty across Yale

CARE’S UNIQUE STRENGTHS RESEARCH

RESEARCH COMMUNITY INTERVENTIONS FOR HEALTH • International collaborative to prevent chronic disease • New Haven is first US city to participate http://www.3four50.com/cih/

Knowledge = Power • Identify and document community issues • Learn about experiences, priorities, and concerns of community members • Mobilize community members and leaders • Identify areas for improvement and solutions • Determine whether solutions have worked • Convince funders to provide resources • Persuade policymakers to support needed programs and services

CARE’S UNIQUE STRENGTHS ENGAGEMENT

ENGAGEMENT Build trust, visibility, integrity, leadership 2007 • Future Search Consensus Conference • Diabetes Awareness Day 2008 • Heart Health • Childhood Obesity Summit • Sexual Health: Real Life, Real Talk • 6 Community forums on Public Health & Health Disparities 2009 • Arts and Ideas Festival – CIH LAUNCH • Conference /Workshops on Ethics, Dissemination, &Translation • Community Forum on Health Equity 2010 • Community conversations • Active work with neighborhood groups

CARE‟S UNIQUE STRENGTHS C OMMUNITY A LLIANCE R ESEARCH E NGAGEMENT

Community Interventions for Health Prevent chronic disease

Risk Factors – 3 Four 70 Unhealthy Diet Lack of exercise Tobacco Use Mokdad et al. JAMA . 2004;291:1238-45

Why Chronic Disease? It‟s costly! It‟s preventable! 75% of the nation’s $2.5 trillion health care expenditures

Chronic Disease in the US • Prevalence: 133 million, 50% >1 chronic condition • Mortality: 70% of all deaths • Premature Mortality: 33% yrs life lost before age 65 • Costs : >75% of the nation‟s $2.5 trillion annually (direct + indirect, 2005) – Smoking: $193 billion – Obesity: $117 billion – Heart disease & stroke: $448 billion – Diabetes: $174 billion – Cancer: $89 billion http://www.cdc.gov/NCCdphp/overview

Preventable Hospitalizations, CT 2008 >47,000 preventable hospitalizations accounting for 255,000 patient days and $1.2 billion in charges – These patients utilized more health care resources in hospital and post-discharge – New Haven County - highest per capita rates for 12 of 19 conditions (e.g., asthma, CHF, COPD, diabetes-related, LBW babies) – Reflect gaps in primary care, disease management, access to health services that lead to increased disease severity and hospitalization (CT Office of Health Care Access, 2010)

CT Cost: “Preventable” Hospitalizations Ambulatory Care Sensitive Conditions, linked to Chronic Disease $1,500,000,000 1,160,000,000 893,000,000 $1,000,000,000 611,000,000 $500,000,000 $0 2000 2004 2008 (CT Office of Health Care Access, 2010)

Prevention is Cost-Effective • Clinical smoking cessation interventions cost an estimated $2,587 for each year of life saved, the most cost-effective of all clinical preventative services. • $1 spent on preconception care programs for women with diabetes, can reduce health costs by up to $5.19, by preventing complications for both mothers and babies. http://www.cdc.gov/NCCdphp/overview

Barriers • Time and monetary constraints for engaging in healthy behaviors • Accessibility/availability of healthy options • Lack of knowledge and risk perception • Institutional awareness of evidence- based practices to prevent chronic disease  Community Interventions for Health (CIH) is a solution

CIH: A Solution Action : Intervention Programs Framework for effective intervention strategies to promote healthy lifestyles and healthy communities: programs and policies that address health and social indicators. Evidence : Research Study Large multinational cohort study to identify best practice approaches in chronic disease prevention; comparative analyses .  New Haven is first US city in CIH collaborative.

Long Empirical Tradition CIH: Comprehensive Community Interventions CIH focuses on developing populations using structural interventions at the ground level AND includes a strong evaluation component Region/Country Specific: Case control AGITA(Brazil) Stanford 5(USA) Biomarker Specific: Cohorts: Setting Specific: Minnesota Heart Healthy (USA) Interheart Risk Factor Brazil 1982 Cohort CATCH (school) Pawtucket (US) CARMELA Pelotas Wisewomen (HC) Isfahan(Iran) British Cohort 1970 Sorenson Well- North Karelia (Finland) (BCS70) Work Study (W) German CVD Prevention Study DONALD Study Glasglow Take Finnmark Study (Norway) Germany 1985 Heart(W) Tromsø (Norway) Danish National Birth Finbalt Study Cohort 1996 MRFIT (USA) Framingham USA Bogalusa Heart Study for Children (USA) Surveillance Interventions MONICA Comprehensive Cardiovascular Community Control Program EPIC CINDI CARMEN

CIH: Strategies for Change 1. Strengthen broad collaborative partnerships to improve individual and community health, reduce disparities. 2. Develop and implement targeted program and policy interventions. 3. Evaluate impact of interventions through rigorous assessment over time; ensure effectiveness and sustainability.

Examples of Structural Interventions • Neighborhoods – Safe routes for walking and bicycling – Affordable/accessible fruit carts or farmers markets • Schools/Worksite – Healthy food/drink in cafeteria and vending machines – Advertisement-free schools – Incentives for participation in on-site and off-site physical activity – Before and after school programs: • students, teachers, staff, families • Health care settings – Smoke-free hospitals with healthy food options – Incentives and training for providers to screen for and prevent chronic disease

Importance of CIH • Comprehensive community interventions rare . Most studies target single setting populations with mixed success and challenges regarding sustainable change. • Structural interventions work . Systemic changes are cost-effective and sustainable given focus on policy, environmental and economic change rather than isolated individual behavioral change. • CIH includes an extensive evaluation that include both process and outcome/impact evaluation. • Urgent need to understand evidence based programs/policies to prevent chronic disease, preserve quality of life, strengthen neighborhoods, and reduce costs.