Friday, November 20, 2015

Assessing the Health of Our Community

A Community Health Assessment and Improvement Plan (CHA/CHIP) is a community-based assessment of health status and the factors affecting health, accompanied by a specific plan created by the community to improve health.

The Mid-Michigan District Health Department serves Clinton, Gratiot and Montcalm counties. The first CHA/CHIPs were created in these counties in 2012. Now, all three counties have teams working to assess these CHA/CHIPs and revise them based on the past three years of experience. The process in Gratiot County is called Live Well Gratiot. In Montcalm it is Healthy Montcalm. Clinton County is collaborating with Eaton and Ingham counties on a tri-county plan called Healthy! Capital Counties. Colorful logos developed to brand these projects are at the top of this post.

It is challenging working on three plans at once. Why not just do one plan for the entire district? The reason is that the three counties are distinctive, with strong community identities, different service providers to collaborate with, and even different health problems to a surprising extent. Another reason is related to our unique take on what a CHA/CHIP should be. Let’s face it, we live in a time of data overload and to some extent, planning overload. For example, many of the organizations we partner with are required by their funders to pull together collaborations to write community assessments and strategic plans. So, we don’t want to try to substitute our plan for theirs, nor do we want to appear to be trying to get them to do our work. Instead, we want the CHA/CHIPs to call out those most important activities that our partners are already doing to promote health, and describe how we can support them. Our plan should braid together all the good work that is being done and show how together we can have maximum impact on health.

The data we have been looking at for the three counties tell some compelling stories.  The first is that chronic disease remains by far the most important health challenge including heart disease, stroke, diabetes and related problems. In Gratiot and Montcalm, especially, we have not improved lifestyles much if at all. We are still eating poor diets, not getting much exercise and continuing to have high rates of smoking. This is clearly evident in high chronic disease mortality rates. (Clinton County, parts of which include affluent suburbs of Lansing, is somewhat better off and is one of the healthiest counties in Michigan, if not actually very healthy.)

You may be aware that the national media have recently been reporting that among low income Americans mortality rates have started to rise again after years of steady decline. This is a striking trend and is unknown in the rest of the world. Chronic disease contributes to this, but also driving this trend are mental health problems including substance abuse and suicide.  In our data we saw how poverty drives poor mental health which in turn leads to myriad health problems.

There were many bright spots in the data. For one thing, youth substance abuse including tobacco and alcohol continues to go down and marijuana has not started increasing as many had feared with the change in attitudes toward marijuana. Connecting Point has been highlighting the downward trend in teen pregnancy rates for some time, and that continues. Our three counties have very low homicide and assault rates as well. Finally, the three counties have very low infant mortality rates. This is a precious asset which we must nurture and try to understand better. We have high rates of family poverty, as mentioned, and many of the problems that come along with that. But our children are nonetheless getting a surprisingly healthy start in life.

It seems the work before us is to build on the healthy start our youth are getting and turn that into a healthy adulthood. To do this we need to do much more than simply hector people to eat less and move more. We need to attack the rural poverty that leaves so many without the means to live healthier.