Draft September 23, 2012

Recommendations 6

• R1
  Adopt Three Strategic Initiatives:  Empower the community to improve health through programs, policies, and activities  Enhance community health and safety by emphasizing prevention  Ensure access to culturally and linguistically appropriate, customer friendly services
• R2
  Promote and practice “Health in All Policies” with traditional and non-traditional community partners
• R3
  Take a Regional Approach:  Create four regional, cross-Bureau Community Action Teams (CATs)  Form conduits for regular communication  Engage community service providers in implementation
• R4
  Realign Programs and Resources:  Eliminate duplicative work  Formalize inter-Bureau information sharing  Prioritize and fast-track top regional priorities  Adopt cross-cutting evaluation measures
• R5
  Document and evaluate systems changes; reassess
• R6
  Continue involving residents and collaborating with community-based organizations, cities, schools, agencies, nontraditional groups, and faith based 4 sectors Today in Monterey County Monterey County, located on California’s central coast, features beaches and seaside cliffs, estuaries, the Salinas Valley, the Gabilan Hills, and the Santa Lucia Mountain Range. The county’s 3,322 square miles are bounded by Santa Cruz County to the north, San Benito, Fresno, and Kings Counties to the east, San Luis Obispo County to the south, and the Pacific Ocean to the west. Monterey County’s 12 incorporated cities comprise approximately 75% of the population and 15% of the total land area. Five cities are located in the Salinas Valley and seven on the Monterey Bay Peninsula, with small towns and housing areas located in unincorporated areas. More than 20 higher education and research institutions are located within the Monterey Bay area, with an annual enrollment of 65,000 students. Military and language schools, marine and oceanographic sciences, and other disciplines offer unique programs that bring students, visitors, and other professionals into the region. 5 “We are a walking town, so many Selected Monterey County Assets, 2010 Quantity people can get walking exercise; Area (square miles) 3,322 Can we create walking groups?” Coastline (linear miles) 90 North County Resident State parks (acres) 16,000 County parks (acres) 12,500 “Mental health services are Agricultural/grazing land (acres) 1.25 million lacking, especially for teens & Incorporated cities (number) 12 parents, retired people and those Unincorporated areas (number) 16 who need substance abuse K-12 school districts (number) 24 programs; Parents and families Adult schools (number) 8 need more education for anger Colleges and universities (number) 6 management and depression.” City and county library branches (number) 23 Coastal Region Resident Hospitals (number) 4 “Mucha gente no hacen chequeo County-run health clinics (number) 8 de salud porque no tienen dinero o County-run behavioral health clinics (number) 8 aseguranza.” Sources: Monterey County Convention and Visitors Bureau. U.S. Census Bureau. County of Monterey Health Department. Residente de la Región de Salinas The population of Monterey County grew to 433,238 residents in 2010, according to forecasts estimated by the California Department “If you don’t speak English need of Finance. Hispanic/Latino residents were estimated to represent to bring a family member to the largest percentage (57%) of Monterey County’s population. Nearly translate” 44% of the population was under age 18; slightly more than 16% were South County Resident over age 65. The 2005-2009 American Community Survey estimated that 14% of all Monterey County households were in linguistic isolation, that is, no member of the household over the age of 14 spoke English “very well.” Of those households that speak Spanish, 34% were estimated to be in linguistic isolation (n=15,370). Race/Ethnicity Number Monterey County Population by Race/Ethnicity, 2010 Hispanic 246,849 White non 135,006 White non- -Hispanic Hispanic, 57% Hispanic, 31% Asian/Pacific 28,612 Islander African Amer- 10,955 ican Other/Multi- 11,861 Race Asian/Pacific TOTAL 433,328 Islander, 7% Source: California Department of Finance African American, 3% Other/Multi, Note: percentages do not total to 100% due to rounding. 3% 6 Source: California Department of Finance Families accounted for 71% of Monterey Monterey County Population Estimates by Jurisdiction, 2000-2008 County households in 2009, and the average family size was 3.62 people per family. More Numeric Percent Jurisdiction 2000 2008 than 3,000 households were composed of Change Change grandparents who had responsibility for Carmel 4,081 4,037 -44 -1.1 raising their own grandchildren under age 18. Del Rey Oaks 1,650 1,632 -18 -1.1 Gonzales 7,564 9,025 1,461 19.3 The population of Salinas increased by 9,912 Greenfield 12,648 17,547 4,899 38.7 residents from 2000 to 2008, accounting for King City 11,204 12,024 820 7.3 nearly one-third of the county’s population Marina 18,925 19,265 340 1.8 growth. The greatest percentage of Monterey 29,696 29,244 -452 -1.5 population growth from 2000 to 2008 Pacific Grove 15,522 15,536 14 0.1 occurred in South County, representing a Salinas 142,685 152,597 9,912 6.9 total increase of 11,395 residents (note that Sand City 261 312 51 19.5 Soledad’s population includes the Salinas Seaside 33,097 34,240 1,143 3.5 Valley State Prison population). Soledad* 23,015 28,050 5,035 21.9 In 2009, just over 80% of households were Unincorporated 101,414 108,383 6,969 6.9 estimated to have lived in the same residence County Total 401,762 431,892 30,130 7.5 in the prior year. Seventy percent (70%) of *Includes Salinas Valley State Prison population. the county population was born in the U. S., Note: The State Department of Finance estimates the county population and the jurisdictional population in different a different manner which can cause a discrepancy between the two estimates. and 30% were foreign born. Nearly 80% of The Jurisdictional Population Estimate was based on estimates of occupied housing units, household size, household population, and group quarters population. Census 2000 data provide the baseline for foreign born residents were from central these estimates, and revisions are made according to data provided to the State from local jurisdictions, military, and group quarter facilities. Data may be affected by the timeliness of reporting (predominantly Mexico) and south America. agencies. Source: State of California, Department of Finance, E-1 Population Estimates for Cities, Counties and the State with Annual Percent Change, 2000 and 2008. By 2025, Monterey County’s Hispanic residents will grow to 61% of the entire “Obesity occurs all around. It population. White, non-Hispanic residents is not an individual problem, will decrease to 27%, while percentages for it is a problem in families. We Asian/Pacific Islander and African American need that to offer more educa- populations will remain about the same. tion to the whole family to change habits.” Monterey County Projected Population by Race/Ethnicity, 1995-2025 Salinas Resident 100 “People don’t feel safe; there is 75 poor lighting, poor or no side- t walks; bushes are overgrown n e c 50 causing fire hazard; gangs. r e P Dangerous for kids to walk to school, especially with no 25 crossing guards, and most parents working so can’t walk 0 with kids.” 1995 2000 2005 2010 2015 2020 2025 South County Resident Hispanic White Non-Hispanic Asian African American 7 Source: State of California, Department of Finance, Race/Ethnic Population with Age and Sex Detail, 2000–2050. Sacramento, CA, July 2007. 13% of Monterey County residents (n=51,400) lived below the Federal Poverty income threshold of $10,830 per person annually in 2009. While the Federal Poverty income threshold for a family of four was $22,050 annually, the average Monterey County family “Every additional $12,500 income that year was $84,815. in a San Francisco Bay area Of Monterey County’s 51,400 residents living in poverty, 40% (20,200) household income buys one were children under age 18; 73% (37,672) were Hispanic. For those living in poverty who were age 25 or older, 53% had not graduated additional year of life from high school. Of those age 16 and older, 71% had worked full expectancy.” time, part time, or seasonally in the prior year. Tony Iton, MD, JD, MPH For decades, researchers have known that poverty and health status The California Endowment are directly correlated; the lower a person's socioeconomic status, the greater are his or her chances of having some sort of health disorder. In 2010, slightly more than 71% of Monterey County infants (n=4,759) were born into poverty. 54% of these births (n=2548) occurred at Natividad Medical Center. Educational attainment is an important Educational Attainment for Monterey County Residents Ages 25 and older, 2005-2009 factor in individual and community health. Lower educational attainment, when associated AA/AS, with lower income levels, is more likely to result BA/BS, in an individual or family having little or no MA/MS, Ph.D. health insurance. Low educational attainment Some College, has been associated with higher levels of risky No Degree health behaviors such as smoking, being H.S. Diploma overweight, or having a low level of physical or Equal activity. Studies have also shown that mental Less than illness and emotional disturbance are H.S. Diploma contributing factors toward a significant percentage of dropouts. 0 25 50 75 100 In 2008-2009, more than 1 in 5 Monterey County Percent 9th to 12th graders dropped out of school. By Source: U. S. Census Bureau American Community Survey 2005-2009. race/ethnic grouping, 22% of Hispanic students Monterey County Dropouts by Race/Ethnicity, had dropped out, compared to 20% of African 2005-2009 American students, 13% White non-Hispanic African students, and 9% of Asian students. American Approximately one-third of Monterey County adults over age 25 in 2006-2008 had not yet Asian earned a high school diploma or equivalency. By race/ethnic grouping, the disparity is quite White non- Hispanic striking: 56% of Hispanic residents age 25 and older did not have a high school diploma in 2005- Hispanic 2009 compared to 7% of White non-Hispanic residents who did. 0 25 50 75 100 Percent Source: U. S. Census Bureau American Community Survey 2005-2009. Monterey County Residents with Less than a High School Diploma, 2005-2009 100 75 t n 50 e c r e P 25 0 Males Females Hispanic White Asian African American 9 Note: Includes residents age 25 or older. Source: State of California, Department of Finance, Race/Ethnic Population with Age and Sex Detail, 2000–2050. Sacramento, CA, July 2007. Health inequalities are health conditions that occur differently Health inequities are differences in health status when comparing various segments of the population, which can be attributed to social factors such as socioeconomic status, race or and mortality rates across ethnicity, cultural barriers, educational attainment, gender/sexual population groups that are orientation, disability, or geographic location. systemic, avoidable, unfair, and unjust. A study of Monterey County health disparities found these inequities when comparing predominant race/ethnic groups: Margaret Whitehead World Health Organization Hispanic  Highest teen birth rate  Highest late entry to prenatal care  Highest motor vehicle-related death rate African American  Highest homicide death rate  Highest infant death rate  Highest low weight births White non-Hispanic  Highest Chlamydia and gonorrhea rates  Highest cancer death rate (all cancers)  Highest AIDS case rate  Highest lung cancer death rate  Highest heart disease death rate  Highest suicide death rate  Highest diabetes death rate Asian/Pacific Islander  Increasing stroke death rates  Longest acute care hospital stays  Highest fetal death rate  Increasing suicide death rates Monterey County’s Five Leading Causes of Death by Race/Ethnic Groups, 2005-2008 (Measured as age-adjusted rate per 100,000 people based on U.S. 2000 Standard Population) Total for All Race/ White, Asian/ # Hispanic African American Ethnic Groups Non-Hispanic Pacific Islander Heart Disease Heart Disease Heart Disease Heart Disease Cancer 1 154 125 168 120 267 Cancer Cancer Cancer Cancer Heart Disease 2 135 89 156 104 249 Stroke Stroke CLRD Stroke Stroke 3 37 31 38 39 80 CLRD Diabetes Mellitus Stroke Diabetes Mellitus Diabetes Mellitus 4 31 28 36 21 61 Unintentional Influenza/ Unintentional Influenza/ CLRD 5 Injury Pneumonia Injury Pneumonia 39 29 25 36 17 CLRD=Chronic Lower Respiratory Disease, which includes chronic bronchitis, emphysema, and asthma. Note: Predominant Monterey County race/ethnic groups are shown; Total includes other and unspecified race/ethnicities. Source: California Department of Public Health, Health Information and Research Section, Death Statistical Master Files, 2005-2008. Regional Health Disparities Years of Potential Life Lost (YPLL) is an important measure of premature death. YPLL is calculated by subtracting the age at which death occurs from the average life expectancy (often age 75 is used). The total years of potential life lost due to various Four Regions of Disparate Health causes of premature death as a percentage of total YPLL are presented in the regional graphs below. North County Region Coastal Region YPLL differences between four Monterey County South County Region regions appear to correlate with the unique socio- Greater Salinas Region demographic differences found in each region. These analyses provide good reason to use a regional approach to plan and deliver public health education and services. Top Causes of Premature Death as a Percent of Years of Potential Life Lost (prior to age 75) Monterey County Region, 2006-2008 Coastal Region North County Region Cancer Unintentional Injury Unintentional Injury Perinatal Conditions Heart Disease Cancer Suicide Homicide 0 25 50 75 100 0 25 50 75 100 Percent Percent Greater Salinas Region South County Region Unintentional Injury Unintentional Injury Cancer Cancer Heart Disease Liver Disease Homicide Homicide 0 25 50 75 100 0 25 50 75 100 Percent Percent 11 Source: Source: California Department of Public Health, Health Information and Research Section, Death Statistical Master Files, 2006-2008 and US Census Bureau. An example of YPLL disparities in Monterey County can be seen when comparing socio-economic data for the cities of Monterey and Greenfield. The chart below indicates that life expectancy is 3 years longer in the City of Monterey compared to the City of Greenfield. In Greenfield, residents experience 1,353 more years of potential life lost, representing a 29% increase over the number of years of potential life lost in Monterey. Differences Between Variables A. City of Monterey B. City of Greenfield the Two Cities Median age 39 years 26 years 13 years Under age 5 5% 11% 6% Over age 64 15% 5% 10% High School diploma or 93% 49% 44% more Households in poverty 6% 18% 12% Life expectancy 83 years 80 years 3 years Years of life lost (less 4,547 years of life lost 5,900 years of life lost 1,353 years of than age 75, age adjusted) per 100,000 people per 100,000 people potential life lost Source: California Department of Public Health, Health Information and Research Section, Death Statistical Master Files, 2005-2008 and US Census Bureau. Research has repeatedly correlated lower educational attainment and shorter life expectancy. The graph below illustrates this direct “Castroville has no WIC center— correlation in Monterey County: residents with lower education levels we have to go to Salinas.” suffer from the greatest rate of years of potential life lost. North County Resident “Teen pregnancy and access to Premature Death by Educational Attainment, Monterey County, 2008 birth control are important issues” 8000 Coastal Region Resident ) d te “Aunque hay falta de servicios, st o L s u 6000 estamos abriendo puertas. e j d fa Promotores pueden desarollar iL e lg confianza con la gente.” aa it n ,5 4000 Residente de la Región de Salinas e7 t o e Pg fa “There is agricultural run-off into o n sa 2000 the town of Chualar, and children rh at e s play in those puddles.” Ys e l( South County Resident 0 <60% 60% - 79% 80% - 92% 93%+ Percent of Population With 12th Grade Education or Greater 12 Source: California Department of Public Health, Health Information and Research Section, Death Statistical Master Files, 2005-2008, US Census Bureau, and ESRI. Regional Strengths, Concerns, & Solutions Regional Community Meetings were held for 6 months throughout Monterey County to present residents with the strategic planning process, current community health assessment data, and the evident health disparities found among the four Monterey County regions. Residents of each region were asked to name their most urgent health Community input was concerns and talk about the improvements they would like to see. In all, from November 2010 to April 2011, more than 500 people used to develop this attended meetings in 21 locations and/or responded to an online 2011-2015 Strategic survey. Plan, which is a living document that will be discussed and refined over the years to reflect our community conversations. 1133 North County Region Community Input Results Top Concerns: Perinatal mortality Access to health care Limited recreation programs Limited health services Strengths: Local Programs… Castroville Com. Center, Migrant parent program Basic healthcare… Local clinic, Natividad Medical Center Healthy food… free lunch at Castroville Community Center Challenges: Availability of healthcare services… need more appointment times Access to healthcare… distance to hospital, no local pharmacy Cost of healthcare… not qualified for Healthy Families Healthy food… need better school lunches Solutions: Affordable Healthcare… low cost clinics for pregnant women Outdoor Activities… more bike paths & parks Health Education… after school programs North County Region Coastal Region Examples of Comments from Community South County Region Greater Salinas Region Meeting Participants: Castroville Senior Center provides food (breakfast  and lunch) and has activities. We are a walking town, so many people can get  walking exercise; Can we create walking groups? We need more after school activities like sports,  cooking, art, dancing, drill teams, field days. We also need a farmers market and cooking healthy classes.  There is no pharmacy in Castroville; We need a local pharmacy.  Dental services (for care and prevention) are inadequate.  Lighting and sidewalk conditions are poor in Castroville; I don’t feel safe walking at night.  There are not enough fields, parks, bike trails, and other locations that are free and accessible for sports and  recreation. What are causes of premature death due to perinatal conditions?  I think we need more prevention services because it's too late when they get sick.  Many people here don’t qualify for Healthy Families insurance and other programs but they still need services.  Castroville has no WIC center—we have to go to Salinas.  Our library, community center, and Migrant Parent Program are our strengths.  14 Coastal Region Community Input Results Top Concerns: Healthcare access Childhood asthma Mental health Childhood obesity Teen births School bullying Strengths: Local Programs… YMCA, Grief Busters, Sticks & Stones, school nurses Outdoor Activities… Sports Center, bike trails, parks Challenges: Cost of healthcare… insurance programs for middle-income folks Community safety… unsafe parks, dangerous roads, school zones Physical Activity… funds for child/teen programs, affordable gyms Solutions: Safety programs… Neighborhood Watch, after school programs Empowerment programs… health & nutrition workshops for parents Healthcare access… elder assistance, school counseling, bus vouchers, incentives for maintaining good health North County Region Coastal Region Examples of Comments from Community South County Region Meeting Participants: Greater Salinas Region Our neighborhoods are pretty safe; people in Monterey  know their neighbors; We have good police presence and the schools and parks are safe. We need more parks and recreation activities in Seaside;  The parks we have are not safe and there’s graffiti everywhere. Seniors need more access to health care and all types of living  assistance. Libraries, churches, and lots of youth programs are our strengths.  Fewer doctors accept Medi-Cal and Medi-Care, employers are offering  less insurance coverage, and many people don’t qualify for health services. Mental health services are lacking, especially for teens & parents, retired people and those who need substance abuse  programs; Parents and families need more education for anger management and depression. More nutrition, and exercise, and healthy living programs are needed in schools and for the public—especially for non  -English speaking residents. More health education and safety programs are needed in the schools, especially about depression, alcohol & drug use,  smoking, and safe driving. Teen pregnancy and access to birth control are important issues.  15 Free or affordable after school activities of all types are needed for children & youth to keep them safe and healthy.  South County Region Community Input Results Top Concerns: Teen births Obesity Diabetes Injuries Healthcare access Drug & alcohol use Strengths: Basic healthcare… clinics, hospitals Outdoor Activities… Little League, parks, swimming pools Safety Programs… crossing guards, gang task force, fire department Challenges: Availability of healthcare services… more options are needed Cost of healthcare… lack of insurance & eligibility Community safety… poor lighting, dangerous streets Solutions: Empowerment programs… youth serving programs and activities Safety Programs… activities that prevent and address violence Healthcare access… payment plans, free clinics, bus vouchers Examples of Comments from Community North County Region Coastal Region Meeting Participants: South County Region Greater Salinas Region Our strengths include schools, youth serving  organizations, local clinics and hospital. Neighbors here watch out for each other.  There are no services for our youth who are struggling with  emotional issues such as depression and drugs. The community has grown in numbers, but resources have not  grown to match the need. Getting to health care is a challenge – it takes a long time on the bus and  walking is dangerous. We need more health care options in South County.  Getting medications refilled is challenging. It takes a few weeks to get refills.  Need translation services in clinics or for doctors.  Not feeling safe outside because of gang members, don't go outside to play  There is agricultural run-off into the town of Chualar; children play in those puddles.  Families lack knowledge to help make healthy choices.  Joining gangs, dropping out of school, and pregnancy are youth options. Concerned about increased teen birth rate.  Need educational support for better jobs and more after-school options for youth. Greater Salinas Region Community Input Results Top Concerns: Mental health Diabetes Dental care Violence Obesity Teen births Access to health care Strengths: Basic healthcare… clinics, hospitals Local Programs… social supports, high school clubs Outdoor Activities… soccer fields, parks Challenges: Cost of healthcare… medical, dental, vision Limited health knowledge… more chronic disease education Violence and risk behaviors… gangs, shootings, alcohol, drugs Solutions: Universal coverage, affordable prescriptions, free health screenings Safety… crossing guards, sobriety checks, Neighborhood Watch Health education… after school programs, gang prevention North County Region Examples of Comments from Community Coastal Region South County Region Meeting Participants: Greater Salinas Region We have many strengths, including hospitals, clinics,  prevention programs, Healthy Families, parks, gyms, schools, no tolerance at schools for gangs, and 2-1-1. There is great need for mental health services, especially for  those without Medi-Cal or other insurance and services in the schools for children. The children are eligible for these services but they aren’t offered. The parents have to insist, but many do not know, or do not want to cause problems. There are long wait times for a doctor’s appointment – this causes poorer  health because you can't get an appointment and then the condition gets worse. Promotores can develop trust with the people. Developing a low income clinic with only $20 per visit (no matter  what the visit for) would help because when Promotores send a person to a clinic and they end up being charged a lot for the visit, the person loses heart and that leads to less trust of the Promotores. As parents we need provide the education of prevention. The schools need to share the information to the parents  not only to the children /girls. Education for the parents is basic – the schools need to teach to parents to share the information. 17 2011-2015 Strategic Initiatives Monterey County Health Department’s 2011-2015 Strategic Initiatives developed by planning committee reflect overarching community objectives that span the regionally specific needs and solutions identified in the six-month community input process. It is important to note that other recent community assessments had identified similar overarching concerns and objectives — these are:  Public Health Regional Teams data, 2010 • MoRe Health studies  MCHD annual Health Profiles, 2005-2009 • Public input at community meetings  MCHD Maternal, Child, & Adolescent Health Assessment, 2011 • Federal health care reforms  Women and Girls’ Quality of Life Report, 2011 • Castroville LULAC study, 2009  Building Healthy Communities planning documents, 2010 Initiative 1: Empower the community to improve health through programs, policies, and activities. In 5 years, Monterey County Health Department will increase opportunities for community participation in public health dialogues. • Objective 1: Promote a health focus in public policy and planning. • Objective 2: Develop and support a network of volunteers and peers that advocate for and support community health-oriented solutions. 18 2011-2015 Strategic Initiatives (continued) Initiative 2: Enhance community health and safety through prevention. In 5 years, Monterey County Health Department will strengthen the community’s ability to respond to health and safety issues. • Objective 1: Increase opportunities for community-led primary prevention safety efforts through family and youth engagement. • Objective 2: Support social networks working to address and respond to public health and safety risks. • Objective 3: Engage community organizations, businesses and other governmental agencies in assessing and preventing violence & reducing injuries in the community. Initiative 3: Ensure access to culturally and linguistically appropriate, customer-friendly, quality health services. In 5 years, Monterey County Health Department will ensure access to health care through culturally and linguistically appropriate customer service and by aligning public health, primary care, behavioral health, and community resources with health care reforms. • Objective 1: Maximize prevention and wellness opportunities as funded by health care reform. • Objective 2: Support integrated primary care, including clinical preventive services. • Objective 3: Incorporate bridges linking clinical and community-based prevention activities. • Objective 4: Ensure access to appropriate health care resources, especially specialty care and ancillary (such as diagnostic and therapeutic) services, regardless of a person’s ability to pay. Moving Forward: A Regional Team Approach Justification for a Regional Team Approach From very early in the Strategic Planning Committee’s process, the group worked to identify the best approach for compiling data regarding the health indicators of the County. Committee members insisted on ensuring that the data presented to the community was relevant and helpful in engaging Monterey County residents in meaningful conversations about health assets, challenges and their community’s specific needs. Because of distinct differences found between four North County Region Coastal Region county regions (north, coastal, Salinas, and south), South County Region the Strategic Planning Committee members agreed Greater Salinas Region upon a regional approach to addressing health conditions and disparities. The regional approach is documented* as being relevant and promising in reducing health inequities. This approach examines how thinking, communication and culture interact, and offers assistance in understanding those interactions. In regionalizing socioeconomic and health data in conjunction with our community engagement process, residents were able to associate the data with their concerns, regional strengths, challenges, and appropriate solutions. Distribution of Monterey County Residents Distribution of Monterey County Residents with Less than High School Diploma Living in Poverty 20 *Wallack, Lawrence (2008). You can get there from here; Social Equity and Opportunity Forum, Portland University. Next Steps: Promoting Health in All Policies Health in All Policies (HiAP) is a collaborative approach that has been used internationally to create greater access to health, diminish disparities, and focus on preventive aspects of public health. HiAP recognizes that health and prevention are impacted by policies that are managed by both non-health government and non-government entities, and that many strategies for improving health also help to meet the policy objectives of other agencies. The biggest opportunities we have to address remaining large disease/illness burdens are often in the policy realm. Policies have Yielded Many of our Biggest Improvements in Public Health Problems Policies Outcomes Significantly less Lung High Lung Cancer Smoking Bans Disease & Death Prevalence & Mortality Tobacco Tax Significantly less 2nd Hand Smoke Seat belt Laws Motor Vehicle-Related Significantly Fewer Helmet Laws Injuries & Deaths Injuries & Deaths Car Seat Laws Measles, Mumps, Immunization Rubella, Influenza, Significantly Less Requirements Diphtheria Prevalence & Disease Prevalence No/Low Cost IZs Deaths With Collaboration and Cooperation, Health in All Policies Can Get Us From To Here Here Problems Policies Outcomes Access to Health Care Improved Access Obesity Decreased Obesity Heart Disease Health in Decreased heart Disease Stroke Decreased Stroke All Policies Poor Birth Outcomes Improved Birth Outcomes Violence Increased Safety Premature Death Decreased YPLL 21 Samples of Health in All Policies Goals from Other Communities Sample: California  All residents have the option to safely walk, bicycle, or take public transit to school, work, and essential destinations.  All residents live in safe, healthy, affordable housing.  All residents have access to places to be active, including parks, green space, and healthy tree canopy.  All residents are able to live and be active in their communities without fear of violence or crime.  All residents have access to healthy, affordable foods at school, at work, and in their neighborhoods.  Decision makers are informed about the health consequences of various policy options during the policy development process. Sample: East Palo Alto  Improved access to safe public transportation  Expanded neighborhood resources, including access to fresh produce  Increased opportunities for physical activity and active transportation  Decreased pedestrian and bicyclist injuries  Increased access to safe, high quality public spaces  Increased social networks Sample: Pacifica  Using the Health System to access data on local health issues  Educating the community about how general plan policies impact long-term health outcomes  Engaging the community, especially vulnerable populations, to develop a common vision that health policies will support  Drafting internally consistent health policies or an entire health element  Providing sample language of promising practices 22 “Castroville Senior Center provides food (breakfast and lunch) and they have activities.” “We also need a farmers market and cooking healthy classes.” North County Residents “We need more parent education, especially for how to change bad nutrition habits.” “High schools don't open their track to the public.” Coastal Region Residents What Can MCHD do to Promote Health in All Policies? “We need to put more vegetables & fruits in schools and make them  Support and promote Health in All Policies county- cheaper than junk food.” wide. “Estuviera bién en las ferias de  Draft internally consistent health policies or an salud de incluir mas juegos y entire health element for the county (see activides de nuestra cultura, esto le llamara el interes a toda la