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HomeMy WebLinkAboutPacket Health Board Jun 11 2019Whatcom County Council as the Health Board COUNTY COURTHOUSE 311 Grand Avenue, Ste #105 Bellingham, WA 98225-4038 (360) 778-5010 Meeting Agenda Tuesday, June 11, 2019 9AM Garden Level Conference Room JOINT HEALTH BOARD / PUBLIC HEALTH ADVISORY BOARD MEETING COUNCILMEMBERS Barbara Brenner Rud Browne Barry Buchanan Tyler Byrd Todd Donovan Carol Frazey Satpal Sidhu CLERK OF THE COUNCIL Dana Brown -Davis, C.M.C. Council as the Health Board Meeting Agenda June 11, 2019 Call To Order Roll Call Opening Year in Review 2019 Health Po1Gcy Agenda Priorities - What Does the Data Tell Us Panel - Stories From the Community Policy - What It Is, Why it Matters, and How We Can do More AB2019-341 Presentation regarding policy - what it is, why it matters, and how we can do more Policy Road Map for the Year Ahead Closing Comments Public Comment Photo Adiournment Whatcom County Page 2 Printed on 112912024 Whatcom County Agenda Bill Report File Number: AB2019-341 COUNTY COURTHOUSE 311 Grand Avenue, Ste #105 Bellingham, WA 98225-4038 (360)778-5010 File ID: AB2019-341 Version: 1 Status: Presented File Created: 06/04/2019 Entered by: TAxlund@co.whatcom.wa.us Department: Health Department File Type: Presentation Assigned to: Council as the Health Board Final Action: 06/11/2019 Agenda Date: 06/11/2019 Enactment #: Primary Contact Email: taxlund@co.whatcom.wa.us TITLE FOR AGENDA ITEM: Presentation regarding policy - what it is, why it matters, and how we can do more SUMMARY STATEMENT OR LEGAL NOTICE LANGUAGE: None HISTORY OF LEGISLATIVE FILE Date: Acting Body: Action: Sent To: Attachments: Presentation on Policy Whatcom County Page 1 Printed on 1/29/2024 Health Policy Leadership why it matters and h.r.,:tw we can dct m..= re June 11, 2019 Whatcom County )ll HEALTH Department fUIL Whatcom County HEALTH Department Programmatic interventions help people beat the odds; systemic interventions change their odds. - Karen Pittman fflL Whatcom County HEALTH Department I MCREA16ING ff1 0 RTC -N E E D ED-- ID Source: The Health Impact Pyramid by Thomas R. Frieden. Obtained from https:Hreport.digitaldivides.nz/a-pyramid-of-impact Key definitions Policy refers to decisions, plans, and actions undertaken to achieve specific health goals within a society (World Health Organization (WHO)) Health Policy: national, state, or local regulation or financial appropriation that creates a structure, environment, system, incentive, or penalty related to health. Typically, the goal of health policy is to make healthy choices easier. fUIL Whatcom County HEALTH Department Source: https://www.who.int/topics/health_policy/en/ Windows cl -Pppr.,4rtunity Public Policy Interventions Regulate • Incentivize Subsidize • Contract out Tax & Spend • Privatize Charge fees • Educate Conduct Research Problem Possible Solutions Political Will fulL Whatcom County HEALTH Department "POLICY without POLITICS is like architecture without engineering" Legislation Source: Adapted from presentation by Dr. David M. Mirvis. Available at http://www. urbanch ildi nstitute. org/sites/a II/files/2006-09-Health_Po I icy_Foru m-M i rvis. pdf Lce ngest's P-c-4 Icy Cycle Framewc rk Pte#Breoces of indiwidusl, cPfywtzMjMns. inl$rRst groups, *Iong w+th b*ologlcar, cuRural. derrK3jVaah;. eco"W.M. econowAg. 4$hWM. WKPI], PqYChQkPUjCaI..qfId mchnologPaw inputs PSI ky IFOFF"OP I ]" P hose Winds rwr of Oppontinily Agenda " Prcuefns % P4�rmibf13 ZWtfl++ S F P-DIgticaF C lFaumstarrres n?VR�Op rtexw Pofluy Inn-ple mentation -Ph4i" ym&" Vr g --3b. ore-r- ion Potkcy IIModification-- Fe dback fulL Whatcom County HEALTH Department Source: Longest's Policy Framework Redrawn from Longest, B. [2010]. Health policymaking in the United States [5th ed.]. Chicago: Health Administration. Retrieved from presentation by Dr. Dipti Sorte. Available at https://www.slideshare.net/diptisorte/policy-politics-and-nursing iscussic.,4 n What are examples where we've made healthy choices easier as a county? (think broadly) Locally, what kinds nf public policy interventirns are we open/classed to pursuing? Hew can we improve the way we advance policy through fnrmulatinn, implementation, and mndificatinn? i4o"11 Whatcom County HEALTH Department Resources Centers for Disease Control & Prevention (CDC) Policy Process Visit https?//www.cdc.gov/pnlicy/analysts/process/ Georgia Health Policy Center ViSit.https?.//_ghpc.gsu.edu/tnnis-framewnrks/ ilof�IL Whatcom County HEALTH Department WHATC(>M CPUNTY C(>UNCIL AS THE HEALTH BPARD JQINT MEETING WITH THE PUBLIC HEALTH ADVISQRY BPARD Tuesday, June 11, 2019 19 a.m. —12:00 p.m. Garden Level Conference Room, 322 N Commercial St. R,ales: Facilitator: Holly O'Neil A G E N D Aresenters: Regina, Barry, Chi-Na, and Rachel • Ensure that we have a solid, foundational understanding of policy Meeting . Expand our understanding of how policy can work, and how we could do more Putcr4zmesc • Continue to build alignment between the Public Health Advisory Board (PHAB) and the Health Board in advancing our 2019 Health Priorities. 9:00 - 9:30 Opening - Welcome, Intended Outcomes for Today, Introductions Barry, Regina, Holly 9:30 - 9:45 Year in Review — What have we accomplished, and what did we learn? Chi-na 2019 Health Policy Agenda Priorities -What does the data tell us? 9:45 —10:00 ➢ Child and Family Health ➢ Housing and Homelessness Regina 10:00 —10:30 Panel — Stories from the Community Holly 10:30 —10:45 Break Holly Policy — what it is, why it matters, and how we can do more o Overview of policy tools, and the importance of this work 10.45 —11.15 o Reflect on policies we have adopted in the last few years, and the Rachel impact these have had o Brainstorm opportunities for the years ahead Policy Road Map for the year ahead 11:15 —11:35 o Child and Family resolution action plan January 2020 o Health for Immigrant Families Resolution Holly o Community Health Improvement Plan Priorities: Child Care, Housing for Families, Youth Mental Health 11:35 -11:50 Closing Comments Holly 11.50 -12.00 Public Comment Barry 12:00 (Noon) Photo All Whatcom County ���HEALTH Department Ift What fz m Wfzrking Tr,.. o w a r d X-A _W�Lbe�n9L Select 'ndicatcrscf child, family and community well-being In Whatcc m Cr4unty ............................................................................................................................................................................................................................................................................... -Octr ber 4, 2017 Prepared for Generations Forward Conference Whatcom HEALTHD1. County }t D e p a r t rn ego nit Meetingof Health Board and PHAB 061119 Page 1 9 I n t rco d u c t I c-4 n "The well-being eaf cur children is a barometer far the future. In one short generation, they will be the parents, wearkers, valunteers, leaders, and change -makers determining the social and eccncmiic vitality ctf Washi;ngtan State. If we want a better future for all cf us, we need better results for kids neaw." tate cf Washingtc-n's Kids 20161 In this report key child, family, and community indicators have been assembled to provide a backdrop to the Generations Forward conference. These indicators are a subset of a larger assessment to be released later in 2017 and are a companion to qualitative data being sent under separate cover. This report is a work in progress and will benefit from feedback from initial readers and reviewers. The purpose of this summary report is to: Increase understanding of the current experiences of young children and their families in Whatcom County Assess gaps in services and supports including utilization of existing services Provide a foundation for community action, cross -sector collaboration, and system change focused on young children and families Over the last decade there has been a growing awareness of the importance of early childhood. In Whatcom County, community leaders have prioritized a focus on young children and families as part of the Whatcom County Community Health Improvement Plan process, recognizing that investing in our youngest children from the start is the most effective approach to improving health, reducing disparities, and advancing health equity.2 Organizations, community leaders and individuals in Whatcom County have heard the call to action to invest in young children and have responded. Indeed, the call is urgent. Each year over 2,000 babies are born in Whatcom County. All of these babies demand our keen attention. The environments in which these babies are born and the care that they receive in their first few years will lay the foundation for their lifetimes. Every child is a product of their own ecosystem. Children live within families and families live within communities. The conditions within these families and communities are the most significant determinants of child well-being, especially in the early years. A child's early experiences have the power to create a trajectory toward health and well-being throughout the lifespan or, conversely, to set-up profound challenges that need to be overcome. Ensuring the health and well-being of the next generation is up to all of us. Healthy People 2020 defines health equity as the "attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities."3 Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 Joint Meeting of Health Board and PHAB 061 119 Page 2 Page 2 The Life Course Perspective The Life Course Perspective helps explain health and disease across populations and overtime. Instead of focusing on differences in health patterns one condition at a time, the Life Course Perspective emphasizes the importance of health equity as a means to improve health for all and points to broad social, economic and environmental factors as underlying causes of persistent inequalities in overall health. Key concepts include: o Timeline: Today's experiences and exposures influence tomorrow's health, and the health of the next generation. o Timing: Health trajectories are particularly affected during critical or sensitive periods. Critical periods include prenatal/in-utero, early childhood, and adolescence/young adulthood. o Environment: The broader community environment strongly affects the capacity to be healthy. o Lifelong development/lifelong intervention: Throughout life and at all stages, risk factors (such as homelessness, living in poverty, domestic violence and racial discrimination) can be reduced and protective factors (such as a safe neighborhood, a nurturing family, economic security and high quality early learning) can be enhanced to improve current and future health and well-being.4 A growing body of research about brain science demonstrates the importance of the earliest years. Extraordinary development occurs prenatally to age five, which forms the foundation of lifelong health, cognitive ability and emotional well-being. When children receive nurturing supports and appropriate stimulation during this time, they are far more likely to have a lifetime of good health and productivity.5 Toxic stress occurs when there is a strong, frequent and/or prolonged activation of the body's stress response system without adequate protective relationships and other mediating factors. Prolonged and frequent activation of the stress response can change the development of the brain and body systems. Toxic stress in utero and early in life can have far-reaching effects on physical, cognitive, social and emotional development.6 The effects of toxic stress can be seen in a wide range of poorer outcomes for individuals and populations. The landmark Adverse Childhood Experiences study demonstrates the correlation between adverse experiences (child abuse/neglect as well as household dysfunction) early in life and poor health in adulthood.? Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 Joint Meeting of Health Board and PHAB 061 119 Page 3 Page 3 Strengthening Families Framewt^rk Nurturing relationships between caregivers and children, and households that support basic needs are essential for healthy development. Child maltreatment and household dysfunction can lead to a toxic stress response in children, which interferes with healthy development. The Strengthening Families Framework outlines five Protective Factors that support healthy development: 1. parental resilience 2. social connections 3. concrete support in times of need 4. knowledge of parenting and child development 5. social and emotional competence of children Research shows that these protective factors build family strengths and create a family environment that promotes optimal child and youth development, and reduces the likelihood of child abuse and neglect.$ W rking T2ward Well-being., A Framework 0 Ccmmunity Approaches tc Tc,xic Stress The Working Toward Well-being Framework is a companion of the Strengthening Families Framework and outlines a comprehensive community approach to toxic stress embedded within a broader context of working toward healthy development. The Working Toward Well-being Framework articulates how multiple efforts can and should fit together to decrease the likelihood that children will experience toxic stress and increase the likelihood of appropriate supports when they do. The framework is intended to help community groups, organizations and individuals to see their part in moving from a fragmented approach to a comprehensive and coordinated effort.9 According to this framework, in order for children to have healthy development and so that children and families thrive: Parents and Caregivers • Develop strategies to prevent and respond to stressors • Learn, develop and share strategies to respond to impact of stress • Develop leadership skills to partner with providers and policy makers Providers Community Partners and Policy Makers • Build awareness of impact of toxic • Engage diverse sectors to support stress families • Develop and implement strategies • Support programmatic changes to prevent toxic stress • Effectively screen for needed services • Build capacity to respond to intensive needs • Ensure adequate services and supports are available to families • Promote policies that mitigate stress • Reduce or eliminate root causes of toxic stress in communities Maps are used in this report to visualize certain health indicators by geography within Whatcom County. The rankings help to compare health and social factors that may contribute to disparities in a community. The rankings should not be interpreted as absolute values and should not be used to diagnose a community health issue or to label a community. Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 Joint Meeting of Health Board and PHAB 061 119 Page 4 Page 4 Demographics Demographics are not only the counting of people, they are also the measure of change and of consistency within a community and how these dynamics impact people. Demographic information can help a community anticipate new needs based on the changing size and make-up of the population. Demographic data provide valuable insights about a community's future infrastructure needs and helps guide resource allocation. 4W Key Indicatcrp Birth Characteristics and Family Structure Why this matters. Data about annual births, family structure and socio-economic status provide a snapshot of emerging families in a community. In Whatcom County, the number of annual births in recent years has remained fairly steady (2200-2300) despite growth in the overall population. As of 2015, just over 50% of all births in Whatcom County were paid for by Medicaid. Pregnant women whose household income is at or below 200% of the Federal Poverty Level qualify for Medicaid. This is an income level at which most families struggle to meet their basic needs. Births to single mothers have risen only slightly over the last ten years from 26.5% of all births in 2006 to 30% of all births in 2015. Although a relatively small change, this is one part of a growing trend of increasing diversity in family structure. The number of single mother households is significant because the income inequality between dual -income and single -income families has grown dramatically and accounts for as much as 40% of the growth in income inequality nationally.10 Figure It The number 0 Whatcom Cc,unty births to single mc,thers and tc I,cwer-Incr,me women has increasru ai►giiLiy over time. Total count of births, single mother births, and births to women on Medicaid 2500 2000 1500 1000 500 0 2006 2007 2142 2245 2300 2231 2222 2205 1 1 1 M N 0 67�I�I'�I�I�ZE1 Total Births in Whatcom County 1151 F. 1101 1076 1125 2010 2011 2012 Number of Births to Single Mothers 2265 71 1140 2330 2013 2014 2015 — Number of Medicaid Births Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 Joint Meeting of Health Board and PHAB 061 119 Page 5 Page 5 Figure 2c Mist hnusehcids with children under f in Whatcom County are married-cauple family hcusehcIds. Percentage of all households with children under 6 by household type, 2011-2015 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% ■ Married -couple family household Single, male householder ■ Single, female householder ' Key Indicatcrt Racial and Ethnic Diversity Why this matters. Currently, we see through local, state and national data that non -whites are more likely to have poor health and education outcomes compared to their white peers.11.12.13 In Whatcom County there are approximately 11,000 children under age 5. Young children are more racially and ethnically diverse than the population of Whatcom County as a whole. Increasing diversity demands that our communities and schools respond in new and different ways. In order for the community to continue to prosper and thrive, opportunities leading to good health and educational success need to be equally available to everyone in our community. 100% Figure & The pepulaticn under age 5 in Whatcn_m Cc,unty is mere diverse than the total pcpuIatic n. Race%thnicity of population under 5 and total population as a percentage of total, 2016 White Only -NH ftpulatian under 5 66.3% 7.7% 18.1% ■ Black Only -NH AIIIIIIIIIIIIIIII American Indian/Alaskan Trtal pcpulaticn 80.3% 0% 10% 20% 30% 40% 50% Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 Native Only -NH 3.4%d 8.8% Asian Only -NH Pacific Islander Only -NH ■ Multi -Race -NH 60% 70% 80% 90% 100% Hispanic as Race Joint Meeting of Health Board and PHAB 061119 Page 6 Page 6 Child Well-being The life course perspective clarifies that today's experiences influence tomorrow's health and that of the next generation. To assess child well-being on a community level requires assessment of measures at each of the critical life stages of development. Included in this section are measures from pregnancy, infancy, early childhood and adolescence. ........................................................................................................................................................................................................................................ Life Course Stages Prenatal and Rcstpartum Having a healthy pregnancy is one of the best ways to promote a healthy birth and a healthy child. Disparities seen in prenatal and postpartum health can set up some children to be less healthy than others. This can perpetuate disparities among low-income and racial or ethnic minority populations. IWKey Indicatcrt Early Prenatal Care IM Why this matters. Prenatal care provided early in a woman's pregnancy and consistently thereafter plays an important role in keeping women and infants healthy. For lower -income women who may lack ongoing preventive health care before pregnancy, timely prenatal care and regular visits are particularly important. Women with late or no prenatal care are more likely to have a poor birth outcome such as prematurity or low birth weight.14 Figure 4e The gap between It^_wer inc.r_me wr_men and all w,r_men receiving early prenatal care is decreasing but remains. Percent of women who received care during the first three months of pregnancy 100% Healthy People 2020 Target: 78% 80% ------------------------------------ 60% 40% S Whatcom Women Who Received Prenatal Care in 1st Trimester 20% Washington Women Who Received Prenatal Care in 1st Trimester Lower Income Whatcom Women who Received Prenatal Care in 1st Trimester 0% T1 tiP,Db tiP '31 1P0$ 10p9 S,0 ti�11 ti�1� tid1b tiP1� tiPNb Figure- Early prenatal care by census tract 'ercent of women giving birth who received prenatal care in the first trimester of pregnancy, 2015 7) ❑ 73.3 - 79.2% ❑ 70.6-73.1% ❑ 60.3 - 70.2% ❑ data not reliable Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 Joint Meeting of Health Board and PHAB 061119 Page 7 Page 7 Life Course Staget Birth tc Infancy A healthy start includes a child's early months when a child's brain is rapidly developing. Access to good nutrition and safe, stable nurturing relationships and environments right from the start set children up for lifelong health and well-being. ........................................................................................................................................................................................................................................................................... NEER Key Indicatprc Lcw Birth Weight Why this matters. The birth weight of a child is one of the earliest indications of well-being. This indicator can also highlight the existence of health disparities in a community. Babies born at low birth weight (less than 2,500 grams or five and a half pounds) are at greater risk of dying in the first year of life as well as at increased risk of experiencing health and learning difficulties as they age.15 Figure 6c Whatcom Caunty's low birth weight rate has been consistently lowe, than the Washington State average. Rate of babies born with low birth weight per 1,000 births 100 80 60 40 20 1 — Whatcom County WA State National - ■ ■ 10 Year Trend (Whatcom) 'b�� ��O�ry�O0 0 �O�Dti�0� O ti�11 ti�1ryti�1� ti�1� ti�1h ............................................................................................................................................................................................................................................................................... Life Course Stagec Early Child hczczd The brain is one of the only organs not fully developed at birth. Most of the cells are there, but the connections that form the architecture are not. These connections form very rapidly in early childhood as every experience a baby has forms a neural connection in the brain.16 From the time a baby is born until they enter kindergarten there are only 2000 days. Opportunities to increase a child's resilience and capabilities are improved by receiving nurturing care from supportive adults at home and in early care settings; receiving regular preventative health and dental care; and by participating in robust learning opportunities that include being read to and problem -solving. ' Key Indicatart S_r_clal-Em^tianal Readiness at Kindergarten Entry' Why this matters. Social and emotional development provides a foundation for healthy development. Social and emotional skills allow children to engage with others, manage their emotions, handle stress and set goals. Studies show that good social emotional skills can lead to better education, employment and health and fewer problems with substance abuse and relationships." Note: Developmental assessment of entering kindergarteners is relatively new to Washington State so no data trends are yet available. Figure 7: Lower -income kindergartners are less likely to demonstrate social -emotional readiness than their peers. Percent of students who demonstrate social -emotional readiness characteristics of entering kindergarteners, 2016 80% 60% 40% 20% 0% rdents ■ Lower -Income Students Whatcom County Washington State Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 Joint Meeting of Health Board and PHAB 061 119 Page 8 Page 8 Life Oct urse Stages Adea lescence Adolescence and young adulthood are generally healthy times of life, but because they are in developmental transition, adolescence is considered a critical period for a person's overall health trajectory. Environmental factors, including family, peer group, school and neighborhood can either support or challenge young people's health. Ensuring the positive development of adolescents makes it more likely that they will be healthy and prepared to nurture and care for the next generation. ' Key Indicatcrt Teen Births Why this matters. Teen births can result in a lifetime of decreased opportunities. Teen mothers are more likely to be a single parent, to live in poverty and to experience depression. Infants born to teens are more likely to be born early, to have low birth weight and to experience abuse or neglect. Teen parents are a particularly vulnerable population in need of specialized social, economic and health supports.18 Figure Sc The teen birth rate has Jecllned significantly aver the last 10 years In both Whatc m Caunty and Washingtan State. Teen births, rate per 1,000 females aged 10 Whatcom County Washington State ■ 12 Year Trend (Whatcom) ti�O� ti�Oy ti�Ob A ti�Oti�O� ti�O� �� � y ti�1O ti�11 ti�1ti��ti�1ti�1 Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 Joint Meeting of Health Board and PHAB 061 119 Page 9 Page 9 Family Well-being The social and physical environment that a family provides a young child is the most critical element impacting their development. Key factors impacting family well-being include economic security, access to health and social services and the sense of support and connectedness. A key indicator of family well-being is the rate of child abuse and neglect. Key Indicato-re. Child Abuse and Neglect Safe, stable and nurturing relationships are more likely to breakdown when the adult caregivers are experiencing substance abuse, mental health issues, or significant stress due to chronic health issues, financial problems, and social isolation. Child abuse and neglect are evidence of a severe breakdown in the family system. Whatcom County has had a higher rate of child abuse and neglect accepted referrals than the Washington State average for more than a decade. Figure 9s The rate cf child abuse and neglect Is consistently In Whatceam Why this matters. County than in Washington State. "Accepted child abuse and neglect referrals" are Victims of child abuse and neglect in accepted referrals, rate per 1,000 children instances where Child Protective Services determines 60 there is enough potential risk to a child that an investigation is merited. Impacts of child abuse and 50 neglect are far-reaching and they are especially 40 damaging if the abuse and neglect occur early in life and/or is prolonged. Consequences can last a life time 30 and may affect the child physically, psychologically and 20 behaviorally. Current research suggests chronic 0 neglect can be more harmful than other forms of state Whatcom County abuse. A strong caregiver relationship outside of abuse 0 and neglect can buffer the impacts for a child.19 0`> 06 0A 01b o° 1° °ti 1* °1h 16 n°ti°ti 'ti° Figure 10e Rate ,^f child abuse and neglect by schccI district, Whatcom County, 2005-2016 10-year average rate of child abuse and neglect per 1,000 children 22.6 — 39.72 ❑ 39.79 — 43.15 ❑ 56.62 — 60.43 El data not reliable Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 Joint Meeting of Health Board and PHAB 061119 Page 10 page 10 * Key Indicat?r: Ecrnrmic Security Poverty is the single greatest threat to a child's well-being. Poverty creates barriers to accessing basic needs, including health services, healthy food, and other necessities that contribute to poor health status. Poverty also creates barriers to accessing enriching learning opportunities for young children. The effect of family socioeconomic circumstances on children's language development is evident as early as 18 months and persists throughout childhood.20 Why this matters. Caregivers that lack economic security are less able to consistently support and nurture a child. The availability of caregivers to consistently respond and engage with their children is a key ingredient to healthy brain development. Families that do not have an income that provides for basic needs and stability are much more likely to live in an environment so full of stress that it is toxic to a developing brain.21 Figure 11. Nearly cf Whatcom Cc,unty's yaungest children live in families that lack ecocnlr mic security. Percent of children ages 0-5 living below 200% of federal poverty level, 2014 100% 90% 80 70% 60 50% ■ Below 200% FPL ■ Below 200% FPL 40% 30% 20% 10% 0% Whatcom Washingtr_n State Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 Joint Meeting of Health Board and PHAB 061119 Page 11 Page 11 to Key Indicator Maternal & Child Health Service Utilizatirm While social, economic and environmental factors have the greater influence on health and development, health and social services play a critical role in building health and well-being, especially for those families experiencing high levels of stress. "Concrete supports in times of need" is one of the five research -based protective factors in the Strengthening Families Framework. Concrete supports in times of need ensures families have access to basic necessities such as healthy food and a safe environment as well as available health, mental health, social, and educational services. Why this matters. Women, Infants and Children (WIC) is a federal program focused on supporting nutrition by providing financial support for healthy foods, breastfeeding support and nutrition education. Maternity Support Services (MSS) is a state program that provides a team to give women health education, referrals, and counseling during pregnancy and early postpartum. Both programs are designed to support all of Washington State's low-income families during pregnancy and early childhood and, as such, have the potential to offer services and supports to improve the health trajectory of lower -income children right from the start. Figure 12c MSS utilization has had a precipitaus decline in Whatcom County. Percent of eligible women using Maternity Support Services 100% 90% 1 . 80% 70% 60% 50% 40% 30% 20% Whatcom Washington State 10% 10 Year Trend (Whatcom) 0% i 1P 1P lip IV IV Figure 13c WIC utilization has had a ready decline in Whatcam 02unty. Percent of eligible individuals using WIC services 80% 70% 60% 50% 40% 30% 20% Whatcom 10% Statewide 0% 2012 2013 2014 2015 2016 2017 Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 Joint Meeting of Health Board and PHAB 061119 Page 12 Page 12 qW Key Indicatrrs Social Support & Crnnecticns Social connections are a protective factor in the Strengthening Families Framework. "Several research studies have demonstrated that — for both mothers and fathers — high levels of emotional, information, instrumental and spiritual support is associated with positive parental mood; positive perceptions and responsiveness to one's children; parental satisfaction and well-being and sense of competence; and lower levels of anger, anxiety and depression."22 Why this matters. Social and emotional support is critical for navigating the challenges of daily life as well as for good mental health. Social and emotional support is also linked to educational achievement and economic stability. Having trusted people to take care of your kids is demonstration of having the type of connections in a community that act as protective factors. Figure 14c Mcst adults in Whatcom Caunty say they have cammunity support and cannectInns. Percent of individuals self -reporting through Behavioral Risk Factor Surveillance Survey (BRFSS), 2015 rJ adults In Whatceam Crmnty say they have ccmmunity support. of adults In Wbatcrm Ccunty say they have sc mec ne they trust tc take care 0 their kids. Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 Joint Meeting of Health Board and PHAB 061119 Page 13 Page 13 Community Well-being A growing body of research points to community conditions as pivotal to perpetuating disparities in health and education outcomes. In order to build health equity for all community members, community conditions need to be addressed to ensure all people have access to the essentials for health and well-being. This is especially important for families with young children during the critical window of opportunity for healthy brain development.23 *N Key Indicatcri Life Expectancy at Birth Life expectancy at birth refers to the average number of years a newborn is expected to live if mortality patterns at the time of its birth remain constant in the future. Life expectancy is closely connected with health conditions. Even small differences in life expectancy values imply important differences in health status. Life expectancy at birth is a sentinel measure of potential health disparities within a community. Figure 15s Life expectancy at birth by census tract Average number of years a newborn is expected to live given current mortality rates, 2015 14 84.03 - 92.35 years ❑ 79.66 - 83.79 years ❑ 76.12 - 79.52 years Why this matters. Whatcom County has an average life expectancy at birth of 82.1 years. This indicator reflects the cumulative risks and protective factors of the residents of Whatcom County. Despite overall improvements in population health over time, many disparities have widened. Disparities in health not only affect the groups facing disparities but also have broad community impacts. Whatcom County benefits when everyone has the opportunity to live long, healthy and productive lives. Disparities are one measure of the overall health of a community.24 Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 Joint Meeting of Health Board and PHAB 061119 Page 14 Page 14 kKey Indicatrrs Hcusin+g Crst Burden Housing affects all aspects of development. It is the primary environment in which most young children spend their time. Housing's impacts on health result from three interrelated issues: the physical conditions within homes; conditions in the neighborhoods surrounding homes; and housing affordability. The shortage of affordable housing limits families' choices about where they live and often results in lower -income families living in substandard housing in neighborhoods with higher poverty and fewer resources. Housing insecurity is associated with poor health, lower weight and developmental risk among young children.25 Why this matters. High housing costs and high prices for basic necessities place a significant burden on lower -income households and contribute to increased stress in a family environment. Families who pay more than 30% of their income for housing are considered cost burdened and may have difficulty affording necessities such as food, clothing, transportation, and medical care. Figure 16c Mc re than 50% 2f renters In Whatcm Caunty are burdened by housing casts. Percent of owner- and renter -occupied households spending more than 30% of income on housing, 2015 60% 50% 40% 30% 20% 10% — Percent of owners cost burdened Percent of renters cost burdened 0% T 2010 2011 2012 2013 2014 2015 WKey Indicatom. Health Insurance C^verage Access to high quality, family -centered health and social services is important for promoting and maintaining health and achieving health equity. Access involves entry into the service system, availability of needed services in the community and establishing a relationship with trusted service providers. Why this matters. Health insurance coverage is essential to access the health care system for both children and adults. The health of the primary caregiver affects children's health and well-being by contributing to a stressful family environment. Evidence suggests that insuring caregivers means that children are more likely to keep their health insurance and receive needed preventive care.26 Figure M Adults In Whatcom Ccunty are far less likely tc have Insurance coverage than children. Percent of Whatcom Countv residents without health insurance, 2015 ■ 21-64 yo, less than 200% FPL 1 21-64 yo, All Incomes ■ Under 19, less than 200%FPL Under 19, All Incomes 0% 5% 10% 15% 20% Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 Joint Meeting of Health Board and PHAB 061119 Page 15 Page 15 k Key Indicator Child Care Availability Whether formal or informal supports, families of young children need access to high quality programming that builds up and reinforces parental capabilities, provides enriching learning opportunities and, when needed, provides surrogate safe, stable and nurturing relationships for young children. Investment in high quality child care and early learning opportunities has been demonstrated to be a cost-effective way to improve child outcomes and reduce disparities.27 Why this matters. Having reliable, high quality child care is critical to provide the experiences and nurturing necessary for optimal child development, and to provide the working parents the peace of mind that their child is well cared for while they work. Due to low availability of licensed child care, Whatcom County is considered a child care desert. The majority of licensed child care available is within Bellingham city limits, leaving much of the rest of the county the choice between informal arrangements or coming to Bellingham. Informal child care arrangements can be fruitful for some families but often lack the security and assurance of quality found in licensed programs. There are child care ■■■■■ sl'cts ■■■■ available fc r every children In Whatcom Pa 9nay.* - � oral chll ran ages Figure IS: Availability 0 licensed child care is largely .:rncentrated in Bellingham. Licensed child care by capacity range, 2017 DWI- 0. % 0 Bay CJster Della Clear6raok C • O O O �nd- O O Nc�Msack Ever9on O Gr¢envrood � 4 0 ° O • 0 O •%0 Mountain � Laurel O O Goshen Vi¢w FeR119, _ q> O 0 O CP Neptune eeach _ 0 Van Wyck .01 • • © � Dewey O MarietlaAl�erwootl � h a Agate Bay Bellim • G LJmm, lalantl0 • Portage island Lummi lsfand Chnekan�l Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 0 3 t O Maple Falls Kendall 0" Wsmlck Glacier Nugenls O Corner welcome O Deming Total Eicens.d Cap.dy O 0te 12.5 b 12.5 to 30 • 30 to45 Van7vdl O 45 t. 60 Q50 to 55 t55 to 100 1000127 127 to 127 ( o Acme '3 South Twin 0 Blue Canyon SaROR + ,,, P201]Gdayk-M ydatB OZ01�0wgle Zblll_J iermy of Vse aepeNamap enar Joint Meeting of Health Board and PHAB 061119 Page 16 Page 16 Data Sources and References [1]: Kids Count Data Center (2016). State of Washington's Kids 2016. Retrieved from http://kidscountwa.org/state-of-washingtons-kids-2016/ [2]: PeaceHealth St. Joseph Medical Center, Whatcom County Health Department (2013). Whatcom County Community Health Improvement Plan Update. Retrieved from http://www.co.whatcom.wa.us/DocumentCenter/Home/View/1498 [3] U.S. Department of Health and Human Services, Healthy People 2020 (2017). Disparities. Retrieved from https://www.healthypeople.qov/2020/abouVfoundation-health-measures/Disparities [4]: U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (November 2010). Rethinking MCH: The Life Course Model as an Organizing Framework. Retrieved from https://www.hrsa.gov/sites/default/files/ourstories/mchb75th/images/rethinkingmch.pdf [5]: Center on the Developing Child, Harvard University (2007). The Science of Early Childhood Development (InBrieo. Retrieved from https:I/developingchild.harvard.edu/resources/inbrief-science-of-ecd/ [6]: Center on the Developing Child, Harvard University (2007). The Impact of Early Adversity on Children's Development (InBrief). Retrieved from https://developingchild.harvard.edu/resources/inbrief-the-impact-of-early-adversity-on-childrens-development/ [7]: Centers for Disease Control and Prevention (2016). About Adverse Childhood Experiences. Retrieved from https://www.cdc.qov/violenceprevention/acestudy/about_ace.html [8]: Center for the Study of Social Policy (2014). The Strengthening Families Approach and Protective Factors Framework: Branching Out and Reaching Deeper. Retrieved from https://www.cssp.org/reform/strengthen ingfamiIies/2014/The-Strengthening-Families-Approach-and-Protective- Factors-Framework Branching-Out-and-Reaching-Deeper.pdf [9]: Center for the Study of Social Policy (Unknown date). Working Toward Well-being: Community Approaches to Toxic Stress. Retrieved from hftps://www.cssp.org/reform/early-childhood/early-childhood-linc/working-toward-well-being-commu n ity-approaches-to-toxic-stress-web. pdf [10]: RWJF Commission to Build a Healthier America (2014) Time to Act: Investing in the Health of our Children and Communities. Retrieved from https://www.rw'f.org/en/library/research/2014/01 /recommendations-from-the-rwif-commission-to-build-a-healthier-am.htmI Figure 1: Washington State Heath Care Authority. Reproductive Health. (2006-2015) Characteristics of Women Who Gave Birth by County [data file]. Retrieved from https://www.hca.wa.gov/assets/billers-and-providers/characteristics-women-whatcom.pdf Figure 2: U.S. Census Bureau. (2011-2015). American Community Survey 5-Year Estimates Table S0901: Children Characteristics [data file]. Available from https://www.census.gov/acs/www/data/data-tables-and-tools/subject-tables/. [11]: U.S. Department of Health and Human Services, Healthy People 2020 (2017). Disparities User Guide. Retrieved from hftps://www.healthypeople.qov/2020/disparities-user-quide [12]: Washington State Department of Health (no date). Data and Tools for Project Planning. Retrieved from https://www.doh.wa.gov/CommunityandEnvironmenUHeaIthEguity/DataandTools [13]: State of Washington Office of Superintendent of Public Instruction (2016). Dropout and Graduation Reports. Retrieved from http://www.kl2.wa.us/DataAdmin/Dropout-Grad.aspx Figure 3: Washington State Department of Health, Center for Health Statistics, Community Health Assessment Tool (CHAT). (January 2017). Single Year Intercensal Estimates 2001-2016 from Washington State Office of Financial Management, Forecasting Division [data file]. Available from CHAT http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/PublicHealthSystemResourcesandServices/CommunityHealthAssessmentandlmpro vement/CHAT [14]: U.S. Department of Health and Human Services, National Institutes of Health (no date). What is Prenatal Care and Why is it Important? Retrieved from https://www.nichd.nih.qov/health/topicslpregnancy/conditioninfo/Pages/prenatal-care.aspx#prenatal Figure 4: Washington Tracking Network Washington Department of Health. Data obtained from the Community Health Assessment Tool (CHAT). (29 March 2016) Prenatal Care [data file]. Available from https://fortress.wa.gov/doh/wtn/WTNPortal/ Figure 5: Washington State Heath Care Authority. Reproductive Health. (2006-2015) Characteristics of Women Who Gave Birth by County [data file]. Retrieved from https://www.hca.wa.gov/assets/billers-and-providers/characteristics-women-whatcom.pdf [15]: March of Dimes (2014). Low Birthweight. Retrieved from http://www.marchofdimes.org/complications/low-birthweight.aspx Figure 6: Washington State Department of Health: Center for Health Statistics. (June 2017). Birth Certificate Data 1990-2016 [data file]. Available from Community Health Assessment Tool (CHAT) http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/PublicHealthSystemResourcesandServices/CommunityHealthAssessmentandImpro vement/CHAT. [16,17]: Center on the Developing Child, Harvard University (2007). The Science of Early Childhood Development (InBrieo. Retrieved from https://developingchild.harvard.ed u/resources/inbrief-science-of-ecd/ Figure 7: Office of Superintendent of Public Instruction. (2017). Washington Kindergarten Inventory of Developing Skills [data file]. Available from http://reportcard.ospi.kl2.wa.us/WaKidsDetaiIPage.aspx?domain=WaKIDS&year=2016-17&wakidsyr=2013- 14&school Id=1 &waslCategory=1 &numberOrChart=1 &yrs=2016-17&chartType=1 [18]: Centers for Disease Control and Prevention (2017). About Teen Pregnancy. Retrieved from https://www.cdc.qov/teenpregnancy/abouVindex.htm Figure 8: Washington State Department of Social & Health Services (July 2017). Risk and Protection Profile for Substance Abuse Prevention in Whatcom County [data file] Retrieved from https://www.dshs.wa.qov/data/research/4.47-whatcom.xlsx [19]: Center on the Developing Child, Harvard University (2013). The Science of Neglect (InBrief). Retrieved from https://deveIopingchiid.harvard.edu/resources/inbrief-the-science-of-neglect/ Figure 9,10: Washington State Department of Social & Health Services (July 2017). Risk and Protection Profile for Substance Abuse Prevention in Whatcom County [data file] Retrieved from https://www.dshs.wa.qov/datalresearch/4.47-whatcom.xlsx [20]: Hurt, Hallam & Betancourt, Laura M. (2016) Effect of Socioeconomic Status Disparity on Child Language and Neural Outcome: How Early is Early? Nature. Retrieved from http://www.nature.com/pr/iournal/v79/nl-2labs/pr2Ol5202a.html?foxtrotcallback=true Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 Joint Meeting of Health Board and PHAB 061119 Page 17 Page 17 [21]: Center on the Developing Child, Harvard University (2007). The Impact of Early Adversity on Children's Development (InBrielJ. Retrieved from https://developingchiId.harvard.edu/resources/inbrief-the-impact-of-early-adversity-on-chiIdrens-development/ Figure 11: Kids Count in Washington. (2016) State of Washington's Kids 2016. Retrieved from http://kidscountwa.org/state-of-washingtons-kids- 2016/ Figure 12: Washington State Heath Care Authority. Reproductive Health. (2006-2015). Characteristics of Women Who Gave Birth by County [data file] Retrieved from https://www.hca.wa.gov/assets/billers-and-providers/characteristics-women-whatcom.pdf Figure 13: Washington State Department of Health. (September 2017). Data on Whatcom County WIC Nutrition Program Participation [custom data set by email communication]. [22]: Center for the Study of Social Policy (2014). The Strengthening Families Approach and Protective Factors Framework: Branching Out and Reaching Deeper. Retrieved from https://www.cssp.org/reform/strengtheningfamilies/2014/The-Strengthening-Families-Approach-and-Protective- Factors-Framework Branch ing-Out-and-Reaching-Deeper.pdf Figure 14: Washington State Department of Health. (2017). Behavioral Risk Factor Surveillance System (BRFSS) [data file]. Available from http://www.doh.wa.qov/DataandStatisticaIReports/DataSystems/BehavioraIRiskFactorSurveiIlanceSystemBRFSS [23]: RWJF Commission to Build a Healthier America (2014) Time to Act: Investing in the Health of our Children and Communities. Retrieved from https://www.rw'f.org/en/library/research/2014/01 /recommendations-from-the-rwif-commission-to-build-a-healthier-am. html Figure 15: Washington State Department of Health, Center for Health Statistics, Community Health Assessment Tool (CHAT). (August 2016). Death Certificate Data 1990-2015 [data file]. Available from http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/PublicHealthSystemResourcesandServices/CommunityHealthAssessmentandImpro vement/CHAT [24]: U.S. Department of Health and Human Services, Healthy People 2020 (2017). Disparities. Retrieved from https://www.heaIthypeoPIe.qov/2020/abouVfoundation-health-measures/Disparities [25]: Cutts, Diana B., Meyers, Alan F., Black, Maureen M., Casey, Patrick H. et al. (2011). US Housing Insecurity and the Health of Very Young Children. American Journal of Public Health. Retrieved from http://aiph.aphapublications.org/doi/abs/10.2105/AJPH.2011.300139 Figure 16: U.S. Census Bureau. (2015). American Community Survey 5-Year Estimates Table DP04: Selected Housing Characteristics [data file]. Available from https://factfinder.census.gov/faces/tableservices/isf/pages/productview.xhtml?src=bkmk [26]: Henry J. Kaiser Family Foundation (2012). The Uninsured and the Difference Health Insurance Makes. Retrieved from https://www.kff.org/health-reform/fact-sheeVthe-uninsured-and-the-difference-health-insurance/ Figure 17: U.S. Census Bureau (2017). Small Area Health Insurance Estimates. Available from https://www.census.gov/did/www/sahie/data/interactive/sahie.html [27]: Trust for America's Health (2015). A Healthy Early Childhood Action Plan: Policies for a Lifetime of Well-being. Retrieved from http://healthVamericans.org/reports/ [28]: Kids Count in Washington. (2016) State of Washington's Kids 2016. Retrieved from http://kidscountwa.org/state-of-washingtons-kids-2016/ Figure 18: Child Care Aware of Whatcom County. (January 2017). Geographic distribution of licensed child care in Whatcom County. [custom data set by e-mail communication]. Whatcom Working Toward Well-being I Whatcom County Health Department I October 4, 2017 Joint Meeting of Health Board and PHAB 061119 Page 18 Page 18 A*A O;lr,A Ah Ah HOMELESSNESS FcHILD H01 AELESSNF C S � N0 umber of individuals experiencing homelessness ublic school students experiencing homelessness Whatcom County, 2008-2018 hatcom County, 2007-201/ Source: Whatcom County Coalition to End Homelessness, Annual Point in Time Reports Source: Whatcom County Coalition to End Homelessness Annual Reports goo 851 1200 815 41 41 41 Msoo Y 7o8 700 719742 1aoo 981 700 649 959 651 • Housing and health Housing insecurity and 847 821 �� 846 854 intersect and people 600 561 553 basic needs are at the 8°° --- Want to see a Housing 493 forefront of What public 699 705 First approach With 5°° school nurses are wraparound services. 60� p dealing With rather than • Lack of temporary �`� medical issues. Kids Definition of homelessness for students housingor shelter beds Definition of homelessness These numbers are cumulative over the school year. This is a snapshot of homelessness on a single day. (Point -in -Time Count) Who don t have Includes students who meet any of the following criteria: available for various Includes only those literally homeless. They meet one of the following adequate access arena are doubled -up with another family to prevent becoming literally homeless. criteria: are in a temporary foster placement. populations. are unsheltered ready to learn. are unsheltered. • stayed in an emergency shelter stayed in an emergency shelter. • stayed in homeless transitional housing stayed in homeless transitional housing. o 0, O� oo, ti� p'y,' tit ti� tip` ti� tib tit ti� ,�� ,�� -tip D,ti� ti-ti2 -,�' -tip -tip 01V OA 20 ,LO 2� 2 2� 2� 20 20 2� 2� 2� ��� Oti �'�. 0,2 HOUSING AFFU Yr i W I� I SENIOR LIVING A91 Percenta e of households that are cost -burdened ercentage of adults 65 and older living alone g �� Whatcom County, 2ull-201i Whatcom County, 2010-2017, i-year estimates Source: American Community Survey, US Census Bureau Cost -burdened households pay 30% or more of monthly income in housing 50% 4% A* Source: American Community Survey, US Census Bureau WA Whatcom 0 ioo/ (Renters Owners Y � 45% go% • Challenge of being Limited and expensive 40% "priced out" of the areas $°' housing options With 35% Where people Would 70% sufficient supports, prefer to live, frequently 60, 57% 57% 57% 57% including assisted living, 30% closer to places of o are not keeping up With 25 5�� employment such as anticipated population � Bellingham. 40' 44% growth. 20% • Housing quality is a Social isolation and � 30' �5% � 0 12.10% 0 12.go% loneliness contribute to 10,80/ � 11.10/ problem In many parts of � the count including20' 2 � 85�/. 10.10/ .. • • ... , , , :. • � - � • ..10,30/ ° 9 2�� 26� poor health outcomes for 10%Y -.• households having no 10% seniors. 5% electricity, Water, or full o% Seniors desire more 8.70% 9.40% 9.50% Zo.00/ 9.70% Zo.00/ 9.8o% kitchens. options for emotional �% 2010-2014 2011-2015 2012-2016 2013-2017 2011 2012 2013 2014 2015 2016 2017 connections and relationships. Joint Meeting of Health Board and PHAB 061119 Page 19 Health Policy Leadership why it matters and h.r.,:tw we can dct mare June 11, 2019 Whatcom County )ll HEALTH Department Joint Meeting of Health Board and PHAB 061119 Page 20 fUIL Whatcom County HEALTH Department Programmatic interventions help people beat the odds; systemic interventions change their odds. - Karen Pittman Joint Meeting of Health Board and PHAB 061119 Page 21 fflL Whatcom County HEALTH Department I MCREA16ING ff1 0 RTC -N E E D ED-- ID Source: The Health Impact Pyramid by Thomas R. Frieden. Obtained from https://report.digitaldivides.nz/a-pyramid-of-impact Joint Meeting of Health Board and PHAB 061119 Page 2 Key definitic.4 ns Policy refers to decisions, plans, and actions undertaken to achieve specific health goals within a society (World Health Organization (WHO)) Health Policy: national, state, or local regulation or financial appropriation that creates a structure, environment, system, incentive, or penalty related to health. Typically, the goal of health policy is to make healthy choices easier. i4o"11 Whatcom County HEALTH Department Source: https://www.who.int/topics/health_policy/en/ Joint Meeting of Health Board and PHAB 061119 Page 23 Windows cf Ppp�rtunity Public Policy Interventions Regulate • Incentivize Subsidize • Contract out Tax & Spend • Privatize Charge fees • Educate Conduct Research Problem Possible Solutions Political Will fulL Whatcom County HEALTH Department "POLICY without POLITICS is like architecture without engineering" Legislation Source: Adapted from presentation by Dr. David M. Mirvis. Available at http://www. urbanch ildi nstitute. org/sites/a II/files/2006-09-Health_Po I icy_Foru m-M i rvis. pdf Joint Meeting of Health Board and PHAB 061119 Page 24 Lce ngest's Pce Icy Cycle Framewc.. rk Pte#ereoces 41 individual, ofgorimuons. inlerQst groups, *long w+th b*ologicar. CkOW al. derrf�raVhi I ecln"ww. � n4, �@lhwWl, legal. ��•y� �l, efid Eeehnakogpcw Inputs PSI ky IFOFF"OP 4I F" Phose Windaw of Oppontinily Aged " Prcue ns % P4�rmibll3 ZWtfl++ S F P-DIgticaF C lFaumstarrre's n?VR�Oorrtexw al ! "-,Zoa xeoo�� ; BrMbad by Forrnal En"Imank e! LoqLallation Pofluy Imple mentation -Ph4i" �rtl�ukrrx� � r,7rt�t��M'! Potkcy Modi cation -- Fe dback fulL Whatcom County HEALTH Department Source: Longest's Policy Framework Redrawn from Longest, B. [2010]. Health policymaking in the United States [5th ed.]. Chicago: Health Administration. Retrieved from presentation by Dr. Dipti Sorte. Available at https://www.slideshare.net/diptisorte/policy-politics-and-nursing pint Meeting of Health Board and PHAB 061119 Page 2 Discussion What are examples where we've made healthy choices easier as a county? (think broadly) Locally, what kinds nf public policy interventions are we open/classed to pursuing? Hew can we improve the way we advance policy through fnrmulatinn, implementation, and mndificatinn? i4o"11 Whatcom County HEALTH Department Joint Meeting of Health Board and PHAB 061119 Page 26 Resources Centers for Disease Control & Prevention (CDC) Policy Process ViSit.httpst//www.cdc.gnv/pnlicy/analysis/prncess/ Georgia Health Policy Center Visit https.//g_hpc.cisu.edu/tnnls-frameworks/ i4o"11 Whatcom County HEALTH Department Joint Meeting of Health Board and PHAB 061119 Page 27