BBA
Associate Professor
Health Science Department; Master of Science in Health Administration and Leadership
Winter 2016
S
Acknowledgements
This project paper demonstrates the integration of the knowledge I acquired from the courses in Master of Health Administration and Leadership Program and the collaborative application with this project’s community partner, MidMichigan Health to improve the community health in Gratiot County, Michigan. I am thankful for getting this valuable opportunity to work with a large healthcare organization.
First and foremost, I would like to thank my parents who worked really hard to financially and emotionally support me in pursuing further education overseas. They comfort me every time I get into trouble and are always there to encourage me to stay strong and positive to face the challenges in a totally different culture.
I also would like to thank Shanna Hensler, the community health education coordinator of MidMichigan Medical Center-Gratiot. She has been nothing but patient, friendly and helpful to me. A large amount of credit should go to her for walking me through structural concepts in healthcare organizations, for example how different organizations work together to contribute to the improvement of community health.
Lastly, I would like to thank myself for my persistence. Transferring into a different field in a different culture is indeed a big challenge. There were many times that I wanted to quit because of the pressure and lacking self-confidence. However, I have overcome a lot of difficulties and challenges. I also gained self-confidence along the way.
Chapter 1: Overview of the Project
Introduction
Background
Rationale
Chapter 2: Description of the Problem
Purpose of the project
Chapter 3: Literature Review
Chapter 4: Description of the Project
Chapter 5: Conclusion and Lessons Learned
Abstract
In response to the Patient Protection and Affordable Care Act’s requirement that non-profit healthcare organizations conduct a community health needs assessment every three years, the Mid-Michigan District Health Department approached Mid-Michigan Medical Center-Gratiot to conduct a comprehensive community health assessment and prepare a health improvement process. The Health Department contributed to the process by inviting Gratiot County Stakeholders to participate in this assessment. The Mid-Michigan Organization arranged committee meetings and provided financial and professional support.
This project focuses on the details and methodologies to meet the community health goals of Mid-Michigan Medical Center- Gratiot in terms of reducing obesity rate and providing recommendations Methods used in conducting this assessment and recommendations for further study will also be identified within this Capstone paper.
Chapter 1
Introduction
“Non-profit hospitals have historically played and continue to play a key role in the financing and delivery of healthcare in the United States because they are bound by the missions to do good for the benefit of the communities they serve.”
----------------------Greg Pope, VP of philanthropy for the Saint Thomas Health Services Foundation, Nashville, Tennessee
Tax-exempt hospitals are required by section 9007 (a) of the Patient Protection and Affordable Care Act added sections 501(r) to conduct a community health needs assessment (CHNA) and implement health improvement strategies every three years. These assessments and strategies aim to identify community health needs and devise improvement plans. The implementation of a community health needs assessment requires corporation among hospitals, health department and community boards.
Section 501(r), added to the Code by the ACA, imposes new requirements on 501(c)() (3) organizations that operate one or more hospital facilities (hospital organizations). Each 501(c)() (3) hospital organization is required to conduct a community health needs assessment (CHNA) and adopt an implementation strategy at least once every three years. (These CHNA requirements are effective for tax years beginning after March 23, 2012). In December 29, 2014 the Department of Treasury and the IRS released its final regulations implementing the ACA’s provisions relative to non-profit hospital community benefit reporting obligations. The final regulations expanded the examples of health needs that a hospital facility may consider in its CHNA to include not only the need to address financial and other barriers to care but also the need to prevent illness, to ensure adequate nutrition, or to address social, behavioral and environmental factors that influence health in the community.
The purpose of the community health needs assessment (CHNA) is to describe the health status of the community the healthcare organization serves, identify the community’s health behaviors, identifyand identify leading causes of sickness and deaths. The community health improvement plan (CHIP) is a process designed to achieve the goal to improve the community’s overall health level by collecting and analyzing data, mobilizing communities, and coming up with plans based on the resources gathered.
Background
In response to the legislation that is required by ACA that tax-exempt healthcare facilities are obligated to conduct a community health needs assessment in every 3-year period, the Mid-Michigan District Health Department followed the legislation and approached the Mid-Michigan Medical center-Gratiot. Live Well Gratiot is a community collaborative comprised of individuals that represent a broad interest in the community. These include representatives from Gratiot County Community Mental Health, Mid-Michigan District Health Department, MSU Extension, Alma College, Child Advocacy, Gratiot-Isabella RESD, Gratiot County Substance Abuse Coalition and MidMichigan Medical Center-Gratiot. Its health improvement plan based on the community health needs assessment and targeted to Gratiot County, which has a relatively small population compared to other Counties in Michigan State.
MidMichigan Health has several subsidiaries in the state of Michigan. One of the subsidiary is located in Alma, the most populated city in Gratiot. The 2013-2015 Live Well Gratiot Community Health Needs Assessment was accomplished by Live Well Gratiot team’s great effort on researching health data (hospital data, vital statistics), community interview input and every single member’s expertise in their professional field.
According to the 2013-2015 Live Well Gratiot Community Health Assessment there are four major health problems existing in Gratiot County and these. These four major problems as the health priorities are:
1. Obesity. Overall, Gratiot County has a greater percentage of obese population than Michigan’s average. (35.6% compared to 31.1%)
2. Alcohol and drug abuse. Gratiot County has a similar portion of binge drinking adults with Michigan’s average. (See Figure 1)
3. Mental Health.
4. Access to care. A great number of residents living in Gratiot County do not have personal healthcare provider and the percentage of people without health insurance is higher than Michigan’s average (21.6% compared to 16.2%).
In addition, mental health has also been taken into concern in the 2016-2018 Live Well Gratiot Community Health Needs Assessment
This project will focus specifically upon providing recommendations for obesity program planning.
Rationale
Since tax-exempt hospitals are responsible for their communities’ wellbeing in health, obliged to be aware of their needs and protect the community from avoidable harm, it is logical and ethical for hospitals to enhance the health of their community members.
The main purpose of this project is to assess methods and strategies that can be used in fighting obesity, which is the most significant health problem in Gratiot County. In order to improve the community’s health by fighting obesity, intervention strategies, barriers and resources will be demonstrated and analyzed in this project, The methods and strategies that are determined to be the most likely succeed will be adopted, implemented and further monitored by the Live Well Gratiot team. The Live Well Gratiot team will gather frequently to report and monitor the progress on progress made in reducing obesity rates in Gratiot Count adultsAdults and youth
The Live Well Gratiot community health improvement plan process is a major effort dedicated to maximize common good. Through collaboration, Livelive well Gratiot as a community can achieve more goals and objectives relating to the four health priorities and have a significant impact on the community’s health.
Chapter 2
Statement of the problem
Figure 1. (Source: Behavioral Risk Factor Surveillance, Gratiot County, Mid-Michigan District Health Department 2008-10)
Obesity, defined as body mass index (BMI) >30 kg/m2, is a multifactorial, chronic disease with complex behavioral, metabolic, physiologic, genetic, environments (cultural and social), and psychological causes and consequences (Fitch et al., 2013). Obesity is a major health challenge globally (Brown & Kuk, 2014). Its prevalence is increasing at an alarming rate globally in both developed and developing countries (Fitch et al., 2013). Between 1980 and 2013, its worldwide prevalence has increased significantly from 29.8 percent to 38.0 percent in adult females and from 28.8 percent to 36.9 percent in adult males (Brown & Kuk, 2014). Obesity is considered an epidemic in the United States, affecting approximately 78 million adults (Fitch et al., 2013). Behavioral and environmental changes caused by urbanization, modernization and economic development have been associated with the rise in worldwide obesity (Fitch et al., 2013). Obesity is currently the fifth leading cause of mortality globally (Brown & Kuk, 2014). In the United States, it is the second leading cause of mortality, after only tobacco (Fitch et al., 2013). According to the research Live Well Gratiot team has done previously, Gratiot County also has a higher rate in chronic diseases and since obesity is a risk factor for many chronic diseases, fighting obesity will not only decrease BMI but it can reduce the prevalence of other chronic diseases including heart disease, diabetesetc.
Impact of Obesity
Obesity affects individuals in various dimensions, including physical health and psychosocial wellbeing as well as economically (Brown & Kuk, 2014). The health consequences of obesity are increasingly becoming evident (Fitch et al., 2013). The link between obesity and heightened risk for chronic health diseases, including type 2 diabetes mellitus and cardiovascular disease (CVD), is well established (Brown & Kuk, 2014). Obesity is linked to heightened risk of heart failure, stroke, coronary artery disease, myocardial infarction, osteoarthritis, chronic back pain, hypercholesterolemia, asthma, hypertension and some cancers (including prostate, pancreatic, kidney, esophageal, colorectal, ovarian, endometrial, and breast) (Djalalinia, Qorbani, Peykari, & Kelishadi, 2015). Since obese youth are likely to live a greater proportion of their life as obese with these co-morbid health conditions, it has been projected that today’s youth will liver lives that are unhealthier and maybe have a shorter life expectancy relative to their parents (Brown & Kuk, 2015).
Obesity has also been linked to various psychosocial problems, including lower quality of life and social discrimination. Obese individuals often report lower health-related quality of life compared with their normal weight counterparts. Obesity is also a major social prejudice because obese and overweight individuals are often stigmatized. The social obstacles experienced by obese individuals are a major cause of psychological suffering (Agrawal et al., 2015) and compromised psychological wellbeing, including low self-esteem. Reflected appraisals theory proposes that individuals are likely to have critical self-views if they thinks others have a negative perception of them (Carr & Jaffe, 2012). Indeed, obesity has been shown to increase the risk of major depression that could increase the potential of developing a smoking and/or drinking habit (Fitch et al., 2013).
Figure 2.
(Source: Behavioral Risk Factor Surveillance, Gratiot County. Mid-michganMichigan District Health Department 2008-2010)
Figure 3
(Source: Behavioral Risk Factor Surveillance, Gratiot County. Mid-michganMichigan District Health Department 2008-2010)
Community Benefits
Reversing the obesity epidemic requires effective prevention strategies. The scientific community has accepted whole-population or population-wide public health programs as the means to obesity prevention (Middleton, Henderson, & Evans, 2013). Healthcare organizations that help in the fighting obesity can benefit the communities. They employ programs of activities at the community level, either via community settings or through engaging with existing groups in the community. Community-based obesity programs provide the basis for population-wide approaches because their implementation rationale is founded on addressing the various factors that influence obesity. They also cover multiple settings, increasing their likelihood of targeting a wider population (Middleton et al., 2013). Such interventions are likely to influence energy balance in the community by promoting individual behavior change, including engagement in physical activity and healthy eating, thereby promoting obesity prevention efforts (Whelan et al., 2015).
Involving the community in the planning, implementing, resourcing, managing and evaluating the obesity prevention programs is likely to create a sense of ownership among members of the community and help ensure the success of preventive efforts (Whelan et al., 2015). Healthcare organizations that fight obesity also encourage universal or primary prevention of obesity. Such approaches are typified by efforts to improve the health of the community members with not previous risk screening, but who have a great potential of experiencing health inequities. Primary prevention strategies can help minimize the incidence of obesity in the community (Middleton et al., 2013). In a nutshell, people in Gratiot County will benefit from this project by MidMichigan Health and Live Well Gratiot team in terms of reducing the prevalence of obesity and as a consequence a better condition of health both physically and mentally.
Chapter 3
Introduction
There is a growing obesity epidemic throughout the country. This is a concern when it comes to the general health of society. Residents are becoming more overweight and obese every decade, resulting in a variety of health issues throughout the country. Obesity is also a great health concern amongst children. “Since the 1980s, the number of obese children and adolescents in the United States has tripled, and nearly one-third of American children and adolescents now are classified as either overweight or obese” (Faguy, 2016, p. 279). Overall, the prevalence of overweight and obese individuals remains a concern throughout the United States (Li, 2016).
In 2010, approximately 64 percent of individuals living in Gratiot County, Michigan were considered overweight or obese. This lead to the Live Well Gratiot Initiative to create the 2013-2015 Community Health Improvement Plan (CHIP) for Gratiot County. Members representing Live Well Gratiot used health data and community input to conduct a community health assessment. This made it possible for the Live Well Gratiot members to identify current health issues existing throughout the county. After assessing the community information, the Live Well Gratiot Steering & Advisory Committee members concluded there were four main health issues throughout the county: obesity, tobacco use, drug and alcohol use, and access to care. This paper addresses the Community Health Improvement Plan for Gratiot County in regards to obesity reviewing successful obesity intervention programs throughout the country.
Gratiot County
Gratiot County is primarily rural. By 2010, the population of Gratiot County was approximately 42,000. At the same time, the total population of Michigan was 9,883,640. Thus, Gratiot County represents only .43 percent of the total population of Michigan. There are several health issues faced by residents This is due to the fact that 64 percent of Gratiot County residents are considered overweight or obese. Being overweight or obese “can increase the likelihood of developing chronic conditions such as hypertension, heart disease, chronic lung disease, stroke, and diabetes” (Live Well Gratiot Community Health Assessment, 2012). Furthermore, there are five health conditions that are responsible for almost two-thirds of the deaths throughout Michigan as well as Gratiot County. These health conditions are: cancer, heart disease, stroke, unintentional injuries and chronic lung disease (Live Well Gratiot Community Health Assessment, 2012) . ).
The prevalence of adult obesity throughout the state of Michigan has climbed substantially. In 2000, 22.5 percent of the population was considered obese. In 2009, that rate grew to 30.9 percent. In Gratiot County, a higher proportion of adults are classified as being obese than Michigan (29.8 percent compared to 35.7 percent). Data suggests that obesity does not discriminate. Both males and females are equally likely to be obese. Furthermore, education does not have a direct effect on obesity. It has been shown that the likelihood of being obese increases sharply during the third decade of life and remains steady until approximately 75 years of age. Lastly, obesity is more prevalent in the Hispanic population and other minority races (Live Well Gratiot Community Health Assessment, 2012).
Diet is important relative to obesity and other life altering disease. Research has shown that diets rich in fruits and vegetables reduce an individual’s risk for certain chronic disease. Only 9 percent of adults who reside in Gratiot County eat five or more servings of fruits and vegetables a day. Throughout Gratiot County, the access to fast food is high. It is believed this has a direct impact on the prevalence of overweight and obese individuals throughout Gratiot County. As the access to fast food grows, it increases the likelihood that more individuals will consume more processed food that contain lower nutritional content. “Greater access to healthier food options (like fresh fruits and vegetables) at an affordable cost, such as products sold at local farmer’s market or grocery stores, provide a means for residents to make healthier eating decisions” (Live Well Gratiot Community Health Assessment, 2012, p. 25).
Approximately 23% percent of Gratiot County residents and 24.1% of Michigan adults are sedentary. Sedentary refers to adults who do not participate in any type of leisure physical activity. Leisure activity consists of jogging, walking, or golf. Sedentary lifestyles hveshives been shown to increase with age and decreases with income and higher education. It is also more common in females than in males (Live Well Gratiot Community Health Assessment, 2012,).
. In Gratiot County, only 19.6 percent of Michigan high school students reported incorporating fruits and vegetables into their daily diet at least five times a day. Furthermore, 22.8 percent of Gratiot County high school students consume the recommended three cups of fat-free milk a day. This is compared to only 13.3 percent of Michigan high school students. However, 35.4 percent of Gratiot County high school students reported they consumed at least one cup of soda a day. Only 27.6 percent of the rest of Michigan high school students reported they consumed one cup of soda a day (Live Well Gratiot Community Health Assessment, 2012).
Community Health Improvement Plan for Gratiot County
A high percentage of obese adults is found throughout Gratiot County. The percentage of obese individuals throughout Michigan is 30.9 percent of adults compared to 32.7 in Gratiot County. Gratiot County also has a higher percentage of high school students who are obese than the rest of Michigan. Over 18 percent of Gratiot County high school students are considered obese compared to 12.1 percent for Michigan as a whole. However, a higher percentage of Gratiot County students spent at least 60 minutes a day exercising, five days a week (56.4 percent compared to 46.8 percent).
The objective of the CHIP is to decrease the rate of obesity After three years of implementing the program, Live Well Gratiot's 2013-2016 goal was to decrease the percentage of obese adults in Gratiot County by 3 percent (from 32.7 percent to 29.7 percent). They also wanted to decrease high school aged obese throughout Gratiot County by three percent (from 18.6 percent to 15.6 percent). The initiative also hoped to increase the percentage of students who are physically active for at least 60 minutes a day, five days a week by 5 percent (from 56.4 percent to 61.4 percent). They also wanted to decrease the percentage Gratiot County adults who do not consume the recommended fruit and vegetable servings fromservings from 91.1 percent to 86.1 percent. (Live Well Gratiot Community Health Assessment, 2012). “Evidence suggests that community-based programs implementing environmental and policy intervention to stimulate healthier behavior can reduce health-related risk factors and, possibly, disease prevalence” (SubicaSubic, Grills & Douglas, 2016, p. 79).
Intervention strategies
Chronic disease, such as heart disease, stroke and diabetes, are the most common and preventable health issues throughout the United States. Many of the leading causes of death develop over a long period of time and can potentially be addressed through programs and preventive actions.
Heart disease is the leading cause of death in Gratiot County, the State of Michigan and the United States. High blood cholesterol is one of the main risk factors for coronary heart disease throughout the United States. Serum blood cholesterol is used to identify individuals at for developing coronary heart disease. Approximately 40.8 percent of Gratiot County adults have been informed by a health care provider that they have high cholesterol. Men are more likely to be affected by high cholesterol than women (Live Well Gratiot Community Health Assessment, 2012).
Live Well Gratiot designed four strategies to lower the percentage of obese adults and students. The overall goal of these strategies was to increase physical activity as well as increase the percentage of individuals who eat healthy. These are the two main problem areas relative to health concerns in Gratiot County (Community Health Assessment, p. 29).
Implement a community-wide campaign to increase physical activity
The first strategy is to enhance interventions in the community settings. This intervention consists of creating buddy systems to support physical activity. Another intervention entails creating networks of walking groups to promote physical activity. In order to create awareness of these campaigns, the organization could use television, newspaper or the radio in order to deliver these messages throughout the community (Live Well Gratiot Community Health Assessment, 2012.
Enhance places for physical activity and informational outreach
The second strategy is to expand places for physical activity and informational outreach. By increasing access to places for physical activities in combination withcombination with informational outreach activities, the, the Live Well Gratiot Initiative can educate individuals on different aspects of health while also encouraging physical activity (Live Well Gratiot Community Health Assessment, 2012.
Enhance local farmer’s market
The third strategy is to enhance local farmer’s markets. As mentioned above, 91.1 percent of Gratiot County adults do not consume the recommended amount of fruits and vegetables. That is a high percentage of the population. Thus, increasing the availability of fresh produce may encourage individuals to eat healthy. Another intervention is to improve access to markets for those individuals throughout the county who are receiving food assistance. Partnerships between local farmers and the community should be encourage. For example, the community and the farmers could consider a year round farmer’s market for the members of the community or partnership with local food markets like Meijer and Walmart. This would be a way to increase access to healthy fruits and vegetables throughout the community (Live Well Gratiot Community Health Assessment, 2012).
Health and Fitness Programs
Fit & Strong!
Fit and Strong is a community physical activity intervention. The program offers balance, stretching, endurance and aerobic exercise. Fit and Strong also incorporates health education in their program. This consists of goal setting and problem solving when it comes to health issues and exercise. Fit and Strong was designed to specifically target sedentary adults, especially those who suffer from stiffness and joint pain. The classes are eight weeks in duration and are conducted three times a week for 90 minutes each. Classes are also conducted by certified exercise instructors (Fit & Strong, 2016).
Fit & Strong is a low-cost exercise program. It combines strength training with flexibility and aerobic walking. The program has been proven to improve: lower extremity pain and stiffness, aerobic capacity, and lower extremity strength. “These benefits were maintained at six months at which time participates also experienced the additional significant benefits of increased confidence in their ability to adhere to exercise over time, a significant decrease in lower extremity joint pain, and a marginally significant increase in their confidence in their ability to manage arthritis pain” (Fit & Strong, 2016).
Fit & Strong program consists of two different sets of activities. The first is exercise. This includes warming up and participating in stretching exercises for fifteen minutes. Stretching is then followed by fitness walking for twenty minutes. Lower extremity strengthening and resistance exercises are then conducted for twenty minutes. This is followed by a five minute cool-down. The second part of the Fit & Strong program is a group discussion and health education. Topics for discussion consist of physical activity, motivation for living a physically active lifestyle and problem-solving barriers when it comes to participating in physical activity (Fit & Strong, 2016).
Walk With Ease (WWE)
The Walk with Ease (WWE) program is developed by the Arthritis Foundation and the University of North Carolina. The program was designed to teach participants to walk safely and develop healthy walking habits to incorporate in their daily routine. The program is offered in either a self-directed format or a group format. In the self-directed format, individuals walk on their own and read Walk with Ease books and manuals. The group format offers a group-setting were people walk and interact with one another in order to learn about the benefits of walking (Arthritis Foundation, 2016).
The Arthritis Foundation created Walk with Ease, a community-walking program to help increase physical activity. “Research shows that for an average person, walking an additional 5,000 to 7,000 steps a day has significant health benefits, cutting the risk for disease such as cancer, diabetes, osteoporosis and heat disease” (Arthritis Foundation, 2016). Walk with Ease consists of group sessions that meet for six weeks, three times a week. A pre-walk discussion consists of health related topics that are related to exercise and/or arthritis. Then the group participates in a 10-40 minute walk. This time includes a warm-up and cool-down period. The Walk with Ease program is offered throughout several different states (Arthritis Foundation, 2016).
The Walk with Ease program also offers Walk with Ease in the Worksite program. It is a low-cost, six-week walking program that employers can integrate into their daily schedule. “Walk with Ease has been proven effective in increasing balance, reducing pain, improving mental health, flexibility and overall physical health” (Arthritis Foundation, 2016). Employers use this program in order to motivate and incentivizes their employees. It also helps improve the overall health of their employees, which in return, decreases the amount of days an employee misses throughout any given year (Arthritis Foundation, 2016).
The Childhood Obesity Prevention Coalition
The Childhood Obesity Prevention Coalition is a statewide organization focusing on the health of youth throughout the state of Washington. The Childhood Obesity Prevention Coalition is seeks to improve the environment for our children to live an active, healthy lifestyle. The coalition is presently addressing is healthier beverage choices for youth. The coalition has taken various efforts to decrease the amount of sugary drinks that are consumed by today’s youth. The statewide collation has also taken steps to increase access to health beverages for these young individuals (Childhood Obesity Prevention Coalition, 2016).
For example, the coalition requested one million dollars from the capital budget in order to place water bottle filling stations throughout schools. The coalition also created the Soda Free Sundays Campaign. Over 1,000 individuals and several different organizations throughout Seattle pledged to stop drinking sugary drinks to increase healthy beverage consumption. The hopes for these programs is that vending machines will eventually be replaced throughout public schools to decrease the amount of sugary substances today’s youth consumes (Childhood Obesity Prevention Coalition, 2016).
The state of Washington demonstrated other successes in implementing healthy foods throughout facilities. In 2013, the governor passed an Executive Order requiring healthful foods throughout all the vending machines in state facilities. Furthermore, the YMCA adopted the goal of a 100 percent healthy vending machine. This type of vending machine consists of apples and low-fat string cheese. Other organizations throughout the state have also implemented the healthy vending goal. However, some organizations only apply this idea to 50 percent of their vending machines. Leaving the other half for unhealthy food choices (Childhood Obesity Prevention Coalition, 2016).
Chapter 4 Project Description
Description of the project
Resources for this project were identified using databases Google Scholar and CINHL, which both provided huge amounts of insight into the benefits of healthy eating projects in local areas. The search terms used to identify appropriate resources were “healthy eating”, “obesity”, and “projects” and “access”, as these were the most relevant to the project. Only resources less than ten years old were included as these are the most relevant to the current project. Resources were also identified using Google, as this allowed for access to specific information about Gratiot County in particular. This information was combined with the information from the meeting described above.
Remember that Chapter 4 describes your methodology and timeline related to how you conducted your project from inception through implementation and completion (what are the major steps and when did they occur. So, before describing Gratiot County’s resources you need to share that you met with your community partner, Shanna- MidMichigan Health Gratiot on (whenever was your initial meeting date) to discuss the community health needs of Gratiot County. At that meeting you were provided with the Live Well Gratiot Community Health Improvement Plan (CHIP) has 4 priority issues Obesity, Mental Health, Substance Abuse, utilization of Health Services. As obesity has far reaching population health implications you chose to focus upon obesity and access to recreational resources and healthy food sources in Gratiot County. You then began your secondary research using the following databases: here is where you identify if you used google scholar, Cinhal, Proquest, etc. and then identify your search terms and any parameters or limitations (i.e. articles no earlier than 2010, etc).
Gratiot County Resources
Gyms
A sufficient amount of physical activity is recommended to keep our bodies fit and healthy. Gyms and fitness centers provide equipment and classes to help build healthier and stronger bodies. Table 1 identifies t the available fitness centers and gyms that Gratiot community member can easily get access withaccess with information of their addresses, prices and operation hours.
Gratiot County residents have several choices withchoices with gyms and fitness centers. Endurance Fitness Center of Alma offers cardio machines, group classes and strength training. The fitness center also offers a wide variety of classes that residents can choice from and utilize. They also offer 24-hour access for members. Snap offers 24-hour access to members as well, however, Snap Fitness offers personal trainers. Stay Fit Gratiot County offers residents something a little different. While they do have 24-hour access for members, they also give residents the option of only using the fitness center during lunch time and pay for hours used. In other words, residents are able to utilize the fitness center and all of the equipment for fifteen dollars per month. This gives individuals a gym option that does not require a membership.
Parks
Parks can be a good choice for community members to walk, and, and participate in recreational activities with their families for example hiking, golfing and biking. Table 2 lists several park choices for Gratiot community members to consider going during their leisure time.
There are several parks in Gratiot County that residents can utilize. For example, Reed County Park is a 100-acre park withpark trailswith trails and different picnic pavilions. It also has an 18-hole golf course. There are beaches and playgrounds offeringplaygrounds offering physical activity for children and young adults. It is a free park open to the public from the hours of 8am till 9pm. HubscherHubster Park is a small park. It only has 60 acres and has a man-made lake. Unlike the forest trails that Reed County Park offers, HubscherHubster Park consists of open space giving Gratiot County residentsCounty residents a selection of environments to choice from.
For those individuals interested in different kinds of activities, Gratiot County offers canoe and bike trails. . The Pine River Canoe Trail is a 30 mile canoe trail extendingtrail extending through the flood plain forests of Gratiot County. Alma Mountain Bike Trail is also in the Pine River Park & Outdoor Center. It offers a 2.5 mile single bike trail. The trail is comprisedis comprised of six different sections, all offering different terrain. The first three sections are of average difficulty and the trails gradually become more difficult throughout the remaining sections. Both the bike and canoe trail are located in Pine River Park. The park offers residents amenities in itself. The park has picnic facilities and a nature trail. The park is also wheelchair accessible at LuneackLonick Landing.
Farm Markets and Grocery Stores
Consuming healthy food is essential to maintain physical wellbeing and lead a healthy lifestyle. A well-balanced nutritious diet along with physical exercise serves as the foundation of a healthy body. Fresh fruits and vegetables play an essential part in preventing illnesses. The U.S. Department of Agriculture recommends having at least half plate of fruits and vegetables each meal. Taking the suggested amount of fresh fruits and vegetables can meet the body’s needs of vitamins, antioxidants and minerals that can reduce the risk of chronic diseases.
There are two farmers markets located in Gratiot County: Alma Farmers’ Market and Ithaca Farmers Market. Both offer residents a wide variety of healthy and organic products. Both provideBoth provide an array of fresh fruits and vegetables, as well as aas a variety of baked goods. There are, however, notable, notable limitations with these farmers markets. First, they are only open during the summer months. Second, they are only open for a couple of hours each week during those months. This makes it difficult for people to have access to fresh fruit during the off-season and if their schedules conflict with those of the markets.
However, there is also a Wal-Mart located in Alma offeringAlma offering several fresh food options. Wal-Mart is open 24 hours, making it easy for people to have access to fresh food 24 hours a day. This gives residents a healthy alternative to fast food during all hours of the day. Wal-Mart may not offer residentsoffer residents as abundant organicabundant organic produce as the farmers markets, however, the fruits and vegetables that Wal-Mart and Meijer is preferable over fast food.
Implementing Programs in Gratiot County
Gratiot County can benefit from taking example by the health and fitness programs that are being adopted among the nation for instance Fit & Strong, Walk with Ease and Health Vending.
Fit & Strong
Implementing Fit & Strong into Gratiot County would not be difficult. It is recommended that the class containclass contain no more thanmore than 25 participants. With 20 participants, the estimated price per person would be $88. This may be considered to be a high price, however, this price includes ankle weights, exercise bands, mats, and the participant manuals. This estimated cost is for an eightan eight-week program (24-90 minute sessions held three different times a week). The program requiresprogram requires a certified exercise instructor, either paid or a volunteer. The approximate cost for a certified exercise instructor would be $1,650 for1,650 for the eight week program, i.e. 55 hours at $30/hour (F&S Implementation Guide, 2014).
Recruitment would be relatively easy. Newspapers, television and radio can all be utilized to create awareness of the program. Also, conducting a free class of the Fit & Strong program may increase individualincrease individual willingness to register for the program. Ads can be place throughout the county describingcounty describing the program whoprogram who it is targeting, and where it is located. All of the above can help to create awareness for the program.
The program can be conducted at any of the parks or gyms located in Gratiot County. If individuals did not want to pay for gym memberships, then they could utilize what the free parks have to offer. The only physical requirement of the Fit & Strong program is a flat place to stretch and participate in resistance exercises. The program also requires walking that can easily be accomplished at all parks throughout Gratiot County.AsCounty. As previously mentioned, the local gyms also offer these amenities. However, there are additional costs when utilizing these facilities.
Outcome Assessment/ Program Impact
Measuring and evaluating the program must be completed to assure it is meeting target goals. It is recommended that Fit & Strong trainers conduct assessments between weeks two and four of the programs. This willThis will ensure bothensure both the instructor and the participants are meeting their respective objectives with thewith the essential components of the program. At the program’s completion,ecompletion participants also completealso complete an outcome assessment. This assessment allows an individual to see where they compare to other individuals who have participated in the Fit & Strong program. “The outcome assessment includes five key outcomes: participation in exercise, lower-extremity pain, lower-extremity stiffness, energy/fatigue and self-efficacy for exercise” (F&S Implementation Guide, 2014, p.3).
Walk with Ease
Walk with Ease can also be easily implemented in Gratiot County. Similar to Fitto Fit & Strong, the program must be advertised through any media means possible forpossible for individuals to gain awareness of the program. Furthermore, Walk with Ease can be conducted at any of the gyms or parks located throughout Gratiot County. Individuals can choose whether or not to participate in the six-week program individually or with a group of other people.
Outcome Assessment/ Program Impact
The program’s success can be measured by a self-reported survey in which participates fill out prior to and after the six-week program. Gratiot County can also encourage businesses to participate in Walk with Ease in the Workplace. Not only would they be improving the overall health of their employees, Walk with Ease has been also shown to motivate individuals while they are at work (Arthritis Foundation, 2016).
Healthy vending
Similar to the state of Washington, Gratiot County could implement a county wide program to replace unhealthy food and drinks in vending machines with healthier alternative. Compared to the state of Michigan, Gratiot County high school students consume more soda and sugary drinks than high school students throughout the rest of the state. Replacing healthier alternatives in schools may help decrease the likelihood these individuals will incorporate soda or unhealthy sugary drinks into their diet.
In Washington, state government took action and required state facilities to replace their vending machines with 100 percent healthy vending. Some private facilities took it upon themselves tothemselves becameto become part of the initiative as well. While some organizations fully implemented 100 percent healthy vending, other organizations only replaced 50 percent of their vending machines with healthy vending choices. Furthermore, some counties throughout the state of Washington required their schools to replace their vending machines with healthy vending, giving students a healthy alternative to sugary foods and drinks.
Gratiot County could implement a similar strategy to encourage healthy eating throughout the youth population. Even replacing 50 percent of school vending machine with healthy food would help increase the amount of people who choose healthy food over unhealthy alternative. Replacing 100 percent of the vending machines with healthy food would greatlywould greatly diminish the ability that high school students have to access to unhealthy food choices, like soda or other sugary drinks.
Outcome Assessment/ Program Impact
If the entire community implements this strategy throughout all of their schools, then measurements could be taken in order to access the impact healthy vending has on high school student and youth obesity. Obesity is easily measured through a combination of weight and BMI measurements from high school students. It may also be useful to include a qualitative survey to assess the views of these students on the availability of healthy food vending machines and the impact that this has had on their ability to eat better quality food. It will also provide insight into the actual effects of healthy eating availability on obesity, as respondents can describe how the availability of these foods have had an impact on both their weight and their activity levels.
The state of Washington has demonstrated tremendous success with their healthy vending program. This project has allowed individuals better access to healthy food choices, which in turn has had a positive impact on their weight. Johnson & Smith (2006) notes that the Washington State Nutrition and Physical Activity Plan provides a useful framework for policy makers to assess the needs of the community and the best approaches to reducing the incidence of obesity in a geographical area. In Moses Lake, Washington State, there has been a significant decrease in the number of individuals that are obese as a result of the plan, which suggests that it can be used to improve the health of others in similar towns (Johnson & Smith, 2006). Each day, more businesses and individuals participate in the healthy vending program by increasing the amount of healthy food that is sold in vending machines throughout the state.
Chapter 5 Conclusions and Lessons Learned
Recommendations to Mid-Michigan Gratiot
With the increasing number of obese individuals throughout Gratiot County, actions could be taken to implement these programs throughout the county. One area obese adults in Gratiot County could focus upon is to replace their sedentary lifestyles with greater recreational activity . activity. The Walk with Ease program focuses on sedentary adults and is designed to motivate them to walk throughout the day. Obese youth throughout Gratiot County couldCounty could decrease the number of sugary drinks in their diet and increase their physical activity. Schools should evaluateshould evaluate their vending machine selections and consider adding items with nutritional value to their options. All of the above programs target these two concern areas.
Both Fit & Strong and Walk with Ease are programs that can be implemented throughout the community and encourage individuals to incorporate walking in their daily lifestyle. These programs also educate individuals on the positive aspects of exercise and ways to eat healthier. By working together, the community can educate and encourage healthy living throughout the population. These programs also bring the community together, and therefore, strengthening the bonds within the community. If Gratiot County can properly implement these programs into their community then they should be able to successfully decrease the number of obese individuals throughout the county. These recommendations will be shared directly with my community partner representative, Shanna Hensler upon completion of this Capstone Paper.
Suggestions for Further Study
In this context, it would be useful for further study to assess the actual impact on health outcomes in terms of hospital admissions and survival rates. As hospitals are increasingly reimbursed based upon patient outcomes via the HVBP and the providers via the PVBP, these programs have the potential to improve not only the health of the community overall but also the reimbursement rates for hospitals. Further research should include an investigation of the number of obesity-related admissions and deaths in the local area before, during, and after the implementation of these vending machines to give real insight into how well the program is working in the area. These hospital admission data will also highlight the need for further changes to the study in cases of failure, which is highly important in terms of ensuring that population health needs are met and the goals of the ACA to focus on community health are considered when implementing programs such as this.
Further study needs to include further evaluating the success of each program instituted in Gratiot County. It would be beneficial to collect both qualitative and quantitative data about how the residents feel the program has impacted on their health since it has been instituted. This would give an insight into the psychological effects of these programs as well as the physiological measured by BMI and weight. The Community Mapping and Community Health Needs Assessment can be used as a basis for providing insight into these topics in Gratiot County as they are required by the ACA and IRC 501(r) as systems of measurements. The ACA also has a strong focus on population health, which means that implementing this type of program fits into both state and national-level goals from improving health from a holistic perspective. As noted above, obesity is one of the biggest issues facing health providers in the United States, so further study on the topic of small-scale implementation of healthy food vending can provide a huge amount of insight into solving the problem on a national level.
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