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>>> hello.and welcome to public health live.the third thursday breakfast broadcast.before we get started i would like to ask that you please fillout your online registration after the broadcast.your feedback is helpful in planning future programs.we encourage you to let us know how to best meet your needs.today is prevention agenda, for community action to improvehealth in fork state. our guests are the president ofthe new york academy of medicine

and sylvia, the director of theoffice of public health practice at the new york state departmentof health. thank you so much for beinghere. >> thank you.>> new york's plan to improve the health of all new yorkers,over the last few years, new york has been in the middle ofthe pack in national rankings of population health status.new york state ranks 18 in america's health rankings, butnew yorkers should have good health and as good of quality oflife as those in the top ranked

states.you, new york's public leadership, are key inimplementing a strategy. we're going to take thisopportunity to watch a short video discussing prevention.let's take a look. >> new york academy of medicinewas established in 1847 by a group of physicians who wereconcerned about the quality of care in new york and since thenwe've been very involved in a whole series of important publichealth issues in the city. our current priorities arehealthy aging, prevention and

eliminating health disparities.prevention is, we believe, the key to improving the health ofthe population. it's wonderful to provide accessto care and treatment to people when they're sick, but it's alsoimportant to try to avert disease whenever possible toprevent suffering and health care expenditures.>> there are two important ways of intervening on prevention.one is personal prevention. the second very important areaand the evidence that's increasing about how importantthis is community-based

prevention.>> there's very good evidence that preventive activity makes adifference and increasing prevention in tobacco, exercise,alcohol, to create healthier communities that make thehealthy choice the easy choice for everyone.the. >> prevention has really becomea critical part of improving health care, and in new yorkstate, governor cuomo and commissioner shaw have been atthe leading edge for the health care system through prevention.let's take a moment to hear from

dr. shaw.>> why is it important for new york state to have a preventionagenda? >> well, we need to worktogether to focus our priorities to make any progress.five years ago, we had a prevention agenda that focusedon ten areas. this time we're working onfocusing on five areas, and really making progress in shortterms on measurable evidence-based programs andpolicies that will help improve the health of all new yorkers.our prevention agenda focuses on

five areas.first, on the promotion of healthy and safe environments,the prevention of chronic diseases, the promotion ofhealthy women, infants and children, promotion of mentalhealth and prevention of substance abuse, and theprevention of hiv, stds, vaccine preventable diseases andhealth care facilitated infections.what's new about the prevention agenda of 2013 through 2017?well, this time we were able to work with over 140 differentgroups from across all of the

communities of new york,including local public health, hospitals, primary care systems,to come together on what our agenda should be.the five areas that we selected were at the end of the daysomething that we all selected together.that's where the evidence is greatest, where we are best ableto measure things over time, and make an impact over time.why is collaboration so important?you know, in the old days, it was all about creating nichesand competing.

today we know that success onlycomes from sharing and collaborating.just look at facebook, look at open government initiatives.and for us, we decided that the prevention agenda has to embracethese principles, and it will only serve as a guide to localhealth departments and mobilize the community partners to assesshealth status, identify local priorities and develop andimplement intervention to address these priorities if we can getcollaboration working across the spectrum.hospitals and local health

departments are doing this inconjunction with required community health assessments,community health improvement plans, and community serviceplans. in these tough economic times,one may ask, how can we take on these added roles andresponsibilities? the answer is, we can't affordnot to take on these roles and responsibilities.by focusing on a smaller set of priorities, we can actually movethe needle much further than each of us working independentlyon our own separate programs

that collectively don't make theimpact. so what is my vision for newyork state? under governor cuomo'sleadership, we've made significant strides in improvingthe delivery of health care services thu our medicaidprogram and improving access by building a health benefitexchange. but we know that the health caredelivery system is only responsible for up to 20% ofhealth. the social determinants ofhealth, our behaviors and the

environment influence a vastamount greater than the 20% of the health care delivery system.our hope with the state health improvement plan is to focus onthe behaviors and the environment, and improve thoseover time to impact health in a much greater degree than justthe health care delivery system. thank you.>> so it was really great to see both of those videos.it sets the context for what we're talking about.it's clear from both of the video that new york state isreally working towards a

prevention orientation.sylvia, dr. shaw mentioned the importance of workingcollaboratively, and working where the evidence base isgreatest so we can make the most amount of progress andmeasurable progress over time. can you tell us about some ofthe urgent health issues driving the agenda?>> certainly, rachel. let's look at some of data thatillustrates where the need is most important.you can see some of the most severe outcomes.this graph shows the number of

deaths for some of the leadingcauses of death per 100,000 new yorkers over the last ten years.heart disease, cancer, chronic disease and stroke are allchronic conditions that are largely preventable andaddressed by one of our priorities.pneumonia and influenza are vaccine preventable diseases andfall under the fifth group, prevent hiv, sexuallytransmitted diseases and health care acquired infections.unintentional injuries round out the group and are oftenbehaviorally modifiable.

the one that promotes a healthyand safe environment, and another one promoting mentalhealth and preventing substance abuse.>> so when we look at that big picture and leading causes ofdeath, how many of them would you say are preventable if wewere able to modify behaviors? >> a national study published inthe march 2004 journal of the american medical associationfound that 46% of actual deaths, causes of death are attributableto eight modifiable behaviors. the slide shows the estimatednumber of deaths in new york

state, tobacco, physicalactivity and alcohol contributed the most, and each of thoseeight behaviors that you see in the slide link to one or more ofthe five priorities of the new prevention agenda.>> now, in looking at that chart, tobacco is leading thepack this, if you will. >> it is.>> can you talk to us a little bit about tobacco use in newyork state? >> certainly.you're going to see in the next slide the age adjustedpercentage of smokers in new

york state.the darker the color on the map, the higher the rate.the overall current smoking rate for the state in 2009 was 17%.but what you see on the map is that some geographic disparitiesexist. the county rates vary from thelowest rate of 9.7% among rockland county residents in thehudson valley to the highest rate of almost 31% in shamungcounty residents in the southern tier.in general, our upstate counties had higher rates of currentsmokers.

>> now, when we hook at thesedifferent health conditions, whether it's tobacco use orotherwise, it's true that they don't affect all new yorkers atthe same rate or they don't affect all new yorkers equally?>> correct. we have a lot of disparities inhealth conditions in new york state.we have unacceptable disparities, for example, forpeople who have health disabilities, and the next slidewill show you the disparities for that group compared to thosepeople who don't have health

disabilities.so the blue bars are those -- are the indicators, the rates ofdisease for cigarette smoking, for example, or obesity forthose with disabilities, and the red bars are the rates for thosewithout disabilities. so you see in some cases almostdouble the rate of these diseases.>> which is pretty -- that's a pretty staggering disparity tolook at, to look at the chart like that.now, there are other conditions as well that disproportionatelyaffect other groups.

can you talk about some ofthose? >> sure.we have many disparities in many diseases in new york,unfortunately. health disparities exist fordifferent outcomes such as premature death, before the ageof 75 for the american indian group versus the whitenonhispanics, high breast cancer incidence on whites versusothers. heart disease death rate hasjust gone up. even though the rates have beendeclining over the past decade

for all racial ethnic groups,the disparity still exists. in 2009, the heart disease ratewas two and a half times higher than the black nonhispanicgroup, compared to the asian nonhispanic group at the bottomof the slide in the dark red color.>> big pictures to look at with the different disparities youtalked about. >> absolutely.>> joe, in addition to looking at the disparities, what elsewent into the consideration when you were developing the newprevention agenda?

>> we really wanted to start bylooking at what worked and didn't work between 2008 and2012. and at that time, as thecommissioner said, it included ten priorities.we decided to narrow in on five priority areas for this part ofthe plan. so as he said, to get moreconcerted action to see the results at the community level.collaboration was an important theme, for the first preventionagenda. the but in fact, the plan waslargely developed by the state

health department and we didbring in a group of organizations and individualsstatewide to help with implementation.and we knew we needed to start this process earlier, this timearound. as we looked at the outcomesreported at the local level of the planning process, it wasclear that many local communities, the hospitaldirectors, the public health department directors did worktogether. but it others, it was moredifficult.

and in many as well, they werenot able to bring a lot of other community institutions, orindividuals to the table. so that had to be a focus ofconcern. and part of the reason was theyneeded more support, more technical assistance on thepartnership issue, on setting priorities, on implementing --developing implementation plans and evaluation.we paid a lot of attention to that in this new plan.>> so how was the development of the plan different this timearound?

>> well, we started with theplan really being led from the very beginning by an add hockcommittee of individuals and organizations statewide.they were officially appointed by the public health and healthplanning council. they had this status in workingin partnership with the health committee members, and includedkey leaders around the state, in the hospital industry, inhealth -- public health and professional associations, statenetworks of advocacy groups concerned about various healthissues, professional

associations, and the businesscommunity. this group met four times duringthe course of about 18 months to really help shape the initiativefrom the beginning. and they reviewed and approvedthe final draft of the report before it went to the statepublic health and health planning council in december.>> it seems like you certainly got a lot of people involved inthe process. can you tell us why it is soimportant to have such a large group of people helping to forma new plan?

>> well, broad participation isreally important because of the creation of the -- in creatingthe plan, we really wanted to tackle the many determinants ofhealth beyond the personal health care system.so this diagram that's going up is from a very important paperfrom whitehead. if you look in the circle in themiddle, we're really born with some kind of attributes thatcan't be changed, age, sex, ethnicity.as soon as the child is born, these influences from theirfamilies, from their

communities, begin to have astrong influence on their health status.and when we move out into the community, we begin to see thatwider influences on health that shape resources available incommunities like housing, workplace conditions, crime, andpublic safety, and the availability of healthy food andplaces to exercise, are all shaped by health policy.the weight of the evidence is getting to be pretty convincingthat we've got to act on these factors if we're going to seeresults in the communities'

health.>> isn't the health agenda, the prevention agenda really agovernment initiative, though is this.>> not really. some people say, i think we'veseen in new york, while the governmental public healthagencies are sort of the backbone of the public healthsystem, the concept now is that the public health system reallyhas to include multiple stakeholders.and the next diagram you can see the model that's really beenbuilt by the u.s. institute of

medicine.and it really states that you've got to try to identify for anyparticular health issue where the resources are in a givencommunity, to develop a plan and to begin to implement the plan.again, you see the same list of stakeholders, business academia,committee-based organizations, the health care delivery systemwhich in new york is a major factor.and the challenge of developing the prevention agenda will bereally aligning the interests of all of these potential actors atthe community level to really

get the highest health resultsfor individuals and for that community.>> i have to say, listening to everything you've just shared,the scope of this sounds very ambitious.>> it is ambitious, and i think happily we were able to reallytake advantage of what we've learned since the last time theprevention agenda came through. we've really been using a modelthat requires each of the teams and groups ta are looking at thebig five goals for new york state to really look at a widerange of intervention.

so we've been using this pyramidstructure, which was developed out of the centers for diseasecontrol as framework for action at the five levels of publichealth systems. one is if you start at the top,we see the engagement with personal counseling andpreventive services, which are emphasized certainly in the newhealth care reform at the national level, such asimmunization. as we begin to move further downthe pyramid, we see that we bring individuals into lookingat the circumstances they live

in in their communities, how canwe change environments, clean water, safe roads, availabilityof healthy foods so the healthy choice is the easy choice forthem. as we move even further down, wereally confront this sort of outer circle, if you will, ofthe last diagram where the policies that create theconditions in communities become more important.so every plan for each of the five objectives really has toinclude action at each of these levels, because if we can act inthe -- at the same time and

align our interventions, we havea much better chance of making a difference.>> i understand there are efforts that have been made toquantify or evaluate how the community factors affect healthoutcomes as well. can you talk to us about that?>> yeah. there is a very interestingproject out of the population health institute at theuniversity of wisconsin called county health rankings.and they have produced a report for each of the states,including new york, over the

last three years, and thisreport really tries to illustrate how importantcommunity conditions are in influencing the state of healthof individuals. so if we look at the diagramthat kind of lays out these variables, if we start at thetop, the overall score really relates to health outcomes.the mortality rates in a community and the morbidityrates in community and how they rank within the state.these are developed by equal weightings of what are calledhealth factors.

if you look down the middle ofthe diagram, you see the issues of health behaviors, clinicalcare, social and economic factors, and the physicalenvironment. each of those are furtherdefined on the right-hand column.so a score is possible for each of these areas, and theweighting, as i mentioned, really reflects, again, thispyramid, this impact that we know of acting at the individualas well as at the policy level. so the scores are aggregated.and they yield scores for each

county.and then we can begin to develop a map, such as you see here,which is the 2013 map of new york state's rankings.and the dark green are the counties which are having theworst time with these health and social variables, and many ofthe causes are often related to poverty.and these are important issues that require concerted actionwithin the community, and also the kind of policy support thatwe hope the prevention agenda will help to motivate.>> this is a helpful way to

conceptualize what you'retalking about and see in green on our slide, but in black andwhite, really, how these issues affect different communities.so what is the -- you've got the broad partnership of all thesepeople invested in the prevention agenda.what do you really hope to accomplish?>> well, this broad-based group that i mentioned was developedfor four goals for the plan. we want to see certain thingshappen while this process is ongoing.the first, of course, is the

overall purpose, which is toimprove the health status of all new yorkers in the five selectedareas, and especially to tackle the issue of health disparities.the we sort of agree on a vision of making new york thehealthiest state, as you said, getting it out of the middle ofthe pack. the second goal is really tobegin to tackle these broader determinants of health, and thedetermine of all policies is often used to help reflect thefact that in the areas of agriculture or food safety orhousing or transportation, air

quality, there are decisionsthat can be made if all of those areas, in a particular programor program, is this going to help promote health.and our job is to really get these other actors to understandhow what they're doing can really contribute to the healthagenda. the third area is that we wantto leave behind a very much stronger public healthinfrastructure at the state and local level.we know that public health is not as well funded as we'd like.and the public health agencies

are really pulling together hereto get results, including the involvement of the department ofmental health, and the office of youth services which are engagedin the fourth goal area of the state plan.the partnerships that have to be created among all of the actorsthat we've talked about, we want to see them sustained, so itisn't a one-off exercise, that they get together pause theyhave to submit a report to the state.but they really begin to develop relationships and see thatworking together in the

community, they can make anenormous difference. and finally, as this diversegroup sat around, the ad hoc group, we realized we probablyweren't making a strong enough case of public health andprevention. so we really had to think abouthow to you make the case to business, how do you make thecase to those who aren't as familiar or as committed to ourinterests. and one of the reallysignificant things is, again, an increasing understanding of whatyou might call the return on

investment for every dollarinvested in community based preventive services on thingslike tobacco, exercise and diet that sylvia mentioned.there's a possibility for all pair savings of almost $6.this can happen in a fairly short time period, two to fiveyears, and this is very different understanding of whatthe time frame for real prevention results than we'vehad in the past. so it's very encouraging andgets people motivated. >> excellent.so how does this fit in with

other health initiatives at thefederal, state or even local level?>> well, we looked at those, because context is everythingwhen you're trying to start an initiative.the first thing we did is really look at the national health carereform, and the affordable care act really does provide a lot ofmessages and a lot of unprecedented funding forpreventive services. and this is certainlyinfluencing the state waiver and the state application.we can see that in the medicaid

redesign program.for example, individuals now should be getting ageappropriate preventive services without any co-pay regardless oftheir insurer. and that's a huge change.the agenda also tries to align local programming efforts, andbuild up on those programs. for example, the state healthdepartment with state and federal funding supportsprograms like healthy heart, or asthma control, or maternalchild health initiatives and vaccination.and the prevention agenda really

hopes to be a call for action tohelp those groups really see how they can connect their own planswith the state prevention agenda, especially in their owncommunities. because that's really theessence of success of this program.and the work will be anchored by the community service planningand local health departments, community health assessments,which the state has asked the hospitals and local healthdirectors to conduct. >> sylvia, can you talk to us alittle bit about the local

community health planningefforts? >> certainly.and dr. shaw talked about this as well.we have required in new york state that local healthdepartments and hospitals conduct community healthassessments and planning at least until 198 #.what's new this year is the prevention agenda is requiringthem to do this collaboratively. it provides a blueprint for howto assess health status, identify local priorities anddevelop a plan for addressing

them.we're really hoping it's the toolbox for them to take out intheir local communities. at the beginning of thisplanning process, in december, dr. shaw sent out a letter tohospitals and health departments requiring them to work togetheron this. and asked them to identify intheir process at least two prevention agenda prioritiesthat made sense based on the data in their community.one of them has to address a health disparity.that's how we're setting it up

this year for that localplanning. >> great.thank you. and some of the work that sylviadiscussed is happening close to us here in the capital region.we had the opportunity to speak with jim connelly about the youmatter program and some of the great work they're doing.they've recently hosted a press conference to address the youmatter campaign. the let's take a look at thatright now. >> our program, the you matterprogram in schenectady mirrors a

program i first saw in chicago.the health system in chicago for the past ten years has beenengaged in this kind of a program.the principle of it being there is a great deal of healthrelated data and a lot of different data bases.but that data sometimes does not cover significant diseases inthe community. in fact, sometimes it masks thediseases that exist in communities.and people who experience those diseases, that they don't haveanybody to advocate for them and

bring those diseases to light.the way to unmask this data to bring these things to light isto do a neighborhood by neighborhood door by door surveyto assess what people's needs are.i think what's different about this approach is it's not beingdriven by an institution. this is not an institutionalprogram in assessing the community's health.it is very much driven by the community.the hospitals and other health care providers are facilitatingit, enabling it, supporting it.

but it is not our particularprogram. we're not actually conductingthe program that's being conducted by a communitywidecoalition. it is a door-to-door survey asopposed to just looking at data bases and abstract in the data.it doesn't mean we won't look at the data, but it's meshed withperson-to-person interviews. what's different about ourinitiative is we're actually using people in theneighborhoods. we're having neighbors askneighbors these questions.

these very same people who areasking the questions can also be people who help screen theanswers. they'll be able to determinewhen an answer is truly reflective of the same kinds ofhealth issues they're facing and making sure the answers aretruthful and accurate. people will not need to use thehospitals as much, the e.r.s as often.and that's a good thing, because it will drive down consumptionand drive down health care costs.of course, in the short run,

that may hurt us, becauseobviously things that we get paid for will disappear, but wehave to adjust our business model.i think this program aligns with the prevention agenda, becausemany of the things that the prevention agenda called for aresort of cornerstones of this community health initiative,trying to keep the population well.so we are carrying out at the grass roots level all the thingsthat have been identified at the federal and then state andcounty levels, and then we have

worked with the county in thepast to roll it out into our community.in terms of the principles of what you're trying to do, ithink aligns perfectly with those health principles, thosehealth guidelines. in terms of collaboration withthe community in creating collaborative community planningprocess, this is much better than this.because a lot of time and attention has been paid to thisinitiative, because even though ellis is involved, even thoughhometown health is involved,

even though the department ofhealth is involved, it is a community-driven organization.and it's very, very apparent that the institutions are not incontrol of this thing, facilitating it.>> so it's clear to me at least that schenectady county andellis hospital are very important in getting thecollaboration. sylvia, can you talk about howthe five specific priority areas were identified, and how localcommunities can use that information in developing theirown or addressing their own

priorities?>> certainly. jo talked a little bit about thead hoc committee that we had that helped identify the fivepriorities based on that data. the once the priorities wereselected, we invited a whole host of additional people, therewere over 200 actually, from a wide range of sectors to developthe priority-specific plans. we had slept participation fromcolleagues in public health, in medicine, community-basedorganizations, several business representatives, some media.so we really, again, did that

collaboration that made such adifference. we organized these people intofive different committees, one for each priority.they were chaired by pairs of people, one from the governmentsector, one from nongovernment. and they led a process overseveral intensive months, july through september, to developpriority-specific action plans for each priority.we had a steering committee made up of the chairs of each of thefive committees and other people to keep us moving.and we were funded in part by

the robert wood johnsonfoundation, which supported our efforts.>> can you describe for me and for the audience, what is ineach of the priority action plans?>> certainly. we developed a set of tools foreach priority area. and they include the following.for each priority area, we have focus areas, we then have goals,measurable objectives or metrics for each of the goals, and a setof evidence-based interventions. those are sorted both by thesector, or the stakeholder group

and then by the health impactpyramid that jo talked about. and before walking you throughan example of this tool for the disease priority, i want tospend a few minutes talking about intervention.>> sure, i think that would be great.>> the list of interventions are evidence-based approaches forconsideration. the purpose was to suggestactions for consideration at the local level, but not to beprescriptive. included in the list ofinterventions are the background

resources where you can learnmore about them and how to adapt them in your community.each community is going to consider circumstances beforeselecting the interventions from the menu provided.we are anticipating partners sitting around these localtables will expand and refine the lists through theirimplementation. now, i want to walk through acomplete example of one priority area for chronic disease, so youcan see what's included. >> sure, i think that would bereally helpful to illustrate how

this will all come together.>> okay. so for the prevent chronicdisease priority, there were three focus areas.the first has to do with reducing obesity in children andadults, the second has to do with addressing to ba could,tobacco use and secondhand smoke.the second has to do with access to high quality diseaseprevention and management in both clinical and communitysettings. so i'm going to talk aboutreducing obesity in children and

adults, which as you saw in theother slide is a huge factor in contributing to illness in newyork state. one of the goals for the reduceobesity in children and adults is to create communityenvironments that support healthy food and beverage choicesand physical activity. that's the goal area there.and we after several objectives for this goal.i'm showing you here just one. we have an overall objective foradults, which you can see is to reduce by 5% the rate ofobesity.

and then we have somesubobjectives, for those people with low incomes under $25,000,and another one for people with disabilities.again, you saw the previous slight on disparities thatpeople with disabilities suffered disproportionately fromobesity. we wanted to have a specificmeasurable goal so we can track our progress in addressing it.and then we move on to interventions.for the particular focus area of reducing obesity in children andadults, we have sort of the

interventions by that pyramidthat dr. buford discussed earlier.what you're seeing here is the top of the pyramid.here are some of the interventions for reducingobesity in children and adults in, say, the second levelclinical interventions. we want those in the clinicalfield to increase the capacity of primary care in treatmentmeasures and prevention for obesity.again, there are many more interventions in the plan.these are just a couple you

could choose from.and then the next slide shows the bottom of the pyramid, whereyou can see interventions to implement that relate tochanging the context to make individual decisions healthy.jo spoke about this. this is about improving thecommunity so people can milwaukee the healthy decision.we focused on business model in this case that support increaseof healthy, locally-grown food. the socioeconomic factors, whichas difficult as it might be to address, we have to focus onthat as well.

it's best to intervene in asmany levels of the pyramid as possible to have the biggesteffect. >> and there are interventionsby sectors as well? >> yes.so we also sorted them the second way by sector.when developing a local plan, those community groups at thetable will be able to say, if i'm a health carerepresentative, here's something i can do.adopt hospital policies to change the food we serve in ourcafeteria to both the public

that comes in and to thepatients who are served in that hospital.that's a huge effort. >> sure.>> media can support us by doing public service announcements topromote healthy eating or breast-feeding.then you can see the other slides as well.there's interventions for academia, for governmentagencies, and then finally, the final slide in this group forthe nongovernmental sector, policymakers who are veryimportant, communities and

philanthropy.we identified an evidence-based or promising practice for eachof the sectors we hope will play a role in the communitycollaborations. >> it seems like it's very welllaid out. a nice linear format for peopleto follow along and say, this is our goal, how do we get frompoint a to point b. >> that's what we're hoping for.we hope it's a useful document. the final slide i wanted toshare with you is back to the pyramid, where you can see allthe sectors that we really want

to engage.here you see all laid out what each sector's role can be inaddressing obesity prevention. and it's another way tosummarize what we've done. >> and i think looking at itthat way, it's a very helpful way for people to see where theyfit into the picture of moving things forward toward the goalsof the prevention agenda. i think that was a very helpfullook at the prevention agenda. i think it would be helpful toturn to an example of schenectady county and howthey've implemented a program to

some of the interventions we'vediscussed. let's listen to staff in thatprogram. >> this project really relatesto the decreasing the prevention items.here we're working with a group of individuals who aredevelopmentally disabled that are disproportionately affectedby chronic disease. this project really looks tomitigate that chronic disease by increasing our access to freshproduce. >> the pilot program thatstarted in 2010 involved around

70-plus individuals.it varied depending on the stage of the program.at the end of the program, we found that the vegetables weredistribute, i would say almost to every group home we have.there are 20 group homes. they were sent home to the grouphomes. they were sent to family homesas well as the participants living with their families orcaregivers, and they went back to the day programs.we benefited an incredible number of our participantsthrough this program.

we did note that they tended towant to eat vegetables on a more regular basis.>> we've got 20 houses. we try to send them to eachhouse. and i can see they eathealthier. because they ask for vegetablesnow. >> i love it here.it relaxes me so much. i grow vegetables, flowers.i get my hands dirty. >> the collaboration betweenschenectady ars and the public health services is a newpartnership we've developed over

the last three years.that has proved invaluable to us in the strategic line forhealth. they've really taken theirexperience with horticulture and spread it throughout thecommunity and has been working with other partners as well.>> it's an economical program. we have a horticulturecoordinator who works side by side with the participantsthrough the entire growing process, teaching them how tocultivate a plant, harvest a plant.that's part of the requirement

and that's an in-kind expensethrough our agency, so that individual's providing thatservice and this becomes part of our day program.we obtained a small grant from the schenectady strategicalliance for health and we proceeded to the eat, grow andeat your own vegetables program. >> i was eating bad, really bad.and after i came here and we started eating -- now i'm eatinggreens. my health very much improvedjust by gardening and learning how to eat better.i can do a lot more stuff.

and i can eat a lot better.and i don't eat garbage. >> we're really looking atdesigning our community health improvement plan through ahealth equity lens. and looking at populations thatare underserved and highly affected.these innovative programs allow us to do that.>> it was really great for us to be able to go out there and talkto both those who started the program, who are working in theprogram and even put folks who are participating in theprogram.

i think it really helps to put aface on how this plan is coming into action.let's take a moment now to move beyond just chronic disease andtalk about some of the other priority areas.>> certainly. one of the priority areas thatwas new to include in a state health improvement plan was topromote the mental health priority area.it's not something usually that we in the health field thinkthat we can address, but this was really a great collaborationwith the office of mental health

and the office of alcohol andabuse. mental and emotional well-beingbe essential to the overall health.we have to include it in our plan.nationally at any given time, almost 1 in 5 young people isaffected by a mental or behavioral disorder.we're really focusing on prevention, not treatment inthis plan. >> excellent.and what about a goal around preventing infection or disease?>> yes.

so this is one of the moretraditional public health issues.but we've combined this, many of these into one here.we had, again, a broad range of stakeholders helping addressthis. new york remains at theepicenter of the hiv epidemic, ranking first in the number ofpersons living with hiv aids. the same behaviors andcharacteristics, places individuals in the area of stds.new york state, where we're below the national goals on ourimmunization rates for young

children, that's why this needsto continue to be a priority. and we're focusing on healthcare associated infections at this time as well, becausethey're preventable, and we continue to experience a largenumber of infections and associated deaths with those.>> sure. and what about promoting healthin women and infant children? >> included in this priorityarea is a recognition that key population indicators for thisarea have been stagnant recently.this area includes goals related

to reducing pre-term births andmaternal mortality, promoting breast-feeding, increasing useof comprehensive child care -- child health services across thestate, reducing dental issues, which are preventable.pregnancies for both teenagers and women.and women's health, not just maternal health, but increasinguse of health care and appropriate prevention for womenof all ages and all stages of their life.>> and what about, i know we had discussion earlier about therole of the environment and what

that plays in.it's not just the characteristics you're bornwith, but there are the environmental factors.how does that fit into the priority areas?>> the promote a healthy and safe environment tackled some ofthe more traditional environmental health issues,such as air quality and water quality.but also tackled the environment we build around ourselves fromhomes, to workplaces, to roads and parks.so they're really talking about

climate change, focus a littleon especially after superstorm sandy, this is a reallyimportant priority area. they also, as jo mentioned,included the word safe in this to focus on reducing bothintentional injuries, related to violence and unintentionalinjuries, especially as people age.this is an important area for many people around the state.>> it sounds like a lot of thought went into thesepriorities. they seem to be on point witheverything you're discussing so

far.but seems very ambitious. what are the plans to measureprogress on these goals? >> measurement andaccountability are at the heart of this effort.each committee has support from the public health informationgroup staff, helped to identify relevant indicators for eachfocus area. and came up with measurableobjectives. there are many measurableobjectives in the plan. we'll track 58 of them annually,so we'll be able to report on

those and keep track of ourprogress. >> and what data on healthindicators are available to counties to help them in theirplanning? >> the data that are availablefor counties are available on our website.we've identified data both at the statewide level and thecounty level. so what you're going to see onthe slide is an example of a prevention agenda countydashboard for albany county, and there's one for every othercounty in the state.

the link is on the slide.the table contains data for 65 individual prevention agendatracking indicators with baseline county data, and theoverall state targets for the end of the five-year period.so there's links to data tables, there's links to maps so you canbetter visualize what's going on in your county as well as othercounties. >> excellent.is there a prevention agenda website as well that you wantedto share? >> sure.there is indeed.

we've been working hard onimproving this. this is the -- part of thewebsite that you see here, and where the arrows show you is howto get to those dashboards and the data.>> excellent. just a reminder, we know thatsome of the images can be hard to see on the screen as it'sbroadcast to you, but all of the handouts are available on ourwebsite as well if any of it is not so easy to be seen on thescreen. now, it seems like there's beena tremendous amount of work

that's gone into developing theplan. but when we look at what theplan has laid out, i would imagine a lot of the really hardwork is going to come in the implementation.so can you talk to us a little bit about that?>> yeah. that's a focus of what i saidearlier. the things we found out lasttime around is that many communities had difficulties andchallenges. the work that sylvia and hercolleagues have done to create

these amazing resources i thinkwill help, because people can take them and adapt them totheir own situation. but part of -- while grounded inthe hospital and local health department responses, because ofthe state requirements, we've started a communications planwhich begins with the hospital. so a greater new york hospitalassociation, the new york state association have already begunwebinars, explaining to their constituency about the rolesthat they can play. there have been broad-basedpresentations, consultations

throughout the state to multipleaudiences. we've been really gratified athow the ad hoc leadership group have invited folks from thehealth department and from their colleagues to come and talkabout the agenda. we also -- the health departmentwill also be rolling out a communications plan which hasbeen funded by the johnson foundation, and with supportfrom the raven martin firm where experts in communicationsprocesses, we hope to really engage all of these multiplesectors in ways that help them

help us understand what healthmeans to them when you talk about it, and then help themunderstand the roles that they can play at the local level.the steps in the plan are -- really start with the idea ofunderstanding the health concerns of some of these othergroups. so in the slide that you'll see,the first step is really having conversations and reallyunderstanding what do they mean by health and what are theissues that are going to happen. the second step was reallydeveloping a strategy to

identify statewide and nationalopportunities to promote the prevention agenda.a third step is developing a tool kit, which we hope willalso be very helpful to communities in addressingdisparities. a set of media spokespersonswill be identified and trained. and we hope to get them on thecircuit and get them around so they can really share themessage with the communities. and finally, as you've seen,there will be continuous development of web content andmedia, and we really hope to --

we'll be seeking additionalfunding to really make the websites more interactive andcapable of collecting the good practices going on around thestate. and sharing it acrosscommunities. >> excellent.and one of the other things you had mentioned was technicalsupport. can you talk about that a littlebit? >> yeah.again, really looking at what wasn't available the last time.a proposal has been put out by

the health department asking fororganizations who can operate either at the regional orstatewide level to provide support to local communityhealth coalitions in their work on the prevention agenda.so they will use multiple techniques, meetings, we hopesome in person and webinars. the key topics will becoalition building and the challenging of the partnerships,especially the kind of broad-based partnerships we wantto see. identifying priorities and usingthe data sets that are available

to them to make it easier toidentify and design interventions.then finally, using continuous quality improvement approach tothe testing and implementation, and especially the measurementof performance on this agenda. so all of this work will begoing on over the next nine months, as the plans are reallybeing developed. and we hope to be able tocontinue, again, with additional funding, the technical supportduring the implementation phase. we've developed a very importantpartnership between the public

health council and the minorityhealth council on really working together to tackle the issue ofhealth disparities and develop specific framework and toolsthat local communities can use for that purpose.>> now, you've both covered a tremendous amount of informationtoday. so is there a place where peoplecan go for more information on new york state's preventionagenda? >> yeah.that's the home page of the new york state health department,now has on it a very big blue

button which we worked very hardto get there. it will be seen as your portalto the prevention agenda. push that button and you're in,and you can access all the materials that sylvia's shownand discussed about each of the five priority areas.and then there are a series of other resources in subsequentslides here to begin to answer some of the questions.some of them come from the state health department and othersvery importantly come from other hospital associations, communityhealth organizations at the

national and regional level.and then in the next slide, on data resources, again, thecounty rankings data, videos that may be available, obviouslythe records of telecasts and broadcasts like this will beavailable for the use of local communities.and we really hope to continue to develop the capability andflexibility of the website to serve the purposes of those whowill be working so hard together, and really breakingground in very important ways to implement the prevention agenda.>> great.

thank you so much, both of you,for all of the information you've covered.>> you're very welcome. >> we do have a couple ofquestions that we've gotten. so if you don't mind, the firstwas, how would you describe a health disparity?i live in a county that's predominantly white and i needclarification on how this information regarding healthdisparities affects me and relates to my county.>> that's a very good question. thank you, whoever asked it.health disparities is defined in

a health status betweendifferent population groups. sometimes it's measured by thedifference, sometimes the ratio of difference, you can do itdifferent ways. really what's important here iswe're talking about different population groups, not justracial ethnic minorities or majorities in some counties.we're talking about socioeconomic status, which isvery important, especially in rural communities.we're talking about people with disabilities.we're talking about zip codes in

some areas.so people who live in one part of town versus another part oftown. if people can demonstrate thatdisparity, sometimes it might be related to transportation, oraccess to the service. so i think people can describeand define the disparity, how it makes sense in their community.we're not just talking about race or ethnicity.>> i think that's a helpful way to clarify that.we have another question, what were some of the challenges thatyou saw in creating partnerships

at the local level?>> well, i think in talking with people who have been at this,this is the first round, and we're happy to hear i think thisis changing. originally in some communities,hospital leadership and the local public health leadershiphad never really talked to each other.sometimes they didn't know who the other one was.so i think in the first round of the prevention agenda, a lot ofthose barriers were broken down. and hopefully some of thoserelationships have been

sustained and are going to makeit much easier in the next round.i think the work of the hospital associations and public healthassociations in really raising the profile of the agenda andthe importance of these partnerships is kind of theanchor in communities, is going to be very important.the second challenge, which the ad hoc committee has been veryconcerned about is how do we bring those other groups thatwere in the bubbles that you've looked at to the table.and so we're hoping by also

involving the state levelnetworks of those organizations and community groups, andindividuals really, that they will then be able to tap intothe local chapter, to the local individuals.and really begin to come to the table and knock on the door ofthe local hospitals, or the public health director and say,i understand this prevention agenda is going through, i'mworking on obesity, i'm working on heart disease, i'm working onfood safety. and i want to be in theconversation.

and that those will besustained. so it's going to be a lot ofwork. we know some communities arealready doing it very successfully.>> schenectady, for example. >> yes, that's a great exampleof people of working in the right direction.>> we've heard that going through.the hope is that those that are working well will be able tospotlight what they're doing and share their experience withtheir colleagues and make it

easier for the others.>> excellent. it seems like a lot of reallygreat work is going to start happening.there's been a lot of work that went into developing the plan.i thank you both so much for sharing all of this with ourviewers. i think it's been tremendouslyhelpful. >> thank you.>> thanks for the opportunity. >> sure.and thank you very much for joining us today.please remember to fill out your

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