By Alice Yoder, RN, MSN, Director, Community Health and Wellness, Lancaster General Health
Unlike some states, Pennsylvania does not have county level health departments. Instead, Lancaster County is served by a regional health department that is responsible for the entire southeast portion of Pennsylvania. So, for some time, our community’s health has been a shared responsibility by a broad health collaborative with, often, Lancaster General Health, the local nonprofit hospital, at the center of initiatives and programs.
In the mid-90s, this loose collaborative decided to conduct our first county-wide health needs assessment. After the assessment, it was decided that Lancaster General Health would take on the responsibility of periodically conducting assessments and we have done so ever since.
For many reasons, this evolving community approach to health dramatically informed the way our hospital did business. Through the leadership of our President/CEO and Board of Trustees (BOT), community health improvement was elevated to a Board level committee. In fact, the chairperson of our community benefit* committee becomes the chair of the hospital’s entire board the following year. Our succession bylaws require our board chair to fully understand and be well versed in the importance of expanding our reach from the clinical setting into the community. Over the past 20 years, Lancaster General, the various BOTs, and each committee operated with the idea that good public health doesn’t happen solely in the clinical setting.
Another advantage to starting from health needs assessments is that we learned quickly how good data can help inform decisions. For instance, in 2000, our health needs assessment demonstrated that tobacco, in the form of cardiovascular disease, was taking a huge toll on our community. We also were aware that the Tobacco Master Settlement Agreement was about to start dispersing funds to localities.
With data from the assessment and support from the Master Settlement, we were able to create a community coalition – which included all four county hospitals, the county’s Drug and Alcohol Commission, district schools, local colleges and others – to implement best practices on preventing tobacco use, including ensuring people have access to tobacco dependence treatment and training healthcare providers to ask about tobacco use, advise cessation and refer patients to resources. In addition, we educated worksites and policy leaders on how to reduce exposure to secondhand smoke and created youth-based programs so tobacco use is not seen as the norm for our community. As a result, our county went from 23 percent tobacco usage to 13 percent among adults.
As we continued to conduct assessments, it became clear that obesity was surpassing tobacco as the county’s biggest health threat. Learning from our work on tobacco, Lancaster General Health, serving as a sort of integrator, began another community coalition called Lighten Up Lancaster. After about a year or so of work, we became aware of Community Transformation Grants (CTG), which focus on increasing clinical preventative services, healthy eating, healthy and safe physical environments, active living and tobacco free living.
Initial and pilot projects of Lighten Up Lancaster have included creating extensive awareness resources, managing the process of changing a city ordinance to allow mobile fresh food vendors to operate in residential neighborhoods, coordinating a training session for school wellness council coordinators from the 16 local school districts and developing a scorecard to track the level of obesity prevention awareness “impressions”. The scorecard project is of particular importance because, with obesity increasing at epidemic proportions, it is critical that our community understands the enormity of the problem. Heightened awareness of the health issue works to increase the number of adults and children maintaining a healthy weight.
In short, Lighten Up Lancaster promotes policy, system and environmental changes that will reduce obesity by focusing on complete streets, bikeability/walkability, increasing access to healthy foods and improving school district nutrition policies.
All of Lighten Up Lancaster’s members are committed to a concentrated, organized effort to fight obesity. Without their work, there would be only fragmented programs, probably focused on individual workplaces or schools. In reality, a broad-based approach is required to tackle this long term challenge through policy, systems and environmental changes focused on improving nutrition and increasing physical activity.
We have been successful in Lancaster for many reasons. We have great community organizations that come together when a problem has been identified. Lancaster General Health serves in the data collection and dissemination role in addition to community convener. Figure 1 highlights the establishment of collaboratives that focus on specific health issues. In addition to the Harm Reduction Coalition, some examples of “issue specific” coalitions are Lighten Up Lancaster Coalition, Tobacco-Free Coalition of Lancaster County, Mental Health Collaborative and Refugee Health Network to name a few.
With the advent of population health management and accountable care organizations, there has been increased emphasis on the work Lancaster community has been doing for some time. In short, it’s painfully clear that if you’re working to improve the health of a community you must include all the relevant partners, which boils down to basically every community group from education to commerce to transportation to traditional public health. In addition, there needs to be an organization that oversees all community resources and organizations, and, with data, can help create a plan to address the most pressing health needs of a community.
* More on “Community Benefit”
“In order for a nonprofit hospital to be exempt from federal income tax, they are required to provide community benefit. This is currently interpreted to mean providing community benefit programs — to support the health and public good of the community they serve. As of a review in 2009, a majority of community benefit funds were used to help pay for care for the uninsured or underinsured — supporting charity care, uncompensated care, means-tested payer discounted care and Medicare shortfalls represented approximately 72 percent of hospitals’ community benefit activities, while community health improvement and community building activities only represented approximately five percent of community benefit activities.”
“New [Community Benefit] requirements provide an opportunity for nonprofit hospitals across the country to re-evaluate and reconsider their current approach to community benefit programming, and assess how increased attention to community health improvement and prevention can help improve the health of their patients and lower health care costs.” – From Partner with Nonprofit Hospitals to Maximize Community Benefit Programs’ Impact on Prevention. For more information on Community Benefit, please see A Healthier America 2013: Strategies to Move from Sick Care to Health Care in Four Years.