Total Health: Public Health and Health Care in Action

February 12, 2013

Total Health: Public Health and Health Care in Action

By Tyler Norris, vice president, Total Health Partnerships, Kaiser Permanente


The burden of preventable chronic disease is placing significant strain on the physical and fiscal health of our nation. Nothing less than the long term well-being of the country is at stake. It is therefore incumbent on the health care sector to not only deliver the best patient outcomes at the lowest possible cost, but also to reduce demand on the healthcare system overall, and contribute to the health of our population by embracing prevention as a central element of providing value.

In everything we do at Kaiser Permanente, our aim is to measurably improve the health of our members and the communities we serve. As an integrated health care system serving more than nine million members in nine states and the District of Columbia, primary community prevention is a top priority. The National Committee for Quality Assurance recently published its annual 2012 report ranking health plans in three categories: Medicare, Medicaid and Private (Commercial). For the second year in a row, Kaiser Permanente’s three largest regions, totaling nearly seven million members, had the top three Medicare health plans in the nation. Our success demonstrates the dedication of our physicians and care teams working collaboratively to create a better, safer patient experience. But it also reflects our commitment to work with local, state, and national partners to prevent disease, improve population health status, and address the underlying determinants of health and drivers of disparities. We are committed to helping our members, our workforce, their families, and our communities achieve Total Health through the services we provide, and by promoting clinical, educational, environmental, and social actions that improve the health of all people.

Total Health

To accomplish our aim of making lives better, we bring four primary resources to bear:

1. Clinical Quality: We have 17,000 physicians. In addition to providing high quality care, our physicians are responsible for making primary prevention in the clinical environment a major component of care. Further, they bring a valuable medical voice to local, state and national initiatives working on priorities such as increasing regular physical activity, and providing access to healthy affordable foods.

2. Behavior Change: We work closely with our members and corporate customers to employ strategies that help people eat more nutritious foods, be more physically active, quit tobacco, and use alcohol only in moderation. These are the four primary risk factors that lead to the big-four killers: cardio-vascular disease, diabetes, some cancers, and chronic respiratory disease. These are the primary chronic diseases which are the leading driver of the spiraling demand for, and cost of health care in our nation.

3. Healthy Environments: When we talk about environments, we include built, food and beverage environments, as well as social, cultural and natural environments. To support the guidance we provide to patients in the clinical setting, it is vital to help support healthy behavior choices where people live, learn, work, pray and play. We work collaboratively with our community partners to ensure that the healthier  choices are the easier choices.

4. Community Engagement and Grantmaking: In addition to providing extensive charity care and coverage to low income/ high need residents of the communities we serve, we are also investing in over 40 long-term community health initiatives that employ evidence-informed best practices derived from decades of learning. We do this via targeted grantmaking, convening, and partnering with trusted community organizations such as community health centers, schools and after school programs, farmers markets, YMCA’s, and faith based programs.

Obesity Prevention and Treatment: Exercise as a Vital Sign

There is no equivocating: obesity is driving multiple chronic conditions that are seriously damaging the health status of our nation, while concurrently driving up medical care costs. Underlying obesity is the epidemic of physical inactivity which places inactive individuals at risk of disease at every weight.

As an integrated delivery system, Kaiser Permanente is applying its full array of resources to prevent our members from becoming obese and/or developing chronic conditions such as type-2 diabetes and hypertension. In the clinical environment, we now we routinely ask patients about their physical activity.

We call this Exercise as a Vital Sign. For many years, our doctors have asked patients whether they smoke, and then guided users of tobacco products to the means to quit. Now, we ask how active you are, and then provide an array of means to support recommended physical activity. Physical inactivity, even in people who appear to be fit or skinny, is a significant predictor of long-term chronic disease. If people say they aren’t physically active, or get less than the recommended 30 minutes of moderate to vigorous physical activity a day, five days a week our doctors make recommendations, increasingly linking to our community partners, to encourage activity. For example, a pre-diabetic patient might be referred to a YMCA Diabetes Prevention Program or the programmatic offerings of a faith-based partnership or community recreation center.

We have to go beyond saying “you need to walk more, or be more physically active.” So, our physicians write walking prescriptions for patients. In turn, we are beginning to connect patients with safe, convenient, affordable community resources that support walking and physical activity.

There is no simpler, more powerful, more enjoyable thing we can do for our health than taking a brisk walk 30 minutes a day, five days a week! The health benefits for body, mind, and spirit are proven and well documented. Walk with your family and friends.

Walk the kids to school. Have a walking meeting. Walk the dog! In short, we may offer the highest quality health care in the nation, but, if our members leave the doctor’s office, and go back into their daily lives and community settings where there are inadequate supports to healthier lifestyles — we miss the opportunity to optimize our individual and collective health potential. At a time when health care costs are rising we all need to do what we can to improve prevention and keep people out of the care delivery system to start with.

Going Into Our Communities

Many health-related organizations and foundations provide funding for community efforts. We’re a bit different in our grantmaking and community partnership work — as we are not a philanthropy, rather a not for profit integrated health system, with a long-term stake in the communities we serve and the health of the nation. We regularly engage in community benefit activity by assessing community health needs, making investments in priority areas, and tracking outcomes over time.

Our employees and members are with us for the long term, and our facilities and investments are rooted in place. In short, we’re not going anywhere. So we don’t simply make shortterm grants and then move on. As a nonprofit mission-driven organization, we invest in our communities over the long term, to encourage and support changes that go beyond what we can do in our clinical settings alone.

Consequently, when engaging in community partnerships, we typically engage for a minimum of seven to ten years. To affect measurable population level behavior and health changes, you can’t make a grant, and then expect lasting change in just two to three years. We take a longer view, focusing on community assets and environments, and help build the long-term capacity of community partners. The latter is vital so that communities build the collective efficacy that is requisite to effecting measurable impact, at scale, with sufficient reach and intensity, over time. The stronger community bonds and assets we help forge, the better our clinical offerings can integrate with community supports in a way that assures total health and well-being.

We also practice what we preach and apply the “power of the white coat.” Our physicians often volunteer with community partnerships. Over the years, they have stepped up to educate on the health benefits of Safe Routes to School, Complete Streets, and the importance of neighborhood safety and affordable access to healthy foods.

Every Body Walk!

Walking is central to everything we do at Kaiser Permanente. Every Body Walk!, a national public health campaign, powered by Kaiser Permanente, aims to get adult Americans walking 30 minutes a day, five days a week (60 minutes for children). The online walking hub at contains all that’s needed to begin a walking routine — maps, tips, medical advice, partner resources, inspiring videos, and a free mobile application.

We know that walking can cut the rate of diabetes and heart disease and even Alzheimer’s. It’s fun, easy and free and has amazing health benefits. That’s why our doctors are advocating the benefits of walking and getting out to walk with their patients.

Community Health Initiatives

Our Community Health Initiatives take a preventive approach to health care, focusing on policies and programs that promote healthy eating and active living where we live, learn, work, and play. Community health improves in an environment that promotes health and wellbeing and the creation of that environment is accomplished through providing the best medicine combined with education and vital public health activities that support an informed and empowered population.

Educational Theatre

Kaiser Permanente created Educational Theatre Programs (ETPs) to inspire children, teens and adults to make informed decisions about their health, to build stronger, healthier neighborhoods, and to improve public health by using the arts, creative education and youth advocacy.

Our ETPs are presented free of charge to schools and community organizations and performed in school and community settings. Over the past 25 years, the Program has reached 15 million children. Kaiser Permanente’s ETPs use live theatre, music, comedy, and drama to inspire children, teens, and adults to make healthier choices and better decisions about their well-being. ETP’s live, interactive performances enable students to identify and emotionally engage with characters onstage, as well as learn information in a dynamic way. ETP productions are offered free of charge to eligible schools and community groups.

National Partnerships:

Nationally, Kaiser Permanente engages in a wide array of partnerships including:

  • The Convergence Partnership supports healthy policy change at all levels, promoting and supporting partnerships among organizations and entities in multiple fields.
  • The Weight of the Nation™ documentary series and public health campaign presents a unique opportunity to spotlight the severity of the obesity epidemic, to showcase strategies that work and, most importantly, to catalyze action to end obesity. and
  • The Community Commons is an interactive GIS mapping, networking, and learning utility for the healthy, sustainable, and livable communities’ movement.
  • is a free web-based platform designed to assist critical access hospitals, non-profit organizations, state and local health departments, financial institutions, and other organizations seeking to better understand the needs and assets of their communities — to make measurable improvements in community health and

Everywhere Kaiser Permanente operates, our mission remains the same: to provide high-quality affordable health care and to improve the health of our members and the communities we serve. This means making the communities safer, healthier places to live, learn, work and play. We do this via:

  • Providing access to affordable high quality care and coverage;
  • Helping public hospitals and community clinics improve the care they deliver and expand their treatment capacity;
  • Supporting research, education and training;
  • Promoting health through better diet, physical activity, and vibrant neighborhoods; and
  • Leveraging the power of the white coat to promote prevention and ensure people who want to can get and remain healthy.

A nations’ health is it also its wealth. To assure a strong 3rd American Century, it is incumbent on providers, payers, purchasers, employers, labor, government agencies, community organizations and residents of all types to do their part. Health is not simply a private good — it is a strategic asset for the wellbeing and security of our nation. With wise private and public sector investments in prevention and public health, we can concurrently improve our nation’s health, while lowering the preventable demand-driven costs of care over time. This is good for people, good for our communities, and good for our nation.

MAZON: Healthy food in hard times

Kaiser Permanente is proud to partner with MAZON: A Jewish Response to Hunger, in Healthy Options, Healthy Meals, a groundbreaking national initiative to make healthy and nutritious food more accessible for low-income families. Feeding America food banks in the eight Kaiser Permanente regions were invited to participate in this two-and-a-half year initiative, which aims to strengthen their capacity to achieve their healthy food goals, wherever they may be along the healthy eating continuum. Healthy Options, Healthy Meals is designed to be collaborative not prescriptive; together, MAZON and participating food bank partners will co-create a process for change and help shape how the food bank community conducts this type of work. MAZON will provide a framework for approaching this important work, as well as technical resources and a peer-to-peer network. MAZON will also provide individualized support, assisting each food bank in customizing a plan that is tailored to its needs and strategic goals on its path to becoming a stronger change agent and community resource for healthy eating.

Farmers Market

Each year, more than 30,000 people attend Green Market – a Farmers market held every Saturday from May through October in Piedmont Park, Atlanta, Georgia – which offers a variety of organic fruits, vegetables, fresh cut flowers, baked goods and more. In addition to the marketplace, the event offers healthy cooking demonstrations and fitness classes to encourage everyone to get healthy and stay healthy.

Food Oasis in Oregon

The Village Gardens project unites three neighborhoods — St. John’s Woods, New Columbia, and Tamarack — with people working together to create an oasis of food security. Community gardens are staffed and tended to by nearly 100 families representing 18 different nationalities. Future goals are to serve the 10,000 people living within a half-mile radius, and to be a model that others can use to create a healthier, more sustainable force in their community. Kaiser Permanente is one of several key partners working collaboratively to fund and support the vision of the Village Gardens community.

Live Well Colorado

Back in 2005, Kaiser Permanente Colorado introduced our Thriving Communities initiative. This effort sought to mobilize and partner with Colorado communities to develop programs, environmental strategies, and policies that will work best in their respective neighborhoods to promote healthy eating and active living. Eleven community

organizations were provided funding and resources through the Thriving Communities initiative to collaborate with local health organizations, businesses, neighborhood associations, faith-based organizations, local government, and parks and recreation departments in assessing needs and developing plans towards reaching their goals. Each of the 11 communities developed unique programs aimed at improving healthy eating and increasing active living.

The activities ranged from teaching nutrition through growing and maintaining gardens to improving local roads and infrastructure for better walking accessibility. Kaiser Permanente Colorado continued to develop partnerships to support the Thriving Communities initiative, including working with the Colorado Department of Public Health and Environment, The Colorado Health Foundation, Governor Bill Ritter, and Lt. Gov. Barbara O’Brien. Through these partnerships, Thriving Communities evolved into the statewide initiative now called LiveWell Colorado.

Today, LiveWell Colorado provides support to 17 community organizations serving about 750,000 people in 11 Colorado counties (Adams, Alamosa, Broomfield, Denver, Eagle, El Paso, Jefferson, La Plata, Larimer, Prowers, and Summit). Its goal: to initiate policy, environmental, and lifestyle changes that remove barriers and encourage healthy behaviors among all Coloradans.

Kaiser Permanente at a Glance:

  • 9 million members
  • 9 states and the District of Columbia served
  • 17,000 physicians
  • 35 million office visits
  • 170,000 employees
  • $1.8 billion in community investment in 2011

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