A Pound of Prevention - The Colorado Health Foundation

The Quarterly
Journal
of the
Colorado
Health
Foundation
FALL 2012
A Pound of
Prevention
IGNORE THE OLD ADAGE: OUR HEALTH
NEEDS MORE THAN AN OUNCE
BRAIN BOOST
EXERCISE HELPS MANAGE
MENTAL ILLNESS
GET THE LEAD OUT
LEADVILLE LOSES
A TON – LITERALLY
Cartoon Corner by John Branch
22
Jaime Stuever, mayor of
Leadville, stands high above
the mountain town where
earlier this year, residents
collectively lost more than
2,000 pounds and gained a
stronger sense of community.
D E PA R T M E N T S
the Colorado Health Foundation
3
Walking the Talk
10
What’s Working
501 South Cherry Street, Suite 1100
Denver, Colorado 80246
303.953.3600
www.ColoradoHealth.org
Fall 2012
F E AT U R E S
4
8
Weighing Prevention
Let’s put health dollars
“upfront” to stop disease
and injury.
Chew on This
18
Education and early
treatment are vital to
combat the silent epidemic
of oral disease.
Inside Cover:
Cartoon Corner
Cartoonist John Branch
provides his take on
prevention.
20
Shift attention to
prevention, says Anne
Warhover, president and
CEO of the Colorado
Health Foundation.
Medicaid, a Boulder dental
program, a mental health
center and a Denver
business are building
prevention into their efforts.
22
Out of the Box
23
News & Events
24
True Story
25
Tips
The Expert View
Prevention Institute in
Oakland, Calif., analyzes
problems and shares
solutions so communities
can prevent disease
and injury, says Larry
Cohen, MSW, founder
and executive director
of the institute.
Observations
James O. Hill, PhD,
executive director of
University of Colorado
Denver’s Anschutz Health
and Wellness Center,
thinks it’s time for new
approaches to the state’s
obesity epidemic.
Leadville residents lost
a ton – literally – during
a communitywide
fitness challenge.
The latest news from
the Colorado Health
Foundation.
Chris Urbina, MD, MPH,
executive director and
chief medical officer of
the Colorado Department
of Public Health and
Environment, shares
his Ride The Rockies
experience and its
prevention lessons.
Heard enough of the
same old “eat healthy and
exercise” prevention advice?
Try these concrete ideas to
put words into actions.
Fall 2012 | w w w.ColoradoHealth .org | Health Elevations | 1
ABOUT THE COLORADO HEALTH FOUNDATION
The Colorado Health Foundation works to make
Colorado the healthiest state in the nation by investing in grants and
initiatives to health-related nonprofits that focus on encouraging
healthy living; increasing the number of Coloradans with health
insurance; and ensuring they have access to quality, coordinated
care as well as operating medical education programs to increase
the health care workforce. For more information, please visit
www.ColoradoHealth.org.
Colorado Healthcare Communicators
Gold Leaf Award Winner
President/CEO,
The Colorado Health Foundation
Anne Warhover
Vice President, Communications
Charles Reyman
Editors
The Colorado Health Foundation
Caren Henderson, Bob Mook
COMMITMENT TO RESULTS The Colorado
Health Foundation’s commitment
to the people of Colorado is to use
our resources to make Colorado
the healthiest state in the nation by
delivering measurable results toward
three outcomes:
HealthyLiving
HealthCoverage
HealthCare
BOARD OF DIRECTORS
Chair of
of the
the Board
Board
Chair
Stephen H. Shogan, MD
Colorado Neurosurgery Associates PC
Bruce K. Alexander
President and CEO
Vectra Bank
Jerome M. Buckley, MD
(retired)
Toti Cadavid
President
Senku Marketing
Jerome Davis
Regional Vice President
Xcel Energy
Russ Dispense
President
King Soopers/City Market
The Kroger Company
Jim GarcÍa
Executive Director
Clinica Tepeyac
Executive Director
Clinica Tepeyac
Stuart Gottesfeld, MD
Clinical Professor
University of Colorado
School of Medicine
Janet L. Houser, PhD
Academic Dean
Rueckert-Hartman College
for Health Professions
Regis University
John Hughes, Jr., CPA, CVA
Partner
CliftonLarsonAllen LLP
Grant Jones
Executive Director
Center for African American Health
Virgilio Licona, MD
Associate Medical Director
Salud Family Health Centers
David Livingston
CFO/Director of Administration
HealthTeamWorks
Virginia Maloney, PhD
Program Director
Chambers Family Fund
John McWilliams
President
Western Skies Inc.
2 | Health Elevations | The Journal of the Colorado Health Foundation
Project Manager/Managing Editor
Sandy Graham Communications
Advisors
The Colorado Health Foundation
Khanh Nguyen, Sue Williamson
Creative Team
Welch Creative Group Inc.
Photographers
Dan Sidor, Howard Sokol,
Barry Staver
On the Cover
Photography By Howard Sokol
Donald Murphy, MD
Co-Principal
Senior Care Colorado
Ruth Nauts, MD
Regional Department Chief,
Orthopedics
Kaiser Permanente Colorado
Denny O’Malley
Strategy Consultant
D2inc
Diane Padalino
Vice President
Goldman Sachs & Co.
John Sabel, MD
South Denver Gastroenterology
Mary A. Schaefer
CEO (retired)
Health Care Consultant
Sara C. Stratton
Manager (retired)
Qwest Pension Fund
John M. Westfall, MD, MPH
Associate Dean for Rural Health
University of Colorado
School of Medicine
WALKING THE TALK
The Power of Positive Prevention
When I started work at the Colorado Health Foundation, I had no clue what “public health”
meant. Then, a colleague informed me that public health has saved more lives than all of the
drugs, surgeries and medical interventions combined. “When public health is working we take it for granted
because it is almost invisible. It’s when it is not working that we realize how important it is.”
Indeed, public health permeates many aspects of our day-to-day routines, from the breakfast we eat in the
morning to the clean water we brush our teeth with at night. Since the turn of the last century, the public health
sector has come close to eliminating waterborne illnesses and to stopping contaminated food products from
reaching the grocery. Thanks to prevention and public health, Americans are no longer susceptible to crippling
ailments like polio, smallpox and many other deadly infectious diseases.
More recently, prevention efforts raised public awareness about the serious health
implications of smoking, drunk driving and not wearing safety belts. Tobacco policies
and laws have reduced incidents of heart disease and lung cancer in the United States,
and strict enforcement measures have reduced traffic fatalities to their lowest rate in
more than 60 years.
Colorado has its own share of public health success stories. For example, Colorado
ranks No. 1 in the nation for mothers who exclusively breastfeed their babies during
the first six months in life, according to a report by the Centers for Disease Control
and Prevention. Breastfed babies are far less likely to develop health problems such
as infections, asthma and childhood obesity. Also related to public health, regulatory
compliance for hazardous material rose from 25 percent in 2008 to 65 percent in
2010 because of an innovative statewide self-certification program.
Beyond the obvious quality-of-life benefits, research shows evidence-based public health programs could
substantially reduce health costs in Colorado. One study estimates that an annual investment of $10 per
Coloradan in community-based prevention initiatives could generate a 500 percent return.
Yet, despite these proven benefits, prevention represents a small portion (less than 5 percent) of every dollar spent
on health care in this country. Given that only 10 percent of health is influenced by actual health care, the current
equation is backwards. According to the U.S. Department of Health and Human Services, 90 percent of health is
influenced by factors such as income level; education; transportation; food insecurity; environment; and personal
habits such smoking, drinking and obesity – a growing problem in Colorado and around the nation.
This edition of Health Elevations explores the challenges and opportunities of prevention in Colorado. Among
our What’s Working features, we highlight a dental health education initiative that helps pregnant women, an
innovative employee wellness program, and a holistic approach to mental health that includes an array of
fitness and emotional well-being practices.
We also look at how the small town of Leadville incented its residents to lose weight. Chris Urbina, MD, MPH,
executive director and chief medical officer of the Colorado Department of Public Health and Environment, shares
what he learned about prevention (and Colorado) when he took a six-day, 442-mile bike ride through the state. We
also feature insights on prevention from James O. Hill, executive director of the Anschutz Health and Wellness Center.
We hope the creative thinkers featured in this edition will further demonstrate why – to quote Benjamin Franklin –
“an ounce of prevention is worth a pound of cure.”
Anne Warhover, President and CEO
The Colorado Health Foundation
Fall 2012 | w w w.ColoradoHealth .org | Health Elevations | 3
Is a
POUND
of Prevention
Better Than an
OUNCE
of Cure?
As the data makes it increasingly clear,
the answer is ‘yes.’
By Sandy Graham
Despite impressive health victories throughout
the decades, America’s efforts to prevent disease
and injury still have a long way to go.
“We’ve done dreadfully,” says James Marks, MD, MPH, senior
vice president and director of the health group at the Robert
Wood Johnson Foundation in New Jersey. “We are 50th among
nations in life expectancy and yet we spend on average twice
what any other country spends on health care. It’s hard to
imagine how we could have done worse on prevention in our
health care system.”
To be sure, prevention efforts have done away with many of the
country’s historic causes of death and sickness. Water treatment
has nearly erased waterborne killers. Antibiotics have banished a
host of deadly infectious diseases. Immunizations have freed us
from many ailments such as measles and polio. Tobacco policies
and laws have cut into smoking-related cases of heart disease
and lung cancer. Traffic fatalities are the lowest in 63 years with
help from DUI enforcement, seat belt usage and safer vehicle
and highway designs.
However, Colorado and other states are faced with rising
rates of some chronic diseases, especially diabetes and obesity.
Childhood obesity rates nationally have tripled. Older adults
account for high numbers of chronic ailments such as arthritis,
high blood pressure and mental health disorders. Despite
progress, tobacco-related diseases remain the nation’s leading
cause of preventable death. Chronic diseases swallow roughly
75 percent of our health care spending of $2.6 trillion annually,
according to the Centers for Disease Control and Prevention (CDC).
Topping chronic disease concerns is our expanding collective
girth and its associated health problems. The United States is
the sixth most obese nation, according to the Central Intelligence
Agency World Factbook. Colorado, although it remains the
nation’s “thinnest” state, has seen its adult obesity rate increase
from 19 percent to 22 percent – a number that would have earned
it “fattest” state honors in 1995, according to LiveWell Colorado,
an anti-obesity nonprofit.
“Prevention has a mixed record,” says Ursula Bauer, PhD,
MPH, director of the CDC’s National Center for Chronic
Disease Prevention and Health Promotion. “Certainly we’ve
gotten the message around tobacco, the leading cause of death
in this country. We have recognized prevention does work. …
But we haven’t learned that lesson for obesity.”
Three Facets of Prevention
Prevention efforts fall into three categories, says Chris Urbina,
MD, MPH, executive director and chief medical officer of the
Colorado Department of Public Health and Environment.
• Primary prevention focuses on stopping diseases or injuries
before they occur – by actions such as wearing seat belts or
immunizing against childhood diseases, for example.
• Secondary prevention occurs during illnesses or injury.
The goal is to diagnose early and reduce the progression
of the disease or injury. For example, a woman whose
history puts her at high risk for cancer might undergo
mammography, Pap tests and colonoscopies regularly.
• Tertiary prevention occurs once the illness or injury has
occurred and involves managing long-term health problems
such as heart disease or diabetes to maximize quality of
life and avoid complications.
“I believe people want to be healthy. People make choices in
their lives every day and those choices can be healthy ones – that’s
what prevention is all about,” Urbina says. “If I’m eating healthy
foods and exercising on a regular basis and reducing stress, then
I’m doing everything in my power to reduce the chances of injury
or infection. I think that’s what most people want to do.”
Unfortunately, making those healthy choices is not always
easy or even possible.
“While each of us does need to take responsibility for our
health, we can’t do that if healthy choices are not available,”
Bauer says.
Thus, prevention involves more than teaching the hows and
whys of healthy living: Children who want to walk or bicycle to
school need safe routes. Adults who want to buy more fresh fruits
and vegetables need affordable, convenient markets. Commuters
who want to avoid the stress of sitting in traffic for hours need
easy access to economical public transit.
“There are millions of people who live in circumstances
that make healthy choices almost impossible,” Marks says.
“No government program is going to take the place of people
making healthy choices for themselves and their families.
But there are ways we can use policy and legislation to make
healthy choices easier or harder.” Good examples of making
healthy choices easier are clean indoor air laws to protect
workers and the public from other people’s smoke, or making
sure only healthy food is served in schools.
Fall 2012 | w w w.ColoradoHealth .org | Health Elevations | 5
PREVENTION PUNCH: Where to Focus
Where should America best focus its prevention dollars? The
Centers for Disease Control and Prevention (CDC) has identified
10 issues for which there are known, effective strategies that will
make an impact quickly.
The 10, which the CDC calls Winnable Battles, are food safety,
global immunizations, health care associated infections, HIV in the
and substance use, obesity, oral health, safe food, tobacco and
unintended pregnancy.
Of those, Gov. John Hickenlooper has chosen three primary
targets: obesity, oral health (especially for children who are
3 years old or younger), and mental health and substance use.
“In some areas, we’re doing quite well. In others, we have more
United States, motor vehicle crashes, obesity, teen pregnancy,
to do,” says Chris Urbina, MD, MPH, executive director of the health
tobacco, global mother-to-child transmission of HIV and syphilis,
department. In addressing clean air, clean water, food safety,
and lymphatic filariasis (LF) in the Americas. (LF is a disabling
childhood immunizations and hospital infections, the state has made
parasitic disease spread by infected mosquitoes.)
progress “with a few hiccups,” Urbina says. Colorado faces greater
The Colorado Department of Public Health and Environment
challenges in addressing mental health, substance use and obesity.
has identified its own 10 Winnable Battles: clean air, clean water,
Urbina also is concerned about tobacco use rates, which are stalled
infectious disease prevention, injury prevention, mental health
at about 17 percent. (The national rate is 20 percent.)
Larry Cohen, MSW, founder and executive director of Prevention
costs. The report concluded that putting $10 per person per year in
Institute in Oakland, Calif., notes that the community prevention
proven community-based programs to increase physical activity,
strategies that help keep people from getting sick or injured initially
improve nutrition and prevent smoking and other tobacco use
also are vital to rehabilitating or maintaining the health of people
could save the country more than $16 billion annually within five
who have diseases or injuries. A walkable community helps treat
years, a return of $5.60 for every $1 spent. The report estimated
as well as prevent heart disease, for example.
that in Colorado, the $10 per person per year investment would
Does Prevention Save Money?
On first glance – and considering some of the successes in public
health during the past century – it seems that prevention ought to
help the United States hold the line on or even reduce its evergrowing bill for health care.
save $232 million, a 5-to-1 return. The economic findings are
based on a model developed by researchers at the Urban Institute
and a review of evidence-based studies conducted by The New
York Academy of Medicine.
Those returns are encouraging. Still, prevention doesn’t always
pay. In 2009, the Congressional Budget Office (CBO) concluded that
“Investing in prevention is about saving lives and reducing
for most preventive services, “expanded utilization leads to higher,
misery, but it’s important to note that we save money at the same
not lower, medical spending overall.” The CBO says preventive care
time in most cases,” Cohen says. (For more about the institute’s
has the largest benefit relative to cost when it can be targeted to
work, see The Expert View, page 18.) Roughly 96 percent to
higher-risk people, but that it is often difficult to predict who is at
97 percent of the country’s health care spending is “after the fact,”
most risk. Therefore, many people receive preventive care although
he says. “We could reduce health care costs if we invested more
only a relative few truly need it.
of that spending before the fact.”
Prevention efforts also pay off in less tangible ways, the CDC’s
Bauer says. “Healthy people work longer, they’re more productive
There are expenses – housing, food, clothing, health care and
so forth – associated with longer life spans as well.
“If you live longer, it’s going to cost you more,” Marks says.
and they pay more taxes,” she says. “That starts to round out the
“But we all do want to live longer. We want to be
equation.” There’s also an intrinsic value in individuals simply
able to garden, travel and see the grandkids.
being and feeling healthy, she adds.
Some of those extra ‘costs’ will be spent
A report by the Trust for America’s Health and Prevention
doing things you like and you’ll have
Institute found that even a small strategic investment in disease
longer to do them if you can stay
prevention could result in significant savings in U.S. health care
healthy. That’s a good thing!”
6 | Health Elevations | The Journal of the Colorado Health Foundation
Marks argues for a better balance between prevention and treatment.
groups. It involves educating people to demand preventive choices,
“We are better off as a society making decisions which get us
just as once-scorned air bags and seat belts in motor vehicles are
the most health at the best price. Sometimes it will be [through]
prevention and sometimes health care,” he says.
Prevention is a compelling approach to the obesity epidemic,
one of the nation’s greatest health challenges, says James O. Hill,
now desired safety features.
Economics of prevention aside, the discussion of its merits
has become more robust.
“I’m very encouraged by what I’d describe as a groundswell
PhD, executive director of the Anschutz Health and Wellness
across the country in community after community,” Bauer says.
Center at the University of Colorado Denver.
“The discussion is not so much about making people more healthy,
“Science shows that once you’re obese for a period of time, the
but making communities more attractive to businesses and to
body seems to defend that weight. Also, it’s pretty easy to lose
residents so that people can get where they need to go easily and
weight, but hard to keep it off, again because the body defends the
where health care costs to businesses are not so overwhelming.
higher weight,” Hill says. “Prevention really makes sense to keep
“Prevention is a best buy for Americans,” she says.”
you from getting [obese] in the first place.”
Preventing obesity and weight gain may be sensible, but it isn’t easy.
“I know how to prevent infections: You wash your hands. You get
immunized,” says the state health department’s Urbina. “Obesity
is much more complex.” Fighting obesity can include ensuring
that neighborhoods are built to promote active living and access to
healthy foods and addressing the inequities among socioeconomic
PREVENTION AND THE AFFORDABLE CARE ACT
The Affordable Care Act (ACA), the federal health
reform law upheld by the U.S. Supreme Court earlier
this year, is helping to turn a spotlight on prevention,
but attracting plenty of political flak in the process.
Since taking effect in 2010, the ACA gave preventive
services such as mammograms and colonoscopies to
traditional Medicare beneficiaries with no copayment
or deductible. This is the first time a health care bill
has included resources for prevention, although they
represent a small amount in the overall cost estimate
for the ACA.
The ACA also authorized formation of a National
Prevention, Health Promotion, and Public Health
Council, which released its action plan earlier this year.
The law further set up a 10-year, $15 billion Prevention
and Public Health Fund to fight obesity, cut tobacco
use, integrate primary and behavioral health care,
improve nutrition and physical activity, train prevention
professionals and undertake other preventive activities.
Congress, however, has diverted billions of dollars
to other purposes. Some $6 billion was shifted to keep
interest rates low on student loans earlier this year.
Still, the fund was able to award $1.25 billion last year
in prevention grants, about $17 million of that amount in
Colorado, according to U.S. Department of Health and
Human Services. Another $1 billion will be spent this year.
Prevention remains a key focus of the ACA despite the
funding issues – a necessary focus, according to Ursula
Bauer, PhD, MPH, director of the National Center for
Chronic Disease Prevention and Health Promotion at
the Centers for Disease Control and Prevention. The
ACA is going to provide new insurance coverage to
millions of Americans who will want care.
“I really think there was no choice,” Bauer says.
“We have to improve Americans’ health in order to
afford their health care. If we want to deliver healthier
students to school [who are] ready to learn and
healthier workers who can be productive and won’t
saddle employers with huge health care costs, we
have to have a healthier population.”
Fall 2012 | w w w.ColoradoHealth .org | Health Elevations | 7
Putting Money Where
Our Mouths Are
By Sandy Graham
If cavities are preventable, why was
Colorado doing such a poor job stopping
tooth decay? It was an obvious question, but one that didn’t
dawn on Caring for Colorado Foundation executive
Linda Reiner and other oral health advocates at first.
“At Caring for Colorado, we began our work in addressing
Coloradans’ oral health needs by supporting safety-net dental
clinics around the state. However, we soon found that we also
needed to bolster efforts to prevent oral disease in the first
place, as the treatment needs were overwhelming,” says Reiner,
director of planning and evaluation.
The Caring for Colorado Foundation, one of the state’s leaders
in health grant making, had chosen oral health as a focus based
on community input when it first began awarding funds in 2001.
In the years since, it has worked to expand the oral health safety
net for lower-income people, support school-based prevention
programs and spearhead Colorado’s Cavity Free at Three program
to prevent tooth decay in young children.
But there’s still a long way to go.
Across Colorado and throughout the United States, dental
and oral diseases represent a “silent epidemic.” Cavities and gum
(or periodontal) disease often can be ignored until they are in an
advanced stage and begin causing pain. Nationally, tooth decay
is the most common chronic disease among children – five times
more prevalent than asthma.
Among adults, more than one in five Americans have
untreated cavities, according to the Centers for Disease Control
and Prevention (CDC). CDC statistics for Colorado show that
about 33 percent of Colorado adults have not visited a dentist
or had a teeth cleaning in the past year. Fifteen percent of
Coloradans who are 65 years or older have lost all of their teeth.
About a quarter of the population lives in communities where
there is no fluoride in drinking water, shown to be one of the
most cost-effective ways to prevent tooth decay. Nine Colorado
counties have no licensed dentists, and 11 have no licensed dental
hygienists, according to Oral Health Colorado, an advocacy group.
And while about 20 percent of all Colorado adults under age
65 do not have health insurance, an even larger percentage –
42 percent – do not have dental insurance, according to state
statistics. Dental procedures are expensive and out of the reach
of many people, Reiner says. “And the more you delay care, the
more expensive it gets,” she adds.
Patricia Braun, MD, MPH, a pediatrician for Denver Health
and oral health advocate for the American Academy of Pediatrics’
Colorado chapter, says the health of teeth and gums has not been
a priority until recently.
“Unfortunately, oral health is something that society has
neglected for a long time,” she says.
And as with so many other health concerns, lower-income
individuals have higher rates of oral disease and less access to
dental services. “A large disparity exists in whom [oral disease]
affects,” Braun says.
It can be a deadly disparity. In 2007, Deamonte Driver, a
12-year-old in Prince George’s County, Md., died of a brain
infection caused by a tooth abscess after his mother could
not find a dentist who would accept Medicaid.
“Deamonte’s not the only one [who has died of decay],”
says Braun. Such sad outcomes at least raise awareness that
poorer people may not have easy access to oral care, she adds.
Oral health is a priority for federal and state public health
authorities, making both the CDC’s and the Colorado health
department’s Winnable Battles priority lists of health concerns.
(See box, page 6.) There is also strong support among
Colorado’s foundations for improving oral care.
Preventing dental disease early in life is key to turning the
tide on this disease, Reiner says.
“We are working to have a new generation with better oral
health outcomes than their parents,” she says.
Cavity Free at Three, a statewide program to train primary
care physicians, dental providers and public health nurses
about early childhood cavity prevention, is funded by Caring
for Colorado Foundation, the Colorado Health Foundation,
The Colorado Trust, Delta Dental of Colorado Foundation,
Kaiser Permanente and Rose Community Foundation.
In addition to dental providers, the program works with
pediatricians and family physicians; Women, Infants, and
Children (WIC) programs; public health clinics; and child
care centers – “wherever children are,” Reiner says – to
assess and improve children’s dental health during the first
three years of life. The program also works to educate
pregnant women about their dental care needs because
often the mother’s oral health status will determine her
children’s oral health status. Dental disease is communicable
and transmissible from mother to child.
8 | Health Elevations | The Journal of the Colorado Health Foundation
Braun, who has been at Denver Health for more than 15
years, also is involved in Cavity Free at Three. The health
system treats about one-third of all children in the city.
Through a Delta Dental of Colorado grant about five
years ago, Braun and her colleagues hired dental hygienists
to work in five practices across Colorado. Four of the
hygienists are still in practice. Equally important has been
efforts to enlist medical providers in the early treatment,
prevention and education efforts, she adds.
“They’ve been fantastic!” Braun says of her medical
colleagues. “It’s a team effort. We really need to work
together as dental and medical health providers.”
While treatments such as fluoride varnishes to stave
off cavities are important to children’s dental health,
educating parents and other caregivers is even more vital.
“In high-risk, disadvantaged populations especially,
cavities are a part of life,” Braun says. “It’s new to them
to learn cavities can be prevented. Family awareness and
giving parents the education and tools to care for teeth at
home is really what will have an impact on the health of
children’s teeth.”
Change won’t happen overnight, but gradually, dental
health advocates hope that more people will come to
understand that cavities are not inevitable and that a good
start on dental health will pay off throughout life.
DENTAL HEALTH’S IMPACT ON OVERALL HEALTH
While oral diseases in themselves are problems, equally concerning is the impact that poor oral health has on the rest
of a person’s mental and physical health.
• A 2012 study of nearly 1,400 Swedish adults found that dental plaque, the bacterial film on teeth
that can lead to decay and gum disease, was associated with higher rates of cancer deaths.
• Gum infections (periodontal disease) can spread to other parts of the body if a person has a weak immune system.
• Hormone levels in pregnancy can make some dental problems worse.
• Some studies have shown that bacteria responsible for tooth decay can be passed from mother to child.
• Gum infections also have been linked to premature birth and low-birth-weight babies.
• People with diabetes, osteoporosis or HIV/AIDS are at higher risk for oral disease.
• Diabetics with periodontal disease have a harder time controlling their blood sugar.
However, concerns that untreated gum disease led to heart disease and stroke needs further research. The American Heart
Association stated earlier this year “current science does not support a direct association.”
In addition to the physical impacts of poor dental health, bad teeth and gums can negatively affect a person’s ability
to gain employment, sleep properly, maintain a healthy diet, concentrate at school or work, and live a pain-free life.
“We all know that a bright smile has such an impact on self-esteem and how people are viewed,” says Patricia Braun, MD,
MPH, a Denver Health pediatrician and oral health advocate.
Fall 2012 | w w w.ColoradoHealth .org | Health Elevations | 9
WHAT’S WORKING
Hearts and Minds
How Exercise Can Ease Mental Illness
By Rebecca Jones
Photography by Howard Sokol
For a while, just dragging herself out
of bed in the morning was the extent
of Pam Case’s fitness routine. Her depression
sapped her energy, and any attempts at an
exercise regimen derailed after a few days.
Then last spring, something finally clicked for
the Wheat Ridge woman, who is bipolar and has
been a client of the Jefferson Center for Mental
Health (JCMH) for the past five years.
With encouragement from a health coach at
the center, she set a simple goal of walking to
the mailbox and back every day. She gradually
built her confidence to the point where she
began swimming. Now she is swimming 30 to
45 minutes every day, and she is ready to take
up dancing.
“Exercising has made a really big difference
for me,” says Case, 47. “I’ve got energy now I
didn’t know I had.”
She has also lost 10 pounds and has eliminated
all the sugar from her diet, which could help
prevent complications from her diabetes.
As Case’s physical health has improved, so has
her mental health. That’s the whole point behind
the JCMH Wellness Now! program, an innovative
approach that offers holistic services extending
far beyond traditional mental health therapy.
The center offers free health screenings and
free classes in a range of fitness and emotional
well-being practices so consumers can choose
options most effective for them.
The classes and health screenings are open
to anyone in the community. But for mental
health center clients, there are more free benefits.
They can be assigned health coaches and can
work out with a trainer at the Wheat Ridge
Recreation Center.
“We’re trying to help clients take control of
their health and in doing so, take control of their
depression and anxiety,” says Kathy Baur, PhD,
senior clinical psychologist at the center. Severe
mental illness takes a physical toll: Medications
can cause weight gain. The mentally ill are
more likely to smoke. On average, people
with mental illness die 25 years earlier than
the general population.
Focusing on healthy diet and exercise habits
not only improves physical health, it influences
mental health as well, she says.
“The changes people make are amazing,” Baur
says. “They start noticing they have more energy.
They don’t have the mood swings. They start
sleeping better. The impact on their mental
health is significant.”
The center has the statistics to back up its
contention. Surveys of its clients show that more
than three-quarters of those who participate in
the Wellness Now! program learn at least one
new wellness skill, 70 percent say they have
achieved some if not all of their wellness goals,
and two-thirds reported an enhanced feeling
of well-being.
The positive impact of exercise on the mental
health of adults is well-documented. Many
studies show exercise reduces anxiety, relieves
depression and boosts self-esteem. While experts
expect the same is also true for children and
adolescents, there is little in the way of hard data
to prove that claim. So JCMH is now partnering
with Klein Buendel, a Golden health research firm,
to determine whether exercise can improve the
mood of depressed adolescents.
“It’s a preliminary study, looking at whether
it makes sense to do a full trial,” Baur says. “It’s
been exciting. What we’re seeing is that the
kids in the study do seem to get better. So we’re
really seeing the impact of these free or lowcost interventions.”
10 | Health Elevations | The Journal of the Colorado Health Foundation
Pam Case (right), who participates in the JCMH
Wellness Now! program, and Kathy Baur, PhD,
senior clinical psychologist at JCMH, recognize
the positive impact of exercise and a healthy
diet on physical and mental well-being.
THE CHANGES PEOPLE MAKE ARE AMAZING. THEY
START NOTICING THEY HAVE MORE ENERGY. THE IMPACT
ON THEIR MENTAL HEALTH IS SIGNIFICANT.
Kathy Baur, PhD
Senior Clinical Psychologist
Jefferson Center for Mental Health
WHAT’S WORKING
Prevention Payoff
Financial Group Earns ‘Healthiest’ Title for Wellness
By Rebecca Jones
Photography by Barry Staver
Chuck Marlow had no reason to suspect
anything might be wrong when he completed
the biometric testing encouraged by his employer to
establish his risk levels for certain medical conditions.
A physical just six months earlier had found him to be
in good health.
But when his PSA test, which screens for prostate
cancer, came back three points higher than it had been,
his doctor grew concerned by the sudden uptick.
“Unfortunately, I did have cancer,” says Marlow, 65,
an account executive. “I had surgery and five years later,
I am cancer-free. You’re talking to the No. 1 cheerleader
for this program.”
The program that Marlow praises is the “ibenefit”
health risk management program launched six years ago
by his employer, IMA Financial Group, a financial services
company with offices in Colorado, Kansas and Texas.
“The thing that is unique about our firm is we have a
consulting practice in health care,” says Kyle Orndorff,
IMA’s senior vice president and director of human
resources. “There’s added pressure for us to practice
what we preach. If we’re going to tell companies how
to get in front of their health care costs, we need to
make sure we’re doing what we say. So we put an
extreme focus on this.”
Chairman and CEO Rob Cohen calls company
employees “the most valuable asset” the company has.
“Investing in their health is a top priority,” says Cohen.
“It really brings it home when we hear the personal
stories of people who have diagnosed cancer early or
overcome challenges like diabetes as a result of the
health screenings. It’s something that goes beyond just
doing good business.”
The core of IMA’s ibenefit program is prevention –
both developing a medical condition or the worsening
of an existing one. It’s built around a point system
that begins with a health questionnaire and biometric
health screening that yields a health score for every
participating employee. As participants do things to
ward off health problems, they get points that drive that
score down. As their scores go down, so do their health
premiums, Orndorff says.
“If you do the questionnaire and the screening, and
you get those results to your physician, you immediately
get $20 a month off your health premiums,” he says.
“If you don’t, we charge you an extra $20. So it’s a $40
swing. Then you start building points and taking more
money off as you go.”
Employees who participate in the maximum number
of wellness options can save as much as $375 annually
just in premium costs, he says.
The company offers a range of wellness activities.
During the holidays, it supported formation of teams to
hold the line on holiday weight gain, and employees who
avoided putting on the pounds were eligible for prizes.
It hosts mammogram parties at radiology clinics that
feature champagne, chocolate fountains, balloons –
and free mammograms.
Other programs have dealt with stress management,
healthy eating and even wealth management seminars
that are tailored to help avoid health issues that might
follow financial worry. For its efforts, IMA last year was
named Denver’s healthiest medium-size company by
Denver Business Journal.
Such programs aren’t cheap. Orndorff estimates IMA
spends about $150,000 a year on these programs. But
the return on that investment is about four times that
amount, he says. “We’re saving about $100 per member
per month as of the end of last year,” he says.
It took awhile to get there, he warns. The first year
and a half of the ibenefit program actually saw a spike
in health claims, not a decrease.
“The reason for that is when you start getting that
kind of participation, that many people getting screened,
getting to their physicians, you start finding problems,”
he says. “But in years two through six, those claims have
significantly come down. The trend line is actually going
downward, which is unbelievable.”
12 | Health Elevations | The Journal of the Colorado Health Foundation
WHAT’S WORKING
YOU’RE TALKING TO
THE NO. 1 CHEERLEADER
FOR THIS PROGRAM.
Chuck Marlow
Account Executive
IMA Financial Group, who discovered he had
cancer after a company health screening
Fall 2012 | w w w.ColoradoHealth .org | Health Elevations | 13
WHAT’S WORKING
Reasons to Smile
A Brighter Future for Families in Oral Health Program
By Rebecca Jones
Photography by Barry Staver
Flor Duarte’s young children were puzzled
when their mom started pulling something
that looked like string between her teeth and even more
so when she called them over to watch and learn.
“I say, ‘Come here – I’m going to show you how to floss,’
and they were amazed,” says Duarte, 26. “Before, I had
never thought of flossing. But now I floss every day.”
Duarte’s new commitment to flossing and proper dental
care will not only help her three eldest children, it will also
pay off for the unborn child she carries because oral bacteria
can be transferred from moms to their babies.
Duarte is among the 450 or so women whose oral health
will be improved this year thanks to the efforts of Bright
Smiles for Bright Futures, a dental health and education
program sponsored by Dental Aid to help pregnant women
in Boulder County.
Founded in 1974, Dental Aid was the first not-for-profit
comprehensive dental clinic in the United States. Today, it
serves more than 7,000 children and adults every year at
its three clinics in Boulder, Longmont and Louisville, and a
satellite clinic in the Boulder Shelter for the Homeless.
Bright Smiles targets an especially vulnerable population.
Babies who are born prematurely – before 37 weeks in the
womb – may face numerous health complications. Research
indicates that women with periodontal disease are three
to five times more likely to have a baby born preterm (and
therefore underweight) compared with other women.
Women also are more susceptible to gum disease when
pregnant.
“Initially, our idea was that if we could get the pregnant
moms’ gums healthy and clean, we’d have fewer low-birthweight babies and fewer preterm births,” says Dennis Lewis,
DDS, president and CEO of Dental Aid.
Sure enough – the clinic saw a marked decrease in
low-birth-weight babies among its Bright Smiles patients
in 2008 and 2009: down to about 4.5 percent, which is
substantially lower than the county average of 6.5 percent.
Then a surprising thing happened: The new moms who
had received treatment at the clinic began bringing their
children in.
“Not only were they more likely to bring their children in
than women who hadn’t been in the program, but they
were likely to bring them in earlier,” Lewis says. “In a high14 | Health Elevations | The Journal of the Colorado Health Foundation
risk population, the chances of us seeing a child by the first
birthday are virtually nil. But with these women, we do.
And by age 3, their children have about a third as many
cavities as other kids in the same income group.”
And when kids do get cavities, they are smaller and less
expensive to treat. They also are more likely to avoid the
surgery that can be involved. Lewis notes that Children’s
Hospital Colorado keeps several operating rooms busy
daily with oral disease cases.
RESEARCH INDICATES THAT
WOMEN WITH PERIODONTAL
DISEASE ARE THREE TO FIVE TIMES
MORE LIKELY TO HAVE A BABY
BORN PRETERM (AND THEREFORE
UNDERWEIGHT) COMPARED
WITH OTHER WOMEN.
“That means they have to go to the hospital less often.
It really does affect the whole cycle,” Lewis says.
Elva Quintana, Bright Smiles case manager, makes it a
point to visit her clients in their home, to talk to them about
the importance of regular dental visits and to stress taking
their children to the dentist early on.
“I had one mom with five kids, and the first two had to
have surgery at an early age because of caries [cavities],”
Quintana says. “She didn’t begin to learn about the
importance of oral health until her last baby. But now, all
her kids are cavity-free, even the oldest ones. They’re in
here every six months. I feel like we’re making a difference
in a lot of lives. Whether it’s Baby No. 1 or Baby No. 7, moms
can still learn.”
Duarte, who never had dental problems as a child, simply
took her good teeth for granted. Then one day her gums
began hurting and she went to Dental Aid.
“I learned a lot of stuff at Dental Aid,” she says. “I had
never thought of flossing before. I didn’t know how, but they
taught me. I just want to say thank you to them for bringing
back my smile.”
Flor Duarte (left) gives
her daughter Liana, 9,
a few tips on flossing.
Fall 2012 | w w w.ColoradoHealth .org | Health Elevations | 15
WHAT’S WORKING
Heading Off Trouble
Program Takes Aim at Early Intervention
By Rebecca Jones
Photography by Barry Staver
Kelly Stahlman’s twin 20-year-old sons Mark and
Eric play baseball and basketball and date girls.
They go to school, to the movies, to ballgames.
“In our family, we do everything everyone else does,”
the Littleton woman says. “It just looks different.”
It looks different because the twins were born with
cerebral palsy. They suffer from significant – at times
overwhelming – medical and emotional issues. They
require watchful eyes 24 hours a day.
Mark’s and Eric’s healthy, safe and active lives are made
possible by the certified nurse aides who not only help the
Stahlmans in their home, but also accompany the boys
into the community.
“Since there are two of them, I couldn’t do it by myself,”
Stahlman says. “If it weren’t for the aides, Mark and Eric
would never be able to do anything that allows them to
leave the house.”
Many private insurers would have capped long ago the
number of visits aides were able to make to the Stahlmans.
But thanks to a 45-year-old federal mandate – the Early
and Periodic Screening, Diagnostic and Treatment (EPSDT)
benefit – children served by Medicaid cannot be denied
medically necessary therapy. It mandates that children
under 21 and pregnant women receive comprehensive,
coordinated, family-centered and culturally competent care
for as long as needed.
The program’s name details its provisions: Children are
screened early, as soon as possible; their health is checked
at regular intervals; physical, mental, dental, developmental
and other screenings are provided during checkups;
diagnostic tests are performed when a risk is found; and
appropriate treatment is given.
In the long run, that’s just good preventive practice, says
Gina Robinson, program administrator with the Colorado
Department of Health Care Policy and Financing, which
administers the Medicaid program. Medicaid, a state and
federally funded partnership, provides health insurance
for low-income children and families, pregnant women
and people with disabilities.
Children who get the therapy and treatment they need
early in life stand a much better chance of growing up to
be healthy adults, she says. Also, children who get only
16 | Health Elevations | The Journal of the Colorado Health Foundation
limited therapy early on means schools must provide even
costlier care when children become school age.
“When children enter kindergarten, the school district has
to pick up the cost of therapy of the child,” Robinson says.
“That’s just shifting the cost of therapy onto the schools.
We want education money to be spent on education.”
In Colorado, EPSDT outreach is known as Healthy
Communities. Services are contracted to 23 social
services, public health and nonprofit agencies that
provide case management and outreach services to
people who are eligible for EPSDT and Child Health Plan
Plus, says Robinson.
The contractors employ family health coordinators to
help clients understand their benefits and navigate the
medical system to get needed care through “medical
homes,” which involve a team approach to comprehensive
medical, mental and dental care. Colorado’s integration
of EPSDT into the medical home initiative is an exemplary
practice, notes a 2010 study by the National Academy
for State Health Policy.
Coordinators also help with specialty care referrals,
follow-up on missed appointments, home visits,
transportation, billing issues and coordination with
other community resources, such as food banks.
Dawn Joyce manages the Healthy Communities
program in Boulder County.
“Navigating the health system is complicated,” Joyce
says. “EPSDT staff members partner with families to
ensure that they are able to access the medical
services they need. EPSDT staff also helps link them
to complementary services – such as nutrition assistance
and transportation services – that help ensure that
their medical care will be a success.”
It can be an overwhelming job. In Boulder County, three
Healthy Communities case managers serve 17,000 Medicaid
clients. “It’s a very underfunded program,” Joyce
says. “It’s exceptionally valuable, and they
do a tremendous amount of work, but
nowhere near as much as they could
do if the ratio were 1-to-500. If we
invested just a fraction, we would
see tremendous returns.”
Mark (left) and Eric
Stahlman enjoy an active
lifestyle with the help
of their mother, Kelly
(second from left), and
aide Liz Cervantes.
NAVIGATING THE HEALTH SYSTEM IS
COMPLICATED. [OUR] STAFF MEMBERS PARTNER
WITH FAMILIES TO ENSURE THAT THEY ARE ABLE
TO ACCESS THE MEDICAL SERVICES THEY NEED.
Dawn Joyce
Manager
Boulder County Healthy Communities
Spring 2012 | w w w.ColoradoHealth .org | Health Elevations | 17
THE EXPERT VIEW
Larry Cohen, MSW
Practicing Prevention
with a Capital ‘P’
By Sandy Graham
E DI T OR ’ S N O T E Larry Cohen is the
founder and executive director of
Prevention Institute, based in Oakland, Calif.
The nonprofit national center, established in
1997, leads efforts to improve community
health and equity through effective primary
prevention of illness and injury. Cohen raised
awareness of violence as a preventable public
health concern. He formed the coalition that
created the nation’s first multicity smoking
ban. He has advanced traffic safety, including
helmet laws and stronger adult and child
motor vehicle restraint laws. A speaker at the
2011 Colorado Health Symposium, Cohen has
helped to reframe healthy eating and activity
as more than just individual responsibility but
as community environment issues with
government and corporate responsibility.
Explain what you mean when you
say Prevention Institute focuses on
“quality” prevention.
When we talk about quality prevention, not just
prevention, we mean that telling people what to do is not
enough. We mean focusing on the practices, policies and
design of communities so that health becomes a more
natural choice, not a challenge. … We think of the institute
as a kind of magnet where people can learn about quality
prevention. In turn, they bring us their experience and
learning, which enhance our expertise, so it’s an evergrowing cycle. So many buildings say “emergency room”
or “hospital” outside. Our building is the only one where
the sign says “prevention.”
Why do you support New York City Board
of Health’s decision to ban the sale of sugary
drinks larger than 16 ounces in many venues?
This regulation is an important step. I see it as building
momentum for reducing the use of a potentially dangerous
product. Super-sized, sugar-sweetened beverages have
a lot of unnecessary calories, and there is no nutrition
in these drinks. I regret that we live in a world where we
have to use regulations like this, but we can’t give industry
18 | Health Elevations | The Journal of the Colorado Health Foundation
carte blanche to aggressively market and profit from
products that are virtually guaranteed to make many of us
unhealthy. It may seem narrow, but it’s an example of how
policy change can lead to norms change and have more
significant impact.
When I helped pass the country’s first anti-smoking law,
it merely moved smokers to one side of the room, but it
had a dramatic impact because it catalyzed other laws in
other places and began to change norms. People suddenly
understood that they could expect to be in an environment
without smoking, which couldn’t have been possible
before. That minor move in California obviously has had
implications all over the country and the world.
We are seeing more efforts to reduce the consumption
of unhealthy foods that are heavily marketed to all of us.
Richmond, Calif., has been talking about being the first city
with a new tax on sodas. Putting calorie labeling on menus
is another way to change community norms to healthier
eating. We’re hearing more debate on healthy foods as
Congress considers reauthorization of the Farm Bill. [See
Health Elevations, Spring 2012, for more about the Farm Bill
and the food system.]
What role do communities play in prevention?
Our health is affected by where we live, work and learn.
All of our work emphasizes health equity because socially
and economically disadvantaged communities often
face more challenging conditions and environments that
negatively impact their health.
SO MANY BUILDINGS
SAY ‘EMERGENCY ROOM’
OR ‘HOSPITAL’ OUTSIDE.
OUR BUILDING IS THE ONLY
ONE WHERE THE SIGN
SAYS ‘PREVENTION.’
Larry Cohen, MSW
Founder and Executive Director
Prevention Institute
Communities also have a critical role to play in setting
their priorities and actions for improving their health and
safety. We base our work in community wisdom, which is
the knowledge, intuition, skills and assets that residents
bring to solving collective challenges. There hasn’t been
the funding and investment in prevention to develop the
hard evidence that would satisfy some scientists. So we
talk about “evidence-informed” rather than “evidencebased” approaches to prevention and integrate that with
the wisdom of the communities and of practitioners.
One of the capacities the institute brings to prevention
efforts is a set of skills and approaches that have worked
in one area and can be applied in others. As a result of
no-smoking policies, smoking rates have plummeted
50 percent. [Note: About 40 percent of adult Americans
smoked in the 1940s through the 1970s; today, about
20 percent of adult Americans smoke.] Norms changed
as a result of policy and community leadership. We can
bring the lessons learned from previous successes to
change environments to promote healthy foods. We
cannot allow people to die or suffer if we have a pretty
good idea of what will have an impact.
Without the perfect base of evidence, have you
ever gone down the wrong road in your work?
Mostly, we’ve successfully focused on things that do
work. As far as the wrong road, there have been times
when there wasn’t the response we’d hoped for. An
example is that we don’t talk about obesity. We have
suggested the term be dropped because it stigmatizes
people without indicating a clear solution. It blames
the person for not eating better and exercising more. It
doesn’t take into account the person’s circumstances and
community factors. Instead, we talk about factors where
we can make changes that impact whole populations,
including healthier food environments, availability of bike
paths, streets free of violence with thriving businesses,
healthy public policies and healthy food marketing. …
We’ve definitely made great strides in moving away from
an individual focus to more community-level solutions, but
frankly, we haven’t accomplished much by raising the issue
of the term “obesity.”
How can we get people to take ownership of
prevention, whether it’s in their lives or in their
communities?
One of our most important successes has been to
convince more people that prevention is important and
that prevention efforts are successful. One of the most
common responses we get is how inspiring our message
is. So much of the news and emphasis in health care is
on after-the-fact treatment. When we remind people how
much we’ve accomplished and the lives we’ve saved through
children’s car seats, seat belts, helmets and fewer people
facing cancer or heart disease because of smoking laws, it
really has created an atmosphere of optimism and hope.
Our work has helped people who are interested in
health and prevention really understand the value of
quality, community-level prevention. My next book will be
called “The Prevention Diaries” and it will [explain] why
prevention matters by sharing what the problems are and
more importantly what the solutions are. I hope that will
get people very, very inspired.
If you had the power to change society to better
address prevention, what would you do?
I would reinvigorate the American value of collaboration
and the understanding that what affects one of us affects
all of us. I’d really look for innovation – solutions where the
diametric opposition of politicians is replaced by commonsense compassion for each other.
While there are prevention actions that are important
for each of us to take individually, it’s together that we’ll
have an impact.
How different are communities’ prevention
priorities? Are Denver’s issues vastly different
from Dallas’ or Detroit’s?
Every community is different, but there are
commonalities and strategies that run through all
communities. Communities can learn from the successes
and failures of others. For that reason, we develop tools,
frameworks and strategies so that each community can
move through its own process to determine its priorities
and craft its approach. We also collect success stories
and share them broadly so each community can select
and tailor successful strategies that might best serve its
community’s needs. The left and right are in very different
places politically these days, but polling shows that both
sides strongly support prevention.
Larry Cohen, MSW
OBSERVATIONS
James O. Hill, PhD
‘Weighting’ Job Performance
to Health and Prevention
By Sandy Graham
E DI T OR ’ S N O T E James O. Hill, PhD, wears
many hats in the fight against obesity. He is
the executive director of the Anschutz Health and
Wellness Center on the University of Colorado
Denver Anschutz Medical Campus and director of
the Colorado Nutrition Obesity Research Center.
Hill also co-founded America on the Move, a
national weight gain prevention initiative, and the
National Weight Control Registry, which tracks
7,000 individuals who have maintained significant
weight losses. Hill serves on the board of LiveWell
Colorado, a statewide campaign to reduce obesity
by promoting healthy eating and active living, and
was a panelist in the 2012 Colorado Health
Symposium debate about government regulation
versus personal choice in children’s nutrition.
Suppose your annual workplace review gauged
not only your job performance, but also how
successfully you met health goals.
James O. Hill, PhD, executive director of the Anschutz
Health and Wellness Center at the University of Colorado
Denver, believes that’s a “carrot” that could help
Coloradans keep weight off and prevent the litany
of ailments that often afflict those who are overweight
or obese.
“That’s a different way of thinking,” says Hill, with
a bit of understatement. He points out, however, that
research shows that workers with healthy weights are
more productive and less frequently absent. “What CEO
doesn’t want to get the best out of employees?” he asks.
The Anschutz Health and Wellness Center, consisting
of a state-of-the-art fitness center, research labs and
equipment, a bistro for healthy foods (dine-in, takeout or
catering) and wellness services ranging from meditation
to massage, is exploring pay-for-health-performance and
other cutting-edge weapons in the “battle of the bulge.”
The center opened on the Anschutz Medical Campus
in April 2012.
“My dream is that everybody in Colorado weighs
the same next year as they do this year,” Hill says. “If
that were to continue, we could turn things around [in
obesity] in a couple of generations.”
20 | Health Elevations | The Journal of the Colorado Health Foundation
When Colorado – widely touted as the nation’s
“thinnest” state – saw its obesity rate edge above
20 percent this year for the first time to 22 percent,
Hill wasn’t surprised. “It was totally expected, and it’s
going to increase more unless we ramp things up,” he
says. When being overweight is also taken into account,
about half of all Coloradans exceed a desirable weight.
Hill notes that there have been some excellent efforts
in Colorado to educate people about obesity and how
to become more active and eat healthier from LiveWell
Colorado and the Anschutz Center, to name just two.
Generally speaking, it’s no mystery what causes weight gain.
“I think most people know what the healthier choices
are,” Hill says. “While we live in an environment that
causes obesity, people aren’t unhappy about it.”
Hill sees it as a classic “supply and demand” issue: If
people are given reason to, they will demand healthier
choices, thus increasing supply. Where people work is
one place to start.
While many employers have workplace wellness
programs for employees, they may fall short of Hill’s
ideal program. Workers often have to pursue wellness
activities on their own time and incentives are just
“T-shirts and hats,” he says. Ten percent to 20 percent
participation may be all such programs see.
Adding a health component to annual job performance
evaluations would be a much stronger incentive – and get
every employee involved, Hill says. He is discussing this
idea with a couple of interested Denver-area employers,
but the Anschutz campus administrative staff will be the
first to try it out later this year. Each employee will set
his or her own health goals and then be given the tools
to help reach them. For example, they will be given two
15-minute walking breaks daily. Healthy foods will be
available on-site. Any business-related meals must meet
health guidelines.
“We don’t have it all worked out,” Hill says. “We’re fans
of starting simple. We’ll be doing these work sites as
research: Does this approach work?”
In addition to being a resource about health and
health care costs for the Colorado business community,
the Anschutz Health and Wellness Center is a wellness
hub for workers and visitors on the Anschutz campus.
The campus, on the decommissioned Fitzsimons Army
Medical Center, is home to Children’s Hospital Colorado,
the University of Colorado health sciences programs and
James O. Hill
Executive Director
Anschutz Health and Wellness Center
University of Colorado Denver
IF PEOPLE ARE GIVEN REASON TO, THEY WILL DEMAND HEALTHIER CHOICES,
THUS INCREASING SUPPLY. WHERE PEOPLE WORK IS ONE PLACE TO START.
schools, University Hospital and in a few more years,
a new Veterans Affairs hospital. Roughly 25,000
people will work on campus then.
“It’s a small city out here,” Hill says. Anschutz
campus employees can buy discounted
memberships to the Health and Wellness Center;
residents of nearby communities can join as well
but pay full rates. Hill estimates the center can
accommodate about 2,500 members; it has 1,500.
But not everyone wants – or needs – a formal
fitness center. Hill’s staff is planning walking clubs,
lunch-hour dances and other “fun” activities that
encourage physical activity among campus workers.
Once an individual achieves a healthy weight and
reduces risk factors for chronic conditions to a low
level, Hill considers that a “neutral” state. He’d like
to see people take further steps to “accumulate
wellness” through diet, adequate sleep, exercise,
stress reduction, good relationships, appreciation of
beauty and other factors.
“We’ve developed a new wellness definition that
goes way beyond prevention,” he says. “It’s more
than just the absence of chronic disease, but making
you as well as possible.”
Fall 2012 | w w w.ColoradoHealth .org | Health Elevations | 21
OUT OF THE BOX
Mountains of Motivation
Leadville Competition Spurs Town Weight Loss
By Rebecca Jones
Photography by Dan Sidor
Leadville Mayor Jaime Stuever likes to
point out that residents of the highest
incorporated city in the United States don’t have a hard
time getting enough exercise. “At two miles above sea level,
everything you do is physical. Just getting out of bed in the
morning is exercise,” he notes.
Even so, when the town’s newspaper, the Herald Democrat,
announced plans for a townwide weight-loss competition
after last winter’s holidays, 196 people signed up out of a
population of about 2,700.
For 16 weeks, 36 teams vied with each other in the Get the
Lead Out challenge. The newspaper reported the results of
the weekly weigh-ins and encouraged residents to take part
in classes and other special events.
“We didn’t tell people how to lose the weight. We figured
that’s their business,” says Karen Rinehart, advertising director
for the Herald Democrat and organizer of the event. “We
just provided structure. I think the reason it worked was the
accountability. People were accountable to their teammates,
and there was that weekly weigh-in.”
THE ADDITIONAL BENEFIT
OF FORMING TREMENDOUS
RELATIONSHIPS IN THE
COMMUNITY IS PRICELESS.
Karen Rinehart
Organizer
Get the Lead Out weight-loss challenge
By the final weigh-in, Leadville residents collectively had
lost more than a ton: 2,357.2 pounds. The winning female
competitor lost 45 pounds, and the winning male lost 75.
Rinehart lost 15 pounds herself and wishes it had been
more. “I got so caught up in organizing it that I wasn’t doing
what I could have,” she admits.
Stuever lost 20 pounds using a power-walking regimen.
“My office is upstairs in a two-story building, so I started
running up the stairs,” he says. “And every time I went to a
meeting, I walked fast. I’m still doing it, and I haven’t gained
any of the weight back.”
Leadville Mayor Jaime Stuever
was one of nearly 200 residents
who participated in the
community’s overwhelmingly
successful weight-loss challenge.
Rinehart initially proposed the competition as a way to sell
more newspaper ads during a traditionally slack advertising
season. She figured businesses might want to buy ads in the
weekly newspaper section about the competition.
Unfortunately as a revenue-maker, Get the Lead Out wasn’t
a triumph, she admits. “If you added up all the hours we put
in on it, we’d be at negative-something on the revenue made.
But we’re not going there,” she laughs. But it did bring in
some additional dollars.
“And the additional benefit of forming tremendous
relationships in the community is priceless,” she says.
“Though our man-hours outweighed our income, we
consider it a great promotion.”
Rinehart says she would do it all again, and she would
expand the challenge to make it broader in scope and more
about fitness, not just weight loss.
Stuever remains impressed with the community-building
aspect of the project.
“Everywhere you go, folks are still talking about it. It’s a
huge reflection on our community,” he says. “Safeway, our
only supermarket, says sales of fatty foods went way down
because everyone was shopping healthier. They could really
see a difference in what people were buying.”
22 | Health Elevations | The Journal of the Colorado Health Foundation
Next grant deadlines
February 15, 2013 l June 15, 2013
NEWS AND EVENTS
Battling for Colorado’s Health
To keep pace with emerging public
health challenges; to address
the leading causes of death and
disability; and to improve, protect
and preserve our environment and
natural resources, the Colorado
Department of Public Health and
Environment (CDPHE) initiated an
effort in 2011 to achieve measurable
impact in 10 areas. Colorado’s 10
Winnable Battles are public health
and environmental priorities with
large-scale impact on health and
the environment, and with known,
effective strategies to address them.
CDPHE identified the following areas of priority:
• Clean air
• Clean water
• Infectious disease
prevention
• Injury prevention
• Mental health and
•Obesity
• Oral health
• Safe food
•Tobacco
•Unintended
pregnancy
substance use
CDPHE welcomes all partners
and stakeholders in helping
address these Winnable Battles.
With collective efforts, we can
make a difference!
Symposium in a Snapshot
From Michael Minor’s mission to fight obesity by banning fried
chicken to author Wes Moore’s standing ovation, the 2012
Colorado Health Symposium was chock-full of surprising and insightful moments.
For those who weren’t able to attend this year’s sold-out event, “Insights:
2012 Colorado Health Symposium,” a report summarizing the three-day
event, is now available online at www.coloradohealth.org/studies.aspx. You
can also watch any of the speakers’ presentations through live streaming
at www.ustream.tv/channel/the-2012-colorado-health-symposium.
Looking forward to the next Symposium? Mark your calendars for August 7-9, 2013.
Yondorf Earns Iglehart Award
Consumer advocate Barbara Yondorf received the John K.
Iglehart Award for Leadership in Health Policy during
July’s Colorado Health Symposium. The author of numerous studies,
reports and white papers on health policy, Yondorf has served on many
health-minded organizations throughout Colorado. Named after the
founding editor of the influential Health Affairs magazine, the Iglehart
Award honors a person whose wisdom, involvement and leadership
have helped define and promote positive health care reform.
Fall 2012 | w w w.ColoradoHealth .org | Health Elevations | 23
TRUE STORY
On the Road to
Prevention and Health
By Chris Urbina, MD, MPH
E DI T OR ’ S N O T E Chris Urbina, MD, MPH,
executive director and chief medical
officer of the Colorado Department of Public
Health and Environment, participated in the
2012 Ride The Rockies, a six-day, 442-mile bike
ride through the Colorado Rockies. Throughout
the ride, he blogged about his experiences,
especially as they relate to prevention and
health. Here are some excerpts.
Friday, June 8: TWO DAYS BEFORE THE RIDE
Preparing for Ride The Rockies has been good for me. I’ve
lost 12 pounds, lowered my total cholesterol by 39 points
and my LDL by 22 points. My blood pressure is 112 over 70.
My wife likes the new me.
Saturday, June 9: FINALLY HERE
We drove over Kenosha Pass down U.S. 285, then
went over Monarch Pass. It never gets old seeing the
mountains and blue skies. We set up tents near Gunnison
Middle School.
Sunday, June 10: GUNNISON TO HOTCHKISS (79 MILES)
On Day 1, we rode by Blue Mesa and then over the Black
Canyon. Karen O’Brien, a public health educator from Delta,
told me about the work she and colleagues are doing to
address obesity, tobacco prevention and preparedness.
Monday, June 11: HOTCHKISS TO CARBONDALE (68 MILES)
Today there were lots of opportunities to practice injury
prevention. We all have our bikes in top shape and are
required to wear helmets. State Patrol rides along to protect
us from traffic. And we have rules on the road. Despite all
that, I was involved in a bike accident. I was unhurt, but
my rear wheel looked like a potato chip. Fortunately, we
could fix it.
Independence Pass. I spent time with Judy Tyson, director
of public health in Leadville, and discussed the Superfund
[hazardous waste] sites in Leadville. Leadville has made
good progress in cleaning up former mining sites and
screening kids for lead exposure.
Wednesday, June 13: LEADVILLE TO GRANBY (94 MILES)
On a ride like this, you are always hungry. Fortunately, at
every aid station they have fruit, animal crackers, pretzels,
water and a sport drink. They also have candy, burgers,
cookies and brownies. So, like in real life, you have choices.
Today I ate a veggie burrito. I found that in rural Colorado,
access to fresh fruits and vegetables is sometimes difficult.
Many communities are working on this.
Thursday, June 14: GRANBY TO ESTES PARK (63 MILES)
Let’s talk active living. Not everyone has to ride the
Rockies or run a marathon. You can walk. You can dance,
skip, climb stairs, swim or do yoga. Daily physical activity
helps maintain a healthy weight, reduces stress and is great
for your heart and bones.
Friday, June 15: ESTES PARK TO FORT COLLINS (55 MILES)
It’s the final day of the ride. We are being rerouted
because of the High Park fire. There’s an air quality advisory
from our team at the air quality division at [Colorado
Department of Public Health and Environment]. We care
about clean air.
Monday, June 18: BACK HOME
I hope you take the challenge to go out and enjoy our
beautiful state by biking, hiking, swimming, boating or
whatever gets you physically active, but practice good
injury prevention. Eat healthier and if you enjoy chocolate
like I do, eat it in moderation. Enjoy our clean air, clean
water and safe food. Reduce your chances of getting
infections by washing your hands – and by all means get
immunized. Get help if you are stressed or depressed or
are using alcohol excessively or drugs. Your families and
we care about you.
Tuesday, June 12: CARBONDALE TO LEADVILLE (83 MILES)
We arrived in Leadville after a grueling ride over
2 4 | Health Elevations | The Journal of the Colorado Health Foundation
And yes: I’VE KEPT MY WEIGHT LOSS OFF!
What Parents Can Do
to Prevent Diabetes
Health care providers are finding more children with type 2 diabetes, a
disease that usually is diagnosed in adults who are 40 years old or older.
The epidemic of obesity and the low level of physical activity among young people as
well as exposure to their mothers’ diabetes during pregnancy may be major contributors to
the increase, according to the Centers for Disease Control and Prevention (CDC).
While there is no simple solution to the childhood obesity epidemic, the CDC has some ideas that
parents and guardians can adopt so that the healthy choice becomes the easy choice for children.
•
Limit media time – TV, computers and video games – to no more than one to two hours
of quality programming per day whether at home, school or child care.
•
Visit your child’s child care center to see if healthier foods and drinks are served and if
TV and video time is limited.
•
Work with schools to limit foods and drinks with added sugar, fat and salt that can be
purchased outside the school lunch program. See the CDC’s fact sheet on the topic at
www.cdc.gov/HealthyYouth/nutrition/pdf/nutrition_factsheet_parents.pdf.
•
Provide plenty of fruits, whole grains and vegetables for your child and prepare healthier
foods at family meals. Visit www.FruitsandVeggiesMatter.gov for a database of recipes.
•
Help your child understand that all foods can be enjoyed in moderation, but reduce
temptation by providing high-fat and high-sugar snacks only sometimes.
•
Consider healthy snacks of 100 calories or less such as a medium-size apple; medium-size
banana; one cup each of blueberries or grapes; or a cup of carrots, broccoli or bell peppers
with two tablespoons of hummus.
•
Don’t “super-size” family meal servings. Better understand portion control by playing the CDC’s
“Portion Pitfalls” game at www.cdc.gov/healthyweight/healthy_eating/portion_size.html.
•
Look for ways to make favorite meals healthier by reducing fat, salt and sugar content.
Dietary fat, sugar and salt allowances vary by age and recommended calorie intake.
•
Serve your family water instead of sugar drinks.
•
Make sure your child or adolescent gets an hour of mostly aerobic activity daily. Activity
can be of moderate intensity (such as brisk walking) or high intensity (such as running).
•
Encourage your child to walk or bike to school, if safe routes are available.
•
Suggest your child sign up for a sports program or dance class.
•
Set a good example by eating well and being active yourself.
•
Remember that small changes daily can lead to success!
Source: Centers for Disease Control and Prevention.
Fall 2012 | w w w.ColoradoHealth .org | Health Elevations | 25
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