Community Health Improvement September 2006
Transcription
Community Health Improvement September 2006
B E R G E N C O U N T Y Community Health Improvement Plan September 2006 Bergen County, New Jersey B E R G E N C O U N T Y CHIP Committee Member Organizations Allendale Board of Education Columbia University – School of Public Health American Cancer Society, Northern NJ Region Comprehensive Behavioral Healthcare, Inc. American Red Cross, Bergen-Hudson Chapter Englewood Hospital and Medical Center Amerigroup NJ Fairleigh Dickinson University Atlantic Stewardship Bank Girl Scout Council of Bergen County Bergen Community College Hackensack Health Department Bergen County Cooperative Library System Hackensack University Medical Center Bergen County Department of Health Services Holy Name Hospital Bergen County Department of Human Services Horizon NJ Health Bergen County Division of Community Development Korean-American Association of New Jersey Bergen County Office on Multicultural Community Affairs Lakeland Bank Bergen County Medical Society Mount Olive Baptist Church Bergen County Municipal Nurses Association National Coalition of 100 Black Women Bergen County Police Department New Hope Baptist Church Bergen County PTA New Jersey City University Bergen County Public Health Partnership New Jersey Local Boards of Health Association Bergen County’s United Way NJ AARP Bergen County Youth Services Commission NJ Department of Education, Bergen County Office Bergen Family Center Northern NJ Maternal Child Health Consortium Bergen Regional Medical Center Paramus Board of Health Bergenfield Health Department Partnership for Community Health, Inc. Bergen Volunteer Medical Initiative, Inc. Ramapo College Buddies of New Jersey, Inc. Realtime Nutrition, Inc. Care One @ Valley Ridgewood YMCA Care Plus NJ, Inc. Sacred Heart Church, Haworth The Center for Alcohol and Drug Resources, Inc. Teaneck Department of Health and Human Services Citizens-at-large The Valley Hospital Columbia University – School of Dental & Oral Surgery 2 B E R G E N C O U N T Y Community Health Improvement Plan n 2006 Table of Contents Vision and Values.............................................................................................................. 4 Executive Summary .......................................................................................................... 5 The Framework: A Strategic Planning Model................................................................. 6 Public Health Priority Issues and Strategies Issue One: Access to Health Care .......................................................................... 12 Issue Two: Mental Health....................................................................................... 15 Issue Three: Obesity – Nutrition and Physical Activity......................................... 18 Issue Four: Alcohol, Tobacco and Other Drugs..................................................... 22 Issue Five: Communication of Health Issues ......................................................... 25 The Path Ahead.............................................................................................................. 28 Community Resources and Contributors....................................................................... 29 Task Force Member Organizations by Health Priority.................................................. 30 10 Tips for Better Health ............................................................................................... 31 County of Bergen Dennis McNerney, County Executive Bergen County Department of Health Services [email protected] • 201-634-2600 www.bergenhealth.org Partnership for Community Health, Inc. [email protected] • 201-986-7715 www.bergenpch.org Bergen County Public Health Partnership [email protected] B E R G E N C O U N T Y Community Health Improvement Plan n 2006 3 B E R G E N C O U N T Y The CHIP Committee of Bergen County embraces the following Vision and Values VISION All people in Bergen County will have access to resources that enable them to reach optimum health, well being and quality of life, supported by a continually improving, clean, safe and economically sound community. Community stakeholders will collaborate to create and leverage resources to build a healthier Bergen County. VALUES 4 Systems Thinking Strategic Thinking Dialogue Action Shared Vision Celebration of Successes Data-based Assessment/ Evaluation Partnerships B E R G E N C O U N T Y Community Health Improvement Plan n 2006 Executive Summary The CHIP Committee of Bergen County is pleased to present the following Community Health Improvement Plan (CHIP) to county residents, community organizations and civic groups after engaging in a two-year strategic planning process. The CHIP Committee is composed of over 50 member organizations and individuals who represent a broad spectrum of the community and subscribe to a broad definition of health. The community health assessment data was both quantitative and qualitative. Input was gathered from residents through community forums, focus groups and a 1,000 respondent telephone survey. Other assessments involved gathering data on the health status of the community and the workings of the local public health system as well as an assessment of forces likely to impact the health of the public in the near future. The resulting data was examined by the CHIP Committee, who identified five issues as health priorities. They are: • Access to Health Care • Mental Health • Obesity – Nutrition and Physical Activity • Alcohol, Tobacco and Other Drugs • Communication of Health Issues Goals and objectives relating to these issues as well as suggested strategies, barriers and community resources comprise the health improvement plan. The next step in the process is an anticipated three-year action cycle during which the strategies deemed most promising will be implemented. Currently, task forces composed of individuals and groups committed to improving the identified health issues are being organized. Many task force members have been drawn from CHIP Committee organizations engaged in the process to date, and other community residents are encouraged to step forward. The CHIP process is an ambitious and bold effort at community engagement for a common good. No single organization has the depth of resources needed to raise community health to an optimal level or even to maintain it at its current level. The CHIP process is based on the idea that through collaboration and synergy two plus two will equal a great deal more than four. Another important feature of CHIP is that the plan arises out of the community, which then has a greater investment in its implementation. Residents and community groups are encouraged to join the CHIP process as it enters the Action Phase. For more information, please refer to The Path Ahead on page 28 of this document. By collaborating on priority health issues, local residents and community organizations will exhibit their deep commitment to maintaining Bergen County as a healthy place to live and work. B E R G E N C O U N T Y Community Health Improvement Plan n 2006 5 B E R G E N C O U N T Y The Framework: A Strategic Planning Model Bergen County is a suburban community that is the most populous of the state’s 21 counties and the fourth most densely populated. Population is densest in the southeastern portion of the county, pictured here as seen from the Hudson River, and least dense in the northwest. A group of 50 key stakeholders in the health of the Bergen County convened on June 29, 2004, in Hasbrouck Heights. Their purpose was to craft a new public health agenda for the county through a two-year strategic planning process. The endeavor was in line with the revised Public Health Practice Standards for Local Boards of Health in New Jersey, effective in 2003. 6 B E R G E N C O U N T Y Community Health Improvement Plan n 2006 The group, dubbed the CHIP Committee for their anticipated product, the Community Health Improvement Plan, was organized under the umbrella of the Partnership for Community Health, Inc., a countywide coalition established a decade prior to improve the health, well-being and quality of life for all who live and work in Bergen County. Other key sponsors were the Bergen County Department of Health Services and the Public Health Partnership, a volunteer coalition of Bergen County health officers. A total of nine members from these three organizations had come together a few months prior as a steering committee. Calling themselves the CHIP Core Group, they had proceeded to organize the larger committee composed of stakeholders in the health of the community. The participating individuals and organizations – eventually numbering over 50 – were drawn from all sectors of the community, including public health, health care, third-party payers, education, businesses, faith groups, law enforcement, social service agencies, and philanthropic and community organizations. They were charged with following a strategic planning model borrowed from the business community called MAPP, or Mobilizing for Action through Planning and Partnerships.* MAPP had been developed by the Centers for Disease Control and Prevention and NACCHO, the National Association of County and City Health Officials. The outcome would be the CHIP, scheduled for a countywide rollout in the summer of 2006. At their initial meeting in June 2004, CHIP Committee members accepted their charge and agreed to meet quarterly in order to meet the projected time line. They also adopted a broad definition of health as “more than just the absence of disease, but a state of optimal well-being.” They crafted a Vision of a healthy Bergen County and accepted the Values of the Partnership for Community Health, Inc. Six health assessments planned The group began in the fall of 2004 to conduct four types of community health assessments as suggested by the MAPP process. The time line adopted by the group specified the completion of all assessments by December 31, 2005. The assessments included: • Community Themes and Strengths Assessment • Local Public Health System Assessment • Community Health Status Report • Forces of Change Assessment The Community Themes and Strengths Assessment, designed to gather information from the community about their perceived quality of life and community assets, would be carried out using three methodologies: community forums, a telephone survey and focus groups. The additional surveys would boost the total number of assessments to six. Community forums elicit lively dialogue The first assessment undertaken was the Community Forums in November 2004. The forums were to be conducted using the human resources and facilities donated by CHIP Committee members. The donations were solicited via a questionnaire, and a series of forums was scheduled along with a plan for recruiting participants. Forums were planned in four municipalities: Tenafly, Ramsey, Hackensack, and Ridgewood. The Hackensack forum was scheduled for daytime for the convenience of older adults, while the other three forums were set in the evening for residents aged 18 and older. * For more information on MAPP log on to http://mapp.naccho.org B E R G E N C O U N T Y Community Health Improvement Plan n 2006 7 B E R G E N C O U N T Y The forums were publicized through a press release and flyer distributed through the CHIP Committee and the Public Health Partnership. Members were charged with the outreach of participants who reflected the county’s diverse population, and approximately 140 residents with diverse demographics were registered. participants to introduce themselves. The co-facilitators then reviewed the Ground Rules, such as Respect for One Another; Respect for Confidentiality; and a Willingness to Share and Listen. The Circle, Check-In, and Ground Rules are all techniques of Dialogue that had been modeled at the orientation session. Several CHIP Committee members volunteered to co-facilitate the forums. Prior to the first forum they were oriented to help ensure that the gatherings would be conducted in a consistent manner and with the use of Dialogue skills. Dialogue skills and techniques are recommended by the MAPP process to help provide the optimum setting, conditions and methods to encourage true dialogue, which involves listening as well as speaking. Local dialogue trainers, a resource previously developed within the Partnership for Community Health, modeled the skills and techniques at the facilitator orientation. Participants engaged in a debriefing of the entries on the easel, at which time they amplified their answers about their health-related issue of concern. Then they were randomly assigned to a table to discuss three specific questions. Each small group first selected a scribe and a reporter before exchanging views. The scribe was responsible for recording the comments on a sheet of newsprint. When the small group discussions wound down, participants were asked to reconvene to the large circle for debriefing. The designated reporters posted their newsprint sheets and communicated the outcome of the small group discussions to all present. The agenda for all four forums was uniform. As participants arrived and before they took a seat in a large circle, they were invited to enter their response to the following question on an easel: What health or health-related issue is important to you and your community? In a closing exercise, participants were asked to name one issue besides the one they had brought in with them that they now felt was of equal or greater importance. Before leaving, participants were requested to complete an evaluation form and were given an opportunity to request a copy of the CHIP. Public reaction was highly positive. As one resident said, “Someone should Next, to open the meeting a “CheckIn” exercise was conducted enabling all 8 B E R G E N C O U N T Y Community Health Improvement Plan n have thought of this before. Excellent start. Now make it a reality, please.” 1,000 respondent telephone survey allows data to be queried Initial plans called for a written survey, but the CHIP Core Group decided in favor of a telephone survey as it would have greater validity. The Partnership for Community Health, Inc. selected a consultant with wide experience in health surveys who had the capability to post the results on a web page accessible to CHIP Committee members, who would then be able to query the data. The CHIP Committee was highly involved in crafting the telephone survey questions. The survey was designed to solicit residents’ perspectives of factors that contribute to the health of the local community as well as information concerning their personal health needs. The questions were designed to complement an annual survey of the New Jersey Department of Health and Senior Services called the Behavior Risk Factor Surveillance Survey (BRFSS). Rather than resurvey identical questions, the consultant agreed to post on the web page the county-level BRFSS data provided by the NJ Center for Health Statistics. This strategy freed survey time to ask additional questions, although the resulting limitation was that data from the two surveys could not be cross-tabulated. 2006 Bergen County Municipalities MAHWAH UPPER SADDLE RIVER RAMSEY MONTVALE PARK RIDGE ALLENDALE OAKLAND SADDLE RIVER RIVER VALE WOODCLIFF LAKE OLD TAPPAN WALDWICK WYCKOFF FRANKLIN LAKES ROCKLEIGH HOHOKUS MIDLAND PARK NORWOOD WASHINGTON TOWNSHIP WESTWOOD HARRINGTON PARK RIDGEWOOD EMERSON DEMAREST ORADELL PARAMUS DUMONT BERGENFIELD TENAFLY K SAC ENGLEWOOD KEN TEANECK ENGLEWOOD CLIFFS HAC GARFIELD MAY SADDLE BROOK WO ROCHELLE PARK ELMWOOD PARK NEW MILFORD CRESSKILL OD RIVER EDGE FAIR LAWN ALPINE CLOSTER HAWORTH GLEN ROCK State of New Jersey NORTHVALE HILLSDALE LODI WOOD-RIDGE MOONACHIE RU T CARLSTADT HE RF OR D EAST RUTHERFORD SH AC K FORT LEE PALISADES PARK RIDGEFIELD EW ATE R LITTLE FERRY LEONIA RIDGEFIELD PARK CLIFFSIDE PARK FAIRVIEW EDG Located in the northeastern corner of New Jersey, Bergen County is home to 884,118 residents according to the 2000 census. Its 70 municipalities are served by 15 non-contiguous health jurisdictions, each with its own health officer, including the Bergen County Department of Health Services, which delivers some of its services countywide. K AC WALLINGTON SH SH HA S HE BRO IG U HT CK S TET ERB OR O BOGOTA LYNDHURST NORTH ARLINGTON B E R G E N C O U N T Y Community Health Improvement Plan n 2006 9 B E R G E N C O U N T Y The telephone survey achieved a margin of error between 3 and 4 percent, the accepted level for all major surveys. A live web demonstration showing how to query the data for the responses of various subgroups was presented at the October 2005 CHIP Committee meeting with positive feedback. Focus groups targeted to specific populations The final segment of the Community Themes and Strengths Assessment, a series of six focus groups, was planned for the fall of 2005. The purpose was to pursue in greater depth the most pressing health issues that had arisen during the community forums and how to best address them. The Partnership for Community Health, Inc. engaged a consultant to conduct the groups, while the CHIP Committee was responsible for scheduling them and recruiting participants. Focus groups were planned for specific target groups including Young People, Senior Adults, Men, Women, Parents and Recent Immigrants. Participants for the Men’s, Women’s and Recent Immigrants’ group were successfully recruited through the CHIP Committee and the Public Health Partnership. However, the Parents’ group was eventually folded into the Men’s and Women’s group due to inadequate registration. 10 County resources were instrumental in reaching young people and older adults. High school students were accessed through the county school district, which enrolls students from all parts of Bergen County. Similarly, senior adults were reached through the county’s senior activity program and transported to the focus group site by the county’s transportation system. As with the telephone survey, the CHIP Committee provided a great deal of input regarding the focus group discussion guide. First, CHIP Core Group members analyzed the proceedings of the community forums to select topic areas to pursue, and then CHIP Committee members narrowed them down and drafted questions. The areas of questioning revolved around Access to Health Care, Obesity/Nutrition and Physical Activity, Mental Health Issues and Communicable Disease. An additional topic for the Recent Immigrants’ group was Cultural Sensitivity, while the Youth group also discussed Substance Use and Abuse. Total attendance at all five groups exclusive of facilitators and observers was 98. Observers noted a reflection of the diverse nature of the county among the participants as well as a strong willingness on their part to listen and share. A great deal of enthusiasm for improving public health issues was voiced, generating high expectations for the CHIP Committee to fulfill. B E R G E N C O U N T Y Community Health Improvement Plan n Local Public Health System Assessment completed by the PHP An assessment of the local public health system measures the capacity and performance of the larger Local Public Health System, defined as all organizations and entities that contribute to the public’s health. This assessment was undertaken by the Public Health Partnership (PHP), a volunteer coalition of Bergen’s 15 health officers. They delegated the drafting of the assessment to a subcommittee with an anticipated consensus of the entire PHP by December 31, 2005. The assessment tool was provided by the New Jersey Department of Health and Senior Services. The subcommittee met frequently beginning in the summer of 2005 to complete the task. As a preliminary step, they established ground rules in an attempt to answer the numerous questions in a consistent manner. Upon completion of the draft, the subcommittee presented it to the PHP for consensus, and it was adopted prior to the planned delivery date. Forces of Change Assessment calls upon CHIP Committee as experts The Forces of Change Assessment uses community experts to identify forces, events and trends that are or will be affecting the community or the local public health system. The CHIP Core 2006 Group decided to invite the CHIP Committee members to participate in the assessment as the experts on Bergen County. The Partnership for Community Health, Inc. engaged a consultant to design a half-day workshop in conjunction with the CHIP Core Group. The categories used to capture the Forces of Change were: Scientific/ Technology; Ethical/Legal; Environmental; Social; Political; and Economic. The assessment was undertaken in April 2005, with a total of 30 CHIP Committee members attending. The Forces of Change assessment was divided into two parts. First, six sub-groups of 5 people defined a set of Forces under each of the above categories and pinpointed several Forces of Change that appeared most critical to consider for later discussion. Through large group consensus the Critical Forces were reduced to three in each category. In the second part of the process, six subgroups were assigned to one of the six Forces of Change categories, like Social or Economic. Under each category the three previously identified Critical Forces were listed. The task of each sub-group was to develop a set of potential Threats and Opportunities that would manifest under each Force. Community Health Status Report provides additional data The Community Health Status Report assesses data about health status, quality of life, and risk factors in the community. Completion of this assessment was assigned in the fall of 2004 to the Office of Planning staff at the Bergen County Department of Health Services. The report was completed in time for a January 2006 presentation to the CHIP Committee. Selecting priorities and moving to the Action Phase Although the health status of Bergen County was generally recognized as good, a number of areas were identified where energy could be focused to help residents reach optimal health as stated in the CHIP Committee Vision. The CHIP Core Group was instrumental in identifying five health priorities emerging from the multiple community health assessments, and the CHIP Committee endorsed them. Most of these priorities are reflective of Healthy New Jersey 2010 and, as such, help move the state’s health agenda forward. CHIP Committee members reviewed what were initially called “Problem Statements,” or rationales for selecting each priority issue, and “templates” that listed the goals, measurable objectives, risk factors, suggested strategies, resources and barriers for each. Finally, in April 2006 as part of the process, CHIP Committee member organizations were requested to declare their support for one or more of the emerging health priorities. Issues that received a critical mass of support were to be included in the CHIP. As a result of the high level of support shown, each of the five health priorities identified through the CHIP process will be the subject of a countywide task force. With the presentation of the CHIP to the community, the Action Phase of the MAPP process begins. Interventions are likely to be multi-level, reaching the population through multiple channels, as well as multi-faceted, with behavioral, social and environmental aspects addressed for greater effectiveness. The Action Phase is projected to last three years, at which time progress toward objectives will be reported to the community. Since health needs are constantly emerging, the cyclical nature of the MAPP process allows the periodic identification of new priorities and the realignment of activities and resources to address them. B E R G E N C O U N T Y Community Health Improvement Plan n 2006 11 Public Health Priority Issues I S S U E O N E : Access to Health Care Most residents named access to care as their most important issue upon arrival at the community forums. Included under this topic was lack of preventive health care, long-term care, dental care and prescription drugs. By the conclusion of the forums over one-third of participants ranked access to health care as the first or second most important local health issue. Lack of public transportation and English language skills cited as barriers The difficulty of accessing care also animated discussions at the focus 12 Courtesy of North Jersey Community Newspapers / Michael Karas Community input to identify issues of interest to residents was solicited using three methods: community forums, focus groups and a 1,000 respondent telephone survey. Each assessment showed that access to health care was an issue of top concern. Immunizations are one important aspect of preventive health care for adults as well as children. Residents who lack adequate health insurance or a medical “home” and those who face language, cultural and other barriers often encounter greater difficulty in obtaining preventive health services and continuity of care. groups held for immigrants, men and women. Among the barriers cited was the lack of public transportation especially among senior adults, although transportation constituted a need for all age groups according to the Forces of Change Assessment. Recent immigrants spoke about the common practice of using hospital emergency rooms as sources of B E R G E N C O U N T Y Community Health Improvement Plan n 11.3% of Bergen County adults, or 76,960, lack health insurance coverage.* * Data from telephone surveys conducted in Bergen County from 2003-2005 2006 and Strategies Goal Outcome Objectives/Indicators Increase Access to Health Care Increase the percentage of adults who have access to primary care to more than 89% Decrease hospital admissions rate for Ambulatory Care Sensitive Diagnoses for adults under age 65 per 1,000 population to 13; and for children under age 5 per 1,000 population to 23 Risk Factors Impact Objectives Low income Young adult Recent immigrant Employee of small company Part-time employee • Improve access to primary care for residents who live below 200% of the federal poverty level • Strengthen the linkage and referral system between agencies that offer free health care and other social service and health care agencies • Increase delivery of culturally competent services Suggested Intervention Strategies Contributing Factors Direct contributing factors: • Lack of health insurance coverage • Poverty • Cost • Unavailability and inappropriate use of treatment resources Indirect contributing factors: • Health coverage system based on employment • Lack of education • Lack of jobs • Substance abuse Increase awareness of/# referrals to available free health care facilities Promote enrollment in KidCare and other free or low cost health coverage programs (e.g., Catastrophic Children’s Fund) Advocate for the establishment of nonprofit health care facilities providing free health care to the uninsured Advocate for financial or other incentives to hospitals willing to share lab and radiology services with free health care facilities Increase awareness to improve the delivery of culturally competent health care services Increase awareness of free or reduced cost prescription drug programs Increase awareness of proper use of preventive health care services Promote Health Literacy as a means to increasing access to care Advocate to decrease barriers to care Advocate to incorporate screening into health care at all clinical services Review guidelines for eligibility for Federal and State programs in relation to Bergen County living costs and advocate for changes if warranted Resources Available Federal programs Nonprofit health clinics Free/reduced cost prescription drug programs Barriers Transportation Language Cultural Lack of knowledge of existing resources B E R G E N C O U N T Y Community Health Improvement Plan n 2006 13 I S S U E O N E : Access to Health Care, Cont’d. primary care, an inappropriate use of resources arising out of their needs. They complained particularly of the lack of continuity of care at hospital emergency rooms and clinics, as well as their perceived lack of bilingual interpreters and materials in their native languages. More than 13 percent of Bergen residents speak English “less than very well” according to the Health Status Report. Residents express need for more accessible health care The telephone survey revealed that nearly 60 percent of county residents feel that Access to Preventive Health Services is a factor that needs to be improved in the community, and those below the 200 percent federal poverty level feel the need more keenly. The following additional statistics emerged from the survey: • 11.3 percent of Bergen County adults have no health insurance • 18.8 percent of Bergen County adults could not get prescription medication in the past 12 months due to cost • 12.7 percent of Bergen County adults could not get dental care in the past 12 months due to cost. 14 In the absence of universal health insurance coverage, access to health care is a key issue for communities across the country. Barriers such as the cost of physician visits, prescription medicine and dental care are prohibitive factors for many residents. Nevertheless, in 58.9% of Bergen County adults, or 401,146, perceive that Accessibility to Preventive Health Care needs to be improved in the community. Among adult residents below 200% of the poverty level, the figure climbs to 71.6%.* * Data from telephone surveys conducted in Bergen County from 2003-2005 the past year a higher proportion of Bergen County residents than residents nationwide obtained dental care, and the Healthy People 2010 objective for annual dental exams was satisfied. a lower incidence of uninsured adults and higher proportions of adults and children having had a routine checkup in the past year. Although the county scored better than the nation as a whole on these indicators, the lack of universal health insurance – an objective of Healthy People 2010 – leaves a sizeable proportion of our residents vulnerable. The data indicates that more than one in ten Bergen County adults manages their health without primary health care coverage. Residents strongly voiced their need for increased access to health care through focus groups and community forums. The Forces of Change Assessment reinforced its importance as a top issue. In the discussion on economic conditions, Forces of Change participants noted increasing numbers of uninsured residents and the perceived burdens on local hospitals related to treating patients under Charity Care funding. Also cited was the need for some residents to compromise on basics like food to pay for medical care and prescription drugs. More than one in ten lack health care coverage Outperforming the nation on specific measures, Bergen County experienced B E R G E N C O U N T Y Community Health Improvement Plan n 2006 I S S U E T W O : Mental Health Strong concerns about Mental Health were heard from residents at the Community Forums, and it was one of the few topics that had more champions at the conclusion of the forums than at the start. Nearly one in five participants ranked mental health issues as first or second in importance. In regard to the diagnosed mentally ill, participants called for more providers of care and more support, education, housing subsidies, job training and placement. However, they also cited mental health issues such as lifestyle pressures and stress for the general population. Stress was viewed as a public health issue affecting all residents, including children. Factors perceived as contributing to mental health issues were the hectic pace of life in the Residents expressed mental health concerns that encompassed the needs of both those with diagnosed mental illness as well as those coping with everyday stress, anxiety and depression. Having a support system and a feeling of belongingness in the community are some of the factors that help promote “mental wellness.” B E R G E N C O U N T Y Community Health Improvement Plan n 2006 15 I S S U E T W O : Mental Health, Cont’d. Nearly one in three Bergen County adults, or 32.2%, report “too much job-related stress” (9.0%) or “a lot of job-related stress” (23.3%).* metropolitan area and the pursuit of a lifestyle that is out of reach for many. Young people note stress and anxiety, older folks cite depression and isolation The concern for mental health issues was repeated at the Focus Groups. Most attendees indicated that depression, anxiety and stress are the serious problems they see. Young people noted that stress and anxiety over school and peer pressure affected their age group. Additional mental health issues for children were highlighted at the Forces of Change Assessment such as harassment and bullying of peers including cyber bullying, or intimidation occurring via the Internet. In the older adult focus group, participants expressed particular concerns about depression and isolation. The Forces of Change Assessment reinforced those concerns as participants 16 noted the aging of the population was creating a need for more senior services, including those related to mental health. Access to care and stigma remain problems Although participants attending the focus groups expressed that depression is a problem keenly felt by the individual and his or her respective family, the telephone survey found that the prevalence of self-reported depression is lower in Bergen County than nationwide. However, the difficulty of accessing treatment was expressed, especially for immigrants with a language barrier. All agreed that the stigma attached to mental illness remains troublesome and that more education on mental illness, its causes and treatment would be helpful. 52.4% of Bergen County adults, or 356,877, perceive that adequate mental health services need to be improved in the community. Among adult residents below 200% of the poverty level, the figure climbs to 68.0%. * Data from telephone surveys conducted in Bergen County from 2003-2005 Telephone surveys indicate the following: • 9 percent of Bergen County adults feel “too much” job-related stress on a regular basis • 23.3 percent report “a lot of ” job-related stress on a regular basis • Bergen County adults report on average of 27 good mental health days in the past month. B E R G E N C O U N T Y Community Health Improvement Plan Adequacy of mental health services Over 40 percent of telephone survey respondents feel that Mental Health Issues are a major or moderate problem in the community. The Forces of Change Assessment reinforced that view by citing the need for more mental health services, partially as a result of n the terrorist attack on the World Trade Center on September 11, 2001, an assault that took the lives of hundreds of county residents and shook the security of thousands more. The telephone survey also revealed that more than 52 percent of Bergen County adults feel that Mental Health Services is an attribute that needs to be improved in the community, and those below the 200 percent federal poverty level feel the need more keenly. 2006 Goal Outcome Objectives/Indicators Promote Mental Health in the community Increase days able to do usual activities during past 30 days due to good mental health from 27 to 28 Reduce the proportion of the adult population reporting their mental health was not good more than 7 days in the past month Impact Objectives Risk Factors • Improve access to mental health services • Reduce stigma of mental illness in the community • Strengthen the linkage and referral system between mental health providers and other service organizations • Increase the proportion of mental health care providers who are culturally and linguistically competent Family history Lack of access to care Suggested Intervention Strategies Contributing Factors Increase awareness and use of mental health referral and help lines Direct contributing factors: • Poverty • Aging • Lack of insurance coverage • Cost of treatment/medications • Unavailability of treatment resources • Unavailability of culturally competent care • Stigma • Domestic violence • Lack of understanding that treatment works Increase awareness and use of the community mental health system Increase awareness and use of Employee Assistance Programs Promote depression and anxiety screening by medical providers and encourage referral to appropriate services Incorporate mental health promotion, including media messages, into chronic disease prevention efforts Advocate for expanded mental health care programs Advocate for increasing the number of specifically trained treatment specialists to address unique and various cultural groups Increase understanding and knowledge of the people affected and the community at large concerning mental illnesses Indirect contributing factors: • Substance abuse • Social attitudes Increase the pool of child and adolescent psychiatrists by advocating for parity coverage for providers and an increase in Medicaid reimbursement Improve parenting skills through education and treatment Facilitate training of school and youth group based personnel to enable earlier preventive interventions Advocate for increased character development and education (e.g., antibullying, positive coping mechanisms, social interaction, etc.) to minimize isolation and increase opportunities for prevention/early intervention Replicate successful substance abuse treatment program models with special attention to Mentally Impaired Chemically Addicted, parent/child settings, chronic substance abuse and adolescent girls Resources Available County supported mental health system Free/reduced cost prescription drug programs NAMI (National Alliance on Mental Illness) Barriers Transportation Stigma Language Cultural B E R G E N C O U N T Y Community Health Improvement Plan n 2006 17 I S S U E T H R E E : Obesity – Nutrition and Physical Activity The telephone survey revealed that over half of Bergen County adults are overweight or obese, and nearly three out of four residents surveyed perceive overweight/obesity as a major or moderate problem in the community. Fewer than half of Bergen County adults, or 46.3%, meet the recommendation for moderate physical activity.* * Data from telephone surveys conducted in Bergen County from 2003-2005 18 The current trend toward increased overweight and obesity is evident among children as well as adults and increases the risk for chronic diseases. Good nutrition and adequate exercise are lifestyle habits that combat overweight and can be fostered by a favorable environment, both social and physical. Health experts recognize obesity as a risk factor for a number of chronic diseases including heart disease and cancer, which together comprise the leading causes of death. Obesity and overweight are also associated with Type 2 diabetes, a disease that is on the B E R G E N C O U N T Y Community Health Improvement Plan n rise nationally and can lead to serious complications and premature death. A problem for young and old In various health assessments, obesity was cited as a problem for both senior adults and young people. For example, 2006 during the Forces of Change Assessment participants noted the increase in childhood obesity along with the increased amount of time young people spend in sedentary activities. Similarly, participants at the Community Forums cited obesity as an issue for younger residents, although they also saw poor nutrition for senior adults as a concern. Discussions about nutrition and physical activity, two major risk factors for obesity, elicited strong reactions particularly from Focus Group participants. Numerous barriers to healthy eating and exercise were cited, although the relationship of these behaviors to desirable weight and good health was readily acknowledged. Members of all focus groups deemed lack of time a major barrier, whereas senior adults were also impeded by a lack of public transportation to food markets, and young people and women were hampered by their lack of cooking skills. Interestingly, immigrants cited the need for more public 38.6% of Bergen County adults, or 261,890, are overweight. The Healthy New Jersey 2010 objective is 27.6% or lower.* Overweight/not obese is defined as having a body mass index (BMI) – a ratio of weight to height – between 25.0 and 29.9. transportation as a means of combating obesity as opposed to driving doorto-door. Another factor contributing to overweight was noted in the ready availability and low price of so-called “junk” foods. Telephone surveys indicate the following: • 16.2 percent of Bergen County adults are obese • An additional 38.6 percent are overweight Over half of Bergen County adults, • Fewer than 1 in 3 (28.4 percent) meet the recommendation for five fruits and vegetables a day or 373,223, are overweight or obese.* • Fewer than 1 in 4 (22.6 percent) participate in frequent leisure time physical activity. 54.8%, The data is based on self-reported height and weight. * Data from telephone surveys conducted in Bergen County from 2003-2005 in New Jersey as a whole (2004 data) and in the US (2005), the percentage does not meet the objective for Healthy NJ 2010. Furthermore, only 41.8 percent of overweight Bergen County adults have been advised to lose weight, and only 27 percent overall received advice from a health professional in the past 12 months about their weight. On the other hand, residents had no shortage of suggested strategies for problems of overweight and obesity and called for education campaigns, cooking classes and opening more recreational 16.2% of Bergen County adults, or 110,332, are obese. For adult residents at less than 200% of the poverty level, more than twice as many, or 36.0%, are obese. The Healthy New Jersey 2010 objective is 12% or lower.* Obesity is defined as having a body mass index (BMI) – a ratio of weight to height – greater than or equal to 30.0. Need for more medical advice on weight loss Although the percentage of obese adults in Bergen County is lower than B E R G E N C O U N T Y Community Health Improvement Plan n 2006 19 I S S U E T H R E E : Obesity – Nutrition and Physical Activity, Cont’d. and rehabilitation facilities for use by the community, as well as instituting better nutrition education, physical education and cafeteria offerings in the schools. Residents short on fruit and vegetable intake and physical activity Expert advice for weight loss calls for decreasing calorie intake and/or increasing physical activity. Moreover, adequate physical activity and a nutritious diet serve to reduce the risk for Of the county’s 681,064 adult residents, only 28.4%, or 193,422, meet the recommendation for five fruits and vegetables a day. * The Healthy New Jersey 2010 objective is 35% or higher. * Data from telephone surveys conducted in Bergen County from 2003-2005 mendation for five or more fruits and vegetables a day. Bergen County adults are less likely than adults nationwide to meet this recommendation and therefore fail to satisfy this objective for Healthy New Jersey 2010. 46.4% of Bergen County adults, or 316,013, perceive that the environment for walking needs to be improved in the community.* 22.6 % of Bergen County adults, or 153,920, report not engaging in any leisuretime physical activity in the past month.* Bergen County adults are more likely to participate in physical activity than adults nationwide, but fewer than half (46.3 percent) meet the recommendation for at least 30 minutes of activity most days of the week. Fewer than a quarter of Bergen County adults (22.6 percent) engage in frequent leisure time physical activity, although more than half (53.9 percent) perceive a lack of physical activity as a major or moderate problem in the community. Improving the social environment to foster healthy decisions Healthy decisions encompass many areas including an individual’s nutrition choices and level of physical activity. Decision-making is often influenced by the social environment — the actions and/or attitudes of those around us. More than half of Bergen County adults (57 percent) feel that the social environment needs to be improved to encourage healthy decisionmaking, for example, through positive peer pressure, changing community norms or role-modeling. chronic disease, even in the absence of obesity. A diet that is moderate in fat and calorie intake is helpful for weight control and generally meets the recom- 20 B E R G E N C O U N T Y Community Health Improvement Plan n 2006 Goal Outcome Objectives/Indicators Reduce the prevalence of Obesity and Overweight through improved Nutrition and Physical Activity Increase the intake of fruits and vegetables Reduce the percentage of obese and overweight people Increase the percentage of people who engage in regular physical activity Increase the percentage of overweight adults who are modifying diet and increasing physical activity to lose weight Reduce the percentage of children entering K, 5th and 9th grades who have a BMI above the recommended level Risk Factors Impact Objectives Unhealthy diet Physical inactivity Lack of education Low income Minority group member, i.e., African American, Latino, etc. • Increase the number of restaurants/school cafeterias offering/promoting healthy choices • Increase the number of community groups developing policies on healthy refreshments • Increase the number of families engaging in physical activity together • Increase the number of low cost/free cooking and exercise classes in the community Suggested Intervention Strategies Contributing Factors Direct contributing factors: • Lack of knowledge • Lack of time • Poor eating habits • Lifestyle does not incorporate physical activity Indirect contributing factors: • Advertising unhealthy foods to children • Lack of access to wholesome foods • Availability of calorie-dense food • Using food as “drug” • Lack of access to exercise facilities • Environment unfavorable to physical activity • Role models • Chronic illness • Disabilities Resources Available Municipal and county parks Nonprofit recreational organizations School and hospital exercise facilities American Dietetic Association website 5-A-Day Program Women’s, Infants and Children’s Supplemental Food Program Internship programs at local colleges and universities Increase awareness and knowledge of the benefits of regular physical activity and good nutrition for all county residents throughout the lifespan Improve consumers’ perceptions concerning the value of healthy food choices and regular exercise Advocate for creating/sustaining an environment conducive to physical activity including “walkable” communities that respect pedestrian rights and have sidewalks in good repair, bicycle paths, improved lighting, etc. Increase awareness and access to different types of physical activity, programs and facilities Develop/advocate for policies in schools, senior programs, worksites and other community groups that are consistent with good nutrition and increased exercise Advocate for expanded nutrition/physical education in schools and other community settings Increase knowledge and skills among all groups needed to purchase, prepare and consume healthy foods and incorporate exercise into lifestyle Advocate for restrictions on unhealthy food advertising aimed at children Advocate for parents and caregivers to serve children healthy snacks and encourage physical activity Increase distribution of nutrition information Increase awareness of sources of credible nutrition information and criteria for determining credibility Advocate for food providers to develop and implement incentive programs that promote consumers’ healthy food choices Increase awareness of programs and resources providing increased access to healthy food choices Barriers Cost Time constraints Lack of knowledge Attitudes about nutrition/physical activity Concerns about safety B E R G E N C O U N T Y Community Health Improvement Plan n 2006 21 I S S U E F O U R : Alcohol, Tobacco and Other Drugs According to the telephone survey, over half of Bergen County adults feel that Tobacco Use and Alcohol and Drug Abuse are major or moderate problems in the community. The fact that tobacco use adversely affects health is well accepted. National data shows that one out of three smokers die prematurely with an average of 12 to 15 years of potential life lost as compared to normal life expectancy. Even non-smokers experience deleterious health effects as a result of exposure to secondhand smoke. Telephone surveys indicate the following: • 16.2 percent of Bergen County adults currently smoke • 13 percent of Bergen County adults engaged in binge drinking (defined as five or more drinks on an occasion) in the past 30 days. 22 Patterns of substance use and abuse like smoking and binge drinking often appear during pre-teen and teenage years. Preventive approaches include arming children with “developmental assets,” or factors like their sense of personal responsibility and self worth as well as their “connectedness” to their families, schools and communities. Smoking and binge drinking rates fall short of goals; drug use a concern The telephone survey reveals that Bergen County fails to meet the Healthy People 2010 objective for binge drinking, although the prevalence of binge drinking is lower than national averages. Similarly, the prevalence of adult cigarette smoking in Bergen County does not satisfy state and federal goals even though the rate is lower than in the nation and New Jersey as a whole. B E R G E N C O U N T Y Community Health Improvement Plan n 2006 13% of Bergen County adults, or 88,538, report binge drinking in the past 30 days (consuming five or more drinks on one occasion). * The Healthy New Jersey 2010 objective is 10.6% or lower. * Data from telephone surveys conducted in Bergen County from 2003-2005 Goal Reduce use and abuse of Alcohol, Tobacco and Other Drugs (ATOD) Outcome Objectives/Indicators Decrease percentage of high school students who say they are currently smoking to 30% Decrease the percentage of high school students who have used substances in the past 30 days Increase percentage of current smokers who quit for a day within the past year Decrease the percentage of adults engaging in binge drinking Risk Factors Impact Objectives Contributing Factors Suggested Intervention Strategies • Raise the age of initiation to tobacco use • Reduce the availability of smoking materials by enforcing tobacco age of sale laws • Increase number of expectant mothers who quit smoking and/or establish smoke-free homes Youth, especially those under age 18 Isolation and loss, especially for senior adults Parental/peer use of tobacco and other substances Direct contributing factors: • Peer pressure • Lack of knowledge/refusal skills • Lack of resiliency or developmental assets • Attitudes about substance use/ abuse • Access to smoking materials and other substances • Addiction Indirect contributing factors: • Low self-esteem • Role models • Lack of family management skills • Lack of community support for the elderly • Lack of support for those quitting tobacco • Lack of smoking policies • Media portrayals of substance use Resources Available REBEL (Reach Everyone By Exposing Lies, for youth) The Center for Alcohol and Drug Resources, Inc. Municipal Alliance to Prevent Alcoholism & Drug Abuse TASE Program (Tobacco Age of Sale) Internship programs at local colleges and universities Public and private treatment programs Organize town meetings and other events to increase awareness about the issue of underage drinking Promote use of programs/initiatives for ATOD prevention, especially those involving schools, parents and faith-based organizations that take into account culture and language spoken Increase awareness of Quit Smoking Programs and substance abuse resources including those promoting risks of alcohol, e.g., effects on fetus, driving under the influence, etc. Advocate for increased funding of ATOD programs, including funding for School Resource Officers Increase youth involvement in ATOD prevention and cessation activities Promote Resiliency Building for young people in youth programs, schools and other community settings Improve parenting skills through education Advocate for legislation to enable investigation of underage alcohol use on private property Encourage health care professionals to advise patients who use and abuse ATOD of the health risks Increase awareness of grassroots efforts to reduce use and abuse of substances, e.g., Municipal Alliances Advocate for increased alcohol abuse interventions among the elderly Create uniformity throughout the county in regard to education, policies and enforcement on alcohol and other substances Advocate for the development of municipal policies in relation to substance use, including messages sent to young people about underage drinking Barriers Attitudes about substance use/abuse Lag time in appearance of detrimental effects B E R G E N C O U N T Y Community Health Improvement Plan n 2006 23 I S S U E F O U R : Alcohol, Tobacco and Other Drugs, Cont’d. In alignment with these findings, participants at the Community Forums cited tobacco use and substance abuse as concerns. Among those in the Youth Focus Group most agreed that tobacco use was harmful, alcohol use was routine, and marijuana use was relatively accepted among their peers. Some felt that illegal substances could easily be 16.2% of Bergen County adults, or 110,332, are current smokers.* The Healthy New Jersey 2010 objective is 15% or lower for adults, and the Healthy People 2010 objective for the nation is 12%. obtained in the community, and some youth were aware of peers using “hard drugs,” although use of these drugs was seen as not acceptable. The drivers for drug use according to the group were anxiety and boredom. The Forces of Change Assessment reinforced the data gathered at the Youth Focus Group in regard to the acceptance of alcohol use by children and a perceived rise in the popularity of methamphetamine use. Also noted was a perceived moderate increase in crime influenced by drugs. 24 Factors leaving children vulnerable Concerning the vulnerability of young people to substance use and abuse, the Forces of Change assessment made note of social factors impacting the manner in which children are currently raised. Participants’ perceptions were that more single-parent households exist and that more parents are in the workforce, leading to a decrease in family recreation time and closeness. The increasing use of computers and computer games was another factor seen as decreasing social 57.0 % of Bergen County adults, or 388,206, perceive that the social environment in the community needs to be improved to encourage healthy decision-making. Among adult residents below 200% of the poverty level, the figure climbs to 63.6%.* (57 percent) feel that the community’s social environment needs to be improved to encourage healthy decisionmaking, for example, through positive peer pressure, changing community norms, and role modeling against use and abuse of substances. Adequacy of substance abuse services Community members who become addicted to substances often require assistance from substance abuse programs. The telephone survey revealed that over half of residents (53 percent) feel that Adequate Substance Abuse Services is an attribute that needs to be improved in the community, and those below the 200 percent federal poverty level feel the need more keenly. 53.7% interaction. Finally, a loss of the parental role in family relationships was noted as a negative factor. * Data from telephone surveys conducted in Bergen County from 2003-2005 Healthy decision-making affects an individual’s using or non-using status. More than half of county residents B E R G E N C O U N T Y Community Health Improvement Plan n of Bergen County adults, or 365,731, perceive that adequate substance abuse services need to be improved in the community. Among adult residents below 200% of the poverty level, the figure climbs to 67.2%.* 2006 I S S U E F I v E : Communication of Health Issues The call for more communication, health promotion and health education emerged through all three Community Themes assessments that engaged residents: community forums, focus groups and the telephone survey. The request for more activity in this area was not limited by age group, gender or immigrant status but rather was heard as a generalized theme from throughout the community. Community perspectives gathered through forums, focus groups and surveys revealed residents’ needs for improving their health-related skills and increasing their knowledge and awareness of health-related resources. Nearly one in five residents discussing health issues at the Community Forums ranked Increasing Awareness of Health Issues or Health Education first or second in importance. Participants called for better communication in regard to the availability of public health and social service programs, increased advocacy for health issues, and better use of communications to increase motivation for better health choices. Young people as well as older adults cited the need for increased health education on specific topics such as STDs, HIV and asthma. ing awareness of health issues were heard at the Focus Groups. There were calls for improving communication through more public meetings, more effective use of the news media, and increased information in languages other than English. Both men and women spoke about the need to better promote public health services and for more education on specific subjects like parenting skills and mental illness. Recent immigrants cited an increased need for health education among the foreign born because of different focuses in educational systems abroad. Health education, awareness-building themes repeated at focus groups Similar comments about the importance of health education and increas- Older adults requested more speakers on health issues on a regular basis in the programs that serve them and more personalized assistance in improving their health. They also recognized the importance of health education for youth and characterized young people as a channel to the entire family. Teens recognized the need for more school-based health education on topics like nutrition and substance use. They suggested the establishment of local teen health centers for better dissemination 10.6% of Bergen County adults, or 72,192, can’t name their desired source of credible health information.* * Data from telephone surveys conducted in Bergen County from 2003-2005 B E R G E N C O U N T Y Community Health Improvement Plan n 2006 25 I S S U E F I v E : Communication of Health Issues, Cont’d. of information on varied topics such as mental health, STDs, and risks for children of alcoholics. Some of the young people recognized that dispensing health information was a drawing card for offering other types of health services. Need to increase awareness on multiple topics revealed through survey The telephone survey revealed specific “disconnects” in the community in terms of awareness. For example, when asked if there were an authorized place for the disposal of household hazardous or toxic waste, almost one in three (32 percent) were uncertain or answered “no.” Nearly one in three Bergen County adults 32%, or 217,940, don’t know or do not believe there is an authorized location for the disposal of household hazardous or toxic waste in Bergen County.* * Data from telephone surveys conducted in Bergen County from 2003-2005 Similarly, over 70 percent were unaware of plans in their community in the event of an emergency such as a bioterrorism incident or an emerging epidemic. Of the more than 7 percent of residents who had concerns about having enough food for themselves or their family in 26 the last 30 days, over 16 percent did not know where to turn for help. Technology gap, multicultural considerations add to needs The need for increased Communication on Health Issues was reinforced by the Forces of Change Assessment and the Health Status Report. The Forces of Change Assessment cited a widen- 72.3% of Bergen County adults, or 492,409, are unaware of community emergency plans in the event of a public health emergency.* ing gap in access to technology, which places lower socio-economic segments of the population at a disadvantage in regard to accessing information, including health information. The same assessment noted an increase in immigration and foreign-speaking residents from diverse countries leading to multi-cultural considerations. According to the Health Status Report, nearly one-third of Bergen County residents speak a language other than English at home and more than 13 percent speak English “less than very well.” Both the gap in access to technology and the increasing diversification of county residents call for targeted communication efforts to reach the affected populations. B E R G E N C O U N T Y Community Health Improvement Plan n Other factors increasing the need for improved communication The Forces of Change Assessment noted additional factors increasing the importance of health communications such as the threat of bioterrorism and emerging or re-emerging infections like pandemic or avian influenza. Should these events occur, the need to communicate with the public would become more acute. Channels for disseminating health messages currently exist; however, increased efforts to strengthen them would constitute positive steps. On a related theme, the Health Status Report characterized antimicrobial resistance (AR) as a topic of interest worldwide and one of the world’s most pressing public health problems. AR occurs when bacteria change in a way that decreases or eliminates the effectiveness of an antibiotic. Nearly all significant bacterial infections in the world are becoming resistant to most commonly prescribed antibiotic treatments. Prevention includes educational programs for physicians and the community about the concern with AR and the proper use of antibiotics. Addressing communication of health issues through the CHIP would not only help accommodate the expressed needs of county residents, but also constitute another link in the communications network for educating and alerting the community about engineered and emerging biological health threats. 2006 Goal Outcome Objectives/Indicators Improve Communication of Health Issues Increase percentage of residents able to access information on health and health-related issues/programs Increase percentage of residents who indicate awareness and knowledge of local environmental, health and social service programs and emergency planning Risk Factors Impact Objectives Contributing Factors Suggested Intervention Strategies Low literacy Foreign speaking Lack of education Low income • Establish/improve channels of communication with minority and special needs populations • Increase the number of people who seek information on health and social services programs through Bergen County Cooperative Library System (BCCLS) • Increase the number of foreign-language health education materials available in local libraries • Increase the number of health messages broadcast via radio Direct contributing factors: • Poverty • Increased diversity/immigration • Lack of knowledge of information sources • Lack of access to Internet Indirect contributing factors: • Low promotional budgets of public health and social service agencies • Challenge of broadcasting local messages in the New York metropolitan media market • Identify gaps in communication through systematic analysis • Develop/gather and disseminate media messages on priority health issues • Use nonprint media as well as print media to increase awareness of key phone numbers to access health information and services • Increase participation in non health-related community events to increase visibility of health services • Establish a web page to direct users to health information in English and foreign languages • Provide criteria to identify credible sources of health information to local libraries for use by patrons • Develop newspaper inserts or fillers for municipal and other community newsletters on health services • Outreach community groups regularly with appropriate health information Resources Available BCCLS (Bergen County Cooperative Library System) NJ Dept. of Health and Senior Services, Office of Minority and Multicultural Health CDC Website Pooled language capabilities of CHIP Committee Internship programs at local colleges and universities Barriers Language, including low literacy Cultural Fragmented public health system B E R G E N C O U N T Y Community Health Improvement Plan n 2006 27 B E R G E N C O U N T Y The Path Ahead By definition the CHIP process is a cyclical progression toward community health improvement. With the completion of the Community Health Improvement Plan, participants will move to the Action Phase. This part of the cycle consists of Planning, Implementing and Evaluating initiatives and interventions to reach measurable objectives. Members of the CHIP Committee have already joined task forces that will focus on each of the five priority health issues. Their next step will be to bring more community members “to the table” who will help set measurable objectives and select strategies to reach them. Evaluation will remain foremost so that progress toward goals can be quantified. The level of achievement will result from the commitment of the task force members. All residents and community and civic organizations are invited to join the effort. To become involved or for more information, contact the CHIP Initiative at the: Bergen County Department of Health Services 327 E. Ridgewood Avenue Paramus, New Jersey 07652-4895 Phone: 201-634-2600 [email protected] www.bergenhealth.org Or: Partnership for Community Health, Inc. 690 Kinderkamack Road, Suite 202 Oradell, New Jersey 07649 Phone: 201-986-7715 [email protected] www.bergenpch.org Public Health Partnership A volunteer coalition of Bergen County health officers, the Public Health Partnership is one of three co-sponsoring organizations of the CHIP. Gratitude is expressed to the health officers, who assisted in developing the CHIP during the two-year planning and assessment process through the dedication of their time, professional expertise and financial resources. Stephen C. Tiffinger Bergen County Department of Health Services Serving: Allendale, Alpine, Cliffside Park, Dumont, East Rutherford, Edgewater, Fairview, Franklin Lakes, Glen Rock, Hasbrouck Heights, Haworth, Ho-Ho-Kus, Little Ferry, Lodi, Lyndhurst, Maywood, Moonachie, North Arlington, Norwood, Oakland, Oradell, Park Ridge, Rochelle Park, Rutherford, Saddle Brook, Teterboro, Woodcliff Lake, Woodridge Carol Wagner Fair Lawn Health Department Serving: Fair Lawn, Ridgewood Village Jad Mihalinec Palisades Park Health Department Serving: Palisades Park, Ridgefield Boro Stephen S. Wielkocz Fort Lee Health Department Serving: Fort Lee John Hopper Paramus Board of Health Serving: Mahwah, Paramus John G. Christ Hackensack Health Department Serving: Hackensack, Saddle River David Volpe Bergenfield Health Department Serving: Bergenfield Sam Yanovich Mid-Bergen Regional Health Commission Serving: Bogota, Carlstadt, Englewood Cliffs, Garfield, Leonia, New Milford, Ramsey, River Edge, South Hackensack Twp., Tenafly, Wallington Wayne A. Fisher Teaneck Department of Health & Human Services Serving: Teaneck Louis S. Apa Closter Health Department Serving: Serving: Closter, Rockleigh Deborah Ricci Elmwood Park Department of Health Serving: Elmwood Park, Ridgefield Park Paula Jenkins Englewood Health Department Serving: Englewood 28 Daniel G. Levy Township of Washington Serving: Cresskill, Demarest, Emerson, Harrington Park, River Vale, Washington Twp. Angela R. Musella Northwest Bergen Regional Health Commission Serving: Hillsdale, Midland Park, Montvale, Northvale, Old Tappan, Upper Saddle River, Waldwick, Wyckoff Twp. B E R G E N C O U N T Y Community Health Improvement Plan n Rod W. Preiss Borough of Westwood Serving: Westwood 2006 Community Resources and Contributors The Community Health Improvement Plan was developed through the generous support of CHIP Committee member organizations that contributed their time, talent and other resources. Sincere appreciation is expressed to the individuals who served as members of the CHIP Committee for their personal commitment to a healthier Bergen County and for their invaluable insight and expertise in carrying out the health assessments, identifying priority issues, and suggesting strategies for reaching goals. Thanks are also extended to the three co-sponsoring organizations and the nine members of the CHIP Core Group, the leadership body overseeing the entire process. Raymond Arons, Dr.PH Columbia University – School of Public Health Joan Basic Bergen County Medical Society Aaron R. Graham, Ed.D NJ Department of Education, Bergen County Office Carol Grebowiec The Valley Hospital Noreen Best Bergen County Division of Community Development Geraldine Harris New Hope Baptist Church Dorothy Leung Blakeslee Citizen-at-large Glennena Haynes-Smith Fairleigh Dickinson University Barbara Buff Bergen Community College Marcia Pinkett Heller New Jersey City University Traci Burgess, MD National Coalition of 100 Black Women Rev. Gregory Jackson Mount Olive Baptist Church Roberta Campbell Girl Scout Council of Bergen County Judy Jusinski Amerigroup NJ Jerilyn Caprio, Ed.D Allendale Board of Education Jeffrey P. Kahn* Partnership for Community Health, Inc. John Christ* Hackensack Health Department Mary Kalman CareOne@Valley Miriam Confer American Cancer Society, Northern NJ Region Kathleen Kaminsky Englewood Hospital and Medical Center Piyumike Kularatne Columbia University – College of Dental Medicine Christine Contillo Paramus Board of Health Gail DeKovessey Bergen County Division of Community Development Sharol Lewis, MD Horizon Blue Cross Blue Shield of New Jersey Mary-Frances Dougherty* Bergen County Department of Health Services Leonard Fiorenza* Bergen County Department of Health Services Wayne A. Fisher* Teaneck Department of Health & Human Services Lt. Christine Francois Bergen County Police Department Jesus Galvis Bergen County Hispanic-American Advisory Council Richard Garcia Lakeland Bank Claudia Garcia Del Puerto, MD Citizen-at-large Carol Livingstone Ridgewood YMCA Jackie Lue Raia* Partnership for Community Health, Inc. Patricia Mattingly Realtime Nutrition, Inc. Catherine McDougall Health Awareness Regional Program Catherine Mirra Bergen County Youth Services Commission Paula Murphy Bergen County Municipal Nurses Association Robin Ratliff Hackensack University Medical Center Vernon Reed American Red Cross, Bergen-Hudson Chapter Ellen Rocca The Center for Alcohol and Drug Resources, Inc. Lara L. Rodriguez Ramapo College/NJ Meadowlands Commission Gail Rosewater Bergen County Department of Human Services Peter Scerbo Comprehensive Behavioral Healthcare, Inc. Stephen Scheuermann Buddies of New Jersey, Inc. Lou Schwartz NJ AARP Karen Shinevar Bergen County PTA Ann Sissler Bergen Regional Medical Center Nancy Storey Care Plus, NJ, Inc. Stephen C. Tiffinger* Bergen County Department of Health Services Thomas Toronto Bergen County’s United Way Joan Valas, Ph.D* NJ Local Boards of Health Association David Volpe* Bergenfield Health Department Mibs Wagner Citizen-at-large Earl Wheaton, MD Bergen Volunteer Medical Initative Robert White Bergen County Cooperative Library System Catherine Yaxley Holy Name Hospital Jay Byun Yong Korean American Association of New Jersey Ilise Zimmerman Northern NJ Maternal Child Health Consortium *Member of the CHIP Core Group B E R G E N C O U N T Y Community Health Improvement Plan n 2006 29 B E R G E N C O U N T Y C H I P C O M M I T T E E Task Force Member Organizations By Health Priority Access to Health Care Bergen Community College Bergen County Department of Health Services Bergen County Department of Human Services Bergen County Municipal Nurses Association Bergen County Office of Multicultural Community Affairs Bergen Volunteer Medical Initiative Bergen County’s United Way Citizen-at-large Comprehensive Behavioral Health Care, Inc. Fair Lawn Health Department Hackensack University Medical Center Holy Name Hospital New Hope Baptist Church of Hackensack NJ Department of Education, Bergen County Partnership for Community Health, Inc. The Valley Hospital Alcohol, Tobacco and Other Drugs Bergen County Department of Health Services Bergen County Department of Human Services Bergen County Municipal Nurses Association Bergen County Office of Multicultural Community Affairs Bergen County Technical Schools The Center for Alcohol and Drug Resources, Inc. Hackensack Health Department NJ Department of Education, Bergen County NJ Local Boards of Health Association, Bergen County Chapter Palisades Learning Center Partnership for Community Health, Inc. Communication of Health Issues American Red Cross, Bergen-Hudson Chapter Bergen Community College Bergen County Cooperative Library System Bergen County Department of Health Services Bergen County Medical Society Bergen County Municipal Nurses Association Bergen County Office of Multicultural Community Affairs Bergen County’s United Way Citizens-at-large Holy Name Hospital NJ Department of Education, Bergen County NJ Local Boards of Health Association, Bergen County Chapter NJ Meadowlands Environment Ctr./Ramapo College of New Jersey Northwest Bergen Regional Health Commission Palisades Learning Center Paramus Board of Health Partnership for Community Health, Inc. 30 Sacred Heart Church of Haworth The Valley Hospital Mental Health Bergen County Department of Health Services Bergen County Department of Human Services Bergen County Division of Community Development/Sr. Centers Bergen County Municipal Nurses Association Bergen County Office of Multicultural Community Affairs Bergen County Police Department Bergen County Youth Services Commission Bergen Regional Medical Center Care Plus NJ, Inc. Closter Health Department Comprehensive Behavioral Health Care, Inc. Fair Lawn Health Department Holy Name Hospital National Coalition of 100 Black Women NJ Department of Education, Bergen County NJ Department of Human Services Palisades Learning Center Partnership for Community Health, Inc. Teaneck Department of Health and Human Services Vantage Health System, Inc. Obesity: Nutrition and Physical Activity American Cancer Society, Northern NJ Region Bergen County Academies Bergen County Department of Health Services Bergen County Division of Community Development/Sr. Centers Bergen County Municipal Nurses Association Bergen County Office of Multicultural Community Affairs Bergen County PTA Bergenfield Health Department Citizen-at-large Englewood Health Department Fort Lee Health Department Girl Scout Council of Bergen County Holy Name Hospital National Coalition of 100 Black Women NJ Department of Education, Bergen County NJ Meadowlands Environment Ctr./Ramapo College of New Jersey Paramus Board of Health Partnership for Community Health, Inc. Ramsey Board of Health Realtime Nutrition, Inc. Ridgewood YMCA Sacred Heart Church of Haworth The Valley Hospital B E R G E N C O U N T Y Community Health Improvement Plan n 2006 10 Tips for Better Health During the Action Phase of the Community Health Improvement process, CHIP Task Force member organizations will work together to select and implement strategies to improve the health of all. Individuals as well as community groups are encouraged to take action. Following are 10 Tips that residents can employ for better health. 1) Engage in moderate exercise for at least 30 minutes most days of the week. 2) Eat five to nine servings of fruits and vegetables a day. 3) Maintain or achieve desirable weight. 4) Strive for open communication with your children. They will be better able to resist substance use and abuse. 5) Quit smoking and talk with your children about the dangers of smoking. 6) Limit alcohol use to no more than one drink a day for women or two drinks a day for men. 7) Recognize that mental illness can happen to anyone and can be treated. 8) Reduce unhealthy stress and recognize symptoms of depression. 9) Find and use credible sources of health information. 10) Call your local health department for possible sources of affordable preventive health care. B E R G E N C O U N T Y Community Health Improvement Plan n 2006 31 B E R G E N C O U N T Y Community Health Improvement Plan County of Bergen Dennis McNerney, County Executive Bergen County Department of Health Services [email protected] • 201-634-2600 www.bergenhealth.org Partnership for Community Health, Inc. [email protected] • 201-986-7715 www.bergenpch.org Bergen County Public Health Partnership [email protected]