Get Healthy, Greenfield!

Approved by the Greenfield Board of Health March 8, 2012

Get Healthy, Greenfield!

A Community Health Improvement Plan, 2012-2016

2 An Invitation to the Community

To Greenfield Residents:

It is our distinct pleasure to present to you Get Healthy, Greenfield! Greenfield Residents Living Better, Longer. Get Healthy, Greenfield! represents the fulfillment of the statutory requirement for each local health department to create a community health improvement plan every five years.

It is important to note that Get Healthy, Greenfield! was not created on a whim. This plan was created by assessing and analyzing health data to determine those areas most important to contributing to a better and longer life for all Greenfield residents. Furthermore, this plan was created with the cooperation of community leaders and residents with a passion and interest in improving the health of our city.

Healthiest Wisconsin 2020, the current state health plan, was used as a framework for identifying health priority areas. The vision of Healthiest Wisconsin 2020 is everyone living better, longer. This is a noble vision, and one that we hope will be realized in the City of Greenfield over the next five years.

Through our planning process we identified five health priority areas that align with those in Healthiest Wisconsin 2020. These health priority areas are fundamental to the Get Healthy, Greenfield! plan:

Nutrition

Physical Activity Chronic Disease Injury and Violence Mental Health

The health priority areas identified in this plan are your health priority areas; we must work together to achieve success. There are multiple opportunities for residents, community leaders, and businesses to plan and work together. Achieving health and wellness depends on valued partnerships within our community. Our hope is that this plan will provide new opportunities to broaden or create community partnerships in the desire to improve the collective health of the community. We invite input from all Greenfield residents since Get Healthy, Greenfield! belongs to the community and is an ongoing effort to live better, longer.

Yours in Health,

Darren J. Rausch, MS, CPH Andrew Martinez, Pharm acist Health Officer/Director Chairperson

3 Acknowledgements

The Greenfield Board of Health wishes to thank those individuals who contributed their time and energies to the development of Get Healthy, Greenfield! .

Community Team participants Organization

John Ackeret Aurora Health Care

Pamela Akers Greenfield Alderperson, Greenfield Board of Health

Beth Anderson, RN Greenfield Health Department

Judy Baxter Greenfield Chamber of Commerce

Christi Brzycki Greenfield School District

Jon Cohn Greenfield Fire Department

Linda Goyette, RN Greenfield Health Department

Vicki Hopper, RN Greenfield School District

Mary Kitten, RN Greenfield Board of Health

Sue Larson, RN Whitnall High School

Cindy Leranth Greenfield Board of Health

Andrew Martinez, RPH Greenfield Board of Health

Stephanie Navarre Southwest YMCA

Darren Rausch, MS, CPH Greenfield Health Department

Leon Saryan, PhD Greenfield Board of Health

Shirley Saryan Greenfield Alderperson

Sandy Schubert, RN Greenfield Health Department

Delores Skowronek Community Member

Russ Spahn Community Member

Kate Wall Southwest YMCA

Laure Zulkowski Clement Manor

In addition, the Board of Health wishes to thank Sandy Schubert , RN, Public Health Nurse, and Pangnha Yang, RN, BSN, Public Health Intern, for their diligent efforts in gathering and analyzing health data, pr esenting the information to the community partners, and contributing to the overall development of Get Healthy, Greenfield!

Get Healthy, Greenfield! is dedicated to the citizens who strive to make our community a safe and healthy place to live, work and p lay.

Greenfield Board of Health

Ald. Pamela Akers Common Council Representative

Mary Kitten, RN Cindy Leranth

Paula Lucey, RN (Resigned, Effective September 2011) Thomas Mance, DO Medical Advisor, Ex-Officio Member

Andrew Martinez, RPH Chairperson

Allen Owen, DDS

Darren J. Rausch, MS, CPH Health Officer/Director Leon A. Saryan, PhD

4 Introduction

A Community Health Improvement Plan (CHIP) planning process identifies,

prioritizes, and develops a plan to address identified health needs in a community. Community health improvement planning is an important process for all

communities. Planning provides an opportunity for health departments to work with residents and other partners to develop a wide -reaching and comprehensive plan to improve the health status of all residents in key health priority areas. The selection of the health priority areas is important, but even more important is the collective work of the community to address and improve upon these areas.

Ultimately, health focus areas identified in this plan will be improved upon so that they will not be the focus of future community health improvement plans.

This plan hopes to build upon previous plans published in 1997 , 2001, and 2006 to improve the health of Greenfi eld’s 36,000+ residents. This plan is the result of a community assessment process that brought together a broad representation of Greenfield community leaders and residents. The new CHIP is closely aligned to the Healthiest Wisconsin 2020 State Health P lan and the identified health focus areas; the Greenfield CHIP directly addresses five key areas that are most significant to the health of our residents.

Process

A Community Team was assembled in September 2011 to share available data, collect and discuss areas of need, determine priorities, and develop a plan to help the community address local health priorities. A total of 46 members were selected based on previous CHIP participation, and additional members included key

community leaders, elected offi cials, and Board of Health.

Community Team members were sent a Save the Date notification in late

September, followed by a formal invitation letter from the Health Officer/Director in mid-October. The formal invitation letter provided background about th e CHIP process and included several reference documents, including a copy of the

Greenfield Health Department Annual Report, a summary report of the Commun ity Health Assessment 2011 and a copy of the Healthiest Greenfield 2010 progress report. Potential Community Team members were asked to RSVP for the kick -off meeting. Seventeen community members attended the kick -off meeting.

At the kick-off meeting the Health Officer/Director presented key findings from the Community Health Assessment that had been c onducted from June-October, 2011. This presentation was followed by a discussion among participants about the data and health problems within the City of Greenfield. Next, the Health

Officer/Director reviewed the Healthiest Wisconsin 2020 State Health Pl an and provided an overview of the plan and the health focus areas identified within the plan. The new Greenfield CHIP will be linked to the State Health Plan by striving to meet key health focus areas chosen in partnership with the Community Team.

5

Kick-off meeting participants wrote five to seven action items they felt strongly would contribute to improving the health of Greenfield residents. When complete, these action items were grouped according to the health focus area they were related to. The Health Officer/Director led a discussion related to the top five areas (with the most action items): nutrition, physical activity, injuries and

violence, mental health, and chronic disease . Additional action items were added or clarified during this discuss ion.

Each participant was provided ten stickers to vote for their top hea lth focus areas. The votes were as follows: 38 votes for nutrition, 37 votes for chronic disease, 27 votes for injuries and violence, 19 votes for mental health, and 57 votes for

physical activity. Following the voting process, discussion among the Community Team centered on the potential to include all five selected areas considering they are very interrelated and based on available data.

Health Department staff summarize d the health focus areas and the corresponding action items. The information was made available via email and on SurveyMonkey to obtain additional feedback from those Community Team members that could not attend. Team members not in attendance at the kick -off meeting were sent

information and given the opportunity to provide additional feedback using SurveyMonkey.

Health Department staff met to discuss the vote results and how the CHIP could be focused to meet the health needs of the community within the con fines of staff and resource limitations. A draft plan was disseminated via email in early January to Community Team members, and another meeting was held on February 9th, 2012, to review the draft CHIP plan, offer suggestions for improvement, and to begin discussion on how the community team can support the CHIP over the next five years.

The February 9t h meeting provided an opportunity to the Community Team to review the draft plan and provide any additional revisions and comments. At this meeting, Team members split into three groups to identify programs and activities that may accomplish Action Items. These programs and activities were noted by Health Department staff and added to the final draft.

The final draft was accepted and approved by the Gr eenfield Board of Health on March 8, 2012. The plan will be disseminated to elected officials and key

community leaders in the months to follow.

Healthiest Wisconsin 2020

The state health plan, Healthiest Wisconsin 2020 Everyone Living Better, Longer , was released in July 2010. This plan is the public health agenda for the state, and

6

serves as the foundation for all community health improvement plans for local jurisdictions within the state. The vision of the state health plan is included in the title, “everyone living better, longer.” The specific goals for the plan are to

improve health across the lifespan, and eliminate health disparities and achieve health equity.

The Healthiest Wisconsin 2020 plan identifies 23 different focus areas, including both Infrastructure Focus Areas and Health Focus Areas. Additionally, the plan identifies ten Pillar Objectives – objectives that seek to “work together in mutually supportive ways to advance the plans goals.” The Infrastructure Focus Areas will be referenced in the Greenfield Health Department Strategic Plan that will be completed later in 2012. The twelve Health Focus Areas were identified by the Health Department and Board of Health as potential areas for prioritization in the new CHIP. While supporti ve of the Pillar Objectives, this CHIP does not address any Pillar Objective directly since the scope of these objectives if more far

-reaching than simply the Greenfield community.

The Healthiest Wisconsin 2020 Health Focus Areas include the following: Adequate, appropriate, and safe food and nutrition

Alcohol and other substance use

Chronic disease prevention and management Communicable disease prevention and control Environmental and occupational health hazards Healthy growth and development

Injury and violence Mental health Oral health Physical activity

Reproductive and sexual health Tobacco use and exposure Selected Health Priority Areas

Based on the community health assessment, t he planning process identified five health priority areas for improv ement in the new Greenfield Community Health Improvement Plan. These areas include:

Nutrition

Physical Activity Chronic Disease Injury and Violence Mental Health

7

In the following pages, the health priority areas are defined and goals and action steps are listed for each priority. Action steps for each priority area will be based on public health best practices. Sources for best practices will include The

Community Guide (http://www.thecommunityguide.org/index.html) and What Works for Health (http://whatworksforhealth.wisc.edu/); additional sources of best practices will include Wisconsin Department of Health Services and Centers for Disease Control and Prevention guidelines, plans, and publications.

8

NUTRITION

As defined in the Healthiest Wisconsin 2020 Plan, appropriate, adequate an d safe food and nutrition means a regular and sufficient consumption of nutritious foods throughout the lifespan, which includes breastfeeding. Appropriate and adequate nutrition is important to support normal growth and development of children and promote physical, emotional, and social well -being for all people. It also includes safe handling, preparation, serving and storing of food and beverages.

Impact

Healthy eating plays a vital role in maintaining a healthy lifestyle and helps to prevent chronic diseases. Besides being essential for survival, eating has become a source for enjoyment. The nutritional, social, cultural and pleasurable aspects of food all contribute to one’s quality of life.

Data Snapshot

What is your daily consumption… 2003 2006 2009

Fruits (2+ servings/day) 67% 62% 63%

Vegetables (3+ servings/day) 27% 27% 24%

9 Goals and Action Steps

By December 31, 2016, increase knowledge of Greenfield residents to make well -informed personal choices related to adequate, appropriate and safe food and nutrition.

Improve awareness and education related to healthy food choices and nutrition through community education classes

Educate residents on MyPlate and healthy eating

Work with WIC to promote breast feeding for new mothers of infants Work with chef and/or registered dietitians to educate residents on how to

prepare healthier meals

Continue to support the WIC Program and Stock Box Program

By December 31, 2016, increase the number o f healthy eating opportunities within the City of Greenfield.

Compile a list of health y dining options in Greenfield

Work with both Greenfield and Whitnall School District Lunch Program staff regarding healthy food options for students

Explore the possibility of a farmer’s market

Work with local food retailers and restaurants to highlight healthier food choices, i.e., menu labeling, etc.

Increase number of vending machines in schools that contain a higher percent of healthier food items; decrease competitiv e food items in schools

10

PHYSICAL ACTIVITY

Physical Activity Definition

Physical activity means any bodily activity that enhances or maintains physical fitness and overall health. Physical activity includes a specific time set aside for exercising as well as activity that is a part of a person’s daily routine (lifestyle activity).

Regular exercise has been shown to reduce the risk of certain diseases such as high blood pressure, stroke, coronary ar tery disease, type 2 diabetes, obesity, colon cancer, and osteoporosis. The Center of Disease Control and Prevention recommends:

Adults work in 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity and strengthening activities three days per week

Children (aged 6-17) get 60 minutes of aerobic activity per day. This includes vigorous activity and strengthening activities three days per week

Older adults participate in guided physical activities to improve strength, prevent falls, improve cardiovascular performance and restore resilience and social connection

Impact

Physical activity is at the top of the list for preventing many chronic diseases, to help maintain a healthy Body Mass Index (BMI), and to improve overall mental health. It is one of the most talked about ways to improve your health, yet many still struggle with the recommended daily amount of physical activity.

Data Snapshot

What is your physical activity level… 2003 2006 2009 Moderate Activity (5 t imes/ 3 0 mi nut es) 24% 38% 36%

Vigorous Activity (3 t imes/ 2 0 mi nut es) n/a 20% 23%

Recommended Moderate or Vigorous n/a 46% 48%

11 Goals & Action Steps

By December 31, 2016, increase knowledge of Greenfield residents t o make well-informed personal choices related to physical activity

Educate residents on the importance of good physical activity Educate residents on ways they can increase their physical activity

By December 31, 2016, increase the awareness of physical a ctivity opportunities within the City of Greenfield.

Increase awareness of opportunities within the City related to physical activity

Organize community events to promote physical activity Partner with gyms, fitness clubs, to meet the CHIP plan goal.

By December 31, 2016, address significant policy barriers that hinder physical activity for residents.

Continue to work to create system of sidewalks in accordance with City ordinance

Support bike/pedestrian improvements Continue Safe Routes to School efforts

12

CHRONIC DISEASE

Healthiest Wisconsin 2020 Health Focus Area Chronic Disease Prevention and Management Definition

In general terms, chronic disease is defined as an illness lasting longer than 6 months, may not be curable and may result in disability later in life. Chronic diseases such as heart disease, stroke, diabetes and cancer are among the most prevalent, costly and prevent able of all diseases.

Impact

In the City of Greenfield, cancers and cardiac -related diseases are at the top of the list for causes of death. Four modifiable risk factors that are responsible for much of the suffering related to chronic disease are unhe althy nutrition, excess alcohol use, insufficient physical activity and tobacco use or exposure to second hand smoke.

Data Snapshot

Have you been diagnosed with… 2003 2006 2009

High blood pressure 33% 33% 29%

High cholesterol 25% 25% 25%

Heart disease/condition 9% 9% 11%

Asthma 10% 10% 8%

Diabetes 7% 7% 6%

Cancer n/a n/a 5%

Stroke 2% 2% 1%

13 Goal and Action Steps

By December 31, 2016, increase knowledge of Greenfield residents to prevent and manage chronic disease.

Provide messaging via health department blog related to chronic disease prevention and management

Improve awareness and education related to chronic health conditions Conduct an assessment of health screening locations to refer individuals Explore providing community health screening opportunities

Complete assessment of community resources for older adults

14

INJURY & VIOLENCE

Injury and Violence Definition

This category encompasses a broad array of topics. Injuries include in tentional or unintentional damage to the body. Unintentional injuries are sometimes referred to as accidents and are highly preventable. Falls, drowning, motor vehicle crashes, suffocation and poisoning are examples of unintentional injuries. Intentiona l injuries include those that were purposely inflicted with the intent to injure or kill someone (including self). Some examples of intentional injuries are homicide, child maltreatment, sexual assault, bullying and suicide. Intentional injuries usually involve a violent act.

Impact

The burden of injuries varies across the lifespan. The effects of unintentional and intentional injury may include costs related to care and treatment of injuries, but also a loss of productivity, years of potential life l ost due to injury mortality, and the influence of injury and violence on chronic disease, physical and mental health. Data Snapshot

How often do you… 2003 2006 2009

Use seatbelts (always) 89% 89% 87% Use bicycle helmets (always) 24% 25% 23%

D a t a ob t a i n ed f r om Gr e e n fi e ld C o m mu n i t y H e a lt h Su r v e ys .

Firearm Safety 2003 2006 2009

Of all households…

Have a firearm 23% 25% 24% Have a loaded firearm 2% 3% <1% Have a loaded firearm unlocked 1% 2% <1%

D a t a ob t a i n ed f r om Gr e e n fi e ld C o m mu n i t y H e a lt h Su r v e ys .

Personal Safety 2003 2006 2009

Afraid for their safety 4% 7% 9% Pushed, kicked, slapped or hit 2% 2% 4% Had at least one of the two

safety issues listed above. 5% 8% 9%

15

D a t a ob t a i n ed f r om h i gh sc h o ol su r v e y .

Goal

By December 31, 2016, increase availability of resources, programs and activities that assure prevention of injuries and violence among Greenfield residents .

Continue efforts to provide bike rodeos within the community Educate residents on safe walking/biking in the community

Continue partnership with other city departments related to the Bike and Pedestrian Plan and Safe Routes to School

Assure availability of child car seat checks in the City Assure access to safe cribs

Provide information about safe infant sleeping environment

Provide/assure education for older adults related to fall prevention

Assure educational opportunities for residents related to domestic violence, bullying, and other violent behaviors

Assure opportunities for neighborhood watch programs

Have you ever… Yes No

...been bullied at school?” 23% 76% ...been electronically bullied?” 18% 81% ...bullied someone else?” 19% 80%

16

MENTAL HEALTH

Mental Health Definition

“Mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the nor mal stressors of life, can work productively and fruitfully and is able to make a contribution to his/her community” (World Health Organization, 2001). Mental health may range from a clinically diagnosed issue to general feelings of anxiety, stress, and/o r depression.

Impact

Mental health issues often are associated with higher rates of chronic disease and risk factors such as smoking, physical inactivity, obesity, and substance use and abuse.

Data Snapshot

How often have you… 2003 2006 2009

Nearly always felt sad, blue or depressed 6% 5% 10% Seldom/never find meaning in daily life 8% 6% 7% Considered suicide <1% 4% 6% Diagnosed mental health condition 2% 3% 14%

D a t a ob t a i n ed f r om Gr e e n fi e ld C o m mu n i t y H e a lt h Su r v e ys .

17 Goal and Action Steps

By December 31, 2016, increase awareness of the im pact of mental health on personal wellness and the availability of community resources for all Greenfield residents.

Improve awareness and education related to mental health issues and challenges

Access availability of mental health resources in the commun ity

Create a list of mental health care providers and resources in the community Enhance understanding of the mental health referral process

Develop resource list for families dealing with dementia and other mental health issues for older adults

Partner with school districts in their efforts to meet the needs of stud ents with mental health issues

18

Monitoring Progress

While the action items are the respo nsibility of all community partners in the City of Greenfield, monitoring progress toward achieving the goals identified in this plan will be the responsibility of the Greenfield Health Department. The

department will include updates in the annual report and will engage community partners and residents for additional updates as necessary.

Next Steps and Implementation

The Greenfield Health Department and Board of Health are committed to

measuring the improvement in health status related to the priority a reas, goals, and action steps cited herein. Whenever possible, improvement will be measured quantitatively using data available from the Greenfield Community Health Surveys and other data sources. Unfortunately, however, quantitative data may not be available for all areas; in this case, improvement will be measured qualitatively based on information collected throughout the duration of this community health improvement plan. When necessary, data collection may be part of the assessment process and data collected early in the CHIP period will be used as a baseline for measuring improvement.

Implementation of the Community Health Improvement Plan action goals and action steps is contingent on community involvement. Lack of community

involvement will cause a lack of progress towards completing the action steps and the proposed goals.

Conclusion

By definition, and through its design, the Community Health Improvement Plan process represents a cyclical progression toward improving the health of the community. Due to this fact, the Get Healthy, Greenfield! plan is a living document that must be reviewed annually and adjusted according to changing needs within the community. As we move into the implementation phases of the plan, we must appreciate that the journey is just beginning and there is no doubt that there will be bumps in the road, detours and road blocks. The end goal is overall improvement of our community’s health, and we will only make a difference in the lives of our community members through hard work and community partnerships.

19 References

2003 Greenfield Community Health Survey Summary. Available at

http://www.aurorahealthcare.org/yourhealth/comm -health-reports/index.asp.

2006 Greenfield Community Health Survey Summary. Available at

http://www.aurorahealthcare.org/yourhealth/comm -health-reports/index.asp.

2009 Greenfield Community Health Survey Summary. Available at

http://www.aurorahealthcare.org/yourhealth/comm -health-reports/index.asp.

Wisconsin Department of Health Services, Division of Public Health, Office of Policy

and Practice Alignment. Healthiest Wisconsin 2020: Everyone Living Better, Longer. A State Health Plan to Improve Health Across the Life Span, and Eliminate Health

Disparities and Achieve Health Equity. P-00187. July 2010. Available at

http://dhs.wisconsin.gov/hw2020/.

Wisconsin Department of Health Services. Wisconsin Suicide Rates. Retrieved from:

http://www.wisconsinwatch.org/2010/02/21/wisconsin-suicide-toll-rises-exceeds-rates-of-neighboring-states/

World Health Organization. Strengthening Mental Health Promotion. Geneva, World Health Organization (Fact Sheet No. 220), 2001.

20

7325 West Forest Home Ave. 414-329-5275 (phone) Greenfield, Wisconsin 53220 414-543-5713 (fax)

Or visit us online at:

www.greenfieldwi.us

https://www.facebook.com/GreenfieldHealthDepartment https://twitter.com/#!/GreenfieldHD