Ray Baxter from Kaiser Permanente's Community Benefit presented at the Bay Area Open Space Council's 2011 conference. More about the conference here: http://openspacecouncil.org/upload/page.php?pageid=53

1. Open Spaces, Healthy Places
together
WE BUILD A BRIGHTER FUTURE
2011 Open Space Conference
Raymond J. Baxter, PhD
Senior Vice President, Community Benefit, Research and Health Policy
May 12, 2011
kp.org/communitybenefit

2. The Epidemic of Overweight and Obesity
“Unless effective population-
level interventions to reduce
obesity are developed, the steady
rise in life expectancy observed in
the modern era may soon come
to an end and the youth of today
may, on average, live less healthy
and possibly even shorter lives
than their parents”
S. Jay Olshansky, Ph.D., Douglas J. Passaro, M.D., Ronald C.
Hershow, M.D., Jennifer Layden, M.P.H., Bruce A. Carnes,
Ph.D., Jacob Brody, M.D., Leonard Hayflick, Ph.D., Robert
N. Butler, M.D., David B. Allison, Ph.D., and David S.
Ludwig, M.D., Ph.D. New England Journal of Medicine
2005
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3. Obesity Trends Among U.S. Adults
1989 1999
2009
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person
Source: CDC 3

4. Rising Obesity Rates Could Eat Our Lunch
Total Obesity-Related Direct Health Care Spending, U.S. (2008-2018)
Projected
$400,000 Holding Obesity Rates Constant
$350,000
$300,000
$250,000
(Millions)
$200,000
$150,000
$100,000
$50,000
$0
2008 2013 2018
Source: Thorpe, 2009
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5. Many Factors Drive and Shape Health
Health is driven by multiple factors that are intricately linked – of which
medical care is one component.
Drivers of Health
Personal Behaviors
40% Family History
and Genetics
30%
Environmental
and Social 10%
Factors
Medical Care
20%
Source: Determinants of Health and Their Contribution to Premature Death, JAMA 1993
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6. Behaviors Shape Health
Actual Causes of Death in the U.S. in 1990 and 2000
Number (and %) Number (and %)
Actual Cause 1990* 2000
Tobacco 400,000 (19%) 435,000 (18.1%)
Poor diet and physical inactivity 300,000 (14%) 400,000 (16.6%)
Alcohol consumption 100,000 (5%) 85,000 (3.5%)
Microbial agents 90,000 (4%) 75,000 (3.1%)
Toxic agents 60,000 (3%) 55,000 (2.3%)
Motor vehicle 25,000 (1%) 43,000 (1.8%)
Firearms 35,000 (2%) 29,000 (1.2%)
Sexual behavior 30,000 (1%) 20,000 (0.8%)
Illicit drug use 20,000 (<1%) 17,000 (0/7%)
Total 1,060,000 (50%) 1,159.000 (48.2%)
*Data are from McGinnis and Foege. Percentages are for all deaths.
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7. Social and Economic Factors Drive Health
• Education/Literacy • Community Safety
Social and • Employment • Early Childhood
Economic • Income • Race and Ethnicity
Factors • Family and social support
San Francisco Bay Area – Kaiser Permanente Members
Poverty, Diabetes and Obesity (2010)
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8. The Environment Shapes Health
San Francisco Bay Area
Kaiser Permanente
Childhood Obesity and
Park Space
(2010)
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9. What We’re Up Against
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10. What We’re Up Against
7% of Americans’
urban trips are
biking/walking:
46% in Holland
0.4 White Male White Female
Black Male Black Female
Probability of Obesity
0.3
0.2
0.1
0
0 100 200 300 400 500
Minutes Spent in Car Per Day
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Slide courtesy of Richard Jackson, MD

11. What We’re Up Against
Change in price of items since 1978, relative to overall inflation, as measured by the
Consumer Price Index. The price of carbonated drinks, for example, has fallen 34 percent
relative to all other prices.
Source: Leonhardt, 2010 11

12. We Must Address Health at All Levels
Growing evidence indicates we must take on the issues at multiple levels.
Deploying Kaiser Permanente Assets for Total Health
Physical and Mental Health Care
Clinical Prevention Health Education
Research Individual / Access to Social and
Family Economical Supports
Home / School /
Worksite
Community Health 1 Worksite
Initiatives Wellness
Neighborhood /
Community
Environmental
Stewardship Public Policy
Society
Public Education
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13. Kaiser Permanente’s Community Health Strategies
Neighborhoods
 Parks, trails and other active public spaces
 General Plan amendments Schools Neighborhood
 Corner store conversion efforts
 Farmers markets and community gardens
Schools
 Cafeteria reforms
 PE standards, after school programs
 Joint Use Agreements
 Safe routes to school
Healthcare
 BMI as a vital sign Work Site Healthcare
 Breastfeeding promotion
 Hospital cafeterias
Worksites
 Stairwell prompts
 Lactation support
 Worksite wellness programs
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14. Kaiser Permanente’s Healthy Eating Active
Living Intervention Sites
We Support 40+ Communities
Clark County, WA
 Cleveland, OH
Portland, OR 
Santa Rosa
 
Richmond   
  
Modesto Prince George’s
 County, MD
6 HEAC Sites

21 LiveWell
Colorado
(statewide)
Atlanta, GA
Denver, CO
 Community Health Initiative sites Commerce City, Park Hill,
 Joint initiatives with other funders Lincoln Park
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15. The Environment Matters
Kaiser Permanente Environmental Strategy Priority Areas
Safe Chemicals Climate/Energy
Waste Reduction Water Sustainable Food
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16. The Road Ahead is Challenging
But we can find the way…
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17. Example: Making the Healthy Choice the Easy Choice
Benefits of walking can be expressed in terms of improved environmental
and personal health, enhanced quality of life, economic rewards, and more.
Evidence of Short and Long Term Benefits
Aerobic exercise Gain 1.3-1.5
helps strengthen healthy years
Helps people with
the heart, lungs, of life
diabetes to control
and muscles
their blood sugar
Reduces risk of Improves mood
oseteoporosis Raises and energy
and broken HDL
bones
Reduces the Regular walking
pain and can prevent
swelling from misery of colds
arthritis
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18. Example: East Bay Regional Park District
Increase use of parks and outdoor space to
GOAL
promote health
 Trails Challenge for up to 5,000 participants/year in
East Bay Regional Parks
 Camp-related efforts (e.g., scholarships for underserved youth,
Healthy meals at camp, organic garden at Camp Arroyo in
Livermore)
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19. Example: Trust for Public Land
Increase/enhance more outdoors space for
GOAL
safe physical activity
 Advocacy for park deficient
communities to benefit from state
infrastructure bonds
 Expansion of Fitness Zones in
Southern CA
 Analysis of benefits of parks in
City/County of Denver
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20. Example: Rails to Trails Conservancy
Assess recreational & health needs of communities
GOAL adjacent to 1-mile stretch of the Metropolitan Branch Trail
that can be used for recreation and active transport
 Needs assessment/research and community engagement to identify:
 Recreational and physical activities resources, needs, and opportunities.
 Strategies to increase physical activity for members of target communities.
 Trail tours and bike rides for community members
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21. Example: Land Use
Advocated for adding health elements to the
GOAL
Richmond General Plan
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22. Example: Walk There!
Increase the number of
GOAL
people walking for
short trips rather than
using car for both
health and
environmental benefits
 Development of walking guidebook with 50
walks in 4-county region
 Series of 20 guided walks in Portland area
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23. Example: Organizational Endorsement
Portland Metro Bond  Acquiring natural areas for protecting
Measure 26-80 for Natural wildlife habitat, preserving water quality,
Areas, Parks and Streams and enhancing public access to nature
(2006, passed)
 Minimum physical education minutes
Oregon House Bill 3141 during school
(2007, signed by Gov)  Data collection on number of physical
education minutes provided
 AB 32 requires that greenhouse emission
Opposition to California
levels in the state be cut to 1990 levels by
Prop 23 (to suspend AB 32) 2020
(2010, defeated)
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24. Example: Engaging Organizational Assets
To leverage the assets of the total organization
GOAL
to make a difference in communities.
 National Get Outdoors Day in Denver
 Colorado employees built playground in
underserved neighborhood in partnership
with KaBoom!
 Southern CA facilities services employees
adopted Pasadena city parks with baseball
facilities
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25. How We Partner
 Kaiser Permanente looks for:
In the last 5 years, we have given over $6M in grants related to open space
 Efforts that target underserved communities
 Creative, multi-faceted partnerships that incorporate “nexus” strategies
 Opportunities to leverage multiple resources/assets at Kaiser Permanente
 Efforts that are sustainable and have long-term impact
 Target healthy eating and active living (primarily)
 Health partners care about….health outcomes, and more!
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26. kp.org/communitybenefit
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