The Providence Institute for a Healthier Community is embarking on a journey to create the first Health & Well-being Index of Snohomish County. Listening deeply to the community in order to hear directly from those living in Snohomish County, what health means to them.
Find updates on work done to date and early results here!
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EOA2015: Snohomish County Well-Being Index: Jody Early and Stuart Elway
1. Panelist
Jody Early,
Associate Professor, UW Bothell School of
Nursing & Health Studies
Stuart Elway,
President, Elway Research, Inc.
2015 Snohomish County
Health & Well-being Index
2. 3
Providence Institute statement of purpose:
Healthier body,
Healthier relationships,
Healthier communities.
Created together.
It takes
a village
3. Providence Institute for a
Healthier Community
The PIHC will affect health behavior changes through partnerships in four areas:
Center for Health
Priorities & Progress
Center for Health
Education & Healing
Center for Workforce
Health & Productivity
Center for Community
Health Transformation
Focus: Targeted, innovative community partnerships
based on a common agenda & shared metrics to
improve population health.
Focus: productivity & competitiveness through
innovative employer wellness tools and resources,
and best business practices.
Focus: Listening deeply. Allow individuals
(not health systems) to define health &
wellbeing on their own terms. Track progress.
Focus: co-creating with community
partners a clearinghouse of relevant
tools and resources to optimize health.
4. • Focus:
• Create /promote a community-based view of vibrant health & well being
• Drive a common agenda for better health and well-being
• Consumer information to improve healthcare literacy and informed
healthcare decisions (Year 2+)
• Measurement/evaluation of Institute program efficacy
Center for Health
Priorities & Progress
• 2015 Initiatives:
–Community Voices listening campaign
–Vital Signs: The Snohomish County Health & Well-being Index
–Collaboration with The Daily Herald – online and print platform for reporting results
–LiveHealthy2020 campaign – support for countywide shared measurement
5.
6. Building our capacity to “see”
community health
A concept for GIS
mapping capabilities for
Health & Well-being
Index results and other
purposes (in this case,
LiveHealthy2020
signatory locations)
being explored through
the Providence Institute
for a Healthier
Community.
7. Digital home & clearinghouse
A concept for
online, searchable
community assets
with a broad array
of resources,
being explored
through the
Providence
Institute for a
Healthier
Community.
8. Community co-creation
A concept for
“gold-card”
access allowing
community
partners to self-
submit content,
being explored
through the
Providence
Institute for a
Healthier
Community.
9. Snohomish County
Vital Signs
Toward a County Wellbeing Index
Jody Early, Ph.D., M.S., MCHES
Associate Professor
School of Nursing and Health Studies
University of Washington-Bothell
H. Stuart Elway, Ph.D.
President
Elway Research, Inc.
10. Vital Signs Index
• Systematic, representative measure of behaviors
and opinions
• Visible and owned by our community
• Used as a means to build common agenda and set
priorities
• Track and report changes and progress
11. Framework: Existing Paradigms
• Build on existing models
• Ground the models in the here and now
• What works for Snohomish County in 2015?
13. Social Determinants of Health
• Economic Stability
• Poverty
• Employment
• Food Security
• Housing Stability
• Education
• High School Graduation
• Enrollment in Higher Education
• Language and Literacy
• Early Childhood Education and Development
• Social and Community Context
• Social Cohesion
• Civic Participation
• Perceptions of Discrimination and Equity
• Incarceration/Institutionalization
• Health and Health Care
• Access to Health Care
• Access to Primary Care
• Health Literacy
• Neighborhood and Built Environment
• Access to Healthy Foods
• Quality of Housing
• Crime and Violence
• Environmental Conditions
14. WA Behavioral Risk Factor
Surveillance System
• Centers for Disease Control and Prevention
• WA Department of Health
• Snohomish Health District
16. Gallup / Healthways
• PURPOSE: Motivated; I like what I do
• SOCIAL: Supportive relationships
• FINANCIAL: Security; Degree of stress
• COMMUNITY: Like where you live; Safety; Pride
• PHYSICAL: Energy, Nutrition, Exercise
18. Community-Based Participatory Research
• Collaborative approach to research
• Cyclical and iterative Process
• Equitably involves community members
in the research process
• Covers issues important
to the community involved
19. •Recognizes the unique strengths that each partner
brings.
•Fosters colearning and capacity building among
partners
•Includes multiple sources of knowledge and
methods of discovery
•Based on guiding principle of reciprocity
•Goal of taking action for social change
Community-Based Participatory Research
20. Why Participatory Research?
• Involves the community in the process
• More complete and accurate information
• Better chance of addressing community needs
• Changes people’s sense of efficacy
• Builds community capacity to address issues
21. Who is The Community?
• Encompasses a variety of social organizations that
operate at a number of levels of size and complexity.
• Members share a common interest or identity.
• Examples:
• Arlington, Edmonds Residents
• Latino Community
• Facebook Friends
• Soccer Leagues
22. First steps
• Person on the street interviews
• Pictures of Health
• Daily Herald poll
• Focus groups
• Non-random/purposeful
• Random recruitment
• County-wide representative sample survey
23. “Lake Stevens schools rate so high… people try to move their kids there.”
Rich community, youth drug use, need youth outreach.
The lake, swimming, year round fun
Don’t let the weather determine your activity
Our group as recruited to
interview outlying towns
in Snohomish County
Providence Institute approached
the University of Washington, Bothell
For help with their community health
needs assessment.
By: Devyn Nixon, Charlotte Jordan, Ana Burcheci, Gagan Kaur and Katrina Carpenter
We completed a windshield survey of Arlington and through
this process chose other small communities to visit
“Homeless are the most vulnerable”
“People are using [drugs] to cope”
“Your health can be undermined by the exposure that
comes with street life…
Exposure to crime… communicable diseases…
“People slept by the river, they made that illegal.”
“We have homeless here [the library] who are coming to sleep…
Where else are they going to go?”
“Do not have the same access to the healthcare”
“I worry about qualifications people have to have to get access”
Walking has done more good than anything.
“It’s a pretty health operation…
we would know if there was an impact of sickness.”
People’s occupations contribute to their health.
Intercept Interview & Windshield Survey
24. Social Media Photo Contest
• Health and well-being are perceived in a variety of ways.
• Photography and art can be a common language
• How do people “picture” health and wellbeing?
• Photo contest open to all
• Collection of images of health and well-being
• To see the #PicturesOfHealth challenge on Facebook login to the
PIHC Page at www.facebook.com/PIHCSnohomish.
26. Daily Herald Poll
• State of your health
• Satisfaction with health
• Impacts on your health
• Behaviors
• Health of community
• What is important from the
point of view of the
individual?
• How are factors are related
to each other in people’s
view of their own health?
29. • Listen to a cross section of Snohomish voices
• Let people discuss health and wellness in their
own words
• Hear voices not typically heard
• Deepen our understanding of health through
the eyes of residents
Focus Groups
30. Focus Groups
• Everett + North / <$65,000
• Everett + South / >$65,000
• Arlington Area /Age 25-45
• Monroe Area / Age 45-65
•College Youth from ethnic minority groups/EVCC
[Everett]
•Adults in low income housing or transition housing
[Lynnwood]
•Latina mothers/(all non-native U.S.) [Everett]
•Latina female lay health workers/Promotoras/
[Lynnwood]
•Low income females/mixed ethnicities/ [Lake Stevens]
•Adults/most middle age/ all Caucasian and most lower
income (2 under $65K; 9 under $40K) [Granite Falls]
•Primarily Senior citizens(10/12); mostly
Caucasian/female/ lower income (3 under $65K; 9 under
$40K) [Arlington]
UW Bothell
Lutheran Community Services NW
Elway Research, Inc.
34. Definitions of Health
• Not sick /Lack of Disease/
Free from addiction
• Medical insurance /
Access to regular medical and
dental check ups
• Having an active family
• Pollution/ Clean water
• Living in a safe environment
• Staying alive
• You feel good
• Energy
• Independence
• Mental health
• Lack of pain
• Genetics
• Prevention
• Attitude
• Diet & Exercise
• Social Connections
36. Definitions of Wellness
More all-encompassing than “health”
• Don’t they usually say ‘health and wellness?’ It’s
almost separate. I feel that when you’re thinking
about wellness, you’re thinking outside of the box of
what you’ve normally done.
• Whole body/holistic approach
• To me it’s more like a proactive approach to feeling
better, being better, for wellness.
37. Definitions of Wellness
• Health is maintenance and wellness is
extracurricular activities almost.
• I would consider if you're happy with the way you are,
you think, you live, your health, your life, your family,
your church. That's wellness to me.
• Do you remember that show, “The Waltons”? That’s
kind of what I picture.
• Some type of peace; serenity with one’s self.
39. Definitions of Wellness
Having Resources
• Having enough food …When I think of wellness, I think of
a world where there isn’t hunger.
• I cannot afford dieticians, hypnosis and holistic approaches
to my health…I am barely surviving!
• When I envision wellness, I think: “ She gets to eat salads
and it doesn’t matter if meat is $13 a chunk.”
40. Optimal Health & Wellness
•Self awareness / Maturity
•Acceptance of limitations
• I think you have to know yourself
because what is right for someone else may
not work for you. You have to be in tune
with your mental and physical well-being
and know when something needs a change.
• You could have my body and be happy with
it, or this tofu person would think I’m
absolutely disgusting. It’s perspective, it’s
what’s important to you.
• It's not comparing myself to somebody
who's 10, 20 or 30 years younger than me,
it's being conscious of who I am now at this
stage in my life. And being active with what
I know I can do.
• I put nutrition ahead of medicine and
other things. I accepted that I needed to
spend the money to feel better, to make that
choice.
41. Optimal Health & Wellness
•Self awareness /
Maturity
•Acceptance of
limitations
•Being active
•Access: food,
information, services
•Participate more in
community activities
•If you want to do something there's
nothing stopping you from doing it,
physically or mentally.
•I asked my surgeon, ‘Why is it people
walk funny after surgery?’ She said,
“Because they didn't do the physical
therapy.” I never wanted to walk
funny, so I've accomplished that too,
just by keeping moving.
•Being able to eat more fruits and
vegetables when they are more
affordable.”
•People having more secure housing.
•Having access to health information
and preventative services.
42. Optimal Health & Wellness
•Self awareness / Maturity
•Acceptance of limitations
•Being active
•Access: food, information,
services
•Participate more in
community activities
•Mental health
•Attitude
• I think healthy may be a mental
state where if you're mentally
healthy then everything else will
probably just work. If it wasn't
working, your mental health
could keep you locked down and
not concentrating on healthy
things.”
• Being spiritual. “I’m spiritual. I
believe this has a lot to do with
wellness.”
43. Barriers to Health
What prevents you from being as healthy as you want to be?
•Immediate gratification
(vs. delayed, indefinite price or
payoff)
•Time / Schedule /
Convenience
•Attitude / motivation
• [After work],The last thing I want to do
is go to the gym and stand more. All I
want to do is sit down.
• Families are splintered, too busy
running to soccer, grab a burger, this
and that, rather than sitting around
with the family. Everything is out of the
freezer, prepared meals, or processed,
which is generally less healthy.
• I don’t know if I want to live to 120.
44. Barriers to Health
What prevents you from being as healthy as you want to be?
•Resources
•It cost more to eat healthy
•Access: Information,
Services
•Not knowing where to go
for health information
• It is getting more costly to eat healthy.
Sometimes you look at the food, it’s so much
money to eat good but you've got to make
that choice.
• I eat frozen meals like Lean Cuisine not to
lose weight but because they are on sale
and the only thing that looks healthy that I
can buy.
• I can’t afford a gym and it’s not safe to
exercise in neighborhood. I want to join a
social group of some kind and exercise, but I
cannot afford what’s available.
• I think food is probably the last thing people
go to buy because everything else is so
demanding. Food is not demanding, food is
a luxury.
45. Barriers to Health
What prevents you from being as healthy as you want to be?
•Cost of medical care/
insurance
•Food options
•Lack of transportation
•Lack of affordable housing
• I have insurance, but I cannot afford to
pay the deductible so I don’t go to the
doctor to avoid having to pay.
• There have been times where [food
bank] clients have gone through and
they couldn’t get near the food that they
were offered because they said I’m on
foot, which was super sad because they
couldn’t take anything that was heavy.
• I want to experience the community and
cannot because of my health and
transportation issues. I have a lot to
give still.
46. Barriers to Health
What prevents you from being as healthy as you want to be?
•Cultural
misunderstanding
•Racial/Ethnic
discrimination
•Immigration status
•Language barriers
• There is chronic stress of constantly living in anonymity.
• I am Columbian. When I go to school, I don’t see people like
me. I have been discriminated against because I speak
Spanish. I have had to form my own sense of community and
find people who accept me. When people say, “Go back to
your country, I’m like…’Where would you like me to go? This
is my country!”
• At a certain level, I want to be accepted by the larger society,
but if people are haters, I want to give up.
• If I go see a doctor, I am fearful that I’ll be sent back and
taken away from my family.
• Even though I have credentials in another country, I cannot
get hired here with those same credentials. That gives me
limited options.
• I was a little bit angry when I found out that the Timberline
was built on Indian burial ground. That could be bad for
your health physically, mentally.
• Actually I never been to any hospital after I moved here,
because …..I feel like I can’t really communicate with doctors
because of the language, you know?”
47. Barriers to Health
What prevents you from being as healthy as you want to be?
• Drugs & Addiction
• Crime and Violence
• Lack of jobs
• Lack of education
• Lack of mental health
resources
• Not feeling connected to
anyone or to the
community
• This county has a severe heroin problem.
Four youth this year alone have died from
heroin overdoses.
• We need more full-time job opportunities
in Snohomish County.
• We will never be healthy until we as a
community take care of our children’s
safety. We have to address the crime in our
area.
• …I don’t know any of my neighbors, I don’t
even know like who they are…I don’t know
anything about them, I just know we all
live in the same place, and that we stop by
at night, and we leave and that’s it you
know ?
48. Resources
Where do you go for health information, help?
• Family members – Mother
• Friends/ Peers
• Healthcare Provider
• Nutritionist
• Internet
• Pharmacist
• 2-1-1
• Social services and non-profits
• Theme of people not knowing where in
the community to go for reliable health
information outside of family, doctor or
clinic.
• My mother. She has helped me through a lot. I
see her before the doctor.
• The realm of information that we got 10 years
ago compared to now. Now it's readily available
and you can just go, I'll read this about this
doctor. Ten doctors said this.
• Yes, the information is incredible.
• In Everett, they have really good resources. I
just feel like they’re spread out. Right here is
DSHS and Child Support Enforcement, but
Pregnancy Research Center and Planned
Parenthood are way in the other direction. The
men’s shelters are way over there. It’s like
they’re not in a centralized area, where if they
were I think more people would have access to
them.
49. What makes a healthy community?
• People
• Relationships/ Engagement
• Infrastructure/ Access
• Safety/ Security
• Community activities
• Affordable youth sports programs
• Health/ Healthcare
• Parks and trails
• Good public transportation
• Affordable healthy food options
•You don’t have the vice of
anonymity.
•I’ve been playing soccer since I
was 13 and a lot of the people I
have played with since I was at
that age I still come across
them… you just find familiar
faces everywhere you go
basically.
•We will never be healthy until we
as a community take care of our
children’s safety. We have to
address the crime in our area.
50. What makes a healthy community?
• People
• Relationships/ Engagement
• Community activities
• Infrastructure/ Access
• Safety/ Security
• Affordable youth sports programs
• Health/ Healthcare
• Parks and trails
• Good public transportation
• Affordable healthy food options
• Being able to hang out with your
neighbors…everybody watches
everybody’s house. Everybody
watches everybody’s kids, so we
make sure nothing happens in our
neighborhood. That's the
community I like.
• I'm going to say village, when I think
of community. Everybody in the
village is responsible for the
community. Everybody needs to be
responsible.
• A healthy community has a lot of
outlets. It also produces healthier
activities and minds. There's just
more of a variety of things to do.
51. What can we, as a community, do
to make our community healthier?
• Improve transportation
• Sidewalks/ Bike paths
• Grocery stores
• More jobs
• Information/ Education about
Resources
• Community Activities
• Mental health services
•Every community should have a
family center! Anything you
need, you can come to the family
center for resources.
•We need a Boys and Girls Club
up here. Some place they have to
go in case they need to talk to
somebody other than their
parents.
•I'd love to see the Centennial
Trail go through. Honestly we'd
probably ride our bikes to
Snohomish then.
52. What can we, as a community, do to
create a healthier community?
• Create more full-time jobs
• Help people become aware of
community resources
• Affordable dental
• Organize more community
events
• Create more safe places for
people to walk and exercise
• Address ongoing ethnic
discrimination and build cultural
understanding
•More local food sources /
Community gardens
•Connect seniors to the
community—beyond the senior
centers
•Parenting classes
•Make sports affordable to all.
When we are on the
field….we are all just
players.
53. 2035: What will success look like?
• More food options
• Less Crime/ Drug use
• Better transportation/
Less driving
• People getting outside
• Stable economy
• More engagement in the
community /Volunteering
• More housing/ Housing options
• Community P-Patches, where people
grow their own food, and get out there
and till the earth, and feel good about
it. Sharing with the food banks.
• After-school programs for the kids,
accessibility to them. Even if they’re
low-income, let them go to the Y.
• Reward businesses…if you let your
employees volunteer for a half day,
maybe they should be able to get some
sort of tax credit for that.
• Aren’t we supposed to be on Mars by
then?
54. Next Steps
• Pictures of Health
• Compile and publish the Daily Herald Poll
• On-going community conversations
• Design and test survey questionnaire
• Conduct baseline Vital Signs Index
