Getting to the Heart of the Matter in Michigan
Submission Date: March 2018
Entry Type: Case Study
State/Territory Submitted on the Behalf of: Michigan
States/Territories Involved: Michigan
Funding Source: CDC
CDC Funding:Yes
CDC Funding (Specified):Preventive Health and Health Services Block Grant
Domain Addressed:Community-Clinical Linkages, Environmental Approaches, Health Systems Strategies
Public Health Issue:Chronic diseases are common and often preventable. The 2015 Michigan Behavioral Risk Factor Surveillance System reports over 27% of residents have two or more chronic conditions. Health risk behaviors such as lack of physical activity, poor diet and tobacco use contribute to chronic disease. The County Health Rankings Roadmaps states that 31% of Michigan’s adults are obese and 20% are active tobacco users.
Primary prevention addresses health risk behaviors now to prevent future chronic disease. Being mindful of other factors while creating interventions, including social and physical environments, access to care and support and healthy child development, elevates primary prevention. Michigan Department of Health and Human Services (MDHHS) is focusing on physical and social determinants of health to enhance existing evidence-based public health strategies.
Project Objectives:In order to move health promotion upstream, a new approach had to be instituted. An approach that looked at health and wellness as a journey with many facets; that when addressed in isolation, denied the compounding impact. Getting to the Heart of the Matter in Michigan (GTHM) is a demonstration project of MDHHS, Division of Chronic Disease and Injury Control. It utilizes Prevent Block Grant funding that was previously divided amongst disease specific programming, and creates a collective work plan to continue addressing those same diseases but from a higher perch. That higher perch is impacting access to health care services and resources, improving natural and built environments and implementing policy change in worksites and schools.
GTHM program objectives focus on environmental and policy changes to increase opportunities for:
- Physical activity
- Healthier nutrition
- Assistance with quitting tobacco and
- Building community resiliency
This focus is directed in multiple settings including:
- Local health departments
- Health and dental clinics, including Federally Qualified Health Centers
- Worksites
- Other community locations such as parks, food pantries, schools, etc.
GTHM joins tobacco, diabetes, oral health, cancer, worksite wellness and building healthy communities for a collective impact on increasing healthy lifestyles, decreasing obesity and decreasing tobacco use among vulnerable populations. It is in one urban and one rural setting. However the program aims to achieve sustainable environmental and policy changes so the reach is greater. GTHM includes Adverse Childhood Experiences and its impact on overall health in an effort to build community resilience.
GTHM is working in two Community Health Innovation Regions (CHIRs) participating in Michigan’s State Innovation Model.Local health departments were contracted to increase their capacity and as a direct liaison with the CHIR governance.Local health departments utilize their staff and community partners to implement evidence-based practices and meet objectives.
Data/Other Information Collected:GTHM is collecting quantitative data related to each objective and activity implemented. This data includes:
Tobacco Dependence Treatment
Number of health systems and dental clinics participating in program
Number of tobacco users assessed and assisted
Number of medical and dental providers implementing guidelines
Consumer action measurements (i.e., calls to the Quitline, hits to various websites, etc.)
Worksite Wellness
Number registered to use the Designing Healthy Environments at Work
Number implementing worksite wellness programs
Number with policies to increase opportunities for healthy eating and physical activity
Number that employ low-wage workers served by lifestyle change programs
Number referring employees to evidence-based chronic disease self-management programs
Number of policies and environmental changes to support healthy eating and physical activity
Number of employees covered by Medicaid and Healthy Michigan Plan
Number of employees with health insurance plans with coverage of programs that support healthier lifestyles
Number of lifestyle success stories submitted
Number of employees enrolled in worksite wellness programs
Number of employees who took the MI Healthier Tomorrow healthy lifestyle pledge
Number of employees who quit smoking
Number of employees with increased physical activity
Number of employees with increased healthy eating
Diabetes Prevention Program
Number of participants and demographic data collected by DPP
Number of participants and demographic data collected by Enhance Fitness programs
Number of referral partners to build lifestyle program participation
Wise Choices (modeled after WISEWOMAN)
Percentage of Wise Choices client setting lifestyle goals
Percentage of Wise Choices clients who completed goals complete outcome evaluation contact
Number of referral partners to build Wise Choices
Enhance Fitness
Physical activity/strength changes
Weight loss
Number of minutes of physical activity per week
Building Healthy Communities
Number of policy/environmental changes initiated to support walking and healthy eating
Change in food and physical activity resource inequities
Number of settings implementing components of community plans
Number of Dietary Guidelines for Americans implemented in multiple settings
Adverse Childhood Experiences
Number of gap analyses completed
Number of CHIR regions that receive gap analysis data
Media
Reach and frequency of media ads
Number of regions media campaign was implemented
Additionally, GTHM is using companion qualitative data obtained through key informant interviews. Key informant interviews were conducted in 2017 with organizations contracted by the local health departments to assist in achieving the objectives. These interviews have proven to be invaluable for adding context to the quantitative data and for strategizing the progression of the program. In 2019 we intend to have local health department partners interview diverse sectors of their county including education, law enforcement, business, health, parents, residents and others to ensure that community identified needs are being addressed.
Impact/Accomplishments:In its third year of implementation, GTHM has had successes as a demonstration on how to bring multiple sectors
together under common goals. Program activities can be designed to follow the pathways to these common
goals. These common goals speak to social determinants of health and aim to affect health equity.
MDHHS is reviewing how to further braid funding to increase efficiency and successes with
programming. Local health department partners are seeking funding to leverage for its common goals.
They are more effectively using request for proposal processes to engage community partners. Internally they
are enhancing operations by creating cross referral policies which produce a “no wrong
door” effect.
Achievements include:
Overall Reach – 653,227
Number of Michigan counties involved – 40
Number of Environmental Changes – 1,310
Number of Policy Changes – 385
Challenges/Lessons Learned:With any project aspiring to make sustainable environmental and policy change, challenges are wide and varied. The amount of time for these types of interventions is often longer than the needed outcome measures based on funding requirements. Outcomes are long term and impact is hard to measure in short intervals. Therefore it is important to develop milestones on a continuum. These milestones can be used as a framework to gauge achievement.
Next Steps:GTHM is currently developing a database to store data across the years. As this program involves multiple sectors of public health, the database will allow flexibility in reporting from activity specific to broad efforts. The team continues to work with local health department partners to diversify funding and increase sustainability efforts. Additionally the team maintains a strong relationship with the State Innovation Model team to continually explore ways to support their efforts.
Program Areas:Healthy Communities (general), Tobacco
State Contact Information:
MI
Holly Wilson
Michigan Department of Health and Human Services
517-373-8602
wilsonh1@michigan.gov