Illinois Through a High-Functioning Public Health System Comprised of Active Public, Private and Voluntary Partners

SHIP Vision

Optimal physical, mental and social well-being for all people in Illinois through a high-functioning public health system comprised of active public, private and voluntary partners.

Illinois State Health Improvement Plan

Illinois State Board of Health

May 2007

Prepared by

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. World Health Organization, 1994

The mission of public health is to fulfill society's interest in assuring conditions in which people can be healthy. Institute of Medicine, 1988

The public health system is the collection of public, private and voluntary entities as well as individuals and informal associations that contribute to the public’s health. U.S. Centers for Disease Control and Prevention, 2003

Table of Contents

Introductory Letter ...... i Acknowledgements ...... iii Members of State Board of Health ...... iv Members of State Health Improvement Plan Team...... v List of Acronyms...... vi

Executive Summary...... 1 Introduction...... 3 SHIP...... 3 Recommendations ...... 5

Assessment Findings and Logic Models By Strategic Issue……………… ...... 7 Access...... 9 Data and Information Technology ...... 13 Disparities ...... 17 Measure, Manage and Improve the Public Health System...... 21 Workforce...... 25 Priority Health Conditions...... 31

Appendices Appendix A: Assessment Findings...... 41 Appendix B: Glossary...... 51 Appendix C: List of Electronic Supporting Documents ...... 61

State Health Improvement Plan December 2006

Dear Public Health System Partner:

For the past year, it has been our privilege to work together on the State Health Improvement Planning process. We have been proud to work with an incredibly thoughtful, talented and committed Team representing business, labor, health care providers, academia, philanthropy, non-profit health organizations, local health departments, the legislature, and state government agencies.

We are pleased to present the State Health Improvement Plan to all our partners in the public health system - the Governor, the General Assembly, and all those working to improve the health of Illinois residents.

The Plan envisions optimal physical, mental and social well-being for all people in Illinois through a high-functioning public health system comprised of active public, private and voluntary partners.

The Plan focuses on several key system priorities and outcomes that, when achieved, will support health improvement across a wide range of health issues. In addition, the Plan has identified four priority health conditions as risk factors for a number of diseases and disabilities. Strategic, system-focused planning has resulted in a State Health Improvement Plan that can be embraced and implemented by all.

It is the hope of the State Board of Health and the Planning Team that you will use activities associated with your sector in the Plan as a springboard for future action to improve the functioning and outcomes of the public health system.

We and our colleagues on the Planning Team are eager to work with everyone in the Illinois public health system to make this plan a successful blueprint for the good health of our communities.

Sincerely,

Eric E. Whitaker, M.D., M.P.H. Robert Kieckhefer Javette Orgain, M.D. Director Blue Cross/Blue Shield of Illinois Chair Illinois Dept. of Public Health Co-Chair, SHIP Team Illinois State Board of Co-Chair, SHIP Team Health Member, SHIP Team

i State Health Improvement Plan ii State Health Improvement Plan Acknowledgements

As early advocates for the passage of legislation creating the State Health Improvement Plan, the staff and steering committee of the Illinois Public Health Institute were proud to be able to play a role in facilitating the efforts of the State Board of Health and the Planning Team to undertake this effort.

Gov. Rod R. Blagojevich and Illinois Department of Public Health Director Eric E. Whitaker, M.D. provided resources and leadership to the SHIP process. IDPH Deputy Director David Carvalho and Division Chief Patti Kimmel contributed their expertise and support to the process.

We are especially grateful to the more than 150 individuals and organizations that participated in various data collection processes, including the focus groups and the two iterations of the National Public Health Performance Standards assessment.

The Institute staff, including Laura Landrum , Mark Edgar, Sarah Duggan-Goldstein, Chris Giangreco , Kathy Karsten, Diana Derige, Zoe Zhang and Kuliva Wilburn were instrumental in the planning process and production of the report. Laura McAlpine, of McAlpine Consulting for Growth, provided expert facilitation.

Our deep appreciation is owed to Bob Kieckhefer and the staff at Blue Cross/Blue Shield of Illinois, who hosted several Team meetings.

Elissa J. Bassler, Executive Director Illinois Public Health Institute December 8, 2006

iii State Health Improvement Plan Illinois State Board of Health

Javette C. Orgain, M.D., M.P.H. (Chairperson) David B. McCurdy, D.Min., BCC (Co-Chairperson)

Steven M. Derks Caswell A. Evans, D.D.S., M.P.H. Jorge A. Girotti, Ph.D. Kevin D. Hutchison, R.N., M.S., M.P.H. Jane L. Jackman, M.D. Jerry Kruse, M.D., M.S.P.H. Peter Orris, M.D., M.P.H. Ann O'Sullivan, R.N., M.S.N. Karen Phelan Timothy J. Vega, M.D. Herbert E. Whiteley, D.V.M., Ph.D.

iv State Health Improvement Plan State Health Improvement Planning Team Co-Chairs: Robert Kieckhefer, Blue Cross/Blue Shield of Illinois Eric E. Whitaker, M.D., M.P.H., director, Illinois Department of Public Health

Team Members Carol L. Adams, Ph.D., secretary, Illinois Dept. of Human Services Joseph A. Antolin, J.D., Heartland Alliance for Human Needs and Human Rights Margaret Blackshere, AFL-CIO Larry S. Boress, Midwest Business Group on Health Patricia Canessa, Ph.D., Salud Latina/Latino Health Greg Chance, LEHP, M.P.H., CPHA, Illinois Association of Public Health Administrators Rowland Chang, M.D., M.P.H., Northwestern University Feinberg School of Medicine State Rep. Elizabeth Coulson, R-Glenview Steven M. Derks, American Cancer Society-Illinois Division Shelly M. Ebbert, M.P.H., Illinois Public Health Association Caswell Evans, D.D.S., M.P.H., University of Illinois, Chicago, College of Dentistry Ann Guild, M.P.H., Illinois Hospital Association J.A. Herrmann, D.V.M., M.P.H., University of Illinois, Urbana-Champaign, College of Veterinary Medicine Miriam Link-Mullison, M.S., Southern Illinois Public Health Consortium Mark Loveless, Rainbow PUSH Coalition Vasyl Markus, J.D., Service Employees International Union Barry Maram, Illinois Department of Healthcare and Family Services William McDade, M.D., Ph.D., Illinois State Medical Society, Cook County Physicians Association Michael O’Donnell, East Central Illinois Area Agency on Aging Ann O’Sullivan, R.N., M.S.N., Illinois Nurses Association Javette Orgain, M.D., M.P.H., Illinois State Board of Health Hugh Parry, United Way of Illinois, Prevent Blindness America Dennis Richling, M.D., CorSolutions Erica Salem, M.P.H., Chicago Department of Public Health Doug Scott, Illinois Environmental Protection Agency Richard H. Sewell, M.P.H., University of Illinois, Chicago, School of Public Health Barbara Shaw, Illinois Violence Prevention Authority Nanette Silva, M.P.H., Community Memorial Foundation State Senator Donne Trotter, D-Chicago Kathleen Welshimer, M.P.H., Ph.D., Southern Illinois University - Carbondale Anita Winslow, COHN-S, Caterpillar Inc. Carol Wozniewski, M.A., Mental Health Association in Illinois

v State Health Improvement Plan List of Acronyms (Glossary found in Appendix B)

AHCTF Adequate Health Care Task Force ATOD Alcohol, Tobacco and Other Drugs BRFSS Behavioral Risk Factor Surveillance System CBO Community-based Organization CBPR Community-based Participatory Research CDC U.S. Centers for Disease Control and Prevention DCFS Illinois Department of Children and Family Services EMS Emergency Medical Services EPHS Essential Public Health Services EPSDT Early Periodic Screening Diagnosis and Testing GS/HS Grade School/High School HC Health Care IACET International Association of Continuing Education Training IDHS Illinois Department of Human Services IDPH Illinois Department of Public Health IDHFS Illinois Department of Healthcare and Family Services IPLAN Illinois Project for Local Assessment of Needs IT Information Technology LBW Low Birth Weight LCC Language and Culture Competence LEP Limited English Proficiency LHD Local Health Department LMS Learning Management System MAPP Mobilizing for Action through Planning and Partnerships MCH Maternal and Child Health MH Mental Health NACCHO National Association of County and City Health Officials NPHPS National Public Health Performance Standards PBM Pharmacy Benefits Management PH Public Health SHIP State Health Improvement Plan TA Technical Assistance UIC University of Illinois at Chicago WHO World Health Organization WIC Women, Infants and Children YPLL Years of Potential Life Lost

State Health Improvement Plan Executive Summary Data and Information Technology: assure that current health status and public health

system data are used to plan and The State Health Improvement Plan implement policy and programs. In August 2004, Gov. Rod R. Blagojevich A well-understood and utilized linked signed the State Health Improvement Plan • data system that measures, analyzes Act. This groundbreaking law requires that and reports on the health status of Illinois develop a prevention-focused State Illinois residents, including those Health Improvement Plan (SHIP) every impacted by health disparities. four years. Disparities: monitor health disparities and

implement effective strategies to eliminate The 2006 Illinois State Health Improvement them. Plan was crafted by a diverse leadership team appointed by the director of the • A public health system actively Illinois Department of Public Health (IDPH) engaged in addressing health to work with the Illinois State Board of disparities and the social determinants Health. Team members represent public, that affect health outcomes across the private and voluntary sectors. IDPH lifespan. engaged the Illinois Public Health Institute Measure, Manage and Improve the Public (IPHI) to facilitate the SHIP process. The Health System: assure accountability, Team developed a vision, six strategic ongoing improvement, and performance issues with associated long- and management. intermediate-term outcomes, and • A high functioning public health system recommendations of strategies and actions comprised of active public, private and for the sectors that make up the public voluntary partners. health system. • Ongoing monitoring of the identified health conditions and risk factors. SHIP Vision Workforce: assure an optimal, diverse and Optimal physical, mental and social well- competent workforce. being for all people in Illinois through a • A workforce that is optimal in terms of high-functioning public health system preparation, distribution and number of comprised of active public, private and public health and health care workers. voluntary partners. • A workforce that reflects the diversity of the state and is culturally and SHIP Strategic Issues and Outcomes linguistically competent. Access: access to health care and public Priority Health Conditions: monitor priority health services, including quality health conditions and risk factors, and prevention programs, oral health, mental implement effective strategies to reduce health, medical and long-term care. them. o A health care and public health system • Decrease use of alcohol, tobacco and that: illegal drugs and the misuse of legal • is responsive to the cultural, linguistic drugs. and other needs of the population. • Reduce the proportion of children and • integrates prevention and care. adolescents who are overweight or • is universally available and affordable. obese, and the proportion of adults who are obese.

State Health Improvement Plan 1 • Improve the physical activity level of passionate advocates for many health Illinois residents. conditions and populations, and that our • Reduce violence and exposure to state has many health needs. Thus, the violence. Team sought to identify cross-cutting issues affecting the public health system SHIP Strategies/Actions and opportunities to strengthen it. It was The SHIP addresses strategies and the intention of the Team to fashion the six actions for each priority for many sectors, priority areas such that all system partners including local health departments, state could see their particular issue or area of agencies, health care providers, the concern reflected and that most health legislature, community-based organi- conditions of concern could be more zations, voluntary health organizations, effectively addressed. The Team believes higher and K-12 education, health plans, that as Illinois advances in addressing employers, philanthropy, the media and health improvement in multiple domains organized labor. and across the lifespan, we must always be cognizant of and working on the critical Proposed actions include employer system supports that make a healthy wellness programs, the design of a new population possible. and comprehensive health data system, workforce training in cultural competency, The Team challenges the partners in the investment in local health priorities, and public health system to focus their energy development of a statewide physical on the issues and objectives identified in activity and obesity prevention initiative. this plan, and to take these critical first implementation steps to ensure the Recommendations realization of the State Health The Illinois State Health Improvement Improvement Plan vision: Planning Team recognized that Illinois has

Initial Steps: • Focused and committed leadership is needed for SHIP. The public and private sectors should collaborate to advance and monitor SHIP implementation efforts.

• The Governor and General Assembly should use the critical recommendations found in SHIP to shape budgetary and legislative priorities for the coming years.

• Partners in the Illinois public health system – employers, health care providers, local health departments, community groups and others – should identify priorities in SHIP to which they contribute and expand upon and implement the recommended strategic actions.

• The Governor should ensure the promotion and coordination of SHIP implementation efforts across state agencies. State agencies should use their monitoring and improvement activities as opportunities to incorporate the strategies described in SHIP.

• The philanthropic sector should re-direct funding resources to include the systems and infrastructure approaches addressed in this Plan.

State Health Improvement Plan 2 Introduction 2. Strengthen the governmental public health infrastructure—the backbone of

any public health system; In August 2004, Gov. Rod R. Blagojevich 3. Create a new generation of signed Illinois Public Act 93-0975, the partnerships to build consensus on State Health Improvement Plan Act. This health priorities and support community groundbreaking law requires that a and individual health actions; prevention-focused State Health 4. Develop appropriate systems of Improvement Plan (SHIP) be developed accountability at all levels to ensure every four years. Recognizing that that population health goals are met; improvements in the health of the public 5. Assure that action is based on will need the collective action of evidence; and stakeholders across the state, the law calls 6. Acknowledge communication as the for the state public health director to key to forging partnerships, assuring appoint a multi-sector planning team to accountability, and utilizing evidence for carry out the planning process. After a decision making and action.” series of public hearings, the State Board of Health delivers the plan to the Governor The Illinois State Health Improvement Plan who then submits the SHIP to the General Act provides a vehicle to examine and Assembly for use in public policy effectively carry out these critical public development. health system imperatives.

In The Future of the Public’s Health in the Thus, SHIP is not a plan for government 21st Century1, the Institute of Medicine action. Rather, it is a plan for the entire (IOM) issued a call to action: public health system – all those institutions with a stake in a healthy population, “Achieving the vision of healthy people in including state government, to come healthy communities is a difficult and together in a strategic fashion. complex task that cannot be accomplished through a single plan of action or by a As described below, the process used to single governmental agency or develop SHIP sought input from a broad nongovernmental entity. Rather, broad representation of experts in public health societal action is required at every level…. and health care and comments from the To support the creation of an effective public. This process resulted in a plan that intersectoral public health system, the IOM focuses on issues of critical importance committee identified six areas of action and that can be strategically addressed to change: improve the health of the population and the functioning of the public health system. 1. Adopt a population health approach that builds on evidence of the multiple determinants of health; SHIP In October 2005, the Illinois Department of Public Health (IDPH) director, Eric E. 1 The Future of the Public’s Health in the 21st Whitaker, M.D., convened the SHIP Century (2003), Board on Health Promotion and Planning Team. The Team was comprised Disease Prevention (HPDP), Institute of Medicine of a diverse leadership group representing (IOM)

State Health Improvement Plan 3 public, private and voluntary sectors. IDPH health care providers) and population engaged the Illinois Public Health Institute groups (e.g., minority populations); (2) (IPHI) to facilitate the SHIP process and local public health priorities; and (3) direct the Team through a state-level state-level strategic plans; and adaptation of the Mobilizing for Action • a Forces of Change Assessment, through Planning and Partnerships (MAPP) identifying externally-driven challenges strategic planning model. and opportunities that the Illinois public health system will face in the coming Originally developed for use in local public years. health jurisdictions, the MAPP framework is broad in scope and strategic in its focus More complete information on the and readily adaptable to state-level assessments can be found in Appendix A planning. The phases of the MAPP and at www.idph.state.il.us/ship. process were carried out by the members of the Planning Team, meeting as a From each assessment the Team committee of the whole and in developed findings. The Team worked subcommittees. through a process of clustering the resulting information to identify issues that Early in the process the team crafted a were supported by findings across the vision statement to guide the development assessments. These cross-cutting issues of the SHIP. were of strategic importance and gave rise to the final set of Strategic Issues that Optimal physical, mental and social served as a framework for all subsequent well-being for all people in Illinois work by the Team. The six strategic issues through a high-functioning public are presented below. health system comprised of active public, private and voluntary partners.

In order to craft a plan driven by data, both qualitative and quantitative, the Team conducted the four types of assessments suggested by the MAPP process. These assessment modules include:

• a State Health Profile, examining the health of the state’s population • a State Public Health System Assessment, examining the performance of the Illinois public health system in carrying out the ten essential public health services • a Statewide Themes and Strengths Assessment, examining (1) the perceptions of various sectors (e.g.,

State Health Improvement Plan 4 SHIP Strategic Issues Specific long-term and intermediate 1. Access—Access to health care and outcomes and multi-sectoral strategies public health services, including quality were developed for each strategic issue. prevention programs, oral health, Successful implementation of these mental health, medical and long-term strategies will improve the health of Illinois’ care. population, enhance the effectiveness of 2. Data and Information Technology— the Illinois public health system and Assure that current health status and constitute progress toward accomplishing public health system data are used to the SHIP vision. plan and implement policy and programs. The Illinois State Board of Health held 3. Disparities—Monitor health disparities three public hearings on the draft State and implement effective strategies to Health Improvement Plan in August of eliminate them. 2006. The meetings were held in Mount 4. Measure, Manage and Improve the Vernon, Bloomington and Chicago. At each Public Health System—Assure hearing, a variety of citizens’ groups, accountability, ongoing improvement, provider organizations, trade associations, and performance management. health organizations and local health 5. Workforce—Assure an optimal, diverse departments commented on the Plan’s and competent workforce. impact on their work and issue areas. 6. Priority Health Conditions—Monitor Public comments also were accepted priority health conditions and risk through the Internet. There were a total of factors, and implement effective 33 public comments accepted at the strategies to reduce them. hearings and 45 written comments submitted.

Figure: 1: Strategic Issues The Planning Team and the Illinois Public Health Institute reviewed the testimony based on the plan’s strategic orientation. Priority Health Disparities They evaluated and incorporated testimony Conditions that was consistent with the plan’s support for health improvement across the spectrum of health status issues through

Improved systems development. The Planning Team believes that many of the issues raised in Workforce Health Access Outcomes testimony and comment, but not directly incorporated into the plan, may be achieved as a result of the public health system changes promoted by the State Measure, Health Improvement Plan. Manage and Data and IT Improve the PH System Recommendations The Illinois State Health Improvement Planning Team recognized that Illinois has passionate advocates for many health

State Health Improvement Plan 5 conditions and populations, and that our health improvement in multiple domains state has many health needs. and across the lifespan, we must always be cognizant of and working on the critical Thus, the Team sought to identify cross- system supports that make a healthy cutting issues affecting the public health population possible. system and opportunities to strengthen it. It was the intention of the Team to fashion The Team challenges the partners in the the six priority areas such that all system public health system to focus their energy partners could see their particular issue or on the issues and objectives identified in area of concern reflected and that most this plan, and to take these critical first health conditions of concern could be more implementation steps to ensure the effectively addressed. The Team believes realization of the State Health that as Illinois advances in addressing Improvement Plan vision:

Initial Steps:

• Focused and committed leadership is needed for SHIP. The public and private sectors should collaborate to advance and monitor SHIP implementation efforts.

• The Governor and General Assembly should use the critical recommendations found in SHIP to shape budgetary and legislative priorities for the coming years.

• The philanthropic sector should re-direct funding resources to include the systems and infrastructure approaches addressed in this Plan.

State Health Improvement Plan 6 Assessment Findings and Logic Models By Strategic Issue

Following the identification of the strategic The logic models provide a framework that issues, the Team began a process of various actors within the sectors (and delineating long- and intermediate- term coalitions of actors across sectors) can use outcomes related to each issue. In to begin taking action on the identified addition, the Team began identifying the outcomes and strategic issues. It is most various sectors (e.g. Local Health likely necessary that for any strategic Departments, employers, etc.) that would activity outlined here, partners will have to need to take action to achieve the build a set of action steps to implement the outcomes. The Team delineated within- activity. Public health system partners are and across-sector strategies and actions encouraged to identify and seize other that would be necessary to accomplish the opportunities to help realize the outcomes outcomes and to realize the improved identified in SHIP. The logic models should “state of the public health system” therefore be used as tools for catalyzing represented in the strategic issues. work to improve the health of all persons living in Illinois. The logic models for each strategic issue follow. For each strategic issue, there is a The working logic models used by the Team narrative description of the relevant for their deliberations included inputs. In the findings from the assessments, followed by interest of space, they are not described a two-page logic model(s). The logic separately in the following pages. Inputs are models include the statement of the the resources necessary to implement a strategic issue itself, the long- and program or policy as well as barriers and intermediate-term outcomes and the constraints in the current environment. The inputs included in all the working logic models strategies and actions for the various were: sectors identified in the process. There is also an additional multi-sector box for • Training those strategies and actions that were • Legislation thought to be necessary for multiple, if not • Recruitment all, sectors. • Policy development

• Research While the Team attempted to be as comprehensive as possible in identifying • Coalition development strategies and actions, the proposals are • Partnerships not exhaustive; groups may determine • Program development other actions or strategies that will move • Resource development Illinois toward the stated outcomes. The • Incentives Team proposed a range of sectors that • Needs assessment could engage in the actions proposed, but • Gap analysis many other groups, even if not specifically • Data collection and analysis listed, could and should participate in realizing the vision of this plan.

State Health Improvement Plan 7

State Health Improvement Plan 8 Strategic Issue: Access health care workforce distribution, lack of insurance, financial challenges and How can the people of Illinois gain access limited cultural and linguistic to health care and public health services, competence. including quality prevention programs, oral • Illinois’ residents must have knowledge health, mental health, medical and long- of the health care system, the services, term care when they need it? programs or payment options that are available within a community to assist Access to health care is one of the most in achieving optimal health. important issues to the health of Illinois • Access to care includes access to residents. Because of Illinois’ diverse mental health, oral health, vision, population, health care services not only subspecialty services and prevention. need to be present but also need to • A variety of issues complicate the accommodate the variety of cultures and problem of health care access: limited languages of Illinois. Adequate access to outreach services, the relationship of health services also includes mental health malpractice rates to the decrease in services, oral health services, vision and physicians, the ability to navigate the prevention programs. In order to have a system and long wait times for services. healthy Illinois, the availability of and • The local public health system needs access to health care must be increased. assistance in developing partnerships to reduce barriers and promote access Key Findings from Assessments: to health care for underserved • Illinois compares unfavorably with other populations. states when looking at the number of • Illinois partners must work together to people without access to health care. develop the health care infrastructure • People are increasingly becoming (e.g., hospitals, clinics), which will uninsured, as employment benefits are improve access to care. decreasing and health care costs rise. • Access to care remains a high priority The logic model developed for the access among Illinois organizations. Interest in strategic issue follows. access encompasses basic health care and the factors that affect access: the

State Health Improvement Plan 9 Access Strategic Issue: How can the people of Illinois gain access to health care and public health services, including quality prevention programs, oral health, mental health, medical and long–term care when they need it? Long-Term Outcomes: 1. A health care and public health system that is responsive to the cultural, linguistic, and other needs of the population 2. A health care and public health system that integrates prevention and care 3. A health care and public health system that is universally available and affordable Intermediate Outcomes: • Immigrants, including those without documentation, have access to the full range of care • Institutional, legal and workforce biases that are barriers to access are eliminated • Public health and the health care system promote community health priorities • Individuals have needed information, motivation and skills in prevention and self-management • Financing systems and policies that support prevention in health care are in place • Adequate funding for public health infrastructure to ensure effective prevention and health promotion programming is available to all residents • A comprehensive approach to expand access (e.g., AHCTF) is supported, analyzed and, where needed, additional efforts and resources are expended to improve access

The efforts of organizations and individuals from numerous different sectors of the community will be necessary to achieve the long-term and intermediate goals related to this strategic issue. Proposed actions and strategies for these various sectors are listed in the tables below and on the facing page.

Strategies/Actions By Sector

Local Health Departments State Agencies • Lead and facilitate community needs • Support and implement All Kids re: EPSDT assessment/planning • Ensure that application materials and • Implement clear policies and consistent procedures are not barriers to access including procedures to meet the needs of groups with requirements for documentation of citizenship cultural, linguistic or other barriers • Reimburse and promote prevention in publicly • Incorporate prevention into direct health care funded HC programs (e.g., All Kids) service programs • Utilize regulatory role to improve quality of • Work with community partners to improve long-term care access • Improve Medicaid reimbursement rates, eligibility, covered services and provider certification for oral and mental health

Health Care Providers Legislature • Implement clear policies and consistent • Fund health care coverage for immigrants procedures to meet the needs of groups with despite federal barriers cultural, linguistic, or other barriers • Fund All Kids re: EPSDT • Incorporate prevention into clinical patient • Fund programming for local community health interactions priorities (e.g., IPLAN) • Partner with payers to develop prevention • Fund access expansion initiatives (e.g., reimbursement opportunities AHCTF, Medicaid) • Expand mental health parity laws

State Health Improvement Plan 10 Strategies/Actions By Sector

Community-Based Organizations Voluntary Health Organizations • Incorporate prevention into direct health care • Partner with HC community to promote service programs prevention in HC interactions

Higher Education Philanthropy • Evaluate prevention elements utilized in HC • Convene partners to address issues related to interactions access • Provide training and resources to improve • Fund pilot programs, research, policy analysis workforce competency and development regarding integrating preventive care and reducing barriers • Fund social marketing programs to enhance uptake of access initiatives, especially for immigrants • Fund agency operating costs of primary care centers

Health Plans Employers • Pay providers for prevention and health • Implement workplace wellness programs promotion services focusing on disease prevention and health • Provide mental health parity in benefit design promotion programs supportive of healthy • Reduce limitations on pre-existing conditions choices • Provide print and Web-based information on • Provide information to employees on accessing prevention and self-management public and community HC programs

Multi-Sector Education • Participate in state level and local community • Promote coordinated school health programs needs assessments/planning, including health and school-based clinics care facility planning • Implement social marketing programs to enhance uptake of access initiatives, esp. for immigrants • Develop and implement programs to reduce stigma related to mental health issues • Ensure adequate access to long-term care for seniors, the disabled and mentally ill in the least restrictive setting and promote consumer choice • Collaborate to address crisis in EMS access in rural communities

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State Health Improvement Plan 12 Strategic Issue: Data and IT the needs of planners and policy- makers. How can the Illinois public health system • Categories used in data collection (e.g. assure that current health status and public race) are not standardized across all health system data are used to plan and data systems. implement policy and programs? • Health care problems go undocumented and untreated without In the course of its work, the Team and accurate data. several subcommittees considered data • Data systems need enhancement to from many different sources. One provide more useful analyses, using unambiguous finding is that an opportunity tool such as Geographic Information exists to enhance the capacity, quality and Systems applications. usefulness of state and local data systems • Lack of data regarding health in Illinois. Additional human, financial and disparities is particularly problematic in technical resources to facilitate adequate smaller communities. data collection, analysis and dissemination • Current surveillance systems must be are critical to assure accurate redesigned to improve monitoring of understanding of community health issues, health problems development of appropriate interventions • To improve data collection, more and evaluation of the impact of such information must be collected about interventions. individuals’ health behaviors; this must

Expansion of the capacity to collect and be guided by protocols to protect analyze data by various subpopulations, personal health information and including but not limited to age, race, maintain confidentiality of data with ethnicity, education, geography, disability, personal identifiers. gender and sexual orientation is critical to • Results of performance evaluations and understanding and eliminating health assessments of public health programs disparities. In order to have a healthy must be shared with partners for use in Illinois, the public health system must local health improvement and strategic improve the quality, variety and versatility planning. of health data. • A statewide communication process for sharing research findings on innovative Key Findings from Assessments: public health practices would improve • Illinois has many advantages regarding public health planning and policy public health data such as the IPLAN development. data system and county specific • Personnel with statistical, epi- BRFSS data demiological and systems management • Integration of systems and disparate expertise must be involved in health data sources is a significant challenge, status monitoring. without which effective cross-program planning cannot occur. The logic model developed for the data • The resources for data collection, and IT strategic issue follows. analysis and dissemination do not meet

State Health Improvement Plan 13 Data and Information Technology Strategic Issue: How can the Illinois public health system assure that current health status and public health system data are used to plan and implement policy and programs? Long-Term Outcomes: A well-understood and utilized linked data system that measures analyzes and reports on the health status of Illinois residents, including those impacted by health disparities. Intermediate Outcomes: • IDPH leads state agencies and private organizations to design and implement a timely, flexible, reliable, publicly accessible data system that incorporates data from participating public and private data collectors/holders • Public health workforce and other public health partners have increased ability to collect and use health data as a result of TA, training and capacity building • State agencies have rational and streamlined data reporting processes for system partners and provide information back in a timely manner

Strategies/Actions By Sector

Local Health Departments State Agencies • Participate in development of legislative data • Adopt standardized racial, ethnic, gender, age, system initiative, educate legislators socio-economic and geographic categories • Adopt standardized racial, ethnic, gender, • Propose/support legislative data system age, socio-economic and geographic initiative categories • Work with system partners to identify and • Have and utilize IT capacity ameliorate confusing and difficult data reporting • Educate workforce in data/IT issues and uses processes • Use data for planning and policy development • Provide adequate staff and financial resources for IT infrastructure, data collection, analysis and dissemination activities • Create and deliver TA/training programs on using and accessing data • Create legal framework/mechanisms to allow HIPAA-compliant data sharing • Use data for planning and policy development

Health Care Providers Legislature • Contribute to design of the linked data system • Mandate and fund existing health data • Adopt standardized racial, ethnic, gender, infrastructure and planning and development of age, socio-economic and geographic enhancements to the system categories • Expand data collection regarding groups that • Contribute data experience health disparities • Improve IT connectivity • Use data for planning and policy development • Educate workforce in data/IT issues and uses

State Health Improvement Plan 14 Strategies/Actions By Sector

Community-Based Organizations Voluntary Health Organizations • Assist in identifying data reporting process • Adopt standardized racial, ethnic, gender, age, barriers and in crafting solutions socio-economic and geographic categories • Educate legislators on need for data system • Create and deliver TA/training programs on • Adopt standardized racial, ethnic, gender, age, using and accessing data socio-economic and geographic categories • Use data for planning and policy development

Higher Education Education K-12 • Train PH and HC workforce re: data and IT • Participate in data collection surveys • Train Data and IT workforce re: PH and HC

Health Plans Business • Provide data to the data system • IT companies assist in design of • Use state provided data on health conditions in interoperability, architecture, data analysis designing prevention and intervention benefits methods and data integration strategies

Multi-Sector Philanthropy • Participate in and advocate for the development • Fund pilot programs, policy analysis and policy of the data system initiative development activities related to data issues • Contribute to design of the linked data system • Convene partners to address issues related to • Contribute data data and IT • Adopt standardized racial, ethnic, gender, age, socio-economic and geographic categories • Ensure the collection of data on the social and cultural determinants of health in addition to race and ethnicity (e.g., poverty, education, sexual orientation)

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State Health Improvement Plan 16 Strategic Issue: Disparities acknowledge the multiple social determinants that affect health outcomes. How can the Illinois public health system monitor health disparities and identify and Key Findings from Assessments: implement effective strategies to eliminate • Health has many determinants – not them? only access to insurance and quality health care, but also varied social and Across Illinois community organizations, economic factors. practitioners, providers and researchers • Bias and discrimination are barriers to report health disparities in various achieving optimal health for many segments of the population. Health underserved populations. Issues disparities occur as a result of a variety of relating to optimal health include determinants – limited access to social and alienation from the health system within economic resources, lack of education and those communities, as well as linguistic educational opportunities, poor access to and cultural barriers, such as the lack of health care due to geographical location, translated materials and the providers’ behavioral risks, age, gender and other lack of knowledge of cultural practices. individual characteristics. • Programs must be developed to increase the cultural and linguistic Lack of attention on the part of public competency of the public health and health practitioners and health care personal health care workforce. (See providers to the differential effects of these the Glossary in Appendix B for determinants perpetuates existing dis- definitions of cultural and linguistic parities. Members of minority communities competency.) are disproportionately affected by many of • Populations such as people recently these determinants. Experiences of bias released from incarceration, and discrimination have resulted in distrust undocumented immigrants and non- of the health care system that prevents English speaking persons need support people from achieving optimal health. to overcome the social and economic Recognition of the varied cultural practices barriers inhibiting healthy lifestyles. and linguistic needs of Illinois residents is a critical component in efforts to eliminate The logic model developed for the disparities. Illinois must actively address disparities strategic issue follows. health disparities through interventions that

State Health Improvement Plan 17 Disparities Strategic Issue: How can the Illinois public health system monitor health disparities and identify and implement effective strategies to eliminate them? Long-Term Outcomes: A public health system actively engaged in addressing health disparities and the social determinants that affect health outcomes across the lifespan. Intermediate Outcomes: • Healthcare is accessible to all residents. See access model. • Public health system partners incorporate strategies to reduce poverty, adverse childhood events and environmental exposure inequalities and increase educational opportunities, support independent living and address other social determinants of health • PH and HC workers are trained in health disparities and the role of social determinants • PH and HC workforce is more diverse and culturally and linguistically competent. (See workforce model.)

Strategies/Actions By Sector

Local Health Departments State Agencies • Disseminate and utilize the findings of the • Create flexibility in funding streams to Community Guide to Preventive Services implement cross-cutting, dynamic programs at • Engage in community-based participatory the local level research projects with universities, state • IDPH– Disseminate, utilize and provide agencies, CBOs and HC providers and use technical assistance for the Community Guide results to improve health to Preventive Services • Engage with non-traditional partners (e.g., • Partner with universities to evaluate programs business, faith, education) in health • Create incentives for community-based improvement efforts participatory research through grants and • Ensure groups impacted by disparities are contracts and use results to improve health included in planning • Ensure groups impacted by disparities are included in planning

Health Care Providers Legislature • Market and utilize findings of the Community • Create flexibility in funding streams to Guide to Preventive Services implement cross-cutting, dynamic programs at • Engage in community-based participatory the local level research regarding health disparities and the • Fund capital improvements in schools in social determinants of health and implement communities impacted by health disparities to findings eliminate environmental inequities that cause • Utilize holistic approaches to HC service negative health outcomes provision that account for the social determinants of health

State Health Improvement Plan 18

Strategies/Actions By Sector

Community-Based Organizations Voluntary Health Organizations • Participate in community-based participatory • Engage in community-based participatory research opportunities regarding health research regarding health disparities and the disparities and the social determinants of health social determinants of health and implement use results to improve health findings

Higher Education Consumer Advocacy Groups • Support community-based participatory • Conduct social marketing programs and research with local and state health agencies, community-based participatory research CBOs and HC providers • Incorporate material on health disparities and social determinants into training and educational programs

Health Plans Employers • Create demand for holistic approaches through • Participate in community health initiatives design of insurance products • Adopt evidence-based health • Train staff and assist providers in delivering promotion/disease prevention programs in the services to members with diverse cultures and workplace languages • Raise awareness of health care disparities

Multi-Sector Philanthropy • Develop/implement programs to increase health • Fund research and interventions addressing literacy health disparities and the social determinants of • Work with researchers to increase health understanding of and intervention on health • Convene partners to address issues related to disparities and the social determinants of health health disparities (see individual sector boxes) • Advocate for policies/practices to reduce health and health care disparities • Train staff and assist providers in delivering services to members with diverse cultures and languages

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State Health Improvement Plan 20 Strategic Issue: Measure, • Public health policy needs to direct the allocation of current resources and Manage and Improve the develop new resources to support Public Health System health status monitoring, diagnosis, intervention, health planning and policy How can the Illinois public health system development. ensure accountability, ongoing improve- • System-wide resources (workforce, ment and performance management? technology and financing) need to be coordinated to implement health In the face of new and ever more complex communications, health education and public health challenges, including newly promotion services. This will encourage emerging and re-emerging infectious the development of constituencies, diseases, bioterrorism and health partnership mobilization, health disparities, Illinois’ public health and health planning and policy-making. care systems must adapt. Health care • Resources need to be committed for providers, community organizations, the sustainability of public health government public health departments and partnerships. businesses must work as partners to • Programs and projects must integrate coordinate their activities and develop state and local action. opportunities to collaborate on health- • Evaluations of the population-based related projects. Collaborative planning, and personal health services offered data and program development across throughout the state help improve the organizations and departments is required quality of the public health system. to improve the functioning of the entire • Insufficient coordination of public system. health/emergency medical systems leads to inadequate responses. Key Findings from Assessments: • The continuing focus on bioterrorism • Gaps in the health system infra- diverts attention and resources from structure, including a lack of other public health issues. understanding by public system • Medical and public health organizations stakeholders of their role in the system are becoming interdependent due to are an impediment to achieving optimal challenges of public funding. health. • Public health system partners must • Resources to implement community implement and support new health plans are insufficient, creating a technologies such as telemedicine. fundamental disconnect between health priorities and the action needed to The logic model developed for the strategic address them. issue measure, manage and improve the • The public health system must direct public health system follows. the garnering, leveraging and managing of resources for a more proactive public health system.

State Health Improvement Plan 21 Measure, Manage and Improve the Public Health System Strategic Issue: How can the Illinois public health system assure accountability, ongoing improvement and performance management? Long-Term Outcomes: 1. A high functioning public health system comprised of active public, private and voluntary partners 2. Ongoing monitoring of the health conditions and risk factors identified in SHIP Intermediate Outcomes: • Stakeholders report on progress toward SHIP goals and objectives at a biennial summit • Stakeholders create and implement revised action plans to improve progress toward SHIP objectives • An adequately staffed and funded system to monitor SHIP goals and objectives and implement improvements • IDPH produces an annual State Health Profile that is in a searchable Web-based format (see data model)

Strategies/Actions By Sector

Local Health Departments State agencies • Align organizational plans with SHIP • Allocate resources necessary for implementation objectives • Align organizational plans with SHIP objectives • Continue to move towards conducting NPHPS • Periodically conduct National Public Health and IPLAN process Performance Standards (NPHPS) assessment • Promote SHIP objectives with partners and implement recommendations • Improve coordination between agencies • Provide training and TA regarding health data collection, reporting and use for planning purposes • IDPH to allocate resources to plan for annual data compilation and publication • Review current funding priorities and resource allocation and re-align where possible to implement components of SHIP

Health Care Providers Legislature • Allocate resources necessary for implementation • Align organizational plans with SHIP • Fund development and ongoing management of objectives monitoring system • Fund local public health systems assessment and needs assessment and planning (e.g., IPLAN) • Review current funding priorities and resource allocation and re-align where possible to implement components of SHIP

State Health Improvement Plan 22

Strategies/Actions By Sector

Community-Based Organizations Voluntary Health Organizations • Align organizational plans with SHIP objectives • Align organizational plans with SHIP objectives

Higher Education Education K-12 • Align organizational plans with SHIP objectives • Align organizational plans with SHIP objectives

Health Plans Business • Align organizational plans with SHIP objectives • Inform business community about SHIP objectives • Align local business coalition plans with SHIP objectives

Philanthropy Multi-Sector • Align funding priorities with SHIP objectives • Use data for planning purposes • Fund development and ongoing management of monitoring system • Convene partners to address issues related to public health systems improvement

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State Health Improvement Plan 24 Strategic Issue: Workforce • Local public health systems need assistance in developing partnerships How can the Illinois public health system to reduce barriers and promote access assure an optimal, diverse and competent to health care for underserved workforce? populations. • The workforce must be assessed Outcome 1 – Distribution, Number and regarding its capacity to deliver Preparation statewide population-based and clinical The demand for public health and health health care services. care workers will soon outpace the • A statewide public health workforce capacity of the workforce. Health care plan is needed to guide development. workers need to be trained and prepared to • Partnership linkages facilitate the deal with the diverse health needs of improvement of continuing educational Illinois’ residents. With an optimal, diverse offerings. and competent workforce, Illinois can • System-wide resources need to be improve the state public health system. shared in order to conduct more effective workforce activities. Outcome 2 – Diversity and Cultural/ • The public health system must assure Linguistic Competency training through enforcement person- Illinois has a diverse population that nel, licensing and other regulations. requires multi-cultural and linguistically • Expansion of information sources appropriate health care services. To available to the public increases the improve the quality of the public health demand on health care services. system, public health and health care • Increasing recognition of the workers must be trained to recognize and importance of public health in other understand a patient’s cultural and professions expands the reach of linguistic needs. practitioners beyond their familiar working environments. Key Findings from Assessments: • The malpractice “crisis” limits specialty • Current demands of the public health care in Illinois. workforce outpace its capacity. • Infrastructure barriers include shortage The logic models developed for the or maldistribution of both the public workforce strategic issue follow. health workforce and health care providers.

State Health Improvement Plan 25 Workforce (Distribution, Number and Preparation) Strategic Issue: How can the Illinois public health system assure an optimal, diverse and competent workforce? Long-Term Outcome: A workforce that is optimal in terms of preparation, distribution and number of public health and health care workers Intermediate Outcomes: • Public health and health care workforce of sufficient number and distribution to meet the need • A more competent public health and health care workforce • A system that effectively analyzes and addresses the preparation, distribution and number of public health and health care workers

Strategies/Actions By Sector

Local Health Departments State Agencies • Contribute data on workforce needs • Enhance capacity/utilization of Learning • Increase utilization of Learning Management System Management System (LMS) • Reinforce standards and expectations • Develop/participate in internship through rules/grants/contracts opportunities • Participate in the interstate nursing • Promote public health careers compact • Maximize the use of skills by reducing regulatory and policy barriers regarding educational “silo-ization”

Health Care Providers Legislature • Research the number and distribution of • Pass legislation and fund consolidation of the workforce/analyze workforce needs public health and health care workforce • Increase number of primary care providers development activities and family physicians • Develop incentives to work in underserved areas (e.g. rural and inner city areas) • Allocate funding to improve PH infrastructure/programming/salaries

State Health Improvement Plan 26 Strategies/Actions By Sector

Community-Based Organizations Voluntary Health Organizations • Develop/participate in internship opportunities • Develop/participate in internship opportunities

Higher Education Education K-12 • Research the number and distribution of the • Promote health careers workforce/analyze workforce needs • Provide continuing education in topical areas • Track graduates • Educate on evidence-based practice • Provide education on data use • Develop more faculty

Health Plans Trade Associations • Insurance industry: reinforce standards and • Contribute data on workforce expectations through rules/grants/contracts • Promote career paths, professional certification

Organized Labor

• Contribute data on workforce

Multi-Sector Philanthropy • Develop a career lattice and a related set of • Fund workforce development initiatives educational opportunities to provide entrance to • Convene partners to address issues related to and progress through PH and HC careers for a workforce development broad sub-set of the working age population • Participate in certification/licensure process in support of the SHIP

State Health Improvement Plan 27 Workforce (Diversity, Cultural/Linguistic Competency) Strategic Issue: How can the Illinois public health system assure an optimal, diverse and competent workforce? Long-Term Outcomes: A workforce that reflects the diversity of the state and is culturally and linguistically competent Intermediate Outcomes: • Increased number (proportion) of racial and ethnic minorities enter PH and HC educational and career opportunities • PH and HC workforce trained in and utilizing cultural and linguistic competency skills • More bilingual and multi-lingual workers in the PH and HC workforce

Strategies/Actions By Sector

Local Health Departments State Agencies • Conduct needs assessment of current • Reinforce standards and expectations workforce/demand for services/consumer regarding cultural and linguistic need/populations served competency through grants/ • Market public health as career to diverse contracts/certification/policies populations (see educational institutions) • Develop and fund incentives/changes in • Ensure staff receive cultural competency regulations to increase workforce training diversity/cultural and linguistic competency • Encourage staff development and offer career ladders

Health Care Providers Legislature • Conduct needs assessment of current • Fund loan and scholarship initiative to workforce/demand for services/consumer increase recruitment and secure retention need/populations served of students and faculty • Engage/train paraprofessionals/community • Develop funding incentives/changes in health workers/translators regulations to increase workforce • Implement policies/procedures to improve diversity/cultural and linguistic competency cultural and linguistic competency of workforce • Implement retention/training/recruitment initiatives (see legislature) • Develop programs to encourage health careers, especially among young people • Ensure staff receive cultural competency training • Encourage staff development and offer career ladders for diverse staff

State Health Improvement Plan 28

Strategies/Actions By Sector

Community-Based Organizations Voluntary Health Organizations • Engage/train paraprofessionals/community • Ensure staff receive cultural competency health workers/translators training • Create career ladders • Develop programs to encourage health careers, especially among young people

Higher Education Education K-12 • Develop two-year/community college programs, • Develop a PH/HC high school/charter school GS/HS introduction programs program • Develop diverse faculty • Develop programs to encourage health careers, • Develop curriculum/competencies/assessment especially among young people tools for training of PH and HC workforce • Expand training on/use of CBPR

Health Plans Philanthropy • Develop incentives/requirements for cultural • Convene partners to address issues related to competency training cultural and linguistic competency • Identify/assess needs of current workforce/ • Fund workforce development initiatives demand for services/consumer need/populations served • Reinforce standards and expectations through rules/grants/contracts

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State Health Improvement Plan 30 Strategic Issue: Priority asthma; even health problems once seen as fatal, like HIV/AIDS, are now Health Conditions treated more like chronic health maladies. How can the Illinois public health system • There is an inherent conflict between monitor priority health conditions and risk population health approaches and factors and implement effective strategies “American individualism” that inhibits to reduce them? effective prevention programs.

• Categories ranked as the most Illinois residents face mounting health important Illinois health problems are challenges; more people suffer from injury and violence; overweight and conditions that put them at risk of chronic obesity and maternal, infant, and child illness, disability and premature death. The health. public health system must think about • Substance abuse/methamphetamine health as a broad concept and embrace use and production continues to plague approaches that are more comprehensive Illinois residents in rural, suburban and for health improvement and the elimination urban areas. of the problems associated with these priority health conditions in Illinois. • Emerging infectious disease does not appear to be the cause of the current Key Findings from Assessments: health crisis; the crisis is driven by behavioral health factors leading to • Negative trends were found in the chronic disease. areas of Overweight and obesity; diabetes; injury and violence; access and general health. The Team identified four priority health • Integration of state and local action is conditions, 1) alcohol, tobacco and other needed, especially in building state- drugs; 2) obesity; 3) physical activity and 4) level and local partnerships to identify violence. The process for choosing these and solve health problems and provide four conditions is covered in Appendix A: technical assistance. Assessment Findings. The logic models • The overall burden of disease has developed for each of the four priority shifted from acute to chronic disease health conditions follow. burdens like obesity, diabetes and

State Health Improvement Plan 31 Priority Health Conditions: Alcohol, Tobacco and Other Drugs Strategic Issue: How can the Illinois public health system monitor priority health conditions and risk factors and implement effective strategies to reduce them? Long-Term Outcomes: Decrease use of alcohol, tobacco and other illegal drugs and the misuse of legal drugs Intermediate Outcomes: • Reduce cigarette smoking by adults (HP 2010 27-1a) and adolescents (HP 2010 27-2b) • Reduce the proportion of adults (HP2010 26-10a) and adolescents (HP2010 26-10c) using alcohol or any illicit drugs during the past 30 days • Increase smoking and alcohol abstinence during pregnancy (HP 2010 16-17) • Reduce the proportion of adults engaging in binge drinking of alcoholic beverages during the past month (HP 2010 26-11c) • Prevent the misuse of prescription and over the counter drugs

Strategies/Actions By Sector

Local Health Departments State Agencies • Promote tobacco prevention and cessation • Fund programs to reduce use programs • Implement mass media campaigns to educate • Educate local retailers on their enforcement the public of the health effects of use responsibilities • Promote campaigns to educate community on • Implement mass media/social marketing dangers of use campaigns to educate the public of the health • Collaborate with ongoing planning and program effects of use efforts • Implement ATOD prevention programs in the community utilizing coalitions

Health Care Providers Legislature • Educate on the health effects of use • Increase taxes and fees on the sale of alcohol • Provide prevention and treatment programs and tobacco products to discourage use • Improve identification and screening of persons • Ban smoking in public accessible businesses at risk of/using ATOD and facilities • Engage in coalition efforts to reduce ATOD use • Develop rehabilitative programs for those arrested for drug crimes • Increase fines for selling tobacco, alcohol products to minors • Provide adequate funding/earmark funding for prevention and treatment programs • Update comprehensive health education legislation

State Health Improvement Plan 32 Strategies/Actions By Sector

Community-Based Organizations Voluntary Health Organizations • Promote campaigns to educate community on • Educate on the negative aspects of use dangers of use • Engage in coalition efforts to reduce ATOD use • Promote cessation contests, especially for tobacco products • Create support groups for those trying to quit • Promote campaign to discourage advertising and promotion of alcohol and tobacco • Engage in coalition efforts to reduce ATOD use

Higher Education Education K-12 • Develop educational component on the health • Develop educational component on the health effects of use effects of use • Promote coordinated school health programs • Implement comprehensive health education curricula • Engage in coalition efforts to reduce ATOD use

Health Plans Employers • Provide funding for treatment programs • Promote and provide funds for cessation • Establish incentives for tobacco cessation programs • Use benefit design to promote cessation and • Discourage use by creating policies restricting support treatment use at the workplace • Provide funding for treatment programs • Use benefit design to promote cessation and support treatment • Engage in coalition efforts to reduce ATOD use

Local Governments Philanthropy • Encourage/pass smoking bans in places of • Fund programs aimed at reducing the use of public accommodation alcohol, tobacco and other drugs • Improve enforcement activities and training • Fund community based participatory research regarding use and sales and other programs designed to measure the • Reduce access to alcohol and tobacco through efficacy of interventions to reduce use zoning and licensing restrictions • Convene partners to address issues related to alcohol, tobacco and other drug use

Media • Assist in education campaigns

State Health Improvement Plan 33 Priority Health Conditions: Obesity Strategic Issue: How can the Illinois public health system monitor priority health conditions and risk factors and implement effective strategies to reduce them? Long-Term Outcomes: Reduce the proportion of children and adolescents who are overweight or obese (HP 2010 19-3c) and the proportion of adults who are obese (HP 2010 19-2) Intermediate Outcomes: • Increase physical activity (see physical activity model) • Increase consumption of fruits, vegetables and whole grains • Reduce consumption of fat, saturated fat and sodium • Increase rates of breastfeeding initiation and breastfeeding six months post-partum

Strategies/Actions By Sector

Local Health Departments State Agencies • Develop programs to encourage nutritional • Fund incentives to develop evidence-based eating habits in communities, including programs encouraging nutritional eating among mothers, infants and young children habits in communities • Implement social marketing campaigns on • Support legislation and programs to the importance of nutritional eating to encourage healthy eating combat obesity • Implement social marketing campaigns to • Participate in development of a legislative encourage healthy eating campaign for a physical activity and obesity • Assist in development of legislative reduction initiative initiative; implement initiative

Health Care Providers Legislature • Educate patients/parents/providers on • Pass an Illinois physical activity and obesity nutrition and healthy eating reduction initiative incorporating nutrition • Educate patients on the chronic problems and physical activity components and a soft of obesity drink tax to fund the program (see physical • Participate in development of a legislative activity model) campaign for a physical activity and obesity • Develop policies that support nutritional reduction initiative food and beverage choices in schools and • Provide comprehensive nutrition government buildings counseling to pregnant women • Provide education on benefits of breastfeeding and supportive services for breastfeeding mothers including access to lactation counseling

State Health Improvement Plan 34

Strategies/Actions By Sector

Community-Based Organizations Voluntary Health Organizations • Develop programs to encourage healthy eating • Educate patients/providers on nutrition and habits in communities healthy eating • Promote awareness of obesity through social • Educate patients/providers on chronic problems marketing of obesity • Improve availability and marketing of healthy • Participate in development of a physical activity foods and obesity reduction initiative • Lead council to coordinate efforts of chronic disease initiative

Philanthropy Education K-12 • Fund and support programs promoting healthy, • Develop nutritional education programs for nutritional eating habits and reducing obesity families and school children • Fund community-based participatory research • Eliminate unhealthy food and drinks in schools designed to measure the efficacy of programs • Promote coordinated school health programs to promote healthy eating and reduce obesity • Implement comprehensive health education • Convene partners to address issues related to curricula obesity • Support mental health staff to work with children at risk of eating disorders • Promote healthy eating behaviors in the school community • Implement active school wellness council and promote new wellness initiatives

Health Plans Employers • Educate members about the value of having an • Promote weight loss programs in the workplace appropriate weight and offer programs and • Establish policies that promote appropriate food information to assist them in reducing weight choices • Develop nutritional education programs for employees • Provide healthy food choices in the workplace • Implement policies and procedures to support breastfeeding mothers when they return to work (i.e., lactation rooms, breaks to pump milk)

Business Media • Improve availability and marketing of healthy • Assist in education campaigns food • Promote portion control and nutrition labeling in Illinois restaurants

State Health Improvement Plan 35 Priority Health Conditions: Physical Activity Strategic Issue: How can the Illinois public health system monitor priority health conditions and risk factors and implement effective strategies to reduce them? Long-Term Outcomes: Improvement in physical activity level of Illinois residents Intermediate Outcomes: • Increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 minutes per day (HP 2010 22-2) • Increase the proportion of children and adolescents who engage in moderate physical activity for at least 30 minutes on five or more of the previous seven days (HP 2010 22-6)

The efforts of organizations and individuals from numerous different sectors of the community will be necessary to achieve the long- term and intermediate goals related to this strategic issue. Proposed actions and strategies for these various sectors are listed in the tables below and on the facing page.

Strategies/Actions By Sector

Local Health Departments State Agencies • Participate in the development of programs to • Participate in the development of programs to promote physical activity promote physical activity throughout the • Develop health care guidelines regarding lifespan education for patients promoting physical • Develop health care guidelines regarding activity education for patients promoting physical • Implement social marketing campaigns to activity encourage physical activity • Implement social marketing campaigns to • Educate residents on ways to increase physical encourage physical activity activity • Assist in development of legislative initiative; • Participate in development of a legislative implement initiative campaign for a physical activity and obesity reduction initiative

Health Care Providers Legislature • Pass an Illinois physical activity and obesity • Participate in the development of programs to reduction initiative incorporating nutrition and promote physical activity physical activity components and a soft drink • Educate patients on ways to increase physical tax to fund the initiative (see obesity model) activity • Fund physical activity and PE programs and • Participate in development of a legislative capital development in schools to create gym campaign for a physical activity and obesity and other facilities for physical activity and PE reduction initiative

State Health Improvement Plan 36

Strategies/Actions By Sector

Community-Based Organizations Voluntary Health Organizations • Develop programs promoting physical activity • Participate in the development of programs to for neighbors and clients promote physical activity • Encourage participation in physical activity as • Implement social marketing campaigns to recreational and therapeutic activity encourage physical activity • Participate in development of and legislative campaign for a physical activity and obesity reduction initiative

Higher Education Education K-12 • Teach future PE teachers to implement health • Encourage participation in sports, including related fitness approaches to PE noncompetitive sports • Develop programming to promote physical • Maintain, enhance and increase the availability activity in the school community of PE programs using best practices in physical • Implement health related fitness approaches to education PE courses offered to students • Maintain recess periods in K-12 • Promote coordinated school health programs • Incorporate physical activity into the classroom and other school activities • Implement comprehensive health education curricula

Local Government and Legislature Employers • Provide environment that promotes physical • Develop policies to encourage participation in activity (consult Community Guide to physical activities and other fitness programs Prevention) (consult Community Guide to Prevention) • Require new school construction to include • Allot time during work/provide flexible physical activity space schedules for physical activity • Include building and grounds designs that encourage physical activity

Health Plans Philanthropy • Help members understand the value of • Fund programs encouraging physical activity maintaining and improving fitness and offer and healthy lifestyles programs and information to assist in increasing • Convene partners to address issues related to physical activity physical activity

Media • Assist in education campaigns

State Health Improvement Plan 37

Priority Health Conditions: Violence Strategic Issue: How can the Illinois public health system monitor priority health conditions and risk factors and implement effective strategies to reduce them? Long-Term Outcomes: Reduce violence and exposure to violence Intermediate Outcomes: • Reduce incidence of abuse/neglect of older persons • Reduce maltreatment of children (HP 2010a 15- 33a) and maltreatment fatalities (HP 2010a 15- 33b) • Reduce the annual rate of rape, attempted rape (HP 2010 15-35), sexual assault (HP 2010 15-36) and physical assault by current or former intimate partners (HP 2010 15-34) • Reduce physical assaults (HP 2010 15-37) and homicides (HP 2010 15-31) • Reduce physical fighting (HP 2010 15-38) and weapon carrying among adolescents • Reduce the prevalence and ameliorate the consequences of adverse childhood experiences that contribute to childhood trauma (see access and alcohol, tobacco and other drug [ATOD] models) • Reduce the suicide rate (HP 2010 18-1)

Strategies/Actions By Sector

Local Health Departments State Agencies • Expand programs for home visitation by nurses or • Provide therapeutic foster care for children in trained paraprofessionals for families at risk of DCFS care violence • Expand programs for home visitation by nurses • Train staff, doctors and dentists to recognize or trained paraprofessionals for families at risk of domestic/other violence/child abuse violence • Educate clients on services for violence • Enforce firearm and violence prevention prevention and intervention, when appropriate programs • Implement screening and referral protocols for • Implement mass media campaigns about elder family violence and suicide abuse, family violence and other harms of • Expand systems of care to serve families who are violence experiencing violence

Health Care Providers Legislature • Expand programs for home visitation by • Enact laws requiring certification, licensing and nurses/trained paraprofessionals for families at training for gun owners and restrictions for risk of violence people with a history of violence • Educate providers and staff to recognize • Enact ban on certain firearms and ammunition domestic/other violence/child abuse • Fund expansion of violence prevention • Educate clients on services for violence programs (e.g., Safe From the Start; Illinois prevention and intervention Health Cares) • Implement screening and referral protocols for • Fund a range of child abuse prevention services family violence and services to support children in households w/ • Expand systems of care to serve families who are substance abuse or mental illness experiencing violence • Tax sale/rental of violent video games

State Health Improvement Plan 38 Strategies/Actions By Sector

Community-Based Organizations Voluntary Health Organizations • Expand programs for home visitation by nurses • Expand programs for home visitation by nurses or trained paraprofessionals for families at risk or trained paraprofessionals for families at risk of violence of violence and ATOD use • Expand therapeutic foster care for children in • Educate providers and staff to recognize DCFS care domestic/other violence/child abuse • Expand systems of care to serve families who • Educate clients on services for violence are experiencing violence prevention/intervention • Implement violence prevention programs

Higher Education Education K-12 • Research risk/protective factors and effective • Address firearms and other weapons at schools use of prevention/treatment programs • Educate families on methods of conflict • Provide training on violence prevention and management interventions • Train mental health staff to work with children at risk of or exposed to violence and household member ATOD use • Implement school safety/violence prevention programs • Promote coordinated school health programs • Add comprehensive health education curricula Multi-Sector • Train staff on recognizing child abuse and • Fund, implement and/or participate in a range mandatory reporting of violence prevention programs and services for children exposed to violence

Philanthropy Employers • Fund multi-faceted violence prevention • Provide access to therapy and other services programs for employees with problems associated with • Convene partners to address issues related to violence and ATOD use violence • Offer workplace violence policies and conflict • Fund community-based participatory research management programs designed to measure program efficacy/effectiveness

Media • Assist in educational campaigns

State Health Improvement Plan 39 Appendix A: Assessment Findings

State Health Improvement Plan 40 Assessment Findings 7) Link people to needed personal health services and assure the provision of health care when otherwise unavailable Public Health System 8) Assure a competent public health and personal health care workforce Assessment 9) Evaluate effectiveness, accessibility, and quality of personal and population- The National Public Health Performance based health services Standards (NPHPS) program was de- 10) Research for new insights and veloped to improve the quality of public innovative solutions to health problems health practice by creating performance standards to encourage public health In 2004 IPHI collaborated with the Illinois systems to promote continuous quality Departments of Public Health (IDPH) and improvement; strengthen the science base Human Services (IDHS) to implement the for public health practice improvement; and state-level NPHPS assessment in Illinois. engage in national, state and local The assessment, From Silos to Systems: partnerships to improve public health Assessing Illinois’ Public Health System, preparedness. The four concepts that drive found that overall Illinois scores are fairly the NPHPS are that 1) the standards are low, with nine out of the 10 essential designed around the 10 Essential Public services ranked as either partially met or Health Services (EPHS), 2) the standards not met. Only one essential service, #2: focus on the overall public health system Diagnose and Investigate Health Problems rather than a single organization, 3) the and Health Hazards, received a score of standards describe an optimal level of substantially met. In analyzing the performance rather than provide minimum qualitative data from the assessment expectations and 4) the standards are retreat, a conclusion emerged that while intended to support a process of quality there is more or less activity going on improvement. related to each standard and measure (sometimes quite a lot of effort) the work is The 10 essential public health services are: not well-coordinated in a systematic way.

1) Monitor health status to identify and The participants in the assessment, solve health problems conducted at a two-day retreat in June 2) Diagnose and investigate health 2004, concluded that the data are baseline problems and health hazards information that needs to be used by 3) Inform, educate, and empower people stakeholders in the Illinois public health about health issues system to inform quality improvement 4) Mobilize partnerships to identify and activities and next steps. Overall, the solve health problems Illinois public health system assessment 5) Develop policies and plans that support resulted in an average score of 32. individual and statewide health efforts 6) Enforce laws and regulations that protect health and ensure safety

State Health Improvement Plan 41

Figure A-1: Essential Public Health Services Scores Illinois 2004

A verage Tot al Perf o rmance Score 32 .0%

EPHS 1: M onit or Healt h St at us 28.0%

EPHS 2: Diagnose and Invest igat e Healt h 64.0% Problems 27.0% EPHS 3: Inf orm, Educat e, and Emp ower People EPHS 4: M obilize Community Partnerships 25.0%

EPHS 5: Develop Policies and Plans 23.0%

EPHS 6: Enforce Laws and Regulations 32 .0%

EPHS 7: Link Peop le t o Needed Personal Healt h 37.0% Services 31.0% EPHS 8: Assure a Competent Workforce

EPHS 9: Evaluate Effectiveness, Accessibility and 27.0% Quality EPHS 10: Research f or New Insight s and 27.0% Innovative Solutions

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

A second retreat, held August 9, 2005, Planning Team on December 14, 2005. reviewed the performance standards These six topic areas, with a total of 51 assessment results of 2004 and developed priorities, are: a set of findings and priorities for consideration by the State Health • Collect Data and Use Information Improvement Plan Planning Team, to Effectively assist in designing next steps to improve • Garner and Leverage Resources for a the Illinois public health system. The State More Proactive Public Health System Health Improvement Plan Team began • Integrate State and Local Action reviewing the Illinois NPHPS assessment • Manage Continuous Improvement findings in November 2005 via • Infuse Cultural Competency throughout subcommittee, in order to review all the Public Health System priorities identified in the August 2005 • Invest in the Public Health and retreat. The subcommittee presented six Personal Care Workforce topic areas needing improvement in the Illinois public health system to the full

State Health Improvement Plan 42

Forces of Change Changing Demography Assessment Several issues regarding how to serve a changing population have emerged as a The purpose of the Forces of Change result of recent demographic fluctuations in Assessment was to identify the external Illinois that include an increasing immigrant factors that affect the environment in which population, an aging population, an the Illinois public health system operates increasing urban and suburban population and the related challenges and and an increasing incarcerated population. opportunities these factors pose. Forces of Change are not driven within the public Emergency Response health system but rather are imposed on Despite the importance of issues related to either by the system itself, or on the preparedness for bioterrorism, focus on parameters within which public health bioterrorism has diverted attention from professionals operate. broader public health issues and from other emergency response issues such as At the November 10, 2005 meeting of the the emergence of infectious diseases and State Health Improvement Plan Team, the insufficient coordination of emergency Planning Team members brainstormed response systems. specific forces of change that create these effects and organized them into the areas Environment/Social of focus that shape or influence the public Environmental and social issues, including health system. The effects of these focus the transformation of public housing, the areas could be on any part of the public role of the built environment, introduction of health system, including resources, new chemicals into products and the strategic issues, infrastructure, culture or environment and a lack of adequate environment. In order to help identify ways funding for the education system, result in either to enhance or mitigate the effects of deleterious effects on the health of the these forces of change, Planning Team public. members identified challenges and opportunities within each force. Final Funding and Resources presentation of the assessment was made Factors detrimental to a well-functioning at the December 14, 2005, meeting of the health care system include rising health Planning Team. care and insurance costs, lack of universal coverage, organization by payment system Eighteen specific areas of focus were rather than health and health care needs, identified by the Planning Team. Within lack of specialty care and malpractice each of these focus areas, specific trends issues. Adequate and consistent funding or forces were identified that were thought and resources for public health are to be affecting the public health system in threatened by lack of support from some way. The focus areas are government officials, lack of advocacy categorized below, including key trends or efforts with legislators, a focus on forces that were discussed as part of the categorical funding and other events like focus area: the Iraq War and Hurricane Katrina. Government programs, such as Medicaid, Medicare and All Kids pose both opportunities and challenges. State Health Improvement Plan 43

health and heath care workforce operate Image of Public Health within this changing knowledge base. The shift from acute to chronic illnesses provides an opportunity and a challenge to clarify the role of public health and to Statewide Themes and underscore the importance of public health Strengths Assessment in other professions.

This assessment is designed to gather Public Health Approaches/Policy/Law thoughts, opinions and concerns from Public health practice does not match community members to answer the statutes governing and funding boards of following questions: What is important to health. Medical and public health systems our state? How is quality of life perceived are becoming more interdependent in our state? What assets do we have that because of challenges of public funding. can be used to improve Illinois’ health? Concurrently, there is an increasing This information leads to a portrait of emphasis on prevention and evidence- Illinois as seen through the eyes of its based practice, which may not be residents. Three tools were used to inform adequately funded. Ideology and a focus the assessment: qualitative data collection on individualism are conflicting with via focus groups; review of data from appropriate development of science policy IPLAN (Illinois Project for Local and population approaches. The quality Assessment of Needs) reports; and a and availability of public health data are review of current or recently completed inadequate, yet at the same time, the state and regional strategic planning public demands transparency regarding processes. A subcommittee of the how public health and medical care Planning Team was created to assist in providers operate and how health data are focus group design, as well as to provide used. preliminary review of the data from the

three tools. Specific Health Conditions

Several health conditions and issues The subcommittee met in late November currently need attention, including chronic 2005 to choose the focus group questions. diseases, substance abuse, low birth Held in Springfield and Chicago, a total of weight rates, tobacco smoke exposure and seven focus groups were made up of behavioral health. representatives from the following: local

health departments; state/governmental Technology/Telemedicine agencies; health issue and prevention There is a need for appropriate groups; special populations; local implementation of and support for new community partnerships; providers; technologies (telemedicine, electronic nontraditional partners; and business. The health records, etc.). same seven questions were asked to all

groups over a two-hour period. Workforce There are demands that outpace the capacity of the current workforce. In addition, the public has access to more health information than ever, and the

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Focus Group Questions potential match with one of the Healthy 1. What do your constituents like about People 2010 (HP 2010) 10 Leading Health living in Illinois? Indicators. 2. What are the top three concerns or issues facing your constituents? Several strategic plans were chosen for 3. Where does health fit in your top review by the committee and included the three concerns? following: 4. How would you define health? 5. What are important health issues that your constituents face every Population/Issue Specific Plans: day or every week? • State Oral Health Plan 6. How would your constituents • Illinois State Nutrition Action Plan describe their health? • Children’s Mental Health Strategic Plan 7. What are the things that make your constituents well? Infrastructure/ Resource Specific Plans: • Illinois Rural Health Workforce IPLAN is a community health assessment Assessment and planning process that is conducted • Racial and Ethnic Health Disparities every five years by local health jurisdictions Action Council: Strategy in Action in Illinois. The subcommittee reviewed the • Adequate Health Care following data that are warehoused at the Taskforce/Health Care Justice Act Illinois Department of Public Health: • Rural EMS Assessment summary statement on IPLAN data; round • Enrich and Strengthen Governmental one data 1994 - 1998; round two data 1999 Public Health - 2003; round three data 2004 - February • Heartland Alliance Poverty Report 2006 (only 24 out of 102 local health • Cultural Competency and Literacy Plan jurisdictions collected thus far).

Eleven key findings of the assessment IPLAN priorities were sorted by prevalence were reviewed and agreed upon by the for rounds one, two and three. Also noted Planning Team at the meeting on March were changes in prevalence of types of 23, 2006. They are as follows: priorities between rounds and the percentage of total priority share for rounds one, two and three. Differences in priorities • “Health” is seen as a broad concept. between urban and rural health This shared understanding is a strength jurisdictions were also identified. Local for Illinois. health departments that identified IPLAN • Health is influenced by many factors – priorities also reported the related impact services, insurance, providers, and and priority objectives that will be social and economic determinants. accomplished through intervention Understanding determinants is strategies. From the 335 priorities identified important in shaping interventions. in Round 2, 1603 intervention strategies • Reducing risk factors for chronic were identified. Of approximately 1600 disease is a critical tool. intervention strategies, only 451 mention a • The top local health priorities are specific target group or subpopulation. All access to care, cancer and indicators also were assessed for their cardiovascular disease.

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• Illinois has a diverse population that with presentation to the Planning Team on requires multi-cultural and linguistic January 27, 2006: competence Unfortunately, bias and discrimination remain obstacles. • Healthy People 2010 Leading Health • Awareness of health disparities and the Indicators and Objectives – Healthy need to eliminate them are evident, but People 2010 provides a framework for data are insufficient to address them. prevention for the United States, with national health objectives designed to • People view access to care as identify the most significant preventable encompassing health, mental health threats to health and establish national and dental services, which can be goals to reduce these threats. The two affected by workforce distribution, lack goals are: a) increase quality and years of insurance and finances, limited of healthy life and b) eliminate health cultural and linguistic competence, and disparities. knowledge. • Centers for Disease Control and • Healthy relationships with friends and Prevention State Health Profiles – family combined with a strong profiles are collected in partnership with community where violence is minimized all 50 states and housed at the National are key elements to making people Center for Health Statistics. well. • Illinois Project for Local Assessment of • Illinois attempts to improve health in the Need (IPLAN) indicators – the group of state through system approaches. indicators used by certified local health Gaps in the health system infrastructure jurisdictions when developing a are an impediment to achieving community health assessment and plan optimum health. every five years. • There is a fairly strong planning culture in Illinois, but resources for community The Healthy People 2010 Leading Health implementation are insufficient. Indicators and other HP 2010 objectives • Despite geographic differences in provided a main focus for comparison to population density, major health issues Illinois data and a framework for seem to be prioritized similarly in both categorizing the indicators in the profile. urban and rural communities. The committee also reviewed information on leading causes of death and years of State Health Profile potential life lost. Attempts were made to collect data by gender, race, ethnicity, Assessment education, income, age and geography.

The purpose of the State Health Profile Key Health Status Findings Assessment was to develop a set of Overall, Illinois compares favorably to only measures that broadly communicate the six of 33 Healthy People 2010 objectives “health profile” of Illinois’ population. It is under consideration in this profile. The important to collect these data in a manner committee used seven criteria to rank the that facilitates the description of health categories. The seven criteria included: disparities experienced by special • Comparison criterion- How do the populations. A subcommittee of the State Illinois values for the various indicators Health Improvement Plan Team was related to each category compare to the formed and reviewed the following data,

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HP 2010 objective and/or the national data collection, analysis, dissemination and value? use are inadequate to meet needs. The • Trend criterion- Does there appear to availability of data for sub-populations is be a trend moving in the right direction, uneven and must be improved. If we are no trend/stability or a trend moving in serious about reducing disparities, then we the wrong direction? must be able to document them. • Disparities criterion- Are there Choosing Priority Health disparities by the categorization Conditions variables of age, race, ethnicity, The committee used the information from gender, socioeconomic status, the ranking exercise and several additional geography and education? criteria to arrive at a shorter list of priority • Magnitude criterion- What proportion health conditions from among the of the population is affected? categories under consideration for the • Severity criterion- How severe are the State Health Improvement Plan. To assure consequences regarding mortality, the plan would take a preventive approach, morbidity, years of potential life lost, the committee focused on conditions that: years lived with a disability or a chronic disease? • Have a large impact/affect a number of • Effect on youth criterion- To what other conditions degree do the health issues included in • Have broad appeal (can engage a the category affect young people (those diverse set of public health system younger than 18 years of age)? partners) • Data criterion- What are the • Provide an opportunity for action availability, timeliness and accuracy of (there's a gap to be filled) the data for each of the indicators • Have evidence-based interventions included in a category? available When considering all seven criteria, the • Are amenable to an ecological categories ranked most important were: approach injury and violence; overweight and • Are cost effective obesity; and maternal, infant and child. • Are measurable Mental health, HIV, diabetes and cancer had equal rankings just behind the top Using these criteria, the committee arrived three followed by a group with access, at a final list of four priority health tobacco use and physical activity. conditions: physical activity; obesity; alcohol, tobacco and other drugs; and The committee’s efforts revealed as much violence for inclusion in the State Health about the state of our information systems Improvement Plan. infrastructure as it did about the health of the population. Serious challenges existed Figure A-2 provides a graphical depiction in compiling this assessment regarding of the four priority health conditions and the data quality issues, timeliness and data relationship between those conditions and availability. Illinois has many advantages the other categories. The number included regarding public health data, such as the under the four priority health conditions IPLAN data system, but integration of signifies how many of the 17 other systems and data sources is a significant categories are affected by the priority challenge. It appears that resources for health condition. The number in each of State Health Improvement Plan 47

the category boxes shows how many of the these four priority health conditions four priority health conditions are related to ensures that the other categories will be that category. Choosing to work directly on affected at least indirectly.

Figure A-2: Relationship Among Four Priority Health Conditions and Seventeen Healthy People 2010 Categories

Arthritis (2)

Asthma/ Respiratory Physical Disease (3) Activity (12) Cancer (3)

Diabetes (3)

Heart Disease and Stroke (4)

Obesity HIV (2)

(10) Immunizations (0)

Injury and Violence (2)

MCH (4)

Alcohol, Mental Health (4) Tobacco and Other Drugs Oral Health (4) (13) Overweight and Obesity (3)

Physical Activity (3)

Responsible Sexual Behavior (3) Violence (11) STDs (2)

Substance Abuse (2)

Tobacco Use (2)

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Appendix B: Glossary

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Glossary

Access2 Secretary of the Department of Human The potential for or actual entry of a Services, are ex officio members. The population into the health system. Entry is Task Force is charged with creating a dependent upon the wants, resources and health care plan that provides access to a needs that individuals bring to the care- full range of preventive, acute and long- seeking process. The ability to obtain term health care services and maintains wanted or needed services may be and improves the quality of health care influenced by many factors, including services. travel, distance, waiting time, available financial resources, and availability of a Adverse Childhood Experiences (ACE)4 regular source of care. Childhood abuse, neglect, and exposure to other traumatic stressors. The ACE Study Access to Care uses the ACE Score, which is a count of Access to care problems include lack of the total number of ACE respondents access for health, mental health, dental, reported. This score is composed of vision and specialty services and exposure to the following conditions during prevention education. The affordability childhood: abuse (emotional, physical or of and ability to pay for care, which are sexual); neglect (emotional or physical); or tied to health insurance difficulties, are household dysfunction (including mother also prominent access to care issues. treated violently, substance abusing Other issues include limited outreach household member, mentally ill household services, the relationship between member, parental separation or divorce malpractice rates and the loss of and incarceration of a member of the physicians, the ability to navigate the household). The State Health Improvement system, the lack of community-based Plan (SHIP) process focused on the ACE’s services and long wait times for of abuse, neglect, mother treated violently, services. substance abusing household member and mentally ill household member. Adequate Health Care Task Force3 Illinois Public Act 93-0973 established an Advocacy5 Adequate Health Care Task Force with 29 The process of supporting and enabling voting members—five appointed by the people to express their views and Governor and six appointed by each of the concerns, access information and services, four leaders of the General Assembly (the defend and promote their rights, and Speaker of the House, the House Minority explore choices and options. Advocates Leader, the President of the Senate and support and argue the case for service the Senate Minority Leader). The directors users and help them put across their point of the departments of Public Health and of view. Healthcare and Family Services and Department on Aging, along with the

2 National Public Health Performance Standards Program (NPHPSP) Glossary, 4 CDC (http://www.cdc.gov/nccdphp/ace/index.htm) www.cdc.gov/od/ocphp/nphpsp/documents/gloss 5 Public Health Electronic Library (UK) ary.pdf http://www.phel.gov.uk/glossary/glossaryAZ.asp? 3 For more information: getletter=A http://www.idph.state.il.us/hcja/index.htm

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All Kids6 Community Guide to Preventive The All Kids program is a complete health Services9 care program for every child in Illinois. All The Community Guide to Preventive Kids covers a wide range of services: Services is an online clearinghouse of doctor visits, hospital stays, prescription evidence-based health policies and drugs, vision care, dental care, practices developed by the Centers for immunizations, and special services like Disease Control and Prevention. medical equipment, speech therapy, and physical therapy for children who need Community-Based Organizations10,11: them. The term community-based organization (CBO) implies a public or private nonprofit Bias and Discrimination organization of demonstrated effectiveness Bias, or influence in an unfair way, and that is representative of a community or discrimination, the unfair treatment of a significant segments of a community, and person or group on the basis of prejudice, provides educational or related services to are problems in achieving optimal health individuals in the community. CBOs are for special populations. Issues related to typically value-based and function, in achieving optimal health include alienation whole or in part, on charitable donations from the health system within minority and voluntary service. Some are faith- communities as well as linguistic and based organizations; others promote policy cultural barriers, such as the lack of advocacy. Although the non-governmental translated materials and the lack of sector has become increasingly knowledge of culturally-influenced health professionalized over the last two decades, practices in communities. principles of altruism and voluntarism remain key defining characteristics. Children’s Mental Health Strategic Plan7 The Illinois Violence Prevention Authority Comprehensive Health Education12 and 20 different agencies identified the key Comprehensive health education is the issues and gaps in mental health programs combination of planned social actions and and services for children. learning experiences based on current, scientifically proven information designed Community-Based Participatory to enable people to gain control over the Research (CBPR)8 Community-based participatory research 9 CDC . For more information: www.thecommunityguide.org advances a collaborative approach to 10 research that involves all partners in the US Department of Education website “Title XI: General Provisions - Definitions.” development and implementation of http://www.ed.gov/policy/elsec/leg/esea02/pg107.ht applied research. Grounding itself in a ml community's concerns, CBPR aims to 11 World Bank website "Nongovernmental combine methodological and technical Organizations and Civil Society/Overview." expertise with community expertise to achieve social change. 12 Meeting Global Health Challenges, XIV World Health Conference on Health Education, World 6 For more information: www.allkidscovered.com Health Organization, International Union for Health 7 For more information: Education http://www.ivpa.org/childrensmhtf/ Joint Committee on Health Education Technology: 8 University of Michigan School of Public Health, Association of State and Territorial Directors of Community Health Scholars Program. Health Promotion and Public Health Education, http://www.sph.umich.edu/chsp/ Association of State and Territorial Health Officers

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determinants of health and health A broad definition put forth by the U.S. behaviors, and the conditions that affect Department of Health and Human Services their health status and the health status of Office of Minority Health National others. The planned social actions and Standards of Cultural and Linguistic learning experiences include modules to Competency is “the ability of health care support an understanding of the biological, providers to understand and respond to the emotional, psychological, social and sexual cultural and linguistic needs brought by components of health and behaviors patients to the health care encounter.” leading to health. The ideal goal of Lavizzo-Mourey and Mackenzie (1996) comprehensive health education is to conceptualized cultural competence “as facilitate voluntary adaptations of behaviors the demonstrated awareness and conducive to health. integration of three population-specific issues: health related beliefs and cultural Culture13 values, disease incidence and prevalence, The integrated pattern of human behavior and treatment efficacy.” that includes thoughts, communications, actions, customs, beliefs, values, and Cultural competence requires that institutions of a racial, ethnic, religious, or organizations: social group. The anthropological concept 1. Have a defined set of values and of culture has been broadened to include principles and demonstrate behaviors, such factors as gender, functional status, attitudes, policies and structures that age, sexual identity, and profession. enable them to work effectively cross- culturally; Cultural Competence14 2. Have the capacity to a) value diversity, A set of skills that result in an individual’s b) conduct self-assessment, c) manage the understanding and appreciating cultural dynamics of difference, d) acquire and differences and similarities within, among, institutionalize cultural knowledge, and e) and between groups and individuals. The adapt to diversity and the cultural contexts word “competence” is used because it of the communities they serve; implies having the capacity to function 3. Incorporate the above in all aspects of effectively. This competence requires that policy making, administration, practice, the individual draw on the community- service delivery and systematically involve based values, traditions and customs to consumers, key stakeholders, and work with knowledgeable persons of and communities. from the community in developing targeted interventions and communications. Determinants of Health15 Direct causes and risk factors that, based on scientific evidence or theory, are thought to directly influence the level of a 13 A National Health Care Disparities Report, 2002, specific health problem. These may be www.iom.edu/Object.File/Master/11/919/Disp- defined as the “upstream” factors that Gamble.pdf 14 affect the health status of populations and NPHPSP Glossary, www.cdc.gov/od/ocphp/nphpsp/documents/gloss individuals. Roughly divided into the social ary.pdf, and The Right Thing to Do, The Smart environment (cultural, political, policy, Thing to Do: Enhancing Diversity in Health economic systems, social capital, etc.), the Professions -- Summary of the Symposium on Diversity in Health Professions in Honor of 15 Herbert W. Nickens, M.D., 2001, Institute of NPHPSP Glossary, Medicine www.cdc.gov/od/ocphp/nphpsp/documents/glossary .pdf

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physical environment (natural and built), cognitive decline in aging men and women; and genetic endowment. The determinants and more socially integrated societies of health affect both individual response appear to have better overall quality of life (behavior and biology) and the prevalence and lower rates of mortality from all of illness and disease. causes.

Dietary Guidelines for Americans16 Enrich and Strengthen Governmental These Guidelines are published every five Public Health years by the Department of Health and The Illinois Department of Public Health Human Services (HHS) and the convened public health practitioners across Department of Agriculture (USDA). It the state to create a comprehensive plan to provides authoritative advice about how improve the structure and effectiveness of good dietary habits can promote health the public health system in Illinois. and reduce risk for major chronic diseases. Evidence-Based Practice19 Diversity17 Evidence-based practice is the process of Diverse populations include both visible systematically reviewing, appraising, and and invisible diversity. Some visible forms using programs, policies or other practices of diversity would include physical that have been researched and found to be differences, abilities and disabilities, race effective in achieving their desired goal. or ethnicity, and speech differences. Other types of diversity include sexual Health20 orientation, gender identification, Health is a state of complete physical, socioeconomic status and age. mental and social well-being and not merely the absence of disease or infirmity. Ecological Model18 An ecological model assumes that health Health Care System21 and well being are affected by interaction A system comprised of the organizations, among multiple determinants, including institutions, and resources that are devoted biology, behavior and the environment. to producing a health action, whether in Interaction unfolds over the life course of personal health care or in public health individuals, families and communities, and services. The primary purpose of the evidence is emerging that societal-level health care system is to improve the health factors are critical to understanding and of the general population or a specified and improving the health of the public. For recognized segment of the general example, epidemiologic evidence demon- population. strates that social support improves the prognosis and survival of people with serious cardiovascular disease; social engagement and networks slow the rate of

19 16 CDC, Evidence-based Practice Centers. For more information: http://www.ahrq.gov/clinic/epc/ and Association of http://www.healthierus.gov/dietaryguidelines/ 17 State and Territorial Health Officials Adapted from American Medical Student http://www.astho.org/?template=evidence_based Association Diversity Curriculum, _ph_practice.html. www.amsa.org/programs/diversitycurriculum.cfm 20 World Health Organization, 18 Who Will Keep the Public Healthy? Educating www.who.int/about/definition/en/ Public Health Professionals for the 21st Century 21 World Health Organization, World Health Report (2003), Board on Health Promotion and Disease 2000: Health Systems : Improving Performance, Prevention (HPDP), Institute of Medicine (IOM) http://www.who.int/whr/en/

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Health Disparities The report identified the number of Illinois Health disparities are the differences in residents living in poverty, assessed the incidence, prevalence, mortality, and populations most affected, compared rates burden of diseases and other adverse of poverty in Illinois to those of other health conditions that exist among specific states, and strategized ways to decrease population groups in the United States. poverty rates.

Health Promotion22 Illinois Rural Health Workforce The science and art of helping people Assessment25 change their lifestyle to move toward a The UIC Illinois Regional Health Workforce state of optimal health. Optimal health is Center investigated health resource policy defined as a balance of physical, issues and the health status of rural Illinois emotional, social, spiritual and intellectual residents and evaluated rural staffing health. Lifestyle change can be facilitated levels. through a combination of efforts to enhance awareness, change behavior, and Illinois State Nutrition Action Plan26 create environments that support good Illinois State Board of Education, U.S. health practices. Department of Agriculture and other organizations promoted adoption of healthy Illinois Health Cares dietary patterns and regular physical Illinois Health Cares is an initiative of the activity and increased awareness about the Illinois Violence Prevention Authority importance of a healthy school nutrition conducted in partnership with the Illinois environment. Department of Public Health (IDPH). It provides grants to community coalitions to IPLAN27 conduct activities that improve the local The Illinois Project for Local Assessment of health system’s capacity to respond to, Needs (IPLAN) is a community health intervene early with, and prevent domestic assessment and planning process that is violence and sexual assault. conducted every five years by local health jurisdictions in Illinois. Based on the Illinois Oral Health Plan 23 Assessment Protocol for Excellence in IFLOSS coalition (a private-public Public Health (APEX-PH) model, IPLAN is partnership that works through advocacy grounded in the core functions of public and education), IDPH Division of Oral health and addresses public health Health, and other organizations provided a practice standards. The completion of guidepost for improving the oral health of IPLAN fulfills most of the requirements for all people in Illinois in addition to serving as local health department certification under a model for other states. Illinois Administrative Code Section 600.400: Certified Local Health Illinois Poverty Summit – 2006 Report Department Code Public Health Practice on Illinois Poverty24 Standards. The essential elements of IPLAN are: 22 American Journal of Health Promotion, www.healthpromotionjournal.com 23 For the full assessment: 25 For more information: www.cdc.gov/OralHealth/state_reports/oh_plans/P http://www.uic.edu/sph/irhwc/index.html DF/IL.pdf 26 For the full assessment: 24 For the full assessment: http://inc.aces.uiuc.edu/SNAPactionplan102.05.pdf http://www.heartlandalliance.org/creatingchange/ 27 Illinois Department of Public Health, documents/Povertyreport2006lr.pdf http://app.idph.state.il.us/

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• an organizational capacity assessment; services accessible, uniform and high • a community health needs assessment; quality. and • a community health plan, focusing on a Multi-Sector Partnerships minimum of three priority health Multi-sector partnerships are the problems. collaboration of a variety of sectors or fields. In public health, multi-sector Learning Management System (LMS)28 partnerships can include government The Illinois Department of Public Health public health officials, hospital LMS is a Web-based application through administrators, legislators, health which training content is delivered and insurance agents, trade union managed. It includes functionality for representatives, physicians and other cataloging and launching courses, professionals working in the health care registering users, tracking user progress, field. and assessing user learning. The LMS 29 uses a browser interface to display a public Prevention front-end for the learner and a private Prevention is a method of averting health back-end for administrators and problems (e.g., disease, injury) through instructors. It seamlessly displays real-time interventions. Preventing and reducing the information, drawn from a secure database incidence of illness and injury may be within a graphically attractive and user- accomplished through three mechanisms: friendly interface. Competency-driven activities reducing factors leading to health assessment and course associations are problems (primary); activities involving the integrated in the system, as are online early detection of, and intervention in the quizzing and evaluation processes. The potential development or occurrence of a result is measurement and reporting of health problem (secondary); and activities training progress that are both accurate focusing on the treatment of health and automated. problems and the prevention of further deterioration and recurrence (tertiary). Linguistic Competence Selective prevention interventions are The capacity of an organization and its targeted to individuals or a sub-group of personnel to communicate effectively and the population whose risk of developing convey information in a manner that is disorders is significantly higher than easily understood by diverse audiences average. The risk may be imminent, or it including persons of limited English may be a lifetime risk. proficiency, those who have low literacy 30 skills or are not literate and individuals with Provider disabilities. A person, agency, department, unit, subcontractor or other entity that delivers a Literacy and Cultural Competency health-related service, whether for Strategic Plan payment or as an employee of a The Illinois Department of Human Services governmental or other entity. Examples coordinated the policy and planning efforts include hospitals, clinics, free clinics, surrounding issues of literacy and cultural competency to make language-assisted 29 Public Health Agency of Canada, www.phac- aspc.gc.ca/vs-sb/voluntarysector/glossary.html 30 28 University of Illinois-Chicago, Center for the NPHPSP Glossary, Advancement of Distance Education, www.cdc.gov/od/ocphp/nphpsp/documents/glossary http://www.uic.edu/sph/cade/case_idph.htm .pdf

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community health centers, private include those workers who occasionally practitioners, the local health department, contribute to the public health effort while etc. fulfilling other responsibilities.

Public Health31 Racial and Ethnic Health The science and the art of preventing Disparities Action Council35 disease, prolonging life, and promoting Council of more than 30 minority health physical health and mental health and stakeholders organized by the Illinois efficiency through organized community Public Health Institute to develop strategies efforts toward a sanitary environment; the on issues surrounding reducing racial and control of community infections; the ethnic health disparities. In 2005, the education of the individual in principles of Council issued “Strategy in Action: personal hygiene; the organization of Eliminating Health Disparity in Illinois,” an medical and nursing service for the early assessment of disparities with diagnosis and treatment of disease; and recommendations for action. the development of the social machinery to ensure to every individual in the community Rural Emergency Medical a standard of living adequate for the Services (EMS) Assessment36 maintenance of health. The Illinois Rural Health Association and 350 individuals from 48 counties Public Health Infrastructure32 investigated the challenges facing rural The systems, competencies, relationships EMS providers in Illinois. and resources that enable performance of public health’s core functions and essential Safe from the Start services in every community. Categories Safe from the Start is a program of the include human, organizational, informa- Illinois Violence Prevention Authority. It tional and fiscal resources. provides grants to seven selected sites to develop, implement and evaluate Public Health System33 community-based models for identifying The collection of public, private and and providing services to young children voluntary entities as well as individuals and (0-5) who have been exposed to and informal associations that contribute to the traumatized by violence, such as domestic public’s health within a jurisdiction. violence. Program activities also include public education and systems advocacy Public Health Worker34 related to preventing children’s exposure to Individuals who are responsible for violence and intervening early when providing the essential public health necessary. services whether or not they work in an official health agency. At the state level, Social Marketing37 many workers have public health A technique, often used in public health, responsibilities even though they may work which employs marketing principles and for non-public health agencies, such as environment, agriculture and education 35 For the full assessment: departments. This definition does not http://app.idph.state.il.us/phfi/Home%20page/RE HDAC_Strategy%20In%20Action%20- %20FINAL%20REPORT.pdf 31 Ibid. 36 For the full assessment: 32 Ibid. http://www.ilruralhealth.org/doc/EMS%20Final%2 33 Ibid. 0Report%20Executive%20Summary.doc 34 www.healthypeople.gov 37 US Department of Health & Human Service

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techniques to influence a target audience to voluntarily accept, reject, modify or abandon a behavior for the benefit of individuals, groups or society as a whole.

Special Populations The special populations identified in the State Health Improvement Plan include: African-American Asian Disabled Lesbian, Gay, Bisexual, Transgender (LGBT) Homeless Incarcerated/formerly incarcerated Latinos (including immigrants and non- English speakers) Low-income (including uninsured) Mentally ill Other ethnicities: Middle Eastern, Native American, Polish, non-English speakers Rural Seniors Women Youth/children

These special populations can be summarized in the following categories: race/ethnicity, geography, socioeconomic status, gender, ability, sexual orientation, age and legal status.

Violence38 Violence is the intentional use of physical force or power, threatened or actual, against oneself, another person or living being, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.

38 World Health Organization, http://www.who.int/violence_injury_prevention/viole nce/en/

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Appendix C: List of Electronic Supporting Documents

1. Public Health System Assessment 2. Forces of Change Assessment 3. Statewide Themes and Strengths Assessment 4. State Health Profile Assessment 5. Public Comment

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Printed by Authority of the State of Illinois P.O. #273022 350 4/07