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Getting There Quicker

Community Health Improvement

BY: PAUL B. MCGINNIS

Jerry Nickell doesn't usually start his morning commute at 4:30 am to travel the 14 miles from his home to the hospital in Baker City, Oregon. But on September 1, 2005 Jerry had to start early because his unicycle could only carry him so fast.

Jerry is the vice president of Mission & Human Resource for St. Elizabeth Health Services and a member of the Baker County Community Health Improvement Partnership (CHIP). He rode the. unicycle to promote leave Your Car at Home Day. “The year prior I walked. It took me three-and-a-half-hours, and I had to get there quicker this year.” Getting THERE quicker, wherever THERE may be, is one of many reasons Oregonians and other Americans waistlines are growing. Obesity experts say our dependence on motor vehicles for short trips, a lack of safe walking and biking environments, sedentary lifestyles and eating on-the –go all contribute to the obesity epidemic

In February of 2003, the Oregon Department of Human Resource’s Health Promotion and Chronic Disease Prevention Section released two companion statewide plans promoting physical activity and improved nutrition. The Healthy Active Oregon plans called Oregonian into action and provided simple, yet eloquent, guidance on evidence-based practices that community residents could employ. Both rural and urban communities throughout Oregon embraced the challenge and are mobilizing and starting to create projects and programs.

Jerry Nickell unicycles 28 miles round trip during Leave Your Car at Home Day. (Photo Courtesy of the Baker City Herald).		“No single project or activity will solve the obesity epidemic. It must be attacked on federal, state and local policy fronts and in the community environments where residents work and spend most of their time. Individuals, in conjunction with their families, must take responsibility for their own health,” said Jane Moore, PhD head of Oregon Health Promotion and Chronic Disease Prevention Section. CHIP is a comprehensive community health development model coordinated through the Oregon Office of Rural Health. During the past three years, several CHIP programs throughout Oregon have decided to focus on "promotion of physical activity" and "improved nutrition" as a means to improve community health. Karen Bondley, CHIP Coordinator for coastal Lincoln

County summed it up this way, "the contributing behaviors to many of the leading causes of death are diet, obesity and a lack of exercise. So, we decided to focus some of our efforts in those areas."

The Lincoln County CHIP decided to pursue a policy path as well as implementing some community projects. They sponsored two workshops attended by community leaders. The first was an awareness raising session, which profiled all of the goals and objectives in the statewide Healthy Active Oregon, plans and asked participants to identify gaps between what was currently happening in the county and what was called for in the plans. The second workshop focused on nutrition and exercise policies in public schools.

The Lincoln County CHIP's community projects included scholarships for kids to participate in Recreation Center activities, and Walk to School events planned in conjunction with Lincoln County Public Health. A more permanent project was the creation of a com­munity garden in a low-income housing complex. Master gardeners along with the local Extension Service worked with the managers and residents to create a large com­munity vegetable garden. The twelve raised beds were surrounded by strawberry plants to prevent erosion, and various berry bushes and fruit trees. According to Debra Spoelstra of the Community Development

Corporation of Lincoln County, 'This Community Garden is providing low income families, seniors and youth in our programs an opportunity to work together, mentor one another and share in a bounty of fresh vegetables, food preservation and fun. The value of our garden provides more than just good nutrition."

Each community is unique and solutions that fit one might not make sense in another. "One evidenced based strategy suggested placing signs next to elevators prompting people to take the stairs. There are only a few elevators in all of Baker County," said Barbara Tylka MD, General Surgeon and Baker CHIP member. Tylka and a CHIP committee created a resource inventory of physical activity opportunities and started a Why Not Walk? campaign to discourage people from driving three or four blocks while going between stores in Baker City's historic downtown district.

The Baker County CHIP furthered its activities by applying for a grant from the Catholic Health Initiatives community benefit program and created Health in Action (HIA). Sherrie Kvamme has served as the HIA Coordinator since its inception, and she has been busy.  Over 1,500 people in Baker County (about 10% of the population) are registered with the HIA program. There have been Walk Across Baker activities where community residents tracked their walking distances and plotted them on a chart that represented traversing the 100 plus miles from Hells Canyon to the abandoned gold fields of Sumpter. HIA also distributed pedometers, which have been shown to increase physical activity by

		some 10,000 steps per day if used regularly The project has expanded to Kids in Action, which through the public schools promotes the ten healthy habits for kids to model. Rewards for "Getting Caught by HIA" doing something positive for your health, include key chains, T-Shirts, water bottles and other gifts, and are now a hallmark of the HIA and KIA programs.
Jim Thomas was seen parking his car in the furthest reaches of his parking lot and walking an extra few steps to work		In Richland, Oregon (population 150), a part of Baker County where the health care

system is limited to emergency medical services, a woman was told by her doctor she needed to lose some pounds and suggested she join Weight Watchers. The problem is, there is no Weight Watchers program in Richland and the logistics, cost, and time spent getting to the nearest service made no sense to her. Still she wanted to comply with her doctors request so she did what many rural people do when confronted with similar situations, she created her own set of common sense guidelines and recruited friends and neighbors to a group called WAGs (Weight Accountability Group). The WAGs meet Tuesday mornings, weigh-in, and talk about their progress toward short and long-range goals. The WAGs do not endorse a specific diet or exercise program. They support sensible individual choices. The WAGs concept has spread to Halfway, Oregon where a new group is forming.

The East Linn CHIP embraced the active community environment strategy to promote health. The Build Lebanon Trails (BLT) project was created as part of the Trails Committee. Rod Sell, a City of Lebanon employee who serves as chair of the committee said, "Our goal is to tie together the community of Lebanon with a trail system that connects each school, public building, park, the hospital, neighborhoods and the business district." The long range vision is to build 45 miles of 12 foot wide, paved, fully ADA accessible trails. As planned, these trails would connect Lebanon to other communities in Linn County and beyond. This is an ambitious plan but local government, residents and businesses have come together to "share the vision." Public meetings were held to develop a matrix to prioritize which of the over 60 trail segments would be pursued and in what order. The first segment is called the Marks Slough Trail and makes the scenic waterways in the community more accessible. 'Trails are the greatest asset to any community and nature is all around us. With trails we can embrace all the great outdoors Oregon offers, and we can get fit and stay healthy in the process," said Sell.

		The Ridge Garden Club members enjoy the fruits of their labor.
An Abandoned overflow pipe will be converted into a walking and biking bridge as part of the Build Lebanon Trails plan.

Just up the road from Lebanon, Craig Martin, City Manager, Sweet Home, Oregon and East Linn CHIP member has targeted his Healthy Active Oregon efforts to his own workplace. Sweet Home employees now receive comprehensive employee health screenings, telephone health coaching consultations for those who want to change behaviors, walking competitions between departments using pedometers, and the "Monday Munchy" program which provides healthy alternative snacks in employee break areas. "The efforts here have raised employee awareness that their individual behaviors can indeed have an impact on our insurance costs, while at the same time help­ing them be healthier and more productive," said Martin.

The CHIP's in Baker County, Lincoln County, and Reedsport determined to give their local doctors a resource to help individual patients in need. Weight loss coun­seling is not a service covered by many insurance plans so these communities created Health Coach positions. These lay residents were trained in Motivational Interviewing techniques an emerging field with the intent of helping the client resolve ambivalence around barriers to their goals. Clinicians in all three places can refer patients to a Health Coach for up to three hours of one-on-one service. Health Coaching is a form of health education, not medical treatment and is part of a self­management program for clients.

These community efforts in rural Oregon through the CHIP groups demonstrate the desire and ability among community members to help their own fellow citizens improve their health. The obesity interventions in the workplace, schools, and community combined with nutrition and physical activity policies are all helping to achieve the goal of a Healthy Active Oregon.