Educational and Community-Based Programs

Background

During the past century there has been a shift from infectious disease to chronic, life-style-related illness as the major cause of death and disability. The West Virginia Bureau for Public Health (WVBPH) has responded to this change by placing a greater emphasis on preventing chronic disease through promoting more healthful behaviors. Preventive approaches that hold the greatest promise for changing behaviors are community-based efforts that focus on both individual and societal influences. The Division of Health Promotion has three programs aimed at increasing the capacity of local groups to promote health: Community Health Promotion (CHP), Comprehensive School Health Program (CSHP), and WV HealthStyles (WVHS).

COMMUNITY Community health promotion focuses on the community to promote informed decision-making on health issues. Health behavior change occurs more often, is more successful, and is longer lasting when the need for such change is decided upon by community members themselves. Many health problems cannot be solved by individuals alone, nor do they exist in a vacuum. Community health promotion programs must therefore use broader approaches, drawing upon as many aspects of community life as possible.

SCHOOLS Two strategies are currently being implemented in West Virginia to improve the status of the state's children. In 1990, the legislature created the Cabinet on Children and Families, chaired by Governor Gaston Caperton. The Cabinet brings together state agency leaders to oversee the delivery of services to children and families, including the elimination of barriers to access. The mission is to enhance the ability of families to protect, nurture, educate, and support the development of their children so that each child's full potential is achieved. The overall goal of the strategy is to shift from an illness/treatment model to one that promotes health, development, and well-being.

The second strategy is the state's Comprehensive School Health Program. In a collaborative effort, the WV Department of Education and the WVBPH are working together to facilitate the bridging of school health programs with prevention programs from health care institutions and the community at large. The CSHP consists of eight components: health services, health education, physical education, counseling/social services, healthy school environment, nutrition, teacher-staff wellness, and community involvement.

WORKSITES The worksite provides one of the few arenas for reaching working-age adults. Worksite health promotion programs can provide the social support and cultural change initiatives for modifying behavioral norms. There are three basic categories of worksite health promotion and wellness programs: awareness and education, individual behavior change programs, and initiatives that strive toward creating a healthy and supportive environment at the workplace.

Community Health Promotion, CSHP, and WV HealthStyles, all of which are located within WVBPH, have been designated as the lead agencies in developing plans to achieve the objectives for educational, worksite, and community-based programs. The program managers of each program will coordinate plan development and implementation.

The Objectives

OBJECTIVE 8.1 Establish at least one organized community-based health promotion program in each county in West Virginia. (Community is herein defined as synonymous with county.)

UPDATE As a result of focusing greater responsibility for health improvement at the community level, there has been an enormous increase of community-based health promotion groups and coalitions addressing community-identified specific health needs. As of 1996, all counties in West Virginia had at least one organized community health promotion program, achieving Objective 8.1 (see Figure 1).

Past measurements have included such community groups as Planned Approach to Community Health (PATCH), Assessment Protocol for Excellence in Public Health (APEX/PH), and Community-Oriented Primary Care (COPC). In recent years, however, more funding has been allocated to communities to develop coalitions that address specific health issues such as cancer, tobacco, diabetes, AIDS, immunizations, etc. In addition to these many specific-issue coalitions located throughout the state, by 1996 PATCH groups were established in 18 counties, COPCs in seven counties, and APEX/PH groups in one regional and 25 county health departments.

OBJECTIVE 8.2 Establish at least one comprehensive school health program in each region.

UPDATE Through the continuing efforts of the WVBPH and the WV Department of Education, comprehensive school health programs have continued to expand across the state. As of 1996, each region in the state had at least one CSHP, achieving the objective. Ten counties had fully funded CSHP programs, with a staff member specifically dedicated to coordinate countywide activities. Thirty-seven counties had begun school health initiatives that include some, but not all, of the eight CSHP components.

OBJECTIVE 8.3 Increase to at least 75% the proportion of workplaces with 50 or more employees that offer health promotion activities for their employees, preferably as part of a comprehensive employee health promotion program.

UPDATE Questions on worksite wellness programs were included in a 1993 survey conducted by the WV Health Care Planning Commission of 1,041 West Virginia business establishments. Of these businesses, 203 (20%) were defined as large, i.e., having 50 or more employees. Forty-one (20%) of the large companies reported having an employee worksite wellness program. Almost half (49%) of those large companies that had a wellness program had an established wellness budget, while 66% had a designated wellness program coordinator.

Additional data on worksite wellness programs will be collected in a worksite survey scheduled to be conducted in spring 1997 by West Virginia University (WVU).

OBJECTIVE 8.4 Increase years of healthy life to at least 65 years. (Years of healthy life is a summary measure of health that combines mortality [quantity of life] and morbidity and disability [quality of life] into a single measure.)

UPDATE No state baseline data are available for this objective. The estimated national baseline for 1990 was 64 years. By 1992, this had fallen to 63.4 years. For persons aged 65 and older, the 2000 target goal is 14 years of healthy life remaining at age 65. The 1990 baseline for this was 11.9 years, which remained unchanged in 1992.

Meeting the Objectives

The three programs within the Division of Health Promotion that are addressing Objectives 8.1-8.3 will use the health promotion channels listed in the box above to reach communities and individuals with the healthy West Virginia message. (A more detailed discussion of these channels is found in the Introduction to this document.)

COMMUNITY With limited resources available, a need exists for increased coordination and collaboration among the various county, regional, and statewide initiatives. This has led to the expansion of the Community Health Promotion Specialist (CHPS) network from six to nine regions. The nine CHPSs are located in six local health departments and three Health Science Center Medical Schools and work toward the coordination of community service activities.

The CHP mini-grant program has expanded linkages with the Community Based Initiative (CBI) program through the Office of Rural Health Policy. The CBI program funds community-based health promotion programs through consortia; consortium members include a variety of health care providers such as primary care centers, rural hospitals, and local health departments, as well as community-based organizations such as schools, higher education institutions, businesses, and volunteer groups.

SCHOOLS The WVBPH has established school clinics in 12 rural counties that provide primary care and preventive services. Health educators from the Dept. of Education and WVBPH are developing policy in such areas as nutrition, sexually transmitted diseases, tobacco prevention, and physical activity. "Teen issue forums" have been conducted and teachers across the state have received training in date violence, sexual harassment, and parenting skills. The legislature has assisted the CSHP with mandates on safe schools, drug abuse, tobacco control, and physical education.

WORKSITES The worksite survey to be conducted in the spring of 1997 by WVU will provide data to assess the availability of and need for worksite wellness programs in all businesses in the state. Within the public arena, in 1997 the Public Employees Insurance Agency (PEIA) was providing wellness programming through four pilot projects to 44,500 public employees in 18 counties in West Virginia. Worksites include state government agencies (including WVBPH) and public schools. Interventions include health risk appraisal, health screenings, newsletters, brochures, incentive-based behavioral modification programs, and nutrition/weight loss programs. All sites place an emphasis on fitness and exercise. As funding becomes available, the PEIA hopes to expand to employees in all 55 counties.

Educational and Community-Based Programs - Meeting the Objectives

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