Introduction WV Year 2000 Midcourse Review

In 1990, a group of over 100 health professionals participated in the development of goals and objectives for the health of West Virginia in the year 2000. This effort culminated in a document known as Healthy People 2000: Setting the Stage for a Healthier West Virginia.

Following the example set by Healthy People 2000: Objectives for the Nation, state objectives were set for twenty-one of the twenty-two national priority areas (priority area 6: mental health and mental disorders was omitted in the original state document), dealing with aspects of health ranging from nutrition to tobacco use to occupational safety and health to clinical preventive services. Chronic disease conditions such as cancer, heart disease, and diabetes were addressed, as were emerging issues such as HIV infection, environmental safety, and violent behavior.

At this time, the West Virginia Bureau for Public Health (WVBPH) is releasing a West Virginia Healthy People 2000 Midcourse ReviewWest Virginia's current position in relation to the goals and objectives set at , a comprehensive update of the beginning of the decade. The Review serves to extend and augment the earlier Healthy People 2000 Midcourse UpdatesUpdates dealt with thirteen of twenty-one priority areas on an individual released between 1993 and 1995. The basis.

It is important to note that the Midcourse Review is just that a review. While an attempt has been made to provide complete information on where we are to date in our progress toward the year 2000 objectives, there was no intent to revise unrealistic or unmeasurable objectives for the review. In this document, you will find all of the original objectives, the year 2000 targets, and a description of progress to date. In those instances where it has become obvious that the original objective was not attainable or measurable, the targets were not reset; that was not our purpose here. It is anticipated that this document will be followed by a new planning process to set objectives for the year 2010. It is from the lessons learned in the Midcourse Review that the direction for our future will be determined.

The Healthy West Virginia Coalition (select to view site)

Concurrent with the development of West Virginia Healthy People 2000 was the formation of the Healthy West Virginia Coalition (HWVC) in 1991. At that time, the Coalition's mission was to develop, implement, and evaluate integrated wellness processes to educate and encourage West Virginians to achieve and maintain healthy behaviors. To be successful, it was recognized that a comprehensive health promotion/wellness initiative must address not only the groups targeted for change and the necessary interventions but also the channels through which to convey the Healthy West Virginia message. The HWVC therefore proposed using five major channels to deliver health promotion programming throughout the state, each represented by a member organization:

The State Health Education Council - (Networks)
West Virginia Bureau for Public Health - (Public Health Programs)
West Virginia Wellness Council - (Worksites) -
West Virginia State Medical Association - (Health Care Providers) -
West Virginia School Health Committee - (Schools)

In 1996, the HWVC was restructured, given a new focus, and widened to include a sixth channel, higher education, with an increase in the number of members to 18 (three organizations per channel). The original five member organizations plus the WV Rural Health Education Partnership, representing higher education, would serve as a six-member steering committee. A revised mission statement reflected the Coalition's new direction: The mission of the Healthy West Virginia Coalition is to provide an environment that links groups and organizations thereby increasing their capacity to encourage healthy lifestyles for West Virginians through education and prevention.

It is important to note that Healthy People 2000 is at the very center of the HWVC wheel (right). The Healthy People 2000 goals, and accompanying objectives, provide the focus for the restructured Coalition. Despite the fact that each of the member organizations has its own mission or agenda, they share an interest in helping to advance the health of the state of West Virginia and a commitment to achieving the objectives of Healthy People 2000.

The ring surrounding the inner circle of the wheel is labeled West Virginia Communities. Its placement recognizes the strategic importance of the community in maintaining and advancing the health of the state. Behavioral and lifestyle changes are generally not most effectively addressed on a statewide basis, nor is it an efficient use of resources to target such change on an individual basis. The most effective and efficient way to address the health of West Virginians is through their communities.

While the term community can take on different meanings at different times, it is most helpful for us to think of communities as the 55 counties in our state. All West Virginians, whether city dwellers or rural inhabitants, are citizens of a particular county, and statistics on the health status of our residents are readily available on the county level, which is often the smallest geographical area and population base used for data collection and analysis.

West Virginia Communities and CHPS

A statewide network has been established that organizes West Virginia's 55 counties into nine regions, or health management districts. Each region is served by a Community Health Promotion Specialist (CHPS). In some instances, the specialists are housed in local (county) health departments, in others at one of the state's schools of health sciences. The map below shows the nine regions, identifying the specialist serving each region as of March 1997, as well as the location of each CHPS office.

The CHPS are working to coordinate the various health promotion efforts in each region that are directed toward the year 2000 goals and objectives. Their role has evolved from one of community development to one of establishing linkages and facilitating coordination in areas of health promotion. The CHPS are organizing a series of meetings of the HWVC around the state during the spring of 1997 for the purpose of identifying and coordinating activities throughout West Virginia. This will reduce duplication of effort and maximize the utilization of limited resources.

Health Promotion Channels

The six health promotion channels depicted in the middle ring of the HWVC wheel represent the communication routes through which the Healthy West Virginia messages can be directed to individuals in the communities. Using multiple channels increases the opportunity to both reach individuals with health messages and make system-level changes to support healthy communities. .

1. Public Health Programs Public health is primarily population-based health and includes those agencies and organizations that take a strategic approach to promotion, prevention, and protection. One way in which public health accomplishes this is through the fostering of health-related coalitions and consortiums and by providing financial support to statewide and community-based organizations. Another public health intervention method involves advocacy for laws, ordinances, and regulations that protect the health of the community. Public health takes a strong interest in the issue of access to preventive health services for all of the state's population, including the access to periodic screenings and immunizations. The public health channel is represented on the HWVC by the WVBPH Division of Health Promotion, the CHPS, and the Mary Babb Randolph Cancer Center.

2. Health Care System The health care system is the body of for-profit and not-for-profit providers who offer medical care throughout West Virginia. These include traditional hospitals, physicians, nurses, dentists, and other professionals involved in the delivery of health care. While strongly associated with care for the sick and injured, the health care system also provides an important avenue for the prevention of disease and injury through health education and promotion, immunizations, and other interventions. The health care system is represented by the State Medical Association, the WV Hospital Association, and the WV Nurses Association.

3. Worksites The worksite channel is composed of those activities through which employers, unions, and insurers try to influence the health of workers in a positive fashion. This includes such diverse interventions as worksite wellness incentives, health fairs, health screenings, distribution of health-related information (brochures, paycheck stuffers, employee newsletters, posters at the worksite, etc,), and clean indoor air policies. The worksite channel is represented on the HWVC by the Wellness Council of West Virginia, the Public Employees Insurance Agency, and the WV Chamber of Commerce.

4. Schools Schools are a key intervention channel for influencing health behaviors in a positive way. Elementary and secondary schools provide a structured opportunity to reach youth with interventions and health messages that can set the stage for a healthy lifestyle now and in the future. In addition to health promotion messages, more direct interventions are being demonstrated in schools by policies that ban tobacco use, provide healthy cafeteria menus, and prohibit knives and guns on school property. The school channel is represented by the West Virginia Healthy Schools Program, the School Based Health Assembly, and the Regional Education Service Agencies.

5. Higher Education Via both direct and indirect means, higher education has the opportunity to make a positive difference in our health status. Higher education includes not only university programs for professionals pursuing their formal degrees but also continuing education for currently practicing providers. By placing students and faculty in rural areas for training and community service and by expanding off-campus training opportunities, higher education is striving to meet the health needs of West Virginians. Professional training for health care professionals is emphasizing prevention and illness management. In addition to community health promotion efforts, higher education in West Virginia is also actively pursuing research projects to support prevention, policy, and social change. The higher education channel is represented by the West Virginia Rural Health Education Partnership (WVRHEP) program, the West Virginia University Prevention Research Center, and the West Virginia University Community Health Program.

6. Networks The networks channel is a heterogeneous potpourri or grouping of not-for-profit associations that are interested and/or involved in the health of their communities. They are not included in any of the other five channels, yet they can have considerable influence and a major impact on community health. The networks channel is represented on HWVC by the State Health Education Council, the Council of Churches, and the Center on Aging at West Virginia University.

The Coalition Approach

Considerable synergy is possible when health promotion efforts combine one or more channels in their approach. For this reason, the coalition model has been chosen to bring together agencies and organizations to work together toward a common purpose.

The Healthy West Virginia Coalition is a broad-based alliance built around the six intervention channels described above. Its mission is to link the channels in a combined effort to educate West Virginia's citizens on the need to achieve and maintain healthy lifestyles. While the broad-based approach of the HWVC is necessary to help chart the way to an overall healthier state, specific-issue coalitions are also needed to address individual health problems and provide more targeted action. There are currently several specific-issue coalitions active in West Virginia, addressing such areas as nutrition, physical activity, diabetes, tobacco control, and AIDS. Coalitions that address other single issues, e.g., immunization and injury, were in the process of development as this document went to press.

West Virginia's strategy in improving the health of its population has evolved into a multidirectional approach combining social marketing, policy intervention, improved access to preventive services, increased self-efficacy, and the effective use of media. We have learned that programs will be far more productive if statewide and community organizations work together in developing and implementing interventions. Coalitions provide an effective vehicle for bringing together all those who can help to make West Virginia a healthier place in which to live, work, and raise our families. Through such continued cooperation, West Virginians can enjoy an improved health status by the year 2000.

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