Enjoy Bike Month Safely: Bicycling Safety Considerations To Keep in Mind from Recent Injury Prevention Research

Enjoy Bike Month Safely:

Bicycling Safety Considerations To Keep in Mind from Recent Injury Prevention Research

bicycle rent renting bike Charlottesville Virginia
Bicycling is a fun form of active transportation or a leisure activity that many people enjoy. The bicycle in this photo is for rent in Charlottesville, VA through Jill + Ian’s bicycle rentals. Photo © Jillian Regan 2018. 

Bicycling is an enjoyable form of physical activity for many people. Most people (89.8%) in a recent survey have ridden a bicycle at one point in their life.1 People ride bicycles for a variety of different reasons. A recent survey found that most survey respondents (76%) ride bicycles for fun and almost half (47%) also ride bicycles for exercise.1 Many (22%) ride bicycles to ride with friends, family, or coworkers who ride bicycles as well to commute to work or school (27%).1 Only a few people say they ride bicycles to help the environment (18%), run errands (6%), for bicycling competitions (2%) or do not ride bicycles at all (6%).1

The month of May is National Bike Month in the U.S. Celebrate Bike Month safely by taking into consideration recent bicycling safety research when riding a bicycle.

bike rentals renting for rent Charlottesville Virginia bicycle safety public health injury prevention
Wearing a bicycle helmet reduces the risk of head injuries. Many bicycle rental services, such as Jill + Ian’s bicycle rentals, also rent helmets in addition to bicycles. Photo © Jillian Regan 2018

Wearing bicycling helmets has been proved to be effective in reducing head injuries as well as fatalities. Specifically, wearing helmets were found to reduce head injuries by 48%, serious head injuries by 60%, and traumatic brain injuries by 53% by a recent meta-analysis study.2 In addition, wearing bicycling helmets has been found to be protective against facial injuries, including facial fractures, as well as reduced hospitalization costs for those involved in a bicycling accident while wearing a bicycle helmet compared to those not wearing a helmet. 2,3,4 

While wearing a bicycle helmet is definitely recommended, it is also important to note that the design of bicycle helmets is continuously improving and that not all bicycle helmets have the same level of protection against head injuries.5 It could be a good idea to get a new bicycle helmet every few years as well as more thoroughly research the safety, design, and customer reviews of different kinds of bicycling helmets before purchasing one.

bike rentals renting for rent Charlottesville Virginia bicycle safety injury prevention
A relatively new bicycle helmet. This helmet is for rent in Charlottesville, Virginia through Jill + Ian’s bicycle rentals. Photo © Jillian Regan 2018

It is important to keep in mind that bicycle helmets do not protect other areas of the body in case of a collision or other bicycling accident. For example, shoulder injuries, some of which can be quite serious, can occur from bicycling accidents and there is not yet any protective gear designed specifically for protecting the shoulders in case of an accident while riding a bicycle.6 This could be a great new market for the entrepreneurial minded looking to design a type of shoulder protective gear or adapt designs from other sports to be used for shoulder protection for bicyclists. For those who simply ride bicycles and are interested in designing gear to protect their shoulders, this can be a reminder to follow other safe practices for riding bicycles, such as following the rules of the road and not riding a bicycle while under the influence of alcohol or other substances, in addition to wearing a helmet and to not ride more recklessly just because a helmet is being worn.

bike rentals renting for rent Charlottesville Virginia Safety injury prevention
Reflective bicycling safety vests with detachable lights can improve the visibility of the bicyclist to motor vehicles as well as to pedestrians. This particular reflective vest is available for rent through Jill + Ian’s Bicycle Rentals. Photo © Jillian Regan 2018

Visibility of the bicyclist on the road or on the trail is also an important safety factor to take into consideration. Using at least one visibility aid, such as a flashing light or reflective clothing while bicycling can reduce the chance of hospitalization from a motor vehicle collision.Wearing light colored clothing on the upper body to improve visibility while bicycling in the daytime, not just at night, is also important in reducing the risk of collision with motor vehicles.

bike rentals renting for rent Charlottesville Virginia bicycle safety bicycle month injury prevention
A red, rechargeable, battery operated tail light that can be attached to a bicycle’s seat post is another way to improve visibility of the bicyclist to motor vehicles, other bicyclists, and pedestrian. This tail light is available for rent in Charlottesville, VA through Jill + Ian’s Bicycle Rentals. Photo © Jillian Regan 2018

Attaching reflective tape to the back of the bicycle frame was founded to greatly increase the visibility of the bicycle at night and is a method highly recommended by the researchers,although may not be a popular idea with bicyclists who are concerned about the appearance of their bicycle and the risk of damaging the bicycle’s paint with reflective tape. Attaching reflective tape to the bicycle pedals was also found to improve bicycle visibility at night, but not as much as attaching the tape to the back of the bicycle frame.8

Another way of improving safety while bicycling can be through bicycling specific safety training specific. In a study of evidence based hazard perception training used with young elementary school aged bicyclists found that after the training, the young bicyclists detected more hazards and reacted more quickly than a control group of young bicyclist who did not receive the training.9 Focusing on safety when learning to ride a bicycle at a young age may help reduce bicycling accidents.

In addition to adolescents, older adults are another population who may be more at risk for bicycling injuries. While bicycling has many health benefits for older adults, such as maintaining balance control and coordination through regular bicycling which can help the risk of falling while walking, it is especially important that older adult bicyclists follow all safety precautions and only bicycle under safe conditions to avoid potentially debilitating injuries.10,11

bike for rent rentals renting Charlottesville Virginia bike month bicycle safety injury prevention
A bicycle headlight on the handlebars of a bicycle. This headlight and bicycle are available for rent through Jill + Ian’s bicycle rentals. Photo © Jillian Regan 2018

Conclusion

Reviewing recent injury prevention research on different aspects of bicycling safety can give insight as how to take these ideas into consideration when celebrating National Bike Month in the month of May in the U.S. and enjoying a safe ride on a bicycle.

What recent bicycling safety research have you heard of that I didn’t include in this article? Share a link to it in the comments below!

Jillian Regan, MPH is a consultant at Rillian. She enjoys helping organizations find new ways or evaluate improve existing community health improvement efforts, so that the organization can better serve its community members, clients, customers, patients, or other stakeholders. Connect with her by email at Jillian.Regan@RillianConsulting.com or Twitter (@JillianReganMPH) or LinkedIn

Follow Rillian on Facebook to get updates on articles like this one or updates about current projects, like a bicycling survey!

This post was created in collaboration with two of Rillian’s affiliated businesses, Jillian Regan Photography and Jill + Ian. Rillian conducted research and development for a bicycle rental service that Jill + Ian now runs. Jillian Regan Photography provides photography and photos for Rillian.

Sources:
1. Regan J. Not yet published preliminary results from recent bicycling survey. 2018.

2. Høye A. Bicycle helmets – To wear or not to wear? A meta-analyses of the effects of bicycle helmets on injuries. Accid Anal Prev. 2018 Apr 17;117:85-97. doi: 10.1016/j.aap.2018.03.026.

3. Fitzpatrick DG, Goh M, Howlett DC, Williams M. Bicycle helmets are protective against facial injuries, including facial fractures: a meta-analysis. Int J Oral Maxillofac Surg. 2018 Apr 2. Pii: S0901-5027(18)30077-8. doi: 10.1016/j.ijom.2018.03.005.

4. Michael PD, Davenport DL, Draus JM Jr. Bicycle Helmets Save More than Heads: Experience from a Pediatric Level I Trauma Hospital. Am Surg. 2017 Sep 1; 83(9): 1007-1011.http://www.ingentaconnect.com/content/sesc/tas/2017/00000083/00000009/ art00039;jsessionid=34vhu1ejf2uao.x-ic-live-01

 

5. Bland ML, Zuby DS, Mueller BC, Rowson S. Differences in the protective capabilities of bicycle helmets in real-world and standard-specified impact scenarios. Traffic Inj Prev. 2018 Feb 28;19(sup1):S158-S163. doi: 10.1080/15389588.2017.1388915.

6. Goldstein Y, Dolkart O, Kaufman E, Amar E, Sharfman ZT, Rath E, Mozes G, Maman E. Bicycle-Related Shoulder Injuries: Etiology and the Need for Protective Gear. Isr Med Assoc J. 2016 Jan;18(1):23-6.

7. Hagel BE, Romanow NT, Morgunov N, Embree T, Couperthwaite AB, Voaklander D, Rowe BH. The relationship between visibility aid use and motor vehicle related injuries among bicyclists presenting to emergency departments. Accid Anal Prev. 2014 Apr; 65:85-96. doi: 10.1016/j.aap.2013.12.014. Epub 2014 Jan 3.

8. Costa M, Bonetti L, Bellelli M, Lantieri C, Vignali V, Simone A. Reflective Tape Applied to Bicycle Frame and Conspicuity Enhancement at Night. Hum Factors. 2017 May; 59(3): 485-500. Doi: 10.1177/0018720816677145. Epub 2016 Dec 6.

9. Zeuwts LHRH, Vansteenkiste P, Deconinck FJA, Cardon G, Lenoir M. Hazard perception training in young bicyclists improves early detection of risk: A cluster-randomized controlled trial. Accid Anal Prev. 2017 Nov;108:112-121. doi: 10.1016/j.aap.2017.08.024. Epub 2017 Sep 1

10. Ikpeze, TC,Glaun, G, McCalla, D ,Elfar, J. Geriatric Cyclists: Assessing Risks, Safety, and Benefits. Geriatr Orthop Surg Rehabil. 2018 Jan 23;9:2151458517748742. doi: 10.1177/2151458517748742. eCollection 2018.

11. Batcir S, Melzer I. Daily Bicycling in Older Adults May Be Effective to Reduce Fall Risks – A Case Control Study. J Aging Phys Act. 2018 Jan 18:1-21. doi: 10.1123/japa.2017-0263

An Efficient Certificate: My Lean Six Sigma Yellow Belt Certification

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Jillian Regan, consultant at Rillian holding her Lean Six Sigma Yellow Belt certification from the Technical University of Munich (TUM). Photo © Jillian Regan 2018.

I recently got my Lean Six Sigma Yellow Belt certification from the Technical University of Munich (TUM) through an online course offered by TUM on the edX platform. I admire how the certificate itself and the process of obtaining it was highly efficient, exemplifying the ideas of Lean and Six Sigma, reducing waste and reducing variation in quality improvement.

Lean and Six Sigma are two separate, but related philosophies in the quality improvement and management realm across a variety of different industries. I was first introduced to the concept in the healthcare industry and in the field of public health.

Wanting to further my knowledge and be able to better apply the data and fact driven quality improvement Lean and Six Sigma tools to improve my performance and range of services offered as a consultant, I decided to get certified in Lean and Six Sigma.

I found that an online series of three courses offered by TUM through the edX platform was the most efficient and cost effective way to gain this certification. Online courses allowed me to work my continuing education around my work schedule. Also the cost was low enough to not waste or strain the resources of a fresh, innovative, new consulting agency for providing professional growth and development for its consultants. 

I also thought it would be interesting to take online courses from a German university, TUM, with professors from backgrounds in industries, such as manufacturing, that I am not experienced in as I learned of Lean and Six Sigma from a public health and healthcare background, thus providing a different perspective.

Today Lean and Six Sigma are often combined, and I wanted to be able to provide the combined effect that has been shown to reduce costs, improve customer, client or other stakeholder satisfaction with quality control and continuous quality improvement in processes, services, or products in the projects I work on.

Though they are often combined, Lean and Six Sigma are two separate, but related philosophies. It can be useful to differentiate between the two.

Lean focuses on reducing waste while Six Sigma focus on reducing variation, such as variation in a process, product, or service that is out of specification. Variations are often considered to be errors or mistakes, depending on how far out of specification the variation is and how the variation affects the process, service, or product. 

My Lean Six Sigma Yellow Belt certification from TUM efficiently lists out and differentiates which topics covered in the series of certification courses I took fall under each umbrella: Lean or Six Sigma. Most professional continuing education certificates do not include such detail, which causes wastes in time or an increased risk of error in understanding what topics were included in the course(s) that the certification was obtained through. The listing out of the topics on my Yellow Belt certificate allows me to easily, efficiently, and with a reduced chance of errors in listing the topic under the wrong umbrella, list them out in the table below if you are curious to learn which umbrella each topic falls under.

Differences between Topics in Lean vs Six Sigma at the Yellow Belt Level

Lean
Six Sigma
Continuous Improvement (Kaizen)DMAIC = Define Measure Analyze Improve Control
 8D Problem SolovingSIPOC
 Value Stream MappingProcess Mapping/Flow Diagram
3 Ms: Mura, Muri, MudaProbability Distributions
Poka Yoke SolutionsDescriptive Statistics
Visual ManagementPlots (Pareto, Scatter, Time Series)
Workplace OrganizationProcess Capability: Yield, ppm, DPMO, Sigma Level
Capacity Analysis, Little’s Law Inductive Statistics: Confidence Intervals, Hypothesis Tests
 Queuing TheoryLinear Regression / ANOVA 
Setups and BatchesDOE
Mixed Model ProductionFailure Mode and Effect Analysis
JIT/Pull SystemsSPC, Control Charts
Scheduling Pull SystemsControl and Response Plan
KanbanDesign for Six Sigma
Total Productive MaintenanceTolerance Design
Single Minute Exchange of DieProject Identification and Definition
Overall Equipment Effectiveness Critical-to-Quality Parameters, Customer Expectations, VOC, Kano

It has taken a longer than expected amount of time to post about getting Lean Six Sigma certified consultant becoming certified at the Yellow Belt level because I have been busy getting Jill + Ian’s bicycle rental service started — a service that Rillian provided research and development for and is now being added as a service provided by of our affiliated businesses, Jill + Ian–and applying Lean Six Sigma principles to the service from the start to improve access to bicycles through a quality focused and innovative bicycle rental service.

However, due to the application of Lean and Six Sigma principles in my photography business, Jillian Regan Photography, LLC, I was able to quickly and efficiently add photos to complement this blog post.

Jillian Regan, consultant at Rillian, has been very busy getting Jill + Ian’s bicycle rental service started–a service that Rillian provided research and development services for–and only just now had time to pose for a photo with her Lean Six Sigma Yellow Belt Certificate and her bicycle. Her bicycle is available for rent through Jill + Ian’s Bicycle Rentals. Photo © Jillian Regan 2018.

Conclusion

Getting my Lean Six Sigma Yellow belt certification from TUM through the edX platform was an efficient way to improve my performance as a consultant and be able to better offer data driven quality improvement technical assistance and support and consulting to other organizations.

The certificate itself is created to reduce waste and variation by efficiently listing out the topics covered under Six Sigma and Lean and details not normally included on a professional continuing education certificate itself for easy and efficient access and comprehension. 

 

#HDTweets: Ways In Which Twitter Can Be Used by Health Departments

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A screenshot of the author’s Twitter profile as shown on a computer screen, taken on 3/27/2018.

Twitter is a social media platform with 330 million active monthly users as of 2017 for sharing posts of up to 280 characters–as of November 2017; prior to November, the character limit was 140 characters–that can also include images, links to articles, and short video clips.

Twitter is useful for health departments because it is low cost. Unlike running an ad in a newspaper or on the radio–there is no cost to share a post (called “Tweeting”), reply or share other users’ posts (called “Retweeting”), or like or otherwise engage with Tweets. The only costs are staff time and resources dedicated to creating the content to post, posting the content, engaging with the Twitter audience, and to post paid advertisements on Twitter.

Health departments can use Twitter as part of their overall communications strategy, participating in or hosting Twitter chats, to research barriers to accessing programs or services or to meet Public Health Accreditation Board (PHAB) standards and measures.

As part of the overall communications strategy

Some health departments (approximately 217 as of 2012)(1) use Twitter as part of their communications strategy. They communicate information with the community, the media, and other partner organizations and stakeholders about public health issues, health education topics, current public health related events like health fairs or an ongoing community health assessment, and other related topics.

When using Twitter as part of a communications strategy often in conjunction with using other forms of social media, it is important to keep in mind adapting the message for the format (240 characters with option to add photos and video clips) and audience using Twitter, which is slightly different than other social media platforms.

Also the time of day when the target audience will be active on Twitter is important to consider since that time of day may not coincide with the hours the person managing the health department’s Twitter account will be at work and posting on the Twitter account.

One way to handle this is by scheduling posts using an online social media manager like Hootsuite or Buffer. Whichever social media management system is used, it should include a way to schedule posts for each type of social media account, including Twitter, and not just one post with the exact same wording pushed to all social media accounts. While social media like Facebook and Instagram can handle long posts, Twitter posts are limited to 240 characters, so these posts need to be short and sweet and leave room for a couple hashtags.

Also, while the posts may be scheduled to be posted at optimal times for when the health department’s target audience is on Twitter, it is still important to have someone engaging with the audience on the platform by liking, responding to comments, and retweeting posts during that time, which may be outside of normal working hours. Some social media management agencies who have some staff with a background in both social media management and public health or a public health focused consulting agency might be able to assist a health department with managing their social media presence including Twitter.

social media management public health accreditation board phab mph research community
A screenshot of a Tweet announcing a community health assessment (CHA) meeting, screenshot taken in 3/2018.

Twitter Chats

Hosting or participating in Twitter chats — scheduled conversations on a certain topic or event– is another way of using Twitter to communicate and engage with an audience on the platform.

For example a recent study found that there was moderate engagement and a measure called return on engagement between the organizers of the Twitter Chat and the chat participants for a Twitter chat #LiveFitNOLA on health and wellness topics in New Orleans, Louisiana.(2)  The Twitter chat is organized and hosted by the Tulane Prevention Research Center (@TulanePRC), a university-based research and education center, and the City of New Orleans Health Department’s Fit NOLA Initiative (@FitNOLA). The authors noted that the level of engagement as two communication between the host organization or organizations depends on a variety of factors including the audience, context, scope, scale, and goal of the Twitter chat. It also depends on what other organized hashtag-based communications the organization or host already has on Twitter.(2)

To Research Barriers to Participating in Programs or Services

Twitter can also be used for researching barriers to participating in programs or services by searching specific hashtags in a local area. For example a recent study examined the barriers to CPR training in Pennsylvania using four years of Twitter data. The barriers were found to be time, duration, and location of the training.(3) A similar method might be able to be used by a health department or a research organization or consulting agency in partnership with the health department to find barriers to attending or participating in the health department’s services and programs.

social media management public health board accreditation community research mph
A screenshot of Franklin County Health Department’s Twitter feed, taken in 3/2018.

To meet Public Health Accreditation Board (PHAB) Standards and Measures

Some health departments were early adopters of using Twitter, starting to use the platform in 2009(1), while others have only begun to use it more recently to use it or are just now considering using it. As more health departments are becoming Public Health Accreditation Board (PHAB) accredited or are in the process of PHAB accreditation or getting reaccredited, they are incorporating social media usage, such as Twitter as well as other social media platforms like Facebook, into their communications strategy to meet PHAB standards and measures in domains, such as Domain 3 (Inform and educate about public health issues and functions).

Depending on how the health department uses Twitter, its Twitter strategy and usage could be used as examples to meet other measures in other domains such as Domain 4 (engage with the community to identify and address health problems). Some health departments have even used Twitter in their community health assessment (CHA) and/or community health improvement (CHIP) process — tweeting links to an online survey as part of the CHA or letting people know about and inviting them to their CHA or CHIP meetings.

social media management public health board accreditation phab mph research community
A screenshot of a Tweet including a link to a CHA survey, screenshot taken in 3/2018.

Sharing information on Twitter can also make it easy for the health department’s partner organizations and other stakeholders who may be involved in the CHA / CHIP or are partners for other health department programs to share their message by simply clicking the button below the post to like and another to “retweet” it.

social media management public health accreditation board accreditation mph research community
A screenshot of tweets about the hashtag #communityhealthassessment, screenshot taken in March 2018.

Tracking engagement & results

As more health departments use or are thinking of starting to use Twitter, it is important to measure and track metrics related to Twitter usage. Tracking metrics and results is a way that the health department can know if the resources they have put into using Twitter are getting the desired results.  

Also, tracking metrics for engagement is important, not just of how many tweets they post or retweet a month, but how many followers they have and how engaged those followers are with the content the post, such as the number of likes, replies, and retweets the Tweets get. Tracking the results, as well as measuring if there’s any difference over time or for tracking a specific health promotion campaign can also provide valuable insights into how the health department can improve their Twitter usage to communicate with their target audience.

Having a dedicated staff role of public information officer

Having a dedicated staff role of public information officer (PIO), either as a separate position or as part of a role of another staff position at the health department is one way to manage social media, including Twitter, usage. Having a PIO role has been found to be associated with a health department having a larger number of Twitter followers who are local, or in other words are part of the local community that the health department is trying to reach.(1)

Having a PIO role is also one of the requirements for PHAB accreditation (PHAB measure 3.3). Although, as noted in the cited study, determining the locality of Twitter users is not very precise, due to many individuals using Twitter not including location information on their Twitter profile pages, whereas most Twitter accounts for businesses and organizations do include location information in their profiles.

Conclusion

Health departments can use Twitter as part of their overall communications strategy to engage with their audience, participating in or hosting Twitter chats, to research barriers to accessing programs or services or to meet Public Health Accreditation Board (PHAB) standards and measures.

Tracking metrics, including engagement, and results of Twitter usage is essential to know if the resources being put into using Twitter to engage with the health department’s audience and communicate information are effective in doing so. Working with a social media agency that has staff with a public health background in addition to social media management skills or a public health focused consulting agency is one way to help create content, manage posts, and/or measure metrics and results from Twitter usage by the health department. Having a PIO role either as a separate position or as part of a role of another staff position has been found to be associated with a health department having a larger number of Twitter followers who are local.(1)

Do you know of a health department who’s active on Twitter? How do they use Twitter, do they post content, or participate in Twitter chats, or use Twitter for researching barriers or do they use it in another way? Share in the comments below!

Jillian Regan, MPH is a consultant at Rillian. She enjoys helping organizations find new ways or evaluate improve existing community health improvement efforts, so that the organization can better serve its community members, clients, customers, patients, or other stakeholders. Connect with her by email at Jillian.Regan@RillianConsulting.com or Twitter (@JillianReganMPH) or LinkedIn

Follow Rillian on Facebook to get updates on articles like this one or updates about current projects, like a bicycling survey!

Sources:

  1. Harris, JK, Choucair, B, Maier, RC, Jolani, N, and Bernhardt, JM. Are Public Health Organizations Tweeting to the Choir? Understanding Local Health Department Twitter Followership. J Med Internet Res. 2014; 16(2): e31. doi:  10.2196/jmir.2972
  2. Rabarison, KM, Croston, MA, Englar, NK, Bish, CL, Flynn, SM, and Johnson, CC. Measuring Audience Engagement for Public Health Twitter Chats: Insights From #LiveFitNOLA. JMIR Public Health Surveill. 2017; 3(2):e34. doi:10.2196/publichealth.7181
  3. McGovern, SK, Blewer, AL, Murray, A, Leary, M, Abella, BS, and Merchant, RM. Characterizing barriers to CPR training attainment using Twitter. Resuscitation. 2018; pii: S0300-9572 (18) 30118-7. doi: 10.1016/j.resuscitation.2018.03.010

Community Driven Population Health Improvement Efforts with Health Equity & Cultural Competence: Healthy Food Programs in Sitka, Alaska

public health accreditation board healthy food programs systems health equity
Shoppers, vendors, and fresh produce at a Farmer’s Market. Photo © Jillian Regan 2017 courtesy of Jillian Regan Photography, LLC.

Community driven population health improvement efforts that include a health equity lens as well as cultural competence in their programs and initiative work to address population health issues. Through a community driven, collaborative approach, essential stakeholders as well individual citizens provide valuable insight, data, research, ideas for ways to address the population health issues, funding, and gives the stakeholders more of a stake and ownership of the programs and initiative. When  health equity is taken into account, programs and initiatives can be designed to provide additional help those who may be at a higher risk of a certain issue or at more of a disadvantage in some way than others in the same community. Looking at examples of real-world examples of a community driven, health equity focused population health improvement efforts can provide better understanding of and ideas for practical ways to do this in one’s own community.

The Sitka Health Summit’s healthy food programs are a one example to of a community driven population health improvement programs that include a health equity lens.

healthy food programs systems community health public health accreditation board health equity
Eggplants and vendor at table at a farmer’s market. Photo © Jillian Regan 2017. courtesy of Jillian Regan Photography, LLC.

The Sitka Health Summit, is an ongoing, community driven population health improvement annual event that started in 2008 in the small, coastal town of Sitka, Alaska (population 8,863 as of 2015). The Summit was began through a partnership between Sitka’s two hospitals. Local citizens identify and decide on two health initiatives to work on in the next year during the Summit. Each initiative is then funded with a $2,000 grant with the funding for the grant provided by the two hospitals as well as other community organizations. At many of the Summits, health issues relating to lack of access to and consumption of healthy food was recognized as a major challenge.

Factors such as Sitka’s relatively remote location in a cold climate meant that a lot of foods had to be imported in, thus increasing the cost of healthy foods like oranges as well as food overall. For example the average family food cost per week in Sitka is higher than in other communities in Alaska such as Juneau and Anchorage, as well as higher than that of the US average.  As a result, several healthy food programs were developed, beginning with the Sitka Local Foods Network. Several interesting and innovative healthy foods programs have come out of the Sitka Health Summit’s annual initiatives.

The healthy food programs include finding ways to improve access to both healthy, fresh locally -grown foods as well as traditional, healthy Tlingit food because of their focus on food as important for nutrition as well as having cultural importance. The Tlingit are the Alaska native people who have inhabited the Sitka, Alaska area for a long time. The healthy food programs in Sitka include The Sitka Local Foods Network, St. Peter’s Fellowship Farm, Sitka Farmer’s Market, Garden Mentoring Program, Sick-A-Waste Sitka Composting Project, the Sitka Kich, serving local fish in school lunches, Stream to Plate Fish to School Classroom Lessons, and an annual Sitka Seafood Festival.

Sitka Local Foods Network

This is a nonprofit organization whose mission is to increase the amount of locally produced and harvested food in the diets of Southeast Alaskans that began as a result of the first Sitka Health Summit in 2008 as a way to tie two, healthy food initiatives together: creation of a community garden and greenhouse as well as a farmer’s market. It has since then expanded it’s programs to include expanding community and family gardens, providing educational opportunities, technical expertise and encouragement, Promoting the responsible and sustainable use of traditional foods, also called subsistence foods, and conducting a community food needs assessment in 2012.

Throughout their programs, the food network takes into consideration health equity as well as cultural competence. For example, they try to provide assistance so that those in the community who may be at a economic disadvantage can also participate in and purchase healthy, local produce. Also, their promotion of sustainable use of traditional or subsistence foods includes collaborating with the Alaska Native communities to promote foods such as local salmon, halibut, cod, herring eggs, deer, berries, seaweeds and other foods that were traditionally consumed by the Tlingít, Haida and Tsimshian diets before non-Native Alaskans arrived in Sitka.

healthy food programs systems public health accreditation board phab community health population health
Fresh, organic produce at a farmer’s market. Photo © Jillian Regan 2017 courtesy of Jillian Regan Photography, LLC.

St. Peter’s Fellowship Farm

This community farm was created in partnership with the Sitka Local Foods Network and St. Peter’s By-The-Sea Episcopal Church. Community members organized by the Sitka Local Foods Network built raised garden beds on the church’s land. Local contractors provided the soil. Engaging people from all different sectors of the community was an important aspect of the project, involving different groups, like elementary school students who were involved with planting, weeding, harvesting some of the crops. Celebrated. The opening of the farm was celebrated a big community potluck, featuring healthy produce from the gardens.

Sitka Farmer’s Market

This farmer’s market was created and operated by the Sitka Local Foods Network initially as a way to sell off the extra produce from the St. Peter’s Fellowship Farm. Over time it grew to include other local vendors as well as vendors from other parts of the region. One interesting aspect of this program is that it partnered with the Alaska Native Brotherhood and the Alaska Native Sisterhood to use part of their building and parking lot for the farmer’s market. Another is how it was adapted to accept SNAP benefits to help those at a economic disadvantage being able to purchasing healthy foods from the farmers market.

Later on the Farmer’s Market added an additional program, Quest cards, once the program realized that even with SNAP benefits, the healthy produce at the farmer’s market was too expensive. Quest cards are a Sitka initiative to encourage families who qualify for SNAP to buy healthy food from the farmer’s market. The Quest card gives the participants $1 for every dollar spent on purchase of healthy foods at the farmer’s market to encourage and enable them to buy fresh, healthy produce from the farmer’s market instead of buying unhealthy foods from convenience stores.

healthy food programs systems public health accreditation community health assessment
An outdoor farmer’s market. Photo © Jillian Regan 2017 courtesy of Jillian Regan Photography, LLC.

Garden Mentoring Program

This program run by the Sitka Local Foods Network provides education, training, and technical assistance to local organizations or citizens who want to grow their own gardens to increase the amount of food grown and harvested locally. This helps provide those without previous experience gardening with valuable resources.

Sick-A-Waste Sitka Composting Project

As a companion project to the Garden Mentoring Program and St. Peter’s Fellowship Farm, this initiative by the Sitka Local Foods Network was to create a community compost with contributions of compostable waste by community members that could be turned into compost used in community and family gardens.

Sitka Kich

A commercial kitchen for community members to use for for processing and canning the food grown, harvested, farmed, or caught locally was created through the Sitka Local Food Network partnering with: the Sitka Conservation Society, the Sitka Health Summit, the First Presbyterian Church, the Sitka Food Co-op, the Sustainable Southeast Partnership and the University of Alaska-Southeast Cooperative Extension.

In addition to offering the use of a commercial kitchen, they hold classes teaching people how to can foods such as salmon and vegetables, with the idea of encouraging individuals in the community to create a cottage food industry of healthy, locally sourced foods.

A commercial kitchen is great for supporting healthy food programs because food safety is an important aspect of healthy food, that is sometimes overlooked when healthy food programs solely focus on nutritional value and healthy diet. Without proper equipment when preparing large batches of food for sale, there is a much higher risk of contamination of the food with pathogens, leading to an increased risk of contracting a foodborne illness for those who consume the food.

Serving local fish in school lunches

Local schools in Sitka now serve locally harvested fish once a week in the school cafeterias along with a coordinating educational program for the elementary school students that came to be as a result of a partnership between the Sitka Conservation Society, local schools, commercial fishermen, local seafood processors, the school food service provider, Sitka Native Education Program (SNEP), the Alaska Department of Fish and Game (ADF&G) and the National Park Service.

healthy food programs community health assessment public health board accreditation seafood
Filets of freshly caught fish at a market. Photo © Jillian Regan 2010 courtesy of Jillian Regan Photography, LLC

A Guide to Serving Local Fish in School Cafeterias

This guide was created to help other schools in similar communities, such as those in Southeast Alaska, adopt similar programs. It provides details on the organizations and process involved with getting local fish to be served in school cafeterias as well as getting the students interested in and excited about eating the  

Stream to Plate Fish to School Classroom Lessons

This document includes lesson plans, worksheets, and picture cards for teaching a program called “Stream to Plate” about the local fishing industry to get young students excited about and interested in learning more about the fish they’re eating in the cafeteria for lunch. The lessons are geared towards 2nd to 5th grade elementary school students.

healthy food programs public health accreditation board community health assessments fish
Fresh seafood at a market. Photo © Jillian Regan 2010 courtesy of Jillian Regan Photography, LLC

Sitka Seafood Festival

Held every year to celebrate local seafood, this festival includes a contest where people make a fish dish and judges award prizes, such as Alaska Airline tickets. Including locally harvested seafood as well as celebrating the different cultures within the community helps to emphasize the cultural importance of seafood as well as its nutritional, environmental, and economic importance.

healthy food programs public health accreditation board accreditation community health assessment restaurant
A seafood dish. Photo © Jillian Regan 2011 courtesy of Jillian Regan Photography, LLC
Sharing

In addition to having some very interesting healthy food programs including a focus on health equity, the Sitka Health Summit shares information about their programs in order to inspire and inform other communities looking to start, grow, or improve their healthy food programs. One way they share about their healthy food programs is through Live Stories. LiveStories is an all-in-one data platform makes it easy to analyze local data, get benchmarks, and create interactive stories. The Sitka Health Summit’s Live Story on their healthy food programs includes interactive graphs of data such as the difference between food costs in Sitka compared to the US average, two other cities in Alaska–Juneau  and Anchorage–, and two cities in mainland US — Seattle, WA, and Portland. Check out the Sitka Health Summit LiveStories page to take a look at these data visualizations and narratives.

Another way Sitka’s healthy food programs get shared with others in the public health or community development field is through discussing their healthy food programs in online webinars. Loyd Platson, with Sitka Counseling and who is on the board of the Sitka Health Summit recently told the story of and shared details about Sitka’s healthy food programs on LiveStories webinar on the topic of Healthy Food Access on February 13, 2018.

healthy food programs systems public health accreditation board community health assessment
A customer buying fresh produce from a vendor at a farmer’s market. Photo © Jillian Regan 2017 courtesy of Jillian Regan Photography, LLC.
Conclusion

Partnerships with a multitude of organizations in a collaborative, community driven process, that includes a focus on health equity have created innovative healthy food programs to increase access to healthy foods in Sitka, Alaska. By looking at the example of the Sitka Health Summit’s healthy food programs other communities may be able to use ideas, lessons learned from these programs in Sitka and find ways that will help create or improve on existing healthy food initiatives in their own community in ways that may provide additional resources to those most at risk or at a disadvantage compared to the rest of the community so that more of the community can access and benefit from the healthy food programs.

Are there healthy food programs similar to these in your community?

Share a link below to a website, article, about the healthy food program so everyone reading the comments can check them out!

Jillian Regan, MPH is a consultant at Rillian. She enjoys helping organizations find new ways or evaluate improve existing community health improvement efforts, so that the organization can better serve its community members, clients, customers, patients, or other stakeholders. Connect with her by email at Jillian.Regan@RillianConsulting.com or Twitter (@JillianReganMPH) or LinkedIn.

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Systems and Software for Six Sigma Projects: Review of SixSigma Guide Software

Six Sigma is a quality improvement methodology that organizations in many different fields utilize to improve their organization’s processes and performance.

A systematic way for keeping track of Six Sigma projects is essential to being able to effectively use Six Sigma to improve the processes and performance of the organization. It is also important that this system is standardized throughout the organization and that all employees who will be using it are trained on how to correctly use it.

A good system will include a way to decide if the problem identified is enough a problem to be addressed in a Six Sigma project, before proceeding to conducting a Six Sigma project. In addition there should be a way to track both the impact of the problem and solution on the customer (voice of the customer) as well as on the business (voice of the business). It is important to document attributes of the data that is to be collected, such as if it is ordinal scale or nominal scale, to make it easier to keep track of which types of statistical analysis are appropriate to apply to the data.

One way to have a good system for Six Sigma projects could be to use a software program specifically designed for this, such as SixSigma Guide. SixSigma Guide is a software guide designed specifically for Six Sigma Projects.

quality improvement strategic planning
The homepage for SoftLogic, with SixSigma guide on the far right and two other software programs on the left and middle.

About SixSigma Guide:

  • It was created by Dr. Reiner Hutwelker
    • He is a business consultant,
    • Master Black Belt in Six Sigma,
    • and an adjunct professor at Hochschule für angewandte Wissenschaften München and Management Center Innsbruck in Eresing, Germany.
  • More details about the software can be found here (orginal website is in German-will need to have your browser translate it): http://www.softlogik.de/p_sigmaGuide_description_de.html
  • There is a trial version of this software available at http://www.softlogik.de/p_service_download_de.html
  • Note: this software tool does not provide the statistical analytic capabilities needed in most Six Sigma projects, so a statistical software program like R, SAS, Minitab, or Stata can be used for statistical analysis of the data in conjunction with this software tool

Review of SixSigma Guide:

  • This software is a useful and practical tool, although it may not be the right fit for every organization. It was clearly developed by a Master Black Belt in Six Sigma who used his many years of practical experience in conducting Six Sigma projects as well as in educating future Six Sigma quality improvement professionals. This software is relatively easy to learn how to use for people who are familiar with other software like Microsoft Excel. One of the best things about it is that it walks the user, step by step through the whole Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) cycle. Instead of having all these steps and sub-steps saved in different spreadsheets in folders on a shared drive, with this software, everything can be kept track of in one place.
  • While it is functional and relatively user friendly, I feel that in order to be more marketable the design of the user interface might need to be enhanced. While it is perfectly functional, people have become used to seeing beautifully designed software programs. Large organizations may also wish to be able to customize it with their logos and branding when implementing it across the organization.
quality improvement
A screenshot of the download page to download the SixSigma Guide software. The option to download the free trial is listed first. Both English and German slides with examples of using the software for a Six Sigma project are linked below the download link.

Another way could be to use a combination of different types of software the organization is currently using, such as Microsoft Excel or Google Docs, combined with a file sharing system, such as a server or cloud based storage solution, such as DropBox, so that all stakeholders who need access to the projects can easily access it.

Whichever systems and software you choose to use, it is essential that it there is a systematic and standardized way of conducting and keeping track of Six Sigma projects across your organization.

I’d love to hear your thoughts! Have you used SixSigma Guide software or a similar software for Six Sigma projects? What do you think about it?

Disclaimer: This is an independent review of software, I am not sponsored in anyway by any of the software companies or individuals listed or reviewed in this article. None of the links are affiliate links. I am just sharing my thoughts about software that could be useful for Six Sigma projects. I learned of this software while taking an online course on Six Sigma, from the Technical University of Munich (TUM) in Germany and edX.org, in which Dr. Hutwelker was a guest lecturer.

Jillian Regan, MPH is a consultant at Rillian. She enjoys quality  improvement using data to improve processes within the organization, so that the organization can better serve its clients, customers, patients, or others. Connect with her by email at Jillian.Regan@RillianConsulting.com or Twitter (@JillianReganMPH) or LinkedIn

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Ways to Break Down Data Silos Within and Across Organizations

data silos analysis consultant analyst consulting virginia
Silos in Harrisonburg, VA. Photo: © Jillian Regan 2011

In the information age, organizations and departments within organizations often encounter the problem of data existing in silos, where one department or organization cannot easily access data that they need for a project from another department or organization. This can lead to inefficiencies, such as having to stop a project and use time and resources just to retrieve the data needed before the project could continue.

Keep in Mind the Goals for the Data Project

It is important to keep in mind the organization’s problem or goal which the data project needs to measure or address.(1)  Focus on that first instead of seeing what data may already be available. While it could be more time and resource intensive, the goal of the project may require new data to be collected because there is not existing data that meets the needs of the project.

Support from the Top and From All Involved

The executive team should be supporting and leading the effort as well as involving the managers of each department.(1) Also, staff involved in all levels of data collection, data entry, and data analysis should be aware of and involved to some degree in the organization’s effort to reduce data silos. Other staff who may not be directly involved in inputting the data should also be made aware of and engaged to some degree in the process of reducing data silos.

Make a New Framework for Data Collection

After breaking down silos, or when collecting new data, make a plan or framework for how the data can be integrated for all the stakeholders so that new data silos are not created.(2) For example instead of separate data files being stored on separate computers, have a shared drive that can be accessed by those who need access to that data across departments or organizations. (3)

Training and Relationship Building

Enhancing knowledge of other’s data needs and increasing trust between people from different departments or organizations is key to breaking down data silos and improving data sharing.

Workshops and learning lunch events are one way to do this. These bring people together to learn about what other departments, organizations, or projects needs, as well as create an atmosphere where people can connect with one another and improve their working relationships. (3)

Documentation is Key

Keep track of data sources, i.e. where the data came from. This is vital to understanding the data. This will also make it easier to know where to go to get updated data as needed. It is also essential to do when having teams of people working on the data project, so that everyone will be on the same page.

Have a system for keeping track of the person or persons to reach out to for specific data and their contact information who may be in a different department, on a different team, or from another organization.

data silos analysis virginia analyst consultant
Silos on a farm in Virginia Photo © Jillian Regan 2011

Examples of Breaking Down Data Silos:

Breaking Down Data Silos Across Different Research Topic Areas

A recent study included a collaboration with multiple sectors: researchers, a children’s hospital, and a police department to use sources of data–spatial video and geographic information systems (GIS)–that was able to provide insights into two different research topic areas–active school transport (AST) and child injury research– in which the data was usually siloed in different research projects.(4)

State Government Initiative for Open Data Portal

The state government of Virginia (in the United States) has an initiative of creating an open data portal, Data VA, of non-sensitive, public information that is made freely available for public use in an easily readable format.(5) At Datapalooza 2017, Virginia Secretary of Health and Human Resources, Bill Hazel, spoke about the need for the different sectors of state government to need to go horizontally across sectors in order to best be able to serve people because no one person whom they serve only fits into only one of the sectors. (6) He also spoke about the need for ethical use of data for a public purpose.

data silos analyst analysis consultant consulting virginia
Silos in Harrisonburg, VA. Photo © Jillian Regan 2011

Conclusion

Breaking down data silos can allow organizations or departments within organizations to access data that will provide valuable insights into their organizations. This article presented a few ways in which to do this.

I’d love to hear from you about your ideas! Has your organization or department had success in breaking down data silos? What are some of the ways in which they were able to do this?



Sources:

  1. Wilder-James, E. Breaking Down Data Silos. Harvard Business Review. December 5, 2016. https://hbr.org/2016/12/breaking-down-data-silos
  2. Goh, G. The Danger of Data Silos, Part 3: How To Bring Them Down. Bedrock Data Blog. 2017. https://www.bedrockdata.com/blog/the-danger-of-data-silos-part-3-how-to-bring-them-down
  3. 5 Ways To Avoid Project Data Silos. Ten Six Consulting. June 4, 2014. https://tensix.com/2014/06/5-ways-to-avoid-project-data-silos/
  4. Schuch L, Curtis JW, Curtis A, Hudson C, Wuensch H, Sampsell M, Wiles E, Infantino M4, Davis AJ. Breaking Out of Surveillance Silos: Integrative Geospatial Data Collection for Child Injury Risk and Active School Transport. J Urban Health. 2016 Feb;93(1):36-52. doi: 10.1007/s11524-015-0006-9. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794455/
  5. Data VA: Virginia Open Data Source Portal. 2017. https://data.virginia.gov/
  6. Hazel, B. Introduction to UVA Data Science Research Highlights Presentations at Datapalooza 2017. November 10, 2017; Charlottesville, VA.

Cross Sector Collaborations Addressing Population Health Issues

Cross sector collaborations can be a great way to address population health issues. There are myriad ways and types of cross sector collaborations as well as a variety of types of organizations involved in cross sector collaborations. Here are a few examples of current or recent collaborations.

Examples

Engaging Youth in Building a Culture of Health — Collaboration between the National 4-H Council, the Robert Wood Johnson Foundation, the national Cooperative Extension System, and Local Health Councils

The National 4-H Council is partnering with the Robert Wood Johnson Foundation, the national Cooperative Extension System and local Health Councils in 1,000 different communities in the U.S. with a focus on engaging youth in to promote a culture of health in their communities. (1).

The 4-H organization is a youth development organization that focuses on empowering youth to by providing youth with experiences that help to develop critical life skills. The Robert Wood Johnson Foundation works to improve health and health care, with an emphasis on creating a culture of health.

This new partnership will focus on involving youth in addressing top public health priorities in cross-sector collaborations between the youth and community members, local public health organizations, businesses, government entities, and non-profit agencies. Three main focus areas of this partnership will be designing a network to promote health and wellness  in communities, creating and disseminating tools for healthier communities, and launching a training curriculum for local community advocates. The network, tools, and curriculum created from this partnership will be able to be applied to other communities in the U.S. (1)

Opioid Addiction Treatment through Telemedicine in Rural Communities– a Cross-Disciplinary Team

The opioid addiction epidemic is a serious and severe population health issues. Many different organizations are working to address this issue. One way is through cross sector collaboration. An example is a cross disciplinary team of psychiatrists, a nurse practitioner, and a social worker from the University of Maryland School of Medicine and health system working with a non-profit organization to develop and implement opioid telemedicine programs in rural communities as part of Robert Wood Johnson Foundation’s Clinical Scholars program.(2)

Collaborators:

  • Eric Weintraub, MD, director of substance abuse services at University of Maryland School of Medicine (UMSOM)
  • Seth Himelhoch, MD, professor of psychiatry at UMSOM
  • Jewell Benford, LCSW-C, a lead social worker at UMSOM,
  • Marian Currens, director of chemical dependency, University of Maryland Medical System
  • Wells House, a non-profit providing recovery services to community members battling drug and alcohol dependencies in Hagerstown, MD

NACCHO – FDA – Health Departments Collaboration to offer a Mentorship program to improve and standardize Retail Food Regulatory programs

Having robust, standardized retail food protection programs can improve food safety inspections and help to reduce the risk and occurrence of foodborne illness outbreaks in retail food establishments.

The National Association of City and County Health Officials (NACCHO) and the Food and Drug Administration (FDA) connect retail food regulatory programs (RFRP) that are looking to improve and standardize their retail food protection services with mentors from RFRP’s that are already experienced with implementing the FDA’s Retail Food Regulatory Program standards.(3) The FDA’s RFRP standards are a set of 9 standards that focus on the improving the design and management of existing RFRP’s so that they can better provide their services to reduce risk factors that contribute to foodborne illnesses in their jurisdiction. (4)

In addition to facilitating the mentorship experience NACCHO and the FDA provide funding for both the mentee and the mentor RFRP’s. Other assistance is also provided, such as sharing of policies, procedures, tools, and technical assistance to help RFRP’s implement the FDA’s RFRP standards to better be able to improve food safety in their community or jurisdiction.(5)  

Conclusion

Learning about different cross sector collaborations has hopefully given you some ideas for how your organization or an organization you work with can collaborate with other organizations in different sectors to address a population health issue.

Organizations collaborating in cross sector collaborations can come from a variety of industries, ranging from the federal government, national non-profits focused on supporting local health officials or creating a culture of health, university hospitals, health departments, and more. Cross sector collaborations can be a great way to address population health issues.

Do you have any examples of cross sector collaborations working to improve community health issues, or have you or your organization been a part of a cross sector collaboration that you would like to share about? Then leave a comment below!

Jillian Regan, MPH is a consultant at Rillian. She enjoys providing technical assistance to organizations, so that the organization can better serve its clients, customers, patients, or other stakeholders. Connect with her by email at Jillian.Regan@RillianConsulting.com or Twitter (@JillianReganMPH) or LinkedIn

Follow Rillian on Facebook to get updates on articles like this one or updates about current projects, like a bicycling survey!



 

Sources:

  1. National 4-H Council and the Robert Wood Johnson Foundation Partner to Empower Youth in Creating Healthier Communities. Robert Wood Johnson Foundation. Retrieved 9/14/17 from https://www.rwjf.org/en/library/articles-and-news/2017/09/national-4-h-council-and-rwjf-partner-to-empower-youth-in-creating-healthier-communities.html
  2. Felix, K. New Leaders Use Telehealth—and Teamwork—to Tackle Opioid Use. Robert Wood Johnson Foundation. Retrieved 9/26/17 from https://www.rwjf.org/en/culture-of-health/2017/09/new-leaders-use-telehealth-to-tackle-opioid-use.html
  3. National Associated of City and County Health Officials (NACCHO). NACCHO Mentorship Program. Retrieved 11/5/17 from https://www.naccho.org/programs/environmental-health/hazards/food-safety/mentorship
  4. Food and Drug Administration (FDA). 2015. Voluntary National Retail Food Regulatory Program Standards – Introduction. Retrieved 11/5/17 from https://www.fda.gov/downloads/Food/GuidanceRegulation/RetailFoodProtection/ProgramStandards/UCM372399.pdf
  5. National Associated of City and County Health Officials (NACCHO). Retail Food Program Standards Flyer. Retrieved 11/5/17 from https://www.naccho.org/uploads/downloadable-resources/Retail-Program-Standards-Mentorship-Program-Flyer.pdf

Public Health Accreditation Board (PHAB) Accredited State and Local Health Departments

Public Health Accreditation Board (PHAB) Accreditation is a set of nationally recognized standards in the U.S. that are intended to improve the quality and performance of all public health departments, whether they are Tribal, state, local, or territorial health departments.

As of this past August 2017, over half (51%) of state health departments are PHAB accredited, while another quarter (25%) of them are in the process of getting PHAB accredited. Less than a quarter (24%) of state health departments in the U.S. are not PHAB accredited nor in the process of getting PHAB accredited (Figure 1).

The percentage of state health departments that are PHAB accredited, in the process of getting PHAB accredited, or are neither PHAB accredited nor in the process of getting PHAB accredited as of August 2017. Data Source: Public Health Accreditation Board (PHAB). Accredited Health Departments as of June 2017. Graph: Rillian.

At the local level, only 21% of local health departments (LHD’s) are engaged in PHAB accreditation as of 2016. This percentage has increased greatly since 2013 when it was only 6% of LHD’s that were formally engaged in PHAB accreditation (Figure 2).

The percentage of local health departments (LHDs) that are formally engaged in PHAB accreditation between 2013 to 2016. Data Source: National Association of County and City Health Officials (NACCHO). 2016 National Profile of Local Health Departments. Graph: Rillian.

Only 4% of LHD’s are PHAB accredited as of 2016 with another 5% having just completed the application for PHAB accreditation, and 3% having registered in e-PHAB, the electronic system PHAB uses for document submission for PHAB accreditation application (Figure 3). Another 17% of LHD’s have plans to apply for PHAB accreditation in the future, but have not yet taken the first step of registering in ePHAB. Some LHD’s (31%) have not yet decided if they are going to apply for PHAB accreditation, while 20% of LHD’s have decided not to apply as of 2016 (Figure 3).

Local health departments (LHDs) level of engagement with PHAB accreditation as of 2016. Data Source: National Association of County and City Health Officials (NACCHO). 2016 National Profile of Local Health Departments. Graph: Rillian.

It should be noted that states vary in the structure of their public health department systems, so in some states, once the state health department is PHAB accredited, the accreditation may also apply to the LHD’s in states in which the local health department is essentially just an outpost of the state health department.

 

Summary

 

At the state health department level, most states (51%) are either PHAB accredited or in the process of becoming PHAB accredited (25%) while at the local level less than a quarter (21%) of local health departments are formally engaged in PHAB accreditation.

 

Check out PHAB’s interactive map of the PHAB accredited health departments to find out if your local, state, or tribal health department is accredited.

 

Sources:

 

  1. Public Health Accreditation Board (PHAB). What is Public Health Department accreditation?. Retrieved 9/4/17 from http://www.phaboard.org/accreditation-overview/what-is-accreditation/

 

  1. Public Health Accreditation Board (PHAB). Accredited Health Departments as of June 2017. Retrieved 8/15/17 from http://www.phaboard.org/news-room/accreditation-activity/


3. National Association of County and City Health Officials (NACCHO). 2016 National Profile of Local Health Departments. Retrieved 9/4/17 from http://nacchoprofilestudy.org/wp-content/uploads/2017/04/ProfileReport_Final3b.pdf

Ways to Include Environmental Health Data When Assessing Community Health–Using the Environmental Profile of a Community’s Health (EPOCH) Instrument

Rillian EPOCH Environmental Health Community Health Assessments

The Environmental Profile of a Community’s Health (EPOCH)

One way in which to conduct a study specific to the community is by using the Environmental Profile of a Community’s Health (EPOCH), a measurement tool designed for collecting data on environmental factors that are associated with cardiovascular disease (CVD) risk factors. EPOCH measures both objective factors as well as subjective perceptions of the environment of community members.(1) EPOCH has two parts, EPOCH 1 that assesses the physical environment and EPOCH 2 is an survey of participants’ perceptions of environmental factors in their communities (2). This instrument has been tested in both urban and rural communities (n = 84) in 5 different countries on different continents  (Brazil, Canada, China, Columbia, and India) with a sample size of 2,360 individual respondents, or an average of 28 respondents per community surveyed, and found to be a reliable measure (reliability > 0.8) for all of the community-level measures.(1) 

 

EPOCH In Use in Recent Studies

The EPOCH instrument was used to collect data on these CVD risk factors in a large city in Southeast Asia (Karachi, Pakistan), an area in which there has not been a lot of research conducted on CVD environmental risk factors.(3)

  • This study focused on two different middle to high income communities in Karachi with a study population of young adults 18-25 years old (n = 120).
  • These communities were found to be exposed to CVD risk factors in their environment, such as a high proportion of tobacco shops and fast food restaurants compared to recreational parks and vendors or stores selling fresh fruits and/or vegetables, as well as perceive tobacco use by men as socially acceptable in their communities.

The EPOCH instrument was recently adapted for use with a photographic evaluation of the community built environment, and called the EPOCH Photo Neighbourhood Evaluation Tool (EP-NET). (4)

  • This method was found to be a reliable and reproducible way (intra-class correlation for most (87%) of the survey items  of > or = 0.70) to assess these specific built environment factors across a diverse, international range of communities. EP-NET involves a systematic method for taking and analyzing the photos.
  • Link to EPOCH EP-NET Survey Instrument. Source: Source: Corsi et al 2014. (4)
  • Link to EPOCH EP-NET Instruction Manual. Source: Source: Corsi et al 2014. (4)

Another study used EPOCH to specifically study one CVD environmental risk factor, tobacco advertising, across both urban (n = 235) and rural (n = 227) communities  in 16 different countries with 11,842 individual study participants. (5).

  • Lower-income countries were found to have higher levels of tobacco marketing than higher income countries.
  • However, even in countries that had ratified the (FCTC), there were still high levels of tobacco marketing.
  • Almost half (45%) of study participants reported seeing at least one type of tobacco ad, and 10% reported seeing at least 5 types of tobacco marketing in the 6 months prior to the survey.
  • Urban communities were found to have higher intensities of tobacco marketing than rural communities.
Cardia Disease Environmental Health
Hollow log shaped like a heart outside in the environment at Kemper Park, Charlottesville, VA. Photo © Jillian Regan 2017

Conclusion

EPOCH is an instrument that can be useful for measuring environmental CVD risk factors when assessing the community’s health. It has been found to be reliable in both urban and rural communities as well as across a diverse range of countries at various levels of development.

Links to the PDFs of the EPOCH survey instruments:

 

Sources:

  1. Corsi, DJ; Subramanian, SV; McKee, M; Swaminathan, S; Lopez-Jaramillo, P; Avezum, A; Lear, SA; Dagenais, G; Rangarajan, S; Teo, K; Yusuf, S; Chow, CK. (2012). Environmental Profile of a Community’s Health (EPOCH): an ecometric assessment of measures of the community environment based on individual perception. PLoS One;7(9):e44410. doi: 10.1371/journal.pone.0044410. Epub 2012 Sep 4.
  2. Chow, CK; Lock, K; Madhavan, M; Corsi DJ; Gilmore, AB; Subramanian, SV; Wei, L; Swaminathan, S; Lopez-Jaramillo, P; Avezum, A; Lear, S; Dagenais, G; Teo, K; McKee, M; and Yusuf, S. (2010). Environmental Profile of a Community’s Health (EPOCH): An Instrument to Measure Environmental Determinants of Cardiovascular Health in Five Countries. PLoS One. 2010; 5(12): e14294.Published online 2010 Dec 10. doi:  10.1371/journal.pone.0014294
  3. Hussain, MA; Noorani, S; Khan, A; Asad, H; Rehan, A; Kazi, A; Baig, MZ; Noor, A; Agil, A; Bham, NS; Khan, MA; Hassan, IN; and Kadir, MM. (2015). The Role of Neighborhood Environment in Promoting Risk Factors of Cardiovascular Disease among Young Adults: Data from Middle to High Income Population in an Asian Megacity. PLoS One. 2015 May 6;10(5):e0124827. doi: 10.1371/journal.pone.0124827. eCollection 2015.
  4. Chow, CK; Corsi, DJ; Lock, K; Madhavan, M; Mackie, P; Li, W; Yi, S; Wang, Y; Swaminathan, S; Lopez- Jaramillo, P; Gomez-Arbelaez; Avezum, A; Lear, SA; Dagenais, G; Teo, K; McKee, M; and Yusuf, S. (2014). A novel method to evaluate the community built environment using photographs–Environmental Profile of a Community Health (EPOCH) photo neighbourhood evaluation tool. PLoS One. 2014 Nov 4;9(11):e110042. doi: 10.1371/journal.pone.0110042. eCollection 2014.
  5. Savell, E; Gilmore, AB; Sims, M; Mony, PK; Koon, T; Yusoff, K; Lear, S; Seron, P; Ismail, N; Calik, KBT; Rosengren, A; Afridi, A; Rahman, O; Chifamba, J; zatonska, K; Mohan, V; Mohan, D; Lopez-Jaramillo; Avezum, A; Poirier, P; Orlandini, A; Wei, Li; McKee, M; Rangarajan, S; Yusuf, S; and Chow, C. (2015). The environmental profile of a community’s health: a cross-sectional study on tobacco marketing in 16 countries. Bulletin of the World Health Organization 2015;93:851-861G. doi: http://dx.doi.org/10.2471/BLT.15.155846