The following is an excerpt from a recent podcast in which NACCHO interviewed Dr. Wilma Wooten, MD, MPH, Public Health Officer, County of San Diego Health and Human Services Agency. This interview was originally recorded at NACCHO Annual 2014.
- Live Well San Diego is a 10-year initiative to transform the health and well-being of all San Diegans. Has the initiative started?
Wooten: Absolutely. The visioning for the Live Well San Diego actually began in 2008. There are three components. It is a long-term vision because we recognize we aren’t going to stop after 10 years. It’s a long-term vision to support healthy, safe, and thriving communities throughout San Diego. The three primary components are Building Better Health, which was approved by our Board of Supervisors in July 2010. The second component, Living Safely, was approved by the Board of Supervisors in September 2012. We anticipate the third and final component, which is Thriving, will be approved in fall of 2014.
- How long did it take to get this program approved and what were some of the hurdles you had to overcome?
Wooten: The first hurdle, or criterion rather, that needs to be in place is political will and the passion and commitment to such an effort. That was in place and it grew out of the vision of our agency director. What started as a focus within our health and human services agency grew to become a county-wide effort not only throughout our government but also throughout the geographic county of San Diego, engaging all of our partners at various sector-levels.
- Were there programs in other cities or counties that inspired Live Well San Diego?
Wooten: At the time when we started this journey in 2008, we weren’t aware of any other initiatives in other jurisdictions. Later as we were into the program, I became aware of Live Well Sonoma County, which is a county in California, and we ultimately became aware of all the other initiatives. But when we first started, it was just out of the organic effort within our county government to create healthy and thriving communities.
- What kind of results are you looking for in San Diego?
Wooten: The Building Better Health component is based on the 3/4/50 principle, which focuses on three behaviors that contribute to four chronic diseases that account for over 50% of death. So we’re looking at outcomes along that line. Living Safely is about resilient, safe communities and preparedness. The overall initiative has five areas of influence: health, finance, knowledge or education, community, and social. There are 10 leading indicators across those five areas of influence. We looked at nationwide resources—what’s going on in other communities, the Blue Zone, American Human Development Index, Gallup’s Principle of Well-Being—and that helped us to land on these five areas of influence. We wanted to select indicators that could be drilled down to the local level but also be measured at the national as well as state level.
- What is considered success for this initiative?
Wooten: Let’s start with some of the anticipated indicators—life expectancy; quality of life; knowledge; how many individuals finish high school; unemployment rates; safety in the community; the physical environment, which speaks to air quality, water quality; and the built environment (e.g., how many parks and sidewalks are in our community). And then looking at our vulnerable communities. How do we provide services for our elderly or for those individuals who are disabled? Are community members involved? Do they vote and volunteer? Those are some of the high-level indicators that we are measuring. We presented these indicators to our Board of Supervisors [in October 2013] and we’re going back in [September 2014] with a second report on where we are and what successes we’ve had.
We’ve begun to see results. We actually began to see results before Live Well was officially implemented. Based on the fact that we’ve seen results over the past 10 years, we anticipate that we will have results for these specific indicators. We’ve brought on over 50 community partners. We’re looking at heart disease and reducing incidences of stroke. We definitely have seen results there, specifically with stroke. When I first came to San Diego about 25 years ago, African-American males were far above the Healthy People objective; now, there’s almost parity—they are either at or just above the Health People 2010 objective. That’s occurred long term, but that’s even improved in the past several years.
We’ve also seen a reduction in obesity in our children. We have two examples of that. The first is the comparison of the Fitnessgram results, where the height and weight of fifth-, seventh-, and ninth-graders are measured. The UCLA Center for Health Policy and Research compared the results from 2005 with 2010. With that—and that’s with a coordinated initiative that is part of Live Well—we saw a 3.2% reduction in obesity. Then we have a local elementary school that is one of our Live Well partners. The principal committed to measure all of their 25,000 elementary students; they saw a 3% reduction in obesity as well. They are one of our partners and they’ve published a toolkit and we worked to make it available to all of the school districts in San Diego.
- What is the social engagement of Live Well San Diego like?
Wooten: When the first component of Live Well San Diego was approved by our Board of Supervisors, our operational regional managers immediately began to engage their community constituents. There are community collaboratives throughout San Diego. We actually have five representing the six operational regions for our health and human services agency where our regional managers and the Board of Supervisors engage community members in all sectors—healthcare, transportation, community-based organizations, faith-based organizations. We actually use that model to support our accreditation requirements for developing our community health assessment (CHA) and our community health improvement plan (CHIP). [Accreditation] was very synergistic from the beginning with Live Well San Diego and the requirement of having the CHA/CHIP for public health accreditation. So Live Well San Diego really is a foundational component for our accreditation requirements.
- What can other local health departments learn from your efforts in San Diego?
Wooten: San Diego is known for its public-private partnerships. I think again having the vision; having the political will, passion, and commitment to making a change in the community; and getting the community partners involved and letting the community know that public health can’t change the health of the community alone. It really requires involvement from all sectors throughout the community. Everyone has a role and everyone has a responsibility in contributing to the health of the community.
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