2005 Model Practice Application (Public)

Mayor's Healthy Hometown Movement

Louisville Metro Health Department

The Mayor’s Healthy Hometown Movement (MHHM) is a long-term, multi-phase program led by Louisville Metro Health Department (LMHD). It is designed to change the culture in Louisville Metro (LM) to one in which physical activity and healthy eating are the norms. MHHM also strengthens the infrastructure for public health by uniting community partners and initiatives to improve health.

The nearly 700,000 residents of LM are the target audience for MHHM. It is estimated that more than 75% of adults have been reached via media, public speaking events, BRFSS surveys and direct community involvement.

Key elements to replicate MHHM are: (1) awareness of the need to improve health status; (2) broad base of commitment in the health system; and (3) involvement of a well-respected community role model.

Obesity and overweight exact a high toll on the health of Kentucky residents. The nearly two-thirds of Kentuckians who are overweight or obese are at increased risk for chronic conditions including diabetes, heart disease, arthritis, high blood pressure, asthma, and several forms of cancer. In October 2004, the University of Kentucky Prevention Research Center released a report entitled The Kentucky Obesity Epidemic, defining the scope of the problem by noting that only 29% of Kentucky adults engage in regular physical activity; more than a third of them do not participate in any physical activity. About 20% of adults eat the recommended five or more servings of fruits and vegetables a day. Kentucky’s young people did not fare much better. Approximately 15% of Kentucky high school students are overweight, with an additional 15% at risk for becoming overweight. Only 13% of high school students met the guideline for fruit and vegetable consumption. The report summary asserted, “Health campaigns, policy changes, and personal changes in eating and exercising habits have the best chance of slowing and reversing this epidemic.”

In Metro Louisville (ML) the Louisville Metro Health Department’(LMHD) Health Status Assessment Report 2004 listed the following alarming statistics:

• 59.6% of Louisvillians are overweight; of those, 28.6% are obese.
  
  
• 78% are not eating five or more servings of fruits and vegetable per day.
  
  
• 35% engage in no leisure time physical activity.
  
  
• 289 out of every 100,000 Louisvillians will die of heart disease, compared to 247 nationwide.
  
  
• 61 out of every 100,000 Louisvillians will die of stroke, compared to 58 nationwide.
  
  
• 9% of Louisvillians have been diagnosed with diabetes as compared to 6% nationwide

Increasingly concerned about the health status of his community, Mayor Jerry Abramson announced his 2004-2007 vision for a newly-merged Metro Louisville: “A Community All People Are Proud to Call Home.” As part of his strategic plan to achieve this vision, he included a goal to “improve quality of life,” by “transforming the Health Department to better focus on health promotion and education, disease prevention, reduction of health disparities...” To make this goal a reality, Mayor Abramson charged the Louisville Metro Health Department (LMHD) to be the lead agency in developing his Mayor’s Healthy Hometown Movement (MHHM), a long-term effort to coalesce community resources, programs and projects to promote healthier lifestyles and improve health status.

MHHM was rolled out with the following overall goal, “to create a community wide culture that encourages and supports healthy lifestyles by promoting increased physical activity (10,000 steps/day goal), optimal nutrition, healthy public policy and access to resources and facilities that bolster the stated goal.” MHHM is designed to be a long-standing, multi-phase program that will change the culture in Louisville Metro to one in which physical activity and healthy eating are the norms. It has been described by Adewale Troutman, MD, MPH, Health Department Director, as a “marathon, not a sprint,” in which community partners initiate cultural change in worksites, schools, health organizations, and neighborhoods.

Initial goals were set to focus attention on behaviors considered most relevant and most changeable for improving health—physical activity and healthy eating. Specific goals include:

• Increasing the number of people in Louisville Metro who engage in 30 minutes of moderate physical activity at least 5 days a week by 15%.
  
  
• Decreasing the percentage of overweight or obese people in Louisville Metro by 10%.
  
  
• Increasing from 22% to 38% the number of people in Louisville Metro who eat five or more servings of fruits and vegetables per day. Past and future Behavior Risk Factor Surveillance System (BRFSS)

The LMHD was assigned by the Mayor to be the lead agency in coordinating the MHHM. MHHM strengthens the infrastructure for public health and health improvement by uniting government partners—including Parks, Neighborhoods, Planning & Design and Transit Authority River City (TARC)—with corporate and community initiatives to improve health. Its approach is therefore truly comprehensive—reaching people at worksites, places of worship, schools, and in neighborhoods where they live. A comprehensive social marketing campaign carries the “Move It, Louisville” message via public service and paid advertising outlets, working to create a culture where healthy behavior is the norm. At the same time, LMHD has conducted outreach to local employers to assure a heightened awareness of the relationship of healthy employees to a vibrant workforce and reduced health care costs. They have beefed up collaborative efforts with Jefferson County’s Health Promotion Schools of Excellence program, to train teachers about the role of physical activity in health.

Stakeholders and partners participate at several levels. First, the MHHM Advisory Council is composed of all the major elements of the community that have significant influence on quality of life in Louisville, including corporations, educational institutions, healthcare providers, faith-based organizations, neighborhoods, government and the fitness industry, and academia. The Advisory Council meets quarterly to guarantee coordinated activities and evaluate new approaches and potential resources to further the goal of the movement. Members advise the Mayor and LMHD on direction, goals, objectives and opportunities for partner expansion. The Advisory Group is shifting to be increasingly collaborative, taking steps to define itself as a Coalition with partners sharing both ideas and resources.

To assure community input and quality assurance for Phase I of the MHHM (“Move It, Louisville”) LMHD convened the “Fitness Roundtable” comprised of representatives from academia and private and non-profit providers of fitness services. This group meets monthly to review “Move It, Louisville” progress and recommend related research and community involvement strategies.

Finally, at the grassroots community level, MHHM has created an environment in Louisville Metro in which interest in public health is especially high. LMHD staff have capitalized on this interest and have successfully initiated a Mobilizing for Action through Planning and Partnerships (MAPP) process to invite community involvement in improving health and quality of life. As this process moves forward, it will provide important input to the MHHM Advisory Council and Health Department, and help mobilize new partnerships for strategic action.

The LMHD has absorbed much of the costs of developing and supporting the MHHM. As lead agency, they contribute in-kind in the form of staff time from the Health Department Director, Public Information Officer, Administrator of Health Promotion and Education and two support staff. Funds that support employee time, as well as costs outlined below, have been either in-kind donations from LMHD or have come from Health Department General Funds.

• Advertising: $7,800
  
  
• Banners: $4,100
  
  
• TCC Incentives: $4,690
  
  
• MHHM shirts: $3,110
  
  
• Communications/PR: $9,999
  
  
• MHHM Mini-grants: $80,000

Other Metro government departments have made in-kind and financial contributions, as well. The Mayor’s Office communication staff have added MHHM information to Metro Intranet, and Health Department IT has added web links to the LMHD website. Metro Parks developed an on-line directory that highlights the many physical activity opportunities available within the more than 10,000 acres of Louisville’s parks and forests. Mayor Abramson convened the “Bike Summit” in February—an event that pulled together 200 area citizens and cyclists to develop plans for making Louisville a more bike-friendly community. TARC (Metro bus service) provided public awareness support via a student art contest to develop bus displays that will be used to promote physical fitness.

Tasks in implementation include:

• April - May 2004: Review of available data to assess needs
  
  
• May 2004: Convene Fitness Roundtable group
  
  
• Summer 2004: Development of MHHM Vision and Goal Statements
  
  
• September 2004/On: Identifying priorities for public health policy
  
  
• September 2004: Convene Mayor’s Healthy Hometown Movement Advisory Council, announce Phase I “Move It, Louisville” and Take Charge Challenge (TCC)
  
  
• September 2004: Kick-Off Event for MHHM and TCC
  
  
• October 2004: Implementation of TCC program for Metro employees
  
  
• October 2004: Development of TCC materials to be shared with area employers
  
  
• January 2005: Initiation of a mini-grants program to fund community or faith-based initiatives to increase physical activity
  
  
• January 2005/On: Enhancing partnership with the district’s Health Promotion Schools of Excellence Program via training, in-kind support, and event collaboration
  
  
• January 2005: Increasing participation of the faith community by inviting them to participate and creating an Office of Faith & Health at the LMHD
  
  
• January 2005: Implementing strategies including the MHHM Mini-grants

Phase I of MHHM,"Move It, Louisville”, kicked off in September of 2004 with a half-day physical activity event that rolled out the TCC program to the Mayor’s most valuable resource—his Metro government employees. More than 900 employees signed up to participate in the 10-week voluntary program, which uses a team, as well as personal approach to physical activity. Participants set personal goals for regular activity and recorded it in 10-minute blocks of time, with the goal of being active 20 minutes most days (as recommended in the Surgeon General’s Report). Pre- and post-TCC assessments collect data about each participant’s stage of change and point goals. TCC training guides were copied and made available to share with area employers, as well.

Community partners have donated personnel time for service on the MHHM Advisory Council and the Fitness Roundtable. Metro government, the Greater Louisville YMCA and Powerhouse Gym, the University of Louisville and other local businesses donated incentives for TCC participants.

Giving participants the opportunity to have regular input to all aspects of the Mayor’s Healthy Hometown Movement ensures stakeholder commitment. MHHM Advisory Council members are encouraged to participate in one or more of the Advisory Council committees. The Fitness Roundtable gives physical activity practitioners and researchers a voice in the ongoing development and enhancement of the “Move It, Louisville” phase of MHHM.

Finally, the Mayor’s support for this movement in word (via public addresses) and deed (via his Strategic Plan for Metro Louisville) does much to secure the development of increased interest and new partnerships to improve the health of Metro citizens in all venues. Mayor Abramson is the only Mayor of Louisville to have been elected to three terms, including the first Mayor of the newly merged Metro in 2002. He has announced plans to run for another term.

Work to sustain MHHM over time is currently underway on several fronts. LMHD has placed a request in the upcoming fiscal year budget to support an annual BRFSS survey. Additionally, the Department has hired a Grants Coordinator, who will make application for related grant monies that might support ongoing program development. Leadership from the LMHD Director and the Mayor will certainly drive this process and encourage active participation. Perhaps most importantly, however, the MHHM Advisory Council is planning to move toward a coalition model, which will ask members to bring resources to the table. The initiation of the MAPP process will also coalesce community awareness of health issues and activate new partnerships to address specific health needs identified by Louisville Metro residents.

Regarding outcome evaluation, an initial evaluation was conducted through the use of the Metro BRFSS. Further, with the assistance of Metro Council members and academic partners, additional evaluative measures will be developed and implemented. LMHD plans to support Youth Risk Behavior Surveillance System surveys in the schools via the Health Promotion Schools of Excellence. Spalding University has developed a worksite wellness survey that will be mailed to area businesses to begin to collect information about how many companies have programs and which might be interested in developing them. Regarding the MHHM goals for longer-term changes in health behavior, data will be gathered and reviewed annually via the BRFSS.

For the TCC portion of the MHHM, data collection is ongoing and proposed to improve the program’s reach and effectiveness. LMHD collected stage of change information and point goals for all Metro government TCC participants, both pre- and post-TCC. In the first round of TCC, 15% of Metro employees participated; 79% of those either held or increased their physical activity stage (of change). Spalding University’s Health Psychology program faculty and students have proposed a study, which would collect survey data from all Metro employees to determine the best ways to move all employees toward participation in TCC and/or a higher stage of change. To date, they have completed an exhaustive review of literature about related worksite programs, and propose using this information with the data collected to develop a TCC “Gold Standard”.

Work is underway to arrange for the sharing of data and outcomes with MHHM Advisory Council community partners, as well.

MHHM is an increasingly worthwhile investment because it creates an environment in which residents, employers and developers can enjoy the benefits of a healthier lifestyle. The Mayor and the Health Department Director promote improvements in health and a more physical activity-friendly environment as important to economic development. As a result of MHHM, employers with employee wellness programs are coming together at MHHM Advisory Council and committee meetings to share their experiences and outcomes. Additionally, MHHM has played a significant role in creating a supportive milieu for the MAPP project to reach out to and involve the community in planning for improved health. The mini-grants program and faith-based initiative of the LMHD—which will address health disparities in a meaningful, ongoing way—came out of the MHHM, as well.

Regarding unintended consequences, MHHM has led to a groundswell of awareness about the health status of the community and an interest in participating in decision-making to make improvements. The Mayor’s support of the Movement has generated interest especially among employers with whom LMHD had worked with only in a limited way previously. Finally, it has provided an effective public platform for public health to provide leadership to improve the quality of life in LM.

Indeed, MHHM has made significant progress toward the Mayor’s overall goal for the movement: creating a community wide culture that encourages and supports healthy lifestyles by promoting increased physical activity (10,000 steps/day goal), optimal nutrition, healthy public policy and access to resources and facilities that bolster the stated goal. Regarding the physical activity aspect of the goal, TCC (physical activity focus) has entered a second round of participation among Metro Government employees, and has been shared with several large employer groups, who have committed to implement it within the next six months. Planning for Phase II of MHHM—“Lose It, Louisville” (for optimal nutrition) is underway via a MHHM Advisory Council Public Awareness Committee. Health policy is being addressed for bicycle safety and related environmental changes, and developing new green spaces and public trails via Metro Parks. Final