MOUNT VERNON — Following the 2018-2021 Community Health Assessment (CHA), the Knox Health Planning Partnership (KHPP) adopted the Community Health Improvement Plan (CHIP). Now the CHIP has reached its six month marker and is starting to address the needs of the county as identified by the assessment.
The questions in the CHA were Center for Disease Control certified, Health Department Quality Improvement Coordinator Carmen Barbuto explained. This allows the county to easily compare to other counties across the state, and states across the nation, that are all asking their own populations similar questions.
The CHAs are conducted every three years, Barbuto said. In past Knox County CHAs, questions focused more on qualitative data that answered how residents felt about the health of the community and their own health. The 2018-2021 CHA instead focused on the quantitative health data of the residents.
“Both are of equal value, but when it comes to measurable change and measurable benchmarks, and looking at the impact we’re making in this community, that raw data and that health data is so important,” Barbuto explained. “So that’s the reason that we did it in a different way this go-around.”
Though 2018’s information doesn’t compare well with the 2015 information gathered by the CHA, Barbuto explained that moving forward, the quantitative data will allow the KHPP to measure the impact their initiatives are having in the community.
The responses to the CHA, Barbuto said, identified three key priority areas for improvement in Knox County: Chronic disease, access to care and mental health and addiction. Once the priority areas are established, the KHPP gets to work on planning initiatives to help address the priority areas within a three year plan. KHPP gets together once a month to discuss progress and aims to inform the community of the progress on a regular basis, which will include annual updates and a final three year update to show what the community achieved over the course of the CHIP.
The chronic disease priority area encompasses obesity and poor rates of cardiovascular health, Barbuto explained, and also covers the “underlying” issue of tobacco cessation.
According to Barbuto, 73 percent of county citizens are overweight or obese, according to self-reported BMI; 35 percent have high blood pressure; 35 percent reported high cholesterol and 29 percent considered themselves sedentary.
Barbuto explained that the KHPP decided to tackle chronic disease by increasing access to healthy foods, creating access to a community-wide physical activity campaign and by initiating workplace wellness campaigns.
Within the last six months, the Local Food Council has offered to lead the community garden strategy, Barbuto said, which will address access to healthier foods. Currently, she said, the council is putting together an interactive map by assessing the landscape in the county of potential sites by identifying which areas are considered “food deserts,” which have low food accessibility.
The Workplace Wellness Team, a branch of the Creating Healthy Communities Grant and of the KHHP team, has been working to recruit local businesses to participate in workplace wellness. Six local workplaces including the Health Department, Job and Family Services, Burrow’s Packaging, The Knox Board of Developmental Disabilities, The YMCA and the Knox County Career Center, are currently enrolled in workplace wellness campaigns.
“It may be they pass a policy regarding healthy food at meetings. It may be that they have a healthy vending policy, a no soda policy. They may do some kind of fitness challenge,” Barbuto explained. “But the Workplace Wellness Team is really there to help guide their decision making and help them figure out what will work best within their agency.”
Barbuto explained that tobacco use rates, while still relatively high, have gone down over the years, but have not accounted for the addition of vaping and Juuls, chewing tobacco, and often don’t cover smoking rates for those under age 18. To address the issue, tobacco cessation specialists with the health department have been working to enroll individuals in cessation classes. Within 2018, Barbuto said, 205 individuals have been enrolled in cessation classes.
The Board of Health, Barbuto noted, also adopted a policy in support of Tobacco 21, a nationwide initiative to increase the smoking age to 21.
“Our Board of Health has done their due diligence and they’ve learned about what this policy is and what it may look like in Knox County and they have kind of adopted this supportive role in advocating for Tobacco 21 policy within Mount Vernon city,” Barbuto said. “And that’s also something that city council has looked at as well.”
Access to Care
Access to care is limited in Knox County, Barbuto said, not because there are not enough doctors, which she said is still a problem, but because the doctors and medical services, especially in preventative care and specialized care, tend to be concentrated to the city of Mount Vernon. Very specialized care, Barbuto said, can even require leaving the county.
Insurance can be a huge barrier in limiting county resident access to care, especially routine preventative care, Barbuto explained. With an average of 15 percent of residents falling at or below the poverty level, high deductibles or no insurance coverage whatsoever (11 percent of Knox County residents) limit resident access to routine preventative care.
Transportation also has been a barrier to care for Knox County residents, Barbuto said.
“We’re trying to close that gap and reduce those barriers,” Barbuto said. “The goal really behind that is a lot of times, people will wait and wait, and wait and then a lot of times their issue is so large that it takes months to recover and months to kind of get through whatever it is that they put off going to see the doctor for. Preventative care is so important.”
The KHPP, in partnership with the Health Department and Knox Community Hospital, has come up with a comprehensive list of providers that offer preventative care that includes information about which insurance’s the different providers accept, with the goal of removing some of the stress residents feel of finding a provider that they can afford. In future months, Barbuto said, KHPP, Knox Community and the Health Department will be working together to form a marketing and promotional plan to help raise awareness.
Within the access to care priority area, the KHPP is also looking at providing comprehensive sex-education through doctors offices “in terms of contraceptive education” and within area schools through “comprehensive preventative sexual education for our students and our teenagers,” Barbuto explained.
Roughly 19 to 20 percent of Knox County Parents, according to the CHA, don’t speak with their teens about risky behavior which includes drugs and alcohol use, as well as preventative sex-education, Barbuto said. So far, KHPP has identified two potential evidence-based comprehensive sex-ed health education curriculum, which Barbuto said will need further research and conversation about how they “may or may not” be introduced as a potential resource for students.
Mental Health and Addiction
Mental health and addiction was chosen as a priority area, according to Barbuto, because of the large amounts of drug abuse and misuse issues reported in the area. She explained that the approach to the priority area will be different because it will look at the issue of addiction through the scope of mental illness.
“So many times people want to talk about addiction and addiction solely and not just addiction and mental health, because they do go hand-in-hand,” Barbuto said. “We have big focuses on resilience and adverse childhood experiences. Basically, in the best way I know how to explain that is, when you look at someone, instead of saying ‘what’s wrong with you?’ you say ‘what happened to you?’
“So that’s sort of what our approach is right now, looking at strategies that help create a trauma informed community, so it changes everyone’s outlook to ‘what happened to you?’ ‘cause you can find a lot more empathy that way and I think that we’ll get a lot more done when focus on this idea that it’s not one single solitary issue, it’s a culmination of things that have gone on in people’s lives,” Barbuto continued.
The Resilience Team, a part of KHPP, has lead six showings of the film “Resilience: The Biology of Stress & The Science of Hope” to a total of 775 people in the community, Barbuto said. The films focus on adverse childhood experiences and how they effect adult health and also help teach the audience about trauma informed care.
“Just that initial viewing and just kind of getting that basic understanding of you know ‘this is something that is an issue’ leads to a lot of questions and it leads to a lot of people wanting to know more,” Barbuto said.
Three 2-day mental health first aid training sessions through Mental Health and Recovery of Licking and Knox County have been hosted in Knox County as well to teach attendees how to address to mental health crises.
Barbuto explained that the CHA revealed that nine percent of Knox County residents feel sad or depressed “consistently, every day, for two plus weeks.” Nine percent of the population of Knox County’s roughly 61,000 residents is more than 5,000 people, Barbuto said.
“That number was really scary to me because it was like ‘that’s a lot that’s a lot of people,” Barbuto said. “That’s 5,000 people in our county that are struggling with depression and all the, you know, risks of depression and what it could potentially lead to. But that is also 5,000 opportunities to really help someone and really change their life.”