Doing Things That Matter June 13, 2018 Presenting To Annual Arizona Biomedical Research Commission NAU-Center for Equity Research | Yuma Forum B. Michael Nayeri, NMD, FABMP, FACFE Director, Healthy Aging

(On Being a Catalyst for Community Change!) Improving Health Equity Through Collective Community Action Doing Things that Matter! (On Being a Catalyst for Community Change!)

Head & Heart Head Stuff….. Heart Stuff….. Where’s the evidence? Where’s the funding? Who are my partners? Measured outcomes? Sustainability? Heart My commitment? My confidence? Making a difference? Staying focused? My resilience?

Un-equal Opportunity

Before we drill down… Population aging is unprecedented, profound and pervasive Population aging presents enormous social, economic and political challenges for societies

Proportions Aged 65+ and Under Five: 1950-2050 Japan 43 55 Italy 42 51 Germany 42 49 USA 36 41 China 33 45

Chronic Disease Costs in Arizona Charges Diabetes $7,887,188,974 Lung Disease $3,810,191,045 Coronary Heart Disease $1,652,315,698 Stroke $1,231,308,356 Total $14,581,004,073 Source: Arizona Hospital Discharge Database

Hospitalization & ED d/c 2015 County Diabetes-related discharges Diabetes as 1st listed diagnosis Apache 1,839 189 Cochise 5,474 558 Coconino 5,114 373 Gila 3,252 287 Graham 2,527 188 Greenlee 391 22 La Paz 844 82 Maricopa 180,647 14,296 Mohave 15,848 1,098 Navajo 5,207 390 Pima 48,644 3,778 Pinal 23,817 1,631 Santa Cruz 2,505 182 Yavapai 10,598 819 Yuma 11,881 766 Total 318,588 24,659 Hospitalization & ED d/c 2015

In 2015, Apache County had the highest proportion of respondents consuming vegetables three times and fruits twice daily, 19.4%. Coconino County had the lowest, 4.3% (see Figure).

Know the Level of Engagement The Spectrum of Prevention Influencing Policy & Legislation Changing Organizational Practices Fostering Coalitions & Networks Educating workforce including Healthcare Providers Promoting Community Education Strengthening Individual Knowledge & Skills

Healthy Aging Falls Prevention Alzheimer’s Disease Chronic Disease Self-Management Alzheimer’s Disease Falls Prevention

Take Home #1 Know what works! Where’s the evidence? What holds promise? Comprehensive (360 degrees) approach Bold, High-Impact Messaging (formative research) Are there models that are relevant to the local context [Community-Centric]? Integration of National, State and Local Efforts – Who shares in our endeavor? Crossing traditional boundaries (new ways of thinking & doing)

Know what works….and remember: Achieving community health is everyone’s business. Evidence-Based (EvB) programs do NOT always work across all providers and communities. No one size fits all!

Fun/Challenge Opportunity or Dangerous?

Take Home #2 Listen……so that others will talk Take Home #2 Listen……so that others will talk! What does the community want? People’s experiences shape their perceptions Be quick to hear…..slow to speak Identify, develop & disseminate resources Address gaps in service/education e.g., De-structuring of resettlement programs [impact on non-profits] Develop & incubate pilot projects Change systems Advocate

“By joining together around an issue of mutual interest, organizations and agencies reduce competing and duplicative efforts. Also, there is strength in numbers; therefore, coalitions can be especially effective in addressing issues relating to policy changes and the enforcement of existing policies & laws.” - Organizations Working Together in Tobacco Control

Take Home #3 Leave a Legacy. Thinking beyond our lifetime. (urgency … Take Home #3 Leave a Legacy! Thinking beyond our lifetime! (urgency ….with a long view) Measured impact! What does success look like? Scalability Sustainability Change systems, not people! Create policies, not services! Take programs to people…..not the reverse!

A Catalyst for Change… (in countless present moments) Informed by the past…..and Anticipating the future……but Performing in the NOW!

Recapturing the Soul of Medicine In the daily toil of “getting things done:” We can describe what we do……and we can describe how we do it. But we can easily lose track of the “why.”

Are people suffering and/or dying of causes that could have been prevented or managed in a timely manner? Are people who are at risk of, or living with _____ better off because of our work? Do we deeply experience the privilege of serving these people?

https://youtu.be/Kq65aAYCHOw

Resources The Community ToolBox http://ctb.ku.edu/en/Default.htm Healthy Cities/Healthy Communities https://ctb.ku.edu/en/table-of-contents/overview/models-for-community-health-and-development/healthy-cities-healthy-communities/main Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities https://www.cdc.gov/obesity/downloads/CDCHealthEquityObesityToolkit508.pdf Healthy Rural Communities Tool Kit https://www.publichealthontario.ca/en/ServicesAndTools/Documents/LDCP/HealthyRuralCommunitiesToolKit%20compressed.pdf Berkowitz B, Wolff T. The Spirit of the Coalition (2000) Coalitions Work http://www.coalitionswork.com/

THANK YOU Dr. B. Michael Nayeri | Director, Healthy Aging Michael.Nayeri@azdhs.gov | 602-364-0868 azhealth.gov @azdhs facebook.com/azdhs