Creating a Culture of Health Rural Opportunities Conference 2018 Sharolyn Flaming Jackson Extension Specialist, Family and Consumer Sciences

K-State Research and Extension brings the university classroom to every county in Kansas. Local professionals addressing local needs through state and national networks and resources.

Thinking globally – acting locally Extension works in: Agriculture and Natural Resources Family and Consumer Sciences 4-H Youth Development Community Vitality and Development Local boards and program development committees work with agents to identify local needs and issues, and how KSRE can address those. We work to address 5 Grand Challenges – Health being one of those.

What is culture of health? What do we mean when we say “Culture of Health?” Use the analogy of fishing

Give a person a fish, and they eat for a day Give a person a fish, and they eat for a day. Teach a person to fish, and they know how to catch a fish. Give a person a fish, and they eat for a day. Teach a person to fish, and they know how to catch a fish. But what if that model, is no longer the most effective strategy? What if that is not the best way to arrive at the long term outcomes that we dream of --- in our well designed logic models? What if research shows us that providing educational efforts may increase knowledge, attitude, skills and aspirations but ultimately not long term behavior change? (THIS IS WHAT WE ARE REALLY WRESTLING WITH) Many of us in Extension are pretty deeply rooted in our history and impact, including myself – with 35 years in this thing called KSRE. We are so good at providing information – knowledge for life! We can educate as well or better than most. But what we are finding out, especially in the world of health, having the knowledge is not translating into behavior. We most figure out how to move the needle on health behaviors.   So, a change has been underfoot for the last few years, a change where “teaching a person to fish” is not good enough --- it is not creating the change that is needed. What if this was our new paradigm…

Give a person a fish, and they eat for a day Give a person a fish, and they eat for a day. Teach a person to fish, and they know how to catch a fish. Partner to create a culture of fishing in the community, and they can sustain themselves for a lifetime. This is what we mean by creating a culture of health.

Why is Health a Grand Challenge? What are the Health issues in Kansas? Going back to the grand challenges that KSRE is working to address – Why is health a Grand Challenge?

Why focus on Health? We live in a time when we no longer expect that American children will live a longer life than their parents. 25% related to genes and health behaviors 75% related to other things… Poverty, inequities among races and ethnicities, access to health care… etc. “Social and Environmental Determinants” of health According to the Centers for Disease Control and Prevention, genes, biology, and health behaviors together account for about 25% of population health. The remaining 75% can be attributed to the social environment, physical environment, and health services/medical care. (education, housing, work, environment, lifestyles, etc) Many of these population health disparities are due to poverty, inequities among minority racial and ethnic groups, and lack of access to health care. The impact of these factors are especially hard-felt by Kansans living in rural and frontier regions that are challenged by geographic & social isolation, and lack of access to consistent health care services and professionals. Lack of access to health care services and professionals is complicated by distance to health care services, high rates of poverty, and unique health conditions associated with working in agriculture. Rural communities also confront out-migration of young people leaving for education and employment, while elderly citizens age in-place, families living in poverty remain, and new immigrants migrate to the area in pursuit of jobs and social mobility. (Environmental determinants of health (e.g. access to parks and green areas, air pollution, road safety, urban solid waste treatment)) __________________________________________ In talking about health, we must take a holistic and broad approach. Research has consistently shown that only 25% of health outcomes are due to genes and the health behaviors that we practice across our lifespan; 75% of our health outcomes, rather, are due to the social and environmental determinants of health, such as poverty, inequities among races and ethnicities, access to quality health care and education, and physical environments (CDC, 2014). This fact singlehandedly shows that strategies to improve community health must include both individual and family-level interventions, but more importantly, community-level interventions. Center for Disease Control

Kansas Statistics KDHE… between 2013 and 2015 opioid addiction increased by 28% and heroin deaths by 71%. Both are on the rise. CDC and Dept of Veterans Affairs…. Farmers in some states have higher suicide rates than veterans… both too high. Obesity is 31% in all age groups over age 10 and 13% in 2-4 year olds (40th in the nation) Nearly 20% of our children are food insecure More than 12% poverty rate ……. A closer look at Kansas Statistics: Opioid Stats: According to the CDC, from 1999 to 2015, the amount of prescription opioids dispensed in the US nearly quadrupled, yet there has been no verifiable change in the amount of pain that Americans report. There are effective treatment options for opioid dependence, yet only 10% of people who need such treatment are receiving it. Closer look at Opioids in Kansas. KDHE – A recent report from the CDC highlighted 220 counties from across the country that are at a disproportionate risk for vulnerability related to opioid abuse and overdose. Kansas has four counties on that list – Woodson, Allen, Wilson, and Rawlins. Although we did only have four counties on the list (Kentucky has the highest rates at 54 out of 120 counties), it should be noted that 24 states did not even make the list. NEW PUB from Dr. Erin Yelland – Highlight steps individuals and communities can take to address this issue. (To be released in May) Suicide: In Kansas, death by suicide has increased 31% in the last ten years alone. In 2016, suicide was the 10th leading cause of death in Kansas – more than 500 Kansans died by suicide. Males made up 78% of these, and it is important to note that the least populated counties had the highest rates of suicide deaths in Kansas in 2016 – 26 per 100,000 in frontier counties.) One other statistic that merits our attention, is the occupation group of farmers, fishing and forestry had the highest suicide rate among all occupation groups in the nation – certainly relevant to our discussion around this issue in Kansas due to our focus on agriculture. Obesity: Contributes to a number of chronic diseases NEARLY 20% of our children are food insecure More than 12% poverty rate

Life Expectancy by Zip Code

Kansas County Health Rankings

What can KSRE do? What can you do? Nutrition and physical activity education Community zoning or guidelines Safe and adequate water supply Connections to help relieve farm stress, drug addiction, anxiety, etc. Social and emotional development to improve relationships We asked ourselves, KSRE, what can we do? Here are some possibilities and many other organizations – I’m sure – can see themselves doing the same things.

What can KSRE do? What can you do? Help families manage money to prepare for unknown expenses and retirement Help alleviate poverty Help youth connect in healthy ways to prevent bullying, anxiety, drug use, and other stresses of growing up Help communities prepare for emergencies

What can KSRE do? What can you do? Help people practice safety in the work environment Help people understand health insurance and how to access health care Work to create “healthy communities” SHICK -- $$ amount saved through KSRE efforts last year.

Health crosses all boundaries of KSRE Community Vitality Youth Development Agriculture Family and Consumer Sciences Crosses all boundaries ----- we are defining health broadly.

Involve community members We can’t solve the issues alone – it is going to take all Need community connections and collaboration Improvements needed in policies, systems and environments Not every community is in the same situation… many are already addressing issues and Extension may be involved

Extension Health Framework

National Health Framework… (The Cooperative Extension) model arose at a time when American agriculture was largely inefficient and only marginally productive. The consequences of the agricultural practices of the time were endangering our Nation’s economic, environmental, and personal health. A century later, American agriculture is without equal in its contributing food to a growing world population. We, and others, believe that this same system of Extension can do for the nation’s health what it did for American agriculture. Cooperative Extension’s National Framework for Health and Wellness, 2014

Healthy Communities What we (KSRE) are doing right now: Partnerships Facilitating conversations Helping create a “Culture of Health”

What is a Culture of Health? Health flourishes for all Health is a social value We have healthy environments in which to live, work, learn, and play Health care doesn’t burden the economy We make proactive healthy choices Health care is available to all Robert Wood Johnson Foundation

Give a person a fish, and they eat for a day. Teach a person to fish, and they eat for a lifetime. Back to the fishing analogy, and as I mention “fishing” think about “health” ------- Yes, at times we are giving a person a fish to tide them over And, we will be teaching a person to fish – to build capacity in individuals But that will not bring the outcomes we desire unless we also make sure and…. Create a culture where fishing is a part of the social norm, and this change is supported by family, friends and your community – that the norms and standards support fishing (Social Ecological model- interpersonnel and community) That the person can get an affordable fishing license and that policies are such that they have access to the lake – that may mean public lakes, or transportation available (organizational or public policy) That there are adequate lakes in the area with quality water and nutrients of a level that will insure quality fish being caught (organizational and public policy) And, throughout – data is helping us and the community understand the deeper issues that are supporting or preventing the person from being able to fish   We can no longer be just about “teaching a person to fish” – we need to be “engaging communities and partners in creating a culture of fishing”

Give a person a fish, and they eat for a day. Teach a person to fish, and they eat for a lifetime. Culture of health …. where the healthy choice is the easy choice to make   We can no longer be just about “teaching one about healthful behaviors, such as nutrition/exercise/not smoking, etc.” – we need to be “engaging communities and partners in creating a culture of health for all – where the healthy choice is the easy choice to make.”