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Cortland County Health Department Community Health Improvement Plan 2013‐2017 60 Central Avenue Cortland NY 13045 Phone 607‐753‐5135 Fax 607‐753‐5209 http://cchd.cortland‐co.org CCHD Mission Statement: The mission of the Cortland County Health Department is to promote health, prevent disease, injury, and disability while enhancing the quality of the life within our community. ---PAGE BREAK--- The development of Cortland’s Community Health Improvement Plan was a collaborative process involving key leaders of Health and Human Services programs. The committees reviewed pertinent data and established priority areas for the Community Health Improvement Plan. Consideration was given to other community plans, including those of the Mental Health Department that includes mental health and substance abuse. In partnership with our local hospital, Cortland Regional Medical Center, we chose the areas of Chronic Disease and Healthy Women, Infants and Children as the priorities on which to concentrate through 2017. The assessment process, data analysis, choosing of priority areas and identification of community partners culminated in the development of a Community Health Improvement Plan. Spearheaded by Health Department teams (with representation from each program and job title), the plan clearly defines our path for health improvement over the next four years. The process was enlightening, informative and fostered real collaboration amongst staff. They are vested in the plan and the positive health outcomes that will result. ---PAGE BREAK--- Cortland County Health Department Community Health Improvement Plan 2013‐2017 Priority – Chronic Disease Focus Area – Reduce Obesity in Children and Adults Goal #1 – Create community environments that promote and support healthy food and beverage choices and physical activity Objectives Improvement Strategies Partners Timeframe Target Performance Measure 1‐Reduce the percentage of adults who are obese by 5% so that the age‐adjusted percentage of adults ages 18 years and older who are obese is reduced from 29.7% to 28.22% 1‐Establish complete streets policies within our municipalities. CCHD Municipalities Political figures Healthy Now Highway Dept. Dec‐16 At least 3 complete Street policies will be established in surrounding municipalities 2‐Initiate the creation and adoption of a multimodal transportation policy that will impact future road improvements in the City of Cortland and one on the SUNY Cortland Campus Local Business CCHD Municipalities Political Figures Healthy Now Highway Dept. SUNY Cortland Dec‐16 Multimodal transportation policy will be created and used in the City of Cortland and SUNY Cortland Campus 3‐Promote Walking Trails already available in community, including improvements to existing trails (Little York). Local Business CCHD Municipalities political figures Healthy Now School Districts SVHC On‐going Trails will be promoted and improvements to trails will be made 4‐Promote drinking 1% milk for all people over age 2. CCHD Pediatricians School Districts Day Care Centers On‐going Drinking 1% milk will be promoted 5‐Promote water as drink of choice in schools, on sports teams, workplaces. Local Business CCHD School Districts Physicians On‐going Drinking water will be promoted 6‐Include educational messages on drink choices, with food permits through Environmental Health CCHD On‐going Educational messages will be distributed with food permits from Environmental Health 7‐Encourage restaurants to offer a smaller portion menu/ half portion menu that is half the portion as well as half the price to people of all ages. Restaurant association School Districts SUNY Cortland students and professors City Youth Bureau Dec‐16 Restaurants will be encouraged to offer smaller portions ---PAGE BREAK--- 8‐Establish policies in a minimum of three worksites for sugar‐sweetened beverage and/or snack options for their employees. CCHD Businesses Mar‐16 Three worksites will establish policies surrounding healthy beverage and snack options 9‐Establish and promote the use of famers' markets and implement innovative strategies to increase access to healthy foods in high need areas. CCHD SVHC Sustainable Cortland Mar‐15 Farmers markets will be promoted throughout the community 10‐Implement the Harvest to Home campaign in two new community grocery stores in order to increase the availability and variety of fruits and vegetables as well as initiate an increase in overall shelf space for healthful food offerings. CCHD SVHC Local Businesses Mar‐15 Two new community grocery stores will implement the harvest to home campaign 2‐Reduce the age‐adjusted percentage of adults ages 18 years and older with and annual income less than $25,000 who are overweight by 5% from 23.1% to 21.9% 1‐Develop a template and plan for sustainable grocery store tours incorporating WIC food items and healthier shopping for Cortland County groceries stores. CCHD WIC Grocery Stores Mar‐ 15 A template will be created with local grocery stores in conjunction with the WIC program 2‐Establish an education plan to low income families receiving WIC on limiting sugary drinks, and stretching juices by adding water to dilute them. WIC June‐15 An education plan will be given to low income families receiving WIC regarding limiting sugar in beverages Goal #2 – Prevent childhood obesity through early child care and schools Objectives Improvement Strategies Partners Timeframe Target Performance Measure 1‐ Reduce the percentage of children and adolescents who are obese by 5% so that the percentage of public school children in Cortland County who are obese is reduced from 17.8% to 16.91% 1‐Establish policies within the day care centers and family day care homes for nutrition, physical activity and television screen time. Child Development Council YWCA/YMCA CAPCO FRC SUNY Cortland Daycare Jan‐17 Policies surrounding nutrition, physical activity will be established Cincinnatus Central School 7% OW, 32% OB 2‐Increase the number of schools that establish strong nutritional standards including reducing sugary drinks and promoting access to free drinking water. School Districts CCHD Jan‐17 At least three school districts will establish strong nutritional standards Cortland City School District 17% OW, 18% OB 3‐Assist schools in creating policies around wellness including nutrition and physical activity. School Districts CCHD Jan‐17 Schools will be assisting in creating new policies around wellness Homer Central School District 15% OW, 17% OB 4‐Establish policies within the before/afterschool programs to encourage physical activity and healthy snacks and reduced sugary drinks YWCA/YMCA CAPCO School districts Jan‐17 Policies will be created to encourage physical activity and healthy snacks and before and after school programs ---PAGE BREAK--- Healthy Now City Youth Bureau McGraw Central School District 11% OW, 17% OB 5‐Establish educational outreach to teens and young adults through Facebook with daily nutritional tips and facts CC Youth Bureau City Youth Bureau School Districts Jan‐17 Educational outreach about nutrition will be provided through Facebook Goal #3 – Expand the role of health care and health service providers and insurers in obesity prevention Objectives Improvement Strategies Partners Timeframe Target Performance Measure 1‐Increase the number of children and adolescents ages 3 through 17 years with an outpatient visit with the primary care provider or obstetrics/gynecology practitioner. 1‐Provide CRMC and primary care providers and obstetrics/gynecology practitioners with referrals to comprehensive youth programming in the county. Physicians CRMC CCHD Healthy Now Recreational Sports Jan‐17 Appropriate health care providers will receive and distribute referrals to comprehensive youth programming Priority – Chronic Disease Focus Area – Reduce illness, disability and death related to tobacco use and secondhand smoke exposure Goal #1 – Prevent initiation of tobacco use by youth and adults, especially among low socioeconomic status Objectives Improvement Strategies Partners Timeframe Target Performance Measure 1‐Decrease the prevalence of cigarette use by high school age students by 10% from 10.8% to 9.72%. 1‐Pursue policy action to reduce the impact of tobacco marketing in lower‐income and racial/ethnic minority communities. Tobacco Free Cortland CCHD Quest for Excellence NYSDOH Dec‐16 Policy will be created to reduce tobacco marketing in disparate communities 2‐Use media and health communications to highlight the dangers of tobacco promote effective tobacco control policies and reshape social norms. Tobacco Free Cortland CCHD Quest for Excellence NYSDOH On‐going Media and health communications will be used to highlight dangers of tobacco use 3‐Present Point of Sale information and educate on the dangers of tobacco to youth in the community. Tobacco Free Cortland CCHD Quest for Excellence NYSDOH On‐going The community will be educated on point of sale information 4‐Education that specifically informs teens of negative impacts of smoking that matter to their age group (i.e. dating, money, etc.) Tobacco Free Cortland CCHD Quest for Excellence NYSDOH On‐going Teens in the community will be informed of the negative impacts of smoking 5‐Keep the price of tobacco uniformly high by regulating tobacco company practices that reduce the real price of cigarettes through discounts. Tobacco Free Cortland CCHD Quest for Excellence NYSDOH Jan‐15 Discounts on tobacco will be limited throughout the community 6‐Educate and communicate with elected officials about the impact of retail tobacco product marketing on youth. Tobacco Free Cortland CCHD Quest for Excellence NYSDOH On‐going Elected officials will be educated on the impact of tobacco marketing on youth ---PAGE BREAK--- 7‐Approach NYSDOH to consider contracts in lieu of either fines or revocation that eliminate advertising of tobacco products in stores which are found to be in violation of ATUPA Tobacco Free Cortland CCHD Quest for Excellence NYSDOH Dec‐ 16 NYSDOH will be approached to consider the idea of contracts for those with violations of ATUPA 2‐Decrease the prevalence of cigarette smoking by adults ages 18‐24 years by 10% from 24% to 21.6%. 1‐Keep the price of tobacco uniformly high by regulating tobacco company practices that reduce the real price of cigarettes through discounts. Tobacco Free Cortland CCHD Quest for Excellence NYSDOH Jan‐15 Discounts on tobacco will be limited throughout the community 2‐Pursue policy action to reduce the impact of tobacco marketing in lower‐income and racial/ethnic minority communities. Tobacco Free Cortland CCHD Quest for Excellence NYSDOH Dec‐16 Policy will be created to reduce tobacco marketing in disparate communities 3‐Increase the number of municipalities that restrict tobacco marketing (including banning store displays, limiting the density of tobacco vendors and their proximity to schools) from zero to one. 1‐Pursue policy action to reduce the impact of tobacco marketing in lower‐income and racial/ethnic minority communities. Tobacco Free Cortland CCHD Quest for Excellence NYSDOH Dec‐16 Policy will be created to reduce tobacco marketing in disparate communities 2‐Present Point of Sale information and educate on the dangers of tobacco to youth in the community. Tobacco Free Cortland CCHD Quest for Excellence NYSDOH On‐going The community will be educated on point of sale information 3‐Educate and communicate with elected officials about the impact of retail tobacco product marketing on youth. Tobacco Free Cortland CCHD Quest for Excellence NYSDOH On‐going Elected officials will be educated on the impact of tobacco marketing on youth 4‐Approach NYSDOH to consider contracts in lieu of either fines or revocation that eliminate advertising of tobacco products in stores which are found to be in violation of ATUPA Tobacco Free Cortland CCHD Quest for Excellence NYSDOH Jan‐15 NYSDOH will be approached to consider the idea of contracts for those with violations of ATUPA Goal #2 – Promote tobacco use cessation, especially among low SES populations and those with poor mental health Objectives Improvement Strategies Partners Timeframe Target Performance Measure 1‐Increase the number of unique callers to the NYS Smokers’ Quitline by 5% from 387 to 406 annually. 1‐Use health communication to increase the impact and utilization of the NYS Smoker’s Quitline, particularly among disparate populations. NYS Quitline Team ACT On‐going Health Communication will increase the use of the NYS Smokers Quitline by disparate populations 2‐Decrease the prevalence of cigarette smoking by adults ages 18 years and older: By 5 % from 22.1 % to 21% among all adults. 1‐Use health communication to increase the impact and utilization of the NYS Smoker’s Quitline, particularly among disparate populations. NYS Quitline Team ACT On‐going Health Communication will increase the use of the NYS Smokers Quitline by disparate populations 1‐Advocate for expanded Medicaid and other health plan coverage of tobacco dependence NYSDOH CCHD On‐going Expanded Medicaid coverage for ---PAGE BREAK--- treatment counseling and medications. Team ACT tobacco related treatment and medications will be advocated for 2‐Promote smoking cessation benefits among Medicaid beneficiaries and providers. NYSDOH CCHD Team ACT Physicians On‐going Medicaid beneficiaries and physicians will be provided with cessation materials Goal #3 – Eliminate exposure to Secondhand smoke Objectives Improvement Strategies Partners Timeframe Target Performance Measure 1‐Decrease the percentage of adults who are exposed to secondhand smoke by establishing 8 additional smoke‐ free public spaces 1‐Increase the number of smoke‐free parks, beaches, playgrounds, college and hospital campuses, and other public spaces. Tobacco ‐Free Cortland CCHD Municipalities On‐going The number of smoke‐free public spaces will be increased 2‐Advocate with organizational decision makers, conduct community education, and use paid and earned media to increase community knowledge of the dangers of secondhand smoke exposure. Tobacco ‐Free Cortland CCHD On‐going The dangers of secondhand smoke will be provided throughout the community 2‐increase the number of local housing authorities that adopt a tobacco‐free policy for all housing units from 0 to 1. 1‐Promote smoke‐free policies in multi‐unit housing, including apartment complexes, condominiums and co‐ops, especially those that house low‐SES residents. Tobacco ‐Free Cortland CCHD Cortland Housing Authority Land Lords Dec‐16 At least one local housing authority will adopt a tobacco free policy Priority – Promote Healthy Women, Infants and Children Focus Area – Maternal Infant Health Goal #1 – Reduce Premature Births Objectives Improvement Strategies Partners Timeframe Target Performance Measure 1‐Increase the % of women in Cortland County who receive prenatal care in the first trimester by 8% to 79.9% 1‐Identify 2 sites that do pregnancy testing and establish a referral policy to refer to OB provider and for insurance if uninsured /underinsured JCRH, CRMC. Cayuga Medical Center June‐15 At least 2 sites will have policy in place 2‐Develop educational campaign that addresses the importance of early prenatal care. MBPN, WIC, FHN, DSS Medial Providers Dec‐15 Campaign will be developed 3‐ Launch Educational Campaign Human Services Agencies, Medical Community Jan‐16 Campaign is launched 2‐Increase the # of referrals from providers for women who have multiple missed OB visits 1‐ Identify 2 OB providers that will establish a referral policy for missed OB appointments OB providers, FHN, Dec‐15 At least 2 OB providers will have a policy in place 2‐Develop educational campaign that addresses MBPN, WIC, Medical Dec‐15 Campaign is developed ---PAGE BREAK--- the importance of attending prenatal visits providers 3‐Launch educational campaign Human services Agencies, Medical community Jan‐16 Campaign is launched 3‐ Reduce the rate of cigarette use by women in Cortland County during pregnancy by at least 12 % to 28.9% (Baseline 32.8%) 1‐Provide tobacco cessation training to at least 3 health care providers in the community who serve pregnant women Cessation Center June‐15 At least 3 health care providers who provide care to pregnant women will complete training 2‐Identify 2 agencies who will establish a policy to participate in the NYS Smokers Quit Line‐Fax to Quit Program Cessation Center, NYS Quit line Dec‐15 At least 2 agencies will have a policy in place 3‐Obtain 1 or more local laws that‐*keep tobacco products out of consumer view in stores *restrict the location , or type of retailer “Pharmacy” that sell tobacco products *restrict coupon redemption Tobacco Free Cortland, Municipal Boards Dec‐16 At least 1 local law will be in place 4‐Identify health care facilities without tobacco free policies and at least 1 health care facility specializing in prenatal care will adopt tobacco free outdoor policies Tobacco Free Cortland Dec‐14 At least 1 health care facility specializing in prenatal care will adopt a tobacco free outdoor policy Priority – Promote Healthy Women, Infants and Children Focus Area – Maternal Infant Health Goal #2 – Increase the proportion of babies that are breastfed Objectives Improvement Strategies Partners Timeframe Target Performance Measure 1‐Increase the % of infants born in Cortland County who are exclusively breastfed in the hospital by 10% to 66.3% 1‐Encourage local hospital to sign on to Great Beginnings NY CRMC, NYSDOH Dec‐13 Local Hospital sign on date to participate in Great Beginnings NY 2‐Partner with CRMC to convene a stakeholder committee CRMC, NYSDOH, Medical providers LeLeche, WIC, CCE, Insurance companies, Catholic Charities June‐14 Date stakeholder committee convened 3‐Stakeholder committee will assist in the establishment and development of policies and practices that promote exclusive breastfeeding CRMC, NYSDOH, Medical providers LeLeche, WIC, CCE, Insurance companies, Catholic Charities Dec‐14 Stakeholder committee meeting dates and policies developed 4‐Survey local businesses to determine if they have breastfeeding friendly policies in place. Stakeholder committee Jan‐14 # of local businesses surveyed 5‐Survey local medical practices to determine if they have breastfeeding friendly policies in place Stakeholder committee Jan‐14 # of local medical practices surveyed ---PAGE BREAK--- 6‐Assist 2 prenatal providers in establishing a referral policy for breastfeeding education and consultation LeLeche, WIC, Medical providers, CCE Dec‐14 At least 2 prenatal offices will have a policy in place 2‐ Increase the % of WIC infants breastfed through 4‐6 months by 20% (current rate for Cortland County is 6.4%) 1‐Apply for funding to train individuals to become certified and/or breastfeeding counselors CCHD Dec‐13 Funding received 2‐Asssit at least 2 OB, Pediatric and/or Family practice offices in establishing a referral policy for breastfeeding education and consultation CRMC, MBPN, LeLeche, WIC, Catholic Charities, CCE, Pediatricians, Family practitioners Dec‐14 At least 2 of the offices will have a policy in place 3‐Stakeholder committee will assist in activities to promote breastfeeding among low income/WIC families CRMC, MBPN, LeLeche, WIC, Catholic Charities, CCE, Medical providers June‐14 Stakeholder committee meetings and activities are documented 4‐Develop educational campaign through the stakeholder committee that addresses the importance and benefits of breastfeeding Stakeholder committee Dec‐14 Campaign is developed 5‐Provide Breastfeeding education, support, and consultation to low income/WIC families through at least 2 agencies in the community Stakeholder committee Dec‐14 At least 2 agencies will provide breastfeeding education, support, and consultation 6‐Stakeholder committee will promote breastfeeding friendly policies among local businesses. Stakeholder committee June‐14 # of local businesses that received promotion of breastfeeding friendly policies 7‐Stakeholder committee will promote breastfeeding friendly policies among local medical practices Stakeholder committee June‐14 # of local medical practices that received promotion of breastfeeding friendly policies CAPCO/WIC initiation (ever breastfed) rate for 4/12‐3/13 was 70.2% (regional %age is 66.6% and state wide %age is 76.2%) CAPCO/WIC duration (weaned) rate at 4‐6 months as of 7/1/2013 is 6.4% (regional %age is 5.7% and state wide %age is 9.1%)