Goal 13: Help Our Citizens Get Healthy
Increase Louisville's health ranking among 15 peer cities to the top half by 2020, and top 3rd by 2030, by implementing the community health improvement plan, Healthy Louisville 2020. (HL2020). HL2020 is a public health agenda that aims to guide Louisville Metro towards becoming a healthier city, narrowing the gap in health disparities among its residents and achieving health equity by 2020. The Healthy Louisville report and areas of focus can be viewed at:
According to the latest analysis conducted by the Greater Louisville Project using Robert Wood Johnson County Health Rankings 2015, Louisville ranks 12th among 15 peer cities in health outcomes. Improving health outcomes will directly improve the quality of life, prosperity, and competitiveness of our city. While we have many great health programs in Louisville, we still have a long way to go to move up in the health rankings. Health is everyone's business and improving the health of our community will take a collective effort.
The Robert Wood Johnson Foundation County Health Rankings relies on multi-year averages and data that lags up to 2-3 years. We are able to monitor related sources with available data as recent as 2014. This allows us to react to the current state of health in Louisville and improve our ranking in the years to come.
Initiative Health: What are we doing to accomplish this?
Louisville ranks 12th among 15 peer cities with regard to the health outcomes composite score measured by Robert Wood Johnson Foundation's County Health Rankings.
Healthy Louisville 2020 identifies 13 focus areas designed to address some of Louisville Metro’s most pressing, as well as emerging, public health issues. Within those focus areas 50 indicators were selected, each having a baseline and target measure.
The first draft of Healthy Louisville 2020 was completed on time. A finalized version was released in February 2014.
In 2014, Healthy Louisville 2020 was publicly announced via press release by Dr. Nesbitt and the Mayor in conjunction with The Greater Louisville Project. It can be viewed in a web-based format at healthylouisvillemetro.org.
We created an employer on-site wellness clinic and pharmacy in conjunction with a Wellness Program and other tools to enhance the quality of life of all Metro employees. A tobacco user surcharge was implemented which promotes healthy lifestyles, changing unhealthy behaviors, disease prevention, and nutrition & exercise.
The implementation of the Affordable Care Act provided health insurance coverage to many citizens for the first time. As a result of efforts to encourage enrolment, the percentage of uninsured residents has substantially declined.
The Board of Health Outreach and Enrollment committee is working to ensure all Louisville Metro residents eligible for Medicaid are enrolled as part of the expansion under the Affordable Care Act (ACA). The group meets monthly. The original goal was to enroll 55,000 of 101,366 residents eligible for Medicaid. As of August 2014, 70,281 residents had been enrolled in Medicaid. As of September 2015, a total of 163,324 individuals were enrolled in Medicaid or a Qualified Health Plan (QHP).
From 2008 through 2014, a combination of public health initiatives and policy has led to a 7 percentage-point decline in smoking rates in adults.
1. Currently transitioning smoking cessation classes to the American Lung Association Freedom from Smoking model.
2. Advocating for the Louisville Metro smoke-free ordinance to include e-cigarettes/vaping and hookah.
3. Partnered with Waterfront Parks to expand smoke-free zones in outdoor children's recreation areas.
4. A collaboration with Louisville Metro Department of Parks and Recreation lead to designating 19 'spray-grounds' as smoke-free areas.
The number of days with an Air Quality Index exceeding 100 has declined tremendously. However, Louisville Metro is ranked 13th of 15 peer cities with respect to air pollution. We continue to monitor and look for opportunities to partner with other agencies to improve air quality.
Louisville Metro Department of Public Health and Wellness
1. Take a coactive approach to improving air quality by promoting environmentally friendly transportation modes, and advocating for increased greenspace and sustainability. Serve on the board of AIR Louisville which is focused on asthma outcomes due to poor air quality.
Public Works & Assets:
1. Increase percentage of people traveling to work by utilizing public transit, bicycling, and walking from 8.1% in 2013 to 25% by 2030. See Goal #1.
Transit Authority of River City:
1. Replaced 10 downtown trollies with zero-emission electric busses, with plans to increase fleet to a total of 15.
2. Replacing older busses with 11 hybrid-electric and 28 clean diesel busses.
Jefferson County Public Schools:
1. Prohibit school bus idling on days where AQI exceeds 100. JCPS policy is enforced at all locations.
Air Pollution Control District:
1. Monitor and report air quality; enforce regulations, advocate for policy change.
2. Working with LG&E to convert Cane Run to natural gas, improve pollution control equipment at Mill Creek plant. Will reduce 4823 tons of NOx and 52 tons of VOC thru Cane Run conversion by end of 2015. By end of 2016 will increase SO2 removal at Mill Creek from 90% to 98%
3. Kentuckiana Air Education (KAIRE): community outreach, promote green infrastructure and tree canopy commission, support Complete Streets initiative, analysis of air quality.
Louisville Metro Public Health and Wellness continues to take a coactive approach to decreasing obesity rates in Louisville. The following initiatives are currently active with collaborative agencies.
Louisville Metro Public Health and Wellness:
1. Hosts wellness classes for the public with topics covering diabetes management and smoking cessation.
2. WIC: Provides medical nutrition therapy (MNT) for obese participants. Initiatives are ongoing to increase participation and solicit customer feedback.
3. Building relationships with the Food Port project to inform programming related to healthy eating/nutrition.
4. Grantor to the Food Literacy Project and the People's Gardens.
5. Piloting a healthy vending policy, if successful will roll-out to other metro government sites.
6. Through collaboration with Humana's Bold Moves program - YMCA Diabetes Prevention program focusing on weight loss and healthy eating
Public Works & Assets:
1. Create/maintain 66.63 miles of bike lane miles as of 30 Nov 14.
2. Expand implementation of Complete Streets policies
3. Currently rehabbing sidewalks in poor condition to ensure walkability and accessibility. See Goal 1
1. Repurpose empty and vacant lots into community gardens, playgrounds, or greenspaces. Since 2012, they have worked with 7 Community Partners on 9 projects that repurposed 18 vacant lots totaling more than 2.5 acres.
Parks & Recreation:
1. Increasing shared use paths (57 miles as of Dec 2014 vs. goal of 72 miles by Dec 2016).
2. Healthy opportunities: Printed recreation guides distributed to community partners/centers, social media posts, limited advertising at golf/community/athletic centers, materials provided to health fairs and public events.
3. Increasing community center Kids Cafe programing
4. Ongoing expansion of Louisville Loop: Current mileage as of Oct 31, 2015: 40.55 miles with 15.09 miles of paved connecting/alternative routes.
Louisville Metro Public Health and Wellness (LMPHW) uses a Health in all Policies approach to promote healthy social and physical environments for all Louisville Metro residents
1. A new director for the Center for Health Equity has been hired and will ramp-up work in 2016.
2. Pivot to Peace: LMPHW participates on the steering committee of this interventional program directed at males age 18-34 in the Louisville Metro Police District 1st and 2nd district.
3. Continued support of the Office of Safe and Healthy Neighborhoods with the One Love Louisville initiatives. One Love Louisville Action plan addresses the socioeconomic determinants of disparity in life expectancy.
4. A process that allows LMPHW to systematically review proposed laws, ordinances and regulations at the state and local level is being developed.
5. LMPHW routinely collects and analyzes data from a multitude of sources to understand the contributing factors to health disparities and the gap in life expectancy.
1. Healthy Babies Louisville and its strategic plan were announced Jan 2016, a culmination of a year's work with community partners and stakeholders to create and implement a plan to improve health outcomes and reduce infant mortality for babies born in Louisville.
2. WIC program: Medical nutrition therapy for WIC users with a medical condition including pregnant women with gestational diabetes, etc. Piloting an online WIC education program to make access easier for women.
3. Louisville Metro Public Health and Wellness Office of Health Promotion administers several programs to prevent abuse and promote infant wellness:
- Periods of Purple Crying program to provide early intervention in preventing infant abuse.
- Early Periodic Screening Diagnosis and Treatment (EPSDT)
- Cribs for Kids
- Partnership with March of Dimes to create grand rounds programs for obstetricians and pediatricians restarting the Fetal Infant Mortality Review
- Baby and Me are Smoke Free program
4. Renewed Healthy Start grant: restructured to a 3-tier plan where the highest risk/highest need women in 6 zip codes receive case management/home visits, and promote social support groups for moms.
HIV is too often discovered at an advances stage. Identifying persons early in infection and providing them with appropriate counseling, education, and opportunities for linkage to care are necessary steps to controlling HIV.
Louisville Metro Public Health and Wellness:
1. Implemented and monitor a Syringe Exchange Program that includes HIV and Hepatitis C testing for these high-risk participants.
2. Implemented a policy in 2014 for all clinics to offer HIV screening.
3. Expanded Disease Investigation Specialist (DIS) workers' duties to include conducting contact investigations.
4. HIV prevention workers conduct regular outreach with community partners.
1. By December 1st, 2015, will have 2 Volunteers of America sites for HIV testing. Louisville Metro Public Health and Wellness works closely with the 550 clinic for referrals of HIV positive individuals to start treatment.
2. Promoting and supporting new/planned PrEP HIV clinics managed by KentuckyOne and Norton.
Measuring the number of unhealthy days is an indicator of quality of life. Analysis conducted by Louisville Metro Public Health and Wellness indicates that some groups of citizens are more likely to have a high number of mentally unhealthy days, such as young adults, racial and ethnic minorities, and women.
1. Targeting adolescent/pre-teen population through the BOUNCE coalition’s training teachers to work with students who have experienced traumatic events in their lives.
2. Received a grant to convene organizations that use a trauma-informed-care approach in order to collaborate and develop best practices.
3. Other partnerships include Community Shield with Center for Women and Families and Convene, Connect, and Celebrate coalition that targets social support for women and families.
4. Collaborating with Jefferson County Public Schools to improve suicide prevention training to students and improving access to centers for counseling. Jefferson County Public Schools also has begun incorporating mindfulness training for students through the Compassionate Schools program.
4. Louisville Metro Public Health and Wellness senior staff participate and/or are committee chairs on the Health Advisory Council organized by Humana. Louisville Metro Public Health and Wellness collaborates through this organization to contribute to Humana's Bold Moves Initiative which uses healthy days as a benchmark. This organization includes a committee focused on improving behavioral health in Louisville Metro.
5. Collaborate with the Office of Safe and Healthy Neighborhoods Taskforce on Suicide.
6. Dual Diagnosis Cross functional Team: Louisville Metro Public Health and Wellness is a part of the Dual Diagnosis Cross Functional Team, which addresses the system impact of dual diagnosis individuals (mental health and substance abuse disorders) who frequently cycle through the system, and the need to develop community-wide pathways and protocols (including a complex case management network and specialized public safety protocols for early diversion prior to arrest).
Measuring the number of unhealthy days is an indicator of quality of life. Analysis conducted by Louisville Metro Public Health and Wellness indicates that some groups of citizens are more likely to have a high number of physically unhealthy days, such as older adults and those with certain chronic diseases and health risk factors like obesity and smoking. Thus, work being done to address obesity and smoking initiatives contributes significantly to this goal as well.
1. Conducted analysis and presented to the Louisville Health Advisory Board describing unique attributes of the population of Louisvillians who report 30 unhealthy days in the prior month, in order to inform policy and program targets.
2. Louisville Metro Public Health and Wellness senior staff participates and/or are committee chairs on the Health Advisory Council organized by Humana. Louisville Metro Public Health and Wellness collaborates through this organization to contribute to Humana's Bold Moves Initiative which uses healthy days as a benchmark.
3. Grant agreement with Colon Cancer Prevention Project (C2P2) providing a central navigator who receives referrals from the community. Client receives a screening (either FIT or colonoscopy).
4. Administers the Kentucky Women’s Cancer Screening. Cervical cancer screening, clinical breast exams, and HPV screening performed at Family Health Centers. Abnormal results referred on to Norton or James Graham Brown Cancer Center (for abnormal results) for diagnosis and treatment.
5. Participates in Partnership for Cancer Control, along with local hospitals, Family Health Centers and Federally Qualified Health Centers, focusing on colon cancer and women's cancer.
6. Louisville Metro Public Health and Wellness conducted the Community Health Needs Assessment in conjunction with all area hospitals. Results will be published in early 2016.
7. Engaged in a pilot project to assess the effectiveness of implementing blood pressure home monitoring training, equipment and education, in helping Family Health Center patients with hypertension.
8. Starting asthma work in collaboration with clinical partners, University of Louisville School of Public Health and Information Sciences, Air Louisville, and others, we anticipate improving healthy days for people with asthma.
9. Provide community health worker/diabetes educator to make in-office and in-home visits to Family Health Center patients diagnosed with diabetes to ensure patient understands how to take medication and modify lifestyle to manage their disease