The Steps to a HealthierUS five-year cooperative agreement program
aims to help Americans live longer, better, and healthier lives by reducing the
burden of diabetes, overweight, obesity, and asthma and addressing three related
risk factors—physical inactivity, poor nutrition, and tobacco use.
For FY 2003, this U.S. Department of Health and Human Services (HHS) program
allocated $13.6 million to fund 23 communities, including Seattle and King
County in Washington, to implement community action plans to reduce health
disparities and promote quality health care and prevention services.
Project Area
Six contiguous cities in Seattle and King County, Washington (population
352,836); includes three school districts.
Target Population for Steps Interventions
People with household incomes less than 200% of the federal poverty line,
English, Spanish, and Vietnamese-speaking people.
Proposed Interventions
Media
Promote public awareness of chronic diseases and their symptoms; the
importance of proper diagnosis and medical care; and the impact of nutrition,
physical activity, and tobacco use on health through targeted media campaigns.
Policy
Review a range of policies to prevent and control chronic illness,
including
Cultural competence in asthma, diabetes, and obesity
clinical management.
Funding mechanisms to support care coordination,
self-management education/support groups, community health workers, and
access to medical supplies.
School policies that support students with asthma and
diabetes, discourage sales of nonnutritious foods, and encourage physical
activity.
Housing and community development policies that support
physical activity, nutrition, and healthy home environments for people with
asthma.
School-Based
Complete a comprehensive School Health Index (a CDC assessment and
planning guide) to identify targets for interventions in Steps schools.
Implement a comprehensive, prevention-oriented health curriculum.
Train and support staff in asthma trigger reduction in the school
environment and diabetes management.
Use asthma action plans for all students with asthma.
Provide chronic disease and healthy living education for students.
Conduct staff wellness promotion activities.
Increase opportunities for physical activity.
Create an environment that supports healthy eating.
Community-Based
Conduct diabetes education and self-management classes at community sites.
Facilitate support groups tailored to the cultural and language needs of
participants.
Support community health workers who make home visits to encourage asthma
and diabetes self-management and provide community outreach and education.
Train child care providers in asthma management and breast-feeding
promotion.
Expand the Master Home Environmentalist program, designed to help people
learn more about health risks from pollutants in their homes through free home
assessments.
Work with faith communities to train lay educators in health promotion.
Disseminate diabetes self-screening tools.
Work to improve asthma awareness and care through neighborhood committees.
Promote environmental and programmatic interventions to encourage physical
activity (e.g., running for adolescent girls, walking groups, biking to
school) and good nutrition (e.g., food preparation demonstrations).
Workplace
Implement point-of-decision physical activity prompts (e.g., use the
stairs, not the elevator).
Conduct food preparation demonstrations.
Health Care
Clinics
Improve the quality of care for asthma, diabetes, and obesity using the
Chronic Care Model.
Use chronic disease and wellness coordinators to facilitate systems
change to implement quality improvement activities, link patients with
community resources, and provide limited case-management services.
Establish and maintain tracking systems to monitor quality of care.
Offer training to staff in asthma and obesity management.
Emergency Departments
Establish a reporting system of asthma and diabetes visits for
epidemiological surveillance and clinical follow-up.
Medicaid Managed Care Organizations
Share anonymous utilization and pharmacy data.
Coordinate member education with Steps community-wide education
messages.
Coordinate case management.
Refer members to Steps and other community resources.
Evaluation
HHS will provide training and technical assistance to help each Steps
community develop measurable program objectives and specific indicators of
progress and use relevant data to support ongoing program improvement. HHS also
will conduct a national evaluation of the overall program. Existing data
sources, such as the Behavioral Risk Factor Surveillance System and the Youth
Risk Behavior Surveillance System, will be used to identify and measure program
outcomes and assess progress toward program goals.
Community Consortium
The Steps Consortium is open to all organizations, agencies, and
persons interested in the Steps initiative. There are currently over 100
members, including community-based organizations, health care providers,
hospitals, health plans, clinics, universities, faith-based groups, government
agencies, and school districts.
Seattle and King County Steps Contact
- James Krieger, MD, MPH
- Chief, Epidemiology, Planning and Evaluation Unit
- Public Health–Seattle & King County
- 999 Third Ave, Suite 1200
- Seattle, WA 98104
- (206) 296-6817
- (206) 205-5314 fax
- james.krieger@metrokc.gov
- www.metrokc.gov/health
Note: Steps communities have until May 2004 to finalize their
community action plans. Proposed interventions may change accordingly.
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