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Leaders in Fulton County Bring Together Diverse Community Stakeholders in NACo Community Health Dialogue

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NACo, in partnership with the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute (UWPHI), has conducted community dialogues in six counties across the country. The NACo Community Dialogue to Improve County Health sessions are intended to assist counties in assessing, planning and strategizing current efforts toward coordinating initiatives to improve the overall health of residents in these counties. These sessions are a part of NACo's Elected County Officials' Guide to County Health Rankings & Roadmaps project, which aims to bring together public and private partners to share innovative ideas and strategize about how to resolve various challenges counties face. The sixth and final session of the series was held in Fulton County, Ga., on October 30.

Fulton-County-Comm.jpg Fulton County Commissioner and NACo Healthy Counties Advisory Board Chair Joan P. Garner with keynote speaker Dr. Reuben Warren, Director of the Tuskegee University National Center for Bioethics in Research and Health Care.

With leadership from Fulton County Commissioner Joan P. Garner and her staff, Fulton County Director of Health Services Dr. Patrice Harris and the Fulton County Department of Health and Wellness, a broad coalition of stakeholders from across the county were brought together to hear from experts on health and engage in a discussion about what the county and its partners can do to increase collaboration to improve health across the community. The day of dialogue, entitled "Lights, Camera, Action: Collaborating to Build Award-Winning Healthy Communities in Fulton County," included two separate "Acts" that featured informational and breakout sessions, respectively.

The informational sessions, or Act I, covered a number of important issues, including examining how Fulton County ranks in the County Health Rankings & Roadmaps on various health indicators , working towards health equity in Fulton County, the impact of social determinants of health and a keynote address on "Optimal Health: From Measurement to Meaning." Kate Konkle, Community Coach from UWPHI gave an overview of the County Health Rankings & Roadmaps , including how Fulton County ranks against other Georgia counties, as well as other important health factor data. For instance, Fulton County is 21st out of 159 Georgia counties in health factors. Among those health factors are social and economic factors, for which Fulton County ranks 44th, including a 64 percent high school graduation rate.

Dr. Patrice Harris, Fulton County Director of Health Services, addressed achieving health equity in the county. She used local data to show community-wide health disparities on a map of the county, in particular she looked at areas where physical health and health factors were more acute, including graduation and housing insecurity rates. She discussed the impact that social determinants have on community health, which Fulton County is looking to prioritize working on social determinants of health in its health improvement efforts. Dr. Harris mentioned that lack of transportation is one of the biggest predictors of ill health. As part of improvement efforts, the Fulton County Board of Commissioners and county agencies have undertaken the Common Ground Initiative, which is utilizing more collaborative approaches at the county-level to address social determinants of health. The goals of the initiative all aim to create equity and access to care by engaging a broad coalition of agencies.

Social-Det.jpg Graphic representation of the Social Determinants of Health Panel created by Graphic Facilitator Julie Stuart.

Commissioner Joan Garner facilitated a panel of community leaders and experts on the social determinants of health. The panel was made up of a number of key community providers and thought leaders, including Vanessa Stacks, Director of Care Coordination at the Grady Health System; Elizabeth Fuller from the Georgia State University Health Policy Center; Michael Claeys, Executive Director for Mental Health Services at the Grady Health System; Tom Andrews, President at Mercy Care and Matthew McKenna, Medical Director of the Fulton County Department of Health and Wellness. Panelists discussed key issues of integrating social determinants of health in delivering health services and the move towards integrated care models, including health homes, to ensure a holistic approach to health care delivery. There was also a discussion on breaking down functional barriers between organizations and agencies, for instance between housing and health services. Fulton County is working to overcome the many regulatory barriers that separate agencies and make it difficult to collaborate across sectors.

Warren0Keynote.jpg Graphic representation of Dr. Warren's keynote address created by Graphic Facilitator Julie Stuart.

Dr. Reuben Warren, Director of the Tuskegee University National Center for Bioethics in Research and Health Care, delivered the keynote address entitled "Optimal Health: From Measurement to Meaning." Prior to becoming Director of the National Center for Bioethics in Research and Health Care, Dr. Warren served in a number of public health posts in academia, as well as the federal and state level, including at the Rollins School of Public Health at Emory University, the Public Health dentistry program at the Mississippi State Department of Health and the Centers for Disease Control and Prevention. Dr. Warren focused his remarks on the idea that health is a journey, or as he put it, health is "a journey to a state of greatest aliveness." He emphasized that health is far more than health care, pointing out that only 15 percent of a person's health is attributed to care.

Following the keynote address from Dr. Warren, participants spent the afternoon attending breakout sessions. The breakout sessions included discussions on strategies for better integration of care, considering Health in All Policies (HiAP) and the What Works for Health tool made available through the County Health Rankings & Roadmaps program. Each breakout session featured a short presentation by an expert on the respective topic, followed by an interactive exercise and dialogue. The first breakout session, entitled "Strategies for Better Integration of Care," was led by Dr. Charles Moore, Associate Professor of Otolaryngology at Emory University School of Medicine, Co-Director of the Emory Urban Health Initiative and Chief of Service in the Department of Otolaryngology at Grady Health System. Dr. Moore is also the founder and CEO of the HEALing Community Center, which is a community-based organization that provides access to comprehensive health care in an underserved area of Fulton County. During this session, Dr. Moore examined the social, economic and environmental barriers to accessing care in the county and how social, physical and individual health determinants can create barriers to integrating care. He also discussed work currently being done in Fulton County to address these barriers, including the work that the HEALing Center does to integrate care in underserved areas of the county. Following his presentation, Dr. Moore led participants through a group discussion on organizational, financial/funding, policy and infrastructure barriers to integrating care in Fulton County.

The second breakout session, entitled "Considering a Health in All Policies Approach to Improving Health," was led by Dr. Elizabeth Fuller, Associate Project Director at the Georgia Health Policy Center at Georgia State University. Dr. Fuller's presentation focused on how HiAP is done from a practical perspective, including the three phases of a HiAP approach to health improvement (information-sharing, collaboration and integration). She also emphasized that HiAP is a two-way conversation, not other sectors simply adopting and integrating a public health approach to their work. Following Dr. Fuller's presentation, participants engaged in a Root Cause Mapping exercise to think through what factors impact health and how interventions can be undertaken across sectors.

Graphic-Facilitator.jpg Graphic Facilitator Julie Stuart gives a walk-through of the discussion throughout the day using the art she created to capture those conversations.

The final breakout session, entitled "What Works for Health: Evidence for Decision-Making," was led by Kate Konkle, Community Coach with the County Health Rankings & Roadmaps program at UWPHI. Ms. Konkle focused on the importance of using evidence-based strategies for improving health and how the County Health Rankings & Roadmaps What Works for Health tool can be used to search for and verify evidence-based policies, programs and strategies for health improvement. She provided a demonstration of the What Works for Health tool online and led participants through a discussion exercise on selecting evidence-based strategies using the online tool.

Throughout the day Graphic Facilitator Julie Stuart from Making Ideas Visible was capturing the discussion visually. She led a walk-through of what she captured during each session as a way to reflect on the discussion that took place. Participants also wrote ideas on Post-it Notes that they added to an "Idea Wall" throughout the day.

For more information on the County Health Rankings & Roadmaps, listen to the NACo podcast about [give a brief description here] or visit countyhealthrankings.org .

To learn more about the Community Dialogues to Improve County, join NACo on December 4, 2014, for a webinar featuring two Community Dialogue counties and the University of Wisconsin Population Health Institute. For more information or to register for the webinar, visit NACo Community Dialogues to Improve County Health: Lessons Learned .

For additional information on the Community Dialogues to Improve County Health and NACo's Elected County Officials' Guide to County Health Rankings & Roadmaps, please contact Andrew Whitacre, Health Associate, awhitacre@naco.org or 202.942.4215.

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