HEALing Communities is a five-part series that highlights Kaiser Permanente’s approach to building healthy communities through Healthy Eating Active Living collaboratives, a program developed by Kaiser Permanente’s Community Benefit organization.
Throughout this HEALing Communities story series, Kaiser Permanente has been sharing insights from the work the organization is doing to support the health of communities through Healthy Eating Active Living (HEAL) collaboratives that seek to transform the places where people live, work and play in order to support them in making health choices. But how is it possible to measure the impact of efforts like these? How does the organization know if a community it’s working with is healthier as a result of its support?
Pamela Schwartz asks these questions every day in her line of work. As director of program evaluation for Kaiser Permanente’s Community Benefit, Schwartz’s job is to gather the data that is critical to informing how to best engage communities to improve their overall health.
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“The work of our Community Health Initiatives evaluation team is to tell the story of the impact of our HEAL interventions in the communities we serve,” explains Schwartz. “We document the changes that are taking place — healthier corner stores, better food in schools, more physical activity in school and after school — and what impact those changes have on the lifestyles of community residents.”
Kaiser Permanente’s place-based HEAL efforts began several years ago in Colorado with just three collaboratives. Today, there are more than 40 HEAL collaboratives across many of Kaiser Permanente’s eight regions. Evaluation efforts have documented that health interventions in these collaboratives have touched more than a half million lives.
Working with an evaluation team from the Center for Community Health and Evaluation, as well as local evaluators in Kaiser Permanente regions, Schwartz and her colleagues use tools such as surveys, interviews, storytelling and photography to gather data that helps to inform the work of HEAL collaboratives. The information ensures that communities have the strongest and most effective interventions possible.
“We take program improvement very seriously. We’re constantly reviewing our findings to make sure we can bring information back into the community and back into our Kaiser Permanente regions for strategic discussions about how to get the most out of our investments.”
In 2011, Schwartz and her colleagues completed assessments on 26 of the HEAL collaboratives. The following are some of the findings:
- A total of 510 distinct community change strategies were being implemented. These included school and worksite wellness policies, body mass index screenings in community clinics, creating community gardens that supply local food pantries with fresh fruit and vegetables, and improving infrastructure to promote walking and biking to school.
- Once fully implemented, these strategies will impact nearly 500,000 people through community-based interventions in neighborhoods, worksites and health clinics and another 148,000 children through school-based interventions.
- The strategies are working on every level of the socio-ecological spectrum: 24 percent focus on individuals and families, 23 percent on environmental change, 30 percent on organizational and public policy change, and 23 percent on building local expertise and infrastructure.
- Fifty-nine percent of strategies are focused on neighborhoods (e.g., refurbishment of parks, grocery-store improvement), 21 percent on schools (e.g., cafeteria reforms), 11 percent on workplaces (e.g., campaigns to promote stairwell use), and 9 percent on the health sector (e.g., body mass index screenings).
A Powerful ‘Dose’
One of the most important insights to date to come forth from HEAL evaluation efforts is the concept of “dose” — the idea that, in order to make the greatest impact, the organization needs to consider the strength of its community interventions. The more people reached with the strongest interventions, the more likely there will be an observable difference in the behavior of people living in the target community.
Recent evaluation results from the Kaiser Permanente Northern California region confirm the importance of the dose concept.
“When we took a first pass at the data several years ago, we didn’t see any patterns in population health. But with concept of dose in mind, when we looked at high dose interventions, we started to see improvements in population health,” explains Schwartz. “Paying attention to how many lives we’re touching and the strength of that touch really does matter. At the end of the day, if we do this, we all can get to where we want to get to which is smart interventions that lead to healthier communities.”
For more information on Kaiser Permanente’s Community Health Initiatives, visit www.kp.org/communityhealth.