HomeMy WebLinkAboutMINUTES - 03011994 - IO.4 TO: -Al 'BOARD OF SUPERVISORS 1 .0.-4 g... Contra
l
FROM: INTERNAL OPERATIONS COMMITTEE �� " Costa
, County
DATE:
February ,14i 1994
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SUBJECT: REPORT ON FUNDING FOR A PROSPECTIVE STUDY OF THE INCIDENCE OF
CANCER IN CONTRA COSTA COUNTY
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
1 . ACCEPT the attached report from the Public Health Director on
a Symposium 'on Health Research Needs to Ensure Environmental
Justice,
2 . DIRECT the Health Services Director to prepare letters for the
Chairman of the. Board of Supervisors . to send to all
appropriate agencies at the State and Federal level indicating
that Contra Costa County and the Bay Area Cancer Coalition are
prepared to undertake a prospective study of the incidence of
cancer and believe that we have the necessary resources
available to make such a study meaningful .
3 . DIRECT the Health Services Director to approach the Robert
Wood Johnson Foundation and Kaiser Foundation regarding
possible funding for a prospective study of the incidence of
cancer in Contra Costa County.
4 . DIRECT the Health Services Director to prepare reports to the
Board of Supervisors on an every 3-4 week basis on the various
elements of the report from the Public. and Environmental
Health Advisory Board entitled "A Community Response:
Partnership Strategies for a Healthy County" .
0 5 . REQUEST the Public Health Director to report again to our
Committee on May 9, 1994 regarding the status of efforts to
fund a prospective study of the incidence of cancer in Contra
Costa County.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF C NTY DMI TRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE ER
SIGNATURE(S):
u.
ACTION OF BOARD ONMaL
APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
�X UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. Q L�
ATTESTED—Im
Contact: PHIL BATCHELOR,CLERK OF THE BOARD OF
CC: County Administrator SUPERVISORS AND COUNTY ADMINISTRATOR
Health Services Director
Public Health Director /v�1/,�►/�
BY �_J,�IJV��/�� ' , ` • .,DEPUTY
I .O.-4
-2-
BACKGROUND:
The Board of Supervisors last approved a report from the Internal
Operations Committee on this subject on December 14, 1993 . At that
time, the Health Services Department was asked to report to our
Committee again on a quarterly basis. On February 14, 1994, Dr.
Wendel Brunner, our Public Health Director, distributed the
attached report and discussed it with us . Dr. Brunner had just
returned from a Symposium in Washington, D.C. which was addressing
some of the very questions which we have been urging be addressed
for the past several years . As Dr. Brunner' s report indicates,
there appears to be a new awareness of the need for a meaningful
research agenda which addresses health needs of minority and poor
communities resulting from environmental health issues . There
seems to be a new willingness to undertake the research necessary
to document such things as the extent to which environmental
factors contribute to the incidence of cancer in certain
communities .
In view of this new interest at the Federal level, we are
suggesting that the Chairman be authorized to send letters to all
appropriate State and Federal agencies indicating the willingness
and ability of the Bay Area Cancer Coalition and Contra Costa
County to head up such a study. However, we do not want to limit
ourselves to funding from other levels of government. Therefore,
we are also asking that the Health Services Director approach the
Robert Wood Johnson Foundation and Kaiser Foundation about their
interest in funding such a study.
We are also highly impressed by the community study which was
undertaken by the Public & Environmental Health Advisory Board
(PEHAB) , "A Community Response: Partnership Strategies for a
Healthy County" . Another copy of this report is attached for the
Board ready reference. While the Board of Supervisors received
this report a few weeks ago, a careful review of the report
indicates a number of critical issues which deserve a more detailed
review with the Board of Supervisors . Therefore, we are
recommending that the Health Services Director schedule a series of
presentations before the Board of Supervisors at 3-4 week intervals
when the Board of Supervisors can focus on one specific element of
this report at a time and spend some time reviewing the data on
that specific element of the report.
Finally, we are recommending that Dr. Brunner make a further status
report to our Committee on May 9, 1994 on this subject, outlining
what action has been taken on the recommendations made above and on
previous actions which have been taken by the Board on this
subject. We would welcome the continuing involvement of Supervisor
McPeak in this subject, even after she leaves the Board of
Supervisors .
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1
Community Response: Partnership Strategies for a Heahhy County
' irzi/9a
PUBLIC AND ENVIRONMENTAL HEALTH ADVISORY BOARD
MEMBERS
Doris Copperman
Carlota Dunhower
Vicki Harrington
Art Hatchett
Michele Jackson
Richard J. Jackson, MD, MPH
Edith Loewenstein, MD
Bessanderson McNeil, MPH
Julio Mendoza, DDS
Dorothy Oda, DNS, FAAN
Carolyn Robinson
Mary Rocha
Jean Siri
Inh Sooksampan
Rev. Curtis A. Timmons, BaThD
William Vega, PhD
Community Response: Partnership Strategies for a Healthy County
' 121/'94
. ACKNOWLEDGEMENTS
Both "A Community Response: Partnership Strategies for a Healthy County" and the
previous "1992 Status of Health in Contra Costa County" reports were initiated by the
County's Public and Environmental Health Advisory Board (PEHAB), with staffing
provided by the Public Health Division of the Health Services Department. PEHAB
members gave invaluable input, advice and assistance, particularly in organizing the
community meetings for this report. Many community leaders and activists were also
involved in inviting their clients and constituents. Special thanks go to those who
moderated the meetings, facilitated the small group discussions, and provided translation
services: Phil Arnold, James Banks, Jun Becker, Tina Demonbreum, Priscilla Enriquez,
Carrie Frazier, Ruth Goodin, Frances Greene, Vicki Harrington, Dave Hobbs, Fred
Jackson, Michele Jackson, Norma Jellison, Paul Kilkenny, Joyce Kingery, Mary Lou
Laubscher, Annette Lerma, Richard Martinez, Dorothy McMichaels, Bessanderson
McNeil, Linda Miller, Julia Robinson-Ellis, Mary Rocha, Jean Siri, Inh Sooksampan,
Rev. Curtis Timmons, and Joan Ward.
Health Services Department staff from the Public Health Division, Substance Abuse
Division, and Office for Service Integration updated data, made presentations and
participated in discussions at the community meetings. Graduate student Cathy Miller
coordinated the focus groups, with assistance from Donna Coit of the Prevention
Program, and with partial funding from United Way. The report could not have been
completed without the patient and tireless efforts of Amelia Hernandez.
Community Response: Partnership Strategies for a Healthy County
121194
CONTENTS
ExecutiveSummary . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i - iii
BackgroundInformation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - 2
Key Findings, Discussion and Participant Recommendations . . . . . . . . . . . . . . 2 - 10
PEHAB Recommendations to.Health Services Department . . . . . . . . . . . . . . . . . 10 - 11-
Recommendations
0 - 11Recommendations to Board of Supervisors . . . . . . . . . . . . . ... . . . . . . . . ... . . . . . . . 12
PEHAB Priorities for 1994 . . . . . . . . . . . . . . . . . . . . . . . . . . 13 - 14
Appendices:
A. Data Collection Methodology -
B. Regional Community Meeting,Co-Sponsors
C. Organizations Participating in Community Meetings
D. Regional Forum Panelists
Community Response: Parraership Strategies for a Healthy County
1/21/94
EXECUTIVE SUMMARY
INTRODUCTION
Since 1986, the Public and Environmental Health Advisory Board (PEHAB) has helped
the Health Services Department identify critical health issues in the county, and has
advocated for programs responding to the needs of underserved communities. In 1987
and in 1992, PEHAB worked with Health Services Department staff to produce reports
on health status in Contra Costa In the Spring of 1993, PEHAB held a series of
community forums with nearly 200 community leaders, clients, and local service providers
to get their input and feedback on the 1992 Report. The findings from that effort, along
with recommendations to the Health Services Department, and PEHAB's own action
plan for 1994 are described herein.
1992 HEALTH STATUS REPORT HIGHLIGHTS
• The County has experienced a dramatic increase in ethnic diversity: the Asian/Pacific
Islander population has grown 156%, and the Latino population 62%. The majority
of these groups reside in West and East County.
• Chronic disease accounted for two-thirds of all deaths in Contra Costa; the county's
death rate for cardiovascular disease, cancer, and diabetes exceeded the state average.
• Eighty thousand county residents were dependent on or serious abusers of alcohol
and other drugs. These substances were involved in 64% of the suicides, 85% of the
homicides and 58% of all fatal car crashes.
• In terms of trauma, car crashes accouwited for nearly half of all unintentional injury
deaths in Contra Costa in 1988-90 (42 %). Firearms were the major killer of children
aged 10-18 years old.
• More than 800 residents were diagnosed with AIDS and 554 Contra Costans had died
of the disease. (Note: As of April 1993, over 1,000 residents had been diagnosed
with AIDS.)
• While perinatal indicators are generally good for the County, African American
newborns died at twice the rate of Caucasians, and West County residents fared most
poorly on major perinatal health indicators.
COMMUNITY FORUM HIGHLIGHTS
Health Problems
* Chronic disease, AIDS, substance abuse, unintentional injury and violence,
perinatal health, and family and adolescent health issues continue to be the major
health concerns in Contra Costa.
-i-
Community Response: Partnership Strategies for a Healthy Cou•ty
1211'94
* Substance abuse prevention and violence prevention are the two most critical
concerns; other health problems spring from or are worsened by these. Young
people are particularly at risk.
* Environmental health, mental health services for children and parents, and job
training/development are the primary additional health priorities.
* Significant barriers to services continue to exist, particularly for low income
families and certain ethnic communities.
Key Actions Needed
* Involvement of affected communities in planning and implementing solutions is
needed. Community organizations not traditionally considered part of the health
care system must be integrated into an overall prevention approach. Solutions
need to be tailored to the specific needs of local communities.
* A multi-faceted, broad-based environmental approach to prevention must
encompass not only clinical services and individual education, but policy and
legislative action, and expanded community-based outreach and education.
* Development of programs responsive to the needs of multi-cultural communities
must continue to be a major priority for the Health Services Department.
* Youth, single, teen and working parents, immigrants and refugees, people of color,
seniors, women, and workers need to be the focus of expanded prevention efforts.
PEHAB RECOMMENDATIONS TO HEALTH SERVICES DEPARTMENT
* Shift from a county-wide, generic approach to a more localized effort, tailoring
prevention and health care services to the unique needs of affected communities.
* Promote an "environmental approach," involving organizations outside the
traditional health care system in planning and implementing a community-wide
prevention strategy. Key participants would include: school districts, PTA, church
leaders, Housing Authority, Parks and Recreation Department staff senior
centers, Boys and Girls Clubs, and others.
* ]Focus prevention efforts in East and West County and in the Concord area of
Central county, which contain the largest concentrations of underserved low
income and ethnic communities.
* Expand existing efforts to sub-contract with community agencies to provide
outreach, education, and other health-related services. Streamline county contract
procedures, and provide training and technical assistance to build agency skills.
-ii-
Community Response: Partnership Strategies for a Healthy County
121194
* Develop additional county funds specifically for community-based prevention
programs and assist community organizations in identifying and applying for
funding.
* Hire and train local residents as outreach workers, aides, and peer health
educators in both public health and clinical services programs.
* Work with labor,disabled, ethnic communities, and other underserved groups to
identify their health needs, and develop programs responsive to those concerns.
Solicit their representation on County advisory boards, commissions, and planning
task forces.
* Involve young people in identifying health problems and solutions by creating
specific youth positions on advisory boards and planning committees. Provide
training so they can participate effectively.
* Evaluate personnel policies and revise as needed to enhance recruitment and
retention of minority staff and Board members. Expand opportunities for
professional advancement.
* Establish a mandated program providing training in cultural diversity, post-
traumatic stress syndrome, violence and abuse prevention, and issues for special
need populations such as youth, seniors, women, and immigrants and refugees.
-iii-
'. Community Response: Partnership Strategies for a Healthy County
121/94
Appendix D: Regional Forum Panelists
Mary Lou Laubscher, Cambridge Community Center
Abby Schofield, Contra Costa County Adult Protective Services
Guity Kiani, Center for New Americans
Frank Camargo, Familias Unidas
Dave Hobbs, Pittsburg Healthy Cities Project
Jim Hernandez, Richmond Unified School District
Bessanderson McNeil, West County Elected Officials Health Care Advisory Committee
Somchith Phongboupha, Lao Family Community Development, Inc.
Susan Prather, Homeless Task Force
Frances Greene, Pittsburg Pre-School Coordinating Council
Kitty Angel, Battered Women's Alternatives
Elsa Zavala, Pittsburg Family Center
Duane Chapman and Sue Crosby, Health Care for the Homeless Project
Community Response: Partnership Strategies for a Healthy County
121/94
A COMMUNITY RESPONSE TO THE PEHAB HEALTH STATUS REPORT
I. Background
In 1987, the Contra Costa Public and Environmental Health Advisory Board
(PEHAB) conducted a survey of nearly 140 community leaders to determine the
most important health issues in the county. The survey results and an extensive
review of local health data led to the identification of six major public health
issues: 1) chronic disease; 2) perinatal health; 3) AIDS; 4) trauma (including
unintentional and intentional injury); 5) substance abuse; and 6) family and
adolescent issues. PEHAB produced a report focusing on the health status in the
county in these areas in 1988. With assistance from HSD staff, PEHAB released
a follow-up report in 1992 examining how these issues currently impacted the
health of county residents, and making recommendations for actions to take to
prevent these problems from occurring.
II. Highlights of the 1992 Health Status Report
The 1992 report used local, state and national health statistics to demonstrate that
these six issues continue to be of extreme concern to Contra Costa. Among the
report's key findings were that:
• The County has experienced a dramatic increase in ethnic diversity: the
Asian/Pacific Islander population has grown 156%, and the Latino population
62%. The majority of these groups reside in West and East County.
• Chronic disease accounted for two-zthirds of all deaths in the county; Contra
Costa's death rate for cardiovascular disease, cancer, and diabetes exceeded the
state average.
• Eighty thousand county residents were estimated to be dependent on or serious
abusers of alcohol and other drugs. Alcohol and other drugs were involved in
64% of the suicides, 85% of the homicides and 58% of all fatal car crashes.
• In terms of trauma, car crashes accounted for nearly half of all unintentional
injury deaths, and firearms were the major killer of children aged 10-18 years
old.
• More than 800 residents had been diagnosed with AIDS and 554 Contra
Costans had died of the disease. (As of April 1993, over 1,000 residents had
been diagnosed.)
• While perinatal indicators are generally good for the County, African American
newborns died at twice the rate of Caucasians, and West County residents
fared most poorly on major perinatal health indicators.
1
Community Response: Partnership Strategies for a Healthy County
121/'94
III. ®verview of the Community Feedback Process
Early this year, PEHAB took the "1992 Health Status Report" to the broader
community for input, sponsoring a series of regional community meetings, focus
groups, and panel discussions with local activists. The goal was to: 1) share the
report information and educate the public on these issues; and 2) get feedback on
whether the six issues continue to be the major health priorities and whether the
actions recommended are most appropriate. Nearly 200 residents throughout the
county participated. This report contains the key findings from that assessment,
PEHAB's recommendations for responding to community concerns, and its own
action plan for the coming year.
PEHAB hopes the information from this report will:
1. Assist the Health Services Department and Public Health Division in setting
future priorities for developing programs responsive to the county's increasingly
diverse population;
2. Help advocate for the needs of low income, people of color, and other
underserved populations; and
3. Guide and shape local policies and decisions about allocating resources in the
six priority areas.
IV. Kev Findings/Recommendations From Participants
Although the meetings were not attended by every possible constituency group,
and the results may not represent all points of view, the process provided an
important vehicle for broader community input. The findings reflect the concerns
of a certain interested and involved segment of the community, including many
respected community leaders and grassroots organizations serving at the
neighborhood level. (See Appendices A-D for further discussion of data
collection methods and listings of participants.) The following highlights represent
the dominant themes from the small group discussions held at the community
meetings, the focus groups, and the regional panel presentations.
Health Problems:
* Chronic disease, AIDS, substance abuse, unintentional injury and violence,
perinatal health, and family and adolescent health issues continue to be the
major health concerns in Contra Costa
* Substance abuse prevention and violence prevention are the two most critical
public health concerns; most other health conditions spring from or are
worsened by these problems. Young people are particularly at risk and in need
of prevention programs.
2
Community Response: Partnership Strategies for a Healthy County
121/94
* Environmental health, mental health services for children and parents, and job
training/development are the primary additional health priorities.
' Significant barriers to services continue to exist, particularly for low income
families and certain ethnic communities.
Recommendations:
' Involvement by the affected communities in planning and implementing
programs is needed. Community organizations not traditionally considered part
of the health care system must be integrated into an overall prevention
approach. Solutions need to be tailored to the specific needs of local
communities.
Development of programs responsive to the needs of multi-cultural
communities must continue to be a major priority for the Health Services
Department.
• Youth, single, teen and working parents, immigrants and refugees, and people
of color need to be the focus of expanded prevention efforts.
* A multi-faceted, broad-based environmental approach to prevention must
encompass not only clinical services and individual education, but policy and
legislative action, and expanded community-based outreach and education.
V. Discussion of Forum Findings and Participant Recommendations
While it was hoped that these forums would provide information useful in
planning regional responses to the six public health issues, the similarities between
regions and groups were more striking than the differences. Whether the topic
was substance abuse, AIDS, or chronic disease, participants emphasized a process
and an overall approach that is reflected in the recommendations that follow.
County-wide and regional responses were universally rejected in favor of more
local, neighborhood-based efforts.
Again, it is important to note that the comments do not reflect every point of
view, but the opinions of a certain interested and involved segment of the
community. For example, workers, disabled residents and seniors (except in
Central County) were visibly missing and their 'voice" may not be represented.
The following is an in-depth review of the specific comments made by participants
in this process related to each of the.major recommendations.
3
Community Response: Partnership Strategies for a Heahhy County
121/94
ONGOING INVOLVEMENT BY THE AFFECTED COMM JNITIES IS NEEDED
IN PLANNING AND IMPLEMENTING PROGRAMS.
The most consistent message from participants was that the local health
department needs to continue to redefine its working relationship with the
community. Key community organizations and groups need to be involved from
the beginning in planning, decision-making, and implementation of health
programs. Many have skills, expertise and influence that have gone largely
untapped. Involvement by these trusted local groups will help insure that
solutions tailored to the unique needs of their communities are identified and
implemented.
Specific recommendations for actions the Health Services Department can take
included the following:
* Make community organizations not traditionally considered part of the health
care system a focal point for education and prevention efforts. The Boys and
Girls Clubs, schools, senior centers, recreation, leisure and sports centers,
churches and others are already focal points for community activity. The
Health Services Department can more actively involve these groups in health
promotion and prevention efforts, and can provide technical assistance, training
and help in identifying sources of potential funding for prevention programs.
* Institutionalize a mechanism for regular community input into the
development of programs. Although certain Health Services Department
programs periodically conduct needs. assessments, there needs to be a
coordinated, comprehensive strategy for regularly soliciting community input on
broad health concerns. The forums and focus groups were seen as a highly
effective means of soliciting community ideas.
* Advocate for and help fund health-promoting alternatives as part of the
prevention strategy. For example, midnight basketball, after-school
recreational programs, and 24-hour community centers were suggested as
primaryways of preventing violence and substance abuse among youth.
* Continue to improve collaboration and coordination between community
eroups and the Health Services Department. This will reduce duplication of
services and enhance prevention efforts. Of particular importance was
'collaborations with the schools and church groups.
* Incorporate job trainine and development into all efforts to improve the health
of the community. The Health Services Department needs to expand its efforts
to hire and train local residents, particularly in low income communities, to
provide services. Outreach workers, aides, and peer health educators are
positions well-suited to this effort. This approach is especially important in
preventing violence and substance abuse problems among youth.
4
Community Response: Partnership Strategies for a Heahhy County
1211'94
. • Restricts placement of alcohol and tobacco advertisement on billboards
and in local publications, and reduces exposure to youth and certain
ethnic groups targeted by these industries.
• Makes tobacco use in public illegal, and restricts youth access to
purchase of tobacco.
• Redirects substance abuse funds from the criminal justice system to
prevention, education and rehabilitation. Expand funds for primary
prevention, particularly with youth and families.
• Mandates employee family leave, and other policies that support
families in crisis or experiencing profound change.
• Enacts local gun control legislation.
• Mandates nutrition assessment and education counseling for new
recipients of food stamps.
• Establishes policies and guidelines for offering healthy food choices to
recipients of government-sponsored food programs.
2. Develop additional county funds earmarked specifically for community-
based prevention.
3. Advocate for responsible media portrayal of violence, alcohol, and tobacco
use and support policies which recognize and respond to the links between
these issues.
4. Promote the establishment of child safety seat recycling programs and other
programs that will increase parents' ability to provide safe alternatives for
their children.
3. Expanded Community-Based Outreach and Education
Participants discussed at length the barriers to successful prevention education
efforts:
* Lack of both client and practitioner awareness of existing programs and
resources.
* Language, cultural and social differences leading to ineffective educational
messages.
* Lack of tools or means for adopting healthy behaviors.
6
Community Response: Partnership Strategies for a Feahhy County
121/94
` Improve staff ability to respond appropriately to diverse communities by
mandating cultural sensitivity training and training in working with special
needs populations. Specific topics should include: violence and abuse
prevention, dealing with post-traumatic stress and "migration trauma" (i.e., the
trauma experienced by immigrants and refugees who leave their native country
under highly stressful circumstances), and issues for substance abusing and
mentally ill clients.
• Recruit and hire staff and administrators who reflect the diversity of the
communities served.
' Establish mechanisms to promote retention of Merrithew Hospital primary care
medical residents. These residents are an important resource for minority and
female practitioners.
CHILDREN, ADOLESCENTS, FAMDL1ES, BUffiGRANTS, PEOPLE OF
COLOR, SENIORS, AND WOMEN NEED TO BE THE FOCUS OF
PREVENTION EFFORTS.
Certain populations were seen to be at higher risk for health problems, with fewer
resources to respond, and having special needs for services and programs. An
overview of the issues identified as most relevant to each group is provided below.
Children and Adolescents: Protecting the health of the county's young people was
a priority concern. Extreme social pressures, existence of few healthy
alternatives/options, lack of good role models, and limited parental and
community support place them at special risk. Many young people, particularly in
low income communities, experience tremendous fear, isolation and hopelessness.
Schools, which used to be a place to socialize, are no longer safe. Young people
exposed to violence suffer post-traumatic stress symptoms of sleeplessness,
inattentiveness and others, and schools and the community do not acknowledge
and address these problems. Youth are targeted for unhealthy behaviors by the
alcohol and tobacco industries.
Families: Participants universally felt that families need to be the focus of
prevention efforts. Many parents lack the skills to be good role models for
healthy behaviors. The growing number of single and teen parent families in
Contra Costa have limited opportunities for improving the quality of their lives.
Immigrant and refugee families face serious obstacles to keeping their families
intact and reconciling differing values and customs.
Increasing numbers of families are at risk for homelessness and abuse. Few
programs intervene to prevent serious problems from occurring in the home, and
protective services are available only in life or death situations. Low income
families and families from other cultures need assistance with job training,
affordable childcare options, and in many cases, ESL classes.
8
Community Response: Partnership Strategies for a Healthy County
121194
Homeless: According to homeless advocates, many homeless suffer serious
multiple health problems. A majority have not received regular health care in
over ten years. The increasing tendency for early hospital discharge of homeless
patients directly to homeless shelters, with no follow-up plan has further
exacerbated this problem. With only two shelters remaining open in the county,
there is often no place for them to go. Homeless Contra Costans are frequent
victims of violence, and suffer severe mental health problems, including post-
traumatic stress. Staff providing services may not reflect the diversity of the client
population and may be inadequately trained to deal with their needs. Homeless
advocates state that clients' rights are frequently abused.
VI. PEHAB's Recommendations for Health Services Department and Public Health
Division Actions
The Health Services Department and Public Health Division have begun to
address many of the concerns outlined in this report. There are several examples
of programs tackling some of these problems and applying the approaches
recommended by community members. These efforts need to be continued,
expanded, and institutionalized as the standard for the Department where
possible. PEHAB recommends that the Health Services Department (HSD) and
Public Health Division (PHD):
* Shift from a county-wide, generic approach to a more localized effort tailoring
public health prevention and health care services to the unique needs of
affected and underserved communities. A "local network model" similar to the
one developed by the Tobacco Prevention Project, where local community
groups actively participate in determining strategies and programs, could be
adapted and utilized.
* Promote an environmental approach involving community-based organizations
not traditionally considered part of the health care system. Take the lead in
convening strategizing meetings with key leaders from these organizations.
Facilitate a process where these organizations jointly plan with the HSD to
implement an environmental approach to preventing these health problems.
Key participants would include: school district, PTA, church leaders, Housing
Authority, Parks and Recreation Department staff:, senior centers, and others.
' Focus prevention efforts in East and West County and in the Concord area of
Central county which contain the largest concentrations of underserved low
income and ethnic populations.
' Institutionalize a mechanism for regular community input on broader public
health issues.
10
Community Response: Partnership Strategies for a Healthy County
1/21/94
VII. Recommendations for Board of Supervisors
The Board of Supervisors plays a crucial role in the implementation of the
recommendations outlined in this report. The Board can take the lead in keeping
these issues and strategies on the public's agenda, in supporting policies and
legislative actions locally and statewide that promote a broad-based prevention
approach, and in helping to identify potential funding sources that can be
allocated to the HSD and community organizations so they can operationalize the
recommendations described.
Specifically, the Board can:
' Promote passage and enforcement of laws that:
• Make tobacco use in public illegal and restrict youth access to purchase of
tobacco products.
• Increase funds for substance abuse prevention and rehabilitation and for
mental health services. Develop additional funding sources for primary
prevention in these areas, particularly with youths and families.
• Mandate employee family leave, and other policies that support families in
crisis or experiencing profound change.
• Enact local gun control legislation. Help educate other local elected
officials to the issues pertinent to violence prevention.
• Mandate nutrition assessment and education counseling for new recipients
of food stamps.
• Establish policies and guidelines for offering healthy food choices to
recipients of government-sponsored food programs.
• Support restrictions on placement of alcohol and tobacco advertisements
locally, in order to reduce exposure to youth and communities of people of
color.
• Help develop additional county funds specifically for community-based
prevention.
• Advocate for responsible media portrayal of violence, alcohol, and tobacco use.
Support policies which recognize and respond to the links between these issues.
• Support the establishment of child safety seat recycling programs and other
programs that will increase parents' ability to provide safe alternatives for their
children.
12
Community Response: Partnership Strategies for a Healthy County
1204
• Work with the Tobacco Prevention Program, Food and Nutrition Policy
Consortium, the voluntaries, and others on conducting a community audit
to assess availability and access of tobacco, alcohol and nutritious foods in
different regions of the county. This information will be used in developing
the chronic disease prevention strategy for the PHD.
3. Convene a Violence Prevention Subcommittee to:
• Work with the HSD Prevention Program and others on developing a .
Department-wide and county-wide violence prevention action plan.
4. Convene an Environmental and Occupational Health Subcommittee which will:
• Develop a position paper on environmental health concerns of the
community, particularly the residents and workers who are directly affected
by toxic exposures.
14
e
Community Response: Partnership Strategies for a Healthy County
1/21194
Who Attended: One hundred and twenty-two participants attended.the meetings. '
Overall, 35% self:identified as clients/consumers, 47% were community-based
organization (CBO) staff or other service providers, and 12% were Health Services
Department staff. (See Appendix C for list of participating organizations.) West
County had a higher percentage of CBO representatives (70%), while Central County
had the highest percent of clients (30%). Although West County had good
representation from the African American community, in general the sessions lacked
significant participation from certain ethnic communities, particularly Asian/Pacific
Islander and Latino groups.
B. Focus Group Discussions
To respond to community input that the meetings needed to involve these groups and
other low income consumers of health services, PEHAB and the Public Health
Division's Prevention Program jointly conducted four focus groups with clients from
these communities(partial funding provided by United Way). The following agencies
participated and recruited clients: Pittsburg Pre-School Coordinating Council,
Familias Unidas, Lao Family Community Development, and Cambridge Community
Center. The questions were the same as those posed at the forums although time
constraints required that each focus group's participants selected two of the six public
health issues to discuss. The focus group at Familias Unidas was conducted in
Spanish and the discussion at Lao Family Development, Inc. was conducted in
Laotian. Participants were given food vouchers from Safeway for taking part in the
discussion.
A total of 32 people (22 women and 10 men) participated in the focus groups. All
four groups chose to discuss substance abuse prevention, two groups chose violence,
and one each chose chronic disease and unintentional injury.
C. Panel Presentations on Regional Health Issues
Beginning with its meeting in January, PEHAB held panel presentations on health
issues in each of the three major regions of the county. (See Appendix D for list of
panelists.) Local activists were invited to speak on the following concerns: 1)
homelessness; 2) violence prevention; 3) health issues for low income and
communities of people:of color; and 4) health issues for immigrant and refugee .
populations. Panelists were asked to address the following questions:
* Who is most at risk/affected by this.issue in your community and bow have you
seen the community's needs change over time?
* What are the barriers to providing effective services to prevent the problems?
* What successful strategies have been used?
* What recommendations do you have for more effective programs?
dP
Community Response: Partnership Strategies for a Healthy County
121M
Comparison of Methods
The community meetings and the small focus group discussions each had strengths
and drawbacks as a data collection method.
The forums attracted a certain segment of the community, i.e., those leaders, activists,
and clients already connected with the health care system. There was a diversity of
opinions and perspectives present that participants found challenging and educational.
The meetings provided an opportunity to network with other residents, providers and
professionals concerned about similar issues. It served as a catalyst for subsequent
organizing around the issues by some groups present, such as the West County
Elected Officials Health Care Advisory Committee, the League of Women Voters
Health Committee, and the Pittsburg Healthy Cities Committee.
The forums were not successful in reaching the low income, ethnic populations that
are traditionally underserved. Although the use of a small group format fostered
discussion, people who were not native English speakers found participation difficult
even when translators were available. The low income residents who did attend
pointed out the difficulties posed by lack of transportation to the meeting location,
and lack of childcare at the event.
The focus groups were much more successful at reaching these populations. Holding
the meetings at local neighborhood centers and offering food remo-ved some barriers
and provide enticement to attend. The largest number of parent/caregivers were
present at the Pittsburg Pre-School Coordinating Council, where childcare was not an
issue. Conducting the focus groups in people's native languages facilitated discussion;
this would have been nearly impossible to do at the larger meetings. The
disadvantages to the focus groups include that small numbers were reached for a large
outlay of staff time, and there was less diversity of opinion and sharing of alternative
points of view.
Community Response: Partnership Strategies for a Healthy County
121/'94
Appendix B: „Regional Community Meeting Co-Sponsors
Black Families Association of Central Contra Costa County
Cambridge Community Center
Central Labor Council
Delta 2000
Familias Unidas
Inter-Denominational Ministerial Alliance of Pittsburg
Lao Family-Community Development, Inc.
League of Women Voters
Martin Luther King Family Health Center
Neighborhood House of North Richmond
Pittsburg Pre-School Coordinating Council
United Council of Spanish Speaking Organizations
West County Elected Officials' Health Care Advisory Committee
1
Community Response: Partnership Strategies for a Healthy County
1211'94
Appendix Q Organizations Participating in Community Meetings
American Cancer Society Mental Health Advisory Board
American Lung Association NAACP
Antioch Police Department Neighborbood House of North Richmond
Battered Women's Alternative Office on Aging
Bay Area Addiction,Research &Treatment,Inc. Pittsburg,City of
Breast and Cervical Cancer Intervention Study Pittsburg Preschool.Coordinating Council
Bay Area Urban League Planned Parenthood
Black Families Association of Contra Costa County Pregnancy Center
Boys&Girls Club,East County PSCC
Brookside Hospital Public and Environmental Health Advisory Board
Cambridge Community Center Rape Crisis Center
Center for Human Development Richmond Chamber of Commerce
Center for New Americans Richmond Rescue Mission
Child Abuse Prevention Senator Boatwright's Office
Contra Costa County Housing Authority Sojourne Counseling Center
Delta 2000 Supervisor Tom Powers'Office
El Cerrito City Council The Wellness Community
E] Pueblo Boys& Girls Club Tobacco Prevention Project Coalition
El Pueblo Community Center Tranquillium
El Pueblo Teatro United Council of Spanish Speaking Organizations
Familias Unidas Visiting Nurses Association &Hospice
Later-Denom Ministerial Alliance of Pittsburg Inc. Walnut Creek,Mayor of
John F. Kennedy University Health Group W Co Elected Officials Health Care Advisory
John Muir Medical Center Committee
Joyce White&Associates West City Elected Officials Health Commission
Lao Family Community Development Inc. West County Mayors Health Advisory Board
League of Women Voters West County Times
Liberty Child Care,Inc. Women & Girls Against Tobacco Project
Martin Luther King Health Center
Mayors Office,Walnut Creek
r
O, y
Contra. Costa County
=,• Health Services Department
_--_ PUBLIC HEALTH DIVISION
Administrative Offices
597 Center Avenue
•` = •y�4 Suite 200
Martinez,California 94553
COUPZ
TO: Internal Operations Committee
Supervisor Jeff Smith
Supervisor Sunne Wright McPeak
FROM: Wendel Brunner, M.D.
Assistant Health Services Director for Public Health
DATE: February 14, 1994
SUBJECT: CAUSES AND PREVENTION OF CANCER
The most recent report from the Federal Government released last week indicates once
again that the rate of cancer in the population appears to be increasing over the last decade.
The rise of lung cancer among women is explicable, the Virginia Slims effect, the probable
increase in breast cancer is not. Even after all the known effects of lifestyle and smoking
are taken into account, the study reports that there remains an unexplained increase that
may be the result of environmental factors. What is perhaps most frustrating is that not only
the causes of the increase are unknown,but even its existence is in dispute. Epidemiologists
commenting on the report suggest that this apparent increase may result from various
methodologic artifacts.
Contra Costa County has tried to develop an approach to cancer evaluation and control that
reflects the multiple determinants of external physical environment, cultural aspects and
environmental influences, including poverty, on the causes and distribution of cancer. The
Bay Area Cancer Coalition (BACC) is a result of this multi-factored approach, looking at
cancer trends in communities that cut across county lines. The BACC has promoted
research and interventions that recognize that cancer control has many cultural, as well as
environmental factors, and must be tailored to the diverse communities in our area
WASHINGTON D.C., SYMPOSIUM ON HEALTH RESEARCH NEEDS TO ENSURE
ENVIRONMENTAL JUSTICE
This conference, sponsored by the US Environmental Protection Agency, National Institute
of Environmental Health Sciences, The Centers for Disease Control and Prevention, US
Department of Energy, and three other Federal agencies, brought together 1,000
researchers, academics,community representatives,agency staff, and at least one local health
department to discuss both the environmental impacts on minority and poor communities
and a meaningful research agenda to address these health needs. More than one speaker
A372 (7/91)
Community Response: Partnership Strategies for a Healthy County
121/94
PUBLIC AND ENVIRONMENTAL HEALTH ADVISORY BOARD
MEMBERS
Doris Copperman
Carlota Dunhower
Vicki Harrington
Art Hatchett
Michele Jackson �..
Richard J. Jackson, MD, MPH
Edith Loewenstein, MD
Bessanderson McNeil, MPH
Julio Mendoza, DDS
Dorothy Oda, DNS, FAAN _ ll
I
Carolyn Robinson
Mary Rocha
Jean Siri
Inh Sooksampan
.Rev.,Curtis A. Timmons, BaThD
William Vega, PhD
Community Response: Partnership Strategies for a Healthy County
121194
ACKNOWLEDGEMENTS
Both "A Community Response: Partnership Strategies for a Healthy County" and the
previous "1992 Status of Health in Contra Costa County" reports were initiated by the
County's Public and Environmental Health Advisory Board (PEHAB), with staffing
provided by the Public Health Division of the Health Services Department. PEHAB
members gave invaluable input, advice and assistance, particularly in organizing the
community meetings for this report. Many community leaders and activists were also
involved in inviting their clients and. constituents. Special thanks go to those who
moderated the meetings, facilitated the small group discussions, and provided translation
services: Phil Arnold, James Banks, Jim Becker, Tina Demonbreum, Piiscilla Enriquez,
Carrie Frazier, Ruth Goodin, Frances Greene, Vicki Harrington, Dave Hobbs, Fred
Jackson, Michele Jackson, Norma Jellison, Paul Kilkenny, Joyce Kingery, Mary Lou
Laubscher, Annette Lerma, Richard Martinez, Dorothy McMichaels, Bessanderson
McNeil, Linda Miller, Julia Robinson-Ellis, Mary Rocha, Jean Siri, Inh Sooksampan,
Rev. Curtis Timmons, and Joan Ward.
Health Services Department staff from the Public Health Division, Substance Abuse
Division, and Office for Service Integration updated data, made presentations and
participated in discussions at the community meetings. Graduate student Cathy Miller
coordinated the focus groups, with assistance from Donna Coit of the Prevention
Program, and with partial funding from United Way. The report could not have been
completed without the patient and. tireless efforts of Amelia Hernandez.
Community Response: Partnership Strategies for a Healthy County
1/21/94
CONTENTS
.Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i - iii
Background Information . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - 2
Key Findings, Discussion and Participant Recommendations .. . . . . . . . . . . . . . . 2 - 10
i
i
PEHAB Recommendations to Health Services Department . . . . . . . . . . . . . . . . ..10 - 11
. I .
Recommendations to Board of Supervisors . . . . . .. . . . . . . . . . . . . . . ... . . . . . . . . . . 12 T {
PEHAB Priorities for 1994 . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . 13 - 14
I .
i
Appendices: '?
A. Data Collection Methodology
B. Regional Community Meeting Co-Sponsors
*G Organizations Participating in Community Meetings
D. Regional Forum Panelists
Community Response: Partaership Strategies for a Healthy County
121/94
EXECUTIVE SUMMARY
INTRODUCTION
Since 1986, the Public and Environmental Health Advisory Board (PEHAB) has helped
the Health Services Department identify critical health issues in the.county, and has
advocated for programs responding to the needs of underserved communities. In 1987
and in 1992, PEHAB worked with Health Services Department staff to produce reports
on health status in Contra Costa. In the Spring of 1993, PEHAB held a series of
community forums with nearly 200 community leaders, clients, and local service providers
to get their input and feedback on the 1992 Report. The findings from that effort, along
with recommendations to the Health Services Department, and PEHAB's own action
plan for 1994 are described herein.
1992 HEALTH STATUS REPORT HIGHLIGHTS
The County has experienced a dramatic increase in ethnic diversity: the Asian/Pacific
Islander population has.grown 156%, and the Latino population 62%. The majority
of these groups reside in West and East County.
• Chronic disease accounted for two-thirds of all deaths in Contra Costa; the.county's
death rate for cardiovascular disease, cancer, and diabetes exceeded the.state average.
• Eighty thousand county residents were dependent on or serious abusers of alcohol
and other.drugs. These substances were involved_ in 64% of the;,smcides, 85..9o' of the
homicides and 506' of all.fatal car crashes.
e In.terms of trauma, car crashes accowited for nearly half of all unintentional injury
deaths in Contra Costa in-198840'(42%).' -Firearms were them 16r k lzer of`children
aged 10-18 years old.
- .. .. :.l.w'� w ... ,J... .i.: J 1 ..\'�.5'•rv`.%f Yi �f�V✓.�'}#M�+M-lli lei... I
More than 800 residents were diagnosedjwitfi A;ID `and' 'S4'" �n a�9snsa�iad died
of the disease. (Note:. As-of A.pril.1993, over 1,000 residenus Ad�bed
with AIDS.) 1 ,
• While perinatal indicators.are generally good for the County, African American..'.
newborns died at twice the rate of Caucasians, and West.County:,residents fared most
poorly on major perinatal health indicators.
CON54UNITY FORUM HIGHLIGHTS t s�
Health Problems
Chronic disease,AIDS, substance abuse, unintentional injury.and violence,
perinatal health, and family and adolescent health issues continue.to.be`.the major
.health concerns in Contra Costa.
-i-
Community Response: Partnership Strategies for a Healthy County
121/94
* Develop additional county funds specifically for community-based prevention
programs and assist community organizations in identifying and applying for
funding.
* Hire and train local residents as outreach workers, aides, and peer health
educators in both public health and clinical services programs.
* Work with labor,disabled, ethnic communities, and other underserved groups to
identify their health needs, and develop programs responsive to those concerns.
Solicit their representation on County advisory boards, commissions, and planning
task forces.
* Involve young people in identifying health problems and solutions by creating
specific youth positions on advisory boards and planning committees. Provide
training so they can participate effectively.
* Evaluate personnel policies and revise as needed to enhance recruitment and
retention of minority staff and Board members. Expand opportunities for
professional advancement.
* Establish a mandated program providing training in cultural diversity, post-
traumatic stress syndrome, violence and abuse prevention, and issues for special
need populations such as youth, seniors, women, and immigrants and refugees.
i
1
-iii-
Community Response: Putnership.Strategies for a Healthy County
121/94
A COMMUNITY RESPONSE TO THE PEHAB HEALTH STATUS REPORT
I. Background
In 1987, the Contra Costa Public and Environmental Health Advisory Board
(PEHAB) conducted a survey of nearly 140 community leaders to determine the
most important health issues.in the county. The survey results and an extensive
review.of local health data led to the identification of six major public health
issues: 1) chronic,disease; 2) perinatal health; 3) AIDS; 4) trauma (including
unintentional and intentional injury); 5) substance abuse; and 6) family and
adolescent issues. PEHAB produced a report focusing on the health status in the
county in these areas in 1988. With assistance from HSD staff; PEHAB released
a follow-up report in 1992 examining how these issues currentlyimpacted the
health of county residents, and making recommendations for actions to take to
prevent these problems from occurring.
II. Hi2hliehts of the 1992 Health Status Reuort i
I
The 1992 report used local, state and national health statistics to demonstrate that
these six issues continue to be of extreme concern to Contra Costa Among the
report's key findings were that:
• The County has experienced a dramatic increase in ethnic diversity: the
Asian/Pacific Islander population has grown 156%, and the Latino population
62%. The majority of these groups reside in West and East County.
• Chronic disease.accounted for two-zthirds of all deaths in the county; Contra
Costa's death .rate for cardiovascular disease, cancer, and diabetes exceeded the
,-•:. .-- "•. '.
• Eighty thousand county,residents were estunated to be depe denton or,.serious
abusers of alcohok and;other drugs.: Alcohol and other rugs were^involved in
64:%of.the �igdes„85%,of,the homicides and 58 00 all fatal car crashes:
• In terms.of.trauma,car crashes accounted for nearly half of allunintentional
injury,deaths' and firearms were the major killer of children aged 10-18 years:
old.
• More than residents
residents had been diagnosedwith AIDS;and'S54 Contra
Costans had died of the disease. (As of April 1993, over'•1000 residents had
been diagnosed.) j
• While perinatal,indicators are generally good for the County, African American
V.
newborns died at twice the rate of Caucasians, and West:County r-es.
esid
ents
fared most poorly on major perinatal health indicators.
1
Community Response: Partnership Strategies for a Healthy County
121/94
* Environmental health, mental health services for children and parents, and job
training/development are the primary additional health priorities.
* Significant barriers to services continue toexist, particularly for low income
families and certain ethnic communities.
Recommendations:
* Involvement by the affected communities in planning and implementing
programs is needed. Community organizations not traditionally considered part
of the health care system must be integrated into an overall prevention
approach. Solutions need to be tailored to the specific needs of local
communities.
* Development of programs responsive to the needs of multi-cultural
communities must continue to be a major priority for the Health Services
Department.
* Youth, single, teen and working parents, immigrants and refugees, and people
of color need to be the focus of expanded prevention efforts.
* A multi-faceted, broad-based environmental approach to prevention must
encompass not only clinical services and individual education, but policy and
legislative action, and expanded community-based outreach and education.
V. Discussion of Forum Findings and Participant Recommendations
While it was hoped that these forums would provide information useful in
planning regional responses to the six public health issues, the similarities between
regions and groups were more striking than the differences. Whether the topic
was substance abuse, AIDS, or chronic disease, participants emphasized a process
and an overall approach-that is reflected in the recommendations that follow.
County-wide and regional responses were universally rejected in favor of more
local, neighborhood-based efforts.
Again, it is important to note that the comments do not reflect every point of
view, but the opinions of a certain interested and involved segment of the
community. For example,workers, disabled residents and seniors (except in
Central County) were visibly missing and their 'voice" may not be represented.
The following is an in-depth review of the specific comments made by participants
in this process related to each of the major recommendations.
3
Community Response: Partnership Strategies for a Healthy County
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A MULTI-FACETED, BROAD-BASED APPROACH TO PREVENTION MUST
ENCOMPASS NOT ONLY CLINICAL SERVICES AND INDIVIDUAL
EDUCATION, BUT POLICY AND LEGISLATIVE ACTION,AND EXPANDED
COMMUNITY-BASED OUTREACH AND EDUCATION.
1. Clinical Services Recommendations
Clinical services need to be family-and community-focused, tailored to the
special needs of populations most at-risk, oriented toward prevention, and
offered at the neighborhood level whenever possible. Specific
recommendations were for the Health Services Department to:
* Develop more accessible clinic-based programs that are culturally sensitive
and age-specific and that incorporate more prevention education. Key
elements would include more timely translation services, availability of
culturally and linguistically appropriate education materials, and alternative
educational tools such as videos for the semi-literate, and for young people.
* Establish community health liaison positions with local agencies serving
immigrant and refugee populations. Local groups such as Center for New
Americans, Lao Family Community Development Inc., Familias Unidas and
others serve as entry points into the system. Their clients often need
health screening referrals and prevention education.
* Create an appointment system responsive to the needs of children and
adolescents, and teen, working and single.parents. Offer evening and
weekend hours, make the appointment-making procedure more flexible,
offer on-site childcare, provide transportation or set up satellite clinics in
neighborhoods, and decrease current lengthy waiting times at clinics.
Develop an accessible system for after-hours, urgent care situations.
* Expand home and respite care services, particularly to families at risk for
child and elder abuse, substance abuse, and other public health broblems.
* Expand street outreach for health care for homeless residents.
2. Policy and Leeislative Action
Policy and legislative action were seen as essential tools in creating social
norms that encourage people to make healthy choices. The Health Services
Department needs to frame these policies as public health issues. It was
recommended that the HSD:
1. Take a more visible role in promoting passage and enforcement of
legislation that:
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* Conflicting information from the media and within the community.
* Education offered too late, after behaviors are set.
* Individual depression and sense of being overwhelmed with problems,
making disease prevention a low priority.
* Fear and denial, peer pressure, social stigma of certain diseases.
To help overcome these barriers, the Health Services Department needs to:
* Work with the media and community leaders to create consistent
prevention messages. Educate the media on its role in influencing people's
choices about healthy behaviors.
* Begin prevention education efforts with young children and their families.
* Use a combination of channels for outreach and education; e.g., work with
schools, churches and the local media; use videos to reach.semi-literate
groups and young people; establish peer educator programs in community-
based organizations.
* Support and conduct skill-building training, especially for childb en,
adolescents and parents. Include parenting skills, crisis management,
4 violence prevention, self-esteem, and job training. Basic life skills may be
needed, such as how to fill out an application or handle a job interview.
* Develop, distribute, and widely publicize a resource guide to available
services.
PROGRAMS MUST BE RESPONSIVE TO THE NEEDS OF THE GROWING
MULTICULTURAL COMMUNITY.
Responding to multi-cultural issues needs to continue to be a major priority for
the Health Services Department. Training in cultural diversity and in responding
to the needs of certain populations like African Americans, Latinos, Asian/Pacific
Islanders, refugees and immigrants is essential. The Health Services Department
also needs to enhance its recruitment and hiring process so that staff composition
more closely mirrors the cultural diversity of the community. Key
recommendations include:
* Work directly with affected communities to identify problems, barriers, and
solutions that can be tailored to their unique needs.
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Community Response: Partnership Strategies for a Healthy County
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Immigrants and Refugees: Most immigrants enter the county healthy, but the
stress of adjusting to the new culture and being separated from family leads to a
rapid deterioration of physical.and mental health. Receiving little or no routine
preventive care, and with chaotic lives that often do not permit advance .
appointment-making, these residents rely extensively on emergency rooms for
crisis care.
Latinos: Agencies serving the Latino community have observed an increase in
poverty, unemployment, and violence. In families where English is a second
language, the children have difficulty in school. Parents who are semi-literate
have problems getting jobs or getting job training that prepares them for our
highly technical work force. One agency serving the mental health needs of the
community reports that 20% of their Latino clients are chronically mentally ill,
and many are ambulatory schizophrenics who need extensive community support
and follow-up. A large percentage of the children in the families they serve are
abused.
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Asian/Pacific Islanders: Like other immigrant populations, the Asian/Pacific I
Islander community suffers severe mental stress from dealing with adjusting to
another culture. Children of immigrants struggle to reconcile the norms and
values of the two cultures and often experience a role reversal as they guide their I
parents through the American system. Some cultural norms, such as not speaking
up and avoiding eye contact, are counter-productive.in school and other settings. i
Women's roles'are substantially different.
Women:-. Violence against women cannot be prevented without'addressing the
social norms which condone it. Women who are at risk for abuseneed to have
access..to temporary and long term housing (particularly if they'have'cluldieri),
need,support from the.legal.system and.need mental.health counseling and,job
t framing �.,:. +L; - v .:r_
Seniors The Monument Boulevard Comdor'is home tothe largest number of
low income senors..in the,county. ;Contra Costa seniors often have'need for food
supplementation,housing.assistance, and.prevention of of protection against elder
-abuse. . . . .
Elder abuse is a significant.problem in Contra Costa, with approximately 30..
referrals received monthly by;the Adult-Protective Services;:countless other.:cases
are estimated to go unreported (Contra Costa Adult Protective Services). Ninety
percent of the abusers are family members, usually adult ch ldren with mental
health and financial problems. Immigrant and refugee families may be at_higher
risk because of tfie extreme'.stress and isolation associated with relocation as well
as the burden of financial difficulties. Abused elders have few options for
emergency shelters, since most homeless shelters do not have the necessary .
waivers to allow seniors admission.
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Community Response: Partnership Strategies for a Healthy County
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* Take a leadership role,in promoting passage and enforcement of legislation and
policies that support people in making healthy choices. This would include
restrictions on placement of alcohol and tobacco ads, restrictions on public use
of tobacco and access to youth,.enactment.of local gun control legislation, and
creation of policies that encourage healthy food options in government food
programs.
* Expand existing efforts to sub-contract with community agencies to provide
outreach, education, and other health-related services. Streamline and simplify
county contract procedures, and provide ongoing training and technical
assistance to help agencies develop skills necessary to provide the services.
Establish a mentor program linking more experienced local organizations with
those which are less experienced.
* Develop additional county funds specifically for community-based prevention .
programs,.and assist community organizations in identifying and applying for
program funding. i
* Hire and train local residents as outreach workers, aides, and,peer health
educators. Establish youth training programs where feasible. Build these
positions into future program efforts. j
* Work with labor, disabled, ethnic communities, and other underserved groups
to identify their health needs, and develop programs responsive to those j
concerns. Solicit representatives from.each of these constituencies to serve on
County advisoryboards, commissions, and planning task forces. j
* Involve young people in!idenffying health.problems and solutions, by creating
specific youth positions on advisory boards and planning committees and
providing necessal'training so they can participate effectively..j' :>
* Evaluate personnel policies and revise them as needed to enhance recruitment i
and retention of minority staff'and Advisory-Board members. Public Health `
Division efforts to createran entrylevel classification that will improve access to ,
county positions by minority candidates should be supported and advanced,
* Establish mechanisms to;promote.retention of Merrithew Hospital primary care
medical residents. These residents are an important resource for minority and
-female practitioners.
* Establish a mandated program for HSD staff providing training in.cultural
diversity, post-traumatic stress syndrome, violence and abuse prevention and
identification, and issues for special need populations such as youth, seniors,
refugees and immigrants, and women.
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Community Response: Partnership Strategies for a Healthy County
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VIII. PEHAB Priorities for 1994
This process also guided PEHAB in setting its own priorities for 1994. While the
"1992 Health Status Report for Contra Costa County" had used health data to
establish local public health priorities, the forums provided community input on
the most pressing topical health issues. Community participants reaffirmed the six
priority public health issues and identified environmental health, mental health,
and jobs/economic development for youth as additional critical priorities.
In establishing its own action plan PEHAB examined these issues in terms of the
following questions: 1. Which issues affect the largest number of people? 2.
Which have the fewest resources currently dedicated to them in terms of funding?
3. Which have already established committees or advisory boards whose function
is to act as community advocates? and 4. Which match with PEHAB's members <:
skills, expertise and interests?
Many of these issues are already a priority in the county, with well-established
programs coordinated and overseen by community advisory boards. PEHAB
determined it would be most effective in concentrating its efforts in those areas
which have historically received less attention and resources: chronic disease
prevention, violence prevention, and environmental and occupational health issues.
PEHAB's plans for 1994 are to:
1. Release the "Community Response: Partnership Strategies for a Healthy
County" report and ensure its utilization by:
Working with the Public Health Division, Environmental Health Division,
HSD, other advisory_boards, and the Medi-Cal Advisory Commission to
implement its recommendations.
• Informing local organizations, city elected officials, the Mayors Conference
and others on the findings from this report and encouraging their support
in implementing the recommendations.
• Collaborating with local organizations whose work reflects the spirit of the
recommendations, to provide them with technical assistance and training so
they can be spokespersons for the report in a series of media stories.
2. Convene a subcommittee on Chronic Disease Prevention which will:
• Work with the Public Health Division (PHD) to develop a Division-wide
chronic disease prevention plan.
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Community Response: Partnership Strategies for a Healthy County
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Appendix A: Data Collection Methodology
Introduction
Data for this report was gathered from three sources: 1) regional community meetings;
2) small focus group discussions; and 3) panel discussions with local activists. The
process and findings from each forum is described in.more detail below.
As stated previously, the process did not include every possible constituency in the
community and may not represent all concerns and points of view. Although many well-
respected community leaders and grassroots organizations participated, there was limited
involvement by consumers of services, particularly members of the Asian/Pacific Islander,
Latino, labor, disabled, and gay and lesbian communities. To address some of these
gaps, PEHAB expanded from only conducting regional meetings, to sponsoring focus
groups with members of some of these underrepresented communities, and holding panel
discussions with local activists working within some of these communities. In evaluating
the data, special attention was paid to identifying concerns and solutions common to all
three forums.
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A, Community Meetings
The Process: In May 1993, PEHAB sponsored open community meetings in West,
East and Central County to get community feedback on its "1992 Health Status in
Contra Costa County" report. Each meeting was co-sponsored.by a number of
respected community-based organizations from that region (see.Appendix B for j
sponsors). An effort was made to get representation and participation from groups i
that represented the ethnic diversity of each region., Ou each;methods for the.
meetings included: personal invitations by sponsoring agencies to their,
membership/clientele, press releases and communityevent,notices,placed:in local
papers, announcements run on the community events board'sof-local cable stations,
flyers distributed.in the.two area PTA newsletters, and a.personal mailing to over.
1000,county r`esiden . :. ..r x ,si ....,.
'1Ji,.• ..: t i;sr •�'.. sr. ,_ *?,.. .:Tf;t ��' •''� t=^.tra
Format of Meetings:` Each meeting:ope"ed witli Health;Senvices Department staff
presenting the highlights from the 1992 report. `FoUowing:this,the audience divided
into small groups by health issue, and trained community facWtators..guided them
through the following questions: 1) What are the barriers to achieving'health in this
area? 2) What kinds of activities/acdons would prevent,this health problem from
occurring? 3) What is the most important action to take'in terms of prevention? and
4) Are there other "burning" health issues not described in the report? To get
feedback from participants who may have been uncomfortable speaking in the groups, j
the evaluation forms included the following questions: 1) Which of the-six'priorities
are you most interested in getting involved in? and 2) What other burning health
issues are missing from the report? Health Services Department staff attending the
meetings took notes in order to bring the community's input back to their programs.
Community Response: Partnership Strategies for a Healthy County
imrga
Comparison of Methods
The community meetings and the small focus group discussions each had strengths
and drawbacks as a data collection method.
The forums attracted a certain segment of the community, i.e., those leaders, activists,
and clients already connected with the health care system. There was a diversity of
opinions and perspectives present that participants found challenging and educational.
The meetings provided an opportunity to network with other residents, providers and
professionals concerned about similar issues. It served as a catalyst for subsequent
organizing around the issues by some groups present, such as the West County
Elected Officials. Health Care Advisory Committee, the League of Women Voters.
Health Committee, and the Pittsburg Healthy Cities Committee.
The forums were not successful in reaching the low income, ethnic populations that
are traditionally underserved. Although the use of a small group format fostered
discussion, people who were not native English speakers found participation difficult
even when translators were available. The low income residents who did attend
pointed out the difficulties posed by lack of transportation to the meeting location,
and lack of childcare at the event.
The focus groups were much more successful at reaching these populations. Holding j
the meetings at local neighborhood centers and offering food removed some barriers
g � B �
and provide enticement to attend. The largest number of parent/caregivers were
present at the Pittsburg Pre-School Coordinating Council, where childcare was not an
issue. Conducting the focus groups in people's native languages facilitated discussion;
this would have been nearly impossible to do.at the larger meetings. The I
disadvantages to the focus groups include that small numbers were reached for a large
outlay of staff time, and there was less diversity of opinion and sharing of alternative
points of view. %
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` Community Response: Partnership Strategies for a Healthy County
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Appendix B: Regional Community Meeting Co-Sponsors
Black Families Association of Central Contra Costa County
Cambridge Community Center
Central Labor Council
Delta 2000
Familias Unidas
Inter-Denominational Ministerial Alliance of Pittsburg
Lao Family Community Development, Inc.
i
League.of Women Voters
Martin Luther King Family Health Center j
I
Neighborhood House of North Richmond j
Pittsburg Pre-School Coordinating Council
United Council of Spanish Speaking Organizations
West County Elected Officials'.Health Care Advisory Committee
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Community Response: Partnership Strategies for a Healthy County
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Appendix C: Organizations Participating in Community Meetings
American Cancer Society Mental Health Advisory Board
American Lung Association NAACP
Antioch Police Department Neighborhood House of North Richmond
Battered Women's Alternative Office on Aging
Bay Area Addiction,Research &Treatment,Inc. Pittsburg,City of
Breast and Cervical Cancer Intervention Study Pittsburg Preschool Coordinating Council
Bay Area Urban League Planned Parenthood
Black Families Association of Contra Costa County Pregnancy Center
Boys& Girls Club,East County PSCC
Brookside Hospital Public and Environmental Health Advisory Board
Cambridge Community Center . Rape Crisis Center
Center for Human Development Richmond Chamber of Commence
Center for New Americans Richmond Rescue Mission
Child Abuse Prevention Senator Boatwright's Office
Contra Costa County Housing Authority Sojourne Counseling Center
Delta 2000 Supervisor Tom Powers'Office
El Cerrito City Council The Wellness Community
El Pueblo Boys& Girls Club Tobacco Prevention Project Coalition
E1 Pueblo Community Center Tranquillium
El Pueblo Teatro United Council of Spanish Speaking Organizations i
Familias Unidas Visiting Nurses Association &Hospice
Inter-Denom Ministerial Allianoe of Pittsburg Inc. Walnut Greek,Mayor of "
John F. Kennedy University Health Group W Co Elected Officials Health Care Advisory
John Muir Medical Center Committee
Joyce White &Associates West City Elected Officials Health Commission
Lao Family Community Development Inc. West County Mayors Health Advisory Board
League of Women Voters West County Tunes .
Liberty Child Care,Inc. Women &Girls Against Tobacco Project
Martin Luther King Health Center
Mayors Office,Walnut Creek
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Community Response: Partnership Strategies for a Healthy County
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Appendix D: Regional Forum Panelists
Mary Lou Laubscher, Cambridge Community Center
Abby Schofield, Contra Costa County Adult Protective Services
Guity Kiani, Center for New Americans
Frank Camargo, Familias Unidas
Dave Hobbs, Pittsburg Healthy Cities Project
Jim Hernandez, Richmond Unified School District
Bessanderson McNeil, West County Elected Officials Health Care Advisory Committee
Somchith Phongboupha, Lao Family Community Development, Inc.
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Susan Prather, Homeless Task Force
Frances Greene, Pittsburg Pre-School Coordinating Council
Kitty Angel, Battered Women's Alternatives
Elsa Zavala, Pittsburg Family Center
t
Duane Chapman and Sue Crosby, Health Care for the Homeless Project
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