The San Bernardino Countywide Vision calls for collaboration across all sectors to create a vibrant, physically and economically healthy county in the next 20 years. The Vision outlines how 10 elements – wellness, jobs and the economy, education, housing, public safety, infrastructure, quality of life, environment, water, and image – are all part of an inter-connected system that relies on all elements working in concert to improve the quality of life for the county’s residents. This feature focuses on the Wellness element, looking at what has been done to date, and what more needs to be done, to help the county reach its vision for wellness.
THE VISION FOR WELLNESS
The wellness of San Bernardino County’s residents directly impacts the quality of life, productivity, and prosperity of our communities. Studies show that students do better in school when they enter the classroom healthy and ready to learn, and healthy employees are more productive and miss fewer workdays. Wellness ensures a thriving workforce, a reduction in health care costs, increased productivity, and a stronger economy overall.
San Bernardino County’s Community Vital Signs Initiative (Vital Signs) is charged with implementing the Wellness element of the Countywide Vision. Vital Signs was started in 2011 by the San Bernardino County Departments of Public Health and Behavioral Health, in partnership with Arrowhead Regional Medical Center, and has grown into a community-driven health improvement framework. It is based on the mobilization of a powerful network of local and regional leaders who are deeply committed to improve the health of San Bernardino County’s residents.
Involving and Empowering San Bernardino County’s Residents
In 2013, 23 community engagement meetings were conducted in San Bernardino County to build on the Vital Signs foundation. Over 1,000 community members – made up of a rich mixture of professionals, community leaders, and residents – reviewed data on a broad range of topics with the intent to prioritize the most urgent issues that impact the health and wellness of county residents.
During these meetings, community members discussed their vision for a healthy and vital community. They prioritized four areas for action: education, the economy, access to health and wellness, and safety. Based on these four priority areas, Vital Signs reconvened over 1,200 community stakeholders representing health care, education, public safety, the business sector, planning and transportation, faith-based and community-based organizations, local juris- dictions, policy makers, and residents, in order to develop a Community Transformation Plan. The Plan sets out a community health improve- ment framework with evidence-based goals and priorities that encompass policy, education, the environment, and systems change in addition to quality, affordable and accessible health care, and prevention services.
In short, the Vital Signs Initiative and Commu- nity Transformation Plan promote aligning and leveraging resources among diverse agencies, organizations, and institutions to empower the community to make healthy choices.
San Bernardino County residents’ priorities are education, the economy, health, and safety.
MUCH WORK TO BE DONE
San Bernardino County consistently ranks near the bottom of California’s counties across a spectrum of health outcomes including length and quality of life. In 2016, the county ranked 42nd out of 57 counties in California for overall health outcomes.1 Death rates for San Bernardino County residents due to diabetes were 2nd highest in the state. For deaths due to coronary heart disease, the county ranked 12th highest.2
Many factors in uence the wellness of our residents. The vast size of San Bernardino County, coupled with large numbers of remote and unincorporated communities, pose substantial challenges to promoting healthy living and providing access to health services. Additional barriers to transforming the county’s culture to one of health and empowerment include higher than average unemployment and poverty rates, and a lower than average percentage of high school and college graduates.
San Bernardino County’s health is poor compared to 57 other California Counties
Many factors influence our health
residents are unemployed (about 143,350)
1 out of 5
residents do not have a high school diploma
1 out of 5
residents live in poverty
Chronic illness costs THE County more than two billion dollars each year
|Medical Costs||Cost of Absenteeism|
|Cardiovascular Disease||$1.5 Billion||$81 Million|
|Diabetes||$700 Million||$31 Million|
|Total||$2.2 Billion||$112 Million|
A call to action
These figures and trends highlight the areas that must be addressed to improve our residents’ health. They are a call to action to motivate government, business and community leaders to work together to create environments in our neighborhoods, schools, and workplaces that promote and support the health and well-being of our residents.
Transforming our Communities
Traditionally, efforts to improve health outcomes within communities have focused on public health programs and health care services. In contrast, Vital Signs depends on the support of multiple sectors, disciplines, organizations, and leaders to collectively create systemic change. The Community Trans- formation Plan provides a common understanding of key health issues that county residents face, and how social and environmental factors such as economy, education, safety, and health issues affect one another. It is founded on the concept that every aspect of health and well-being of our communities is part of an interrelated system that must be addressed collectively.
Education and Wellness
Of the four priority areas, research shows that the one that most signi cantly in uences health outcomes is educational attainment. The National Poverty Center reports that people with more education have lower rates of the most common acute chronic diseases.4 Further, high school graduates earn higher salaries, have better self-esteem, more personal life satisfaction, fewer health problems, and less involvement in criminal activity compared to high school dropouts.5 The Robert Wood Johnson Foundation reports that “people with more education are likely to live longer, to experience better health outcomes, and to
practice health-promoting behaviors such as exercising regularly, refraining from smoking, and obtaining timely health care check-ups and screenings.”6
If educational attainment impacts people’s health, the reverse is also true – an individual’s health also impacts their educational outcomes. For example, children who are in poor health have a harder time focusing in class and miss more school days. They are more likely to fall behind in their studies, have lower test scores, and ultimately, lower educational attainment.
Economy and Wellness
Economic factors including poverty, availability of employment opportunities, and access to affordable housing have also been shown to in uence access to health care and health outcomes. According to the Robert Wood Johnson Foundation, loss of employment is clearly associated with reductions in health coverage. Lack of health coverage affects residents’ ability to access preventive health care and other health services.8 In addition, studies have shown that stable, affordable housing may improve health outcomes by freeing up family resources for healthy food and
health care expenses, reducing environmental exposure from unstable and unsafe housing, and decreasing stress.
Healthy Behaviors and Wellness
Many of the health challenges facing San Bernardino County’s residents are driven by chronic or “lifestyle” diseases correlated with health behaviors, such as smoking or drinking habits, or a lack of physical activity. Regular physical activity substantially reduces the risk of coronary heart disease (the nation’s leading cause of death) and decreases the risk of stroke, colon cancer, diabetes, and high blood pressure.
According to 2016 County Health Rankings, 29% of adult residents were obese compared with 23% in California. More residents lacked adequate access to exercise opportunities in San Bernardino County than in California as a whole (10% vs. 6%, respectively); and 19% of San Bernardino County residents aged 20 years and older reported having no leisure-time physical activity compared to 17% statewide. Among county residents, 14% of adults are current smokers and 18% report excessive drinking habits. These measures highlight the need to support and improve healthy behaviors for county residents.
Safety and Wellness
Healthy and safe environments allow people to access resources and make healthy choices they might not otherwise be able to make. According to the Robert Wood Johnson Foundation, “Social and economic features of neighborhoods have been linked with mortality, general health status, disability, birth outcomes, chronic conditions, health behaviors and other risk factors for chronic disease, as well as with mental health, injuries, violence and other important health indicators.”12 People living in unsafe neighborhoods tend to have fewer options for active transportation, such as biking and walking, or open spaces to be active, further in uencing their ability to participate in healthy behaviors.
As reported in Our Community Vital Signs 2013 Final Report, crime contributes to poorer physical health for victims, perpetrators, and community members. In addition to direct physical injury, victims of violence are at increased risk of depression, substance abuse, anxiety, reproductive health problems, and suicidal behavior, according to the World Health Organization’s “World Report on Violence and Health.”
In essence, the Community Transformation Plan is a roadmap to improving health and wellness, with speci c goals, success metrics, and cross-cutting strategies and policy recommendations for addressing the four priority areas in a strategic manner. The following are examples of projects being implemented in the community by Vital Signs partners to help residents achieve wellness.
Countywide Cradle to Career Roadmap
Priority Area: Education
Goal: Increase high school graduation rates
To support the goal of increasing high school graduation rates, the Countywide Vision developed the Cradle-to-Career Roadmap, which focuses on a continuum approach in which families, educators, government, business and labor, and faith- and community–based organizations act as pillars of support for students from the time they are born until they complete advanced educational programs. The continuum is based on students achieving speci c benchmarks at each age and grade level, including reading at grade level by third grade – an important predictor of high school graduation and career success. By addressing reading pro ciency early, students are more likely to graduate, be college-ready, and achieve career and job success.
Students Advise Policy Makers About Priorities
More than 100 students representing 41 high schools across 15 school districts participated in Student Advisory Panels during the 2015-16 school year. Students from public and private schools worked in teams to prioritize immediate needs and identify speci c actions within each focus area of the Community Transformation Plan, including the economy, education, safety, and health and wellness. The students’ efforts culminated in a presentation of their recommendations to local and state elected of cials and key county administrators who provided feedback to students based on their experience with civic engagement and current programs. Legislators and administrators gained student insight on priority issues impacting the vitality of the communities they serve.
• Students shared that Career Centers in schools need to be strengthened and staffed by knowledgeable guidance technicians to help students obtain and maintain jobs. Career Centers can serve a role in connecting local businesses with schools to provide voluntary internships for students, speci cally in areas that would provide students with opportunities to serve their community.
• Schools need resources and caring personnel to support early identi cation of socio-emotional distress. Student groups identi ed child and family abuse, bullying, gang involvement, poor attendance, substance abuse and suicidal tendencies as issues that prevent students from fully functioning in school and positively contributing to the well-being of the community in the future. Students identi ed a need for teacher training in identi cation of socio-emotional distress, and the need for more school counselors and mental health professionals to support at-risk students.
• Students expressed concerns regarding the limited number of students who are equipped to excel in the Science, Technology, Engineering, and Mathematics (STEM) elds. Anxiety about the rigor of STEM education, coupled with students’ lack of con dence in their own abilities, results in few students enrolling in advanced STEM coursework. Students suggested that schools and community groups might help ease this anxiety and build con dence in students by exposing early elementary students to the STEM eld, creating smooth transitions and pathways for students moving from elementary to middle school and middle school to high school, and providing more STEM classes and programs such as Project Lead the Way, science fairs and science camps to increase interest and con dence in completing STEM coursework.
“We find ourselves in an era where school and community agencies must collaborate more closely than ever to assure the health, academic success, and career readiness of all our students. One of our most engaging efforts was to provide a forum for student voices as part of the Vital Signs Initiative and Community Transformation Plan. High school students from across the county had the opportunity to share their perspectives and offer solutions to policymakers. It is these types of activities that are paving the way for creating long-term, positive change, and building healthier families and stronger schools and communities.”Ted Alejandre, San Bernardino County Superintendent
Priority Goal: Economy/Housing
Goal: Increase Access to safe and affordable housing for all residents
In May 2016, the rst phase of the Bloomington Revitalization project was completed. Phase 2 is currently underway with scheduled completion in February 2017. This project provides an affordable mixed-generational housing community, including a new Bloomington Public Library and new community center.
The Bloomington Revitalization project is an essential approach to improving health outcomes by providing affordable and stable housing, thereby reducing the risk of homelessness, overcrowding and unsafe living conditions. In addition to providing 190 affordable housing units, it will enhance the well- being of the community by promoting economic and community revitalization. Additionally, it is designed with integrated open spaces and pathways where residents and families can safely walk and bike, providing opportunities for increased physical activity. The new local community center will provide a convenient and safe venue for residents to attend educational, training, and cultural events.
Health is one of the most important factors in our lives. It affects our ability to thrive in the workforce, care for our families, achieve educational milestones, and prosper economically. With the Vital Signs Initiative as the framework, and the Community Transformation Plan as the roadmap, many sectors within our community are working together to improve health and wellness in the county.