Communities across Colorado have been engaged in assessing the health of local populations since the Colorado Public Health Act took effect in 2008. It called for major reforms to government public-health systems to ensure that every person, regardless of where they live, will have access to a consistent standard of health care.
The Colorado Department of Public Health and Environment provides funds to accomplish that mission through the Colorado Health Assessment and Planning System, CHAPS, a five-year program designed to help fulfill the mission on the local level.
CHAPS is an eight-step process intended to provide a detailed picture of citizen health, vulnerable populations, and symptoms and causes of poor and/ or good health.
Ultimately, the CHAPS project will develop individualized county public-health improvement plans.
The Montezuma County Health Department received its first funding for the five-year program in October 2016. Since then, the CHAPS management team has been laying the groundwork for the assessment stage, planning an inclusive approach to gathering data essential to understanding the issue from diverse points of view.
The first stakeholder meeting, held in late April, introduced the project to people in county services, institutions and community interest groups.
“How do we create a healthy community?” asked Rebecca Larson, Regional OMNI Institute Consultant and facilitator with the CHAPS project. “What can we as a local society do collectively to assure that people can be healthy?
“We are asking you to contribute to our assessment,” she said, “while we make important decisions for the people of the county.”
Assessment is both a science and an art, Larson explained.
It is essential that current, local data drives the prioritization process, and this begins with the assessment stage.
“If we don’t have that level of data, it can be challenging to know what is actually happening in our community beyond our own perceptions of what we experience.”
Through CHAPS, she explained, community stakeholders have the opportunity to customize the process and analyze the data to fit the culture.
“Montezuma County is more than just tables and charts in a PowerPoint presentation,” Larson told the Free Press in a subsequent interview. “We are unique and diverse perspectives, strengths, and stories that are working and living and recreating together.”
The big picture
The CHAPS team has identified 170 organizations that directly work to affect the well-being of people in Montezuma County. They include educators, city and county elected officials, health providers, social services, business groups such as the Board of Realtors and Chamber of Commerce, advocacy groups, and individuals in the community who have expressed interest in public-health issues.
Three hundred people received invitations to the meeting, and about 10 percent responded, including representatives of some organizations that might easily have been passed over in a less-inclusive process, such as the Cortez Sanitation District and the Montezuma County Landfill.
Larson shared the current baseline county data collected by the Colorado Department of Public Health showing Montezuma County in relation to the state. The charts included statistics as diverse as the percentages of various faith-based congregations, percentage of neighborhoods with sufficient sidewalks or shoulders, and violent crime rates. The data was gathered by means other than the direct survey of the county population.
But with the help of the stakeholders at the meeting, the CHAPS project hopes to develop and distribute a survey that will bring such pertinent issues and questions directly to the people of the county to flesh out the state data with accurate, in-depth local input.
The survey results and analysis will lead to more-inclusive health-care strategies to address local issues while also improving decisions made on the state level for people in Montezuma County. The local survey information will then be used to develop the county health-improvement plan.
Dores Jay-Pang, Tobacco Prevention Program health educator at the county health department and a member of the CHAPS management team, told the Free Press her department sees the face of public health in a larger context than organizations with more targeted missions.
“People sometimes think we have county jobs where we just go to the office everyday and do only the work description of that office, but instead we focus on the health of the whole community.
“That’s why we developed a participation list for the CHAPS meeting with such diversity. We see the big picture of health in the county department,” including faith-based, safety, environmental, and homeless advocacy groups together at the table with health providers and food programs.
The input group was asked to define health issues by creating maps linking one issue to another, such as homelessness with the cost of housing; or mental health with environmental issues, quality of life, and public transportation; or oral health with state Medicaid expansion.
The maps were surprisingly informative, showing the health of the community to be intricately linked and complex, with each concern a contributing factor to many others – a vivid demonstration of how the bigger picture of health is dependent on all the parts.
Disparities in access to and cost of health care; education and ethnicity; social and economic factors; recreation costs; nutritional food resources; transportation factors – all these showed up as links in a range of adjunct patterns.
But other factors were missing.
For instance, climate change affects all aspects of health. It can affect the choice to be outside on a hike, or contribute to missing days of work, yet the topic did not appear in any of the links. Laurel Schafer, grant manager at the county health department, told the Free Press that a follow-up meeting will address how to include such missing issues. “This project is using a deep, local model of collaboration to gather survey information. That process will lead to broader issues as well as specific needs,” Shafer explained, such as how to plan a community-wide “environment of help” that takes the extra step to help solve client issues when they need it most.
“At the health department we try to find the answer for the client – an appointment for dental care, or finding guidance for insurance, or child care. But there isn’t one place in the county that provides all the answers. Most organizations address specialized needs.”
Leila Hanson, a broker at Century 21 West Slope Realty, hopes the group will look more closely at the cost of technology services such as MRIs and CT scans at Southwest Memorial Hospital.
Although the technology for providing these services exists in the county, the interpretive professionalism is only found in Durango, she said.
“How do we try to solve the finances around that issue? Where do we as a county population want to spend our money?
“It especially affects elder care, and the cost to elders to be transported out of here for better diagnosis,” she said. “The last three years of a person’s life are the most medically expensive.”
Social determinants such as transportation and the local economy are connected to almost all issues. Sarada Leavenworth, director of strategy and development at Cortez Integrated Health Care, told the Free Press their service helps clients access all the components needed for good health. That may include help finding affordable insurance, connecting patients to support groups for transitional housing, or even caretaking relief.
“People sometimes don’t come to the provider because they’re worried about not having insurance, or the cost of prescriptions. They think they can’t afford to come.
“But people don’t need to solve the problems before they come to the doctor. We can help with support for those issues, offer more than primary care, mental-health counseling, and substance- abuse treatment.”
If information about this type of service is not well known in the county, the survey should prove the point.
It’s easy to overlook the obvious, explained Jay-Pang. “As the management team identified the organizations we wanted to invite to our meeting, I studied the list and realized we had left out the nutritional-food component. It’s a crucial part of our health in the community. ‘Where’s the food?’ I asked, and then we added the food organizations to the invitation list.”
Even design considerations such as traffic control and public infrastructure can boost people’s health. In Montezuma County, the parks are a shining example. The numerous large parks contribute to the rich quality of life in the region, not just the city. This builds positive feelings among all people.
The Centers for Disease Control Healthy Community Design Initiative works to improve public health by linking it to community-design decisions. The idea is that improving community design can lead to partnerships with decisionmakers that will improve community health overall and lower costs of care.
“I’d call myself an engaged member of the community interested in public health,” said Read Brugger, a participant in the CHAPS stakeholder meeting. “I found the meeting valuable simply because it happened.
“I hope it helped the process,” he told the Free Press. “People took the time to learn about our current understanding of health issues in Montezuma County. “Many will be part of a team – including me – that will design and conduct a new health assessment for the county that will better tailor our available resources to the found needs.”
The CHAPS team asked the stakeholders to suggest ways to get the survey out throughout the county. If they are successful, what they learn will help assure that key components of a healthy community are available to the people.
Jay-Pang said the information acquired could have real benefits.
Domestic violence is an example, she said. What makes it increase or decrease? It’s possible to compare factors (poverty, mental health, familiar dysfunction, alcoholism) when violence occurs.
“If we can gather enough information to define the types of violence and who is involved, maybe we can determine the exact causes of violence in Montezuma County households.
“Hopefully the CHAPS assessment will make people think of results not just as data but a real indication about community health.”