By Nick Macchione, FACHE, Director and Deputy Chief Administrative Officer, Health and Human Services Agency, County of San Diego, California

 

Ask any given person what immediately comes to mind when they think of San Diego, and you’ll likely get a response about its role as a vacation destination, with its plentiful beaches, mountains and desert landscapes; its incredible weather; its friendly residents; its robust military presence; or its role as a key corridor for commerce. Sunny San Diego County bustles year-round with activity, ranging from Navy SEAL trainings to weekly charitable walkathons.

With all that San Diego has to offer, a logical conclusion would be that San Diego County residents are healthy and thriving.

Unfortunately, the reality is that one out of every two San Diego adults is overweight or obese. To make matters worse, nearly one-third of all fifth, seventh and ninth graders are overweight or obese. In other words, San Diego is as physically unfit as any other geographical region of our nation. The County of

San Diego, Health and Human Services Agency (HHSA) recently identified a looming health “tsunami” that, absent any action, is poised to hit our shores. We refer to this major threat as “3-4-50,” noting that three behaviors (poor diet, lack of physical activity, and smoking) contribute to four chronic diseases (heart disease/stroke, cancer, Type II diabetes, and lung disease) that cause over 50 percent of all deaths in the region.

The statistics are sobering: over 4 billion dollars are spent each year in San Diego County to treat these four chronic diseases alone.

However, the County of San Diego is not willing to allow the area that boasts America’s Finest City to continue down this destructive path.

In 2010, the County set out to make a major course correction and rolled out a regional effort to steer San Diego away from a state of chronic disease and spiraling health care costs, and towards a future in which all San Diegans are healthy, safe and thriving. The ten-year roadmap to help us get there is known as, “Live Well, San Diego!” It’s a three-part plan that harmonizes health, safety and economic vitality for the entire region. The first part of the plan was adopted by the County Board of Supervisors in July 2010 and focuses on Building Better Health. The Building Better Health component of Live Well, San Diego! has four key goals:

1. Building a Better Service Delivery System for the over 600,000 San Diegans we serve each year;
2. Supporting Positive Healthy Choices by all San Diegans;
3. Pursuing Policy and Environmental Changes by supporting sustainable policy and environmental improvements; and
4. Changing Culture From Within County Government by promoting employee wellness.

The second and third parts of the plan are referred to as “Living Safely” and “Thriving,” and both are currently being developed to synergize with our Building Better Health strategy.

It’s a decidedly ambitious plan that requires active involvement from the entire region. We are engaging San Diegans of all ages—from school-aged children to seniors—and from all walks of life—from teachers to farmers to military officers to philanthropists to community leaders.

We’re also reaching out to entities in all sectors—ranging from governments to businesses to faith-based organizations to health and social service providers to life science and biotech innovators. The goal is to create community convergence by establishing “Accountable Care Communities,” in which all members of our communities are working together to establish community-wide health goals and measure their performance against those shared goals.

One surprising—and tremendously encouraging—development has been that the business community has turned out to be one of the most enthusiastic supporters of Live Well, San Diego!

We have found that a major draw of Live Well, San Diego! is that it offers the business community an opportunity to achieve what we at the County call “a healthy bottom line.” The idea is that supporting healthier lifestyles will lead to healthier families and employees, and lower health care expenditures by keeping chronic conditions at bay.

There are many ways in which the business community has been participating in Live Well, San Diego! For example, the County of San Diego teamed up with the San Diego Business Journal to support the promotion of employee wellness through their San Diego’s Healthiest Companies Award competition.

In so doing, we have begun to highlight wellness efforts across the community, issue calls to action and provide positive examples for other companies to follow. In addition, the County has worked with the business community to create and support breastfeeding programs. When you think of programs that can have short- and long-term benefits that are low-tech and low-cost, breastfeeding certainly springs to mind.

We know that breastfeeding in the workplace helps avoid absenteeism on behalf of parents and will help make for a healthier child—who will hopefully grow up to become a healthier worker in the future. Another example is our efforts to support ICANATWORK.org, a free website where any San Diego organization can join and create campaigns to promote employee wellness. One major take-away from all of these efforts has been that you can’t incentivize businesses to promote employee wellness by burdening them with more regulations; instead you have to demonstrate how embracing employee wellness improves the bottom line for both business and its surrounding community.

Of course, we have to go beyond the business community to achieve population-level health improvements. To do so, we have created a “SEA of Change”: Support, Encouragement and Accountability between members of the San Diego community as we pursue the goals of Live Well, San Diego! Through federal grants (including Communities Putting Prevention to Work and the Community Transformation Grants) and new collaborations, we are eliminating silos and working side-by-side with other entities in the region to promote wellness. We are working with the Navy Southwest Region and Medical Center, for example, to increase collaboration and address health challenges that face military families, such as tobacco use, obesity, and mental health awareness. In addition, HHSA has piloted a Care Transitions Intervention program with Sharp Memorial Hospital to empower chronically ill patients to take active roles in their own wellness after discharge. In the first 10 months, 138 patients have taken part in the program, and participation has resulted in a reduction of the 30-day readmission rate to 2.3 percent, as compared to the 12.6 percent readmission rate for non-participants. It should be noted that our efforts to improve the health of the region didn’t start with Live Well, San Diego!

Rather, Live Well, San Diego! has truly been built upon the groundwork laid by the local health and social service provider community over the past few decades. As a result of these long-standing efforts, we have begun to see encouraging trends emerge. We are one of the few regions in the nation to reduce heart disease and stroke from the first leading cause of death from chronic disease to the second leading cause. Furthermore, the University of California at Los Angeles recently completed an independent evaluation of childhood obesity, finding that San Diego County reduced obese/overweight children by 3.7 percent—the largest reduction in Southern California.

Despite these encouraging trends, there is still much work to be done. This journey ahead will require continuous innovation, commitment to excellence, and engagement of not only those within government, but our entire citizenship. Due to the scale of what we are undertaking, it will take many more years—and perhaps even generations—to see the true impact of Live Well, San Diego!

I hope I’ve illustrated that Live Well, San Diego! isn’t about a singular, one-size-fits-all solution, or government alone—it’s more about the important role of local government as a convener of all sectors to create community convergence around health and wellness. And San Diego County is not alone in this quest for wellness—other jurisdictions throughout our great nation are making great strides on the wellness front. My hope is that we can patch our collective efforts to achieve sustainable results to win back our nation’s health—that we can achieve “Live Well, America!”

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