Florida State Health Improvement Plan

Chronic Disease Prevention

Strategic Issue
2012-2013 Collaborative Implementation Plan

MISSION: To protect, promote and improve the

health of all people in Florida through integrated state, county, & community efforts.

VISION: To be the Healthiest State in the Nation.

Florida State Health Improvement Plan

Chronic Disease Prevention

Strategic Issue 2012-2013 Collaborative Implementation Plan Table of Contents
Letter from the State Surgeon General Executive Summary I. The Burden of Chronic Disease in Florida II. Background and Development of the 2012-2013 Chronic Disease Prevention Collaborative Implementation Plan III. Implementation IV. Monitoring & Evaluation V. Communications VI. 2012-2013 Chronic Disease Prevention Collaborative Implementation Plan Goal CD1: Increase the percentage of adults and children who are at a healthy weight Goal CD2: Increase access to resources that promote healthy behaviors Goal CD3: Reduce chronic disease morbidity and mortality Goal CD4: Reduce illness, disability, and death related to tobacco use and secondhand smoke exposure VII. Acknowledgments iii iv 1 5 6 9 9 10 10 13 17 22 23

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 iii

Executive Summary
This document describes the implementation of goals, objectives, and strategies found in the Florida State Health Improvement Plans Chronic Disease Prevention Strategic Issue. Information on the need to address chronic disease in Florida is provided, along with background information on the development of the Chronic Disease Prevention Collaborative Implementation Plan and plans for implementation, monitoring, and evaluation

The Need to Address Chronic Disease in Florida

Chronic disease has emerged as the major public health threat facing our nation. According to the Centers for Disease Control and Prevention (CDC), chronic disease currently accounts for 70 percent of all deaths in the United States, affecting 130 million Americans and accounting for nearly 75 percent of our health care costs. More than one in four Americans have multiple (two or more) chronic illnesses, and there are disproportionately higher rates of chronic disease among the elderly, persons with disabilities, and racial and ethnic minorities. Although chronic diseases are the most common and costly health problems, they are also the most preventable. Adopting healthy behaviors such as eating nutritious foods, being physically active and avoiding tobacco use can help prevent or control the devastating effects of these diseases.

Chronic Disease Prevention Strategic Issue

In the Florida State Health Improvement Plan 2012-2015 (SHIP), a statewide plan for public health system partners and stakeholders to improve the health of Floridians, chronic disease prevention is recognized as one of five strategic issues. The Chronic Disease Prevention Strategic Issue details goals, strategies and objectives for addressing the growing burden of chronic disease on Floridians. To enable loosely networked system partners to coordinate in a more targeted, efficient, and integrated way, an annual action planning and implementation process has been put into effect. Annual implementation plans will be developed each May as part of a continuous planning, implementation, monitoring, and improvement process. Progress will be updated quarterly to reflect status (not started, on schedule, complete); describe progress, barriers, and successes; and shift strategies, activities, and lead responsibilities where appropriate. Achieving the milestones described will help achieve the statewide objectives and our shared vision of a healthier future for the people of Florida.

2012-2013 Chronic Disease Prevention Collaborative Implementation Plan

In May 2012, multiple stakeholders, including state and local government, health care providers, employees, community groups, universities and schools, and environmental groups, met to review the Chronic Disease Prevention Strategic Issue, prioritize objectives, and develop an implementation plan for the 2012-2013 state fiscal year. The 2012-2013 Collaborative Implementation Plan (CD-PIP) describes the collaborative activities to be put into action by June 30, 2013 to accomplish objectives in the SHIP that partners determined were priorities. This effort is just the beginning of the ongoing systematic implementation of activities to address the goals and objectives of the SHIP. All four goals defined in the SHIPs Chronic Disease Prevention Strategic Issue are addressed in the 2012-2013 CD-PIP. The Bureau of Chronic Disease Prevention (BCDP) and its partners committed to take responsibility for the Chronic Disease Prevention Strategic Issue and the CD-PIP to achieve statewide objectives.

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I. The Burden of Chronic Disease in Florida

Chronic diseases are conditions that are slow in progression and long in duration.1 Heart disease, stroke, cancer, chronic respiratory diseases, diabetes, and other chronic diseases are the leading causes of mortality in the world, representing 63 percent of all deaths.2 Nationally, 133 million Americans almost one out of every two adults have at least one chronic illness;3 approximately 75 million people have two or more chronic conditions.4 In 2011, chronic diseases contributed to more than 60 percent of all deaths in Florida.5

Figure 1: Major Causes of Death in Florida, by Cause, 2011

Deaths Caused by Chronic Disease in Florida, 2011

Non-Chronic Disease Related Deaths 39.2%

Cancer 23.8%

Heart Disease 23.4%

Stroke 4.8%

Diabetes Mellitus 2.9%

Chronic Lower Respiratory Disease (including Asthma) 5.9%

Heart Disease and Stroke

heart disease and stroke are the most common cardiovascular diseases.1 In 2010, 34 percent of adults in Florida were diagnosed with hypertension,2 and nearly four percent had ever had a stroke.2 More than 10 percent of adults in Florida have some form of heart disease.2 In 2011, heart disease and stroke were the second and fifth major causes of death in Florida, respectively.3

Cancer
More than 321,000 Floridians have some form of cancer.7 In 2011, cancer was the leading major cause of death in Florida.3 The lifetime risk of developing cancer is one in two for males and one in three for females.8

Diabetes
In 2011, diabetes was the sixth major cause of death in Florida.9 The number of people with diabetes worldwide is expected to increase more than 50 percent from 285 million in 2010 to 438 million by 2030.10 There were 577,529 hospitalizations of Floridians from or with diabetes in 2011.11 In 2010, more than 10 percent of adults in Florida were diagnosed with diabetes.12

Asthma
More than eight percent of adults in Florida currently have asthma.13 In 2011, 164,092 people were hospitalized from or with asthma.14 In 2008, an estimated 954,707 adults in Florida had asthma.15 Adult lifetime asthma prevalence in Florida in 2008 was 10.2 percent, and adult current asthma prevalence was 6.6 percent; U.S. rates that year were 13.3 percent and 8.5 percent, respectively.16

Arthritis
In Florida, 27 percent (3,768,000) of adults ages 18 or older have arthritis; the percentage increases with age. Among Florida adults ages 18 or older with self-reported doctor-diagnosed arthritis, 46 percent (1,726,000) have activity limitations due to their arthritis and 28 percent (1,035,000) have severe joint pain due to their arthritis. Of working age (18-64 years of age) adults with arthritis, 34 percent (713,000) have work related limitations due to arthritis.

Health Disparities
Florida is the fourth most populated state in the nation. With an estimated population of 18.8 million residents,17 Florida is home to many diverse racial and ethnic groups. Chronic diseases are not limited to any particular age group, gender, or racial/ethnic background; however, Floridas racial and ethnic minorities and persons with disabilities experience significantly higher rates of chronic diseases.19 Chronic diseases account for five of the top 10 causes of disability in the U.S., including the number one cause of disability, arthritis.20

Table 1: Health Disparities in Florida for Selected Health Status Indicators

50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Prevalence of Smoking Prevalence of Obesity Prevalence of Diabetes

White Black Hispanic Asian Native American/Alaska Native Non-Hispanic Multiracial

Health Status Indicator

The estimated prevalence of disability in Florida is nearly 26 percent; higher than the national average of 22 percent.21 Chronic diseases account for more than 50 percent of all deaths in the United States each year,22 and disproportionately affect persons with disabilities,23 making accessible health care and health promotion particularly critical for this group. People with disabilities are more likely than those without disabilities to experience limited access to care due to cost, transportation difficulties, and physical access barriers.6 Six persons with disabilities are also more likely to smoke cigarettes than are those without disabilities. More than 23 percent of Floridians with disabilities are current smokers, compared to more than 15 percent of persons without disabilities.24

Table 2: Chronic health conditions by disability status-Florida

People without disabilities 17.4% 6.1% 6.5% 4.9% 1.4%

Indicator (Year) Arthritis (2009) Currently have asthma (2010) Diabetes (2010) Prostate Cancer (2010) Stroke (2010)

People with disabilities 47.0% 16.1% 15.2% 5.5% 6.8%

Disparity 29.6 10.0 8.7 0.6 5.4

Modifiable Risk Factors

The prevalence of chronic disease is increasing due to an aging population and a rise in disease-specific risk factors such as obesity.25 Modifiable risk factors such as tobacco use, poor dietary habits, and physical inactivity are the main causes of chronic disease. According to the World Health Organization, most cardiovascular diseases can be prevented by addressing risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity, raised blood pressure, diabetes and raised lipids.26 17.1 percent of Florida adults are current smokers.27 3.3 percent of middle school students and 10.1 percent of high school students are current cigarette smokers.28 37.8 percent of Florida adults are overweight and 27.2 percent are obese.29 13.6 percent of Florida high school students are overweight; 11.5 percent are obese.30 21.4 percent of Florida adults meet vigorous physical activity recommendations.31 43.6 percent of high school students meet the current recommendation of being physically active for a total of 60 minutes per day on five or more of the past seven days.32 24.4 percent of adults eat at least 5 servings of fruits and vegetables a day.33 22.6 percent of youth eat at least 5 servings of fruits and vegetables a day.34

The Cost of Chronic Disease in Florida

In addition to the loss of human life and livelihood, chronic diseases cost the state of Florida more than $86.3 billion in treatment expenditures and lost productivity in 2012.35 For the approximately 47 percent of Americans with multiple chronic disease or conditions, health costs increase dramatically.36 In 2006, disability-associated healthcare expenditures accounted for nearly $400 billion of all adult healthcare expenditures in the US, and exceeded $23 million in Florida.37 The annual additional cost to Florida employers for each obese worker is $1,850, and the annual additional cost to Florida employers for each worker who smokes is $1,275.37 Investing in disease prevention is the most effective way to improve health.39 Prevention has the potential to spare millions of Americans from developing chronic illnesses, reducing health care costs, and improving productivity to foster a robust and competitive work force. There is a growing need for statewide collaborative efforts to counter the increasing burden of chronic disease. Furthermore, the positive return on investment underscores the value that can be obtained through targeted and coordinated efforts with multiple stakeholders. For these reasons, stakeholders were eager to begin collaborating to achieve the goals in the Chronic Disease Prevention Strategic Issue. Partners are committed to leadership responsibilities in carrying out the activities in the 2012 2013 CD-PIP.

Table 3: Return on Investment (ROI) of $10.00 per Person

1 - 2 Years
Total State Savings State Net Savings
(net savings = total savings minus intervention costs)

5 Years
$1,245,300,000

10 - 20 Years
$1,367,300,000 $1,193,600,000

$369,700,000

$196,100,000

$1,071,600,000

ROI for State

1.13:1

6.17:1

6.87:1

II. Background and Development of the 2012-2013 Chronic Disease Prevention Collaborative Implementation Plan
In response to the growing burden of chronic disease in Florida, stakeholders from across the state came together to develop a plan to implement the chronic disease prevention and health promotion objectives in the SHIP. The implementation plan would be realistic, practical, and achievable, and would highlight opportunities for collaboration across traditional disease-specific funding silos. This implementation plan is different from an internal agency strategic plan in that it involves external partners in Floridas public health system and therefore has a greater potential to improve the health of Floridians and visitors to the state of Florida. To support this effort, the BCDP applied for and received funding from the CDC for development of a coordinated chronic disease prevention program. As part of the funding, the BCDP was required to develop a state plan. The CDC guidelines suggested that the plan include: effective strategies to improve policies, environments, programs and infrastructure to address a range of chronic diseases, conditions and risk factors; measurable outcomes; a plan to monitor progress toward programmatic objectives to achieve measurable program improvements; a strategy to engage partners and stakeholders; and a communications plan. Additionally, the CDC developed four domains around which chronic disease prevention and control initiatives revolve. These domains are: Environmental Approaches, Health Systems, CommunityClinical Linkages, and Epidemiology and Surveillance.

Around the same time, the DOH began work on a statewide plan for public health system partners and stakeholders to improve the health of Floridians. The State Health Improvement Plan 2012-2015 (SHIP) includes five priority health areas, called strategic issues. The strategic issues are: Health Protection Chronic Disease Prevention Community Redevelopment and Partnerships Access to Care Health Finance and Infrastructure The SHIP was initially released in April 2012. The Chronic Disease Prevention Strategic Issue section of the SHIP includes four overarching goals: Goal 1: Goal 2: Goal 3: Goal 4: Increase the percentage of adults and children who are at a healthy weight; Increase access to resources that promote healthy behaviors; Reduce chronic disease morbidity and mortality; and Reduce illness, disability and death related to tobacco use and secondhand smoke exposure.

Strategies are identified under each goal, and measurable objectives are identified in relation to each strategy. The Chronic Disease Prevention Strategic Issue is discussed on pages 14-17 of the SHIP, which may be downloaded here. The BCDP assembled stakeholders from across the state to develop an implementation plan to operationalize the strategies and objectives included in the SHIP Chronic Disease Prevention Strategic Issue. Partners agreed to adopt the strategic issue as the state plan, and to prioritize objectives for implementation during 2012-2013.

III. Implementation
The milestones laid out in the CDP Strategic Issue are ambitious and require a comprehensive, integrated, and systematic approach. Implementation is a shared responsibility among the partners in Floridas public health system. Floridas chronic disease prevention initiatives are being championed by public and private partners throughout the state. To coordinate these initiatives in a more targeted, efficient, and integrated way, partners were convened to discuss the CDP Strategic Issue and develop an implementation plan. The 2012-2013 CD-PIP is the first of five annual collaborative action plans that will be developed, implemented, and monitored as a means of implementing the CDP Strategic Issue. This implementation plan was developed during a two-day state planning summit with active involvement by chronic disease partners and health system experts from across the state. The summit is discussed in detail below, followed by the 2012-2013 CD-PIP.

The 2012 Chronic Disease Prevention State Plan Summit

The CDP State Plan Summit was held in Tallahassee on May 17-18, 2012. Multiple stakeholders, including state and local government, health care providers, employees, community groups, universities, schools, and environmental groups, worked in tandem to address shared challenges such as the burden of chronic disease, common elements of the disease-specific primary risk factors for chronic disease, and disease management. Individuals shared information about their current and past disease-specific efforts prior to and during the summit. Successes and challenges were discussed, and participants gained a greater understanding of what approaches were effective or ineffective. In preparing for the summit, the first step was to identify common strategies and access points shared by individual disease programs or initiatives. Potential partners responded to a BCDP survey about the strategies they implement to reduce and prevent chronic diseases and their complications. Common strategies included self-management education, social marketing, evidence-based interventions, policy development, and systems and environmental changes. A new approach was developed which, instead of focusing on the traditional silos of specific diseases, brings partners together based on settings where health care and disease prevention occur. In this new model, which was unveiled at the 2012 Summit, four action teams were created which reflect these settings:

Clinical Communities Schools Worksites

The four action teams are comprised of individuals with expertise in various aspects of chronic disease prevention and control. Although participants specialties might be disease specific, their ability to impact health is improved by collaborating across traditional silos, working on teams that can work in partnership to address common risk factors. Action teams are supported by programmatic, evaluation, and surveillance and epidemiology liaisons and other individuals with expertise related to each access point. Action teams work together via regularly scheduled conference calls and webinars to implement annual collaborative action plans. The action plans include strategies and objectives from the CDP Strategic Issue and list activities for which partners either have taken responsibility or have signed on in a coordinating capacity. Responsible partners and a timeline for completion are defined for each activity. Annual action plans are developed in May of each year as part of a continuous planning, implementation, monitoring and performance improvement process. During the summit, participants met in breakouts by action teams and reviewed the Chronic Disease strategic issue from the SHIP. Each action team prioritized and selected two objectives to address in the 2012-2013 state fiscal year. Action team members then identified specific activities for achieving each objective. Emphasis was placed on defining activities where collaboration/integration would enable a more targeted and efficient approach to maximize the reach, impact and return on investment of partners efforts. Additionally, bureau staff identified areas where their grant-funded activities align with and support the priority objectives. 7

The 2012-2013 CD-PIP (Section VI) was developed as the implementation plan for the priority objectives identified at the Summit. It includes activities for which external partners have taken responsibility and activities for which bureau staff have a lead or coordinating role. Responsible partners and a timeline for completion were defined for each activity, as shown in the action plan. As mentioned, the implementation plan reflects the four domains established by the CDC for addressing chronic diseases. Examples of how the objectives prioritized by the action teams address the CDCs domains include:

Environmental Approaches
Strategy CD4.1: Prevent Floridas youth and young adults from initiating tobacco use. The Schools Action Team supports school districts in passing the comprehensive tobacco-free tobacco-free policies is creation of an environment that does not normalize tobacco use to youth. Strategy CD2.2: Support use of evidence-based employee wellness programs to promote healthy behaviors. The Worksites Action Team prioritized two worksite wellness objectives. Their goal is to change corporate culture in public and private organizations to support wellness initiatives that improve employee health and result in documented return on investment.

Health Systems

Strategy CD2.1: Collaborate with partner agencies and organizations to implement initiatives that promote healthy behaviors. Systems change, according to the CDCs CHANGE Action Guide, is change that impacts all elements, including social norms of an organization, institution, or system and that may include a policy or environmental change strategy. The Communities Action Team has identified three projects that promote healthy behaviors by impacting the health system. The systems approach will be used to provide clinicians, patients, researchers, community health workers, students, teachers, parents, and other partners with tools to prevent or delay chronic disease and its complications.

Community-Clinical Linkages
Strategy CD3.2: Promote early detection and screening for chronic diseases such as asthma, cancer, heart disease and diabetes. The Clinical Action Team has taken lead on an activity under this strategy that uses the community health worker (CHW) model to connect underserved populations with screening services and medical homes. By establishing a relationship with the communities they serve, CHWs have been shown to not only improve health outcomes, but also achieve a 4-1 return on investment.41

Epidemiology and Surveillance +

The BCDP assigned an evaluator and an epidemiologist to track progress on all objectives in the plan; to serve as liaisons with program-specific evaluators and epidemiologists throughout the department; and to lead an evaluation team comprised of department staff and partners from each of the four action teams. Partners have taken responsibility for data collection, monitoring,and reporting across the four action teams and the other three domains. The

first task undertaken by the evaluation team is the development of an inventory of evaluation initiatives, an inventory of epidemiologic data sources and baseline data, and an evaluation plan.

Health Equity
Health Equity is a key priority for the stakeholders engaged in implementation efforts. Health equity is achieved when every person has the opportunity to attain his or her full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances.42 The following activities are being carried out under this Plan toward the goal of achieving health equity: 1. A fact sheet on chronic disease health disparities in Florida will be developed and distributed in year 2013. 2. One member of each action team will be designated the health equity representative. This representative will help ensure that discussions and decisions include health equity components and/or address relevant health equity issues. 3. A specific evaluation will be developed and carried out collaboratively with stakeholders to better understand the extent to which implementation of this plan addresses health disparities. Improvement efforts will be implemented based on evaluation findings.

IV. Monitoring and Evaluation

Implementation of Floridas CDP Strategic Issue annual collaborative implementation plans will be monitored quarterly by an evaluation workgroup. This workgroup consists of representatives from each action team and BCDP staff. The BCDP evaluator, the leader of the evaluation workgroup, will participate in all action team meetings/conference calls and will lead discussion on evaluation progress. In addition, a strategic evaluation plan following the CDC framework for evaluation will be put into practice for the five-year implementation period. The plan will describe the steps and measures that will be used to evaluate processes and outcomes/impacts toward achievement of objectives and longer-term outcomes. Specific chronic disease conditions and risk factor impact measures will be used as part of this evaluation process. Evaluation data and information will be collected systematically. Findings will be communicated to and used by action teams, programs, partners, and other stakeholders to improve efforts and accelerate progress towards chronic disease objectives defined in the state plan.

V. Communications
An important aspect of partnership development and collaborative action is communication. As more statewide partners are identified, communication becomes both more complex and crucial. The implementation of this collaborative action plan is enhanced by a well-defined communication plan. The Department of Health Coordinated Chronic Disease Prevention communication plan details opportunities to exchange ideas and promote interaction among current and potential partners, media, and decision makers. The communication plan also clarifies how the department will use strategic internal communication to shape efforts and common, unified messages, paired with strategic external communication and outreach to partners, stakeholders, media, and decision makers who will promote these messages as they move forward on reaching goals and objectives of the plan. It helps all of our

partners understand how the BCDP's efforts and activities align with the goals and objectives in the SHIP, particularly those in the CDP Strategic Issue. A copy of the Department of Health Coordinated Chronic Disease Prevention communications plan may be requested from the bureau.

VI. 2012-2013 Chronic Disease Prevention Collaborative Implementation Plan (CD-PIP)

The 2012-2013 CD-PIP includes collaborative activities to be put into action by June 30, 2013 to accomplish objectives that Communications partners determined were priorities. The work plans shown below were developed during the 2012 summit to address the selected objectives. While only some objectives were prioritized by partners and included herein, it is important to note that activities to accomplish the other objectives are in progress under the leadership of programs within DOH Bureau of Chronic Disease Prevention and other partners. Combined efforts of DOH programs and statewide partners are monitored quarterly and a comprehensive report on year one progress towards ALL objectives will be prepared and distributed after July 31, 2013.

Goal CD1: Increase the Percentage of Adults and Children Who Are at a Healthy Weight
Strategy CD1.3: Increase the availability of healthy food.
Objective CD1.3.1: By June 30, 2013, DOH will identify and disseminate model policies and practices that increase availability and consumption of healthy foods. Data Source for Monitoring: CD-PIP Progress Tracker Action Team minutes and other documentation Overall Measures of Success: Number of model policies and practices identified Method(s) and date(s) by which policies and practices were disseminated

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Action Team - COMMUNITIES

Action Team Activity Coordinator/ Partners Betsy Wood, (DOH) Target Completion Date 10/30/2012

Communities

1. DOH designates an employee to coordinate activities with partners 2. Florida Department of Agriculture and Consumer Services (FDACS) designates an employee to coordinate activities with partners. 3. Set up/facilitate conference calls and opportunities for subcommittee to carry out collaborative activities. (This includes communication mechanisms such as a listserv or other strategies.) 4. Establish and maintain subcommittee of Communities Action Team to work with DOH and FDACS staff members on evidencebased projects to: a) identify policies and practices that promote access to healthy foods b) Identify seed money and other resources to support implementation of projects. (This may include a grant writer, etc.) c) Disseminate information about practices and policies to partners and post on DOH and FDACS websites

Communities

Robin Safley, (FDACS)

10/30/2012

Communities

M.R. Street, Lauren Berlow, (DOH)

10/30/2012 and Ongoing

Communities

Subcommittee

10/30/2012 and Ongoing

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Objective CD1.3.6: By June 30, 2015 DOH, the Department of Education (DOE) and FDACS will develop model programs and policies that address the following: Serving healthy foods in schools and food kitchens. Using garden food in school cafeterias. Supporting edible, rather than ornamental foliage on public land. Expanding the Healthier U.S. School Challenge and Healthy Schools programs. Data Source for Monitoring: CD-PIP Progress Tracker Overall Measures of Success: Number of model program and policies implemented through DOH, DOE and FDACS

Action Team - SCHOOLS

Activity Team Activity Coordinator/ Partners Subcommittee: Target Completion Date 1/30/2013

Schools

1. Develop an inventory of model programs, practices, and policies (evidence informed) related to physical education, physical activity, and nutrition that address the following: serving healthy foods in schools and food kitchens; using garden food in school cafeterias; supporting edible, rather than ornamental foliage on public land; expanding the Healthy Schools Program and/or Healthier US School Challenge; adopting inter-class and interschool wellness competitions; increasing the number of school gardens; and enhancing food and exercise related curricula such as Agriculture in Classroom.

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Action Team - SCHOOLS

Activity Team Activity

(continued)
Coordinator/ Partners Jan Daly (DOH), Penny Taylor (DOE), Robin Safley, (FDACS), Karla Shelnutt (UF IFAS) DOH/DOE/ FDACS leads to be determined Target Completion Date 6/30/2013

Schools

2. Distribute this inventory in advance of the new school year.

Schools

3. Develop and collect (for quarterly updates to the inventory) additional examples of model programs, practices, and policies

06/30/2013 and ongoing through 06/30/2015

Goal CD2: Increase Access to Resources that Promote Healthy Behaviors

Strategy CD2.1: Collaborate with partner agencies and organizations to implement initiatives that promote healthy behaviors.
Objective CD 2.1.1: By Dec. 31, 2014, implement at least three statewideinitiatives that promote healthy behaviors such as obtaining healthy weight and tobacco cessation. Data Source for Monitoring: Automated Tobacco Activity Collection System (ATACS) CD-PIP Progress Tracker Action Team minutes and other documentation Overall Measures of Success: Number of statewide initiatives (target: three) have been implemented to promote healthy behaviors such as obtaining healthy weight and tobacco cessation.

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Action Team - COMMUNITIES

Action Team Activity Coordinator/ Partners Betsy Wood, (DOH) Target Completion Date 6/1/2012

Communities

1. DOH designates an employee to coordinate infrastructure development, provide technical assistance to communities for promoting healthy behaviors. 2. Set up conference calls, opportunities for subcommittee to continue collaborative activities. 3. Establish and maintain subcommittees of the Communities Action Team to work with staff members on initiatives to promote healthy behaviors, share information, create linkages with partners, and find resources. Subcommittees will focus on: a) developing a website clearinghouse of professional, evidence-based resources (Collaborate with other action teams) b) identifying and applying for funding c) educating professionals about available resources d) selecting three statewide partners to serve as statewide initiative sites that can be replicated in other areas by other coalition / committee partners --TOUCH (Transforming Our Communitys Health), lead is Health Foundation of South Florida; --National Diabetes Prevention Program, lead is University of Florida IFAS; --Safe Routes to School, lead is Dept. of Transportation 4. Promote evidence-based chronic disease self-management education (SME) programs in accordance with national guidelines (e.g., Stanford CDSMP, Diabetes SME, Asthma SME)

Communities

M.R. Street, Lauren Berlow, (DOH) a) Website subcommittee b) Lead is Debbie Saulsbury, grant writer c) Lead to be determined d) Program selection subcommittee

10/30/2012 and Ongoing

Communities

10/30/2012 and Ongoing

Communities

Lead: Martha Pelaez; partners: DOH Diabetes and Asthma programs

6/30/2013 and Ongoing

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Strategy Strategy CD2.2: Support use of evidence-based employee wellness programs to promote healthy behaviors.
Objective CD2.2.1: By Dec. 31, 2013, increase by 5 percent the availability of employee wellness programs that address nutrition, weight management, and smoking cessation counseling services in state agencies in Florida. Objective CD2.2.2: By June 30, 2014, increase by 5 percent the availability of employee wellness programs that address nutrition, weight management and smoking cessation counseling services in workplaces other than state agencies. Data Source for Monitoring: CD-PIP Progress Tracker Action Team minutes and other documentation Overall Measures of Success: Percent of employee wellness programs in state agencies in Florida (Focus: County Health Departments) Percent of employee wellness programs in workplaces other than state agencies (Focus: School Districts).

Action Team - WORKSITES

Action Team Activity Coordinator/ Partners Karen van Caulil (lead); Faith Schafer-Moody (University of Central Florida MPH intern) Target Completion Date 10/30/2012 and Ongoing

Worksites

1. Develop easy-to-use website and post information about starting employee wellness program. Collaborate with other action teams on website development. Enlist a partner who can develop and maintain a website to share and promote: --Evidence-based practices --FAQs --Lessons learned --Success stories for companies and individuals --Toolkits --ROI --Other information to enhance partner collaboration Conduct beta test and make changes as needed to website.

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Action Team - WORKSITES (continued)

Action Team Activity Coordinator/ Partners Target Completion Date Sept. 2012

Worksites

2. Determine what research has been conducted related to SHIP. Definition of worksite/employee wellness program Baseline information Survey tool used How are they measuring the availability of worksite wellness programs? 3. Work with Bureau Evaluator to determine: Definition of worksite/employee wellness Baseline information Appropriate survey tool Appropriate measure of success 4. Conduct a literature search on wellness and chronic condition programs that have high-level engagement. 5. Develop evaluation plan. New and enhanced programs Web trends (utilization) 6. Implement marketing and communication plan. Determine target audience

Plangineer (M.R. Street)

Worksites

Julia Fitz; Evaluation Subcommittee

01/31/2013

Worksites

Karen van Caulil (lead); Faith Schafer-Moody MPH intern) Julia Fitz; Evaluation Subcommittee Lead to be determined; Collaborate with Allison BarnesCarter (DOH Communications) Carol Vickers, BCDP Heart Disease & Stroke Prevention Program

02/28/2013

Worksites

03/31/2013

Worksites

06/30/2013 and Ongoing

BCDP

7. Promote and support employee wellness programs in all school districts in Florida, including: Four school districts receiving CDC grant awards to support a district coordinator An additional twenty-three school districts participate in a Healthy School District Collaborative

06/30/2013

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Goal CD3: Reduce Chronic Disease Morbidity and Mortality

Strategy CD3.1: Promote chronic disease self-management education.
Objective CD3.1.1: By Dec. 31, 2015 increase the percentage of adults with diagnosed diabetes that have ever taken a course or class in how to manage their diabetes from 55.1 percent to 59 percent. Data Source for Monitoring: BRFSS CD-PIP Progress Tracker Overall Measures of Success: Percentage of adults with diagnosed diabetes that have ever taken a course or class in how to manage their diabetes is 59%. Objective CD3.1.2: By Dec. 31, 2015, increase the percentage of adults with diagnosed arthritis that have ever taken an educational course or class to learn how to manage problems related to arthritis or joint symptoms from 14.4 percent to 20 percent. (BRFSS) Data Source for Monitoring: BRFSS CD-PIP Progress Tracker Overall Measures of Success: Percentage of adults with diagnosed arthritis that have ever taken an educational course or class to learn how to manage problems related to arthritis or joint symptoms is 20%. Objective CD3.1.3: By Dec. 31, 2015, increase the percentage adults with diagnosed asthma that have taken a course or class to learn how to manage asthma from 10.2 percent to 13 percent. Data Source for Monitoring: Adult Asthma Call Back Survey CD-PIP Progress Tracker Overall Measures of Success: Percentage of adults with diagnosed asthma that have taken a course or class to learn how to manage asthma is 13%. 17

Action Team - CLINICAL

Activity Team Activity Coordinator/ Partners UF Disability and Health Program (DHP) and DOH Disability and Health Program; support from contacts listed* Target Completion Date

Clinical

1. Identify the organizations that provide self-management programs for diabetes, asthma, and arthritis. *Contacts for Collecting Information: DOH Diabetes Prevention and Control Program (DPCP) (CD3.1.1); DOH Asthma Prevention Program (CD3.1.3); Health Planning Councils in Florida

Clinical

2. Develop survey to determine how participants are referred to programs and the referral sources

Miten Patel, UF MPH student; Claudia Tamayo, UF DHP (mentor) Miten Patel and Claudia Tamayo Miten Patel and Claudia Tamayo

04/30/2013

Clinical

3. Implement survey of organizations that provide self-management programs 4. Analyze survey results, looking for: Who should be referring but is not; Who is referring; Referral methods used and not 5. Develop a dissemination plan for communicating and using the survey results 6. Promote establishment of recognized or accredited diabetes self-management education (DSME) programs in the 24 counties in Florida that do not have a recognized or accredited program. 7. Maintain DSME referral systems through the Quitline (tobacco cessation), the Insulin Distribution Program, and other systems.

05/30/2013

Clinical

06/30/2013

Clinical

Allison Barnes-Carter

12/30/2013

Clinical

DPCP

03/31/2014

Clinical

DPCP

03/31/2014

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Strategy CD3.2: Promote early detection and screening for chronic diseases such as asthma, cancer, heart disease and diabetes.
Objective CD3.2.1: By Dec. 31, 2015, increase by 10 percent the proportion of women who receive a breast cancer screening based on the most recent clinical guidelines. Data Source for Monitoring: BRFSS CD-PIP Progress Tracker Overall Measures of Success: Percentage of women who receive a breast cancer screening based on the most recent clinical guidelines increases from 61.9% (2010) to 71.9%. Objective CD3.2.2: By Dec. 31, 2015, increase by 10 percent the proportion of women who receive a cervical cancer screening based on the most recent clinical guidelines. Data Source for Monitoring: BRFSS CD-PIP Progress Tracker Overall Measures of Success: The percentage of women who receive a cervical cancer screening based on the most recent clinical guidelines increases from 57.1% (2010) to 67.1%. Objective CD3.2.3: By Dec. 31, 2015, increase the percentage of adults 50 years of age and older who receive a colorectal cancer screening (blood stool test in the past year or sigmoidoscopy or colonoscopy in the past five years) from 57 percent to 80 percent. Data Source for Monitoring: BRFSS CD-PIP Progress Tracker Overall Measures of Success: The percentage of adults who had their cholesterol checked in the past two years is 76.3%. Objective CD3.2.5: By Dec. 31, 2015, increase the percent of adults in Florida that have had a test for high blood sugar or diabetes within the past three years from 62.6 percent to 65 percent. Data Source for Monitoring: BRFSS CD-PIP Progress Tracker Overall Measures of Success: The percentage of adults in Florida that have had a test for high blood sugar or diabetes within the past three years is 65%.

19

Objective CD3.2.6: By Dec. 31, 2015, increase the proportion of persons whose diabetes has been diagnosed from 10.4 to 12 percent (As measured by the percent of adults in Florida who have ever been told by a doctor they have diabetes. There are approximately 767,666 adults in Florida living with undiagnosed diabetes. Prevalence will increase until these adults are identified.) Data Source for Monitoring: BRFSS CD-PIP Progress Tracker Overall Measures of Success: The percentage of persons whose diabetes has been diagnosed is 12%.

Action Team - CLINICAL

Activity Team Activity Coordinator/ Partners Lead to be determined Target Completion Date 01/31/2013

Clinical

1. Determine screening organizations and screening locations that serve uninsured/low income populations. 2. Develop a web portal system (Collaborate with other action teams). 2 segments: one for consumers, one for collaborative activities 3. Explore feasibility of mobile screening units and/or providers in rural/underserved areas Incentives for servicing areas with unmet needs 4. Promote screening referrals by health care providers. 4b. Provide and promote webinars related to cancer screening.

Clinical

Website Subcommittee

01/31/2013

Clinical

Miten Patel and Claudia Tamayo

05/30/2013

Clinical

Lead to be determined DOH Cancer prevention Program

01/31/2013 and ongoing 01/31/2013 and ongoing

Clinical

20

Action Team - CLINICAL (continued)

Activity Team Activity Coordinator/ Partners Lead to be determined Target Completion Date 01/31/2013 and ongoing

Clinical

5. Encourage people to obtain screenings using the community health worker (CHW) model 6. Encourage physicians to select screening measures for meaningful use incentives. 7. Convene screening organizations hosted by DOH in joint meeting with AHCA to determine collaborative opportunities. Identify and focus on screenings with good evidence-based results and cost savings (ROI) Include other payers

Clinical

Lead to be determined

01/31/2013

Clinical

DOH/AHCA leads to be determined

06/30/2013

21

Goal CD4: Reduce Illness, Disability, and Death related to Tobacco Use and Secondhand Smoke Exposure
Strategy CD4.1: Prevent Floridas youth and young adults from initiating tobacco use.
Objective CD4.1.1: By Dec. 31, 2015, increase the number of committed never smokers among Floridas youth, ages 11-17 from 62.6 percent to 68.9 percent. Data Source for Monitoring: Florida Youth Tobacco Survey (FYTS) ATACS CD-PIP Progress Tracker Overall Measures of Success: Percentage of committed never smokers among Floridas youth is 68.9%

Action Team - Schools

Action Team Activity Coordinator/ Partners Lead = James Mosteller; partners: American Lung Association, American Heart Association, American Cancer Society, FL Asthma Coalition, Action for Healthy Kids Bureau of Tobacco-Free Florida; partners: M.R. Street, Julie Dudley Target Completion Date 06/30/2013 and Ongoing

Schools

1. Support school districts in passing the comprehensive tobacco-free campus model school policy for K-12 by distributing recognition awards.

Schools

2. Promote the comprehensive tobacco-free campus model district policy through multiple wellnessrelated networks.

06/30/2013 and Ongoing

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VII. Acknowledgments The Bureau of Chronic Disease Prevention gratefully acknowledges the partners who make the development and implementation of this plan possible. Attended Summit
Leslie Beitsch, MD, JD Florida State University, College of Medicine Philippe A. Bilger, DDS Palm Beach County Health Department Carol Bryant, PhD University of South Florida Ms. Sarah Catalanotto, MPH, TTS Suwannee River AHEC Ms. Laura Cantwell AARP Florida Alma Y. Dixon, EdD, MPH, RN Odessa C. Chambliss Wellness Center Bethune-Cookman University Ms. Lynne Drawdy Summit Facilitator Dawn Emerick, PhD Health Planning Council of N.E. Florida, Inc. Chet Evans, MS, DPM Diabetes Advisory Council Chair and LECOM/Bradenton College of Osteopathic Medicine Claude Earl Fox, MD, MPH Florida Public Health Institute Ms. Allyson Hall University of Florida Mr. William Hightower Florida Osteopathic Medical Association Mr. Paul Hull American Cancer Society-Florida Division Ms. Princilla Jefferson Agency for Health Care Administration Ms. Marilyn Leeds Lake Okeechobee Rural Health Network Mr. Steven Marcus, EdD Florida Partnership for Healthy People and Healthy Places Mr. James Mosteller American Heart Association Ms. Terry Murphy Blue Cross & Blue Shield of Florida Foundation Ms. Miranda Paschal Florida Assn. of Community Health Centers Martha Pelaez, PhD Health Foundation of South Florida Mr. Gerald Popp Florida A & M University Ms. Carol Pulley Florida Safe Routes to School State Network Penny A. Ralston, Ph.D. Center on Better Health and Life for Underserved Populations Ms. Linda J. Redman, MPH, MA Centers for Disease Control and Prevention Barbara E. Richardson, PhD, RN University of Florida AHEC Program Ms. Janisse Schoepp Health Foundation of South Florida Ms. Robin Safley Florida Department of Agriculture Ms. Jessica Schumacher, PhD University of Florida

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Ms. Cynthia Seaborn Florida A&M University Ms. Twila Sisk Agency for Health Care Administration Bonnie Sorensen, MD Volusia County Health Department Debra A. Susie, PhD Florida Impact Claudia Tamayo University of Florida Ms. Penny Taylor, CPP Department of Education Karen van Caulil, PhD Florida Health Care Coalition Ms. Debbie Watson Winter Park Health Foundation Ms. Melanie Weaver Carr Department of Transportation Ms. Ann-Karen Weller, RN, BSN, ICCE Miami-Dade County Health Department

Florida Department of Health Subject Matter Experts and Facilitators Ms. Christine Abarca, MPH, MCHES Nicoletta Alexander, Ph.D. Ms. Susan Allen Ms. Allison Barnes-Carter Ms. Lauren Berlow Ms. Mary Bowers Ms. Sarah Cawthon Ms. Evie Crosby Janice A. Daly, PhD, MCHES Ms. Valerie Diaz Barrios Ms. Julie Dudley Ms. Laura Ethridge Ms. Jamie Forrest Ms. Deborah Glotzbach Ms. Linda Greis, RN, BSN Ms. Sue Higgins, MPH Mr. Mike Mason Ms. Jane Parker Ms. Lauren Porter Ms. Kalinda Pyles Mr. Gregg Smith Ms. Corine Stancil, MPH, M.Ed, CHES Ms. M.R. Street, MPH Ms. Trina Thompson, MA Ms. Betsy M. Wood, BSN, MPH

24

Other Partners
Linda Benjamin Bobroff, PhD, RD, LD/N University of Florida IFAS Ms. Kim Bertron Leadership Council of the Florida Alliance for Diabetes Prevention and Care Ms. Brittaney Bialas Duval County Health Department Ms. Janiece Davis Palm Beach County Health Department Ms. Megan OMeara Diehl, MS Alliance for a Healthier Generation Florida Department of Health Ms. Laura Corbin Ms. Susan Redmon Ms. Rita Diaz-Kenney, RD, MPH, LDN Leadership Council of the Florida Alliance for Diabetes Prevention and Care Ms. Beth Eastman Agency for Health Care Administration Ms. Leigh Ann Edwards, MPH, RD Share Our Strength Ms. Tori Gabriel, MBA-HA Florida Heart Research Institute Mr. David Garison Putnam County Health Department Thomas J. George, MD, FACP Cancer Control & Research Advisory Council Mr. Jeffrey Gregg Agency for Health Care Administration Ms. Melodie Griffin, MHA Seminole County Public Schools Ms. Sharon Hatch United Health Care Tammie Johnson, Dr.PH University of North Florida Roderick King, MD, MPH Florida Public Health Institute Ms. Beth Labasky COPD Foundation Ms. Pauline E. Lowe American Diabetes Association Ms. Daniyel Macomber Duval County Health Department Ms. Michele Manzie Duval County Health Department Mr. Stephen McCloskey Alliance for a Healthier Generation Ms. Holly Miller Florida Medical Association Ms. Lori Nelson Dairy Council of Florida Mr. Kevin O'Flaherty Campaign for Tobacco-Free Kids Ms. Brenda Olsen American Lung Association of Florida Ms. Kerri-Anne Parkes, MPH, CHES Miami-Dade County Health Department Mr. Ryan Reid American Cancer Society Ms. Brendaly Rodriguez, MA South Florida Center for Reducing Cancer Disparities (SUCCESS) Ms. Kimberly Sandmaier Palm Beach County Schools Edward Shahady, MD Florida Academy of Family Physicians

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Karla Shelnutt, PhD, RD University of Florida IFAS Ms. Jennifer Sills Dairy Council of Florida Ms. Gabrielle Solomon Health Foundation of South Florida Ms. Lindsey Sowders Duval County Health Department Ms. Jamie Sullivan, MPH COPD Foundation Students Working Against Tobacco (SWAT)

Ms. Sarita Taylor Department of Transportation (Safe Routes to School) Mr. Timothy Tyler Health Connect in Our Schools Ms. Erica Whitfield Palm Beach County Health Department Ms. Nichole Wilder DOE Office of Healthy Schools Ms. Heather Wildermuth American Cancer Society

Bureau of Chronic Disease Prevention Technical Assistance Team

The Plangineers (provide overall technical assistance and support to all action teams and subcommittees) M.R. Street Lauren Berlow Sarah Cawthon Jan Daly Julie Dudley Julia Fitz Shamarial Roberson Worksites Felisha Dickey Deborah Glotzbach Clinical Susan Fleming Linda Greis Communities Marion Banzhaf Corine Stancil Schools Sue Higgins Carol Vickers

26

References
World Health Organization (2012). Health Topics: Chronic Diseases, http://www.who.int/topics/chronic_diseases/en/ World Health Organization (2012). Health Topics: Chronic Diseases, http://www.who.int/topics/chronic_diseases/en/ The Power of Prevention: Chronic Disease ... the Public Health Challenge of the 21st Century. National Center for Chronic Disease Prevention and Health Promotion (2009). Web. 17 Dec. 2012. <http://www.cdc.gov/chronicdisease/pdf/2009-power-of-prevention.pdf>. Parekh, Anand K., MD, MPH, and Mary B. Barton, MD, MPP. "The Challenge of Multiple Comorbidity for the US Health Care System." Journal of the American Medical Association 303.13 (2010): 1303-304. Web. 17 Dec. 2012. <http://jama.jamanetwork.com/article.aspx?articleid=185601>
5 4 3 1

Major Causes of Death for 2011. Florida CHARTS: http://www.floridacharts.com/charts/DisplayHTML.aspx?ReportType=7226&County=69&year=2011 &tn=33. Major Causes of Death for 2011. Florida CHARTS: http://www.floridacharts.com/charts/DisplayHTML.aspx?ReportType=7226&County=69&year=2011 &tn=33.

Cancer Incidence. Florida CHARTS: http://www.floridacharts.com/charts/OtherIndicators/NonVitalIndDataViewer.aspx?cid=0460.

8

Lifetime risk of developing cancer, American Cancer Society. Web. http://www.cancer.org/cancer/cancerbasics/lifetime-probability-of-developing-or-dying-from-cancer.

Major Causes of Death for 2011. Florida CHARTS: http://www.floridacharts.com/charts/DisplayHTML.aspx?ReportType=7226&County=69&year=2011 &tn=33. Number of Americans with Diabetes Projected to Double or Triple by 2050. CDC Press Release, Oct. 22, 2010. Web http://www.cdc.gov/media/pressrel/2010/r101022.html.
10

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Hospitalizations from or with Diabetes, 2011. Florida CHARTS: http://www.floridacharts.com/charts/OtherIndicators/NonVitalIndDataViewer.aspx?cid=0334. Trends in Diabetes and Risk Factors: Diagnosed Diabetes Among Adults, age-adjusted, 2010. CDC: http://www.cdc.gov/diabetes/atlas/obesityrisk/atlas.html. Florida, 2010: Asthma. CDC Prevalence and Trends Data, http://apps.nccd.cdc.gov/brfss/display.asp?cat=AS&yr=2010&qkey=4416&state=FL.
14 Asthma 15 Asthma 13 12

11

Hospitalizations. Florida Environmental Public Health Tracking, 2010.

in Florida. Centers for Disease Control and Prevention, National Asthma Control Program, http://www.cdc.gov/asthma/stateprofiles/Asthma_in_FL.pdf.
16 Asthma

in Florida. Centers for Disease Control and Prevention, National Asthma Control Program, http://www.cdc.gov/asthma/stateprofiles/Asthma_in_FL.pdf. Arthritis Program: State Burden, http://www.cdc.gov/arthritis/state_programs/programs/florida.htm (This is the source for all the arthritis data points in this section.) U.S. Census 2010 Interactive Population Map. U.S. Census Bureau, http://2010.census.gov/2010census/popmap/ Cannell, M. B., Brumback, B., Bouldin, E. D., Andresen, E. M., Tamayo, C., Schumacher, J. R., & Hall, A. (2011). Adult Disability Prevalence: Results from the 2010 Florida Behavorial Risk Factor Surveillance System (BRFSS). Gainesville: Florida Office on Disability and Health at the University of Florida. http://fodh.phhp.ufl.edu/files/2011/05/Adult_Disability_Prevalence_2010_10-03-2011FINAL.pdf Prevalence and Most Common Causes of Disability Among Adults --- United States, 2005. Morbidity and Mortality Weekly Report, May 1, 2009 / 58(16); 421-426. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5816a2.htm#tab2 Cannell, M. B., Brumback, B., Bouldin, E. D., Andresen, E. M., Tamayo, C., Schumacher, J. R., & Hall, A. (2011). Adult Disability Prevalence: Results from the 2010 Florida Behavorial Risk Factor Surveillance System (BRFSS). Gainesville: Florida Office on Disability and Health at the University of Florida. http://fodh.phhp.ufl.edu/files/2011/05/Adult_Disability_Prevalence_2010_10-03-2011FINAL.pdf Kochanek, K. D., Xu, J., Murphy, S. L., Minino, A. M., & Kung, H. C. (2011). National Vital Statistics Reports - Deaths: Final Data for 2009. US Department of Health and Human Services.
23 22 21 20 19 18 17 Florida

Office of the Surgeon General. (2005). The Surgeon General's Call to Action to Improve the Health and Wellness of Person with Disabilities. Washington DC: US Department of HEalth and Human Services. Web. http://www.surgeongeneral.gov/library/calls/disabilities/calltoaction.pdf.pdf Cannell, M. B., Brumback, B., Bouldin, E. D., Andresen, E. M., Tamayo, C., Schumacher, J. R., & Hall, A. (2011). Adult Disability Prevalence: Results from the 2010 Florida Behavorial Risk Factor Surveillance System (BRFSS). Gainesville: Florida Office on Disability and Health at the University of Florida. http://fodh.phhp.ufl.edu/files/2011/05/Adult_Disability_Prevalence_2010_10-03-2011FINAL.pdf Bodenheimer, T., Chen, E., & Bennett, H. (2009, January/ February). Confromting the growing burden of chronic disease: can the US health care workforce do the job? Health Affairs, 28(1), 64 - 74.

24

25

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World Health Organization (2012). Media Centre: Cardiovascular Diseases (CVDs), http://www.who.int/mediacentre/factsheets/fs317/en/index.html 28

27

2010 Florida Behavioral Risk Factor Surveillance System (BRFSS) Data Report, http://apps.nccd.cdc.gov/brfss/display.asp?cat=TU&yr=2009&qkey=4396&state=FL

2012 Florida Youth Tobacco Survey, Fact Sheet 1. http://www.doh.state.fl.us/disease_ctrl/epi/Chronic_Disease/FYTS/2012_FYTS/FS1-CigaretteUse.pdf

29 30

28

2010 Florida BRFSS Data Report

Florida Department of Health. Overweight and Unhealthy Dietary Behaviors Among Florida Public High School Students: Results from the 2011 Florida Youth Risk Behavior Survey, Fact Sheet 5. http://www.doh.state.fl.us/disease_ctrl/epi/Chronic_Disease/YRBS/2011/Fact_Sheet_5_Weight_Manage ment.pdf 2011 Florida BRFSS Prevalence and Trends Data Report. http://apps.nccd.cdc.gov/brfss/display.asp?cat=PA&yr=2011&qkey=8291&state=FL Florida Department of Health (2011). Physical Activity Among Florida Public High School Students: Results from the 2011 Florida Youth Risk Behavior Survey, Fact Sheet 7. http://www.doh.state.fl.us/disease_ctrl/epi/Chronic_Disease/YRBS/2011/Fact_Sheet_7_Physical_activity. pdf. 2009 Florida BRFSS Prevalence and Trends Data Report, http://apps.nccd.cdc.gov/brfss/display.asp?cat=FV&yr=2009&qkey=4415&state=FL Florida Department of Health (2011), Dietary Behaviors Among Florida Public High School Students: Results from the 2011 Florida Youth Risk Behavior Survey, Fact Sheet 6. http://www.doh.state.fl.us/disease_ctrl/epi/Chronic_Disease/YRBS/2011/Fact_Sheet_6_Dietary_behavior. pdf 2011 Healthy Communities, Healthy People Report, Bureau of Chronic Disease Prevention, Florida Department of Health Bodenheimer, T., Chen, E., & Bennett, H. (2009, January/ February). Confromting the growing burden of chronic disease: can the US health care workforce do the job? Health Affairs, 28(1), 64 - 74.
37 36 35 34 33 32 31

Andersen, W. L., Armour, B. S., Finkelstein, E. A., & Wiener, J. M. (2010, Jan - Feb). Estimates of state level healthcare expenditures assoicated with disability. Public Health Reports, 125(1), 44 - 51 Health Day News. "Obese Workers' Health Care Costs Top Those of Smokers." US News. U.S. News & World Report, 13 Apr. 2012. Web. 17 Dec. 2012. <http://health.usnews.com/healthnews/news/articles/2012/04/13/obese-workers-health-care-costs-top-those-of-smokers>.

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Trust for America's Health. (2011). Investing in America's Health: A State - by - State Look at Public Health Funding and Key Health Facts. Robert Wood Johnson Foundation.

Trust for America's Health. (2011). Investing in America's Health: A State - by - State Look at Public Health Funding and Key Health Facts. Robert Wood Johnson Foundation. Financing Community Health Workers: Why and How. National Community Voices Initiative at the Center for Primary Care at Morehouse School of Medicine and the Northern Manhattan Community Voices at the Columbia University Center for Community Health Partnerships. Web, http://www.pscinc.com/LinkClick.aspx?fileticket=Vu_X9O_UHHg%3D&tabid=65.
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CDC. Healthy Communities Program. http://www.cdc.gov/healthycommunitiesprogram/overview/healthequity.htm. 29

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Florida State Health Improvement Plan

Chronic Disease Prevention

Strategic Issue
2012-2013 Collaborative Implementation Plan

Florida Department of Health Bureau of Chronic Disease Prevention