Community Focus 2015
A REPORT FOR SPRINGFIELD & GREENE COUNTY

COMMUNITY HEALTH

The health of our community is a critical component to creating an attractive, successful and vibrant place for people to live, play and work. It is proven that focusing on health and wellness opportunities and integrating health-care services can impact our community's social determinants of health and subsequent outcomes in a sustainable manner. Springfield must continue pursuing full-scale investment in comprehensive health and wellness opportunities and integration across the continuum of care, which will lead to increased economic development, higher educational attainment and overall improved quality of life.

BLUE RIBBONS

Worksite Wellness

The Springfield business community is slowly but surely coming to understand the importance of offering employee wellness programs. Rising health-care costs and a depleted workforce over the last few years have forced companies that previously viewed wellness programs as a bonus to realize they may be key to their overall success.

Many companies now understand that improving the health of employees directly improves the health of the organization's bottom line. Additionally, improving population health leads to a greater ability to acquire and retain talent, both at an employee and community level.

When we first considered a wellness program, we were focused on the renewals and what our company would gain in savings moving forward. Little did we know that in the first steps of the program, it would actually save the life of at least one key person in our organization. From that point forward, wellness has become about the heart and soul of our company.

THOMAS H. DOULAS
OWNER OF JMARK BUSINESS SOLUTIONS

Efforts made by businesses to encourage and promote health should be applauded and boldly continue to create the best Springfield possible. JMARK, a local information technology firm, has realized success after implementing an employee wellness program in 2010. Participation in the employee wellness program has continually increased and now hovers around 90 percent, surpassing national averages. Participating employees have achieved more than a 5 percent decrease in high cholesterol levels and more than a 4 percent decrease in blood pressure levels. The Centers for Disease Control and Prevention (CDC) states that a 1 percent reduction in health risks such as weight, blood pressure, glucose, and cholesterol risk factors would save $83 to $103 annually in medical costs per person. Although some employers are making progress in worksite wellness, many have yet to launch comprehensive wellness benefits.

Over the past several years, Springfield has made great progress in the area of employee wellness with the addition of many employers incorporating wellness programs as part of their employee benefit structure. The Wellness Council of America (WELCOA) conducted a study of Springfield business in 2014. WELCOA was interested in how Springfield stacked up against national statistics regarding their wellness programs. Springfield scored lower in all but one of the seven categories. Springfield may not be leading the charge to improve the health of our community, but we are now at least in the race with a number of companies initiating change to offer support and encouragement to employees by offering worksite wellness programs. Continued focus on increasing the number of employers that offer simple, well-designed programs with quantifiable results is necessary to support our community and contribute to overall population health improvement.

Health and Wellness Infrastructure

Employees from downtown businesses participate in yoga on the square, sponsored by the Healthy Living Alliance.

Springfield continues its great tradition of a strong health-care infrastructure. Many great efforts also have contributed to improving and promoting a health and wellness infrastructure over the past few years, strengthened by the leadership and infusion of CDC funding through the Healthy Living Alliance. Infrastructure is important for supporting businesses striving to promote and reward healthy employees by giving people of our community opportunities to engage. This infrastructure also will support the health-care systems in the efforts they are undertaking to improve the health of the populations served.

TRANSPORTATION INFRASTRUCTURE

Ozarks Greenways

Linear trail network encourages non-motorized transportation.

Let's Go Smart

Community partnership to encourage wise transportation choices (biking, buses, walking, etc.)

City of Springfield: The Link

Accessible route for walking and biking along low-volume, slow-speed streets throughout Springfield's core linking to activity centers.

City of Springfield Complete Streets Policy

In December 2014, the City of Springfield passed this policy so that streets, walkways, and greenways trail should be planned, designed, constructed, maintained and operated to provide a transportation system that gives all users options to safely and conveniently travel to their destinations.

Healthy Living Alliance: Walkable Neighborhood Project

Aims to create good sidewalks, safe streets, slower traffic, healthy residents, and neighborhood communities, increase local businesses, and create walkable destinations close to where people live.

HEALTHY EATING INFRASTRUCTURE

Ozarks Regional Food Policy Council

Food Hub Project will provide improved access to locally grown healthy foods as well as economic development for local producers.

Springfield Public School (SPS) Food Policy Changes

SPS has made great efforts to increase access to healthier food options and has provided additional guidance through policy to promote healthy alternatives to celebrating birthdays and other occasions.

Healthy Living Alliance: Local Sprouts

YMCA project to feed local, healthy snacks to children in childcare programs has been successful in increasing consumption of healthy, locally grown produce.

Local Farmers Markets

The C-Street Farmers Market, the Farmers Market of the Ozarks and the Greater Springfield Farmers Market continue to grow and serve members of our community and support the message of eating healthy.

LEISURE ACTIVITY INFRASTRUCTURE

Springfield-Greene County Park Board

The award-winning parks department offers more than 100 sites, including parks, facilities, four golf courses and a zoo.

RED FLAGS

Community Health Coordination

Unsustainable growth of health-care costs and poor health outcomes call us to reevaluate ways to improve the community's health. When care coordination is fragmented, individuals struggle to understand access points and how to self-manage their conditions, which further drives poor health outcomes. In Springfield, there is little coordination across the full continuum of care (from the hospital to the home), especially when individuals need medical, behavioral and/or oral health services. There is little coordination between health-care providers and social service agencies that can address issues like hunger, shelter, transportation, and other ancillary needs. Greater investment in collaboration is needed to ensure all individuals understand how to manage their health and are connected to the appropriate resources; thus, ultimately improving the community's health.

To coordinate care in an effective manner, data-sharing investments are essential. Not unlike other national attempts, Missouri tried to build a data-sharing platform for providers to exchange patient information, but the effort has faced many roadblocks. If providers and employers are to take more responsibility to improving the community's health, data must be shared and frequently analyzed to determine what indicators can be changed.

Community Health Outcomes

When compared to Missouri and the United States, Springfield consistently ranks poorly, indicating that it is an unhealthy place to live. Recognizing that community health is determined by several interrelated factors, Springfield should focus on health and wellness services in a coordinated care model to reduce individual and economic costs and improve health outcomes. This is a low-cost, high-impact way to improve health and change behaviors in a sustainable way.

Health outcomes are somewhat driven by those who have health insurance and access to care. Prior to the enactment of Missouri's Health Exchanges, approximately 17 percent of Springfield citizens were uninsured. Since then, 38 percent more citizens have enrolled in coverage, increasing access to care. Health systems, employers and community health agencies should be more incentivized to collaborate, providing greater health and wellness services that help improve our community's health outcomes.

Behavioral Health

About 25 percent of the population experiences a behavioral health disorder each year, and these individuals are likely to enter primary medical care services with a co-morbid physical health condition. About 6 percent of the population experiences a serious mental illness in a given year, and co-occurring health conditions are even more devastating among this group. Those with serious mental illness die an average of 25 years younger, account for 60 percent of chronic disease incidences and cost employers an average of $80—$100 billion annually, according to the American Hospital Association. Greene County is home to an estimated 18,800 adults with untreated serious mental illness, with total estimated costs of $124.5 million. These costs include direct medical expenses, incarceration and criminal justice involvement, disability payments, lost wages, and reduced productivity. Actuarial analysis indicates other troubling red flags, including 13 deaths by suicide, 2,321 incarcerations and 3,051 cases of adult unemployment, all due to untreated mental illness. Because Medicaid has not been expanded in Missouri, 37,260 individuals were dropped from coverage in 2014, further decreasing access to critical behavioral health services among a population at very high risk. The Health Care Foundation of Greater Kansas City reports as the number of behavioral health providers and psychiatric beds decline due to shrinking reimbursements and budget cuts, many adults and children face limited access options.

Because behavioral health conditions co-occur with chronic disease and this combination can substantially worsen associated health outcomes, Springfield should integrate and co-locate behavioral health services with health-care and other community services. Communities that have pursued this model have experienced significant improvements in physical and behavioral health outcomes and employer-related costs.

HEALTH FACTORS

Greene County Missouri U.S.
Adult Smoking 21.0% 23.0% 17.0%
Adult Obesity (BMI ≥30) 29.0% 31.0% 34.9%
Physical Inactivity 24.0% 27.0% 20.0%
Teen Births PER 1,000 37.0 41.0 34.2
Sexually Transmitted Infections PER 100,000 451.0 464.0 446.6
Food Environment Index 7.4 7.3 – –

HEALTH OUTCOMES

Greene County Missouri U.S.
Breast Cancer Incidence PER 100,000 123.9 122.6 122.7
Cervical Cancer Incidence PER 100,000 6.4 8.1 7.8
Colon & Rectal Cancer Incidence PER 100,000 39.8 45.6 43.3
Lung Cancer Incidence PER 100,000 72.3 76.1 64.9
Prostate Cancer Incidence PER 100,000 115.4 121.8 142.3
Diabetes PER 100,000 8.4 9.59 9.09
Heart Disease 3.18% 4.82% 4.40%
High Blood Pressure 26.6% 29.5% 28.16%
Infant Mortality PER 1,000 BIRTHS 6.7 7.2 6.5
Low Birth Weight 7.1% 8.0% 8.2%

Source: Community Commons, Community Health Needs Assessment, 2015

Follow Greene County's progress on many of the categories mentioned on this page, including mortality rate, poor mental health days and more at Community Commons.