Healthy Louisville 2020; Creating a Healthier City

Kudos to my new city for the public health plan released last week! The roadmap serves as a call to action to guide Louisville towards a healthier city. The mission of the Louisville Metro Department of Public Health and Wellness (LMPHW) is to promote health and wellness; prevent disease, illness, and injury; and protect the health and safety of Metro Louisville residents and visitors. The focus is prevention, evidence-based intervention and health in all policies. There are 13 goals within this roadmap. It's incredibly comprehensive. 

Of course being a school health consultant, who works nationally to create healthier schools, and living in Louisville, I need to make some suggestions as to how schools may be able to support this public health plan. I see that Donna Hargens, the Superintendent of Jefferson County Public Schools is on the Mayor's Healthy Hometown Movement Leadership Team. I love this! I'd like to suggest some recommendations from a K-12 school perspective that align to the 13 goals within the plan. I see a few mentions in the document regarding schools, but that doesn't mean we can't build off the recommendations and add more to support the plan at the K-12 level. Here we go...

Access to Healthcare: All Louisville Metro residents will have health insurance coverage and receive care in a patient-centered medial home. 

My Recommendations:

1. Utilize access to parents/guardians in schools to bring awareness and education of changes in eligibility criteria for Medicaid and ensure all Metro residents eligible for Medicaid are enrolled as part of the expansion under ACA. 

2. Promote and open School-Based Health Centers

 

Cancer Prevention and Screening: Decrease the incidence and death rates for all cancers in Louisville Metro. Goals include: decreasing lung, breast, cervical, prostate, colorectal cancers. Recommendations do include increasing awareness of HPV vaccine for both males and females through outreach to schools.

My Recommendation: Within a K-12 comprehensive health education program and within JCPSs health education scope and sequence that includes age appropriate Healthy Behavioral Outcomes from Centers for Disease Control and Prevention's Health Education Curriculum Analysis in the areas of healthy eating, physical activity, sexual health and tobacco. HBOs included should be for both knowledge and skill content standards.

 

Chronic Disease Prevention and Screening: Prevent, detect, and reduce risk factors that cause diabetes, coronary heart disease, and stroke among Louisville Metro residents. 

My Recommendations:
1. Work with Nutrition Services and JCPSs Coordinated School Health Wellness Committee to review expectations of this plan to JCPSs Wellness Policy. Possibly revise if there are opportunities to strengthen the policy.

2. Within a K-12 comprehensive health education program and within JCPSs health education scope and sequence that includes age appropriate Healthy Behavioral Outcomes from Centers for Disease Control and Prevention's Health Education Curriculum Analysis in the areas of healthy eating, physical activity, and tobacco. HBOs included should be for both knowledge and skill content standards. Some examples include:

HBO: Eat an abundance of fruits and vegetables every day.
Example of a K-2 Knowledge Expectation:
Explain the importance of choosing healthy foods and beverages. 
Example of a K-2 Skill Expectation:  Demonstrate effective refusal skills to avoid unhealthy food choices and promote healthy eating (Interpersonal Communication is the National Health Education Standard).

HBO: Regularly engage in physical activities that enhance cardio-respiratory endurance, flexibility, muscle endurance, and muscle strength. 
Example of a 9-12 Knowledge Expectation:
Evaluate the short-term and long-tern benefits of physical activity, including improving cardiovascular health, strength, endurance, and flexibility; healthy weight management; and reducing chronic diseases.
Example of a 9-12 Skill Expectation: Formulate an effective long-term personal health plan to achieve a personal goal to be physically active (Goal-Setting is the National Health Education Standard)

 

Healthy Neighborhoods and Healthy Homes: Reduce the prevalence of and death rate related to tobacco use and exposure to secondhand smoke in Louisville Metro. 

My Recommendation: Within a K-12 comprehensive health education program and within JCPSs health education scope and sequence that includes age appropriate Healthy Behavioral Outcomes from Centers for Disease Control and Prevention's Health Education Curriculum Analysis in the area of  tobacco. HBOs included should be for both knowledge and skill content standards. Some examples include:

HBO example: Avoid second-hand smoke and support a tobacco-free environment. 
Example of a 6-8 Knowledge Expectation: Summarize the effects of secondhand smoke. 
Example of a 6-8 Skill Expectation: Persuade others to be tobacco-free and avoid exposure to second-hand smoke (Advocacy is the National Health Education Standard).

 

Healthy Mothers and Healthy Babies: Improve the health and well-being of mothers and babies in Louisville Metro. One recommendation includes implementing evidence-based teen pregnancy prevention programs in Louisville. 

My Recommendation: Write and implement a K-12 sexual health policy that includes comprehensive, age appropriate sex education. See model policies through NASBE. Use HECAT to develop a sexual health promotion strand within JCPSs scope and sequence.

 

HIV Prevention and Screening: Reduce human immunodeficiency virus (HIV) infection among Louisville Metro residents.

My Recommendation: Within a K-12 comprehensive health education program and within JCPSs health education scope and sequence that includes age appropriate Healthy Behavioral Outcomes from Centers for Disease Control and Prevention's Health Education Curriculum Analysis in the area of sexual health. HBOs included should be for both knowledge and skill content standards. Some examples include:

HBO example: Engage in behaviors that prevent or reduce sexually transmitted disease (STD), including HIV infection. 
Example of a 9-12 Knowledge Expectations: Justify why abstinence from sex and drugs are the safest, most effective risk avoidance methods of protection from HIV, other STDs, and pregnancy and summarize ways to prevent pregnancy and the sexual transmission of HIV and other common STDs. 
Example of a 9-12 Skill Expectation: Determine when professional sexual healthcare services may be required (Accessing Valid Information is the National Health Education Standard). 

 

Injury and Violence Prevention: Decrease the prevalence of violence and unintentional injuries in Louisville Metro. The plan includes identifying opportunities to increase educational attainment, close the achievement gap, and reduce the disproportionate number of school suspensions and alternative school placements by race. 

My Recommendation: Within a K-12 comprehensive health education program and within JCPSs health education scope and sequence that includes age appropriate Healthy Behavioral Outcomes from Centers for Disease Control and Prevention's Health Education Curriculum Analysis in the areas of violence and safety. HBOs included should be for both knowledge and skill content standards. Some examples include:

HBO Violence example: Manage interpersonal conflict in nonviolent ways. 
HBO Safey example: Support others to avoid risky behaviors and be safe. 
Example of a 3-5 Knowledge Expectation: Explain the role of bystanders in escalating, preventing or stopping bullying, fighting and violence. 
Example of a 3-5 Skill Expectation: Analyze how relevant influences of media and technology affect personal violence practices and behaviors (Analyzing Influences is the National Health Education Standard).

 

Mental and Behavioral Health: Improve the mental and emotional well-being of Louisville Metro residents. Plan includes a recommendation around improving mental and behavioral health data collection, including suicide attempts in grades K-12.

My Recommendations: 

1. Work with Kentucky Department of Education to implement CDCs Youth Risk Behavior Survey in all schools.

2. Within a K-12 comprehensive health education program and within JCPSs health education scope and sequence that includes age appropriate Healthy Behavioral Outcomes from Centers for Disease Control and Prevention's Health Education Curriculum Analysis in the areas of mental and emotional health and violence (where suicide is addressed in the HECAT). HBOs included should be for both knowledge and skill content standards. Some examples include:

HBO example: Get help for oneself or others who are in danger of hurting themselves. 
Example of a 6-8 Knowledge Expectations: Explain the importance of telling an adult if there are people who are in danger of hurting themselves of others and describe the signs and symptoms of people who are in danger of hurting themselves or others. 
Example of a 6-8 Skill Expectation: State a health-enhancing position on a violence prevention topic, supported with accurate information, to improve the health of others (Advocacy is the National Health Education Standard).

 

Obesity Prevention: Reduce the proportion of Louisville Metro residents that are overweight and obese. Included in the plan are to implement a system to monitor BMI through the required school physical exam for children entering kindergarten and sixth grade.

My Recommendations: 

1. Use CDCs BMI Measurement in Schools best practices document when collecting BMI information.

2. Increase Walk and Bike to School Initiatives, using best practice programs.

3. Fully implement Alliance for a Healthier Generation's Healthy School Program.

4. Work with Nutrition Services and JCPSs Coordinated School Health Wellness Committee to review expectations of this plan to JCPSs Wellness Policy. Possibly revise if there are opportunities to strengthen the policy.

5. Set strong recess policies and offer recess before lunch

6. Increase the implementation of Human Vitality among staff. Promote school employee wellness programs.

7. Offer, at bare minimum, the national recommendation of minutes for physical education K-12. Hire qualified PE specialists to teach PE, K-12.

5. Within a K-12 comprehensive health education program and within JCPSs health education scope and sequence that includes age appropriate Healthy Behavioral Outcomes from Centers for Disease Control and Prevention's Health Education Curriculum Analysis in the areas of healthy eating and physical activity. 

 

Oral Health: Improve the oral health of Louisville Metro residents by reducing tooth decay and gum disease. The plan includes to expand school-based dental sealant programs in schools with the greatest need. Improve oral health data collection for youth and children in Louisville Metro. 

My Recommendation: None at this time, but oral health plays a role in attendance of students. It is imperative to have a school-oral health plan. Screening and education.

 

Public Health Infrastructure: Ensure LMPHW has the infrastructure to provide Louisville Metro residents public health services at an optimal level on a daily basis as well as during emergencies. 

My Recommendation: None at this time.

 

Social Determinants of Health: Create social and physical environments that promote good health for all Louisville Metro residents. 

My Recommendation: None at this time.

 

Substance Abuse: Reduce the number of Louisville Metro adults and youth engaging in risky behaviors such as binge drinking and drug abuse. Plan includes a recommendation to adopt and implement a “reality-based approach” as opposed to an emphasis on “abstinence” or “zero-tolerance” as a prevention strategy for teen drug and alcohol use. A reality-based approach provides teens with honest, science-based information; promotes an understanding of the legal and social consequences of drug use, and prioritizes safety through personal responsibility and knowledge.

My Recommendation: 

Within a K-12 comprehensive health education program and within JCPSs health education scope and sequence that includes age appropriate Healthy Behavioral Outcomes from Centers for Disease Control and Prevention's Health Education Curriculum Analysis in the areas of tobacco and other drugs. HBOs included should be for both knowledge and skill content standards. Some examples include:

HBO example: Avoid experimentation with alcohol and other drugs. 
Example of a 9-12 Knowledge Expectations:  Describe the effects of using alcohol and other drugs on school performance, job performance, job absenteeism, and job loss.
Example of a 9-12 Skill Expectation: Generate alternatives when making a decision related to alcohol and other drug use (Decision-making is the National Health Education Standard).  

Phew! Yup- that was a lot of work. However, this Healthy Louisville 2020 blueprint can be used to advocate for a stronger Coordinated School Health program and K-12 comprehensive health and physical education program locally. Let's embrace it and work together for a healthier community!