(upbeat music) (bubbles pop) - Hello and welcome to "The Journal."

I'm Steve Kendall.

County health departments assess and then address health issues in their communities.

Wood County is unveiling its community health improvement plan.

We're gonna talk about, though, what precedes that, which is the health assessment plan, as well.

We're joined by the Wood County Health Department commissioner, Ben Robison, also, the president of Wood County Hospital, Stan Korducki, and Erin Hachtel from the United Way of Wood County.

So, welcome, all of you, to "The Journal," and, yeah, we'll get to the "CHIP" how we're gonna address the things that came up in the assessment.

But Stan, kind of talk about what the community health assessment is.

So, for people that aren't familiar with it, how often does it happen and how do you go about conducting that survey?

- Well, thanks Steve, and thanks for having us on.

You know, I'm really proud of this.

You know, the community health assessment is something we've been doing here in Wood County for multiple decades, actually, before it became fashionable or even required across the country, because it was part of the Affordable Care Act legislation required the community health assessment process to be more formal, nationally.

But we do it together.

The health department takes the lead with the hospital and other agencies like United Way, and we do an intensive survey process to kind of look at health issues.

We look at data.

We look at outcomes, but more importantly, we also survey people directly and find out what their problems are, what their attitudes are, and so that we can put together what is really a very focused plan for improvement.

- Yeah, and you do this every three years, correct?

This is a triennial?

[Stan] It's a triennial process, yes.

And then what follows then is, obviously the other part of this we're gonna talk about is you look at that information, okay, now what do we need to address the issues that have come up in this assessment plan?

We're gonna look at some of the information as it comes up because obviously there's a lot to cover here.

When you looked at this year's health assessment.

Commissioner Robison, what are some of the things that have come out?

Is there anything that surprised you, or is there something new that popped up that hadn't been here maybe three years ago, or is something intensified more or something we've actually done better at?

So kind of talk us through the main points that came out of this year's assessment.

- Yeah, absolutely.

And again, thank you for having us here.

And what we noticed was that our data was very much reflective of the time in which it was collected.

And we chose to collect this data in the winter of 2021, going into the spring of 2021, so very much still feeling the impacts of the COVID pandemic, coming out of that first really significant surge at the end of 2020 and going into 2021.

And what we found in that context was more than before, was a significant impact on mental health.

We saw that at the adult level and the child level as well.

We still saw some other things remain like chronic disease and impacts on weight and other things like that.

And we also saw a significant impact on adverse childhood experiences, or ACEs.

And those were the things that showed up.

And like we've seen in many other assessments over the many years, income continued to be a factor that contributed to worse health outcomes than families that had a higher rate of income or greater access to resources.

- Now, Erin, with the United Way, obviously you interact with all the different agencies that kind of fall under the umbrella there, the participating agencies.

When you look at this assessment, obviously you then look at the resources you have and the organizations you deal with that are part of that umbrella.

How do you guys then assess how do you direct those resources or when you interact with those other organizations, hey, here's the information, where do we want to go with that?

How do you guys work that out?

- So, we're in a great position as both a funder and a convener of community solutions groups.

So as a funder, we can look at, what are the ways that we can use the dollars that we raise to invest in some of these programs that will result in better health outcomes?

And in addition to that, because we have great network of relationships with all of the agencies in the community, as you mentioned, we can bring together folks to start talking about, what already exists to address some of these things that have been revealed in the community assessment, and then where are those gaps that we need to come together and have some new conversations?

- Yeah, now, when we look at that list, and the first one you had on the list, I know, Ben, was mental health is an issue across all age groups, and I think we've become more aware of the fact that children's mental health is incredibly important, if not the most important thing in terms of child development.

And yet the first thing on your list is mental health, an issue across all age groups.

What do we think underlies all that?

I mean, obviously COVID would skew things a little bit, but is that something that...

It's been an issue for a long time.

Maybe it's just getting more attention now.

Is that why we're seeing it rise to the top here?

- We definitely think that COVID and the context of the time of the collection had a lot to do with what we saw, but we also know that here in Northwest Ohio, not just Wood County, we are an area that does not have access to sufficient mental health professionals.

So one of the things that we know is that the needs that are identified from year to year may not be able to be adequately addressed because of the access to available healthcare personnel.

And so certainly as we look at the numbers that we saw this year, we're interested not only in understanding them, but being able to think about ways to increase access to those services, as well as encourage people to take up those services.

It was noteworthy that about one in two adults said that their mental health days were not good four or more days per month.

[Steve] Right, yeah, I saw that.

That's seems like a lot.

To a layperson that seems like, wow, because I think most people like to think they feel good most of the time, but that was astounding when I saw that.

[Ben] It was.

And what was also remarkable is that about one in four adults said that they needed no help to address their mental health needs.

So there's a disparity between what we are reporting and the care seeking behavior that may help people to recover more quickly.

[Steve] Yeah, and what do you... And I know we're probably gonna get in the weeds on that a little bit, but why do you think that is that people say, "Yeah, you know, "I don't feel quite right or I have whatever," however you wanna describe that, "Four days a month, "but I don't wanna do anything to address it?"

How do you figure what's the mindset there?

And I know we can't get into everybody's minds, but... - Well, you know, I'm sure there are different answers to that, but for many people, there's a stigma associated with seeking that kind of help.

And so people are reluctant to do that.

You know, we hear about it from adults.

We hear about it sometimes from our own workforce.

And certainly, you know, in our discussions and work with the university by Falcon Health Center, sometimes it comes up that people are just reluctant to admit that they can't handle these things on their own.

- And I guess it's true of physical health issues too.

People will say, "Well, I don't wanna know," or, "I'm gonna ignore it and hope it gets better "without any kind of assistance or intervention."

So I guess maybe it isn't surprising that health is even probably more that way because, as you said, there's more of a stigma even attached to that than saying, "Gee, you know, I'm sick today."

A lot of people don't ever wanna admit they get sick, or they don't wanna know that they've gotten sick, which is always interesting.

You know, next on the list here is alcohol consumption.

It's increased, which, again, may be a little bit because of the pandemic, but we're higher than the average in the state of Ohio and higher than the average around the country.

I mean, obviously we're trying to find out why all this stuff happens.

Is there any idea why that would be different here in Wood County than, say, Athens County in the Southeastern part of the state?

- Well, I think what's important is that when people take on these behaviors, what they're trying to do is to address their mental health needs.

And so for here in Wood County, we find that this is a behavior that is more normalized than other places.

And so when people begin to talk about how they engage their own mental health challenges, this is something that they're gonna hear discussed commonly across this community.

And so it becomes something that is more accessible in terms of how people think about how do they want to address these things.

And as a result, we saw a bit of an increase in the rate as people were experiencing a higher rate of mental health needs.

[Steve] Yeah, okay.

[Stan] You know, and the twist is that with that, there's a connection between that behavior and other physical health attributes.

And so obesity, hypertension, all of the things that we talk about in general through society is often linked to that lifestyle.

So we really can do a lot by impacting that, Steve.

[Steve] Interesting.

Well, we come back, we can talk a little bit more about that, and obviously we've got a couple of other things on here that are the bullet points that came out of this.

So back in just a moment with Wood County Health Commissioner, Ben Robison, also Stan Korducki of the Wood County Hospital, President, and Erin Hachtel, Director of United Way of Wood County.

Back in just a second here on "The Journal."

Thank you for staying with us here on "The Journal."

Our guests are Ben Robison, Wood County Health Commissioner, also Erin Hachtel, Director of Wood County, excuse me, United Way of Wood County, and Stan Korducki who's the President of Wood County Hospital.

That last segment we talked about the fact that alcohol consumption tends to roll through all of the other impacts in a lot of ways, because that's in some ways how people address their mental health issues to some degree.

But then the other thing that happens too is it affects, of course, their physical health in other ways, but then we get into how it affects the children because one of the things we see on here, adverse childhood experiences, and, Commissioner Robison, talk a little bit about what that means because that's sort of the foundation.

If you have those kind of things, a child, it probably makes it more difficult to not get into some of these other behaviors later on to maybe no fall of your own actually.

- Right, so adverse childhood experiences, or ACEs, we know can have a lifelong impact, not only on mental health, but physical health.

Children who experienced three or more of these are significantly more likely to have worse health outcomes over the course of their lifetime, even after they have taken the time to address the impacts of those ACEs.

In looking at our own data here in Wood County, we found that children who had three or more ACEs were substantially more likely to experience a number of impacts, everything from misusing prescription drugs to be more likely to consider or attempt suicide than children who didn't have the experience of any ACEs.

In fact, here in our own county data, looking at what we found through interviewing school children there in the middle schools and high schools, although kids may use alcohol and marijuana and smoke, the vast majority of those students who do those behaviors are gonna have three or more ACEs.

And so you'd expect that there would be about, you know, one in five students have three or more ACEs.

So those rates would be one in five for those behaviors, but they aren't.

They're substantially higher for those three things.

So although we can tend to think of those as behavior issues, what they really may be is a signal that there's a mental health need for something that's going on that the child is coping with.

- And we know that there are those long-term outcomes.

So, you know, Ben mentioned the health outcomes.

There are also some social conditions that are long-term outcomes of having experienced an ACEs as well.

And so when we think about addressing some of the social determinants of health, experiencing those adverse childhood experiences may make more likely that you are at a lower income when you are older, and your income is absolutely connected to your health outcomes.

- And you know, I know that as we look at that too, it is interesting you look at the list of things, and Ben you talked about this, that these are things that everybody is aware of, you know, sexual abuse, parental separation or divorce, mother may have been treated violently, which then creates issues for children and encouch someone who is unfortunately in the criminal justice system for whatever reason, all of these things, which you said start to impact, connect to all of these other pieces.

The one thing that's interesting too, and you touched on just there at the end, Erin, was the fact that income, as you said, is a determinant for a lot of this, which, of course, then gets back to the fact that we know that what we hear from the state and from everybody is we need more and better jobs, jobs that pay more that allow people to live a better lifestyle and maybe not get into this situation, but lower income is one that's a little more difficult for you folks to address because no one really controls that.

No one really controls it at all.

So from a health perspective, when you see that, who do you go to to say, hey, here's the thing we've gotta address?

How do you go about addressing that one when you really don't have any control of it really?

- Well, you know, the great thing about Wood County is that we have many agencies that work together because what we found is that in any one area, everything is linked.

And so what's really important is that, and I guess the surveys process is indicative of the way we are together is that we communicate and we share resources because, you know, you look at any of the issues that you can attribute to a low income situation.

I may not be able at Wood County Hospital to impact some of them, but it may well be that through United Way and some of those agencies there are other resources.

[Steve] Yeah, so you can get them resources and maybe at least improve their income in the sense of they have access to services that help with their income status in an indirect way.

[Erin] Sure, sure.

And I think that there's a rule as well for advocacy for public policy as well that, you know, we're getting all of this information and we're not just keeping it to ourselves.

We're making sure that we're sharing it here and many other places, so that decision makers can be aware of the things that they can do kind of at that system level to make some changes that can have some better long-term outcomes.

- Yeah, and we know that when we look at... Obviously no one likes to hear news that isn't of the best variety.

These are tough.

Some of these things are tough numbers to bring forward and say, look, yeah, we've got a problem because generally speaking, jurisdictions don't like to hear they have a problem, whether it's a city, a county, a state, a country that, well, no, it doesn't happen in our neighborhood.

The reality is this isn't just unique to Wood County.

If we were looking at the assessment for Putnam County or Franklin County, they would have similar or a list of things like that.

But you're right, it needs to be brought out, so you can then address and try to fix the problems as best you can.

When you guys get together with all of these different organizations, what's the one issue they bring forward in terms is it still resource issues for the agencies to deal with the things we're talking about, or are we getting better at providing resource to address these?

[Steve] (laughs) Not really.

[Stan] Well, everyone could always use more funds.

[Steve] Okay.

[Erin] Yeah, yeah.

- But I think there is a much more pragmatic understanding that these things can't be siloed, that they all link together.

So we can impact health status by also impacting the availability of transportation or the availability of better housing.

And so that to me is the silver lining to look ahead.

And, you know, if there's anything that came out of the pandemic, it really has forged even more effective working relationships between all of us.

[Erin] Yeah.

[Steve] Okay.

Well, that's good to hear.

That's good to hear.

When we come back, we've got obviously a lot of other information to cover here because we haven't really got into the actual plan to address some of these things.

So back in just a moment with Ben Robison, Wood County Health Commissioner, Stan Korducki, President of Wood County Hospital, and Erin Hachtel, Director of United Way of Wood County.

Back on "The Journal" in just a second.

You're with us on "The Journal," and we're talking about the Wood County health assessment plan and then also the plan that then addresses the issues that come out of that assessment.

One of the things that we talked about a little bit was the fact that, yes, we're talking about cultural change, behavioral change, dealing with that.

And one of the pieces that came up that kind of addresses this is called How do we start the process to get long-term progress, long-term solutions?"

So Commissioner Robison, talk a little about that about how we're gonna go about trying or here's the way we think we can start to address that in a long-term fashion, so we're not sitting here 12 years from now talking about a triennial plan that has a lot of the same things on it.

- Well, Erin mentioned earlier the term social determinants of health, and what that basically means is they are the things that are outside the control of the individual that informs the context within which they make healthy choices.

So if we think about our goal in public health and our goal with our partners in improving health status, it's to give people the ability, the opportunity to make healthy choices.

We know that people who have access to great opportunities may not always choose that.

So we wanna understand how we can make that easier.

Some people may not have the ability to make the choice.

And so that's what we're trying to do is to address people on both ends of that spectrum.

When we think about all the things that inform health status, it's not just things like how much I as individual exercise, although that's very important, or even the foods that I might choose for lunch.

It's also about access to those foods, understanding my health status and the value of exercise.

It's things like housing and transportation, access to mental health professionals and medical professionals, dental professionals that can help us to be healthy, and really having good engagement in your community and connection to the overall social network.

These are the things that we know when they exist, people not only feel more equipped and empowered to be healthy, but they tend to actually live out healthy lifestyles.

And so our goal is not simply to launch an initiative.

There are lots of great things that are one time events that can raise awareness, but they don't move lifestyles unless we shift the culture over the course of a long-term.

So that's really what our goal is is to identify ways to do that.

And we set up 12 priority strategies that we think will help us to get at those underlying needs first and foremost across not just the Health Department, but all of the partners that are involved.

[Steve] Yeah, when we look at these, obviously, as you said, it involves the whole consortium of people.

United Way, obviously you have the whole umbrella of agencies that go from every level of mental health to domestic issues to physical health.

How do you all interact to start to implement these?

How do we make this work now?

Because obviously, it's a lot of work.

It's a lot of work.

- Yeah, absolutely.

And the Wood County Health partners brought together many of these folks over the course of a series of meetings this spring to talk about, how do we take all of this information that we've learned and actually put it into some strategies that we can not just build some new processes, but bring along things that already exist?

So for example, in addressing our housing challenges, we said, hey, we've got a Wood County Housing Coalition already in place.

How can we make sure that the work that they're doing is now connected with this work to have these kinds of health outcomes?

Same thing with transportation and some of our food pantry organizations to really bring all of those folks into the room together to talk about what exists now, what else can we do together.

- Yeah, and I know that, you know, the first one on this list talks about housing options, and we know that that can be a treadmill for people.

They make just enough to continue to rent, but never maybe get to the point where they can own.

And that, of course, means that their income is being directed to just subsistence in a way.

Not there's anything wrong with renting, but it doesn't allow them then to progress and maybe put money aside because it's a constant situation, and I don't want to digress too much, but we don't think that we have a homeless issue in Wood County, but we probably... We do have homeless people obviously.

Maybe it's not as apparent as in large jurisdictions, but that too is a part of this mix because those people obviously in a lot of ways don't access health, either mental or physical health situations.

They're probably not living the greatest lifestyle.

So that is a piece below this that kind of factors in too, and we talk about housing.

Well, some people, you know, end up not being able to stay in some sort of housing that we would like them to have.

The other thing I noticed was on this list too, is, again, back to the childhood part, the ACEs part, how significant that is.

And again, that deals with... You know, you all see that and when people come to your doors, whether it's the hospital or it's the Health Department.

You have those issues to deal with.

So what's the package to... Again, it's again a consortium group, but how do you really start to get at the root of those things?

Because that's where it kind of starts now it looks like.

- Well, you know, many of these are challenging problems, and if you look at earlier health assessments, you don't see all of them or in the same intensity as you do with this one, but there's been a pattern.

Now, the good part about our plan is that we just don't have 12 points.

We've identified organizations to take the lead.

And so it's really important that with housing, actually I'll pick on Erin because United Way is listed that in terms of coordinating efforts to impact that, they're identified with some of the ACEs for kids, ESC, and Children's Resource Center are identified.

And so, we're trying to be proactive in terms of getting people identified to say, organizationally, you're gonna take the lead in trying to come up with a proactive plan and to initiate some things, but we're all on board with you.

- Yeah, mhm, okay, good, good.

- And I think Stan will also say none of these agencies are expected to, on their own, solve the problem.

[Steve] Solve the problem.

- Well, sure.

- We are taking that lead in bringing folks together to say, you know, what are the things that we can do at both the system level and then also, how do we encourage folks at the individual level?

- Yeah, because, you know, it's an interesting thing because it's so interconnected, all of these pieces, whether it's a health issue, a mental issue, an abuse issue of either, you know, a chemical or a domestic abuse issue.

How they're all not one piece of it is the whole answer to it, and it's all those things that come together.

I noticed when we look at this too, obviously, we do our share of nicotine use in Wood County obviously.

And that's again another, you know, health issue that resonates through a lot of ways, not just for the people smoking, but the lifestyle then and the income that gets directed to that versus something that might be a little healthier, not that we all don't have certain things that we probably shouldn't spend money on, but you deal with that.

And then residents who just don't necessarily have access to good food because we hear a lot about the fact that there's, you know, food insecurity everywhere, not just here but everywhere, and that leads right into not being able to eat nutritious, which, you know, then affects mental health.

Everything, it all rolls through this again.

And I noticed too, you know, we're talking about exercise.

Well, we all know that at least a lot of us would probably do more, but that's, yeah.

When you look at these, and as you said, so, which ones, I mean, where do you actually start with this?

And I know I've asked this question, which one do you start with to try and say, okay, well we'll get a foothold here and then we can start dealing?

That starts to give us positive impact in some of these other areas.

Is there one that you would say, here's where we really need to start?

[Ben] Well, unfortunately- [Steve] It's probably not that simple, I know, I know it's not that simple, but... - Well, fortunately, and as Stan highlighted, we don't have to choose.

Because we have a great coalition of partners, we get to engage in all 12 of these areas simultaneously.

And really the reason we want people to be aware of them isn't just to understand their relationship to health, but to also have an opportunity to be engaged.

And so we'd love to have people from the community be involved.

We want people who lead organizations to bring the organizations in because we really recognize that unless everyone is involved together and working cooperatively, we won't have the outcomes that we are really hoping for.

This is not the entire list of things we could have chosen.

These were the things that rose to the top.

And to be honest with you, choosing 12 things is kind of a long list if you're making a priority list.

(Steve laughs) But because we've got great relationships and great organizations that are already working in many of these spaces, we were able to expand our footprint and say, let's do as much as we can, make as much progress as possible, check in with each other, and then in three years when we do this again, see how much progress we've made.

- Yeah, because incrementally, you can address all of these on a broader front and saying it 'cause we can address each of these to some degree.

It leads to a bigger hole at the end where we've got success in an overall way versus we were able to take care of a little bit of this, but then this is still gonna drag, hold us back from moving forward a little bit.

So yeah, yeah.

- And you know, there's a domino effect here because everything is linked.

So if you make meaningful progress in one or two of those areas, there will be a ripple.

[Steve] Yeah, yeah, great, great.

Well, I appreciate you guys coming on.

And as I've always said, the door is always open for any of you to come on and talk about this or any other thing that's involved with making sure we improve our mental and physical health for all the residents not just in Wood County, but our viewing area as well.

So we appreciate that.

You can check us out at wbgu.org.

You can watch us every Thursday night at 8:30 on WBGU-PBS.

We will see you again next time.

Goodnight and good luck.

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