HomeMy WebLinkAbout12 Health Chapter 12-31-19
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12. Community Health
Chapter Highlights
• Edina strives for a high standard of health overall,
although specific concerns and racial and
economic disparities exist that need to be
addressed.
• Understanding of health concerns is limited by the
lack of community-specific data.
• Changing demographics and aging in the
community will continue to change health
outcomes and needs.
• Public health is impacted by a range of social and
environmental factors that require a multi-faceted
approach across all of the city.
• Health in all policies provides an approach to
comprehensively address health concerns across
the full city government, in cooperation with
partners.
Introduction
Public health is the art, practice and science of protecting
and improving the health of the population. Public health
is about what makes us healthy, what makes us sick, and
what we can do together about it. When we think about
health, what often comes to mind is the individual and
ways he or she can stay healthy. Public health shifts the
focus to the population – from me to all of us.
Research suggests that around 80% of health outcomes
are influenced by the environment and by human
behavior. As a result, comprehensive planning can have a
significant impact on the factors that contribute to health,
by shaping the environment and helping to positively
impact behavior in ways that lead to healthier
communities and people.
There are a number of principles underlying public health:
• Public health is about prevention. This means
intervening early and keeping people from getting
sick or injured.
• Public health is about populations. This means
focusing on groups of people rather than single
individuals.
• Public health is about overall wellness. This
means the broadest possible view of what makes
and keeps us healthy including our mental health, everyday health choices, and our
surroundings – not just health care services.
Definitions
Chronic disease: A disease that is
permanent, causes disability, is
caused by a nonreversible
pathological alteration, and/or
requires a long period of
supervision, observation or care.
Behavioral risk factors: Behaviors
that cause or contribute to
accidents, injuries, disease, and death
during youth and adolescence as
well as significant morbidity and
mortality in later life.
Environmental hazards:
Situations or materials that pose a
threat to human health and safety in
the built or natural environment.
Health disparity: When a health
outcome is seen to a greater or
lesser extent between specific
population groups.
Health equity: Achieving the
conditions in which all people can
realize the highest level of health
possible, without limits from
structural inequities.
Morbidity: Illness or lack of health
caused by disease, disability, or
injury.
Mortality: A measure of the
incidence of deaths in a population.
Social determinants: Structural
factors and conditions in which
people are born, grow, live, work
and age, that impact health.
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• Public health is about local needs. This means identifying what a community needs to
improve health and assuring effective action which uses local assets to solve unique
challenges.
The mission of the Edina Public Health Division is to protect the health and promote the general
well-being and welfare of the city’s residents, and to prevent disease and illness in the community.
Accomplishing this mission involves a range of programs and initiatives, run directly by the City
and through its public partners. This chapter provides a policy framework for continued progress
on the division’s mission and goals.
However, the vision for a healthy community in Edina is bigger than just the charge to one
division. This chapter also outlines a “health in all policies” approach, wherein health is
systematically addressed and included in policies throughout the plan. Addressing health and
wellness is essential to ensuring a sustainable community, and to maintaining the high quality of
life enjoyed by Edina’s residents.
Background
The city has long had a Public Health Department, and the promotion of public health is a core
value which is promulgated through numerous regulations and initiatives – both directly through
the city and in partnership with others.
The City of Edina is designated as a Community Health Board (CHB) by Minnesota Statute 145A.
A CHB is the legal governing authority for local public health in Minnesota, and community health
boards work with the Minnesota Department of Health (MDH) to promote the public's health.
The City Council acts as the CHB governing body and is responsible for fulfilling the statutory
duties of a CHB, which are to:
1. Assure an adequate local public health infrastructure by maintaining the basic foundational
capacities of a well-functioning public health system that include:
o Data analysis and utilization
o Health planning o Partnership development and community mobilization o Policy development, analysis and decision support
o Communication
o Public health research, evaluation and quality improvement
Example: Assess health priorities with community input; develop community health improvement
plans to address identified needs and monitor progress.
2. Promote healthy communities and healthy behavior through activities that improve health
in a population, such as: o Investing in healthy families
o Engaging communities to change policies, systems or environments to promote
positive health or prevent adverse health o Providing information and education about healthy communities or population
health status
o Addressing issues of health equity, health disparities, and the social determinants
of health
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Example: Minimize tobacco use and exposure among residents through policy change such as
raising the purchasing age to 21 years (“Tobacco 21 Ordinance”).
3. Prevent the spread of communicable disease by preventing diseases that are caused by
infectious agents through:
o Detecting acute infectious diseases
o Ensuring the reporting of infectious diseases
o Preventing the transmission of infectious diseases o Implementing control measures during infectious disease outbreaks
Example: Monitor immunization levels and perform outreach to high-risk groups; run
immunization clinics; investigate outbreaks and conduct contact interviews with exposed
individuals.
4. Protect against environmental health hazards by addressing aspects of the environment
that pose risks to human health, such as:
o Monitoring air and water quality
o Developing policies and programs to reduce exposure to environmental health
risks and promote healthy environments o Identifying and mitigating environmental risks such as food and waterborne
diseases, radiation, occupational health hazards, and public health nuisances
Example: Conduct restaurant and swimming pool inspections, respond to reports of unsanitary
and uninhabitable housing conditions, and inspect indoor air quality of parking garages in multi-
unit dwellings.
5. Prepare and respond to emergencies by engaging in activities that prepare public health
departments to respond to events and incidents and assist communities in recovery, such
as:
o Providing leadership for public health preparedness activities within a community o Developing, exercising and periodically reviewing response plans for public health
threats
o Developing and maintaining a system of public health workforce readiness,
deployment and response
Example: Share resources with Bloomington and Richfield for Public Health Emergency
Preparedness activities; hold events simulating natural disasters or mass dispensing of medication
in response to an outbreak or other threat. See Community Services and Facilities chapter for
more information on emergency preparedness measures.
6. Assure health services by engaging in activities such as:
o Assessing the availability of health-related services and health care providers in
local communities
o Identifying gaps and barriers in services
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o Convening community partners to improve community health systems o Providing services identified as priorities by the local assessment and planning
process
Example: The City’s annual agreement with Edina Public Schools to provide funding for chemical
dependency services.
Current Conditions
Municipal Structures
The Edina Community Health Commission (CHC) is comprised of volunteer residents serving in
an advisory capacity to the Edina CHB (City Council). A representative of the CHB is appointed
annually to represent the City on the State Community Health Services Advisory Committee
(SCHSAC). A CHC member has filled the SCHSAC seat in recent years.
The Health Division of the Edina Police Department provides Environmental Public Health
services to residents, such as regulation of food, pool, lodging, body art, and massage
establishments, housing and code enforcement inspections, noise complaint response, and public
health nuisance investigations.
Additional Public Health services such as health education and promotion, communicable disease
prevention programs, public health nursing services, home health visits, maternal and child health
services, health assessments and public health emergency preparedness are provided to Edina
residents through a contract with Bloomington Public Health.
Population Health Status
It is difficult to assess the health status of Edina residents at the population level. This is in large
part due to a lack of Edina-specific health data. Where data are available (often because it can be
aggregated by zip code following statewide data collection), there are frequently limitations to
what can be inferred, in part related to data privacy concerns regarding the sharing of health
information for individuals. Some examples providing key, albeit imperfect, information about
Edina residents are below:
Incidence of Chronic Disease.
According to the Minnesota Department of Health, Edina has low rates of hospitalization from
both chronic obstructive pulmonary disease (COPD) as well as asthma when compared to
neighboring suburbs. While COPD predominantly affects the elderly, asthma hospitalization is a
greater risk for pediatric populations, especially those living below federal poverty levels. In an
effort to maintain strong respiratory health at all ages by preventing tobacco use, exposure and
addiction, in 2017 the City passed an ordinance limiting tobacco sales to those over age 21.
Youth Health
The Minnesota Student Survey is another rich data source. The survey is administered every
three years of middle school and high school grades with voluntary participation. Data are
available at the school district level, including Edina School District. More information about the
survey and recent results can be found in a resource section at the end of the chapter Consistent
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with other health data, Edina students typically are above statewide averages in terms of their
well-being.
Reflecting broader regional and state trends, there has been a consistent reported decline over
the past ten years in many of the risky and negative behaviors tracked among students. There are
a few notable exceptions:
• Recent data show a possible upward trend in alcohol/tobacco use among 9th grade girls.
It also confirms the uptick of e-cigarette consumption. Rates are still below state averages
for the same time period.
• There has been a reported increase in online bullying, counter to a trend of declining
physical bullying.
• There has been a substantial increase in the number of students reporting that they have
been treated for a mental health, emotional, or behavioral problem, particularly among
girls.
Adult Health
Another source of information that can help to triangulate current health conditions in Edina is
the Adult Survey of the Health of All Populations and the Environment (SHAPE). In Hennepin
County, SHAPE has been administered every four years since 1998, surveying randomly chosen
adults about their health. In this survey, Edina is grouped with Richfield and Fort Snelling in the
category of South Suburbs – Inner Ring. While it captures some overall health perceptions and
specific conditions such as overweight, asthma, diabetes and hypertension, it is very difficult to
evaluate where Edina sits relative to other communities in this area. Overall, the survey suggests
that the majority of people in the area think their health is excellent or very good (over 65%),
and that the highest reported health concerns are being overweight (33%) or having high
cholesterol (32%). It is unknown if these aggregate numbers represent Edina.
The City of Edina 2017 Quality of Life Survey asked a few questions of residents related to health,
summarized below:
• 92% thought health and wellness opportunities in Edina are “excellent” or “good.”
• 86% thought the City’s public health services were “excellent” or “good.”
• 4% had been in contact with the health department during the course of the year.
• 75% thought fitness opportunities (including exercise classes and paths or trails, etc.) are
“excellent” or “good.”
• 1500 surveys were sent out with 477 respondents for a 34% response rate to the 2017
Quality of Life Survey.
In terms of understanding baseline health status and trends over time, it would be highly beneficial
if Edina were able to build on these sort of satisfaction-driven questions as well as collect baseline
city-specific data relevant to disease prevalence, mental health needs, environmental exposures,
or other metrics.
Health Care Resources
In addition to the community health services provided through the Health Department, there are
private health services and facilities serving Edina.
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Generally speaking, the Edina area has excellent access to health care facilities, as well as health
education and wellness programs. In addition to a level two trauma center within the City, there are
numerous smaller specialty clinics, medical offices, dental services, and ambulatory surgical centers
serving Edina. Most are located in and around the Greater Southdale area. At the regional level, other
major medical centers provide access to specialty care as needed.
Trends, Challenges and Opportunities
Many factors combine to affect the health of individuals and communities. At the time this plan
was developed, the following factors were emerging or priority issues to be addressed over the
next ten years:
Health, Economic, and Racial Disparities
Disparities exist across many factors in the city including health, economics, and race. Structural
inequities occur when structures or systems of society—such as finance, housing, transportation,
education, social opportunities, etc.—are designed in such a way that they benefit one population
unfairly (whether intended or not). One example of a disparity in Edina is that from 2012-2016 there
were lower than average rates of health insurance coverage among certain groups including non-US
citizens (83.1%), people with less than a high school education (80.0%), and individuals of color (89.6%
for Black or African American; 81.5% for Alaska Native or American Indian; 74.4% for Hispanic or
Latino) despite fairly high health insurance rates in the city overall (97.4%).
Premature death, defined as dying before age 65, is used to identify largely preventable causes of death
impacting our community. On average from 2013-2015, 10% of white individuals died before 65
compared to 31% of individuals of color living in Edina. Blacks in Edina are especially disparate with 42%
of premature deaths. Additionally, according to 9th grade responses in the 2016 Minnesota Student
Survey, 64% and 44% of Hispanic and Black students respectively respond to enrollment in Free and
Reduced Lunch program compared to just 3% of white students in Edina. See the resource section at
the end of the chapter for further illustrations of racial and income disparities in Edina.
Edina: A Community of Learning. Edina has a prized education system of high-quality
public schools. The Community Health chapter of the Comprehensive Plan recognizes the importance
of extending the benefits of education to the entire community, and to people at all stages of life.
Public education about health is a core component of the Public Health Division’s role, including:
• Conducting and sharing research and analysis to support policy and program development
• Providing information and education about healthy communities or population health status
• Tracking public health indicators in Edina, and working to expand the amount and quality of
data available
• Working with Edina Public Schools on public health partnerships
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Transportation & Mobility
Transportation is an integral component of an individual’s health, from utilizing transportation to access
healthy foods and healthcare, to walking and biking for exercise as well as travel. The City will consider
the health benefits of an active transportation system when development and road construction projects
are designed and constructed. Adequate transit access is another part of a transportation system that
supports healthy living. While a ‘circulator’ for seniors debuted in 2018, it will be important to build
upon and track success with that investment.
Access to Healthy Foods
While Edina has an array of healthy food resources, it has fewer community food service programs than
both Bloomington and Richfield, according to a 2013 Community Food Assessment. See the resource
section at the end of the chapter for a map of Edina Community Food Asset Locations and additional
information from the assessment. It will be important to assess whether the food service programs
provided are adequate to meet existing and future community needs.
Aging Population
The aging population will require adjustments in many areas, from expansion of care facilities to adding
senior-focused recreational opportunities. According to the 2012-2016 American Community Survey,
disability rates are higher for seniors in Edina. 60% of those aged 65 and older are disabled (two-thirds
of those are over age 75). This includes hearing, vision, cognitive, ambulatory and self-care difficulties.
Providing a full spectrum of community services to support aging in place will be critical.
Mental Health and Social Connectedness
There is an increasing need for mental health services for all ages in the city, from elementary and
middle school children to seniors. Social connectedness contributes to improved mental and physical
health in people of all ages. In older adults, social conditions like loneliness and isolation have a significant
negative impact on long-term health and wellbeing. As Edina continues to age and the number of adults
living alone continues to increase, strategies to address social isolation will become important to
improve community health.
According to the 2014 SHAPE survey, nearly 25% of the population in Hennepin County had been
diagnosed with depression and another more than 20% with anxiety. The numbers were slightly higher
in the south suburbs (which would include Edina) than the county at large. While it is not possible to
tease out Edina specifically given the survey design, these are staggering numbers that indicate the need
for mental health support in our community and surrounding areas. As noted in the Youth Health
section, the Minnesota Student Survey indicates that mental health concerns are surfacing among the
younger generation as well.
Addiction and opioid abuse/overdose are growing issues across the state, as well, including in Hennepin
County. Municipal activities such as first responder training with naloxone (an opioid antagonist used to
reverse overdose) are important, as are sufficient community resources to address mental health needs,
treatment, and prevention.
Housing
Safe and affordable housing is one of the most basic and powerful social determinants of health. Quality
housing improves the health of vulnerable populations and is a cornerstone of a strong and healthy
community. The City will continuously evaluate housing policies and regulations to provide safe and
affordable housing for residents of all ages, cultural backgrounds, and social demographics. This might
include enhanced efforts to address the large proportion of homes that register elevated radon levels.
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The City will also look at ways to support sustainable housing. Homelessness disparities were
pronounced among black 9th graders in Edina (14% compared to 5% among white students) as
measured in the 2016 Minnesota Student Survey. Additional information on affordable housing in Edina
is provided in the Housing Chapter.
Recommendations
To effectively address the trends and challenges identified above, it is recommended that Edina
commit to the following actions:
Enhance Data Collection
Collection of quality health-related data, especially at the city level, is becoming increasingly difficult and
expensive. Traditional survey methods like mail or landline telephone use are typically answered by only
certain demographics which results in poor quality data that does not represent the community as a
whole. The City will research and invest in collection methods for quality, city-specific health data to
better inform local decisions. The City will study best practices, including around privacy protections,
and work to design a comprehensive public health survey that can be used consistently from year to
year with flexibility to ask detailed questions about emerging trends.
Address Social Determinants of Health
Health is a critical aspect of planning. In fact, a community’s plan for housing, transportation, land use,
parks, and economic development encompasses the largest factors that determine one’s health. “Social
determinants of health” are structural factors and conditions in which people are born, grow, live, work
and age. Most premature deaths are connected to these determinants, like air and water quality or
access to physical activity and healthy food. Since the practice of community planning plays a significant
role in shaping the built environment, local planning can have real and significant impacts on community
health. The comprehensive plan is a tool to strategically increase health and reduce health disparities for
all.
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Source: Checklist: Comprehensive Planning for a Healthy Community, Metro Healthy Comprehensive
Planning Workshop
Use a Health in All Policies Approach
“Health in All Policies” is a collaborative approach to improve health by incorporating health
considerations into decision-making across all policy areas. A Health in All Policies approach will be
embedded in decision-making across all policy areas within the city. Questions to be addressed while
pursuing this strategy include:
a. Does it empower those that live and work in Edina to support their physical,
mental and social well-being?
b. How does this decision affect social determinants of health?
c. How will this decision reduce health disparities and improve health equity?
i. Health Disparity – When a health outcome is seen to a greater or
lesser extent between populations, there is a health disparity. Populations
may be defined by race, ethnicity, gender, sexual orientation, age,
disability, socioeconomic status, or location.
ii. Health Equity – Achieving the conditions in which all people have the
opportunity to realize their health potential – the highest level of health
possible for that person- without limits imposed by structural inequities.
Data Collection
Goal: Improve the quality and availability of city-specific public health data in Edina to inform policy
development and monitor impacts.
1. Research and invest in collection methods for quality, city-specific health data to better inform
local decisions.
2. Study best practices, including around privacy protections, and work to design a comprehensive
public health survey that can be used consistently from year to year with flexibility to ask
detailed questions about emerging trends.
3. Work with public and private sector partners on joint data collection and data sharing initiatives,
particularly when providing community-specific results.
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Additional Resources
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There are 15 grocery stores in Edina, including six supermarkets, six convenience/limited grocery stores,
and three small grocery stores. Three of these stores accept WIC and 12 accept SNAP/EBT. There are
no ethnic markets in the city. The City of Edina piloted a community garden in summer 2013, which
offers garden plots to city residents at a nominal fee, and an Edible Playground Garden that is open to
families of registered playground program participants.
Edina also has two farmers markets. The City-run market has 32 vendors including those selling locally
grown produce and an extensive variety of other locally produced foods product such as breads and
specialty bakery goods, candies, jams and other items. The Edina Farmers Market began accepting
SNAP/EBT at the beginning of its 2013 market season but does not accept WIC. In 2013, Fairview
Southdale Hospital opened the Farm to Fairview Farmers Market with four vendors who sell a variety of
locally grown produce. The Farm to Fairview market does not accept EBT or WIC. Edina has one
privately owned farm stand open seven days a week during the summer growing season. There are four
CSA farm drop sites in Edina, only one of which is located near low-income dense residential areas and
a bus line.
Given the substantially smaller number of low-income residents in Edina, there are fewer community
food service programs within city limits. There is one community dining site located in a housing
complex that serves senior residents. There are four meal delivery and four grocery delivery services.
There are two mobile food shelf drop sites located at apartment buildings within city limits, but these
services are limited to residents only. There are no Fare For All drop sites in Edina. Healthy, low-cost or
free food options in Edina are limited, which presents challenges for low-income and senior residents
with mobility issues and fixed incomes.
40.66%
0.00%0.00%2.39%All Edina Children,
3.25%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Black or African
American Alone
Hispanic or Latino Asian Alone White Alone - Not
Hispanic or Latino
Child Poverty by Race & Ethnicity in Edina-2015
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