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B E R G E N
C O U N T Y
Community Health
Improvement Plan
September 2006
Bergen County, New Jersey
B E R G E N
C O U N T Y
CHIP Committee
Member Organizations
Allendale Board of Education
Columbia University – School of Public Health
American Cancer Society, Northern NJ Region
Comprehensive Behavioral Healthcare, Inc.
American Red Cross, Bergen-Hudson Chapter
Englewood Hospital and Medical Center
Amerigroup NJ
Fairleigh Dickinson University
Atlantic Stewardship Bank
Girl Scout Council of Bergen County
Bergen Community College
Hackensack Health Department
Bergen County Cooperative Library System
Hackensack University Medical Center
Bergen County Department of Health Services
Holy Name Hospital
Bergen County Department of Human Services
Horizon NJ Health
Bergen County Division of Community Development
Korean-American Association of New Jersey
Bergen County Office on Multicultural Community Affairs
Lakeland Bank
Bergen County Medical Society
Mount Olive Baptist Church
Bergen County Municipal Nurses Association
National Coalition of 100 Black Women
Bergen County Police Department
New Hope Baptist Church
Bergen County PTA
New Jersey City University
Bergen County Public Health Partnership
New Jersey Local Boards of Health Association
Bergen County’s United Way
NJ AARP
Bergen County Youth Services Commission
NJ Department of Education, Bergen County Office
Bergen Family Center
Northern NJ Maternal Child Health Consortium
Bergen Regional Medical Center
Paramus Board of Health
Bergenfield Health Department
Partnership for Community Health, Inc.
Bergen Volunteer Medical Initiative, Inc.
Ramapo College
Buddies of New Jersey, Inc.
Realtime Nutrition, Inc.
Care One @ Valley
Ridgewood YMCA
Care Plus NJ, Inc.
Sacred Heart Church, Haworth
The Center for Alcohol and Drug Resources, Inc.
Teaneck Department of Health and Human Services
Citizens-at-large
The Valley Hospital
Columbia University – School of Dental & Oral Surgery
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Table of Contents
Vision and Values.............................................................................................................. 4
Executive Summary .......................................................................................................... 5
The Framework: A Strategic Planning Model................................................................. 6
Public Health Priority Issues and Strategies
Issue One: Access to Health Care .......................................................................... 12
Issue Two: Mental Health....................................................................................... 15
Issue Three: Obesity – Nutrition and Physical Activity......................................... 18
Issue Four: Alcohol, Tobacco and Other Drugs..................................................... 22
Issue Five: Communication of Health Issues ......................................................... 25
The Path Ahead.............................................................................................................. 28
Community Resources and Contributors....................................................................... 29
Task Force Member Organizations by Health Priority.................................................. 30
10 Tips for Better Health ............................................................................................... 31
County of Bergen
Dennis McNerney, County Executive
Bergen County Department of Health Services
[email protected] • 201-634-2600
www.bergenhealth.org
Partnership for Community Health, Inc.
[email protected] • 201-986-7715
www.bergenpch.org
Bergen County Public Health Partnership
[email protected]
B E R G E N C O U N T Y Community Health Improvement Plan
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B E R G E N
C O U N T Y
The CHIP Committee of Bergen County
embraces the following Vision and Values
VISION
All people in Bergen County will have access to resources that enable them
to reach optimum health, well being and quality of life, supported by a
continually improving, clean, safe and economically sound community.
Community stakeholders will collaborate to
create and leverage resources to build a healthier Bergen County.
VALUES
4
Systems Thinking
Strategic Thinking
Dialogue
Action
Shared Vision
Celebration of Successes
Data-based Assessment/
Evaluation
Partnerships
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Executive Summary
The CHIP Committee of
Bergen County is pleased
to present the following
Community Health
Improvement Plan (CHIP) to
county residents, community
organizations and civic groups
after engaging in a two-year
strategic planning process.
The CHIP Committee is
composed of over 50 member
organizations and individuals
who represent a broad
spectrum of the community
and subscribe to a broad
definition of health.
The community health assessment
data was both quantitative and
qualitative. Input was gathered from
residents through community forums,
focus groups and a 1,000 respondent
telephone survey. Other assessments
involved gathering data on the health
status of the community and the
workings of the local public health
system as well as an assessment of
forces likely to impact the health of the
public in the near future. The resulting
data was examined by the CHIP
Committee, who identified five issues
as health priorities. They are:
• Access to Health Care
• Mental Health
• Obesity – Nutrition and Physical
Activity
• Alcohol, Tobacco and Other Drugs
• Communication of Health Issues
Goals and objectives relating to these
issues as well as suggested strategies,
barriers and community resources
comprise the health improvement plan.
The next step in the process is an
anticipated three-year action cycle
during which the strategies deemed
most promising will be implemented.
Currently, task forces composed of
individuals and groups committed to
improving the identified health issues
are being organized. Many task force
members have been drawn from CHIP
Committee organizations engaged
in the process to date, and other
community residents are encouraged to
step forward.
The CHIP process is an ambitious
and bold effort at community
engagement for a common good. No
single organization has the depth of
resources needed to raise community
health to an optimal level or even to
maintain it at its current level. The
CHIP process is based on the idea that
through collaboration and synergy two
plus two will equal a great deal more
than four. Another important feature of
CHIP is that the plan arises out of the
community, which then has a greater
investment in its implementation.
Residents and community groups are
encouraged to join the CHIP process
as it enters the Action Phase. For more
information, please refer to The Path
Ahead on page 28 of this document.
By collaborating on priority health
issues, local residents and community
organizations will exhibit their deep
commitment to maintaining Bergen
County as a healthy place to live
and work.
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B E R G E N
C O U N T Y
The Framework:
A Strategic Planning Model
Bergen County is a suburban community that is the most populous of the state’s
21 counties and the fourth most densely populated. Population is densest in the
southeastern portion of the county, pictured here as seen from the Hudson River,
and least dense in the northwest.
A group of 50 key stakeholders in the health of the Bergen County convened
on June 29, 2004, in Hasbrouck Heights. Their purpose was to craft a new
public health agenda for the county through a two-year strategic planning
process. The endeavor was in line with the revised Public Health Practice
Standards for Local Boards of Health in New Jersey, effective in 2003.
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The group, dubbed the CHIP Committee for their anticipated product,
the Community Health Improvement
Plan, was organized under the umbrella
of the Partnership for Community
Health, Inc., a countywide coalition
established a decade prior to improve
the health, well-being and quality of
life for all who live and work in Bergen
County. Other key sponsors were the
Bergen County Department of Health
Services and the Public Health Partnership, a volunteer coalition of Bergen
County health officers.
A total of nine members from these
three organizations had come together
a few months prior as a steering committee. Calling themselves the CHIP
Core Group, they had proceeded to
organize the larger committee composed of stakeholders in the health of
the community. The participating individuals and organizations – eventually
numbering over 50 – were drawn from
all sectors of the community, including
public health, health care, third-party
payers, education, businesses, faith
groups, law enforcement, social service
agencies, and philanthropic and community organizations.
They were charged with following a
strategic planning model borrowed
from the business community called
MAPP, or Mobilizing for Action
through Planning and Partnerships.*
MAPP had been developed by the
Centers for Disease Control and Prevention and NACCHO, the National
Association of County and City Health
Officials. The outcome would be the
CHIP, scheduled for a countywide
rollout in the summer of 2006.
At their initial meeting in June 2004,
CHIP Committee members accepted
their charge and agreed to meet quarterly in order to meet the projected
time line. They also adopted a broad
definition of health as “more than just
the absence of disease, but a state of
optimal well-being.” They crafted a
Vision of a healthy Bergen County and
accepted the Values of the Partnership
for Community Health, Inc.
Six health assessments planned
The group began in the fall of 2004
to conduct four types of community
health assessments as suggested by the
MAPP process. The time line adopted
by the group specified the completion
of all assessments by December 31,
2005. The assessments included:
• Community Themes and Strengths
Assessment
• Local Public Health System
Assessment
• Community Health Status Report
• Forces of Change Assessment
The Community Themes and
Strengths Assessment, designed to
gather information from the community about their perceived quality of life
and community assets, would be carried
out using three methodologies: community forums, a telephone survey and
focus groups. The additional surveys
would boost the total number of assessments to six.
Community forums elicit lively
dialogue
The first assessment undertaken was
the Community Forums in November
2004. The forums were to be conducted
using the human resources and facilities
donated by CHIP Committee members. The donations were solicited via
a questionnaire, and a series of forums
was scheduled along with a plan for
recruiting participants.
Forums were planned in four municipalities: Tenafly, Ramsey, Hackensack,
and Ridgewood. The Hackensack
forum was scheduled for daytime for
the convenience of older adults, while
the other three forums were set in the
evening for residents aged 18 and older.
* For more information on MAPP log on to
http://mapp.naccho.org
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B E R G E N
C O U N T Y
The forums were publicized through
a press release and flyer distributed
through the CHIP Committee and
the Public Health Partnership. Members were charged with the outreach of
participants who reflected the county’s
diverse population, and approximately
140 residents with diverse demographics were registered.
participants to introduce themselves.
The co-facilitators then reviewed the
Ground Rules, such as Respect for One
Another; Respect for Confidentiality;
and a Willingness to Share and Listen.
The Circle, Check-In, and Ground
Rules are all techniques of Dialogue
that had been modeled at the orientation session.
Several CHIP Committee members
volunteered to co-facilitate the forums. Prior to the first forum they
were oriented to help ensure that the
gatherings would be conducted in a
consistent manner and with the use
of Dialogue skills. Dialogue skills and
techniques are recommended by the
MAPP process to help provide the
optimum setting, conditions and methods to encourage true dialogue, which
involves listening as well as speaking.
Local dialogue trainers, a resource previously developed within the Partnership for Community Health, modeled
the skills and techniques at the facilitator orientation.
Participants engaged in a debriefing of
the entries on the easel, at which time
they amplified their answers about
their health-related issue of concern.
Then they were randomly assigned to
a table to discuss three specific questions. Each small group first selected a
scribe and a reporter before exchanging views. The scribe was responsible
for recording the comments on a sheet
of newsprint. When the small group
discussions wound down, participants
were asked to reconvene to the large
circle for debriefing. The designated
reporters posted their newsprint sheets
and communicated the outcome of the
small group discussions to all present.
The agenda for all four forums was uniform. As participants arrived and before
they took a seat in a large circle, they
were invited to enter their response
to the following question on an easel:
What health or health-related issue is
important to you and your community?
In a closing exercise, participants were
asked to name one issue besides the
one they had brought in with them that
they now felt was of equal or greater
importance. Before leaving, participants
were requested to complete an evaluation form and were given an opportunity to request a copy of the CHIP.
Public reaction was highly positive. As
one resident said, “Someone should
Next, to open the meeting a “CheckIn” exercise was conducted enabling all
8
B E R G E N C O U N T Y Community Health Improvement Plan
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have thought of this before. Excellent
start. Now make it a reality, please.”
1,000 respondent telephone survey
allows data to be queried
Initial plans called for a written survey,
but the CHIP Core Group decided in
favor of a telephone survey as it would
have greater validity. The Partnership
for Community Health, Inc. selected
a consultant with wide experience in
health surveys who had the capability
to post the results on a web page
accessible to CHIP Committee
members, who would then be able to
query the data.
The CHIP Committee was highly involved in crafting the telephone survey
questions. The survey was designed to
solicit residents’ perspectives of factors
that contribute to the health of the
local community as well as information concerning their personal health
needs. The questions were designed
to complement an annual survey of
the New Jersey Department of Health
and Senior Services called the Behavior Risk Factor Surveillance Survey
(BRFSS). Rather than resurvey identical questions, the consultant agreed to
post on the web page the county-level
BRFSS data provided by the NJ Center
for Health Statistics. This strategy freed
survey time to ask additional questions,
although the resulting limitation was
that data from the two surveys could
not be cross-tabulated.
2006
Bergen County
Municipalities
MAHWAH
UPPER
SADDLE RIVER
RAMSEY
MONTVALE
PARK RIDGE
ALLENDALE
OAKLAND
SADDLE RIVER
RIVER
VALE
WOODCLIFF LAKE
OLD TAPPAN
WALDWICK
WYCKOFF
FRANKLIN LAKES
ROCKLEIGH
HOHOKUS
MIDLAND
PARK
NORWOOD
WASHINGTON
TOWNSHIP
WESTWOOD
HARRINGTON
PARK
RIDGEWOOD
EMERSON
DEMAREST
ORADELL
PARAMUS
DUMONT
BERGENFIELD
TENAFLY
K
SAC
ENGLEWOOD
KEN
TEANECK
ENGLEWOOD
CLIFFS
HAC
GARFIELD
MAY
SADDLE
BROOK
WO
ROCHELLE
PARK
ELMWOOD
PARK
NEW
MILFORD
CRESSKILL
OD
RIVER
EDGE
FAIR LAWN
ALPINE
CLOSTER
HAWORTH
GLEN ROCK
State of New Jersey
NORTHVALE
HILLSDALE
LODI
WOOD-RIDGE
MOONACHIE
RU
T
CARLSTADT
HE
RF
OR
D
EAST
RUTHERFORD
SH
AC
K
FORT LEE
PALISADES
PARK
RIDGEFIELD
EW
ATE
R
LITTLE
FERRY
LEONIA
RIDGEFIELD
PARK
CLIFFSIDE
PARK
FAIRVIEW
EDG
Located in the northeastern corner
of New Jersey, Bergen County
is home to 884,118 residents
according to the 2000 census.
Its 70 municipalities are served
by 15 non-contiguous health
jurisdictions, each with its own
health officer, including the
Bergen County Department of
Health Services, which delivers
some of its services countywide.
K
AC
WALLINGTON
SH
SH
HA
S
HE BRO
IG U
HT CK
S
TET
ERB
OR
O
BOGOTA
LYNDHURST
NORTH
ARLINGTON
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B E R G E N
C O U N T Y
The telephone survey achieved a margin of error between 3 and 4 percent,
the accepted level for all major surveys.
A live web demonstration showing how
to query the data for the responses of
various subgroups was presented at the
October 2005 CHIP Committee meeting with positive feedback.
Focus groups targeted to specific
populations
The final segment of the Community
Themes and Strengths Assessment, a
series of six focus groups, was planned
for the fall of 2005. The purpose was
to pursue in greater depth the most
pressing health issues that had arisen
during the community forums and how
to best address them. The Partnership
for Community Health, Inc. engaged a
consultant to conduct the groups, while
the CHIP Committee was responsible
for scheduling them and recruiting
participants.
Focus groups were planned for specific
target groups including Young People,
Senior Adults, Men, Women, Parents
and Recent Immigrants. Participants for
the Men’s, Women’s and Recent Immigrants’ group were successfully recruited
through the CHIP Committee and the
Public Health Partnership. However,
the Parents’ group was eventually folded
into the Men’s and Women’s group due
to inadequate registration.
10
County resources were instrumental in
reaching young people and older adults.
High school students were accessed
through the county school district,
which enrolls students from all parts of
Bergen County. Similarly, senior adults
were reached through the county’s
senior activity program and transported
to the focus group site by the county’s
transportation system.
As with the telephone survey, the
CHIP Committee provided a great
deal of input regarding the focus group
discussion guide. First, CHIP Core
Group members analyzed the proceedings of the community forums to select
topic areas to pursue, and then CHIP
Committee members narrowed them
down and drafted questions. The areas
of questioning revolved around Access to Health Care, Obesity/Nutrition
and Physical Activity, Mental Health
Issues and Communicable Disease. An
additional topic for the Recent Immigrants’ group was Cultural Sensitivity,
while the Youth group also discussed
Substance Use and Abuse.
Total attendance at all five groups exclusive of facilitators and observers was
98. Observers noted a reflection of the
diverse nature of the county among the
participants as well as a strong willingness on their part to listen and share. A
great deal of enthusiasm for improving
public health issues was voiced, generating high expectations for the CHIP
Committee to fulfill.
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Local Public Health System Assessment completed by the PHP
An assessment of the local public
health system measures the capacity
and performance of the larger Local
Public Health System, defined as all
organizations and entities that contribute to the public’s health. This assessment was undertaken by the Public
Health Partnership (PHP), a volunteer
coalition of Bergen’s 15 health officers.
They delegated the drafting of the
assessment to a subcommittee with
an anticipated consensus of the entire
PHP by December 31, 2005. The
assessment tool was provided by the
New Jersey Department of Health and
Senior Services.
The subcommittee met frequently
beginning in the summer of 2005 to
complete the task. As a preliminary
step, they established ground rules in
an attempt to answer the numerous
questions in a consistent manner. Upon
completion of the draft, the subcommittee presented it to the PHP for
consensus, and it was adopted prior to
the planned delivery date.
Forces of Change Assessment calls
upon CHIP Committee as experts
The Forces of Change Assessment uses
community experts to identify forces,
events and trends that are or will be
affecting the community or the local
public health system. The CHIP Core
2006
Group decided to invite the CHIP
Committee members to participate in
the assessment as the experts on Bergen
County. The Partnership for Community Health, Inc. engaged a consultant to design a half-day workshop
in conjunction with the CHIP Core
Group. The categories used to capture
the Forces of Change were: Scientific/
Technology; Ethical/Legal; Environmental; Social; Political; and Economic.
The assessment was undertaken in
April 2005, with a total of 30 CHIP
Committee members attending.
The Forces of Change assessment
was divided into two parts. First, six
sub-groups of 5 people defined a set of
Forces under each of the above categories and pinpointed several Forces of
Change that appeared most critical to
consider for later discussion. Through
large group consensus the Critical
Forces were reduced to three in each
category.
In the second part of the process, six
subgroups were assigned to one of
the six Forces of Change categories,
like Social or Economic. Under each
category the three previously identified
Critical Forces were listed. The task of
each sub-group was to develop a set of
potential Threats and Opportunities
that would manifest under each Force.
Community Health Status Report
provides additional data
The Community Health Status Report
assesses data about health status, quality
of life, and risk factors in the community. Completion of this assessment
was assigned in the fall of 2004 to the
Office of Planning staff at the Bergen
County Department of Health Services. The report was completed in time
for a January 2006 presentation to the
CHIP Committee.
Selecting priorities and moving to
the Action Phase
Although the health status of Bergen
County was generally recognized as
good, a number of areas were identified
where energy could be focused to help
residents reach optimal health as stated
in the CHIP Committee Vision. The
CHIP Core Group was instrumental
in identifying five health priorities
emerging from the multiple community health assessments, and the CHIP
Committee endorsed them. Most of
these priorities are reflective of Healthy
New Jersey 2010 and, as such, help
move the state’s health agenda forward.
CHIP Committee members reviewed
what were initially called “Problem
Statements,” or rationales for selecting
each priority issue, and “templates” that
listed the goals, measurable objectives, risk factors, suggested strategies,
resources and barriers for each.
Finally, in April 2006 as part of the
process, CHIP Committee member
organizations were requested to declare
their support for one or more of the
emerging health priorities. Issues that
received a critical mass of support were
to be included in the CHIP. As a result
of the high level of support shown, each
of the five health priorities identified
through the CHIP process will be the
subject of a countywide task force.
With the presentation of the CHIP to
the community, the Action Phase of the
MAPP process begins. Interventions
are likely to be multi-level, reaching the
population through multiple channels,
as well as multi-faceted, with behavioral, social and environmental aspects
addressed for greater effectiveness.
The Action Phase is projected to last
three years, at which time progress
toward objectives will be reported to
the community.
Since health needs are constantly
emerging, the cyclical nature of the
MAPP process allows the periodic
identification of new priorities and the
realignment of activities and resources
to address them.
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Public Health Priority Issues
I S S U E
O N E :
Access to Health Care
Most residents named access to care as
their most important issue upon arrival
at the community forums. Included
under this topic was lack of preventive
health care, long-term care, dental care
and prescription drugs. By the conclusion of the forums over one-third of
participants ranked access to health care
as the first or second most important
local health issue.
Lack of public transportation
and English language skills cited
as barriers
The difficulty of accessing care also
animated discussions at the focus
12
Courtesy of North Jersey Community Newspapers / Michael Karas
Community input to
identify issues of interest
to residents was solicited
using three methods:
community forums,
focus groups and a 1,000
respondent telephone
survey. Each assessment
showed that access to
health care was an issue of
top concern.
Immunizations are one important aspect of preventive health care for
adults as well as children. Residents who lack adequate health insurance
or a medical “home” and those who face language, cultural and other
barriers often encounter greater difficulty in obtaining preventive health
services and continuity of care.
groups held for immigrants, men and
women. Among the barriers cited was
the lack of public transportation especially among senior adults, although
transportation constituted a need for all
age groups according to the Forces of
Change Assessment.
Recent immigrants spoke about the
common practice of using hospital
emergency rooms as sources of
B E R G E N C O U N T Y Community Health Improvement Plan
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11.3%
of Bergen County
adults, or 76,960,
lack health
insurance coverage.*
* Data from telephone surveys conducted
in Bergen County from 2003-2005
2006
and Strategies
Goal
Outcome Objectives/Indicators
Increase Access to Health Care
Increase the percentage of adults who have access to primary care
to more than 89%
Decrease hospital admissions rate for Ambulatory Care Sensitive Diagnoses
for adults under age 65 per 1,000 population to 13; and for children under
age 5 per 1,000 population to 23
Risk Factors
Impact Objectives
Low income
Young adult
Recent immigrant
Employee of small company
Part-time employee
• Improve access to primary care for residents who live below 200% of the
federal poverty level
• Strengthen the linkage and referral system between agencies that offer
free health care and other social service and health care agencies
• Increase delivery of culturally competent services
Suggested Intervention Strategies
Contributing Factors
Direct contributing factors:
• Lack of health insurance coverage
• Poverty
• Cost
• Unavailability and inappropriate
use of treatment resources
Indirect contributing factors:
• Health coverage system based on
employment
• Lack of education
• Lack of jobs
• Substance abuse
Increase awareness of/# referrals to available free health care facilities
Promote enrollment in KidCare and other free or low cost health coverage
programs (e.g., Catastrophic Children’s Fund)
Advocate for the establishment of nonprofit health care facilities providing
free health care to the uninsured
Advocate for financial or other incentives to hospitals willing to share lab
and radiology services with free health care facilities
Increase awareness to improve the delivery of culturally competent health
care services
Increase awareness of free or reduced cost prescription drug programs
Increase awareness of proper use of preventive health care services
Promote Health Literacy as a means to increasing access to care
Advocate to decrease barriers to care
Advocate to incorporate screening into health care at all clinical services
Review guidelines for eligibility for Federal and State programs in relation
to Bergen County living costs and advocate for changes if warranted
Resources Available
Federal programs
Nonprofit health clinics
Free/reduced cost prescription
drug programs
Barriers
Transportation
Language
Cultural
Lack of knowledge of existing resources
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I S S U E
O N E :
Access to Health Care, Cont’d.
primary care, an inappropriate use of
resources arising out of their needs.
They complained particularly of the
lack of continuity of care at hospital
emergency rooms and clinics, as well as
their perceived lack of bilingual interpreters and materials in their native
languages. More than 13 percent of
Bergen residents speak English “less
than very well” according to the Health
Status Report.
Residents express need for more
accessible health care
The telephone survey revealed that
nearly 60 percent of county residents
feel that Access to Preventive Health
Services is a factor that needs to be
improved in the community, and those
below the 200 percent federal poverty
level feel the need more keenly. The
following additional statistics emerged
from the survey:
• 11.3 percent of Bergen County
adults have no health insurance
• 18.8 percent of Bergen County
adults could not get prescription
medication in the past
12 months due to cost
• 12.7 percent of Bergen County
adults could not get dental
care in the past 12 months
due to cost.
14
In the absence of universal health
insurance coverage, access to health care
is a key issue for communities across
the country. Barriers such as the cost of
physician visits, prescription medicine
and dental care are prohibitive factors
for many residents. Nevertheless, in
58.9%
of Bergen County
adults, or
401,146, perceive
that Accessibility to
Preventive Health Care
needs to be
improved in the
community. Among
adult residents below
200% of the poverty
level, the figure
climbs to 71.6%.*
* Data from telephone surveys conducted
in Bergen County from 2003-2005
the past year a higher proportion of
Bergen County residents than residents
nationwide obtained dental care, and
the Healthy People 2010 objective for
annual dental exams was satisfied.
a lower incidence of uninsured adults
and higher proportions of adults and
children having had a routine checkup
in the past year. Although the county
scored better than the nation as a whole
on these indicators, the lack of universal health insurance – an objective of
Healthy People 2010 – leaves a sizeable
proportion of our residents vulnerable.
The data indicates that more than one
in ten Bergen County adults manages
their health without primary health
care coverage.
Residents strongly voiced their need for
increased access to health care through
focus groups and community forums.
The Forces of Change Assessment
reinforced its importance as a top issue.
In the discussion on economic conditions, Forces of Change participants
noted increasing numbers of uninsured
residents and the perceived burdens
on local hospitals related to treating
patients under Charity Care funding. Also cited was the need for some
residents to compromise on basics like
food to pay for medical care and prescription drugs.
More than one in ten lack health
care coverage
Outperforming the nation on specific
measures, Bergen County experienced
B E R G E N C O U N T Y Community Health Improvement Plan
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2006
I S S U E
T W O :
Mental Health
Strong concerns about
Mental Health were heard
from residents at the
Community Forums, and
it was one of the few topics
that had more champions
at the conclusion of the
forums than at the start.
Nearly one in five participants ranked mental health
issues as first or second in
importance.
In regard to the diagnosed mentally ill,
participants called for more providers
of care and more support, education,
housing subsidies, job training and
placement. However, they also cited
mental health issues such as lifestyle
pressures and stress for the general
population. Stress was viewed as a public health issue affecting all residents,
including children. Factors perceived
as contributing to mental health issues
were the hectic pace of life in the
Residents expressed mental health concerns that encompassed the needs
of both those with diagnosed mental illness as well as those coping with
everyday stress, anxiety and depression. Having a support system and a
feeling of belongingness in the community are some of the factors that
help promote “mental wellness.”
B E R G E N C O U N T Y Community Health Improvement Plan
n
2006
15
I S S U E
T W O :
Mental Health, Cont’d.
Nearly one in three
Bergen County adults, or
32.2%,
report “too much
job-related stress”
(9.0%) or “a lot of
job-related stress”
(23.3%).*
metropolitan area and the pursuit of a
lifestyle that is out of reach for many.
Young people note stress and
anxiety, older folks cite depression
and isolation
The concern for mental health issues
was repeated at the Focus Groups.
Most attendees indicated that depression, anxiety and stress are the serious
problems they see. Young people noted
that stress and anxiety over school and
peer pressure affected their age group.
Additional mental health issues for
children were highlighted at the Forces
of Change Assessment such as harassment and bullying of peers including
cyber bullying, or intimidation occurring via the Internet.
In the older adult focus group, participants expressed particular concerns
about depression and isolation. The
Forces of Change Assessment reinforced those concerns as participants
16
noted the aging of the population
was creating a need for more senior
services, including those related to
mental health.
Access to care and stigma
remain problems
Although participants attending the
focus groups expressed that depression
is a problem keenly felt by the individual and his or her respective family,
the telephone survey found that the
prevalence of self-reported depression
is lower in Bergen County than nationwide. However, the difficulty of accessing treatment was expressed, especially
for immigrants with a language barrier.
All agreed that the stigma attached to
mental illness remains troublesome and
that more education on mental illness, its
causes and treatment would be helpful.
52.4%
of Bergen County adults,
or 356,877, perceive
that adequate mental
health services need to
be improved in the community. Among adult
residents below 200%
of the poverty level, the
figure climbs to 68.0%.
* Data from telephone surveys conducted
in Bergen County from 2003-2005
Telephone surveys indicate the
following:
• 9 percent of Bergen County
adults feel “too much” job-related stress on a regular basis
• 23.3 percent report “a lot of ”
job-related stress on a
regular basis
• Bergen County adults report
on average of 27 good mental
health days in the past month.
B E R G E N C O U N T Y Community Health Improvement Plan
Adequacy of mental health services
Over 40 percent of telephone survey
respondents feel that Mental Health
Issues are a major or moderate problem in the community. The Forces of
Change Assessment reinforced that
view by citing the need for more mental
health services, partially as a result of
n
the terrorist attack on the World Trade
Center on September 11, 2001, an
assault that took the lives of hundreds
of county residents and shook the
security of thousands more.
The telephone survey also revealed
that more than 52 percent of Bergen
County adults feel that Mental Health
Services is an attribute that needs to be
improved in the community, and those
below the 200 percent federal poverty
level feel the need more keenly.
2006
Goal
Outcome Objectives/Indicators
Promote Mental Health in the
community
Increase days able to do usual activities during past 30 days due to good
mental health from 27 to 28
Reduce the proportion of the adult population reporting their mental
health was not good more than 7 days in the past month
Impact Objectives
Risk Factors
• Improve access to mental health services
• Reduce stigma of mental illness in the community
• Strengthen the linkage and referral system between mental health
providers and other service organizations
• Increase the proportion of mental health care providers who are
culturally and linguistically competent
Family history
Lack of access to care
Suggested Intervention Strategies
Contributing Factors
Increase awareness and use of mental health referral and help lines
Direct contributing factors:
• Poverty
• Aging
• Lack of insurance coverage
• Cost of treatment/medications
• Unavailability of treatment
resources
• Unavailability of culturally
competent care
• Stigma
• Domestic violence
• Lack of understanding that
treatment works
Increase awareness and use of the community mental health system
Increase awareness and use of Employee Assistance Programs
Promote depression and anxiety screening by medical providers and
encourage referral to appropriate services
Incorporate mental health promotion, including media messages, into
chronic disease prevention efforts
Advocate for expanded mental health care programs
Advocate for increasing the number of specifically trained treatment
specialists to address unique and various cultural groups
Increase understanding and knowledge of the people affected and the
community at large concerning mental illnesses
Indirect contributing factors:
• Substance abuse
• Social attitudes
Increase the pool of child and adolescent psychiatrists by advocating for
parity coverage for providers and an increase in Medicaid reimbursement
Improve parenting skills through education and treatment
Facilitate training of school and youth group based personnel to enable
earlier preventive interventions
Advocate for increased character development and education (e.g., antibullying, positive coping mechanisms, social interaction, etc.) to minimize
isolation and increase opportunities for prevention/early intervention
Replicate successful substance abuse treatment program models with
special attention to Mentally Impaired Chemically Addicted, parent/child
settings, chronic substance abuse and adolescent girls
Resources Available
County supported mental health system
Free/reduced cost prescription
drug programs
NAMI (National Alliance on
Mental Illness)
Barriers
Transportation
Stigma
Language
Cultural
B E R G E N C O U N T Y Community Health Improvement Plan
n
2006
17
I S S U E
T H R E E :
Obesity – Nutrition and
Physical Activity
The telephone survey
revealed that over half of
Bergen County adults are
overweight or obese, and
nearly three out of four
residents surveyed perceive
overweight/obesity as a
major or moderate problem
in the community.
Fewer than half
of Bergen County
adults, or
46.3%,
meet the recommendation for moderate
physical activity.*
* Data from telephone surveys conducted
in Bergen County from 2003-2005
18
The current trend toward increased overweight and obesity is evident
among children as well as adults and increases the risk for chronic
diseases. Good nutrition and adequate exercise are lifestyle habits that
combat overweight and can be fostered by a favorable environment, both
social and physical.
Health experts recognize obesity as
a risk factor for a number of chronic
diseases including heart disease and
cancer, which together comprise the
leading causes of death. Obesity and
overweight are also associated with
Type 2 diabetes, a disease that is on the
B E R G E N C O U N T Y Community Health Improvement Plan
n
rise nationally and can lead to serious
complications and premature death.
A problem for young and old
In various health assessments, obesity
was cited as a problem for both senior
adults and young people. For example,
2006
during the Forces of Change Assessment participants noted the increase
in childhood obesity along with the
increased amount of time young people
spend in sedentary activities. Similarly,
participants at the Community Forums
cited obesity as an issue for younger
residents, although they also saw poor
nutrition for senior adults as a concern.
Discussions about nutrition and physical activity, two major risk factors for
obesity, elicited strong reactions particularly from Focus Group participants.
Numerous barriers to healthy eating
and exercise were cited, although the
relationship of these behaviors to desirable weight and good health was readily
acknowledged. Members of all focus
groups deemed lack of time a major
barrier, whereas senior adults were also
impeded by a lack of public transportation to food markets, and young people
and women were hampered by their
lack of cooking skills. Interestingly, immigrants cited the need for more public
38.6%
of Bergen County adults,
or 261,890, are overweight. The Healthy
New Jersey 2010 objective is 27.6% or lower.*
Overweight/not obese is
defined as having a body
mass index (BMI) – a ratio of
weight to height – between
25.0 and 29.9.
transportation as a means of combating
obesity as opposed to driving doorto-door. Another factor contributing
to overweight was noted in the ready
availability and low price of so-called
“junk” foods.
Telephone surveys indicate the
following:
• 16.2 percent of Bergen County
adults are obese
• An additional 38.6 percent are
overweight
Over half of
Bergen County adults,
• Fewer than 1 in 3 (28.4 percent)
meet the recommendation for five
fruits and vegetables a day
or 373,223, are
overweight or obese.*
• Fewer than 1 in 4 (22.6 percent)
participate in frequent leisure time
physical activity.
54.8%,
The data is based on
self-reported height
and weight.
* Data from telephone surveys conducted
in Bergen County from 2003-2005
in New Jersey as a whole (2004 data)
and in the US (2005), the percentage
does not meet the objective for Healthy
NJ 2010. Furthermore, only 41.8
percent of overweight Bergen County
adults have been advised to lose weight,
and only 27 percent overall received
advice from a health professional in the
past 12 months about their weight.
On the other hand, residents had no
shortage of suggested strategies for
problems of overweight and obesity and
called for education campaigns, cooking
classes and opening more recreational
16.2%
of Bergen County
adults, or 110,332,
are obese. For adult
residents at less than
200% of the poverty
level, more than twice
as many, or 36.0%, are
obese. The Healthy
New Jersey 2010 objective is 12% or lower.*
Obesity is defined as
having a body mass index
(BMI) – a ratio of weight
to height – greater than or
equal to 30.0.
Need for more medical advice on
weight loss
Although the percentage of obese
adults in Bergen County is lower than
B E R G E N C O U N T Y Community Health Improvement Plan
n
2006
19
I S S U E
T H R E E :
Obesity – Nutrition and Physical
Activity, Cont’d.
and rehabilitation facilities for use by
the community, as well as instituting
better nutrition education, physical
education and cafeteria offerings in
the schools.
Residents short on fruit and vegetable intake and physical activity
Expert advice for weight loss calls
for decreasing calorie intake and/or
increasing physical activity. Moreover,
adequate physical activity and a nutritious diet serve to reduce the risk for
Of the county’s 681,064
adult residents, only
28.4%,
or 193,422, meet the
recommendation for
five fruits and vegetables a day. * The Healthy
New Jersey 2010
objective is 35%
or higher.
* Data from telephone surveys conducted
in Bergen County from 2003-2005
mendation for five or more fruits and
vegetables a day. Bergen County adults
are less likely than adults nationwide
to meet this recommendation and
therefore fail to satisfy this objective for
Healthy New Jersey 2010.
46.4%
of Bergen County adults,
or 316,013, perceive
that the environment
for walking needs to be
improved in the
community.*
22.6 %
of Bergen County adults,
or 153,920, report not
engaging in any leisuretime physical activity in
the past month.*
Bergen County adults are more likely
to participate in physical activity than
adults nationwide, but fewer than half
(46.3 percent) meet the recommendation for at least 30 minutes of activity
most days of the week. Fewer than a
quarter of Bergen County adults (22.6
percent) engage in frequent leisure time
physical activity, although more than
half (53.9 percent) perceive a lack of
physical activity as a major or moderate
problem in the community.
Improving the social environment
to foster healthy decisions
Healthy decisions encompass many
areas including an individual’s nutrition
choices and level of physical activity.
Decision-making is often influenced
by the social environment — the
actions and/or attitudes of those
around us. More than half of Bergen
County adults (57 percent) feel that the
social environment needs to be improved to encourage healthy decisionmaking, for example, through positive
peer pressure, changing community
norms or role-modeling.
chronic disease, even in the absence of
obesity. A diet that is moderate in fat
and calorie intake is helpful for weight
control and generally meets the recom-
20
B E R G E N C O U N T Y Community Health Improvement Plan
n
2006
Goal
Outcome Objectives/Indicators
Reduce the prevalence of Obesity
and Overweight through improved
Nutrition and Physical Activity
Increase the intake of fruits and vegetables
Reduce the percentage of obese and overweight people
Increase the percentage of people who engage in regular physical activity
Increase the percentage of overweight adults who are modifying diet and increasing
physical activity to lose weight
Reduce the percentage of children entering K, 5th and 9th grades who have a BMI
above the recommended level
Risk Factors
Impact Objectives
Unhealthy diet
Physical inactivity
Lack of education
Low income
Minority group member, i.e.,
African American, Latino, etc.
• Increase the number of restaurants/school cafeterias offering/promoting healthy choices
• Increase the number of community groups developing policies on
healthy refreshments
• Increase the number of families engaging in physical activity together
• Increase the number of low cost/free cooking and exercise classes in the community
Suggested Intervention Strategies
Contributing Factors
Direct contributing factors:
• Lack of knowledge
• Lack of time
• Poor eating habits
• Lifestyle does not incorporate
physical activity
Indirect contributing factors:
• Advertising unhealthy foods to
children
• Lack of access to wholesome foods
• Availability of calorie-dense food
• Using food as “drug”
• Lack of access to exercise facilities
• Environment unfavorable to
physical activity
• Role models
• Chronic illness
• Disabilities
Resources Available
Municipal and county parks
Nonprofit recreational organizations
School and hospital exercise facilities
American Dietetic Association website
5-A-Day Program
Women’s, Infants and Children’s
Supplemental Food Program
Internship programs at local colleges
and universities
Increase awareness and knowledge of the benefits of regular physical activity and good
nutrition for all county residents throughout the lifespan
Improve consumers’ perceptions concerning the value of healthy food choices and
regular exercise
Advocate for creating/sustaining an environment conducive to physical activity
including “walkable” communities that respect pedestrian rights and have sidewalks in
good repair, bicycle paths, improved lighting, etc.
Increase awareness and access to different types of physical activity, programs and facilities
Develop/advocate for policies in schools, senior programs, worksites and other
community groups that are consistent with good nutrition and increased exercise
Advocate for expanded nutrition/physical education in schools and other community settings
Increase knowledge and skills among all groups needed to purchase, prepare and
consume healthy foods and incorporate exercise into lifestyle
Advocate for restrictions on unhealthy food advertising aimed at children
Advocate for parents and caregivers to serve children healthy snacks and encourage
physical activity
Increase distribution of nutrition information
Increase awareness of sources of credible nutrition information and criteria for
determining credibility
Advocate for food providers to develop and implement incentive programs that
promote consumers’ healthy food choices
Increase awareness of programs and resources providing increased access to healthy
food choices
Barriers
Cost
Time constraints
Lack of knowledge
Attitudes about nutrition/physical activity
Concerns about safety
B E R G E N C O U N T Y Community Health Improvement Plan
n
2006
21
I S S U E
F O U R :
Alcohol, Tobacco and
Other Drugs
According to the telephone survey, over half of Bergen County
adults feel that Tobacco Use
and Alcohol and Drug Abuse
are major or moderate problems
in the community. The fact that
tobacco use adversely affects
health is well accepted. National
data shows that one out of three
smokers die prematurely with
an average of 12 to 15 years of
potential life lost as compared
to normal life expectancy. Even
non-smokers experience deleterious health effects as a result of
exposure to secondhand smoke.
Telephone surveys indicate the
following:
• 16.2 percent of Bergen County adults
currently smoke
• 13 percent of Bergen County adults
engaged in binge drinking (defined as
five or more drinks on an occasion) in
the past 30 days.
22
Patterns of substance use and abuse like smoking and binge drinking
often appear during pre-teen and teenage years. Preventive approaches
include arming children with “developmental assets,” or factors like
their sense of personal responsibility and self worth as well as their
“connectedness” to their families, schools and communities.
Smoking and binge drinking rates fall
short of goals; drug use a concern
The telephone survey reveals that Bergen County fails to meet the Healthy
People 2010 objective for binge drinking, although the prevalence of binge
drinking is lower than national averages. Similarly, the prevalence of adult
cigarette smoking in Bergen County
does not satisfy state and federal goals
even though the rate is lower than in
the nation and New Jersey as a whole.
B E R G E N C O U N T Y Community Health Improvement Plan
n
2006
13%
of Bergen County adults,
or 88,538, report binge
drinking in the past 30
days (consuming five or
more drinks on one occasion). * The Healthy New
Jersey 2010 objective is
10.6% or lower.
* Data from telephone surveys conducted
in Bergen County from 2003-2005
Goal
Reduce use and abuse of Alcohol,
Tobacco and Other Drugs (ATOD)
Outcome Objectives/Indicators
Decrease percentage of high school students who say they are currently
smoking to 30%
Decrease the percentage of high school students who have used substances in
the past 30 days
Increase percentage of current smokers who quit for a day within the past year
Decrease the percentage of adults engaging in binge drinking
Risk Factors
Impact Objectives
Contributing Factors
Suggested Intervention Strategies
• Raise the age of initiation to tobacco use
• Reduce the availability of smoking materials by enforcing tobacco age of
sale laws
• Increase number of expectant mothers who quit smoking and/or
establish smoke-free homes
Youth, especially those under age 18
Isolation and loss, especially for
senior adults
Parental/peer use of tobacco and
other substances
Direct contributing factors:
• Peer pressure
• Lack of knowledge/refusal skills
• Lack of resiliency or
developmental assets
• Attitudes about substance use/
abuse
• Access to smoking materials and
other substances
• Addiction
Indirect contributing factors:
• Low self-esteem
• Role models
• Lack of family management skills
• Lack of community support for
the elderly
• Lack of support for those quitting
tobacco
• Lack of smoking policies
• Media portrayals of substance use
Resources Available
REBEL (Reach Everyone By
Exposing Lies, for youth)
The Center for Alcohol and Drug
Resources, Inc.
Municipal Alliance to Prevent
Alcoholism & Drug Abuse
TASE Program (Tobacco Age of Sale)
Internship programs at local colleges
and universities
Public and private treatment programs
Organize town meetings and other events to increase awareness about the
issue of underage drinking
Promote use of programs/initiatives for ATOD prevention, especially those
involving schools, parents and faith-based organizations that take into
account culture and language spoken
Increase awareness of Quit Smoking Programs and substance abuse resources
including those promoting risks of alcohol, e.g., effects on fetus, driving
under the influence, etc.
Advocate for increased funding of ATOD programs, including funding for
School Resource Officers
Increase youth involvement in ATOD prevention and cessation activities
Promote Resiliency Building for young people in youth programs, schools
and other community settings
Improve parenting skills through education
Advocate for legislation to enable investigation of underage alcohol use on
private property
Encourage health care professionals to advise patients who use and abuse
ATOD of the health risks
Increase awareness of grassroots efforts to reduce use and abuse of substances,
e.g., Municipal Alliances
Advocate for increased alcohol abuse interventions among the elderly
Create uniformity throughout the county in regard to education, policies and
enforcement on alcohol and other substances
Advocate for the development of municipal policies in relation to substance
use, including messages sent to young people about underage drinking
Barriers
Attitudes about substance use/abuse
Lag time in appearance of detrimental effects
B E R G E N C O U N T Y Community Health Improvement Plan
n
2006
23
I S S U E
F O U R :
Alcohol, Tobacco and Other Drugs, Cont’d.
In alignment with these findings,
participants at the Community Forums
cited tobacco use and substance abuse
as concerns. Among those in the Youth
Focus Group most agreed that tobacco
use was harmful, alcohol use was routine, and marijuana use was relatively
accepted among their peers. Some felt
that illegal substances could easily be
16.2%
of Bergen County adults,
or 110,332, are current
smokers.* The Healthy
New Jersey 2010 objective
is 15% or lower for adults,
and the Healthy People
2010 objective for the
nation is 12%.
obtained in the community, and some
youth were aware of peers using “hard
drugs,” although use of these drugs was
seen as not acceptable. The drivers for
drug use according to the group were
anxiety and boredom.
The Forces of Change Assessment
reinforced the data gathered at the
Youth Focus Group in regard to the
acceptance of alcohol use by children
and a perceived rise in the popularity of
methamphetamine use. Also noted was
a perceived moderate increase in crime
influenced by drugs.
24
Factors leaving children vulnerable
Concerning the vulnerability of young
people to substance use and abuse, the
Forces of Change assessment made note
of social factors impacting the manner
in which children are currently raised.
Participants’ perceptions were that more
single-parent households exist and that
more parents are in the workforce, leading to a decrease in family recreation
time and closeness. The increasing use
of computers and computer games was
another factor seen as decreasing social
57.0 %
of Bergen County
adults, or 388,206,
perceive that the social
environment in the
community needs to
be improved to
encourage healthy
decision-making.
Among adult residents
below 200% of the
poverty level, the
figure climbs
to 63.6%.*
(57 percent) feel that the community’s
social environment needs to be improved to encourage healthy decisionmaking, for example, through positive
peer pressure, changing community
norms, and role modeling against use
and abuse of substances.
Adequacy of substance abuse services
Community members who become addicted to substances often require assistance from substance abuse programs.
The telephone survey revealed that over
half of residents (53 percent) feel that
Adequate Substance Abuse Services is
an attribute that needs to be improved
in the community, and those below the
200 percent federal poverty level feel
the need more keenly.
53.7%
interaction. Finally, a loss of the parental
role in family relationships was noted as
a negative factor.
* Data from telephone surveys conducted
in Bergen County from 2003-2005
Healthy decision-making affects an
individual’s using or non-using status.
More than half of county residents
B E R G E N C O U N T Y Community Health Improvement Plan
n
of Bergen County
adults, or 365,731,
perceive that adequate
substance abuse services need to be improved
in the community.
Among adult residents
below 200% of the
poverty level, the
figure climbs to
67.2%.*
2006
I S S U E
F I v E :
Communication of Health Issues
The call for more communication, health promotion and
health education emerged
through all three Community
Themes assessments that engaged residents: community
forums, focus groups and the
telephone survey. The request for more activity in this
area was not limited by age
group, gender or immigrant
status but rather was heard
as a generalized theme from
throughout the community.
Community perspectives gathered through forums, focus groups and
surveys revealed residents’ needs for improving their health-related skills
and increasing their knowledge and awareness of health-related resources.
Nearly one in five residents discussing
health issues at the Community Forums
ranked Increasing Awareness of Health
Issues or Health Education first or second in importance. Participants called
for better communication in regard
to the availability of public health and
social service programs, increased advocacy for health issues, and better use of
communications to increase motivation
for better health choices. Young people
as well as older adults cited the need for
increased health education on specific
topics such as STDs, HIV and asthma.
ing awareness of health issues were
heard at the Focus Groups. There were
calls for improving communication
through more public meetings, more
effective use of the news media, and increased information in languages other
than English. Both men and women
spoke about the need to better promote
public health services and for more
education on specific subjects like parenting skills and mental illness. Recent
immigrants cited an increased need for
health education among the foreign
born because of different focuses in
educational systems abroad.
Health education, awareness-building themes repeated at focus groups
Similar comments about the importance of health education and increas-
Older adults requested more speakers
on health issues on a regular basis in
the programs that serve them and more
personalized assistance in improving
their health. They also recognized the
importance of health education for
youth and characterized young people
as a channel to the entire family.
Teens recognized the need for more
school-based health education on topics
like nutrition and substance use. They
suggested the establishment of local teen
health centers for better dissemination
10.6%
of Bergen County adults,
or 72,192, can’t name
their desired source
of credible health
information.*
* Data from telephone surveys conducted
in Bergen County from 2003-2005
B E R G E N C O U N T Y Community Health Improvement Plan
n
2006
25
I S S U E
F I v E :
Communication of Health Issues, Cont’d.
of information on varied topics such as
mental health, STDs, and risks for children of alcoholics. Some of the young
people recognized that dispensing health
information was a drawing card for offering other types of health services.
Need to increase awareness on multiple topics revealed through survey
The telephone survey revealed specific
“disconnects” in the community in terms
of awareness. For example, when asked
if there were an authorized place for the
disposal of household hazardous or toxic
waste, almost one in three (32 percent)
were uncertain or answered “no.”
Nearly one in three
Bergen County adults
32%,
or 217,940, don’t know
or do not believe there
is an authorized location
for the disposal of
household hazardous or
toxic waste in
Bergen County.*
* Data from telephone surveys conducted
in Bergen County from 2003-2005
Similarly, over 70 percent were unaware
of plans in their community in the event
of an emergency such as a bioterrorism
incident or an emerging epidemic. Of
the more than 7 percent of residents
who had concerns about having enough
food for themselves or their family in
26
the last 30 days, over 16 percent did not
know where to turn for help.
Technology gap, multicultural considerations add to needs
The need for increased Communication on Health Issues was reinforced by
the Forces of Change Assessment and
the Health Status Report. The Forces
of Change Assessment cited a widen-
72.3%
of Bergen County adults,
or 492,409, are unaware
of community emergency
plans in the event of a
public health emergency.*
ing gap in access to technology, which
places lower socio-economic segments
of the population at a disadvantage in
regard to accessing information, including health information.
The same assessment noted an increase
in immigration and foreign-speaking
residents from diverse countries leading
to multi-cultural considerations. According to the Health Status Report, nearly
one-third of Bergen County residents
speak a language other than English at
home and more than 13 percent speak
English “less than very well.” Both the
gap in access to technology and the
increasing diversification of county residents call for targeted communication
efforts to reach the affected populations.
B E R G E N C O U N T Y Community Health Improvement Plan
n
Other factors increasing the need
for improved communication
The Forces of Change Assessment
noted additional factors increasing the
importance of health communications
such as the threat of bioterrorism and
emerging or re-emerging infections like
pandemic or avian influenza. Should
these events occur, the need to communicate with the public would become
more acute. Channels for disseminating
health messages currently exist; however, increased efforts to strengthen them
would constitute positive steps.
On a related theme, the Health Status
Report characterized antimicrobial
resistance (AR) as a topic of interest
worldwide and one of the world’s most
pressing public health problems. AR
occurs when bacteria change in a way
that decreases or eliminates the effectiveness of an antibiotic. Nearly all
significant bacterial infections in the
world are becoming resistant to most
commonly prescribed antibiotic treatments. Prevention includes educational
programs for physicians and the community about the concern with AR and
the proper use of antibiotics.
Addressing communication of health issues through the CHIP would not only
help accommodate the expressed needs
of county residents, but also constitute
another link in the communications
network for educating and alerting
the community about engineered and
emerging biological health threats.
2006
Goal
Outcome Objectives/Indicators
Improve Communication of
Health Issues
Increase percentage of residents able to access information on health and
health-related issues/programs
Increase percentage of residents who indicate awareness and knowledge
of local environmental, health and social service programs and emergency
planning
Risk Factors
Impact Objectives
Contributing Factors
Suggested Intervention Strategies
Low literacy
Foreign speaking
Lack of education
Low income
• Establish/improve channels of communication with minority and
special needs populations
• Increase the number of people who seek information on health and
social services programs through Bergen County Cooperative Library
System (BCCLS)
• Increase the number of foreign-language health education materials
available in local libraries
• Increase the number of health messages broadcast via radio
Direct contributing factors:
• Poverty
• Increased diversity/immigration
• Lack of knowledge of information
sources
• Lack of access to Internet
Indirect contributing factors:
• Low promotional budgets of public
health and social service agencies
• Challenge of broadcasting local
messages in the New York
metropolitan media market
• Identify gaps in communication through systematic analysis
• Develop/gather and disseminate media messages on priority health
issues
• Use nonprint media as well as print media to increase awareness of key
phone numbers to access health information and services
• Increase participation in non health-related community events to
increase visibility of health services
• Establish a web page to direct users to health information in English
and foreign languages
• Provide criteria to identify credible sources of health information to
local libraries for use by patrons
• Develop newspaper inserts or fillers for municipal and other community
newsletters on health services
• Outreach community groups regularly with appropriate health
information
Resources Available
BCCLS (Bergen County
Cooperative Library System)
NJ Dept. of Health and Senior
Services, Office of
Minority and Multicultural Health
CDC Website
Pooled language capabilities of
CHIP Committee
Internship programs at local colleges
and universities
Barriers
Language, including low literacy
Cultural
Fragmented public health system
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27
B E R G E N
C O U N T Y
The Path Ahead
By definition the CHIP process is a cyclical progression toward community health improvement. With the completion of
the Community Health Improvement Plan, participants will move to the Action Phase. This part of the cycle consists of
Planning, Implementing and Evaluating initiatives and interventions to reach measurable objectives. Members of the CHIP
Committee have already joined task forces that will focus on each of the five priority health issues. Their next step will be to
bring more community members “to the table” who will help set measurable objectives and select strategies to reach them.
Evaluation will remain foremost so that progress toward goals can be quantified.
The level of achievement will result from the commitment of the task force members. All residents and community and civic
organizations are invited to join the effort. To become involved or for more information, contact the CHIP Initiative at the:
Bergen County Department of Health Services
327 E. Ridgewood Avenue
Paramus, New Jersey 07652-4895
Phone: 201-634-2600
[email protected]
www.bergenhealth.org
Or:
Partnership for Community Health, Inc.
690 Kinderkamack Road, Suite 202
Oradell, New Jersey 07649
Phone: 201-986-7715
[email protected]
www.bergenpch.org
Public Health Partnership
A volunteer coalition of Bergen County health officers, the Public Health Partnership is one of three co-sponsoring organizations of the CHIP. Gratitude is expressed to the health officers, who assisted in developing the CHIP during the two-year
planning and assessment process through the dedication of their time, professional expertise and financial resources.
Stephen C. Tiffinger
Bergen County Department of Health Services
Serving: Allendale, Alpine, Cliffside Park,
Dumont, East Rutherford, Edgewater,
Fairview, Franklin Lakes, Glen Rock,
Hasbrouck Heights, Haworth, Ho-Ho-Kus,
Little Ferry, Lodi, Lyndhurst, Maywood,
Moonachie, North Arlington, Norwood,
Oakland, Oradell, Park Ridge, Rochelle
Park, Rutherford, Saddle Brook, Teterboro,
Woodcliff Lake, Woodridge
Carol Wagner
Fair Lawn Health Department
Serving: Fair Lawn, Ridgewood Village
Jad Mihalinec
Palisades Park Health Department
Serving: Palisades Park, Ridgefield Boro
Stephen S. Wielkocz
Fort Lee Health Department
Serving: Fort Lee
John Hopper
Paramus Board of Health
Serving: Mahwah, Paramus
John G. Christ
Hackensack Health Department
Serving: Hackensack, Saddle River
David Volpe
Bergenfield Health Department
Serving: Bergenfield
Sam Yanovich
Mid-Bergen Regional Health Commission
Serving: Bogota, Carlstadt, Englewood
Cliffs, Garfield, Leonia, New Milford,
Ramsey, River Edge, South Hackensack
Twp., Tenafly, Wallington
Wayne A. Fisher
Teaneck Department of Health &
Human Services
Serving: Teaneck
Louis S. Apa
Closter Health Department
Serving: Serving: Closter, Rockleigh
Deborah Ricci
Elmwood Park Department of Health
Serving: Elmwood Park, Ridgefield Park
Paula Jenkins
Englewood Health Department
Serving: Englewood
28
Daniel G. Levy
Township of Washington
Serving: Cresskill, Demarest, Emerson,
Harrington Park, River Vale,
Washington Twp.
Angela R. Musella
Northwest Bergen Regional Health
Commission
Serving: Hillsdale, Midland Park,
Montvale, Northvale, Old Tappan, Upper
Saddle River, Waldwick, Wyckoff Twp.
B E R G E N C O U N T Y Community Health Improvement Plan
n
Rod W. Preiss
Borough of Westwood
Serving: Westwood
2006
Community Resources and Contributors
The Community Health Improvement Plan was developed through the generous support of CHIP Committee member
organizations that contributed their time, talent and other resources. Sincere appreciation is expressed to the individuals
who served as members of the CHIP Committee for their personal commitment to a healthier Bergen County and for their
invaluable insight and expertise in carrying out the health assessments, identifying priority issues, and suggesting strategies
for reaching goals. Thanks are also extended to the three co-sponsoring organizations and the nine members of the CHIP
Core Group, the leadership body overseeing the entire process.
Raymond Arons, Dr.PH
Columbia University – School of Public Health
Joan Basic
Bergen County Medical Society
Aaron R. Graham, Ed.D
NJ Department of Education,
Bergen County Office
Carol Grebowiec
The Valley Hospital
Noreen Best
Bergen County Division of
Community Development
Geraldine Harris
New Hope Baptist Church
Dorothy Leung Blakeslee
Citizen-at-large
Glennena Haynes-Smith
Fairleigh Dickinson University
Barbara Buff
Bergen Community College
Marcia Pinkett Heller
New Jersey City University
Traci Burgess, MD
National Coalition of 100 Black Women
Rev. Gregory Jackson
Mount Olive Baptist Church
Roberta Campbell
Girl Scout Council of Bergen County
Judy Jusinski
Amerigroup NJ
Jerilyn Caprio, Ed.D
Allendale Board of Education
Jeffrey P. Kahn*
Partnership for Community Health, Inc.
John Christ*
Hackensack Health Department
Mary Kalman
CareOne@Valley
Miriam Confer
American Cancer Society, Northern
NJ Region
Kathleen Kaminsky
Englewood Hospital and Medical Center
Piyumike Kularatne
Columbia University – College of
Dental Medicine
Christine Contillo
Paramus Board of Health
Gail DeKovessey
Bergen County Division of
Community Development
Sharol Lewis, MD
Horizon Blue Cross Blue Shield of New Jersey
Mary-Frances Dougherty*
Bergen County Department of Health Services
Leonard Fiorenza*
Bergen County Department of Health Services
Wayne A. Fisher*
Teaneck Department of Health &
Human Services
Lt. Christine Francois
Bergen County Police Department
Jesus Galvis
Bergen County Hispanic-American
Advisory Council
Richard Garcia
Lakeland Bank
Claudia Garcia Del Puerto, MD
Citizen-at-large
Carol Livingstone
Ridgewood YMCA
Jackie Lue Raia*
Partnership for Community Health, Inc.
Patricia Mattingly
Realtime Nutrition, Inc.
Catherine McDougall
Health Awareness Regional Program
Catherine Mirra
Bergen County Youth Services Commission
Paula Murphy
Bergen County Municipal Nurses Association
Robin Ratliff
Hackensack University Medical Center
Vernon Reed
American Red Cross, Bergen-Hudson Chapter
Ellen Rocca
The Center for Alcohol and Drug Resources, Inc.
Lara L. Rodriguez
Ramapo College/NJ Meadowlands Commission
Gail Rosewater
Bergen County Department of Human Services
Peter Scerbo
Comprehensive Behavioral Healthcare, Inc.
Stephen Scheuermann
Buddies of New Jersey, Inc.
Lou Schwartz
NJ AARP
Karen Shinevar
Bergen County PTA
Ann Sissler
Bergen Regional Medical Center
Nancy Storey
Care Plus, NJ, Inc.
Stephen C. Tiffinger*
Bergen County Department of Health Services
Thomas Toronto
Bergen County’s United Way
Joan Valas, Ph.D*
NJ Local Boards of Health Association
David Volpe*
Bergenfield Health Department
Mibs Wagner
Citizen-at-large
Earl Wheaton, MD
Bergen Volunteer Medical Initative
Robert White
Bergen County Cooperative Library System
Catherine Yaxley
Holy Name Hospital
Jay Byun Yong
Korean American Association of New Jersey
Ilise Zimmerman
Northern NJ Maternal Child Health
Consortium
*Member of the CHIP Core Group
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29
B E R G E N
C O U N T Y
C H I P
C O M M I T T E E
Task Force Member Organizations
By Health Priority
Access to Health Care
Bergen Community College
Bergen County Department of Health Services
Bergen County Department of Human Services
Bergen County Municipal Nurses Association
Bergen County Office of Multicultural Community Affairs
Bergen Volunteer Medical Initiative
Bergen County’s United Way
Citizen-at-large
Comprehensive Behavioral Health Care, Inc.
Fair Lawn Health Department
Hackensack University Medical Center
Holy Name Hospital
New Hope Baptist Church of Hackensack
NJ Department of Education, Bergen County
Partnership for Community Health, Inc.
The Valley Hospital
Alcohol, Tobacco and Other Drugs
Bergen County Department of Health Services
Bergen County Department of Human Services
Bergen County Municipal Nurses Association
Bergen County Office of Multicultural Community Affairs
Bergen County Technical Schools
The Center for Alcohol and Drug Resources, Inc.
Hackensack Health Department
NJ Department of Education, Bergen County
NJ Local Boards of Health Association, Bergen County Chapter
Palisades Learning Center
Partnership for Community Health, Inc.
Communication of Health Issues
American Red Cross, Bergen-Hudson Chapter
Bergen Community College
Bergen County Cooperative Library System
Bergen County Department of Health Services
Bergen County Medical Society
Bergen County Municipal Nurses Association
Bergen County Office of Multicultural Community Affairs
Bergen County’s United Way
Citizens-at-large
Holy Name Hospital
NJ Department of Education, Bergen County
NJ Local Boards of Health Association, Bergen County Chapter
NJ Meadowlands Environment Ctr./Ramapo College of New Jersey
Northwest Bergen Regional Health Commission
Palisades Learning Center
Paramus Board of Health
Partnership for Community Health, Inc.
30
Sacred Heart Church of Haworth
The Valley Hospital
Mental Health
Bergen County Department of Health Services
Bergen County Department of Human Services
Bergen County Division of Community Development/Sr. Centers
Bergen County Municipal Nurses Association
Bergen County Office of Multicultural Community Affairs
Bergen County Police Department
Bergen County Youth Services Commission
Bergen Regional Medical Center
Care Plus NJ, Inc.
Closter Health Department
Comprehensive Behavioral Health Care, Inc.
Fair Lawn Health Department
Holy Name Hospital
National Coalition of 100 Black Women
NJ Department of Education, Bergen County
NJ Department of Human Services
Palisades Learning Center
Partnership for Community Health, Inc.
Teaneck Department of Health and Human Services
Vantage Health System, Inc.
Obesity: Nutrition and Physical Activity
American Cancer Society, Northern NJ Region
Bergen County Academies
Bergen County Department of Health Services
Bergen County Division of Community Development/Sr. Centers
Bergen County Municipal Nurses Association
Bergen County Office of Multicultural Community Affairs
Bergen County PTA
Bergenfield Health Department
Citizen-at-large
Englewood Health Department
Fort Lee Health Department
Girl Scout Council of Bergen County
Holy Name Hospital
National Coalition of 100 Black Women
NJ Department of Education, Bergen County
NJ Meadowlands Environment Ctr./Ramapo College of New Jersey
Paramus Board of Health
Partnership for Community Health, Inc.
Ramsey Board of Health
Realtime Nutrition, Inc.
Ridgewood YMCA
Sacred Heart Church of Haworth
The Valley Hospital
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10 Tips
for Better Health
During the Action Phase of the Community Health Improvement process, CHIP Task Force
member organizations will work together to select and implement strategies to improve the
health of all. Individuals as well as community groups are encouraged to take action. Following
are 10 Tips that residents can employ for better health.
1)
Engage in moderate exercise for at least 30 minutes most days of the week.
2)
Eat five to nine servings of fruits and vegetables a day.
3)
Maintain or achieve desirable weight.
4)
Strive for open communication with your children. They will be better
able to resist substance use and abuse.
5)
Quit smoking and talk with your children about the dangers of smoking.
6)
Limit alcohol use to no more than one drink a day for women or
two drinks a day for men.
7)
Recognize that mental illness can happen to anyone and can be treated.
8)
Reduce unhealthy stress and recognize symptoms of depression.
9)
Find and use credible sources of health information.
10)
Call your local health department for possible sources of affordable
preventive health care.
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B E R G E N
C O U N T Y
Community Health
Improvement Plan
County of Bergen
Dennis McNerney, County Executive
Bergen County Department of Health Services
[email protected] • 201-634-2600
www.bergenhealth.org
Partnership for Community Health, Inc.
[email protected] • 201-986-7715
www.bergenpch.org
Bergen County Public Health Partnership
[email protected]