OC Health Improvement Plan 2020-2022

HEALTHIEROrange County’s

Orange County

Health Improvement Plan
2020-2022

www.ochealthiertogether.org

SUGGESTED CITATION

Orange County Health Improvement Plan 2020-22. Santa Ana, CA. January 2020.
Available at: www.ochealthiertogether.org

HEALTHIEROrange County’s Orange County’s Healthier Together is a community-
wide initiative that aligns public and private resources
within the public health system to improve health for all
who live, work, and play in Orange County. The initiative

is administered by Orange County Health Care Agency,

Public Health Services.

1 BACKGROUND Contents
Acknowledgements | Message from the Chairs |
Vision and Values | Summary of Priorities

2 PRIORITY AREA PLANS
Social Determinants of Health | Access and System
Navigation | Health Promotion and Community
Planning | Mental Health and Substance Use |
Older Adult Health | Sexual Health | Public Health System

3 PLANNING & ASSESSMENTS
Planning Framework and Timeline |
Determining Priorities | Forces of Change Assessment |
Community Themes and Strengths Assessment

4 COMMUNITY HEALTH INDICATORS
Selecting Indicators | Social and Demographic Profile |
Social and Economic Indicators | Access to Health Services | Cancer |
Diabetes, Disabilities and Heart Disease and Stroke | Exercise, Nutrition,
and Weight | Injury and Accidents | Maternal, Fetal, and Infant Health
and Family Planning| Mental Health and Mental Disorders |
Respiratory Diseases | Substance Abuse | Summary Measures of Health |
Older Adults and Aging | Oral Health
5 REFERENCE DOCUMENTS
Abbreviations and Acronyms | Citations

Orange County’s Healthier Together is a community-wide Acknowledgements
initiative that aligns public and private resources within the
public health system to improve health for all communities in
Orange County. This initiative is led by the Orange County’s
Healthier Together Health Improvement Partnership.

HEALTH IMPROVEMENT PARTNERSHIP (HIP)

The Health Improvement Partnership guides and leads the
Orange County Healthier Together assessment and planning
process. Member organizations include:

• 2-1-1 Orange County • Multi-Ethnic Collaborative of
• Alzheimer’s Family Services Community Agencies (MECCA)

Center • Omada Health
• American Heart Association • Orange County Asian and Pacific
• Beacon Health Options
• Boat People SOS Islander Community Alliance
• CalOptima (OCAPICA)
• Chapman University • Orange County Department of
• Children’s Bureau of Southern Education
• Orange County Health Care
California Agency
• Children’s Hospital of Orange • Orange County Medical
Association
County • Orange County Social Services
• California State University at Agency
• Orange County United Way
Fullerton (CSUF) • Orange County Women’s Health
• Community Health Initiative of Project
• Providence St. Joseph Health
Orange County • The Cambodian Family
• CSUF Center for Successful Aging Community Center
• First 5 Children and Families • University of California at Irvine
(UCI) Health
Commission of Orange County • UCI Institute for Clinical and
• Health Funders Partnership Translational Science
• Hoag Memorial Hospital • UCI Program in Public Health
• Kaiser Permanente
• Latino Health Access (LHA)
• LGBT Center of Orange County
• MemorialCare Health System
• MOMS Orange County

iv « Acknowledgements « OCHIP 2020-22

We extend special thanks to the following individuals and work groups who provided leadership
and guidance in the planning process throughout 2019.

HEALTH IMPROVEMENT PARTNERSHIP CO-CHAIRS

David Souleles November ‘14 - Present Orange County Health Care Agency, Public Health Services
Vattana Peong January ‘19 - Present The Cambodian Family Community Center

HEALTH IMPROVEMENT PARTNERSHIP STEERING COMMITTEE

Cecilia Bustamante-Pixa St. Joseph Hospital
Helene Calvet Orange County Healthy Aging Intiative
Patricia Cantero Latino Health Access
Christy Cornwall Mission Hospital
Tamarra Jones Orange County Health Care Agency, Public Health Services
Dareen Khatib Orange County Department of Education
David Nuñez Orange County Health Care Agency, Public Health Services
Oladele Ogunseitan University of California at Irvine, Program in Public Health
Debbie Rose California State University at Fullerton, Center for Successful Aging

Incoming Members: Orange County Strategic Plan for Aging
Cynthia Okialda Be Well Orange County
Clayton Chau CalOptima
Claudia Magee Women’s Health Project
Allyson Sonenshine

HEALTH IMPROVEMENT PARTNERSHIP WORK GROUPS AND
PLANNING PARTNERS

Social Determinants of Health - HIP Social Determinants of Health Work Group
Access and System Navigation – HIP Steering Committee, Be Well Orange County, CalOptima
Health Promotion and Disease Prevention - HIP Health Promotion and Disease Prevention Work Group
Mental Health and Substance Use – Be Well Orange County
Older Adult Health – Orange County Strategic Plan for Aging
Sexual Health – Orange County STI Coalition

OCHIP 2020-22 » Acknowledgements » v

OTHER PARTICIPATING AGENCIES

Thank you to the following organizations for your contributions through
participation in assessments, focus groups, and work groups. Your input and
feedback was invaluable in shaping this plan.

Altamed Health Services Marshall B. Ketchum University
America on Track Mission Hospital
American Lung Association National Alliance on Mental Illness Orange County
Asian Americans Advancing Justice – Orange County Nu Care
Be Well Orange County OC Grantmakers
Boys and Girls Club of Garden Grove OC Mental Health Board
Cancer Kinship Orange Grants
Center for Oral Health Pathways
Children’s Bureau Regional Perinatal Program of California
Community Action Partnership of OC Saddleback Hospital
Council on Aging – Southern California Santa Ana Unified School District
Covered OC Collaborative SeniorServ
Early Childhood OC Sequoia Foundation
Early Childhood Mental Health Collaborative SJH Community Partnership Fund
Emory University Staff of Supervisor Andrew Do
Family Resource Centers - Gary Center, South OC St. Joseph Hospital
Healthy Smiles for Kids of Orange County St. Jude Medical Center
Help Me Grow The Coalition of Orange County Community Health
Hospital Association of Southern California Centers
Kid Healthy The Olin Group
Laguna Hospital UC Cooperative Extension
Latino Health Access Vietnamese American Cancer Foundation
Live Healthy OC Western Governors University
March of Dimes

Special thanks to the following staff of the Orange County Health Care Agency,
Public Health Services for their assistance in producing this plan: Donna
Fleming, DPA, MSW, Consultant; Jane Chai, MPH, Public Health Projects Manager;
Genesis Sandoval, MPH, CHES, Staff Specialist; and Kristin Alix, MPH, Health
Communications Specialist.

vi « Acknowledgements « OCHIP 2020-22

Message from the Chairs On behalf of the Orange County Health Improvement Partnership
(HIP), we are pleased to present the 2020-22 Orange County Health
Improvement Plan. This plan was informed by a year-long community
health assessment that found that while Orange County’s health, as a
whole, continues to fare well compared to other areas, there are some
troubling trends and disparities that impact our communities.

The HIP identified that improving health in Orange County requires a
close look at the conditions that create health inequities. To that end,
two of the six focus areas in this plan address overall system issues:
Social Determinants of Health and Access and System Navigation. The
remaining four areas highlight health topics identified as the most
pressing to work on in the next three years: Health Promotion and
Disease Prevention; Mental Health and Substance Use; Older Adult
Health; and Sexual Health.

We are pleased to welcome Be Well OC, CalOptima, OC Strategic Plan
on Aging, and OC STI Coalition and thank our HIP Steering Committee,
Social Determinants of Health Work Group, and Health Promotion and
Disease Prevention Work Group for leading work in their respective
focus areas. The goals, objectives, and strategies outlined in the
plan reflect their hard work and commitment to improving health in
Orange County.

We want to especially thank the residents and community partners
who contributed their time and ideas in developing this plan. By
working together, we know we can achieve our vision that “Orange
County is a community where everyone has opportunities and
resources to be healthy and enjoy safety and optimal quality of life.”

S i n c e r e l y,
HIP Co-Chairs

Vattana Peong, MPH David Souleles, MPH
Executive Director
Deputy Agency Director
The Cambodian Family Community Center Orange County Health Care Agency

Public Health Services

OCHIP 2020-22 » Message from the Chairs » 1

Vision for a Healthy Orange County

VISION

Orange County is a community where everyone has
opportunities and resources to be healthy and enjoy safety
and optimal quality of life.

VISION FOR A SYSTEM THAT WILL
SUPPORT A HEALTHY ORANGE COUNTY

The public health system is a partnership promoting a healthy Orange County
that includes residents, health care providers, community and faith-based
organizations, schools, businesses, government entities, and others. Our vision
of Orange County’s public health system is driven by our shared values and
strives to be:

• responsive, accessible, and accountable to the communities it serves
• well-connected and coordinated across various sectors
• driven by data and committed to quality through learning, innovation,

and use of best practices
• positioned to anticipate and respond to current and future challenges

and opportunities impacting health

2 « Vision and Values « OCHIP 2020-22

VALUES

Our vision for a healthy Orange County is driven by the following common
values:

Inclusivity and Diversity

Healthy communities and systems value and respect the needs, perspectives, and
contributions of all people.

Equity

Eliminating disparities and attaining optimal health for all is best achieved by
addressing root causes of inequalities.

Comprehensive

Health includes physical, mental, and emotional well-being and is impacted by many
factors (but not limited to) economics, environments, education, and social conditions.

Collaborative

Optimal health requires cross-sectorial partnerships between many entities including
(but not limited to) residents, health providers, community-based organizations, faith-
based organizations, schools, businesses, and government.

Multi-dimensional

Health must be understood at the individual, family, and neighborhood level.

Prevention and Health Promotion

Optimal health starts with the prevention of disease and injury at its root cause,
including the creation and sustenance of health promoting and protective environments;
and is supported by prevention initiatives, early intervention services, and access to
high quality care and treatment.

Self Sufficiency and Autonomy

Health and overall wellbeing includes self-sufficiency, the ability to advocate for one’s
self and others, and functional independence for those with disabilities and illness.

OCHIP 2020-22 » Vision and Values » 3

2020 - 22 Orange County Health Improvement Plan

Summary of Priority Areas

SYSTEM TOPICS

ACCESS AND SYSTEM NAVIGATION
The HIP will work with CalOptima and Be Well OC to meet our ideals
of a public health system that is:
• responsive, accessible, and accountable to the communities it

serves;
• well connected and coordinated across various sectors.
SOCIAL DETERMINANTS OF HEALTH
Goal: Achieve health equity by addressing the root causes that

impact health outcomes across Orange County.

4 « Summary of Priorities « OCHIP 2020-22

HEALTH TOPICS

HEALTH PROMOTION AND DISEASE PREVENTION
Goal 1: Increase the proportion of community members who are

in a healthy weight category.
Goal 2: Reverse the trend of increasing rates of diabetes.

MENTAL AND SUBSTANCE USE
Goal: Orange County will lead the nation in optimal mental health

and wellness for all residents.

OLDER ADULT HEALTH
Goal: Orange County is a place that creatively nurtures, encourages,

and supports the growing numbers of older residents.

SEXUAL HEALTH
Goal 1: Reduce sexually transmitted infection (STI) rates in Orange

County.
Goal 2: Reduce teen birth rates in Orange County.

OCHIP 2020-22 » Summary of Priorities » 5



Priority
Area Plans

Social Determinants
of Health

Our health is influenced by social factors such as where we
are born, what our family’s income is, what education we get
and jobs we have, how much support we get from family and
friends, and what stigma we face in the community. Therefore,
improving health for all must address factors influencing
health at the community level including income, education,
transportation, social environment, and public safety.1,2

Social determinants of health was as resource limitations, lack of political
identified as a new area of interest in will, and low awareness about the topic,
the 2017-2019 Orange County Health stifle work in the area and will need to be
Improvement Plan. As a result, the Health addressed.
Improvement Partnership (HIP) formed a
Social Determinants of Health Work Group In recent years, interest in work to
to explore work in this area. The work address social determinants of health
group conducted a survey with Orange has increased with CalOptima and non-
County ’s Healthier Together stakeholders profit hospitals funding efforts to address
that revealed that the vast majority of economic insecurity and housing. In
partners are doing some work on key social addition, collaboratives such as Be Well
determinants of health issues including Orange County and the Orange County
economic stability, educational attainment, Strategic Plan for Aging have prioritized
healthy social and community contexts, social determinants such as housing and
health care access, and neighborhood and transportation in their work.
built environment. However, barriers such

8 « Social Determinants of Health « OCHIP 2020-22

QUICK FACTS Babies born just
miles apart in Orange
įį Asian or Pacific Islander baby County face up to a
girls can expect to live almost
10 years longer than African 7-year difference
American baby boys.3 in life expectancy.³

įį Economically disadvantaged 5th
graders are three times more
likely to be obese than others.a

įį Residents with lower education
levels are more likely to report
poorer health status, higher
rates of disability, and higher
rates of serious psychological
distress.4

Learn more at:
www.ochealthiertogether.org/
socialdeterminants

OCHIP 2020-22 » Social Determinants of Health » 9

Social Determinants of Health

Goals, Objectives, and Strategies

HIP Planning Partner: Goal

Social Determinants of Achieve health equity
Health Work Group by addressing the root
causes that impact health
The OC Health Improvement Partnership’s outcomes across Orange
Social Determinant of Health Work Group County.
currently guides efforts in this area. The
work group is led by representatives from
the American Heart Association/American
Stroke Association, Mission Hospital, and
Orange County Department of Education
with participation from Chapman University,
Children’s Hospital of Orange County,
Institute of Healthcare Advancement, Orange
County Health Care Agency, St. Joseph
Health, UC Cooperative Extension, and UCI.

10 « Social Determinants of Health « OCHIP 2020-22

Objective 1: By December 2022, increase diverse sectors to work collaboratively to
the engagement of diverse sectors to address social determinants of health.
identify and support opportunities that
address the root causes of health. • Create a health equity pledge that can
be used by various sectors to serve
Measures: as a commitment to address social
determinants of health.
• Increase new partners from diverse
community sectors engaged in social Objective 2: By December 2022, increase
determinants of health work. the capacity of cross sector community
partners to address health equity
• Increase the number of Orange County through their work.
Health Improvement Partnership
members who participate in cross sector *This objective will be further developed
discussions and partnerships. after initiation of Objective 1.

• Increase the number of partners who can
identify at least one social determinants
focus in their work.

Strategies:

• Create common language that can be
used to discuss social determinants of
health.

• Convene a network of partners from

OCHIP 2020-22 » Social Determinants of Health » 11

Access and System
Navigation

Access to health care impacts an individual’s overall health including
prevention of disease and detection and treatment of health conditions.1
In addition to having health insurance, access to health care must
consider cost of care, ability to navigate the system, and cultural and
linguistic competency of providers.

Orange County’s health care system Health care services are paid for through a

includes more than 37 medical hospitals, mix of comm e rcial heal th in surance, 5pIunb l i c
funds, privat e funding, an d self-pay.
two behavioral health hospitals, 210 home

heal th and hos pice ag encies, 76 l ocnl ign-itcesr.m2 Orange County, Medi-Cal is managed through
care fa cilit es, and 65 commu nit y
i CalOptima, a County-organized health

Orange County has no public hospital system that provides publicly-funded health

and safety net services are provided care coverage for low-income children,

by a combination of public and private adults, seniors and people with disabilities

entities including private physicians, in Orange County. CalOptima’s programs

hospitals, urgent care centers, and include Medi-Cal, OneCare Connect Cal

emergency departments. Orange County’s MediConnect Plan (Medicare-Medicaid Plan),

37 hospita ls h ave about n8t,s0.020T be ds and OneCare (HMO SNP), and the Program of
27 emerge ncy departme he re are
All-Inclusive Care for the Elderly (PACE) and
26 community clinic organizations with cover almost 25% of county residents.6 In

over 7 6 sites in Orange County t hy.a3t, 4s e r v e 2018, CalOptima conducted a comprehensive
abou t 3 40,00 0 resident s annua ll
Member Health Needs Assessment that

Behavioral health services are provided helped to inform care delivery and improve

through a collaboration of public and private access to care. In 2018, Be Well Orange

partnerships largely led by Orange County County emerged as an initiative to bring

Health Care Agency, Behavioral Health together public and private partners to

Services and are described in more detail create a coordinated system of mental

in the Mental Health and Substance Use health care in Orange County.

section of this plan.

12 « Access and System Navigation « OCHIP 2020-22

QUICK FACTS Almost

įį Almost 1 in 7 Orange County 1 in 6
adults over 19 years of age do
not have health insurance a people in Orange
County report not
įį Almost 1 in 10 people in Orange having a usual place to
County reported delays or go when they are sick.d
difficulty getting medical care
they felt they needed b

įį More than 1 in 3 Orange County
adults who indicated needing
behavioral health care services
did not receive them c

Learn more at:
www.ochealthiertogether.org/access

OCHIP 2020-22 » Access and System Navigation » 13

Access and System Navigation

Partner Priorities

Health Improvement Partnership (HIP) CalOptima

The HIP’s vision for the public health system CalOptima is the sole Medi-Cal plan in
is one that is responsive, accessible, and Orange County, serving approximately
accountable to the communities it serves and 740,000 members (at time of printing)
well connected and coordinated across various through its Medi-Cal, OneCare Connect,
sectors. The HIP is working with CalOptima OneCare, and PACE programs.6 CalOptima
and Be Well Orange County as planning is an important part of the health care
partners in improving access and system sector and is in a unique position to impact
navigation. and address access and system navigation
in Orange County, particularly for low-
As described in the Public Health System income individuals who qualify for services.
section of this plan, the HIP has developed CalOptima’s 2020-22 Strategic Plan includes
next steps for improving the public health key priorities to improve access and system
system based on its ideals for the system. The navigation.
HIP identified seven next steps in improving
the public health system, including one that CalOptima’s 2020-22 Strategic Plan includes
focuses on access and system navigation: five priority areas. Highlighted objectives that
align with the HIP’s goal to improve access
• Expand inventory of services and and system navigation are shown here.
resources and work to develop workforce
capacity and improve coordination and Innovate and Be Proactive
integration of services will be next step for • Leverage new federal and state programs
improving the public health system.
and services to improve access and quality
These next steps are key priorities for action of care for members
for the HIP and its Steering Committee. • Seek opportunities to further integrate
care for members

Expand CalOptima’s Member-Centric Focus
• Focus on population health

14 « Access and System Navigation « OCHIP 2020-22

3. Close Treatment Gaps and Improve Access: Be Well Orange County
All Orange County residents can access
Launched in 2018, Be Well OC is an initiative
• neSetrdeendgpthroegnrparmosviadnedr nseertvwicoersk wanhdenacacnedss to that brings together public, private, academic,
wchaerree they need them and faith-based organizations to create a
coordinated system of mental health care and
• Enhance member experience and customer support, including substance use services, for
Perfosrmeravniccee indicators: all Orange County residents.
3a. Mental health equity and disparities
3bS.t rEexnpgatnhdenutCiloizmatmiounnoitfypPeaerrtnseerrvsihciepssand Access and system navigation is a cross
cutting initiative of the six result areas
• grIonwcreparosevicdoelrlapbooorlation with providers and identified by Be Well Orange County.
3c. Ocpotmimmaul ninittyersotragkaenhiozladteiorsnatlociamreprpoavtehwcaaryes
Result 1. Reduce Mental Health Stigma
• anUdtiwliazremstcroonnngeacdtivoisnosry committee
participation to inform community Result 2. Prevent and Act Early

4. SternegnaggtehmenenCtrsistirsatReegpieosnses: All Orange Result 3. Close Treatment Gaps and Improve
I•n cttCrhepEoearvuuaomasrnulcsetugh,yhVaaartasnaeeildsnunaigdedentiesdagwntnirittomdaasrtlkpIecmtalgooenipfmoeraflsseoactncvchietelasivtCtsaiedaclusrrreiiemvs-Diebsoaqebssluiuielvaepdelpirtoyyrt Access

P44eba••r.. fIAsaonunaDchMprcidamdopcieraddmiriaepdinoernnleeepnppotclssrcrayaeesoiet(isainivisasnntoeiontendfndftcoeoeteiumisccvadmstsuaealiettslpntdriooizttvoevrsaamisntec,lte:eicepdhrosommreenmolabiivonlvpetifeadhlrenCrsiyctntSirsgmoUisnohoesfsids)gahehaneln-dsaqdltutEhhaDalaittnyd Result 4. Strengthen Crisis Responses
4c•E. n UnhaIatnvnilvicigezeaastOttiioiopnnneiarnoapfftrpmiaosontbrauillceEtxuscureepllpaenondrcteesfaefnircvdiiecEneftsfiacniedncy
5.• EhCsepEootanproaolgprtbcdaholeigi,rnsstebshaueewtnChesoidaotriv,mkeiifosnmortraueclgnehriaateyntaedlWdthi,deraleelnnnsdtpeiosfwysnesdHlelenuvebesslso: pment Result 5. Establish Community Wellness
Hubs
Mosbereerhvaiincvfeioosrrmcaalaphtaeiocainlttyha.t,Inuwtrweggewrna.tctaneldeoeppdtrsiimm, maaro.oybrciglae.re/
Result 6. Align Partners, Policies, and
Programs

More information at www.bewelloc.org.

OCHIP 2020-22 » Access and System Navigation » 15

Health Promotion and
Disease Prevention

Chronic diseases such as heart disease, cancer, and stroke account
for 7 in 10 deaths in Orange County.1 Prevention and management
of conditions such as obesity, diabetes, and high blood pressure
are key to decreasing illness and death due to these conditions.

Orange County has many programs working helped to coordinate these efforts using
to prevent chronic diseases by promoting a collective impact approach. The Orange
and supporting healthy behaviors and access County Diabetes Collaborative has worked
to preventative services. Women, Infants, to coordinate these efforts and increase
and Children (WIC) offers education and screening and chronic disease management
food assistance for low-income residents activities in Orange County.
to purchase healthy food. CalFresh Healthy
Living provides nutrition education in school Health care providers, hospitals, and
and community settings. community based organizations offer
chronic disease screening, prevention, and
Orange County is also rich in collaboratives management programs throughout the
working on prevention of obesity and other county. Environmental approaches are used
chronic diseases. The Nutrition and Physical by some programs to create community-
Activity Collaborative (NuPAC) brings level changes in the built environment or
together partners to facilitate networking to increase access to healthy choices. An
and collaboration in the areas of nutrition example is the OC Health Care Agency’s
and physical activity. Collaboratives have Healthy Neighborhoods Program, which
formed to coordinate and network around partners with jurisdictions to create
policies and programs that improve health. environments that are walkable and include
The Health Improvement Partnership’s options for healthy eating.
Obesity Work Group formed in 2014 and

16 « Health Promotion and Disease Prevention « OCHIP 2020-22

QUICK FACTS 7 in 10

įį 1 in 5 adults in Orange County deaths in Orange
is obese.a County are caused by
chronic diseases such
įį More than 1 in 4 Orange as heart disease,
County adults have high blood cancer, and stroke.¹
pressure.b

įį Rates of diabetes have
increased by 45% in Orange
County in the last ten years.c

įį In 2018-2019, 53.4% of
economically disadvantaged
5th graders in Orange County
were in the healthy weight
category.²

Learn more at:
www.ochealthiertogether.org/
healthpromotion

OCHIP 2020-22 » Health Promotion and Disease Prevention » 17

Health Promotion and Disease Prevention

Goals, Objectives, and Strategies

HIP Planning Partner: Goal 1

HIP Health Promotion and Increase the proportion of
Disease Prevention Work Group community members who are
in a healthy weight category.
The OC Health Improvement Partnership’s
Health Promotion and Disease Prevention Objective 1: By December 2022, increase
Work Group guides efforts in this area. The by 1% the proportion of economically
work group reorganized in 2019 and is disadvantaged children and adolescents
composed of members from the former OC who are in the healthy weight category.
HIP Obesity Work Group and the OC Diabetes
Collaborative, which each previously Objective 2: By December 2022, increase
addressed the Obesity and Diabetes priority by 0.5% the proportion of economically
area of previous Orange County Health disadvantaged children and adolescents
Improvement Plans. Current members who are in the healthy weight category
include community partners representing in Anaheim, Buena Park, La Habra, and
America on Track, American Diabetes Santa Ana.
Association, California State University at
Fullerton, CalOptima, Community Action Countywide Strategies:
Partnership of Orange County, Dairy Council
of California, First 5 Orange County, Kid • Coordinate consistent messages about
Healthy, MOMS Orange County, Orange obesity with health care providers.
County Department of Education, Orange
County Health Care Agency, PHFE Women, • Provide resident leadership academy
Infants, and Children Program (WIC), training.
Providence St. Joseph, Southland Integrated
Services, and University of California • P rovide capacity support to coalitions
Cooperative Extension. throughout Orange County.

18 « Health Promotion and Disease Prevention « OCHIP 2020-22

Targeted Strategies for Anaheim, Goal 2
Buena Park, La Habra, and Santa Ana:
Reverse the trend of
Support community-specific coalitions in increasing rates of diabetes.
implementing collective impact approaches
including multi-sector interventions Objective 1: By December 2022, hold
specified such as the following: the Type 2 Diabetes prevalence under
• Support implementation of school current statewide rates of increase to
9.0%.
wellness plans.
Strategies:
• Collaborate with partners to assess
Early Childhood Education sites that • Promote and expand availability
implement nutrition and physical activity and utilization of effective diabetes
standards and follow-up with technical prevention and self-management
assistance. programs by persons who are at risk for
diabetes and living with pre-diabetes,
• Promote and expand community efforts diabetes, or gestational diabetes.
involving parents and families.
• Improve coordination of and
• Identify ways to engage WIC participants communication about diabetes
up to five to improve a “healthy start” for screening, diabetes prevention, and
nutrition. self-management education efforts to
ensure that programs are accessible to
• Build the capacity of residents to work all populations, with special emphasis on
with school districts, schools, Parent those at greatest risk.
Teacher Student Associations and
educators to expand Policy, system, and
environmental changes.

OCHIP 2020-22 » Health Promotion and Disease Prevention » 19

Mental Health and
Substance Use

Nearly 1 in 6 people in Orange County report needing help with mental,
emotional, or substance abuse problems.d Mental health is essential to
a person’s emotional, social, and psychological well-being, and can have
a serious impact on physical health. Mental health disorders and chronic
substance use are associated with increased risk of diseases and health
conditions including diabetes, hypertension, stroke, heart disease, and
cancer and unintended injuries.1, 2

Orange County’s mental health system, fund a full continuum of mental health
including services addressing substance and supportive services to address serious
use, is largely led by the Orange County mental illness, as well as prevention
Health Care Agency, Behavioral Health efforts. Components of the system include
Services (BHS). Through public and private community services and supports, workforce
partnerships including CalOptima, hospital education and training, prevention and early
systems, and private and community intervention, housing, capital facilities and
providers, BHS works to coordinate technology, and innovation. The Orange
prevention and treatment services across County Health Care Agency’s Prevention
the lifespan and improve the quality of and and Intervention Team works with a range
access to services. Additionally, the Orange of community partners to address underage
County Mental Health Board is advisory to drinking, prescription drug misuse, and
the Orange County Board of Supervisors driving under the influence of alcohol or
and is the official community body that drugs. In 2018, Be Well Orange County
advocates for an accessible, appropriate, emerged as an initiative to bring together
and effective mental health system. Orange public and private partners to create a
County is also a recipient of Mental Health coordinated system of mental health care in
Services Act (MHSA) funds, which help to Orange County.

20 « Mental Health and Substance Use « OCHIP 2020-22

QUICK FACTS Nearly

įį More than 1 in 3 Orange County 1 in 6
adults who indicate needing
behavioral health care services did people in Orange
not receive them.a County report
needing help with
įį T here has been an increase in mental, emotional,
suicide rates in Orange County in or substance abuse
the past 10 years.b problems.d

įį Orange County has higher
hospitalization rates due
to alcohol or substance use
compared to 75% of California
counties.e,f

Learn more at:
www.ochealthiertogether.org/
mentalhealth

OCHIP 2020-22 » Mental Health and Substance Use » 21

Mental Health and Substance Use

Goals, Objectives, and Strategies

HIP Planning Partner: Goal

Be Well Orange County Orange County will lead the
nation in optimal mental health
The OC Health Improvement Plan supports and wellness for all residents.
and aligns with goals, objectives, and
strategies identified by Be Well Orange 1. Reduce Stigma: Improved mental health
County (www.bewelloc.org). Launched in awareness attitudes, and understanding
2018, Be Well OC is an initiative that brings throughout the Orange County community.
together public, private, academic, and faith-
based organizations to create a coordinated Performance indicators:
system of mental health care and support, 1a. Public awareness and changed
including substance use services, for all
Orange County residents. conversation
1b. Ability to recognize disorders
Be Well OC has identified six results and 1c. Knowledge of professional help and
associated performance indicators to
improve mental health and substance use in treatment availability
Orange County. These will be tracked as part 1d. Knowledge of effective self-help
of the Orange County Health Improvement
Plan in support of the mental health and strategies
substance use focus area. At the time of
publishing, Be Well OC partners are actively 2. Prevent and Act Early: Effective prevention
working on defining indicators to track and and early intervention services are available
measure progress. Objectives and strategies to all Orange County residents.
for Be Well OC will be updated as part of the
Be Well OC ’s regular planning process and Performance indicators:
will be updated on www.ochealthiertogether. 2a. Investments in prevention and early
org and www.bewelloc.org.
intervention
2b. Expand Social-Emotional Learning in

early childhood education/care settings
2c. Outreach, engagement by peers and

early diagnosis

22 « Mental Health and Substance Use « OCHIP 2020-22

3. Close Treatment Gaps and Improve Access: treatment strategically located in three
All Orange County residents can access geographic regional areas.
needed programs and services when and
where they need them. Performance indicators:
5a. Inter-agency and interorganizational
Performance indicators:
3a. Mental health equity and disparities collaboration
3b. Expand utilization of peer services and 5b. Implement core Hub services, and

grow provider pool region-specific services
3c. Optimal interorganizational care 5c. Broad array of services (e.g. crisis,

pathways and warm connections wellness, mobile health, in-home
support, peer run education)
4. Strengthen Crisis Responses: All Orange
County residents can access crisis support 6. Align Partners, Policies, and Programs:
through a network of facilities, mobile Addressing complex, interrelated
teams, and digital tools. issues of mental illness, addiction, and
homelessness, among others.
Performance indicators:
4a. Incidence of mental health crises and Performance indicators:
6a. Homeless System of Care
suicides (attempts, completions) 6b. ACEs and Trauma informed care
4b. Appropriate utilization of CSUs and ED 6c. Cross-sector partnerships
6d. University-Behavioral Health program
and inpatient services
4c. Utilization of mobile support services partnerships

and navigation app

5. Establish Community Wellness Hubs:
Coordinated, integrated, response
health, behavioral health and wellness
services capacity. Integrated primary care/
behavioral health, urgent needs, mobile

OCHIP 2020-22 » Mental Health and Substance Use » 23

Older Adult Health

There are over 470,000 Orange County residents 65 years old
or older. That number is expected to double by the year 2040,
when one in four residents will be 65 or older.1 As older adults
are faced with various health, economic, and social concerns, it is
critical for the public health to be prepared to meet the needs of
our aging population.

Orange County benefits from numerous large countywide programs, serve specific
programs and agencies that serve the needs needs of seniors, such as nutritional
of older adults, including the Office on assistance, adult day health care, chronic
Aging, Council on Aging-Southern California, disease self-management classes, and
other governmental agencies, health programs to promote health and
care systems, academic institutions with socialization in seniors.
special research/focus on older adults and
numerous community-based organizations. Older adults in Orange County enjoy a high
The Office on Aging is the lead advocate, level of health insurance coverage (almost
systems planner, and facilitator relative to 99%) and many resources exist to assist
all aging issues, and oversees the Senior seniors with their health care and social
Citizen Advisory Council (SCAC), manages needs. The Orange County Aging Services
an information/assistance line for seniors, Collaborative (OCASC) brings together many
provides outreach and services, and of the larger partners in senior services to
coordinates state-required planning efforts. increase awareness and coordinate services
Council on Aging-Southern California for this growing population. In 2016, OCASC
oversees the Ombudsman Program, the brought together community partners in
ReConnect EIOSA program, a financial order to create the first Orange County
abuse team, a health insurance counseling Strategic Plan for Aging (OCSPA). OCSPA has
program, and a friendly visitor program for identified key initiatives to improve the lives
seniors. Numerous entities and programs, of older adults in Orange County.
from cities to small nonprofits to

24 « Older Adult Health « OCHIP 2020-22

QUICK FACTS The older adult
population is
įį More than 1 in 4 older adults expected to
have heart disease.a double by 2040,
when one in four
įį 1 in 4 older adults have Orange County
diabetes.b residents will be
65 or older.f
įį More than 1 in 10 older adults
were treated for Alzheimer’s 2x
disease or dementia.c

įį Large proportions of older
adults, 42.5% of single elders
and 19.8% of elder couples,
cannot afford basic costs for
housing, health care, food,
and transportation.d,e

Learn more at:
www.ochealthiertogether.org/
olderadulthealth

OCHIP 2020-22 » Older Adult Health » 25

Older Adult Health

Goals, Objectives, and Strategies

HIP Planning Partner: Goal

OC Strategic Plan for Aging Orange County is a place
that creatively nurtures,
The OC Health Improvement Plan supports encourages, and supports
and aligns with goals, objectives, and the growing number of older
strategies identified in the Orange County residents.
Strategic Plan for Aging (www.ocagingplan.
org). OCSPA is a countywide initiative
created by Orange County’s community
leaders including Alzheimer ’s Orange County,
Meals on Wheels Orange County, CalOptima,
Orange County Health Care Agency, Orange
County Community Foundation and others to
develop short and long term strategic plans
for Orange County’s growing older adult
population.

OCSPA has identified 10 key initiatives to
improve the lives of older adults in Orange
County. Two initiatives will be tracked as part
of the Orange County Health Improvement
Plan including: Health Care and Senior
Nutrition and Food Security. Objectives and
strategies for the Strategic Plan for Aging at
time of publishing the 2020-2022 OC Health
Improvement Plan are set for June 2020
and will be updated as part of the OCSPA’s
regular planning process.

26 « Older Adult Health « OCHIP 2020-22

Health Care Nutrition and Food Security

Objective 1: By June 2020, promote evidence- Objective 1: By June 2020, increase food
based health promotion programs with at security for Orange County’s older adults
least 700 older adults who complete the age 60+.
workshops.
Strategies:
Objective 2: By June 2020, create outreach
strategy and promote physical activity • Coordinate efforts to increase enrollment
recommendations for older adults. in CalFresh, the federal nutrition program
to help eligible, low-income individuals
Objective 3: Increase utilization of the purchase food they need for good health.
Annual Wellness Visit by 1% per year.
• Increase participation in Restaurant
Strategies: Meal Program (RMP), which allows
elderly, disabled, and homeless CalFresh
• Support the promotion and marketing recipients and their spouse to use Golden
outreach efforts of evidence-based health state Advantage (EBT) card to purchase
promotion programs to community prepared meals from participating
providers. restaurants.

• Identify existing at-home exercise • Increase awareness of overall food help
guides for older adults and highlight on for older adults and the www.ocfoodhelp.
IrisOC, a local digital hub to distribute org website as a resource for food help
healthy aging information and provide information.
connections to senior-focused community
resources and individuals.

• Identify and support activities led by
Council on Aging Southern California
to promote the Annual Wellness Visit
toolkit.

OCHIP 2020-22 » Older Adult Health » 27

Sexual Health
Sexual health is an important part of overall health and includes
avoiding sexually transmitted infections (STIs) and unplanned
pregnancies.1 Syphilis, gonorrhea and chlamydia cases are at the
highest levels in 30 years and continue to increase.2 Disparities
in teen pregnancy and STIs also have significant implications for
certain communities in Orange County.3

Orange County’s STI and family planning Care Agency’s HIV Planning and Coordination
services are offered through Orange County unit administers funding for HIV prevention,
Health Care Agency, private providers, and testing, care, and support services through
community-based clinics and programs. County and community providers. Support
Orange County Health Care Agency, services includes case management services,
Communicable Disease Control Division and which help to remove barriers to health care
HIV Surveillance monitor trends in STIs and and connect persons living with HIV/AIDS to
HIV and help Public Health Investigators link community resources.
individuals to care.
The California Healthy Youth Act requires
County and community-based family public school districts to provide
planning service providers offer initiation comprehensive sexual health education
and management of all FDA-approved to all students in grades 7 through 12, at
methods of contraception, STI and HIV least once in middle school and again in
testing and treatment, and individual high school.6 However, few school districts
reproductive health education and comply with the legal mandate. Health
counseling for clients. STI/HIV testing education is offered through community-
sites are concentrated in central Orange based organizations, colleges and
County, with sites in the high risk and high universities. The OC Health Care Agency has
population cities of Santa Ana, Anaheim, and a health educator who provides community
Garden Grove. Over 40 medical providers and provider education and training. In 2019,
in Orange County prescribe pre and post- the OC Health Care Agency launched STI
exposure prophylaxis (PrEP and PEP). The OC testing and HIV anti-stigma media campaigns
Health Care Agency offers partner services, in English, Spanish, and Vietnamese to cities
which helps inform partners of potential with the highest rates of STIs and HIV.
exposure to HIV or syphilis. The OC Health

28 « Sexual Health « OCHIP 2020-22

QUICK FACTS At 13.8 per 100,000,
Orange County’s 2018
įį At 120.7 per 100,000 Orange primary and
County’s 2018 gonorrhea secondary syphilis
incidence rate is more than three rate is almost
time higher than it was in 2010.ª six times higher
than it was in 2010.c
įį Comparing 2010 to 2018, the
chlamydia case rate increased 6x
from 281.5 per 100,000 to 443.8
per 100,000.b OCHIP 2020-22 » Sexual Health » 29

įį Each year, about 300 people
are newly diagnosed with HIV
disease in Orange County.4

įį Teen birth rates in Santa Ana,
La Habra, Anaheim, and Buena
Park are higher than the state
average.5

Learn more at:
www.ochealthiertogether.org/
sexualhealth

Sexual Health

Goals, Objectives, and Strategies

HIP Planning Partner: Goal 1

Orange County STI Coalition Reduce STI rates in Orange
County.
The OC Health Improvement Plan (HIP)
planning partner for the Sexual Health Objective 1: By December 2022, stabilize
priority area is the Orange County Sexually the early syphilis disease case rate in
Transmitted Infection Coalition (OC STIC). Orange County to at or below 23.9 per
OC STIC ’s mission is to decrease STIs in 100,000 people.
Orange County through community education
and advocacy. OC STIC members include Objective 2: By December 2022, train at
government programs, key community least 150 providers on the STI and HIV
stakeholders, health care providers, Standards of Care.
community-based organizations, and
educators. Strategies:

• Establish a Sexual Health work group
to coordinate, share data and engage in
community advocacy

• Adopt an STI and HIV Standards of Care
curriculum

• Coordinate outreach and provision of STI
and HIV Standards of Care community
provider training

• Increase social media engagement within
priority cities and sub-populations

30 « Sexual Health « OCHIP 2020-22

Goal 2 • P rovide SRH education to parents and
adults who work with youth
Reduce Teen birth rates in
Orange County. • I ncrease social media engagement within
priority cities and sub-populations
Objective 1: By December 2022, reduce
birth rate per 1,000 females, 15 to 19
years of age, by 10% in cities that exceed
the Orange County teen birth rate.

Strategies:

• O ffer schools and school districts
technical assistance with the California
Healthy Youth Act (CHYA), starting in
cities with a teen birth rate that exceeds
the Orange County teen birth rate

• Provide education to schools and
providers regarding minors’ rights and
barriers to access

• Promote sexual and reproductive health
(SRH) core competencies in primary care

• P rovide SRH education to at risk youth
outside of school setting

OCHIP 2020-22 » Sexual Health » 31

Public Health System

Improving the health of the community public health system is a partnership
requires a well-coordinated and promoting a healthy Orange County that
functioning public health system that includes residents, health care providers,
supports efforts to provide high-quality community and faith-based organizations,
programs and services. As depicted in schools, business, government entities and
the illustration below, Orange County ’s others.

Elected CorrecƟons
Officials
Transit Public
Hospitals Safety
Businesses
City
Planners Schools

Community Research
Based Orgs.
Public
Behavioral Health Health Care
Health Providers

Health
CollaboraƟves

Social Residents Civic
Services Groups
Parks
Faith-Based & Rec
InsƟtuƟons

In April and May 2019, the Health
Improvement Partnership (HIP) conducted
the Orange County Public Health System
Assessment, which included an online
survey and an in-person discussion to
determine strengths, weaknesses, and
opportunities to improve Orange County’s
public health system. A full summary of
the Orange County Public Health System
Assessment including specific feedback and
discussion of strengths, weaknesses, and
opportunities for improvement is available
on the Orange County ’s Healthier Together
Community Health Assessment page at:
www.ochealthiertogether.org /CHA2019

32 « Public Health System « OCHIP 2020-22

Next Steps

Based on findings from the Public Health System Assessment, the Health Improvement

Partnership is working on the following next steps to improve Orange County’s public

health system.

51 Engage community partners and stakeholders in sectors such as public
safety, parks and recreation, transportation, and business to identify and
support opportunities to promote health and other mutually beneficial
goals that address social determinants of health.

25 Expand inventory of services and resources and work to develop
workforce capacity and improve coordination and integration of services
across Orange County.

35 Disseminate community health data and the Orange County Health
Improvement Plan to stakeholders, staff, and funders through
communications and marketing that leverage www.ochealthiertogether.
org as a resource.

45 Engage funders to ensure buy-in and funding of identified needs and
priorities and use the Orange County Health Improvement Plan to drive
and leverage funding.

55 Coordinate access to data and encourage use of consistent definitions,
timeframes, and sources for measurement and planning through use of
data and resources on www.ochealthiertogether.org.

56 Promote access to and sharing of aggregate health data from health
providers and health plans to better inform planning efforts.

75 Ensure that social determinants of health, such as poverty, education,
and social environment, are represented and emphasized as contributors
to health in data and best practices.

OCHIP 2020-22 » Public Health System » 33



Planning and
Assessments

Planning Framework and Timeline

The Orange County Health Improvement Health Officials (NACCHO) and the Centers
Partnership (HIP) began assessment and for Disease Control and Prevention (CDC)
planning for the 2020-2022 Orange County as a tool to bring together stakeholders
Health Improvement Plan at the beginning to identify community health issues and
of 2019. The plan is the foundation of take action. Key phases of MAPP include 1)
Orange County ’s Healthier Together organizing and partnership development;
initiative and seeks to align efforts by the 2) visioning; 3) conducting assessments; 4)
various parts of the public health system identifying strategic issues; 5) formulating
to improve health for all communities in goals and strategies; and 6) acting. A
Orange County. distinctive feature of MAPP is the use
of four coordinated assessments, each
The HIP utilized Mobilizing for Action of which yields important information
through Planning and Partnerships and, when taken as a whole, provides
(MAPP) as its framework for this planning a comprehensive understanding of a
process. MAPP was developed by the community’s health.
National Association of City and County

The following is a summary of each assessment:

Forces of Change Community Health Status

Conduct stakeholder group discussions to Review key health indicators with Health
determine: Improvement Partnership to determine:

• What is occurring or might occur that affects the • What does the health status of Orange County
health of our community? look like?

• What are specific threats or opportuniƟes • How healthy are our residents?
generated by these occurrences?

Consider community focus groups to determine: Conduct assessment with key stakeholders to
• What are our prioriƟes for health? determine:
• What is working well in how we address health? • How responsive, accessible, and accountable is our
• What are areas for improvement?
system?
Community Themes and Strengths • How well connected and coordinated is our system?
• How data-driven and focused on best pracƟces and

quality is our system?
• How well posiƟoned to anƟcipate and respond to

health impacts is our system?

OC Public Health System

36 « Planning Framework and Timeline « OCHIP 2020-22

The table below shows the HIP’s timeline for the completion of this plan. As shown,
assessments were conducted and findings were reviewed in a series of meetings to
guide the HIP in determining goals, objectives, and strategies to be published in its
final plan.

2019 Determine planning process and choose community health indicators
A rm foundation principles
JAN-FEB
Forces of Change Assessment
MAR OC Public Health System Assessment

MAR

APR - MAY

JUN Community Themes and Strengths Assessments

JUL Community Health Status Assessment

JUL Identify preliminary priority areas

MAR-SEP Share ndings of community health assessments

Determine goals, objectives, and strategies SEP - NOV

Approve work plans and next steps NOV

Disseminate Plan for public comment DEC

Finalize and publish OC Health Improvement Plan JAN 2020

Summaries of community health assessments are available on Orange County’s
Healthier Together Community Health Assessment page at www.ochealthiertogether.
org/CHA2019.

OCHIP 2020-22 » Planning Framework and Timeline » 37

Criteria for Selection of Priorities

At its meeting on March 20, 2019, the Health Improvement Partnership reviewed
and proposed revisions to criteria for selection of priorities. The Health
Improvement Partnership reviewed and affirmed the following revised criteria at
is meeting on May 2, 2019.

The following were the criteria for selection of priority issues:

1. Health Im pact: To what degree would action on this health issue
improve overall health in Orange County?

2. Disparity: To what degree does addressing this health issue reduce
health disparities within the county?

3. Trends: To what degree does addressing this health issue assist
Orange County in intervening with a health indicator that is
trending negatively or progressing too slowly?

4. Root Cause: To what degree does the health issue have a
root cause that is modifiable at the individual, community,
institutional level?

5 . Efficiency: To what degree can action on this health issue
address multiple issues?

6. Economic Im pact: To what degree would addressing this health
issue decrease economic impact downstream?

7. Prevention: To what degree does the health issue benefit from
primary prevention?

8. Early Intervention: To what degree does the health issue
benefit from early intervention?

9. Collaboration: To what degree would collaborative or multi-
sector approaches to address this health issue improve chances
for success?

10.Under-addressed Issue: To what degree is this health issue not
addressed or is under-addressed in Orange County?

38 « Determining Priorities « OCHIP 2020-22

Determining Priority Areas

On July 17, 2019, the Health Improvement At the end of the day, the HIP reviewed their
Partnership (HIP) hosted a one-day meeting criteria for selection of priorities and went
with about 70 people representing more through a Consensus Workshop process to
than 40 agencies including hospitals, non- determine priority areas to include in the
profit agencies, universities, community 2020-22 Orange County Health Improvement
health centers, and others. The meeting Plan. The following is a summary of the
was Orange County’s community health priority topics:
assessment using the MAPP framework.
Handouts summarizing the Forces of Change 1. Social Determinants of Health
and Orange County Public Health System 2. Access and System Navigation
Assessment were provided before the 3. Mental Health and Substance Use
meeting and referred to during the day. 4. Sexual Health
During the day, subject-matter experts 5. Older Adults
then gave presentations as part of the 6. C hronic Disease Prevention and
Community Health Status Assessment,
discussing trends and populations at risk Management and Health Promotion
for over 50 key health indicators for Orange (working name)
County. A summary of indicators presented After the meeting, HIP Steering Committee
as part of the Community Health Status
Assessment are available in the Summary
of Health Indicators section. The most
current indicators are available on the www.
OCHealthierTogether.org /CHADashboard.

As part of the Community Themes and members and work group leads began
Strengths Assessment, a panel presented working on identifying partners that would
findings from recent community needs lead and establish a plan for each area. As
assessments including CalOptima’s 2018 the HIP’s approach is to align with and uplift
Member Health Needs Assessment, Kaiser existing work, partners for each focus area
Permanente and UCI Health’s community were selected because they were already
health needs assessments, and HIP focus conducting significant work in the focus area
groups. consistent with the HIP’s identified values
as a HIP work group or existing community
collaborative.

Presentations for the day are posted on the
July 17, 2019 Meeting page.

OCHIP 2020-22 » Determining Priorities » 39

Forces of Change Assessment

On March 20, 2019, members of collaboratives, and others participated in
Orange County’s public health system this assessment.
participated in an assessment (Forces
of Change Assessment) to identify The assessment included a discussion of
trends, events, or factors (forces) that forces specific to the social, economic,
affect the community’s health. Forty- technological and political environment in
five stakeholders representing 26 which we live and work. The following is a
agencies including Orange County Health summary of key forces that were identified
Care Agency, community-based health during the meeting along with threats and
and social service providers, health opportunities associated with each.
care providers, academic institutions,

ECONOMIC FORCES

1. Affordable Housing O P P O RTU N ITI E S
TH REATS
įį new models of housing being developed
įį increased disease transmission from įį increased public awareness of the crisis
crowding
and need for solutions
įį increased stressors
įį impediments to children’s development

and education

2. Economic Disparity O P P O RTU N ITI E S
TH REATS
įį public assistance programs including Cal
įį inability to access nutritious foods, safe Fresh
and adequate housing, health care
įį potential new models for funding
įį may increase violence/crimes education and work force development
įį increased stressors

40 « Forces of Change Assessment « OCHIP 2020-22

3. Health Care Costs O P P O RTU N ITI E S
TH REATS
įį new models of care
įį businesses leaving įį increased focus on prevention
įį people choosing high deductibles/copays

and not accessing care

4. Health Care Financing Structures

TH REATS O P P O RTU N ITI E S

įį inadequate number of providers accepting įį new models
insurance

įį preferential treatment based on personal
resources

įį systems still incentivizing illness/disease
treatment rather than prevention

5. Food Industry O P P O RTU N ITI E S
TH REATS
įį increased public awareness about
įį consumption of inexpensive, high-calorie, nutrition
nutrient-poor foods leading to obesity and
nutrition-related diseases such as diabetes įį initiatives on locally grown foods
įį corporations could produce healthier
įį food waste associated with mass
production of foods options for large markets

Additional Topics Discussed

įį Climate change: long-term significant impacts to health, economics
įį Automation: elimination of many jobs and inadequate opportunities for other training
įį Aging population: inadequate economic base to support aging population
įį Public Health funding: decreases to funding are reducing prevention efforts

OCHIP 2020-22 » Forces of Change Assessment » 41

TECHNOLOGICAL FORCES

1. New Provider Tech nologies O P P O RTU N ITI E S
TH REATS
įį more information and consultation
įį more information sharing decreases available for care
individual privacy and may decrease trust
įį greater access in rural areas
įį less personal care įį improved continuity of care and less
įį more provider time may be spent on
duplication and cost
documentation

2. New Patient Tech nologies O P P O RTU N ITI E S
TH REATS
įį more reliable information
įį loss of privacy įį quicker feedback loop on health status
įį a feeling of less personal care įį patient empowerment
įį dependent upon patient health literacy įį reinforces prevention

and ability to use systems and information
įį uncertainty/unreliability of web-based

information; information overload

3. Automation O P P O RTU N ITI E S
TH REATS
įį safer driverless cars
įį decreases in physical activity leading to įį increased self-sufficiency for people with
weight gain, disease, pain and injury
disabilities
įį jobs are being displaced by automation įį lower cost of products
įį potentially less direct social interaction įį safer work environments

4. Personal Devices and Applications

TH REATS O P P O RTU N ITI E S

įį addiction to tech įį decreased isolation
įį decreased socialization and activity įį access to information including health
įį risk of misinformation
įį bullying promotion/education
įį dependence on literacy įį emergency notifications

42 « Forces of Change Assessment « OCHIP 2020-22

Additional Topics Discussed

įį Automated statewide welfare system: increased consistency and accessibility across the state
įį Telecommuting: increased isolation and tension between office-based and telecommuting

employees, more flexibility for worker, reduced carbon foot print

POLITICAL FORCES O P P O RTU N ITI E S

1. Immigration įį grassroots efforts and advocacy may
TH REATS strengthen communities

įį immigrants fearful of accessing needed
services resulting in exacerbation of health
issues and potential spread of disease

įį stressors have increased, potential for
violence against immigrants has increased,
and separation of families has impacted
mental health and economic stability

2. Health for All O P P O RTU N ITI E S
TH REATS
įį discussions may lead to new models that
įį structural changes could decrease access increase access and/or control costs.
(if costs shift to individuals), decrease
quality (by limiting services), and lead to
provider shortages

3. Federal Administration O P P O RTU N ITI E S
TH REATS
įį increased community engagement and
įį reduced access to service, particularly advocacy
prevention services, may result in poor
health outcomes, increases in unplanned
pregnancies (particularly teen), etc.

OCHIP 2020-22 » Forces of Change Assessment » 43

4. State Administration O P P O RTU N ITI E S
TH REATS
įį new policies should increase support
įį there likely will be diversion of funds for early childhood education, universal
from existing programs, new taxes and/ health care, affordable housing, family
or diversion of county funds to fund state leave, etc.
initiatives

Additional Topics Discussed

įį Land use: vacant lots in Santa Ana, gentrification of neighborhoods and displacement of
residents and businesses

įį The Orange County political landscape: shift from right to center
įį Fragmentation between state and counties in California: lack of accountability, inconsistencies,

and lack of parity between counties
įį Mental Health Services Act funding in Orange County

SOCIAL FORCES

1. Social Media and Globalization of Information

TH REATS O P P O RTU N ITI E S

įį social media and the increased įį there is increased access to information,
commercial use of the Internet have and, for many, increased connectivity and
resulted in a decrease in privacy, parental sense of community, particularly for those
involvement and family cohesion who are physically isolated

įį new opportunities for exploitation and the
propagation of misinformation including
public health information

2. Immigration O P P O RTU N ITI E S
TH REATS
įį none identified
įį policy changes and increased fear
have resulted in separation of families,
immigrants not accessing critical
services and health care, and increased
vulnerability of immigrants to exploitation
and violence

44 « Forces of Change Assessment « OCHIP 2020-22