The American Planning Association (APA) and American Public Health Association (APHA) have joined together to connect communities by funding work at the intersection of planning and public health. The new program, Plan4Health, supports creative partnerships to build sustainable, cross-sector coalitions. The Center for Disease Control awarded APA grant monies to fund local programs. Umatilla County, Oregon was awarded one of the grants as part of the Plan4Health Cohort II funding cycle — one of only two rural projects selected from throughout the U.S. The Umatilla County Plan4Health Initiative began in March 2016 with a Coalition kick-off meeting that included persons from private and public sectors and a broad cross-section of industry types and interest groups. The role of the coalition was to identify policy, systems, and environmental changes and strategies that could promote healthy lifestyles in rural Oregon.
Why Umatilla County?
Planning and Public Health leadership recognized Plan4Health as an opportunity to study conditions in the county and to identify programs that might reverse the trend of poor health statistics. In Plan4Health parlance, those conditions are referred to as Policies, Systems and Environmental (PSE) conditions. In Umatilla County, there is a stark contrast between our status as the number one food producing county in the state and our relatively poor public health statistics. If we grow such a vast variety of produce, wheat, and cattle, why are county residents experiencing poor health outcomes?
Umatilla County ranks 26th out of 34 counties in Oregon in health outcomes metrics, and 31st in both quality of life and health behaviors. Umatilla County has high rates of obesity (33 percent) and low rates of adults who reported participating in physical activities (24 percent). Only 65 percent of residents report having access to exercise opportunities, which is well below the state and national rates. These same indicators are worse for Latino/Hispanic residents, where nearly 76 percent of adults reported being overweight or obese. Children in Umatilla County reported high rates of screen time and soda consumption as well as low rates of fruit and vegetable consumption. Only 18.7 percent of children consumed the recommended five servings of fruits and vegetables a day.
Methodology, Research, and Results
The University of Oregon’s Community Service Center (CSC) was hired to conduct the Community Needs and Readiness Assessment (CNRA). The county coalition served as the public involvement component. The assessment consisted of a mail-home survey to registered voters, focus groups with vulnerable populations, and community outreach at public events. The CNRA model was chosen to better understand perceptions and barriers around access to healthy food and physical activity. The information gathered helped the coalition direct resources towards projects that are achievable based on characteristics and desires of the community. The report assessed health needs and gaps in services and identified opportunity areas where the coalition can focus efforts and take action.
The CSC conducted a review of existing health related surveys, research, and public health and planning efforts in Umatilla County. When data was missing or incomplete, such as with recreation facilities and food access, the CSC conducted their own data collection to provide documentation of those resources. The data collected was combined with demographic and socioeconomic data from the U.S. Census Bureau to develop health profiles for the county and incorporated cities. The CSC team created maps from this data to show how health and wellness characteristics are distributed within Umatilla County. In addition to data collection, the CSC team gathered input from residents of Umatilla County through community workshops in several cities to create a direct dialogue with residents. The profiles for the county and cities provide baseline health and demographic data in contrast with state and national averages to highlight how the area stacks up in comparison. The profiles will be used to inform communities, develop outreach content, resources for grants and future funding opportunities, and direct the work of the Umatilla County Plan4Health Coalition.
Through the process of conducting this type of data collection and working in a rural area, several lessons were learned. ‘Rural independence’ and ‘established informal networks’ were two of the underlying conditions identified that are particularly difficult to capture through standard data collection. The ‘rural independence’ condition is not necessarily a detriment to health, but the assessment has shown that in the absence of health programming and other resources in geographically isolated areas, many people have taken it upon themselves to develop healthy lifestyle programs. For example, rural residents in east County may not have heard about health programs offered in the west County, yet they have established a walking group with neighbors. Another example of an informal network increasing access uncovered through the assessment, revealed that in one remote community, where it is a 40-minute drive to a full-service grocery store, individuals often volunteer to shop for neighbors and those who are home-bound. Informal networks such as these were difficult to capture through the mail-home survey, so the CSC and county staff reached out directly to meet community members where they live, work, and play through focus groups and outreach at community events. The approach resulted in a much deeper understanding of barriers and perceptions unique to rural areas and allowed the team to capture one-of-a-kind qualitative data.
The University of Oregon CSC generated a final report alongside a spreadsheet of recommendations for the Umatilla County Plan4Health Initiative. The Plan4Health Coalition will focus on the following categories in the coming years:
Policy change, education, infrastructure and changes to physical environment, information dissemination – showcasing and publicizing existing resources, food access and connections to local agriculture, and changing organizations’ mindset – collaboration for health.
The chart below illustrates the PSE categories and specific implementation actions. In an upcoming Oregon Planner’s Journal, the second part of this article will include a more specific analysis of the strategies as well as describe several implementation projects that are already moving forward, made possible through mini-grants administered by the Umatilla County Plan4Health Initiative.
Submitted by Tamra Mabbott, Planning Director, Umatilla County and Taylor Smith, Healthy Communities Coordinator, Umatilla County.
Visit the Umatilla County Plan4Health web site here: http://plan4health.us/plan4health-coalitions/umatilla-county-or-umatilla-county-plan4health/
 Oregon Department of Agriculture Annual Report 2015.
Robert Wood Johnson Foundation, County Health Rankings
2015 Umatilla County Community Health Assessment
 2015 Oregon Healthy Teens Survey