Emily Petersen wasn't sure how she would be able to help when she entered the doors of Memorial Community Hospital and Health System's Howard Sievers Conference Room on Thursday morning for a community health improvement planning session hosted by the Three Rivers Public Health Department.
But, after nearly five hours of collaboration, the executive director of Three Rivers was pleased with what Petersen and about 30 other volunteers representing the business, government, school and health care sectors in Washington County, accomplished in helping to determine ways to improve the health of the county.
Terra Uhing, executive director of Three Rivers, which serves Washington, Dodge and Saunders counties, was grateful for the work put in by the group and offeredher thanks to those in attendance, especially considering the time put in.
"We toyed with the length of the meeting," Uhing said, noting that three years ago, a similar meeting was shorter, but didn't provide enough time for the discussion.
In the end, Petersen and the other volunteers were happy with the role they played in helping Three Rivers in their planning.
"The day went well, it was smooth and was interesting," Petersen said. "I though we really had a successful day."
Going into the day, the group was tasked with answering the question: "Based on our community assessments, what will we choose to focus on over the next three to five years to improve the health of all who live, work and play in our communities?"
A similar effort in 2016, yielded three areas of focus — preventative health education, mental health and obesity.
Guided by facilitator Deb Burnight, Thursday's group kept obesity on the list, and although it didn't stand on its own, mental health was also addressed.
Joining obesity as the top areas of focus were:
• Access to affordable, accessible and quality health care, including mental health.
• Risky behaviors, such as texting and driving, underage drinking, vaping and marijuana use.
• The need for more collaboration between the various entities in the community.
Determining the areas of focus was the result of a three-step process facilitated by Burnight that included small and large group discussions.
It began with a presentation of the results of a Community Health Assessment (CHA), data which included results from a recent community health survey taken by residents in the Three Rivers Public Health District and other sources.
Obesity rates increasing
According to the CHA, obesity rates in Washington County increased from 31.2 percent in 2011 to 32.6 percent in 2015. In 2017, an estimated 33.2 percent of the entire district's adult population was obese. The state percentage is 32.8.
The percentage of adults who are considered obese and/or overweight has also been increasing in the district, according to the assessment, with 71.4 percent of the adult population falling into that category. The state percentage is 69.
As they discussed the issue, group members talked about the need for more education about the benefits of health food.
Access to health care needed
Access to affordable, accessible, quality heath care, including mental health, received the most votes among the group as they narrowed down the areas of focus.
Increasing health care costs, changes in health care legislation, uncertainty in the health care system, local doctors leaving, better access to health care and access to mental health care were concerns and issues addressed by the group.
According to the CHA, the ratio of the population with access to health care professionals in Washington County is 1,873 residents to 1 primary care physician and 2,960 residents to 1 mental health providers.
Risky behaviors on the rise
According to the CHA, 56 percent of respondents in Washington County said they have texted while driving, while 80 percent talked on their phone while driving. A 2017 Behavior Risk Factors Surveillance System study showed 27 percent of people in the Three Rivers district texted and 68 percent talked while driving.
Texting and talking on a phone while driving, youth alcohol use, marijuana use and vaping were among the risky behaviors discussed by the group after seeing the statistics in the CHA.
According to the recent Nebraska Risk and Protective Factors Student Survey, youth alcohol is rising in the Three Rivers district. According to the survey, past 30-day alcohol use among high school seniors increased to 34 percent, from a low of 30 percent in 2012. Binge drinking, however, decreased in 2018, with 16 percent of seniors in the district engaging in the activity in the past 30 days, compared to 25 percent in 2015.
In 2018, 19 percent of high school seniors reported marijuana use in the past 30 days, an increase of 3 percent in 2016.
The highest area of concern was youth vaping. According to the CHA, vaping among high school seniors in the Three Rivers district doubled between 2016 and 2018, with 40.5 percent saying they had done so in the past 30-days.
Groups need to collaborate
As the process moves forward, the group cited the need for more collaboration in the community. One group noted that the various sectors in the health care industry tend to work in silos and that there's not a lot of communication on how they can work together. One entity, they said, cannot address everything.
However, collaboration should not only involve the health care industry but, community, business and government leaders and the patients themselves, the group said.
Thursday's planning session in Washington County was the first of three in the Three Rivers Public Health Department. On Monday, a planning session was held in Dodge County and on Aug. 29, officials will meet with volunteers in Saunders County.
Uhing said once the meetings are done, the next step will be to put together a draft community health improvement plan, which should be ready by the middle of September. After that, Uhing will schedule community meetings in each county to get further input.
"We don't want this to be off what the health department thinks," Uhing said. "We want to get input on how to push this forward to really make a difference in the communities we serve."