After five months of traveling to Colorado communities across the state – urban and suburban, rural and frontier – the #HealthiestCO Statewide Tour finished with three sessions in Denver in early March. 凯伦欢迎了150多名社区成员, at the 历史 Colorado Center and the Wellshire 事件 Center, 包括领导人, 老师, 倡导者和照顾者, who engaged with each other and candidly shared the assets and barriers to health in the Denver metro area.
The robust conversations began with a discussion of Denver’s assets: First on the list, 在所有的三个疗程中, 是丹佛的公园, 自然环境和户外机会. Children have access to parks and recreation center services at no cost, 让很多人更容易出门活动. The city itself was also described as an asset – with burgeoning bike and transportation infrastructure, 靠近州立法机关, 博物馆及公共图书馆. 与会者还讨论了丹佛的经济复苏, 具有较强的创业精神和创新意识.
良好的当地社区基础设施意味着强大, connected communities with increasing racial and ethnic diversity. Movements around local food and urban farming are addressing food deserts and making fresh, 让更多的人获得健康食品.
在丹佛, residents have access to a strong health care system and provider network, with health coverage gains being made through Medicaid expansion. 该地区有各种各样的心理健康中心, including a regional crisis center and suicide prevention center. A surveillance system is in place that includes a chronic disease registry and monitoring indicators of better population health, 包括烟草使用, BMI和其他健康指标.
Attendees mentioned the city’s strong collaborative spirit as evidenced through collective efforts such as the Mile High Health Alliance and integrated care initiatives. 在丹佛, There is a sense in Denver that there is a critical mass of nonprofits that work together and support each other. 校本保健中心, healthy schools collective impact initiatives and a strong network of early childhood advocates support the health and education of Denver’s youngest residents.
当我们问及健康障碍时, 我们听到了一遍又一遍, that systems do not have the capacity to care for residents in the new ways they are being asked to: School districts have limited behavioral health personnel; the criminal justice system has inadequate resources to treat substance addiction; behavioral health care providers have three-to-four month-long waiting lists for the homeless population; the disability population has strong advocates, 但是资源不够. Attendees also expressed concern about the recent legalization of recreational marijuana, 以及缺乏教育, 对它的认识和管理.
Issues with affordable housing was cited as one of the most significant barriers to health – creating cycles of poverty and displacement and impacting the whole family, 尤其是儿童. The ripple effect of this housing crisis means that families have less to spend on healthy food or health care, making it even more difficult for families to break the cycle of poor health and poverty.
When families need to access health care, it often isn’t easy. Without a central location to learn about how to access health care, 没有弹性工作时间的供应商, 以及高昂的公共交通成本, 许多丹佛居民没有时间, 获得医疗保健的成本和努力. 初级保健短缺, a lack of specialty providers who take Medicaid and Medicare and the persistent stigma around mental health compound the problem.
Though attendees pointed out that early interventions for young children (up to age 3) are available, the biggest barrier to children’s health is the continuum of care once they are in kindergarten. There is a significant need for wrap-around services for families that include behavioral health, 小儿牙科, 饮食失调治疗, 残疾方案和一般健康教育.
Achieving stability in existing child health services is a challenge because the early childhood workforce is described as underpaid and under supported, 高流动率和人员流失. 稳定这些专业人员, 通过适当的工资和体制支持, would drive continuity of care and prevent behavioral and physical health issues later in life. Attendees also brought up that there are misperceptions about our state when it comes to health – we’re thought to be the healthiest state rates of childhood obesity are on the rise.
Underlying these myriad issues is the need for a paradigm shift when it comes to the understanding of the link between socioeconomic factors – such as poverty and educational attainment – and health outcomes. 连接这两个数据集是非常复杂的, and public health leaders need more granular data to paint the picture of the localized communities.
尽管围绕健康障碍的讨论非常广泛, the Denver community members continued to come back to the need to convene everyone – funders, 保险业司, 州卫生机构, 保险公司, nonprofits and for-profits – around this conversation about health. 最重要的是，讨论解决方案. 丹佛社区希望听到他们的声音, needs more general funding for nonprofits and on-the-ground policy work and is looking to funders to share creative and innovative ways of tackling the issues.
As each session wrapped up, the collective feeling was one of solidarity and purpose. 丹佛的资产很多, and though the city is facing many challenges as it quickly grows and evolves, there was the recognition that the first step in solving these problems is to give them a voice.