Rural Health

The Recession’s Not Over In Your Town, Is It?

By Lorna Stone, Vice President of Programs

We were glad to hear that the Bill and Melinda Gates Foundation has made additional grants to assist families in Washington that are feeling the impact of the economic downturn. A number of community foundations serving rural areas in Washington received funds, including:

• Blue Mountain Community Foundation
($60,000) serves Columbia, Garfield, and Walla Walla counties and plans to award grant funds to projects and programs that encourage collaborative and innovative approaches to improving access to basic needs such as food, housing, and livable wages.

• Community Foundation of North Central Washington (CFNCW)
($75,000) serves the citizens of Chelan, Douglas, and Okanogan counties. CFNCW will use its grant funds to support the nonprofit organizations in North Central Washington with the Gates Great Giving Match (G3M), a program aimed at engaging new and existing donors to participate in philanthropy and modeled after a program used successfully in several other states.

• Community Foundation of for Southwest Washington
($75,000), with current assets of over $43 million, is currently celebrating its 25th anniversary of serving southwest Washington communities. Grant funding will address the significant increase in demand for local food bank services by supporting current, and creating new, food distribution systems in rural areas of southwest Washington.

• Grays Harbor Community Foundation
($45,000) has supported other nonprofits in Grays Harbor for 15 years, giving $824,000 to more than 50 organizations in 2008. The Foundation will use its grant funds to provide additional support to four food banks, its countywide Senior Nutrition Program, and Coastal Harvest (a distribution center that serves 42 food banks in five counties). More than 750 families and 3,000 seniors will be provided nutritious food.

• Inland Northwest Community Foundation
($150,000) will award two regional grant programs: one serving Spokane County and one serving the tri-county region of Ferry, Stevens, and Pend Oreille counties. Grants will be awarded to organizations that demonstrate a proven record of building strong families and strengthening communities.

• Orcas Island Community Foundation
($30,000) works to foster philanthropy and encourage contribution within San Juan County. Grant funding will support four programs aimed at connecting children and families to services and programs providing nutritional and educational support. The specific organizations that will benefit include Readiness to Learn, Kaleidoscope, Orcas Family Connections, and Farm to Cafeteria.

• Skagit Community Foundation
($30,000) will use grant funds to help nonprofit organizations in Skagit County respond to community needs. The community foundation will support efforts to increase access to public benefits, prevent and reduce violence, strengthen food distribution systems, and build strong families and communities

• Three Rivers Community Foundation
($57,000) receives and distributes funds in Benton and Franklin counties with the goal of building a stronger community and investing in the diverse capacities of individuals, organizations, and neighborhoods. Grant funds will be available and distributed to organizations that are successful candidates in the areas of reducing and preventing violence, community building, and fighting hunger. 

• Whatcom Community Foundation
($75,000) serves residents in Whatcom County, and will utilize this funding to offer a competitive grant process, which will begin this year. To promote and explain the grant opportunities, WCF will host several orientation meetings for local organizations in the coming weeks.

• Yakima Valley Community Foundation
($75,000) seeks to improve the Yakima Valley region’s quality of life. The grant will help the Union Gospel Mission strengthen its local food distribution system and support a partnership between organizations aimed at preventing and reducing gang-related violence and building strong families, including Nuestra Casa, Comprehensive Mental Health’s Strong Families (Familias Fuertes) program, and Sunnyside’s Promise.

Rules To Eat By!

By Kristina Alnajjar, Grants Program Assistant

Every culture has traditions guiding behaviors and decisions created by the accumulated wisdom of the community.  As Michael Pollan points out in the article Rules to eat by, humans managed to choose foods and stay healthy by relying on culture passed down through families and communities.  In the US, some of these traditions have faded while others have been completely replaced. 

But, for old (and healthier) times sake, lets take a look back at this food wisdom.  The old sayings and Food Rules were collected by Michael Pollan and included in the article mentioned above. 

Do any of these remind you of what your grandmother used to say?  Father?  Eccentric elderly aunt? 

“It is better to pay the grocer than the doctor”

“You don’t get fat on food you pray over.” 
--Meals prepared at home, served at the table and given thanks for are more appreciated and more healthful than food eaten on the run. 

“Breakfast, you should eat alone.  Lunch, you should share with a friend.  Dinner, give to your enemy.”

“Don’t eat anything that took more energy to ship than grow.”

“Non si puo lasciare la tavola fino che hai finito la frutta.” 
--You cannot leave the table until you have finished your fruit. 

“Eat until you are seven-tenths full and save the other three-tenths for hunger.  That way, food always tastes good, and you don’t eat too much.”

“If you are not hungry enough to eat an apple, than you are not hungry.”

“GO HO –incorporate five different cooking methods (steamed rice, simmered vegetables, grilled tofu, sautéed vegetables, raw fish, etc).  GO SHIKI – incorporate five colors (red, white, green, black, yellow).  GO MI – incorporate five flavors (sweet, sour, salty, bitter, spicy).” 

Good News from Port Angeles...Reduce Risk and Save Money

By Lorna Stone, Vice President of Programs

Jody Moss, of United Way Clallam County, is sharing some good news in these dire times. 

“A number of years ago, the University of Washington launched a long term research study in which Port Angeles became a participant – the project was called Communities That Care. The results of that study have now been released with very promising outcomes demonstrating reduced use of drugs, alcohol, binge drinking and other negative behaviors in youth.  Hopefully, someday we (as a nation, a state, and locally) will have more funds to invest in these kinds of prevention programs more comprehensively.  In the meantime a local county-wide program continues for another year with state grant funding, known as the Healthy Youth Coalition. “ –Jody Moss

In a media release reporting the outcomes from the study, researchers describe the randomized trial of Communities That Care (CTC), an evidence-based community-focused substance-use prevention system, that showed significant reductions in the initiation of alcohol use, tobacco use, binge drinking, and delinquent behavior among middle schoolers as they progressed from the fifth through the eighth grades.

"The results of this trial confirm that tools do exist that give communities the power to reduce risk for multiple problem behaviors across a community," said National Institute on Drug Abuse Director Dr. Nora Volkow. "What makes Communities That Care unique is that it enables communities to identify their own special issues so they can hand pick the right prevention programs."

Prevention research has produced programs with efficacy in reducing the risk of substance abuse among youth, but the process of getting these programs into communities has been difficult. CTC helps individual communities identify prevalent risk factors for future substance use among their youth and choose evidence-based programs to address those risk factors across the community. Recent research shows that for each dollar invested in research-based prevention programs, a savings of up to $10 in treatment for alcohol or other substance abuse can be seen.

Communities that are interested in reducing substance abuse among youth can find CTC information and Tools for Community Leaders: A Guidebook for Getting Started.
 

De Comunidad a Comunidad a Cocinas Sanas a Las Margaritas

 
By Katharine Sanders and Rosalinda Guillen

It all started with cooking classes.  Far from their first homes in Central and South America, farm workers gathered together to share their favorite traditional dishes, but ended up creating so much more.

In 2006 and 2007 Community to Community Development (C2C), a non-profit group aimed at organizing and supporting Latino farm workers in rural Whatcom County, offered five Cocinas Sanas/Healthy Kitchens workshops to introduce new ways of cooking traditional foods with local healthy ingredients.  Executive Director Rosalinda Guillen, explained to us that she and her co-workers knew whatever they ended up with had to fit the farm workers’ cultures and traditions, or the foods would not be cooked or eaten. The best way to discover useful recipes for healthy eating was to ask the family cooks to have a part in their development.  They learned, cooked and ate together.

Through word of mouth, other farm workers approached Guillen about developing a worker owned organic farming cooperative – Cooperativa Jacal.  Soon some of the farm worker women who had learned to cook healthier traditional Mexican food, decided to form their own worker owned catering cooperative -- Las Margaritas.  

By working together members of both cooperatives found a way to add value to what they produced. Las Margaritas cooked local organic produce grown by Cooperativa Jacal in traditional Mexican cuisine at a Bellingham Farmers Market Food Booth. To introduce their produce and cooking to the broader community Las Margaritas now cooks and sells fresh, healthy Mexican food every Saturday at the Bellingham Farmers Market.  If you are close to the area, check them out!  Popular dishes include kale and chard tamales, squash tacos and all vegetarian tostadas.

They’ve made great progress, but challenges remain. “Even though the farm workers are growing crops sold at the local food co-op, they were not shopping there,” says Guillen. “These cooperatives helped the members understand the value of sustainable and organic food – and they now shop for most of their ingredients at the co-op and of course from local farmers at the Bellingham Farmers Market.”

Part of what drives this effort is the Latino Paradox. As a group, new Latino immigrants have better overall health than native-born Americans, even though they are poorer. But as shown in the documentary series Unnatural Causes, (now being aired on public TV stations) within five years of arriving in the United States Latino immigrants develop chronic conditions and diseases such as high blood pressure, diabetes and mental illness - and their overall health ends up being worse than the general population. Food is only one of the factors implicated.

Community to Community (De Comunidad a Comunidad) – a Healthiest State Grant Partner, uses the family dining table as the center of healthy living. Signs of a new path to farm worker health and well-being are emerging as farm workers take leadership roles from the beginning; educating themselves, conducting community outreach, growing organic food, developing culturally relevant recipes, and then cooking the food themselves.

A cooking lesson

 

Pumpkins, not just for pie and carving!

By Kristina Alnajjar, Grants Program Assistant

In just 2 weeks, Halloween will be here.  But we are already getting our first taste of fall--leaves are changing, temperatures are dropping, and Squash and Pumpkins are in now in season!  Blue Earth Farms, a Healthiest State grant partner, publishes a monthly newsletter and this month we loved their topic of choice--Pumpkins!  

Here is an excerpt from their October newsletter.   

Most of us have taken part in the ritual of carving pumpkins for Halloween and perhaps roasting the seeds. This season, branch out and try some new recipes with this nutritious and prolific crop, easy to grow in the Pacific Northwest. Health Attributes Pumpkins are a great low fat calorie food, rich in potassium which assists in maintaining kidney function and blood pressure.  Pumpkins are also high in Fiber, Vitamin C, a potent Anti-Oxidant and Beta-Carotene which promotes eye health.  The seeds themselves provide several nutrients which include: Magnesium for bone strength and copper.  If that isn't good enough they also have cholesterol lowering phyto-sterols and omega-3 fatty acids!  Nutrition Information-- Per 1 cup cooked, boiled or mashed: Calories 49 Fat   .17 g Fiber    2.7 g Vitamin A 612 mcg Beta-carotene  5135 mcg Potassium    564 mcg

And here are some recipes they shared with us. 

ROASTED PUMPKIN SALAD

1/2 cup hulled pumpkins seeds

1 small sugar or other sweet variety pumpkin (~4 lbs), peel, remove seeds and chop into ~1" chunks

~1/4 cup olive oil

1-2 tbs honey or agave nectar

3 tbs fresh lime juice

6 cloves garlic unpeeled

1/2- 1 tbs chili sauce

1 bag fresh spinach

6 oz crumbled Feta cheese

**Toast cleaned pumpkin seeds on stove top in cast iron skillet until slightly brown with nice aroma.  Pre-heat oven to 450 degrees.  In a large rimmed baking pan toss the pumpkin chunks and garlic cloves in half of the olive oil and the chili sauce. Roast in oven tossing occasionally until pumpkin in tender.  25-30 minutes.  Remove garlic cloves.  Drizzle 2 tbs honey over pumpkin and toss to coat.  Return to oven, continue roasting until glazed, tossing occasionally ~5-10 minutes.  Let cool slightly.  Squeeze out garlic cloves from skins into large bowl; add lime juice & last tbs honey, salt, pepper.  Whisk together.  While whisking, stream in remainder of olive oil.  Toss pumpkin and fresh spinach with dressing, roasted pumpkins seeds and feta cheese.  Approximately 4 servings. 

ROASTED PUMPKIN SEEDS

1 1/2 cups cleaned pumpkins seeds, a little pulp is ok but remove big stuff

2 tsp olive oil or melted butter

Salt to taste

**Preheat oven to 300 degrees.  Toss seeds in oil and salt.  Bake for ~30 minutes stirring occasionally until golden brown.  Be adventurous!  Zest it up with garlic salt or other spicy seasonings!

______________________________________________________________________________

The Blue Earth Farms Project was launched in 2007 with a vision to create an educational working farm to assist Lewis County in exploring & implementing healthy lifestyles & living practices with a practical focus on organic gardening, nutrition & environmental sciences.  Based on this vision, they created an “action plan” to explore healthy sustainable lifestyles and they are still as focused as ever.

Imagining Improved Women’s Health in Okanogan County

By Katharine Sanders, Director of Grantmaking

An Okanogan County coalition that advocates for improving the health of women and their children is finding that progress comes in many forms and can take longer than anyone imagined.

Families in Okanogan County experience high rates of pre-term births, low birth weights, chlamydia and other sexually transmitted infections, teen pregnancies, births by Caesarian section, and hospitalizations related to pregnancy complications. They also have some of the lowest breast cancer screening rates in the state. Supported in part by a Healthiest State grant focused on Protecting Against Injury and Disease, Okanogan County Public Health convened a coalition of community health leaders to explore how to address the issues.

The opportunity to apply for a grant from the Department of Health to plan for a school-based health clinic led the coalition to present the issues at school board meetings in Omak, Tonasket, Brewster and Bridgeport. Members discovered that parents and community members had different ideas about what reproductive health information and access to mental health services should be available to teens at school. The controversy led the group to focus on action in areas where there was agreement.

During Women’s Health Week the coalition sponsored a workshop on Reproductive Life Planning – a process through which people set goals about having (or not having) children, based on their personal values and resources. The coalition produced and placed a series of positive messages about women’s health on local radio. To obtain more information on the dynamics of women’s health issues, Okanogan County Public Health has entered a partnership with Okanogan Family Planning to investigate the relationship of reproductive health status and birth outcomes among clients accessing reproductive health services. The partnership will include a one day a week reproductive health clinic at Okanogan County Public Health.

While action toward the goal of improving women’s health may move at a slower rate in Okanogan County than some had hoped, the coalition successfully raised the issue, built support and laid the ground work for future progress.

Heroes of Health Awards

By Kristina Alnajjar, Grants Program Assistant

  Come join us for the Washington Foundation's annual Heroes of Health event.  This year we will celebrate at the Seattle Aquarium on November 12th from 6:30pm – 9:00pm.  Join us in honoring our 2009 Heroes.  Click here to register.  

Or check out more details on our Heroes of Health webpage. 

This annual event showcases the participants in the Healthiest State Campaign who best exemplify the leadership needed to make Washington the Healthiest State in the Nation! 

Many of our past award recipients have been from rural communities. It is our pleasure to recognize their great work once again. 

2009	Healthy Systems Award	City of Bridgeport	Bridgeport, WA
2008	Healthy Systems Award	Promotores de Salud of Quincy Community Health Center	Quincy, WA
2007	Healthy Living	City of Dayton	Dayton, WA
2006	Lifetime Achievement Award	Edmund W. Gray, M.D.	Colville, WA
2005	Healthy Systems Award	Clallam Citizens for Dental Health	Port Angeles, WA
2004	Award for Innovation	Nancy Nash-Mendez	Omak, WA
2004	Excellence in Public Health Service	Dr. Thomas Locke, Health Officer for Clallam and Jefferson Counties	Port Angeles, WA
2003	Award for Leadership in Health	Carlos Olivares, Yakima Valley Farm Workers Clinic	Toppenish, WA
2002	Award for Leadership in Health	Mel Tonasket, Tribal Council, Colville Confederated Tribes	Nespelem, WA
2001	Award for Leadership in Health	Dr. Willa Fisher, NW Center for Public Health Practice	Bremerton, WA
2001	Award for Innovation	Jamestown S’Klallam Tribe	Sequim, WA
2000	Lifetime Achievement Award	Howard Gamble, Okanogan Douglas District Hospital	Brewster, WA
2000	Award for Collaboration	Providence Healthy Communities Alliance	Wapato, WA

This November we are also hosting Improving Health Through National Reform Conference, November 13th from 8:00am – 4:00pm. 

For 23 years, the University of Washington put on the annual Washington Health Legislative Conference.  This year, the University of Washington has asked the Washington Health Foundation to assume responsibility for hosting the event.  Please plan to join us for this unique conference at the Bell Harbor International Conference Center--and expect to see a few changes!  Click here to register.
Or check out more details on our Legislative Conference webpage. 

Eat Together Month

By Kristina Alnajjar, Grants Program Assistant

Eat together, eat better!  National eat together month is October.  What does this mean for you and your family? 

It could mean making time to eat with one another, shopping for new foods together, or preparing interesting seasonal recipes.  Whatever it may be, statistics show when families sit down and eat together, everyone has better overall nutrition.  One study conducted by Harvard researchers found that families who reported eating together “almost every day” took in more healthy nutrients such as Calcium, Fiber, Iron, Vitamins B6, B12, C, and E than families who “rarely eat together.”  Another study by the University of Minnesota found that children whose families ate together often consume more fruits and vegetables and fewer snack foods than those who did not. 

The benefits of eating together extend further than just good nutrition.  It is also likely that kids will do better in school, are less likely to take drugs, develop appropriate language skills, and are more reassured of their parent’s interest and concern for their lives. 

In that spirit, we wanted to share some easy, fall, family friendly recipes one of our 2008 Healthiest State Grant Partners, Mason County Conservation District-WSU Small Farms Extension, pulled together.  A group of local farmers – Nature’s Networks – worked with the Squaxin Tribal Diabetes Program to produce and incorporate locally grown healthy food into the diet.  Their innovative project elevates the health status of Tribal members by providing food for community events, and teaching about healthy food and its preparation.

Eggplant Teriyaki: Fall Recipe. This recipe serves 4. 

Ingredients:
1-2 Eggplants, thinly sliced (1/4” at most)
2 cups Rice
3 ¾ cups Water
1 medium Leek, sliced
¼ c Tamari or Soy sauce
4 cloves Garlic
½ tsp Ginger, fresh, grated
1 tsp Lemon juice
  ½ cup Chunked pineapple (optional) 
  Fenugreek (optional)

Directions:
1. Steam rice with water and fenugreek.
2. Heat skillet with olive oil. Add sliced leek and garlic.
3. Lay strips of eggplant on top of simmering garlic & leek.
4. Sauté on both sides for a few minutes while you make the sauce.
5. In a bowl, mix tamari or soy sauce with ginger and garlic.
6. Add lemon juice and pineapple to skillet.
7. Sauté until golden and bubbly.
8. Serve on rice.

Salsa Verde: Fall Recipe. This recipe serves 4.

Ingredients:
1 lb Tomatillos
1 lb Tomatoes
8 oz Sweet Pepper
1 medium Onion
4-6 cloves Garlic
To taste Cilantro and Hot peppers
1 tsp Lemon juice

Directions:
1. Remove husks and cores from tomatillos.
2. Put minced onion and garlic in saucepan with butter or oil on medium heat.
3. Add peppers and sauté for 2-3 minutes before adding chopped tomatillos, tomato, and cilantro.
4. Cook until desired consistency, adding water if necessary.
5. Serve warm or cold with tortilla chips or your favorite dish.

You Have No Idea What Health Really Costs

We want to thank Jody Moss, Executive Director of United Way of Clallam County, for alerting us to a recent Washington Post article on real health care costs, titled You Have No Idea What Health Really Costs, If You Did, You Might Just Want Real Reform.

As Jody said, “If all you have time to read is the beginning, just read the first 12 paragraphs”.

We’re copying them for you here. Click the link above if you want to read the whole article.

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The most important health-care document released this week was not Sen. Max Baucus's Healthy Future Act. It was the Kaiser Family Foundation's 2009 Employer Benefits Survey. 

While the proposal by Baucus, chairman of the Senate Finance Committee, outlines a direction for policy, the survey, which polls employers about health benefits to assemble a detailed look at the actual cost of health care, fits it squarely in our pocketbooks.

The truth is we all pay, and much more than we recognize, for health care.

For many, it's among the largest investments we'll make, on par, even, with the money we spend on a house or tuck away for retirement. But while it's easy to track our stock portfolios as they tank along with the market, our outlay for health care is less obvious. Employers pay some, and so do individuals, and taxpayers. And some even hides behind the deficit. As such, few of us see the full picture. But to make sense of the proposals for reform, getting a grasp of the cost is critical.

The average health-care coverage for the average family now costs $13,375, according to Kaiser. Over the past decade, premiums have increased by 138 percent. And if the trend continues, by 2019 the average family plan will cost $30,083.

Three years of slightly above-average health insurance will cost a solid six figures.

Those are numbers to marvel at. Those are numbers to fear. But they are not the numbers that loom in the minds of most Americans. And therein lies the problem for health-care reform.

About 160 million Americans receive health coverage through their employers. In general, the employer picks up 73 percent of the tab. This seems like a good deal. In reality, that money comes out of wages.

As Ezekiel Emanuel, who advises Office of Management and Budget Director Peter Orszag on health-care policy, has pointed out, health-care premiums have risen by 300 percent over the past 30 years (and that's after adjusting for inflation). Corporate profit per employee has soared by 200 percent. Hourly earnings for workers, adjusted for inflation, have fallen. The wage increases have been consumed by health-care costs.

Another 80 million Americans are on public plans, mainly Medicare and Medicaid. Those costs are paid by taxpayers. And about 46 million Americans are uninsured. The costs for their care are shifted to the insured: This raises premiums for the average family by $1,100 each year, according to an analysis by Ben Furnas and Peter Harbage of the Center for American Progress.

Imagine if people who touched a hot stove felt only a small fraction of the pain from the burn. That's pretty much what's happening in our health-care system. It hurts enough that we would prefer it to stop, but the urgency is lost.

That's the dilemma for Washington wonks trying to fix this mess: They look at the numbers and see health-care costs crushing our economy, overwhelming our government, swallowing our wages. But the public isn't feeling it. Virtually no one cuts a $13,375 check for health care. Most pay 27 percent of it, or even less. The surest way to cut health-care spending would be to make people shoulder more of the burden directly, as opposed to hiding it in taxes and lost wages. But that's about as popular as a puppy pot roast.

Health Equity Policy Brief

By Kristina Alnajjar, Grants Program Assistant

"The only thing necessary for the triumph of evil is for good men to do nothing." –Edmund Burke

This is the dramatic quote that Dr. David R. Williams ended his presentation with earlier this week.  His topic of discussion was Moving Upstream: How Interventions on the Social Determinants of Health Can Reduce Health Disparities.  He spoke to a diverse and passionate group at the University Of Washington School Of Social Work. 

Dr. Williams is a professor at the Harvard school of Public Health and Professor of African American Studies.  Beyond fulfilling the role of being a professor, he is the Executive Director of the Robert Wood Johnson Foundation Commission to Build a Healthier America and was a major contributor to the Unnatural Causes: Is Inequality Making us Sick documentary series. 

According to Dr. Williams’ research, if you make less than 10K a year you are 3 times more likely to die before the age of 60 than someone making over 100K a year.  If you are Native American, Black or Hispanic, you have a higher chance of developing Type 2 Diabetes.  And, if your mother did not did not finish high school you were nearly twice as likely to die before your first birthday than babies born to college graduates. 

He said most Americans are not aware Health Disparities exist.  But, socioeconomic and racial disparities are cutting people’s lives short.  Dr. Williams focused much of his presentation on discrimination.  He said “Discrimination is a source of stress that affects health; undeniably and across all racial or ethnic groups.  When people are exposed to social and economic adversity over their life’s course, their stress usually manifests in the physical body.” 

Dr. Williams used the Edmund Burke quote to emphasize his belief that now is the time to address health outcomes in diverse populations.  Inaction will only cause more disparities.  Those in low income groups and in certain racial and ethnic minorities account for an ever increasing share of the country’s populations, yet they are more likely to become sick and to die sooner than those who are more affluent and those who are Caucasian. 

The Washington Health Foundation believes that we must address health disparities to reach our goal of one day becoming the Healthiest State in the Nation. Among the actions that are needed: Congress should use savings from medical care reform to take actions that will increase high school graduation rates; new legislation should include a national Health Impact Assessment. In our Health Equity Policy Brief, we discuss these solutions and others.  Read the full brief.

   Dr. David R. Williams