Rural Health

Do you talk about mental illness?

By Kristina Alnajjar, Rural Program Associate

Mental illness affects 10% of Americans today.  That is 1 in 10 people who have mental health disorders.  Mental Illness comes in many forms including major depression, bipolar disorder, anxiety disorder, attention deficit hyperactivity disorder, panic attacks, schizophrenia and more.  Fewer than 25% of people with a diagnosable mental disorder seek treatment. Even fewer are in supportive environments where their disease is discussed.  The ripple effects on families, friends and communities are huge. Since May is Mental Health Awareness Month, we wanted to talk about mental illness with you. 

Great Resource: An evidence based program that encourages dialogue and increased understanding for family members of those with a mental illness is called The Family-To-Family Program, developed by the National Alliance on Mental Illness.  It is a 12-week course that is taught by other graduates of the program.  With over 115,000 people trained, the studies have shown it reduces subjective burden and worry, increases empowerment and increases understanding of the mental health system.  To find a program in Washington—click here.

Whether or not you have a friend or family member with a mental health concern, it is important to be aware of the diseases and resources as they exist in your communities wherever you live.  Several recent movies depict the reality of mental illness.  Check them out this month.

• The Soloist  
• Reign Over Me  
• A Beautiful Mind
• Unlisted (Independent Movie out of Seattle)

What I learned about Healthy Living from Italy

By Crista Carlson, AmeriCorps member at La Conner School District

As a longtime lover of Italian food, I could only imagine all of the delicious dishes I would be eating during my first trip to Italy.  Even though I was devouring all kinds of pizza, pasta and tiramisu I still came home five pounds lighter and with more energy.   Despite all of the delicious food Italians are surrounded with, I saw very few people who were overweight.

One of the key differences I noticed was in the way they did their shopping.  Here in America or at least here in La Conner, we often head to Safeway for our weekly groceries and Costco for everything else.  Instead Italians have daily markets which are filled with fresh produce to be used for that day’s meal.  I also noticed most if not all walk to accomplish this daily task.  If they do have a car, it is usually so tiny they really couldn’t put more than one bag of groceries in it anyway.

I concluded that meals were determined by foods available and foods available were determined by the region you lived in.  Brilliant!  Sorrento is famous for lemons and because of it lemons are used in everything.  There are lemon noodles, lemon milk, lemon salad, lemon bread, lemon jelly and it all tastes delicious. There are lemons the size of a cantaloupe; something I didn’t even know was possible.
 
It was also hard to ignore how much the average Italian walked. Even if they did own a car, driving was not usually a daily activity.  As many people know the cities are just not built for it.  Venice is perhaps the ultimate example of this. There are no cars in Venice, only small alleys and bridges to cross every canal. Walking actually allows you to absorb more of the atmosphere and beauty around you, things I tend to miss while driving.

While traveling I never felt deprived. It just became the way it was, a way of life. I didn’t crave a midnight snack knowing that going to retrieve one could potentially involve a two-mile walk! Walking to get to places began to seem natural and easy.

After coming home I recognized how truly easy it is in America to overeat or become inactive. We have so many conveniences in our daily lives. We have cars to take us where we need to go instead of walking, we have escalators many times instead of stairs and we have 24 hour convenience stores and drive-throughs instead of fresh daily markets.  I realized in order to keep those five pounds off, I would have to make a conscious effort. While I do love the convenience of my American ways, I might just incorporate a little bit of Italy into my lifestyle!

If you ran health insurance...

By Katharine Sanders, Director of Rural Programs

If you ran health insurance you might not need someone to help you untangle your health care bills, understand what’s covered by your plan (and what is not), and help you find the best combination of health insurance for you, your family or your business. If you ran health insurance you might not need a personal health advocate.

We know the bad news – you don’t run health insurance yet - and it will take a while longer for people in the U.S. to make a health care system that’s easy to use and helps keep us all healthy.

But there is good news, too. You don’t have to wait! Dave and Jet at the Healthiest State xChange are personal health advocates and they are ready to help you use the system we have right now.

When you make the Healthiest State  xChange your health insurance broker Dave and Jet will help you get what you need - in spite of our complicated health system.  The bottom line is:

1. It costs you no extra money to switch your broker.
2. You choose where your commission goes. You don’t pay the commission, your health plan does – and the money will help assure the future of the Washington Health Foundation and our rural grant programs.

These are just two of the biggest reasons to make the switch.

Sound interesting? Check out the website and then call 855-924.3258 (855-WA-HEALTH). Dave or Jet can help you make sense of the system. And thank you for supporting the Washington Health Foundation!

 
 

What we can’t see, CAN hurt you!

By Onika Shabazz, WHF Intern

 As a Masters in Social Work (MSW) candidate, my focus is on understanding obesity from a more holistic perspective, which includes one’s childhood experiences. So, it was perfect when I was tasked with writing about adverse childhood experiences (ACEs) and health outcomes in adulthood. For years I have struggled to explain my point of view: For many, obesity is not (just) about food, but about emotional scares, past histories and other things that we cannot see, but I think the ACEs study helps make my point more understandable.

For nearly three decades, researchers from the Centers for Disease Control and Prevention (CDC) and Kaiser have been exploring the connectedness between ACEs and health outcomes in adulthood, and what they have shown thus far is astonishing. However, their findings simply support what lay people have been saying all along; that childhood experiences indeed affect health and influence our behaviors throughout the lifespan. Either way, it’s great that this important information has surfaced.

In the mid-1980s, physicians in Kaiser Permanente's Department of Preventive Medicine, while doing an obesity study, discovered that patients successfully losing weight in the Weight Program were the most likely to drop out. “This unexpected observation led to our discovery that overeating and obesity were often being used unconsciously as protective solutions to unrecognized problems dating back to childhood. Counter-intuitively, obesity provided hidden benefits: it often was sexually, physically, or emotionally protective” The ACEs study grew out of Kaiser’s obesity research, and has since led to various papers explaining the correlation between adverse childhood experiences and later health outcomes.

ACEs refer to traumas/experiences including (but not limited to):
 Recurrent physical abuse
 Recurrent emotional abuse
 Contact sexual abuse
 An alcohol and/or drug abuser in the 
household
 An incarcerated household member
 Someone who is chronically depressed, mentally ill, institutionalized, or suicidal
 Mother is treated violently
 One or no parents
 Emotional or physical neglect

The study further explains that the more ACEs you have, the worse your health outcomes will be.  The purpose behind this ongoing collaborative study is to “Bridge the gap between childhood trauma and negative consequences later in life”.

I am not writing this blog to simply provide information on what ACEs are, but to ask that we all be aware of these experiences and how they have shaped our own lives, the lives of people we love, and how we can interrupt and prevent ACEs in the lives of children around us (be it our own, a niece/nephew or neighbor). Understand that ACEs do not just affect health outcomes, but habits that may permeate our everyday lives like smoking, alcoholism, drug use and abuse, violent behaviors, depression and obesity, which affect the people around us.

Understanding ACEs allows us to realize the power and necessity of programs like HeadStart, nurse-family partners, community health promoters, and a host of other programs and organizations that work with and support children and families to prevent and/or overcome adverse childhood experiences. Let’s remember, children are resilient, and given love and support following any type of traumatic event can make a tremendous difference.

I am also writing this blog to emphasize that, with this knowledge we can empower ourselves, build stronger families, communities, improve our health and fight for programs and services that support these endeavors.

The ACEs research has done more than provide statistics and outcomes related to adult health, it has provided a platform, an open space and evidenced based research, for individuals who have for so long, struggled to explain the connection between their medical illness and past/historical traumas. This research offers a language for us to articulate and command that our voices and stories be heard in the medical realm and around all issues of health and wellness. 

Rural Impact:  Recently Omak, WA brought an ACEs instructor to train the community about this research.  There are resources out there so if you want someone to come to your community, email Renee Gubert @ rgubert@omaksd.wednet.edu , AmeriCorps member at Omak School District, to learn how she helped make the training possible. 

Klickitat Community Developing Local Trail

By Kristina Alnajjar, Rural Program Associate

If you haven't heard of the Healthy People Alliance of Klickitat County and you live in Klickitat County--this is a wrong we need to right quickly.  They are a great community group in south central part of the state busy at work fulfilling their mission to prevent and reduce chronic disease in their community by promoting Healthy Choices regarding nutrition, physical activity, and tobacco use through policy, systems and environmental change strategies. 

This Alliance has been working to finish and connect the Little Klickitat River Trail.  As written by Alysa Haas, AmeriCorps member serving as Community Health Promoter for Klickitat County Health Department, for the Sentinel, "Since the group's inception in 2009, the chronic disease prevention-focused Alliance has been working toward fully developing the trail as a safe, beautiful, and no-cost place for local residents to exercise.  Yes you could join a gym, or get a pass to the pool, but walking is free.  The Healthy People Alliance wants to make sure that everyone in Klickitat County can be physically fit, regardless of income."

In addition to developing this local trail for exercise, the Alliance collaborates withGoldendale and White Salmon Head Start in establishing a school garden and integrating nutrition into curriculum and is creating a free workplace wellness toolkit that local work-sites can access to adopt a work-site wellness program.  We are happy to be partnering with such a strong, creative community group.  

Just recently, they were honored by the Washington State Public Health Association as a 2011 Health Champion. They won the Community Category which signifies they have contributed significant time, effort and passion to making the community a healthier place.  Check out the website to learn more about what this Alliance has done. We also want to congratulate this Alliance for all they do! 

Can We Collaborate?

By Lorna Stone, Vice President of Programs

 
There are lots of great blogs and newsletters out there, but one of my favorites is Eye on Health, edited by Tim Size of the Rural Wisconsin Health Cooperative. The following excerpt is from Leadership Insights: Can We Collaborate?, an article in their May issue, by Jo Anne Preston. 

 “Cooperation is great, but the word is not interchangeable with collaboration. … But when opinions clash, resources are scarce and priorities differ, collaboration is an effort that requires technical and interpersonal skill…"

Here are some things you can do to build more success at leading collaboration:

1. Decide why collaboration is in YOUR best interest. Is there something big you really want to achieve? Could it be more attainable if you got the support of others? When you ask for their support, make sure to find out what is in it for them too.

2. Identify together a clear purpose that is in everyone’s interest. This is your guiding light in times of personal agendas and egos flaring. Redirect the group to the mutual purpose when competition threatens to overtake collaboration.

3. Look for opportunities to share the credit…

4. Aspire to achieve a balance between ‘process’ and ‘outcome’. The dilemma: you won’t reach your deliverables if you don’t maintain relationships, and you won’t maintain relationships if you don’t eventually deliver. So you have to do both. If your personality is more attuned to the agenda, partner with someone who has a good intuitive sense of how the people process is working, and vice verse.

5. More collaboration = less control. Can you get more comfortable with that?

6. Create a ‘go to’ mantra for yourself, for when the going gets messy. For example,
‘Whatever we achieve together may take longer but will also last longer.’

7. Empathy goes a long way. Conflicts pop up when we see things differently. The old ‘seek first to understand’ softens the communication, opens up doors to understanding, and from there you can build. ..

8. Work to eliminate jargon. It’s safe to assume that if you use a lot of jargon, there will be some people who feel left out, not part of the group. Many will never tell you about it because they don’t want to look stupid. When you lose them, you lose your influence, so strive to keep your communication as clear as you can.

9. Good facilitation skills take the ‘personal’ out of differences. They help people process their thinking, make decisions that benefit the larger purpose and keep the focus on team. If you are not skilled in facilitation tools, either bring someone on the team to help with that, or learn them.”

Editor’s Note: If you are trying to make a decision about how you want to work with other organizations, Arthur Himmelman’s paper on the topic may be of interest.