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Even With Advantages of Suburban Life, Many Residents Still Not Healthy

In Morris County, long commutes, difficult-to-reach parks and income inequality cited as factors contributing to poor health

From left: James Barber, Xiomara Guevara, and Chris Kirk

New Jersey has some of the wealthiest suburbs in the country, but many of their residents live very unhealthy lives.

For example, Morris County has the ninth-highest median household incomes in the country and the third-best health outcomes in the state.

But 21 percent of its adult residents are obese, and Morris County is worse than the state averages in the share of commuters who drive to work alone or have long commutes – two factors linked to poor health.

However, public-health advocates are working together in many suburban communities on projects that they believe will improve residents’ health.

From making it easier for children to walk to school -- and for everyone to walk to parks -- to programs connecting low- and moderate-income residents with both behavioral-health and medical care, suburban towns are trying to close gaps in community services that contribute to pockets of poor health outcomes.

In Morris County, one of the organizations driving for broad-based health improvements is the North Jersey Health Collaborative, an alliance between local health and social-service providers organized by Atlantic Health System, the parent of Morristown Medical Center.

Collaborative President and Chairman Chris M. Kirk, who works for Atlantic, said Atlantic’s hospitals assessed the needs of their local communities and found that local public-health agencies and service providers were doing similar assessments. That led to a partnership in which they share data about their communities with a goal of better understanding the health issues of residents.

“We still have these really persistent, sort of nasty, intractable problems,” Kirk said. “Although we have a great resources in many different areas, we haven’t moved the ball on a lot of things,” but may be able to do so by pooling their efforts with other groups.

The Robert Wood Johnson Foundation is supporting health-focused collaborations statewide.

As part of its mission to build a “culture of health,” the foundation officials is emphasizing cross-sector collaborations as one of four areas where communities and organizations can measure progress. The other action areas are making health a value shared by everyone; creating healthier, more equitable communities; and strengthening the integration of health services and healthcare systems.

At a forum the foundation sponsored in Parsippany, RWJF chief of staff Robin Mockenhaupt said the organization is building a baseline this year so that it can measure national progress on each of these action areas in the future. She encouraged New Jersey communities making progress on health to inform the foundation so that they can be considered for use as examples nationally.

“Sometimes there are policies in places -- in organizations and government -- that prevent collaboration from happening,” Mockenhaupt said. “So how can we get more policies that support people being able to collaborate together?”

In Morris County, employers have been active in some of these collaborative efforts. Morris County Chamber of Commerce President Paul A. Boudreau said employers have a “bully pulpit” to encourage their workers to live more healthily – and a stake in having a healthy, productive workforce.

So far, local employers have simply encouraged workers to participate in health screenings and healthy activities through incentives, but could use penalties in the future.

“They would rather use the carrot than the stick,” he said.

One employer that’s been active in promoting employee health has been the township government of Parsippany-Troy Hill.

The township was facing annual health-insurance cost increases upwards of 20 percent in 2010, said Mayor James R. Barberio.

The township launched a wellness program and saw more than three-quarters of its employees sign up for screenings. Barberio said township workers lost a collective 1,900 pounds (he lost 44 pounds himself). And it’s had an effect in producing lower health-related costs.

One obstacle to being more active in some suburban towns: a lack of sidewalks and bike paths.

Leigh Ann Von Hagen, senior research specialist at Rutgers University’s Alan M. Voorhees Transportation Center, said local communities can benefit from making walking and bicycling safer. She noted a recent report by U.S. Surgeon General Dr. Vivek H. Murthy calling for everyone to get at least 22 minutes of physical activity such as walking every day.

Cedar Knolls-based nonprofit TransOptions has been encouraging walking by both children and adults. TransOptions representatives visit schools to encourage both students and workers to walk or bike to school or work.

Health problems are greater among certain subsets of the population in wealthy suburbs.

Hispanic residents of Morris County faces] unique obstacles to better health, according to Xiomara Guevara, executive director of the Morris County Organization for Hispanic Affairs. Along with dealing with language barriers, many Hispanic residents don’t have access to medical specialists, she said.

And Dr. Rina Ramirez of Zufall Health – a federally qualified health center that services six northern New Jersey counties -- added that Hispanic residents working two jobs have difficulty traveling to parks, which are a focal point for physical activity in the county.

Guevara added that there has been success with some programs targeting Latinos, including Faithful Families, which encourages nutrition and exercise through religious congregations.

More broadly, health experts pointed to a concentration of chronic diseases among lower-income residents who are present in even the wealthiest areas.

Eva Turbiner, president and CEO of Zufall Health, said income inequality underlies health problems in New Jersey’s wealthier counties. She noted that thousands of area residents work multiple jobs without sick leave or vacation days, which makes it difficult for them to get medical or behavioral healthcare.

She would like to see county-level policies supporting paid sick leave and getting people who aren’t legally authorized to be in the country paid “on the books,” with benefits.

Robert L. Parker, CEO of behavioral health provider New Bridge Services, said linking behavioral healthcare with other medical services is essential to making broader improvements in health. This is particularly true for the “superutilizers” who account for a large share of healthcare services and spending, he said.

Parker noted that the federal law guaranteeing that behavioral health and other medical care are equally accessible is still being implemented.

Bob Atkins, who directs the Robert Wood Johnson Foundation’s New Jersey Health Initiatives, said the work being done by the groups collaborating in Morris County is an example of what the foundation is seeking to encourage throughout the state.

The foundation recently announced that it is expanding its Communities Moving to Action program to 10 more communities in 2016. The program, which provides $200,000 to help form local health-focused coalitions, announced its first 10 grant recipients in July. The North Jersey Health Collaborative was one of the grant winners in that round.

Disclosure: The Robert Wood Johnson Foundation provides funding for NJ Spotlight’s health coverage.

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