LAKE COUNTY MICHIGAN AND

COMMUNITY HEALTH: A STRATEGY TO

REDUCE MORTALITY RISKS
Presented by:
Julie Dragt Amy Lewis Leslie Rush Sara Young Amy Wirick
Ferris State University

LAKE COUNTY MICHIGAN

Rural community: population 11,498
Baldwin is the county seat with
surrounding communities of Irons,
Luther, Chase, Idlewild & Branch
Manistee National Forest and Pere
Marquette State Forest cover 48%
of the county
Industry: retail, construction,
healthcare, farming
Primary Race/Age: White, middleaged
(Lake County Chamber of Commerce, 2014)

LAKE COUNTY STRENGTHS

Lake County Community Foundation promotes education, well-

being, outdoor concerts and community gardens

Lake County Department of Health Services

Close proximity to neighboring hospitals: Spectrum Health in

Reed City and Big Rapids

Numerous lakes, parks and national forests to promote

outdoor activities

Lake County is part of the Live Well campaign that focuses on

efforts to reduce obesity and increase physical activity

LAKE COUNTY WEAKNESSES

High school Education

80.8%

88.7%

# people per PCP

5,758

1,271

# people below poverty

24.1%

16.3%

Jobless rate

12.7

8.7

Smoking

27%

20.3%

Obesity

43.1%

35.6%

Cancer Mortality Rate

(per 100,000)

221.5

180.3

Cardiovascular
Disease Mortality (per
100,000)

232.8

259.4

Diabetes related
mortality (per 100,000)

92.5

76.9
(District Health Department #10, 2013)

ANALYSIS OF DATA
Social-Ecological Model

The weaknesses
of Lake County
can be applied to
this model where
influences and
behaviors of the
community
observe negative
health outcomes
in relation to the
state of Michigan

LAKE COUNTY RESOURCES

Meals on Wheels
WIC (Women, Infants, Children)
Baldwin Family Healthcare
Lake County Community Foundation
Yates Dial-A-Ride public transportation
Commission on Aging with Senior centers
Manistee National Forest Trails

* Although resources appear to be numerous, they may not be

enough to meet the demands of the community which suffer
from chronic disease. Awareness, transportation and poverty
may contribute to under-use of these programs (Carl Frost Center, 2011).

LAKE COUNTY RESOURCES

Live Well established by District 10 to promote healthy

lifestyles: http://www.livewell4health.org/

Michigan State University Extension: education and research

from campus to community. Programs include Agriculture and

Agribusiness, Children & Youth, Health & Nutrition and
Greening Michigan

Lake County Resource: links to support and information:

http://web1mdcs.state.mi.us/webinfo/EHWResources/LakeCo
untyResources.pdf

ANALYSIS OF DATA: BARRIERS

It is clear that Lake County residents suffer from numerous

and complex factors that may contribute to greater mortality

rates than the state of Michigan as a whole:

Lack of education and awareness regarding disease process

Lack of primary care providers
Lack of adequate resources and counseling
High obesity rates that contribute to cancers, cardiovascular
disease and diabetes
Low income and socioeconomic factors
Lack of physical activity
Rural Community

ANALYSIS OF DATA: BARRIERS

Lack of education and
knowledge: disease
process & nutrition

Health behaviors and

Indicators lead to
increased mortality

High obesity rates and

lack of physical activity
lead to cancers,
cardiovascular disease,
and diabetes

Poverty: few or low

paying jobs in area,
inability to purchase
healthy nutritious foods

Lack of resources:
community support and
policy, gyms, grocery
stores, primary care
providers, health
insurance, transportation

PROBLEM STATEMENT

Risk of increased mortality among adult

residents of Lake County, Michigan
related to obesity as demonstrated by
higher than average rates of cancer,
heart disease and diabetes

REVIEW OF LITERATURE
Obesity has been associated with diabetes, cardiovascular

disease, hypertension and other chronic diseases and increased

mortality (Vucenik & Stains, 2012)

Epidemiological studies show that obesity is an established risk

factor for numerous cancers including colon, breast, liver, kidney,

pancreatic obesity leads to poor treatment outcome and
increased cancer-related mortality (Vucenik & Stains, 2012)

A study by Ludwig et. al (2011) shows that prevalence of obesity

and diabetes are reduced in neighborhoods with less poverty

REVIEW OF LITERATURE
Education at a level less than high school completion is commonly

associated with individuals in poverty. It has also been shown

that lower levels of education are associated with obesity and
poor nutrition

Smoking contributes to chronic conditions such as cancer,

respiratory and cardiovascular diseases- risk of stroke doubles

for those who smoke compared to those who do not

Regular physical activity is associated with decreased risk of

developing conditions such as diabetes, colon cancer and high

blood pressure as well controlling weight

(Jacobson, 2012)

PLANNING
Goal:
Community awareness and plan of action to fight obesity among
Lake County residents in an effort to reduce cancer, diabetes
and cardiovascular related mortality rates by way of primary and
secondary prevention- Yearly Community Health Fair (MayAugust) along with cooking/nutrition/disease classes, farmers
market, walk/run program and 5K finale

Who, What, When, Where, How?

The Logic Model (Harkness & DeMarco, 2012, p. 147) will provide
a visual representation of the plan. This model serves as a
planning and communication tool to carry out the process

PLANNING: THE LOGIC MODEL

Inputs/Resources

Public health nurse (advocate

for community policy change)
MSU Extension site and
students (site for initial
screenings, gardening
education and farmers
market)

Volunteers (cooking classes,

run/walk club)

Baldwin Family Healthcare &

employees
(funding/screenings)

Spectrum Hospital
(funding/screenings)

Activities/Interventions

Hold initial screening kickoff

in May fair will run through
August for Lake County
adults

Conduct initial survey at

health fair to determine
health behaviors

Fitness test, weight, BMI,

blood pressure, glucose
check, cholesterol screening

Run/walk club begins-times

and schedule determined by
club members- pedometers
welcome! 5K finale August

Yates dial-a-ride
(transportation)
Lake County Health
Department (info/brochures)

Advertisement/flyers in
schools and community

Dept Natural
Resources/Manistee Nat.
Forest (trails for 5K)

Farmers market throughout

summer-encourage community
policy
Cooking preparation and
nutrition classes offered
Disease prevention and
education classes
Participants encouraged to
keep journal of progress

Outputs/ Measures

(#) Lake County adults

initially screened

(#) Lake County

overweight/obese adults
screened

Outcomes/SMART Goals

August re-screen/survey
demonstrates positive change
in health behaviors:

Decreased BMI (10%) and/or

10lb weight loss

Journal: physical
activity/walking documented
30 min 5/days week--5K
completed!

Confidence expressed in
choosing and preparing
healthy foods/meals 3-4
days/week

(#) Lake County

residents joined
walk/run club

(#) Lake County

residents who attended
Farmers market

(#) Lake County

residents who attended
cooking/nutrition classes

(#) Lake County

residents completed 5K

Community policy enacted to

increase fruits/veg supply
local mkt within 1 year

(#) Lake County

Residents rescreened

Verbalization of risk factors

related to disease process
and mortality

Decreased mortality rates:

10% within 5 year period
Lake County adults

5-10% participation increase

at Health fair each year

Cost of health fair

PLANNING
Collaborate with local officials to promote awareness and obesity

prevention in Lake County

Utilize and refer to existing Lake County Resources

Secure site for Community Health Fair and screenings
Enlist volunteers and local agencies for funding and participation

(Baldwin Healthcare, Spectrum Hospital)

Advertise community program via Facebook, flyers, schools,

churches, community, radio, local newspapers, local TV news

Encourage community physical activity: utilize trails for walk/run

programs

Promote fruits and vegetables in local grocery and farmers

market-encourage policy enactment

INTERVENTIONS-EVIDENCE BASED
The CDC (2010) supports population evidence based approaches
to prevent and control obesity:
Policy, systems and environmental change (local, state, and

federal)

Create and maintain safe neighborhoods for physical activity

Improve access to parks and playgrounds
Support programs that bring local fruits and vegetables to

schools, businesses and communities

INTERVENTIONS-EVIDENCE BASED
The Institute of Medicine (2012) offers implementation strategies for community obesity
prevention:

Strategy 1-2: Provide and support community programs designed to increase physical
activity

Goal 2: create food and beverage environments that ensure that healthy food and
beverage options are the routine, easy choice

Strategy 3-1: develop and support a sustained, targeted physical activity and
nutrition social marketing program

Strategy 4-1: provide standardized care and advocate for community health
environmentsthis includes prevention, screening, diagnosis, and treatment of
overweight and obesity to help achieve and maintain a healthy weight and avoid
obesity-related complications. Examples include routine Body Mass Index screening,
physical activity and dietary counseling

INTERVENTIONS-EVIDENCE BASED
The CDC (2013) has criteria for selection of policies and

practices:

Supported by systematic reviews (The Guide to Community Preventive

Cited in national strategy or action plan (Healthy People 2020)

Recommended by recognized expert body, panel, or organization with an

evidence-based focus (Institute of Medicine)

Services)

Despite efforts to reduce obesity, according to the Healthy

People 2020 progress update (2014), obesity among adults and

daily intake of vegetables has shown little to no detectable
change

LEWINS MODEL OF CHANGE

Karl Lewins 3-step process of organizational change may be of

use when creating behavioral change at the community level:

moves community from

denial to awareness
Preplanning stage
education

Unfreezing

Changing
Transition toward
change begins
Achieved through
cycles or steps

Stabilization of
change
Goal is to sustain
change

Refreezing

(Harkness & DeMarco, 2012)

EVALUATION
The ultimate goal for Lake County residents is to realize a

decrease in cancer, cardiovascular and diabetes mortality rates

related to obesity

Creating change through awareness, diet, BMI, and physical

activity in the community will lower obesity rates. Yearly

reassessments with surveys and screenings will track progress

Collaborative efforts and utilization of resources within Lake

County along with a yearly Health Fair will bring needed attention
to the problem

Reassessing and re-evaluation of outcomes to determine the

needs of the community is an ongoing process to create change

EVALUATION
Reassessments & Measures
Monitor number of participants in yearly Health Fair: goal would be to
increase participation of Lake County residents each year by 10%
Yearly BMI, weight, blood pressure, glucose and cholesterol levels will

be documented at Health Fair in May: goal is to reduce BMI by 10% or

10lb by August

Overall goal is for Lake County residents to meet the

2020 obesity target of 30.5% over 5 year period

Healthy People

Increase consumption of fresh fruits and vegetables among residents

as reported in yearly survey

Increase physical activity to 30 minutes/day 5 days week as reported

in yearly survey

EVALUATION
Statistics and data will be obtained each year through

surveys, reporting, and tracking

Re-evaluation of program interventions, goals and outcomes

will be monitored and adjusted to:

Meet the needs of the community

Meet Healthy People 2020 obesity target goals

Realize lowered mortality of cancer, cardiovascular, and diabetic diseases

Create an overall healthier community

REVERSING THE OBESITY EPIDEMIC IS A SHARED

RESPONSIBILITY. SOCIAL AND ENVIRONMENTAL
CHANGES ARE INFLUENCED BY THE EFFORTS OF
MANY

(CDC, 2005)

REFERENCES
Carl Frost Center for Social Science Research Hope College. (2011). Health and health care landscape of

Osceola and Lake counties: Research results from the 2011 community-wide health needs
assessment. Retrieved from
http://www.spectrumhealth.org/documents/Osceola_and_Lake_Counties_CHNA.pdf
Centers for Disease Control and Prevention (CDC). (2013). Prevention status report. Retrieved from
http://www.cdc.gov/stltpublichealth/psr/npao/2013/MI-npao.pdf
Centers for Disease Control and Prevention (CDC). (2010). Adult obesity: What can be done. Retrieved
from http://www.cdc.gov/vitalsigns/AdultObesity/#Whatcanbedone
Centers for Disease Control and Prevention (CDC). (2005). Healthy communities: What local governments

can do to reduce and prevent obesity. Retrieved from

http://www.cdc.gov/obesity/downloads/CDC_Healthy_Communities.pdf
Department of Health and Human Services. (2014). Healthy People 2020 leading health indicators:

Progress update. Retrieved from http://www.healthypeople.gov/2020/LHI/LHI-ProgressReportExecSum.pdf

District Health Department #10. (2013). Health profile chartbook 2013: Lake county. Retrieved from
http://dhd10.org/dhd-community-statistics
Harkness, G.A. & DeMarco, R.F. (2012). Community and public health nursing: Evidence for practice.
Wolters Kluwer Lippincott Williams & Wilkins: Philadelphia, PA.

Institute of Medicine. (2012). Accelerating progress in obesity prevention: Solving the weight of the
nation. Retrieved from www.iom.edu/acceleratingobesityprevention
Jacobson, J. (2012). Fighting obesity, locally and nationally. American Journal of Nursing, 112, 17-23.
Lake County Chamber of Commerce. (2014). Welcome to Lake County, Michigan: Michigans outdoor
recreation paradise. Retrieved from http://www.lakecountymichigan.com/index.html
Ludwig, J., Sanbonmatsu, L., Gennetian, L., Adam, E., Duncan, G.J., Katz, L.F., Kessler, R.C., Kling, J.R.,
Lindau, S.T., Whitaker, R.C. & McDade, T.W. (2011). Neighborhoods, obesity, and diabetes: A
randomized social experiment. The New England Journal of Medicine, 365, 1509-1519.
Vucenik, I., & Stains, J.P. (2012). Obesity and cancer risk: Evidence, mechanisms, and recommendations.

Annals of the New York Academy of Sciences, 1271, 37-43. doi: 10.111/j.1749-6632.2012.06750.x