A MAPP Forces of Change Activity Report

A MAPP Forces of Change Activity Report A Conference Report for Burlington County Leaders Are We There Yet? Planning for Healthy Communities Burlington County 2015 Burlington County Community College August 7, 2006 Report prepared by Robert Corman President, NPSE Inc. I. Introduction A gathering of leaders from across Burlington County participated in a morning-long session on August 7, 2006 to receive a progress report from various committees and to conduct a MAPP Forces of Change activity. Committees established one year earlier at the launching of the MAPP process reported on their progress in the following areas: a Community Health Assessment survey across all Burlington County towns (which was soon to be completed), a Local Public Health System Assessment of all towns, and a Community Strengths and Themes Update. This Summary Report focuses on the Forces of Change activity of the August 7 th session. A working Vision Statement and six overlapping questions viewed in context with the Vision Statement helped secure a current understanding of the forces influencing the creation of a healthy Burlington County. These relevant forces were decidedly not limited to Burlington County, but rather encompassed statewide, regional, national, and global dynamics deemed relevant to achieving the Vision of the County in 2015, as follows: In the vision of the future, the citizens of Burlington County will relate to one another within a culture of personal respect for their common interests as well as for their differences. This capacity will be derived from the creation of a host of educational, social, medical, environmental, and economic support systems that promote and sustain individual and collective self respect. Citizens, together, in their private lives or in the community, whether in the workplace, marketplace, schools, religious setting, or in any other activity, will create a healthy and safe

community that supports shared leadership, interconnected use of limited resources, accountability, and a capacity to change. The results will stimulate organizations to work for the long term public interest, and ensure positive health outcomes, strong families and households, and the clean environment and open spaces needed for sound social and economic development. Working with a facilitator, the following six questions were to small groups of participants at the August 7 th session. 1. What has occurred recently that may affect our local public health system or community? 2. What may occur in the future? 3. Are there any trends occurring that will have an impact? Describe the trends. 4. What forces are occurring locally? Regionally? Nationally? Globally? 5. What characteristics of our jurisdiction or state may pose an opportunity or threat? 6. What may occur or has occurred that may pose a barrier to achieving a shared vision? This summary is intended to capture the results of these individual groups in aggregate, highlighting and analyzing the consensus findings which emerged. This will help the MAPP process advance its planning and implementation as the leaders across the County strategize to achieve the vision of a Healthy Burlington County. Each question is examined below in sequence. NPSE has segmented the principal forces identified by participants in the exercise into various categories: short versus long term forces, from local to global forces, from financial to natural forces, and from positive to negative or a mix of both. It is important to keep in mind that edges of one force often meld with other identified forces, defying neat classification of one to the next. Finally, the capacity of the people and the leaders across Burlington County to directly impact upon or respond to these forces is directly related to the degree to which a force is local or statewide in nature. II. What has occurred recently that may affect our local public health system or community? This question called for a fresh, top of mind response from participants. Below, presented from the most often mentioned to the less often mentioned, are the top five categories delineated by participants. For the forces mentioned less frequently are also important to consider. Please refer to the table at the end of this section to see them. NPSE 2

A. Forces with global effects composed the most dominant category of forces in response to this question. Grouped together these forces have roots in international politics, global energy, and, global weather whether man-made or natural. In terms of preparedness, with a partial exception for terrorism, none of these issues are subject to Burlington County based action. The issue of immigration, which appears later, could also have been put into this predominant category. Global effects/oil/gas costs/terrorism/global weather B. The next grouping related to local/state financial matters. The relatively recent shutdown of State government due to budgetary shortfalls surfaced here, among other matters, particularly concerns with pressures felt from a variety of taxes. Financial issues/jersey Budget/taxes/ cost impact on housing C. Fear of specific diseases comprised the next category. This category was overwhelming focused on a pandemic of bird influenza, but also included two non contagious diseases. Outbreaks/Flu/West Nile/Lyme D. Issues related to personal responsibility prominently emphasizing a big worry about the emergence of gangs were mentioned by many groups. Gangs/Personal accountability/generation clashes E. The remaining groupings have a distinctive characteristic: they all represent subjects which can be addressed by local and statewide players. Q1. What has occurred recently that may affect our local public health system or community? Global effects/oil/gas costs/terrorism/global weather 10 Financial issues/jersey Budget/taxes/ cost impact on housing 8 Outbreaks/Flu/West Nile/Lyme 7 Gangs/Personal accountability/generation clashes 6 Health Prevention issues/cancer ratios/stress2/low government PH priority 4 Health services access/homeless shelter closings/emt shortage 3 Immigration/language barriers 3 Preparedness/personal/family/Local Board of Health inactivity 2 Environmental quality/air/noise 2 Infrastructure/safety/dams/traffic control 2 Political infrastructure- municipal boundary changes 1 NPSE 3

III. What may occur in the future? Participants were asked to look forward and, again, dwelling on the vision statement, share their projections of events. Both positive and negative perceptions were voiced, along with some perceptions that had the potential to carry both positive and negative elements or implications. A. Concerns primarily reflected a level of perceived vulnerability of the general population and its key institutions. Most of the concern focused on the rising costs of health care and health care operations on the day-to-day vis-à-vis the emergency room and the hospitals generally. Health care costs/access/hospital closings/weak ER capacity B. Major demographic shifts from population growth, influxes and immigration were the underlying cause of the next major concern. The tension cited here related to lack of above referenced capacity to serve the public s needs and also to the tension associated with growing racial bias. Associated with this issue is the worry about the growing income gap between rich and poor, which appears lower on the list but could well be merged into this concern. Demographic shifts/population increases/aging baby boomers/immigration C. Capacity again highlighted the next negative projection of the future. The readiness to address disasters from floods, over building. The general worry about readiness appears in responses throughout this question, whether displayed in comments about a weak E R capacity, or disaster readiness, or concerns about a pandemic. Disasters- due to floods/overdevelopment/better response capacity needed D. A few items appeared on the positive side of the ledger. These related to alternative and pilot program innovations, efforts to attempt fresh collaborative strategies and improved awareness of the need to be prepared. The message here seems to be that if positive efforts are tried, hope increases. Q2. What may occur in the future? Negative Health care costs/access/hospital closings/weak ER capacity 6 Demographic shifts/population increases/aging baby boomers/immigration 6 Disasters- due to floods/overdevelopment/better response capacity needed 3 Economic gap/ rich versus poor/causing population distribution 3 Int'l threats/pandemic 2 Global warming 1 NPSE 4

Positive Better public ed on being preparation/knowledge of services/fqhc 3 Merging towns/ Shared services between towns 2 Higher minimum wage 1 Alternate energy sources 1 PILOT programs 1 More affordable housing 1 Positive and Negative Implications Technology + and - 1 Diversity of immigration 1 Shared services can make a difference if trend grows 1 IV. Are there any trends occurring that will have an impact? Describe the trends. This question engaged participants in their current sense of present trends that they believed would have impact on the future. The positive message that came through posing this question was based in perceived success in getting towns to work together, better communication of timely information on preparedness and confidence that good uses of technology can make a difference. The negative messages that came through related once again to shortages of money for health services, shortages of those services and the rise in population and immigrants. Concerns about the widening gap between rich and poor and homelessness, as well as a host of personal behaviors related to youth and risky sexual practices signaled concern about the weakening of the social fabric of the community. Various doubts about the strength, capacity and judgment of government rounded out comments on the trends. Q3. Are there any trends occurring that will have an impact? Describe the trends. Positive Getting towns to work together and with Homeland Security/CERT teams 3 Better focus of technology- biotech 2 More public info to help people prepare 1 Communication skills/tech shift to IM and computers 1 Negative Health cost/access and Mental health, nursing shortage, hospitals bottom line focused 5 Population increases, Immigration, 4 Youth issues - their isolated, unconnected to nature, poorly guided, youth crime, 3 Loss of middle class, Homelessness, gentrification 3 Individual behaviors - High risk - AIDS, STDs, road rage cell phone use 3 Development in environmentally sensitive areas/farms/waterfronts 2 Narrow political awareness politicians just get re-elected 1 Challenges of military engagement- mental health impact on families of GIs/contractors 1 Government policy of eminent domain 1 Lack of transportation system in county 1 Weak education system, literacy 1 Threat of identity theft 1 NPSE 5

V. What forces are occurring locally? Regionally? Nationally? Globally? The patterns of responses to this question carry forward the themes that emerged in the previous questions. It reflects the ties and interdependence of the four levels. A. Lack of preparedness at local regional and national levels. B. Worry about income shortages and capacity to maintain living standards particularly at the local level but also at the regional and national levels. C. Serious concern about the mass movement of people through immigration, at all four levels from local to global. D. Voiced concern about the effects of global warming at all four levels. E. At the global level there was great focus on war, violence and intolerance. Q4. What forces are occurring locally, Regionally? Nationally? Globally? Local Income shortages, cost of living, gentrification, more work and less family time 5 Immigration, population growth, age discrimination 3 Preparedness 2 Outsourcing, poorer paying jobs 2 Global Warming Pollution/toxic waste Loss of youth activity Insurance costs for professionals in health care Regional Immigration, population growth 2 Preparedness Income shortages to maintain living standards Tri-state politics Outsourcing Communication Pollution/toxic waste Global Warming National Immigration, population growth 2 Preparedness Global Warming Income shortages to maintain living standards Outsourcing Over-sensationalism of possible events Too much consumerism Infrastructure weakness NPSE 6

Global War, Violence/WMDs/Intolerance of differences/silos vs. bridges 6 Global Warming, environment, control of resources 4 Too much consumerism Immigration Geo-politics VI. What characteristics of our jurisdiction or state may pose opportunity or threat? While cited in earlier questions, participants elevated the negative practices of towns in the County and the size of the County to a higher level. These political entities and their failure to work more together was the most mentioned negative characteristic about Burlington County. Other comments, directly related to this concern include references to the E/W split of the County and the challenges of commuter populations living and working in and outside of the County. Other negative characteristics are also cited. On the positive side of the equation some see an increase in the very collaboration called for in the paragraph above. The reference to a good emergency management system speaks to the concerns about preparedness voiced in earlier questions. Other positives are offered. The positive and negative implications should also be noted. Q5. What characteristics of our jurisdiction or state may pose an opportunity or threat? Negative County's size/ towns won't work together/town structures too varied/ towns interests not aligned 4 Rural transportation in County/Commuter population in and out of County/E/W split to County 3 Vulnerability to pandemic given population density Lack of community involvement Poor communication State budgetary issues/ distribution of funds High insurance rates Aging population Positive Good collaboration between agencies and organization in County 4 Good emergency management system Strong County College with only use of human simulators Diverse economic base Increasing scientific innovations and facilities Positive and Negative Implications NJ highly regulated Proximity to major cities/waterways Military bases Regionalization of some municipal services Potential for population growth NPSE 7

VII. What may occur or has occurred that may pose a barrier to achieving a shared vision? This question elicited what appears as a rich synopsis of the substance that emerged from the overall Forces of Change process. It added one key element to the mix: The need to promote the overall vision of a Healthy Burlington County. While each of these items appearing here are crucial and require strategic and collective thought, strategies and action, the communication of the vision may prove to be the most basic building/starting point for the leaders of the County in order to address the other barriers mentioned.. Communications on what the vision is, why it s important, building buy-in and caring Q6. What may occur or has occurred that may pose a barrier to achieving a shared vision? Gov't bureaucracy, politics, resistance to change, home rule, unwillingness among legislators 7 Lack of community outreach, involvement, and money for outreach 5 Intolerance toward issues, Stereotypes, lack of trust, greed, red vs. blue, lack of compromise, 4 Communications on what the vision is, why it s important, building buy-in and caring 3 Lack of planning to facilitate change, lack of teamwork & sharing of governmental resources 3 Terrorism, terrorist event or PH crises 3 Too much immigration, language barriers 2 VIII. Conclusion The synopsis of the Forces of Change exercise, presented here, when melded with the other work of parallel committees in the MAPP process will assist in guiding the strategies of leaders in the various sectors. The Vision Statement is the driving tool of the leaders of Burlington County working to achieve Healthy Communities Burlington County 2015. In designing the Community Health Improvement Plan (CHIP), the Vision Statement will prove its weight in gold ensuring that stakeholders stay focused and frame approaches that speak to individuals whether leaders or members of the general public. Public dissemination of the Vision Statement along with strategic explanations of the specific issues that will be addressed over time through the CHIP can help develop the very momentum Burlington County will need. NPSE 8