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May 2014

Last modified 2015-01-07 09:07

Health Advocates Empowering a Community


Program Spotlight


It takes time and commitment to develop a health education program that values collaboration, advocacy, community, culture, health equity, and leadership development. Over the last two years, the Salishan community of Tacoma has nurtured a Community Health Advocate (CHA) program that embodies all of these values. The project was community-driven from the beginning. The Comprehensive Health Education Foundation (CHEF) worked with Tacoma Pierce County Health Department, Tacoma Housing Authority, and Salishan Association to do an assessment of the Salishan community. They involved community members in the assessment, through focus groups, and in making decisions based on the results. The community said it needed a Community Health Worker program. So, one was started.

H.E.R.E. spent some time with three representatives of Salishan’s CHA program: Gretchen Hansen, the coordinator, and advocates Destiny Patterson and Than Him. Mr. Him and Destiny are two of the 15 CHAs at Salishan. The CHAs range in age from 16-70, but they all work together to connect their diverse community to the services and information they need to make healthy life choices.

Regardless of age, gender, or ethnicity, these people collectively support each other. For Salishan youth, the CHAs facilitate a youth kitchen, bike program, and an annual National Night Out event. Advocates reach all residents through regular tabling events, Bingo twice a month for elders, and community outreach. Whenever CHAs lead events for the Salishan community, they incorporate health education. Whether educating elderly about signs of stroke and heart attack at a Bingo night, or teaching youth about nutrition while gardening, these advocates recognize teachable moments in everything they do. Language and 360 cultural translations are provided whenever possible. According to Destiny, “Events help our community get away from bad things…This helped with the community as a whole.” The community now demands more programs and Destiny points out, “the residents always have a say.”   

CHAs understand the barriers that keep residents from accessing services. Gretchen says they “care to learn if the resident even knows the basics. Most cultures don’t operate as rapidly as medical professionals.” As Gretchen puts it, “we let them sit with [the information]” so residents can not only seek treatment or screening, but also understand why or how it helps them be healthier. They take the time to identify the underlying barriers to care (insurance, transportation, unemployment, lack of childcare, translation services needed, etc.) and connect residents with solutions.

When asked about secrets to their success, Gretchen, Destiny, and Mr. Him listed the following:
  • Each team member feels ownership of the program.
  • Treat the team as a circle, not a ladder. Each member carries weight and function in different ways while working to help each other learn and grow.
  • Understand they are volunteers. Provide food and childcare at every evening meeting.
  • Allow advocates to have realistic and flexible schedules.
  • Provide structure, mentorship, and opportunities for growth.
  • If you take time to recruit, you get good people. If you take time to listen, develop, and grow, you get good projects. If you take time to train, you don’t just get do-ers, you get leaders.
  • Work to their potential, not their ability.
  • Community partnerships should start with listening not asking. Programs should get to know one another, then help each other connect to services or resource-people. Be connectors and allies, not just takers.
  • It’s about empowering people on every level of community health advocacy—from training advocates to teaching community members.
For more information about community health education and the Salishan project, contact Gretchen at or 253-732-8755.

Let’s Talk About Stroke

Every 40 seconds, someone in the United States has a stroke. And every four minutes, stroke claims a life. Stroke is a major health issue for Americans—it’s the 4th leading cause of death nationwide and the leading cause of disability. However, only 1 out of 10 people in the United States think stroke is a major health concern.

So what do you really need to know about stroke?

Stroke shares risk factors with other chronic diseases. You can reduce your risk for stroke by:
  • Managing blood pressure
  • Eating a healthy diet
  • Being physically active
  • Maintaining a healthy weight
  • Keeping your cholesterol levels down
  • Making sure blood sugar levels are within a healthy range
  • Not smoking

Talk with your healthcare provider to come up with a plan that works for your health.

Having more than one chronic disease increases your risk for stroke. People with diabetes have twice the risk of stroke than people without diabetes. There is support for people with more than one chronic disease. Search for a Living Well program on or call 211.

Symptoms and signs can be easily remembered by the acronym F.A.S.T.

F = Face drooping
A = Arm weakness
S = Speech difficulty
T = Time to call 911

It’s important that people who experience stroke symptoms or signs be transported to the hospital by ambulance as soon as possible. Early arrival improves the chances of full recovery. The Washington State Emergency Cardiac and Stroke System is fully activated.

For more information on stroke, visit the American Stroke Association at

Prevention Status Reports–Washington Summary

In the January H.E.R.E. newsletter, we looked at how Washington is doing in preventing motor vehicle injuries. This was one of the 10 health concerns covered in the Centers for Disease Control and Prevention’s 2013 Prevention Status reports. Let’s look at how we’re doing for the other nine health concerns.

Policies and practices listed in the “what we’re doing well” column were established in accordance with supporting evidence and/or expert recommendations.

Policies and practices listed in the “what still needs work” column were partially established or are absent.

Policies and practices that are italized and bold in the “what we’re doing well” category were implemented after the 2013 Prevention Status Reports were written.


Health concern
What we’re doing well
What still needs work
  • State distilled spirits tax.
  • Commercial host liability law.
  • State beer tax.
  • State wine tax.
  • Local authority to regulate alcohol outlet density.
  • Speed of reported E. coli testing.
  • Completeness of reported Salmonella cases.
  • State participation in nationwide prevention effort.
  • Pharmacist collaborative drug therapy management policy.
  • Implementation of electronic health records.
  • State Medicaid reimbursement for routine HIV screening.
  • State HIV testing laws.
  • Reporting of CD4 and viral load data to sate HIV surveillance program.
  • State nutrition standards policy for foods and beverages sold or provided by state government agencies.
  • Secondary schools not selling less nutritious foods and beverages.
  • Inclusion of nutrition and physical activity standards in state regulations of licensed childcare facilities.
  • State physical education time requirement for high school students.
  • Average birth facility score for breastfeeding support.
  • State pain clinic law.
  • Prescription drug monitoring programs following selected best practices.
  • Expansion of state Medicaid family planning eligibility.
  • State cigarette excise tax
  • Comprehensive state smoke-free policy.
  • Funding for tobacco control.

For more information, visit the CDC’s Prevention Status Reports webpage.

National Public Health Week

Each year, the first full week of April brings attention to public health and prevention through the observance of National Public Health Week (NPHW). This year’s NPHW celebrated the theme “Public Health: Start Here.” From April 7-April 13 NPHW daily themes drew attention to maternal health, health at home, school nutrition, home life, emergency preparedness, prevention, food safety, and community health while focusing on the role of public health professionals as “guides” to help communities navigate the changing health system.In case you missed it, here are some highlights from this year’s NPHW:

  • On Monday, President Obama contributed his thoughts and thanks to NPHW, “All Americans deserve the chance to lead a healthy life and achieve their full potential.  And as a Nation, the health and well-being of our people must remain a top priority.”
  • On Tuesday, the Senate passed Resolution 415: Supporting the goals and ideals of national public health week and recognizes the role of the public health system in improving the health of the entire population.
  • A NPHW twitter chat on Wednesday generated 5339 tweets from 1099 people. The overwhelming participation made NPHW a national trending twitter topic that day.
  • Throughout the week, Social Media at CDC released their new online campaign: Public Health Nerd (#PHNerd) which uses social media to promote awareness and spark conversation around important public health topics and the CDC’s work. 
  • Friday marked the end of this year’s National Public Health Week. The take away message: Investments in public health have the potential to improve health outcomes and reduce healthcare costs. We can be the healthiest nation in one generation, and public health professionals can lead the way.
National Public Health Week plays an important role in connecting public health professionals and increasing awareness of health issues.  For more information on this year’s NPHW, including podcasts, videos, and other resources, visit  

Material Spotlight

New workbook on HERE! Steps to Quit Smoking: How Other Moms Have Quit is a tool for providers, health educators, local health, and care coordinators to give to pregnant women who need help quitting tobacco. The workbook offers information about tobacco, marijuana, and E-cigarettes, a 5-step plan, and quit-tobacco tips and resources. The workbook can guide a woman through the steps on her own or with her provider.


Asthma Awareness 

In Washington, adult asthma prevalence continues to be higher than the United States average and identified by the Centers for Disease Control and Prevention (CDC) as one of the highest in the nation. In addition, an estimated 110,000 youth in Washington have asthma.

Asthma is associated with reduced quality of life among individuals and a significant social and economic burden on the state. In 2010, hospitals charged $73 million for asthma related hospitalizations, and work related asthma claims cost the state $300,000.

Yet asthma is manageable. To reduce the overall burden of asthma, it is important for people to know common triggers, how those triggers can lead to attacks, and how to manage or prevent them. Providers play an essential role in getting this information to patients. In 2013, about two-thirds of adults with asthma who smoke were advised to quit by their healthcare provider during at least one visit in the past year.

Increasing awareness of how lifestyle affects asthma is essential. Currently, about 35% of adults with asthma report not visiting the doctor for routine checkups, and only one-third of youth with asthma have a written asthma plan to help them control their medication and exposure. Written asthma plans and routine checkups are best practice. They support positive lifestyle change and asthma management.

For people with asthma, key recommendations include:

  • Reduce exposure to asthma triggers in the environment and home, especially smoke, dust mites, pests, pet dander, mold, and scented or chemical products.
  • Stop smoking to eliminate a prime cause of asthma.
  • Avoid eating pre-packaged foods by cooking your own meals.
  • Exercise regularly and talk to your doctor about weight management.
  • Practice stress management.
  • Refer to the nearest asthma home-visit program.

The Washington State Department of Health Asthma Program has information and resources to share. Help make Washington a friendlier place for people living with asthma. For more information, visit the Department of Health Asthma page.

H.E.R.E. Bids Farewell to Don Martin


Don Martin began working in public service in 1985 and has spent the last 24 years working for the Department of Health.

In 1995, the Department of Health received a grant from the Centers for Disease Control and Prevention (CDC) to create a clearinghouse for health education materials. Don facilitated the beginning of the clearinghouse, the Health Education and Resource Exchange (H.E.R.E), and has ensured the sustainability of H.E.R.E. through today. He started by surveying health professionals to find out what they need information on and in what formats. He helped build H.E.R.E. to meet their needs and has made sure that the website kept up with the evolution of public health, the needs of professionals, and technology. He was recognized twice for this work; in 1998 by the CDC and in 2003 by Governor Gary Locke. Today, H.E.R.E. is the only clearinghouse still sustained in the nation.

Don has also passionately and persistently promoted culturally and linguistically appropriate services (CLAS) at policy, systems, and program levels. He believes that to best serve populations with the greatest needs, we need to ensure that our services and materials are easy to understand and respect our state’s cultural diversity. He has succeeded in changing translation practices in our division and is bringing attention to this work at the agency leadership level.

Don will retire in June 2014. He has made a career of going the extra mile for the people of Washington and will leave behind an incredibly successful health education resource and a budding internal movement to promote CLAS. Thank you and good luck, Don!

H.E.R.E. is Taking Nominations for Colleagues to Spotlight!

Every newsletter, we spotlight a colleague in the field who is making important contributions to public health. Do you know someone who has made an impact in public health? Nominate him or her for the Colleague Spotlightby clicking here!

New Materials and Events on H.E.R.E. 

Check out the materials and upcoming events we added to the H.E.R.E. site since our last newsletter:  

Impact of Asthma in Washington State infographic

Substance Free for My Baby handout 

Policy, Systems, and Environmental Change Health Equity Forum (June 6, 2014) Seattle, WA

Tribal Public Health Emergency Preparedness Conference 2014 (June 17-18) Portland, OR

STD Update with Optional Clinical Practicum (August 14, 2014) Boise, ID

Venipuncture Technique (August 22, 2014) Seattle, WA


Nominate a Colleague to Spotlight in the Newsletter

Do you know someone who has made an impact in public health? Nominate them for the Colleague Spotlight article.