The Wisconsin Healthy People at Every Stage of Life Framework
By Susan Uttech, MS
Director, Bureau of Community Health Promotion, Wisconsin Division of Public Health
How It Began
The Wisconsin Division of Public Health, Bureau of Community Health Promotion (BCHP) has supported the life course approach to improve health outcomes for some time. Research was beginning to inform BCHP about the origins of chronic disease and the complex interplay of protective and common risk factors (Halfon and Hockstein 2002; Lu and Halfon, 2003). For example, babies born at a low birth weight are more likely to have heart disease, hypertension and diabetes later in life. BCHP staff recognize that we are better, together.
In 2007, an existing division-wide program integration work group reviewed more than 300 program messages and consolidated them into six key messages for all programs to use as “the elevator speech” describing what we do to have Healthy People at Every Stage of Life (HPESL). The six key messages were:
Stay clear of tobacco
Achieve mental wellness
In 2008, Wisconsin was selected by the CDC as one of four states to participate in the Negotiated Agreement Pilot (NAP) to focus on chronic disease program integration. Participation in the NAP project provided the impetus to further develop, share and use the framework. BCHP staff incorporated and improved the HPESL framework by developing a matrix with embedded program specific messages within the broader HPESL framework applied over five life stages (or age groups) across the life span. For each life stage, the HPESL framework depicts a set of core messages which fall into the overarching categories of the key messages. The HPESL framework describes how health promotion and disease prevention efforts fit together across the life course.
How the Framework is Implemented in the Bureau
The majority of BCHP staff were actively involved in developing the framework resulting in significant “buy in” among staff. Evaluation results during the NAP project showed that many staff used the HPESL framework. On surveys conducted during 2010-2012, staff were asked if they have used the HPESL framework in the past month, and if so how. On each survey, 20 percent of respondents reported that they used the HPESL framework in the past month.
Out of the 133 examples described, the most common reported uses of the framework were for: program planning, developing messages, communicating with partners, creating funding applications and explaining with BCHP does.
Accomplishments Related to the Framework in the Bureau
BCHP staff said the framework lead to efficiencies in multiple areas by providing structure, reducing duplication of activities, providing guidance for program planning, and sharing messages to use across all BCHP programs. Staff also noted that having this clear, defined framework has provided stability and focus and helps BCHP to stay on course with its mission. In addition, the framework was helpful to reduce turf issues among programs and encouraged programs to look at modifiable risk factors (such as diet, physical activity, tobacco exposure, and alcohol use) when planning programs. As a result, staff were more inclined to “think out of their program box” and explore how a focus on modifiable risk factors could promote a life course approach. Examples of some topics that were pursued included: gestational diabetes; smoking during pregnancy; and children and youth with special health care needs and chronic disease prevention.