June 2013
Centers for Disease Control and Prevention
Prevention Research Centers

The CDC Worksite Health ScoreCard may be just what Cheshire County, New Hampshire needs to achieve its aspired status as "the healthiest community in the nation" by the year 2020. The scorecard was developed and validated by researchers from the Emory University Prevention Research Center, in partnership with CDC, state health departments, and worksite health experts. The ScoreCard is a tool that helps employers assess their use of proven health promotion strategies at their worksites, focusing on topics such as hypertension, tobacco control, nutrition, depression, and diabetes. At the end of 2012, the Keene, NH-based community partners of the Dartmouth College Prevention Research Center started using the ScoreCard in Cheshire County, and have already used it with several organizations. Read more to see how using this tool is increasing Cheshire County's chances of meeting their 2020 health goals.

County Leadership Casts the Vision

In 2006, the Vision 2020 initiative was launched in Cheshire County, in which its citizens and organizations were encouraged to become "the healthiest community in the nation" by the year 2020. The county has a population of 77,000 and has one unified healthcare system called Cheshire Medical Center/Dartmouth-Hitchcock Keene (CMC/DHK)*. The medical center houses primary health care, specialty health services, preparedness efforts, disease prevention and health promotion, and the Keene-based work of the Dartmouth College PRC in Cheshire County.

Unlike most states, New Hampshire does not have a public health infrastructure of county health departments. Instead, the state is split into public health regions, each with a designated public health advisory board. The CMC/DHK medical center had convened the Council for a Healthier Community in 1995, and this group easily stepped into this role of public health advisory board for the region in 2012. The Council represents multiple sectors, including schools and childcare, clergy, government, emergency management, home healthcare, employers, dentistry, healthcare, human services agencies, service clubs, and higher education. It provides leadership for examining the community's status, needs, and determinants of health.

Employers Become the Champions

Under the banner of Vision 2020, more than 1,900 individuals and 80 organizations are currently registered in a "Champions Program." This program engages members to promote healthy lifestyle behaviors through monthly newsletters, awareness activities throughout the year, and an annual recognition event. From its inception, employers have been a part of the Vision 2020 initiative, and they are now committed as champions through pledges to either initiate or improve an employee wellness program. This workplace wellness initiative was initially conceived by Cheshire County HEAL (Healthy Eating/Active Living) with the major source of funding from the Healthy New Hampshire Foundation. Their impact on health may be great—employer-based health promotion programs have a high capacity for reaching most adults in Cheshire County as there are approximately 45,000 working-age adults in Cheshire County, and a particularly low unemployment rate of about 5%.

The CDC Worksite Health ScoreCard Becomes the Tool

Within a few months of introducing the CDC Worksite Health ScoreCard, several employers in Cheshire County started using it:

  • Cheshire Medical Center/Dartmouth Hitchcock Keene medical center (1400 employees)
  • Keene State College (>1000 employees)
  • Monadnock Family Services (225 employees)
  • Home Healthcare, Hospice and Community Services (447 employees)
  • Chamber of Commerce (6 employees)

Using the results from the ScoreCard, organizations are encouraged to select at least three items as first-year priorities and receive assistance creating an action plan. A list of practical technical assistance and local resources is being built for county employers, which relates to each question on the ScoreCard. The tool will eventually be used with all the champion organizations, with the intention of completing all baseline surveys before the end of 2013. The ScoreCard will be used yearly to track improvements in employer programs and overall employee health over time.

Evaluation Plays a Central Role

Vision 2020 has an expert evaluation team and a specified set of core indicators to monitor the challenges and successes of the initiative. This team is able to use existing BRFSS measures and a county-level validated survey of health behavior and health access to support and track the progress of Vision 2020. This same team will align these data with the work done through employers and the ScoreCard and potentially see county-wide benchmarks of progress and improvements in health related to employee wellness endeavors.

A unique, and potentially beneficial, attribute of Cheshire County is that the closest large city is about an hour away, which makes the health needs, as well as the solutions and results, for the county quite distinct. Though there are certainly challenges that come with geographic isolation, this characteristic may allow for data that are straightforward and results that are attributable to this local initiative and not easily complicated by surrounding programs and variables.

What the Future Holds

With the county leadership casting Vision 2020, and the support and commitment of county businesses to improve employee wellness programs, this community has positioned itself to make a powerful impact on the health of its people. The introduction of the CDC Worksite Health ScoreCard seems to have come at an ideal time, to equip these employers with the necessary tools to follow through on their commitment to impact the health and wellness of their employees. The ScoreCard is also simple enough to implement with multiple employers, for employers to complete each year, and to assess progress through time. The leadership of Vision 2020 anticipates that corporate behavior surrounding the issue of health will increasingly improve as they see results, until it becomes more of a cultural norm for businesses around the county to be motivated to improve the health of their employees, their families, and the community as a whole. Vision 2020 may very well be achieved through the hard work of Cheshire County employers and leadership, the CDC Worksite Health ScoreCard, and the Dartmouth PRC.

* Participation does not imply endorsement by DHHS.

Download the CDC Worksite Health ScoreCard and visit the Workplace Health Program website. Also see the achievement about the Emory University PRC developing the ScoreCard.

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