CORONAVIRUS (COVID-19) RESOURCE CENTER Read More

Worksite Wellness Collaborative Outreach Model - Including Public Health, Business, Government, and Community Partners

State: CO Type: Model Practice Year: 2014

1) Location:Tri-County Health Department (TCHD) is located in the Denver metropolitan area of Colorado and serves the Counties of Douglas, Arapahoe, and Adams. 2)Public health issue: According to a report by the Centers for Disease Control (CDC), American businesses are losing their competitive edge due in large part to lost productivity and unsustainable healthcare costs incurred by chronic disease. Medical costs associated with chronic diseases account for more than 75% of the nation’s medical care costs. (Chronic Diseases: The Power to Prevent, the Call to Control, 2009). It is well documented that lifestyle habits, including an unhealthy diet, physical inactivity and tobacco use, are risk factors for chronic diseases. Healthy People 2020 Occupational Safety and Health Objectives recommends that preventive strategies aimed at reducing health-related risks include worksite offerings of prevention and wellness programs. 3)Goals and objectives: The goal of this project is to create a culture of wellness among Aurora employers and decrease employee risk factors for lifestyle-related chronic diseases. This will be done by working with employers to implement best practices in worksite wellness to address employee access to healthy foods, physical activity, and engagement in prevention health strategies. Specific objectives follow. Obj 1. Eight to ten small employers (<600 employees) in the City of Aurora will be recruited to implement worksite wellness programs. Obj 2. Participating employers will complete a series of benchmarks within a 19-month period. The benchmarks are based on the CDC’s best practices for worksite wellness and are outlined in the Evaluation section of this application. Obj 3. Following completion of the benchmarks, participating employers will take a leadership role in developing a sustainability plan. TCHD and the other original stakeholders will assume a supportive role in this process. Practice implementation: 4)Implementation steps for the initiative included the following. Formed a taskforce of diverse stakeholders including Tri-County Health Department (TCHD), Aurora Chamber of Commerce, YMCA of Metropolitan Denver, City of Aurora, LiveWell Colorado, a local business owner and consultant. Surveyed local employers through a questionnaire sent by the Chamber of Commerce. Those employers who indicated on the questionnaire that they were interested in learning more about worksite wellness, were invited to a kick-off event at the Chamber. Eight employers committed to participating in the initiative. TCHD’s worksite wellness advisor provided technical assistance to each employer as they developed a worksite wellness program. Employers attended the following: quarterly educational/networking workshops; the Colorado Culture of Health Conference, and the Aurora Chamber's Awards Ceremony. 5)Results and outcomes: The three objectives of the initiative were achieved as follows. A total of eight employers in the City of Aurora were recruited to participate. Seven of the eight employers completed the required benchmarks within a 19-month time period. The benchmarks and additional accomplishments of the employers are fully outlined in the Evaluation section of this application. A sustainability plan was developed by the participating employers. The plan includes a component to build on programs developed by the original employers as well as acomponent for recruiting new employers to join the initiative. 7)Specific factors that led to the success of this practice: The taskforce was a diverse group of stakeholders representing business, government, non-profit, and the public health sectors. Members contributed both their personal expertise and their organization's unique resources. Additional factors that led to the success of thie practice include the following. The Aurora Chamber of Commerce was a key stakeholder. As an established institution within the business community, they were an integral part of communicating messages and recruiting employers. The practice was tailored to meet the needs and pace of each employer. It provided flexible accountability without rigidity. The quarterly workshops and conference provided valuable networking and mentoring opportunities. An innovative concept known as Prize Philanthropy was used to incentivize employers to complete the initiative’s benchmarks. The concept is explained in the Responsiveness and Innovation section. 8)Public health impact of the practice: The public health impact of the practice of worksite wellness among local employers will ultimately be a reduction in risk factors for chronic disease among employees who work for employers that follow the best practices for worksite wellness implementation. A secondary impact will be to establish the importance of worksites as environments having a strong impact on the health of our community. This involves employers acknowledging the significant role they play in the health of their community and embracing worksite wellness as a business strategy.
1) Brief description of Tri-County Health Department:Originally known as Tri-County Health District, the health department opened on January 1, 1948 in the basement of the psychopathic ward at a local hospital serving the 150,000 residents of Adams, Arapahoe and Jefferson Counties. In the years since, Douglas County was added and Jefferson County has established a separate health department. Today Tri-County Health Department (TCHD) serves 1.3 million people in Adams, Arapahoe and Douglas Counties Tri-County has over 60 programs, with 11 offices in a 3,000 square mile region. Five divisions at TCHD provide a variety of services including the following. Birth and death certificates issued to the public Nursing programs that include immunizations, family planning and birth control, Children with Special Needs referrals, Medicaid assistance and outreach, prenatal and parenting case management, health screenings for underinsured and uninsured women, dental services for seniors Investigation of individual cases of a wide variety of notifiable diseases, identifying and investigating disease outbreaks , and conducting ongoing epidemiologic surveillance of numerous infectious diseases Environmental Health Services such as restaurant and childcare center inspections, occupational health and industrial hygiene, and emergency preparedness and response Nutrition services including WIC, community classes, childcare nutrition, community gardens and tasting cafés and a dietetic internship 2) Statement of the problem/public health issue: Chronic diseases are the leading cause of death and disability in the United States. Medical costs associated with chronic diseases account for more than 75% of the nation’s medical care costs. (Chronic Diseases: The Power to Prevent, the Call to Control, 2009). Diseases such as diabetes, cancer and heart disease are among the nation’s most costly yet preventable conditions to treat. There is a large body of research to support the link between lifestyle health risk factors including physical inactivity, poor nutrition and tobacco use, with the onset of chronic disease. According to the World Health Organization, if lifestyle risk factors were eliminated, at least 80% of all heart disease, stroke and Type 2 Diabetes would be prevented; and, over 40% of cancers would be prevented (Preventing Chronic Disease, a Vital Investment, WHO, 2005). Healthcare expenditures and health insurance premiums continue to rise for large and small employers. For smaller employers, work days lost to employee illness, injury, and absenteeism continue to be financial burdens and the effects of chronic diseases compound these issues. Smaller employers have an unprecedented opportunity to impact the health and wellness of their employees while at the same time, improving their businesses’ bottom line. The past few decades have seen increased employer interest in ways to decrease employer health-care expenditures and improve employee productivity. Because many Americans spend more than half of their waking hours at work, the worksite culture and environment can play a critical role in either supporting or undermining an individual’s attempt to practice a healthy lifestyle. Worksite wellness programs are gaining ground as a means of addressing modifiable health risk factors in order to stem the tide of chronic disease and ultimately control healthcare costs. Businesses which employ large numbers of workers have traditionally been the trend setters when it comes to implementing these programs. While larger employers are making wellness programs available to their employees, it has been noted that smaller employers are not as likely to offer these programs. Reasons cited by smaller employers for not offering employee wellness programs include cost and time. However, because 37% of employees in the state of Colorado work for small businesses (<100 employees), smaller employers cannot be overlooked as a valuable point of access to reach a significant portion of our constituents with health information (U.S. Census Bureau, 2008). Engaging the business sector in addressing the epidemic of obesity and lifestyle-related illness in our community is a win-win-win situation; a win for employers because a healthier workforce is a more productive workforce (CDC Worksite Health Scorecard, 2012); a win for public health because the worksite provides a captive audience to disseminate health messages to constituents; and, a win for employees who gain ready access to resources and tools to support their efforts to lead a healthy lifestyle and lower their risk for chronic illness. 3) What target population is affected? The target population for this practice includes eight employers and the sub-population can be defined as the employees, the approximately 1,250 individuals who work for the participating employers. Employer size ranged from 7 to 600 employees and included the following industries: a car dealership, a credit union, an emergency ambulance contractor, two local non-profit organizations (the local chamber of commerce and a health education center), an insurance broker, a hotel, and a security management company. It should be noted that one of the eight employers, the insurance broker with a total of 8 employees, was not fully engaged during the initiative and did not complete all of the benchmarks. 4) What has been done in the past to address this problem? Efforts to reach out to the business sector on behalf of public health have been initiated across the country at the local and state level and more recently at the national level, under the National Healthy Worksite Project, a CDC initiative being conducted in seven regions across the country. In order to learn what outreach practices were successful and what failed, past and current worksite wellness initiatives in the state were researched prior to implementation of this practice. Examples in Colorado include annual employer workshops conducted by the Colorado Physical Activity and Nutrition Coalition between 2004-2010. In Northern Colorado, the Weld County Health Department led efforts in 2005 to earn a "Well City" designation for the City of Greeley. This involved convening local employers for educational presentations on wellness topics. LiveWell Colorado has supported local worksite wellness efforts in both Longmont and Fort Collins since 2008.A notable contribution to worksite wellness efforts in the state is the Colorado Business Group on Health's annual conference. Titled "Colorado Culture of Health," the conference highlights examples of innovation in healthcare and worksite wellness. Because the conference is well known as a high quality venue for obtaining worksite wellness resources, the stakeholders of the current practice made the decision to allocate funds towards covering the conference registration fee for the participating employers. Although much was learned from examining earlier initiatives, it became apparent that something was missing from these earlier models. They were heavy on education and light on implementation and follow- up. Missing was a method or strategy for engaging employers in the actual implementation of best practices and the tracking and evaluation of their worksite wellness programs. 5) Why is current practice better? There were two significant differences between the present practice and prior outreach models. First, the participating employers in the current initiative were provided with ongoing access and support of a worksite wellness advisor. In this case the role of advisor was assumed by TCHD's existing worksite wellness coordinator. In addition to providing technical assistance, the advisor linked employers to local free and low-cost resources and checked in with each employer on a bi-monthly basis for progress reports. This strategy kept employers engaged and prevented them from slipping through the cracks. The second distinguishing factor of the current initiative was the way in which funding was utilized to incentivize employers. In lieu of offering mini-grants at the beginning of the initiative, as was done by prior initiatives, the concept of Prize Philanthropy was introduced as an incentive model mid-way through the initiative. This was tried because it was reported by coordinators of prior initiatives that it was difficult if not impossible to get employers to complete even the simplest of mini-grant applications. With Prize Philanthropy, employers were not required to complete an application stating what they would do with the money. Rather, they were awarded with a financial reward after having completed certain objectives of the initiative within a prescribed time period. The funds were allocated to an employer's worksite wellness budget and the employee wellness committee for that employer then determined what future programs they would utilize the funds for. Employers reported that their employee committees were empowered by the financial incentive. The Evaluation section of this application outlines how the money was utilized by the employers. 6) Is current practice innovative?Yes, the current practice employed the creative use of both an existing tool and concept as outlined below. Creative use of an existing tool: The Community Health Assessment and Group Evaluation (CHANGE) form was originally created by the CDC as a tool to assess what sectors within a particular community could benefit most by an intervention. In addition to be utilized in its intended form early on in the initiative, the tool was also utilized as a resource by the TCHD advisor during the initial employer interview and worksite environment audit. The CHANGE form includes a checklist of policy and environmental elements that, when put in place, support health and wellness in the worksite. The checklist was divided into the following five categories which conveniently align with the CDC's best practices for worksite wellness: Leadership and institutional support; access to opportunities to engage in physical activity; access to nutritious food during the workday; access to tobacco cessation resources; and access to chronic disease management and prevention resources. Creative use of an existing concept: Prize Philanthropy, often used in the corporate world to award innovation, was used creatively in the current practice in lieu of the more traditional mini-grant that former outreach models have employed. Instead of completing an application explaining what they planned to do with funds, the employers were awarded, mid-way through the initiative, for achieving certain benchmarks. This did away with the necessity of employers having to complete grant applications which have been cited as a barrier to participation in earlier outreach models. Award money was deposited into the employer’s worksite wellness budget to be spent on employee wellness programs. Additional unique features of the current practice are listed below. The taskforce was comprised of a diverse group of stakeholders representing business, government, non-profit, and the public health sectors. The Aurora Chamber of Commerce was key to building relationships with the employers. As an established institution within the business community, they were an integral part of communicating messages and recruiting employers. The practice was tailored to meet the needs and pace of each employer. It provided flexible accountability without rigidity. The quarterly workshops and conference provided valuable networking and mentoring opportunities. Sustainability – Both the original stakeholders and participating employers were committed from day one of the initiative to making it sustainable. A plan was developed with the employers taking the lead. The plan includes integrating the worksite wellness initiative within the healthcare committee at the Aurora Chamber of Commerce. Additionally, the original employers will conduct quarterly workshops or CEO/wellness champion breakfasts, as they will be called, beginning January, 2014. New employers will be invited to the workshops and will be mentored on the practice of worksite wellness by the original employers. 7) Is current practice evidence-based? The practice employs best-practices for worksite wellness as recommended by the CDC and Wellness Councils of America.
Nutrition, Physical Activity, and Obesity|Tobacco
1) Goals and objectives of practice:The goal of this project is to create a culture of wellness among Aurora employers and decrease employee risk factors for lifestyle-related chronic diseases. This will be done by working with employers to implement best practices in worksite wellness to address employee access to healthy foods, physical activity, and engagement in prevention health strategies. Specific objectives follow. Obj 1. Eight to ten small employers (<600 employees) in the City of Aurora will be recruited to implement worksite wellness programs. Obj 2. Participating employers will complete a series of benchmarks within a 19-month period. The benchmarks are based on the CDC’s best practices for worksite wellness and are outlined in the Evaluation section of this application. Obj 3. Following completion of the benchmarks, participating employers will take a leadership role in developing a sustainability plan. TCHD and the other original stakeholders will assume a supportive role in this process. 2) Steps taken to implement the program: In 2010, the City of Aurora, Colorado was identified as an ACHIEVE community (Action Communities for Health, Innovation, and EnVironmental change) under the CDC’s Healthy Communities Program which is focused on reducing risk factors related to chronic disease through community collaboration that address major health risk factors including physical inactivity, unhealthful eating and tobacco use. The designation included an ACHIEVE grant which was awarded to the YMCA of Metropolitan Denver. A charter team was formed and trained to perform a community assessment utilizing the Community Health Assessment and Group Evaluation (CHANGE) tool to determine which sectors would benefit from an intervention. Worksites and schools were identified as the two sectors most in need of improvement. A task force was formed for each. This model practice application will focus on the worksite initiative. Action steps for the initiative included the following. Formed a worksite wellness taskforce of diverse stakeholders to include Tri-County Health Department (TCHD) Administered worksite wellness questionnaire to local employers through the Aurora Chamber of Commerce Invited employers who expressed interest in worksite wellness to a kick-off breakfast event at Chamber. Established commitment from eight employers at the breakfast Advisor conducted an individual meeting and worksite environment audit with each employer Employer designated an employee champion, formed an employee wellness committee, and adopted a worksite wellness mission statement Employers administered employee needs and interest survey and met with advisor to review results and develop an action plan Employers attended quarterly information/education workshops and the annual Colorado Culture of Health Conference. Employers were honored at an awards ceremony hosted by the Aurora Chamber of Commerce A sustainability plan was drafted by the participating employers. The employers committed to growing their initiatives and recruiting and mentoring new employers. 3) Criteria for who was selected to receive the practice:Small to mid-size employers (<600 employees) were recruited. In order to participate, the employers needed to have a worksite in Aurora or at least conduct business within that community because the CDC grant was originally awarded for work within the Aurora community. Although not required, since employers were recruited through the Aurora Chamber, by default all participating employers were members of the Chamber. 4) Timeframe for the practice: May 2011 - December, 2012: Recruitment, engagement, action, reinforcement January 2013 – Present: Sustainability plan to institutionalize worksite wellness within the Chamber and expand to include more local employers 5) Role of the other stakeholders and how collaboration was fostered: The worksite wellness taskforce represented a diverse group of stakeholders and included Tri-County Health Department, the Aurora Chamber of Commerce, YMCA of Metropolitan Denver, the City of Aurora Parks and Recreation Division, LiveWell Colorado, a local business owner, Paul Suss of Suss Buick GMC and a local business management consulting firm, EMERGE. The taskforce operated within the following parameters. The taskforce met monthly during the first six months then as needed with much action occurring via email The stakeholders split up tasks according to skill sets of individuals and resources of their respective organizations The taskforce kept abreast of other local and state initiatives that were related to the Aurora initiative and sought opportunities to share resources There was an underlying theme and focus on sustainability. Members of the taskforce were committed to this initiative continuing and growing as a movement versus a one-time program. 6) Start-up or in-kind costs and funding services associated with this practice: As outlined in the Overview section, this initiative was part of an ACHIEVE grant received by the YMCA of Metropolitan Denver. A breakdown of expenses involved in the worksite wellness initiative follows. Supplies/Meetings $ 674.00 Worksite Wellness Advisor: Tri-County Health Department $ 2,850.00 Translation: Employee survey translated into Spanish $ 135.00 Incentives: Prize Philanthropy and conference fees* $ 4,900.00 Total Expenses $ 8,559.00 An additional $2,000 remains for the sustainability phase *Employer incentives included seven employers receiving $600 each allocated to their worksite wellness program budgets. Registration fees for the Colorado Culture of Health Conference were paid for participating employers.
The overall evaluation is based on whether or not the three original project objectives were completed. Additionally, each participating employer was evaluated according to whether or not they achieved the required benchmarks outlined by the initiative. The three objectives with outcomes are outlined below.Obj 1. Eight to ten small employers (<600 employees) in the City of Aurora will be recruited to implement worksite wellness programs. Outcome: Eight employers were recruited and engaged in the initiative. Obj 2. Participating employers will complete a series of benchmarks within a 19-month period. The benchmarks are based on the CDC’s best practices for worksite wellness and are outlined in the Evaluation section of this application. Outcome: Seven of the eight employers completed all of the benchmarks within the 19-month time period. The benchmarks are outlined below. Obj 3. Following completion of the benchmarks, participating employers will take a leadership role in developing a sustainability plan. TCHD and the other original stakeholders will assume a supportive role in this process. Outcome: A plan was developed with the employers taking the lead. The plan includes integrating the worksite wellness initiative within the healthcare committee at the Aurora Chamber of Commerce. Additionally, the original employers will conduct quarterly workshops or CEO/wellness champion breakfasts, as they will be called, beginning January, 2014. New employers will be invited to the workshops and will be mentored on the practice of worksite wellness by the original employers. Employer Benchmarks Establish executive level support Complete an initial interview and worksite audit with the worksite wellness advisor Form a worksite wellness committee Adopt a worksite wellness mission statement Survey employees to determine needs and interests Attend at least three of the quarterly workshops (employers could attend the Colorado Culture of Health Conference in place of one workshop) Establish a worksite wellness budget (optional step prior to the incentive funds being awarded) Implement two policies related to physical activity, access to healthy food, the practice of prevention health management strategies or tobacco cessation The accomplishments of each employer are highlighted below. Aurora Chamber of Commerce: Policies: Healthy Meeting/Event Policy; Healthy Food and Beverage Policy Funds: Staff team building event Posted healthy meeting policy certificate in conference room to inform members and guests. Included in general guidelines for use of conference rooms by outside parties Central Colorado Area Health Education Center: Policies: Prevention/Health Education Policy; Healthy Breaks and Meetings Policy Funds: Chair massage sessions on two different dates and hosted healthy holiday dinner for employees and their families  Fruit bowl (employees take turns stocking) Campaign to promote stair use  Healthy potlucks (and recipe sharing) Connect staff with Anschutz campus health and wellness resources Suss Buick GMC: Policies: Physical Activity Policy; Healthy Food and Beverage Policy Funds: Used to purchase pedometers for challenge 24-Hour Fitness performed onsite fitness evaluations Step challenge Free fruit in break room Weekly healthy smoothie breaks Tri-County Nutritionist presentation – lunch provided Provided onsite biometric screenings. Performed by TCHD staff: Body Mass Index, blood glucose, and cholesterol Developed a flyer describing worksite wellness program for new employees Rural/Metro Pridemark Ambulance: Policies: Physical Activity Policy; Healthy Food and Beverage Policy Funds: Used part of funds to bring in presenter – “How to make healthy brown-bag lunches” Regional office contracted with national company to provide worksite wellness program in 2013 Fitzsimons Federal Credit Union: Policies: Adopted multiple policies including Chronic Disease Prevention, Physical Activity, and Healthy Meetings and Events Policies Funds: Purchased a scale for challenge (scale then kept in workout room) Onsite fitness room and a separate “quiet” room 2011 - Holiday pedometer challenge Four-week Spring activity challenge – “Going the Distance” Healthy Potlucks – Valentines and St. Patrick’s Day • Employees receive one hour during workday to get a flu shot First Aid and CPR/AED training provided at no cost to employees Employees and family members participate in local fun runs and hiking excursions. Wellness committee provides an article each month in the employee newsletter Biggest Loser Challenge. Weekly weigh-ins for individuals. Each participant contributed $1/week. Top three receive percentage of cash Staybridge Suites, Denver International Airport: Policies: Physical Activity Policy; Healthy Food and Beverage Policy Funds: To be determined Healthier snack options for employees Integrated healthy food choices into their guest services (meetings and events) Advantage Security: Policies: Chronic Disease Prevention Policy; Physical Activity Policy Funds: Employee flu shots and expenses for three team activities Include wellness column in employer newsletter Team activities including two mountain hikes and participation in American Heart Association’s plane pull Provided onsite biometric screenings. Performed by TCHD staff: Body Mass Index, blood glucose, and cholesterol Flu shots – provided onsite at the same time as the biometric screenings Colorado Insurance Professionals, Inc: Fruit bowl in break room stocked by employer regularly Incorporate their client wellness services into employee wellness program Ongoing process evaluations were employed to assess the effectiveness of the model during the 19-month initiative. Employers were asked for progress reports on a quarterly basis. The employers’ progress reports were provided during the quarterly workshops or directly to the worksite wellness advisor during phone or in-person meetings. If an employer’s progress report revealed that they were struggling, other participating employers would mentor the employer and/or the advisor would provide recommendations and resources to address barriers or issues that were deterring progress. Following the awards ceremony in December 2012, the seven employers who completed the benchmarks were contacted by the TCHD advisor to schedule de-briefing interviews. De-briefing interviews took place in January and February, 2013. When asked what components of the initiative helped them in the process of developing their worksite wellness programs, employers cited the following six elements. The initial kickoff presentation at the Chamber Quarterly employer workshops • Assistance from the TCHD advisor Mission and policy examples The funds provided mid-way through (Prize Philanthropy)  The awards ceremony at the end When asked to narrow down their selection to the top two key components of the initiative, all of the seven employers identified prize philanthropy and the quarterly workshops, in that order, as the two strongest components of the initiative. The employers expressed that the Prize Philanthropy incentive funds represented either a reward or an incentive, depending on how far along they were in achieving the benchmarks of the initiative. For those employers who were ahead of the game in terms of satisfying the benchmarks, the funding was a reward. For those employers who were not as far along, the funds represented an incentive to achieve the mid-point benchmarks by the deadline. The employers expressed that their employee worksite wellness committee was empowered by receiving the funds. This was especially true for those employers who had not yet established a worksite wellness budget (five of the seven employers). The second key component cited by each of the seven employers was the quarterly workshops. The employers expressed that coming together every few months for the workshops helped them to stay engaged with the initiative because they knew they would need to report on their progress. Other reasons for valuing the workshops included: the peer support and feeling of camaraderie that developed among the participants, the opportunity to share ideas with the other employers, and, the opportunity to learn about resources and tools from the presenters at each of the workshops.
Since the awards ceremony for participating employers took place in December, 2012, the original group of stakeholders that led the current practice has convened three times to work on the development of a sustainability plan. Elements of the plan include the following. Find a home-base for the initiative within an existing institution. The Aurora Chamber agreed to be that home-base. Specifically, within the Healthcare Committee which meets monthly. Convene the original group of employers to determine their commitment level and gain feedback on moving forward. A CEO breakfast was held at the Chamber on October 25, 2013 with CEOS and champions from each employer invited. Identify a leader among the employers to assume most of the coordinating duties, in place of THCD’s worksite wellness advisor. The CEO of one of the participating employers, Paul Suss of Suss Buick GMC, has agreed to take the leadership role. Participate in the planning and implementation of the Aurora Chamber’s first healthcare summit event. CEO’s from the original employers have agreed to meet quarterly and invite other employers, who are interested in worksite wellness, to attend the meetings. Much like the quarterly workshops, the quarterly CEO meetings will include progress reports, mentoring, and an educational component (to be provided by TCHD and other community health organizations at the request of the employer group). A portion of the remaining $2,000 from the original ACHIEVE grant will be allocated towards the 2014 quarterly CEO meetings which the original employers have agreed to organize. A plan for allocating the remaining funds will be developed by the CEO leadership group. Because this outreach model proved to be successful both in terms of collaborating with stakeholders and engaging employers to complete the objectives, plans for replicating it, with lessons learned, are underway. The model will be applied in Douglas County with a group of employers in the Castle Rock business community. The stakeholders are currently being recruited in the Castle Rock community. Similar to the current practice, the stakeholder group will represent government, public health and the non-profit sectors.
Colleague in my LHD