Ken Ulman on Fostering a Healthy Howard County
Howard County has been the healthiest in Maryland since the Country Health Rankings launched in 2010. NewPublicHealth recently spoke with the county’s executive, Ken Ulman, about how the Rankings have helped drive further progress in improving the health of Howard County. Health initiatives introduced by Howard County have included a program that certifies schools as “Healthy Schools,” if they meet criteria in several areas including nutrition and physical activity, and a smoking ban in all county parks.
NewPublicHealth: Howard County has been consistently been ranked the healthiest county in Maryland. What key factors do you credit for that?
Ken Ulman: We start with some advantages. We have the blessings of a highly educated population that cares deeply about their community and have good jobs, and many, though not all, have [adequate financial] resources and access to care. We also have the advantage of having a nonprofit, the Horizon Foundation, based in Howard County that is dedicated to improving the health and wellbeing of people living and working in our county.
So it’s a combination of policy initiatives coupled with a public that really wants to make progress in these areas.
NPH: Have the County Health Rankings helped drive any of your public health and prevention initiatives?
Ken Ulman: Absolutely. Many of our decisions are based on looking at evidence-based data on where we’re doing well, and where we need to make improvements, and one area ripe for improvement is obesity. The Rankings also show us where we need to improve. As much as I like being named number one, when I look at our metrics in the County Health Rankings, they also give us a roadmap of where we need to improve. What do we need to do to really move the needle?
In Howard County, frankly, it would be fairly easy to look the other way and focus on something else, because we are doing very well, but the public demands it and I demand it as County Executive for us to constantly do better. .One recent thing we did is to announce a new vending policy in all county buildings to increase access to healthy options. We will no longer have full calorie sugar sweetened beverages available in our vending machines in county buildings, at county parks, or at county libraries.
NPH: The county has an innovative voluntary program called Healthy Howard. What is its scope and what impact has it had?
Ken Ulman: Healthy Howard joins together individuals, businesses, schools, community organizations and government to bring healthy choices and health care options to Howard County residents. If you're looking to change the way you eat, live, work and play, you'll be able to find information on healthy restaurants, workplaces, schools, homes, recreation, and individual programs in the county. If you’re uninsured, you can learn about insurance and non-insurance options, which give people access to affordable health providers.
What we’re able to do with Healthy Howard is reach people where they are—workplace, community, restaurants, childcare. Focusing on so many different areas is a key part of what made us first in the state of Maryland in the County Health Rankings. The healthy designations we award are all voluntary, but we’ve reached out to the private sector with guidelines and resources. I find that most people really want to do the right thing, but they’re busy and they’re not necessarily focused on what it takes to get there.
NPH: Have you seen that the designations you’ve created for healthy establishments matter to both proprietors and consumers, and drive change?
Ken Ulman: Absolutely. Healthy restaurants in Howard County, for example, have five criteria: no violations of a smoke-free workplace, clean health inspections, no trans-fats, nutritional information easily available, and meeting calorie, fat and salt guidelines. In addition, at least two menu items served throughout the day must meet the designated standards for total calories, sodium, and servings of lean protein and vegetables. The environmental inspection record is often times the limiting factor—we want to see that they also have a history of running a clean and safe establishment
Some fast food restaurants qualified as healthy restaurants because we weren’t saying that everything that you serve has to be healthy, but you have to display healthy options and alternatives. And in some of those restaurants you can get a grilled chicken sandwich with a bottle of water and that is prominently displayed. And now we’re hearing that many consumers will only eat at Howard County-certified healthy restaurants. We are currently doing an evaluation of owners and patrons on whether healthy choices appear to be a factor in the restaurants they choose, and we expect to have the results later this year.
NPH: When it comes to public health and prevention, how do you think Howard County has changed over the last decade? And how do you think it will look ten years from now?
Ken Ulman: I sat on the county council when we passed smoke-free legislation. That was seven or eight years ago and I can’t imagine needing to have that conversation again today. I’m proud of the work that we’ve done. We are also the first county in Maryland that banned smoking in all county parks. We also became the first county in the country at the time, to ban minors using tanning beds. We have moved the needle when it comes to a set of policies around cancer prevention, access to care and healthy lifestyle options at restaurants, workplaces, schools and childcare facilities.
But we still have a ways to go. I see a future where our school system is a partner and right now we’re still struggling to get there. The school system needs to really embrace healthy eating, healthy choices and wellness. I think that we’re going to see the use of technology integrated in a much more interactive, easy to reach way. And I think the future will include a lot more support of local produce and farming. We’re going to launch very soon a food hub and a food council with a goal of tying the local agricultural community with restaurants, consumers, and the school system, with a goal of becoming a much more sustainable community.
NPH: How do you help educate the community when it comes to new initiatives?
Ken Ulman: Change is hard. It takes education and a change in culture. It requires changing the way we do business, and the way we operate as families and as citizens, while at the same time, for example, food and beverage manufacturers have a vested interest in people continuing to eat the way they are now.
I think to really solve our problems we’ve got to do some level of reimagining. I think health care is an area that is ripe for that. So imagine a new world—maybe my doctor is on a screen on my iPad, maybe the test for diabetes is done electronically. Maybe I get an incentive for certain behavioral changes.
NPH: How do you make partnerships work so that you can move from concept to successful partnership and see meaningful results?
Ken Ulman: There has to be a level of trust. You have to work on that relationship because a partnership has to have the incentive and the trust from both sides. You’ve got to present an idea in a way that understands how that suggestion is going to be received—what fears with regard to change your partners have and how you bring that group or that person along to understand that it’s in their self-interest as well and they’ll reap the benefit. It’s a challenge.