Linking Communities and Public Health Promotion to Eliminate Health Disparities CDC Examples Janet B. Croft, PhD Division of Adult and Community Health National Center for Chronic Disease Prevention and Health Promotion Any use, copying, or distribution without written permission from the presenter is prohibited. 1
Disparities in health care are among the nation s s most serious health care problems. Research has extensively documented the pervasiveness of racial and ethnic disparities. Institute of Medicine, 2002 Any use, copying, or distribution without written permission from the presenter is prohibited. 2
Alarming Facts Heart disease death rates 30% higher for African-Americans Americans than whites; stroke death rates 41% higher. Diabetes higher among American Indians and Alaska Natives (2.3 times), African Americans (1.6 times), and Hispanics (1.5 times.) Vietnamese American women have a higher cervical cancer rate than any other ethnic group (55 times non-hispanic white women.) African American infants are 2.5 times more likely to die before their first birthday. Any use, copying, or distribution without written permission from the presenter is prohibited. 3
Community Health Promotion: CDC Activates Change at the Local Level REACH U.S. Racial and Ethnic Approaches to Community Health. Steps Program Integrated chronic disease program in 40+ local health departments. Any use, copying, or distribution without written permission from the presenter is prohibited. 4
RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH Dr. Leandris Liburd, PhD, MD Branch Chief Community Health and Program Services Branch www.cdc.gov/reach Any use, copying, or distribution without written permission from the presenter is prohibited. 5
REACH Works to Overcome Challenges Recognizes that innovative solutions needed. Focuses on community mobilization and empowerment Attempts to address the underlying causes of health disparities. Any use, copying, or distribution without written permission from the presenter is prohibited. 6
Action Communities implementation and evaluation of established and innovative interventions Centers of Excellence in the Elimination of Disparities (CEED) expert consultation, mentorship, dissemination to more communities REACH Any use, copying, or distribution without written permission from the presenter is prohibited. 7
What Are REACH Communities Doing? Empowering community members to seek better health Bridging gaps between the health care system and community Changing social and physical environments to overcome barriers to good health Implementing strategies that fit unique social, political, economic, and cultural circumstances Mobilizing resources of all partners Moving beyond individuals to community and systems change Any use, copying, or distribution without written permission from the presenter is prohibited. 8
Local Communities Making Changes Schools Work sites Faith-based organizations Community groups Affordable healthy food options in local grocery stores and restaurants Safe places for physical activity Access to preventive care Transportation systems that support walking and biking Any use, copying, or distribution without written permission from the presenter is prohibited. 9
#1 Lesson Learned: Health disparities are not insurmountable, and CAN be overcome. Any use, copying, or distribution without written permission from the presenter is prohibited. 10
REACH Successes: Health Outcomes South Carolina REACH Communities: : 36% and 44% reduction in amputations among African-American American men; 21% gap in blood sugar testing virtually eliminated. Lawrence, Massachusetts Latino Health Project Participants: : Improvements in blood sugar (8.7%,) systolic blood pressure (17.5%) and diastolic blood pressure (14.4%.) Detroit REACH similar results. Any use, copying, or distribution without written permission from the presenter is prohibited. 11
REACH Successes: Bridging Gaps in Preventive Services CA REACH Community: 48% of Vietnamese women who had never had a Pap test got one after meeting with lay health workers 15% overall increase in Vietnamese women receiving a Pap. Any use, copying, or distribution without written permission from the presenter is prohibited. 12
Producing Results: Risk Factor Improvements Atlanta, GA; Portland, OR; and others. Any use, copying, or distribution without written permission from the presenter is prohibited. 13
REACH Successes: Policy Opportunities Bronx Health REACH: Changes in faith-based organizations, schools, local bodegas. Los Angeles REACH: Filling gaps in access to healthy foods and physical activity opportunities. Any use, copying, or distribution without written permission from the presenter is prohibited. 14
Driven Why REACH Works Programs and Community- Policy- Development Any use, copying, or distribution without written permission from the presenter is prohibited. 15
Why REACH Works: Community-Driven Programs and Policy-Development EMPOWERMENT of individuals EMPOWERMENT I ve learned to be ready for the doctor when I go to the doctor s s office and I go into the exam room, I take off my shoes and socks. I don t t wait for him to tell me. On the counter I lay my monitor book with all my blood pressures and all my sugars. So it is there so he don t have to walk out and come back. I m m getting every bit of the minutes he s s supposed to be giving me. Participant, REACH Seattle-King County, WA Any use, copying, or distribution without written permission from the presenter is prohibited. 16
Why REACH Works: Community, Academic, and Governmental Partnerships Any use, copying, or distribution without written permission from the presenter is prohibited. 17
Why REACH Works: Community, Academic and Governmental Partnerships TRUSTED ORGANIZATIONS, COMMUNITY LEADERS, SUSTAINABILITY Massachusetts Success: Boston HIV Any use, copying, or distribution without written permission from the presenter is prohibited. 18
Community Expertise Why REACH Works: Any use, copying, or distribution without written permission from the presenter is prohibited. 19
Why REACH Works: HISTORICAL AND CULTURAL CONTEXT Community Expertise Successes: Detroit, MI Genessee County, MI Cherokee Choices, NC Any use, copying, or distribution without written permission from the presenter is prohibited. 20
Steps Program: Activating Change at the Local Level Alyssa Easton, PhD, MPH Program Director Steps to a HealthierUS www.cdc.gov/steps Any use, copying, or distribution without written permission from the presenter is prohibited. 21
Steps Facts Specific focus areas include: obesity, diabetes, asthma, physical inactivity, poor nutrition, and tobacco use. Provides funding to 22 grantees representing 40 communities and the YMCA. Sectors include: schools, communities, work sites, and health care settings. Any use, copying, or distribution without written permission from the presenter is prohibited. 22
Steps Niche Transforms local public health Makes inroads into rural counties, large cities, and tribal areas Enhances existing public health programs Serves as a tipping point for local momentum and will to change Develops community models that can guide chronic disease prevention & public health practice in the 21 st century Accelerates change Reaches across multiple disease outcomes and risk factors Promotes traditional and non-traditional partnerships Any use, copying, or distribution without written permission from the presenter is prohibited. 23
Impact of Steps Community level improvements in health Policy Organizations and systems Environmental Any use, copying, or distribution without written permission from the presenter is prohibited. 24
Examples of Local Success - Schools Minnesota School districts in all 4 communities passed healthy vending machine policies. Broome County, NY and Tioga County, PA 15 school districts created a consolidated bid to purchase healthy foods for a centralized school lunch menu. Fresh fruit and vegetable consumption increased 14%. Hillsborough, FL Created a policy in over 200 schools allowing students with asthma to self-medicate during school hours improved attendance. Cherokee Nation, OK 9 schools developed and implemented 24/7 tobacco-free environmental policies Any use, copying, or distribution without written permission from the presenter is prohibited. 25
Local Success - Communities Salinas, CA Implemented agriculture-focused interventions farmers market in a low-income neighborhood. Healthier options in ¼ of taco stands and a county-wide policy to encourage fitness and good nutrition. Boston, MA Collaborated with community organizations and retail businesses to improve the walking environment by developing pedestrian signage, walking guides, and community policing. Cleveland, OH Over 13 community gardens have been established providing thousands of pounds of fresh fruits and vegetables to food pantries. Any use, copying, or distribution without written permission from the presenter is prohibited. 26
Local Success Health Care Sites and Worksites Alabama-River Region Through training of Diabetes Wellness Advocates,, emergency and inpatient visits decreased as did health care costs. Chautauqua County, NY Through partnership with local health systems, instituted a 2-2 minute physician intervention strategy to reduce tobacco use. % of adult smokers decreased from 28.8% to 23.7% between 2004 and 2005. Austin, Texas Through a worksite wellness partnership with Capital Metro, transit employee absences decreased 44% as did health care costs. Any use, copying, or distribution without written permission from the presenter is prohibited. 27
Why These 2 Programs Work: Investment in Communities Any use, copying, or distribution without written permission from the presenter is prohibited. 28
08 Investment in Communities X U LA HOPE Any use, copying, or distribution without written permission from the presenter is prohibited. 29
Healthy Communities, Healthy Living: A National Movement Any use, copying, or distribution without written permission from the presenter is prohibited. 30