Transcript Emerging Issues in Maternal and Child Health:

Emerging Issues in
Maternal and Child Health:
Reducing Health Inequities:
The Impact of Neighborhood
Factors on Health
Goal
To improve the understanding of the impact of neighborhood factors
on health inequities.
Objectives
As a result of the presentation, participants will be able to:
• List neighborhood factors that can contribute to health inequities;
• Describe national and local health department initiatives addressing
neighborhood factors affecting health outcomes, and;
• Identify opportunities for program and policy development
addressing these risk factors to reduce health inequities.
Moderator
Peter Simon, MD, MPH
Assistant Medical Director
Rhode Island Department of Health
Providence, RI
Presenters
Rebecca Flournoy, MPH
Senior Associate
PolicyLink
Oakland, CA
Sara Shubert
Community Lead Program Manager
City of Milwaukee Health Department
Milwaukee, WI
Community Strategies to
Improve Health
March 16, 2006
Rebecca Flournoy, MPH
PolicyLink is a national nonprofit research,
communications, capacity building, and
advocacy organization, dedicated to advancing
policies to achieve economic and social equity
based on the wisdom, voice, and experience of
local constituencies.
Why Focus on Community Factors
and Health?
Access to care accounts for only 10% of total
mortality in the U.S.
Environmental conditions, race, social and
economic factors, and health behaviors all
impact health status
Employment, Income, Wealth and Assets
Quality and quantity of employment opportunities available
to residents; the amount of collective wealth and assets in
the community.
Factors protecting against disparities
Living wage jobs with health benefits; safe workplaces. Savings,
adequate retirement income, and homeownership provide
economic stability.
Factors increasing risk for disparities
Large numbers of community residents with low-wage jobs with no
benefits and unsafe working conditions. Racial and economic
segregation and concentrated poverty lead to higher stress and
premature mortality.
Neighborhood Economic Conditions
Presence of commercial services including grocery stores,
banks and restaurants.
Factors protecting against disparities
Attracts public and private investment in services and infrastructure.
Factors increasing risk for disparities
Disinvestment leads to loss of jobs, businesses, and decline in property
values.
Cultural Characteristics
Values, attitudes and norms (related to a range of behaviors,
including diet) deriving from race/ethnicity/gender, religion or
nationality, as well as from other types of social and cultural
groupings.
Factors protecting against disparities
Cohesion, a sense of community, and access to key cultural institutions with
healthy cultural norms/attributes.
Factors increasing risk for disparities
Racism, language barriers, and acceptance of unhealthy behaviors.
Absence of community norms and expectations that promote healthy
behavior and community safety.
Social Support and Networks
Friends, family, colleagues, and neighborhood acquaintances
And organizations. These networks exist within the community
and beyond it, such as churches and clubs.
Factors protecting against disparities
Social capital that can provide access to social supports and economic
opportunities, as well as to certain health services and resources. Adult role
models and peer networks are influential to young people.
Factors increasing risk for disparities
Lack of social supports and role models. Residents do not have access to
networks outside the neighborhood that can link them to employment and
other key opportunities. Sometimes referred to as absence of “bridging”
social capital.
Environmental Quality
Air, water, land shared across a region.
Factors protecting against disparities
Policies and practices that maintain a clean, healthy environment.
Factors increasing risk for disparities
Presence of and exposure to toxics and pollution.
Built Environment and Infrastructure
Housing, parks and recreation, and workplaces.
Factors protecting against disparities
Access to affordable, high-quality housing, local parks, and safe workplaces.
Urban design that supports physical activity.
Factors increasing risk for disparities
Exposure to lead paint, problems with inadequate sanitation and pest
infestation, dangerous types of work and unsafe work environments. Urban
design that inhibits physical activity.
Health Services
Accessibility, affordability, and quality of care for individuals
and families.
Factors protecting against disparities
Necessary, accessible care delivered in a culturally sensitive manner in
satisfactory health facilities with well-trained and culturally appropriate
practitioners with attention to acute and preventive care.
Factors increasing risk for disparities
Lack of access to necessary health care services, while what is available is
culturally inappropriate and of poor quality.
What is Advocacy?
1. Identifying an Issue
2. Drawing attention to the issue
3. Working towards a solution
The Advocacy Process
ORGANIZING
AND
COALITION
BUILDING
CLIMATE READY
FINDING
INFORMATION/
RESEARCH
POLICY
CHANGE
FOR CHANGE
MOBILIZATION AND
COMMUNICATIONS
MAKING A
PLAN
Community Action to Fight
Asthma (CAFA)


3-year initiative
Focus on reducing
environmental triggers for
children with asthma
Organization of CAFA



12 Local Coalitions
State Coordinating Office
Technical Assistance Providers
PolicyLink Role


Technical Assistance: Policy and
Communications
Inform and Mobilize CAFA State
Policy Efforts
CAFA Policy Successes
Local Examples
 Helped pass ordinance to replace old diesel city buses
 Influenced discussions about regional air regulations
and enforcement
 Brought health voice to discussions about local
freeway expansion
State Examples

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Helped get eight bills passed and 2 air quality regulations
Invited to suggest bill language
Other Outcomes



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New leaders
Increased awareness
New partnerships
Enhanced skills
For More Information:
www.policylink.org
Community Factors:
www.policylink.org/Research/JC-Stronger
Communities
www.policylink.org/CHB
Advocacy:
www.policylink.org/AdvocatingForChange
Laying the Foundation
for Healthy Neighborhoods
A Community-based Approach to
Health Promotion and Disease Prevention
Surveillance:
Trends in Milwaukee
Annual Prevalence Rates
(Children with elevated blood lead levels)
2004
2003
2002
2001
2000
1999
1998
1997
1996
Milwaukee 9.8%
1995
National 1.6%
45
40
35
30
25
20
15
10
5
0
Community engagement is necessary in the
process of change:
— Community Organizing
— Community Health Promotion
Community-based Approach
• Invest in the
development of
community
leadership
Milwaukee Community Capacity Project
Milwaukee Community Capacity Project
Utilizes a community organizing approach
Goal is to accomplish improvements in
community health outcomes
Jobs!
Safety
!
Housing
!
Community Capacity Model for
Improving Community Health Outcomes
Uses comparable community organizing and
community health education techniques to:
Increase community awareness of health issue
Increase community understanding of health issue
Increase community’s risk perception for health issue
Increase community efficacy to be part of the solution

Creates a climate which supports:
Environmental
Political
Behavioral Change
Spiritual
Emotional

Social Change
Psychological
Physical

Resulting in:
Community residents with sustainable leadership capabilities
Improved community health outcomes that are perpetual in nature
Why Take the Risk?
Community value for lead-safe housing is
needed to:
PUSH!
PULL!
Milwaukee Community Capacity
Project
Project Description:
MHD contracts with CBO’s
CBO’s maintain a health organizer
on staff
Organizer builds a resident group
based upon self-interests
Residents become leaders for healthy
housing/neighborhoods
Community Capacity Project
Outcomes:
• Targeted, neighborhood- specific community
education and awareness initiatives
• Increased involvement of residents in healthy
housing and neighborhood improvement
activities
• Community empowerment and capacity to
support healthier neighborhoods in
Milwaukee!
Hmong American Friendship Association
HAFA PAL Builds Awareness:
HAFA PAL Builds Community:
HAFA PAL Builds Leadership:
16th Street Community Health Center
2001: Strategic Planning Process
Southside PAL’s Goal:
All rental property in the near southside (zip
53204) be lead-safe and habitable (zero code
violations) by the year 2004.
2002 Neighborhood Information Fair
SSPAL built and maintains relationships
with political leaders
SSPAL continues to work to assure landlords
fix and maintain their properties
2003: SSPAL succeeded in creating a
Housing Advocate for their target area
Cristo Rey (ELCA) Community Services
Broadens the role of the CCP’s
 Serves as a liaison between
landlords, tenants and city
services to improve southside
housing
 Promotes Primary
Prevention activities and
leverages additional repairs
 Provides tenant education
and advocacy
Working With CBO’s:
What’s Needed?
VALUE
for community involvement
Identify “insiders” to champion efforts
Tell the success stories to demonstrate
the power of community involvement
Create opportunities for positive
interaction between stakeholders
What’s Needed?
RELATIONSHIPS
with community organizations
Identify common ground
Be unfailingly, reliably involved
Listen
Find creative ways to respond to needs
Be honest/build trust
What’s Needed?
FUNDING
to support focused projects
Build into existing activities
Rely on trusted community relationships to assist
in advocating for resources
Evaluate and report successes
Streamline and simplify processes
What’s Needed?
COMMITTMENT
to maintain meaningful projects
Ensure sponsoring organization is vested
in the project outcomes
Ensure the provision of on-going technical
assistance and support
Maintain a voice “on the inside” for resource
brokering/community advocacy
For more information:
Sara Schubert
Community Lead Program Manager
City of Milwaukee Health Department
(414) 286-5537
[email protected]