Transforming the Health Department

In the wake of Hurricane Katrina, a cross-sector partnership of the City's Health Department, schools, businesses, and nonprofit organizations has made public health and prevention a major component of the ongoing recovery effort. Before Katrina the City’s approach to health was the same as that found in many places across the country—focused more on clinical care rather than prevention and public health, according to Dr. Karen DeSalvo, Health Commissioner for the City of New Orleans. She said using the Public Health Accreditation Board’s  accreditation blueprint as a roadmap has helped the department go quickly from “broken and outmoded” to a modern public health agency.

That is how we’re getting from a place where we were treating the consequences of poor health decisions and the impacts of social determinants of health, and actually move into a place where we’re upstream and we can prevent it, but then work with other sectors,” said DeSalvo.

But she knows that no one health department can solve every health challenge in a community. One of the biggest keys was bringing together a collection of partners that reflect all the social determinants of health and help ensure health is a consideration in every new policy.

“As we rebuild our roads, buildings, parks and playgrounds, we are thinking about not only health from a physical activity and a nutritional standpoint, but also mental health and addressing those chronic disease needs that communities have,” said DeSalvo.

Reinvesting in Health

Partners include Ochsner Health System, Louisiana’s largest not-for-profit health system, with eight hospitals and 900 physicians in its medical group model. The company has a wellness program with incentives to help its employees stay healthy and works closely with the city on raising awareness and defining policies.

Warner L. Thomas, Ochsner’s president and CEO, said working with New Orleans and reinvesting in the area is part of its role as a not for profit.

“From my perspective, we’re part of the community—we’re a community asset, and we should be helping our community get healthier,” he said.

Since Katrina, New Orleans has developed a system of 103, community-based health care access points for uninsured, underinsured and low-income patients, with 68 being primary care clinics. It has also adopted electronic medical records across the health care system and implemented the Greater New Orleans Health Information Exchange to share clinical data for the improvement of population health.

Access to Healthy Food, Opportunities to Be Fit

Part of prevention is making sure people have access to healthy food and opportunities for physical activity. Fit NOLA is a Health Department-led, multi-faceted partnership with the goal of making New Orleans one of the ten fittest U.S. cities by 2018—the city’s 300th anniversary.

The Fresh Food Retailer Initiative is the perfect example of a public private partnership,” said DeSalvo. “It is a project that has been bringing grocery stores that have a specified amount of fresh fruits and vegetables on their shelves to communities that are typically food deserts. And so it gives an opportunity for every family in my city to be able to access the food that they need to be as nutritionally fit as possible.”

A related program is responsible for helping Circle Food Store to re-open its doors. Founded in 1939 as the first African American-owned grocery store in New Orleans, the community anchor and staple was so damaged by Katrina that it was forced to close. Owner Dwayne Boudreaux hoped to re-open, but had great difficulty in getting funding—until he received a loan from the Fresh Food Retailer Initiative.

“It’s like the Fresh Food Initiative was the glue,” said Boudreaux. “It’s like once they came into existence and said ‘Okay, we’re here, this is what we’re going to pledge,’ then all of the bankers came onboard and the other financial partners came onboard.”

The Right Choices

Also a part of Fit NOLA, the Edible Schoolyard initiative uses gardens to make healthy foods not just something you see in stores, but a part of New Orleans residents’ everyday lives—particularly for kids. A renewed focus on schools promoting academic achievement and good health offers new gardens and cooking classrooms, as well as state-of-the-art kitchens and new physical activity programs in schools.

One of the core determinants of health is that if the right choices are in front of us that we make that right choice and that right choice is easier,” said DeSalvo. “So bringing farming back into the urban environment is a really important way to get people comfortable with fresh food and expand their horizons for what they like and what tastes good to them and how to cook it and how to be comfortable with it in their households.”

New Orleans’ new approach to public health is an ongoing experiment. A sort of “work in progress” by design—a health department engaged in a continuous community dialogue to help ensure everyone is moving together in the direction of a healthier New Orleans.

“Hurricane Katrina exposed the problems we had in this community—she didn’t create all of them,” said DeSalvo. “But indeed it brought to our attention the dramatic challenges we have with health… It was a rallying cry for all of us to come together and find a way to solve those problems as a community.”