David Law: "Determined to Bring Healthy Choices Into Our Neighborhoods"
In Detroit, Michigan, the Joy-Southfield Community Development Corporation has developed a targeted approach to promoting health equity, based on the four factors measured by the County Health Rankings: health behaviors, clinical care, social and economic factors and physical environment. Despite its location in one of the most racially segregated cities in the country, with poor public transportation, high poverty and unemployment, and vast food deserts, the Joy-Southfield neighborhood has become a hub of partnerships and activities aimed at long-term health improvement. Several community groups and funders have collaborated to empower youth through mentoring and community garden projects; renovate vacant properties to attract new businesses; improve community safety; provide job training and foreclosure prevention services and more.
NewPublicHealth spoke with David Law, PhD, Executive Director at Joy-Southfield, about the program.
NewPublicHealth: Tell us about the Joy-Southfield Community Development Corporation. How did your priorities evolve, and how did the County Health Rankings help shape them?
David Law: Joy-Southfield was founded by a church in West Side Detroit in 2001 and began with a broad mission of community revitalization. An early needs assessment showed that access to health care was really a huge issue, and one of the members was a physician who had experience with a free clinic in Chicago. So, we started off operating a free clinic initially out of the church.
Our first epiphany was about the incredible burden of poorly managed chronic disease, so we began to think more about preventive health education, chronic disease management and referral for specialty care for conditions such as diabetes and hypertension.
Looking further we began to wonder if some of the root causes were impacted by the social determinants of health. In 2010, when we ran across the first publication of the County Health Rankings it gave us the insight we needed to be very deliberate while putting this socio-ecological model together. The most recent initiative has been on commercial and economic development. We got a grant from the State of Michigan, which provided a blueprint to completely revitalize our commercial corridor. The Rankings gave us the data we needed to make a compelling case initially with the staff and the board and then later on with grant makers and stakeholders.
NPH: Is it too early to point to outcomes?
David Law: In terms of outcomes, on the clinic side fairly early on we adopted a health information technology platform that allowed us to measure outcomes. It’s calibrated to national standards of care and designed for chronic disease management. It has prompting and reminding functions and clinical decision support, and we’ve seen our health outcomes improve dramatically since we’ve adopted that platform. We have outcomes in other areas as well. We’re starting to look at outcome for our childhood obesity prevention program.
NPH: Tell us more about that program and how it will be measured.
David Law: We got a $200,000 grant over two and a half years to develop a socio-ecological model for preventing obesity. We determined our goals with community input, the goals for the indicators and then we developed a custom database that allows us to track indicators before and post-intervention so we can actually demonstrate whether we did anything or not. We don’t have a huge database yet. We’re just now wrapping up the first year of implementation, and it’s really a pilot project, but we’re feeling pretty good about the workshops that we’ve developed and tracking some of the outputs that we have. We also developed a community garden and farmer’s market program. We’re promoting physical activity, we’re renovating the local parks, and part of renovating our commercial corridor will include improved walkability, and we’ll put in bike lanes. It’s a big picture view.
We’re also working with local retail outlets to get healthier food in the stores and restaurants. So, we’re kind of chipping away. There’s no one thing that’s going to solve everything, but eventually you start seeing the whole environment kind of change, it’s a systemic and incremental growth.
NPH: What are some of the health and socioeconomic challenges you face specifically in Detroit?
David Law: If you look at the County Health Rankings, Wayne County, which largely encompasses Detroit, is 81st overall out of 82 counties in the state when it comes to health outcomes, and the only reason it’s not absolutely last is that Wayne County also includes some relatively affluent suburbs. The county has a shortage of both primary and specialty care providers. We have high levels of uninsured individuals. We have racial and ethnic health disparities. For example, the overall mortality rate for African Americans is 136 percent higher than for whites.
We’ve got food deserts, recreation voids; we’ve got limited access to goods and services. We have a whole host of poverty-related stressors. People tend to make poor choices when they’re dealing with the stress of poverty. So we’re certainly educating our patients and other clients about healthy choices, but we’re also determined to bring those healthy choices into the neighborhoods. And we’re already starting to see some changes. We have one liquor store that’s converting into a sit-down restaurant, another one’s converting into a full-service grocery store. So those are the kinds of incremental changes that eventually will change the environment that we live in.
NPH: Is there anything that has been particularly surprising to you as you begin to see our efforts succeed?
David Law: Well, I guess the real big surprises have just been how quickly we’ve been able to expand the things we do. We didn’t really think we’d be doing economic redevelopment, but we were working with the City of Detroit on health care and then they said, “Well, what about some economic development?” We wrote an initial grant for the city, and they suggested we go to the state. We were one of eight organizations to get funding for the Downtowns of Promise program and we were the only one that wasn’t a traditional downtown. We’re actually on the West Side of Detroit, but the reality is, we can’t just rebuild downtown. Detroit’s a large city with a low-density population and we have to revitalize all the commercial quarters for people to be healthier.