What Can Communities Do Now for Health Equity?
Jan 28, 2016, 1:21 PM, Posted by Joe Marx
The Culture of Health Prize communities demonstrate that there's no single formula to address health equity locally, but there are key lessons we can all learn from their success.
Our annual RWJF Culture of Health Prize honors and elevates communities across the United States that are making great strides in their journey toward better health.
A scan of the 2015 winners reveals something we’ve seen in previous years: There is no single blueprint. Even when solving common problems, these Prize communities innovate in their own ways. Each brings fresh ideas to the forefront and offers a unique perspective on how to holistically address our nation’s most complex health issues. So it makes sense to turn to them to answer the question that is at the heart of our work today: How can communities come together to create places where health can happen – for everyone?
We ask that question a lot and sometimes our answers can be pretty lofty: work together across sectors, think about health broadly, and so on. While all true, communities looking to take action sometimes ask us to, well, be a bit more specific. What can we do tomorrow? Where do we start?
Here, we dive in to look at how the 2015 Culture of Health communities approached that Prize-winning question.
Start a Conversation on Race and Health, Then Do Something About It
Racial injustice, segregation, discrimination and lack of economic opportunity are at the heart of health disparities in many communities. These are tough conversations, but the communities that are taking them on and coming together to give all residents their best opportunity for good health, are seeing things change for the better.
- In Everett, institutional racism and racial profiling were creating unhealthy conditions. The city set up forums where residents could discuss the hiring practices and diversity of the police department and suggest ways to build better community-police relations. The city also took steps to help immigrants who didn’t speak English navigate the health care system and to assist people of color in finding living-wage jobs and health care services.
- Community organizers across Kansas City—after reviewing shocking data about the life expectancy gap between its white and African-American residents, began frank and difficult discussions about systemic racism and its health implications. Armed with what they discovered, one of the city’s first actions was passing the Community Health Improvement Plan in 2001 as a direct response to the life expectancy gap. Fast forward to 2013, when Kansas City began collecting a health levy to fund hospitals and public health activities; Structured as a property tax, it was established to fund hospital and public health activities and generates more than $50 million annually. By examining disparities systematically and crafting solutions, the city has closed the life expectancy gap from 6.5 to 5 years.
Facing the Past: Acknowledge and Begin to Heal from Historic Trauma
Wisconsin’s Waaswaaganing Anishinaabeg (Lac du Flambeau) Tribe and Menominee Nation have each seen surges in substance abuse, domestic violence, poverty and low graduation rates over the past several decades. Recognizing that these problems are inextricably tied to historic oppression and trauma, each tribe took its health into its own hands, redefining what it means to live a culture of health.
- The Waaswaaganing called upon their native roots and cultural traditions to revitalize the well-being of their people. They began by teaching tribe members, mostly students, the Ojibwe language. Learning their tribe’s native tongue is just one way cultural emersion is giving students a greater connection to tribal elders, to school and to traditional practices. Overall, school attendance and engagement have been on the upswing.
- Menominee Nation’s approach was equally steeped in reclaiming traditional cultural identity. The tribe’s schools focused on healing from loss and trauma, asking what had happened to young people, rather than what was wrong with them. This approach has set the stage for youth to develop into healthier adults who can help the tribe’s legacy carry on. Already, this Culture of Health Prize winner has seen its young people’s 4-year graduation rates increase from less than 60 percent in 2007 to nearly 99 percent in 2014.
Get Creative about Engaging — and Leveraging — Partners For Health
The communities of Lawrence, Massachusetts; The Bronx, New York; Spartanburg County, South Carolina; and Bridgeport, Connecticut, have all thrived by looking to some unusual suspects as partners in their efforts for health.
- Spartanburg organized a collective of about 40 organizations including the regional health care system, neighborhood groups, churches, barber shops and more to focus on health, together. In one example, the city’s jail system partnered with the local hospital and saw that the ER’s super users had cycled through the jails. Mental health and substance abuse were big drivers, so they worked together to bring mental health and substance counseling to people in jails. Yoga and mindfulness classes were also offered. Hospital readmissions are down and those once called prisoners are now people with support and the tools to succeed. Working with a local medical school, which built a new campus on the site of an abandoned mill, Spartanburg is connecting low-income residents to community resources. This helps people receive coordinated and ongoing care rather than sporadic care punctuated by emergency room visits.
- Bridgeport went local and looked to corner stores for solutions. Bridgeport’s health department in collaboration with community groups listened to the wisdom of the owners of these stores – the only accessible source of groceries for 57% of residents, according to a community survey – and provided the tools and support to help them provide healthier offerings. The program has boosted profits for store owners, expanded access to healthy food, and is part of a larger effort to revitalize and transform the city.
- In some cases, it’s about getting partners involved in a whole new way. Lawrence envisioned schools as a hub for both fiscal and physical health for whole families. With support from the United Way, schools have become community centers where parents receive social services for their children and financial and employment guidance for themselves. Now that graduation rates are beginning to rise, it’s clear that when parents are taken care of, so are children.
- The Bronx also looked at schools as hubs for health – in this case, bringing health centers right into the schools’ walls. They knew disparities in health and education went hand and hand, and saw the power in tackling both together, by offering mental health counseling, reproductive health resources, and chronic disease management support – just down the hall from where learning took place. One high school reported a 40 percent decline in positive pregnancy tests over four years, while also improving academic performance and attendance.
What unites these communities is their commitment to making better health an opportunity for ALL of their citizens. Over the next few months, we will examine the road each community took on their journey to build a Culture of Health. Stay tuned for more as we continue to learn from these creative, visionary communities and their unique approaches to health.
Joe Marx is a Senior Advisor and Senior Communications Officer at the Robert Wood Johnson Foundation and oversees marketing and advocacy efforts for the Culture of Health Prize and County Health Rankings. Read his full bio.