How Do You Transform a Community After a Century of Neglect?

Nov 20, 2013, 1:00 PM


Bithlo, Fla. is a town of 8,000 that is just 30 minutes outside Orlando and not much farther from the “happiest place on Earth” — but is beset by poverty, illiteracy, unemployment and toxic dumps that have infiltrated the drinking water. The water is so bad that it has eroded many residents’ teeth, making it that much harder for them to find jobs. Streets filled with trash, frequent road deaths and injuries from a lack of transportation options and safe places to walk, and dropping out before 10th grade were all the norm.


In just a short time, a collection of partners and volunteers have begun to reverse some of the decades-old problems Bithlo has faced. And earlier this week, the town that had been forgotten for almost a century was the scene of a hubbub of activity as hundreds of volunteers descended on the town to continue work on “Transformation Village,” Bithlo’s future main street, which will sport a combination library/coffee shop, schools, shops and many other services, all long missing from Bithlo.

Over the last few months, NewPublicHealth has reported on initiatives of the participating members of Stakeholder Health, formerly known as the Health Systems Learning Group. Stakeholder Health is a learning collaborative made up of 43 organizations, including 36 nonprofit health systems, that share innovative practices aimed at improving health and economic viability of communities.

>>Read more on the Stakeholder Health effort to leverage health care systems to improve community health.

One of the Stakeholder Health members is the Adventist Health System, a not-for-profit health care system that has hospitals across the country. Recently, Adventist’s flagship health care provider, Florida Hospital in Orlando, began supporting United Global Outreach (UGO), a non-profit group aimed at building up communities in need, in their four-year-long effort to transform the town of Bithlo.

NewPublicHealth recently spoke with Tim McKinney, executive vice president of United Global Outreach, and Verbelee Neilsen-Swanson, vice president of community impact at Florida Hospital, about the partnerships and commitment that have gone into Bithlo’s transformation into a town that is looking forward to new housing stock, jobs, stores, better education and improved health outcomes for the its citizens.


NewPublicHealth: Not every problem in Bithlo is directly a health issue —unemployment and school drop-out rates, for example. Why has the hospital taken on such a full range of issues facing the community?

Verbelee Nielsen-Swanson: Those are all components to a healthy, vibrant community. Florida Hospital’s mission is to extend healing. And we see that as not only within the walls of our hospital, but extending it out to others.

It is also an opportunity to have a living laboratory, and really be able to measure the change. Our goal is to have replicable models, so that we can work in other communities here in Central Florida, as well as across the Adventist health system to help communities reach their full potential.

NPH: Tim, what are the issues you’re focusing on?

Tim: Our key areas include education, health care, transportation, housing, environmental issues, basic needs, and building a sense of community. We’ve been working on all of them simultaneously.

Highlights of improvements that have been achieved include…

file Orange County Academy in the new Transformation Village


We decided to immediately open a private school, Orange County Academy. The purpose of the school really wasn’t to stop the educational deficit, but rather to try to see if we could establish some best practices for educating the children of Bithlo, that for generations had not been succeeding, for a variety of reasons, in public schools. The public school has already started to take note. We’re helping them reshape the way that they’ve been addressing this population, so that these kids can actually get past the ninth grade and graduate with diplomas that are more than just certificates of completion.

Health Care

There had never been a permanent doctor’s office in the Bithlo community. It seemed like everybody was taking an ambulance to the emergency room. Florida Hospital is the closest hospital and that is fifteen miles away. We recruited a federally qualified health center to open a clinic and they’ve been open about a year now. It’s probably the most historic thing that’s happened in the community, to have their own primary medical home in their neighborhood.

file New bus service to Bithlo that stops at the new medical clinic


For years there was no public bus line for this community. This posed a danger because many people walked or biked and Bithlo is split down the middle by a major highway and there has been a high rate of accidents. But after two years of work, public bus service was restored earlier this year. They’ve set aside $9.1 million to fix a key bridge and put in a bike and pedestrian path next year. Additional funds will fix the road that runs through Bithlo and add sidewalks as well as street lights, and separate areas for bikers and walkers.


Verbelee Neilsen-Swanson: We’ve launched “Hire Local Bithlo.” Our contractors are interviewing individuals and then bringing them into the construction trade. These are entry-level jobs and if they prove themselves, then they’re provided with training and the goal is that they become hired full-time by an employer. It's also about restoring smiles. That’s not all, of course, but it’s a big start. The water has damaged just about everyone’s teeth — discoloration, teeth missing — it impacts many peoples’ opportunities to be hired. But we’re pulling teeth, getting dentures restored and creating opportunities for people to become employed.  

NPH: How did Bithlo get to be where it is in terms of health and social challenges?

Tim McKinney: Bithlo is a unique mess due to the fact that it was a municipality that went bankrupt in the late 1920s. There was no functioning government. However, it was an incorporated municipality until the end of the 1970s, so it was like a town with no sheriff.

NPH: How are partners beyond government critical for this initiative?

Tim McKinney: Our perspective is the government has a seat at the table, but they cannot be at the head of the table. Elected officials come and go. And so we’re only plugging them in, in areas where government should be working. And in other areas, we’re initiating public partnerships and grassroots movements.


NPH: What are some of the partners the hospital has brought to the table?

Verbelee Neilsen-Swanson: We have been able to bring in the University of Central Florida, which is the second largest university in the nation, including schools of engineering, nursing, administration, medical, education and public health. We’ve also been able to engage a number of our vendors and contractors to help us with facilities and renovations.

The hospital’s emergency medicine group helped provide uniforms for the students, conducted health screenings and bought bikes for each student so that they could get to and from school. Others we’ve brought to the table include bankers and realtors to help the revitalization. An important aspect of Florida Hospital’s involvement was in creating awareness, advocacy, and an urgency—letting our partners know that Bithlo was important to us.  

Tim McKinney: Having Florida Hospital as an anchor partners put us so far ahead. We realized we needed to build up influence and collaboration outside of the Bithlo community. Having Florida Hospital on board instantly caused elected officials and other key stakeholders to care.

It’s also important to understand the chronology. The medical clinic for Bithlo was already in the works when we approached the hospital. Our interest in the engaging the hospital was not health care-related. It was related to wanting the community to have access to a healthy lifestyle.

file A wooded area of Transformation Village, with the new community garden in the lower right

NPH: How are you measuring success?

Tim McKinney:  Because Bithlo is lacking so much in its infrastructure, it’s very easy to measure success because we identified, for example, that we needed buses. Now there are buses. The bridge needs to be widened. It’s now being widened. There is no medical clinic. Now there’s a medical clinic. Now, as we transition into the community engagement phase, we are working with sociology students from the University of Central Florida to do a community assessment so that we’ll have baseline data.  

NPH: In what ways is Bithlo a model for other communities?

Verbelee Neilsen-Swanson: It’s working across all aspects of the community — it’s a holistic approach.

What is unique in Bithlo is the goal to make it a vibrant healthy community, and not need to have us involved in future transformations — for Bithlo to be able to sustain itself.

Tim McKinney: From my perspective, it’s important that, not only in Bithlo, but in every community, you have to go in there believing that transformation is possible. We believe that every person can be transformed. Whether it is the kids in our school, or a 61 year old lady that asked me this week if she can get her GED. Because now she feels inspired to go forward.

Every community can be changed. I think sometimes we’ve had such problems for so long in some neighborhoods that we decide instead to develop over them. Because we’ve given up on them. Then that really only disperses the problem to someone else’s neighborhood. The uniqueness about Bithlo is, we want to help everybody. We work to help them turn around, so that they might become healthy, instead of developed over. Transformation efforts aren’t program-centered, they’re relationship-centered.

This commentary originally appeared on the RWJF New Public Health blog.