RWJF COH Miami. August 29-31, 2016.  Pictures of people exercising (walk, run, bike) along Miami Beach neighborhood area.

2016 RWJF Culture of Health Prize Winner

 A Healthy Target: Let’s Help ‘Everyone’

Miami is like no other place in North America, or possibly the world. Famously welcoming, Miami-Dade County—also known as the “Gateway to the Americas"—has served as a haven for generations of refugees from Cuba, Colombia, Nicaragua and other Latin American countries. The county’s population of 2.7 million encompasses 79 different cultures; 51 percent of Miami’s residents are foreign-born, more than any other city in the United States. This multicultural mecca also hosts 13 million visitors a year, all contributing to a vibrant stew of Latino music, international restaurants, regular street festivals, forests of high rises downtown and brightly-hued houses and streets in its many ethnic neighborhoods.

But under the high-energy surface, Miami is grappling with pressing social and health risks. About 1 in 5 of the county’s residents live below the federal poverty line, including nearly 1 in 3 children. A third of the population is uninsured, two-thirds of adults are overweight or obese, and too many neighborhoods lack nearby access to affordable healthy food or safe parks.

A fractured response wouldn’t meet these challenges. Instead, in 2003 the Consortium for a Healthier Miami-Dade County was formed to address the county’s overall health. Determined from its creation to be as inclusive as possible, the consortium started with 160 partner organizations, focused on prevention and on the social factors that impact health. Successes over the past decade include putting healthy menus in place in the county’s public schools, which serve 340,000 children; installing fitness equipment that is free to all in 16 parks, with seven more teed up; reducing the homeless population; and offering routine HIV testing in all health facilities.

The consortium’s membership grew along with its mission. There are more than 900 members and 300 partners today, including government agencies, nonprofits, restaurants, churches, broadcasters, universities, insurers, schools and city planners.

“The strength of the consortium is that it is made up of members of the community from every sector,” says co-chair Alina Soto. “We have everyone from the state health department to Holly Zwerling, founder of the Fatherhood Task Force of South Florida, who is a spokesperson for engaging fathers in the community. We have over 75 restaurants that now offer healthier menu items. It’s community, it’s grassroots and it’s individuals. And it’s a foundation for us to create a culture of health in this community.”

Because of this long-term focus on collaboration, inclusion and outreach, Miami-Dade County has been honored with the RWJF Culture of Health Prize.

A woman and child read together at the ConnectFamilias center in Little Havana neighborhood of Miami.

The consortium’s broad-based action is driven by its determination to address health in ways that resonate with each unique culture and community. Take Little Havana, for example. One of the city’s most underserved neighborhoods, it has been lifted by ConnectFamilias, a nonprofit formed in 2007 by a variety of local partners dedicated to strengthening the community’s children—and by extension their families. On any given day in ConnectFamilia’s offices, in the heart of the neighborhood’s business district, staffers and volunteers are helping adults learn how to write a resume and handle a job interview, conducting “mommy and me” classes for mothers and their toddlers and reading with young children and their parents, in English and Spanish. ConnectFamilias offers job training and helps teens find internships. The organization also worked with the community to build a safe park—an amenity Little Havana sorely lacked.

“When you think about the work that needs to take place to have a healthy community, it’s not just going to the doctor,” says ConnectFamilias President & CEO, Betty Alonso, who grew up and still lives in the community she serves. “It's really going to find a job, having a good education, addressing so many things around those social determinants of health. No one agency, no one funder, no one partnership can do that by itself.”

Miami-Dade County, Florida

A vibrant, collaborative and coordinated approach to improved health.

Lead coordinator for the Lazarus Project, Edward Suarez, Jr., and team member Rose Anderson talk with a homeless community member in downtown Miami.
Street art in the Wynwood Walls area of Miami.

The range of consortium-supported programs is as vast as the county, but most are tailored to the communities they serve. Initiatives developed for Little Havana are not shoehorned into Liberty City, a neighborhood that is home to one of the largest black communities in Florida and the site of the nation’s first public housing project. There, the nonprofit Miami Children’s Initiative provides many of the same types of supports and the same level of community empowerment as ConnectFamilias does in Little Havana, but in ways that best meet the needs of Liberty City.

At the same time, broader countywide initiatives, such as those geared toward preventing violence, serve the county’s common good. Miami’s crime rate is twice the national average. The Violence Intervention Project and the Miami-Dade Anti-Gang Strategy were created to engage and empower youth to halt violence in their communities, with support from law enforcement. In August, dozens of residents and police officers came together in a show of unity to march through Liberty City, which has been plagued by gang violence. The parade was followed by a back-to-school block party and barbecue that gave residents and police a unique opportunity to connect.

“It takes all of us coming together to create a different Liberty City and a different reality for the children of this neighborhood,” said Cecilia Gutierrez, the event organizer and president of the Miami Children’s Initiative.

The consortium and its partners also enjoy robust support from county and city government, and indirectly, from the millions of visitors to the city. Miami-Dade’s safety net hospital network, Jackson Health System, is financed in part by a half-penny sales tax, while a portion of the food and beverage tax is used for homeless services.

In July the county commission approved a $300 million overhaul of Liberty City’s public housing, with grocery stores and parks—now almost nonexistent—as part of the master plan. “You'll see our communities that are traditionally underserved will begin to thrive,” predicts Miami-Dade deputy mayor Russell Benford, while hailing the capital investments. “Every part of this community needs to prosper if any of us are going to prosper.”

Preschoolers exercise during their physical education class.

Fit2Play Keeps Kids Healthy

In Florida, 1 in 4 children is overweight or obese. To turn those stats around in the state’s most populous county, the Miami-Dade Parks Department teamed up with the University of Miami Health System to create Fit2Play, a daily after-school and summer program that serves 1,400 to 1,800 children daily in almost 40 parks throughout the county.

Though focused on physical activity, Fit2Play also teaches children other basics of a healthy lifestyle, including good nutrition and helpful study habits. Each day’s session begins with homework help, followed by games designed to build physical and social skills. Fees are on a sliding scale pegged to a family’s income. What makes this after-school program stand out, however, is the data proving it is “highly effective.”

Sarah Messiah, a research associate professor of pediatrics at the University of Miami, helped design Fit2Play and conducted an initial study of nearly 300 children, ages 6 to 14, enrolled during the 2010-2011 school year.  Almost all the children were black and Hispanic, drawn from underserved neighborhoods. At the beginning and end of the program, the kids underwent a series of measurements to determine fitness, including body mass index—or BMI—and blood pressure. Physical fitness was assessed by sit-and-reach tests, timed sit-ups and push-ups and a 400-meter run.

After the first year, Messiah found that Fit2Play participants maintained healthy BMI throughout the school year, and those who started with high blood pressure had lowered it. The children significantly improved their fitness levels and their knowledge of nutrition and healthy lifestyle behaviors.

Messiah just completed her sixth year of data collection, surveying more than 2,000 kids. “Overwhelmingly, we’re seeing really great results,” she says. Not only does Fit2Play help children struggling with their weight get back on a healthy trajectory, but kids within normal weight ranges are able to maintain a healthy weight.

“That’s prevention in the truest sense of the word,” Messiah says.

Annia Stjusle with her son, Rashad Strong-Stjusle, 6, at their home in the Liberty City neighborhood near the Charles R. Drew Middle School that is served by the Miami Children's Initiative.

The Culture of Health Prize

The Prize honors and elevates U.S. communities working at the forefront of advancing health, opportunity, and equity for all.

Helping Kids From Cradle to College

When Cecilia Gutierrez walks through Miami’s Liberty City, she is besieged by children. They want a hug, they want to dance and they want her to help them tend one of 20 community gardens. Gutierrez, president and CEO of Miami Children’s Initiative, in turn encourages the kids to eat healthy snacks, asks whether they did their homework and dances.

The initiative is tightly intertwined with Liberty City, home to more than 160,000 people and one of the oldest black communities in Florida. Once a thriving middle-class area, since the 1960s Liberty City has been hard hit by joblessness, low-performing schools, crime, drugs and poor health. To bring Liberty City back to strength, in 2009 the Florida Legislature created Miami Children’s Initiative to address the neighborhood’s problems with a laser focus. Local residents and businesses along with leaders in health care, education and human services banded together to provide a “cradle-to-college” support system for children in Liberty City, with services ranging from neonatal nutrition to college prep classes.

Revitalizing Neighborhoods

Revitalizing Neighborhoods Through Community Engagement

A sign displays motivating words at a community playground.
Children play outside at an afterschool program put on by Miami Childrens Initiative.

A Park for the Ages

It may be hard to imagine that residents of Miami-Dade County could have a difficult time finding places to exercise, given the region’s abundance of beaches and natural beauty. But a drive through some of the county’s underserved neighborhoods reveals a notable void: There aren’t enough safe parks and playgrounds.

Through a series of actions, Miami-Dade is changing that.  

The county is carving out more space for cycling by building nature trails and bike lanes throughout the city. New playgrounds have been added as well, and the Consortium for a Healthier Miami-Dade County is creating “pop-up parks” in urban neighborhoods that have little green space. These parks come to life when a team temporarily cordons off an area for a day, lays down mats and brings in play equipment—notifying the community with flyers.

A handpainted sign displays the community's wish at a local park.
A community garden in the Liberty City housing development gets handpainted art.
Local street art sits proudly on display on "Calle 8" in Little Havana.

But the most ambitious undertaking is the Underline, a 10-mile, 100-acre ribbon of a park to be built on the unused land below Miami’s Metrorail, running alongside the Miami River. Construction is scheduled to start in 2017.

Designed by the same firm responsible for Manhattan’s wildly popular High Line park—which was built on an abandoned elevated rail line—the Underline will use private and public funds to cover its $100 million cost. Walking and cycling paths will run the length of it, winding through permanent and temporary outdoor art installations.

“Miami-Dade County is known for its tough traffic, and so we're looking for alternate methods for people to commute to and from work and play,” says Miami-Dade deputy mayor Russell Benford. The Underline will offer residents the opportunity to ride their bikes or walk to work, and it will serve as a connector between adjacent communities. An added bonus: It’s expected to generate $50 million in economic activity annually once completed.

A 'Continuum of Care’ for the Homeless

In a light-filled room in Miami’s Camillus House, art students prepare their work for a group show. Beveann Charles, 38, proudly shows off a series of flower watercolors that capture the vibrant colors of the city she calls home. Except that Beveann has been homeless for almost a year—she first lost her job, then her apartment. Camillus House, a full-service homeless center, helped her regain confidence and learn new skills so she can tackle the job market again.

“I’ve learned that anyone can be homeless,” says Beveann, who has a college degree. “Camillus gave me a place to go and people who cared. They helped me believe in myself again.”

Irene Onody works on her paintings during a Camillus House art program for the homeless residents.

Founded in 1960, Camillus House provides whatever services are needed to help Miami-Dade’s more than 4,000 homeless residents move into permanent homes. Camillus’s huge campus in downtown Miami houses 340 shelter beds, health clinics, dining rooms, job training programs, even a Hope Choir made up of homeless members. The organization operates 14 more locations, works with landlords and builders to develop affordable housing and helps homeless people obtain the documents they need to receive benefits.

A few years ago Camillus started the Lazarus Project to reach the more than 600 people sleeping outdoors because they are homeless. To keep this population—many with mental health problems—from having to go back and forth between the psychiatric ward and the sidewalks, Camillus staffers travel out night after night to provide medication and health treatments to the homeless wherever they are. As a result, many of these vulnerable men and women have been convinced to come to the shelter for the comprehensive care that might get them off the streets for good.

“It’s all about creating a continuum of care,” says Camillus CEO Shed Boren. “So many of the homeless are broken in spirit and in health.” Camillus, he says, is a place where they can mend.

I’ve learned that anyone can be homeless. Camillus gave me a place to go and people who cared. They helped me believe in myself again.

Beveann Charles, Miami-Dade County resident

A Focus on Seniors

On a sultry summer afternoon, 15 people are trying to master the slow movements of Tai-Chi at the Arcola Lakes Senior Center. The center is buzzing with activity as some older adults train in the pool while others are engaged in a ceramics class. All these activities—and the center—are free, just a sampling of the many services offered in Miami-Dade County to promote good health among its oldest residents.

Since the 1950s, Florida has been a favored destination for retirees, and in Miami-Dade County, 15 percent of the population is 65 and older. Recognizing that older adults are the most vulnerable to ill health, poverty and isolation, the Consortium for a Healthier Miami-Dade County has prioritized easy-to-access programs and services for this cohort.

The mayor's office joined forces with the consortium’s senior outreach in 2006 to establish the Initiative on Aging, a robust program that provides resources and information on assisted living, transportation and other senior needs. The program’s staff also organize free cultural events for people 62 and older, and find other creative ways to encourage physical activity. In the Age-Friendly Business District in Little Havana, for example, every Tuesday more than 25 businesses provide coupons to older adults living nearby to encourage them to walk to their stores.

"Calle Ocho" (8th Street), the main cultural area of Little Havana's Cuban culture.

To make sure seniors stay socially, as well as physically, active, some 50 sites in the county offer elder classes sponsored by the Health Foundation of South Florida, which focuses on older adults. Steven Marcus, president and CEO of the foundation, says he sees successes every day.

“We've had people who brought in their breathing equipment, and some of them (eventually) ... got rid of all their equipment and they actually became trainers, teaching classes,” he says.

Children play outside at an afterschool program put on by Miami Childrens Initiative.
A Lazarus Project team member talks with Pierre Kennedy, a homeless community member who stays in the downtown area of Miami.