A father and son playing basketball together.
A father and son playing basketball together. Playing Basketball

2017 RWJF Culture of Health Prize Winner

Confronting Historic Inequity to Build a Better Future for All

Richmond, Virginia’s downtown district has an up-and-coming vibe. Boutique storefronts and apartment buildings appear recently rehabbed. Restaurants and coffee shops housed in historic buildings are retro hip. At the intersection of Broad and Adams streets, a new statue of Maggie Walker, a former slave’s daughter who became America’s first female bank owner, stands proudly.

But elsewhere in this city that once was the capital of the Confederacy, history has a heavier footprint via the lasting impact of decades of discriminatory urban policies. The result has been what lifelong Richmonder Duron Chavis, community engagement coordinator at Lewis Ginter Botanical Garden, calls a “toxic cocktail of concentrated poverty” as well as entrenched inequities in education, health, and housing.

Richmond, Virginia

A city whose education, housing, and everyday life was historically divided by race, Richmond is striving to build a community of inclusion.

Richmonders are strong in the belief that they can only change their city’s future and improve health for all if they understand its past. Stakeholders from across the city are coming together to create agency and opportunity for all residents, empowering them to make healthy choices and forge pathways out of poverty.

“Richmond is becoming a place where regardless of the color of your skin, where you live, or how much you have in the bank, you can enjoy a healthy lifestyle,” says Mayor Levar Stoney.  

Reaching that goal means helping people build wealth after generations of African-American families were prevented from doing so by discriminatory lending and hiring practices. It means creating inviting, socio-economically integrated neighborhoods in lieu of the sprawling public housing developments of the 1960s and 1970s. It means making sure families that have lived in poverty for generations are not left to fend for themselves, but rather are given supports so they can thrive.

“Something that’s going on in another neighborhood ... is still my problem because this is an entire community—I think there's a growing understanding of that,” says Becky Clay Christensen, director of community partnerships at Bon Secours Health System, Richmond. “The quality of this community is not based on its individual parts being strong, but all of us being strong and taking ownership.”

The quality of this community is not based on its individual parts being strong, but all of us being strong and taking ownership.

Becky Clay Christensen, director of community partnerships, Bon Secours Health System, Richmond

A family standing next to a mobile market.

A City Responds to a Crisis of Economic Opportunity

2016 Culture of Health Prize Winner
Two young adult students talking in a classroom.

Louisville, Kentucky—Degrees of Achievement

In Louisville, a continuum of programs starting in early childhood bolsters education and training to help residents achieve self-sufficiency.

In her nine years as the employee of a Richmond, Virginia, grocery store, Kiocia Wilkerson worked just about every job: cashiering, staffing the pharmacy, filing paperwork. But toward the end, she wasn’t getting the steady hours she needed to support her two young children on her own. Without childcare, she was unavailable for evening and weekend shifts. Some weeks, she had just four hours of work, or none at all.

It was a financial crisis for Wilkerson’s family, but also a crisis of opportunity. “The way I was getting paid, I was never going to move in life,” she says.

Poverty is entrenched in Richmond. About a quarter of residents and four in 10 children live in poverty. The rate is much higher in some neighborhoods, such as the Census tract that includes Fairfield Court, the East End housing development where Wilkerson and her children lived until earlier this year. There, more than two-thirds of families live in poverty.

In response to widespread intergenerational poverty, the city in 2014 made a bold commitment to reduce child poverty by 50 percent and overall poverty by 40 percent by 2030. Richmond’s Office of Community Wealth Building, the first office of its kind in the nation, was created that year to lead the charge.

“The thought was to put pieces of [poverty reduction] under one department so there can be a strategy to move thousands of people to self-sufficiency,” says Richmond native Reggie Gordon, the office’s director.

Two women happily talking outdoors. Kiocia Wilkerson (right) chats with Sandee Smith, program coordinator for Richmond's Building Lives to Independence and Self-Sufficiency (BLISS) program, outside Wilkerson's home in a mixed-income neighborhood. By participating in BLISS, Wilkerson has been able to meet financial and personal goals and move out of public housing.

To lift families out of poverty, the city is working to expand employment possibilities, supporting individuals along the way. At the Office of Community Wealth Building’s Center for Workforce Innovation, participants are matched with intensive case managers who connect them to education, vocational training and job opportunities, provided through partnerships with local higher education institutions and businesses. The city also has opened “Future Centers” in every Richmond public high school to prepare students for college and careers through mentoring, college application support, and soft-skills training.

In the East End, the Peter Paul Development Center is taking a neighborhood-based approach to building assets in families that have had few educational and employment opportunities. The center works with more than 200 children and their families, providing out-of-school time and summer programming, and creating plans for all members of the family to achieve milestones and goals along the path to self-sufficiency.

Building wealth in families that faced discrimination for generations will take time, people here say. Wilkerson can attest to that.

But she feels herself moving forward, with help from the Center for Workforce Innovation and Building Lives to Independence and Self-Sufficiency, or BLISS. This intensive program, launched in 2015, provides similar supports to families that live in public housing.

Wilkerson got a job two years ago as a school cafeteria worker, and she and her children recently moved into a mixed-income neighborhood, becoming the sixth BLISS family to leave a public housing development. Eventually, Wilkerson wants a career helping people, so she’s studying human services at Reynolds Community College.

“Our whole reason for working with our families is to empower them to remove barriers they never thought they could,” says BLISS Program Coordinator Sandee Smith, who has worked with Wilkerson the past few years. “We put them in front of resources that make things happen.”

The Office of Community Wealth Building promotes Richmond's ambitious goal of reducing child poverty by 50 percent, and overall poverty by 40 percent, by 2030.
Happy siblings holding a basketball on the court. Basketball Court

Clinics, Coaches, and a New Approach to Public Housing

Danny Avula didn’t expect to become an expert on public housing when he joined the Richmond City Health District as deputy director eight years ago.

But he soon would. Early in his tenure, the district mapped the prevalence of Richmond, Virginia’s health indicators—such as infant mortality, teen pregnancy, gun violence, chronic disease, obesity, substance abuse, and STDs—across the city’s neighborhoods.

“They all lit up in public housing,” he says.

Avula went to the Richmond Redevelopment and Housing Authority, a quasi-governmental agency that oversees the city’s public housing developments.

“I told them, ‘Health outcomes are bad in your communities. How do we deal with that?’” recalls Avula, who now directs the health district.

The answer was a collaboration between the two agencies. As a result, health resource centers are now embedded in Richmond’s six largest public housing developments as well as a middle school. Each center has clinic hours one day a week. A nurse practitioner and a public health nurse offer chronic disease screening, breast and cervical cancer screening, STD testing, family planning services and referrals. A range of nonprofits, public and private funders, and partners in the city support the facilities.

A key innovation is staffing the centers five days a week with community health workers who have lived in public housing.

“People trust me that I know what they’re going through,” says Stephanie Carrington, a community health worker at the Creighton Resource Center. Carrington, who grew up in the Creighton Court public housing development, connects residents to health insurance, weight loss clinics, nutrition classes, mental health counseling, employment services, and other supports. Each year, the resource centers see more than 2,000 medical patients and make 4,000 referrals to social and community services.

Even so, Avula says the centers can’t change the fact that poverty is heavily concentrated in Richmond’s public housing developments. Over the years, the city has recognized that getting to the root of the residents’ health and social problems means changing the environment in which they live.

There have been missteps in that effort. When the city tore down and replaced the Blackwell development in the early 2000s, many residents were displaced or became homeless because not enough subsidized units had been built.

This time around, the city will replace units one-to-one, moving residents in stages as new mixed-income housing is constructed. And to make sure people don’t fall through the cracks, last year the housing authority contracted the health district to hire two social workers. Their job: help the first 100 families safely move to new homes in 2018, or to another neighborhood if they choose. These “family transition coaches” expect to work with each head of household for a year or more, helping them do things like land a steady job that will allow them to save for a deposit. They’ll work together to set and meet goals that will prepare residents for a move.

“Our goal is to have them live a well-balanced life,” says coach Nikki Patterson, who spent part of her childhood in Creighton Court, “and be able to prosper wherever they move.”

Two people talking in the front yard of an apartment complex.. Community health worker Stephanie Carrington talks to public-housing resident Willie Davis outside the Creighton Resource Center. Richmond has embedded health resource centers in its six largest public housing developments and a middle school.
A mother and young daughter sitting together while enjoying watermelon.. Mother and Daughter

All In to Lower the Barriers to Healthy Eating

A smiling man posing for a photo. Community organizer Omari Al-Qadaffi was recently tapped by the city to lead the Richmond Food Justice Alliance and get residents involved in improving food equity in the city.

Omari Al-Qadaffi wants you to know he recently convinced two boys at Whitcomb Court, a Richmond, Virginia, public housing development, to eat tomatoes as though they were apples.

“They didn’t want to eat them at first,” he says. “But they liked them.”

Al-Qadaffi has made it his mission to help Richmonders eat their vegetables, both as a matter of health and as a matter of justice. As lead organizer of the Richmond Food Justice Alliance, launched this past summer by the Richmond Health District and the American Heart Association, he is training the first cohort of Richmond-area residents to get fellow community members involved in improving food equity in the city.

The task couldn’t be more urgent. Four in 10 Richmonders live in neighborhoods with significant poverty and a dearth of grocery stores, according to an analysis by the Mayor’s Food Policy Task Force in 2013. The city’s “food deserts” are layered on top of neighborhoods where health problems are most pressing. Among African-Americans in Richmond’s East End—home to four large public housing developments and no full-service grocery stores—high blood pressure, obesity, smoking, diabetes and cardiovascular disease occur at higher rates than in the rest of the metro area. There is as much as a 20-year gap in life expectancy between the city’s poorer and more affluent ZIP codes, according to research by Virginia Commonwealth University in Richmond.

If you have no car, no healthy foods or fresh produce, you aren’t going to grow
up with the knowledge of, ‘What do I do with this squash?’

Omari Al-Qadaffi, lead organizer, Richmond Food Justice Alliance

Al-Qadaffi's grassroots alliance is working in concert with a wide array of like-minded Richmonders intent on bringing food justice. For example, the Richmond Health District’s Healthy Corner Store Initiative has since 2015 worked with Shalom Farms, a local nonprofit produce grower, to put refrigerated displays full of fruits and vegetables in nine corner stores. A similar program run by Tricycle Gardens, a nonprofit urban agriculture organization, is in 21 corner stores. And Shalom Farms and RVA Food Collaborative—which is comprised of farmers, grocery store owners, and other public and private partners—in 2016 launched Grown to Go, a mobile market serving more than a dozen public and private housing developments.

Meanwhile, plans for a full-service grocery store in the East End are in the works, led by Richmond philanthropist and businessman Steven Markel.

To be sure efforts are addressing the wants and needs of residents, Richmond’s Institute for Public Health Innovation recently conducted focus groups in neighborhoods with poor access to healthy foods. What it found was a strong desire for cooking and food classes. Many Richmond organizations, including Bon Secours Sarah Garland Jones Center for Healthy Living in the East End, are obliging, offering free hands-on opportunities to grow, cook, and learn about food.

The momentum for change is building, as the city is studying policy changes such as creating incentives for grocery store development in food deserts and incorporating urban agriculture into the city’s master plan.

“We have to look at all the factors in someone’s life that support them living a healthier lifestyle,” says Elizabeth Theriault, chronic disease supervisor at the Richmond City Health District. To achieve that, she says, the city must help all citizens “find ways to make the healthy choice the easy choice.”

Two men stand together posing for a picture. Duron Chavis (right), community engagement coordinator at the Lewis Ginter Botanical Garden, and Dominic Barrett, executive director of nonprofit produce grower Shalom Farms, visit the McDonough Community Garden, which Chavis helped found in Richmond's Southside.
2016 Culture of Health Prize Winner

Columbia Gorge - Veggie Rx: A Fresh Produce Prescription

In the Columbia Gorge Region of Washington and Oregon, doctors and social service agencies prescribe fresh fruits and vegetables to people who face food insecurity.

Working Together to Ensure Lasting Change

RWJF Culture of Health Prize

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