Our commitments to each other are authentic, and we drive and leverage those relationships to get things done.
—Kimm Campbell, director, Broward County Human Services Department
2019 RWJF Culture of Health Prize Winner
Broward County’s ‘Destination’: Health Equity
In Broward County, Fla., the unofficial motto among health partners is “go big or go home,” and for good reason.
This community in South Florida, sandwiched between Miami-Dade and Palm Beach counties, stretches from the high rises of Fort Lauderdale to the wetlands of the Everglades. It is larger in population than 14 states with 1.9 million people, a third of whom were born in countries other than the United States.
Community partners have come to realize that everything from affordable housing to school quality to how they address racism will have an impact on the health of their residents. And to tackle such big, complex, intertwined issues across this geographically and demographically diverse and populous county, they recognize the need to work together. More than 60 percent of the population are people of color, including 30 percent Black and 28 percent Hispanic.
“Our destination ultimately is for everybody to have health equity, for everybody to be able to reach their optimal health status, and for barriers to be eliminated,” says Paula Thaqi, director of the Florida Department of Health in Broward County.
Broward County is one of the most expensive places to live in the country, creating an economic barrier to health. About half of residents pay more than a third of their income on housing. Of working individuals and families, 44 percent are unable to afford the basic necessities of housing, food, child care, health care and transportation, according to a United Way study.
When too much of a paycheck goes toward rent or mortgage, it makes it hard to afford the doctor, cover utility bills, or maintain reliable transportation to work or school, all of which have an impact on health. Broward also has the second highest rate of new HIV/AIDS diagnoses in the country, which has led the county to make treatment, prevention, and access to care a health priority.
Other barriers to health are not as easily measured, but no less obstacles, such as the collective trauma from devastating hurricanes and mass violence, as well as an ongoing legacy of racial segregation and discrimination.
To address these challenges, leaders from government, businesses and nonprofits work in tandem through the Coordinating Council of Broward to advocate for action, aligning around four core issues: increasing affordable housing; recovering from disasters; dealing with collective trauma; and ensuring the county’s aging population can live well.
At the neighborhood level, residents are encouraged to champion their community’s health through five county-led Healthy Community Zones.
They identify their most pressing health challenges and help shape policies and practices to address those concerns, such as creating safer streets or reducing tobacco use.
Our commitments to each other are authentic, and we drive and leverage those relationships to get things done.
—Kimm Campbell, director, Broward County Human Services Department
RWJF supports initiatives that enable communities and all of their residents to thrive and reach their greatest health potential by improving the contexts in which residents live, learn, work, and play.
In “going big,” the Broward community has:
Leaders use data to pinpoint opportunities for health improvement, and rely on collaboration to accomplish common goals. One of many examples is Broward Unlimited Potential (UP), an initiative led by Broward College with partners in business, nonprofits and other community groups to increase educational access and promote economic opportunity. To identify neighborhoods with high need, Broward UP looks at ZIP codes with disproportionately high unemployment rates, low educational attainment, and low household incomes.
“There is a gift that the county has,” says Gregory Haile, the college’s president, “of being able to compartmentalize its egos.”
The Culture of Health Prize validates this spirit of partnership, says Kimm Campbell, director of Broward County Human Services Department. “Our commitments to each other are authentic,” Campbell says. “And we drive and leverage those relationships to get things done.”
Going Big to Improve Health
What’s in a name? For African American residents of Broward County, everything.
Sistrunk Boulevard pays tribute to James F. Sistrunk, a Black surgeon who started Fort Lauderdale’s first hospital for Blacks in 1938 because he was not allowed to perform surgical procedures in white hospitals.
The Von D. Mizell-Eula Johnson State Park honors two Civil Rights Movement leaders who staged “wade in” protests at exclusive all-White beaches.
Walker Elementary School recognizes educator Clarence Walker, who led the fight in the 1940s for a full day of school for Black children, who were expected to work in the fields harvesting crops.
These tributes through public names are signals that the community honors and values the assets of its diverse residents, and publicly recognizes the history of racism that has affected everyone in the community, but led to measurable disparities for Blacks. More specifically, the legacy of segregation is a challenge that partners in Broward are addressing head-on, recognizing that entrenched biases are barriers to improving health.
“This is a community that is inviting and open to people from all walks of life, all parts of the world,” says David Watkins, director of equity and diversity for Broward County Public Schools. “But we also have to be cognizant of the fact that there is a history in our country and in our community that has marginalized many of those voices and silenced some of those voices.”
Broward County spotlights how a community can actively address and change the structures that perpetuate inequities by openly acknowledging practices that historically exclude some groups. They are creating public spaces for difficult conversations about racism that are changing policies and practices, as well as attitudes.
The Dismantling Racism Initiative, launched by four county partners in 2016, has trained about 3,400 people within government agencies, schools, social service providers and faith-based organizations. To continue the work of the initiative, regular caucuses are held—one for people of color, one for whites, and one for both. “It’s easier now to have this conversation,” says Sharon Hughes, an African American community health worker at the YMCA, who went through the training.
To help bridge the racial achievement gap in the Broward County School District, every school has an equity liaison to ensure that each student has the same level of opportunity. Liaisons set goals and benchmarks for schools, tracking such markers as classroom performance and behavioral incidents, while also searching for patterns behind numbers that might be creating a disadvantage for students of color.
At one elementary school, an equity liaison detected a high level of disciplinary action during dismissal and, by connecting the dots, learned that the school had no after-school program. Hallways became jammed with students hurrying for rides home.
“Maybe it wasn’t the kids? Maybe it was the process,” recalls Marion Williams, an equity liaison for the district. The school began staggering dismissal and disciplinary referrals dropped by 40 percent, she says.
To improve educational outcomes, public schools have a range of initiatives, such as a Mentoring Tomorrow’s Leaders program and efforts to increase Black and brown student participation in activities such as computer coding and the district’s acclaimed debate program. Graduation rates for Black students have increased from 66 percent in 2013 to 79 percent in 2018, and the school district has more African American students enrolled in Advanced Placement computer classes than the rest of the state combined.
“We’re really entering this work of disparate outcomes by addressing the root cause of systemic racism,” says Kimm Campbell, director of Broward County Human Services.
Children’s Services Council—one of the anchor agencies behind the Dismantling Racism effort, along with the Florida Department of Health-Broward, Broward County Public Schools, and Broward County—conducts regular talks in the community on the local history of racism and encourages people to participate in the two-day workshop. Some public offices use a racial equity lens to improve outcomes in such areas as health, economic well-being, and mental health—and apply it to policy decisions. County commissioners, for example, approved a 10-year land use plan that included a policy to consider the environmental impact of projects on different race and ethnic groups.
Efforts to reduce racial disparities in the child welfare system have resulted in a decrease in the removal of Black children from families into out-of-home care—from 749 in 2016 to 595 in 2018. Campell says children of color stay in care twice as long as their white counterparts.
The county has launched a new effort to try to keep children in their homes by wrapping services and supports around these families. This reflects an attempt to put dismantling racism into practice and to root out inadvertent policies, practices and procedures that perpetuate racism and racist practices, she says. “We’re not talking about individual, person-to-person racism,” Campbell says. “We’re talking about the infrastructure of systemic and institutional racism that plays out day in and day out in the lives of the patients and the clients that we serve.”
People from across Everett have come together to examine cultural and racial inequity and how they might affect residents’ well-being.
This is a community that is inviting and open to people from all walks of life, all parts of the world.
David Watkins, director of equity and diversity, Broward County Public Schools
In the Sunrise neighborhood, construction workers have gutted a one-story house to its cinder-block walls—the only thing salvageable after Hurricane Irma in 2017 tore the roof off the dwelling, drenching the interior and leaving the homeowner without a place to live.
The retired teacher had few options: The median sale price for a single-family home in Broward County was about $350,000 in 2018. “She never would have been able to afford a house,” says Jason Mann of the nonprofit Rebuilding Together, which is restoring the property at no cost to the fixed-income retiree.
Count this as one small victory in a daunting battle to create or maintain more units of affordable housing. The Broward community is taking purposeful action to address health issues that the residents and leaders of the county prioritized together—from building more housing for lower-income residents to strengthening long-term recovery planning after damaging hurricanes. They know that factors like high housing costs and long commutes don’t just make it hard to get by—they affect residents’ health, and the well-being of the community as a whole.
Broward is not just talking about its health challenges, but pursuing policy changes and practices on multiple fronts in a way that is both sustainable and comprehensive. Community partners are advocating on issues that don’t typically garner support for public funding, such as affordable housing, and residents are responding, realizing that everyone in the community is better off when everyone can afford to have a place to call home. Voters have supported new taxes to fund transportation improvements, as well as the creation of a Housing Trust Fund for the construction of more affordable housing.
“People are willing to vote to tax themselves for something that’s important to all the people in the county, not just to themselves,” says Nan Rich, a Broward County commissioner and chair of the Coordinating Council of Broward (CCB), which convenes senior executives from business, government, and the nonprofit sector to work on mutual concerns in health and human services.
South Florida continues to be one of the most cost-burdened metropolitan regions in the nation, with about half of Broward residents spending more than 30 percent of their monthly income on housing. Many work in the hospitality and service sectors. “We have our most precious tourism industry that we could not live without, and yet folks who work in that No. 1 industry of ours can’t afford to live here,” says Sandra Veszi Einhorn, the CCB’s executive director. The lack of affordable housing, she adds, “inhibits our ability to be economically sustainable.”
Santa Monica employs housing policy to promote economic diversity.
Improvements in the Sistrunk Corridor section of the city of Fort Lauderdale point to the importance of collaboration to community success. In Northwest Gardens, the Housing Authority of the City of Fort Lauderdale has replaced aging public housing with 669 new affordable units in developments that include a system of pedestrian pathways, scattered urban gardens and community space.
The housing authority also partners with the L.A. Lee YMCA to involve residents in taking a more active role in their health and the health of their community through a county-led designation as a Healthy Community Zone. Working with the housing authority, residents have come up with a “SHE” lens for evaluating everything they do—every decision and action must be sustainable, healthy and equitable. Community health workers, meanwhile, serve as advocates for residents, guiding them through their health goals.
The YMCA is upgrading its aging facility in Sistrunk, where residents have a life expectancy rate that is eight years less than residents just on the other side of the tracks in Fort Lauderdale. The YMCA broke ground recently for a $17 million facility that will include a theater, ground-level retailing, and floor devoted to classrooms for Broward College.
“Partnerships are everything,” says Gabe Ochoa, vice president of community health strategies for the YMCA of South Florida. Other counties, he adds, look to Broward and say, “You know how to partner. You know how to go farther together.”
We have our most precious tourism industry that we could not live without, and yet folks who work in that No. 1 industry of ours can’t afford to live here.
—Sandra Veszi Einhorn, executive director, Coordinating Council of Broward
Next door to a health food store in a shopping center, a new drop-in wellness center presents an immediate aura of calm. A circle of teens practices deep breathing exercises. Other young people meet with staff in private rooms, decorated with murals of mountains and motivational sayings like “The best views come after the hardest climbs.”
This is Eagle’s Haven, and it is in Parkland, just across the highway from Marjory Stoneman Douglas High School (MSD), where a lone shooter killed 17 and injured 17 others on February 14, 2018.
Community partners have harnessed the power of residents to heal and restore hope, creating pathways to recovery and strengthening community bonds to endure collective trauma. In the wake of the tragedy, everyone wanted to help. There was momentum for action—to channel all of the grief and trauma into movement and change for the common good. The Coordinating Council of Broward has taken on the mission of seeing the big picture of trauma’s impact on the community, and focusing efforts on shared goals. The coordinating council will track who’s doing what and how different entities can work together around such issues as school safety, trauma-informed care, and suicide prevention.
“We bring everyone together for communication, collaboration and coordination,” says Sandra Veszi Einhorn, executive director of the coordinating council, which includes leaders in health and human services from government, business and the nonprofit sector.
At Eagle’s Haven, the first thing one sees after walking through the front door is a painting with 17 hearts, a quiet reminder of what is pulling students, parents, and neighbors into this space. The center, opened in the summer of 2019, is run by Jewish Adoption and Family Care Options, and funded through the Children’s Services Council (CSC), which channels about $100 million in taxpayer funds for services and programs to improve the lives of Broward’s children—everything from child welfare supports to school health.
“The tragedy in Parkland cut me to my core,” says Cindy Arenberg Seltzer, CSC’s chief executive officer. “As the mom of a 12-year-old who lives a mile from the school, it terrified me and still terrifies me.”
But with the tragedy in the media spotlight for so long, “there was some outrage from other parts of the community that experience gun violence on a daily basis,” Seltzer says. Where was the help and support for them? “That stopped me short.”
It put the concept of racial equity into practice in real time at CSC, one of the lead groups in the county’s dismantling racism effort. “It didn’t mean that we shouldn’t pay attention to what was happening in Parkland,” she adds, “but it caused us to take more of a focus on the trauma of gun violence throughout the county.”
At CSC, Parkland has had an unintended impact, transforming the agency “in a pretty fundamental way” by building into everything more attention to trauma awareness and support, Seltzer says.
One result: CSC will work with other communities experiencing high levels of violence to identify trusted partners who could operate three centers, similar in approach to Eagle’s Haven, in their neighborhoods. In addition to offering free activities such as yoga or kickboxing, Eagle’s Haven allows for interactions with trauma-trained staff who can steer students or adults to additional therapeutic support.
2018 Culture of Health Prize winner Cicero, Ill., helps officers and the people they serve deal with the “bad things” they witness and experience every day.
The Prize honors and elevates U.S. communities working at the forefront of advancing health, opportunity, and equity for all.
As with all programs and services that CSC supports, the agency tracks data and outcomes to set priorities, assess performance and drive decisions. Reflecting a commitment to accountability and continuous improvement, the agency annually publishes a budget book, covering more than 200 pages, that assesses on a contract-by-contract basis how each provider is performing.
Another new pathway to healing after Parkland has been the introduction of Mind Body Ambassador Clubs in schools. The idea started at MSD, where students, as well as teachers and administrators, have been trained in self-care techniques like deep breathing and meditation.
“I wondered, ‘How am I ever going to teach again?’” says Diane Wolk-Rogers, a history teacher at MSD. After going through training, she shared what she learned with students, staff and parents. The idea spread, and about 100 students now serve as Mind Body Ambassadors and teach calming techniques to others. Given the student support of the program at MSD, CSC wants to introduce clubs across the school district.
“I found that calm in myself,” says Wolk-Rogers. “And rather than seeing students as survivors or victims, I see them as leaders.”
[R]ather than seeing students as survivors or victims, I see them as leaders.
—Diane Wolk-Rogers, history teacher, Marjory Stoneman Douglas High School