New Orleans, LA: 2013 RWJF Culture of Health Prize Winner

Transforming the Health Department

Efforts to improve health in New Orleans have gone hand-in-hand with efforts to recover from, and rebuild after, Hurricane Katrina. Before the storm, the city’s approach to health was the same as that found in many places across the country—focused more on clinical care rather than prevention and public health. In the wake of Hurricane Katrina, a cross-sector partnership of the City's Health Department, schools, businesses, and nonprofit organizations has made public health and prevention a major component of the ongoing recovery effort.

Hurricane Katrina exposed the problems that we had in this community,” said Dr. Karen DeSalvo, former Health Commissioner for the City of New Orleans. “The storm created a vacuum in all of our sectors, and gave us a chance to rush into that vacuum and create a new and better way that would improve the health of our population.

The first step in reorienting the department’s efforts towards health was the completion of the Public Health Accreditation Board’s (PBHA) accreditation process. In early 2014, New Orleans became one of the first 50 health departments to be accredited by PBHA.

“That for us was a moment of distinction and validation, as to where we’re trying to take our health department,” said current Health Commissioner, Charlotte Parent.

“That is how were getting from a place where we were treating the consequences of poor health decisions and the impacts of social determinants of health, and actually move into a place where we’re upstream and we can prevent it, but then work with other sectors, said former Commissioner DeSalvo.

But that the staff at the department are acutely aware that no one health department can solve every health challenge in a community. One of the biggest keys was bringing together a collection of partners that reflect all the social determinants of health and help ensure health is a consideration in every new policy.

Access to Healthy Food, Opportunities to Be Fit

A centerpiece of the city’s efforts is Fit NOLA—a health department-led, multifaceted partnership created with the stated goal of making New Orleans one of the ten fittest US cities by 2018.

Among Fit NOLA’s many priorities is ensuring residents have access to healthy food and opportunities for physical activity – in part through a program called the Fresh Food Retailer Initiative.

The Fresh Food Retailer Initiative is the perfect example of a public private partnership,” said DeSalvo. “It is a project that has been bringing grocery stores that have a specified amount of fresh fruits and vegetables on their shelves to communities that are typically food deserts.”

A related program is responsible for helping the iconic Circle Food Store to re-open its doors. Founded in 1939 as the first African American-owned grocery store in New Orleans, the community anchor and staple was so damaged by Katrina that it was forced to close. Owner Dwayne Boudreaux hoped to re-open, but had great difficulty in getting funding—until he received a loan from the Fresh Food Retailer Initiative.

It’s like the Fresh Food Initiative was the glue,” said Boudreaux. “It’s like once they came into existence and said ‘Okay, we’re here, this is what we’re going to pledge,’ then all of the bankers came onboard and the other financial partners came onboard.

Also a part of Fit NOLA, the Edible Schoolyard initiative uses gardens to make healthy foods not just something you see in stores, but a part of New Orleans residents’ everyday lives—particularly for kids. A renewed focus on schools promoting academic achievement and good health offers new gardens and cooking classrooms, as well as state-of-the-art kitchens and new physical activity programs in schools.

Thanks in part to programs like these, New Orleans has made major strides in restoring access to healthy food. A recent study from the Tulane University Prevention Research Center showed that the number of grocery stores in New Orleans have rebounded to pre-Katrina levels, even within some traditionally underserved, and pre-dominantly African American neighborhoods.

In addition, the city’s health department recently concluded the first health impact assessment ever conducted in the state. The assessment helped to identify the food and nutrition needs of a neighborhood before the opening of a new grocery store. As a result of the assessment, the grocery store was able to identify what the community wanted with regards to access to fresh food.

The Right Choices

New Orleans’ leaders in the health department and beyond are also focused on building healthy practices throughout the city—including within schools and even in the city’s fabled music halls and bars.

Under the umbrella of Mayor Mitch Landrieu’s “NOLA for Life” campaign, the health department has partnered with schools in order to train teachers and school administrators in trauma-informed care and restorative justice.

We’re figuring out ways to teach techniques like conflict resolution and anger management so that instead of putting a child out of school, we can keep them in school,” said Parent.

The health department and community advocates also recently scored a major victory with the implementation of a public smoking ban. Long a priority for many, including many of the city’s musicians who often perform in smoke-filled bars, the no-smoking ordinance was a result of vocal support from community members themselves.

Early in the process, we spent a lot of time educating the public about what the proposal meant, how it would work and the negative effects of smoking,” said Parent. “After that, the health department didn’t have to do a whole lot of talking. The community stepped up and said, this is what we want.

Seven months later, the ordinance has been an unqualified success. Reported violations have been virtually nonexistent, and a recent air quality survey of some of the city’s most popular public venues revealed that air quality had improved by more than 90 percent.

Emergency Preparedness and Health Care Delivery

Despite the incredible progress that has been made, perhaps nothing is as resonant as the city’s efforts to ensure that everyone in New Orleans is prepared should an emergency strike.  “Ten years ago people only prepared for hurricanes,” said Parent. “Today, preparedness has now become part of the norm.”

Partners include Ochsner Health System, Louisiana’s largest not-for-profit health system, with eight hospitals and 900 physicians in its medical group model. A pillar of this work has been improving access to health care delivery – both for emergency situations and everyday care. The city has built a system of 103, community-based health care access points for uninsured, underinsured and low-income patients, with 68 being primary care clinics. It has also adopted electronic medical records across the health care system and implemented the Greater New Orleans Health Information Exchange to share clinical data for the improvement of population health. Finally, two new hospitals have opened, including one in the New Orleans East neighborhood, which was hard hit during Hurricane Katrina. In 2016, a third hospital will open when construction of the city’s new VA Medical Center is complete.

New Orleans has also established a special needs registry that maintains up-to-date records on more than 4,000 residents who require extra assistance in an emergency. The registry provides city officials with information about the transportation and medical equipment needs of residents.

Progress Together

The progress made across the city is staggering in its breadth and diversity, but is united by a common thread. “None of this can happen without affirmation from the community that these are important things to do,” said Parent.

Ten years after Katrina, a collective priority on health has prepared the city for the next step in a journey towards a Culture of Health. According to Parent, the health department and a myriad of partners across the city are looking at broader issues of equity, poverty and housing, and the many social determinants that influence the health outcomes of residents from New Orleans East to the French Quarter.

“In ten years, we took a system that was broken and changed that system that we think in time will help to transform our community,” said Parent. “Now, we hope to build an infrastructure that will have staying power. We want to be at the forefront of building a culture of health that ensures that people are living life in a way that creates health and wellness individually, and as a community. We’re proud to be part of the movement.”