Brownsville understood that one person’s health was linked to that of another and how working together to improve the entire community—to treat the “whole body”—was the best way to create sustainable health solutions.

There were several catalysts that propelled Brownsville down its current journey to a Culture of Health, including The University of Texas School of Public Health, which came to the city in 2001 and worked hard to become a true community partner — overcoming a history of mistrust of academic institutions that “swooped in” to conduct research without sharing results or collaborating on next steps. The School began by sharing local health data with residents in neighborhood meetings, which sparked a desire to do something to turn the dire rates of obesity and overweight around.

Together with now more than 200 organizations, residents and individuals from health care, education, business and community groups, the School formed the Community Advisory Board (CAB) to examine the data on the community’s health risks, and work collaboratively with partners to find solutions that will drive better health. The CAB’s members “carry the message of wellness into their homes and businesses, and they’re able to affect policy and environmental changes by voting and leadership—and that’s how we have been able to include the community, by engaging them every single step of the way,” said Belinda Reininger, DrPh, Associate Professor at The University of Texas School of Public Health.

About the same time, the city and other large employers in the area embarked on a long-range plan called Imagine Brownsville. The strategy was a business-driven look at the city’s future that evaluated the environment, health, education and other factors to assess the community’s needs. Together with the Community Advisory Board, Imagine Brownsville developed a set of shared measurable goals in areas such as fostering active transportation and healthy eating, with a community champion for each.

“We knew that health did not belong in a silo,” Gowen said. “We knew that there were economic factors and educational factors, so we learned very quickly how to speak different languages. We learned how to talk about health in terms of the economy, how to talk about it in terms of the environment and where to find those common areas where all of those factors intersected.”

The result? The diverse set of partners now share instead of compete for resources, have worked together to pass bold new health-promoting policies such as an ordinance for new businesses to install sidewalks; and an increase in parking meter fees to generate income to support bike safety and downtown revitalization, and have been tapped as a model for creative, low-cost, solutions that capitalize on existing assets to create a vibrant, healthy community.

“It should be possible to walk to a bus stop, get on a bus and walk safely to your destination. It should be possible to ride your bike to a bus stop, put your bike on a bus and use your bike when you get off a bus,” said Gowen. “And that is what we’re striving for: Seamless, uninterrupted transportation.”

Brownsville has placed a heavy emphasis on active transportation as part of its efforts to build a healthier community. “Brownsville In Motion” uses community meetings and an interactive website to solicit feedback about the best routes for trails, identify issues of safety and violence that need to be addressed to enable outdoor activity, and to galvanize support for sweeping policies that were adopted by city leadership, including a Complete Streets policy.

The Belden Trail is the start of a larger planned network of bike and pedestrian trails, and the community is committed to ensuring that every Brownsville resident is within a half-mile radius from a bike trail  Already, after much effort among partners, approximately 20 percent more people (35,000) now enjoy this access.

The city has also created a number of bike programs to encourage getting from “A” to “B” through healthy movement. One example is the Bike Barn, which brings kids together to learn about the importance of staying active, teaches them the constructive skill of bike repair as well as bike safety and then—after a set period of volunteering—gives them their very own bike.

“The Bike Barn has become very effective in engaging the interest of the children that live in the area in not only bike repair, but community building and riding bikes on a more frequent basis,” Gowen said. “It is a great model that could be duplicated in other schools and other parks throughout the city.”

Finally there is CycloBia, where thousands of residents walk, run, cycle, and enjoy outdoor activities in traffic-free streets They’re usually on Sundays, although recently the city has started nighttime CycloBias as a way to escape the heat on Friday nights. Thousands of people — yes, thousands — come together for this event, enjoying their city in a new and active way, said Art Rodriguez, director of the City of Brownsville Health Department.

Promoting Healthy Living

Effective communication and advocacy within a community means knowing the community—who they are, their culture, their concerns—and speaking with residents in ways they’ll understand best. For Brownsville, that means a bilingual approach.

According to Gowen, “The Mexican-American culture in Brownsville is a strength. We live and work and celebrate on both sides of the border, and it’s important that we reach out in English and Spanish. The more that we are diverse in our messaging, the more people we reach and the more changes we effect.”

Part of that approach is the use of “Promotoras”—community health workers who engage and educate people who otherwise wouldn’t have access to health care, as well as to connect them with community resources. As community members themselves, the Promotoras also benefit from job training and economic opportunities. This helps to fuel the local economy and create more opportunities for health through stable income.

Although community health workers exist in many different places throughout the country, one thing that sets the Brownsville effort apart is the extent to which this role has been institutionalized. Brownsville’s Promotoras are certified through a state program, but many do not have college degrees. Despite this obstacle, Brownsville’s Community Advisory Board leadership recently succeeded in creating academic appointments (with benefits) for the Brownsville community health workers, who are now serving as Research Assistants at the UT Brownsville School of Public Health.

Promotoras also serve an important connecting role in the community. Gowen notes examples: “They also speak to the community about events that are coming... They engage folks in healthy cooking lessons while they’re in the homes and tell them where free exercise classes are. They also provide referrals to needed health resources. Their work is effective and translates to fewer trips to the hospital, lower rates of chronic illness, higher engagement and higher participation in the community as a whole.”

One of the key community resources the Promotoras now have to connect residents to is a robust system of affordable, healthy food and economic opportunities through the Brownsville Farmers’ Market. Community gardens in economically depressed food insecure neighborhoods are part of the mission of the Market, in an effort to boost income generation opportunities, as well as healthy foods options, for the entire community. Families gather in groups for training on gardening, small business development, nutrition and health, and plant their gardens in city-donated vacant lots, some of which are designed by architecture students and built by AmeriCorps/YouthBuild volunteers.

Finally, Brownsville’s public health efforts include “Tu Salud ¡Si Cuenta!”—or “Your Health Matters!”—a bilingual community wide campaign program that uses television, radio and print to motivate people on both sides of the border to increase their physical activity and healthful food choices said Reininger. Results from the Cameron County Hispanic Cohort study indicate this approach works, as residents are more likely to be physically active and eat more fruits and vegetables.

Looking Forward

“People in Brownsville are looking for better: Better economy, better education, better health,” said Gowen. “They’re listening, and they’re learning how they can tie all of those together with programs that encourage healthy eating and active living.”

And while the community has accomplished much, she’s careful to point out that this is only the beginning.

“The destination of a healthier Brownsville is in view, but it’s not the only destination,” Gowen said. “It’s only a stop along the way. We recognize that just like individual wellness not only has to be achieved but also has to be maintained, so too will our community need to have an ongoing commitment to wellness. We will continue to recruit partners and implement strategies to enhance health as we go.”