Community Strategies to Improve Health

1. Community Strategies to Improve Health March 16, 2006 Rebecca Flournoy, MPH

2. PolicyLink is a national nonprofit research, communications, capacity building, and advocacy organization, dedicated to advancing policies to achieve economic and social equity based on the wisdom, voice, and experience of local constituencies.

3. Why Focus on Community Factors and Health? Access to care accounts for only 10% of total mortality in the U.S. Environmental conditions, race, social and economic factors, and health behaviors all impact health status

6. Employment, Income, Wealth and Assets Quality and quantity of employment opportunities available to residents; the amount of collective wealth and assets in the community. Factors protecting against disparities Living wage jobs with health benefits; safe workplaces. Savings, adequate retirement income, and homeownership provide economic stability. Factors increasing risk for disparities Large numbers of community residents with low-wage jobs with no benefits and unsafe working conditions. Racial and economic segregation and concentrated poverty lead to higher stress and premature mortality.

7. Neighborhood Economic Conditions Presence of commercial services including grocery stores, banks and restaurants. Factors protecting against disparities Attracts public and private investment in services and infrastructure. Factors increasing risk for disparities Disinvestment leads to loss of jobs, businesses, and decline in property values.

9. Cultural Characteristics Values, attitudes and norms (related to a range of behaviors, including diet) deriving from race/ethnicity/gender, religion or nationality, as well as from other types of social and cultural groupings. Factors protecting against disparities Cohesion, a sense of community, and access to key cultural institutions with healthy cultural norms/attributes. Factors increasing risk for disparities Racism, language barriers, and acceptance of unhealthy behaviors. Absence of community norms and expectations that promote healthy behavior and community safety.

10. Social Support and Networks Friends, family, colleagues, and neighborhood acquaintances And organizations. These networks exist within the community and beyond it, such as churches and clubs. Factors protecting against disparities Social capital that can provide access to social supports and economic opportunities, as well as to certain health services and resources. Adult role models and peer networks are influential to young people. Factors increasing risk for disparities Lack of social supports and role models. Residents do not have access to networks outside the neighborhood that can link them to employment and other key opportunities. Sometimes referred to as absence of “bridging” social capital.

12. Environmental Quality Air, water, land shared across a region. Factors protecting against disparities Policies and practices that maintain a clean, healthy environment. Factors increasing risk for disparities Presence of and exposure to toxics and pollution.

13. Built Environment and Infrastructure Housing, parks and recreation, and workplaces. Factors protecting against disparities Access to affordable, high-quality housing, local parks, and safe workplaces. Urban design that supports physical activity. Factors increasing risk for disparities Exposure to lead paint, problems with inadequate sanitation and pest infestation, dangerous types of work and unsafe work environments. Urban design that inhibits physical activity.

15. Health Services Accessibility, affordability, and quality of care for individuals and families. Factors protecting against disparities Necessary, accessible care delivered in a culturally sensitive manner in satisfactory health facilities with well-trained and culturally appropriate practitioners with attention to acute and preventive care. Factors increasing risk for disparities Lack of access to necessary health care services, while what is available is culturally inappropriate and of poor quality.

17. What is Advocacy? • 1. Identifying an Issue • 2. Drawing attention to the issue • 3. Working towards a solution

18. The Advocacy Process FINDING INFORMATION/ RESEARCH ORGANIZING AND COALITION BUILDING CLIMATE READY POLICY CHANGE FOR CHANGE MAKING A PLAN MOBILIZATION AND COMMUNICATIONS

19. Community Action to Fight Asthma (CAFA) • 3-year initiative • Focus on reducing environmental triggers for children with asthma

20. Organization of CAFA • 12 Local Coalitions • State Coordinating Office • Technical Assistance Providers

21. PolicyLink Role • Technical Assistance: Policy and Communications • Inform and Mobilize CAFA State Policy Efforts

22. CAFA Policy Successes Local Examples • Helped pass ordinance to replace old diesel city buses • Influenced discussions about regional air regulations and enforcement • Brought health voice to discussions about local freeway expansion State Examples • Helped get eight bills passed and 2 air quality regulations • Invited to suggest bill language

23. Other Outcomes • New leaders • Increased awareness • New partnerships • Enhanced skills

24. For More Information: www.policylink.org Community Factors: www.policylink.org/Research/JC-Stronger Communities www.policylink.org/CHB Advocacy: www.policylink.org/AdvocatingForChange