RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
The Power to Reduce Health Disparities Voices from REACH Communities
U.S. Department of Health and Human Services centers for disease control and prevention For more information about the REACH program or to obtain copies of this document, contact
Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Racial and Ethnic Approaches to Community Health (REACH) Telephone: 770-488-5426 E-mail: [email protected] Web site: http://www.cdc.gov/reach
Suggested Citation
Centers for Disease Control and Prevention. The Power to Reduce Health Disparities: Voices from REACH Communities. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2007. The Power to Reduce Health Disparities Voices from REACH Communities
U.S. Department of Health and Human Services centers for disease control and prevention
From the Director
Eliminating racial and ethnic disparities in health has become a focal point in the prevention of unnecessary illness, disability, and premature death and the promotion of quality years of life for all people. The Centers for Disease Control and Prevention (CDC) has responded to disparities in health among racial and ethnic minority populations by launching Racial and Ethnic Approaches to Community Health (REACH). The REACH program is a cornerstone of CDC’s efforts to identify, reduce, and ultimately eliminate health disparities. CDC funds REACH communities to address key health areas in which minority groups traditionally experience serious inequities in health outcomes. REACH communities form coalitions that plan, implement, and evaluate strategies to focus on the needs of one or more groups that include African Americans, Alaska Natives, American Indians, Asian Americans, Hispanics/Latinos, and Pacific Islanders. Through The Power to Reduce Health Disparities: Voices from REACH Communities, we are pleased to share with you the successes and lessons learned in eliminating health disparities through the REACH program. The accomplishments highlighted in this publication make a powerful case for the importance of working with communities to improve the health and well-being of their members. We now know that we can eliminate health disparities by engaging local leaders, building community partnerships, recognizing cultural influences, creating sustainable programs, leveraging resources, and empowering individuals and communities. The community profiles in this publication represent only a fraction of the many ways that REACH communities are overcoming barriers to good health. It is inspiring to imagine the possibilities if communities across the country were to put these strategies into practice. Our intent in sharing these innovative strategies and interventions is to assist others in their efforts to successfully close health gaps among racial and ethnic minority groups around the nation. It is a public health imperative that we help people, especially those experiencing the greatest disparities in health, obtain and maintain the highest level of health possible.
Janet L. Collins, PhD Director, National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention
Contents
Introduction...... 1 Community Profiles Alabama University of Alabama at Birmingham: Alabama REACH 2010 Breast and Cervical Cancer Coalition...... 3 Alaska Chugachmiut Native Organization: Alaska Native Cardiovascular Disease Prevention/ Core Capacity Building Project...... 5 California Community Health Councils of Los Angeles: African Americans Building a Legacy of Health...... 7 Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center: Immunize LA Kids Coalition...... 9 San Francisco Department of Public Health: SevenPrinciples Project...... 11 Special Services for Groups, Inc.: REACH 2010/Health Access for Pacific Asian Seniors...... 13 University of California, San Francisco: Vietnamese REACH for Health Initiative Coalition...... 15 Florida Florida International University: Coalition to Reduce HIV in Broward’s Minority Communities...... 17 Georgia Fulton County Department of Health and Wellness: REACH for Wellness...... 19 Illinois Access Community Health Network and University of Illinois at Chicago: REACH Out...... 21 Chicago Department of Health: REACH 2010/Lawndale Health Promotion Project...... 23 University of Illinois at Chicago: Chicago Southeast Diabetes Community Action Coalition...... 25 Louisiana Black Women’s Health Imperative: REACH 2010: At the Heart of New Orleans Coalition...... 27 Massachusetts Boston Public Health Commission: Boston REACH 2010 Breast and Cervical Cancer Coalition...... 29 Boston Public Health Commission: REACH Boston Elders 2010...... 31 Center for Community Health, Education & Research, Inc.: Metropolitan Boston Haitian REACH 2010 HIV Coalition...... 33 Greater Lawrence Family Health Center: REACH 2010 Latino Health Project...... 35 Lowell Community Health Center: Cambodian Community Health 2010 Program...... 37 Michigan Community Health & Social Services Center, Inc.: REACH Detroit Partnership...... 39 Genesee County Health Department: Genesee County REACH 2010 Team...... 41 Missouri Missouri Coalition for Primary Care: Kansas City - Chronic Disease Coalition...... 43 Nevada University of Nevada, Reno: Healthy Hearts Project...... 45 New Hampshire New Hampshire Minority Health Coalition: New Hampshire REACH 2010 Initiative...... 47 New Mexico Albuquerque Area Indian Health Board, Inc.: Partners in Tribal Community Capacity Building (REACH 2010) Project...... 49 Hidalgo Medical Services: La Vida Program...... 51 National Indian Council on Aging: Diabetes Educational Outreach Strategies Project...... 53 New York Institute for Urban Family Health: Bronx Health REACH Coalition...... 55 Mailman School of Public Health of Columbia University: Northern Manhattan Start Right Coalition...... 57 North Carolina Carolinas HealthCare System: Charlotte REACH 2010 Coalition...... 59 Eastern Band of Cherokee Indians: Cherokee Choices/REACH 2010 Diabetes Prevention Program...... 61 Oklahoma Association of American Indian Physicians: Oklahoma REACH HIV/AIDS American Indian Capacity Building...... 63 Choctaw Nation of Oklahoma: Choctaw Nation Core Capacity Building Program...... 65 Oklahoma State Department of Health: Oklahoma Native American REACH 2010 Project...... 67 Oregon African American Health Coalition, Inc.: REACH African American Health Coalition...... 69 South Carolina Medical University of South Carolina: REACH 2010 Charleston and Georgetown Diabetes Coalition...... 71 Tennessee Matthew Walker Comprehensive Health Center: Nashville Health Disparities Coalition REACH 2010 Project...... 73 United South and Eastern Tribes, Inc.: REACH 2010 Immunization and Infant Mortality Project...... 75 Texas Latino Education Project: REACH Latino Education Project...... 77 Migrant Health Promotion: REACH Promotora Community Coalition...... 79 Washington Public Health - Seattle & King County: Seattle & King County REACH 2010 Coalition...... 81
Index
REACH Communities by Racial and Ethnic Group...... 83
REACH Communities by Health Priority Area...... 84 Introduction
As racial and ethnic minority groups REACH communities have produced By developing, implementing, and evaluat- continue to make up an increasingly larger impressive results and proven that health ing a broad range of innovative strategies, percentage of the U.S. population, the disparities are not inevitable and can REACH communities have been able to reality of health disparities continues to be overcome. We are learning from the n Build and sustain effective long-term severely impact our nation’s health. REACH experience that community-driven partnerships. Although life expectancy and overall strategies that fully engage community n Provide individuals and communities health have improved in recent years for members and address social, economic, with the tools to seek and demand most Americans, not everyone is benefit- and cultural circumstances can improve better health and local resources. ing equally. Many racial and ethnic minor- health outcomes and reduce health n Make sustainable improvements to ity groups have persistently higher rates of disparities. The successes reported in these community systems and infrastructures. illness and death than the U.S. population communities provide a strong foundation n Share lessons learned and best practices as a whole. for the future, as the REACH program that can be used in other communities. continues to expand and share its lessons The well-documented link between race/ learned and best practices. This publication celebrates the successes ethnicity and health disparities motivates of REACH communities throughout the programs such as the Racial and Ethnic Community engagement and partnerships United States. Each community profile Approaches to Community Health are key to the success of the REACH presents community-driven strategies and (REACH) program to ensure that all U.S. program. Each local program is built solutions, as well as specific examples of residents have an equal chance to live a around a community coalition that includes how the communities are reducing health healthy life. at least one community-based organiza- disparities and improving people’s health. tion, research institution, and state or local REACH is an important cornerstone of health department. These coalitions also These profiles demonstrate the REACH CDC’s efforts to eliminate health disparities bring together participants and resources program’s unique contribution to address- in the United States. During 2000–2007, from other government agencies, faith- ing health disparities in multiple settings, CDC funded 40 communities that focused based groups, community centers, and including communities, schools, work on innovative strategies to eliminate health civic organizations. sites, and health care settings. By sharing disparities in key health areas, including their strategies, lessons learned, and cardiovascular disease, diabetes, breast CDC provides training, technical assis- best practices, the REACH communities and cervical cancer, immunizations, infant tance, and support to REACH communi- give other communities and public health mortality, and HIV/AIDS. These programs ties to help them address the multiple programs across the country valuable tools target several racial and ethnic groups, factors that influence health and health to eliminate health disparities among racial including African Americans, Alaska disparities. With this support, communities and ethnic minority populations. Natives, American Indians, Asian Ameri- develop and implement effective interven- cans, Hispanics/Latinos, and Pacific tions, evaluate their programs, and Islanders. disseminate their findings through the media and the scientific literature.
RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“Before the Alabama REACH 2010 project came to my community, I was afraid to even say the word “cancer.” Perhaps I was afraid because, as a child, I had seen so many relatives die of cancer. When I was asked to attend the REACH training program, I saw a chance to learn more about the “C” word. Now that I’ve been a community health advisor for the past 4 years, I can boldly say that cancer is not a death sentence because there are resources and help available. Now, I’m telling everyone I know about the program that changed my life!” —Community health advisor REACHing African American Women in Rural Alabama
Who We Are The Solution (a free screening program funded The University of Alabama at n The ABCCC created a community by CDC) and helping women get Birmingham coordinates the Alabama action plan to address the barriers to their screening appointments REACH 2010 Breast and Cervical that prevent African American women by visiting, calling, and sending Cancer Coalition (ABCCC). aged 40 or older from receiving breast reminders. and cervical cancer screening services. n The ABCCC includes an array of n Action plan activities include Our Achievements partners, such as community groups, 1) creating a core working group of n During 2001–2003, the ABCCC state and national organizations, health lay volunteers, church representatives, launched an intervention to increase care providers, and researchers. and health professionals in each breast and cervical cancer screening n The ABCCC is working to eliminate targeted county; 2) awarding mini- among African American women in the target counties. disparities in breast and cervical cancer grants to nonprofit groups that target n In 2002, self-reported baseline data among African American women by breast and cervical cancer screening; showed that only 48% of women promoting awareness of and access to 3) conducting outreach activities to participating in this intervention had prevention and screening services. assess screening status and promote n The coalition serves women in two received a mammogram. Within 2 future screenings; and 4) distributing years, 62% reported having a urban and six rural counties in Alabama, educational materials. in an area known as the Black Belt. mammogram. n Other action plan activities include n Also in 2002, 55% of participating promoting the Breast and Cervical women said they had previously The Problem Cancer Early Detection Program received a Pap test. Within 2 years of n Breast cancer is diagnosed less often the intervention, 66% had received a in African American women than white Racial and Ethnic Approaches Pap test. women, but more African American to Community Health (REACH) n Before the ABCCC intervention, a women die of this disease each year. is a community-based public 17% disparity in mammography n Cervical cancer is diagnosed more often health program funded by CDC screening existed between African in African American women than white to eliminate racial and ethnic American and white women in the women, and more African American health disparities. target counties. During 2001–2003, women die of this disease each year. www.cdc.gov/reach this disparity decreased to 11%.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources niversity of Alabama at Birmingham (UAB); University of Alabama; Western UKentucky University; Markey Cancer Center; Tuskegee University, National Center for Bioethics; Alabama Cooperative Extension System; Alabama Department of Public Health, Office of Minority Health; Community Care Network; American Cancer Society; National Black Church Family Council; SISTAs Can Survive; Mineral District Medical Society; Tuskegee Area Health Education Center; B & D Cancer Care Center; Alabama Quality Assurance Foundation; Alabama Breast and Cervical Cancer Early Detection Program; Maude L. Whatley Health Services; UAB Comprehensive Cancer Center; UAB Minority Health and Research Center.
Our Future REACH 2010 Project,” WAKA Channel Keys to Lasting Change in the The ABCCC will continue to 1) increase 8 News, April 18, 2001. African American Community women’s awareness and use of breast To make the Alabama REACH 2010 and cervical cancer screening services in Generating New and project a success, we worked to empower Alabama, 2) work with existing partners Exciting Science residents to be their own health advo- and project supporters and add new n “Addressing Disparities Through cates and to build community capacity by coalition members, 3) refer eligible Coalition Building: Alabama REACH training residents to serve as community women to the Breast and Cervical Cancer 2010 Lessons Learned.” Journal health advisors. Early Detection Program, 4) share our of Health Care for the Poor and research findings with the community, Underserved 2006;17(2, suppl): We also were able to create a sense of and 5) educate stakeholders about S55–S77. ownership for the project by drawing on the REACH program and its efforts to n “A Community-Driven Action Plan to community groups and a core work- eliminate health disparities in breast and Eliminate Breast and Cervical Cancer ing group of volunteers to create and cervical cancer. Disparity: Successes and Limitations.” implement the community action plan. Journal of Cancer Education 2006; In addition, we adopted the principles of Getting the Word Out Locally 21(suppl):S91–S100. community-based participatory research, n “Alabama REACH 2010,” 30-minute n “The Development of a Community which is designed to involve researchers, documentary video. Action Plan to Reduce Breast and organizations, and community members n “Governor’s Black Belt Action Cervical Cancer Disparities Between as equal partners in all aspects of the Commission,” health committee African American and White Women.” research process. press release, June 21, 2005. Ethnicity & Disease 2004;14 n “Promoting Cancer Awareness in the (3, suppl 1):54–62. These activities led to the creation of a African American Community,” WIAT n “REACH 2010: A Unique Opportunity unified and motivated coalition. We were Channel 42 News, April 20, 2002. to Create Strategies to Eliminate Health able to see results above and beyond our n “Development of a Community Action Disparities Among Women of Color.” expectations because of mutual collabo- Plan to Combat Breast and Cervical American Journal of Health Studies ration and trust between our coalition Cancer: An Overview of the Alabama 2001;17(2):93–106. and community volunteers.
For More Information
Mona Fouad, MD, MPH, Principal Investigator University of Alabama at Birmingham, MTB 618 1530 3rd Ave. S., Birmingham, AL 35294-4410 Phone: 205-934-4307 • Fax: 205-934-7959 E-mail: [email protected] • Web site: http://www.uabmhrc.com RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“I walked a lot of steps this month, ran 10 miles, exercised for 120 hours, lost 5 pounds, and went from 20 cigarettes a day to 5. I feel great!” —Alaska Native woman, aged 22
REACHing Alaska Natives in Chugach Region, Alaska
Who We Are n Alaska Natives also have higher rates n We partner with local tribal councils, The Chugachmiut Native Organization of risk factors for heart disease than community health aides, community coordinates the Alaska Native other population groups. For example, health representatives, and traveling Cardiovascular Disease Prevention/ they are more likely to be smokers and health care providers to increase Core Capacity Building Project. to be physically inactive and obese, support for this project. and they are less likely to be screened n We work to develop and implement n This project serves seven rural and for high cholesterol. programs and activities that will remote Alaska Native communities increase community members’ that are spread across more than The Solution awareness of heart disease and 15,000 square miles in the Prince n To address these problems, the Alaska promote healthy lifestyle changes. William Sound, Resurrection Bay, and Native Cardiovascular Disease Preven- These programs and activities reflect Lower Cook Inlet areas of Alaska. All tion/Core Capacity Building Project has the native cultures and languages of villages except two are accessible only trained community wellness advocates the communities we serve. by plane. in each of its REACH communities. This n We also conduct community health n The project is working to help Chugach training was provided through a 1-year assessments and provide technical region communities reduce the high distance-learning program offered assistance and training to guide local rates of death and disability from heart by the University of Alaska in Sitka in interventions in all Chugach region disease among their residents. conjunction with the SouthEast Alaska communities. Regional Health Consortium. The Problem Our Achievements n Heart disease is the leading cause n Community wellness advocates of death for American Indians and are working in all Chugach region Alaska Natives. Racial and Ethnic Approaches communities. n American Indians and Alaska Natives to Community Health (REACH) n We have implemented a variety of have higher rates of heart disease and is a community-based public programs and activities that reflect local premature death than any other racial health program funded by CDC cultures and are helping to promote or ethnic group in the United States. to eliminate racial and ethnic healthy behaviors among local residents. health disparities. www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources ur partners include tribal chiefs, tribal councils, community health Oaides, community health representatives, community school representatives, and traveling health care providers in the seven villages of the Chugach region—Nanwalek, Port Graham, Seward, Chenega Bay, Tatitlek, Valdez, and Cordova.
Our Achievements, cont. in the Chugach region about heart n “Community Wellness Advocates: Building n We developed an interactive calendar disease and other chronic diseases and Healthy Hearts Through Health Education called Take the Idita-Heart Challenge. their risk factors. We also will continue in Chugach Region Tribal Communities.” Residents can use the calendar to set to share information and lessons Presented at the Alaska Health Education goals and track their progress toward learned from this project with local, Consortium Spring Meeting in Anchorage, eating a healthy diet, being more regional, and national audiences. Alaska, May 2006. physically active, not smoking, losing n “Community Wellness Advocates: weight, and lowering their blood Getting the Word Out Locally Creating Behavioral Changes Through pressure and cholesterol levels. They also n Nupuat , the Chugachmiut quarterly Health Education in Native Villages.” can register for monthly prize drawings. newsletter, features articles about this Presented at the CDC Diabetes and n We implemented 312 events in local project in every issue. Obesity Prevention and Control communities, making 3,959 contacts n Monthly articles are written by Conference, Denver, Colorado, May 2006. with community members. These events community wellness advocates in local included exercise classes, nutrition and tribal newsletters. Keys to Lasting Change in healthy cooking classes, heart disease Alaska Native Communities prevention classes, a smoking cessation Generating New and Death and disability from heart disease program, and local health fairs. Exciting Science can be prevented or controlled by reducing n We completed 1,106 heart disease n “Community Wellness Advocates: several known risk factors, including high awareness tests. Results showed that Creating Behavioral Health Changes to blood pressure, high blood cholesterol, residents who participated in our Build Healthy Hearts in Alaska Native smoking, physical inactivity, diabetes, activities were knowledgeable about Communities.” Presented at the Annual obesity, and poor diet. heart disease and how to manage and Meeting of the American Public Health prevent it. Association, Boston, Massachusetts, Control of these risk factors at individual November 2006. and community levels is key to prevent- Our Future n “Community Wellness Advocates: ing heart disease and its complications. The Alaska Native Cardiovascular Disease Creating Healthy Changes in Chugach Community support and involvement Prevention/Core Capacity Building Project Region Communities.” Presented at the also are vital to the success of prevention will continue to educate Alaska Natives Alaska Tribal Health System Showcase programs. in Anchorage, Alaska, September 2006.
For More Information
Heather Davis, MPH, Director, Alaska Native Cardiovascular Disease Prevention/ Core Capacity Building Project, Chugachmiut Native Organization 1840 S. Bragaw Street, Suite 110, Anchorage, AK 99508 Phone: 907-334-0131 or 1-800-478-2891 • Fax: 907-563-2891 E-mail: [email protected] • Web site: http://www.chugachmiut.org RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“The wellness program created enough buzz around the office—people interested in walking more, drinking more water, avoiding processed foods—that a second 8-week set of classes was set up for people who missed the opportunity the first time around. The program is a great way to improve health and quality of life, and it pays dividends to participants and the community as a whole.” —Emile Gardner, assistant general manager, First Transit, Los Angeles
REACHing African Americans in Los Angeles, California
Who We Are and diabetes than any other racial by promoting activities proven to Community Health Councils (CHC) of or ethnic group in the United States. improve health and by funding disease- Los Angeles coordinates the African n South Los Angeles has the country’s management services at local hospitals Americans Building a Legacy of Health highest incidence of obesity (30%). and clinics. coalition. n Compared with residents of similar n The coalition also worked to integrate cities, South Los Angeles residents wellness policies and practices into n CHC is a nonprofit group based in have little or no access to resources local workplaces. Los Angeles that is committed to such as healthy food options and safe building coalitions, conducting places to be physically active that Our Achievements community-based participatory could help to improve their health. n The Los Angeles City Council adopted a research, and developing policies policy to provide incentives to retailers to increase public awareness The Solution that sell healthy foods to encourage and improve health care services n The African Americans Building a them to locate in disadvantaged areas. in communities with limited Legacy of Health coalition found ways The Los Angeles County Board of Supervisors adopted a policy to resources. to improve food and physical activity improve the quality of food offered in n CHC brought together a cross section options in South Los Angeles through county-sponsored programs. of groups and key stakeholders to community development, awareness, form the African Americans Building n The coalition trained nearly 75 health and advocacy. care professionals on new and better a Legacy of Health coalition. n The coalition worked to improve access n This coalition works to promote healthy ways to manage and treat heart to and quality of health care resources disease and diabetes in African communities and reduce disparities Americans. in the rates of diabetes, heart disease, Racial and Ethnic Approaches n The coalition created a network and stroke for African Americans living to Community Health (REACH) of more than 35 physical activity and working in South Los Angeles. is a community-based public programs through seed funding health program funded by CDC to community and faith-based The Problem to eliminate racial and ethnic groups, reaching more than n African Americans in Los Angeles health disparities. 1,500 people in nontraditional County have higher rates of death www.cdc.gov/reach settings. from coronary heart disease, stroke,
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources niversity of Southern California; University of California, LA; American Cancer USociety; American Heart Association; Apostolic Faith Home Assembly; California Department of Health Services; Cedars-Sinai Medical Center; Central Baptist Church; Centinela/Freeman Hospital-ULAAC Project; Drew Medical Society; Los Angeles County Department of Public Health; Los Angeles Urban League; Mount Moriah Baptist Church; Office of Assemblyman Mark Ridley Thomas, Assembly District 48 Empowerment Congress; Office of Assemblyman Jerome Horton, Assembly District 51; T.H.E. (To Help Everyone) Clinic; Watts Healthcare Corporation; Willowbrook Senior Center; Worksite Wellness LA.
Our Achievements, cont. Getting the Word Out Locally n “Putting Promotion into Practice: The n The coalition helped develop wellness n “Hungry for a Supermarket,” African Americans Building a Legacy programs and policies in nearly 50 Los Angeles Times, August 2006. of Health Organizational Wellness local workplaces, reaching more n “Culture of Healthy Eating Urged Program.” Health Promotion Practice than 650 people. at Workplace,” Daily Breeze, July 2006. 2006;7(3, suppl 1):233S–246S. n The coalition preserved a local n “Road to Health” segment on n “African Americans’ Access to Healthy community fitness center and the lack of healthy food options in Food Options in South Los Angeles transferred program management predominantly poor and minority Restaurants.” American Journal of to the Los Angeles YMCA. It also communities, The Tavis Smiley Show, Public Health 2005;95(4):668–673. helped increase membership from November 17, 2005. n “Improving the Nutritional Resource 300 to more than 1,000. n “Limited Healthy Food Choices Environment for Healthy Living Through Community-Based Participatory Our Future in South L.A. Restaurants, Study Says,” Los Angeles Business Journal, Research.” Journal of General Internal CHC’s future plans include promoting March 2005. Medicine 2003;18:568–575. and adopting community standards for n “Eating Good in the ‘Hood,’ ” healthy food options in local stores and VIBE, February 2004. Keys to Lasting Change in the calling for the establishment of one or African American Community more local health food suppliers. Generating New and Each of the following is equally important Exciting Science and crucial to creating and sustaining CHC also will provide training and n “Assessing Resource Environments community change: identifying and program development to help improve to Target Prevention Interventions in getting the support of key stakeholders, the quality of health care offered by local Community Chronic Disease Control.” engaging community partners in planning health care providers and will expand the Journal of Health Care for the Poor and implementation activities, making existing network of physical activity and and Underserved 2006;17(2, suppl): sure all partners are treated equally, and workplace wellness programs by 20%. 146–158. identifying appropriate at-risk populations and interventions to target.
For More Information
Gwendolyn Flynn, Project Director, African Americans Building a Legacy of Health, Community Health Councils 3731 Stocker St., Suite 201, Los Angeles, CA 90008 Phone: 323-295-9372 • Fax: 323-295-9467 E-mail: [email protected] • Web site: http://www.chc-inc.org RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“A parent of a 2-year-old who had received only one series of shots at 2 months came to us asking for information on immunizations. Neither parent nor child had medical insurance. Immunize LA Kids staff discussed the importance of immunizations and being up to date, and provided the mother with supportive educational materials. As a result of this interaction, the mother made an appointment to begin getting her child up to date on her immunizations.” —Immunize LA Kids Coalition community health promoter
REACHing Latino and African American Children in South Los Angeles, California
Who We Are the 2004–2005 school year were n The coalition’s interventions also The Los Angeles Biomedical Research up to date on their immunizations are designed to increase community Institute at Harbor-UCLA Medical at age 2, compared with 75% of demand for immunizations by Center coordinates the white children. providing reminders for parents, Immunize LA Kids Coalition. including those whose children receive The Solution WIC services, and conducting outreach n The coalition is administered by n The Immunize LA Kids Coalition to families of at-risk children. South Los Angeles Health Projects, developed a multifaceted community a community-based unit of the action plan that reflects recent Our Achievements Los Angeles Biomedical Research recommendations by the Task Force n In April 2006, 82% of WIC clients Institute. on Community Preventive Services in our service area, most of whom n The coalition links public and private and the Advisory Committee on are Latino or African American, agencies, health care providers, and Immunization Practices. were up to date with recommended the community to help Latino and n The coalition has implemented immunizations at age 2. n In 2005, we provided immunization African American children in South culturally appropriate interventions information to nearly 10,000 parents Los Angeles get the immunizations that seek to overcome barriers to through outreach activities at health they need. immunization by working to fairs, schools, faith-based events, improve practices in health care The Problem and door-to-door visits. provider settings. n n Although Los Angeles County has met Nearly 4,000 children in our service area have received an immunization the Healthy People 2010 objective assessment and information from of 80% of children receiving all Racial and Ethnic Approaches a community health promoter. recommended vaccines by age 2, to Community Health (REACH) n We also provided technical assistance, nearly 1 in 5 infants and young is a community-based public consultation, and follow-up services to children are not up to date on their health program funded by CDC 75 medical offices. immunizations. to eliminate racial and ethnic n In California, only 53% of African health disparities. American and 72% of Hispanic www.cdc.gov/reach children entering kindergarten during
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources alifornia Coalition on Childhood Immunization; California Department Cof Health Services, Immunization Branch; California Distance Learning Health Network; Child Health and Disability Prevention Program; Los Angeles County Department of Children and Family Services; Clinica Monseñor Oscar A. Romero; Esperanza Community Housing Corporation; GlaxoSmithKline; Grace Elliott Center; Healthy African American Families; Immunization Coalition of Los Angeles County; L.A. Care Health Plan; Los Angeles County Department of Public Health, Immunization Program; MedImmune, Inc.; Merck Vaccine Division; MotherNet LA; Sanofi Pasteur; SHIELDS for Families, Inc.; South Los Angeles Health Projects; St. Francis Medical Center; St. John’s Well Child Center; T.H.E. (To Help Everyone) Clinic; Watts Healthcare Corporation; Wyeth; community representatives.
Our Future Generating New and of all coalition members, including Our coalition will disseminate findings Exciting Science parents, community members, and health from the immunization program at n “Programs Aim to Improve Immuniza- care providers. This attitude ensures that conferences and in professional journals tion Coverage in Practices.” Infectious our strategies and materials are culturally and publish a technical brief. Diseases in Children April 2006: appropriate and meet community and 24–26. family needs. Coalition partners work We also plan to enter WIC client n “Evaluation of Immunize LA Kids’ together and with other regional and records into a countywide immunization Enhanced-AFIX Intervention in South state groups, and these partnerships registry, encourage physicians to use Los Angeles: What Worked?” Presented promote sharing of resources, lessons this registry, and focus on immunization at the 2006 National Immunization learned, and coordinated approaches follow-up strategies in African American Conference, Atlanta, Georgia, to improving immunization rates. communities. March 6, 2006. n “Closing the Immunization Gap.” We use evidence-based approaches Getting the Word Out Locally Minority Nurse Magazine 2004; that have been proven to work and n “It’s a Family Affair! Immunization Winter:28–33. that address the broad array of barriers Health Fair,” Our Weekly, August 2006. to improving immunization rates. n “Culturally Appropriate Outreach Keys to Lasting Change in the By promoting these strategies and Boosts South LA Immunization Rates,” Latino and African American integrating system changes into health First 5 LA Monday Morning Report, Communities care provider and community settings, June 26, 2006. The Immunize LA Kids Coalition includes we ensure that our interventions are n “Proteja a Sus Niños, Vacunelos a a diverse group of individuals and effective and have a lasting effect on Tiempo,” El Ahorro, August 2005. organizations. We value the contributions the community.
For More Information
Tamekia Mosley, MPA, CHES, Project Coordinator, Immunize LA Kids Coalition Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center 2930 West Imperial Highway, Suite 601, Inglewood, CA 90303 Phone: 323-757-7244 (ext. 281) • Fax: 323-779-1190 E-mail: [email protected] • Web site: http://www.izlakids.org RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“Since attending an anti-racism workshop, I serve as a resource at work and in the community.” —Participant in a SevenPrinciples Undoing RacismTM workshop
REACHing African American Infants and Families in San Francisco, California
Who We Are The Solution n The third is skills training and work- The San Francisco Department of Public n The SevenPrinciples Project has imple- shops for health care providers to Health coordinates the SevenPrinciples mented three interventions that have improve patient-provider interactions, Project. shown promise in reducing disparities promote mutual respect, and examine and improving infant survival rates the impact of race and racism on n This project includes a diverse coalition among African Americans in San health disparities and health outcomes. of people who are working to improve Francisco. the health of African American families n The first intervention is community Our Achievements and the survival rate of African Ameri- awareness campaigns that address n The community awareness campaigns can infants in San Francisco. the lack of knowledge among African were seen by 62% of African Ameri- Americans about their community’s cans in the REACH community. People The Problem health and the disparities in infant who had seen the campaigns were n Infant death rates for African Ameri- death rates. more aware of the racial disparity in cans are higher than rates for all n The second is activities designed to im- infant death rates in their community. other racial and ethnic groups in San prove community health by addressing They also knew about correct sleep Francisco, both separately and com- social factors that have been linked to positions for infants, which help reduce bined. Twice as many African American high infant death rates. These include deaths. infants die each year as white infants. violence, substance abuse, crime, poor n Community action teams assessed the n African American women also are more nutrition, food insecurity, and lack of levels of violence, crime, poor nutrition, likely not to receive prenatal care until community unity and leadership. food insecurity, and community unity late in their pregnancy and to deliver and leadership in their neighborhoods. an infant that is preterm or has a low They proposed and implemented birth weight. Racial and Ethnic Approaches actions to correct the problems they n African Americans often have less to Community Health (REACH) found. access to health care and receive lower is a community-based public n We developed a cultural competency quality care. They are more likely to health program funded by CDC training class for health care providers to be affected by social, economic, and to eliminate racial and ethnic help them communicate better with their environmental factors that have been health disparities. patients and understand the influence of linked to high infant death rates and www.cdc.gov/reach racism on patient-physician interactions. other poor health outcomes.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources lue Cross Wellpoint; Black Coalition on AIDS; Booker T. Washington BCommunity Service Center; I.T. Bookman Community Center; Jelani House; Homeless Prenatal Program; Parents Who Care; Goodwill Industries; University of California, San Francisco, Family Health Outcomes Project.
Our Achievements, cont. community members about 1) the high Keys to Lasting Change in the n After the training, 78% of participants infant death rates and other health African American Community said they were more confident using disparities among African Americans; The African American community has the recommended communication 2) the correct sleep position for infants, endured inequalities and has struggled with tools, 65% were more confident which can help to prevent sudden infant the burden of violence, crime, substance accessing resources for cultural death syndrome (SIDS); and 3) the need abuse, limited access to healthy food, and a competency, and 63% were more to take action to prevent poor health lack of community unity and leadership. To confident in their ability to describe outcomes for African American infants. eliminate the longstanding disparity in infant social conditions linked to high infant In addition, the San Francisco Depart- death rates between African Americans and death rates among African Americans. ment of Public Health has made the all other U.S. racial and ethnic groups, the n We also provided anti-racism work- anti-racism workshop a standard offering entire African American community must be shops that examined the role of racism for its staff and community partners. aware of the social, economic, and environ- in poor health outcomes. After the mental factors that have been linked to high workshops, participants said they Getting the Word Out Locally infant death rates. intended to be a resource within their n Habari Gani, a quarterly newsletter organizations. published by the SevenPrinciples In addition, health care agencies must n More than 200 health care providers Project. commit to improving the relationships participated in the trainings and between health care providers and their workshops. Generating New and African American patients and to ensuring Exciting Science equal health care for all Americans. Our Future n “Lessons Learned From an Evaluation Community and health care agencies also The SevenPrinciples Project has of Community Action Teams: Methods must adopt and enforce anti-racism policies identified partner agencies that will and Recommendations for Similar and principles that will help to improve health offer the cultural competency training Community Action Evaluations.” behaviors and health outcomes at local levels. classes to health care providers and Presented at the 134th Annual other employees within their agencies. Meeting of the American Public Health These partners also will conduct Association, Boston, Massachusetts, awareness campaigns to educate November 7, 2006.
For More Information
Virginia Smyly, MPH, Principal Investigator, Community Programs, San Francisco Department of Public Health 30 Van Ness Ave., Suite 2300, San Francisco, CA 94102 Phone: 415-581-2400 • Fax: 415-581-2490 E-mail: [email protected] RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“I believe that without the HAPAS project in the community, I would still be an uninformed person living with diabetes, without a clue how to successfully manage and control diabetes. I also attribute my interest in health advocacy and community involvement to the HAPAS project. I became a volunteer for the project and was trained as a lay health worker for the Chamorro community diabetes education program.” —Frank G., HAPAS project lay health worker
REACHing Asian American and Pacific Islander Older Adults in California
Who We Are aged 60 or older are cancer, heart n When the HAPAS project surveyed Special Service for Groups, Inc., coordinates disease, diabetes, pneumonia, and older adults in Los Angeles County the REACH 2010/Health Access for Pacific influenza. and Orange County, nearly all Asian Seniors (HAPAS) project. n Data on immunization, diabetes, respondents said that immunizations and heart disease rates among older were only for children. n This project is part of the Older Adults adults in Southeast Asian, Pacific n Older adults are at increased risk for Program of Special Service for Groups, Islander, and Filipino communities many vaccine-preventable diseases. a nonprofit community group based in are limited. In 1999, about 90% of all deaths Los Angeles. n Many people believe that Asian related to influenza and pneumonia n The project created a coalition of Americans and Pacific Islanders occurred among people aged 65 or health care providers, community are “generally healthy,” but health older. groups, grassroots groups, faith-based disparities are a problem among some groups, universities, and local health subpopulations in this diverse group. The Solution departments to work together to n Southeast Asians are among the n To address these health disparities, reduce health disparities among Asian most disadvantaged within this the HAPAS coalition developed health American and Pacific Islander older group. Problems include poverty, poor education and media materials that adults living in Los Angeles County and education, and social isolation because reflect the cultures and languages of Orange County, California. of language barriers. Many Southeast the target populations. n The coalition focuses on disparities in Asians also lack health insurance, which n The coalition provided training to adult immunization, type 2 diabetes, limits their access to health care services. local health care providers to increase and heart disease in the Cambodian, their awareness of and sensitivity Chamorro (Guamanian), Filipino, to the cultural traditions of Asian Laotian, Samoan, Thai, Tongan, and Racial and Ethnic Approaches Americans and Pacific Islanders. Vietnamese communities. to Community Health (REACH) n The coalition also conducted is a community-based public community-based research and The Problem health program funded by CDC evaluation activities in these under- n The leading causes of death among to eliminate racial and ethnic represented communities, and it health disparities. Asian Americans and Pacific Islanders coordinated community health fairs. www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources pecial Service for Groups, Inc.; Little Tokyo Service Center, Asian and SPacific Islander Older Adult Task Force; Cambodian Association of America; St. Mary Medical Center, Families in Good Health; Federation of Filipino America Association; Guam Communications Network; Samoan National Nurses Association; Special Service for Groups, Tongan Community Service Center; Orange County Asian Pacific Islander Community Alliance; University of California, Los Angeles, School of Public Affairs, Department of Social Welfare.
Our Achievements education and help us identify health n “REACH 2010, UCLA, Thai Nurses n The HAPAS coalition produced a disparities among Asian American and Association, and the Asian Pacific resource tool kit for health care Pacific Islander subgroups. Health Care Venture Provide Hepatitis providers and community leaders. The B and Health Screenings in North tool kit was created to address health Our Future Hollywood,” Thai Town USA, disparities identified by a community The REACH 2010 HAPAS project will December 5, 2004. focus group in eight Asian American and continue to educate older adults and Pacific Islander communities. caregivers about adult immunization, Keys to Lasting Change in Asian n The coalition produced educational diabetes, and heart disease. We also will American and Pacific Islander brochures on adult immunization, continue to teach health care providers Communities diabetes, and heart disease in eight how to provide culturally sensitive services Policy makers, researchers, and members languages and distributed these to Asian Americans and Pacific Islanders. of the private and public sector need data brochures to more than 40,000 people. specific to Asian American and Pacific n We reached more than 100,000 older Getting the Word Out Locally Islander communities to understand and adults, health care providers, and n “Medical System Gap: Underestimation reduce health disparities among these caregivers through various venues, of the Need, Language, and Cultural populations. More programs and research including ethnic media, health fairs, and Barriers Creates Blind Spots in Health projects need to target these populations community outreach activities. Care Needs of Asian and Pacific Islander to collect these data. n We developed eight multilingual Health Care,” Sing Tao Daily, May 18, evaluation tools on immunization, 2006. We also need a stronger commitment diabetes, and heart disease in colla- n “Health Prevention Information for to recruit and train bilingual and boration with the Department of Social Seniors: REACH 2010 HAPAS (Health bicultural members of underrepresented Welfare at the University of California, Access for Pacific Asian Seniors),” communities to work in health and social Los Angeles. These tools assess the Sereechai Newspaper, April 22–26, service fields. effectiveness of one-on-one outreach 2006.
For More Information
David Yim, MSW, Program Director, Special Service for Groups, Older Adults Program 605 W. Olympic Blvd., Suite 600, Los Angeles, CA 90015 Phone: 213-553-1884 • Fax: 213-236-9662 E-mail: [email protected] • Web site: http://www.ssgmain.org RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“If I had known about this earlier, maybe I would not have lost my sister, who died from cervical cancer. She was just busy working, taking care of her kids and her husband. She had to get a hysterectomy, but then she died last year. I now know as a result of the VRHI Coalition that we can prevent and treat this disease if it is detected early. Now, when I meet women in the street, at school, or in the market, I encourage them to get a Pap test.” —Lay health worker
REACHing Vietnamese-American Women in Santa Clara County, California
Who We Are n Breast cancer can be detected early n During 2004–2007, the coalition The University of California, San with regular mammograms, but 25% planned and implemented a breast Francisco, coordinates the Vietnamese of Vietnamese-American women cancer action plan that included REACH for Health Initiative (VRHI) aged 40 or older have not had a a multimedia campaign, outreach Coalition. mammogram within the past 2 years. activities by lay health workers, patient navigation assistance, continuing n The VRHI Coalition is a partnership of The Solution medical education for Vietnamese 16 community groups, county health n During 2000–2004, the VRHI health care professionals, and providers, and researchers at the Coalition planned and implemented collaboration with Every Woman University of California, San Francisco. a cervical cancer action plan that Counts, the state’s breast and cervical n The coalition works to promote included a multimedia campaign, cancer program. awareness and use of breast and outreach activities by lay health cervical cancer screenings among workers, a Pap test clinic that provides Our Achievements the more than 105,000 Vietnamese- patient navigation assistance, a Pap n An evaluation of coalition programs Americans living in Santa Clara County. test registry and reminder system, showed that 47.7% of participants who continuing medical education for had never had a Pap test received one The Problem Vietnamese health care professionals, after meeting with a lay health worker. n Vietnamese-American women have the and return of the Breast and Cervical n The evaluation also showed that highest age-adjusted incidence rate Cancer Control Program in Santa 17.9% of participants received a of cervical cancer in the United States: Clara County. mammogram and 27.9% received 43 per 100,000 people. This rate is 5 a clinical breast exam after meeting times higher than the rate for white with a lay health worker, compared women, which is 8.7. Racial and Ethnic Approaches with 3.9% and 5.1%, respectively, of n Cervical cancer can be detected and to Community Health (REACH) women who did not meet with a lay prevented with regular Pap tests, is a community-based public health worker. health program funded by CDC but more than 25% of Vietnamese- n In addition, 52.1% of participants had American women have never had a to eliminate racial and ethnic a repeat Pap test within 18 months, health disparities. Pap test, compared with less than 5% and 4,187 women enrolled in a of all U.S. women. www.cdc.gov/reach reminder system.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources sian Americans for Community Involvement; American Cancer Society; Blue ACross of California; Catholic Charities of Santa Clara County, John XXIII Multiservice Center; Community Health Partnership; Immigrant Resettlement and Culture Center; Kaiser Permanente; Northern California Cancer Center; Premier Care of Northern California Medical Group; Santa Clara County Public Health Department; Santa Clara County Ambulatory and Community Health Services; Santa Clara Family Health Plan; Southeast Asian Community Center; Vietnamese Physician Association of Northern California; Vietnamese Voluntary Foundation, Inc.; Vietnamese Community Health Promotion Project.
Our Achievements, cont. Getting the Word Out Locally Focused on Preventing Cervical Cancer n More than 50 Vietnamese-American n “Cervical Cancer Deaths Frustrate Among Vietnamese.” Health Promotion physicians attended each of 6 continuing Doctors,” The Associated Press, Practice 2006;7(3, suppl):223S–232S. education seminars to learn more about July 25, 2005. n “Increasing Vietnamese-American breast and cervical cancer screening. n “UCSF Community Program Wins U.S. Physicians’ Knowledge of Cervical n The VRHI Coalition led a petition drive to ‘Closing the Health Gap’ Award,” UCSF Cancer and Pap Testing: Impact reinstate the Breast and Cervical Cancer Today, November 24, 2004. of Continuing Medical Education Control Program in Santa Clara County. n “Community Forum on Cervical Cancer Programs.” Ethnicity & Disease The program returned in 2003 as the Among Vietnamese Women,” Thoi Bao 2004;14(3, suppl 1):S122–S127. Every Woman Counts program, offering and California Today, September 18, 2003. breast and cervical cancer screening to n “Culture Puts Vietnamese Women at Keys to Lasting Change in all low-income women in the county. Increased Cancer Risk,” Los Angeles the Vietnamese-American n The percentage of women who received Times, October 20, 2000. Community a Pap test increased from 77.5% in 2000 Researchers who work at the community to 84.2% in 2004, according to a study Generating New and level must reach out to residents to gener- that compared Santa Clara County with Exciting Science ate trust and to help community members a control community where residents n “Community-Based Participatory become effective researchers themselves. received no intervention. Research Increases Cervical Cancer Research projects should be flexible Screening Among Vietnamese- enough to adjust to community input. Our Future Americans.” Journal of Health Care for The VRHI Coalition will continue to refer the Poor and Underserved 2006;17(2, Projects will succeed if organizers are women to Every Women Counts clinics suppl):31–54. committed to building a broad coalition and to recruit health care providers n “Papanicolaou Testing Among of people who share a common goal, for these clinics. We also will continue Vietnamese Americans: Results of a decision-making power, and resources. to educate stakeholders about health Multifaceted Intervention.” American Coalition members also should be disparities in California. Journal of Preventive Medicine equal partners in designing, developing, 2006;31(1):1–9. conducting, and interpreting the results n “Processes and Capacity-Building of research projects. Benefits of Lay Health Worker Outreach
For More Information
Thoa Nguyen, Program Manager 44 Page Street, Suite 500, San Francisco, CA 94102 Phone: 415-476-0557 • Fax: 415-431-7700 E-mail: [email protected] • Web site: http://www.healthisgold.org RACIAL AND ETHNIC A p p ROACHES TO COMMUNITY HEALTH
“I didn’t know how huge the HIV problem was in Broward, especially in my community. I think it’s great to have people like the REACH 2010 staff giving out information and other stuff to help us protect ourselves. I also didn’t know that female condoms existed and how to use them. Those are very helpful when the guy doesn’t want to use them himself. I haven’t taken an HIV test yet, but now I’m pretty worried and want to know if I am positive, so I will take the test.” —African American woman, aged 23
REACHing African Americans and Hispanics in Broward County, Florida
Who We Are among racial and ethnic minorities These strategies included 1) a Florida International University in Broward County occurred among continuing presence and persistent coordinates the Coalition to Reduce HIV residents in just 12 of 53 zip codes. outreach to area residents; 2) outreach in Broward’s Minority Communities. to local businesses, organizations, The Solution and community leaders; 3) efforts n The coalition is a group of partners n The coalition is working to reduce the to educate individuals and mobilize working together to reduce the burden high disease rates among young adults communities for collective action; of disease and death due to infection in the African American, Caribbean, and 4) efforts to build capacity for with HIV and AIDS among young and Hispanic communities in the 12 zip community groups and enhance adults aged 18–39 years who live codes identified as having the highest the public health infrastructure. in Broward County, Florida. numbers of HIV/AIDS cases. n The coalition’s mission is to promote n Based on input from community Our Achievements the primary prevention of HIV/AIDS members, the coalition designed a n Telephone interviews conducted with and to facilitate social change by comprehensive, multilevel, multisector, more than 2,000 residents indicate helping communities respond more and multiphased intervention to that we are reaching the target effectively to this health crisis. interrupt the transmission of HIV. audience, increasing AIDS awareness, n The coalition used culturally sensitive and stimulating change. The Problem community-level strategies to enhance n P ersonal interviews with more than n The Florida Department of Health services already provided by the 150 residents and noninvasive urine testing for sexually transmitted estimates that nearly 1% of Broward Broward County Health Department. County residents are infected with diseases helped to identify previously undiagnosed and untreated infections. HIV, about three times the estimated Racial and Ethnic Approaches n Thousands of HIV prevention national average. to Community Health (REACH) supplies (e.g., condoms, latex n African American and Hispanic young is a community-based public sheets, lubricant tubes) have been adults in Broward are at increased risk health program funded by CDC discussed, demonstrated, and offered for HIV infection. to eliminate racial and ethnic free to adult community members. n Research indicates that 73% of the health disparities. 1994–1999 AIDS cases reported www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources ast and present coalition members: PHispanic Unity of Florida; Urban League of Broward County; Minority Development and Empowerment Inc.; Florida International University, Robert Stempel School of Public Health.
Our Achievements, cont. Getting the Word Out Locally n “Should HIV-Prevention Programs n The percentage of self-reported sex n “The Protection Racket: And the Band Promote Abstinence and Mutual without a condom declined from Plays On,” Broward-Palm Beach New Monogamy or Condom Use?” 26.3% in 2001 to 21.5% in 2005 Times, February 2, 2006. Sexologies 2006;15:S35. among the project’s target population. n “Broward Works to Keep the Promise,” n “Impact of a Comprehensive Community- n Self-reported condom use at least once Miami Herald, December 1, 2005. Level HIV Prevention Program on in the past year increased steadily n “Push on to End Stigma of AIDS the Behaviors of Racial and Ethnic among the Caribbean population, from Among Latinos,” Miami Herald, Minority Young Adults in Broward 51.8% in 2001 to 65.8% in 2005. October 13, 2005. County, Florida.” Presented at the 2006 n “SIDA: 25 Años Después,” El Sentinel, National STD Prevention Conference in Our Future June 3, 2006. Jacksonville, Florida, May 9, 2006. The coalition will continue to provide n “Taking It to the Streets: An FIU Team Is outreach services to the targeted Leading Grass-Roots Efforts to Empower Keys to Lasting Change in the communities. We will continue to Communities in the Fight Against HIV/ African American, Caribbean, and improve our communication strategies AIDS,” FIU Magazine, Summer 2004. Hispanic Communities to make sure we increase people’s To reach highly mobile immigrant com- awareness of the HIV problem in their Generating New and munities, such as those in Broward County, own communities. Exciting Science Florida, sustained and culturally appropri- n “HIV Risk Reduction Among Young ate educational messages and outreach We also hope to prevent future HIV Minority Adults in Broward County.” interventions are crucial. Such efforts can infections by reducing the prevalence of Journal of Health Care for the Poor help residents learn what they need to risky sexual practices, increasing healthy and Underserved 2006;17:159–173. know about HIV/AIDS and how to change behaviors, and transforming community n “Eliminating Disparities in HIV Disease: their behaviors and prevent infection. conditions and systems to create a Community Mobilization to Prevent supportive environment for change. HIV Transmission Among Black and Key stakeholders and community leaders, Hispanic Young Adults in Broward including those in the faith communities, County, Florida.” Ethnicity & Disease should be actively involved in helping to 2004; 14(3, suppl 1):108–116. deliver these types of interventions.
For More Information
Claudia Uribe, MD, MHA, Project Associate Director REACH 2010 Community Demonstration Project, Florida International University 3000 NE 151st Street, TR-7, North Miami, FL 33181 Phone: 305-919-4501 • Fax: 305-919-5673 E-mail: [email protected] • Web site: http://www.fiu.edu/~reach RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“When REACH came into the picture, that was a blessing for me because it was just like my vision had come to fruition. Through REACH, I was able to take free aerobics classes. I later trained to become a fitness instructor. And now I teach aerobics classes at my church. REACH is phenomenal!” —Aerobics class participant who is now a certified instructor
REACHing African Americans in Atlanta, Georgia
Who We Are n Heart disease is the leading cause of n The program offers free, community- The Fulton County Department of death in Georgia. African American men based services such as nutrition Health and Wellness coordinates the living in Fulton County can expect to live education classes, physical activity REACH for Wellness program. to age 61, compared with white men, programs, empowerment groups who can expect to live to age 71. African for men and women, cardiovascular n REACH for Wellness works to improve American women can expect to live to wellness centers in churches, and nutrition, increase physical activity, age 72, compared with white women, cardiovascular resource centers in create a smoke-free community, and who can expect to live to age 79. barbershops and beauty salons. manage stress for residents in the Atlanta Renewal Community. The Solution Our Achievements n The Atlanta Renewal Community, n REACH for Wellness is helping to n REACH for Wellness has served located in Fulton County, Georgia, improve cardiovascular health for more than 24,000 people in the receives special tax incentives to spur Atlanta Renewal Community residents Atlanta Renewal Community, and economic development and help through collaborative planning, improvements have been reported eliminate high poverty, unemployment, advocacy, empowerment, community since the program began. and crime rates. action, and systems change. The n The percentage of African American n The Atlanta Renewal Community’s program also works to improve adults who currently smoke decreased from 25.8% in 2002 population is 90% African American, overall health for this population to 20.8% in 2004. and 76% of the population is made and to eliminate health disparities n Adults who reported having their up of female-headed households living among minority groups. below the poverty level, with a median blood cholesterol level checked household income of $8,953. increased from 69.1% in 2002 Racial and Ethnic Approaches to 79.7% in 2004. to Community Health (REACH) n Medication adherence among The Problem is a community-based public adults with high blood pressure n In 2002, age-adjusted death rates for health program funded by CDC increased from 79.1% in 2002 to diseases of the heart were 30% higher to eliminate racial and ethnic 80.5% in 2004. for African Americans than for whites health disparities. in the United States; death rates for www.cdc.gov/reach stroke were 41% higher.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources ssociation of Black Cardiologists; Association of Black Psychologists; AMorehouse School of Medicine; Divine Universal Sisterhood; Sisters Action Team; Fulton County Library System; Georgia Office of Women’s Health; Dunbar Neighborhood Center; Fulton County Board of Health; Center for Black Women’s Wellness; Arial Bowen Church; Mechanicsville Civic Association; Concerned Black Clergy; Reynoldstown Civic Improvement Association; West End Medical Centers; Phyllis Wheatley YWCA; Dunbar Recreation Center; New Hope Baptist Church; Eddie’s Barbershop; Emmaus House; Diabetes Association of Atlanta; The Villages at Carver; Hunger Coalition; Kool Smiles; Butler St. Baptist Church; Chapel of Christian Love; Cosmopolitan AME; Faith AME Zion; Greater Deliverance Baptist; Greater Vine City; Liberty Baptist; Mt. Gilead Missionary; Mt. Olive Baptist Church; Martin Street Church of God; New Hope Baptist; St. Mark Baptist; True Light Baptist; West Oakland Baptist; Wheat Street Baptist.
Our Achievements, cont. to monitor residents’ blood pressure and Keys to Lasting Change in the n The percentage of adults who provide health education through the African American Community participate in moderate activity at cardiovascular resource centers. REACH for Wellness is working effectively least 30 minutes a day 5 days a with African Americans in the Atlanta week or in vigorous physical activity at Getting the Word Out Locally Renewal Community by using several least 20 minutes a day 3 days a week n “Black Barbers Join Fight to Cut key strategies. We recruit community increased from 25.4% in 2002 to Heart Diseases,” The Atlanta Journal- volunteers from within the community to 28.7% in 2004. Constitution, March 14, 2006. be lay health educators. n The percentage of adults who are not n “Take Good Care of Your Heart,” physically active decreased from 32.6% The Atlanta Voice, February 23– We take our interventions to places that in 2002 to 30.6% in 2004. March 1, 2006. are comfortable and easy for people to
n “REACHing Out to Bring Health get to, such as churches, local recreation Our Future to Community,” Atlanta Business centers, libraries, and barbershops. The REACH for Wellness program will Chronicle, May 13–19, 2005. continue to teach Atlanta Renewal We provide activities and resources— Community residents about heart Generating New and such as child care, primary medical care, disease and stroke through its coalition Exciting Science and substance abuse treatment—that partners, cardiovascular wellness centers n “REACH 2010 Coalitions: Reaching for can make it easier for people to in churches, and cardiovascular resource Ways to Prevent Cardiovascular Disease participate in these wellness programs. centers in barbershops and beauty salons. and Diabetes.” Journal of Women’s Health & Gender-Based Medicine We also will continue to train community 2002;11(10):829–839. volunteers as health promotion specialists
For More Information
Larry L. Johnson, MPH, Program Manager, REACH for Wellness 250 Auburn Ave. SW, Suite 500, Atlanta, GA 30303 Phone: 404-730-1513 • Fax: 404-730-1521 E-mail: [email protected] • Web site: http://www.reachforwellnessatlanta.com RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“I discovered something beautiful through the REACH program. I discovered that I can help other women and make a difference in someone’s life. I share my story with other women when I give workshops. I tell them that because my Pap test showed abnormal cells, I need to go every 6 months to make sure I don’t get cervical cancer. I encourage them to get their Pap test and to use the REACH program to get their Pap tests and mammograms. I tell women that cervical cancer can be prevented if detected early.” —REACH Out lay health worker
REACHing African American and Hispanic Women in Chicago, Illinois
Who We Are n Women with no insurance are 28% sermons, holding focus groups, setting The Access Community Health less likely to get routine mammograms up support groups, and sponsoring Network (ACCESS) and the University and 12% less likely to get routine health fairs. of Illinois at Chicago coordinate the Pap tests than women with insurance. n The program also reaches more women REACH Out program. Uninsured women also are 2–3 times by working with ACCESS, which offers more likely to have breast cancer primary care services in 47 health n REACH Out is a collaborative program diagnosed at a later stage. centers in medically underserved that works with local faith leaders to areas around Chicago. help low-income women of color get The Solution tested for breast and cervical cancer. n REACH Out encourages low-income Our Achievements n REACH Out targets women in the African American and Hispanic women n Since the program began more than Chicago metro area and is currently to get early breast and cervical cancer 5 years ago, 9,089 African American working with 17 churches in Chicago, screenings. and Hispanic women have attended Cicero, and Berwyn. n The program reaches women by REACH Out educational sessions on getting support from local faith leaders, breast and cervical cancer. n In addition, 5,188 African American The Problem recruiting lay health workers from and Hispanic women have been n Breast cancer is the second leading participating churches, adding health referred for a Pap test or mammogram. cause of cancer deaths among African information and reminders into Sunday American women and the leading n African American women aged 40 cause of cancer deaths among or older who received one piece of Hispanic women in the United States. information about mammograms or breast cancer were 80% more likely n African American women are more Racial and Ethnic Approaches to get a mammogram during or right than twice as likely to die of cervical to Community Health (REACH) after a REACH Out intervention at their cancer than white women, partly is a community-based public church. Those who received information because the disease is often diagnosed health program funded by CDC four or more times were 15 times more at later stages. to eliminate racial and ethnic likely to get a mammogram. n Hispanic women are about 1.5 times health disparities. more likely to die of cervical cancer www.cdc.gov/reach than white women.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources ccess Community Health Network (ACCESS); nine African American Achurches; eight Latino churches; The Resurrection Project; Interfaith Leadership Project; University of Illinois at Chicago; Y-Me National Breast Cancer Organization.
Our Future Generating New and Keys to Lasting Change Among REACH Out will continue to work with Exciting Science African American Women community partners to meet the health n “A Qualitative Evaluation of a Faith- and Latinas needs of low-income women in the Based Breast and Cervical Cancer The REACH Out program is unique Chicago metro area. Screening Intervention for African because it draws on the support of local American Women.” Health Education faith leaders and the faith community to Getting the Word Out Locally and Behavior 2006;33(5):643–663. encourage women to seek early breast n REACH Out staff appeared on a n “Knowledge About Breast Cancer and and cervical cancer screenings. The CAN-TV show to promote the Participation in a Faith-Based Breast program uses lay health workers program, January 17, 2006, and Cancer Program and Other Predictors recruited from participating churches October 25, 2005. of Mammography Screening Among to teach women about breast and n “REACH Sponsored Breast Cancer African American Women and Latinas.” cervical cancer. The lay health workers Survivor’s Celebration,” Austin Health Promotion Practice 2006; hold workshops in the churches, attend Weekly News, October 19, 2005. 7(3, suppl):201S–212S. health fairs, and go out into nearby n Staff appeared on Univision Radio’s n “Sustaining a Safety Net Breast and neighborhoods to reach more women. “Una Nueva Dia” show with Javier Cervical Cancer Detection Program.” Salas to discuss the REACH Out Journal of Health Care for the Poor This approach can extend life-saving program, May 17, 2005. and Underserved 2006;17(2):20–30. prevention programs and screening services across cultural divides to communities that would not likely be reached by traditional programs.
For More Information
Elizabeth Calhoun, PhD, Principal Investigator, REACH Out Health Policy and Administration (MC923), University of Illinois at Chicago 1603 W. Taylor Street #758, Chicago, IL 60612 Phone: 312-355-1572 • Fax: 312-996-5356 E-mail: [email protected] • Web site: http://www.accesscommunityhealth.net RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“From the beginning, they teach you how to shop, what to shop for, and how to read food labels. I used to read labels very little, but now I read them in detail and know what I’m looking for. My blood sugar is down 40 points, my cholesterol is down, my blood pressure is down, and the doctor has taken me off some of my medications. REACH 2010 has been a turning point in my health.” —Health education class participant
REACHing Hispanics and African Americans in Chicago, Illinois
Who We Are n During 1996–1998, African Americans screenings, information and referral The Chicago Department of Health made up 63.4% of all deaths from services, smoking cessation programs, coordinates the REACH 2010/Lawndale heart disease in Lawndale, compared nutrition and cooking classes, and Health Promotion Project. with the national average of 40%. walking groups. n In Lawndale, 28% of residents are n The project increases residents’ n This project seeks to eliminate health overweight and 29% are obese. access to local health care providers disparities in type 2 diabetes and heart through physician referrals. It also disease among Hispanics and African The Solution offers education and services to help Americans living in Lawndale. n The Lawndale Health Promotion people with diabetes and heart disease n It includes a coalition of community Project offers health education classes manage these diseases better. residents, local hospitals, community to increase residents’ awareness about n In addition, this project includes groups, area universities, and risk factors for diabetes and heart African American and Hispanic case government agencies. disease, such as high blood pressure, managers and community health n Lawndale includes two communities high blood cholesterol, obesity, workers who assess residents’ risk for on Chicago’s West side and is home to smoking, unhealthy eating habits, and diabetes and heart disease. about 66,700 Hispanics and 54,500 lack of regular physical activity. These African Americans. classes are designed to reflect the Our Achievements culture and language of local residents. n More than 7,000 assessments for The Problem n To help residents overcome these diabetes and heart disease risk have n African Americans are 1.8 times more risk factors, the project offers health been conducted with community likely to develop diabetes than whites, residents. These assessments increased and Hispanics are 1.7 times more likely residents’ awareness of risk factors for to develop diabetes than whites. Racial and Ethnic Approaches these diseases. to Community Health (REACH) n In Lawndale, 71% of residents are at n Nine hundred residents were referred to is a community-based public risk for diabetes, and 85% are at risk local health agencies for medical care. for heart disease. health program funded by CDC to eliminate racial and ethnic health disparities. www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources merican Diabetes Association; American Heart Association; Chicago Department of Public AHealth, Office of Substance Abuse; Chalmers Elementary School; Chicago Hispanic Health Coalition; Dominicks; Family Focus Lawndale; Jorge Prieto Family Health Center; Joseph E. Gary Elementary School; Lawndale Christian Health Center; Loyola University Chicago, Stitch School of Medicine; Matthew Henson Elementary School; North Lawndale Symphony of Services; U.S. Department of Health and Human Services, Office of Minority Health, Public Health Service Region V; Osco Pharmacy/Lawndale; Our Lady of Tepeyac Parish Church and School; Programa CIELO; Saint Anthony Hospital; Sinai Health Systems; University of Chicago, Diabetes Education Center; University of Illinois, School of Public Health; University of Illinois Extension; University of Illinois at Chicago Neighborhoods Initiative, Division of Community Health.
Our Achievements, cont. In addition, we will work to educate Keys to Lasting Change in n In addition, 350 residents with local and state stakeholders about health Hispanic and African American diabetes or heart disease received disparities in Chicago. Communities case management services, which To effectively reach people with health sharply increased their use of Getting the Word Out Locally messages, educational materials should health screenings. For example, the n Community Partners, CAN TV program reflect the culture and language of local percentage of this group who received on diabetes awareness, November 9, populations. Health professionals also annual blood sugar tests increased 2006. should work closely with community from 21% to 96%, the percentage members who are strongly committed to who received annual eye exams Generating New and improving their community. For example, increased from 22% to 72%, the Exciting Science a community health worker with the percentage who received annual foot n “Using Multilevel, Multisource Lawndale Health Promotion Project exams increased from 42% to 72%, Needs Assessment Data for Planning recruited a local group to provide free, and the percentage who received Community Interventions.” Health on-site fitness classes. We also have annual cholesterol tests increased from Promotion Practice 2004;5(1):59–68. collaborated with local health agencies 47% to 77%. n “Evaluating Community Based Public to improve access to health care services Health Projects—REACH 2010: The for people without insurance and to Our Future Chicago Lawndale Health Promotion expand the ability of community health The Lawndale Health Promotion Project Project (LHPP).” Presented at the 132nd workers to refer residents to other will continue to provide diabetes and Annual Meeting of the American Public community services. In addition, we are heart disease awareness training to Health Association, Washington, DC, using a community mapping tool to the Lawndale community. We also will November 10, 2004. identify resources that can help residents continue to partner with community improve their health. groups and faith institutions to increase health education opportunities.
For More Information
Berenice Tow, MPH, Program Director, REACH 2010/Lawndale Health Promotion Project Chicago Department of Public Health, DePaul Center, Room 320 333 S. Sate Street, Chicago, IL 60604 Phone: 312-745-0590 • Fax: 312-747-9420 E-mail: [email protected] • Web site: http://webapps.cityofchicago.org/lhpp/Home.jsp RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“I have been a diabetic for over 14 years. It has been a constant battle to try to stay focused. I enjoy cooking and eating, and this combination can be a problem. I know how to eat healthy, but other factors interfere, like when I work late hours and can’t eat on time. Too little exercise is one of my biggest downfalls. But the DEEP class is a big help. With them teaching us all they know and what can happen, I think twice and try to make a better choice. Keep up the good work!” —Nancy Chico, community resident and director of YMCA South Chicago
REACHing African Americans and Hispanics in Chicago, Illinois
Who We Are n Hispanics often do not receive distribution and to increase demand for The University of Illinois at Chicago quality health care because of fruits and vegetables. coordinates the Chicago Southeast lack of insurance related to high n The coalition supported the Diabetes Community Action Coalition. unemployment (42.6%). implementation and testing of the Diabetes Empowerment Education n The coalition includes community, The Solution Program (DEEP), a diabetes self- health care, and business groups, n The coalition is working to address management class for community as well as academic institutions. disparities in diabetes education and residents. Local health care providers n Coalition partners work together quality of care by building community and lay health workers are trained to reduce the high rates of diabetes capacity, identifying people at high to teach the class, and they receive in the African American and Hispanic risk for diabetes, offering training and regular updates on diabetes care and communities in Southeast Chicago education, supporting health promotion prevention. by educating people about the disease. activities, and creating diabetes self- n Two diabetes self-care centers were care centers. set up in target communities to offer The Problem n Coalition partners provide information outreach, health promotion, and n In Southeast Chicago, 16.6% of to increase people’s knowledge about education activities. African American adults and 10.8% diabetes and to promote health at of Hispanic adults reported having health fairs and screening events. Our Achievements diabetes in 2000. n Business and health groups work n Coalition members have sponsored or n Also in 2000, 63.6% of whites in together to influence changes in food participated in more than 200 health Southeast Chicago received diabetes fairs and community awareness events, education from their health care Racial and Ethnic Approaches reaching over 37,000 people. providers, compared with 47.5% to Community Health (REACH) n Thirty-five DEEP classes, which of African Americans and 57.1% is a community-based public last 10 weeks, have been offered of Hispanics. Twenty-nine percent health program funded by CDC in targeted communities, and more of African Americans and 25% of to eliminate racial and ethnic than 350 people have completed Hispanics with diabetes received an health disparities. these classes. annual flu shot, compared with 44% www.cdc.gov/reach of whites.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources niversity of Illinois at Chicago; Healthcare Consortium of Illinois; Centro UComunitario Juan Diego; Chicago Family Health Center; Hispanic Center for Wellbeing and Health Promotion; Hegewisch Community Committee; South Chicago Chamber of Commerce; Healthy South Chicago; Villa Guadalupe Senior Center.
Our Achievements, cont. n “Diabetes Class: Glucose Levels and and Behavioral Outcomes in Patients n When DEEP participants were evalu- Pounds Drop,” Southeast Chicago with Diabetes.” Presented at the 134th ated after the class, they showed Observer, May 15, 2005. Annual Meeting of the American improvements in their eating habits n “Diabetes Update: A Quarterly Bilingual Public Health Association, Boston, and physical activity levels. Newsletter,” coalition publication for Massachusetts, November 6, 2006. n Participants also showed lower blood Southeast Chicago. n “Promoting Healthy Eating in the sugar levels after taking the class. Latino South Chicago Neighborhood: Generating New and An Ecological Approach.” Presented Our Future Exciting Science at the 134th Annual Meeting of the Our DEEP class is being implemented in a n “Reducing Diabetes Health Disparities American Public Health Association, local health clinic, and we are expanding Through Community-Based Participatory Boston, Massachusetts, November 6, and strengthening the “train the trainer” Action Research: The Chicago Southeast 2006. part of the program. We have completed Diabetes Community Action Coalition.” a community survey to evaluate changes Public Health Reports 2003;118: Keys to Lasting Change in the in diabetes prevalence, risk factors, and 309–323. Hispanic and African American quality of care. This information will help n “Trends in Diabetes Prevalence and Communities us to plan future activities Risk Factors Among Minority Residents Empowering communities through in Southeast Chicago.” Presented at the education at individual, group, and Getting the Word Out Locally CDC Diabetes and Obesity Conference, community levels is essential for success. n “Center’s Goal: Confronting and Denver, Colorado, May 17, 2006. This strategy includes addressing Conquering Diabetes,” Southeast n “A Participatory Training Program for individual needs by providing knowledge, Chicago Observer, September 28, Community Health Workers.” Presented peer support, and information; teaching 2005. at the CDC Diabetes and Obesity people to help others while helping n “DEEP Diplomas Awarded at St. Conference, Denver, Colorado, themselves; involving business groups and Kevin’s,” Southeast Chicago Observer, May 17, 2006. providing a win-win strategy for change; July 20, 2005. n “Use of Empowerment Theory and and spreading the word and inviting Adult Education in Affecting Clinical support from advocates and legislators.
For More Information
Amparo Castillo, MD, Program Manager, Midwest Latino Health Research Training and Policy Center (MC 625), 1640 W. Roosevelt Road, Suite 636 University of Illinois at Chicago, Chicago, IL 60608 Phone: 312-413-2050 • Fax: 312-996-3212 E-mail: [email protected] • Web site: http://www.uic.edu/jaddams/csdcac RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“REACH helped us to understand that if we don’t take care of ourselves, we can’t take care of our husbands, our children, and our people. REACH 2010 is the best thing that could have happened to New Orleans. It helped us to see what our needs are and determine better ways of meeting our health needs.” —Delores Aaron, REACH 2010 participant and New Orleans community leader
REACHing African American Women in New Orleans, Louisiana
Who We Are n Nationally, African Americans have n We evaluate our interventions to make The Black Women’s Health Imperative a disproportionate burden of heart sure they are effectively promoting coordinates the REACH 2010: At the disease and stroke compared with positive community changes over time. Heart of New Orleans Coalition. other U.S. racial and ethnic groups. Our Achievements n The coalition is a community-based The Solution n We organized African American health participatory research project that is n REACH 2010 interventions are guided professionals to provide free screenings working with local churches to reduce by community-based participatory and health counseling on risk factors risk factors for heart disease among research methods that emphasize for heart disease and prediabetes for African American women. community collaboration and control. more than 10,000 African Americans n The coalition includes community We are working with 40 African at church and community sites. groups, city and state health depart- American churches across 10 denomi- n We conducted 500 health education ments, a historically black university, nations in New Orleans to tailor our classes focused on heart disease. We the local public library, and 40 African interventions to local communities. also worked with local communities American churches in New Orleans. n Our interventions are designed to and churches to implement the Black n The Black Women’s Health Imperative reduce risk factors for heart disease and Women’s Health Imperative’s signature is a national nonprofit educational, prediabetes among African Americans fitness program, Walking for Wellness. advocacy, and leadership develop- in New Orleans. Activities include health n We planned and facilitated more ment group committed to the health screenings, workshops on how to than 150 Sister Circle self-help group and well-being of black women, their navigate the health care system, health sessions for women at local church, families, and their communities. education classes, self-help group community, and work sites. We also sessions, and a walking program. trained 35 REACH volunteers as self- The Problem help facilitators for these sessions. n Heart disease is the leading cause of Racial and Ethnic Approaches n We trained more than 300 volunteers to death for men and women in Louisi- to Community Health (REACH) support our interventions. ana. In 2002, heart disease killed more is a community-based public n We promoted community-wide physical women than men in Louisiana. health program funded by CDC activity and healthy eating programs, n In 2000, 32% of African Americans to eliminate racial and ethnic reaching more than 30,000 African who died of heart disease in Louisiana health disparities. Americans through multiple media were younger than 65, compared with www.cdc.gov/reach outlets. 16% of whites.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources lack Women’s Health Imperative; Southern University and A&M College Bin Baton Rouge, School of Nursing; Drexel University School of Public Health, Healthy Heart Community Prevention Project; City of New Orleans Health Department; Louisiana Office of Public Health, Cardiovascular Health Program; Black Women’s Health Project of Louisiana; New Orleans Public Library; Shiloh Missionary Baptist Church, Baton Rouge; and 40 area churches.
Our Future n “Health Issues 2010,” local TV show Keys to Lasting Change in the The REACH 2010: At the Heart of New addressing heart disease and other African American Community Orleans Coalition will continue to help health issues. Co-produced with the The REACH 2010 project has built African American churches reduce heart Healthy Heart Community Prevention collaborative relationships with 40 disease and associated risk factors among Project. churches across 10 denominations to its members. We will continue to make n The Healing Voice, the coalition’s reduce risk factors for heart disease people more aware of the need to quarterly newsletter. among African Americans in Louisiana. prevent heart disease in all African American communities. Generating New and We have found that certain components Exciting Science are essential to making positive and The Black Women’s Health Imperative n “Mentoring for Leadership to Eliminate sustainable changes at the community will continue to provide leadership to Health Disparities.” Presented at the level. These components include sharing achieve these goals. In addition, one 19th National Conference on Chronic power and decision-making across of our coalition partners, Southern Disease Prevention and Control, groups, establishing clear roles for University, has applied to become a Atlanta, Georgia, March 1, 2005. all partners, and respecting people’s Center of Excellence to eliminate heart n “Keep the Faith: Lessons Learned in differences. We also must communicate disease disparities among African Working with Health Ministries in and coordinate our activities across American women in the Gulf region. Faith Communities.” Presented at the all groups, emphasize a principle 133rd Annual Meeting of the American of personal caring, and anticipate Getting the Word Out Locally Public Health Association, Philadelphia, challenges and barriers. n “Diet is a Dirty Word and a Dreadful Pennsylvania, December 13, 2005. Thought,” Louisiana Weekly, February n “Community Lifeguards of Black In addition, we must understand that 28–March 5, 2005. Women’s Health.” The Women’s Health African American women can be agents n “Women Get the Word Out on Heart Activist Nov/Dec 2004;29(6):3. of change for their own health as Disease,” The Times Picayune, February n “At the Heart of New Orleans: Nurses well as for the health of their families 17, 2005. and Community Health Workers Find and communities. To do so, women n “Program Focuses on Women’s Innovative Ways to Reduce Health need safe spaces to tell their stories, Health,” The Times Picayune, February Disparities.” Texas/Louisiana: Advance connect with other women, and receive 3, 2005. for Nurses 2003;1(4):25. emotional support.
For More Information
Cheryl Taylor, PhD, Principal Investigator, REACH 2010: At the Heart of New Orleans Coalition Southern University and A&M College, School of Nursing, Office of Research P.O. Box 11794, Baton Rouge, LA 70813 • Phone: 504-680-2810 E-mail: [email protected] • Web site: http://www.blackwomenshealth.org/reach2010 RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“The input I received from the group reflected our motto: ‘Strong women growing stronger.’ Women came into the meeting already strong advocates for themselves, and they went away further equipped with specific tools and strategies for maximizing their health care experiences.” —REACH 2010 Women’s Health Ambassador
REACHing Black and African Descendent Women in Boston, Massachusetts
Who We Are services is not the reason for the project also offers cultural competency The Boston Public Health Commission higher death rates. training for primary care providers. coordinates the Boston REACH 2010 n Black women in the United States n Community outreach workers, called Breast and Cervical Cancer Coalition. die of breast cancer at a higher rate Women’s Health Ambassadors, provide (33.6 deaths per 100,000) than white education on breast and cervical health n The coalition includes community women (29.6 per 100,000). and racial disparities at health fairs, members, community groups, health n Black women in Boston die of cervical hair and nail salons, and faith-based care providers, business and faith cancer at a significantly higher rate institutions. They also provide support leaders, and academic partners. (6.1 per 100,000) than white women and resources to community members n The mission of the coalition is to (2.5 per 100,000). through workshops in people’s homes eliminate racial and ethnic disparities and at community locations. in breast and cervical cancer by The Solution n The coalition has earned a reputation promoting screening, education, n To address these problems, the coali- in the local and public health commu- prevention, treatment, and access to tion implemented the Women’s Health nities for raising awareness of health care for black women and women of Demonstration Project. This project en- disparities, educating residents about African descent in Boston. sures that black women and women of health issues that affect Boston’s black n By working directly with the community, African descent in Boston get primary community, and building partnerships we make sure our programs reflect the care and follow-up services when they with key community stakeholders. culture of local populations. receive an abnormal result from breast and cervical cancer screenings. The Our Achievements The Problem n The coalition’s community interventions n Black Bostonians have a 12% higher have reached more than 3,500 women death rate for all cancers than white Racial and Ethnic Approaches in Boston. Bostonians. to Community Health (REACH) n Nearly 1,600 women are enrolled in n Death rates are particularly high for is a community-based public the Women’s Health Demonstration breast, prostate, and cervical cancers, health program funded by CDC Project, where case managers at four even when screening rates are higher to eliminate racial and ethnic area health centers connect women health disparities. among black residents. This finding with resources and information. suggests that access to health care www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources oston Public Health Commission; REACH Boston Elders 2010; Boston BSTEPS; YWCA; Boston Black Women’s Health Institute; Cherishing Our Hearts and Souls Coalition; Project Right; Hyde Square Task Force; faith- based organizations; schools; community centers; other city programs; Boston Mayor Thomas M. Menino.
Our Achievements, cont. Getting the Word Out Locally n “Boston’s REACH 2010 Coalitions: n Our Women’s Health Ambassadors n “Breast Cancer: Two Women Struggle Creating Change and Collaborating for have reached thousands of women in for Survival,” The Boston Banner, the Future.” Presented at the Office of hundreds of workshops since 2000. October 12, 2006. Minority Health National Leadership n After participating in a public policy n “The Boston Disparities Project: Summit on Eliminating Racial and Ethnic training session, 50 coalition members Closing the Gap,” Boston Neighbor- Disparities in Health, Washington, DC, came together to lead a community hood Network, June 2005. Episode January 10, 2006. campaign to support breast and cervical no. 2 featured the director of the cancer programs across the state. REACH coalition. Keys to Lasting Change for n “REACH 2010: Spreading the Word Black Women and Women Our Future About Racial and Ethnic Health of African Descent The coalition will expand its scope to Disparities and the Work of the REACH The coalition has brought together commu- address public health issues related 2010 Breast and Cervical Cancer nity residents and public health partners to to men’s health, adolescent wellness, Coalition,” WILD FM radio, 2003. eliminate racial and ethnic health disparities community advocacy, public policy, in Boston. REACH staff and partners have and environmental health. A strategic Generating New and coined the phrase “REACH: Each one, teach plan will ensure that community efforts Exciting Science one,” to reflect their belief that information to eliminate racial and ethnic health n “Evaluation of Health Disparities Out- provided in a way that takes into account disparities can be sustained. comes: Process and Policy.” Presented the culture of the target population can at the Moffit Cancer Center’s 5th spread through the community and have a Our demonstration project is encouraging Biennial Conference, titled Cancer, positive impact. community health centers to adopt a case Culture and Literacy: Solutions for management model that will help them Addressing Health Disparities Through Our efforts have been successful because continue to improve communication be- Community Partnerships, Clearwater they draw on systemic change and tween patients and health care providers. Beach, Florida, May 19, 2006. community empowerment models that use education, case management, and cultural competency training to address health disparities at personal, community, and public policy levels.
For More Information
Nashira Baril, MPH, Director, REACH 2010 Breast and Cervical Cancer Coalition Boston Public Health Commission 1010 Massachusetts Ave., Floor 2, Boston, MA 02118 Phone: 617-534-2291 • Fax: 617-534-5179 E-mail: [email protected] • Web site: http://www.bphc.org/reach2010 RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“The REACH Boston Elders 2010 project had a great impact on my life, especially being a diabetic who had been noncompliant. Regarding racial disparities in the black community, I have seen the facts come to life before my eyes. I have been more observant of my health care providers and how patients have been treated, including myself.” —REACH program participant
REACHing Black Older Adults in Boston, Massachusetts
Who We Are n Massachusetts adults aged 75 years or community members how to properly The Boston Public Health Commission older are more than twice as likely to care for older adults, especially those coordinates the REACH Boston Elders have diabetes as those aged 45–64. with diabetes and heart disease. 2010 project. n Heart disease is the leading cause of n The REACH Boston Elders 2010 death in Massachusetts. Blacks are at project uses seminars, health fairs, n This project works to eliminate health the greatest risk for health problems walk-a-thons, and intensive health disparities in diabetes and heart related to overweight and obesity, training sessions to reinforce and disease among black older adults in which are major risk factors for heart support the adoption of healthy Boston. disease. lifestyles and to help connect older n This project provides opportunities adults with needed services. for black older adults to actively lead, The Solution n The coalition also offers classes and plan, and develop a citywide model n To address these problems, the REACH workshops on topics important to to improve health outcomes and raise Boston Elders 2010 project uses an older adults, such as nutrition, self- awareness of the problems faced by approach that includes community management of chronic diseases, and the black older adult population. mobilization, education, and training safe exercises such as tai chi. n As part of a community approach, a to eliminate the unequal burden of coalition was formed to develop a disease and social inequities in the Our Achievements community action plan. This coalition health care system. n In 2006, the REACH Boston Elders 2010 includes community elders, health care n An education and training model project reached more than 2,000 black providers, educators, researchers, and teaches health care providers and older adults through 49 health education representatives of local government workshops, presentations, and events. agencies. These activities focused on issues such as Racial and Ethnic Approaches physical activity, nutrition, heart disease, The Problem to Community Health (REACH) diabetes, health disparities, advocacy, n In Massachusetts, the estimated preva- is a community-based public medications, and Medicare/Medicaid. lence of diabetes among non-Hispanic health program funded by CDC n When surveyed, 86% of respondents said blacks is 9.9%, compared with 6.0% to eliminate racial and ethnic they had learned something new at these among non-Hispanic whites. health disparities. events, and 60% said they would change www.cdc.gov/reach their behavior.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources oston Public Health Commission; Action for Boston Community BDevelopment; Commission on Affairs of the Elderly; Center for Community Health Education Research and Service; Jubilee Christian Church; American Diabetes Association, Boston Chapter; American Heart Association, Boston Chapter; Central Boston Elder Services; 60 Plus Veterans; The Goldenaires of Freedom House.
Our Achievements, cont. in developing a solid community-based Conference, Mashantucket, Connecticut, n When surveyed, 90% of people who model to improve health and health care April 3, 2007. attended the coalition’s monthly meet- access for blacks in Boston and beyond. ing said they had made changes in their Keys to Lasting Change in the lifestyle as a result of attending these Getting the Word Out Locally Black Older Adult Community meetings. n “Health Care Disparities Among the Community commitment and active n In 2007, our coalition received the Races: REACH Boston Elders 2010,” participation by black older adults, along Community Leaders Award from Health National Public Radio/WBUR Boston, with various stakeholders and key state Care for All, a nationally recognized September 28, 2005. and local policy makers, have increased health care, policy, and advocacy group. n “Pair Keep Eye on Health of Hub’s the visibility and knowledge of public Minority Elders,” Boston Herald, health problems affecting black older Our Future December 3, 2004. adults in Boston. Our coalition’s ability The REACH Boston Elders 2010 project to effectively address the high rates of will continue to highlight the concerns of Generating New and diabetes, heart disease, and their related black older adults in Boston, and we will Exciting Science risk factors and complications among incorporate an intergenerational approach n “REACHing Beyond Expectations: Black, local residents has demonstrated the to reducing health disparities in Boston. Elderly, and Fighting for Health, Justice strength of community organizing. and Equality.” Presented at the 10th An- Our coalition will continue to address niversary Conference of the Community- We have found that health disparities topics and activities related to diabetes Campus Partnerships for Health, Toronto, can be addressed through ongoing and heart disease prevention, the need Canada, April 11–14, 2007. education, long-term partnerships, and a for equal access to care, and other social n “REACH Boston Elders 2010: Moving a commitment to change. We have made determinants of health. Coalition members Community and Changing the Business significant strides in improving the health and partners will continue to support black as Usual.” Presented at the 5th New of black older adults in Boston. older adults in Boston and lead the way England Regional Minority Health
For More Information April J. Taylor, MPH, Director, REACH Boston Elders 2010 1010 Massachusetts Ave., 2nd Floor, Boston, MA 02118 Phone: 617-534-2472 • Fax: 617-534-2365 E-mail: [email protected] Web site: http://www.bphc.org/reachelders RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“I used to say that HIV/AIDS is all about politics. Now I know it’s real. I would like all folks to take this class because there are so many people like me who think SIDA [AIDS] is ‘politics.’ I have learned a lot, not only about HIV/AIDS, but about other diseases and about domestic violence. Thanks to the facilitators.” —Participant in an HIV education workshop
REACHing the Haitian Community in Boston, Massachusetts
Who We Are the state’s general population, Our Achievements The Center for Community Health, where women represent 24% n The coalition completed the first Education & Research, Inc. (CCHER) of HIV/AIDS cases. comprehensive survey of the adult coordinates the Metropolitan Boston Haitian population in Boston, Haitian REACH 2010 HIV Coalition. The Solution documenting the health attitudes, n The coalition provides HIV prevention beliefs, and behaviors of more than n The coalition includes community education through a community- 2,700 men and women. groups, community health centers, wide media campaign and culturally n The coalition provided six HIV/AIDS educational programs, reaching more and one faith-based group. appropriate workshops for Haitian than 500 women, 200 men, 250 youth, n Coalition members work to reduce the immigrants. It also provides access 60 couples, 60 Haitians living with HIV, high HIV/AIDS rates among Haitian to HIV testing. and 130 new immigrants. immigrants in the Boston metropolitan n The project targets six groups of area. n The coalition also launched an HIV people: women, men, youth, couples, prevention media campaign in Creole Haitians living with HIV, and new The Problem on billboards, buses, trains, and Haitian immigrants. radio stations, reaching more than n As of February 1, 2005, there were n The coalition works to educate and 12,000 Haitians in the Boston 1,074 cases of HIV/AIDS reported involve community leaders, including metropolitan area. among Haitian-born people living faith and media leaders, in HIV n More than 80 Haitian faith and in Massachusetts. prevention efforts. media leaders received training in n The rate of heterosexual transmission HIV prevention strategies. of HIV within the Massachusetts n Forty non-Haitian health care and Haitian community is more than three Racial and Ethnic Approaches social service providers received times the rate among non-Haitians. to Community Health (REACH) cultural competency training. n Haitian women represent 41% of all is a community-based public n The coalition also set up a statewide Haitian-born people with HIV/AIDS health program funded by CDC network of groups to address health in Massachusetts, compared with to eliminate racial and ethnic disparities related to HIV/AIDS rates in health disparities. communities of color. www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources he Center for Community Health, Education & Research, Inc.; TAssociation of Haitian Women in Boston; Boston Medical Center, Supporting Parents and Resilient Kids Program; Cambridge Health Alliance, Haitian Health Outreach Project; Caribbean U-Turn; Dorchester Nazarene Compassionate Center; Haitian American Public Health Initiative; Haitian Multi-Service Center; Massachusetts Coalition for Health Services, Brockton CHASE AIDS.
Our Future Generating New and Keys to Lasting Change in the Working with other groups that serve Exciting Science Haitian Community immigrants, the Metropolitan Boston n “Cultural Barriers to HIV-Preventive Our program has succeeded because Haitian REACH 2010 HIV Coalition will Behaviors Among Haitian Immigrants we created a solid infrastructure within continue to provide educational programs in Metro Boston.” Oral presentation at the community that is supported by health tailored to specific groups of people. In the American Public Health Association care providers, faith leaders, and media the future, we plan to expand the program Annual Meeting, Philadelphia, leaders. The unique network of Haitian to include advanced behavioral-change Pennsylvania, December 12, 2005. groups and health care providers sets an training. The coalition structure also will n “Role and Importance of Media in example for collaborative action, makes be used to address other health needs, Health Promotion: The Case of the more health care services available to the such as improving women’s access to Haitian Population in HIV Prevention community, and creates a way to address mammograms. in the Greater Boston Area.” Presented other community needs. at the New England Conference on Getting the Word Out Locally Health Disparities, Portland, Maine, Because health care providers, community n “SIDA Se Zafé Nou Tout. Ann Potekole April 2005. partners, residents, faith leaders, and local Nan Yon Konbit Kominote Pou N n “The Boston Haitian HIV Prevention and state officials are willing to work Bare Wout Li” (“HIV/AIDS: We Are Coalition Formative Evaluation: A together to reduce health disparities in All Concerned. Let’s Work Together Participatory Approach to Community the Haitian community, we can tackle to Stop the Virus”), ongoing media Self-Assessment.” Ethnicity & Disease major challenges related to sex education, campaign that includes weekly radio 2004;14(3, suppl 1):20–26. the stigma of HIV/AIDS, and disclosure of shows, posters, billboards, brochures, n “Overcoming Historical and Institutional HIV status. and flyers. Distrust: Key Elements in Developing and Sustaining the Community Mobilization Against HIV in the Boston Haitian Community.” Ethnicity & Disease 2004;14(3, suppl 1):46–52.
For More Information
Eustache Jean-Louis, MD, MPH, Project Investigator Center for Community Health Education and Research 420 Washington Street, Dorchester, MA 02124 Phone: 617-265-0628 (ext. 213) • Fax: 617-265-4134 E-mail: [email protected] • Web site: http://www.ccher.org RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“I am grateful for all you have done for me and my health. Before I began this course, my diabetes was really bad, and I was really depressed, disillusioned, and sad. With this program, I learned to be more conscientious. I feel different, better.” —REACH project participant
REACHing Latinos in Lawrence, Massachusetts
Who We Are The Solution Our Achievements The Greater Lawrence Family Health n The REACH 2010 Latino Health n More than 10,000 Latinos in Lawrence Center coordinates the REACH 2010 Project works to raise people’s who had little access to information Latino Health Project. awareness about diabetes, teach about diabetes or heart disease before them how to eat a healthy diet and now know where to go for help. n This project works to eliminate health be more physically active, and help n In 2006, blood sugar levels improved disparities among Latinos living in them to understand that diabetes can from an average of 8.21 to 7.67 among Lawrence, Massachusetts, who have be prevented and controlled. participants in Winning with Diabetes, diabetes and associated heart disease. n The project provides information on a 10-week educational program at the n Lawrence is the poorest city in how to prevent and manage diabetes Lawrence Senior Center. Massachusetts. About 68.7% of its that reflects the local culture. n Also in 2006, the percentage of partici- population is Latino, primarily from the n The project also provides outreach pants with total cholesterol levels <200 Dominican Republic and Puerto Rico. activities through a local health mg/dL increased from 75% to 80%. education center, works with n The percentage of Latinos receiving The Problem community groups, partners with services at the Greater Lawrence Family n The prevalence of diabetes among local health care providers, and Health Center (GLFHC) who had their Puerto Rican and Dominican adults in promotes health messages through blood sugar level measured at least Lawrence is 11.8%, nearly twice the a media campaign. twice a year as recommended increased rate among whites in Massachusetts. from 50.6% in 2002 to 61.6% in 2006 n Diabetes prevalence is 7.4% among after the center took specific steps to Latinos statewide, compared with only improve the health of its Latino clients 6.4% among non-Hispanic whites. with diabetes. n One in three children born in 2000 in Racial and Ethnic Approaches n The percentage of Latinos receiving the United States will develop diabetes. to Community Health (REACH) services at the GLFHC who reached The incidence among Hispanic females is a community-based public their blood sugar goal (A1C level <7) born in 2000 is closer to 1 in 2. health program funded by CDC increased from 20.7% in 2002 to to eliminate racial and ethnic 43.4% in 2006. health disparities. www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources reater Lawrence Family Health Center; Lawrence Council on Aging; GHome Health VNA; Merrimack Valley Nutrition Project; Lawrence General Hospital; Greater Lawrence YWCA; more than 30 other community groups.
Our Achievements, cont. Getting the Word Out Locally n “Integrating Health Education and n The percentage of Latinos receiving n “La Coalición Contra la Diabetes de Health Promotion to Reduce Health services at the GLFHC who had an Lawrence Celebra su 3rd Feria Anual Disparities Related to Diabetes in a annual flu shot increased from 44.2% ‘Fiesta de Salud,’ ” RUMBO, April 22, Latino Population.” Presented at the in 2005 to 55% in 2006. 2006. 23rd National Conference on Health n The Diabetes Self Management n “La Feria de Salud Latina,” RUMBO, Promotion and Education, Minneapolis, Education program at the GLFHC April 15, 2004. Minnesota, May 25, 2005. received the American Diabetes n Regular appearances on Para tu Salud, n “Practice-Based Interventions to Association’s Education Recognition a program produced by the Greater Improve Health Care for Latinos award. Lawrence Family Health Center on With Diabetes.” Ethnicity & Disease n A wellness group that began with Lawrence Community Access Television 2004;14(3, suppl 1):117–121. one physician teaching 25 groups has (LCAT). expanded to include several physicians. n Ad campaign promoting awareness Keys to Lasting Change of type 2 diabetes and public service in the Latino Community Our Future announcements on area radio stations The keys to lasting change in the Latino We plan to expand a community-based WCCM, WCEC, and WEZE. community are education, social support, intervention called Alcanzando el n “Who’s at Risk for Diabetes?” ad and community collaboration. The REACH Bienestar/REACHing for Wellness that campaign on Univision-Noticiero TV. 2010 Latino Health Project aims to use is designed to reflect the culture and the relationships that already exist among traditions of Latino adults and youth in Generating New and Latino populations and community groups Lawrence. We will continue to improve Exciting Science in Lawrence to promote community health care for Latinos with diabetes. n “Changing Lives of Latinos Who Have wellness. These relationships can provide We also will continue to publish our Diabetes: Three Case Studies.” Presented the foundation to create the health research findings to improve the quality at the Office of Minority Health National care support needed to improve health of information available to patients, Leadership Summit on Eliminating outcomes and to encourage more people researchers, and health care professionals Racial and Ethnic Disparities in Health, to use diabetes prevention services. dealing with the burden of diabetes. Washington, DC, January 9, 2006.
For More Information
Dean Cleghorn, EdD, Principal Investigator, REACH 2010 Latino Health Greater Lawrence Family Health Center One Canal Street, Lawrence, MA 01840 Phone: 978-686-6029 • Fax: 978-683-5791 E-mail: [email protected] • Web site: http://www.glfhc.org/ RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“Before, my cholesterol level was close to 400. But after I exercised regularly and ate healthier, my cholesterol level right now is at 160. I am extremely happy with this improvement.” —Cambodian senior in the Lowell Senior Center exercise program
REACHing Cambodian Adults in Lowell, Massachusetts
Who We Are n Also in 2002, 77% of Cambodian men wellness programs such as peer The Lowell Community Health Center said they had smoked 100 cigarettes or support groups, exercise classes, coordinates the Cambodian Community more in their lifetime, and 37% were and stress management sessions. Health 2010 Program (CCH 2010). current smokers. n CCH 2010 increases awareness among n The survey also found that 99% of health care providers and researchers n CCH 2010 is a coalition of health care Cambodian adults in Lowell were born about Cambodian culture, health care providers, community groups, and in Cambodia, and 85% had spent beliefs, and health care needs. representatives from the University time in a refugee camp. Among adults n The program also offers educational of Massachusetts Lowell. aged 50 years or older, men received sessions to teach Cambodians about n Our goal is to reduce health disparities an average 7.2 years of schooling in heart disease and diabetes and to in the rates of heart disease and Cambodia, and women received an teach those who have these diseases diabetes among Cambodians living average 3.1 years. When they talk with how to manage them better. in Lowell, Massachusetts. a doctor who does not speak Khmer, n Lowell has the second largest their main language, 89% said they Our Achievements Cambodian community in the wanted an interpreter. n The number of Cambodian patients United States. accessing health care at Lowell The Solution Community Health Center’s Metta The Problem n CCH 2010 increases access to the Health Center increased from 0 in n In Lowell, Cambodian adults aged health care system for Cambodians. 2000 to more than 4,000 in 2005. n During September 2003–2006, 45 years or older have higher death It also increases participation in rates from stroke (15.9%) and 901 health and human service professionals attended classes to diabetes (13.4%) compared with Racial and Ethnic Approaches help them understand Cambodian all Massachusetts adults in this age to Community Health (REACH) culture, and 424 people attended group (6.5% for stroke, 2.5% for is a community-based public presentations on Cambodian culture diabetes). health program funded by CDC and health care beliefs and practices. n In 2002, 65% of Cambodian adults to eliminate racial and ethnic n Seven local pharmacies agreed to aged 50 years or older reported that health disparities. help improve communications with their health was fair or poor in a www.cdc.gov/reach Cambodians about their medications. survey conducted by CCH 2010.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources owell Community Health Center; Cambodian Mutual Assistance Association Lof Greater Lowell; University of Massachusetts Lowell, Center for Family, Work and Community and School of Health and Environment; Visiting Nurse Association of Greater Lowell; City of Lowell Council on Aging; Saint Julie Asian Center; Saints Memorial Medical Center; Lowell General Hospital; Greater Lawrence Family Health Center, Merrimack Valley Area Health Education Center; Massachusetts Department of Public Health, Division of Community Health Promotion; Khmer Health Advocates; Lowell Police Department; Trinity EMS; Lowell Telecommunications; City of Lowell Health Department.
Our Achievements, cont. Getting the Word Out Locally n “Building on the Strengths of a n During September 2003–2006, n “Deep Wounds Fester From Horror Cambodian Refugee Community 82 Cambodian health professionals Inflicted by the Khmer Rouge,” The Through Community-Based Outreach.” completed a Khmer medical terminol- Boston Globe, April 18, 2006. Health Promotion Practice 2007 ogy course to improve their ability to n “Conference Touches Upon Cambodian (in press). recognize and understand definitions Health Issues,” The Lowell Sun, and analysis of medical terms, as well September 29, 2005. Keys to Lasting Change in the as anatomic, diagnostic, operative, and n “Seminar Promotes an Understanding Cambodian Community symptomatic terms. of Health Literacy,” The Shuttle, CCH 2010 interventions are succeeding n CCH 2010 helped to change policies April 20, 2005. because we have implemented lasting related to language accessibility ser- change in the social service and health vices at the Lowell Community Health Center and local hospitals by develop- Generating New and care community. We also are continuing ing and implementing an interpreter Exciting Science to develop and invest in a strong competency and training program. n “Self-Reported Health Among infrastructure that represents the n CCH 2010 provided content for 75 Cambodians in Lowell, Massachusetts.” community, is capable of mobilizing one-hour shows for Jivit Thmey, a Journal of Health Care for the Poor prevention efforts, and encourages the Khmer-language cable television and Underserved 2006;17(2, suppl): development of individuals and groups program. 133–145. who can make change. n “Smoking Among Cambodian Adults Our Future in Lowell, Massachusetts, and Ideas for Other important factors for success are In addition to providing culturally Promoting Cessation.” Presented at innovative community outreach practices appropriate community wellness and the American Public Health Association that promote health, help people advocate educational programs, CCH 2010 will Annual Meeting, Philadelphia, for their own health, and can sustain continue to educate and work with local Pennsylvania, December 12, 2005. communitywide behavior change. By stakeholders to implement solutions to n “Bringing Equal Health Outcomes making sure that community members are eliminate health disparities in Lowell’s Within REACH.” Minority Nurse involved in planning outreach activities, Cambodian community. 2003; Fall:27–32. we are helping to improve the health of Cambodians in Lowell.
For More Information
Sidney Liang, Director, Cambodian Community Health 2010 Program Lowell Community Health Center, 15-17 Warren Street, Lowell, MA 01852 Phone: 978-746-7829 • Fax: 978-937-3918 E-mail: [email protected] • Web site: http://www.cch2010.info RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“Whenever I look in the refrigerator to get something to eat, I see my family health advocate’s face, and I know that I better not get anything unhealthy to eat or eat too much.” —An intervention participant
REACHing African Americans and Latinos in Detroit, Michigan
Who We Are group. For example, 13.4% of whites care providers, and opportunities for The Community Health & Social and 26.2% of African Americans aged healthy eating and physical activity. Services Center, Inc., coordinates 55–64 years have diabetes. n The program also offers health the REACH Detroit Partnership. n More than 25% of African Americans education classes and bilingual health and more than 30% of Latinos in information for residents. n This partnership works to inform, edu- the target area reported a sedentary cate, and involve families, communities, lifestyle, and less than 35% of both Our Achievements and health care systems to prevent groups met minimum recommenda- n The Family Intervention targeted two and manage diabetes among Detroit tions for regular physical activity. groups, and participants in both groups residents. showed improvements as a result of this n The partnership targets African Ameri- The Solution program. cans and Latinos living in the east side n The REACH Detroit Partnership n In the first group, 70.8% of participants and southwest communities of Detroit. conducts interrelated family, had blood sugar levels ≥7, which put health system, social network, and them at higher risk for diabetes complica- The Problem community interventions to help tions. After 1 year, this percentage had n Nationally, African Americans and residents prevent and manage dropped to 57.3%, and participants Latinos are more likely to be obese and diabetes. reported improvements in self care, to have diabetes than whites. In the n Program services include interventions diabetes knowledge, and healthy eating. area of Detroit targeted by the REACH led by family health advocates, con- n In the second group, participants were Detroit Partnership, 68.8% of African tinuing medical education for health divided into two subgroups, with some Americans and 73.8% of Latinos are receiving interventions right away and overweight or obese. others receiving interventions 6 months n According to state data, diabetes prev- Racial and Ethnic Approaches later. Participants in subgroup 1 showed a alence is 7.3% among whites, 8.5% to Community Health (REACH) mean decrease of 1.2 in their blood sugar among Latinos, and 11.0% among is a community-based public levels, compared with 0.02 for subgroup African Americans in Michigan. Dispari- health program funded by CDC 2. Participants in subgroup 1 also showed ties between racial and ethnic groups to eliminate racial and ethnic improvements in diabetes-related depres- health disparities. are even higher when reported by age sion and consumption of high-fat foods. www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources ommunity Health & Social Services Center, Inc.; Friends of Parkside; CAlkebu-lan Village; Detroit Department of Health and Wellness Promotion; Michigan Department of Community Health; Henry Ford Health System; University of Michigan, School of Social Work, School of Public Health, and Medical School; Southeast Michigan Diabetes Outreach Network; Detroit Community-Academic Urban Research Center.
Our Achievements, cont. n “Books Donated to Bowen, Conely, n “Racial and Ethnic Approaches to n To promote healthy eating, we conduct- and Gray Branch Libraries,” El Central, Community Health (REACH) Detroit ed 166 mini-markets at 16 locations, January 22, 2004. Partnership: Improving Diabetes-Related 139 food demonstrations at 33 locations, n “REACH Helps Fight Diabetes Spread,” Outcomes Among African American and 125 community education events, and The Michigan Chronicle, March 31– Latino Adults.” American Journal of 250 support group sessions. April 6, 2004. Public Health 2005;95(9):1552–1560. n “Arabs Join Other Minorities in Our Future Diabetes Risk,” Detroit Free Press, Keys to Lasting Change in The REACH Detroit Partnership will October 23, 2003. African American and Latino continue to evaluate the effectiveness of n “REACH Pamper Day Picnic,” Communities the family health advocate model. We El Central, July 10, 2003. Family heath advocates understand and also plan to evaluate and distribute the share the challenges that residents face in tool kits used by our staff. We will expand Generating New and making healthy lifestyle changes. By the healthy eating component of the Exciting Science bringing together public health professionals Family Intervention to find new ways to n “Chronic Disease-Related Behaviors with community members and other help residents have greater access to and Health Among African Americans partners, we can find new ways to address healthy foods and to help communities and Hispanics in the REACH Detroit diabetes and its complications and eliminate grow and sell fresh produce. In addition, 2010 Communities, Michigan, and the health disparities. These partnerships we will evaluate our physical activity United States.” Health Promotion Practice also will help community members plan, interventions more rigorously to assess 2006;7(3, suppl):256S–264S. implement, and evaluate intervention health outcomes among participants n “Diabetes-Specific Emotional Distress activities; develop and disseminate tool kits, and the effectiveness of our train-the- Among African Americans and Hispan- educational resources, and lessons learned; trainer program. ics with Type 2 Diabetes.” Journal of and take a more active role in conducting Health Care for the Poor and Underserved community-based participatory research Getting the Word Out Locally 2006;17(2, suppl):88–105. in their communities. In addition, building n “Fighting Back: Group Aims to Help n “The Relationship Between Knowledge of relationships between health care providers, Hispanics, African Americans Beat Recent HbA1c Values and Diabetes Care their patients, and REACH family health Diabetes Odds,” Detroit Free Press, Understanding and Self-Management.” advocates helps providers communicate November 12, 2006. Diabetes Care 2005;28(4):816–822. better with their patients.
For More Information
Gloria Palmisano, MA, Project Manager, REACH Detroit Partnership Community Health & Social Services Center, Inc. 2727 Second Ave., Suite 300, Detroit, MI 48201 Phone: 313-961-1030 • Fax: 313-961-1453 E-mail: [email protected] • Web site: http://www.reachdetroit.org RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“It takes so much more than being open-minded. It takes work. There are so many levels and layers to this problem. However, I have hope that because universities and organizations are training their people through REACH 2010, there will be changes.” —Genesee County REACH 2010 participant
REACHing African Americans in Flint, Michigan
Who We Are The Solution n Other activities include assigning The Genesee County Health n The Genesee County REACH 2010 maternal and infant health advocates Department coordinates the Genesee Team has implemented a community (MIHAs) to help pregnant women County REACH 2010 Team. action plan designed to mobilize people and teaching healthy eating through at the community level; improve health community dinners called Harambee n The team is a coalition of 12 groups care services for infants; and reduce (Swahili for “pulling together”) working with people at the community racism at individual, institutional, and dinners. level to reduce health disparities in systems levels. infant death rates among African n Activities include community dialogue Our Achievements Americans living in Flint, Michigan. sessions, workshops that address n Our team conducted 20 Undoing n Genesee County has the fifth largest racism, a media campaign, educational RacismTM workshops that were population of any county in Michigan, sessions at a local African Cultural attended by 764 people, including 48 with 436,141 residents. Flint is the Education Development Center, doctors, from more than 100 groups. largest city in Genesee County, with educational classes for parents, and n MIHAs have provided support and a population of 124,943, of whom cultural competency classes for health mentoring to 691 African American 53.27% are African American. care providers and local university women and helped them to navigate students. the medical system. This support The Problem is provided during the women’s n Despite more than 20 years of efforts, pregnancies and for 1 year after the the racial disparity in infant death rates birth of their children. among African Americans persists in n More than 1,079 African American Flint and Genesee County. women and 105 African American n The infant death rate among African Racial and Ethnic Approaches men have attended “One Stop Village” Americans living in Genesee County is to Community Health (REACH) classes, which teach parenting skills nearly 3 times higher than the rate for is a community-based public and car seat safety and provide white infants. This disparity is highest health program funded by CDC information about breast-feeding. in the areas targeted by the REACH to eliminate racial and ethnic 2010 Team (ZIP codes 48503, 48504, health disparities. 48505, and 48458). www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources enesee County Health Department; Faith Access to Community GEconomic Development; Flint Family Road; Flint Odyssey House Inc. Health Awareness Center; Genesee County Community Action Resource Department; Greater Flint Health Coalition; Hurley Medical Center; Genesys Regional Medical Center; Mott Children’s Health Center; PRIDE (Programs to Reduce Infant Deaths Effectively) Medical Services Committee; University of Michigan-Flint; University of Michigan, School of Public Health.
Our Achievements, cont. We also will develop training manuals A Paraprofessional Intervention Aimed n The African Cultural Education and provide technical help for duplicating at Addressing Infant Mortality in African Development Center has given REACH activities in other communities Americans.” Ethnicity & Disease 2004;14 hundreds of educational tours and of color. (3, suppl 1):102–107. hosted seven sessions called Middle Passage Experiences, reaching more Getting the Word Out Locally Keys to Lasting Change in the than 270 African Americans and 45 n “Flint’s Black Infant Deaths Drop in African American Community whites. The center also sponsored Wake of Local Efforts,” The Flint Journal, No single intervention is likely to Racism 101 classes, reaching more August 18, 2006. eliminate the high infant death than 200 people. n “Doctors Learn to Have Patience With rates among African Americans, in n We developed a standard prenatal Patients,” The Flint Journal, February 7, part because the 9-month period screening tool that is now being used 2005. of pregnancy is simply too short to in 11 local medical offices. n “Black Men Focus on Infant Mortality,” address effectively the many risk factors n Our Cultural Competence in Health The Flint Journal, January 30, 2005. important to infant health. Care class has trained more than 160 students at the local university. Generating New and Many different types of solutions are Exciting Science needed, and our coalition is working Our Future n “Teaching Cultural Competence to Reduce to be a part of this process. In addition, The coalition will continue its efforts to Health Disparities.” Health Promotion to eliminate health disparities among reduce racial disparities in infant death Practice 2006;7(3, suppl):247S–255S. African Americans completely, com- rates in Genesee County. We will conduct n “A Birth Records Analysis of the Maternal munities must address underlying social research to evaluate the impact of the Infant Health Advocate Service Program: inequalities and racism. REACH community action plan.
For More Information
Tonya Turner, REACH 2010 Coordinator, Genesee County Health Department, Floyd J. McCree Courts and Human Services Center 630 S. Saginaw St., Flint, MI 48502-1540 Phone: 810-257-3194 • Fax: 810-237-6167 E-mail: [email protected] • Web site: http://www.gchd.us “T he Healthy Habits program has freed me to take better charge of my health. The availability and variety of information offered have allowed me to share with friends and family. And best of all, my overall health has improved through making positive changes in my life.” —Community member
reaching african americans and latinos in Kansas city
who we are The solution n I n addition, various organizations, including The Missouri Coalition for Primary n To address these problems, the KC-CDC community groups, government agencies, Care created the Kansas City - Chronic launched a community campaign called and health care centers, can enter into Disease Coalition (KC- CDC) to We Practice Healthy Habits, or Nosotros ”Pick 6” service agreements that promote coordinate the REACH 2010 initiative. Practicamos Habitos Saludables in changes in programs, policies, and proce Spanish. This campaign promotes ways dures to support healthy habits. “Pick 6” n KC-CDC is a community-based network that individuals and communities can activities come from a list of 86 options of groups working together to reduce help people with diabetes and heart developed by community members. risk factors for diabetes and heart disease improve their health. n E xamples of community activities that disease among African Americans and n The campaign includes a community partners can choose to promote include Hispanics/Latinos living in the urban core action plan that offers a wide range of encouraging people to walk as a natural of Kansas City, Missouri, and Kansas changes that can be made at a variety of way to get from place to place, offering City, Kansas. levels. For example, individuals can create community cooking classes with tips on n The groups involved in this initiative a personal plan to adopt healthy habits healthy meals, and developing campaigns come from nine sectors, including faith, to reduce their risk for chronic diseases, that promote healthy lifestyles. cultural, neighborhood, government, and they can request materials to support n O ther activities include assessing grocery media, health and human services, law their efforts. Neighborhood and faith store chains and their weekly ads to see enforcement, private, and education. groups can become resource partners how well they promote healthy food to help people adopt healthy habits. options to cost-conscious consumers, The Problem working with schools to promote healthy n I n Kansas City, the average life expectan school meals and snacks, developing best cy for people of color is 11 years shorter practices for treating diabetes and heart than the life expectancy for whites. Racial and Ethnic Approaches disease, and promoting these best practices n African Americans in Kansas City are to Community Health (REACH) with local heath care providers. 2.5 times more likely to die of diabetes is a community-based public and 1.5 times more likely to die of heart health program funded by CDC our achievements to eliminate racial and ethnic disease compared with whites. n We have documented more than 500 health disparities. n H ispanics/Latinos in Kansas City are community changes made or promoted Tonya Turner, REACH 2010 Coordinator, Genesee County Health slightly more than 1.5 times more likely www.cdc.gov/reach by coalition partners, and 55% of these Department, Floyd J. McCree Courts and Human Services Center to die of diabetes compared with whites. changes are ongoing. 630 S. Saginaw St., Flint, MI 48502-1540 Phone: 810-257-3194 • Fax: 810-237-6167 E-mail: [email protected] • Web site: http://www.gchd.us U.S. Department of HealtH anD HUman ServiceS centerS for DiSeaSe control anD prevention Mobilizing Community Resources l-Haqq Islamic Center; American Diabetes Association; American Heart Association; American AIndian Council; Battleflood Heights Neighborhood Association; Black Health Care Coalition; Blue Valley Neighborhood Association; Cabot Westside Health Center; Camino Verdad y Vida/Way, Truth and Life Church; Centennial United Methodist; Christ Temple; Corinthian Missionary Baptist Church; The Diabetes Center; El Centro; Foxtown East Neighborhood Association; Harvesters; Housing Authority of Kansas City; Ivanhoe Neighborhood Council; Jesucristo el Buen Pastor; Kansas City Free Health Clinic; Maternal and Child Health Coalition; Metropolitan Spiritual Church; N.O.B.L.E. Neighborhood Association; Phi Delta Kappa; Samuel Rodgers Health Services; Somali Foundation Inc.; Swope Health Services; Sisters Let’s Talk; Swope Parkway UCC; Tony Aguirre Center; Troost Corridor; Troost Plateau; University of Missouri Extension; Victoria Arms Senior Center; Victorious Life; Vineyard Neighborhood Association; The Wellness Journey; Women of Excellence; Donnelly College Student Association; American Postal Workers Union.
Our Achievements, cont. n Maria Boudreaux appeared on KPRT City. These strategies include training a n In addition, 46% of all changes target 1180 AM radio’s “Diabetes and wide range of partners from community African Americans, while 16% target Nutrition” segment, January 17, 2007. and faith groups on primary prevention Hispanics/Latinos. n A local campaign aimed at faith techniques and making sure that our n Early results indicate that older African networks and focusing on Hispanic/ program goals take into account the American women have benefited the Latino churches and residents included cultures of our REACH communities. most from our community change model. a bilingual flyer and ads inThe Kansas We also make sure that our educational City Star, December 2006. programs and materials reflect the Our Future n “Group Promotes KC’s Healthy, Scenic cultures and languages of these KC-CDC will continue to refine its network Walks,” The Kansas City Star, April 16, communities and that local leaders and approach to best serve the needs of our 2003. groups receive the funds they need to community. This concept is supported make changes in their communities. by a strong community coalition that Generating New and continually reevaluates and capitalizes Exciting Science We promote health education and on its strengths. Our coalition also will n “Analyzing a Community-Based disease prevention in Hispanic/Latino continue to create new activities and Coalition’s Contributions to Reducing communities through Hispanic/Latino programs in areas of need to improve the Risk for Chronic Disease and Health media and faith networks. The We health of Kansas City residents. Disparities in Kansas City, Missouri.” Practice Healthy Habits/Nosotros Preventing Chronic Disease [serial Practicamos Habitos program has Getting the Word Out Locally online] 2007;4(3). Available at http:// been effective at the community level n Maria Boudreaux, licensed nutritionist www.cdc.gov/pcd/issues/2007/jul/ because of its strong primary prevention and KC-CDC board member, appeared 06_0101.htm. messages: eat better, exercise more, on Fox 4 Morning Show’s “Healthy quit tobacco use, see a health care Eating” segment, January 28, 2007. Keys to Lasting Change in professional on a regular basis, and n Maria Boudreaux appeared on KSHB African American and Hispanic/ reduce stress. Our coalition partners work 41 Morning Show’s “Gluten-free Diet Latino Communities hard to teach people that these risk- Tied to Healthy Habits” segment, KC-CDC has used several strategies to reducing behaviors can be achieved and January 25, 2007. improve the health of African Americans that they are a practical way to avoid or and Hispanics/Latinos living in Kansas manage diabetes and heart disease.
For More Information
Marianne Ronan, REACH 2010 Initiative Manager, Kansas City - Chronic Disease Coalition 2700 East 18th, Suite 258, Kansas City, MO 64127 Phone: 816-920-6840 • Fax: 816-231-6035 E-mail: [email protected] • Web site: http://www.mo-pca.org/kccdc/default.htm RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“Excellent introduction to the pool, as I was extremely frightened. The workout gave me confidence and interest to continue. The exercises are useful for muscles not generally used. Recommended! Thank you for the opportunity. Great instructors!” —Healthy Hearts Project participant
REACHing African Americans in Clark County, Nevada
Who We Are n As part of this project, we implemented Community Partners for Better Health The University of Nevada, Reno educational and awareness programs Coalition, a faith-based group that coordinates the Healthy Hearts Project. to address the lack of knowledge works to address health disparities about heart disease and its risk factors among people of color. n This project works with the university’s among African Americans living in n We worked with local health care College of Cooperative Extension and the Clark County. providers to improve primary and local faith community to deliver educa- n We hired and trained community secondary preventive care for African tional and awareness programs on heart members from local churches to Americans at risk for heart disease. disease to Nevada residents. implement our interventions. n We increased community members’ n The target population is African Americans n We also helped plan and develop awareness of how some risk factors living in Clark County, Nevada, mainly in educational programs as part of for heart disease can be controlled, two ZIP codes (89030 and 89106). health ministries in three local and we increased their awareness of churches and one mosque. These the disparity in disease rates among The Problem programs increase members’ aware- African Americans. n Heart disease is the leading cause of ness of health disparities among n We also have given community death for women and men in Nevada African Americans in Nevada. members the information and skills and the United States. they need to change their behaviors n African Americans have a higher death Our Achievements and lower their risk for heart disease. rate for heart disease than any other racial n Our project provided support and n Sixty-one churches and four or ethnic group in Clark County, Nevada. resources to help strengthen the senior and recreation centers are participating in this project. The Solution n Our project has reached more n We began the Healthy Hearts Project by Racial and Ethnic Approaches than 6,000 people through 127 assessing the target community to identify to Community Health (REACH) workshops, 3 women’s conferences, residents’ health needs and the types of is a community-based public 2 physical activity festivals, and 35 programs that could be used to address health program funded by CDC physician seminars. these needs. to eliminate racial and ethnic health disparities. www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources merican Diabetes Association; American Heart Association; American Stroke AAssociation; 100 Black Men of America, LV Chapter; Clark County Health District, Health Education Division; Clark County Library District; Community Baptist Church; Courage Unlimited; CSM Consultants; Ebenezer COGIC; First African Methodist Episcopal Church (FAME); Holy Trinity AME Church; National Black Leadership Initiative on Cancer; Nevada Cancer Institute; Miracle Hands Foundation; Powerhouse COGIC; Reach One Teach One; Second Baptist Church; Sisters Network; Southern Nevada Black Nurses; Southern Nevada Cancer Research Foundation; University of Nevada, Reno, College of Cooperative Extension; Victory Baptist Church; Zion United Methodist Church.
Our Future n “Fair Shows Benefits of Diet, Exercise,” Keys to Lasting Change in The Healthy Hearts Project will continue Las Vegas Sentinel Voice, September the African American Community to help its community partners improve 23, 2004. The Healthy Hearts Project developed from their ability to reduce disparities in n “Doolittle Festival Focuses on Health,” the community it serves. Members of pre- heart disease among African Americans Las Vegas Sentinel Voice, September dominately African American churches and in Clark County, Nevada. We also will 16, 2004. a coalition of community groups helped continue to develop and strengthen n “Workshop Focuses on Female Health,” make decisions and create an action plan Las Vegas Sentinel Voice, July 8, 2004. health ministries in the faith community. to address disparities in heart disease rates In addition, we plan to use physician among African Americans in Clark County. seminars and community workshops to Generating New and Exciting Science help health care providers improve their Church members were recruited to help n “Techniques for Establishing Educa- interactions with patients. implement activities and programs, most of tional Programs Through the African which grew out of input from the commu- Getting the Word Out Locally American Faith Community.” Journal of Extension [serial online] 2006;44(1). nity. Over the life of this project, we have n “Healthy Hearts Project Promotes Article no. 1T0T3, published at http:// used community feedback to make changes Fitness,” Las Vegas Sentinel Voice, to ensure that our efforts are effective. September 15, 2005. www.joe.org/joe/2006february/tt3. shtml. Local churches also have created health n “Variety May Be the Key: Cooperative ministries to help them meet the health Extension Offers a Number of Pro- n “Food for Health and Soul: A Curricu- education needs of their members. grams,” Las Vegas Review Journal, lum Designed to Facilitate Healthful January 11, 2005. Recipe Modifications to Family Favor- ites.” Journal of Nutrition Education and Behavior 2005;37(6):323–324.
For More Information
Joyce M. Woodson, MS, RD, Principal Investigator University of Nevada Cooperative Extension 8050 S. Maryland Parkway, Las Vegas, NV 89123-0855 Phone: 702-257-5508 • Fax: 702-222-3100 • E-mail: [email protected] Web site: http://www.unce.unr.edu/programs/health/index.asp?ID=87 RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“Now I can tell that the program is not just a diet or exercise program. It’s more like my choice to choose and replace my unhealthy habit for a healthy habit.” —Cambia tu Vida program participant
REACHing African Descendents and Latinos in Hillsborough County, New Hampshire
Who We Are n Nationally, African Americans are program helps African descendents The New Hampshire Minority Health 30% more likely to die of heart disease and Latinos adopt healthy habits to Coalition coordinates the New than whites. reduce their risk for diabetes and high Hampshire REACH 2010 Initiative. n African Americans and Latinos also blood pressure. have higher rates of overweight and n Another program is Let’s Talk Diabetes, n This initiative works to improve the obesity, which are two of the leading or Hablemos de Diabetes in Spanish. health of African descendents and risk factors for diabetes and This community-based program pro- Latinos living in Hillsborough County heart disease. vides education and support to people by conducting outreach, educational, with diabetes and their families. and research activities that focus on The Solution n Other activities include a community diabetes and high blood pressure. n One of the main goals of the New walking program, educational and n The county’s population is very cultur- Hampshire REACH 2010 Initiative is to nutritional counseling for people ally diverse. We use the phrase “African implement programs that will reduce with diabetes, and a Community descendents” to refer to African health disparities in diabetes and high Health Advisory Board made up of Americans and recent immigrants from blood pressure. local leaders. Africa and the Caribbean. Our Latino n Our programs are designed by the n We also collect data on the health population also includes U.S. citizens target communities to reflect their status, health care access, and health and recent immigrants. cultures and languages. One such pro- behaviors of African descendents and n In Manchester and Nashua, the two gram is Change for Life, or Cambia tu Latinos in Hillsborough County. These largest cities in Hillsborough County, Vida in Spanish. This community-based data can be used to educate state the Latino populations grew more than officials about the need for equal 133% and 124%, respectively, during health care services for all residents. 1990–2000. Racial and Ethnic Approaches to Community Health (REACH) Our Achievements is a community-based public The Problem n We are the first group in New Hamp- n Compared with white adults in the health program funded by CDC shire to collect significant data about to eliminate racial and ethnic United States, African Americans are health disparities among African health disparities. 1.6 times more likely to have diabetes. descendent and Latino populations in Latinos are 1.5 times more likely to www.cdc.gov/reach Hillsborough County. have diabetes than whites.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources ew Hampshire Minority Health Coalition; Dartmouth Medical School, NNew Hampshire Area Health Education Center; Dartmouth-Hitchcock Nashua; Manchester Community Health Center; Manchester Public Health Department; Nashua Area Health Center (a center of Lamprey Health Care); New Fellowship Baptist Church; Southern New Hampshire Area Health Education Center; Ujima Collective; University of New Hampshire.
Our Achievements, cont. n “Discrimination May Discourage Im- Hampshire.” Journal of Health Care for n We contributed these data to New migrants From Getting Health Care,” the Poor and Underserved 2006;17 Hampshire Diabetes Data, 2003, a The Boston Globe, October 4, 2006. (2, suppl):116–132. report by the New Hampshire Depart- n “Study: Racism Affects Health of n “Change for Life! ¡Cambia Tu Vida! ment of Health and Human Services. Minorities,” The Union Leader, A Community-Based Intervention n More than 1,300 African descendents September 29, 2006. Addressing Behavioral Risk Factors for and Latinos in Hillsborough County Diabetes and Hypertension.” Presented have participated in our education and Generating New and at the Office of Minority Health National prevention programs. Exciting Science Leadership Summit on Eliminating n We created the Community Health n “Self-Reported Discrimination and Racial and Ethnic Disparities in Health, Advisory Board to advise our initiative Mental Health Status Among African Washington, DC, January 2006. on how best to serve African descen- Descendents, Mexican Americans, dent and Latino populations. and Other Latinos in the New Hamp- Keys to Lasting Change in shire REACH 2010 Initiative: The African Descendent and Latino Our Future Added Dimension of Immigration.” Communities Our initiative will provide training and American Journal of Public Health The New Hampshire REACH 2010 Initiative assistance to community leaders and 2006;96(10):1821–1828. helps African descendents and Latinos residents who want to use the Change n “Change For Life/Cambia Tu Vida: A adopt healthy habits to reduce their risk for for Life/Cambia tu Vida and Let’s Health Promotion Program Based on diabetes and high blood pressure. To achieve Talk Diabetes/Hablemos de Diabetes the Stages of Change Model for Afri- this goal, we use tailored home-based programs in their communities. We can Descendent and Latino adults in interventions for Latinos and faith-based also will work with state policy leaders New Hampshire.” Preventing Chronic interventions for African descendents. to ensure that appropriate data are Disease [serial online] 2006;3(3). collected and analyzed to identify and Available at http://www.cdc.gov/pcd/ Our programs and materials reflect the address health disparities. issues/2006/jul/05_0218.htm. cultures and languages of the target com- n “The Association Between Self- munities, which is key to their effectiveness. Getting the Word Out Locally Reported Discrimination, Physical We also have found that offering follow-up n “Discrimination Stops Immigrants From Health, and Blood Pressure: Findings services, such as ongoing support groups, Seeking Care,” The Nashua Telegraph, from African Americans, Black Immi- to program participants helps them sustain October 5, 2006. grants, and Latino Immigrants in New healthy habits over time.
For More Information
Jeanie Holt, RN, Project Director, New Hampshire REACH 2010 Initiative P.O. Box 3992, Manchester, NH 03105 Phone: 603-627-7703 (ext. 228) • Fax: 603-627-8527 E-mail: [email protected] • Web site: http://www.nhhealthequity.org RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“When we had the workshop down at the Chapter House, mostly women attended. There were only about two men, but the women were going over to the stomach and prostate cancer awareness booth to get information. We need to try and get everyone in.” —Tribal health care provider
REACHing American Indians in New Mexico and Colorado
Who We Are of the Ramah Band of Navajo Indians programs, tribal leaders, and nontribal The Albuquerque Area Indian Health had received a mammogram, com- groups. We also conducted focus groups Board, Inc., coordinates the Partners pared with 47% of all American Indian to gather more information about in Tribal Community Capacity Building women in this age group. community members’ knowledge and (REACH 2010) Project. n Overcoming these health disparities awareness of cancer and about their can be hard because of cultural beliefs screening behaviors. n This project targets seven American about the causes of cancer and the n To encourage more tribal women Indian tribes whose members live on belief that cancer cannot be cured. In aged 40 or older living in the pilot ancestral lands in New Mexico and the Navajo language, cancer is trans- community to get screened for breast southern Colorado. Together, these lated as “the sore that will not heal.” cancer, we used a socioecological tribes include about 19,000 members. n Other barriers include an overall lack framework and community-based n The project works to build community of awareness of cancer risks and participatory research principles to and scientific capacity to address the symptoms and a lack of access to design and implement an intervention rising incidence of breast and cervical transportation and screening services. called Mammography Days. cancer among American Indian women. n For this intervention, project staff The Solution scheduled mammograms for tribal The Problem n To address these problems, our project women at the nearest hospital, about n Breast cancer is the second leading worked with a pilot community, the 45 miles away. The project trans- cause of death for American Indian Ramah Band of Navajo Indians, to create ported the women to the hospital in women, with rates that equal those partnerships between local tribal health groups to create social support for of all racial and ethnic groups in the the screenings. Staff also provided United States combined. health information that reflected the n Rates of cervical cancer and cervical Racial and Ethnic Approaches women’s tribal culture and language. dysplasia are consistently high among to Community Health (REACH) n Tribal health care providers received American Indian women, but screening is a community-based public training in public health topics, rates are very low. health program funded by CDC cancer-screening techniques, and n In 2003, only 5.5% of American Indian to eliminate racial and ethnic surveillance methods to improve their women aged 40 or older who are part health disparities. patient care. www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources amah Band of Navajo Indians; Alamo Band of Navajo Indians; RCañoncito (Tóhajiilee) Band of Navajo Indians; Jicarilla Apache Nation; Mescalero Apache Tribe; Southern Ute Indian Tribe; Ute Mountain Ute Tribe.
Our Achievements Our Future Disease [serial online] 2006;3(3). n Project staff implemented a model REACH project staff are working to Available at http://www.cdc.gov/pcd/ called Community Involvement to duplicate the successful Mammography issues/2006/jul/06_0052.htm. Renew Commitment, Leadership, and Days intervention in other tribal n “Intermediate Outcomes of Tribal Effectiveness (CIRCLE) to help develop communities. We also will continue to Community Public Health Infrastructure public health capacity among the build the capacity of tribal and non- Assessment.” Ethnicity and Disease targeted tribes. tribal health care providers to educate 2004;14(3, suppl 1):61–69. n Breast cancer awareness has increased community members about cancer in a significantly among tribal women since way that takes their native cultures and Keys to Lasting Change in a case manager who specializes in languages into account. the American Indian Community breast health was hired in 2004. The Partners in Tribal Community Capacity n As part of the Mammography Days Generating New and Building (REACH 2010) Project has shown intervention, 130 women aged 40 or Exciting Science that a community-driven intervention that older have received a mammogram, n “A Socioecological Approach to is based on a capacity-building model and some for the first time in their lives. Improving Mammography Rates in a reflects the culture of the target population n In addition, the Albuquerque Area Tribal Community.” Health Education can improve mammography screening in a Indian Health Board produced a video & Behavior 2006. Published online tribal community. We also found that this called “Healthy Navajo Women: Walk November 17, 2006, at http:// type of intervention will succeed if it includes in Beauty” that features health care heb.sagepub.com/pap.dtl. a range of partners, such as tribal leaders, providers and community members n “Building True Capacity: Indigenous community members, the scientific commu- discussing breast and cervical cancer Models for Indigenous Communities.” nity, and other relevant programs and com- in English and Navajo. The video is American Journal of Public Health munity groups. In addition, the intervention shown as part of Mammography Days 2006;96(4):596–599. should serve as a model for similar health educational activities. n “Healthy Navajo Women: Walk in initiatives in other tribal communities. Beauty” [video]. Preventing Chronic
For More Information
Connie Z. Garcia, Program Director, Partners in Tribal Community Capacity Building (REACH 2010) Project, Albuquerque Area Indian Health Board, Inc. 5015 Prospect Avenue NE, Albuquerque, NM 87110 Phone: 505-764-0036 • Fax: 505-764-0446 E-mail: [email protected] • Web site: http://www.aaihb.org RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“The promotora [lay health worker] did all the work for me. I was just lost. I didn’t know where I was going to get medical attention—help that I needed. She enrolled me in everything right away. I looked through the phone book myself, [but] if you don’t have insurance, you’re kind of lost. There was all the help I needed in one little building.” —La Vida Program participant
REACHing Hispanics in Hidalgo and Grant Counties, New Mexico
Who We Are The Solution physical, emotional, spiritual, intellectual, Hidalgo Medical Services coordinates n The La Vida Program offers services social, cultural, occupational, material and the La Vida Program. aimed at Hispanics with or at risk financial, and environmental. for diabetes. These services include n Lay health workers, called promotoras n The La Vida (Lifestyles and Values diabetes education classes, support in Spanish, provide support for program Impact Diabetes Awareness) Program is groups, community outreach, and participants. Promotoras are members a collaboration of community partners grocery store tours that include of the local culture and community, and working in southwestern New Mexico. instructions on how to read food most are bilingual. n The program works to raise awareness labels. about diabetes and lessen its negative n The program also offers a restaurant Our Achievements effect on Hispanics living in Hidalgo intervention that teaches people how n The La Vida Program has been well- and Grant counties in New Mexico. to make healthy eating choices and received in the Hispanic community, identify healthy options on menus. serving more than 13,000 clients during The Problem n The program includes a physical fitness 2005–2006. n Hidalgo Medical Services serves a program called Active and Alive that is n After initial involvement in the La Vida geographically large and remote rural available at several local health clubs; Program, Hidalgo Medical Services patients area that has a high percentage of it also offers classes, home visits, and had an average hemoglobin A1c level of Hispanics among its 35,000 residents. one-on-one sessions with certified 8.2, compared with the national average Many of these residents are poor, diabetes educators. of 9.0 for Hispanics. (Levels ≥7 increase a elderly, and have major health problems. n Our holistic approach addresses the person’s risk for diabetes complications.) n In our service area, 1 in 5 people does following nine dimensions of health: After 9–12 months of involvement in the not have health insurance, and 1 in 11 program, patients’ average A1c levels has diabetes. Racial and Ethnic Approaches dropped to 7.6. n Diabetes is a serious health problem to Community Health (REACH) n Patients’ median A1c levels dropped for Hispanics because of its growing is a community-based public significantly within 1 year of a promotora prevalence and the high number of risk health program funded by CDC visit or education class. factors and complications among this to eliminate racial and ethnic n In a recent survey, nearly 74% of population. The problem must be ad- health disparities. residents had heard of the La Vida dressed as the number of Hispanics in www.cdc.gov/reach education classes. the United States continues to grow.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources Hidalgo Medical Services Gila Regional Medical Center New Mexico Department of Health
Our Achievements, cont. Getting the Word Out Locally n “Developing a Holistic Family Support n The La Vida Program has been n “HMS to Celebrate National Health Center Program in a Rural Area.” Presented at designated a best practice model by Week,” Hidalgo Herald, August 4, 2006. the National Conference of the Family the federal Health Resources and n “Hidalgo Medical Services Receives Support of America, Chicago, Illinois, Services Administration. Award of Excellence from the New April 29, 2006. n Over the past several years, Hidalgo Mexico Primary Care Association,” n “Providing Holistic Family Support: Medical Services has used funds Lordsburg Liberal, June 30, 2006. Creating Systems Change.” Presented at from other sources to expand the La n “La Vida Approves 23 Menu Items for the Annual Conference of the New Mexico Vida Program into a more integrated Diabetics at Bayard Restaurant,” Silver Public Health Association, Albuquerque, program that provides family support City Daily Press, June 29, 2006. New Mexico, October 2005. services (including case management n “Diabetes Seminar for Hispanic Women and referrals), a medication assistance Scheduled on Saturday,” Silver City Daily Keys to Lasting Change in Rural program, smoking cessation classes, Press, February 1, 2006. Hispanic Communities and nutrition programs. We have learned that the best approach Generating New and to helping people with diabetes is to view Our Future Exciting Science them first as people, not just “people with a The La Vida Program will continue to n “Model Clinical and Family Support disease,” and to provide a holistic program provide services and develop new ones Program in Southwestern New Mexico.” that meets all their needs in an integrated way. as needed. Because this program is Presented at the Annual Conference of considered a best practice model, we the National Rural Health Association, Our use of promotoras helped our clients would like to introduce it to other federal Anchorage, Alaska, May 2007. relate to and learn from their peers. This health centers that serve low-income n “A Holistic, Integrated Diabetes approach was more successful—and got residents who are members of minority Intervention Model in Hispanic, Rural more people involved—than our previous populations at higher risk for health Communities.” Presented at the Ameri- efforts because it reflected the culture of disparities. Sharing our program will can Association of Diabetes Educators local residents. We also attribute our success require seminars to teach others how to Annual Meeting, Los Angeles, California, to our partnerships with other diabetes replicate our model and fund their own August 11, 2006. groups working in New Mexico. family support programs.
For More Information
Donna Flenniken, Program Manager, Hidalgo Medical Services 530 DeMoss St., Lordsburg, NM 88045 Phone: 505-542-8384 • Fax: 505-542-8367 E-mail: [email protected] • Web site: http://www.hmsnm.org RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“People who attended our diabetes prevention support group say they look forward to the planned activities in the prevention program. I have seen a big difference in the people who are actively involved. They look healthier, and most have lost weight.” —Diabetes prevention coordinator and registered nurse
REACHing American Indian Elders in New Mexico
Who We Are than all other racial or ethnic groups can reduce the risk of developing The National Indian Council on Aging in the United States. diabetes by 58% across all U.S. racial coordinates the Diabetes Educational n The risk of developing diabetes and ethnic groups. Outreach Strategies (DEOS) Project. increases with age. For example, in n The DEOS Project offers technical 2002, the prevalence of diagnosed assistance to build capacity for grass- n This project serves American Indian diabetes among American Indian and roots educational programs to help elders who live in New Mexico’s two Alaska Native adults aged 20–34 American Indian and Alaska Native American Indian reservations and years was 3.1%, compared with elders with diabetes better manage four pueblos and are members of the 28.3% for those aged 65 or older. the disease. following tribes: Pueblo of Cochiti, n American Indians and Alaska Natives n The DEOS Project provides training and Ramah Navajo Band of Indians, Pueblo also report significantly higher rates guidance on how to assess community of Laguna, Mescalero Apache, To’ha- of health risk factors, such as obe- needs through focus groups, commu- jiilee Navajo Band of Indians, Pueblo sity, smoking, and lack of physical nity surveys, and personal interviews. of Isleta, and Pueblo of Santa Ana. exercise, than other racial and ethnic n The project also helps communities n The DEOS Project works to make groups in the United States. build coalitions to address local health American Indian elders aware of the disparities and establish diabetes self- importance of making healthy lifestyle The Solution management support groups. choices to prevent or control diabetes. n A major research study conducted It also offers technical assistance to by the Diabetes Prevention Program Our Achievements help mobilize communities to achieve found that healthy lifestyle changes n The DEOS Project trained community this goal. members at 10 reservations to begin and maintain diabetes support groups. The Problem Racial and Ethnic Approaches Training materials were modified to fit n The prevalence of diabetes is 2–4 to Community Health (REACH) the needs of each community. times higher among American Indians is a community-based public n More than 66% of participants said and Alaska Natives of all ages than it is health program funded by CDC the support groups helped them main- among non-Hispanic whites. American to eliminate racial and ethnic tain their healthy eating and physical Indians and Alaska Natives also have health disparities. fitness goals. higher rates of diabetes complications www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources Bemidji Area: Mille Lacs Band of Chippewa Indians (Onamia, MN); St. Croix Band of Lake Superior Chippewa Indians (Webster, WI); Fond du Lac Band of Lake Superior Chippewa (Cloquet, MN).
Albuquerque Area: Pueblo of Cochiti (Cochiti Pueblo, NM); Ramah Navajo Band of Indians (Ramah-Pine Hill, NM); Pueblo of Laguna (Laguna, NM); Mescalero Apache (Mescalero, NM); Tohajiilee Navajo Band of Indians (To’hajiilee, NM); Pueblo of Isleta (Isleta, NM); Pueblo of Santa Ana (Santa Ana, NM).
Our Achievements, cont. n “Make the Link! Diabetes, Heart Health Board, Denver, Colorado, October n The project also supported capacity Disease and Stroke” (adapted from an 10–13, 2006. building for outreach and fostered American Diabetes Association initia- n “Community Gardening & Diabetes partnerships with community groups tive), Elder Visions, Fall 2006. Prevention.” Presented at the American that share common goals. n “Confetti Salmon Cakes” (recipe), Society on Aging Conference, Anaheim, Elder Visions, Fall 2006. California, March 2006. Our Future n “What DEOS Can Do for You . . .” n “Community Support for Diabetes The National Indian Council on Aging NICOA/DEOS Brochure, September 5, Prevention and Treatment.” Presented at (NICOA) will develop a road map to help 2006. the American Heart Association/American project partners assess each community’s n “Attitudes Weigh Heavy in Reducing Stroke Association/Indian Health Service level of readiness to address diabetes Pounds,” Elder Visions, Spring/Summer Conference, Denver, Colorado, May 2005. prevention. The stage of readiness will 2006. indicate to local leaders what approach n “Orange Almond Chicken” (recipe), Keys to Lasting Change for they should take before they plan for Elder Visions, Spring/Summer 2006. Native American Elders capacity building. This road map can be n “Planting Gardens at Elderly Centers We developed educational standards and used along with a community needs to Address Diabetes,” Elder Visions, used social marketing practices to create assessment tool to provide guidelines Spring/Summer 2006. community support for healthy lifestyles on how to evaluate diabetes interven- n “What’s in What We Eat?” Elder among American Indian and Alaska Native tions and ensure that they are improving Visions, Winter 2005. elders. To improve diabetes education for the health of the target population. The n “Support for a Healthy Change,” Elder this population, we must develop materials DEOS Project also will create marketing Visions, March 2005. that appeal to elders and work with local materials that can be used by community diabetes educators to provide programs in groups to promote their activities and Generating New and their communities. Communication and make residents aware of what services Exciting Science cooperation with community service provid- are available in their communities. n “Creating the Vision for Change: A Two ers that represent and advocate for American Front Approach to Diabetes Prevention Indian and Alaska Native elders also must be Getting the Word Out Locally for Our Native American Elders.” enhanced. In addition, we are working with n “Eating Healthy on the Road,” Elder Presented at the 23rd Annual Consumer appropriate agencies to maximize resources Visions, the NICOA quarterly news- Conference of the National Indian and increase the efficiency and effectiveness letter, Fall 2006. of service delivery systems.
For More Information
Robert A. Comer, DEOS Project Director 10501 Montgomery Blvd. NE, Suite 210, Albuquerque, NM 87111-3846 Phone: 505-292-2001 • Fax: 505-292-1922 E-mail: [email protected] • Web site: http://www.nicoa.org RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“The church is strategically situated to communicate health messages of importance and also to heighten the awareness of our friends and neighbors and constituents regarding the absence of fair and equitable delivery of health services to our communities. We must be foot soldiers for medical justice.” —Rev. Robert L. Foley, Sr., pastor, Cosmopolitan Church of the Lord Jesus
REACHing Blacks and Latinos in Bronx, New York
Who We Are n Women in the South Bronx are 20 public health education programs, and The Institute for Urban Family Health times more likely to die of diabetes community health advocacy programs. coordinates the Bronx Health REACH than women living on the Upper n We also conducted a survey to identify Coalition. East Side of Manhattan, a 10-minute community members living with or at subway ride away. risk for diabetes. This information helped n This coalition develops and implements us develop and tailor our programs. community-based health promotion The Solution programs focused on preventing n Research shows that improving nutri- Our Achievements diabetes and related conditions. It also tion, increasing physical activity, losing n The faith-based outreach initiative mobilizes community leaders to make 5%–7% of body weight, and having works with 22 churches to educate local health equality a reality by addressing better access to preventive care can residents and empower them to adopt local and state health policies. prevent or delay the onset of diabetes healthy lifestyles. This initiative includes n We focus on black and Latino commu- or decrease the rate of poor outcomes. a program called Fine, Fit and Fabulous nities in the southwestern area of the n In response to these findings, the that helps people make positive and Bronx, which include 280,000 people Bronx Health REACH Coalition has sustainable changes to their eating living in the following ZIP codes: implemented several programs, habits and activity levels. 10452, 10453, 10456, and 10457. including a faith-based outreach initia- n Local pastors include health messages in tive, a nutrition and fitness initiative, their weekly sermons, and many churches The Problem include health-related information in n In the South Bronx, where more than their weekly church bulletins. 95% of the population is black or n The nutrition and fitness initiative Latino, 18% of residents have works to improve residents’ access to diabetes, 64% are overweight, and Racial and Ethnic Approaches healthy foods. New York City schools 24% are obese. to Community Health (REACH) have switched from whole milk to low- n The death rate for heart disease is is a community-based public fat milk, neighborhood grocers carry 17% higher for people living in the health program funded by CDC low-fat milk and healthier snacks, and Bronx compared with people living in to eliminate racial and ethnic local restaurants highlight their healthy New York state. health disparities. menu options. www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources ronx District Public Health Office; New York City Department of Health and Mental Hygiene; B22 churches in the Faith-Based Outreach Network; Bronx Westchester Area Health Education Center; Center for Health and Public Service Research, New York University; Center for Medicare and Medicaid Services, New York Regional Office, Commission on the Public’s Health System; Correction Community Linkage Program; New York City Department of Education, Region 1; City University of New York, Lehman College, Department of Health Services; Health People; Highbridge Community Life Center; Joyce Davis Associates; Leukemia & Lymphoma Society; Math Arts Recreation Center After School Program; Mid-Bronx Senior Citizens Council; Montefiore School Health Program; Mount Hope Housing Company; Neighborhood Self-Help for Older Persons; New York State Department of Health, Diabetes Prevention and Control Program; Healthy Hearts Program; Cornell University Cooperative Extension; New York Lawyers for the Public Interest; Partners in Health; U.S. Department of Justice, Office of Civil Rights, Region II; Women’s Housing and Economic Development Corporation.
Our Achievements, cont. n “In New York Schools, Whole Milk Is n “Separate and Unequal Care in New n Our coalition produced a video called Cast from the Menu,” The New York York City.” Journal of Health Care Law “Voices for Health Equality,” and we Times, February 2, 2006. and Policy 2006;9(1):105–120. developed a cultural competency train- n “New York Pushing Better Diet in Poorer n “Making Health Equality a Reality: The ing program for health care providers. Neighborhoods,” The New York Times, Bronx Takes Action.” Health Affairs n We published Separate and Unequal: January 20, 2006. 2005;24(2):491–498. Medical Apartheid in NYC, a report that n “Apartheid at Apple Hospitals,” New examines the policies and practices that York Post, October 16, 2005. Keys to Lasting Change in Black contribute to differences in access to and n “El Bronx en plan de comer saludable,” and Latino Communities quality of health care for members of Hoy Nueva York, October 24, 2006. To develop and implement model community different racial and ethnic groups. programs in black and Latino communi- Generating New and ties, the Bronx Health REACH Coalition has Our Future Exciting Science designed, developed, and implemented inter- The Bronx Health REACH Coalition will n “Fostering Organizational Change ventions that reflect local cultures and have expand its faith-based outreach initiative, Through a Community-Based Initia- become part of the targeted communities. continue to develop and support a public tive.” Health Promotion Practice policy agenda to address obesity, and 2006;7(3, suppl):181S–190S. We also have promoted policy changes that conduct a community food assessment. n “Racial and Ethnic Disparities in help to sustain improvements in community We also will promote a new medical Health: A View from the South Bronx.” health. We developed a health policy reimbursement policy designed to offset Journal of Health Care for the Poor and agenda and mobilized community leaders some of the underlying causes for the Underserved 2006;17(1):116–127. to educate government officials about this separate and unequal health care system n “The Role of Faith-Based Institutions in agenda. Our coalition also has conducted in New York City. Addressing Health Disparities: A Case research to identify the barriers to quality Study of an Initiative in the Southwest health care; disseminated our findings to Getting the Word Out Locally Bronx.” Journal of Health Care for the public policy makers, regulators, legislators, n “Eateries Go on a Trim Fling,” Daily Poor and Underserved 2006;17 and health care officials; and developed News, October 23, 2006. (2, suppl):9–19. recommendations for improvement.
For More Information
Charmaine Ruddock, MS, Project Director, Bronx Health REACH Coalition C/O IUFH, 16 East 16th St., New York, NY 10003 Phone: 212-633-0800 (ext. 291) • Fax: 212-989-2840 E-mail: [email protected] • Web site: http://www.Institute2000.org RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“I learned how to inquire about the immunizations my baby should get. Now I know what shots the baby needs. This program helped me by giving me information on places to go for immunizations and also by handing out lots of materials on immunizations. Some people are not aware of how important it is to keep your child’s immunizations up to date.” —Parent enrolled in the Start Right program
REACHing Children and Families in Harlem and Washington Heights, New York
Who We Are n Before the Start Right program began, materials, health education strategies, The Mailman School of Public Health fewer than half of children in the evaluation activities, and record- of Columbia University coordinates target communities were immunized keeping activities. the Northern Manhattan Start Right on time. n Of the 902 community health workers Coalition. we trained through the Start Right The Solution program, 577 completed the entire n This coalition serves the predominantly n Our coalition’s strategy is to promote series and 261 are actively promoting low-income communities of Harlem and immunization through existing immunizations as part of their regular Washington Heights/Inwood of Northern community programs that serve the program activities. Manhattan in New York City. Of the needs of parents of young children. nearly 462,000 residents in this area, Examples include programs that offer Our Achievements 32% are African American and 52% are parenting education or support, early n Start Right community health workers Latino. childhood education, WIC services, have talked with more than 10,000 n The coalition includes 17 community and facilitated enrollment in the State families about the importance of children groups or agencies, two health care Children’s Health Insurance Program. being up to date on all immunizations. networks, the New York City health n We developed a five-part training By September 2006, we had enrolled department, and Columbia University’s program for community health work- 9,560 children. Mailman School of Public Health. ers that integrates community health n We increased the immunization rate to n The coalition is working to improve low worker materials, immunization 76% for children of all ages enrolled in immunization rates among children our program during 2002–2006, with living in Northern Manhattan. Our goal 86.5% of children up to date by age 3. is to bring 10,000 children younger than n We have closed the immunization dispar- age 3 up to date on all recommended Racial and Ethnic Approaches ity gap in Northern Manhattan. Latino childhood immunizations. to Community Health (REACH) and African American children enrolled is a community-based public in the Start Right program no longer lag The Problem health program funded by CDC behind the city and nation in their immu- n In 2000, childhood immunization rates to eliminate racial and ethnic nization rates. In fact, the rate for children in Northern Manhattan were 11% health disparities. aged 19–35 months now exceeds the below the rates in other parts of New www.cdc.gov/reach national average. York City and 19% below national rates.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources rthur Eugene & Thelma Adair Community Life Centers; Alianza Dominicana, AInc.; CHILD Head Start, Inc., Riverside Center; Dominican Women’s Develop- ment Center; Ecumenical Community Development Organization; Ft. George Community Enrichment Center; Harlem Children’s Zone (The Baby College); Harlem Congregations for Community Improvement; Harlem Hospital WIC Program; Mailman School of Public Health, Columbia University; Northern Manhattan Improvement Corp.; Northern Manhattan Perinatal Partnership, Inc.; Puerto Rican Family Institute/Vacunas Para la Familia; Washington Heights/Inwood Early Childhood Education Coalition; New York Presbyterian Hospital Department of Pediatrics; Northern Manhattan Community Voices Collaborative; New York City Department of Health and Mental Hygiene, Bureau of Immunizations.
Our Future and the Community Health Worker Keys to Lasting Change in African The Northern Manhattan Start Right Institute of Alianza Dominicana, Inc. American and Latino Communities Coalition will continue to expand its efforts To sustain lasting change in the immuni- and to work with other groups throughout Generating New and zation rates of children in Northern our communities. To make our training Exciting Science Manhattan, our coalition has learned program available nationwide, we are n “Community-Based Strategies to that a program must have community working with community health worker Reduce Childhood Immunization leaders, peer health educators, integration networks to put our materials on the Disparities.” Health Promotion Practice with community social service programs, Internet. 2006;7(3, suppl):191S–200S. and linkage with community health care n “The Impact of Community Health providers. Our program has relied on proven Getting the Word Out Locally Worker Training and Programs in New strategies, including setting up reminder n “Bank of America Supports Local York City.” Journal of Health Care for and tracking systems and providing positive Community Organization,” El Diario, the Poor and Underserved 2006;17(1): feedback to community groups and parents. February 14, 2006. S24–S43. n “The Start Right Coalition Increases n “Community Empowerment to Reduce We also learned that parents must be Childhood Immunization in Northern Childhood Immunization Disparities empowered as active partners so they will Manhattan,” Manhattan Times, in New York City.” Ethnicity & Disease help promote the importance of immuni- December 9, 2004. 2004;14(3, suppl 1):134–141. zations beyond the doctor’s office and n Starting Right: A Community-Based Com- n “Community-Provider Partnerships to into the community. In addition, we found munity Health Worker Training Program. Reduce Immunization Disparities: Field that integrating immunization promotion Developed by the Northern Manhattan Report from Northern Manhattan.” activities into ongoing programs (e.g., WIC, Start Right Coalition, the Mailman School American Journal of Public Health Head Start) is an effective approach. of Public Health of Columbia University, 2003;93(7):1041–1044.
For More Information
Sally Findley, PhD, Principal Investigator, or Martha Sanchez, MA, Program Director Northern Manhattan Start Right Coalition, Mailman School of Public Health, Columbia University 60 Haven Ave. B2, New York, NY 10032 Phone: 212-304-5501 • Fax: 212-544-1953 E-mail: [email protected] or [email protected] RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“Since I took the nutrition class, I’ve changed my eating habits. The nutritionist showed us what a portion looked like. It was hard at first. I also learned that eating in the morning is important, even if it’s nothing but a little bit. I stopped eating all fried foods, and I’ve gotten away from eating fast food. I’ve lost 77 pounds.” —Neighborhood resident
REACHing African Americans in Charlotte, North Carolina
Who We Are 7% of all North Carolinians and 9% of are recruited from local communities The Carolinas HealthCare System African Americans in North Carolina. affected by health disparities. coordinates the Charlotte REACH n Also in 2000, 35% of Northwest Area n Our outreach and education programs 2010 Coalition. residents had high blood pressure, help community members change compared with 23% of all North unhealthy behaviors and increase n The coalition is made up of several Carolinians and 26% of African activities that can reduce disease risk, community and health care groups Americans in North Carolina. such as being more physically active, who are working together to reduce eating a healthy diet, and quitting the incidence of heart disease and The Solution smoking. diabetes among African Americans n The Charlotte REACH 2010 Coalition living in the Northwest Area of has implemented interventions that Our Achievements Charlotte, North Carolina (ZIP codes focus on the primary prevention of heart n In 2001, a neighborhood farmers’ 28208 and 28216). disease and diabetes. These interven- market was opened to provide n According to the 2000 U.S. Census, tions focus on physical activity, nutrition, Northwest Area residents with greater 89% of residents in the Northwest smoking cessation, tobacco use preven- access to fresh fruits and vegetables. Area are African American. tion, and systems and environmental The market is open every Saturday changes. We also evaluate our interven- (except during winter) and averages The Problem tions to ensure their effectiveness. about 350 customers a week. It is n The average death rate for heart n The foundation of our efforts is the managed by a neighborhood group disease among residents of Charlotte’s use of trained lay health advisors who and provides space for local vendors to Northwest Area is nearly 40% higher sell their produce. than the rate for the rest of Mecklen- n Since the market opened, 73% of burg County. Racial and Ethnic Approaches residents said they are eating more n The average death rate for stroke in the to Community Health (REACH) fresh fruits and vegetables each day. Northwest Area is nearly twice the rate is a community-based public In addition, 72% said they are being for the rest of Mecklenburg County. health program funded by CDC more physically active, and 67% said n In 2000, 10% of Northwest Area to eliminate racial and ethnic they have reduced the amount of fat in residents had diabetes, compared with health disparities. their diet. www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources arolinas HealthCare System; University Park Neighborhood CAssociation; North Carolina Department of Health and Human Services; Mecklenburg County Health Department; McCrorey Family YMCA; Substance Abuse Prevention Services, Inc.; University of North Carolina at Charlotte.
Our Achievements, cont. n “A Fighting Chance,” Pride Magazine, n “A Community-Oriented Primary Care n Through a partnership with the Greater Summer 2003. Demonstration Project: Refining Inter- Charlotte YMCA (McCrorey Branch), n “Making a Difference in Diabetes: vention for Cardiovascular Disease and exercise classes are provided free at Working to Control Your Diabetes for Diabetes.” Annals of Family Medicine community recreational centers and Life,” The Charlotte Observer, May 29, 2004;2(2):103–109. the local YMCA branch. 2003. n “Seasonal Solution Gathers Keys to Lasting Change in the Our Future Momentum,” The Charlotte Observer, African American Community The Charlotte REACH 2010 Coalition February 10, 2003. The success and effectiveness in will continue to bring together more promoting primary prevention of heart community partners to help reduce racial Generating New and disease and diabetes in this African and ethnic health disparities among Exciting Science American community is directly related North Carolina residents. Our current n “A Lay Health Advisor Program to to the commitment and dedication of the efforts, including the lay health advisors, Promote Community Capacity and members of the Charlotte REACH 2010 the neighborhood farmers’ market, and Change Among Change Agents.” Coalition. The purpose of the coalition is the YMCA partnership, have all been Health Promotion Practice. Published to provide direction and to monitor our well-received by the community. These online November 14, 2006, at progress. Members include grassroots interventions will continue to be a part of http://heb.sagepub.com/pap.dtl. groups and representatives from health our efforts to promote healthy lifestyles n “A Qualitative Assessment of Charlotte and human service agencies. Without in North Carolina. REACH: An Ecological Perspective for these collaborations, the work of each Decreasing CVD and Diabetes Among group would be less effective. Getting the Word Out Locally African Americans.” Ethnicity & Disease n “No Butts About It,” Pride Magazine, 2004;14(3, suppl 1):77–82. Summer 2004.
For More Information
LaTonya Chavis, MS, Director, Charlotte REACH 2010 Coalition 1350 South Kings Drive, Charlotte, NC 28207 Phone: 704-446-1539 • Fax: 704-446-1155 E-mail: [email protected] Web site: http://www.reach2010charlottenc.org RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“At Cherokee Elementary, I’ve noticed that since we’ve had Cherokee Choices in our school, the students are much more aware of the necessity of physical exercise and eating healthy foods. When they come to the library, they’re looking for materials on cooking and about their bodies and maturing. We see them out walking on our track, and they’re trying to be healthier overall.” —Cherokee Elementary School teacher
REACHing Eastern Band of Cherokee Indians in Cherokee, North Carolina
Who We Are combined is 23.8%. This rate is more and health knowledge. These mentors The Eastern Band of Cherokee Indians than three times the combined rate for also developed a weekly after-school coordinates the Cherokee Choices/ men and women from all other racial program to enhance teamwork, cultural REACH 2010 Diabetes Prevention and ethnic groups in North Carolina. awareness, and physical health. Program. n Nutritionists, dietitians, and fitness The Solution workers help tribal members partici- n Cherokee Choices includes three n Cherokee Choices works to mobilize the pate in activities at their churches and components: mentoring for elemen- community to confront environmental work sites that are designed to help tary school students, work site well- and biological factors that put Cherokee them reduce stress, eat healthier ness programs for adults, and health people at higher risk for diabetes. Our foods, and increase their physical promotion activities at local churches. efforts include addressing issues related activity levels. It is administered by the Health and to racism and mental health; creating a Medical Division of the Eastern Band supportive environment for community Our Achievements of Cherokee Indians. participation; and developing policies n Cherokee Choices has changed the n The cornerstones of this program are for schools, work sites, and churches culture of local schools, allowing policy listening to the community and provid- that promote positive health changes. changes that support physical activity ing social support to increase physical n Mentors work with elementary school programs for students and staff. activity and promote well-being and children and staff to develop lesson n To promote healthy eating, the Cherokee healthy choices, which can reduce the plans on self-esteem, cultural pride, Central School System Board reduced risk for obesity and diabetes. conflict resolution, emotional well-being, the amount of saturated fat allowed in school meals. The Problem n A significant increase in healthy eating n Cherokee men and women are twice Racial and Ethnic Approaches and physical activity has been reported as likely to be obese as members of to Community Health (REACH) in Cherokee schools and at participating other racial and ethnic groups in North is a community-based public work sites; 96% of school participants Carolina. health program funded by CDC said they know how to make healthier n The prevalence rate of type 2 diabetes to eliminate racial and ethnic food choices. among Cherokee men and women health disparities. www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources herokee Central School System; Cherokee Hospital; Cherokee Diabetes CClinic; Community Club Council; Cherokee Human Resources; Healthy Cherokee; Cherokee Central School System Board; United Methodist Church; Latter Day Saints; Cherokee Tribal Planning Office; multiple Cherokee work sites.
Our Achievements, cont. We will seek funding to create a more Keys to Lasting Change in n Some program participants have been walkable community with greenways and the Cherokee Community able to decrease or eliminate their use sidewalks. As our program grows, we will Our program’s community-based of medications for diabetes and high try to show the link between our program participatory approach has prompted blood pressure. and health care costs paid by the tribe, to strong community involvement and n We produced a documentary called illustrate the value of investing in prevention. earned respect from community members. “Generations of Wellness,” which This approach makes Cherokee Choices provides positive stories and role Getting the Word Out Locally different from the top-down programs models for the community. n “Students Lend a Leg to Fight Diabetes typically provided by social service agencies n Five area churches and 170 church Among Cherokee,” Asheville Citizens- in Cherokee communities. As a result, members are involved in the Walk to Times, February 26, 2004. community members have expressed Jerusalem project, where participants n “Living With Diabetes,” published interest in using the same techniques to try to walk the equivalent distance monthly in Cherokee One Feather, the deal with other local health issues. between Cherokee and Jerusalem. weekly newspaper of the Tribal Council Participants have collectively walked of Eastern Band of Cherokee Indians. Now that community members have seen more than 31,600 miles in 6 months. n Three 30-second television ads shown positive changes in their children and Progress is tracked on a map at each throughout western North Carolina, their co-workers, they are learning that a church, and celebrations are held 2005–2006. diabetes diagnosis is not inevitable. The periodically to keep people motivated. philosophy that underlies the Cherokee Generating New and Choices program is that conducting mul- Our Future Exciting Science tiple activities at the same time can bring The Cherokee Choices/REACH 2010 n “Cherokee Choices: A Diabetes Preven- about community and system changes. Diabetes Prevention Program hopes to tion Program for American Indians.” expand to incorporate more schools, work Preventing Chronic Disease [serial sites, and churches. We will share our online] 2006;3(3). Available at http:// knowledge and promote development of www.cdc.gov/pcd/issues/2006/jul/ similar programs in surrounding counties. 05_0221.htm.
For More Information
Jeff Bachar, MPH, Principal Investigator, Cherokee Choices/REACH 2010 Eastern Band of Cherokee Indians P.O. Box 666, Cherokee, NC 28719 Phone: 828-497-1970 • Fax: 828-497-1799 • E-mail: [email protected] Web site: http://www.cherokee-hmd.org/Departmental/cherokee_choices.htm RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“If it was not for my involvement with the coalition, I would have never been able to talk about HIV. Now I can talk with my family about the risk factors associated with HIV and prevention. As a result of the knowledge of HIV that I gained through the coalition, I am now in a leadership program for the prevention of hepatitis C.” —OKRAICB coalition member
REACHing American Indians in Oklahoma
Who We Are already face other severe and more n By developing interventions that reflect The Association of American Indian visible health and social problems, the culture of tribal communities, Physicians coordinates the Oklahoma such as alcoholism, diabetes, and high coalition members have helped change REACH HIV/AIDS American Indian unemployment. attitudes and beliefs about HIV and Capacity Building (OKRAICB) program. n As a group, American Indians often AIDS among community leaders. have high levels of risk factors that n Coalitions have hosted several n The OKRAICB program has established allow the easy spread of HIV, including community events to raise awareness community coalitions in three high rates of sexually transmitted about HIV and AIDS, including a Oklahoma regions. Partners in these infections and illegal drug use. concert and powwow called BUH: coalitions include community groups Battling Stigma to Unite Indian Youth that serve American Indians, county The Solution Against HIV/AIDS. health care providers, federal health n By working with and supporting other n The OKRAICB program also teaches care providers, and tribal health community groups and by targeting coalition members about behavioral care systems. young people, the OKRAICB coalitions theories and how to create community n The OKRAICB program promotes have been able to raise awareness interventions; holds monthly planning awareness about HIV and AIDS among about and interest in dealing with the meetings in each community; and American Indians. problem of HIV infection in American provides quarterly training sessions n The program also helps tribes address Indian communities. These efforts to teach coalition members how issues related to HIV and AIDS by have helped overcome the stigma of to conduct Internet research, write helping them develop interventions that the disease. grants, and create PowerPoint reflect the culture of tribal communities. presentations.
The Problem Racial and Ethnic Approaches Our Achievements n American Indians are infected with HIV to Community Health (REACH) n In 2006, more than 1,000 community and AIDS at a rate of 11.7 per 100,000 is a community-based public members attended community-based people, which is nearly 1.5 times the health program funded by CDC activities sponsored by the coalitions. to eliminate racial and ethnic rate for whites (7.9). n Coalitions have gained the support of n HIV infection often goes unnoticed health disparities. tribal members within the communities. in American Indian communities that www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources he OKRAICB program includes three coalitions—the Oklahoma Native TNations United Against AIDS Coalition, the Pani HOPE Coalition, and the HEART Coalition. The partners in each coalition are listed below.
Our Achievements, cont. Kiowa Tribe Substance Abuse Program; Hider Jay Community Clinic; Tulsa Indian n In 2006, 100 American Indian mothers Anadarko Indian Health Center; Health Care Resource Center; Inter- brought their daughters to a community Consortium Against Substance Abuse; Tribal Substance Abuse & Treatment training session that addressed basic Comanche Nation New Pathways; Law- Center; Freeman Health System. facts about HIV and AIDS. ton Indian Hospital; Kiowa Tribe Injury n Coalitions have gained the support of and Prevention Program; Kiowa Work- Getting the Word Out Locally the public school systems and tribal force Investment Act Program. n “Group Tells Indians About AIDS,” boarding schools in their regions. Tulsa World, May 22, 2006. Pani HOPE Coalition: Kaw Nation of Our Future Oklahoma/Kanza Health Center; Pawnee Keys to Lasting Change in The OKRAICB program will continue to Nation Tax Commission; Pawnee Indian the American Indian Community support the efforts of the community Health Center; Pawnee Gaming Com- Partners in the OKRAICB program have coalitions. We also will continue to mission; Hunter Health Clinic; Pawnee learned many important lessons that develop the skills of community leaders Nation Tribal Council; Pawnee Nation have helped to sustain real change in to help them prevent HIV and AIDS in Diabetes Program; Pawnee Public the American Indian community. For their communities. Schools Indian Education Program; example, we learned that it takes at least Pawnee Nation Health Education 12 months to develop a community- Mobilizing Community Resources Program; Pawnee Nation Title VI Elderly driven prevention program. We also Oklahoma Native Nations United Meals Program; White Eagle Indian learned that, for community-based and Against AIDS Coalition: Comanche Health Center; Pawnee County CASA; community-driven interventions to work, Nation Substance Abuse Program; Ft. Pawnee Nation Housing Authority; staff members must gain the respect of Sill Apache Emergency Youth Shelter; Pawnee Nation Fire Department. the community and create interventions Anadarko Public Schools Indian Education that reflect local cultures. In addition, Program; Riverside Indian School; Caddo HEART Coalition: Cherokee Nation community interventions must meet County Department of Human Health Ser- Behavioral Health Services; Northeastern the specific needs of each community vices; Wichita & Affiliated Tribes Juvenile Tribal Health Center; Cherokee Nation to be successful. Services Program; Wichita Tribal Youth Community Health Nursing; Claremore Program; Apache Tribe Caregiver Program; Indian Hospital; Planned Parenthood of Apache Tribe Title VI AOA Program; Arkansas and Eastern Oklahoma; Sam
For More Information
Margaret Knight, Executive Director, Association of American Indian Physicians 1225 Sovereign Row, Suite 103, Oklahoma City, OK 73108 Phone: 405-946-7072 • Fax: 405-946-7651 • E-mail: [email protected] Web site: http://www.aaip.org/programs/hiv_aids/community_capacity/ community_capacity.htm RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“Outstanding program. Thank you for making such a wonderful program available for our students. Programs like this are greatly needed. Thank you for caring about the future of our youth.” —Sixth-grade teacher in Talihina, Oklahoma
REACHing American Indians in the Choctaw Nation of Oklahoma
Who We Are n Substance abuse, especially of metham- disease prevention and to address the The Choctaw Nation of Oklahoma phetamines, is affecting more and more identified needs of each community. coordinates the Choctaw Nation Core Choctaw Nation of Oklahoma communi- n When several Choctaw communities Capacity Building Program. ties. Research has shown that substance said they needed educational programs abuse can have a devastating effect on on substance abuse, we created a slide n This program works to identify the heart health. presentation that describes the effects burden of heart disease among Ameri- of certain drugs on a person’s heart. We can Indians living within the Choctaw The Solution have shown this presentation at a variety Nation of Oklahoma boundaries. It also n The Choctaw Nation Core Capacity of community events, and we put it on assesses current prevention efforts and Building Program has successfully worked our Web site. We also provide copies to works to implement better strategies with its partners to create 12 community anyone who wants to share this presen- to prevent and control disease among coalitions within the 11 counties of the tation with other groups. this population. Choctaw Nation of Oklahoma. These n We found that children, particularly those n More than 80,000 American Indians coalitions are raising awareness about in kindergarten and Head Start programs, live inside the Choctaw Nation of heart disease prevention, improving were the most receptive to our presenta- Oklahoma boundaries. More than access to care, and assessing the health tion. Many students said they wanted to 395,000 American Indians live in the needs of each community. keep their hearts healthy, and that they state of Oklahoma. n This program also has developed an would never use drugs because they did innovative educational program that not want their hearts to stop beating. The Problem works to increase awareness about heart n Prevalence rates for heart disease and Our Achievements many of its risk factors are high among n We have presented our educational American Indians/Alaska Natives in the Racial and Ethnic Approaches program at 17 national conferences United States. For example, the rate for to Community Health (REACH) and 116 state events. heart disease is 5.2%, the rate for high is a community-based public n We have made 92 presentations at 45 blood pressure is 24.4%, and the rate health program funded by CDC schools, educating students and staff for high cholesterol is 31.6%. to eliminate racial and ethnic about heart disease prevention and the n Heart disease is the leading cause of health disparities. devastating effects of substance abuse death for American Indians living in www.cdc.gov/reach on heart health. Oklahoma.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources hoctaw County Coalition; Atoka/Coal County Partnership for Change; CCommunity Chest; Pushmataha County Turning Point; A Better Clayton Coalition; McCurtain County Coalition for Change; Haskell County Coalition; Inter-Service Agency Organization; Local Service Coalition; Bryan County Community Services Council; Living in Latimer Coalition; Parents Against Substance Abuse.
Our Achievements, cont. with other tribes, school systems, and Keys to Lasting Change in n As a result of our partnerships with coalitions, as well as at public events. the American Indian Community local community and public health We also plan to work with partners such We have found that programs are more groups, the Choctaw Nation Recovery as Colorado State University’s Center for effective if they first assess the needs of Center added questions about heart Applied Studies in American Ethnicity to individual communities, and then respond health to its patient intake forms and integrate heart disease prevention into to those needs with tailored interventions. follow-up interviews. college curriculums. This approach works better than using a n We also partnered with Colorado preconceived curriculum, and it has greatly State University’s Tri-Ethnic Center to Getting the Word Out Locally increased community participation in our create a survey to assess communities’ n “Choctaw Nation Shares Link Between program. readiness to address the health issues Substance Abuse and Heart Disease,” identified in needs assessment surveys. American Indian Horizons, Fall 2006. n We partnered with the Oklahoma For example, we have been able to reach n “The Choctaw Nation Preventive Health many more people with our message State Department of Health to link Core Capacity Program,” Bishinik, the about the effects of substance abuse on the state’s death certificate database official publication of the Choctaw heart health because substance abuse was with the Indian Health Service Patient Nation of Oklahoma, July 2006. identified as a major concern in Choctaw Registration database. This linkage n “Choctaw Nation and Pekin Woman will help to correct the problem of Partner to Show Effects of Substance communities. In addition, many school American Indians being misclassified Abuse,” Bishinik, September 2005. administrators have asked us to bring our as members of other races on their n “Choctaws Get Help from Pekin educational program to their schools to death certificates (which happens Woman,” Pekin Daily Times, address the health of young children, teach about one-third of the time). June 3, 2005. them about heart disease prevention, and deter them from drug use. These children Our Future Generating New and might not have been as receptive to learn- The Choctaw Nation Core Capacity Exciting Science ing about heart health in a traditional way, Building Program will continue to n “Cardiovascular Risk Factors and Use but they are very interested in our program raise awareness about heart disease of Medical Advice in Native Americans.” when we make these connections. prevention by sharing our community Journal of Health Care for the Poor and capacity plan locally and nationally Underserved 2007 (in press).
For More Information
Janeen Gray, Program Manager, Choctaw Nation Core Capacity Building Program 318 South 3rd, McAlester, OK 74501 Phone: 918-426-5700 • Fax: 918-426-5702 E-mail: [email protected] • Web site: http://www.choctawnationcore.com RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“This program has been instrumental in causing a major lifestyle change for me. I use the fitness centers 3–5 days a week, and I teach fitness classes. I walk my dog and do yoga every day. Before, in addition to being overweight, I was sedentary, had high blood pressure and high cholesterol, and I smoked. I had all the risk factors for diabetes and heart disease. I have lost 86 pounds and 24 inches since I started working with the REACH project.” —Assistant program manager, Wichita and Affiliated Tribes’ REACH 2010 program
REACHing Native Americans in Oklahoma
Who We Are The Solution n We also educated participants about the The Oklahoma State Department of n To help reduce racial disparities in importance of physical activity and good Health coordinates the Oklahoma diabetes, heart disease, and their risk nutrition to their health. Native American REACH 2010 Project. factors in Oklahoma, our coalition is working to promote physical activity Our Achievements n This project includes a coalition of and make it more available at the n More than 5,000 participants are enrolled representatives from eight Native community level. in the Oklahoma Native American REACH American tribes or nations, one urban n Our project has implemented physical 2010 Project. Indian health center, and the Chronic fitness and wellness interventions, n Trained and certified staff members in the Disease Service of the Oklahoma State trained physical fitness specialists (or nine REACH communities have collectively Department of Health. equivalents), and supported policy and implemented more than 75 physical n The main goal of this project is to environmental changes in our nine activities each week. reduce disparities in heart disease and REACH communities. n More than 75 tribal staff and community diabetes among Native Americans in n For our interventions, we collected members have been trained in fitness and nine communities through primary and baseline and follow-up measurements, health promotion. secondary prevention efforts. such as body mass index, waist-to- n Partners in all nine communities have hip ratios, and body fat percentages, developed employee fitness/wellness The Problem from participants to help track their programs and implemented secondary n The age-adjusted death rate for progress. prevention programs related to good diabetes among Native Americans in nutrition, smoking cessation, and obesity. Oklahoma is nearly 200% higher than n All partners have made environmental the rate for whites. changes such as policies that control or n The prevalence rate for diabetes Racial and Ethnic Approaches prevent tobacco use, promote employee among Oklahoma adults is 13.1% to Community Health (REACH) fitness, and encourage healthy eating. for Native Americans, compared with is a community-based public n We have developed new partnerships with 7.0% for whites. The prevalence rate health program funded by CDC community health representatives, tribal for obesity is 31.6%, compared with to eliminate racial and ethnic fitness facilities, schools, local colleges and 22.2% for whites. health disparities. universities, and Indian Health Service/ www.cdc.gov/reach Tribal Health Service diabetes prevention and heart disease programs.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources bsentee Shawnee Tribe of Oklahoma; Cherokee Nation; Cheyenne- AArapaho Tribes of Oklahoma; Chickasaw Nation; Choctaw Nation of Oklahoma; Indian Health Care Resource Center of Tulsa; Oklahoma State Department of Health; Pawnee Nation of Oklahoma; Seminole Nation of Oklahoma; Wichita and Affiliated Tribes.
Our Achievements, cont. n “REACH 2010 5-K Run at Bigfoot Keys to Lasting Change in the n Our community partners have received Festival,” Talihina American, 2005. Native American Community more than $2 million in funding from n “REACH Activities,” Watonga Republican, State, federal, and tribal governments can other sources to expand and enhance December 2004. work together to accomplish a common their programs. n “REACH Success Stories from Our goal. Respect and trust are key components n We have shared information about our Communities,” a DVD that highlights to working successfully with Native American project through 34 national presentations, projects in Oklahoma and other states. tribes to build a foundation that ensures two international presentations, three peer- long-term partnerships and collaboration. reviewed articles, one book chapter, and Generating New and For our project, collaboration with other two reports. Exciting Science programs, departments, and professionals n “Behavioral Risk Factors, Chronic within tribes has been essential. Our Future Diseases, Health Care Access and Health The Oklahoma Native American REACH 2010 Status of Rural American Indian Women Personal relationships with intervention Project will continue to work to sustain its in Oklahoma.” In: Rural Women’s Health: participants also are important. Monthly programs, institutionalize its activities, and Linking Mental, Behavioral, and Physical logs are an effective way to motivate share information and lessons learned with Health. New York: Springer Publishing; participants because they show improve- other Native American communities. 2006. ments over time. Parents must be taught n “From Risky Behaviors to Chronic good nutrition concepts while their Getting the Word Out Locally Outcomes: Current Status and Healthy children are infants. Parents also should n “REACH 2010 Leading the Way,” Bishinik, People 2010 Goals for American Indians be educated about the importance of the official publication of the Choctaw in Oklahoma.” Journal of the Oklahoma increasing physical activity and limiting Nation of Oklahoma, January 2006. State Medical Association 2003;96(12): the amount of time their children spend n “Absentee Shawnee Basketball Chal- 569–574. in front of the TV or computer. To make lenge,” The Absentee Shawnee News, n “Prevalence of Current Smoking Among our project even more successful, we need American Indians in Oklahoma: A Com- January 2006. more resources for collecting data and parison.” Journal of the Oklahoma State n “Healthy Choices Available in Vending conducting evaluations. Machines,” Cherokee Phoenix, Medical Association 2002;95(3):155–158. September 2005.
For More Information
Janis Campbell, PhD, Principal Investigator, Oklahoma State Department of Health Chronic Disease Service, REACH 2010 1000 N.E. 10th Street, Oklahoma City, OK 73117 Phone: 405-271-4072 • Fax: 405-271-6315 • E-mail: [email protected] Web site: http://www.health.state.ok.us/program/cds/reach.html RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“The coalition’s work and dedication over the past 10 years have brought exercise and health consciousness to the African American community. This is no doubt helping families to reclaim their health, prolong their lives, strengthen their social networks, and increase their quality of life.” —Tricia Tillman, REACH participant
REACHing African Americans in Portland, Oregon
Who We Are 97.3 for Asians and Pacific Islanders, local populations. These programs train The African American Health Coalition, and 63.5 for Hispanics. community health workers to help Inc., coordinates the REACH program n The death rate for stroke among African Americans in Oregon make and in Portland, Oregon. African Americans living in Oregon sustain healthy lifestyle choices. was 88% higher than the rate for n Our holistic approach includes a hands- n The coalition’s mission is to promote whites in 2001. on nutrition program called Spice It and improve the health of African Up, which teaches people how to cook Americans living in Oregon through The Solution healthy foods on a budget. Nutrition education, advocacy, and research, n To address these health disparities, seminars are held in partnership with with a focus on heart disease. our coalition has designed and the Oregon Food Bank and a local n The African American population in implemented four major programs health food store. Oregon is less than 2% of the total and three annual events to increase population, making us an isolated knowledge and change attitudes and Our Achievements community within an isolated behaviors related to heart disease and n The Lookin’ Tight, Livin’ Right interven- population. its risk factors, including diabetes, poor tion trained 11 beauty and barber shop n Our vision is to make the African nutrition, obesity, and inactivity. operators as lay health educators to talk American community in Portland the n We are working to build capacity at with their clients about heart disease and healthiest in the nation. the community level by developing its risk factors. Participants have enrolled programs that reflect the culture of more than 480 clients each year and con- The Problem ducted more than 3,500 “health chats.” n Heart disease is the leading cause n In 2005, 47 African American high school of death in Oregon, accounting for students participated in the Healthy 34.8% of all deaths in 2002. Racial and Ethnic Approaches Options Living Longer Actively (HOLLA) n In 2001, the death rate for heart to Community Health (REACH) program. Through this program, students disease among African Americans is a community-based public gave 164 presentations on heart disease in Oregon was 254 per 100,000, health program funded by CDC and its risk factors to 1,086 of their peers compared with 194 for whites, to eliminate racial and ethnic and family members. health disparities. www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources meriCorps*VISTA; Eli Lilly; Northwest Health Foundation; City Aof Portland Parks and Recreation; Oregon Health Division; New Seasons Market; Multnomah County Health Department; American Heart Association; Oregon Food Bank; Portland State Regional Research Institute; Center for Health Disparities Research; Urban League of Portland; Albina Community Bank; Black United Fund; Trimet; four major health care systems; Office of Mayor Tom Potter; many other organizations.
Our Achievements, cont. Our Future Generating New and n During 2002–2006, more than 4,700 The African American Health Coalition will Exciting Science community members participated in continue to build community capacity and n “The African American Wellness Village a free physical activity program called sustain our current efforts to reduce health in Portland, Oregon.” Preventing Chronic the Wellness Within REACH, which disparities among African Americans Disease [serial online] 2006;3(3). provides access to a variety of culturally in Oregon. We will continue to educate Available at http://www.cdc.gov/pcd/ appropriate exercise classes. As a our policy makers, expand our existing key issues/2006/jul/05_0211.htm. result, 58% of participants say they are partnerships, and implement a strategic n “Wellness Within REACH: Mind, Body, exercising more. development plan to sustain our programs and Soul: A No-Cost Physical Activity n Our coalition holds an annual health into the future. Program for African Americans in Port- fair, called the Wellness Village, that land, Oregon, to Combat Cardiovascular offers free health screenings and Getting the Word Out Locally Disease.” Ethnicity & Disease 2004;14 information to residents in a way n “Take It Off, Keep It Off,” The (3, suppl 1):93–101. that reflects their local culture. When Oregonian, February 26, 2006. we evaluated these events, 50% of n “Leaders Fight Racial Health Dispari- Keys to Lasting Change in the respondents said the Wellness Village ties,” The Portland Observer, October African American Community is the only place they get health 26, 2005. According to community members, REACH screenings. n “ ‘Blessed’ Patient Bolstered by Black is a “movement” that has changed the n In 2006, more than 4,200 people Sisterhood,” The Oregonian, September African American community’s behaviors participated in our programs. 11, 2005. related to health, physical activity, and n Our coalition received the 2006 Spirit n “Teaming Up for Healthy Hearts,” nutrition. Our REACH participants are of Portland Award for Non-Profit The Oregonian, September 7, 2005. active in all areas of our coalition, and Organization of the Year. This award n “Coalition Shines Light on Commu- they educate local policy makers about the recognizes outstanding contributions nity Health,” The Portland Observer, effect this program has had on their lives. to the community. September 10, 2003. n “The Way to a Healthy Heart? Through Our programs have been so successful that the Hairdo,” The Oregonian, April 10, the City of Portland has partnered with 2002. us to ensure affordable access to physical activity for all REACH participants.
For More Information
Corliss McKeever, MSW, President and CEO, African American Health Coalition 2800 N. Vancouver Ave., Suite 100, Portland, OR 97227 Phone: 503-413-1850 • Fax: 503-413-1851 E-mail: [email protected] • Web site: http://www.aahc-portland.org RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“Many of the participants have invited others to come to the [diabetes self-management] class. They are taking their [patient report cards] with them to see the doctor, and they are asking questions. The doctors are listening to them.”
—REACH 2010 community health advisor
REACHing African Americans in Charleston and Georgetown Counties, South Carolina
Who We Are higher rates of heart disease, amputa- care visits, health and information fairs, The Medical University of South Carolina tions, and kidney disease compared support groups, grocery store tours, and coordinates the REACH 2010 Charleston with whites and members of other Internet access at local public libraries. and Georgetown Diabetes Coalition. racial and ethnic groups. Our Achievements n This urban-rural, community-university The Solution n During 1999–2004, chart audits of African coalition works to eliminate racial and n To overcome these health disparities, Americans who visited partner health ethnic disparities in diabetes in South our coalition works to 1) help people centers showed sharp increases in the Carolina. better manage their diabetes, 2) help use of annual testing for diabetes and its n The coalition reaches more than 13,000 health care providers give better complications. The percentage who had African Americans with diabetes living diabetes care, and 3) build community their blood sugar level checked annually in Charleston and Georgetown counties, advocacy and support to sustain these increased from 77% to 97%, while the South Carolina. efforts. percentage who had their blood choles- n To make our efforts more effective, we terol level checked increased from 47% to The Problem use approaches that reflect the culture 81%. Kidney testing increased from 13% n African Americans are almost twice as of local populations. to 53%, and foot exams increased from likely to have diabetes as the majority n We developed a comprehensive 64% to 97%. of Americans. community action plan that includes n Health care providers documented better n In 1999, African Americans living in walk-talk groups, home and telephone adherence to American Diabetes Associa- Charleston and Georgetown counties visits, educational sessions, health tion guidelines for self-management, from were less physically active, ate a less 41% to 94% of patients. healthy diet, and had higher rates of n Emergency room visits decreased by about obesity compared with whites and Racial and Ethnic Approaches 50% for people who have diabetes but do members of other racial and ethnic to Community Health (REACH) not have health insurance. groups. is a community-based public n Fewer lower extremity amputations were n In addition, African Americans with health program funded by CDC reported among African American men diabetes living in Charleston and to eliminate racial and ethnic in Charleston and Georgetown counties, Georgetown counties reported a lower health disparities. from 80 per 1,000 hospitalizations in quality of diabetes care, as well as www.cdc.gov/reach 1999 to 33 per 1,000 in 2004.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources lpha Kappa Alpha, Omicron Rho Omega Chapter; Carolinas Center for Medical AExcellence; Charleston Diabetes Coalition; Commun-I-Care; Diabetes Initiative of South Carolina; East Cooper Community Outreach; Franklin C. Fetter Family Health Center; Georgetown County Diabetes CORE Group; Medical University of South Carolina, College of Nursing; South Carolina State Budget and Control Board; South Carolina Department of Environmental Control, Diabetes Prevention and Control Program, Region 7 (Charleston) and Region 5 (Georgetown); South-Santee St. James Community Center; Tri-County Black Nurses Association; Trident United Way; St. James Santee Family Health Center; area churches, community centers, work sites, and libraries.
Our Achievements, cont. Getting the Word Out Locally n “Reducing Disparities for African n We established a faith-based diabetes n “Rural Health Fair Tackles Diabetes,” Americans with Diabetes: Progress Made program that matches patients treated Coastal Observer, July 6, 2006. by the REACH 2010 Charleston and at a local hospital with volunteers from n “Area Program to Combat Diabetes Rec- Georgetown Diabetes Coalition.” Public a local church. These volunteers provide ognized as a National Model,” Charleston Health Reports 2004;119(3):322–330. social support for patients and help Post and Courier, June 20, 2006. them get information from diabetes n “Classes Help Diabetics Improve Health,” Keys to Lasting Change in the educators. Several volunteers expanded Georgetown Times, April 7, 2006. African American Community the program to include fellow church n “Diabetes CORE Group Program to Focus Our coalition found that identifying members who were treated at other on the Loss of Eyesight,” Georgetown principles and goals early will help to hospitals. Times, February 15, 2006. resolve problems that may arise. All n Our coalition partners received viewpoints are important, and involving two national awards in 2006: the Generating New and all partners equally in solving community Community-Campus Partnerships Exciting Science issues will help you to move beyond for Health Award and the U.S. n “Equal Care, Unequal Outcomes: Experi- power struggles. National Commission on Libraries ences of a REACH 2010 Community.” and Information Science’s Health Journal of Health Disparities Research We also found that the combined Information Award for Libraries. and Practice 2006;1(1):47–62. resources of all partners create power n “A Community-Based Participatory Health far beyond that of individuals. Providing Our Future Information Needs Assessment to Help opportunities to learn about each The REACH Charleston and Georgetown Eliminate Diabetes Information Dispari- partner’s culture benefits the coalition as Diabetes Coalition will continue to work ties.” Health Promotion Practice 2006;7 a whole. Health care professionals provide to link people with resources to reduce (3, suppl):213S–222S. the “science of diabetes,” while the disparities in diabetes, its risk factors, and n “Racial Disparity in the Diagnosis of Obe- community determines how to translate its complications, especially heart disease sity Among People with Diabetes.” Journal this science into practice. By working as and amputations. of Health Care for the Poor and Under- equal partners, we can eliminate health served 2006;17(2, suppl):106–115. disparities in diabetes in South Carolina.
For More Information
Carolyn Jenkins, DrPH, Principal Investigator, Medical University of South Carolina, College of Nursing P.O. Box 250160, Charleston, SC 29425 Phone: 843-792-5872 • Fax: 843-792-5822 E-mail: [email protected] • Web site: http://www.musc.edu/reach RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“Until I enrolled in a smoking cessation class, I was unaware of the effects smoking had on my body. I have high blood pressure and diabetes, and smoking increased my chances for life-threatening complications. I’m glad I found REACH.” —REACH Quit and Win campaign participant
REACHing African Americans in Nashville, Tennessee
Who We Are The Solution Our Achievements The Matthew Walker Comprehensive n The Nashville Health Disparities Coali- n Our coalition expanded the hours of Health Center coordinates the Nashville tion developed a community action plan operation at six community clinics to Health Disparities Coalition REACH to address health disparities among improve residents’ access to care. 2010 Project. African Americans who have or are n We developed and disseminated 500 at risk of developing diabetes, heart screening manuals and trained local n This project is working to reduce and disease, or high blood pressure. groups to conduct health screenings. Since eliminate health disparities in diabetes n We created teams to develop strategies 2000, more than 4,000 people have been and heart disease rates among African to address the following key health screened for diabetes, heart disease, and Americans living in North Nashville, issues: tobacco use, access to health associated risk factors. Tennessee. care, health screenings, and overall n We developed the Nashville REACH 2010 n In 2000, 88% of North Nashville resi- health and wellness. Resource Manual to link people who dents were African American. n We formed partnerships with several have diabetes and heart disease with the groups and institutions to increase health services they need. This booklet The Problem residents’ access to health care services was distributed to more than 15,000 n In 2003, 15.7% of African American and reduce their risk of developing local residents. residents living in North Nashville had chronic diseases such as diabetes. n We provided diabetes self-management diabetes, and 33.6% had high blood classes to local community groups and pressure. to 720 clients at the Matthew Walker n African Americans in North Nashville Comprehensive Health Center. are three times more likely to die of n We worked with local nutrition groups complications of diabetes and heart to start community gardens and produce disease than white residents. Racial and Ethnic Approaches stands. We also changed local school n Although 52% of African American to Community Health (REACH) menus, reduced the amount of junk food women living in North Nashville are is a community-based public sold in vending machines, and provided obese, many residents are unaware health program funded by CDC nutrition education to residents. to eliminate racial and ethnic that obesity is a major risk factor for n We worked with other local groups to health disparities. diabetes, and many residents may have convince the governor to sign into law a undiagnosed diabetes. www.cdc.gov/reach no-smoking policy in state office buildings.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources etro Public Health Department; Tennessee Department of Health; MVanderbilt University; Matthew Walker Comprehensive Health Center; Meharry Medical College; Tennessee State University; Fisk University; Interdenominational Ministers’ Fellowship; Nashville Branch of the NAACP; Metro General Hospital; American Baptist College.
Our Future Generating New and Keys to Lasting Change in the The Nashville REACH 2010 Project will Exciting Science African American Community continue to implement and evaluate n “REACH-Meharry Community-Campus People working at the community level interventions designed to promote health Partnership: Developing Culturally must keep in mind that social and and prevent disease, particularly those Competent Health Care Providers.” environmental factors such as poverty, that address diabetes and heart disease. Journal of Health Care for the Poor and racism, violence, crime, lack of opportu- Underserved 2006;17(2, suppl):78–87. nity, education, and housing can have Getting the Word Out Locally n “Diabetes Management Among Low- negative effects on community health. n “Nashville REACH 2010 at Matthew Income African Americans: A Description When people have stressful lives, they Walker Comprehensive Health Center of a Pilot Strategy for Empowerment.” often do not make their health a priority. Announces its 2nd Annual ‘Quit and Journal of Ambulatory Care Manage- Win’ Campaign to Help Smokers,” The ment 2006;29(2):162–166. To make and sustain positive changes in Tennessee Tribune, August 10, 2006. n “An Evaluation of the Nashville REACH people’s lifestyles and health, we must n “Program Teaches Children Songs, 2010 Community Health Screening address society’s problems head-on, and Words to Persuade Family to Quit,” Strategy.” Journal of Ambulatory Care all sectors of the community, including Tennessean, July 25, 2006. Management 2006;29(2):151–161. churches, must participate. These efforts n “Smoking Ban Leaves Lasting Effects n “Development and Evaluation of a Bible also require sustainable resources, and on Legislative Plaza,” The City Paper, College-Based Course on Faith and communities must address this issue to June 21, 2006. Health.” Journal of Ambulatory Care continue their work. Management 2006;29(2):141–150.
For More Information
Linda H. McClellan, MPH, Project Director and Chair, Nashville Health Disparities Coalition 1501 Herman Street, Nashville, TN 37208 Phone: 615-340-1289 • Fax: 615-327-2806 • E-mail: [email protected] Web site: http://healthbehavior.psy.vanderbilt.edu/reach RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“The REACH 2010 program has allowed tribes affiliated with United South and Eastern Tribes to increase—and in some cases establish for the first time—immunization surveillance for their children. With so many health disparities affecting American Indians in the eastern United States, REACH has allowed us to address a fundamental aspect of bettering the health of our tribal children.” —Jim Marshall, epidemiologist at the USET Tribal Epidemiology Center
REACHing American Indians in the United South and Eastern Tribes
Who We Are The Problem known because of racial misclass- United South and Eastern Tribes, Inc. n In general, American Indians have ification of this population in state (USET) coordinates the REACH 2010 higher rates of death and disease than data systems and incomplete reporting Immunization and Infant Mortality members of other racial and ethnic in tribal systems. Project. groups in the United States. n In 2003, the infant mortality rate for The Solution n USET is a nonprofit intertribal group American Indians was 8.7 per 1,000 n Twenty USET tribes are working with that collectively represents 24 federal- live births, compared with 6.8 for all the Infant Mortality Project to collect ly recognized American Indian tribes races and 5.7 for white infants. prenatal data and identify what factors at regional and national levels. USET n Childhood immunization coverage may influence infant death. In addition, serves about 60,000 American Indians for USET tribes is well below Healthy 23 tribes are collecting mortality data in 12 states. People 2010 goals. For example, that will be linked with birth records. n USET’s REACH project is working 74% of children aged 19–35 months n USET helps tribes conduct local surveil- to promote healthy lifestyles and to received all recommended immuniza- lance for immunization coverage and reduce health disparities, particularly tions in 2005. The Healthy People vaccine-preventable disease incidence in immunization and infant mortality 2010 goal is 90%. and then link the data collected with rates, among American Indians. n The incidence of vaccine-preventable state immunization registries. We also n USET’s Tribal Epidemiology Center helps disease among American Indians is not help tribes develop community-specific tribes implement and enhance disease interventions. surveillance systems for their communi- n USET provides training, technical sup- ties. The resulting data can be used to port, information sharing, and coordina- guide public health policy and activities, tion of activities between tribal, local, prioritize health objectives, and monitor Racial and Ethnic Approaches state, and federal public health groups. progress toward meeting these objec- to Community Health (REACH) n USET also assesses tribal-level data to tives. The data also help tribes develop, is a community-based public identify and address gaps in the data implement, and evaluate disease health program funded by CDC and improve data quality. prevention and control programs. to eliminate racial and ethnic health disparities. www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources astern Band of Cherokee; Mississippi Band of Choctaw; Miccosukee Tribe; ESeminole Tribe of Florida; Chitimacha Tribe of Louisiana; Seneca Nation of Indians; Coushatta Tribe of Louisiana; St. Regis Band of Mohawk Indians; Penobscot Indian Nation and the Passamaquoddy Tribes; Houlton Band of Maliseet Indians; Tunica-Biloxi Indians of Louisiana; Poarch Band of Creek Indians; Narragansett Indian Tribe; Mashantucket Pequot Tribe; Wampanoag Tribe of Gay Head (Aquinnah); Alabama-Coushatta Tribe of Texas; Oneida Indian Nation; Aroostook Band of Micmac Indians; Catawba Indian Nation; Jena Band of Choctaw Indians; Mohegan Tribe of Connecticut; Cayuga Nation.
Our Achievements is as complete as possible, and we will Keys to Lasting Change in n Of the 24 USET tribes, 83% are continue to provide mortality reports to American Indian Communities participating in the Infant Mortality tribal programs. USET will work to estab- For projects to succeed in American Project. lish data-sharing agreements with state Indian communities, we must build n The number of tribes using immuni- agencies and to improve relationships relationships with community members. zation registries has increased from between states and tribes. We will pro- Because community support is key, 9 to 21. The number of American vide prenatal care, assessment reports, leaders of projects such as REACH Indian children whose immunization and recommendations to tribal programs must show how these projects will serve coverage is now being tracked has to help reduce infant deaths. and benefit local residents. Consistent increased threefold. communication between project leaders n USET has provided training to tribes Getting the Word Out Locally and communities also is important. on how to use immunization registries, n USET produces and distributes annual and we have helped tribes gain access reports on tribal-specific, aggregated In the past, the relationship between to registries in their respective states. data on immunization coverage and researchers and communities was often n USET produces and distributes annual infant death rates. one-sided. The researchers dictated the reports on tribal-specific data, immuni- process, even when community members zation coverage, and infant death Generating New and knew from experience that a different rates. These reports provide an over- Exciting Science approach would be more effective. In view of tribal programs and help the n “Building Immunization Surveillance contrast, USET projects promote community tribes monitor their progress. Capacity in Tribal Health Programs.” participation and empowerment, which Presented at the Office of Minority are important factors in achieving lasting Our Future Health National Leadership Summit on change. Our projects are also flexible USET will continue to provide technical Eliminating Racial and Ethnic Disparities enough to allow for changes that help assistance and training for our tribal in Health, Washington, DC, January to ensure sustainability. In addition, we immunization programs. We also will 9–11, 2006. have found that sharing the results of continue to focus on improving immuni- n “Building Immunization Surveillance these projects in annual reports to the zation rates at the community level. We Capacity in Tribal Health Programs.” affected communities is key to maintaining will assess data quality for each tribe to Presented at the 2006 National Immu- community support and making progress ensure that the tribal health data system nization Conference, Atlanta, Georgia, toward meeting our health goals. March 6–9, 2006.
For More Information
John Mosely Hayes, DrPH, MBA, MSPH, Immunizations Project; Chris Compher, MHS, Mortality Project, USET, Inc. 711 Stewarts Ferry Pike, Suite 100, Nashville, TN 37214 Phone: 615-872-7900 • Fax: 615-872-7417 E-mail: [email protected] • Web site: http://www.usetinc.org RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“As a promotora de salud [lay health worker], I feel that we best help our community when we promote ‘una vida sana y buena’ [‘a healthy and good life’]!” —A promotora de salud working with the REACH project
REACHing Hispanic Older Adults in the Texas Coastal Bend Area
Who We Are Medicare patients each year, which is giving us insight into the unique experi- The Latino Education Project (LEP) nearly three times the national average ences and diverse backgrounds of our coordinates the REach Project in the of 1.6 per 1,000. target population. Texas Coastal Bend. n Lack of access to timely and affordable n We have found that people can make health care, lack of transportation, and healthy lifestyle changes, such as n This project promotes awareness of the high levels of poverty are typical of eating a healthy diet and being more need for early screening and diagnosis many rural communities in the Coastal physically active, if interventions are to prevent diabetes and its complications Bend. These problems contribute to accessible and appropriate for their among Hispanic older adults and their the high incidence of diabetes and its culture and age. families living in the Texas Coastal Bend. complications among residents. n We also have found that increasing n The Coastal Bend is a 12-county area community capacity for self-help and located along the south-central Gulf The Solution empowerment will build community Coast shore of Texas. It includes the city n LEP has implemented interventions to ownership for health problems. of Corpus Christi. prevent and control diabetes at indi- n LEP is a community-based, nonprofit vidual, family, and community levels. Our Achievements group that uses innovative approaches to n We partner with more than 25 commu- n Lay health workers, called promotores help people improve their health. These nity groups, as well as local health care de salud in Spanish, are expected to be approaches take into account the age providers, educators, business people, leaders in creating social and economic and diverse experiences of the target and older adults. These community conditions that help people control population. members provide input to our programs, and manage their health. They are certified by the state and considered The Problem valuable members of the health care n Nearly 34% of the Hispanic older Racial and Ethnic Approaches workforce. adults living in the Texas Coastal Bend to Community Health (REACH) n For its interventions, LEP first identifies have diabetes or complications from is a community-based public the desired health outcome, and then diabetes, including heart disease, renal health program funded by CDC identifies the knowledge and skills disease, blindness, and amputations. to eliminate racial and ethnic needed to achieve this outcome. Then, n The City of Corpus Christi averages 4.4 health disparities. we find promotores de salud who have lower-extremity amputations per 1,000 www.cdc.gov/reach the necessary knowledge and skills.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources hild Protective Services; Coordinator Congregational Health Ministry; CRegional Cancer Center; American Cancer Society; Texas Cooperative Extension Service; CHRISTUS Spohn South Health Systems; City of Corpus Christi Senior Community Services; Community Service Aide, Nueces County Health Department.
Our Achievements, cont. adults living in the Coastal Bend. We will n “Looking Back, Moving Forward—REACH n Promotores de salud conduct free refine our data management system to 2010: Promotores de Salud in Commu- 12-week discussion groups for older increase our ability to evaluate our interven- nity Building Strategy.” Presented at the adults called Study Circles. Discussions tions. We will increase the scope and range California REACH 2010 Conference, Los include a wide variety of health topics, of our media programs to reach more resi- Angeles, California, May 17, 2006. including diabetes, nutrition, exercise, dents and to find new partners to expand n “Betting on Health Education: Increasing and medication management. the reach of the REACH project. the Odds for Collaboration.” Presented n We hold biannual, community-wide at the Society for Public Health Education health forums that bring together Getting the Word Out Locally (SOPHE) 2006 Midyear Scientific Confer- approximately 400 community stake- n Nuestra Salud, LEP quarterly newsletter. ence, Las Vegas, Nevada, May 4–7, 2006. holders who support the goals and n “Perks of Getting Older: Recognizing objectives of the REACH project. Benefits of Exercise, Insurance Firms, Keys to Lasting Change in the n LEP’s diabetes prevention and control Community Centers Offer Free Classes Hispanic Older Adult Community efforts are enhanced by health literacy to Seniors,” Corpus Christi Caller-Times: The Hispanic older adult community must programs, educational programs that Mi Vida, January 2005. take ownership of the diabetes problem, its teach people how to manage their medi- complications, and the obesity crisis that is cations, and wide media coverage of our Generating New and devastating Hispanic communities in South health forums. Exciting Science Texas and the Coastal Bend. Residents, n We built on the REACH project to n “Building Community Capacity for Health health care providers, and local stakehold- provide other services to isolated, rural, Promotion in a Hispanic Community.” ers can bring their unique experiences and and low-income older adults and their Preventing Chronic Disease [serial online] diverse backgrounds together to support families. These services include afford- 2007;4(1). Available at http://www.cdc. and expand activities that promote health. able housing, a low-income tax clinic, gov/pcd/issues/2007/jan/06_0086.htm. Interventions designed to promote healthy and a Senior Medicare Patrol program. n “Reaching for the Stars: Innovative Tools lifestyles and well-being must take into for the Trade.” Presented at the Annual account the cultures, languages, and Our Future Conference of the Texas Society for traditions of local residents. In addition, LEP will continue to identify best practices Public Health Education, Houston, Texas, the traditional medical establishment must in the early prevention and treatment of September 22–23, 2006. accept community-based, nonprofit groups diabetes that can be used to help older as legitimate partners in these efforts.
For More Information
Frances Pawlik, Executive Director, Latino Education Project 1045 Airline Rd., Suite 2, Corpus Christi, TX 78412 Phone: 361-980-0361 • Fax: 361-980-0951 E-mail: [email protected] Web site: http://www.latinoeducationproject.org RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“I am very happy with this aerobics class. I am a mother of six children, I’m 30 years old, and I almost hit 290 on the scale. This class has really helped me on different levels. My weight dropped to 270 in 3 weeks. My self-esteem picked up, and my health has improved. This program does a lot for people like me who don’t have time and resources to exercise.”
—Marilu Sifuentes, REACH program participant
REACHing Mexican Americans on the Texas-Mexico Border
Who We Are The Problem chose diabetes as the leading health Migrant Health Promotion coordinates n In 1997, the estimated prevalence of problem in the Rio Grande Valley. the REACH Promotora Community diabetes for residents in Cameron and n Residents offered several solutions to Coalition. Hidalgo counties was 23% and 18%, address this problem. These solutions respectively, compared with 5.9% for included improving access to clinics, n Migrant Health Promotion is a commu- all Texas residents. hospitals, specialists, medications, and nity organization that serves counties n The diabetes death rate for residents in other medical services for low-income with predominantly Mexican-American the Rio Grande Valley of Cameron and residents; providing health education populations along the Texas-Mexico Hidalgo counties is nearly twice the and information in residents’ homes, border. rate for the rest of the state. schools, churches, and supermarkets; n The group develops, implements, n Rates of poverty, unemployment, and and creating a community environment and evaluates programs that use peer underemployment are high among that encourages healthy behaviors. health educators, called promotores border residents. Many residents also n The REACH Promotora Community and promotoras in Spanish, to bring lack transportation and live in sub- Coalition developed a community action information, resources, and improved standard housing or neighborhoods plan that includes school-based, clinic- access to health services to their without municipal services. based, and colonia-based interventions. communities. Colonias are rural, unregulated, low- n The REACH Promotora Community The Solution income neighborhoods. Coalition developed and initiated a n More than 600 residents participated n Promotores and promotoras share community action plan to reduce in 46 community work groups and the same socioeconomic background, diabetes and its complications for language, and culture as the community residents in three communities in members they serve. Cameron and Hidalgo counties. Racial and Ethnic Approaches n Hispanics make up 86% of the to Community Health (REACH) Our Achievements population in Cameron County and is a community-based public n Our coalition enrolled more than 2,800 89% of the population in Hidalgo health program funded by CDC community residents in walking and County, compared with 35% overall to eliminate racial and ethnic nutrition classes. for the state of Texas. health disparities. n We provided diabetes self-management www.cdc.gov/reach classes to more than 800 health clinic patients with diabetes.
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources uestra Clinica del Valle; University of Texas Pan American, Border Health Office; NSu Clinica Familiar; Brownsville Community Health Center; University of Arizona, Mel and Enid Zuckerman School of Rural Public Health; Weslaco Independent School District; City of Weslaco, Parks and Recreation; Santa Rosa Independent School District; Progreso Community Center; City of Weslaco; Rio Hondo Independent School District; Los Fresnos Housing Authority; Texas A & M University, Center for Housing and Urban Development; Texas Department of State and Health Services; U.S.-Mexico Border Health Commission.
Our Achievements, cont. Getting the Word Out Locally Keys to Lasting Change in the n More than 500 parents participated n “Support Groups Hope to Prevent Mexican-American Community in diabetes education sessions at local Diabetes,” The Monitor, June 5, 2006. The REACH Promotora Community Coalition schools. n “Una Lucha Diaria Contra Diabetes,” is led by promotores/promotoras and n Our coalition received the Border El Valle, January 18, 2005. includes agencies and community members Models of Excellence Award from the n “Students Join to Fight Diabetes,” Valley committed to ending health disparities in U.S.-Mexico Border Health Commission. Morning Star, January 1, 2005. the Rio Grande Valley. The promotores/ n Before our clinic intervention, baseline n “Healthy Choices,” The Monitor, promotoras are the heart of this project data showed that 24.5% of patients November 28, 2004. because they share the same cultural, with diabetes drank whole milk. After n “Santa Rosa Warriors Walk for Diabetes,” linguistic, educational, and economic our intervention, patients reported a La Feria News, November 24, 2004. characteristics as the community members 14% decrease in their consumption of they serve. They advocate for diabetes whole milk. Generating New and awareness, education, and self-management n Moderate walking increased by 25% Exciting Science programs in their communities, and they among community residents. n “Promotora-Led Changes in Nutrition promote systems and policy changes to and Physical Activity Among Hispanic encourage healthy behaviors. Our Future Residents of the Texas Rio Grande Valley.” The REACH Promotora Community Presented at the 134th Annual Meeting Our community action plan’s integrated Coalition is duplicating its intervention in of the American Public Health Associa- strategies are supported by ongoing capacity two other communities in Texas. We plan tion, Boston, Massachusetts, building, training, program development, to disseminate our data in journals and at November 7, 2006. and evaluation activities. Our coalition state and national conferences. We also n “REACH 2010 Community Health Work- combines health education with advocacy will continue to work with local and state ers Use Community Forums to Promote for community and systems changes that policy makers to improve the health of Strategic Action and Policy Change in support healthy lifestyles. residents in the lower Rio Grande Valley. Their Communities.” Presented at the 134th Annual Meeting of the American Public Health Association, Boston, Massachusetts, November 6, 2006.
For More Information
Rebecca Garza, PhD, Principal Investigator, Migrant Health Promotion P.O. Box 337, Progreso, TX 78579 Phone: 956-565-0002 • Fax: 956-565-0136 E-mail: [email protected] • Web site: http://www.migranthealth.org RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
“Well, I have learned a lot since I have been coming to the diabetes classes, and I try to keep up with everything I hear. I have learned a lot about taking care of myself and what to eat.” —African American participant in a REACH diabetes class
REACHing African Americans, Asian Americans, and Latinos in Seattle and King County, Washington
Who We Are n The diabetes death rate for Latinos in n We provided support groups, peer Public Health - Seattle & King County King County is 62% higher than the education, self-management classes, coordinates the Seattle & King County rate for whites. faith-based education, and case REACH 2010 Coalition. n Members of several Asian American management services. and Pacific Islander groups have higher n We also provided interpreter services n Coalition partners include community rates of undiagnosed diabetes than and translated educational materials members, community groups, and com- whites. The diabetes death rate for this into Cambodian, Chinese (Cantonese munity health centers; local health care population in King County is slightly and Mandarin), Filipino, Korean, providers; public health professionals; higher than the rate for whites. Spanish, Samoan, and Vietnamese. and researchers at the University of Washington. The Solution Our Achievements n The coalition’s goal is to reduce n To address these health disparities, n In 2002, we collaborated with the Wash- health disparities related to diabetes our coalition first assessed the status ington State Department of Health to train among African Americans, Asian of diabetes prevention and control 21 peer and health educators at local Americans and Pacific Islanders, and efforts in minority communities in community health centers in the Spanish Latinos living in Seattle and King Seattle and King County. Then, we version of the Chronic Disease Self- County, Washington. developed and implemented an Management Program. Previously, only intervention plan that reflected the two people nationwide had been trained The Problem cultures and languages of the target to teach this program in Spanish. n In general, minority populations in populations. n The percentage of people participating the United States have higher rates of in our interventions who were able to diabetes-related deaths, complications, keep their blood sugar level under control and risk factors. In addition, they often Racial and Ethnic Approaches increased from 48% to 56%. have limited access to health care to Community Health (REACH) n The percentage of participants who said services and health insurance. is a community-based public they were confident they could stick to n The diabetes death rate for African health program funded by CDC their diet increased from 56% to 69%. Americans in King County is 3.5 times to eliminate racial and ethnic higher than the rate for whites. health disparities. www.cdc.gov/reach
U.S. Department of Health and Human Services centers for disease control and prevention Mobilizing Community Resources ging and Disability Services; American Diabetes Association; American Heart Association; AAmerican Lung Association; Center for MultiCultural Health; Harborview Medical Center; International Community Health Services; Kin On Health Centers; National Asian Pacific Center on Aging; Urban Impact, Rainer Health and Fitness; Pacific Northwest Research Institute; Public Health - Seattle & King County; Qualis Health; Sea Mar Community Health Centers; Seattle Indian Health Board; Senior Services of Seattle/King County; University of Washington, School of Nursing, School of Nutritional Sciences, Health Promotion Research Center, School of Public Health and Community Medicine; Washington State Department of Health; Center for Health Training; Eli Lilly; Northwest Kidney Center; Urban Indian Health Institute; Washington Health Foundation; Washington State University Extension.
Our Achievements, cont. Generating New and and educational materials to reflect the n The percentage of participants who said Exciting Science cultures and languages of the target their health was good, very good, or n “A Community-Based Participatory populations. We also found that hiring excellent increased from 34% to 39%. Theater Project to Educate Latinos bilingual and bicultural staff members and n The percentage of participants who report- About Diabetes.” Presented at the serving culturally appropriate foods at ed being more physically active increased 134th Annual Meeting of the American events is important. from 75% to 86%. Public Health Association, Boston, Massachusetts, November 6, 2006. In addition, we learned the value of identi- Our Future n “Building and Sustaining a Multicultural fying key community members and groups The Seattle & King County REACH 2010 Partnership.” Presented at the Midyear to work with and making time to develop Coalition will explore the possibility of Scientific Conference of the Society for relationships and trust. This approach will expanding its focus to include other Public Health Education (SOPHE), open many doors for recruitment, service diabetes-related diseases, such as heart Las Vegas, Nevada, May 4–7, 2006. delivery, and research. For the African disease and obesity. n “A Community-Based Approach to American community, successful outreach Diabetes Control in Multiple Cultural strategies include working with beauty Getting the Word Out Locally Groups.” Ethnicity & Disease 2004; salons and the faith community. n “Diabetes Not Equal Opportunity 14(3, suppl 1):83–93. Disease,” Seattle Post Intelligencer, n “Learning from the Community: The For Asian Americans and Pacific Islanders, February 7, 2006. Challenges and Rewards of Diabetes outreach strategies varied. We partnered n “Community Clinic Encourages Patients Interventions Among Culturally Diverse with community groups and associations to Learn About Their Risks for Diabetes,” Populations.” Presented at the 132nd to reach Chinese, Filipino, and Vietnamese International Examiner, December 6, Annual Meeting of the American Public residents. We partnered with churches and 2005. Health Association, Washington, DC, the faith community to reach Korean and n “Diabetes: Una Epidemia en Auge— November 9, 2004. Samoan residents. For the Latino commu- Es La Séptima Causa de Muerta en el nity, churches were critical for outreach Condado de King,” Sea Latino, Keys to Lasting Change in activities and service delivery. We also November 18, 2005. Minority Communities used promotoras (Spanish for “lay health Our coalition found that the most workers”) to reach Latino residents. successful strategy is to tailor interventions
For More Information
Blishda Lacet, MPH, MBA, REACH Program Manager, Public Health - Seattle & King County 999 3rd Ave., Suite 500, Seattle, WA 98104 Phone: 206-296-7621 • Fax: 206-205-3919 E-mail: [email protected] • Web site: http://www.metrokc.gov/health/REACH Index
REACH Communities by Racial and Ethnic Group African American African American Health Coalition, Inc.: REACH African American Health Coalition...... 69 Black Women’s Health Imperative: REACH 2010: At the Heart of New Orleans Coalition...... 27 Boston Public Health Commission: Boston REACH 2010 Breast and Cervical Cancer Coalition...... 29 Boston Public Health Commission: REACH Boston Elders 2010...... 31 Carolinas HealthCare System: Charlotte REACH 2010 Coalition...... 59 Center for Community Health, Education & Research, Inc.: Metropolitan Boston Haitian REACH 2010 HIV Coalition...... 33 Community Health Councils of Los Angeles: African Americans Building a Legacy of Health...... 7 Fulton County Department of Health and Wellness: REACH for Wellness...... 19 Genesee County Health Department: Genesee County REACH 2010 Team...... 41 Matthew Walker Comprehensive Health Center: Nashville Health Disparities Coalition REACH 2010 Project...... 73 Medical University of South Carolina: REACH 2010 Charleston and Georgetown Diabetes Coalition...... 71 San Francisco Department of Public Health: SevenPrinciples Project...... 11 University of Alabama at Birmingham: Alabama REACH 2010 Breast and Cervical Cancer Coalition...... 3 University of Nevada, Reno: Healthy Hearts Project...... 45 African American, Asian American, PacificI slander, and Hispanic/Latino Public Health - Seattle & King County: Seattle & King County REACH 2010 Coalition...... 81 African American and Hispanic/Latino Access Community Health Network and University of Illinois at Chicago: REACH Out...... 21 Chicago Department of Health: REACH 2010/Lawndale Health Promotion Project...... 23 Community Health & Social Services Center, Inc.: REACH Detroit Partnership...... 39 Florida International University: Coalition to Reduce HIV in Broward’s Minority Communities...... 17 Institute for Urban Family Health: Bronx Health REACH Coalition...... 55 Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center: Immunize LA Kids Coalition...... 9 Mailman School of Public Health of Columbia University: Northern Manhattan Start Right Coalition...... 57 Missouri Coalition for Primary Care: Kansas City - Chronic Disease Coalition...... 43 New Hampshire Minority Health Coalition: New Hampshire REACH 2010 Initiative...... 47 University of Illinois at Chicago: Chicago Southeast Diabetes Community Action Coalition...... 25 American Indian Eastern Band of Cherokee Indians: Cherokee Choices/REACH 2010 Diabetes Prevention Program...... 61 Oklahoma State Department of Health: Oklahoma Native American REACH 2010 Project...... 67 American Indian/Alaska Native Albuquerque Area Indian Health Board, Inc.: Partners in Tribal Community Capacity Building (REACH 2010) Project...... 49 Association of American Indian Physicians: Oklahoma REACH HIV/AIDS American Indian Capacity Building...... 63 Choctaw Nation of Oklahoma: Choctaw Nation Core Capacity Building Program...... 65 Chugachmiut Native Organization: Alaska Native Cardiovascular Disease Prevention/Core Capacity Building Project...... 5 National Indian Council on Aging: Diabetes Educational Outreach Strategies Project...... 53 United South and Eastern Tribes, Inc.: REACH 2010 Immunization and Infant Mortality Project...... 75 Asian American Lowell Community Health Center: Cambodian Community Health 2010 Program...... 37 Special Services for Groups, Inc.: REACH 2010/Health Access for Pacific Asian Seniors...... 13 University of California, San Francisco: Vietnamese REACH for Health Initiative Coalition...... 15
83 Hispanic/Latino Greater Lawrence Family Health Center: REACH 2010 Latino Health Project...... 35 Hidalgo Medical Services: La Vida Program...... 51 Latino Education Project: REACH Latino Education Project...... 77 Migrant Health Promotion: REACH Promotora Community Coalition...... 79
REACH Communities by Health Priority Area Breast and Cervical Cancer Access Community Health Network and University of Illinois at Chicago: REACH Out...... 21 Albuquerque Area Indian Health Board, Inc.: Partners in Tribal Community Capacity Building (REACH 2010) Project...... 49 Boston Public Health Commission: Boston REACH 2010 Breast and Cervical Cancer Coalition...... 29 University of Alabama at Birmingham: Alabama REACH 2010 Breast and Cervical Cancer Coalition...... 3 University of California, San Francisco: Vietnamese REACH for Health Initiative Coalition...... 15 Cardiovascular Disease African American Health Coalition, Inc.: REACH African American Health Coalition...... 69 Black Women’s Health Imperative: REACH 2010: At the Heart of New Orleans Coalition...... 27 Choctaw Nation of Oklahoma: Choctaw Nation Core Capacity Building Program...... 65 Chugachmiut Native Organization: Alaska Native Cardiovascular Disease Prevention/Core Capacity Building Project...... 5 Fulton County Department of Health and Wellness: REACH for Wellness...... 19 University of Nevada, Reno: Healthy Hearts Project...... 45 Diabetes Community Health & Social Services Center, Inc.: REACH Detroit Partnership...... 39 Eastern Band of Cherokee Indians: Cherokee Choices/REACH 2010 Diabetes Prevention Program...... 61 Hidalgo Medical Services: La Vida Program...... 51 Medical University of South Carolina: REACH 2010 Charleston and Georgetown Diabetes Coalition...... 71 Migrant Health Promotion: REACH Promotora Community Coalition...... 79 National Indian Council on Aging: Diabetes Educational Outreach Strategies Project...... 53 New Hampshire Minority Health Coalition: New Hampshire REACH 2010 Initiative...... 47 Public Health - Seattle & King County: Seattle & King County REACH 2010 Coalition...... 81 University of Illinois at Chicago: Chicago Southeast Diabetes Community Action Coalition...... 25 Diabetes and Cardiovascular Disease Boston Public Health Commission: REACH Boston Elders 2010...... 31 Carolinas HealthCare System: Charlotte REACH 2010 Coalition...... 59 Chicago Department of Health: REACH 2010/Lawndale Health Promotion Project...... 23 Community Health Councils of Los Angeles: African Americans Building a Legacy of Health...... 7 Greater Lawrence Family Health Center: REACH 2010 Latino Health Project...... 35 Institute for Urban Family Health: Bronx Health REACH Coalition...... 55 Latino Education Project: REACH Latino Education Project...... 77 Lowell Community Health Center: Cambodian Community Health 2010 Program...... 37 Matthew Walker Comprehensive Health Center: Nashville Health Disparities Coalition REACH 2010 Project...... 73 Missouri Coalition for Primary Care: Kansas City - Chronic Disease Coalition...... 43 Oklahoma State Department of Health: Oklahoma Native American REACH 2010 Project...... 67
84 HIV/AIDS Association of American Indian Physicians: Oklahoma REACH HIV/AIDS American Indian Capacity Building...... 63 Center for Community Health, Education & Research, Inc.: Metropolitan Boston Haitian REACH 2010 HIV Coalition...... 33 Florida International University: Coalition to Reduce HIV in Broward’s Minority Communities...... 17 Immunization Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center: Immunize LA Kids Coalition...... 9 Mailman School of Public Health of Columbia University: Northern Manhattan Start Right Coalition...... 57 Immunization, Diabetes, and Cardiovascular Disease Special Services for Groups, Inc.: REACH 2010/Health Access for Pacific Asian Seniors...... 13 Immunization and Infant Mortality United South and Eastern Tribes, Inc.: REACH 2010 Immunization and Infant Mortality Project...... 75 Infant Mortality Genesee County Health Department: Genesee County REACH 2010 Team...... 41 San Francisco Department of Public Health: SevenPrinciples Project...... 11
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