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Early Findings from the East Harlem Neighborhood Health Action Center

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Early Findings from the East Harlem Neighborhood Health Action Center Journal of Community Health (2020) 45:161–169 https://doi.org/10.1007/s10900-019-00712-y ORIGINAL PAPER The Neighborhood as a Unit of Change for Health: Early Findings from the East Harlem Neighborhood Health Action Center Rachel Dannefer1 · Barbara C. Wong2 · Padmore John1 · Jaime Gutierrez1 · La’Shawn Brown‑Dudley1 · Kim Freeman3 · Calpurnyia Roberts3 · Elana Martins4 · Ewel Napier4 · Philip Noyes4 · Hannah Seoh2 · Jane Bedell3 · Cassiopeia Toner2 · Torian Easterling4 · Javier Lopez5 · Noel Manyindo1 · Karen Aletha Maybank6 Received: 11 June 2019 / Revised: 9 July 2019 / Accepted: 25 July 2019 / Published online: 26 August 2019 © The Author(s) 2019 Abstract Place-based approaches have been promoted as one way to reduce health inequities by addressing community-level factors that shape health, such as housing quality, healthcare systems, the built environment, and social capital. In 2016–2017, the NYC Health Department’s Center for Health Equity launched three Neighborhood Health Action Centers (Action Centers), which use a place-based approach to improve health in neighborhoods with disproportionate burdens of premature mortality. We describe this approach and the genesis of the Action Centers. We then describe the East Harlem Action Center, which was the frst to open, and share fndings from qualitative interviews with the East Harlem Action Center’s Governance Council, a group comprised of Action Center staf and co-located partners and programs which supports Action Center coordination. Interviewees felt that collaboration, being responsive to community needs, and being community based were essential ele- ments of the Action Center. Interviewees recognized the complex dynamic of a large city agency serving as the host for the Action Center while simultaneously aiming to establish more equitable relationships with partners. Governance Council members’ expectations and hopes for the East Harlem Action Center were consistent with the overall vision and model for the Action Centers, which may facilitate implementation. Keywords Health equity · Place-based interventions · Collaboration · Local public health departments · Service co-location Introduction * Rachel Dannefer [email protected] Though New York City (NYC) is one of the wealthiest cities in the United States, it is also one of the most economically 1 Harlem Neighborhood Health Action Centers, Center unequal and racially segregated. Since the colonization of for Health Equity, NYC Department of Health and Mental NYC in the 1600’s, racially-based discriminatory practices Hygiene, 161-169 East 110th Street, New York, NY 10029, USA have directed where people live and the resources available in their neighborhoods [1]. The cumulative impact of these 2 Division Management, Center for Health Equity, NYC Department of Health and Mental Hygiene, Long Island City, processes has led to stark diferences between neighbor- NY, USA hoods based on race and wealth, afecting issues such as 3 Bronx Neighborhood Health Action Centers, Center housing conditions and public resources and contributing for Health Equity, NYC Department of Health and Mental to deep and persistent health inequities. Hygiene, Bronx, NY, USA Place-based approaches have been promoted as a way to 4 Brooklyn Neighborhood Health Action Centers, Center reduce health inequities by addressing community-level fac- for Health Equity, NYC Department of Health and Mental tors that shape health, such as housing quality, healthcare Hygiene, Brooklyn, NY, USA systems, the built environment, and social capital [2]. In 5 Systems Partnerships, Center for Health Equity, NYC 2016–2017, the Center for Health Equity at the NYC Depart- Department of Health and Mental Hygiene, Long Island City, ment of Health and Mental Hygiene (Health Department) NY, USA launched three Neighborhood Health Action Centers (Action 6 Center for Health Equity, NYC Department of Health Centers), which use a place-based approach to improve and Mental Hygiene, Long Island City, NY, USA Vol.:(0123456789)1 3 162 Journal of Community Health (2020) 45:161–169 Fig. 1 NYC Health Department Neighborhood Health Action Centers, 2017 health in neighborhoods with disproportionate burdens of interrelated forms of oppression such as racism, inequitable premature mortality (Fig. 1). The Action Centers are part of wealth distribution, diferential access to community power a neighborhood strategy that co-locates clinical and commu- and resources, and the resulting poor health outcomes with nity-based services, leverages a referral system to facilitate the long-term goal of eliminating inequities in infant and linkages across service providers and meet residents’ social premature mortality and self-reported health. and health needs, ofers a vibrant community space and local The Action Centers bring together a number of evidence- programming, and seeks to engage communities and amplify based approaches to improve health. Co-location of commu- community power to bring the lived experiences and input of nity-based resources, multi-disciplinary services, and devel- marginalized groups to greater prominence to afect policy opment of referral systems have been identifed as efective and systems change. Recognizing neighborhoods as a key strategies to address social determinants of health, provide unit of social transformation, Action Centers aim to address preventive services, and improve health outcomes [3, 4]. 1 3 Journal of Community Health (2020) 45:161–169 163 Interventions employing broad-based community collabo- convening space, host community events, feature common ration and partnerships have also been efective in address- spaces to foster cross-sector interaction, and ofer a wide ing social determinants of health and improving community spectrum of programs—from art exhibitions to legal ser- health [5]. However, to our knowledge, the Action Centers vices—to promote health. The Action Centers have two geo- are the frst instance of a local health department bringing graphic boundaries. The Action Center “neighborhood” is together co-location, a referral and linkage system, coordi- the community district in which the Action Center building nation and community engagement, and eforts to amplify is located, while the “catchment area” includes additional community power for a place-based approach to improve community districts that defned the District Public Health neighborhood health. Ofce areas (Fig. 1). In this paper, we discuss our neighborhood strategy and the genesis of the Action Centers. We then describe the Neighborhood Strategy East Harlem Action Center, which was the frst to open, and share fndings from interviews with its Governance Council, The Action Centers are part of a neighborhood strategy that which supports coordination for the Action Centers. These is informed by reimagining the neighborhood health center interviews explored early expectations for and implementa- movement that started in East Harlem in 1921, and more tion of the East Harlem Action Center. contemporarily by the Bay Area Regional Health Inequi- ties Initiative framework, which illustrates the connections between health and social inequalities [6, 7]. The framework Background encourages the public health community to shift from its traditionally “downstream” focus on individual behaviors The Genesis of the Action Centers to focus on the “upstream” factors of social and institutional inequities and living conditions [7]. The Action Centers The Action Centers build on the legacy of NYC’s District were also inspired by other models of co-location, includ- Health Center movement, which began in 1921 with a pilot ing the settlement house movement, and by the Community- project in East Harlem to co-locate health services, welfare Centered Health Home model [8, 9]. agencies and community-based organizations to coordinate The neighborhood strategy is comprised of three com- health and social services for the neighborhood [6]. Based ponents to address social and institutional issues that afect on this project’s success, District Health Centers were rep- health (Fig. 2). The frst is co-location of services and a licated in other NYC neighborhoods until World War II and referral system to better serve residents, coordinate ser- other events led to their defunding as resources went else- vices, and identify gaps in coverage and reduce duplica- where. In 2003, under then-Deputy Commissioner Dr. Mary tion. The second is innovation in programs and policies by T. Bassett, the Health Department renewed its neighborhood using data and resident expertise to ensure that programs, focus by establishing District Public Health Ofces. These systems, and policies are responsive to neighborhood needs ofces promoted health equity through resources, program- and gaps, and to leverage the Health Department’s power to ming and partnerships in NYC neighborhoods with the high- coordinate with other city agencies to improve neighborhood est rates of illness and premature death: the South Bronx, conditions. The third is community engagement, action and East and Central Harlem, and North and Central Brooklyn. impact through collaboration with community-based organi- In 2014, Dr. Bassett was appointed Health Commissioner zations and residents, with the goal of bringing community for NYC, and under her leadership advancing health equity voices to city agency decisions around resources and poli- became a clearly stated agency goal. As part of this com- cies. These components are mutually reinforcing and refect mitment
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