Health Education Specialist UAB Mid-South Regional Meeting Good morning! Thank you for inviting me to participate in your meeting. The purpose of my talk today is to discuss REACH Programs over the years. Before I start, I thought it might be helpful for you to know more about the Community Health and Equity Branch where REACH is currently located. REACH U.S.: Past, Present, & Future # 2 The focus of the branch is to: build healthier communities promote health equity eliminate health disparities provide national leadership in these areas of public health While our programs focus is on community health and health disparities, the ultimate goal is to achieve health equity. The elimination of disparities is a key part of health equity, but health equity has a broader goal. Shannon White, MPH Health Education Specialist REACH U.S. UAB Mid-South Regional Meeting August 23, 2011 #3 Since health equity has a broader focus, our programs employ multi-level strategies to achieve health equity on a national level. National Center for Chronic Disease Prevention and Health Promotion Division of Community Health (proposed)

Program Focus on Health Equity The focus of the branch is to: build healthier communities promote health equity eliminate health disparities provide national leadership in these areas of public health While our programs focus is on community health and health disparities, the ultimate goal is to achieve health equity. The elimination of disparities is a key part of health equity, but health equity has a broader goal. Program Focus on Health Equity Health equity is at the core of all our programs and activities. Health equity is achieving the highest level of health for all people. It entails focused societal efforts to address avoidable inequalities. The goal is to equalize conditions for health for all groups, especially for those experiencing socioeconomic disadvantage or historical injustices. Moving on - this map illustrates the national presence of our programs. Today, you’ll hear about these programs: REACH U.S. (shown by purple circles) REACH CORE (shown by blue squares) REACH U.S. Minority-Serving Organizations (shown by red cross marks) REHDAI program (illustrated by red stripes) Healthy People 2020 2

A National, Multilevel Approach Moving on - this map illustrates the national presence of our programs. Today, you’ll hear about these programs: REACH U.S. (shown by purple circles) REACH CORE (shown by blue squares) REACH U.S. Minority-Serving Organizations (shown by red cross marks) REHDAI program (illustrated by red stripes) INDIVIDUAL Education Income Wealth Occupation Race Age Gender Genetics Health behaviors Health Resources Health beliefs 2. INTERPERSONAL Family Peers Neighbors 3. ORGANIZATIONAL Stores and community shops/marketplaces Community groups/organizations Police Schools Health care providers/institutions Employers Churches and other Faith-based institutions Transit system/public transportation 4. COMMUNITY/ENVIRONMENT Physical Environment Healthy foods Exercise/play areas Built environments Public Safety Pollution/toxins 2. Social/Cultural Environment Health-related norms Community capacity Community relationships Community assets 5. SOCIETY/SOCIETAL CONDITIONS Other policy (e.g., education, economic, urban planning, housing, criminal justice) Segregation Racism and discrimination Economic conditions Health policy Marketing of lifestyle choices Media Programs and Activities A National, Multilevel Approach

Racial and Ethnic Approaches to Community Health (REACH) Goals of the REACH program: Support grantee partners to establish and/or support community based programs Use interventions that are culturally-tailored Ultimately, eliminate health disparities among racial and ethnic minority groups. Racial and Ethnic Approaches to Community Health (REACH) The REACH program began in 1999 and was closely aligned with the Healthy People 2010 goals. The current REACH U.S. program began in 2007. It was built on knowledge learned from earlier projects. There are 40 REACH grantee partners throughout the U.S. The program uses community-based participatory approaches – community coalitions are a critical part of the program REACH U.S. also has a focus on dissemination which is a task of the 18 Centers of Excellence for the Elimination of Disparities, or CEEDS, which implement, coordinate, refine, and disseminate programmatic activities and also provide pilot funding to Legacy Projects. There are 22 Action Communities who implement and evaluate successful practice-based or evidence-based approaches to impact population groups rather than individuals. REACH also Supports 6 minority-serving national organizations to enable sharing of evidence and practice-based programs with local affiliates and chapters which I will discuss shortly. Cornerstone of CDC efforts to eliminate racial and ethnic health disparities Program began in 1999 Was aligned with Healthy People 2010 goals Became REACH Across the U.S. (REACH U.S.) in 2007 REACH U.S. program is funded through 2012 REACH U.S. communities identify a particular health disparity to target. Several communities choose to focus on more than one health priority area and/or more than one racial/ethnic group. The program has 8 health priority areas and 5 priority populations that are listed here. Next you’ll hear more about some of the early successes that have been identified from some of the grantees.

Today, you’ll hear about these programs: Moving on - this map illustrates the national presence of our programs. Today, you’ll hear about these programs: REACH U.S. (shown by purple circles) REACH CORE (shown by blue squares) REACH U.S. Minority-Serving Organizations (shown by red cross marks) REHDAI program (illustrated by red stripes) (Individual/interpersonal/institutional level change) Bronx Health REACH has achieved important neighborhood changes by working on food supply chain issues – as a result, neighborhood grocers now carry low-fat milk and healthier snacks. Local restaurants now highlight their healthy menu options. And, the community has supported a city-wide policy decision to switch from whole milk to low-fat milk in New York City schools. Obesity data (1/4 obese) from 2003-2005, which is the time of the campaign – public school children. “1% or less campaign” began in the Bronx, with the Bronx Health REACH Coalition – already working on community education and environmental strategies to reduce health disparities – played a leading role in the effort along with other partners. South Bronx is poorest urban Congressional district in US – very diverse (African Americans, Caribbean American and Latinos from Central America, West African immigrants) In a system that serves 120 million containers of milk per year, this effort was met with pressure from the American Dairy Council and skepticism from school food administrators and elected officials. Parents, educational leaders, advocates, and health professionals collaborated to educate school children and their families to choose low-fat milk. Research published in MMWR Weekly in January 2010 found that while total DOE per student school milk purchases declined 8% from 2004-2006, purchases then gradually began increasing, and by 2009, DOE per student milk purchases (adjusted for school system enrollment) had increased 1.3%, from 112 per student in 2004 to nearly 114 in 2009.

Socio-Ecological Model Here, is a depiction of the Socio-ecological model in which our programs are based. We know that working on the outer rings of the model will ultimately improve the health of individuals and communities.

REACH Through the REACH program: Goals of the REACH program: Support grantee partners to establish and/or support community based programs Use interventions that are culturally-tailored Ultimately, eliminate health disparities among racial and ethnic minority groups. Through the REACH program: CDC supports grantee partners to establish and/or support community-based programs and culturally-tailored interventions to eliminate health disparities among racial and ethnic minority groups.

Breast and cervical cancer Cardiovascular disease Priority Health Areas Adult immunizations Asthma Breast and cervical cancer Cardiovascular disease Diabetes mellitus Infant mortality Hepatitis B Tuberculosis Racial/Ethnic Groups African Americans American Indians and Alaska Natives Asian Americans Hispanics/Latinos Pacific Islanders REACH U.S. communities identify a particular health disparity to target. Several communities choose to focus on more than one health priority area and/or more than one racial/ethnic group. The program has 8 health priority areas and 5 priority populations that are listed here. Next you’ll hear more about some of the early successes that have been identified from some of the grantees.

Institute for Urban Family Health Example: REACH U.S. CEED Program Institute for Urban Family Health (New York, New York) Mooove to 1% or Less – Yes! Changing the Milk Policy in New York City Schools Bronx Health REACH has achieved important neighborhood changes by working on food supply chain issues – as a result, neighborhood grocers now carry low-fat milk and healthier snacks. Local restaurants now highlight their healthy menu options. And, the community has supported a city-wide policy decision to switch from whole milk to low-fat milk in New York City schools. “1% or less campaign” began in the Bronx, with the Bronx Health REACH Coalition – already working on community education and environmental strategies to reduce health disparities – played a leading role in the effort along with other partners. South Bronx is poorest urban Congressional district in US – very diverse (African Americans, Caribbean American and Latinos from Central America, West African immigrants) In a system that serves 120 million containers of milk per year, this effort was met with pressure from the American Dairy Council and skepticism from school food administrators and elected officials. Parents, educational leaders, advocates, and health professionals collaborated to educate school children and their families to choose low-fat milk. Research published in MMWR Weekly in January 2010 found that while total DOE per student school milk purchases declined 8% from 2004-2006, purchases then gradually began increasing, and by 2009, DOE per student milk purchases (adjusted for school system enrollment) had increased 1.3%, from 112 per student in 2004 to nearly 114 in 2009. Public health issue: An estimated 120 million containers of whole milk, sweetened vanilla, chocolate, and strawberry milk are served each year in the public health system. Outcome: A citywide low-fat/skim milk only policy was put in place in NYC public schools.

Mt. Sinai School of Medicine Example: REACH U.S. CEED Program Mt. Sinai School of Medicine Save Half For Later Campaign Public health issue: Increase consumer and business awareness about portion control and its relation to obesity and diabetes. Outcome: Trained restaurant managers and staff to promote and implement portion control strategy. Mt. Sinai School of Medicine trained restaurant managers and their staff to implement portion control strategies by offering take out containers prior to serving the meal. To date, this CEED has been successful in training multiple restaurant staff.

Mt. Sinai School of Medicine Example: REACH U.S. Legacy Program Mt. Sinai School of Medicine Concrete Safaris Public health issue: To increase youth engagement in physical activities and nutrition principles as a means of early age diabetes prevention. Outcome: Enrolled more than 35 children into the program where they learned gardening as a form of exercise and about healthy eating. Concrete Safaris is an outdoor, health-based, service-learning program targeting 7-12-year old children in East Harlem. Youth grow perennials and vegetables in a third-of-an-acre space called Mad Fun Farm, the first kid-centered farm on NYC Housing Authority property. They study nutrition and physical fitness in hands-on, diabetes prevention and education sessions. The children started the first kid-run farm stand on NYC Housing Authority property during an intensive, after school and summertime, tri-weekly workshops, and receive a weekly box of fresh vegetables.

Chicago Department of Public Health Example: Action Community Chicago Department of Public Health Lawndale Christian Health Center Public health issue: Increase the proportion of the population who report meeting the daily physical activity requirement. Outcome: Lawndale Christian Health Center expanded to address access to healthcare and physical activity/nutrition resources and offers medical care on a sliding scale fee.  The Chicago Department of Public Health has been successful in increasing the proportion of community members who exercise daily by collaborating with the Lawndale Christian Health Center. The health center has been able to expand access to its healthcare and physical activity to local residents.

REACH U.S. Program Accomplishments Implementing strategies that fit unique social, political, economic, and cultural circumstances Moving beyond individuals to community and systems change As you have seen, we are seeing some success through our efforts to Implement strategies that fit unique social, political, economic, and cultural circumstances and Move beyond individuals to community and systems change

REACH U.S. Program Accomplishments Empowering community members to seek better health Bridging gaps between health care system and community Changing social and physical environments to overcome barriers to good health These programs Empower community members to seek better health Bridge gaps between health care system and community Change social and physical environments to overcome barriers to good health

Expanding REACH Programs and Activities As I move forward quickly, I will discuss some of the other programs that are also under the REACH umbrella. Programs and Activities Expanding REACH

REACH National Organizations that Serve Minority Communities Launched in 2009, this REACH program funds six national minority-serving organizations. Through their local affiliates and chapters, they provide training and technical assistance in two areas: dissemination of evidence-based strategies and tools capacity building Launched in 2009, this REACH program funds six minority-serving organizations. Through their local affiliates and chapters, they provide training and technical assistance in two areas: dissemination of evidence-based strategies and tools capacity building

REACH National Organizations that Serve Minority Communities Asian Pacific Partners for Empowerment, Advocacy and Leadership (APPEAL) National Black Women’s Health Imperative National Council of La Raza Inter-Tribal Council of Michigan Society for Public Health Education (SOPHE) Joint Center for Political and Economic Studies Here, you can see the funded organizations that serve minority communities: Asian Pacific Partners for Empowerment, Advocacy, and Leadership National Black Women’s Health Imperative National Council of La Raza Inter-Tribal Council of Michigan Society for Public Health Education (SOPHE) Joint Center for Political and Economic Studies

Example: REACH U.S. National Organizations that Serve Minority Communities Asian Pacific Partners for Empowerment, Advocacy, and Leadership (APPEAL), Oakland, CA National Asian American and Pacific Islander Network To Eliminate Health Disparities (NAPNEHD) Affiliates: Coalition for Asian American Children and Families (New York, NY), Coalition for a Tobacco Free Palau (Palau), and Washington Asian Pacific Islander (WAPI) Community Service (Seattle, WA) Cardiovascular Disease Among Asian Americans, Native Hawaiians & Pacific Islanders The Asian Americans, Native Hawaiians and Pacific Islanders (AA&NHPIs) are one of the fast-growing minority groups in the U.S., with populations expected to more than double by 2050. The health of this highly diverse, relatively young, and fast-growing population will have major implications in the future public health costs. Cardiovascular Disease: One of the Leading Causes of Death Cardiovascular disease (CVD) is one of the leading causes of death among AA&NHPIs. In 2007, it accounted for about one in four deaths among AA&NHPIs (24.4%). Asian Americans appear to be at greater risk for CVD at lower body mass index (BMI) than other ethnic groups. For e.g., Asian Indians have the highest CVD rates among Asian subgroups but traditional risk factors such as obesity, hypertension, and high cholesterol do not account completely for the high CVD prevalence and mortality in this subgroup. APPEAL National Asian American and Pacific Islander Network to Eliminate Health Disparities (NAPNEHD) Recognizing the importance of creating environmental changes that promote health for the AA&NHPI communities, APPEAL began the National Asian American and Pacific Islander Network to Eliminate Health Disparities (NAPNEHD) in October 2009. The goal of this Network is to support the development of local capacity and strengthen community networks so as to improve the conditions of health for the AA&NHPI communities through policy changes. Public health issue: Reduce cardiovascular disease through environmental and policy changes promoting healthy eating and active living. Outcome: Increased capacity in AA and NHPI communities for policy change by implementing APPEAL’s Community Readiness, Leadership, Technical Assistance and Training (TAT) and Four-Prong Policy Change Models.

REACH Community Organized to Respond and Evaluate (CORE) The two-year REACH CORE program supports communities transitioning from the analysis of intervention results to the use of these results in facilitating health equity and policy change. One of the other funded programs began in 2010. The two-year REACH CORE program supports communities transitioning from the analysis of intervention results to the use of these results in facilitating health equity and policy change.

REACH Community Organized to Respond and Evaluate (CORE) Health Departments and Universities: Regents of the University of California, Los Angeles University of Kansas Center for Research, Inc. Arizona Department of Health Services North Carolina Department of Health & Human Services Department of Environment, City, and County of San Francisco Schenectady County Public Health Service Louisiana Public Health Institute Michigan Public Health Institute Asian Media Access Maternal, Child and family Health Coalition of Metropolitan St. Louis The program funds two universities, four local and state health department, two public health institutes, and two community based organizations. An example of one of grantee’s efforts is UCLA who is initiating a program entitled “Turning Data into Action, Fighting Air Pollution in Two Immigrant Communities” in an effort to change policies and practices that reduce exposure to goods movement-related air pollution in two Latino communities in Boyles Heights and Long Beach California.

University of California Los Angeles Center for Health Policy Research Example: REACH CORE Program University of California Los Angeles Center for Health Policy Research (Los Angeles, CA) Turning Data Into Action: Fighting Air Pollution in Two Immigrant Communities Two Latino communities in Los Angeles county, Boyles Heights and Long Beach are impacted by the ship, train, truck, and car traffic generated by the transportation of commercial products through their neighborhoods. The air pollution generated by that traffic is known to have the highest impact on persons living closest to the transportation routes, especially for asthma, cardiovascular disease, and low-birth weight. Through the utilization of the Mobilizing for Planning and Partnership process, or MAPP, The Turning Data Into Action program is currently working to change public policies, regulations, and transportation practices that currently place a disproportionate burden of air pollution these two communities. Public health issue: Air pollution in two Latino communities: Boyles Heights and Long Beach, CA. Goal: Change public policies, regulations, and transportation practices to address disproportional burden of air pollution.

Racial and Ethnic Health Disparities Action Institute (REHDAI) Begun in 2008, this three-year program: Equips nine community teams with the knowledge and tools necessary to launch and sustain an effective local community action plan. REACH U.S. CEEDs facilitate networking opportunities to help build capacity. I think you may be familiar with the Racial and Ethnic Health Disparities Action Institute or REHDAI Teams. CDC identified 9 community teams to launch and sustain an effective local community action plan. With the help of the CEEDS, the REHDAI teams compete in the Legacy Project selection process, receive technical assistance and resources.

Racial and Ethnic Health Disparities Action Institute (REHDAI) Nine REHDAI Teams and CEEDs: Florida (Genesee County Health Department) Kentucky (University of Illinois-Chicago) Maryland (Mt. Sinai School of Medicine) Minnesota (Regents of University of California, Los Angeles) Mississippi (Medical University of South Carolina) Missouri (Hidalgo Medical Services) Oregon (Regional Asthma Management and Prevention Initiative) Tennessee (University of Alabama – Birmingham) Texas (Boston Public Health Commission) Nine REHDAI Teams and CEEDs: Florida (Genesee County Health Department) Kentucky (University of Illinois-Chicago) Maryland (Mt. Sinai School of Medicine) Minnesota (Regents of University of California, Los Angeles) Mississippi (Medical University of South Carolina) Missouri (Hidalgo Medical Services) Oregon (Regional Asthma Management and Prevention Initiative) Tennessee (University of Alabama – Birmingham) Texas (Boston Public Health Commission)

Oregon Coalition to Improve Birth Outcomes (OCIBO) Example: Oregon REHDAI Oregon Coalition to Improve Birth Outcomes (OCIBO) Public health issue: Improve birth outcomes for women of color. Outcome:    State legislation directs Oregon Health Authority to present plan to improve birth outcomes for underserved women through use of doulas (birth companion) and community health workers by February 2012. Key Accomplishments   In the spring of 2010, ICTC through its REDHAI affiliation was invited to submit a grant to RAMP in May to create policy to reduce infant mortality in the state of Oregon. The REDHAI Team agreed on a two tier approach. One to increase the number of doulas of color in Oregon to help improve birth outcomes and two, to begin a legislative process for doulas to be able to receive third party reimbursement to sustain doulas of color in the profession.

EVALUATING PROGRAM RESULTS As you can see, we have a myriad of programs. It is important for us to identify successes, challenges, and lessons learned. We want our programs to contribute to the research to achieving health equity. In order to do that, an evaluation is currently being conducted of the program. Programs and Activities EVALUATING PROGRAM RESULTS

National REACH Program Evaluation Analysis: Use all available evaluation data to analyze REACH program contributions and outcomes in the four areas of study. Conduct other health economic, policy and network analyses. The evaluation will enable us to analyze contributions and outcomes in four major areas including: culturally tailored interventions, policy, system, and environmental changes, translation and dissemination, and Legacy Projects. We also plan to conduct health economic, policy and network analyses.

Literature/Document Reviews and Interviews CDC: Retrospective (Completed) Purpose and fit with overarching program model Early decisions / challenges Map literature review findings to evaluation questions (Assessing the gap) Interviews CEED POCs (June-July) REHDAI POCs (July-August) The evaluation will include interviews, literature map assessment, and retrospective analysis.

Programs and Activities PROGRAM IMPACT

REACH U.S. Risk Factor Survey The REACH U.S. Risk Factor Survey began in 2009. It gathers data annually from 28 communities located in 17 states with REACH U.S. community health interventions. The survey includes questions about health, chronic diseases, diet, exercise, preventive services, and adult immunizations. These community-level survey data are being used by CDC and community coalitions to monitor and evaluate interventions in each community. To date, we have shown some success particularly through the REACH Risk Factor Survey which is a large-scale community-based surveys and surveillance systems designed to monitor the health status of minority populations is limited. The REACH U.S. Risk Factor Survey is conducted annually by CDC in REACH communities. The survey focuses on black, Hispanic/Latino, Asian (including native Hawaiian and other Pacific Islander), and American Indian populations. An address-based sampling design was used in the 2009 survey in 28 communities located in 17 states. Self-reported data was collected through telephone, questionnaire mailing, and in-person interviews. An average of 900 residents aged > 18 years in each community were surveyed.

TALKING POINTS (prevalence of smoking men) American Indian Asian Black TALKING POINTS (prevalence of smoking men) As an example, you can see here that the prevalence of smoking declined for all the minority groups, especially in Asian men in communities where REACH was implemented. Hispanic REACH U.S. communities focusing on cardiovascular disease/diabetes mellitus (2002 – 2006) Racial and Ethnic Approaches to Community Health REACH Data, 2006, comparative data 2002-2006.

EXPANDING PROGRAM OUTREACH Programs and Activities EXPANDING PROGRAM OUTREACH

International Outreach Expanding the influence of our programs through international health promotion efforts in: United Kingdom Zambia Sub-Sahara Africa We have had the opportunity to expand our reach internationally. To the United Kingdom, Zambia, and Sub-Sahara Africa. We are developing a relationship with a group from Brazil who wanted to attend this meeting. However do to schedules they were unable to be here.

Translation and Training Social Determinants of Health and Health Equity Communication Resources DANYA International Project Health Equity Workbook Update CHEB Training Cadre’ Cultural Competency Community Coalition Tools Just as we have asked the grantees to focus on training and translation, we implement those activities as well. Our efforts include developing tools and resources as well as training a cadre of experts.

Morbidity and Mortality Weekly Report Dissemination Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health: http://www.cdc.gov/nccdphp/dach/chhep/pdf/SDOHworkbook.pdf Morbidity and Mortality Weekly Report Surveillance Summaries / Vol. 60 / No. 6 May 20, 2011 Surveillance of Health Status in Minority Communities — Racial and Ethnic Approaches to Community Health Across the U.S. (REACH U.S.) Risk Factor Survey, United States, 2009 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6006a1.htm?s_cid=ss6006a1_w Supplement to Family & Community Health, The Journal of Health Promotion & Maintenance – Racial and Ethnic Approaches to Community Health (REACH): Translating Processes of Change and Attributing Improved Health Outcomes to Social Determinants of Health Programs. Published January 2011. http://journals.lww.com/familyandcommunityhealth/toc/2011/01001 We are also working to disseminate our efforts. Examples include the Social Determinants Workbook, the MMWR that focuses on findings from the 2009 REACH Risk Factor Data and the supplement to the Family & Community Health Journal that features articles from selected grantees.

Community Health and Equity Program Partners Directors of Health Promotion and Education Institutes of Medicine of the National Academies National Association of Chronic Disease Directors National Association of County and City Health Officials Society for Public Health Education As you can see here, we have a number of partners who support our efforts. Directors of Health Promotion and Education (DHPE) Institutes of Medicine of the National Academies (IOM) National Association of Chronic Disease Directors (NACCD) National Association of County and City Health Officials (NACCHO) Society for Public Health Education (SOPHE)

Next Steps

Community Transformation Grants “… in order to reduce chronic disease rates, address health disparities, and develop a stronger evidence base of effective prevention programming” I thought it might be helpful to share with you the latest updates about the Community Transformation Grants. I am sure that you may have heard a little something about those right? The Prevention and Public Health Fund could finance competitive grants for the “implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, address health disparities, and develop a stronger evidence-base of effective prevention programming.” The Prevention and Public Health Trust Fund provides: $500 million in 2010 and $750 million in 2011 The fund allows expenditures for evidence-based community public health interventions, a National Prevention Strategy and Community Transformation Grants Community Transformation Grants has received $145 million for FY11 and the recently released President’s Budget has proposed $221 million for FY 2012 $145 million announced by HHS for FY 2011 President’s Budget proposal for FY 2012 includes $221 million

Community Transformation Grants Program focus Implementation, evaluation, and dissemination of community-based community prevention activities Eligibility State/local governmental agencies, state/local non-profit organizations, tribes, national network CBOs Current status Applications were due July 15; objective review the week of August 15; funding begins September 2011 Building on success Work from programs such as REACH and CPPW will help inform CTGs The Community Transformation Grant is one of several items from the Prevention and Public Health Fund that were approved by the Department of Health and Human Services FY 11. The work from programs such as REACH and CPPW will help to inform CTGs. There was a lot of interest in the CTG as you can see, we received over 800 Letters of Intent and over 200 applications.

Award Categories for Community CTGs Capacity Building Awards range from $50,000-$500,000 Implementation States, local governments, nonprofit organizations: $500,000-$10,000,000 Territories: $100,000-$150,000 Tribal and AI/AN Consortia: $100,000- $500,000 Up to 75 awards will be made The CTG capacity building grants will range from $50,000 - $500,000. Implementation grantees will be awarded from $100,000 – 10,000,000 based on the organization type. We should know who will be awarded CTG funds in the coming weeks.

Links to Useful Resources Community Health and Equity Branch Web Site: http://www.cdc.gov/nccdphp/dach/chhep/index.htm REACH Web Site: http://www.cdc.gov/reach/ REHDAI Web Site: http://www.cdc.gov/nccdphp/dach/chhep/features/REHDAI.htm

Links to Useful Resources Community Health and Equity Branch Web Site: http://www.cdc.gov/nccdphp/dach/chhep/index.htm REACH Web Site: http://www.cdc.gov/reach/ REHDAI Web Site: http://www.cdc.gov/nccdphp/dach/chhep/features/REHDAI.htm

Before closing, I want to thank you for all of your hard work Before closing, I want to thank you for all of your hard work. I know that it has been challenging to do your work in times of uncertainty. You have built a strong partnership across the Mid-South and made strides in eliminating disparities. As we move forward, it will be more important for you to rely on your partnership and collaboration and seeking multi-disciplinary partners. It will also be important for you to evaluate and disseminate your work to show what you have done. I hope that you continue to work together in some capacity to achieve the ultimate goal of eliminating disparities. Questions??? National Center for Chronic Disease Prevention and Health Promotion Division of Community Health (proposed)