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

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

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

Community Strategies to Improve Health

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

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

Community Strategies to Improve Health

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

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

Community Strategies to Improve Health

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

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

Community Strategies to Improve Health

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

Community Strategies to Improve Health

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

Community Strategies to Improve Health The Advocacy Process ORGANIZING AND COALITION BUILDING MOBILIZATION AND COMMUNICATIONS MAKING A PLAN FINDING INFORMATION/ RESEARCH POLICY CHANGE FOR CHANGE CLIMATE READY

Community Strategies to Improve Health Community Action to Fight Asthma (CAFA)  3-year initiative  Focus on reducing environmental triggers for children with asthma

Community Strategies to Improve Health Organization of CAFA  12 Local Coalitions  State Coordinating Office  Technical Assistance Providers

Community Strategies to Improve Health PolicyLink Role  Technical Assistance: Policy and Communications  Inform and Mobilize CAFA State Policy Efforts

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

Community Strategies to Improve Health Other Outcomes  New leaders  Increased awareness  New partnerships  Enhanced skills

Community Strategies to Improve Health For More Information: Community Factors: Communities Advocacy: