NONTRADITIONAL APPROACHES TO COMMUNITY HEALTH Health Disparities the

NON-TRADITIONAL APPROACHES TO COMMUNITY HEALTH Health Disparities & the Community Health Empowerment Model Nicole A. Primus-Henry, MPA Community Outreach Program Manager Arthur Ashe Institute for Urban Health Brooklyn Health Disparities Center

Objectives Explain health disparities, SDOH & the role of systems on health Understand the role of research in addressing health disparities Describe the Community Health Empowerment model & Community. Based Participatory Research

Agenda Health Disparities & Social Determinants of Health Disparities vs. Inequalities Addressing health disparities Research: Community-based participatory research Community Health Empowerment (CHE) model New partnership models

AAIUH Guiding Philosophy “To achieve greatness, start where you are, use what you have and do what you can” ~Arthur Ashe

Start Where you Are AAIUH founded, Brooklyn, New York, 1992 Multi-cultural, lingual , racial, Ethnically & religiously diversity Incubator for testing the effectiveness of cultural competency health care models Develop new models for health care in Brooklyn and test potential for replication

Use What you Have Partner—SUNY Downstate Medical Center Access to: 800 worshiping congregations 1600 beauty salons 700 barber shops 300 laundry mats 40 body piercing and tattoo parlors 27 public high schools 60 branches of the public library

Do What You Can New approach/strategies Address the increasing diversity of the population (cultural expectations, assumptions, language as factors affecting quality of care) Strategies that increase diversity in the health care professions (improved access to care, greater patient satisfaction, reduced cultural and linguistic barriers)

Health Disparities What do we mean by this? ?

What are Health Disparities? “Differences in health status between advantaged and disadvantaged populations that are considered unfair and avoidable. ” avoidable (Inequity) “A difference in health among segments of the population that occur by gender, race, ethnicity, education, income, disability, geography or sexual orientation. ”

Behavioral and Biological Risk Factors Genetic Attributes e. g. Sickle cell anemia, BRACA 1 & 2 genes (most common in people with ancestors from West African countries, Mediterranean countries, South or Central American countries, Caribbean islands, India, and Saudi Arabia); BRACA 1 & 2 genes (Breast cancer & Ashkenazi Jewish ethnicity Risk Taking Behaviors e. g. teenagers & Seat belts, injury, accidents

Social Determinants of Health ?

Definition (World Health Organization) The social determinants of health are the conditions in which people are BORN GROW LIVE WORK/PLAY AGE

Some Examples EDUCATION INCOME AND/OR WEALTH ENVIRONMENT Social Determinants of Health RACE

Activity: The Game of Pick a Piece:

Activity: The Game of Blue: Lives in a 2 - bedroom rented apartment, family of five (no spouse, a retired grandparent, and three children) Blue: Went to school but did not finish high school because the first child was born.

Activity: The Game of LIFE Red: Lives in a 3 - bedroom condo, alone. Red: Has a high school diploma, no college degree Has some nice ‘connections’

Activity: The Game of LIFE Green: Lives in a four bedroom house, family of five (spouse, and three children) Green: Has a high school diploma, some college

The Game of LIFE Who has insurance? What kind? Where do they work? What kinds of job do you imagine they each have? What school(s) do their children (if they have any) go to? What kind of jobs do you imagine they have? Do they have savings?

Activity: The Game of LIFE Blue/Red/Green: Due to a national recession, all three loss their jobs. At the same time, they all had to go for major surgery, 2 week hospital stay, stay home for additional 6 -8 weeks

Activity: The Game of LIFE Blue: No insurance, had not applied yet for insurance through the marketplace. What happens: Job? Housing? Stress level? Health?

Activity: The Game of LIFE Red: Applied through the marketplace and has insurance What happens: Job? Housing? Stress level? Health?

Activity: The Game of LIFE Green: Covered by Blue Cross Blue Shield health insurance What happens: Job? Housing? Stress level? Health?

Summarize: Game of LIFE Activity What happened to each person as they went through the exact same issues? How did it affect their health? Can you see the relation between education, environment, social support, and finances when it comes to health?

SDOH: Focus on Race RACE Social Determinants of Health

LEVELS OF RACISM: A THEORETIC FRAMEWORK & A GARDENERS TALE By Dr. Camara Jones

Activity 1: Flower Pot Half of you are: you: Flower Pot 1 the other half of Flower Pot 2

Activity 1: Flower Pot 1 Flower Pot 2

Post Flower Pot Activity Which flower pot had the better flowers? What do you mean by ‘better’? Who defines ‘better’? Did the gardener do anything wrong? Who is the gardener? What is the soil?

Explanation of Racism Dr. Camara Jones’ three forms of racism: Institutional: this is a systems approach to racism. Examples?

Explanation of Racism Dr. Camara Jones’ three forms of racism: Personally- Mediated: prejudice or discrimination. Examples?

Explanation of Racism Dr. Camara Jones’ three forms of racism: Internalized: How you view yourself. Limiting yourself based on your own personal perceptions to your race Example?

Access is not the Only Issue Quality/Equal Who Care gets asked? Whose needs matter? RESEARCH

The “Un” Populations: Who matter, get served Underserved Unemployed Undocumented Uninformed UN-ASKED Underprivileged Uninsured Uneducated UNIMPORTANT

Example of the ‘UN’ applied Race and/or Ethnicity American Indian/Alaska Native Asian Black or African American Hispanic or Latino White Native Hawaiian or Other Pacific Islander (NHOPI) Concerns Are all groups of people represented? Self reported?

Research: What & Why A systematic investigation to investigate an issue, answer a question or to understand test a theory or treatment (clinical/behavioral) inform policy

Death Rate due to Heart Disease by Race/Ethnicity, 2006 Deaths per 100, 000 population: White, Non-Hispanic Hispani c African American Asian and Pacific Islander American Indian/ Alaska Native White, Non. Hispanic African American Asian and Pacific Islander NOTES: Rates are age-adjusted. DATA: Centers for Disease Control and Prevention/National Center for Health Statistics, National Vital Statistics System. SOURCE: Health US, 2009 Table 32. American Indian/ Alaska Native

The question remains Do the graphs tell us what the issue is? Do they tell us why the issues exist? Why do disparities related research?

Ethics in Research & programs Tuskegee Experiment (1932 -1972) Puerto Rico Sterilization Campaign (1930’s-1970’s) ‘Parachute’ research practices

Check-in Do you remember the Arthur Ashe Guiding Principle? Hint: Start….

Promoting a Model not a Disease Community Health Empowerment (CHE) Giving people tools and resources Educating in ways that encourage them to be proactive Leveraging existing assets in the communities on behalf of the community’s health (Anti-UN)

AAIUH’S APPROACH: LEVERAGING COMMUNITY ASSETS q All communities have assets that can be engaged on behalf of the communities health (businesses, churches, local health and social service agencies, personal care establishments, libraries, schools, etc. ) q q Proprietors, stylists, barbers, ministers, nurses are trusted members of the communities Potential for long-term sustainability

The Institute Believes Strong Health Education and Services Must: Address the whole individual Be easily accessible in trusted venues Empower individuals and communities to advocate for their own health concerns Increase urban youth pursuing health careers Target diseases that affect impacted populations Provide programs that address ethnic, racial, and gender disparities in health

Culturally Tailored Community Driven Strategy Empower individuals, groups to lead their own efforts to become and remain healthy By partnering with personal care establishments to create a cadre of lay health educators who deliver culturally tailored health messages

Institute’s Core Programming Black Pearls and Soul Sense of Beauty (breast cancer & CVD) Different ‘Fades’ of Health (AA men, CVD, Prostate cancer) Minority Asthma Partnership First Impressions Agape Nuestra Belleza y Bien Peinado y Saludable Health Science Academy Health Disparities Center

RESEARCH SUB-PROJECTS Barbershop Talk With Brothers q q q HIV/AIDS risk reduction in heterosexual African American males Prostate cancer education Barbershop as recruitment and training site Obstructive Sleep Apnea q q Identification of AA men and women at risk for OSA Recruitment venues: Salons, barbershops and churches

Increasing Minority Representation in the Health professions: Health Science Academy A unique 3 -year, curriculum-based, collegelevel course Graduated more than 900 students since 1995 Aimed toward low-income high school students entering health professions Talented ‘minority’ students often lack support to make them competitive college students

Creating a Partnership for CBPR Community-Based Participatory Research: "collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community, has the aim of combining knowledge with action and achieving social change to improve health outcomes and eliminate health disparities. " WK Kellogg Foundation Community Health Scholars Program

COMMUNITY-BASED PARTICIPATORY RESEARCH (CBPR) Ø Combines action and advocacy to cause positive social change, achieve social justice and health equity

CBPR: GUIDING PRINCIPLES *Unit of Identity *Strength & resources *Collaboration *Integration of knowledge *Equity *Cyclical learning *Mutual benefit *Dissemination

BENEFITS OF CBPR ?

BENEFITS OF CBPR Strengthens intervention design and implementation Knowledge gained benefits community Provides resources to community (money, partnership with experts, new skills, employment) Increases trust Empowers marginalized individuals Enhances sustainability of programs

CBPR: COMMUNITY Developing the research question Developing the research study Disseminating results COMMUNITY Interpreting Research Findings Recruiting for the study Implementin g the research study

Community Advisory Board American Cancer Society Arab-American Family Support Center Brooklyn Perinatal Network Inc. CAMBA Caribbean Women's Health Association, Inc. Community Counseling and Mediation BCID Diaspora Community Services East New York Farms Greater Brooklyn Health Coalition Haitian American Community Coalition Inc. Make the Road New York The People's Institute for Survival and Beyond 54

Summary Institutional, Environmental, Social Conditions Behavioral (and sometimes Biological) Factors Health outcomes of the individual

Acknowledgements Travis Howlette B. S. , Jeff Wisniowski B. S. , MPH and Kelsey Anilionis B. S. (Health Equity Peer Educator Training) Camara Jones, Ph. D. Levels of Racism: A theoretical Framework & Gardeners Tale Marilyn Fraser-White, MD (AAIUH, BHDC)

THANK YOU QUESTIONS?