The Lawndale Health Promotion Project Racial and Ethnic Approaches to Community Health (REACH 2010)

1. The Lawndale Health Promotion Project Racial and Ethnic Approaches to Community Health (REACH 2010)

2. Presenters: Shirley Fleming, CNM, DrPH Principal Investigator First Deputy Commissioner Chicago Dept. of Public Health Geneva M. Edwards, MPH Program Director REACH 2010/Lawndale Health Promotion Project

4. Greetings from the members of the “Lawndale Health Promotion Project” Funded by the CDC

12. REACH 2010: Lawndale Health Promotion Project • North and South Lawndale – two contiguous community areas • Hispanics (predominantly Mexican Americans) and African Americans – represents two largest minority groups in Chicago • High prevalence of DM, CVD and their related risk factors

13. Social Services Media Churches Residents Universities LHPP Hospitals Health Departments Schools Pharmacists Park Districts National Associations

14. Planning Council

15. Membership

16. Goals of the Presentation • Describe a community-based intervention to decrease racial & ethnic disparities. • Provide a practical example of translating research findings into public health practice. • Share information regarding the wisdom & challenges related to this experience. • Offer suggestions for future research.

17. How do we close the gap? “We must remake the world. The task is nothing less than that. To be part of this great uniting force of our age is the crowning experience of life.” Mary McLeod Bethune

18. “When you have people together who believe in something very strongly - whether it’s religion or politics or unions - things happen”. Cesar Chavez

19. Scientific and Empirical Foundations for Community Planning • Fawcett’s Model • McLeroy’s Model for Health Promotion • Flay’s Triadic Model

20. Step 1: Creating an awareness of the problem

21. Step 2: Listening to the Community • Health is important to us, but little information is available • Culturally and linguistically appropriate health education, services and programs are needed • Providers need to represent and be part of the community

22. Step 3: Documenting Risk & Protective Factors The Assessment

24. Needs Assessment Tools • BRFSS (Behavioral Risk Factor Surveillance Survey) • Focus groups • Key informant interviews • Community Landscape Asset Mapping (CLAM) process - few positive messages, limited access to healthy foods and walking paths

25. Tools (continued) • Epi data (rates of disease and risk factors, disparities in access to care, social risk factors such as poverty, uninsured, etc.) • Literature review

26. Selected Research Findings • 71% of residents are at risk for diabetes due to family history or other risk factors • Most residents are not aware of their risk Level of risk:

27. Selected Research Findings (cont.) Prevalence of risk factors: • 28% are overweight based on BMI • 29% are obese based on BMI • 34% have been advised to lose weight by their providers • 30% are trying to maintain their weight • 45% are trying to lose weight or reduce fat intake

28. Selected Research Findings (cont.) • 22% eat 5+ fruits/vegetables per day • 81% are trying to reduce fat in their diets • 41% are very confident that they can change their eating habits • 39% are somewhat confident that they can change their eating habits Prevalence of risk factors (healthy eating):

29. Selected Research Findings (cont.) • 25.9% smoke everyday or some days • 75% have quit smoking for one or more days in the last 12 months Prevalence of risk factors (smoking):

30. Selected Research Findings (cont.) • Lack of family support • Lack of knowledge regarding disease and medical regimens • Lack of employment and safety • Feelings of helplessness and loss of control • Inability to afford medication Stressors that threaten well-being:

31. Community Landscape Asset Mapping: Overview 11 Lawndale residents walked around and observed specific items, in the area from Roosevelt to 26th; Sacramento to Keeler, during early October. Observed: -147 Blocks using Looking Around - 46 Restaurants using Eating Out - 33 Grocery Stores using Grocery Shopping

32. CLAM Observer Training • Most observers also participated in the pilot of CLAM. • Received and reviewed forms, which had been modified based on the pilot. • Received safety training.

33. Looking AroundFindings • 79% of blocks had few to no people. • Nearly 92% had some or a lot of garbage, only 24% had garbage cans. • Safety: 58 police cars seen (on 40 blocks), none seen walking or on bikes. • Parks: 6 parks, 5 had walking paths, 3 had people walking in them. • Exercise: 1 other place to exercise

34. Police Presence (at least 1 car) Garbage on Street (Lots) 4200W 3800W 3600W 3400W 3200W 4000W 3000W Roosevelt Area not completed 16th 18th Cermak 26th

35. Vacant Lots 4200W 3800W 3600W 3400W 3200W 4000W 3000W Roosevelt Area not completed 16th 18th Cermak 26th

36. Eating OutFindings • 9 Smoke Free Restaurants, 5 with a non-smoking section (2 of these were larger than the smoking sections) • 18 restaurant menus contained pictures of the food, 16 contained descriptions of the food, none had symbols to identify low salt or low fat items.

37. Grocery Store Locations Restaurant Locations 4200W 3800W 3600W 3400W 3200W 4000W 3000W Roosevelt Area not completed 16th 18th Cermak 26th

38. Bulletin Boards in Area Businesses Health-Related Posters or Billboards 4200W 3800W 3600W 3400W 3200W 4000W 3000W Roosevelt Area not completed 16th 18th Cermak 26th

39. Impact of Cardiovascular Disease • An estimated 85% of adult Lawndale residents either have CVD or are at-risk. • CVD is the number one cause on death. • It is a major cause of disabilities due to stroke and heart disease. • It contributes significantly to loss productivity and health care expenditures. • 5. Nationally, the estimated cost was $299 billion in 2001.

40. Impact of Diabetes & Related Risk Factors • An estimated 71% or 85, 910 adult Lawndale residents either have diabetes or are at-risk of developing diabetes. • It is the 6th leading cause of death. • It is a major cause of heart disease, blindness, stroke, kidney failure, amputations and lost productivity. • 4. The average health care cost per year is $10,071.

41. Impact of CVD and Diabetes Spiritually Limits ones capacity to fulfill their purpose !!

42. Strengths of the Community • Health is a major concern and highly valued • Family resources exist • High level of racial/ethnic identity and pride • Interest in improvement exists

43. Step 4: The Community Speaks — Vision & Strategies • Health for all • More health education programs that • focus on prevention & treatment • Prevent disease in family members • Family support • Exercise programs

44. Step 4: The Community Speaks — Vision & Strategies (continued) • Provider sensitivity • Culturally & linguistically appropriate • information • Affordable health care & medication • Safe communities • Beautiful environment

45. Step 5: Translating Research into Public Health Practice Community Systems Change

46. “A man who removes a mountain begins by carrying away small stones.” Chinese Proverb

48. Fawcett’s Framework for Promoting Health for All Planning & Building Capacity Eliminating & Reducing Disparities Targeted Action Behavior Change Risk Protection Community & Systems Change

50. Human Decisions / Intentions & Behavior