Communities in Action Pathways to Health Equity (2017) / Chapter Skim
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5 Examples of Communities Tackling Health Inequity
5 Examples of Communities Tackling Health Inequity
Pages 211-334
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The committee also comments on a number of crosscutting essential elements that show promise for promoting health equity in communities. Finally, the committee summarizes a number of lessons learned from both the success and the failures of the strategies described.
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In brief, the committee queried local and state organizations, relevant philanthropic organizations, researchers and others; reviewed relevant reports and publications on the topic of community health; and undertook a literature review. It is important to note that the committee did not evaluate the overall effectiveness of these community efforts.
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. These summaries highlight the core and aspirational criteria that the committee developed and the approach that each community took toward making health equity a shared vision and value, increasing community capacity to shape outcomes and fostering multi-sector collaboration as well as showing how the strategies addressed the broader socioeconomic and political context to ultimately achieve healthier, more equitable communities.
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214 FIGURE 5-2 Geographic distribution of the nine community examples.
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Statements and opinions expressed are those of the community organization and have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. 4 For more information, see http://www.minneapolismn.gov/health/youth/yvp/ blueprint (accessed September 13, 2016)
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• environment Public safety •* • • Social • • • environment Transportation • • Key community County and city Community Other Local nonprofits, partners departments, health community local school local school associations, stakeholder district, city district, local educational organizations, agencies, youth agencies, institutions, educational faith-based faith-based agricultural institutions, organizations, organizations, co-ops nonprofit educational local businesses organizations institutions, health providers, local elected officials Outcomes From 2007–2015: • Rate of low From 2014–2015: From 2015– • 62% birth weight • Percent of 2016, number reduction babies high school of survey in youth decreased students at respondents who gunshot from 20.7% in or above answered that: victims 2013 to 3.8% grade level Child care is • 34% in 2015 according available to reduction to state them when in youth mathematics needed most victims of assessments of the time crime increased or sometimes • 76% from 36% to increased reduction in 63% from 80% to youth arrests 100% with a gun
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, housing groups, community government, youth local elected legal partners, leaders nonprofit, for- development officials, energy and profit, faith, organizations, nonprofits solar providers, and community housing and NGOs, government group developers, private-sector agencies, local associations government businesses elected officials that connect agencies, programs and foundations providers • Average PICO • In 2016, 57.3 • 641,000+ • Currently • New policies member percent of pounds of conducting and legislative engages in children produce regional reform on 76% more ages 0 to 5 distributed in mapping issues related civic duty had access food insecure project (to be to air quality than average to a place communities completed monitoring and resident other than an • 76% of end of 2016) use of harmful • Reduction in emergency shoppers measuring compounds incarceration room when reported number of such as BPA in Marion sick or in increased redevelopers and County will need of consumption be measured health-related of fruits and using data services vegetables submitted to U.S.
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In 2006, a county survey revealed that gangs were considered a neighborhood problem by 40 percent of Hispanics, 35 percent of African Americans, 24 percent of Asians/Pacific Islanders, and 11 percent of whites (see Table 5-2 for data on Minneapolis demographics) (Blueprint for Action, 2013)
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The mayor recommended a roster of stakeholders to engage and the city council adopted a motion that specifically identified partners to include in the process of development. Leaders who came together to develop the blueprint included representatives from law enforcement, juvenile supervision, public health, youth programs,
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The Minneapolis health department and Minneapolis 5 For more information on the 2013 Blueprint for Action, see http://www.minneapolismn. gov/www/groups/public/@health/documents/webcontent/wcms1p-114466.pdf (accessed September 13, 2016)
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In 2009 the program expanded to 22 neighborhoods, and the target age range was extended to age 24, based on indicators that demonstrated a higher risk of youth violence in Minneapolis for this population. These indicators were based on data compiled by the local health department from sources across various sectors, including the U.S.
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Public safety The primary goal of the blueprint is to reduce homicides and firearm-related injuries, in addition to improving juvenile interactions with the criminal justice system as needed. One program that seeks to do FIGURE 5-3 The alignment of the five Minneapolis blueprint goals with the National Forum to Prevent Youth Violence Strategies and the continuum of public health services.
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The North4 program is operated by Emerge, a place-based community development agency, and provides workforce and life skills training for youth who are gang-involved and who have 7 Source available by request from the National Academies of Sciences, Engineering, and Medicine's Public Access Records Office (PARO@nas.edu)
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. The Neighborhood Clean Sweep program partners with neighborhood associations to make neighborhoods cleaner.
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Health systems and services The blueprint has partnered with two local level I trauma center hospitals to improve health care services for victims of violence. Together, they developed a protocol for intervening and providing psychosocial assessments within 24 hours to every youth (ages 10–24)
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The multi-sector partnerships required increased communication to reduce the redundancy of programs 8 For more information, see http://www.ci.minneapolis.mn.us/coordinator/rm/index. htm (accessed September 19, 2016)
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These partnerships allowed for the coordination of data collection from various sectors to inform the blueprint's objectives and priorities in addition to systematically tracking progress. The blueprint has resulted in an increased capacity across multiple levels in Minneapolis, including the creation of a Youth Violence Prevention Executive Committee and a youth congress.
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model, DHC develops and implements community development initiatives and projects, all coordinated through the clinic. DHC operates nine community health centers in Mound Bayou (the primary 9 This summary is an edited account that was prepared on the basis of templates com pleted by staff of each community initiative.
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Mound Bayou, the town where DHC's main campus is located, is the oldest predominantly African American community in the country. The level of black-white residential segregation in Bolivar County measures at 61 out of a total 10013 on the index of dissimilarity (County Health Rankings, 2016a)
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. Geiger asserts that although community development and social change are not explicit goals of the COPC model, they are implicit in the model's emphasis on community organization and local participation with health professionals (Geiger, 2002)
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test courses for community residents. Today, DHC partners with the tri-county school system to invite youth ages 14–18 who have an interest in medical careers to shadow providers and assist with local health fairs.
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DHC leveraged its funding by proposing that it would deposit the council's funding and cash flow 14 For more information on Delta Fresh Foods, see http://deltafreshfoods.org (accessed September 28, 2016)
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Promoting Health Equity: Key Elements DHC works across sectors and disciplines to serve the needs of the community in the Mississippi Delta. In 2015 the center partnered with educational institutions such as Emory University and Mississippi State University to engage student volunteers who worked on affordable housing and gardening projects (see Figure 5-6)
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234 COMMUNITIES IN ACTION FIGURE 5-6 Mississippi State University students visit DHC and work on community garden with Delta Fresh Foods (2015)
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By remaining visible and active in community activities (e.g., festivals, health fairs, career day in schools) , in addition to being transparent about adhering to Health Insurance Portability and Accountability Act privacy rules, DHC has worked to build trust among community residents.
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The organization's commitment to these values is a key factor in its successful implementation over the past three decades of various initiatives aimed at improving the health and well-being of the community it serves. As a community organizing and planning group, DSNI's membership includes approximately 3,600 residents as well as community stakeholder 15 This summary is an edited account that was prepared on the basis of templates com pleted by staff of each community initiative.
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. Four board seats are reserved for African American residents, four for Cape Verdean residents, four for Latino residents, four for white residents, four for youth, seven seats for local health and human service nonprofits, two for community development corporations, two for small businesses, two for religious organizations, and two seats for residents appointed by the board (DSNI, 2016b)
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In the year of its founding, the organization purchased vacant lots in Boston to rebuild the land into affordable housing, urban agricultural and gardening sites, a town commons, parks and 16 The National Community Land Trust Network describes community land trusts with the following description: "CLTs develop rural and urban agriculture projects, commercial spaces to serve local communities, affordable rental and cooperative housing projects, and conserve land or urban green spaces. However, the heart of their work is the creation of homes that remain permanently affordable, providing successful homeownership opportunities for generations of lower income families" (National Community Land Trust Network, 2016)
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Department of Education awarded DSNI a Promise Neighborhood planning grant of $500,000 in 2010 and a $5,000,000 implementation grant in 2012, from which DSNI launched the Boston Promise Initiative. The initiative is intended to support families, schools, and neighborhoods in ensuring that every child in the community has "cradle to career" opportunities to succeed through access to quality education, social support systems, and safe environments.
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. DSNI also participates in the Greater Boston Community Land Trust Network in cooperation with other local organizations to further promote the development of affordable housing and open spaces through the community land trust model (DSNI, 2016e)
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. Physical environment DSNI supports food security by partnering with two other Boston-based nonprofits -- the Food Project and Alternatives for Community & Environment -- to increase residents' access to healthy and locally grown food options through the Dudley Real Food Hub and to provide loans for new and existing local food businesses.
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Residents have been recruited and paid as researchers in neighborhood surveys for the Boston Promise Initiative and for studies commissioned by the Healthy Neighborhoods Equity Fund, a participatory action research initiative investigating the effects of real estate development on residents' health. The arts and data merge in the form of interactive data visualizations at neighborhood events.
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Dudley Neighbors, Inc., has contributed to the creation of a Chinatown community land trust and, as a certified state community development corporation, secured $100,000 in community tax investment credits. To help children achieve greater school readiness, residents and community stakeholders have convened working groups to assist families with children ages 0 to 5.
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Average amount in savings accounts Increased from $3.43 to $1,555.26 Average amount in checking accounts Increased from $200.51 to $775.83 Average amount in total assets Increased from $452.42 to $5,899.46 Average subsidy income Reduced from $128.25 to $47.56 SOURCE: Personal communication from Andrew Seeder to National Academies staff on September 21, 2016. Available by request from the National Academies of Sciences, Engineering, and Medicine's Public Access Records Office (PARO@nas.edu)
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Through efforts relating to its community land trust, the organization engages with development organizations and other nonprofits to improve housing and land use management. Through initiatives such as the Boston Promise Initiative, Dudley Real Food Hub, Dudley Workforce Collaborative, and Fairmont Cultural Corridor, the organization engages with businesses, local arts and cultural institutions, and other nonprofits to improve economic, agricultural, and cultural development.
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This means that young people are at the table and actively providing their voices during decision-making processes. Additionally, DSNI organizes to ensure that anchor institutions make upstream investments in the social determinants of health in alignment with the ACA's changes to how hospitals and other health providers make investments in community health.
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-- Harry Smith, Director of Sustainable Economic Development, Dudley Street Neighborhood Initiative Eastside Promise Neighborhood17 Background and History The Eastside Promise Neighborhood (EPN) was founded as an implementation site of the U.S.
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The term "EastPoint" is used to describe the area of collective impact for all of the activity occurring as a result of this significant federal investment. 18SA2020 is "a community vision and movement born from a series of public forums in 2010 to develop goals for improving San Antonio by the year 2020." For more information, see http://www.sanantonio.gov/sustainability/SA2020.aspx (accessed December 5, 2016)
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The American Community Survey found that from 2005 to 2009 the neighborhood's annual median household income was $19,766, as compared with $43,087 for all of San Antonio (Drennon, 2011; PolicyLink, 2014)
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, meaningful engagement from parents and caregivers, and a safe environment are also emphasized as essential components of EPN's pathway to achieving academic success. EPN partners with the San Antonio Independent School District (SAISD)
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FIGURE 5-9 EPN's cradle-to-career pathway.
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Partnerships with several nonprofits (including the Boys and Girls Clubs of San Antonio, the Girl Scouts of Southwest Texas, HIS Bridgebuilders, and the YMCA of Greater San Antonio) provide afterschool and summer programs that emphasize STEM education.
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In addition to partnerships that have created children's playgrounds, community gardens, and farmer's markets, access to healthy food is also addressed through a partnership with the San Antonio Food Bank to provide families with fresh produce. Public safety for youth has also been addressed.
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The goals are developed based on the ED's Government Performance Results Act indicators, which are standard measurements for all Promise Neighborhood grant recipients. The target-setting process was conducted using the results-based accountability (RBA)
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Philip's College, San Antonio Growth on the Eastside, San Antonio Housing Authority, Workforce Solutions Alamo, Family Services Association, and the San Antonio Police Department. These core partnerships were formed during the planning phase of the process or the early implementation 21 For more information on initiatives related to each of the 10 promises as well as out comes data and targets for past years, see http://eastsidepromise.org/the-results (accessed December 5, 2016)
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or a job training • In 2011, 1.3 percent of students earned industry certification. recognized certifications.
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, and the San Antonio Spurs. Its key partners in carrying out its health and wellness initiatives include the Martinez Street Women's Center, the San Antonio Food Bank, Methodist Health Care Ministries, the City of San Antonio, University Health Systems, CommuniCare, SAISD, University of the Incarnate Word Bowden Eye Care and Health Center, the San Antonio Metropolitan Health District, HIS Bridgebuilders, and the University of Texas Health Science Center.22 Additionally, EPN engages with local politicians in its governance process.
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. One of EPN's ongoing challenges is ensuring that informal and formal communication systems successfully facilitate knowledge of the variety of resources available to community residents, as many families face transportation and access barriers and may not be aware of the resources and events available to them.
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A series of meetings will be held in 2016, including community information-sharing sessions; visits to local neighborhood association meetings coined as "EPN Road Shows"; and community subject matter convenings to identify sustainable solutions, partner agencies who are interested in carrying the work forward, and potential areas for capacity-building for those partner agencies and gaps in service if no partner can be identified. The information captured will be used to design an EPN-recommended long-term sustainability strategy that will be submitted to the advisory council for approval and shared with the coordinating council.
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The combined leadership of the EastPoint Coordinating Council also recognizes the importance of sustainability in its broadest sense. Initial collaborations and collective successes in the targeted EastPoint footprint have been a testament of how working together can achieve greater success and will be the foundation to the forthcoming initiatives for the City of San Antonio.
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24 For more information, see http://www.indycan.org/about (accessed September 13, 2016)
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Today, IndyCAN's "Opportunity for All" Policy Platform has the following objectives: • create career pathways to jobs of the future • invest in equitable regional transit that gets people to work • reduce mass incarceration and gun violence • and pass a fair, direct, and inclusive pathway to citizenship for 11 million aspiring Americans (IndyCAN, 2014) The Indianapolis metropolitan area faces many economic and social challenges (see Table 5-10 for the demographics of Marion County)
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. Between 1985 and 2014, the per capita jail population in Marion County doubled, with African Americans being 3.1 times as likely to be in jail than their white counterparts (IndyCAN, 2016b)
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. In 2014, IndyCAN doubled the African American and Latino turnout in three pilot districts, and by 2015, IndyCAN voter contact grew to 11 percent of every person that cast a ballot in Marion County, Indiana (IndyCAN, 2016a)
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. IndyCAN also convenes educational institutions, workforce development organizations, and community members to expand the career pipeline by putting best practices, such as on-the-job training, in place.
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and community leaders" that prompted the city council to halt the project and commit to restorative criminal justice reform strategies (Paschall, 2016)
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IndyCAN clergy, staff, and leaders conducted 108 trainings, including 29 For more information, see http://www.indycan.org/transit/the-ticket-to-opportunity -platform (accessed September 14, 2016)
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. IndyCAN also relies on data sources across various sectors to inform and support their platforms on issues such as public safety and transit expansion.
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Promoting Health Equity: Key Elements IndyCAN's main platform, "Opportunity for All," is based on the premise that every person should have equal opportunity to access the conditions and resources necessary for the region to achieve racial and economic equity. This shared vision of opportunity for all is central to achieving community health, economic growth, and, ultimately, health equity.
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The training program is often the only place in the area where people gather and build relationships across race, class, and religion to understand the intersections of IndyCAN's work and build a shared commitment to the work of racial and economic justice. 30 For more information, see http://www.indycan.org/tools (accessed September 14, 2016)
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Statements and opinions expressed are those of the community organization and have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. 32 For more information, see https://www.all4kids.org (accessed December 5, 2016)
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High rates of child abuse, child neglect, and spousal abuse are also present within this community. These neighborhoods are vulnerable, high-need, and TABLE 5-11 Demographics of MCI Catchment Area in West Adams, Pico Union, and North Figeroa Corridor Neighborhoods Total ~35,000 youth residents Race/ethnicity 75% Latino 11% Asian 8% White 5% African American Health 35% of children are obese Education 40% of children enter kindergarten unprepared 73% of children are not proficient in reading by third grade 40% of students will not graduate from high school on time Income 65% of children live in poverty NOTE: Percentages may not add up to 100 percent due to varied reporting, rounding, and missing data from source.
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. Community Level Change Model The Magnolia Community Initiative Partners, along with the Children's Council of Los Angeles and First 5 LA, developed a Community Level Change Model.
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From these protective factors come a greater sense of community and connectedness plus a move toward civic engagement that is truly resident-owned and resident-led. Resident-owned and -led actions result in partnerships that change institutional policies and practices, transforming and creating neighborhood assets such as high-quality schools and child care, economically viable jobs, good affordable health care and mental health services, safe and affordable housing, safe streets and parks, and other community elements such as libraries, banks, stores, and transportation options.
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. MCI also created a learning system for partners which consists of meetings, working groups, and improvement projects that build relationships and which aligns actions among agencies and with community residents, improves staff practices, builds agency capacity to better use data to understand the effects of one's practice, and introduces improvement science approaches to improve change processes.
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Available by request from the National Academies of Sciences, Engineering, and Medicine's Public Access Records Office (PARO@nas.
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Available by request from the National Academies of Sciences, Engineering, and Medicine's Public Access Records Office (PARO@nas.edu)
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. Promoting Health Equity: Key Elements A shared vision for improved outcomes among children and families is what binds together the network of more than 70 government and private-sector partner organizations that make up MCI.
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Available by request from the National Academies of Sciences, Engineering, and Medicine's Public Access Records Office (PARO@nas.
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While recognizing that moving to managing a staff team requires a fair amount of time and energy, MCI decided at this time that having a stronger staff infrastructure will ensure success in sustaining MCI's approach to community change.
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Incorporated as a nonprofit in 2004 and based in West Oakland, Mandela MarketPlace's mission is "to work in partnership with local residents, family farmers, and community-based businesses to improve 35 This summary is an edited account that was prepared on the basis of templates com pleted by staff of each community initiative. Statements and opinions expressed are those of the community organization and have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
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. Between 2000 and 2010, West Oakland's African American population declined 20 percent, while the number of Asian/Pacific Islander and white residents increased by 39 percent and 135 percent, respectively (Alameda County Public Health Department, 2015)
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-- Dana Harvey, Executive Director, Mandela MarketPlace Residents of West Oakland have been rebuilding their community and fighting socioeconomic and environmental injustices that have
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In 2009 Mandela Foods Cooperative opened and remains the only full-service grocery store serving West Oakland, operating as a worker cooperative owned by community members. It was incorporated by community members in 2004 as a worker-owned cooperative with grant and loan support from several sources, including the Walter and Elise Haas Fund, the West Oakland Project Advisory Community, a city council member, and the Oakland Business Development Center.
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, which has benefited its worker-owners as well as members of the Mandela Foods Distribution network. Supported by a 2006 grant from The California Endowment and a 2011 grant from the California Department of Food and Agriculture, the network includes under-resourced farmers of color who operate within 200 miles of the Bay Area and who have access to flexible, no-interest loans that can be repaid with produce through Mandela MarketPlace's Harvest to Market loan program.37 Physical and social environment Mandela MarketPlace also provides a range of educational programming related to health and nutrition.
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Promoting Health Equity: Key Elements Since its founding, Mandela has encouraged shared responsibility among community members and stakeholders in developing programs to achieve better health and socioeconomic outcomes. Meaningful resident and stakeholder engagement has been essential in the organization's FIGURE 5-19 Mandela MarketPlace's model for a community-owned food system and outcomes data.
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, foundations, and others. Specific partners have included the University of California, Davis; Nutrition Policy Institute; Alameda Health Systems; Alameda County Public Health Department; East Bay Community Law Center; Sustainable Economies Law Center; PolicyLink; Centro Community Partners; Oakland Housing Authority; Resources for Community Development; Self-Help Credit Union; California FreshWorks Fund; FarmLink; Alameda County's Community Development Agency; City of Oakland's Community Action Partnership program; Mercury LLC (an advertising and marketing firm)
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A case study in Mandela's sustained relationships in community change can be seen in the organization's longtime work with James Berk, one of Mandela Foods Cooperative's co-owners. When Berk first walked into Mandela's office to participate in the CX3 community survey project, in partnership with Alameda County Public Health Department (ACPHD)
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Berk, along with and six other youth who were part of the summer program, charged themselves with using the data to identify and act on built environment improvements. With continued support from ACPHD and CDPH, Mandela MarketPlace and the youth team were able to make important changes in their community, building self-efficacy along with a series of projects aimed at improving their community, increasing healthy food access, and launching the Healthy Neighborhood Store Alliance program in West Oakland.
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. 42 For more information on the Fresh Creds program, see http://www.mandela marketplace.org/freshcreds (accessed December 5, 2016)
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is a nonprofit with a membership base of community residents that focuses on securing sustainable affordable housing for residents of the West Side neighborhood of Buffalo, New York. Its mission is "to mobilize residents to create strong neighborhoods with quality, affordable housing, expand local hiring opportunities, and to advance economic justice" (PUSH, 2012a)
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. Annual community planning meetings followed, from which the Green Development Zone emerged in 2008.
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Solutions to Address the Social Determinants of Health PUSH operates several suborganizations whose efforts address disparities specific to housing, employment, and the physical and social environments. Housing and employment The organization's main activity is reclaiming community control of vacant lots and redeveloping abandoned properties into sustainable, affordable housing for low-income residents.
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. As part of the development plan for the Green Development Zone, PUSH also emphasizes energy-efficient housing improvement practices and sustainable jobs.
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Available by request from the National Academies of Sciences, Engineering, and Medicine's Public Access Records Office (PARO@nas.edu)
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. The organization has also created community gardens and urban agriculture plots in previously vacant lots in the Green Development Zone.
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Promoting Health Equity: Key Elements From its initial grassroots campaigns to the present day, PUSH's efforts have consistently reflected the concerns and needs expressed by residents of the community. Seventy-five percent of members of the organization's board of directors are community residents directly residing in PUSH's target zone -- the Green Development Zone -- and the organization convenes a community development committee monthly to determine resident needs and develop solutions to address these needs.
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. Additionally, the organization often invites individuals from other organizations to tour the Green Development Zone and gain insights that can be taken back to their own communities.
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-- Clarke Gocker, Director of Policy and Initiatives, PUSH Buffalo WE ACT for Environmental Justice45 Background and History WE ACT for Environmental Justice (WE ACT) , formally known as West Harlem Environmental Action, Inc., is a nonprofit, membership organization that engages in community organizing, community-based participatory research, and advocacy to fight environmental injustices faced by residents of color in West, Central, and East Harlem and Washington Heights/Inwood, marginalized neighborhoods located in northern Manhattan in New York City.
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from West Harlem, WE ACT was the first environmental justice organization in New York City. The organization's creation was catalyzed by residents' protests of the North River Sewage Treatment Plant on the Hudson River, which had opened in 1986 and was releasing high levels of toxic emissions and odors.
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Available by request from the National Academies of Sciences, Engineering, and Medicine's Public Access Records Office (PARO@nas.edu)
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In addition to the environmental racism claims in the North River Sewage Treatment Plant case, the second of WE ACT's earliest activities also used civil rights law to create policy change. In 1988, WE ACT filed an injunction in the state supreme court calling for an environmental impact statement by the Metropolitan Transit Authority (MTA)
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Available by request from the National Academies of Sciences, Engineering, and Medicine's Public Access Records Office (PARO@ nas.edu)
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Building on the success of the community-planning process for the Harlem Piers waterfront park, which encourages active living, WE ACT organized a 40-group Northern Manhattan Environmental Justice Coalition in a campaign known as Fair Share, not Lion's Share. The campaign achieved the decommissioning of the 135th Street marine transfer station (MTS)
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WE ACT partnered with Fordham Law School's Community Development Law Clinic, which produced legal research on land use and zoning and assisted community residents in developing their testimony for hearings on the environmental impact statement and the city's Uniform Land Use Review Process, which required city council approval. WE ACT's Deputy Director Cecil CorbinMark was a lead community negotiator acting to hold the university accountable for providing a community benefits agreement (CBA)
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that has documented the exposure to banned pesticides of 720 mothers and newborns in northern Manhattan and the South Bronx, WE ACT and NYPIRG worked with members of the New York City Council to introduce bills requiring notification of neighbors when pesticides are applied and requiring a 48 The Clean Power Plan Tool Kit is available at http://www.ejleadershipforum.org/clean power-plan-tool-kit (accessed December 5, 2016)
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Lautenberg Chemical Safety for the 21st Century Act, which mandates safety reviews of chemicals currently in use as well as new chemicals not yet on the market and includes some protections for vulnerable communities. Transportation In 1997 WE ACT launched its Dump Dirty Diesel campaign to promote public awareness among community residents of the high levels of pollution in many neighborhoods of northern Manhattan due to the toxic diesel exhaust fumes being released by MTA buses and
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Department of Transportation mandated that the MTA uphold civil rights law and take environmental concerns into consideration in its future decision making. In 2008 WE ACT, along with the MTA and a community task force, began holding community planning sessions to transform the Mother Clara Hale bus depot to comply with LEED standards.
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advance effective New York City housing policies that address current housing, building code, and enforcement gaps; protect public health; and reduce harmful indoor environmental exposures. Since launching the campaign, WE ACT has worked to secure citywide healthy housing legislative and regulatory policies aimed at improving health outcomes in multifamily affordable housing by partnering with allies from a broad cross-section of social justice advocacy, housing, government, research, and green building sectors in a collaborative campaign that uses mobilization, convening, and communications strategies to educate city officials to support the Asthma-Free Homes bill pending at the New York City Council -- a bill that would require landlords to fix housing violations that affect asthmatic tenants.
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WE ACT partners with academic institutions to conduct CBPR and uses data as evidence to drive its campaigns. To demonstrate the effects of air pollutants, harmful chemicals, and pesticides on children's health and birth outcomes and to advocate for policy changes to improve these outcomes, WE ACT has collected data on air quality by producing maps showing sources of pollution overlaid with health and income data.
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WE ACT has partnered extensively with educational institutions to conduct research and collect data for its advocacy work. Its North River Sewage Treatment Plant complaint was submitted after conducting a CBPR project to determine whether high levels of pollution were to blame for the high rates of asthma among the community's children, a majority of whom were African American or Latino.
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In 2017 WE ACT will disseminate a report on its findings and recommendations for how to improve these strategies. WE ACT has also hosted forums for candidates to speak on environmental justice issues and has trained residents to testify at city council hearings.
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Daniel Faber at Northeastern University, document that environmental justice organizations receive half of 1 percent of all environmental funding nationally (Faber, 2001)
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Key elements that have facilitated WE ACT's success are its achievement of trust and a shared vision with the northern Manhattan neighborhoods plus a strong engagement with environmental justice organizations around the country. With strong partnerships with other nonprofits and academic institutions with similar goals, the organization has consistently sought outcomes that are beneficial for all stakeholders.
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Although reviewing just nine examples does not constitute a systematic review, the communities described in this chapter make it clear that it is possible to act effectively at the community level to modify social determinants of health that may, in turn, reduce health disparities and promote health equity. All of the nine community examples highlight the three key elements of effective community change from the committee's central figure: equity as a shared vision and value, increased community capacity, and enhanced multi-sectoral collaboration.
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Trust among residents and other community stakeholders, in addition to the belief that change is possible, is essential for community actors to be empowered and develop agency. Interventions at the community level are uniquely positioned to empower community residents to seek change and galvanize communities to act.
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For example, an early protest march by leaders of WE ACT resulted in their arrest while blocking traffic. This arrest increased the visibility of the group and demonstrated its seriousness of purpose, which built community support and led to the group's successful partnership to sue New York City for greater environmental justice.
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From page 318... ...
Many of these examples show collaborative interventions across many sectors; these broad partnerships were crucial in affecting change within challenging domains, ranging from youth violence to local poverty and unemployment. The Minneapolis Blueprint for Action to Prevent Youth Violence is a striking example of multi-sectoral collaboration to address youth violence.
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From page 319... ...
Among the communities that had a leadership board, substantial and accurate representation of the community residents was vital. Generally, the communities in the examples employ structured, bottom-up approaches to decision making.
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From page 320... ...
WE ACT and IndyCAN partnered with education institutions for data collection and research, and DHC engaged students at local educational institutions to assist with the center's community projects. In the case of Mandela MarketPlace, when community organizers recognized a need for technical expertise, they commissioned external consultants to provide assistance developing a business model.
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From page 321... ...
With the exception of a few, the communities featured in this chapter did not approach the design and implementation of their solutions with the frame of improving health. Instead, their ultimate goals were safe and affordable housing, economic development and dignity, safety, social cohesion, educational achievement among youth, neighborhood revitalization, or environmental justice -- all of which are ingredients for a healthy community and foundational to health equity.
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From page 322... ...
Although no recipe for successful collaboration to promote health equity exists, some additional approaches emerging from the literature and community-based practices include • Leverage existing efforts whenever possible. • Adopt explicit strategies for authentic community engagement, owner ship, involvement, and input throughout all stages of such efforts.
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From page 323... ...
The first core criterion requires that the solution in the example addresses at least one (preferably more) of the nine social determinants of health identified by the committee: education, employment, health systems and services, housing, income and wealth, the physical environment, public safety, the social environment, and transportation.
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From page 324... ...
/committee (health systems and services, education, employment, the physical environment, the social environment, housing, income and wealth, public safety, and transportation) and affects a local population that is affected by health inequities 2.
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From page 325... ...
The solution is freely available to the community and not a proprietary resource Set 3: Contextual Criteriad 14. Address a range of the nine determinants of health identified by RWJF/ committee (health systems and services, education, employment, the physical environment, the social environment, housing, income and wealth, public safety, and transportation)
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From page 326... ...
This comes from the committee's understanding that engaging community stakeholders outside of the traditional health disciplines will facilitate cross-sector collaboration in addition to maximizing the impact on the social determinants of health. Such partnerships can increase reach and capacity by drawing on different backgrounds, skill sets, and knowledge bases (HHS, 2014)
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From page 327... ...
REFERENCES Alameda County Public Health Department.
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From page 328... ...
Alameda County Public Health Department Community Assessment, Planning, and Education (CAPE) Unit and Division of Communicable Disease Control and Prevention.
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From page 329... ...
http://eastside promise.org/wp-content/uploads/2013/03/Cradle-to-Career-Pathway-e136397 4021347.png (accessed September 19, 2016)
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From page 330... ...
http:// bphc.hrsa.gov/uds/datacenter.aspx? q=d&bid=040780&state=MS (accessed September 20, 2016)
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From page 331... ...
http://www.promiseneighborhoodsinsti tute.org/sites/default/files/documents/pni/PNI_san%20antonio_091914_a_0.pdf (accessed September 16, 2016)
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From page 332... ...
http://pushbuffalo.org/netzero-house (accessed September 26, 2016)
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From page 333... ...
http://www.weact.org/timeline (accessed September 22, 2016)
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Key Terms
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information on Chapter Skim is available.