NON-TRADITIONAL APPROACHES TO COMMUNITY HEALTH

1. 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

2. 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

3. 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

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

5. 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

6. 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

7. 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)

8. Health Disparities What do we mean by this? ?

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

10. 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

11. Social Determinants of Health ?

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

13. Some Examples Social Determinants of Health

14. Activity: The Game of Pick a Piece:

15. 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.

16. 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’

17. 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

18. 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?

19. 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

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

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

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

23. 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?

24. SDOH: Focus on Race Social Determinants of Health

25. Levels of racism: A theoretic framework & a gardeners tale By Dr. Camara Jones

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

27. Activity 1: Flower Pot Flower Pot 1 Flower Pot 2

28. 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?

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

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

31. 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?

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

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

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

35. 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

36. White, Non-Hispanic American Indian/ Alaska Native Hispanic AfricanAmerican Asian and Pacific Islander Death Rate due to Heart Disease by Race/Ethnicity, 2006 Deaths per 100,000 population: AfricanAmerican White,Non- Hispanic Hispanic Asian and Pacific Islander American Indian/ Alaska Native 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.

37. 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?

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

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

40. 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)

41. AAIUH’S APPROACH: LEVERAGING COMMUNITY ASSETS • 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.) • Proprietors, stylists, barbers, ministers, nurses are trusted members of the communities • Potential for long-term sustainability

42. 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 care careers • Target diseases that affect impacted populations • Provide programs that address ethnic, racial, and gender disparities in health

43. 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

44. 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

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

46. Increasing Minority Representation in the Health professions: Health Science Academy • A unique 3-year, curriculum-based, college-level 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

48. 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

49. Community-Based Participatory Research (CBPR) • Combines action and advocacy to cause positive social change, achieve social justice and health equity

50. CBPR: GUIDING PRINCIPLES