National Center for Chronic Disease Prevention and Health Promotion

1. REACH U.S.: Past, Present, & Future Shannon White, MPH National Center for Chronic Disease Prevention and Health Promotion Division of Community Health (proposed) Health Education Specialist REACH U.S. UAB Mid-South Regional Meeting August 23, 2011

2. Program Focus on Health Equity • Health equity is at the core of all our programs and activities. • Health equity is achieving the highest level of health for all people. • It entails focused societal efforts to address avoidable inequalities. • The goal is to equalize conditions for health for all groups, especially for those experiencing socioeconomic disadvantage or historical injustices. Healthy People 2020

3. Programs and Activities A National, Multilevel Approach

4. Racial and Ethnic Approaches to Community Health (REACH) • Cornerstone of CDC efforts to eliminate racial and ethnic health disparities • Program began in 1999 • Was aligned with Healthy People 2010 goals • Became REACH Across the U.S. (REACH U.S.) in 2007 • REACH U.S. program is funded through 2012

6. Socio-Ecological Model

7. REACH • Through the REACH program: CDC supports grantee partners to establish and/or support community-based programs and culturally-tailored interventions to eliminate health disparities among racial and ethnic minority groups.

9. Example: REACH U.S. CEED Program Institute for Urban Family Health (New York, New York) Mooove to 1% or Less – Yes! Changing the Milk Policy in New York City Schools Public health issue: An estimated 120 million containers of whole milk, sweetened vanilla, chocolate, and strawberry milk are served each year in the public health system. Outcome: A citywide low-fat/skim milk only policy was put in place in NYC public schools.

10. Example: REACH U.S. CEED Program Mt. Sinai School of Medicine Save Half For Later Campaign Public health issue: Increase consumer and business awareness about portion control and its relation to obesity and diabetes. Outcome: Trained restaurant managers and staff to promote and implement portion control strategy.

11. Example: REACH U.S. Legacy Program Mt. Sinai School of Medicine Concrete Safaris Public health issue: To increase youth engagement in physical activities and nutrition principles as a means of early age diabetes prevention. Outcome: Enrolled more than 35 children into the program where they learned gardening as a form of exercise and about healthy eating.

12. Example: Action Community Chicago Department of Public Health Lawndale Christian Health Center Public health issue: Increase the proportion of the population who report meeting the daily physical activity requirement. Outcome: Lawndale Christian Health Center expanded to address access to healthcare and physical activity/nutrition resources and offers medical care on a sliding scale fee. 

13. REACH U.S. Program Accomplishments • Implementing strategies that fit unique social, political, economic, and cultural circumstances • Moving beyond individuals to community and systems change

14. REACH U.S. Program Accomplishments • Empowering community members to seek better health • Bridging gaps between health care system and community • Changing social and physical environments to overcome barriers to good health

15. Programs and Activities Expanding REACH

16. REACH National Organizations that Serve Minority Communities • Launched in 2009, this REACH program funds six national minority-serving organizations. • Through their local affiliates and chapters, they provide training and technical assistance in two areas: • dissemination of evidence-based strategies and tools • capacity building

17. REACH National Organizations that Serve Minority Communities • Asian Pacific Partners for Empowerment, Advocacy and Leadership (APPEAL) National Black Women’s Health Imperative National Council of La Raza Inter-Tribal Council of Michigan Society for Public Health Education (SOPHE) Joint Center for Political and Economic Studies

18. Example: REACH U.S. National Organizations that Serve Minority Communities Asian Pacific Partners for Empowerment, Advocacy, and Leadership (APPEAL), Oakland, CANational Asian American and Pacific Islander Network To Eliminate Health Disparities (NAPNEHD) Affiliates: Coalition for Asian American Children and Families (New York, NY), Coalition for a Tobacco Free Palau (Palau), and Washington Asian Pacific Islander (WAPI) Community Service (Seattle, WA) Public health issue: Reduce cardiovascular disease through environmental and policy changes promoting healthy eating and active living. Outcome: Increased capacity in AA and NHPI communities for policy change by implementing APPEAL’s Community Readiness, Leadership, Technical Assistance and Training (TAT) and Four-Prong Policy Change Models.

19. REACH Community Organized to Respond and Evaluate (CORE) • The two-year REACH CORE program supports communities transitioning from the analysis of intervention results to the use of these results in facilitating health equity and policy change.

20. REACH Community Organized to Respond and Evaluate (CORE) • Health Departments and Universities: • Regents of the University of California, Los Angeles • University of Kansas Center for Research, Inc. • Arizona Department of Health Services • North Carolina Department of Health & Human Services • Department of Environment, City, and County of San Francisco • Schenectady County Public Health Service • Louisiana Public Health Institute • Michigan Public Health Institute • Asian Media Access • Maternal, Child and family Health Coalition of Metropolitan St. Louis

21. Example: REACH CORE Program University of California Los Angeles Center for Health Policy Research (Los Angeles, CA) Turning Data Into Action: Fighting Air Pollution in Two Immigrant Communities Public health issue: Air pollution in two Latino communities: Boyles Heights and Long Beach, CA. Goal: Change public policies, regulations, and transportation practices to address disproportional burden of air pollution.

22. Racial and Ethnic Health Disparities Action Institute (REHDAI) • Begun in 2008, this three-year program: • Equips nine community teams with the knowledge and tools necessary to launch and sustain an effective local community action plan. • REACH U.S. CEEDs facilitate networking opportunities to help build capacity.

23. Racial and Ethnic Health Disparities Action Institute (REHDAI) • Nine REHDAI Teams and CEEDs: • Florida (Genesee County Health Department) • Kentucky (University of Illinois-Chicago) • Maryland (Mt. Sinai School of Medicine) • Minnesota (Regents of University of California, Los Angeles) • Mississippi (Medical University of South Carolina) • Missouri (Hidalgo Medical Services) • Oregon (Regional Asthma Management and Prevention Initiative) • Tennessee (University of Alabama – Birmingham) • Texas (Boston Public Health Commission)

24. Example: Oregon REHDAI Oregon Coalition to Improve Birth Outcomes (OCIBO) Public health issue: Improve birth outcomes for women of color. Outcome: State legislation directs Oregon Health Authority to present plan to improve birth outcomes for underserved women through use of doulas (birth companion) and community health workers by February 2012.

25. Programs and Activities EVALUATING PROGRAM RESULTS

26. National REACH Program Evaluation • Analysis: • Use all available evaluation data to analyze REACH program contributions and outcomes in the four areas of study. • Conduct other health economic, policy and network analyses.

27. Literature/Document Reviews and Interviews • CDC: Retrospective (Completed) • Purpose and fit with overarching program model • Early decisions / challenges • Map literature review findings to evaluation questions (Assessing the gap) • Interviews • CEED POCs (June-July) • REHDAI POCs (July-August)

28. Programs and Activities PROGRAM IMPACT

29. REACH U.S. Risk Factor Survey • The REACH U.S. Risk Factor Survey began in 2009. • It gathers data annually from 28 communities located in 17 states with REACH U.S. community health interventions. • The survey includes questions about health, chronic diseases, diet, exercise, preventive services, and adult immunizations. • These community-level survey data are being used by CDC and community coalitions to monitor and evaluate interventions in each community.

30. American Indian Asian Black Hispanic REACH U.S. communities focusing on cardiovascular disease/diabetes mellitus (2002 – 2006) Racial and Ethnic Approaches to Community Health REACH Data, 2006, comparative data 2002-2006.

31. Programs and Activities EXPANDING PROGRAM OUTREACH

32. International Outreach • Expanding the influence of our programs through international health promotion efforts in: • United Kingdom • Zambia • Sub-Sahara Africa

33. Translation and Training • Social Determinants of Health and Health Equity • Communication Resources • DANYA International Project • Health Equity Workbook Update • CHEB Training Cadre’ • Cultural Competency • Community Coalition Tools

34. Dissemination Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health: http://www.cdc.gov/nccdphp/dach/chhep/pdf/SDOHworkbook.pdf Morbidity and Mortality Weekly Report Surveillance Summaries / Vol. 60 / No. 6 May 20, 2011 Surveillance of Health Status in Minority Communities — Racial and Ethnic Approaches to Community Health Across the U.S. (REACH U.S.) Risk Factor Survey, United States, 2009 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6006a1.htm?s_cid=ss6006a1_w Supplement to Family & Community Health, The Journal of Health Promotion & Maintenance – Racial and Ethnic Approaches to Community Health (REACH): Translating Processes of Change and Attributing Improved Health Outcomes to Social Determinants of Health Programs. Published January 2011. http://journals.lww.com/familyandcommunityhealth/toc/2011/01001

35. Community Health and Equity Program Partners • Directors of Health Promotion and Education • Institutes of Medicine of the National Academies • National Association of Chronic Disease Directors • National Association of County and City Health Officials • Society for Public Health Education

36. Next Steps

37. Community Transformation Grants “… in order to reduce chronic disease rates, address health disparities, and develop a stronger evidence base of effective prevention programming” $145 million announced by HHS for FY 2011 President’s Budget proposal for FY 2012 includes $221 million

38. Community Transformation Grants

39. Award Categories for Community CTGs • Capacity Building • Awards range from $50,000-$500,000 • Implementation • States, local governments, nonprofit organizations: $500,000-$10,000,000 • Territories: $100,000-$150,000 • Tribal and AI/AN Consortia: $100,000-$500,000 • Up to 75 awards will be made

40. National Center for Chronic Disease Prevention and Health Promotion Division of Community Health (proposed)