Community Conversations Help Residents Take Charge of Their Health
Until recently, debates over health disparities were bounded by what’s been called an individual, bio-medical model that focuses almost exclusively on the roles of health care, medical technologies, and individual behaviors in shaping health outcomes. The social determinants of health equity framework offers a model for understanding health inequities. The social determinants of health are the conditions in which people are born, grow, live, work, and age, including the health system. This framework understands political and economic structures that offer advantages to some and disadvantages to others to be a root cause of different health outcomes both within and between populations.
Social determinants of health might include elements of everyday life, such as a lack of safety, access to fresh fruits and vegetables, unhealthy behaviors, and environment. For example, crumbling sidewalks may send the message that an area is in disrepair and may discourage people from walking in that area. This, in turn, can lead to a chain of events that ultimately results in an environment less conducive to healthy behaviors. The social determinants of health framework illuminates how the social conditions that can make people healthy or sick do not arise “naturally,” but instead are driven by political decisions and economic arrangements that influence the allocation of resources within society.
P² Collaborative of Western New York (P² Collaborative), the leader of the Aligning Forces for Quality Alliance in Western New York, initiated a series of Community Conversations in 2012 to bring communities together to take action on social determinants of health. Three initial conversations have taken place in the Delavan Grider area of Buffalo, the First Ward of Lackawanna, and Gowanda in Southern Erie County.
Between 20 and 40 committed citizens have rallied in each of these communities in initial conversations. Subsequent conversations have retained a core group of community leaders. Who are the stakeholders? It depends on the community. Participants have been ordinary residents, patients, politicians, and health care providers. Communities sought out representatives from all different groups within a community to participate. For example, Lackawanna is diverse, with a significant population of Arab-Americans and Hispanics. Leaders of the community were invited to participate to bring the various voices of the First Ward to the table. Realizing that communities best understand their own needs, P² Collaborative gave them the tools and allowed them to take off.
Conversation allows the community to choose what determinants of health are most important to them.
Conversation allows the community to choose what determinants of health are most important to them. The Community Conversations program gives residents the opportunity to initiate improvement projects and make their neighborhoods more healthy, livable, and safe. Participants identified key priorities and have led the way to making change in their community. P² Collaborative provided local health and determinants of health data, drilled down as much as possible, but took a hands-off approach in determining what determinants the communities should work on and implementing those changes. The residents of the communities are in charge, and P2 provides facilitation and guidance.
Event facilitators engaged those in attendance with thought-provoking questions about the social determinants of health, from cracked sidewalks and the appearance of neighborhoods to learned behaviors and stress levels. Notice access to health care is not listed. While access to actual health care is important, it only comprises 10 percent to 20 percent of a person’s overall health. Areas selected for further discussion and solution implementation included youth services, transportation, and access to fresh foods.
The Community Conversations already have seen positive changes. The Delavan Grider Community is located in a food desert, and this determinant was one of the three the group selected at its initial conversation. Residents addressed the inability to access fresh fruits and vegetables and took the initiative to establish a van service for the community. “They were tired of being neglected,” said Kelly Showard, project manager, health engagement outreach with P² Collaborative. “So the community met, made a plan, and executed it.” With the help of a local university, they received a mini-grant to assist in offsetting the cost of the service, which is being provided free of charge by area churches. Additionally, the group is developing a calendar of events to assist them in changing their current habits. This behavior modification can have a great effect on the health of an individual. When using it in concert with medical care, the community is taking responsibility for its health.
Other achievements include starting up a youth afterschool basketball program and Friday-night skating in Gowanda, which in the medical model increases physical activity among the youth, leading to lower levels of obesity. In Lackawanna residents have been responsible for getting bus shelters fixed, providing for a safer environment. They have requested the city and municipal housing authorities to increase lighting on the streets. This, too, creates a safer environment. P2 is building capacity in these communities to help residents with chronic disease better manage their conditions. Classes include the evidence-based programs like the Self-Management programs from Stanford University and the Diabetes Prevention Program (which educates individuals in making healthier decisions about their health). It’s paying off with better-educated, empowered patients ready to tackle their diabetes. “Residents in these communities are starting to live healthier, safer lives,” said Showard.