Social Neighborhoods and Community Health

 Guest Author: Shauna Batcheller, Owner, Urban Nest and Nestability

Guest Author: Shauna Batcheller, Owner, Urban Nest and Nestability

How might a neighborhood improve health? One answer to explore is social-contact design. Environmental cues can encourage social interaction. Over time, frequent social interaction may develop into neighborly support and deeper relationships. People with supportive social ties have lower levels of mortality, better physical health, and improved psychological well-being. The Harvard Study of Adult Development, an 80-year longitudinal study, has found that, “Our relationships and how happy we are in our relationships has a powerful influence on our health”. Close relationships are better predictors of happiness and longevity than genes, socioeconomic status, IQ, or even cholesterol levels.

Socially-designed neighborhoods such as pocket neighborhoods and intentional communities, have seen a steady increase in development in the United States over the past 20 years. A pocket neighborhood is a pattern of housing that fosters a strong sense of community among nearby neighbors, while preserving their need for privacy. An intentional community refers to the intentionality of the residents to share common values and associate with each other. In studies, residents in socially-designed neighborhoods have reported higher levels of perceived quality of life, feelings of mutual support, and less isolation compared to similar non-residents.

My graduate research focused on how socially supportive neighborhoods may facilitate healthy aging. I have been lucky enough to meet a group of people interested in building an intentional community in Sioux Falls. For many of them, buying into a socially-designed, aging-friendly neighborhood is a strategic move to stay healthy and in control of their lives. Everyone in the group desires a balance of privacy and socialization that will shift over time as their needs change.

At our last meeting, we also discovered that our group shares some commonalities in important neighborhood design parameters. Members have prioritized age diversity, easy maintenance, social activities, sustainability, and beautiful green spaces. They want to be with family and friends and have opportunities to meet new like-minded neighbors.

This group, along with numerous retirees I have interviewed in recent years, share a desire to be a part of things without commitment. They want the freedom to participate or not, on their terms. And that is the beauty of social-contact design. The walkable green space and social activation make participation spontaneous and natural. The shared morning walk, the playground conversation, and all the chance encounters grow into something more - health and happiness. To learn more, visit www.nestcompanies.com and/or email at shauna@nestcompanies.com.

Sharing Success of Evidence-Based Practice

A story is “that one thing happens in consequence of another” (Davidson, 2017). A story consists of a beginning, middle, and ending or is crafted of three elements; plot, character, and moral (Davidson, 2017). Imagine you are immersed in reading an exciting book, where the story is building, and you eagerly read to see how it ends…but your dog gets a hold of your book and proceeds to chew up the last few pages…leaving you wondering how the story ends.  Now let us apply that same scenario, sans dog, to development, implementation, and evaluation of a project or public health program. Likely a considerable amount of work, expertise, and time will have been spent on that program, only to not understand how the story ends.

As has been discussed in prior articles, a body of research supports the growing demand and need to utilize evidence is important to inform practice, including development, implementation, and evaluation of public health programs. However, it is also important to tell a story about the program, which is becoming a standard part for federal funding, highlighting how evidence was used to inform practice, program results, as well as successes that accompanied it. Sharing successes through a story is an important method to disseminate best practices and share what works in specific populations in order to support replication of the original model in other communities and/or populations.

In real life, don’t we as humans search out recommendations for projects, products, services, etc. before we sign on the dotted line? Thus, sharing successes helps strengthen public health practice and evidence, helping practitioners see what works and providing a guide for design, implementation, and evaluation of a program because it works.  For example, County Health Rankings highlights scientific evidence that supports cell phone-based tobacco cessation interventions to increase quit rates and Text2Quit is one example how that evidence was applies, providing personalized text message cessation program to may increase quit rates (2018). This program can serve as model to develop similar programs because it works.

Disseminating program results and sharing successes can influence policy, educating policy-makers on the value of a program guided by evidence and put an issue to the top of a political agenda. In addition, according to the Rural Health Information Hub, sharing successes “can help rural community health programs to build relationships with project partners and funders, increase visibility, share best practices, and may attract new funding” (2018). Moreover, the Association of State and Territorial Health Officials recognizes that “state and territorial health agencies can make an incredible impact in public health and health care integration by decoding the key elements for success that can then be shared with others to promote further integration, increase healthcare quality, decrease cost, and improve overall population health” (2013).

There are various methods for sharing successes and many resources available to support dissemination and identification of best practices.  County Health Rankings & Roadmaps highlights “What Works for Health”, and The Community Guide shares “Stories from the Field” of successes programs informed by evidence, both of which invite story submissions. In addition, the Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Success Stories provides opportunities for sharing success stories through an application process. Story Banking is another strategy for sharing people’s stories and successes in a compelling way. Moreover, depending your audience, some methods of dissemination may include infographics, publishing program briefs, publishing findings in a journal, sharing information through social media, or presenting at local or national conferences. Developing a communication strategy can support success dissemination of a story.

Regardless of how the story is shared, make a point to share it. After all, why go to all of that work, only to keep it all to yourself. If population health is truly going to improve, knowledge is key!

References

1.      Association of State and Territorial Health Officials. (2013). Public health and healthcare reintegration success stories. Retrieved from http://www.astho.org/Presidents-Challenge-2013/Stories/

2.      County Health Ranking & Roadmaps. (2018). What works for health. Retrieved from http://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health

3.      Davidson, G. (2017, September). Storytelling and evidence-based policy: lessons from the grey literature. Palgrave Communications. Retrieved from 3:17093 |DOI: 10.1057/palcomms.2017.93

4.      Rural Health Information Hub. (2018). Disseminating best practices. Retrieved from https://www.ruralhealthinfo.org/toolkits/rural-toolkit/6/dissemination-methods

Achieving Health Equity: Why It Matters

According to the Merriam-Webster Dictionary (20118), equitable means “having or exhibiting equity or dealing fairly and equally with all concerned” (2018).  In an equitable society everyone would have equal access to goods and services regardless of socio-economic status, gender, race, and the alike. When we look at equity from a health lens, that means that everyone has the opportunity to achieve their highest level of health (Benjamin, 2018). Now, in an ideal world, that would be great, however, since we do not live in one, there is ample opportunity and need to achieve health equity.

Health equity is “the principle underlying commitment to reduce – and, ultimately, eliminate disparities in health and in its determinants, including social determinants” (Braveman, 2014, p. 6). Achieving health equity means ensuring health for everyone, especially populations at great risk for poor health based on socio-economic status.  Achieving health equity is growing in demand and necessity to truly improve population health. A growing body of evidence links differences in health among populations to social, economic, and environmental factors.

One way to measure progress towards health equity is health disparities. Healthy People 2020 define health disparities as a “particular type of health difference that is closely linked economic, social, or environmental disadvantage.” These disparities adversely affect a population who has experienced greater social or economic barriers to health based on their race, religion, socio-economic status, gender, age, sexual orientation, physical disability, or even geographic location.

Let’s consider two families who live in a rural community, one of them is of high income and the other low income. Both families seek medical care as needed from a health care provider who visits a local clinic two times a week, with the high-income family who has health insurance through an employer and the low-income family who must pay out of pocket. However, when health care needs require specialty care in another city, such as a dermatologist or oncologist, the high-income family likely has the means to access that care while the low-income family does not have the opportunity to access care due to income and transportation barriers. Thus, reducing the opportunity to live the highest level of health.

If you are paying attention lately, health equity is the focus of many conferences nationwide, as well as research and public health practice. Powerhouse public health organizations understand the enormity and necessity to achieve health equity and creating a culture of health where we live, work, learn, and play, regardless socio-economics. Specifically, the American Public Health Association identifies creating health equity as one of its “guiding priorities and core values”, and the Robert Wood Johnson Foundation mission is “to improve the health and health care of all Americans”, creating a culture of health. While achieving health equity is a guiding priority for national organization, it is also a focus for many federal, regional, state, and local entities. Federal funding agencies are taking stock of the need to address health disparities at the local level to improve health outcomes. Local agencies are also taking notice and shifting efforts towards achieving health equity by reducing socio-economic gaps that exist among advantaged and disadvantaged populations, including educational opportunities or access to quality and affordable housing.

The reality is that differences to exist between rural, urban, and tribal communities. Research shows that rural populations are decreasing in size and people are moving to urban areas. Rural America face inequities that results in poor health outcomes and higher chronic disease rates when compared to urban communities, due in part to access to care, geographic isolation, low employment and income. In addition, rural residents who live on farms, ranches, reservations, and frontiers often are forced to travel long distance to access health services, which means taking time off work throughout the care process.  Many tribal communities are in rural America and affected by similar factors. However, American Indian and Alaska Native people have also historically experienced lower health status compared to other Americans, including lower life expectancy, higher disease rates. Inadequate education, disproportionate poverty, and cultural differences are just some of the quality of life issues that are rooted in economic adversity and poor social conditions that affect tribal communities (Indian Health Service, 2018). Conversely, even though urban areas are growing and assumed to have available resources to support resident to live the highest health possible, inequities are present in urban settings. Food deserts, food insecurity, and access to goods and services due to income are just some of the factors continue to affect populations in urban areas.

Is it also important to discuss the role that racism and discrimination play in our communities.  According to the APHA Executive Director, Georges Benjamin, "It is simply impossible to talk about the roles that racism and discrimination play in the health of our communities without taking a hard look inward..." Achieving health equity means naming racism and discrimination as a force in determining how social determinants, such as employment, housing, healthcare food access, and education, are distributed (Benjamin, 2018).

So how is health equity achieved? Recently, I had the opportunity to moderate a panel of public health experts whose focus expands urban, rural, and tribal communities. While there are unique health differences that affect these communities, one common theme across them to achieve health equity is collaboration. Collaboration with a diverse group of partners and sectors who can come together to address the social, economic, and environmental factors that influence health and create this divide. If a child does not have access to food, how can we expect them to succeed in school when they are hungry. This is an opportunity where the education and community and even business sectors can intersect. In the words of the panelists, “there is always opportunity to collaborate, it just may mean looking at it from a different lens.” According to the American Public Health Association, we achieve health equity by valuing all people equally – optimizing conditions in which people live, work, learn and play. Moreover, investment in communities and public health, not less, is a key strategy to achieve health equity, including investment in rural communities.

So, how can society improve the health of populations and achieve health equity if we do not recognize the factors causing those inequities?

References

American Public Health Association. (2018). Health Equity. Retrieved from https://www.apha.org/topics-and-issues/health-equity

Benjamin, G. (2015, May 19). Health equity and social justice: a health improvement tool. Grantmakers in Health. Retrieved from https://www.apha.org/-/media/files/pdf/topics/equity/health_equity_social_justice_apha_may_2015.ashx?la=en&hash=1AB844B23465836A5ECAEEFA12FAD0805C16CEC2

Braveman, P. (2014). What are health disparities and health equity? We need to be clear. Public Health Reports, 129(2), 5-8

Indian Health Service. (2018, April). Disparities. Retrieved from https://www.ihs.gov/newsroom/factsheets/disparities/?mobileFormat=0

Warshaw, R. (2017, October 31). Health disparities affect million in rural U.S. communities. Association of American Medical Colleges News. Retrieved from https://news.aamc.org/patient-care/article/health-disparities-affect-millions-rural-us-commun/

Alzheimer's Disease: A Profile of South Dakota's Efforts to Address it

 Executive Director, South Dakota Alzheimer's Association

Executive Director, South Dakota Alzheimer's Association

Right now, at least 17,000 South Dakotans are living with Alzheimer’s disease. It is the 5th leading cause of death in our state. South Dakota also has the 3rd highest Alzheimer’s death rate in America. The numbers are staggering, and yet South Dakota remains one of just a handful of states that does not have a State Plan on Alzheimer’s and related dementias.

A state plan acts as a roadmap of sorts – a comprehensive guide for our state to ensure resources, training and access to care are available for all who are impacted by this disease. State plans are as varied as the states that have them. To determine what South Dakota’s state plan should look like, a grassroots effort consisting of policymakers, professional and family caregivers, legal and financial experts, and health care administrators formed the South Dakota Alzheimer’s/Dementia State Plan Work Group. The group convened in April of 2017, and last summer completed a statewide needs assessment to determine what South Dakotans would most like to see in a state plan. More than 1,000 people completed surveys in 57 South Dakota counties. More than 100 people attended focus groups across the state. Their collective experience can be summed up in two key takeaways: 1.) Services and resources are inadequate or missing throughout the state. 2.) Where resources and services exist, they are constrained by high costs, insufficient workforce numbers, a lack of know-how, and debilitating stigma.

The needs assessment report also demonstrates that public health has a critical role to play in promoting the cognitive functioning of adults and addressing soaring costs to healthcare, social, and economic systems. As part of the state Alzheimer's plan response, public health can apply its broad community-based approach to educate South Dakotans about brain health, advance early detection and diagnosis, improve safety and quality of care for people living with dementia, and assure caregivers get needed support. We also need surveillance data from the South Dakota Behavioral Risk Factor Surveillance System to help track our progress in improving outcomes.

The findings from the needs assessment will now serve as the backbone of the state plan. The work group will be writing the plan throughout 2018, and will present it to the South Dakota Legislature in the 2019 session. While a way to treat or cure Alzheimer’s and related dementias might still be years away, a state plan can help ensure there are services in place to help those who are dealing with this condition right now. That’s also the focus of the Alzheimer’s Association South Dakota. Our trained staff provide care consultations, information and referrals, support groups, and a 24/7 Helpline (800.272.3900). To access these services visit alz.org/sd or call 605.339.4543.

Using a Community Champion to Address Rural Health

Over the past few months, I have spent a lot of time traveling and focusing on rural health, including barriers to healthy living and strategies to bridge clinical-community partnerships. Through my travels, I am reminded of the vastness of a state such as South Dakota and how truly rural much America is. Recent findings from the 2012-2016 American Community Survey report that rural areas cover 97 percent of the United States (US), but only 19.11 percent of the US population lives in them. Population shifts since 2010 from rural to urban areas have shed light on the changing landscape. Urban and rural areas are both affected by disease associated with social, environmental, and economic specific those areas, however rural America is disproportionately affected by health disparities when compared to urban areas.

Rural America suffers from higher rates of a chronic disease, mortality and lower life expectancies (Rural Health Information Hub, 2012-2018).  Recent findings from Garcia, Faul and Massetti (2017) found that rural America is “more likely to die from five leading causes, including heart disease, stroke, chronic lower respiratory disease, cancer, and unintentional injury, than their urban counterparts, highlighting a critical gap between rural and urban Americans”.  Much of the gap of health outcomes in rural areas compared to urban areas is associated with socio-economic and environmental factors specific to rural areas, including low or no access to health care services, healthy foods, or physical activity opportunities, geographic isolation, limited job opportunities, and poverty.  As the saying goes, backed by research, “zip code is a stronger predictor of health than genetics”.  This mean social, economic, and environmental factors where a person lives, work, learns and play defines health outcomes.

While the reality of rural health may now sound dim, the reality is that rural communities across America are addressing and improving the health of their communities to reduce these health disparities. Funding agencies are taking notice of the health needs in rural America and that efforts at the local level are one of the keys to positively move the needle on health outcomes.  

So just who is “they”? They include residents, albeit coalitions, decision makers, or individuals affected by disease, committed and passionate about ensuring their community is healthy. One of those residents that can advocate for change and health improvement, is a community champion.  A community champion can be a public official, community leaders, concerned citizen or a volunteer, and who is committed to leading the charge in addressing the health of their community (Center for Community Health and Development, 2018).  The notion is that a community champion lives in and understands the community and has established relationships with key stakeholders in the community who are integral to addressing those social, economic and environmental factors that affect rural health outcomes.  Imagine where you live and an outsider who does not know your community wants to come in and improve access to healthy foods, not knowing the community, any historical challenges with community collaboration, and who the residents are. While the outsider will eventually gain an understanding the community, identifying a community champion to help lead these efforts will increase likelihood of success.

Communities across the US have had success in addressing these factors with the support of a community champion. For example, South Dakota State University Extension has worked with rural South Dakota communities with high obesity rates to identify community champions to help lead efforts to address access to physical activity opportunities and healthy foods through evidence-based approaches focused on improving health behaviors and reducing death and disease. These community champions live in those communities and have the ear of key stakeholders and residents important to support local needs assessment and implementation of evidence-base approaches to address priority health issues.

So, if you live or work in a rural community and want to move the needle on health outcomes, find a community champion who can advocate for change.

References

Center for Community Health and Development, University of Kansas. (2012-2018). The Community Tool Box. Retrieved from https://ctb.ku.edu/en

Garcia MC, Faul M, Massetti G, et al. Reducing Potentially Excess Deaths from the. MMWR Surveill Summ 2017;66(No. SS-2):1–7. DOI: http://dx.doi.org/10.15585/mmwr.ss6602a1.

Health Resources and Services Administration. (2002-2018). Rural Health Information Hub. Retrieved from https://www.ruralhealthinfo.org/

Improving Maternal-Fetal Outcomes Begins with Community

 Lisa Groon, Founder Ovo Birth Center

Lisa Groon, Founder Ovo Birth Center

There were 3.978 million births in the United States in 2015. When compared with all other developed countries, the United States has the worst maternal mortality rates. The worst. Why? Because on the most basic level, we just aren’t listening to mothers. And when we don’t trust women and the physiology of birth, we see unusually high inductions and cesareans and women experience excessive medical interventions like episiotomies, and ultimately, we see higher mortality rates. Our society is no longer talking about normal, physiologic birth, and it’s resulting in dire consequences for moms and babies. Not only do families deserve a model of care that honors the whole family, but they deserve a community, because research has told us time and time again that the health in moms and babies lies in the presence of a supportive community. When families have seamless access to health care providers, resources, and most importantly, a diverse group of people who can offer a comprehensive array of options, lessons, and wisdom, they are more educated and involved in their care.

In a small study with a Northern Plains American Indian tribe, the researchers described how a community-based approach that includes elder women, fathers, midwives, and other important individuals not only increases utilization of care during pregnancy but also empowers women before, during, and after pregnancy. They also specifically requested to have midwives provide their care. Separately, a large study in India showed that implementation of community-based interventions led to reduction in neonatal mortality, increased rates of early breastfeeding, and ultimately, significant decreases in neonatal and maternal morbidity. In the 2011 Surgeon General’s Call to Action to Support Breastfeeding, societal factors including lack of knowledge, social norms, poor family and social support, embarrassment, among others were cited as having a significant impact on low breastfeeding initiation and duration rates in the US.

An approach by a midwife in Florida called the JJ Way utilizes four core tenants to address maternal health outcomes in her clinic; Access, Connection, Education, and Empowerment. Her model demonstrates consistently better health outcomes compared to the national average and she does this first by ensuring that all women who seek care, receive care and then her team invites them into a supportive community which offers kinship, wisdom, and empowerment. As her team has shown, community-based care is an important component of providing a continuum of care for low-resource communities.

It has been proven time and time again that the solution to improving maternal outcomes starts with community. It starts with making midwives available to Native American women and Centering Pregnancy programs to women in urban communities so that women can experience more favorable birth, neonatal, and reproductive outcomes. It starts with bringing back a village of families where we know our neighbors and deliver meals to new moms, breastfeed in public, and watch the other kids at the park without question.  We know that organized social services and programmatic medical care works to improve mortality rates and we can continue to improving these outcomes through collaborative systems approach, involving providers, friends, family, and neighbors. It truly does take a village to raise a child.

References

1.      Martin JA, Hamilton BE, Osterman MJK. (2016, September). Births in the United States, 2015. NCHS data brief, no 258. National Center for Health Statistics.

2.      Andrea T. Roche, MS, RD, Kimberly B. Owen, MS, Teresa T. Fung, ScD, RD. (2015). Opinions Toward Breastfeeding in Public and Appropriate Duration, ICAN: Infant, Child, & Adolescent Nutrition, Volume: 7 issue: 1, page(s): 44-53.

3.      Ickovics JR, Earnshaw V Lewis JB Kershaw TS, Magriples U, Stasko E, Rising SS, Cassells A, Cunningham S, Bernstein P, Tobin JN. (2016). Cluster Randomized Controlled Trial of Group Prenatal Care: Perinatal Outcomes Among Adolescents in New York City Health Centers, 2016. American Journal of Public Health. 106(2):359-65. doi: 10.2105/AJPH.2015.302960.

4.      New York Times (2018, February 4). Making Pregnancy Safer for Women of Color. Retrieved from https://www.nytimes.com/2018/02/14/opinion/pregnancy-safer-women-color.html

5.      Lassi ZS, Kumar R, Bhutta ZA. Community-Based Care to Improve Maternal, Newborn, and Child Health. In: Black RE, Laxminarayan R, Temmerman M, et al., editors. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC):

6.      The International Bank for Reconstruction and Development / The World Bank (2016 April 5). Chapter 14. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361898/  

Sinha, B,  Chowdhury, R., Sankar, M.J., Martines, J.R., Taneja, S., Mazumder, S., Rollins, N, Bahl, R., & Bhandari, N. (2015, July 16). Interventions to improve breastfeeding outcomes: a systematic review and meta‐analysis, 2015. Acta Piadatrica. https://doi.org/10.1111/apa.13127