Patients who live in safe neighborhoods with access to basic community services, ample sources of nutritious food and health facilities are typically able to obtain needed health care services. But people living in low-income areas are less likely to be able to do that.
Enter the BUILD Health Challenge,(www.build-health.wp.csldev.com) a competitive awards program that is attempting to reverse the socioeconomic trends that contribute to poor health by supporting local initiatives that address health issues tied to a specific social need. Specifically, the program aims to recognize community collaborations that are taking Bold, Upstream, Integrated, Local andData-driven approaches to improve community health, promote health equity and provide resources to communities that are implementing these strategies.
On June 9, the BUILD Health Challenge awarded grants to 18 such initiatives. Seven initiatives at the implementation stage received $250,000 grants over two years to enhance existing projects through data collection or stronger partnerships. Eleven projects in the planning stage received $75,000 to initiate new projects with specific health problems with a community action group.
A complete list of award recipients(www.build-health.wp.csldev.com) is available on the BUILD Health Challenge website.
During a ceremony held to recognize the award recipients, Karen DeSalvo, M.D., acting assistant secretary for health at HHS, discussed the relationship between the health of individuals and the community in which they live.
“We are losing the battle for public health,” she said. “Despite all of the progress in medicine, the public is not as healthy as we want them to be.”
While working as a physician in New Orleans, DeSalvo recalled treating patients with diabetes who were unable to maintain a healthy lifestyle because their surrounding community had limited resources. What she learned was that social and environmental factors influence health as much as one’s physical condition.
“One of the major determinants about mortality and overall health depends upon where you live,” DeSalvo said.
Some of her patients, for example, missed appointments because the bus they relied on was late. Others often went to the ER for medication refills because they couldn’t afford to pay for the drugs. And despite being warned about high salt intake, many community residents had little choice but to shop at a local convenience store where healthy foods were not available.
Through the years, improvements in public health have been made in tandem with other civic initiatives, said DeSalvo. A drive to provide clean water required enhanced sanitation efforts. To treat tuberculosis, sound housing policy was just as important as prescribing the right medicine, she noted.
That same rationale lies at the heart of the BUILD Health Challenge. Here is a look at some of the newly named grant recipients and what they’re doing to improve community health:
Ending Community Violence in Miami
In Miami’s Liberty City neighborhood, organizers are seeking to make a safer environment for children. The area has struggled for years against high rates of youth violence and gang activity. As proof, Roderick King, M.D., CEO of the Florida Institute for Health Innovation, cited a recent case in which a 10-year boy simply riding his bicycle became the victim of a drive-by shooting. Fortunately, he said, the boy has now been released from the hospital.
King said children and elderly residents in the area are frequently injured by gun violence. Young school-age children are often in the streets late in the afternoon. By offering more structured after-school activities, organizers hope to place these children in a safe environment before dark.
But that’s not all, said King — violence in the community is linked to other health problems. When public spaces are no longer safe, for example, residents will not walk outside or spend time in parks, which can lead to higher obesity rates. King said physicians can serve as opinion leaders to demonstrate how the violence is a threat to public health in the entire community.
Boosting Health Care Access in Aurora
In a city of 350,000 with residents spread across 17 zip codes, local program organizers in Aurora, Colorado, are targeting three zip codes that reported the highest use of behavioral health services and the most ER visits in the state. The area is home to immigrants and refugees from Latin America, Bhutan, Nepal, Burma, Somalia and Ethiopia.
Many of the residents are poor, have lived in the United States for only a brief period and experienced some form of trauma in their homeland, according to Eliana Mastrangelo, a community organizer with Together Colorado.
Despite their obvious needs, Abby English Waldman, research and prevention coordinator for the Children’s Advocacy Institute, said program directors are attempting to identify what barriers to access exist without making any assumptions. A joint initiative is being undertaken by the county health department, Children’s Hospital Colorado and Together Colorado.
Cultivating Community Activists in Baltimore
After riots caught the nation’s attention in April, Baltimore residents are trying to address the frustration voiced by the city’s youth. One grant recipient plans to build a network of young activists who will learn how to advocate for their needs at the city level.
“Baltimore is not just a depressed city, it’s an unorganized city,” said Jane Henderson, executive director of Communities United. The program intends to help locals navigate city and other public services and demand more from their government. A key component will be developing young leaders who can help recruit their peers to participate in monthly meetings. Rachel Donegan, program director at the University of Maryland School of Social Work, said organizers want to channel young residents’ hunger to participate in something.
“They are very aware that the system doesn’t support them and is not made for them,” Donegan said. “That is the source of their anger and discontent. We want to acknowledge that and provide something that can help them advocate for themselves.”
BUILD Health Challenge Evolves
The four groups that launched the BUILD Health Challenge — the Advisory Board Company, the de Beaumont Foundation, the Kresge Foundation and the Robert Wood Johnson Foundation — have now been joined by the Colorado Health Foundation. Other partners are Duke University, the Housing Partnership Network, the Prevention Institute and the County Health Rankings & Roadmaps program at the University of Wisconsin Population Health Institute.
The BUILD Health Challenge is the second phase of a broader project to improve community health dubbed A Practical Playbook: Public Health & Primary Care Together.(www.practicalplaybook.org)