“How can you deal with rising health costs when people don’t have jobs? How can you really look at some of the negative aspects around health when people don’t have income, when people can’t have a roof over their heads?” This is a question recently posed by Karen Washington, a longtime community activist in the Bronx.
Washington is a member of the Northwest Bronx Community and Clergy Coalition (NWBCCC), a grassroots, member-led organization that recently created a cross-sector partnership to address the root causes of health problems in the Bronx. Through the initiative, called the Bronx Healthy Buildings Program, the members of NWBCCC hope to alleviate the social conditions that cause disproportionately high rates of asthma in the Bronx. Because Bronx residents face environmental, economic, educational, and political barriers to health and wellness, the intervention tries to address multiple factors through a community-based approach. The program partners aim to create a borough where all actors work together to ensure holistic community health by investing in safe living conditions, creating high-road jobs for low-income residents, and designing a healthcare system that prevents health disparities before they emerge.
One of the most pressing public health challenges in the Bronx is asthma, a chronic lung disease that impacts low-income, non-white communities at an alarming rate. In the Bronx, the prevalence of asthma is slightly lower than the state average. But, the rate at which asthma sufferers seek emergency treatment greatly outpaces the rest of New York state. In fact, asthma emergency room visits in the Bronx amount to more than four times the state average. In addition, the borough’s asthma mortality rates are six times that of New York state.
Treating asthma can be very challenging for people living with limited resources. While some people with asthma rarely experience symptoms, others have persistent wheezing, shortness of breath, or chest tightness. Because there is no cure for the condition, the aim of treatment is to manage the symptoms through controller medications and the avoidance of environmental triggers that cause or exacerbate symptoms. An important step in controlling asthma symptoms is to reduce exposure to triggers in the home like environmental tobacco smoke, cockroaches, dust mites, pets, and mold.
For many Bronxites who spend a significant percentage of their income on housing and utility expenses, the cost of healthcare relative to their income presents a key challenge. These households struggle to afford consistent asthma treatment and as a result assume the risk of severe symptoms that may require emergency treatment. Without regular asthma check-ups, patients are also not properly educated about asthma self-management or the role that housing conditions play in their health.
Bronx residents living with asthma also face exposure to social and environmental conditions that further aggravate their asthma symptoms. More than eighty percent are renters and must rely on their landlords to maintain their deteriorating housing conditions. Because many tenants are unaware of their rights to safe and sanitary housing or are fearful of retaliatory eviction, they reside in dangerous and unhealthy living conditions. This population also lives with other stressors such as overcrowding, unemployment, and racial discrimination-conditions that create additional risks for asthma attacks.
In order to comprehensively address many of the conditions that cause or exacerbate asthma symptoms, the Bronx Healthy Buildings Program includes a diverse set of partners to provide technical expertise on various dimensions of the project. MIT Community Innovators Lab will help identify buildings in the Northwest and Central Bronx with social and environmental conditions that place residents at high risk for asthma attacks. The selection process will rely on several datasets: the rate of asthma emergency department visits and hospitalizations of residents, housing condition violations, rent stabilized registrations, and the non-compliance list for heating-oil conversion to cleaner fuels. The Northwest Bronx Community and Clergy Coalition will train residents of the selected buildings on how housing conditions affect individual health and how to organize tenants’ associations to advocate for needed building upgrades.
Through the assistance of Blocpower and the New York City Department of Health and Mental Hygiene, the Bronx Healthy Buildings Program will perform energy- and health-related assessments on targeted buildings to determine which interventions are needed and how landlords can secure financing for the upgrades. Blocpower and the New York City Department of Health will also work with tenants and landlords to select local construction firms with fair-wage positions and ecological practices to complete the retrofits.
In addition to the building upgrades, the project will recruit and train Community Health Workers to serve as liaisons between the tenants, landlords and the healthcare system. With assistance from Montefiore Health System, the CHWs will deliver in-home outreach to tenants about asthma self-management practices and how to control environmental health hazards. The CHWs will also help conduct progress assessments with residents in order to help evaluate behavioral changes for analysis. In an attempt to share lessons widely, The Bronx Healthy Buildings Program will publish its findings and provide recommendations for how to replicate the model nationally.
For four decades, the Northwest Bronx Community and Clergy Coalition has helped Bronx residents develop visionary leadership to revitalize their neighborhoods and build community power. Most recently, parent leaders from the NWBCCC worked with a coalition to pass legislation that ensures prompt disclosure of hazardous toxins found in NYC public schools. The Bronx Healthy Buildings Program builds on the history of putting community residents at the center of transforming the conditions and outcomes that matter to them. Through diverse partnerships with healthcare providers, city agencies, and other technical experts, the project includes numerous opportunities to address the conditions that lead to health disparities in the Bronx. By remediating poor living conditions, converting to cleaner and more efficient energy consumption, creating high-road jobs, increasing health literacy, ensuring housing affordability, and building community power, all partners hope the Bronx will become a leader in innovative community health solutions.
The Bronx Healthy Buildings Program received implementation support from the Build Health Challenge for its innovative approach for improving health in low-income communities. The lead partners of the project include the Northwest Bronx Community and Clergy Coalition, New York City Department of Health and Mental Hygiene, Montefiore Health System, Emerald Cities Collaborative, New York Lawyers for the Public Interest, BlocPower, Bronx Cooperative Development Initiative, and MIT Community Innovators Lab.