Green and healthy planning

Green & Healthy Planning: Livability and Equal Access for All!

SNEAPA 2016Friday, October 21 2016

2:20 – 3:35 PM

Health Equity Zones (HEZ)The Rhode Island Department of Health’s Collective Impact Approach to Community DevelopmentChristopher Ausura

What Determines Population Health?

Determinants of Health

Social Supports

Safe Housing & Neighborhoods

Education & Employment

Seeking Medical Care

Diet & Exercise

Substance Use

Genetics[30%]

Healthcare[10%]

Social & Environmental

[20%]

Individual Behavior

[40%]

Affordability Health Literacy

Access to Care Adapted from Schroeder, SA. (2007).

Health Equity Framework - Equity Pyramid

This pyramid is adapted from Thomas Frieden, MD, MPH, Health Impact Pyramid presentation at the Weight of the Nation conference, Washington D.C., July 27, 2009

1. Education & Counselinge.g. Eat Right

2. Clinical Interventionse.g. diabetes control; pediatric

weight management counseling

3. Long Lasting Protective Public Health Interventions

e.g. immunizations; HIV testing; BMI screening?

4. Changing the Context-Healthy Choices as Default Optionse.g. smoke free laws; healthy food in schools law

5. Social and Environmental Determinants of Healthe.g. housing, education, inequalities; community garden

Lowest Impact

(1)

Highest Impact (5)

Life C

ours

e App

roac

hEm

otional and Social Competencies

Collaboration, Integration, Partnerships

Most Individual

Effort

Least Individual

Effort

Health Equity Zones (HEZ)• In 2015 RIDOH issued an RFP for community led projects called “Health Equity

Zones” that would address the social and environmental drivers of health disparities

• HEZ are contiguous geographic areas that have measurable and documented health disparities, poor health outcomes, and identifiable social and environmental conditions to be improved

• A 4 year, $13 million, investment of state and federal grant dollars by the RI Department of Health spread across 10 health equity zones

• Focuses on the development of sustainable community collaboratives who will work to improve the health of their communities using a collective impact approach to address the social and environmental determinants of health

The Composite of Health Equity Zones for Rhode Island

Health Equity Zone (HEZ) – Implementation Build/expand local collaborative

Evidence of meaningful, true engagement of key stakeholders

Should include: Community residents, local housing authority, Local planning department, local education agency, city or town leaders, FQCHC and mental health community centers, other health care providers (e.g. hospitals. PCPs insurers…), CBO’s, youth organizations

Identify backbone organization

Collectively identify and prioritize local health issues Conduct community health needs assessment

(needs/assets) Review these findings with the community

Develop and implement local plans of action Community-based, evidence-based strategies and programs Address multiple health impact domains Focused on the elimination of disparities

Health Equity Zone (HEZ) Implementation • Build/expand local collaborative• Collectively identify and prioritize local health issues• Develop and implement local plans of action

Strong communities infrastructure begins with genuine community engagement, and the establishment of strong community partnerships. Each community should:

• Understand the community infrastructure, assets, needs and opportunities for development

• Understand the social and environmental determinants of health

• Develop diverse community reflective collaboratives

• Ensure community decision making is fair and equitable, and inclusive of vulnerable community members

• Understand and take ownership of the health and development of their community

• Reach collective agreement on a vision for improved community health, functioning, and prosperity

• Invest in the development of community leaders who reflect the community

• Leverage investments to achieve the highest possible positive impact on the community

To sustain development of resilient, healthy communities and improve population health, resources and policies must be aligned. Multi-sector funders and policy makers should:

• Invest collaboratively to increase the effectiveness of investments while reducing redundant reporting

• Target investments to strategies proven to eliminate disparities of all kinds while growing local economies

• Develop investments that link community development to health improvement

• Listen actively to community needs and be responsive to reinforce genuine commitment

• Prioritize investments that support sustainable community development projects, policies, and strategies

• Support projects and policies aimed at social and environmental determinants of health

• Seek out and engage non-traditional partners

• Utilize health improvement outcomes and costs savings to guide future policy changes and investments

• Implement sustainable design strategies

By responding to community needs, and investing in sustainable community development, Rhode Island communities will demonstrate improvements. Communities will:

• Be more livable places that attract and retain both residents and businesses

• Consist of residents who civically engaged• Have exemplary health and social services• Collectively improve the safety net

needed for healthy human development • Have stronger and healthier economies

driven by the strengths of the communities

• Eliminate or be working to eliminate health, education, and other disparities

• Reduce healthcare costs and expenditures by improving both physical and behavioral health outcomes

• Be stronger, more disaster ready, and adaptable to unforeseen changes

• Have developed sustainable strategies for community development

• Be able to demonstrate returns on investments

• Demonstrate increased self-sufficiency and community pride

Health Equity Zone Theory of ChangeIF Rhode Island collaboratively invests together in defined geographic areas to develop sustainable infrastructure, and aligns a diverse set of resources to support community-identified needs, THEN positive impacts on the social and environmental conditions driving disparities and poor health outcomes will be demonstrated.

Community Development Sustained Investment Positive Impact

Health Impact Domains• Integrated Healthcare DomainThis domain focuses on the system of healthcare and social services, including quality, affordability, and access to physical and behavioral health and the connection to individual biological and psychological behaviors, attitudes, and beliefs that affect patient health.• Community Functioning and Social DomainThis domain focuses on factors that influence the health of individuals in the community. This may include social, cultural, and spiritual aspects, economic drivers, and civic and community engagement. • Physical and Environmental Determinants DomainThis domain focuses on the physical conditions of the environment in which people are born, live, learn, play, work, and age. This may include the natural environment, build environment, critical infrastructure, and hazards and risks. • Socio-Economic and Demographic DomainThis domain focuses on the social standing of an individual or group in relationship to the combination of education, income, and occupation attainment.

Health Impact Domains• Integrated Healthcare Domain• Community Functioning and Social Domain• Physical and Environmental Determinants Domain• Socio-Economic and Demographic Domain

Community Development and Health• Using the Theory of Change to invest in the Health Impact

Domains we envision better connections between the sectors that affect the social and environmental determinants of health• The alignment of community development sectors with

health improvement sectors provides significant opportunities for both to leverage existing work to increase effectiveness and better document impacts• Collaboration between these sectors already occurs, but

the outcomes are frequently not reported collectively and leads to outcome reporting that is undervalued compared to their actual impact

Impact to Date• More than $1,000,000 of additional funding has been

leveraged by HEZ collaboratives to support sustainability, these are dollars the communities have raised for themselves• Over 200 different community organizations, businesses,

and community agencies have come together across the 10 HEZ to collectively improve the health of their communities• HEZ collaboratives are working with town and city leaders

across the state to improve their communities from within by re-designating buildings for community use, creating new policies and regulations, and holding community events to increase civic engagement

Impact to Date• More than $1,000,000 of additional funding raised• Collaboration of over 200 different community organizations• Collaboratives are working with local governments to get things done!

Next Steps• We are currently meeting with partners across the

state to establish indicators of community health based on the Health Impact Domains that will inform community health index scores reflective of the diverse set of factors that affect health in a community• RIDOH wants to create a Health Equity Zone in every

city and town in Rhode Island; to support a HEZ in every city and town RIDOH, in partnership with other private and public funders, plans to raise and invest $70 million in capital into comprehensive community development

Bristol, RI Health Equity ZoneCraig Pereira

This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).

What will the Health Equity Zone result in for the Bristol community?1. A comprehensive baseline assessment of the factors that drive poor health outcomes across the community.

2. Development of innovative place-based approaches to prevent chronic diseases, improve birth outcomes, and improve the social and environmental conditions of Bristol’s neighborhoods.

3. Implementation of a community Work Plan of action by municipal leaders, residents, businesses, transportation and community planners, law enforcement, education systems and health systems, among others over a three to four year period, to improve the overall health and quality of life for Bristol’s residents.


Why does Bristol need a HEZ?1. Despite the overall increasing household wealth of Bristol residents from 2000 to 2012, there still remains a population living in Bristol with very limited financial means.

2. 32.1% of all Bristol households have what public agencies define as extremely low income levels, (incomes at or below 30% of the area’s median income) - a significant amount that will affect the general housing, nutrition, and educational needs of the community.

3. The Bristol HEZ will provide the structure for bringing the numerous social services and community-based organizations currently working independently together in a collaborative framework so that more can be accomplished in the area of public health.


Five Primary PartnersBristol Warren Thrive by Five and Beyond

East Bay Food Pantry

East Bay Community Action Program (EBCAP)

Bristol - Warren Regional School District

Mosaico Community Development Corporation.


Three Target Demographics

Low to Moderate Income Residents

Elderly Population

Portuguese Population


Three Primary DeliverablesEstablish a Collaborative

Baseline Assessment of Health Needs in the Community

Development of a Work Plan

Looking Back on Year One... Establish a Collaborative1. Reached out to existing programs, services and leaders in the community2. Conducted in-person interviews and on-line survey 3. Identified individual strengths and personal interests4. Provided training to the Collaborative5. Developed Year 1 scope of work with newly-established Collaborative6. Encouraged Collaborative members to engage with the community7. Structured Collaborative ‘levels of participation’ based on their role in the community, their interest level, and their capacity to participate.8. Community Partners Outreach Survey employed to better understand the community stories related to health issues, community strengths and weaknesses, and health indicators related to at-risk populations.9. Developed list serve/constant contact list of Collaborative member’s constituents.



Looking Back on Year One... Establish a Collaborative

Looking Back on Year One... Baseline Assessment of Health Needs in the Community1. Utilized Collaborative outreach data to identify general ‘topic areas’ 2. Researched National public health/health equity assessment models3. Identified range of implementation methods4. Implemented on-line and hard copy surveys5. Conducted Focus Groups6. Participated in and organized community events7. Gained a snapshot of the community centered around general ‘topic areas’ by understanding the gaps in services and needs of the community 8. Identified feasible alternatives for programming and delivery of services 9. Created ‘institutional awareness’ of the Bristol Healthy Equity Zone initiative



Looking Back on Year One... Baseline Assessment of Health Needs in the Community

Looking Back on Year One... Development of a Work Plan1. Adhered to ‘Guidance’ provided by CDC via RI DOH.2. Solicited Collaborative for strategies3. Utilized findings from the Baseline Assessment4. Prioritized submitted strategies with Collaborative5. Refined the details on each strategy6. Approved Work Plan submission with Steering Committee7. Strategy to address the identified gaps in services and needs of the community8. Realization of the strength of the community and desire for improved quality of life9. Celebrated our award of $321,225 towards implementation of strategies for Year 2 at week-long community celebration



Looking Back on Year One... Development of a Work Plan

Lessons learned... Successful endeavors…

1. Building on the strength of an already-existing organization/network

2. Hitting the streets for public

outreach/Listening

3. Leveraging community resources



Lessons Learned


Lessons Learned

Lessons learned... Not so successful endeavors…

1. Time

2. Communications

3. Flexibility


What’s Happening in Year 2...

Shift towards a ‘sustainable model’

1. Collaborative’s transition to Working Groups and Champions

2. Higher engagement of Primary Partners

3. Reconstitution of Steering Committee





Comprehensive integration into the community

1. Bristol Warren Regional School District

2. Roger Williams University

3. Engagement of Primary Care Providers





Implementation of new programs and services1. Personal Health and Wellness

2. Physical Activity

3. Food and Nutrition

4. Substance Abuse Awareness and Prevention




What’s Really Happening in

Year 2... Implementation…

Evaluation…Revision…

Implementation…Evaluation…Revision…




Public Health Considerations in

City Planning

Patrice Barrett, MPH

https://nextcity.org/daily/entry/visual-primer-social-impact-design.

https://nextcity.org/daily/entry/visual-primer-social-impact-design

Presentation• My background• CDC/ATSDR • Grant with Horsley Witten Group• Public health considerations in city

planning projects • Brownfields and public health

ID needs of the population Link health data to specific environment Public engagement & education both

important

Public Health in City Planning

• Good partners & advocates • Provide insight and expertise• Consider: Health Impact Assessment (HIA) -

assessing health impacts of policies, plans and projects in diverse economic sectors using quantitative, qualitative and participatory techniques.• Public health practice a very broad discipline

CDC/ATSDR Grant & Horsley Witten• City Middletown, CT • One year CDC

planning & outreach only brownfield revitalization grant from ATSDR • People recognized

important to be part of a transparent city project

• Learn needs of population • Ask citizens what they

want for community green space • First learn who they are• 3 census tracts centrally

Our Project• Approx. 47,000

population • Small university • SES portrait different

from whole city (much lower income, poorer housing quality)• Densely populated tracts• Mixed business and

residential use• Minimal green space

• Infrastructure issues (prevent safe pedestrian use)• SO – little physical activity

or interest

Quality of life neighborhood survey results at grant start

Insightful and set the stage

Grant Areas & Properties

Brownfield Work• Grant for where abundance

of properties• Portrait of the population

living there: Socioeconomic

characteristics Number of children vs. adults Quality of life issues Health status – obesity,

asthma, child lead issues, other exposures leading to illness

Public Health EducationWhile planners are doing property

research and planning – Public health educates in the community:• What is a brownfield ? (huge task)• Exposures & pathways• Exposure = possible disease. Little

physical activity = obesity, diabetes. OR risky exposure (kids and lead, hands in mouth with soil)• Chronic health disease impacts• How to advocate for issues important to

you and your neighborhood peers….

Education Takes Many Forms

Stakeholders are importantThey fill in the blanks

• Include all community sectors• Provide

valuable insight and wisdom• Help you

navigate the rough spots• Know what the

data do not show

Engagement: a Multi-Headed Friendly Beast

Public Service Announcement on local Public Radio

Photo Voice: A Common Public Health Technique

Litter on the streets . . .

Favorite Things about Middletown:Nice atmosphere Restaurants ∙ ∙Town keeps developing and that helps everyone ∙Any development by the water is good ∙Teachers are great and dedicated, and always push studentsThings they would change:Generally feel safe Cleaner would always be nice ∙ ∙A dog park would be nice

We need new sidewalks

People and things otherwise not heard or seen

What happened?

Favorite Things about Middletown:Like Middletown, nice family townHappy with soup kitchen and that it’s open every dayLike that there are women businesses owners up and down main street, woman taking the leadThings about Middletown that they would change:Parking is hard to find

A familiar North End sight

Some of the Results• Many residents

got their soil tested• Planner site

designs took into account what people felt• Some residents

saw areas of the city they never knew (you live where ?)

Thanks & Contact Info

• Thanks for listening today• Group activity

planned• Can ask questions

during that time

• Patrice Barrett, MPH• PatriceBarrettMPH

@gmail.com• LinkedIn profile

mailto:[email protected]

mailto:[email protected]

Scenario Activity• Spilt into groups of no more than 8 people• Take 5 minutes to read the scenario• Take 15 minutes to answer the questions

with your group

Greetings from

Cabo San Lobstah

Snappy and Delectable since 1737

Government & Nonprofit

Green and healthy planning