Learning Exchange with UK Communities for Health

Bronx Health REACH was selected by the Centers for Disease Control and Prevention to participate in an exchange with representatives from the United Kingdom’s Communities for Health program. The Communities for Health program intends to increase the role of local government in supporting health improvement and reducing health inequalities. Bronx Health REACH hosted visitors from the city of Nottingham, including the director of the health and well being partnership of the Nottingham City Council and a Nottingham city councilwoman, on November 16^th and 17^th.

As a community coalition dedicated to the elimination of racial and ethnic health disparities, Bronx Health REACH targets individuals through programs to promote healthy lifestyle change, as well as works with policymakers and stakeholders to effect policy change. Bronx Health REACH staff put together presentations to highlight programs that work with faith-based organizations, community groups, health care providers, elected officials, and others to improve health outcomes in the Bronx. We also invited our partners to speak about their work with the coalition and how they believe that Bronx Health REACH has impacted the health of the community. On the second day of the visit, we brought our visitors to the south Bronx and had them participate in a number of events. These included a “Can I Still Be Puerto Rican and Eat Healthy?” event at the MARC Academy and Family Center and the annual Thanksgiving dinner put on by the culinary committee at Walker Memorial Baptist Church for Bronx Health REACH’s Faith-Based Outreach Initiative. This annual event showcases the healthy dishes that have come about because of the nutrition training provided by Bronx Health REACH.

Throughout the learning exchange, we had a number of interesting conversations about the state of health care in the U.S. in comparison to the system in England. Because most citizens in the UK have public health insurance through the National Health Service, the UK visitors were struck by the differences in quality of care between publicly and privately insured patients in the U.S. They also repeatedly mentioned how shocked they were by the level of poverty in the south Bronx and, after hearing about the segregated system of care in New York, said they would go back to the UK with a renewed commitment to avert any efforts by the conservative leaning coalition government to introduce any aspect of a U.S. type health care system.

Time and time again the visitors voiced their awe at how much communities, through the efforts of Bronx Health REACH and others, have undertaken to meet their health challenges from the ground up. At the same time, they also voiced their consternation at the lack of a systemic effort to address health inequities, be it at the city, state, or the national levels. However impressed our visitors were with the work that Bronx Health REACH is doing to improve health in the south Bronx area, their lasting impressions of the broken health care system in the U.S. and the pervasive inequity in our country are profound. It shocked them that the richest country in the world could have such glaring poverty and inequity.

For those of us that work in this field, these realizations are nothing new, but it’s an eye-opener when outsiders so easily see the problems in our system. The learning exchange allowed Bronx Health REACH to showcase our efforts around nutrition, fitness, and health inequity in the community, but it also provided an opportunity to think critically about how health in our country stacks up against others. Unfortunately, we learned that we don’t stack up too well. In order for health to improve in underserved communities in a lasting way, policy and systems change must be at the forefront of our efforts. We all have a part to play to improve health outcomes and the Bronx Health REACH coalition will continue to drive change in its community to achieve health equity.

Addressing the Social Determinants of Health Disparities

As those of us who work in public health know, improving health outcomes has a lot to do with improving the environment in which people live, work, and learn. Addressing the social determinants of health, such as education and income, is critical in order to create healthier communities.

At the New York REACH US Health Disparities Summit a few weeks ago, Dr. Robert Fullilove gave a keynote address on the social determinants of health disparities, exhorting the audience to look at a variety of factors when working within communities to improve health. Dr. Fullilove, the Associate Dean for Community and Minority Affairs and a Professor of Clinical Sociomedical Sciences at the Mailman School of Public Health at Columbia University, has an extensive background working on minority health issues, especially in urban environments. He spoke about rebuilding communities as a way to improve health and referenced the breakdown of family cohesion in crime-blighted neighborhoods as an impediment to public health.

Though Dr. Fullilove touched upon many social determinants of health, one of his major points was the need to engage formerly incarcerated people, especially men, in the public health field. He examined the health needs of the so-called “million dollar blocks”, single city blocks with residents whom the state spends over a million dollars per year to incarcerate. Dr. Fullilove spoke about efforts to engage these men as partners in improving the health of their community upon their reentry into society. He also addressed the plight of at-risk populations, positing that risky behavior is not always a personal decision, but a factor of the environment. He called on the audience to realize that it was necessary to rebuild communities and the social fabric in order to improve health outcomes. As Dr. Fullilove said, “We don’t need a mass movement, we’re looking for people and for communities.”

The push for a community-based solution to eliminate health disparities remains a central component of Bronx Health REACH’s mission. As a number of Bronx Health REACH’s projects have shown, building support within a community to improve health outcomes does lead to positive results. Our work in churches and schools to promote healthy eating and increased physical activity has led to behavior change, as well as changes in the environment. To take one example, Bronx Health REACH’s Culinary Initiative, which aims to introduce healthy options in church meals, has led to less fat and salt being used by church culinary committees in preparing meals. Our efforts to engage all facets of the community also resonate with Dr. Fullilove’s call to action. In the fight to achieve health equity, it’s necessary to reach out to new partners and work with them to improve health outcomes.