Healthy communities projects can help lay foundation for improved education
Healthy communities projects can help lay foundation for improved education
Improve patient's ability to put knowledge into action
The Mentor Mom program in Duarte, CA, may seem on the surface like a hospital-based outreach effort. An employee of Arcadia-based Methodist Hospital runs the program, soliciting and training mentors to work with pregnant teens. Mentors are required to have at least two hours of contact per month with the pregnant teen, either by writing letters, telephoning, or visiting in person. The employee also organizes monthly meetings where teens learn about healthy eating habits, childbirth preparation, job skills, and college opportunities.
It's all an effort to ensure that pregnant teens give birth to babies that weigh at least five pounds and that they return to school eight weeks after the birth of their baby, says Dora Barilla, MPH, CHES, teen coordinator for the Mentor Mom program.
What is unique about this Mentor Mom program vs. many others patient education managers have participated in across the country? The project is not a hospital outreach effort, although Barilla is hospital-employed. It is a component of the city of Duarte's California Healthy Cities and Communities initiative. After a health assessment identified teen pregnancy as a communitywide problem, the city formed partnerships with the hospital and a counseling center to intervene.
Healthy community initiatives like the one in Duarte are being implemented in communities worldwide. Unlike the model Patient Education Management reviewed last month, a community benefits network comprising health care facilities, this model is a collaborative effort among local governments, agencies, organizations, businesses, and citizens to create conditions that support health and improve equity in health delivery. The community as a whole, not just health care professionals, determines what will improve health. In turn, health care providers determine how they best fit into the community projects.
"The healthy communities movement is a way of trying to involve communities and their local governments in making that community a healthier place to live," says Trevor Hancock, MD, MHSC, a health promotion consultant in Kleinburg, Ontario, Canada. Health care facilities play an important role in these initiatives, but their contributions don't always reflect traditional health improvement efforts. Good health is not as simple as providing good medical care and information on how to quit smoking, says Hancock.
While most people understand that such healthful habits as good nutrition, exercise, and physical exams help prevent chronic disease, they often overlook other factors that contribute to health, such as economic opportunity, housing, and transportation. People who don't have good jobs and who live in low-income neighborhoods often cannot afford to make healthful food choices, even if they have been taught about nutrition.
Therefore, they can be at risk for chronic diseases such as heart disease and diabetes. "If you think about it, what are often called the diseases of choice are also in fact diseases of limited choice," says Hancock.
The goal of the healthy communities initiatives is to unite all parts of the community that affect the ability of individuals to make healthful choices. The idea is to make the healthful choice the easiest choice, explains Joan Twiss, director of California Healthy Cities and Communities in Sacramento. In spite of educational efforts, citizens won't walk for exercise if their neighborhoods are crime-ridden and they don't have easy access to a mall or walking trail. Therefore, building well-lit neighborhood walking trails might be a very good use of health care dollars, explains Twiss.
One of many partners
Health care facilities can initiate a healthy community process, but they must quickly move from the role of initiator and catalyst to the role of partner, says Hancock.
Anderson (SC) Area Medical provides a good example of how it can be done. Called Partners for a Healthy Community, Anderson County's healthy community initiative began when the medical center offered the community $1 million to conduct a health needs assessment. The effort was not directed by the health care facility, but by a steering committee of 20 community representatives, two of whom were from the medical center. The assessment identified seven critical issues the community needed to address. (For information on choosing projects to develop to address community health needs, see article on p. 111.)
Once critical issues were identified, money from the fund was used to send seven people to a training session on creating healthy communities conducted by the Columbia-based South Carolina Department of Health and Environmental Control, says Russell Harris, CFRE, executive director of Partners for a Healthy Community. The hospital then provided $2 million to get the project rolling.
Healthy community initiatives aren't one organization or institution reaching out to the community, but everyone in the community working together, says Peter Lee, MPH, director of the South Carolina Healthy Communities Initiative of the Community Development Branch of the Department of Health and Environmental Control. "Ask what the people in the community envision a healthier future to be, and then listen to them and help them accomplish that," advises Lee.
Twiss emphasizes the importance of community involvement. "The more grass-roots involvement you have, the more true to the community it will be," she says. What differentiates the healthy city movement from other community development models is the participation of all segments of the community. A great effort is made to get the opinions of all citizens through focus groups and community forums.
To foster community involvement in Hampton County, SC, the planning committee for the local project spent two months alerting citizens by word of mouth and by advertising in the newspaper, on the radio, and on billboards. A slide show also was created and shown at civic groups, churches, and schools. Approximately 250 people showed up at the first forum. Large crowds continued to attend the following forums, which helped to identify four key issues in Hampton county, says Peggy Parker, EdD, interim executive director for PRO (Pride in yourself; Respect for others; Opportunity for all) Hampton County in Hampton, SC. Those issues were economics, education, health and lifestyles, and intergroup relations.
Yet community involvement did not stop there. People from all segments of the community signed up for task forces to determine how to address each of the key issues identified at the forums. Also, citizens from all walks of life are involved in the action phase, and participate in the projects.
The community forums actually are the third step in the process of laying the foundation for a healthy community movement. The first step is to conduct a formal community needs assessment, where facts and figures are gathered, and also to assess community assets. It's important to determine what programs already exist in the community and how issues are already being addressed, says Lee.
Secondly, it's important to mix projects that will make a difference in people's lives immediately with projects that will have a long-term impact, adds Hancock. "A healthy community initiative is not either long-term nor short-term projects; it is both," he says.
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