How Can We Work with Grassroots Organizations?

How Can We Work with Grassroots Organizations? from Patient Empowerment Network on Vimeo.

Dr. Judith Flores of the National Hispanic Medical Association (NHMA) defines grassroots organizations and shares examples on how to work with them to provide trusted resources.

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Transcript

Sasha Tanori:

Can you briefly describe what a grassroots organization is? 

Judith Flores:

That is an interesting definition to come up with by someone like me, I think what I refer to are people that are working on the ground, people that are working, that have developed their organization, their structure from the community itself. They have within that community, the resources to organize to communicate and to provide other resources to their neighbors and larger community. 

Sasha Tanori: Can you give us an example on how to work with grassroots organizations to better provide everyday trusted resources?   

Judith Flores: Yes, of course. I’ve been doing a lot of work this year related to vaccine engagement and understanding of the COVID vaccine in communities, and I would have been able… I would not have been able to do any of this work without the community-based partners that you call grassroots organizations. I work with community-based partners that are faith-based, that are community-based within regions, and they are always the people that provide the bridge to that community and the entree to be able to be accepted and trusted when I’m giving my messages mostly around COVID vaccination.

What Are Community Healthcare Workers?

What Are Community Healthcare Workers? from Patient Empowerment Network on Vimeo.

Dr. Judith Flores of the National Hispanic Medical Association (NHMA) explains the role of community healthcare workers and how you can identify them.

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Transcript

Sasha Tanori:

What is the purpose of Community Healthcare Workers?  

Judith Flores: A community healthcare worker provides a bridge. They come in different flavors and names, depending on where you are in the country. We call them community health care workers, we call them from promotoras, we call them navigators, they have different varieties of training and experience, but they are the bridge back to the community and back to the patient. They have more time to spend with the patient. They’re able, in many cases, to speak their language and understand their culture, and they’re able to direct them to the resources that will help them get the care that they need. 

Sasha Tanori:

And how can we identify community healthcare workers? 

Judith Flores:

A community healthcare worker comes in various varieties and with various names and titles, and they do have different types of training. The most important thing is community health workers provide that extra time with the patient. It’s been shown in… Actually, in the Journal of Internal Medicine, recently, as recent as 2017, that having a community health care worker integrated into the health care team of a hospital setting does reduce the number of emergency room visits and improves the quality of care, something that we are all judged on. Producing good quality care at lower cost.

Moving from Equality to Equity

Health equality means giving everyone the same opportunities, care, and services.  This has been the focus for laws, polices, procedures, and medical training. This focuses on elimination of differences in health diagnoses and treatments. Health equity focuses on fundamental justice. The goal is to ensure equal access to quality healthcare and good health, even if this requires giving some people more support and resources. Health equity considers different cultures, access to resources, and socioeconomic status. 

Under an equality focused approach, a doctor might offer the same test to everyone at the same interval or provide the same information to everyone. The doctor might also believe that, if they treat everyone the same, they are not behaving in biased ways.  Policies and laws that focus on this can resolve some health disparities, especially when the disparity stems from lower quality treatment, deliberate discrimination, or lack of adequate screening.   

Disease and health disparities cause different but preventable outcomes among groups. These can include race, such as Black men dying more often from prostate cancer due to lack of access to quality care and social inequality. Sexism can lead to the level of pain not being believed. Disparities can also create barriers due to lack of transportation, age, financial status, and literacy levels, to name a few. While current cancer screening guidelines focus on it equality, data indicates that these need to be adjusted to disparities within specific communities. The incidences of preventable cancer and higher mortality are impacted by the type of cancer, geographic location, race and ethnicity, country of origin, and gender. Studies and guidelines also need to expand to add more underrepresented groups.  While studies show that at least half of the patients offered to participate in a trial do, physicians are less likely to discuss a clinical trial with a patient of color. 

 To address the underlying issues and individual needs, public health needs to move toward an equity-based approach. Health equity considers different cultures, access to resources, and socioeconomic status. The goal is to ensure equal access to quality healthcare and good health, even if this requires giving some people more support and resources. Some initiatives are underway to address this.  The Woodlawn Center in Chicago, added a clinic to serve Black men. This has improved the experiences with the health care system, increasing a positive environment leading to increased usage. In Multnomah County Oregon a partnership between nonprofits, government organizations, local health care providers and several community- and faith-based groups was formed to address the specific needs of the local Black and Latino communities.   

We must strive to take equity further by applying justice, where we move to fix the issues. Equity-minded medical professionals must consider how social determinants of health such as access to a healthy diet, stress, and trauma affect outcomes. They must also consider how apparently equal systems lead to inequitable and unjust outcomes. An equity lens moves health systems closer to removing disparities. It also encourages policymakers to think about the myriad ways social environments affect health. 

Until medical schools and training of health care professionals expand to include environmental and social impacts, patients and care partners need to work with the health care professionals to include these factors.  Find out if the testing and screening is based on the “average” person or includes the segment of the population that includes the patient.  Do the “standard of care” recommendations consider the ability of the patient to comply?  For example, a doctor who knows a person has limited access to healthy food may work with the person to strategize ways to overcome this challenge and reduce the risk of health issues. The doctor might also lobby for policies to address this issue. There is no “average” person.  Everyone is unique and the best outcomes come from the medical personnel, patient, and care support working together as a team. 

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References

“What are the differences between health equity and health equality?”, Medical News Today 

Racial Disparities in Cancer Outcomes, Screening, and Treatment”, KFF 

“Equity vs. Equality: What’s the Difference?”, Milken Institute School of Public Health at George Washington University 

Designing Sustainable and Healthy Communities

Just about every aspect of our lives involves strategy and planning. Let’s use moving as an example. We likely plan this move in a way that will create more convenience for our lifestyle.  Are grocery stores close by, a hospital or urgent care, childcare or a school, an interstate for easy access to work or general use? These conveniences can reduce stress and worry associated with difficulties accessing everyday necessities. 

Healthy Community Design was a concept that could break down the barriers between communities and their necessities by establishing convenience to schools, healthcare facilities, and other benefits that should be accessible (CDC, 2014). This was implemented by the Centers for Disease Control and Prevention (CDC). While this initiative is no longer funded, the information provided can still serve value when determining how to improve communities. Being that this initiative is no longer federally funded this places even more importance for communities and local leaders to implement practices to better their neighborhoods. Based on the initiative, the way in which communities are designed could play a role in one’s physical and mental wellness. Obtaining a better understanding of this concept and its importance can help us build and improve more healthy communities. 

Envisioning a Healthy Community Design

Overall, the objective of this concept is to promote good health by planning the outline of the community to create better accessibility for everyday essentials (CDC, n.d.). So what does this actually look like? The CDC listed out a number of benefits such as increasing physical activity by placing schools, businesses, and other essentials in walkable distance; reducing the use of transportation due to decreased distances, improving community morale by implementing centers and spaces to increase communication, and so forth (CDC, n.d.). 

In essence this is all about bridging the gap between disparities. Now of course, in some communities the design landscape will be different. As we know, underserved populations tend to have more barriers within their communities compared to their White counterparts. Therefore the focus will be different especially when looking at available community resources and leadership. We must understand the needs of these communities first.  

For example, in research conducted in South Los Angeles, California under the Healthy Community Neighborhood Initiative (HCNI), it was documented that the community is affected by high rates of preventable diseases, obesity, unemployment, home foreclosure, crime, lack of access to care, and other health inequities  which affect a significant number of African American and Latino people in this area (Brown et al., 2016). The research conducted in this community was completed in partnership with local universities and organizations such as UCLA, Los Angeles Urban League, among others. The groups developed a framework to obtain a better understanding of the health of their community and factors influencing the outcomes. While the research studied a limited number of participants the information can still be useful in identifying factors that influence inaccessibility of resources in other communities.

Why Healthy Communities Are Necessary

Developing healthy communities has demonstrated to play an integral role in its residents’ lives. These types of communities aid in decreasing the disparities experienced.  As previously mentioned, there is a requirement to understand exactly what the community needs in order to develop a strategy to address these issues. It takes a village to make change and support in understanding the needs of the community must come from a community, local, state, and federal level. 

According to the CDC, healthy living aids in preventing chronic diseases and bridging the health inequities gap between ethnicities (CDC, 2017). Federally funded programs such as the CDC’s REACH, is dedicated to addressing such disparities and assisting in reducing them (CDC, 2022a). The REACH program collaborates directly with the community and local partners to make improvements for their residents’ health (mentally and physically), living environments, and overall quality of life. This initiative works because there is involvement from multiple parties in order to reach the community and satisfy its needs. 

So not only is this collaboration important, policies play a role in maintaining these communities. The U.S. is no stranger to policies affecting access to basic needs. An example of this is outlined in the article, “Food Outcry: Dismantling Food Inaccessibility in BIPOC Communities”. This article highlighted how public policies have denied individuals in urban communities access to nutritious foods (Food Deserts) and funding entering the neighborhoods (redlining). How can we develop or maintain healthy communities with discriminatory policies as a barrier? Policies and zoning laws should be developed with the health of the community in mind. Planning and strategic development can help promote a sustainable life for residents (CDC, 2022b). These plans and laws involve creating communities that safely place schools, religious centers, businesses, etc. in close range and promote communication between residents. With developing these policies and laws, engaging the voices of residents helps to identify what will and will not work for the health of their community. 

Doing the Work

We’ve discussed what healthy community design looks like and its importance but how do we achieve it? Developing these neighborhoods will require strategy and planning. What will best benefit the community in need? What types of resources is the community lacking? Is the community safe? These are questions to ask when planning and executing a healthy community design. 

We’ve mentioned implementing policies and resident input to encourage this concept but how can this be carried out? Establishing programs and initiatives to engage the community in design decision making, testing development methods in at- risk neighborhoods; and conducting audits to identify housing and areas to promote physical activity (CDC, 2022b). The CDC also proposed the use of pop ups to obtain a better idea of what the community may or may not want to see permanently (i.e. pop-up shops and events). 

There are a number of ways to improve neighborhoods. The following are tools I propose for improving and designing a more healthy community::

  • Establish pop-up urgent care centers to assist communities with their health needs.
  • Communities and their local leaders can partner with public transportation to create a health rideshare system for easy access to doctors appointments and pharmacies. 
  • Voting and becoming politically involved with the community. Voting is probably the number one tool to make change. We are a democracy and this needs to be utilized more. The changes can possibly be made when electing the RIGHT official. 
  • Partner with local schools, colleges, and universities to host community field days for the youth, maybe biweekly or monthly, to give them something to look forward to. This will encourage physical activity among youth and create a gathering space for the community as a whole. 

Developing a healthy community is definitely possible. It just takes collaboration, strategy, and planning. Where people live has the ability to affect their overall quality of life. To ease associated stresses communities can work together to create a more sustainable life. Although the Healthy Community Design initiative is no longer federally funded, this does not mean the ideology can no longer be carried out. This initiative has the ability and has made changes in lives and the health of residents within communities across the US. We must continue to work together to build communities that promote longevity for generations to come. 


References:

Brown, A. F., Morris, D. M., Kahn, K. L., Sankaré, I. C., King, K. M., Vargas, R., Lucas-Wright, A., Jones, L. F., Flowers, A., Jones, F. U., Bross, R., Banner, D., Del Pino, H. E., Pitts, O. L., Zhang, L., Porter, C., Madrigal, S. K., Vassar, S. D., Vangala, S., Liang, L. J., … Norris, K. C. (2016). The Healthy Community Neighborhood Initiative: Rationale and Design. Ethnicity & disease, 26(1), 123–132. https://doi.org/10.18865/ed.26.1.123

 

Center for Disease Control and Prevention (2014). CDC’s Built Environment and Health Initiative: Why invest?. https://www.cdc.gov/healthyplaces/why_invest.htm 

Center for Disease Control and Prevention (n.d.). Healthy Community Design. https://www.cdc.gov/healthyplaces/docs/Healthy_Community_Design.pdf

 

Center for Disease Control and Prevention (2017). NCCDPHP: Community Health. https://www.cdc.gov/nccdphp/dch/about/index.htm

 

Center for Disease Control and Prevention (2022a). REACH. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/reach.htm

Center for Disease Control and Prevention (2022b). Land Use and Community Design. https://www.cdc.gov/physicalactivity/activepeoplehealthynation/everyone-can-be-involved/land-use-and-community-design.html

How Can We Address Language Barriers?

How Can We Address Language Barriers? from Patient Empowerment Network on Vimeo.

Dr. Judith Flores of the National Hispanic Medical Association discusses the importance of addressing language barriers so people with cancer can receive the best care.

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Transcript

Sasha Tanori:  

Over the past few years, how have you seen language barriers addressed and how can we continue addressing them? 

Judith Flores:  

I think we have to understand that addressing language barriers is extremely important. It can be fatal for someone if they don’t access care because they cannot get it in their own preferred language. Of course, we have some federal funds through the Accountable Care Act that allow us to have resources for limited English proficiency, but to be honest, the best thing to do is to try to develop a workforce that looks like the patients they serve, speaks their language and understands their culture.  

I’m going to quote from the cdc’s definition of health equity. Health equity implies that every person has the opportunity to attain their full health potential. No one is at a disadvantage because of social position. That’s a tall order, and that’s something that we all have to work towards, especially now, and we want to add the piece of health justice which implies that people, all people are valued and that health and reconciliation is a goal for all of us.

How Can We Make Resources Accessible to Everyone?

How Can We Make Resources Accessible to Everyone? from Patient Empowerment Network on Vimeo.

Dr. Judith Flores of the National Hispanic Medical Association discusses barriers to care and ways to overcome them.

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Transcript

Sasha Tanori:

What specific barriers to care have you noticed that stand out to you?   

Judith Flores:

I’ve been doing quite a lot of work with communities and populations in New York City for over many years, and it’s always the very same thing we look at. We always think in terms of finances, can someone have coverage to access care? But to be honest, once you do have coverage, a lot of the other things have to do with what’s available to you, what is in your preferred language, what speaks to you and to your community.   

Sasha Tanori:

All right, thank you. Why aren’t all resources accessible to everyone, and how can we change that?   

Judith Flores:

I think that’s a very, very important question for us, and it’s a question for us to look at in this country as we evolve health care. We’ve always had a financial barrier in this country. The opportunities are very uneven across the states, and that produces a lot of unequity or disequity from person to person and group to group, even within states, people that may not have access because they don’t know that they are eligible for certain resources due to perhaps language barriers or culturally incompetent practices.