Category Archives: Community Health
In 2012, a new campus was constructed for the Buckingham K-5 public school in rural Dillwyn, Va., replacing the original middle and high school buildings that had stood since 1954 and 1962.
The Charlottesville, Va., architectural firm VMDO Inc., which constructed the campus, says the sites were transformed into a modern learning campus with the aim of addressing the growing concerns of student health and wellbeing. New facilities include a teaching kitchen; innovative food and nutritional displays; an open servery to promote demonstration cooking; a food lab; a small group learning lounge; scratch bakery; dehydrating food composter; ample natural daylight; flexible seating arrangements; and outdoor student gardens.
The firm took advantage of the school’s natural setting surrounding a pine and oak forest and wove them into the design and construction to showcase the “active landscape.” The school’s project committee and design team worked collaboratively to create a total learning environment in order to support learning both inside and outside the traditional classroom. Each grade level enjoys age-appropriate outdoor gardens and play terraces, which encourage children to re-connect and spend time in their natural surroundings. Inside the schools, in addition to core classrooms, each grade level has small group learning spaces that transform pathways into child-centric “learning streets” that have soft seating and fun colors that communicate both collaborative and shared learning experiences.
To study the impact of the healthy design features, VMDO teamed with Matthew Trowbridge, MD, MPH, an associate professor at the University of Virginia School of Medicine, with a special interest in the impact of the built environment on public health to study how health-promoting educational design strategies can support active communities and reduce incidence rates of childhood obesity.
NewPublicHealth recently spoke with Trowbridge about the project.
NewPublicHealth: How did the project come about?
Matthew Trowbridge: Through a collaboration between me and Terry Huang, who was a program officer at the National Institute of Child Health and Human Development and a leader in that institute’s childhood obesity research portfolio. [Editor’s note: He is now a Professor and Chair of the Department of Health Promotion, Social & Behavioral Health University of Nebraska Medical Center College of Public Health.] Back in 2007, Terry had been thinking about how architecture, and particularly school architecture, could be utilized as a tool for obesity prevention. The thinking behind that is that schools have always been a particularly interesting environment for child health very broadly, but also obesity prevention in particular, partly because children spend so much time at school and because the school day provides an important opportunity to help children develop healthy lifelong attitudes and behaviors.
One of the insights that Terry had was that while public health had done a lot to develop programming for school-based obesity prevention, the actual school building itself had really not been looked at in terms of opportunities to help make school-based obesity prevention programs work most effectively. In 2007, Terry actually wrote a journal article outlining ideas for ways in which architecture could be used to augment school-based childhood obesity prevention programs that was published in one of the top obesity journals. When I met Terry at NIH, we realized we both shared an interest in moving beyond studying the association between built environment and health toward real world translation. In other words, providing tangible tools and guidelines to foster collaboration between public health and the design community to bring these ideas into action.
More than half of youths in the United States have access to parks or playground areas; recreation centers; boys’ and girls’ clubs; and walking paths or sidewalks in their neighborhoods, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC), State Indicator Report on Physical Activity, 2014.
While that information might conjure up images of newly built, dedicated playgrounds, the reality is different...and less expensive. Thousands of communities have created physical activity opportunities by developing shared use agreements with schools to allow the use of facilities after school hours and on weekends.
In 2011, for example, the nonprofit Partners for Active Living (PAL), in Spartanburg, S.C., met with the city’s Parks and Recreation Department and learned that while the city did have access to defunct school facilities, it had no shared use agreements that would let PAL use school facilities for exercise. With help from a board member (who was also a member of the city council) and online resources for shared use agreements, PAL was able to move the concept forward by showing that:
- Under South Carolina law, school districts and third parties would be protected under the recreational user statute.
- The South Carolina Tort Claims Act imposes the same liabilities and protections both during and after the school day.
- The school district may be liable for negligent supervision of a student only if a duty is executed in a grossly negligent manner.
After about a year of discussions with parents, activists, policymakers, school officials and others, agreements were worked out in 2012 for school soccer fields, basketball courts, trails, playgrounds and football fields to remain open to the community on weekends and from 9 a.m. to 6 p.m. on non-school days and after school until 6 p.m. on school days, with supervision by the Parks and Recreation Department to deal with damage, vandalism and other concerns. The agreement is automatically renewed every five years unless amended. To promote the continued usage of school playgrounds, the department will offer regularly scheduled programming at each site and PAL will be tracking usage.
Earlier this year, when a federal task force convened to look at how to help Detroit pull out of bankruptcy and regain resident and business confidence, one of the first recommendations was to assess the many blighted areas of the city—typically created when residents leave an area in droves, or when a business moves out of a building and isn’t replaced by another—and begin restoring them for residential, business or green space use.
Blight matters. Beyond making a city ugly, abandoned areas become a haven for trash, toxic elements, drug sales and prostitution. In Dorchester, outside Boston, a space sold by the city for a parking lot was left vacant for years and became a trash dump with mounds of cigarettes, and cars and tires—all leaching toxins.
A growing number of communities are starting to clean up those lots. In Baltimore, flight from the city has left close to a million homes and apartment buildings vacant over the last few decades, leaving in their place empty, dirty spaces that invite crime and trash. Bon Secours Community Works—the foundation of the Bon Secours Health System with hospitals in Baltimore and other cities—supports initiatives aimed at creating stable housing, including a program called Clean and Green, which is a part of Bon Secours' Housing and Neighborhood Revitalization Department.
Clean and Green is a landscaping training program that has transformed more than 85 vacant lots into green spaces, and has also begun to initiate community arts projects such as large public murals and community gardens. The program is designed to teach green job development skills, as well as provide free cleanup and beautification services to Baltimore neighborhoods.
Each program team is hired for six months of on-the-job training in green landscaping, during which they learn how to use landscaping and gardening tools and then go out into the field to clean lots, plant trees, pick up trash and do weeding. As part of their training, each individual gives at least three presentations about some aspect of green landscaping that they’ve learned, further preparing them for job interviews and jobs in the field. Each summer, youth employees also join the Clean and Green team for six weeks, working alongside the adults to learn about green landscaping and giving back to a community.
Planners, public health experts, community development leaders, architects and many others have come together over the past decade to focus on housing as a framework for a healthy life. A report released earlier this year by the Robert Wood Johnson Foundation’s (RWJF) Commission to Build a Healthier America made the link between health and housing clear:
“Living in unhealthy homes and communities can severely limit choices and resources. Healthy environments—including safe, well-kept housing and neighborhoods with sidewalks, playgrounds and full-service supermarkets—encourage healthy behaviors and make it easier to adopt and maintain them.”
Housing also impacts health when people spend so much on their rent or mortgage that they don’t have enough left over to pay for critical expenses such as food and medicine. According to the MacArthur Foundation—which released its second annual “Housing Matters” survey last month—during the past three years more than half of all U.S. adults have had to make at least one sacrifice in order to cover their rent or mortgage, including:
- Getting an additional job
- Deferring saving for retirement
- Cutting back on health care and healthy foods
- Running up credit card debt
- Moving to a less-safe neighborhood or one with worse schools
Ianna Kachoris, a MacArthur Foundation program officer who oversees its How Housing Matters to Families and Communities research initiative, said that the quality and safety of a home make a significant impact on a person’s overall quality of life. Among the housing specifics that can impact health are lead or mold; the need to move frequently; having to live with many other people to make housing affordable; and concern over being able to afford the rent, the mortgage or needed housing repairs. The survey also found that accessing affordable quality housing in their communities is difficult for many people, including families with average income, young people just getting started in the labor force and families who want to live in quality school districts.
Last month the Washington Post held a live event, Health Beyond Health Care, that brought together doctors, bankers, architects, teachers and others to focus on health beyond the doctor’s office. The goal of the Washington, D.C., event—which was co-sponsored by the Robert Wood Johnson Foundation (RWJF) and others—was to showcase examples of novel places that are working to create cultures of health, such as a newly designed school that promotes physical activity and healthy eating in Virginia, and free outdoor exercise classes in Detroit.
Videos from the Post event are now online and include conversations with:
- Dan Nissenbaum, managing director in the Goldman Sachs Urban Investment Group, about community development.
- Brookings Institution fellow Alice Rivlin about the RWJF Commission to Build a Healthier America, which released its report Beyond Health Care in January.
- Chris Allen, CEO of the Detroit Wayne County Health Authority, about moving the community from a focus on sick care to a focus on prevention and wellness.
The Post's continuing coverage also includes articles about how city design can open up new opportunities for health; how greenways and complete streets can get people moving; and how workplaces can get a makeover for healthier employees.
Over the next few days, NewPublicHealth will report on additional efforts across the country to promote a culture of health across neighborhoods, schools, homes and workplaces.
Explore the Post’s special report on “Health Beyond Health Care” here.
Study: Global Child TB Rates 25 Percent Higher than Previously Realized
The true number of children who develop tuberculosis (TB) each year in the 22 countries with the worst TB rates is nearly 25 percent higher than the World Health Organization (WHO) estimated as recently as 2012, according to a new study in The Lancet Global Health. Researchers used mathematical modeling to determine that approximately 650,000 children in these countries develop TB each year; the WHO estimate was 530,000. The study also determined that approximately 15 million children are exposed to TB every year and 53 million are living with latent TB infections which can become infectious active TB. While the findings are troubling, they also indicate promising ways to reduce the risk. "Our findings highlight an enormous opportunity for preventive antibiotic treatment among the 15 million children younger than 15 years of age who are living in the same household as an adult with infectious TB,” said lead author Peter Dodd, MD, from the University of Sheffield in the United Kingdom, in a release. "Wider use of isoniazid therapy for these children as a preventative measure would probably substantially reduce the numbers of children who go on to develop the disease." Read more on global health.
Severe Obesity Can Cut a Person’s Lifespan by Nearly 14 Years
Severe obesity can take nearly 14 years off a person’s life, according to a new study in the journal PLOS Medicine. Using data from 20 previous studies, researchers determined that severe obesity—defined as a body mass index (BMI) greater than 40—can cut lives short by anywhere from 6.5 to 13.7 years, due to increased risk of health problems such as heart disease, cancer and diabetes. "We found that the death rates in severely obese adults were about 2.5 times higher than in adults in the normal weight range," said lead investigator Cari Kitahara, a research fellow at the U.S. National Cancer Institute, according to HealthDay. Approximately 6 percent of U.S. adults are severely obese; severe obesity accounts for approximately 509 deaths per 100,000 men annually and 382 deaths per 100,000 women annually. Read more on obesity.
HHS: $100M for 150 New Community Health Centers
The U.S. Department of Health and Human Services (HHS) has announced approximately $100 million in available funds for communities to expand access to affordable, high-quality primary care through an estimated 150 new community health centers in 2015. Currently there are approximately 1,300 health centers with more than 9,200 service sites providing care to more than 21 million people in the United States and its territories. The centers, made possible under the Affordable Care Act (ACA), have also helped approximately 4.7 million people enroll for ACA coverage. Read more on community health.
Late last month several organizations in Washington, D.C., and suburban Maryland—including CASA de Maryland, the Urban Institute, Prince George’s County Public Schools and other Langley Park Promise Neighborhood partners—released the Langley Park Community Needs Assessment Report, a year-long community assessment supported by the U.S. Department of Education Promise Neighborhoods program.
The assessment found that few of Langley Park’s 3,700 children—nearly all of whom were born in the United States—are currently on track for a strong future and that their lives are severely impacted by poverty; poor access to health care; high rates of neighborhood crime; chronic housing instability and school mobility; and low levels of parent education and English proficiency. Fewer than half of the community’s children graduate high school in four years, often because of high rates of early pregnancy and early entry into the work force to help support their families.
Following the release of the report, NewPublicHealth spoke with Zorayda Moreira-Smith, the Housing and Community Development Manager at CASA de Maryland.
NewPublicHealth: One factor in students not finishing high school in Langley Park is that many high schools students ages 16-19 drop out so that they can go to work and help support their families. Is this especially an issue of concern in the Latino community?
Zorayda Moreira-Smith: There are a number of reasons people drop out at that age. One of them is that 35 percent are working because of family need. The safety nets that are generally there for individuals aren’t there for immigrant communities. Most of the parents in these families probably left school after 8th or 9th grade. And once you reach a certain age, you’re also seen as an adult, so there’s an expectation that you help out with the family needs. For most of the families in the area, there’s a high unemployment rate or they have temporary jobs or are day laborers. So, as soon as children reach a certain age, there’s the expectation to start helping out financially and I think it’s very common.
And most immigrant families not only support the people that make up their household here in the United States, but also support their family in the countries of their origin. And while our data doesn’t show it, some of these individuals and kids in households could be living with family members who aren’t their parents—they could be their aunts or their uncles or what not. So, also as soon as they’re working, they’re often supporting their siblings or their parents or their grandparents in their origin countries.
At this week’s Spotlight: Health conference at the Aspen Ideas Festival, Michael Murphy of the MASS Design Group will be part of a panel called “Buildings that Heal.” Murphy is a recent recipient of a grant from the Robert Wood Johnson Foundation (RWJF) for a two-year year research initiative to investigate effective and innovative models of health care facilities in Rwanda and other Sub-Saharan African countries. The goal is to gauge the implications for community health and economic development and then disseminate the findings in order to help improve facilities in the United States.
NewPublicHealth spoke with Murphy ahead of the Spotlight: Health conference.
NewPublicHealth: Tell us about the scope of your work.
Michael Murphy: I’m an architect and designer by training, and I launched MASS Design with my partner, Alan Ricks, around designing built environments to improve health outcomes. We have been working with a number of NGOs in the global south, thinking about the way that hospitals are designed and the built environment, and seeing very specific and direct links between our built environment and the health of our individual selves and our communities. We were struck by the direct links between the two, and how un-designed those environments are when they could be so easily shifted to improve people’s health.
NPH: Where have you done your work?
Murphy: We have an office in Rwanda where we built the Butaro Hospital in Northern Rwanda, together with the healthcare nonprofit Partners in Health. That first opportunity came about after meeting with the group and seeing that they were doing a lot of their work without the help of designers and architects. We were given the opportunity to assist their infrastructure team to help them rethink hospitals. We finished Butaro Hospital in 2011 and since then have brought this model to other countries, eight of which are in Africa: Tanzania, Uganda, Gabon, Liberia, Zambia, Malawi, the Democratic Republic of the Congo, Burundi and Haiti.
So, we have quite a bit of experience thinking about the health care environments that are affecting some of the more vulnerable communities in the world, and we encountered some real insights that could actually vastly improve the way in which we think about our health care environments back at home in the United States.
This Thursday at Spotlight: Health, the two-and-a-half day extension of the Aspen Ideas Festival, a number of speakers discussed the many facets that are integral to building a community that thrives. Speakers included Kennedy Odede, the Co-Founder, President and CEO of Shining Hope for Communities; Belinda Reininger, Associate Professor of Health Promotion and Behavioral Science and the University of Texas School of Public Health; Gabe Klein, Senior Visiting Fellow at the Urban Land Institute; and Gina Murdock, Founder and Director of the Aspen Yoga Society.
Although the communities they serve and the work they do vary greatly, all four presenters agreed on four key themes:
- The importance of listening to the community
- Working with the residents, rather than over their heads, to create what they believe will be a thriving place to live
- Measuring outcomes
- Setting goals
To the first theme, Odede explained that “people in the community must be ready for change and we can’t import it.” Growing up in Kenya’s Kiberia Slum, Odede went on to found Shining Hope For Communities—an organization that combats gender inequality and extreme poverty in urban slums by linking free schools for girls to holistic community services for all. By connecting these services with a school for girls, Odede and Shining Hope for Communities show that benefiting women has a positive impact on the entire community. The organization’s model relies on community input and solutions.
In Brownsville, Texas, a family-oriented town requires a family-oriented approach to improving health. Sitting in one of the poorest metro areas in the nation, the town is known for its low graduation rates and high prevalence of obesity and diabetes. However, the community had a goal of being one of the healthiest areas in the state and began chipping away at the obstacles by including all residents.
“Everything we do is driven by families,” said Reininger. “We wanted to be the healthiest area in the state, and to get there we all had to be part of it.”
Brownsville is beginning to see improvements across the community in physical activity and food choice. In fact, the thriving and changing community has been selected by the Robert Wood Johnson Foundation (RWJF) as one of this year’s Culture of Health prize winners.
Gabe Klein, who in addition to his work with the Urban Land Institute is a former Vice President of Zipcar, spoke about the importance of communication in affecting community change. “In Chicago, we never talked about bike lanes for the sake of bike lanes, we talked about opportunities for better health and ways to get where you’re going,” said Klein. “You have to communicate the larger vision.”
The session moderator, RWJF President and CEO Risa Lavizzo-Mourey, stressed the importance of goal setting and metrics. According to Lavizzo-Mourey, defining a vision is critical to success and measurements lead you to the outcomes you are trying to reach.
At this week’s Spotlight: Health conference, an expansion this year of the annual Aspen Ideas Festival, angel investor Esther Dyson will be talking about “The Way to Wellville,” a contest that her nonprofit Health Initiative Coordinating Council—or “HICCup”—is organizing to encourage a rethinking of how communities produce health. The Way to Wellville is a five-year national competition among five communities to see which can make the greatest improvements in five measures of health and economic vitality.
“In the end, we hope to show that the best way to produce health is to change multiple interacting factors—diet, physical activity, preventive measures, smoking and the like—as well as more effective traditional health care,” said Dyson. “We’re less concerned with specific ‘innovations’ or digital miracles and more with simply applying what we already know at critical density.”
The five health measures have not been finalized yet, but are likely to include health impact, financial impact, social/environmental impact (such as crime rate or high school graduation rate), sustainability (such as a health financing system) and a specific “wild card” that each community will set for itself, such as teenage pregnancy or smoking rates.
NewPublicHealth spoke with Dyson ahead of the Spotlight: Health conference about the Wellville contest.
NewPublicHealth: How did the contest come about?
Esther Dyson: I had signed up to be a judge on the Health Care X Prize, but unfortunately it never materialized. For the next few years I kept thinking somebody should do this, and as I got more and more interested in health, I thought that with greater and greater enthusiasm. I had to give some remarks at a quantified self conference last year and was going to say that “someone should do this.” But I realized that would be a very lame talk and ultimately I announced that I would do it. Having appointed myself, I arranged several open-call brainstorming sessions. At one of them, a nice gentleman showed up with lots of awkward questions about metrics, funding, evaluation...the usual! So I appointed him as CEO. That’s Rick Brush, who formerly worked at Cigna and more recently has been running asthma-prevention programs with innovative financial models.