BEST PRACTICES

In efforts to address health disparities

In promoting wellness and prevention

These are not services developed for a community; rather they are developed from within the community.

The practices that have been identified by local community participants through focus group sessions as being successful in improving the lifestyles and health outcomes in most minority populations are grassroots programs with direct neighborhood connection.

These are not services developed for a community; rather they are developed from within the community. Essential to the success of this type of program is support from leadership and resources from the broader area who are committed to listening and understanding the issues and concerns of the neighborhood. Examples of successful local programs include:

• Faith ministry programs such as the Parish Health Ministry, Central Texas Nurses Parish Health Ministry, and Health Ministry Teen Projects are successfully serving local neighborhoods with a variety of health promotional services. While these programs do not reach large numbers, their connectiveness to the community gives the community a sense of ownership and pride in their success.
• Thurmond Heights Wellness Center serves neighborhoods in the 78753 and 78758 zip code areas of Travis County, providing wellness and health promotion services. A public health nurse and two community health workers staff the Center. Some of the specific services provided are immunizations, blood pressure and blood glucose checks, pregnancy testing, and counseling on healthy behaviors. This is not a medical care facility but provides services to help individuals improve their lifestyle for an overall better health outcome.
• St. David's Root Cause Project is a new project started in 1999 serving a mixed neighborhood of about 50,000 people in North Central Austin. This is a long-term project to work with a specific community to help them improve their health by identifying and addressing the root cause(s) of their major health issues. The community residents themselves work with project leadership to design the activities of this project.
• The annual Flu Fight campaign is a collaboration of public and private entities joining forces to deliver flu vaccines to people at various locations around the community.
• Skippy Express Mobile Health Clinic is an outreach project from Children's Hospital of Austin. The unit travels to various neighborhoods providing comprehensive health services to medically under-served children. The unit provides free immunizations, low cost well child exams, sports physicals, vision and hearing exams, and minor illness treatments.
• Programs that employ one-on-one prevention counseling and case management services, such as used in communicable disease prevention programs, are successful in preventing the spread of infectious diseases. However, this practice should be limited for those at greatest risk to unhealthy behaviors because it is labor intensive and serves a limited number of people.
• Proactive food safety programs where sanitarians take advantage of the opportunity during food establishments inspections to coach and problem solve with operators on ways to improve operations and reducing the risk of foodborne illness are also successful. The Austin/Travis County HHSD sanitarians are well adapted to this process, which builds cooperation and expectance from within the food service community.

In addition to the local programs identified by the community focus groups, other initiatives and programs have been developed in other areas of the United States that can serve as models of successful approaches. For example, to improve access to health services:

• The Robert Wood Johnson Foundation initiative "Communities in Charge" assists local communities interested in improving access to health care services for low-income uninsured individuals. The program is designed for local communities interested in improving access to care for low-income, uninsured individuals by rethinking the organization and financing of local care delivery. The initiative will help broad-based community consortia design and implement sustainable new delivery systems that manage care, promote prevention and early intervention, and integrate services. This program is open to communities with a minimum population of 250,000 and at least 37,500 low-income, uninsured individuals.
• One nationally recognized community model is the Hillsborough HealthCare System, a county-sponsored managed care program in Hillsborough County, Florida, that was created in 1992 to provide health care services to low-income, uninsured individuals.
  
  The Hillsborough HealthCare System enrolls and serves 30,000 uninsured individuals each year, integrating community-based medical and social services under a coordinated managed care framework. The program has reduced per capita monthly health care costs from $600 to $233 by promoting prevention and early intervention. The Hillsborough County program is a direct result of the county's decision to restructure services to create a new enrollment-based safety net program. Hillsborough County has received national attention and awards for their achievements, including the Ford Foundation's prestigious award for Innovations in Local Government.

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In efforts to address health disparities:

• The Centers for Disease Control and Prevention has budgeted $10 million for support of 30 communities to conduct community planning activities. The planning activities include establishing infrastructure for community-level data collection, establishing collaborative partnerships, establishing linkages with other state and local agencies, and working with federal agencies and other partners to identify "best practices". These community planning projects promote program activities which will underpin intervention activities, and award community planning cooperative agreements to community-based demonstration projects testing science-based approaches to achieve health disparity reduction goals. Results from these demonstrations will be important in shaping strategies to eliminate disparities, and for improving the focus and effectiveness community-based wellness programs (Centers for Disease Control and Prevention, November 2000).

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In promoting wellness and prevention:

• There are three comprehensive community-based disease prevention models that are universally accepted as standards for community prevention strategies. The Stanford Five-City Project, the Minnesota Heart Health Program, and the Pawtucket Heart Health Program all targeted reduction of cardiovascular disease risk but have been applied to multiple prevention and wellness programs. Each study lasted from five to eight years and included multifaceted campaigns of education and risk reduction, simultaneously addressing the prevention, treatment, and control aspects of hypertension, cigarette smoking, high dietary fat, obesity, and sedentary lifestyles. The three projects shared a common intervention strategy of primary prevention, including direct education of health professionals and the public through media and personal contact as well as community organization to foster institutional and environmental support (Winkleby, Feldman, & Murray, 1997).
• The Pawtucket Heart Health Program, which focused on community organization, campaigns of risk reduction, and screening, counseling, and referral activities, was the most successful, producing improvements in total cholesterol, systolic and diastolic blood pressures, smoking reduction, and body mass index. The hypothesis that cardiovascular disease risk can be altered by community-based education was correct but statistically significant differences were lost after the programs were discontinued. Accelerating risk factor changes will likely require a sustained community effort with reinforcement from state, regional, and national policies and programs (Carleton et al., 1995).
• Workplace and school wellness programs are a proven strategy for developing a foundation to improving healthy behaviors. These programs have also shown to be effective in increasing productivity, reducing absenteeism, and improving the overall effectiveness of individuals participating (see figure 4-1: Wellness in the Workplace, Section IV). There are many different models of varying degrees. The more inclusive and accessible the more successful the results. Models that provide onsite services or allow work-time for participation have demonstrated overall increases in productivity. Recent research suggests that multiple behavioral risk factors are likely to cluster among adult workers. For example smokers are more likely to have multiple other risk factors, and nonsmokers are more likely to engage in health behaviors such as exercise. Addressing one behavioral change results in improvements in multiple behaviors. (Campbell et al., 2000).
• The Centers for Disease Control and Prevention, Guidelines for School and Community Programs Promoting Lifelong Physical Activity; and CDC's Guidelines for School and Health Programs Promoting Lifelong Healthy Eating are excellent standards for school and community wellness programs. (CDC Guidelines. Online, 2000).

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