Physicians can counsel patients to make healthier decisions, but some things that affect their health are entirely outside an individual patient's control.
For example, said Sandra Lobo, executive director of the Northwest Bronx Community and Clergy Coalition, residents of one Bronx, N.Y., neighborhood were alarmed to discover that a school contained levels of carcinogens that were 100 times more dangerous than what was considered safe. Her daughter was a student at the school.
"Residents of the community said, 'How is this possible and what are we going to do about it?'" recalled Lobo, a panelist at the 2017 Practical Playbook National Meeting,(www.practicalplaybook.org) which was held here May 31-June 2. The meeting focused on collaborative strategies to improve population health, and speakers highlighted successful initiatives.
Family physicians are increasingly aware that social determinants of health, such as poor housing conditions, contribute to a high volume of hospitalizations and office visits and that local initiatives often can empower individuals to improve these health factors.
Organizers of one of these initiatives, the Bronx Healthy Buildings Program,(www.healthandcommunity.org) are working to reduce exposure to asthma triggers by improving environmental conditions inside apartment buildings. This meant forming partnerships with tenants' erstwhile adversaries: the buildings' landlords.
Lobo and Katherine Mella, M.P.H., program associate for the Massachusetts Institute of Technology Community Innovators Lab,(colab.mit.edu) described how the program started with the specific aims of reducing ER visits and hospital admissions and subsequently developed into an ongoing community engagement effort.
"We wanted to have a different relationship with landlords and make buildings healthy," Mella said.
In 2015, the program obtained a $250,000 grant from the Build Health Challenge,(buildhealthchallenge.org) which encourages local nonprofit organizations to tackle population health needs. Montefiore Medical Center served as the hospital partner and provided a matching grant. The initiative identified five neighborhoods as areas of greatest need because they recorded high rates of asthma and hospital admissions.
The priorities were to
- reduce asthma triggers in apartment buildings,
- reduce greenhouse gas emissions,
- reduce residents' energy bills,
- encourage tenant activism and
- create construction jobs that helped in the greening efforts.
It was an ambitious agenda that outsiders wondered whether the program could achieve.
"People said, 'Why don't you do just one of those things? Aren't you doing too much?'" Lobo recalled.
Project organizers started by advising residents to take a diplomatic approach with building owners. This was a change in the tenant-landlord relationship that Lobo illustrated when she said some tenants threatened to take legal action against a landlord if they encountered initial resistance -- a sure way to discourage cooperation.
The project gained strength through the recruitment of multiple partners, including a city council member, the city's Department of Housing Preservation and Development, and a legal aid team.
And looking to the future, Lobo insisted that the buildings be upgraded in a way that would allow current residents to continue living there, not as a prelude to gentrification.
"If the same people could not afford to live here, that was a deal breaker," she said.
The program is continuing, and Lobo and Mella stressed that public financing is often available to launch similar work elsewhere if activists are willing to search aggressively.
"There is so much work being done on housing and health," she said.
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