Working with Communities to Improve Health
Improving health is not always a matter of prescribing the right medicine. Sometimes the environment needs to change. Many Americans live in neighborhoods that lack safe walking routes, grocery stores, and health facilities.
“Are there places for kids to play? Are there good farmers markets or grocery stores?” asks Irene Dankwa-Mullan, M.D., M.P.H., formerly of NIMHD and now deputy chief health officer of IBM Watson Health. Such features help people in a neighborhood live healthier lives. Along with NIMHD director Eliseo Pérez-Stable, Dr. Dankwa-Mullan wrote an editorial in the April 2016 issue of the American Journal of Public Health, “Addressing Health Disparities Is a Place-Based Issue.”
Efforts to address these problems in particular communities are called “place-based interventions.” Ideally, these interventions come from a collaboration among community members, businesses, and other stakeholders, working together with police, urban planners, and other groups to improve their neighborhood. Community members are involved to make sure the interventions are based on their values.
Examples of place-based interventions include an effort to bring a farmers market to a neighborhood without a grocery store or promoting public safety so that residents feel safe walking on the street. Walking is a simple way to improve health, but there can be many barriers to walking, a fact highlighted in the Surgeon General’s Call to Action on walking.
Place-based interventions have been used successfully in rural areas, disadvantaged urban neighborhoods, and Indian reservations. People who live in such places tend to have particular health problems, such as diabetes and heart disease, and working to change the place-based conditions may help address health disparities.
Communities are complicated, and figuring out the best way to improve the health of all residents in a particular place can be a daunting task. “Part of the issue is that we do not have a best practices model for place-based interventions,” Dr. Dankwa-Mullan says. The editorial in the American Journal of Public Health was part of a new series on best practices for place-based interventions. Through this series, public health professionals will be able to learn how to develop place-based interventions.
One key to success of place-based interventions is involving the community. This is similar to community-based participatory research, a way of doing research in which the community sets priorities, ensuring that communities that are asked to participate in research get answers to the questions that are most important to them.
A research program in Baltimore is looking at bringing healthier food to African Americans who have high blood pressure and mild or moderate chronic kidney disease. The Dietary Approaches to Stop Hypertension (DASH) diet can lower blood pressure without medication. But it can be difficult for people who live in low-income areas with few supermarkets to get the vegetables and other healthy foods that are part of the diet. In the study led by an NIMHD grantee, participants will learn about the DASH diet and receive $30 per week of potassium-rich foods. Researchers will monitor participants’ blood pressure and kidney health to see whether the intervention helps.
In rural Kentucky, another NIMHD grantee is trying to improve health by teaching children about healthy foods and drinks, in cooperation with community organizations and farmers markets.
Another NIH-funded project in Baltimore is exploring alcohol policies that may reduce neighborhood violence. The researchers are examining how the density of liquor stores affects violence among youth.
These studies are not only delivering interventions; they are testing whether the individual interventions work to improve health. “Programs need to have evaluations or metrics of success,” Dr. Dankwa-Mullan says. “We need more research on the impact.” By funding research on place-based interventions, NIMHD hopes to find out the best ways to improve the health of disadvantaged people and reduce health disparities.
- Dankwa-Mullan, I., & Pérez-Stable, E. (2016). Addressing health disparities is a place-based issue. American Journal of Public Health, 106, 637–639. doi: 10.2105/AJPH.2016.303077.
- Johnson, L. A. (1974). The people of East Harlem. New York, NY: Mount Sinai School of Medicine.
- McDermott, W., & Deuschle, K. W. (1970). The people’s health: Anthropology and medicine in a Navajo community. New York, NY: Appleton-Century-Crofts.