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The Health Impact Project launched an 18-month initiative in February 2016 that funded six projects aimed at addressing pressing health concerns in Southern and Appalachian states. Grantees targeted housing, education, neighborhood planning, and other sectors that are linked to disparities in health.
Several teams are conducting a health impact assessment (HIA), a flexible process that uses scientific data and engages stakeholders—including community members and decision-makers—to identify and evaluate the public health implications of proposed projects, plans, programs, or policies. Few HIAs have been conducted in these regions, which have high rates of chronic and preventable diseases. At the same time, these areas have many assets, such as nonprofits and faith-based networks, and vast natural resources.
These teams are making tangible progress toward ensuring that everyone in their communities has the same opportunities to be healthy.
Building on well-established evidence connecting housing and health, Arkansas Community Institute (ACI), in partnership with the Central Arkansas Re-Entry Coalition, University of Arkansas for Medical Sciences College of Public Health, the Center for Arkansas Legal Services, and the consumer protection clinic at the University of Arkansas-Little Rock Bowen School of Law, is conducting an HIA on a state “warranty of habitability” policy, which would improve living conditions in public and private rental housing. Through the HIA process, ACI aims to raise awareness among decision-makers and the public of the links between housing and health. Arkansas is the only state with a criminal eviction statute, where failure to pay rent can be punishable with jail time. It is also the only state without an implied warranty of habitability, which uses local building codes and state statutes to specify minimum livability requirements and essential services such as heat, water, and plumbing. A renter could be living in a property where the roof is caving in and there is no running water but could be put in jail for withholding rent. The HIA is examining how introducing housing quality standards could affect low-income renters in Little Rock. Using data on housing code violations and hospital discharges, ACI is creating maps to show concentrations of these properties to inform and educate renters and local code enforcement agencies, and mobilize the public to engage elected officials about better housing. Information from focus groups with renters, landlords, and other affected stakeholders, and literature on the links between housing quality and health, will supplement the maps.
Partners Collaborative Solutions Inc. and the Low Income Housing Coalition of Alabama, with funding from the Daniel Foundation of Alabama, are drawing on evidence and lessons from an HIA in Georgia to increase the number of affordable, healthy housing units developed for low- to moderate-income Alabama families. Their work includes convening a steering committee to provide recommendations on incorporating additional health-related criteria into two state plans that guide the distribution of federal funds for affordable housing: the Qualified Allocation Plan for Alabama’s Low Income Housing Tax Credit program and the HOME Action Plan. They are also providing information on the benefits of Enterprise Green Communities criteria to housing developers in the state. These guidelines promote resource conservation, energy efficiency, healthy living environments, and planning neighborhoods so that residents can access public transportation, green space, and services. Two affordable housing developers in the state are already seeking certification, which could help demonstrate the value of integrating community priorities, health data and green design even before it is incorporated in the state plans.
Nashville Civic Design Center is promoting infrastructure improvements, such as sidewalks, bike lanes, and trail networks to enhance community connectivity and increase physical activity in two Tennessee counties. In Scott County, it is working with K-12 students in several ways to identify connections between infrastructure and health, and conduct neighborhood health assessments using “citizenship in action” curricula, as well as the HIA and Shaping the Healthy Community frameworks. In Madison County, the center worked with University of Memphis-Lambuth students to identify changes that could promote health and encourage physical activity. For example, bus stops with benches and weatherization could increase the use of public transportation, or vacant lots could be revitalized into a health clinic or a farmers market to fill community needs. Finally, the center is partnering with the local Invest Health team to envision safe streets for all users and generate renovation ideas for a historic former high school, which is strategically located to serve as an anchor institution for the downtown Jackson corridor. The center is using a health-in-all-policies approach to guide these activities, which emphasizes cross-sector collaboration, stakeholder engagement, and use of evidence to integrate health into policies, programs, and plans.
Research shows that higher levels of education are linked to a higher income—and, in turn, better health. Suspensions are strongly correlated with high school dropout rates. To lower the number of out-of-school suspensions and office discipline referrals at A.W. Watson Elementary School in rural Claiborne County, Mississippi, One Voice is working with the school and stakeholders in the community. It intends to replicate this work in the school district’s middle and high schools, and ultimately increase high school graduation rates. Department of Education civil rights data from the 2011-12 school year, the most recent available, show that Mississippi’s suspension rate for black males was the second highest in the nation. The school district’s poverty rate for children ages 5-17 in families is 54.7 percent, compared with 30.1 percent statewide and 19.5 percent nationally, according to 2015 U.S. Census Bureau data. To guide the changes, the project will use the Positive Behavioral Interventions and Supports framework and other methods. Select teachers are receiving training on evidence-based school discipline interventions, and the elementary school plans to update its code of conduct.
The project’s recent work with the American Planning Association demonstrated that planners are in a unique position to ensure that decision-makers consider health across a range of sectors. The Regional Planning Commission of Greater Birmingham, a metropolitan planning organization, in collaboration with the Edge of Chaos at the University of Alabama at Birmingham, is developing a health scorecard across 20 neighborhoods in Birmingham. The scorecard will be integrated into community framework plans, which will be used to guide short- and long-term decisions regarding land use, zoning, transportation improvements, parks, trails, housing, and economic development. In addition to increasing community engagement in regional planning initiatives, this effort will give decision-makers data on neighborhood conditions that affect health. The team plans to combine quantitative data with community experience. Using PhotoVoice, 12 residents from across the city collected over 300 photographs of elements in their environment that hurt their quality of life and health, such as damaged sidewalks and abandoned buildings in disrepair.
Research shows that having strong social connections can improve health, and there is a growing body of evidence describing how integrating arts and culture in public spaces can also boost it. YouthBuild Louisville, IDEAS xLab, and The Special Project for Families Affected by Incarceration are using arts and culture interventions such as drum circles, screen printing workshops, and spoken-word performances to increase social connections among residents in the Smoketown neighborhood of Louisville, Kentucky. Smoketown is a historic African-American community in Louisville with a rich heritage of music, storytelling, and performance. Despite these assets, residents’ life expectancy is nine years shorter than that of the rest of the city, 55 percent of families live below the poverty line, and many people have been or are currently incarcerated. The group is conducting two HIAs that will explore the links connecting arts interventions, a community’s critical consciousness, social justice policies, and health: one on the use of family responsibility statements, which would take potential effects on the family into account during sentencing decisions, and one on a program that trains artists to use creative strategies to bring health information to policies in other sectors.
The Kresge Foundation provided support for the projects in Arkansas, Tennessee, Mississippi, and Kentucky. All grants conclude in the fall. Until then, the organizations will participate in a peer network to build connections between groups working on health equity in the South and Appalachia and learn from each other’s successes and challenges. Through this work, the Health Impact Project hopes to show how community engagement and the effective use of data can address physical environment, social, and economic factors that lead to disparities in health.
Rebecca Morley directs and Emily Bever is an associate with the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.