Health equity—meeting the community where they are

By Sandra Millon Underwood
RN, PhD, FAAN Professor, UW-Milwaukee College of Nursing

Lately we are hearing a lot about health equity, but there are some misconceptions about what it is and who it affects. According to the Centers for Disease Control and Prevention (CDC), health equity occurs when every person “attains his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” Health inequities occur when there are disproportionate differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment.

With a grant from the Robert Wood Johnson Foundation, the nation’s largest foundation focused solely on health, the American Cancer Society (ACS) is working with community partners to accelerate efforts that advance a culture of health equity and make it a shared value.

“Milwaukee was chosen as one of the pilot communities in the nation to implement community-driven solutions and address systemic and structural barriers contributing to cancer and other health disparities. We are working with volunteers, partners, and communities at the local and state levels, and specific populations to address and change this dynamic,” said Kimberly Abell, Program Manager with the American Cancer Society.

Abell said that people sometimes assume that health is driven by genetics or hereditary factors, but it is more involved than that.

“Health determinants involve where we live, learn, grow, and work. Factors such as access to transportation and healthcare systems, availability of healthy and affordable food, access to safe and affordable housing, and many other social determinants that influence a person’s ability to prevent, find, treat, and survive cancer,” said Abell.

Lola Awoyinka, a researcher and doctoral student at the Medical College of Wisconsin agrees. She’s been collecting and analyzing data for the health equity project, including gathering data from community organizations like Milwaukee’s Running Rebels, a mentoring organization that serves 2,500 kids annually.

“We know that there are some serious racial disparities related to survivorship, quality of life after cancer diagnosis, much of which is driven by systemic issues, so part of our focus is on kids because we want to reach out to them and educate them early on.

“We created the infrastructure and are surveying residents, especially for the kids’ portion of the project. We wanted to access the kids’ awareness of issues such as their awareness of the link between food, nutrition, and cancer. Some of our research has involved learning about their food environments—identifying some of the strengths and barriers—to learn how we can best support them. We also wanted to know how familiar they are with the importance of nutrient education,” said Awoyinka.

Collection of baseline data has been an integral part of Awoyinka’s involvement with the project, as well as targeting education to address some disparities. After reviewing some of the initial survey results, Awoyinka said that one of the biggest surprises she discovered was the large number of kids who equate weight with diet. She said there exists a culture of ‘fat shaming’ and some kids believe that being healthy means you must be thin but, in fact, good health can be achieved at a spectrum of sizes.

“We do encourage healthy weight, but that is not the only goal for healthy eating. Some children, as young as 11 and 12 years old, already have it in their minds that being healthy is just about being thin. We glamourize being ‘thin’ because our society is so weight-centric,” said Awoyinka.

Disparities such as food access and insecurity, nutrition, education, and other systemic factors also played a significant role in selecting the target areas for the health equity study, according to Awoyinka.

“We’re having talking with residents, as we try to raise awareness about disparities among our partners and the community. As we gather data and begin to interact with residents, we are taking ‘baby steps’ to address health concerns among residents,” said Awoyinka.

As part of the health equity project, the American Cancer Society is also partnering with Groundwork Milwaukee which oversees 85-100 community gardens. Groundwork has identified three ‘health hubs’ that this project will focus on. They are: We Got This Community Garden, 824 W. Ring Street; Thurston Woods Community Garden, 5974 N. 40th Street; and Uptown Crossing Community Garden, 2321-25 N. 45th Street.

“We are working with these three health hubs to create a new culture around community gardens to address food insecurity and food access. Working with community health workers, we are going out into the community, visiting the community gardens, teaching residents how to harvest and preserve these healthy foods, and through cooking demonstrations, showing them how to prepare these foods,” said Abell.

Chef Marvin Jones, of ‘Unsalt’d Life’ engages the residents through cooking demonstrations, discusses the importance of eating plantbased, having a healthy diet, and, best of all, encourages the residents to sample the nutritious food he cooks.

“We know that 20 percent of cancer diagnosis can be prevented by adopting a healthier lifestyle—including maintaining a healthy diet. Studies show that it is never too late to change, and these small changes make a difference,” said Abell.

In addition to surveying residents Groundwork Milwaukee has also contracted with community health workers to be on hand for planned events, like the cooking demonstrations. They provide health and education resources on high blood pressure, heart disease, diabetes to teach residents how to reduce their risk of cancers and to answer questions. They also distribute free, Healthy Families Guidebooks, which are also available for download at www.acskohls.org.

“The healthy equity project is something new for Groundwork Milwaukee. They really want to open community gardens up to citizens—within a 10-15 minute walk of resident neighborhoods. They want residents to know that they are welcome to come to the gardens, participate and engage with their neighbors, watch the cooking demonstrations, and talk to the community health workers right in their neighborhoods. This is a place to come for resources and at the same time, we are able to address some of the health barriers such as food insecurity or access to food,” said Abell.

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The Healthy Eating and Active Living Milwaukee (HEAL) is a culturally-tailored program that aims to provide education, resources to secure healthy foods, and active living supports for adults at-risk for developing lifestyle-related diseases; and, to empower adults to make changes in their physical and social environment to improve nutrition and physical activity. ‘Like’ their Facebook page that’s full of videos of healthy recipes and low-cost, no-cost exercise.