Place-Based Initiatives to Improve Health in Disadvantaged Communities: Cross-Sector Characteristics and Networks of Local Actors in North Carolina

Harlem Health Advocacy Partners: A Local Health Department's Place-Based Community Health Worker Program

In January 2015, the New York City Department of Health and Mental Hygiene launched Harlem Health Advocacy Partners (HHAP), a place-based initiative to demonstrate the capacity of a CHW workforce to improve the health of residents of public housing. The long-term goal of HHAP is to improve the population health of residents of public housing in East and Central Harlem and to close racial gaps in health and social outcomes. A variety of evaluation approaches have been used to assess the initiative. This paper describes the HHAP model and methods for evaluating the program.

Government, governance, and place-based approaches: lessons from and for public policy

BACKGROUND

Place-based approaches are increasingly applied to address the determinants of health, many of which are complex problems, to ultimately improve population health outcomes. Through public policy, government actions can affect the effectiveness of place-based approaches by influencing the conceptualisation, development, implementation, governance, and/or evaluation of place-based approaches. Despite the important role of public policy, there has been limited examination of public policy related to place-based approaches. We add to the limited knowledge base by analysing Australian national public policy, to explore: (1) the definitions, conceptualisations, and characteristics of place-based approaches in public policy; (2) the government's perception and communication of its role in place-based approaches; and (3) the extent to which government policy reflects the necessary conditions for successful place-based governance developed by Marsh and colleagues, namely localised context, embedded learning, and reciprocal accountability.

METHODS

This research was underpinned by the Theory of Systems Change and methodologically informed by the READ approach to document analysis. Ritchie and Spencer's framework method was utilised to analyse the data.

RESULTS

We identified and reviewed 67 policy documents. In terms of conceptualisation, common characteristics of place-based approaches related to collaboration, including community in decision-making, responsiveness to community needs, and suitability of place-based approaches to address complex problems and socio-economic determinants of health. Three roles of government were identified: funder, partner, and creator of a supportive policy environment. From the three criteria for successful place-based governance, localised context was the most dominant across the documents and reciprocal accountability the least.

CONCLUSIONS

Based on our findings, we drew key implications for public policy and research. There was a disproportionate emphasis on the bottom-up approach across the documents, which presents the risk of diminishing government interest in place-based approaches, potentially burdening communities experiencing disadvantage beyond their capacities. Governments engaged in place-based approaches should work towards a more balanced hybrid approach to place-based approaches that maintain the central functions of government while allowing for successful place-based governance. This could be achieved by promoting consistency in conceptualisations of 'place-based', employing an active role in trust building, advancing the creation of a supportive policy environment, and embedding 'learning' across place-based approaches.

The Children, Caregivers, and Community (C3) study of together growing strong: A protocol for an observational, place-based initiative in Sunset Park, Brooklyn

Reaching population-level impact for families in poverty requires moving beyond a sole focus on individuals, to a wider focus on interactions between individuals and their broader environmental contexts. Place-based initiatives have emerged as a policy response to promote community-level change around these broader interactions between individuals and their local communities through addressing long-standing disparities in housing, employment, education, and health. Together Growing Strong (TGS) is one such place-based initiative focused on transforming the health, wellbeing, and development of young children and their families in Sunset Park, Brooklyn. The Children, Caregivers, and Community (C3) Study is an outcomes-based study designed to assess the trajectories of children and families in Sunset Park along indicators such as family health and wellbeing and child development in relation to TGS program participation. The aims, scope, and protocol of the C3 Study are the subjects of this paper.

Analyzing the Effectiveness of Data-Linked Projects for Health Promotion in Public Health Centers of South Korea

Purpose

The purpose of this study lies in verifying the effectiveness of the health promotion project which the public health center at the local level conducted by systematically linking the health examination results from the Health Insurance Corporation. We intend to emphasize the importance of linking the health-related public data.

Methods

A survey was conducted to measure the effect of improving health behavior using EQ-5D-5L and demographic variables.

Results

As a result of the analysis, the residents (3.13) who had experienced the use of public health centers recognized more necessity for the service linked systematically with health checkup data than those (2.93) who had not. In addition, the residents who had experienced the use of public health centers responded that their chronic diseases had improved compared to a year ago (2.78→2.93). Next, those (3.04) who had experienced the services linked with health checkup data recognized that their chronic diseases and health conditions had been improved compared to those (2.81) who had not. However, in EQ-5D-5L, after using the service, mobility showed no difference between those who had used the service and those who had not. Furthermore, even in terms of self-management, daily life, etc., the management ability was further improved compared to those who had not used it, before using the service.

Conclusion

This study showed the improved health level when the health promotion service of the public health center was provided by systematically linking the health checkup data of the Health Insurance Corporation in Korea. In order to increase the effectiveness of health data-linked projects, it is necessary to prepare guidelines for linking the public health data and to expand the data-linked project. It will be needed to further subdivide the health checkup results to provide customized services, and to secure dedicated personnel to reinforce the system link.

Perceived Barriers to Rural Elderly Women's Health-Promoting Behaviors: An Ecological Perspective

This study multidimensionally examines rural elderly women's subjective barriers to practicing health-promoting behaviors. Twenty-six rural elderly women participated in three focus group interviews. Content analysis and a qualitative research method were used. The results, based on an ecological model, show that the implementation of health-promoting behaviors in rural elderly women was comprehensively related to intrapersonal (functional decline, passive attitude, and lack of implementation), interpersonal (lack of social support), community (restrictive conditions, accessibility issues, and lack of infrastructure), and public policy (lack of policy support) factors. Interventions addressing each factor can help reduce or eliminate the perceived barriers to health-promoting behaviors through interactions. Our findings can contribute to the development of health-promoting programs focused specifically on the socialization of rural elderly women and community-centered health policies in the future.

Collaborative Action on Child Equity: Lessons from the Field

The Collaborative Action on Child Equity (CACE) pursued child-focused program and policy research through the Morehouse School of Medicine's Transdisciplinary Collaborative Center (TCC). CACE engaged with partners representing 13 states in the United States to implement the Smart and Secure Children Parent Leadership Program (SSC) and to develop local child-focused Policy Action Plans. The objectives of SSC are to support the development of parental agency and leadership in order to achieve positive health and academic readiness among school-aged children. Of the 13 partners, 9 were able to successfully implement SSC, with more than 350 parent-peer learners completing the program. Additionally, several partners were able to successfully develop Policy Action Plans. We discuss our efforts to bring SSC to scale in a national replication effort and to build policy development, implementation and evaluation capacity in organizations serving children and families. We highlight lessons learned in this replication effort and consider their implications for revisions to our training protocols, recruitment and implementation strategies, methods for providing technical assistance and evaluation models. SSC has demonstrated encouraging efficacy results, was developed using community-based participatory research methods and, as such, the lessons learned are critical for how we engage diverse communities to advance positive child development and academic success.