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Reach 2010: a unique opportunity to create strategies to eliminate health disparities among women of color.

Abstract: Racial and Ethnic Approaches to Community Health (REACH 2010), a five-year demonstration project is part of the DHHS response to the President's race initiative and goal for 2010 to eliminate disparities in health status experienced by racial and ethnic minority populations in sixpriority areas. These areas include: infant mortality, deficits in breast and cervical cancer screening and management, cardiovascular diseases, diabetes, HIV infections/AIDS, and child and adult immunizations. All of these with perhaps the exception of child immunizations, which are very much dependent upon the health-seeking behaviors of women, are directly connected to the health status of women. This article will describe the significance of this project and the potential impact that it will have on improving women's health and serving as a catalyst to eliminate health disparities nationally and perhaps globally.

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On June 14, 1997, President Clinton announced One America in the 21st Century: The President's Initiative on Race (Department of Health and Human Services (DHHS), 1998). The Initiative includes the goal of eliminating racial and ethnic disparities in health by the year 2010. The U.S. racial/ethnic groups targeted by this initiative include African-Americans (including all blacks of African decent), Alaska Natives, American Indians, Asian-Americans, Hispanic- Americans, and Pacific Islanders.

The Racial and Ethnic Approaches to Community Health (REACH 2010) demonstration project is part of the Department of Health and Human Services (DHHS) response to the Federal Race Initiative and goal for year 2010 to eliminate disparities in health in six health priority areas. These areas include: infant mortality, deficits in breast and cervical cancer screening and management, cardiovascular diseases, diabetes, HIV infections/AIDS, and child and adult immunizations. All of these areas, with perhaps the exception of child immunizations which are very much dependent upon the health seeking behaviors of women, are directly connected to the health status of women. This article focuses on milestones achieved in reaching women of color in the first three health areas above.

REACH 2010 is a two-phased, five-year demonstration project to support community coalitions in the design, implementation, and evaluation of unique community-driven strategies to eliminate health disparities. Phase I is a 12-month planning phase to support planning and development of demonstration programs. Phase II is the implementation of demonstration projects and evaluation. Phase II is four years in duration.

During Phase I, grantees utilized local data and in some cases used formative research techniques to create baseline data and developed a Community Action Plan (CAP) to guide the work of the coalition through Phase II activities. The CAPs target one or more of the specific racial or ethnic minority community groups mentioned above and one or more of the six health priority areas. Coalition membership includes at a minimum a community-based organization and three other organizations, of which at least one had to be either a local or state health department, or university or research organization. The program budget for fiscal year 1999 included approximately $ 9.4 million to support awards to thirty-two grantees. The budget for FY 2000 was $30 million which supported twenty-four Phase II (continuation) projects, fourteen new Phase I projects and four new projects serving the elderly through an interagency agreement with the Administration on Aging.

The Centers for Disease Control and Prevention (CDC) has been deeply committed to maximizing the success of the REACH 2010 Project. During Phase I, three technical assistance workshops were held by the CDC in Atlanta for REACH 2010 grantees. The first, an orientation workshop, was held November 14-17, 1999. The purpose of the workshop was to share best practices and lessons learned regarding community demonstration projects, to provide information on the planning process, and to develop community action plans and evaluations. Experts from across the nation participated in the workshop. The goal of the workshop was to enhance the skills and provide tools that would enable the grantees to develop effective CAPs. A second workshop on program evaluation was held from March 8-10, 2000. Evaluation experts both internal and external to CDC provided guidance to the grantees on evaluation strategies that would be useful and important for establishing credible measures for these demonstration projects. Finally, a pre-application technical assistance workshop was held on May 12, 2000 to provide guidance to the 32 REACH 2010 grantees as they prepared applications for the competitive Phase II of the program.

METHODS

REACH 2010 coalitions were engaged in a planning process for a twelve month period, the culmination of which has been the production of individual CAPs to guide the work of the coalitions over the next four years. These demonstration projects have been encouraged to develop innovative and creative strategies to reduce and ultimately eliminate health disparities -- potentially effective strategies that can be translated and adapted for use by communities across the U.S. The first phase of the REACH 2010 demonstration project was an extremely important phase for organizations to build the capacity of the coalitions, conduct formative research and to effect changes among the communities and the leaders or "change agents."

COALITION STORIES

The following are individual stories submitted by six coalitions in response to the question "What significant accomplishments did you have concerning reaching and including women in your REACH 2010 demonstration project?" The first three projects focus on the most dominant health priority areas selected by the grantees and funded as part of the REACH 2010 project, cardio-vascular diseases and/or diabetes (30/38 projects). The Fulton County, Georgia (Atlanta), Lowell, Massachusetts, and Nashville, Tennessee, coalitions tell incredible stories of compassion and inclusion, inviting women who are affected and impacted by these health conditions to the planning table to contribute from the heart. The coalitions took seriously the CDC charge to "think outside the box" and develop unique strategies for eliminating health disparities in their communities.

FULTON COUNTY, GEORGIA (CVD)

BACKGROUND

A discussion of health disparities between people of color and whites in the United States is perhaps best initiated by looking at the historical example of African-Americans. Health disparities that plague the African-American community have deep roots that must be addressed. They are to be found in the slave health deficit and decades of overt, covert, personally mediated and institutional racism. Personally mediated racism is defined by Dr. Camara R Jones as prejudice and discrimination (Jones, 2000). Institutional racism is defined as differential access to the goods, services, and opportunities of society by race (Jones, 2000). Race has long been used as a criteria for determining how certain groups of people should be treated. Research findings that have linked race to pathologies, intelligence, educational capacity, etc., have been used to justify the misguided health care given to African-Americans and other people of color (Jack & Liburd, 2000).

The antecedents of our contemporary crisis are to be found in the pathological relationships between those enslaved and those who held the power of life and death over African-American women, men, and children. The role of women in this oppressive system then must by definition be a central theme in this process to understand and then rectify long-standing and deep-rooted health disparities. Any programmatic initiative that has as its focus the elimination of health status disparities, and through a narrow tunnel vision view sees only the risk factors that have been well established such as poor nutrition, lack of physical activity, smoking and obesity and doesn't acknowledge that these are symptoms of a greater disease, will surely miss the mark.

In December 1994, the Department of Housing and Urban Development designated Atlanta an Urban Empowerment Zone and provided financial assistance and economic incentives. The Atlanta Empowerment Zone (AEZ) encompasses approximately nine square miles in the central portion of Fulton County, Georgia. In 1990 the population of the AEZ was 49,448 of whom 95% were African American and 55% of the residents were female. The median income of persons living in the AEZ was under $11,000 per year. The linkage communities are neighborhoods surrounding the AEZ. The target area (AEZ and linkage neighborhoods) represents 29% of the population of Fulton County and 47% of the African-American population in Fulton County (Fulton County Department of Health and Wellness (DHW), 1999).

Hospital discharge data was utilized in the analysis of the problem. The findings showed a significant disparity in the rates for cardiovascular diseases and associated risk factors. The rates at which AEZ resident women were hospitalized for diabetes was 56.1 per 10,000 compared to 11.4 per 10,000 for women who lived elsewhere in Fulton County. The rates of hospitalization for women with ischemic heart disease was 72.5 per 10,000 for residents of the AEZ compared with 32.1 per 10,000 for women living elsewhere. The hospital rates for congestive heart failure followed a similar pattern (129.0 per 10,000 vs. 30.6 per 10,000) as well as that for stroke (16.1 per 10,000 vs. 9.1 per 10,000) (Fulton County DHW, 1999).

ACCOMPLISHMENTS

The creation of health equity, which by definition means the elimination of health status disparities, must examine and in fact provide a mechanism for those historically abused, ignored, and locked out of society to be about the process of empowerment. Further, it must have at its core belief, an awareness of the inextricable relationship between social justice and health equity. REACH 2010 has provided an opportunity to begin to dialogue with the African American community about these issues. The Fulton County Department of Health and Wellness, the lead organization in this project and its community partners, chose cardiovascular disease in the African-American community as the target for our work. The project has given us a unique opportunity to collaborate with women of color in all phases of the development of a CAP to disproportionately affect African-American women.

OUTREACH TO ORGANIZATIONS

The empowerment of African-Americans through the creations of the conditions, through which they can focus on wellness as a function of self-determination, is a central part of the REACH community action plan. REACH 2010 has allowed us to outreach to such organizations as the Center for Black Women's Wellness and the National Black Women's Health Network to participate in the planning efforts to address CVD in the Atlanta Empowerment Zone. More specifically, along with the Sisters Action Team, we have developed planning for the implementation of a network of women's empowerment of personal growth and empowerment among African American women and change the face of the community.

PARTNERSHIP WITH UNIVERSAL SISTERHOOD AND OTHER ORGANIZATIONS

The project has also brought us into partnership with the Universal Sisterhood, a community-based organization dedicated to community nutrition education. Our community action plan places the Sisterhood in control of a wide ranging initiative that includes partnering with all the major supermarket chains in Atlanta, the faith community, community centers, the Atlanta Housing Authority and other community agencies in an effort to provide nutrition education and food demonstrations to our target population. Our collaboration with the Association of Black Cardiologists allowed us to incorporate the Savvy Sisters program, a unique faith-based physical activity program targeting African-American women, into our CAP. In addition, our plan allowed us to outreach beauty parlors and calls for the creation of cardiovascular wellness centers at some 50 businesses that service African-American women in the Atlanta Empowerment Zone.

In summary, African-American women's organizations and community residents are key to the success of this program. REACH 2010 has provided a unique vehicle to outreach this vital segment of the affected community. These partners contributed significantly to the planning and development of the E community action plan. We are confident that this involvement will move us to model the strategy that has the best chance of empowering this nation to reach its goal of the elimination of health disparities by the year 2010.

LOWELL, MASSACHUSETTS (CVD)

BACKGROUND

Lowell, Massachusetts is home to approximately 25,000 Cambodians, and this community makes up nearly 25% of the city's population of 104,418. Although precise figures on the age structure of the Cambodian community are not available, it is estimated that over 15% (3,750) of the population is over age 45 (MA Department of Public Health (DPH), 1996).

Cambodians in Lowell are at disproportional risk for morbidity and mortality due to CVD and diabetes. Among Cambodians in Lowell, a disproportionate share of adult deaths (age [greater than or equal to] 45 years) are attributable to stroke (t 5.9%) and diabetes (13.4%), when compared wi th all MA residents (6.5 % and 2.5 %, respectively) (MA D P H, 1996). Heart disease was the leading cause of death for both Cambodian and all MA adults, representing 19.5% and 33.1% of deaths, respectively. When heart disease, stroke, and diabetes are combined, the proportion of deaths attributable to these is 48.9% for Cambodians, compared with 42.1% for all Massachusetts adults (MA DPH, 1996).

ACCOMPLISHMENTS

Deep within the city of Lowell, Massachusetts, a sedentary group of elder Cambodian immigrants isolate themselves and are confined to homes of closed doors and neighbors of incomprehensible words. Much pain within them can only be imagined. The 1990 Census indicated that 26% of Cambodian families are headed by single females. Cambodian Community Health 2010 (REACH-2010) in its first phase was able to open a dialogue with them.

COMMUNITY CONVERSATIONS HELD

The program conducted fourteen community conversations, held in seven locations throughout the community. In total one hundred and forty-one participant participated. There were fifty-one males and ninety females ranging in age from 19 to 81 years old. Unlike in Cambodia, where men generally dominate conversations, the women in these groups forward their voices. They share their experiences, their knowledge, their ideas, and their plans with us, allowing the development of the community action plan for Phase II to involve even more women in the communities. We were able to involve a group of Buddhist nuns from Cambodian temples who are helping to inform other women in the communities about health care issues.

CAMBODIAN ELDERS COUNCIL CREATED

As a form of outreach to elders we have created a Cambodian Elders Council consisting often people, eight of whom are women. As Savann, a female member said: "Forming a Cambodian Elders Council is an action proven to preserve the Cambodian cultures, beliefs, literatures and customs. There are many young people in the community who need your services and relationships. I am proud of your commitment to providing better health care for the Cambodian people."

This is simply a small example of opening doors to spoken words, this gesture looks meaningless to those who live in a democratic state, but if for years, emotions are forbidden to be shown, then this is one giant step for the Cambodian elder women.

NASHVILLE, TENNESSEE (CVD/DIABETES)

BACKGROUND

In 1999 an estimated 534,458 persons lived in Nashville/Davidson County, Tennessee; 134,755 (25%) are African-American. The eleven census tracts that make up the area known as North Nashville are home to 41,302 persons, 37,097 (90%) of whom are African-Americans. Compared with Nashville's majority population, age-adjusted death rates and premature death rates due to cardiovascular disease and diabetes are 78-134% higher among North Nashville's African-American women (Metropolitan Nashville Department of Health Statistics, 1998). Eighty percent of the areas African-American females report being inactive, 52% are overweight, 12% have diabetes and 45% have hypertension, all substantially higher than the county's white women. An estimated 4,500 African-Americans in North Nashville have diabetes, 16,500 have high blood pressure, and 5,000 have high blood cholesterol. Our CAP aims to reduce risk factors for these diseases and promote better screening and standards of care. (Metropolitan Nashville Department of Health Statistics, 1998).

ACCOMPLISHMENTS

Using a variety of survey and social marketing strategies, the Nashville REACH 2010 Coalition set out to learn how African-American women from North Nashville view the disparities, the risk factors underlying them, and how to attack them. One project involved comprehensive telephone surveys with more than 3,000 Nashvillians, with substantial over-sampling in North Nashville. Another rich source of information came from 58 participants in five focus group interviews involving persons with CVD or diabetes, residents of low income housing, health care providers, religious leaders, or high school youth (Dennie, 2000). Quotes from many women revealed important themes, a few of which are highlighted below:

PHYSICAL EFFECTS OF STRESS

[We need] community support for emotional issues. I say this is the key because everyone is going to have stress. Black folk are going to have more stress then you will see the physical side effects of emotional issues.

A lot of us can't afford a vacation. But when we go to relax [at home], here come the children, "Mama can I have this and Mama can I have that." And then you just say "Forget it [relaxing]." I go ahead and get up and do what I got to do. That's stress. You may not realize it, but you are about to blow your top.

Several Nashville REACH 2010 interventions will emphasize stress management.

Body Image

There is a perception of health that bigger is better, because it means you have something, you are not poor. It is what Mama and Grandma said.

Interventions will include culturally appropriate messages balancing acceptance of self and health promotion.

Food Selections and Perceptions

Our neighborhood [large national chain grocery] has a terrible produce section. If the fruit is bad, why would you want to get it?

In the [school's free] food line they serve vegetables and fruit, [but] nobody wants to go to [that] line. Beside the vegetables they have french fries they keep the big, fresh cookies coming out. You can smell them all over the cafeteria.

Community interventions will target restaurant and grocery managers and school authorities to influence availability and promotion of healthy food choices.

Barriers to Physical Activity

My neighborhood street lights are broken out [and] fear of loose dogs and some of the people. Most churches have space for doing those types of things [referring to a variety of indoor physical activities] churches can have events and show the congregation.

Interventions will include teaching residents to lobby city government services for safer streets, and providing model exercise/ nutrition programs and start-up resources for community businesses and faith-based organizations.

Health Care Systems

We have to wait too long to see the doctor. You can get sick from the waiting.

Whenever I applied for insurance, I could not get it [due to] preexisting conditions. Most of them [insurance companies] when you say you have diabetes, then they drop you like that (finger snapping motion).

Interventions will include close collaboration with community safety net health care providers for poor and uninsured, continuing medical education, and audits of care practices with feedback for community physicians.

In summary, lifestyle risks for CVD and diabetes among African-American women are disparately high both nationally and in Nashville (Brancati, et al.; Metropolitan Nashville DHS, 1998). Nashville's disparities are not faceless statistics to us. They are people with whom we live and for whom we care. Many community-based African-American women have had a significant voice in identifying local barriers and planning to overcome them. We expect that their recommended interventions will prove to reduce and in time eliminate racial disparities due to cardiovascular disease and diabetes in metropolitan Nashville, Tennessee.

After cardiovascular disease and/or diabetes (29/38 projects), the next largest area of concern for the REACH 2010 projects is breast and cervical cancer screening and management (5/38 projects). The following stories offered from coalitions in Alabama, Boston, and Chicago coalitions again show the breadth of issues addressed and approaches created by the REACH 2010 projects to eliminate health disparities in women of color.

ALABAMA (BCC)

BACKGROUND

The Alabama REACH 2010 Project addressed the priority area of deficits in breast and cervical cancer screening management. The project was conducted in six rural black belt and three urban counties in Alabama. The black belt refers to a 50 mile-wide band of rich, dark soil stretching across Alabama's mid-section. The targeted rural counties are: Macon, Lowndes, Dallas, Marengo, Choctaw, and Sumter. The three urban counties are Tuscaloosa, Montgomery, and Mobile. The total population of the catchment area is 879,242, and the target population is 124,540 African American women aged eighteen years and older. African-Americans comprise more than 70% of the population in some counties. The average per capita personal income for these counties is $9,443, approximately 29.8% of this population lives below the poverty level, 9% are unemployed, and 21% of individuals have less than a high school education (Alabama Dept. of Archives and History, 1994). The target counties are characterized by lower accessibility to health care, with relatively low ratios of physicians, registered nurses, and hospital beds (US DHHS, 1993).

In Alabama it is estimated that nearly 2,500 women will be diagnosed with breast cancer during 1999 (National Cancer Institute, 1998). Although overall incidence of breast cancer in Alabama stabilized by 1990, the rate among African American women continues to increase by 1% annually (Laedtke & Dignan, 1992). An estimated 200 cases of cervical cancer are expected to occur among women in Alabama. Although Alabama's cervical cancer mortality rate has decreased, it continues to be among the top ten highest rates in the nation. Of the projected 2,500 new cases of breast cancer in Alabama, 23% are attributable to our targeted counties. It is estimated that there will be 200 cervical cancer cases, of which 23% will occur in the target counties (USDHHS, 1993; Laedtke & Dignan, 1992).

ACCOMPLISHMENTS

The qualitative analysis identified three major barriers to early detection and treatment of breast and cervical cancer: 1) individual, 2) community, and 3) health care provider.

INDIVIDUAL BARRIERS

Women tended to associate breast and cervical cancer with fear, death, depression, and danger. Although the women were aware of early detection and screening for cancer, they tended to have a fatalistic view of their health outcomes once they had cancer. The fear surrounding cancer seems to be steeped in myth and legend in these communities. However, women in urban areas and those with more cancer information were more likely to view early detection as important to their survival of cancer.

COMMUNITY SYSTEM BARRIERS:

The likelihood that women would obtain early detection and screening was hindered by lack of family or community support, transportation, and access to primary care physicians. There were immense physical and psychological barriers in these counties. Having money and insurance were not enough to make these women feel safe.

HEALTH CARE PROVIDER BARRIERS:

The women indicated that they saw health care providers as the source of much of the problem. They felt that inadequate providers made good health care difficult. They spoke of health providers who belittled their complaints, over-booked appointments and kept them waiting, and made it difficult for them to obtain the best care.

BOSTON, MASSACHUSETTS SOMALI COMMUNITY (BCC)

BACKGROUND

Boston is the largest city. in Massachusetts with a population of 574,283 and is home to the REACH Boston 2010 Project. In 1990, African-Americans made up 25.5% of the population; slightly more than 53,000 were Black women over eighteen years of age. African-American women in Boston who are diagnosed with breast or cervical cancer have a much higher death rate than other women. From 1996-98, the age-adjusted cervical cancer mortality rate for African-American women in Boston was 6.7 per 100,000 v. 2.5 for White women. The age-adjusted breast cancer mortality rate in Boston between 1996-98 was 22.9 per 100,000 for African-American women v. 21.1 for white women (Boston Public Health Commission, 1999).

Data from a sample of women in predominately low-income neighborhoods of Boston indicate that the percent of African-American women in Boston who have never had a mammogram is 23%, 8 times the rate for white women (Boston PHC, 1999). Initial findings from a review of medical records at Boston Medical Center (BMC) showed that differences in Pap smear rates correlate with the amount of time women had lived in the U.S. Among those in the U.S. 5 years or less (including Somalis, Haitians and others), 20% had never had a Pap smear (compared to 10% or less for women who had lived in the U.S. more than 15 years) (BMC, 1996).

A major research focus for Phase II data collection will be the identification of potential screening disparities among sub-populations of African-American women. Boston's REACH 2010 Project has the undaunted task of eliminating racial and ethnic disparities in breast and cervical cancer by creating, with the community, a culturally competent system which promotes screening, education, prevention, treatment, and access to care for women of African descent in the City of Boston.

Through the collaborative efforts of a coalition organized by the city s public health department and comprised of over 45 members representing various community-based, faith-based and advocacy organizations, medical research centers, community residents, etc., a community action plan was developed. One of the key coalition members is the Somali Development Center, Incorporated (SDC) in Jamaica Plain, Massachusetts.

ACCOMPLISHMENTS

The Somali Development Center is a major provider of support services for new immigrants (< 18 months) and other Somali's who have a longer tenure here in the United States. Advocacy, interpretation, and education services are provided in the areas of housing, ESL, citizenship, computer training, job training and placement, legal assistance, health care access, youth programs, and public information. The Somali Development Center also serves as a central place where people gather to have conversation and stay connected other Somali's.

One goal of REACH Boston 2010 is to address the issue of cultural competence and sensitivity of providers. REACH 2010 has gained enormous insight into the numerous issues that affect the Somali community through SDC's participation in the coalition; as well as by having a Somali woman as a cluster leader on this project.

Training of Cluster Leaders and Others

REACH trains its cluster leaders in several areas of self-help and advocacy. The cluster Leader then holds cluster meetings to impart the same information into and gather new perspectives from community women. Trainings conducted include coalition leadership, self-help, cultural sensitivity, anti-racism, developing a community action plan, grant writing, breast and cervical cancer, and culture and communication.

March Meeting

In March, 2000 during an informational visit to SDC, approximately 12 Somali women shared their concerns with REACH project staff. With the help of the cluster leader serving as an interpreter, the women recanted stories of sitting in hospital waiting rooms for hours only to leave without having seen a doctor. The shortage of Somali interpreters in health care facilities makes it almost impossible for women to receive the medical services needed. Cultural identity and sensitivity is another barrier for this population. The lack of self-identification with the providers makes many women uncomfortable expressing their health concerns and symptoms during doctor visits. Having more providers who mirror the diverse linguistic, ethnic, and racial backgrounds of clients will make it easier for women to seek medical services.

CHICAGO: BCC

BACKGROUND

Reach Out is a Chicago area collaboration that draws on the dedication of local faith leadership within African American and Latino churches to mobilize low income women of color to seek early breast and cervical cancer detection. The collaboration is anchored by Access Community Health Network, a community health center organization offering primary care in 20 health center sites, all located in medically under served neighborhoods.

The total target area population, including eighteen community areas in greater Chicago, is 862,991. Area-wide the African-American population is 63.8% of the total population, with some community areas as high as 99% and one with 0. The area-wide Hispanic population is 20.3% of the total population, with some community areas as high as 85.2% and others with 0. Women make up 53.7% of the total population, 38.5% of whom live below the poverty level, and 60.0% of whom live below 200% of the poverty level. Area-wide, the average breast cancer mortality rate (per 100,000) is 13.4, with a high in one community area of 26. The average cervical cancer incidence (per 100,000) for the total population is 11.6, with a high in three community areas of 16. From community areas with information available, the average percentage of cases with late-stage detection of breast or cervical cancer is 54.4%. One community area had a high rate of 82% (Cook County Department of Public Health Community Area health Inventory, 1999).

During the planning year, the Reach Out coalition convened seven focus groups within African American and Latino churches to learn more about the beliefs and faith motivations of women members regarding early cancer detection issues. Based on these sessions, and with leadership from an interfaith steering committee of pastors, church members and health center professionals, the coalition initiated three pilot educational forums in churches to mobilize women to seek early breast and cervical cancer detection.

ACCOMPLISHMENTS

The message from the focus groups as to how to accomplish this was clear: the groups wanted high quality information about how breast and cervical cancer could affect them as individuals and as a community information that would be clinically grounded and spiritually relevant.

Pilot Education Session Held

The energy generated by Reach Out is typified by the pilot education session offered by Mount Vernon Baptist Church in Chicago's predominately African-American Garfield Park neighborhood on the West Side, an area characterized by poor health status across a range of indicators including cancer. Community area data show that well over half of cancer patients living in this neighborhood are diagnosed at a late stage (Freund, 2000).

Actual Education Sessions

On this year's Memorial Day holiday weekend, 66 women in the church came together for an educational session lasting 4 hours led by lay educators, and backed by physicians and nurses from Access Community Health Network. Mount Vernon is one of Reach Out's lead churches in all, nine African-American churches, each with ties to a broad church network, and 2 Latino Catholic church organizations, together comprising a network of over 300 Chicago area churches.

With strong support from their pastor and participation in the session by their pastors wife, the women came away from the event acknowledging their own success, the knowledge it generated, and the health that it will bring their neighborhood. We've never done anything like this before, explained one of the members, and we're proud of what we have accomplished here today.

During the next four years, Reach Out will touch the lives of low income African-American women and Latinas in their churches with interventions that they design and lead to change knowledge, beliefs and behavior regarding early detection of breast and cervical cancer.

DISCUSSION

To-date, the community coalitions embarked upon a dynamic process which has engaged a number of traditional and non-traditional public health partners in the planning process. This process was one of' engaging the appropriate agencies and individuals in assessing the needs of the community and strategically mapping a plan for reducing disparities in the area(s) selected. Included in this process have been health departments, community-based organizations, universities and research organizations, Indian tribes, national and regional minority organizations, the American Cancer Society, YWCAs, health ministries, faith/church collaboratives and nursing organizations. Coalitions have focused on conducting needs assessments, collecting and analyzing baseline data, and expanding their coalitions to include all appropriate partners. Needs assessments that were conducted have included such strategies as: community forums, interviews, focus groups, outreach, and training.

The development of community interventions by community coalitions provides an effective way of impacting health disparities. This article has highlighted specific experiences of some community coalitions such as capacity building, conducting needs assessments, describing what worked in understanding the contributing factors to health disparities among women of color. The real life stories in the voices of those impacted first hand add a sense of reality and of urgency, relating to their conditions. These projects will serve as catalysts in the quest to eliminate health disparities, perhaps generating more questions than answers in some areas. However, the goal of this project is to produce replicable and translatable findings that can be shared nation-wide and perhaps world wide, the quest to eliminate health disparities by the year 2010. Exploring answers to questions that delve deeply into the root causes of health disparities and that acknowledge the obvious (historical racism, discrimination, differential treatment), will move us further along the continuum of eliminating health disparities.

SELECT WEB SITES

DHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion. About Cardiovascular Disease. [Online]. Available: http://www.cdc.gov/nccdphp/cvd/aboutcardio.hm.

DHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion. Cardiovascular Disease. [Online]. Available: http://www.cdc.gov/nccdphp/cardiov.htm

DHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion. Cardiovascular Disease Health Program. [Online]. Available: http://www.cdc.gov/nccdphp/cvd/)

DHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Diabetes: A serious Public Health Problem. At-A Glance. 2000. [Online]. Available: http://www.cdc.gov/diabetes/pubs/glance.htm)

DHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Chronic Diseases and Their Risk Factors: The Nations Leading Causes of Death (1999).[Online]. Available: http://www.cdc.gov/nccdphp/statbook/pdf/cdrf1999.pdf

DHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Diabetes Public Health Resource. National Diabetes Fact Sheet. [Online]. Available: http://www.cdc.gov/diabetes/pubs/facts98.htm

DHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion. Minority and Ethnic Groups. [Online]. Available: www.cdc.gov/nccdoho/minority.htm)

NOTES:

Other Contributing CDC staff include: Sterling, Terrie D., Ph.D., Presley-Cantrell, Letitia, M..Ed., Imara, H; M.P.H; Hughes, M, MPA; Montanez, ED.; Tullier, Chris, Jones, CP, MD, MPH. All authors submitting on behalf of their coalitions recognize the contributions of coalition members to this document and overall contributions to the planning process. We would like to express sincere thanks to the following REACH 2010 coalitions for contributing to this article:

* Alabama Breast and Cervical Cancer Control Coalition, Nashville REACH Coalition

* Atlanta REACH Initiative, Cambodian Health 2010 (Lowell), Faith-based Health Promotion

* Breast and Cervical Cancer Coalition (Chicago), REACH Boston 2010 Breast and Cervical Cancer Coalition.

Special mention to: Barbara Ferrer, Ph.D. (Boston); Kerry Brock, BA (Chicago); Thijuanie Lockhart, (Atlanta) for their assistance.

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Imani Ma'at, Ed.D, Ed.M, MCP., is Director of the REACH 2010 Demonstration Program, at the Centers for Disease Control and Prevention (CDC). Imani Fouad, MD, MPH, is an Associate Professor of Medicine in the Division of Preventive Medicine at the University of Alabama at Birmingham. Dorcas Grigg-Saito, MSPH, is with the Lowell Community Health Center. Sidney L. Liang, BS, is the CDC Program Coordinator at the Lowell Community Health Center. Kenyia McLaren, MPH, is the REACH Project Manager for the Boston Public Health Commission. James W. Pichert, PhD, is an Associate Professor of Education in Medicine at Vanderbilt University. Linda Diamond Shapiro, AM, MBA, is Vice President for External Affairs in the Access Community Health Network. Adewale Troutman, MD, MPH, is with the Fulton County Department of Health and Wellness. Address all correspondence to Dr. Ma'at at REACH 2010 Demonstration Program; Centers for Disease Control and Prevention (CDC); Division of Adult and Community Health; Mail Stop K-45; Koger Rhodes Building, Rm 4172; 4770 Buford Highway; Chamblee, GA 30341; Ph: 770.488.5646; Fax: 770.488.5964; Email: IXT1@cdc.gov.
COPYRIGHT 2001 University of Alabama, Department of Health Sciences
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Author:Troutman, Adewale
Publication:American Journal of Health Studies
Geographic Code:1USA
Date:Mar 22, 2001
Words:6234
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