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The Key to Public Health Is Community.

The movement called community health means more than just access to health care. It's strong families, good schools, safe neighborhoods, caring adults, and economic opportunities. It's powered by individuals and organizations in the community and collaborations across many sectors.

For nearly a decade, breast cancer had been the leading cause of cancer death in New York State's chautauqua county. Yet research studies found that more than 60 percent of local women did not follow guidelines for early breast cancer detection.

Now, five years later, breast cancer deaths in the county are down. The number of mammograms has increased by 33 percent, and the number of breast cancer tumors that are detected early has increased by 22 percent.

What made the difference?

A community coalition. The improvements were the result of a grassroots education and training program called the Women's Health Initiative. The Woman's christian Association Healthcare System worked with the American cancer Association, the local health department, and Westfield Hospital to create the successful initiative. Together, they organized a media campaign, a network of breast health educators in neighborhoods, and a mobile mammography unit called "health on wheels."

Far from an exception, the initiative is among perhaps hundreds of other coalitions across New York State that are part of a movement that has gained momentum over the past decade--community health. Founded on a vision that the involvement of individuals, businesses, and organizations in the community and collaborations across many sectors are the keys to improving the well-being of communities and their residents, community health broadens the definition of public health and is reshaping public health care practices.

"The central concept to community health is maximizing healthy human development in all its aspects, from conception to old age," says Charles McClintock, a professor of policy analysis and management who conducts research on health and human service coalitions. "community health is more than just having access to a doctor, a nurse, or a clinic. Those things are all important, but it also has to do with lifestyle and the other resources available that maximize health and development, such as strong families, good schools, safe neighborhoods and housing, caring adults, and economic opportunities."

In New York State, the push for local community action to address the causes of poor health resulted in the identification of 12 community health priorities by the New York State Department of Health in the 1996 report Communities Working Together for a Healthier New York. They are access to and delivery of health care; education; healthy births; mental health; nutrition; physical activity; safe and healthy work environment; sexual activity; substance abuse; tobacco use; unintentional injury; and violent and abusive behavior. Cornell vice provost Cutberto Garza, then a member of the New York State Public Health Council, served on the committee that developed the report.

As a pioneer in the community health movement, Cornell has facilitated projects similar to the Women's Health Initiative in Chautauqua County to enhance the health of New Yorkers in at least 10 of the 12 priority areas.

Take, for example, nutrition and community food systems. Cornell Cooperative Extension (CCE) associations have helped operate the Expanded Food and Nutrition Education Program (EFNEP) for 25 years. EFNEP helps low-income families and youth acquire nutrition knowledge and food management skills to improve their diets. The program has reached almost 200,000 families in 41 New York State counties and four boroughs in New York City. Similar projects in the Division of Nutritional Sciences focus on food security and nutritional surveillance.

Addressing sexual activity, another priority, CCE staff members in Albany, Schenectady, Nassau, and New York City have supported since 1989 a program called Talking with Kids about AIDS. The educators provide teaching materials and run interactive workshops in which parents learn about the illness, risk reduction methods and local resources while practicing adult-child communication skills.

Another program created in 1995, Breast Cancer and Environmental Risk Factors (BCERF), addresses the priority safe and healthy work environment by responding to the growing concern over high breast cancer rates in certain counties in New York State. Integrating research and education, Cornell experts in toxicology, environmental studies, nutrition, food safety and health, risk management, integrated pest management, community-based education, and public policy translate scientific findings and data into understandable breast cancer information and risk reduction factors for the public.

For 25 years the college's Family Life Development Center (FLDC) has worked on preventing violence and abusive behavior by training child protective and other human service professionals. Most recently, the FLDC has been designated the Upstate Center for Excellence through a Department of Health grant to provide technical assistance and training for eight community coalitions working on youth health, including Cornell Cooperative Extension associations in Otsego and Jefferson Counties. Each of the coalitions will develop prevention and youth development strategies. The FLDC will assist by providing training seminars for community partners on violence prevention, youth development best practices, diversity awareness, self-esteem, HIV/AIDS prevention, behavioral risk and protective factors, sexually transmitted disease prevention, healthy lifestyle tips, teen smoking, alcohol and drug abuse, community mobilization, career exploration and development, and college preparation.

To make all these efforts work effectively, the crucial elements are collaboration and community, McClintock says. Successful community health initiatives require counties, towns, villages, and neighborhoods to build bridges across a number of sectors, including government, the media, health care and social services, business, and others.

Another effort that seeks to support community health coalitions is the New York State Community Health Partnership (NYSCHP), established in 1997. Because of its statewide extension mission, Cornell is the only academic partner in the group whose members also include the state Department of Health, the Healthcare Association of New York State, the Medical Society of New York State, the New York State Nurses Association, the Healthcare Trustees of New York State, the Business Council of New York State, the State Communities Aid Association, and the New York State Public Health Association.

NYSCHP recently released a survey of 44 coalitions in New York State identifying health and collaboration success factors, barriers to collaboration, and capacity building needs. These coalitions, such as the Women's Health Initiative in Chautauqua County, vary across a wide range of health concerns--from injury prevention and healthy births to treatment of disease and substance abuse. In Binghamton, N.Y., for example, a physicians' free clinic for uninsured adults was initiated by a group of retired doctors in the region. They formed a partnership with the Broome County Health Department and the SUNY Health Science Center College of Medicine that paved the way for the program, which operates once per week in the evening. An advisory board comprising professional organizations, businesses, media groups, religious organizations, social services, volunteer health agencies, and governmental bureaus oversees the clinical services and spreads the word about the project to the community.

"Our research in New York State, along with work on rural health coalitions [led by Donald Tobias, associate professor of policy analysis and management and director of Cornell's Community and Rural Development Institute], is of enormous value to community groups that are struggling to create and sustain their coalitions as well as those who help fund these efforts," says McClintock. "Leadership and bold action are the main factors associated with successful health and collaboration outcomes."

He points to the three most important strategies that can strengthen community health coalitions: acquiring government funding for innovative efforts, reducing bureaucratic barriers that inhibit state and local agencies from working together, and developing training and technical assistance programs.

To provide such training, McClintock will be working with the other NYSCHP partners to develop a Community Health Institute under a new grant from the Robert Wood Johnson Foundation.

"If a community group wants to evaluate the impact of its work, for example, the institute will teach its members about research and evaluation," McClintock says. "If a community needs to know what teen pregnancy resources are available in the community, the institute will provide training on bow to do a needs assessment."

McClintock believes that strong community health coalitions will not only help relieve or cure health problems in New York State communities, but work to keep them at bay in the first place.

"The biggest benefits of community health are prevention and the development of community resources," he says. "The amount we spend on health care keeps going up. One solution is to prevent health problems--by strengthening our communities, changing our lifestyles, and reducing risks in our environment--so that we need fewer health services."
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Publication:Human Ecology
Geographic Code:1U2NY
Date:Mar 22, 2000
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