National Center for Chronic Disease Prevention and Health PromotionDivision of Community Health (proposed)

REACH U.S.: Past, Present, & Future

Shannon White, MPH Health Education Specialist

REACH U.S. UAB Mid-South Regional Meeting

August 23, 2011

Healthy People 2020

Program Focus on Health Equity

Health equity is at the core of all our programs and activities.

Health equity is achieving the highest level of health for all people.

It entails focused societal efforts to address avoidable inequalities.

The goal is to equalize conditions for health for all groups, especially for those experiencing socioeconomic disadvantage or historical injustices.

A NATIONAL, MULTILEVEL APPROACH

Programs and Activities

Racial and Ethnic Approaches to Community Health (REACH)

Cornerstone of CDC efforts to eliminate racial and ethnic health disparities

Program began in 1999 Was aligned with Healthy People 2010 goals

Became REACH Across the U.S. (REACH U.S.) in 2007

REACH U.S. program is funded through 2012

Socio-Ecological Model

REACH

Through the REACH program:CDC supports grantee partners to establish and/or support community-based programs and culturally-tailored interventions to eliminate health disparities among racial and ethnic minority groups.

Priority Health Areas

Adult immunizations

AsthmaBreast and cervical

cancerCardiovascular disease

Diabetes mellitus

Infant mortality

Hepatitis B

Tuberculosis

Racial/Ethnic Groups

African Americans

American Indians andAlaska Natives

Asian Americans

Hispanics/Latinos

Pacific Islanders

Example: REACH U.S. CEED Program

Institute for Urban Family Health(New York, New York)

Mooove to 1% or Less – Yes!Changing the Milk Policy in New York City Schools

Public health issue:An estimated 120 million containers of whole milk, sweetened vanilla, chocolate, and strawberry milk are served each year in the public health system.

Outcome:A citywide low-fat/skim milk only policy was put in place in NYC public schools.

Example: REACH U.S. CEED Program

Mt. Sinai School of Medicine

Save Half For Later Campaign

Public health issue:Increase consumer and business awareness about portion control and its relation to obesity and diabetes.

Outcome:Trained restaurant managers and staff to promote and implement portion control strategy.

Example: REACH U.S. Legacy Program

Mt. Sinai School of Medicine

Concrete Safaris

Public health issue:To increase youth engagement in physical activities and nutrition principles as a means of early age diabetes prevention.

Outcome:Enrolled more than 35 children into the program where they learned gardening as a form of exercise and about healthy eating.

Example: Action Community

Chicago Department of Public Health

Lawndale Christian Health Center

Public health issue: Increase the proportion of the population who report meeting the daily physical activity requirement.

Outcome: Lawndale Christian Health Center expanded to address access to healthcare and physical activity/nutrition resources and offers medical care on a sliding scale fee. 

REACH U.S. Program Accomplishments

Implementing strategies that fit unique social, political, economic, and cultural circumstances

Moving beyond individuals to community and systems change

REACH U.S. Program Accomplishments

Empowering community members to seek better health

Bridging gaps between health care system and community

Changing social and physical environments to overcome barriers to good health

Programs and Activities

Expanding REACH

REACH National Organizations that Serve Minority Communities

Launched in 2009, this REACH program funds six national minority-serving organizations.

– Through their local affiliates and chapters, they provide training and technical assistance in two areas:

1) dissemination of evidence-based strategies and tools

2) capacity building

REACH National Organizations that Serve Minority Communities

Asian Pacific Partners for Empowerment, Advocacy and Leadership (APPEAL)

National Black Women’s Health Imperative

National Council of La Raza

Inter-Tribal Council of Michigan

Society for Public Health Education (SOPHE)

Joint Center for Political and Economic Studies

Example: REACH U.S. National Organizations that Serve Minority Communities

Asian Pacific Partners for Empowerment, Advocacy, and Leadership (APPEAL),

Oakland, CANational Asian American and Pacific Islander Network To Eliminate Health

Disparities (NAPNEHD)

Affiliates: Coalition for Asian American Children and Families (New York, NY), Coalition for a Tobacco Free Palau (Palau), and Washington Asian Pacific Islander (WAPI) Community Service (Seattle, WA)Public health issue:

Reduce cardiovascular disease through environmental and policy changes promoting healthy eating and active living. Outcome:Increased capacity in AA and NHPI communities for policy change by implementing APPEAL’s Community Readiness, Leadership, Technical Assistance and Training (TAT) and Four-ProngPolicy Change Models.

REACH Community Organized to Respond and Evaluate (CORE)

The two-year REACH CORE program supports communities transitioning from the analysis of intervention results to the use of these results in facilitating health equity and policy change.

REACH Community Organized to Respond and Evaluate (CORE)

Health Departments and Universities:

– Regents of the University of California, Los Angeles – University of Kansas Center for Research, Inc. – Arizona Department of Health Services– North Carolina Department of Health & Human Services – Department of Environment, City, and County of San Francisco– Schenectady County Public Health Service– Louisiana Public Health Institute– Michigan Public Health Institute– Asian Media Access– Maternal, Child and family Health Coalition of Metropolitan St.

Louis

Example: REACH CORE Program

University of California Los Angeles Center for Health Policy Research

(Los Angeles, CA)

Turning Data Into Action: Fighting Air Pollution in Two Immigrant Communities

Public health issue:Air pollution in two Latino communities: Boyles Heights and Long Beach, CA.

Goal: Change public policies, regulations, and transportation practices to address disproportional burden of air pollution.

Racial and Ethnic Health Disparities Action Institute (REHDAI)

Begun in 2008, this three-year program:

– Equips nine community teams with the knowledge and tools necessary to launch and sustain an effective local community action plan.

– REACH U.S. CEEDs facilitate networking opportunities to help build capacity.

Racial and Ethnic Health Disparities Action Institute (REHDAI)

Nine REHDAI Teams and CEEDs:– Florida (Genesee County Health Department)

– Kentucky (University of Illinois-Chicago)

– Maryland (Mt. Sinai School of Medicine)

– Minnesota (Regents of University of California, Los Angeles)

– Mississippi (Medical University of South Carolina)

– Missouri (Hidalgo Medical Services)

– Oregon (Regional Asthma Management and Prevention Initiative)

– Tennessee (University of Alabama – Birmingham)

– Texas (Boston Public Health Commission)

Example: Oregon REHDAI

Oregon Coalition to Improve Birth Outcomes (OCIBO)

Public health issue:Improve birth outcomes for women of color.

Outcome:   State legislation directs Oregon Health Authority to present plan to improve birth outcomes for underserved women through use of doulas (birth companion) and community health workers by February 2012.

Programs and Activities

EVALUATING PROGRAM RESULTS

National REACH Program Evaluation

Analysis: – Use all available evaluation data to

analyze REACH program contributions and outcomes in the four areas of study.

– Conduct other health economic, policy and network analyses.

Literature/Document Reviews and Interviews

CDC: Retrospective (Completed) – Purpose and fit with overarching program model– Early decisions / challenges

Map literature review findings to evaluation questions (Assessing the gap)

Interviews– CEED POCs (June-July)– REHDAI POCs (July-August)

Programs and Activities

PROGRAM IMPACT

REACH U.S. Risk Factor Survey

• The REACH U.S. Risk Factor Survey began in 2009.

• It gathers data annually from 28 communities located in 17 states with REACH U.S. community health interventions.

• The survey includes questions about health, chronic diseases, diet, exercise, preventive services, and adult immunizations.

• These community-level survey data are being used by CDC and community coalitions to monitor and evaluate interventions in each community.

American Indian

Asian

Hispanic

Black

REACH U.S. communities focusing on cardiovascular disease/diabetes mellitus (2002 – 2006)

Racial and Ethnic Approaches to Community Health REACH Data, 2006, comparative data 2002-2006.

Programs and Activities

EXPANDING PROGRAM OUTREACH

International Outreach

Expanding the influence of our programs through international health promotion efforts in:

United Kingdom Zambia Sub-Sahara Africa

Social Determinants of Health and Health Equity

• Communication Resources • DANYA International Project

• Health Equity Workbook Update

• CHEB Training Cadre’

Cultural Competency• Community Coalition Tools

Translation and Training

Dissemination

Promoting Health Equity: A Resource to Help Communities Address Social

Determinants of Health: http://www.cdc.gov/nccdphp/dach/chhep/pdf/SDOHworkbook.pdf

Morbidity and Mortality Weekly Report

Surveillance Summaries / Vol. 60 / No. 6 May 20, 2011

Surveillance of Health Status in Minority Communities — Racial and Ethnic Approaches to Community

Health Across the U.S. (REACH U.S.) Risk Factor Survey, United States, 2009

http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6006a1.htm?s_cid=ss6006a1_w

Supplement to Family & Community Health, The Journal of Health Promotion & Maintenance – Racial and Ethnic Approaches to Community Health (REACH): Translating Processes of Change and Attributing Improved Health Outcomes to Social Determinants of Health Programs. Published January 2011.

http://journals.lww.com/familyandcommunityhealth/toc/2011/01001

Directors of Health Promotion and Education

Institutes of Medicine of the National Academies

National Association of Chronic Disease Directors

National Association of County and City Health Officials

Society for Public Health Education

Community Health and Equity Program Partners

Next Steps

Community Transformation Grants

$145 million announced by HHS for FY 2011

President’s Budget proposal for FY 2012 includes

$221 million

“… in order to reduce chronic disease rates, address

health disparities, and develop a

stronger evidence base of effective

prevention programming”

Community Transformation Grants

•Implementation, evaluation, and dissemination of community-based community prevention activities

Program focus

•State/local governmental agencies, state/local non-profit organizations, tribes, national network CBOs

Eligibility

•Applications were due July 15; objective review the week of August 15; funding begins September 2011

Current status

•Work from programs such as REACH and CPPW will help inform CTGs

Building on

success

Award Categories for Community CTGs

Capacity Building– Awards range from $50,000-$500,000

Implementation– States, local governments, nonprofit

organizations: $500,000-$10,000,000– Territories: $100,000-$150,000– Tribal and AI/AN Consortia: $100,000-

$500,000

Up to 75 awards will be made

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Center for Chronic Disease Prevention and Health Promotion

Division of Community Health (proposed)