Editor’s Note: This post is part of an ongoing series written for Health Affairs Blog by local leaders from communities honored with the annual Robert Wood Johnson Foundation Culture of Health Prize. In 2014, six winning communities were selected by RWJF from more than 250 applicants and celebrated for placing a priority on health and creating powerful partnerships to drive change.
Brownsville is a culturally diverse, south Texas border town, a stone’s throw from Mexico. The 180,000 residents, mostly Spanish-speaking, live in one of the poorest metropolitan areas in the United States and have massive public health needs. In Brownsville, 48 percent of the children live in poverty, and 80 percent of our population is obese or overweight. Thirty percent have diabetes and half of them don’t know it. About 67 percent have no health insurance.
But in Brownsville, you will also find a robust, bike-friendly city, community gardens, and the world’s largest Zumba® class. That’s because in the last 10 years Brownsville has developed innovative partnerships, extensive outreach efforts, and a shared commitment to achieve wellness.
Using Data to Engage the Community
In 2001, the University of Texas opened its School of Public Health in Brownsville, where I serve as an associate professor and investigator. As faculty and staff, we didn’t want to be a university that researches health needs but does little to improve them. We talked to community groups and city leaders about what they thought were the city’s most pressing needs. We assessed our problems and found that the rising prevalence of diabetes and obesity were paramount.
Overall, the community lacked the programs and policies needed to prevent and manage these conditions. After seeing the data and discussing the harsh reality, we helped form a partnership, the Community Advisory Board, to create integrated programs to teach people the importance of health and its effect on everything from education to their wallets.
First, we looked for funding. In 2003, the University of Texas School of Public Health secured a National Institute of Health grant for $6.2 million that gave us start-up money for programs and partnerships still active today. One of these is a study of the health of Brownsville residents. A School of Public Health team has been enrolling people in a prospective study and following them every five years by inviting people to come to our clinical research unit where a team gathers extensive health information including a clinical exam.
Today, the study includes 3,000 people who are re-assessed at every five year anniversary in the study. It’s giving us a wealth of information about Brownsville’s actual health needs including the extent of disease and disability in the city. These data have led to research papers and additional grants funding.
Community Advisory Board Programs
We developed the School of Public Health’s Community Advisory Board (CAB) in 2003, which today includes 200 people and organizations, from private citizens to elected officials, business executives, and non-profits. At first, the CAB examined health by itself, but it now works to build a vibrant community by addressing the relationships between health, poverty, education, and the economy. A number of programs have been implemented. For example:
Brownsville in Motion a community group, the CAB and a City Commissioner, promote infrastructure and policy improvements, to ensure every neighborhood has sidewalks and safe access to trails and bike lanes. Key laws have been passed, including an ordinance to create streets that are safe for pedestrians, bicycles, and cars and an ordinance that requires motor vehicles to pass pedestrians and cyclists with sufficient room to ensure safety. Improvements are being made in street signs, lighting, and bike lanes. The Belden Trail, an abandoned train track running through a low-income neighborhood and past several schools is now a mile-long paved, landscaped, and well-lit trail.
As part of CylocBia, a fitness event modelled after a similar project in Bogata, Columbia, certain city streets are closed to traffic four times a year, and thousands of people come out to walk, jog, and bike. During the event supported by local businesses, people can stop for free bike repairs, exercise classes, and rock wall climbing to name a few.
Brownsville Farmers’ Market and its Community Garden program aim to promote healthy eating and improve economic development. Opened in 2008, the weekly market has not only increased the availability of locally grown produce, it’s a popular destination for cooking and exercise classes, and health screenings. Low-income residents can obtain a plot at the community gardens, receive gardening and business training, and sell their produce at the market. There are four community gardens around the city and all the plots are subscribed, reaching nearly 80 families.
The Community-Wide Obesity Prevention Campaign, Tu Salud ¡Si Cuenta! (Your Health Matters!), reaches residents through Spanish and English-language media, including weekly health segments on a popular Spanish-language TV talk show. The campaign includes a Weight Loss Challenge sponsored by some of the city’s biggest employers. The four-month challenge, which offers prizes, has been an annual event for five years. The Challenge sponsors free exercise events, such as an outdoor Zumba ® class which drew more than 1,200 people and put Brownsville in the Guinness Book of World Records.
An evidence-based chronic care program began in 2013 for people with uncontrolled diabetes. Community health workers who speak Spanish and are paid livable wages are part of a multidisciplinary team to provide support to lower A1c levels. This kind of support for chronic disease management is critical in a town where two-thirds of the population have no insurance.
From projects like these we have learned that the process of engaging the community creates a sense of ownership and pride. Improving health isn’t just about making changes; it’s about having residents involved in the process. We have also seen how having little money can be an asset: Limited resources demand innovative thinking and attention to evidence-based practices.
Brownsville intends to complete the bike routes, expand the farmer’s market and community garden programs and continue to address health in a collaborative manner. Ultimately, we envision a Brownsville known for its culture of health, not its health challenges.