Bridging the Gap: Neighbors Supporting Neighbors in Harlem

This guest post is by Manmeet Kaur, Founder and Executive Director of City Health Works — a nonprofit, social enterprise that aims to close the gap between hospitals and communities in Harlem.

Manmeet KaurIn order for health to flourish, we need people in our lives that make us feel supported and accepted. Social support is essential to well-being and plays a fundamental role in one’s ability to make healthier choices—it is a critical aspect of making health a shared value. Unfortunately, only half of adults in the U.S. report getting the social support they need. Those numbers are even lower among minority groups and those with lower levels of education and income.

In many countries around the world, however, communities already employ effective approaches that have demonstrated impact. In Cape Town, South Africa, for example, I worked with a nonprofit that hired people from the community and trained them as peer health educators to tackle chronic health issues. This is where I first witnessed the power of peer education and the ripple effect such educators have not only on an individual’s health, but also on other aspects of their lives.

When I returned to my hometown of New York City, I immediately saw the potential to adapt this model of health care delivery from abroad and apply it to my neighborhood here in East Harlem. This is a neighborhood in which life expectancy is 9 years lower than the life expectancy of residents of midtown Manhattan. 50% of healthcare spending in this community is on only 5% of the population. The level of chronic illness in this community is so great that clinicians struggle to deliver the high-quality care patients need. They often aren’t able to support patients through the necessary long-term nutritional and behavioral changes to keep chronic illness under check. They are completely overburdened.

That’s where City Health Works comes in.

Inspired by community health worker innovations from South Africa, City Health Works engages community members to serve as the bridge between the doctor’s office and the real challenges people with chronic illnesses face on an ongoing basis. We don’t replace traditional medical care. We simply fill a gap between the health care system and the everyday lives of the people that system is meant to serve.

We start by finding and employing individuals living within the neighborhood who have a strong sense of empathy and good listening skills, are non-judgmental in nature, and can speak to shared life experiences. We train them to become health coaches: we teach them how to build relationships with their patients and truly get to know their needs, which often go beyond health and health care. In addition to receiving training on basic health care in a clinical environment, health coaches learn how to make referrals to services like banking and housing, and recommendations for recreational activities, such as local walking groups, knitting clubs, and bingo nights.

Hospitals and clinics can refer patients directly to us. They refer individuals who struggle with multiple chronic diseases and the stressors of poverty, old age, physical and mental limitations, and language or literacy barriers. Most of them experience depression and struggle with social isolation.

We pair each patient with one of our health coaches so they can receive personalized support and the resources they need to make healthy choices. Initially, there is some hesitation on the part of patients. Health choices are, after all, deeply personal. But once they learn that their coach is from the same neighborhood, they grew up down the street from them, or they even live in their same housing complex, they become more comfortable. Trust is assumed and they open up.

Today, our health coaches meet one-on-one with more than 300 patients in East Harlem on a regular basis. Over the first two years of the program, we measured depression levels amongst our patients and found that simply having a health coach who visits them regularly had a huge effect on their social and emotional well-being. Coaches have a powerful ability to motivate their patients, help them build self-confidence, and strengthen their ability to manage their lifestyle and medical care. We are proving that adding extra support for those who need it most not only saves money, but saves lives.

By adopting practices from outside of the U.S.––an approach for which the Robert Wood Johnson Foundation is now actively seeking proposals––City Health Works has been able to provide critical social support for the people in New York City who need it most. We are changing attitudes about the role of community, fostering health as a shared value, and changing our patient’s expectations about the level of care they should be getting. By fostering an engaged community, we are breaking through the walls of isolation and building a Culture of Health.

Overheard at TEDMED: Let’s Dance

Optimized-MichaelPainterThis guest blog post was written by Michael Painter, senior program officer and senior member of the Robert Wood Johnson Foundation’s Quality/Equality team.

Most have seen Derek Sivers’ 2010 TED talk, “How to start a movement.” In it a horde of dancers danced. That horde didn’t come out of nowhere of course. It started with a single nutty guy’s idea of a dance. Soon another joined, then more and more. Those two eventually became that dancing horde. Change—even big change—is like that dance. It starts small. An idea moves out of a mind into a conversation. Sometimes a small conversation, even over lunch, turns into a bigger one—a much bigger one.

At TEDMED 2015, TEDMED asked its community to dance about health. They asked each of us: what is your role in building a Culture of Health? Sure, we can agree on an ultimate far-off health goal for the country: everyone would have the hope, the means, and lots of opportunities to lead the healthiest lives possible. There are many (many) ways to get to that future. Some of those ideas can be remarkably different—most of them aren’t easy—but together they will help us create our Culture of Health dance.

TEDMED drove that conversation—that dance—with open-ended questions to spark powerful discussions about the role of health in our lives and communities. More than 800 TEDMED Delegates participated on-site, and over 150 contributed their perspectives online in response to thought-provoking questions like:

  • What is masquerading as health?
  • How can business positively impact society’s health?
  • Name one small shift that would make the biggest impact on health?
  • What is the secret to making health a shared value?

Blog post 4A dance floor is only as rich as its many wild dancers. The TEDMED team captured over 1,000 responses that reflected a range of diverse thoughts and insights from health care professionals, government officials, scientific researchers, entrepreneurs, journalists, bloggers, and more.

Blogpost3These TEDMED dancers pointed to barriers and opportunities that will help us all make health a shared value. For example, many questioned whether we have placed too much trust in technology and the latest health apps and gadgets, instead of focusing on building real-life social connections and trusting human relationships. Conversations also highlighted the importance of addressing social determinants (such as housing, discrimination and economic status), and debated whether the government should try to provide incentives for healthy behavior.

TEDMED saw some emerging themes in the Culture of Health dance, summarized in the attached piece. Take a look. See what you think. Help us keep the conversation going in your communities – both online (using the #CultureofHealth and #TEDMED hashtags) and off. We can absolutely build our healthy future—but only if we dance together. Is your toe tapping yet?

Building Healthy Cities

This guest blog post was written by Gil Penalosa, Founder and Chair of the Board of 8 80 Cities and World Urban Parks, as well as former Commissioner for Parks, Sport and Recreation for the City of Bogota, Colombia.

CicLAvia Wilshire 06-2013

CicLAvia, Wilshire Boulevard (2013)

How would your life be different if you lived within a culture of health?

Consider the city. Over 85% of us in the U.S. live in cities. Think about how you go to places, where your children go to school, where your friends live, how you cross the street. This built environment – one that can feel so comforting and routine – is actually damaging to your health.

If you looked down on the average U.S. city from the air, you would find that 15 – 25% of the land is paved with streets. Of the land that is public – as in, not privately owned –  streets occupy between 70 – 90% of space that we all share. In this environment, the automobile has become our community connector. Children used to walk and bike to school, now they are driven. When our children make new friends at those schools, we drive them to their play dates. Parks are few and far between so we drive the kids to soccer practice. As cities spread, we drive for an hour or more to report to work. With all these cars on the road, we advocate for wider streets with more lanes and higher speed limits. In many communities, sidewalks do not even exist.

This method of navigating our built environment is killing us. Studies show that the chances of being killed increase by 75% when hit by a car going 35 mph versus one going 20 mph. Around the world, a person walking is killed by a person driving a car every 2 minutes. Twenty years ago, no state in the US had a population with an obesity rate over 20%. Today, there is not a single state whose obesity rate is less than 20%. Concern over obesity is not aesthetic: it causes heart attacks, respiratory problems, cancer, depression and anxiety.

And the challenges are increasing. Currently in the US there are 42 million people over 65 years old; in just 35 years, this number will double to 85 million. Of all the people who have ever lived to 65, half are alive today. We are living longer – much longer – yet our cities are becoming less friendly to older adults. As wider streets lead to longer crossing times, older people are being killed in crosswalks at 4 times the rate of their proportion of the population. The main issues facing the elderly are isolation and mobility. How are we going to address those if we continue to build communities that quite literally threaten their lives?

How do we change the future? To live a culture of health, citizens can no longer be spectators. We must act. We must each commit to participate.

Call on your governments – elected officials and your city staff in departments of planning, transportation, public health, education, parks and recreation – to commit to working with each other and with other sectors like businesses, media, activists and universities to guide the development of our cities with people in mind, creating healthy communities where all people will live happier.

Reclaim your streets. Walking and bicycle riding are the only individual modes of mobility for all people under the age of 16 and for many adults. Safe and enjoyable walking and cycling should be a right for all people. Support budgets that include money for sidewalks. Advocate for Open Streets, the closing of streets to cars on Sundays so that people can use this public space to walk, bike, be with each other. Make it easy for people be out and about in their communities, to visit other neighborhoods, to meet other people meet as equals.

Support investment in parks, large and small, that thread through your city, in all neighborhoods so that every child has a play area within ¼ mile at any given time. If land is not readily available, public properties can be converted for recreational use. School playgrounds can be used by the school during the weekdays but open to the community in the evenings and weekends.

We must improve the use of all land that is public. It belongs to all people. We must stop building cities as if everyone was 30 years old and athletic and create great cities for all. Any city, of any size, should pay attention to how well they treat its most vulnerable citizens, including children, older adults, disabled and poorer residents.

How is your city doing? You don’t have to be an expert to assess whether a park, street, sidewalk, school, library, actually any public space invites people to walk or ride. Simply use 8 80 Cities’ practice. If evaluating an intersection, think of a child you love, someone around 8 years old. Now think of an 80-year-old that you love. Would you send them across that intersection? Would they feel safe? Can they walk to school or to a park? If your answer is yes, it is good enough. But if it is no, it must be changed. The 8 and the 80 year olds are indicators. If a city promotes a culture of health for them, it will promote a culture of health for everyone, a built environment where everyone can live the healthiest lives possible.