CHMP

Charmaine Ruddock is a Senior Fellow and project director of Bronx Health REACH. 

Bronx Health REACH Town Hall Meeting: “Make Health Equality a Reality” – April 28^th

Bronx Health REACH, along with Assemblymember Nelson Castro and New York Lawyers for the Public Interest, is organizing a Town Hall meeting on Saturday, April 28^th from 10 am to 1 pm called “Make Health Equality a Reality.” The event will take place at P.S. 33 in the Bronx (2424 Jerome Avenue). The Town Hall will include a panel of legislators, doctors, community members, and lawyers discussing the inequities in the health care system. Audience members will be invited to ask questions about health care access. The event is open to all and breakfast will be provided for all attendees. Please see the attached flier for more information (English and Spanish). We hope to see you all there!

Charmaine Ruddock is a Senior Fellow at CHMP.  She joined the Institute for Family Health formerly known as The Institute for Urban Family Health in 2000 to direct Bronx Health REACH, a coalition of 50 community and faith-based organizations, funded by the Centers for Disease Control’s REACH 2010 Initiative to address racial and ethnic health disparities.  

A few months ago, Bronx Health REACH and its 3 fellow REACH projects  in New York  played  hosts to visitors from the UK who wanted to hear, see, feel and, where possible, even touch the work that we were doing in our respective communities to address the problem of racial and ethnic health disparities.  For those who may not know, there are 40 REACH communities across the country who are part of the Centers for Disease Control and Prevention’s cornerstone effort to have local communities design and implement solutions to the health disparities in their respective community.  Community can be a geographic location or a unique socio-cultural ethnic/racial grouping.  REACH which stands for Racial and Ethnic Approaches to Community Health focus is on eliminating underlying determinants through policy, system and environmental change.

The UK visitors are part of a collaborative effort by CDC, the UK Department of Health Communities for Health (C4H) program, the International Union for Health Promotion and Education; and Health Action Partnership International to create a REACH US/UK Learning Exchange project aimed at cultivating a learning exchange between select communities in the US and the UK.  The exchange is designed to provide participating communities with opportunities to share interventions and tools found to be effective in addressing social determinants and ensuring health equity in disparate groups.  The ambitious goal of this learning exchange is that the best practices and lessons learned from the work done in these communities will be disseminated to inform and improve global public health.  For the US visit, four English local authorities were twinned with cities in the US- Nottingham with New York (Brooklyn and the Bronx); Sandwell with  New York; Stoke with Alabama; and Coventry with Boston and New York.

The first thing that struck Bronx Health REACH about our group of visitors was that one of them was an elected official.  As we described our work to them and took them on tour of the sites of some of our Bronx based partners their responses were around four key points.  1) Our Bronx Health REACH team did not include elected officials (an issue they visited time and time again); 2) the depth of our community engagement and involvement; 3) the paucity of our healthcare system.  (They left with a burning commitment to thwart any effort back in the UK to adopt or borrow any aspect of our healthcare system); and, 4) the level of poverty they saw led them to rethink what they pointed out was their very distorted view of the American safety net system.  Following are some of the points they made in their report documenting their reflections of what they saw and understood of our work within the larger context of addressing the determinants of health disparities.

• Individual projects have not been set up to overcome huge barriers.  Challenges such as structural poverty, denial of access to adequate health care for specific groups, lack of public sector infrastructure etc. are too large to be overcome at a local level.
• The challenges in implementing health program based on a social determinants approach include scaling up, managing policy changes, developing cross-sector processes and ensuring sustainability. There is a need for partnership and collaboration across sectors so that a common vision and objectives can be identified and implemented.
• An asset based approach appears to be the way forward at a community level.  The projects had a good understanding of the importance of using assets that already existed in their communities and there were excellent examples of how this had been achieved.
• There was much evidence that small amounts of funding at a local level enable innovation. However, if success at a project level is to be maintained or expanded there is a need for clear, high-level strategic leadership, accompanied by long-term funding focused on reducing health inequities?
• It is not usually the remit of community-based projects to strive for health to be embedded in all policies at a higher strategic level.  However, it is clear that the projects tried to influence policy makers to consider health in its widest sense.

It was a unique and welcome experience to see our work through their eyes. So much of their interpretation of what they saw is what REACH communities have understood and have been advocating for as a new framework for sustained response to health inequities.  It is also what informs the work of the National REACH Coalition and its offspring, the National Health Equity Coalition at the federal level.

A reciprocal trip is being planned for the REACH grantees to visit their UK counterparts in summer 2012. It will be interesting to look at their communities, their safety net system, and efforts to address the determinants of health through our particular lens of health care access, and socio/economic/environmental determinants of health.

I will keep you posted.

Charmaine Ruddock

Photo: McDonald's Happy Meals

Charmaine Ruddock directs Bronx Health REACH, a coalition of 50 community and faith-based organizations, funded by the Centers for Disease Control’s REACH 2010 Initiative to address racial and ethnic health disparities.

Last week, Julie Deardorff,  health and fitness reporter at the Chicago Tribune wrote ” The obesity epidemic: Can parents say ‘no?’ in response to a comment by McDonald’s CEO Jim Skinner.  Skinner, in responding to a request at the shareholders recent annual meeting to assess its policy on childhood obesity, stated that “many choices …fit within the balanced active lifestyle.’” Skinner continued his remarks by saying that. “It is up to parents to choose” and “it is their responsibility to do so.”  What Skinner should have gone on to say is that McDonald’s multi-billion dollar marketing and advertising has as its sole purpose the hijacking of parents’ choice and the elimination of their responsibility. “Happy Meals” is McDonald’s black eye to Skinner’s parent choice and responsibility.

This was originally posted on Bronx Health REACH’s blog Making Health Equality a Reality on May 3, 2011

According to the Food and Drug Administration (FDA), nearly 4,000 youth under age 18 try their first cigarette each day in the United States and an additional 1,000 become daily smokers. In the Bronx, 3,000 public high school students are current smokers (NYC Department of Health, 2009) and a third of them are likely to die prematurely from the effects of cigarette smoking, based on statewide data from the Centers for Disease Control and Prevention.

Tobacco companies market heavily to youth with the goal of finding and securing “replacement smokers.” The Campaign for Tobacco-Free Kids notes that tobacco industry internal documents identify children as young as 11 years old as a “key market.” A newly published FDA report indicates that 80% of black and 50% of Hispanic teens smoke menthol cigarettes such as Newport. This is particularly relevant to the Bronx, which is 91% black and Hispanic, according to the 2010 census. According to a report published this year by the Tobacco Products Scientific Advisory Committee (TPSAC), menthol cigarettes reinforce smoking behavior through their cooling “throat grab”, which reduces the aversion to nicotine among new smokers, thus promoting continued use leading to addiction. One manufacturer of a menthol-containing brand that is extremely popular among black and Hispanic teens, notes: “[T]he base of our business is the high school student.”

Although cigarette companies claim that they have discontinued intentional marketing to youth through targeted ads and promotional items, they have found another powerful venue for the promotion and sale of their products—the local neighborhood store. The corner store is a favored stop off point for youth on their way to and from school. A recent Bronx community mapping survey showed that 85% of these establishments are located within a five block radius of a school. Cigarette and spit-tobacco companies continue to advertise heavily at these stores with large ads and signs clearly visible from the outside.

On June 22, 2010, the FDA issued a new ruling designed to limit the effect of tobacco advertising on youth.

Among other things, the rule:

• Prohibits the sale of cigarettes or smokeless tobacco to people younger than 18,
• Prohibits the sale of cigarette packages with less than 20 cigarettes,
• Prohibits distribution of free samples of cigarettes or smokeless tobacco, and
• Prohibits gifts or other items in exchange for buying cigarettes or smokeless tobacco products.

To ensure compliance, the FDA has promised to conduct unannounced inspections of local retail establishments and to impose “enforcement action,” which could include warning letters, civil money penalties, and orders prohibiting the future sale of tobacco products.

While these provisions are important, they do not address the key issue of tobacco signage in local neighborhood stores. In the Bronx, this is a major issue, due to their proximity to schools, and the tendency of many to violate the FDA ruling by selling small quantities of cigarettes and other tobacco products to youth, and failure to verify their age at the time of sale.

What can communities do? Bronx Health REACH (BHR) has spent the last few months as a community contractor with the Bronx Smoke-Free partnership under a grant funded by the New York City Department of Health. We have met with local members of the Assembly, Senate and City Council to encourage their continued advocacy and support of smoking prevention and cessation efforts in the Bronx, which has one of the city’s highest overall smoking rates and highest pediatric asthma hospitalization rate. In addition, we have met with Community Boards 3 and 5, representatives from our key target schools in Districts 7 and 9, and members of our Faith-Based Outreach Coalition to inform and sensitize them to the issue of youth-focused tobacco marketing in the local retail market.

Bronx Health REACH is currently working with eight schools under the New York State Department of Health-funded HEA+LTHY Schools NY program to bolster school wellness policies focusing on nutrition, physical fitness and tobacco prevention. It has also encouraged its faith-based coalition to actively engage their youth groups in tobacco prevention advocacy, since youth are the target of tobacco marketing efforts. Several youth groups in member churches have already been sensitized to the importance of healthy eating through participation in the God’s Health Squad program, a multi-unit participatory curriculum that covers key concepts related to nutrition, fitness, good health and positive body image. REACH staff and members of the Bronx Smoke-Free Partnership will work with these same youth groups in targeting local retailers to encourage them to remove tobacco signage outside their stores and reduce tobacco product visibility inside.

Charmaine Ruddock, director of Bronx Health REACH, is a coalition of 50 community and faith-based organizations, funded by the Centers for Disease Control’s REACH 2010 Initiative to address racial and ethnic health disparities.

Happy Valentine (Not So Much) from President Obama

A week ago on Valentine’s Day REACH communities across the country received the kind of Valentine’s Day gift that had no love behind it.  Included in the President’s proposed budget for FY12 was the defunding of the 12 year REACH program. REACH which stands for Racial and Ethnic Approaches to Community Health is CDC’s cornerstone effort to address the stubborn and persistent gap between the health outcomes of whites and those of people of color be they Asian/Pacific Islanders, Blacks, Hispanics, Alaska Natives and American Indians.  The genius of this effort is that in 1999 CDC took the unprecedented approach that the communities most affected by disparities should take the lead in addressing their disparities.  By all accounts this was a major departure in public health.  Heretofore, health disparities was something studied and researched with papers written and academic treatises produced but not much done in terms of addressing them in the local context where there were occurring and definitely not with a community based participatory approach. Enter REACH.  In 1999, under the leadership of the then head of CDC, Dr.David Saatcher grants were made to 36 communities.  Their mandate was to convene coalitions made up of people who work, worship, and live in the community –residents, healthcare providers, academic institutions, faith-based organizations, public health departments, elected officials, business people etc. The Coalitions first task was to put together a community action plan to address the prevailing disparity and its underlying contributing factors in their community.  This was no knight in shining armor riding in on a white horse telling ‘those people’ what their communities should be doing. Instead, communities were given the resources to figure out what they needed to do and then go about doing it. Read the rest of this entry »

Bronx Health REACH /credit BHR

The last few months have been a very exciting time in the fight for health equality.  In March, after decade of efforts by dedicated advocates and policymakers, we saw comprehensive health care reform become a reality when President Obama signed into law the Patient Protection and Affordable Care Act.  While we are thrilled that the new law will do much to improve access to healthcare, we also know that access alone will not be enough to end racial and ethnic health disparities.  At the same time that access to primary care and preventative services is being drastically expanded, the segregated system of outpatient specialty care in New York City’s academic medical centers persists.

To this day, when patients without insurance and those covered by Medicaid seek specialty care at New York City’s academic medical centers, they are sent to hospital clinics.  Meanwhile, privately insured patients are sent to faculty practices where they find more experienced doctors, shorter wait times, more coordination of care and, greater access to their physicians outside of office hours.  Because patients without insurance or on Medicaid are more likely to be racial and ethnic minorities, this system amounts to a form of segregation.

The Bronx Health REACH Coalition of more that 60 faith and community based organizations has been fighting to change this segregated system of specialty care for more than a decade.  Two years ago we filed a formal complaint with New York State Attorney General Andrew Cuomo, now Governor-elect Cuomo.  When the Attorney General refused to act, we talked and educated elected officials about this issue.  As a result, two legislators introduced legislation in both the Assembly and the Senate in Albany.  However, with the state budget crisis consuming everyone’s attention and energy, the legislation was not passed.   We are not disheartened.  The Bronx Health REACH Coalition understands that we are in a fight to save lives and increase the quality of life for many.  We believe, as Martin Luther King so eloquently put it in an address in 1967 to the Southern Christian Leadership Conference, ‘…that the arc of the moral universe is long but it bends toward justice.’  We have built a movement whose slogan is, Making Health Equality a Reality. We will not stop until that is so.

CHMP Senior Fellow Charmaine Ruddock, MS, is Project Director of Bronx Health REACH a coalition of 50 community and faith-based organizations, funded by the Centers for Disease Control’s REACH 2010 Initiative to address racial and ethnic health disparities. Bronx Health Reach works with the Institute for Family Health.