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In North Philadelphia, community organizing is path to better health

When Lamont Jefferson started knocking on North Philadelphia doors last fall to inform residents about how to get health insurance under the Affordable Care Act, he had a head start on your average solicitor.

Community Connectors have helped families in North Philadelphia understand their options under new federal health insurance rules.

As a “Community Connector” for Asociación Puertorriqueños en Marcha (APM), a LISC partner and one of the largest social service and community development organizations in Philadelphia, he’d been there before, engaging residents in a variety of issues from taking parks back from drug dealers to encouraging participation in computer classes.

Jefferson, 47, was no stranger. He grew up in the neighborhood and never left.

The familiarity paid off.

Of the 1,200 people Jefferson and other APM Community Connectors contacted regarding federal health insurance, 700 were referred for enrollment, benefiting from the expanded Medicaid coverage the legislation allowed.

Business as usual

For the Community Connectors—APM currently has nine of the part-timers working on six-month contracts—outreach for the Affordable Care Act was just another day at the office. That’s what they do. 

But their work, and that of their counterparts in other cities, underscores a key factor in LISC’s approach to creating healthier neighborhoods through the availability of nutritious food, safe places to exercise and primary medical care: Even when those elements of a healthier lifestyle are available, they won’t do much good if no one’s aware of them.

When the health insurance enrollment began in North Philadelphia, though, APM already had the infrastructure and capacity in place to get the word out via the Community Connectors, funded by Philadelphia LISC.

“They’re organizers, basically,” says APM’s Angel Rodriguez. “Part-timers. All from the neighborhood. Many are students.”

“We realized the best way to do that wasn’t through some fancy communications approach or social media, or whatever, but through good old-fashioned door-knocking.”

The Connectors were originally established as a way to directly inform residents about the organization’s programs and services. “We realized the best way to do that,” Rodriguez says, “wasn’t through some fancy communications approach or social media, or whatever, but through good old-fashioned door-knocking.”

Roughly half the people in APM’s service area are Hispanic, he adds, and whatever news they get is typically through newspapers or Univision.

“Many don’t have computers or computer skills,” he says. “They’re not online, reading the Huffington Post. What concerns them are base-line survival issues. If it’s not related to their pain, they’re not interested.” 

The ACA campaign, he says, was very specific. “We used voter registration rolls and set up a grid to identify people who’d be eligible. We flyered more than 1,000 homes, then went door-to-door and got pledge cards from people, who we referred to other agencies that could enroll them.”

Meanwhile, similar efforts were underway in other cities. Through a state grant, LISC Chicago hired navigators to inform and enroll people in ACA via 21 neighborhood organizations. 

That health-related outreach was so successful in Chicago that LISC is now using the community organizer approach to enroll uninsured children in All Kids, a state-supported health insurance program.

ACA outreach promotes other health work

In North Philadelphia, the health insurance experience also led APM’s Connectors to other health-related campaigns, such as working with Temple University to clean up vacant lots and fight back against illegal dumping.

Old tires, for instance, pose a particularly vexing problem in the neighborhood. The water that collects in them becomes a breeding ground for mosquitoes and the diseases they carry. After a three-day clean-up project, Community Connectors and resident volunteers removed more than 1,000 tires.

The value of community engagement doesn’t surprise Nancy Rothman, a professor of urban community nursing at Temple University who manages community-based programming at Health Connections, a new Federally Qualified Health Center in North Philadelphia.

A health center at Paseo Verde, a new mixed-income development in North Philadelphia, has benefited from building relationships in the local community.

In an effort to make health care more accessible, APM invited Health Connections, operated by the Public Health Management Corporation (PHMC), to be a tenant at Paseo Verde, the greenest building in Philadelphia and a $48 million transit-oriented development with mixed-income apartments.

A few months after opening, the health center continued to struggle with low participation from local residents. Just because you build it doesn’t mean they’ll come.

“The health center must do marketing to get people there,” Rothman says. “A lot of it is education. Education and trying to understand. To listen.”

Some women, she says, are reluctant to get mammograms because they think if they’re diagnosed with breast cancer they’ll die. “That’s one of the perspectives,” she says.

And men are even less likely to visit.

Don’t just come in when you’re sick

Because there are few safe places in North Philadelphia where people can exercise, the health center listened to resident interest and began offering Zumba fitness classes.

Women loved them. And once they showed up for the Zumba classes, they took advantage of the center’s medical services. (Zumba didn’t strike a chord with men, though, whose exercise preference was kickboxing. The center couldn’t offer that because of liability issues.)

“Good health care isn’t just coming in when you’re sick.”

“Good health care,” Rothman says, “isn’t just coming in when you’re sick.”

The staff at Health Connections works to establish a comfortable relationship with patients so they’ll return for regular screenings around blood pressure, diabetes, colorectal cancer and other medical problems that typically plague people in underserved neighborhoods. 

And they need plenty more, said Rothman, including programs for stress reduction, exercise, smoking cessation, weight reduction, gardening, food preparation and STD prevention, among others.

That “relationship”—an essential tenet of community organizing—is the key to boosting participation in those programs. This is where the work of health and community development professionals overlaps—and why they’re starting to work together.

LISC, for example, has begun convening PHMC, Temple and APM to coordinate health programs and services, as well as community engagement around health.

And thanks to a $30 million Choice Neighborhoods grant through the White House’s Neighborhood Revitalization Initiative, APM and LISC plan to hire a new health navigator and sports coordinator to help residents get the exercise and care they need to be healthy.

Programs like this healthy food buying club in North Philadelphia help get the word out about healthier options in the community.

“We know that health is significantly determined by neighborhood quality of life,” said Dana Hanchin, deputy director of Philadelphia LISC. “Engaging residents has always been at the heart of that work. Now we are excited to elevate LISC’s role to work directly with health partners and community developers to help families and neighborhoods become healthier and stronger.”

“There’s a big difference in ‘doing it to’ the community as opposed to ‘doing it with’ the community,” says APM’s Rodriguez. “How do you do it with them? You teach them to advocate for themselves. The work is very low tech but really effective. It’s like using a 1970s mimeograph machine. It’s old school stuff. But people want to see you walking in the community.”

Rothman agrees: “It’s all about outreach. Get them to the health center. Do the screenings, have social work support them. It takes everything. It takes a village to do all of this.”

Posted in Engaging, Health & Wellness, Philadelphia

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