Ideas and Proposals from the Second Meeting of the West End Work Group
To the W. End Work Group:
When we last met on June 19, I thought we had some very good discussion, and made progress on casting a plan for SPHIS outreach into W. Louisville. The following narrative, only a draft, takes some of the ideas we discussed at the meeting and puts them into a narrative proposal. See what you think. I may have made some assumptions that are not the consensus of the group, or perhaps there are some ideas that we discussed that are not included. We’ll be scheduling another meeting soon, and I’m hoping we can discuss this draft at that time.
Richard
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West Louisville doesn’t really exist as a precise geographic or government unit of Louisville Metro. As a concept it can be depicted by drawing a line from the Ohio River at 9th Street all the way to the southern edge of Jefferson County: everything from that line west to the Ohio River is considered W. Louisville. Aside from the geographic limits, the term “W. Louisville” conjures minority populations, widespread poverty, limited investment or economic development, few occupational resources, unsafe neighborhoods, and a stock of decaying housing and vacant lots. To an extent, these conditions can be found in other areas of Louisville Metro, but W. Louisville is the most concentrated nexus of disadvantage and disparities. It is important to note here that while leaders and interested parties often refer to W. Louisville as a single entity, residents are more likely to identify with their specific neighborhood, such as Portland or Russell, rather than W. Louisville as a whole.
Various individuals and groups from U of L have, for many years, gone into W. Louisville to gather data for research purposes. While these efforts, for the most part, have been legitimate and in keeping with U of L’s mission to create new knowledge, some segments of the community see these efforts as “taking” or “exploiting” without any apparent benefit to the neighborhoods. The motives of U of L and individual researchers are not always trusted. Because of that historical background, there was consensus at the last meeting that the main emphasis of this Work Group will be to strategically plan service and intervention projects that can be implemented by SPHIS faculty, staff, and students, in collaboration with key partners. The emphasis will be on “helping” the community overcome health and related disadvantages, rather than answer primary research questions.
This emphasis is in no way meant to discourage existing or future research endeavors in the W. Louisville community. Rather, the intention is to prioritize outreach into West End neighborhoods as a way to contribute to that part of the Louisville Metro community.
Like all public health efforts, this endeavor should be data driven. Whatever service projects we initiate, we have to be addressing documented needs. Traditionally, public health agencies are guided by leading causes of death and disease. Those health problems impacting the greatest number of people often become priorities. The burden of disease is typically defined by headcounts. Within the Louisville Metro community, there is abundant data of this type, documenting morbidity and mortality as well as the prevalence of health risk behavior. Some of these data are only available for the city as a whole, not by neighborhood or census tract. At the county level, it is possible to analyze by race / ethnicity and socioeconomic status to produce a representation of some of the localized needs in W. Louisville. However, the W. End Work Group is suggesting priorities based on different criteria.
W. Louisville health disparities are significant and of dismaying proportions. For example, the infant mortality rates calculated by the Metro Health Department show the rates in W. Louisville are often double those of the city as a whole. The underlying causes for this and many other disparities are ecological: many factors come together, leading to these terrible health outcomes. Rather than taking a more traditional approach, selecting the worst of the disparities for intervention, based on morbidity and mortality data, the W. End Work Group is suggesting that priorities be based on upstream social determinants. Michael Marmot, Tom Friedan, and many other researchers and public health leaders suggest that the most impactful approach to improving the public’s health, especially in the long view, is to improve socioeconomic factors. While these factors are many, perhaps two of the most basic are educational success and full employment. For long term improvement of public health in W. Louisville, children and adolescents need to be successful in education, finishing high school prepared for higher education and technical training. In the adult population, most adults need to be fully employed.
In the past, education and employment have been seen as tangential to public health efforts: important things for which other agencies are responsible, but not direct concerns for public health. However, the Work Group is suggesting that SPHIS use education and employment as criteria to select and prioritize health problems on which to focus. In other words, the importance of health issues is determined not primarily by population prevalence, but by the impact they have on student learning and adult employment. For practical reasons mostly related to our size as an academic unit, the Work Group further recommends that youth education be addressed first, with adult employment receiving attention in the future.
Here is what this means. For long term improvement of health and quality of life in W. Louisville, SPHIS wants to help every child learn, to have educational achievement at the highest possible capacity. We intend to identify and describe the junction between this academic achievement and health issues. Using assessment techniques, we call for an inventory of the health characteristics that support high level academic success and the health problems that are the greatest barriers. Once these factors are recognized and understood, we will collaborate with the local and state education agencies and other health and human service agencies to address good health as an enabling factor for school success.
Some of these health factors linked to school success are well recognized, such as asthma, while others are not. The assessment process will include literature searching, interviews with key experts on this issue, analysis of concept documents published by professional groups such as the American Academy of Pediatrics and the American School Health Association. There will also be a need to analyze primary data: most schools have no systematic aggregation of absenteeism documentation, and don’t tabulate the illness reasons for children missing school. SPHIS may decide to develop a data system to capture this from the JCPS schools, making this part of the assessment process.
The approach recommended by the Work Group goes in the direction described above, meaning that other opportunities are going to be left behind. It is likely that some of the problems selected for attention will have a smaller prevalence or lower mortality than other health problems. Outcomes of our effort will be about targeted health improvement, as well as high school graduation, successful passage from grade to grade, decreased dropout rates, improvements of standardized testing scores, and so forth. Note that those educational outcomes are reliant on many more factors besides health. The intention is to assure that health barriers to education are removed. The strategic decision is to make investments in health to enable long term educational excellence. In the long term, educational advancement will then lead to broader improvements in health outcomes, including those not specifically addressed by SPHIS efforts.
The strategic steps for this process will include the following:
· Conducting a targeted assessment to identify health factors most closely related to education success and failure.
o Enlist faculty, staff, and students to complete necessary tasks
o Seek funding to support these efforts
· Identify and collaborate with relevant agency and community partners.
o As seems fitting, connect with Signature Partnership leaders
o Consider partnerships within the U of L community as well as partnerships with clinical providers and community agencies, including schools
o Engage partners through individual and small group discussions, town hall meetings
o Find service gaps that are attractive targets for SPHIS
· Plan and implement indicated interventions
o Seek third party funding
o Interventions might consist of education and social marketing, environmental surveillance, policy advocacy, and support from all SPHIS departments
· Evaluate and fine-tune initiatives to monitor and improve outcomes
o As feasible, delegate to masters and doctoral students as active learning assignments
· Disseminate reports and presentations on our successes (and failures)
o Form data analysis and writing teams to produce academic deliverable
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