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Teaching
Tools, Strategies, and Resources, continued
| Vignette
1: Improving the Health of a Multicultural Community |
A
team of your students has been asked to consult with a
local county health department on a project designed to
improve the health of the East Park Community. East Park
is a neighborhood within a major city that is nearby your
campus. The local health department chose to focus on East
Park because it has some of the worst health disparities
in the county, including high rates of morbidity and mortality
related to asthma, diabetes, violence, obesity, HIV/AIDS,
and breast cancer. Of particular concern are the increasing
rates of these problems in children, adolescents, and young
adults.
This
community was also chosen because of interest expressed
by the Mayor’s
office in involving law enforcement, schools, hospitals, churches, the university,
and other organizations in addressing the issues in this neighborhood. Local
youth and residents also had begun to organize to develop and advocate for
solutions to the violence and other health problems. Finally,
the community was chosen
because of its interesting mix of long-term residents, with an unusually high
rate of home ownership, and influx of first generation immigrants. The long-term
residents are African American, whereas the immigrants are Mexicans, Salvadorans,
Koreans, and Vietnamese.
The data
readily available show the following: Mexican immigrants
are the most rapidly growing population in East
Park and make up 30% of the population.
The remainder of the population consists of African Americans, 45%; Koreans
and Vietnamese,
15%; Salvadorans, 5%; and Caucasians, 5%. Many residents from all groups
live in poverty, whereas some of the longer-term residents
are working or lower
middle class. A high percentage of residents are employed, but lack employer-sponsored
health insurance and as a result are uninsured or have Medicaid. East Park
schools
are among the worst academically in the city and have high rates of violence.
High rates of unemployment exist among youth ages 17–24.
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Goals
- Improve
the health of the people living in the East Park community.
- Engage
diverse community partners.
The county health department
requested consultation on the following:
- What frameworks
and processes should the health department consider to develop
and implement a multifaceted strategy and
interventions
that address the major health problems and their root
causes?
- What
would the scope of possible interventions include?
- How should
the county health department engage and empower the community
in developing and owning priority problems
and solutions?
- How can
the county health department effectively partner with key local
organizations to develop
and implement solutions
that
address health care, mental health care, public
health, and community factors?
- How will
success be measured?
- What
are the key steps in the process you would recommend?
Faculty
Guidance
 The following
are suggested considerations and questions to guide faculty in
evaluating the approach developed
by the students.
The strategy
and process to analyze problems and develop interventions should
include, at a minimum, the following:
- An ethnographic
need and strength assessment to gather more and better data.
- Root
cause frameworks and concepts.
- Multifaceted
approaches that include health, mental health, public health,
and community
development interventions
and players.
- The community
and specific group involvement, empowerment, and capacity building.
- The
important role of social capital; and
- Community-wide
solutions that apply across multiple cultures as well as culture-specific
interventions.
- Is there
a structure in place to guide and oversee the process?
- Is there
acknowledgment of the cultural differences between these
groups, including but not limited
to, family and
kin structure,
formal and informal leadership
structure, income, language, religion, vocation,
gender roles,
etc.? Is there recognition
that the root
causes and problems may differ
significantly for each of these groups? Is there also an
acknowledgment
of
in-group variation?
What kind of an impact do all
these factors make on the strategic plan
and evaluation?
- Will the
process result in a written strategic plan and a
related action
plan?
- Are factors
related to immigration status, acculturation, and
changing economic
status adequately incorporated
into the plan?
- Is there
a plan to assess and address limited English
proficiency
and
literacy in the
native language or
in English?
- Is there
a sufficient plan for evaluation? Will it
include both
outcome and
process measures?
- Are
the tools and process strengths-based?
- Do the strategy
and process include community involvement
in setting
priorities and
developing solutions?
- Are
the solutions based on solid data,
including
data
about race,
ethnicity,
socio-economic
status and/or is there a
process for
tracking and linking
these factors to
health and mental
health status
and service
utilization over
time?
- Are partnerships
or coalitions
across organizations
formed and operated
using sound partnership
principles? (See Campus-Community
Partnerships
for Health).
- Is
there a strategy for youth empowerment
and capacity
building?
- Is there
a plan
for leadership
development
and change
management
among the
organizational
partners?
Is there
a plan
for these with
diverse
communities
and does
it take
cultural differences
into
account?
- Is there
a plan for community
empowerment
and capacity
building
for policy advocacy
to change
problematic
conditions?
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