Thinking about the Social Determinants of Health

Dr Crook EditedAt the end of November 2017, Dr. Errol Crook, Director of the Center for Healthy Communities and the Abraham Mitchell Chair of Internal Medicine at the USA College of Medicine, gave a presentation during Internal Medicine Grand Rounds on “The Social Determinants of Health: A Focus on Poverty.” Dr. Crook started by saying that he wanted to talk more about public health than focusing on one patient. Through the presentation, he explored:

  • Health equity and health disparities
  • Discussed socio-cultural determinants of health in the U.S. (and the world)
  • Reviewed the impact of poverty on health
  • Examined the importance of understanding how social factors may impact care of individual patients

Poverty in contextIn the discussion on poverty, Dr. Crook explained the importance of context and understanding that

  • Having an income does not remove the risk of poverty
  • Wealth and income are different as a person may have income but not the accumulated wealth to cover emergency expenses such as unforeseen health issues
  • People living in poverty usually work many hours and many jobs.

In other words, for people living in poverty or near it, health care and education costs are discretionary expenses. They have to decide between buying medication or seeking care and paying for gas to get to work.

With that background, he introduced two projects from the Center for Healthy Communities. First, The Impact of Labor Force/Labor Market Status On Access To Health Care with Dr. Kenneth Hudson as Principal Investigator explored the relationship between job types (good job, mediocre job, or bad job) and health. The study looked at a random sample of households in census tracts in Mobile, AL, with at least 50% of residents living at or below the federal poverty line. Dr. Hudson and his team found that

  • 91.5% of respondents were working
  • The majority of respondents were in bad jobs — those without health or retirement benefits and paying poverty wages
  • The participants spent a large percentage of income on basics such as rent and utilities
  • For those who did not acquire a job with health insurance or retirement benefits before the age of the 30, the most likely never would.

Dr. Crook also talked about the importance of data from The Sentinel Surveillance to Monitor Progress Towards Health Equity with Dr. Martha Arrieta as Principal Investigator. Given the difficulty of obtaining good information on the health status of individuals living in low-resource areas, the project used a sentinel surveillance approach to choose data collection sites that intersected with the daily lives of residents in three high poverty zip codes in Mobile, AL. The research produced a lot of information on the number of people below the age of 65 reporting having chronic diseases such as diabetes and high blood pressure. Dr. Crook emphasized that 68% of those responding to the survey felt that diabetes would result in severe complications regardless of what treatment or lifestyle changes a person underwent.

Dr. Crook closed his presentation by drawing together the threads of social factors, income and wealth disparities, employment status, and attitudes toward health into a single pattern focused on an individual patient and her health needs. He asked those attending to think about the patient’s future prospects based on what her educational and socio-economic status were. He encouraged those working in the clinics to think about these issues as they worked with individuals.

View Dr. Crook’s presentation online.


APHA Reflections: Lynette Parker

Lynette croppedFrom November 5 to 7, 2017,  members of the Center for Healthy Communities Research Core attended the American Public Health Association’s Annual Meeting and Expo in Atlanta, GA. Below, Ms. Lynette Parker, research assistant,  shares some thoughts on her first time attending the APHA meeting.

In general, what was your impression of the event?
APHA was huge. Choosing sessions to attend was difficult due to the diversity of subject matter and approaches. I ended up in sessions on community-based participatory research, violence, exercise, and big data. It was definitely a trove of information and learning.

Tell us about one session or activity that stood out to you?
A couple of things stand out to me. First, I attended a session titled “COmmunity voices: Community member perspectives on community-academic partnerships and CBPR.” Each of the presenters focused on the work of their partnerships and the findings from their research. The final presentation “Research Ethics in the Time of Crisis” really stood out to me as the presenter discussed the development of a Community Ethics Review Board in Flint, Michigan, following the water crisis.  In my opinion, the presentation — and work it is based on — offers an important example of how a marginalized community can have a voice in determining community direction and the research that is conducted within its boundaries.

A second experience was presenting the Research Core’s poster on its process for involving community members in the planning process for disseminating the findings of the Sentinel Surveillance Project. The conversations with others working on community-engaged projects were enlightening. I had a long conversation with a researcher from North Carolina who was doing work with Adverse Childhood Events in North Carolina. We talked about different ways of bringing community members more into projects so that they can help improve the research and interventions.

What are some lessons you learned at APHA?
I don’t know if it was a lesson learned or more of one reinforced, but the many sessions that I attended solidified the importance of community engagement in my mind. From a big data social media project to the Community Ethics Review Board to the improvement of an exercise intervention after user feedback, many of the sessions I attended pointed to the need to learning from those we are working with.

Is there anything else you would like to share about your experience?
APHA was very informative if a little overwhelming. It was good to get feedback on the work we are doing.

CHA Led Project: Learning about Nutrition and Gardening

IMG_1504On October 30th, Community Health Advocates (CHA) Bo and Sheena Williams hosted an event promoting gardening at the Taylor Park Community Center and Garden. The event started with a talk from Bo Williams on the history of gardening in the African American Community. This was followed by a lunch and a day in the garden. Children at the Taylor Park Center helped construct raised beds that are easily accessible for senior adults.

Learn more about the CHA program and activities.

HDRG Recap: Building Community Based Research through Community Coalitions

DannyEditedAt the November 2017, Health Disparities Research Group (HDRG) meeting, Danny Patterson, Coordinator, Collaborations and Partnerships, Gulf States Health Policy Center (GSHPC), shared about their experiences with coalition building to work for improving health outcomes. Working in 5 states (Alabama, Florida, Mississippi, Louisiana, and Texas) GSHPC united with community members, partner organizations, and service providers to form coalitions including 130 multi-sector community organizations in the states of Alabama (cities of Bayou La Batre, Mobile, Birmingham) and Mississippi (cities of Hattiesburg and Gulfport/Biloxi) and Louisiana via LSU in Baton Rouge. Coalition members represent a range of groups including faith-based organizations, government, education, primary care, mental health, housing, academia, public health, business, law enforcement, and other community-based organizations. GSHPC works with both local and national partners in their work. The work is supported by the National Institute of Minority Health Disparities.

With a focus on health policy research that leads to positive change, the coalition building process included three basic phases: member recruitment, development of strategic partnerships, and training of coalition members. Activities taking place throughout the process include community information meetings, coalition member recruitment, policy focus area identification, subject matter expert presentations, community forums/policy scans, literature reviews, community action plans (in development) and action plan implementation. The goal is to “empower communities and increase their capacity to improve health outcomes.”

The local coalition is currently working in 3 policy areas: health literacy, financial literacy, and educational literacy.  In terms of health literacy, the coalition is working on local practice or policy change by creating pathways for data sharing between Ozanam Charitable Pharmacy and Mobile Board of Health Clinics. The current research pilot, designed by the coalition, will recruit 50 diagnosed diabetes patients (as of November 6, 31 had been recruited). The two organizations serve mostly low-income and homeless individuals. The process under study will facilitate the sharing of information for the participating patients in order to provide more holistic care. To date, lack of transportation from the clinic to the pharmacy has been identified as one of the problems that will need to be addressed. The study will evaluate whether or not the increased communication between pharmacy and doctor translates into improved care and disease medication management for the patients.

During the question and answer phase of the HDRG meeting, Danny stressed the importance of transparency and open dialogue to build the coalition. Such an approach — a willingness to give a little while building something greater — helps develop the relationships needed to develop a healthy and impactful coalition.

Along with projects related to policy, the GSHPC coalition focuses on building community-based leadership capacity. This capacity is critical for sustainable once funding for the projects are over. The built capacity for local leaders to continue the policy work is essential for continued progress toward health equity.

Learn more about the Gulf States Health Policy Center.
Learn more about the Health Disparities Research Group.

APHA Reflections: Marcellus Hudson

Marcellus APHA_smallFrom November 5 to 7, 2017,  members of the Center for Healthy Communities Research Core attended the American Public Health Association’s Annual Meeting and Expo in Atlanta, GA. Below, Mr. Marcellus Hudson, research technician III,  shares some thoughts on his first time attending the APHA meeting.

In general, what was your impression of the event?
I  was impressed by the number of people in attendance. I felt welcomed in the first session I attended. I, also, felt like everything was organized.

Tell us about one session or activity that stood out to you?
The session that stood out to me was the Black Caucus of Health Workers. This session stood out because I wasn’t aware of an organization that focuses on recognizing the health care needs of Blacks in America. They explained their organization’s history and why it was formed. I was told that it was one of APHA’s oldest organizations.

What are some lessons you learned at APHA?
I learned the difference between the Public Health field and Medical field. I understand that the Public Health field is focused more on populations while the Medical field is focused more on individuals. I  learned about effectively using social media to engage your audience by utilizing tools like HootSuite and Buffer.

Is there anything else you would like to share about your experience?
It was an amazing experience and I look forward to next year’s!


CHA Led Event: 6th Annual Rainbow Cancer Walk-a-Thon

event_editedOn October 27, 2017, Revelation Missionary Baptist Church held its 6th Annual Rainbow Cancer Walk-a-Thon. Started by Community Health Advocate Mrs. Gloria Carter, the event offers an opportunity for participants to memorialize the lives lost to cancer, celebrate cancer survivors, and learn more about different forms of cancer. After opening in prayer, Walk-a-Thon participants walked around the church’s life center.
Cancer education was provided by representatives of the Mitchell Cancer Institute. Mobile’s Azalea Trail Maids came out to show their support.

APHA Reflections: Naima Wells

Naima_smallFrom November 5 to 7, 2017,  members of the Center for Healthy Communities Research Core attended the American Public Health Association’s Annual Meeting and Expo in Atlanta, GA. Below, Mrs. Naima Wells, research coordinator,  shares some thoughts on her first time attending the APHA meeting.

In general, what was your impression of the event?
Although, APHA was a large event it felt inclusive and interactive through the use of the APHA app and social media. Overall, it was well organized and well managed.

Tell us about one session or activity that stood out to you?
One session that stood out was “Qualitative Research & The Arts: Translating Results Into Action”. Through a CBPR partnership with youth in the community and the session presenter, an art-based youth driven conceptual model was used to present qualitative data that expressed the voice and lived experiences of the community. It also helped to contextualize the data. The youth would create drawings, poems, rap songs, or other creative mediums to share findings with the community and government officials. One interesting component was the media campaign to present positive imagery of young black males by taking “mugshots” of the young men in a cap and gown holding a sign that displayed their career goals.

What are some lessons you learned at APHA?
One lesson I learned is how public administration and public policy factor into the social determinants of health and health equity.  Typically, public administration focuses on effectively and efficiently achieving public policy goals through administrative systems, insomuch there are some areas that interrelate to public health concerns.  I also learned that as a public administrator, I could address some of the challenges and opportunities in population health and health equity through a policy framework.

Is there anything else you would like to share about your experience?
The “Industry Expert Theater” was very informative and effective considering each presentation was very short lasting approximately 15 minutes each. I also, appreciate that there are opportunities for free training offered by ChangeLab Solutions on public health law and policy.

CHC Represented at APHA 2017

Four members of the Center for Healthy Communities Research Core attended the American Public Health Association (APHA) Annual Meeting and Expo in Atlanta, GA during early November.  Along with learning from the diverse sessions and experiences offered by the event, the team presented two posters related to the Sentinel Surveillance to Monitor Progress Towards Health Equity Project (Sentinel Surveillance).

Arreita Poster Cropped smallDuring the session “Recent Studies on Health Disparities in Public Health Epidemiology,” Dr. Martha Arrieta presented a poster that discussed a comparison between data provided by the Sentinel Surveillance methodology — primary data — with small area estimates (SAEs) based on the Behavioural Risk Factor Surveillance System (BFRSS) and Census data. Titled “Can we sharpen the focus? Small Area and Sentinel Surveillance Estimates for a Health Disparate Population, “ the poster provided a comparison of both types of data from the focus area for the Sentinel Surveillance project with a review of the estimates for the prevalence of diabetes, high blood pressure, asthma, stroke, cancer, and kidney disease as well as the proportion of persons lacking health insurance. The analysis showed that while the SAEs pinpoint geographic areas of health inequity, the SS sample provides age-specific estimates and can further delineate person-level characteristics useful to focus and tailor health equity interventions.

Lynette poster cropped smallIn the session “Diversity and Dynamics in CBPR Partnerships and Coalitions,”  Lynette Parker presented an overview of the team’s dissemination planning process developed to ensure that Sentinel Surveillance findings are communicated to the community in a useful manner. Titled “Returning what was given: Communicating research findings in the community,” the poster provided a description of the engagement process used to include three distinct community voices into the dissemination planning process: 1) the Community Advisory Board consisting of community leaders who had advised on the project from its inception; 2) Research Apprentices who had been recruited and trained to collect data for the Sentinel Surveillance project as well as conducting other important tasks on the project; and 3) Community Health Advocates who had been involved in various projects through the Center for Healthy Communities Community Outreach Core. The presentation highlighted the importance of listening to diverse community voices in developing an effective dissemination plan.

The three days spent at the APHA Annual Meeting were fruitful and informative. Staff reflections on the event will be posted in the coming weeks.






Partnering to Make a Difference


Hodnett and Free_edited
CHA Barbara Hodnett with Mr. Clint Free from Trinity Family Ministries

Recently, the Center for Healthy Communities (CHC) formed a partnership with Trinity Family Ministries to provide health education services during the organization’s annual Fall Festival and Health Fair. Through the partnership, Community Health Advocates (CHA) will teach participating youth about container gardening as a way to improve nutrition.


The partnership idea originated with a suggestion from Mr. John Jones, a member of the Sentinel Surveillance project Community Advisory Board. Through that connection, Dr. Martha Arrieta and Ms. Candis Patterson from the  CHC met with Mr. Clint Free, Coordinator of Community Development with Trinity Family Ministries to discuss ways in which the two organizations could partner. The result was CHA participation in the November 18th health fair. To learn more about the event, download the Fall Festival and Health Fair flyer.

Connecting Regionally: The UAB Community Engagement Institute Livestream



On Friday, October 6, 2017, as hundreds of community members and researchers gathered in Birmingham, Alabama, for the 4th Annual Community Engagement Institute (CEI), a smaller group gathered at the University of South Alabama (USA) Faculty Club to participate through a combination of livestreaming and in-person, interactive sessions. Dubbed the “USA CEI livestream”, this unique event came about through the Regional Community Engagement initiative of the UAB Center for Clinical and Translational Sciences of which USA is a partner. The goals of the event were 1) to test a method for expanding the ability of regional partner institutions to participate in a large event from a distance, 2) to bring the CEI experience to USA’s research and community partners. The 22 individuals attending the event in Mobile watched a livestream of keynote speakers Dr. Errol Crook and Ms. Diane Bell McKoy. Through the Twitter hashtag #CEI2017, the Mobile attendees were able to ask questions of the speakers and connect with the events in Birmingham.

ArrietaDuring the breakout sessions, the Mobile site offered two presentations on community-engaged research. The first presenter, Dr. Martha Arrieta, provided an overview of the research apprentice concept as a new model of peer research. In doing so, she described the contributions of research apprentices to the Sentinel Surveillance Project, the benefits of the experience for apprentices, and the potential for future development. 

The second breakout presentation, by Naima Wells and Lynette Parker, told the story of engaging community members in planning for dissemination of the Sentinel Surveillance Project findings in the community. After an introduction to the project, they discussed the process of developing a framework for engagement, identifying key advisors for the planning purpose, and the methodology for ensuring community voices were heard and incorporated into the work.

Hanks_editedThe two presentations were followed by a discussion led by Dr. Roma Hanks. The dialogue focus was driven by the interest of attendees who sought first to learn more about the research apprenticeship and ways to make it become more formalized.  As the discussion evolved the participants sought to identify meaningful ways to expand community-engaged research to address community problems and identify opportunities to expand scholarly efforts. The discussion was followed by a networking lunch.

By providing the livestream with local activities and networking opportunities, the UAB CCTS in conjunction with the USA Center for Healthy Communities and USA Office of Research Development and Learning worked together to develop the regional engagement strategies. The goal is to continue developing strategies to further connect communities and researchers in the state and region.