Building Communities for Better Health

Community organizations are improving health equity by tackling the cycle of poverty in urban neighborhoods.

Growing Together, an organization in Tulsa, Oklahoma, is working to improve lives in the city’s Kendall-Whittier neighborhood. PHOTO CREDIT: GROWING TOGETHER

Carol Naughton recently took a group of visitors on a tour of an Atlanta neighborhood that her organization, Purpose Built Communities, has worked to transform from impoverished and blighted into a safer, healthier place to live.

They stopped in front of a school where kids were outside for recess, running around playing in the sunshine.

“I asked the group, ‘What do you see?’” Naughton recalls. “They said ‘a group of integrated kids, being joyful, and – oh my gosh – nobody is overweight!’”

As president of Purpose Built Communities, that is exactly what Naughton wants to hear. It means the organization is doing its job, partnering with local leaders to break the intergenerational cycle of poverty in urban neighborhoods across the United States. When that pattern is broken and quality of life improves, evidence shows, the health of the community improves as well.

“We’re focused on moving the health care needle outside of the health care system,” Naughton says. “Medical care is mostly sick care. We are keeping kids out of that process. Living in concentrated poverty is like breathing polluted air – the longer you do it, the worse it is for you.”

Her assertion is backed by multiple studies that show the adverse effects of poverty on health, including:

  • Life expectancy at age 40 increases continuously with income percentile. Most of that difference is attributable to health behaviors.
  • There is a gap in life expectancy of about 15 years for men and 10 years for women when comparing the most affluent 1 percent of individuals with the poorest 1 percent. For women, that is the same as the decrease in longevity from a lifetime of smoking.
  • Black people are, on average, at least twice as likely as white people to be poor or to be unemployed. Those disparities are reflected in their health: Black people ages 18-49 are twice as likely to die from heart disease than white people, and those ages 35-64 are 50 percent more likely to have high blood pressure.
  • About 1 in 5 (19 percent) black children and 1 in 6 (16 percent) Hispanic children ages 2-5 are obese. Obese preschoolers are more likely to be obese later in childhood and adolescence, which is associated with high cholesterol, high blood sugar, asthma and mental health problems. They also are 5 times as likely as normal-weight children to be overweight or obese as adults.
  • Families that make less than 100 percent of the federal poverty level have a 12.2 percent childhood asthma rate. That compares with 9.9 percent for families at 200 percent of the federal poverty level and 8.2 percent in families above 200 percent. The current poverty level is $25,100 for a family of four.

While these physical effects of poverty may be limited to certain ethnic, income or geographic groups, their impact can be felt throughout the U.S. economy, says Dr. Derek Robinson, an emergency medicine physician and vice president of enterprise quality and accreditation for Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma and Texas.

“There is so much to be gained from having a healthy, productive community,” Robinson says. “For example, a high-quality education is important in delivering individuals who are literate and prepared to make good, well-informed decisions regarding their health. Too many communities suffer a disproportionate burden of challenges spanning from broken schools, high unemployment, exposure to violence, and poor access to healthy food.  When a community can’t deliver young people who are physically, mentally and intellectually healthy and prepared for life and the workforce, you set the stage for a generation of unfulfilled potential.”

When that happens, he says, society must spend time and money addressing those health consequences, rather than investing in opportunities to enhance the health of the entire community.

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“While the magnitude of these problems are indeed daunting, the good news is that they are not reflective of simple misfortune but the outcome of systemic decisions and policies that we can address,” Robinson says. “Each of us has a role.”

Finding purpose

Purpose Built Communities took root in the East Lake neighborhood of Atlanta in 1995, then was formally established in 2009. Its hyper-local approach focuses only on a neighborhood within an urban area. It values the role of excellent schools, along with high-quality mixed-income housing and community wellness programs in its successful model.

These improvements, which can take years to implement, are guided by a “community quarterback,” which is a local organization that acts as the leader and convener for the work that needs to be done. To date, Purpose Built has engaged with partners to help 18 neighborhoods throughout the country with revitalization projects.

Living in concentrated poverty is like breathing polluted air.

Naughton says it is especially gratifying to see the effect on kids and knowing they can break the cycle of unhealthiness in their families.

“We opened a new school in 2001 and I would bet 90 percent of the kids were overweight,” Naughton says. “If you go back to that same school today, you won’t find anybody who has even five extra pounds. It is a dramatic change in kids’ health – and we never even had an anti-obesity program. What we did is make a lot of smart decisions that led to good health outcomes for our kids. We designed communities where people can walk to do things, kids can walk to school, they have physical education three times a week and recess every day. Lunch is a healthy meal – no more french fries and donuts.”

Growing Together

One of Purpose Built’s community quarterbacks is Growing Together, a local organization in Tulsa, Oklahoma, that’s focused on improving lives in the city’s Kendall-Whittier neighborhood, a 2.5-square-mile area of about 13,000 mostly Latino people.

As middle-class families moved out of Kendall-Whittier in the 1960s, the neighborhood became known for its adult entertainment. In fact, Kirk Wester, executive director of Growing Together, works in an office next door to what used to be an adult theater. He and his wife, Jania, decided to live in the area — to the bewilderment of their friends and family — after they got married 20 years ago.

Since then, they have watched the neighborhood undergo a major transformation. His group, along with other partners, are accelerating a movement that the community itself started many years ago, disrupting the pockets of poverty that led to vastly underperforming schools and a lack of affordable housing.

Growing Together was initially formed by a local community organization, CAP Tulsa, along with the Kaiser Family Foundation and the Tulsa Area United Way. It then formed the partnership with Purpose Built to put in a system for improvement that becomes more self-sustaining over time. It has formed relationships with housing partners and implemented programs to attract middle-income homeowners to the area, such as offering teachers at local schools money for a down payment.

Today, the neighborhood is working toward high-performing, highly desirable schools. Wester says one school improved from having just 18 percent of students reading at a third-grade level to 40 percent.

“Our primary focus — our mission — is to create plausible solutions for a large number of kids to break the cycle of poverty,” Wester says. “We need to empower this community to ensure they make their voices heard.”

In addition to deficits in housing and education, Wester recalls a time when Tulsa was largely underserved for health services. It had only one Federally Qualified Health Center to serve low-income patients, and there was little outreach specifically geared toward the predominantly Latino residents.  That has changed with the area’s new, state-of-the-art FQHC.

“We went from a community that was basically served by volunteer clinics to people now having a full medical home,” Wester says. “Our schools also have created partnerships with the medical services in town.”

Wester stresses that the success of a project like the Kendall-Whittier neighborhood lies in understanding what the residents themselves want and need, while leveraging the community’s assets. He recalls one project that included baseball diamonds in a revamped park near a local school. Nobody used them because baseball wasn’t a popular sport in the neighborhood.

“We brought in 20 Latino families to ask what they wanted — and they wanted soccer, not baseball. So, a multi-use court where they could play soccer was built. Now there are no less than 50 kids out there anytime school is out. And on the weekend, parents come out and set up tables to sell refreshments, and there are dozens of people on the track around the park while the kids play. It is a night and day difference.”

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