Project Overview
Pre-Planning Phase
On November 13th, 2015, the Regional Planning Commission of Greater Birmingham (RPC), in collaboration with researchers at the University of Alabama at Birmingham (UAB), responded to a call for proposals (CFP) from Pew Charitable Trusts and the Robert Wood Johnson Foundation. The CFP solicited applications from Southern States in the Appalachian region to conduct a health impact assessment (HIA). According to the World Health Organization, a health impact assessment “is a means of assessing health impact policies, plans and projects in diverse economic sectors using quantitative, qualitative and [community based] participatory techniques.” Furthermore, health impact assessments inform “communities, decision makers, and practitioners to make choices that improve public health through community design.”
In our application, we proposed to include a HIA in the City of Birmingham’s Framework Plans, and by developing a health report card for each neighborhood in the Birmingham city limits. The implementation of health impact assessments, in future framework plans, aims to integrate health in the early stages of city planning to promote population health and health equity. By February 2016, program officers at PEW informed RPC that we were awarded a $45,000 grant to conduct the first two of the six core stages of the health impact assessment: screening and scoping, which are pertinent to the planning phase of the HIA project. A month later, our HIA team attended a workshop at the PEW headquarters in Washington, D.C., where we received training, technical assistance, and peer learning to launch a HIA. The technical training consisted of a curriculum, which included topics such as leading and managing teams and cross-team collaborations, understanding the social determinants of health, and developing outcomes-based initiatives. The technical assistance, which we received throughout the eight-month planning phase, included tailored support and guidance to refine our HIA plan, and to build coalitions across key organizations. In addition, the technical training inherently involved peer learning and networking to share knowledge across other HIA grantees in the South.
In our application, we proposed to include a HIA in the City of Birmingham’s Framework Plans, and by developing a health report card for each neighborhood in the Birmingham city limits. The implementation of health impact assessments, in future framework plans, aims to integrate health in the early stages of city planning to promote population health and health equity. By February 2016, program officers at PEW informed RPC that we were awarded a $45,000 grant to conduct the first two of the six core stages of the health impact assessment: screening and scoping, which are pertinent to the planning phase of the HIA project. A month later, our HIA team attended a workshop at the PEW headquarters in Washington, D.C., where we received training, technical assistance, and peer learning to launch a HIA. The technical training consisted of a curriculum, which included topics such as leading and managing teams and cross-team collaborations, understanding the social determinants of health, and developing outcomes-based initiatives. The technical assistance, which we received throughout the eight-month planning phase, included tailored support and guidance to refine our HIA plan, and to build coalitions across key organizations. In addition, the technical training inherently involved peer learning and networking to share knowledge across other HIA grantees in the South.
Planning Phase
During the planning phase of the health impact assessment, we took a series of imperative steps to solicit input from stakeholders—including leaders of influential organizations and residents of Birmingham—to identify both the assets and barriers, in the community, that affect the quality of life for local residents. In an effort to solicit input from key stakeholders, we organized two meetings in August 2016 at the Edge of Chaos: one for leaders from non-profits and one for residents. We emailed invitations to recruit representatives from key non-profits and city government, and approximately 40 organizational stakeholders attended the meeting. However, the recruitment of local residents took more effort and community engagement. These efforts included attending 16 neighborhood association meetings during July and August 2016. We spoke to over 120 residents during these meetings, and we collected their contact information to invite them to a more formal stakeholder meeting. Before our meeting with residents, we called and mailed letters to all residents on our contact list to remind them about the meeting, and to assure them that their insights were imperative to our project. Furthermore, we provided transportation to the meeting for residents. The meeting was critical for identifying and prioritizing pressing health equity challenges at the neighborhood-level. The meetings created a space to promote health as a shared value, build community collaboration across stakeholders, and to cultivate a greater sense of community among residents.
The format of the organizational stakeholder meeting and resident meeting were similar. First, we hosted keynote speakers from prominent offices in the state and city. Then, we educated the community about the social determinants of health, and we also conducted a workshop, in which participants identified the assets and barriers in Birmingham (i.e., organizational stakeholders), and their neighborhoods (i.e., community residents) that had the most impact on health and quality of life. We were able to gain community buy-in for our work, identify important resources that organizations have agreed to share with our HIA team, and establish the social determinants of health that should be included as metrics in the health report card. Figure 1 and 2 below illustrates the social determinants of health that were identified by stakeholders. For the results of the Stakeholder meeting click the button below.
The format of the organizational stakeholder meeting and resident meeting were similar. First, we hosted keynote speakers from prominent offices in the state and city. Then, we educated the community about the social determinants of health, and we also conducted a workshop, in which participants identified the assets and barriers in Birmingham (i.e., organizational stakeholders), and their neighborhoods (i.e., community residents) that had the most impact on health and quality of life. We were able to gain community buy-in for our work, identify important resources that organizations have agreed to share with our HIA team, and establish the social determinants of health that should be included as metrics in the health report card. Figure 1 and 2 below illustrates the social determinants of health that were identified by stakeholders. For the results of the Stakeholder meeting click the button below.
Built Environment & Health
In the last two decades, sociologists and population health researchers, have advanced the theory that the quality of an individual’s health is not only influenced by proximate causes of diseases, such as diet, cholesterol level, and exercise (Link et al. 1995). Instead, health is also related to a complex web of lifestyles and behaviors (Cockerham 2010) that are situated in a social milieu that strongly shape individuals’ access to health and their health decisions.
There has long been a need and interest to understand why some groups and communities are more prone to poor health outcomes than others (Rosich and Hankin 2010). Hence, this quest for understanding ushered in a wave of empirical research that examined the relationship between more fundamental causes of disease, “such as knowledge, money, power, prestige, and beneficial social connections” (Phelan et al. 2010: S29). These vast “array of resources” are deeply embedded in “social, economic, and political structures of society (Phelan et al. 2010: S28), and inequalities are pervasive in these structures.
The health of an individual cannot be adequately analyzed without a comprehensive evaluation beyond the individual. A proper analysis also requires an evaluation of macro-level policy, such as the healthcare landscape, as well as meso-level factors, at the neighborhood-level (Rosich and Hankin 2010).
Public policy at the local level, or municipal level, has much influence on neighborhood level resources; especially via budget allocation and zoning policies, that shape health. Much can be done at the local level to implement “policies that target the physical and social infrastructures of disadvantaged neighborhoods by mitigating the conditions” and “stressors that negatively impact health” (Rosich and Hankin 2010: S7).
Exposure to stress and health deteriorating processes are more common in neighborhoods that are bereft of positive social assets. For example, Williams and Sternhal (2010: S20) point out that there are numerous pathways through which neighborhood residential patterns affect health.
The evidence is conclusive: the social environment plays a large role in health. Now, it is time to translate the empirical evidence into practice. Policymakers in Birmingham have heeded the call “to promote and implement policies that seek to eliminate or reduce the conditions in society that results in [health] disparities among groups” at the neighborhood level (Rosich and Hankins 2010: S27). Therefore, Shape Bham is embarking on feat to complete a Healthy Community Assessment Tool (HCAT) that will serve as a report card, and provide an evaluation of the social health of Birmingham’s 99 neighborhoods. Other cities, across the country, such as Minneapolis, MN, San Francisco, CA, and Charlotte, NC, have implemented similar assessments. Nevertheless, the initiative is still relatively novel, especially compared to other cohort cities throughout the Southeast.
References:
There has long been a need and interest to understand why some groups and communities are more prone to poor health outcomes than others (Rosich and Hankin 2010). Hence, this quest for understanding ushered in a wave of empirical research that examined the relationship between more fundamental causes of disease, “such as knowledge, money, power, prestige, and beneficial social connections” (Phelan et al. 2010: S29). These vast “array of resources” are deeply embedded in “social, economic, and political structures of society (Phelan et al. 2010: S28), and inequalities are pervasive in these structures.
The health of an individual cannot be adequately analyzed without a comprehensive evaluation beyond the individual. A proper analysis also requires an evaluation of macro-level policy, such as the healthcare landscape, as well as meso-level factors, at the neighborhood-level (Rosich and Hankin 2010).
Public policy at the local level, or municipal level, has much influence on neighborhood level resources; especially via budget allocation and zoning policies, that shape health. Much can be done at the local level to implement “policies that target the physical and social infrastructures of disadvantaged neighborhoods by mitigating the conditions” and “stressors that negatively impact health” (Rosich and Hankin 2010: S7).
Exposure to stress and health deteriorating processes are more common in neighborhoods that are bereft of positive social assets. For example, Williams and Sternhal (2010: S20) point out that there are numerous pathways through which neighborhood residential patterns affect health.
- Segregation restricts SES attainment by limiting access to quality education and employment.
- The residential conditions of concentrated poverty and social disorder can make it “difficult for residents to eat nutritiously, exercise regularly” and engage in recreational activities during leisure.
- Concentrated poverty, at the neighborhood level, can amplify financial stress and hardship and chronic and acute stressors.
- Poor neighborhood and community infrastructure can strain interpersonal relationships and trust among residents.
- Institutional neglect and disinvestment in neighborhoods that are already poor and segregated increases exposure to environmental toxins, poor quality housing, and crime.
- Residential segregation is linked to poor access to healthcare and elevated mortality and morbidity.
The evidence is conclusive: the social environment plays a large role in health. Now, it is time to translate the empirical evidence into practice. Policymakers in Birmingham have heeded the call “to promote and implement policies that seek to eliminate or reduce the conditions in society that results in [health] disparities among groups” at the neighborhood level (Rosich and Hankins 2010: S27). Therefore, Shape Bham is embarking on feat to complete a Healthy Community Assessment Tool (HCAT) that will serve as a report card, and provide an evaluation of the social health of Birmingham’s 99 neighborhoods. Other cities, across the country, such as Minneapolis, MN, San Francisco, CA, and Charlotte, NC, have implemented similar assessments. Nevertheless, the initiative is still relatively novel, especially compared to other cohort cities throughout the Southeast.
References:
- Link, Bruce G. and Jo C. Phelan. 1995. “Social Conditions As Fundamental Causes of Disease.” Journal of Health and Social Behavior 35(Extra Issue):80–94.
- Cockerham, William C. 2010. Medical Sociology. Upper Saddle River, NJ: Pearson Education.
- Rosich, Katherine J. and Janet R. Hankin. 2010. “Executive Summary: What Do We Know? Key Findings from 50 Years of Medical Sociology.” Journal of Health and Social Behavior 51(1):S1–9.
- Phelan, Jo C., Bruce G. Link, and Parisa Tehranifar. 2010. “Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications.” Journal of Health and Social Behavior 51(1):S28–49.
- Williams, David R. and Michelle Sternthal. 2010. “Understanding Racial-Ethnic Disparities in Health: Sociological Contributions.” Journal of Health and Social Behavior 51(1):S15–27.