In Your Neighborhood

A shot in the arm for community health, prevention

New funding will expand CHEW programs and launch a series of Health Equity Zones

Photo By Richard Asinof

Sharon Wells, West Elmwood Housing Executive Director, left, and Rachel Newman Greene, director of Partnerships and Community Projects, at the opening of the new community gardening space that is part of the Sankofa Initiative. New funding to promote prevention and community health will be expanding these programs in Rhode Island.

By Richard Asinof
Posted 10/6/14
New investments are being made at the front-end of Rhode Island’s health care system, focused on creating healthier communities through prevention. The new community-focused Health Equity Zones will expand the pioneering work of the R.I. Department of Health’s Centers for Health, Equity and Wellness programs. The four-year, roughly $4 million program puts the emphasis on collaboration at the community level.
In addition, the additional $3.9 million in new funds for Providence’s lead abatement program will support the building or renovation of 250 safe, healthy and sustainable housing units.
When will the community-based investments in health, nutrition and prevention become an integral part of the state’s economic development priorities? When will the kinds of health innovation represented by these investments become part of a map of health innovation in Rhode Island? Which candidate running for governor will be the first to champion such programs as a way to grow healthier communities and create jobs and lower costs – to manufacture better, healthier communities? How will these new initiatives connect with the Rhode Island Alliance for Healthy Homes? And the new effort to develop clinical guidelines for toxic stress in children?
In terms of community health in Rhode Island, one of the biggest changes for the better is the new, stricter regulations for prescription painkillers. Effective Monday, Oct. 6, the prescription painkiller hydrocodone – the most popular pain medication prescribed in Rhode Island, often under the brand names of Vicodin and Percocet, will be reclassified as a Schedule II medication. There were about 22 million doses filled in 2013, according to health agency officials.
Under the new classification, stricter regulations have been put into place:
•The prescription cannot have refills.
•The prescription is not valid after 90 days
•A verbal prescription is allows only in emergency situations and a written prescription must follow within seven days.
•Faxed, original prescriptions are only allowed for home infusion pain therapy, long-term care facilities, and hospice/terminally ill patients.
•The quantity is limited to a 30-day supply.

PROVIDENCE – Community health and prevention just got a big shot in the arm in Rhode Island – some $3.5 million over the next four years – to expand the work of the Centers for Health, Equity and Wellness [or CHEW] programs at the R.I. Department of Health.

The money, which is targeted to reduce chronic diseases, promote healthier lifestyles, reduce health disparities and control health care spending in Rhode Island, is being administered through the Centers for Disease Control and Prevention.

The program, which is being financed through the Prevention and Public Health Fund that is part of the Affordable Care Act, is one of 21 new grants awarded to states and large-city health departments to focus on prevention of obesity, diabetes, heart disease and stroke – and to reduce health disparities among adults through combined efforts of communities and health systems,

The emphasis is on prevention and health at the front end of health care – and on communities, not just agencies.

At least half of the money will go to local communities to support place-based initiatives, according to Ana Novais, the executive director of Health at the agency, overseeing the Division of Community, Family Health and Equity.

Novais told ConvergenceRI that the infusion of new funds would enable the agency to issue a request for proposals for “Health Equity Zones” – a broader vision of the CHEW programs, with more of a geographic focus, in the coming weeks.

Among the community programs that are currently being funded under CHEW include:
•The community garden initiative to create some 10,000 square of community gardens in the West End of Providence, led by the West Elmwood Housing Development Corporation.
•The statewide expansion of the Ready To Learn Providence to better train childcare professionals and parents about brain development and the core competencies of an emotionally and socially healthy person.

The priority populations to be served under the new grant are those people with racial/ethnic or socio-economic disparities, including inadequate access to health care, poor quality of health care, or are low-income.

“This is the next generation of CHEW grantees,” Novais explained. “Instead of funding an organization, we will be funding community collaborations to do the same kind of work.” The aim is to act on the community level, and not just at the agency level, according to Novais.

As part of the RFP, the communities will have to identify the issues and the community’s strengths and challenges. “They need to let us know what the issues are that they want to address,” she said.

In each proposed community Health Equity Zone, Novais continued, “We want to know what every single member of the collaborative will be doing, who the community leaders are, the specific contributions, and the common goals.”

Novais said she hoped to have the RFP issued within the next two weeks. Respondents would then have about four weeks to submit a proposal, to share what their ideas are. The agency will review the initial proposals, meet with the applicants, and then invite full proposals. “I hope to have contracts in place by March 1,” she said.

An engaged community
Through the creation of Health Equity Zones, the communities’ voices will be better heard – and become engaged, healthier communities, according to Novais.

“It is a two-pronged approach,” she said. “We are working with communities to help them clearly identify the health issues that matter to them – and to advocate and implement plans of action to address those issues.”

The focus on chronic disease, Novais continued, will be on implementing evidence-based programs to maintain a healthy lifestyle – to bring diabetes, heart disease and obesity under control.

“When people enter the medical system, seeking health care, they are being treated for an acute episode,” she said, drawing the distinction about how the money is being invested. “The community is there with the resources to sustain that person staying healthy.”

At the same time, Novais expects that the new Health Equity Zones will build relationships, linkages and collaborations with existing clinical health care delivery facilities and programs, including community health centers, community health teams and home visiting programs.

“Achieving the best preventive health care is vital to successful health outcomes,” said Dr. Michael Fine, director of the R.I. Department of Health, talking about the partnership between primary health care providers and the new initiative. “Through community-based public health efforts that support intensive and sustained interventions that include health care settings, together we can improve population health outcomes.”

Fine connected the dots between preventive health in the community, better health outcomes, and lower health care costs. “In this country, chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death, disability, and health care costs, accounting for 7 of 10 deaths among Americans each year, and more than 80 percent of the $2.7 trillion our nation spends annually on medical care.”

More good news
The city of Providence was awarded $3.9 million last week from the U.S. Department of Housing and Urban Development to remove the hazards of lead paint from residents’ homes.

The new grant will be used by the city’s Department of Planning and Development to support building or renovation of 250 safe, healthy and sustainable housing units in Providence.

Over the past 15 years, lead paint hazards have been addressed at some 1,500 housing units in Providence through HUD’s lead abatement program, according to Providence Mayor Angel Taveras. “These additional funds allow us to continue the work to improve the well-being, educational potential and life prospects of all residents,” Taveras said.


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