PROVIDENCE – When ConvergenceRI sat in on the city’s Healthy Communities Advisory Council meeting on March 26 at the Lifespan Community Health Services offices on Prairie Avenue, it was much like walking into the middle of an ongoing conversation, a work-in-progress, a convergence, in the development of a new kind of community-building toolkit focused on neighborhood-level health.

First, there were details of a $368,000 Health Equity Zone grant that Providence's Healthy Communities Office had been awarded in April by the R.I. Department of Health as the lead agency in a collaborative effort, one of 11 such grants statewide.

Ellen Cynar, program manager at the city’s Healthy Communities office, briefly walked through what the objectives of the Health Equity Zones were during the first-year’s efforts, targeting the creation of a recreation action plan, focused on bolstering programs at the city’s nine recreation centers, parks and community centers, and in supporting what Cynar termed “green infrastructure” in a half-mile radius around the recreation centers.

The plans include a diverse, neighborhood-based approach to strategies that leverage the city’s ability to improve health: increasing the options for healthy food and beverages at recreation centers, identifying opportunities for community gardens, conducting lifestyle self-management programs in partnership with Clinica Esperanza, and developing a multigenerational approach to recreation programs.

In addition, the Health Equity Zone will include non-violence training with the Institute for the Study and Practice of Nonviolence. It will also be focused on creating smoke-free environments and in reducing youth access to tobacco. Cynar cited the city’s new tobacco-free city parks ordinance, which went into effect on March 11.

New tools on the block
The Health Equity Zone conversation converged nicely with a discussion of efforts now underway as part of Providence’s membership in what’s known as the Healthy Communities Transformation Initiative.

Providence is one of four cities selected to be part of a pilot project, the Healthy Communities Transformation Initiative, funded by the U.S. HUD’s Office of Healthy Homes and Lead Hazard Control. The other cities participating are Albuquerque, N.M., Minneapolis, Minn., and San Diego, Calif.

The goal, according to the website, sketched in broad brush strokes, is “to improve the health systems, and the physical, social, and economic service structures that support healthy living and healthy behaviors in our communities.”

To support that work, two key evidence-based tools are being developed: what’s known as a Healthy Communities Index and a Healthy Communities Assessment Tool.

The Index enables communities to identify baseline conditions, prioritize investments and evaluate progress in achieving goals, focused on 10 domains: educational opportunities, economic health, employment opportunities, environmental hazards, health systems and public safety, housing, natural areas, neighborhood characteristics, transportation and social cohesion.

Those 10 domains have been translated into 37 core evidence-based community health indicators, five demographic and contextual measures.

In work being coordinated by Peter Asen, director of Providence’s Healthy Communities office, a website has been created to input the data, by city neighborhood, into the indicator categories. Asen displayed the work-in-progress of the Providence Healthy Communities Transformation Initiative website at the meeting.

Equally important in the process is developing the metrics to measure and evaluate what the neighborhood-level health factors mean. This information takes on new significance as a result of the requirement under the Affordable Care Act for hospitals to conduct community-based needs assessments, raising the potential of partnerships with Lifespan, Care New England and CharterCARE.

Toward that end, Dr. Rajiv Bhatia of The Civic Engine and Noreen Beatley of Healthy Housing Solutions gave a show-and-tell presentation on the potential uses of the database, the website, and the assessment tool.

Not reinventing the wheel
In developing a set of core indicators, Beatley said it was important not to try and recreate the wheel, to develop indicators that any community could use, and to identify strong evidence indicators.

“The indicators don’t look at outcomes, but at the central economic and social determinants of health,” Beatley said. “Access to food, access to transportation, affordable housing; the idea is to look at indicators at the neighborhood level, where they can be actionable.”

Beatley praised Providence for its rapid pace of work, despite the fact that the city joined the project and signed an MOU in December of 2013.

Bhatia, who had helped create health indicators for San Francisco in 2004 and 2005, in what then became the gold standard for health indicators, talked about the importance of measuring data at the neighborhood level, explaining that in San Francisco, there was only one federal air quality monitor, and it was far removed from most of the traffic flow.

As a result of developing different data sources, San Francisco was able to map health indicators for poor air quality, and then to use that information to create some actionable solutions: new housing in the areas that were shown to have poor air quality were required to install high-quality ventilation systems.

The visualization of the data into maps also proved to be an important tool, according to Bhatia.

A continuing conversation

The next meeting of the Healthy Communities Advisory Council will take place on May 28, with the location planned to be at a recreation center in Providence.