Use it or Lose it!

High Point Residents watch the actions from the 'bumping space'

I attended the High Point Community Health Fair in West Seattle on Friday. Much to the relief of the organisers (and to me...we have had a lot of rain of late...) - it was a gloriously sunny day which resulted in a great turn out from the community. High Point is a very diverse community and it was great to see so many people from different backgrounds working and mingling together.

The Health Fair was held at the High Point Centre where I'd visited earlier in the week to learn about the 'Be Active Together Project' (not to be confused with 'Altogether Better'...but has some things in common...which I'll come back to in a later blog).  The High Point Centre is, "a home for anti-poverty services that strengthen local families and support the development of a healthy, vibrant and green community” (see their website for more) and the health fair was a real hive of activity!

There was a ‘Healthy Food Walks’ encouraging people to explore the neighbourhood to find places they could access healthy foods including impressive looking produce from local market garden, a range of stalls and information from community groups and service providers, acupuncture sessions and physical activity sessions of all kinds.

There were also demonstrations from local community groups, including a line dancing session from the Providence Elizabeth House (PEH) Line Dancing Group. PEH is an independent residential facility for seniors and I got chatting to Charlotte and Kay who live at PEH and are committed members of the Line Dancing Group. Charlotte and Kay were proud of the Line Dancing Groups slogan,  “use in or lose it!”, emblazoned on their bright blue t-shirts. They dance once a week and visit other residential facilities for seniors, to demonstrate their dancing skills and encourage others to join in. Kay told me how much she valued the class, “I love it. I would do it every day if I could.”

Both Kay and Charlotte have lived in High Point for 5 years and seemingly love it - they told me a little more about why...

Charlotte and Kay from the PEH Line Dancing Group
and happy High Point residents.

Charlotte told me how residents of PEH came from all over the world, and whilst some of them did not have English as a first or second language, they all got along – as Charlotte said, “we have times when we sit and we share our stories and our histories...so we learn about where people have come from and how they live their lives…it’s really interesting and helps us understand one another.” She grinned as she added, “We are friends despite our differences.  We hug each other a lot…”…and I guess you can hug in any language.

Charlotte also pointed to the 'bumping space' and the small amphitheatre on the grass outside of the High Point Centre. She told me this was where people met to sit and chat or watch some local perfomance or activity. It's just across from PEH so is a great, yet very simple, facility for the residents and other community members.

Seems High Point is a community residents of PEH enjoy living in - and that the line dancing keeps them active, keeps them engaged, allows them to socialise and meet new people and seemingly helps keep them happy! Physical activity and social capital rolled into one….

A great day and some lovely, lovely people! :)

Food for thought…

Without wanting to state the obvious – access to food is an essential element of health and well-being. Lack of adequate food impacts on both our short and long-term health and also effects children’s psychosocial development and learning (Communities Count: Social and Community Indicators Across King County (2008).

In a 2007 survey, up to 8.2% of adults in one area of King County reported that they often or sometimes ran out of food and did not have money to purchase more. The same survey found that 8.4% of King County adults could not always afford to eat balanced meals (in Seattle the rate was 10.8%). (Figures from: Communities Count: Social and Community Indicators Across King County (2008), King County Public Health Department)

Seattle has a number of food banks which seek to address the issue of food insecurity. The number of King County residents who rely on food banks in order to have enough food for themselves and their families is not known but one programme, King County food banks, served 110,292 households and 215,941 people in 2007. These families used food bank services an average of 7.2 times during the year (Figures from: Communities Count: Social and Community Indicators Across King County (2008), King County Public Health Department).

I visited one Food Bank South of the city , in Auburn, to see what went on.



Debbie Christian, Director of Auburn Food Bank, WA.



Debbie Christian is the Director of the Auburn Food bank which serves around 2, 100 homes which equates to around 8,500 people each month. Auburn has a very diverse population of around 68,000 and also has the lowest income per capita in South King County. Auburn also has the highest teen pregnancy rate and the highest rate of single parents in the County.  As you might expect, there are also a large number of agencies serving the community but Debbie described the food bank as the “first line of defence for those in need”. They act as a hub for referrals from and to other agencies as many of the people accessing the food bank have multiple issues they may need support or assistance with.

Talking to Debbie about the Food Banks history – I realise Auburn Food Bank originated as a result of social capital in a community. It began as the Auburn Community Chest, an organisation set up after a family home was burned down in the 1930’s and local people got together to help rehouse the family and provide replacement furniture and furnishings. The Community Chest continued to provide furniture and resources to families in need until making a decision to focus solely on food provision.

I asked Debbie about how people accessed the Food Bank and she explained that the only criteria is that they must live in Auburn, “All that is required is proof of an Auburn address”, (an exception is made for homeless people who do not need to provide this). Access to the food bank provision is not means tested as, as Debbie said, “we work on the basis that if people turn up it’s because they need to and they’re hungry – I don’t believe people would choose to visit a food bank if they had a choice – it’s a matter of pride and dignity”.

People can access food packages twice a month. Packages are made up of tinned fruit and vegetables, rice or grain, bread products. 90% of the food is donated from a regional food bank supplier and the rest from local grocery stores and people in the community. Often times the food packages will include other personal care items such as soap and toilet paper – as Debbie said, “if you can’t afford food – you’re not going to be buying soap or personal hygiene products and we know it’s important for people’s self-respect and self-esteem that they can look after themselves and start the day ‘fresh’…especially if they might be looking for work or whatever.”

Food Bank Vounteer Sandy -
sorting food and making up packs.

The food bank has a large number of volunteers and relies on around 20 volunteers each day to function. On the day I visited, volunteers were hard at work on the front desk, bagging and packing food in the kitchen, unloading newly arrived produce off the van, and handing out the surplus food out front (food that needs to be taken and used that day) - it was a real hive of activity and energy! I asked about the food bank  volunteers and Debbie explained that, many had been with the organisation for a long time and gave a huge committment and that Auburn has, “a lot of loving caring people who say they’ll take care of their own.”

In addition to the direct food provision, the food bank also provides:

·         Two Community Dinners each week and a number of lunch programmes.

·         Two food delivery programmes, one delivers food packages to seniors who are house bound and another is for families with small children.

·         A financial aid programme where people can apply for up to $250 to cover ‘emergencies’ such as paying unpaid bills or emergency medicine needs.

·        Signposting and referrals to other services e.g. homeless shelter, pregnancy care programme.

They have also recently appointed a cook who runs a two hour session every Wednesday to help people learn what to do with some of the produce and items they may get in their packages. Debbie explained, “Often times there might items such as dried beans or other unfamiliar foods in the food packages, and many people don’t know how to use these. So, the cooking sessions were set up to help overcome this issue.”

The YMCA and the city of Auburn have also run a course on "eating healthy on a tight budget” to help people make better shopping choices. In addition to teaching people new skills, these sessions have proved a good meeting place for community members who have started to turn up early to sessions to chat and play cards together. The sessions have become a social occasion thereby increasing community engagement, reducing social exclusion and helping build social capital – as well as building capacity and teaching new skills.

The Auburn Food Bank really is a central hub for people - not only to access essential food - but to find out about other services, meet new people and learn new skills - and is clearly making an important contribution to building social capital in the community it serves. 

Advocating for Community Health and Well-being in Seattle

Today I visited my first American Community Health Centre. The International Community Health Services (ICHS) is a non-profit community health centre that offers affordable health care services to Seattle and King County's Asian, Native Hawaiian, and Pacific Islander communities, as well as other communities in need. ICHS delivers and advocates for health interventions that are comprehensive and culturally competent, empowering community members to improve their health and well-being.

Sounded the kind of place I needed to learn more about….

Over the past 35 years, ICHS has grown from a small storefront clinic in Seattle’s International District into the largest Asian, Native Hawaiian, and Pacific Islander community health centre in Washington State. It offers a full range of primary medical and dental care, preventive health education services, as well as Chinese Traditional Medicine.  ICHS charges patients a fee based on their family size and household income. Those without insurance are helped to identify if they qualify for any free or low-cost insurance programs.

ICHS has 7 Community Advocates who act as para-professional health educators, teaching ICHS patients and other community members about a variety of health issues, such as cancer screening and diabetes. They represent ICHS at community events, sharing their knowledge of ICHS services with prospective and current patients. They also provide interpretation and translation for ICHS. Community Advocates are paid staff members of the ICHS. Each community advocate works with a different community (Chinese, Filipino, Korean, Mien, Pacific Islander and Vietnamese).  

The role of Community Advocates is to:

·         Link patients and community members to appropriate resources

·         Advocate for patient / community needs

·         Provide basic health education and support

·         Identify patient needs

·         Provide follow up and guidance to patients

·         Empower patients to advocate for their own health

·         Know when to refer patients and where to

I met with one of the ICHS Community Advocates, Irene Chen, who works with the Chinese community. Irene (also known as 'the lady with purple hair' as some of her clients have trouble pronouncing her name!) came to Seattle in 1963 from Hong Kong and has worked as a community advocate for the past 16 years.



Community Advocate, Irene Chen (2nd from right)
and CISC Colleagues at the Advocacy Info Stand.



We met at the Chinese Information Service Center (CISC) in the International District of Seattle where Irene runs a drop in session every week to provide advocacy support to people new to the city from China or Vietnam.  Irene explained, “when people arrive in the city...they often have no health insurance, no job, no income”. Irene’s role is to help people identify what they need, provide support and refer them onto to relevant agencies.

Irene is employed for 30 hours a week – but in reality, she says she is on call 24/7, “people recognise me and approach me in restaurants and when I’m out and about…you can’t tell people to go away because you’re busy…my phone is always ringing”. Irene also does a lots of translation support work, as many of the people she works with do not have English as a first language. She provides an essential bridge between communities and services and enables people to make choices.

In addition to the drop in at the CISC, Irene also runs a diabetes training course– a 6 week programme based loosely on the Stanford model – and also has a role in encouraging the uptake of cancer screening (breast and cervical) by recruiting and enrolling people onto screening programmes.

Whilst at CISC (after being force fed home made green tea jelly by Irene!) I also met Andes Kong who co-ordinates the Sunshine Garden Seniors Day Care Center. The Sunshine Center opened in 1987 and runs a wide variety of activities for seniors living in the community. Their impressive calendar of events included Tai Chi, fall prevention exercises, a singing group, meditation, game playing…and of course – that old favourite - bingo! The Sunshine Centre also provide health checks and information – whilst I was there, a group of people were waiting to have their blood pressure checked, they also have health professionals come and do talks on different health topics on a regular basis.

But it’s not just about bringing in expertise from outside, the group members themselves also contribute to the activities. Andes told me how the seniors within the group share their skills with each other - so someone might do a cookery demonstration, or show people how to do a new craft or art technique. It’s a way of people sharing their skills and knowledge (their assets), encouraging participation and enabling others to learn something new.

Later in the day, I had a useful discussion with Abbie Zahler and Michael McKee at the ICHS who manage the Community Advocates scheme. They explained the origins of the Community Advocates and how they were initially the ‘visible presence’ of the ICHS in the community. The role has developed into more of a health education role over the years as the skills of the advocates developed and different funding streams became available (e.g. funding to increase cancer screening or hep B testing) and the ICHS saw a role for the Advocates in achieving these outcomes. The Community Advocate role also developed out of recognition of the numerous barriers to accessing the US health care system for new arrivals.
Community Advocates have received training on a range of different health issues to enable them to respond to the wide range of queries and requests they receive (e.g. diabetes, cancer screening, smoking, Hepatitis B).



Exchanging materials & ideas about
 Community Health Advocacy
 with Abbie and Michael at ICHS, Seattle.

I asked about the criteria for recruiting and selecting Community Advocates. Michael explained how they key qualities they needed were to be:

 i) bi-lingual

ii) bi—cultural

iii) a trusted leader in their communities.

Abbie explained how a ‘cookie cutter’ approach to selecting Community Advocates is not appropriate as the needs of different communities vary so much.



Other key skills Community Advocates have include:

·        Networking with patients and community members

·         Health disparities

·         Effective patient education

·        Motivational interviewing / self-management

·         Public speaking / group facilitation

·         Health education

·         Building community leadership

·         Multitasking

·         Computer skills

·         Immigrant laws and benefits

Some of which sounds familiar hey…?

Read more about ICHS Community Advocates and view a short film here.

Goodbye Canada - Hello USA!

So, I’ve left lovely Canada after 6 great weeks spent visiting 5 different cities from East to West. I met some great people and learnt lots - and certainly have had plenty to reflect on during my time out in Jasper and Vancouver (in-between spotting bears, elks, orcas, sea lions and so many bald eagles I confess I became a bit blase…).

So, I’m now in the USA and spending the final leg of my journey in Seattle. I have a busy few days ahead with visits to a range of people and projects including…

The Auburn Food Bank 

The Chinese Information Service Center - to learn more about and observe what Community Advocates in Seattle do.

The International Community Health Services Center  where I hope to observe a diabetes education class and meet the Health Services Director and Health Advocacy Manager.

The Seattle Department of Neighbourhoods - including visits to a Neighborhood Payment and Information Service center (NPIS) and Neighborhood District Coordinators Program  I’ll also get  chance to learn more about the Neighborhood Matching Fund Project & PPatch gardens in the city.

The Public Health Department of King County Council to learn more about their ‘Communities Count’ project and equity and social justice work.

I’ll end the week with a visit to the High Point neighborhood who are holding a Health Fair for community members on Friday evening. High Point is one of Seattle’s most diverse neighbourhoods and the High Point Neighborhood Association’s mission is to foster "the development of a vibrant and caring community committed to service, inclusiveness, lifelong learning, and well-being." Sounds just my kinda thing....

So - a busy old week but I am really looking forward to it…watch this space for updates!

What makes a community healthy? Why not ask them…?

Who’s to say what makes us and our communities healthy? Concepts of what we need to make and keep us healthy may vary amongst individuals and from community to community. Having said that, we know there are some recognised determinants of health such as:

·         where we live and our physical environment

·         our income level and socio-economic status

·         our education levels and whether we have a job (and what kind of job it is)

·         the services we have access to

·         our ability to cope and manage our lives

·         our social networks and social support

·         our gender and culture.

Colleen Cameron and Susan Eaton of the Coady International Institute have been heavily involved in development and implementation of the People Assessing Their Health (PATH) project in Canada and overseas. PATH is a community driven health impact assessment process, and both Susan and Colleen were keen to stress that, “Community engagement, empowerment and capacity building are central to the PATH approach.”

Sounded right up my street…. I was keen to learn more.

The PATH process provides a way for communities to identify what a healthy community means to them. The first stage of the PATH process involves the community identifying what impacts on their health – with a focus on the wider social determinants of health (those things listed above). They are tasked with answering the question: “What does it take to make and keep our community healthy?” and asked to devise a vision of a healthy community. Community members are invited to use the following prompts to help them come up with their responses:

“A healthy community is….” Or “In a healthy community…”

Some examples have been:

·         A healthy community is a dynamic community.

·         A healthy community is a changing community.

·         In a healthy community, assets are valued.

·         In a healthy community, diversity is valued.

·         In a healthy community, people work together.

·         In a healthy community, the goal is the overall health of the community.

         

[An example from the Antigonish Town & County Community Health Board is below to give an idea of what these might look like.]

Colleen explained that most groups identify the same kind of issues that affect health – with some cultural differences in terms of language and focus (e.g. for aboriginal peoples).

The next stage in the PATH process is for the community to design and test a Community Health Impact Assessment Tool (CHIAT) which can be used to assess the potential impact of any policy or intervention, actual or proposed. The CHIAT asks, “Will [name of intervention/policy] have an impact on…[dimension of a healthy community]” . The impact can be a positive or negative  – and sometimes is both (some things can be both good and bad – depending on which way you look at it – right?).For example, a new factory may create more jobs and may also increase air pollution.

As Susan said, PATH isn’t about saying what is ‘right or wrong’ or ‘good or bad’ but that there was, ”great value in hearing different voices and viewpoints…it promotes dialogue.” Susan went on to explain that, “PATH is about a conversation, about social learning…it’s a way for communities to create new knowledge and that’s just so empowering”.

The final stage in the PATH process is for the group to make a plan to use the CHIAT to assess the impact of a proposed or actual policy or action. An example of a policy assessed using the CHIAT was that of proposed school closures. In one community the closure would have led to negative impacts and loss of services (as the building was used for many things) in another community, the process enabled the community to identify of how the school could be used for other community activity.

I asked about what changes had occurred as a result of the PATH process, but as Susan and Colleen explained – identifying what makes a healthy community is one thing – influencing policy change as a result is a different matter, “The central idea is that communities use the tool to assess the impact of policies or interventions on the health of the community…but the PATH process needs to be supported in some way. People need resources to keep going and to take actions.”

So - where does PATH fit into the ideas about asset based approaches and building social capital….?

Well, in identifying what makes the community healthy the PATH process helps people to identify the assets they have that make (or keep) them and their communities healthy. These might be individual assets such as having a job or having family nearby, or community assets such as a local market providing access to cheap fresh fruit & veg, a community garden or a good public transport so people can get around and are less isolated.

It also seems that PATH is an incredibly empowering process for community members. It helps participants develop analytical skills and articulate what makes and keeps them healthy. The PATH process facilitates the development of a unique health impact assessment tool that a community can use when considering the effect projects or policies will have on community well-being and is recognition that, when it comes to health, the community voice is a valuable voice.

The PATH process could also be a way of helping to develop health public policy in helping to identify that any impact on the wider social determinants of health are taken into account when implementing or considering changes in policy, practice or service provision.

The Antigonish Town & County Community Health Board (ATCCHB) is a community-based health planning board.

Mission:

To develop a community health plan through broad community participation and consultation that includes strategies that promote and improve the health of our community.

A healthy community is a dynamic community, which includes:

·         Participation

·         Community leadership (from women and men)

·         People having control over decision-making that affects their lives

·         Institutional support

A healthy community is a changing community, which means:

·         It is evolving, not stagnant

·         It is open to embracing new ideas, people and approaches

·         It is prepared for change

·         It encourages intergenerational activities

In a healthy community, assets are valued, which means:

·         People’s various talents and skills are fully utilized

·         People feel that they are listened to and that their opinions are respected

·         Special attention is given to those not normally heard

In a healthy community, diversity is valued, which means:

·         Valuing the things that different groups can bring to the community, not just focusing on what can be “done” for them

·         Acknowledging that policies and programs can affect different groups in different ways

·         Consciously integrating different groups and cultures into our work

In a healthy community, people work together, which means:

·         There is collaboration (between churches, organizations, municipal governments, etc.)

·         Efforts are made to foster cooperation and overcome community “turf” protection

·         Leadership and participation skills are supported

·         Communication uses clear language

In a healthy community, the goal is the overall health of the community, which means:

·         Health includes all aspects of people’s lives (economic, social, spiritual and cultural, as well as physical)

·         The health of people and the community is influenced by a broad range of factors generally called the “determinants of health”

·         Primary health care (including health education, health promotion, disease prevention, rehabilitation, and the support and treatment of illness and injury including palliative care) is alive and well and available to all with no gaps.

More information on the PATH process as used by Antigonish Women's Centre can be found here.