6 Ways Communities Put Health First
From play space for kids to AIDS activism: the fight against disease goes grassroots.
No matter how much attention we pay to our diet, exercise, and other health maintenance, we’re subject to environmental risks that are outside our control. And we’re only human: We still get sick. Here are six communities where residents have worked together to address those bigger challenges and provided pedestrian-friendly neighborhoods, safe places for children to play outdoors, and clinics with affordable treatment for all.
1. Country Doctor in the City
Seattle’s Country Doctor Community Health Center opened in 1971 after Linda McVeigh and a group of grassroots activists saw a match between unmet needs and underutilized skills. The city was in the midst of an economic slump—Boeing layoffs had produced a wave of unemployed, uninsured people. At the same time, Vietnam vets, many with medical training, were returning home with few job prospects. Country Doctor was started to provide primary healthcare regardless of ability to pay.
They were not alone: Health professionals and community activists (like the Black Panthers) championed Community Health Centers (CHCs) in the ’60s and ’70s. From humble beginnings as storefronts on shoestring budgets, those clinics thrive today—furnishing health care to more than 20 million patients in the United States.
Affordable primary and preventive care saves lives and money—people can get treatment before they end up in emergency rooms for expensive urgent care. And care at CHCs costs 41 percent less than private clinics, according to a recent American Academy of Family Physicians report.
Like the other 1,200 Community Health Centers serving 8,000 locations around the country, Country Doctor accepts patients whether they have health insurance or not—and 55 percent don’t. Fees, when charged, are on a sliding scale. “We are not solving the problems of the world,” says McVeigh, who is now the executive director of Country Doctor, “but last year 18,000 people got health care who otherwise might not have. Some of these people got employed because they got health care.”
Financial backing to deliver care to at least 2.5 million new patients nationwide is budgeted for 2013, and increased support for community health centers through the Affordable Care Act could provide services for up to 44 million people by 2015.
2. How Activists Fought for HIV Treatment
AIDS activists provide a dramatic example of community organizing for better health care. In the 1980s, a time when mainstream culture was unsympathetic to the plight of people with HIV/AIDS, these activists became fierce advocates, engaged in a battle—which they won—for improved treatment for AIDS patients and research into HIV.
The activists, mostly gay men, with support from lesbians and straights, organized to struggle against the epidemic. ACT UP—the AIDS Coalition to Unleash Power—and its offshoot TAG—the Treatment Action Group—carved out new terrain for activist organizations. A new documentary film, How to Survive a Plague, tells the story of their rage against official indifference toward what was then an untreatable, fatal disease.
With archival footage from the 1980s and ’90s, filmmaker David France retraces controversial civil disobedience and other hotly debated political actions. He constructs a powerful view of what happens when an activist community that won’t give up focuses passionate dedication, innovative thinking, and self-reliance toward achieving a goal.
AIDS activists needed little prodding beyond the horrible effects of the plague itself. Seeing friends and lovers die from AIDS with no effective treatment on the horizon forced a sense of extreme urgency. Members of ACT UP and TAG educated themselves about the immune system and possible treatments. Partly because of their first-hand experience with HIV/AIDS, they designed drug trial agendas that accelerated the research and approval process used by professional medical researchers
The activists used lobbying, direct action, and mass demonstrations to pressure the FDA to advance medical research and push drug trials forward. Through tactics that ranged from public education and media-savvy street theater to a fiercely confrontational “political funeral” on the lawn of the White House, AIDS activists brought about legislation, policies, medical research, and treatment that radically slowed the loss of health and lives. Without their constant demands for attention and unrelenting agitation, it is unlikely that effective treatment for HIV would have developed as quickly. Thanks to their hard slog, HIV no longer automatically implies a death sentence.
3. Latino Health Advocates Promote Outside Play and Exercise
To be healthy, children need to go outside and play. But, with only one park per 1,000 residents in a largely Latino community in Santa Ana, Calif., kids had no safe place to play outdoors—in fact, parking lots after business hours were the only open space where kids could play ball games, jump rope, or ride bikes. Then a neighborhood mom got the idea of organizing. The result was a shared project for “Parents with Green Hearts,” and their local health nonprofit, Latino Health Access. After 10 years of lobbying city officials and raising funds through everything from tamale sales to business partnerships, the community is finally getting its park.
Expected to be completed this fall, the new Latino Health Access Park and Community Center will include a 3,000-square-foot community center, a walking and jogging path, bathrooms, and security. And neighborhood residents now sit on the Community Park Advisory Board to advocate for additional open spaces.
Latino Health Access sees the park project as part of its broader mission to promote health in the mostly poor urban neighborhoods in inland Orange County. The nonprofit focuses on illness prevention through community outreach carried out by “Promotores,” or community workers, who advise and educate in their own neighborhoods about health issues like diabetes, breast cancer, obesity, domestic violence, and parenting.
4. WE ACT for Environmental Justice
Based in Harlem, WE ACT for Environmental Justice has a densely populated urban backyard that features six of Manhattan’s seven bus depots, the city’s only diesel truck depot, and all of its sewage treatment plants. Since 1988, the group has fought for clean air, affordable transit, and people-friendly waterfront development.
After nearby residents complained of fumes from a sewage plant and respiratory problems, WE ACT filed suit to improve management of the North River Sewage Treatment Plant, calling it a “nuisance.” WE ACT won and subsequently hired its first three staff members with the settlement.
Harlem residents’ high asthma hospitalization rates—three times higher than the rest of New York City and six times the national rate—also caught WE ACT’s attention. The nonprofit negotiated with the EPA to test Harlem’s air quality and pushed for a pilot study of Harlem schoolchildren. The data supported demands for alternative fuels for city buses.
WE ACT’s advocacy, which includes lobbying, petitions, letter-writing campaigns, community mobilization, civil disobedience, and litigation, has also influenced decisions about land use in areas where residents have few open spaces for recreation. It partnered with New York City authorities for the Harlem-on-the-River project, which increased access to the Harlem waterfront in one of Northern Manhattan’s most neglected neighborhoods. As a result, the West Harlem Waterfront Park opened in 2009.
5. Making Streets Pedestrian-Friendly
Several New York City communities, including the Times Square Alliance, wanted to make their streets more pedestrian-friendly and convert underutilized street space to serve more people more efficiently. But the idea of cutting off car access didn’t exactly sell itself in a city where traffic congestion is a constant source of irritation.
They turned to the Project for Public Spaces (PPS), a design and educational nonprofit that has advocated for more and better public space since 1975. PPS developed photo simulations to illustrate how public spaces could be reclaimed from streets. The end result: five blocks of Broadway were permanently closed to cars.
Through partnerships, conferences, and advocacy, PPS trains city planners and community organizations to build better public spaces that highlight local assets, serve common needs, and foster healthier living. Some of the programs PPS is involved in aim to improve low-income communities’ access to healthy foods. Others target creating greenways and bike lanes. In Indianapolis, for instance, PPS was involved in the design of the Cultural Trail Project, an eight-mile greenway to improve the downtown area.
PPS takes a holistic approach to “placemaking” by bringing together the skills of specialists in environmental design, architecture, urban planning, and transportation. “A lot of our work is training existing staff to do things differently,” Ethan Kent, PPS vice president, said. “Before, they just planned for cars and traffic, and now they are building for communities. They need examples and new tools. It is a new process, to work with the community more collaboratively.”
6. Affordable Acupuncture
You might say that participants in community acupuncture clinics draw energy from each other. The clinics utilize a group visit model that allows one practitioner to treat multiple clients at one time. In a typical community setting, four or more patients get treatment while reclining in adjustable loungers, often in a relaxing, softly-lit, living-room-like area.
The model brings the cost of the acupuncture down and makes the ancient Eastern practice affordable for more people. That lowered cost has propelled a rapid national expansion in community acupuncture clinics. Many clinics charge their clients on a sliding scale—generally $15 to $50, much less than the standard $80-per-hour private rates.
More than 200 clinics belong to the People’s Organization of Community Acupuncture (pocacoop.com), according to Lisa Rohleder, co-founder of Working Class Acupuncture in Portland, Ore. “Many more are using this kind of model, but aren’t official members yet,” she adds. Rohleder pioneered the community acupuncture movement and watched it spread across the country, from Alaska to Florida, Wyoming to Wisconsin, and many points between.
Rohleder says Working Class Acupuncture’s practitioners treat about 75 patients a week; the conventional U.S. practioner sees 12 to 20.
Like other community clinics, Working Class Acupuncture serves a wide variety of patients. Recently, patients from immigrant and refugee communities are trying the alternative treatment. The clinic also donates time to an agency that works with human trafficking victims, Rohleder says.