Spotlighting Minority
Populations of New York:
Our Journey to Health Equity
for African Americans
By Dr. Ruth Browne
CEO, Arthur Ashe Institute for Urban Health
Webinar for New York State
Department of Health
Office of Minority Health
May 20, 2010
The Arthur Ashe Institute for
Urban Health
Is located in multi-ethnic Brooklyn at
SUNY Downstate, and collaborates
with a diverse array of partners to
design, incubate and replicate
neighborhood-based interventions
based on a Community Health
Empowerment Model addressing
health conditions disproportionately
affecting minorities.
Health Disparities:
Conditions Disproportionately
Affecting African Americans
Entrenched Problem,
Complex Causation
Health disparities result from the
complex interaction among factors
such as biology, the environment, and
specific behaviors significantly
impacted by a shortage of racial and
ethnic minority health professionals,
discrimination, and inequities in
income, education, and access to
health care.
Healthy People 2010 Goals
Still Unmet for African Americans
The US Department of Health’s Initiative
Healthy People 2010 was designed to
achieve two overarching goals:
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Increase Quality and Years of Healthy Life
Eliminate Health Disparities
African Americans Experience Disparities
in All Leading Health Indicators
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Physical Activity
Overweight and
Obesity
Tobacco Use
Substance Abuse
Responsible Sexual
Behavior
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Mental Health
Injury and
Violence
Environmental
Quality
Immunization
Access to Health
Care
In New York City
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30 percent more African American men and
20 percent more African American women
die of all causes than their white
counterparts
Infant mortality is highest among African
American babies and African Americans have
the highest rate of new HIV diagnoses
One in four African American and Latino New
Yorkers are obese, increasing their risk of
disease, disability and premature death
Every year, this disparity in mortality
accounts for more than 4000 deaths.
Nationally
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African Americans’ expected lifespan is
seven years shorter than their white
peers’
African Americans are twice as likely to
die from heart disease, diabetes and
various forms of cancer
African Americans are half as likely as
whites to be insured, significantly
decreasing usage of preventative care,
timely screening, early detection, and
quality treatment options.
Under-representation in
Healthcare Workforce
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Although service utilization and
health outcomes improve when
healthcare practitioners are culturally
similar to their patients
African Americans represent only two
percent of the healthcare workforce,
despite representing over a quarter of
the general population.
Critical National Need
for Successful Models of Change
The Census Bureau predicts racial and
ethnic minority populations in the
U.S. will double in size during the
21st century. Innovative strategic
partnerships among all segments of
our society including the community
will be critical in the NIH effort to
eliminate health disparities.
The Institute’s Approach:
Leverage Community Assets
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All communities have assets that can be
engaged on behalf of the communities health
Assets include businesses, churches, local
health and social service agencies, personal
care establishments, libraries, schools, etc.
Proprietors, personal care givers, stylists,
barbers, ministers/faith leaders, nurses and
other health care practitioners who live in
communities can be engaged in community
health empowerment (CHE) as lay health
advocates
Identify Local Heroes:
Lay Health Advocates
facilitate behavioral change and engage communities in
academic /community partnerships. They
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Participate in the design, implementation and evaluation
of interventions
Build trust by drawing on existing relationships and
standing in community
Provide informal counseling and health education based
on most current research
Tailor content for cultural and linguistic fit
Assess readiness and individualize message to stages of
change
Offer connection to health services through referral and
follow-up services
Build individual and community capacity for advocacy and
dissemination of tailored health messages.
Community Health Empowerment Model
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Underlies programs
addressing ethnic,
racial, and gender
disparities, targeting
diseases that affect
our communities
disproportionately
Addresses the whole
individual to inform
health decisionmaking through
trusted venues and
messengers
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Builds knowledge and
skill for individuals to
address their own
health concerns
Develops advocacy
skills for communities
to build health equity
Facilitates increasing
representation of
minorities in the
health professions
CHE Model Underlies
Multi-Pronged Program Design
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We partner with a wide variety of grassroots,
institutional organizations and policy makers
to provide
Community Health Interventions Outreach
initiatives using lay health advocates in
trusted venues, such as barber shops, salons
and Laundromats
Health Science Academy Culturally
appropriate after-school programming to
increase the number of minority healthcare
practitioners
Brooklyn Disparities Center Research,
training and advocacy through a 13 year old
campus-community partnership with SUNY
Downstate Medical Center.
The CHE Model in Action:
Three Institute Programs
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Soul Sense of Beauty (Community Health
Intervention)
Health Science Academy (After School Science
Enrichment)
Brooklyn Health Disparities Center (Research,
Outreach, Training and Advocacy)
Soul Sense of Beauty:
Behavioral Health
Change Model
The Salon as
Community Health Center:
Meeting People Where They Are
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In minority communities, the beauty salon is a traditional safehaven and cultural epicenter where social norms and public
opinions about health are often shaped
Hair stylists and cosmetologists already discuss a wide range of
health topics with their clients, especially in the areas of
dieting and physical activity
Beauty professionals in minority communities enjoy a level of
trust from their clients that opens up avenues for
communication that may not always be available to
researchers from outside the community.
Soul Sense of Beauty:
Overview
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Innovative breast cancer awareness program
National Cancer Institute funded training
program for hairstylists to teach them how
to talk to their own customers about breast
health
Three messages: practice self-examination,
get annual clinical breast exam,
mammography
Objectives
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To select and train community-based
professional stylists in specific knowledge,
attitudes, and practices of delivering breast
cancer control messages to their customers
To examine, via a randomized controlled
trial, the impact of stylist-delivered breast
cancer control messages on the breast
health behaviors of beauty salon customers
Objectives
(continued)
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To develop a portable stylist training and
communications package for ongoing training
To conduct an outcome evaluation of breast
health behaviors of salon customers
comparing method of stylist training (video
versus live-training)
To organize a community-based Health and
Beauty Council to continue the stylist
training program in support of the
intervention
Cultural Targeting
Focus groups were conducted with African
American and Afro-Caribbean stylists to
 Inform the cultural content of the
training prior to its development
 Determine the cultural acceptance of
the training curriculum and breast
health messages
Activities
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Customers were pretested on knowledge
at each salon
Breast health information, including videos and
shower cards on breast self-exams and pamphlets
on breast health were available at each salon
Church volunteers - trained to assist in
demonstrating breast self-exams during the Health
and Beauty Days
Breast Cancer Survivor – played vital role in
recruitment, promotion of breast healthy
behaviors
Results & Highlights
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2,284 pre intervention surveys were
collected from salon customers
Stylists from 50 salons in Brooklyn
completed the program
Self-reported exposure to stylistdelivered messages was associated with
improved breast self-examination rates
and with greater intentions to have a
clinical breast examination
Results & Highlights
(continued)
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8 church facilitators trained
Media coverage: New York Times, BET, NY 1,
ABC local TV and German TV
Mammography provided by ACS and American
Italian Cancer Foundation
Stylists were recognized by the Brooklyn
Borough President at a special ceremony
Lasting relationships to build on for next
intervention
Refining and Adapting the Model
• The behavioral health change model
developed through Soul Sense of Beauty
provides an adaptable base for the Institute’s
future work.
• Content based on current research is being
developed for interventions related to
colorectal cancer, HIV, cardio-vascular
disease, prostate cancer etc.
• Our approach is continually refined based on
an evaluation of health behavior of customers
based on stylist delivered health messages in a
trusted environment.
Health Science Academy:
Increasing Minority Representation in
the Healthcare Workforce
Health Science Academy:
Overview
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Free after school science enrichment
A three-year college level curriculum in
Anatomy and Physiology
High school and middle school minority
students are exposed to a broad spectrum
of health science careers
Objectives
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To prepare minority high school students to be
competitive in applying to, entering and
completing higher education in the health
sciences
To develop, through interactive activities, habits
of mind and methods of questioning to succeed in
rigorous academic study
To provide experience in community service, an
understanding of health disparities and a
commitment to improving healthcare in their
communities
Activities
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We partner with 12 local schools with high
concentration of minority and immigrant students
We recruit students with an overall 85% average
who are interested in science and willing to
commit to a three-year program
We offer a rigorous highly interactive curriculum
of Anatomy and Physiology at SUNY Downstate,
Brooklyn’s only Academic Medical Center
We support faculty made up of graduate students
and other clinicians, targeting minority
practitioners who can serve as role models and
mentors
Activities
(continued)
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We supplement the curriculum with trips,
community service, internships, dissections, lab
tours and guest speakers
We frame the clinical content within a context of
health disparities, drawing from community
experience, supplemented with course work
providing strategies for academic success
We extend the health education pipeline to
younger students through piloting a career
exposure program “Be the Cure” in two Brooklyn
middle schools.
Results and Highlights
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Nearly 75% of students’ parents and 26% of the
students were born outside the US
Since 1994, more than 750 young people have
attended the academy, with over 250 graduating
and going onto to college
Approximately 60% of students in the last two
graduating classes have majored in science.
Results and Highlights
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The Academy enrolls between 150 and 186
students annually for the last three years
Over 86% of the 2009 class indicated interest in
health science careers
This summer 30 Academy students will study
health disparities and research methods and
perform internships in local community-based
organizations under an NIH P20 grant.
The Brooklyn
Health Disparities Center:
Local Infrastructure for
National Impact
Overview: Community Outreach &
Information Dissemination (COID) Core
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Partnering with SUNY Downstate and the
Brooklyn Borough President’s Office, the
Institute leads the Brooklyn Health
Disparities Center
Because of its location and cultivating
student and faculty bodies that reflect the
communities it serves, Center partners
have gained a tremendous wealth of
expertise on minority health and health
disparities.
Funded by NIH, the Center is anchored
through points of connection in grassroots
organizations engaged in direct services to
neighborhood residents.
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Community Advisory Board
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American Cancer
Society
Arab-American Family
Support Center
Brooklyn Perinatal
Network
Caribbean Women’s
Health Association
Diaspora Community
Services
Flatbush Haitian
Center
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Greater Southern
Brooklyn Health
Coalition
Haitian Centers
Council
Korean Community
Services (KCS) Public
Health Program
Make the Road By
Walking
Goal of COID
The goal of the COID is to translate
scientific information on reducing
risks of cardiovascular disease and to
deliver this information to the
Brooklyn community utilizing
already-established mechanisms of
outreach that engage community
service providers.
Objectives
Our overarching long term goal is to reduce
morbidity and mortality by
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Improving health knowledge
Informing decision-making
Facilitating behavior change
Expanding access to care
Increasing minority representation in
the healthcare workforce
Activities
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Coordinate advocacy efforts with
community partners and academic medical
center
Prepare clinicians to offer more culturally
competent care and community based
partners to build capacity
Organize a coalition to build a more
responsive and effective health education
pipeline to increase minority
representation in the healthcare workforce
Engage in Community Based Participatory
Research to address root causes of health
disparities, publish and widely disseminate
findings.
Critical Elements of
Community Empowerment:
Recommendations
Summary
The three programs, guided by our model,
address complex root causes through
approaches and activities designed to
narrow gaps in
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Trust
Information
Motivation
Access
Representation
Closing the Trust Gap
Reliable culturally-tailored health
messages are delivered by
community advocates in comfortable
informal settings.
Closing the Information Gap
Accurate current information on
wellness, prevention, screening is
distributed through trusted
community venues by well-supported
peer educators to inform health
decision-making.
Closing the Motivation Gap
Community advocates are coached to
meet people at individual stages of
readiness, build on incremental
behavioral change to encourage
positive “social contagion,” passing
accurate health messages along
through family and neighborhood
networks.
Closing the Access Gap
Information on screening is
accompanied with referrals to
culturally competent clinicians and
means to enroll in low or no cost
health coverage.
Closing Representation Gap
Local minority youth explore and
prepare for health careers, engage in
disparities solutions, and serve as
information resources for their
community and policy makers
through the Health Science Academy,
located at Downstate, facilitating
increasing minority representation in
the healthcare workforce.
Concluding Recommendations
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Convene a representative advisory board
Elicit their input and insights in the design
of the intervention, crafting of health
messages, implementation and evaluation
Leave expertise in the community by
educating and supporting lay advocates to
carry the message, evaluate the results and
adapt the intervention
Interpret findings for both sides of the
Campus/Community partnership and
disseminate strategically for optimum
impact.