Focus

Region ups efforts in health equity battle

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Health is often affected by many factors that are independent of the care received in a doctor’s office.

John Place (center), with grandsons Aidan Place (left) and Elijah Place, enjoys fishing at Prospect Lake. The surrounding Hillside neighborhood has been identified as having health equity issues.

Mia Ramirez said it’s hard to imagine, but something seemingly as insignificant as one’s ZIP code could subtract more than a decade from a lifespan.

“We’re starting to see powerful data citing life-expectancy gaps between neighborhoods in the city,” said Ramirez, community partner for The Colorado Trust, a Denver-based health equity foundation. “More affluent neighborhoods can see almost a 20-year life expectancy gap [compared to less-affluent neighborhoods] within our own city.”

Ramirez began in her position with the trust just over a year ago, and since last March, she has embedded herself in communities in much of central Colorado, including Douglas, El Paso and Teller counties.

Today, much of the trust’s work in the region is being done in the Hillside Neighborhood, which borders landmarks such as Memorial Park and the former Gazette and St. Francis Hospital campuses.

That community, along with much of southeast Colorado Springs and the 80909 neighborhood by The Citadel mall, have seen increased attention from a variety of local agencies over the last year, all with the goal of improving those residents’ social determinants of health.

Social determinants 

Health is often affected by many factors that are independent of the care received in a doctor’s office.

“Factors known as the ‘social determinants of health’ can either positively or negatively impact the ability for all Coloradans to lead healthy, productive lives,” according to The Colorado Trust’s website.

Those factors include safe neighborhoods, educational and job opportunities, livable wages, “and the opportunity to make decisions that affect our own and our family’s health,” the website states.

“Social determinants are systematic and can’t always be measured,” according to Mina Liebert, El Paso County Public Health planner.

El Paso County Public Health has been focused on the southeast’s 80916 ZIP code, where about half the families live below the federal poverty line and violent crime statistics often outpace those in the rest of the city.

In 2015, a collaboration between the YMCA of the Pikes Peak Region, LiveWell Colorado Springs, Penrose-St. Francis Health Services, El Paso County Public Health, Colorado Community Center Collaborative and more, was selected to receive a $75,000 grant to improve community health through the BUILD Health Challenge, a national grants program.

The collaboration, known as Project ACCESS, targets geographic and demographic disparities to include proximity to services, health care and safe environments.

“BUILD provided funding opportunities to five or six foundations across the nation. We were part of the initial 17 planning communities granted to look at more upstream issues of health outcomes,” Liebert said. “That means looking at why there are community and neighborhood disparities. … We listened to what people were asking for — safe spaces, places to gather and opportunities to get together. We also heard a need for jobs [skills] and life-skills development. As a result, we’ve created a partnership with Harrison School District to ensure some of those spaces. For instance, the community now has access to Zumba at Deerfield Hills [Community Center] and Panorama Middle School.”

Other community-building opportunities include a trail cleanup and an upcoming mural project with Silver Key Senior Services.

The ZIP code could also benefit from CPR training within Harrison schools, and babysitting and first aid classes, so students can find employment during the summer months, Liebert said.

Starting early

Pikes Peak United Way is another organization working on the front lines of social determinants of health. One program, Colorado Springs Promise, has targeted Mitchell High School and the surrounding neighborhood.

“With Colorado Springs Promise, we’re starting to engage the youth in a little bit of a different way,” said Deana Hunt, PPUW senior vice president of community impact.

“Over the next year we’ll be developing a youth advisory council so they can help us determine what some of the needs in the community are. Some of the things we’ve heard in brief conversations with students and at Mitchell High School specifically are concerns about safety in the neighborhoods and the [conditions of] apartments in those neighborhoods.”

PPUW does not provide direct services, Hunt said, but rather directs those in need to the appropriate agencies.

Through Colorado Springs Promise, however, the nonprofit has taken a more boots-on-the-ground approach in addressing social determinants of health in the 80909 ZIP code.

Hunt said the Mitchell neighborhood was chosen because Colorado Springs School District 11 often takes a backseat to districts such as Harrison when it comes to social investments.

“It seemed there were a lot of resources and people wanting to help [Harrison School] District 2, but not as many partnerships with District 11,” Hunt said. “We looked at all of District 11, and Mitchell has the lowest graduation rates in the district, among typical high schools.”

Hunt said Mitchell also presented the highest mobility and English-learner rates in the district.

“We were shocked by the number of seniors who hadn’t been in the district their junior year, let alone further back,” she said. “The freshman rates were even higher.”

The homeless rate for students at Mitchell High School is also higher than surrounding D-11 schools, she said.

“We need to look at the apartments surrounding the school and their policies. We’d like to engage landlords about rental agreements and find out if there is a reason people are leaving in six months. The hope is we’ll do more of that this year.”

Hunt said, with students often working more than one job to help their family, education becomes a secondary priority and opportunities diminish.

“Education, for me, is the key to move people above and beyond,” she said. “Education is an incredibly important piece that is sometimes overlooked when we talk about social determinants of health. That means ensuring everyone has access to high-quality educational opportunities. But if you don’t have that foundation of housing or access to food, you’re not able to learn either.”

Taking ownership

Theresa Trujillo is Ramirez’s trust counterpart in the southeastern part of the state. The trust, encompassing 10 counties, has made outlying communities its priorities, Trujillo said, and has slowly worked its way into more urban environments. Trujillo began a year before Ramirez, and said residents in her region are beginning to implement plans built over the past 2½ years.

Trujillo said the keys to success thus far in towns like Manzanola and Avondale have involved creating a sense of ownership from within. In Avondale, for instance, community leaders decided to spend $16,000 in trust funding on staffing its local Boys & Girls Club so kids have a safe place to go after school.

“There’s a lot of need down here,” Trujillo said. “In lots of ways, these communities see two Colorados, and it’s split where the El Paso and Pueblo county lines meet. The state often touts its recovery from the recession, but a lot of rural communities haven’t felt that relief.”

Trujillo said, however, that there has been a “transition of power from funders determining what the community should be working on and how communities get pots of money.”

The trust, instead, aims for those communities to depend on their own analyses and draw their own conclusions on how to achieve health equity.

“If they take more ownership, the solutions will be better and more relevant,” she said.

But southern Colorado does, on occasion, look to its northern neighbors for guidance, Trujillo said.

“Colorado Springs, as a more urban environment, sets the tone for the region,” she said. “If our neighbors do well, we do better too.”

And Hunt said, no matter where poverty and health inequality exists, it will continue in perpetuity if  the “haves” don’t assist the “have-nots.”

“It’s incredibly hard to break the cycle of poverty,” Hunt said. “And in order for that to happen, people typically need some kind of hand up, someone to support them.  I don’t think people recognize that as much as they should.”

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