For Mia Ramirez, health care is less about the number of urgent care clinics in a ZIP code or educating its population about diabetes. Ramirez, who is about two months into her newly created position with The Colorado Trust, based in Denver, says healthy neighborhoods start with crosswalks, clean parks, transit options, community centers and grocery stores.
In February, Ramirez became one of seven community partners in the state. Her responsibilities with the nonprofit organization include embedding at the neighborhood level within communities in El Paso, Teller, Lincoln, Elbert and Douglas counties and facilitating grassroots activism to strengthen health equity.
“Chronic disease management isn’t something that can be solved in a doctor’s office,” Ramirez said. “A large part of chronic diseases stem from what your environment looks like.
“Are there opportunities to exercise? Is there access to healthy foods in your immediate environment?”
Ramirez said the group’s focus isn’t on building clinics, hospitals and freestanding emergency rooms.
“We need to prevent them from going to these places,” she said. “So what are the environments that shape health and allow choices in the community to keep them healthy?”
An exploratory phase
The Colorado Trust was created in 1985 when nonprofit PSL Healthcare Corp. was sold to a for-profit organization. The proceeds were used to create the Trust: “A foundation dedicated exclusively to the health of the people of Colorado,” according to its website.
Providing nearly a half-billion dollars in grants through 2014, the Trust first began targeting rural Colorado. About a year and a half ago, it expanded its community partnerships to include the greater Denver area and Region 6, which includes Colorado Springs, Fountain and Woodland Park.
According to Ramirez, the group operated for years on the oft-copied philanthropic model of doling out funds to nonprofits, which would create programs based on macro-level research.
“That hasn’t really worked in the past,” she said. “We don’t have the answers and don’t know what’s going to work on their block. That’s why we’re relying on the residents to drive the process.”
At the state level, the Trust is responsible for bringing 9-1-1 emergency medical care to 38 counties and helping foster the development of the state’s second-largest regional transportation district in the Roaring Fork Valley.
“More recently, the Trust began a new strategy aimed at empowering resident-led initiatives to advance health equity at the community level,” its website states.
And that’s where the community partners, like Ramirez, come in.
“Right now I’m in a fact-finding, exploration phase,” she said. “We have access to data and know at a 30,000-foot view what the issues are. But what we don’t know is what’s affecting people day-to-day in their neighborhoods, on their block and in their school districts.”
She uses big data to pinpoint areas with the greatest needs, she said.
“I’ve been as far west as Cripple Creek and Victor and as far east as Kiowa,” she said. “I’ve gone to individuals’ homes to talk about what it’s like to live there. I’ve gone to community meetings and soccer meetings. Wherever people naturally convene, I’ve been sort of the fly on the wall.”
She tells groups why she is there and what she hopes to learn.
“We’ve been asking folks mainly three questions: What do you love about the community, park, school, home or neighborhood we happen to be in? What’s challenging about living here? And what’s something that would make life easier?”
Ramirez said, overall, neighborhood pride is omnipresent.
“I’ve done a lot of interviews in southeastern Colorado Springs, and people take pride in their neighborhood, in the beauty of the city, in their schools.”
Simple challenges like transportation to and from employment or schools can, over time, impact physical health, she said.
“We’re looking upstream of those individual health outcomes and working in housing, education, transportation and economics,” she said. “Health really hasn’t come up in the way we traditionally talk about health. [Communities aren’t] talking to me about doctors. They’re talking about crosswalks and how hard it is to get across the street with a toddler in a stroller. It’s not clinics and shots. It’s housing and how far the health department is or that the Department of Human Services on Garden of the Gods is a two-hour, one-way trip.”
Ramirez said addressing social isolation, particularly among the region’s rapidly growing aging population, will be vital for community health.
While Silver Key has not officially entered into any agreements with the Trust, Lorri Orwig said she’s discussed collaboration with Ramirez.
Silver Key addresses social isolation for seniors through programs like its Golden Circle Nutrition Program, which creates a place for participants to congregate for meals.
“If you have people who are able to get out and enjoy intergenerational kinds of things, it improves health,” said Orwig, who is Silver Key’s chief development officer. “Some people just want to engage in their community so they’re not so alone.”
Silver Key is in the process of opening a new facility on South Murray Boulevard, an area that she says could benefit from the Trust.
“There are very few food pantries, and transportation is not easily accessible,” Orwig said. “I envision that office as being a hub for community gatherings. Mia and I have had conversations about holding focus groups there.”
Brittney Stroh, executive director of Atlas Preparatory School, also expects to collaborate.
“For whatever reason, a lot of resources are located on the Westside,” Stroh said. “I’ve been [in Colorado Springs] for 19 years and it’s only gotten worse.”
Students at the charter school are often portals to their families, Stroh said.
“It goes beyond being just a school,” she said. “It’s a hub where we can get access with all members of the family. Other than a workplace, it’s hard to have that consistent contact.”
No matter the community, youths should also have a safe place to congregate outside of school, Ramirez said.
“Many communities don’t have structured opportunities and parents don’t want kids hanging out in the park until they can be picked up,” she said.
While there are some recreation options on the southeast side of town, including the Boys and Girls Club and the YMCA, transit and hours of operation often fall short of needs.
“It doesn’t matter that it’s there if kids can’t get to it,” Stroh said. “And not all parents work from 8 to 5. There are opportunities for kids, but it’s hard to say there are enough.”
Set the table
The “big vision” for the Trust is to begin prioritizing community needs and creating strategies to facilitate solutions.
“We want neighborhoods to develop solutions and strategies where the trust can come alongside and fund them,” Ramirez said. “But it’s incumbent upon [the communities]. … Oftentimes, from a foundation perspective, foundations come in and do things for communities or to communities. The approach has been, ‘We have the data, we know it will work for you.’”
While the Trust is designed to improve the well-being of neighborhoods on a micro level, Ramirez said those improvements have substantial impacts on regional economies.
“I can’t put a dollar amount on it, but when building those relationships among each other with traditional institutions like police, along with a free outlet through physical activity — I see cost savings in health care because of the exercise, there are cost savings in behavioral health because parents and kids have an outlet,” she said.
“Parents are building relationships with other parents and can share resources and their troubles. … There’s a reduction in cost to the legal system because police are less likely to see undesired behavior.”