Mrs. Delagard, a 76-year-old,
was scheduled to have her leg amputated.
One of her family members came
to a community REACH
diabetes education class
and talked with a community health advisor
about Mrs. Delagard's problems.
As a result she has her leg.
Diabetes was really a closeted issue.
Even people who are on insulin
often didn't share that with their family
and support systems.
Today
it's really a community conversation.
We started out with about
a rate of 40 amputations
per 1,000 hospitalizations
with people with diabetes.
And we've reduced that by 50 percent.
That translates into a cost savings of
about $2 million per year.
In 2003, we did our
initial community readiness surveys.
And what we found out
is that the community
wanted to talk about methamphetamine.
They really weren't interested
in talking about
cardiovascular health.
But with the knowledge that we gained from the surveys
we were able to develop a presentation
that dealt with the impact of methamphetamine
and substance abuse
on cardiovascular health.
So this was an innovative approach
and it captured the attention of the community.
The community really felt like that we were talking about
what they wanted to talk about.
And through that we were successful
in getting across our
heart health message.
Welcome to Cooking with the Council.
We're going to be cooking some
vegetable chicken stir fry.
We have a program called Cooking with the Council.
What we did is we take recipes
that we're used to
that we've grown up with,
and they change the ingredients around
and make them healthier recipes,
and we were wanting to show these
in our healthcare facilities,
our exercise facilities.
We're gonna learn
right with you all today.
This is kind of new for me, too.
So in 2004
Bronx Health REACH Coalition
with a number
of its community partners,
piloted
an initiative
in a number of Bronx schools
to start offering low-fat, no-fat milk to the children.
It's a place where we could reduce the calorie intake.
The office of school food decided to do it system-wide
and remove whole milk from all New York City public schools,
and that you're talking about over a million children.
By that very system change
we saw that
the overall calorie consumption
of New York City public schools
had fallen between 25 and 81 percent.
It speaks to the REACH model
that plays a large role
in reducing those health disparities.
We work with Pacific Islander
and Southeast Asian women
around breast and cervical cancer
and we've worked with them
to increase screening.
We do patient navigation.
So we'll do everything.
The total population is
about 600,000 women
that we could reach throughout
Southern California and other areas.
We reach about 150,000.
For the Asian and Pacific Islander community
cancer really had a stigma.
People equated cancer with death.
Through our program,
not only did they build trust,
but we built communication up
with the providers.
We've had several hospitals
be really supportive to the women.
For example, one hospital has been hosting
our Thai cancer survivors group.
And in fact, we just had a fashion show
with the cancer survivors.
The doctors come out.
They help to run the support group as well.
After our program,
70 percent of the women got screened,
and they get screened regularly
on an annual basis.
I'll never forget
a woman came up to me and she said,
"I know you don't know me,
but I went to this education program."
And she said,
"It was like I was blind
and learned to see."
She said,
"I figured out a way to take care of myself.
I'm happy. I'm not on nearly as many drugs
as I used to be.
I'm under control with just one diabetic medication,
and my life has changed."
We are in the middle
of the deep South
and we have the majority of our population
are low income and minorities.
And most of the people there
are completely isolated,
lack of transportation.
Lack of healthcare access,
very limited facilities for mammography.
We train about 170 women to serve as
as community health advisors.
And by giving them the knowledge
they can be empowered to help and serve,
and educate their neighbors
and the women in their communities.
They took those messages and delivered it
in their own way.
For example, they had a hat show
in the church and
invited all the community to come and watch the hat show.
But then they delivered the message about screening.
They reached at least we know
about over 3,000 women.
We were able to reduce the disparity of mammography screening
from 18 percent to 3 percent.
The Community Asthma Initiative
is a program that addresses asthma disparities
in Boston
We serve 908 patients
that have had hospitalizations
or emergency department visits,
and have provided home visiting
and nurse case management
and community health worker,
and nurse case management home visits.
What's really remarkable is that
we've had an 80 percent reduction
in the hospital,
the need for hospitalizations for children,
and 60 percent reduction in children
with any emergency department visits.
And we found that for every dollar spent on the program
there is $1.46 saved.
When we add quality of life in trying to estimate the cost
of missed school days or missed work days,
there actually was a $1.73
return on investment.
And that's savings to insurers and to society,
not to the hospital.
We're funding two of
our SOPHE chapters to do
this REACH program.
One of the biggest challenges
was that the community
were looking towards us to, okay,
tell us what to do.
And now when we look at that,
fast forward it a couple of years
what we're finding is that chapters
are no longer being the lead organization
it's really the community groups and their leaders
are really saying,
this is what we want to do,
and we want you to help us do it right and show us,
and then help us identify
evidence-based best practice strategies
that are going to really be effective
when you're talking about
diabetes prevention and management.
We really see our role
as being an expert resource
and research center on hepatitis B.
With this REACH funding
we've been able to create networks
link partners
link community organizations
that didn't know that there was a community organization
in the state right next door to them
doing a similar project.
[Commercial in Mandarin Chinese]
We developed a campaign
based on a lot of data
that we've been collecting
in the communities
There's a big LED screen on the corner
where the large part of our community,
the Korean and the Chinese community live
and it was there every 20 minutes.
We're really thinking long term.
We want to be able to sustain this project
and develop something that will work
in other communities.
We are focusing on
eliminating cardiovascular disease
and diabetes disparities
into the African-American, Latino,
Asian and Pacific Islander community.
Physical activity and nutrition:
those are two big areas.
Using instant recess
as our catalyst
we've worked to
bring
physical activity
into those environments
in which people are working.
They dance or exercise together.
And in one instance
we were able to work with
the at-risk Appalachian community.
Our grant is specifically
looking at our West Indian population
to address the high prevalence
of Type 2 diabetes
in their community.
We discovered that 28.5 percent
of our West Indians are affected by Type 2 diabetes
as adults.
We're helping people recognize
that they can make a difference within their own neighborhoods
and local communities.
We have two other programs in Schenectady County
that were funded through the CDC.
And because we have these three programs working in synergy
we're able to create stronger programs
and really improve the prospects
for changing systems and environment
within Schenectady.
The genius of what CDC has done with REACH
is that
someone decided that
the communities that were most affected
should be the ones that
designed
the solutions to their problem.
I think the biggest inspiration
from this
is that CDC had their trust in us,
that we really knew the answers
for our community.
The most exciting thing about REACH
is
the community ownership.
They really have taken this project
and made it their own.
It's one thing to ask people to be a partner.
It's another thing to really actively
engage folks in the process
from the beginning.
For communities of color
REACH gave us hope.