Graphic from U.S. Department of Health & Human Services, Office of Minority Health, ACT NOW program.

Graphic from U.S. Department of Health & Human Services, Office of Minority Health, ACT NOW program.

Improving Health Among Public Housing Residents In The District: A Resident Driven Process PANEL Kenneth Council, Resident Leader Charles Debnam, Director of Health Education Services, Breathe DC Robert M. Grom, Deputy Director, DC Cancer Consortium Diana Lapp, M.D., Deputy Medical Officer, Unity Health Care, Inc. MODERATOR Julian C. Wilson, Jr. Resident Services Specialist, District of Columbia Housing Authority

Citywide Advisory Board Health Committee OBJECTIVE Conduct a series of Health and Wellness Workshops to educate residents on the concept of health inequities and the effects on their health outcomes. Use these workshops as a vehicle to motivate residents to take more personal and collective action to improve their health and that of other residents. STRATEGY Develop resource network of community health providers to include local government agencies, hospitals, universities, community health clinics, and nonprofit organizations that offer services and advocacy to reduce health inequities.

Citywide Advisory Board Health Committee Following a meeting in December 2010, experts worked to help residents develop a community health needs assessment tool to be administered to all public housing properties. Residents presented the assessment plan to the Executive Director to solicit support to implement the assessment, which they hoped to perform with help from the Department of Health, ORS staff and other partners with requisite research and community health expertise.

Health Needs Assessment

Health Needs Assessment

Citywide Advisory Board Health Committee

Citywide Advisory Board Health Committee Initiatives DCHA staff has worked closely with several partners to launch initiatives to improve health among public housing residents. These efforts included: Collaboration with DC Breathe to support a grant application to the DC Department of Health to support a tobacco cessation project at DCHA to develop a pilot effort designed to reduce smoking behavior at selected housing developments. Because of DCHA involvement, the design for this project includes resident empowerment and will enlist leadership for the CWAB to help determine which developments can best advance tobacco cessation effort in DC public housing. Collaboration with UDC as the lead applicant in the development of a grant application to HUD for improvement of asthma management in public housing.

Citywide Advisory Board Health Committee Initiatives Introduction of the Langston Gardening Club (LGC) to program managers at DOH has enabled LGC to make a grant application to expand its efforts and introduce community gardening to other public housing and low-income communities. Because of the particular severity of health problems in Wards 7 and 8, staff has met with senior officials at both the Children s National Medical Center and the United Medical Center (UMC) where the Emergency ward of Children s National Medical Center is housed. Staff has connected both medical institutions to the CWAB to coordinate balanced services of projects to all properties located in these two wards. Breathe DC won a competitive grant with support and technical guidance from ORS to provide education on the dangers of smoking and second hand smoke in public housing and to offer smoking cessation classes to public housing residents. The grant is funded under an HHS grant to the District Department of Health.

CANCER ISSUES IN THE DISTRICT Each year 2,700 District residents are diagnosed with cancer; each year 1,100 die The District has the nation s highest death rates for breast, prostate, and colorectal cancer Access to cancer specialists for DC s low-income population remains a persistent challenge despite one of the nation s highest insured populations and some of the country s best hospitals

CANCER ISSUES IN THE DISTRICT DC s income gap is rising, and disparities in cancer death rates and access to care persist among DC s most prosperous and poorest wards Insufficient Medicaid reimbursement rates which continue to fall result in more and more physicians refusing to treat the District s most vulnerable residents

CANCER ISSUES IN THE DISTRICT Persons with lower socioeconomic status (SES) have higher cancer mortality rates than those with higher (SES) regardless of race/ethnicity. Uninsured persons are more likely to be diagnosed with cancer at later stages and less likely to receive standard treatment. Racial and ethnic minorities tend to receive lower quality health care even when income and insurance status are controlled. Social inequalities, including discrimination, persist and have a negative impact on cancer treatment outcomes. Source: American Cancer Society, Cancer Facts and Figures, 2012

CANCER ISSUES IN THE DISTRICT Efforts toward social justice, defined as equitable distribution of social, economic, and political resources, opportunities, and responsibilities and their consequences will promote prevention and improve treatment and survival outcomes of persons living with cancer.* Extracted from 2011-2016 DC Cancer Control Plan Health Equity: Christopher J. King, FACHE *Source: Braveman, P. & Gruskin, S. (2003). Defining Equity in Health. Journal of Epidemiology and Community Health. 57, 254-258.

CANCER ISSUES IN THE DISTRICT More than 60% of the District s residents are racial/ethnic minorities, 12.5% are foreign born, and 14.2% do not speak English as a primary language. Approximately 17% of its 601,723 residents live in poverty many of whom are concentrated in communities east of the Anacostia.* Extracted from 2011-2016 DC Cancer Control Plan Health Equity: Christopher J. King, FACHE * Source: Ward, E., Jemal, A. & Cokkinides, V. (March/April 2004). Cancer Disparities by Race/Ethnicity and Socioeconomic Status. Cancer Disparities. 54(2), 78-93.

TOBACCO ISSUES IN THE DISTRICT In the US, cigarette smoking and exposure to secondhand smoke causes approximately 443,000 deaths each year. When states are ranked for mortality rates, DC ranks highest for deaths from all smoking-related cancers for both men and women. In the District, black males are at the highest risk for smokingrelated cancers. Survival rates from smoking-related cancers are poor.

TOBACCO ISSUES IN THE DISTRICT In the District of Columbia, 16.2% of adults are current cigarette smokers, over 77,000 individuals, compared to the national median of 18.4%. This figure places the District 10 th among states for smoking; however DC ranks highest for deaths from all smoking-related cancers, for both men and women. Among adult District residents who smoke, the following demographic characteristics have been documented: More men than women smoke (19.2% compared to 13.7%, respectively) Education appears to be a factor, with 27.2% of smokers having less than high school education compared to 12.5% of those with more than high school degree Smoking appears to decrease with age with 23.8% of those 18-24 reporting they are smokers, compared to 14.9% for 25-44 year olds; 19.8% for 45-64 year olds; and 10.6% for those 65 and older Racially, more African Americans (23.3%) and Hispanics (13.4%) are smokers than whites (9.1%) Source: Centers for Disease Control and Prevention, Tobacco Control State Highlights 2010

TOBACCO ISSUES IN THE DISTRICT DC is one of only 5 states to spend nothing on tobacco programs The District currently spends ZERO local dollars on cancer or tobacco programs and 0% of tobacco tax collections are reinvested to fight the health burdens caused by those products. Tobacco-related health costs alone top $600 million each year in DC

Smoke Free Public Housing Working with community leaders to empower residents to quit smoking!

Breathe DC Smoke Free Public Housing In March 2011 Breathe DC was awarded $150K by the DC Department of Health s Community Putting Prevention to Work project to collaborate with four selected public housing developments to bring awareness to the dangers of tobacco and to prepare the over 1000 residents for a policy change that would make the public housing development they reside in totally smoke free in their units and on campus.

Program Outline Identify existing leadership within 4 public housing developments and assist them with assembling a team of individuals committed to empowering fellow residents to quit smoking Help Leadership Teams engage the community and educate smokers about the program

Program Outline Conduct 2 four week group sessions per development focusing on how to successfully quit smoking, the dangers of second-hand smoke, and community engagement Empower residents who completed the program to fight for smoke free environments

DC Public Housing Developments Langston Dwellings 274 Units Ward 5 Green Leaf 242 Units and Green Leaf Senior Bldg. 215 Units - Ward 6 Benning Terrace 274 Units Ward 7 Knox Hill 122 Units Ward 8

Collaboration/Partners ANC s DC Department of Health Tobacco Control Dept. DC Public Housing Authority DC City Wide Advisory Board DC City Wide Advisory Board Health Committee Resident Council Members Catalyst Grantees Clergy

Accomplishments Conducted 6 four week cessation groups 216 participants completed All residents received quitline cards 5 Secondhand Smoke Exposure presentations 2 Brown bag trainings conducted in other wards 5 Resident Leader Teams developed Presented Public Housing Webinar with Boston Housing Authority

Graphic from U.S. Department of Health & Human Services, Office of Minority Health, ACT NOW program.