Applying a Community-Based Participatory Research Approach to Address Determinants of Cardiovascular Disease and Diabetes Mellitus in an Urban Setting

TOBIA HENRY AKINTOBI, PHD, MPH, KISHA B. HOLDEN, PHD, MSCR, LATRICE ROLLINS, PHD, MSW, RODNEY LYN, PHD, MPH, HARRY J. HEIMAN, MD, MPH, PAMELA DANIELS, PHD, MBA, GLENDA WRENN, MD, ALLYSON S. BELTON, MPH, PETER BALTRUS, PHD, SHANICE BATTLE, MPH, AND LASHAWN M. HOFFMAN

While the scientific evidence demonstrates that individually focused interventions designed to decrease cardiovascular disease (CVD) and diabetes risk can be impactful, individuals and families reside within social and physical environ- ments/communities that may serve as barriers or facilitators of healthy lifestyles. This chapter details an established community-based participatory research (CBPR) model designed to reduce risk for CVD and type 2 diabetes mellitus (DMII) among underserved and vulnerable African Americans through policy, systems, and environmental improvement in a Metropolitan Atlanta community. To comprehensively employ CBPR processes to the community health needs assessment (CHNA), lessons learned over a 15-year collaboration led by a community- majority board were employed and included a mixed-method community health needs assessment led by community residents. To move beyond mapping and documenting health disparities, the CHNA results were prioritized toward the identification of community and evidence-based initiatives in response. Reducing the future burden of DMII and CVD depends on the success of both “top-down” national/state initiatives and “bottom-up” targeted CBPR approaches that bring together transdisciplinary teams that not only address health disparities but also employ policy, systems, and environment changes that advance health equity.

Introduction

The 2013 Centers for Disease Control and Prevention (CDC) Health Disparities and Inequalities Report1 offers a comprehensive “assessment that highlights health disparities and inequalities across a wide range of diseases, behavioral risk factors, environmental exposures, social determinants, and health-care access by sex, race and ethnicity, income, education, disability status, and other social characteristics.” In the report, Meyer et al.1, p184 concluded that “reducing disparities requires national leadership to engage a diverse array of stakeholders; facilitate coordination and alignment among federal departments, agencies, offices, and nonfederal partners; champion the implementation of effective policies and programs; and ensure accountability.” The majority of such initiatives are “top-down” and do not incorporate the leadership and guidance from those living in communities that represent both the burdens and potential solutions central to understanding and addressing obstinate health disparities. When extreme differences in health/health outcomes are significantly associated with social disadvantages, the differences can be labeled as health inequities; and in most cases these differences (1) are systematic and avoidable; (2) are facilitated and exacerbated by circumstances in which people live, work, and contend with illness; and (3) may be intensified by political, economic, and/or social influences.2 It is imperative that public health professionals, researchers, clinicians and health policy makers embrace lead roles and multidisciplinary teams that include community leaders to bridge the gap between the rich and the poor concerning health issues, by promoting health equity and setting guidelines for global health initiatives. In order to address health inequities, social justice must be expanded to reach people on a larger scale which is more inclusive and less exclusive.

While the scientific evidence demonstrates that individually focused interventions can be impactful, individuals and families reside within social and physical environments/communities that may serve as barriers or facilitators of healthy lifestyles. Health risk factors not only cluster within individuals and families but are also influenced by social, economic, and structural factors that impact health-promoting lifestyles. The concentration of disadvantage that often permeates urban, low-income, underserved, vulnerable, and racial/ethnic minority neighborhoods may restrict resident opportunities to engage in healthy behaviors that reduce risk for chronic diseases such as diabetes and cardiovascular disease (CVD). Thus, a direct negative impact on the health of these communities may ensue. This chapter details the national prevalence and epidemics of CVD and DMII, correlates of risk factors for these diseases, and limitations of using a siloed approach to address CVD and DMII. Most importantly, we present the application of an established CBPR approach to an evidence-based, culturally tailored model designed to reduce risk for CVD and DMII among underserved and vulnerable African Americans through policy, systems, and environmental improvement.

 
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