BY: ROSE M. Z. GOWEN, MD
Nancy Stahl
Brownsville, Texas, was founded in 1848 at the bustling Mexican border on the banks of the Rio Grande River. Immigrants from faraway countries, local Mexicans, American farmers and entrepreneurs all worked together in weaving the culture that I am fortunate to have been born into and that is my home today.
Resources were limited and life was not easy for the early residents. The Mexican-American War was fought here, as was the Civil War's last battle. An epidemic of yellow fever killed thousands. Poverty abounded — and still does. Perhaps worst of all was indifference and underappreciation of the Rio Grande Valley's merit and her people's talent and potential.
Time passed, life happened, and, as in many cities, lifestyles changed. Farmers' markets closed, junk food was born, fast food became the norm, neighborhoods and public spaces were planned, but they focused only on car traffic. Walking to school became a grandmother's memory.
The results of these social changes in Brownsville became apparent 15 years ago, when the University of Texas School of Public Health opened a campus there. School researchers went out into the community and directly evaluated thousands of people to find out who Brownsville residents had become and what health risks had taken the place of yellow fever. They found several staggering realities.
Among residents, 80 percent are either overweight or obese. About 1 in 3 has diabetes — and half of them are not aware of it. Nearly 70 percent of Brownsville's people have no health insurance coverage, and diabetes represents a huge economic factor. The American Diabetes Association estimates that medical expenditures for people with diabetes are 2.3 times higher than for those without diabetes. Statistically, uninsured people with diabetes have 55 percent more emergency department visits than people who have health insurance.1 That's a daunting reality in Brownsville, where so many residents don't know they have the disease but do know they don't feel well, so they turn to emergency rooms or clinics.
As local data was collected and shared, the University of Texas School of Public Health investigators formed the Community Advisory Board, a diverse cross-sector group of community folks and entities representing schools, churches, hospitals, grocery stores, businesses and nonprofits. These people listened and learned why it was imperative that they all get involved in developing solutions to motivate people to make healthy food choices and build regular activity into their daily lives.
Quickly, the audience became partners, and just as the early settlers did, they rolled up their sleeves and began working with available resources to build programs and networks that were accessible to all people, evidenced-based and cost-effective.
The data revealed that the approach needed to be directed at families, including parents and children, given 30 percent of all fourth graders in Brownsville were already obese. Poverty, a well-known social determinant of health, also was a likely a root cause, with 34 percent of the population living below the federal poverty line. The low rates of health insurance and lack of access to care have led many household breadwinners to become disabled or unemployed at younger ages from untreated diabetes or other chronic disease. This vicious cycle creates poverty, and the poverty creates health problems. In addition to diabetes, the region's morbidity and mortality rates, higher than in the rest of the state or in the nation, are driven by higher rates of cardiovascular, liver and kidney disease as well as cancer and infectious disease.
COMMUNITY CAMPAIGN
¡Tu Salud Si Cuenta! (Your Health Matters!) was an early initiative by the founding partners — the University of Texas School of Public Health, Community Advisory Board and city health department — to address health disparities and high rates of obesity and resulting chronic disease. It started as a Spanish-language, community-based media campaign (TV, radio, newspaper) that taught the value of healthy eating and active living featuring local role models.
The founding partners also trained a team of promotoras (lay health-care workers) and deployed them into the community to knock on doors and teach and motivate, while becoming friends and neighbors. Exercise and nutrition classes led by promotoras began in parks, churches and schools on most days of the week.
Today, ¡Tu Salud Si Cuenta! has become an interactive, community-wide campaign that includes media, environmental policy and system changes to promote healthy living and improve health. This campaign is now being replicated in neighboring towns across the county and has engaged city leaders and grassroots community groups to partner on everything from passing smoke-free ordinances and complete streets policies to creating community gardens, farmers markets and hike and bike trails. All has been accomplished with creative collaborations between the School of Public Health and public and private entities.
The Brownsville Farmers' Market was another early initiative, one aimed at increasing access to fresh fruits and vegetables. After a year of investigating how and where a farmers' market might function and thrive, a collaboration comprising the School of Public Health and the city health and parks departments opened the Brownsville Farmers' Market in Linear Park, a little-noticed space in the center of the city. Hundreds visited the market on opening day, and 50 dozen farm eggs sold in 30 minutes. Vegetables sold out shortly thereafter, and, most surprisingly, shoppers stayed and visited in the park for hours. A health-promoting public space was born, and a dormant park became an active one.
Since the market's development, two neighboring cities have opened markets following the same certified farmers' market model, in which consumer buys directly from grower, the market has a board of directors and the goal is to introduce fresh fruits and vegetables to its communities, restaurants and schools. Many of the same farmers participate in all three markets. Our model was awarded a gold medal from the U.S. Border Health Commission, and it was recognized by the Texas Department of State Health Services.
WEIGHT-LOSS CHALLENGE
In an effort to continue "raising the volume" in the city, we began the Brownsville Biggest Loser (BBL) program in 2008. Affectionately called the "Challenge," it is a January through April invitation to try making healthy food choices and inserting physical activity into daily life. The program is free and open to all, and it kicks off with measuring participants' blood pressure, abdominal and hip circumferences and weight.
During the 12-week program, there are free exercise and nutrition classes, motivational text messages, and weekend events like a 1-mile or
5k walk/run and a bicycle ride for children and families. The Challenge has set two Guinness World Records: the first for the largest Zumba dance/exercise class, and the second for the largest ZumbAtomic class (Zumba dance for kids). We have registered more participants each year, totaling more than 6,000. These results tell us that thousands of New Year's resolutions in Brownsville now have a healthy focus and meaning.
The Brownsville Wellness Coalition formed three years ago with the aim of becoming a nonprofit entity to operate the Brownsville Farmers' Market and the newly developed community garden program. Six community gardens are thriving in Brownsville in low-income areas where families enjoy gardening instructions and a plot for as little as $15 a season. It has been proven that they can grow healthy vegetables for themselves and also earn $200 a week selling their excess at the farmers' market. Whereas this may not sound like a lot of money, these neighborhoods have households whose monthly income is $400.
BUILT ENVIRONMENT
How can a person walk if there are no sidewalks, or ride a bicycle if there are no trails or bike lanes? Proceeds from a city-wide plastic bag ban that charges the shopper $1 per transaction if they do not bring their reusable bags funded a master hike and bike plan for Brownsville.
In the last five years, more than $3 million in grant dollars from multiple sources were raised to build segments of the network. Local ordinances have passed for "Complete Streets" (streets that allow safe travel for autos and people on foot and on bicycles) and "Safe Passing" (requiring motor vehicles to stay three feet away from pedestrians and cyclists), and a comprehensive no-smoking ordinance has passed, too.
An open street or ciclovia is a street closed to car traffic for a few hours every week or every month, allowing people to come into the street to walk, ride a bike or jog without the fear of being hit by a car. We began an open streets program that we call "CycloBia" in 2012. Held on Friday evenings or Sunday afternoons, each event attracts as many as 12,000 people. Restaurants along the way have increased sales on CycloBia days, and surveys indicate that more than 80 percent of participants rate the event as a 5 on a fun scale of 1-5. Attendees also report they increase their activity levels by 48 percent after experiencing a CycloBia. We will hold six events in 2015.
Our local data showed us early on that 1 in 3 adults is diabetic and that half of those individuals don't know they have the disease. Coupled with poverty and high rates of those who are uninsured, the result is epidemic numbers of people in Brownsville with untreated and uncontrolled diabetes and high rates of disability from related complications such as amputation, blindness, dialysis and depression. Diabetes is an economic issue for our community as well as a matter of health, because so many adults are either unable to work due to diabetes, or unable to work because they need to care for a family member with diabetes.
Local clinics, hospitals, mental health providers, employers, school districts and nonprofit organizations all are involved in the Community Advisory Board (CAB). Together they support healthy eating and regular activity throughout the community via programing, education, policy change and built environment change in many collaborative ways. Additionally they work together to develop pathways to increase access to health care and connection to a medical home. Our long-range plan called "Imagine Brownsville" involves the city's seven major employers or businesses, all of which participate in the CAB and many of which have started their own employee wellness programs. None has been financially burdened because there so many ways they can contribute to the effort that are inexpensive or free. All benefit from the goal of a vibrant, healthy and economically thriving Brownsville.
Our early settlers had no choice but to work together in unique ways to make a home. They did so with hard work, by building partnerships and by being tenacious. We are following their lead, cultivating and educating partners from all sectors of the community, electing a local physician to the city commission and making sure that healthy choices are available and accessible to the poorest among us. Together, we are ensuring that healthy choices are the easy choices in Brownsville, because Our Health Matters — ¡Nuestra Salud Si Cuenta!
ROSE M. Z. GOWEN was elected to the Brownsville City Commission in 2009 and re-elected in 2013. As a commissioner, she has focused on smart growth, quality-of-life projects and health-related issues such raising awareness of the region's high levels of obesity and related chronic disease. She was instrumental in the design and development of the Brownsville Farmer's Market and served as its first board chair. She is a practicing physician at Su Clinica, a federally qualified health center.
NOTE
- American Diabetes Association http://professional.diabetes.org/News_Display.aspx?TYP=9&CID=91943&loc=ContentPage-statistics.