Racial and Ethnic Approaches to Community Health (REACH) program abstractJuly 2018

In this proposal, we aim to catalyze systems, structure, and policy change to improve population health, reduce the burden of chronic disease, and achieve health equity in Cuyahoga County. This collaborative application builds on successes and momentum achieved through prior REACH initiatives in our community since 2007 and was crafted by leveraging years of foundational work of the Health Improvement Partnership-Cuyahoga (HIP-Cuyahoga), a multi-sector, equity-grounded collective impact community consortium. HIP-Cuyahoga’s vision is for our county to be a place where all residents live, work, learn, and play in healthy, sustainable, and prosperous communities. The HIP-Cuyahoga mission is to inspire, influence, and advance policy, environmental and lifestyle changes that foster health and wellness for everyone, through 4 key approaches: perspective transformation, collective impact, community engagement, and health and equity in all policy.

The purpose of this proposal is to rapidly implement pragmatic approaches to nutrition, physical activity, and community-clinical linkages in the African-American population within Cuyahoga County. The racial disparities in chronic disease health outcomes in our community are the result of historical and contemporary injustices linked to structural racism. This proposed work aims to reduce racial disparities in chronic disease by building on realistic activities found to be successful in the 2014-2018 REACH grant and related HIP-Cuyahoga work to improve nutrition across the lifespan, increase physical activity opportunities, and facilitate resource linkages to chronic disease self-management and other prevention programs through empowerment of neighborhood-based community health workers and the integration of resource referrals within clinical electronic health records.

This proposal addresses new nutrition strategies for residents across the lifespan by leveraging our branded healthy food retail Good Food Here network and facilitating increased communication between partners developing and providing alternative food options in our targeted neighborhoods, implementing and reinforcing nutrition standards, improving access to affordable healthy food through implementation and support for small and large retail stores, as well as, increasing timely, accessible and culturally appropriate lactation support.

From a physical activity perspective, this proposal facilitates design and implementation of protected bicycle facilities through improved land use and new environmental design strategies to improve African-American resident utilization within the greater Cleveland area.

Finally, this proposal aims to build upon prior chronic disease self-management successes and addresses resource disconnects within clinical care by training and deploying community health workers (CHWs) certified in evidence-based chronic disease self-management programs in target neighborhoods while also building a robust two-way electronic health record interface with United Way 2-1-1 for real-time resource referrals during clinical ambulatory encounters.

Intermediate outcomes of these interventions include increases in: (1) number of places offering healthier foods; (2) number of persons with access to healthier foods; (3) number of

continuity of care/community support actions implemented for breastfeeding; (4) number of places that improve community design by connecting safe and accessible places for physical activity; (5) number of persons with safe and accessible places for physical activity; and (6) use of appropriate and locally available health/community programs.

This comprehensive proposal is a product of a strong, established community coalition - HIP-Cuyahoga, that is committed to long-term change while systematically addressing the complex determinants of racial disparities in chronic disease in an effort to achieve health equity.