A local nonprofit in Kisman, Central and Buckeye is launching an initiative to incorporate more community voices into efforts to improve local community health. That’s the idea behind the Community Health Needs Assessments (CHNA), which are in-depth, qualitative health surveys coming to each of those neighborhoods.
“Health and wellness is something that all of the communities that we serve have expressed an interest in,” said Joy Johnson, the executive director of Burten, Bell, Carr Development Inc., the community development corporation (CDC) that serves Kinsman, Central and Buckeye. “We also know that our communities face the strongest health disparities.”
Those health disparities, largely fueled by institutional racism, hit mostly African American neighborhoods in Cleveland hard. A host of environmental factors make health outcomes generally worse in these areas than in mostly white communities elsewhere in the city. That’s where these CHNAs come in: In theory, they will identify the specific environmental factors that perpetuate health disparities on a block-by-block scale. That hyperlocal information helps agencies like Burten, Bell, Carr, which currently bases its programming on data sampled from the city, county and state as whole, devote resources to projects that meet the specific health needs of each community they serve.
“Our ultimate goal is to shift policy,” said Jeff Verespej, the executive director of Old Brooklyn Community Development Corporation, which is a partner on the project. “We know that, in order to truly make those changes, it has to come long term with policy shifts — policy shifts and funding shifts.”
The Old Brooklyn Community Development Corporation will cover most of the project’s costs with about $140,000 in grants from the Mt. Sinai Foundation and the Sears-Swetland Family Foundation. Old Brooklyn CDC, with experience conducting its own CHNA, will advise Burten, Bell, Carr, which will raise some funds of its own to perform most of the on-the-ground work beginning early next year.
Burten, Bell, Carr’s work will begin with a series of community listening sessions to help formulate the CHNA’s questions and build community trust in the initiative. After that, the CDCs will pass along the information they gathered to their research partner, Case Western Reserve University, which will create survey questions and iron out the initiative’s other necessary details.
CHNAs, which focus on environmental health factors like access to food and housing, are most often employed by hospitals or healthcare institutions at the county and state levels, but Old Brooklyn CDC changed that in 2017 when it tailored a CHNA specifically for Old Brooklyn. Bringing CHNAs to Kinsman, Central and Buckeye signifies the first step of an ultimate goal to expand the hyperlocal CHNA model across Cleveland, Verespej said.
“We think this is work that can and should be scaled city wide,” he said. “So that every community, every resident, every neighborhood, every CDC, every council person has a resident-rooted, data-driven map on how to improve health outcomes in their neighborhood.”
Ensuring equitable participation and avoiding exploitation
Kimberly Fields, a lifelong Buckeye resident who has worked at nonprofits and foundations for decades, said that pervasive and consistent effort is necessary to address the health-related issues in her neighborhood. Many of those issues such as housing instability and food access have been festering for years, even decades.
“It’s not going to take a year,” she said. “It’s probably not going to take five years. It’s issues that didn’t happen overnight, so they definitely won’t be fixed overnight.”
To be truly effective, Fields said, the CDCs and researchers behind these CHNAs will have to spend time in the communities they are surveying. That’s the main reason Burten, Bell, Carr is holding those initial listening sessions. It helps that Burten, Bell, Carr is already visible and accessible to the communities they serve, Johnson said.
“Even though we have the institutional history and knowledge and expertise of Case Western Reserve’s Swetland Center formulating the process, it’s going to be important that it’s Burten, Bell, Carr wanting to know, Burten, Bell, Carr asking the questions,” Johnson said.
Some residents in Cleveland’s impoverished neighborhoods view outside institutions collecting data from them as exploitative, Johnson said, as if those institutions only conduct surveys for the grant money. Given Burten, Bell, Carr’s close connections to the communities it serves, residents will be able to hold it accountable to acting on this CHNA.
Fields also said some of the past surveys in her community have missed their marks by amplifying the voices of relatively few very active residents rather than incorporating input from everyone who makes up the neighborhood.
Ensuring equitable participation from different demographics in each neighborhood is baked into this project, Verespej said. When the questionnaire goes out, the research team will monitor response rates to make sure that certain groups don’t disproportionately influence the CHNA, and they will continually formulate ideas for how to better engage typically less active groups.
Even before Burten, Bell, Car and Old Brooklyn CDC applied for this project’s funding, they had conversations about how the survey strategies that worked in Old Brooklyn wouldn’t necessarily work in Central, Buckeye or Kinsman, Johnson said.
“Even within our own neighborhoods, we hear, what you did in Central won’t work in Buckeye and vice versa,” she said. “So we even have to have that diversity of approaches neighborhood-to-neighborhood.”
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Results and reasons
In Old Brooklyn, the CHNA from 2017 helped the local CDC identify six key areas of focus: healthy housing, green space access, food access, neighborhood resources, substance use and chronic disease. More specifically, the CHNA identified the following, according to Verespej:
Residents live in a food desert, traveling on average 3.9 miles to get groceries
A quarter of residents are food insecure, choosing each month between food and other basic necessities
More than half of residents lack awareness of neighborhood resources for social, emotional and mental health
More than 60% of residents don’t access any neighborhood parks
While nearly all of seniors want to age in place, most are worried that they cannot do so
With those issues identified, Old Brooklyn CDC used the neighborhood farmers market as a venue to try out solutions.
“We moved the market from a Tuesday evening to a Saturday morning, from a park nowhere near main streets or multi-family housing to our busiest intersection surrounded by denser, lower-income census tracts,” Verespej wrote in an email. “[We] added a free shuttle service run by our neighborhood senior center that connected apartment buildings to the market to businesses [and] to a distant grocery store. [We] enticed attendees via targeted programming (chef cooking demos, youth programming, social service provider info sessions), and offered bike rides or hikes that started [and] ended at the market.”
Although other factors could have impacted this, Verespej said annual usage of food assistance programs has increased by anywhere from 100% to 250% each year in Old Brooklyn since those changes were put in place.
Food access is a priority for Burten, Bell, Carr, too. The organization has been working to bring a grocery store to Central, where there aren’t many, Johnson said. Some community leaders have chimed in to recommend that the store be owned by someone in the community, or cooperatively by its employees. That way, the store’s owners would have a vested interest in bettering the community rather than just profiting from it.
That’s an example of why listening to the community is important, Johnson said, and the CHNA will prioritize that. Fields, however, said nonprofits haven’t always listened.
“We need to have an opportunity in order to live our best lives and have all the resources that we need,” Fields said. “They [nonprofits] have to be careful, making sure that they don’t think what we need based on their nine-to-five time in the neighborhood. Think beyond that. And we have to have community members sitting at the table — and not the kids table — at the table where the big decisions are being made about us.”
Michael Indriolo is a reporting fellow at The Land
This project is part of Connecting the Dots between Race and Health, a project of Ideastream Public Media funded by The Dr. Donald J. Goodman and Ruth Weber Goodman Philanthropic Fund of The Cleveland Foundation.