A Community Approach to Address Health Disparities
Prevention Institute has updated its Community Approach to Addressing Disparities in Health with the revision of THRIVE: Toolkit for Health and Resilience in Vulnerable Environments. A centerpiece of THRIVE is a set of community level factors that are linked to Healthy People 2010 Leading Health Indicators. It now features a simplified list of thirteen factors to facilitate use of the tool at the local level.
Advancing a Community Resilience Approach to Improve Health Outcomes
Poor health and safety outcomes, including chronic disease, traffic-related injuries, mental illness, substance abuse, teen pregnancy, and violence, are disproportionately high among low-income people and people of color in the United States. In addition, the impact of racism and oppression increases numerous risk factors for illness and injury, including reduced access to fresh nutritious foods, fewer opportunities for physical activity, greater exposure to environmental toxins, and substandard housing and neighborhood conditions.
With the increased recognition of existing health disparities in the United States, there has been an emphasis on treatment and intervention. However, there is also a need to prevent health disparities before the onset of injury, illness, or death. Focusing on underlying factors, both risk and resilience, can save lives and money and reduce suffering. Resilience, defined here as the ability to thrive and overcome risk factors, merits attention in order to achieve health and safety outcomes. Studies show that resilience factors can counteract the negative impact of risk factors and that effective approaches need to include attention to both. Given the preponderance of attention to risk factors, this project will highlight resilience factors that support health and safety outcomes.
Resilience approaches have tended to focus on individual measures; attention to community-level factors is also important. For example, the building blocks of healthy communities include marketing and availability of healthy foods as opposed to fast food and tobacco, safe parks, effective education, health and social services, community gathering places, and locally owned businesses. Research confirms the relationship between such factors and health and safety outcomes. For instance, social cohesion corresponds with significant increases in physical and mental health, academic achievement, and local economic development, as well as lower rates of homicide, suicide, and alcohol and drug abuse. Other examples of community resilience factors include environments that promote walking, bicycling, and other forms of incidental or recreational activity, jobs, a willingness to take action for the common good, positive intergroup relations, and positive behavioral norms. By strengthening such factors, communities have significant capacity to enhance health and safety.
Measuring Community Resilience
The goal of this project was to develop a tool to assess community-level resilience factors that serve as benchmarks for the Leading Health Indicators of Healthy People 2010. The tool, which is informed by research, included an environmental scan and piloting in Del Paso Heights, California; Hidalgo County, New Mexico; and East Harlem, Central Brooklyn, and the South Bronx in New York City. A diverse, national expert panel provided guidance throughout the process. The pilot process confirmed the tools utility in rural and urban settings and for community members as well as practitioners and local policy makers. This tool can help local decision-makers close the health gap. It includes collateral materials such as training materials and preliminary guidelines to translate the THRIVE results into concrete changes in local policies, programs and priorities.
THRIVE (Tool for Health and Resilience in Vulnerable Environments) was created to answer the question, "What can communities do to improve health and safety and reduce inequities?" Developed with funding from Department of Health and Human Services Office of Minority Health, THRIVE is: 1) a process for engaging community members and practitioners in changing community conditions to achieve better health and safety outcomes; and, 2) a tool for assessing the status of community conditions and prioritizing them for action to improve health, safety, and health equity. This overview and background document is organized in a question and answer format to respond to frequently asked questions about THRIVE, such as: Why do health inequities occur? How does THRIVE promote health equity? Why does THRIVE focuses on the community level? What's the relationship between THRIVE and the social determinants of health? What is the role of health care in reducing health inequities?THRIVE Assessment Worksheet
The THRIVE (Tool for Health and Resilience in Vulnerable Environments) Assessment Worksheet enables organizations and coalitions to rate and prioritize 12 THRIVE factors in their community in order to take action to improve daily living conditions, enhance health and safety and reduce inequities. Developed with funding from the Department of Health and Human Services Office of Minority Health, the 12 THRIVE factors are based on extensive research linking medical conditions to community-resilience factors that can be strengthened for better health and safety outcomes. The 12 factors are community-level determinants of health and safety, grouped in 3 interrelated clusters: 1) the social/cultural environment (people), 2) the physical/built environment (place), and 3) the economic/educational environment (equitable opportunity). The Assessment Worksheet is also flexible, and allows communities to add, rate, and prioritize factors that they consider important. THRIVE has demonstrated utility in urban, rural, and suburban settings, as described in the American Journal of Public Health 2005 article, A Community Resilience Approach to Reducing Ethnic and Racial Disparities in Health.
This project is made possible by funding from the Office of Minority Health, U.S. Department of Health and Human Services.
Like many Prevention Institute tools, THRIVE serves as a useful supplement to health-related academic programs. Feedback from MPH students includes:
"...it was enlightening to consider such factors as willingness to act for the common good or what is sold and how it is promoted."
"There were many useful asides about how to collaborate or how to prioritize problems. I also appreciated the practical examples of real results in real communities."
"I found the THRIVE tool very useful and intriguing in its simplicity, effectiveness, and broad scope of application. 'Change comes from within' applies not only to people, but to communities, and the people of the community need to be empowered to do so. Then they have a chance of bringing lasting change. THRIVE seems to be a tool that could be used by lay people and professionals alike."
"I really liked the THRIVE tool. I found it empowering for communities and for health care providers. It is also simple to navigate and easy to understand. The entire site was informative and has potential applications in the future, both in school and beyond. The resources offered were invaluable; it can be difficult to find resources if you don't have anyone pointing you in the right direction."
"I felt that the tool was very useful in breaking down what some of the key issues are within a given community."