Here's a riddle for you. How do you make a public health example out of New Orleans? That's right, the city known for po' boys and partying and a flavor all its own—one that's very often fried and fatty. And that's the sunnier side of the story. New Orleans has suffered one scourge after another: Hurricane Katrina, which flooded 80 percent of the city, killing 1,000 people and leveling homes and beloved landmarks; notorious levels of corruption (Ray Nagin, the mayor during the catastrophe, was recently indicted for fraud, bribery, money laundering and other federal charges); and some of the nation's highest rates of poverty, obesity and crime.
But New Orleans is remaking itself. The health department's "Fit NOLA" campaign has employed a range of sectors and civic groups, and public-private partnerships to envision a city that's among America's 10 healthiest by 2018, New Orleans' tricentennial. The program has earned New Orleans recognition as one of six U.S. communities awarded the Roadmaps to Health prize, a new initiative from the Robert Wood Johnson Foundation (RWJF), which funds public health programs and, in this case, $25,000 to each community. The other prize winners, announced last month, are: Cambridge, Mass.; Falls River, Mass.; Manistique, Mich.; Minneapolis, Minn.; and Santa Cruz County, Calif. (To learn more about these efforts and see the video clips on each community, visit the foundation's website.)
Already, New Orleans boasts multiple achievements—among them, creating a new system of primary-care clinics to emphasize prevention, and requiring healthy vending choices and physical education in schools. Inspired by Philadelphia's "Healthy Corner Stores" program, New Orleans is bringing grocery stores, stocked with fresh fruits and vegetables, to areas that lacked access to nutritious food. How'd they do it?
"It sounds so trite," says Karen DeSalvo, New Orleans Health Commissioner. "You have to start with a shared vision ... we have brought ourselves together." And that means convening some 140 organizations in a city of 360,000 people, she says, to create "durable change" that lasts for generations. Whoever wanted a seat at the proverbial table got one, she says, with youth in particular playing a key role—representing, for example, three of the 15 people on Fit NOLA's steering committee. "They're genuine and real messengers for one of the most important messages of our time," she says, adding that "in our world, they help write the message."
All of the Roadmaps to Health winners relied on data and multiple partnerships to advance their efforts. They also placed an emphasis on youth engagement— an aspect underscored by RWJF President and CEO Risa Lavizzo-Mourey. In many cases, "they were using youth to measure or to come up with solutions or to document what they were doing and really tapping into our sense as a nation that we want the next generation to be healthier than we are and actually pulling in that generation," she says.
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In Santa Cruz, for example, the local United Way partners with Jóvenes SANOS, a group of Latino high school students who advocate for more nutritious and active living. The students live in Watsonville, an area with a dense Latino population where childhood obesity rates are 49 percent, compared to 31 percent in the city of Santa Cruz. "The Watsonville community is surrounded by abundant fields of strawberries, lettuce, artichokes, and other fruits and vegetables—healthy foods picked and packaged by local farm workers that rarely end up on their families' dinner tables or in their children's school cafeteria," according to the United Way, in its application for the Roadmaps to Health prize.
The youth group reported on the lack of healthy food choices in area restaurants, and developed a point system scoring restaurants according to their healthy offerings. They then pressed the city council to adopt an ordinance, which requires new restaurants to meet a minimum grade on their scorecard and recognizes existing restaurants that employ the point system.
In this case and others, such as working to curb binge drinking among area youth and providing health insurance for nearly every child in the county under the age of 5, the United Way of Santa Cruz County canvassed the community for support. For example, in response to an influx of prisoners from overcrowded state prisons, the United Way held a series of town hall meetings to address the issue as a public health problem to build support for releasing, while monitoring and rehabilitating, minor criminals. These meetings featured the offenders and experts in criminology and ultimately won the support of the community, which was necessary to ensure the newly-released prisoners could find a place to live and work, says Mary Lou Goeke, executive director of the United Way of Santa Cruz County.
After three months, 90 percent of these offenders stayed out of jail. In contrast, 70 percent of people who are released from jail without any rehabilitation are back in prison within three months, says Megan Joseph, the agency's director of community organizing.
Such solutions "don't pigeonhole a problem or a person but see how all the different parts of the community can get involved in eliminating problems or improving lives," Goeke says. "Interventions at the person level are not effective ... You can give nutrition education until the cows come home, but just being educated is not going to make a child have a healthy choice," she says. What will? "If you build a community where everybody's working toward this healthy environment, where you make it easy not to drink, you make it easy to have healthy food and fun exercise," she says. "Then you transform the community rather than transforming the people, and once you transform the community, the people get healthier."