A chance encounter with THRIVE (Tool for Health and Resilience In Vulnerable Environments), changed the way Jennifer Haneline saw inequities. A social worker by training who had spent most of her career providing clinical services, she had never heard the term health equity until she participated in a THRIVE training implemented by the Louisiana Public Health Institute (LPHI).
Created by Prevention Institute (PI), this place-based and action-oriented tool and framework engages community leaders, residents, public health practitioners and multiple sectors in a process of assessing, identifying and improving community conditions that can facilitate better health, safety and equity outcomes. As a regional manager for LPHI, Jennifer's new awareness of the social determinants of health created a fundamental shift in her approach to community-based health improvement. Located in New Orleans, LPHI seeks to improve the health and quality of life of Louisianans, across a diverse state with a rich Creole, Cajun and French heritage; a challenging proposition in a state that has been ranked the second unhealthiest in the United States. Within its estimated 4.7M population, 64% are white, 32% black and 5% Hispanic/Latino. On aggregate, Louisiana residents were 37% more likely to die prematurely (before the age of 77) than others in the United States. Staff knew that continuing to attack specific health issues without addressing underlying causes would do little to improve health outcomes, in particular with Louisiana’s most vulnerable residents.
The National Network of Public Health Institutes (NNPHI), a membership organization that serves public health institutes including LPHI, also knew they needed to increase the capacity of its member institutes to engage communities in actively addressing the social determinants of health. In a strategic partnership with PI, NNPHI secured a five-year cooperative agreement from the Department of Health and Human Services Office of Minority Health to support the implementation of THRIVE by member institutes with its collaborative partners. As part of a train-the-trainer model, PI and NNPHI trained 57 staff from 12 member institutes to bring the THRIVE model to local communities with a charge to locally implement the process.
LPHI originally used their funding to support a workshop for 13 New Orleans residents. They went on to share the THRIVE model with all staff through the monthly staff meeting. Quickly, LPHI saw the benefits of exposing a broad range of staff members to the THRIVE model and its concepts. However, it was during a more in-depth training with The Louisiana Campaign for Tobacco-Free Living Regional Managers, including Jennifer that they learned to apply this tool to their own organization. Their enhanced awareness about the social determents of health influenced LPHI to develop an internal health equity work group specifically focused on decreasing the drivers leading to the high premature death rate among Louisiana’s communities of color.
The momentum continued to build when 9 LPHI regional managers, recently tasked with expanding their coalitions’ focus from tobacco-free living to healthy communities learned how THRIVE could serve as a tool for their work. THRIVE enhanced their capacity to understand the broader context from which health behaviors arose and engage community members in discussions about the structural issues that cause poor health outcomes, said Jaymee Lewis Desse, LPHI’s Healthy Communities Program Manager.
For Jennifer Haneline, a combination of things refocused how she did her work and solidified it into her daily practice. At first, she really just thought that THRIVE would help her fix her communities local health disparities, so that she could be “done with it.” Then she realized health equity was a continuum, an on-going movement. This initial training catalyzed her to think in new terms about how to facilitate the Ouachita Parish Healthy Community Coalition (OPHCC) and a need for regional leaders to explore these ideas as a way to develop emerging place-based solutions.
Ouachita Parish, a micropolitan community halfway between Shreveport, LA and Jackson, MS has a population that almost mirrors its state. Among the 156,220 residents, almost 37% identify as African American and 59% white. Among other things, the Parish’s higher than national average obesity rate (34%), physical inactivity rate (32%), and limited access to healthy food contribute to its premature death rate (9,282 per 100,000). To address this, OPHCC decided to move forward a three-tiered approach to improve health outcomes: build community gardens, increase active transportation and update the school district’s health and wellness policies.
The coalition scored a quick win by developing a community garden in South Monroe, a predominantly African American community. Adopted by residents including those from an adjacent housing complex, this new neighborhood fixture has grown via increased beds, signage and crop diversity. In addition, the coalition has recently partnered with the Alliance for a Healthier Generation and Monroe City Schools to implement a more comprehensive health and wellness policy.
Recognizing the need to serve the broader 12 parish region situated in Louisiana rural Northeast corner, Jennifer partnered with her local academic institute, children’s coalition and city government to implement a THRIVE training for almost 100 regional activists and other professionals. Throughout the day, Jennifer lead discussions about the 12 community factors within the THRIVE framework that impact health equity and can be used to promote community resilience.
Jennifer liked THRIVE because, “it challenged how people perceived their surroundings and really opened up their eyes.” She gave an example about what happened in one “great and terrible moment,” when she asked participants, “Why do we tend to see more tobacco, alcohol and fast food advertisements in lower income neighborhoods?” Without pause a participant quickly replied, “Because that’s what they want.” Despite a horrified feeling in the room and a collective silence, this moment provided an opportunity for genuine dialogue about classism and racism, an important component of the social determinants of health.
Jennifer’s initial exposure to the social determinants of health continues to have a ripple effect. As a two-year follow-up to her initial regional conference, Jennifer will implement a Health Equity and Cultural Relationships education and Leadership Summit. This will include discussions about health equity and race relationships with regional leaders, as well as the development of an action plan to collaboratively address these issues.
Since starting this effort, additional institutes adopted components of THRIVE in diverse ways. This has expanded the integration of the social determinants of health concepts into daily practice and enhanced the capacity of LPHI’s and the communities it served to develop institutional and place-based solutions that address the social determinants of health. “Pairing the broad reach of our public health institutes throughout the network with the health equity training and tools provided by PI was a valuable community health and empowerment endeavor,” said Vincent Lafronza, NNPHI’s President and CEO. This unique collaborative approach by DHHS-Office of Minority Health, NNPHI, PI, LPHI and diverse community partners has fostered an expanding circle of dialogue and action with broad reaching outcomes within Ouachita Parish, South Monroe and the larger state.