Health disparities are driven by a complex web of economic, social, cultural, and medical influences, the details of which may vary from location to location, but the consequences are uniformly crippling. Nowhere is this more evident than in the Arkansas Delta region, where economic prosperity remains elusive mainly due to struggles in providing the infrastructure, skilled workforce, quality of life, and good-paying jobs needed to maintain and grow the local economy; and enabling households to generate enough income to support their families.
The primary culprit of health outcome disparities, cardiovascular disease, disproportionately impacts underserved, low-wealth communities despite improvements in management over the past 50 years. Over the years, many health improvement projects led by dedicated, hard-working people have been implemented in the Arkansas Delta region. Unfortunately, most of these projects were unsuccessful for several reasons. The traditional healthcare system is unable or unwilling to develop and maintain community-level interventions targeting communities with poor health outcomes; and grossly underfunded Public Health Departments presiding over a cadre of fragmented programs that proved minimally effective.
Team members in the Heart Healthy Communities project recognize the devastating impact of chronic disease in rural areas and know a “medical only” solution to the problem will not succeed. The Heart Healthy Communities team is domiciled in the UAMS Division of Cardiovascular Medicine but is led by Irion W. Pursell Jr., RN, BSN, MPH. Mr. Pursell is the Division of Cardiovascular Medicine’s director of primary cardiovascular disease prevention — the first public health practitioner in the nation to lead primary prevention efforts in a clinical medical division.
Community health workers are the foundation of our intervention. Community health workers have typically trusted community members, ideally positioned from the same cultural and linguistic backgrounds and life experiences, to provide tailored resources and responsive interventions. The Heart Healthy Communities project is leveraging this strategic model in the rural Arkansas Delta region to support the evolution from a health care system focusing only on medical care to proactively focused onconcentratetion and social determinants of health.
Other team members include:
- Jessica Barnes, Ph.D.
- Mark Massing, M.D., Ph.D.
- Sam Sears, Ph.D.
- Clarence Potter
- Sean Young, Ph.D.
- Allison Caballero, MPH
The Heart Healthy Communities project challenges the long-held assumption that underserved, minority, rural, and socially isolated populations are unwilling or uninterested in participating in improving their health and the health of their family and community. Our hypothesis is that given the opportunity, ‘early adopters’ will engage and experience benefits disseminated through their sphere of influence given a chance. Through first-hand knowledge of a positive outcome in the life of someone they know and through trust-building relationships with community health workers, the second tier of individuals will engage in a team scenario to realize similar benefits for themselves and their families. The team mentality is critical; research shows participation in a team for a common goal is far more impactful than offering someone help. The Heart Healthy Communities project understands the fundamental importance of that team approach for not only individual health but also community health.
With an understanding of previous shortcomings and challenges, the Heart Healthy Communities project was developed over the last decade as an intervention model targeting underserved, low wealth Arkansas communities with health outcomes disparities to address previous flaws preventing the rebalancing of rural health equity. The Heart Healthy Communities project focuses on a community health worker-based patient-centered and community-focused care team with a holistic approach equally valuing disease prevention and acute medical care. The hypothesis is a successful cardiovascular disease prevention strategy prioritizing community engagement, access to safe and effective cardiovascular disease risk reduction, and long-term focus on overall well-being in underserved communities will yield measurable results.
The fee-for-service healthcare funding model has created a shadow population of individuals characterized by social isolation, substance abuse, and chronic disease leading to poor health outcomes. These individuals tend to cluster in low wealth underserved communities. Therefore, designing a prevention/intervention strategy using a geospatial approach that targets specific geographical areas makes sense.
The Heart Healthy Communities project is a novel cohesive approach to improving health and wellness via community relationships enabling long-term fundamental change in individual and community health. Community health workers are the face of the Heart Healthy Communities intervention. Our community health workers team is deployed using a geospatial approach targeting the high-risk neighborhoods to assess and address the needs of residents in each household in the target area. Community health workers are local community members with focused health care training and form the interface between healthcare systems and communities to identify and address social needs and improve health care access, quality of care, and cultural competence. In each geospatially specified neighborhood, community health workers engage every resident 18 years or older. For enrollees, community health workers activate a portfolio of programs and resources to address and manage social and medical factors leading to cardiovascular disease while populating a ‘living registry’ with data enabling the examination of HCC’s impact on social and medical variables and critical metrics, including health outcomes in the target neighborhoods.
We hypothesize that although the top 10-15 overall needs may be the same, their ranking may vary widely due to differing local cultural, environmental, economic, historical, and social influences. The Heart Healthy Communities project’s structure, yet flexibility and focus on local resources allow adaptation to each locale as their needs evolve. This project expands horizontally (from neighborhoods in PC to other Arkansas Delta region counties) and vertically (as neighborhood-specific needs change from baseline) as the effects of resource utilization and improvements in personal and community health improvements advance over time.
A high priority of Heart Healthy Communities is that infrastructure, efforts, and critical stakeholders established with this project remain a fixture in the community, where long-term engagement is vital for continued improvements in health equity. Project data will be showcased and shared with county and state political figures, as well as other researchers in local, regional, and national forums, in hopes similar programs can be adopted in other areas where severe health disparities are ravaging rural communities as well as areas of social isolation and economic despair.
It is the goal of the Heart Healthy Communities project to make community health workers the go-to people for health and wellness advice.
The Metrics and Measures of Success
As Heart Healthy Communities progresses over the first six months, an initial evaluation of enrollee engagement and utilization data from social services referrals, the 20Lighter cardiometabolic health program, Health Science Index wellness optimization application, and telemedicine visits will be undertaken. The analysis will also reveal the number of Heart Healthy Communities enrollees introduced to the program via word of mouth from family, friends, and neighbors and those enrolled after community health workers engagement at their doorsteps. To further hone the model and ensure the portfolio of offerings adequately addresses the enrollee’s needs, structured interviews with community health workers, enrollees, and community focus groups will help evaluate Heart Healthy Communities’ effectiveness and identify opportunities to improve relevance. This data, in aggregate, serves as the first look at overall Heart Healthy Communities performance. Qualitative data serves two purposes: first, as an indicator or proxy for as-yet unmeasurable clinical outcomes, and second, to collect information on the target population’s needs and preferences, which may vary by location and from the general need assumptions made at the Heart Healthy Communities outset. The latter is essential contravention to promote engagement, aligned with enrollees’ needs and priorities, and identify the best delivery method.