Place Matters: Eliminating Health Disparities in Jefferson County, Alabama

Apr 30, 2014, 12:09 PM


Place Matters is a national initiative of the Joint Center for Political and Economic Studies designed to build the capacity of local leaders around the country to identify and improve the social, economic and environmental conditions that shape health. “Addressing upstream causes of poor health, such as issues related to employment, education, poverty, and housing and environmental health risks through community action, policy development, and measuring the indicators associated with these determinants of health, are at the heart of our Place Matters work,” said the project’s program director, Autumn Saxton-Ross, PhD.

Nineteen Place Matters teams are currently working in 27 jurisdictions. This week NewPublicHealth will be highlighting six teams, chosen by Ross as representing both what needs to be fixed and what can be done.

file Jefferson County Place Matters team members take part in Food Day

Jefferson County, Alabama is the most populous county in the state. The Place Matters team, headquartered at the University of Alabama at Birmingham, found that the county leads the nation in chronic diseases and conditions linked to premature death, disability, decreased productivity and high health care costs. The leading causes of death in the county are heart disease, cancer and diabetes, and the county also exceeds state and national rates for obesity.

“At the heart of the Jefferson County Place Matters Team is a commitment to empowerment and civic engagement,” said team leader Monica Baskin, PhD, as associate professor of preventive medicine at the University of Alabama/Birmingham Nutrition and Obesity Research Center. The team works to improve the social determinants of health by:

  • Informing and illuminating public policy debates via research, analysis and information dissemination
  • Building capacity of community leaders
  • Facilitating community action planning and implementation.

Baskin, who has led the team for two and half years, said it has so far focused on improving access to healthy, affordable foods; physical activity opportunities; and obesity-related issues. The team also released a health equity report about the county, timed to coincide with the 50th anniversary of the Birmingham campaign, a touchstone moment in the U.S. civil rights movement.

file Team members at the release of the Community Health Equity Report

“The report really identified that there is quite a bit of variation in the county as it relates to racial concentration, poverty, life expectancy, infant mortality and healthy food access in particular, so that communities within the county that tend to have more whites or be more affluent definitely had better health outcomes,” said Baskin.

Baskin said the team was able to show in a series of maps based on Census data where the target areas are with respect to food deserts, poor life expectancy and other negative health outcomes.

file Population in poverty
file Food deserts
file Life expectancy

“We’ve been able to use that information in several conversations with the mayor of Birmingham, county commissioners and the City Council—which has been pivotal—as the city has embarked on a new comprehensive plan in the last year, the first one that they’ve had in 50 years.”

Baskin pointed out that until this past year, the city’s comprehensive plan was the one that had been in place before the start of the civil rights movement and was what was used to guide planning and zoning and other kinds of things in the city.

“So, we’ve definitely made an impact on conversations now about increasing access to healthy, affordable foods and opportunities for physical activity, but also trying to address some of the issues related to the social determinants of health that the Joint Center really focuses on with the Place Matters work,” she said.

Baskin said the critical future goal of the team is to make sure that this issue of health equity is part of everyone’s mindset as they’re making policy decisions within the local health department, the city council and the county.

“A number of communities within the county are undergoing revitalization, and so we’re hoping to make sure that issues such as access to healthy, affordable foods and access to primary care—for example—are included in the planning,” she said.

The Place Matters team has also been successful in joining with other groups and coalitions across the county that are now trying to use this place-based work in grant-making and the development of programs. The Community Foundation of Greater Birmingham, for example, has provided funding to further share the health equity report and recently made the decision that a part of its grant-making portfolio will target some of the areas identified in the report as having high rates of poverty, infant mortality and food deserts.

“We’ve definitely benefitted from conversations with other Place Matters team members, particularly in the Southeast and the Deep South. Being in a more conservative and fiscally conservative area, addressing needed changes has been a little bit more challenging than at some of the other team locations,” she said. “So we’ve had conversations about how to engage conservatives in the idea that you can have an equitable distribution of resources, so that people can have greater access to improving their health...They really get the economic impact of disparities that exist in our community and how improving the health of all really is a good financially sound strategy for the county.”

This commentary originally appeared on the RWJF New Public Health blog.