Anna J. Thomas, MPHDeputy Public Health Directorathomas@manchesternh.gov(603) 628-6003 ext. 341

City of Manchester Health Department

Neighborhood Health Improvement Strategy:A Public Health Approach to Improving the

Health of Manchester’s Children and Families

LeadRadon

Chemicals/PesticidesCombustion

ProductsMold

Insects/RodentsFire/Injury

Drinking Water

Well ConstructedEnergy EfficiencyAffordableVentilatedMaintainedSafe

Diseaseand/or Hazard Approach

PreventionInterventionTreatment

HousingHealth

(Adapted)

StructuralApproach

Historically, We’ve Had Different Approaches:

“When we think about health, we usually think about health care and access to care and the quality of care.

But what research clearly shows is that healthis embedded in the larger conditions

in which we live, learn, work, play and thrive.

So, the quality of housing and the quality of a neighborhood have dramatic effects on health.”

- Dr. David Williams, Harvard School of Public Health,“Unnatural Causes: Is inequality Making Us Sick?”

The Connection Between Where We Liveand How We Experience Health

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How Health is Produced in Communities

Adapted from Dr. Anthony Iton’s presentation “Achieving Health Equity: Advancing Community Health & Moving the Needle on the SDOH”

RiskBehaviors

Disease& Injury

Mortalityor

Recovery

Social & Neighbor-

Hood Conditions

SocietalInfluences

Preventive Health Sick Care

OutcomesSolutions

Health Inequity Health Disparity

Pu

blic

He

alth

He

alth

Care

Where We Live, Learn, Work and Play

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To “move the dot on the graph”, we must also see and apply ourselves to

the 80%.

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Unclear risks to Manchester’sand New Hampshire’s Future …

Growth in aging, every-changing community diversity and family structure.

Significant increases in local poverty levels (especially among children) compounded with a high cost of living.

Unstable rates of uninsured and reliance on siloed social service providers, public assistance programs, etc.

Inappropriate and/or untimely use of care (at the wrong time and in the wrong place, or not at all).

Some community and neighborhood vulnerabilities exist (violence, crime, unhealthy living and housing conditions).

Nearly 8000 or 54% of Manchester school children were enrolled in free and reduced meals. Of this total, 90% were enrolled in free meals which means that the total family income for these children were below 130% of the federal poverty guidelines (MSD, March 2014).

Over 40% of the City’s children under the age of 18 were living in single-parent households (ACS, 2007-2011).

On average, the MSD identifies nearly 800 students as being displaced or homeless during a school year. In the City’s most impoverished elementary schools, one in 15 children will live with severe housing instability at least once in their lifetime.

Of the 600 students who attended Beech St. Elementary School last year, 400 of these children moved in and out of the school during the academic calendar (SY 2013).

Our Community’s Children Are LivingWith Instability and Vulnerability

Manchester had 2,852 “habitually truant” students (NH DOE, SY 2013). Over one in five of Title I elementary school children experienced 10 or more half days of unexcused absences during the school year. In total, it is estimated that nearly 7,000 children of all ages are in need of some level of school attendance intervention (MSD, SY 2011).

Only 57% of Manchester’s third graders are reading proficiently compared to 77% statewide. Variation in subgroups (i.e.. FRL, LEP, minorities) is significant (NH DOE, SY 2013).

16% four-year cumulative drop out rate compared to 5% throughout the State of New Hampshire (NH DOE, SY 2013).

Our Children Are Struggling to Functionand/or Thrive Which, Unfortunately,

Serves as Our Barometer for the Change Needed

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Students Enrolled in Free/Reduced Meal Plans(Living Below 185% of Federal Poverty Level)

Manchester School District vs. All Other New Hampshire, School Years 03-04 to 11-12

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

SY 03-04

SY 04-05

SY 05-06

SY 06-07

SY 07-08

SY 08-09

SY 09-10

SY 10-11

SY 11-12

% o

f S

tud

ents

in

Gra

des

1-1

2

City of Manchester All Other NH

March 2014

Total 54.0%

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Vulnerable Population Footprint

One American Journal of Public

Health study determined that graduation rate

improvements could positively affect

health more than medical advancesby an 8:1 ratio.

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When Community Violence Occurs WithinIts Safety Net Institutions, Neighborhood Trauma

Can Take Years, Even Decades, to Overcome

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Mapping Maternal and Child Health Risk of Lifetime Povertyin Manchester, NH (Fredenburg, et. al.), 2014

Not everyone experiences

health equally or in the same way.

“In almost all urban areas,serious health problems and unstable social

conditions are highly concentratedin a fairly small number

of distressed neighborhoods.”

Stressful events that are chronic, uncontrollable, and/or experienced without the child having access to support from caring adults disrupts the architecture of a young person’s developing brain which can alter—in a lasting way—the child's capacity to learn and to adapt to challenging situations throughout their lifetime.

Young children who experience toxic stress are at high risk for a number of poor health effects in adulthood, including cardiovascular disease, cancers, asthma, and depression.

The research has shown that even in the most extreme cases of adversity, well-timed changes to children's environments can improve outcomes.

The Directive to ActWith a “Clear, Unrelenting Focus”

- Dr. Michael McAfee, Director of the Promise Neighborhoods Institute at PolicyLink

There is aDose-Response

Relationship With Adverse Childhood Experiences (ACEs)

and NegativeHealth OutcomesOver the Lifespan

The Critical Connection:Healthy Homes and Neighborhoods Matter

in the Development of Children and Families

Policy, Systems, and Environmental (PSE) changes are “interventions that modify environments to provide healthy options and to make healthy choices easy for everyone”.

If we focus on adapting policies, systems, and environments, we can maximize resources by extending our impact to reach more people.

We must do this by harnessing convergent strategies, even if the goals of the collaborating organizations are divergent.

By modifying the environmental context, we can support healthy choices across a population vs. an individual.

Meredith Truss, MPP Maryland Department of Health and Mental HygieneHealth Policy Analyst Center for Cancer Prevention and Control, Prevention and Health Promotion Administration

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When population-based measures,such as violent crime, high school incompletion and inpatient asthma

visits occur at elevated rates,a community-level, place-based response is required in order to

reverse and prevent these trends.

This must be a shared responsibilityby all those who have the opportunity

to impact the lives of residents.

In fact, the current and future healthof our City depends on it.

Our Call to Action …

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Educational Achievement

Economic Wellbeing

Supportive Living

Environments

Access to Appropriate

Care

Healthier Behaviors

Individual & Family Health Status

Social Capital – Networks – Neighborhood Social Construct

Neighborhood Socio-Economic & Physical Environment Social

Connectedness and Safety

City of Manchester Health Departmentwww.manchesternh.gov/health

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Moving from Generational PovertyTo Generational Success

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NHIS Goals and Guiding Principles Prevent toxic stress and adverse childhood experiences.

Attain health equity.

Achieve environmental justice.

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Community Organizing Around Healthy Neighborhoods and Healthy Kids …

Who Has The Power To Get Us Thereand at What Level is it

Most Efficient for Them to Work?

A community school is both place and partnerships between the school and other community resources.

Using public schools as hubs, enduring relationships are built among educators, families and community members.

This means:

Manchester’s Community Schools Model

Listening to our neighbors. Improving access to health care. Increasing social capital by coordinating

and organizing community-based events. Focusing on neighborhood improvement

efforts.

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Current Investment Portfolio

Community care coordination (CHW’s).

Healthy start with maternal and child health home visiting.

Proactive healthy home visits.

Neighborhood and school-based events, family gyms and fitness programming.

Co-location of mental/behavioral health in the schools.

Strengthening childhood resiliency.

Building adult capacities.

Pro-attendance case management (SW’s).

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Private-Public Partnerships Are Key …

And Provide An Opportunity to ReinforceCommunity Values (Philanthropy, Art, Environment,

Neighborhood Pride, Healthy Living, etc.)

No crosswalks/ no walk buttons

Local Park crosses the street, but no way to cross safely

Near local elementary School

Speed of traffic

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Focus on Evaluation

Are we seeing the expected/anticipated outcomes?

Continuous Quality Improvement to demonstrate small tests of change for scalability and replication. Example: Decrease the % of habitually-truant students to 20% or

less by the end of SY2015

Utilizing Promise/Results Scorecard to set up a centralized database for monitoring process and outcome indicators.

Developing a “MyManchester” Website to mutually share neighborhood-relevant information as one step towards authentically engaging residents in problem solving.

Where Do You See Yourselfin Community Change for the Better?

A Special Thanks to Our Supporters for Helping Us Build aCollective Impact Model and More Strategic and Integrated Ways

to Plan/Fund/Foster the Change We, and the Residents,Want to See in Our Neighborhoods

Robert Wood Johnson Foundation Granite United Way Endowment for Health NH Charitable Foundation Cogswell Benevolent Trust Norwin S. and Elizabeth N. Bean Foundation The Dartmouth Institute HNH Foundation Corporate Sponsors

Convergence Innovation Fund EPA New England Asthma Regional Council NH Department of Transportation US HUD Community Improvement Program PolicyLink St. Mary’s Bank US DHHS

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Thank You !!!

QUESTIONS???

Great Links: http://www.manchesternh.gov/Departments/Health/

PublicHealthData/ReportsandDocuments.aspx

https://www.youtube.com/watch?v=QN7VpIdtDpE

http://nhpr.org/topic/queen-city-crime

“Like” the MHD on Facebook:

https://www.facebook.com/CityOfManchesterNHHealth