The Southeastern San Diego Cardiac Disparities Project works with faith organizations to provide holistic heart health programs in African-American communities. Its first steps are confronting racism and building trust.
Editor’s Note: This post originally appeared on the National Civic League website. We are reposting it with permission this February which is Black History Month as well as American Heart Month.
The Southeastern San Diego Cardiac Disparities Project is improving the cardiovascular health of black residents in South San Diego by altering two fundamental systems that can influence their health: faith organizations and health care providers.
Elizabeth Bustos, director of community engagement for Be There San Diego, and Reverend Gerald Brown, executive director at United African American Ministerial Action Council are leading the effort. They are recipients of the 2017 Award for Health Equity, which was presented to them by the National Civic League and Robert Wood Johnson Foundation. The Award honors leaders who are changing systems and showing how solutions at the community level can lead to health equity.
The heart of this project is trust—as well as its power to heal and build. It focuses on Southeastern San Diego, the city’s African-American hub—the community experiencing the county’s highest rates of heart attack and stroke. Its goal is to improve cardiovascular health in the 6,400 black adults living there by transforming faith organizations and health care, two influencers of health.
Southeastern San Diego is comprised of a cluster of working-class neighborhoods where over fifty percent of families earn less than the self-sufficiency standard. It has barren parks, too many liquor stores and fast-food restaurants, yet just one supermarket.
Bustos and Brown were not the first people to approach black congregations in Southeastern San Diego in hopes of forming a partnership around health. But previous efforts that over-promised and under-delivered left many congregations mistrustful of such partnerships. Over the years, many pastors had opened their congregations to researchers who came then disappeared. As Senior Pastor William Benson explained, “We were concerned about people coming into the community with passion, but what they really wanted was our numbers, our data...they would put in for grants and get the money, and it never came back to the community. We were tired of being played.”
A New Approach
Where others might gloss over or ignore the legacy of race and racism in shaping health in African-American communities, Bustos and Brown recognize that these are truths that must be discussed, confronted, and considered.
Brown pledged to his fellow pastors that, “We’re going to do things differently.” And indeed, they have. Bustos and Brown took the time to listen to these concerns, to acknowledge the community’s history, and to build relationships. Work meetings became forums for candid dialogue about the roles that race, exploitation, and neglect had played—and continue to play—in the community.
The pastors demanded that the project be transparent for them to consider joining. They wanted to know what data was going to be collected, who was going to collect it, and how it was going to be used. The project director developed a data stewardship agreement that gave the pastors the transparency they wanted and ownership of their data. It took nearly a year of listening, learning, and conversations to build the trust necessary to act.
The project puts the community in the driver’s seat. It calls for each congregation to develop its own “heart-healthy plan” to reduce heart attacks and strokes, based on its unique demographics, resources and needs. The plan must have three components: nutrition education; exercise and health monitoring; and tracking participants’ blood pressure and weight. The pastors also agreed to come together once a month to learn from one another. And they agreed to meet with clinicians, particularly doctors, to share their experiences with them. To date, 20 churches and a mosque have full-fledged programs to combat heart disease and strokes, and these are as varied as the faith organizations themselves.
As Bustos and Brown explain, this approach is not simply about creating a heart-healthy intervention. Rather, “it builds a structure for African-Americans to improve their health on their terms, relying on their trusted leaders, and controlling the way they interact with other powerful entities.”
Creating a Culture of Health Within Congregations
At Immanuel Chapel Christian Church, Pastor Christian developed a plan that calls for monthly meetings on a Saturday morning with her congregants. In her opening prayer at the meetings, she tells them that scripture calls for taking care of one’s body to be able to serve God. Afterward, they take a brisk “gospel walk” around the neighborhood, singing an inspirational hymn. They pass businesses, dilapidated houses and empty lots. Each month, they add another block or two to their walk.
Next, as they settle into the pews, the congregants hear from a featured speaker, usually an African-American health professional. The speaker explains the scientific and medical causes of cardiovascular disease and offers practical, culturally appropriate recommendations.
Afterwards, the participants each have their blood pressure and weight registered by a member of the congregation who isa retired nurse. If she sees a problem, she recommends they see their doctor or may gingerly nudge them with suggestions on how to step up their efforts to lose weight. It’s low-key and nonjudgmental.
As morning gives way to noon, the participants enjoy a healthy lunch and fellowship. In a single morning, they’ve nourished their soul, fed their body, participated in group exercise, and received disease prevention information from a trusted source in a language they understand—all paving the way for them to take action in protecting their health.
This work is not only transforming mindsets about health, it connects pastors more closely to their congregations. The doctors, nurses, personal trainers, teachers, and healthy cooking aficionados that pastors find among their congregants are then invited to form health ministries. These lay leaders implement the church’s heart-healthy plan; engage congregants in self-care; and uncover health issues. To date, the congregations are tracking around 2,000 people.
In messages to their flock, the pastors regularly speak on ways to prevent heart attack and stroke with small lifestyle changes. They encourage the congregation to take steps to become healthier: “Don’t forget to stop by to get your blood pressure checked;” “I’m looking forward to next weekend’s health class;” “Remember, no fried food at our monthly reception.” Many congregants publicly announce that they are trying to eat healthier and to lose weight.
Many attendants in these congregations are in their 60s, 70s or older. It’s worth noting, however, that many are the main caretakers of their grandchildren. The project underscores that prevention begins at an early age, and that these project participants are in a position to influence a younger generation.
Trust and Transformation
The legacy of racism and neglect hangs heavily over health discussions in these congregations. Mistreatment breeds mistrust. The pastors tell stories about how some of their congregants do not trust doctors. “There is such a huge trust issue,” Christian told the health care providers at the project’s annual health summit. “People are fearful. They remember what happened to their grandmother, to their sister, their next door neighbor.”
At the same time, the clinicians expressed frustration at how some of their African-American patients do not adhere to their medication regimen, and often follow a relative’s lead, instead of taking what is prescribed.
The project has created safe spaces for clinicians, particularly doctors, to interact with faith leaders. These exchanges provide insights not easily gained elsewhere, raising awareness among clinicians of the history and culture of African-Americans—with the goal of informing all levels of health care—from the treatment of individual patients to how a health system treats a community.
At one event, the ACC/AHA Cardiovascular Risk Calculator was introduced to the health care providers, many of whom were unfamiliar with it. The online calculator estimates the risk of the patient having a heart attack or stroke depending on a variety of factors, including race. Black patients face a significantly higher risk. On the spot, many doctors expressed an interest in beginning to use it. Furthermore, these community-clinical linkages have resulted in doctors volunteering to help the health ministries.
The collective impact of this project contributes to a Culture of Health by fostering a healthy lifestyle from the ground up: Pastors raising awareness of cardiovascular disease from the pulpit; congregants taking steps to reduce their disease risk; doctors and other health practitioners becoming more aware of African-American history. As Bustos and Brown will tell you, “It all begins with a willingness to build trust in a community, and trusting its members to lead the way to lasting solutions.”