Race, cost of living and other divergent factors in community lead to development of a county health plan.
| 2019 Q4 | story by Joshua Falleaf | photos by Steven Hertzog
Vickie Collie-Akers, Beth Llewellyn and Dan Partridge stand outside the Douglas County Community Health Facility.
Paired with the 2018 Douglas County Community Health Assessment, the 2018 Health Equity Report presents some startling health disparities in Lawrence.
Chris Tilden, research project manager at the KU Center for Public Partnerships and Research, says, “We recognize that there are disparities in health that are dependent upon who you are and where you live. If you look at race and ethnicity, if you look at economic well-being, there are differences in health in different populations.”
The Health Equity Report states: “It is important to note that race and ethnicity are often linked with disparities,” largely because the social determinants affecting health, such as “social, economic, and environmental factors,” negatively impact some more than others. However, such health inequities “are avoidable.”
Director of Lawrence-Douglas County Health Department (LDCHD) Dan Partridge and many community coalitions are determined to provide the education and resources necessary to make Lawrence a healthier place for all. In response to the findings, the LDCHD developed the Douglas County Community Health Plan, and underpinning it all is a commitment to making a healthy life available to every member of the community.
“We have a responsibility for our health,” Partridge says, “but we also have a responsibility for each other’s health. There’s a community level to that, and some people need help. Resources are not equally distributed, so some people need a little more than others when it comes to opportunities for good health. And that’s what that plan tries to do.”
The Community Health Plan defines Health Equity as “a fair and just opportunity to be healthier.” The Plan focuses on goals that “remove obstacles to health such as poverty and discrimination, and their consequences, which in this plan includes the lack of access to safe and affordable housing, behavioral health care, jobs that reduce poverty, and healthy foods and built environments that facilitate active living.”
Each of these areas, for many reasons, affect some disproportionately more than others. Tilden, also former director of Community Health, adds, “Recognizing that there are root causes behind those disparities that are oftentimes rooted in social and structural inequities, we need to work to fix these if we’re going to see a narrowing of the gap.” A brief review of the Health Equity Report shows that Lawrence is susceptible to the same structural discrimination that affects other communities.
Addressing the root causes is complicated. They are the same historical biases that have plagued many minority and economically disadvantaged populations. That they still exist is evidence the systems that have historically perpetuated them persist, even in the Free State. But there are good minds and generous spirits working together to explore, innovate and narrow that gap.
Safe and Affordable Housing
The relatively high cost for housing in Douglas County consumes resources that families could be using on education, healthy food and health care. According to the 2017 Health Assessment, there is more than a 10% lower rate of home ownership here than in the rest of Kansas, and more than half of “renters spend 30% or more of their household income on housing.” The assessment finds that a resident “must earn $16.25/hour or $33,800 a year to afford a 2-bedroom apartment.” The median income of black and Asian populations falls roughly $2,500 and $5,500 below this mark.
“But I think part of the reason it raised up on the Community Health Plan is maybe the more
indirect,” says Vicki Collie-Akers, associate professor at the KU Medical Center and liaison for the Academic Health Department. “If people are spending too much of their income on housing, [then there are]trade-offs they have to make to be able to do that.” Many residents who find themselves in this situation are likely to experience significant increases in stress, anxiety and other associated negative health outcomes.
Several proposals to make appropriate housing more accessible include increasing housing density and multifamily spaces so less of the purchase price includes land costs. Also, local leadership continues to seek federal and state resources to decrease rental costs through vouchers and other methods, though these efforts present other challenges.
Top to Bottom: Beth Llewellyn, director of community health at the Health Department; Vickie Collie-Akers, associate professor at the KU Medical Center and liaison for the Academic Health Department; Dan Partridge, Director of Lawrence-Douglas County Health Department
Behavioral Health
“In some ways, [the social component]is implicit in the strategies you see in the Plan,” Collie-Akers explains. This factors even more significantly in the behavioral health goal of the Plan. “There’s a lot of discussion about how do you strengthen peer networks to support people with different substance abuse disorders or mental health challenges?” Collie-Akers continues. “How do you view assets in the community that are delivered through people that have walked that road before and make sure there’s social support?”
“Community” is best suited to improve the health of each other. As such, the goal is to “create an integrated system of care that moves from crisis and illness as a norm to recovery and prevention as a practice.” This practice focuses on proactive measures as opposed to reactive. 23.2% of adults reporting as having been diagnosed with a depressive disorder. Suicide is the second leading cause of death among 15- to 44-year-olds. Prevention and access is the priority.
Much of the effort to address behavioral health involves utilizing resources we already have available. For instance, findings from the 2017 Community Health Assessment suggest there is an “overall satisfaction with the local public health system.”
Food and Healthy-Built Environment
Based on the United States Department of Agriculture criteria, areas of Southwest Lawrence, North Lawrence and East Lawrence are identified as food deserts because residents in these locations who have lower incomes also have low and limited access to grocery stores.
Food insecurity—meaning limited or uncertain availability of or uncertain ability to access nutritionally adequate foods—results in hunger, weight gain and premature death, according to the Community Health Assessment. Many of those suffering from such insecurity are children.
Now a national leader in the field, the Douglas County Food Policy Council (DCFPC) has been developing an understanding of and responding appropriately to local food issues since its formation in 2010. One of the Council’s largest accomplishments is the completion of the Douglas County Food System Plan in 2017. This Plan is a comprehensive look at how local farmers, grocers, consumers, restaurants and others provide and consume healthy and sustainable foods within the local community.
The Community Health Plan is also geared to increase access to healthy foods by way of multiple modes of transportation. The 2016 Citizens Survey “found that only 26% of community residents felt safe navigating community intersections by bicycle.” One group of concerned citizens has welcomed the opportunity to support safe transportation within and throughout the community.
Originally founded to address diet and activity, LiveWell recently has been focused on “creating a more connected system” in Lawrence. One of its projects has been the Lawrence Loop. Once finished, the 22-mile trail around the city of Lawrence will “connect us to each other, because it gets people out in the community and interacting with each other,” says Jeff Severin, director of Campus Planning & Sustainability at the University of Kansas and member of Friends of Lawrence Area Trails (FLAT).
Working to build health into the infrastructure of the community, LiveWell is a “coalition of community leaders” who “aim to change everyday places—neighborhoods, schools, after-school programs, workplaces, restaurants and city streets—into environments where people thrive.” Its mission is to lead “a movement to build communities that support the health and well-being of all.” As a result, this safe and efficient mobility can provide easier access to the nutritional foods people want.
The DCFPC, LiveWell and many other organizations have joined efforts to make a healthy Lawrence much more of a reality through many initiatives, including the USDA Food Insecurity Nutrition Incentive program and Double Up Food Bucks, which support farmers and low-income families in providing support for fresh fruits and vegetables.
In 2019, Be Active Safe Routes program aims to “reduce traffic congestion and air pollution, increasing the opportunity to be physically active and building community cohesion” throughout Lawrence and neighboring communities.
Complete Streets, a similar plan that was approved by the Lawrence City Commission in December 2018, compels that planning “consider all aspects of multimodal transportation in the design and implementation of street and related infrastructure projects.”
Poverty and Jobs
Clear inequities exist when looking at the poverty rates of African American and Asian populations in the Lawrence community, both groups dealing with median incomes numbers that fall below the $33,800 a year necessary to rent, as noted above.
Well-paying jobs could relieve the stress of expensive housing responsibilities for residents. However, according to the Community Health Plan, understanding how to address poverty and jobs in the city “will require further data gathering and analysis.”
Beth Llewellyn, director of community health at the Health Department, admits, “That’s the one issue area that didn’t have a goal except a plan to plan. And we’re in the middle of that process.” While education plays a part, Llewellyn knows it’s much more complicated than one might hope, particularly when dealing with “multigenerational poverty. Do you have the social structures and supports to be able to hold on to a job or stay in school? Are there implicit biases in the system that folks feel like they’re not getting the employment opportunities in the places that have higher wages?”
LDCHD director Partridge remains diligent. “Like with any big problem,” he says, “you break it down into pieces. It’s the education that goes into it. It’s the barriers to employment, whether that be transportation, childcare, discrimination … You just peel it all apart and figure out where can progress be made in our community?”
Healthier Together
According to the 2019 Douglas County Community Health Plan, the way to a better, stronger, healthier Lawrence is a path better taken together. Llewellyn asks: “Who do we have to be for one another?” Of course, the answer to this question implicitly involves who we become as a result of the neighbors with whom and the community in which we live.
“The Community Health Plan is not the big idea,” Partridge says. “The big idea is that improving health is everyone’s work. It’s your work. It’s my work. … It’s everyone’s in this community.
In our private and professional lives—it’s all of our work.”
In order to truly grow and thrive, to improve where we can and celebrate the successes we have had in this remarkable place, Lawrencians must boost one other’s strengths and embrace one another’s challenges; we all have plenty of both. In doing so, we will increase our successes, improve upon our weaknesses and continue to become a community for all.