By Lindsay Tiffany, Communications Specialist, NACCHO

The following post is part of a series of interviews with local health department (LHD) staff who will present at the 2015 NACCHO Annual conference. This post offers a preview of the session “PSE Squared: Public Health and Public Housing: Reducing and Preventing Chronic Disease through Policy, System, and Environmental Change and Partnership, Community Strength, and Engagement,” which will explore a successful partnership between the local health department and the city’s housing authority to combat chronic disease. NACCHO Voice spoke with speakers Patricia Barney, MPH, SHIP Program Coordinator, Saint Paul-Ramsey County (MN) Public Health; Alicia Huckleby, MA, Resident Initiatives Director, Saint Paul (MN) Public Housing Agency; and Ann Dwyer Tranvik, RN, Public Health Nurse, Saint Paul-Ramsey County Public Health.

• Please tell us about your community and its burden of chronic disease.

Alicia: The St. Paul Public Housing Agency (PHA) provides public housing and Section 8 within the city of St. Paul. We have about 4,200 units of public housing that serve about 10,000 individual residents. Our public housing is made up of a combination of town home units and high-rises. In our high-rises, about 77% are either elderly or disabled. In our family sites, about 40% are elderly or disabled heads of household.

Ann: I’m a public health nurse employed by St. Paul-Ramsey County Public Health. I’ve been working with PHA since 2012, when we began our Statewide Health Improvement Program (SHIP) grant. The program allocates state dollars to all 87 Minnesota counties to address chronic disease. The goal is to create good health where Minnesotans live, work, and play using policy, systems, and environmental changes. We approached PHA in 2011 to see if they would be interested in working with our department, which was applying for a SHIP grant. They said yes and together we have done a variety of things to work toward our goal of reducing chronic disease and improving health.

Our county has a population of 506,278 people. It is the most densely populated county in the state. In our county, 61% are overweight or obese, according to self-reported height and weight; 20.6% are smokers; and 73.6% eat too few fruits and vegetables (data from 2012–2013).

Alicia: Access to and affordability of healthy food can be particularly difficult for low-income populations. The fact is that eating healthy and organic can be expensive. Also, our population has some significant transportation and mobility challenges. A small number of our residents are drivers because most can’t afford a vehicle. Part of what we have been doing is figuring out how to bring healthy options to them in their communities.

Ann: One thing I would add—and this is true of all 20 public housing sites—is the great range of diversity, which is reflective of the city of St. Paul. It creates a great opportunity for us to work with people from a variety of backgrounds to try to respond to their health needs in new and innovative ways.

• How the partnership between St. Paul Ramsey County Public Health and St. Paul Public Housing Agency develop?

Alicia: It developed from a cold call from the director of the health department asking if we as the public housing agency were aware of the SHIP grant opportunities that Ramsey County had received; whether we had programs that focused on health and wellness; and if there were ways we could work together. A cold call led to a conversation and brainstorming session between our organizations. They briefed us on the goals and objectives of the grant and how they wanted to use the funding. For PHA, our primary focus is on providing affordable housing and linking our residents to community services. We’re not a community service agency, per se, so we talked about how we could make the partnership work and still have it fit within our mission. In some ways for us it was a leap of faith. It was completely unique to what we had done in the past. We’re very, very glad to say that it’s worked extremely well and it’s one of the partnerships of which we’re most proud.

• How did the policy, system, and environmental change approach affect your efforts?

Ann: Policy, systems, and environmental change is a pretty nebulous term. It’s hard to get your hands around it, but I’ll give you a few examples of how it affected our approach.

The strategies that we’re mandated to pursue with our grant are healthy eating, active living, and reducing exposure to tobacco. The first summer, in 2012, we were out at one of our family sites, McDonough, which has lots of children. They have a nice rec center and a community center, and there are many, many children there in the summer. We wanted to find out whether kids would be interested in a bike club and decided to interview the kids having free lunch that day. We came to find out that the kids either had had a bike once but it was stolen; if they had a bike, they weren’t allowed to bring it to the community center because it would be stolen; or their parents couldn’t afford a bike.

One of the strategies we’ve been working on the last year and a half is providing healthier options in the vending machines. All 16 high-rises have at least three or four vending machines and are a primary source of revenue for them. The vendors agree to give building residents a percentage of sales—between 10 to 15% of sales. Those residents are able to use that money to form their budget to purchase items that they have decided as a group that they want. It is an important source of income for them.

We decided to try to see if we could provide some healthier options in the vending machines. We were concerned that there might be some resistance because, frankly, healthy food isn’t exactly what you go to a vending machine for. We were able to work through the Resident Council, the organization within each high-rise that has a leadership responsibility, to gain support for healthy vending over a period of months.

Our first step was to survey residents in all the high-rises about whether they would be interested in healthier food choices and we found that a large percentage were. We were able to bring that data back to the leadership council to show what residents were saying and ask them to move forward. Our latest progress report shows healthy vending options improved from a baseline average of 10% healthy vending across all hi-rises to 30% healthy vending, with beverages being at 40%. Through the process of working with the residents and involving them in the communication, we’ve been successful. It is a policy now because we’ve added healthy vending standards to our vendor contract.

Alicia: From the very beginning, it was important to us that we move forward only with the support of our Resident Councils and our residents. After all, all the activities we’re engaging in are going to have an impact on their lives. We make sure they have a role at the table to be decision-makers. We meet with them regularly to discuss progress on current initiatives and propose new ideas—whether that’s establishing a local farmer’s market or expanding a walking club.

• What strategies would you recommend to other local health departments to replicate your success?

Ann: Part of our success is the fact that we started out small. For the first year and a half, we started as a pilot project and worked with only five sites out of the 20. By starting small, we gained some skills and understanding about how to do this before expanding to all of the sites. Another important thing was the staff resources PHA has dedicated to the program.

Alicia: I would say don’t neglect your local housing authority or agency. For housing agencies, think more broadly about who your community partners are; likewise for other public health agencies. Another factor was remembering what our mission is and conducting activities that fit within our mission.

Remember that the partnership is a learning experience. There are things that are just not going to work for either organization or for the residents and we shouldn’t try to force that. Another crucial component was learning how to use our current partners in new ways. How could we roll in some of their activities into our SHIP-related work or vice versa—or just work better together, in new ways together to reach more residents? And lastly, individual support from residents is so critical to long-term success and change.

Interested in more interviews with NACCHO Annual 2015 presenters? See more here.

To learn more about the outstanding learning opportunities at NACCHO Annual 2015, July 7–9 in Kansas City, MO, visit http://www.nacchoannual.org. The early-bird registration deadline is June 4. Register today.