RESUMO
BACKGROUND: Diabetes mortality at the United States-Mexico border is twice the national average. Type 2 diabetes mellitus is increasingly diagnosed among children and adolescents. Fragmented services and scarce resources further restrict access to health care. Increased awareness of the incidence of disease and poor health outcomes became a catalyst for creating community-based coalitions and partnerships with the University of Arizona that focused on diabetes. CONTEXT: Five partnerships between the communities and the University of Arizona were formed to address these health issues. They began with health promotion as their goal and were challenged to add policy and environmental change to their objectives. Understanding the meaning of policy in the community context is the first step in the transition from program to policy. Policy participation brings different groups together, strengthening ties and building trust among community members and community organizations. METHODS: Data on progress and outcomes were collected from multiple sources. We used the Centers for Disease Control and Prevention's Racial and Ethnic Approaches to Community Health (REACH) 2010 Community Change Model as the capacity-building and analytic framework for supporting and documenting the transition of coalitions from program to policy. CONSEQUENCES: Over 5 years, the coalitions made the transition, in varying degrees, from a programmatic focus to a policy planning and advocacy focus. The coalitions raised community awareness, built community capacity, encouraged a process of "change in change agents," and advocated for community environmental and policy shifts to improve health behaviors. INTERPRETATION: The five coalitions made environmental and policy impacts by engaging in policy advocacy. These outcomes indicate the successful, if not consistently sustained, transition from program to policy. Whether and how these "changes in change agents" are transferable to the larger community over the long term remains to be seen.
Assuntos
Relações Comunidade-Instituição , Diabetes Mellitus Tipo 2/prevenção & controle , Coalizão em Cuidados de Saúde/organização & administração , Promoção da Saúde/organização & administração , Planejamento Social , Arizona , Emigração e Imigração , Hispânico ou Latino , Humanos , México/etnologia , Inovação Organizacional , Formulação de Políticas , UniversidadesRESUMO
BACKGROUND: Systemic, environmental, and socioeconomic conditions create the context in which community members deal with their health concerns. Comprehensive, community-based chronic disease prevention interventions should address community-wide or regional policy issues that influence lifestyle behaviors associated with chronic diseases. CONTEXT: In two communities along the Arizona-Mexico border, community coalitions that administered a comprehensive diabetes prevention and control intervention expanded their membership to become policy and advocacy coalitions with broad community representation. These coalitions, or Special Action Groups (SAGs), identified and prioritized policy issues that directly or indirectly affect physical activity or nutrition. METHODS: Local schools were one focus of advocacy. The Centers for Disease Control and Prevention's School Health Index was implemented as part of the overall intervention; the SAGs supported schools in advocating for more physical education programs, removal of vending machines, substitution of more healthful options in vending machines, and changes in health education curricula. In the broader community, the SAGs promoted opportunities for walking and bicycling, long-term planning by their cities and counties, and healthy food choices in local grocery stores. Advocacy tactics included attending and making presentations at city council, school board, parks and recreation, and planning and zoning commission meetings; participating on long-range planning committees; organizing an annual community forum for elected and appointed officials; and presenting healthy food and cooking demonstrations in local markets. CONSEQUENCES: After three years, SAGs were able to document changes in local policies and practices attributable to their activities. INTERPRETATION: The SAGs contributed to systems changes in their communities and were able to obtain new resources that support protective behaviors. Also, the advocacy process itself provided strong positive reinforcement to all participants in this comprehensive diabetes intervention.
Assuntos
Relações Comunidade-Instituição , Política de Saúde , Promoção da Saúde , Cooperação Internacional , Arizona , Humanos , MéxicoRESUMO
As part of efforts to help stem the rising tide of diabetes among Hispanic Americans living in Arizona-Mexico border communities, the Border Health Strategic Initiative was launched to foster community-based approaches to diabetes prevention and control. A major thrust of the initiative was establishment of special community action groups (SAGs) to help stimulate policy change and sustain interventions designed to reduce the risk of diabetes and its complications. The SAGs met regularly for more than two years, focusing primarily on policies that encourage development of an infrastructure to support physical activity and healthier nutrition. Through involvement with planning commissions, parks and recreation, and private companies, two community development block grants were obtained to support new walking trails. The SAGs also encouraged elementary schools to improve physical education and change vending machine products, and grocery store owners and managers to allow the demonstration and promotion of healthier foods. These groups, focused on policy and infrastructure change within their communities, may be the glue needed to hold comprehensive community health promotion efforts together.