Regular readers know the past several months have been full of bad news for public health, so I’m happy to be able to highlight something positive: Policy findings from five different communities that took very different approaches to tackling gender health disparities. Articles about their experiences were recently published in a supplement to the journal Women’s Health Issues, where I’m the managing editor. Their experiences show how changing policies at the organizational, local, and state levels to address gender disparities can help reduce barriers to health for everyone.
Articles in the supplement address creating a trauma-informed workforce in Baltimore; assuring safe walking and biking paths in Billings, Montana; using findings on mental health and diaper need to advocate for policies that improve diaper access in New Haven and beyond; updating high school and medical school curricula in Philadelphia; and making it possible for community health workers in Utah to play greater roles in healthcare.
Identifying needs and solutions
The coalitions highlighted in the supplement all received funding from the U.S. Department of Health and Human Services Office on Women’s Health (OWH) as part of OWH’s Coalition for a Healthier Community (CHC) initiative. In a commentary introducing the supplement, OWH’s Stephanie Alexander and Stephen Hayes explain:
The CHC initiative provided long-term support to 10 organizations operating in six regions in the United States. Grantee communities varied in catchment area, nature of interventions, diversity of coalition members, and coalition membership size. Grantee organizations were members of existing community coalitions. Coalitions were composed of local, regional, and national organizations; academic institutions; and public health departments. All coalitions were required to develop a gender-based approach designed to address the roles, behaviors, activities, and biological and psychological attributes society assigns to women and/or men. Coalitions then determined how these factors impacted treatment, access, and overall health (Alexander & Walker, 2015).
The grantees conducted community needs assessments and gender-based analyses to identify gender constraints that affected the health of women and girls, and then developed evidence-based plans to address the health issues they identified. A report from the CHC evaluators summarizes and analyzes the policy changes that all 10 grantees undertook as part of their work – which wasn’t necessarily policy-focused from the start, but often expanded to include policy as the coalitions discovered ways in which policy changes could make their local environments more conducive to public-health improvements.
A wide range of policy approaches
Several of the coalitions focused on interventions to help women improve their diets and become more physically active, and recognized that their local environments can make it hard to adopt such healthy behavior changes. So, in addition to encouraging healthier eating and exercise, they also worked to improve those conditions:
- B’More Fit for Healthy Babies recognized that obesity and trauma both contribute to poor birth outcomes in Baltimore, so they launched a weight-loss intervention using a trauma-informed care approach. The coalition’s trauma-informed approach served as a model that helped Baltimore city agencies improve their capacity to provide services in ways that are sensitive to the needs of city residents who have experienced trauma, with more than 1,000 employees eventually getting trained in trauma-informed care. When Freddie Gray’s death at the hands of the police and the resulting uprising drew national attention and resources to Baltimore, the city was able to build on its trauma-informed progress to offer more coordinated mental health and substance use services to residents.
- The Healthy by Design coalition in Billings, Montana identified unsafe streets and trails and inadequate sidewalks as barriers to physical activity that disproportionately affected women, girls, and residents who rely on mobility devices. They used findings from focus groups of local residents to advocate for a Complete Streets policy “to ensure all roadway users traveling by automobile, bicycle, public transit, foot, or mobility assistive device are considered during the planning and design of roadway projects.” The Billings City Council adopted a Complete Streets resolution in 2011 and passed a stronger version in 2016 after the earlier version faced a repeal threat. Physical activity rates have increased in Billings, and the gap between the percentage of women and men reporting no leisure-time physical activity has narrowed.
- The Philadelphia Ujima coalition focused on several different organizations that influence public health. They worked with a high school and medical school that revamped their curricula to better address gender issues, and with community-based organizations to adopt healthier policies on topics like the nutritional quality of food served at events. One of the churches involved in the coalition recognized through its participation that leadership lacked a sufficient understanding of the gender norms and stereotypes contributing to sexual and relationship violence, and they developed a policy to include relationship and sexual violence in future leadership trainings.
Two of the coalitions are working to change state laws in order to remove barriers:
- The Coalition for a Healthier Community for Utah Women and Girls (CHC-UWAG) developed an intervention that relies on community health workers to help racial and ethnic minority women in Utah adopt healthier lifestyles. Forthcoming trial results suggest the intervention is successful, but training and paying CHWs is challenging when the state lacks mechanisms for certifying them and most insurers don’t reimburse for their services. The coalition’s work has contributed to the creation of a CHW Special Interest Group in the Utah Public Health Association; winning support for CHWs from the Utah Medical Association; and proposed state legislation to promote and support CHWs.
- The New Haven Mental Health Outreach for Mothers (MOMS) Partnership conducted a survey that found mothers with diaper need – that is, struggling to secure enough diapers to send their children to daycare – are more likely to also report mental health need. They reported these findings in a 2013 Pediatrics article that has since been cited in several local, state, and national efforts to improve mothers’ access to diapers. Among the achievements are San Francisco’s distribution of free diapers for those under the age of three in CalWORKs (California’s version of TANF); Connecticut’s exemption of diapers and feminine hygiene products from sales tax starting in 2018; and a Community Diaper Program championed by the Obama administration that helps provide free diapers to low-income families.
These communities’ achievements don’t only help the women who live there. Improvements like safer walking paths and a trauma-informed city workforce can benefit all local residents, and the articles in this supplement (which are free to read for a limited time) can provide useful lessons for other communities interested in developing their own local solutions.
Liz Borkowski, MPH is the managing editor of Women’s Health Issues and a researcher at the George Washington University Milken Institute School of Public Health.