Children ride bicycles through a park.
2014 Culture of Health Prize Winner
Breaking Down Barriers to Achieve Wellness
Only a few years ago they were old train tracks—part of an abandoned rail line that ran by several schools and through one of the lowest-income neighborhoods in Brownsville, Texas. Yes, kids might have walked them as a way to get to school, but in reality the old tracks were just a dusty memory of the community’s past.
Today, it’s a mile-long paved trail. It’s lit and landscaped and bordered by murals painted by local schoolchildren. Families go for walks. People ride their bikes and go running with their dogs. And, of course, kids walk to school along the tree-lined path.
The revitalized Belden Trail is both a marker of how far the community has come in its promotion of wellness and a symbol of one of the steps they’ve taken together down the path toward a healthier Brownsville.
Brownsville, Texas, and Matamoros, Mexico, were founded together and sit on opposite sides of the U.S.-Mexico border. Brownsville is one of the poorest metro areas in the country. Ninety-seven percent of the people in Brownsville are Hispanic and 87 percent prefer to speak Spanish at home. At best, only 60 percent of its students graduate from high school, and 34 percent of its residents live below the poverty level.
“One in three of our people are diabetic, and 80 percent are either obese or overweight,” said Rose Zavaletta Gowen, MD, City Commissioner in Brownsville. “Those statistics reflect not just those that are the poorest among us, but they also reflect those in the highest income levels. So, the entire community faces health disparities.”
Despite these obstacles, over the past decade the people of Brownsville—from its elected officials to its community leaders to its students—have come together in a shared mission to improve the health of everyone who calls it home.
“We knew that as we crossed disciplines, we had to speak to and engage those that are most vulnerable, as well as those that are not,” she said. “Poverty, jobs, education, health are all connected, and you can’t really examine one without the other.”
Brownsville understood that one person’s health was linked to that of another and how working together to improve the entire community—to treat the “whole body”—was the best way to create sustainable health solutions.
There were several catalysts that propelled Brownsville down its current journey to a Culture of Health, including The University of Texas School of Public Health, which came to the city in 2001 and worked hard to become a true community partner — overcoming a history of mistrust of academic institutions that “swooped in” to conduct research without sharing results or collaborating on next steps. The School began by sharing local health data with residents in neighborhood meetings, which sparked a desire to do something to turn the dire rates of obesity and overweight around.
Together with now more than 200 organizations, residents and individuals from health care, education, business and community groups, the School formed the Community Advisory Board (CAB) to examine the data on the community’s health risks, and work collaboratively with partners to find solutions that will drive better health. The CAB’s members “carry the message of wellness into their homes and businesses, and they’re able to affect policy and environmental changes by voting and leadership—and that’s how we have been able to include the community, by engaging them every single step of the way,” said Belinda Reininger, DrPh, Associate Professor at The University of Texas School of Public Health.
About the same time, the city and other large employers in the area embarked on a long-range plan called Imagine Brownsville. The strategy was a business-driven look at the city’s future that evaluated the environment, health, education and other factors to assess the community’s needs. Together with the Community Advisory Board, Imagine Brownsville developed a set of shared measurable goals in areas such as fostering active transportation and healthy eating, with a community champion for each.
“We knew that health did not belong in a silo,” Gowen said. “We knew that there were economic factors and educational factors, so we learned very quickly how to speak different languages. We learned how to talk about health in terms of the economy, how to talk about it in terms of the environment and where to find those common areas where all of those factors intersected.”
The result? The diverse set of partners now share instead of compete for resources, have worked together to pass bold new health-promoting policies such as an ordinance for new businesses to install sidewalks; and an increase in parking meter fees to generate income to support bike safety and downtown revitalization, and have been tapped as a model for creative, low-cost, solutions that capitalize on existing assets to create a vibrant, healthy community.
Brownsville City Commissioner Rose Zavaletta Gowen, MD
Effective communication and advocacy within a community means knowing the community—who they are, their culture, their concerns—and speaking with residents in ways they’ll understand best. For Brownsville, that means a bilingual approach.
According to Gowen, “The Mexican-American culture in Brownsville is a strength. We live and work and celebrate on both sides of the border, and it’s important that we reach out in English and Spanish. The more that we are diverse in our messaging, the more people we reach and the more changes we effect.”
Part of that approach is the use of “Promotoras”—community health workers who engage and educate people who otherwise wouldn’t have access to health care, as well as to connect them with community resources. As community members themselves, the Promotoras also benefit from job training and economic opportunities. This helps to fuel the local economy and create more opportunities for health through stable income.
Although community health workers exist in many different places throughout the country, one thing that sets the Brownsville effort apart is the extent to which this role has been institutionalized. Brownsville’s Promotoras are certified through a state program, but many do not have college degrees. Despite this obstacle, Brownsville’s Community Advisory Board leadership recently succeeded in creating academic appointments (with benefits) for the Brownsville community health workers, who are now serving as Research Assistants at the UT Brownsville School of Public Health.
Promotoras also serve an important connecting role in the community. Gowen notes examples: “They also speak to the community about events that are coming... They engage folks in healthy cooking lessons while they’re in the homes and tell them where free exercise classes are. They also provide referrals to needed health resources. Their work is effective and translates to fewer trips to the hospital, lower rates of chronic illness, higher engagement and higher participation in the community as a whole.”
One of the key community resources the Promotoras now have to connect residents to is a robust system of affordable, healthy food and economic opportunities through the Brownsville Farmers’ Market. Community gardens in economically depressed food insecure neighborhoods are part of the mission of the Market, in an effort to boost income generation opportunities, as well as healthy foods options, for the entire community. Families gather in groups for training on gardening, small business development, nutrition and health, and plant their gardens in city-donated vacant lots, some of which are designed by architecture students and built by AmeriCorps/YouthBuild volunteers.
Finally, Brownsville’s public health efforts include “Tu Salud ¡Si Cuenta!”—or “Your Health Matters!”—a bilingual community wide campaign program that uses television, radio and print to motivate people on both sides of the border to increase their physical activity and healthful food choices said Reininger. Results from the Cameron County Hispanic Cohort study indicate this approach works, as residents are more likely to be physically active and eat more fruits and vegetables.
“People in Brownsville are looking for better: Better economy, better education, better health,” said Gowen. “They’re listening, and they’re learning how they can tie all of those together with programs that encourage healthy eating and active living.”
And while the community has accomplished much, she’s careful to point out that this is only the beginning.
“The destination of a healthier Brownsville is in view, but it’s not the only destination,” Gowen said. “It’s only a stop along the way. We recognize that just like individual wellness not only has to be achieved but also has to be maintained, so too will our community need to have an ongoing commitment to wellness. We will continue to recruit partners and implement strategies to enhance health as we go.”