An NIH investment in health equity - the economic impact of the Flint Center for Health Equity Solutions.

BACKGROUND: Health disparities are pervasive and are linked to economic losses in the United States of up to $135 billion per year. The Flint Center for Health Equity Solutions (FCHES) is a Transdisciplinary Collaborative Center for health disparities research funded by the National Institute of Minority Health and Health Disparities (NIMHD). The purpose of this study was to estimate the economic impact of the 5-year investment in FCHES in Genesee County, Michigan. METHODS: The estimated impacts of FCHES were calculated using a U.S.-specific input/output (I/O) model, IMPLAN, from IMPLAN Group, LLC., which provides a software system to access geographic specific data regarding economic sector interactions from a variety of sources. This allowed us to model the cross-sector economic activity that occurred throughout Genesee County, Michigan, as a result of the FCHES investment. The overall economic impacts were estimated as the sum of three impact types: 1. Direct (the specific expenditures impact of FCHES and the Scientific Research and Development Services sector); 2. Indirect (the impact on suppliers to FCHES and the Scientific Research and Development Services sector); and 3. Induced (the additional economic impact of the spending of these suppliers and employees in the county economy). RESULTS: The total FCHES investment amounted to approximately $11 million between 2016 and 2020. Overall, combined direct, indirect, and induced impacts of the total FCHES federal investment in Genesee County included over 161 job-years, over $7.6 million in personal income, and more than $19.2 million in economic output. In addition, this combined economic activity generated close to $2.3 million in state/local and federal tax revenue. The impact multipliers show the ripple effect of the FCHES investment. For example, the overall output of over $19.2 million led to an impact multiplier of 1.75 - every $1 of federal FCHES investment led to an additional $.75 of economic output in Genesee County. CONCLUSIONS: The FCHES research funding yields significant direct economic impacts above and beyond the direct NIH investment of $11 million. The economic impact estimation method may be relevant and generalizable to other large research centers such as FCHES.

The Continuum of Community Engagement in Research: A Roadmap for Understanding and Assessing Progress.

BACKGROUND: The past two decades have been marked by increased community involvement in the research process. Community-engaged research (CEnR) is increasingly promoted in the literature, and academic programs with a community-academic partnership focus. Community-based participatory research (CBPR) is an approach to frame equitable community involvement in research and is a critical component of the CEnR continuum. As with CEnR, noted benefits of using CBPR expressed in the literature, which include enhancing the relevance and application of the research data, expertise to complex problems at all stages of research, overcoming community distrust, and improving community health. This article presents a community engagement (CE) model that includes seven defined designations for CEnR. In addition, this model includes equity indicators and contextual factors for consideration at the various levels of engagement along the continuum. METHODS: The CE model described in this article combines the principles of CE and CBPR in conjunction with a continuum model. The continuum integrates a focus on health equity and contextual factors providing perspectives from both community and academic partners at each point of engagement. CONCLUSIONS: A broadly defined CEnR continuum will allow researchers, community members and organizations to readily identify 1) where they are on the continuum of CEnR, 2) appropriate access points to enter the continuum based on existing contextual factors, and 3) actions to promote progression on the continuum. Funders have the opportunity to specify the appropriate level of CE needed to accomplish the goals of their identified priorities.

The Church Challenge: A community-based multilevel cluster randomized controlled trial to improve blood pressure and wellness in African American churches in Flint, Michigan.

Chronic disease carries high morbidity and mortality in the United States, with large racial and ethnic disparities observed in chronic disease. Physical activity and healthy food are vital for chronic disease prevention yet challenging to access in economically distressed areas. Public health prevention efforts have become particularly prominent within faith-based organizations over the last three decades. This manuscript describes the protocol of the Church Challenge, a multilevel cluster-randomized controlled nutrition and physical activity trial across 24 churches to reduce blood pressure by 6 mmHg among 576 residents in Flint, MI. The Church Challenge was developed using community-based participatory approaches and is rooted in a church-based program developed by and for primarily African-American Flint church congregations. This three-level intervention addresses health at the community (level 3), church (level 2), and individual (level 1) to reduce blood pressure, reduce chronic disease risk, and promote health equity and wellbeing in Flint. Churches are randomized in a 1:1 ratio to a 16-week physical activity and nutrition program or a 4-session health and wellness workshop. Flint is not a unique community but has a history of traumatic community wide events; even now, the public health infrastructure continues to be a challenge and distract residents from focusing on their health. This trial is highly significant and innovative because it uses a combination of evidence-based practices simultaneously supporting health behavior change for individuals and their faith organizations, and evaluates multilevel efforts to sustain long-term health promotion activities in vulnerable communities like Flint.

Sustainable community engagement in a constantly changing health system.

Engaging patients and communities is invaluable for achieving a patient-centered learning health system. Based on lessons learned in genomic and public health public engagement efforts of our community based organizations in Flint, Michigan, we offer a continuum model for distinguishing various levels of community engagement and recommendations for approaching community, patient and public engagement for healthcare systems that are expanding uses of health information.

Racism, health status, and birth outcomes: results of a participatory community-based intervention and health survey.

Many community-based participatory research (CBPR) partnerships address social determinants of health as a central consideration. However, research studies that explicitly address racism are scarce in the CBPR literature, and there is a dearth of available community-generated data to empirically examine how racism influences health disparities at the local level. In this paper, we provide results of a cross-sectional, population-based health survey conducted in the urban areas of Genesee and Saginaw Counties in Michigan to assess how a sustained community intervention to reduce racism and infant mortality influenced knowledge, beliefs, and experiences of racism and to explore how perceived racism is associated with self-rated health and birth outcomes. We used ANOVA and regression models to compare the responses of intervention participants and non-participants as well as African Americans and European Americans (N = 629). We found that intervention participants reported greater acknowledgment of the enduring and differential impact of racism in comparison to the non-intervention participants. Moreover, survey analyses revealed that racism was associated with health in the following ways: (1) experiences of racial discrimination predicted self-rated physical health, mental health, and smoking status; (2) perceived racism against one's racial group predicted lower self-rated physical health; and (3) emotional responses to racism-related experiences were marginally associated with lower birth-weight births in the study sample. Our study bolsters the published findings on perceived racism and health outcomes and highlights the usefulness of CBPR and community surveys to empirically investigate racism as a social determinant of health.

Community-based organizational capacity building as a strategy to reduce racial health disparities.

One of the biggest challenges facing racial health disparities research is identifying how and where to implement effective, sustainable interventions. Community-based organizations (CBOs) and community-academic partnerships are frequently utilized as vehicles to conduct community health promotion interventions without attending to the viability and sustainability of CBOs or capacity inequities among partners. Utilizing organizational empowerment theory, this paper describes an intervention designed to increase the capacity of CBOs and community-academic partnerships to implement strategies to improve community health. The Capacity Building project illustrates how capacity building interventions can help to identify community health needs, promote community empowerment, and reduce health disparities.

Community engagement in Prevention Research: The Centers for Disease Control and Prevention's Prevention Research Centers' National Community Committee.

The Prevention Research Centers (PRC) Program of the Centers for Disease Control and Prevention (CDC) supports prevention research using community-based participatory research (CBPR) and other community engagement approaches. This paper describes the development of the PRC's National Community Committee (NCC), how the committee strengthened the national program's commitment to CBPR, the impact the committee's activities have had on national initiatives, and the lessons learned from supporting a national community approach in a prevention research program. Community representatives from each PRC's community committee were invited to share and exchange resources, knowledge, and skills to guide the national program. As a result, the NCC was developed. By embracing diversity, building capacity among members, and offering co-learning opportunities, the NCC helped to strengthen the practice of CBPR. The committee's activities helped to ensure community participation at the program's national level and led to involvement in other prevention research initiatives external to the PRC program. Program and committee leaders maintained a shared vision and increased community members' skills. The PRC NCC has taken the concept of community partnership to a national level and has changed the way some community members understand their role in research.

A birth records analysis of the Maternal Infant Health Advocate Service program: a paraprofessional intervention aimed at addressing infant mortality in African Americans.

Recognizing that no single intervention was likely to eliminate racial disparities, the Genesee County REACH 2010 partnership, utilizing both "bench" science and "trench" knowledge, developed 13 broad-based, multi-faceted interventions to eliminate infant mortality. This article provides highlights from a recent birth records comparison analysis of the Maternal Infant Health Advocate Service (MIHAS) intervention, and is solely based on the records of 111 MIHAS clients, and a random sample of 350 African-American women residing in Flint, Michigan. The MIHAS clients were more likely than the comparison sample not to have graduated from high school (56% vs 35%, respectively, P<.0001). The MIHAS clients were more likely to report at least some smoking during pregnancy (20% vs 15%, respectively, P<.05). However, after controlling for age and education, these results were no longer statistically significant. In terms of birth outcomes, the comparative odds of MIHAS clients delivering a low birth-weight infant are 1.124 (95% CI: 0.620-2.038); the odds of their delivering an infant at 37 weeks or earlier are 1.032 (0.609-1.749). Although the MIHAS clients did not have statistically better birth outcomes than those of the general African-American population in Flint, the MIHAS clients did not demonstrate the outcomes one would expect, given their higher level of risk. Based on this analysis, the MIHAS intervention may have brought its clients "up to par" with the general community on several birth outcomes.