November 30, 2011 -- “The greater Cowlitz County thinks this is Tweakerville,” said Liz Haeck, driving around the Highlands neighborhood in Longview, Wash. to visit residents' homes and talk to them about their lives. “Everybody knows where there's a drug house on their block.”
As Haeck drove from house to house on a blustery afternoon, bringing Thanksgiving food boxes, candy and even dog biscuits, she talked to people about their lives, referring them to services that might help them out.
Few people complained about health problems – though one man gave back the turkey, asking instead for Ensure, a liquid energy supplement because he can’t chew solid food and needs dentures which he can’t afford. He also needs assistance with heating costs. Because of his low weight, he’s cold in spaces others would consider room temperature, and needs to keep his apartment well-heated.
Calling these home visits the best part of her job, Haeck’s a community coach in the Highlands, where the household median income is $24,000, and 18 percent of its 5,000 residents are unemployed. In the Highlands neighborhood of Longview, at least 20 percent of residents receive some form of public assistance, and 36 percent of those over the age of 25 don't hold high school diplomas.
Besides being one of the poorest areas in Washington, it's also one of the unhealthiest. A 2009 report by the Cowlitz County Public Health Department revealed the county had the highest incidence of adult and teen alcohol abuse, tobacco use and the percentage of residents with diabetes.
Northwest Health Foundation decided to offer a three-year $221,000 grant to fund neighborhood association programs, including Haeck’s position, to focus on the social determinants of health.
The funds come from the Kaiser Permanente Community Fund.
“A main determinant of health outcomes is actually a community's connection, and the connection neighbors have with each other,” said Chris DeMars, a senior program officer at Northwest Health Foundation, who’s involved with administering the grant and tracking its progress. “One of the really exciting outcomes of this grant is the number of people that they've involved and the number of organizations that are looking into enhancing the livability of the community.”
“Most of what determines health outcomes is outside the healthcare system,” said Chris Kabel, also a senior program officer at the Foundation, who’s focused on taking an “upstream” approach to health by handling problems before they occur and helped create a farmers market in the Lents neighborhood of Portland.
“So much of what a lot of nonprofit and healthcare organizations and government do is oriented downstream,” Kabel said – addressing social problems once they become acute. “One of the things we have to let go of when we go that far upstream is the idea that we're going to see some dramatic improvement in measurable health status in the near term.”
Now he’s looking for interim indicators such as less drug abuse, property crime or violent crime, which will have a long-term effect on the community’s health. “We're really focused on trying to find those interim benchmarks,” Kabel said.
Meanwhile, things are slowly starting to change in the Highlands neighborhood. A small community center has opened, with a library and events are being planned such as flu clinics and classes on how to stay healthy and active during the holidays. There's also a community garden in the back lot.
And Haeck’s committed to making this neighborhood a friendlier, Mayberry-like place, and knows it won't take a single program to bring that about. “It's gonna take a whole bunch of things to turn things around,” she said. “What it's going to take is that we keep moving.”
This article has been corrected to reflect that $24,000 is the household median income in the Highlands neighborhood, not the median income as previously reported. An earlier edition of the story also quotes Chris DeMars as saying community cohestion is the main determinant of health, not a main determinant.