THE POWER TO REDUCE HEALTH DISPARITIES

VOICES FROM REACH COMMUNITIES

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH
For more information about the REACH program

or to obtain copies of this document, contact

Centers for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health Promotion

Racial and Ethnic Approaches to Community Health (REACH)

Telephone: 770-488-5426

E-mail: ccdinfo@cdc.gov

Web site: http://www.cdc.gov/reach

Suggested Citation

Centers for Disease Control and Prevention. The Power to Reduce Health Disparities: 

Voices from REACH Communities. Atlanta: U.S. Department of Health and Human 

Services, Centers for Disease Control and Prevention; 2007.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

THE POWER TO REDUCE HEALTH DISPARITIES

Voices from REACH Communities

Eliminating racial and ethnic disparities in health has become a focal point in the prevention of unnecessary illness, disability,

and premature death and the promotion of quality years of life for all people. 

The Centers for Disease Control and Prevention (CDC) has responded to disparities in health among racial and ethnic minority 

populations by launching Racial and Ethnic Approaches to Community Health (REACH). The REACH program is a cornerstone of 

CDC’s efforts to identify, reduce, and ultimately eliminate health disparities. CDC funds REACH communities to address key health 

areas in which minority groups traditionally experience serious inequities in health outcomes. REACH communities form coalitions 

that plan, implement, and evaluate strategies to focus on the needs of one or more groups that include African Americans, Alaska 

Natives, American Indians, Asian Americans, Hispanics/Latinos, and Pacific Islanders. 

Through The Power to Reduce Health Disparities: Voices from REACH Communities, we are pleased to share with you the successes 

and lessons learned in eliminating health disparities through the REACH program. The accomplishments highlighted in this 

publication make a powerful case for the importance of working with communities to improve the health and well-being of their 

members. We now know that we can eliminate health disparities by engaging local leaders, building community partnerships, 

recognizing cultural influences, creating sustainable programs, leveraging resources, and empowering individuals and communities. 

The community profiles in this publication represent only a fraction of the many ways that REACH communities are overcoming 

barriers to good health. It is inspiring to imagine the possibilities if communities across the country were to put these strategies 

into practice. Our intent in sharing these innovative strategies and interventions is to assist others in their efforts to successfully 

close health gaps among racial and ethnic minority groups around the nation. It is a public health imperative that we help people, 

especially those experiencing the greatest disparities in health, obtain and maintain the highest level of health possible. 

Janet L. Collins, PhD

Director, National Center for Chronic Disease Prevention and Health Promotion

Centers for Disease Control and Prevention

From the Director

Contents

Introduction..........................................................................................................................................................................................1

Community Profiles

Alabama

University of Alabama at Birmingham: Alabama REACH 2010 Breast and Cervical Cancer Coalition ........................................ 3

Alaska

Chugachmiut Native Organization: Alaska Native Cardiovascular Disease Prevention/

 Core Capacity Building Project........................................................................................................................................... 5

California

Community Health Councils of Los Angeles: African Americans Building a Legacy of Health .................................................... 7

Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center: Immunize LA Kids Coalition................................. 9

San Francisco Department of Public Health: SevenPrinciples Project...................................................................................... 11

Special Services for Groups, Inc.: REACH 2010/Health Access for Pacific Asian Seniors........................................................... 13

University of California, San Francisco: Vietnamese REACH for Health Initiative Coalition ...................................................... 15

Florida

Florida International University: Coalition to Reduce HIV in Broward’s Minority Communities................................................ 17

Georgia

Fulton County Department of Health and Wellness: REACH for Wellness............................................................................... 19

Illinois

Access Community Health Network and University of Illinois at Chicago: REACH Out............................................................ 21

Chicago Department of Health: REACH 2010/Lawndale Health Promotion Project ................................................................ 23

University of Illinois at Chicago: Chicago Southeast Diabetes Community Action Coalition .................................................... 25

Louisiana 

Black Women’s Health Imperative: REACH 2010: At the Heart of New Orleans Coalition ....................................................... 27

Massachusetts

Boston Public Health Commission: Boston REACH 2010 Breast and Cervical Cancer Coalition .............................................. 29

Boston Public Health Commission: REACH Boston Elders 2010............................................................................................. 31

Center for Community Health, Education & Research, Inc.: Metropolitan Boston Haitian REACH 2010 HIV Coalition.............. 33

Greater Lawrence Family Health Center: REACH 2010 Latino Health Project ......................................................................... 35

Lowell Community Health Center: Cambodian Community Health 2010 Program ................................................................. 37

Michigan

Community Health & Social Services Center, Inc.: REACH Detroit Partnership ........................................................................ 39

Genesee County Health Department: Genesee County REACH 2010 Team............................................................................ 41

Missouri

Missouri Coalition for Primary Care: Kansas City - Chronic Disease Coalition ........................................................................ 43
Nevada

University of Nevada, Reno: Healthy Hearts Project .............................................................................................................. 45

New Hampshire

New Hampshire Minority Health Coalition: New Hampshire REACH 2010 Initiative............................................................... 47

New Mexico

Albuquerque Area Indian Health Board, Inc.: Partners in Tribal Community Capacity Building (REACH 2010) Project.............. 49

Hidalgo Medical Services: La Vida Program .......................................................................................................................... 51

National Indian Council on Aging: Diabetes Educational Outreach Strategies Project............................................................. 53

New York

Institute for Urban Family Health: Bronx Health REACH Coalition.......................................................................................... 55

Mailman School of Public Health of Columbia University: Northern Manhattan Start Right Coalition ..................................... 57

North Carolina

Carolinas HealthCare System: Charlotte REACH 2010 Coalition............................................................................................ 59

Eastern Band of Cherokee Indians: Cherokee Choices/REACH 2010 Diabetes Prevention Program......................................... 61

Oklahoma

Association of American Indian Physicians: Oklahoma REACH HIV/AIDS American Indian Capacity Building........................... 63

Choctaw Nation of Oklahoma: Choctaw Nation Core Capacity Building Program.................................................................. 65

Oklahoma State Department of Health: Oklahoma Native American REACH 2010 Project ..................................................... 67

Oregon

African American Health Coalition, Inc.: REACH African American Health Coalition ............................................................... 69

South Carolina

Medical University of South Carolina: REACH 2010 Charleston and Georgetown Diabetes Coalition ..................................... 71

Tennessee

Matthew Walker Comprehensive Health Center: Nashville Health Disparities Coalition REACH 2010 Project.......................... 73

United South and Eastern Tribes, Inc.: REACH 2010 Immunization and Infant Mortality Project.............................................. 75

Texas

Latino Education Project: REACH Latino Education Project.................................................................................................... 77

Migrant Health Promotion: REACH Promotora Community Coalition..................................................................................... 79

Washington

Public Health - Seattle & King County: Seattle & King County REACH 2010 Coalition............................................................ 81

Index 

 REACH Communities by Racial and Ethnic Group .................................................................................................... 83

REACH Communities by Health Priority Area............................................................................................................ 84
1

Introduction 

As racial and ethnic minority groups 

continue to make up an increasingly larger 

percentage of the U.S. population, the 

reality of health disparities continues to 

severely impact our nation’s health. 

Although life expectancy and overall 

health have improved in recent years for 

most Americans, not everyone is benefiting equally. Many racial and ethnic minority groups have persistently higher rates of 

illness and death than the U.S. population 

as a whole.

The well-documented link between race/

ethnicity and health disparities motivates 

programs such as the Racial and Ethnic 

Approaches to Community Health 

(REACH) program to ensure that all U.S. 

residents have an equal chance to live a 

healthy life.

REACH is an important cornerstone of 

CDC’s efforts to eliminate health disparities 

in the United States. During 2000–2007, 

CDC funded 40 communities that focused 

on innovative strategies to eliminate health 

disparities in key health areas, including 

cardiovascular disease, diabetes, breast 

and cervical cancer, immunizations, infant 

mortality, and HIV/AIDS. These programs 

target several racial and ethnic groups, 

including African Americans, Alaska

Natives, American Indians, Asian Americans, Hispanics/Latinos, and Pacific 

Islanders. 

REACH communities have produced 

impressive results and proven that health 

disparities are not inevitable and can 

be overcome. We are learning from the 

REACH experience that community-driven 

strategies that fully engage community 

members and address social, economic, 

and cultural circumstances can improve 

health outcomes and reduce health 

disparities. The successes reported in these 

communities provide a strong foundation 

for the future, as the REACH program 

continues to expand and share its lessons 

learned and best practices. 

Community engagement and partnerships 

are key to the success of the REACH 

program. Each local program is built 

around a community coalition that includes 

at least one community-based organization, research institution, and state or local 

health department. These coalitions also 

bring together participants and resources 

from other government agencies, faithbased groups, community centers, and 

civic organizations. 

CDC provides training, technical assistance, and support to REACH communities to help them address the multiple 

factors that influence health and health 

disparities. With this support, communities 

develop and implement effective interventions, evaluate their programs, and

disseminate their findings through the 

media and the scientific literature.

By developing, implementing, and evaluating a broad range of innovative strategies, 

REACH communities have been able to

n Build and sustain effective long-term 

partnerships.

n Provide individuals and communities 

with the tools to seek and demand

better health and local resources.

n Make sustainable improvements to 

community systems and infrastructures.

n Share lessons learned and best practices 

that can be used in other communities.

This publication celebrates the successes 

of REACH communities throughout the 

United States. Each community profile 

presents community-driven strategies and 

solutions, as well as specific examples of 

how the communities are reducing health 

disparities and improving people’s health.

These profiles demonstrate the REACH 

program’s unique contribution to addressing health disparities in multiple settings, 

including communities, schools, work

sites, and health care settings. By sharing

their strategies, lessons learned, and 

best practices, the REACH communities 

give other communities and public health 

programs across the country valuable tools 

to eliminate health disparities among racial 

and ethnic minority populations.

Who We Are 

The University of Alabama at 

Birmingham coordinates the Alabama 

REACH 2010 Breast and Cervical 

Cancer Coalition (ABCCC).

n The ABCCC includes an array of 

partners, such as community groups, 

state and national organizations, health 

care providers, and researchers.

n The ABCCC is working to eliminate 

disparities in breast and cervical cancer 

among African American women by 

promoting awareness of and access to 

prevention and screening services.

n The coalition serves women in two 

urban and six rural counties in Alabama, 

in an area known as the Black Belt.

The Problem 

n Breast cancer is diagnosed less often 

in African American women than white 

women, but more African American 

women die of this disease each year.

n Cervical cancer is diagnosed more often 

in African American women than white 

women, and more African American 

women die of this disease each year. 

The Solution 

n The ABCCC created a community 

action plan to address the barriers 

that prevent African American women 

aged 40 or older from receiving breast 

and cervical cancer screening services.

n Action plan activities include 

1) creating a core working group of 

lay volunteers, church representatives, 

and health professionals in each 

targeted county; 2) awarding minigrants to nonprofit groups that target 

breast and cervical cancer screening; 

3) conducting outreach activities to 

assess screening status and promote 

future screenings; and 4) distributing 

educational materials.

n Other action plan activities include 

promoting the Breast and Cervical 

Cancer Early Detection Program 

REACHing African American Women 

in Rural Alabama

(a free screening program funded 

by CDC) and helping women get 

to their screening appointments 

by visiting, calling, and sending 

reminders. 

 Our Achievements 

n During 2001–2003, the ABCCC 

launched an intervention to increase 

breast and cervical cancer screening 

among African American women in 

the target counties.

n In 2002, self-reported baseline data 

showed that only 48% of women 

participating in this intervention had 

received a mammogram. Within 2 

years, 62% reported having a 

mammogram. 

n Also in 2002, 55% of participating 

women said they had previously 

received a Pap test. Within 2 years of 

the intervention, 66% had received a 

Pap test. 

n Before the ABCCC intervention, a 

17% disparity in mammography 

screening existed between African 

American and white women in the 

target counties. During 2001–2003, 

this disparity decreased to 11%.

“Before the Alabama REACH 2010 project came to my community, I was afraid to even say the word “cancer.” Perhaps I was afraid 

because, as a child, I had seen so many relatives die of cancer. When I was asked to attend the REACH training program, I saw a 

chance to learn more about the “C” word. Now that I’ve been a community health advisor for the past 4 years, I can boldly say 

that cancer is not a death sentence because there are resources and help available. Now, I’m telling everyone I know about the 

program that changed my life!”

—Community health advisor

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Future 

The ABCCC will continue to 1) increase 

women’s awareness and use of breast 

and cervical cancer screening services in 

Alabama, 2) work with existing partners 

and project supporters and add new 

coalition members, 3) refer eligible 

women to the Breast and Cervical Cancer 

Early Detection Program, 4) share our 

research findings with the community, 

and 5) educate stakeholders about 

the REACH program and its efforts to 

eliminate health disparities in breast and 

cervical cancer. 

Getting the Word Out Locally

n “Alabama REACH 2010,” 30-minute 

documentary video.

n “Governor’s Black Belt Action 

Commission,” health committee 

press release, June 21, 2005.

n “Promoting Cancer Awareness in the 

African American Community,” WIAT 

Channel 42 News, April 20, 2002. 

n “Development of a Community Action 

Plan to Combat Breast and Cervical 

Cancer: An Overview of the Alabama 

REACH 2010 Project,” WAKA Channel 

8 News, April 18, 2001. 

Generating New and 

Exciting Science 

n “Addressing Disparities Through 

Coalition Building: Alabama REACH 

2010 Lessons Learned.” Journal 

of Health Care for the Poor and 

Underserved 2006;17(2, suppl):

S55–S77.

n “A Community-Driven Action Plan to 

Eliminate Breast and Cervical Cancer 

Disparity: Successes and Limitations.” 

Journal of Cancer Education 2006;

21(suppl):S91–S100.

n “The Development of a Community 

Action Plan to Reduce Breast and 

Cervical Cancer Disparities Between 

African American and White Women.” 

Ethnicity & Disease 2004;14

(3, suppl 1):54–62.

n “REACH 2010: A Unique Opportunity 

to Create Strategies to Eliminate Health 

Disparities Among Women of Color.” 

American Journal of Health Studies

2001;17(2):93–106. 

Keys to Lasting Change in the 

African American Community 

To make the Alabama REACH 2010 

project a success, we worked to empower 

residents to be their own health advocates and to build community capacity by 

training residents to serve as community 

health advisors. 

We also were able to create a sense of 

ownership for the project by drawing on 

community groups and a core working group of volunteers to create and 

implement the community action plan. 

In addition, we adopted the principles of 

community-based participatory research, 

which is designed to involve researchers, 

organizations, and community members 

as equal partners in all aspects of the 

research process. 

These activities led to the creation of a 

unified and motivated coalition. We were 

able to see results above and beyond our 

expectations because of mutual collaboration and trust between our coalition 

and community volunteers. 

Mobilizing Community Resources 

University of Alabama at Birmingham (UAB); University of Alabama; Western Kentucky University; Markey Cancer Center; Tuskegee University, National Center 

for Bioethics; Alabama Cooperative Extension System; Alabama Department of 

Public Health, Office of Minority Health; Community Care Network; American Cancer 

Society; National Black Church Family Council; SISTAs Can Survive; Mineral District 

Medical Society; Tuskegee Area Health Education Center; B & D Cancer Care Center; 

Alabama Quality Assurance Foundation; Alabama Breast and Cervical Cancer Early 

Detection Program; Maude L. Whatley Health Services; UAB Comprehensive Cancer 

Center; UAB Minority Health and Research Center. 

Mona Fouad, MD, MPH, Principal Investigator 

University of Alabama at Birmingham, MTB 618 

1530 3rd Ave. S., Birmingham, AL 35294-4410

Phone: 205-934-4307 • Fax: 205-934-7959

E-mail: mfouad@uab.edu • Web site: http://www.uabmhrc.com

FOR MORE INFORMATION
Who We Are 

The Chugachmiut Native Organization 

coordinates the Alaska Native 

Cardiovascular Disease Prevention/

Core Capacity Building Project.

n This project serves seven rural and 

remote Alaska Native communities 

that are spread across more than 

15,000 square miles in the Prince 

William Sound, Resurrection Bay, and 

Lower Cook Inlet areas of Alaska. All 

villages except two are accessible only 

by plane.

n The project is working to help Chugach 

region communities reduce the high 

rates of death and disability from heart 

disease among their residents.

The Problem 

n Heart disease is the leading cause 

of death for American Indians and 

Alaska Natives.

n American Indians and Alaska Natives 

have higher rates of heart disease and 

premature death than any other racial 

or ethnic group in the United States.

n Alaska Natives also have higher rates 

of risk factors for heart disease than 

other population groups. For example, 

they are more likely to be smokers and 

to be physically inactive and obese, 

and they are less likely to be screened 

for high cholesterol.

The Solution 

n To address these problems, the Alaska 

Native Cardiovascular Disease Prevention/Core Capacity Building Project has 

trained community wellness advocates 

in each of its REACH communities. This 

training was provided through a 1-year 

distance-learning program offered 

by the University of Alaska in Sitka in 

conjunction with the SouthEast Alaska 

Regional Health Consortium.

REACHing Alaska Natives

in Chugach Region, Alaska

n We partner with local tribal councils, 

community health aides, community 

health representatives, and traveling 

health care providers to increase 

support for this project.

n We work to develop and implement 

programs and activities that will 

increase community members’ 

awareness of heart disease and 

promote healthy lifestyle changes. 

These programs and activities reflect 

the native cultures and languages of 

the communities we serve.

n We also conduct community health 

assessments and provide technical 

assistance and training to guide local 

interventions in all Chugach region 

communities.

Our Achievements 

n Community wellness advocates 

are working in all Chugach region 

communities.

n We have implemented a variety of 

programs and activities that reflect local 

cultures and are helping to promote 

healthy behaviors among local residents.

“I walked a lot of steps this month, ran 10 miles, exercised for 120 hours, lost 5 pounds, and went from 20 cigarettes a day 

to 5. I feel great!” 

—Alaska Native woman, aged 22

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont.

n We developed an interactive calendar 

called Take the Idita-Heart Challenge. 

Residents can use the calendar to set 

goals and track their progress toward 

eating a healthy diet, being more 

physically active, not smoking, losing 

weight, and lowering their blood 

pressure and cholesterol levels. They also 

can register for monthly prize drawings.

n We implemented 312 events in local 

communities, making 3,959 contacts 

with community members. These events 

included exercise classes, nutrition and 

healthy cooking classes, heart disease 

prevention classes, a smoking cessation 

program, and local health fairs.

n We completed 1,106 heart disease 

awareness tests. Results showed that 

residents who participated in our 

activities were knowledgeable about 

heart disease and how to manage and 

prevent it.

Our Future 

The Alaska Native Cardiovascular Disease 

Prevention/Core Capacity Building Project 

will continue to educate Alaska Natives 

in the Chugach region about heart 

disease and other chronic diseases and 

their risk factors. We also will continue 

to share information and lessons 

learned from this project with local, 

regional, and national audiences. 

Getting the Word Out Locally

n Nupuat, the Chugachmiut quarterly 

newsletter, features articles about this 

project in every issue.

n Monthly articles are written by 

community wellness advocates in local 

tribal newsletters.

Generating New and 

Exciting Science 

n “Community Wellness Advocates: 

Creating Behavioral Health Changes to 

Build Healthy Hearts in Alaska Native 

Communities.” Presented at the Annual 

Meeting of the American Public Health 

Association, Boston, Massachusetts, 

November 2006.

n “Community Wellness Advocates: 

Creating Healthy Changes in Chugach 

Region Communities.” Presented at the 

Alaska Tribal Health System Showcase 

in Anchorage, Alaska, September 2006.

n “Community Wellness Advocates: Building 

Healthy Hearts Through Health Education 

in Chugach Region Tribal Communities.” 

Presented at the Alaska Health Education 

Consortium Spring Meeting in Anchorage, 

Alaska, May 2006.

n “Community Wellness Advocates: 

Creating Behavioral Changes Through 

Health Education in Native Villages.” 

Presented at the CDC Diabetes and 

Obesity Prevention and Control 

Conference, Denver, Colorado, May 2006.

Keys to Lasting Change in 

Alaska Native Communities

Death and disability from heart disease 

can be prevented or controlled by reducing 

several known risk factors, including high 

blood pressure, high blood cholesterol, 

smoking, physical inactivity, diabetes, 

obesity, and poor diet. 

Control of these risk factors at individual 

and community levels is key to preventing heart disease and its complications. 

Community support and involvement 

also are vital to the success of prevention 

programs.

Mobilizing Community Resources 

Our partners include tribal chiefs, tribal councils, community health aides, community health representatives, community school 

representatives, and traveling health care providers in the seven villages 

of the Chugach region—Nanwalek, Port Graham, Seward, Chenega Bay, 

Tatitlek, Valdez, and Cordova.

Heather Davis, MPH, Director, Alaska Native Cardiovascular Disease Prevention/

 Core Capacity Building Project, Chugachmiut Native Organization

1840 S. Bragaw Street, Suite 110, Anchorage, AK 99508

Phone: 907-334-0131 or 1-800-478-2891 • Fax: 907-563-2891

E-mail: Heather@Chugachmiut.org • Web site: http://www.chugachmiut.org

FOR MORE INFORMATION
Who We Are 

Community Health Councils (CHC) of 

Los Angeles coordinates the African 

Americans Building a Legacy of Health 

coalition. 

n CHC is a nonprofit group based in 

Los Angeles that is committed to 

building coalitions, conducting 

community-based participatory 

research, and developing policies 

to increase public awareness 

and improve health care services 

in communities with limited 

resources.

n CHC brought together a cross section 

of groups and key stakeholders to 

form the African Americans Building 

a Legacy of Health coalition.

n This coalition works to promote healthy 

communities and reduce disparities 

in the rates of diabetes, heart disease, 

and stroke for African Americans living 

and working in South Los Angeles.

The Problem 

n African Americans in Los Angeles 

County have higher rates of death 

from coronary heart disease, stroke, 

and diabetes than any other racial 

or ethnic group in the United States. 

n South Los Angeles has the country’s 

highest incidence of obesity (30%).

n Compared with residents of similar 

cities, South Los Angeles residents 

have little or no access to resources 

such as healthy food options and safe 

places to be physically active that 

could help to improve their health. 

 The Solution 

n The African Americans Building a 

Legacy of Health coalition found ways 

to improve food and physical activity 

options in South Los Angeles through 

community development, awareness, 

and advocacy.

n The coalition worked to improve access 

to and quality of health care resources 

REACHing African Americans 

in Los Angeles, California

by promoting activities proven to 

improve health and by funding diseasemanagement services at local hospitals 

and clinics.

n The coalition also worked to integrate 

wellness policies and practices into 

local workplaces.

Our Achievements 

n The Los Angeles City Council adopted a 

policy to provide incentives to retailers 

that sell healthy foods to encourage 

them to locate in disadvantaged areas. 

The Los Angeles County Board of

Supervisors adopted a policy to 

improve the quality of food offered in 

county-sponsored programs.

n The coalition trained nearly 75 health 

care professionals on new and better 

ways to manage and treat heart 

disease and diabetes in African 

Americans.

n The coalition created a network 

of more than 35 physical activity 

programs through seed funding 

to community and faith-based 

groups, reaching more than 

1,500 people in nontraditional 

settings.

“The wellness program created enough buzz around the office—people interested in walking more, drinking more water, avoiding 

processed foods—that a second 8-week set of classes was set up for people who missed the opportunity the first time around. The 

program is a great way to improve health and quality of life, and it pays dividends to participants and the community as a whole.” 

—Emile Gardner, assistant general manager, First Transit, Los Angeles

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont.

n The coalition helped develop wellness 

programs and policies in nearly 50 

local workplaces, reaching more 

than 650 people.

n The coalition preserved a local 

community fitness center and 

transferred program management 

to the Los Angeles YMCA. It also 

helped increase membership from 

300 to more than 1,000. 

Our Future 

CHC’s future plans include promoting 

and adopting community standards for 

healthy food options in local stores and 

calling for the establishment of one or 

more local health food suppliers. 

CHC also will provide training and 

program development to help improve 

the quality of health care offered by local 

health care providers and will expand the 

existing network of physical activity and 

workplace wellness programs by 20%. 

Getting the Word Out Locally

n “Hungry for a Supermarket,”

Los Angeles Times, August 2006.

n “Culture of Healthy Eating Urged 

at Workplace,” Daily Breeze, July 2006.

n “Road to Health” segment on 

the lack of healthy food options in 

predominantly poor and minority 

communities, The Tavis Smiley Show, 

November 17, 2005. 

n “Limited Healthy Food Choices 

in South L.A. Restaurants, Study 

Says,” Los Angeles Business Journal,

March 2005.

n “Eating Good in the ‘Hood,’ ” 

VIBE, February 2004.

Generating New and 

Exciting Science 

n “Assessing Resource Environments 

to Target Prevention Interventions in 

Community Chronic Disease Control.” 

Journal of Health Care for the Poor 

and Underserved 2006;17(2, suppl):

146–158.

n “Putting Promotion into Practice: The 

African Americans Building a Legacy 

of Health Organizational Wellness 

Program.” Health Promotion Practice

2006;7(3, suppl 1):233S–246S.

n “African Americans’ Access to Healthy 

Food Options in South Los Angeles 

Restaurants.” American Journal of 

Public Health 2005;95(4):668–673.

n “Improving the Nutritional Resource 

Environment for Healthy Living Through 

Community-Based Participatory 

Research.” Journal of General Internal 

Medicine 2003;18:568–575.

Keys to Lasting Change in the 

African American Community 

Each of the following is equally important 

and crucial to creating and sustaining 

community change: identifying and 

getting the support of key stakeholders, 

engaging community partners in planning 

and implementation activities, making 

sure all partners are treated equally, and 

identifying appropriate at-risk populations 

and interventions to target.

Mobilizing Community Resources 

University of Southern California; University of California, LA; American Cancer Society; American Heart Association; Apostolic Faith Home Assembly; California 

Department of Health Services; Cedars-Sinai Medical Center; Central Baptist Church; 

Centinela/Freeman Hospital-ULAAC Project; Drew Medical Society; Los Angeles 

County Department of Public Health; Los Angeles Urban League; Mount Moriah 

Baptist Church; Office of Assemblyman Mark Ridley Thomas, Assembly District 48 

Empowerment Congress; Office of Assemblyman Jerome Horton, Assembly District 

51; T.H.E. (To Help Everyone) Clinic; Watts Healthcare Corporation; Willowbrook 

Senior Center; Worksite Wellness LA.

Gwendolyn Flynn, Project Director, African Americans Building

 a Legacy of Health, Community Health Councils

3731 Stocker St., Suite 201, Los Angeles, CA 90008

Phone: 323-295-9372 • Fax: 323-295-9467 

E-mail: gwen@chc-inc.org • Web site: http://www.chc-inc.org

FOR MORE INFORMATION
Who We Are 

The Los Angeles Biomedical Research 

Institute at Harbor-UCLA Medical 

Center coordinates the 

Immunize LA Kids Coalition. 

n The coalition is administered by 

South Los Angeles Health Projects, 

a community-based unit of the 

Los Angeles Biomedical Research 

Institute.

n The coalition links public and private 

agencies, health care providers, and 

the community to help Latino and 

African American children in South 

Los Angeles get the immunizations 

they need. 

The Problem 

n Although Los Angeles County has met 

the Healthy People 2010 objective 

of 80% of children receiving all 

recommended vaccines by age 2, 

nearly 1 in 5 infants and young 

children are not up to date on their 

immunizations. 

n In California, only 53% of African 

American and 72% of Hispanic 

children entering kindergarten during 

the 2004–2005 school year were 

up to date on their immunizations 

at age 2, compared with 75% of 

white children. 

 The Solution 

n The Immunize LA Kids Coalition 

developed a multifaceted community 

action plan that reflects recent 

recommendations by the Task Force 

on Community Preventive Services 

and the Advisory Committee on 

Immunization Practices. 

n The coalition has implemented 

culturally appropriate interventions 

that seek to overcome barriers to 

immunization by working to 

improve practices in health care 

provider settings.

REACHing Latino and African American Children

in South Los Angeles, California

n The coalition’s interventions also 

are designed to increase community 

demand for immunizations by 

providing reminders for parents, 

including those whose children receive 

WIC services, and conducting outreach 

to families of at-risk children.

Our Achievements 

n In April 2006, 82% of WIC clients 

in our service area, most of whom 

are Latino or African American, 

were up to date with recommended 

immunizations at age 2. 

n In 2005, we provided immunization 

information to nearly 10,000 parents 

through outreach activities at health 

fairs, schools, faith-based events, 

and door-to-door visits.

n Nearly 4,000 children in our service 

area have received an immunization 

assessment and information from 

a community health promoter. 

n We also provided technical assistance, 

consultation, and follow-up services to 

75 medical offices. 

“A parent of a 2-year-old who had received only one series of shots at 2 months came to us asking for information on immunizations. 

Neither parent nor child had medical insurance. Immunize LA Kids staff discussed the importance of immunizations and being up 

to date, and provided the mother with supportive educational materials. As a result of this interaction, the mother made an 

appointment to begin getting her child up to date on her immunizations.” 

—Immunize LA Kids Coalition community health promoter

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Future 

Our coalition will disseminate findings 

from the immunization program at 

conferences and in professional journals 

and publish a technical brief.

We also plan to enter WIC client 

records into a countywide immunization 

registry, encourage physicians to use 

this registry, and focus on immunization 

follow-up strategies in African American 

communities.

Getting the Word Out Locally

n “It’s a Family Affair! Immunization 

Health Fair,” Our Weekly, August 2006.

n “Culturally Appropriate Outreach 

Boosts South LA Immunization Rates,” 

First 5 LA Monday Morning Report,

June 26, 2006. 

n “Proteja a Sus Niños, Vacunelos a 

Tiempo,” El Ahorro, August 2005.

Generating New and 

Exciting Science 

n “Programs Aim to Improve Immunization Coverage in Practices.” Infectious 

Diseases in Children April 2006:

24–26.

n “Evaluation of Immunize LA Kids’ 

Enhanced-AFIX Intervention in South 

Los Angeles: What Worked?” Presented 

at the 2006 National Immunization 

Conference, Atlanta, Georgia, 

March 6, 2006. 

n “Closing the Immunization Gap.” 

Minority Nurse Magazine 2004; 

Winter:28–33.

Keys to Lasting Change in the 

Latino and African American 

Communities 

The Immunize LA Kids Coalition includes 

a diverse group of individuals and 

organizations. We value the contributions

of all coalition members, including 

parents, community members, and health 

care providers. This attitude ensures that 

our strategies and materials are culturally 

appropriate and meet community and 

family needs. Coalition partners work 

together and with other regional and 

state groups, and these partnerships 

promote sharing of resources, lessons 

learned, and coordinated approaches 

to improving immunization rates. 

We use evidence-based approaches 

that have been proven to work and 

that address the broad array of barriers 

to improving immunization rates. 

By promoting these strategies and 

integrating system changes into health 

care provider and community settings, 

we ensure that our interventions are 

effective and have a lasting effect on 

the community. 

Mobilizing Community Resources 

California Coalition on Childhood Immunization; California Department of Health Services, Immunization Branch; California Distance Learning 

Health Network; Child Health and Disability Prevention Program; Los 

Angeles County Department of Children and Family Services; Clinica 

Monseñor Oscar A. Romero; Esperanza Community Housing Corporation; 

GlaxoSmithKline; Grace Elliott Center; Healthy African American Families; 

Immunization Coalition of Los Angeles County; L.A. Care Health Plan; Los 

Angeles County Department of Public Health, Immunization Program; 

MedImmune, Inc.; Merck Vaccine Division; MotherNet LA; Sanofi Pasteur; 

SHIELDS for Families, Inc.; South Los Angeles Health Projects; St. Francis 

Medical Center; St. John’s Well Child Center; T.H.E. (To Help Everyone) 

Clinic; Watts Healthcare Corporation; Wyeth; community representatives. 

Tamekia Mosley, MPA, CHES, Project Coordinator, Immunize LA Kids Coalition

Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center

2930 West Imperial Highway, Suite 601, Inglewood, CA 90303

Phone: 323-757-7244 (ext. 281) • Fax: 323-779-1190 

E-mail: Tmosley@slahp.org • Web site: http://www.izlakids.org

FOR MORE INFORMATION
Who We Are 

The San Francisco Department of Public 

Health coordinates the SevenPrinciples 

Project.

n This project includes a diverse coalition 

of people who are working to improve 

the health of African American families 

and the survival rate of African American infants in San Francisco.

The Problem 

n Infant death rates for African Americans are higher than rates for all 

other racial and ethnic groups in San 

Francisco, both separately and combined. Twice as many African American 

infants die each year as white infants. 

n African American women also are more 

likely not to receive prenatal care until 

late in their pregnancy and to deliver 

an infant that is preterm or has a low 

birth weight. 

n African Americans often have less 

access to health care and receive lower 

quality care. They are more likely to 

be affected by social, economic, and 

environmental factors that have been 

linked to high infant death rates and 

other poor health outcomes.

The Solution 

n The SevenPrinciples Project has implemented three interventions that have 

shown promise in reducing disparities 

and improving infant survival rates 

among African Americans in San 

Francisco.

n The first intervention is community 

awareness campaigns that address 

the lack of knowledge among African 

Americans about their community’s 

health and the disparities in infant 

death rates.

n The second is activities designed to improve community health by addressing 

social factors that have been linked to 

high infant death rates. These include 

violence, substance abuse, crime, poor 

nutrition, food insecurity, and lack of 

community unity and leadership.

REACHing African American Infants and Families

in San Francisco, California

n The third is skills training and workshops for health care providers to 

improve patient-provider interactions, 

promote mutual respect, and examine 

the impact of race and racism on 

health disparities and health outcomes.

Our Achievements 

n The community awareness campaigns 

were seen by 62% of African Americans in the REACH community. People 

who had seen the campaigns were 

more aware of the racial disparity in 

infant death rates in their community. 

They also knew about correct sleep 

positions for infants, which help reduce 

deaths. 

n Community action teams assessed the 

levels of violence, crime, poor nutrition, 

food insecurity, and community unity 

and leadership in their neighborhoods. 

They proposed and implemented 

actions to correct the problems they 

found. 

n We developed a cultural competency 

training class for health care providers to 

help them communicate better with their 

patients and understand the influence of 

racism on patient-physician interactions. 

“Since attending an anti-racism workshop, I serve as a resource at work and in the community.”

—Participant in a SevenPrinciples Undoing RacismTM workshop

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
n After the training, 78% of participants 

said they were more confident using 

the recommended communication 

tools, 65% were more confident 

accessing resources for cultural 

competency, and 63% were more 

confident in their ability to describe 

social conditions linked to high infant 

death rates among African Americans.

n We also provided anti-racism workshops that examined the role of racism 

in poor health outcomes. After the 

workshops, participants said they 

intended to be a resource within their 

organizations.

n More than 200 health care providers

participated in the trainings and 

workshops.

Our Future 

The SevenPrinciples Project has 

identified partner agencies that will 

offer the cultural competency training 

classes to health care providers and 

other employees within their agencies. 

These partners also will conduct 

awareness campaigns to educate 

community members about 1) the high 

infant death rates and other health 

disparities among African Americans; 

2) the correct sleep position for infants, 

which can help to prevent sudden infant 

death syndrome (SIDS); and 3) the need 

to take action to prevent poor health 

outcomes for African American infants.

In addition, the San Francisco Department of Public Health has made the

anti-racism workshop a standard offering 

for its staff and community partners. 

Getting the Word Out Locally

n Habari Gani, a quarterly newsletter 

published by the SevenPrinciples 

Project.

Generating New and 

Exciting Science 

n “Lessons Learned From an Evaluation 

of Community Action Teams: Methods 

and Recommendations for Similar 

Community Action Evaluations.” 

Presented at the 134th Annual 

Meeting of the American Public Health 

Association, Boston, Massachusetts, 

November 7, 2006.

Keys to Lasting Change in the 

African American Community

The African American community has 

endured inequalities and has struggled with 

the burden of violence, crime, substance 

abuse, limited access to healthy food, and a 

lack of community unity and leadership. To 

eliminate the longstanding disparity in infant 

death rates between African Americans and 

all other U.S. racial and ethnic groups, the 

entire African American community must be 

aware of the social, economic, and environmental factors that have been linked to high 

infant death rates. 

In addition, health care agencies must 

commit to improving the relationships 

between health care providers and their 

African American patients and to ensuring 

equal health care for all Americans. 

Community and health care agencies also 

must adopt and enforce anti-racism policies 

and principles that will help to improve health 

behaviors and health outcomes at local levels.

Mobilizing Community Resources 

Blue Cross Wellpoint; Black Coalition on AIDS; Booker T. Washington Community Service Center; I.T. Bookman Community Center; Jelani 

House; Homeless Prenatal Program; Parents Who Care; Goodwill Industries; 

University of California, San Francisco, Family Health Outcomes Project.

Virginia Smyly, MPH, Principal Investigator, Community

 Programs, San Francisco Department of Public Health

30 Van Ness Ave., Suite 2300, San Francisco, CA 94102

Phone: 415-581-2400 • Fax: 415-581-2490 

E-mail: ginger.smyly@sfdph.org

FOR MORE INFORMATION

Our Achievements, cont.
Who We Are 

Special Service for Groups, Inc., coordinates 

the REACH 2010/Health Access for Pacific 

Asian Seniors (HAPAS) project.

n This project is part of the Older Adults 

Program of Special Service for Groups, 

a nonprofit community group based in 

Los Angeles.

n The project created a coalition of 

health care providers, community 

groups, grassroots groups, faith-based 

groups, universities, and local health 

departments to work together to 

reduce health disparities among Asian 

American and Pacific Islander older 

adults living in Los Angeles County and 

Orange County, California.

n The coalition focuses on disparities in 

adult immunization, type 2 diabetes, 

and heart disease in the Cambodian, 

Chamorro (Guamanian), Filipino, 

Laotian, Samoan, Thai, Tongan, and 

Vietnamese communities.

The Problem 

n The leading causes of death among 

Asian Americans and Pacific Islanders 

aged 60 or older are cancer, heart 

disease, diabetes, pneumonia, and 

influenza.

n Data on immunization, diabetes, 

and heart disease rates among older 

adults in Southeast Asian, Pacific 

Islander, and Filipino communities 

are limited.

n Many people believe that Asian 

Americans and Pacific Islanders 

are “generally healthy,” but health 

disparities are a problem among some 

subpopulations in this diverse group.

n Southeast Asians are among the 

most disadvantaged within this 

group. Problems include poverty, poor 

education, and social isolation because 

of language barriers. Many Southeast 

Asians also lack health insurance, which 

limits their access to health care services.

REACHing Asian American and Pacific Islander

Older Adults in California

n When the HAPAS project surveyed 

older adults in Los Angeles County 

and Orange County, nearly all 

respondents said that immunizations 

were only for children.

n Older adults are at increased risk for 

many vaccine-preventable diseases. 

In 1999, about 90% of all deaths 

related to influenza and pneumonia 

occurred among people aged 65 or 

older.

The Solution 

n To address these health disparities, 

the HAPAS coalition developed health 

education and media materials that 

reflect the cultures and languages of 

the target populations.

n The coalition provided training to 

local health care providers to increase 

their awareness of and sensitivity 

to the cultural traditions of Asian 

Americans and Pacific Islanders.

n The coalition also conducted 

community-based research and 

evaluation activities in these underrepresented communities, and it 

coordinated community health fairs.

“I believe that without the HAPAS project in the community, I would still be an uninformed person living with diabetes, without a 

clue how to successfully manage and control diabetes. I also attribute my interest in health advocacy and community involvement 

to the HAPAS project. I became a volunteer for the project and was trained as a lay health worker for the Chamorro community 

diabetes education program.”

—Frank G., HAPAS project lay health worker

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements 

n The HAPAS coalition produced a 

resource tool kit for health care 

providers and community leaders. The 

tool kit was created to address health 

disparities identified by a community 

focus group in eight Asian American and 

Pacific Islander communities.

n The coalition produced educational 

brochures on adult immunization, 

diabetes, and heart disease in eight 

languages and distributed these 

brochures to more than 40,000 people.

n We reached more than 100,000 older 

adults, health care providers, and 

caregivers through various venues, 

including ethnic media, health fairs, and 

community outreach activities.

n We developed eight multilingual 

evaluation tools on immunization, 

diabetes, and heart disease in collaboration with the Department of Social 

Welfare at the University of California, 

Los Angeles. These tools assess the 

effectiveness of one-on-one outreach 

education and help us identify health 

disparities among Asian American and 

Pacific Islander subgroups. 

Our Future 

The REACH 2010 HAPAS project will 

continue to educate older adults and 

caregivers about adult immunization, 

diabetes, and heart disease. We also will 

continue to teach health care providers 

how to provide culturally sensitive services 

to Asian Americans and Pacific Islanders.

Getting the Word Out Locally

n “Medical System Gap: Underestimation 

of the Need, Language, and Cultural 

Barriers Creates Blind Spots in Health 

Care Needs of Asian and Pacific Islander 

Health Care,” Sing Tao Daily, May 18, 

2006.

n “Health Prevention Information for 

Seniors: REACH 2010 HAPAS (Health 

Access for Pacific Asian Seniors),” 

Sereechai Newspaper, April 22–26, 

2006.

Mobilizing Community Resources 

S

pecial Service for Groups, Inc.; Little Tokyo Service Center, Asian and 

Pacific Islander Older Adult Task Force; Cambodian Association of 

America; St. Mary Medical Center, Families in Good Health; Federation 

of Filipino America Association; Guam Communications Network; 

Samoan National Nurses Association; Special Service for Groups, 

Tongan Community Service Center; Orange County Asian Pacific Islander 

Community Alliance; University of California, Los Angeles, School of Public 

Affairs, Department of Social Welfare.

David Yim, MSW, Program Director, Special Service for Groups, Older Adults Program

605 W. Olympic Blvd., Suite 600, Los Angeles, CA 90015

Phone: 213-553-1884 • Fax: 213-236-9662

E-mail: dyim@ssgmain.org • Web site: http://www.ssgmain.org

FOR MORE INFORMATION

n “REACH 2010, UCLA, Thai Nurses 

Association, and the Asian Pacific 

Health Care Venture Provide Hepatitis 

B and Health Screenings in North 

Hollywood,” Thai Town USA, 

December 5, 2004.

Keys to Lasting Change in Asian 

American and Pacific Islander 

Communities 

Policy makers, researchers, and members 

of the private and public sector need data 

specific to Asian American and Pacific 

Islander communities to understand and 

reduce health disparities among these 

populations. More programs and research 

projects need to target these populations 

to collect these data.

We also need a stronger commitment 

to recruit and train bilingual and 

bicultural members of underrepresented 

communities to work in health and social 

service fields.
Who We Are 

The University of California, San 

Francisco, coordinates the Vietnamese 

REACH for Health Initiative (VRHI) 

Coalition.

n The VRHI Coalition is a partnership of 

16 community groups, county health 

providers, and researchers at the 

University of California, San Francisco. 

n The coalition works to promote 

awareness and use of breast and 

cervical cancer screenings among 

the more than 105,000 VietnameseAmericans living in Santa Clara County.

The Problem 

n Vietnamese-American women have the 

highest age-adjusted incidence rate 

of cervical cancer in the United States: 

43 per 100,000 people. This rate is 5 

times higher than the rate for white 

women, which is 8.7. 

n Cervical cancer can be detected and 

prevented with regular Pap tests, 

but more than 25% of VietnameseAmerican women have never had a 

Pap test, compared with less than 5% 

of all U.S. women. 

n Breast cancer can be detected early 

with regular mammograms, but 25% 

of Vietnamese-American women 

aged 40 or older have not had a 

mammogram within the past 2 years.

 The Solution 

n During 2000–2004, the VRHI 

Coalition planned and implemented 

a cervical cancer action plan that 

included a multimedia campaign, 

outreach activities by lay health 

workers, a Pap test clinic that provides 

patient navigation assistance, a Pap 

test registry and reminder system, 

continuing medical education for 

Vietnamese health care professionals, 

and return of the Breast and Cervical 

Cancer Control Program in Santa 

Clara County. 

REACHing Vietnamese-American Women

in Santa Clara County, California

n During 2004–2007, the coalition 

planned and implemented a breast 

cancer action plan that included 

a multimedia campaign, outreach 

activities by lay health workers, patient 

navigation assistance, continuing 

medical education for Vietnamese 

health care professionals, and 

collaboration with Every Woman 

Counts, the state’s breast and cervical 

cancer program.

Our Achievements 

n An evaluation of coalition programs 

showed that 47.7% of participants who 

had never had a Pap test received one 

after meeting with a lay health worker. 

n The evaluation also showed that 

17.9% of participants received a 

mammogram and 27.9% received 

a clinical breast exam after meeting 

with a lay health worker, compared 

with 3.9% and 5.1%, respectively, of 

women who did not meet with a lay 

health worker.

n In addition, 52.1% of participants had 

a repeat Pap test within 18 months, 

and 4,187 women enrolled in a 

reminder system.

“If I had known about this earlier, maybe I would not have lost my sister, who died from cervical cancer. She was just busy working, 

taking care of her kids and her husband. She had to get a hysterectomy, but then she died last year. I now know as a result of the 

VRHI Coalition that we can prevent and treat this disease if it is detected early. Now, when I meet women in the street, at school, 

or in the market, I encourage them to get a Pap test.” 

—Lay health worker

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont.

n More than 50 Vietnamese-American 

physicians attended each of 6 continuing 

education seminars to learn more about 

breast and cervical cancer screening.

n The VRHI Coalition led a petition drive to 

reinstate the Breast and Cervical Cancer 

Control Program in Santa Clara County. 

The program returned in 2003 as the 

Every Woman Counts program, offering 

breast and cervical cancer screening to

all low-income women in the county.

n The percentage of women who received 

a Pap test increased from 77.5% in 2000 

to 84.2% in 2004, according to a study 

that compared Santa Clara County with 

a control community where residents 

received no intervention.

Our Future 

The VRHI Coalition will continue to refer 

women to Every Women Counts clinics 

and to recruit health care providers 

for these clinics. We also will continue 

to educate stakeholders about health 

disparities in California. 

Getting the Word Out Locally

n “Cervical Cancer Deaths Frustrate 

Doctors,” The Associated Press, 

July 25, 2005.

n “UCSF Community Program Wins U.S. 

‘Closing the Health Gap’ Award,” UCSF 

Today, November 24, 2004. 

n “Community Forum on Cervical Cancer 

Among Vietnamese Women,” Thoi Bao

and California Today, September 18, 2003.

n “Culture Puts Vietnamese Women at 

Increased Cancer Risk,” Los Angeles 

Times, October 20, 2000.

Generating New and 

Exciting Science 

n “Community-Based Participatory 

Research Increases Cervical Cancer 

Screening Among VietnameseAmericans.” Journal of Health Care for 

the Poor and Underserved 2006;17(2, 

suppl):31–54. 

n “Papanicolaou Testing Among 

Vietnamese Americans: Results of a 

Multifaceted Intervention.” American 

Journal of Preventive Medicine

2006;31(1):1–9.

n “Processes and Capacity-Building 

Benefits of Lay Health Worker Outreach 

Focused on Preventing Cervical Cancer 

Among Vietnamese.” Health Promotion 

Practice 2006;7(3, suppl):223S–232S.

n “Increasing Vietnamese-American 

Physicians’ Knowledge of Cervical 

Cancer and Pap Testing: Impact 

of Continuing Medical Education 

Programs.” Ethnicity & Disease

2004;14(3, suppl 1):S122–S127.

Keys to Lasting Change in 

the Vietnamese-American 

Community

Researchers who work at the community 

level must reach out to residents to generate trust and to help community members 

become effective researchers themselves. 

Research projects should be flexible 

enough to adjust to community input. 

Projects will succeed if organizers are 

committed to building a broad coalition 

of people who share a common goal, 

decision-making power, and resources. 

Coalition members also should be 

equal partners in designing, developing, 

conducting, and interpreting the results 

of research projects.

Mobilizing Community Resources 

Asian Americans for Community Involvement; American Cancer Society; Blue Cross of California; Catholic Charities of Santa Clara County, John XXIII 

Multiservice Center; Community Health Partnership; Immigrant Resettlement and 

Culture Center; Kaiser Permanente; Northern California Cancer Center; Premier 

Care of Northern California Medical Group; Santa Clara County Public Health 

Department; Santa Clara County Ambulatory and Community Health Services; 

Santa Clara Family Health Plan; Southeast Asian Community Center; Vietnamese 

Physician Association of Northern California; Vietnamese Voluntary Foundation, 

Inc.; Vietnamese Community Health Promotion Project.

Thoa Nguyen, Program Manager

44 Page Street, Suite 500, San Francisco, CA 94102

Phone: 415-476-0557 • Fax: 415-431-7700

E-mail: thoa.t.nguyen@ucsf.edu • Web site: http://www.healthisgold.org

FOR MORE INFORMATION
Who We Are 

Florida International University 

coordinates the Coalition to Reduce HIV 

in Broward’s Minority Communities.

n The coalition is a group of partners 

working together to reduce the burden 

of disease and death due to infection 

with HIV and AIDS among young 

adults aged 18–39 years who live 

in Broward County, Florida. 

n The coalition’s mission is to promote 

the primary prevention of HIV/AIDS 

and to facilitate social change by 

helping communities respond more 

effectively to this health crisis. 

The Problem 

n The Florida Department of Health 

estimates that nearly 1% of Broward 

County residents are infected with 

HIV, about three times the estimated 

national average. 

n African American and Hispanic young 

adults in Broward are at increased risk 

for HIV infection. 

n Research indicates that 73% of the 

1994–1999 AIDS cases reported 

among racial and ethnic minorities 

in Broward County occurred among 

residents in just 12 of 53 ZIP codes. 

 The Solution 

n The coalition is working to reduce the 

high disease rates among young adults 

in the African American, Caribbean, 

and Hispanic communities in the 12 ZIP

codes identified as having the highest 

numbers of HIV/AIDS cases. 

n Based on input from community 

members, the coalition designed a 

comprehensive, multilevel, multisector, 

and multiphased intervention to 

interrupt the transmission of HIV. 

n The coalition used culturally sensitive 

community-level strategies to enhance 

services already provided by the 

Broward County Health Department. 

REACHing African Americans and Hispanics 

in Broward County, Florida

These strategies included 1) a 

continuing presence and persistent 

outreach to area residents; 2) outreach 

to local businesses, organizations, 

and community leaders; 3) efforts 

to educate individuals and mobilize 

communities for collective action; 

and 4) efforts to build capacity for 

community groups and enhance 

the public health infrastructure. 

 Our Achievements 

n Telephone interviews conducted with 

more than 2,000 residents indicate 

that we are reaching the target 

audience, increasing AIDS awareness, 

and stimulating change. 

n Personal interviews with more than 

150 residents and noninvasive urine 

testing for sexually transmitted 

diseases helped to identify previously 

undiagnosed and untreated infections. 

n Thousands of HIV prevention 

supplies (e.g., condoms, latex 

sheets, lubricant tubes) have been 

discussed, demonstrated, and offered 

free to adult community members. 

“I didn’t know how huge the HIV problem was in Broward, especially in my community. I think it’s great to have people like the 

REACH 2010 staff giving out information and other stuff to help us protect ourselves. I also didn’t know that female condoms 

existed and how to use them. Those are very helpful when the guy doesn’t want to use them himself. I haven’t taken an HIV test 

yet, but now I’m pretty worried and want to know if I am positive, so I will take the test.”

—African American woman, aged 23 

RACIAL AND ETHNIC A P P ROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont.

n The percentage of self-reported sex 

without a condom declined from 

26.3% in 2001 to 21.5% in 2005 

among the project’s target population.

n Self-reported condom use at least once 

in the past year increased steadily 

among the Caribbean population, from 

51.8% in 2001 to 65.8% in 2005.

Our Future 

The coalition will continue to provide 

outreach services to the targeted 

communities. We will continue to 

improve our communication strategies 

to make sure we increase people’s 

awareness of the HIV problem in their 

own communities. 

We also hope to prevent future HIV 

infections by reducing the prevalence of 

risky sexual practices, increasing healthy 

behaviors, and transforming community 

conditions and systems to create a 

supportive environment for change. 

Getting the Word Out Locally

n “The Protection Racket: And the Band 

Plays On,” Broward-Palm Beach New 

Times, February 2, 2006.

n “Broward Works to Keep the Promise,” 

Miami Herald, December 1, 2005.

n “Push on to End Stigma of AIDS 

Among Latinos,” Miami Herald,

October 13, 2005.

n “SIDA: 25 Años Después,” El Sentinel, 

June 3, 2006.

n “Taking It to the Streets: An FIU Team Is 

Leading Grass-Roots Efforts to Empower 

Communities in the Fight Against HIV/

AIDS,” FIU Magazine, Summer 2004.

Generating New and 

Exciting Science 

n “HIV Risk Reduction Among Young 

Minority Adults in Broward County.” 

Journal of Health Care for the Poor 

and Underserved 2006;17:159–173.

n “Eliminating Disparities in HIV Disease: 

Community Mobilization to Prevent 

HIV Transmission Among Black and 

Hispanic Young Adults in Broward 

County, Florida.” Ethnicity & Disease

2004; 14(3, suppl 1):108–116.

n “Should HIV-Prevention Programs 

Promote Abstinence and Mutual 

Monogamy or Condom Use?” 

Sexologies 2006;15:S35.

n “Impact of a Comprehensive CommunityLevel HIV Prevention Program on 

the Behaviors of Racial and Ethnic 

Minority Young Adults in Broward 

County, Florida.” Presented at the 2006 

National STD Prevention Conference in 

Jacksonville, Florida, May 9, 2006.

Keys to Lasting Change in the 

African American, Caribbean, and 

Hispanic Communities 

To reach highly mobile immigrant communities, such as those in Broward County, 

Florida, sustained and culturally appropriate educational messages and outreach 

interventions are crucial. Such efforts can 

help residents learn what they need to 

know about HIV/AIDS and how to change 

their behaviors and prevent infection. 

Key stakeholders and community leaders, 

including those in the faith communities, 

should be actively involved in helping to 

deliver these types of interventions.

Mobilizing Community Resources 

Past and present coalition members: 

Hispanic Unity of Florida; Urban League 

of Broward County; Minority Development 

and Empowerment Inc.; Florida International 

University, Robert Stempel School of Public 

Health.

Claudia Uribe, MD, MHA, Project Associate Director 

REACH 2010 Community Demonstration Project, Florida International University 

3000 NE 151st Street, TR-7, North Miami, FL 33181

Phone: 305-919-4501 • Fax: 305-919-5673 

E-mail: uribec@fiu.edu • Web site: http://www.fiu.edu/~reach

FOR MORE INFORMATION
Who We Are 

The Fulton County Department of 

Health and Wellness coordinates the 

REACH for Wellness program.

n REACH for Wellness works to improve 

nutrition, increase physical activity, 

create a smoke-free community, and 

manage stress for residents in the 

Atlanta Renewal Community.

n The Atlanta Renewal Community, 

located in Fulton County, Georgia, 

receives special tax incentives to spur 

economic development and help 

eliminate high poverty, unemployment, 

and crime rates.

n The Atlanta Renewal Community’s 

population is 90% African American, 

and 76% of the population is made 

up of female-headed households living 

below the poverty level, with a median 

household income of $8,953.

The Problem 

n In 2002, age-adjusted death rates for 

diseases of the heart were 30% higher 

for African Americans than for whites 

in the United States; death rates for 

stroke were 41% higher.

n Heart disease is the leading cause of 

death in Georgia. African American men 

living in Fulton County can expect to live 

to age 61, compared with white men, 

who can expect to live to age 71. African 

American women can expect to live to 

age 72, compared with white women, 

who can expect to live to age 79.

 The Solution 

n REACH for Wellness is helping to 

improve cardiovascular health for 

Atlanta Renewal Community residents 

through collaborative planning, 

advocacy, empowerment, community 

action, and systems change. The 

program also works to improve 

overall health for this population 

and to eliminate health disparities 

among minority groups.

REACHing African Americans

in Atlanta, Georgia

n The program offers free, communitybased services such as nutrition 

education classes, physical activity 

programs, empowerment groups 

for men and women, cardiovascular 

wellness centers in churches, and 

cardiovascular resource centers in 

barbershops and beauty salons.

 Our Achievements 

n REACH for Wellness has served 

more than 24,000 people in the 

Atlanta Renewal Community, and 

improvements have been reported 

since the program began.

n The percentage of African American 

adults who currently smoke 

decreased from 25.8% in 2002 

to 20.8% in 2004. 

n Adults who reported having their 

blood cholesterol level checked 

increased from 69.1% in 2002 

to 79.7% in 2004. 

n Medication adherence among 

adults with high blood pressure 

increased from 79.1% in 2002 to 

80.5% in 2004. 

“When REACH came into the picture, that was a blessing for me because it was just like my vision had come to fruition. Through 

REACH, I was able to take free aerobics classes. I later trained to become a fitness instructor. And now I teach aerobics classes at 

my church. REACH is phenomenal!” 

—Aerobics class participant who is now a certified instructor 

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont.

n The percentage of adults who 

participate in moderate activity at 

least 30 minutes a day 5 days a 

week or in vigorous physical activity at 

least 20 minutes a day 3 days a week 

increased from 25.4% in 2002 to 

28.7% in 2004. 

n The percentage of adults who are not 

physically active decreased from 32.6% 

in 2002 to 30.6% in 2004.

Our Future 

The REACH for Wellness program will 

continue to teach Atlanta Renewal 

Community residents about heart 

disease and stroke through its coalition 

partners, cardiovascular wellness centers 

in churches, and cardiovascular resource 

centers in barbershops and beauty salons. 

We also will continue to train community 

volunteers as health promotion specialists 

to monitor residents’ blood pressure and 

provide health education through the 

cardiovascular resource centers.

Getting the Word Out Locally

n “Black Barbers Join Fight to Cut 

Heart Diseases,” The Atlanta JournalConstitution, March 14, 2006.

n “Take Good Care of Your Heart,” 

The Atlanta Voice, February 23–

March 1, 2006. 

n “REACHing Out to Bring Health 

to Community,” Atlanta Business 

Chronicle, May 13–19, 2005.

Generating New and 

Exciting Science 

n “REACH 2010 Coalitions: Reaching for 

Ways to Prevent Cardiovascular Disease 

and Diabetes.” Journal of Women’s 

Health & Gender-Based Medicine

2002;11(10):829–839.

Keys to Lasting Change in the 

African American Community 

REACH for Wellness is working effectively 

with African Americans in the Atlanta 

Renewal Community by using several 

key strategies. We recruit community 

volunteers from within the community to 

be lay health educators. 

We take our interventions to places that 

are comfortable and easy for people to 

get to, such as churches, local recreation 

centers, libraries, and barbershops. 

We provide activities and resources—

such as child care, primary medical care, 

and substance abuse treatment—that 

can make it easier for people to 

participate in these wellness programs.

Mobilizing Community Resources 

Association of Black Cardiologists; Association of Black Psychologists; Morehouse School of Medicine; Divine Universal Sisterhood; Sisters Action 

Team; Fulton County Library System; Georgia Office of Women’s Health; Dunbar 

Neighborhood Center; Fulton County Board of Health; Center for Black Women’s 

Wellness; Arial Bowen Church; Mechanicsville Civic Association; Concerned Black 

Clergy; Reynoldstown Civic Improvement Association; West End Medical Centers; 

Phyllis Wheatley YWCA; Dunbar Recreation Center; New Hope Baptist Church; 

Eddie’s Barbershop; Emmaus House; Diabetes Association of Atlanta; The Villages at 

Carver; Hunger Coalition; Kool Smiles; Butler St. Baptist Church; Chapel of Christian 

Love; Cosmopolitan AME; Faith AME Zion; Greater Deliverance Baptist; Greater 

Vine City; Liberty Baptist; Mt. Gilead Missionary; Mt. Olive Baptist Church; Martin 

Street Church of God; New Hope Baptist; St. Mark Baptist; True Light Baptist; West 

Oakland Baptist; Wheat Street Baptist.

Larry L. Johnson, MPH, Program Manager, REACH for Wellness 

250 Auburn Ave. SW, Suite 500, Atlanta, GA 30303

Phone: 404-730-1513 • Fax: 404-730-1521 

E-mail: larry.johnson@co.fulton.ga.us • Web site: http://www.reachforwellnessatlanta.com

FOR MORE INFORMATION
Who We Are 

The Access Community Health 

Network (ACCESS) and the University 

of Illinois at Chicago coordinate the 

REACH Out program. 

n REACH Out is a collaborative program 

that works with local faith leaders to 

help low-income women of color get 

tested for breast and cervical cancer. 

n REACH Out targets women in the 

Chicago metro area and is currently 

working with 17 churches in Chicago, 

Cicero, and Berwyn.

The Problem 

n Breast cancer is the second leading 

cause of cancer deaths among African 

American women and the leading 

cause of cancer deaths among 

Hispanic women in the United States.

n African American women are more 

than twice as likely to die of cervical 

cancer than white women, partly 

because the disease is often diagnosed 

at later stages.

n Hispanic women are about 1.5 times 

more likely to die of cervical cancer 

than white women.

n Women with no insurance are 28% 

less likely to get routine mammograms 

and 12% less likely to get routine 

Pap tests than women with insurance. 

Uninsured women also are 2–3 times 

more likely to have breast cancer 

diagnosed at a later stage. 

 The Solution 

n REACH Out encourages low-income 

African American and Hispanic women 

to get early breast and cervical cancer 

screenings.

n The program reaches women by 

getting support from local faith leaders, 

recruiting lay health workers from 

participating churches, adding health 

information and reminders into Sunday

REACHing African American and Hispanic Women 

in Chicago, Illinois

sermons, holding focus groups, setting 

up support groups, and sponsoring 

health fairs.

n The program also reaches more women 

by working with ACCESS, which offers 

primary care services in 47 health 

centers in medically underserved 

areas around Chicago.

Our Achievements 

n Since the program began more than 

5 years ago, 9,089 African American 

and Hispanic women have attended 

REACH Out educational sessions on 

breast and cervical cancer.

n In addition, 5,188 African American 

and Hispanic women have been 

referred for a Pap test or mammogram.

n African American women aged 40 

or older who received one piece of 

information about mammograms or 

breast cancer were 80% more likely 

to get a mammogram during or right 

after a REACH Out intervention at their 

church. Those who received information 

four or more times were 15 times more 

likely to get a mammogram.

“I discovered something beautiful through the REACH program. I discovered that I can help other women and make a difference in 

someone’s life. I share my story with other women when I give workshops. I tell them that because my Pap test showed abnormal 

cells, I need to go every 6 months to make sure I don’t get cervical cancer. I encourage them to get their Pap test and to use the 

REACH program to get their Pap tests and mammograms. I tell women that cervical cancer can be prevented if detected early.”

—REACH Out lay health worker

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Future 

REACH Out will continue to work with 

community partners to meet the health 

needs of low-income women in the 

Chicago metro area.

Getting the Word Out Locally

n REACH Out staff appeared on a

CAN-TV show to promote the 

program, January 17, 2006, and 

October 25, 2005.

n “REACH Sponsored Breast Cancer 

Survivor’s Celebration,” Austin 

Weekly News, October 19, 2005.

n Staff appeared on Univision Radio’s 

“Una Nueva Dia” show with Javier 

Salas to discuss the REACH Out 

program, May 17, 2005.

Generating New and 

Exciting Science 

n “A Qualitative Evaluation of a FaithBased Breast and Cervical Cancer 

Screening Intervention for African 

American Women.” Health Education 

and Behavior 2006;33(5):643–663. 

n “Knowledge About Breast Cancer and 

Participation in a Faith-Based Breast 

Cancer Program and Other Predictors 

of Mammography Screening Among 

African American Women and Latinas.” 

Health Promotion Practice 2006;

7(3, suppl):201S–212S.

n “Sustaining a Safety Net Breast and 

Cervical Cancer Detection Program.” 

Journal of Health Care for the Poor 

and Underserved 2006;17(2):20–30.

Keys to Lasting Change Among 

African American Women 

and Latinas

The REACH Out program is unique 

because it draws on the support of local 

faith leaders and the faith community to 

encourage women to seek early breast 

and cervical cancer screenings. The 

program uses lay health workers 

recruited from participating churches 

to teach women about breast and 

cervical cancer. The lay health workers 

hold workshops in the churches, attend 

health fairs, and go out into nearby 

neighborhoods to reach more women. 

This approach can extend life-saving 

prevention programs and screening 

services across cultural divides to 

communities that would not likely 

be reached by traditional programs.

Mobilizing Community Resources 

Access Community Health Network (ACCESS); nine African American churches; eight Latino churches; The Resurrection Project; Interfaith 

Leadership Project; University of Illinois at Chicago; Y-Me National Breast 

Cancer Organization.

Elizabeth Calhoun, PhD, Principal Investigator, REACH Out

Health Policy and Administration (MC923), University of Illinois at Chicago

1603 W. Taylor Street #758, Chicago, IL 60612

Phone: 312-355-1572 • Fax: 312-996-5356 

E-mail: ecalhoun@uic.edu • Web site: http://www.accesscommunityhealth.net

FOR MORE INFORMATION
Who We Are 

The Chicago Department of Health 

coordinates the REACH 2010/Lawndale 

Health Promotion Project.

n This project seeks to eliminate health 

disparities in type 2 diabetes and heart 

disease among Hispanics and African 

Americans living in Lawndale. 

n It includes a coalition of community 

residents, local hospitals, community 

groups, area universities, and 

government agencies. 

n Lawndale includes two communities 

on Chicago’s West side and is home to 

about 66,700 Hispanics and 54,500 

African Americans.

The Problem 

n African Americans are 1.8 times more 

likely to develop diabetes than whites, 

and Hispanics are 1.7 times more likely 

to develop diabetes than whites.

n In Lawndale, 71% of residents are at 

risk for diabetes, and 85% are at risk 

for heart disease.

n During 1996–1998, African Americans 

made up 63.4% of all deaths from 

heart disease in Lawndale, compared 

with the national average of 40%.

n In Lawndale, 28% of residents are 

overweight and 29% are obese.

The Solution 

n The Lawndale Health Promotion 

Project offers health education classes 

to increase residents’ awareness about 

risk factors for diabetes and heart 

disease, such as high blood pressure, 

high blood cholesterol, obesity, 

smoking, unhealthy eating habits, and 

lack of regular physical activity. These 

classes are designed to reflect the 

culture and language of local residents.

n To help residents overcome these 

risk factors, the project offers health 

REACHing Hispanics and African Americans

in Chicago, Illinois

screenings, information and referral 

services, smoking cessation programs, 

nutrition and cooking classes, and 

walking groups. 

n The project increases residents’ 

access to local health care providers 

through physician referrals. It also 

offers education and services to help 

people with diabetes and heart disease 

manage these diseases better.

n In addition, this project includes 

African American and Hispanic case 

managers and community health 

workers who assess residents’ risk for 

diabetes and heart disease.

Our Achievements 

n More than 7,000 assessments for 

diabetes and heart disease risk have 

been conducted with community 

residents. These assessments increased 

residents’ awareness of risk factors for 

these diseases.

n Nine hundred residents were referred to 

local health agencies for medical care.

“From the beginning, they teach you how to shop, what to shop for, and how to read food labels. I used to read labels very little, 

but now I read them in detail and know what I’m looking for. My blood sugar is down 40 points, my cholesterol is down, my 

blood pressure is down, and the doctor has taken me off some of my medications. REACH 2010 has been a turning point in 

my health.”

—Health education class participant

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont.

n In addition, 350 residents with 

diabetes or heart disease received 

case management services, which 

sharply increased their use of 

health screenings. For example, the 

percentage of this group who received 

annual blood sugar tests increased 

from 21% to 96%, the percentage 

who received annual eye exams 

increased from 22% to 72%, the 

percentage who received annual foot 

exams increased from 42% to 72%, 

and the percentage who received 

annual cholesterol tests increased from 

47% to 77%.

Our Future 

The Lawndale Health Promotion Project 

will continue to provide diabetes and 

heart disease awareness training to 

the Lawndale community. We also will 

continue to partner with community 

groups and faith institutions to increase 

health education opportunities.

In addition, we will work to educate 

local and state stakeholders about health 

disparities in Chicago.

Getting the Word Out Locally

n Community Partners, CAN TV program 

on diabetes awareness, November 9, 

2006.

Generating New and 

Exciting Science 

n “Using Multilevel, Multisource 

Needs Assessment Data for Planning 

Community Interventions.” Health 

Promotion Practice 2004;5(1):59–68.

n “Evaluating Community Based Public 

Health Projects—REACH 2010: The 

Chicago Lawndale Health Promotion 

Project (LHPP).” Presented at the 132nd 

Annual Meeting of the American Public 

Health Association, Washington, DC, 

November 10, 2004.

Keys to Lasting Change in 

Hispanic and African American 

Communities 

To effectively reach people with health 

messages, educational materials should 

reflect the culture and language of local 

populations. Health professionals also 

should work closely with community 

members who are strongly committed to 

improving their community. For example, 

a community health worker with the 

Lawndale Health Promotion Project 

recruited a local group to provide free, 

on-site fitness classes. We also have 

collaborated with local health agencies 

to improve access to health care services 

for people without insurance and to 

expand the ability of community health 

workers to refer residents to other 

community services. In addition, we are 

using a community mapping tool to 

identify resources that can help residents 

improve their health.

Mobilizing Community Resources 

American Diabetes Association; American Heart Association; Chicago Department of Public Health, Office of Substance Abuse; Chalmers Elementary School; Chicago Hispanic Health 

Coalition; Dominicks; Family Focus Lawndale; Jorge Prieto Family Health Center; Joseph E. Gary 

Elementary School; Lawndale Christian Health Center; Loyola University Chicago, Stitch School 

of Medicine; Matthew Henson Elementary School; North Lawndale Symphony of Services; U.S. 

Department of Health and Human Services, Office of Minority Health, Public Health Service 

Region V; Osco Pharmacy/Lawndale; Our Lady of Tepeyac Parish Church and School; Programa 

CIELO; Saint Anthony Hospital; Sinai Health Systems; University of Chicago, Diabetes Education 

Center; University of Illinois, School of Public Health; University of Illinois Extension; University 

of Illinois at Chicago Neighborhoods Initiative, Division of Community Health.

Berenice Tow, MPH, Program Director, REACH 2010/Lawndale Health Promotion Project

Chicago Department of Public Health, DePaul Center, Room 320

333 S. Sate Street, Chicago, IL 60604

Phone: 312-745-0590 • Fax: 312-747-9420

E-mail: tow_berenice@cdph.org • Web site: http://webapps.cityofchicago.org/lhpp/Home.jsp

FOR MORE INFORMATION
Who We Are 

The University of Illinois at Chicago 

coordinates the Chicago Southeast 

Diabetes Community Action Coalition. 

n The coalition includes community, 

health care, and business groups, 

as well as academic institutions. 

n Coalition partners work together 

to reduce the high rates of diabetes 

in the African American and Hispanic 

communities in Southeast Chicago 

by educating people about the disease. 

The Problem 

n In Southeast Chicago, 16.6% of 

African American adults and 10.8% 

of Hispanic adults reported having 

diabetes in 2000.

n Also in 2000, 63.6% of whites in 

Southeast Chicago received diabetes 

education from their health care 

providers, compared with 47.5% 

of African Americans and 57.1% 

of Hispanics. Twenty-nine percent 

of African Americans and 25% of 

Hispanics with diabetes received an 

annual flu shot, compared with 44% 

of whites.

n Hispanics often do not receive 

quality health care because of 

lack of insurance related to high 

unemployment (42.6%).

The Solution 

n The coalition is working to address 

disparities in diabetes education and 

quality of care by building community 

capacity, identifying people at high 

risk for diabetes, offering training and 

education, supporting health promotion 

activities, and creating diabetes selfcare centers.

n Coalition partners provide information 

to increase people’s knowledge about 

diabetes and to promote health at 

health fairs and screening events. 

n Business and health groups work 

together to influence changes in food 

REACHing African Americans and Hispanics 

in Chicago, Illinois

distribution and to increase demand for 

fruits and vegetables.

n The coalition supported the 

implementation and testing of the 

Diabetes Empowerment Education 

Program (DEEP), a diabetes selfmanagement class for community 

residents. Local health care providers 

and lay health workers are trained 

to teach the class, and they receive 

regular updates on diabetes care and 

prevention.

n Two diabetes self-care centers were 

set up in target communities to offer 

outreach, health promotion, and 

education activities. 

Our Achievements 

n Coalition members have sponsored or 

participated in more than 200 health 

fairs and community awareness events, 

reaching over 37,000 people. 

n Thirty-five DEEP classes, which 

last 10 weeks, have been offered 

in targeted communities, and more 

than 350 people have completed 

these classes.

“I have been a diabetic for over 14 years. It has been a constant battle to try to stay focused. I enjoy cooking and eating, and this 

combination can be a problem. I know how to eat healthy, but other factors interfere, like when I work late hours and can’t eat on 

time. Too little exercise is one of my biggest downfalls. But the DEEP class is a big help. With them teaching us all they know and 

what can happen, I think twice and try to make a better choice. Keep up the good work!” 

—Nancy Chico, community resident and director of YMCA South Chicago

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont.

n When DEEP participants were evaluated after the class, they showed 

improvements in their eating habits 

and physical activity levels.

n Participants also showed lower blood 

sugar levels after taking the class.

Our Future 

Our DEEP class is being implemented in a 

local health clinic, and we are expanding 

and strengthening the “train the trainer” 

part of the program. We have completed 

a community survey to evaluate changes 

in diabetes prevalence, risk factors, and 

quality of care. This information will help 

us to plan future activities

Getting the Word Out Locally

n “Center’s Goal: Confronting and 

Conquering Diabetes,” Southeast 

Chicago Observer, September 28, 

2005.

n “DEEP Diplomas Awarded at St. 

Kevin’s,” Southeast Chicago Observer, 

July 20, 2005.

n “Diabetes Class: Glucose Levels and 

Pounds Drop,” Southeast Chicago 

Observer, May 15, 2005.

n “Diabetes Update: A Quarterly Bilingual 

Newsletter,” coalition publication for 

Southeast Chicago.

Generating New and 

Exciting Science 

n “Reducing Diabetes Health Disparities 

Through Community-Based Participatory 

Action Research: The Chicago Southeast 

Diabetes Community Action Coalition.” 

Public Health Reports 2003;118:

309–323.

n “Trends in Diabetes Prevalence and 

Risk Factors Among Minority Residents 

in Southeast Chicago.” Presented at the 

CDC Diabetes and Obesity Conference, 

Denver, Colorado, May 17, 2006.

n “A Participatory Training Program for 

Community Health Workers.” Presented 

at the CDC Diabetes and Obesity 

Conference, Denver, Colorado, 

May 17, 2006.

n “Use of Empowerment Theory and 

Adult Education in Affecting Clinical 

and Behavioral Outcomes in Patients 

with Diabetes.” Presented at the 134th 

Annual Meeting of the American 

Public Health Association, Boston, 

Massachusetts, November 6, 2006.

n “Promoting Healthy Eating in the 

Latino South Chicago Neighborhood: 

An Ecological Approach.” Presented 

at the 134th Annual Meeting of the 

American Public Health Association, 

Boston, Massachusetts, November 6, 

2006.

Keys to Lasting Change in the 

Hispanic and African American 

Communities

Empowering communities through 

education at individual, group, and 

community levels is essential for success. 

This strategy includes addressing 

individual needs by providing knowledge, 

peer support, and information; teaching 

people to help others while helping 

themselves; involving business groups and 

providing a win-win strategy for change; 

and spreading the word and inviting 

support from advocates and legislators.

Mobilizing Community Resources 

University of Illinois at Chicago; Healthcare Consortium of Illinois; Centro Comunitario Juan Diego; Chicago Family Health Center; Hispanic 

Center for Wellbeing and Health Promotion; Hegewisch Community 

Committee; South Chicago Chamber of Commerce; Healthy South Chicago; 

Villa Guadalupe Senior Center.

Amparo Castillo, MD, Program Manager, Midwest Latino Health Research

Training and Policy Center (MC 625), 1640 W. Roosevelt Road, Suite 636

University of Illinois at Chicago, Chicago, IL 60608

Phone: 312-413-2050 • Fax: 312-996-3212 

E-mail: amparo@uic.edu • Web site: http://www.uic.edu/jaddams/csdcac

FOR MORE INFORMATION
Who We Are 

The Black Women’s Health Imperative 

coordinates the REACH 2010: At the 

Heart of New Orleans Coalition.

n The coalition is a community-based 

participatory research project that is 

working with local churches to reduce 

risk factors for heart disease among 

African American women.

n The coalition includes community 

groups, city and state health departments, a historically black university, 

the local public library, and 40 African 

American churches in New Orleans.

n The Black Women’s Health Imperative 

is a national nonprofit educational, 

advocacy, and leadership development group committed to the health 

and well-being of black women, their 

families, and their communities.

The Problem 

n Heart disease is the leading cause of 

death for men and women in Louisiana. In 2002, heart disease killed more 

women than men in Louisiana.

n In 2000, 32% of African Americans 

who died of heart disease in Louisiana 

were younger than 65, compared with 

16% of whites. 

n Nationally, African Americans have

a disproportionate burden of heart

disease and stroke compared with 

other U.S. racial and ethnic groups.

The Solution 

n REACH 2010 interventions are guided 

by community-based participatory 

research methods that emphasize

community collaboration and control. 

We are working with 40 African 

American churches across 10 denominations in New Orleans to tailor our 

interventions to local communities.

n Our interventions are designed to 

reduce risk factors for heart disease and 

prediabetes among African Americans 

in New Orleans. Activities include health 

screenings, workshops on how to 

navigate the health care system, health 

education classes, self-help group 

sessions, and a walking program.

REACHing African American Women

in New Orleans, Louisiana

n We evaluate our interventions to make 

sure they are effectively promoting

positive community changes over time.

Our Achievements 

n We organized African American health 

professionals to provide free screenings 

and health counseling on risk factors 

for heart disease and prediabetes for 

more than 10,000 African Americans 

at church and community sites. 

n We conducted 500 health education 

classes focused on heart disease. We 

also worked with local communities 

and churches to implement the Black 

Women’s Health Imperative’s signature 

fitness program, Walking for Wellness.

n We planned and facilitated more

than 150 Sister Circle self-help group

sessions for women at local church,

community, and work sites. We also

trained 35 REACH volunteers as selfhelp facilitators for these sessions. 

nWe trained more than 300 volunteers to 

support our interventions.

nWe promoted community-wide physical 

activity and healthy eating programs, 

reaching more than 30,000 African

Americans through multiple media 

outlets.

“REACH helped us to understand that if we don’t take care of ourselves, we can’t take care of our husbands, our children, and 

our people. REACH 2010 is the best thing that could have happened to New Orleans. It helped us to see what our needs are and 

determine better ways of meeting our health needs.”

—Delores Aaron, REACH 2010 participant and New Orleans community leader

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Future 

The REACH 2010: At the Heart of New 

Orleans Coalition will continue to help 

African American churches reduce heart

disease and associated risk factors among 

its members. We will continue to make 

people more aware of the need to 

prevent heart disease in all African 

American communities. 

The Black Women’s Health Imperative 

will continue to provide leadership to 

achieve these goals. In addition, one 

of our coalition partners, Southern 

University, has applied to become a 

Center of Excellence to eliminate heart 

disease disparities among African 

American women in the Gulf region. 

Getting the Word Out Locally

n “Diet is a Dirty Word and a Dreadful 

Thought,” Louisiana Weekly, February 

28–March 5, 2005.

n “Women Get the Word Out on Heart 

Disease,” The Times Picayune, February 

17, 2005.

n “Program Focuses on Women’s 

Health,” The Times Picayune, February 

3, 2005.

n “Health Issues 2010,” local TV show

addressing heart disease and other 

health issues. Co-produced with the 

Healthy Heart Community Prevention 

Project.

n The Healing Voice, the coalition’s 

quarterly newsletter.

Generating New and 

Exciting Science 

n “Mentoring for Leadership to Eliminate 

Health Disparities.” Presented at the 

19th National Conference on Chronic 

Disease Prevention and Control, 

Atlanta, Georgia, March 1, 2005.

n “Keep the Faith: Lessons Learned in 

Working with Health Ministries in 

Faith Communities.” Presented at the 

133rd Annual Meeting of the American 

Public Health Association, Philadelphia, 

Pennsylvania, December 13, 2005. 

n “Community Lifeguards of Black 

Women’s Health.” The Women’s Health 

Activist Nov/Dec 2004;29(6):3. 

n “At the Heart of New Orleans: Nurses 

and Community Health Workers Find 

Innovative Ways to Reduce Health 

Disparities.” Texas/Louisiana: Advance 

for Nurses 2003;1(4):25.

Keys to Lasting Change in the 

African American Community

The REACH 2010 project has built 

collaborative relationships with 40 

churches across 10 denominations to 

reduce risk factors for heart disease 

among African Americans in Louisiana. 

We have found that certain components 

are essential to making positive and 

sustainable changes at the community 

level. These components include sharing 

power and decision-making across 

groups, establishing clear roles for 

all partners, and respecting people’s 

differences. We also must communicate 

and coordinate our activities across 

all groups, emphasize a principle 

of personal caring, and anticipate 

challenges and barriers.

In addition, we must understand that 

African American women can be agents 

of change for their own health as 

well as for the health of their families 

and communities. To do so, women 

need safe spaces to tell their stories, 

connect with other women, and receive 

emotional support.

Mobilizing Community Resources 

Black Women’s Health Imperative; Southern University and A&M College in Baton Rouge, School of Nursing; Drexel University School of Public 

Health, Healthy Heart Community Prevention Project; City of New Orleans 

Health Department; Louisiana Office of Public Health, Cardiovascular 

Health Program; Black Women’s Health Project of Louisiana; New Orleans 

Public Library; Shiloh Missionary Baptist Church, Baton Rouge; and 40 area 

churches.

Cheryl Taylor, PhD, Principal Investigator, REACH 2010: At the Heart of New Orleans Coalition

Southern University and A&M College, School of Nursing, Office of Research

P.O. Box 11794, Baton Rouge, LA 70813 • Phone: 504-680-2810

E-mail: cheryltaylor@suson.subr.edu • Web site: http://www.blackwomenshealth.org/reach2010

FOR MORE INFORMATION
Who We Are 

The Boston Public Health Commission 

coordinates the Boston REACH 2010 

Breast and Cervical Cancer Coalition.

n The coalition includes community 

members, community groups, health 

care providers, business and faith

leaders, and academic partners. 

n The mission of the coalition is to

eliminate racial and ethnic disparities 

in breast and cervical cancer by

promoting screening, education, 

prevention, treatment, and access to 

care for black women and women of 

African descent in Boston.

n By working directly with the community, 

we make sure our programs reflect the 

culture of local populations.

The Problem 

n Black Bostonians have a 12% higher 

death rate for all cancers than white 

Bostonians.

n Death rates are particularly high for 

breast, prostate, and cervical cancers, 

even when screening rates are higher 

among black residents. This finding 

suggests that access to health care 

services is not the reason for the 

higher death rates. 

n Black women in the United States 

die of breast cancer at a higher rate 

(33.6 deaths per 100,000) than white 

women (29.6 per 100,000). 

n Black women in Boston die of cervical 

cancer at a significantly higher rate 

(6.1 per 100,000) than white women 

(2.5 per 100,000).

The Solution 

n To address these problems, the coalition implemented the Women’s Health 

Demonstration Project. This project ensures that black women and women of 

African descent in Boston get primary 

care and follow-up services when they 

receive an abnormal result from breast 

and cervical cancer screenings. The 

REACHing Black and African Descendent Women

in Boston, Massachusetts

project also offers cultural competency 

training for primary care providers.

n Community outreach workers, called 

Women’s Health Ambassadors, provide 

education on breast and cervical health 

and racial disparities at health fairs, 

hair and nail salons, and faith-based 

institutions. They also provide support 

and resources to community members 

through workshops in people’s homes 

and at community locations. 

n The coalition has earned a reputation 

in the local and public health communities for raising awareness of health 

disparities, educating residents about 

health issues that affect Boston’s black 

community, and building partnerships 

with key community stakeholders.

Our Achievements 

n The coalition’s community interventions 

have reached more than 3,500 women 

in Boston. 

n Nearly 1,600 women are enrolled in 

the Women’s Health Demonstration 

Project, where case managers at four 

area health centers connect women 

with resources and information.

“The input I received from the group reflected our motto: ‘Strong women growing stronger.’ Women came into the meeting already 

strong advocates for themselves, and they went away further equipped with specific tools and strategies for maximizing their 

health care experiences.”

—REACH 2010 Women’s Health Ambassador

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont.

n Our Women’s Health Ambassadors 

have reached thousands of women in 

hundreds of workshops since 2000. 

n After participating in a public policy 

training session, 50 coalition members 

came together to lead a community 

campaign to support breast and cervical 

cancer programs across the state.

Our Future 

The coalition will expand its scope to 

address public health issues related 

to men’s health, adolescent wellness, 

community advocacy, public policy, 

and environmental health. A strategic 

plan will ensure that community efforts 

to eliminate racial and ethnic health 

disparities can be sustained.

Our demonstration project is encouraging 

community health centers to adopt a case

management model that will help them 

continue to improve communication between patients and health care providers. 

Getting the Word Out Locally

n “Breast Cancer: Two Women Struggle 

for Survival,” The Boston Banner, 

October 12, 2006.

n “The Boston Disparities Project: 

Closing the Gap,” Boston Neighborhood Network, June 2005. Episode 

no. 2 featured the director of the 

REACH coalition.

n “REACH 2010: Spreading the Word 

About Racial and Ethnic Health 

Disparities and the Work of the REACH 

2010 Breast and Cervical Cancer 

Coalition,” WILD FM radio, 2003.

Generating New and 

Exciting Science 

n “Evaluation of Health Disparities Outcomes: Process and Policy.” Presented 

at the Moffit Cancer Center’s 5th 

Biennial Conference, titled Cancer, 

Culture and Literacy: Solutions for 

Addressing Health Disparities Through 

Community Partnerships, Clearwater 

Beach, Florida, May 19, 2006.

n “Boston’s REACH 2010 Coalitions: 

Creating Change and Collaborating for 

the Future.” Presented at the Office of 

Minority Health National Leadership

Summit on Eliminating Racial and Ethnic 

Disparities in Health, Washington, DC, 

January 10, 2006.

Keys to Lasting Change for 

Black Women and Women

of African Descent

The coalition has brought together community residents and public health partners to 

eliminate racial and ethnic health disparities 

in Boston. REACH staff and partners have 

coined the phrase “REACH: Each one, teach 

one,” to reflect their belief that information 

provided in a way that takes into account 

the culture of the target population can 

spread through the community and have a 

positive impact.

Our efforts have been successful because 

they draw on systemic change and 

community empowerment models that use 

education, case management, and cultural 

competency training to address health 

disparities at personal, community, and 

public policy levels. 

Mobilizing Community Resources 

Boston Public Health Commission; REACH Boston Elders 2010; Boston STEPS; YWCA; Boston Black Women’s Health Institute; Cherishing Our 

Hearts and Souls Coalition; Project Right; Hyde Square Task Force; faithbased organizations; schools; community centers; other city programs; 

Boston Mayor Thomas M. Menino.

Nashira Baril, MPH, Director, REACH 2010 Breast and Cervical Cancer Coalition 

Boston Public Health Commission

1010 Massachusetts Ave., Floor 2, Boston, MA 02118

Phone: 617-534-2291 • Fax: 617-534-5179

E-mail: nashira_baril@bphc.org • Web site: http://www.bphc.org/reach2010

FOR MORE INFORMATION
Who We Are 

The Boston Public Health Commission 

coordinates the REACH Boston Elders 

2010 project.

n This project works to eliminate health 

disparities in diabetes and heart 

disease among black older adults in 

Boston.

n This project provides opportunities 

for black older adults to actively lead, 

plan, and develop a citywide model 

to improve health outcomes and raise 

awareness of the problems faced by 

the black older adult population.

n As part of a community approach, a 

coalition was formed to develop a 

community action plan. This coalition 

includes community elders, health care 

providers, educators, researchers, and 

representatives of local government 

agencies.

The Problem 

n In Massachusetts, the estimated prevalence of diabetes among non-Hispanic 

blacks is 9.9%, compared with 6.0% 

among non-Hispanic whites. 

n Massachusetts adults aged 75 years or 

older are more than twice as likely to 

have diabetes as those aged 45–64. 

n Heart disease is the leading cause of 

death in Massachusetts. Blacks are at 

the greatest risk for health problems 

related to overweight and obesity, 

which are major risk factors for heart 

disease.

The Solution 

n To address these problems, the REACH 

Boston Elders 2010 project uses an 

approach that includes community 

mobilization, education, and training 

to eliminate the unequal burden of 

disease and social inequities in the 

health care system. 

n An education and training model 

teaches health care providers and 

REACHing Black Older Adults

in Boston, Massachusetts

community members how to properly 

care for older adults, especially those 

with diabetes and heart disease. 

n The REACH Boston Elders 2010 

project uses seminars, health fairs, 

walk-a-thons, and intensive health 

training sessions to reinforce and 

support the adoption of healthy 

lifestyles and to help connect older 

adults with needed services.

n The coalition also offers classes and 

workshops on topics important to 

older adults, such as nutrition, selfmanagement of chronic diseases, and 

safe exercises such as tai chi.

Our Achievements 

n In 2006, the REACH Boston Elders 2010

project reached more than 2,000 black 

older adults through 49 health education 

workshops, presentations, and events. 

These activities focused on issues such as 

physical activity, nutrition, heart disease, 

diabetes, health disparities, advocacy, 

medications, and Medicare/Medicaid.

n When surveyed, 86% of respondents said 

they had learned something new at these 

events, and 60% said they would change 

their behavior.

“The REACH Boston Elders 2010 project had a great impact on my life, especially being a diabetic who had been noncompliant. 

Regarding racial disparities in the black community, I have seen the facts come to life before my eyes. I have been more observant 

of my health care providers and how patients have been treated, including myself.”

—REACH program participant

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont.

nWhen surveyed, 90% of people who 

attended the coalition’s monthly meeting said they had made changes in their 

lifestyle as a result of attending these 

meetings. 

n In 2007, our coalition received the 

Community Leaders Award from Health 

Care for All, a nationally recognized 

health care, policy, and advocacy group.

Our Future 

The REACH Boston Elders 2010 project 

will continue to highlight the concerns of 

black older adults in Boston, and we will 

incorporate an intergenerational approach 

to reducing health disparities in Boston. 

Our coalition will continue to address 

topics and activities related to diabetes 

and heart disease prevention, the need 

for equal access to care, and other social 

determinants of health. Coalition members 

and partners will continue to support black 

older adults in Boston and lead the way 

in developing a solid community-based 

model to improve health and health care 

access for blacks in Boston and beyond.

Getting the Word Out Locally

n “Health Care Disparities Among the 

Races: REACH Boston Elders 2010,” 

National Public Radio/WBUR Boston, 

September 28, 2005.

n “Pair Keep Eye on Health of Hub’s 

Minority Elders,” Boston Herald, 

December 3, 2004. 

Generating New and

Exciting Science

n “REACHing Beyond Expectations: Black, 

Elderly, and Fighting for Health, Justice 

and Equality.” Presented at the 10th Anniversary Conference of the CommunityCampus Partnerships for Health, Toronto, 

Canada, April 11–14, 2007.

n “REACH Boston Elders 2010: Moving a 

Community and Changing the Business

as Usual.” Presented at the 5th New 

England Regional Minority Health

Mobilizing Community Resources 

Boston Public Health Commission; Action for Boston Community Development; Commission on Affairs of the Elderly; Center for Community 

Health Education Research and Service; Jubilee Christian Church; American 

Diabetes Association, Boston Chapter; American Heart Association, Boston 

Chapter; Central Boston Elder Services; 60 Plus Veterans; The Goldenaires of 

Freedom House.

April J. Taylor, MPH, Director, REACH Boston Elders 2010

1010 Massachusetts Ave., 2nd Floor, Boston, MA 02118

Phone: 617-534-2472 • Fax: 617-534-2365

E-mail: april_taylor@bphc.org

Web site: http://www.bphc.org/reachelders

FOR MORE INFORMATION

Conference, Mashantucket, Connecticut, 

April 3, 2007.

Keys to Lasting Change in the 

Black Older Adult Community 

Community commitment and active 

participation by black older adults, along 

with various stakeholders and key state 

and local policy makers, have increased 

the visibility and knowledge of public 

health problems affecting black older 

adults in Boston. Our coalition’s ability 

to effectively address the high rates of 

diabetes, heart disease, and their related 

risk factors and complications among 

local residents has demonstrated the 

strength of community organizing. 

We have found that health disparities 

can be addressed through ongoing 

education, long-term partnerships, and a 

commitment to change. We have made 

significant strides in improving the health 

of black older adults in Boston.
Who We Are 

The Center for Community Health, 

Education & Research, Inc. (CCHER) 

coordinates the Metropolitan Boston 

Haitian REACH 2010 HIV Coalition. 

n The coalition includes community 

groups, community health centers, 

and one faith-based group.

n Coalition members work to reduce the 

high HIV/AIDS rates among Haitian 

immigrants in the Boston metropolitan 

area. 

The Problem 

n As of February 1, 2005, there were 

1,074 cases of HIV/AIDS reported 

among Haitian-born people living 

in Massachusetts. 

n The rate of heterosexual transmission 

of HIV within the Massachusetts 

Haitian community is more than three 

times the rate among non-Haitians. 

n Haitian women represent 41% of all 

Haitian-born people with HIV/AIDS 

in Massachusetts, compared with 

the state’s general population, 

where women represent 24% 

of HIV/AIDS cases. 

 The Solution 

n The coalition provides HIV prevention 

education through a communitywide media campaign and culturally 

appropriate workshops for Haitian 

immigrants. It also provides access 

to HIV testing.

n The project targets six groups of 

people: women, men, youth, couples, 

Haitians living with HIV, and new 

immigrants. 

n The coalition works to educate and 

involve community leaders, including 

faith and media leaders, in HIV 

prevention efforts.

REACHing the Haitian Community 

in Boston, Massachusetts

Our Achievements 

n The coalition completed the first 

comprehensive survey of the adult 

Haitian population in Boston, 

documenting the health attitudes, 

beliefs, and behaviors of more than 

2,700 men and women.

n The coalition provided six HIV/AIDS 

educational programs, reaching more 

than 500 women, 200 men, 250 youth, 

60 couples, 60 Haitians living with HIV, 

and 130 new immigrants.

n The coalition also launched an HIV 

prevention media campaign in Creole 

on billboards, buses, trains, and Haitian 

radio stations, reaching more than 

12,000 Haitians in the Boston 

metropolitan area.

n More than 80 Haitian faith and 

media leaders received training in 

HIV prevention strategies. 

n Forty non-Haitian health care and 

social service providers received 

cultural competency training.

n The coalition also set up a statewide 

network of groups to address health 

disparities related to HIV/AIDS rates in 

communities of color. 

 “I used to say that HIV/AIDS is all about politics. Now I know it’s real. I would like all folks to take this class because there are so 

many people like me who think SIDA [AIDS] is ‘politics.’ I have learned a lot, not only about HIV/AIDS, but about other diseases 

and about domestic violence. Thanks to the facilitators.” 

—Participant in an HIV education workshop 

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Future 

Working with other groups that serve 

immigrants, the Metropolitan Boston 

Haitian REACH 2010 HIV Coalition will 

continue to provide educational programs 

tailored to specific groups of people. In 

the future, we plan to expand the program 

to include advanced behavioral-change 

training. The coalition structure also will 

be used to address other health needs, 

such as improving women’s access to 

mammograms.

Getting the Word Out Locally

n “SIDA Se Zafé Nou Tout. Ann Potekole 

Nan Yon Konbit Kominote Pou N 

Bare Wout Li” (“HIV/AIDS: We Are 

All Concerned. Let’s Work Together 

to Stop the Virus”), ongoing media 

campaign that includes weekly radio 

shows, posters, billboards, brochures, 

and flyers.

Generating New and 

Exciting Science 

n “Cultural Barriers to HIV-Preventive 

Behaviors Among Haitian Immigrants 

in Metro Boston.” Oral presentation at 

the American Public Health Association 

Annual Meeting, Philadelphia, 

Pennsylvania, December 12, 2005.

n “Role and Importance of Media in 

Health Promotion: The Case of the 

Haitian Population in HIV Prevention 

in the Greater Boston Area.” Presented 

at the New England Conference on 

Health Disparities, Portland, Maine, 

April 2005.

n “The Boston Haitian HIV Prevention 

Coalition Formative Evaluation: A 

Participatory Approach to Community 

Self-Assessment.” Ethnicity & Disease

2004;14(3, suppl 1):20–26.

n “Overcoming Historical and Institutional 

Distrust: Key Elements in Developing and 

Sustaining the Community Mobilization 

Against HIV in the Boston Haitian 

Community.” Ethnicity & Disease

2004;14(3, suppl 1):46–52.

Keys to Lasting Change in the 

Haitian Community 

Our program has succeeded because 

we created a solid infrastructure within 

the community that is supported by health 

care providers, faith leaders, and media 

leaders. The unique network of Haitian 

groups and health care providers sets an 

example for collaborative action, makes 

more health care services available to the 

community, and creates a way to address 

other community needs. 

Because health care providers, community 

partners, residents, faith leaders, and local 

and state officials are willing to work 

together to reduce health disparities in 

the Haitian community, we can tackle 

major challenges related to sex education, 

the stigma of HIV/AIDS, and disclosure of 

HIV status. 

Mobilizing Community Resources 

T

he Center for Community Health, Education & Research, Inc.; 

Association of Haitian Women in Boston; Boston Medical 

Center, Supporting Parents and Resilient Kids Program; Cambridge 

Health Alliance, Haitian Health Outreach Project; Caribbean U-Turn; 

Dorchester Nazarene Compassionate Center; Haitian American 

Public Health Initiative; Haitian Multi-Service Center; Massachusetts 

Coalition for Health Services, Brockton CHASE AIDS. 

Eustache Jean-Louis, MD, MPH, Project Investigator 

Center for Community Health Education and Research

420 Washington Street, Dorchester, MA 02124

Phone: 617-265-0628 (ext. 213) • Fax: 617-265-4134 

E-mail: ejeanlouis@ccher.org • Web site: http://www.ccher.org

FOR MORE INFORMATION
Who We Are 

The Greater Lawrence Family Health 

Center coordinates the REACH 2010 

Latino Health Project.

n This project works to eliminate health 

disparities among Latinos living in 

Lawrence, Massachusetts, who have 

diabetes and associated heart disease. 

n Lawrence is the poorest city in 

Massachusetts. About 68.7% of its 

population is Latino, primarily from the 

Dominican Republic and Puerto Rico.

The Problem 

n The prevalence of diabetes among 

Puerto Rican and Dominican adults in 

Lawrence is 11.8%, nearly twice the 

rate among whites in Massachusetts.

n Diabetes prevalence is 7.4% among 

Latinos statewide, compared with only 

6.4% among non-Hispanic whites.

n One in three children born in 2000 in 

the United States will develop diabetes. 

The incidence among Hispanic females 

born in 2000 is closer to 1 in 2.

The Solution 

n The REACH 2010 Latino Health 

Project works to raise people’s 

awareness about diabetes, teach 

them how to eat a healthy diet and 

be more physically active, and help 

them to understand that diabetes can 

be prevented and controlled.

n The project provides information on 

how to prevent and manage diabetes 

that reflects the local culture.

n The project also provides outreach 

activities through a local health 

education center, works with 

community groups, partners with 

local health care providers, and 

promotes health messages through

a media campaign.

REACHing Latinos

in Lawrence, Massachusetts

Our Achievements 

n More than 10,000 Latinos in Lawrence 

who had little access to information 

about diabetes or heart disease before 

now know where to go for help.

n In 2006, blood sugar levels improved 

from an average of 8.21 to 7.67 among 

participants in Winning with Diabetes, 

a 10-week educational program at the 

Lawrence Senior Center.

n Also in 2006, the percentage of participants with total cholesterol levels <200 

mg/dL increased from 75% to 80%.

n The percentage of Latinos receiving 

services at the Greater Lawrence Family 

Health Center (GLFHC) who had their 

blood sugar level measured at least 

twice a year as recommended increased 

from 50.6% in 2002 to 61.6% in 2006 

after the center took specific steps to 

improve the health of its Latino clients 

with diabetes.

n The percentage of Latinos receiving 

services at the GLFHC who reached 

their blood sugar goal (A1C level <7) 

increased from 20.7% in 2002 to 

43.4% in 2006.

“I am grateful for all you have done for me and my health. Before I began this course, my diabetes was really bad, and I was really 

depressed, disillusioned, and sad. With this program, I learned to be more conscientious. I feel different, better.”

—REACH project participant

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
n The percentage of Latinos receiving 

services at the GLFHC who had an 

annual flu shot increased from 44.2% 

in 2005 to 55% in 2006.

n The Diabetes Self Management 

Education program at the GLFHC

received the American Diabetes

Association’s Education Recognition 

award.

n A wellness group that began with 

one physician teaching 25 groups has 

expanded to include several physicians. 

Our Future 

We plan to expand a community-based 

intervention called Alcanzando el 

Bienestar/REACHing for Wellness that 

is designed to reflect the culture and 

traditions of Latino adults and youth in 

Lawrence. We will continue to improve 

health care for Latinos with diabetes. 

We also will continue to publish our 

research findings to improve the quality 

of information available to patients, 

researchers, and health care professionals 

dealing with the burden of diabetes. 

Getting the Word Out Locally

n “La Coalición Contra la Diabetes de 

Lawrence Celebra su 3rd Feria Anual 

‘Fiesta de Salud,’ ” RUMBO, April 22, 

2006.

n “La Feria de Salud Latina,” RUMBO, 

April 15, 2004.

n Regular appearances on Para tu Salud, 

a program produced by the Greater 

Lawrence Family Health Center on 

Lawrence Community Access Television 

(LCAT).

n Ad campaign promoting awareness 

of type 2 diabetes and public service 

announcements on area radio stations 

WCCM, WCEC, and WEZE.

n “Who’s at Risk for Diabetes?” ad 

campaign on Univision-Noticiero TV.

Generating New and 

Exciting Science 

n “Changing Lives of Latinos Who Have 

Diabetes: Three Case Studies.” Presented 

at the Office of Minority Health National 

Leadership Summit on Eliminating 

Racial and Ethnic Disparities in Health, 

Washington, DC, January 9, 2006.

n “Integrating Health Education and 

Health Promotion to Reduce Health 

Disparities Related to Diabetes in a 

Latino Population.” Presented at the 

23rd National Conference on Health 

Promotion and Education, Minneapolis, 

Minnesota, May 25, 2005.

n “Practice-Based Interventions to

Improve Health Care for Latinos 

With Diabetes.” Ethnicity & Disease

2004;14(3, suppl 1):117–121.

Keys to Lasting Change

in the Latino Community

The keys to lasting change in the Latino 

community are education, social support, 

and community collaboration. The REACH 

2010 Latino Health Project aims to use 

the relationships that already exist among 

Latino populations and community groups 

in Lawrence to promote community 

wellness. These relationships can provide 

the foundation to create the health 

care support needed to improve health 

outcomes and to encourage more people 

to use diabetes prevention services.

Mobilizing Community Resources 

Greater Lawrence Family Health Center; Lawrence Council on Aging; Home Health VNA; Merrimack Valley Nutrition Project; Lawrence 

General Hospital; Greater Lawrence YWCA; more than 30 other community 

groups.

Dean Cleghorn, EdD, Principal Investigator, REACH 2010 Latino Health

Greater Lawrence Family Health Center

One Canal Street, Lawrence, MA 01840

Phone: 978-686-6029 • Fax: 978-683-5791

E-mail: dcleghorn@glfhc.org • Web site: http://www.glfhc.org/

FOR MORE INFORMATION

Our Achievements, cont.
Who We Are 

The Lowell Community Health Center 

coordinates the Cambodian Community 

Health 2010 Program (CCH 2010).

n CCH 2010 is a coalition of health care 

providers, community groups, and 

representatives from the University 

of Massachusetts Lowell.

n Our goal is to reduce health disparities 

in the rates of heart disease and 

diabetes among Cambodians living 

in Lowell, Massachusetts.

n Lowell has the second largest 

Cambodian community in the 

United States. 

The Problem 

n In Lowell, Cambodian adults aged 

45 years or older have higher death 

rates from stroke (15.9%) and 

diabetes (13.4%) compared with 

all Massachusetts adults in this age 

group (6.5% for stroke, 2.5% for 

diabetes).

n In 2002, 65% of Cambodian adults 

aged 50 years or older reported that 

their health was fair or poor in a 

survey conducted by CCH 2010.

n Also in 2002, 77% of Cambodian men 

said they had smoked 100 cigarettes or 

more in their lifetime, and 37% were 

current smokers.

n The survey also found that 99% of 

Cambodian adults in Lowell were born 

in Cambodia, and 85% had spent 

time in a refugee camp. Among adults 

aged 50 years or older, men received 

an average 7.2 years of schooling in 

Cambodia, and women received an 

average 3.1 years. When they talk with 

a doctor who does not speak Khmer, 

their main language, 89% said they 

wanted an interpreter.

 The Solution 

n CCH 2010 increases access to the 

health care system for Cambodians. 

It also increases participation in 

REACHing Cambodian Adults

in Lowell, Massachusetts

wellness programs such as peer 

support groups, exercise classes, 

and stress management sessions.

n CCH 2010 increases awareness among 

health care providers and researchers 

about Cambodian culture, health care 

beliefs, and health care needs.

n The program also offers educational 

sessions to teach Cambodians about 

heart disease and diabetes and to 

teach those who have these diseases 

how to manage them better. 

 Our Achievements 

n The number of Cambodian patients 

accessing health care at Lowell 

Community Health Center’s Metta 

Health Center increased from 0 in 

2000 to more than 4,000 in 2005.

n During September 2003–2006, 

901 health and human service 

professionals attended classes to 

help them understand Cambodian 

culture, and 424 people attended 

presentations on Cambodian culture 

and health care beliefs and practices.

n Seven local pharmacies agreed to 

help improve communications with 

Cambodians about their medications.

“Before, my cholesterol level was close to 400. But after I exercised regularly and ate healthier, my cholesterol level right now is at 

160. I am extremely happy with this improvement.”

—Cambodian senior in the Lowell Senior Center exercise program

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont.

n During September 2003–2006, 

82 Cambodian health professionals 

completed a Khmer medical terminology course to improve their ability to 

recognize and understand definitions 

and analysis of medical terms, as well 

as anatomic, diagnostic, operative, and 

symptomatic terms.

n CCH 2010 helped to change policies 

related to language accessibility services at the Lowell Community Health 

Center and local hospitals by developing and implementing an interpreter 

competency and training program.

n CCH 2010 provided content for 75 

one-hour shows for Jivit Thmey, a 

Khmer-language cable television 

program.

Our Future 

In addition to providing culturally 

appropriate community wellness and 

educational programs, CCH 2010 will 

continue to educate and work with local 

stakeholders to implement solutions to 

eliminate health disparities in Lowell’s 

Cambodian community. 

Getting the Word Out Locally

n “Deep Wounds Fester From Horror 

Inflicted by the Khmer Rouge,” The 

Boston Globe, April 18, 2006.

n “Conference Touches Upon Cambodian 

Health Issues,” The Lowell Sun, 

September 29, 2005. 

n “Seminar Promotes an Understanding 

of Health Literacy,” The Shuttle,

April 20, 2005.

Generating New and 

Exciting Science 

n “Self-Reported Health Among 

Cambodians in Lowell, Massachusetts.” 

Journal of Health Care for the Poor 

and Underserved 2006;17(2, suppl):

133–145.

n “Smoking Among Cambodian Adults 

in Lowell, Massachusetts, and Ideas for 

Promoting Cessation.” Presented at 

the American Public Health Association 

Annual Meeting, Philadelphia, 

Pennsylvania, December 12, 2005.

n “Bringing Equal Health Outcomes 

Within REACH.” Minority Nurse

2003; Fall:27–32.

n “Building on the Strengths of a 

Cambodian Refugee Community 

Through Community-Based Outreach.” 

Health Promotion Practice 2007 

(in press). 

Keys to Lasting Change in the 

Cambodian Community 

CCH 2010 interventions are succeeding 

because we have implemented lasting 

change in the social service and health

care community. We also are continuing 

to develop and invest in a strong 

infrastructure that represents the 

community, is capable of mobilizing 

prevention efforts, and encourages the 

development of individuals and groups 

who can make change. 

Other important factors for success are 

innovative community outreach practices 

that promote health, help people advocate 

for their own health, and can sustain 

communitywide behavior change. By 

making sure that community members are 

involved in planning outreach activities, 

we are helping to improve the health of 

Cambodians in Lowell.

Mobilizing Community Resources 

L

owell Community Health Center; Cambodian Mutual Assistance Association 

of Greater Lowell; University of Massachusetts Lowell, Center for Family, 

Work and Community and School of Health and Environment; Visiting Nurse 

Association of Greater Lowell; City of Lowell Council on Aging; Saint Julie Asian 

Center; Saints Memorial Medical Center; Lowell General Hospital; Greater 

Lawrence Family Health Center, Merrimack Valley Area Health Education Center; 

Massachusetts Department of Public Health, Division of Community Health 

Promotion; Khmer Health Advocates; Lowell Police Department; Trinity EMS; 

Lowell Telecommunications; City of Lowell Health Department. 

Sidney Liang, Director, Cambodian Community Health 2010 Program

Lowell Community Health Center, 15-17 Warren Street, Lowell, MA 01852

Phone: 978-746-7829 • Fax: 978-937-3918

E-mail: SidneyLI@lchealth.org • Web site: http://www.cch2010.info

FOR MORE INFORMATION
Who We Are 

The Community Health & Social 

Services Center, Inc., coordinates

the REACH Detroit Partnership.

n This partnership works to inform, educate, and involve families, communities, 

and health care systems to prevent 

and manage diabetes among Detroit 

residents. 

n The partnership targets African Americans and Latinos living in the east side 

and southwest communities of Detroit.

The Problem 

n Nationally, African Americans and 

Latinos are more likely to be obese and 

to have diabetes than whites. In the 

area of Detroit targeted by the REACH 

Detroit Partnership, 68.8% of African 

Americans and 73.8% of Latinos are 

overweight or obese.

n According to state data, diabetes prevalence is 7.3% among whites, 8.5% 

among Latinos, and 11.0% among 

African Americans in Michigan. Disparities between racial and ethnic groups 

are even higher when reported by age 

group. For example, 13.4% of whites 

and 26.2% of African Americans aged 

55–64 years have diabetes. 

n More than 25% of African Americans 

and more than 30% of Latinos in 

the target area reported a sedentary 

lifestyle, and less than 35% of both 

groups met minimum recommendations for regular physical activity.

 The Solution 

n The REACH Detroit Partnership 

conducts interrelated family, 

health system, social network, and 

community interventions to help 

residents prevent and manage 

diabetes. 

n Program services include interventions 

led by family health advocates, continuing medical education for health 

REACHing African Americans and Latinos

in Detroit, Michigan

care providers, and opportunities for 

healthy eating and physical activity.

n The program also offers health 

education classes and bilingual health 

information for residents. 

Our Achievements 

n The Family Intervention targeted two 

groups, and participants in both groups 

showed improvements as a result of this 

program.

n In the first group, 70.8% of participants 

had blood sugar levels r7, which put 

them at higher risk for diabetes complications. After 1 year, this percentage had 

dropped to 57.3%, and participants

reported improvements in self care,

diabetes knowledge, and healthy eating. 

n In the second group, participants were 

divided into two subgroups, with some 

receiving interventions right away and 

others receiving interventions 6 months 

later. Participants in subgroup 1 showed a 

mean decrease of 1.2 in their blood sugar 

levels, compared with 0.02 for subgroup 

2. Participants in subgroup 1 also showed 

improvements in diabetes-related depression and consumption of high-fat foods. 

“Whenever I look in the refrigerator to get something to eat, I see my family health advocate’s face, and I know that I better not get 

anything unhealthy to eat or eat too much.”

—An intervention participant

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont.

n To promote healthy eating, we conducted 166 mini-markets at 16 locations,

139 food demonstrations at 33 locations, 

125 community education events, and 

250 support group sessions.

Our Future 

The REACH Detroit Partnership will 

continue to evaluate the effectiveness of 

the family health advocate model. We 

also plan to evaluate and distribute the 

tool kits used by our staff. We will expand 

the healthy eating component of the 

Family Intervention to find new ways to 

help residents have greater access to 

healthy foods and to help communities 

grow and sell fresh produce. In addition, 

we will evaluate our physical activity 

interventions more rigorously to assess 

health outcomes among participants 

and the effectiveness of our train-thetrainer program.

Getting the Word Out Locally

n “Fighting Back: Group Aims to Help 

Hispanics, African Americans Beat 

Diabetes Odds,” Detroit Free Press, 

November 12, 2006.

n “Books Donated to Bowen, Conely, 

and Gray Branch Libraries,” El Central, 

January 22, 2004.

n “REACH Helps Fight Diabetes Spread,” 

The Michigan Chronicle, March 31–

April 6, 2004.

n “Arabs Join Other Minorities in 

Diabetes Risk,” Detroit Free Press,

October 23, 2003.

n “REACH Pamper Day Picnic,”

El Central, July 10, 2003.

Generating New and 

Exciting Science 

n “Chronic Disease-Related Behaviors 

and Health Among African Americans 

and Hispanics in the REACH Detroit 

2010 Communities, Michigan, and the 

United States.” Health Promotion Practice

2006;7(3, suppl):256S–264S.

n “Diabetes-Specific Emotional Distress 

Among African Americans and Hispanics with Type 2 Diabetes.” Journal of 

Health Care for the Poor and Underserved 

2006;17(2, suppl):88–105.

n “The Relationship Between Knowledge of 

Recent HbA1c Values and Diabetes Care 

Understanding and Self-Management.” 

Diabetes Care 2005;28(4):816–822.

Mobilizing Community Resources 

Community Health & Social Services Center, Inc.; Friends of Parkside; Alkebu-lan Village; Detroit Department of Health and Wellness 

Promotion; Michigan Department of Community Health; Henry Ford 

Health System; University of Michigan, School of Social Work, School of 

Public Health, and Medical School; Southeast Michigan Diabetes Outreach 

Network; Detroit Community-Academic Urban Research Center. 

Gloria Palmisano, MA, Project Manager, REACH Detroit Partnership

Community Health & Social Services Center, Inc.

2727 Second Ave., Suite 300, Detroit, MI 48201

Phone: 313-961-1030 • Fax: 313-961-1453

E-mail: gpalmisano@chasscenter.org • Web site: http://www.reachdetroit.org

FOR MORE INFORMATION

n “Racial and Ethnic Approaches to 

Community Health (REACH) Detroit 

Partnership: Improving Diabetes-Related 

Outcomes Among African American and 

Latino Adults.” American Journal of 

Public Health 2005;95(9):1552–1560.

Keys to Lasting Change in 

African American and Latino 

Communities

Family heath advocates understand and 

share the challenges that residents face in 

making healthy lifestyle changes. By 

bringing together public health professionals 

with community members and other 

partners, we can find new ways to address 

diabetes and its complications and eliminate 

health disparities. These partnerships 

also will help community members plan, 

implement, and evaluate intervention 

activities; develop and disseminate tool kits, 

educational resources, and lessons learned; 

and take a more active role in conducting 

community-based participatory research 

in their communities. In addition, building 

relationships between health care providers, 

their patients, and REACH family health 

advocates helps providers communicate 

better with their patients.
Who We Are 

The Genesee County Health 

Department coordinates the Genesee 

County REACH 2010 Team.

n The team is a coalition of 12 groups 

working with people at the community 

level to reduce health disparities in 

infant death rates among African 

Americans living in Flint, Michigan.

n Genesee County has the fifth largest 

population of any county in Michigan, 

with 436,141 residents. Flint is the 

largest city in Genesee County, with 

a population of 124,943, of whom 

53.27% are African American.

The Problem 

n Despite more than 20 years of efforts, 

the racial disparity in infant death rates 

among African Americans persists in 

Flint and Genesee County. 

n The infant death rate among African 

Americans living in Genesee County is 

nearly 3 times higher than the rate for 

white infants. This disparity is highest 

in the areas targeted by the REACH 

2010 Team (ZIP codes 48503, 48504, 

48505, and 48458).

The Solution 

n The Genesee County REACH 2010 

Team has implemented a community 

action plan designed to mobilize people 

at the community level; improve health 

care services for infants; and reduce 

racism at individual, institutional, and 

systems levels.

n Activities include community dialogue 

sessions, workshops that address 

racism, a media campaign, educational 

sessions at a local African Cultural 

Education Development Center, 

educational classes for parents, and 

cultural competency classes for health 

care providers and local university 

students.

REACHing African Americans

in Flint, Michigan

n Other activities include assigning 

maternal and infant health advocates 

(MIHAs) to help pregnant women 

and teaching healthy eating through 

community dinners called Harambee 

(Swahili for “pulling together”) 

dinners.

Our Achievements 

n Our team conducted 20 Undoing 

RacismTM workshops that were 

attended by 764 people, including 48 

doctors, from more than 100 groups.

n MIHAs have provided support and 

mentoring to 691 African American 

women and helped them to navigate 

the medical system. This support 

is provided during the women’s 

pregnancies and for 1 year after the 

birth of their children.

n More than 1,079 African American 

women and 105 African American 

men have attended “One Stop Village” 

classes, which teach parenting skills 

and car seat safety and provide 

information about breast-feeding.

“It takes so much more than being open-minded. It takes work. There are so many levels and layers to this problem. However, I have 

hope that because universities and organizations are training their people through REACH 2010, there will be changes.” 

—Genesee County REACH 2010 participant

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
n The African Cultural Education 

Development Center has given 

hundreds of educational tours and 

hosted seven sessions called Middle 

Passage Experiences, reaching more 

than 270 African Americans and 45 

whites. The center also sponsored 

Racism 101 classes, reaching more 

than 200 people. 

n We developed a standard prenatal 

screening tool that is now being used 

in 11 local medical offices. 

n Our Cultural Competence in Health 

Care class has trained more than

160 students at the local university.

Our Future 

The coalition will continue its efforts to 

reduce racial disparities in infant death 

rates in Genesee County. We will conduct 

research to evaluate the impact of the 

REACH community action plan. 

We also will develop training manuals 

and provide technical help for duplicating 

REACH activities in other communities 

of color.

Getting the Word Out Locally

n “Flint’s Black Infant Deaths Drop in 

Wake of Local Efforts,” The Flint Journal, 

August 18, 2006.

n “Doctors Learn to Have Patience With 

Patients,” The Flint Journal, February 7, 

2005.

n “Black Men Focus on Infant Mortality,” 

The Flint Journal, January 30, 2005.

Generating New and 

Exciting Science 

n “Teaching Cultural Competence to Reduce 

Health Disparities.” Health Promotion 

Practice 2006;7(3, suppl):247S–255S.

n “A Birth Records Analysis of the Maternal 

Infant Health Advocate Service Program: 

A Paraprofessional Intervention Aimed 

at Addressing Infant Mortality in African 

Americans.” Ethnicity & Disease 2004;14

(3, suppl 1):102–107.

Keys to Lasting Change in the 

African American Community

No single intervention is likely to 

eliminate the high infant death 

rates among African Americans, in 

part because the 9-month period 

of pregnancy is simply too short to 

address effectively the many risk factors 

important to infant health.

Many different types of solutions are

needed, and our coalition is working 

to be a part of this process. In addition, 

to eliminate health disparities among 

African Americans completely, communities must address underlying social 

inequalities and racism.

Mobilizing Community Resources 

Genesee County Health Department; Faith Access to Community Economic Development; Flint Family Road; Flint Odyssey House Inc. 

Health Awareness Center; Genesee County Community Action Resource 

Department; Greater Flint Health Coalition; Hurley Medical Center; Genesys 

Regional Medical Center; Mott Children’s Health Center; PRIDE (Programs 

to Reduce Infant Deaths Effectively) Medical Services Committee; University 

of Michigan-Flint; University of Michigan, School of Public Health.

Tonya Turner, REACH 2010 Coordinator, Genesee County Health

 Department, Floyd J. McCree Courts and Human Services Center

630 S. Saginaw St., Flint, MI 48502-1540

Phone: 810-257-3194 • Fax: 810-237-6167

E-mail: tturner@gchd.us • Web site: http://www.gchd.us

FOR MORE INFORMATION

Our Achievements, cont.
 

“The Healthy Habits program has freed me to take better charge of my health. The availability and variety of information offered 

have allowed me to share with friends and family.And best of all,my overall health has improved through making positive changes 

in my life.” 

—Community member 

REACHing African Americans

and Latinos in Kansas City 

Who We Are 

The Missouri Coalition for Primary 

Care created the Kansas City - Chronic 

Disease Coalition (KC-CDC) to 

coordinate the REACH 2010 initiative. 

n

of groups working together to reduce 

risk factors for diabetes and heart 

disease among African Americans and 

Hispanics/Latinos living in the urban core 

of Kansas City, Missouri, and Kansas 

City, Kansas. 

n The groups involved in this initiative 

come from nine sectors, including faith, 

cultural, neighborhood, government, 

media, health and human services, law 

enforcement, private, and education. 

KC-CDC is a community-based network 

The Problem 

n In Kansas City, the average life expectan

cy for people of color is 11 years shorter 

than the life expectancy for whites. 

n African Americans in Kansas City are 

2.5 times more likely to die of diabetes 

and 1.5 times more likely to die of heart 

disease compared with whites. 

n Hispanics/Latinos in Kansas City are 

slightly more than 1.5 times more likely 

to die of diabetes compared with whites. 

-

The Solution 

n To address these problems, the KC-CDC 

launched a community campaign called 

We Practice Healthy Habits, or Nosotros 

Practicamos Habitos Saludables in 

Spanish. This campaign promotes ways 

that individuals and communities can 

help people with diabetes and heart 

disease improve their health. 

n The campaign includes a community 

action plan that offers a wide range of 

changes that can be made at a variety of 

levels. For example, individuals can create 

a personal plan to adopt healthy habits 

to reduce their risk for chronic diseases, 

and they can request materials to support 

their efforts. Neighborhood and faith 

groups can become resource partners 

to help people adopt healthy habits. 

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities. 

www.cdc.gov/reach

n In addition, various organizations, including 

community groups, government agencies, 

and health care centers, can enter into 

”Pick 6” service agreements that promote 

changes in programs, policies, and proce

dures to support healthy habits.“Pick 6” 

activities come from a list of 86 options 

developed by community members. 

n Examples of community activities that 

partners can choose to promote include 

encouraging people to walk as a natural 

way to get from place to place, offering 

community cooking classes with tips on 

healthy meals, and developing campaigns 

that promote healthy lifestyles. 

n Other activities include assessing grocery 

store chains and their weekly ads to see 

how well they promote healthy food 

options to cost-conscious consumers, 

working with schools to promote healthy 

school meals and snacks, developing best 

practices for treating diabetes and heart 

disease, and promoting these best practices 

with local heath care providers. 

-

Our Achievements 

n We have documented more than 500 

community changes made or promoted 

by coalition partners, and 55% of these 

changes are ongoing. 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

CENTERS FOR DISEASE CONTROL AND PREVENTION 

43 
Mobilizing Community Resources 

Al-Haqq Islamic Center; American Diabetes Association; American Heart Association; American Indian Council; Battleflood Heights Neighborhood Association; Black Health Care Coalition; 

Blue Valley Neighborhood Association; Cabot Westside Health Center; Camino Verdad y Vida/Way, 

Truth and Life Church; Centennial United Methodist; Christ Temple; Corinthian Missionary Baptist 

Church; The Diabetes Center; El Centro; Foxtown East Neighborhood Association; Harvesters; Housing 

Authority of Kansas City; Ivanhoe Neighborhood Council; Jesucristo el Buen Pastor; Kansas City 

Free Health Clinic; Maternal and Child Health Coalition; Metropolitan Spiritual Church; N.O.B.L.E. 

Neighborhood Association; Phi Delta Kappa; Samuel Rodgers Health Services; Somali Foundation Inc.; 

Swope Health Services; Sisters Let’s Talk; Swope Parkway UCC; Tony Aguirre Center; Troost Corridor; 

Troost Plateau; University of Missouri Extension; Victoria Arms Senior Center; Victorious Life; Vineyard 

Neighborhood Association; The Wellness Journey; Women of Excellence; Donnelly College Student 

Association; American Postal Workers Union.

Our Achievements, cont.

n In addition, 46% of all changes target 

African Americans, while 16% target 

Hispanics/Latinos. 

n Early results indicate that older African 

American women have benefited the 

most from our community change model. 

Our Future 

KC-CDC will continue to refine its network 

approach to best serve the needs of our 

community. This concept is supported 

by a strong community coalition that 

continually reevaluates and capitalizes 

on its strengths. Our coalition also will 

continue to create new activities and 

programs in areas of need to improve the 

health of Kansas City residents.

Getting the Word Out Locally

n Maria Boudreaux, licensed nutritionist 

and KC-CDC board member, appeared 

on Fox 4 Morning Show’s “Healthy 

Eating” segment, January 28, 2007.

n Maria Boudreaux appeared on KSHB 

41 Morning Show’s “Gluten-free Diet 

Tied to Healthy Habits” segment, 

January 25, 2007.

n Maria Boudreaux appeared on KPRT 

1180 AM radio’s “Diabetes and

Nutrition” segment, January 17, 2007.

n A local campaign aimed at faith 

networks and focusing on Hispanic/

Latino churches and residents included

a bilingual flyer and ads in The Kansas 

City Star, December 2006. 

n “Group Promotes KC’s Healthy, Scenic 

Walks,” The Kansas City Star, April 16, 

2003.

Generating New and 

Exciting Science 

n “Analyzing a Community-Based 

Coalition’s Contributions to Reducing 

Risk for Chronic Disease and Health 

Disparities in Kansas City, Missouri.” 

Preventing Chronic Disease [serial 

online] 2007;4(3). Available at http://

www.cdc.gov/pcd/issues/2007/jul/

06_0101.htm.

Keys to Lasting Change in 

African American and Hispanic/

Latino Communities

KC-CDC has used several strategies to 

improve the health of African Americans 

and Hispanics/Latinos living in Kansas 

City. These strategies include training a 

wide range of partners from community 

and faith groups on primary prevention 

techniques and making sure that our 

program goals take into account the 

cultures of our REACH communities. 

We also make sure that our educational 

programs and materials reflect the 

cultures and languages of these 

communities and that local leaders and 

groups receive the funds they need to 

make changes in their communities. 

We promote health education and 

disease prevention in Hispanic/Latino 

communities through Hispanic/Latino 

media and faith networks. The We 

Practice Healthy Habits/Nosotros 

Practicamos Habitos program has 

been effective at the community level 

because of its strong primary prevention 

messages: eat better, exercise more, 

quit tobacco use, see a health care 

professional on a regular basis, and 

reduce stress. Our coalition partners work 

hard to teach people that these riskreducing behaviors can be achieved and 

that they are a practical way to avoid or 

manage diabetes and heart disease.

Marianne Ronan, REACH 2010 Initiative Manager, Kansas City - Chronic Disease Coalition

2700 East 18th, Suite 258, Kansas City, MO 64127

Phone: 816-920-6840 • Fax: 816-231-6035

E-mail: mronan@mo-pca.org • Web site: http://www.mo-pca.org/kccdc/default.htm

FOR MORE INFORMATION
Who We Are 

The University of Nevada, Reno 

coordinates the Healthy Hearts Project.

n This project works with the university’s 

College of Cooperative Extension and the 

local faith community to deliver educational and awareness programs on heart 

disease to Nevada residents.

n The target population is African Americans 

living in Clark County, Nevada, mainly in 

two ZIP codes (89030 and 89106).

The Problem 

n Heart disease is the leading cause of 

death for women and men in Nevada 

and the United States.

n African Americans have a higher death 

rate for heart disease than any other racial 

or ethnic group in Clark County, Nevada.

The Solution 

nWe began the Healthy Hearts Project by 

assessing the target community to identify 

residents’ health needs and the types of 

programs that could be used to address 

these needs.

n As part of this project, we implemented 

educational and awareness programs 

to address the lack of knowledge 

about heart disease and its risk factors 

among African Americans living in 

Clark County.

n We hired and trained community 

members from local churches to 

implement our interventions.

n We also helped plan and develop 

educational programs as part of 

health ministries in three local 

churches and one mosque. These 

programs increase members’ awareness of health disparities among 

African Americans in Nevada.

Our Achievements 

n Our project provided support and 

resources to help strengthen the 

REACHing African Americans

in Clark County, Nevada

Community Partners for Better Health 

Coalition, a faith-based group that 

works to address health disparities 

among people of color.

n We worked with local health care 

providers to improve primary and 

secondary preventive care for African 

Americans at risk for heart disease.

n We increased community members’ 

awareness of how some risk factors 

for heart disease can be controlled, 

and we increased their awareness of 

the disparity in disease rates among 

African Americans.

n We also have given community 

members the information and skills 

they need to change their behaviors 

and lower their risk for heart disease.

n Sixty-one churches and four 

senior and recreation centers are 

participating in this project.

n Our project has reached more 

than 6,000 people through 127 

workshops, 3 women’s conferences, 

2 physical activity festivals, and 35 

physician seminars.

“Excellent introduction to the pool, as I was extremely frightened. The workout gave me confidence and interest to continue. The 

exercises are useful for muscles not generally used. Recommended! Thank you for the opportunity. Great instructors!” 

—Healthy Hearts Project participant

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Future 

The Healthy Hearts Project will continue 

to help its community partners improve 

their ability to reduce disparities in 

heart disease among African Americans 

in Clark County, Nevada. We also will 

continue to develop and strengthen 

health ministries in the faith community. 

In addition, we plan to use physician 

seminars and community workshops to 

help health care providers improve their 

interactions with patients. 

Getting the Word Out Locally

n “Healthy Hearts Project Promotes 

Fitness,” Las Vegas Sentinel Voice,

September 15, 2005.

n “Variety May Be the Key: Cooperative 

Extension Offers a Number of Programs,” Las Vegas Review Journal,

January 11, 2005.

n “Fair Shows Benefits of Diet, Exercise,” 

Las Vegas Sentinel Voice, September 

23, 2004.

n “Doolittle Festival Focuses on Health,” 

Las Vegas Sentinel Voice, September 

16, 2004.

n “Workshop Focuses on Female Health,” 

Las Vegas Sentinel Voice, July 8, 2004.

Generating New and

Exciting Science 

n “Techniques for Establishing Educational Programs Through the African 

American Faith Community.” Journal 

of Extension [serial online] 2006;44(1). 

Article no. 1T0T3, published at http://

www.joe.org/joe/2006february/tt3.

shtml.

n “Food for Health and Soul: A Curriculum Designed to Facilitate Healthful 

Recipe Modifications to Family Favorites.” Journal of Nutrition Education 

and Behavior 2005;37(6):323–324.

Keys to Lasting Change in 

the African American Community

The Healthy Hearts Project developed from 

the community it serves. Members of predominately African American churches and 

a coalition of community groups helped 

make decisions and create an action plan 

to address disparities in heart disease rates 

among African Americans in Clark County. 

Church members were recruited to help 

implement activities and programs, most of 

which grew out of input from the community. Over the life of this project, we have 

used community feedback to make changes 

to ensure that our efforts are effective. 

Local churches also have created health 

ministries to help them meet the health 

education needs of their members.

Mobilizing Community Resources 

American Diabetes Association; American Heart Association; American Stroke Association; 100 Black Men of America, LV Chapter; Clark County Health District, 

Health Education Division; Clark County Library District; Community Baptist Church; 

Courage Unlimited; CSM Consultants; Ebenezer COGIC; First African Methodist 

Episcopal Church (FAME); Holy Trinity AME Church; National Black Leadership Initiative 

on Cancer; Nevada Cancer Institute; Miracle Hands Foundation; Powerhouse COGIC; 

Reach One Teach One; Second Baptist Church; Sisters Network; Southern Nevada Black 

Nurses; Southern Nevada Cancer Research Foundation; University of Nevada, Reno, 

College of Cooperative Extension; Victory Baptist Church; Zion United Methodist Church.

Joyce M. Woodson, MS, RD, Principal Investigator

University of Nevada Cooperative Extension

8050 S. Maryland Parkway, Las Vegas, NV 89123-0855

Phone: 702-257-5508 • Fax: 702-222-3100 • E-mail: woodsonj@unce.unr.edu

Web site: http://www.unce.unr.edu/programs/health/index.asp?ID=87

FOR MORE INFORMATION
Who We Are 

The New Hampshire Minority Health 

Coalition coordinates the New 

Hampshire REACH 2010 Initiative.

n This initiative works to improve the 

health of African descendents and 

Latinos living in Hillsborough County 

by conducting outreach, educational, 

and research activities that focus on 

diabetes and high blood pressure.

n The county’s population is very culturally diverse. We use the phrase “African 

descendents” to refer to African 

Americans and recent immigrants from 

Africa and the Caribbean. Our Latino 

population also includes U.S. citizens 

and recent immigrants.

n In Manchester and Nashua, the two 

largest cities in Hillsborough County, 

the Latino populations grew more than 

133% and 124%, respectively, during 

1990–2000.

The Problem 

n Compared with white adults in the 

United States, African Americans are 

1.6 times more likely to have diabetes. 

Latinos are 1.5 times more likely to 

have diabetes than whites.

n Nationally, African Americans are 

30% more likely to die of heart disease 

than whites.

n African Americans and Latinos also 

have higher rates of overweight and 

obesity, which are two of the leading 

risk factors for diabetes and 

heart disease.

The Solution 

n One of the main goals of the New 

Hampshire REACH 2010 Initiative is to 

implement programs that will reduce 

health disparities in diabetes and high 

blood pressure.

n Our programs are designed by the 

target communities to reflect their 

cultures and languages. One such program is Change for Life, or Cambia tu 

Vida in Spanish. This community-based 

REACHing African Descendents and Latinos

in Hillsborough County, New Hampshire

program helps African descendents 

and Latinos adopt healthy habits to 

reduce their risk for diabetes and high 

blood pressure.

n Another program is Let’s Talk Diabetes, 

or Hablemos de Diabetes in Spanish. 

This community-based program provides education and support to people 

with diabetes and their families.

n Other activities include a community 

walking program, educational and 

nutritional counseling for people 

with diabetes, and a Community 

Health Advisory Board made up of 

local leaders.

n We also collect data on the health 

status, health care access, and health 

behaviors of African descendents and 

Latinos in Hillsborough County. These 

data can be used to educate state 

officials about the need for equal 

health care services for all residents.

Our Achievements 

n We are the first group in New Hampshire to collect significant data about 

health disparities among African 

descendent and Latino populations in 

Hillsborough County. 

“Now I can tell that the program is not just a diet or exercise program. It’s more like my choice to choose and replace my unhealthy 

habit for a healthy habit.” 

—Cambia tu Vida program participant

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont.

n We contributed these data to New 

Hampshire Diabetes Data, 2003, a 

report by the New Hampshire Department of Health and Human Services.

n More than 1,300 African descendents 

and Latinos in Hillsborough County 

have participated in our education and 

prevention programs.

n We created the Community Health

Advisory Board to advise our initiative 

on how best to serve African descendent and Latino populations.

Our Future 

Our initiative will provide training and 

assistance to community leaders and 

residents who want to use the Change 

for Life/Cambia tu Vida and Let’s 

Talk Diabetes/Hablemos de Diabetes 

programs in their communities. We 

also will work with state policy leaders 

to ensure that appropriate data are 

collected and analyzed to identify and 

address health disparities. 

Getting the Word Out Locally

n “Discrimination Stops Immigrants From 

Seeking Care,” The Nashua Telegraph, 

October 5, 2006. 

n “Discrimination May Discourage Immigrants From Getting Health Care,”

The Boston Globe, October 4, 2006.

n “Study: Racism Affects Health of 

Minorities,” The Union Leader, 

September 29, 2006.

Generating New and 

Exciting Science 

n “Self-Reported Discrimination and 

Mental Health Status Among African 

Descendents, Mexican Americans, 

and Other Latinos in the New Hampshire REACH 2010 Initiative: The 

Added Dimension of Immigration.” 

American Journal of Public Health

2006;96(10):1821–1828.

n “Change For Life/Cambia Tu Vida: A 

Health Promotion Program Based on 

the Stages of Change Model for African Descendent and Latino adults in 

New Hampshire.” Preventing Chronic 

Disease [serial online] 2006;3(3). 

Available at http://www.cdc.gov/pcd/

issues/2006/jul/05_0218.htm.

n “The Association Between SelfReported Discrimination, Physical 

Health, and Blood Pressure: Findings 

from African Americans, Black Immigrants, and Latino Immigrants in New 

Hampshire.” Journal of Health Care for 

the Poor and Underserved 2006;17

(2, suppl):116–132.

n “Change for Life! ¡Cambia Tu Vida! 

A Community-Based Intervention 

Addressing Behavioral Risk Factors for 

Diabetes and Hypertension.” Presented 

at the Office of Minority Health National 

Leadership Summit on Eliminating 

Racial and Ethnic Disparities in Health, 

Washington, DC, January 2006.

Keys to Lasting Change in 

African Descendent and Latino 

Communities

The New Hampshire REACH 2010 Initiative 

helps African descendents and Latinos 

adopt healthy habits to reduce their risk for 

diabetes and high blood pressure. To achieve 

this goal, we use tailored home-based 

interventions for Latinos and faith-based 

interventions for African descendents. 

Our programs and materials reflect the 

cultures and languages of the target communities, which is key to their effectiveness. 

We also have found that offering follow-up 

services, such as ongoing support groups, 

to program participants helps them sustain 

healthy habits over time.

Mobilizing Community Resources 

New Hampshire Minority Health Coalition; Dartmouth Medical School, New Hampshire Area Health Education Center; Dartmouth-Hitchcock 

Nashua; Manchester Community Health Center; Manchester Public Health 

Department; Nashua Area Health Center (a center of Lamprey Health Care); 

New Fellowship Baptist Church; Southern New Hampshire Area Health 

Education Center; Ujima Collective; University of New Hampshire.

Jeanie Holt, RN, Project Director, New Hampshire REACH 2010 Initiative 

P.O. Box 3992, Manchester, NH 03105

Phone: 603-627-7703 (ext. 228) • Fax: 603-627-8527

E-mail: jeanie@nhhealthequity.org • Web site: http://www.nhhealthequity.org

FOR MORE INFORMATION
Who We Are 

The Albuquerque Area Indian Health 

Board, Inc., coordinates the Partners 

in Tribal Community Capacity Building 

(REACH 2010) Project.

n This project targets seven American 

Indian tribes whose members live on 

ancestral lands in New Mexico and 

southern Colorado. Together, these 

tribes include about 19,000 members.

n The project works to build community 

and scientific capacity to address the 

rising incidence of breast and cervical 

cancer among American Indian women.

The Problem 

n Breast cancer is the second leading 

cause of death for American Indian 

women, with rates that equal those 

of all racial and ethnic groups in the 

United States combined. 

n Rates of cervical cancer and cervical 

dysplasia are consistently high among 

American Indian women, but screening 

rates are very low.

n In 2003, only 5.5% of American Indian 

women aged 40 or older who are part 

of the Ramah Band of Navajo Indians 

had received a mammogram, compared with 47% of all American Indian 

women in this age group.

n Overcoming these health disparities 

can be hard because of cultural beliefs 

about the causes of cancer and the 

belief that cancer cannot be cured. In 

the Navajo language, cancer is translated as “the sore that will not heal.”

n Other barriers include an overall lack 

of awareness of cancer risks and 

symptoms and a lack of access to 

transportation and screening services.

 The Solution 

n To address these problems, our project 

worked with a pilot community, the 

Ramah Band of Navajo Indians, to create

partnerships between local tribal health 

REACHing American Indians

in New Mexico and Colorado

programs, tribal leaders, and nontribal 

groups. We also conducted focus groups 

to gather more information about 

community members’ knowledge and 

awareness of cancer and about their 

screening behaviors.

n To encourage more tribal women 

aged 40 or older living in the pilot 

community to get screened for breast 

cancer, we used a socioecological 

framework and community-based 

participatory research principles to 

design and implement an intervention 

called Mammography Days.

n For this intervention, project staff 

scheduled mammograms for tribal 

women at the nearest hospital, about 

45 miles away. The project transported the women to the hospital in 

groups to create social support for 

the screenings. Staff also provided 

health information that reflected the 

women’s tribal culture and language.

n Tribal health care providers received 

training in public health topics, 

cancer-screening techniques, and 

surveillance methods to improve their 

patient care.

“When we had the workshop down at the Chapter House, mostly women attended. There were only about two men, but the women 

were going over to the stomach and prostate cancer awareness booth to get information. We need to try and get everyone in.”

—Tribal health care provider

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements 

n Project staff implemented a model 

called Community Involvement to 

Renew Commitment, Leadership, and 

Effectiveness (CIRCLE) to help develop 

public health capacity among the 

targeted tribes.

n Breast cancer awareness has increased 

significantly among tribal women since 

a case manager who specializes in 

breast health was hired in 2004.

n As part of the Mammography Days 

intervention, 130 women aged 40 or 

older have received a mammogram, 

some for the first time in their lives.

n In addition, the Albuquerque Area 

Indian Health Board produced a video 

called “Healthy Navajo Women: Walk 

in Beauty” that features health care 

providers and community members 

discussing breast and cervical cancer 

in English and Navajo. The video is 

shown as part of Mammography Days 

educational activities.

Our Future 

REACH project staff are working to 

duplicate the successful Mammography 

Days intervention in other tribal 

communities. We also will continue to 

build the capacity of tribal and nontribal health care providers to educate 

community members about cancer in a 

way that takes their native cultures and 

languages into account. 

Generating New and 

Exciting Science 

n “A Socioecological Approach to 

Improving Mammography Rates in a 

Tribal Community.” Health Education 

& Behavior 2006. Published online 

November 17, 2006, at http://

heb.sagepub.com/pap.dtl.

n “Building True Capacity: Indigenous 

Models for Indigenous Communities.” 

American Journal of Public Health

2006;96(4):596–599.

n “Healthy Navajo Women: Walk in 

Beauty” [video]. Preventing Chronic 

Disease [serial online] 2006;3(3). 

Available at http://www.cdc.gov/pcd/

issues/2006/jul/06_0052.htm.

n “Intermediate Outcomes of Tribal 

Community Public Health Infrastructure 

Assessment.” Ethnicity and Disease

2004;14(3, suppl 1):61–69.

Keys to Lasting Change in 

the American Indian Community

The Partners in Tribal Community Capacity 

Building (REACH 2010) Project has shown 

that a community-driven intervention that 

is based on a capacity-building model and 

reflects the culture of the target population 

can improve mammography screening in a 

tribal community. We also found that this 

type of intervention will succeed if it includes 

a range of partners, such as tribal leaders, 

community members, the scientific community, and other relevant programs and community groups. In addition, the intervention 

should serve as a model for similar health 

initiatives in other tribal communities.

Mobilizing Community Resources 

Ramah Band of Navajo Indians; Alamo Band of Navajo Indians; Cañoncito (Tóhajiilee) Band of Navajo Indians; Jicarilla Apache Nation; 

Mescalero Apache Tribe; Southern Ute Indian Tribe; Ute Mountain Ute Tribe.

Connie Z. Garcia, Program Director, Partners in Tribal Community Capacity Building

 (REACH 2010) Project, Albuquerque Area Indian Health Board, Inc.

5015 Prospect Avenue NE, Albuquerque, NM 87110

Phone: 505-764-0036 • Fax: 505-764-0446

E-mail: info@aaihb.org • Web site: http://www.aaihb.org

FOR MORE INFORMATION
Who We Are 

Hidalgo Medical Services coordinates 

the La Vida Program.

n The La Vida (Lifestyles and Values 

Impact Diabetes Awareness) Program is 

a collaboration of community partners 

working in southwestern New Mexico.

n The program works to raise awareness 

about diabetes and lessen its negative 

effect on Hispanics living in Hidalgo 

and Grant counties in New Mexico. 

The Problem 

n Hidalgo Medical Services serves a 

geographically large and remote rural 

area that has a high percentage of 

Hispanics among its 35,000 residents. 

Many of these residents are poor, 

elderly, and have major health problems. 

n In our service area, 1 in 5 people does 

not have health insurance, and 1 in 11 

has diabetes.

n Diabetes is a serious health problem 

for Hispanics because of its growing 

prevalence and the high number of risk 

factors and complications among this 

population. The problem must be addressed as the number of Hispanics in 

the United States continues to grow.

The Solution 

n The La Vida Program offers services 

aimed at Hispanics with or at risk 

for diabetes. These services include 

diabetes education classes, support 

groups, community outreach, and 

grocery store tours that include 

instructions on how to read food 

labels.

n The program also offers a restaurant 

intervention that teaches people how 

to make healthy eating choices and 

identify healthy options on menus. 

n The program includes a physical fitness 

program called Active and Alive that is 

available at several local health clubs; 

it also offers classes, home visits, and 

one-on-one sessions with certified 

diabetes educators.

n Our holistic approach addresses the 

following nine dimensions of health: 

REACHing Hispanics in Hidalgo

and Grant Counties, New Mexico

physical, emotional, spiritual, intellectual, 

social, cultural, occupational, material and 

financial, and environmental.

n Lay health workers, called promotoras 

in Spanish, provide support for program 

participants. Promotoras are members 

of the local culture and community, and 

most are bilingual.

Our Achievements 

n The La Vida Program has been wellreceived in the Hispanic community, 

serving more than 13,000 clients during 

2005–2006.

n After initial involvement in the La Vida

Program, Hidalgo Medical Services patients 

had an average hemoglobin A1c level of 

8.2, compared with the national average 

of 9.0 for Hispanics. (Levels 7 increase a 

person’s risk for diabetes complications.)

After 9–12 months of involvement in the 

program, patients’ average A1c levels 

dropped to 7.6.

n Patients’ median A1c levels dropped 

significantly within 1 year of a promotora 

visit or education class.

n In a recent survey, nearly 74% of 

residents had heard of the La Vida 

education classes.

“The promotora [lay health worker] did all the work for me. I was just lost. I didn’t know where I was going to get medical 

attention—help that I needed. She enrolled me in everything right away. I looked through the phone book myself, [but] if you don’t 

have insurance, you’re kind of lost. There was all the help I needed in one little building.”

—La Vida Program participant

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
n The La Vida Program has been 

designated a best practice model by 

the federal Health Resources and

Services Administration. 

n Over the past several years, Hidalgo 

Medical Services has used funds 

from other sources to expand the La 

Vida Program into a more integrated 

program that provides family support 

services (including case management 

and referrals), a medication assistance 

program, smoking cessation classes, 

and nutrition programs. 

Our Future 

The La Vida Program will continue to 

provide services and develop new ones 

as needed. Because this program is 

considered a best practice model, we 

would like to introduce it to other federal 

health centers that serve low-income 

residents who are members of minority 

populations at higher risk for health 

disparities. Sharing our program will 

require seminars to teach others how to 

replicate our model and fund their own 

family support programs. 

Getting the Word Out Locally

n “HMS to Celebrate National Health Center 

Week,” Hidalgo Herald, August 4, 2006.

n “Hidalgo Medical Services Receives 

Award of Excellence from the New 

Mexico Primary Care Association,” 

Lordsburg Liberal, June 30, 2006. 

n “La Vida Approves 23 Menu Items for 

Diabetics at Bayard Restaurant,” Silver 

City Daily Press, June 29, 2006.

n “Diabetes Seminar for Hispanic Women 

Scheduled on Saturday,” Silver City Daily 

Press, February 1, 2006.

Generating New and 

Exciting Science 

n “Model Clinical and Family Support 

Program in Southwestern New Mexico.” 

Presented at the Annual Conference of 

the National Rural Health Association, 

Anchorage, Alaska, May 2007.

n “A Holistic, Integrated Diabetes 

Intervention Model in Hispanic, Rural 

Communities.” Presented at the American Association of Diabetes Educators 

Annual Meeting, Los Angeles, California, 

August 11, 2006.

Mobilizing Community Resources 

Hidalgo Medical Services

Gila Regional Medical Center

New Mexico Department of Health

Donna Flenniken, Program Manager, Hidalgo Medical Services

530 DeMoss St., Lordsburg, NM 88045

Phone: 505-542-8384 • Fax: 505-542-8367

E-mail: dflenniken@hmsnm.org • Web site: http://www.hmsnm.org

FOR MORE INFORMATION

n “Developing a Holistic Family Support 

Program in a Rural Area.” Presented at 

the National Conference of the Family 

Support of America, Chicago, Illinois, 

April 29, 2006.

n “Providing Holistic Family Support:

Creating Systems Change.” Presented at 

the Annual Conference of the New Mexico 

Public Health Association, Albuquerque, 

New Mexico, October 2005.

Keys to Lasting Change in Rural 

Hispanic Communities

We have learned that the best approach 

to helping people with diabetes is to view 

them first as people, not just “people with a 

disease,” and to provide a holistic program 

that meets all their needs in an integrated way. 

Our use of promotoras helped our clients 

relate to and learn from their peers. This 

approach was more successful—and got 

more people involved—than our previous 

efforts because it reflected the culture of 

local residents. We also attribute our success 

to our partnerships with other diabetes 

groups working in New Mexico.

Our Achievements, cont.
Who We Are 

The National Indian Council on Aging 

coordinates the Diabetes Educational 

Outreach Strategies (DEOS) Project.

n This project serves American Indian 

elders who live in New Mexico’s two 

American Indian reservations and 

four pueblos and are members of the 

following tribes: Pueblo of Cochiti, 

Ramah Navajo Band of Indians, Pueblo 

of Laguna, Mescalero Apache, To’hajiilee Navajo Band of Indians, Pueblo

of Isleta, and Pueblo of Santa Ana.

n The DEOS Project works to make 

American Indian elders aware of the 

importance of making healthy lifestyle 

choices to prevent or control diabetes. 

It also offers technical assistance to 

help mobilize communities to achieve 

this goal.

The Problem 

n The prevalence of diabetes is 2–4 

times higher among American Indians 

and Alaska Natives of all ages than it is 

among non-Hispanic whites. American 

Indians and Alaska Natives also have 

higher rates of diabetes complications 

than all other racial or ethnic groups 

in the United States.

n The risk of developing diabetes 

increases with age. For example, in 

2002, the prevalence of diagnosed 

diabetes among American Indian and 

Alaska Native adults aged 20–34 

years was 3.1%, compared with 

28.3% for those aged 65 or older.

n American Indians and Alaska Natives 

also report significantly higher rates 

of health risk factors, such as obesity, smoking, and lack of physical 

exercise, than other racial and ethnic 

groups in the United States.

The Solution 

n A major research study conducted 

by the Diabetes Prevention Program 

found that healthy lifestyle changes 

REACHing American Indian Elders

in New Mexico

can reduce the risk of developing

diabetes by 58% across all U.S. racial 

and ethnic groups. 

n The DEOS Project offers technical 

assistance to build capacity for grassroots educational programs to help 

American Indian and Alaska Native 

elders with diabetes better manage

the disease. 

n The DEOS Project provides training and 

guidance on how to assess community 

needs through focus groups, community surveys, and personal interviews.

n The project also helps communities 

build coalitions to address local health 

disparities and establish diabetes selfmanagement support groups.

Our Achievements 

n The DEOS Project trained community 

members at 10 reservations to begin 

and maintain diabetes support groups. 

Training materials were modified to fit 

the needs of each community.

n More than 66% of participants said 

the support groups helped them maintain their healthy eating and physical 

fitness goals.

“People who attended our diabetes prevention support group say they look forward to the planned activities in the prevention 

program. I have seen a big difference in the people who are actively involved. They look healthier, and most have lost weight.”

—Diabetes prevention coordinator and registered nurse

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
n The project also supported capacity 

building for outreach and fostered 

partnerships with community groups 

that share common goals.

Our Future 

The National Indian Council on Aging 

(NICOA) will develop a road map to help 

project partners assess each community’s 

level of readiness to address diabetes 

prevention. The stage of readiness will 

indicate to local leaders what approach 

they should take before they plan for 

capacity building. This road map can be 

used along with a community needs 

assessment tool to provide guidelines 

on how to evaluate diabetes interventions and ensure that they are improving 

the health of the target population. The 

DEOS Project also will create marketing 

materials that can be used by community 

groups to promote their activities and 

make residents aware of what services 

are available in their communities.

Getting the Word Out Locally

n “Eating Healthy on the Road,” Elder 

Visions, the NICOA quarterly newsletter, Fall 2006.

n “Make the Link! Diabetes, Heart 

Disease and Stroke” (adapted from an 

American Diabetes Association initiative), Elder Visions, Fall 2006.

n “Confetti Salmon Cakes” (recipe), 

Elder Visions, Fall 2006.

n “What DEOS Can Do for You . . .” 

NICOA/DEOS Brochure, September 5, 

2006.

n “Attitudes Weigh Heavy in Reducing 

Pounds,” Elder Visions, Spring/Summer 

2006.

n “Orange Almond Chicken” (recipe), 

Elder Visions, Spring/Summer 2006. 

n “Planting Gardens at Elderly Centers 

to Address Diabetes,” Elder Visions, 

Spring/Summer 2006.

n “What’s in What We Eat?” Elder

Visions, Winter 2005.

n “Support for a Healthy Change,” Elder 

Visions, March 2005.

Generating New and 

Exciting Science 

n “Creating the Vision for Change: A Two 

Front Approach to Diabetes Prevention 

for Our Native American Elders.” 

Presented at the 23rd Annual Consumer 

Conference of the National Indian 

Health Board, Denver, Colorado, October 

10–13, 2006.

n “Community Gardening & Diabetes 

Prevention.” Presented at the American 

Society on Aging Conference, Anaheim, 

California, March 2006.

n “Community Support for Diabetes 

Prevention and Treatment.” Presented at 

the American Heart Association/American 

Stroke Association/Indian Health Service 

Conference, Denver, Colorado, May 2005.

Keys to Lasting Change for

Native American Elders

We developed educational standards and 

used social marketing practices to create 

community support for healthy lifestyles 

among American Indian and Alaska Native 

elders. To improve diabetes education for 

this population, we must develop materials 

that appeal to elders and work with local 

diabetes educators to provide programs in 

their communities. Communication and 

cooperation with community service providers that represent and advocate for American 

Indian and Alaska Native elders also must be 

enhanced. In addition, we are working with 

appropriate agencies to maximize resources 

and increase the efficiency and effectiveness 

of service delivery systems.

Mobilizing Community Resources 

Bemidji Area: Mille Lacs Band of Chippewa Indians (Onamia, MN); St. Croix Band of 

Lake Superior Chippewa Indians (Webster, WI); Fond du Lac Band of Lake Superior 

Chippewa (Cloquet, MN).

Albuquerque Area: Pueblo of Cochiti (Cochiti Pueblo, NM); Ramah Navajo Band of 

Indians (Ramah-Pine Hill, NM); Pueblo of Laguna (Laguna, NM); Mescalero Apache 

(Mescalero, NM); Tohajiilee Navajo Band of Indians (To’hajiilee, NM); Pueblo of Isleta 

(Isleta, NM); Pueblo of Santa Ana (Santa Ana, NM).

Robert A. Comer, DEOS Project Director

10501 Montgomery Blvd. NE, Suite 210, Albuquerque, NM 87111-3846

Phone: 505-292-2001 • Fax: 505-292-1922

E-mail: robert@nicoa.org • Web site: http://www.nicoa.org

FOR MORE INFORMATION

Our Achievements, cont.
Who We Are 

The Institute for Urban Family Health 

coordinates the Bronx Health REACH 

Coalition.

n This coalition develops and implements 

community-based health promotion 

programs focused on preventing 

diabetes and related conditions. It also 

mobilizes community leaders to make 

health equality a reality by addressing 

local and state health policies. 

n We focus on black and Latino communities in the southwestern area of the 

Bronx, which include 280,000 people 

living in the following ZIP codes: 

10452, 10453, 10456, and 10457.

The Problem 

n In the South Bronx, where more than 

95% of the population is black or 

Latino, 18% of residents have 

diabetes, 64% are overweight, and 

24% are obese.

n The death rate for heart disease is 

17% higher for people living in the 

Bronx compared with people living in 

New York state. 

n Women in the South Bronx are 20 

times more likely to die of diabetes 

than women living on the Upper 

East Side of Manhattan, a 10-minute 

subway ride away. 

The Solution 

n Research shows that improving nutrition, increasing physical activity, losing 

5%–7% of body weight, and having 

better access to preventive care can 

prevent or delay the onset of diabetes 

or decrease the rate of poor outcomes.

n In response to these findings, the 

Bronx Health REACH Coalition has 

implemented several programs,

including a faith-based outreach initiative, a nutrition and fitness initiative, 

REACHing Blacks and Latinos

in Bronx, New York

public health education programs, and 

community health advocacy programs.

n We also conducted a survey to identify 

community members living with or at 

risk for diabetes. This information helped 

us develop and tailor our programs.

Our Achievements 

n The faith-based outreach initiative 

works with 22 churches to educate local 

residents and empower them to adopt 

healthy lifestyles. This initiative includes 

a program called Fine, Fit and Fabulous 

that helps people make positive and 

sustainable changes to their eating 

habits and activity levels.

n Local pastors include health messages in 

their weekly sermons, and many churches 

include health-related information in 

their weekly church bulletins.

n The nutrition and fitness initiative 

works to improve residents’ access to 

healthy foods. New York City schools 

have switched from whole milk to lowfat milk, neighborhood grocers carry 

low-fat milk and healthier snacks, and 

local restaurants highlight their healthy 

menu options.

“The church is strategically situated to communicate health messages of importance and also to heighten the awareness of our 

friends and neighbors and constituents regarding the absence of fair and equitable delivery of health services to our communities. 

We must be foot soldiers for medical justice.” 

—Rev. Robert L. Foley, Sr., pastor, Cosmopolitan Church of the Lord Jesus

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
n Our coalition produced a video called 

“Voices for Health Equality,” and we 

developed a cultural competency training program for health care providers.

n We published Separate and Unequal: 

Medical Apartheid in NYC, a report that 

examines the policies and practices that 

contribute to differences in access to and 

quality of health care for members of 

different racial and ethnic groups.

Our Future 

The Bronx Health REACH Coalition will 

expand its faith-based outreach initiative, 

continue to develop and support a public 

policy agenda to address obesity, and 

conduct a community food assessment. 

We also will promote a new medical 

reimbursement policy designed to offset 

some of the underlying causes for the 

separate and unequal health care system 

in New York City.

Getting the Word Out Locally

n “Eateries Go on a Trim Fling,” Daily 

News, October 23, 2006.

n “In New York Schools, Whole Milk Is 

Cast from the Menu,” The New York 

Times, February 2, 2006.

n “New York Pushing Better Diet in Poorer 

Neighborhoods,” The New York Times, 

January 20, 2006.

n “Apartheid at Apple Hospitals,” New 

York Post, October 16, 2005.

n “El Bronx en plan de comer saludable,” 

Hoy Nueva York, October 24, 2006.

Generating New and 

Exciting Science 

n “Fostering Organizational Change 

Through a Community-Based Initiative.” Health Promotion Practice

2006;7(3, suppl):181S–190S.

n “Racial and Ethnic Disparities in 

Health: A View from the South Bronx.” 

Journal of Health Care for the Poor and 

Underserved 2006;17(1):116–127.

n “The Role of Faith-Based Institutions in 

Addressing Health Disparities: A Case 

Study of an Initiative in the Southwest 

Bronx.” Journal of Health Care for the 

Poor and Underserved 2006;17

(2, suppl):9–19.

n “Separate and Unequal Care in New 

York City.” Journal of Health Care Law 

and Policy 2006;9(1):105–120.

n “Making Health Equality a Reality: The 

Bronx Takes Action.” Health Affairs

2005;24(2):491–498.

Keys to Lasting Change in Black 

and Latino Communities

To develop and implement model community 

programs in black and Latino communities, the Bronx Health REACH Coalition has 

designed, developed, and implemented interventions that reflect local cultures and have 

become part of the targeted communities. 

We also have promoted policy changes that 

help to sustain improvements in community 

health. We developed a health policy 

agenda and mobilized community leaders 

to educate government officials about this 

agenda. Our coalition also has conducted 

research to identify the barriers to quality 

health care; disseminated our findings to 

public policy makers, regulators, legislators, 

and health care officials; and developed 

recommendations for improvement.

Mobilizing Community Resources 

Bronx District Public Health Office; New York City Department of Health and Mental Hygiene; 22 churches in the Faith-Based Outreach Network; Bronx Westchester Area Health Education 

Center; Center for Health and Public Service Research, New York University; Center for Medicare 

and Medicaid Services, New York Regional Office, Commission on the Public’s Health System; 

Correction Community Linkage Program; New York City Department of Education, Region 1; 

City University of New York, Lehman College, Department of Health Services; Health People; 

Highbridge Community Life Center; Joyce Davis Associates; Leukemia & Lymphoma Society; 

Math Arts Recreation Center After School Program; Mid-Bronx Senior Citizens Council; 

Montefiore School Health Program; Mount Hope Housing Company; Neighborhood Self-Help for 

Older Persons; New York State Department of Health, Diabetes Prevention and Control Program; 

Healthy Hearts Program; Cornell University Cooperative Extension; New York Lawyers for the 

Public Interest; Partners in Health; U.S. Department of Justice, Office of Civil Rights, Region II; 

Women’s Housing and Economic Development Corporation.

Charmaine Ruddock, MS, Project Director, Bronx Health REACH Coalition

C/O IUFH, 16 East 16th St., New York, NY 10003

Phone: 212-633-0800 (ext. 291) • Fax: 212-989-2840

E-mail: cruddock@institute2000.org • Web site: http://www.Institute2000.org

FOR MORE INFORMATION

Our Achievements, cont.
Who We Are 

The Mailman School of Public Health 

of Columbia University coordinates 

the Northern Manhattan Start Right 

Coalition.

n This coalition serves the predominantly 

low-income communities of Harlem and 

Washington Heights/Inwood of Northern 

Manhattan in New York City. Of the 

nearly 462,000 residents in this area, 

32% are African American and 52% are 

Latino.

n The coalition includes 17 community 

groups or agencies, two health care 

networks, the New York City health 

department, and Columbia University’s 

Mailman School of Public Health.

n The coalition is working to improve low 

immunization rates among children 

living in Northern Manhattan. Our goal 

is to bring 10,000 children younger than 

age 3 up to date on all recommended 

childhood immunizations.

The Problem 

n In 2000, childhood immunization rates 

in Northern Manhattan were 11% 

below the rates in other parts of New 

York City and 19% below national rates.

n Before the Start Right program began, 

fewer than half of children in the 

target communities were immunized 

on time.

The Solution 

n Our coalition’s strategy is to promote 

immunization through existing 

community programs that serve the 

needs of parents of young children. 

Examples include programs that offer 

parenting education or support, early 

childhood education, WIC services, 

and facilitated enrollment in the State 

Children’s Health Insurance Program. 

n We developed a five-part training

program for community health workers that integrates community health 

worker materials, immunization 

REACHing Children and Families

in Harlem and Washington Heights, New York

materials, health education strategies, 

evaluation activities, and recordkeeping activities.

n Of the 902 community health workers 

we trained through the Start Right 

program, 577 completed the entire 

series and 261 are actively promoting 

immunizations as part of their regular 

program activities. 

Our Achievements 

n Start Right community health workers 

have talked with more than 10,000 

families about the importance of children 

being up to date on all immunizations.

By September 2006, we had enrolled 

9,560 children. 

nWe increased the immunization rate to 

76% for children of all ages enrolled in 

our program during 2002–2006, with 

86.5% of children up to date by age 3.

nWe have closed the immunization disparity gap in Northern Manhattan. Latino 

and African American children enrolled 

in the Start Right program no longer lag 

behind the city and nation in their immunization rates. In fact, the rate for children 

aged 19–35 months now exceeds the 

national average.

“I learned how to inquire about the immunizations my baby should get. Now I know what shots the baby needs. This program 

helped me by giving me information on places to go for immunizations and also by handing out lots of materials on immunizations. 

Some people are not aware of how important it is to keep your child’s immunizations up to date.”

—Parent enrolled in the Start Right program

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Future 

The Northern Manhattan Start Right 

Coalition will continue to expand its efforts 

and to work with other groups throughout 

our communities. To make our training 

program available nationwide, we are 

working with community health worker 

networks to put our materials on the 

Internet. 

Getting the Word Out Locally

n “Bank of America Supports Local 

Community Organization,” El Diario, 

February 14, 2006.

n “The Start Right Coalition Increases 

Childhood Immunization in Northern 

Manhattan,” Manhattan Times, 

December 9, 2004. 

n Starting Right: A Community-Based Community Health Worker Training Program. 

Developed by the Northern Manhattan 

Start Right Coalition, the Mailman School 

of Public Health of Columbia University, 

and the Community Health Worker 

Institute of Alianza Dominicana, Inc.

Generating New and 

Exciting Science 

n “Community-Based Strategies to 

Reduce Childhood Immunization 

Disparities.” Health Promotion Practice

2006;7(3, suppl):191S–200S.

n “The Impact of Community Health 

Worker Training and Programs in New 

York City.” Journal of Health Care for 

the Poor and Underserved 2006;17(1):

S24–S43.

n “Community Empowerment to Reduce 

Childhood Immunization Disparities 

in New York City.” Ethnicity & Disease

2004;14(3, suppl 1):134–141.

n “Community-Provider Partnerships to 

Reduce Immunization Disparities: Field 

Report from Northern Manhattan.”

American Journal of Public Health

2003;93(7):1041–1044.

Mobilizing Community Resources 

Arthur Eugene & Thelma Adair Community Life Centers; Alianza Dominicana, Inc.; CHILD Head Start, Inc., Riverside Center; Dominican Women’s Development Center; Ecumenical Community Development Organization; Ft. George 

Community Enrichment Center; Harlem Children’s Zone (The Baby College); 

Harlem Congregations for Community Improvement; Harlem Hospital WIC 

Program; Mailman School of Public Health, Columbia University; Northern 

Manhattan Improvement Corp.; Northern Manhattan Perinatal Partnership, Inc.; 

Puerto Rican Family Institute/Vacunas Para la Familia; Washington Heights/Inwood 

Early Childhood Education Coalition; New York Presbyterian Hospital Department 

of Pediatrics; Northern Manhattan Community Voices Collaborative; New York 

City Department of Health and Mental Hygiene, Bureau of Immunizations.

Sally Findley, PhD, Principal Investigator, or Martha Sanchez, MA, Program Director

Northern Manhattan Start Right Coalition, Mailman School of Public Health, Columbia University

60 Haven Ave. B2, New York, NY 10032

Phone: 212-304-5501 • Fax: 212-544-1953

E-mail: sef5@columbia.edu or ms1998@columbia.edu

FOR MORE INFORMATION

Keys to Lasting Change in African 

American and Latino Communities

To sustain lasting change in the immunization rates of children in Northern 

Manhattan, our coalition has learned 

that a program must have community 

leaders, peer health educators, integration 

with community social service programs, 

and linkage with community health care 

providers. Our program has relied on proven 

strategies, including setting up reminder 

and tracking systems and providing positive 

feedback to community groups and parents. 

We also learned that parents must be 

empowered as active partners so they will 

help promote the importance of immunizations beyond the doctor’s office and 

into the community. In addition, we found 

that integrating immunization promotion 

activities into ongoing programs (e.g., WIC, 

Head Start) is an effective approach.
Who We Are 

The Carolinas HealthCare System 

coordinates the Charlotte REACH 

2010 Coalition.

n The coalition is made up of several 

community and health care groups 

who are working together to reduce 

the incidence of heart disease and 

diabetes among African Americans 

living in the Northwest Area of 

Charlotte, North Carolina (ZIP codes 

28208 and 28216).

n According to the 2000 U.S. Census, 

89% of residents in the Northwest 

Area are African American.

The Problem 

n The average death rate for heart 

disease among residents of Charlotte’s 

Northwest Area is nearly 40% higher 

than the rate for the rest of Mecklenburg County. 

n The average death rate for stroke in the 

Northwest Area is nearly twice the rate 

for the rest of Mecklenburg County. 

n In 2000, 10% of Northwest Area 

residents had diabetes, compared with 

7% of all North Carolinians and 9% of 

African Americans in North Carolina.

n Also in 2000, 35% of Northwest Area 

residents had high blood pressure, 

compared with 23% of all North

Carolinians and 26% of African

Americans in North Carolina. 

The Solution 

n The Charlotte REACH 2010 Coalition 

has implemented interventions that 

focus on the primary prevention of heart 

disease and diabetes. These interventions focus on physical activity, nutrition, 

smoking cessation, tobacco use prevention, and systems and environmental 

changes. We also evaluate our interventions to ensure their effectiveness.

n The foundation of our efforts is the 

use of trained lay health advisors who 

REACHing African Americans

in Charlotte, North Carolina

are recruited from local communities 

affected by health disparities.

n Our outreach and education programs 

help community members change 

unhealthy behaviors and increase 

activities that can reduce disease risk, 

such as being more physically active, 

eating a healthy diet, and quitting 

smoking.

Our Achievements 

n In 2001, a neighborhood farmers’ 

market was opened to provide 

Northwest Area residents with greater 

access to fresh fruits and vegetables. 

The market is open every Saturday 

(except during winter) and averages 

about 350 customers a week. It is 

managed by a neighborhood group 

and provides space for local vendors to 

sell their produce.

n Since the market opened, 73% of 

residents said they are eating more 

fresh fruits and vegetables each day. 

In addition, 72% said they are being 

more physically active, and 67% said 

they have reduced the amount of fat in 

their diet.

“Since I took the nutrition class, I’ve changed my eating habits. The nutritionist showed us what a portion looked like. It was hard 

at first. I also learned that eating in the morning is important, even if it’s nothing but a little bit. I stopped eating all fried foods, 

and I’ve gotten away from eating fast food. I’ve lost 77 pounds.”

—Neighborhood resident

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont. 

n Through a partnership with the Greater 

Charlotte YMCA (McCrorey Branch), 

exercise classes are provided free at 

community recreational centers and 

the local YMCA branch.

Our Future 

The Charlotte REACH 2010 Coalition 

will continue to bring together more 

community partners to help reduce racial 

and ethnic health disparities among 

North Carolina residents. Our current 

efforts, including the lay health advisors, 

the neighborhood farmers’ market, and 

the YMCA partnership, have all been 

well-received by the community. These 

interventions will continue to be a part of 

our efforts to promote healthy lifestyles 

in North Carolina.

Getting the Word Out Locally

n “No Butts About It,” Pride Magazine, 

Summer 2004.

n “A Fighting Chance,” Pride Magazine, 

Summer 2003.

n “Making a Difference in Diabetes: 

Working to Control Your Diabetes for 

Life,” The Charlotte Observer, May 29, 

2003.

n “Seasonal Solution Gathers 

Momentum,” The Charlotte Observer, 

February 10, 2003.

Generating New and 

Exciting Science 

n “A Lay Health Advisor Program to 

Promote Community Capacity and 

Change Among Change Agents.” 

Health Promotion Practice. Published 

online November 14, 2006, at

http://heb.sagepub.com/pap.dtl.

n “A Qualitative Assessment of Charlotte 

REACH: An Ecological Perspective for 

Decreasing CVD and Diabetes Among 

African Americans.” Ethnicity & Disease 

2004;14(3, suppl 1):77–82.

n “A Community-Oriented Primary Care 

Demonstration Project: Refining Intervention for Cardiovascular Disease and 

Diabetes.” Annals of Family Medicine

2004;2(2):103–109.

Keys to Lasting Change in the 

African American Community

The success and effectiveness in 

promoting primary prevention of heart 

disease and diabetes in this African 

American community is directly related 

to the commitment and dedication of the 

members of the Charlotte REACH 2010 

Coalition. The purpose of the coalition is 

to provide direction and to monitor our 

progress. Members include grassroots 

groups and representatives from health 

and human service agencies. Without 

these collaborations, the work of each 

group would be less effective. 

Mobilizing Community Resources 

Carolinas HealthCare System; University Park Neighborhood Association; North Carolina Department of Health and Human 

Services; Mecklenburg County Health Department; McCrorey Family YMCA; 

Substance Abuse Prevention Services, Inc.; University of North Carolina at 

Charlotte.

LaTonya Chavis, MS, Director, Charlotte REACH 2010 Coalition

1350 South Kings Drive, Charlotte, NC 28207

Phone: 704-446-1539 • Fax: 704-446-1155

E-mail: LaTonya.Chavis@carolinashealthcare.org

Web site: http://www.reach2010charlottenc.org

FOR MORE INFORMATION
Who We Are 

The Eastern Band of Cherokee Indians 

coordinates the Cherokee Choices/

REACH 2010 Diabetes Prevention 

Program.

n Cherokee Choices includes three 

components: mentoring for elementary school students, work site wellness programs for adults, and health 

promotion activities at local churches. 

It is administered by the Health and 

Medical Division of the Eastern Band 

of Cherokee Indians.

n The cornerstones of this program are 

listening to the community and providing social support to increase physical 

activity and promote well-being and 

healthy choices, which can reduce the 

risk for obesity and diabetes.

The Problem 

n Cherokee men and women are twice 

as likely to be obese as members of 

other racial and ethnic groups in North 

Carolina.

n The prevalence rate of type 2 diabetes 

among Cherokee men and women 

combined is 23.8%. This rate is more 

than three times the combined rate for 

men and women from all other racial 

and ethnic groups in North Carolina.

The Solution 

n Cherokee Choices works to mobilize the 

community to confront environmental 

and biological factors that put Cherokee 

people at higher risk for diabetes. Our 

efforts include addressing issues related 

to racism and mental health; creating a 

supportive environment for community 

participation; and developing policies 

for schools, work sites, and churches 

that promote positive health changes.

n Mentors work with elementary school 

children and staff to develop lesson 

plans on self-esteem, cultural pride, 

conflict resolution, emotional well-being, 

REACHing Eastern Band of Cherokee Indians

in Cherokee, North Carolina

and health knowledge. These mentors 

also developed a weekly after-school 

program to enhance teamwork, cultural 

awareness, and physical health. 

n Nutritionists, dietitians, and fitness 

workers help tribal members participate in activities at their churches and 

work sites that are designed to help 

them reduce stress, eat healthier 

foods, and increase their physical 

activity levels.

Our Achievements 

n Cherokee Choices has changed the 

culture of local schools, allowing policy 

changes that support physical activity 

programs for students and staff.

n To promote healthy eating, the Cherokee 

Central School System Board reduced 

the amount of saturated fat allowed in 

school meals.

n A significant increase in healthy eating 

and physical activity has been reported 

in Cherokee schools and at participating 

work sites; 96% of school participants 

said they know how to make healthier 

food choices.

“At Cherokee Elementary, I’ve noticed that since we’ve had Cherokee Choices in our school, the students are much more aware of 

the necessity of physical exercise and eating healthy foods. When they come to the library, they’re looking for materials on cooking 

and about their bodies and maturing. We see them out walking on our track, and they’re trying to be healthier overall.”

—Cherokee Elementary School teacher

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
n Some program participants have been 

able to decrease or eliminate their use 

of medications for diabetes and high 

blood pressure.

n We produced a documentary called 

“Generations of Wellness,” which 

provides positive stories and role 

models for the community.

n Five area churches and 170 church 

members are involved in the Walk to 

Jerusalem project, where participants 

try to walk the equivalent distance 

between Cherokee and Jerusalem. 

Participants have collectively walked 

more than 31,600 miles in 6 months. 

Progress is tracked on a map at each 

church, and celebrations are held 

periodically to keep people motivated.

Our Future 

The Cherokee Choices/REACH 2010 

Diabetes Prevention Program hopes to 

expand to incorporate more schools, work 

sites, and churches. We will share our 

knowledge and promote development of 

similar programs in surrounding counties. 

We will seek funding to create a more 

walkable community with greenways and 

sidewalks. As our program grows, we will 

try to show the link between our program 

and health care costs paid by the tribe, to 

illustrate the value of investing in prevention.

Getting the Word Out Locally

n “Students Lend a Leg to Fight Diabetes 

Among Cherokee,” Asheville CitizensTimes, February 26, 2004.

n “Living With Diabetes,” published 

monthly in Cherokee One Feather, the 

weekly newspaper of the Tribal Council

of Eastern Band of Cherokee Indians.

n Three 30-second television ads shown 

throughout western North Carolina, 

2005–2006.

Generating New and 

Exciting Science 

n “Cherokee Choices: A Diabetes Prevention Program for American Indians.”

Preventing Chronic Disease [serial 

online] 2006;3(3). Available at http://

www.cdc.gov/pcd/issues/2006/jul/

05_0221.htm.

Mobilizing Community Resources 

Cherokee Central School System; Cherokee Hospital; Cherokee Diabetes 

Clinic; Community Club Council; Cherokee Human Resources; Healthy 

Cherokee; Cherokee Central School System Board; United Methodist 

Church; Latter Day Saints; Cherokee Tribal Planning Office; multiple 

Cherokee work sites.

Jeff Bachar, MPH, Principal Investigator, Cherokee Choices/REACH 2010 

Eastern Band of Cherokee Indians

P.O. Box 666, Cherokee, NC 28719

Phone: 828-497-1970 • Fax: 828-497-1799 • E-mail: jbachar@nc-cherokee.com

Web site: http://www.cherokee-hmd.org/Departmental/cherokee_choices.htm

FOR MORE INFORMATION

Keys to Lasting Change in 

the Cherokee Community

Our program’s community-based 

participatory approach has prompted 

strong community involvement and 

earned respect from community members. 

This approach makes Cherokee Choices 

different from the top-down programs 

typically provided by social service agencies 

in Cherokee communities. As a result, 

community members have expressed 

interest in using the same techniques to 

deal with other local health issues. 

Now that community members have seen 

positive changes in their children and 

their co-workers, they are learning that a 

diabetes diagnosis is not inevitable. The 

philosophy that underlies the Cherokee 

Choices program is that conducting multiple activities at the same time can bring 

about community and system changes. 

Our Achievements, cont.
Who We Are 

The Association of American Indian 

Physicians coordinates the Oklahoma 

REACH HIV/AIDS American Indian 

Capacity Building (OKRAICB) program.

n The OKRAICB program has established 

community coalitions in three 

Oklahoma regions. Partners in these 

coalitions include community groups 

that serve American Indians, county 

health care providers, federal health 

care providers, and tribal health 

care systems.

n The OKRAICB program promotes 

awareness about HIV and AIDS among 

American Indians.

n The program also helps tribes address 

issues related to HIV and AIDS by 

helping them develop interventions that 

reflect the culture of tribal communities.

The Problem 

n American Indians are infected with HIV 

and AIDS at a rate of 11.7 per 100,000 

people, which is nearly 1.5 times the 

rate for whites (7.9).

n HIV infection often goes unnoticed 

in American Indian communities that 

already face other severe and more 

visible health and social problems, 

such as alcoholism, diabetes, and high 

unemployment.

n As a group, American Indians often 

have high levels of risk factors that 

allow the easy spread of HIV, including 

high rates of sexually transmitted 

infections and illegal drug use.

 The Solution 

n By working with and supporting other 

community groups and by targeting 

young people, the OKRAICB coalitions 

have been able to raise awareness 

about and interest in dealing with the 

problem of HIV infection in American 

Indian communities. These efforts 

have helped overcome the stigma of 

the disease.

REACHing American Indians

in Oklahoma

n By developing interventions that reflect 

the culture of tribal communities, 

coalition members have helped change 

attitudes and beliefs about HIV and 

AIDS among community leaders.

n Coalitions have hosted several 

community events to raise awareness 

about HIV and AIDS, including a 

concert and powwow called BUH: 

Battling Stigma to Unite Indian Youth 

Against HIV/AIDS. 

n The OKRAICB program also teaches 

coalition members about behavioral 

theories and how to create community 

interventions; holds monthly planning 

meetings in each community; and 

provides quarterly training sessions 

to teach coalition members how 

to conduct Internet research, write 

grants, and create PowerPoint 

presentations. 

Our Achievements 

n In 2006, more than 1,000 community 

members attended community-based 

activities sponsored by the coalitions. 

n Coalitions have gained the support of 

tribal members within the communities. 

“If it was not for my involvement with the coalition, I would have never been able to talk about HIV. Now I can talk with my family 

about the risk factors associated with HIV and prevention. As a result of the knowledge of HIV that I gained through the coalition, 

I am now in a leadership program for the prevention of hepatitis C.”

—OKRAICB coalition member

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont. 

n In 2006, 100 American Indian mothers 

brought their daughters to a community 

training session that addressed basic 

facts about HIV and AIDS. 

n Coalitions have gained the support of 

the public school systems and tribal 

boarding schools in their regions.

Our Future 

The OKRAICB program will continue to 

support the efforts of the community 

coalitions. We also will continue to 

develop the skills of community leaders 

to help them prevent HIV and AIDS in 

their communities. 

Mobilizing Community Resources 

Oklahoma Native Nations United 

Against AIDS Coalition: Comanche 

Nation Substance Abuse Program; Ft. 

Sill Apache Emergency Youth Shelter; 

Anadarko Public Schools Indian Education 

Program; Riverside Indian School; Caddo 

County Department of Human Health Services; Wichita & Affiliated Tribes Juvenile 

Services Program; Wichita Tribal Youth 

Program; Apache Tribe Caregiver Program; 

Apache Tribe Title VI AOA Program; 

Kiowa Tribe Substance Abuse Program; 

Anadarko Indian Health Center; 

Consortium Against Substance Abuse; 

Comanche Nation New Pathways; Lawton Indian Hospital; Kiowa Tribe Injury 

and Prevention Program; Kiowa Workforce Investment Act Program.

Pani HOPE Coalition: Kaw Nation of 

Oklahoma/Kanza Health Center; Pawnee 

Nation Tax Commission; Pawnee Indian 

Health Center; Pawnee Gaming Commission; Hunter Health Clinic; Pawnee 

Nation Tribal Council; Pawnee Nation 

Diabetes Program; Pawnee Public 

Schools Indian Education Program; 

Pawnee Nation Health Education 

Program; Pawnee Nation Title VI Elderly 

Meals Program; White Eagle Indian 

Health Center; Pawnee County CASA; 

Pawnee Nation Housing Authority; 

Pawnee Nation Fire Department.

HEART Coalition: Cherokee Nation 

Behavioral Health Services; Northeastern 

Tribal Health Center; Cherokee Nation 

Community Health Nursing; Claremore 

Indian Hospital; Planned Parenthood of 

Arkansas and Eastern Oklahoma; Sam 

Hider Jay Community Clinic; Tulsa Indian 

Health Care Resource Center; InterTribal Substance Abuse & Treatment 

Center; Freeman Health System.

Getting the Word Out Locally

n “Group Tells Indians About AIDS,” 

Tulsa World, May 22, 2006.

Keys to Lasting Change in 

the American Indian Community

Partners in the OKRAICB program have 

learned many important lessons that 

have helped to sustain real change in 

the American Indian community. For 

example, we learned that it takes at least 

12 months to develop a communitydriven prevention program. We also 

learned that, for community-based and 

community-driven interventions to work, 

staff members must gain the respect of 

the community and create interventions 

that reflect local cultures. In addition, 

community interventions must meet 

the specific needs of each community 

to be successful.

Mobilizing Community Resources 

T

he OKRAICB program includes three coalitions—the Oklahoma Native 

Nations United Against AIDS Coalition, the Pani HOPE Coalition, and the 

HEART Coalition. The partners in each coalition are listed below.

Margaret Knight, Executive Director, Association of American Indian Physicians

1225 Sovereign Row, Suite 103, Oklahoma City, OK 73108

Phone: 405-946-7072 • Fax: 405-946-7651 • E-mail: mknight@aaip.org

Web site: http://www.aaip.org/programs/hiv_aids/community_capacity/

community_capacity.htm

FOR MORE INFORMATION
Who We Are 

The Choctaw Nation of Oklahoma 

coordinates the Choctaw Nation Core 

Capacity Building Program.

n This program works to identify the 

burden of heart disease among American Indians living within the Choctaw 

Nation of Oklahoma boundaries. It also 

assesses current prevention efforts and 

works to implement better strategies 

to prevent and control disease among 

this population.

n More than 80,000 American Indians 

live inside the Choctaw Nation of 

Oklahoma boundaries. More than 

395,000 American Indians live in the 

state of Oklahoma.

The Problem 

n Prevalence rates for heart disease and 

many of its risk factors are high among 

American Indians/Alaska Natives in the 

United States. For example, the rate for 

heart disease is 5.2%, the rate for high 

blood pressure is 24.4%, and the rate 

for high cholesterol is 31.6%. 

n Heart disease is the leading cause of 

death for American Indians living in 

Oklahoma.

n Substance abuse, especially of methamphetamines, is affecting more and more 

Choctaw Nation of Oklahoma communities. Research has shown that substance 

abuse can have a devastating effect on 

heart health.

The Solution 

n The Choctaw Nation Core Capacity 

Building Program has successfully worked 

with its partners to create 12 community 

coalitions within the 11 counties of the 

Choctaw Nation of Oklahoma. These 

coalitions are raising awareness about 

heart disease prevention, improving 

access to care, and assessing the health 

needs of each community.

n This program also has developed an 

innovative educational program that 

works to increase awareness about heart 

REACHing American Indians

in the Choctaw Nation of Oklahoma

disease prevention and to address the 

identified needs of each community.

nWhen several Choctaw communities 

said they needed educational programs 

on substance abuse, we created a slide 

presentation that describes the effects 

of certain drugs on a person’s heart. We 

have shown this presentation at a variety 

of community events, and we put it on 

our Web site. We also provide copies to 

anyone who wants to share this presentation with other groups. 

nWe found that children, particularly those 

in kindergarten and Head Start programs, 

were the most receptive to our presentation. Many students said they wanted to 

keep their hearts healthy, and that they 

would never use drugs because they did 

not want their hearts to stop beating.

Our Achievements 

n We have presented our educational 

program at 17 national conferences 

and 116 state events. 

n We have made 92 presentations at 45 

schools, educating students and staff 

about heart disease prevention and the 

devastating effects of substance abuse 

on heart health. 

“Outstanding program. Thank you for making such a wonderful program available for our students. Programs like this are greatly 

needed. Thank you for caring about the future of our youth.” 

—Sixth-grade teacher in Talihina, Oklahoma

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont.

n As a result of our partnerships with 

local community and public health 

groups, the Choctaw Nation Recovery 

Center added questions about heart 

health to its patient intake forms and 

follow-up interviews.

n We also partnered with Colorado 

State University’s Tri-Ethnic Center to 

create a survey to assess communities’ 

readiness to address the health issues 

identified in needs assessment surveys. 

n We partnered with the Oklahoma 

State Department of Health to link 

the state’s death certificate database 

with the Indian Health Service Patient 

Registration database. This linkage 

will help to correct the problem of 

American Indians being misclassified 

as members of other races on their 

death certificates (which happens 

about one-third of the time).

Our Future 

The Choctaw Nation Core Capacity 

Building Program will continue to 

raise awareness about heart disease 

prevention by sharing our community 

capacity plan locally and nationally 

with other tribes, school systems, and 

coalitions, as well as at public events. 

We also plan to work with partners such 

as Colorado State University’s Center for 

Applied Studies in American Ethnicity to 

integrate heart disease prevention into 

college curriculums.

Getting the Word Out Locally

n “Choctaw Nation Shares Link Between 

Substance Abuse and Heart Disease,” 

American Indian Horizons, Fall 2006.

n “The Choctaw Nation Preventive Health 

Core Capacity Program,” Bishinik, the 

official publication of the Choctaw 

Nation of Oklahoma, July 2006.

n “Choctaw Nation and Pekin Woman 

Partner to Show Effects of Substance 

Abuse,” Bishinik, September 2005.

n “Choctaws Get Help from Pekin 

Woman,” Pekin Daily Times, 

June 3, 2005.

Generating New and

Exciting Science 

n “Cardiovascular Risk Factors and Use 

of Medical Advice in Native Americans.” 

Journal of Health Care for the Poor and 

Underserved 2007 (in press).

Keys to Lasting Change in 

the American Indian Community

We have found that programs are more 

effective if they first assess the needs of 

individual communities, and then respond 

to those needs with tailored interventions. 

This approach works better than using a 

preconceived curriculum, and it has greatly 

increased community participation in our 

program. 

For example, we have been able to reach 

many more people with our message 

about the effects of substance abuse on 

heart health because substance abuse was 

identified as a major concern in Choctaw 

communities. In addition, many school 

administrators have asked us to bring our 

educational program to their schools to 

address the health of young children, teach 

them about heart disease prevention, and 

deter them from drug use. These children 

might not have been as receptive to learning about heart health in a traditional way, 

but they are very interested in our program 

when we make these connections.

Mobilizing Community Resources 

Choctaw County Coalition; Atoka/Coal County Partnership for Change; Community Chest; Pushmataha County Turning Point; A Better Clayton 

Coalition; McCurtain County Coalition for Change; Haskell County Coalition; 

Inter-Service Agency Organization; Local Service Coalition; Bryan County 

Community Services Council; Living in Latimer Coalition; Parents Against 

Substance Abuse.

Janeen Gray, Program Manager, Choctaw Nation Core Capacity Building Program

318 South 3rd, McAlester, OK 74501

Phone: 918-426-5700 • Fax: 918-426-5702

E-mail: sjgray@cnhsa.com • Web site: http://www.choctawnationcore.com

FOR MORE INFORMATION
Who We Are 

The Oklahoma State Department of 

Health coordinates the Oklahoma 

Native American REACH 2010 Project.

n This project includes a coalition of 

representatives from eight Native 

American tribes or nations, one urban 

Indian health center, and the Chronic 

Disease Service of the Oklahoma State 

Department of Health.

n The main goal of this project is to 

reduce disparities in heart disease and 

diabetes among Native Americans in 

nine communities through primary and 

secondary prevention efforts.

The Problem 

n The age-adjusted death rate for 

diabetes among Native Americans in 

Oklahoma is nearly 200% higher than 

the rate for whites.

n The prevalence rate for diabetes 

among Oklahoma adults is 13.1% 

for Native Americans, compared with 

7.0% for whites. The prevalence rate 

for obesity is 31.6%, compared with 

22.2% for whites. 

The Solution 

n To help reduce racial disparities in 

diabetes, heart disease, and their risk 

factors in Oklahoma, our coalition is 

working to promote physical activity 

and make it more available at the 

community level. 

n Our project has implemented physical 

fitness and wellness interventions, 

trained physical fitness specialists (or 

equivalents), and supported policy and 

environmental changes in our nine 

REACH communities.

n For our interventions, we collected 

baseline and follow-up measurements, 

such as body mass index, waist-tohip ratios, and body fat percentages, 

from participants to help track their 

progress. 

REACHing Native Americans

in Oklahoma

n We also educated participants about the 

importance of physical activity and good 

nutrition to their health.

Our Achievements 

n More than 5,000 participants are enrolled 

in the Oklahoma Native American REACH 

2010 Project.

n Trained and certified staff members in the 

nine REACH communities have collectively 

implemented more than 75 physical 

activities each week.

n More than 75 tribal staff and community 

members have been trained in fitness and 

health promotion.

n Partners in all nine communities have 

developed employee fitness/wellness 

programs and implemented secondary 

prevention programs related to good 

nutrition, smoking cessation, and obesity.

n All partners have made environmental 

changes such as policies that control or 

prevent tobacco use, promote employee 

fitness, and encourage healthy eating.

nWe have developed new partnerships with 

community health representatives, tribal 

fitness facilities, schools, local colleges and

 universities, and Indian Health Service/

Tribal Health Service diabetes prevention 

and heart disease programs.

“This program has been instrumental in causing a major lifestyle change for me. I use the fitness centers 3–5 days a week, and I 

teach fitness classes. I walk my dog and do yoga every day. Before, in addition to being overweight, I was sedentary, had high blood 

pressure and high cholesterol, and I smoked. I had all the risk factors for diabetes and heart disease. I have lost 86 pounds and 

24 inches since I started working with the REACH project.”

—Assistant program manager, Wichita and Affiliated Tribes’ REACH 2010 program

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont.

n Our community partners have received 

more than $2 million in funding from 

other sources to expand and enhance 

their programs.

nWe have shared information about our 

project through 34 national presentations, 

two international presentations, three peerreviewed articles, one book chapter, and 

two reports.

Our Future 

The Oklahoma Native American REACH 2010 

Project will continue to work to sustain its 

programs, institutionalize its activities, and 

share information and lessons learned with 

other Native American communities.

Getting the Word Out Locally

n “REACH 2010 Leading the Way,” Bishinik, 

the official publication of the Choctaw 

Nation of Oklahoma, January 2006.

n “Absentee Shawnee Basketball Challenge,” The Absentee Shawnee News, 

January 2006.

n “Healthy Choices Available in Vending 

Machines,” Cherokee Phoenix, 

September 2005.

n “REACH 2010 5-K Run at Bigfoot

Festival,” Talihina American, 2005.

n “REACH Activities,” Watonga Republican, 

December 2004.

n “REACH Success Stories from Our 

Communities,” a DVD that highlights 

projects in Oklahoma and other states.

Generating New and 

Exciting Science 

n “Behavioral Risk Factors, Chronic 

Diseases, Health Care Access and Health 

Status of Rural American Indian Women 

in Oklahoma.” In: Rural Women’s Health: 

Linking Mental, Behavioral, and Physical 

Health. New York: Springer Publishing; 

2006.

n “From Risky Behaviors to Chronic 

Outcomes: Current Status and Healthy 

People 2010 Goals for American Indians 

in Oklahoma.” Journal of the Oklahoma 

State Medical Association 2003;96(12):

569–574.

n “Prevalence of Current Smoking Among 

American Indians in Oklahoma: A Comparison.” Journal of the Oklahoma State 

Medical Association 2002;95(3):155–158. 

Mobilizing Community Resources 

Absentee Shawnee Tribe of Oklahoma; Cherokee Nation; CheyenneArapaho Tribes of Oklahoma; Chickasaw Nation; Choctaw Nation of 

Oklahoma; Indian Health Care Resource Center of Tulsa; Oklahoma State 

Department of Health; Pawnee Nation of Oklahoma; Seminole Nation of 

Oklahoma; Wichita and Affiliated Tribes.

Janis Campbell, PhD, Principal Investigator, Oklahoma State Department of Health 

Chronic Disease Service, REACH 2010

1000 N.E. 10th Street, Oklahoma City, OK 73117

Phone: 405-271-4072 • Fax: 405-271-6315 • E-mail: janisc@health.ok.gov

Web site: http://www.health.state.ok.us/program/cds/reach.html

FOR MORE INFORMATION

Keys to Lasting Change in the 

Native American Community

State, federal, and tribal governments can 

work together to accomplish a common 

goal. Respect and trust are key components 

to working successfully with Native American

tribes to build a foundation that ensures 

long-term partnerships and collaboration. 

For our project, collaboration with other 

programs, departments, and professionals 

within tribes has been essential.

Personal relationships with intervention 

participants also are important. Monthly 

logs are an effective way to motivate 

participants because they show improvements over time. Parents must be taught 

good nutrition concepts while their 

children are infants. Parents also should 

be educated about the importance of 

increasing physical activity and limiting 

the amount of time their children spend 

in front of the TV or computer. To make 

our project even more successful, we need 

more resources for collecting data and 

conducting evaluations.
Who We Are 

The African American Health Coalition, 

Inc., coordinates the REACH program 

in Portland, Oregon.

n The coalition’s mission is to promote 

and improve the health of African 

Americans living in Oregon through 

education, advocacy, and research, 

with a focus on heart disease. 

n The African American population in 

Oregon is less than 2% of the total 

population, making us an isolated 

community within an isolated

population. 

n Our vision is to make the African 

American community in Portland the 

healthiest in the nation.

The Problem 

n Heart disease is the leading cause 

of death in Oregon, accounting for 

34.8% of all deaths in 2002.

n In 2001, the death rate for heart

disease among African Americans

in Oregon was 254 per 100,000,

compared with 194 for whites, 

97.3 for Asians and Pacific Islanders, 

and 63.5 for Hispanics.

n The death rate for stroke among 

African Americans living in Oregon 

was 88% higher than the rate for 

whites in 2001.

The Solution 

n To address these health disparities, 

our coalition has designed and 

implemented four major programs 

and three annual events to increase 

knowledge and change attitudes and 

behaviors related to heart disease and 

its risk factors, including diabetes, poor 

nutrition, obesity, and inactivity. 

n We are working to build capacity at 

the community level by developing 

programs that reflect the culture of 

REACHing African Americans

in Portland, Oregon

local populations. These programs train 

community health workers to help 

African Americans in Oregon make and 

sustain healthy lifestyle choices.

n Our holistic approach includes a handson nutrition program called Spice It 

Up, which teaches people how to cook 

healthy foods on a budget. Nutrition 

seminars are held in partnership with 

the Oregon Food Bank and a local 

health food store. 

Our Achievements 

n The Lookin’ Tight, Livin’ Right intervention trained 11 beauty and barber shop 

operators as lay health educators to talk 

with their clients about heart disease and 

its risk factors. Participants have enrolled 

more than 480 clients each year and conducted more than 3,500 “health chats.”

n In 2005, 47 African American high school 

students participated in the Healthy 

Options Living Longer Actively (HOLLA) 

program. Through this program, students 

gave 164 presentations on heart disease 

and its risk factors to 1,086 of their peers 

and family members.

“The coalition’s work and dedication over the past 10 years have brought exercise and health consciousness to the African American

community. This is no doubt helping families to reclaim their health, prolong their lives, strengthen their social networks, and 

increase their quality of life.”

—Tricia Tillman, REACH participant

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
n During 2002–2006, more than 4,700 

community members participated in 

a free physical activity program called 

the Wellness Within REACH, which 

provides access to a variety of culturally 

appropriate exercise classes. As a 

result, 58% of participants say they are 

exercising more. 

n Our coalition holds an annual health 

fair, called the Wellness Village, that 

offers free health screenings and 

information to residents in a way 

that reflects their local culture. When 

we evaluated these events, 50% of 

respondents said the Wellness Village 

is the only place they get health 

screenings.

n In 2006, more than 4,200 people 

participated in our programs.

n Our coalition received the 2006 Spirit 

of Portland Award for Non-Profit 

Organization of the Year. This award 

recognizes outstanding contributions 

to the community.

Our Future 

The African American Health Coalition will 

continue to build community capacity and 

sustain our current efforts to reduce health 

disparities among African Americans 

in Oregon. We will continue to educate 

our policy makers, expand our existing key 

partnerships, and implement a strategic 

development plan to sustain our programs 

into the future. 

Getting the Word Out Locally

n “Take It Off, Keep It Off,” The

Oregonian, February 26, 2006.

n “Leaders Fight Racial Health Disparities,” The Portland Observer, October 

26, 2005.

n “ ‘Blessed’ Patient Bolstered by Black 

Sisterhood,” The Oregonian, September 

11, 2005.

n “Teaming Up for Healthy Hearts,”

The Oregonian, September 7, 2005.

n “Coalition Shines Light on Community Health,” The Portland Observer, 

September 10, 2003.

n “The Way to a Healthy Heart? Through 

the Hairdo,” The Oregonian, April 10, 

2002.

Mobilizing Community Resources 

AmeriCorps*VISTA; Eli Lilly; Northwest Health Foundation; City of Portland Parks and Recreation; Oregon Health Division; New 

Seasons Market; Multnomah County Health Department; American Heart 

Association; Oregon Food Bank; Portland State Regional Research Institute; 

Center for Health Disparities Research; Urban League of Portland; Albina 

Community Bank; Black United Fund; Trimet; four major health care 

systems; Office of Mayor Tom Potter; many other organizations.

Corliss McKeever, MSW, President and CEO, African American Health Coalition

2800 N. Vancouver Ave., Suite 100, Portland, OR 97227

Phone: 503-413-1850 • Fax: 503-413-1851

E-mail: corlissm@aahc-portland.org • Web site: http://www.aahc-portland.org

FOR MORE INFORMATION

Generating New and 

Exciting Science 

n “The African American Wellness Village 

in Portland, Oregon.” Preventing Chronic

Disease [serial online] 2006;3(3). 

Available at http://www.cdc.gov/pcd/

issues/2006/jul/05_0211.htm.

n “Wellness Within REACH: Mind, Body, 

and Soul: A No-Cost Physical Activity 

Program for African Americans in Portland, Oregon, to Combat Cardiovascular 

Disease.” Ethnicity & Disease 2004;14

(3, suppl 1):93–101.

Keys to Lasting Change in the 

African American Community

According to community members, REACH 

is a “movement” that has changed the 

African American community’s behaviors 

related to health, physical activity, and 

nutrition. Our REACH participants are 

active in all areas of our coalition, and 

they educate local policy makers about the 

effect this program has had on their lives. 

Our programs have been so successful that 

the City of Portland has partnered with 

us to ensure affordable access to physical 

activity for all REACH participants.

Our Achievements, cont.
Who We Are 

The Medical University of South Carolina 

coordinates the REACH 2010 Charleston 

and Georgetown Diabetes Coalition.

n This urban-rural, community-university 

coalition works to eliminate racial and 

ethnic disparities in diabetes in South 

Carolina.

n The coalition reaches more than 13,000 

African Americans with diabetes living 

in Charleston and Georgetown counties, 

South Carolina.

The Problem 

n African Americans are almost twice as 

likely to have diabetes as the majority 

of Americans. 

n In 1999, African Americans living in 

Charleston and Georgetown counties 

were less physically active, ate a less 

healthy diet, and had higher rates of 

obesity compared with whites and 

members of other racial and ethnic 

groups. 

n In addition, African Americans with 

diabetes living in Charleston and 

Georgetown counties reported a lower 

quality of diabetes care, as well as 

higher rates of heart disease, amputations, and kidney disease compared 

with whites and members of other 

racial and ethnic groups. 

The Solution 

n To overcome these health disparities, 

our coalition works to 1) help people 

better manage their diabetes, 2) help 

health care providers give better 

diabetes care, and 3) build community 

advocacy and support to sustain these 

efforts.

n To make our efforts more effective, we 

use approaches that reflect the culture 

of local populations.

n We developed a comprehensive 

community action plan that includes 

walk-talk groups, home and telephone 

visits, educational sessions, health 

REACHing African Americans in Charleston

and Georgetown Counties, South Carolina

care visits, health and information fairs, 

support groups, grocery store tours, and 

Internet access at local public libraries.

Our Achievements 

n During 1999–2004, chart audits of African 

Americans who visited partner health 

centers showed sharp increases in the 

use of annual testing for diabetes and its 

complications. The percentage who had 

their blood sugar level checked annually 

increased from 77% to 97%, while the 

percentage who had their blood cholesterol level checked increased from 47% to 

81%. Kidney testing increased from 13% 

to 53%, and foot exams increased from 

64% to 97%.

n Health care providers documented better 

adherence to American Diabetes Association guidelines for self-management, from 

41% to 94% of patients.

n Emergency room visits decreased by about 

50% for people who have diabetes but do 

not have health insurance.

n Fewer lower extremity amputations were 

reported among African American men 

in Charleston and Georgetown counties, 

from 80 per 1,000 hospitalizations in 

1999 to 33 per 1,000 in 2004.

“Many of the participants have invited others to come to the [diabetes self-management] class. They are taking their [patient report 

cards] with them to see the doctor, and they are asking questions. The doctors are listening to them.” 

—REACH 2010 community health advisor

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont.

n We established a faith-based diabetes 

program that matches patients treated 

at a local hospital with volunteers from 

a local church. These volunteers provide 

social support for patients and help 

them get information from diabetes 

educators. Several volunteers expanded 

the program to include fellow church 

members who were treated at other 

hospitals. 

n Our coalition partners received 

two national awards in 2006: the 

Community-Campus Partnerships 

for Health Award and the U.S. 

National Commission on Libraries 

and Information Science’s Health 

Information Award for Libraries.

Our Future 

The REACH Charleston and Georgetown 

Diabetes Coalition will continue to work 

to link people with resources to reduce 

disparities in diabetes, its risk factors, and 

its complications, especially heart disease 

and amputations. 

Getting the Word Out Locally

n “Rural Health Fair Tackles Diabetes,” 

Coastal Observer, July 6, 2006. 

n “Area Program to Combat Diabetes Recognized as a National Model,” Charleston 

Post and Courier, June 20, 2006.

n “Classes Help Diabetics Improve Health,” 

Georgetown Times, April 7, 2006. 

n “Diabetes CORE Group Program to Focus 

on the Loss of Eyesight,” Georgetown 

Times, February 15, 2006.

Generating New and 

Exciting Science

n “Equal Care, Unequal Outcomes: Experiences of a REACH 2010 Community.”

Journal of Health Disparities Research 

and Practice 2006;1(1):47–62.

n “A Community-Based Participatory Health 

Information Needs Assessment to Help 

Eliminate Diabetes Information Disparities.” Health Promotion Practice 2006;7

(3, suppl):213S–222S.

n “Racial Disparity in the Diagnosis of Obesity Among People with Diabetes.” Journal 

of Health Care for the Poor and Underserved 2006;17(2, suppl):106–115.

Mobilizing Community Resources 

Alpha Kappa Alpha, Omicron Rho Omega Chapter; Carolinas Center for Medical Excellence; Charleston Diabetes Coalition; Commun-I-Care; Diabetes Initiative of 

South Carolina; East Cooper Community Outreach; Franklin C. Fetter Family Health 

Center; Georgetown County Diabetes CORE Group; Medical University of South 

Carolina, College of Nursing; South Carolina State Budget and Control Board; South 

Carolina Department of Environmental Control, Diabetes Prevention and Control 

Program, Region 7 (Charleston) and Region 5 (Georgetown); South-Santee St. James 

Community Center; Tri-County Black Nurses Association; Trident United Way; St. James 

Santee Family Health Center; area churches, community centers, work sites, and libraries. 

Carolyn Jenkins, DrPH, Principal Investigator, Medical University of South Carolina, 

College of Nursing

P.O. Box 250160, Charleston, SC 29425

Phone: 843-792-5872 • Fax: 843-792-5822

E-mail: jenkinsc@musc.edu • Web site: http://www.musc.edu/reach

FOR MORE INFORMATION

n “Reducing Disparities for African 

Americans with Diabetes: Progress Made 

by the REACH 2010 Charleston and 

Georgetown Diabetes Coalition.” Public 

Health Reports 2004;119(3):322–330.

Keys to Lasting Change in the 

African American Community

Our coalition found that identifying 

principles and goals early will help to 

resolve problems that may arise. All 

viewpoints are important, and involving 

all partners equally in solving community 

issues will help you to move beyond 

power struggles. 

We also found that the combined 

resources of all partners create power 

far beyond that of individuals. Providing 

opportunities to learn about each 

partner’s culture benefits the coalition as 

a whole. Health care professionals provide 

the “science of diabetes,” while the 

community determines how to translate 

this science into practice. By working as 

equal partners, we can eliminate health 

disparities in diabetes in South Carolina.
Who We Are 

The Matthew Walker Comprehensive 

Health Center coordinates the Nashville 

Health Disparities Coalition REACH 

2010 Project.

n This project is working to reduce and 

eliminate health disparities in diabetes 

and heart disease rates among African 

Americans living in North Nashville, 

Tennessee.

n In 2000, 88% of North Nashville residents were African American.

The Problem 

n In 2003, 15.7% of African American 

residents living in North Nashville had 

diabetes, and 33.6% had high blood 

pressure. 

n African Americans in North Nashville 

are three times more likely to die of 

complications of diabetes and heart 

disease than white residents. 

n Although 52% of African American 

women living in North Nashville are 

obese, many residents are unaware 

that obesity is a major risk factor for 

diabetes, and many residents may have 

undiagnosed diabetes.

The Solution 

n The Nashville Health Disparities Coalition developed a community action plan 

to address health disparities among 

African Americans who have or are 

at risk of developing diabetes, heart 

disease, or high blood pressure.

n We created teams to develop strategies 

to address the following key health 

issues: tobacco use, access to health 

care, health screenings, and overall 

health and wellness. 

n We formed partnerships with several 

groups and institutions to increase 

residents’ access to health care services 

and reduce their risk of developing 

chronic diseases such as diabetes. 

REACHing African Americans

in Nashville, Tennessee

Our Achievements 

n Our coalition expanded the hours of 

operation at six community clinics to 

improve residents’ access to care. 

nWe developed and disseminated 500 

screening manuals and trained local 

groups to conduct health screenings. Since 

2000, more than 4,000 people have been 

screened for diabetes, heart disease, and 

associated risk factors. 

n We developed the Nashville REACH 2010 

Resource Manual to link people who 

have diabetes and heart disease with the 

health services they need. This booklet 

was distributed to more than 15,000 

local residents.

nWe provided diabetes self-management 

classes to local community groups and 

to 720 clients at the Matthew Walker 

Comprehensive Health Center. 

nWe worked with local nutrition groups 

to start community gardens and produce 

stands. We also changed local school 

menus, reduced the amount of junk food 

sold in vending machines, and provided 

nutrition education to residents. 

nWe worked with other local groups to 

convince the governor to sign into law a 

no-smoking policy in state office buildings.

“Until I enrolled in a smoking cessation class, I was unaware of the effects smoking had on my body. I have high blood pressure and 

diabetes, and smoking increased my chances for life-threatening complications. I’m glad I found REACH.”

—REACH Quit and Win campaign participant

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Future 

The Nashville REACH 2010 Project will 

continue to implement and evaluate 

interventions designed to promote health 

and prevent disease, particularly those 

that address diabetes and heart disease.

Getting the Word Out Locally

n “Nashville REACH 2010 at Matthew 

Walker Comprehensive Health Center 

Announces its 2nd Annual ‘Quit and 

Win’ Campaign to Help Smokers,” The 

Tennessee Tribune, August 10, 2006. 

n “Program Teaches Children Songs, 

Words to Persuade Family to Quit,” 

Tennessean, July 25, 2006.

n “Smoking Ban Leaves Lasting Effects 

on Legislative Plaza,” The City Paper, 

June 21, 2006.

Generating New and 

Exciting Science 

n “REACH-Meharry Community-Campus 

Partnership: Developing Culturally 

Competent Health Care Providers.” 

Journal of Health Care for the Poor and 

Underserved 2006;17(2, suppl):78–87.

n “Diabetes Management Among LowIncome African Americans: A Description 

of a Pilot Strategy for Empowerment.” 

Journal of Ambulatory Care Management 2006;29(2):162–166.

n “An Evaluation of the Nashville REACH 

2010 Community Health Screening 

Strategy.” Journal of Ambulatory Care 

Management 2006;29(2):151–161.

n “Development and Evaluation of a Bible 

College-Based Course on Faith and 

Health.” Journal of Ambulatory Care 

Management 2006;29(2):141–150.

Mobilizing Community Resources 

Metro Public Health Department; Tennessee Department of Health; Vanderbilt University; Matthew Walker Comprehensive Health Center; 

Meharry Medical College; Tennessee State University; Fisk University; 

Interdenominational Ministers’ Fellowship; Nashville Branch of the NAACP; 

Metro General Hospital; American Baptist College.

Linda H. McClellan, MPH, Project Director and Chair, Nashville Health Disparities Coalition 

1501 Herman Street, Nashville, TN 37208

Phone: 615-340-1289 • Fax: 615-327-2806 • E-mail: linda.mcclellan@mwchc.org

Web site: http://healthbehavior.psy.vanderbilt.edu/reach

FOR MORE INFORMATION

Keys to Lasting Change in the 

African American Community

People working at the community level 

must keep in mind that social and 

environmental factors such as poverty, 

racism, violence, crime, lack of opportunity, education, and housing can have 

negative effects on community health. 

When people have stressful lives, they 

often do not make their health a priority. 

To make and sustain positive changes in 

people’s lifestyles and health, we must 

address society’s problems head-on, and 

all sectors of the community, including 

churches, must participate. These efforts 

also require sustainable resources, and 

communities must address this issue to 

continue their work. 
Who We Are 

United South and Eastern Tribes, Inc. 

(USET) coordinates the REACH 2010 

Immunization and Infant Mortality 

Project.

n USET is a nonprofit intertribal group 

that collectively represents 24 federally recognized American Indian tribes 

at regional and national levels. USET 

serves about 60,000 American Indians 

in 12 states. 

n USET’s REACH project is working 

to promote healthy lifestyles and to 

reduce health disparities, particularly 

in immunization and infant mortality 

rates, among American Indians.

n USET’s Tribal Epidemiology Center helps 

tribes implement and enhance disease 

surveillance systems for their communities. The resulting data can be used to 

guide public health policy and activities, 

prioritize health objectives, and monitor 

progress toward meeting these objectives. The data also help tribes develop, 

implement, and evaluate disease 

prevention and control programs.

The Problem 

n In general, American Indians have 

higher rates of death and disease than 

members of other racial and ethnic 

groups in the United States.

n In 2003, the infant mortality rate for 

American Indians was 8.7 per 1,000 

live births, compared with 6.8 for all 

races and 5.7 for white infants. 

n Childhood immunization coverage 

for USET tribes is well below Healthy 

People 2010 goals. For example, 

74% of children aged 19–35 months 

received all recommended immunizations in 2005. The Healthy People 

2010 goal is 90%. 

n The incidence of vaccine-preventable 

disease among American Indians is not 

REACHing American Indians in the

United South and Eastern Tribes

known because of racial misclassification of this population in state 

data systems and incomplete reporting

in tribal systems. 

The Solution 

n Twenty USET tribes are working with 

the Infant Mortality Project to collect 

prenatal data and identify what factors 

may influence infant death. In addition, 

23 tribes are collecting mortality data 

that will be linked with birth records.

n USET helps tribes conduct local surveillance for immunization coverage and 

vaccine-preventable disease incidence 

and then link the data collected with 

state immunization registries. We also 

help tribes develop community-specific 

interventions. 

n USET provides training, technical support, information sharing, and coordination of activities between tribal, local, 

state, and federal public health groups.

n USET also assesses tribal-level data to 

identify and address gaps in the data 

and improve data quality.

“The REACH 2010 program has allowed tribes affiliated with United South and Eastern Tribes to increase—and in some cases 

establish for the first time—immunization surveillance for their children. With so many health disparities affecting American 

Indians in the eastern United States, REACH has allowed us to address a fundamental aspect of bettering the health of our 

tribal children.”

—Jim Marshall, epidemiologist at the USET Tribal Epidemiology Center

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements

n Of the 24 USET tribes, 83% are 

participating in the Infant Mortality 

Project.

n The number of tribes using immunization registries has increased from 

9 to 21. The number of American 

Indian children whose immunization 

coverage is now being tracked has 

increased threefold. 

n USET has provided training to tribes 

on how to use immunization registries, 

and we have helped tribes gain access 

to registries in their respective states.

n USET produces and distributes annual

reports on tribal-specific data, immunization coverage, and infant death 

rates. These reports provide an overview of tribal programs and help the 

tribes monitor their progress.

Our Future 

USET will continue to provide technical

assistance and training for our tribal 

immunization programs. We also will 

continue to focus on improving immunization rates at the community level. We 

will assess data quality for each tribe to 

ensure that the tribal health data system 

is as complete as possible, and we will 

continue to provide mortality reports to 

tribal programs. USET will work to establish data-sharing agreements with state 

agencies and to improve relationships 

between states and tribes. We will provide prenatal care, assessment reports, 

and recommendations to tribal programs 

to help reduce infant deaths.

Getting the Word Out Locally

n USET produces and distributes annual 

reports on tribal-specific, aggregated 

data on immunization coverage and 

infant death rates.

Generating New and 

Exciting Science 

n “Building Immunization Surveillance 

Capacity in Tribal Health Programs.” 

Presented at the Office of Minority 

Health National Leadership Summit on 

Eliminating Racial and Ethnic Disparities 

in Health, Washington, DC, January 

9–11, 2006. 

n “Building Immunization Surveillance 

Capacity in Tribal Health Programs.” 

Presented at the 2006 National Immunization Conference, Atlanta, Georgia, 

March 6–9, 2006.

Mobilizing Community Resources 

Eastern Band of Cherokee; Mississippi Band of Choctaw; Miccosukee Tribe; Seminole Tribe of Florida; Chitimacha Tribe of Louisiana; Seneca Nation 

of Indians; Coushatta Tribe of Louisiana; St. Regis Band of Mohawk Indians; 

Penobscot Indian Nation and the Passamaquoddy Tribes; Houlton Band of 

Maliseet Indians; Tunica-Biloxi Indians of Louisiana; Poarch Band of Creek 

Indians; Narragansett Indian Tribe; Mashantucket Pequot Tribe; Wampanoag 

Tribe of Gay Head (Aquinnah); Alabama-Coushatta Tribe of Texas; Oneida Indian 

Nation; Aroostook Band of Micmac Indians; Catawba Indian Nation; Jena Band of 

Choctaw Indians; Mohegan Tribe of Connecticut; Cayuga Nation.

John Mosely Hayes, DrPH, MBA, MSPH, Immunizations Project; Chris Compher, MHS, 

 Mortality Project, USET, Inc.

711 Stewarts Ferry Pike, Suite 100, Nashville, TN 37214

Phone: 615-872-7900 • Fax: 615-872-7417

E-mail: jmhayes@usetinc.org • Web site: http://www.usetinc.org

FOR MORE INFORMATION

Keys to Lasting Change in 

American Indian Communities

For projects to succeed in American 

Indian communities, we must build 

relationships with community members. 

Because community support is key,

leaders of projects such as REACH

must show how these projects will serve 

and benefit local residents. Consistent 

communication between project leaders 

and communities also is important. 

In the past, the relationship between 

researchers and communities was often 

one-sided. The researchers dictated the 

process, even when community members 

knew from experience that a different 

approach would be more effective. In 

contrast, USET projects promote community 

participation and empowerment, which 

are important factors in achieving lasting 

change. Our projects are also flexible 

enough to allow for changes that help 

to ensure sustainability. In addition, we 

have found that sharing the results of 

these projects in annual reports to the 

affected communities is key to maintaining 

community support and making progress 

toward meeting our health goals.
Who We Are 

The Latino Education Project (LEP) 

coordinates the REACH Project in the 

Texas Coastal Bend.

n This project promotes awareness of the 

need for early screening and diagnosis 

to prevent diabetes and its complications 

among Hispanic older adults and their 

families living in the Texas Coastal Bend.

n The Coastal Bend is a 12-county area 

located along the south-central Gulf 

Coast shore of Texas. It includes the city 

of Corpus Christi. 

n LEP is a community-based, nonprofit 

group that uses innovative approaches to 

help people improve their health. These 

approaches take into account the age 

and diverse experiences of the target 

population.

The Problem 

n Nearly 34% of the Hispanic older 

adults living in the Texas Coastal Bend 

have diabetes or complications from 

diabetes, including heart disease, renal 

disease, blindness, and amputations. 

n The City of Corpus Christi averages 4.4 

lower-extremity amputations per 1,000 

Medicare patients each year, which is 

nearly three times the national average 

of 1.6 per 1,000.

n Lack of access to timely and affordable 

health care, lack of transportation, and 

high levels of poverty are typical of 

many rural communities in the Coastal 

Bend. These problems contribute to 

the high incidence of diabetes and its 

complications among residents. 

The Solution 

n LEP has implemented interventions to 

prevent and control diabetes at individual, family, and community levels.

n We partner with more than 25 community groups, as well as local health care 

providers, educators, business people, 

and older adults. These community 

members provide input to our programs, 

REACHing Hispanic Older Adults

in the Texas Coastal Bend Area

giving us insight into the unique experiences and diverse backgrounds of our 

target population.

n We have found that people can make 

healthy lifestyle changes, such as 

eating a healthy diet and being more 

physically active, if interventions are 

accessible and appropriate for their 

culture and age.

n We also have found that increasing 

community capacity for self-help and 

empowerment will build community 

ownership for health problems.

Our Achievements

n Lay health workers, called promotores 

de salud in Spanish, are expected to be 

leaders in creating social and economic 

conditions that help people control 

and manage their health. They are 

certified by the state and considered 

valuable members of the health care 

workforce.

n For its interventions, LEP first identifies 

the desired health outcome, and then 

identifies the knowledge and skills 

needed to achieve this outcome. Then, 

we find promotores de salud who have 

the necessary knowledge and skills.

“As a promotora de salud [lay health worker], I feel that we best help our community when we promote ‘una vida sana y buena’ 

[‘a healthy and good life’]!”

—A promotora de salud working with the REACH project

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
n Promotores de salud conduct free 

12-week discussion groups for older 

adults called Study Circles. Discussions 

include a wide variety of health topics, 

including diabetes, nutrition, exercise, 

and medication management.

nWe hold biannual, community-wide 

health forums that bring together 

approximately 400 community stakeholders who support the goals and 

objectives of the REACH project.

n LEP’s diabetes prevention and control 

efforts are enhanced by health literacy 

programs, educational programs that 

teach people how to manage their medications, and wide media coverage of our 

health forums.

nWe built on the REACH project to 

provide other services to isolated, rural, 

and low-income older adults and their 

families. These services include affordable housing, a low-income tax clinic, 

and a Senior Medicare Patrol program.

Our Future 

LEP will continue to identify best practices 

in the early prevention and treatment of 

diabetes that can be used to help older 

adults living in the Coastal Bend. We will 

refine our data management system to 

increase our ability to evaluate our interventions. We will increase the scope and range 

of our media programs to reach more residents and to find new partners to expand 

the reach of the REACH project.

Getting the Word Out Locally

n Nuestra Salud, LEP quarterly newsletter. 

n “Perks of Getting Older: Recognizing 

Benefits of Exercise, Insurance Firms, 

Community Centers Offer Free Classes 

to Seniors,” Corpus Christi Caller-Times: 

Mi Vida, January 2005.

Generating New and 

Exciting Science 

n “Building Community Capacity for Health 

Promotion in a Hispanic Community.”

Preventing Chronic Disease [serial online] 

2007;4(1). Available at http://www.cdc.

gov/pcd/issues/2007/jan/06_0086.htm. 

n “Reaching for the Stars: Innovative Tools 

for the Trade.” Presented at the Annual

Conference of the Texas Society for 

Public Health Education, Houston, Texas, 

September 22–23, 2006.

Mobilizing Community Resources 

Child Protective Services; Coordinator Congregational Health Ministry; Regional Cancer Center; American Cancer Society; Texas Cooperative 

Extension Service; CHRISTUS Spohn South Health Systems; City of Corpus 

Christi Senior Community Services; Community Service Aide, Nueces County 

Health Department.

Frances Pawlik, Executive Director, Latino Education Project

1045 Airline Rd., Suite 2, Corpus Christi, TX 78412

Phone: 361-980-0361 • Fax: 361-980-0951

E-mail: frances@latinoeducationproject.org

Web site: http://www.latinoeducationproject.org

FOR MORE INFORMATION

n “Looking Back, Moving Forward—REACH 

2010: Promotores de Salud in Community Building Strategy.” Presented at the 

California REACH 2010 Conference, Los 

Angeles, California, May 17, 2006. 

n “Betting on Health Education: Increasing 

the Odds for Collaboration.” Presented 

at the Society for Public Health Education 

(SOPHE) 2006 Midyear Scientific Conference, Las Vegas, Nevada, May 4–7, 2006. 

Keys to Lasting Change in the 

Hispanic Older Adult Community

The Hispanic older adult community must 

take ownership of the diabetes problem, its 

complications, and the obesity crisis that is 

devastating Hispanic communities in South 

Texas and the Coastal Bend. Residents, 

health care providers, and local stakeholders can bring their unique experiences and 

diverse backgrounds together to support 

and expand activities that promote health. 

Interventions designed to promote healthy 

lifestyles and well-being must take into

account the cultures, languages, and 

traditions of local residents. In addition, 

the traditional medical establishment must 

accept community-based, nonprofit groups 

as legitimate partners in these efforts.

Our Achievements, cont.
Who We Are 

Migrant Health Promotion coordinates 

the REACH Promotora Community 

Coalition.

n Migrant Health Promotion is a community organization that serves counties 

with predominantly Mexican-American 

populations along the Texas-Mexico 

border.

n The group develops, implements, 

and evaluates programs that use peer 

health educators, called promotores 

and promotoras in Spanish, to bring 

information, resources, and improved 

access to health services to their 

communities. 

n The REACH Promotora Community 

Coalition developed and initiated a 

community action plan to reduce 

diabetes and its complications for 

residents in three communities in 

Cameron and Hidalgo counties.

n Hispanics make up 86% of the 

population in Cameron County and 

89% of the population in Hidalgo 

County, compared with 35% overall 

for the state of Texas.

The Problem 

n In 1997, the estimated prevalence of 

diabetes for residents in Cameron and 

Hidalgo counties was 23% and 18%, 

respectively, compared with 5.9% for 

all Texas residents. 

n The diabetes death rate for residents in 

the Rio Grande Valley of Cameron and 

Hidalgo counties is nearly twice the 

rate for the rest of the state. 

n Rates of poverty, unemployment, and 

underemployment are high among 

border residents. Many residents also 

lack transportation and live in substandard housing or neighborhoods 

without municipal services. 

The Solution 

n More than 600 residents participated 

in 46 community work groups and 

REACHing Mexican Americans

on the Texas-Mexico Border

chose diabetes as the leading health 

problem in the Rio Grande Valley. 

n Residents offered several solutions to 

address this problem. These solutions 

included improving access to clinics, 

hospitals, specialists, medications, and 

other medical services for low-income 

residents; providing health education 

and information in residents’ homes, 

schools, churches, and supermarkets; 

and creating a community environment 

that encourages healthy behaviors.

n The REACH Promotora Community 

Coalition developed a community action 

plan that includes school-based, clinicbased, and colonia-based interventions. 

Colonias are rural, unregulated, lowincome neighborhoods.

n Promotores and promotoras share 

the same socioeconomic background, 

language, and culture as the community 

members they serve.

Our Achievements 

n Our coalition enrolled more than 2,800 

community residents in walking and 

nutrition classes.

nWe provided diabetes self-management 

classes to more than 800 health clinic 

patients with diabetes.

“I am very happy with this aerobics class. I am a mother of six children, I’m 30 years old, and I almost hit 290 on the scale.

This class has really helped me on different levels. My weight dropped to 270 in 3 weeks. My self-esteem picked up, and my health 

has improved. This program does a lot for people like me who don’t have time and resources to exercise.”

—Marilu Sifuentes, REACH program participant

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
Our Achievements, cont.

n More than 500 parents participated 

in diabetes education sessions at local 

schools.

n Our coalition received the Border 

Models of Excellence Award from the 

U.S.-Mexico Border Health Commission.

n Before our clinic intervention, baseline 

data showed that 24.5% of patients 

with diabetes drank whole milk. After

our intervention, patients reported a 

14% decrease in their consumption of 

whole milk.

n Moderate walking increased by 25% 

among community residents.

Our Future 

The REACH Promotora Community 

Coalition is duplicating its intervention in 

two other communities in Texas. We plan 

to disseminate our data in journals and at 

state and national conferences. We also 

will continue to work with local and state 

policy makers to improve the health of 

residents in the lower Rio Grande Valley.

Getting the Word Out Locally

n “Support Groups Hope to Prevent 

Diabetes,” The Monitor, June 5, 2006.

n “Una Lucha Diaria Contra Diabetes,”

El Valle, January 18, 2005.

n “Students Join to Fight Diabetes,” Valley 

Morning Star, January 1, 2005.

n “Healthy Choices,” The Monitor, 

November 28, 2004.

n “Santa Rosa Warriors Walk for Diabetes,” 

La Feria News, November 24, 2004.

Generating New and 

Exciting Science 

n “Promotora-Led Changes in Nutrition 

and Physical Activity Among Hispanic 

Residents of the Texas Rio Grande Valley.” 

Presented at the 134th Annual Meeting 

of the American Public Health Association, Boston, Massachusetts, 

November 7, 2006.

n “REACH 2010 Community Health Workers Use Community Forums to Promote 

Strategic Action and Policy Change in 

Their Communities.” Presented at the 

134th Annual Meeting of the American 

Public Health Association, Boston, 

Massachusetts, November 6, 2006.

Mobilizing Community Resources 

Nuestra Clinica del Valle; University of Texas Pan American, Border Health Office; Su Clinica Familiar; Brownsville Community Health Center; University of Arizona, 

Mel and Enid Zuckerman School of Rural Public Health; Weslaco Independent School 

District; City of Weslaco, Parks and Recreation; Santa Rosa Independent School 

District; Progreso Community Center; City of Weslaco; Rio Hondo Independent School 

District; Los Fresnos Housing Authority; Texas A & M University, Center for Housing 

and Urban Development; Texas Department of State and Health Services; U.S.-Mexico 

Border Health Commission.

Rebecca Garza, PhD, Principal Investigator, Migrant Health Promotion

P.O. Box 337, Progreso, TX 78579

Phone: 956-565-0002 • Fax: 956-565-0136

E-mail: rgarza@migranthealth.org • Web site: http://www.migranthealth.org

FOR MORE INFORMATION

Keys to Lasting Change in the 

Mexican-American Community

The REACH Promotora Community Coalition 

is led by promotores/promotoras and 

includes agencies and community members 

committed to ending health disparities in 

the Rio Grande Valley. The promotores/

promotoras are the heart of this project 

because they share the same cultural, 

linguistic, educational, and economic 

characteristics as the community members 

they serve. They advocate for diabetes 

awareness, education, and self-management 

programs in their communities, and they 

promote systems and policy changes to 

encourage healthy behaviors.

Our community action plan’s integrated 

strategies are supported by ongoing capacity 

building, training, program development, 

and evaluation activities. Our coalition 

combines health education with advocacy 

for community and systems changes that 

support healthy lifestyles. 
Who We Are 

Public Health - Seattle & King County 

coordinates the Seattle & King County 

REACH 2010 Coalition.

n Coalition partners include community 

members, community groups, and community health centers; local health care 

providers; public health professionals; 

and researchers at the University of 

Washington.

n The coalition’s goal is to reduce 

health disparities related to diabetes 

among African Americans, Asian 

Americans and Pacific Islanders, and 

Latinos living in Seattle and King 

County, Washington.

The Problem 

n In general, minority populations in 

the United States have higher rates of 

diabetes-related deaths, complications, 

and risk factors. In addition, they often 

have limited access to health care 

services and health insurance. 

n The diabetes death rate for African 

Americans in King County is 3.5 times 

higher than the rate for whites. 

n The diabetes death rate for Latinos in 

King County is 62% higher than the 

rate for whites. 

n Members of several Asian American 

and Pacific Islander groups have higher 

rates of undiagnosed diabetes than 

whites. The diabetes death rate for this 

population in King County is slightly 

higher than the rate for whites.

 The Solution 

n To address these health disparities, 

our coalition first assessed the status 

of diabetes prevention and control 

efforts in minority communities in 

Seattle and King County. Then, we 

developed and implemented an 

intervention plan that reflected the 

cultures and languages of the target 

populations.

REACHing African Americans, Asian Americans, and Latinos 

in Seattle and King County, Washington

n We provided support groups, peer 

education, self-management classes, 

faith-based education, and case 

management services.

n We also provided interpreter services 

and translated educational materials 

into Cambodian, Chinese (Cantonese 

and Mandarin), Filipino, Korean, 

Spanish, Samoan, and Vietnamese.

Our Achievements 

n In 2002, we collaborated with the Washington State Department of Health to train 

21 peer and health educators at local 

community health centers in the Spanish 

version of the Chronic Disease SelfManagement Program. Previously, only 

two people nationwide had been trained 

to teach this program in Spanish.

n The percentage of people participating 

in our interventions who were able to 

keep their blood sugar level under control 

increased from 48% to 56%.

n The percentage of participants who said 

they were confident they could stick to 

their diet increased from 56% to 69%.

“Well, I have learned a lot since I have been coming to the diabetes classes, and I try to keep up with everything I hear. I have learned 

a lot about taking care of myself and what to eat.”

—African American participant in a REACH diabetes class

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Racial and Ethnic Approaches 

to Community Health (REACH) 

is a community-based public 

health program funded by CDC 

to eliminate racial and ethnic 

health disparities.

www.cdc.gov/reach
n The percentage of participants who said 

their health was good, very good, or 

excellent increased from 34% to 39%.

n The percentage of participants who reported being more physically active increased 

from 75% to 86%.

Our Future 

The Seattle & King County REACH 2010 

Coalition will explore the possibility of 

expanding its focus to include other 

diabetes-related diseases, such as heart 

disease and obesity.

Getting the Word Out Locally

n “Diabetes Not Equal Opportunity 

Disease,” Seattle Post Intelligencer, 

February 7, 2006.

n “Community Clinic Encourages Patients 

to Learn About Their Risks for Diabetes,” 

International Examiner, December 6, 

2005.

n “Diabetes: Una Epidemia en Auge—

Es La Séptima Causa de Muerta en el 

Condado de King,” Sea Latino, 

November 18, 2005.

Generating New and 

Exciting Science 

n “A Community-Based Participatory 

Theater Project to Educate Latinos 

About Diabetes.” Presented at the 

134th Annual Meeting of the American 

Public Health Association, Boston, 

Massachusetts, November 6, 2006.

n “Building and Sustaining a Multicultural 

Partnership.” Presented at the Midyear 

Scientific Conference of the Society for 

Public Health Education (SOPHE), 

Las Vegas, Nevada, May 4–7, 2006.

n “A Community-Based Approach to 

Diabetes Control in Multiple Cultural 

Groups.” Ethnicity & Disease 2004;

14(3, suppl 1):83–93.

n “Learning from the Community: The 

Challenges and Rewards of Diabetes 

Interventions Among Culturally Diverse 

Populations.” Presented at the 132nd 

Annual Meeting of the American Public 

Health Association, Washington, DC, 

November 9, 2004.

Keys to Lasting Change in 

Minority Communities 

Our coalition found that the most 

successful strategy is to tailor interventions 

Mobilizing Community Resources 

Aging and Disability Services; American Diabetes Association; American Heart Association; 

American Lung Association; Center for MultiCultural Health; Harborview Medical Center; 

International Community Health Services; Kin On Health Centers; National Asian Pacific Center 

on Aging; Urban Impact, Rainer Health and Fitness; Pacific Northwest Research Institute; Public 

Health - Seattle & King County; Qualis Health; Sea Mar Community Health Centers; Seattle 

Indian Health Board; Senior Services of Seattle/King County; University of Washington, School 

of Nursing, School of Nutritional Sciences, Health Promotion Research Center, School of Public 

Health and Community Medicine; Washington State Department of Health; Center for Health 

Training; Eli Lilly; Northwest Kidney Center; Urban Indian Health Institute; Washington Health 

Foundation; Washington State University Extension.

Blishda Lacet, MPH, MBA, REACH Program Manager, Public Health - Seattle & King County

999 3rd Ave., Suite 500, Seattle, WA 98104

Phone: 206-296-7621 • Fax: 206-205-3919

E-mail: blishda.lacet@metrokc.gov • Web site: http://www.metrokc.gov/health/REACH

FOR MORE INFORMATION

and educational materials to reflect the 

cultures and languages of the target 

populations. We also found that hiring 

bilingual and bicultural staff members and 

serving culturally appropriate foods at 

events is important. 

In addition, we learned the value of identifying key community members and groups 

to work with and making time to develop 

relationships and trust. This approach will 

open many doors for recruitment, service 

delivery, and research. For the African 

American community, successful outreach 

strategies include working with beauty 

salons and the faith community. 

For Asian Americans and Pacific Islanders, 

outreach strategies varied. We partnered 

with community groups and associations 

to reach Chinese, Filipino, and Vietnamese 

residents. We partnered with churches and 

the faith community to reach Korean and 

Samoan residents. For the Latino community, churches were critical for outreach 

activities and service delivery. We also 

used promotoras (Spanish for “lay health 

workers”) to reach Latino residents.

Our Achievements, cont.
83

REACH Communities by Racial and Ethnic Group

African American

African American Health Coalition, Inc.: REACH African American Health Coalition ................................................................69

Black Women’s Health Imperative: REACH 2010: At the Heart of New Orleans Coalition ........................................................27

Boston Public Health Commission: Boston REACH 2010 Breast and Cervical Cancer Coalition ...............................................29

Boston Public Health Commission: REACH Boston Elders 2010..............................................................................................31

Carolinas HealthCare System: Charlotte REACH 2010 Coalition.............................................................................................59

Center for Community Health, Education & Research, Inc.: Metropolitan Boston Haitian REACH 2010 HIV Coalition...............33

Community Health Councils of Los Angeles: African Americans Building a Legacy of Health .....................................................7

Fulton County Department of Health and Wellness: REACH for Wellness................................................................................19

Genesee County Health Department: Genesee County REACH 2010 Team.............................................................................41

Matthew Walker Comprehensive Health Center: Nashville Health Disparities Coalition REACH 2010 Project...........................73

Medical University of South Carolina: REACH 2010 Charleston and Georgetown Diabetes Coalition ......................................71

San Francisco Department of Public Health: SevenPrinciples Project.......................................................................................11

University of Alabama at Birmingham: Alabama REACH 2010 Breast and Cervical Cancer Coalition .........................................3

University of Nevada, Reno: Healthy Hearts Project ...............................................................................................................45

African American, Asian American, Pacific Islander, and Hispanic/Latino

Public Health - Seattle & King County: Seattle & King County REACH 2010 Coalition.............................................................81

African American and Hispanic/Latino

Access Community Health Network and University of Illinois at Chicago: REACH Out.............................................................21

Chicago Department of Health: REACH 2010/Lawndale Health Promotion Project .................................................................23

Community Health & Social Services Center, Inc.: REACH Detroit Partnership .........................................................................39

Florida International University: Coalition to Reduce HIV in Broward’s Minority Communities.................................................17

Institute for Urban Family Health: Bronx Health REACH Coalition...........................................................................................55

Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center: Immunize LA Kids Coalition..................................9

Mailman School of Public Health of Columbia University: Northern Manhattan Start Right Coalition ......................................57

Missouri Coalition for Primary Care: Kansas City - Chronic Disease Coalition .........................................................................43

New Hampshire Minority Health Coalition: New Hampshire REACH 2010 Initiative................................................................47

University of Illinois at Chicago: Chicago Southeast Diabetes Community Action Coalition .....................................................25

American Indian

Eastern Band of Cherokee Indians: Cherokee Choices/REACH 2010 Diabetes Prevention Program..........................................61

Oklahoma State Department of Health: Oklahoma Native American REACH 2010 Project ......................................................67

American Indian/Alaska Native

Albuquerque Area Indian Health Board, Inc.: Partners in Tribal Community Capacity Building (REACH 2010) Project...............49

Association of American Indian Physicians: Oklahoma REACH HIV/AIDS American Indian Capacity Building............................63

Choctaw Nation of Oklahoma: Choctaw Nation Core Capacity Building Program...................................................................65

Chugachmiut Native Organization: Alaska Native Cardiovascular Disease Prevention/Core Capacity Building Project................5

National Indian Council on Aging: Diabetes Educational Outreach Strategies Project..............................................................53

United South and Eastern Tribes, Inc.: REACH 2010 Immunization and Infant Mortality Project...............................................75

Asian American

Lowell Community Health Center: Cambodian Community Health 2010 Program ..................................................................37

Special Services for Groups, Inc.: REACH 2010/Health Access for Pacific Asian Seniors............................................................13

University of California, San Francisco: Vietnamese REACH for Health Initiative Coalition .......................................................15

Index
84

Hispanic/Latino

Greater Lawrence Family Health Center: REACH 2010 Latino Health Project ..........................................................................35

Hidalgo Medical Services: La Vida Program ...........................................................................................................................51

Latino Education Project: REACH Latino Education Project.....................................................................................................77

Migrant Health Promotion: REACH Promotora Community Coalition......................................................................................79

REACH Communities by Health Priority Area

Breast and Cervical Cancer

Access Community Health Network and University of Illinois at Chicago: REACH Out.............................................................21

Albuquerque Area Indian Health Board, Inc.: Partners in Tribal Community Capacity Building (REACH 2010) Project...............49

Boston Public Health Commission: Boston REACH 2010 Breast and Cervical Cancer Coalition ...............................................29

University of Alabama at Birmingham: Alabama REACH 2010 Breast and Cervical Cancer Coalition .........................................3

University of California, San Francisco: Vietnamese REACH for Health Initiative Coalition .......................................................15

Cardiovascular Disease

African American Health Coalition, Inc.: REACH African American Health Coalition ................................................................69

Black Women’s Health Imperative: REACH 2010: At the Heart of New Orleans Coalition ........................................................27

Choctaw Nation of Oklahoma: Choctaw Nation Core Capacity Building Program...................................................................65

Chugachmiut Native Organization: Alaska Native Cardiovascular Disease Prevention/Core Capacity Building Project................5

Fulton County Department of Health and Wellness: REACH for Wellness................................................................................19

University of Nevada, Reno: Healthy Hearts Project ...............................................................................................................45

Diabetes

Community Health & Social Services Center, Inc.: REACH Detroit Partnership .........................................................................39

Eastern Band of Cherokee Indians: Cherokee Choices/REACH 2010 Diabetes Prevention Program..........................................61

Hidalgo Medical Services: La Vida Program ...........................................................................................................................51

Medical University of South Carolina: REACH 2010 Charleston and Georgetown Diabetes Coalition ......................................71

Migrant Health Promotion: REACH Promotora Community Coalition......................................................................................79

National Indian Council on Aging: Diabetes Educational Outreach Strategies Project..............................................................53

New Hampshire Minority Health Coalition: New Hampshire REACH 2010 Initiative................................................................47

Public Health - Seattle & King County: Seattle & King County REACH 2010 Coalition.............................................................81

University of Illinois at Chicago: Chicago Southeast Diabetes Community Action Coalition .....................................................25

Diabetes and Cardiovascular Disease

Boston Public Health Commission: REACH Boston Elders 2010..............................................................................................31

Carolinas HealthCare System: Charlotte REACH 2010 Coalition.............................................................................................59

Chicago Department of Health: REACH 2010/Lawndale Health Promotion Project .................................................................23

Community Health Councils of Los Angeles: African Americans Building a Legacy of Health .....................................................7

Greater Lawrence Family Health Center: REACH 2010 Latino Health Project ..........................................................................35

Institute for Urban Family Health: Bronx Health REACH Coalition...........................................................................................55

Latino Education Project: REACH Latino Education Project.....................................................................................................77

Lowell Community Health Center: Cambodian Community Health 2010 Program ..................................................................37

Matthew Walker Comprehensive Health Center: Nashville Health Disparities Coalition REACH 2010 Project...........................73

Missouri Coalition for Primary Care: Kansas City - Chronic Disease Coalition .........................................................................43

Oklahoma State Department of Health: Oklahoma Native American REACH 2010 Project ......................................................67
85

HIV/AIDS

Association of American Indian Physicians: Oklahoma REACH HIV/AIDS American Indian Capacity Building............................63

Center for Community Health, Education & Research, Inc.: Metropolitan Boston Haitian REACH 2010 HIV Coalition...............33

Florida International University: Coalition to Reduce HIV in Broward’s Minority Communities.................................................17

Immunization

Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center: Immunize LA Kids Coalition..................................9

Mailman School of Public Health of Columbia University: Northern Manhattan Start Right Coalition ......................................57

Immunization, Diabetes, and Cardiovascular Disease

Special Services for Groups, Inc.: REACH 2010/Health Access for Pacific Asian Seniors............................................................13

Immunization and Infant Mortality

United South and Eastern Tribes, Inc.: REACH 2010 Immunization and Infant Mortality Project...............................................75

Infant Mortality

Genesee County Health Department: Genesee County REACH 2010 Team.............................................................................41

San Francisco Department of Public Health: SevenPrinciples Project.......................................................................................11

88