Working Hard for Harlem’s Future
See also A Native Son Comes Home
By Christopher Zurawsky
Being a community resource means different things to different organizations. A library provides books and knowledge; a religious congregation, spiritual support and guidance. One thing is certain, however. Such resources are vitally important for a neighborhood’s well-being and growth, particularly in America’s often short-changed urban cores.
One of Harlem’s budding community resources is The Harlem Center for Health Promotion and Disease Prevention, Harlem Health Promotion Center (HPC) for short, which sponsors a wide variety of health projects in Northern Manhattan. for example, with local churches, mosques, schools and businesses, the Heart of Harlem program strives to reduce cardiovascular disease (CVD) morbidity and mortality through programs that emphasize the importance of proper diet, adequate exercise and smoking cessation. Long considered the “community intervention” arm of the Center, Heart of Harlem, under the guiding hand of Principal investigator Edward Healton, M.D., also provides blood pressure screenings and trains community volunteers in the assessment of CVD risk factors.
Led by principal investigator and CSPH Dean Allan Rosenfield, M.D., Harlem HPC is a collaboration between the Centers for Disease Control and Prevention, Harlem Hospital Center, and Columbia School of Public Health. in existence since 1991, it is the only one of fourteen CDC Prevention Research Centers with an urban, African American focus. The Center’s mission—the reduction of morbidity and mortality in Harlem—stems from “Excess Mortality in Harlem,” a landmark 1990 study by Colin McCord, M.D., and Harold P. Freeman, M.D., published in the New England Journal of Medicine. That study found that a black man in Harlem is less likely to reach the age of 65 than a man in Bangladesh, one of the poorest countries on earth. The Center is planning an annual award, named for McCord and Freeman, that will recognize a Harlem HPC paper or project that has made a significant impact on understanding or improving health status in Harlem.
As it pursues federal funding renewal, the Center is doing some soul searching regarding its future and its role in Harlem. An important guidepost in this self-appraisal is the CDC’s directive to forge stronger community partnerships. With that in mind, the Center is continuing to address the major causes of morbidity and mortality in Harlem while expanding its scope to include not just predominantly African-American Central Harlem, but East and West Harlem as well, areas with large Latino populations.
“We are developing research and service with an eye toward expanding our net to include as many groups as possible that have interests in the community—stakeholders—to work on key issues,” says Alwyn Cohall, M.D., the Center’s new director [see profile, page 21]. to that end, the Center hopes to attract more involvement on its community advisory board among Latinos— even Central Harlem is now 10 to 15 percent Latino—as well as from residents involved in education, the faith community, cultural activities, and the economic and business communities. “We want to build on our core group and strengthen it with new blood,” says Cohall.
Harlem HPC researchers, led by Robert Fullilove, Ed.D., recently conducted the Harlem Household Survey, a population-based survey of 695 Central Harlem adults aged 18 to 65 years old, randomly sampled from a careful enumeration of Harlem households. Among the findings of concern:
Harlem Health: By the Numbers
Community Involvement
Muriel Petioni, M.D., a family physician in Harlem for 40 years who has been described as the grande dame of Harlem, is chair of the Friends of Harlem Hospital and a member of the Health Promotion Center’s Community Advisory Board (CAB). She asserts that if the Center wants to be of practical use to those it serves, it needs to tie its research more closely to the community.
“Our health statistics in Harlem are at the bottom,” she points out. “Premature birth and HIV infection rates are among the worst in the city. Our health in Harlem, and all the ‘Harlems’ in America, is regressing. The average young man in Harlem feels he won’t see his 25th birthday.” She also points to a recent study predicting that by 2020, half of all AIDS cases will be in the African-American community.
to improve Harlem’s health, Petioni says the Center needs to decide which problems to confront. “Cardiovascular disease is important, but so is violence. We can’t do everything, but we have many problems to choose from.”
The Center’s positive community impact is reflected in its ongoing asthma prevention efforts in Northern Manhattan, including a recent high-profile study of diesel vehicle emissions, conducted in tandem with West Harlem Environmental Action, a community empowerment group directed by Peggy Shepard, a community advisory board member. That work, headed by Mary Northridge, Ph.D., M.P.H., and Patrick Kinney, Sc.D., of the Division of Environmental Health Sciences’ Center for Environmental Health in Northern Manhattan, is being expanded through a grant from the National institute for Environmental Health Sciences.
The new study will test an “integrated pest management” approach to excluding roaches from housing. The insect has been identified as a possible trigger for asthma. One hundred Harlem and South Bronx families with a child with asthma, 6 to 18 years old, will be recruited. in half the families, researchers will use a pesticide-free approach to roach control which will include sealing off food and water sources, hiding places, and travel routes.
Success Breeds Success
The Center will also continue to focus on cardiovascular health with a major emphasis on smoking. “We want to send the message that if you are smoking, these are ways to kick the habit, and we intend to extend help through churches, schools and community health centers,” Cohall says.
Major tobacco initiatives have been linked with the work of Donald Gemson, M.D., M.P.H., former co-director of the Center. With the assistance of a multidisciplinary team of researchers, as well as Harlem youth volunteers, Gemson has investigated the effect of tobacco advertising and counteradvertising on youth tobacco behavior, and has shown that imposing punitive measures on shop owners who sell cigarettes to minors can reduce sales to young people.
The Center is also positioning itself to expand on recent physician education efforts, also headed by Gemson, aimed at disseminating health promotion messages and practices from doctor to patient. We’re aiming to “weave the threads of prevention into a tapestry, so that all types of health care providers place ‘prevention’ in the forefront of conversations with patients,” Cohall says, adding that the Center plans to “resuscitate” the education program at the Harlem Hospital Center, expanding it from internal medicine to every primary health care specialty.
In the Trenches
as co-director of several community-based interventions, Harlem HPC health educator Joyce Moon-Howard, Dr.P.H., says she works “in the trenches.”
“By ‘in the trenches’ I mean very grassroots-connected work,” she explains. “It’s working at the level of community residents rather than community agencies.”
During visits to Harlem businesses and gathering places like barbershops, beauty shops, the State Department of Motor Vehicles, and utility company payment centers, Moon-Howard and her colleagues ask residents about their health care needs and concerns. The first-hand information is then used to shape interventions like tobacco smoking cessation programs.
“We ask about people’s experience with quitting smoking,” she says. “Why people smoke, when they smoke, what kind of attempts they made to quit, what kind of support they received.” Center workers have even gone as far as asking store owners who sell cigarettes if they would be willing to display smoking cessation literature in their stores.
The Center has forged a strong grassroots link with Harlem’s celebrated faith community and its network of active volunteers. Moon-Howard points out that Harlem is home to a large Islamic community and a growing Buddhist population, and many churches house more than one congregation or faith.
The Harlem Hospital injury Prevention Program has built 21 playgrounds in Central Harlem. Community advisory board member Aissatou Bey-Grecia directs the program.
Faith Alliance in total Health (FAITH), a voluntary group, was established through the Center’s Heart of Harlem program. Beginning with four faith institutions, the Alliance now encompasses twelve Christian and Islamic organizations focused on CVD risk reduction methods including blood pressure screening and counseling. With support from the Robert Wood Johnson Foundation, FAITH is now able to reach beyond its own congregations, providing services like transportation to grocery stores. Moon-Howard notes that the Center’s role in FAITH’s activities has been that of facilitator—bringing groups together—and has provided training in blood pressure management, referrals to health care providers, and exercise programs. FAITH is currently trying to persuade the city to provide safe, designated walking areas—one near City College, another on Eighth Avenue—that are patrolled at convenient times for neighborhood residents.
“We turn to the faith communities because we know they can reach further than an agency, and they’re going to provide services beyond a grant period,” Howard says. “to make a significant change in health status someone has to be there over time.”
Another faith community partnership, called Family to Family, has been developed by Mindy Fullilove, M.D. Growing out of Fullilove’s Center-supported Coming Home project, an assessment of housing rehabilitation in the Bradhurst section of Central Harlem, Family to Family is a family mentoring program created in partnership with the Church of Jesus Christ of Latter Day Saints (LDS). The partnership is an extension of LDS’s Family Home Evening, a 50-year-old program that promotes family fundamentals, from fire drill practice to toy sharing.
“It builds families’ capacity to function as a unit and to have a joyful time together,” Fullilove explains. “LDS is interested in passing along what they know about families as a resource to the larger U.S. society.” She adds that Harlem HPC is considering conducting an evaluation of the effectiveness of the partnership, which receives support from The Edna McConnell Clark Foundation and LDS charities.
Into the Future
Regarding its role both as a community resource and a vital component of one of the country’s leading schools of public health, Howard asserts that the Center should be a conduit for developing minority researchers, providing training as well as practical experience. Part of that mission would be fulfilled by a proposed health education library, replete with internet access, for Harlem-based health care providers and consumers.
“to find our niche in Harlem, we may have to wear several hats,” says Director Alwyn Cohall. He sees expanding even more the close relationship with CSPH and developing additional ties to the New York City Department of Health (DOH) as key to raising the Center’s profile. for instance, “When DOH has a message to get out, they should view us as the primary liaison with the community,” Cohall says. A component of this information dissemination role will be a “chart book” of Harlem health statistics, comparing the neighborhood with other ethnic groups, the city, and the state.
One sure near-term focus is reproductive health, relatively unexplored territory for the Center. A new project, supported by the Soros Foundation/Open Society, the Academy for Education Development, Planned Parenthood and area hospitals, will attempt to raise young peoples’ and health providers’ awareness of emergency contraception. Also known as the “morning-after pill,” post-coital contraception, or the “Yupze method”—named for the physician who developed it— the method entails taking two doses of high-potency birth control pills within 72 hours of unprotected intercourse. The procedure reduces the chance of pregnancy by up to 75 percent, Cohall notes.
Emergency contraception has been available for over 20 years. Surveys show that 90 percent or more of college women have heard of it, compared with a national rate of about 60 percent and a much lower rate among women with no higher education. About 30 percent of adolescent women know about it.
“This is a high-risk and highly motivated group, and they have difficulty getting traditional forms of contraception,” Cohall points out. “The majority of teen pregnancies, about 85 percent, are unwanted or unintended.”
A related project examines the emergency contraception experiences of approximately 60 young women. Researchers also will look at young mens’ knowledge of the method, emphasizing appropriate use.
“We will look at the experiences of young women who have used this method in the past year,” Cohall says, adding that providers are concerned that young women will use emergency contraception indiscriminately and will not switch to more conventional and reliable methods. However, he notes that anecdotal evidence shows this is not true, and a planned retropective analysis should provide firm evidence to the contrary.
While there is clearly work to be done, the Center’s deputy director, Mary Northridge, maintains that “there is more community support than ever, and more meaningful interventions on the Center’s part, like involving the community in planning retreats, helping them build playgrounds, or assisting organizations with grant writing.”
Harlem HPC community advisory board members (left to right) Aissatou Bey-Grecia, Collin Bull, attorney-in-charge, Legal Aid Society, and Sydney Moshette, executive director, Reality House, at a recent meeting with CDC representatives.
“We want to be a community resource, and we want to be able to take the time to make sure that things are done right—meaningful, relevant and completely inclusive,” Northridge says, adding that more funding appears to be on the horizon for prevention research. “You can only do so much on goodwill.”
Joanne Toran, coordinator of community affairs and capital development, notes that the Center’s funding has grown incrementally from a half million dollars at its inception to about $2.9 million now, from all sources.
“Five years from now Harlem HPC should have a solid financial base, not just non-recurrent or competing funding,” she says. “It should become a fixture in the community, not just a passing program that ends when its funding does.”