The Flint Center for Health Equity Solutions (FCHES) is a transdisciplinary collaborative center for Health Disparities Research on Chronic Disease Prevention within the DHHS-defined Region 5. This Center arose from active collaborations among Core Academic Faculty from the Michigan State University College of Human Medicine Public Health Division and The University of Michigan-Flint. Our partnership also includes the University of Michigan main campus in Ann Arbor, MI. Lead Consortium Partner for the Center is the Flint-based Community Based Organization Partners (CBOP). National Consortium Partners include The National Collaborative for Health Equity (NCHE), The National Office of the National Association for the Advancement of Colored People (NAACP), and U.S. Congressman Dan Kildee (5th Congressional District). State partners include State Senator Sheldon Neeley (34th District, which incudes the larger Genesee County and Flint); and local partners including the Genesee County Health Department (GCHD), The Genesee County Land Bank, Flint Odyssey House, Inc., Bridges into the Future, Community Outreach for Families and Youth (COFY) Center, The Greater Flint Health Coalition, and Wellness Services. Core Academic Faculty and their community partners bring significant research and practical expertise in health equity efforts, behavioral health interventions and epidemiology, geography and the effects of built environment on health, and physical fitness and healthy eating in economically distressed, minority-majority communities. The FCHES targets its initial activities within Flint, Michigan, with formative plans to extend the scope and reach of Center activities more generally across the state through the Michigan State University Extension Program and nationally over the course of our work.
The translational work of the FCHES aims to have national impact. Our dissemination, advocacy and policy initiatives includes local, regional, and national activities. Currently in Year 1 of our activity, the FCHES is in the Start-Up/Community Assessment Phase which includes convening and expanding the Consortium Partnership and conducting a community-wide needs and assets assessment. Years 2-5 of the FCHES will be devoted to the performance of two community-based multilevel collaborative intervention research projects, one focused on prevention of chronic physical health disease/condition (specifically obesity and cardiovascular disease) and the other focused on prevention of chronic behavioral health disease/condition (specifically substance abuse and mental illness). Our behavioral health intervention programs have the potential to improve overall physical well-being for families. Our initiatives will reduce health inequities in Flint, Michigan and provide promising insights to promote translational approaches in Region 5 and more broadly across the nation.
Populations of Interest
The proposed FCHES focuses on 3 primary populations, including:
(1) underrepresented racial and ethnic minorities.
(2) geographic areas with high concentrated poverty.
(3) medically underserved communities.
Within Flint, Michigan, and across the region, these three populations reflect the most disparate populations and have the highest need for multi-level interventions, including policy-based approaches to prevent and reduce chronic diseases. The research and activities of the FCHES extends the current wealth of health disparities research in the Region that has identified the need for systemic- and policy-level interventions to ameliorate the ‘downstream’ disparities in morbidity and mortality among our most marginalized populations. Building on this body of work, the FCHES will promote the most promising policy interventions to influence the systemic and structural ‘upstream’ factors that promote health inequalities. Our Center relies upon a systems approach and is transdisciplinary, collaborative, and translational. The FCHES is an assembly of stakeholders, including public health researchers, policy-makers, health officials, community organizations, and faith-based partners across a range of disciplines to mount evidenced-based and promising approaches to prevent chronic disease and reduce health inequities.
The existing Consortium Partners were involved in the design of the FCHES from conception and the Center is a reflection of the Flint community’s deep desire for health equity solutions for their communities. The community’s outstanding commitment is matched by The Michigan State University-College of Human Medicine (MSU-CHM) who is playing a central role in addressing the public health challenges facing Flint and other disparate population across the State. MSU-CHM is wholly committed to the success of this Center. MSU-CHM launched its Public Health Division in Flint in February, 2014.
The FCHES harnesses the collective energy, expertise, and commitments of local stakeholders to create the infrastructure to support sustainable health equity solutions vis a vis the Center. Our long-range goals are to implement health equity solutions to eliminate health disparities among racial minorities, impoverished populations, and the medically underserved in Region 5. Our use of community-based participatory research approaches includes the active participation of our partner organizations in all programmatic aspects of the FCHES. This approach started with the naming and framing of the Center, and continued with the preparation of the application, and will be maintained throughout the active phase of assessment, intervention, implementation, translation and dissemination.
How the FCHES will significantly contribute to the integration
of chronic disease prevention interventions
The various FCHES activities taken together as a whole will significantly contribute to the integration of chronic disease prevention interventions taking into account the dynamic interplay between biological, behavioral, social and environmental health risk and protective factors experienced across the life course. This will occur in several ways. First, each of our multilevel intervention research projects addresses biological, behavioral, social, and environmental risk factors. Second, our Center and Data and Methodology Core Faculty have expertise at all of these levels, including advanced GIS analyses of the effects of built environment on substance use, mental health, healthy eating, and physical activity; health economics; implementation and policy research; social support research; and biobehavioral causes and outcomes of health disparities. Our community partners’ expertise is also broad. For example, our lead Consortium Partner, CBOP, is nationally policy active but also participates in genomics projects. Third, several of the resources and approaches to address the social determinants of health in our research projects (such as churches and community organizations as anchor institutions, policy and advocacy around the built environment, family education, and access to healthy food) can easily be leveraged to address a range of healthy behaviors. Overall, having expertise in one Center that is so varied and broad brought to bear on core health problems, in concert with multilevel intervention projects, in a single geographic area offers great promise in the field of chronic disease prevention.
Project 1 Public Health Approaches to Prevent and Reduce Obesity
and Cardiovascular Disease: The ‘Church Challenge’ to Create Healthier Communities.
The Genesee County Church Challenge is a collaborative effort between consortium partners on the Flint Center for Health Equity Solutions (FCHES) including Bridges Into the Future, the Odis A. Floyd Community Outreach for Families and Youth (COFY) Center, the Flint Odyssey House, Inc., and the Health Awareness Center to engage African American residents of Genesee County to become physically active, improve nutrition, and engage in healthier lifestyles, as well as create safe and wholesome environments that promote good health, physically, emotionally, socially and spiritually. The Church Challenge randomized trial will enroll nearly 1,000 individuals from more than 30 churches Citywide, and then assess the churches’ ability to sustain these activities to benefit their more than 18,000 congregants. The Church Challenge, developed and piloted in the Flint community by pastors working with one of our Community Leads, Pastor Dr. Bailey, is a church-driven physical fitness and nutrition intervention. It focuses on physical activity and healthier food choices, including promoting an understanding of the impact that the African American experience, from a historical and cultural prospective, has had on lifestyle choices. The program also empowers churches not only to encourage congregants to improve health behaviors, but also to engage local policy makers in policy-based interventions to bring healthy food and safe physical activity spaces to the City of Flint. For example, Flint currently has no major food market within its City limits which greatly hinders residents’ ability to readily access healthy food. Therefore, it uses churches as the driver of three levels of change: individual, church, and community-level policy. This is likely to be feasible and the churches are likely to feel ownership over these efforts because it was their idea (see Project 1 for additional details). The research program uses a multi-level approach to bridge public health research, practice, policy, and faith-based communities in a comprehensive, multi-level community intervention that impacts both individual-level behaviors as well as impacts community norms around healthy food preparation, access and physical fitness.
Project 2 Public Health Approaches to Prevent and Reduce Behavioral Health Inequalities: Strengthening Flint Families
The Flint Recovery Corps (FRC) seeks to implement a multi-tiered intervention program designed to provide men and women in recovery from substance abuse with opportunities to “give back” by serving as peer-recovery support advocates and recovery coaches for persons with substance use disorders. The Flint Recovery Corps (FRC) will be built from an evidence-based peer coaching and advocacy recovery support service that is non-clinical and designed to engage persons seeking to access treatment, those preparing to leave treatment and re-establish life in the community, or recent program graduates seeking to access recovery support services. The FRC recognizes the value of those in the city who are often forgotten and still stigmatized. Individuals recovering from substance dependence who have successfully managed their recoveries for at least two years, will be trained and mobilized to serve as peer recovery advocates (PRA’s) across the city. Because they are succeeding against all odds to stay drug-free, they have a wealth of experience and knowledge that they draw on to help others make the same transition from addiction to long-term recovery. The program of research will be multi-tiered and include the evidence based Strengthening Families Program to support family reunification and support for persons with substance use disorder and also include community-level policy interventions to identify unmet geographic need for additional substance use, co-occurring mental health, and support services.
The Public Health Build in Flint
Flint, Michigan is a minority-majority city that is deeply economically distressed. It is one of the most violent US cities (1) and it has zip codes with average life expectancy under 65 (2). Flint’s challenges over the last decades and its slide from one of the wealthiest cities in the US to one of the poorest are iconic of challenges faced by other Rust Belt communities, including Detroit, Gary, Youngstown, Cleveland, Saginaw, Dayton, Buffalo, Cincinnati, Pontiac, Canton, Toledo, Akron, Milwaukee and parts of Pittsburgh, St. Louis, and Chicago.
However, Flint also has a long positive history of community activism and involvement, characterized by the 1936 Flint sit-down strike at General Motors. Activism continued through grass-roots community health efforts, which strengthened in Flint as the formal public infrastructure crumbled. In 2004, community and health organizations from the Flint area decided that a strong medical school presence in Flint would help address pressing public health issues and drive economic revitalization of the city. Community members met with the Flint-based Charles Stewart Mott foundation, who commissioned a feasibility study and approached Michigan State University’s (MSU) College of Human Medicine (CHM), based 48 miles away in East Lansing. They determined that a community-participatory public health focus was compatible with both the city’s needs and with MSU’s mission. The feasibility study concluded that Flint was a good site for public health research because it was big enough to matter and small enough that one could make changes and see results.
Because of the level of activism, passion, commitment, and capacity of community-based organizations in Flint, MSU’s CHM decided to take an unprecedented, community-partnered approach to developing topic areas and hiring research faculty for its new Division of Public Health that would be headquartered in Flint. The faculty would be recruited and hired through a community-participatory search process, with community members and representatives of community organizations making up the majority of the ~25-person search committee. Community members would interview candidates, attend job talks, and vet every applicant as integral partners in the search process. In determining focus areas for these hires, CHM representatives interviewed more than 100 community and health leaders, organizations, and community opinion leaders; completed a community-wide survey; and held community discussions to identify Flint’s most pressing health needs and priorities. Based on survey results, a Community Research Advisory Board advised that MSU-CHM should focus its efforts on recruiting public health researchers in the areas of chronic disease, behavioral health and healthy behaviors. They strongly encouraged that these researchers’ emphasis be on intervention research, with particular attention to health disparities and health equity solutions.
The Public Health academic build in Flint is truly unique. MSU-CHM has a campus in Flint because the community wanted it, funded it, and helped to shape it. The University of Michigan Flint campus has lead public health practice and research in Flint for more than 30 years. The University of Michigan in Ann Arbor has supported research and outreach in Flint for decades, and helped to address some of Flint greatest structural and behavioral health challenges. The FCHES bridges these academic institutions with community-based organizations to work in full partnership to create sustainable health equity solutions in Flint.
Contact: Debra Furr-Holden (Debra.Furr-Holden@hc.msu.edu)