St. Joseph’s Hospital Helps Build a Healthier Near Westside in Syracuse
Since 2014, following its $4.9 million expansion of what is now called the Primary Care Center-West (PCC West), St. Joseph’s Hospital has partnered with other local institutions to improve health outcomes for the approximately 7,000 residents of the Near Westside neighborhood in Syracuse, New York. While many agencies seek to improve residents’ health through their housing programs, organizations also recognize that addressing health is an important part of neighborhood revitalization. As the Robert Wood Johnson Foundation’s recent research shows, where people live influences their health. Along with safe, affordable, and good quality housing, improved physical and social conditions in distressed neighborhoods, such as access to medical care and healthy food, can result in better health. In Near Westside, which has disproportionately higher rates of unemployment and poverty than elsewhere in the city, residents also experience type II diabetes and obesity at higher rates than do residents of many other Syracuse neighborhoods. To address these health challenges, PCC West, along with other Near Westside organizations and Syracuse University’s Lerner Center for Public Health Promotion, is running community programs to promote healthy living from infancy through adulthood.
Meeting Residents’ Health Needs Where They Live
The partnership’s efforts to improve the community’s health began with the Lerner Center staff talking to Near Westside residents to learn about what nutrition means to them. Rebecca Bostwick, the Lerner Center’s managing director, said that residents, many of whom are on limited budgets, defined the word in terms of the cost of food and how long they could make groceries last on a limited income. These conversations led to an important insight, Bostwick says, that has since shaped health interventions in the community. Because of financial constraints, residents might not risk buying healthy food if they thought their children would not like it.
With that information, the Lerner Center partnered with Nojaim Brothers Supermarket, which has operated in Near Westside for 98 years, to launch a program that runs in-store promotions for healthy food at Nojaim Brothers. The discounts resulted in “huge shifts” in people’s purchasing behavior, says Bostwick. By contrast, a food scoring system, NuVal, which compares the nutritional value of foods, neither gained much awareness among shoppers nor changed their buying habits.
At the same time, the Lerner Center launched the Diabetes Self-Management Education program (DSME), which PCC West oversees. The yearlong program piloted in 2016 with 50 PCC West patients with type II diabetes. Participants attended monthly group classes and individual counseling sessions at PCC West in nutrition and cooking. Participants also received coupons for fresh food at Nojaim Brothers, which shares a parking lot with PCC West. The program was successful, with attendance and coupon redemption hovering between 70 and 90 percent. “That fruit and vegetable coupon allowed a little more financial flexibility for participants to try something new,” says Bostwick, and the education sessions offered them new ideas about how to prepare the food.
PCC West took over the program in 2017, with grants from Wholesome Wave and Trinity Health’s Transforming Communities Initiative that will support it for three years. Lisa Yarah, registered dietitian/nutritionist and certified diabetes educator who runs the DSME program, leads classes for 66 participants that focus on a different theme each month, such as carbohydrate counting, label reading, and medication management. Yarah uses individual sessions to review participants’ blood glucose logs, check how well they are responding to medication, and provide personal feedback. The program is fully enrolled, and every day Yarah receives requests from people to join.
Healthy Steps for Young Children is another PCC West program focused on improving community health that began in 2016. Supported with a $350,000 grant from the New York State Office of Mental Health, the 3-year program connects participants with a Healthy Steps specialist who accompanies families on regular pediatrician visits; the specialist also discusses common and complex parental concerns that physicians often lack time to address. Children under 2 years old who are patients at PCC West can participate in the program through age 5; 101 children are currently enrolled.
Improving Health for Adults and Young Children
Although it is too early to provide metrics for PCC West’s Healthy Steps for Young Children program, it has been evaluated nationally and at several of the 45 individual sites around the country where it is run. These evaluations have found many positive outcomes, including reduced childhood obesity rates and more parents reading to their children. DSME continues to be successful, says Stacey Keefe, project manager at St. Joseph’s Hospital. Coupon redemption rates are usually about 90 percent, and patients have lost weight and reduced blood pressure and blood sugar levels. Almost all patients who have completed the program continue to participate because they still want regular support.
DSME also shows the efficacy of collective impact, according to Bostwick. “We need many partners to make changes” in public health, including entities such as Nojaim Brothers or the Near Westside Peacemaking Project, a conflict resolution organization, that “have health nowhere in their mission but … are central to the neighborhood.” Involving these groups encourages community acceptance and provides more opportunities to build social cohesion, both of which are necessary to effect communitywide changes. When taken together, these diverse institutions and the services they provide, whether oriented around economic, social, or physical needs, influence individual health. Moreover, Bostwick asserts that such collaborative efforts can succeed only if anchor institutions learn the language, obligations, and operational concerns of their partner businesses and organizations. Doing so, Bostwick explains, reveals the opportunities and challenges of working with institutions whose primary obligations might have nothing to do with health. Ultimately, such dialogue enables diverse groups to work together to shape sustainable, lasting public health programming while accommodating their often vastly different missions.
PCC West continues to pursue new partnerships to address residents’ desires for better health outcomes. Some DSME participants have indicated that they would like a safe and accessible place to exercise, and St. Joseph’s Hospital is considering starting an exercise program at PCC West. To satisfy community wishes, St. Joseph’s is seeking a partner organization to staff the program, which would be open to people of varying activity and fitness levels.
St. Joseph’s Health. 2014. “St. Joseph’s Opens Expanded Primary Care Center on Syracuse’s Near West Side,” press release, 10 March. Accessed 9 October 2017; City of Syracuse. 2010. “Syracuse Housing Plan.” Accessed 4 October 2017; U.S. Census Bureau. American Factfinder. n.d. “Syracuse city, New York: Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2016 — 2016 Population Estimates.” Accessed 9 October 2017; Maxwell Community Benchmarks Program, n.d. “Below the Line: An Analysis of Concentrated Poverty in Syracuse.” Accessed 4 October 2017; Document provided by Lisa Yarah, registered dietitian/nutritionist and certified diabetes educator; Onondaga County Health Department. 2017. “Onondaga County Community Health Assessment and Improvement Plan, 2016–2018.” Accessed 4 October 2017; Robert Wood Johnson Foundation Commission to Build a Healthier America. 2008. “Where We Live Matters for Our Health: Neighborhoods and Health,” Issue Brief 3, September. Accessed 4 October 2017.×
Interview with Rebecca Bostwick, 22 August 2017; Interview with Lisa Yarah, registered dietitian/nutritionist and certified diabetes educator, St. Joseph’s Health, 23 August 2017.×
Interview with Lisa Yarah, 23 August 2017.×
Interview with Stacey Keefe, project manager, St. Joseph’s Health Center, 25 August 2017; Correspondence from Stacey Keefe, 13 September 2017.×
Zero to Three. n.d. “National and Site-Level Evaluations.” Accessed 4 October 2017; Brian D. Johnston, Colleen E. Huebner, Lynda T. Tyll, William E. Barlow, and Robert S. Thompson. 2004. “Expanding developmental and behavioral services for newborns in primary care: Effects on parental well-being, practice, and satisfaction.” American Journal of Preventative Medicine 26:4, 356–66. Accessed 4 October 2017; Rachel S. Gross, Rahil D. Briggs, Rebecca S. Hershberg, Ellen J. Silver, Nerissa K. Velazco, Nicole R. Hauser, and Andrew D. Racine. 2015. “Early Child Social-Emotional Problems and Child Obesity: Exploring the Protective Role of a Primary Care-Based General Parenting Intervention.” Journal of Developmental Behavioral Pediatrics 36:8, 594–604. Accessed 4 October 2017; Interview with Stacey Keefe, 25 August 2017; Interview with Lisa Yarah, 23 August 2017.×
Interview with Stacey Keefe, 25 August 2017; Correspondence from Stacey Keefe, 16 October 2017.×