Creating an Environment for Healthy Lifestyles in Brownsville

About This Project

“For cross-sector collaboration you might need to talk in terms that you’re not necessarily familiar with, but you have to do your research in order to find those connections to other areas and harness those partners. That is how we were able to make our projects work with very little funding and no line item in the city budget for what we were doing.”— Dr. Rose Zavaletta Gowen, Brownsville City Commissioner

In 2001, the University of Texas School of Public Health (UTSPH) Brownsville campus began clinical research to identify and quantify what health risks existed in Brownsville. They found 80 percent of residents were either obese or overweight, one in three were diabetic (50 percent unknowingly), and 70 percent of residents had no healthcare coverage. After initiating a community media campaign called Tu Salud Si Cuenta, UTSPH formed a Community Advisory Board (CAB) in order to speak about the findings and promote change in the Brownsville community. They involved local clinicians, including Dr. Rose Zavaletta Gowen, an Obstetrician Gynecologist, to inform clinicians and encourage them to get involved. After agreeing actions needed to be taken, a team of UTSPH, the City Health Department, a local community health clinic Su Clinica, and Rose organized and designed a farmers’ market, with the goal of making fresh fruits and vegetables accessible and affordable to every income level in the city. The Brownsville Farmers’ Market opened in 2006 followed by an integrated network of initiatives including The Challenge, an annual weight loss event; CycloBia, an open streets program; policy changes including Sidewalk ordinance, Safe Passing ordinance, Complete Streets Resolution, and Smoking ban ordinance; and a Master Bike and Hike Plan aimed at providing a trail within one half mile of every residence in the city. The CAB, which today includes over 200 members, is actively involved in all of these programs in a variety of capacities to promote a healthier Brownsville.

Rose joined the health initiative as a private practitioner after being approached by the UTSPH in Brownsville. Working on the farmers’ market showed her how much “red tape” was involved in seemingly simple tasks, which led her to run for elected office. Elected as City Commissioner in 2009, Rose helped make the wellness initiative a municipal priority involving multiple departments and several non-city entities. Leaders such as Health Department Director Art Rodriguez and UTSPH faculty were instrumental in shifting perspective and understanding of health in Brownsville.

Balanced Motivations

Rose had practiced medicine as an obstetrician gynecologist in the private sector for over twenty years, but transitioned to the public sector once she realized that it offered her the best chance to affect large-scale community change. For Rose, the scale of the problem identified by UTSPH demonstrated the limitations of a patient-by-patient approach to changing community behavior, and indicated a need for widespread community action on more than one level. As she became engaged with the programs such as the Brownsville Farmers’ Market and its subsequent effects on the community, she was compelled to work on the issues on a larger scale.

Prepared Mind

As the results of the UTSPH evaluation surfaced, UTSPH began meeting with clinicians like Rose to make them aware of the epidemic health risks in Brownsville. In 2006, Rose began to split her time between private practice and working on this community health awareness movement as UTSPH’s Director of Clinical Research. From this new position, she got involved in the development of community projects such as the Brownsville Farmers’ Market (BFM). As the first Chair of the BFM, she became aware of how city administration and elected officials could either enable or hinder projects. Her understanding of the scope of the health problem, her view of the opportunities for local government to affect real change, and her insight into how these health challenges affected the economy led Rose to run for a seat on the City Commission. Rose was elected in 2009 and re-elected in 2013. She now practices at a federally qualified health clinic called Su Clinica while serving as a City Commissioner and adjunct faculty member at UTSPH. Art continues to serve as the City of Brownsville Health Department Director.

Contextual Intelligence

Rose’s experience as Chair of the Farmers’ Market gave her access to each sector and allowed her to understand their differing needs and objectives. Rose, UTSPH, and the team researched what consumers and farmers would look for to participate and what location would optimize patronage from all income levels. Rose was responsible for working with city staff to negotiate permits, agreements, and address other “red tape” issues in the way of opening a market. She and the team recognized the importance of engaging sectors from their own perspectives, whether it be farmers or city officials. While on the city commission, Rose and Art reached out to non-health departments and non-health related businesses by employing this strategy. It was essential to speak to them about how being unhealthy impacted those departments’ and business’ goals and priorities. Learning to speak about health in economic terms, educational terms, and environmental terms was critical. For example, when speaking with the Finance Department, she and Art focused on the financial implications of unhealthy choices including the increasing cost to the health care system and the toll on the local economy as workers become disabled due to health complications. Rose worked with Art and the UTSPH team to show how being an unhealthy community affected society at large and began teaching how wellness initiatives and a healthier community would strengthen connected objectives in education and economics. When speaking the right language, they found greater understanding and “buy in”.

Intellectual Thread

Rose’s experience as a physician was instrumental in her understanding the gravity of the UTSPH’s research results. Learning that the rate of obesity and diabetes in Brownsville were far above the national average, she realized that Brownsville’s entire community regardless of income or education was at risk. This health reality impacts workforce strength and “employability” beyond the everyday healthcare costs. As an RN who has a Masters of Public Health, Art too understood the health implications of the findings. His work in the city government, including in Emergency Management and the Health Department, allowed him to understand that the scale of the problem. Both Rose and Art’s experience in health related fields allowed them to understand that the Health Department could and should get involved with partners on multiple levels inside and outside of city government to work towards a healthier community; their understanding of this larger picture drove their work in the community.

Build a common fact base

Starting in 2001, the UTSPH’s regional campus in Brownsville began compiling data on health in the community, finding very high rates of obesity and obesity-related illness such as diabetes, as well as an overwhelming majority of residents had no healthcare coverage. UTSPH organized a group of citizens and business owners into the Community Advisory Board and reached out to clinicians to share their findings and engage them in finding solutions. These statistics galvanized the meeting participants, including Rose, Art, and CAB members, to look at the larger picture. The CAB soon became an active body pushing for health-based initiatives. One of the first initiatives that the CAB participated in was a local media campaign called Tu Salud Si Cuenta, which delivered the research findings in a community media friendly format and celebrated ordinary people from the community making healthy choices that improved their diabetes, hypertension, and lowered their weight. This community based media campaign created common knowledge on the health reality in the community and also included a team of community health workers, or promatoras, who were trained by UTSPH to go out into the lowest income neighborhoods door to door to engage people in how to make healthy choices.

Establish a governance structure

UTSPH created a Community Advisory Board (CAB) in 2003 to uniting members from the health field, the business community, and a number of government, education, social service, and non-profit organizations to raise awareness of community health issues. CAB has four stated goals: to work with the UTSPH researchers to ensure that health information and research is more accessible and more fully understood by Brownsville residents; to share information, collaborate, and participate in forming networks and pursuing potential funding opportunities; to provide feedback on outreach and recruitment strategies; and to lead policy and environmental change interventions in partnership with local government and community entities. CAB, which began with 35 members, now has 210 members, which break down into subcommittees based on interest and expertise. A five-member leadership team led by Belinda Reininger DrPH, Associate Professor at UTSPH, sets the meeting agendas and runs the meetings, while the actions of the CAB are undertaken by its subcommittees. CAB serves as a central body for community members involved in health programs to coordinate activities and set priorities. Members of the Board approach the City Commission in their individual capacity to lobby for projects, e.g. funding or zoning requests. Though each initiative is managed individually, CAB creates a connection between different programs and serves as a voice for a unified culture of health in the community.

Account for resources

Project funding is a recurring issue for proposed health programs. In an effort to identify program funding, a UTSPH graduate student discovered that Brownsville was not very successful at capturing grant dollars on a state level. Using this information, Rose lobbied to establish a dedicated grant writing department, which did not exist prior to her being elected. One example of collaborative funding is the Belden Trail, for which the Brownsville Community Improvement Corporation was the driving force behind the project. It was awarded funds from the Texas Parks and Wildlife, which they leveraged with their own funds, city funds, transit funds, and funds from the Ford Foundation. Transit funds from B-Metro provided improved sidewalks and bus stops connecting to the Belden Trail while Ford Foundation funds were used to design the trail and conduct community engagement. As health related programs have achieved greater buy-in from city officials due to an improved understanding of shared priorities, and as funding opportunities have expanded through grant seeking and shared resources, expectations of project scale and achievability have grown. CAB likewise acts as a place where leaders can leverage partnerships and share resources to achieve program goals. At CAB, city officials, members of the business community, and social service providers are able to assess needs and offer assistance to achieve project results.

Share discretion

Within CAB, members break down into smaller groups based on interest and expertise, such as pedestrian and bicycle education and senior citizen issues. CAB enables cross-over between programs and allows for ideas, policies, and objectives to be shared and decided upon. Project management for health initiatives is varied depending on expertise as well. The Farmers’ Market, and subsequent Community Garden Program, is run by the Wellness Coalition, a non-profit whose director sits on the CAB. The city remains involved in the BFM by providing labor via the Parks Department for setting up and taking down tents every Saturday. The Parks Department also provides labor to the Community Gardens when needed. An Open Streets program called CycloBia, which closes the street to cars so people can walk together, is produced by the City Health Department where partners from BISD, UTB, Healthy Communities and other community organizations work together.

In Brownsville, “health” has been elevated to a city-wide issue as individuals and groups have come together to build a strong network to support initiatives and ordinances for healthy living. In a city where people believed “healthy” only meant going to the doctor and taking medicine, creating an understanding of health as a lifestyle through active programs, modifications to the city’s landscape, and the growth of a community board of over 200 people, has been a significant change for the community. Healthy moral has improved through several different programs: “The Challenge” resulted in 79 percent of participants surveyed confident that they could be active at least 30 minutes five times a week after completing the program; 84 percent of Brownsville residents surveyed at the Farmers’ Market believe they eat more fruits and vegetables when shopping there. Continuing successes include:

  • Brownsville named 2014 All-America City by the National Civil League and awarded the Robert Wood Johnson Foundation’s 2014 Culture of Health Prize.
  • A 20 percent increase in residents who have access to a network for biking across the city, including the Belden Trail, a well-lit, mile-long path on a former rail line in a low-income area, bike racks on city buses, and a city ordinance creating more sidewalks. CAB helped institutionalize community health workers, many who lack college degrees, by facilitating academic appointments for them. These promotoras, now work as Research Assistants at the UT Brownsville School of Public Health.

Health and Wellbeing