In Lawrence MA, Terry Greene worked on a project called, Casa De Salude that hired and trained residents to be community leaders on environmental health issues such as mercury, lead poisoning, and asthma. The leaders then conducted trainings at culturally familiar sites like daycares, public housing facilities, and faith-based places. The project proved the power of listening; mercury training was focused on mercury in fish, but residents asked, what about the tradition of sprinkling mercury on babies’ cribs? With this knowledge, Greene worked with the community to get local shops to stop selling mercury for such purposes. Casa De Salude, was among the first to test a peer-leadership model. Initial leaders also helped to identify new leaders, and so began a ripple effect.
Today, Greene is the Senior Environmental Health Associate at John Snow, Inc.(JSI)- a public health consulting organization dedicated to “improving the health of underserved people and communities” locally and internationally. Social determinants reveal that the most vulnerable communities are the most affected by environmental challenges to health. Greene’s work with JSI belongs to a broader movement for health equity via community-based participatory research (CBPR). CBPR’s collaborative approach involves community members as equal partners in research and decision-making. In this way, it aims to be responsive to community needs and address root causes of health problems.
https://medium.com/@JSIhealth/kickbutts-for-a-healthy-generation-270b972a1984
During graduate school Greene worked with an advocacy group addressing the childhood cancer cluster in Woburn MA. Residents had been the first to connect the leukemia outbreak to water contamination. The residents’ work is an example of barefoot epidemiology and, along with the pollution disaster of Love Canal in New York, paved the way for a public health model in which those who are affected become leaders in strategizing solutions. Greene’s advocacy work led, in part, to her and two colleagues founding the Environmental Health Center at JSI in 1990. This center, which provides communities with technical assistance, values that those most affected have expertise in the problems facing their communities.
“I guess what’s novel in what we’re trying to do is combine the field of health literacy with environmental literacy and CBPR,” Greene explains. The goal must be to both give individuals the information they need in ways that they can understand and “also to recognize their expertise and place in the decision making.”
Always with a warm smile, Greene spends a lot of time organizing community-based adult and family literacy programs in the field befriending everyone along the way. “Since so many of the affected populations are not necessarily literate [we] do things like adult education classrooms for English and speakers of other languages,” she explains. These programs offer lessons about issues including asthma, toxic substance exposure, tobacco use, and civic participation. Everyone can benefit. But as Greene explains, literacy barriers tend to overlap with poverty, racially segregated communities, and more harmful environmental exposures. That means that environmental health works needs to begin with basic literacy.
In Lowell, MA, Greene is collaborating with the Massachusetts Department of Public Health on the Reducing Older Adult Asthma Disparities Study. It’s the first asthma home-visiting intervention study to use a community health worker model. Using low literacy materials, health workers engage with residents in their homes, showing them how to reduce asthma triggers and properly use medications. Writing a prescription is ineffective if medication is unaffordable or inaccessible, instructions are complicated, or when a person’s home remains full of asthma triggers. Community health workers break literacy, language, and cultural barriers by serving as liaisons between medical providers and patients. The state health department is also conducting racial equity trainings for its employees in order to bring more awareness to racial disparities in health. Working groups are strategizing frameworks for applying a racial equity lens and identifying where changes can be made in existing programs and tool-kits.
Back in Lawrence, Casa Santos Nina Santos or “healthy homes for children,” was a project that trained daycare providers in keeping healthy homes free of asthma triggers. From the initial training, day care networks developed, and thousands were trained as providers both taught one another and the children’s parents.
The key to this approach is entering a community asking about residents’ interests and priorities, Greene says. “Don’t go in with a set program.” She expresses that we need to begin by leaning into conversation and asking: what’s the health status of the community and where are the overlaps in health outcomes, such as with cancer, asthma, and low birth rates? Then we can strategize solutions together. Strategies shouldn’t be done topeople, but with people.
Tox Town is one digital tool that Greene uses with residents and experts to help them to think about perceptions of health hazards. In this virtual town- which presents a variety of potentially polluted sites- residents tend to identify the vacant lot as the most hazardous location. Environmental experts tend to say it’s the least. This signifies that there are differing perceptions of risk, so shared learning needs to be a two-way interaction between residents and experts that combines local and expert knowledge.
But there are critics of course. Greene commonly hears, “these folks have so many stresses in their lives, they don’t have bandwidth to think about environmental health, they’ve got to survive day to day.” But she expresses that in her experience families are extremely concerned about their kids, especially with worsening pollution and droughts and floods due to climate change. Greene refuses to buy into what she calls “that elitism.” It is, she argues, “like that old jobs versus the environment argument…a false dichotomy.” Among people with better environmental health, there is less poverty, improved health conditions, and greater equity.
Community Based Participatory Research offers a promising pathway to health equity. The Center for Health Equity was formed at JSI in order to expand diversity and value the stories of those with lived experiences in the practice of public health. In 2018, the American Public Health Association’s focus has been “health equity now” which speaks to growing recognition of the value of Greene’s efforts. To move the needle in public health, Greene shows us that opportunities for residents to learn at their literacy level and be active stakeholders in bringing about changes in their environment must be present.
https://www.apha.org
“It’s not hard to find leaders, it’s a matter of giving them environmental health information. It’s great when you share it, and then they run with it,” Greene says. “In communities highly impacted by environmental justice, say, or environmental health, I mean, there’s a leader on every block.” With passion and care Greene is finding them, and that is making all the difference.
Feature image: https://cssr.gmu.edu/cssr-capabilities/community-based-participatory-research