Janni Sorensen

A trans-disciplinary approach to the evaluation of social determinants of health in a hispanic population

BackgroundIndividual and community health are adversely impacted by disparities in health outcomes among disadvantaged and vulnerable populations. Understanding the underlying causes for variations in health outcomes is an essential step towards developing effective interventions to ameliorate inequalities and subsequently improve overall community health. Working at the neighborhood scale, this study examines multiple social determinates that can cause health disparities including low neighborhood wealth, weak social networks, inadequate public infrastructure, the presence of hazardous materials in or near a neighborhood, and the lack of access to primary care services. The goal of this research is to develop innovative and replicable strategies to improve community health in disadvantaged communities such as newly arrived Hispanic immigrants.Methods/designThis project is taking place within a primary care practice-based research network (PBRN) using key principles of community-based participatory research (CBPR). Associations between social determinants and rates of hospitalizations, emergency department (ED) use, and ED use for primary care treatable or preventable conditions are being examined. Geospatial models are in development using both hospital and community level data to identify local areas where interventions to improve disparities would have the greatest impact. The developed associations between social determinants and health outcomes as well as the geospatial models will be validated using community surveys and qualitative methods. A rapidly growing and underserved Hispanic immigrant population will be the target of an intervention informed by the research process to impact utilization of primary care services and designed, deployed, and evaluated using the geospatial tools and qualitative research findings. The purpose of this intervention will be to reduce health disparities by improving access to, and utilization of, primary care and preventative services.DiscussionThe results of this study will demonstrate the importance of several novel approaches to ameliorating health disparities, including the use of CBPR, the effectiveness of community-based interventions to influence health outcomes by leveraging social networks, and the importance of primary care access in ameliorating health disparities.

Evolution in partnership: Lessons from the East St Louis Action Research Project

As one of the oldest community–university partnership programs in the United States, the University of Illinois’s East St Louis Action Research Project (ESLARP) has evolved in an ongoing effort to balance stakeholders’ needs, broadly defined to include community partners as well as the university and its involved faculty, students, and staff. While ESLARP’s mission has remained consistent – briefly stated ‘matching needs and opportunities in the community with resources and opportunities on campus for teaching, research and service for social justice’ – what constitutes action research within this partnership has been broadly framed and has evolved due to circumstances on campus and in the community. Based on analysis of projects over the 23-year period and the personal reflections of two participants, this article seeks to reflect on the evolution through what we see as three phases – Neighborhoods First, Technical Assistance, and Engaged Research – in order to gain insights into the negotiations required to sustain a university–community partnership program. Refraining from judgment as to what model might be better, we reflect on the change in five core area: community organizing, direct assistance, popular education, mode of research, and the university’s core teaching mission. We acknowledge the different but important contributions of each phase.

Por nuestros ojos: understanding social determinants of health through the eyes of youth

Background: Understanding the social determinants underlying health disparities benefits from a mixed-methods, participatory research approach. Objectives: Photovoice was used in a research project seeking to identify and validate existing data and models used to address socio-spatial determinants of health in at-risk neighborhoods. Methods: High-risk neighborhoods were identified using geospatial models of pre-identified social determinants of health. Students living within these neighborhoods were trained in Photovoice, and asked to take pictures of elements that influence their neighborhood’s health and to create narratives explaining the photographs. Results: Students took 300 photographs showing elements that they perceived affected community health. Negative factors included poor pedestrian access, inadequate property maintenance, pollution, and evidence of gangs, criminal activity, and vagrancy. Positive features included public service infrastructure and outdoor recreation. Photovoice data confirmed and contextualized the geospatial models while building community awareness and capacity. Conclusions: Photovoice can be a useful research tool for building community capacity and validating quantitative data describing social determinants of health.

Challenges of building community-university partnerships in new poverty landscapes

Abstract This article reflects on six years of community–university partnerships (CUPs) between the Charlotte Action Research Project (CHARP), grassroots organizations, and residents of economically challenged neighborhoods in Charlotte, NC. We share lessons learned in participatory planning and community development by comparing experiences in older, urban neighborhoods with those in suburban, “new poverty landscapes.” We highlight neighborhood typology, residents’ choices to leave, place attachment, and sociospatial and geographic context as defining factors within CUPs. A grounded framework for evaluating CUPs is introduced, and a synthesis of interviews and CHARP archives provide insight into what to do best, and in what conditions, in partnership efforts. We conclude that community-based research should always start by listening and that sometimes moving to action research makes sense, while at other times an advocacy research route is more appropriate. We assert that the most challenged neighborhoods, despite a lack of capacity and readiness, must not be avoided.

Upscaling Action Research and implications for community organizing practice

Case studies are an effective vehicle for telling important stories that may have broader implications, but how is the research study made relevant, or generalizable, to other places or events? This paper discusses the upscaling of Action Research where Action Research was the starting point at the local level that led to additional layers with larger, regional scale implications. The story behind the development process and resulting built form of Windy Ridge, a relatively new subdivision in Charlotte, North Carolina dubbed a “Neighborhood Built to Fail,” presents a compelling story. We trace the development of knowledge around three topics originating in Action Research and how we scaled those topics up to have policy implications: (1) owner occupancy and absentee landlords; (2) stability, instability, and neighborhood resiliency; and (3) zoning changes and environmental justice issues. We reflect on implications for practitioners and academics based on several years of neighborhood partnership and how Action Research can reveal structural issues at work within communities. Action Research findings provided a research- and evidence-based platform from which to advocate for neighborhood change and the motivation for the extended research. This approach produced an expanding research model emanating from Action Research data and questions originating with residents.

Repackaged “urban renewal”: Issues of spatial equity and environmental justice in new construction, suburban neighborhoods, and urban islands of infill

ABSTRACT This study examines environmental justice issues; the tie between infill, sprawl, and inequity; and race and class discrimination as a hindrance to urban sustainability in newly constructed “starter home” neighborhoods in Charlotte, North Carolina, commonly called “cookie-cutter” development. Major findings include a discriminatory practice of locating neighborhoods meant for lower-income and workforce families adjacent to preexisting locally unwanted land uses (LULUs), including environmental hazards and other negative elements in the built environment such as industrial uses or heavy manufacturing, thus placing the most vulnerable populations at greater risk. We find that new construction surrounding the Interstate 485 loop spurred economic development in exurban areas but syphoned it from older inner-ring areas and that the worst location for new starter home neighborhoods is within predominantly low-income urban neighborhoods already challenged on a number of fronts. Rather than acting as a catalyst for positive change, the opposite occurred, and the surrounding problems, instability, and disinvestment spread into the new areas. In such situations, starter homes embody repackaged urban renewal as a new model: islands of suburban-style infill surrounded by decline.

Integrating popular education into a model of empowerment planning

Abstract This research introduces popular education into a neighborhood planning process in a low-income community in Charlotte, NC. Residents and members of a community–university partnership participated in a two-day workshop at the Highlander Education and Research Center in Tennessee and engaged in popular education exercises there to explore neighborhood issues through a lens of structural inequality. Data include interviews, participant observations, and a focus group. This research adds to the literature on empowerment planning – an approach to urban planning that integrates popular education, participatory action research, and community organizing to increase local control of planning and community development efforts.

The effectiveness of Habitat for Humanity as a neighborhood stabilization program: The case of Charlotte, North Carolina

Abstract Habitat for Humanity has been in operation since 1976 as a popular organization that provides housing to low-income families. In more recent years, the organization has gradually shifted its priorities toward becoming a more holistic neighborhood stabilization program, receiving a large amount of federal funding to help stabilize neighborhoods in the wake of the Great Recession. Very limited research has been done to assess the effectiveness of Habitat construction on neighborhood outcomes. This article provides a quantitative assessment of housing price values in Charlotte, North Carolina in neighborhoods that underwent a greater than average amount of Habitat construction compared to a set of similar neighborhoods with no Habitat activity. Using an adjusted interrupted time series model, we find little evidence that Habitat had a substantive impact on housing values compared to control neighborhoods.

No more waiting for Superman: teaching DIY urbanism and reflexive practice

Self-made urbanity is not a new phenomenon. However, decades of economic restructuring and a neoliberalization of the city and state have made the public realm vulnerable to changes in the economic winds. Increasingly, such an environment poses limits to what can be done via formal planning and urban design processes while do-it-yourself (DIY) activities challenge basic assumptions of who and how spaces may be produced. We (the authors) have recognized this challenge and have worked to bring this awareness into our classroom. Through this paper, we illustrate how DIY approaches have been integrated into our interdisciplinary course, the Community Planning Workshop. We describe how the classroom environment can foster an appreciation for DIY approaches, how DIY practices bring the social and the physical into focus, and how grassroots’ strategies have transformational impacts upon students and their understanding of the roles of design and planning professions.