Progress Elementary School student Maleik Owens, 11, visits Our Lady of the Lake Children's Hospital mobile health clinic. The medical clinic and a mobile mental health clinic treat students at his Baton Rouge, La., school weekly as part of the Mayor's Healthy City Initiative.
BATON ROUGE, La. — On board two gleaming mobile clinics — known by locals as the "blue buses" — fifth grader Maleik Owens got linked to support he needed. Care providers on one, a mobile health clinic, gave him a checkup and connected him with a doctor to treat his asthma. Staff on the other, a mobile behavioral health clinic that also parks right outside his Progress Elementary School for visits, taught him how to better control his emotions inside his classroom or at home.
With his asthma better managed, he less often feels like he can't breathe. With his new strategies for remaining calm, he's able to better regulate his own behavior. "If I have problems, I can count to 10, take a deep breath, go to a corner, calm down," he said.
The regular visits by these mobile clinics to Baton Rouge-area zip codes identified as being most in need of health services are just one element of a much larger effort to improve the health of the Baton Rouge population. In this Mississippi Delta city, the mayor is leading a wide coalition of community organizations including Our Lady of the Lake Regional Medical Center, as the organizations assess community health needs, identify priorities and put new programs and services into place to support better health throughout the region.
While the Affordable Care Act requires tax-exempt hospitals to work collaboratively to assess health needs and set action priorities, efforts to improve community health in Baton Rouge have drawn outside notice for the mayor's involvement in bringing organizations together to identify by zip code areas of the greatest unmet health needs, prioritize community health needs and implement strategies to reduce health disparities.
Mayoral initiative
Baton Rouge's Mayor-President Melvin L. "Kip" Holden, points to a number of experiences that prompted his commitment to work in support of a healthier city. As a boy, asthma attacks kept him out of school for days at a time. He also saw the toll chronic health problems took on the well-being of several of his family members.
Holden has been interested in the impact of public policy on public health for years. He highlighted poverty and obesity as areas to focus on while serving as chair of the National League of Cities Council on Youth, Education and Families. As mayor of Baton Rouge, he mobilized the community through a Mayor's Healthy City Initiative, tapping Coletta Barrett, Our Lady of the Lake's vice president of mission, to serve as its leader. Our Lady of the Lake Regional Medical Center, a Catholic hospital that is part of the Franciscan Missionaries of Our Lady Health System, provides health care to Baton Rouge and 11 geographic parishes in south Louisiana.
A task force for the Mayor's Healthy City Initiative began meeting in 2007, and the initiative launched the following year. Representatives from dozens of organizations, from the public schools, to businesses, to social service organizations, got involved.
The initiative includes HealthyBR, efforts focused on healthier eating and a more active lifestyle; MedBR, focused on improving access to care and health outcomes; and the Innovation Center, which is using evidence-based research to assess and improve the healthy city initiative.
Setting priorities
During 2010 and 2011, representatives from Our Lady of the Lake and four other hospitals and the Louisiana Hospital Association jointly analyzed community health data from the County Health Rankings, the Community Healthy Living Index and a variety of other sources. Each hospital's representative conducted one-on-one interviews and roundtable discussions with clinical staff to gauge needs and resources. A total of 40 area organizations approved a list of 10 Baton Rouge health priorities for the community health needs assessment.
From there, the Mayor's Healthy City Initiative prioritized the top four health concerns in the region as obesity, HIV/AIDS, overutilization of emergency departments and a lack of mental and behavioral health resources. Representatives from area organizations met to map existing services and identify gaps. They have since set priorities in each area, and they outline the goals they've reached in an annual report to the community.
Forging community connections
Signs of the efforts are apparent around the Baton Rouge region, from shiny new playground equipment at elementary schools, to a new farmer's market outside a Baptist church, from freshly striped bicycle lanes to the mobile clinics that provide both medical and behavioral health care to select schools. Other initiatives aren't as visible, but are far-reaching, like collaboration be–tween hospitals throughout the region to expand HIV testing.
Barrett said of the approach, "It becomes part of the fabric of the community. You identify the people with the most at stake, (then identify) those who have the resources, then you get out of the way and let them do it."
The HealthyBR group and the MedBR group each meet bimonthly for an hour. Each has a lead person who reports to the Mayor's Healthy City Initiative board of directors on progress or barriers to the work they've set out in three-year action plans. The groups share available resources, collaborate on initiatives and plan joint events.
"We have not thrown a lot of money at this. We have no money to throw," Barrett said. There's no running tab on the initiative, and no specific data to definitively prove the city is becoming a "healthy" one, though area health and hospital officials monitor regional indexes for signs of improvement in population health. Leaders have set goals for improvement, and participants draw on information from the health assessment to pursue grants and donations to fund programs and equipment that support those goals. For instance, Our Lady of the Lake Children's Hospital and the Children's Health Fund, a national organization that provides mobile medical clinics to children most in need, have partnered to bring the mobile clinics to students in six East Baton Rouge Parish Public Schools. They're staffed with doctors, nurses and therapists from the children's hospital.
Playgrounds and produce
The Blue Cross and Blue Shield of Louisiana Foundation awarded a $1 million grant for The Fresh Beginnings Project. The money supports a mobile farmer's market in zip codes identified as the city's largest food deserts. It will help fund the renovation of four corner stores so that owners can provide fresh produce and more healthy meal options. It paid for the Project Fit America program in four schools. The program has brought new physical education equipment and additional training on the program's curriculum. The schools have added more physical fitness time to the school day.
In the Scotlandville neighborhood, dotted with homes in disrepair, some with boarded-over windows, children shimmy up and across new playground equipment at Ryan Elementary School, recognized in recent years with distinction as a National Blue Ribbon School. Inside, charts track students' progress on fitness challenges. Physical education teacher Pam Downing said training and a new curriculum to promote activity have been well-received by students. "They'll come in and say: ‘Are we going to do a challenge today?'" Without the grant, "we never could have afforded equipment like this," she said.
HIV epidemic
HIV/AIDS is a priority in Baton Rouge because the city's rate of new HIV infection is among the highest in the country.
Barrett said that more work will be done this year to make HIV testing an "opt-out" service in Baton Rouge health care settings, rather than an "opt-in" test. She explained that sometimes patients won't ask for an HIV test, fearing that in asking for the test they're acknowledging risky behavior that may have resulted in HIV transmission. By routinely offering the test to patients as part of a health care screening, health officials expect more patients to get tested. This may lead to more people being diagnosed and started on antiretroviral therapy, which can reduce the viral load to undetectable levels — a therapeutic status that research has shown to lower the risk of HIV transmission.
Dawn Beasley, nurse manager at the LSU Health Baton Rouge MidCity Clinic, is part of a Mayor's Healthy City Initiative effort to raise awareness about HIV/AIDS and how to prevent its spread, to reduce stigma and to step up testing in the region.
Beasley said that people who know they have HIV or AIDS often take steps to reduce the risk of transmitting the infection. Research shows diagnosing HIV-positive people earlier in their illness and starting them immediately on antiretroviral treatment leads to better outcomes. Barrett said that as with many health issues in the region, when it comes to fighting HIV/AIDS, no one provider can go it alone. " We have to do it together," she said.
Snapshot of Baton Rouge
East Baton Rouge Parish, where the city of Baton Rouge is located, is Louisiana's largest parish with more than 430,000 residents. It's 51 percent White, 44 percent African-American, 3.7 percent Hispanic and 2 percent Asian.
The parish's median household income is about $46,500. Of the adult population in East Baton Rouge Parish, 20 percent use tobacco products, 30 percent are obese and 16 percent drink alcohol in excess.
The city of Baton Rouge is ranked first or second in the nation for its rate of new HIV/AIDS cases among metropolitan regions, according to the Centers for Disease Control and Prevention.
Source: 2012 Community Health Needs Assessment provided by Our Lady of the Lake Regional Medical Center
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