Mobilizing for Healthy Communities

"Never doubt for a moment that a small group of committed citizens can change the world. Indeed, they are the only thing that ever has." This quote by American anthropologist Margaret Mead began a video by the Missouri Department of Health introducing AIHA's healthy communities programs in Slovakia to participants the conference.

Mead's words encapsulate the spirit of spurring community change, in which the Petrzalka district of Bratislava is working to prevent drug abuse, HIV and behavioral problems in children, and the town of Turcianske Teplice has embarked on healthy lifestyles and environmental projects.

Although Slovakia, like other countries of CEE, lags behind western Europe in life expectancy, rates are rising, said Tom Tronovec, PhD, director of the Institute of Preventive and Clinical Medicine in Bratislava. Between 1989 and 1993, life expectancy for males rose 1.5 years, due in part to changes in dietary habits, such as consuming more fruit and less animal fat.

The healthy communities projects hope to build on that positive change. Conference presentations highlighted accomplishments since the programs began last fall.

In Petrzalka, the Aid to Children at Risk Foundation has started a telephone hotline for children; drug abuse education for teachers, children and parents; a treatment center for children with behavioral problems; a support group for mothers of troubled children; and a summer camp for children with learning and social problems. Future plans include concerts by young people for older members of the community, a sports center, a local television program and partnerships with local churches. Petrzalka is paired with the Truman Medical Center in Kansas City, Missouri.

"A nine-year-old boy at a presentation said to us, 'We can tear down Petrzalka, but it's up to us to build up life around Petrzalka as well,'" Jana Sturova, president of the foundation, said of the growing community involvement in trying to improve conditions in the run-down public housing that makes up a large part of Petrzalka.

In Turcianske Teplice, the town government has been the catalyst for such activities as health walks, town cleanup days and anti-smoking campaigns. Currently, partners from Cleveland MetroHealth System are helping plan for a town emergency medical services program, including the purchase of an ambulance; development of a stress survey for residents; and a health education center inspired by a trip Slovak partners took to the Cleveland Health Education Museum last winter.

The Turcianske Teplice environmental budget has doubled in size and the town's unemployment rate is down to 3.5 percent, compared with a national average of 13.5 percent, said Mayor Alena Chlapikova.

As in Petrzalka, the project has a special focus on children. "Children are our most vulnerable citizens, but also the most perceptive," Chlapikova said. "Therefore, if we really want to improve things we have to influence children," she said of her interest in setting up the health education center, which would start teaching children at an early age about nutrition, healthy lifestyles and how their bodies work.

At a workshop on community assessment, American partners presented models for drawing community members into evaluating their own neighborhoods and determining local priorities. Although the process can be daunting, there are steps to help citizens stay involved and focused, said George Weiner, PhD, director of planning and institutional research at the MetroHealth System, who is embarking on an assessment of both the greater Cleveland population of 2.8 million and of Turcianske Teplice and surrounding towns, with a population of only about 10,000.

One tool for presenting what can be an overwhelming amount of data is known as the dashboard measure, which like on the dashboard of a car, gives a snapshot of the most important findings and what needs attention. In addition, it is important for communities to find an early success to highlight to keep residents motivated during a sometimes long, laborious process, Weiner said.

Weiner's model for assessment calls on institutions to do the bulk of the work with citizen input. Another model, used by the Missouri Department of Health and the Aid to Children at Risk Foundation, draws primarily on the community to shape the assessment and then analyze the data.

"What we end up with is a plan that is defined by the community," said Dan Mueller, PhD, project director of the Community Health Assessment Resource Team for the Missouri Department of Health. "It proves the adage that if you teach people to fish they will eat for a lifetime, but that if you give them fish they will eat only for a day."

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