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Moving Beyond Traditional Structures: Russian CLDP Graduates Use Community Mobilization Techniques to Bring Health to Their CitiesOriginally published in AIHA's Connections, June 2004.By Vira Illiash "A healthcare system alone is not able to improve a person's health because health is the result of much more than just medical care." This sentiment, expressed by Yulia Abrosimova, coordinator of the Russian Healthy Cities Network at the Scientific and Research Institute of Public Health and Healthcare Management, is the underlying philosophy behind the Healthy Communities concept, a programmatic approach endorsed by AIHA as the foundation for its Community Leadership Development Program (CLDP), sponsored by the Open World Leadership Center at the United States Library of Congress. Recognizing that health as a broad concept is a fundamental element of civil society and that today's youth will become tomorrow's leaders, the 2003 CLDP program agenda and exchanges focused on broadening the vision of what creates and sustains a "healthy community" for adolescents and young adults, particularly those at-risk.
In November and December 2003, some 57 healthcare professionals and community leaders representing schools, substance abuse programs, law enforcement, the media, and social services from 12 rural communities in three Russian oblasts—Sakhalin, Samara, and Tomsk—had the opportunity to learn more about the Healthy Communities approach to civic mobilization, as well as how some US communities are addressing issues related to at-risk adolescents. The program began with an orientation in Moscow, where principals of community mobilization and strategic planning—such as bringing citizens together to identify problems, set priorities, and develop an action plan—were discussed. Then, during a 7-day exchange hosted by citizens and families in selected US communities in Minnesota, Iowa, and Texas, participants were given the chance to observed first-hand how the community planning process works and how effective healthcare and social services programs targeting the lifestyles of young people interact with one another. During the exchanges, participants visited school-based programs that promote healthy lifestyle choices, substance abuse prevention and risk reduction programs, athletic events sponsored by schools and communities, and church and employment programs, all of which are working to provide comprehensive, accessible services to citizens—especially to adolescents who often lack both accurate information and the emotional support they need to make healthy lifestyle choices. The program concluded with two days in Washington, DC, where participants met with health policymakers at the US Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services and Congressional leaders, as well as developed action plans to address healthy lifestyles and the health-related needs of young people in their home communities. The projects identified by each community and the action plans they created were the result of what participants had seen on their trip, as well as the application of the Healthy Community mobilization approach to which they had been exposed. "The Healthy Communities method encourages the identifying and solving of local problems by involving different stakeholders at the community level," explains Abrosimova, who served as a trainer for CLDP follow-up meetings held this spring in Russia. Underscoring that empowering a wide variety of people and organizations plays a vital role in improving a community's health outcomes and well being, Abrosimova says that a community's health is directly dependent on its social, economic, and environmental conditions.
"This means that in order to improve health in our communities, we need to combine the efforts of government agencies, nonprofit and private organizations, and the public in the problem solving process. Only the coordinated and organized response of many community members can bring improvement," she explains. The progress of the projects first identified in Washington and initiated by the Russian leaders when they returned to their home communities was discussed at the follow-up meetings convened by AIHA in each participating oblast in February, March, and April 2004. At these highly interactive forums, 2003 CLDP graduates were not only able to share their achievements and experiences about implementing their projects, but also—building upon each others' experiences—reinforce the community mobilization skills and strategies they learned during the study tour. The meetings were also attended by 2002 CLDP alumni and US host partners whose expertise and experience added to the knowledge shared. In addition, CLDP graduates had the chance to meet representatives of the Russian Open World Network, who presented their Web site, which was created to encourage collaboration between the program participants and to promote the Network's civic society initiatives. Tomsk Communities Take First Steps on Road Where Health is Ultimate Destination Bakchar Strives to Improve Quality of Life in High-risk Groups
According to Guseva, a healthy community is achieved when every resident has the opportunity to experience a high quality of life. To address the problem of low-income and high-risk families, the Bakchar team created a working group consisting of social workers, educators, healthcare providers, and a lawyer. "We developed a database of at-risk families and implemented a social aid program that includes employment assistance as well as lodging for families whose living conditions are not acceptable," said Guseva adding that the Backchar Administration also allocated additional funds to pay the kindergarten fee for children from low-income or unemployed families. The program developed by the Backchar team also includes a media campaign aimed at changing the negative attitude of local people toward their unemployed or at-risk neighbors. "Using the media, we are working to raise the community's awareness about the needs of these families and jointly help them to overcome the difficulties associated with their lifestyles, as well as to dispel the stigma surrounding them, which contributes to their social isolation," Guseva explained. Successful Collaboration Across Communities Brings Public Health Center to Molchanovo According to Ivan Prudnikov, deputy head of the Regional Administration, "Cooperation among the different agencies was instrumental for addressing social and health issues at the local level." As an example of how this approach works, he explained that healthcare providers from the Molchanovo Regional Hospital work in concert with local schools to educate children about healthy choices, while organizations and individuals from the sports and cultural sectors help to organize health fairs and sports activities that involve all community members in health programs. In addition, he stressed the role of the militia in building a social support network to fight against drug and substance abuse.
The establishment of the Molchanovo Public Health Center (PHC) was cited by the group as one of their major achievements. According to Prudnikov, the Center, which serves as the coordinating mechanism to promote disease prevention and healthy lifestyle choices is a platform for assuring effective and sustainable program development in the region. Mikhail Chinyayev, head physician of the Molchanovo Regional Hospital, where the PHC is located, said that the Center's priorities are determined by the health problems prevalent among children and the elderly, such as hypertension, diabetes, bronchial asthma, scoliosis, and caries. He explained that all these health concerns are addressed through educational focus groups—an approach borrowed from the experience of the Svetly Public Health Center, which was opened within AIHA's Tomsk/Bemidji partnership and which now serves as a model site for the Molchanovo PHC. In fact, the replication was given as an example of how collaborative support can generate positive change and how relationships across communities become tools for transferring successful social technologies. Shegarka Community Leaders Look for Effective Solutions to Increase Public Involvement
First Deputy Head of the Shegarka Administration Anatoliy Sychev said that it was due to the efforts of the CLDP graduates that the region-wide Economic and Social Development Program adopted by the Municipal Council in 2004 to improve the quality of life of the local population also included a Healthy Communities component. According to Sychev, the healthy community development plan was widely discussed in the media and during meetings held with local citizens. These discussions revealed reluctance on the part of individuals to adhere to healthier lifestyle choices and, as he explained, "[it was at] this initial stage that we realized that we needed to change the attitude of the local population toward their health and that this could only be achieved through well-directed efforts carried out by all of us." Chernov said that as a result of this conclusion, he suggested an analysis of the healthcare needs of each population group within the community so that their specific concerns could be addressed. "Every information campaign should be aimed at a particular target population; only when it concerns environmental conditions, should the entire community be targeted," he said, also emphasizing the importance of getting feedback from community members. As a successful example of how this mechanism works, Chernov told participants about a long-term campaign conducted by the HIV/AIDS Center in cooperation with the Tomsk Polytechnic Institute to fight infectious disease and promote healthy lifestyle choices among students. According to Chernov, through a variety of different educational events including round-table discussions, conferences, workshops, counseling sessions, and articles published in a student newspaper, the group was able to "increase the responsibility of young people toward their lifestyle choices." As proof, Chernov quoted an article that appeared in the student paper written by a group of freshmen as a passionate appeal to their peers to lead a healthy life. Students in the article said that "Young people should recognize the value of health and quit the harmful habits that ruin their bodies. At the same time, alcohol and tobacco advertising should be strictly prohibited." "It took us eight years to get these results," said Chernov, encouraging his colleagues to arm themselves with patience and persistence. Parabel Votes for Sports Promotion as Tool for Improving Health
Having learned that public health statistics show that female adolescents involved in sporting activities have improved self esteem and much lower pregnancy rates and that for both genders physical activities decrease experimentation with and the use of drugs and alcohol, as well as decrease the isolation that can lead to other risky behaviors, the Parabel team decided to focus on getting adolescents involved in such programs. A survey asking "What kind of sports do you like?" conducted in Parabel secondary schools by a multidisciplinary team of CLDP graduates showed that local children favored skiing and hockey. According to Vladimir Denezhko, deputy head of the Parabel Regional Administration, regional authorities combined their efforts with sports and educational institutions to build two skating rinks to meet the needs of children, as well as convinced the local administration to budget in expenses for construction of a ski lodge for the next year. "We are also planning to attract parents of schoolchildren to sports activities because a family approach will be more effective in promoting healthy lifestyles among community members," he said.
On March 23-24, the second CLDP graduate meeting was held for 24 delegates from the communities of Chapaevsk, Kinel-Cherkassi, Krasny Yar, and Stavropol, all located in the Samara Oblast. As with the previous meeting, each group reported on their achievements to date, shared lessons learned about community mobilization strategies, and discussed plans for the future. A media game show designed to build on the ability of the participants to deliver an effective healthy lifestyle message to their communities was also part of the program. Each of the Samara Oblast groups spoke about actions taken to identify specific health needs and adolescent health problems in their communities. To evaluate the extent of tobacco use among teenagers, the group from the city of Chapaevsk conducted an assessment survey in three local schools. As was reported by Irina Kelchina, a teacher at Chapaevsk boarding school #1, the results of the survey were more dire than even the most pessimistic expectations. The survey showed that more than 55 percent of boys and approximately 48 percent of girls smoked regularly, with an additional 20 percent of male and 10 percent of female students admitting to occasional smoking. In an attempt to make their anti-tobacco message loud and clear, the group from Chapaevsk launched a broad-scale campaign. As a starting point, they convinced the City Administration to provide funding for a two-year program aimed at decreasing the number of smokers among teenagers. The program will focus on training peer educators to promote healthy lifestyle choices, organizing races and health fairs that promote smoking cessation, and writing articles for the three local newspapers to raise the awareness of parents and local authorities about the problem, as well as to educate the public in general, regarding the adverse effects of tobacco.
The CLDP groups from Krasny Yar and Kinel-Cherkassi also shared concerns about the large number of adolescent smokers in their communities. Evgeniy Butinov, director of the Krasny Yar Sport and Fitness Center, said that the problem proved much bigger than they initially thought. In many instances parents would give their children money to buy cigarettes to deter them from stealing cigarettes from individuals or grocery stores. To help fight this, the CLDP graduates from Krasny Yar initiated a one-year project that, apart from running anti-smoking information campaigns, offers a marathon, a mini-football tournament, and other sporting events as means of improving health in the adolescent population. The name of the program developed by the community leaders from Kinel-Cherkassi is "Creating Healthy Lifestyles for Teenagers." It takes advantage of the youngsters' fascination with computer games and introduces innovative Biofeedback technology to the school setting. Based on the interactive game format, this technology can pinpoint a broad spectrum of adolescent health problems including asthma, bronchitis, scoliosis, flat-footedness, and stress. A special device connected to certain parts of the human body transmits electrical signals from the muscles to a screen, thereby teaching young patients to associate their muscles with actual levels of tension and allows them to develop the healthier habit of keeping muscles only as tense as necessary, for as long as necessary. According to Yelena Zapolina, deputy head of Kinel-Cherkassi Rayon Hospital, this technology has proven effective in more than 500 regions in Russia and the CLDP graduates have established a coordination team that is now seeking resources to make the technology available to local schoolchildren.
Zapolina also indicated that since their return from the United States in December 2003, the CLDP participants have conducted a healthy lifestyle campaign through a series of sporting competitions in which local professional athletes participated. In addition, the group facilitated the establishment of two hot lines designed to communicate public concerns about security and safety to the local law enforcement authority. They also petitioned the regional Environmental Protection Department to address inappropriate garbage collection practices, poor quality drinking water, and other public and environmental health issues. The Stavropol group was represented by Vasily Sereda, head physician of the Regional Center of Sanitary and Epidemic Control. Explaining that his group is still initiating the first steps of the work plan, he underscored the role of the follow-up workshop, which according to him, "provides a unique opportunity to learn from the experiences of others and will enable us to develop a more detailed action plan to initiate effective programs." Sakhalin Oblast Leaders Reinforce Their Community Mobilization Skills and Identify Further Directions During discussions, interactive sessions, and presentations, the CLDP graduates had the chance to share their progress and reinforce their skills in multidisciplinary teamwork, strategic planning, and methods of community involvement. Most of the 2003 CLDP project participants spoke about the administrative challenges associated with the planning of community-wide environmental protection, social welfare, and healthcare initiatives, while Nadezhda Prikhod'ko, deputy head at the Nogliki Regional Administration, a 2002 CLDP graduate, and guest speaker, shared information about the successful health promotion and community mobilization projects she and member of her CLDP team put into place in the Nogliki region. Talking about health programs initiated in her community, Prikhod'ko stressed the values and influence children derive from their families. "Taking into account that only a healthy family is able to raise a healthy member of society, we decided to support family-oriented projects," she explained. To achieve this goal, the group developed educational programs focused on men's and women's health to train both children and their parents about safe and healthy lifestyle choices. They also established a school for young families, which includes parenting education. As a result, they reported a six-fold decrease in the number of terminated pregnancies over the last year.
Speaking about the community mobilization process, Prikhod'ko told the story of a local youth organization that worked to resist the decision of the Oblast Administration to establish a new local dump. She saw this action of public protest by a group established with the support of CLDP graduates not only a success in environmental protection, but also as an important lesson in how each community member shares responsibility in the building of civil society. Speaking about the April meeting, Victor Makarov, vice-mayor of the Poronaisk Region, said that "the workshop provided enough evidence that community mobilization fosters stronger relationships between local governments, different social sectors, and community members, as well as increases the participatory decision-making processes, expands the role of marginalized populations such as adolescents and the elderly, and helps maximize the use of local resources for the public good." He said that his participation in the CLDP program gave him the opportunity "to observe the value of raising a community's interest in improving their level of life and the necessary knowledge that enabled [him] to alter administrative approaches to encourage these changes." Commenting on the results of all three follow-up meetings, facilitator Abrosimova emphasized that each project defines different objectives and activities, but all have the same critical goal of creating a healthier community, which "makes a sizable and valuable contribution to providing platforms for a safe and better future." — Vira Illiash is AIHA's Staff Writer based in Kiev, Ukraine. |
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