This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

An innovative initiative is chipping away at health disparities in Detroit’s Hope Village neighborhood by looking to community members as leaders and learners in their own lives. The Citizenship for Health initiative is a collaboration among Wayne State University’s (WSU) Center for the Study of Citizenship, Department of Communication, and Integrative Biosciences Center (iBio), along with Hope Village Revitalization Community Development Corporation.

Despite increased attention to racial health disparities and increased activity to address them, disparities continue to be a significant problem in Detroit and across Michigan. While community engagement efforts addressing health disparities have achieved some successes, those efforts tend to prioritize researchers' interests and rely on community-based organizations rather than directly involving citizens themselves. 

Health disparities in Detroit communities involve health conditions such as diabetes, obesity, heart disease, hypertension, and pulmonary diseases, as well as infant and maternal mortality. Citizenship for Health organizers hope that engaging citizens in their own health issues through democratic deliberation will empower them to confront these health problems and their own health trajectories, come up with their own solutions, and decrease disparities community-wide.
Citizen action team members in the Citizenship for Health program discuss their mission and vision for community issues they want to take action on.
"The solutions that the community members are coming up with are small, they're visible, and have a high degree of likelihood of success," says Dr. Pradeep Sopory, a WSU professor conducting research on health, risk, and science communication. "They're not terribly innovative. They're not dramatic. But because they are generated by the community, they are integrated into daily living a lot more easily. And they have a greater likelihood of continuing after the end of the project."

According to the Citizenship for Health website, Detroit’s residents are "commonly disengaged from deliberative practices with their neighbors because of personal, family and community hardships, many of which are directly related to the socio-economic troubles of Detroit over the last six decades. Those hardships have eroded social capital among other assets and in turn, many citizens have lost the habit and support for civic engagement."

In preparation for the Citizenship for Health project, Parada Jordan, director of community engagement for iBio; and Amy Bloom, an independent consultant for the WSU Center for the Study of Citizenship, spent a year in training with the Kettering Foundation's Everyday Democracy program. In turn, they trained six community members who are leading their neighbors in naming, framing, deliberating, and acting upon the health disparities that are taking a toll within their community.

"They were trained in a very formal way by Wayne State folks," Sopory says. "As these six leaders went out into the community to do their deliberation sessions with community members, they would come and get feedback from our trainers."

On location in Hope Village

In 2016, the collaborating partners launched Citizenship for Health in Hope Village. The 100-block neighborhood is located between Dexter Avenue, Hamilton Avenue, the Lodge Service Drive, and the Conrail railroad corridor. The six citizen leaders surveyed residents to find out what they thought were the top issues impacting their health. Together, they deliberated on which issue they wanted to take action on. 

They decided that getting the word out and connecting residents was an important first step toward sharing opportunities for residents to increase physical activity and eat healthier foods. That led to a new page on Hope Village Revitalization’s website and two different social media platforms: HopeVillage 360 on Facebook, and hopevillage360 on Instagram. Then, with funding from the Michigan Health Endowment Fund, the community members became deliberation group leaders. 
Stephanie Johnson-Cobb.
"They work together in groups to develop action plans to address ways to improve nutrition and physical activity," says Stephanie Johnson-Cobb, Hope Village Revitalization deputy director. "The social capital and community building around that became very important."

As an example, Johnson-Cobb shares how one group of citizens — residents of a Hope Village apartment building for older adults — first got neighbors talking to each other and then helped them connect through fitness activities led by a personal trainer from the community. In addition, a community health worker takes groups on wellness walks. They also enlisted Henry Ford Health to provide cooking classes. The ultimate goal is for the community members to develop strategies and practices that support them in making better food choices and enjoying safe, comfortable, and inviting options for physical activity.

"In the conversations around nutrition, we have discovered that the community is not necessarily an empty glass. Many of them are knowledgeable," Johnson-Cobb says. "We find people sharing, ‘Well, I tried this recipe, and it was very good.’ Many of them have lost a couple of inches and a few pounds. Their data shows that they're either making progress or maintaining."
A Citizenship for Health event participant shows off exercise equipment she won.
Success stories include not just weight loss but also improved mobility. One older woman with chronic shoulder issues has recovered range of motion and use of her arm.

"This has been a game changer in many ways," Johnson-Cobb says. "I'd say we've probably engaged about 70 to 75 people total. And in the groups that meet regularly, about 30 people have continued to meet at least once a week or sometimes twice a week."

"Community members have expertise about their own lives"

The community members involved in Citizenship for Health include younger adults, middle-aged adults, and older adults, with older adults having the most involvement. Dr. Marc Kruman, director of WSU’s Center for the Study of Citizenship, notes that as more neighborhood residents hear about the initiative, more are joining in activities.

"There is significant participation in the cooking demonstrations," he says. "The focus of these participants has been on learning about and then executing that healthy eating."

Participants of one deliberation group suggested recruiting two young Black male chefs known to the community to lead some of the demonstrations.

"They saw this as both an avenue to healthy eating and a benefit of striking at the stereotypes in the community about young Black males," Kruman says. "Another one of the deliberation groups developed different kinds of fitness classes. They've been able to bring in fitness instructors and developed a chair yoga group."

Citizenship for Health organizers believe the program will not only directly impact the health of the citizens involved but will also enhance other community-based endeavors by helping residents to build healthy habits, as well as habits around civic engagement, through the process of deliberative democracy.

"We’re engaging community members and asking them to identify the obstacles and to develop solutions to them. One of the keys here is we’re recognizing that community members have expertise about their own lives, their neighbors’ lives, and the life of the community itself," Kruman says. "It’s that reliance on their expertise that separates our work from the very many projects that engage in or embrace the idea of community engagement."

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Photos courtesy of Stephanie Johnson-Cobb.