Mississippi Roadmap to Health Equity is committed to local engagement and the power of institutional partnerships to identify and address the barriers that foster poor health in the state. Initially, the nonprofit focused on expanding opportunities for healthy eating and physical activity, but over time it has steadily broadened its agenda to incorporate youth-focused employment and leadership training.
Recognizing overlapping priorities, the state health department has become a willing listener and strategist at Mississippi Roadmap convenings, and strong ties have been forged as a result. In 2017, the health department and a local health system teamed with Roadmap to transform breastfeeding culture in the state.
A Community-Identified Agenda
Mississippi has some of the nation’s poorest health indicators, according to America’s Health Rankings. By almost every ranking – of obesity and high school graduation rates, incidence of diabetes and infant mortality, access to dental care and preventable hospitalizations, occupational fatalities and the number of children living in poverty – the data are grim. And when the numbers are broken down by race, even greater disparities emerge.
In 2003, a team of researchers from Jackson State University and the University of North Carolina at Chapel Hill, supported by the Kellogg Foundation, came to the capital city of Jackson to begin a series of conversations about health disparities in the region. Beneta Burt, then president and chief executive officer of the Urban League of Greater Jackson, helped to guide the dialogue, pushing to have local voices fully integrated into the search for solutions.
“As a community, we decided that we needed to understand every nuance of community-based participatory research,” said Burt. Too often, she added, “our academician friends come to the community, get a sign-in sheet, bring in a little food and call it engagement. Then they go back and you never hear anything from this process again.”
“Letting the community talk about what it really needs helps us develop the right interventions,” advised Burt, acknowledging that also means moving more slowly. “Community members aren’t shy about telling you what the needs are, but you have to go at their pace.”
To learn how local residents perceived their challenges, the research team asked them to respond to this statement: “A specific thing that causes African Americans to get sicker and die sooner is….” Using a process called “concept mapping,” the researchers then categorized the answers; economic factors, contextual factors, and stress emerged as the most important contributors (findings were published in Ethnicity & Disease, 2008).
A community steering committee formed to build on that information-gathering step and laid out a “roadmap” for improving health outcomes. The Jackson Roadmap to Health Equity was born, with Burt as its leader; it has since been renamed to highlight statewide goals.
Public health professionals were in the room for the early planning meetings, but they weren’t in charge. “I said, ‘drop your PhD and all your other degrees before you enter the building, you can pick them up on the way out,’” explained Burt. “The community needs to feel comfortable. People need to know there is an even playing field when we are talking about issues that affect them.”
“The guiding principle is that community matters, and community together with academicians and public health folks can make a difference.” – Beneta Burt, Mississippi Roadmap to Health Equity
Growing the Interventions, Forging New Ties
In response to community insights, Roadmap concentrated initially on physical activity and nutrition. The decision to turn a shuttered grocery store into a free community fitness center, for example, came after residents commented, “I would love to exercise, but there are no parks in my neighborhood” and “I have to decide between having a gym membership or being able to provide something for my family.”
Local schools and health centers became willing Roadmap partners, searching together for both quick wins and long-term change. The fryers came out of the school cafeterias and were replaced by ovens, and a mobile farmer’s market began making the rounds of two senior citizen residences and a medical complex. Produce from school gardens and greenhouses replaced candy sales as a way to raise class funds and a longstanding relationship with one elementary school led to the development of a leadership training program for fourth and fifth-grade girls. Along the way, Beneta Burt joined the board of the Jackson Public School District, creating a further foundation for cross-cutting work.
As Roadmap was building out, the Mississippi State Department of Health was shifting its own thinking. Increasingly cognizant of the social determinants of health, state officials wanted to deepen their understanding of local issues and concerns.
“We were really trying to figure out how to change behaviors and how to engage folks,” explained Kathy Burk, LCSW, CPM, who directs the health department’s Office of Health Services. “What we had been doing was just not working. We really had to start looking at the social determinants of health and learn how to work with communities to change the climate.”
“It is not just coming in and saying ‘you are obese.’ It’s asking, ‘what do you see as major problems in your area and how do you plan to address them and what are some things we can do to help you?’” – Kathy Burk, Mississippi Department of Health
The health department reached out to other stakeholders to think together about new approaches to building health in Mississippi. One convening attracted some 150 representatives from government, health systems, and education. Ultimately, the health department selected four core priorities: building a Culture of Health, reducing chronic disease, promoting educational attainment, and lowering rates of infant mortality.
As health officials began listening more closely to the people it served, closer ties with the Roadmap project evolved naturally. Beneta Burt was a powerhouse speaker at the department’s bi-annual conference series, Empowering Communities for a Healthy Mississippi, and the partners worked together to attract a new grocery store into an underserved community and get the farmer’s market licensed to accept SNAP benefits.
Health department staff also began coming to the Roadmap office for meetings. Burt was impressed by that. “Usually the government people tell you to come to their space. When they come to us, they see a number of things they don’t normally think about it. It gives them a different sense of the part they can play.”
Breastfeeding and Beyond
With infant mortality high on its agenda, it made sense for the health department to seek opportunities to encourage more breastfeeding, a proven pathway to improved child and maternal health. Only 52 percent of mothers in Mississippi initiate breastfeeding at all, and fewer than one-quarter are still breastfeeding six months after a child’s birth, giving the states some of the lowest rates in the nation (Breastfeeding Report Card). Supportive public policies, workplace guidelines and hospitals designated as “baby-friendly” can all help promote breastfeeding, but little of that is available in the state.
The cross-sector ties already in place in Mississippi helped garner an award from the multi-funder initiative BuildHealth, which looks for community-based organizations, health departments, and hospital systems that can work together to meet upstream goals. Katy Burk reached out to Beneta Burt to suggest a joint proposal – with Roadmap serving as lead agency, as required by the terms of the grant – and then brought in the University of Mississippi Medical Center, which provided the required matching funds. Transforming Breastfeeding Culture in Mississippi was launched in 2017.
“It is a good marriage,” said Kathy Burk with satisfaction. Since the two-year grant began, the health department has helped Roadmap open a Baby Café, where nursing supplies are available, a lactation consultant is on-site to offer guidance, and peers can gather in a comfortable space to share experiences. Meanwhile, the University of Mississippi Medical Center is pursuing the Baby-Friendly Hospital designation.
Health department and Roadmap staff now meet monthly, not only to talk about expanding the breastfeeding effort – they are thinking about starting a Dad’s Café and promoting baby-friendly workplace policies – but also to consider other collaborative opportunities. It’s all part of a larger commitment to “see Mississippi move up from the bottom,” Burk emphasized. “Working with other sectors really is a must to continue to function. We have to work with our partners to change the whole climate.”
“We have recognized that we don’t have to be the ones in front, and we don’t have to be the lead. That’s what true partnerships are about.” – Kathy Burk, Mississippi State Department of Health