The People of Washington, DC’s Anacostia are Building a Culture of Health

The last time I was in Anacostia, Ward 8 of Washington, DC, was almost exactly 2 years ago (!) when I walked with Kait Roe (@Fuse_Kait) and Pierre Vigilance, MD (@PierreVigilance) (see: My #walkwithadoc and patient, exploring the determinants of health in Washington, DC Ward 8 | Ted Eytan, MD). Well actually, I was *near* Anacostia when I walked the future 11th Street bridge (@DCBridgePark) (Photo Friday: Walk With a Doc over a future, beautiful park over water, in Washington, DC, USA | Ted Eytan, MD).

On the ride back to much-less-obese Ward 2 in 2012, I remember asking Pierre about the determinants of the social determinants of health in Ward 8. If people didn’t want to die any earlier in Ward 8 than in Ward 2, how did they want to live? There was so much in the media about dog parks, bike lanes, and food deserts at the time, what was the answer?

It’s now 2 years later, and this time, I didn’t go to Anacostia to go see Anacostia, I was invited, along with my friend Lane (@tlanehudson), to meet Khadijah Tribble (@tribbleme), who is a person who lives in Anacostia. We chatted in the brand newish NURISH Anacostia (@NurishAnacostia) cafe, one of only 3 sit down restaurants in the Ward, one of which has a sign on the door that says, “Please have your shirts on.”

Khadijah used to be over 300 pounds. She’s now at 208 and she let us know that she’s working to create a culture of health in Anacostia, because when she looked for one, it wasn’t there.

“Culture of Health” were her exact words – she said she picked the phrase up from the Robert Wood Johnson Foundation’s newest initiative. Hey I know some people that know a little something about that @RWJF :).

The Maps

Thanks to the still awesome Community Commons platform (@CommunityCommon) I ran some maps of Washington, DC with data on food access, poverty, and high school education. Poverty plus high school education gives you a vulnerability index.

It doesn’t matter which map you look at, you can tell which parts of the city are most in need. The Northwest part of Washington, DC is the least obese, has the greatest income gradient, lowest poverty rate, highest educational attainment, highest access to healthy food. The Southeast part of the city, across the river, where Ward 8 is, the opposite:

The county level obesity data is not useful, as you can tell, and actually tends toward being harmful, because it implies that Washington, DC is in the top quartile of obesity status and that there isn’t a problem. I’ve explored this in a previous blog post – you have to look at sub-county level data (Do national numbers inaccurately represent Washington, DC’s obesity condition? what electronic and personal health records can do to help | Ted Eytan, MD). There is a problem. There are impressive disparities in this city.

I ran a comparison of San Francisco, CA on the food access data, which shows that even the less vulnerable parts of Washington, DC are more challenged in food access than in San Francisco.

The Walk

Khadijah took us on a walk down Martin Luther King, Jr. Ave SE, past “The other U Street” (Southeast, we inhabit U Street NW, which a generation ago was strikingly deprived itself). We passed the largest chair ever made (“The Big Chair”), rededicated as a sign of hope for this community in 2006. The convenience store that I visited in 2012 didn’t seem to be open this time.

I took photos. See if these images are the signs of a healthy community:

I was so lucky that I got to meet The Advoc8te (@TheAdvoc8te), fellow blog writer of the I’ve-been-following Congress Heights on the Rise Blog. She’s in the photo with myself and Khadijah. It was a cool moment for me 🙂 . I also got to meet Dr. Lisa Fitzpatrick (@askdrfitz), who’s currently enrolled at the Harvard Kennedy School mid-summer program.

The Culture (of Health)

Lisa and Khadijah are part of (founded?) The Community Wellness Collective (@comemovenlearn) which is based at the Anacostia Arts Center (@AnacostiaArts), where NURISH is also housed. So where I left Ward 8 2 years ago with a lot of questions, this time I left with a lot of ideas, that are not from me. Those are the best kinds of ideas.

As Khadijah explained, there isn’t yet a sense of “comfort” for women in the community who want to exercise. A lot of messaging (and the assumptions that go along with them) are not appropriate for this audience. Here’s a great example of that: How Low-Income Commuters View Cycling – CityLab. People don’t know how to use health services well, and they don’t know how to shop healthy within their immediate environment, based on what’s available. These add up to challenges that need to be solved at many different levels, because as the data shows, there are large disparities.

The Community Wellness Collective is working toward this, with exercise classes and food instruction. I hope to attend some of these, because all I know is that I don’t know about what’s needed.

Our Cities are Changing

The new Ward 8 7-11 looks a whole lot like this Ward 2 7-11 from 2012, and that’s a healthy thing View on Flickr.com

I just noticed this post on CHOTR: Congress Heights on the Rise: Anacostia welcomes it’s 1st national retailer to the neighborhood!, which is about the first 7-11 opening up in Ward 8. And guess what. The photographs of the Ward 8 7-11 show a similarity to the photographs I took of the Ward 2 7-11 in 2012, right down to the fresh fruits and vegetables..

She writes:

As we were exiting I noticed that several discount stores on Good Hope Rd had undertaken a little upgrade of their own. The shop directly across from 7-11 was sporting some freshly cleaned windows (possibly a first in the 6 years I’ve been in the neighborhood) and a newly organized window display. It seems consumers aren’t the only ones taking notice of the new kid on the block. 😉 Here is to hoping the upgrades continue.

I came to Anacostia for the same reason my generation came to health care – we are not satisfied with the status quo, we love the places that we live in, and we’re here to change everything. Yes, here is to hoping the upgrades continue, because, to quote community leader Ruby Corado (@CasaRubyDC):

Making Cycling in D.C. Less Black and White, Community Building, New Bottles and Old Wine

Advocates Try to Make Cycling in D.C. Less Black and White: DCist.

A photo montage of our journey. Click to enlarge

I was really delighted to see this article in DCist. It’s about Black Women Bike DC (@BWBDC), which has been around since 2011.

I/we didn’t know about Black Women Bike DC when we did our Walk With a Doc in Ward 8 – See:”Photo Friday: What a difference open data plus 5 miles makes in understanding people’s health choices: Capital Bikeshare” and Wards 6 and 5, which was stimuulated by what Kait Roe (@kaitbr) and I read about disparities in bike use in Washington, DC.

Veronica Davis founded Black Women Bike DC and was honored by the White House as a Champion for Change this year.

Since this is a blog about writing what I learn every day, I learned that

  • Open data can drive curiosity and change, but they can’t do the changing
  • Things are happening though – a good check on doing something new is to find out what’s already going on
  • As a friend of mine recently said to me about the work he’s doing, “It’s just community building 101, Ted”

So…from focusing on individual choices to looking at the environment that shape the choices. From apps as the answer to community building.

Which really brings me back to Susannah Fox’s (@susannahfox) recommendation to me that Diana Forsythe’s article “New Bottles, Old Wine: Hidden Cultural Assumptions in a Computerized Explanation System for Migraine Sufferers” be inscribed on cubicle walls. That was in 2008, before there really were mobile apps.

But it’s really the same stuff.

Photo Friday: What a difference open data plus 5 miles makes in understanding people’s health choices: Capital Bikeshare

This is similar treatment to a Photo Friday a few weeks ago (See: Photo Friday: What a difference 5 miles makes in the health choices people can make | Ted Eytan, MD), except it’s about the use of our bicycle sharing program ( @bikeshare ) rather than access to food. The similarity is that I went to both places to see for myself ( with another physician and a patient )

This situation, that there are far less bicycle trips emanating from the Ward 8 stations (Obesity rate: 42%) than the Ward 2 stations (Obesity rate: 13%), is apparent to many in the city, and has been vigorously and thoroughly discussed in local blogs (See my collection of links here). The links even include a thoughtfully produced master’s paper with a series of statistical regressions exploring the factors that cause the stations in Ward 8 (Obesity rate: 42%) to be used less.

One of the main reasons this conversation is happening is because of open government data – Capital Bikeshare is making trip data available to the public to download and analyze, which they are doing.

If you look at the images themselves, you could tell yourself that the environment looks different in some ways and not in others. When we were at the Anacostia station, we could get the sense that it doesn’t seem that there are whole lot of places to ride from this station, given a big freeway in the distance and a metro station right across the street. One thing we did not do is talk to the residents there. I think this comment from a Ward 8 resident on one of the several blog posts is very insightful:

I’m a resident of Anacostia. I also happen to Black. I don’t mind cold temperatures much and I have internet access at work and at home. I’m also an avid runner and camper so the stereotypes in the article and comments section largely do not apply to me. They’re offensive all the same but that’s beside the point. There are 3 Bikeshare stations relatively close to me. Anacostia Library, Anacostia Metro Station and 1 at the foot of the 11th Street Bridge Eastbound next to DCHA. The 2 stations (metro and DCHA)that make sense for me to use are both a considerable walk for me.

There’s a bus that’s used heavily runs right past my condo that takes me to Anacostia Metro in 5 minutes. From there, it’s a 10-15 minute train ride downtown.

If I were to abandon my car totally, Metro is the most convenient way to get around.

I love riding bikes but for longer, leisurely rides. From my reading up on Bikeshare, it’s set up to encourage short rides and not sight seeing trips.

Enough about me. Here are a few reason why I don’t think that DC Bikeshare has not been utilized as much in Wards 7 and 8.

– The passageways across the Anacostia River are not bicycle friendly. Maybe after the completion of the new local overpass at 11th street, there will be an uptick. – Wards 7 and 8 are light on places to shop, eat and run errands. If I were to ever use bikeshare, I’d almost exclusively bike across the river which goes back to issue 1 with the overpasses. – Crime. Riding through certain neighborhoods are flat out dangerous. The first thought that ran through my mind as I thought about whether to purchase a membership was whether someone might rob me and take the bike. Would I be liable? – Cost. When DC instituted the $.05 bag tax, there was a major outcry about its effects on residents here. A $75 start up cost is a dead ender. – Health. A lot of residents in my neighborhood just aren’t fit enough to ride a bike further than a couple of blocks. – Perception. Many people are of the belief that if you have a car, you should drive it… everywhere. Also, bike sharing and car sharing (I’m a Zipcar member)are for white people and “uppity” Black folks.

So what did I learn from going to see things up close?

I am not a transportation expert, and looking at one type of transportation modality as shaping health is a lot different than looking at the food available in the community, so this is a much more complicated discussion.

My feeling from my experience plus reading about the experiences of others is that Bikeshare is not a culprit here but diagnostic of greater environmental forces conspiring to make health less normal in this part of Washinington, DC. From that perspective, through the use of open data, I would consider bike trips one of many markers of the community’s health, rather than focusing on the lack of bikeshare usage as the problem. From the thoughtful master’s paper:

Based on the regression model in this report, low ridership at these stations is primarily explained by socioeconomic factors (namely age and race), low retail amenities and Metrorail stations, and substantial distance from the center of the bicycle sharing system. Although the District continues to reach out to underprivileged communities through marketing and expanded membership access,4 these results point to larger structural forces and spatial constraints to increasing Capital Bikeshare usage among marginalized groups. Most significant among these forces is extreme gentrification over the last 20 years that price low income, primarily African American communities, out of the central city.

Prior to Bikeshare (and social media), we didn’t have the kind of data to have these discussions. One of the tangible results of open data is that 2 doctors and a patient went to see the situation for themselves – data can stimulate action, and this data feels actionable.

Walk With a Doc – Washington, DC , August 10, 2012

The second Walk with a Doc community walk will be on August 10, 2012, leaving from the front of the Kaiser Permanente Center for Total Health (@kptotalhealth) in Washington, DC

Feel free to invite yourself by choosing from one of two social networks:

Walk With a Doc – Washington, DC – Facebook invitation for August 10, 2012

Walk With a Doc – Washington, DC – Google Plus invitation for August 10, 2012

Walk With a Doc is being piloted as a community engagement program between physicians, their patients, members of the community, and partner leaders.

The first walk with a doc happened in Ward 8 of Washington, DC. This one will begin in Ward 6 and Travel into Ward 5. We’ll discuss the health of the community and the people who live there.

This is the second Walk With a Doc event, so we are still in the prototyping phase, to learn how to make this successful.

I’m using Facebook, Google+ and my blog to see if which ways involving people works best. Feel free to sign-up either by adding your name to either of these invitations, or posting a comment on this blog post.

My #walkwithadoc and patient, exploring the determinants of health in Washington, DC Ward 8

So much beer. View on Flickr.com

What struck me most on reviewing my photographs (see below) was the amazing amount of beer in one store.

I took them on a walking tour of Ward 8, known as Anacostia, with another physician Pierre Vigilance, MD, MPH ( @PierreVigilance ) and a patient champion, Kait Roe ( @kaitbr ). Kait and I went because we were curious about the environment that supports an obesity rate of 42%, higher than the highest rate of any state (Mississippi, at 34.4%), and also happens to have a low usage rate of Washington’s bike sharing program, Capital Bikeshare (@bikeshare). You can read the blog post and the comments that got us here: Quantified Community: Visualizing the health and illness of Washington, DC through open data and art | Ted Eytan, MD.

We wanted to go because there’s only so much you can learn from Google and looking at data. We were fortunate that Pierre, who also has the distinction of having been the Director of the Department of Health for Washington, DC, saw my briefing information online and offered to come with us (you can view it here as well: Social Determinants of Health Tour Link Cloud – Ward 8 Washington,DC). In the end, he was way more than that to us : our chauffeur, guide, and discussant of what we saw. Pierre is currently a Visiting Professor for Practice at the George Washington University School of Public Health & Health Services.

We started on Martin Luther King Boulevard, where we stopped into a corner store that happens to be a partner in the Healthy Corners program. We found the Healthy Corner food, and talked with the manager, who has been managing this store for 28 years (!). He told us there is currently a beer price war as well as a tobacco price war in the area. There are further pressures on cigarette prices because some individuals are traveling to Virgina where taxes are lower and reselling cigarettes on the street. If you look at my photos, you can get a sense of what “beer price war” looks like. Beer. Everywhere. As well as just about any household good a person would want, from wigs to stationery.

We walked to the Anacostia Bikeshare station and I took photographs of the area, to try and get a sense of why trips from this station are significantly more sparse than from other stations. I’m going to write a separate post about that, since it’s a more complex issue.

We did some more walking to understand the neighborhood better. There were lots of churches. Lots of cell phone stores. We did see a beautiful new library with its own bikeshare station, as well as a new Safeway grocery store on the other side of Anacostia. At the same time, Anacostia looks like parts of Detroit, with lots of abandoned houses.

On our way back to the heart of Washington, DC, we had such a great conversation, which I recorded (podcast coming). I had so many questions – what is the role of public health? How do people living in this neighborhood feel about their health? What is the role of a physician in this situation? Kait asked wonderful questions – what kinds of interventions is this neighborhood open to – do they want the environment or specific health traits of a Ward 2 resident? How well do we understand that in addition to environment that are a host of other social determinants, like race, gender, and sexuality that modulate health?

I left feeling that there were aspects of a vicious circle at play. This was intensified later that day when I walked into a convenience store in Ward 2 (obesity rate, 13%, lower than the lowest State in the Union, Colorado, at 19%) and saw the difference. Same thing when I photographed the bikeshare station at Dupont Circle for comparison (all the photos are below).

At the same time, there is much understanding about the health disparities that result from social determinants, and Pierre’s work at Department of Health was extremely influential for me.

His Department created the Obesity report that I first blogged about that changed my perception about DC’s State of Health. His Department also released DC’s first ever Preventable Causes of Death report, in 2010, which also hugely changed perceptions about what our most significant health problems are. I am grateful for both as a physician and a resident of this community. Uninsurance is #10 on the list at 0.6 %, by the way. This is why it was so great to have him with us, engaging the residents and pointing out the significant issues of the neighborhood that he was aware of.

My photographs are below – feel free to peruse them and ask, “how different is this from my neighborhood?” “What do I notice that could be contributing to poor or good health?”

I know there is so much excitement about the use of technology to promote good health and behavior change, so I wanted to bring these photos to the attention of people so that we can understand what the problems are.

Thanks, Kait, and Pierre for your innovative spirit. It sounds like the next #walkwithadoc should be in Ward 5. Are you game?

Photo Friday: What a difference 5 miles makes in the health choices people can make

I’ve already tweeted this and posted to Facebook; however the blog is the official record of the journey :). 

I took both photographs yesterday while on a “Social Determinants of Health Tour” (walk) through Ward 8 of Washington, DC, with another physician Pierre Vigilance, MD ( @PierreVigilance ), who was a supremely excellent guide and collaborator given his past experience as The Director of the Washington, DC Department of Health, AND Kait Roe (@kaitbr), patient engagement champion supreme.

I actually didn’t plan on taking the photograph on the left – I happened to walk into a convenience store in Ward 2 and was immediately, immediately taken aback by the difference in appearance and food choices in this store, compared to the store I had just been in. It was a stark contrast to see how convenience stores like the one on the left have morphed into providing healthy choices, dominantly, visibly, compared to the one on the right, which is more challenged. 

The refrigerator in the store on the right is not there by accident. It is part of the Healthy Corner program, which you can learn more about.

I don’t want to imply that Washington, DC is not innovating in this area or that there’s no hope. The goal of the tour was to uncover and show visually what a lot of people don’t realize when they see only data or think that technologically mediated lifestyle reminders are the answer when it comes to obesity.

I’ll post more ( a lot more ) about the social determinants of health tour in the next few days. It involved reviewing data and then going in person, because googling and reading blogs can only go so far.

I found this appropriate quote in one of the blogs I researched in advance of the trip:

It is very telling (and a little demoralizing) to sit in a meeting with organizations (including DC agencies) discussing important Ward 8 issues (like unemployment and economic development) and realizing that not one of them lives in our community.  I think that some of the missteps we have seen in Ward 8 can be tracked back to the lack of representation in the decision making positions. To quote Boyz n the Hood, “Either they don’t know, don’t show, or don’t care about what goes on in the hood.”

You can’t Google the East of the River experience.  My blog may bridge part of the gap but it doesn’t come close to filling the void. East of the river engagement is an “on the ground”  and “in the streets” type of operation.  It involves many different perspectives and skill-sets (and maybe a confrontation or two).  The strategies and tools that may be successful in Columbia Heights may not translate in Congress Heights. You can’t expect a community that has been disenfranchised for a generation to come running at the first mention of a community meeting. It will take more than free hotdogs to get people excited about the Saint Elizabeths project. And you can not,  for the love of all things holy,  continue to engage people to do community outreach east of the river who do not live or work east of the river.

From: Consider This an Intervention, Congress Heights on the Rise Blog, July 17, 2012