Witnessing an escalating number of children coming to Cincinnati Children’s with gunshot wounds, Victor Garcia, MD, General Pediatrics and Thoracic Surgery, asked why. That question set him on a journey that led him to think differently about how to address violence and community health.

Garcia shared his journey at the Comprehensive Children's Injury Center lecture held on July 31, along with the resulting strategic initiative he pioneered to improve the health of families in the urban core — CoreChange.

Setting the scene in 2006, Garcia described how Cincinnati was experiencing an exponential increase in homicides. Cincinnati Children’s had a 300 percent increase in casualties coming in. The patients were also getting even younger, averaging about 13 years old. Garcia served as the director of Trauma at the time.

Things are no different today, according to Garcia.

Though Cincinnati homicides have decreased from 72 to 66 from 2010 to 2011, the homicide rate has remained consistently high for the past decade. Cincinnati leads Ohio with 21.6 deaths per 100,000 residents, as reported by the Cincinnati Police Department. That’s four times the national average of 5.3.

“For the life of me, when I went into pediatric surgery, I never thought that I’d be dealing with this issue,” he said.

Exploring deeper, Garcia looked at the work of sociologists, including Rob Sampson at Harvard University. Sampson made an association between homicides and infant deaths and studied the striking similarities in their geographic concentrations. Garcia found a similar clustering pattern in Cincinnati with not only homicides and infant mortality, but also with asthma, high school dropouts, mass incarceration, obesity and diabetes.

“It started developing a picture for me,” Garcia said. “For the first time in modern history, the illnesses that are affecting us, and particularly children, are not a consequence of infections but of social economic determinants.”

Garcia took a closer at the cause and effect of social, cultural, environmental and economic issues on Cincinnati’s core urban neighborhoods.

For example, dilapidated housing was contributing to asthma. Asthma accounted for more school absenteeism than any other chronic disease; 60 percent of students miss school annually due to respiratory symptoms. Subsequently, this was impacting the graduation rate and employment opportunity.

Looking Upstream

Research shows that changing healthcare services will account for only 15 to 20 percent of a population’s overall improvement in health outcomes. The other 80 to 85 percent comes from focusing on root causes within fundamental systems – the family, neighborhoods and schools.

CoreChange is structured to address these root causes, which are concentrated in a handful of neighborhoods but affect our entire region, Garcia said. These issues include exceptionally high unemployment and underemployment, concentrated poverty, violent crime, low performing schools and health inequities, particularly among children.

“We need new paths and new ways of thinking to begin to address these differences in health. Making sense of these differences means adding socioeconomic status to the conversations and our actions. Our present narrow focus on health behavior alone is not going to be successful in reducing group variations in health,” Garcia said.

CoreChange is making progress in addressing non-medical factors of health and held its first three-day summit this year, sponsored in part by Cincinnati Children’s.

The summit engaged local residents and community partners, like Cincinnati Children’s, in identifying the strengths of Cincinnati’s urban neighborhoods— from people gathering at barber shops to local residents launching a running club —to co-create solutions and leverage these attributes. Other supporters include United Way and Xavier University.

“We look at communities as assets, as opposed to a problem to be fixed,” said Garcia.

As an outgrowth of the summit, CoreChange formed 20 working groups to tackle long-standing challenges — employment for those with limited skills, transportation in and out of the urban core, general health knowledge and more.

COACH program promotes healthy lifestyles

Cincinnati Children’s is supporting the Coaching on Achieving Community Health (COACH) program, tasked with establishing family and peer health coaching to promote healthier lifestyles and to encourage healthcare usage.

Cincinnati Children’s has partnered with the social service agency Seven Hills Neighborhood Houses to implement the program in the Seven Hills community, which includes the West End, Over-the-Rhine and the East End.

COACH has combined the strengths of the action team and community members to collaboratively identify the community’s health needs. The group plans to design and conduct a research study to identify potentially effective health interventions.

Families can participate through a research registry. The registry captures data to be used in grants to fund projects and sustain services. Nearly 30 families already have agreed to participate, and seven community members are serving on a Community Health Advisory Committee.

The program also hosts educational workshops to bring health and learning to the community. Sara Stigler, research assistant III, Asthma Research, and Nikki Barbour, research assistant III, Autoimmune Genomics and Etiology, recently brought a biology program to Seven Hills Summer Camp. Kids used tablets to learn about different organs then got the chance to dissect a fetal pig, a cow eye and a cow’s heart.

In the fall, Cincinnati Children’s and Ohio University photography graduate Angela Smith will present a project called PhotoVoice. Children ages 6 to 12 will take photos that describe how they feel their health is affected by their physical and social community. The photos with corresponding narratives will be displayed at a community gallery night.

According to Melinda Butsch Kovacic, PhD, Asthma Research, more community meetings and focus groups are planned to pinpoint COACH program goals and best approaches moving forward. Once established in Seven Hills, COACH will be expanded to a larger population.

Garcia says the entire community has an interest in addressing the issues affecting inner-city neighborhoods. 

“Even if we fail to open our eyes and drive through some of these neighborhoods with shutters on, we will end up paying for it as a society,” said Garcia. “We’re all in the same boat.”

To learn more about CoreChange or to get involved with a working group, visit www.corechangecincy.com.