February 28, 2020 | Tessa Graham (Program Coordinator II, Office of Public Health Practice) and Sean McMahon (LHC Outreach Coordinator)
Two Ambitious Projects Coming Together
While much public health policy is enacted at the state or federal level, US cities play a crucial role in implementing programs and polices that impact population health. Despite playing this role, there are few systems that track and seek to understand practices at this level. In 2017, the Urban Health Collaborative at Drexel University’s Dornsife School of Public Health initiated a Policy Surveillance Project (UHC PSP) that focused on urban centers with active policy debate.
According to America’s Health Rankings, Alabama ranks 46th in obesity, 48th in diabetes, and 49th in high blood pressure, among other poor health ranking metrics. This was the impetus for the winner of UAB’s Grand Challenge: Live HealthSmart Alabama. This initiative, led by Dr. Mona Fouad (Director, Minority Health & Health Disparities Research Center), works “with businesses, schools, faith-based organizations, and non-profits in order to make changes to policies, systems, and build environment impacting the health of Alabamians.” Dr. Lisa McCormick (Associate Dean of Public Health Practice, UAB School of Public Health) is a collaborator on the Live HealthSmart team and assists them in their goals of transforming Alabama’s health and moving us out of the bottom ten in national health rankings. Live HealthSmart has chosen a team of collaborators from disciplines all across campus, allowing them to assess complex factors detrimental to the health of Alabamians.
Dr. McCormick has chosen to adopt policy surveillance as a part of the Live HealthSmart goals, reaching out to Drexel University’s Urban Health Collaborative in order to become a partner in their Policy Surveillance Project. This partnership opportunity has expanded the reach of Live HealthSmart’s health improvement goals.
Adapting for Context
UHC PSP began with monitoring four cities – Philadelphia, New York City, Washington, DC, and Los Angeles. In 2019, this consortium expanded to include Birmingham, AL; Louisville, KY; and St. Louis, MO, with partner institutions UAB, University of Louisville, and Saint Louis University, respectively. These cities are smaller than the original four and represent different regions of the country. The Urban Health Collaborative provided initial policy surveillance methods and inclusion criteria. Originally, only programs and polices related to education, the environment, and housing were the focus.
While these three areas remain the focus of the broader project, each institution has the flexibility to adapt the PSP to suit their needs and interests. For instance, the St. Louis team developed a category for crime prevention. The UAB team has developed a number of modifications to the original process.
Demographic and economic differences between the original four cities and Birmingham, as well as the incorporation of Live HeatlhSmart’s goals, necessitated adapting these methods and inclusion criteria to better fit a smaller population with fewer resources. To adapt to the needs of Live HealthSmart, the UAB team added three more categories: nutrition, physical activity, and prevention/wellness. These three categories are aligned to Live HealthSmart focus areas. In addition, the UAB team added violence prevention (adopting the “crime” category developed by the SLU team) and an economic development category in an attempt to keep track of Birmingham’s rapid revitalization.
With these five new categories (eight total), the UAB team decided to also expand inclusion criteria. Drexel’s protocol only calls for monitoring citywide programs and polices that come from the municipal government; the UAB team has chosen to monitor programs and polices originating from the private and public sectors as well.
Weekly surveillance for the UAB team began in October 2019. Local news sources, city council minutes, city government websites, organizational newsletters and websites, social media feeds, and more are reviewed to identify program and policy initiatives. Identified programs and policies are compiled in a central database and aligned within the categories of interest. Programs and policies are monitored over time and compared across multiple cities.
The Policy Surveillance Process
To put it simply, policy surveillance is the process of examining information sources (al.com, the Mayor’s Office, Social media profiles of city councilors, and BhamNow, to name a few) for relevant programs and polices, and cataloging them into the appropriate categories for further analysis. Each week, Sean McMahon (LHC) and Tessa Graham (UAB Office of Public Health Practice) sit down and check these sources. We’ve also subscribed to several newsletters and breaking news alert systems, and we play the livestream from the week’s city council meeting. With these sources in front of us, we search for anything related to policy and program initiatives in the Birmingham area that could impact the health of Birmingham’s communities. If Sean and Tessa don’t agree on how to categorize a policy or program, the issue is brought to Dr. McCormick and Dr. Eric Ford, the other members of the UAB team. We then periodically check our sources for updates on the programs and policies we’ve already identified and update as needed.
Moving Forward
The Birmingham Policy Surveillance Initiative monitors and catalogs programs and policies within our city that are intended to improve the population’s health, influence social determinants of health, and promote health equity. Systematically recording the data will allow for comparisons between Birmingham and other metropolitan areas studied in partnership with the Urban Health Collaborative so that gaps can be identified and addressed through Live HealthSmart Alabama. These methods can be used as part of a community assessment process in order to better understand the influence of public policy on the social determinants of health.
The expansion of the Policy Surveillance Project and engagement of new academic partners creates a mechanism for comparing what is happening in Birmingham to other U.S. cities. This will allow us to identify policies that are effectively influencing health that are missing or lacking in Birmingham area. In addition, this project allows us the ability to assess the impact of the monitored programs and polices on health by examining health indicators and outcomes in these urban areas. To learn more, visit the project website or email UHC@drexel.edu.
