Engaging Low Income Urban Residents in Prioritizing Interventions for Health

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Abstract

The goal of this project is to explore the possibility of designing public policies aimed at improving the health of low-income populations. Toward this end, this project has engaged health policy experts and low-income residents in an exploratory exercise aimed at designing an affordable, evidence-based intervention program targeted at addressing socio-economic factors and reducing health disparities among low income urban residents. A three step process is entailed: 1. Identification of candidate interventions that have been shown to ameliorate the socio-economic determinants of health, and estimation of the actuarial costs of offering these services to low income residents of Washington, D.C.; 2. Consideration of a reasonable per capita expenditure for the purpose; 3. Engagement of low-income residents of Washington, D.C. through the use of the REACH exercise to ascertain their priorities for publicly funding the proposed interventions within the assigned budget. Several hundred low-income adults recruited from clinical and community settings have participated in this engagement process through 43 small group exercises in which a facilitated discussion takes place using a previously tested group decision tool, REACH (Reaching Economic Alternatives that Contribute to Health). Data pertaining to participants socio-demographic characteristics, attitudes toward health, and preferences for possible interventions have been collected anonymously. Group discussions have been audio-taped. Data have been analyzed quantitatively and qualitatively to determine preferences for various interventions and their association with socio-demographic characteristics. Participants have been financially compensated for their participation in this study which has been approved by IRBs at the NIH, Howard University and the District of Columbia Department of Heatlh. Study results have yielded information about the interventions that are of utmost priority to low income urban residents in Washington, D.C. This is unique information that may contribute to efforts to find affordable strategies for ameliorating the socio-economic determinants of health for low-income urban population in the US. Three manuscript have been published. In 2013-14 the REACH exercise developed for this project was adapted for use in engaging residents in Birmingham, United Kingdom. In 2021, the REACH exercise was used in a project conducted by The National Institute for Health Research Southampton 1000 DaysPlus Global Nutrition Research Group: leveraging improved nutrition preconception, during pregnancy and postpartum in Sub-Saharan Africa through novel intervention models, at the University of Southampton. Study sites will be in South Africa, Ghana, and Burkina Faso. The overall aim of the research group is to address the double burden of malnutrition in low- and middle-income countries, with a particular focus on the 1000 DaysPlus concept of optimizing nutrition before, during and after pregnancy.