RWJFPastor Clarice Christian gets to know the individuals and families who attend her services at the Immanuel Chapel Christian Church. Some are struggling with a chronic disease. Pastor Christian says a special prayer for them. These days, however, she’s doing a whole lot more for them.

Her congregation is one of 21 participating in the Southeastern San Diego Cardiac Disparities Project. Spearheaded by the 2017 Robert Wood Johnson Foundation – National Civic League Health Equity Award winners – Elizabeth Bustos and Reverend Gerald Brown – the Southeastern San Diego Cardiac Disparities Project is improving the cardiovascular health of African Americans in South San Diego by changing two fundamental systems that can influence their health: faith organizations and healthcare providers.

The heart of this project is trust -- and its power to heal and build.

Ms. Bustos and Rev. Brown were not the first people to approach African American congregations in the hopes of forming a partnership around health. But, previous efforts which over-promised and under-delivered left many congregations mistrustful of such partnerships. Over the years, many pastors had opened their congregations to researchers who had “come into the ‘hood” then disappeared. As Senior Pastor William Benson explained, “We were concerned about people coming into the community with passion but what they really wanted was our numbers, our data… they would put in for grants and get the money and it never came back to the community. We were tired of being played.”

Rev. Brown pledged to his fellow pastors that, “We’re going to do things differently.” And indeed, they have. Ms. Bustos and Rev. Brown took the time to listen to these concerns, to acknowledge the community’s history and to build relationships. Work meetings became forums for candid dialogue about the role race, exploitation and neglect had played – and continues to play -- in the community.

The pastors demanded that the project be transparent for them to consider joining. They wanted to know what data was going to be collected, who was going to collect it and how it was going to be used. As a result, the project director developed a Data Stewardship Agreement that gave the pastors the transparency they wanted and ownership of their data. It took nearly a year of listening, learning and conversations to build the trust necessary to act.

The project puts the community in the driver’s seat. It calls for each congregation to develop its own “heart-healthy plan” to reduce heart attacks and strokes, based on their unique demographics, resources and needs. The plan must have three components: nutrition education, exercise and health monitoring and tracking of participants’ blood pressure and weight. The pastors also agreed to come together once a month to learn from one another. And they agreed to meet with clinicians, particularly doctors, to share their experiences with them. To date, 20 churches and a mosque have full-fledged programs to combat heart disease and strokes, and these are as varied as the faith organizations themselves.

As Bustos and Brown explain this approach is not simply about creating a heart-healthy intervention. Rather “it builds a structure for African Americans to improve their health on their terms, relying on their trusted leaders, and controlling the way they interact with other powerful entities. Other communities get to do this naturally because of their race, economic status or other factors.”

Where others might gloss over or ignore the legacy of race and racism in shaping health in African-American communities, Bustos and Brown recognize that these are truths that must be discussed, confronted and considered.

 

Creating a culture of health within congregations

At Immanuel Chapel Christian Church, Pastor Christian developed a plan that calls for monthly meetings on a Saturday RWJF2morning with her congregants. In her opening prayer at the meetings, she tells them that scripture calls for taking care of one’s body to be able to serve God. Afterward, they take a brisk “Gospel Walk” around the neighborhood, singing an inspirational hymn. They pass businesses, dilapidated houses and empty lots. Each month, they add another block or two to their walk.

Back in the pews, the congregants next hear from a featured speaker - usually an African American health professional. The speaker explains the scientific and medical causes of cardiovascular disease and offer practical, culturally appropriate recommendations.

Afterwards, one-by-one, the participants go to a back room where a member of the congregation, a retired nurse, takes their blood pressure and registers their weight. She recommends they see their doctor if she sees a problem. Sometimes, she tenderly tells them that they need to step up their efforts to lose weight and suggests a couple of ways they can do it. It’s low-key and non-judgmental.

As morning gives way to noon, the participants enjoy a healthy lunch and fellowship. In a single morning, they’ve nourished their soul, fed their body, participated in group exercise and received disease prevention information from a trusted source in a language they understand paving the way for them to act on that information to protect their health.

This work is not only transforming the way parishioners think about their health, it is shifting pastors’ understanding of their congregation. They discovered that they had doctors, nurses, personal trainers, teachers and healthy cooking aficionados among their congregants. They invited these individuals to form health ministries. These lay leaders implement the church’s heart-healthy plan, which includes monitoring and tracking the blood pressure and weight of congregants. This monitoring alone offers opportunities to engage congregants about their health and to detect problems, and lets them know that they are not alone as they face them. To date, the congregations are tracking around 2,000 people.

From the pulpit pastors regularly address issues of health.  They encourage the congregation to take steps to become healthier. “Don’t forget to stop by to get your blood pressure checked,” “I’m looking to next weekend’s health class,” “Remember, no fried food at our monthly reception.”

Many of the people who attend these congregations are in their sixties, seventies or older. It’s worth noting, however, that many take care of their grandchildren. The project underscores that prevention begins at an early age, and that these project participants can influence a younger generation.

 

Creating Space to Confront Mistrust

RWJF3The legacy of racism and neglect hangs heavily over health discussions in these congregations. Mistreatment breeds mistrust.  The pastors tell stories about how some of their congregants do not trust doctors. “There is such a huge trust issue,” Pastor Christian told the healthcare providers at last year’s summit. “People are fearful. They remember what happened to their grandmother, to their sister, their next-door neighbor.”

At the same time, the clinicians expressed frustration at having some of their African Americans patients not adhere to their medication regimen, indeed, who follow a relative’s lead instead of what is prescribed.

The project has created safe spaces for clinicians, particularly doctors, to interact with faith leaders, through its annual health summit. The exchanges provided insights not easily gained anywhere else, raising awareness among clinicians of the history and culture of African Americans, with the goal of informing all levels of health care, from the treatment of individual patients to how a health system treats a community.

RWJF4These meetings have already led to tangible results. At one, the ACC/AHA Cardiovascular Risk calculator was introduced to the healthcare providers, many of whom said they were unfamiliar with it. The online calculator estimates the risk of the patient having a heart attack or stroke depending on a variety of factors, including race. African American patients face a significantly higher risk. On the spot, many doctors expressed an interest in beginning to use it. Furthermore, these community-clinical linkages have resulted in doctors volunteering to help the health ministries. To date, some 24 doctors are sharing their knowledge in meetings, trainings and other health events organized by the churches.

 

Trust and Transformation

The collective impact of this project contributes to a culture of health by fostering a healthy lifestyle from the ground up: Pastors raising awareness of cardiovascular disease from the pulpit, congregants taking steps to reduce their disease risk, doctors and other health practitioners becoming more aware of African Americans’ history.

At every step in this project, its director, Ms. Bustos, and her partner, Rev. Brown, have taken the time to engage distinct communities and build their trust. As Bustos and Brown will tell you, “It all begins with a willingness to build trust in a community and trusting its members lead the way to lasting solutions.”