 It's America Bracho who is around here and late in our own time actually in terms of community health. I first met her many years ago at an event that the School of Social Recruiting Organizing Community Health over at the Beckman Center for the National Academy of Sciences and she was of course the keynote speaker at the time. And we've had many false stats so to speak in getting community health as an academic curriculum, as an area of work that we are all passionate about in public health in many other schools, medicine, social sciences, and even engineering and physical sciences. Last year we did succeed in getting a community engagement program going on campus which was supposed to engage students, faculty and staff. Many of our faculty members work in community and we wanted to make this an important part of the curriculum. I think Professor Chris Day started that program and this morning I got an email that she's being pulled up to another university so it just makes our work even more challenging but also makes today particularly meaningful. So I'm very, very delighted to introduce Dr. America Bracho. She's executive director of Latino Health Access, which is a center that deals with health promotion and disease prevention. The headquarters is in Santa Ana but the breadth of their influence is very broad and it was created under her leadership to assist with the multiple health needs of Latinos in Orange County. But as I mentioned it's a case study for many, many aspects of community health in many different communities across the country. She is a physician who worked in Venezuela before seeing the life in Vietnam MPH at the University of Michigan in health education and health behavior and I'm very sure that she would do wonderful work without the MPH but I'm sure she also expanded her perspective in many ways as we all hope to do with the curriculum that we have here. When she was in Michigan she directed the AIDS Project for Latino Family Services in Detroit and she's a consultant for many, many organizations that we all aspire to be members of including the American Academy of Family Physicians, the Robert Johnson Foundation, the Institute of Medicine and the Kellogg Foundation. All of these organizations that try to do good work in community. So today please join me in welcoming Dr. Bracho. Good afternoon and thank you so much for making me part of your last class. That's the last class, right? Last presentation for you here. So that's good. Hope you enjoy your vacation after all of this. Fine, I was forced. And I am very, very happy that I did my Master in Public Health and I think it helps a lot. As a matter of fact, when I was practicing medicine in Venezuela one of my main frustrations as a physician was to see the same kids with different diabetes every week. The same population affected with tuberculosis and malaria and the same thing with people in my own community that didn't have even money to buy their medications. So clearly find yourself prescribing and almost having to pay for the medications that you prescribe. It's really hard and I love medicine and I love physicians and I hope that when people decide to become physicians they do a good job. They all need a good doctor. And doctors have to put a lot of time seeing individuals. And in a given moment you can decide to balance that professional life or you can decide you just want to see individuals or you can decide that you don't want to see individuals. That you don't want to spend the day seeing 8 patients, 10 patients, 20 patients per day. That's also an option for people that want to work in health. And to tell you the truth, it is when you work in low income communities or when you work with agendas that show you so clearly the limitations that you are doing, you only have the option of finding what else can I do. There I was in rural Venezuela thinking what can I do. And then I discovered public health which doesn't exist in Venezuela and I decided to apply to an hardware and I did my master in public health there. And it was great. Since then I've been in public health. And the same thing that took me to public health takes me here today with you. I'm here today to talk to you as a colleague. You either are working on this already or will be working on this more and more. And the only reason why I love to talk to students is because you have access to information and to a deeper understanding of why things are happening the way they are happening. So for me to compare today has one purpose. One purpose is to think together, to think about how you read data, how you read situations in communities. What do you do with that data? What do you do with what you learn? What is your obligation as a professional? In this type of profession, like in any profession in the world, you have learned that you have the option of practicing different levels of leadership. And I remember talking about this a lot in the graduation of the Master in Public Health at UCLA. When they talk about leadership as this area in which you can be a technical leader or this area in which you can be what they call an adaptive leader. And this word adaptive now comes from Harvard. What is really a leader of change? We call it adaptive, I guess, because people do not react to the word adaptive. You say, well, what is adaptive? By the moment they explain to you, it means change. The technical part is that in which you really know about something. You know about epidemiology. And you know about diseases. And you know about evidence. And you know about HIV. That's the technical part. You know about data. You know about SPSA. You know all of that. The other part is when you know that something is happening because people are not having opportunities, because there is lack of justice. And there is another leadership. And then you probably are already finding yourself in that. But is that combination, what type of, do I want to be in the technical leadership, which is pretty good and usually very safe? Usually. Because it could become also very political. Or do I also combine my technical expertise with the other type of leadership that is needed to change certain circumstances? So this is the reflection for today that I want to share with you. And I'm going to share with you some of the concepts that guide the work of Latino health assets and some of the examples of the work that we do. And my only purpose with this is just to help you think about your own career and your own, to create your own examples of what you want to do. Nothing more than that. So this is the first line. For us at Latino Health Access, the whole concept of health disparity is very important. And now you know people change words and they call it in a different way. But this concept of disparity is something that is not just a difference. There is a health outcome that you have comparing Latinos with the people that have the best outcomes. Health disparities are comparisons with population groups that have the best outcomes. So if you want to know about health disparities in New Zealand, you will have to compare the minority population with the white population. If you want to compare in Bolivia, you might need to compare the indigenous people with the mestizo people, the people that have the best outcomes. In the United States, we compare with Anglos because they have the best outcomes. That's not to say that there are no Anglos that have major conditions and borders. But as a concept, health disparities compare with the group that have the best outcomes. This is not a comparison between older people and young people. So these are not outcomes because there is an age difference. This is a difference, this is an disparity that has to do with conditions that are unacceptable. And you will see this as we go through the examples, as we revise the epidemic on obesity. And you see with your own eyes why we are having more obesity in Santa Ana and in what neighborhoods of Santa Ana. And what are the situations surrounding the epidemic of obesity in the Latino community, for example. Or HIV among African-American and Latino women, or many other conditions. So in the discussion about health disparities, we talk about root causes. What is happening? And I think that I'm convinced at this moment in my life that the best way of thinking, analyzing, trying to understand the situation is asking a lot of questions. A lot of questions. And the question here is why? And why and why? And then you come up with different questions. For example, as you think in Santa Ana, and we are right here, your neighbors, the only separation between UCI and Santa Ana is the freeway. And you can see huge differences between Irvine and Santa Ana in terms of school performance, access to open spaces, safety, and many others. So as you think, why Santa Ana has one of the largest rates of pedestrian injuries? And it does. Santa Ana has huge rates of pedestrian injuries. And you think about it. I tell the medical students, I go here to do some lectures for them once a year. And I ask them to think in themselves going to the emergency room, working in the emergency room. And receiving, during their kind of work in the emergency room, receiving kids that are coming from the same streets in Santa Ana. So these are kids that are coming from Chestnut and Pine. And you do what you need to do. And the kid is there, and he's injured, and he's dying, or he's dead. And you happen to know that this kid is coming from Chestnut and Pine. But then you are on call again. And you receive another kid that comes from Chestnut and Pine. And then another kid that comes from Chestnut and Pine. And the area surrounding Chestnut and Pine. And I ask the students, what would you do? So what would you do? Take the car and come to that place and see what's going on in that intersection. Something is wrong with that intersection. Something is wrong with that intersection. You will be amazed how many people do not think in taking the car and see what's happening in Chestnut and Pine. It's almost, it's almost, I mean this is really a way of thinking that you develop. Before going to the university, I'm sure that the majority of people will say I will drive to Chestnut and Pine. Something happened in the university that at the end people don't think in driving to Chestnut and Pine. And I wonder what is it? What is it that now we think that because we learned so much about other things that we don't have to drive to Chestnut? My investment in this little hour that I'm going to have with you is that what you really need to do to improve the health of communities around the world you already knew before going to the university. You knew that. That's why you came here. You wanted to public health because you wanted to help. And your heart was telling you that's not right. I want to help with this, I want to work with this community, on that community and you saw something that was very wrong. You cannot let all of this university and all of this knowledge to eliminate what really got you into public health. You need to use that information to enhance your capacity of changing this community. So yes, you need to drive to Chestnut and Pine. What you are going to find in Chestnut and Pine is that it's very dark. There is not a stoplight. There is not a space for the kids to play. And the kids run after a ball and then they get injured. Then what do you do with that? You are the doctor in the emergency room. So what do you do with that? I mean that work, some people come to the health department or the public safety department. We'll go to a room planning and what would you tell them? You know a lot of people have tried that. We are really busy here. We are doing some other things. Thank you for caring though. What do you do? That's a community. So how? And that is one of my problems with training. Because we hear a lot about those determinants of health. Have you heard that? Like at senior times you haven't yet. By the way you graduate from your master in public health you are going to be sick and tired of hearing about this ecological model. We have the other model and we can model and we can model the statistics and we can model all the time. And then we go out and we graduate and we don't know what to do. And that is a problem. That is a practical problem because we came into public health with the idea of doing something. And then we go out with what? And the reason why we cannot think about it is because you have been too long in the university. Because we have a youth program. And when we ask the kids in the youth program, what would you do if we don't have open space to play? They say, I'm going to ask Mrs. Martinez if we can use her garage. And then she goes and says, can we use her garage for this afternoon because we want to play? Well you know there is not, well I only have one bathroom. We will leave it clean. But I don't have a lot of money to pay for all the paper you are going to use in the bathroom. I will bring the paper. We will bring work. All of a sudden you see 200 kids around that garage. And they give it to the master in public health. And that is what we need to connect with today. In this presentation we are going to connect with why we came into public health. Because the solution you have, you have it in your head. But you need to be creative and think that all of that that you want to create in the community is possible if you involve the people in that community. These are the determinants of health. This is what you are going to see over and over and over. And you are going to see, you are going to hear this. You know that diseases have biological factors, issues you know they are affected by the physical environment, the social environment, the stress. This is HIV. HIV is not just about the HIV virus. It's about women in poverty in the Bronx. Having sex with men that are using drugs. They themselves using drugs with kids without having a rehab center that accept them with their children. Living in a place where they make $10,000 per year in New York. And having as the big solution to reduce numbers among women a condom. That they cannot put themselves. They cannot use the male condom and the female condom is horrible. This group of women don't know even how to read or they have a fifth grade education, don't know their body. But the only strategy is a condom. And the strategy comes from centers where people were graduated knowing this. And the best they can do is to give you a good analysis. And you can read the best analysis. You go and you Google. Women substance abuse. Women HIV. You are going today to read, you know, how their level of education is low and poverty. They could even say poverty is a major determinant in influencing these high-grade behaviors. And at the end, there's nothing. And the epidemic continues. Well, you know what? I think that the worst, the worst phase of discrimination in the U.S. today, and this is true in many other countries as well, the worst phase is neglect. I have the budget. I have the power. And I'm going to decide not to give any money to your community. Not because I hate that I actually love you. But I won't give you time or money or programs. It doesn't mean that I hate you. I don't want to talk to you about hate or love. I want programs for my community. And this whole neutrality that is very technical, I'm not only a technical guy, you know, I'm just a technical guy. I have the budget. I have the programs. I'm technical. You are not the technical guy. You are making a leadership decision. And in your leadership decision, we are not part of your game. So here is where we then, as people in public health, understand that there is something wrong here. We actually, there has to be something that I can do about this. Ah, they taught me about data. And they taught me about documenting the programs. And they taught me about advocacy. And policy. And health education. And community organizing. They taught me about all of these. I have to be able to use this. Right? Otherwise, you know, you are just giving away your money to UCI. You have to be able to see how I respond to this institution that is allocating the money in this way when these are the disparities and these are the conditions and this is the only strategy that they are using. That's the problem for you. If you decide to take it. If you decide that this is important enough for you to put time saying, well, how do we organize? And for sure it's not going to be you alone. So these are some of the disparities that we are going to hear about. Informatality and cancer. Cardiovascular disease. Diabetes. HIV. Immunization. But it goes on and on. You are going to see these disparities in violence, in alcohol, in liver disease, you know, in many, many. Because there is a major disparity in poverty. For example, in HIV. In HIV we have huge numbers among Latinos and African Americans. They are concentrated in specific places. This is not all over. Poverty. Among children. You can see the numbers of poverty among American Indians and Black and Latinos. And I'm going to share with you this report because you are in public health. I only share this piece of my presentation with certain audiences that I believe, I am assuming that you are going to actually see what's going on with this type of data and the way they manage the data. This is 2007, where you can actually find 2009 already. And it's pretty much the same. That's why I didn't change it. So there is this report in Orange County that talk about children. And in that report, they say, you know, that this is the population of Santa Ana, 80% Latinos, that the numbers of Latino children that are removed from their homes and placed out of home is increasing. But the numbers in what children are decreasing. The number of kids that are removed from their home is a sign of distress, family distress. These are great kids that are put into foster care. And if you look into the outcomes of kids that are grown in foster care, you are going to see that government is a horrible farmer or modeler. The outcomes if you grow in foster care are sometimes worse than if you grow in families with violence. You can actually go and research what's going on in foster care today. And that's why the national policy is pushing towards permanency. Kids need a family. All children need families. Whether it's an adopted family or a kinship family or their own parents, kids need family. They don't need to be in a group. So, but this is happening. And if you read the report, it says the numbers in Orange County are decreasing and then it says underneath, except among Latinos. And that is, for my brain, is like, why? Trying to chestnut and pine. You know, what's going on there? And why is it decreasing in the other group? What is happening? What is happening with the families, with the services? So my brain goes into the why. This says that the majority of kids that are in the program of free and reduced lunch are the ones that cannot read. So this is saying, in other words, that poor kids cannot read. But it also says that almost 100% of the kids in free and reduced lunch are Latinos. Which means that Latinos in fourth grade cannot read. And if you cannot read, you cannot learn about a lot of things. And reading and graduating from school has everything to do with health. So as I'm thinking what type of strategy am I going to develop in Santa Ana, I need to know how many kids are reading. And I need to go to the school and ask them what's going on. And then you find, of course, many, many things you are going to find as inquire about this. And these are the zip codes in Santa Ana, in Orange County, the 10 poorest zip codes. The 9703 is the poorest. And the 9701, which is the one where we have been working for years, is also there and you can see. This is very important because as you get familiar with the concept of healthy cities and healthy communities, which is the concept from the World Organization that I think that we have adopted is the framework we have adopted. You are going to hear more and more this whole concept of place-based interventions. Place-based. And you can actually Google place-based interventions. And you are going to get connected with centers in policy that are working more and more in place-based. And place means that instead of working all over the city or all over the county, when you want to focus on healthy cities, you focus on the place. You find the place. In that place, my friends, in this area of Santa Ana, you do not have parks. That's where you don't have lights and it's dark. And where kids cannot read. In this area of Santa Ana, you have the parks and kids are going to Mother Day. In this area of town, there are liquor stores. In this area, there are parks. So we believe that all kids should go to good schools like Mother Day. But in order to do that, you need to bring balance to the city. The development of that city needs to be different. It can be like you invest in one side of the city and not the other. And in order to do that, you need to find the place where all of that is happening. And in that place, you need to collect data. And you need to compare that data with that site and with urban. And then with that data, you create a plan. And then you find a budget. And then you start presenting this to the political people. And then you start making them accountable and making your programs accountable because they are responding to the strategy of a place. This is what the World of Organization is one of the cornerstones of the framework of healthy cities that I'm going to share with you in a second. It's a place-based. The World of Organization says setting base. Setting is the place-based. Because they say that the place where you play, you live, where you meet the voice of your life, that's your place. See, my kids, I think they have been having sex for quite a while. We don't talk about that. They say, ah, I don't want to talk to you about that. But I know. Because, you know, we find science. But my kids, my son graduated from here from political science. And he's now in Pepperdine. He's going to graduate. And, you know, and I can tell. But he had sex, unprotected sex, many times, with a lot of people. And sometimes protected. If my son were to live in the Bronx, he would be infected with HIV. So the boys in the Bronx, they are not better than my kids and they are not worse than my kids. They are just in the place. There are technical people called seropregaments. And we call in public health the place. That's the place where you live. That's the place where you're going to meet that girl, that boy. So that place is very important. In that place in Santa Ana, in that place, the number of gang members, the Hispanic membership in gangs increased from 70% to 91%. Not in Santa Ana, but in that place. And the kids are being killed in that place. When you heard last year from the 32 kids that were killed in Chicago, all of them black, all of them, the vast majority live in a neighborhood. This is also true for teen pregnancy. And for dropout rate. Same places. Same places. And this is a map of Orange County. And you can see the names. I want you to see the names of the city. Where it's very dark is where you have the majority of teen pregnancy. No, I'm not saying I just spoke. The majority of girls, the majority, no teen pregnancy. You move into the problems, like child abuse, organs, then the names of the cities disappear from the map. And I'm not paranoid. And I know what is the name of the city underneath. So people can say you can figure it out, America. This is nothing against you. Well, it is actually something that is not helping me because when I show this map to any policymaker, they don't care. This is not saying how many kids are in Santa Ana. This is not saying how many gang members are in Santa Ana. This is not saying anything about Santa Ana. It has a bunch of triangles around a bunch of areas in that map. This data doesn't help us. So we are working in creating the first report that will be the second corner store for healthy cities, which is called a city health index. A city health index, which by the way has way more than health data. It has transportation data, housing data, safety data. The city health index is the only way you can plan for a city to become a healthier place. You cannot plan with this type of data. You need to plan with data that can produce indicators. So you actually can see if things are improving. So we are working in creating the first report that can use more than triangles. Look at this. These are kids' information. But we know that they are around Santa Ana and Ahai and all of that, but I want to know where exactly. Not only that they are in Santa Ana, I want to know the census track. The census track. I want to know something smaller than the zip code. So let me tell you a little bit about about, because I don't know that we will cover all the cultural piece. There are so many things that I would love to talk to you about and maybe have a dialogue afterwards. So we know that we don't have a space to play. We were the 9-7-1 zip code has 65,000 people and not a single park. 65,000 people and not a single park. So obesity is a problem. We shouldn't be surprised. There is a design for that and this is a map that was produced by a group of us just to document the level of obesity in schools in those places. And of course the majority of kids that are very obese are in those places. And this is one of the things they call park in that area. This is called French Park and if you saw the Bill Moyer's journal documentary you probably heard when we said you know what type of game can you play in a park that has that sound? Theoretical basketball? You know like and there are other games you can sit in one bench and the other one in the bench and then you play. But other than that I don't think this will help fight obesity and this is what we see these kids playing in dumpsters and and that my friends is a problem. It is a personal problem for me. It's personal. This thing became personal for me long time ago. And the day it stops being personal I will get paralyzed. It has to be personal. I say that you need to bring your personal agenda to your professional work. Know your personal problems and the stories of your boyfriends No, I'm not talking about that personal. I'm talking about your personal agenda and my personal agenda has to do with justice and has to do with equal opportunities. I had those opportunities. I went to a terrific school and by the way my kids went to Mother Day and they had other opportunities. So they have even more obligation than many others to give back. So this is you guys are in UCI you know about opportunities. This is about opportunities. That is about opportunities. This is my friend what is happening in Chestnut and Pine. This is what you saw when you drove there. This kid drove in after the ball. That kid will end up in the emergency room. This is an apartment building in the 9-7-1 where we have our very intense work on building a healthy city and these are the science incident. What the neighbors are telling us is that if the kids they have to sign a contract that says you are going to be fined $50 if your kid plays outside and they tell me look America I understand what you are saying about obesity but the truth is that my kids are safer at home playing Nintendo or whatever game is the new game. They are safer there and if I push it too much they are going to say what happens is that you don't live here so you have all of this steel in your head that we can't go out at 5 and walk we don't live here. You live in an area that is safe and that's why you say that we shouldn't walk. We shouldn't walk. You don't have to do something about gas but I'm not going to call the police. You call the police because you don't know what happened when you called the police on those gang members so they really made you feel that you are vague into theory. So it's like when you tell a man that is being victim of violence you should leave that man and the woman answer to you will you pay my rent? We have to really say how do we make this happen without pushing something that might be extremely insensitive. So what do we say? Wrong, you need to exercise. This is also some things that we find in those buildings and we find moms that are taking care of kids outside their homes and their kids that are alone at home taking care of other kids. Now that we cannot take care of our siblings we can take care of our siblings. If you have siblings that are smaller than you you probably take care of them. That's not a problem. The problem is in which conditions you take care of those siblings. For how long? How well prepared are you to take care of your siblings? So you are going to see how we have integrated all of these analysis in what we do at Latino Health Access. Look at what the media we know that children will will buy things that the media is pushing and we know what the media push and how they push. And for people at our level in a master of public health this has to be a problem because you are going to be deciding the obesity reduction programs and this is what the media is going to be telling your community. So we need comprehensive interventions and this is what they say about places. I wanted to share this one with you. We know this. And the group that you are going to Google is called Policy Link. Policy Link. Right there. They have a great report that is called Why Place Matters. And I am not going to go and detail all of this part. You guys have my presentation. This is in your computer. You can request a copy of that presentation. It is here. It is with your professor. So ask for a copy and get all of that information. But I want you to take a look to the concept of healthy cities and what it means and what are the core aspects. So we are talking about a place-based organization with a lot of community engagement with multiple sectors cooperating because if we want to do something about Feresian Indians in Santa Ana we need to talk to the city and we need to talk to the transportation people and the engineers. Not just the health people. And at this moment health people talk to health and we are just talking about health in a disease way. And that is not going to change community. For communities to change we need to talk to the business people and people from the bank. And we need to talk to the teachers and we need to make them our best friends. Because believe me, the teachers want the kids to learn. So this is not about not wanting it. The doctors want people to be healthy. So that's not the problem. The problem is not that they don't want to. The problem is that we are not thinking as a community and we need to actually learn how to partner. And one of the key elements of healthy cities is called the multiple sectors table. We need a table that has people young and old, gay, straight from different religions from different sectors. Because if you have that table the people of the city will not own the process. And when people do not own the process of change that change is not so stable. You come, you dictate which has happened a lot in the world we go into foreign countries we have a grant from the NIH we decide to do a project we do the project for three years and then we leave. That is not going to happen. We need to actually work with the community in strategies that are sustainable. So here is the whole place base I'm going to pass all of that which you have. This is our group in Latino Health Access and we are 57 people we are in the corner of May and 17. We work with community workers that are called promotoras. These community workers are people that live in that community that came through our programs and that demonstrated that they want to change their community so we hire them. And they have now a full-time job with health benefits and their job is to transform their community. So more than half of the people in our staff are community workers. This works in this type of strategy and also works in medicine if any of you will go into medicine or any other strategy we now are using promotores with Santa Ana College they are called promotores de la educación and these are promotores teaching parents why university is important. These are these people from the community and we have a technical team that includes people like America you know the psychologists and the doctors and the social workers this is our technical team and these are our children and youth promotores we have more than 200 children and youth promotores our youngest community worker is six and they will go home by home doing outreach and they knew that they have an apple in their hand and the apple is better than a pizza thank you so much you know that's probably the 6 year old outreach then you have the 11 year old talking to city council or the 15 year old visiting the police and you know so you have these kids the vast majority unsupervised the vast majority taking care of their siblings so we have a group that is made out of siblings so our youngest kid in the group is three and it's a sibling of a kid that is 12 that couldn't participate unless we have the space for their siblings so they learn about CPR and fire prevention and poison control we have had for four years the program on poison control for the state of California and that grant that we get pays for their teachers and they like train and they go out to talk about injury prevention and guess what as they learn to prevent injury they as providers these kids are providers they are caregivers they go home alone with pedrito now they know how to prevent poison so you are investing in capacity but you also are treating these kids as part of the solution we have a lot of discourse about you know is it fair is it fair you know what maybe not but in the meantime while we discuss that why don't we have them as children promotores and they accumulate points they have points and in those points they relieve their points like a choppy cheese model talking about models of work right so you go and you just work you get 60 points and we have a little market with the things that people give us and they get a little calculator for 30 points and they are awesome and you can go anytime to our agency kids they learn to read better they learn to respect they learn about domestic violence they tell the parents to count to 10 and they tell us my dad is telling you that he has stopped drinking my mother has been crying for three days when we work with these kids you find these kids with a teacher that is not clean and that is a very good indicator that something is happening and we have had the possibilities of helping these kids with moms that are in the hospital and let them alone I mean what do you think a social worker will do if she finds this kid alone that kid is going to be removed so you also as you build community you have to find a way of the taking things and giving support to the families these are some of the kids so this is the part of culture that I promise I will share with you at a later moment what is there yes I want to share with you what we are doing with the obesity epidemic so these are the promotores doing outreach outreach is a key element of our work we find the people we don't believe we are entitled to anything we don't believe that people need to come to Latino Health Access because we have good programs we need to find them and be creative and we enter those homes we do home visits last year we did 40,000 outreach contacts in Latino Health Access 40,000 the year before we did more than 38,000 and this is door to door this is in the streets on an ongoing basis these are some of the kids that are promotores with dresses that their mothers made and this is just one example to tell you that our work in the community is very reciprocal there is not a person that I have met in the community that doesn't want to give something people don't want to be there receiving from you they want to engage in a reciprocal transaction with us and they are desperate for you to ask what can you do and they will cook the tamales for that health care they will do these dresses for their kids they will teach them how to dance they will clean the clinic when you are giving them services as long as you give them a mechanism to give back and stop treating our community like we are stupid because we are not we have so much to give the problem is that we have this dominant discord that says that you only can give if you have formal education and let me tell you the majority of the planet do not have formal education and in the planet we don't have hope the hope is in asking for people to share their talents their talents the carpenter the singer the person that knows how to make piñatas the person that is a natural advocate the mom that knows exactly how to help another mom to get that plan for the kid that is disabled all the time so you have to create a strategy that is reciprocal as a value so this is Maria who is in Breast Health we do it this is Latino Haldasa sharing the data that we collected so people can say what is important some of the programs that we have diabetes, cancer, domestic violence and of course all of our programs have to do with health disparities we don't do anything else but to deal with health disparities and the root causes of health disparities and I can tell you that when promotoras do outreach for breast cancer they get people to get their mammograms they have reached to 4,650 and almost a thousand were linked and received the mammograms promotoras are effective they care and they know how to engage people this is one kid coming to our injury prevention program the car seat and these are the kids that are coming also to the emergency room with no car seats people buy car seats in garage sales car seats that already were in an accident sometimes we do diabetes and we sell tamales to pay for eye surgery for people with diabetes we fight alcohol and liquor stores and we educate with creativity and we ask people what they think this is a Sahrape that I wanted to include in our discussion of culture and we ask the community what would be the best symbol to create a campaign on alcohol and they said a Sahrape because a Sahrape is something that will give work to the community so we said well we need a Sahrape like this and people said well you are not going to find a Sahrape like that nobody thinks a Sahrape like that you either have the table mat size or the big one when we have this conversation that does upholstery did I pronounce that right? upholstery so this guy has the machine for upholstery and he said you know I was I am not gothic anonymous I was a drug dealer in the community and he thinks if you allow me to do my 12th step with you I can do those Sahrapes this is what I am telling you this is a panel and he said how many Sahrapes would you do for us and he did how many do you need so we need 350 correct so he did 350 Sahrapes and we went with these Sahrape house by house and we said to people if your life has been taught by alcohol because you know someone that has died or is sick or is whatever in any way would you display this from your balcony and we will stay in a campaign in that community for a week you know by the third day you will see the entire community display Sahrapes and this again is something that you might not learn in one class but this is you talking to the community and being creative how can we embrace this in a campaign a campaign that has meaning control meaning courageous people with their talents look at that Sahrape that's one of my favorites then we ask people to tell stories and put it on that wall and I don't know how to say that in English again my English is very limited in many areas but it's like the wall that the Jewish community uses to pray that wall and we create a wall of the Sahrape and we ask people to write stories and put it there and that's what this kid is doing he's putting his story in that wall and for a week people will come and read the stories and this is a former addict who also was one of our community workers teaching others with his wisdom and his experience what happens this is a laundry mat and two women that are our promotoras both victims of domestic violence now leading the program on domestic violence they are leading the program they are our employees and they are having a program in a laundry mat this is a borracha connozir which for those of you that think it's foolish it means a well known drunk and it's just to make a joke of alcoholic anonymous she's not anonymous and Sahrape is also one of our lead promotoras in the domestic violence program and he's the community representative in our healthy city table in our multiple sector table this is one of the best advocates that community has together with another group of residents these are the kids doing the campaign the children from children initiative this is the domestic violence group the laundry mat and this is one promotor singing in a camping that we had with families in the domestic violence program because to be able to retreat with your family is a luxury it's a luxury we cannot ask people to think if you don't give them space to think have you ever felt that you needed space to think and you had time to think what happens to every human in the planet so we need to create mechanisms for people to think and reflect you need training and retreats and conversations that are for more than 15 minutes because if we don't create a space for people to think the only one that is going to think is you and only people can change if they think so thinking is a critical piece of your strategy where are we going to think Maria and Pedro and Mrs. Martinez and all of them these are the youth getting organized to fight the legal license which we won we won two times and then we lost and lost and lost so we are working more and more in policy for seven years we have been doing policy and trying to advocate for other things but I want to share with you the healthy weight program so we have this huge issue of obesity huge epidemic we are seeing diabetes in kids at 11 and 12 diabetes type 2 and let me tell you my friends that we are seeing people amputated at 40 and blind at 40 people that develop diabetes are 24 I don't know what is the math if these kids develop diabetes at 11 I don't know when they are going to be blind and I don't want them to be blind so we have this program on obesity and of course we have a health educator and of course we have a great program that teaches people how to eat and I love for people to learn about food label and nutrition and cars and fat and all of that so we have a very good program for kids and parents and we follow up not only they lose weight during the program but we follow up for more than a year in the Latino Health Access Program kids continue losing weight after a year 60% of them 60% continue because we don't follow up and all of that and the other 40% we don't know what happened they move or they continue increasing their weight 60% continue losing weight so it's a good program for kids and parents so we find a place we find a backyard a patio, a parking lot and this is the practical side this is where we are not blind we want to transform the planet but guess what we have a bunch of kids obese today so as much as I want to transform the world today someone is going to go blind so we sell tamales to pay for surgery and in the meantime while we get aboard we are going to do exercise in any place in that community we are in the today and we are in the tomorrow we are in the short term and we are in the long term so this is one of the bands that someone donated to us and of course the people that the kids that love to tag started tagging the the band and we were paying fines and fines to the city to transform the band in a fitness room on wheels so this band, this is the same band that the kids painted and now this band go to every place in the neighborhood for kids to play and these are your short term what they are called early wings and this is what gives people hope because then you can talk to them and say you were saying Mrs. Maria that is not safe for Pedernito to go out that actually you rather have him watching TV and you were saying that probably I couldn't understand that but guess what, we have a band now and you kept coming to the parking lot of the church so now we can talk about the future because we are providing solutions for the community now you are not that guy or that lady that lives elsewhere and just come with theory you are coming with plan for their kids now we can talk about the plan for Pedernito to stop watching TV because now I have an option, you are helping me to have an option these are the women coming to exercise the women coming to exercise because they want to be pretty nobody here want to transform the world or anything they just want to be pretty so we bring them to be pretty and then we invite them to learn about nutrition and the school and how the kids eat and then we invite them to the leadership training and we go into a leadership retreat with the women of the community there is nothing more powerful than the women of our community spirit it doesn't matter the color women are just amazing we are amazing but really there is plenty of research that says that when we educate the women of the world the world is transformed now you blame the researchers on that one but it works for us and these women I am telling you they are incredible and when they were trained they decided they wanted a park for their kids and they fought for that park and fought for seven years and provided testimonials in city council so full everywhere to get our park and this is one of the kids providing testimonials and this is the lot that was identified seven years ago and this is what you can see the Bill Moyers program this is what they feature they fight for this park and after seven years we actually got this park has four parcels three parcels belong to the city and one belong to a local market the city told us three parcels at $2 per year for 40 years if you find that order lot if you get the order lot well guess what we got the order lot and this local market gave it to us and after again seven years going into eight years this is going to be the first park in the 1901 and we are doing groundbreaking on November 15 and you are invited to enter for the families in this area with the help of St. Joseph Hospital Mark Hardy Engineer Taylor Architects Norgate Market and the people of Santa Ana and this is just 0.5 acre park what is our hopes for change right there and half acre this is going to be the park and this is our partnership we are fighting for policy changes policy changes we want those schools open the school closed at 2.30 there is no P.E. in the school at 2.30 we don't have access to the schools so we have the van and we have the classes and we are fighting for the park but we are fighting for even longer term things which is open the schools make those schools community centers for our community we are working with the police to make that safer we are working with the school we don't want the schools destroyed we want programs in those schools so we are not fighting against the school we are fighting with the school so we can get the resources to open those schools and it's complicated it's not simple and those are long term strategies these are the children visiting Lucorrea our senator visiting our city council member these are the kids marching for peace every time someone is killed in our community we march for peace and this is the families of that area going to a town hall meeting to finally decide what they want in the plan that is going to the California endowment for 10 years of funding for Santa Ana to become a help DC after all of these years trying one thing at another more and more partners that have money are trying to assist community with this and the California endowment actually selected 14 sites in California and Santa Ana is one of them and in that area now many years later we have 47 youth participating in the steering committee 47 adults and 30 organizations tomorrow we are approving the plan that is going to be sent to California endowment for 10 years of programs in one place in Santa Ana so you know many things to learn from the process but the families are ready to participate if you work to activate your community and the kids know what they want this is Arai the lady from the Domestic Violence Project this is Arai in one Domestic Violence Group and this is Latino Hope Access registering people to vote because if we don't vote we are not scary we are not we need to be some sort of threat and what really threatened in democracy when you play with democracy you need to vote an organized group of citizens is really the only threat for people to pay attention so I'm going to just finish there this is already one five I'm going to finish there to take some questions thank you very much and there are questions yes so so people invite us to do training the best way to do this is that you probably want to go and visit the Latino Hope Access and you can spend time there and go out to the promotores you can do outreach, you can learn about the agency the creation of the non for profit the way we find funding we are now 70 years in existence and there is a way of funding these programs that you want to learn so we have been invited to different places to train on promotores and I would be delighted to train with you from Oaxaca to Trinidad to Australia to New Zealand but the program is your program for Sierra Leone with the people of Sierra Leone hiding the people from Sierra Leone and getting money to pay them and having the community as volunteers no you only get volunteers from the community you get volunteers from the university but if you pay the university you pay the community how do you met Tom the program you discussed we are all positive in our community there was a certain sense that it was smooth because you went through it so quickly so our interest is you have an approach because not always when you try to bring people together you get agreement there can be two factions they want to do a very different way we have sort of consensus right? and I promise that I could come and have a conversation about the entire creation of these healthy cities and that with 130 so many in the same community how do we create consensus and trust and respect and it has been a long process but if you read the literature about healthy cities you are going to find something new the community was never engaged and they say the people that write this book say the only problem with this process was that the community was not engaged the only people at the table were professionals that get paid to participate so of course if I ask America to sit at the table I mean I am getting paid whether I am here in UCI or whether I am in a meeting so we said in Latino Health Services if we want to really create a healthy city the first thing we are going to do is to engage the community so that was 17 years ago and we started building trust with the community so at this moment many people in the community not all of them, the people because we are not entirely they don't owe anything to us but the people that have worked with us trust us so when the healthy city program came in a more formal way and we invited them to participate they came and we were able to negotiate and to talk because they would have their minds open and also because of the way we had relationship with the organizations we cooperated with them we even had a one day retreat just to talk about respect going to the answer respect and trust because the organizations were saying that the community needs training and the community was saying that the organizations need training the organizations were talking about logic models and the community was talking about a place for their kids to play and they were like one was in AM and the other one was in FM and here is there's a lot of work these are meetings at 7 in the morning at 9pm and Saturday with childcare and food and around $70,000 in stipends for the community to participate and people that were leaders and would participate the majority of them in the houses today you can clean too and we're going to give you a start so you can come at night to a meeting and the process has taken 15 months to submit a plan on June 2nd tomorrow the community is going to approve it and only because you asked I have to tell you that at the end the plan has this huge piece of immigration and the organizations were not expecting that the community wants immigration reform so if we find the public a healthy city plan that is going to a foundation and the city, the police probation is in the plan and the plan says immigration reform and it says that the police cannot stop people like they do in Arizona now the organizations are like ah we can't support that imagine this disaster and they will have to take this to the orange county for supervisors and of course we're going to approve that and finally we said you know we actually don't need the approval of the organizations for the plan we only need your work to improve systems of care we need your work to give us data to help us with but the one that needs to approve the plan is the community do we agree that the organizations will like yes so tomorrow in the afternoon we are going to have a plan that is approved by the community and supported by the organizations and if you think 50 months, it wasn't 50 months it was 17 years of work telling people, not only that but telling people something that I learned that I have dear in my heart in Latino potances could change sometimes by itself it would have happened correct? so we only have been able to do what we have been able to do which means that the only way of changing Santa Ana is to cooperate with all your heart and in order to do that we need to like each other you need to trust them you might be the police of Santa Ana but you need to trust them so we need to cultivate that too this is more human than what anyone can have this is about respect and cooperation and trust and if that isn't there then we can have it Steven Kovic from the 7 habits of highly effective people have you read that book? if you ever want to read a good book about what really is needed for change read that book he even talked about the emotional bank account which you need you need to put some money into the emotional bank account if you only have withdrawals and you betray me once and you betray me two and your account is in zero actually you owe me much so next time you want to party with me guess what? no so Steven Kovic says something in Latin and he says that in order for you to really engage with people you need three things ethos patos and love and that is you need a relationship with that person you need trust and if those two things exist then you can deal with knowledge and this is also what we try to share with people in medicine you will not be able to share any knowledge about diabetes with a person if you don't have a relationship if she doesn't trust you then you can talk about Congress same thing with the community you have a relationship, they trust you let's talk about change but if you only want to talk and that means time and you need to prove yourself where you are white, black, Latino or Native American you need to prove yourself the community doesn't care that you look Latino they care about the fact that you care it doesn't matter that you are white with beautiful blue eyes in that community they are not going to believe you because you are white or because you are Latino or because you are black but if you walk with me and for us it has been amazing to see the community engagement that we have in this project the residents want to create their own structure they don't even want to be part of Latino of access they want to have their own structure with their own decisions and they, this is amazing what is happening and we are just seeing that and saying you know when you do true community work people grow wings and then you need to build their earth with my friend because otherwise you need to chop their wings and that's not where we are going to do the community it's now convinced that going forward it's on your place based strategies the part that you are able to incur I was wondering if it's completely innovative in that like no one has ever done before in these types of communities and also what's the Maori's that people within the 1971 area come to this part consistently in order to get to the health benefits because for other parts or part areas did you have any plans you all saw right? what the first thing is that there are many projects on helping people around the world in Santa Ana this is the unique this is the first part that actually is our part the city doesn't want to have anything to do with the part because if the part belongs to the city they need to keep it open so in order for us to be able to close it even the community doesn't want the part open they want that part close and take with gates because they are afraid of what happens if we leave them open so you need to deal with all of that the part is just an urban part it's a little part for people to walk there so this is this is your class this is your band exercising with kids in parking lots this is your short term today this is your part in that little place where people can walk and this is open schools forever so people can have community centers all over the city so you work in short term and long term and that's why the true change the true change in community work happens when you do policy no matter what you do they say in healthy cities that you are going to start your public health strategies providing services diabetes, HIV that's the first level that you arrive and you skip all of that but I might want to do something just in healthy cities the first step, they talk about stages in healthy cities the first one you mentor a community with services you need to build trust you have to have something on value for that community more services with community engagement then the third level you do even more community engagement now you are hiring people from the community it's really big the fourth level you are starting to build good policy in the fifth level the city is now having to help policy in the general plan so we are in the fourth the city of Santa Ana doesn't have health at all in their policy plan the city of Irvine hired a person to deal with health I think two years ago and it's the only city in the county that actually has a health person there doesn't mean that it has great policies on health but it's the beginning of having something on the city without the policy change cities will not improve because it's because policies that people stores are in those neighborhoods that the parks are built in other places it's because policies schools don't open it's because policies that those streets don't have lights it's policy so if we don't work with policy we are going to be working with charity you get a grant, you put a little light and your grant is gone and that's the extent of it in a given moment you need to do that policy change and understand that if you don't change policies we are not going to be able to bring sustainable change on that note thank you very very much