San Antonio, TEXAS — During the 15th annual Mayor’s Fitness Council Breakfast on Dec. 11, the council honored Jason Rosenfeld with its 2024 Spirit of Service Award and Health Confianza with its 2024 Healthy Champion Award.
The Mayor’s Fitness Council (MFC) is a community-wide collaborative to reduce obesity in San Antonio. The mission of the MFC is to increase awareness and connect San Antonio residents to opportunities for improved emotional well-being, physical activity, and healthy eating.
Jason Rosenfeld, associate professor of medicine at UT Health San Antonio and co-director of Health Confianza, was recognized for a commitment to educating future public health leaders and the innovative health equity initiative titled, Health Confianza.
Rosenfeld and Melanie Stone, assistant professor of Family & Community Medicine and co-director of Health Confianza, established Health Confianza in 2020 to improve the health literacy of health professionals, organizations and community.
About Health Confianza:
Founded in 2021, Health Confianza is a collaborative, multilevel public health initiative aimed at creating a more informed, confident and healthier community. Through health literacy programs designed to help people make health decisions, we are increasing access to and utilization of health information and services. In keeping with its mission, Health Confianza, which is housed at UT Health San Antonio, has engaged with thousands of community members and provided support and training to numerous nonprofit agencies and clinics. In 2024, Health Confianza received the Promising Practice award from the National Association of County and City Health Officials (NACCHO) for its innovative approach and the strides it has made in improving health literacy in underserved, under-resourced communities in Bexar County. To learn how to get involved, visit HealthConfianza.org and WellnessCultura.org.
This article was co-authored and reviewed by Dr. Melanie Stone, DrPH, MEd, CHWI.
San Antonio, Texas — Every health care worker wants their patients and clients to leave an appointment recalling the conversation and knowing what steps to take next.
Unfortunately, that isn’t always the case. For some, an appointment can be an anxiety-filled experience, especially if there are language barriers, or a use of technical words that may make things hard to follow.
But there is a proven approach that can help.
What is Teach Back
Health literacy experts support the use of Teach Back — an evidence-based method — during conversations between health care workers and clients that can improve recall, understanding and adherence to treatment plans.
The Teach Back method is defined as asking patients, in a non-shaming way, to repeat, in their own words, what they need to know or do. For instance, understanding when and how to take their insulin, or how to properly use an inhaler to control asthma symptoms.
An effective way to learn how to use this strategy is a program called the 5Ts for Teach Back. Health literacy expert Kathryn Anderson and a team at the University of New Mexico Hospitals created the 5Ts method, which breaks Teach Back into five skills that can help health care workers do it well with every patient or client conversation.
The 5 Steps
The 5Ts are specific, observable steps: Triage, Tools, Take Responsibility, Tell Me, and Try Again.
Health care workers of various roles, from nurses and physicians to pharmacists and community health workers, rely on this method to get important information across to their audiences.
The following definitions of the 5Ts are excerpts from the original academic paper with some entries edited for brevity. Read the academic article for a more in-depth explanation of each step.
Defining the Steps
Triage – In the first triage step, a health worker determines which one to three topics are most important and will be the focus for education and Teach Back. Research has shown that the more information a clinician delivers, the less information the patient will remember correctly. The authors encourage a “chunk and check,” meaning you deliver one chunk of information and then check back to make sure it is understood. During the teaching step, the provider must use plain language and consider the patient’s cultural and linguistic background context.
Tools — A tool is broadly defined as any aid that can assist the clinician with providing a clear explanation. Reader-friendly handouts, simple pen-and-paper drawings, models or diagrams, use of the health care workers’ own body (such as using the fist to represent the heart pumping), or even a relatable story are possible tools.
Take responsibility — The Take Responsibility step is critical for the non-shaming aspect of the Teach-Back definition. This step happens once the health care worker has delivered a chunk of information. The health care worker may state, “That was a lot of information, and it can be hard to remember all that at once, so I want to make sure I did a good job explaining it.”
Tell me — During the Tell Me step, the health care worker invites patients to state, in their own words, what they understood. The ask needs to be specific, such as, “How will you use your glucose meter when you go home?” This allows the patient and the health care worker to focus on one specific piece of information so they are both on the same page. In some cases, the provider may ask the patient to show, rather than tell, such as demonstrating the use of an inhaler.
Try again — If the patient does not tell back correctly, the health care worker must explain the information again, modifying the explanation to make it clearer. This may mean using plainer words or using a different tool like a drawing or an analogy, to teach in a way that makes sense to the patient. Another round of Teach Back must be done to ensure correct understanding.
How effective is the Teach Back method?
There is a growing body of evidence that supports the effectiveness of Teach Back. It is associated with increased knowledge, better adherence to medical regimens, improved patient outcomes like glycemic control, and improved patient safety.
Teach back is also recommended by The Joint Commission, a nonprofit organization that accredits and certifies health care organization and programs in the United States. It is the number one ranked health literacy practice to teach trainees.
Preheat oven to 325 degrees F. Line a 3-quart rectangular baking dish with foil. In a small bowl, stir together brown sugar, cinnamon, and salt; set aside. In prepared 3-quart rectangular baking dish toss pumpkin with oil. Sprinkle brown sugar mixture evenly over pumpkin.
Bake, covered with foil, for 40 minutes. Uncover and stir pumpkin. Bake, uncovered, about 15 minutes more or until pumpkin is tender. Makes 10 (3/4-cup) servings.
Sauteed brussels sprouts with bacon and onions (side)
4 sprigs thyme or savory, plus 2 teaspoons leaves, divided
1 teaspoon salt
Freshly ground pepper, to taste
2 teaspoons lemon juice (optional)
Directions:
Bring a large pot of water to a boil. If sprouts are very small, cut in half; otherwise cut into quarters. Cook the sprouts until barely tender, 3 to 5 minutes. Drain.
Meanwhile, cook bacon in a large heavy skillet over medium heat, stirring, until brown but not crisp, 3 to 6 minutes. Remove with a slotted spoon to drain on a paper towel. Pour out all but about 1 tablespoon bacon fat from the pan.
Add oil to the pan and heat over medium heat. Add onion and cook, stirring often, until soft but not browned, reducing the heat if necessary, about 4 minutes. Stir in thyme (or savory) sprigs, salt and pepper. Increase heat to medium-high, add the Brussels sprouts, and cook, tossing or stirring occasionally, until tender and warmed through, about 3 minutes. Remove the herb sprigs. Add the bacon, thyme (or savory) leaves and lemon juice, if using, and toss.
Herb-roasted turkey
Servings: 12, calories: 172, protein: 25g
Ingredients:
10- to 12-pound turkey
¼ cup fresh herbs, plus 20 whole sprigs, such as thyme, rosemary, sage, oregano and/or marjoram, divided
Position a rack in the lower third of the oven; preheat to 475°F.
Remove giblets and neck from turkey cavities and reserve for making gravy(optional). Place the turkey, breast-side up, on a rack in a large roasting pan; pat dry with paper towels. Mix 1/4 cup minced herbs, 2 tablespoons oil, 1 teaspoon salt and 1 teaspoon pepper in a small bowl. Rub the herb mixture all over the turkey, under the skin and onto the breast meat. Place 1 1/2 cups aromatics and 10 of the herb sprigs in the cavity. Tuck the wing tips under the turkey. Tie the legs together with kitchen string. Add 3 cups water and the remaining 10 herb sprigs to the pan.
Roast the turkey until the skin is golden brown, 45 minutes. Remove from the oven. Cover the breast with a double layer of foil, cutting as necessary to conform to the breast.
Reduce oven temperature to 350°F and continue roasting until an instant-read thermometer inserted into the thickest part of a thigh without touching bone registers 165°F, 1 1/4 to 1 3/4 hours more. If the pan dries out, tilt the turkey to let juices run out of the cavity and into the pan and add 1 cup water.
Transfer the turkey to a serving platter and cover with foil. Let the turkey rest for 20 minutes. Remove the string and carve.
1 lb. sweet potatoes, unpeeled, cut into 1/2″ cubes
2 Tbsp neutral oil
1 tsp salt
1/4 tsp freshly ground black pepper
Directions:
In a large bowl, toss potatoes with oil and salt. Spread on a baking sheet, then cover with foil, crimping edges to seal.
Arrange a rack in the center of the oven. Place sheet on rack; preheat oven to 450°.
Leave potatoes in the oven for 20 minutes (they will begin to cook as the oven heats up). Remove foil from pan and continue to roast until potatoes are caramelized and tender, about 10 minutes more.
3 (8 ounce) packages haricots verts (French-style green beans), trimmed
5 teaspoons unsalted butter
¼ cup sliced or slivered almonds
1 large shallot, minced
2 cloves garlic, minced
¼ cup dry white wine
¾ teaspoon salt
½ teaspoon ground pepper
Directions:
Bring 1 to 2 inches of water to boil in a large pot fitted with a steamer basket. Fill a large bowl or pot with ice water and set it near the stove. Steam haricots verts until tender, about 3 minutes. Transfer them to the ice water and let stand in the water for about 5 minutes. Drain and pat dry with paper towels.
Melt 5 teaspoons butter in a large skillet over medium-low heat. Add ¼ cup almonds; cook, stirring constantly, until light golden brown, 6 to 8 minutes. Transfer the almonds to a plate.
Increase heat to medium. Add shallot and garlic to the pan; cook until fragrant, 1 to 2 minutes. Stir in ¼ cup wine; cook until slightly thickened, 1 to 2 minutes. Stir in the beans, the almonds, ¾ teaspoon salt and ½ teaspoon pepper; cook, tossing to coat the beans with the sauce, until heated through, 2 to 3 minutes. Remove from heat.
Crispy potatoes
Recipe found on: https://thecleaneatingcouple.com/crispy-sheet-pan-roasted-potatoes/
Making oven roasted potatoes is pretty simple. You’ll just need:
olive oil
potatoes
salt, pepper, garlic powder, onion powder
a baking sheet + parchment paper.
You can use coconut oil, grapeseed oil, or avocado oil.
Cut potatoes: To cut potatoes, first slice them lengthwise into slabs. Then slice them into thick fry-like shapes. Finally, cut potatoes into cubes.
In a bowl, toss together cut potatoes, olive oil + spices. Make sure all pieces are evenly coated
Spread out potatoes on a lined baking sheet
Bake at 450° for 20 minutes and stir potatoes to make sure all sides are getting evenly cooked. Bake for an additional 20 minutes until the potatoes are browned.
The South Texas Community Health Workers Workforce Preparedness Collaborative (STCWPC), an initiative led by UT Health San Antonio, is celebrating the first community health worker apprentices to graduate from its program in South Texas during National Registered Apprenticeship Week, Nov. 17–23.
Established in 2022 to train community health workers (CHW), STCWPC integrates public health competencies into community health training, and advocates for greater CHW employment. These apprenticeship programs are relatively new in the field, but advocates believe they will help to elevate field growth through standardized professional development.
As part of its registered apprenticeship program, STCWPC provides annual stipends for CHW apprentices and mentors, manages documentation for the registered program, provides technical assistance in the design of apprentice evaluation and on-the-job training activities, and can support employers in finding complimentary funding for apprenticeship training.
Community First Health Plans, which offers health care coverage for individuals and families, recently graduated two employees from its apprenticeship program, leveraging support from STCWPC.
“I am so happy that this CHW apprenticeship program was able to address the workforce needs [Community First Health Plans] identified,” said Jason Rosenfeld, associate professor of medicine at UT Health San Antonio and director of the STCWPC. “Community First provides the example, as the first employer to sign up for our registered apprenticeship program and have their apprentices complete their training, for how other health and social service agencies in the region can develop their own, in-house CHW training programs.”
The collaborative is looking to assist more employers in early 2025. To receive assistance, employers must reach out to STCWPC by mid-February 2025.
If you are a hiring manager or employer who wants to learn more about hiring or upskilling a CHW apprentice, watch the collaborative’s recent webinar “Hire a Community Health Worker Apprentice: We’ll do the Heavy Lifting.”
SAN ANTONIO, Nov. 6, 2024 – Bexar County awarded The University of Texas Health Science Center at San Antonio (UT Health San Antonio) three grants totaling $9.9 million in federal coronavirus relief bill funding to improve access to health care and create a more equitable and resilient community.
Money from the legislation, known as the American Rescue Plan Act (ARPA), locally will support further recovery from the COVID-19 pandemic in addressing addiction from substance use, behavioral health and long COVID.
Bexar County selected UT Health San Antonio’s Be Well Institute on Substance Use and Related Disorders, a statewide system of substance use and mental health services, for two, two-year grants totaling $7.6 million to support local substance use treatment and peer recovery support services. And Health Confianza, a countywide multilevel health literacy initiative of UT Health San Antonio, will receive a two-year, $2.3 million grant to address long COVID and health literacy challenges.
Jennifer Sharpe Potter, PhD, MPH
“This funding is a lifeline for individuals in Bexar County who are struggling with homelessness and substance use disorders,” said Jennifer Sharpe Potter, PhD, MPH, vice president for research at UT Health San Antonio and founding director of its Be Well Institute. “Too many people are unable to get the care they need due to limited access, fragmented care and stigma. With this support and the partnership of local organizations, we can bring compassionate, evidence-based services right to our community, ensuring no one is left behind.”
For Health Confianza, the Bexar County grant comes on the heels of the Promising Practice award from the National Association of County and City Health Officials (NACCHO) for its innovative approach to improving health outcomes in underserved, under-resourced communities in San Antonio. Health Confianza collaborates with organizations, health professionals and the community to reduce health inequities using health literacy strategies. A few of the key benefits of health literacy include improved health outcomes, increased ability to navigate the health care system and lower health care costs.
Jason Rosenfeld, DrPH, MPH
“This grant will enable us to empower community members to take charge of their own physical and mental health through our team of dedicated community health workers, said Jason Rosenfeld, DrPH, MPH, associate professor at UT Health San Antonio and co-director of Health Confianza. “At the same time, Health Confianza’s work will help to increase the efficacy and coordination of services of health and social service agencies in Bexar County. When you improve health literacy, you improve the well-being of people living in Bexar County.”
The effects of the pandemic
Congress passed ARPA in 2021 to address the economic and public health impacts of COVID. More than five years after the start of the pandemic, Americans still are experiencing its broad effects, especially those in vulnerable populations with barriers to health care.
Be Well Institute is using its funding to deliver two critical programs aimed at addressing substance use and recovery support in Bexar County. In collaboration with Corazón San Antonio, Be Well Institute is launching a Mobile Medical Team to meet the urgent need for substance use treatment among individuals experiencing homelessness, led by project director Tara Karns-Wright, PhD, MS.
This initiative combines Be Well Texas’ expertise in addiction care with Corazón’s trusted outreach services, providing in-field care, addiction treatment and comprehensive coordination to enhance access to vital health services for this vulnerable population.
Additionally, the funds will enable the launch of the Bexar County Community Recovery Support Services initiative in collaboration with community partner Unity Recovery, with Potter as project director. This project will establish the county’s first recovery community organization and recovery community center to offer peer-led recovery services for individuals facing substance use and mental health concerns, including those at elevated risk of experiencing an overdose.
Operating seven days a week, the center will provide peer recovery support services to individuals and family members, while also expanding the workforce to increase access to peer support services and improve long-term outcomes across the community.
The pandemic also highlighted the health disparities vulnerable communities face, such as poverty, housing instability and lower health literacy, which lead to higher rates of chronic diseases and worse health outcomes.
With Bexar County’s funding, Health Confianza and its main partners — Southside Collaborative, South Central AHEC (Area Health Education Center), WestCare Foundation and YWCA San Antonio — plan to expand health literacy training and programming into 12 high-priority ZIP codes in Bexar County. In keeping with ARPA goals, Health Confianza will also focus on long COVID, chronic illness, and mental health education and training.
Melanie Stone, DrPH, MEd
It is estimated that one out of every five people who have COVID can go on to develop long COVID.
“Long COVID is now a recognized chronic illness, and our understanding of it is growing,” said Melanie Stone, DrPH, MEd, assistant professor of family and community medicine at UT Health San Antonio and co-director of Health Confianza. “Research has shown that it can trigger other issues that our communities already struggle with, such as diabetes and heart issues. By making systemic health literacy improvements, such as equipping organizations to provide better access to long COVID and preventive health education and services, we are helping individuals achieve enhanced well-being for themselves and their families.”
(As of September 30, 2024, Bexar County has chosen to change the source of the funding for the Agreement. The funding for the Agreement will no longer be ARPA SLFRF funds. Rather, as of September 30, 2024, Bexar County has chosen to fund the unspent amount of the Agreement with non-federal funding.)
The key to unlocking improved health outcomes in the United States has been in our hands for hundreds of years: community health workers.
Also known as community outreach workers, patient navigators, health educators, community health representatives and promotores de salud, community health workers deliver a variety of health and social services to people where they live, learn, work and play. They are trusted members of their community, sharing a common ethnicity, language, culture and life experiences.
They connect individuals to resources, and improve quality and cultural competency of care. They build individual and community capacity to increase health knowledge, health behaviors and, ultimately, better health outcomes.
More than 60 years of evidence in primary care, maternal health, chronic disease interventions, immunizations, oral health and HIV care proves community health workers play a crucial role in improving the health of our country.
In Texas, there are more than 5,000 certified community health workers, along with many others working without certification. All are on the front lines of health care to serve our most vulnerable populations.
Unfortunately, community health workers remain on the fringes of public health. With less than 3% of U.S. health care expenditures going to public health and disease prevention, these positions are often grant-funded, contributing to a lack of sustainable recruitment, training, professional development and career pathways.
The good news is the U.S. government has significantly invested in building the community health workforce, an interest renewed in part by COVID-19.
In 2022, the Health Resources and Service Administration granted over $225 million to train community health workers. Three San Antonio organizations received $9 million of these funds. We represent one of these programs, a community-academic collaborative led by the University of Texas Health Science Center at San Antonio (UT Health San Antonio). As part of our efforts, we bring together training centers and employers in an apprentice program to elevate the community health workforce in South Texas.
Like apprenticeships for trades and professions such as plumbing and electrical, a community health worker apprenticeship is a structured training program that combines on-the-job learning with classroom instruction.
Through registered apprenticeships, employers can learn how to optimally integrate community health workers into their organization and mold future leaders to meet the needs of the populations they serve.
As a cross-sector workforce, community health workers work beyond inpatient and outpatient health care. They also work in schools, government agencies, faith-based organizations, neighborhood centers, on the street, and in libraries, pharmacies, affordable housing purveyors and other trusted organizations.
These organizations already face a demand among patrons for linkages to health and social services. A community health worker can alleviate these tasks and allow other team members to focus on other responsibilities.
From the standpoint of an employer, there is no better time to train future health professionals through a registered apprenticeship program. The city of San Antonio’s Ready to Work program and Alamo Workforce Solutions have funds to support the salaries of new and current workers in apprenticeship programs. Our community health worker training program also provides technical expertise in designing job descriptions, executing on-the-job training and mentorship.
One of the most influential actions a South Texas employer can take this year is hiring a community health worker to prioritize health and well-being. By pulling community health workers from the fringes and into a formalized apprenticeship pathway, we can strengthen the entire public health ecosystem.
Shayanne Martin is a senior project manager with the Charles E. Cheever Jr. Center for Medical Humanities and Ethics at UT Health San Antonio. Dr. Jason Rosenfeld is an associate professor of medicine at UT Health San Antonio and co-director of Health Confianza.
San Antonio, TEXAS — The National Association of County and City Health Officials (NACCHO) selected Health Confianza and the City of San Antonio Metropolitan Health District (Metro Health) with its Promising Practice Award for their work to improve health literacy in underserved areas in San Antonio.
The award was presented on Thursday, July 25, at a ceremony during the annual NACCHO360 Conference held in Detroit, Michigan. “Each year, we are thrilled to recognize the incredible work of local health departments through our Model and Promising Practice Awards,” said Lori Tremmel Freeman, NACCHO CEO. “This year’s awardees have demonstrated exceptional service in developing programs to address substance use, health inequities, infant and child health, health literacy, immunization, foodborne illnesses, hepatitis, and other pressing health challenges in their regions. This recognition is sure to inspire continued excellence and progress in public health practices across the country.”
Health Confianza began as a partnership between The University of Texas Health Science Center at San Antonio (UT Health San Antonio), Metro Health and The University of Texas at San Antonio with funding from the U.S. Department of Health & Human Services Office of Minority Health. In 2024, Health Confianza transitioned to UT Health San Antonio and is housed at The Charles E. Cheever, Jr. Center for Medical Humanities & Ethics.
“We are honored to be recognized for Health Confianza’s innovative approaches to public health and health equity,” said Jason Rosenfeld, DrPH, MPH, associate professor at UT Health San Antonio and co-director of Health Confianza. “To sustainably address health inequities, we must address health literacy at the community, workforce and organizational levels – it shouldn’t be the sole responsibility of already marginalized communities to change. It’s incumbent upon all of us to design more responsive systems to deliver culturally and linguistically appropriate services and information.”
Jason Rosenfeld, DrPH, MPH
About 90% of Americans struggle with health literacy challenges, resulting in worse health outcomes, less use of preventive health services, more emergency room visits, fewer cancer screenings and fewer immunizations, and leading to billions of dollars in avoidable health care expenses.
“This U.S. Department of Health and Human Services’ Office of Minority Health grant allowed Metro Health, UT Health San Antonio and partners to launch a health literacy initiative in our community’s under-resourced neighborhoods,” said Metro Health Director and past president of NACCHO Dr. Claude A. Jacob. “These milestones showcase the new ways Metro Health and overall partners have grown and positioned themselves to impact our community’s well-being. I would like to congratulate Drs. Jason Rosenfeld and Melanie Stone (of Health Confianza) for the collaboration, and I am very proud of this national recognition.”
Melanie Stone, DrPH, MEd
“People with low health literacy may not be able to follow instructions on a prescription label, navigate the jargon on health insurance paperwork or know how to make diet changes to prevent diabetes — one of our community’s biggest health challenges,” said Melanie Stone, DrPH, MEd, an assistant professor of Family and Community medicine at UT Health San Antonio and co-director of Health Confianza. “We know health literacy can improve people’s confidence in their ability to make good health decisions for themselves and their families. We hope this award raises awareness of the importance of health literacy and encourages greater community involvement in our efforts.”
Since its inception three years ago, Health Confianza has been featured by global, national, regional and local entities – including the National Academies of Science, Engineering Medicine and now, NACCHO. As a Promising Practice winner, Health Confianza’s strategic model will be featured in NACCHO’s Model Practices Database for other local health departments to review and replicate.
Additional Information:
Established in 2021 as a response to the COVID-19 pandemic, Health Confianza is a collaborative program that utilizes health literacy principles and strategies to enhance health equity for those individuals living in ZIP codes with the most significant health disparities. The goal is to equip people with skills and access to scientific/accurate health information to make informed health decisions for themselves and their families.
Health Confianza offers an innovative Health Literacy Pledge Program for organizations, a peer-based Community Health Club Program for community members, workforce training, mobile clinics, and accurate and accessible bilingual health communications. All programs are provided at no cost to participants.
In 2022, the City of San Antonio Metro Health’s COVID-19 Community Response and Equity Coalition (CREC) was recognized by NACCHO with an Innovative Practice Gold Award acknowledging the efforts of community partners that included Health Confianza.
San Antonio, Texas — Melanie Stone, director of Community Service Learning at The University of Texas Health Science Center San Antonio and co-director of Health Confianza, recently spoke with The School of Public Health at UT Health San Antonio about health literacy and planetary health.
Read the quick 2-minute Q&As below.
Melanie Stone
Q: What is health literacy?
A: Simply put, it’s being able to find, understand and use health information to make decisions that position you for greatest success for health.
Q: Why is health literacy important to health care?
A: As I point out to my students, what is the point of being a health care professional if your patients walk away from your encounter not knowing what to do?
Q: Why is health literacy important to public health and the health system?
A: Community members should not be bearing this burden of health literacy. We need to fix the underlying issues that make our health system so difficult to use.
Q: What program do you oversee and what are its goals?
A: Health Confianza is a novel approach to health literacy, using multi-level strategies that couple technical expertise with trusted partners in the community.
Q: How does organizational health literacy help clients and patients?
A: Organizations have a responsibility to create policies and practices that ensure their health services are able to be used as effectively as possible.
Q: What do you want public health students to know about the power of health literacy?
A: People want to do what’s best for their and their family’s health. Let’s do what we can to make it a level playing field and give everyone that chance.
Stone organizes an annual Community Service Learning conference. Last year, the theme was “One Planet. One Health” conference, exploring the ties between public health and the environment.
Q: What is the difference between planetary health and global health?
A: Planetary health is a transdisciplinary field focused on human disruptions to the planet, inclusive of global health, OneHealth, environmental science, and more.
Q: What did you find most surprising as you delved into this topic during the conference?
A: I was surprised that the US health care sector is a leading contributor to carbon emissions globally. We can do better.
Q: In your opinion, what is the biggest public health challenge related to planetary health?
A: Public health must lead the way in making decisions that will affect our planet for coming generations, while ensuring equity in our mitigation efforts.
Q: What can those in the health professions do to improve our planetary health?
A: Be mindful of the needless waste occurring every day in hospitals and clinics and be advocates for change.
Q: What message can we give to our future generations of leaders?
A: We believe that collectively our actions will reverse the tide and open new pathways to a sustainable future. Time is ticking, but it’s not too late.
San Antonio, Texas — When Guadalupe Campos and Miguel Padilla arrive at Family Service’s The Neighborhood Place in San Antonio’s Westside, they have homemade food in a crockpot, fruit and snacks. With warm smiles, Campos and Padilla turn a classroom space into a cozy retreat with delicious aromas, a welcoming spread for people to come in and grab a place to sit and talk.
The husband-and-wife team, who work for the City of San Antonio Metropolitan Health District’s Healthy Neighborhoods program, co-facilitate a Community Health Club that can best be described as a mix of an adult learning annex and neighborhood party.
Community Health Clubs are a free peer-to-peer learning format focused on improving health and wellbeing. Health Confianza, a health literacy initiative housed at The University of Texas Health Science Center at San Antonio, provides community members with Community Health Club facilitator training, curriculum and ongoing support for clubs throughout Bexar County.
The most successful and effective clubs are tailored to whatever the community needs and are constantly reinventing themselves. Campos and Padilla’s club is a great example of how a club is a living, evolving organism all its own.
Campos started the club about two years ago during the COVID pandemic and Padilla followed as a co-facilitator. Since then, the club has continued to be active, attracting a group of eight to 10 women every week who are predominantly Spanish speaking. Many are retirees or stay-at-home mothers.
In addition to common life experiences, these women share a desire to learn new things and keep moving forward, Campos said, adding this environment of learning and transformation is why they named their club Grupo Nueva Vida, which means New Life Group.
Campos and Padilla have facilitated meetings on nutrition, COVID-19 and computer basics, but they’ve also handed over leadership to other members to facilitate sessions on different subjects. The club format stresses the power of sharing collective knowledge and community wisdom.
“We are a group with a lot of talent. I didn’t know Julieta could teach about real estate, Ernestina knew sewing, or that another knows Eastern medicine. That’s the purpose is to bring out our talents,” Padilla said. “That’s the purpose of the group. It’s not static. It’s not only one thing. Through one another, we can keep learning different things and having different discussions.”
Some of the members have been with the club more than a year, while others a few months, but they all say it is a place they want to keep returning to. When talking about the club, members report feeling relaxed, comfortable and a sense of belonging.
While topics covered during the club may not always be directly health focused, such as the sewing meetings, Padilla said, they are fulfilling a need to learn and socialize.
“If they are relaxing in our club, that is good for their health,” he said.
We sat down recently with club members and asked about their experiences. Below is an excerpt of some of that conversation (translated into English).
Community Roundtable with Grupo Nueva Vida
Maria Rodriguez
“I was invited by Lupita and Miguel Angel. We’ve known each other many years, but we ran into each other again recently. I have been coming here about a month and a half. It’s interesting. I’ve been learning a lot and enjoying the festive atmosphere with the other ladies. I look at all their faces, happy like mine. That helps me and I think that helps them too – to be part of this program that has so many benefits.”
Josie Torres
“I’ve liked everything that I’ve learned here. My (volunteer) work wanted me to work three days in a row, but I told them not on Tuesdays because that’s the day I go to my class. I like it because I feel very relaxed here. Thank you to Angel and Guadalupe. They have a lot of patience.”
Sol Castillo
“I’d like to give thanks to Miguel Angel and Guadalupe for giving us the opportunity to learn things that we might only know a little bit about. Here, we really learn the topics, like finances, health, sewing and decorating. The company is great and we really eat well. We cannot really say a bad thing because we are comfortable here and we look forward to Tuesdays. Like Josie said, it’s relaxing here.”
Julieta Hernandez
“A friend told me that there are some meetings (at the club) here and I just started coming. I am a person who if I have something to give or something to learn, I love to do it. It has been such a privilege for me. I’ve become very comfortable here and have taken advantage of the meetings. I’ve learned about email, sewing and other things. I really like sharing and supporting each other. I’ve seen a closeness develop. I’m listening and learning from other people. We are good here. One relaxes and feels comfortable more than anything.”
Ernestina Galvan
“I love supporting and belonging to various groups. I try to learn lots of things. For a long time, my job has been sewing. I’ve been at it for many years. I have a lot of experience and I want to share that before I leave. It’s not a good paying job but it’s always there, and it is needed in all parts and all communities. In this group, I’ve gotten to know Lupita a little more. We were already in various groups together. But I’ve very grateful to them both. It’s my first steps toward doing what I want to do. I’m grateful to them and to all the girls. I’ve met new friends here. We all have a lot of talent to put forward and share.”
Juanita Mendoza
“Now that I’m not working a lot, I love coming here because I’m learning so many things. For example, about finances, social security and different things about health. I really like coming and inviting people to come because the meetings are really very interesting.”
San Antonio, Texas — As soon as Abraham Baistra, a student at Cast MED High School, heard about the new Community Health Club at his school he was curious.
CAST MED puts an emphasis on project-based learning, medical and biomedical education, college pathways and student organizations. Baistra, a college-bound senior who is interested in a career in medicine, was drawn to discussions the club was having about barriers to health in the community he lives in.
“CAST MED is a small school. We have about 200 students. At the meetings I learned about the changes that can happen in your own community. I thought it was a fantastic idea and I wanted to be part of it,” Baistra said, adding. “We are on the Southside of San Antonio. We learned from our guest speakers that this area is very underserved, and we need help with our health.”
Community Health Clubs are a peer-to-peer learning model focused on improving health literacy in underserved areas, so that people have the information and confidence they need to ask questions and make the best decisions for themselves and their families. Health Confianza, a health literacy initiative serving Bexar County, provides training, curriculums and support for Community Health Clubs across the county.
Jeanette Jacobs, a CAST MED teacher with a doctorate in nursing education, started the club after a professional connection introduced her to Jason Rosenfeld, co-director of Health Confianza and director of Global Health Education at the Charles E. Cheever Jr. Center for Medical Humanities and Ethics. Jacobs admits she didn’t immediately understand how the Community Health Club model could fit into a high school setting.
“I was really struggling with the concept of Community Health Club. I could visualize it in the community, but I was really struggling to see how it would work in schools,” Jacobs said. “A school is a community, and once I realized that, it fell into place for me.”
The group, which includes Jacobs and the school nurse, now has about 30 members. They are called Advocates for Salud (Health).
With direction from Jacobs and Rosenfeld, the students chose a topic of discussion – school lunches. They invited the San Antonio Independent School District’s Child Nutrition Services Department to learn more about how school lunch menus are designed, where the food comes from, and how nutrition is factored into every step of the process. At the same time, they were doing their own self-discovery and sharing what they learned with fellow club members.
“The students now realize that their school has a system for developing what they eat. This isn’t only a school district choice. The food and menu are state influenced and influenced by federal government. They are seeing a systems approach,” she said.
Both Jacobs and Baistra see a for future Advocates for Salud next school year.
Baistra would like to see the club members do more community outreach next year, helping to share the knowledge they gain.
“I think we could help in bringing ideas to others and to work in the community,” he said.
Jacobs is excited about continuing the club and sharing the nutrition and mental health curriculums with students. On top of this, she plans to use the clubs as an example of the importance of health education in schools. In her personal time, Jacobs advocates for the inclusion of health education at all public schools.
“My mission is to let boards of education know that health education should be mandatory. It’s unjust that not all schools are able to offer health education,” she said. “The Community Health Club helps to fill the gap and deliver health education to our students.”
and support for Community Health Clubs across the county.