Violence prevention, health promotion coming together: Projects creating healthier neighborhoods
================================================================================================

* Teddi Dineley Johnson

In Louisville, Ky., some liquor retailers are taking down alcohol ads that once covered their exterior walls. In Chula Vista, Calif., long-vandalized utility boxes are being painted and transformed into works of art. And in a Denver neighborhood, youths at risk for gang violence are sowing seeds of hope in a community garden.

On the surface, the three scenarios might appear to lack a common thread, but joining them is an emerging public health movement that brings practitioners in the fields of violence prevention, healthy eating and active living together to transform their communities in ways that will foster health and safety.

At its core, the work aims to get to the root cause of why some people are not going outside to exercise and not eating healthy foods, said Mighty Fine, MPH, CHES, a public health practice manager in APHA’s Center for Professional Development.

“Promoting healthy eating and physical activity are front and center on the nation’s public health agenda, but people who feel unsafe in their communities are less likely to go outside for walks, take their children to parks or use community centers or services such as public transportation,” Fine said. “And to make matters worse, grocery stores are reluctant to locate in communities in which people feel unsafe, which limits residents’ access to healthy foods.”

Until recently, the connection between violence and health outcomes has not been intuitively apparent to the public health community, and the lack of attention has prevented some people from living a healthy lifestyle, Fine said.

“Initially, it may be hard for people to grasp the concept and understand where the intersection is, but there is an intersection between preventing violence and promoting healthy eating and active living,” Fine aid. “This initiative connects the dots.”

Science clearly upholds the connection between the physical and social environment and a range of behaviors, including violence, exercise and healthy eating, said Howard Spivak, MD, director of the Division of Violence Prevention at the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control.

“What we now have is a growing body of science that is documenting that there is a link between involvement with and or exposure to violence of various sorts and a whole spectrum of chronic illnesses,” Spivak, an APHA member, told *The Nation’s Health*. “And one of the elements of this is a growing understanding of the relationship between violence and how people eat and their risk for obesity, among other things.”

Violence influences where people live, work and shop, according to a 2010 report from the Prevention Institute. The report said prevention strategies are less effective when fear and violence pervade the environment. In other words, designing neighborhoods that encourage people to walk or bicycle to public transit, parks and healthy food retailers, and efforts to bring healthy food retailers into “food desert” communities are useless if residents are afraid to go outside.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/42/3/1.3/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/42/3/1.3/F1)

Volunteers in Chula Vista, Calif., paint designs on neighborhood utility boxes in 2010.

Photo courtesy Prevention Institute

To affect change, the report calls on leaders and advocates from multiple community agencies and organizations — including housing, law enforcement, parks and recreation, city planning, public works, schools, school districts, transportation and youth service organizations — to come together in innovative partnerships.

“We have heard from both sides that the two fields — the violence prevention field and the healthy eating and active living field — have been working in very siloed approaches,” said report co-author Virginia Lee, MPH, CHES, a program manager at Prevention Institute. “Part of this project was thinking about partnerships in a new way. For some, it is the first time the healthy eating folks are talking to the violence prevention folks. A lot of times I don’t think there is an explicit connection.”

## Community programs tackling problems

Translating research into community-level practice, the Convergence Partnership — a national collaboration of funders — in 2010 awarded grants to six pilot projects to explore the effectiveness of community-based strategies for violence prevention and the promotion of healthy eating and active living. Communities selected for pilots were in Chula Vista, Denver, Detroit, Louisville, Philadelphia and Oakland, Calif.

The pilot projects have now been completed and the results are promising, Lee said. For example, in western Chula Vista, an 18-month pilot project has resulted in people feeling safer and walking more, said APHA member Dana Richardson, senior director for advocacy and community health at Community Health Improvement Partners in San Diego.

Joining to improve safety in public spaces that were highly affected by violence, Chula Vista community partners — including more than a dozen middle school and high school students — tackled safety concerns at three trolley stations, two public parks and a neighborhood apartment complex. The students took photos of safety concerns at the sites, and incorporated them in a 136-page report to city leaders that included the students’ recommendations for improving safety, such as eliminating graffiti, improving lighting, prohibiting drinking in the trolley stations’ parking lots and making healthy foods and beverages available in the vicinity of the parks and trolley stations.

![Figure2](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/42/3/1.3/F2.medium.gif)

[Figure2](http://www.thenationshealth.org/content/42/3/1.3/F2)

In Denver’s Westwood neighborhood, community volunteers beautify their surroundings in May with a colorful mural.

Photo courtesy Eric Kornacki

A unique aspect of the pilot involved painting eight municipally owned utility boxes that had long been targets for graffiti. In a series of art workshops that drew about 100 community volunteers and artists, colorful art designs were created and painted on the utility boxes.

“It doesn’t seem like much, but by virtue of people seeing the art on the boxes, it made the area more interesting to walk in and more culturally appropriate,” said Richardson, who noted that the boxes, though painted a year ago, remain undisturbed by vandals and graffiti.

“Graffiti is a public safety concern in most communities, and the presence of graffiti is something that makes people not want to come out because neighborhoods can be identified as gang territory,” he said. “Bringing in art is a unique way to increase physical activity opportunities, makes the environment more community oriented and makes you feel safer.”

Students were also key players in a pilot project in Louisville. Though violence had declined in the city’s Shawnee neighborhood, many residents remained afraid to go outside, said Angela Hollingsworth, community outreach coordinator at the Louisville Metro Department of Public Health and Wellness.

To get to the root cause of their reluctance, 23 students interviewed residents and concluded that an abundance of liquor store signage was contributing to the residents’ perception of feeling unsafe.

The liquor stores “were plastered with alcohol signs, in the stores, outside the stores, on the curbs,” Hollingsworth said, adding that some of them were life-size posters depicting scantily clad women offering beer.

Over time, however, some liquor store owners started to pay attention to the students outside who were filling out surveys and talking about health equity, and they began to remove the signs themselves, Hollingsworth said.

“We took pictures at the beginning, before we started with everything,” she said. “A year later, we went back and took pictures again and where there were liquor stores — free-standing liquor stores that were literally plastered with alcohol signage all the way around outside — a year later all of the signage is down.”

To the west, in Denver, a community garden project gave at-risk youth a unique opportunity to dig deep for the root cause of violence in Westwood, a neighborhood that has long lacked access to healthy foods.

![Figure3](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/42/3/1.3/F3.medium.gif)

[Figure3](http://www.thenationshealth.org/content/42/3/1.3/F3)

In Denver, Nobel Peace Prize winner Rigoberta Menchú Tum, center, tours a community garden tended by at-risk youth.

Photo courtesy Eric Kornacki

“More retailers would come in if it was a safer community,” said Eric Kornacki, executive director of Revision International, a nonprofit organization that focuses on sustainability initiatives in low-income neighborhoods. “We’ve done surveys and community members have responded almost overwhelmingly that they don’t feel safe walking to a local retailer, both because of the built environment and also because of the perception of violence.”

Using urban gardening as a prevention strategy, the pilot project, Semillas de Esperanza, or “seeds of hope,” taught gardening skills to 12- to 17-year-olds who were at risk for joining a gang or were already in a gang. Some of the youth who participated in the pilot project were already in the juvenile justice system, Kornacki said.

In addition to growing the food, the children learned marketing strategies and put their new knowledge to work at a weekly farmers market in the garden, Kornacki said. The project also caught the eye of Nobel Peace Prize winner Rigoberta Menchú Tum, who came to the garden in 2010.

The project exposed the children to a new framework for understanding the community they live in, Kornacki said.

![Figure4](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/42/3/1.3/F4.medium.gif)

[Figure4](http://www.thenationshealth.org/content/42/3/1.3/F4)

In Chula Vista, Calif., these three community volunteers were among those helping out with safety improvement projects.

Photo courtesy Prevention Institute

“As opposed to being young and angry and lashing out through graffiti or joining a gang, we really tried to empower them with the right tools and knowledge that they could become change makers in their neighborhoods,” he said.

For more information, visit [www.preventioninstitute.org](http://www.preventioninstitute.org).

*   Copyright The Nation’s Health, American Public Health Association