DEPARTMENT: Health
DEPARTMENT HEAD: Jennifer Herriott, MPH
COUNCIL DISTRICTS IMPACTED: Citywide
SUBJECT:
An ordinance authorizing the submission of an annual application to the Centers for Disease Control and Prevention (CDC) for the Racial and Ethnic Approaches to Community Health (REACH) grant for an amount of $792,000.00 and authorizing the submission of annual applications for three additional years to and the acceptance of funds upon award from the CDC for the REACH grant.
SUMMARY:
This ordinance authorizes the submission of an application to the CDC for the delivery of services within the REACH grant (CFDA 93.304) for prevention activities and authorizes a personnel compliment for the term September 29, 2019 through September 28, 2020. This ordinance also authorizes the acceptance of funds upon award and the authorization to submit annual applications and accept funds for subsequent years from September 29, 2020 through September 28, 2023.
The funds will be used to focus on community organizing to enact environmental and policy changes to promote community-based healthy eating strategies, tobacco prevention and cessation, as well as community linkage to clinical services with a special focus on engaging racial and ethnic populations. The San Antonio Metropolitan Health District’s (Metro Health’s) Healthy Neighborhoods Program will strengthen and expand current place-based public health initiatives in targeted neighborhoods and include strategies for sub-populations that experience higher rates of chronic disease to include LGBTQ youth, formerly incarcerated youth and adults of color, and Spanish speaking immigrants. Metro Health’s Office of Health Equity will also strengthen and integrate standard strategies into current, ongoing community engagement initiatives conducted by the Health Department.
Furthermore, this ordinance authorizes the Director of Metro Health to initiate, negotiate, and execute any and all necessary documents and a grant contract to effectuate the acceptance of the referenced grant, and to execute contract amendments pertaining to this contract, to include: a) carry-over funds, when ascertained and approved by the funding agency through a revised notice of award; b) line item budget revisions authorized by the funding agency; c) modifications to the performance measures authorized by the funding agency and listed in the contract so long as the terms of the amendment stay within the general parameters of the intent of the grant; d) no cost extensions; e) amendments which will provide supplemental grant funds to the grant by the funding agency in an amount up to 20% of the total amount awarded annually to the grant; f) reimbursement increases of administrative funds for each participant served; g) amendments funding one time equipment purchases or defined program services; and h) changes in state regulations mandated by the funding agency.
BACKGROUND INFORMATION:
Chronic diseases are the leading causes of death and disability in the United States, largely driven by preventable health behaviors. Health behaviors such as tobaccos use, poor nutrition, and physical inactivity are linked to chronic conditions, premature death, and disability. Chronic disease and their outcomes disproportionately impact racial and ethnic populations including African Americans/Blacks, Hispanic/Latino Americans, Asian Americans, Native Hawaiian/Other Pacific Islanders, American Indians and Alaska Natives.
The REACH grant aims to improve health, prevent chronic diseases, and reduce health disparities among racial and ethnic populations with the highest risk by supporting culturally tailored interventions to address the preventable health behaviors of tobacco use and poor nutrition, by strengthening collaboration with our Healthy Neighborhoods Program and the Metro Health Office of Health Equity over the course of a 5-year grant period.
On June 21, 2018, City Council authorized Metro Health to submit an application for the first year of the five year REACH (CFDA 93.304) project period and accept funds up to $900,000 by Ordinance 2018-06-21-0486. Metro Health was subsequently awarded $792,000.00. Subsequent years’ applications will be non-competing and will have level funding. This ordinance also authorizes the acceptance of funds upon award and the authorization to submit annual applications and accept funds for subsequent years from September 29, 2020 through September 28, 2023.
The Healthy Neighborhoods Program has been focusing on chronic disease prevention in targeted neighborhoods for the past five years. Recently the focus has been to implement nutrition and physical activity programs for children and adults. These initiatives have provided chronic disease prevention assistance to the general populations of the target, high need, neighborhoods but have not consistently implemented evidence-based strategies to address the subpopulations of racial and ethnic minorities that experience greater health disparities.
This funding opportunity will also provide the Healthy Neighborhoods Program with the resources to implement tobacco prevention initiatives, supporting the education of youth and families on tobacco use and the Tobacco 21 Ordinance which took effect on October 1, 2018.
The Metro Health Office of Health Equity aims to provide ongoing training and technical assistance to project staff on cultural competence, cultural humility, and culturally specific evidence-based strategies for reaching African American, Hispanic/Latino Americans and Native American populations at large. This will include considerations for subpopulations that experience higher rates of chronic disease to include LGBTQ youth and formerly incarcerated youth and adults of color, and Spanish speaking immigrants with the overall goal to strengthen and integrate these strategies into current, ongoing community engagement initiatives with these target populations.
The Office of Health Equity will also facilitate and organize community-led pláticas (conversations) around the health advocacy and action planning of residents to drive policy change at the neighborhood level. A central purpose of these community conversations is to help build community power and participation of low income minority communities by having community members voice their own experiences to other community members. This creates a safe space to have community-led discussions about social determinants of health, and structural racism and racial bias experienced in community-based preventive services and social services settings. This will also provide project staff and stakeholder partners the opportunity to be responsive to community needs by modifying the way programs and policies are implemented. By providing this training to program staff and the community populations who are most affected, Metro Health will be able to reach the disparate populations outlined by this grant opportunity.
ISSUE:
Metro Health requests City Council authorize the submission of grant documents to the CDC for the REACH grant and authorize the acceptance of funds upon award in an amount not to exceed $792,000.00 for the term ending September 28, 2020. Metro Health also requests City Council authorize the submission of annual REACH grant applications and the acceptance of funds upon award for subsequent years through September 28, 2023. The funds will be used to focus on community organizing to enact environmental and policy changes to promote community-based healthy eating, tobacco prevention and cessation, as well as community linkage to clinical services with a special focus on engaging racial and ethnic populations. This will be accomplished through expansion of the Healthy Neighborhoods Program and integration of the project with the Metro Health Office of Health Equity’s current community engagement initiatives.
ALTERNATIVES:
Should City Council choose not to approve this ordinance, Metro Health will not be able to expand programs that target preventable health behaviors of tobacco use and poor nutrition, and reduce health disparities among racial and ethnic populations with the highest risk in the identified, target neighborhoods of the Healthy Neighborhoods Program.
FISCAL IMPACT:
An ordinance authorizing the submission of a grant application to the Centers for Disease Control and Prevention for an award to improve health, prevent chronic diseases and reduce health disparities among racial and ethnic populations and authorizing the acceptance of up to $792,000 for the term ending September 28, 2020; and authorizing the submission of subsequent grant year applications for the period beginning September 29, 2020 and ending September 28, 2023 and authorizing the acceptance of up to $792,00 each year upon award; and authorizing a personnel complement. There is no impact on the General Fund in the form of a match requirement.
RECOMMENDATION:
Staff recommends City Council authorize the submission of the grant application to the CDC for continued participation in REACH grant activities. Staff also recommends City Council authorize subsequent year applications and the acceptance of funds upon award, in an amount not to exceed $792,000.00 annually and authorize ten (10) full-time positions for the period September 29, 2019 to September 28, 2023.