The Pros and Cons of Comprehensive Community Initiatives at the City Level: The Case of the Urban Health Initiative

· This article describes the trade-offs between the city-level and neighborhood-based approaches in examining the Robert Wood Johnson Foundation’s (RWJF’s) Urban Health Initiative (UHI), an $80 million, 10-year effort to improve the health and safety of young people. · Eight cities engaged in a two-year planning process; five received funding for an eight-year implementation phase. Plans that engaged in bottom-up activities, but left power and control in the hands of civic, business, social service, and political leaders, were favored. Those who had focused exclusively on neighborhood-based approaches were not funded for implementation. · RWJF chose a city-level focus because they believed neighborhood-level initiatives lacked the political clout to make sustainable changes in programs, institutions, systems, and policies. Furthermore, poor outcomes for children were not concentrated in a few neighborhoods, but were found in a substantial portion of the city’s communities. · The UHI sites were successful in bringing existing efforts quickly under their umbrella, strengthening them by bringing added resources, data, technical expertise, and visibility. With citywide focus and leadership, the power between the initiative and local philanthropy was made more balanced. However, the fragmented nature of government service delivery systems at the city level created new obstacles to change in some cases. · The UHI’s citywide focus meant that some of the important roles that neighborhood comprehensive community initiatives have assumed went unfilled. For instance, attention devoted during planning to cultural norms and values that might influence health and safety outcomes quickly ebbed during implementation

Short relative leg length is associated with overweight and obesity in Mexican immigrant women.

BACKGROUND:Prior research suggests that undernutrition and enteric infections predispose children to stunted growth. Undernutrition and infections have been associated with limited access to healthy diets, lack of sanitation, and access barriers to healthcare - all associated with human rights. Stunting has also been documented to be a major determinant of subsequent obesity and non-communicable diseases. Short leg length relative to stature during adulthood seems to be a good proxy indicator tracking such barriers, and has been reported to be associated with adverse health effects during adulthood. Our objective was to examine the association between relative leg length (as measured by the leg length index, LLI) and measures of adiposity - based on body mass index (BMI) and waist circumference (WC) - in a population of recent Mexican immigrant women to the New York City Area. METHODS:The analysis was based on a cross-sectional survey of 200 Mexican immigrant women aged 18 to 70 years, whose data were collected between April and November 2008; although for purposes of the current study we restricted the sample to those aged 18 to 59 years. The dependent variables were BMI and WC, both transformed into categorical variables. The main independent variable was LLI, and other correlates were controlled for (i.e. age, education, having had children, characteristics of the community of origin, acculturation, chronic conditions, sedentary behaviors, access to fresh fruits and vegetables). Two probit models were estimated: the first one analyzed the effect of LLI on BMI categories and the second one estimated the effect of LLI on WC. RESULTS:The probit assessing the effect of LLI on overweight/obesity suggested that having a short LLI increased the probability of overweight/obesity by 21 percentage points. Results from the probit model estimating the effect of LLI on WC indicated that having a short LLI increased the probability of having abdominal adiposity by 39 percentage points. Both results were statistically significant at p < 0.05. CONCLUSION:The study found an association between having shorter legs relative to one's height and increased risk of overweight/obesity and abdominal adiposity. Findings support the epidemiological evidence regarding the association between short leg length, early life socioeconomic conditions (i.e. limited access to basic rights), and increased risk of adverse health effects later in life

Questioning children: Interactional evidence of implicit bias in medical interviews

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