Creating A Social Program

Introduction

Lifestyle diseases pose a considerable threat to the socioeconomic development of the Brownsville area in Texas (Tillman, 2008). These diseases are caused mainly by poor lifestyle choices manifested by poor nutrition, sedentary lifestyles and high incidences of smoking and alcoholism. The diseases impose high direct and indirect costs on the local economy, lead to unemployment, wage losses, disabilities, death and deprivation (TDSHS, 2007).

A social program to reduce the prevalence of these diseases and mitigate their effects and thus boost the socioeconomic status of the area is urgently needed. This proposal describes one such program which seeks to promote lifestyle changes in the Brownsville area. The program will solicit for funding from the League of United Latin American Citizens (LULAC) and will run for a period of 2 years.

Thesis statement

The Brownsville area of Texas can attain significant socioeconomic development through health education and promotion of lifestyle changes at the local level

Problem to be addressed

The program seeks to address the high prevalence of lifestyle diseases in the Brownsville area of Texas

Demographics of Brownsville

Brownsville is situated in the Rio Grande Valley of Texas, U.S.A, near the border with Mexico and is the largest city in the Valley. According to the 2000 Census, the area has the second highest Hispanic population in the entire America (figure 1 below).

Figure 1: the demographics of Brownsville, Texas

Source: TDSHS (2007)

The 2007 estimates put the total population of the MSA at 402,230 people and the median age is 29 years (figure 2 below; Table 1, Appendix).

Figure 2: Population distribution by age

Source: US Census Bureau, 2000

Overall, the area has witnessed a population growth rate of 85 percent since 1980 (US Census Bureau). Brownsville’s mean educational attainment is only 7^th grade and per capita income is way below that of other areas in the country (Fullerton, 2001) (Figure below)

Figure 3: Per capita income

Source: US Bureau of Economic Analysis

Among cities having more than 100,000 inhabitants, Brownsville had the highest rate of poverty at 36 percent. The unemployment rate in Brownsville is double the Texas and U.S rates.

It is important that the problems caused by the lifestyle choices of Brownsville residents be addressed because of several reasons. First, the diseases impose high economic costs on the families of the affected persons and on the local economy. This is because of lost wages, premature mortality, hospitalizations and long term disability. According to the University of Texas (2005), there will be 8 million obese people in Texas alone and this will impose a burden of more than $25 billion on the economy.

Secondly, poor lifestyle choices lead to diseases which are associated with high direct costs. Treatment costs are high and are approximated to be $2 billion. According to TDH (2002), direct and indirect costs associated with diabetes exceeded $9 billion. Third, lifestyle diseases eventually result in life threatening complications if not properly managed and this may result in debility, with further increases in the direct and indirect costs, lost wages, unemployment and mortality. All these outcomes have negative ramifications on the socioeconomic status of the region.

For one, diabetes is the number 1 cause of blindness in adults, the leading cause of end-stage renal disease (ESRD) and the number 1 cause of lower limb amputations. Diabetes also increases the risk for heart disease and stroke by 2-4 times and more than 60 percent of diabetes patients end up with high blood pressure (Harris et al, 1998). By promoting lifestyle changes among the Brownsville residents, the proposed social program will help to solve these problems.

Timeline and analysis

The timeline of the program will be 2 years. As indicated before, the cause of the problem is the poor lifestyle choices made by the residents of Brownsville. The poor lifestyle choices include poor nutrition, prevalence of smoking, high rates of alcohol consumption, and physical inactivity. Brownsville residents eat foods which have low fiber and high fat content. According to CDC (2007), more than 77 percent of all Brownsville residents have a poor nutrition.

According to the Statewide BRFSS Survey, 36 percent of Brownsville residents lead sedentary lifestyles and this compares very poorly to the Texas average. Other causes of the problem are ignorance, poverty, proximity to Mexico and lack of insurance cover (The Brownsville Herald, 2007).

The consequences of the poor lifestyle choices are devastating. Due to the poor lifestyle choices, more than 33 percent of Brownsville residents are obese and this exceeds the Texas average of 28.6 percent. The poor lifestyle choices have also led to a high prevalence of diabetes in the region. The proportion of individuals in Brownsville with diabetes is 12.6 percent. The Texas rate is 10.4 percent. According to TDH, (2002) Hispanics are twice more likely to have diabetes than non-Hispanics. Other consequences include high rates of cardiovascular disease and high mortality rates associated with stroke, heart disease and cardiovascular disease especially among Hispanics (TDSHS, 2005).

In terms of ideology, the program will be based on the theory of planned behavior since it seeks to promote change by influencing the way individuals make life choices rather than through exerting social/biological influences. The people who will gain from the project are residents of Brownsville especially those with existing lifestyle diseases will be the gainers.

Policy Elements

Mission

The mission of the program will be to improve the quality of life of the inhabitants of Brownsville through promotion of lifestyle changes and health education

Goals

            The goals of the program are listed below

• To reduce the incidence of obesity , stroke, cardiovascular diseases and other lifestyle conditions in Brownsville area of Texas
• To reduce the onset and progression of complications associated with these lifestyle diseases
• To help patients living with lifestyle diseases to self-manage their conditions
• To raise the awareness levels of the residents of Brownsville city on the effect of lifestyle choices on health

Objectives

The objectives of the program are

• To increase the percentage of individuals who carry out moderate exercise for half an hour daily to 50 percent of the Brownsville population
• To reduce the number of men taking more than 21 units of liquor every week to less than 15 percent of the population, the number of women taking more than 14 units of liquor every week to less than 10 percent of the population and the number of teenagers taking liquor to less than 5 percent of the population
• To increase the percentage of Brownsville residents who consistently eat not less than 5 portions of fruit and vegetables daily to 50 percent of the population
• To reduce the intake of total and saturated fat by Brownsville residents
• To reduce salt intake among Brownsville residents to 6g daily
• To reduce the rate of smoking in Brownsville by initiating smoking cessation programs and support groups
• To increase awareness on the causes and effects of poor lifestyle choices

Benefits and services

Benefits and services of the program will include free fruits and vegetables for enrolled members, pharmaceutical care services for individuals willing to stop smoking, health education, and client advocacy. The program will also sponsor sports activities in schools, conduct free sessions of aerobics and physical exercise for those interested, print and distribute guidelines/ recommendations for healthy eating and provide counseling services for persons with lifestyle diseases. Other benefits and services will include annual walks, video demonstrations of exercise, and institution of support groups for individuals recovering from alcoholism, smoking and those suffering effects of the lifestyle diseases

Figure 4: Program theory

Figure 5: Program specification

Eligibility rules

The program will be open to obese people (BMI of 30 or higher), cholesterol levels above 6.5mmol/l, and or to individuals diagnosed with any of the lifestyle diseases. Also eligible will be people with poor nutritional status as well as those leading sedentary lifestyles

Service delivery

The service delivery strategy to be used will be indigenous workers. This will allow the program easy access to the affected people. As per the helper-therapy principle, program workers will also benefit from this approach.  Collaborators will deliver the services. Service will also be delivered through publication of a fanzine, the local media, social events, schools, and home visits.

Financing

Funding will be principally sourced from the League of United Latin American Citizens (LULAC). Additional funds will also be sourced from corporate entities within the Brownsville area, government agencies and private individuals. To ensure accountability, the program will employ a full time qualified accountant who will be in charge of the finances. Financial controls will be tightened to conform to established financial regulations. Regular audits will be conducted and these will be outsourced to a reputable firm using the competitive bidding process.

Budget

The total budget for the program will be $600,000.  Out of this amount, $150,000 will be used for education and awareness, $73,000 for staffing and administration and the rest for implementation of other project plans. Funding will be sourced from corporate organizations, private individuals as well as from government agencies tasked with the fight against HIV/AIDS

Staff, Training and Salary

            The program will have an Administrator, an Accountant, a Legal Head and Collaborators. The Collaborators will be divided into 4 workgroups all headed by the Administrator. The Outreach Workgroup will be mandated to seek for community support and act as a link between the program and the media. The Resource Assessment Workgroup will be in charge of identifying any gaps in delivery of services. The implementation workgroup will be made up of collaborators who will include volunteers, nutritionists, physical fitness instructors, counselors and clinicians.  These people will be in charge of delivering the services on the ground. The final workgroup is the Planning, Monitoring and Evaluation group. The board will be the final decision making organ and will incorporate representatives from the community who will also have voting rights (figure 6 below).

Figure 6: Organizational structure

            A needs assessment for training will be regularly performed to determine current skill levels and inform training activities. Training will be carried out through seminars, external conferences, sponsored trips and workshops (Table 1, Appendix).

Since the population being served is predominantly Mexican, the program will look for indigenous employees who are Hispanic, are residents of Brownsville and have once been affected by poor lifestyle choices. The employees will also be qualified in their respective professions. Gender, sexual orientation, political affiliation, or social class will not be an issue in employment.

Schedules and written standard operating procedures to guide employees will be drafted. This will be done so as to ensure that employees offer client-centered care. Detailed job descriptions will also be drafted and distributed to all the workers to help them understand the program expectations. Contract workers will be hired in emergency situations.

Suppliers, Equipment, Travel and Utility

Suppliers will be selected based on their reputation for supply of equipment of high standards, good delivery practices and flexible credit policies.  For backup purposes, request for proposals (RFPs) will be raised for extra suppliers. In order to cushion the program against fluctuating supply costs, purchases will be made in volumes. All travel will be made using public transport where possible. A vehicle will be leased to ease transportation of goods and delivery of supplies. Office space will be leased and will be selected so that it is easily accessible by the public, preferably along a major road. Security, ample parking space and utilities such as internet, power, and telephone lines will be considered in the office selection. The office will be partitioned into several sections for the different workgroups. There will be separate halls for training and storage of equipment and materials

Evaluation

Measures of success will include organizational accountability, community representation, attainment of goals, accessibility to clients, change, service integration and continuity and impact on the community. Evaluation will consist of assessing the attainments and comparing them with the expected outcomes in the objectives section using the defined measures

Conclusion

Lifestyle diseases pose a significant threat to the socioeconomic development of the Brownsville area in Texas. These diseases are caused mainly by poor lifestyle choices manifested by poor nutrition, sedentary lifestyles and high incidences of smoking and alcoholism. The diseases impose high direct and indirect costs on the local economy, lead to unemployment, wage losses, disabilities, death and deprivation. By promoting lifestyle changes among the inhabitants of Brownsville, the proposed social program will help reduce these diseases and thus boost the socioeconomic status of the area.

References

American Community Survey. (2003). Population and Housing Profile:  Brownsville—

            Harlingen–San Benito, TX MSA retrieved on 11^th July, 2009 from

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CDC. (2007). Retrieved on 11^th July, 2009 from

http://apps.nccd.cdc.gov/yrbss/QuestYearTable.asp?ByVar=CI&cat=6&quest=Q80&loc=XX&year=2007

EPODUNK. (2009). Brownsville Community Profile. Retrieved on 11^th July, 2009

            from http://www.epodunk.com/cgi-bin/genInfo.php?locIndex=26204#Deat

Fullerton, T.M. (2001). Educational Attainment and Border Income Performance.

            Economic and Financial Review. Third Quarter, 2001.

Harris, MI, Flegal, K.M, Cowie CC; Eberhadt, M.S; Goldstein, D.E; Little, R.R.;

Wiedmeyer, H.M; Byrd-Holt DD. 1998. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S adults; the Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care 21; 518-524, 1998.

League of United Latin American Citizens. (2009). Retrieved on 9^th July, 2009 from

            http://www.lulac.org/

Mahon, C. (2007). Brownsville Ranks Poorest in the Nation. The Brownsville Herald.

            August 28^th, 2007. Retrieved on 9^th July, 2009 from

http://www.brownsvilleherald.com/news/poverty_79717___article.html/percent_bureau.html

TDSHS. (2007). Cardiovascular Health Facts 2001-2007.Brownsville Metropolitan

            Statistical Area (MSA)

Tillman, L. (2008). Doctor: Brownsville has third world health problems

Valley Morning Star, August 17^th 2008. Retrieved on 11^th July, 2009 from

http://www.valleymorningstar.com/news/brownsville_32855___article.html/health_problems.html

University of Texas System. (2005). The Future of Public health in Texas.