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WINTER 2018
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B
y officially launching the Healthy Beverage Zone (HBZ),
SBH Health System has become part of a Bronx-wide
movement to promote healthy beverage options for all who
work, live in and visit the Bronx. SBH is one of the borough’s
largest HBZ partners and its first hospital core partner.
As part of this process, SBH has
eliminated beverages with added
sugar from vending machines, the
cafeteria and meetings.
“The mission of SBH is to
educate our community on the
link between sugary drinks,
which include soda; sweetened
ice tea; and sports, energy and
fruit drinks, and such health risks
as obesity, tooth decay, heart
disease, type 2 diabetes, and liver
disease,” says Dr. Vanessa Salcedo,
a pediatrician, and the force
behind the launch at SBH and,
prior to this, at Union Community
Health Center.
“This is particularly important in the Bronx, which since
2009 has annually ranked 62nd out of 62 counties in New
York State in terms of poor health outcomes. The Bronx has
the highest rate of obesity in New York City, with 32 percent
of all adults considered obese.”
According to Dr. Salcedo, HBZ is particularly important for the
Bronx, which has the highest consumption of sugar-sweetened
beverages (SSBs) in NYC with 27.8% (335,000 adults)
consuming at least 1 SSB daily. In 2015, Bronx residents spent
$185 million purchasing sugary drinks.
Sugary drink consumption is not only a problem in the Bronx.
Throughout the U.S. the consumption of SSBs has increased
significantly over the past 30 years, with about 50 percent of
American adults drinking at least one sugar-sweetened
beverage (SSB) daily. According to the New York City
Department of Health (DOH), 1.5 million people, about a
quarter of all adults in the city, reported consuming at least
one SSB daily. The DOH has set a goal to reduce the number
of adults who drink at least one sugary beverage per day to 19
percent over the next three years.
Calories in SSBs contribute to weight
gain and provide little if any nutritional
value. While the American Heart
Association recommends consuming
no more than 450 calories from SSBs
weekly – the equivalent of less than
three 12-ounce cans of soda – a study
by the Center for Disease Control and
Prevention found that men consume
an average of 178 calories from sugary
drinks daily and women 103 calories
daily. One study found that SSBs may
be responsible for more than 184,000
adult deaths worldwide annually, with
133,000 deaths from diabetes, 45,000
deaths from cardiovascular disease
and 6,450 deaths from cancer.
With a responsibility as leaders in the community, the
SBH Health and Wellness Committee has challenged its
employees to take a pledge to refrain from drinking sugary
drinks while at SBH especially, and particularly in front of
patients. Those who choose to become “HBZ Champions”
are asked to switch to healthier beverages such as water,
seltzer, unsweetened teas, and low-fat milk; encourage fellow
employees and visitors to also make healthier beverage
choices; and promote HBZ at SBH.
“Decreasing sugary drink consumption is a small, but impactful
evidence-based approach that will yield a significant health
outcome in the community,” says Dr. Salcedo. “By setting an
example at SBH, we can help expedite this process.”
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COMMUNITY PROJECTS
POPULATION HEALTH
M
ariana Sanchez, a Community
Health Worker (CHW) with a.i.r.
bronx, recently visited the home of a
family struggling to help three of their
five children control their asthma. During
her visit, Mariana identified significant
mold in the apartment, along with mice and pests, as well as a
large hole in the bedroom wall. Mariana spoke with Homebase,
the NYC homelessness prevention program, and helped the
family receive the Family Eviction Prevention Subsidy (FEPS).
Homebase worked with the family to secure new housing. The
new apartment is free of mold, rodents, and roaches and the
family is having a much easier time managing asthma.
The Bronx has one of the highest rates of asthma in the United
States. Air quality, housing conditions, smoking, and medication
non-adherence are some of the factors that affect the prevalence
of this disease and lead to poorer health, missed school days and
more hospital visits among community members.
“So many variables come into play when treating asthma
patients in our borough,” says Dr. Alyson Smith, director of
SBH’s Pediatric Allergy Department. “To truly treat patients,
you need to take a look at the whole picture and address these
contributing factors.”
Bronx Partners for Healthy Communities (BPHC), the
Performing Provider System led by SBH, partners with a.i.r.
bronx to provide in-home asthma self-management services
to families in the Bronx. The “a.i.r.” in a.i.r. bronx stands for
Asthma, Intervention, and Relief. They provide these services
to children and adults in New York City using evidence-based
practices and a data-driven model.
The program drives the goal of DSRIP, the state’s Medicaid
transformation initiative, to build an integrated system of
quality, community-based care that addresses the communities’
health disparities.
“It’s really about looking at our patients and seeing the full
person – not just the specific ailment – and providing care
in a more comprehensive way,” says Irene Kaufmann, BPHC
Executive Director.
a.i.r. bronx CHWs visit with families in their homes and work with
them to identify asthma triggers that may be present such as dust,
pests and/or poor ventilation. They review and discuss patients’
asthma medications to make sure they are taking them properly.
They can refer families to support services such as integrated
pest management services and smoking cessation programs
that can make homes environmentally healthier. Like Mariana,
CHWs can even advocate on behalf of the family with
landlords, legal aid, housing and other social service agencies.
“Care coordination right down to the community level is
essential to our effectiveness,” says Kaufmann. “a.i.r. bronx
CHWs are part of a patient’s interdisciplinary care team to
ensure that referrals, screening, interventions, and medication
compliance are coordinated and recorded on the patient’s EMR.”
Kaufmann also notes that CHWs are members of the
communities they serve. They speak the language of their
communities and form trusting relationships with families.
To date, more than 1,000 families have been reached at
home. Referrals come from multiple sources including care
coordinators, emergency department (ED) patient navigators,
and community-based organizations.
BPHC recently piloted a new program, Healthy Buildings,
to connect with asthma patients on a wider scale. Healthy
Buildings is a partnership with Montefiore Medical Center,
city officials and agencies, and several community-based
organizations. Through data collection, the program can help
identify areas or building units, also called “hotspots,” where
there are high rates of asthma and hospital use. Teams work
with tenant leadership and community centers to host family
events that provide food, healthy activities, entertainment, and
education on asthma and other chronic diseases. The goal is to
build asthma self-management programming into buildings
by working with tenant groups and community centers. As the
program grows, BPHC will evaluate its progress and explore
ways to expand it to other communities.
According to Kaufmann, “This is where the convergence of the
care team, community partners and technology allows us to
reach patients where they live, provide them with the services
and support to be healthy, and engage them in their care.”
Helping Our Community Breathe Easier
By Luci de Haan
SBH Launches Healthy Beverage Zone (HBZ)
By Steven Clark
