With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week's subject:
Belinda Reininger is a professor of health promotion and behavioral science at the University of Texas School of Public Health Brownsville Regional Campus. Reininger, in partnership with an active community advisory board in South Texas, has supported policy and environmental changes including tobacco-free ordinances, complete street ordinances, the building of bike trails, community gardens and farmers markets. These efforts and partnerships resulted in the city of Brownsville winning the 2014 Robert Wood Johnson Foundation Culture of Health Prize. Reininger will receive the Faculty Award for Excellence in Academic Public Health Practice from the Association of Schools and Programs of Public Health later this month.
Editor's note: This interview has been edited for length and clarity.
Trib+Health: Where is your research focused, within the the health of minority communities?
Belinda Reininger: My research tends to focus on health disparities. The issues in this case, living on the U.S. and Mexico border, Hispanic populations particularly face disproportionate burden of disease from chronic disease, and they tend to lack the preventative health behavior that we see in other populations. That lends itself to the development of chronic disease.
Trib+Health: What are some notable health issues you are seeing in minority communities that are different than other groups?
Reininger: Among Hispanics, for example, we see that there is a greater burden of Type 2 diabetes. We see a greater burden of obesity. We know that the behaviors that are driving those particular conditions are a lack of physical activity and a lack of healthy food choices over time. That creates the situation where the population becomes unhealthy.
My particular research interest is around human behavior and how we can prevent those chronic diseases from developing. I am particularly interested in how we can prevent those diseases through the implementation and dissemination of good programs, good practices and good policies.
What has been a great blessing for me is working with the communities that I do along the Texas-Mexico border. And how much collaboration we have been able to build and sustain around those ideas of putting into place evidence-based programs, practices and policies — particularly those that are focused on promoting physical activity and healthy food choices.
Trib+Health: You helped implement a farmers market in the city — is that the sort of program you are encouraging?
Reininger: When we think about a program, we say what would be an evidence-based program that we could put in place that would ultimately result in people increasing their physical activity and increasing their ability to make good food choices.
One of the programs that we put in place was developing the farmers market program. There is evidence to show that not only are farmers markets a way to create better access to healthy, locally grown food, but we also know that it was particularly shown in some research that for low-income populations, including those using WIC benefits or SNAP benefits, that if those kinds of benefits could be used in farmers markets that the population would not only do that but it would help them to sustain those healthy food choices over time.
When we developed the Brownsville Farmers' Market, we knew that was going to be a priority for us. We wanted the farmers market to be accessible, comfortable for everyone to attend, no matter their economic status. We wanted to make sure that people with SNAP benefits would be able to use those at the market. We’ve been able to pilot different programs and apply for different grants that have helped us to sustain that and build that market.
That is one example of creating a program that can ultimately result in better food choices. We do lots of evaluation to ensure that the market is meeting the needs of the population, that they are reporting that they are eating a greater variety of fruits and vegetable from shopping at the market, and eating more fruits and vegetables, because of their ability to shop there.
Trib+Health: Do you see anything along those lines, promoting behavioral changes happening in the other parts of the state or in the Legislature?
Reininger: For us in South Texas and Brownsville, in the broader region, one of the main features our networks have created as the foundation of collaboration is the community advisory board that we have in our region, that is over 10 years old. It is a very large and active network of people broadly interested in health. They are not just all health people. They are school, business and clinic people and city planners — just a variety of people who have come together and determined jointly that we can make differences in our community.
Our region is not particularly wealthy, we are very poor in the sense of economics, while there is such a richness of the culture and the collaboration that exists. There is a real dedication to making things work even if we don’t have all the resources that we currently need. We are still going to do something to make our community better.
That community advisory board has made all of the difference in terms of leveraging dollars and ideas for good things. That work resulted in the city of Brownsville being selected as the 2014 Robert Wood Johnson Foundation Culture of Health prize winner. The city was one of six communities in the nation selected for that prize, because of these activities. It is a real testament to what can happen.
In terms of it happening anywhere else, recently, through the 1115 waiver fund, both the University of Texas Health Science Center at San Antonio and Houston supported 1115 waiver projects in South Texas that are now in place. Those waiver projects have allowed us to expand this programming to eight additional cities in the region. And we need further support for similar programs statewide.
Trib+Health: What is your perspective on the health management of population, which has a high rate of people who are not insured?
Reininger: What we understood a decade ago, when we started doing this work, is that because of the lack of health insurance and access to care, driven by the lack of insurance, that only having a medical model approach would limit what we could do. So we had to incorporate a preventative health model to the work in the Valley. If we didn’t prevent new cases and we didn’t work on the behaviors of physical activity and healthy food choice to help control the current problem of chronic disease, the system was just going to continue to be overwhelmed. I think that is why we’ve had such good collaboration.
Trib+Health: What are your thoughts on your award for excellence?
Reininger: I am incredibly humbled and would not have expected that at all. It is really a testament to all the people that I have worked with. Between my staff and our community partners, we have all worked really hard over the past 14 years. For me, it is such an honor to have this work recognized. Because it is a national award and the recognition the city has gotten shows the region is really working hard. Being on the border, maybe it is not as apparent, but things are really happening here. We’ve got some great plans for the future.