The Neighborhood as a Unit of Change for Health: Early Findings from the East Harlem Neighborhood Health Action Center.

Place-based approaches have been promoted as one way to reduce health inequities by addressing community-level factors that shape health, such as housing quality, healthcare systems, the built environment, and social capital. In 2016-2017, the NYC Health Department's Center for Health Equity launched three Neighborhood Health Action Centers (Action Centers), which use a place-based approach to improve health in neighborhoods with disproportionate burdens of premature mortality. We describe this approach and the genesis of the Action Centers. We then describe the East Harlem Action Center, which was the first to open, and share findings from qualitative interviews with the East Harlem Action Center's Governance Council, a group comprised of Action Center staff and co-located partners and programs which supports Action Center coordination. Interviewees felt that collaboration, being responsive to community needs, and being community based were essential elements of the Action Center. Interviewees recognized the complex dynamic of a large city agency serving as the host for the Action Center while simultaneously aiming to establish more equitable relationships with partners. Governance Council members' expectations and hopes for the East Harlem Action Center were consistent with the overall vision and model for the Action Centers, which may facilitate implementation.

Combining clinical and population-level data to understand the health of neighborhoods.

From February through December 2012, we examined responses to health behavior questions integrated into the electronic medical record of primary care centers in the Bronx, New York in the context of New York City Community Health Survey data. We saw a higher proportion of unhealthy behaviors among patients than among the neighborhood population. Analyzing clinical data in the neighborhood context can better target at-risk populations.