Keeping their candles burning was a challenge in the falling temperature and rising wind as 150 committed Southwest Madison residents gathered in Hammersley Park in late November to walk the half-mile to Falk Elementary School. The crowd assembled in response to racist graffiti spray-painted in red the week before on fences and buildings in the neighborhood.
The march, meal and discussion that followed in the school gym were a public display of the Southwest Community Organizing Committee flexing its new muscle. Strength has always been associated with health, so perhaps it's not surprising that this community organization owes its existence to a small team of nurses in the Department of Public Health for Madison and Dane County.
Kim Neuschel, one of six nurses who form the health equity team, watched approvingly as people poured into Falk School. She checked with members of the organizing committee to make sure each table had a facilitator, then took the mike to set the agenda.
"They are the key," Ald. Steve King says of the nurses. "What public health has done is the model for partnering with neighborhood associations and plugging in holistically. They are looking for root causes for what's going on. Kim has connected the dots for everyone, making people think about the socioeconomic issues in a different way."
Sheray Wallace, a long-term resident and member of the Southwest Community Organizing Committee, says that other residents have become more involved in the community since the public nurses became a steady presence. "They bring so much positive energy into everything we do," says Wallace.
The health equity team is the brainchild of Judy Howard, public health supervisor at the public health department. "Public health will always need people focusing on individuals and families," says Howard. "But health starts where we live and play, and this team can focus on the bigger picture - the neighborhoods. Is this a healthy environment? Does public policy support the changes people need to be healthy?"
When Madison and Dane County merged their public health departments in 2008, economies of scale gave Howard enough resources to branch out from vaccinations and food safety inspections to develop a health equity team. Neuschel, already doing some neighborhood nursing in Madison's southwest area, partnered with Jessica LeClair to start garden projects and a resident-run farmers' market. They advocated for an expanded community center and brought residents together at regular community meals.
"Our focus," says LeClair, "was on building social capital, which is at the heart of our work." Social capital is a measure of connections between neighbors and how much voice people have with local government.
Then, in June 2009, a teen-on-teen murder in Meadowood shifted the community's focus. The next neighborhood supper drew an overflow crowd.
"When this murder occurred, you could feel the shift within the community," says Neuschel. "Two other teens were ultimately convicted of the killing. Three lives were just gone. Building food security was no longer the main community concern. We started to look at ways to prevent violence in the community."
Violence prevention was a new direction for the nurses. They researched what other public health agencies were doing around the nation, conducted interviews with area residents, and surveyed perceptions of safety and trust. They pored over police data and began working with the police as part of the neighborhood resource team.
Police Lt. John Patterson, who supervises patrol services and the community policing team for Madison's west district, says working with the nurses "has had a very dramatic impact. Now there is this all-hands-on-deck approach where everyone quickly comes to the table to find solutions.
"From my perch I can see that a lot of what has been done in Meadowood and now Hammersley is inspiring other neighborhoods like Prairie Hills," adds Patterson. "I'm hoping we are going to see this continue to spread."
Randy Stoecker, UW-Madison professor of Community and Environmental Sociology, has provided support to a number of local community organizations and has worked with Neuschel on several projects. He says he is particularly impressed with how the nurses have used community dinners as an "organizing process" and encouraged residents to take the reins.
"Over the last four to five months, Kim is no longer leading the Southwest Community Organizing Committee," says Stoecker. "It's taking charge of itself. Their December meeting will be the first that is led by residents, which is exactly what is supposed to happen."
The health equity team is expanding its reach. LeClair divides her time between the southwest communities and a project she partners with a team member, Pa Vang, in the Brentwood neighborhood on Sherman Avenue near Warner Park.
"That community came to us," says Vang. "They saw our work in southwest Madison, and they wanted something similar."
The project there started with a community assessment. "It's important to get the community's voice, learning what it's like to live here, collecting their dreams and vision."
Vang and LeClair used the same photo-mapping project that initiated the Meadowood organization.
"We gave the kids digital cameras and GPS units, and they did a walking tour of their neighborhood, highlighting areas they like and areas that can use improvement," says Vang. "I put their photos on a projection screen, and they talked about their feelings and their perceptions of safety at a community dinner. The kids loved it. At first they were a little shy, but by the end of the discussion they all wanted to talk."
After analyzing the data, Vang says the next step is to create a list of recommendations to present for feedback at another community supper.
"Our plan is to make recommendations to stakeholders, policy makers and state officials," says Vang. "Next year, we hope to get funding to implement some of these recommendations."
Jenny LuJan divides her time between the health department's tuberculosis program and the health equity team. She calls the team a big-picture program. Her focus is on alcohol and substance abuse throughout Dane County.
"Alcohol is a big problem in this state," says LuJan. Her goal is to ultimately limit the number of establishments that sell alcohol in targeted areas. "The research has shown that when neighborhoods are oversaturated with alcohol outlets, they have increased rates of crime and violence."
LuJan is working with the Dane County Coalition to Reduce Alcohol Abuse and UW-Madison Applied Population Lab to map the location of liquor outlets. The Dane County Chiefs of Police Association has provided four years of crime data that will be superimposed on her map to pinpoint problem areas.
"It's a long-term project," says LuJan. "But that's the work of the health equity team. We have an acute sense of social justice, and that's what drives us."
Members of the health equity team will admit that their brand of nursing leaves the digital thermometer and the blood pressure cuff far behind.
"Our focus is population based," says Vang. "Place matters. We are looking at prevention. People getting to know each other better, and making sure they feel safe - that's very related to health. Doing assessments - that's part of the nursing process. Instead of the typical individual-client relationship, our client is the community."
Neuschel says her medical training is critical. "I definitely feel like my nursing background is important," she adds. "The framework for everything we are doing is about improving health. It's about how neighborhoods and cities are planned. Do you have access to food? Do you feel connected to your neighbors? These are essential elements that improve people's health."
