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HKHC Case Examples: Engaging Immigrant Communities

April, 2012


Benton County, OR, Central Valley, CA, El Paso, TX, King County/Seattle, WA,   Multnomah County/Portland, OR, Phoenix, AZ, Somerville, MA


If current trends continue, the population of the United States will increase from 296 million in 2005 to 438 million in 2050.  According to Pew Research Center projections, 82% of that increase will be due to immigrants and their U.S.-born descendants.  Engaging immigrant populations in healthy eating and active living policy work is therefore imperative to sustain the movement.  It is also critical as many immigrant groups reach higher obesity levels as they assimilate into US culture and communities (Sanghavi et al., 2004).  Immigrants to the U.S. are especially vulnerable due to complex risk factors including cultural perceptions of increased weight, and changes in food costs and availability resulting from immigration (Candib, 2007).  Effectively reaching out and involving recently-arrived populations can help guide responsive policy and advocacy efforts.

Many of these case examples focus on the largest growing immigrant Latino population, which currently comprises 16% of the U.S. population and will triple in size to make up nearly 30% of the population by 2050 (US Census Bureau, 2010 and the Pew Research Center, 2008).  We have highlighted the benefits and challenges to working with these unique populations in our HKHC communities to prevent childhood obesity.

Case Examples

Benton County, OR: Helping Immigrants’ Access City Services
One of Benton County Health Department’s goals through its HKHC initiative is to improve access to affordable healthy foods for at-risk families.  Many of these families include the migrant and seasonal farm workers sustaining the thriving agricultural base of Oregon’s Willamette Valley.  Focusing on this population, the “Creciendo en Salud” (Growing in Health) initiative has pushed for system-wide change to make city services more accessible to non-English speakers.  This has included making financial qualifications for city services simpler, streamlined, and available in Spanish.  Co-placed at both the Benton County Health Department and City of Corvallis Parks and Recreation Department, the HKHC Project Coordinator has helped institute immigrant-friendly initiatives among the two agencies.  In collaboration with the health department, the Parks Department has developed more culturally and linguistically appropriate programming (see Parks and Recreation Case Examples) including deploying bilingual health navigators who coordinate community Zumba classes, reach out to other Latinos to access services such as healthcare and engage them in local health policy initiatives.

Central Valley, CA: Training Immigrant Leaders as Advocates for Healthy Living
Central Valley is a major agricultural region, but the bounty of the land does not extend to the many immigrant residents who harvest the crops.  Engaging the new immigrant population is complicated by their vulnerability caused by failed immigration policies, inhibiting their ability to advocate for change.  In addition, many new immigrants come from politically volatile countries with different local government structure and need assistance in navigating new civic engagement structures.  To address this, the HKHC Central Valley partnership has developed a bilingual Community Leadership and Advocacy program (See Community Engagement Case Examples) that focuses on bringing community members together to build their confidence and skills in advocating for change.  In 2010, the HKHC Community Leadership and Advocacy program established one of its first cohorts in Fairmead, California.  Fairmead is an unincorporated rural community in Madera County.  Over the years the demographics of this community have evolved from a predominately white and African-American town to a largely Latino and new immigrant population.  A group of recently arrived Spanish-speaking immigrants joined Fairmead Community and Friends (FCF) to work on establishing a joint use agreement at Fairmead Elementary school.  By unlocking the school gates after hours, children would have a safe place to play and be active.  The project encountered some institutional difficulties and inter-ethnic conflicts.  To provide graduates the skills they need to negotiate these situations, the HKHC Central Valley partnership has strengthened their leadership curriculum by incorporating conflict resolution into the program and has continued to adjust their leadership program to reflect the needs of its participants.  Through enhanced negotiation with the school and improved relationships within the group, FCF was able to eventually secure a joint use agreement with the school district.  This success marked the groups’ first major victory in creating a healthier community and underscored the power of resident collaboration.

El Paso, TX: Improving the Built Environment on the Border
The work of the HKHC El Paso partnership is inherently linked to immigration issues as it straddles the U.S. – Mexico border.  During the assessment phase of the HKHC grant, focus groups with youth found that the youth were afraid to cross the border and visit family who lived just three miles away in Ciudad Juarez, Mexico.  Given this context, HKHC El Paso has focused on issues within their power to change.  Two issues that have arisen because of their border proximity have centered on encouraging the use of parks and the need for traffic calming.  New immigrants have reportedly avoided their local green space, the Chamizal National Park, because the dark green park ranger uniforms bear an unfortunate resemblance to those worn by U.S. Customs and Border Protection Patrol.  While HKHC El Paso cannot change federal policy on uniforms, they have partnered with the Chamizal National Park to increase utilization of the park.  Chamizal National Park rangers have expressed excitement to connect more with the neighboring community by sponsoring a youth EcoClub (See Youth Engagement Case Examples) and being involved in walkability initiatives.  With frequent border crossings of large freight, another often overlooked issue is the need for traffic calming.  In the words of a long time resident, “We kind of got lost in development once all that came in and they turned Paisano (Drive) into a divided highway.  We see a lot of trucks and a lot of traffic, not a lot of people anymore” (Ramirez, 2011).  By making steps towards a more walkable, livable environment, HKHC El Paso is creating an atmosphere that prioritizes people and gives them a voice to change the health and safety of their environment.

Seattle/ King County, WA: Developing Culturally Appropriate Programming to Encourage Healthy Eating and Active Living
King County, including Seattle, is home to a growing number of immigrants and refugees from many different countries.  The King County Housing Authority (KCHA), in partnership with the Seattle Housing Authority and King County Health Department, uses the HKHC grant to focus on improving policies and systems that support healthy eating and active living for children in four affordable housing developments.  More than half of the participating families do not speak English at home, with the major languages being Somali, Vietnamese, and Ukranian.  Rather than let this diversity divide their work, HKHC Seattle/King County is working to promote cross-cultural exchange among residents.  Within the housing developments, multiple interpreters are present at most community meetings to foster multi-cultural connections and help people communicate with one another.  The partnership is trying to increase opportunities for physical activity for women, particularly of the Muslim faith, who do not feel comfortable exercising in front of men.  To increase access to healthier foods, the neighborhoods have several community gardens and the housing authorities are drafting garden guidelines so that residents can grow their own native foods that may not be available in local grocery or corner stores.

Multnomah County/Portland OR: An Immigrant Voice in Farmers’ Markets
Funded by Kaiser Permanente Community Fund at the Northwest Health Foundation, the Oregon Public Health Institute (the Multnomah/Portland HKHC lead agency) sought to uncover common barriers and potential solutions to increasing access to healthier foods for low-income families, seniors, and immigrants in Portland. Their partner, the Immigrant and Refugee Community Organization (IRCO) helped lead Farmers’ market tours and provided translation and interpretation services to introduce farmers’ markets to tour participants, and demonstrate how to utilize SNAP and WIC Farm Direct Nutrition Program (FDNP) benefits and SNAP Nutrition Incentive Programs. More than 50 Portland residents from the Nepalese, Somali, Russian, and Burmese immigrant communities attended.  The partnership also conducted listening sessions at the end of tours.  Access to transportation (over considerations of price, location, and preferred foods) was one of the most important factors influencing participant’s ability to shop at a farmers’ market.  Many tour participants are accustomed to cultivating land in their native countries for food. However, almost all tour participants currently live in rental housing and have little to no access to land to grow vegetables.  Many participants were unaware of the presence of a farmers market in their neighborhood and expressed interest in returning.

Phoenix, AZ: Engaging Immigrant Populations in Healthy Food Accessibility Assessments
A partnership between St. Luke’s Health Initiatives (SLHI) via its Maryvale on the Move (HKHC) initiative, Greenzona, the Local Food Working Group, and the Arizona State University School of Sustainability sought to assess the availability, accessibility, and affordability of healthy food in Maryvale and Canyon Corridor using the Nutrition Environment Measurement Survey  (NEMS) tool.  NEMS data collection is usually performed by university researchers that have been trained in the method. However, to the best of our knowledge, Maryvale and Canyon Corridor NEMS project set a new precedent by training bilingual residents to train monolingual Spanish-speaking residents to perform NEMS assessments in their community. As many Maryvale and Canyon Corridor residents identify Spanish as their first language, the project became the first in the country to translate the NEMS materials and perform all training and data collection in Spanish. This important benchmark creates an opportunity for other Spanish-speaking communities to perform their own NEMS assessment and create a healthier community.

For a copy of the Final Maryvale NEMS Report

Somerville, MA: Learning the Language of Positive Policy Change
The City of Somerville has focused on developing and implementing policy, environment and system changes to support healthy eating and active living in their community since 2002.  The City has become increasingly focused on ensuring that communities at highest risk for obesity are served by healthy eating/active living strategies, including low-income residents and the City’s large immigrant population.  Shape Up Somerville engaged The Welcome Project, a community-based immigrant services organization, to assist in the development of strategies that would reach the immigrant community.  This collaboration gave birth to two initiatives; a community engagement pilot that incorporates healthy eating/active living policy discussions into ESL (English as a Second Language) classes and a partnership joining the City’s healthy restaurant program with The Welcome Project’s immigrant owned business initiative.  The restaurant partnership has allowed Shape Up Somerville’s healthy restaurants to connect with the Welcome Project’s network of supporters, engage new restaurants in underserved neighborhoods and increase visibility of the healthy restaurant campaign while supporting immigrant business owners.   The ESL pilot provided students from Haiti, Brazil, Eastern Europe, Nepal, and Central America with the knowledge and tools to understand how their environment impacts their health and how to communicate directly with elected officials about healthy community policies.   The class culminated in a meeting with the Mayor where students asked for specific infrastructure changes for safer walking, access to public transportation, and access to fresh foods via supermarkets and farmers’ markets.  The Welcome Project will continue to advocate for these priorities as part of their community agenda.  The partnership attributes part of its successful engagement effort to their learning and persistence after two less effective pilot efforts.

For more information about the Welcome Project’s YUM program
For more information about the ShapeUp Approved program

Lessons Learned

HKHC partnerships across the nation have demonstrated the value of integrating the growing immigrant population into healthy eating and active living work.  HKHC partnerships in Somerville and Phoenix have partnered with immigrant organizations to achieve shared objectives and work on complimentary goals.  Partnerships such as Central Valley and Benton County have developed culturally appropriate programming in making steps towards further advocacy.  In addition to these successes, the partnerships have also highlighted the unique contextual challenges in engaging immigrant populations.  HKHC partnerships in El Paso , Central Valley, and Somerville have identified immigrants’ hesitation in civic engagement, while partnerships in King County/Seattle and Multnomah County/Portland have uncovered cultural unfamiliarity and barriers to policy initiatives.  Through these challenges however, we can see that progress is being made in HKHC communities by forging partnerships around shared values that transcend cultural differences and achieve equity for newer populations in creating healthier communities.

Passel, J., and Cohn, D., 2008, Immigration to Play Lead Role in Future U.S. Growth

U.S. Population Projections: 2005-2050. Pew Research Center

U.S. Census Bureau. (2010). Retrieved February 12, 2012, from Census Bureau, 2011

Candib, M. 2007. Obesity and Diabetes in Vulnerable Populations: Reflection on Proximal and Distal Causes. Ann Fam Med; 5(6): 547–556

Sanghavi, M., McCarthy, E.,  Phillips, R., Wee, C. 2004. Obesity Among US Immigrant Subgroups by Duration of Residence.  JAMA;292(23):2860-2867.

Ramirez, C. (2011, May 10). Obama in El Paso today: Family ties keep Chamizal area alive. El Paso Times. Retrieved February 15, 2011, from