Transcript of Episode 6: Richmond Fitness Warriors

with host David Richards [DR] and guests Dr. Danny Avula [DA] and Lakeshia Allen [LA]  
Listen to the audio

[DR] This week on the Healthy Communities Podcast we’re going to talk about the relationship between housing and health in Richmond with Public Health Director Dr. Danny Avula and Fitness Warrior Lakeshia Allen. We’ll see how empowering residents strengthens a city.

[DR] Welcome to the Learning Network’s Healthy Communities Podcast; I am your host, David Richards from APHA. This is Episode 6: Richmond Fitness Warriors.


[DA] Sure. My name is Danny Avula. I am the public health director here in the city of Richmond and have been here at the health department, first the deputy and now the director, for about nine years. My background, I’m a pediatrician and a preventative medicine doctor by training. I realized pretty early on in my clinical career that I was more interested in and wanted to have more of an impact on the macro sphere. I like to think about how policy, behavior and culture of communities, and the history of practices and policies impact the health and wellbeing of the community. I discovered public health as a medical student and decided that I wanted to be in a local health department. I’ll let Lakeshia talk about herself and her role, and then we’ll talk about some of the demographics in Richmond in the city. 

[LA] My name is Lakeshia Allen. I’ve been in Richmond for about 16 years. Getting into the public health field and interest came about two years ago when I found this program, the Sports Backers, called Fitness Warriors. Being in a community, a public housing community, I saw a need for people to take care of themselves. Being an advocate for the community, I took it upon myself to give this community something that they need, something that would get people moving because I’ve already established trust with a majority of the residents of that community. So, I got involved as a fitness warrior and became a group certified fitness instructor and have been holding classes in public housing for two years now.            

[DA] A little bit about Richmond, Richmond is the capital city of Virginia. It has a population of about 220,000 and that’s been on a significant growth trajectory. It’s grown about 20,000 people in the last seven years or so. That is continuing. There’s been a real resurgence in the city. There have been companies moving here, millennials coming here in droves. It’s really exciting. There are so many wonderful accolades that the city has received. It’s written up in magazines all the time, top ten lists of cities to visit, one of the best food towns and beer towns, and so on and so on. There really is a great energy that is here in the city. But, it also has a really complicated and significant history. Richmond was the capital of the confederacy and the center of the slave trade. That legacy of slavery and how race has played out in our community, politics and business continues to plague us. That plays out right in front like the conversation around monuments. It’s one of the things that people come to visit Richmond for, it’s called monument avenue. It’s a commemoration to confederate soldiers. There is a beautiful stretch of a neighborhood that is dotted with these massive monuments or Robert E. Lee, Stonewall Jackson, and so that has been a center-point conversation about what that means for our city and how we start to think about our history in our current context. One of the things that I have been really hopefully about in recent years is the conversation about the role of race as it relates to opportunity, to health and wellbeing, to educational outcomes is happening constantly. There literally isn’t a week that goes by where I’m not having a conversation with people all over the city about these things. What’s interesting is that it’s not the same people. It’s not just my friends who work in government or thinking about issues in poverty. It is the business sector, the healthcare system, the schools. It’s every piece of this community that is coming to this awakening about our context here. That’s a really surging conversation that has huge implications for our future. 

[DR] I do want to touch on that correlation between race and poverty and health outcomes, do you want to dive more into that? 

[DA] As a city, with a population around 220,000, our poverty rates, our adult poverty rates are a little over 26 percent and our child poverty rates hover right under 40 percent for children living under the poverty line. How does that translate to health outcomes? One significant one, which we’d love to go deeper on in terms of what we’re engaged in here is the obesity rate. The overall obesity rate is 29 percent in the city, which is slightly higher than the state average. But where the difference has been is when you start to disaggregate that data by race and by income. When we start to look and tease out we see that 36.7 percent obesity prevalence in the African American community, as opposed to 23.6 percent in the White community. When you do a different look at that by income and you start teasing out by strata, those making over $75,000 a year obesity rates are 19 percent, but under $35,000 a year it’s 39.8 percent. It’s really important that we start to tease these numbers out by location, race and income, so that we get a better idea of what communities we need to be focused and fixing our efforts in and where we really need to be building understanding and agency for community residents to know their own data and want to do something different with it. 

[DR] Exactly. Speaking of location how does housing impact health?

[DA] Housing and health have lots of different ties. I think there are different levels of that. There’s a level of how concentrated it is, how concentrated low-income housing is. And then there is the more practical like the housing condition that you’re living in directly impact your health. On that end of the spectrum, we’re talk about things like aging housing that has a high rate of lead paints that lead to lead poisoning in infants or older houses that have a lot of water intrusion leading to the growth of mold, which is a huge asthma trigger. We have higher asthma rates in communities with decapitated housing. But when you take a step back and start to look at what is the availability and the distribution of stable and affordable housing, that’s a major issue in our community. Just a couple of weeks ago, maybe a month ago, there was an article in the New York Times about eviction rates across the nation and Richmond has the second highest eviction rate across all regions here in the country. That concept of stable housing is a major issue. That lack of stability is a result of the lack of affordability, but then like many urban centers, we also have high concentration of families living public housing communities. You go back to the 1960s, where there were huge federal funding streams coming in to establish public housing in communities and this was happening on the heels of redlining. A practice that banks engaged in to say that if a community is safe and stable, and the houses look like they’re in good condition, we’re going to start making loans in those communities, but the reality is that on the cleaner, intentional criteria of these banks were if there was a predominately African American communities, we’re not going to lend to those communities. There will be structural policies that created concentrations of lower income African Americans. After redlining took place and that concentration of folks couldn’t get bank loans and own their homes had a huge infusion of federal dollars to establish public housing. How that played out in this city is that the neighborhoods that had the highest concentration of low-income minorities ended up being the same neighborhoods where we built public housing in the 50s. Those are the same neighborhoods of concentrations of minorities living there today. Almost to a T, when you look at disease rates like asthma or diabetes, or you look at social outcomes like percentage of people graduating from high school or percentage of people living with HIV, all of those things aggregate over their same communities. That analysis, looking at a number of health and social indicators, and seeing how they’ve aggregated over public housing communities that’s what took us nine years ago to work with the housing authority to say hey, we’d love to work with you guys to figure out how we can work alongside these residents of these neighborhoods and start developing new practices and programs that will help residents improve their health and wellbeing. That story was the kick-off of a model that we developed called the resource center, which is basically a satellite help center. When we took that data to housing authority, they said one way we can help is that we have vacant units in some of these sites. One by one they would give us a vacant unit, where we do a lot of listening, community engagement of public housing residents. We decided that we would provide one day a week of clinical services where we do chronic disease screening, sexually transmitted disease training and a few other things. Then five days a week where we actually have hired residents of public housing residents to serve as community health workers. Their job would be to connect with leaders and to work with neighbors so that they are plugged into a medical home and to figure out what are the health issues affecting the community and bring in resources or partnership opportunity for residents to learn more to engage their mission more. Over time, that model has proliferated. We just opened our eighth resource center, that’s one in each of our large six public housing communities and then two in lower-income neighborhoods throughout the city. It’s been an amazing story to watch that evolve over time. It has opened the doors to so many more partnerships and programs like the one that Lakeshia is involved in and maybe that’s a good segue for Lakeshia to talk about the Fitness Warriors program and how that’s played out. 

[DR] Lakeshia: please share your experience in your community and your experience as a fitness warrior. 

[LA] Well, Fitness Warriors is a six month commitment that you make to give residents and the community the opportunity to get up and move. When you go through this training, the main things that they look for are people who have the passion and the talent, and the dedication to give those who aren’t able to afford a membership at a gym. Those who are not able to go across town to a fitness class and to learn about how can I be healthy, how can I eat healthy, and how can I develop this healthy lifestyle. The purpose of this program is to bring fitness to those communities who have high rates of chronic disease. That’s what we do as fitness warriors. We make this commitment to try to change lives and that’s what we’ve been doing for the past two years in public housing. You go from being someone who’s in a wheel chair who can barely work out to a year later and they’re getting up to do squats with a five pound weight or having cooking done by the health department and blood pressure checks. Some people haven’t had their blood pressure checked in years and to see okay, I need to work on this and actually having to understand, what, I don’t eat that kind of food, I don’t eat that type of vegetable. They see that they can create a simple salad or a simple meal just by coming to this class to understand that overall, there’s a health revolution in making this commitment to come to make a healthier life or just trying to live.

[DR] That’s fantastic. How are people selected for this?

[LA] You fill out an application. It’s open to everyone. If you want to apply, then we go through an interview process to see who is actually dedicated. Who actually wants to understand that you have to go into communities that most people don’t want to go into. To give six months of their time to volunteer, that’s a lot to ask from someone. We look for those who are dedicated and passionate who want to make a difference. 

[DR] That’s great, thank you. I want to move into that relationship physical fitness and nutritious eating and eating habits.

[DA] Sure. I gave you the history of the resource centers and our on the ground presence in public housing and how the presence in those communities opens the doors to a lot of different valuable partnerships. One of the best examples of that is the work that we’ve done with Sports Backers. Sports Backers is our local sports commission and a lot of what they do impacts in big ways but their mission is to create a more physically active Richmond. They started the Fitness Warriors program a couple years ago and through the connection between the Sports Backers and the Health Department, started to deploy fitness warriors into the communities that we serve. Alongside that, at the same time, another organization called Shalom Farms, which is one of our local urban agricultural organizations, was experimenting with different ways to bring produce to the communities that may need it the most. They developed a mobile pantry. These things were orbiting around each other what you see is that super important connect between healthy eating and active living to work towards a healthier lifestyle. We were thinking about how we practically do this for residents who are living in and who often don’t have these opportunities. So many communities with concentrated poverty don’t have the same access to full service grocery stores and often only have corner stores or fast food restaurants to buy food from. That was the birth of this idea where with on the ground relationships with community health workers with the expertise of Sports Backers could bring to the fitness warriors program and with the amazing produce and nutrition instruction that Shalom Farms could bring, how do we melt it together. That’s where this program was born. I’ll let Lakeshia talk more about what that looks like. 

[LA] With Shalom Farms, it has been awesome for someone to come in and actually show people, hey, that was really good. It’s awesome. When you come to these fitness classes and you receive food vouchers instead of waiting until the first of the month, I’m able to get my benefits and food. Coming to this class is a benefit to me to actually have food in my house. With our classes and stuff, this isn’t a once a month thing, it’s every week. It’s a weekly thing that we do with our residents. They look forward to coming to these classes because at the end of the day, it’s like hey, we do have something positive going on here. This is not just a community dealing with crime or any type of issues around, this is something that is a positive highlight for them.   

[DR] That’s fantastic. What are some of the results? What are you seeing and how do you measure success? 

[DA] There are a few different ways and metrics that we are committed to following. Some of those are process and program measures. Things like how many people actually come to get their health screening. There’s a component of this where people are getting their blood pressure checked on a monthly basis and then we track and follow that. Then there’s the sales metric because if we’re handing out the vouchers in the Fitness Warriors program, we need to figure out if that’s actually moving to purchase and consumption. They report out their sales per week at their mobile pantry that’s tied to the vouchers. Then, there’s a pre-post interview where the participants self-report how much time they’re spending exercising and how many vegetables they’re consuming. There are multiple layers of evaluation that are built into this. A couple of examples of where we’ve really seen success, at one of our sites where we have the mobile market, they started at a baseline of average sales of $16 of produce purchase per week, and then after this 12-week cycle, that went up to $61 produce purchase per week.                    

[DR] Through those sales numbers, you’re seeing an increase of fruits and vegetables servings, so that’s great. 

[DA] David, I have to add that you know. Philosophically, the way that this project has unfolded, it really is about allowing community residents to give a voice to their needs and to shape the program and the approaches to how it’s going to work for them. I think it’s a good example of what I see happening throughout our city where there is a desire to listen better and allow residents to have more agency and decision making to how they’re going to get to a healthier lifestyle. The process of each of these organizations have taken in program development has been really inclusive. It’s been one that has prioritized input from the participants and it’s changed and evolved because of that. The organizations involved are really proud of that fact. We’re proud of the fact that residents of the community are driving the way that we do things and that’s the way it should be.              

[DR] I’ve really enjoyed listening to both of you, so thank you. 

[DA] Thank you, David for the opportunity.                                               


[DR] That’s the show this week! The show was produced by David Richards. Thank you to my guests Dr. Danny Avula and Lakeshia Allen, and thank you all for listening. Links to more resources can be found on the Healthiest Cities & Counties Challenge website at healthiestcities.org under about the challenge, podcast. I’ll see you next time.