The Chief Health Strategist Role in Tarrant County, Texas: Building Walkable Streets and Greener Food Carts

By Vinny Taneja, MBBS, MPH, Director of Tarrant County Public Health

Fort Worth and Arlington are both located in Tarrant County, a fast growing community of approximately 2 million individuals living within 902 square miles. Like many large urban communities, neighborhoods vary significantly by culture, race/ethnic background, income, education, green space, housing, crime and many of other social determinants of health.

All of us deserve a fair chance at a healthy, long and fruitful life. Health equity simply means attainment of the highest levels of health for all. It is easier said than done. What is surprising to many is that the social, environmental and economic conditions around us determine and impact our health more than we can imagine. Due to their significant role in affecting health outcomes, these conditions have been dubbed social determinants of health.

Imagine if you live in a neighborhood with no sidewalks. If there is traffic on the street, you may be less inclined to walk due to fear of getting hit by a car. Now imagine walking on this busy street with your dog or with your kids. Also, think about where you are going: is it just for a walk in a sea of homes, or to somewhere with a purpose? Walkability is one example of how our environment shapes our health. In fact, research shows us that our ability to pound the pavement has a really profound affect. While 43 percent of people with safe places to walk within 10 minutes of home meet daily physical activity recommendations; only 27 percent of those without safe places to walk get their steps in.

Healthy neighborhoods are not just about streets though. There are many areas such as education, employment, healthcare access, community engagement, crime rates, transportation, planned development, housing, and race/ethnic background that can all have an impact on health.

How is Tarrant County addressing health equity?

Tarrant County Public Health (TCPH) is a nationally accredited health department. As part of the accreditation process, TCPH led the efforts in the community-wide development of the 2014 Tarrant County Community Health Improvement Plan (CHIP). The CHIP illuminates four priority issues affecting Tarrant County: education, environment, health care access and partnerships. The collaborative effort of this process has moved diligently toward improving health and wellness, along with addressing health disparities in Tarrant County communities.

For example, for the reasons listed above, an environmental goal is to improve the walkability surrounding elementary school neighborhoods. After gaining support from the community, Texas Christian University’s Harris College of Nursing, Blue Zones Project Fort Worth and TCPH worked with C. C. Moss Elementary School to develop and implement a sustainable walking school bus program called Walking Wednesdays. C. C. Moss is located in a community in dire need of infrastructure improvements to make it a safer environment for kids to walk and bike to school. With help from the City of Fort Worth, the program addresses such issues as dilapidated sidewalks, inadequate school zone speed limit signage and ineffective crosswalks. By partnering with Silver Sneakers, a fitness program for seniors offered by a local chapter of the YMCA, the children who walk are building relationships and bridging the generational gap, while they stay physically active on their way to school.

The department also established the Cultural and Linguistic Competency Policy and Procedures to ensure staff develop and maintain health services that are culturally competent, consumer-guided and community-based, and that help eliminate health inequities. One example is the creation of a Spanish Language Translation Committee, which provides appropriate health-literate communication in the form of written information. Another example is the hiring of bilingual staff to meet the growing needs of our diverse Tarrant County community.

We recognize that training is a key component for the successful implementation of policies. TCPH’s Center for Health Equity (CHE) has trained TCPH staff and the community on the basics of health equity, cultural competence, diversity, social justice and NACCHO’s Roots of Health Inequity. Most recently, the CHE has developed a Limited English Proficiency (LEP) training to assist the Women, Infants and Children (WIC) staff to improve communication with clients.  

TCPH strives to promote “health in all policies,” a concept defined by the Public Health Institute as “a collaborative approach to improving the health of all people by incorporating health considerations into decision-making across sectors and policy areas.” This means that we weave in public health best practices when we build new roads, zone new real estate, or even approve licenses for food vendors. For example, in 2016, TCPH helped the Tarrant County Food Policy Council increase access to healthy foods through three City of Fort Worth ordinance amendments. The results of the ordinance amendments are:

1) Push cart snack vendors were once only authorized to only sell frozen desserts. With a new amendment, vendors with self-propelled carts can now sell fresh produce in residential areas.

2) Fruit and vegetable vendors could once only sell on private property. The city ordinance change now allows the sale of healthy foods on public property, including residential areas. This change increases access to healthy foods in food deserts, where fresh options are limited.

3) The urban agriculture ordinance was amended to allow urban farms to operate in our city, as long as they adhere to certain safety and zoning requirements.

Finally, the department added health equity to the staff development curriculum. We are building traditional and non-traditional partnerships to address health literacy, healthcare access, disease reduction, infant mortality, breast and cervical cancer, access to affordable nutritious foods and integrated transportation.

TCPH is working diligently to advance health equity on our journey to becoming the Fort Worth’s Chief Health strategist by reaching as many residents as we can, no matter where they live or what language they speak, and incorporating the science of public health in to all of the places that touch residents’ lives every day.