Dallas Tackles Its Public Health Challenges

Dallas Chief Resilience Officer, Theresa O’Donnell, recently joined with several 100RC staff and more than 30 city stakeholders at the West Dallas Multipurpose Center, in a Problem-Framing Workshop, to address one of the city’s most pressing issues –  poor community health.

As Dallas develops its Resilience Strategy, with a focus on equity, public health presents as one of the central areas of both concern and potential. O’Donnell realized that the city is in the public health business – its fastest-growing budget expenditures include EMS (Emergency Medical Services) operated by Dallas Fire & Rescue, amounting to $275 million for fiscal year 2017, with over 220,000 ambulance runs reported.  She and her colleagues in the Dallas Office of Community Services had to then discover and distill ways of addressing the myriad interrelated stresses that contribute to emergency management as the measure of first resort it often is, and find ways for Dallas to spend its money where it can actually better affect public health.

The Problem Framing Workshop is a tool available to 100 Resilient Cities Member Cities, developed in collaboration between 100RC and Citymart, and is designed to meet this need through crowd-sourcing in a meaningful, structured way.  It is ideal for CROs seeking to engage an array of city stakeholders to source and communicate existing problems, deepen understanding of these problems, and learn about new ways to solve them. Ideally, the Workshop leads to actionable initiatives that can be further developed and incorporated into the Resilience Strategy itself, or inform new policies and programs after the Strategy is complete.

In Dallas, the first phase of the Resilience Strategy development process, and extensive stakeholder engagement, gave rise to the understanding that underlying stresses of poverty, geographic isolation, language barriers and racial inequity, all contributed to major community health challenges. The city has some stark statistics: 30% of Dallas children live in poverty– the third highest rate amongst US cities over 1 million people – and 20% lack health insurance.

These stresses have an inequitable impact across Dallas, which has the greatest level of inequality between highest and lowest income neighborhoods of any US city. In parts of South Dallas, over 40% of families with children live below the poverty line, and the unemployment rate exceeds 18% (PRA) compared to 3.8% city-wide.

In partnership with Building Community Resilience (BCR), a national collaborative that seeks to improve the health and life outcomes of children, families and communities, O’Donnell began exploring public health as a natural convener for addressing these stresses.  BCR focuses on researching and implementing programs that strengthen buffers that can prevent negative outcomes associated with the “ACEs” – Adverse Childhood Experiences, and Adverse Community Environments.

According to O’Donnell, “The BCR process has enriched and deepened our understanding of the adversities facing Dallas’ children in their homes and in their neighborhoods…and (we) are beginning to collaborate on strategies to strengthen the resilience of our residents and our community overall.” Especially with Dallas County Department of Health and Human Services focused on pandemic-related issues, these longer-term stresses contributing to poor community health have continued to grow worse in southern Dallas neighborhoods, where the city’s chronic stresses are most acute. The city needed a mechanism to better understand and engage with these challenges – the policy gaps as well as other contributing factors. The Problem-Framing Workshop provided an easy way to identify options to prioritize for the new Office of Community Services.

Based on the feedback from the Opportunity Builder (a web application that enables city staff of all levels to present problems and ideas for solutions, collate available resources, and specify factors and timeframes required for best results), O’Donnell invited those stakeholders best suited to provide concrete contributions to develop actionable opportunities.

They included representatives from BCR, JP Morgan Chase, Parkland Hospital, the Office of Welcoming Communities and Immigrants Affairs, the North Texas Food Bank, Homeless Solutions, Community Care, Texas Health Resources, Workforce Solutions, The Senior Source, Dallas County Community College District, Legal Aid of Northwest Texas, the Hunt Institute, and others. The opportunity statements of each of the 5 tables ranged from those regarding public health directly, to those addressing underlying stresses, such as expanding literacy and educational opportunities, workforce development, nutrition, and transportation.

Much of the workshop consists of brainstorming barriers to each of these. For instance, at the table addressing literacy and education, language barriers (40% of Dallasites do not speak English at home), lack of quality childcare for single parents, poor transportation options, and the stigma of a learning disability diagnosis, all surfaced as barriers to literacy and educational opportunities. Teams then dug deeper, formulated vision statements, and provided resources that can lead to measurable change. Finding a metric for measuring discernible change is fundamental to the Workshop’s output.

Based on the output of the Workshop, Opportunity Reports are developed, documenting the types of approaches available in the market to address identified challenges.

As Dallas develops its Resilience Strategy, the Workshop will be key in designing actions that have the best chance of being implemented and being effective. Stakeholder engagement is fundamental to developing a Strategy that is practical and most attuned to a city’s shocks and stresses. However, finding a way to engage with stakeholders in a meaningful and constructive way, that yields actionable results, is difficult. This tool presents a process that can achieve this.