Agents of Change

It’s as old as tribal society and as contemporary as Barack Obama’s presidential campaign.

The use of citizen advocates to effect social change is a proven recipe for success, not only in politics, but also in a variety of other arenas. Within tight-knit communities, neighborhood activists are more powerful catalysts for change than mass media campaigns or appeals from unfamiliar “experts.”

This is particularly true in the field of public health, where a handful of local outreach workers–known as promotoras in Latino culture–can multiply the impact of beneficial programs across an entire community.

Twenty years ago, John P. Elder, San Diego State professor of public health, incorporated the promotora model into a health promotion program in the South Bay community of San Ysidro. Not only did that project prove remarkably effective at the time; several of its components remain in place at the San Ysidro Health Center today.

Get with the program

Currently, Elder directs Aventuras para Niños, a $3.6-million, National Institutes of Health-funded initiative to reduce childhood obesity in South Bay communities. Project staff easily found promotoras to make home visits and talk to parents about the value of exercise, healthy eating and limited screen time for children.

But it took a year to find a second group willing to knock on the doors of the school principals and city and county officials.

“The single most important element of this project,” Elder said, “was to finally find these four courageous Latino women determined to ask the city for $450,000 to clean up neglected public parks. And they succeeded. We gave them the training and the personal reinforcement, but they did it.”

Elder joined the Graduate School of Public Health (GSPH) in 1984, just three years after it welcomed its first degree candidates. From day one, he fostered the school’s commitment to serving diverse national and international populations, particularly San Diego’s growing Latino community.

In fact, Elder and his former students, several of whom are now GSPH faculty, were among the first researchers to verify a spike in obesity, heart disease, asthma, diabetes and other chronic diseases among San Diego’s Latino population.

They identified possible culprits–lack of access to parks and playing fields, greater numbers of fast food outlets in urban Latino communities, excessive screen time and, among children, repeated exposure to television’s barrage of ads for high-fat and sugary foods.

Recognizing the harmful behaviors was just a first step. More important were the twin tasks of taking these results to the community and motivating Latino families to change the habits that compromised their health.

Syndicating good health

Enter Elder’s team of public health researchers. They collaborated with the San Ysidro Health Center to initiate Salsa, an ambitious project designed to reverse poor nutritional habits among San Diego’s low-income Latinos.

Salsa staff disseminated basic health information to the community through Spanish-language newspapers and point-of-purchase materials. The messages were reinforced with meal preparation classes, school health and cafeteria programs and coronary risk factor screenings offered by the health center.

Then, Elder and his team folded a vital ingredient into the Salsa mix–the use of promotoras or local outreach workers charged with increasing awareness of the program within the community.

“It was the first time we used promotoras in San Diego, and it has been the springboard to almost all the work we’ve done since,” Elder said.

Not only has Elder employed promotoras in San Diego; he has also relied on outreach workers in dozens of countries around the world to spread current information related to alcohol abuse, maternal and child health, HIV/AIDS prevention and vector-borne diseases.

“Thousands of people worldwide can attribute their good health to the practice of John Elder’s models of healthy behavior,” attested Thomas R. Scott, vice president of research for SDSU.

In recognition of his work, Elder has been named Distinguished Professor of Public Health and the winner of the 2009 Albert W. Johnson Research Lectureship, an annual award honoring outstanding achievement in research and scholarship by an SDSU faculty member.