Investing in Gulfport: Development of an Academic–Community Partnership to Address Health Disparities

Abstract

Background: Invest Health, a collaboration between the Robert Wood Johnson Foundation and The Reinvestment Fund, selected 50 midsized cities to participate in a health initiative that encourages cross-sector alliances to think creatively about mechanisms that address barriers to reducing health disparities among low-income populations. Gulfport, Mississippi, was 1 of 50 teams chosen to participate.

Objective: To develop an academic–community partnership among the University of Southern Mississippi, Coastal Family Health Center (CFHC), Mercy Housing and Human Development (MHHD), the Mississippi State Department of Health Office of Health Disparity Elimination, and Gulfport residents to create the Healthy Gulfport Initiative, and, ultimately, the Gulf Coast Healthy Communities Collaborative (GCHCC).

Methods: A Gulfport City team was developed per Invest Health guidelines and included five individuals who represented the public sector, community development, and an academic or health-related anchor institution in the community. Several data sources were used to develop city-wide priority health outcomes. A priority neighborhood experiencing health disparities related to the priority health outcomes was identified. A community-engaged needs assessment was conducted in the priority neighborhood. Residents were engaged in prioritizing the health, education, and activity needs of their community via a participatory nominal group process and survey data collection.

Results: Residents in the priority neighborhood lack access to health care and healthy food options owing to transportation difficulties and proximity to resources.

Conclusions: The GCHCC will be established to act as a "backbone organization," so that a common agenda can be created with an emphasis on potential for collective impact.

To effectively address health disparities in chronic disease rates among low-income populations, strong yet diverse cross-sector collaborations are required. One such partnership that has proven to be successful in reducing health disparities in vulnerable populations is an academic–community partnership.^1–4 Using a collective impact framework⁵ with principles of community-based participatory research (CBPR),^6–8 this article describes the beginning work of the Healthy Gulfport Initiative in developing an academic–community partnership to address barriers to health and wellness among vulnerable populations in Gulfport, Mississippi, and the broader Gulf Coast region. The overarching goal of the Healthy Gulfport Initiative is to improve health outcomes and reduce health disparities related to cardiovascular disease, diabetes, obesity, and infant mortality in the city of Gulfport, Mississippi; and to establish the Gulf Coast Healthy Communities Collaborative that brings together partners across multiple sectors to catalyze community-informed, data-driven action at the intersection of community development and health.

THE INVEST HEALTH INITIATIVE

Invest Health,⁹ a collaboration between the Robert Wood Johnson Foundation and The Reinvestment Fund, accepted applications to a new health initiative from midsized cities across the United States. Midsized cities were defined as those having a population between 50,000 and 400,000 residents. Only three midsized cities were eligible within the state of Mississippi (Gulfport, Jackson, and Southaven) for participation. More than 180 teams from 170 cities across the United States competed for education and planning grants to engage cross-sector alliances to think creatively about mechanisms that addressed barriers to reducing health disparities among low-income populations. City teams were to be composed of five individuals who represented the public sector, community development, and an academic or health-related anchor institution in the community. The Gulfport team was 1 of 50 teams selected nationally to participate in the initiative.

The Gulfport team was represented by two anchor institutions—the University of Southern Mississippi and the CFHC. Founded in 1910, The University of Southern Mississippi, provides unparalleled education and resources for the people of South Mississippi. The University of Southern Mississippi provides multilevel employment opportunities in the surrounding city of Gulfport and serves as an anchor point for health-related research locally, regionally, and nationally. Although the campus located in Long Beach is the closest in proximity to the Gulfport area, the Hattiesburg campus is also directly involved in the Healthy Gulfport Initiative. Two assistant professors in the Department of Public Health within the College of Health function as co-principal investigators for the grant. CFHC provides accessible, quality, primary health care on a sliding fee scale for members of low-income populations, and fees are based on income and family size. Open since 1983, more than 75% of their patients are uninsured or have Medicaid, and 50% of their patients live at or below 100% of the Federal Poverty Level. CFHC's outreach programs manager represents CFHC for the Gulfport team.

Additional partners include the Mississippi State Department of Health, Office of Health Disparity Elimination, and MHHD. These additional partners provide representation from government, public, and community development sectors. Since 2003, the Mississippi State Department of Health Office of Health Disparity Elimination has worked to expand disparity elimination efforts to underserved populations. They strive to identify health inequities and their root causes, and promote evidence-based solutions to create a more equitable health system. Recent activities focus on health education, health screenings, and reducing health communication barriers in public health service areas. Since 1997, MHHD has helped low-income families become first-time homebuyers. They offer paths to home ownership through financial counseling and case management. They also offer community classes in budgeting; home, personal, and hurricane safety; and health insurance education via federally trained Affordable Care Act Navigators. Although the team was convened for the purposes of the Invest Health Initiative, we have worked together on numerous federally, state, and locally funded projects to improve health in Mississippi.

National Convenings, Pod Convenings, Web-Based Learning Groups, and Team Support

One of the key features of the Invest Health Initiative is the culture of interactive learning and education. Over the course of the 2-year planning and education program (May 2016 to April 2018), team members from all 50 Invest Health cities traveled to four national convenings, and attended three of five theme-based pod convenings (Table 1).

The first national convening (Philadelphia, Pennsylvania; June 2016) consisted of sessions related to improving team building skills and self-awareness. Topics presented at the subsequent national convenings included social and health equity; community engagement, investment, and development; expanding cross-sector collaborations; and project sustainability. All team members were expected to travel to the national convenings. Teams then chose from three of five smaller pod convenings attended by two to three team members, which provided more intensive subject matter trainings (Table 1), and also provided an opportunity to witness successful host teams in action. Additionally, web-based learning groups offered educational opportunities related to transportation, community education, community development, housing, and food access. At the beginning of the initiative, teams were provided a liaison from Bennet Midland, LLC, a management consulting firm that has primarily worked within the civic sector. Gulfport's team liaison has provided logistical support through site visits, conference calls, and meetings at national convenings to brainstorm goals and objectives, resources to address barriers, connection to other teams facing similar obstacles, and samples of effective tools that have demonstrated success in other similar cities.

Table 1.

Invest Health Initiative National and Pod Convenings (2016–2017)

*Team attendance.

METHODS

Data-Driven Priority Establishment: The Healthy Gulfport Initiative

From the beginning of the Invest Health Initiative, emphasis was placed on data-driven problem identification. All teams were provided access and training for Policy Map,¹⁰ an online Geographic Information System mapping platform that offers demographic, real estate, health, and employment data for communities in the United States. Teams were also introduced to County Health Rankings and Roadmaps, a Robert Wood Johnson Foundation program that provides a summary of health statistics at the county scale.¹¹ Both of these data platforms, along with data from the National Center for Vital Statistics, the Behavior Risk Factor Surveillance Survey, and the Mississippi Infant Mortality Report were used to prioritize health-related needs in Gulfport, and to hone in on geographic locations that showed areas where people were experiencing health disparities.

Harrison County, which includes Gulfport, ranks 24th out of 82 counties in Mississippi with regard to health outcomes based on length and quality of life indicators available through County Health Rankings and Roadmaps; however, they rank 47th with regard to the physical environment, which includes indicators such as air pollution, drinking water violations, and severe housing problems.^11,12 Approximately 35% of children in Harrison County live at or below the poverty line. The 2015 homicide rate in Harrison County was 12.6 per 100,000, which reflects a rate that is higher than the state average (10.3 per 100,000). The homicide rate among non-Whites is almost 5 times higher than the rate among Whites. One-third of adult residents of Harrison County (32.0%) are obese, 21% of adults smoke, and 28% are physically inactive.

Data from the National Vital Statistics Report and the Behavioral Risk Factor Surveillance System Survey indicate that Mississippi ranked highest in the nation for Cardiovascular Deaths¹³ (344.5 per 100,000 population), and 48th for diabetes¹⁴ (13.0% of adults) and obesity¹⁴ (35.5% of adults). Further, health disparities in Mississippi are experienced to the greatest degree by African Americans who make less than $25,000 annually.

Data from the 2015 Mississippi Infant Mortality Report¹² show that Mississippi ranked 50th in the nation for infant mortality, defined as the number of infants deaths within the first year of life per 1,000 live births. Mississippi also ranked 50th in the nation for the percentage of infants born with low birth weight (infants born weighing ≤ 2,500 g). Infant mortality in the Gulfport region in 2015 was 8.2 per 1,000 live births. In the region, Black mothers are disproportionately impacted by infant mortality (11.2 per 1,000 live births) when compared with White mothers (5.9 per 1,000 live births).

The World Health Organization defines health as "a state of complete physical, mental, and social well-being and not just the absence of sickness or frailty."¹⁵ Health should be viewed from a broad context, and in doing so, long-standing barriers that have contributed to health inequities can be addressed. For instance, Gulfport is experiencing many city-wide factors that have traditionally been ignored as contributors to poor health outcomes and health disparities. The area is still recovering from the effects of Hurricane Katrina and the BP Deepwater Horizon oil spill, which deeply impacted the community with job displacement, transportation barriers, and availability of affordable housing. The Gulf States Population Survey¹⁶ reported that 38.4% of Harrison County residents were impacted by the BP oil spill through loss of income or employment. In a recent focus group conducted by a team member,¹⁷ mothers with children in Gulf Coast Head Start Centers reported high rates of movement in and out of different Head Start locations owing to unstable housing situations and unstable employment prospects. Additionally, two of the larger industries that support employment in the area, the casino gaming and seafood industries, were also significantly impacted by Hurricane Katrina, and more recently by the BP Deepwater Horizon oil spill.

In the city of Gulfport, the team will be targeting determinants of infant mortality, as well as determinants of cardiovascular disease, diabetes, and obesity. These choices are data driven, but also resonate with community members. To make the most impact on the identified health priorities, the team sought to focus their efforts by identifying geographic regions in which low-income residents lived, and to engage those residents through a community-based participatory approach.

Priority Neighborhood Selection

Before Hurricane Katrina in 2005, most public housing areas in Gulfport were located south of the I-10 corridor, and residents were in close proximity to grocery stores, green spaces, medical facilities, and employment opportunities. These resources could also be accessed via public transportation routes that run North/South on Highway 49 or East/West on Highway 98 (Figure 1). After Hurricane Katrina, low- to moderate-income public housing was constructed north of the I-10 corridor into areas of north Gulfport to mitigate the potential for wind and storm surge damage should another strong hurricane make landfall. Transportation is a hardship for low-income residents of north Gulfport because the area is more rural and geographically dispersed. Convenience-type foods are more accessible than are healthier options that can only be found up to 10 miles away at full-service grocery stores. Employment, green space/parks, and medical facilities are inaccessible without personal transportation. The nearest public transportation stop is 9 miles away.

After taking these geographical challenges into consideration, the team approached the South Mississippi Housing and Development Corporation about working with a mixed use, mixed income neighborhood north of the I-10 corridor. This neighborhood would be the first prioritized to take part in the Healthy Gulfport Initiative. The neighborhood offers two- and three-bedroom single-family rental homes. Income requirements are based on home occupancy, and range from $14,400 (one occupant) to $54,250 (seven occupants in three-bedroom units). Section 8 vouchers are accepted for more than 10% of the homes, and the neighborhood retains 23% of the homes for senior citizens.

The team made the neighborhood selection based on available data, and the neighborhood's potential barriers to access health care and healthy foods owing to limitations of the built environment; however, there was no guarantee that the neighborhood residents would be interested in participating in the initiative. Additionally, the prioritized health-related needs of the city were based on data that were available at the county or city scale. No neighborhood-level data existed that could inform the team with regard to the health needs of the priority neighborhood. This type of information could only be obtained by engaging the community and conducting a needs assessment.

Community Engagement

CBPR is defined as a "collaborative approach to research, which equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities."⁶ The CBPR approach has found to be effective in reducing health disparities among low-income groups,⁷ and in prioritizing and implementing projects in the built environment that impact health.⁸

Although the data regarding health disparities channeled the selection of the priority population to be served, engaging community members in the planning process to ensure that

Figure 1.

Gulfport public transportation routes along the Highway 49/Interstate 10 corridors

their needs were met rather than organizational needs, or the interests of the team, was critical to the long-term success and sustainability of the partnership. The initiative was to be guided by the principles of CBPR and, as such, the highest priority was placed on engagement of the community residents and building capacity in areas of health that they see as important to their community. Additionally, it is important that this improved capacity eventually results in sustainable change.

Community Needs Assessment and Survey Development

Community forums were the first step in communication, and were used to introduce the potential project to the neighborhood. Neighborhood residents were recruited to participate in the forums through a mailed informational flyer that was also posted on the front door of the neighborhood management office. Two forums were held at different times so that senior participants who were active in the day could attend, and to ensure that participants who worked during the day had the opportunity to participate in an evening forum. At the community forums, the Invest Health Initiative and project team were introduced to neighborhood residents as a potential opportunity for community collaboration. The Invest Health team asked community residents for permission to collect information for the needs assessment and, after consensus was obtained, conducted a participatory nominal group process. Findings from the participatory nominal group process were used to inform the development of a confidential household survey. The survey assessed community members' access to medical services, access to healthy foods, need for transportation, educational interests, and other primary concerns for the neighborhood. The survey also collected information regarding household makeup and neighborhood strengths. The survey was approved by the University of Southern Mississippi's Institutional Review Board (Protocol Number: 16112206). The survey was made available at subsequent community forums to those individuals who wanted to complete it. Before survey data collection, residents were presented with informed consent, information about the survey, risks and benefits to participation, and information about the survey's data collection methods and analysis. For individuals with low literacy, the consent form was reviewed orally, and the survey was completed with assistance from a team member. A letter of information about the Invest Health Initiative, the survey consent form, and the household survey was mailed to each household in the community that did not have a resident in attendance at one of the community forums. For all households, we asked that one adult member of the household complete the consent form and survey and return it to the neighborhood office in a sealed envelope. Whether completed at a community forum or completed at home and returned to the neighborhood office, all survey documents were consistent, ensuring that results could be compiled for all households who elected to participate. Every household that completed a survey was given a $5.00 gift card to a major grocery store as an incentive.

Community Needs Assessment Analysis

Both qualitative data collected through the participatory nominal group process conducted during the community forums and quantitative data collected through the household surveys were used to compile a needs assessment of the priority neighborhood.

Qualitative data were analyzed for recurrent themes. Those themes were used to inform survey development for the quantitative analysis. Survey data were entered into IBM SPSS Statistics for Windows, version 24 (IBM Corp., Armonk, NY). Demographic data and questions pertaining to access to fresh fruits and vegetables, health care, and transportation were analyzed by category and reported as frequencies and percents of the whole sample (Table 2). Statements pertaining to community activity needs and community educational needs were ranked according to the percentage of households who indicated that there was a need in the community for a specific activity or educational session (Table 2). Community strengths and neighborhood features were assessed via a series of statements that residents marked as true or false. Community cohesiveness was assessed via a series of statements that were rated based on an appropriate Likert-type scale (Table 2).

COMMUNITY NEEDS ASSESSMENT RESULTS

The survey was completed by 30 of 62 occupied households in the community (48.4%). Seven household members completed the survey during a community forum. The remaining participants took the survey home, or received it by mail, and returned it at a later time.

The results from the needs assessment can be found in Table 2. Of the 30 households that responded, 53.3% (n =16) were from single female residents ranging in age from 65 to 88 years. The other family types consisted of single parent households with children (n = 6 [20.0%]), married couples with children (n = 6 [16.7%]), and married couples without children (n = 2 [6.7%]). The two most commonly reported

Table 02.

Findings from Community Household Survey (n = 30)

themes were lack of access to basic medical services and lack of access to an affordable grocer that provided fresh produce. In fact, only one household (3.3%) reported eating the recommended daily allowance of fruits and vegetables (five or more servings per day), 10.0% of households reported eating three or four servings per day, and the remaining households reported that they did not regularly eat fruits and vegetables (86.7%). Most of the residents reported transportation issues related to either their ability to afford gasoline or keep their personal car in good working order. All of the respondents reported some form of health insurance coverage, and most (93.3%) were current with health screenings based on requirements for their age. However approximately one-third to one-half reported not being able to see a medical provider (dentist, optometrist, physician) owing to economic hardship.

The needs assessment also brought to light many neighborhood strengths. One theme that was apparent from the participatory nominal group process was that all the residents spoke highly of the property manager. They indicated that she was quick to address any needs that they had, or schedule repairs, and overwhelmingly felt like she "took good care of all the residents." The survey was also helpful in identifying community strengths. For example, 100% of residents thought that the sidewalks throughout the neighborhood were in good condition. Most thought that it was safe to walk around their neighborhood after dark (n = 26 [86.7%]), and that the neighborhood park was a safe place for children to play (n = 29 [96.7%]). Approximately one-third of residents rated the sense of community in the neighborhood as very strong or strong (n = 10 [33.3%]), and nearly all (n = 29 [96.7%]) reported that they were very proud or proud to live in their neighborhood. Additionally, most of the residents (n = 27 [90.0%]) reported that they either strongly agreed or agreed that people of different racial and ethnic backgrounds live together peacefully in the neighborhood.

DISSEMINATION OF FINDINGS AND NEXT STEPS FORWARD

The needs assessment helped to identify neighborhood priorities, and helped to highlight existing strengths and resources within the neighborhood and the broader city of Gulfport. These findings were shared with residents during a community forum to ensure that the data collected were consistent with community perception, and as an opportunity for partnership and collaboration. Several residents provided verbal feedback that the needs assessment was helpful in providing a voice that spoke to the needs of the community.

At the community forum, a brainstorming session was held with residents to list ways to address priority health concerns. Community residents identified increasing access to basic medical services and fresh food as their top priorities and, because reliable transportation was a considerable barrier, a neighborhood resource fair was discussed. The resource fair was planned with special consideration given to potential conflicts with school and community activities that might impact attendance of neighborhood residents. The neighborhood resource fair took place in August 2017, and featured CFHC's Mobile Health Unit. The Mobile Health Unit traveled to the neighborhood so that residents could learn about health care options available through CFHC. Residents were most interested in receiving health screenings (dental, blood pressure, blood glucose), immunizations, and school entry physicals. CFHC is available to provide or coordinate follow-up treatment for individuals who screen positive, and they do so based on an income-based fee scale. MHHD provided information about financial wellness services (homebuyer education, Affordable Care Act Navigation, family budgeting), and hurricane preparedness. The community event also featured fun activities for children and families, and provided opportunities for community members to sample healthy food options.

DISCUSSION

Challenges and Lessons Learned

Over the last 18 months, the team has come to realize the importance of program sustainability. We ultimately want the neighborhood members to have the capacity to prioritize their needs, both health and non-health related, and organize themselves around common goals for change. The needs of the community are diverse, as evidenced by the results from the community needs assessment, and as such, many viewpoints need to be heard, validated, and considered as opportunities for change. One way that we are working to overcome this challenge is to facilitate the development of a neighborhood association. An item on the survey asked respondents to suggest members of the community who might be willing to help others improve the health of the neighborhood as an informal snowball process to identify natural helpers and community leaders. Names of potential volunteers were also collected at the resource fair. These names have been compiled, and the team is in the process reaching out to those individuals to ask them if they would like to participate in organizing a neighborhood association. Other potential projects that were suggested by community members include a community garden, a food pantry, and installing walking path distance markers on existing neighborhood sidewalks. We hope that once the neighborhood association is organized and functioning, it will be able to work with the housing authority management team to implement these projects with funding provided by the Invest Health grant.

Community engagement in the priority neighborhood has also been an ongoing challenge. Less than one-half of the households in the neighborhood completed the household survey. It is important to consider that residents who are too busy to be involved, or those who are uninterested in participating, are not having their voices heard, nor their specific priorities addressed. One limitation of the needs assessment results is that there is no way of knowing if the respondents are representative of the neighborhood as a whole, or other similar populations. Further, we did not collect demographic information about those residents who attended the earlier community forums. This was an active decision by the team, because we did not want the community forums to have a "research feel" about them. We now offer sign-in sheets for community members, but residents are not required to sign in. We know that some of the members who did not feel comfortable completing the household survey have attended events in the neighborhood and have provided verbal input as far as changes they would like to see. The team will need to develop a way to capture this information moving forward, so that many opportunities for input are available to residents. The team hopes that, once the neighborhood association is in operation, committees of interest can be formed, and more households within the neighborhood will contribute to the CBPR process.

Another challenge that we have encountered is staying focused on and committed to the tenants of CBPR. For example, one of the most important aspects of CBPR is partnering with community members in the planning, implementation, and evaluation of program efforts equitably. It may at times seem more efficient to allow the academic partners to engage in outcome writing and evaluation, but this focus can create a power differential in the academic–community partnership. It is especially important that priorities for change are driven by community members rather than the research team, and that there are community-informed goals and agreed upon, measurable outcomes for the partnership moving forward. For long-term change to occur, community members need to feel a sense of ownership of the decisions and priorities that are made about their neighborhood and their city.

Although this goal can be facilitated by engaging the community and continually seeking their input and feedback, some capacity development is needed so that the academic– community partnership can be equitable throughout the research process. To that end, the team is planning to offer Community Research Fellows Training (CRFT) to members of the priority neighborhood and to residents in the broader city of Gulfport.

The original CRFT program was piloted by the Program to Eliminate Cancer Disparities at the Siteman Cancer Center, Barnes Jewish Hospital, and the Division of Public Health Sciences at Washington University School of Medicine.^18–20 The purpose of the CRFT program is to promote the role of racial/ethnic and other underserved populations in the research enterprise by increasing the capacity for CBPR between academic researchers, public health workers, community-based organizations, and community health workers serving Mississippi. The CRFT program is a project undertaken by the Mississippi State Department of Health Office of Health Disparity Elimination, and has been offered in Jackson, Mississippi, and Hattiesburg, Mississippi. The CRFT program covers 19 public health topic areas during once-weekly 3-hour classes held for 15 consecutive weeks. The Invest Health grant will fund this program, and will also fund a series of mini-grants to selected CRFT graduates so they can implement and evaluate priority projects in their own Gulfport communities.

Although the team recognizes the unique needs of the priority neighborhood, we know that we cannot reach our overall goal to improve health outcomes and reduce health disparities in Gulfport related to chronic disease and infant mortality by focusing our efforts in one neighborhood. To overcome this challenge, the team has been organizing efforts that promote healthy changes and the sustainability of the Healthy Gulfport Initiative on a city-wide scale. It is important to acknowledge, however, the challenge of acquiring continued funding for additional projects at the neighborhood and city level.

The Healthy Gulfport Initiative team is made up of volunteers, all who have full-time employment and various other community commitments. Even so, team members have been fully committed to the partnership with the priority neighborhood, and have demonstrated that commitment by attending community forums, contributing to survey development and analysis, and participating in activities prioritized by neighborhood residents. When submitting the budget for the original grant, the team decided that we wanted all funds in the grant that remained after convening travel, to be reserved for programming upstart in the priority neighborhood, and the city of Gulfport. To that end, there is no money in the grant for time and effort of team members. We have since come to realize that there is a need for broader program coordination if the initiative is going to continue to move forward, and that that coordination will require additional funding streams. One challenge that must be overcome is that although there are health coalitions in Gulfport, they are focused on specific health topics (i.e., infant mortality, obesity, diabetes). Further, these coalitions "work in silos" and often apply for grant funding in competition with one another rather than collaboratively. This weakness can become a strength if we can work collectively with other entities and share resources, but this work should be coordinated and facilitated by a "backbone support organization."⁵ We propose that the GCHCC will fulfill this role. The collaborative will be made up of representatives from local communities, hospital systems, work force development agencies, the local and state health departments, city and county government, and industry leaders. One of the aims of the GCHCC will be to create a commonly agreed upon agenda, pool resources and expertise to pursue more substantial funding opportunities, and use shared measurements⁵ to evaluate success.

In the last few months, an opportunity to launch the GCHCC presented itself. Some members of the Healthy Gulfport Initiative Team were also taking part in a steering committee for a community data platform known as The Community ExCHANGE that was funded through the Louisiana Public Health Institute. Because this committee already had representation from many of the cross-sector entities that we were considering inviting for the GCHCC, we discussed the possibility of The Community ExCHANGE taking the lead on launching the GCHCC, and they agreed. Other than the proposed GCHCC, there is currently no city-wide initiative that has health as its focus; however, the Mississippi State Department of Health is in the process of implementing Mayoral Health Councils statewide. We hope that the GCHCC will be able to provide input on the health priorities of represented communities that can ultimately be addressed through the Mayoral Health Councils. GCHCC plans to begin meeting in Spring of 2018, and will work collaboratively with community partners to develop unified health priorities that can be monitored for change over time.

Last, it is important to note that the use of appropriately scaled data is vital to a project such as this. It is difficult to obtain health outcomes data for Mississippi at a scale that is finer than the county level, and for some indicators, only a state-level rate is available. Data at a finer scale makes is far easier to identify geographical areas (neighborhoods) that are experiencing health disparities, and to prioritize these areas for prevention and treatment activities. Recently, a collaboration between the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention resulted in the 500 Cities Project. The 500 Cities Project provides city- and census tract-level small area estimates for chronic disease risk factors, health outcomes, and clinical preventive service use for the largest 500 cities in the United States.²¹ Gulfport was fortunate to be one of the 500 cities for which this finer scaled data were made available. Additionally, the previously mentioned Community ExCHANGE, provides a data plat form and digital tool that supplies census tract-level data for the cities of Gulfport, Biloxi, and Ocean Springs (Harrison, Hancock, and Jackson Counties, respectively). Without these data, we would not know if we were successful in our overarching goal of reducing chronic disease and rates of infant mortality. Moving forward, these data will be used to help continue the establishment of data-driven health priorities in Gulfport and the broader Gulf Coast area. It is our hope that, by continuing to engage in CBPR at the neighborhood level, and using the GCHCC as a backbone organization to support cross-sector collaboration and establish data-driven, community-informed health priorities, we will see the benefits of collective impact on the disparate rates of chronic diseases and infant mortality in the city of Gulfport and the broader Gulf Coast region.