Addressing Economic and Social Determinants of Health Among Low Income,

Ethnically Diverse Women in Rural North Carolina

University of North Carolina Center for Health Promotion and Disease Prevention

Funded by the Centers for Disease Control and Prevention and the Center for Minority Health and Health Disparities,

National Institutes of Health1

HOPE Accounts for Women

Salli Benedict, MPH HOPE Projects Director

Marci K. Campbell, PhD, Principal Investigator

UNC School of Social Work:Michal Grinstein-Weiss Andréa TaylorClinton Key

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Project PartnersNorth Carolina Assets AllianceFDIC Money SmartCommunity bank branchesNC Dept. of Labor

HOPE Accounts for Women Counties

Percentage of North Carolina Adults Who Are Overweight or Obese

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Project HistoryNearly 17 years of working on economic and

health promotion in these communitiesCotton-producing region, heavily dependent

on textile industryClosing of textile mills + Hurricane Floyd

economically devastated the areaUNC’s work in the community led to the

founding of the Community Action Council in 1999

Community Action Council

2009

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Poverty is hazardous to

women’s health • Clear and robust relationship between

individual income and individual health: poorer people have a disproportionate amount of health problems.

• Stair-step pattern of worsening outcomes from rich to poor for almost all risk factors, diseases, and causes of death, which persists within racial and ethnic groups.

The link between health and poverty

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Poverty is hazardous to

women’s health • Low-income Americans are significantly more

likely than those with high incomes to have health risk factors including smoking, being overweight, and sedentary lifestyle; higher prevalence of disability and chronic illness and shorter life expectancy.

• African Americans, Native Americans and Hispanic Americans are more likely to be low income.

• Women are more likely to be low income.

The link between health and poverty

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NIH ARRA Challenge GrantCenter for Minority Health and

Health Disparities

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Threadsofhopenc.org

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HOPE Accounts for Women

Building Financial Assets

HOPE Circles model: goal setting and social supporto Financial literacy and health education

o Hands-on diet and physical activity skill training

Matched savings account (1:1 match up to $600)o Savings can be used for education, job skills and

small business development

Website for tracking savings, progress on goals, & feedback on their Health and Life Goals.

Individual monthly tailored newsletters12

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HOPE Accounts for Women Building Financial AssetsRandomized Control Trial

Primary Measure: Weight loss

Secondary Measures: Assets Building Financial Literacy Physical Activity Fruits and Vegetable

400+ women

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UNC Center for Health Promotion

and Disease Prevention

Coharie Tribal Center

BB&T

Duplin/Sampson Counties

60 Circle Participants

The Healing Lodge

New Century

BankRobeson County

80 Circle Participant

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CommWell Health

BB&T

Lenoir County

80 Circle Participant

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Data Analysis Weight (BMI)Fruit & Vegetable IntakePhysical Activity Psychosocial Measures-

Goal setting, self-efficacy, barriers, hope scale, depression, social support

Financial MeasuresAsset building through savingsFinancial literacy

Demographics

Sub Study: Behavioral EconomicsWorking with Dan Ariely and Janet Schwartz,

Duke University

Qualitative Interviews with all Circle Leaders

• What are some of the negative effects of saving? • How can encouraging someone to save

inadvertently have negative outcomes?• Example: Deciding to stop going to the gym in

order to save.

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Project TimelineSeptember 2009:September 2009 -

June 2010:Summer 2010:

Fall 2010 – Spring 2011:

Spring & Summer 2011:

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Awarded ARRA Challenge Grant

Planning Stage, development of materials, coordinator training

Circle Leader trainings and participant recruitment

Circle sessions and savings period (six months)

Evaluation, data analysis, writing up results for dissemination

ChallengesPatriot Act requires that each individual opens

an account with a social security number

Not AFI = Means that anyone who saves over a certain amount of money may jeopardize govt benefits

Short savings period (6 months)

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HOPE Accounts for Women

“It is possible to eliminate poverty from our world because it is not natural to human beings—it is artificially imposed on them.” -Muhammad Yunus

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Thank you!Questions? Please contact us!

Andrea Taylor (Presenter)andrea_taylor@unc.edu

Salli Benedict (Project Director)salli_benedict@unc.edu