The Well: a neighborhood-based health promotion model for black women.

Abstract

The Well is a community-based drop-in, self-help wellness center located in a high-quality low-income housing complex in Los Angeles. It represents an empowerment approach to developing culturally appropriate neighborhood-based health promotion for women. Wellness is defined by Well members as achieving and maintaining physical, emotional, and spiritual well-being. In this article, the term black refers to African American women and all other women of African descent whose citizenship or ethnic identification is not American (for example, women from the Caribbean, Africa, or Europe). This article describes the process of development and current characteristics of The Well and presents suggestions for replicating this process in other communities. Although women constitute only 7 percent of the women in California, they experience disproportionately poorer health outcomes than other female population groups. A profile of women's health status in California from 1984 to 1994 indicates that women had the shortest life expectancy, the highest levels of mortality at every age, the highest mortality from heart disease and stoke, the highest prevalence of hypertension and obesity, the highest mortality rates from homicide and AIDS, and the highest incidence of other sexually transmitted diseases (Nelson & Dumbauld, 1997). Black women between 15 and 34 years of age are more likely to be victims of unintentional injury and homicide, involved in domestic violence; report low self-esteem, increased depression, anxiety, substance abuse, and eating disorders; experience higher rates of infant mortality and low birth-weight babies; and experience problems with reproductive health and obesity compared to white and Latina women residing in the state (California Women's Health Project, 1993). For women between 35 and 64 years of age, the effect of alcohol and tobacco, a sedentary lifestyle, and nutritional imbalances influence poor health status. This age cohort is marked by the development of chronic major illnesses that span a significant portion of a women's life. Cancer, particularly lung cancer, is the leading cause of death for this group of women. Despite higher rates of screening, mammography and self-examination, women experience higher rates of death from breast cancer than women of other ethnicities. They also experience higher rates of death from cervical cancer, heart disease, liver disease, stroke, and diabetes. (California Women's Health Project, 1993). Black women ages 65 years and older are at greater risk of death from heart disease than cancer. Diabetes, pneumonia, influenza, and coronary obstructive pulmonary disorder are the leading causes of death among this group of women, as well as other populations in this age cohort. GETTING STARTED: DEVELOPMENT OF THE WELL The Well was established by the California Black Women's Health Project (CBWHP) in 1994. CBWHP serves as the statewide coordinating arm of the National Black Women's Health Project (NBWHP), a self-help and health advocacy organization founded in 1983 to promote the health of women through community-based, grassroots initiatives. In 1994 the NBWHP contracted with the University of California, Los Angeles (UCLA), Psychology Department to help develop the statewide organization. The James Irvine Foundation, as part of its Women's Health Initiative, funded the development of the CBWHP. The vision of The Well emerged at a planning retreat attended by 40 women to develop a vision and action plan to promote their wellness and to improve their health status. The planners were invited to participate on the basis of their prior involvement with the NBWHP and their record of community activism on women's issues. Participants engaged in a group process where they shared personal and community issues, concerns, and goals regarding health and wellness. …