Living HealthSmart in Alabama is getting easier thanks to a growing UAB initiative

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By Olivia McMurrey

One of Laura Dudley’s last stops at the Senior Wellness Expo, held at Sixth Avenue Baptist Church in Birmingham’s Titusville neighborhood, was the Live HealthSmart Alabama Mobile Wellness clinic. She chatted with Keisha Taylor, who checked her vital signs.

Dudley said her day had been very busy and she was glad Taylor was taking her blood pressure. 

“Sometimes what you do makes your blood pressure go up,” Dudley said.

The Mobile Wellness clinic is part of the Live HealthSmart Alabama initiative, which the University of Alabama at Birmingham launched in 2019 with a goal of pulling Alabama out of the bottom 10 states in terms of negative health indicators by removing systemic barriers. Pilot projects in four Birmingham neighborhoods wrapped up this year, and organizers hope their success can be replicated throughout the state.

Alabama ranks 45th in obesity rates, 48th in diabetes, and 47th in high blood pressure, according to the American Public Health Association’s 2023 Health Rankings Report.

“You also have to look at the fact that Alabama hovers around the bottom when you think about physical activity and then fresh and nutritious food consumption,”said Lemeshia Chambers, operations director for Live HealthSmart. “So we started with four key pillars. Those are inclusive of prevention and wellness, good nutrition, education and physical activity. We’re wanting individuals to understand how to take charge of their health.”

Addressing systemic barriers

But it’s not just about individual choices. Live HealthSmart Alabama aims to make good health simple by taking a comprehensive approach that addresses systems and environments. 

The four pilot neighborhoods for the initiative were Bush Hills, East Lake, Kingston, and Titusville. Dr. Dalton Norwood, director of prevention and wellness for Live HealthSmart Alabama, says those communities have the worst health outcomes.

“For years, we’ve been telling individuals from these communities, go do exercise, but they don’t have a place to safely do it,” Norwood said. “We have been telling these individuals, you don’t eat enough vegetables and fruits, but they’re living in food deserts. So by doing the systems, policies and environment changes, we are removing those barriers and actually giving enablers.” 

What Live HealthSmart has done

To devise and implement the growing array of programs Live HealthSmart Alabama uses in service of this mission, various departments and university centers, faculty, students, employees, volunteers and partnering organizations from across campus get involved.

Students take part in Live HealthSmart programs through courses and as interns. And they aren’t all health sciences students. The initiative accepts interns from all colleges within the university, Chambers said.

“The Collat School of Business has helped our community members understand how to do strategic planning and how to create a budget as it relates to what they’re attempting to accomplish in their communities,” Chambers said.

Soumya Khanna, a second-year medical student enrolled in a community health education course, said students learn in class about things such as how exercise impacts triglycerides and how certain foods can affect blood sugar.

“What we do here in the community is really help implement what we learned from those lectures,” she said. “You prevent disease from progressing, and we can do that from lifestyle modifications, and not everything needs to be treated with medication.”

Accessing health care

After a quick health screening that includes giving a small blood sample, community members meet with Norwood and students, who explain their test results and health conditions in everyday language and counsel them on lifestyle changes. Approximately 80% of people screened have an abnormal number, Norwood said.

They also meet with a community health coach who lives in their neighborhood. Norwood said this aspect of the Mobile Wellness program is crucial because it makes follow-up care possible.

“Let’s say we need to follow up on their blood pressure, we need to follow up on their lifestyle modifications, or diabetes, or they just need primary care, or they need insurance,” Norwood said. “So this community coach helps them navigate the system to get access to these things that they need.” 

Nutrition students including Madison Chastain also met with those who visit the Mobile Wellness clinic.

“Today, I had my own table where I was doing consultations after they saw the doctor,” Chastain said. “If they have any sort of disease that can be treated with nutrition, then they come to me to talk about changes that they can make.”

The Mobile Market

Chastain says one of the biggest challenges community members face in making those lifestyle changes is access to healthy food. And that’s where another program of Live HealthSmart Alabama comes in. The Mobile Market is a grocery store on wheels: a bright green trailer with produce, proteins and dairy arranged neatly on shelves. The food is sourced from local farmers or grocery stores, sold to the market at cost and offered to the community at the same price. 

The Mobile Market makes a regular stop at Lakeshore Foundation, where people with disabilities go to exercise. Carol Kutik, director of health promotion and fitness at Lakeshore Foundation, said many participants live in food deserts. 

“We have a lot of members who come here with public transportation. They may be wheelchair users or have physical disabilities, so they use public transit to get here. One of the things that is so beneficial to them is that they can get some fresh produce while they’re here working out at Lakeshore.”

Systems and environment changes

The Mobile Market and the Mobile Wellness van also regularly visit the four pilot neighborhoods. Other projects Live HealthSmart Alabama has completed in those neighborhoods include constructing sidewalks, adding stop signs and crosswalks, planting trees, installing outdoor lighting and renovating schools and community spaces.

Chambers said the intention with all these projects is to make improvements that will encourage community members to be more active.

“We might not think it’s a luxury to have a sidewalk in our neighborhood, to be able to go right outside our front doors and walk, but the communities that we’re serving, they don’t have those luxuries,” Chambers said. “They may have had a park, but the grass may have been overgrown, or no fencing, no basketball goals.”

With input from community members, UAB’s Engineering Department helps determine built environment changes that could make physical activity more achievable for residents.

“We are making improvements based on what the community has said,” Chambers said.

Richard Drake, president of the East Lake Neighborhood Association, said Live HealthSmart Alabama representatives began attending the association’s monthly meetings three or four years ago. One project community members identified was upgrading Downey Park, which had fallen into disrepair.

The tree-studded area atop a hill now boasts a newly paved walking trail, new basketball goals, and a brightly painted court. Drake gave a tour on a recent chilly morning. He pointed out a large symbol painted in the center of the court. 

“See how ‘a neighborhood that cares’ is in there, and see the East Lake part on it, and we put that in there so everybody would know what we got here – a neighborhood that cares,” Drake said. “We’re going to care to keep it clean and have it so people would enjoy themselves.”

He said that’s what’s happening. Kids play at the park, adults exercise by walking around the track and groups reserve the pavilion for events. 

Monitoring improvements

There’s data showing the Live HealthSmart Alabama model is working. Chambers said UAB is tracking participation in the initiative, the incidence of chronic disease, health-care access rates and more. 

Norwood said the percentage of Mobile Wellness clinic patients who return for needed follow-up care has increased to 60%, and their outcomes are promising.

“We started very low, like about 20%, in our first couple quarters, but then as we have refined a process, we have increased that follow-up rate significantly,” he said. “We have seen a great improvement in their diabetes numbers, on their blood pressure, in their cholesterol.”

So where’s Live HealthSmart Alabama going next? Chambers said the community-based model will remain, and the initiative has already expanded to five north Birmingham neighborhoods: Central City, Evergreen, Fountain Heights, Druid Hills and Norwood.

“We’ve also begun our expansion throughout the state, starting in Selma, with implementation to happen, hopefully, in Demopolis and Camden in early 2025,” she said. “And then we also have Dothan on the horizon. We’ve done enough in the city of Birmingham to show what the capabilities are, if you follow the playbook that has been established by Live HealthSmart Alabama.”

Chambers said UAB has created a map, based on areas with the highest incidence of chronic disease, and will use it to order invitations to implement Live HealthSmart. 

Back at the Senior Wellness Expo in Titusville, Laura Dudley was eager to know her blood pressure.

“That’s low, isn’t it?” she responded when Keisha Taylor, a UAB clinical research coordinator, told her.

“The bottom number is a little high, but the top number is good,” Taylor said. “So for all that you’ve been doing today, I think that’s pretty good.”

“I just ran here and there,” Dudley said.

Dudley’s awareness of how her actions affect her health is exactly what Live HealthSmart organizers are trying to cultivate. 

The hope, Chambers said, is that Live HealthSmart will graduate from the initiative phase – and just become a way of life.

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