Defining geographic areas for complex interventions to address health disparities

Community health planning involves engaging people and organizations in actions to advance health. The Communities IMPACT Diabetes Center of Excellence in the Elimination of Disparities has developed an approach to reduce health disparities in diabetes among Latinos and African Americans. Program activities focus on the continuum of diabetes prevention, treatment and control of complications, and address factors at the individual, clinical, and community environmental levels. For complex interventions, location provides a useful framework for integrating health promotion activities and outcomes assessment. A key component of the approach used in East Harlem involves identification of a small, manageable zone for intensive assessment, referred to as the Sector of Excellence for Elimination of Disparities or SEED. Selection of this small geographic area for a complex intervention included formation of a site selection group composed of community residents and academic partners, identification of selection criteria such as population size, development and use of GIS mapping to survey the built environment of East Harlem, review and discussion of candidate areas, and selection of the target zone. Two other zones in East and Central Harlem with similar characteristics were identified for comparison. The site selection process implemented for the IMPACT Diabetes Center offers a model for other community health planning efforts. Factors that need to be considered to translate this approach to other community settings and regions are highlighted.