If you build it, they will come: A partnership between a community health center and a local YWCA/YMCA

Public health's social justice approach to eliminating inequalities requires institutional change in systems that affect biological susceptibility and behavioral risk. Lack of access to safe, affordable exercise is a key factor impeding low-income inner city residents from adopting healthier lifestyles. Administrators at community health centers and YWCA/YMCAs can reduce and/or eliminate inequalities in opportunity to engage in physical activity through developing partnerships. Through a health center/YWCA/ YMCA/university partnership, one community has shown that low-income, deconditioned patients will take advantage of open access to physical fitness facilities. Through an institutional membership process, the YWCA allowed patients to use the facility gratis. During a 5-year period, 1134 patients made more than 27,395 visits to the facility. Patients with diabetes comprised ¼ of patients using the YWCA and 1/5 of all visits; most frequent users had statistically significant reductions in HbA1c readings. Female and Hispanic patients were more likely to use the YWCA than non-female and non-Hispanic patients. The YMCA initially used the same model of institutional membership permitting free acess; during the initial 24 months, 705 patients used the YMCA for a total of 8126 visits. Subsequently, the YMCA changed the access model to require that adult patients could use the facility gratis for a 30-day trial period, after which they were required to pay a monthly $10 fee to continue. Comparisons of usage under open access and low cost membership show the effect of a financial requirement of patient use overall, patient use by sociodemographic characteristics, and patient diabetes indicators.