Community Assessment Highlights Residents’ Health Concerns in Montgomery

The birthplace of the Civil Rights Movement, Montgomery is no stranger to the fight for justice and equality. The city’s long history of transforming challenges into opportunities for positive change is a testament to the community’s desire for and commitment to progress.  

Montgomery’s approximate 200,600 population is 60.6% Black/African American and 52.9% female with 21.2% of residents living at or below the poverty line. Almost 40% of people living in Montgomery classify as obese, and more than 14% of residents have experienced significant food insecurity. Challenging the city’s public health landscape further, in 2021, amid high rates of heart disease, cancer, and diabetes, nearly 10% of the population lacked health insurance.  

City leadership’s newly proposed Envision Montgomery 2040 plan, geared toward sustainable development and enhancing quality of life in the community, marks a symbolic step forward in tackling ongoing challenges of lingering inequality in access to health care, employment, education, housing, transportation, and food. Anchored by a restored focus on the future, Montgomery is poised for a new chapter.

A Community Health Needs Assessment (CHNA) supported by Partners In Health United States (PIH-US), in partnership with the city of Montgomery and the Alabama Department of Public Health (ADPH), is guiding comprehensive reforms in Montgomery, aimed at addressing the city’s high social vulnerability and improving community wellness. Identifying critical gaps in vital resources and prioritizing interventions that target the root causes of health inequity, the assessment offers evidence-based recommendations for systemic changes that respond to the community's specific needs and create a healthier environment.

Public Health and Safety Challenges

In the wake of the COVID-19 pandemic, Montgomery secured a grant from the CDC and ADPH to redress health disparities impacting the city’s underserved populations. This grant, awarded in 2021, uniquely supported local community health workers (CHWs), whose close understanding of residents’ needs plays a key role in addressing social vulnerabilities and strengthening community resilience.  

A welcome addition to a city with very few public health offerings, PIH-US provided education guiding the city in its integration of CHWs for the first time. As community members, CHWs bridged the gap between Montgomery’s health care providers and the communities they serve and were on the frontlines of the city’s coronavirus response.

“I think initially the priority for the city was to identify health issues and health disparities and fix it,” recalled Kelbrey Porter, grants director for the city of Montgomery. “So, the route we've been taking as far as grants have been concerned, up until this point, is to apply for everything we qualify for, and in that process, we found that we qualify, but we're not competitive and we're missing a lot of data that is required.”

Recognizing the value of their proximity and expertise, PIH-US staff consulted CHWs in developing the assessment, ensuring the appropriateness of survey language and subject matter. Staff also mentored and trained CHWs responsible for administering the survey, walking them through the process of interviewing participants and recording their responses into a database.  

The assessment consisted of 27 questions that explored respondents’ demographic information, their perspectives on community health, and their actions and beliefs around the COVID-19 vaccine. Between January and May 2023, eight CHWs used the survey to collect data from over 1,000 residents across 17 zip codes through community canvassing and city-supported health events. Data from the assessment, closely tracked and analyzed by PIH-US staff, helped identify residents’ health behaviors, challenges, and strengths and offered a detailed look into local issues threatening public health and safety.  

According to the assessment’s findings, people living in Montgomery are most concerned by violent crime, substance abuse, mental health, and lack of community support.  

Survey participants also expressed significant dissatisfaction with their ability to access safe drinking water, fruits and vegetables, grocery stores, public transportation, adult education, and health insurance—all social determinants of health.  

Gun Crime, Violence Top of Mind

One year after the assessment was completed, in April 2024, PIH-US conducted six focus group discussions and three key informant interviews, delving deeper into survey findings. At separate events held at the Loveless and Regency Park Community Centers, 30 study participants shared thoughts on the issues shaping their neighborhoods’ health and their experiences contending with gaps in government services and facilities.  

At Regency Park, community members voiced deep concerns about public safety, particularly gun crime and youth involvement in violence, highlighting socioeconomic factors like limited opportunities as key drivers.  

“We think that a lot of times it's the crime that's the issue, but it's really opportunity, it's education, it's economics,” one focus group participant explained.  

According to residents, young people living in the city often find themselves both perpetrators and victims of violence, a troubling cycle that stems from barriers to meaningful opportunities for education, employment, social networks, and other resources that help people live longer and healthier lives.  

“When I first started working with young people,” a city employee shared, “they used to have a term ‘youth at risk.’ All youth are at risk now.”

Loveless Center discussions, capturing the perspectives of community leaders and health care providers, echoed similar sentiments, emphasizing strained relationships with law enforcement, a lack of community togetherness, and feelings of isolation as underlying causes for violent behavior. Respondents stressed the need for mentorship programs that integrate social, cultural, and career development activities. They were confident that professional therapy services in schools could not only address emotional problems but also serve as a preventive measure against crime. Other key suggestions included increasing economic opportunities, educational resources, and programs designed to address the underlying social drivers of violence, as well as improving neighborhood infrastructure with video surveillance and better street lighting.  

Gaps in Mental Health Care

City health care providers are troubled by the increasing severity of mental health issues since the pandemic. Difficulties accessing care, coupled with pervasive stigmas and a lack of awareness about mental health and available services, undermine efforts to improve community wellness. For providers who are under-resourced and understaffed, bridging gaps in knowledge and combatting misinformation are only the tip of the iceberg.  

"It's heartbreaking to think that we're having to [discharge clients from social service programs] even when we're providing referrals, even when we're putting them in the car and taking them to a service provider,” a community member shared in a focus group discussion. “If that service provider is over capacity and says, ‘I'm sorry, there's nothing we can do,’ we're having to exit people from a program that is meant to save lives.”

Montgomery residents, law enforcement, and health care workers are keen on implementing initiatives that better prepare them for responding to mental health crises within the community, advocating for broader access to mental health services and more funding toward mental health programming, facilities, and staff.

A Need for Better Transportation, Nutrition, and Recreation  

Another barrier to addressing health issues in the city is transportation, repeatedly named as a root cause of inequity. The obstacles created by lack of transportation commonly derail efforts to tackle Montgomery’s health disparities, which has resulted in unanimous support for improvements to public transportation, ensuring health care and outreach efforts for particularly vulnerable populations are not in vain.  

The reallocation of funding to improve Montgomery’s transportation infrastructure, however, will only be as successful as the quality of local facilities made available.  

Residents participating in the assessment noted a host of chronic conditions that would benefit from better recreational facilities and nutritional support, including asthma, diabetes, hypertension, heart disease, and obesity. In discussions, they agreed the lack of affordable resources geared toward improving physical health such as diverse food options, safer biking and walking trails, and community gyms and health clinics played a fundamental role in Montgomery’s poor health.  

“If you're trying to get people that aren't doing any of this now, they may not know what they might enjoy... sometimes you have to just get them into something that would draw them to an event, and then have [activities] available,” a community member shared during a focus group.

Creating a Stronger Sense of Community

At the center of Montgomery’s struggle to better connect residents to local resources is a sheer desire to cultivate community. Nearly every discussion attributed negative health and social conditions, at least partially, to an absent feeling of belonging and togetherness within families, neighborhoods, and the city.

Montgomery’s leaders and residents alike share a vision for community development through neighborhood-based facilities that serve as hubs for health information and programming, including regular testing and preventative interventions. These community centers would offer support for youth, caretakers, and those at risk of social isolation, providing recreational spaces to convene with friends and family, particularly during emergencies.

In addition to funding for community centers, residents hope to see the city revitalize public infrastructure and improve collaboration across community organizations and government agencies to better promote available resources without duplicating services.

“I think for us we got a better understanding of what health equity is,” Porter explained. “We're addressing different health disparities in areas that may appear to be the same on the outside or by demographic, but within their community there are differences, and they've been able to highlight those and advise us on where we can make changes.”  

Thanks to PIH-US's support of the assessment and focus groups, health equity in Montgomery is becoming more tangible. PIH-US staff developed an infographic CHWs could distribute and discuss with residents that gives a snapshot of their community’s health landscape and outlines the effort to create a healthier environment.  

Results from the assessment will also be used to design a Community Health Improvement Plan, focused on the most actionable recommendations. PIH-US will continue partnering with the city, inviting contributions from community members to help determine the most effective and inclusive path to equitable access to health resources and services.  

“Now the city is looking at considering Community Health Workers as a position for the city based on the work that we did here and the information and data we can support that we received from the team,” Porter shared.  

Working closely with PIH-US staff, the city plans to facilitate a Health and Human Services Committee that will manage the planning and implementation of health initiatives. The committee will bring together community leaders and local health care providers to collaborate on responses to Montgomery’s health needs and establish goals that have widespread impact. 

PIH-US staff and city officials together plan to seek, apply for, and manage grants that address concerns made evident by the assessment’s findings. The city is committed to expanding efforts to reduce Montgomery’s social vulnerability, relying heavily on data provided by PIH-US to inform strategies and help secure funding for improved health and wellness in the community.