East Harlem is very different from the rest of the US. With its excessively high incidence of diabetes, health solutions geared for the general population are clearly not working. Time to re-think the approach.






East Harlem is a neighborhood unlike any other in Manhattan – and maybe the country. It has its charm, culture, and some unique problems. The incidence of diabetes in East Harlem far surpasses the rest of Manhattan. The challenges are deep – culture, income and ready accessibility inexpensive, unhealthy food at outlets throughout the neighborhood.

City Health Works, an organization seeking to reduce diabetes in East Harlem, recruited 4B to help create a roadmap for the initiative.



While diabetes strike males and females alike, diet is a primary factor. In East Harlem, females are the family’s “food gatekeepers.” Females do the majority of the shopping, and cooking. Understanding females, as well as family dynamics, led to actionable solutions.

It became obvious that East Harlem is unique, and the program set up for the country by the National Diabetes Foundation had very little chance of success in East Harlem. Our solution: investigate what public programs and initiatives have worked in East Harlem, meet with people in those organizations who can advise on their methods, and extrapolate.

The program we recommended was based on the “pull” rather than “push” model. Meaning, may the program attractive and engaging, lower the initial commitment to participate, and gear trainers and other staff members to perform the tasks they are best at, and most enthusiastic about.

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CHW has expanded significantly over the last two years. With various aspects of the recommendations being implemented, CHW is having a noticeable impact on the health of families living in East Harlem.

Collective members: Dan Formosa, Yvonne Lin