Hunger in the Community Context:
Roles of Health Care Leaders in Addressing the
Social Determinants of Health
ProMedica and the Alliance to End Hunger Summit
Albuquerque, NM
June 2, 2015
Kevin BarneK, DrPH, MCP
Senior InvesMgator
Public Health InsMtute
The ImperaMve for Health Care TransformaMon
•
Demonstrated commitment to
–
Transparency
–
Evidence-‐informed prac7ce
–
Con7nuous improvement
•
Integra7on of care redesign and community health
•
Move beyond compliance mentality
•
Build internal popula7on health capacity
•
Build an ethic of shared ownership for health with diverse
PopulaMon Health in Context
Medical
Model
Population Health
Assess patient health status
Ensure timely access to clinical
services and medications
Clinical case management through
team-based care
Patient education
Use EMR to ID and group risk
populations, monitor service
utilization and patient outcomes
Lament
persistent patient
noncompliance
Place-Based
Population Health
Assess patient health status,
social and
environmental risk factors
Ensure access to clinical services
& link to
social support systems
Case management through clinical and
community-based teams
Community-based
education,
problem
solving, and advocacy
Use
EHR
and
GIS
to identify geo conc. of
health disparities, target interventions,
&
monitor population health outcomes
Leverage HC resources through
strategic
engagement
of diverse stakeholders
Coming to Terms with Health InequiMes
•
Unhealthy housing
•
Exposure to array of
environmental hazards
•
Limited access to healthy
food sources & basic
services
•
Unsafe neighborhoods
•
Lack of public space, sites
for exercise
•
Limited public
transportaMon opMons
•
Inflexible and/or poor
working condiMons
•
Health impacts (e.g.,
allostaMc load) of chronic
stress
Working Anything but 9 to 5
Scheduling Technology Leaves Low-‐Income Parents With Hours of Chaos
By Jodi Kantor, Photographs by Sam Hodgson
When the external becomes internal:
How we internalize our environment
Allostatic Load
Inadequate
Transportation
Long
Commutes
Housing
Lack of social
capital
High
Demand-Low Control
Jobs
Lack of
access to
stores, jobs,
services
Crime
Stress
Stress
Stress
Stress
Stress
Stress
Source: Anthony Iton, MD, JD, SVP, The California Endowment
OpportuniMes for Alignment
Issue-‐Specific Assessments (Health Impact Assessment) Local Health Departments (CHAs/CHIPs) Tax-‐exempt Hospitals (CHNAs/ISs) Community Health Centers (Sec7on 330 Applica7on)United Ways
(CHAs) Community AcMon Agencies (Community Services Block Grant Applica7on) Financial InsMtuMons (CRA Performance Context Review) When available, HIAs provide an
addiMonal layer of informaMon, most o`en relaMng to broader environmental impacts, in the design of strategies to improve health. Given reduced public funding,, ongoing collabora7on with diverse stakeholders provides an opportunity to leverage experMse and secure poliMcal support for LHD leadership in monitoring and advancement of policies that reinforce and sustain improvements in health status and quality of life.
IRS allows hospitals to develop ISs in collaboraMon with other hospitals and State and local agencies, such as public health departments. Expanded enrollment and movement towards global budgeMng will require work with others who can help address the determinants of health and reduce health dispari7es. CHCS are encouraged to link with other providers such as LHDs and
hospitals to provide beZer-‐ coordinated, higher quality, and more cost-‐ effec7ve services.
UWs have an
established history of collaboraMng with other stakeholders in conduc7ng assessments and addressing unmet health needs. Standard 2.1 emphasizes partnerships across the community, CAAs can o`en “serve as a backbone organizaMon of community efforts to address poverty and community revitaliza7on: leveraging funds, convening key partners…”” Targeted CRA investments in housing, retail, educa7on, and job crea7on in targeted low-‐ income census tracts that are aligned with parallel
interven7ons and investments of health care and public health stakeholders provide an opportunity to address social determinants of health and help reduce health care costs.
Bayview/Hunter’s
Point
Hunters View Alice GriffinVisatacion Valley
SunnydaleTenderloin
Portrero Hill
Chinatown
Tract status for Community Reinvestment Act (CRA) eligibility, as of 2012
Obesity – CollecMve Impact Approach
Public Sector
Public Health Parks and Recreation Community Development
Community
Backbone EnMty
Care
Management
Affordable Housing
with support services
Shared Metrics
↓
Diabetes PQI ↑ Food Access ↑ + Op7ons in schools ↑ Awareness/knowledge ↑ Physical ac7vityHealth
EducaMon
Community
MobilizaMon
Policy
Developmen
t
Grocery/corner
store development
Child care/development
CBOs/CoaliMons
Local Philanthropy
Transit-‐Oriented
Develop/Walkability
Financial InsMtuMons
Hospitals/CHCs
A`er school
programs
Sample
Obesity
Convergence
Strategy
Areas of Investment for Hospitals/Health Systems
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Pre-‐development loans
for affordable housing
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Capital campaign bridge loan
for low income dental care center
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Revolving loan fund
for small business development nonprofit
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Lending capital
for post disaster reconstruc7on
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Scholarship Loan Programs
for under-‐represented youth
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Loans for child care businesses
and other small business
development
–
Financing for
neighborhood revitalizaMon
–
Housing
linked with support services
•
Isolated seniors
Strengthen Family
and Neighborhood
Support Systems
Indicators
Outcomes
Content Focus Area
Decrease in “latchkey” children
Child development center
After school programs
Leadership development
Child care cooperative
Neighborhood watch
Community garden
Neighborhood skills bank
Decreased parent work absence
Decrease in truancy
Improved academic performance
Decreased juvenile delinquency Decreased suspension/expel
Increased access to fresh produce Increased civic activity
Increase local income generation Decreases purchase of goods and services outside neighborhood (import substitution
Decreased pre-diabetes/diabetes Decreased dropout rate
Decreased domestic abuse
Decreased youth violence-related injuries
Decreased burglary/vandalism Increased youth employment Improved child intellectual and emotional function Decreased child abuse
Reduced graffiti/trash Increased property values
Addressing Determinants of Health:
2014 launch of
Alignment for Health Equity
and Development
to support alignment of
community health and community
development programs and investments.
Generous funding from the Kresge
Founda7on, with matching support from
local stakeholders
Five pilot sites, including:
Atlanta
Boston
Dallas
Detroit
Portland
Larger cohort of learning communi7es across
the country to par7cipate in webinars,
NaMonal Office – PHI/TRF
Technical Assistance/Support
Framing, Stakeholder Engagement, Analysis Support, Investment/IntervenMon Design,
Metrics, Learning Community, DisseminaMon
Local Backbone En7ty
Convene – Facilitate – Administer and Manage – Monitor and Evaluate – Communicate
Local Philanthropy
Core Funding for Infrastructure and Analysis
Hospital
Community
Benefit
Compliance
OrientaMon
Annual ReporMng
Programs and Services
Process Measures
Proprietary Bias
Limit exposure
Intersectoral
Place-‐Based
CHI
TransformaMonal
OrientaMon
Intersectoral
Shared Ownership
Data Sharing
Quality Improvement
Measurable Outcomes
Sustainability
Community
Development
TransacMonal
OrientaMon
Reduce Risks
Close the Deal
Build Track Record
SMmulate ReplicaMon
Convergence at the Center
The Case for Advocacy
•
Hospitals one of the largest employers in communi7es
•
Hospital leaders have unusual access to and influence with
public officials
•
Hospitals assuming increasing financial risk for poor health
•
More than 80% of what improves health is outside of medical
care delivery
•
Health inequi7es concentrated in urban and rural
communi7es with high poverty, limited access to healthy
food, poor quality housing, dysfunc7onal schools
The Case for Investment
•
It’s not about bleeding hearts, but making
good societal investments
–
Child development or incarcera7on?
–
Healthy food access/policies or medical
bankruptcy and reduced life expectancy?
–
Affordable housing and support services or
homelessness and full emergency rooms?