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Hunger in the Community Context: Roles of Health Care Leaders in Addressing the Social Determinants of Health

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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

 

(2)

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  

(3)

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

(4)

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  

(5)

Working  Anything  but  9  to  5  

Scheduling  Technology  Leaves  Low-­‐Income  Parents  With  Hours  of  Chaos  

By  Jodi  Kantor,  Photographs  by  Sam  Hodgson  

(6)

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

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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.    

(8)

Bayview/Hunter’s  

Point  

  Hunters  View     Alice  Griffin  

Visatacion  Valley  

Sunnydale  

Tenderloin  

Portrero  Hill  

 

Chinatown  

(9)

Tract  status  for  Community  Reinvestment  Act  (CRA)  eligibility,  as  of  2012  

(10)

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  ac7vity  

Health    

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  

(11)

Sample  

Obesity  

Convergence    

Strategy  

(12)

Areas  of  Investment  for  Hospitals/Health  Systems  

Pre-­‐development  loans  

for  affordable  housing  

Capital  campaign  bridge  loan

 for  low  income  dental  care  center  

Revolving  loan  fund  

for  small  business  development  nonprofit  

Lending  capital  

for  post  disaster  reconstruc7on  

Scholarship  Loan  Programs  

for  under-­‐represented  youth  

Loans  for  child  care  businesses  

and  other  small  business  

development  

Financing  for  

neighborhood  revitalizaMon  

Housing  

linked  with  support  services  

Isolated  seniors  

(13)

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:

(14)

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,  

(15)

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  

(16)

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  

 

(17)
(18)

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  

 

(19)

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?  

 

Job  opportuni7es  and  living  wage  or  despair  and  

(20)

References

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