Over the last 20 years, Prevention Institute has worked with a broad array of community organizations, funders, government agencies, and others to achieve better health and safety outcomes and prevent health inequity, with the aim of reducing family and community suffering, lowering costs to our public systems, and investing tax-payer dollars wisely. Shifting the focus upstream takes vision, strategy, multi-sector partnerships, and creative approaches with data, evaluation, and financing.
President and CEO of Grantmakers In Health, Faith Mitchell, recently expressed both the challenge and the urgency that grantmakers face in moving their resources from after-the-fact solutions to up-front change. She writes, “U.S. health policy largely ignores the social determinants of health. … In fact, a recent National Academy of Medicine report concludes that a health policy framework addressing social and behavioral determinants of health would achieve better population health, less inequality, and lower costs than our current policies (Adler, Et Al 2016).”
She also highlights statements by GIH grantmakers and other leaders about the importance of addressing community determinants of health to achieve better population health and also health equity. Here are a few of them:
“We have to educate our “non-health” colleagues about the importance of cross-sector collaboration that provides win-win results, such as improvements to both education and health, or to both housing and health.”
“If we know the social determinants are responsible for the majority of health outcomes, we should consider how to shift funding upstream, toward root causes and prevention, using the $3.2 trillion in the health system to do so.”
We really appreciated reading GIH perspectives. These are precisely the issues we all must tenaciously solve together.
Mitchell's piece also highlighted for us something that we've been thinking a lot about lately, which is: now is the time to go boldly from the understanding that community determinants of health matter to acting with a deep sense of urgency on embedding for spread and scale.
We need much deeper and more consistent engagement on the kinds of community-oriented practices that will sustain system and institutional transformations. This means, for example, new ways of working and relating between state and local health departments, "non-health" agency folks, community-based advocacy groups, and healthcare institutions. Look at how L.A. County is working with local advocates to address urban oil drilling in communities of color* and how Cuyahoga County, Ohio is working on embedding health and racial equity into its policies.
Moving upstream and staying there is going to take much more tenacity around carving out real investments for prevention. This will mean increasing our national and state outlays for community-based prevention practices through prevention and wellness funds; restructuring reimbursements; and looking closely at bending financing decisions outside of the health system toward quality prevention and health equity. Seattle's Best Starts for Kids gives us a sense of direction; so does work in Vermont on Accountable Communities for Health and Massachusetts on Prevention and Wellness Trusts. As more examples emerge, we'll need to share and improve.
When the Patient Protection and Affordable Care Act passed, it stimulated innovative thinking and new innovations among hospitals, providers, insurers, and payers. Sadly, looming threats to the ACA have caused volatility in the healthcare market and put a chill on some efforts. But many of these organizations remain intent on broadening their work to address root causes of homelessness, invest in community-based approaches to mental health and wellbeing, and explore the anchor institution role more fully.
As a field, we are making progress shifting our work upstream. We need many more spaces to have conversations like the one Faith Mitchell is having with the grantmakers at GIH and to keep pushing further upstream together on our collective journey to improve health and safety outcomes for all.
The entire Grantmakers In Health letter is worth reading.
*For more information about L.A. County efforts to address urban oil drilling, contact email@example.com.