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Prevention Institute

April 13th, 2015

Health Care-Community Linkages Can Advance Health Equity

In a recent Equity of Care blog post, PI Managing Director Leslie Mikkelsen discusses how healthcare entities are increasingly looking outside their own walls, and to the community, for ways to overcome health inequalities.

The Institute of Medicine has identified three vital elements for achieving greater medical equity: equal access to high quality treatment, diverse medical leadership that represents the populations served, and treatment that’s culturally and linguistically appropriate.   But looking mainly at the treatment system is a mistake. The known gap in life expectancy between residents of wealthy and poor areas isn’t primarily due to differences in treatment. It’s related to ordinary community issues with unnoticed health impacts that degenerate into medical concerns.

Closing that gap, and creating health equity, has become a part of healthcare’s mandate, and one way to actualize that mandate is to expand the medical care system’s reach to the community environment.  Across the country, hospital systems, clinics, and physicians are spurring change at the community level that is creating healthier conditions for everyone—from increased access to healthy food, to more green space for exercise, to safer neighborhoods.  

The Equity of Care collaboration* is part of this effort. The coalition of national health care organizations works together on national improvement efforts, and provides hospitals, clinicians, and educators with tools to help eliminate healthcare disparities.

In her post on the Equity of Care collaboration’s blog, Ms. Mikkelsen discusses her realization, as a new dietitian at a hospital years ago, about the importance of health equity, and reveals a growing number of current opportunities to create equity through a focus on community:

“The order came through: Conduct a dietary consult for a 75-year-old man with high blood pressure admitted for complications associated with chronic heart failure. This was one of my first patients during my clinical dietetics internship at Oak Knoll Naval Hospital in Oakland, Calif.  I was a bit nervous, but mostly excited to get started; I knew that good food had the power to heal and to prevent disease. After reviewing the man’s chart, I gathered the patient handouts for a low-sodium diet and went to his room. I introduced myself and explained why I was there. The man looked me straight in the eye and said, “I’m dying. I’m going to eat whatever I want!” It was not the teachable moment I was hoping for.

Happily, there were many opportunities to heal during my internship in the hospital.  But I was also constantly reminded of the tremendous opportunity to apply nutrition and other tools to prevent illness and injuries before they occur.  In the decades since my early training at Oak Knoll Naval Hospital, the most important advancement in nutrition therapy has been the recognition that community environments and social circumstances are the strongest drivers of food choices.

Right down the hill from Oak Knoll Naval Hospital (now closed), residents of the flatlands of East Oakland face major challenges to their health and wellness. The flatlands were once an economically thriving community of middle-class homeowners who were employed in a variety of nearby food-related industries. Today’s residents face limited employment opportunities, run-down rental properties, a plethora of fast-food establishments, and recurring closures of the one full-service grocery store. High homicide rates add to daily stress. It is no wonder that the Alameda County Health Department has documented a more-than-7-year discrepancy in life expectancy between children born in the well-off Oakland Hills and children born in the flatlands. [The discrepancy expands to 15 years when race, as well as place, is factored in.]

Fortunately, our nation is in perhaps the biggest teachable moment ever for improving the health of all residents. Our national commitment to build a health system that meets the Triple Aim (improving the patient experience of care, the health of populations, and reducing costs) is opening the door to healthcare-community partnerships that can successfully overcome inequalities in health.

The American Hospital Association’s newly released toolkit is a call to action for hospitals and health systems to put greater emphasis on prevention and to strengthen partnerships to improve the health of the community. There are many resources and networks to support this journey:
•    THRIVE (Tool for Health and Resilience in Vulnerable Environments), one of many Prevention Institute tools to support communities to take action to promote health equity.
•    Stakeholder Health, a community of practice of people working in hospital systems to address underlying causes of poor health.
•    100 Million Healthier Lives, an ambitious initiative, conceived and co-created by the Institute for Healthcare Improvement and a diverse, cross-sector Guiding Coalition that is committed to supporting 100 million people living healthier lives by 2020.
•    Community-Centered Health Homes, core practices for healthcare – community partnerships to address the factors outside clinic walls that are driving poor health.”

*Equity of Care member organizations include the American College of Healthcare Executives, American Hospital Association, America’s Essential Hospitals, American Association of Medical Colleges, and Catholic Health Association of the United States.

Medicare and Community Health

Government officials announced in January a timeline for Medicare’s shift to paying clinicians based on quality of care rather than quantity of services. Our KevinMD blog post outlines how this move suggests momentum is building for the potential of integrated, holistic healthcare, which can be inclusive of community-centered health and prevention.

Community-Centered Health Homes 

Community-Centered Health Homes: Bridging the Gap Between Health Services and Community Prevention outlines an approach for upstream integration between community-based efforts and clinical services. Download here.

From Illness Care to Promoting Health

In the first of a series of articles for the Times-Colonist in Victoria, British Columbia, PI Advisory Board Member Trevor Hancock examines how to move Canada from an “illness-care system” to a system focused on promoting health.

Personal Journeys Help Us Expand the Concept of Health

In order to expand our concept of health to include where people live, work, play, and learn, we must step beyond our place-based comfort zones, and integrate our personal experiences and values into what we learn from doing so. Dr. Karen Hein elaborates on this approach in a new piece published in Academic Pediatrics.

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