What has the most potential to improve health, lengthen life expectancy, and curb rising health care costs in our communities?
If you chose the third answer, you’re correct. These social and environmental determinants of health tend to affect our well-being far more than what we and our health care providers do as individuals. And these social factors also influence the first two answers, through effects on health care quality and access—and on such health behaviors as smoking. Strengthening social determinants will be the focus of Group Health’s 2016 Birnbaum Lecture, delivered by nationally renowned Baltimore Health Commissioner Leana Wen, MD, MSc.
“So much of our research at Group Health is related to the social factors that we know deeply affect health,” says Group Health Physician, Associate Medical Director for Research and Translation, and Group Health Research Institute (GHRI) Senior Investigator Paula Lozano, MD, MPH. “We’ve always studied common conditions, prevention, and population health—including, but not limited to, Group Health patients and our community.”
Group Health researchers have long documented how social and environmental factors are connected to disparities in health—and health care. We have explored the impact of social factors including poverty, lack of education—and environmental factors such as neighborhoods that are unsafe for walking or playing—on the prevalence of obesity, diabetes, and other conditions.
But GHRI work transcends simply tracing ill health to social burdens.
“Some of our work also helps to promote and sustain healthy communities,” Dr. Lozano says, citing contributions by GHRI’s Center for Community Health and Evaluation (CCHE) and the MacColl Center for Health Care Innovation. Community resources and policies are a pillar of the Chronic Care Model, and MacColl has long been committed to helping U.S. primary care practices, including community health centers, integrate community resources into health improvement.
At CCHE, community health evaluators study both the clinical and nonclinical aspects of health improvement. “We help health care systems to address social factors as well as possible in medical visits,” explains Allen Cheadle, PhD, senior investigator and CCHE director.
A prime example is Learning to Integrate Neighborhoods and Clinical Care (LINCC), led by Assistant Investigator Clarissa Hsu, PhD. LINCC is testing a “community resource specialist” role in primary care clinics at Group Health. This new role resembles community health workers: trusted laypeople who provide basic health information to (and about) their communities and help connect people with community resources that support health and wellness.
In LINCC, the community resource specialists help patients to set and achieve health goals, with action planning and follow-up. They connect patients with health-promoting resources in their own neighborhoods—like YMCAs, community centers, and foodbanks—with the help of online tools like the Group Health-sponsored Neighborhood Health Link. And they follow up with patients to see how they are doing with the goals they set and the resources to which they’ve been referred.
In a related project funded by a grant from Kaiser Permanente, CCHE is evaluating whether having Health Leads connect patients with resources such as food, childcare, and transportation is having an impact on patients’ health in a clinic in Contra Costa County, Calif.
“We know that if people have a higher standard of living, they tend to be healthier,” Dr. Cheadle says. “But it’s hard to address their standard of living globally—and raise it.” So CCHE also evaluates community-based health improvement initiatives around the country. “We are building knowledge about how multisector community investments may successfully lead to more concentrated impact not just for patients, but for the community as well,” he adds.
This work includes evaluating small grants, intended to spur innovation, from the California Freshworks Fund. A public-private partnership loan and grant fund, it brings healthy food retail and distribution (including community-supported agriculture and mobile markets) to communities that lack them, employing community members who need jobs. CCHE is also evaluating the Healthy Futures Fund, a Kresge Foundation-supported social investment initiative financing colocation of community clinics with nonclinical services that affect social determinants of health, like affordable housing, healthy food outlets, and job training.
Here are just a few other examples of Group Health research on how to strengthen social determinants:
Please join us at the Birnbaum Lecture on June 27.
by Rebecca Hughes
Keynote speaker: Dr. Leana Wen, nationally acclaimed TED speaker and health commissioner for the city of Baltimore.