Addressing social determinants of health needs to involve organizational transformation and community-focused outreach.
Someone living in downtown Chicago can expect to live to be about 85. But go seven miles south or west, and that age drops by 10 years or more.
“When audiences start to think about the cause, they think of violence — because they hear all about gun violence,” said Dr. David Ansell of Rush University Medical Center on Chicago’s West Side.
But the actual No. 1 and No. 2 causes of death in those communities are cancer and heart disease, Ansell said. “So you have to say, what’s the root cause? Poverty. And poverty is something that’s been imposed.”
People on Chicago’s south and west sides are getting sick more often and dying younger because social factors limit their ability to get healthy food, make a living wage and get around safely.
Ansell discussed the root causes that impact health during a panel presentation at MATTER, a health care incubator in Chicago. He was joined by James Williams and Dr. Thomas Fisher, both of UChicago Medicine, and Jessica Hager of Feeding America, a network of 200 food banks across the United States. The panelists described how their organizations are working to address social determinants of health.
Joel Farran, senior vice president and chief brand officer of Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas, moderated the discussion.
Hager said efforts aimed at addressing health disparities too often focus on trying to get people to change their behavior. They’re chided for using the emergency room — regardless of whether they have access to primary care. They’re told they should eat healthier food but there may be no grocery store in their neighborhood.
“To put the onus on the individual is problematic,” Hager said.
Organizations are beginning to realize they need to make their own systems work better for their communities.
Ansell noted that many institutions have systems in place that may perpetuate poverty or inequality.
Society created it. Therefore, you have the ability to change it.
In that vein, Rush examined how its own practices could affect health equity. It found entry-level workers in some jobs were not making a living wage. They could work at Rush for 30 years and still retire in poverty.
“It required us to look inward at our own policies on advancing low-wage employees,” Ansell said. “If we can’t get it right here, how can we get it right in our communities?”
As part of that effort, Rush started two new career pathways in 2018. One, a pathway for medical assistants to become nurses, had 300 applicants in the first week.
Those committed to taking on health disparities are also reaching out — to individuals and to communities.
Williams described a pilot program of the Urban Health Initiative at UChicago Medicine that sends community health workers into the homes of children with asthma. They provide resources and support in addition to teaching kids and their parents how to better control their condition. It has resulted in fewer missed days of school and work.
“We need to meet patients where they are and provide what’s necessary to change some of those behaviors,” Williams said.
Another outreach effort underway through the Urban Health Initiative addressing intentional violence is the Southland Health Equity and Innovation Collaborative between UChicago Medicine and Advocate Christ Hospital. SHEIC aims to reduce mortality related to intentional violence and increase life expectancy for people ages 18 to 30 in targeted communities.
Ansell stressed the importance of “respecting the voice of the community.”
Rush and three other health care institutions are part of a collaborative called West Side United.
The health care providers are working with businesses and community and faith-based organizations to make the neighborhoods healthier. West Side United’s goal is to close the life-expectancy gap for residents by half by 2030.
Solving the web of problems behind health disparities may seem overwhelming at times. When that happens, Fisher said he keeps these words in mind: “Society created it. Therefore, you have the ability to change it.”
In that vein, Blue Cross and Blue Shield of Illinois recently issued a nationwide Health Equity Innovation Challenge to help close the gaps for members who are facing social, cultural and economic barriers to care. The insurer offered the top three finalists cash prizes and a six-month membership at MATTER, while the winning team has an opportunity to pilot their solution to advance health equity with BCBSIL’s in-house incubator.