As the healthcare industry places a stronger emphasis on patient engagement, a new study from the Institute for Alternative Futures shows how some community health centers are going beyond clinical care, improving health by changing community conditions.
Community health centers (CHCs), the care providers of last resort for many low-income people, have long sought to reach beyond the hospital walls to help shift the social, economic, and environmental factors that shape their patients' health.
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In the new report, titled "Community Health Centers Leveraging the Social Determinants of Health," futurists and health experts from the Institute for Alternative Futures (IAF) conduct a systematic view of the non-clinical work of CHCs.
The IAF study comes after a recent Robert Wood Johnson Foundation-sponsored poll found that most physicians recognize the importance of the patient's community and social conditions – also known as the social determinants of health (SDH) – but many are not confident in their capacity to address their patients' social needs and believe this impedes their ability to provide quality care. The IAF report describes the patterns across many initiatives and also details recommendations developed at a national workshop of community and public health leaders on how to support and expand these actions.
The efforts identified by the study address a range of factors, including youth development; family and social support; access to legal aid and healthy foods; adult education; job skills and employment; physical activity; community safety, wellbeing, and involvement; healthy, safe, and affordable housing; recreational spaces and improved air and water quality in the community.
Specific examples from the study include:
- La Clínica de La Raza in California created its Latino Youth Brigade program to foster a link between the clinic, school, and home, and to promote positive self-esteem, community involvement, and leadership among youth. Participants in the program showed an 80-90 percent improvement in their perception of success at school, sense of self, ability to communicate, ability to learn new things, ability to connect with adults, ability to work with others, and ability to stay safe.
- Sea Mar Community Health Centers in Washington State provides safe affordable temporary housing for migrant farmworkers, and 20 rental apartments for low-income families plus five units for families transitioning from homelessness.
- Sixteenth Street Community Health Center in Wisconsin reduced the prevalence of lead poisoning among children from 34 percent in 1996 to 1.8 percent in 2011. The CHC helped residents address health and safety issues in their homes, and took the lead in the redevelopment of 300 acres of brownfields which has led about three dozen companies to move into or to expand in the area, creating more than 4,200 jobs. The effort also developed over one million square feet of green buildings, seven miles of trails, and 45 acres of native plants, leading to improved wildlife habitat and water quality.
Key findings from the project include:
- CHC leadership is key to the development of these efforts, which often originate as a response to an issue brought to the attention of the clinic by patients, CHC board or staff, or the community.
- A number of existing programs are available for CHCs to adopt, but most efforts are designed by CHCs themselves.
- CHCs often rely on specialized staff, departments, or subsidiaries to manage their efforts. Other efforts are seamlessly integrated with clinic operations, or operate as independent organizations or semi-independent coalitions.
- Partnerships are crucial to leveraging the SDH, and CHCs have become adept at seeking and maintaining them at the local, state, and federal levels.
- Funding may come from various sources and must be renewed or replaced by another source every few years. Some efforts are self-sustainable (e.g. low-income housing programs).
- Many efforts show impressive results, but most have not been formally evaluated.
Recommendations for moving these efforts forward include developing shared visions for community health with the public and target SDH work accordingly; leveraging the SDH in existing national CHC breakthrough collaboratives sponsored by HRSA; establishing payment systems and non-economic recognition for this work; and creating a formal, governmental inter-agency group that systematically promotes, advances and supports efforts addressing the SDH within communities. The report also suggested that philanthropy should support building a bridge between the SDH and the clinical setting.
Highlighting 176 efforts by 52 organizations, with 10 in-depth case studies, the report can be found on IAF's website. The study was developed in partnership with the National Association of Community Health Centers (NACHC), and with support from the Kresge Foundation.
"This report highlights the incredibly important, and largely unnoticed, role that community health centers play in improving the health of not just their individual patients, but their communities," said David Fukuzawa, Kresge's program director for health. "The case studies by themselves provide both vivid and inspiring examples of how healthcare providers can improve population health."