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The Intersection between Community Health and Community Development

National Public Radio (NPR) recently published a segment titled “Your ZIP Code Might Be As Important To Your Health As Your Genetic Code.” The segment details Kaiser Permanente, a nationwide care consortium’s, Portland, Oregon hospital. When a patient approaches the receptionist’s desk, she is asked to fill out a “life situation form,” which inventories the patient’s non-medical stressors. The questions, which gather information about housing, finances, transportation, and food access, provide Kaiser Permanente a richer picture of the factors that influence their patients’ health so that they can more effectively treat them.

The life situation form is a mechanism for determining the social factors that influence a person’s health and, for years, public health professionals have championed studying and addressing these factors, designated the Social Determinants of Health.

“My personal belief is that putting more money into health care is a moral sin,” said Nicole Friedman, a regional manager at Kaiser Permanente Northwest. “We need to take money out of health care and put it into other social inputs like housing and food and transportation.”

Friedman’s statement reveals a conviction among proponents of the Social Determinants of Health: health inequalities will persist among the rich and the poor, regardless of equal access to health care services, if the underlying causes of health issues remain untreated. A study conducted by Dr. Leonard Syme, Professor Emeritus of Epidemiology and Community Health at Berkeley’s School of Public Health, offers an example. Dr. Syme and researchers studied health problems among San Francisco, CA bus drivers over the age of 60. The researchers noted high rates of hypertension, back pain, alcoholism, and gastrointestinal and respiratory problems in the study population, problems that were eventually identified as a consequence of the job. 

“Computers devised a rigid bus schedule that allocated time depending on the number of buses available, but the computers were allocating time in a city with a bus shortage. Drivers had to get from Mission and Army Street to Mission and Geneva Street, for example, in 2 minutes. A fast ride in your Ferrari on Sunday morning would take longer. In addition, because drivers were penalized when they arrived late, they gave up rest stops and dashed into fast-food restaurants instead. And since the drivers were almost always late, the passengers were almost always angry. Drivers lacked control over a host of variables such as traffic and terrible shift arrangements, and drove during both morning and evening rush hours without enough time to go home in between shifts. At the end of a long day, many visited the local tavern. When they got home, they did not often socialize, but went to bed, only to get up at 4:00 a.m. to begin another grueling day.”

This study reveals that social class, as determined by a person’s profession, underprivileges those, who without an advanced degree, hold certain jobs. The intersecting and mutually reinforcing factors that comprise the Social Determinants of Health must, therefore, be met with complex and innovative solutions.

Each year, the American Hospital Association (AHA) recognizes the engineers of these innovative “collective impact” strategies. The AHA Nova Awards are bestowed upon AHA member hospitals that engage local stakeholders to improve community health by addressing the economic and social barriers to care. 2017’s AHA Nova Award recipients have worked to tackle the opioid epidemic, fight childhood asthma, transition youth out of the foster care system, deploy mobile pediatric healthcare vans to public schools, and provide free dental care to the uninsured. They do so by identifying the root causes of health inequality in their communities and applying preventive care to mitigate further inequality down the road.

Prosperity Indiana and the Indiana Assets & Opportunity Network enthusiastically agree that a community’s social determinants ― a zip code that has quality public schools, clean air, parks and playgrounds, grocery stores and farmers markets, strong social connections, and affordable, safe, and secure housing ― enables or constrains its ability to prosper. Each determinant is a crucial ingredient to a healthy person and a healthy community. That’s why Prosperity Indiana has chosen to highlight the Social Determinants of Health at its Summit on January 24, 2018.

"A comprehensive approach to community development studies the impact that the health of communities has on economic opportunity," said Andy Fraizer, Executive Director of Prosperity Indiana. "Community health and community development are interrelated fields well-suited to collaborative work."


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Kathleen Taylor