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Practically everything, it
turns out. According to statistics compiled by the WHO, for
example, the United States has the worst overall health care
among similar (developed) countries. That includes a life
expectancy rate that is 42nd among all 224
nations; a similar rate of infant mortality and at the
bottom or near the bottom in obesity rates, heart and lung
disease, sexually transmitted diseases, injuries and
homicides.
The fact that the United
States lags far behind similar nations in the rate of health
care coverage of citizens – about 27 million are still
uninsured – is an important contributing factor. However,
clinical and medical care, ProMedica has determined, is only
one part of the critical factors in a person’s health and
well-being – only about 20 percent, in fact.
The rest of the
contributing factors in a person’s well being include the
physical environment, social and economic factors and health
behaviors.
“The non-clinical things
that impact health are: where you live, your job, your
school – the social and economic factors,” says Kate
Sommerfeld, president of the Social Determinants of Health
Institute for ProMedica. Social Determinants was formed
about three years ago to advance the health system’s
commitment to improving the quality of life for residents
and investing in neighborhoods and communities of northwest
Ohio and southeast Michigan.
The first task the Social
Determinants group undertook in 2015 was to ask residents,
those who came into facilities, “are you hungry?” The staff
screened patients for food issues, set up a food clinic in
Toledo Hospital and assembled a three-day bag of food for
families, says Sommerfeld.
Then the department took a
look at infant mortality in Lucas County and the racial
disparities within those statistics – among
African-Americans the infant mortality rate is 16.5 deaths
per thousand births. Among Caucasians, the rate is 1.6 per
thousand. Accordingly, ProMedica began to change the way it
monitored the progress of pregnant women – providing proper
food and security and assigning them community health
workers. Approximately 20,000 moms have undergone these
enhanced procedures since 2015.
All of this increased
attention to the overall living conditions of patients has
led to, in this first phase – or “bucket” – as Sommerfeld
terms it, closer scrutiny of patients during the screening
process. That scrutiny includes questions about the
incidences and impact of domestic violence, the availability
of transportation, living conditions and jobs, for example.
Then came the second
phase, or bucket: “How are we driving meaningful change in
the community?”
During this phase
ProMedica has brought in Kendra Smith, director of Social
Determinants of Health, who came aboard earlier this summer.
Smith has over 10 years of experience in real estate
development, urban planning, housing policy and community
organizing.
The second phase brings
ProMedica into the community “to look at a comprehensive
approach and doing it in a neighborhood way,” says Smith.
That includes partnering with organizations such as The Arts
Commission or Toledo LISC (Local Initiatives Support
Corporation) to examine all aspects of neighborhood life and
activities. In Toledo’s UpTown area, ProMedia has
established a presence with the Ebeid Neighborhood Promise (ENP)
to begin the process of creating a model for neighborhood
revitalization.
The Ebeid Market at the
corner of Madison and 18th Streets is part of
that project as is the financial coaching program in the
same building. “The goal of the neighborhood revitalization
initiative is to create and implement a viable
infrastructure that will support long-term neighborhood
health and growth,” says ProMedica literature on the
project. UpTown, according to Smith, will be the model that
can be replicated in other areas around the city and the
region.
Some of the
revitalization, says Smith, “is bricks and mortar
development since 60 percent of the land in UpTown is
vacant.”
“How do we use our voice
and our influence to help the neighborhood,” adds Sommerfeld.
Phase three is the
research and data analytics part of the equation – a look at
outcomes, the financial costs and benefits of such
approaches. “We want to see the outcomes,” says Sommerfeld.
On a micro level, those would be the outcomes for
individuals and, and on a macro level – for the
neighborhoods. The return on investment has to play a part
in the research as it would for any large, financially
responsible organization.
It’s not just lip service
ProMedica has committed to this venture. Between ProMedica
and LISC, $25 million has been put assembled for the
pre-development phase – primarily in the form of loans to
community groups. ProMedica has purchased numerous buildings
in the UpTown area that are waiting to be developed. The
Social Determinants department has a total of 51 full time
employees including those in the market, five financial
coaches and community health workers striving to fulfill the
ProMedia mission of developing “a vibrant, healthy community
that supports social, financial, physical and mental
health.”
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