Improving the health of the community is the guiding mission for most hospitals. It also is one of the chief drivers behind efforts to shift from a volume-based, fee-for-service payment system to a system based on value and health outcomes. Multiple factors influence the health of an individual and a community, and many are outside of the hospital's control. Understanding these social and environmental factors, and how to address them, is central to hospitals' abilities to fulfill their mission and commitment to improve community health.
Social and environmental disparities have a real and measurable impact on individual and community health. These social determinants of health include factors like sufficient and equitable access to food, housing, education and employment. Healthy People 2020 has organized social determinants of health into five key areas defined as follows:
- Economic Stability: Poverty, employment, food insecurity and housing instability;
- Education: High school graduation, enrollment in higher education, language and literacy, and early childhood education and development;
- Social and Community Context: Social cohesion, civic participation, discrimination and incarceration;
- Health and Health Care: Access to health care, access to primary care and health literacy; and
- Neighborhood and Built Environment: Access to foods that support health eating patterns, quality of housing, crime and violence, and environmental conditions.
The Kaiser Family Foundation offers similar definitions, but separates food insecurity and access to healthy foods as a sixth social determinant of health.
While urban settings for these social factors often come to mind, nearly one-third of U.S. hospitals are rural. For rural counties, the stakes for impacting social determinants of health are even greater. Rural areas experience higher rates of chronic disease; life expectancy is shorter; rates of college completion are lower; employment growth lags; rates of poverty are higher; and geographic isolation and distance make transportation a critical element for ensuring access to health care, schools, work, groceries and social interaction. For policy makers, health organizations and other social service agencies, it is essential to acknowledge and address these challenges and barriers to health for rural residents. To view your community health data and social determinants in your area, go to www.KansasHealthMatters.org.
Improving Health through Non-Traditional Approaches
Hospitals seeking to improve community health are recognizing the value and importance of focusing on social disparities in achieving their mission. Research has shown that genetics, individual health behaviors, and social and environmental factors all have greater influence on health risks and well-being than health care itself.
Tackling disparate and complex social factors cannot be achieved by hospitals or health systems acting alone. The transformation of health care and pursuit of the Institute of Medicine's Triple Aim over recent years has compelled many hospitals and health systems to serve as the anchor or backbone for broad-based partnerships with other community organizations and agencies. Together, these partnerships focus on leveraging each organization's expertise and resources to collaboratively address social inequities; thus, improving community health. The Kansas Hospital Association is part of the statewide partnership that created KansasHealthMatters.org, a resource for community health-related statistical data. This site can help individuals learn about the health of the community and ways to help improve it.
Resources to Help Tackle Social Determinants of Health
Efforts to improve community health begin with data, information and knowledge about the current health status of the community. The hospital's community health needs assessment is an important source for this information. Kansas Health Matters is a great resource for Kansas data and contains not only statewide data, but also data by regions, counties, large cities, zip codes and census tracts. Current demographic data and tools to customize a dashboard also are available on this site. In addition to Kansas Health Matters, the Centers for Disease Control and Prevention provides a number of tools and resources, including an interactive web application that can produce a health profile for every U.S. County.
CDC Health Impact in Five Years. The CDC's Health Impact in five Years (HI-5) initiative focuses on non-clinical community-wide approaches that have evidence reporting positive health impacts, results within five years and cost-effectiveness and/or cost-savings. Social determinants of health form the base of the HI-5 approach because addressing these determinants has the greatest potential to impact health by reaching a greater number of people in the broader community with activities like early childhood education or public transportation.
County Health Rankings and Roadmaps Program. The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute collaborate to offer the County Health Rankings & Roadmaps Program. The County Health Rankings component of the program ranks the health of nearly every U.S. county and state, and provides supporting data for the health measures used. Its Roadmaps to Health offers strategies and action plans which are complemented with policies, programs, webinars, and community coaches designed to support community efforts to impact and improve community health.
Root Cause Coalition. The Root Cause Coalition is a partnership of diverse health care and community organizations that includes the American Hospital Association. The coalition seeks to address root causes of health disparities by "focusing on hunger and other social determinants to reverse the nationwide epidemic of preventable chronic health conditions." Members of the coalition may participate in and have access to research, educational sessions, webinars, conferences and advisory committees, along with best practice programs and advocacy for related policy issues.
National Prevention Council. The National Prevention Council was established by the Affordable Care Act and is comprised of 20 federal departments, agencies and offices committed to prevention and wellness. The National Prevention Strategy is designed to promote collaborative efforts to advance health for all Americans by shifting the health care focus from sickness and disease to prevention and wellness. Its four strategic directions include healthy and safe community environments, clinical and community preventive services, empowered people, and elimination of health disparities.
Healthy People 2020. For more than 30 years, Healthy People has represented the nation's health agenda. In 2010, the U.S. Department of Health and Human Services announced Healthy People 2020, a 10-year health initiative. The goals of Healthy People 2020 are to:
- Attain high-quality, longer lives free of preventable disease, disability, injury and premature death;
- Achieve health equity, eliminate disparities and improve the health of all groups;
- Create social and physical environments that promote good health for all; and
- Promote quality of life, healthy development and healthy behaviors across all life stages.
Kansas Health Matters contains a Healthy People 2020 Progress Tracker to show where we are, both statewide and by county.
Making an Impact: The Board Sets the Tone
The definition of community health included in AHA's report Next Generation of Community Health notes that community health initiatives generally address the impact of social determinants of health. Hospitals and health systems have significant opportunity to make a difference to social determinants of health through community health initiatives. To really have an impact, the emphasis on community health must come from the board. AHA recommends that boards infuse the importance of community health initiatives and partnerships by:
- Making community health core to your hospital's mission;
- Educating trustees about the community health needs assessment process and results;
- Engaging a diverse board that reflects the community in establishing partnerships;
- Illustrating to your board how community health is a moral imperative, but also a business imperative;
- Committing to community health through dedicated staff and resources;
- Measuring and reporting success on meeting community health goals to your board; and
- Building a culture that supports sustained community health improvement.
Special thanks to The Walker Company for use of: Achieving Your Mission Means Addressing Social Disparities. Additional trustee resources from KHA are available in the Trustee Section of the KHA website. Additional resources from Larry Walker can be found at: www.walkercompany.com.