Transcription:
Making Societal Factors Part of a Health Equity Strategy

Intro: The following SHSMD podcast is a production of DoctorPodcasting.com.

Bill Klaproth (Host): On this edition of the SHSMD Podcast, we're going to talk about social determinants of health, a topic that is finally getting its due. And it's the subject of an upcoming session at the SHSMD Connections, virtual event, this October, titled Making Societal Factors, Part of a Health Equity Strategy. What a great topic.

And we're going to talk with Julia Resnick and Ji Im. They are going to be presenting this session. And it's going to be wonderful. So, let's find out more what they have to say shall we? I think we shall, so let's get to it right now.

This is the SHSMD Podcast, Rapid Insights for healthcare strategy professionals in planning, business development, marketing, communications, and public relations. I'm your host Bill Klaproth. And in this episode, we talk with Julia Resnick, Senior Program Manager, Strategic Initiatives at the American Hospital Association and Ji Im, System Senior Director of Community Population Health at Common Spirit Health, and they are presenting at the SHSMD Connections virtual event this October 20th and 21st, and we're going to talk to them about their session, Making Societal Factors Part of a Health Equity Strategy. Julia and Ji, welcome to the SHSMD podcast. We start every episode of the SHSMD podcast with Rapid Insights, one quick tip someone can use to make their marketing communications better today. Julia, you're up first. Give us your Rapid Insight.

Julia Resnick (Guest): You got it. So when we're talking about health, both within our hospitals and in our communities, we really have to remember that health is more than just healthcare.

Host: Oh, I like that. That is good. Health is more than healthcare, Julia. Thank you for that. Okay, Ji you are up next. Give us your Rapid Insight.

Ji Im (Guest): Hey Bill. I would say inclusion of diverse consumer voices.

Host: Oh, that's a good one, too. Inclusion of diverse consumer voices. Ji, thank you for that. And Julia, thank you so much. Well we are looking forward to your session, Making Societal Factors Part of a Health Equity Strategy. And that's what we're going to talk about today to get a feel of your session. So Julia, the COVID-19 pandemic has placed the spotlight on health inequities in the United States and one pathway for improving health equity is to address the societal factors that influence health. So Julia, when we talk about the societal factors that influence health, what are those factors?

Julia: Thanks Bill. And that's a really great place to start. So, the societal factors are really the nonmedical factors that influence whether we stay healthy or become ill. It's really important to understand that only about 20% of our health comes from the medical care we receive. That means that the whopping other 80% is attributable to the societal factors.

That's where and how we live our day-to-day lives. Things like if our air is not clean, if our home is not safe, our food isn't nutritious. If our job doesn't cover our bills or our children don't receive a quality education, health inevitably suffers. So, I just want to note that one of the silver linings of the COVID-19 pandemic has been that as a society, we're really understanding and recognizing how societal factors lead to health inequities more than ever before. I can't tell you how excited I was to hear people talking about social determinants of health on cable news. That's very different than what we've been seeing before.

And though it's really tragic that we needed to see such immense and equitable loss of life; it really drove home point for people, not just who are in this space professionally, but for our society as a whole. As we're thinking about improving health equity, it's not just about providing more equitable health care, which is certainly important. It's about how we can address the nonmedical factors in our society that contribute to these health inequities. And as anchors in their communities with missions that are really explicitly tied to improving health and wellbeing for the communities they serve, I think hospitals have a really important role to play in this space.

Host: Yeah, it certainly sounds like it. Did I hear you correctly? Only 20% of our health comes from the medical community and actual healthcare. Is that right?

Julia: That is correct. There's been a lot, a growing body of research on this space. It really shows that 80% of your health comes from outside of the healthcare you receive.

Host: That is an eye opening statistic. So thank you for sharing that with us, that really paints a picture of what we're talking about today. So, how can a hospital or health system diagnose the societal health of their individual community? I imagine it's different from community to community. How do they assess their own community to determine those health inequities, Julia?

Julia: Absolutely. And I think there are two complimentary ways that hospitals can approach understanding the societal factors that impact their patients in the communities they serve. So, if the patient level, I'd say it's screening for social needs. So, this means that like when a patient comes in for a clinical visit, providers can screen those patients to identify if they have non-medical social needs that might be impacting their health.

Do they have a safe and stable home to live in? Do they have access to healthy food? And once the provider understands the patient's situation outside of those four walls of the clinic or the hospital, it enables them to provide better more holistic care. And it also allows them if they're documenting this, they can track it see what social needs are appearing most often in their patient population.

But then taking it up and thinking about the broader community and what's happening out there. I think the community health needs assessment process is a great place to start. So, for those who aren't familiar, all nonprofit hospitals in the US are required to conduct a CHNA every three years to identify and address community health needs. And as part of that process, hospitals partner with community stakeholders and community members to understand their perspectives, they really dig into the data and review both quantitative and qualitative data to decide, or to figure out what those most pressing community health needs are, and then decide what to focus on.

And I really think this process can be instrumental in figuring out how societal factors are presenting in the community. And as you said, it's different in every one. So each community has to go through that process themselves, and with their community stakeholders, and then use that information to develop a plan for addressing those issues in partnership with their community stakeholders.

Host: Yeah, that's really good. So, Julia, when you talk about understanding the societal needs of your community and then developing a plan. So, once a hospital or health system understands that, how do they go about addressing then what they've found, the societal factors that influence health in their community? How do they put together a plan for this?

Julia: Yeah, and that's really the crux of the issue. And that's a far more complex than we can talk about today, on this podcast. But, I can scratch the surface of it. And I know that Ji will tell you more about what she's doing at Common Spirit. So, we recognize that this work is challenging and it's outside the scope of traditional medical practice.

What I really want to emphasize is that healthcare organizations and hospitals they really can make an impact in this space. And at the AHA, we're trying to create resources, that help hospitals to understand like what steps they can take to make progress on that journey. So in services that we developed a practical framework, that sets forth three distinct yet connected levels that show how hospitals can address patients' social needs, social determinants of health in the community, and the systemic causes of those health inequities. And there's a nice little graphic of the framework and related resources that are accessible at aha.org/societalfactors. So, I'd urge you to check that out so you can see the image that goes with what I'm talking about.

But just a quick overview is that it starts at the person level and that social needs, which I talked about a couple minutes ago. And these are individuals' non-medical, social or economic circumstances that hinder their ability to stay healthy or to recover from illness. And as health providers know about these, social needs can be addressed through either referrals or providing additional services directly to the patient.

If you take it up a level, we're thinking about the community and these are the social determinants of health, which is a term that I know people are pretty familiar with at this point. Those are the underlying social and economic conditions that influence people's ability to be healthy and social determinants include community-wide issues such as food deserts, lack of affordable housing options, those sorts of things at the community level. And when hospitals are addressing social determinants, they're doing so in partnership with other community stakeholders to improve the community environment where people are living. And then taking it out another step is really the broadest level of the framework. And that's what we're calling systemic causes. These are the fundamental origins of social inequities that lead to poor health. These are things like racism, sexism, and poverty. And while hospitals obviously cannot solve these issues alone, they can work in partnership with other stakeholders to affect policy, system, environmental and cultural changes.

So, that's just a really broad overview what hospitals can do. And I'm so excited that Ji is with us today because her hospital and health system is just doing so much exciting work in this space. Like I think can really bring it to life.

Host: Absolutely. And I like how you said right up front, this work is challenging, but hospitals can make an impact in this space. And you said the things that are really important are understanding the social needs, then think of that community and then understanding the systemic causes. And you said for more information on societal factors, people can go to aha.org/societalfactors. Is that right?

Julia: That is correct.

Host: Great. And I'm glad you brought up Ji so we are very happy to have G with us, and we're very interested in learning about what she has done at Common Spirit Health. So, Ji, thank you so much for being with us as well. So, we're just talking about discovering those societal factors in each community. Ji, what did you discover about the societal health of your communities?

Ji Im (Guest): Yeah, thanks Bill. Julia and the rest of the AHA team have done such a great work in creating this framework. You get both the macro view of the systemic causes as well as the individual level micro view. Julia also brought up the point of CHNAs. So, definitely all our hospitals conduct community health needs assessments, we do look at secondary data that's publicly available for other communities to use, but we also do local serving, interviewing focus groups, maybe town halls, all of these, pre COVID, were in person. We do this on a three-year basis, to really identify what are the needs that our communities are facing. And I would say that through this process, the top needs don't really change too much.

Access has always been a top issue, access to coverage. Navigation, benefit programs. Behavioral health is another top need. Mental health and substance use disorders. And then we see obesity, chronic diseases and violence and safety as well as other social determinants of health as top rising needs.

So again, we don't really see these needs changing year to year. The other reality is that all these societal factors are so closely interconnected. A person is never having a health coverage issue or an unstable housing issue alone. If these individuals are struggling with one, then the chances that they're struggling with another part of their life, is pretty likely. So these are some of the things that we're seeing Bill.

Host: Yeah, that's really interesting how you put that. It's kind of like a comorbidity. If you're suffering or struggling with one, chances are you're struggling with another, and you said access to care and mental health needs kind of top the list. And that's kind of unchanging from what you see is that right?

Ji: Absolutely. Yes.

Host: Yeah, that's really interesting. So, tell us then Ji how has Common Spirit Health deployed a strategic effort to address these factors that you've found in the communities that you serve?

Ji: All this, it really takes me to this work that's happening in Common Spirit. We call it the Connected Community Network. I'll reference it as a CCN. The CCN model, it's a multi-stakeholder initiative. It was formed to address the social needs of individuals living in a community. So, basically we've been building a network of community organizations to be on one technology platform, to coordinate care, to communicate with one another and to collaborate on various different initiatives.

Again, this is a belief that our systems are designed vertically. We have solutions for housing, we have solutions for food. The reality is that people live their lives horizontally. All of these verticals need to be knitted together for the system to work for individuals. And that is a belief, that the CCN is operating on. It is to help individuals navigate the complex health and social systems by connecting people to the resources that they need, when they need it. And the biggest piece of this work is the emphasis on building a comprehensive, active community network.

This really means bringing a lot of the stakeholders, community-based organizations, government, foundations, health plans, health providers, to all come together to say, we need to figure out how to create a community network that addresses people's social needs. And how can we work better together, so that the care, that the onus is not only on individuals to figure out how to navigate these systems alone. And then I'll say one thing about our work, like most work in healthcare, the most important thing of doing this work and achieving equity, isn't always what is being done, but how the work is being executed.

And so at Common Spirit, the most important thing of how we've been doing, we have been building community networks, wasn't really the technology itself. It's really about our community partners. Effectively, it's about identifying a neutral convener to lead the work in the community for us, to either be a fiscal agent, to develop community governance, to allow the community to own the work. Again, it's not large systems designing these solutions, but it's really the active community partners who are closest to the issues designing the solutions. And that's been really important for us as we have built these CCNs across multiple communities, across multiple states.

Host: Right. The Connected Community Network or CCN as you phrased it, it sounds like it really is important in these individual communities. I also like how you said people live their lives horizontally, not vertically. That's really interesting. And you also said building a comprehensive, active community health network is vital.

So Ji, how would someone go about doing that? Could you just briefly share a couple of steps how someone builds one of these comprehensive, active community health networks?

Ji: Yeah. Well, I will say that there are some guiding principles that I'm happy to go through and share with anyone, but it really is bringing the partners together. There's a lot of facilitating and convening that happens so that this isn't a Common Spirit Health solution or initiative. It's not one organization's work. It has to be the community's work. And so at the heart of the CCN, there are four central tenets. One, there's a neutral convener, community convener. Second, there's a role that the local 211s play and those are effectively the community navigators. Third, there's a collaborative community network.

So, these are organizations that are all coming together and saying, we want to be a part of a network so that we can work together with one another to help people in the community. It's not just about a food bank solving everything about their client's issue, but the food bank connecting with others, family resource centers or the housing service provider to help the client solve issues. Now the fourth and the last tenet and here is the technology which is, could be a platform that allows all the partners to be on one so that there is a way to effectively and safely share necessary information to allow that kind of referral or allow that kind of collaboration to happen.

And so all these four tenets come together. I would say that CCNs can still operate without all of these four. But what we have seen is that having a neutral convener to be an integral process of the work really creates for a successful and sustainable work. I want to also add a few pieces. When we build a CCN, it's not just a siloed solution that we're building. It has to be aligned and integrated with all the work that's already happening in the community with the county, with the city, with the foundations, with the community organizations, the grassroots organizations that have been working on issues in the community for decades.

So, it's not about going in and being the new kid on the block and saying, I have a solution for the community, everyone get on this and we'll figure it out. It's about listening, active listening. It's about making sure that the CCN is a part of all the other solutions and projects that are happening in the community.

Host: Yeah, as you've raised it, bringing the partners together, this is the community's work and you talk about the four tenets, the community convener, the community navigators, right. Basically the community network or resources, and then the technology. So, bringing all of those people together really helps build this connected community network. Is that right?

Ji: Absolutely. And I would say that everyone is thinking, who pays for it? How is it financially sustainable? And so we developed this concept of a community bank where multiple organizations can put money into the community bank, very much like monopoly and that community bank, those dollars are used to spend on things that people don't typically know to spend it on. The convener, the actual convening work that has to happen in the community, the data sharing, the data quality work that needs to happen in the community, that community navigation that is typically fundraised anyway, but is very resourced.

But it lacks resources to, to do and carry on. And there are bandwidth issues to address that. And I think that the day when we make referrals to our community partners, we're straining them a lot more than they are already strained. And so how do we build capacity? And so another part of the community bank model is to build a community capacity fund that allows support, financial support for organizations to participate in this work.

Host: The community capacity fund and that goes along with the community bank. So, another important part of all of this. Well, this session is really going to be good. And I know that you're going to dig into a lot more of this during the session. So, let's wrap up with your thoughts on the session coming up at SHSMD. So Julia, tell us about your session and what you hope session goers will walk away with.

Julia: Sure. Well, I think all of you from listening to Ji for the past few minutes, are excited about just the potential for the cool work that hospitals can do in this space, as they're thinking about how they improve health equity in their communities. But I think as a field, we have a long way to go, with telling those stories. They're not as straightforward as like our medical stories.

I've also found over the years that people who work in community health are humble to a fault. And are just not ready to tell their stories until they fixed everything, but there's so much power in the process of these stories and learning from each other about how to get it done, how to communicate it to different stakeholders, both within our hospitals and as we're thinking about building partnerships with community stakeholders. So we'll be diving more into, you know, the work that's happening at Common Spirit, how we're trying to frame things at AHA, and really how to, how to tell the stories. It's really inspiring and important work that hospitals are doing.

Host: Yeah, it is inspiring and important work. And there's no question about that. And Ji, can you share with us your thoughts about what you want session goers to walk away with?

Ji: I think that Julia wrapped it up really well. I would just add that a couple of things that we will touch on is initiatives on the facade that may look like it's improving equity or reducing disparities, but not necessarily be the case. Again, we will be really focusing on how the work is being done, not just what is being done and some of the recommendations and insights on how to identify those opportunities that should be highlighted in the news, I guess.

Host: Well, there should be more awareness of it. And I'm happy to hear that we are talking more about social determinants of health now. It seems like it is becoming a regular part of the conversation where several years ago, it really wasn't. Right? I mean, it's, it's good that we're talking about this finally.

Julia: Absolutely definitely a sign of progress.

Host: Yeah. So that's what we're all about.

Ji: This is our moment.

Host: Amen to that. I agree. Well, Julia and Ji thank you so much for your time. This is going to be a fantastic session. Making Societal Factors Part of a Health Equity Strategy, Julia and Ji will be presenting. And we look forward to this session. Julia and Ji, thank you so much for your time today. This has really been fascinating. Thank you.

Julia: Great. Thank you so much Bill

Ji: Thanks for having us.

Host: And once again, this Julia Resnick and Ji Im, and you can get registered for this year's SHSMD Connections, virtual conference, which is October 20th and 21st. Just go to shsmd.org/education/annualconference. And if you found this podcast helpful and come on, how could you not, please make sure you share it on all of your social channels. And please hit the subscribe or follow button to get every episode. This has been a production of Dr. Podcasting. I'm Bill Klaproth. See you.