How VCU Health is Working to Combat the Social Determinants of Health
VCU Health is working to improve the health of the Richmond Community. Sheryl Garland, Chief of Health Impact of VCU Health System, discusses these exciting changes.
Featured Speaker:
Sheryl Garland, MHA; FACHE
Sheryl Garland received an undergraduate degree from Wake Forest University in 1982 and a Masters in Health Administration from Virginia Commonwealth University in 1988. She began her career with the VCU Health System in 1988, serving in various leadership roles including Vice President for Health Policy and Community Relations, Vice President for Community Outreach, Director of Ambulatory Care Services, and Director of Planning. As Chief Health Impact Officer, she is responsible for establishing the strategic direction and building partnerships to make measurable, sustainable improvement on health issues that impact the populations and communities served by VCU Health. In addition to her health system responsibilities, she has held numerous positions within Virginia Commonwealth University’s School of Medicine including Director of Community Outreach for the VCU Institute for Women's Health, Administrative Director of the VCU Center on Health Disparities, and Director of the VCU Office of Health Innovation. Ms. Garland has been the recipient of a number of awards including the American College of Health Care Executives Regent’s Early Career Healthcare Executive Award (1994), the VCU Presidential Awards for Community Multicultural Enrichment (Administrator Award – 1996), VCU/MCV School of Medicine Dean’s Award for Community Service (1999), YWCA of Richmond Outstanding Woman of the Year Award in the field of Health/Science (2000), and the VCU Department of Health Administration Alumni of the Year Award (2016). She has also participated in Leadership Metro Richmond (1992), the National Association of Public Hospitals and Health Systems’ (now America’ Essential Hospitals) ambulatory fellows program (2003), the Grace E. Harris Leadership Institute (2004), and LEAD Virginia (2005). Ms. Garland serves on the boards of the MCV Foundation, VCU Health Continuing Education, the Institute for Public Health Innovation, and the American Heart Association, Mid-Atlantic Affiliate, currently serving as President of the board. She is also a member of SisterFund, an African American Women’s Giving Circle, chair of the Vizient Vulnerable Patient Populations Network, and is a Fellow in the American College of Health Care Executives. Transcription:
How VCU Health is Working to Combat the Social Determinants of Health
Alyne Ellis (Host): Health screenings, nutrition counseling, chronic disease management; these are just a few of the free services you’ll find at VCU’s Health Hub at 25th in Richmond, Virginia. Let’s talk today to Sheryl Garland, the Chief of Health Impact for the VCU Health System. This is Healthy with VCU Health. I’m Alyne Ellis. Sheryl, tell us why you chose this location for the Health Hub at 25th?
Sheryl Garland, MHA, FACHE (Guest): We chose this location because it is in a community that has historically had some challenges. When we look at the city of Richmond, and the demographics, what we know is that this is a community, the east end, where four of the city’s public housing developments are located. It is also a community that has historically been rich in its assets, in its community engagement. However, over time, there have been changes that have occurred with the closing of businesses, and the east end of Richmond happens to include census tracts that are food deserts. It is a community that has gone through multiple changes over the years. Throughout the work of many of the faculty and team members at VCU and the VCU Health System, we receive feedback from the community about the need for services and programs to address some of the needs that exist.
Therefore, when the new market at 25th was in the planning stages, an opportunity arose for our teams to come to the table to look at how we could bring resources and assets from the University and Health System to address some of the unmet needs.
Host: So, when you say new market, that means a grocery store, right around the corner or right close to the Health Hub?
Sheryl: That’s correct. The market at 25th is the newest grocery store in the east end of Richmond. And our Health Hub is located adjacent to the market and it’s also in the same development where Reynolds Community College will be opening its new Culinary Arts Program.
Host: What do we know about low income communities and why they in particular are so vulnerable?
Sheryl: Well, what we know about low income communities is that individuals who live in those communities are facing issues that impact their health outcomes, impact their education, and impact their overall health and wellbeing. And many of these are called social determinants. There’s truly a body of evidence that links economic and social disadvantage with avoidable illness, disability, suffering and even premature death.
There’s a body of work that’s been done by the University of Wisconsin through its County Health Rankings Model that actually has demonstrated that in 50% of health outcomes, that is how long people live, their quality of life is impacted by factors that are related to these social determinants. Social determinants are essentially the conditions in which people are born, grow, live, work and age, including access to health insurance and coverage. Examples of social determinants might be whether somebody is employed and whether or not they live in poverty. Are they faced with food insecurities? Do they live in safe neighborhoods? Have access to transportation? Or even have health literacy issues, which are often driven by their level of education.
Host: An example of this might be that the rates of heart disease or presence of diabetes would be higher in a community that is low income?
Sheryl: Yes. That is correct. There are studies that have been done by our own local health department that look at where are the highest incidences of poverty in our communities. We then overlay the where it is that we see high concentrations of poverty by census tract with where is it that we are seeing the highest incidence of diseases such as diabetes or hypertension or heart disease. Unfortunately, what we are finding is that in many of the communities where we have the highest poverty rates, we are also seeing the highest incidence of these chronic conditions.
Host: So, meeting the needs of people in their own communities is probably more successful, I would assume, than having them go across town to see a doctor or get more education?
Sheryl: Yes, I think that is a fair comment because one of the things that we know is addressing an individual’s condition in their community, in their home, has a huge impact on their overall wellbeing and their health outcomes. If the only interactions that our healthcare system and providers are having with individuals is when they are in our clinical environments, when they are in our hospitals, in our emergency departments, then we are missing a huge component of what it is that may be driving the conditions that individuals are faced with.
Host: The Health Hub sounds like a place where people can connect with their neighbors and encourage each other and develop new healthy habits together. Tell us what it’s like to be in that space.
Sheryl: So, the Health Hub is a creative space that does a few things. First, it brings together assets across VCU and VCU Health System to really focus on the issues that have been identified by community members through either focus groups or conversations or surveys. Moreover, we look at data that shows us what some of the issues are. Our goals are to really focus on improving health and wellness through the delivery of preventive and supportive services. The Health Hub give us an opportunity to bring together our faculty from VCU, our students, and our team members with community members around focused programs and initiatives that directly address their concerns.
We have consultation spaces where there is an opportunity to have one on one conversations with community members and or their family members. And, we also have large educational spaces where we can bring together groups who are working together to address issues, to work on fitness activities, to learn about what some of the drivers are behind chronic conditions or issues that community residents are dealing with.
Host: It also sounds like a fun place in the sense that neighbors can encourage each other in an exercise class for example - there is time for that?
Sheryl: Yes, there is. We have partnered with Sports Backers and their Fitness Warriors Program to host sessions for that group. And, that has been very exciting and very well received by community members because the trainers are often individuals who live within the community and who have the skills to lead fitness classes.
Host: What about the health screenings that are free? How does one participate in that?
Sheryl: We have partnered with a couple of the schools to implement the screenings. One particular program that is functioning at the Health Hub is being managed by the Richmond Health and Wellness Program. This is a program that is interdisciplinary in nature and brings together representatives from a host of schools, including our school of nursing, pharmacy. We have folks from our department of psychology as well as our college of health professions which brings occupational therapists into the group. The goal is to build off a program that has historically worked with seniors in congregate living facilities, primarily senior high rises throughout the city, and provide coordination services to help seniors age in place longer.
What we understand is that not all seniors live in congregate facilities. We continue to have seniors who may live with their family members in single housing or live by themselves. And so, we’ve taken this Richmond Health and Wellness Program model and we’ve now introduced it into the Health Hub. A couple of days a week, we bring in team members from the Richmond Health and Wellness Program, from these various schools and programs who are available for not only seniors but also for anyone in the community. Anyone who might need some help in getting a better understanding of what is going on with their health condition, connecting with their primary care provider, or identifying other resources that might be helpful so that they can continue to manage whatever condition they have.
Host: And everything that one would receive from the Health Hub is free?
Sheryl: That’s correct. We are not charging for services and again, part of it is because we are leveraging the resources and the assets that we have in our university and our health system. But the other reason is that there are healthcare services that exist throughout the community that we do not need to duplicate. The goal for the Health Hub is to provide programs and initiatives that compliment and often fill in gaps related to how people navigate to those resources and services. And so, we like to make sure that it’s understood that we are there to create partnerships and to make sure that the residents in the east end have an opportunity to learn about what resources might be available that they haven’t tapped into and we have the assets that can help them to do that.
Host: And someone to help follow up with them and encourage them as they move along that journey.
Sheryl: That’s correct. In fact, one of the things that we have done is partnered with the Richmond City Health District and introduced a community health worker into the Health Hub. Her job is to help individuals navigate the resources that are available in the community and across the city. It might be that they are in need of something that we do not even offer at the Health Hub. The community health worker is there to help people navigate to those services.
Host: Is there anything else you’d like to add Sheryl?
Sheryl: This innovative initiative allows VCU and VCU Health System to really transform the way that we are engaging our students, the way that we are working with the community that we have served for so many years. Our hope is to build new relationships and trusted relationships with community residents so that we are able to bring many of the services and resources into a community that has expressed the need for filling in some gaps, and address some issues that are impacting the health and life of so many individuals.
Host: Sheryl Garland is the Chief of Health Impact for the VCU Health System. For more information on the Health Hub at 25th, please visit www.vcuhealth.org. Thank you for joining us for this episode of Healthy with VCU Health. I’m Alyne Ellis. To listen to this podcast again and check out our other episodes, please visit www.vcuhealth.org/podcasts.
How VCU Health is Working to Combat the Social Determinants of Health
Alyne Ellis (Host): Health screenings, nutrition counseling, chronic disease management; these are just a few of the free services you’ll find at VCU’s Health Hub at 25th in Richmond, Virginia. Let’s talk today to Sheryl Garland, the Chief of Health Impact for the VCU Health System. This is Healthy with VCU Health. I’m Alyne Ellis. Sheryl, tell us why you chose this location for the Health Hub at 25th?
Sheryl Garland, MHA, FACHE (Guest): We chose this location because it is in a community that has historically had some challenges. When we look at the city of Richmond, and the demographics, what we know is that this is a community, the east end, where four of the city’s public housing developments are located. It is also a community that has historically been rich in its assets, in its community engagement. However, over time, there have been changes that have occurred with the closing of businesses, and the east end of Richmond happens to include census tracts that are food deserts. It is a community that has gone through multiple changes over the years. Throughout the work of many of the faculty and team members at VCU and the VCU Health System, we receive feedback from the community about the need for services and programs to address some of the needs that exist.
Therefore, when the new market at 25th was in the planning stages, an opportunity arose for our teams to come to the table to look at how we could bring resources and assets from the University and Health System to address some of the unmet needs.
Host: So, when you say new market, that means a grocery store, right around the corner or right close to the Health Hub?
Sheryl: That’s correct. The market at 25th is the newest grocery store in the east end of Richmond. And our Health Hub is located adjacent to the market and it’s also in the same development where Reynolds Community College will be opening its new Culinary Arts Program.
Host: What do we know about low income communities and why they in particular are so vulnerable?
Sheryl: Well, what we know about low income communities is that individuals who live in those communities are facing issues that impact their health outcomes, impact their education, and impact their overall health and wellbeing. And many of these are called social determinants. There’s truly a body of evidence that links economic and social disadvantage with avoidable illness, disability, suffering and even premature death.
There’s a body of work that’s been done by the University of Wisconsin through its County Health Rankings Model that actually has demonstrated that in 50% of health outcomes, that is how long people live, their quality of life is impacted by factors that are related to these social determinants. Social determinants are essentially the conditions in which people are born, grow, live, work and age, including access to health insurance and coverage. Examples of social determinants might be whether somebody is employed and whether or not they live in poverty. Are they faced with food insecurities? Do they live in safe neighborhoods? Have access to transportation? Or even have health literacy issues, which are often driven by their level of education.
Host: An example of this might be that the rates of heart disease or presence of diabetes would be higher in a community that is low income?
Sheryl: Yes. That is correct. There are studies that have been done by our own local health department that look at where are the highest incidences of poverty in our communities. We then overlay the where it is that we see high concentrations of poverty by census tract with where is it that we are seeing the highest incidence of diseases such as diabetes or hypertension or heart disease. Unfortunately, what we are finding is that in many of the communities where we have the highest poverty rates, we are also seeing the highest incidence of these chronic conditions.
Host: So, meeting the needs of people in their own communities is probably more successful, I would assume, than having them go across town to see a doctor or get more education?
Sheryl: Yes, I think that is a fair comment because one of the things that we know is addressing an individual’s condition in their community, in their home, has a huge impact on their overall wellbeing and their health outcomes. If the only interactions that our healthcare system and providers are having with individuals is when they are in our clinical environments, when they are in our hospitals, in our emergency departments, then we are missing a huge component of what it is that may be driving the conditions that individuals are faced with.
Host: The Health Hub sounds like a place where people can connect with their neighbors and encourage each other and develop new healthy habits together. Tell us what it’s like to be in that space.
Sheryl: So, the Health Hub is a creative space that does a few things. First, it brings together assets across VCU and VCU Health System to really focus on the issues that have been identified by community members through either focus groups or conversations or surveys. Moreover, we look at data that shows us what some of the issues are. Our goals are to really focus on improving health and wellness through the delivery of preventive and supportive services. The Health Hub give us an opportunity to bring together our faculty from VCU, our students, and our team members with community members around focused programs and initiatives that directly address their concerns.
We have consultation spaces where there is an opportunity to have one on one conversations with community members and or their family members. And, we also have large educational spaces where we can bring together groups who are working together to address issues, to work on fitness activities, to learn about what some of the drivers are behind chronic conditions or issues that community residents are dealing with.
Host: It also sounds like a fun place in the sense that neighbors can encourage each other in an exercise class for example - there is time for that?
Sheryl: Yes, there is. We have partnered with Sports Backers and their Fitness Warriors Program to host sessions for that group. And, that has been very exciting and very well received by community members because the trainers are often individuals who live within the community and who have the skills to lead fitness classes.
Host: What about the health screenings that are free? How does one participate in that?
Sheryl: We have partnered with a couple of the schools to implement the screenings. One particular program that is functioning at the Health Hub is being managed by the Richmond Health and Wellness Program. This is a program that is interdisciplinary in nature and brings together representatives from a host of schools, including our school of nursing, pharmacy. We have folks from our department of psychology as well as our college of health professions which brings occupational therapists into the group. The goal is to build off a program that has historically worked with seniors in congregate living facilities, primarily senior high rises throughout the city, and provide coordination services to help seniors age in place longer.
What we understand is that not all seniors live in congregate facilities. We continue to have seniors who may live with their family members in single housing or live by themselves. And so, we’ve taken this Richmond Health and Wellness Program model and we’ve now introduced it into the Health Hub. A couple of days a week, we bring in team members from the Richmond Health and Wellness Program, from these various schools and programs who are available for not only seniors but also for anyone in the community. Anyone who might need some help in getting a better understanding of what is going on with their health condition, connecting with their primary care provider, or identifying other resources that might be helpful so that they can continue to manage whatever condition they have.
Host: And everything that one would receive from the Health Hub is free?
Sheryl: That’s correct. We are not charging for services and again, part of it is because we are leveraging the resources and the assets that we have in our university and our health system. But the other reason is that there are healthcare services that exist throughout the community that we do not need to duplicate. The goal for the Health Hub is to provide programs and initiatives that compliment and often fill in gaps related to how people navigate to those resources and services. And so, we like to make sure that it’s understood that we are there to create partnerships and to make sure that the residents in the east end have an opportunity to learn about what resources might be available that they haven’t tapped into and we have the assets that can help them to do that.
Host: And someone to help follow up with them and encourage them as they move along that journey.
Sheryl: That’s correct. In fact, one of the things that we have done is partnered with the Richmond City Health District and introduced a community health worker into the Health Hub. Her job is to help individuals navigate the resources that are available in the community and across the city. It might be that they are in need of something that we do not even offer at the Health Hub. The community health worker is there to help people navigate to those services.
Host: Is there anything else you’d like to add Sheryl?
Sheryl: This innovative initiative allows VCU and VCU Health System to really transform the way that we are engaging our students, the way that we are working with the community that we have served for so many years. Our hope is to build new relationships and trusted relationships with community residents so that we are able to bring many of the services and resources into a community that has expressed the need for filling in some gaps, and address some issues that are impacting the health and life of so many individuals.
Host: Sheryl Garland is the Chief of Health Impact for the VCU Health System. For more information on the Health Hub at 25th, please visit www.vcuhealth.org. Thank you for joining us for this episode of Healthy with VCU Health. I’m Alyne Ellis. To listen to this podcast again and check out our other episodes, please visit www.vcuhealth.org/podcasts.