For the past several years, Greenlining has led a statewide coalition to advocate for not-for-profit hospitals to increase investments that improve the holistic health and well-being of communities of color and low-income communities. Each year, not-for-profit hospitals receive billions of dollars in tax exemptions and subsidies – totaling nearly $3.3 billion amongst not-for-profit hospital systems in California in 2010. In exchange, these hospitals are required to provide vital investments that address the health needs of the communities they serve, with an emphasis on building community health and disease prevention. These investments are known as community benefits.
Communities of color and low-income communities, California’s most vulnerable populations, have the most to gain from community benefits when these investments target the root causes of poor health – poverty, lack of access to healthy foods, and poor air and water quality, to name a few.
Many Californians face huge challenges in accessing substance use treatment services. Social and environmental factors including low socioeconomic status, low literacy, unemployment, discrimination, and other factors negatively impact our ability to lead healthy lives. Many people of color and Limited English Proficient populations additionally face a lack of culturally competent and linguistically appropriate services. Further, stigma and discrimination linked with accessing services also remain barriers to accessing treatment for many, especially those with previous criminal justice involvement.
California’s Medi-Cal 2020 1115(a) Waiver Demonstration Project provides new opportunities to expand substance use services to include a fuller continuum of care that includes withdrawal management, medication-assisted treatment, short-term residential, case management and care coordination with physical and mental health, and recovery support services. Drug Medi-Cal eligibility also expands to include single adults without children, which mean more people are able to receive substance use treatment services than ever before.
To address these barriers and disparities, communities of color – those most in need of services – need to be involved in the development and design of treatment options, and policymakers must consider the root causes of substance use disorders in vulnerable and underserved communities. That’s why CPEHN is engaging our communities to get involved so that the needs of underserved communities are included and addressed in the implementation of these new services. With stakeholder input from underserved populations, county departments of behavioral health can better meet the needs of the most vulnerable communities.
By aligning strategies across the portfolio, the interventions achieve a synergistic effect and compound into true population health improvement for communities. The success of this type of approach has been demonstrated repeatedly over the last 50 years through health improvement efforts that have incorporated both individual intervention and community-based prevention to take on issues as diverse as tobacco, driving under the influence, lead exposure, and violence, leading to public health victories that would never have been possible through individual sectors’ separate efforts.
“The Community-Centered Health Homes model has spurred a phenomenal transformation in our community and our clinic. CCHH is a way to make the connection to what we’re doing in the community to the services & treatment that we provide in the exam room.”
A new Prevention Institute (PI) brief outlines what we’ve learned in advancing the Community-Centered Health Homes (CCHH) model across the country since it was first released five years ago. PI originally developed the CCHH model to provide a framework for healthcare organizations to systematically address the community conditions that impact their patients. By implementing activities based on community needs rather than medical treatment needs alone, we can improve health, safety, and equity outcomes.
In the five years since the first report release, the CCHH model has catalyzed action and activity in communities across the country - including California, the Gulf Coast Region, North Carolina, and Texas. The brief reviews and analyzes what we’ve heard from healthcare organizations actively involved in community change – particularly clinics doing early testing of the CCHH model – and summarizes lessons learned, recommendations for success, and common themes that have emerged for healthcare organizations and funders looking to implement the model. The brief was funded by The Kresge Foundation.
A new Prevention Institute (PI) brief shares key learnings from a recent summit in Los Angeles (LA) to discuss tools and strategies for supporting healthy community development without displacing current residents. The October meeting of policymakers, funders, academics, practitioners, and resident activists added a strong health frame to the ongoing conversation in LA on gentrification and displacement.
To effectively identify racial and ethnic disparities in health and health care, it is essential that key elements such as patient race, ethnicity, and language proficiency be collected routinely and then utilized to measure performance. There is now also great attention being given to the impact of social determinants on health disparities--including environmental factors, food insecurity, transportation, and safe housing--among others. Hospitals in Pursuit of Excellence of the American Hospital Association and the Disparities Solutions Center at Massachusetts General Hospital are hosting a webinar, “Going Beyond REaL Data Collection: Collecting Social Determinants of Health” on Tuesday, February 23rd, from 9:00 AM – 10:00 AM PT.
This webinar will discuss strategies and approaches implemented by hospitals and health care systems to collect the social determinants of health, with the understanding that this information will be critical for population health efforts of health plans, hospitals and health centers nationwide. Speakers include:
Kirsten Bibbins-Domingo, PhD, MD, MAS, Director, UCSF Center for Vulnerable Populations at San Francisco General Hospital
Lenny López, MD, MDiv, MPH, Chief of Hospital Medicine, University of California San Francisco - SFVA and Senior Faculty, the Disparities Solutions Center at Massachusetts General Hospital
Aswita Tan-McGrory, MBA, MSPH, Deputy Director, Disparities Solutions Center at Massachusetts General Hospital
Prevention Institute (PI) and The College for Behavioral Health Leadership are co-hosting Summit 2016 - Population Health: Leadership for Building Healthier Communities this April 6-8, 2016 in San Diego. Conference participants will seek to identify and address opportunities for improvement, promote emerging consensus, contribute to the evolution of behavioral health and wellness, and positively impact the health of communities.
On November 4, 2015 I attended “Smart on Safety,” an invitational summit to examine how California can reform the criminal justice system and transform communities to prioritize prevention over punishment. As Adam Kruggel, Director of Organizing for PICO California, stated, “mass incarceration creates a legitimacy crisis for some of our most deeply held values – that everyone has a right to be a human being.” Harsh sentences, three strikes, mandatory minimums, racial profiling, gang injunctions, and transfer of juveniles to adult courts have demonized poor black and brown males as less deserving “others” – predators who are beyond redemption.
Anyone who works in marginalized communities knows the toll that these policies take on the health and life prospects of their teen patients. Although one would hope that the appalling scene in South Carolina is not the norm, it has been well documented that black students are three times more likely to be suspended than white students. Suspension is a gateway to dropout, economic instability, crime and incarceration. And we don’t need to look only at teens to see how “tough on crime” affects children’s health. Tamir Rice, a 12 year old who was playing with a toy gun in a park, is dead. The children of Eric Gardner and Walter Scott are fatherless. Approximately 2.7 million children have a parent in prison – a vastly disproportionate number of whom are poor and black. Millions more children experience post-traumatic stress disorder from extended exposure to violent encounters between citizens and law enforcement in their communities.
When it comes to recreational space, not all neighborhoods are created equal. Low-income communities and communities of color consistently have the fewest recreational facilities. Even where recreational facilities do exist, there are often other barriers to meaningful access, such as safety concerns, lack of transportation to the facilities, and poor maintenance due to inadequate funding. The result: Residents of these communities often have the fewest opportunities for physical activity.
In Los Angeles, for instance, access to recreational space is disturbingly inequitable. While standards vary, many experts recommend that a city have at least ten acres of park and recreation space per thousand residents. White L.A. neighborhoods more than meet that standard – with an average of 32 acres of park space per thousand residents – but Latino and African-American neighborhoods have only 0.6 and 1.7 park acres, respectively. Similarly, low-income neighborhoods have less than a half-acre of park space per thousand residents, while higher-income neighborhoods have 21 acres.
These patterns are pervasive. Throughout California and the country, low-income communities and communities of color are far less likely to have access to recreational spaces than their white, higher-income counterparts. Unfortunately, and perhaps not surprisingly, the places with the fewest opportunities for physical activity often have worse health outcomes.
Health Inequities in California
The lack of safe, affordable places to play and be active contributes to the health inequities facing low-income communities and communities of color across the state. Residents of “park poor” communities disproportionately bear the burdens of the obesity and diabetes crises:
PI first developed THRIVE in 2002, with funding from the OMH and The California Endowment. Since then, the public health community has created many more frameworks on the factors that shape health outcomes outside the healthcare system – i.e., SDOH.
According to the World Health Organization (WHO), SDOHs are largely understood as the broad set of factors that influence health outcomes directly and shape community environments. These factors reach far beyond the healthcare system, and include structural drivers, such as racism, and the conditions of daily living – the community determinants of health. PI is working with WHO's SDOH team to explore the use of our equity tools and updated THRIVE approach as a resource for advancing community efforts in other countries.