Thriving Together Under One Roof by Sandra Gee, BS
The Health Care Council of the Lehigh Valley (HCC) issued a Community Health Profile entitled “The Road to Health” in March 2016. The HCC was created by the not-for-profit health care systems of the Lehigh Valley, and later expanded to include local health departments and the community health center, with the aim to collaborate on one regional Community Health Profile. These health systems and health bureaus serve the same region in Pennsylvania, therefore, a combined effort to develop a regional profile that looked at the overall health of the citizens of the Lehigh Valley and the factors that influence the health of the patients they serve was more efficient and minimized duplications. This approach leveraged the strengths of each of the HCC member agencies and created a collective understanding of health in the region.
According to the 2016 report, community members of the Lehigh Valley are living longer than in the past, however, many are not living healthy lifestyles. The Lehigh Valley ranked in the top 20th percentile among all Pennsylvania counties in length of life (mortality), but in the bottom 50th percentile in quality of life (morbidity). Although access to high quality health care continues to improve, this appears to be reflected significantly in the length of life but not in the quality of life. It is becoming more and more evident that many factors outside of traditional health care influence our overall health. In 1993, in their landmark article titled “Actual Causes of Death in the United States,” Michael McGinnis and William Foege identified major non-genetic factors that contribute to death in the United States as tobacco/alcohol use, diet and activity patterns, sexual behavior, exposure to toxic agents, and motor vehicle accidents. More recently, the University of Wisconsin Population Health Institute’s David Kindig expanded on this research and explains that clinical care only contributes to 20% of overall health. The other 80% includes social and economic factors such as education and employment (40%); daily health behaviors such as drug/alcohol use, diet and exercise (30%); and physical environment such as housing and air quality (10%). The Road to Health highlights areas for improvement in the social factors that have a major impact on the overall health of the community.
In order to improve the health of citizens in the Lehigh Valley, we must address the social determinants that influence health outside of the health care system walls. This task cannot be solved solely by health care services from medical providers. It is a complex social issue that requires a different approach, namely cross-sector partnerships. Physical and mental health care, education, business, housing, transportation, and nutrition are all intertwined factors that transform geographic areas of land into a community that people desire to be a part of and, more importantly, are the building blocks of a healthy and productive community that can continue to grow and thrive. These factors have bi-directional influence on one another and combine to have a significant impact on community members. For example, a child who has a mental disability or physical illness in a low-income family where access to health care is limited may not perform well in school because of increased absences or inattentiveness. An employee who is traumatized or sleep-deprived because of the violence of the unsafe neighborhood he or she lives in may not be able to perform well at work and this can decrease productivity of a business. These are just two of many examples in which the quality of life of a person is the result of various connected factors that have a combined impact on daily life. The quality of life and overall health of a community are of paramount importance in creating a successful environment where we can continue to grow and prosper.
If the health of a community is influenced by multiple sectors and factors, then one singular solution to improve the quality of life and overall health of the Lehigh Valley cannot succeed. One sector alone cannot change the health of an entire community. Cross-sector partnerships can help us to be more effective and efficient in reaching our overall goal by lending multiple perspectives to the conversation and leveraging the strengths of each sector at the table. Continuous communication and collaboration will help to keep each other moving in a positive direction that will benefit the community and decrease conflicts that can arise as a result of competition and individual agendas. Adaptive problems require adaptive solutions. Working together capitalizes on the collective strength of the human and social services, business community, and medical providers in the Lehigh Valley region to bring about wide-spread, sustained community change.
One of the major models of collaboration gaining steam throughout the country is Collective Impact. In 2011, John Kania and Mark Kramer published an article in the Stanford Social Innovation Review in which they emphasized the need for a systemic approach to social impact that focuses on relationships between organizations and the progress toward shared objectives – Collective Impact. They expressed five conditions as part of a model that produces alignment and success in collectively addressing complex issues in communities. These conditions include a common agenda, shared measurement systems, mutually reinforcing activities, continuous communication, and backbone support organizations. Many communities throughout the country are now using this model and have been successful in addressing complex issues.
One example of a cross-sector partnership in which the Collective Impact model is leading to positive wide-spread change in the health of a community is the Vital Village Community Engagement Network. This initiative is a network of residents and organizations across three Boston neighborhoods committed to maximizing child, family, and community well-being through improved education, health, and nutrition. Since their formation in 2011, the Vital Village Community Engagement Network has developed a variety of successful projects that promote healthy social and emotional development in early childhood, such as the Parks & Greenspaces for Mattapan Project. This project brought together community members and youth to transform an empty lot surrounded by violence into a garden designed by the residents themselves to promote neighborhood cohesion and community pride. The Network has grown from 25 community-based agency partners and 40 strategic planning members to over 65 community-based agency partners and more than 150 active participants in Network activities in just the past three years.
There are challenges that arise in the short run when attempting to work together to address complex issues. For example, community development consultant Tom Wolff has written an article about collaboration and collective impact in which he voices his concerns regarding the time, finances, labor, and adequate communication that it takes for collaborative efforts to be successful. However, in the long run, by working together as one community, we will be able to gain a greater understanding of the complex issues faced by the community and address them in a more efficient and constructive manner by utilizing the knowledge and resources of several perspectives. We can be more confident in the direction we are going when we are moving forward as one team. Working together enables us to create a more wide-spread change in the health of the community because everyone is playing a part and contributing towards the same goal.
Improving the health of the community should involve individuals from every layer of the community. Collaboration will help make this possible. It is important that in coming together to address these complex issues, we hear the perspectives of not only the organizations who are trying to solve these problems but also from the communities who are actually experiencing these problems. In a recent roundtable discussion initiated by the Aspen Institute Forum for Community Solutions, scholars and practitioners gathered to discuss the importance of engaging the community to create community solutions. Martin Zanghi, the director of youth and community engagement at the University of Southern Maine Muskie School of Public Service, spoke about this approach, expressing that “the most powerful voices I’ve experienced over the last 20 years are youths who have changed policy, changed practices, and changed our belief systems so that we’re actually doing better by the people we’re trying to serve.”
One of the ways that the Health Care Council of the Lehigh Valley included the community’s voice was by holding focus groups to reflect on the quantitative data that was compiled about the region, and their input was woven into the Lehigh Valley health profile. Three different focus groups were held, with each group consisting of participants from all over the Lehigh Valley and a wide cross-section of age, race, ethnicity, physical ability, and income. When asked what factor influenced health the most, housing was the most commonly mentioned influence among all three focus groups. Housing is the foundation of a healthy life. Where we live impacts our behaviors, education, nutrition, social relationships, access to quality health care, and other circumstances. In fact, the mission statement of the U.S. Department of Housing and Urban Development (HUD) lists housing as a multidisciplinary issue. HUD expresses the desire to create strong communities, specifically utilizing housing as a platform to improve quality of life. The physical environment of a home, the surrounding neighborhood/community, and the financial implications associated with owning versus renting a home have a major impact on quality of life and overall health. The table on the following page presents an overview of the impact that housing has on four areas of health, demonstrating the connection between these major aspects of health and social issues.
On September 16, 2016, a community development symposium will be held to provide an opportunity to come together to discuss the complex issue of housing as an example of a social issue that would benefit from a cross-sector approach and the impact it has on health. The goal is to use this issue as a lens to better understand the benefits of a multiple-sector perspective. As the Lehigh Valley continues to grow, it is important that we grow together and are committed to creating a healthy and prosperous community.
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