Dr. Alexander: Keys to better health held by communities

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Department of Health Director Dr. Alexander Nicole-Scott stopped by the weekly meeting of the Warwick Rotary Club Thursday to share a presentation with the group about overall health trends in the country and how the state is seeking to improve health in its communities.

The half-hour presentation centered around one major factor that Alexander-Scott led with – for the first time in about 50 years, life expectancy in America has been decreasing year over year rather than increasing.

“That’s a problem,” Alexander-Scott said. “That’s something that we definitely need to, and can, fix.”

The problem persists despite the United States spending exorbitantly more dollars per capita on healthcare than other developed nations around the world. Alexander-Scott showed a chart that outlined how America spends nearly 75 percent of its massive healthcare budget on so-called clinical healthcare – traditional means of reactive healthcare such as emergency rooms and hospitals.

However, “clinical care makes up only 10 percent of what makes someone healthy,” according to Alexander-Scott.

While another small percentage of healthiness is attributed to the randomness of the human genome, Alexander-Scott said that a vast majority (80 percent) of what makes somebody healthy are social and economic factors, such as the physical environment where they grow up, access to essentials like healthy food, good water and vital health services within the community.

“Being from New York City originally, I can definitely speak to walking a few blocks into a new zip code and seeing totally different life expectancy outcomes,” Alexander-Scott said, emphasizing that the impetus must be to allocate more resources to preventative care and improving the living conditions of people to prevent health problems rather than to continue primarily funding treatment once they have already established unhealthy livings.

“Those types of environmental outcomes make tremendous differences in determining how healthy someone is, but it also impacts educational outcomes, employment and what happens to our society,” she said. “In the long run, that impacts everyone’s bottom line.”

The formula is superficially simple. Give everybody, regardless of their zip code, access to good schools, safe water, healthy food options and a safe community and they are much more likely to avoid health problems than people in communities without that security. Getting there for a whole state – much less an entire nation – however, requires significant planning.

Getting the community involved

Alexander-Scott emphasized that creating a healthier tomorrow cannot simply be dictated from above at the state level, with the hopes that the communities will adhere to regulations and mandates. Instead, she said the answer is to incorporate individual communities as the actual drivers of change themselves.

“Our goal is to start there,” she said. “Instead of us, as a state, saying ‘We know what you need to fix and this is how to do it,’ we want to be more deliberate in engaging with our community partners, provide some structure to it, but be able to work with them on achieving the specific goals that they know are needed to help make it a better place to live. We know that’s going to improve health outcomes.”

There are two ways that the Department of Health is setting out to do this. One is by training community health workers. These are healthcare clinicians and other trained medical professionals who are further certified and trained to go into local municipalities and provide assistance directly to communities in need.

The other approach involves the setting up of “health equity zones,” which are comprehensive partnerships between the state and participating municipalities that illustrate a health-related problem they want to address and demonstrate an ability to collaboratively work towards solving that problem.

This process boils down to one community organization acting as a “backbone” for the health equity zone, which would receive seed money from the state to begin the work. Alexander-Scott pointed to Bristol as an example of this, where municipal health organizations partnered with a church to provide addiction recovery services and worked with the town government to pass an ordinance banning smoking at town parks.

While there are currently nine of these health equity zones operating – with at least one in each county of the state – Alexander-Scott said the goal is to continue to expand the program in Rhode Island and also demonstrate it as a state-municipal partnership model that could be implemented nationally.

“We’d love to have a health equity zone in any of the cities and towns in the state that want to be able to do it,” she said.

Overall, Alexander-Scott and the Department of Health are trying to improve health outcomes in the state by adhering to five core strategies, which are:

1.) Promoting healthy living for all, at all stages of life;

2.) Ensuring access to safe food, water and healthy environments to all communities;

3.) Making it so physical, behavioral and oral health systems are navigable, accessible and affordable to all;

4.) Prevent, investigate, control and eliminate health hazards and emerging threats, whether it is a flu outbreak, a new virus such as Zika or the overdose epidemic;

5.) To not only collect data and analyze it, but communicate data to drive action.

  To learn more about health equity zones, visit www.health.ri.gov/programs/detail.php?pgm_id=1108.

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