Community health is more than how someone’s physical health needs are being met. It involves all the physical, social, and environmental factors — access to nutritious food, stable income and housing, education opportunities, and more. These social determinants of health, or SDoH, are interconnected and integral to the overall health of communities across the world — and health care systems are taking note.
With the onset of the COVID-19 pandemic, it became clear one person’s health could influence the health of entire communities — that we are all connected. Community health was brought to the forefront as it became increasingly apparent that just treating the clinical needs of patients wasn’t going to be enough. Health care providers saw that only 20% of a patient’s needs could be met inside the four walls of a hospital; the other 80% was determined by what happens outside of hospitals and health clinics.
In addition, the pandemic exacerbated other health issues. Hospitals saw a 67% increase in demand for services, especially behavioral health needs after the first year of COVID-19. As hospitals continue to face an influx of ER visits and readmittance, health care providers see firsthand how hospitals and care centers are the downstream ‘catch-all’ for societal and economic issues. What they see in the ERs and waiting rooms can not be solved by treating the immediate health care needs of the patients alone. Providers and administrators are motivated to find a solution — a solution that not only makes economic sense but also makes communities healthier.
While health care systems are there to care for those in need, they also feel the straining effects of their overextended providers and overwhelmed ER staff being used to treat preventable illnesses and behavioral health needs, the majority of which are distributed unequally in our communities. A recent study found that about $320 billion in annual health care spending was being used to treat these health inequities. This number is projected to grow incrementally if unaddressed. Working to build a healthier community makes the health care process better for all — less time in waiting rooms, increased budgets for programs, and most importantly, better health for all.
Community health will continue to evolve as we identify and address inequities that exist within our patient populations. Below are four predictions for the ever-evolving nature of community health — which requires a commitment of time, resources, and providers.
1. Mental health support and resources will become top priorities.
Over half of U.S. adults with a mental illness do not receive treatment. In the St. Louis area, health care providers have seen visits to the ER for mental health issues increase by more than 40%.
This increased need combined with a lack of viable treatment options has caused ERs to be erroneously used for behavioral health care needs in new and returning patients. Dr. Alexander Garza, Chief Community Health Officer at SSM Health, says treating behavioral health and mental health needs can become ‘really challenging, really quickly’ because of the lack of access to funding for the programs and medications needed to make this care available.
Unmet behavioral health needs often result in a toll on more than the well-being of the patient. It can cause a domino effect. Someone with an untreated mental health issue might miss work, resulting in job instability and a missed paycheck or two, which then leads to missed rent and their housing not being guaranteed anymore. Both of these SDoH — job status and physical environment — can put significant strains on not only the health care resources in a community but also the social services resources.
Suppose providers can begin increasing access to behavioral health programs. In that case, health care systems can better diagnose, treat, and help patients stabilize their mental health and avoid losing their stability in SDoH. Programs like behavioral health urgent cares, long-acting injectables clinics, and centers focused on maternal mental health create accessible, welcoming environments for patients to receive the treatment they need, allowing them to focus on things outside of their illness, such as their family relationships, advancing their careers, and more.
2. SDoH training will be imperative for providers.
Across the nation, health care systems are experiencing long-term nursing shortages and staffing challenges to meet the demand for ever-increasing care services. To serve their patients holistically, providers will need to make connections with social service agencies and community partners.
Health care workers should be trained in the community’s constantly evolving needs and the different populations that require varied support. “Having a well-organized program of training and resources for hospital staff will be critical to identify inequities and achieve positive outcomes,” says Dr. Garza.
SSM Health, a large health care system in St. Louis, is starting to work on providing a clear pathway for patients from admittance to discharge, in addition to readmittance prevention. By training staff on recognizing SDoH on top of the presenting health symptoms, health care providers can become more well-rounded and help recognize where they can connect the patient to SDoH resources in their network.
3. Health care will get social.
Health care providers know they can’t be the answer to every patient’s basic needs. But they can be the opening to a safety net built for patients to receive holistic wellness — a safety net that meets patients where they’re at.
For example, a common barrier to health care access is not having transportation to a doctor’s appointment. If a patient is at risk for colorectal cancer because of family history and age, the provider will order a colonoscopy to make sure they can find anything wrong early so that it won’t spread and become a fatal diagnosis later. But if the patient doesn’t have access to a car or a nearby bus to hop on, they probably won’t make it to the appointment, missing the chance to prevent a worse outcome. The same applies to patients whose health insurance may not cover the screening or may be uninsured. With deep partnerships with community partners, health care systems can help patients in underinsured populations receive access to at-home tests, reducing at least one or two SDoH barriers.
Finding available resources for patients means more than at-home tests. It means partnering with local food banks for food drive-throughs, setting up health fairs to increase access, providing direct phone lines to housing resources, and opening internal medicine clinics in underinsured areas to lower health care costs.
Supporting our community’s health means treating the whole patient, ensuring their basic needs are met, economic stability is accessible, safe housing is available, and much more. It will take nurturing relationships with those trained to respond accordingly. It is finding out how health care systems can work alongside these partners and organizations to support the community through robust pathways to care.
4. Philanthropy will be essential to big-picture community health success.
When you look at the equity of a community holistically, you can see who has the preferred health outcome — the population in the high percentile ranking for social and economic factors, physical environment, clinical care, behaviors, and so on. “If you want to interrupt poverty, you must give people a path out,” says Dr. Garza.
And hospitals can’t do this alone. Initiatives require resources and support from the surrounding community. Cutting-edge health care systems are enhancing their philanthropy components to continue to fuel the ‘do-good engine.’ They’re increasing communication between system initiatives and fundraising teams, so the community can see the bigger picture of how their support can affect community health.
It’s more than donating money; it’s having that donation provide a bag filled with nutritious food for a patient to bring home to their growing children. It’s having a health care worker sit at the bedside of an elderly patient receiving care alone, and it’s giving a single father and his kids a safe place to stay when their house was flooded.
By fundraising effectively and building resources to help community members receive access to what they need and the tools to succeed, the health care systems can set up a better pathway for not only the patient’s route within the system but also their future — and that’s better for everyone.
A path forward
The overall well-being of our communities can be improved by developing partnerships, programs, and resources that will stabilize, support, and strengthen community health. From all aspects, people are committed to making strides in community health, and community members are at the forefront.
It’s important to acknowledge that the great disparities in health equities took years to create, and the efforts health care systems and communities make now to improve community health may not be seen for years to come. But results won’t be realized if there are no intentional support efforts. To continue moving forward, internal resources, external partnerships, philanthropic commitment, and community advocates are needed to make change happen now and into the future.
About Paul R. Ross
Paul R. Ross is the president of SSM Health Foundation – St. Louis and regional vice president of philanthropy at SSM Health St. Louis, Mid-Missouri, Southern Illinois. An experienced leader and a philanthropy professional, Paul’s passion is in purpose and mission. As a servant leader, he has humbly led multi-faceted fundraising teams throughout health care and higher education arenas. Paul has successfully provided leadership to billion-dollar-plus campaigns for several organizations around the country, resulting in significant impact to organizations and the communities they serve.
About Dr. Alexander Garza
As SSM Health Chief Community Health Officer, Dr. Alexander Garza is responsible for deepening SSM Health’s focus on social determinants of health, equity, and social justice, as well as supporting the work of SSM Health’s transition to population health. His decades of experience in public health, quality and safety, and policy development helped lead SSM Health’s overall response to the COVID-19 pandemic. He has previously served several leadership roles within SSM Health, including Chief Medical Officer and Chief Equality Officer. Dr. Garza is a Colonel with more than 20 years of service in the U.S. Army Reserves. His passion for helping others pushes him to work hard to achieve equity in our communities.
