On the heels of releasing the “Playbook for Fostering Hospital-Community Partnerships to Build a Culture of Health,” a collaboration between the Robert Wood Johnson Foundation and the American Hospital Association’s Health Research & Education Trust, the AHA hosted a webinar highlighting how two health systems — St. Mary’s Health System in Lewiston, Maine, and Chicago's Sinai Health System — were able to harness the assets of their communities to create lasting partnerships that improved health.
Below are a few examples of how the two systems partnered with local organizations and residents to address the social determinants of health affecting their communities.
Tackling the lead problem
Lewiston and its twin city across the Androscoggin River, Auburn, had the highest lead poisoning rates in Maine, according to Elizabeth Keene, vice president of mission integration at St. Mary’s. The problem was largely due to poor housing quality in the area.
In 2014, St. Mary’s Regional Medical Center, Central Maine Medical Center and a number of community partners — including the Maine Housing Authority and Maine Center for Disease Control and Prevention — came together to bring the Green & Healthy Homes Initiative to Lewiston. The GHHI model is a national network that focuses on lead-free, pest-free, safe and energy-efficient homes. The network applies root-cause analysis to determine how to improve conditions for homes affected by lead.
As part of that effort, a community-requested Neighbor to Neighbor class was created with the help of Healthy Androscoggin, the city’s community health coalition. The program trains local Somali women on the dangers of lead and educates them on a number of other health issues, including chronic disease. Those women, in turn, commit to visit at least two other households in the area to share their knowledge.
Keene says there wasn’t a word for lead in the vocabulary of those Somali families that came to Lewiston but, in the first three years of the program, 63 percent of people surveyed door-to-door could identify lead as a health hazard, she said.
Addressing food insecurity
A community food assessment was completed in 2013 by Good Food for Lewiston-Auburn, a program sponsored by St. Mary’s Nutrition Center with local partners, including Bates College and the Muskie School of Public Service. The assessment revealed a few startling statistics. For instance, the poverty rate for children under 5 was 43 percent, nearly twice the state average, and at Lewiston's Longley Elementary School 100 percent of children were eligible for free or reduced price lunches.
As a result, food insecurity became a top issue for the community. The Good Food Council of Lewiston-Auburn was formed to bring together community members and local agencies. It evaluates and influences policy, serves as a forum for discussion and supports local program needs.
The council's efforts encourage community members to actively take responsibility for their own health. As part of a partnership with Portland, Maine, the federal government and local employers, a Good Food Bus serves healthy items at the community's farmers market and stops by local businesses to bring fresh food to employees where they work.
In addition, a farm-to-school network has provided nutrition education to more than 900 students and helped the neighboring Auburn school district obtain a farm-to-school planning grant from the U.S. Department of Agriculture. Lewiston now has 120 community gardeners growing food, up from 14 gardeners in its first year of the program.
“Despite the challenges, it’s worth it,” Keene says. “We’ve seen a strong revitalization in commitment to our community and college graduates choosing to stay and live here.”
Taking a robust approach to addressing social determinants
Sinai Health System, Chicago, serves a population of nearly 1.5 million, primarily on the city's West and Southwest sides. The health system has been working with residents to address Chicago’s infant mortality problems, diabetes and overall health before the term "social determinants of health" entered the health care vernacular.
In 1993, the system took a robust approach and created the Sinai Community Institute to “be the bridge to the community, the eyes and ears on behalf of the health system, [and] to understand what’s going on in our community,” said Debra Wesley, president of SCI and executive vice president of community outreach at Sinai Health System.
With input from community voices, Sinai was able to create a host of programs around needs the community felt were important, including food, employment, housing, clothing and health care.
SCI's intensive case management program brings credentialed case managers into community homes to assess the family’s risk levels and health history. The case managers visit monthly, at a minimum, to monitor outcomes and provide referrals to the many programs formed as part of SCI. In 2017, 1,759 individual cases were completed, according to Wesley.
One of the programs formed by SCI is the Illinois Subsequent Pregnancy Program in Chicago's Lawndale neighborhood. The program, which was developed in collaboration with the state of Illinois, is designed to delay second pregnancies in adolescent mothers.
SCI's Women, Infants and Children program is the largest in Illinois and provides nutrition education and food to children ages 5 and under and eligible parents. More than 16,000 women and children have benefited from this program so far in 2017.
In addition, SCI’s “How Healthy is Your ZipCode?” program is a health summit series that informs residents about the health disparity challenges in their community. Research findings are shared, and resources are provided around heath issues such as diabetes, asthma, obesity and breast cancer.
Learning more through research
The Sinai Urban Health Institute was established through a research and evaluation lens and works to achieve health equity through data-driven research.
One of its most recent projects was the Sinai Community Health Survey 2.0, which surveyed more than 1,500 households across nine Sinai service communities. With funding from Chicago Community Trust, the survey looked at 16 health-related topics, including general health status, obesity, violence and food insecurity.
In five of the neighborhoods surveyed, more than half of female residents reported being obese. And at least half of non-Hispanic black females and females of Puerto Rican origin were obese. When it comes to food resources, 40 percent of households in three of the nine neighborhoods surveyed reported being food insecure in the past year.
The survey was completed in March, and SUHI is now developing policy briefs and sharing the survey data with the Chicago Health Atlas as a way to mobilize action toward improving community health. Included in the Chicago Health Atlas are tailored infographics detailing health statistics for specific Chicago neighborhoods.
“We understood from a health system point of view that there were things that we do very well, but there are certain things that we can only do in partnership with the community,” said Wesley.