Mapping Health Assets
Disparities in health status are preventable, but this requires responses that incorporate a rigorous social analysis, and a commitment to finding, supporting and jointly building upon the strengths and capacities – the ‘assets’ – that exist in complex communities. Health and well-being – long before illness – begin in our homes, schools, jobs, and communities. Community-based prevention, particularly interventions that look upstream to address the root causes of disease, can reduce the burden of preventable illnesses both on the population and the health care system overall.
Paying attention to the determinants of health opens up the public debate regarding individual versus social responsibility in the broad spectrum of our life together. The tendency is to advocate for one or the other rather than acknowledge that both are legitimate, related, and interacting constructs. In health care, we tend to focus on getting individual patients to adopt healthy behaviors; their failure to do so is often viewed as non-compliance, or a lack of individual responsibility.
This is driven in part by an inclination to focus on issues that lie within provider control. physical and social environments are beyond the direct control of medicine, and so may be discounted. Clinicians are typically trained and incentivized to manage the diseases and symptoms of individuals. We have also created a system of care that is highly successful in attending to a person’s physical parts. Specialties and sub-specialties allow for deep understanding and skill in addressing disease as it manifests itself physically or externally. Technology affords us the ability to isolate and treat very specific aspects of our bodies and their functioning. Care that connects the person’s body, mind, and spirit may be a goal that all of our health care systems strive for, but communication and integration across and beyond specific specialties and disciplines is incredibly difficult to do well.
The new paradigm that health care providers are being asked to embrace asserts that our patients will be best served by not only attending to their individual bodies, but also to the communal assets (including relationships) they might hold, and to the social determinants of their health—to the health of the community as a whole. For example, the Affordable Care Act (ACA) not only requires tax-exempt hospitals to conduct Community health needs assessments and Implementation Strategies to address identified needs, but asks the hospitals to track the five-year impact on broader community health trends. We are being asked, not only to identify community health issues, but also to be accountable for improving the health of our communities. affecting health trends across a community requires a deeper understanding of the communities in which our patients and families live and intervention strategies that are grassroots-based, collaborative, and focused on root causes.
Actualizing the treatment plans will depend not only on individual medication and behavioral recommendations but also on making neighborhood improvements that facilitate access to healthy foods and safe places for physical activity. It will also call into play the resources or ‘assets’ (tangible and intangible) that are available within their own context to the person on treatment. These environmental and relational changes are important for preventing disease, for delaying and reducing its onset and extent, for minimizing its impact for those who are affected, and for enhancing their quality of life.
This paradigm shift is a challenge for our health systems; but the readiness is there. In a recent survey of chief executives, 98% of respondents agreed that, at least some level, hospitals should investigate and implement population health strategies.28 Michael rowan, executive vice president and chief operating officer of Catholic health Initiatives in Englewood, Colorado, noted that in an environment where ‘collaboration, preventive health, value-based purchasing and accountable care are the watch-words … we’re no longer focused predominantly on acute care services: instead we are managing the wellness of entire populations, which simply underscores the historic mission of Catholic health care.
There is no doubt that staff in our health systems are already experiencing and working with patients and families whose illnesses are exacerbated by social conditions. A brief, unscientific survey of staff in six health systems that are members of the Stakeholder Health Partnership identified access to Care, Mental health issues, Substance Use, and Diet and Exercise as the top social issues affecting the patients they serve. Barriers that they experience in attending to patients with these social issues included adequate resources, costs, reimbursement structures, and knowledge of effective intervention and best practices.
Image: Memphis Community Mapping, Faith &Health.