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The following article summarizes key points from Episode 6 of The Better Care Podcast with Leslie Meehan, Deputy Commissioner for the Tennessee Department of Health, on how hospitals, payers, and the public sector can create health equity through collaboration.

Some quotes have been slightly edited for brevity.

The Intersection of Urban Planning and Health

Leslie Meehan’s background is in urban planning, which plays a pivotal role in the infrastructure that allows for an environment of health equity. Urban planners are responsible for shaping communities, determining the allocation of resources, and ensuring the availability of essential services. They play a pivotal role in deciding where housing, transportation infrastructure, educational institutions, and other vital amenities are located. These decisions directly impact the quality of life, accessibility of healthcare, and overall health outcomes for residents.

Urban planners – whether intentional or not – influence health equity through the distribution of resources and services in a way that impacts all community members. By strategically locating healthcare facilities in underserved areas and designing neighborhoods that promote physical activity and access to healthy food options, urban planners can contribute to reducing health disparities.

Addressing Social Determinants of Health

One of the critical aspects of achieving health equity is addressing social determinants of health—conditions in which people are born, grow, live, work, and age. These determinants encompass factors such as housing stability, transportation accessibility, education opportunities, income levels, and access to healthcare services.

Housing affordability, for example, plays a significant role in health equity. Many individuals and families spend a disproportionate amount of their income on housing, leaving limited financial resources for other essentials like healthcare. By zoning land for diverse housing options, urban planners can ensure the availability of affordable housing for individuals across different income levels.

Additionally, implementing policies that protect tenants from eviction and promote safe and stable housing environments can have a positive impact on health outcomes.

“Our goal is to encourage more innovative thinking. We’re not just considering private individuals having to pay for their own rent or mortgage, nor solely relying on the government to provide subsidized housing. Instead, we contemplate the possibility of involving a third party, such as a health system, to step in and offer housing, thereby potentially saving costs for all parties involved.” -Leslie Meehan

Housing is a creative collaboration being explored with government and health systems. Tax breaks and financial incentives – similar to ones given to private businesses for setting up their headquarters in a new city – can be put in place to encourage health systems, which possess substantial real estate footprints, to invest in housing initiatives.

By building housing near healthcare facilities, providers can offer stable housing to their staff and even patients who are considered “frequent fliers” of the ED who don’t have a better housing option. This approach has proven beneficial at reducing healthcare costs and improving patient outcomes.

Transportation is another key factor that impacts health equity. Limited access to public transportation, especially in rural areas, can hinder individuals’ ability to reach healthcare facilities, educational institutions, and employment opportunities. By designing communities that prioritize alternative transportation options such as walking, biking, and reliable public transit, urban planners can create inclusive environments that promote health and well-being. Collaboration with transportation authorities is essential to ensure seamless connections between neighborhoods and necessary services.

Transforming Healthcare Facilities

Traditionally, public healthcare has been associated with hospitals and clinics, but the government’s role in promoting health equity extends beyond these institutions. The Department of Health has recognized the importance of creating healthcare facilities that are more than just clinical spaces. By transforming these facilities into community hubs, they can become public spaces that promote physical activity, social interaction, and overall well-being.

“Many of our health departments are in very rural parts of our state, and there may not be a lot of places to exercise or gather. There may not be a picnic shelter or playground nearby. Therefore, we can consider how our health departments can better serve the public. On the inside of the building, we aim for it to be warm and welcoming. We are truly striving to make clinical care feel less clinical and to make the building an extension of the warmth and care that our staff provide to our patients. Our goal is to create an environment that reciprocates and reflects that type of caring concern.” -Leslie Meehan

This is the type of preventative action that can take out social determinants of health at the root.

Measuring Impact and Tracking Outcomes

Assessing the impact of initiatives aimed at improving health equity is crucial. The Department of Health conducts patient surveys to gather feedback and measure the effectiveness of their programs and services. They also collect pre- and post-data for initiatives such as the creation of community parks, walking tracks, or farmers market pavilions. While it can be challenging to measure prevention and long-term health outcomes, these efforts are seen as valuable investments that positively impact the community’s overall well-being.

“It’s hard to measure prevention. You’re basically trying to measure disease and injury that’s not happening… and the results don’t happen overnight. We are often given grants for things like diabetes prevention, and you can’t do outreach into the community and expect diabetes rates to fall the next year, so these are long-term strategies, and we fully believe that they’re sound investments paying off in more ways than one.” -Leslie Meehan

It’s important to establish metrics that capture the various dimensions of health equity. By measuring indicators such as access to healthcare services, health outcomes, health disparities, and social determinants of health, governments can track progress and identify areas that require further attention. Collaboration with academic institutions and research organizations can provide valuable insights and expertise in measuring and evaluating health equity initiatives.

Collaborative Solutions for Health Equity

Achieving health equity is a collective responsibility. Collaboration between different sectors, including government, healthcare, transportation, and housing, is essential to address the multifaceted nature of health disparities. Intentional conversations and knowledge-sharing can create opportunities for collaboration, fostering innovative solutions to address the complex challenges faced by the US healthcare system.

One of the key reasons why intentional conversations are essential is to create opportunities for collaboration. Within the healthcare sector, specifically the payer and provider relationship, there is often a lack of knowledge sharing regarding initiatives for health equity. This raises a question about the responsibility for addressing these issues. Is health equity the sole responsibility of the provider?

“I really think about our providers the same way that I think about teachers. We often look at our school systems to try to meet all the educational needs of children, including their physical activity needs, their social-emotional needs, and whether we are helping them with external factors such as stable housing, transportation, and access to food. Are we overtasking a system that was originally meant to simply deliver educational content? When we consider our providers, I think the same thing: How much can we expect a provider to dig in when a patient may only show up to an annual visit and be there for about 10 minutes?” -Leslie Meehan

Both payers and providers are grappling with these challenges, aiming to find profitable solutions that address social determinants of health and improve patient outcomes. To truly advance health equity, we need to go beyond the confines of funding-focused metrics.

A broader perspective is necessary to address the larger systems at play. Currently, sectors like government, healthcare, and transportation often prioritize metrics relevant to their specific objectives. However, we must shift towards adopting common sets of metrics that reflect the interconnectedness of our efforts. By expanding our measurement of outputs and success, we can create a more comprehensive and holistic approach to health equity.

Key takeaways of creative collaborative health equity

    • Urban planners have the power to impact health equity by considering resource distribution and services that benefit all community members.
    • Addressing social determinants of health, such as housing affordability and transportation accessibility, is crucial for achieving health equity.
    • Transforming healthcare facilities into community hubs promotes physical activity and overall well-being.
    • Measuring the impact and tracking outcomes of health equity initiatives is important for evaluating progress.
    • Collaboration between different sectors is essential for addressing the multifaceted nature of health disparities.
    • A broader perspective and common sets of metrics are needed to create a comprehensive and holistic approach to health equity.

“If you’re not already partnering with the government, whether it’s public health, your state, local school system, or Parks and Recreation, there are components of the government that are funded to make investments in the community. Often, these decisions have a direct impact on the lives of the patients we serve. If you’re interested in learning more about these systems, you can honestly cold call someone and ask them to go have a cup of coffee… Some of the best partnerships have formed organically through understanding each other’s systems, bottom lines, and decision-making priorities. So, don’t hesitate to reach out to someone who may work in a completely different field.” -Leslie Meehan

Listen to the Full Episode of The Better Care Podcast, to hear Leslie Meehan and Amy Deaton discuss more examples of creating collaboration for health equity. Available now on all major podcast platforms.