February 22 2016

When it comes to population health and equity, no single intervention or improvement strategy can solve our challenges alone. That’s the case made in a new commentary just released by Prevention Institute and JSI Research & Training Institute, Inc. That’s also why it’s so important that the request for proposals for Accountable Communities for Health (ACH) pilots in California includes a requirement that ACHs adopt a portfolio of strategies for advancing health. These include:

  • Clinical Services
  • Community and Social Services Programs
  • Clinical-Community Linkages
  • Environment
  • Public Policy and Systems Change

By aligning strategies across the portfolio, the interventions achieve a synergistic effect and compound into true population health improvement for communities. The success of this type of approach has been demonstrated repeatedly over the last 50 years through health improvement efforts that have incorporated both individual intervention and community-based prevention to take on issues as diverse as tobacco, driving under the influence, lead exposure, and violence, leading to public health victories that would never have been possible through individual sectors’ separate efforts.

To understand how this portfolio of strategies might impact an individual, let’s consider a fictional 14-year-old boy living in a low-income, industrialized community adjacent to a major port. The boy suffers from asthma, a common health problem a potential local ACH would be particularly suited to address. When he has a serious asthma attack, the ACH provides him with clinical services at a local emergency department. He and his family are given medication and information on behavioral and environmental triggers to avoid, provided an asthma treatment plan, and connected to a patient-centered medical home.

The attending physician discovers that the boy lives in an older apartment with black mold growing on the walls. The hospital care transitions team uses its community-clinical linkages to connect him to community and social service programs such as subsidized mold abatement services and medical-legal partnerships to address his housing issue.

Yet his challenges with asthma are not limited to his individual housing situation. The entire neighborhood is negatively impacted by high levels of particulate matter in the air due to the nearby freeways, port, and heavy truck traffic on residential roads. Fortunately, the ACH has the capacity to address this issue, through both environment and public policy and systems change. That’s because the ACH includes a consortium of community groups, advocacy organizations, transportation officials, healthcare providers, and others who are making the case for policy change to improve the community determinants of health in his neighborhood, leading to cleaner air and healthier lives.

The alignment of all these strategies and stakeholders – as a recent brief detailing the ACH model demonstrates – ensures that community residents receive an adequate dose of interventions across sectors, and boosts health through the synergy of multi-sectoral work. These same types of strategies and lessons apply to broader health systems transformation efforts, such as the Community-Centered Health Homes model.

The plight of this 14 year-old boy is fictional, but not hypothetical; these circumstances are far too real for many. An African American child born in West Oakland can expect to die an average of 15 years earlier than a Caucasian child born in the Oakland Hills, where there are higher household incomes, lower unemployment rates, and more park space and food stores. Sadly, this pattern is duplicated in communities across the country.

We can address, and even eliminate, these systemic health inequities through community-healthcare partnerships and a focus on quality prevention — because the social, economic, and physical conditions that create health disparities are changeable. When multiple sectors align strategies effectively, the communities they serve can see rapid improvements in health, safety, and equity.

California’s workforce, our economy, and our children’s futures depend on people living in healthy, thriving communities. An ACH approach that aligns strategies across a portfolio that includes individual services and community-based prevention will reach the most people and create the greatest impact. The synergistic effects of these interventions can move the state toward a more effective and equitable system of health.


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