Soneida Rodriguez: Primary care should be a grassroots movement

Sunday, October 20, 2019 - 4:08pm

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Zip code, postal code, area code — whatever you want to call it, this five-digit, benign figure identifies your general location on the U.S map. In 2017,  the National Center for Health Statistics released life expectancy across American neighborhoods that actually proved your zip code is a map in and of itself. Similar to how your DNA can map out your susceptibility to disease or death, so can your zip code. So much so that even the Director of the National Institute of Health Francis Collins is referring to zip codes as “our ZNA.” How can a five digit number be so powerful? In short, years of inequality have left their mark on American society. Where one lives largely correlates to what has been coined one’s social determinants of health. These determinants refer to factors like “access to healthy food, good schools, affordable housing” and income, all of which empower individuals to prevent illness, protect against stress or access health care. 

The Detroit News found that Michigan’s life expectancy had a 29-year range across different neighborhoods. It maxed out at around 91 years in an East Grand Rapids neighborhood, and fell to as low as 62 in one Detroit area. Clearly, we need to be treating disease as not just a breakdown of the body, but a symptom of a breakdown in American society.

Right now, primary health care providers, local non-profits, local health departments and community members are working independently to promote community health. Combating years of inequality will require these stakeholders to work together in order to identify and target a community’s social and medical needs. In essence, we need to revolutionize America’s reactive health system and transform it into a proactive one. A grassroots movement approach to community health can catalyze this revolution by enhancing communication and collaboration between those four key stakeholders.

As powerful as the federal government sounds, it's the local government that has the most profound impact on day-to-day well-being. All over the country, there are 2,800 local health departments, each one entrusted with protecting community health. These departments run free health clinics, launch heart disease awareness campaigns and respond to public health threats like the Hepatitis A outbreak currently ravaging Washtenaw County. While this work is vital, it is still far too reactive. Health departments should be anticipating the social and medical needs of a community before those needs turn into the next infectious outbreak or chronic disease epidemic.

The best way to do this is by communicating with the front lines of health care: primary care professionals. Primary care providers include nurses, doctors, physician assistants and allied health professionals. Whether they work in emergency departments or out-patient clinics, these providers witness the results of our different “ZNA” firsthand. The clinical trends observed by primary care workers on the frontlines are powerful. If primary health care professionals have the ability to communicate clinical trends to health department officials, they can tailor public health programs to fit the needs of community members.

Consequently, informing health departments of new data about high blood pressure diagnoses in a particular neighborhood can prevent a decrease in life expectancy in this area years later. A grassroots movement approaches demand meetings between all stakeholders. Organizing consistent meetings to discuss these trends will empower health departments to customize public health initiatives in order to tackle these concerns. Furthermore, such communication could enhance shared infrastructure between the two stakeholders, yet another key component of a healthy grassroots effort. Working together, local health professionals and health departments could design software that could de-identify patient data and map out unmet social and medical needs in different neighborhoods.

Beyond building bridges between health departments and health providers, a grassroots approach would also foster collaboration between health providers and local non-profits. 

When creating treatment plans, health providers are well qualified to combat chronic disease threats like heart disease with prescriptions and diet recommendations. However, this type of treatment is worthless if a patient lives in a food desert or does not have the proper housing to refrigerate their medication. The reality is that many communities have local non-profits who can satisfy the social needs of patients. Consequently, these non-profits deserve to be a part of the treatment plan.

For instance, Fresh Express is a non-profit mobile produce market that purchases produce “at wholesale and sells it without a markup” in food desert neighborhoods in Arizona, or areas where it is difficult to access affordable produce. Imagine if health care professionals had the capability to make non-profits such as Fresh Express a part of their patients’ treatment plans, rather than only prescribing a diet recommendation. Health providers could also connect patients with local nonprofits that can provide access to the fresh produce needed to live up to this diet recommendation. Patients would no longer be alone in the struggle to adhere to a treatment plan and improve one's health. Through a grassroots approach, non-profits serving the community would have an established relationship with health practitioners. In turn, this relationship would enable non-profits like Fresh Express to communicate when patients reach out to them for support and see if their resources are enough to help the patient.

Perhaps you are convinced this is the responsibility of social workers; however, not all primary care clinics are equipped to hire a full-time social worker. There is no reason that social needs and medical concerns cannot be integrated into the same treatment plan. 

Overall, it is clear how vital collaboration between primary caregivers, health departments and nonprofits is in treating inequality in America. However, the question still remains as to who should be responsible for catalyzing these types of movements in communities across the country. With burnout and budget cuts plaguing health professionals, it's not fair to leave organizing such a movement only to these stakeholders. Instead, students in high school or post-secondary education should be the ones to take the initiative. As future patients and health professionals, the next generation has the most to lose or gain from any action taken to impact a community’s health. Young professionals are capable of energizing a neighborhood around the idea of community health as a grassroots movement through town halls, demonstrations and public speaking. The world saw this capacity to energize first hand with both the Climate Strike and the March For Our Lives demonstration. When the youth take the reins on a large scale, it awakens a sense of urgency in all of society. Ultimately, inequality has assaulted American communities since its founding. There is no one-stop solution. Nevertheless, transforming community health, the root of our society, by uprooting our practice of health care and public health is a powerful way to start.

Soneida Rodriguez can be reached at soneida@umich.edu.