Nancy Vaughan Column: Healthy communities require individual and system solutions

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By Nancy Vaughan | For The Herald Bulletin Jan 27, 2019 
“Happiness is nothing more than good health and a bad memory,” according to Albert Schweitzer.
Defining good health, and how to achieve it, is a complicated endeavor that affects individuals, families, communities and our planet. There has been a movement within health care and human services to address “social determinants of health,” defined as the conditions in the environments in which people are born, live, learn, work, play, worship and age. There is even a growing profession — community health worker — focused on helping people navigate the conditions that negatively impact health.
A recent episode of the television series “New Amsterdam” provided an example of this approach with a storyline of a homeless man who had become a “frequent flyer” to the emergency room, costing the hospital millions of dollars. The medical director writes a prescription for “a home” paid for by the hospital. When the man shows up to the ER again, the medical director realizes that he also craves a sense of place and purpose, so he puts him to work as a hospitality volunteer. Problem solved in under 60 minutes, at least for this man.
A blog posted by argues that the growing focus on meeting individual social needs falls short of addressing the larger systemic and societal issues that create an unhealthy population in general. While applauding the efforts of organizations to help at the individual level, the authors urge “a broad, community-wide focus on the underlying social and economic conditions in which people live, rather than the immediate needs of any one individual.”
This is not an either/or choice. Locally, health care navigators and human services providers like the THRIVE Network coaches are working together to address access to healthcare AND safe and affordable housing, transportation, nutrition, education and employment. However, as the blog noted, these helpers can’t change the availability of resources within a community, create family-sustaining jobs, increase worker benefits or improve the quality of the education system.
This is why public policy is such an important component of human services. However, for public policy to change, everyone needs to understand the issues. The Centers for Disease Control has developed 14 evidence-based, community-wide interventions to improve population health. The list has two categories: address the social determinants of health, and change the context by making healthy choices the easy choice.
Number one in the first category is early childhood education. The CDC notes that high-quality early childhood programs reduce obesity, child abuse and neglect, youth violence and emergency department visits by providing physical activity, nutritious meals, parental support, health screenings and access to social services. Other interventions include public transportation, home improvement loans and grants, earned income tax credits, water fluoridation and clean diesel bus fleets.
The second category includes school-based physical activity and violence prevention programs, safe routes to school, tobacco control interventions, pricing strategies for alcohol products, motorcycle injury prevention, access to clean syringes and worksite obesity prevention.
Together, we can resolve to create a healthy community by supporting organizations and policies that address these issues.