We hear a lot about health care being in crisis. It’s increasingly expensive for everyone – consumers, providers, payers and the government alike. Compound this with the fact that we can’t improve health by focusing on health care alone, and we realize that much of our resources and energy are spent on addressing the consequences of poor health, rather than achieving good health.
Health starts well before an individual finds his or her way into a doctor’s office, clinic or emergency room. In fact, what happens outside the boundaries of the health care system – where we live, work and play – matters so much more.
Our communities struggle with chronic, obstinate conditions driven in large part by the environments in which we live. And, although our world-class health care system can often heal us when we become sick, it is no match for poverty, allergen and toxin-laden living and working environments, lack of transportation, food deserts, lead-contaminated water or unsafe neighborhoods not conducive to play. And if we truly want to improve health and lower health care costs, looking at – and addressing – these upstream determinants of health is where we need to focus more of our time and our money.
Luckily, there are places in North Carolina where this is happening already. In fact, we see it in work we are supporting from Greensboro to Asheville to Gastonia, where diverse stakeholders are sitting at the table together looking at health as a community issue, rather than that of individuals. Faith leaders, college professors, hospital administrators, nonprofit leaders and city officials are seeing the value in working together not simply to better their community, but as a pathway to bettering the health of those living within it.
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Rather than discussing how to bolster access to asthma care or make medications more affordable, they are instead looking to solve the problems that are leading to the spike in asthma to begin with, such as the pest and mold problems that persist in lower-cost housing in so many neighborhoods. They are asking questions such as should a free clinic be located beside the hospital – allowing for convenience for the doctors serving both – or should it instead reside deep within the community where the patients, many of whom struggle with transportation, can easily make it to on foot.
Whereas building a playground may be one of their priorities to get children outside, so too might their desire to install street lights and increase community police presence to make going outside a truly safe alternative. And they are looking at ways to bring jobs and community-based business back into neighborhoods where they once thrived, understanding the burdens that unemployment and underemployment place on health.
By looking at health in this way, both the perspective and voice of residents is elevated, broadening the coalition of voices calling for changes to the conditions that lead to poor health to begin with.
However, this is not simply an opportunity for communities, but also for those who support them, which is why we see increasing traction within the philanthropic sector, including with our colleagues at The Duke Endowment, Kate B. Reynolds Charitable Trust and others, funding place-based health initiatives across North Carolina.
And there is national movement as well, in particular the BUILD Health Challenge, a collection of funders from across the country, calling on communities to think boldly and innovatively about the systemic challenges they face and fostering collaboration to find solutions.
This year, they will fund 21 community collaborations across the country, including at least one in North Carolina. The Blue Cross and Blue Shield of North Carolina Foundation recently became part of the BUILD Health Challenge to create the opportunity and resources for a North Carolina city or town to be part of this upstream movement to addressing health. Applications are being accepted through Feb. 21, and we are encouraging communities across North Carolina to consider this opportunity. More information can be found at www.buildhealthchallenge.org.
Good health is attainable, however it is time we look beyond the health care system for answers and instead look to the places we call home.
Kathy Higgins is president of the Blue Cross and Blue Shield of North Carolina Foundation.