Addressing social determinants of health through research

Elaina Kook is the community resource specialist at Group Health’s Rainier Medical Center. This new role, connecting patients and providers with community resources, was designed and is being evaluated by the LINCC project.

Many Group Health studies look at the social side of health—and help to lessen related health disparities

What has the most potential to improve health, lengthen life expectancy, and curb rising health care costs in our communities?

• The care we receive from hospitals and providers?
• Our own health behaviors?
• Or our income, education, safety—and where we live, work, learn, play, socialize, move, and shop?

If you chose the third answer, you’re correct. These social and environmental determinants of health tend to affect our well-being far more than what we and our health care providers do as individuals. And these social factors also influence the first two answers, through effects on health care quality and access—and on such health behaviors as smoking. Strengthening social determinants will be the focus of Group Health’s 2016 Birnbaum Lecture, delivered by nationally renowned Baltimore Health Commissioner Leana Wen, MD, MSc.

Studying health disparities is integral to GHRI’s work

“So much of our research at Group Health is related to the social factors that we know deeply affect health,” says Group Health Physician, Associate Medical Director for Research and Translation, and Group Health Research Institute (GHRI) Senior Investigator Paula Lozano, MD, MPH. “We’ve always studied common conditions, prevention, and population health—including, but not limited to, Group Health patients and our community.”

Group Health researchers have long documented how social and environmental factors are connected to disparities in health—and health care. We have explored the impact of social factors including poverty, lack of education—and environmental factors such as neighborhoods that are unsafe for walking or playing—on the prevalence of obesity, diabetes, and other conditions.

But GHRI work transcends simply tracing ill health to social burdens.

Our research is also part of the solution

“Some of our work also helps to promote and sustain healthy communities,” Dr. Lozano says, citing contributions by GHRI’s Center for Community Health and Evaluation (CCHE) and the MacColl Center for Health Care Innovation. Community resources and policies are a pillar of the Chronic Care Model, and MacColl has long been committed to helping U.S. primary care practices, including community health centers, integrate community resources into health improvement.

At CCHE, community health evaluators study both the clinical and nonclinical aspects of health improvement. “We help health care systems to address social factors as well as possible in medical visits,” explains Allen Cheadle, PhD, senior investigator and CCHE director.

A prime example is Learning to Integrate Neighborhoods and Clinical Care (LINCC), led by Assistant Investigator Clarissa Hsu, PhD. LINCC is testing a “community resource specialist” role in primary care clinics at Group Health. This new role resembles community health workers: trusted laypeople who provide basic health information to (and about) their communities and help connect people with community resources that support health and wellness.

In LINCC, the community resource specialists help patients to set and achieve health goals, with action planning and follow-up. They connect patients with health-promoting resources in their own neighborhoods—like YMCAs, community centers, and foodbanks—with the help of online tools like the Group Health-sponsored Neighborhood Health Link. And they follow up with patients to see how they are doing with the goals they set and the resources to which they’ve been referred.

In a related project funded by a grant from Kaiser Permanente, CCHE is evaluating whether having Health Leads connect patients with resources such as food, childcare, and transportation is having an impact on patients’ health in a clinic in Contra Costa County, Calif.

Nonclinical interventions

“We know that if people have a higher standard of living, they tend to be healthier,” Dr. Cheadle says. “But it’s hard to address their standard of living globally—and raise it.” So CCHE also evaluates community-based health improvement initiatives around the country. “We are building knowledge about how multisector community investments may successfully lead to more concentrated impact not just for patients, but for the community as well,” he adds.

This work includes evaluating small grants, intended to spur innovation, from the California Freshworks Fund. A public-private partnership loan and grant fund, it brings healthy food retail and distribution (including community-supported agriculture and mobile markets) to communities that lack them, employing community members who need jobs. CCHE is also evaluating the Healthy Futures Fund, a Kresge Foundation-supported social investment initiative financing colocation of community clinics with nonclinical services that affect social determinants of health, like affordable housing, healthy food outlets, and job training.

And there’s more

Here are just a few other examples of Group Health research on how to strengthen social determinants:

• Community health workers do home visits to patients of community health centers to improve asthma management in Guidelines to Practice (G2P). The project promotes more consistent use of treatment guidelines to make uncontrolled asthma less common in low-income people and people of color. Dr. Lozano is a coinvestigator on G2P, led by James Stout, MD, MPH, of Seattle-King County Public Health.
• Group Health Physician and GHRI Associate Investigator Beverly Green, MD, MPH, is working with colleagues at community health centers to decrease disparities in screening for colon cancer—using approaches that have been proven to save money.
• Senior Investigator Greg Simon, MD, MPH, helps lead multisite research across the Mental Health Research Network regarding the effects of race, ethnicity, and neighborhood socioeconomic status on the quality and outcomes of mental health treatment. And he’s helping to identify the roots of resilience in mental health. 
• Senior Investigator Katharine Bradley, MD, MPH, studies Group Health‘s strengthening of its behavioral health integration. And the King County Health Needs Assessment identified this kind of integration—and controlling health care costs—as part of the solution to help strengthen social determinants and lessen disparities.

Please join us at the Birnbaum Lecture on June 27.

by Rebecca Hughes