Studies have increasingly found that social determinants, such as where you live and who you socialize with, have a lot to do with how healthy you are likely to be.
It’s research that is starting to disrupt the health care field, with health-policy organizations as large as the World Health Organization and as small as county governments incorporating new programs based on this idea. In Rhode Island, it’s taken hold through the R.I. Department of Health’s Health Equity Zones.
“This is one of our signature initiatives,” said Sophie O’Connell, the health-equity communications lead. “We know that, and data shows, and research shows, that about actually 80 percent of our health outcomes are determined outside of the doctor’s office and really inside our homes, in our schools, jobs and communities.”
Four years since Health Director Dr. Nicole Alexander-Scott first started the initiative, the state wants to expand the program, with $1.4 million from the state and federal government to start new collaborations. Grant proposals are currently under review. Selected communities will start in July with a one-year contract.
The money “is intended to be an initial seed investment over a few years to build capacity to spark community development,” O’Connell said.
The program, which now has nine zones, was founded on a core belief that communities best understand the challenges facing them.
“I get out of the driver’s seat and get into the passenger’s seat,” is how co-coordinator of the Newport HEZ Neyda DeJesus put it.
DeJesus grew up in low-income housing, where English was the second language. She says the traditional, cookie-cutter programs governments have historically tried to implement often don’t quite fit local communities, making it hard to build local support.
“When communities are low income, with poverty and neglect, diabetes [is] the last thing on their mind,” DeJesus said.
‘Eighty percent of our health outcomes are determined outside of the doctor’s office.’
SOPHIE O’CONNELL, state health-equity communications lead
But when the community is asked what it needs to be healthier, and to come up with a list of ideas it’s invested in, such as adding farmers markets or creating more-walkable neighborhoods, addressing social determinants can help change health care outcomes. Since the HEZ’s – which all include a diabetes component – there has been a 5-7 percent drop in body weight for 21 percent of Diabetes Prevention Program participants.
Based on data reported annually to the state, there are other signs of success too. Teen pregnancy is down 24 percent in Central Falls. A 40 percent increase in redemptions of Supplemental Nutrition Assistance Program farmers market incentives was reported in West Warwick, and a 36 percent increase in access to fruit and vegetables in Providence’s Olneyville neighborhood. They’ve also strung together some unique accomplishments that would have previously seemed outside of the health department’s wheelhouse, such as Central Falls’ Complete and Green Street Ordinance passed in January 2018 that will allow everyone, regardless of age, ability or mode of transportation, to use the streets.
The scope of the HEZ’s is paradoxically both one of the greatest successes health department officials point to and one of their greatest frustrations.
“One of the frustrating things in implementing this program from the health department perspective is they’re generating so much at the community level, so much information, excitement and identifying so many needs, that we couldn’t work well with them,” said Deb Garneau, the HEZ program lead for the state.
Many of the health needs identified – such as road infrastructure – were outside the health department’s control, and at times made finding supplemental funding challenging.
“This is a very different way of supporting the community and advancing priorities, and so I don’t want to say it has been easy to find funding,” Garneau said.
Funders with broad program priorities tend to be the most receptive, she added.
Over the past four years though, Garneau and O’Connell said the state has learned how to better support the initiatives by linking the HEZ collaborative – which includes a task force made up of elected officials, business leaders, nonprofits, health care officials and other community stakeholders – with other agencies to braid resources together.
The nine HEZ’s have pulled in $10.4 million by seeking funding from other government agencies or philanthropic foundations.
While the state remains optimistic about the program, it hasn’t worked everywhere. Two of the original 11 HEZ’s dropped out.
“Two communities decided not to continue … since they didn’t have the local capacity to carry out a collaborative project,” O’Connell said.
But in communities that have stuck with it, health improvements have been seen, officials said.
“I would have been better off [living in] a Health Equity Zone when I was a kid,” DeJesus said.
