Collaborating on Population Health and Creating Healthier Communities

The United States healthcare system has to start spending less time fixing people and more time and money on reducing the need to fix them by getting to people earlier, according to panelists who participated in the Brookings Institution’s event “New Directions for Communities: How They Can Boost Neighborhood Health.”

Where a person lives can have a huge impact on their health: they might not have any grocery stores in the neighborhood or the ability to walk safely outside or access to transportation to get to a doctor’s appointment. Kavita Patel, MD, nonresident fellow at the Brookings Institution, moderated 2 panel discussions on the social factors of improving health and healthy communities.

In the first panel discussion, Dayna Bowen Matthew, JD, nonresident senior fellow in the Center for Health Policy at Brookings, explained that her biggest concern regarding health on the population level is inequity.

“If we don’t appreciate that inequity means that resources needed to be healthy are inequitably distributed, then our solutions won’t focus on the fact that that inequity will be exacerbated if we don’t look at it,” she said.

She provided the example of a community in Colorado, where a 6-lane highway is being expanded to 8 lanes. The project will displace 200 families, which becomes a challenge to find new housing for families who had affordable housing. The community also deals with low resources, such as food, employment, and places to exercise.

“We’re not talking about health anymore on an individual, what I call, retail level,” Bowen Matthew said. “We have to talk about health in the community so we can affect populations.”

Stuart M. Butler, PhD, MA, senior fellow of economic studies at Brookings, made the argument that appreciating what is happening in the health area necessitates understanding what is happening in housing and transportation and other areas.

“We’re certainly appreciation a lot more … how these other nonmedical factors influence healthcare,” he said. “We’re learning a lot about how what happens to a child in the early years—everything from stress to abuse and so on—can have long lasting effects on healthcare.”

The solution is to deal with those issues upfront for a big payoff further down the road, he added. However, improved communities and housing not only help children’s health, but also the elderly, who fall in apartments with slippery carpets or poorly designed bathtubs.

Butler is looking at how to intervene and get the various sectors to talk to one another and share insights on how to deal with issues associated with where spending takes place.

Bowen Matthew provided the example that hospitals can work with housing to create medical respites to reduce readmission. There can be collaboration with food banks and farmers markets to address food insecurity and help people eat healthier and educational components, like cooking classes, to reduce chronic disease.

“Why don’t we have this?” she asked. “We don’t have this because we’re still reimbursing per member per month. We’re still reimbursing people in a way that incentivizes them to think about illness instead of wellness. That incentivizes them to think about individual healthcare as opposed to population healthcare.”

The panelists discussed Medicaid and how it could be affected by the GOP healthcare bill that recently passed the House of Representatives. Bowen Matthew noted that hospitals and providers should be leading the charge to protect Medicaid expansion, while Butler advocated for being able to use Medicaid dollars for nontraditional things.

“That makes a lot of people understandably nervous,” he said, because it means money intended for people’s health could start drifting to other areas.

If states could have more flexibility with Medicaid money, as the GOP is proposing, there could be more exploration of using medical money in a way to deal with health issues.

“These are difficult issues,” Butler said. “We’re on a roll in one sense, but it’s a roll that's sort of bashing in walls here as people think about what could go wrong.”