Let’s start with the basic premise underlying my Bush Fellowship--we need to dramatically shift course on health in this region and country. Health costs have been rising to unsustainable levels, while positive health outcomes are stagnant or declining. Health inequities abound. We know that people need good health to have strong communities and a strong economy, and vice versa. Health experts acknowledge that one's zip code is as important as one's genetic code for determining health outcomes. Defined as social determinants of health (i.e. the conditions in which people are born, grow, live, work and age), research has shown these circumstances have far greater influence on an individual’s health than the health care system—90% (conditions) vs. 10% (care).
Here’s the opportunity: The Community Reinvestment Act (CRA), passed 35 years ago, transformed the community development sector into a multi-million dollar industry devoted to community improvement. The Affordable Care Act (ACA) has the same potential to fundamentally transform how we address individual and public health. Simply put, the ACA “triple aim” is to improve individual health outcomes, improve community population health, and reduce costs. If social and economic determinants are the major influence for individual and community population health, mapping community development onto health care improvements is an idea whose time has come. And yet, the health and community development sectors are virtually unknown to one another.
Luckily, the community development sector is starting to take note. For example, the Federal Reserve Bank system has hosted a series of cross-sector forums, initiated under the leadership at the San Francisco Fed a few years ago and continued across the country, including the third annual hosting here in Minnesota earlier this month. I’ve been a part of this regional dialogue and my organization, LISC—the Local Initiatives Support Corporation—has been involved in this emerging conversation with health care and public health systems. My Bush Fellowship is allowing me time and resources to go beyond these periodic discussions and deeper into the intersection between health and community development. In the past six months since launching my Fellowship I’ve just started to scratch the surface of what we’ll need to uncover to truly achieve cross-sector collaboration to maximize the impact on health. One thing is very clear neither sector will be able to innovate while doing our work as we’ve always done it.
The Fellowship is helping me open doors to leaders in the health sector who are wrestling with changes promoted through the Affordable Care Act. In one recent conversation with a community benefits director of a regional hospital, we found that our respective sectors are increasingly trying to solve the part of the “triple aim” we have the least control over. For example, health care is trying to address community population health and community development is struggling with whether or not it can address (and measure) patient activation and better individual outcomes within its strategies, most notably affordable housing. There are some early signs of potential health cost savings in housing and other community development strategies, however, where costs occur (e.g. hospitals) and where savings are realized (e.g. payers – government and/or insurers) are two different places. Finding the right alignment of incentives to maximize greater collaboration between the sectors is one of my goals during this Fellowship.
Carving out time to pursue this conversation and immerse myself in health care systems learning has been more difficult than I expected and I continue to have to push myself and rely on my advisors to get beyond everyday work. I’m grateful for the Bush Foundation’s investment in me and for being a Bush Fellow at this incredible time. We have a window of opportunity created through the passage of ACA and its “triple aim.” Like CRA was to the banking and financial services industry, ACA could be the catalyst for new ways to improve communities in addition to our health.