Targeting root causes to improve community health

Experts across the spectrum of health care agree that the root causes of poor health must be addressed to make a transformative, healing impact on U.S. communities, especially for those who are poor and vulnerable.

With that in mind, Livonia, Mich.-based Trinity Health in 2016 launched the Transforming Communities Initiative (TCI), the health system’s first major investment to employ policy, system and environmental change strategies to improve health.

“In a health system, traditionally every- body is very comfortable addressing clinical needs and managing specific conditions,” said Mouhanad Hammami, M.D., Trinity Health’s senior vice president of safety net transformation, community health and well-being. “But unless we’re addressing the conditions in which patients live and their societal influences, our treatment is going to be incomplete.”

The five-year TCI strategy consists of six initiatives:

• Raising the nicotine/tobacco product purchase age to 21 and other tobacco-control policies.
• Complete Streets policies to make roads safe and accessible for all.
• Improving nutrition standards in early-childhood settings.
• School wellness policies to increase physical activity.
• Enhancement of breastfeeding policies to support breastfeeding.
• Healthier food and beverage options in schools and communities.

“These six evidence-based strategies have been proven to, at a rapid pace, improve the health of individuals,” said Jaime Dircksen, Trinity Health vice president of community health and well-being. 

“Because tobacco is the leading cause of preventable death in our country, we wanted to pursue policies such as Tobacco 21 to effect change in our communities.”

Funding for the $65 million program includes $18 million from Trinity Health’s Community Health Institute and $7 million from community match dollars.

TCI has been implemented in eight communities across the country where Trinity Health operates hospitals: Boise, Idaho; Fresno, Calif.; Hartford, Conn.; Maywood, Ill.; Silver Spring, Md.; Springfield, Mass.; Syracuse, N.Y.; and Trenton, N.J.

The population within these communities is estimated at 2.24 million. All eight communities are faced with a 20-45% poverty rate; high unemployment; high levels of food insecurity; and large racial/ethnic populations experiencing significant health inequities.

Each community receives a grant of up to $450,000 a year for five years. Trinity Health contracts with the local Trinity Health hospital and a local community-based organization, both of which are responsible for the fiscal and operational oversight of the grant. Funded communities also receive other supportive services, including technical assistance from national partners and Trinity Health staff.

The outcomes of the program thus far:

• In seven states and numerous counties and/or local jurisdictions, policies have been adopted to raise the tobacco purchasing age from 18 to 21.
• In Syracuse, the TCI team is working with eight “corner” neighborhood stores to increase access to healthful food options. All except one are within 1,000 feet of a school. During the first year, participating stores received mini grant funding for such items as refrigeration units, produce baskets and healthful food promotion signs.
• In a variety of school districts, TCI efforts are helping schools make significant gains in child safety, nutrition and  fitness.
• In Boise, the city leveraged data collected through TCI to obtain a $250,000 Safe Routes to School grant to construct the first bike lane with a curb and gutter along a 1-mile stretch in front of a community school.
• New Jersey and Idaho passed legislation defining breastfeeding as a civil right and protecting breastfeeding mothers from indecent exposure.

The positive outcomes would not be possible without collaboration, Hammami said. “No health system can or should do this on its own. It takes collaboration with our community partners and stakeholders, and getting support from policymakers and legislators. The recipe for any health system is that you start with the community and partnerships, and the rest is easy.”