Healthcare Access, Challenges and Opportunities
Looking Toward Aspire United 2030
Jennifer Sampson began the conversation with a look toward the new campaign year for United Way, and our next iteration of 10-year community impact goals in the areas of education, income and health. “We call these long-term goals Aspire United 2030,” she said, “and our North Star aspiration is that every North Texan, regardless of race or ZIP code, has the opportunity and access needed to achieve their full potential.
“Aspire United 2030 will drive investment and engagement to address the root causes of systemic issues that lead to unacceptable outcomes in the areas of education, income and health,” Sampson said. “And all three areas are interconnected, inextricably linked.”
Sampson gave examples of the ways in which education, income and health coexist:
- More than 130,000 kids in North Texas have emotional disturbance or addictive disorders. These kids will have a harder time getting a quality education if their mental health isn’t improved.
- Higher levels of education contribute to lower levels of mental stress. In other words, psychological health is improved by education.
- Financial issues and mental health also often go hand in hand. Those with high financial stress are twice as likely to report overall mental health.
- People with depression and anxiety are three times more likely to be in debt.
What Are the Critical Health Issues?
The panel began with a discussion of what each panelist considered the most important health issues facing the North Texas community.
Ken Smith: Smith said he thinks back to his 10 years working at Kaiser Permanente and Blue Cross Blue Shield. “It’s the system” that’s badly flawed, he said. “It’s a system that is supposed to deliver health care, but the system is so big and so convoluted and amorphous that it gets in its own way. … We have a system that has so many fiefdoms in it that the concentration is not the care of the patient but is on the delivery of profits. I would love to see a new type of system, even if it competes with the current system.”
He also noted, “We don’t empower people, or people don’t empower themselves, to get the most out of the system that we can. I think we should go back to making health care what happens between your doctor or hospital visits and not what is at the visit. That requires the empowerment of a person at the home center.”
Anthony Hill: Hill said Smith “hit the nail on the head about access and cost.” He also mentioned the information overload from so many different sources. “In our current climate, a big problem is how do we disburse information accurately and how do we process it,” he said. “There’s no shortage of information, no shortage of technology. But people don’t know what’s a “nice to know” versus “must know.
“How do we decipher our current climate and how do we decipher our day-to-day health and access to health care?”
Ryan D. Van Ramshorst: Previously a practicing pediatrician, Van Ramshorst, said he had seen firsthand the impact of nonmedical social drivers that affect a family’s health status.
“I think of prevention [as the critical issue]”, he said. “We’re so laser focused on finding a (COVID-19) vaccine, but there are so many other consequences of this pandemic regarding prevention.” For instance, he said, providers have seen a precipitous drop in immunization rates for both children and adults since the pandemic began in the U.S. in early spring. “We need to see what we can do as a community to promote immunizations, whether it’s the communication that Anthony was talking about, or whether it’s making sure the health system is not as complex as it’s perceived to be, or something else.”
And it’s not just vaccinations that have dropped. “We have so many Texans with underlying health conditions, Type 2 diabetes, high blood pressure, so many things, and we know that they are not seeking care like they might have been before the pandemic.”
What Are the Solutions?
Van Ramshorst: “If there is a silver lining to this incredibly terrible and challenging pandemic, it’s that it has shocked the entire system to really look toward innovative solutions, like telemedicine and telehealth to deliver needed care,” he said. “I’ve heard from lots of providers that the families and the providers love this technology. It’s convenient, it’s easy, but this has only highlighted to leaders that we have another huge challenge, and that’s connectivity. We have to make sure that people have the broadband access to really leverage telemedicine and telehealth services moving forward, even after the pandemic.”
Hill: He said focus on mental health as key to improving health in all areas. “I don’t think we recognize the severity of it, and until we do so, it makes it less appealing for people who are struggling with mental health to come forth.
“Systemically, this is a severe issue. … If you’re not in a safe place with anonymity, you don’t want to be calling the hot line, you don’t want to be in a waiting room saying you’re here for your mental health. Until we can remove the stigma (of mental health) and make safe places more day-to-day, we’re going to continue to see issues with that.”
Smith: With any type of health care, Smith said, it’s essential to “be sure to get the most comprehensive feedback you can about where that person lives, who is in that family.” He mentioned the high rate of asthma in ZIP codes 75215 and 75210. In one case, he said, a community health worker noticed that one family had rugs everywhere, collecting dust and mold. Once they were removed, “the asthma disappeared. … That never would have taken place if we were just depending on a doctor’s visit where the patient had to go to an outside place.”
Smith said health care needs to go back to an earlier model, which emphasized the physical home and self-reliance, along with school and health-care partnerships. “Let’s educate our people. Let’s get with the [Dallas] ISD, let’s get those community liaisons back into the schools so that the health-care provider can have an educational link provider, and we can take a look at holistically taking care of our population.”
Also, he said, it’s important to remember that all education takes time. “I hear a lot about the (food) dessert, and there’s definitely a dessert in my community. But access is one thing, and eating arugula is another,” he said to other panelists’ laughter.
“If you’ve grown up eating potato chips and pickles and candy and those sorts of things and we introduce arugula or kale or something like that—well, arugula is a learning curve.”
Hinton recalled his mom trying to make him eat lima beans: “You do have to meet people where they are,” he said with a chuckle. “You have to help them understand the healthy foods versus the types of foods they’ve grown up with.”
Hill: Responding to a query from Hinton about food desserts, he said, “Whenever you talk about food insecurities or food desserts, you can’t have that conversation without talking about factors of poverty and other economic issues in the community,” he said. Education and income come into play when there’s a shortage of healthy food available in a community.
He mentioned Move What Matters, an Uber program that supports small businesses. “If you can get a book through that in an hour that would take 24 hours from Amazon, you’re more likely to, and you’re supporting small business” and helping the area’s economy. The same applies to food delivery, he said.
Who Are Community Health Workers?
Hinton: “I’m not sure if you talked to most people in North Texas, they would have a common definition of what a community health worker is, what role they play and how they can be part of this solution.”
Here’s some help on that, courtesy of the American Public Health Association:
The Community Health Worker Section has adopted the following definition of a community health worker: a frontline public–health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. A community health worker also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.
Smith: “I just love my community health workers,” he said. “They come to the table with passion and love. I know that sounds really corny, but if you care about the people you’re going to take care of, then you automatically see them holistically, and they get it.”
He praised UT-Southwestern and Parkland for planning to put clinics in the Red Bird area of southern Dallas but said that has been curtailed temporarily by the coronavirus. UT-Southwestern, he said, “had the common sense to pull people together for focus groups and they sat there, and they listened. And I tell you folks gave them an earful about fear, trust, access and care. And they told us that this is the community that is high touch, they have to touch and see and feel you. There has been so much distrust in the past. Community health workers people can (literally) touch that person and have trust in them.”
Hinton: “When you reduce fear you increase access.”
What Are Some Positives You See Right Now?
Hill: “This discomfort has made us aware of issues that we didn’t know how to talk about. We’ve been able to talk through a lot of things” surrounding education, income and health. “We’ve also been able to address and talk through different systemic racial issues in our country, different economic issues—whether it’s housing, whatever—and these things can’t be ignored.”
“Another bright point is that we all agree on a lot more than we ever realized. We have to find a path forward that is helpful to one another and look to community service.”
Van Ramshorst: “The pandemic has really brought to light some longstanding chronic health disparities; we know that communities of color have been significantly negatively impacted,” he said. He noted that the THHSC is working on a study specific to Texas that will look at those disparities to help inform future steps.
Smith: He deferred to other “real experts” he said he’d talked to in the last few days.
From Dr. Brenda Richardson-Rowe, clinical director at the Community Development Center Counseling Center: “It has forced us to slow down, it has made us realize work is not our God. We have more private time to evaluate and think, more family time (that can be challenging!). We’re setting our priorities better, and this causes us to think outside the box.”
From Rodrigua Ross, executive director of the Park South Family YMCA: “Nonprofits are working together better than they ever have before, and the ask is much easier and gets responded to more quickly. Our walk-ins are at an all-time high and we’re serving more people. … Proximity breeds empathy.”
It’s a Wrap
Concluding, Hinton said, “I’m tired of seeing the words ‘unprecedented’ and ‘uncertain’ and ‘unimaginable.’ It’s time to reimagine and recommit, and to learn from what’s occurred to strengthen the core of our communities in health, in education and in economic opportunities.”
Jennifer Sampson told the panelists, “Your wisdom reiterates the need for unity and collective efforts to ensure that every North Texan has the access and opportunity to achieve their full potential.”
She continued, “We encourage each of you on the call to go to Aspire United 2030 and sign on as a hand-raiser and learn more about how collectively we can put opportunity in the hands of North Texans. Together we’ll fold in solutions to health, education and income issues that have been pervasive in our region.”
This article was published on: Jul 28, 2020