Four state and local approaches that address determinants of health

First, a few definitions for the layman:

1. Health is more than someone’s disease state. Socioeconomic factors, including housing, nutrition, mental illness, community environment, lifestyle and employment status, can affect people’s health as well as their ability to access the care needed to improve it.

2. Population health is more than the overall health of a population; it includes the distribution of health. An ideal delivery system substantially reduces or eliminates differences within a group to improve the health outcomes of the group as a whole.

An integrated service delivery model can meet these holistic needs at the individual and population level. Here are four examples of programs in the United States that have successfully adopted these concepts. These programs improve health, community health and population health and address the social and other determinants of health. They also highlight ideas that can increase the effectiveness of government assistance programs.

State of Minnesota

Minnesota is consistently one of the highest-performing states in terms of healthcare indicators. For the third year in a row, the state ranked first in The Commonwealth Fund’s annual “State Health System Performance” report.

Minnesota created a Statewide Health Improvement Program (SHIP) to help make healthy choices easier. Through SHIP, communities receive support from local organizations to create programs that help individuals and communities improve overall health levels. Examples include:

• Safer walking and biking routes to school that help kids increase physical activity.
• Opening farmers markets to give families more access to fruits and vegetables.
• Encouraging workplace wellness programs.

SHIP focuses on increasing physical activity, improving nutrition and reducing tobacco usage and exposure. The SHIP program recognizes the differences between the demographics, health issues and environmental challenges between urban and rural communities, and that a one-size-fits-all approach to determinants of health will not work. Instead, the program is structured in a way that allows communities to employ the strategies that best address their needs.

Hennepin County, Minnesota Human Services and Public Health Department

In 2004, the county reorganized six departments that previously provided various social services, financial assistance, work support and public health programs. The consolidated organization became the Human Services and Public Health Department (HSPHD).

Using project management principles, data and input from staff, they developed a client-centered framework called the Client Service Delivery Model, which combines “financial, social services and public health services into an integrated model of services…to provide a holistic assessment of each client at initial contact.”

They assess their members across a spectrum of health and human service concerns. This enables them to address an individual’s issues and affect outcomes. These efforts are combined with community and population health efforts to produce a greater effect on health.

Hennepin County embraces mobile technology to allow staff to work outside of the office, increasing availability to members of the community. They also access and share information through the HSPHD Enterprise Communication Framework, “a secure web-based content and process management application that links workers, systems, cases, clients and information.”

Today, Hennepin County has several initiatives that address social determinants:

• Encouraging teens to postpone parenthood until they are adults.
• Integrating behavioral healthcare for residents of county correctional facilities.
• An interdisciplinary team coordinates case management, housing and chemical dependency treatment to combat substance addiction.
• Early childhood screening occurs where adults already go for services.
• A 10-year plan to end homelessness, bringing together more than 120 local non-profit organizations, businesses, alliances and concerned citizens. 

Montgomery County, Maryland

In 2009, the county began the Montgomery County Community Health Improvement Process. It assessed all planning processes and compiled information related to health and well-being and the social determinants of health across several populations and communities. Leaders established a “set of (about 100) indicators that could be examined through a comprehensive needs assessment.”

The Healthy Montgomery Needs Assessment helps set priorities. Six categories were selected for action and prioritized. Two were selected for immediate action: behavioral health and obesity. The Behavioral Health and Obesity Work Groups were formed and “charged with… developing action plans that demonstrate impact on access, health inequities and unhealthy behaviors.”

Montgomery County is developing the organizational structure to address individual and community well-being across its Health and Human Services agency. The county has assessed their needs, prioritized the issues and continually moves forward. The county’s three-year-plan sets goals for developing innovations in service delivery and to transform their organization to meet future needs.

San Diego County, California

In 2010, the county’s Board of Supervisors adopted the Live Well San Diego vision. It has three goals: building better health, living safely and thriving. This vision includes four strategic approaches:

1. Build a better service delivery system.
2. Support positive choices.
3. Pursue policy and environmental changes.
4. Improve the culture within county government.

San Diego County includes stakeholder organizations to fulfill its vision and implement strategic approaches. They include “cities, schools, businesses, the military and faith and community-based organizations, as well as residents.” The county uses “Top 10 and Expanded” indicators to measure progress on well-being. They measure:

• Health
• Knowledge
• Standard of Living
• Community
• Social

In May of 2016 leaders announced an effort to fully integrate health, human services and housing.

These examples demonstrate efforts in the U.S. to address health and social and other determinants of health at an individual, community and population level. They all are successfully (re)organizing to serve the citizens better while developing new programs and continuing to evolve and expand existing programs to meet the needs of citizens. Each organization has developed initiatives and prioritized them to meet the specific needs of their state, county or community. There are valuable lessons to be learned through all of their efforts.