A Health System Focused on Downstream Treatment, Ignoring Upstream Causes of Poor Health
According to research, up to 90 percent of a person’s health can be attributed to social and environmental factors, and health behaviors, while only 10 percent can be connected to direct medical care.
Long-standing health and social inequities have led to persistent health disparities. Despite this, health spending disproportionately flows to downstream medical care rather than upstream prevention efforts.
Aligning Sectors to Boost Equity and Improve Community Well-Being
With socioeconomic status and the environment serving as major influencers of health outcomes, over 100 leaders in San Diego joined forces to flip the script and adopt a collaborative approach that prioritizes community well-being over treatment.
The resulting initiative, the San Diego Accountable Community for Health (SD ACH), believes a better system is possible and that everyone should have access to all they need to create a lifetime of health and wellness, regardless of their race, ethnicity or zip code.
The first aim of the SD ACH is to support ideal cardiovascular health across the lifespan with a focus on the health, behavioral, social and environmental factors that protect individuals from cardiovascular disease.
ACH IN ACTION
Creating New Linkages Between Clinical and Community Stakeholders
The SD ACH has since launched Neighborhood Networks, a program designed to achieve better individual health outcomes, lower costs and improved population health, by linking health care systems with community-based organizations and services. Neighborhood Networks’ coordinated approach helps these systems work together to address the health-related social needs of community members, offering the support of trusted community health workers.
A Stakeholder Learning Collaborative meets several times a year to convene partners from multiple sectors to engage in deep, meaningful and sometimes difficult conversations that aren’t happening anywhere else in San Diego County. Topics have included trauma-informed care, building equity into COVID-19 response and relief efforts, and addressing the impacts of adverse childhood experiences (ACEs).
The SD ACH is also focused on linking clinical and community programs in new ways that lead to better health and wellness. With strong partner support and involvement, SD ACH developed a portfolio of interventions and an action plan with the goal of assuring that all residents of the North Inland region of San Diego County have sufficient quantities of nutritious foods. This work has been particularly relevant during the COVID-19 pandemic, with so many individuals facing food insecurity.
SIGNS OF SUCCESS
Working Together to Achieve Positive Outcomes
So far, SD ACH’s impacts are promising. The initiative has helped expand the capacity of community partners to work together toward health equity. Building on previous efforts and partnerships, SD ACH is also helping to create a multi-sector, trauma-informed network of care to effectively address the needs of children and families experiencing ACEs.
Neighborhood Networks uses evidence-based approaches to identify and address multiple risk factors that influence health outcomes. This program builds a local workforce of community health workers and heightens the capacity of community-based organizations. As a social enterprise, Neighborhood Networks generates revenues that will eventually fuel innovative approaches to improving community health for years to come.
To learn more and get involved with the San Diego Accountable Community for Health, visit www.sdach.org or contact Kitty Bailey, Executive Director, at kitty (at) betheresandiego.org.
To learn more about CACHI and the ACH model across California, please contact Barbara Masters at CACHImgr@communitypartners.org or visit the website at www.CACHI.org.
The California Accountable Communities for Health Initiative (CACHI) was established to spearhead efforts to modernize our health system and build a healthier California. To realize this vision, CACHI utilizes a model known as Accountable Communities for Health (ACH) where multiple sectors align goals and collaborate to address the leading health issues facing our communities.