Lia Spiliotes: CHP seeks big picture on health

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GREAT BARRINGTON &mdash Does your physician, nurse practitioner or other health care professional ask you about stress? Or about whether you feel connected to your neighbors and community? How stable your housing is? Or whether transportation problems have kept you from work or medical appointments?

Questions like these will soon become familiar as Community Health Programs' healthcare providers begin focusing on collecting information on what we call "the social determinants of health (SoDH)."

The "Big Data" movement in healthcare, which collects and analyzes complex sets of data, has helped create new medical treatments, therapeutic care, and the beginnings of personalized medicine. Now the trend is toward gathering even deeper information about economic, social, and environmental factors — so-called social determinants – that affect the health of individuals, as well as neighborhoods and cities.

This fall, community health centers across the U.S., including Community Health Programs, will begin asking more questions. We will ask about a patient's financial security, social integration, education, employment and stress levels, since any of these factors can impact mental and physical health. For instance, lack of financial security often means choosing food over medication. Working multiple jobs — as many Berkshire residents do — can impede healthy eating and exercise. Poor housing conditions can impact the cleanliness of air and water.

While physical access to health care providers is essential for healthy people and communities, health cannot be sustained through medical interventions alone. That's why collecting SoDH data is so critical. To better understand why specific health issues persist in communities we need more insight.

For instance, Northern Berkshire residents are, on average, less healthy than residents elsewhere in the state and county, but with better information and collaborations, we can improve disease prevention and promote greater well-being for all residents.

Healthier communities

More than 50 years ago Dr. H. Jack Geiger observed that "the determinants of health are in the social order — not in health care." The community health center movement was launched on the notion of creating healthier communities for healthier individuals, taking novel approaches to addressing the social and environmental issues impacting health.

CHP (originally Children's Health Program) was at the forefront of this movement, with grass-roots, back-roads outreach to families with children. Today, CHP conducts much of the same grass-roots outreach to people of all ages throughout Berkshire County, with an increasing number of partnerships and collaborations.

For instance, Community Health Programs has partnered with local farmers to bring local produce to the CHP-Great Barrington campus on Thursdays. CHP collaborates with local nonprofit organizations — such as Greenagers and the Berkshire Natural Resources Council — to build and expand walking trails around our property, for patients, children, staff and visitors.

Our Family Services program collaborates with such organizations Berkshire Baby Box, to promote safe sleeping conditions for newborns. CHP offers nutritional cooking and parenting classes for families. With the addition of two medical offices in Northern Berkshire CHP will be expanding nutrition services to support practitioners there.

In addition, community health centers have surpassed more traditional care providers with integration of behavioral health and primary care services. At CHP, many patient care team includes a behavioral health professional who is readily accessible if a patient shares concerns about depression or other mental health issues during a medical visit. This "warm hand-off" — an on-the- spot referral to an available mental health professional — ensures that patients' overall care is seamless. It helps reduce the stigma of seeking mental health services.

Today we have technology that we didn't have at the start of the health center movement. What's more, the data we can gather provides opportunities for innovators and entrepreneurs across the landscape of healthcare, life sciences, digital and biotechnology industries to play a role in improving community health.

Opportunities to drive change could come from seemingly unrelated industries — information around housing conditions could inspire better air filter systems to help reduce acquired asthma. Data about material insecurity could stimulate the banking community to create and market new financial products to under-served consumers.

By collecting and acting on non-clinical data in the Berkshires, CHP will be better positioned to identify if regional services are adequate to address the social determinants of health in a sustainable way. Big data can help improve patient outcomes, decrease health disparities, lower the total cost of care, and address population care management on a macro level.

It's a huge, incredible challenge but a step in the right direction. So please join us in our efforts, and be ready for a new set of questions in the exam room.

Lia Spiliotes is interim CEO of Community Health Programs.


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