Challenges and Successes in Reducing Health Disparities Workshop Summary (2008) / Chapter Skim
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3 Clinical and Community-Development Approaches to Reducing Disparities
3 Clinical and Community-Development Approaches to Reducing Disparities
Pages 47-68
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From page 47... ...
DISPARATE APPROACHES TO ADDRESSING HEALTH DISPARITIES There has not been enough progress toward reducing health disparities using standard accepted practices, explained Dr. Horowitz. Typically, community approaches to health disparities are made through interventions or other efforts mediated through clinical or community settings (Figure 3-1)
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? Community Local Factors Improved Setting - Services available Community Status - Built environment - Social environment FIGURE 3-1 The "two paths" of community approaches to disparities.
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From page 49... ...
In addition, issues such as these can be considered outside of the purview of the primary program objectives; local factors are therefore not measured at baseline, making it impossible to determine whether or not interventions or programs effectively addressed these issues or impacted disparities in a community. Silos Efforts to reduce health disparities using either clinical or community approaches, but not the two approaches in combination, are thought of as silos.
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When the funding stopped, the results stopped. Without the Diabetes Prevention Program, people are really struggling with how to manage their diabetes-related health concerns, and, although the program demonstrated a potential solution for reducing diabetes, it is no longer being used.
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Pursuing a Hybrid Approach A hybrid model combines aspects of both the clinical and community approaches to reducing health disparities. This model would empower and
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Community approaches address social determinants of health, and efforts may enhance both community resources and capacity. Some community models may also be more sustainable than others.
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Involving community health workers can improve patients' access and help them decrease asthma symptoms or urgent care use or improve their blood pressure control. An example of a hybrid approach that is research-centered is the general field of community-based participatory research (CBPR)
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From page 54... ...
Challenges of Hybrid Approaches There are several challenges to advancing hybrid approaches, including adapting the clinical enterprise, building effective partnerships, building support for empirical evaluation, and relying more heavily on public health ideals. There has been some progress in advancing hybrid approaches, but future efforts must move beyond translating materials into appropriate languages and cultural competency training.
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The paper, "Community Approaches to Addressing Health Disparities" (see Appendix D) , details how hybrid approaches have the potential to positively affect social determinants of health.
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From page 56... ...
There are other community-development efforts as well. As discussed earlier, LISC is one of several community-development investment corporations in the United States, operating in many of the same communities of TABLE 3-2 Continuum of Spending from Basic Research to Community Development Translational Clinical Hybrid Community Basic Science Programs Practice Approaches settings NIH Human Clinical Agency for CDC REACH Local Initiatives Genome Transitional Healthcare Support Project Science Award Research Corporation and Quality (LISC)
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Another example of a Regional Health Authority at the community level is the West-Side Health Authority in Chicago. For nearly 20 years this organization has been addressing community health indicators identified by representatives from the community and has tackled housing and employment concerns.
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Provider networks organizations operate collectively, sharing revenues and resources, but they also work together programmatically on health care concerns and other issues that affect population health conditions in a neighborhood. Many models could be adapted or modified for the purpose of creating hybrid approaches.
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It is also important to consider community involvement in clinical enterprises in which communities and clinical investigators work in shared arrangements. Some of the CTSAs coming out of NIH require bench to bedside care.
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To reach health disparity goals, a very different commitment is needed to partnerships than has been characterized in many disparities initiatives to date. The set of potential partners for these community approaches should be considered in very broad and ambitious terms.
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A way must be found to combine all available expertise and funding sources so there can be a measurable impact at the community level. For years, concluded Dr.
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Traditional forms of leadership created at the institutional and community levels may not be sufficient to work on these problems. He maintained that some thought needs to be given about future investments in leadership and what programs focusing on leadership might look like.
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Dr. Levi commented that while participants are asking community groups to design programs that are sustainable, there is also an obligation on the part of the federal government and other funders to make sure that their funding streams are sustained as well.
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Some communities are taking on projects simply because they have received a grant to work on a specific health issue, regardless of whether or not that issue is a priority in their community. Not all community leaders know what the pressing health issues are in their community; they may not be doing regular community assessments or may have only outdated data.
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Louis commented about the role of her organization as an intermediary. One of the challenges her organization faces is that traditional funding streams are from clinical settings conducting research or from the university setting, and intermediaries fall somewhere between these two entities.
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Community Capacity Ms. Kubisch works in the area of community development, community change, and community building and she commented about the importance of community capacity.
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They are powerful institutions in the form of urban hospitals, and there is a great deal of money devoted to health initiatives. Can partnerships between the health community and community development be formed that value the importance of building the capacities to do the work cross-sectorially?
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From page 68... ...
Community capacity is necessary at the organizational level in terms of being able to do the data analysis, community organizing, and advocacy that will allow these funding streams to be pulled together. Reference IOM (Institute of Medicine)
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