At Partnership Health Center, we believe that access to medical, behavioral health and dental care is critical for maintaining health, but we know that it is not enough.
Health and well-being begin in the communities where we live, work and play, well before we set foot in a doctor’s office. Social and economic factors like access to education, healthy food, safe and affordable housing and control of resources influence our lifelong health and well-being more than any single trip to the doctor’s office.
These factors are the social determinants of health. They help us understand health as a complex interaction of social and economic factors that present unequal opportunities for achieving health and well-being.
Take housing as an example. Access to safe and affordable housing is a powerful and well-researched social determinant of health. People experiencing chronic homelessness have poorer physical and mental health outcomes as well as higher medical expenditures resulting from increased emergency room utilization. Unstable housing also influences health.
In Missoula, an estimated 49 percent of renters are cost-burdened, defined as spending over 30 percent of their household income on rent. When families spend more on housing, there is less money available to spend on other things such as healthy food, prescriptions, trips to the doctor’s office and recreational activities.
Medical care accounts for 10 percent of what makes us healthy, while other things like the environment (20 percent), health behaviors (50 percent) and genetics (20 percent) account for much more. However, national spending on health care does not reflect this. In the United States, 88 percent of health care spending is on access to medical care. This disparity between what we spend on health care and what keeps us healthy has a very real effect on the health of our nation.
Life expectancy has declined in the United States over the past three years and some argue it is because of the increasing number of “deaths of despair.” These are deaths related to substance use, (including alcohol and opioids) and suicide. Some of the largest increases in deaths of despair have been in regions of the country where economic and educational opportunities are limited – in other words, in places where the social determinants of health are least likely to support optimal health and wellbeing.
Although there is no single answer, at Partnership Health Center, we want to help create the solution. We carefully design our care and programming with the social determinants of health in mind. We have a robust and highly skilled social work team that can address immediate social needs. We also promote programing designed to enhance lifelong health and well-being before the onset of disease or disparities in health outcomes can occur.
For example, in July of this year, we started Reach out Read – a national program for promoting early childhood literacy during well-child visits. The ages of 0-5 are critical for language and social/emotional development; reading with infants, babies and toddlers – even during the earliest weeks – is beneficial for their development.
For a variety of reasons, not every child has early exposure to books. Through Reach out and Read, PHC providers give age-appropriate books to every child during their well-child checks along with a “prescription” for the caregiver to read out loud with their young child every day. Through these efforts, we hope that every child that comes into our office will hear more words before their sixth birthday, laying the foundation for educational achievement and lifelong health and wellbeing.
This program and others reflect our commitment to positively affecting all factors – including and especially the social determinants of health – that influence health and wellbeing in our community. We could not do the work we do without our community partners. Together, and with this important science in mind, we can continue to build a healthy and strong community.
Becca Goe, MS, MPH is a Program Development Manager at Partnership Health Center. Health Beat is a column written for Missoula Current by Partnership Health Center in Missoula.