When I started my career as a nurse over 20 years ago, I did so because I believed good medicine was the answer to the suffering I saw in the ER and in the streets.

But nothing in our training revealed to my colleagues and me that our work in delivering health care, while critical, was downstream of structural issues that negatively impact individuals and entire populations.

Health care, as traditionally defined, was and continues to be important, but the reality – supported by both first-hand experience and robust scientific evidence – is that it is insufficient to improve health and wellbeing on the scale I envisioned when I started in this field.

In primary care, we can be quite expert at preventing, diagnosing, and treating medical and dental problems.  We can, at times, reverse very difficult medical diseases, and we are even able to provide - when done well - a safe environment where an individual or family’s priorities are heard, supported and incorporated in treatment plans.  Using such empathic approaches, we can offer a connection that promotes healing.  When we are at our best, our work can increase a person’s sense of hope that life will become richer and less difficult as their health improves.

Yet, fostering high levels of health and wellbeing in all people – regardless of gender identity, sexual orientation, housing status, income level, childhood experiences, educational attainment, veteran status or skin color – requires us to examine the forces that work against health for all.  It necessitates a scrutiny of the data which reveals who is benefiting in this society and in our current costly system of care, and whose health outcomes are being left out in the cold.

According to studies, it turns out that the number of deaths attributed to low education is on par with deaths from heart attacks; that social isolation as a contributor to death is close to those related to lung cancer.  In healthcare, as we look at these factors (most often the result of unequal distribution of resources) and their associated outcomes, we are forced to say, “Not good enough”.

With this data in mind, we must ask ourselves how innovation and the redeployment of dollars from healthcare can significantly enhance the return on investment.  Not only do we need to reduce waste within healthcare, we want to shift that spending to equalize access to outstanding education and job creation that support sustainable living.


As our societal understanding of what truly impacts health and wellbeing catches up to what the data clearly shows, it is essential that decision-makers in healthcare lead, act and design differently.

While health care, unfortunately, cannot fix the ills of imbalanced distribution of opportunity (in the land that prides itself on the opposite) on our own, we feel compelled to address the underlying “root” causes of poor health outcomes by involving patients and community partners in innovative, co-designed pilot projects.  Further, we advocate for systemic change and the reallocation of precious resources to create equitable health outcomes for all.

With this in mind, Partnership Health Center, along with myriad organizations in Missoula, is creating innovative programs and attracting the attention of others.  As you look at Missoula, the amount of potentially game-changing awareness and action around food, housing, behavioral health, and safe neighborhoods is absolutely heartwarming – even as the country at large has yet to shift funding priorities in accordance with the data.

Specifically at PHC, we have programs that work with people whose complex lives lead them to the hospital and emergency room, repeatedly.  By hiring amazing staff and offering creative programming, we are able to truly listen to these patients and help address upstream issues.  Last year, this improved outcomes and saved the state of Montana $1 million.  Sadly, this innovative programming is not yet reimbursable despite its overwhelmingly successful outcomes.

Additionally, PHC is creating new programs that connect older folks to healthcare and social support more efficiently, providing peer support to groups who are structurally disenfranchised, and partnering with passionate community members who will organize and use their voices powerfully to change such structures.  In the future, PHC and the Missoula Food Bank and Community Center intend to co-locate health care and food.

Each of us is harmed by the disparities we experience in the world, even as we suppress that pain and look away from humans, just like us, living on the street.  When the social and economic pyramid gets higher and steeper such that some have much and many have little, there are widespread psychological and physiologic costs to all of us.

As PHC innovates with the many progressive organizations in town and the support of a number of foundations, so does the city and county of Missoula.  We look forward to serving, advocating, organizing, voting and creating a just world where all of us have equal access to a long life that is supported by connection, education, adequate income and person-centered health care for all.

Laurie Francis is the Executive Director of Partnership Health Center. Health Beat is a monthly feature of Missoula Current.


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