Half a century later, moving toward 'Communities of Solution'

Farmers markets have become sites to engage members of a community on their health directly through the foods they eat. Photo by Joseph Molieri/Bread for the World.

Editor’s note: This post is part of a weekly, year-long series called the Nourishing Effect. It explores how hunger affects health through the lens of the 2016 Hunger Report. The Hunger Report is an annual publication of Bread for the World Institute.

By Bread for the World Institute Staff

Nearly half a century has passed since forward-thinking leaders in health care recognized a fundamental problem with the U.S. healthcare system. The 1967 Folsom Report, one of the seminal works in the field of public health, argued that healthcare institutions, on their own, were incapable of dealing with the array of factors affecting community health outcomes. The Folsom Report introduced the term Communities of Solution, based on the concept that a healthy community depends on contributions from a range of actors, inside and outside the healthcare sector, working together in a coordinated manner.   

Community-based partnerships bring together a wide range of stakeholders who share a common interest in improving population health, meaning health outcomes spread over a community. For example, Nemours, a children’s health system based in Delaware, serves a population with high rates of asthma. Nemours works with community partners to teach parents how to manage their children’s asthma. Nemours also pays to replace dusty mattresses, curtains, and carpets with hypoallergenic alternatives, and its partners make sure the purchases are made. Less than a year after the initiative began, children’s asthma-related emergency room visits had dropped by 40 percent.  

In Colorado, Kaiser Permanente partners with Hunger Free Colorado, a statewide advocacy and outreach organization, to help counter the effects of food insecurity on diet-related diseases. Healthcare providers within Kaiser Permanente identify patients at risk of hunger and refer them to Hunger Free Colorado. The staff there reviews patients’ eligibility for federal nutrition programs, educates them about which programs they qualify for, and helps them apply. Patients also learn about food pantries, senior food programs, and home-delivered meal programs that are available. Seventy-eight percent of the patients referred to Hunger Free Colorado are taking advantage of the opportunity to get help from the organization.

These two examples of institutions working with partners outside the formal healthcare system to improve population health outcomes in the communities they serve are not the only examples— but such partnerships are still uncommon. The healthcare sector has not focused its attention and resources upstream to social determinants of health such as food insecurity or substandard housing.

The Affordable Care Act (ACA) of 2010 has begun to change this. The triple aim (see graphic below) of this landmark healthcare reform legislation is 1) to improve the patient experience, 2) to improve population health, and 3) to reduce the per capita cost of care. The key to reducing per capita costs will come mostly from improvements in population health. Preventable chronic diseases now account for 86 percent of U.S. healthcare costs and affect 50 percent of the population. Food insecurity and other social determinants are directly related to higher rates of chronic diseases. Accordingly, the ACA includes a number of carrots and sticks to encourage healthcare institutions to work more closely with community partners.  

This text originally appeared in Chapter 2 of the 2016 Hunger Report: The Nourishing Effect. Read the full report and find references for the information shared above. 

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