Culture of Health Blog

Why States Matter

States have long been laboratories for innovations that influence the health and well-being of their residents. This role has only expanded with the greater flexibility being given to the states, especially as gridlock in Washington, D.C. inspires more local action. The bevvy of new governors and state legislators who took office early this year also widens the door to creativity.

Medicaid is perhaps the most familiar example of state leadership on health. With costs and decisions shared by state and federal governments, the program allows state policymakers to tailor strategies that meet the unique needs of their residents. Among other examples, efforts are underway in California to expand Medicaid access to undocumented adults, and in Montana to connect unemployed Medicaid beneficiaries to employment training and supports.

In Washington state and elsewhere, Medicaid dollars can now cover supportive housing services, while Michigan is among the states requiring Medicaid managed care organizations to submit detailed plans explaining how they address social determinants of health for their enrollees. All of this experimentation is happening as states struggle to control the growth of their health care spending—a balancing act of immense proportions.

Today, nearly 50 percent of children—over 35.5 million—are enrolled in Medicaid or the Children’s Health Insurance Program. These programs are essential to low-income children, and particularly children of color, who are more likely to lack access to other forms of health coverage. Both programs have been providing medical care to kids for about half a century.

However, the treatment of chronic illness, special needs, and adverse birth outcomes often receive higher priority attention than preventive interventions. This is because treatment for medically complex conditions drives costs in the health care system. So it is where state Medicaid agencies, and the managed care organizations (MCOs) that help them control cost, utilization and quality, invest their time and energy.

With most of the focus on treatment, it’s often difficult to make the case for community-based, family-centered prevention. But some states have started to implement prevention activities addressing childhood obesity and other areas of health promotion and disease prevention.

Change is not easy and it takes time. It can be especially challenging when we’re working to change policies and systems that have been in place for decades. But we know change is necessary because many people in America still face discrimination, live in poverty, and do not have the basics they need to be healthy.

We also know that some places are making progress to replace policies that are driving inequities with new policies that can help close health gaps. Places like Newark, N.J., where a unique collaboration led by the state’s largest health care system is accelerating a movement to transform the community’s food system.

A roof over our heads. Shelter from the storm. A beautiful day in the neighborhood. Home is where the heart is.

None of these phrases directly talks about health. But in our common language, we clearly recognize the centrality to our well-being and our happiness of the homes and neighborhoods in which we live.

In fact, there is a strong and growing evidence base linking our homes to our health. Where we can afford to live impacts where we live—and our neighborhood’s location can make it easier or harder to get a quality education and earn living wages, to afford to eat nutritious food, and to enjoy active lifestyles. And when we’re spending too much of our income on rent or a mortgage, that leaves little to pay for transportation to work or the doctor or to put healthy food on the table for our kids.

A few years ago, I read a painfully insightful account in the New York Times of what it means to be a black American struggling with mental health. The author vividly describes how socio-historical “trauma lives in our blood,” materializing in our daily lives, and ultimately affecting our mental health.

Editor’s Note: This post originally appeared on the National Civic League website. We are reposting it with permission this February which is Black History Month as well as American Heart Month.

The Southeastern San Diego Cardiac Disparities Project is improving the cardiovascular health of black residents in South San Diego by altering two fundamental systems that can influence their health: faith organizations and health care providers.

Elizabeth Bustos, director of community engagement for Be There San Diego, and Reverend Gerald Brown, executive director at United African American Ministerial Action Council are leading the effort. They are recipients of the 2017 Award for Health Equity, which was presented to them by the National Civic League and Robert Wood Johnson Foundation. The Award honors leaders who are changing systems and showing how solutions at the community level can lead to health equity.

Dr. James Comer is a pioneer. Decades before the science of learning and development caught up to him, he understood that all children need well-rounded developmental experiences in order to seize opportunities in life. His parents hailed from the deeply segregated South, but they helped him thrive in the era of Jim Crow, investing in his social and emotional well-being and providing safe, supportive, nurturing and demanding educational experiences.

Through that lived experience and Dr. Comer’s work as a physician and child psychiatrist, he understood that one of the most important ways to support children was to focus on where they spend a substantial part of their day: schools. He also understood that many children did not have opportunities to benefit from an environment that supported their well-being and their ability to have a full learning experience. He set out to change this through a remarkable model that has earned him the moniker “the godfather of social and emotional learning.”

In the Boston Edison neighborhood of Detroit, black children raised in low-income households have grown up to have an average household income of $28,000/year as adults, and under 1 percent of that population has been incarcerated as adults. In contiguous Dexter-Linwood, just one census tract to the north, the average earnings for the same group is $17,000/year, with adult incarceration rates hovering close to 8 percent.

If some neighborhoods lift children out of poverty, and others trap them there, the obvious next step is to figure out how these communities differ. Travel to Charlotte, N.C., which has one of the highest job growth rates in America. But data reveals (surprisingly) that availability of jobs and a strong regional economy do not translate to upward mobility in this region. Children who grew up in low-income families in Charlotte have one of the lowest economic mobility rates in the nation. What does help, according to the The Opportunity Atlas (the Atlas), is growing up with less discrimination, around people who have jobs and higher incomes—but only when those factors are found in their immediate neighborhood. If they are present a mile away, it doesn’t seem to matter much according to the data.

It’s only January and already, I’m counting down the days to spring when warm weather will arrive. The long, cold months of winter can be isolating—the snow and subzero temperatures make it difficult to get out and about. Winter is particularly tough for children who can’t go outside to play, and for newcomers from warmer climates who are not accustomed to the cold. For people who don’t have meaningful social connections, the cold weather season can exacerbate the isolation they face year-round.

Social isolation is a serious problem for many. It can lead to anxiety, depression, substance abuse, and even suicidal thoughts. Social isolation can impact our health in other ways too—by escalating unhealthy habits, stress, lack of sleep—and putting us at higher risk for coronary heart disease and stroke.

Fortunately, there are many creative ways in which communities across the United States are tackling social isolation and building a sense of community.

The small city of Hudson is nestled in Upstate New York and home to fewer than 7,000 people. The city was hit hard by deindustrialization in the late 20th century, facing economic decline as factories closed and industry jobs left. In recent years development has surged, with the opening of antique stores, restaurants and art galleries. The city has become a popular destination for tourists and second-home owners.

While our town is often celebrated as a story of revival, development has not benefited all of our community’s residents. For example, despite the presence of several high-end restaurants, there is still no grocery store. Rising costs have increased inequity, causing displacement for many families. Public funding is often directed toward maintaining Hudson as an attractive tourist destination versus addressing the needs of local youth and families.

Our organizations here in Hudson, Greater Hudson Promise Neighborhood and Kite’s Nest, have been working in partnership with many community organizations and individuals to improve conditions for youth and families.