Listening And Learning: An Assessment Of Social Drivers Of Health
Developing the Foundation’s Strategic Direction has been a year-long, serious undertaking. We wanted to base the plan on the facts about health issues in Greater High Point and take advantage of current data, including the many existing assessments of community health. We also wanted to listen to local residents and leaders—to align with community priorities.
Focus groups, surveys, and interviews elicited many thoughtful insights—including comments pointing to the complex social determinants of health. As one participant said, “You know overall health is improved throughout one’s life if you get a good start and you get a good education, and you have a good job… [but] many, many children [are] arriving at school, not on a successful path.”
The Foundation engaged the National Institute of Minority Economic Development (the Institute) and the UNCG Center for Housing and Community Studies (CHCS) to conduct community research. We wanted to have a better understanding of our community members’ current health needs and barriers—including where there are disparities in access to health care and health outcomes based on income, race, gender, and other social attributes—and what we can do to improve health equity in the region.
|A frequent comment reflected “the lack of systems-based solutions, and systems needing to be bigger than just a treatment-based model that seems to be the traditional trend that people like to implement when they’re addressing people’s problems.”|
Thorough Review of Existing Data
Additional data came from local agencies, the local health department, and state sources like the North Carolina State Center for Health Statistics. We also drew upon data from federal and national sources such as the Center for Disease Control, the American Community Survey, PolicyMap, etc.
Stephen Sills, Ph.D., vice president of the Institute’s Research, Policy & Impact Center, led this research effort along with Meredith DiMattina, GISP, GIS analyst at CHCS. Their report follows the Community Health Rankings Model and aligns with the Healthy North Carolina (HNC) 2030 goals. It details how social and economic mobility has been limited for some low- and middle-income neighborhoods. These neighborhoods have experienced the lasting influences of intergenerational poverty, health risks from poor environmental and housing conditions, and other social problems such as high rates of opioid overdoses, Adverse Childhood Experiences, and community violence. These same neighborhoods in High Point have been recognized as food, transportation, and medical deserts. The outcomes are chronic illnesses such as diabetes, hypertension, and heart disease; respiratory issues such as asthma and COPD; and poor self-reported mental health.
|As one health care provider explained, “The working poor have some form of employment, part-time manual labor at hourly wages. And then, while their wages are a living wage in the sense that they can pay their rent, they can pay their gas—health care is expensive, and they can’t afford the out-of-pocket, or they can’t afford their premiums. I mean, you know, it’s just a challenge.”|
In the first phase of data gathering, researchers conducted in-depth one-on-one interviews with representatives from the governmental, nonprofit, healthcare, philanthropy, and justice sectors. The responses varied from a specific, downstream approach to healthcare access; to mid-stream solutions related to wages and transportation; to an upstream, systems-based approach to job creation and policy change.
Downstream Approach—Individual Impact:
One medical professional noted, “We see a lot of folks with diabetes, we see a lot of people who have mental health issues that had been untreated for a long time, we see people who have high blood pressure, and we try to find ways to identify resources for them and to assist them with the cost of their care.”
One person explained, “I would like to see people have access to good health care, both mentally and physically. I would say open and free health care for people… If you’re feeling sick, [you] can go into a clinic and get treated, and it’s not a financial hit that you’re going to have to take because I think people delay getting treatment because they don’t have the funds to support it, even if they’re insured.”
A community leader said, “Minimum-wage jobs versus livable-wage jobs … I think that there needs to be more cognizance given to the ability for people who work these jobs can they, can they make a living, can they support their families with these jobs.”
Another talked about barriers to good jobs. “For people who don’t have transportation, you know, the way our bus system is running currently, they can get to a first shift job and get home. And they can go to a second shift job, but they can’t get home because the bus transportation stops. And they definitely cannot get to a third shift.”
Upstream Approach—Systems and Community Impact:
A philanthropist pointed out the need to develop more small business prospects to increase employment. He said, “governments and foundations don’t create jobs, entrepreneurs do, and for too long … we’ve been under-investing in our small business and entrepreneurial ecosystems and … to give them access to capital so that they can create these businesses.”
Others discussed the overall effect of local conditions and the built environment. They described the need for affordable, sanitary housing in safe neighborhoods with access to healthy food. “You have a medical desert, and you have a food desert. These things are kind of on top of each other.”
|Another direct service provider said, “I go into a lot of the homes when we do the senior food box delivery and take their box of food to the kitchen or whatever, and I’m really surprised at the condition of some of the homes, that a person is living there, and these are people, usually elderly, … and it’s very disturbing.”|
Throughout the interviews and subsequent listening sessions, focus groups, and surveys was an underlying thread of health inequalities. The elderly, refugees, people of color, LGBTQ+ populations, individuals with intellectual disability, and specific areas like Census tract 143 were identified as populations and places experiencing inequitable outcomes.
“We’re dealing with complex inequities over many generations,” said one respondent. “… We frequently see families who continue to cycle through the public access system… And we know with violence and abuse, traumatic stress … and how that manifests in children.”
Many of the challenges listed fall into the categories of the social determinants of health: access to healthcare, economic conditions, neighborhood issues such as transportation and housing, educational opportunity, etc.
“We are grateful to the members of our community who took the time to share their thoughts and perspective,” said Curtis Holloman, executive director of the Foundation for a Healthy High Point. “We are also indebted to the researchers who provided such a comprehensive basis from which to develop our new Strategic Plan.
“We look forward to working together to address the underlying factors causing the long-standing health issues confronting our community,” Holloman added. He noted how much Foundation leadership agreed with the respondent who noted: “you talk about strategy; the best thing nonprofits and the philanthropic group can do is work together collaboratively … bring everybody together. And you’ve got to bring the government along with you; there are policy changes that need to take place.”