Understanding Community Health and Health Equity: Insights from Keely Gallagher

hi my name is Keely Gallagher and I said I am the community health coordinator at Advocate Good Shepherd Hospital before

that I did work at a local health department and I have about 15 years of experience in community health so what

is community health I can tell you that when I ask people what community health is I hear about flu shot clinics or

covid-19 testing or going to a Health Resource fair and getting a bunch of free stuff which is great and it is a

small part of what we do in community health but Community Health has really changed

and evolved over the last several decades and had much more of a focus on Health Equity and addressing social

influences in the community and looking at root cause issues of Health and we're in an interesting time right

now because looking at coming out of covid-19 and out of this pandemic there's been so much more of a focus on

Community Health but it's also highlighted disparities of Health within populations and given us a really great

opportunity to talk about what Health Equity is and so that is why I chose that for my talk this evening

so starting out what is health what's the Baseline health is a state of complete physical social and mental

well-being and not merely the absence of disease this is the World Health Organization definition it's the one

I've seen most widely used for health definition I will point out that it does not include spiritual and cultural

health and a lot of other health definitions do and I think those are extremely important to note

so then what is Health Equity Health Equity is achieved when no one person is disadvantaged from achieving their full

health potential because of social position and social determinants of health so what are some of the examples

of then Health Equity it is your life expectancy it is the quality of that life it is rates of disease it can be

disabilities and when I see disabilities I'm not just looking at what is the rate of a disability within a population but

are those disabilities being addressed also mortality rates severity of disease and access to treatment so like

disabilities is there just a high rate of disease or are we actually treating those diseases and this whole list that

I just went through that's not just individuals it's also a zip code what is the life expectancy of this person but

also what's the average life expectancy in the zip code looking at disparities in other populations what's the life

expectancy for his Annex in the United States versus the white population or males versus females so really

dissecting what that looks like and I will tell you that when we look at health and equities most of the time

it's racial and ethnic minority groups that are disproportionately affected and covid-19 is the perfect example

unfortunately but when you look at the kova 19 pandemic and who is affected by you can look at case rates mortality

rates socioeconomic factors on who got that who took on the biggest burden of

covid-19 you will see that it was people of color it was lower income individuals it is households with lower education

those that are food insecure those that live in crowded housing examples like those

and so another thing that I always like to point out when I talk about Equity is what the differences are with equality

and Equity so a lot of times the knee-jerk reaction when we see any kind of disparity is immediately to go well

we need to make things equal we want equality and that makes complete sense that that's what you would want to do

but having that just making things equal is not always what works out unfortunately and I do have a Graphic

that you'll see now and it is from the CDC and it's one that I always like to include when I discuss any kind of

equity and that is so on the top you will see everyone received a bike to be on the path of Health we made it equal

everyone gets a fair bike it's all the same but you will see in the graphic that the first person in the wheelchair

can't even get on the bike to ride and the second person is completely hunched over knees up can barely ride the third

person is able to ride the bike but the child can't even reach the pedals so the equality one size fits all did not work

but when we looked at equity and everyone got exactly what they needed for their individual needs everyone was

able to be on the path to receive Optimal Health and that is the goal looking at the impact of social

determinants of Health that looks at your economic your social and your environmental factors that go into what

makes a person healthy so let's look into that a little bit more so in your socioeconomic factors what are those

those are your income it is your job status it is your education and that all goes into your socioeconomic status that

is 40 of what makes a person healthy which is interesting because when you think about what makes a person healthy

you most the time don't think about your job I will say that research most of the

time shows that when you do look at those socioeconomic factors the number one that comes to the Forefront is

childhood poverty and that is because childhood poverty has such a trickle effect if you grow up in poverty you are

much more likely to have a hard time in grade school if you have a hard time in grade school you have a very difficult

time graduating high school if you don't graduate high school you have a very difficult time of getting a nice paying

job live in a safe community and that is that trickle effect next is your physical environment your

physical environment encompasses 10 of what makes a person healthy your physical environment is the built

environment around you it's your Korean spaces it's your sidewalks it's your safe Community it is anything that is

around you physically healthy behaviors healthy behaviors encompasses 30 of what makes a person

healthy those are the choices you make it's the behaviors you do out in the world it is if you use tobacco it is if

you vape use recreational drugs if you exercise regularly if you have a strong diet or if you're having fast food and

healthy foods that all goes into your behaviors that is 30 percent Health Care Health Care only takes in 20

percent and that's so interesting surveys have shown that if you ask someone what makes a healthy person they

are going to tell you going to the doctor getting my regular screenings making sure that I'm okay once a year

and that's only 20 of what makes a person healthy it's still extremely important it's 20 I don't want to say

access to care is not important but if you look at those socioeconomic factors almost everything ties back into those

and I will show you because of Health Care so we live in the United States most the time Health Care the gateway to

Health Care is health insurance most people have health insurance through their employer so that wraps up back to

your socioeconomic your socioeconomic you need a full-time job most the time in the United States to get health

coverage so that ties into did you have a college degree what kind of job can you get and it ties back into education

looking at your physical environment for physical environment most the time you can afford safe housing and a safe

neighborhood if you have a good paying job you got the good paying job by having a quality education it goes back

to your socioeconomic factors and then your health behaviors that is if you have a nice paying job you're able to

afford a gym membership you have access to fruits and vegetables you have access to a clean safe environment to live in

to work out so it all really does tie back to the socioeconomic factors so what can be done as a community I do see

quite a few presentations that well this is Health Equity these are the inequalities you know good luck with it

but I do want to show that there are changes moving forward and those changes are to working with everyone together

and what are we looking at how do we achieve Health Equity it is shifting from programs to PSE change and that is

policies systems and environments so let's use an example of teens and trying to keep them away from tobacco and

vaping and giving education now if we have a program the program let's say is teens against

tobacco and it's a one-hour educational series for one month and so that is going to be a behavior modification

you're telling them about the dangers of tobacco why to stay away from it first of all

telling any kind of behavior modification is extremely difficult to achieve even when you have all the

education in the world behavior modification might be the one of the most difficult things to tackle

in healthcare it's also time bound you're only going to be able to affect the people that

came to that program were able to make the series it's also short term Studies have shown that any kind of program that

has education normally lasts about three months the person forgets about it it's kind of like diets you know you need to

lose weight three months later like I'll be fine and it's also targeting an individual let's say 15 to 20 kids were

able to attend the program it's only going to affect the 10 to 20 kids that affected the program

now let's look at a policy system and environment so that has a long-term change an example of this would be in

Illinois outlying flavored vaping products and also outlying marketing for teens and children for Vaping products

let's also look at Illinois tobacco 21. those are large programs they are long-standing the governor signed them

it would be very difficult to get rid of them they're structural changes they are ongoing they don't have an end date and

they also Target the entire community and for these examples that targets all of the youth in Illinois or any youth

that comes into Illinois targets parents it targets everyone and so that little change makes a huge difference when you

compare it to programs so this just gives a little bit more of examples of program policy and systems so a program

would be a 5K run um you talk about obesity you have a 5K run I don't want to take anything away

from 5K runs I think that they can be great they're a weight great way to get out and exercise they're social

emotional seeing people they have their purpose but they certainly aren't going to move the needle on anything another

example would be taking teaching classes on how to cook fruits and vegetables again I think that's wonderful I saw at

a local farmers market where someone was teaching people how to make zucchini and squash I think that's great a lot of

people don't know how to cook certain types of vegetables that has its place but it's only going to affect the people

that were there and that short amount of time if you look at a policy a policy would be keeping PE in physical

education and all of Illinois schools or the Illinois 21 that I brought up or having ordinances for sidewalks for be

able to get to A to B safely that is effect that's a policy that's going to affect everyone and that is

long-standing looking at systems an example of a system would be employers or insurance companies paying for gym

memberships to keep people healthy so it's not a financial burden for them and it's also allowing WIC and snap to be

used at farmers markets and that is a targeted systematic change that is mothers with children who need fruits

and vegetables at the home giving them free access to healthy foods environmental changes like I said that

is your built environment that is having open Community Gardens where people can go and they can have their make their

own fruits and vegetables and grow those it is also having physical equipment in green spaces and I'll tell you I've seen

so much more of that where in the middle of a park you see a gym and my kids ask me what that is and you can you have

free Green Space to walk work out and so those are also environmental changes another example would be sidewalks and

ramps that are Ada accessible sidewalks for people that are disabled those are environmental changes and those make the

biggest impact uh with this I do want to say that Healthcare systems are also looking at

this and this is just an example of what Advocate Aurora is doing but I will let you know that other Healthcare systems

are in the same boat looking at the same things while we do clinics while we do flu shots while we are looking at

vaccines the things that when people think of Community Health we are still doing a small piece of those but we're

also doing food insecurity because food insecurity actually does it leads to obesity at least to a lot of other

chronic issues we are looking at Workforce Development because we know that when there's high unemployment

rates or people aren't insured or people aren't employed they're more likely to be unhealthy we're going to look at

housing we are looking at access to Behavioral Health Community safety and we are also looking at where people can

have access to All Care all Health Care uh with this I do want to say that Health disparities and Health Equity

they are huge Concepts and there are whole college classes dedicated to even just explaining what Health Equity is I

took those when I was getting my Master's in public health so this is a very condensed way to describe it but I

do want to say that we can move a needle it takes decades to make these huge systematic changes but they absolutely

can be made but it takes a multi-sector multi-layer approach and when I say that multi-sector it takes the Health Care

Systems moving in One Direction it takes education moving our local Health departments our state government our

local libraries our non-for-profits if we are all moving in the same direction we will absolutely move the needle and

again when I say multi-layer those programs in the community are absolutely important and they will reach people but

also looking at that multi-layer of policy complementing it with screenings called preliminating it with

environmental changes and that's how you move the needle forward