When thinking about health care, most people primarily factor doctors’ visits into the equation. But Dr. Roopa Thakur, a pediatrician and associate program director of the Pediatric Residency Program with the Cleveland Clinic, urges journalists to focus on the root causes of poor health in communities. “Only 20% of a population’s health is determined by the clinical care that it receives,” she said. “Policies and programs that influence the physical environment and socioeconomic factors can have more than double that impact.” Combined with the individual choices people make based on their available resources, the path to optimal health is blocked for most Americans. Thakur discussed the strategies used by the Cleveland Clinic to build trusting relationships in communities and prevent serious health issues from developing. [Transcript | Video]
5 takeaways:
➀ Meet children where they are.
“Kids aren’t necessarily walking into our doors to begin with,” Thakur said. “Especially during the pandemic, our well-child visit rates dropped. We are still not quite back up to 2019 levels. So maybe we need to go to those kids rather than expecting them to come to us.” In schools, clinicians can provide yearly physicals, immunizations, and age-appropriate screenings. Health programs in schools can help children develop healthy habits to strengthen their mental and physical health before they would need to see a doctor.
In one school-based program, a mental health provider teaches children mindfulness, signs of anxiety and mood swings to help students manage their emotions. Medical students at the Cleveland Clinic’s Lerner College of Medicine “have developed a curriculum around hygiene and healthy habits” to help the school, too. School-based programs can also screen children for lead exposure, including young children enrolled in childcare centers.
➁ It pays to improve health.
Efforts to reduce exposure to lead in old houses provide economic and social benefits. “Ohio has the third-highest percentage of elevated blood lead levels in the country, and that 41% of those children live in Cuyahoga County,” Thakur said. When lead enters a child’s bloodstream, it can result in decreased bone and muscle growth, nervous system damage, hearing loss, ADHD and developmental delays. Children exposed to lead are 27% less likely to be on track for kindergarten, and teens are 25-30% more likely to enter the juvenile justice system.
While doctors can screen and test children for lead, they’re still “identifying those kids when it’s too late,” Thakur said. Lead abatement that removes it from the system entirely is preferable. “For every $1 spent on lead abatement, there’s a minimum of $17 return on investment, and that’s pretty conservative,” Thakur said. “When efforts are targeted in high-risk communities, like the city of Cleveland, the return on investment can reach as high as $221.”
➂ Food security is a community responsibility.
Approximately 9 million children across the U.S. experience food insecurity, Thakur said. Furthermore, food insecurity “disproportionately affects Black and Latino youth.” Thakur said to combat food insecurity, which is especially high in Cuyahoga County, children who receive care in the Cleveland Clinic’s primary care and OB departments receive food insecurity screening at least once annually. From there, community health workers help enroll food insecure patients in welfare programs like the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), connecting them with Cleveland Clinic and other food assistance options.
➃ Group healthcare can yield better results for everyone.
To combat Cleveland’s high infant mortality rates, the Centering Pregnancy and Centering Parenting programs allow mothers in roughly the same stage of pregnancy to attend “shared medical appointments.” They can learn from the medical provider and from the other mothers in the appointment. Community health workers are often involved in appointments. “It really forms kind of a support network, with that community health worker acting as kind of glue for the group, and handholding through a lot of the issues that they might face in those two years of pregnancy in the first year of life,” Thakur said.”
➄ Partnerships between the medical and legal professions can improve outcomes for patients.
Those partnerships integrate legal expertise into primary care, which can improve health outcomes, reduce the frequency of hospital admissions, and reduce stress. “In this model, lawyers and paralegals are embedded in our primary care practices,” Thakur said. These partnerships can provide free legal services to low-income patients, removing the legal barrier to health. Lawyers involved in healthcare can also advocate for patients’ rights in cases like inheritance, healthcare proxy and guardianship. Legal aid partners can also help families navigate 504 plans for children with disabilities.
This fellowship is funded by the David and Lucile Packard Foundation, the W.K. Kellogg Foundation and the Heising-Simons Foundation. NPF is solely responsible for programming and content.
