Dr. Jay Bhatt has dedicated his entire career to ending healthcare disparities. Through his extensive research and grassroots initiatives, Bhatt, leader of the Deloitte Center for Health Solutions and Deloitte Health Equity Institute, has been on the frontlines of this fight for years.
Bhatt’s experiences have led him to conclude that community-based ecosystems (CBEs) are a key component for victory.
Also known as place-based networks, these CBEs Bhatt has seen work wonders in multiple cities and are headed to Houston if Bhatt has his way. According to him, Houston is the perfect place to unleash this potential healthcare game-changer.
WHAT IS A COMMUNITY-BASED ECOSYSTEM
As the name suggests, CBEs are all about community.
“Hospitals and health systems and other health plans have been long at the heart of delivering care,” said Bhatt. “But now, as consumers, patients, and families move closer to the center, really the focal point, trusted organizations in the community are beginning to play a more significant role. With CBEs, health equity is everybody’s business.”
As health systems move to meet people where they are (in the community), Bhatt says CBEs provide education, care delivery, instill trust and break down barriers much more effectively than health providers alone because community entities have a much larger impact on the social, economic, and environmental factors that can make health less equitable, i.e. the drivers of health, such as lack of access to fresh, affordable, healthy food, or lack of transportation, or lack of access to jobs or education.
Bhatt says community-based organizations include a wide range of nontraditional players beyond health systems and health plans, such as churches, YMCAs, food banks, urban gardens, and transportation companies, which can offer huge improvements to health outcomes.
“We know that the drivers of health, to others known as social determinants of health, affect up to 80% of health outcomes. So, 80% of health outcomes for an individual are impacted by these issues of environment, food, housing, isolation, financial security, and jobs. And 20% are related to clinical care,” added Bhatt, again emphasizing the need for CBEs.
COST OF HEALTHCARE INEQUITIES
Current healthcare inequities are not only costing the lives of the nation’s have-nots, they cost the country $320 billion annually. That bill is set to grow to $1 trillion annually by 2040, creating an untenable situation for not just the nation’s less economically well-off, but everyone. According to the Deloitte article “US health care can’t afford health inequities,” “Inequities across the US health system limit underserved people’s access to affordable, high-quality care, create avoidable costs and financial waste that span society, and impact every individual’s potential to achieve health and well-being.” [AW1] [AW2]
The article continues, “This avoidable expense (in dollars and lives) is the result of an inequitable health system and could have major consequences for the health and well-being of all individuals. No individual, family, or health system is equipped to sustain that kind of inefficiency and its implications.”
In other words, the groups suffering the most from healthcare inequities – Black and Latinx persons of all socio-economic backgrounds, poor whites, LGBTQ+ persons, the disabled and the “poor,” a demographic predominantly made up of women and children – will not be the only ones who see their current level of healthcare access and quality decrease as the cost of these inequities continue to rise.
According to Pierre Theodore, MD, vice president of health disparities, Johnson & Johnson Global Public Health, “When you address inequities for one population, you raise health for all populations.”
That’s exactly what Bhatt wants to do via the CBE approach to healthcare.
THE STATS
Here are some numbers to consider when thinking about healthcare inequities:
- High blood pressure is common in 33% vs. 22% of Blacks aged 35-49 years compared to whites.
- Diabetes is common in 10% of Blacks aged 35-49 compared to 6% of whites.
- Stroke affects 2% of Blacks compared to 1% of whites aged 35-49 and 7% vs. 4%, respectively, of those aged 50-64.
- The CDC contends that social factors adversely impact Blacks at younger ages compared to whites, including unemployment, living in poverty, not owning a home, cost-prohibitive effects of trying to see an MD, smoking, inactive lifestyle, or obesity.
- A Cigna white paper noted Blacks are 20% more likely than whites to report psychological distress and 50% less likely to receive mental health treatment.
- Per the American Cancer Society, Blacks have the highest death rate and shortest survival for most cancers, though the overall cancer death rate for Blacks has dropped faster than it has for whites since 1990.
- The Office of Minority Health says Blacks (nearly 13% of the U.S. population) make up roughly 33% of all US patients receiving dialysis due to kidney failure.
Alan R. Nelson, MD, chair of the IOM Committee on Understanding Racial and Ethnic Disparities in Health Care, summarizes these numbers and the focus on them as follows: “The real challenge lies not in debating whether disparities exist, but in developing and implementing strategies to reduce and eliminate them.”
HOUSTON, WE HAVE THE INGREDIENTS
Even though the state of healthcare access in Houston, with its Texas Medical Center and other health systems, can be described as medical apartheid, Bayou City has all the ingredients necessary to create the nation’s exemplary community-based ecosystem.
Houston also has Bhatt’s attention.
“Houston is one of those other places we’re looking at, as well as other cities around the country, to bring public/private stakeholders together and show that, again, as we have in other communities, that this model can work,” he said.
Here are just a few of the “ingredients” Houston possesses:
Health Systems
· Texas Medical Center
· Expanding Harris Health System institutions
Urban Gardens
· Alabama Urban Garden
· Blodgett Urban Garden
· Fifth Ward Urban Garden
· Northeast Houston Community Garden
Efforts to Fight Food Insecurity
· PVAMU’s Mobile Kitchen: fighting food insecurity
· Target Hunger Mobile Food Pantry
· Sunnyside’s Fresh Houwse Grocery fights food desert
Holistic Wellness
· Community Wellness Initiative
· Dr. Baxter Montgomery & Montgomery Heart & Wellness Center
· Dr. Willie Mae Lewis & Women’s Resource Center, Inc.
· Jennifer Jones & JENuine Nutrition
Business Partnerships
Mental Health
· Dr. Alauna Curry & The Trauma C.U.R.E.
Current Partnerships
· PVAMU, COH Healthy Houston Initiative
Educational Initiatives
· TSU’s new Center for Transformative Health
· State of Black Women Health Forum by the Defender Network
· Trinity UMC: Farmers Market & Mini-Health Fair every 4th Saturday of the month
· Trinity East UMC: Outreach Food Pantry four times a month
· Riverside UMC: Food Pantry every 2nd & 4th Saturday of the month from 9 a.m. – noon. Riverside also grows a community Garden done in partnership with UH students.
· Good Hope Missionary Baptist: Food Pantry every Saturday from 9 a.m. – noon.
· Church Without Walls: Monthly #WeServe Community Drive-Thru Food Fair. Annual Community Fall Festival & Health and Wellness Fair.
· Wesley AME Church: Periodic chef-led lessons in preparing healthy meals.
· St. Mary’s UMC: Offers Senior Boxes, food care packages for the elderly.
· Shrine of the Black Madonna: Host of We Are One Mobile Food Pantry organized by the Foundation for Black Heritage and Culture every 1st and 3rd Saturday from 11 a.m. – 2 p.m.
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