Health is more than what happens at the doctors office as illustrated in the model on the screen, a wide range of factors influences how long and how well we live from education and income to what we eat and how we move to the quality of our housing in the safety of our neighborhoods. For some people the essential elements for a healthy life are readily available. For others the opportunities for healthy choices are significantly limited with a focus on helping communities move data to action. For addressing the challenges of HealthEquity in health disparities, the County health rankings and Rd Maps project points to significant differences in health outcomes from one County to the next, an among racial and ethnic groups, HealthEquity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health, such as poverty and discrimination, and their consequences, including powerlessness. An lack of access to good jobs with fair pay. Quality education and housing. Safe environments and health care. Health disparities or differences in health or in the key determinants of health such as education, safe housing and discrimination which adversely affect marginalized or excluded groups. Studies demonstrate that social and economic factors in health behaviors, including substance abuse, diet and exercise, contribute the most to health outcomes. High utilizers of health care services are also high utilizers across other systems like housing, criminal justice and social care. The CDC views Population health management as an interdisciplinary, customizable approach that connects practiced apolosi for change to happen locally. This approach utilizes nontraditional partnerships among different sectors of the Community, public health industry, academia, healthcare, local government entities, etc. To address social and behavioral determinants of health, collectively and ultimately, to achieve positive health outcomes, simply stated. Population Health Management requires a community specific interdisciplinary approach. Do you remember the following patient and provider stories from videos? In course one at the time you were focused on examples of good quality Health Care now that you've spent some time examining the concept of population health, do you recall how these providers drew upon non medical community resources to meet the needs of their patients? Watch these again, this time noting examples of how determinants of health were addressed. Have your digital or analog paper handy to record your insights. Initially I contacted Miss Powers because. Her care manager had noted that she needed assistance with transportation, and there was also a note in the task that she was waiting to hear back from a prescription assistance program they called up and wanted to know did I need anything you know, is there anything that I needed to get better in the course of our conversation? You know, I asked you heard back from your prescription assistance program about your insulin and she had an had. Denied an. She mentioned that she hadn't purchased any insulin for herself in over a year. She had been using. Samples from her physician and family members were giving her their leftover insulin. That's what I'd have to use because I couldn't. I couldn't get any. I couldn't afford it. My heart dropped when she told me that hearing from someone I haven't filled this medication in over a year and it's a medication that they need to be healthy. That's not something I can just let go up. She actually helped me get insulin for the first time, so that's why I called my little pit bull 'cause she gets ahold of something she don't let go. Geez, not plan. She's not going to just do what she thinks I wanted to do. She's going to do it the way it's supposed to be done. She's going to do it right. She's going to make sure I get what I need to see. His tells everybody that I'm her Pitbull because she's like you know, you're just you're not going to stop you're not going to give up and you're going to keep calling and you're going to make sure that this really works out so that's I've never been called a pit bull before. Definitely she saved my life. I would be. I would not be here today. I don't think it all. If it wasn't for her helping me get my insulin, helping me, listening to me. You know, when nobody else would listen to me. You know, it was like that so. Pretty rare thing in this day and age where people actually care about somebody else. This was incredible. You know, I really feel like we helped Miss Powers. I really feel like she can help herself now and we continue to work and so it hasn't really ended. I don't think that a perfect experience is something that's just done and then you move on. I think that it's just the beginning. I think that it really is something that keeps going. Second thing is humanas around for me. They keep me going and which is great. I could never. I could never thank him enough for what they've done for me, specially my little pit bull. Thanks honey. I was asking some questions about somebody working with the situations and I was going through it and then the Kia stepped in so I was giving attached to Social service task. Miss Powell's care manager. Initially the goal was to assist her with getting compression stockings. So I reached out to her just to kind of talk about what she needed. Give her some resources and let her know how that process will work and so his family got that. I can get that boy, I can look into that for you, baby, please do 'cause I need it. I'm going to call. I'm going to research I'm going to dig up all the resources that I can. I'm going to connect you with those things and it's really my mission just to make life a little bit. Easier, this is a concerned person. An look like she could just enter in, you know? Your body and can. Can understand the situation. More so than you think she would. She takes it in everything you. And work with it. Being a health partner for life. Looks like someone who's calling an genuinely is concerned about you. It encompases different areas of our lives, so it doesn't just mean physical health and maybe mental and maybe spiritual. I'm going to assess the complete person if you tell me that there's something else going on that I'm going to assist you with that. And I really do appreciate that because. I've never really had an insurance company, but people to step in and surround me. Anne, let me to know that they're there for me. It's time me sometimes things happen that you have to normalize that because a lot of times when people are in situations they feel that it's only them. Nobody understands what they're going through. Nobody's been there, nobody's there is just them. You know I was feeling that type of way that nobody cared. Nobody loves me nobody showed love, unlike they were supposed to show toward me. Mercy step writing. Zip theater, so to have their helping hand and have someone there that can guide them that gives me so much joy to be able to do that because I'm making their life a little bit easier in reference to something that is so meaningful. We're just to know that it was somebody that step into my life. And with concern. An. It was right there for me. I would like Miss Power to know that we're here for her, that I'm here for her. Really, she's a sweetie. I love it. I'm actually currently working with her nails some other things, but it's definitely been a relationship that has progressed in. I like to think that it's been a perfect experience for her. What were some of the examples of determinants of health that were addressed in these videos? Does your list reflect the following assistance with transportation needs assistance with financial needs such as prescriptions and bills? Assistance connecting patients with community based resources and assessing the whole person by examining physical, mental and spiritual health. These providers understand the population health work of the community they are in and how to leverage resources for the patients they serve.
