>>> NEW YORK CITY, ALTHOUGH ONE

OF THE MOST AFFLUENT CITIES IN

THE WORLD, THERE ARE SOME

COMMUNITIES THAT STRUGGLE DALLY

POVERTY, LACK OF ACCESS TO

EDUCATION, FOOD INSECURITIES AND

MANY OTHER SOCIAL FACTORS THAT

CONTRIBUTE TO POOR HEALTH.

NOW THE FAMILY HEALTH CENTERS AT

NYU LANGONE ARE SEEKING TO

GENERATE BETTER HEALTH IN THE

BIG APPLE THROUGH RESEARCH AND

SERVICE PROVIDING CARE TO MORE

THAN 130,000 PEOPLE RANGING FROM

INFANTS, TEENS, ADULTS AND

SENIORS, THE CENTER IS LOOKING

AT THE BIGGER PICTURE OF HEALTH

AND WELLNESS STARTING WITH THE

IMPACT OF SOCIAL FACTORS ON

HEALTH.

AS A PART OF OUR CHASING THE

DREAM INITIATIVE ON POVERTY AND

OPPORTUNITY IN AMERICA, WE'LL

TAKE A DEEPER LOOK AT THESE

FACTORS AND THEIR ROLE.

HERE WITH MORE ON THIS AND TO

HELP US UNDERSTAND THIS, FAMILY

HEALTH CENTERS OF NYU LANGONE'S

CHIEF MEDICAL CENTER, ITS VICE

PRESIDENT OF COMMUNITY PROGRAMS

AND ITS EXECUTIVE DIRECTOR.

WELCOME TO ALL OF YOU.

>> THANK YOU.

>> THANKS FOR HAVING US.

>> AS I HAVE BEEN LEARNING ABOUT

THIS IT SEEMS LIKE SUCH A

FASCINATING INITIATIVE AND PART

OF IT SEEMS LIKE WHY HAVEN'T WE

BEEN DOING THAT BEFORE?

I'LL ASK YOU ABOUT THAT.

AND HOW IT IS THAT WE THINK THIS

IMPROVE HEALTH CARE.

HOW DID THIS GET STARTED?

>> WE ARE A FEDERALLY QUALIFIED

HEALTH CENTER.

AND THEY WERE STARTED 52 YEARS

AGO IN THE COUNTRY BECAUSE

ACCESS WAS THE ORIGINAL PROBLEM

PEOPLE HAD.

THEY DIDN'T HAVE ACCESS TO

HEALTH INSURANCE OR A DOCTOR.

SO THE FEDERAL GOVERNMENT AT

THAT TIME DID AN EXPERIMENT TO

PUT COMMUNITY-BASED CLINICS IN

UNDERSERVED AREAS.

SO 52 YEARS AGO THERE WAS NO

SUCH THING AS MEDICAID AND AT

THAT TIME YOU HAD TO COME TO THE

IVORY TOWER TO GET CARE.

YOU HAD TO MAKE THE BIG TREK TO

THE ACADEMIC MEDICAL CENTER AND

WHAT HAPPENED WAS PEOPLE WERE

NOT ENGAGED IN HEALTH CARE.

THEY WERE A NUMBER.

THEY WOULDN'T MAKE THE TRIP,

THEY WOULDN'T SEEK CARE SO ROLL

IT FORWARD 52 YEARS, NOW WE HAVE

MEDICAID, WE HAVE CLINICS IN

UNDERSERVED COMMUNITIES SO THE

ACCESS ISSUE WAS STARTING TO GO

AWAY.

SO WE'VE GOT SCHOOL-BASED

CLINICS.

WE HAVE COMMUNITY-BASED CLINICS

AND NOW YOU UNDERSTAND THE

ISSUES OF HEALTH CARE.

IT'S NOT JUST ABOUT ACCESSING

HEALTH CARE BUT UNDERSTANDING

WHO IS THAT PERSON.

SO A DOCTOR WILL WANT TO DO

CLINICALLY BEST PRACTICE

MEDICINE.

BUT HOW DO THEY APPLY IT TO THE

UNIQUE SITUATION THAT EVERY

PERSON IS IN?

TREATING A DIABETIC THAT'S

HOMELESS IS DIFFERENT THAN

TREATING A DIE BET THAT I CAN IS

IN COLLEGE.

TREATING A PREGNANT WOMAN OF A

CHINESE BACKGROUND IS DIFFERENT

THAN TREATING SOMEONE OF AN

ENGLISH BACKGROUND.

SOME CULTURES MAY ASSUME YOU

DON'T NEED TO SEE A DOCTOR AND

THAT IT'S A NATURAL CONDITION

AND YOU ONLY GO TO THE DOCTOR

BECAUSE YOU'RE SICK.

AS TIME MOVES FORWARD AND WE

LOOK AT THE UNITED STATES WHO

SPENDS MORE AND MORE OF THEIR

MONEY ON HEALTH CARE BUT THE

HEALTH OF THE POPULATION ISN'T

GETTING BETTER AND WE COMPARE

OURSELVES TO OTHER COUNTRIES WHO

SPEND LESS ON MEDICAL CARE AND

MORE ON SOCIAL SERVICES AROUND

CARE, THEY HAVE BETTER OUTCOMES

SO THAT'S WHAT LED US TO THIS

POINT.

>> THAT'S A FASCINATING PARADOX,

AND YET WHEN THE STUDIES COME

OUT IN TERMS OF WHERE WE FALL ON

THE LIST, IT'S ALWAYS STAGGERING

TO SEE WHERE WE ARE.

SO THE FIRST QUESTION IS ACCESS,

HAVE A PLACE FOR PEOPLE TO GO.

THEN YOU GET TO THIS NOTION OF

SOCIAL FACTORS AND DOCTOR LET ME

ASK YOU THIS.

AS A PHYSICIAN, AGAIN AS WE SIT

HERE AND TALK ABOUT IT YOU SAY

WELL, THAT MAKES SENSE.

IT WILL HAVE AN IMPACT ON HEALTH

BUT HAVE WE ALWAYS ACTIVELY

ENGAGED IN THAT NOTION AND TRIED

TO CREATE AND PROVIDE HEALTH

CARE THAT HAS A CORRELATION TO

SOCIAL FACTORS?

>> WELL, I WANT TO START BY

TALKING TO YOU ABOUT WHAT A

DOCTOR/PATIENT RELATIONSHIP IS.

YOU KNOW, YOU COME IN, A PATIENT

COMES IN, SEES A DOCTOR, OVER

TIME YOU GET TO KNOW EACH OTHER,

THE DOCTOR DIAGNOSIS OR

IDENTIFIES CONDITIONS PEOPLE

HAVE AND THEY CREATE A PLAN OF

CARE, THEY SAY I WANT YOU TO

TAKE THIS ANTIBIOTIC OR YOU

SHOULD SEE THIS OTHER TYPE OF

DOCTOR AND WHAT'S BEEN THE

EXPERIENCE OF FOLKS WHO WORK IN

CAN'T ACHIEVE THE GOALS SET FOR

THEM.

THEY DON'T GET THE MEDICINE FOR

A VARIETY OF REASONS GETTING TO

SEE THE NEXT DOCTORING CARE.

THEY MAY NOT -- SO WHEN YOU

START TO THINK ABOUT -- DOCTORS

HAVE RECOGNIZED THIS FOR A LONG

TIME.

WHAT WE HAVEN'T DONE IS

SYSTEMATICALLY TRIED TO IDENTIFY

WHAT THE FACTORS ARE THAT

INTERFERE WITH THESE TREATMENT

PLANS.

I'LL GIVE YOU ONE QUICK EXAMPLE,

IF YOU DON'T READ AND I GIVE YOU

A PIECE OF PAPER TELLING YOU HOW

TO TAKE CARE OF YOUR DIABETES,

IT DOESN'T GO ANYWHERE SO REALLY

WHAT KATHY PUT TOGETHER, THE

FAMILY SUPPORT CENTER, IT FILLS

IN THAT GAP.

IT HELPS BRING TO BEAR RESOURCES

THAT HAVEN'T BEEN THOUGHT OF AS

THE MEDICAL PROVIDERS' PROBLEM.

>> HOW DO YOU DO THAT.

WE UNDERSTAND THE CONCEPTS HERE

AND THEN YOU HAVE TO GET IT

DONE.

HOW DOES THAT HAPPEN?

>> INTERESTING YOU ASKED.

LIKE WHY HAVEN'T WE BEEN

ADDRESSING THESE ISSUES BEFORE

THIS BUT IN REALITY OUR

ORGANIZATION HAS BEEN ADDRESSING

THESE ISSUES FOR CLOSE TO 42, 45

YEARS, RIGHT?

EARLY ON IN THE ORGANIZATION'S

HISTORY THEY REALIZED THAT

HEALTH IS NOT ABOUT PHYSICAL

WELL-BEING.

IT'S ABOUT THE OTHER FACTORS AND

SYSTEM THAT AFFECT A PERSON'S

LIFE.

WE DON'T LIVE IN SILOS, WE LIVE

IN THE CONTEXT OF INDIVIDUAL

COMMUNITY AND FAMILY.

SO WHAT ARE SOME OF THE BARRIERS

TO CARE THAT OUR PATIENTS ARE UP

AGAINST.

HOW AS A HEALTH CARE SYSTEM CAN

WE START LOOKING AT ADDRESSING

THOSE BARRIERS.

SO OUTSIDE OF THE FOUR WALLS OF

OUR MEDICAL PRACTICE AND IN THE

HEART OF COMMUNITY WE'RE

ADDRESSING ALL OF THOSE SOCIAL

RISK FACTORS STARTING FROM

PRE-NATAL TO EARLY CHILDHOOD

CENTERS TO ADULT EDUCATION AND

WORK FORCE DEVELOPMENT TO OLDER

ADULT SERVICES.

>> WHAT, THEN, HAVE YOU FOUND?

ALL OF YOU CAN JUMP IN ON THIS.

WHAT HAVE YOU FOUND HAVE BEEN

THE MOST SIGNIFICANT BARRIERS TO

GOOD QUALITY HEALTH CARE AND

WHAT ARE THE CENTERS DOING TO

GET OVER THIS?

>> ONE IS THE WHOLE IDEA OF HOW

AM I GOING TO PAY FOR THIS.

COMMUNITY HEALTH CENTERS THAT'S

NOT AN ISSUE.

THE FIRST QUESTION OUT OF OUR

MOUTH ISN'T WHAT'S YOUR

INSURANCE PLAN.

>> AND THAT MUST BE AN ENORMOUS

RELIEF TO A LOT OF PATIENTS

COMING IN.

>> SO THAT'S A SOCIAL

DETERMINANT HEALTH FACTOR FOR

MANY PARENTS.

THEY DON'T KNOW IF THEY'LL BE

ABLE TO AFFORD THE TREATMENT

YOU'LL PRESCRIBE.

WE TAKE THAT BARRIER AWAY WE

FEEL DO THAT THROUGH A LOT OF

FEDERAL SUPPORT BUT JUST

REMOVING THAT AS THE ISSUE WILL

AFFECT WHETHER A PATIENT CAN

FOLLOW THE TREATMENT PLAN IS

VERY IMPORTANT.

ANOTHER VERY IMPORTANT THING IS

CULTURAL COMPETENCE.

IF I PATIENT FEELS YOU WON'T

UNDERSTAND THEM BECAUSE THEY

DON'T SPEAK THE LANGUAGE OR YOU

DON'T SPEAK THEIR LANGUAGE, IF

THEY COME FROM A DIFFERENT

BACKGROUND THAN THE DOCTOR DOES,

THEY MAY HAVE THIS PERCEPTION OF

YOU'RE NOT GOING TO TAKE MY

CONCERNS SERIOUSLY OR I MAY NOT

BE ABLE TO EXPRESS WHAT I'M

GOING THROUGH.

YOU KNOW THAT NEW YORK CITY HAS

MANY, MANY IMMIGRANTS AND THAT

BRINGS WITH IT A LOT OF ISSUES.

WE DON'T CARE ABOUT IMMIGRANT

STATUS.

WE CARE ABOUT YOU AS A PERSON.

WE'RE NOT TRYING TO FIGURE OUT,

YOU KNOW, WHAT YOUR CITIZENSHIP

STATUS IS.

WE'RE TRYING TO MAKE SURE YOU

CAN BE HEALTHY SO THAT YOU CAN

GET A JOB SO THAT YOU CAN

PROVIDE FOR YOUR FAMILY.

SO I WOULD SAY THAT THOSE ARE

TWO OR THREE OF THE MOST

IMPORTANT ISSUES.

>> AND THE OTHER IS REALLY HOW

DO WE -- SO WE HAVE THIS CADRE

OF SERVICES THAT ARE AVAILABLE.

EVEN OUR COMMUNITY-BASED PARTNER

WES WORK CLOSELY WITH OFFER A

LOT OF SERVICES.

HOW DO WE INTENTIONALLY CONNECT

OUR PATIENTS TO THOSE SERVICES

IN A MEANINGFUL WAY WHERE THEY

GET THE SERVICES THAT THEY ARE

ENTITLED TO AND CAN LEAD THEM ON

A BETTER TRAJECTORY TO GOOD

HEALTH OUTCOMES.

>> TALK ABOUT THE SERVICES AND

HOW AS A PHYSICIAN YOU CAN BE

INVOLVED IN THESE SERVICES.

>> I'LL GIVE YOU A CLASSIC AND

INCREDIBLE EXAMPLE.

I THINK WE DELIVERED 1600 BABIES

LAST YEAR AND WE HAD NOT BEEN

MEANINGFULLY SCREENING WOMEN TO

DETERMINE WHETHER THEY HAVE

ISSUES WITH HOUSING, FOR

EXAMPLE.

WE STARTED DOING THAT AND WE

RELATIVELY QUICKLY IDENTIFIED

THREE WOMEN WHO WERE PREGNANT

WHO DIDN'T HAVE A PLACE TO STAY.

NOW -- I MEAN, I HAVE THREE

CHILDREN.

I CAN'T IMAGINE WHAT THAT IS

LIKE SO BY CONNECTING WITH THE

FAMILY SUPPORT CENTER AND

HOUSING AGENCIES IN BROOKLYN WE

WERE ABLE TO HELP THOSE

INDIVIDUALS GET CONNECTED TO A

PLACE TO STAY.

THAT ITSELF REDUCES STRESS.

STRESS HAS ALWAYS BEEN

ASSOCIATED WITH BAD PREGNANCY

OUTCOMES AND IT ALSO SETS THE

STAGE FOR EARLY CHILDHOOD

DEVELOPMENT LATER ON.

IT HAS SUCH IMPLICATIONS SO IT'S

ABOUT -- THE ONE THING THAT IS I

THINK DIFFERENT ON THE MEDICAL

SIDE IS THAT WE'VE STARTED TO

INTENTIONALLY SCREEN OR ASK

QUESTIONS TO TRY TO IDENTIFY

SOME OF THESE FACTORS.

THAT'S LED TO A SYSTEMATIC

REVISION OF HOW WE THINK ABOUT

HOW WE'RE ASKING PEOPLE THAT

WILL LEAD TO THEIR HEALTH

OUTCOME.

>> WE TALKED ABOUT SOME OF THE

SCREENINGS.

WHAT OTHER THINGS ARE AVAILABLE?

>> FOOD INSECURITY IS ANOTHER

ISSUE.

HAVE THEY WORRIED ABOUT MEETING

RENT OBLIGATIONS AND IN ASKING

THOSE QUESTIONS AGAIN CONNECTING

PEOPLE TO BENEFITS THEY MAY BE

ENTITLED TO LIKE A WIC PROGRAM

OR FOOD STAMPS APPLICATIONS OR

IF IT'S AN EMERGENCY ISSUE THERE

ARE FOOD PANTRIES IN THE

COMMUNITY SO HELP WITH IMMEDIATE

SHORT-TERM MITIGATION BUT ALSO

LOOKING AT HOW ON A LONG TERM

CAN WE INCREASE THIS FAMILY'S

RESOURCES SO THAT FOOD

INSECURITY WILL NOT BE AN ISSUE

TO THEM AND KNOWING THAT FOOD

INSECURITY AFFECTS SOMEONE'S

DIABETES STATUS, AFFECTS WEIGHTS

OF CHILDHOOD OBESITY.

>> ALL INTERCONNECTED.

PART OF THE FABRIC OF THEIR

LIVES, I WOULD THINK.

WE KNOW THAT NYU LANGONE HAS HAD

A LONG AND RICH TRADITION OF

CARING FOR MEMBERS OF ITS

COMMUNITY AND I THINK FAMILY

HEALTH CENTER IS ANOTHER

ILLUSTRATION OF THE WORK THEY'RE

DOING.

FABULOUS WORK MUCH TO BE DONE

I'M SURE AS YOU KNOW BUT WE HAVE

TO GET STARTED SOMEPLACE.

HOPEFULLY THIS WILL BECOME A

MODEL FOR OTHER HOSPITALS

THROUGHOUT THE COUNTRY.

I WANT TO THANK YOU FOR SPENDING

TIME AND SHARING YOUR THOUGHTS

AND WE'LL CHECK BACK IN AND SEE

HOW THINGS ARE GOING.

>> THANKS SO MUCH.

>> BE WELL.