>>> 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.