Betty Priskorn has seen many efforts to promote healthy communities as a healthcare administrator. But she hadn’t seen much progress. So she decided to organize communities, one at a time.
Working for Oakwood Healthcare in 2014 (the health system later merged with Beaumont Health), Priskorn was responsible for overseeing community health needs assessments (CHNA) as required by the Affordable Care Act. These surveys identify chronic diseases such as heart disease and diabetes, as well as health risks like obesity affecting people living in the vicinity of Oakwood hospitals. The healthy community initiatives are the health system's method of responding to community health needs.
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Betty Priskom. Photo by David Lewinski.
Beginning with Dearborn, then expanding to Trenton, Taylor, and Wayne, Priskorn's staff organized community opinion leaders around priority issues. Each community developed its own "healthy community" initiative, led by the city's elected leadership and including representatives from schools, faith-based, employers, restaurants and food retailers, and residents. Each initiative has its local flavor and unique activities.
Healthy community initiatives require the active involvement of civic leaders but are not directed by them. Nor are they hospital-directed. They are organized at the community level and "owned" by the citizenry. The funding portfolio varies, relying on leveraging community assets.
"None of us can improve health alone," says Priskorn, now vice president of Community Health and Outreach for Beaumont Health. The challenge is complicated by the many factors that affect health -- known as social determinants -- such as poor housing, lack of transportation, unemployment, and inadequate access to good food.
She cites the Harlem Children’s Zone Project as a model for her healthy communities initiatives. The project is a collaboration among many different groups that work to improve health and social well-being, cooperating in areas of sharing information and partnering in program development.
Beaumont Health was recognized this year by the Michigan Health and Hospital Association and the Michigan Fitness Foundation for these initiatives.
The challenge is enormous in Wayne County, which has the worst health rankings of any county in Michigan, according to the annual Robert Wood Johnson Foundation County Health Rankings.
St. Mary Mercy Hospital, based in Livonia, established Healthy Livonia in 2016 and has chosen to develop its healthy community project slowly, building a strong collaborative with members of the Livonia Chamber of Commerce, Livonia city administration and parks and recreation staff, and Livonia Public Schools, according to Michaeline Raczka, the hospital’s director of Community Health. The initiative will expand this base to other sectors of the community. Healthy Livonia has leveraged existing programs, like a 5k race/walk, and is planning new initiatives.
"We want to build on the successes that are already there," Raczka says. The hospital’s community health needs assessments looks not only at the needs in the community, but it’s assets," she says. "We look at what kinds of nutrition programs are there. What kinds of farmers markets? Are their walking programs...exercise programs? What kinds of youth services are there? We look at health in the broad sense."
Raczka’s cites the "Blue Zones" approach to healthy living as a model used by Healthy Livonia. Blue Zones views health beyond disease treatment and prevention, she says. "There are a lot of assets that combined (can) spark something huge."
Mental health concerns
Needs assessments in both communities identified mental health as a concern; While it may not be as clearly identifiable as diabetes or hypertension, mental health comes out indirectly through focus group interviews as "loneliness" or "social isolation." The problem is significant enough that Priskorn expects mental health to become identified as a major concern in her next round of assessments.
This, coupled with the cumulative impact of toxic stress, makes mental health a sort of hidden malady -- evident to those who are diagnosed or otherwise in therapy, but also impacting many others.
"We know that social isolation has the same impact on people as 15 cigarettes a day," Priskorn says, citing the research by Dr. Julianne Holt-Lunstad. Seemingly elementary activities such as walking and promote socialization, promoted by healthy communities, can improve psychological, as well as physical well-being.
Public policy impact
Getting elected leaders involved in healthy communities creates a channel for public policy change, from creating safe, non-motorized pathways, to considering health in all policies approaches to assessing health impact.
Priskorn cites the early adoption of the healthy communities by mayors John O’Reilly of Dearborn and Kyle Stack of Trenton. Raczka says Livonia mayor Dennis Wright has also been an active proponent of the Healthy Livonia initiative. Several healthy communities are working with their city administrations to establish safe, non-motorized transportation systems. Municipal support has also helped healthy communities stage runs, walks, group cycling, farmer’s markets, park-based fitness events, and health fairs.
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Micaeline Raczka. Photo by David Lewinski.
Livonia’s strategy of slow growth and leverage existing activities has given the initiative a strong foundation, Raczka says. On July 11, Healthy Livonia launched its first new project, a universally accessible playspace, financed by the Rotary Club of Dearborn, the Michigan Economic Development Corporation, and Healthy Livonia.
Last year, St. Mary’s donated corporate memberships to the Livonia Recreation Center, allowing 45 families to use the facility free for eight months. 230 residents took advantage of the program resulting in over 1,000 facility visits. The program is continuing this year.
Sustainability
Financial stability is perhaps the most significant challenge for community health efforts. The Beaumont and St. Mary’s initiatives each rely on a backbone commitment by the health systems, which are leveraging their charitable funds and engaging other foundations and individual funders to support the cause.
Raczka and Priskorn believe a culture of health is emerging, but it’s difficult to demonstrate evidence in broad measurements such as the county health rankings.
"You measure it by seeing people out and about, riding and walking," Raczka says. "It’s about attitude, knowledge, and behaviors. You’re starting to see an awareness. As we start to talk more about Healthy Livonia, that increases awareness. Just the conversation (about) health is important."
It’s not going to happen in one year, or even five years, Priskorn says.
"I do see a culture of health emerging," Priskorn says. "We have a long way to go to make large-scale change in health. With the different political environments, sometimes you make progress and sometimes it stalls.
"This is going to take a long time."
This article is part of the Culture of Health series about programs that foster a healthy, equitable culture in Wayne County. It is made possible with funding from Wayne County. Read more of the series here.