Population Health Blog

Population Health Blog

Why It Matters

Philanthropists need to invest in solutions, not symptoms of distress

By Dennis Archambault

As the biblical story goes, it is better to teach someone to fish rather than give them some fish. Some leaders in the philanthropic sector are beginning to channel their support addressing the root causes of the social symptoms they would otherwise try to mitigate. With population health there are a lot of areas where philanthropic leadership could be beneficial.

In his commentary, “Why Giving Back Isn’t Enough” published in The New York Times on Dec. 17 (http://www.nytimes.com/2015/12/18/opinion/why-giving-back-isnt-enough.html?_r=0), Darren Walker, president of the Ford Foundation (https://www.fordfoundation.org/), reminds us of Dr. Martin Luther King, Jr.’s cautionary words: “Philanthropy is commendable, but it must not cause the philanthropist to overlook the circumstances of economic injustice which make philanthropy necessary.”

Indeed, Crain’s Detroit Business within the past week published an article that harkens back to the “Walking Man” saga of earlier in 2015: “Making it work for workers: Employers aim to retain low income employees, improve bottom line” (http://www.crainsdetroit.com/article/20151213/NEWS/312139982/making-it-work-for-workers-employers-aim-to-retain-low-income). Transportation, housing, child care, mental health — these are among the factors that undercut the efforts by low income people to work, which in itself is a critical determinant of health.

Walker’s comments challenge philanthropists to adopt a new “Gospel of Wealth,” which addresses “the underlying causes that perpetuate human suffering. In other words, philanthropy can no longer grapple simply with what is happening in the world, but also with how and why.

The Kellogg Foundation has certainly been in the forefront of this by exploring the impact of structural racism on the well-being of America’s poor. By supporting programs such as the Nurse-Family Partnership, which helps build strong character traits in first time mothers while contributing to healthy birth outcomes, and the Population Health Council, sponsored by Authority Health, in its efforts to generate local health policy solutions.

Walker advocates for the philanthropist to assume the role of activist, or at least support activists: “We, as foundations and individuals, should fund people, their ideas and organizations that are capable of addressing deep-rooted injustice. We should ensure that the voices of those most affected by injustice — women, racial minorities, the poor, religious and ethnic minorities and L.G.B.T. individuals — help decide where and what philanthropy puts money behind, not in simply receiving whatever philanthropy decides to give them.”

The idea of a safety net may be passé — or at least not the objective. People shouldn’t fall, to begin with. Funders, through strategic investment in the social and health infrastructure, are in a position to create a healthier environment, on all levels.

Dennis Archambault is director, Public Affairs, of Authority Health, which sponsors the Population Health Council.

Defining a role for social workers in chronic disease management

By Dennis Archambault

Discussion around care management for chronically ill populations, within practice groups and among various constituent groups has grown considerably in recent years. There has been considerable discussion about the role of nurse clinicians as care managers, but from another perspective medical social workers are in a position to assess needs, identify resources, and motivate client behavior. I looked at this role in a blog post submitted to the Wayne State University School of Social Work: http://agingnthed.weebly.com/blog.

Dennis Archambault is director, Public Affairs, for Authority Health.

Connectivity helps address chronic stress

By Dennis Archambault

We have found ourselves in a new age of anxiety. As the New York Times phrased it: “The killings are happening too often. Bunched too close together. At places you would never imagine. As the long roll call of mass shootings added a prosaic holiday party in San Bernardino, Calif., to its list, a wide swath of America’s populace finds itself engulfed in a collective fear.”

Collective fear, resulting chronic stress, is a condition low income and minority communities have known, more-or-less, as an ongoing condition of life. Not to diminish the anxiety produced by domestic terrorism — regardless of its ideological roots — chronic stress is a social determinant that needs to be considered high in the hierarchy of threats to population health.

Social and public health research have correlated life stress with negative health indications and health inequity. Most recently, “Cumulative Neighborhood Risk of Psychosocial Stress and Alostatic Load in Adolescents,” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3530361/

A 2007 article in the journal Psychiatry, “Social Support and Resilience to Stress,” notes that social support is exceptionally important for maintaining good physical and mental health. Overall, it appears that positive social support of high quality can enhance resilience to stress, help protect against developing trauma-related psychopathology, decrease the functional consequences of trauma-induced disorders, such as posttraumatic stress disorder (PTSD), and reduce medical morbidity and mortality.1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/

A 2013 article in the journal BMC Public Health poses the question, “Is volunteering a public health intervention?”http://www.biomedcentral.com/1471-2458/13/773:

Research has associated volunteering with increased longevity; improved ability to carry out activities of daily living; better health coping mechanisms; adoption of healthy lifestyles; and improved quality of life, social support, interaction, and self-esteem, according to the article. Reductions in depression, stress, hospitalization, pain and psychological distress in volunteers were also reported.”

In the past two decades, American culture has been evolving into more of a virtual society, from the creation of “friends” on social media to creating an online retail economy that has significantly changed the communal shopping experience. This withdrawl from the town square can lead to diminished socialization — just at a time when it’s needed the most.

As the New York Times headline warns, “Fear in the Air, Americans Look Over Their Shoulders,” the social stress that comes from mass anxiety could not only result in paranoia, it could diminish health status on a massive level.

This suggests that efforts should be made to encourage constructive socialization — to create “connectedness” in a fragmented society.

Edge Magazine, this past September, published an essay written by Kathy Parkin on “Connectedness through Volunteering.” http://www.edgemagazine.net/2015/09/connectedness-through-volunteering/. Parkin writes about how she was transformed through the otherwise mundane act of counting and labeling trees for the Portland, Oregon, Parks and Recreation Department. While the project mattered to the recreation department, Parkin noted the greater gain was hers:

“I learned how to cooperate with people I didn’t know, as well as learning about tree identification.” She also volunteers for the county library system, which she says is “a community center for people of all kinds,” a neighborhood community center called “Friendly House,” and delivers groceries to a senior high rise building through a non-profit. “By nature, I am really quite a solitary person, but I love the feeling of being connected with other people in the way that volunteering brings…”

In an age of anxiety, volunteerism may not only fill voids in the social safety net, it could be a way of improving population health.

Dennis Archambault is director of Public Affairs for Authority Health.