Population Health Blog

Population Health Blog

Why It Matters

Addressing toxic stress among immigrant populations

By Dennis Archambault

The immigrant experience in America has never been comfortable. However, a recent analysis of current immigrants from Latino and Muslim backgrounds has shown high, persistent toxic stress, causing health providers to project long-term consequences. As we learn more about the correlation between oppressive stress and health, we’re challenged to identify solutions.

The Kaiser Family Foundation has published an issue brief on the topic, “Living in an Immigrant Family in America: How Feear and Toxic Stress are Affecting Daily Life, Well-being, & Health. (https://www.kff.org/disparities-policy/issue-brief/living-in-an-immigrant-family-in-america-how-fear-and-toxic-stress-are-affecting-daily-life-well-being-health/?utm_campaign=KFF-2017-December-Immigrant-Families-Lawfully-Undocumented&utm_medium=email&_hsenc=p2ANqtz-8xI-zjSyEnYAmzKe6jnP2CY_kFRn5345TQyL7bITQBtN1Fq5lSNAqyaVfwortyfzUUKjYRE2DWRV-8hLhc1s3dHMU2eg&_hsmi=59313422&utm_content=59313422&utm_source=hs_email&hsCtaTracking=1196ea7e-a1b6-40eb-a050-e5c7a95a7e6b%7C97ced1cb-5293-47c5-b9f0-10dca70ce629)  As one pediatrician noted in the document, “When you’re worried every day that your parents are going to be taken away or that your family will be split up, that really is a form of toxic stress…we know that it’s going to have long-term implications for heart disease, for health outcomes for these children in adulthood.”

As this issue gains greater exposure, mental health, public health, and integrated primary care providers will become more engaged in solutions. The problem is, most solutions require some funding. Whether it’s increasing access to community mental health services or community organizing around resilience, population health comes at a cost. Unfortunately, we’re more concerned about limiting access for immigrants, than creating a healthy environment for those who are here.

Immigrants have always helped define the future of America. If the current wave of immigrants is crippled by untreated toxic stress, the cost to society will be much greater than addressing issues today.

Dennis Archambault is vice president of Public Affairs for Authority Health. Authority Health will be hosting a population health forum on toxic stress and resilience in April 2018.

Anticipating an epidemic among socially isolated older adults

By Dennis Archambault

“I want to be alone.”

– Greta Garbo

There’s really nothing new in the recent New York Times headline, “How Loneliness Affects Our Health,” except a reference in the body of the article (https://www.nytimes.com/2017/12/11/well/mind/how-loneliness-affects-our-health.html?_r=0) that it is a “growing epidemic.”

Social isolation is a problem for anyone. It affects one’s ability to thrive in incremental ways, sometimes impacting mental health and overall wellness. For older adults, isolation from social engagement — work, society, family — not only contributes to depression, but has a biochemical impact, “raising the levels of stress hormones and inflammation, which in turn can increase the risk of heart disease, arthritis, Type 2 diabetes, dementia and even suicide attempts.”

It’s not that social isolation itself is the trigger for health issues. The article notes, “People can be socially isolated and not feel lonely; they simply prefer a more hermitic existing. Likewise, people can feel lonely even when surrounded by lots of people, especially if the relationships are not emotionally rewarding.”

We became acutely aware of this risk when the Griswold Building was converted from a HUD-underwritten low income senior apartment building to a market-rate apartment. One hundred and fifteen residents were evicted, most of them frail elderly. The trauma of the dislocation was profound. But the situation raised the question, how was the quality of the mental and physical health of these residents? Not being in a structured senior community, social isolation was likely to be profound. How do we address the well-being of this population as America ages. Virtual connectivity may help establishing linkages, but it doesn’t replace the mental and physical quality of real time human engagement.

While the researchers conclude that loneliness is not limited to the frail elderly, the disconnectedness of society is certain to increase and with it the challenge of maintaining the health of this population.

Dennis Archambault is vice president, Public Affairs, for Authority Health.

Kaiser: Time for health systems to help mitigate social determinants

By Dennis Archambault

The Patient Protection and Affordable Care Act (ACA) underscored the importance of health systems to identify and meet the health needs of the areas immediately adjacent to their hospitals, not just the market segments they wish to serve. This is one of the unsung qualities of the much publicized law. In meeting this requirement, hospitals have been identifying these needs and developing action plans for addressing the needs, leveraging community resources. However, this work is largely done in isolation.

An analysis of Baltimore, one of the cities with the worst asthma rates, has concluded that hospitals need to invest on the front end of the problem, not profit from the patient care required at the back end. A report published by the Kaiser Health News and University of Maryland Capital News Service (https://khn.org/news/hospitals-find-asthma-hot-spots-more-profitable-to-neglect-than-fix/?) notes, “The medical system knows how to help. But there’s no money in it.”

The article references a resident of the zip code with the worst asthma rate, 21223, where an abundance of houses are in disrepair or abandoned, rodents and bugs trigger the disease, and few community doctors are working to prevent asthma emergencies. “Like hospitals across the country, (Baltimore hospitals) have done little to address the root causes of asthma. The perverse incentives of the health care payment system have long made it far more lucrative to treat severe, dangerous asthma attacks than to prevent them.”

Ben Carson, a retired pediatric neurosurgeon and Secretary of Housing and Urban Development concurs: “The cost of not taking care of people is probably greater than the cost of taking care of them… It depends on whether you take the short-term view or the long-term view.”

The ACA requirement is significant not only in getting hospitals to assume responsibility for the geographic area where they are situated, but also in preventing the conditions they treat, and profit from. It’s a significant adjustment for hospital marketing processes, which have for years targeted services and populations that are most profitable. Now, to retain their tax-exempt status, they must become allies in population health management. It may, in the end, contribute to the downsizing of the health care industry. On the other hand, as the euphemism goes, it may “right size” the industry.

Dennis Archambault is vice president, Public Affairs, for Authority Health.