Promoting Health Equity in America’s Communities

Back to Summer 2019: Volume 108, Number 2

Dr. Shreya Kangovi, a primary care doctor, civic leader, and founding Executive Director of the Penn Center for Community Health Workers (CHWs), is the 2019 winner of the annual Health Equity Award. The award is presented by the National Civic League in conjunction with the Robert Wood Johnson Foundation.

The award recognizes individuals who have successfully implemented a systems-change approach within the past two years to improve health outcomes for those most impacted by health disparities. Winners of the award address the factors that lead to health disparities related to one or more of the following areas: access to quality care, education, employment, income, community environment, housing, and public safety and demonstrate a commitment to resident/civic engagement.

The National Civic League views engagement as more than presenting information or having people respond to questionnaires (though both are important); instead, we promote efforts that seek to listen to, and learn from, residents in ongoing conversations and leverage those insights to shape the way programs are administered, designed and executed.

In seeking nominations for the Health Equity Award, the League has learned of grass roots activities throughout the country.

Community Health Workers in West Philadelphia

Working as a primary care doctor in West Philadelphia, Dr. Shreya Kangovi, found that it was impossible to escape the reality that the health care system was broken, especially for the most vulnerable patients. The root causes of her patients’ poor health were often socioeconomic issues such as lack of housing, loneliness, trauma or hunger, conditions that aren’t easy to “treat” in a clinic or hospital.

To improve the health of the people in West Philadelphia and similar communities, she reasoned, would require changes in the ways that healthcare was delivered. Although she had her own ideas about better ways to delivery healthcare, she was aware that low-income community residents were seldom involved in the design of health delivery innovations.

Dr. Kangovi and a team of co-workers had one-on-one conversations with 1,500 people who lived in high-poverty neighborhoods in West and Southwest Philadelphia. Meeting with residents and civic leaders in a variety of settings, they asked patients: “What makes it hard for you to stay healthy and what should we be doing to help?” Patients shared their experiences with health care, their barriers to health and their vision of what a holistic approach to caring for people would look like.

The team used the stories, input and guidance from her community interviews to design, administer and execute a transformative new care model called IMPaCT, a standardized, scalable community health worker program relying on trusted laypeople to help their communities achieve health and well-being.

Community health workers are not new, but typically such programs have struggled with high rates of turnover, lack of standardization and insufficient evaluation. Dr. Kangovi’s model addressed those factors through specialized hiring tools designed to identify community members who are natural helpers; standardized workflow manuals, supervision, management software and training that ensure a structured, supportive work environment; and rigorous scientific evidence.

IMPaCT targets a broad population: residents of high-poverty neighborhoods who are uninsured or publicly ensured. Community health workers meet eligible individuals when they come in to the hospital or doctor’s office. IMPaCT community health workers get to know patients as people, including asking them about any unmet social need including but not limited to income, employment, transportation or housing. Community health workers ask patients: “What do you think you need in order to improve your health?”

Based on this initial interview, the community health workers help patients develop action plans for improving their lives and health. A hallmark of IMPaCT is that these action plans are tailored to each individual and all of his or her lived experience. Community health workers then provide flexible, hands-on support to help patients carry out their action plans. This can take the form of navigation, connection to social services and health coaching but it can also be more creative and grass-roots.

For instance, one community health worker helped a young man who had been paralyzed in a violent crime obtain a ramp for his home and sign up for a wheelchair basketball league. Another community health worker helped a woman with low self-esteem due to an abusive mother create and lead a support group for other young women. Shifting to an approach of holistic health, incorporating all aspects of a person’s life, has concrete and measurable advantages.

Simply put, the model works better than programs that attack individual social determinants of health such as food insecurity and transportation as one-offs. It also compared favorably with the many technology-based “screen-and-refer” solutions that have proliferated in recent years. Poverty creates complex layers of problems in unique fingerprints. Solve one, others linger. The holistic person-centered approach that IMPaCT has taken to the social determinants of health is probably a key factor behind its effectiveness.

Dr. Kangovi is a visionary thinker with bold goals. Her goal for the IMPaCT program is to eliminate health disparities—as measured by metrics like chronic disease control, hospitalizations and mental health—by deploying effective, scalable community health worker programs. IMPaCT has already reduced health disparities in the greater Philadelphia region and is now the most widely disseminated community health worker program in the country.

Other Examples of Grassroots Health Equity Work

To help people live healthier lives. Nanci Jenkins, a dietician with the Bonner County Coalition for Health in rural northern Idaho, is helping to implement a program called Community Partnerships for Healthy Mothers and Children, connecting mothers to healthy food and other resources and rallying the community to fight cancer and foster an environment more conducive to healthy behavior.

A state representative teamed up with a wellness program director to improve health in Erie County, New York, which had scored poorly on the Robert Wood Johnson Foundation’s county health rankings. In response, Michael Kearns and Phil Haberstro worked with local schools to provide mental health services and informational programs to encourage healthy behavior. The two also worked to make health screenings available in the community and create better access to healthy food.

Another example of work to create health equity is a project by two social entrepreneurs in one of the poorest parts of New York, rural Sullivan County, who founded ENGN (engine) Civic Creative Center “to address the systemic nature in which people are emotionally and economically disconnected from one another and from their own innate strength.” Isaac Green Diebboll and Thomas John Bosket felt that an underlying factor causing poverty and poor health was the disconnect among individuals and set out to create an intergenerational program to build relationships through youth-focused sustainability projects.

A graduate student, Marisa Westbrook, and professor, Tony Robinson, at the University of Colorado at Denver conducted a study of “anti-homeless” laws in the Denver area and showed that such laws “measurably harm the quality of life of Denver’s most vulnerable residents and are unhealthy by design.” Westbrook and Robinson are working with local nonprofits to reverse these laws and find better solutions to addressing homelessness.

When she witnessed first-hand how poorly people with health problems were treated by the current health system in Kershaw County, South Carolina, Susan Witkowski founded the Community Medical Clinic to provide free and low-cost care to residents and promote health countywide. Susan helped create a school-based health center at the local middle and high school and has convened seminars, a health improvement plan and other community discussions to improve the health of Kershaw County.

Across the country, heath care professionals and community activists are finding innovative ways of addressing the root causes of health disparities that exist in all communities. The Health Equity Award is given to recognize those innovators and cast a national spotlight on the work they are doing to provide a source of inspiration and information for others who may undertake similar efforts in their communities. For more information, visit the Health Equity Award page on the National Civic League’s website.

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