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Experts explain how we can do more to address the social drivers of health

Experts explain how we can do more to address the social drivers of health

Picture of Alissa Zhu
(Photo by Joe Raedle/Getty Images)
(Photo by Joe Raedle/Getty Images)

The doctor’s visit needs to do more work than it used to, say a growing number of providers who are searching for new ways of addressing the social factors shaping health.

For instance, when someone goes to the OB-GYN, they should not only have their blood pressure taken but they should also be asked about their housing situation, said Dr. Erin Saleeby, director of women’s health programs and innovation for the Los Angeles County Department of Health Services and chair of the Department of Obstetrics and Gynecology at Harbor-UCLA Medical Center.

Housing instability, trauma and food insecurity are all sources of chronic stress that could have devastating impacts on the health of mothers as well as their babies, Saleeby said.

Those broader social issues are the focus of MAMA’s Neighborhood, a program that aims to redesign prenatal care by bringing together more than 200 neighborhood agencies to address a variety of needs for expecting mothers. Saleeby serves as principal investigator in Los Angeles County for the federal program, which is part of the Strong Start for Mothers and Newborns Initiative.

As part of the program, each mother receives an individualized “prescription for health” and is connected with agencies that provide stable housing, mental health services, substance abuse treatment and other services.

“Recognizing that all of the things we would usually do in an exam room or OB-GYN office … may be necessary, but they're probably insufficient when you're talking about a problem that’s as big or as multifactorial, as multigenerational as racism,” Saleeby told journalists at the 2021 California Fellowship this week.

Saleeby was joined by Ben Metcalf, managing director of the Turner Center on Housing Innovation at UC Berkeley, and Romina Ruiz-Goiriena, national housing and social services reporter for USA TODAY, in a discussion about what it means to holistically and effectively serve the most vulnerable.

It’s about knowing the “full person,” Ruiz-Goiriena said, a point also emphasized by Saleeby.

The goal is “really knowing the whole human that’s in front of you and what all of the needs of that person and their family might mean to the conversation in a collaborative care team meeting,” Saleeby said.

The chronic stress caused by racism and factors disproportionately affecting minorities help explain why Black mothers experience preterm births at significantly higher rates than the national average, and why Black infant mortality is three times higher than that of other racial and ethnic groups, Saleeby said.

MAMA’s Neighborhood has had success in addressing the health equity gap. Black women enrolled in the program are 75% less likely to have preterm births and mothers are more likely to come back for health checkups and care after they give birth, she said.

The interventions by MAMA’s Neighborhood have not only proven clinically significant but cost effective, she said. The program spends about $680 per beneficiary, while preterm births can cost more than $30,000 — that’s 10 times as much as a normal term birth, she said.

Saleeby described one mother in MAMA’s Neighborhood who found out she was pregnant while living out of her car. The program helped her find interim housing with a goal of securing her a more permanent place to stay. Through CalWorks, a welfare and jobs assistance program, she now has a job. With the help of legal aid resources, she got custody of her two older sons back. “Our lives completely changed” after meeting her care coordinator, the mother said.

Metcalf, with the Turner Center on Housing Innovation, said housing struggles remain a huge source of stress for vulnerable families.

Housing, particularly in coastal communities, has become increasingly unaffordable in the state and across the country, Metcalf said, pricing minorities, millennials and people on fixed incomes out of the housing market. Meanwhile, those moving in tend to be wealthier and whiter, he said.

“It’s also a longer story of the widening gulf in wealth and wealth disparities because those who did not buy homes in California 20 years ago are increasingly left behind in being able to access what has otherwise been the primary wealth building mechanism for low-income Californians in the last couple of decades,” Metcalf said. “They can’t get their foot in the door.”

The COVID-19 pandemic has exacerbated economic hardship, particularly for low-income homeowners and renters of color, he said. Moratoriums on evictions have blunted some of the impact, according to Metcalf, but many people have little knowledge of the federal assistance programs created to help people in positions like theirs.

The key, he told journalists, is to continue telling stories of the programs proven to work in helping people secure permanent housing and ending homelessness.

Ruiz-Goiriena has centered her career on working for “the lost, the least and the last,” she said. Before working for USA TODAY, she worked on the investigation teams at the Miami Herald and El Nuevo Herald, where she traced the links between immigration and dirty money in the real estate industry in South Florida.

She had three main tips for journalists.

First, take stock of what you bring to the story as a reporter. Her reporting is informed by her personal identities as well as her past body of work, Ruiz-Goiriena said. “I bring every single story I have ever covered, even in far distant places as a foreign correspondent, and I apply it here.”

Second, she urged fellow journalists to build an extensive network of sources who are directly experiencing the issues they’re covering. Ruiz-Goiriena said she posts her number everywhere and as a result she has contacts within the White House as well as at homeless shelters. It’s vital for journalists to take what they hear from politicians and run them by the individuals on the street, whose lives reflect the reality of the situation.

“A lot of stories aren’t scoops,” she said. “They are things people experience daily that we haven’t done a good job of explaining or reporting. Sometimes simple questions lead to scoops.”

Ruiz-Goiriena’s final tip: Give yourself time to learn.

“You’re not a stenographer — evidence-based reporting is key,” Ruiz-Goiriena said. Spend time tracking down data, and at the same time, work to put a human face to what the data and policy are showing, she said.

For instance, Ruiz-Goiriena’s recent story about minimum wage in the U.S. featured Elsa Romero, a woman who struggles to make ends meet while working two jobs. Romero, a diabetic, is forced to ration her insulin and skip meals to save money.

“This story resonated with readers a lot,” Ruiz-Goiriena said. “While you and I know there are a lot of stories on minimum wage, I think what this profile did is, instead of telling the choices people made, it showed the impossible choices, and that it’s about more than money.”

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