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Diagnosis:Poverty. Looking at social determinants of health with a new lens

February 17th, 2020

One of the many benefits of a career in healthcare is the ability to work with smart, interesting people whose words and actions motivate you to be a better version of yourself – and, in turn, to do the same for others. In Medical Network One’s last in person learning session of the regional Moving Upstream Learning Collaborative, we had the privilege of hosting Marcella Wilson, Ph.D. as the morning keynote. Marcella told us she spoke three languages: English, sarcasm and profanity. She kept her talk to the first language, but the comment got a chuckle from what would be an enthralled audience. In this era of tech distractions, she spoke for 90 minutes about the experiences that led to writing her new (and first) book, Diagnosis: Poverty, while holding the rapt attention of 75 care managers, physicians, nurses, social workers and public health experts.

“Poverty is a medical condition – not a character flaw.” Those are Marcella’s words, but I second them. Through her national program, Transitions to Success (TTS), which treats the condition of poverty with a client-centered, community-based continuum of care and began when Marcella was CEO of Matrix Human Services in Detroit, she has honed into the social determinants of health (#SDOH) at their core – and found a prescription, with impressive statistics, to help tackle them.

As my team and I work with practices to delve further into #SDOH, we are seeking solution-oriented approaches that dig deep to attack the negative repercussions of being poor. (And note that every primary care practice, regardless of location, includes patients with financial woes of varying degrees.) Always among the key challenges is transportation. It’s the common denominator that keeps people from working, from parents taking their babies to “free” wellness exams, and from individuals accessing other no cost services that boost health, well-being, income, job-readiness and self-sustainability. While the transportation issue always seems more vexing than it should be (aren’t we the Motor City?), one of the solutions Marcella offered was the idea of peer volunteers. Not new perhaps, but new to me, and I suspect many in the audience. ‘

Peer volunteers don’t drive in from the suburbs to assist those in poverty (although the volunteer services of our suburban friends are extremely important, and we need more of them.) These volunteers live in the neighborhoods of those impacted by #SDOH and understand each other’s life challenges first-hand. Through sharing of services, for example a peer volunteer with a car takes mom and baby to the pediatrician in exchange for babysitting services at a later date, a network is built and reinforced and another step to alleviate an #SDOH obstacle is taken.

Another take-away is TTS’ Map of My Dreams®. The poor have dreams just like the rest of us! An individual of any economic status needs a plan to accomplish a dream, and TTS incorporates it into their approach, mapping out each individual step needed to achieve a longer-term goal. Does a PCP office have time to help patients map out their dreams? Likely not, but a community health worker (CHW) can help them take the first steps. Perhaps the lesson here is to not react to potential solutions with the stance that they won’t work – when they’ve already proven to do so!  I’m grateful to Marcella for her insights (and her humor), but the discussion on #SDOH isn’t over. For those who want to continue the conversation and interact with like-minded individuals poised to take action to overcome or eliminate #SDOH limitations, MedNetOne Health Solutions is again partnering with Oakland University’s School of Health Sciences for the Healthology Symposium, Better Upstream Health, Better Downstream Care, to be held on the OU campus on Tuesday, May 5. There is also a free community event the evening of May 4. Let me know if you’d like to get involved.

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