Shifting to a Long-term, Systems Approach to Improving Community Health - Wellville [Podcast Series]
[:56] Dr. Bantham introduces her guest, Rick Brush
Rick Brush is the CEO of Wellville, the national nonprofit sponsor of a 10-year initiative to improve equitable wellbeing in five U.S. communities.
He is also the Founder & CEO of Collective Health, a consultancy focused on innovative health and financial models.
[1:20] Measuring short- and long-term success
“So what we're looking at is overall equitable wellbeing in five places, somewhat determined by what they think is important. And when we say equitable wellbeing, we are talking about measuring not only the overall outcomes, but also the gaps. So are people at the very highest levels achieving far greater wellbeing in measures like health outcomes, education outcomes, quality of life than people who are not experiencing as strong outcomes?”
[3:13] The role of community engagement and collaboration
“We started out with five communities, five years and five metrics, and quickly realized that five years was barely enough time to get these collaboratives working together effectively and differently, in such a way that they would produce different outcomes. So Esther, in her generosity said, ‘Well, let's extend this to 10 years.’ By 10 years, we think we can have a good base of strong collaboration, some early indicators of results, and more importantly, the kind of capacity that's going to be needed for these communities to continue the work well beyond the decade.”
[5:39] Collective impact
“There are many, many, there are hundreds of communities that are doing this kind of work around the country, this kind of multi-sector collaborative—it's often called collective impact kind of work. And there's a reason for that. Institutions, and individuals are realizing that they can't accomplish the kind of change that they want alone.”
[7:52] Community-led initiatives
“Another way of thinking about community-driven is truly driven by the individuals, the residents who live in those communities. And what we're discovering is that the priorities shift, sometimes pretty significantly, depending upon the level of involvement of individual residents in the work. So I would say across the board in all five places, there is more intention to bring community members and residents more front and center in the work, so that the work of the institutions and the funders and community members working together really makes a difference in people's lives, who live in the communities.”
[10:51] Having the right people at the table for collaboration
“There were priorities that the community identified that didn't match the interests and capacity of the people who were at the table. So a lot of this is forming, sometimes disbanding, sometimes reforming collaboratives. And I would say, Amy, to your point, becoming more inclusive of, as you call them, the right people. It becomes evident when you're doing the work, that important people are missing.”
[12:42] Healthcare addressing social determinants of health to improve health outcomes
“So you've got these social determinants of health screenings. Now, health systems are implementing these platforms to partner with and make referrals to social services organizations. So it's about food security, it's about jobs, it's about housing security, all things that healthcare systems are not equipped to deal with. But, they are actually making inroads and seeing the kind of outcomes at a population level that they wouldn't see if they were only focused on clinical.”
[16:34] Healthy weight initiatives
“...we would need a 10 year window to make a significant change in doing this. And that if we did that, then we could look upstream. And one of the focuses is on healthy weight. So it's not only managing weight at the point of care, or at the point of intervention, it's saying, ‘Well, what are the systems that are causing higher obesity rates, and you can start looking at food systems and incentives, and barriers to access. So it really changes the kinds of interventions that communities can do.”
[19:48] Addressing health inequities
“So, I think, there is a commonality that has emerged in our communities, is a focus on, we can do all the health improvement and well being improvement work and shift systems. But until we get to some of these root causes that are driving inequities, we will never be successful in ensuring that every single individual has that fair and just opportunity for a life well lived, and also that every individual can contribute.”
[23:04] Shifting from short-term to long-term thinking about investing in community health
“If we know that we can make smarter investments and get better outcomes, maybe at less cost, Why aren't we doing it?...Because we're addicted to short-term thinking as a nation, as individuals, as institutions. It's about political cycles, it's about quarterly earnings. It's a path, what do I need to do to take care of me versus the greater good? But that's not inevitable.”
“And I come out on the side that we're really at our heart as human beings about kindness and generosity and collaboration. And that we're stuck in structures that incentivize short-term thinking and self interest. So how do you break free from that? That's really what our communities are doing.”
[28:22] Moving upstream
“If we want the kind of outcomes that we say we want, the only way to achieve those is to collaborate and to do it with a longer-term focus. The short-term fix for an illness might be writing a prescription, the long-term strategy for greater wellbeing improvement is about reshaping communities. A lot of what we're doing with our collaboratives is really pointing further upstream and pointing further into the future. And having those communities come together around what they care about and what they want to achieve over the long haul.”
[28:53] Integrating healthcare and communities
“Our theory of change is based on the belief that we all are built to be good collaborators. And that when given the chance to work together toward a shared goal or outcome, and given the support and the incentives to do so. Every great thing that humankind has achieved, has resulted from that.”
