It’s time for the monthly health department update. WNIN’s Tim Jagielo spoke with both Merritt Bates-Thomas, the Public Information Officer with the Green River Health District and Lynn Herr the Director of Clinical and Outreach Divisions at the Vanderburgh County Health Department about how “Social Determinants” can impact health outcomes.
Timothy Jagielo
You wanted to talk about health or social determinants for June — Is there anything specific about the middle of summer that makes you want to talk about social determinants?
Merritt Bates-Thomas
I think just the timing in our progression of the interviews makes it a very timely topic. We've talked about community health assessment, we've talked about public health awareness month, if we go back to our first interview. So I think the next step — better understanding public health and the work we do, especially the work we do behind the scenes, is having a better clearer understanding of social determinants of health, and how whether we realize it or not think about it or not, impacts all of us.
Lynn Herr
And then I guess, just for the summer, that's when we see folks, that's when we really have a chance to also connect with our community events. Sometimes, you know, we don't it's not people walking in through our doors, but we're able to connect to them in their neighborhood. And I always think that that's a, you know, a great opportunity for us to get a good picture of our community,
MBT
Okay, and social determinants of health to better understand really, and truly what they are. They're those non-medical factors that impact — they're everywhere, they're where we live, learn there were born, live, learn, work, play, worship, and age, they're all around us.
LH
Some of the individual things is, our access to transportation, that is probably our biggest barrier. You know, everyone assumes here in southern Indiana and Western Kentucky that everyone has a vehicle; that is not the case, and not everywhere. Do you have public transportation that can get you to the places that you need for your health care? So there are many different social determinants of health, but I can say for Vanderburgh county that is access- related to transportation is probably one of our number one social determinants of health.
MBT
Well, you look at neighborhoods and the ‘built environment.’ And you know, we have many communities if you will, within one larger city, just as in Western Kentucky. We have regions within our seven county district, even within counties that make those areas unique. As Lynn mentioned, some had better access to all sorts of things, not just transportation, but access to health care, access to groceries. And really something else that's emerging is access to childcare for young families, as you have both parents are in single parent households, or in households where grandparents or other family members might be raising children. Access to childcare is also crucial and critical.
LH
Along with pharmacy — because if you get a prescription for a drug that's really going to impact your health does not mean that you have a way to go and get that.
MBT
Economic stability is another key driver. Just looking at things that keep our economies going. And one of the things to get back to social determinants of health communities don't often think is, health being really a number one priority. But when you think about it, healthy children learn better. Healthy employees are at work, they're on time, they have fewer days missed. So there's more health care costs, lower health care costs, as well.
TJ
So if you could give me what is the definition of social determinants from the perspective of the Health Department?
LH
Really, it's any outside contributor to health —
MBT
— those conditions that impact the health of individuals living within a community.
TJ
How can ‘region’ be a social determinant? And can you give examples from this area?
LH
So just actually looking at our zip codes within the Evansville area, are 47713, or 47714, and our 47711, have the highest impact of infant mortality, poor maternal outcomes, lead poisoning, overdose, so you can really see that actually where you live, can impact your life expectancy and your health outcomes throughout your life.
TJ
What can people do? How can people be aware of them? And what can they do about the information?
MBT
Well, I think it starts with, first of all, if you're living in conditions where they're directly impacting you, you may feel as though there's very little you can do. I think for all of us, though, it's important to realize and recognize that it does impact all of us if there's an area of our community, that is having difficulties that in some way is suffering, at some point that can spill out and affect all of us within a specific town, city, or region.
And so taking action, being aware of what we can do — calling attention to it, and working toward better living conditions, and better outcomes for all of us making the contributions we can because one person's issue soon becomes an entire community's issue. It may take place over time, but it's important to remember that left unchecked, it does tend to grow and spread.
LH
So we really need to focus our initiatives and focus some of our projects our awareness around those individual regions. Because when we improve the health in those areas, everything gets better.
TJ
Do you have examples that kinds (of social determinants) come up? I think you talked about the word diagram. And that's, so if there was like a word diagram, social determinant that comes up a lot, maybe in Vanderburgh. County, what have you seen?
LH
Access tends to be the number one. But also, we do see big health disparities in our data related to race. So our outcomes, we really need to focus on that with just like, our black infant mortality is much higher than our white infant mortality. So we really need to break that down and, and look at those root causes.
Whether that is the inability to, to get where we need to be. A lot of people don't realize that it's just not super easy to get on a bus when our biggest OB hospital is just outside the county. So we have to look at initiatives. Okay, so what can we do? What can we do for people that are living downtown to be able to get out to to gateway or the Women's Hospital?
MBT
And the other thing to consider too, you know, we were talking more diagrams, mental health more frequently is popping up and emerging as a key factor is well.
TJ
Merritt, we talked last month about COVID. You get a monthly COVID report, basically. And we were talking earlier, you mentioned that the pandemic actually showed health departments a lot about social determinants. Can you talk about that a little bit?
(technical audio issue covers Bates-Thomas)
Merritt Bates
… very small apartments or homes where multi generations were living together under one roof or in very cramped living conditions. In larger cities, where there are more people per square inch, than there are in our area, that's much more spacious things we take for granted if we can drive to work and be in a car by ourselves.
Or if we can walk to work and not be in cramped quarters, that's much much different. And we were less likely to be exposed than those people who relied on public transportation who had to get to work and work with others, even if they were masking versus those who were able to telecommute work from home, or if they were working in the office, maybe more of their co workers for telecommuting. So those are things to keep in mind in terms of what we were learning, those people are at greater risk already, because of their social determinants of health. And were those that were really being impacted.
LH
Those with comorbidities didn’t have the best outcomes. Regardless, they were really impacted. And I had a you know, we saw food insecurity when people couldn't go to work or the breadwinner got sick, because they were providing key services. And then the whole family was hungry. And it kind of spread through the house or the home and multigenerational really played a factor in that.
TJ
I always like to try to make it practical for people. Is there anything you can say to people who might be concerned about these social determinants? It especially if they know like I've got a problem with transportation like what would you suggest that they do?
LH
Well, again, we want to empower people and we don't want their circumstances to define their outcomes. So again, providing those social services. So one of the things that's kind of raised its head with COVID, but also has raised our health department, those individuals that we serve, have some very complex issues or some hurdles to get over including some mental health issues.
The pandemic did did raise our awareness of just being able to help them and provide those social services and not just putting a quick band aid with an immunization or a testing or medication or you know, a program that they take care of, but looking at the person in the family as a whole, and being able to provide all kinds of wraparound services, and we feel like that is really going to elevate the health of our, of our community. But again, funding makes it hard for us to provide those social services, but we try our very, very best.
MBT
(You can also try) reaching out to your health systems, your local health department, reaching out to your elected officials to start a conversation with them, you know — who's the council person, that your elected official that you're voting for, that represents your particular area. It can seem intimidating, but they're in that position to represent you. Making them aware, and realizing and recognizing it's an issue that impacts all of us.
And so for those of us who think we aren't affected aren't affected as dramatically or drastically, it's important to realize we all play a role in this being more understanding and stepping back realizing that everybody has their battle that they're fighting. And for some people, though, social social determinants of health can really be more impactful than we can imagine.
LH
And really tying into community partners, which is a really important part of as, as an accredited Health Department. We, you know, it's hard for us to do everything. So leaning in our community partners and and bringing their awareness to social determinants of health, and how they address social determinants of health, as a community and all working in the same direction, we can make a bigger impact.
MBT
And for people experiencing food insecurity, in some cases to their people that prefer not to reach out for assistance, they've maybe never had to seek any sort of assistance before. But seeing if they qualify for SNAP, which used to be food stamps, if you're a young family, young mother at home with an infant or young children under the age of five, you may very likely qualify for WIC, which is a service our health departments offer seniors in Kentucky we have a senior Farmers Market Nutrition Program that issues manifests, and in many cases to that access to the local farmers market can be very beneficial. In Kentucky, we have the community farm alliance that provides double dollars. And that's a great way to even multiply that benefit that you're getting.
TJ
Well, it's the middle of June, or it's past the middle. You just had Juneteenth — what's going on next for the departments?
MBT
Believe it or not at our agency, we're already thinking a bit about back to school, focusing on those important immunizations. And making sure that families are aware of the importance of keeping those immunizations up to date. Of course, we've seen the immunizations and that awareness grow. But it's important not to develop that immunization fatigue, if you will. And keep in mind that there are there is a regular series of immunizations that children need as they go through school. So reaching out to your health department keeping those vaccination those immunization records handy, so that they can be updated, and you can stay up to date with what your children need.
LH
And I'll just piggyback onto that. So we have our mobile unit, which is up and running. And at each individual key festival or community at you know, whatever is going on in the community. And there's a whole list and please go to our website to see where our mobile unit is. And that allows us to take not only immunizations, but testing for STDs, actually, I think we're going to be end up doing some TB testing as well on our mobile unit. So just being out there in the community, so that people can see us, we can build trust, and then we can also address that social determinants of health, of lack of transportation to get services.
TJ
Thank you both so much for your time again, as always, we appreciate it.
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