By Hannah Esqueda
Image via United Workers
MERCED, Calif. — The Merced County Department of Public Health recently announced plans to address three major community health issues identified in its 2016 Community Health Assessment (CHA). In its announcement the department noted the plans are inspired by a social justice framework that emphasizes community engagement.
The priority areas identified in the CHA include access to health care, preventable chronic diseases and substance abuse within the community.
“We’re happy to say that there’s more local data available this year than in previous years thanks to community groups and other local assessments,” said Christopher Jensen, alcohol and drug prevention specialist with the county’s Behavioral Health and Recovery Services. “We’ll be using that information to take a community-based approach and address key problems over the next five years.”
Released earlier this year, the CHA found 100 percent of Merced County qualifies as a health professional shortage area. The region also ranked 43 out of 59 California counties on the primary care physician (PCP) to patient ratio, with more than 2,300 residents for every PCP.
For many of the county’s low-income and rural communities, access is further compounded by limited transportation and few medical office sites.
Even as Medi-Cal expansion and the Affordable Care Act helped decrease the reported rate of residents without any insurance (from 25.2 percent in 2012 to 9.2 percent in 2015), 43.8 percent of Merced County adults reported difficulty in obtaining health care services. The CHA also revealed that non-white county residents are significantly less likely to report having a specific or consistent source of medical care than white residents.
To help change the inequality in access to care, Jensen said the department is looking to form a coalition with public agencies, private citizens, nonprofits and other community voices and address each of the three goals head-on.
The department’s stated goals are: ensuring “all individuals in Merced County have access to quality health care,” “optimizing social and physical environments to support healthy lifestyles” and increasing wellness in Merced County “by addressing the conditions that lead to drug and alcohol abuse.” The department has given itself until 2021 to achieve each of these goals.
While the scope of work may be daunting, department officials say they hope to achieve true healthy equity by incorporating a wide-spectrum of voices and community representatives in the planned coalition.
An initial training event was held last week, and invited agencies, advocates and community representatives heard from Paul Nolfo, a consultant with the Center for Applied Research Solutions, about how the coalition can affect population-level change.
“Rather than just looking at the life-expectancy of an individual, you should examine the life-expectancy average of an entire community,” he said. “Your county’s CHA is a great start so now it’s up to you to keep pushing for that change.”
The shift towards a social justice-oriented approach was prompted by the department’s finding that environment has a huge impact on resident’s health.
“We know that social determinants like income, education and employment are closely intertwined with determining health factors,” said Kristynn Sullivan, an epidemiologist with the county’s health department.
While gathering data for the CHA, she said the department reached out to many of the county’s minority and underserved populations to hear what they identified as top health problems. Based on those site visits and focus groups the department was able to identify an alarming trend affecting many resident’s health.
“We found that some community problems are so deep and consistent that many residents didn’t view it as a problem that could be fixed anymore,” Sullivan said. “They had begun to just accept it as a part of the community.”
Community problems like lack of sidewalks, green spaces and safe places are not traditionally thoughts of as health issues, but all contribute to local health outcomes, she said.
By expanding the scope of the department’s report to include such issues like substandard housing and homelessness, violence and even crime statistics, officials were able to get a much more detailed look at the community’s health and craft a more precise plan for achieving their 2021 goals.
Among the objectives listed under its access to health care goal, MCDPH officials said the county will be looking to develop culturally responsive health care. The planned coalition will also work with schools and even UC Merced to help build up the local health care workforce and create community-based health support services.
To help residents get a handle on preventable chronic diseases by 2021, the coalition is also planning to address environmental factors currently limiting healthy lifestyles. Increasing access to parks and social networks are both elements listed within the department’s goal statement.
The third priority area identified by the CHA includes substance use and by 2021 department and the coalition hope to increase treatment capacity and accessibility within the county. A shift in local policy focus from punishment to prevention and increased investment in youth are also part of the department’s recommended goal statement. Officials say both elements should help educate the community while diminishing the stigma surrounding substance use.
“We’re really hoping to get the word out there about how the community can be involved and part of the solution,” Jensen said. “So many factors go into our community’s health and we want to hear from people what their ideas are for how we can help create real change.”