Insights for Change

Building Health Instead of Healthcare

Are we working to produce healthcare or to produce health for children?

It’s a key question posed by Kelly Kelleher, MD, MPH throughout his presentation as the featured speaker at the 7th annual Dworkin Lecture in Hartford. The Pediatrics Grand Rounds session honors Paul H. Dworkin, MD, Connecticut Children’s executive vice president for community child health, founding director of Help Me Grow National Center, and former Connecticut Children’s physician-in-chief and chair of the UCONN Department of Pediatrics.

Dr. Kelleher is vice president for community health at Nationwide Children’s Hospital in Columbus, Ohio, which is among the largest children’s hospitals in the country.

In introducing Dr. Kelleher, Dr. Dworkin noted his initial and extensive focus on health services research pertaining to mental health disorders. He also highlighted Dr. Kelleher’s status as one of the nation’s leading advocates for hospitals and providers to address the impact social determinants of health have on children and families, particularly in the areas of housing conditions, violence, neglect and substance abuse.

“Kelly’s work has been instrumental in defining the very field in which we labor today and his career has been nothing short of remarkable,” said Dr. Dworkin to the audience of physicians, nurses, residents, hospital staff and others. “His research, particularly his health services research, has laid the framework and the groundwork for the way in which we address the needs of vulnerable children and promote their optimal health, development and well-being.”

Key Priorities to Impact Health

Dr. Kelleher’s lecture, Home is Where the Health Is: Hospitals and Housing, highlighted the work of Nationwide Children’s in addressing housing and health by building partnerships and leveraging financial resources to quite literally build a community near its world-class facility.

“Pediatrics, in my opinion, is a thing of the past. We are fixated on our office-based practice of medical care and I do not believe we can survive that route going forward,” stated Kelleher. “We have a problem with how we deliver medical care and it’s because we’re producing medical care and not the health of children.”

Dr. Kelleher acknowledged past and current approaches to addressing social determinants of health, which include remediating lead, asbestos and asthma-triggering allergens in homes; preventing injuries and violence; and strengthening parenting skills.

However, he noted that providers and hospital systems must do more to make a substantial impact on the lives of children and families. They must partner with corporations and others to design and build healthy housing with green space, plants and natural lighting. They should bring healthcare into homes and schools through community health workers and telemedicine. Finally, they should embrace the community as the patient in need of care.

“We can do all the training and parent interventions we want, but unless we provide a healthy community, the evidence suggests that we’re not going to make very much difference,” said Dr. Kelleher.

Building Communities

Dr. Kelleher described the work of Nationwide Children’s Hospital in gathering community partners together to launch its Healthy Neighborhoods, Healthy Families (HNHF) initiative, with results published in the journal Pediatrics.

The hospital targeted the Southern Orchards area of Columbus as its first “patient neighborhood” beginning in 2008. The area, with a population of about 2,000 people, sits next to the hospital’s main campus and suffered high poverty and violent crime.

The HNHF approach targeted the community as a whole, instead of focusing solely on the needs of individual children and families. Nationwide brought high-quality clinical services into the community, after recognizing a substantial amount of families in the area were not travelling to the hospital for well visits or other care. Providers in these neighborhood clinics also began connecting families to community-based social services to ensure support for non-medical needs. Additionally, Nationwide developed partnerships, secured grants, and leveraged its own financial resources to oversee the rehabilitation of more than 300 homes, as well as the construction of 58 affordable housing units in a development that also features an embedded workforce training facility. The initiative is expected to move into a second neighborhood soon.

Dr. Kelleher presented data comparing emergency department visits and inpatient days for children from Columbus’ Southside and Northeast sections, which showed dramatically fewer emergency department visits and inpatient days for Southside children from 2008 though 2016. Had children from the Southside experienced similar healthcare usage as Northeast children, Nationwide estimates that would have meant an additional 5,106 emergency department visits and 413 inpatient days during that time frame.

To date, the HNHF initiative has transformed the Southern Orchards area through $41 million in construction. In addition, Dr. Kelleher stated that another $22 million in construction or renovations is underway with $20 million more in negotiation. All told, the effort will bring 1,000 new units of affordable housing into Columbus, which has an estimated 50,000-unit affordable housing shortage.

“It’s a huge investment. It’s a great idea, and it’s important but it’s not enough. Every hospital has to get more involved,” he stated.

The Future of Medicine

Dr. Kelleher ended his presentation encouraging providers and hospital systems to assess their missions and adopt measures to assess the health and well-being of children. He also encouraged them to build health for children, instead of healthcare, by shifting their focus to improving housing, unemployment rates, job training and education.

“I spent the first 10 years of my career seeing a lot of patients and I felt like I was connecting with them and making a difference,” said Dr. Kelleher. “But those families were living in a community that was very, very challenging. I knew that wasn’t right, but I didn’t know what to do about it. I think we now have more information about what to do about it. So, is it really ethical to stay in our clinics and not act? Our clinical services are never going to get us to where we want to be.”

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