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What are the “social determinants of health,” and why are we transforming to meet them?

Healthcare doesn’t start or stop at the clinic or hospital doors. That’s why M Health Fairview is focused on addressing factors like stable housing and racial inequality in the Twin Cities.
In an effort to reduce barriers to healthcare, M Health Fairview has partnered with community groups to provide free flu shots across the Twin Cities. The program is one of the ways our health system is addressing the social determinants of health.

M Health Fairview is committed to the health and wellbeing of everyone we serve. As part of that commitment and in partnership with Ramsey County, M Health Fairview Bethesda Hospital is being converted to a homeless shelter that will serve some of the most vulnerable people in the Twin Cities.

How does reducing homelessness connect to M Health Fairview’s healthcare mission? As it turns out, providing stable housing is one of the best ways for us to address one root cause of poor health.

“A lot of people think healthcare means going to the doctor, being admitted to the hospital, taking medicine, or getting treatment,” said M Health Fairview Family Medicine Physician Kelley Jewett, MD, medical director, primary care and family medicine. “But that’s only one small part of our overall health.”

Another key part of health is what Jewett and other experts call the “social determinants of health.” These are factors in our lives that do not seem to be health-related, yet still have a dramatic effect on our health. Examples include:

  • Food insecurity: Lack of access to healthy food affects a person’s nutrition and diet.
  • Race: Systemic inequality leads to worse health outcomes for minority communities.
  • Income: Money ensures access to healthcare and influences other factors on this list.
  • Education: Better education can lead to higher-paying jobs and more opportunities.
  • Violence: Being a victim of violence, trauma, or abuse can cause chronic stress and anxiety, in addition to the physical harm involved.
  • Support: Without a strong support network, people are at greater risk of depression and other mental health challenges.
  • Housing: People without stable housing face a range of challenges, from getting a job to having enough money to pay for healthcare.

“We don’t all have the same starting points in life, in terms of privileges, opportunities, or resources. Data shows that those disparities can cause poor health outcomes,” said M Health Fairview’s Chris Beamish, system director of outpatient mental health. “If you’re worried about not having a roof over your head or not having enough to eat, it’s difficult to focus on your health.”

Seen through that lens, homelessness has a clear impact on public health. Providing stable housing for people at risk of homelessness can make our communities healthier. This has become even more important in 2020, as this year’s economic recession pushed nearly 400 people in St. Paul into homelessness. Complicating matters further, the city’s existing shelters must limit their capacity to prevent COVID-19 from spreading. The need has never been greater.

Earlier this year, M Health Fairview leaders visited homeless encampments in St. Paul. What they saw reinforced the decision to convert Bethesda Hospital into a shelter. 

Learn more about the changes we’re making to our health system that will help us deliver simpler, more affordable, more accessible and more equitable care to all members of our community.

“Many people who are experiencing homelessness have untreated mental illness or substance use issues,” Jewett said. “Just giving them an apartment doesn’t do enough to address the underlying issues. Without wraparound services, many people will end up back on the street again.”

As a health system, M Health Fairview is well positioned to offer these wraparound programs – including social services, job counseling, nutrition counseling, medical or substance use treatment, and mental health treatment. Access to these services at Bethesda will increase shelter residents’ chances of maintaining stable housing. Upon that foundation, they can begin to build a healthier future.

“As a large healthcare organization in the region, we have the right platform to address these issues in partnership with our community and government partners,” said Keith Allen, manager of community collaborations for M Health Fairview. “Because 90 percent of health happens in the community, this is where we can make an impact. We don’t have to wait for folks to come to our brick-and-mortar facilities to support their wellbeing.”

“Our goal is not only to treat sickness,” said Fairview Health Services President and CEO James Hereford. “We’re taking a broader view focused in part on addressing the issues and inequalities that make people sick. We’re creating healthcare that makes our community better, for everyone, today and long into the future.”