When an entire community becomes the patient
Healthcare providers often find it challenging to effect lasting change for their patients’ health. The challenge becomes bigger when people have other -- sometimes more pressing -- issues like family dysfunction, poverty and housing insecurity.
The impact of the environment on a person's life, behavior, and ultimately, health is known as the neighborhood effect syndrome. For example, research has shown that children from low-income families in areas with less poverty and lower crime rates have better financial outcomes in adulthood.
Can health be improved if the environment is addressed first?
Yes, say researchers from Nationwide Children’s Hospital in Columbus, Ohio who collaborated with community partners to create the Healthy Neighborhood, Healthy Families Initiative. The results were published on Friday in the journal Pediatrics and chronicled the team's efforts over the last 10 years.
Dr. Kelly Kheller, a pediatrician, vice president for Community Health at Nationwide Children’s and lead author for the study, told ABC News he started to see many patients, mostly kids on Medicaid, whose families had difficulty paying for medications or attending clinic visits. At the same time, employee turnover at the hospital was very high. Kheller wanted to change that at the community level.
“One in three houses was vacant, the [nearby] school park was deserted, patients and [hospital] employees needed a safe place to go. And the mayor was concerned about the extreme [housing] vacancy rates. The question became: Can we show that the hospital was committed to the neighboring residents? Can we show that we are committed to being there for the long haul?"
Once they embraced the community as the patient, the team identified the most pressing issue, often referred to in medicine as the "chief complaint" -- in this case neighborhood safety -- or lack of it, because people were moving out of the area and abandoning their homes.
The next step was finding partners to help increase neighborhood safety -- and as word spread about the project, community interest and investments grew.
“So many partners wanted to participate: the mayor, the local realtor association, construction companies. This led to Community Development for All People,” Kheller said, referring to a not-for-profit development corporation that collaborated with Nationwide Children’s to form what they called the "neighborhood treatment team."
The team got to work, and their intervention unfolded in several phases. They started by getting homes ready for sale -- they improved the exterior appearance, made homes energy efficient and repaired roofs. Next, they obtained tax credits to build new apartment buildings, providing quality housing for minimum-wage hospital employees and low-income families.
What has been the impact on the neighborhood’s residents?
The housing vacancy rate has declined from over 25 percent to 6 percent; youth who have participated in development programs in the area have shown increased emotional health and academic skills; and homicides have declined in the area in the last year, according to the study.
Kheller added, “High school graduate rates have climbed up. Private developers are now coming in and we’re seeing an increase in rent and property values. Restaurants [in the area] have increased.”
Now, they’re working on analyzing how long people are staying in the community and working at the hospital.
So far, Kheller said, “Employee turnaround has decreased and the hospital has hired 800 people from the neighborhood itself.”
The question will be how long the positive impact on the community lasts and how it affects people’s health outcomes, especially children from the neighborhood.
But the future is optimistic -- when a family is employed, when financial security is established, that’s when a person’s physical and mental health can become a priority again.
Dr. Stephanie Sophie Lee is a pediatrician and preventive medicine resident in South Carolina and a resident in the ABC News Medical Unit.
ABC News’ Dr. Aditi Vyas also contributed to this report.
