By Marti Webb Slay
The Jefferson County Department of Health released a new strategic plan last year that differed from the plans of the past, and Health Officer David Hicks, DO, MPH, FAAFP, believes it includes an approach that can be applied to all medical practices for improved health outcomes.
“This plan governs the work of our health department for the next few years,” he said. “The difference between this plan and plans we’ve used in the past is that this is an adaptive strategic plan. Traditional strategic plans will list outcomes or tactics you want to address, such as reducing diabetes, and the plan will list tactics to address and measure that. Our new plan is constructed to plug in any emerging public health issue, with a framework of how we are going to move the needle on those strategic initiatives. It will allow us to adapt to what is happening presently, as opposed to specifying a particular healthcare issue.”
The plan outlines four strategic directions:
Collaborate with community partners to positively influence the determinants of health
Focus on health system transformation
Foster a thriving, equitable workplace
Serve as a trusted source of public health data and information
The goal of the Department of Health is a healthier Jefferson County for all, and that requires an emphasis on health equity. “We apply an equity lens and hope to get to some of the underlying drivers of poor health outcomes in our community,” Hicks said. “Working with partners is key to achieving better outcomes. We want to be at the nexus between underlying policies and structural factors that influence the social determinants of health on one side and how health is experienced on the other side.
“First, we have to educate our community and our partners about our challenges. People are used to hearing about health data, like when we report high levels of cancer and heart disease and diabetes. Now we have to get to what is driving it, and what we are going to do about it. We have to look deeper and understand why someone may have higher blood pressure than someone else. We can have a greater impact on the community long-term if we understand the root causes.”
The traditional approach to high blood pressure, for instance, would be to recommend a change in diet, exercise, and medicine. But if there are no healthy food options in a patient’s neighborhood, no safe and affordable place to exercise, and gainful employment is scarce, traditional advice will have limited results.
Engaging with partners will eliminate some of the barriers and put patients in a place to make better choices. Having access to safe places to exercise is important, for instance. “Our health department has been a leader in this for the past several years,” Hicks said. “We’ve worked to address the environment for building out the trail system, supporting parks and other amenities.”
Ultimately, Hicks wants to see doctors ask the deeper questions that allow them to link patients to the resources that will lead to better health outcomes. He admits this is not as easy as it sounds. “It can be intimidating to have to ask every patient about safety or transportation because you might not have an answer if they tell you there’s a need.
“I’m trained as a family medicine doctor. I understand that it can be overwhelming to ask a medical provider to add one more thing to all they’re currently doing. Our job is to figure out how to message this so providers know it’s in their patients’ best interest to go down this line of inquiry. Ultimately, it can help you achieve improved health outcomes. It can be frustrating as providers to offer the information and prescriptions, and then we question why our patients aren’t having the results.”
It doesn’t always have to be the doctor asking the questions, however. It can be a questionnaire on paper or online that the patient fills out even before they come to the clinic, or a staff member can sit down and talk to the patient. In this way, it doesn’t have to detract from a provider’s limited time.
“Sometimes we mislabel the patient as noncompliant,” Hicks said. “But it may be that they have significant barriers to doing what the provider is asking them to do. In the past, we haven’t had a mechanism to assess those barriers. We can actually help improve patients’ lives by taking the time to understand the social determinants.”
