Using lessons learned in other countries, a local project, Global to Local, continues its search for the best ways to improve health through improving communities.
Inequity is a solvable problem, and this community is a great place to start efforts in that direction. Dr. David Fleming, whose expertise is in health, is serious about that. King County has rampant inequality, but he said it also has a history of public and private innovation.
Fleming earned praise for his work over seven years as director of Public Health – Seattle & King County. In 2014, he left that position and became vice president of public health for PATH, a nonprofit that uses innovation to improve health in poor countries.
These days he’s excited about a nonprofit, Global to Local (G2L), where he’s a board member. It works to improve the health of people who have the least resources by bringing to the U.S. lessons learned elsewhere in the world. Those lessons revolve around a fundamental change in our approach to health problems.
The United States is not a poor country, but far too many people here live in poverty, often concentrated in neighborhoods where the impact is magnified. Fleming made that dramatically obvious with a map of King County when he was head of the health department. It showed how closely neighborhood economic health and physical health match each other.
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Poverty has real health impacts.
“The United States spends more on health care than almost any other country,” Fleming said in an interview last week. “And when you look at the measures of health that we have in this country, we’re close to the bottom of the pack.”
That, he said, leads people to ask, “What’s wrong with our health-care system?” But that’s the wrong question — or at least not the question that explains the map, he said.
The health-care system can do only so much to produce good health outcomes, he said. People’s health is heavily affected by living conditions — the places where we live and work and play — and by the resources we have and the stresses we face. If the U.S. paid more attention to social services, it could have better health outcomes.
Seattle has a lot of nonprofits that work on health issues around the world, which has helped spur conversations in health circles about what’s working elsewhere that might work here too.
That’s how G2L got started, first as an initiative in 2010. It became a nonprofit at the end of 2012 and has more than 40 partners here, including businesses, health-care organizations, nonprofits like PATH, and local governments.
Because there is so much poverty in South King County, the partnership began pilot programs in two cities, SeaTac and Tukwila. G2L has piloted more than dozen programs so far, according to G2L Communications Manager Allison Mountjoy. They’ve evolved into four main programs now in various stages of development.
One is the Connection Desk at the HealthPoint clinic in SeaTac. Someone may come in because of high blood pressure, Fleming said, and it might turn out the patient didn’t have a job, maybe for lack of certain skills or inability to speak English well enough.
That person might get a “prescription” for a language course, job training or help paying utility bills. Then, rather than doctors using their time to find help, trained volunteers — university students — would connect the person to the appropriate social services.
Solutions vary depending on the problem. G2L worked with small grocery stores to help them carry healthy foods that might appeal to people in their neighborhood. And G2L uses a cellphone application to help people deal with their diabetes. Mountjoy pointed to a UW study that showed health improvement for many of the app users. That was easy to measure, but not all interventions are.
“It’s harder to measure a sense of social connectedness,” Mountjoy said, but that’s important, too.
Fleming said people working on health issues in other cities, including Baltimore, Detroit and the Navajo Nation, are now interested in the project.
In all of those places, attention to people’s lives outside the doctor’s office could do wonders for their health and for the health of their communities.