Housing as a Social Determinant of Health
HIP began 2016 with a new strategic plan that reflects the priorities of the HIP Council participants. This shifting focus to the social determinants of health was highlighted by emerging programs, such as Health Homes and High Utilizer Group (HUGS), as well as the March Community Forum. These programs have a simple message: housing is health care. With the help of Monica Martinez of Encompass Community Services, Dori Rose Inda of Salud Para La Gente and Henry Martin of the Watsonville Law Center, HIP Council discussed this shifting role of the health care system as intentionally inclusive of the social determinants of health. Watsonville Law Center’s Executive Director, Henry Martin, presented Carla’s story to HIP Council. Carla is the 5-year-old daughter of a single mother and is constantly absent from school due to her poor physical health. Carla lives in a small apartment with her mother and two siblings. Their landlord refuses to stop smoking, exacerbating Carla’s asthma. Carla’s mother works picking strawberries and cannot afford to move. Her health is shaped by the environment she lives in, creating a perpetual cycle of illness. Sadly, there are many people, children and adults, that are effected by their social and economic environment. Health is determined by several factors. These factors can be categorized as physical environment, genes and biology, clinical care, health behaviors, and social and economic factors. As published in the Annals of New York Academy of Science, of these factors, an individual’s health is largely determined by social and economic factors. One of the most important indicators of health is access to quality, affordable housing. Access to proper housing is associated with reduced onset of new illness and injury, reduced Emergency Department use and readmission, and improved physical and behavioral health.
A new national movement is forming to help families like Carla’s in easing the burden of environmental and social factors. Led by the Watsonville Law Center in Santa Cruz County, the Medical Legal Partnership offers free legal services for low income families who are facing legal problems that affect basic needs. The goal of Medical Legal Partnerships is to expand health care by shifting the burden from the patient to the provider. This shift coincides with the volume to value, quality focused health care and upstream medicine. Salud is working toward a model where a patient can rely on lawyers and social services to provide support through access of services to improve their quality of life. This intersection of health, law, and social services is the new health care team. As stated by Henry, “when you get to the edge of your expertise, there is someone else in the community who knows what to do”. Patients benefit from these types of partnerships and the linkages they create. In Santa Cruz County, these partnerships and services are expanding. Monica Martinez, Encompass CEO, a new HIP Council participant, presented on their new framework of integration. This whole person-centric framework focuses on Integrated Behavioral Health, Community Based Support, and Child Development.
After discussing Encompass’ organizational direction, Monica featured the Housing 4 Health program. The Housing 4 Health program’s purpose is to end chronic homelessness and improve the quality of health through “scattered site” permanent supportive housing. Currently Housing 4 Health houses 70 chronically homeless individuals with complex co-occurring disorders including mental health and substance use disorder needs. This program is based on a service delivery model with an interdisciplinary team of Clinical Supervisors, Registered Nurses, and Case Managers providing treatment. The program also engages support from the County Housing Authority and primary care medical homes. This program epitomizes integration of healthcare and housing, and is an ideal example of how prioritizing housing leads to positive health outcomes for community members.