The health of New Jersey’s urban residents is worse than the health of state residents as a whole – and detailed new report focused on the state’s capital city draws a vivid portrait of the problem and its scope.
A new community health-needs assessment found that if healthcare providers in Trenton are going to successfully treat city residents, they must address daunting social problems including crime and low health literacy.
The assessment was conducted by the Trenton Health Team (THT)], an organization dedicated to coordinating the efforts of the city’s healthcare providers
The study ranked reducing crime and increasing health literacy as two of the top five healthcare priorities for the city, along with reducing obesity, substance abuse and chronic diseases.
THT Executive Director Dr. Ruth Perry noted that both urban crime (both directly through gunshot victims and indirectly through the pervasive fear it causes in a community) and health literacy (the ability to understand medical information and use it to make decisions) are related to the other health priorities.
The team heard from residents who said “We know we need to exercise, but we don’t feel safe walking in our communities,” Perry said.
Her conclusion: “You see how all of these five priorities are interrelated.”
The 2010 Affordable Care Act mandates that nonprofit hospitals conduct these assessments every three years. The assessments generally include analysis of hospital patient data and participation by local public health experts. This information must then be used to adopt plans to meet the needs of the community.
The amount of time and effort that hospitals commit to the assessments can vary, but officials with Capital Health, which operates Capital Health Regional Medical Center, and St. Francis Medical Center decided to work together in an intensive effort as part of the THT, which also includes Henry J. Austin Health Center and city officials. They were able to take a more comprehensive approach involving dozens of local community organizations, thanks to a grant from the Robert Wood Johnson Foundation.
Perry said the assessment was unique because it looked at the root causes of local health problems, rather than just tallying medical cases.
“If residents are afraid their kids going to get shot, then they’re not going to exercise,” Perry said.
St. Francis executive vice president Christy Stephenson, who codirected the assessment with Perry, said the new study was different from one her hospital conducted in 2010 because there was much more community involvement, including a series of public forums.
“It became clear after the second forum that the issues in Trenton were not confined to diabetes, hypertension, heart disease — it was like peeling an onion and people were talking about the environmental things as well as the social barriers” to achieving improved health, she said.
This led the group to directly ask residents what environmental and social factors affect healthcare.
“Crime and violence came up right away,” Stephenson said. “Many of the parents and grandparents felt that was one of the reasons that obesity was so high.”
The social factors came to the forefront in part because the assessment focused on city residents, rather than looking at the needs of the hospitals’ suburban patients.
“In some ways Mercer County is like the land of the haves and the have-nots,” Stephenson said. “That is very much the case where it comes to crime, violence and health literacy.”
Among non-English-speaking residents, language barriers affected residents’ health literacy, she noted. The assessment noted that 35.4 percent of Trenton residents speak a language other than English at home, higher than the 29.2-percent statewide average.
Perry added that if the THT can address health literacy, it would help residents to take care of themselves.
Dr. Robert Remstein, Capital Health’s vice president for accountable care, said the concerns about health literacy matched his own experience in the city.
“If patients don’t have the basic fund of knowledge of what diabetes is,” as well as its complications and symptoms, Remstein said, “we’re not going to get off the dime with those patients and we’re really going to have bad outcomes.”
Remstein said the assessment was eye-opening for him. While he has worked as a doctor in Trenton since completing his residency in 1985, he had always thought of crime as a distinct problem, rather than as a cause of other health problems.
“The impact of where you live and the trauma of poverty around that area directly impacts your health,” he said. “I don’t think I ever realized that as an independent variable that can impact your health.”
He noted that as the THT conducted the assessment, scientific studies were published that linked stress to genetic changes.
Remstein said hospitals have traditionally based community health needs assessments on “the colored glasses of the organization.” Having an assessment that involved multiple hospitals led to a broader perspective.
Perry acknowledged that the THT took on an extremely difficult task by producing an assessment that focuses on major social problems.
“It can make it more difficult to address them, but I think here in Trenton we’re in a unique position” because every health provider, community organization and the city government are united in the effort, she said.
Perry gave another reason – based on economics — for investing in addressing these issues.
“I personally think that this is really key for Trenton because if we cannot get our population healthier and safer, then I think it limits Trenton’s ability to have a renaissance,” Perry said, noting that the chronic diseases that result from these factors affect the city’s workforce. “Businesses will not come if they think the community is not safe.”
The THT has assembled five working groups to look at each of the five priorities listed in the assessment. They will meet over the next two months with a goal of developing a plan to address the needs as soon as late September. Each of the group must develop concrete goals and objectives that can be measured, Perry said.
Stephenson sees the hospitals taking a new approach to addressing community needs as a result of the assessment. Rather than tailoring programs to meet individual diseases as concern about them arises, the hospitals will be able to prioritize their programs to address the larger priorities laid out in the assessment.
“They’re big (and)…audacious goals, but I think we’ll be much more effective not overlapping but working in concert,” she said.