Op-Ed: Lessons We’ve Learned in Trenton Shine Light on National Health Care Debate

Gregory Paulson | February 27, 2020 | Opinion
Trenton Health Team found addressing drivers of poor health in under-resourced communities is key
Credit: Trenton Health Team
Gregory Paulson of the Trenton Health Team

As our nation continues debating the future of health care, lessons we’ve learned in Trenton over the past decade offer a way forward.

Trenton Health Team began as the answer to an urgent problem — the pending closure of Mercer Medical Center in 2006 and concerns about the effect on city residents who lacked consistent access to primary care and instead relied heavily on emergency rooms.

In response, Capital Health, St. Francis Medical Center, Henry J. Austin Health Center, and the Trenton Department of Health and Human Services began collaborating for the first time. In February 2010, that collaboration was incorporated as Trenton Health Team (THT).

THT has grown significantly since its founding, recently receiving designation as one of New Jersey’s first regional health hubs to collect and disseminate local data, be a conduit between state and local priorities, and serve residents who often lack access to the resources needed to be, and stay, healthy.

Regional health hubs (RHH) have replaced state Medicaid accountable care organizations (ACOs) to better serve residents receiving health care coverage through Medicaid. New Jersey’s regional partnerships — THT, Camden Coalition of Healthcare Providers, Healthy Greater Newark and Health Coalition of Passaic County — work with both clinical and social service providers to improve patient care and outcomes. The new law allows expansion of the RHH model in other communities statewide.

As one of the state’s first health hubs, THT works with health care providers and community organizations to integrate, coordinate and align disconnected services to help make our community healthier. Over the years, we have learned how every aspect of a community affects health outcomes, and that we will never get people healthy if we only focus on providing them with more health care.

Likewise, our nation cannot hope to make progress on health care without finding common purpose among diverse stakeholder groups.

Impacts of poverty, racism, food insecurity

Underlying drivers of poor health in Trenton, and across our nation, are many and varied, including poverty, structural racism, food insecurity, housing quality, childhood trauma, and other issues that doctors and health care providers are ill equipped to address.

Our experience shows that educating families about including more fruits and vegetables in their diets is helpful, yet their healthy choices alone cannot counteract the impact of living in a community that has been under resourced for generations.

To improve health, we must address these deeper, upstream, root causes — while continuing the traditional public health work of delivery system improvement, alignment of services across medical and social service areas, and education about and access to a healthy lifestyle.

We’ve learned the role of integrator — creating partnerships among those with diverse viewpoints to address complex conditions such as challenges facing someone managing diabetes while living in a healthy food desert — is critical. Convening members of government agencies, nonprofits, health care and the community has revealed valuable perspectives and opportunities for innovation.

To meet our community’s needs, THT has evolved beyond just a health care-focused organization. Our national debate on health care also must evolve. For too long, arguments have focused on just the tip of the iceberg — but a health care focus cannot be the only strategy for addressing the health status of a community, or a nation. We have the health data to know that simply prescribing asthma medication does not improve the health of a child living in a home with mold.

Over the years, THT has shifted more resources toward prevention and policies that build health and well-being. We visit barbershops and churches to provide health screenings and connect participants to food pantries or other social services. We partner with other community agencies to identify children chronically absent due to health issues, then assess and remediate any housing conditions contributing to their illness.

Why is Trenton Health Team interested in school attendance? Because attendance predicts educational outcomes and high school graduation rates, which may in turn impact Trenton’s economic future — and the city’s economic health impacts resident health. National policymakers, take note.

Need for collaboration

We’ve learned that seemingly independent organizations — primary care, hospitals and social services, for example — are actually components of a heavily interdependent system and must work as a team. We’ve helped competitors build trust, become partners, and make a real difference. Today, two hospitals, a federally qualified health center, a Catholic social service agency, and housing providers are collaborating to provide free services to pregnant women struggling with addiction. Together, we celebrate each healthy birth and reunited family.

Indeed, Trenton is now a bright spot for this kind of multi-sector partnership and a national model for integrated health and well-being services. THT did begin in response to a health care crisis; but we have learned that every aspect of a community affects health outcomes. That’s a reality our country is just starting to confront.