An Upstream View of Population Health

Graphic of a single illuminated lightbulb

The Upstream Imperative, Volume 2

This article is part of “The Upstream Imperative,” a series exploring the challenges and opportunities facing the social services sector.

By Adair Mosley, President and CEO, Pillsbury United Communities

If you’re like me, you want to solve the stubborn disparities that exist in our community. It can be daunting to talk about, and there are no easy answers. But I believe the change we want is possible if we are willing to zoom out. Only by tackling the root causes that brought us to this place can we get past them as a society. 

This is what I mean by the Upstream Imperative: elevating our strategy to engage the systems — not merely the symptoms — that hold back people’s lives across generations. 

Facing the factors

Nowhere is this upstream response more needed than in population health. We know that the health of our community is shaped to the greatest extent by social determinants: factors including neighborhood livability, housing, education, and economic prosperity. These factors influence people’s lifelong wellbeing more than any hospital, doctor, or medication. 

Why does Minnesota have some of the largest racial disparities in the nation? Because life in black and brown communities has long been adversely impacted by systemic racism and inequity. This context affects everything: people’s access to nutritious food and health education, their exposure to environmental hazards, and their likelihood of living in substandard housing. It imposes extra costs and barriers when they access healthcare and produces toxic stress that puts people at risk for lifelong health problems.

If we’re serious about closing these gaps, we need to think at the scale of this systemic challenge. That means bringing all stakeholders to the table to innovate with an inclusive approach. 

Assessing root causes

We can’t solve problems we don’t clearly understand. Which is why the Affordable Care Act mandated that non-profit health systems conduct health assessments in the communities they serve. Such assessments can unite payers, providers, and policymakers around the same goal — be it care access, nutrition, housing, education, or all of the above — and guide a coordinated response. 

Without a mandate to address social needs and root causes, the efforts of health systems to date have been largely reactive and disconnected from the people they’re meant to help. As that mandate changes, organizations like Pillsbury United have an essential role to play. As a connector between healthcare systems and our communities, we can help produce a truer picture of life and health in our neighborhoods — the first step in creating an effective response based on the community’s real needs and assets.

Human connections

Foremost among these assets are people. In communities of color, there have always been navigators — people who deeply understand their neighbors’ perspective and help them navigate their critical social needs, from health care to housing. The role they play is usually hidden and seldom compensated, but their impact is no less important than that of doctors. They guide people to overcome cultural and economic barriers to better health in ways the traditional healthcare model cannot. 

That’s an opportunity. By investing in the capacity of these navigators and elevating their role as true Community Health Workers, we can empower our communities’ human resources to do even more. They deserve better tools and support and to have a voice in matters than affect their families and neighbors. Despite proof that such a model works, it is not as well funded as it should be. Policymakers, payers, and healthcare systems can help change that. 

Convener and conduit

Health has been at the center of our work for over 140 years. Supporting whole people in whole communities is part of our Settlement House roots. We understand the importance of working in, for, and with community, listening to people most affected and giving them tools to create solutions relevant to their lives.

As healthcare systems begin to embrace more encompassing, community-based solutions, agencies like Pillsbury United are poised to make them successful. As intentional partners, we can ensure an intersecting regional response big enough to create historic change aligned with the goals of stakeholders and needs on the ground.

We envision a future where people achieve greater personal health and wellbeing together. For the communities we serve, this future can’t wait.

Transforming community through art, theatre

Jon-Michael Reese from Pillsbury House Theatres’ ‘Jimmy and Lorraine: a Musing.’ Photo by Rich Ryan

Pictured above: Jon-Michael Reese from Pillsbury House Theatres’ ‘Jimmy and Lorraine: a Musing.’ Photo by Rich Ryan.

Recognizing that art has more to offer than just a means in which to be entertained, Pillsbury House and Theatre continues the early settlement house tradition of using art as a transformative tool for social justice, a way for people to connect and promote cultural understanding. Speaking of their work within the overall mission of Pillsbury United Communities, Faye Price, Co-Artistic Producing Director of the Pillsbury House Theatre and Co-Director of Pillsbury House, says, “I always think that art, and specifically the art that we do, is another path to health and wellness.”

Their current production, Jimmy and Lorraine: a Musing by Talvin Wilks, explores the lives of James Baldwin and Lorraine Hansberry, prominent artists and civil rights activists of the 50’s-60’s whose words regarding politics, race, and relationships remain timeless. Price, speaking about how the lives and work of these two individuals are still so relevant in light of the inequities our country continues to face, says, “Our hope is that people can watch these characters—and relive in some cases—or learn who they are and what they had to offer us. And their words of hope, their words of anger. Why does this all feel so familiar decades later? Why are we still going through all of this?” And, at the end of it all, when the lights go down and the play concludes, for the playgoers she hopes for some kind of transformation, that “something has been touched to make them question an event, a feeling, a belief, a thought.”

In addition to theatre being a powerful tool to shift mindsets, it also provides a unique way for strangers to connect. Hull House, the first settlement house established in the U.S. by Jane Addams, used theatre as a way for new European immigrants to mingle. With Italians showcasing the work of their best Italian playwrights, the Polish putting on plays produced by their own best artists, and so on and so forth, different groups used this artistic expression to learn more about one another. “That’s what we’re doing,” Price says. “We believe that culture is a way to speak to everyone. Our demographics have changed, but we’re still doing the work and really kind of walking the talk in terms of using the arts to intersect with people. Inside of our theatre, we see women from shelters sitting beside well-to-do lawyers from the suburbs and Somali teenagers sitting next to Caucasian senior citizens. You enter into this space as strangers and you come out of it with a shared experience which I think is a lovely thing. And hopefully you continue the conversation.”

Also staying rooted in settlement house traditions of valuing accessibility of the arts, Pillsbury House Theatre uses a pay-what-you-can ticketing system so that everyone can experience their productions. “We want people to see theatre that are not able to see theatre, that feel like they’re priced out of it,” Price says. Not only that, but this unique hub for creativity and community also threads art throughout their human service programming of Pillsbury House Neighborhood Center. Resident artists teach classes at their daycare as well as are involved with their on-site day training and habilitation program for adults with disabilities. Older adults are engaged in a ‘Visual Memoir’ class. Their Breaking Ice program uses the arts for diversity, equity, and inclusion trainings. Local artists rotate through a structure in their lobby every two months to “remind everybody that this is a place of the arts, how the arts bring people together, and how the arts can encourage healthy and vibrant communities,” Price says.

And hopefully, this was a small reminder of just that—the power art carries to foster connectedness, creativity, and change. If you haven’t had the chance already, we encourage you to see this in action over at Pillsbury House and Theatre. (Jimmy and Lorraine: a Musing is on-stage until October 20th!)

Planting Our Flag

Graphic of a single illuminated lightbulb

The Upstream Imperative, Volume 1

This is the first article in “The Upstream Imperative,” a series of articles exploring the challenges and opportunities facing the social services sector.

By Adair Mosley, President and CEO, Pillsbury United Communities

Here’s a hard truth: our systems are failing our communities. The black and brown families we see every day inhabit a society where they are in last place. Minnesota is 49th or 50th nationally for disparities in earning high school diplomas. We are 49th for racial gaps in home ownership. Mortality rates for African-American and Native residents are up to 3.5 times higher than for other racial and ethnic groups.

While these challenges disproportionately affect people of color and families living in poverty, they are a legacy of choices we’ve made as a community. So how will we respond to these shared problems as a society?

Will we focus on providing services that ease suffering in the short term, while ignoring the systemic causes that have brought us to this point? Or will we embrace deeper, more lasting solutions?

Make no mistake, traditional human services are a lifeline our communities can’t do without. Our sector improves millions of lives in thousands of communities by working to close gaps in food, housing, education and beyond. These efforts must be preserved and strengthened.

But on their own, they are not enough. Beyond delivering programs and services, it’s time to re-envision the ecosystem and impact of our work as a whole. To remove systemic barriers that hold back people’s lives, we need to embrace radical and disruptive innovation. And urgently.

Social needs: widening the scope

Agencies often say they address social determinants of health when in reality they treat symptoms. Food shelves help feed families, but they don’t solve the financial and transportation burdens that put grocery stores out of reach for many communities. Health education can save lives, but it only succeeds when supported by healthcare infrastructure that makes the knowledge actionable to people where they live.

While providing near-term services to individuals is necessary, it does little to change the systemic issues on the ground — most importantly the long-term economic disadvantages faced by families living in poverty. Until we confront that social reality, food, housing and health assistance will be a temporary salve at best.

Responding only to individual needs can give us a false sense of progress. We celebrate the number of people we’ve served through our programs while ignoring the conditions that make these programs necessary.

To move the needle on a population scale, we must take a broader view. If we are serious about addressing social determinants of health, we must dismantle the systems that perpetuate inequities and hold people back across generations.

Changing the ecosystem

Shifting the context in which people live their lives is hard work. System-wide solutions take more effort, money, and political will. They require cross-sector partnerships that can reform complicated entities like our health care and education system. They require us to ask difficult questions, demand more of ourselves and our partners, and refuse to be complacent.

The social services sector can’t be expected to move these mountains on its own. Partners in government, philanthropic community, and businesses must also step up. When money is restricted to incremental solutions, entrenched problems fester and our communities remain unstable. We need brave financial partners willing to collaborate on ambitious solutions — and allow those with proximity to the community to focus dollars and energy where it matters most.

In over a century working with and for our community, we have learned that the best solutions flow from the community itself. But only when we understand the lives behind the challenges and stay anchored in their dreams and aspirations.

This is where we plant our flag as an agency. We envision communities where people achieve greater personal health and wellbeing together. Where cultural understanding creates social connections. Where prosperity is shared by all through equitable education and employment opportunities.

This is our motivation: going upstream to reform entrenched systems that can meaningfully change people’s lives long term. As an agency, as a sector, and as a society, we must be willing to think bigger and do the hard things. Only then can we realize a healthier, happier, more prosperous future for everyone in our community, no exceptions.

Gearing up for Census 2020: We all count

Census 2020: Waite House staff holding "We Count" signs

Medicaid. SNAP. Housing assistance. School meal programs. Child care assistance. Employment and transit services. Head Start. Health and unemployment insurance. The list goes on and on for programs and services that receive federal funding based off of census data. For Minnesota, it’s estimated that the state will lose $28,000 per person over a decade for not counting just one person. So, it’s no surprise that oftentimes it’s the historically undercounted communities that have been historically under-resourced as well.

The census is much more than just a count of who lives here. In addition to it serving as a significant determinant of the allocation of resources to our communities, it also impacts local, state, and national political representation. For this census coming up next year, Minnesota is at risk of losing a congressional seat. And—following the 2010 census results, North Minneapolis actually lost a councilmember. Though the population might actually stay the same (or even increase!), the impacts of not being counted have significant repercussions.

So, what all does this have to do with us? Everything. When resources are underestimated and communities are underrepresented, the opportunity to flourish and thrive diminishes. As an agency who has deep roots in these undercounted communities in Minneapolis—immigrants and refugees, those experiencing homelessness, indigenous communities, low-income households, renters, and more—we have a natural role and responsibility in taking part in census efforts to ensure a complete and accurate count.

We launched our efforts by hosting a census hiring fair at Brian Coyle Center in Cedar Riverside, with hopes to recruit census staff who represent the very communities they have a hard time reaching. As a registered Complete Count Committee with the Census Bureau, we plan to continue our efforts by engaging in culturally relevant outreach and engagement via our direct service programs, community events and info sessions, awareness through our media outlets North News and KRSM Radio, door-knocking, and more. With this being the first census where online participation is encouraged, we also plan to host open computer lab times to assist community members with this task, recognizing the very real digital divide in our community when it comes to technology access and literacy. Not only that, but with the census collecting responses in only 13 languages (none of which are Somali or Oromo), it’s imperative that our staff, who collectively speak 19 languages, are equipped to assist in these efforts.

Lastly, engaging with our communities to help participate and take leadership roles in these outreach efforts will be key. We want to provide the tools and support needed for folks to be part of the systems and solutions that impact their lives, recognizing it’s important that those who are doing much of the outreach reflect the communities they’re trying to reach. Especially with fear of government entities so prevalent, it’s trust and connection that will effectively get the message across.

Ultimately, the Census means more resources coming into our communities and fair representation, political power. But it also just means – you exist. We exist. We count. We are here and this is our home.

Want to volunteer or partner with us in our census efforts? Contact Meghan: MeghanM@pillsburyunited.org, 612-455-0388.

Register now for Greater>Together 2019

Adair Mosley at Greater>Together 2018

Registration for our 2019 Greater>Together fundraiser is now open! Join us on October 2 to celebrate 140 years of powering people, place, and prosperity. Purchase tickets via the form below, or click here for more information.

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