The social determinants of health greatly affect the overall health of Washington’s citizens, and many health care organizations are working on projects aimed at improving the effects they can have on the population.
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Alison Poulsen, Leah Bicknell, Alison Kreutzinger, and Robert DeGregorio discuss some of these projects during the panel “Innovative Approaches to Addressing Social Determinants of Health” at 2022 Internal Health Policy Conference for Northwest Reform State.
Access to education, work environments, health care services and housing are all social determinants that affect health, said DeGregorio, lead organizer at Spokane Health Equity Circle.
On top of that, we have cultural conditions,” DiGregorio said. “This is where you often see racism, homophobia, all these ‘doctrines’, and how [they] affect this individual. What is really important to us is finding innovative ways to target [those] Regions. And one of the biggest things is how do we find a social determinant that we have the power to change? “
Health Equity members are working to increase the number of languages written on prescription medications. They began to focus on the issue when members visited a Spanish-speaking family and discovered that a family member was taking much higher doses of medication than prescribed because they could not read their prescription. This person ended up in the emergency room due to an overdose, DiGregorio said.
Team members worked with lawmakers on the issue, which led to the introduction of House Bell 1852. The bill would have required the Pharmacy Quality Assurance Committee to adopt rules setting out additional requirements for translating prescription drug labels and other prescription information, but it was not passed during the last legislative session.
“We didn’t necessarily think this would pass; we were hoping that it would,” said DiGregorio. “But it is very important to normalize the idea; To get the support behind them and build the strength to make that change. Although she stumbled on the committee, we had several people testify before the House and Senate. A lot of people have shown their support for this.”
Becknell, director of account management at Beacon Health Options, discussed a pilot project run by Beacon that placed Narcan vending machines in rural north-central Washington areas, including Douglas County.
“Our goal was to increase access to reflexology medications for low-blockage overdose, specifically Narcan,” Bicknell said. “What we have done is look for opportunities to stock Narcan vending machines in very strategic locations across the region. We see a lot of variance about whether or not naloxone is available to individuals who might need it. It is not adequately stocked in many locations, no Especially minority neighborhoods. We are aware of rural pharmacy deserts.”
There are also a lot of stigmas associated with people who order Narcan at drugstores, Bicknell said.
So even if it was free and available, people wouldn’t go out to get it,” Bicknell said. “And we really wanted to meet the harm reduction principle to try to meet people where they are, when they might need it. We used funding for drug use and blocked grants or federal grants so we could do that.”
In the first six months of the program’s operation, Becknell and its partners said they distributed nearly 800 Narcan kits.
“There is definitely demand for them,” Bicknell said. “We can trace the lives of 39 people rescued by Narcan that we distributed in just the first six months. We are looking to expand this and we have machines in the southwest region where we will be placing 5 machines. We are actively working to place a number of machines in Pierce County as well.”
Paulsen, CEO of Better Health Together, said the organization recently worked with Newport School District to set up a student health care clinic.
“And they have a provider who comes in two or three times a week,” Paulsen said. “It was great to take some break from the school nurse, who was covering nursery school up to 12th grade. It resulted in the children getting more regular care.”
Krutsinger is the Director of Governmental Affairs and Community Engagement at the Department of Children, Youth and Families (DCYF), a statewide agency focused on child care.
“Many systems have failed in families that used to end at our door,” said Kreuzinger. Education systems, economic systems, and housing systems failed in families. Families and Families BIPOC disproportionately [with] low income. Why do families end up in the child care system, in the juvenile justice system? And how do we really go downstream and begin to prevent problems that really relate to the social determinants of health? “
About 70-80% of young adults who serve in DCYF have a prior involvement in childcare, Krutzinger said. Many are leaving the juvenile justice system and trying to return to their communities.
“We have expanded and brought in housing specialists and housing vouchers as we consider addressing the needs of young people in partnership with housing entities,” said Kreuzinger. “Another piece of innovation is that we ran an agency to introduce a phased alternative to prison called community transformation services. Most of them are young people who are returning to their communities.
How can we help this transition happen sooner? And one of the questions we thought about was how do we make sure that communities are prepared so that young people can come back and succeed? So we’ve had really slow build and implementation, but we’ve done quite extensive work over the last couple of years looking at case profiles and customer studies. Now you’ll see us start asking for the next set of resources to help build the service.”
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