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LNJ Part IV: Amoebas and Collective Impact, or the Complexity of Public Health

April 2015 Seminar
This blog is part of a ten-part series capturing my experiences as part of the 2015 Lead NJ Class, which follows the monthly two-day seminars our class participates in over the course of one year.  For the next several weeks I’ll be posting a blog every Monday up through my graduation in early December 2015.


If there’s one thing I learned from the Lead NJ Human Services and Healthcare seminar, it’s that most systems we wrestle with in our society can be classed, ultimately, as public health issues. This is a viewpoint that was completely new to me – one that is both motivating and daunting. [Fair warning: I’m throwing the “recommended length” rules for blogs out the window here. While this isn’t an epic tale, I’m not willing to shortchange sharing information on what I think are very important issues in order to fit standard blog formats. I hope you’ll stick with me.]

We had a variety of speakers join us for this seminar, ranging from the NJ Dept. of Human Services, to The Children’s Specialized Hospital to our own classmates, Jackie Cornell-Bechelli (Regional Dir., U.S. Dept. of Health & Human Services), Kamili Williams (VP of Programs, Community Foodbank of NJ), and Diane Litterer (CEO & ED, NJ Prevention Network) who gave us a variety of perspectives on issues surrounding health, healthcare, and other human services. There were also a couple of key exercises we participated in that helped to illustrate the layers of complexity with our health issues, including hunting for Supplemental Nutrition Assistance Program (SNAP) eligible foods in local bodegas and role playing a case study of the 2012 Jersey City Christ Hospital sale, which I’ll describe in greater detail below.

In looking back over my notes and thinking about my experiences, there were six key areas that seem to be essential in understanding public health issues: Education, Technology, Jobs, Legislation, Nutrition, and Human Dignity. Here’s how I’d depict it visually – amoeba-like, multi-layered, and interstitial:

Amoeba_1x

But for the sake of understanding how these key areas behave and interact, I’ll break them out to look more like the diagram below – the point is, these areas should not and cannot be treated as exclusive, neat little silos because they are not, and the trouble I find with diagrams like the modified one below is that it bears little relation to the reality of the situation.

Amoeba_2

Human Dignity

I’ll start with Human Dignity, because I think it is the one area that is, perhaps the one we tend to pay the least attention to in the way we design our systems of care and support. As individuals, it matters when we are treated in ways that value our questions, our concerns and our needs. It makes us more likely to trust, more likely to seek help when help is needed, makes us more likely to listen to and understand the needs of others.  Socio-economic privilege often makes the pathway to human dignity more accessible, and as a society we need to look hard at changing our systems to make that true for ALL people.  Our first exercise of this seminar helped expose the disparity between both socio-economic privilege and the privilege of taking action to make change happen.

On our first day, we were given a task: to shop for food that was eligible for Supplemental Nutrition Assistance Program (SNAP) benefits at local bodegas a block from our meeting place at Rutgers. We had a set budget and set circumstances, which included the assumptions that we represented a single mother of two children, the youngest of whom had juvenile diabetes and the eldest of whom was not born in the United States and was therefore ineligible for SNAP benefits. Our groups dispersed and we flooded the often tiny stores or bulk produce markets.

Elijah's PromiseIn so doing, we came flat up against our privilege in a unique way – by entering a socio-economic community that some of us don’t encounter on a regular basis, or may not have ever encountered in a meaningful way before. The exercise was designed for us to each donate $5 to our “budget,” to purchase non-perishables from the local stores that we determined we needed for our exercise, and then to donate the food we purchased to the local food bank Elijah’s Promise. We had to present our choices to and receive feedback from our classmates on our purchases. We debriefed: Some members of our class felt voyeuristic and guilty, some shared that their backgrounds were akin to the circumstances described in our exercise. One classmate responded in a proactive way to the expressions of guilt by saying, “Don’t pity us [those of us in lower income brackets]. You want to do something? Take it to the voting booth. Do something by voting for policies and politicians that will change the situation.”

Nutrition

I’ll come back to voting and legislation in a minute. One of the other outcomes of the SNAP exercise was realizing how difficult it is to find nutritional, affordable food, particularly when you have to take into account illnesses like diabetes. The cost of fresh produce, of protein, and of alternative grains and pastas that don’t drive carbohydrate counts (which metabolize into sugar and can wreak havoc on blood sugar levels) was cost prohibitive. What if you add into that mix a food allergy? What if English is not your first language? How do you know what to buy, what to look for, or where to shop, if you can even easily get there?  That’s where our next amoeba comes in.

Education

SNAP is intended, as its name suggests, to be a supplemental program, and yet it is relied on by millions as a primary source of food. Education is key here, at all levels. Education about nutrition from school food programs to doctor’s offices and emergency waiting rooms, to local supermarkets. Proper nutrition for our children is a public health issue, because without proper nutrition it is more difficult for our children to learn, and therefore what is happening in our educational system is also a public health issue. Information and guidance about what illnesses mean for families, what preventative measures can be taken, what treatments are available and where to find affordable healthcare is also an essential piece of public education. But there are varying levels of success with more traditional delivery methods for information. So what are new and alternative ways to monitor health and help ensure proper nutrition?

Technology

telemedicine ear examOur speakers from The Children’s Specialized Hospital shared how technology in the health world seems to be moving at lighting speed. Gadgets like FitBits, the Apple watch and other wearable technologies, even smartphones, are accelerating the possibilities of “telemedicine” technologies that allow doctors to work through video conferencing and other virtual communication tools that can take basic vital measurements in non-life threatening scenarios. The “gamification” of health knowledge and service also helps to educate and motivate both patients and providers, done predominantly through apps. In writing this blog, I stumbled across an interesting article by Charlyn Stanberry about the potential for mobile phone health apps to help manage chronic diseases in minority communities. Note: the link for the “Minorities, Mobile Broadband and the Management of Chronic Diseases” report referenced at the end of the article is broken, but you can access it here.

And before I leave The Children’s Specialized Hospital I’m going to circle back around to human dignity: The hospital is designed to be welcoming – its walls are colorful, the rooms and waiting room areas are dressed to feel more home-like. The Hospital even put in washers and dryers for the families to use on site, as many families will stay nearby for the duration of their child’s stay, which can be a long time for some. It’s these details that help encourage and preserve the human dignity of their patients and their families. I’d like to see every hospital start to move in this direction because it expands the idea of “technology” to the environmental design of spaces where certain health outcomes want to be achieved.

Jobs

Deputy Commissioner Lowell Arye (NJ Dept. of Human Services) shared insights on the aging baby-boomer population and the immense demand for elder care (generally defined as care for patients 75+ years) that the Department is anticipating in the near future. There has also been movement to foster ambulatory care centers that allow people to be treated closer to home. Mobile health care is the one of the largest job growth sectors in New Jersey, which means we need to start training people for those future jobs now, or we’ll find ourselves with a shortage of qualified individuals. As many people may be aware, the home health aid worker receives, according to U.S. News & World Report an average of $10 per hour. That’s $10 per hour to clean, dress, administer medication, be aware of any changes in health of their patients, some of whom also have illnesses like dementia or Alzheimer’s.

nursing-services2Chasing the facts above to an economic conclusion, we are presented with the need to start preparing ourselves, from a budgetary standpoint, to pay better in a multitude of positions. How can we expect to attract our current college and high school students into the field of elder care without offering to pay a living wage?

In bridging this key are of jobs back to education, I began to wonder what will happen to the mid-career elder care professionals as the boomers start to pass away? How can we train people to shift their expertise to other needed areas when the demand for elder care slacks? And what happens to jobs as traditional hospitals start to close and the models of healthcare shift?

Legislation

Our final exercise of the seminar was to read and role play a New Jersey case study: In 2012, the Christ Hospital in Jersey City was facing bankruptcy and sought a buyer. We were assigned different groups to represent: the hospital Board of Trustees, the potential buyer, the CEO of the hospital, the doctors, the local advocates, union leaders, and the State Planning Board that was to hear the case and determine the course of action based on the evidence. We were joined by a panel of experts, some of whom worked on the case, to help answer questions and pose questions.

Each group’s role and point of view was different, and the positions they had to defend sometimes conflicted with their own assessment of the case study. I was assigned the role of Commissioner of the Dept. of Human Services on the State Planning Board overseeing the hearing. What I learned as a Planning Board member was this:

  • It is incredibly challenging to try to make sure everyone has all of the relevant information needed to fully understand the decisions made.
  • The level of complexity in cases that deeply affect public access to healthcare, that affect jobs and the local economy is difficult to communicate and to understand.
  • We are constrained by the roles we play and the organizations/groups/constituencies we represent.
  • We will never hear everyone’s voices, because of time constraints, regulatory constraints or other constraints.
  • Where we might wish for flexibility we must hold to the group message.
  • Where we decide to move forward – we learn, too late, that we only have the power to make recommendations, not to decide and implement.

I am not entirely sure if those lessons are all bad – because to a degree it does mean that checks and balances are working (sometimes we don’t hear everyone’s voices because public comment opportunities have occurred prior to the hearing; the trick is making sure that those opportunities are well advertised and community feedback is genuinely sought). However, if there is an impulse to change a part of the system for the better, it can be very, very difficult to do.

From a legislative standpoint, then, what are small ways we can help to find the balance that keeps human dignity, jobs, the cost of technology, and accessibility to care all in the mix?

The complexity of public health issues can feel overwhelming. But can we, as leaders, each help to clear the path for multiple ways forward? Can we start to shift educational policies to encourage people to enter essential healthcare fields and provide flexible training to keep them relevant and employable in 20-30 years? Can we shift corporate and economic policies to encourage private sector tech entrepreneurs to work with healthcare providers and health educators? Can nonprofits, the private sector, and government all work together to make the case for preserving human dignity and “take it to the voting booth” by encouraging legislative changes alongside the work we’re all doing? Yes. And we need to start now.

Those questions feel…intertwined, multi-layered…amoeba-like. And while amoebas may be single-celled, there are complex processes at work in them. But here’s the beauty of complex systems: there are hundreds of entry points to keep the work moving forward. The more we can encourage leaders to work across fields, to consider who else we can talk with and how else we can collaborate for collective impact, the more resilient we will become.

 


Kacy O’Brien is the Program Manager at Creative New Jersey, a statewide initiative dedicated to fostering creativity, innovation, and sustainability by empowering cross-sector partnerships in commerce, education, philanthropy, government, and culture, in order to ensure dynamic communities and a thriving economy.

This blog is part of a ten-part series capturing Kacy’s experiences as part of the 2015 Lead NJ Class, which follows the monthly two-day seminars her class participates in over the course of one year. Topics range from policy to the economy, to education, arts and culture, energy, criminal justice and healthcare, with a focus on New Jersey’s current state and its future. The views and opinions expressed in this blog are those of the author and do not necessarily represent those of Lead NJ, The Geraldine R. Dodge Foundation, Creative New Jersey, their staffs, and/or any/all contributors to this site.  For corrections or questions, please email Kacy at: kobrien@creativenj.org.

Kacy gratefully acknowledges Lead NJ and The Geraldine R. Dodge Foundation for their support of her participation in the 2015 Lead NJ program.

lead nj logo             Dodge JPG

 

 

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