Why understanding chronic illness improves community health
[Music]
[Music]
let’s talk about
charles you may have seen charles
sleeping in the park asking for change
on the sidewalk
opening the convenience store door
karate fighting an invisible opponent
surrounded by police
charles has had 50 emergency room visits
in the last year
43 police encounters 37 ems
transports and more than a hundred days
in jail
just in one year charles lives in the
bushes
in the park i’ve had the privilege
of working with people like charles for
the last 10 years
here’s the facts 5 of our population
utilizes 50 of the costs and resources
and health care
think about that that’s a stunning
number and it affects
everyone in this room and everyone in
our country
whether it’s employers trying to cover
the cost of health care for their
employees
the government shouldering the cost of
medicare and medicaid
individuals trying to afford health
insurance and health care
health care costs have risen to over 17
percent
of gdp
as a nurse i’ve been working with the
five percent
learning who they are what are their
stories
what really matters and how can we
change the system
to improve their lives when you see that
number you might be thinking
this has got to be wow a really big
group of
older people with lots of chronic
diseases
and maybe people near the end of their
life but what i’ve been seeing over the
last ten years
there’s definitely a very important
group of older people in the five
percent
but there’s also some very important
drivers
that are having a bigger and bigger
impact on everyone from 22 year olds
to 96 year olds
one of those drivers is safe housing
if you did not have a safe place to live
and you were trying to manage diabetes
and you were couch surfing
where would you store your medications
if you had anxiety and depression
where would you go to feel safe if you
had no home
if you had surgery where would you find
a clean place to recuperate
the second driver is behavioral health
in our country less than 50 percent of
the population
with mental illness or addiction are
accessing
treatment if you have anyone in your
family with these issues
you know this path what can happen
is a felony record which is followed by
stigma
the inability to get employment the
inability to get housing
and that spreads costs all across our
country in criminal justice and many
other systems
but the first place it shows up is the
safe harbor
of the emergency room
the third driver is social isolation
i was working with an older gentleman
who came over and over to the hospital
he had chest pain we brought him into
the er
we gave him all kinds of expensive
diagnostic tests
all kinds of procedures inpatient
admissions
we did the deluxe healthcare experience
until i stopped to actually ask him his
story
i had no idea his wife had died
he was coming to us with a broken heart
a simple question about someone’s story
can change the whole course not only for
the five percent
but all of us the fourth
complex driver is trauma
research clearly shows the correlation
between childhood trauma
and adult complex illness but i see a
very different face of trauma
and this may not surprise you if you
look in your own community
40 year old women coming to the er over
and over
with unexplained abdominal pain and the
real root cause
is domestic violence
veterans returning with chronic pain
over and over again
when the real root causes ptsd
understanding the five percent is like
tapping into the canaries in the coal
mine
of our social issues today compared to
other countries
the united states spends one of the
smallest amount on social services
four percent of gdp
that lack of investment then shows up
in health care and criminal justice in
other places
so one of the gifts of working with the
population
is seeing what makes a difference in
that
let’s go back to charles and his story
charles had
all four of those drivers not everybody
in the 4 percent does but charles did
and charles is a real person he taught
me a lot
about what makes a difference so the
first thing that happened for charles
is his community a police officer
and a social worker reached out directly
to see if charles would tell his story
of course the first time he said no who
would believe this
they went back a couple of more times
and charles
started to tell what his life story was
for charles what happened is he was had
the experience of being seen
and heard this is a transformative
moment
for people in the five percent here’s
what he said
charles had lived in the community for
25 years
he had a wife a child he had a
successful business
he’d actually even been an alcoholics
anonymous sponsor
things fell apart in pieces and he had
several losses and went into a downward
spiral
and one day found himself living under
the bushes in the park
when they asked his story they said what
matters most to you
what mattered most to charles was
getting well enough
to meet his first grandchild
being seen and heard is a two-way street
it’s not only important for the people
in the five percent
it’s important for the people taking
care of them
the police the nurses the doctors
the social workers the paramedics
all of those folks are trying to solve
social issues
in a system that was designed to
diagnose
treat transport and maybe even arrest
that’s not why they all went into their
professions
people want to do the right thing and if
you want to change the system
and change care for the five percent you
also need to attend to those folks
what happened in charles community is
they did just that
they looked around the community and
this is not a magical perfect community
where
everyone gets along and it’s a
disney song there were old rifts in this
community some of the worst
health outcomes in their state some of
those
complex addiction and lack of resource
issues
but that community looked around and
said
who else is in this boat with me the
police
fire ems social services
behavioral health health care and they
sat around a table together
and talked about being seen and heard
amongst each other about what they were
carrying and trying to solve they
created a collaborative
called project restoration where they
worked on things as a community
they shared charles story together they
organized care around charles goals
what mattered most to him charles got
addiction treatment
and transitional housing and most
importantly
a sense of belonging he was no longer
alone
the same thing happened for the
community belonging
was critically important as they sat at
this table
and stepped out of their silos and they
stopped competing
for limited resources and they actually
walked outside of their buildings
and worked together on a shared
community problem
they create had a sense of belonging
with each other
this started to really change the game
the pivotal part for charles came when
he was
in housing the way they set up their
housing unit
is everyone who lives there is part of
running it
not only do they run it once they’re
more stable
they become a mentor and appear to the
new people
there and then once they’re stable
enough they join the collaborative
and they bring their voice to the table
about what they think
will change things for the community
this shifted to the third
key principle for healing in the system
and people
with the five percent charles had a
sense of connection
a sense of agency he could make
change and he was part of we
the same thing happened for the
community they shared resources
they stopped competing for dollars they
got a lot done
they opened a transitional housing unit
they fixed the transportation system
they created an agency for co-located
agencies
but most importantly and the most
valuable change that happened for them
is they also had a sense of connection a
sense of agency
a sense of we can change this and they
did i can show hard numbers from that
community
and i want you to know how much that
it’s
bigger than just this community the same
approach is being taken
in in a range of environments from
rural california to urban memphis
some of the numbers from those programs
are 82 reduction
in criminal justice costs 70 percent
reduction
in health care costs 40 reduction in
hospital visits
but the most valuable change is a return
to dignity
a health care system reimagined
around what matters most and sure
there’s
policy and education and funding and
regulatory changes we can make
to make that happen but the fastest way
it will happen is if we turn to each
other
and ask what matters
most
[Applause]