This is the longer original piece with all the links and images that were the genesis for the Florida Times-Union commentary.

This past month I had the opportunity to participate during Humana’s half-day Bold Goal launch conference in Jacksonville, Florida (the county seat is Jacksonville and there has been a consolidated government of Duval County since 1968, so some refer to the broader county).  The conference had excellent presentations and I was honored to be included with a distinguished group of panelists from the Health Department, hospitals, providers of care, and the Duval County Medical Society. It was nice to be involved in an event and try to play a role in improving the health of the community in which I live.

There are other efforts ongoing to improve community health in Jacksonville, including the Clinton Health Matters Initiative, which has focused on solving the hunger issues and a number of hospitals have launched their own efforts as part of the Community Health Assessment and Improvement Plan. While these programs and others in the community may have made some progress, Jacksonville still faces major health issues and our quality measures are poor:

• Major Causes of Death are considerably higher than the state average,
• Of 67 Florida counties, Duval ranks 48th (having fallen from 43rd the prior year)  on Health Outcomes, 48th on Length of life, 49th on Quality of Life, and 58th on Physical Environment. Yet it ranks 11th on Clinical Care; which just goes to show that one’s health is driven less by the available healthcare system than by the Social Determinants of Health.

Some of the major barriers we face include:

• we tend to say we need more data or another study,
• we have not been very innovative, and
• we have little accountability.

As far as data goes, there are plenty of studies available in addition to those cited above. Here are just a few more interesting ones:

• The Gallup Healthways Well-being Index and their recently released Gallup Healthways study on Diabetes,
• CMS and
• the Commonwealth Fund Scorecard.

For data on Health Literacy, the University of North Carolina has a fantastic website. The map itself can be accessed here. The screenshot below shows Duval County with areas of poor health literacy in red and orange. The locations highlighted with below-average health literacy will come as no surprise to those who understand the community, poverty, Social Determinants of Health, and their relationship to health status.

As a community we clearly can find and/or know what the issues are,  where the issues are, and have a multitude of organizations and funds apparently working on them; yet we continue to see our community’s outcomes in many key areas remain the same or get worse.  It’s long overdue for Jacksonville to do something about our community’s poor health status and the inequities that cause it.
If we are to make a difference we need to begin by having the will to:

• make a difference,
• recognize what the problems are,
• speak of them openly,
• collaborate,
• do something, and
• hold ourselves and those working on these issues accountable for results.

The following are some basic principles I think should be incorporated into our efforts:

1. Recognition that most of what we have been doing has not worked.  We need new ideas, new programs, new approaches. I recently moderated a webinar on Health Literacy during which Cynthia Baur, Director of Health Literacy for the CDC said “We’ve known for 30 years that handing out pamphlets and reading materials does not improve health literacy, yet we continue to do it.”  We need to identify similar inadequate approaches and discontinue them.
2. Look beyond the healthcare system for our solutions.  Many of our issues are not “care” related.  Jacksonville, like other communities, is experiencing the impact of Social Determinants of Health.  Solving these problems requires looking to expertise, services, and solutions outside the “care” system.
3. Saying “no” to calls to do another study so that we can measure some aspect of the community’s health status before we start doing something. We know what the opportunities are from a multitude of local and national studies.   Instead, we should take the money we intend to spend on studies and apply it elsewhere, like perhaps trying some innovative pilot programs.
4. Collaborating for the benefit of the community, not the benefit of the organization.  There is mission here that is larger than any one person or any one organization.  Each should leave their agenda at the door and recognize that for the community to benefit, different services may be required than those an organization offers.
5. Holding each organization working on aspects of this accountable by requiring them to report outcome measures. Too many organizations seek to justify their existence by reporting process measures or anecdotes. If an organization cannot measure its outcomes and show significant results, those funds should be spent elsewhere. Just as we are moving towards value-based purchasing of health care services, we should move to value-based purchasing of community services.
6. Asking our healthcare system to focus internally. If the providers of our healthcare which ranked 11th of 67 counties really care’s about the community’s health, they should work on getting the 30% of waste discussed by the Institute of Medicine out of the system. Imagine what we could do with those funds. Here’s another interesting data set from Eliminating Waste in Healthcare, Berwick, D. M. et al, JAMA April 11, 2012.
7. Looking to new approaches. Tray Cockerell of Humana pointed out that these problems are complex and complex problems can’t be solved using traditional approaches.
8. Ensuring that any solutions tried are scalable. We have a large and geographically distributed community, funded programs must be able to provide a solution for a large number and/or geographically dispersed population.

Jacksonville, like other major cities, struggles with a lot of issues that affect the health of members of our community; but with the will, an agreement on basic principles, and some new thinking we can create a thriving, healthy community for all of us.