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Grand Rounds: Overall Community Health Lifts the Well-Being of Individuals

July 30, 2019

Brita Roy, MD, MPH, MHS, assistant professor of medicine (general medicine) and director of population health at Yale Medicine, takes a different approach to a familiar subject: well-being. Roy, who gave a lecture titled “Collective Well-Being: An Action-Oriented Framework to Improve Population Health” at the Department of Internal Medicine’s grand rounds last week, suggested an especially broad focus on community is needed when looking to optimize people’s health.

“Historically, most people working on health disparities here and nationally focus on mitigating the negative,” Roy said. “What if we started identifying the health assets in our community, and started promoting those instead?”

Overall health has declined in the United States for the past fifteen years with an unprecedented decline in life expectancy for the past three years, while income disparities have increased, Roy said. Obstacles such as language barriers, lack of insurance, and poverty all contribute to health disparities in certain populations.

But consider the good it could do, she said, if in addition to trying to lessen these community problems, leaders worked to utilize community characteristics to improve collective well-being? Resources like walkability, access to green space, tolerance, social connectedness, robust healthcare and transportation systems, and economic security and mobility can all positively influence collective health.

“In healthy populations, higher levels of optimism and positive affect were associated with a lower risk of all-cause mortality and cardiovascular mortality,” Roy said, citing several studies. And the greater number of healthy individuals may well improve a community’s collective well-being, which then continues to have positive impacts on health and well-being at the individual level.

A broad focus is essential, she said, because narrowly focused interventions may not resolve the root cause of a problem. For example, building a grocery store in a known food desert does not necessarily improve individual or overall health of a community, because it does not address other influencers of eating behaviors such as the cost of healthy foods, time for and skills in healthy food preparation, and cultural or family dietary habits.

During her time at Yale, Roy has focused on utilizing existing resources to track and improve overall well-being in the community, by thinking of the city of New Haven as “the patient.”

She and the Yale Medicine population health team have worked to expand comprehensive care by setting up e-consult and enhanced referral programs, supporting the implementation of online mechanisms to link providers with community-based organizations, and supporting telehealth programs.

“Our patients spend a very small amount of time with us here in health care system,” Roy said. “They spend the majority of their time out in the community, where their opportunities to engage in healthy behaviors are shaped and where they form relationships. And those opportunities and relationships have long term impacts on their health.”

Data collection on collective well-being can be difficult, Roy said. The key is continuing to follow up with individuals once they have left the health care system and entered back into their community systems.

“If you want to know how a person is doing,” Roy said, “you have to ask.”

Submitted by Robert Forman on July 30, 2019