Health and Wellness: A Whole Person Approach
Our Heart & Science magazine highlights International Community Health Services' work to address the social determinants that create better health outcomes
January 10, 2018
By Naomi Ishisaka. This article was first published in Seattle Foundation's Heart & Science Magazine Volume 4.
International Community Health Services provides culturally appropriate health care in a multitude of languages to improve health and outcomes of Asian Americans, Pacific Islanders and the broader community.
Longtime patient Suet Chin gets her blood pressure taken at the International District Clinic.
When Suet Chin moved to Seattle from Guangdong, China, 27 years ago, she found a second home at an unlikely place: the doctor's office. With nurses who spoke her language and support for all aspects of her family life, Chin gave birth to four children and raised them to adulthood with the help of International Community Health Services, or ICHS.
When she had her first baby at ICHS and had little family support, the nurses supplied baby clothes and food. As her children got older, ICHS provided nutrition support and employment services for them.
Now, her entire extended family of 20 all receive care from ICHS, including her father, who is being treated for Parkinson’s Disease. “I feel like ICHS can provide good service and a variety of service,” she said through an interpreter. “Whenever I need something, I just have to call and they know my family really well.”
This approach to providing wraparound support for a family’s full spectrum of needs is not by accident.
Focusing on the social determinants of health
Long before “social determinants of health” were buzzwords in public health circles, ICHS offered its clients a broad range of support, from culturally appropriate care with in-language navigation, to food security programs, health-insurance assistance, food assistance, and culturally-specific programs for elders, youth, children and families.
Social determinants of health are the factors and conditions in which people live, work and age that affect their health, including socioeconomic status, race, ethnicity, education, environment, employment, sexual orientation, social networks and access to health care.
ICHS serves the Asian American and Pacific Islander communities of King County, addressing those social determinants of health broadly. Rana Amini, health advocacy manager at ICHS, describes their approach as giving clients the keys to open different doors, based on their needs, with 13 bilingual community advocates serving as the guides. That includes a wide range of help across those social determinants, from connecting clients with resources to find a job, affordable housing, English classes and more.
Angela Wan, a Community Advocate at ICHS, teaches the senior line dancing class, which provides exercise and camaraderie at the International District/Chinatown Community Center.
ICHS began in the early 1970s as a small, grassroots effort to provide culturally and linguistically appropriate care to Asian American and Pacific Islander clients. It was the first clinic in the country to do so, and has since grown from a humble storefront into an eight-location health organization with mobile and school-based clinics. ICHS now serves nearly 29,000 patients, 74 percent of whom are Asian American. Sixty percent are low income and 55 percent use interpretive services. Their clinics provide medical, dental, behavioral health, and soon, vision care.
Looking beyond healthcare
While most of our national conversation centers on the fight over access to health insurance, there is good reason to look at social determinants as the foundation of good health. According to research from the Kaiser Family Foundation, health care accounts for just 10 percent of factors leading to premature death, vs. 90 percent from social and environmental causes, individual behavior and genetics.
King County Public Health Officer Jeff Duchin, M.D., said it’s critical to look beyond health care to improve health outcomes. He said a person’s ZIP code can be more revealing than his or her genetic code. “We know that in the U.S., people with higher incomes live longer and healthier lives than people with lower incomes. This is an important issue because our goal as public health professionals people have equal opportunities to live healthy and fulfilled lives. Understanding the causes of these health inequities or differences in health outcomes is an important way for us to begin to address them.”
ICHS CEO Teresita Batayola believes access to care is an issue of social justice and that everyone has a right to health care that makes a difference for them. “It should never be an issue of money or background, never an issue of whether or not they have the right papers. It's a universal right. What people are so shortsighted about is that the health of the person in the next house, the next chair to you, affects you. If somebody does not have access to care, it will become a public health issue.”
Building relationships to build health
Batayola says a key part of the center’s success is connecting with patients on a personal level. “ICHS is a medical home, which means that we provide service through a team. Our goal is for our patients, especially due to language and culture issues, to bond with someone on the team.”
Patient Lucia Leandro Gimeno appreciates ICHS' whole person approach to health care.
ICHS patient Lucia Leandro Gimeno knows firsthand the impact of this approach. Gimeno, who describes himself as an Afro-Latinx, transmasculine femme (he was was born a female, and currently identifies in the middle of the masculine and feminine gender spectrum), came to ICHS after three weeks in the hospital following a diagnosis of end-stage kidney failure. He said the difference in ICHS’s care was immediately apparent. “My primary care physician was the first doctor that ever asked me ... ‘How are you doing with all of these changes?’ And I literally almost burst into tears.” Gimeno said. It was one of the first times a doctor had inquired about his mental health, not just his physical health. The doctor offered counseling support through ICHS. “He was always super competent and great about the medical stuff, but also was really kind and compassionate,” Gimeno says.
While he will need a kidney transplant, Gimeno’s health has stabilized through ICHS and he credits it to the whole-person approach and excellent care.
“The people are so thoughtful and caring. They are always asking, ‘Do you need anything else?’ and ‘How can we support you?’" he said. “I've just figured out through my health crisis that the difference between life and death is whether people respect you and listen to you.”
Upstream approaches to King County's disparities
Duchin of King County Public Health says it’s critical to engage in these kinds of upstream approaches. “In general, the poorer a person is and the poorer the neighborhood they live in, the more they struggle to meet the basic needs of life and have access to healthy food and recreation, safe neighborhoods and so on, the more difficult it is for them to achieve good health,” he said.
According to a recent study in the medical journal, The Lancet, disparities in health outcomes for King County are dramatic. While life expectancy in King County overall is among the highest in the country, wealthier communities have the highest life expectancy, at 14 to 18 years greater than that of the poorest communities.
Healthy meals are prepared and served at ICHS’ community kitchen events.
To tackle challenges like that, King County is participating in a five-year regional health effort called the Accountable Community of Health, or ACH. One of nine efforts across the state, the King County ACH is taking aim at social determinants of health to improve care and better use resources as part of the restructuring of Medicaid. Batayola is part of the leadership council overseeing this initiative.
Amini, who has a background in global and public health, acknowledges that successes in tackling social determinants can be hard to quantify. She said it’s like trying to find a pill to stop youth suicide when what makes a difference is addressing the underlying issues. “If you want to get to the root of all of this, we need to go back to the community and try to change the root cause of the problem. Because the pill won't solve the pandemic. We need to do something else."
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