OVERARCHING THEMES WITHIN THE CHIP PROCESS
The four interconnected overarching approaches and themes, which were transparent across the development of the CHIP and will be throughout its implementation, include:
improving life expectancy, especially in disparate areas
improving the population’s health
achieving health equity
accessing health care
A. IMPROVING LIFE EXPECTANCY
Disparities in life expectancy were one of the main findings from the 2016 CHIP. For this reason, it was a goal throughout the five workgroups to consider whether the root causes to address the main headline indicators, as well as the strategies to address these root causes were going to make a positive change in the community, especially in areas where the resources are scarce and the living situations are of poorer conditions. The lack of resources and infrastructure to be healthy and thrive, including all of the social determinants of health such as education, employment, access to food, and access to transportation, among others, contribute to the higher rates of chronic conditions and violence in those areas, which lead to premature death. Aiming to reverse this trend to improve conditions for those living in underserved areas was therefore one of the main foci of this CHIP. (See Figure 2.)
B. IMPROVING THE POPULATION’S HEALTH
To improve the population’s health also means to help Bexar County residents live longer healthier lives, as discussed in the above mentioned theme. Improving the population’s health requires upstream interventions and changes to the social and physical environments. It means ensuring that all residents in Bexar County have their most basic needs met (e.g., shelter, food). It involves creating environments that are conducive to the healthy choice being the default or easiest choice.
From a more practical point of view, improving the population’s health means to set goals to achieve positive health outcomes and to monitor progress toward that goal until the outcomes are improved.
C. ACHIEVING HEALTH EQUITY
Achieving health equity means to attain the highest level of health for all residents of Bexar County by providing them with full and equal access to opportunities that enable them to lead healthy lives. To achieve health equity, we must address the root causes or the systematic and structural barriers that cause inequities across sectors and people including in education, employment, housing, and health care. Figure 6 provides a simple example of health equity.
Achieving health equity also involves investing in innovative solutions such as nationally recognized evidence-based interventions to address the social determinants of health of people at highest risk. The National Quality Forum released a report in September 2017 entitled A Roadmap for Promoting Health Equity and Eliminating Disparities: The Four I’s for Health Equity where they lay out a roadmap with four actions to reduce disparities. The four actions are listed in Figure 7. As an overall theme, these key actions for health equity were kept in mind throughout the planning and development of the CHIP.
D. ACCESSING HEALTH CARE
Having access to care is essential for prevention (e.g., immunization), screening (e.g., sexual transmitted diseases), diagnosis (e.g., diabetes), and treatment when ill (e.g., mental illness). Accessing health care early, for example through a primary care provider, is associated with better health outcomes, fewer disparities, and lower costs. Health literacy also plays an important role in accessing care to understand health information and make informed health decisions. In addition, having health insurance can help to increase access to care and decrease medical costs. Many providers will simply not treat the uninsured and underinsured, which leaves those without insurance to seek care from publicly funded safety net providers, many of whom are overwhelmed and or underfunded (Chokshi, Chang, & Wilson, 2016). Ensuring access to care can bring about numerous benefits for the health and longevity of county residents, which is why it was considered the last overarching theme of the 2017 CHIP.
Chokshi, D. A., Chang, J. E., & Wilson, R. M. (2016). Health Reform and the Changing Safety Net in the United States. The New England Journal of Medicine, 375(18), 1790-1796.
National Quality Forum. (2017). A Roadmap for Promoting Health Equity and Eliminating Disparities: The Four I’s for Health Equity. Retrieved from https://essentialhospitals.org/wp-content/uploads/2017/10/disparities1_final_report.pdf