When the Office of Economic Opportunity, which was funding Geiger’s clinic (the first community health center in Moundville, Mississippi funded by Lyndon Johnson’s Great Society) , found out, they were furious — and sent an official down to Mississippi to inform Geiger that they expected their dollars to be used for medical care. To which Geiger famously replied: “The last time I checked my textbooks, the specific therapy for malnutrition was food.” [Excerpt from “Wellness is More than Not Being Sick” by Rebecca Onie, Chapter 18 in Creating Good Work: The World’s Leading Social Entrepreneurs Show How to Build A Healthy Economy edited by Ron Schultz]

When Dr Jack Geiger got to Moundville in 1964, he found conditions to be reminiscent of those he had seen in South Africa, and not in a good way. The staff of the community health center, who supposed they were going to be dealing with TB, cancer, and other medical problems instead found themselves overwhelmed by the social problems that undermined health in the region, such as hunger and unemployment. In a way that was prescient,  members of the community were included for the first time in decisions about their health and the future of the area through inclusion on the board and the clinic staff.

These medical folks soon found themselves engaged in food security, developing safe drinking water, and economic development, The clinic developed a farm cooperative to allow community members to grow food for themselves and earn additional money from selling produce to others. They not only saw patients in their offices but went into people’s homes to focus efforts on how to prevent illness. In the days of Jim Crow, they were considered a significant threat to the status quo.

Today, the Delta Health Center has a Facebook presence. The community health movement has spread to almost every part of the country. It is not unusual for the local Center to provide services to all, regardless of ability to pay. However, it isn’t enough. Just as Dr. Geiger saw that food was the treatment for malnutrition, we now know that chronic illness, cancer, and premature death are caused as much by poverty and genetic predisposition as by bad luck. The zip code you are born in predicts whether you will live an additional decade and what that experience will be like. The next Dr. Geiger will need to get into the weeds a bit more.

The Center for Health Innovation at CMS has put together a blueprint to get to the next step. Called Accountable Communities, it envisions health professionals hooking folks up with food, pest control, legal services, and other resources needed to help them overcome the tyranny of the zip code. Health Affairs has outlined what resources we as care providers need to overcome that tyranny:

1) Health Systems Need To Commit To Real Clinical Integration Of Social Needs – If we are going to anticipate the “rising risk” patient, we as care providers need to know something not only about the “really sick” but about all folks in the community and their anticipated needs. Some insurance plans are capturing this on all of their covered folks but doing a terrible job of sharing with other members of the health care team. We need to all know who is suffering so we can match people with resources.

2. Commit To Developing A Workforce That Is Truly Focused On Addressing Social Needs – It will take more and different types of care providers to help folks to not get sick in the first place. What should our outreach strategy be? Do we develop community health workers? Do we recruit volunteers? While it takes a village, more importantly it takes way more than just doctors. Once a need is identified, we need case workers engaged in hooking folks up with services such as food pantries, financial planners, pest control specialists, and legal aid.

3. Commit To Giving That Workforce The Information They Need To Do Their Jobs Well– Community resource availability is an ever-changing picture. Static information sources (books, pamphlets, etc) are rapidly out of date. Medical personnel often are unaware of what the community has to offer. Whose job is it to hook up community agencies with sick people?
4. Commit To Follow Up – For folks at risk of getting sick, repeated contact to help them become motivated to change is the key, even when they don’t want to think about their health. Who makes this contact? Do we aggressively pursue those who feel they don’t need services but clearly do?
5. Commit To Collecting And Analyzing Data – This is a lot of data on people. Target knows when a person is pregnant, often before the baby-daddy does. Do we use this data for the forces of good? If so, who does and how do they use it?
The Great Society didn’t make us great but it sure helped this county. Although still poor, the health markers in Bolivar county are better than 11 other Mississippi counties. For rural Mississippi, that is saying something. Maybe through Accountable Communities we can all take that a step to disassociating illness and poverty.