Douglas A. Spotts MD, FAAFP, FCPP Vice President and Chief Health Officer, Meritus Health
As COVID-19 cases increase in a new and dangerous way right before our beloved time of holiday gatherings with friends and family, and “pandemic fatigue” looms large in even the most controlled communities and states across the nation, Meritus Health, a 275-bed community hospital and health system inHagerstown, Maryland and over 40 community partners have decided to launch “Go for Bold: Do, Eat, and Believe in a Healthy Washington County!” The ultimate goal is to lose one million community pounds by 2030, and after an exciting October 6, 2020 kick-off, over 30 partners have pledged to lose and maintain the loss of close to 300,000 of those pounds to date. We pledge to do this by yearly action plans aimed at increasing activity (DO), making healthier food choices and addressing food deserts in the city of Hagerstown and surrounding Washington County (EAT), and reducing stress, and addressing behavioral health needs, including addiction, to improve the mental health of all citizens (BELIEVE). Why is this campaign so important at this critical time in the life of our community? It is because really addressing the population health needs and social determinant drivers of health care concerns has never been so important as in this time of state and national pandemic crisis. Knowing that 80% of health outcomes are driven by the social determinants of health, we must fully engage patients in determining their risk based on loneliness, housing and income stability, healthy food and nutrition access, transportation, and any existing chronic health comorbidities. Using our electronic health record helps us to identify these risks for those who can reach us in our clinics, but more important, we have learned that we must reach those who cannot get to us. Rapid deployment of telehealth and virtual visits in this time of the COVID pandemic (two weeks in our case for what was going to take at least a year) must continue after the pandemic returns to safer and more manageable levels. Indeed, a public and population health infrastructure must be reestablished before any future pandemics or natural disasters come our way. Health inequity has been glaringly exposed, and all of us in health and health care must address the inequality that exists in our society when it comes to health and health care services, disease management, and health outcomes.
In practical terms, we will manage weight lost and maintained by signing up for a community weight tracker- a password protected, accountability tool, where an individual can record their current weight and also make note if they are a part of an employer or community organization team weight loss/maintenance goal. The cumulative community pounds lost is reported by participants and organizations monthly, and a prominent display for the downtown is currently in the making. All resources and the weight tracker are displayed on the Healthy Washington County website where the synergy and energy of the community is magnified and displayed around “Do, Eat, and Believe!” Yes, it is about the pounds lost month by month, year by year, and to ultimately get to one million lost by 2030 in alignment with Healthy People 2030, but it is also about addressing the community health needs assessment data that shows that Washington County is more obese and diabetic than other counties in Maryland ( 18th place out of 24) and Maryland is more obese and diabetic than other States in the United States ( 36 out of 50). This plan outlines with the Maryland Diabetes Action Plan in knowing an individual’s risk for pre-diabetes and opportunity for better diabetic management if already diagnosed with this chronic disease. This is measured by fasting and two hour post prandial glucose levels, measurement and knowledge of Hgb A1C levels, and by understanding the goals of healthy blood pressure readings and more ideal body weight parameters. This is one chronic disease example of how “Do, Eat, and Believe” can help an individual patient achieve success in improving their own health journey, thus helping them avoid the high costs of chronic disease and health care. This is an attempt to “quit mopping the floor by turning off the faucet,” a phrase attributed to population health expert, David Nash MD. Other attempts to “turn off the faucet” include obtaining complete social determinants of health information (SDOH) and not only identifying the needs of our patients “outside of the walls of the hospital” but linking patients to those services by care manager nurses and trained community health and social workers as well as guaranteeing the referrals were completed. It also means bringing healthy foods and nutrition education to places where it is much easier and less expensive to choose less healthy options. More important, it is a campaign to unite a community and health system around the key mission of improving the health of all people. This is the time for improved health in not only this community, but in all communities across our nation! It is a time to put population health into action form theory; it is a time to make primary care and public health the bedrock of our health as a nation. It is the time to address health inequity with intentionality and vigorous response, in really digging into racial and other socioeconomic disparities to better understand how to overcome these barriers. The call to “turn off the faucet and quit mopping up the floor” is the urgent call for action now. It is also an image of hope for better days ahead!