In a Nutshell: Health is about more than diet and exercise. It also depends on a host of other underlying factors that determine overall well-being. National Health Foundation is on a mission to address systemic health care problems by offering wellness resources to those in debt and in underserved communities. The Foundation also improves access to preventative care, which can address serious illnesses before they become severe.
Some people think that regular exercise, eating the right foods, and regular visits to the doctor for preventative care are the most significant factors in maintaining overall health.
In a way, they are correct, but those healthy choices depend on a variety of other factors that many people take for granted.
“A person’s ability to be healthy is 80% predicated on social determinants versus what we think about health,” said Kelly Bruno, CEO of National Health Foundation.
Since 1973, National Health Foundation has aimed to improve health outcomes in under-resourced communities. It accomplishes that mission by focusing on the social determinants of health that allow people to participate in common, everyday activities that keep them healthy.
National Health Foundation focuses on communities in Los Angeles and Ventura, California. But its research can offer valuable lessons and set strong examples for improving health and quality of life in communities across the country.
“We use the word under-resourced on purpose because we understand that persistent health inequities have prevented people from accessing the resources they need to be healthy,” Kelly said. “These communities experience greater barriers to health care, and social and economic opportunities, and therefore experience worse health outcomes.”
Empowering People to Achieve Better Health Outcomes
National Health Foundation’s work focuses on four social determinants of health: housing, food insecurity, environment, and education. It can help build a strong foundation for communities to improve the health and well-being of their residents by addressing systemic problems in those areas.
Although National Health Foundation is instrumental in addressing issues, it doesn’t bring solutions to communities. Instead, it helps communities take control, identify problems, and create solutions.
“NHF helps communities identify their strengths and amplify their voice to influence decisions being made that impact health,” Kelly said.
National Health Foundation brings ideas, solutions, and resources to the table rather than imposing top-down solutions. The organization allows the communities themselves to decide what will work best.
After all, individual communities understand their needs better than any outside organization. National Health Foundation provides funding and support, but, more importantly, it provides autonomy and control.
“It’s about recognizing that communities have power and know best how to address issues about health at the neighborhood level,” Kelly said. “All they’re missing is the resources.”
Access to Services Often Depends on Environmental Factors
National Health Foundation’s efforts aim to ensure people have access to health care when they need it. Having the resources to exercise and afford quality food are relatively small goals. Health care is increasingly costly in the U.S., and it is often tied to employment — through earnings or employer-provided health insurance.
However, health care access isn’t only about the ability to pay to see a doctor or receive treatment or medication. It also depends on social determinants of health, including education, debt, and built environment.
“Factors such as whether I have reliable transportation, someone to watch my children while I’m gone, or whether I have health insurance will impact my ability to access the health care I need,” Kelly said. “If I need to see a provider that is not in my community, that’s an added barrier and cost to access.”
When someone needs to visit a specialist, but none are nearby, traveling to an appointment could be an all-day affair. And they don’t just need to meet the specialist’s costs; they need to meet the ancillary costs as well — including taking time off work.
That can be difficult for someone working a minimum-wage job and supporting children. Taking a day off from work can damage a household’s income, forcing people to choose between making ends meet, accruing more debt, and getting the health care they need so they can continue supporting their families.
“People either have to wait because they can’t afford it or because they don’t have access. These barriers might cause them to become sicker and cost them more in the long-term,” Kelly said. “It’s not just a case of building more hospitals. Other things play a massive role.”
Lack of Preventative Care Can Lead to Financial Problems
When even sick people can’t make a trip to the doctor, regular checkups are most likely out of the question. That means illnesses may be noticed or treated much later when they are more severe.
“Many low-income communities forego primary care appointments due to high costs, difficulty getting to their appointment or an inability to take time off work,” Kelly said. “Delayed care causes more serious issues in the long term that might result in an emergency room visit where the costs can go through the roof. On top of that, the care they receive is not always 100% covered.”
As a result, people in under-resourced communities can get caught in a vicious cycle. They can’t afford to monitor and maintain their health due to income or debt, and, as a result, they may end up with higher costs down the road.
The COVID-19 pandemic only exacerbated that situation. Beyond the obstacles they typically face when seeking health care, people now had to deal with financial problems and the prospect of more debt if they did seek medical care at a clinic or hospital.
“The cost of delayed care can be devastating. In general, people are entering the hospital much sicker because they couldn’t get the preventative care or resources to identify the illness ahead of time,” Kelly said. “Ideally, they want to avoid the hospital, so as to not catch COVID-19, but often times the hospital is their only option.”
NHF: Laying the Foundation for Lifelong Wellness
One of the most crucial determining factors of health is housing. Without a stable housing situation — or any housing at all — people are more susceptible to illness and less inclined to seek help.
National Health Foundation focuses heavily on recuperative care to address that. The organization provides a stable foundation for ongoing wellness by helping people obtain and maintain housing.
“People who are housed have a place to go while they recover after a hospital visit,” Kelly said. It makes it easier for them to heal quickly and resume normal life. If you’re experiencing homelessness, you are often recuperating on the streets, which leads people back into the hospital.”
National Health Foundation is currently focused on housing older adults experiencing homelessness. According to Kelly, older people are the fastest-growing unhoused population in Los Angeles County, with a growth rate of 17% from 2019 to 2021.
Traditionally, veteran homelessness has been a significant problem throughout the United States. It often stems from mental health problems and physical trauma that can lead to substance abuse and depression. The elder homelessness problem likewise requires a combined solution involving health care and housing. When people have stable homes, they’re better positioned to address health issues and improve their well-being.
“We believe in a housing-first model that says that a person’s basic needs, such as shelter, food, and clothing, should be met before anything else,” Kelly said. “If I’m worried about what I’m going to eat today or where I’m going to sleep tonight, it’s hard to focus on other things in life.”