Case Studies

A global learning for health equity project funded by Robert Wood Johnson Foundation led in Baltimore, Maryland learning from Dara Institute in Rio de Janeiro in Brazil.​ Baltimore is not alone in the health equity challenges it faces. ​Rio de Janeiro in Brazil is an example where population groups have nearly identical social and health outcomes as people in Baltimore. ​These common health inequities transcend national borders offering an opportunity for learn and develop shared solutions. One distinct difference, in Rio de Janeiro, Brazil they have a program that is successfully tackling the problem of social isolation early in life for vulnerable families of critically ill children.​

​​​The Saude Crianza program is an evidence based program that has assisted over 70,000 individuals over 3 decades. There primary focus has been helping critically ill children and their families thrive. despite their poverty. Their social methodology ensures that the first point of consideration is that social inclusion is central to health. The program recruits families from marginalized communities from the health system. They do a baseline assessment to really understand social determinants of health needs for the family and then, understanding the family and the family situation they develop a co-responsibility agreement that the family will develop a family action plan and that they will assist the family as they walk through that family action plan focusing on five areas: health, housing, citizenship, income generation, and education. Families attend monthly support groups where they receive services that they need to achieve their goals in the five areas and they stay with the program over 24 visits and two years.

Global concept implemented in the US: The bi-directional partnership between teams in Northern Togo and Montefiore in Bronx, New York was built on long-standing existing ties. In an effort to improve current Community Health Workers programs locally, the team sought learning and best practices from guides established through the Community Health Impact Coalition (CHIC). The Northern Togo Team focused on utilizing a performance improvement tool, the Community Health Worker Assessment & Improvement Matrix (CHW AIM), as an implementing guide to optimize programs aimed at integrating CHWs into healthcare systems through enhanced supervision, data systems, community engagement and quality improvement approaches.

The Community Health Worker Assessment & Improvement Matrix (CHW AIM) is an evidence-based, easy-to-use diagnostic tool to design high-performing CHW programs. The program at Montefiore in Bronx, New York addressed health equity by providing a community solution in the form of community health workers (community experts) to partner with health systems to address social inequities that impact health outcomes.

In 2015, Henry Ford Health System based in Detroit, Michigan, was invited by the Institute for Healthcare Improvement (IHI) and the Commonwealth Fund to participate in a Learning and Action Network to promote global learning to transform U.S. health care systems. Within this initiative, the Henry Food team in the U.S selected two of four innovations after visiting these originator sites. Both originator sites’ innovations focused on promoting better community health integration with clinical care delivery. Leading the team’s participation was Henry Ford’s Global Health Initiative, its international research, training, and capacity development arm.

The team adapted the “Call and Check” model that originated with the Jersey Post in the Channel Islands. There, letter carriers visit elderly residents who live along their routes for weekly chats to improve feelings of loneliness and social isolation. They work with regional medical and pharmacy authorities to fill prescriptions, make appointment reminders, and share urgent updates with care providers.

While efforts to pilot the “Call and Check” model with the Detroit branch of the United States Postal Service were unsuccessful, Henry Ford adapted the “Call and Check” model and implemented the “Knock and Check” program with its internal community health workers program. These community health workers conducted weekly check-ins with elderly residents of a senior care facility near their downtown, flagship hospital. Screenings and referrals to community resources were made to address social determinants of health vulnerabilities including isolation and loneliness, while care management activities helped improve access to preventive care for elderly residents.

A community-based non-profit organization in Navajo Nation was invited by Medical Education Cooperation with Cuba (MEDICC) to take part in a U.S. network of global learners. MEDICC is a non-profit working to promote United States/Cuba health collaboration and highlight Cuba’s public health contributions to global health equity and universal health care. One of MEDICC’s initiatives – Community Partnerships for Health Equity (CPHE) sends teams of community members from the United States on a series of trips to Cuba to learn from Cuban society, culture, and healthcare in order to apply concepts in their own communities.

All of the teams invited by MEDICC to take part in CPHE represent communities of color that have experienced health disparities due to systematic exclusion from social and economic opportunities. Drawing loosely from their experiences in Cuba, the Navajo CPHE team set up a diverse group of youth-focused programs including trash into art, community gardening, local agriculture projects, and early child health promotion by celebrating local champions and pride in Navajo culture.

The program addressed health equity by emphasizing the importance of self-sufficiency and empowerment among participating community members and leaders. Navajo stakeholders identified strongly with an important Cuban concept: that equitable health systems are grounded in societal values of community engagement and inter-connectedness. This approach used reflects what the team witnessed (Dine’ culture) in Cuba: that societies experiencing an oppressive history of colonization can often bear the present-day imprints of continued reliance on the external resources. The solution therefore lies in the “long game” of community-led efforts to re-center agency within communities themselves, promote self-reliance and local capacity, and nurture local inter-connectedness.

The Athens City County Health Department (ACCHD) was invited to apply for an international exchange in social participation in health, facilitated by the Training and Research Support Centre. Five U.S. sites and 12 international sites were selected based on their interest and ability to apply various aspects of social participation in their own communities.

From this experience, the ACCHD established a Community Health Workers’ workforce in Athens County to address social determinants leading to high-risk diabetes, such as health literacy, access to care gaps, isolation, and resources for daily living among Medicare and Medicaid populations. The program evaluated health system level and patient level outcomes. Outcomes measured access to care and analyzed health policies and practices with a health equity lens toward greater accessibility of services and shared decision-making.