Roots - randomized & uncontrolled

Root:
Origin. Beginning. Foundation. Nub. Bedrock. Source. Seed. Underpinning.

Cause.

The root causes -- social determinants of health. Those social and economic circumstances that determine our health, well-being, and trajectories in life. Areas upon which many programs, policies and systemwide structures in other countries are based, and which the U.S. lags so far behind in, in acknowledging and addressing in a meaningful, effective way.

Long before we need medical care, our foundation for health begins in our homes, schools, jobs and neighborhoods. For everyone in our nation to have an equal opportunity for good health, more attention must be focused on the social and economic factors that most affect health where we live, learn, work and play.
Robert Wood Johnson Foundation

Those working at the community level know this. But for small nonprofits, health care providers, and others, the challenge remains in how to take on the root causes of problems in the communities and individuals they serve. The effects are obvious, every day, of inadequate housing, poor quality schools, distressed neighborhood environments, under- and unemployment, low wages, institutionalized and interpersonal racism, and more. My nonprofit colleagues frequently and loudly express their frustration at the lack of funding to do much more than what they may rightly feel is a bandaid approach to a problem, and with daunting requirements to show results, prove it was your one little program in this vast sea of influences that made the difference, bow to the almighty P value, measure the unmeasurable.

This past week a number of stories caught my eye for their creative thinking, courage to take a sharp detour from the usual approaches, and incisiveness in getting at the root of the matter. Here are three of my favorites, shared in the hope that they will give inspiration and hope to anyone feeling that their work is hopeless and capabilities inadequate. Believe me, I've been there.

1. This one's personal. My husband and I are currently assisting a local organization here in Rockland, Maine, that is preparing to launch a Weekend Backpack Program to reduce food insecurity. About half our county's schoolchildren qualify for free or reduced-price school lunch - in one school it's over 70%. During the week they get fed at school. However, the kids often show up dragging on Monday, have trouble staying alert in class, sometimes get disruptive, etc. Grades can suffer. The Weekend Backpack Program - already operating in other Maine communities - entails a food pantry working directly with the school to provide each eligible child with a backpack of food for them and their family, to take home on Friday. (I will reserve more detail on this until the big launch.)

This is a perfect example of a social determinant of health (actually two) being addressed: Are a child's grades slipping? Let's address her family's hunger/food insecurity. Participating children, families and teachers have been thrilled with the program, and we're very excited to be helping get it going in our home town. Results have been tremendous -- ah, but how does something like this get measured? The program can count how many children and families are served, they can measure iron levels, or even track school performance, using control children (e.g., well-fed and unfed ones not in the program) checking the almighty P value to make sure it wasn't just by chance that a fed child did better than an undernourished one... 

How do you measure the unmeasurable? How do you demonstrate those qualitative, positive ripple effects -- the pride a child feels in helping his family eat, the awareness that others care, the reduced worry over when her next meal or snack will be, or - and I suspect this is a big one - the relief for parents? Not being able to feed your children is a primal horror, and the effects of chronic stress on children's cognitive and social development are well known. For this reason, gathering those statements, testimonies from the people benefitting directly from and those witnessing the program (e.g., volunteers and teachers stuffing backpacks with food) are key. If possible, in-depth interviews can further get at the more subtle, though no less powerful, aspects of the impact a program might have. Package the statements, deliver them to the public and potential donors and funders in a powerful way.

My other two favorites of the week - and I will just provide the links, as they speak for themselves. Both of these intrigue me, because they likely go a long way in addressing inner social determinants - the need for the opportunity to learn, for others to believe in you, and for companionship. Powerful stuff, and whether it passes that P value test or not, it makes common sense and is simply the right thing to do. Do read on...

2. A different approach to juvenile detention in New Mexico
3. Elders and college students - fellow nursing home residents

Next time: the arts.

Yours in the struggle - Carla

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