How Rush University Medical Center is addressing the root causes of social determinants of health

Leaders across the health care industry increasingly recognize that a person’s ZIP code is more important to their health outcomes than their genetic code. Mounting evidence demonstrates that when a community faces insufficient social goods—including healthy food, safe housing, and living wages—population health declines. These social determinants of health most negatively impact marginalized populations, including communities of color.

Social determinants of health pose a major challenge in Chicago. The inequitable distribution of resources across neighborhoods results in vastly different quality of life and health outcomes for white and black communities. In the primarily black neighborhoods on the West Side of Chicago, where Rush University Medical Center is located, patients are more likely to have serious health challenges and less likely to be able to access and afford the care they need.

In West Garfield Park, one of the neighborhoods on the West Side, 25% of residents are unemployed and 40% live below the poverty line. Per capita income is just over $10,000. Compared with primarily white downtown Chicago neighborhoods, such as the Loop, West Side residents are:

• 4x more likely to die from diabetes
• 3x more likely to die as an infant
• 2x more likely to die from cancer

As a result, West Side residents lose an average of 16 years of life compared with residents of the primarily white neighborhoods in downtown Chicago.

This death gap did not occur by chance. The root causes include the enduring legacies of structural racism and intergenerational poverty.

Many provider organizations now focus on addressing the social determinants of health, and their efforts can meaningfully impact the lives of patients who receive social support. However, most organizations’ initiatives target consequences to the health system—such as ED utilization and readmissions—reflecting a short-term ambition. This approach perpetuates a revolving door of need. In order to break the cycle, leaders need to set a long-term ambition centered on the structural root causes.

Realizing they couldn’t effectively address the root causes of the social determinants of health alone, Rush University Medical Center launched a community-led partnership, West Side United. This coalition of over 50 local organizations elevates the expertise of community leaders to impact four focus areas:

• Economic vitality
• Education
• Health and health care
• Neighborhood and physical environment

West Side United’s goal is to reduce the life expectancy gap between the West Side and the Loop by 50% by 2030.

Structural change requires broad community coalitions. But organizations can also take steps independently to adopt equitable business practices, invest in economic development, and demonstrate their commitment to the community, ultimately serving as a true anchor institution.

Rush University Medical Center started by determining how they could better serve their “first community”—their staff. Internal champions, including Dr. David Ansell, the SVP of Community Health Equity, successful advocated for an organization-wide $15 minimum wage and the creation of career pipelines for local residents and entry-level incumbent staff.

Rush also realized they could channel their resources to strengthen locally owned businesses. Leaders re-engineered their supply chain processes to ensure they purchase from as many local businesses as possible. They also dedicated $6 million in social impact loans by partnering with Community Development Financial Institutions.

As a pioneer in the field, Rush University Medical Center learned tactics to embrace and missteps to avoid along the way. Provider organizations that strive to address the root causes of social determinants of health should review these six lessons from Rush and West Side United leaders:

1. Repair historical mistrust by acknowledging past mistakes
2. Initiate candid conversations to pinpoint actionable opportunities
3. Follow the community’s lead to design effective solutions
4. Create structural accountability for senior leadership
5. Expect that staff will want to be a part of structural change
6. Commit to long-term investments to yield a true ROI

Since the launch of West Side United in 2017, community leaders have achieved:

• $6.5M dedicated to social impact loans
• 1,800+ new West Side hospital hires
• 1,500 patients served by community health workers
• $125K dedicated to co-locating mental health care in the community