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Evolving the Role of Academic Health Systems in Community Resilience

Eugene Washington — Former Bellagio Resident

Immunization is one of the most important things a parent can do

In January, Duke Medicine changed its name to Duke Health. Those of us in medicine know just how monumental it was to replace that one word “medicine” with “health.” This was not a re-branding exercise aimed at energizing the face of an academic health system. It was, and is, a declaration that Duke is ready to lead a paradigm shift in how the medical community views and delivers health.

When I entered medical school, the focus of the profession was on addressing the needs of individual patients—treating their illnesses, injuries, or diseases. We didn’t give any real thought to those who didn’t seek our care. Many in medicine still remain focused on the delivery of care without fully considering the importance of disease prevention and health promotion.

“Factors like income, education, safety, nutritious food, exercise, and physical environment all determine whether a community has what it takes to be resilient and whether its people have a genuine opportunity to thrive.”

But research tells us that medical care by itself is only responsible for 20 to 25 percent of a person’s health. That means that even if we all provide the best medical care and latest treatments, other factors may have an even greater impact on how long or well a person lives—factors like income, education, safety, nutritious food, exercise, and physical environment all determine whether a community has what it takes to be resilient and whether its people have a genuine opportunity to thrive.

I went into medicine to improve people’s lives, and this data has transformed how I think about health. What I see is a golden opportunity for academic health systems to take the lead. Historically, academic health systems have defined their overall mission as improving the health of society through three distinct pathways: medical education, research, and patient care. It is time to add a fourth societal responsibility—population health improvement.

Some might argue that this is the purview of public health. The reality is that public health agencies do not have the capacity to take this on alone. And academic health systems do have substantial contributions to make as influential agents in local commerce, employment, and health care delivery. Academic health systems can offer expertise, resources, and a shared aspiration. We are part of these communities, and if we can help improve the health of our communities, we will also enhance the health of the patients we serve.

I am not suggesting that we supplant public health agencies or that we do this alone. This effort requires the work of a complementary group of players, all invested in the community and the outcomes of the work. Sounds simple, but it’s not.

That is why leadership is so important. Success depends on establishing partnerships with key leaders and organizations in the community, including education, business, faith-based leaders, consumers, and others. In Durham, NC, many stakeholders including the mayor, the superintendent of schools, the head of the Chamber of Commerce, and representatives from business have all come to the table. And Duke is playing a leadership role in convening this coalition. For example, we are now working with IBM, which has more employees in North Carolina than in any other state, on a population health improvement project funded through its IBM Health Corps awards.

For Duke Health, and I am certain for many of the country’s 135 academic health systems, this is not a significant leap. Academic health systems are already implementing patient-focused models of care and engaging in population-specific management. We are committed to improving quality while reducing cost. And we are already spending millions of dollars to develop initiatives designed to meet community health benefit requirements established as part of the Affordable Care Act.

Universities are so often pillars of their communities and are positioned to do both enormous societal good, and enhance their academic and institutional missions by engaging with the community. These institutions have a stake in building the resilience of the regions in which they operate—resilient communities rebound faster from both acute shocks and slow burning stresses, leading to a host of benefits including improved population health.

To meet the needs of an increasingly diverse population, we cannot ignore the status of the communities in which people live. Transforming our approach to improve population health will not be easy, but we have no choice but to succeed. We have the tools and technologies to create new models of care that factor in the social determinants of health and well-being. We believe fully that treating patients is not enough. We must treat our community as the patient as well.

Dr. Eugene Washington was an Academic Writing Resident at Bellagio in November 2015. He is the President and CEO of Duke University Health System and the Chancellor for Health Affairs of Duke University.

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