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How Do We Make Disease Prevention a Reality for Underserved Communities?

Ron DePinho on Opa Health

Changing mindsets to change behaviors.

Up to half of all diseases are preventable with knowledge in hand today and yet we fall short in realizing such social and economic benefit. Moreover, the Covid-19 pandemic has shined a light on an even greater gap in the health and resiliency for underserved communities. For nearly all major U.S. cities, health outcomes contrast starkly from one neighborhood to another located just a short distance away. An illustrative example is Baltimore where life expectancy of the East Greenmount neighborhood is equivalent to that of North Korea and Yemen, while nearby affluent neighborhoods enjoy life expectancy rates of over 80 years of age, similar to that of Japan. What is the basis for these glaring inequities and how can we address them?

Ours is a disease-care, not a healthcare, system. We spend just a fraction of a penny on prevention relative to the treatment of diseases. Yet, the greatest positive impact we can have on the health of a community, particularly of an underserved community, is in disease prevention. To better understand why we are missing the mark, we at Opa Health conducted a landscape analysis across many organizations with the potential to impact public health – governments and leaders, healthcare delivery systems, academic medical centers, faith-based organizations, educational institutions, non-governmental organizations, and medical societies. This analysis identified three key gaps and opportunities to bridge what we know and what we can actually do.

The first opportunity is to gather and propagate use of highly granular data. In an interview with CDC officials, we learned of the need for high-resolution neighborhood-level data relating to the major instigators of disease such as tobacco use, obesity, vaccination rates, and more. At present, much of the available information is conveyed at the whole-city or county level. Localized neighborhood data insights are fundamental to a more accurate and asymmetric deployment of the right policies, education and services to address and quell specific disease instigators present in specific neighborhoods. Moreover, once we identify the problem, many communities are ill-equipped to know which solutions to implement for what problem. Many of the current evidence-based strategies to improve health are largely inaccessible and not actionable and are often ‘trapped’ in medical journals or various governmental websites. Needed is a ‘What-Works-Clearinghouse’ of solutions that are relevant to underserved communities.

The second opportunity gleaned from our many stakeholder conversations was the need for a greater focus on protecting the future health of our youth. It became evident that many do not appreciate that the prevention of disease in adulthood requires action during childhood and adolescence. For example, the prevention of adult cancers caused by the human papilloma virus, thirty-four thousand cases per year, requires vaccination during teenage years, optimally between the ages of 11 and 12. Another example is the fact that nearly all adult smokers start their addiction during childhood; 95 percent before the age of 21. Melanoma risk is doubled by youngsters using tanning beds just 11 times under the age of 18. These, and many other examples demonstrate that while healthy living is important to maintain as adults, it is critical that such action be taken early in life. Preventative actions during childhood and adolescence can reduce adult disease by up to 50 percent. That equates to huge savings in healthcare costs, reduced human suffering, and long-term health improvements for entire communities.

The third area of opportunity relates to the need for greater communication and collaboration among diverse stakeholders, each with specific contributions to effective solutions. Opa Health’s co-founder and president, Rick Little, refers to this as an ‘uncommon table.’ Localized collaborations empowered by highly detailed data can magnify the reach and effectiveness of every preventative effort, sparking innovative interventions that fundamentally shift the balance from costly disease-care to effective disease prevention. For example, examination of a high neighborhood rate of childhood obesity correlated with a food desert or sugary soda access in schools can become the focus of targeted investments focused on integrated programs that combine policies and nutrition education with stipends and block-by-block access to healthy food choices. In a neighborhood where the incidence of cervical cancer among young women is alarmingly high, a neighborhood faith center could work with local schools and clinics to develop a peer-based education group that encourages discussion of HPV vaccination and screening.

I’m encouraged by the new COVID-19 Health Equity Task Force established by Executive Order on the 2nd day of the Biden administration because it embraces this model, both in its call for a broad cross-section of federal and lived-experience participants and its mandate for expedited local data collection in underserved communities, including people of color; sexual and gender minority groups; those living with disabilities; those living at the margins of our economy; and those in rural and Tribal communities, territories and other geographically isolated communities.

To enable science-based disease prevention rather than disease treatment, I have been privileged to work with a caring and talented team who are committed to launching Opa Health, a non-profit charged with bridging the gap between knowing and doing, of shifting community health care from disease care to wellness, prevention, and community resilience. Under the guidance of tech leader Clyde Boyer, Opa is currently assembling and synthesizing actionable multivariate data to the zip code level for one pilot effort and talking with stakeholders there about forming uncommon tables to address specific local opportunities.

Opa Health is an outgrowth of work begun in 2018 by a seasoned team of social entrepreneurs spanning global health, technology, education, public affairs and policy, public/private partnerships and youth development organizations who came together to help make disease prevention a reality. Since 2018, the original team has visited with over 300 organizations and leaders. The need is enormous, and the opportunity global, to use a science-based approach to build preventative public health initiatives for all people in every community – urban or rural, large or small, and irrespective of race or ethnicity, nationality, faith, gender, or income. We believe it is possible to bridge the knowing-doing gap, to provide young people, their families and their communities with relevant knowledge and tools to make better health and life choices. All of us need to contribute to the solution in our own way. We are an uncommon table devoted to a common cause. Please learn more about Opa Health by visiting our website.

 

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