Our healthcare system concentrates too many resources on clinical care and patient-centered treatments while neglecting equity, preventive care and population health. The Institute of Medicine reported in 2013 that, given the United States’ healthcare spending, the country’s poorer health outcomes can be attributed to the effects of health systems, health behaviors and social and environmental factors. Similarly, Americans’ behavior and environments account for at least 60 percent of their health, while genes account for 20-30 percent and healthcare accounts for only 10 percent., Therefore, we cannot simply rely on medical treatment to improve health outcomes. We must also change our behavior and environments.
One method of bridging healthcare, behavior and environments is being pioneered by clinical-community partnerships. These partnerships are necessary to address social determinants of health, but it is difficult to form them and ensure that they are strong, effective, efficient and sustainable. Active Living By Design (ALBD) is well-positioned to support these partnerships through that process. By helping clinical groups coordinate with public agencies, residents, businesses and community organizations, ALBD is supporting these partnerships as they address social determinants of health and make policy, systems and environmental changes. These long-term changes will lead to improved health behavior and community-level health outcomes.
To advance this work in North Carolina, ALBD partnered with Blue Cross and Blue Shield of North Carolina Foundation and Care Share Health Alliance to assist clinical-community partnerships that want to improve community prevention and health. Together, we are helping each partnership make challenging systems changes that require long-term planning and capacity-building.
One component of ALBD’s support is to expand and enrich a learning network with useful material regarding clinical-community collaboration. This allows partnerships to learn from others facing similar challenges while creating positive change. As a contribution to the field, ALBD has identified and written case studies about clinical-community partnerships around the United States which have successfully addressed social determinants of health and have advocated to change community conditions. These case studies explore how the partnerships were developed and what processes, structures and practices were implemented to integrate upstream preventive actions with clinical practice.
In writing these case examples, ALBD recognized specific actions and processes that made it possible for these partnerships to succeed. Clinical-community partnerships can benefit from employing some of these “best practices” that are appropriate to a given situation. While reading the case studies, look out for a few of the following “best practices” identified on the first page and described within the story.
You can view a combined PDF of all the case examples here.
 National Academies (U.S.) and Institute of Medicine (U.S.), U.S. Health in International Perspective: Shorter Lives, Poorer Health, ed. by Steven H. Woolf and Laudan Y. Aron (Washington, D.C: The National Academies Press, 2013).
 J. Michael McGinnis, ‘Actual Causes of Death in the United States’, JAMA: The Journal of the American Medical Association, 270.18 (1993), 2207 <http://dx.doi.org/10.1001/jama.1993.03510180077038>.
 J. M. McGinnis, P. Williams-Russo and J. R. Knickman, ‘The Case For More Active Policy Attention To Health Promotion’, Health Affairs, 21.2 (2002), 78–93 <http://dx.doi.org/10.1377/hlthaff.21.2.78>.