PROFILE: Circumventing the Social Determinants of Health

Social determinants of health, as defined by the World Health Organization, “are the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness.” Historically, those with more means have better care, and therefore better health. Aurora Health Access (AHA) is working to circumvent these factors and ensure that all members of the community have access to health care, regardless of economic standing.

The Aurora Health Access Taskforce first convened in 2009 with representatives from Together Colorado, St. Therese Catholic Church, Colorado Coalition for the Medically Underserved, and other government, provider, and consumer stakeholders. After several years of collaboration, the Task Force voted to become an established organization, Aurora Health Access. In 2013 AHA received a three-year grant from the Colorado Health Foundation to help support governance and sustainability as well as further AHA’s goals.

In a community that spans several counties, the goals of AHA are ambitious. The U.S. Census Bureau estimates that nearly 17 percent of the population of Aurora has an income below the poverty line and of the total residents, 22 percent have no health insurance. Despite world-class medical institutions within the city borders, many of the citizens don’t have access to health care due to location or lack of means. AHA aims to create a community where all residents have an opportunity for health.

“We listen to the people, families, and organizations,” explains Denise Denton, Executive Director, “to identify what is working well, and not so well. We celebrate and promote what is working, and pull together people, groups, and organizations to work collaboratively to find solutions to what isn’t working so well.” It is this collective determination that makes AHA successful, with over 15 organizations in the alliance all working to the same end.

The alliance members stress the value of having AHA in their community. A member from Together Colorado says, “Our participation in AHA is critical.  While we can do grass roots organizing around health care very well, without AHA, we’d have to then work hard to reach all the various hospitals, clinics, decision-makers and bureaucrats one at a time. AHA gives us a platform to reach our intended audience more efficiently.”

The shared effort makes it difficult to ascribe any particular successes to AHA, clarifies Denton. “We can show a lot of contribution to successes, but not often attribution, in part because we really don’t care who takes the credit. In fact, we hope everyone does.” While sharing the credit, AHA can point to several changes in the health care landscape that they have had a direct hand in realizing:

  • Expansion of “medical home” resources and information for children and families throughout Aurora.
  • Addition of community navigators in Aurora Public Schools to work with children most in need.
  • Involvement of Aurora’s ethnic restaurants in health insurance enrollment efforts.
  • The opening (this spring) of a new student-run-free clinic focusing on Aurora’s most vulnerable populations.
  • Coordinated effort among Aurora’s hospitals and clinics to better understand and address the needs of high users of emergency rooms; high users with either medical or mental health issues.
  • Better understanding of and information about health insurance options for small businesses, the 2-1-1 call center, and Medicaid expansion to cover oral health for adults.

Unfortunately, with successes also come challenges. Portions of Aurora are designated as Health Professional Shortage Areas, meaning that there are not enough providers for primary, dental or mental health care. Ms. Denton also notes that “the Affordable Care Act has brought hundreds more Aurorans into the health care system thanks to Medicaid expansion and insurance availability. While we’re doing a better job of providing primary care, we’re finding barriers to accessing specialty care services.” She explains that thankfully, through AHA, they are able to readily bring key stakeholders to the table to explore possible solutions.

AHA is particularly creative when coming up with solutions. In their philosophy, nothing demonstrates love like getting health insurance coverage.  During the final weeks of the Affordable Care Act’s open enrollment period they held a poetry contest through their Facebook page.

Submissions were encouraged and the best poem won a $50 gift card. Ms. Denton submitted a poem of her own to share her passion for coverage, as have many others. Here is a small sample of entries:

Chocolates and cookies,
And cakes – ‘pan’ or layered,
Are still not as sweet,
As if we’d single payer-ed.
– Rich McLean

Daises are yellow,
Roses are red,
I need good coverage,
From my toe to my head!
– Joe Sammen

In Colorado we are lucky because we have Denise Denton,
At Aurora Health Access a resourceful invention.
Before you celebrate Valentine’s Day with your lover,
Come by to enroll and they will help you get covered.
– Lou Ann Wilroy

Noses get sneezy,
Lungs get wheezy,
You get insurance,
While it’s still easy!
– Sharon with the Psychotherapy Center of Colorado

People are more than their circumstances. AHA is a commendable advocate and support system for those among us who are often overlooked or ignored. The vulnerable of Aurora are in good hands.

Previously published as part of CIVHC’s Spotlight on Innovation series.

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