By: Ruth Perry
Posted: August 30, 2013
Early in my medical career, working as Attending Physician in the Department of Emergency Medicine for Albert Einstein Medical Center in Philadelphia and Associate Professor of Medicine at Temple University Hospital, I was struck by the fact that most of our patients had complex health issues that went far beyond the physical symptoms we were treating on any given day – and treating very well, I might add. Many of our emergency department and inpatient visits were in fact the medical manifestation of social problems, which the medical system was not structured to address in an integrated manner.
This realization stayed with me and was recently reaffirmed as the Trenton Health Team undertook a unified Community Health Needs Assessment for the city of Trenton. What emerged from the comprehensive process, which combined both quantitative and qualitative information in a way that captured the voice of the community, was a clear picture of the convergence of medical, social, and environmental issues that our citizens face. The results of these analyses, available in our summary report: http://www.trentonhealthteam.org/tht/, illustrate the complex healthcare crisis in the city of Trenton—a crisis that stretches beyond the exam room, through the streets and into the workplaces, schools, parks, shelters, homes and hearts of residents who could represent the face of any urban area in the United States.
The fact that these issues are not unique to Trenton was made clear in a snapshot of a hypothetical graduating class of 2013 compiled by senior research scientist David Murphey and published by Child Trends earlier this year (http://www.childtrends.org/news/news-releases/what-do-we-know-about-the-high-school-class-of-2013/). In this statistically derived portrait of high school seniors, 71% have experienced physical assault, 28% have been victimized sexually, 32% have experienced some form of child maltreatment, 34% are overweight (18% are obese), and 22% are living in poverty, with 10% in deep poverty. Also troubling is the fact that just over one-quarter (27% for writing and 26% for math) scored “proficient or above” in a standardized achievement test, 29% felt “sad and hopeless” for at least two weeks during the past year, and 24% were binge-drinking in the past two weeks.
This information, coupled with what we have learned from the Centers for Disease Control-Kaiser Permanente study of Adverse Childhood Experiences (http://www.cdc.gov/ace/), points to a range of potential challenges for these young people, ranging from physical to emotional and socio-economic. Many doctors have found that adverse childhood experiences alter biochemical pathways in the affected children. Dr. Jack Shonkoff, a professor of pediatrics at Harvard Medical School, says, “We now know that adversity early in life can not only disrupt brain circuits that lead to problems with literacy; it can also affect the development of the cardiovascular, immune and metabolic regulatory systems. This leads not only to more problems learning in school, but also greater risk for diabetes and hypertension and heart disease and cancer and depression and substance abuse.” (http://www.newyorker.com/reporting/2011/03/21/110321fa_fact_tough) These challenges are manifest on a daily basis within so many of our urban and rural-poor communities, including Trenton.
Recognizing the confluence of physical, social, and emotional factors is a first step towards improving health for individuals and the community. Working collaboratively across healthcare providers is a vital next step to offering coordinated and integrated services that address the full range of patient needs. At Trenton Health Team we are committed to doing this and have established an infrastructure and partnerships that are connecting residents to integrated health homes and care management teams, increasing access to primary and behavioral health care. We are working to improve health literacy and knowledge regarding preventive care and self-management. The Community Health Improvement Plan we are developing, with input from a range of agencies and community residents, will address the priorities that emerged through our health needs assessment, creating targeted strategies and programs to move us towards our vision to make Trenton the healthiest city in the state of New Jersey.
Dr. Perry received a B.A. in Biology from Swarthmore College, and M.D. from Temple University School of Medicine. She completed her residency in Internal Medicine at the Medical College of Pennsylvania and is board certified in Internal Medicine and Emergency Medicine. Prior to joining Trenton Health Team as Executive Director in 2011, she was the Director of Health and Product Stewardship for the Rohm and Haas Company. Dr. Perry is a Diplomat of the American College of Physicians and serves on several National Quality Forum working groups and task forces, the Board of Directors of the Black Pearl Chamber Orchestra, Global Health Connections International, Temple University School Alumni Council, Ben Franklin Technology Partners Bio-Technology Advisory Council. The desire to work collaboratively with others to develop innovative and integrated solutions to health care issues was the impetus for her to join the Trenton Health Team.