Health Care - Community Partnerships Are Necessary To Advance Equity

March 2, 2015

The order came through; conduct a dietary consult for a 75-year-old man with high blood pressure admitted for complications associated with chronic heart failure. This was one of my first patients during my clinical dietetics internship at Oak Knoll Naval Hospital in Oakland, Calif.  I was a bit nervous, but mostly excited to get started; I knew that good food had the power to heal and to prevent disease. After reviewing the man’s chart, I gathered the patient handouts for a low-sodium diet and went to his room. I introduced myself and explained why I was there. The man looked me straight in the eye and said, “I’m dying. I’m going to eat whatever I want!” It was not the teachable moment I was hoping for.

Happily, there were many opportunities to heal during my internship in the hospital.  But I was also constantly reminded of the tremendous opportunity to apply nutrition and other tools to prevent illness and injuries before they occur.  In the decades since my early training at Oak Knoll Naval Hospital, the most important advancement in nutrition therapy has been the recognition that community environments and social circumstances are the strongest drivers of food choices.

Right down the hill from Oak Knoll Naval Hospital (now closed), residents of the flatlands of East Oakland face major challenges to their health and wellness. The flatlands were once an economically thriving community of middle-class homeowners who were employed in a variety of nearby food-related industries. Today’s residents face limited employment opportunities, run-down rental properties, a plethora of fast-food establishments and recurring closures of the one full-service grocery store. High homicide rates add to daily stress. It is no wonder that the Alameda County Health Department has documented a more than 7-year discrepancy in life expectancy between children born in the well-off Oakland Hills and children born in the flatlands.

Fortunately, our nation is in perhaps the biggest teachable moment ever for improving the health of all residents. Our national commitment to build a health system that meets the Triple Aim (improving the patient experience of care, the health of populations and reducing costs) is opening the door to health care-community partnerships that can successfully overcome inequalities in health.

The American Hospital Association’s newly released Toolkit for Redefining the H is a call to action for hospitals and health systems to put greater emphasis on prevention and to strengthen partnerships to improve the health of the community. There are many resources and networks to support this journey:

  • THRIVE (Tool for Health and Resilience in Vulnerable Environments), one of many Prevention Institute tools to support communities to take action to promote health equity.
  • Stakeholder Health, a community of practice of people working in hospital systems to address underlying causes of poor health.
  • 100 Million Healthier Lives, an ambitious initiative, conceived and co-created by the Institute for Healthcare Improvement and a diverse, cross-sector Guiding Coalition that is committed to supporting 100 million people living healthier lives by 2020.
  • Community Centered Health Homes, core practices for health care – community partnerships to address the factors outside clinic walls that are driving poor health.


Leslie Mikkelsen, MPH, RD
Managing Director
Prevention Institute

The views, opinions and positions expressed in this blog are solely those of the individual authors and do not represent the views, opinions and positions of Equity of Care.

Other posts from March 2015:

Policy Brief: How Focusing on Diversity Can Help Health Care Organizations Achieve the Triple Aim (March 16, 2015)
Creating a Movement: Achieving Equity in Quality (March 23, 2015)


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