Engulfed in a clump of trees and perched along Bethlehem’s South Mountain is St. Luke’s University Hospital.
Inside, it is not as calm as outside its doors — stretchers spin in and out of the emergency room as panicked mothers make phone calls in the waiting room, wondering how they will pay for critical surgeries.
Some health professionals at St. Luke’s and other Lehigh Valley health organizations are trying to save more vulnerable populations from having to seek emergency care.
They are trying to understand what is making people sick.
Connected Communities are Healthy Communities
Rajika Reed, vice president for community health at St. Luke’s University Health Network, has worked with the hospital for 10 years. She said to understand a community, you must immerse yourself in it.
“We’ve built great relationships with our community to help serve and connect folks to care,” Reed said.
She said St. Luke’s Community Health Department, which opened in the late 90s, targets the more vulnerable individuals in the community who make less money or are uninsured.
The department also works closely with Star Community Health, a federally qualified health center in South Bethlehem that identifies critical health disparities among community residents.
Reed said Star Community Health’s target populations are individuals with medical assistants, uninsured patients or anyone who cannot receive the care they need. Last year, Star saw 40,000 new patients and 60,000 visits.
Locating and Addressing Health Needs
As mandated by the Affordable Care Act, Reed said St. Luke’s conducts Community Health Needs Assessments every three years.
In the June 2022 Bethlehem Campus and Star Community Health Community Health Needs Assessment, COVID-19 and access to care were the highest needs. Workforce development, food security, physical activity and mental health services were next on the list.
Ensuring access to care is one of the aspects Reed said she wants to see implemented more than it currently is.
“Having a hospital or an office isn’t really what’s ensuring that people are getting really good care,” Reed said. “It’s also working with your community, getting to know them, and then building that trust to ensure folks are able to actually receive the care they need.”
Ed Meehan, executive director of the Leonard Parker Pool Institute for Health, said the institute focuses on factors in the community that impact health.
Meehan referred to these factors as the “social determinants of health.” He defined this as “the factors in the community that impact health in addition to health care.”
For example, according to the U.S. Census Bureau, 43,938 Lehigh County residents and 23,835 Northampton County residents were living in poverty in July 2021. Many of these residents were uninsured or had limited accessible health care options.
These two aspects — money and health — seem to be intertwined. The more money people have, the greater healthcare access they have. The poorer people are, the less access they have.
Meehan said the County Health Rankings and Roadmaps report, a program of the University of Wisconsin Population Health Institute, provides health data for different counties.
“There’s no glaring deficiency when you look at it at a county-wide level,” He said. “It’s not until you start to disaggregate the data, where you see real things that just pop out at you as disparities in health.”
Meehan said those disparities fall along racial, ethnic, geographic and educational lines, which are key social determinants of health.
The counties have other warning signs, as well. According to the Lehigh Valley Health Network’s 2022 Community Health Needs Assessment, 31% of Lehigh County residents are obese, and that percentage has continually increased since 2004.
According to the same assessment, 19% of adult residents in Lehigh County self-report having poor or fair health, which is higher than the state’s 17.7% rate.
In a study done by the National Library of Medicine, opioid overdoses were found to be more common in zip codes where impoverished and low-income families were more prevalent.
In the same study, higher rates of opioid overdoses were reported in lower-income communities. Communities with multiple macroeconomic stressors, such as high unemployment rates, poverty and low education rates, were found to be disproportionately affected by opioid use.
A Health.gov study found residents living in impoverished communities are also at an increased risk for mental illness, chronic disease, higher mortality and lower life expectancy.
Meehan said health has more to do with all these social determinants than it does with healthcare.
“These disparities in health have been around for a long time,” Meehan said. “It’s just that we’re just beginning to shine a light on them.”
Putting Health Care Changes to the Test
In an effort to combat the relationship between poverty and lack of health care, organizations in the Lehigh Valley have had to rethink their practices to better fit their underserved patient populations.
Diana Heckman, director of training and development at Treatment Trends, an Allentown-based organization that specializes in helping individuals struggling with substance abuse, said new medical models need to be developed in order to provide better care for those who are underserved.
Treatment Trend’s annual report showed Northampton and Lehigh counties are the most highly referred counties it serves.
These counties’ populations are consistent with the theory that poverty and a lack of healthcare go hand in hand — with poverty rates of 7.6% in Northampton County and 11.7% in Lehigh County.
Armed with this knowledge, Treatment Trends has changed the way it addresses drug abuse issues.
In the past, Heckman said Treatment Trends had operated on an abstinence-only model but as opioid abuse prevails, it has had to adjust its treatment options.
She said in the past five years, the organization has incorporated medication as a form of treatment for opioid use disorders.
Since switching models, Treatment Trends has had to expand its medical staff and facilities to successfully operate.
“It’s been a lot of education on our part,” Heckman said. “A lot of learning and growing on our clinical teams.”
Meehan said more and more health professionals need to focus on the social determinants of health.
He said health care might be responsible for 20% of whether a community is healthy or not — the other 80% is housing, education, safe streets and social connectivity.
“We really have to rethink how we go about this in large,” Meehan said.