The Business Case for Health Equity with Dr. Jean Accius
About This Episode
According to this week's guest, there is a direct and unbreakable connection between the time we have as individuals to use each day and the broader health of our communities. All right, that doesn't sound like an earth-shattering observation, especially to listeners of this show.
But, if that's the case, if we understand clearly that our communities are only as healthy as the members who contribute to it, then why are so many of our communities sick?
This week, Carrie Fox sits down with Dr. Jean Accius, President and CEO of Creating Healthier Communities (CHC), to discuss what it means to build healthier and more equitable communities. As Dr. Accius notes, “The work that we’re doing is about addressing these gaps because what it means is that it’s shortening people's ability, their time to contribute to their family, to their communities, and to our broader economy."
And make no mistake, it is the broader economy that is at stake. Social determinants of health and our ability to address them connect every one of us to keystone issues: who gets access to affordable health care? How do we approach the pressing mental health crisis facing our youth? What do we do when we look at communities directly impacted by climate change without access to health resources?
Carrie and Dr. Accius explore strategies for assessing and responding to the unique needs of different communities through strategic partnerships and deep listening. “Let’s take the time to get close and understand what our people are saying ... in terms of to what extent we are supporting their total well-being,” explains Dr. Accius.
We face challenges. But we hope you find after listening to this conversation that there is hope. There is hope for cross-sector collaboration and truly human-centered innovation across the healthcare landscape. There is hope for connection between and across communities to lift one another toward change. There is hope that the louder organizations like CHC call for change, the more we will rise to the challenge of building community health improvements through connection, compassion, and collective action.
Our great thanks to Dr. Accius and CHC for making this conversation possible.
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Welcome to Mission Forward.
Carrie Fox:
Okay. So quick story before we get into today's episode. So right before starting today's interview, literally a minute before the recording starts, I look down on my phone and I see a text, actually a whole string of texts from my daughter who is in middle school, eighth grade saying that her school is in lockdown. She doesn't know what's happening. They're in shelter in place, kids are screaming, she's scared. "Holy, moly," I think to myself. "What is going on?"
So as I open up the line to tell Jean that we're going to need to reschedule, I get a note from a parent who says, "Looks like it was something in the community. Lockdown has been lifted. Shelter in place is over. Kids are fine." And then I prepare to go into this conversation with this wonderful, Dr. Jean Accius leading Creating Healthier Communities, recognizing that threats to our health, to our children's mental health, to our community's health are all around us.
On any given day, one of us, many of us, all of us are facing threats to our health. So as you listen to today's conversation, have that in the back of your mind. Recognize that I may have sounded a little bit distracted and for good reason, but recognize also that we all have a stake in Creating Healthier Communities. Now onto the show.
Hi, there and welcome to the Mission Forward podcast, where each week we bring you a thought-provoking and perspective shifting conversation on the power of communication. I'm Carrie Fox, your host and CEO of Mission Partners, a social impact communications firm and certified B corporation. So I've got a quick story for you. A few weeks ago, Radiolab, which is one of my favorite radio programs, ran a fascinating story about the interstitium. You got that interstitium. It's this amazing and newly discovered human body part and the mysteries that it might help us solve.
So I love this story about the interstitium as a powerful scientific discovery and you should absolutely go check it out. But also as Jennifer Brandel who brings us the story pointed out, "I love the interstitium for what it represents. It's this powerful system that actually connects everything in our bodies to make our bodies work better."
If we think for just a moment about what it means for the human body to have this unified system that we never knew existed until just a few years ago, what would it look like if we carried forward that same concept to social sector organizations? What if there was this equally powerful network that can help social organizations, communities, and people work together across issues, boundaries, and sectors to create a deeper and more powerful impact, a more thriving and healthy non-profit ecosystem?
I like to think that today's guest, Dr. Jean Accius, is working at the interstitium level. He is actively convening and connecting dots across corporate America, in communities and with fellow non-profit organizations to address how we can most effectively create healthier communities. And for good reason, because it takes all of us across sectors, across backgrounds and roles to create healthier, more equitable and thriving communities. Dr. Accius is president and CEO of Creating Healthier Communities, also known as CHC, and we are thrilled to have him here with us today to talk about what it really takes to create healthier communities. Dr. Accius, welcome to Mission Forward. Thanks for being with us today.
Dr. Jean Accius:
Thank you so much, Carrie for having me. I'm deeply honored to be having this conversation with you.
Carrie Fox:
Me too. So let's talk a little bit about how you got into this work. You've got a fascinating background. I've seen you noted as a leader in aging, longevity, health, long-term care policy. Clearly you've got this deep purpose and passion for healthy living and healthy communities. What brings you to this work?
Dr. Jean Accius:
Well, I'll tell you, Carrie, that we all have a personal story. And my story is one in which where I grew up in a community where I had an opportunity to see my aunt who's like a mother to me, work as a housekeeper and a nanny and really try to make ends meet. When we needed medical care, we would go to our local community health center. And the days that I did not have to go to school, I would actually go with her to her employer, the family that she was caring for. And they lived in a beautiful mega mansion in a beautiful city that's about maybe 20 to 25 miles away from me.
I was just as a young person trying to understand how is it possible that you could have two communities about 20 miles apart and have two totally different environments? I started to question this. Now, don't get me wrong. I grew up in a loving environment where my family was spiritually rich and I never went without. But it was one of those things where I saw around me in my community where there were deficits or where there lack. But there were also strengths and there was also assets. And over time throughout my journey, I started to see this show up in many, many other communities.
I started to see how this actually had a toll on families, on communities as well as on our broader economy. So as you mentioned during your opening, the work that we do to create healthy communities means that we're creating opportunities for families to stay connected, to create moments of connection, to recreate those lifelong memories that are so vitally important.
We're helping communities thrive in a way that allows these healthy individuals to be healthy workers for businesses. And when businesses have healthy workers, they have a more profitable, more productive, more impactful bottom line, which actually benefits our broader economy. So I saw these connections over time that there was an opportunity, whether it's in the policy space or whether it's in the practitioner space or whether that's in the private sector, to really connect the dots in terms of exactly when we talk about health.
What we're talking about here is really an opportunity to live a longer, healthier and more productive life. And what tends to happen is that there's huge, a 20-year life expectancy difference in the United States depending on where you live. Now you might be saying, "Well, how does that impact me?" Well, it impacts you in a lot of ways because the issue here is the fact that what we're talking about is the opportunity or the lack of an opportunity to spend more time.
If you think about it, time is the only non-renewable resource we can find anything else to replace. We can innovate, create different alternatives except for time. Once time has been spent, it can never be taken back. So when we talk about a lot of the work that we're doing in terms of Creating Healthier Communities, what I hope we will step back is really to reflect that what we're talking about is that these are opportunities to create more time with people that you care about, your family, your friends, to give back to community, to contribute to your purpose, to be able to engage in the things that matter most to you. Because at the end of the day, that is the only non-renewable resource we have. But there's huge differences in terms of exactly how much time you might have solely driven by where you live and the zip code in which you're at.
Carrie Fox:
Dr. Accius, the work that you were doing is so big and so critical that I wonder where you even know where to begin.
Dr. Jean Accius:
Well, that's an excellent question. One of my favorite quotes is by Bryan Stevenson, and his book is... He's the author of Just Mercy, leader with the Equal Justice Initiative, and he talks about the fact that you cannot be an effective problem solver from a distance. There are nuances and details you will miss unless you get close. And to answer your question, Carrie, I think how we start to figure out where to start is by engaging with the communities in which we care so deeply about. It starts with listening. It starts with actively getting close to understand the lived experiences of those in which you are engaging with.
So whether you are a business leader or you're a leader in a nonprofit or you're a leader in government, or whether you're just an active community organizer, whatever you might be doing on a day-to-day basis, whether it's by your title or not, that there's an opportunity to get close. And that getting close is really spending some time in the communities and hearing what are your strengths? What are your preferences? What are your desires?
If you think about it, Maslow's Hierarchy of Needs indicated this very clear, that there are fundamental basic rights that we all want as human beings, housing, food, a safe environment, good education, a good paying job. That is universal. That is a universal experience. So let's take the time to get close and understand what are our employees saying at all levels of the organization in terms of to what extent are we supporting their total well-being. What are community saying in terms of exactly what they want and need and how are we co-creating solutions with them? How are we listening and what is our perspective and lens in which we're approaching the conversation?
When we are engaging with individuals, do we see their strengths? Do we see what they value? Do we see their assets or do we approach those interactions from a position of here's what they lack. There's a liability. Or here's what I'm going to do for you. No community wants to know what their problems are. They already know. They already know. So we have an opportunity to think about how do we actively listen? And I will tell you, the private sector has gotten this right in many ways. What I mean by that is the fact that I remember a while back there was this idea called segmentation. How are we relevant to the different segments of our customer base.
What can we do in terms of really understanding their experiences and their encounters with us? So how do we take that same mentality, that same framework, and apply it within a community setting and saying, "You know what? To your point, each community, each neighborhood might have different priorities." So let's assume we know what they want. Let's just start...
Carrie Fox:
Right. You are speaking my love language. Let me tell you because this is the work that we do at Mission Partners. I wrote a book about this called More Than Words. I've worked in partnership with your organization on this topic of the idea of really listening first and radically listening. What's fascinating as I listen to you and how you have radically listened and how your organization radically listens that CHC, for those who are listening and may not know the story, CHC has had this incredible 60 years. Is that right? Maybe history that five years ago if I was talking with the organization, would've been a different organization, would've been a different conversation I should say. Because CHC is this wonderfully interesting case study about an organization that was on one path and making great impact, but hit a fork in the road and said to themselves, what if we leaned fully into our mission and vision to create healthier communities? What would that look like? Right? It wasn't always called Creating Healthier Communities. It was, if you can remind me, it was...
Dr. Jean Accius:
It was Community Health Charities.
Carrie Fox:
Right. So I think it's fascinating to think about how CHC has evolved as an organization and is living into its purpose and its values and what a great model you've set up for so many other organizations who are similarly wondering, what if we actually leaned into that purpose and those values too? I'm curious, I know you're still relatively new to the organization, but what it feels like to be in an organization that's gone through that evolution?
Dr. Jean Accius:
I will tell you, Carrie, many organizations exist to continue to exist is that traditional bureaucratic culture that is oftentimes not intentional, but it is what it is. But the idea that you would step back and say, "Why do we exist? Should we continue to exist?" Those are very tough questions to ask yourselves as leaders and particularly for a board to grapple with. It's been an amazing journey for the organization because of the fact that our leadership at the time really said, "You know what? We want to have deeper, more meaningful impact. We really want to think about exactly how do we, given the series of issues families and communities are grappling with on a day-to-day basis and feeling the pressures on all sides, what role could CHC play in helping to alleviate, in helping to improve many of the systems, particularly at the community level, so that they could live a more optimal life?"
And what I mean by optimal, I'm referring to the holistic nature of it. It's not just the physical, it's the mental, the emotional, this idea of being psychologically safe and that you belong. And for the last 10 months, I have thoroughly enjoyed the journey that I've been so privileged to be a part of, an organization that clearly wants to ensure that every person in every community can live their healthiest life. An organization that sits at the intersections of business, nonprofits, community-based organizations, and leveraging that ability to convene and connect, to drive systemic and social change.
Carrie Fox:
Right. I'm so glad you used that word. Certainly this is a great example of courageous leadership, how CHC has led and evolved over these last few years. I'm so glad that you mentioned at the top social determinants of health. I know that's a critical element of your work. You're constantly thinking about them and reviewing them, and I've got in the back of my mind, the surgeon general's warning this year that mental health is our greatest health emergency that we are facing now.
When you look out across your work, what are the issues in health and community health, and social determinants of health, equity, speaking broadly about health equity that feel most pressing as we come out of 2023 and into 2024 that we have to have our eye on.
Dr. Jean Accius:
So there's a couple, Carrie. One is, I think, you just hit it on the nail, and that is really, we have to really address the ongoing mental health challenges facing our youth and people of all ages in this country across all different communities. And in many ways, mental health is an area of focus for CHC because it cuts across. It's a cutting edge issue. Whether you're in the workplace, if you're an employer listening to this podcast, to what extent are you supporting the mental health of your workforce. Going beyond your employee assistance programs to really think about what are the opportunities to ensure that your workforce has the support that they need to be able to weather what ever storm that may be seen or unseen.
And that actually occurs at all levels of the organization. There's been a recent series of stories that highlights, unfortunately the tragic situation we're seeing with some C-suite executives who have committed suicide because of a range of pressures. So oftentimes it's what's not seen that we need to really think about how are we creating that culture to provide that support and promote well-being taking place.
I have an aunt who used to take mental days off before taking mental days off was a thing. But it's so vitally important for your mental health. I think in addition to addressing the issues of mental health as a cross-cutting issue for any organization at all levels within an organization. I think the other aspect of this too is extreme weather events or the challenge we actually seeing with climate change and you say, "Well, why would an organization like CHC actually be focused on or looking at this as a particular emerging issue? Well, it actually cuts across everything that we're working on. Many of the communities that are under-resourced are disproportionately impacted by extreme weather events, disproportionately impacted by the huge levels of disparities that we actually see.
I grew up in Florida, South Florida to be exact, and one of the narratives whenever there was a predictable hurricane was, "Can't you just leave?" Some people don't actually have the option in terms of mobility to be able to leave. They have to literally weather the storm. So at the organization, what role could we play in helping to provide education tools and resources to help people literally weather the storms? How can we as an organization, work with business and work with first responders and work with the healthcare system to ensure that there's an integrated ecosystem that supports the needs of individuals as we're all experiencing these different changes?
I think the other aspect too is access to healthcare. In many cases, one might have health insurance, but you might be under insured. How can we ensure as an organization that you're in the driver's seat of your own destiny by being able to navigate what is a very complicated complex as well as not, and many would argue, not person centered system of care in the United States. So there are a range of emerging, or what I refer to as cross-cutting issues that literally cuts across industries and sectors that we need to be focused on.
No one [inaudible 00:19:22] or one organization can solve this in isolation, which is why we value partnerships the way that we do because we believe that we are so much stronger together and we can go so much further together than we can ever do by ourselves.
Carrie Fox:
You've just named such an incredible range of issues and projects and partnerships that you are working on. For folks who are listening, they may be thinking, "All right, this is really interesting. There are some really groundbreaking work happening that CHC is leading." Where do your partners come in or how can organizations work with you or partner with you on the work you have underway?
Dr. Jean Accius:
I love that question Carrie because we're looking to literally create a movement. And that movement is to really address the inequities that we see across the country to ensure that every person in every community can live their healthiest life. This is about really addressing what I refer to around time and that when we eliminate these disparities, but we're talking about here is really a trend that everyone has an opportunity to enjoy that time, that non-renewable aspect that matters so much in our lives.
How can you join us? By all means, you can visit us at chcimpact.org. You can definitely reach out to me. We are constantly looking for partners because again, the work that is taking place across communities are such that no one organization can do it in isolation. We are looking to really address the needs of communities and nonprofits across this country.
We serve about 5,000 nonprofits on an annual basis, and these nonprofits range from organizations who are supporting children with cancer to organizations who are supporting people with dementia and Alzheimer's, and everything in between. What we hear from many of our partners is the fact that the need is great. The challenges are magnified as a result of the pandemic and the outcome of the pandemic. And that there's need for us to really think innovatively about how we create strategic partnerships in a way that can accelerate the pace of change because a household is not dealing with these issues in isolation.
They're in a confluence of these issues at the same time. So we're really looking to accelerate our pace to continue to build our partnerships with organizations who share our vision for a world where every person can live their healthiest life and have the opportunity to do so because we're working to reduce the barriers that might exist in a community. And as you can imagine, Carrie, each community is unique and each community is different. So we're also looking for partners who are willing, courageous enough to be willing to get a little bit close, whether it's the community that's in your own backyard, to what extent can we work together that you do some of those listening journeys and to go into a community and just be a student for a day and to listen and then have just one question, what can I do to help?
Carrie Fox:
I imagine there are so many things in common across communities, but probably every community has its own unique story too and lens, which is why it's so important to be listening so widely across communities to understand where are the connecting points and the disconnecting points to ensure that health and public health can reach everyone. We've had quite a few conversations on this podcast about public health, and there was one earlier this season actually, that we talked about how everyone has a stake in the public's health. And often folks will think about their own personal health first, then maybe they'll expand and think about their family's health, and then maybe they'll think about their neighbors and their friends and families and making sure that folks are healthy and have access to good quality services.
But how often are we really thinking about the role of our community's health and when our community is healthy, what that means is that bubbles up to then our nation, our society, our democracy, right? Everything else hinges on whether or not we are healthy. If I'm not good, then nothing's good. And if our community is not good, then what happens then? So I love how you are thinking both deeply inside communities and listening and learning from communities, but also thinking about how do we connect the dots to create an impact that is also larger than any community too.
Dr. Jean Accius:
That is exactly the goal, which is why a partnership is so critically important. I think if we were to reflect back to three years ago in 2020 and 2021, one of the things that really stuck out to me so clearly was that how interdependent we are. I'm a big fan of Covey and Covey talks about the mature continuum. In our society where we are preached. And the messaging is that you got to be independent. You got to be independent. I think the true form of independence is interdependence, meaning the fact that, Carrie, what you do impacts me and what I do impacts you. That's what public health is. That's what we saw with this pandemic.
What's so interesting about this, this was global. Right? And I think as a society where we want to go is to really get to a place where we understand the value of our interdependency. It's not being weak by any means of the imagination. However, when we focus solely on independence, we miss a couple of things. One is the fact that we actually believe that we don't need anyone or anything in order to be successful.
I challenged that narrative. In order for you to get in your car, someone had to ensure that the oil change was taken care of, that when you went to the gas station, someone had to ensure that there was gas available for you to put in your car. We're interdependent. Our level of success is contingent upon the ability and the support of those around us. So I say that to say that when we think about the work that we're doing, and there's been some studies that actually demonstrate this, that if we don't address these inequities in our communities, it actually costs the United States government about $8 trillion by 2050. Think about it, 8 trillion.
So another way to think about it, if we were actually able to close these gaps, Deloitte has done some research on this demonstrating that health disparities in the United States cost us about $321 billion. In 2022, you have a Kellogg foundation who has demonstrated that if we were able to address these inequities that on the federal side of the house, federal taxes, we would see an additional $450 billion in annual, annual tax revenue. States would see an average of about 100 billion in annual state tax revenue. Think about that for a second, Carrie.
The fact that we're not intentionally addressing these issues would literally start off... That starts at the community level. It means that we're all suffering as a result. What would $450 billion in additional tax revenue get us on an annual basis? What would $100 billion in annual state tax revenue get us on an annual basis? That could pay our teachers way more than what they are getting paid today. That could help address many of the infrastructure challenges that we have.
It would make sure that our veterans have the benefits that they need and well deserve, and it would address some of our deficits. So think about this, the fact that... And again, it gets back to what we were talking about earlier. The work that we're doing is about addressing these gaps because what it means is that it's showing people's ability, their time to contribute to their family, to their communities, and to our broader economy. And we all are suffering as a result.
And then just finally, just one last point, particularly for the business leaders who are listening to the podcast, there's a direct and indirect cost. So what I mean by that is the fact that not addressing the inequities or the challenges your employees might face is actually impacting your bottom line. There's a [inaudible 00:28:08] that you might see, and that might be in terms of the rising healthcare costs, that might be in terms of what other metrics one might look at, but there's also indirect costs to your business. So there is an economic reason to also address this.
Carrie Fox:
Right. You've just so compellingly laid out the cost of doing nothing on this issue and that everyone has a stake in the health of their community and of communities, right? Hence the incredible work that you all are doing. As I sit here and listen to you and think about the impact that your organizations have and is going to continue to have, I will certainly make sure we put some links in the podcast show notes so folks can go and connect with you all and learn from you all.
But I want you to tell me, and you've started to hint at this a little bit of what gives you hope and optimism as you think about where we are? Certainly this is a big systemic issue you have outlined, but what is giving you hope and optimism for the future?
Dr. Jean Accius:
For me, Carrie, is the fact that there is innovation taking place in all of these communities that we talk about today. Meaning the fact that the ability to figure out how to work and innovate and to address some of these challenges is happening today, that there's a sense of resiliency even within the challenges that many communities face. And there's sense of hope. And for me, I get inspired by that.
Because if you think about just the story of the United States of America, it is one of hope. It is one of consistently working to get better. It is that idea that I see in many of the communities in which we're engaged in, the ability to laugh, the ability to smile, the ability to connect, the ability to say, "You know what? We may not have all the resources, but we're happy with what we've got and we're going to make this work." If you think about that, that is the same mindset in some cases in Silicon Valley, is how can we continue to innovate based on what we have?
Many of these communities are doing it with limited resources, but they have the passion, they have the drive, they have the determination, and they have the will. And as a leader, I say this all the time, if I have staff that's passionate, if I have partners who have the will and the drive, nothing can hold us back. And I think the idea here is the fact that that's what gives me hope, is the ability to hear the stories of some of the women who have gone through our Black Birthing Initiative and to hear how one woman just recently gave birth to her baby on November 2nd, and the system was trying to convince her to do a C-section.
And because of the advocacy and the support, and the resources that she received through this initiative, she was able to advocate for herself as to what she wanted and the experience she wanted. And guess what, Carrie? Successful birth. That gives me hope.
Carrie Fox:
Yes.
Dr. Jean Accius:
Or the work that we're doing in Cleveland, or the work that we're doing in Atlanta where we're at literally work with our partners to meet people where they are. And look how the system can better integrate and coordinate to ensure that no one is falling through the cracks. We have the privilege of having technology like an iPhone where you have an app on your phone before you knew you needed that app. Why start to create a system of care in this country, particularly at the local levels that ensures that when someone needs a service, or when someone has a crisis and needs assistance, that the system is there to be responsive so they don't fall to the crowd. And then finally, what gives me hope is the fact that we have an opportunity to get close and ensure that those who are often in the margins become part of the center of the care designs that we want to see. That's what gives me hope.
Carrie Fox:
As you talk about the system, a friend of mine, Eric, who was on the podcast a long time ago, he uses this line that you can't have systems change without human change. And as I listen to your passion and your drive, and your optimism, and your stories, I recognize again and again as I suspect folks who are listening will hear too, that first, it starts with human connection, right? It starts with how we work together, how we come together. We are interconnected and we are meant to be together. And then the power of what we can do together, well, that's CHC on display.
So thank you for everything that you are doing and what you are modeling and how you are leading courageously. It was really a privilege to talk with you today, and I look forward to watching your work into the new year. But thank you. Thanks for this great conversation today and for the inspiration that you've given me.
Dr. Jean Accius:
Thank you, Carrie.
