ALBUQUERQUE, N.M. — First Choice Community Healthcare, founded 43 years ago in the rectory of St. Francis Xavier Catholic Church on Broadway south of Coal Avenue, has concluded it has failed in its mission to improve the health and wellness of the communities it serves.
First Choice provides excellent medical care in its nine clinics. More than 54,000 patients visited First Choice clinics 163,000 times last year for medical, dental and behavioral health care visits. A quarter of them were children, 97 percent had incomes below 200 percent of the federal poverty level ($48,500 for a family of four), and 23 percent were Spanish-speaking. Diabetes was controlled, children were immunized, high cholesterol was treated, teeth were cleaned.
“After 43 years, we still don’t see population health,” First Choice CEO Bob DeFelice said.
The reason is that the core business of First Choice and other provider systems is to deliver medical care, and medical care makes a pretty small contribution to the health of a population. A University of California, San Francisco, School of Mecicine study found that medical care is responsible for preventing 10 to 15 percent of preventable deaths in the United States. Things like sanitation, nutrition, adequate housing, exercise and healthy lifestyles are responsible for preventing 85 to 90 percent of preventable deaths.
“What makes a community healthy?” DeFelice asked. “It’s social determinants: jobs, education, early childhood development, access to high-quality, affordable food, safety, environmental factors.”
Public health studies consistently show a link between social determinants and population health. A 2011 National Center for Health Statistics study found that a college graduate in the United States could expect to live nine years longer than a high-school dropout. Infant mortality rates experienced by mothers with less than a high school education are more than twice as high as rates for mothers with a college education. Although 30.4 percent of children in families earning less than 100 percent of the federal poverty level ($24,250 for a family of four) are reported to experience less than “very good health,” that’s true of only 6.9 percent of children in families earning more than 400 percent of the federal poverty level, or $97,000 for a family of four. Adults living in a family with an income less than 100 percent of the federal poverty level are almost four times more likely to suffer from a chronic disease that limits their activities than are adults with a family income greater than 400 percent of the federal poverty level.
These kinds of social problems are entrenched in the South Valley.
A 2014 analysis published by the state Children, Youth and Families Department reports that from 2008 through 2012, South Valley unemployment was almost twice the rate of all of Bernalillo County. Almost 19 percent of South Valley residents have incomes less than the federal poverty level, compared with 16.4 percent of all Bernalillo County residents. The 2012 high school graduation rate in the South Valley was 66.3 percent, compared with 86.3 percent in Bernalillo County, according to CYFD.
It should come as no surprise that CYFD’s analysis showed health outcomes in the South Valley in areas like infant mortality and premature births are much worse than in Bernalillo County as a whole.
To improve South Valley health, First Choice will invest what DeFelice expects will be $25 million over the next five to seven years to create a collection of businesses and activities on its existing South Valley campus off Isleta Boulevard to attack problems of inadequate education, joblessness, poor nutrition and other social determinants of health. The money will come from several sources, including grants, partnerships with other organizations, donations, and revenue generated by businesses that will be located on the expanded campus.
“People get high-quality care here, but they return to a community without resources,” DeFelice said. A diabetic who can’t get to a store that sells enough fresh fruits and vegetables can’t stay healthy. An obese child whose neighborhood is too dangerous to walk in can’t get exercise. South Valley residents will be able to find the resources they need at the First Choice campus, a place where they already seek care and which they already trust.
Along with existing clinics and other services, a 30,000-square-foot Health Leadership High School, established by the Center for School Leadership, will prepare as many as 400 students a year for health careers. A 15,000-square-foot wellness center will house fitness programs, pain management clinics, physical and occupational therapy and diabetes education. A 6,200-square-foot child development and day care center will be built. There will be a 4-acre farm, help for South Valley farmers trying to reach markets and a farm-to-table restaurant. Walking trails will be installed. In addition to the 400 people First Choice employs today, another 140 jobs will be created.
“We are going to create a wellness ecosystem,” DeFelice said. “We are going to produce a product called wellness in our community.”
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