When Reno’s Renown Health and the Washoe County Health District teamed up to conduct a Community Health Needs Assessment (CHNA) in 2014, they found that the region shared a basic health profile with the rest of the state and country. Heart disease, cancer, and chronic lower respiratory disease were the leading causes of death. However, the CHNA found that the mortality rates from these causes were higher in the region than in the rest of Nevada or the U.S., and found that chronic disease was a cause of major economic strain for local families. And within the county, some communities fared far worse than others.
All nonprofit healthcare systems like Renown are required by the Affordable Care Act to conduct CHNAs. The rule is designed to look more holistically at the drivers of poor health and incentivize providers to address the social determinants of health.
The ACA requirement has catalyzed partnerships nationally between the healthcare system and local health authorities. In Reno, leaders in the community development, public, and private sectors are tackling the barriers to health in one of its highest-needs ZIP codes.
The largely low-income 89502 ZIP code is the focus of Truckee Meadows Healthy Communities (TMHC), a project that unites elected leaders, service providers, health professionals, and businesses in support of community well-being. TMHC is a product of the Healthy Communities Initiative, a cross-sector partnership between the Federal Reserve Bank of San Francisco and the Robert Wood Johnson Foundation.
“In order to help people out of poverty, you have to address all of the issues that impact that person or family,” said Joselyn Cousins, a regional manager at the SF Fed and leader in the Reno effort. Health is one such issue: physical and mental well-being can affect employment, prosperity, and community engagement.
The SF Fed and the public and private partners of the TMHC Committee believed they could have the biggest initial impact working at the ZIP code level. The goal is to determine the effect of coordinating services across a small population, and eventually produce a model that could be replicated.
The TMHC leaders honed in on 89502, a southeastern Reno area characterized by concentrated poverty with small pockets of affluence. The residents, a quarter of whom never finished high school, have trouble finding living-wage jobs, according to a report by local service providers. Many cannot afford health care or nutritious food. The ZIP code also has a much higher mortality rate than the rest of the county and state.
At the same time, residents say, the social fabric in 89502 is tightly knit. People are involved in their neighborhoods and churches. So it follows that residents and practitioners alike have embraced a collaborative effort to make their community healthier.
More than 200 practitioners showed up to the first TMHC conference in January 2015. Since then, TMHC has convened service providers like hospitals and food banks and helped them deploy their resources in a coordinated fashion to improve health and opportunities in 89502. In many cases, organizations were previously unaware of one another, said District Health Officer Kevin Dick.
Local leaders have different ideas and different capabilities, which can benefit cross-sector projects. The goal is not to convince organizations to do things differently, Cousins said, but for them to apply what they do well to the shared goal of physical and economic health in 89502.
Since TMHC launched, the practitioners have hosted health fairs—“pop-up hubs for service delivery,” Dick said. Visitors can obtain produce from the food bank, information from the housing authority, immunizations from the health district, legal assistance on immigration issues, and job application advice.
The ZIP code is a testing ground for a collective, cross-sector model.
The fairs address the “low-hanging fruit,” Cousins said. Next up: attention to larger outcomes, like kids’ success in school.
Before they got too ambitious, the TMHC leaders had to get acquainted with the community, making sure residents were on board. They met with them in local churches and other safe spots.
The practitioners had not realized tensions ran high between community members and the police, Cousins said. Some residents did not trust officers or believe they made their neighborhoods safer. The TMHC leaders had to forge connections between local youth and the police. They made sure officers showed up to community events to get to know residents and discuss health and safety in a casual environment.
Last year the project got a boost from the Arnold Foundation. TMHC, through the Food Bank of Northern Nevada, received a Feeding America grant, which supports a long-range planning initiative to address food security, housing, employment, and health in the disadvantaged portions of the 89502 zip code .
“It’s all about scaling,” Cousins said. With traditional health providers like Renown and the Washoe County Health District at the helm of a community development project, the 89502 area is testing ground for a collective, cross-sector model that leaders hope will provide insight into efforts in regions near and far.
Top photo courtesy of TMHC.