Does Community Outreach Hold the Key to Healthcare Accessibility?
By Annelise Swords
Driving down the streets of Memphis, Tennessee, it is nearly impossible to miss the plethora of churches that line each block. Some of these churches have steeples reaching hundreds of feet into the clear winter sky, and some are reminiscent of centuries-old castles, while some of the more recent congregations have taken up residence in former homes and store fronts. These churches also provide excellent landmarks, given my exceptionally poor sense of direction, and as I pass them on my daily commute, I am reminded of Memphis’s location on the buckle of America’s bible belt.
This commute brings me to one of Memphis’s many exceptional hospitals, where I perform rounds a few days out of the week. As one of the patient experience interns, I get to know our patients and ask about the quality of their stay, in addition to assisting healthcare staff in little ways. In this role, I get a feel for what it takes to work as a cohesive unit within the hospital system. The sense of community here is palpable. It’s in our nature to trust our neighbors during times of vulnerability, and so it should come as no surprise that when I mention the goings on of Memphis, patients drop their guard. The conversation shifts from pleasant formalities to warm, friendly conversation. Once this bond is established, it’s much easier for patients to confide their needs to providers, and for providers to help fulfill these needs.
For me, the role of community in providing excellent healthcare could not be clearer. Oftentimes, when one of the patients expresses a concern whose nature reaches outside of the hospital’s sphere of influence, I put in a request for a patient advocate. However, such situations lead me to question how we can bridge the gap between addressing a patient’s needs in the hospital and their needs in the community.
Congregational outreach organizations have confronted this challenge. They aim to address inaccessibility to healthcare by forming partnerships between healthcare representatives and local religious leaders. Religious leaders, such as pastors, priests, and preachers, hold vital roles in the communities they serve. As beacons of trust, their encouragement to participate in routine screenings is highly regarded and often heeded by their congregants. In turn, healthcare representatives provide health education, transportation to and from appointments, and access to free or reduced cost screenings. Not only do these programs provide immediate preventative care, they aim to mend the bond of trust between patient and provider, one that has been historically damaged by generational medical discrimination.
Curious to learn more about how congregational outreach works in communities like Memphis, I reached out to Dr. Johnathan Lewis, the current director of the Congregational Health Network (CHN), which operates through the Methodist Le Bonheur Healthcare system here in Memphis.
I asked Dr. Lewis why Memphis’s churches, specifically, fit the model for such a network.
Dr. L: Memphis certainly has a lot of churches and pastors, but they are not merely numerous. Churches and pastors in Memphis are cornerstones of community trust and action. Because of that, working with churches and pastors in Memphis to impact the health of the community is an example of “asset based community development”—focusing on the assets and strengths of a community rather than on its deficits or shortcomings. Memphis has a church on almost every corner, and every one of those churches represents important, trusted, and rooted relationships with families, neighborhoods, and generations of people. Memphis also has some of the most pervasive struggles with poverty and public health issues, especially chronic disease. In order to make lasting and widespread impact with those health issues, a system like MLH needs to work outside of the hospital walls, and in Memphis, a great place to do that is in churches.
While it is widely known that Memphis is one of many cities that has historically ranked low for preventative screenings and exhibits high rates of breast and colon cancer mortality, treating these chronic diseases has continued to be a major challenge for the city. Oftentimes, it seems as though one of the biggest issues in illness prevention is identifying the obstacles.
This brought me to my next question about how organizations like the CHN go about addressing obstacles to treating and managing chronic illness.
Dr. L: A major emphasis for MLH and the CHN is the problem of chronic disease in Memphis, for example, chronic hypertension, diabetes, heart and vascular disease, and cancer. People suffering from these conditions are likely to be hospitalized with serious complications, and in some cases, they might find themselves in the hospital repeatedly. One of the goals of the CHN is to increase education, awareness, and prevention, pushing those resources further and further outside the hospital, so that hopefully our communities have a better chance to learn about and practice prevention in their lifestyles and their healthcare.
Here, Dr. Lewis speaks to my original question of how we can address a patient’s needs when they exist outside of the hospital’s sphere of influence. Congregational Health Network appears to recognize that the issues surrounding management of chronic illnesses are multifaceted. CHN aims to overcome barriers with inventive approaches. Firstly, they focus on improving access to routine visits for diagnostic screenings and primary care, which allows ailments such as cancer to be addressed early. Secondly, they provide transportation to and from the hospital which allows for patients to complete treatments, ensuring their effectiveness. Finally, they deliver healthcare education, providing community members with chronic illnesses the knowledge to play an active role in their care while providing assistance as needed.
I began to wonder how the organization goes about engaging with the religious communities in which they serve. Chronic illness can cause feelings of vulnerability, and many find it difficult to talk about their conditions with strangers. Dr. Lewis has explained that working with trusted community leaders fosters trust between patients and providers. Dr. Lewis believes that the success of the CHN’s programs are contingent upon the “exchange of trust” between CHN workers and local congregations.
Dr. L: We have hosted health screening events at churches so that community members can begin to “know the numbers” of their health. Through the CHN Academy, we have trained thousands of community members on dozens of important healthcare topics, everything from caring for the dying to diabetes management to monitoring the health of your eyes. Pastors have preached from the pulpit on the importance of health and healthcare, even addressing topics like mental health and suicide, trying to decrease the stigma around topics like those and raise awareness for timely intervention. In our Centennial year, 2018, we started the “MLH Sunday” program, which is now an annual event where congregations dedicate a Sunday service time to celebrate health and healing in their churches, in their neighborhood, and in our hospitals.
I think this is the key to the program’s success. CHN has tailored its outreach program to the needs of the people of Memphis, which has, in turn, improved the community’s relationship with its healthcare system. The creation and success of organizations such as CHN opens up avenues for future community outreach efforts. Many communities around the country have since reached out to CHN, hoping to replicate their results elsewhere in the United States. I asked Dr. Lewis how community outreach can be applied to future endeavors in healthcare accessibility.
Dr. L: We know so much about the many factors that impact the health of communities, and while some of those factors are clinical and biological—medicines, procedures, genetics, etc.—far more of a person’s health is determined by social factors—finances, food, housing, relationships, and more.
Recognizing the social determinants of health is only a first step in the process of improving community health, and thankfully, it seems as though these determinants are receiving more attention—yet the pandemic has proven that we still have a long way to go. CHN has found partnerships with local congregations in Memphis, yet those outside of faith communities also stand to benefit from improved access to healthcare resources. Thinking beyond the Sunday service, I wonder where other community leaders can be found for future partnerships that can build on the strengths of communities. Illness affects the individual and individuals make the community. Partnering with communities to overcome the obstacles to addressing the social determinants of health is crucial to all of our health.