Social program leaders in Alaska spoke about the ways different social determinants of health (SDOH) contribute to health outcomes for Alaskans at the 2023 Alaska State of Reform Conference last month.
Monica Gross, MD, MPH, senior director at Restorative and Reentry Services, LLC, discussed housing and homelessness in Alaska, saying homelessness should be treated similarly to a physical ailment.
“The way our current system is set up, you get on a waiting list for housing and often your name doesn’t come up for months or even years,” Gross said. “Just think if you walked into the ER and you were having a heart attack and they said, ‘Oh, we’ll put you on the list and when your name comes up we’ll take care of you.’ That doesn’t work for people in chronic homelessness, who are really in a state of trauma.”
Gross believes leaders have spent too much time talking about solutions that are not possible, when instead they could be looking at solutions that already exist.
“I think we really need to redefine all the possibilities for housing and do what we can do rather than talk about what we can’t do.”
— Gross
Some of these possibilities include congregate shelters, tiny homes, and group living situations.
Beyond the housing itself, Gross said it is important to improve the triage and referral process in order to meet the different needs of people experiencing homelessness—factors contributing to their situation can range from simple to complex.
She referenced her first job dealing with homelessness at United Way of Anchorage as an example. They started a project called Home for Good, in which they made lists of people who were chronically homeless and high users of the healthcare and safety net systems, then cross-referenced to produce a list of highly vulnerable people. These individuals were then given access to housing and other support services.
According to United Way’s website, the program has successfully reduced arrests, safety center intakes, calls for EMS transport, and shelter stays in the state.
Another SDOH is literacy. Lori Pickett, executive director of the Alaska Literacy Program, discussed the importance of literacy and how it affects health. She also mentioned that low English literacy affects non-English speaking immigrants very quickly.
“The statistics that were coming to us about 12 years ago is that when immigrants arrive, newly arriving immigrants, their health deteriorates quickly. Very quickly. We’re seeing within two to three years significant decreases in their health,” Pickett said. “… What we found is that we are the first spot for so many new arrivals and that we need to be engaged in health literacy.”
Literacy not only affects an individual’s ability to find work, but also their ability to understand vital aspects of the healthcare system and communicate with healthcare providers.
“The idea to start offering health literacy classes grew into a program to support community based workers engaging in public health efforts with the students from within their own community,” Pickett said.
Monique Martin, vice president of Intergovernmental Affairs at the Alaska Native Tribal Health Consortium, discussed another SDOH: transportation to healthcare services.
Although Alaska is geographically the biggest state in the US, it has a low number of public roads. The Alaska Department of Transportation reported that in 2020, there were 17,681 miles of public roads. Texas, the second largest state with less than half the square mileage of Alaska, reports having more than 314,000 miles of public roads.
For those in rural communities, lack of easy travel to healthcare facilities can cause people to not seek care when they aren’t experiencing an urgent health event.
“If you had a high travel burden, you were 10-14% less likely to have had preventative screenings.”
— Martin
Martin said the Department of Health revised some Medicaid guidance in August, which gave Medicaid recipients a travel benefit in order to more easily access preventative care.
Andrew Jensen, the policy advisor of food security and agriculture in Gov. Mike Dunleavy’s office, emphasized the importance of addressing SDOH.
“Looking at statistics, about 80% of health are things that are not in the healthcare system, but things that are related to housing, related to diet,” Jensen said. “[The data] shows you’re going to save money by improving [your] diet.”
A poor diet is linked to a variety of health problems, which in turn create additional healthcare costs.
Jensen also emphasized the importance of diets being fresh and nutritious, noting the benefit of locally sourced foods. Approximately 95% of food in Alaska is currently imported. This can be a problem for some areas of Alaska due to climate and the transportation of fresh produce to more remote areas. Having good food transportation infrastructure is important for a state as large and varying in climate as Alaska.
“Investments in infrastructure is one [area] where the state policy can make a big difference in food security.”
— Jensen