Mattresses under Emerald Street Bridge provide a make shift resting place for addicts, in the Kensington section of Philadelphia, PA on July 31, 2017.
Bastiaan Slabbers—NurPhoto via Getty Images
By Garth Graham
June 28, 2018

We spend an average of 7,000 hours awake each year. When you take an inventory of those hours, where do you think you spent the most time?

As a physician, I know most healthy Americans will only spend about two to three hours in a clinical setting each year. While that might not seem like enough, it actually makes sense when you consider that only 10% of factors impacting premature death are related to clinical care.

In addition to our genetics, our health is primarily influenced by “social determinants of health” (SDOH), which include such things as access to healthy foods, safe outdoor spaces, and quality education. These things add and detract from your health every day—depending on where you live—and are the reason your zip code matters more than any other impact factors when it comes to your health. Because of SDOH, the solutions to most of the greatest issues in public health aren’t going to be found in the latest medical innovations or top-ranked hospitals. If you zoom out from the national picture of health, what you’re really looking at is a collage of local stories. That means solutions are in our local communities where the roots of these issues are growing, including the biggest issue impacting our nation right now: the opioid crisis.

A once in a generation public health issue

In 2015, our life expectancy dropped for the first time since the height of the AIDS epidemic. That can be blamed largely on the opioid epidemic, which is plaguing communities, families, and individuals across the United States. In fact, in a single year, more than 40,000 individuals died due to opioid drug overdoses.

Just this past March, the CDC released new data showing this epidemic is not slowing down, with a 30% increase in emergency room visits for overdoses.

Even our healthiest communities aren’t immune. Communities that otherwise score high on social determinants like clean air, good schools, and walkability are suffering from this epidemic. Communities like Philadelphia and Montgomery County, Md. have been hit, even though they were both included on the Healthiest Communities rankings collaboration between U.S. News & World Report and the Aetna (AET) Foundation.

Every community, every family, and every person facing opioid addiction faces a unique battle, which is why we’re looking for local solutions to solve the crisis. For example, we’re supporting a new data dashboard in Pennsylvania that will allow the state to rapidly collect data from hospitals, first responders, and law enforcement to help them gain a better picture of which areas across the state are hardest hit and where resources are needed the most.

Data indicates that if an overdose victim is connected to supportive services within 12 hours of an emergency room crisis for an overdose, there is a better chance at a successful intervention. That’s why in Florida, we recently joined forces with the Florida Alcohol & Drug Abuse Association to support the expansion of resources in hospitals.

Lastly, in North Carolina, we’ve found that in rural communities, friends and neighbors have become the frontline defense against overdose deaths. We are helping the North Carolina Harm Reduction Coalition give individuals the tools they need to recognize and respond to an overdose in order to save more lives.

Disrupting the disruptor

The opioid crisis has disrupted our usual view of how social determinants of health impact life expectancy trends. However, the same tactics we’ve learned in combatting SDOH can be used to interrupt and put an end to this crisis that has impacted communities large and small.

 

The work happening in Florida, Pennsylvania, and North Carolina are examples of how this approach works. By understanding the unique challenges and strengths of each community, we can prescribe better tactics to tackle these problems at a grassroots level.

We all have a role to play when it comes to solving our most pressing public health issues. When it comes to tacking the biggest issues in public health, it’s about empowering communities by empowering individuals and families. That’s why we’re working locally to support the people in the most impacted communities with the tools they need to truly make a difference.

Garth Graham, M.D., MPH, is president of the Aetna Foundation and VP of Community Health for Aetna. A practicing cardiologist, Dr. Graham oversees the community health initiatives and CSR for the Foundation and Aetna, Inc.

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