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Addressing the Root Causes of Health Problems: Rebecca Onie of Health Leads

March 22nd, 2013
by Lee-Lee Prina

I recently returned from covering the Grantmakers In Health (GIH) annual meeting in San Francisco, where Rebecca Onie was among the keynote speakers. She was a 2012 Robert Wood Johnson Foundation Young Leader award winner and received a “genius grant” from the John D. and Catherine T. MacArthur Foundation in 2009.

Health Leads, a Boston-based program with sites in six cities, focuses on the root causes of health problems, because doing so will result in lower-cost health care, Robin Mockenhaupt of the Robert Wood Johnson Foundation (RWJF) noted in her introduction of Rebecca Onie, cofounder (with physician Barry Zuckerman) and CEO of the innovative program. The RWJF is a major funder of Health Leads.

Health Leads relies on college students who work as volunteers in six cities: Baltimore, Boston, Chicago, New York, Providence, and Washington, D.C. They help patients with such challenges as not having enough food to eat, living in unsafe housing, finding high-quality child care, or securing utility assistance. Academics would say that these criteria are “social determinants of health.”

Onie, who started the program when she was a sophomore at Harvard undergrad and who subsequently graduated from Harvard Law School, says that she grew frustrated with intervening “downstream” in the health care system. For example, when the real issue is that a patient has no food to eat, his or her doctor may not have time or know how to solve that problem. (And she said, frankly, that many doctors have a “don’t ask, don’t tell policy” when it comes to uncovering these sorts of health-related problems.)

So, she started Health Leads, which received its initial funding in 1996 from the Boston Foundation to support its inaugural program at Boston Medical Center (then known as Boston City Hospital). This community foundation took a “leap of faith” and made a grant to Health Leads for this program engaging student volunteers in helping to connect patients with social services.

So, how does Health Leads actually work? “Physicians can prescribe food, health, and other basic resources their patients need to be healthy, alongside prescriptions for medication,” Onie explained. “Patients then take their prescriptions to our desk in the clinic waiting room, where our corps of well-trained college student advocates ‘fill’ those prescriptions by working side-by-side with the patients to access the existing landscape of community resources.”

With electronic health records, physicians can refer patients to Health Leads for social services when a need arises, instead of trying to find such services themselves.

As of now, there are approximately 1,000 college student volunteers in the program in the six sites around the country. So, for example, volunteers from Johns Hopkins University and other area universities work at several Baltimore sites, and volunteers from George Washington University and the University of Maryland, College Park, work at two clinics in the District of Columbia. Health Leads volunteers work at pediatric outpatient clinics, newborn nurseries, and community health centers.

She mentioned three steps needed to achieve patient-centered care. The first is to recognize that it is possible and practical to have a system “in which the primary mission and metrics are about health, not care.” The second is to broaden the “place” of health care so that patients and the resources or social services to help them get healthy are in the same location.

The third is to widen the definition of a health care provider beyond being a medical professional—he or she can also be a lay practitioner, such as a community health worker. And a health care provider can be a college student. Students can help patients find social services because they are persistent and are “armed with an unparalleled competency in information retrieval,” from experience using Google, Onie noted!

Health Leads has a database of resources that is constantly updated, she said. It includes information on SNAP (the Supplemental Nutrition Assistance Program)—otherwise known as food stamps, Head Start, and food pantries, as well as many other resources. Details included are hours open and languages spoken.

Onie pointed out to the staffers from numerous philanthropies who were attending the GIH meeting from around the country that foundations’ “dollars have enormous power to change the system” and do it for good. She added that philanthropy can “motivate” others. Foundations need to lead—to advocate for a system that invests in and measures health. They have the power to decline to fund proposals that are just additional “stop-gaps”—that is, projects that don’t support people getting healthy, Onie said.

Instead, she urged them to say “yes” to funding the right kinds of experiments. And she pointed out that nonprofit hospitals, where Health Leads sites are often based, must do community benefit work anyway to maintain their tax status. And hospitals will soon have more money to spend after federal health reform is further implemented in 2014, because there will be fewer uninsured, non-paying patients.

During the Q & A session, Onie noted that Health Leads has not expanded since 2006—it is hard to do this work well, and she wants to accomplish that first.

The motto of Health Leads is “Better Health. One connection at a time.”

Some of the current funders of Health Leads (in alphabetical order) include the Amgen Foundation, Robert Wood Johnson Foundation, JPB Foundation, New Profit (a venture philanthropy organization), Pershing Square Foundation, Physicians Foundation, Samberg Family Foundation, and Skoll Foundation.

Are you a college student who wants to volunteer? If you are a student at one of these colleges, click here for more information on volunteering—at least six hours a week for a minimum of two semesters.

Related reading:

Read the profile of Rebecca Onie in Health Affairs’ December 2012 issue (free access to subscribers). She received an RWJF Young Leader award in 2012.


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