By Andrea Blanch, Ph.D. and David Shern, Ph.D.
In Kansas City, local leaders have created an innovative vision for a healthier community. Healthy KC is a partnership of the local Chamber of Commerce, KC Blue Cross/Blue Shield, and a number of regional health and wellness leaders. The group’s recommendations are consistent with our recent review of research on the impact of toxic stress and trauma on the nation’s health and well-being. They are also consistent with the premise that behavioral health is a key component of public health.
There are several aspects of the Kansas City vision that deserve careful consideration for potential application in other communities.
Healthy KC is based on the recognition that the nation’s human capital has seriously eroded over the past 25 years, and that a public health approach is essential to solving this problem. The report notes that Missouri and Kansas are among the states with the most significant decline in health status. Missouri’s rate of heart disease is above the national average, its tobacco tax is the lowest in the country, and the state spends less money per capita on public health than any other state. Kansas has one of the lowest rates for child and adolescent immunizations, one of the 20 highest smoking rates, and ranks 44th in public health spending. By acknowledging the extent of current problems, the report serves as an urgent call for action.
Healthy KC recognizes that health – and its impact on human capital - is a critical economic issue. In 2014, a member of the World Economic Forum’s Managing Board made this statement about the Forum’s Annual Meeting in Davos: “We want to convince the world’s corporate, political and civil society leaders that good health – both mental and physical – is one of the most pressing social and economic issues of the day.” He went on to say that “If that’s to happen, we need to elevate health to a high-level, cross-sectoral conversation that informs every decision a society makes.” Healthy KC is doing just that. The report notes that the health of a community is one of the most important aspects people consider when relocating to a new city. Cities with the strongest growth in business start-ups and population are those that have made a conscious decision to focus on health. Clearly, the leaders of Healthy KC understand that investing in health and well-being is sound economic policy.
Healthy KC identifies behavioral health as an essential part of public health. Behavioral health is one of five top priorities identified in the report, along with healthy eating, active living, tobacco use prevention and cessation, and workplace wellness. The report notes that “For more than a century, behavioral health services have been separated from primary care or physical healthcare. Today there is a wide recognition that medical problems and mental illnesses, including substance abuse, are interrelated.” The report also notes that “Employers throughout the community report antidepressant medications as one of the top 5 most costly aspects for their health plans” and that “Every dollar invested in behavioral health capacity results in an estimated cost savings of $8 to $10.”
Healthy KC highlights the critical role of trauma and toxic stress in the development of health and behavioral health problems, and cites the need for services to become “trauma-informed.” The report describes the ACE study and the impact of childhood adversity on lifelong health and wellness, specifically citing high rates of absenteeism, under-performing at work and school, and high healthcare costs. It goes on to note that trauma-Informed practices “. . . recognize the prevalence of trauma in the community and support every person by understanding the changes in the brain associated with adverse events.” The report recommends that trauma-informed approaches be used in a wide variety of community settings, including law enforcement, business, schools, and families, and highlights a community coalition – Trauma Matters KC – that currently includes over 30 agencies and 100 individuals.
Healthy KC recognizes that community education, prevention, early intervention, treatment, and social supports are all essential elements in an effective behavioral health system. One of the hallmarks of a public health approach is that prevention, intervention and support are effectively coordinated to reduce the incidence and impact of a given health condition. In many social service systems, these programs and services operate independently, with different funding streams, regulatory bodies, and advocacy organizations. Often they compete with each other. Healthy KC takes a more holistic approach, prioritizing not just access to mental health services, but also prevention of violence, access to safe and stable housing, and provision of prevention programs in schools and workplaces.
Healthy KC highlights the fact that providing services and supports that people want to use, when they need them, can prevent a wide variety of negative outcomes. It also promotes strategies that put people in charge of their own well-being. Providing services that are attractive and effective to underserved populations can not only prevent many people diagnosed with mental health problems from becoming disabled, it can also “reduce suicide, incarceration, school failure or dropout, unemployment, prolonged suffering, homelessness, and removal of children from their families.” The report highlights the importance of identifying individuals and groups at risk and offering supports during key transitions. It also highlights the importance of strategies that appeal to people by supporting their individualism, growth and autonomy, rather than attempting to increase control over their options. Examples include peer and family-based approaches, client-led definitions of goals and outcomes, fostering resilience, recognizing and addressing the impact of social injustice, embracing culturally diverse approaches, and communication based on mutual respect.
The Kansas City Chamber of Commerce, Blue Cross and Blue Shield, and civic leaders should be commended for their far-sighted report and recommendations. Let’s hope that other communities across the country follow suit.
||Andy Blanch, PhD, has been an advocate for the development of trauma-informed public policies and programs for the past 30 years.|
||Dr. David Shern is the Senior Science Advisor at Mental Health America having served as its President/CEO from 2006-2014. He also has a faculty appointment in the Department of Mental Health at the Hopkins Bloomberg School of Public Health and previously was a Dean and Professor at the University of South Florida.