Last month, the Rhode Island Foundation — the largest philanthropic organization in Rhode Island — revealed their ambitious 10-year vision to close the health disparity gap and make Rhode Island “the healthiest state in the nation,” according to President and CEO Neil Steinberg ’75. Soon, he said, the plan will be presented at the Rhode Island State House.
The report, titled Health in Rhode Island: A Long-Term Vision, states that “medical care determines just 20 percent of health outcomes; 80 percent are determined by the interplay of genetics and social, economic and environmental factors.”
R.I. Department of Health Director Dr. Nicole Alexander-Scott MPH ’11 believes the report “broadens the conversation about health” by recognizing that health outcomes depend on more than just healthcare. “Most of the things that affect our health happen outside the clinic and inside our homes, schools, jobs and communities,” she wrote in an email to The Herald.
“It’s just not right that there are people that have insurance but can’t get to the doctor because they can’t get transportation, or they get to the doctor and can’t afford the copay or the prescription,” Steinberg said. “We need to close those gaps: housing, food security, transportation.”
The long-term vision “is not an implementation plan” — instead, Steinberg believes it will pressure the government and community organizations to take further action. The R.I. Foundation plans to donate $1 million of its $1.1 billion endowment to kick-start the process, he added.
But Ira Wilson, professor and chair of health services, policy and practice at the University, said it will be difficult to execute this vision in the face of opposition from competing interests, such as hospitals which may lobby against the reduction of facility-based care.
The report’s planning committee brought together doctors, insurers, corporations, university leaders and members of government, such as the president and CEO of Tufts Health Plan and the dean of the School of Public Health at Brown. This senior-level representation across industries which usually work more independently was the “key” to the multifaceted approach of the plan, Steinberg said.
In order to minimize competing interests between members, the committee had two rules: “Look long-term and leave your stripes at the door,” Steinberg said.
The report calls attention to health disparities in Rhode Island, such as the fact that “the infant mortality rate for Black and African-American Rhode Islanders is 2.6 times that of whites,” and that “Hispanic and Asian residents are far more likely to go without a primary source of care.”
According to Pol Tavarez, a member of the city’s Racial and Environmental Justice Committee, health inequities in the Ocean State go far beyond the statistics mentioned in the report. “Seventy percent of the asthma-related issues in emergency rooms and hospitals are coming from our low-income community,” he Tavarez, adding that “childhood lead rates are huge in the city for those living in lower-income neighborhoods and neighborhoods that are primarily people of color, Black and indigenous.”
Steinberg said the planning committee also worked with the nonprofit Healthcentric Advisors to establish an “Evaluation Framework,” which Alexander-Scott believes will “hold (R.I.) accountable” by “tracking our progress toward achieving health equity.”
The framework will track direct measurements of health such as obesity rates and alcohol-related deaths, as well as factors that affect health indirectly, such as housing cost burden and diploma completion rates. This data will allow the planning committee to compare these rates to those in other states, according to an email from the Foundation’s Senior Communications and Marketing Officer Chris Barnett.
Steinberg said the committee will continue to convene a few times a year and release updated data for the Evaluation Framework annually. “Our goal was to have it be inspirational and aspirational,” he said. “We want to set the bar high … and make significant strides.”
