Rebecca Onie: What if our healthcare system kept us healthy?

Internship Experience and Health Leads

Introduction to Internship

• The speaker recounts their freshman year internship at Greater Boston Legal Services, where they expected to perform basic tasks but were instead engaged directly with clients by attorney Jeff Purcell.

• They encountered low-income families facing housing issues often intertwined with health problems, highlighting the complexity of social determinants of health.

Case Studies and Innovative Strategies

• A specific case involved a client facing eviction due to unpaid rent, which was caused by the need to pay for HIV medication. This illustrates the financial struggles faced by many clients.

• Another example included children living in unhealthy conditions, such as asthma exacerbated by cockroach infestations; the speaker used creative litigation strategies involving visual evidence (cockroaches glued to poster boards).

Frustration with Systemic Issues

• The speaker expresses frustration about intervening too late in clients' crises, feeling that assistance should occur earlier in the process rather than waiting until families are in dire situations.

• Inspired by Dr. Barry Zuckerman's work at Boston Medical Center, the speaker sought to address these underlying issues more proactively.

Conversations with Healthcare Providers

• During six months at Boston Medical Center, the speaker asked doctors what resources they would provide if they had unlimited means; responses consistently pointed out social issues like food insecurity and overcrowded living conditions affecting patient health.

• Doctors expressed helplessness due to time constraints and lack of knowledge about community resources available for patients.

Birth of Health Leads

• These conversations led to the creation of Health Leads, a model allowing healthcare providers to "prescribe" basic needs like food and heat alongside medical treatment.

• Initially starting small with college student advocates connecting families to resources, Health Leads has grown significantly since its inception.

Historical Context and Challenges

Connection with Historical Figures

• The speaker received an email from Dr. Jack Geiger congratulating them on Health Leads while sharing historical context about his pioneering work in community health centers during the 1960s.

• Dr. Geiger's innovative approach included prescribing food for malnutrition; however, this practice faced bureaucratic pushback from funding agencies focused solely on medical care.

Reflection on Progress Over Time

• Despite advancements over decades since Geiger’s time, there remains a reluctance among some healthcare providers today to address social determinants openly—illustrating ongoing systemic challenges within healthcare practices.

Aspirations for Healthcare Reform

• The speaker reflects on why straightforward solutions are not implemented despite knowing how essential they are for patient well-being; it requires confronting uncomfortable truths about current healthcare realities.

Healthcare as a System of Choices

Reclaiming Healthcare Resources

• The speaker compares healthcare to any other system, emphasizing that it consists of choices made by individuals. They propose the idea of reclaiming parts of healthcare that have been neglected.

• Health Leads was initiated with the concept of using a prescription pad not just for medications but to address broader health needs and aspirations.

Addressing Social Determinants of Health

• At Children's National Medical Center, doctors inquire about patients' basic needs like food security and housing during visits, which informs better clinical decisions.

• This approach allows doctors to prescribe resources (e.g., food assistance), integrating social determinants into healthcare practices.

Transforming Healthcare Systems

• The goal is to shift the entire healthcare system's presumption towards addressing basic resource needs alongside medical care.

• At Harlem Hospital Center, an electronic medical record automatically generates prescriptions for health resources when patients present with elevated BMI, promoting proactive health management.

Redefining Waiting Rooms in Clinics

• The speaker critiques traditional clinic waiting rooms where patients passively wait and suggests transforming them into active spaces for health promotion.

• By reimagining waiting rooms as gateways to connect patients with necessary resources, Health Leads aims to enhance patient engagement and support.

Expanding the Healthcare Workforce

• Acknowledging that current healthcare professionals are insufficient for comprehensive care, the speaker advocates for a non-clinical workforce including community health workers.

• They suggest leveraging college students as volunteers who can provide valuable support without clinical responsibilities while being motivated by their experiences in sports or other commitments.

Engaging College Students in Community Health

• The potential impact of college students is highlighted; they possess skills in information retrieval and can navigate bureaucracies effectively.

• The comparison is made between college athletes' commitment levels and what could be expected from students engaged in community health initiatives through programs like Health Leads.

Competitive Recruitment for Impactful Work

Healthcare Leadership and Student Involvement

The Role of College Students in Healthcare

• New York has a significant number of college students, with half a million enrolled, many of whom are involved in Medicaid patient care.

• These students serve not just as temporary workers but as future leaders in healthcare, gaining valuable experience by interacting with patients over several years.

• Mia Lozada, a Chief Resident at UCSF Medical Center, reflects on her time volunteering at Boston Medical Center, emphasizing the importance of understanding patients' broader needs beyond prescriptions.

• Key questions learned from Health Leads include whether families can read prescriptions and if they have access to transportation or food—issues often overlooked in medical training.

• The speaker discusses the potential for utilizing existing healthcare resources more effectively to meet basic health aspirations.

Pursuing Vision in Healthcare

• After nine months at Legal Services, the speaker felt compelled to pursue an idea about mobilizing college students for addressing health needs despite initial fears of disappointing their attorney.

• Jeff Purcell encouraged the speaker to realize their vision for healthcare, highlighting the obligation that comes with having a vision. This moment sparked a commitment to chase that vision relentlessly.