My 4-Step Plan

By Verlon E. Salley

Every other month I have written an article about diversity and/or health equity. After this article, I plan to take a timeout from writing to focus more my role as vice president of health equity at University of Alabama Birmingham (UAB) Health System. This work is so important currently that I want to dedicate even more time to it. I want to improve health equity, especially here in Alabama. 

How can I help to improve health equity in Alabama? First by recognizing my organization’s influence. UAB Health System is ranked the number one health system in the state of Alabama. We are also the number one employer in the state. What we do has ripple effects across the state. Therefore, I am going to ask all of you to keep me honest. In this article, I am going to divulge my personal four step plan of attack (see below).

1. Insight  
2. Discovery
3. Action 
4. Outcomes 

Insight

I will study the social determinants of health in my target area (Jefferson County, Alabama). We have created our own social determinant index where we identified and ranked the communities in the county using a Likert scale within seven domains.

The seven domains are defined:

• Income – percent of population in a census tract that is below the poverty line.
• Unemployment Rate – percent of population in a census tract that is unemployed.
• Education – percent of population in a census tract that does not have a high school diploma.
• Health Insurance – percent of population in a census tract that does not have health insurance.
• Life Expectancy – is the average number of years an individual is expected to live.
• Food Insecurity – a community with at least 500 people and/or 33% of the census tract’s population residing more than one mile from a supermarket or large grocery store in urban areas. 
• Affordable Housing – percent of monthly housing cost as a percent of household expenses for household incomes at or between $35K-$50K.

Because of this process, we have focused on the top 10 vulnerable/marginalized ZIP codes in the county. In all initiatives we create, we will attempt to apply them to one or all of these top 10 areas.  

Discovery

In our discovery phase, we will focus on our internal clinical data. We will analyze our utilization, valued-based care metrics, community health needs assessments and other health surveys. We will filter these data sets by race, payor and locations. The goal is to find differences and disparities in preventive care, access and clinical outcomes.

Action

Once the prior two phases are complete, we will partner with community-based organizations and payors to create initiatives that will have a positive and equitable impact on the communities we want to target. Currently, our mission as a health system is to provide quality and effective care to the community we serve. Moreover, we are not equipped to solve social determinants of health. Instead, we can partner with organizations that can provide transportation for care. We can partner with organizations that have a voice and trust with our targeted marginalized communities to deliver preventative care (i.e. – vaccines, health education and awareness). 

Outcomes

The final phase is to create a dashboard to measure the success of the initiatives we create through our own means and partnerships. As a manager of an outpatient imaging center I once said, “If you don’t measure it, you can’t manage it.” This mantra of mine still applies to my new responsibilities. We will create a dashboard to ensure we are moving in a positive direction to achieve health equity in our target area. 

Overall, I am happy in my role and responsibilities. I cannot wait to resume writing in this publication to share successful endeavors. Stay tuned.   •

Verlon Salley is the vice president of community health equity at UAB Health System.