MetroHealth CEO Calls For More Holistic Approach To Wellness In Cleveland

Cleveland's healthcare providers need to better address trauma and social determinants of health as a way to improve the health of communities, said MetroHealth CEO Dr. Akram Boutros at The City Club of Cleveland Friday.

Boutros pushed for the city's major hospital systems to change their focus from curing diseases to preventing poor health outcomes in the first place.

That would mean directing more money, programs and support to neighborhoods and communities most impacted by these issues. For example, Cuyahoga County's black infant mortality rate needs more focus and resources — it's four to six times higher than the white infant mortality rate.

"It's time for health system executives' deeds to match both their rhetoric and the needs of our community," Boutros said.

Social determinants of health — such as poverty, education, or exposure to stress and trauma — contribute to 70 to 80 percent of health outcomes, Boutros added.

"That’s three-and-a-half to four times the impact that your doctor, hospital, medications and surgeries have on your health," Boutros said. "It's time to focus on promoting health rather than fighting illness."

Boutros emphasized addressing ACEs, or Adverse Childhood Experiences. Research has shown that traumatic experiences in childhood like abuse, neglect or violence impact victims' health significantly in the long term. It's a topic   California’s Surgeon General Dr. Nadine Burke Harris has spoken about at length, noting that addressing toxic stress is necessary to prevent worse health outcomes later.

Over the last 10 years, less than five percent of the billions of dollars generated by hospital systems in Cleveland was being directed to communities in need, Boutros said.

"This lopsided support goes to promote the status quo instead of changing it," Boutros said. "If the reverse was true, every health system would have to quickly pivot its attention to the programs that improves the health outcomes of the entire community."

In 2017, Northeast Ohio's three major hospital systems increased their community benefits spending from $1.3 billion to $1.5 billion, with MetroHealth channeling 20 percent of its operating revenues, Cleveland Clinic 11 percent and University Hospitals 8 percent. But both Cleveland Clinic and UH decreased their individual spending on community health programs that year. Non-profit hospitals are required to contribute to community benefits in the areas in which they operate, like education and non-reimbursed Medicaid care.

Cleveland Clinic employees in the audience at City Club Friday told ideastream they could not comment on community benefit spending or plans. UH was not represented at the event.

One way MetroHealth aims to address ACEs and social determinants of health is by using the Open Table model, Boutros said, with volunteers providing support to families or individuals in need of assistance with job hunting or other issues.