Introduction
The contemporary medical field is concerned with numerous matters, among which population health (PH) and community health (CH) deserve closer attention. There appears to be no one generally accepted interpretation of PH. The concept can be understood as the health outcomes of groups defined by various factors alongside the distribution of these outcomes (Alderwick & Gottlieb, 2019; Silberberg et al., 2019).
In comparison, Tebes et al. (2019) describe PH as the aggregated health status of people sharing some characteristics and state that PH involves the study of determinants shaping the allocation of health outcomes in populations. Furthermore, CH refers to a certain cluster’s health status and the actions and conditions meant to facilitate, protect, and preserve the individuals’ well-being (Johnson et al., 2021). Accordingly, addressing both PH and CH is important to aid the nation, and one organization that has achieved considerable progress in this field is Methodist Healthcare (MH). Throughout different counties in Southwest Texas, MH, and its companions have affected PH and CH in relation to social needs and social determinants of health experienced by underprivileged persons.
Methodist Healthcare
To understand the impact of MH, it is meaningful first to examine the institution’s essence. MH was established in 1963 and is a co-ownership that is affiliated with such organizations as Methodist Healthcare Ministries (MHM) and HCA Healthcare (Methodist Healthcare [MH], n.d.a). MH operates in San Antonio, which is part of Southwest Texas and strives to advance the health and wellness of the local community in honor of God.
The organization employs more than 12,000 individuals across different facilities that include but are not limited to Methodist Hospitals, Methodist Children’s Heart Institute, and free-standing Methodist emergency rooms. For instance, in terms of the former facilities, MH has hospitals in different locations and one that is specifically oriented toward assisting youths. Moreover, MH has a long history of providing community investments and is known to contribute to charity and indigent care (MH, n.d.a). Accordingly, MH is an influential co-ownership within the healthcare system of San Antonio.
A substantial portion of MH’s efforts in promoting CH and PH is supported by MHM. The facility is a non-profit organization with a faith orientation that provides healthcare services to low-income families and uninsured individuals in several counties across Texas (Loomis et al., 2019; MH, n.d.b). MHM offers a variety of direct services but also engages in community partnerships and strategic funding. For example, for many years, MHM has been investing millions in grants meant to enable collaborative efforts, encourage health outcomes of high quality, and strengthen systems associated with medical activities (Loomis et al., 2019).
MHM puts an emphasis on assets and clients to champion and empower the voice of the populations it serves (Methodist Healthcare Ministries [MHM], n.d.a). The relationship between MH and MHM appears to be mutually beneficial due to delivering better services to the residents while also furnishing the revenue needed for programs that make a change in society (MH, n.d.b). Therefore, the operations of MHM and MH are interconnected and reinforce each other in aiding those living in Texas.
Another crucial element of MH’s work is its affiliation with HCA Healthcare. The organization is the largest hospital network in the United States (US), and it functions in a private manner. HCA Healthcare comprises multiple small, medium, and large facilities across 21 US states (Jones et al., 2023). The connection between MH and HCA Healthcare can be characterized by such benefits to the former as the latter’s operational excellence alongside advice and expertise on the finest hospital practices (MH, n.d.a). Consequentially, MH’s collaboration with HCA Healthcare opens opportunities for helping people in need based on knowledge acquired through nationwide work.
Best Practices
Another aspect that should be explored to comprehend MH’s impact on PH and CH for the Southwest Texas counties is the best practices generally accepted for facilitating CH and PH. The definitions of the two concepts were given earlier, and now it is meaningful to address their connection. Peek et al. (2021) suggest that CH can be viewed as a goal that defines PH objectives for specific groups. A certain community may have better or worse health than the larger population to which it belongs. As a result, improvements in CH are important for PH’s advancement (Peek et al., 2021).
Similarly, Sharofutdinova et al. (2021) imply that PH is a reflection of people’s mental, physical, and social status as they live at the level of particular communities. Zhu et al. (2019) note that one of the action areas for better PH is the creation of more equitable groups within society. Accordingly, CH and PH are interconnected as the changes, whether positive or negative, in one can be associated with modifications in the other.
Furthermore, the best practices regarding both PH and CH concern social determinants of health (SDOH). The concept refers to the conditions in which individuals are born, raised, live, work, and mature in relation to the allocation of resources, money, and power. SDOH includes one’s education, employment, income, housing, and other factors that shape health outcomes for the whole population (Alderwick & Gottlieb, 2019).
Stoto et al. (2019) suggest that addressing SDOH is within CH improvement processes that can lead to advancing PH. Wallace et al. (2019) indicate that SDOHs are influential for CH and health equity. Zhu et al. (2019) state that managing SDOH is significant for any systematic effort meant to improve PH since where and how people live greatly impacts their prospects of being fit. Moreover, the researchers propose that medical care cannot facilitate health without considering the influence of SDOH (Zhu et al., 2019). Consequentially, the examination of literature for best practices demonstrates that PH and CH can be advanced by focusing on SDOH.
An important element of SDOH that should also be considered is people’s social needs (SNs). Health-related SNs depict what matters to an individual and can be utilized to provide them with better services. SNs depend on a person’s preferences and priorities and are reflected in such matters as transportation to hospital appointments, accommodation support, or monetary assistance (Alderwick & Gottlieb, 2019). SNs that remain unmet represent adverse SDOH, including unemployment, housing instability, and food insecurity (Escobar et al., 2021). Therefore, when addressing SDOH to advance CH and PH, it is crucial to consider ways to provide people with their SNs.
Efforts and Impacts
The above-discussed organizations were visited to observe how they adjust to PH and CH concerns in Southwest Texas. For instance, MHM strives to bridge the gap in health outcomes based on its collaboration and partnership initiatives with relevant stakeholders to understand local communities better. MHM wishes to become the leader in enhancing the wellness of those underserved. MHM’s pursuits contribute to MH’s work, including the management of the largest living donor program in the nation. Finally, its merger with HCA Healthcare allows MH to operate while maintaining its mission and reducing costs (“Short reflection,” 2023). Overall, MH and its affiliated organizations aspire to help people within their reach.
The efforts and impacts of MH at the community levels in Texas in relation to CH and PH can be seen by considering SDOH, starting from Bexar County, where Sant Antonio is located. Stoto et al. (2019) indicate that Methodist Hospitals in Bexar County have one of the most developed implementation strategies in terms of CH improvement processes. The approach has concentrated on providing education regarding diabetes to vulnerable patients (Stoto et al., 2019). Accordingly, in Bexar County, MH has taken action to ensure that the residents know how to access care when facing diabetes.
Another way MH facilitates PH and CH in Southwest Texas is by addressing the SN for transportation. For example, in three of its several Methodist Hospitals across Bexar County, MH offers a free bus service to patients who experience mobility-related difficulties. The provided vehicle moves between different facilities has seat belts and is accessible for wheelchairs. There are certain zip code restrictions, and it is necessary to schedule a ride, but the bus picks up each person close to their home and drives them back after their hospital appointment (MH, n.d.c). MH helps people from Bexar County to meet their transportation needs in order to access healthcare.
Furthermore, MH advances CH and PH through the Wesley Nurse (WN) of MHM. WN is the largest geographic outreach program offered by MHM and spans over 80 sites across Texas (MHM, n.d.b). WN is meant to support underserved people through health education and promotion in diverse areas where WN members operate. Those who are involved with WN as experts have the opportunity to learn more about serving others and facilitating resources to communities. Notably, all WN activities are free, and the participants are supported by the church and MHM (Machicek, 2020; MHM, n.d.b). MH enhances CH and subsequent PH through the work of WN specialists enabled by MHM.
MH also promotes PH and CH through its partnership with HCA Healthcare. MH is among the several transplant teams of HCA Healthcare and oversees the Specialty and Transplant program (STP), which performs the most living and deceased donor transplants across the nation (HCA Healthcare, 2022b). STP helps many underserved communities alongside the Hispanic population around Texas counties, where there is a high demand for kidney transplantation. Accordingly, through HCA Healthcare, MH facilitates the health of Texas communities by making transplantation possible for those in need.
One more way MH assists people is by addressing SNs associated with individuals’ socioeconomic status. MH has a Financial Assistance Policy (FAP), which provides care to patients in challenging monetary positions, including those uninsured or underinsured, regardless of their race, color, creed, or immigration status. The charge for a person who applies and is eligible under FAP is likely not to exceed the average amount of insured people’s bills. When determining who qualifies under FAP, MH refers to the US Department of Health and Human Services poverty income guidelines (MH, n.d.d). Consequently, MH promotes the health of individuals experiencing financial difficulties.
A substantial effort in relation to community levels has been made by MH in many counties of Texas’s Southwest through MHM’s Sí Texas Project. In five years since its foundation in 2014, Sí Texas has funded eight organizations across Texas’s areas that border Mexico to address the health needs of local inhabitants (Loomis et al., 2019; Wolff et al., 2020). Sí Texas has operated in such counties as Cameron, Webb, Willacy, Duval, Hidalgo, Jim Wells, Jim Hogg, Starr, Kleberg, Kenedy, Zapata, and Brooks (Wolff et al., 2020). Individuals living across Southwest Texas do not always have access to such necessities as good food and medical services (Loomis et al., 2019). Sí Texas’s areas are populated by low-income and uninsured people living in urban cities but also ranch lands, oilfields, colonies, and rural communities (Wolff et al., 2020). Consequentially, MH’s affiliate MHM has strived to assist Texan locals whose SDOH is associated with impoverishment and limited access to medical care.
Furthermore, Sí Texas appears to have generated a positive impact for those involved. MHM sought to identify strategies that would advance the health outcomes of Texan residents in the above-listed counties (Loomis et al., 2019; Wolff et al., 2020). For example, organizations performing in Sí Texas examined the effectiveness of integrated behavioral health in comparison to each facility’s standard of care (Loomis et al., 2019; Wolff et al., 2020). The findings revealed that Sí Texas participants showed more health improvements after twelve months than those who received conventional assistance (Zandniapour & Hyde, 2022). Accordingly, MHM’s Sí Texas Project has provided a basis for enhancing the well-being of communities across several counties in Texas’s Southwest.
Strategic Priorities
It is meaningful to note that MH’s strategic priorities align with the topic of PH and CH. The organization has developed a Community Health Improvement Plan (CHIP) for the period of 2023-2025. CHIP lists several prerogative areas, barriers, and efforts MH hopes to implement. For instance, CHIP identifies healthy eating and active living as a subject of interest based on the analysis of Bexar and Atascosa Counties. The matter is intended to be handled by facilitating healthy behaviors and ensuring access to built environments and nutritious foods through such methods as education, speaking seminars, and collaboration (MH, 2022). Since, as discussed above, improvements in PH depend on the progress of CH, one can anticipate that MH’s CHIP will also lead to PH advancement (Peek et al., 2021). Accordingly, MH has devised a plan to facilitate CH, which is likely to result in better PH.
Alongside MH, MHM’s priorities for the future also align with the matter of CH and PH. In its recent legislative policy agenda, MHM states that, under the Methodist Church’s guidance, it strives to improve the wellness of those least served, with its strategic focus being the promotion of health equity. There are several areas of interest for MHM, including access to affordable and quality healthcare, children’s and women’s health, food security and nutrition, and public infrastructure.
For example, through the latter element, MHM acknowledges the need for better access to water, which the organization strives to provide by helping rural communities qualify for water development funds (MHM, 2023). Such a concern is important since, for instance, Tuggle and Crews (2023) recognize water insecurity as influencing CH, while Daher et al. (2019) indicate that Texas is at a high risk of a water gap. Consequently, MHM’s outlook for the future concentrates on enhancing CH, which may affect PH.
Finally, it is important to mention that MH’s companion, HCA Healthcare, also appears to view PH and CH among its priorities. While HCA Healthcare has not published a specific strategic plan, one can assume that CH and PH are of the organization’s interests due to the principles it has recently set for building healthy communities. In particular, the institution aims to address health disparities and increase access to affordable care, serving patients who are insured and uninsured. For instance, ways of assisting people include financial counseling, pricing information, monetary support, and patient-friendly billing (HCA Healthcare, 2022a). Overall, while not sharing its strategic pursuit, HCA Healthcare appears to prioritize CH and PB in its operations by devising approaches for helping the public.
Conclusion
To summarize, MH and its affiliates have impacted the CH and PH of those living in different counties of Southwest Texas by focusing on social determinants of health and the social needs of people facing inequalities. PH can be enhanced by improvements in CH, which in turn depends on the management of SDOH and SNs. MH is connected to such organizations as MHM and HCA Healthcare, and together, the joint forces address challenges encountered by the inhabitants of Texas’s Southwest.
For example, MH provides financial assistance to impoverished, underinsured, and uninsured individuals living in Texas, regardless of their immigration status, race, creed, or color. MHM has conducted a major project to facilitate the health of those residing in the rural areas of Hidalgo, Webb, Cameron, and many other counties. HCA Healthcare facilitates MH’s STP to give transplant opportunities to Texan citizens in need. Therefore, MH and its companions put substantial effort at the community levels across Texas to help people access quality healthcare.
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