Public Health and Prevention is on the Move in Rhode Island

How health literate are you?

Associate Professor Carol Cummings, coordinator of the community health and wellness program at Rhode Island College, is co-principal investigator on a project to assess and build the health literacy of R.I. Medicaid beneficiaries and the health care professionals who serve them. 

Health literacy is the ability to navigate health systems and advocate for one’s own care, according to Cummings​. If you are proficient in health literacy, she said, you feel comfortable asking your providers questions about your care. You also feel confident seeking out resources and services within the health care system.

Often patients fall through communication gaps, particularly racial and ethnic minorities, due to lack of health literacy skills, said Cummings. As a result, they avoid using the health care system until there is an emergency, which contributes to escalating costs for the state and poorer health outcomes.

According to the Rhode Island Healthcare Workforce Transformation Report​, racial and ethnic minorities make up almost 30 percent of the state’s population. About one in seven residents are foreign born and over one in five speak a language other than English at home. Yet “lower income and minority communities also experience poorer health outcomes and higher rates of chronic disease and behavioral risk factors than do white, non-Hispanic residents,” the report stated.

“It’s important that health care professionals be able to work effectively within the cultural context of diverse communities,” said Cummings. 

“A culturally competent provider is sensitive to social determinants of health,” she said, meaning the social, economic and environmental factors that influence health outcomes. In fact, public health analysts consider socioeconomic factors to have a much greater impact on health than medical care.

Health care professionals tell their patients to exercise every day and eat fruits and vegetables at every meal, Cummings stated; however, a low-income patient who works two jobs and has minimal access to exercise equipment or healthy food is less likely to carry out that prescription for health than a high-income patient who goes to a local gym and has easy access to fruits and vegetables.

“Culturally competent care is patient-centered – tailored to the individual’s or community’s needs,” Cummings said. 

This health literacy project is one of numerous Rhode Island Healthcare System Transformation Projects federally funded by the Centers for Medicaid & Medicare Services. The driver has been the Affordable Care Act, said Cummings. 

While a lot of attention has been given to the expansion of health coverage under the Affordable Care Act (an estimated 20 to 24 million Americans – roughly half of the uninsured population – were insured by 2016), less attention has been given to the law’s impact on public health and prevention. 

“The Affordable Care Act is the first U.S. health care reform legislation to elevate public health and prevention to a national priority,” Cummings said. 

The Act created the $15 billion Prevention and Public Health Fund, and for the first time, there was a source of ongoing, dedicated funding for new and existing public health programs written into federal law. 

Among other benefits, the Prevention and Public Health Fund made it possible for the Centers for Medicare & Medicaid Services under the U.S. Department of Health and Human Services to support Healthcare System Transformation Projects in states like Rhode Island.

In 2015 Rhode Island was awarded a $20 million State Innovation Model Test Grant from the Centers for Medicare & Medicaid Services with the expectation that the funds will be used to improve the physical and behavioral health of the population, improve the experience of care and reduce the cost of health care. 

“It’s also important to note that since the passage of the Affordable Care Act, the health educator and community health worker professions have grown tremendously,” Cummings said. “The U.S. Bureau of Labor Statistics projected a 16 percent growth rate from 2016 to 2026 – much faster than the average for all occupations.”

Given the high correlation between social determinants of health and unhealthy behaviors, community health workers undergird the health of the nation. Whereas clinical professionals treat individuals after they become sick or injured, public health professionals try to prevent problems from happening or recurring by implementing educational programs, recommending policies, administering services and conducting research.

“There’s a growing need for community health professionals in our state,” Cummings said. “Rhode Island College produces highly qualified graduates from community health and wellness, health care administration, nursing and social work programs every year. When you consider that 70 percent of our graduates stay in the state, we are making a huge contribution to the health care workforce.”​​