• 2022 National Conference

    Speaker: Look Upstream to Improve Community Health

    August 4, 2022, 11:31 a.m. David Mitchell (Kansas City, Mo.) — After Bechara Choucair, M.D., gave his first television interview as commissioner of the Chicago Department of Public Health, he sent the video to his family in Lebanon. His mother, who had been extremely proud when her son was a practicing family physician in the United States, was less enthusiastic about his work in municipal administration.

    “What happened to being a real doctor?” she asked.

    “It took a while for me to get her to appreciate the different roles physicians can play,” said Choucair, the July 28 mainstage speaker during the National Conference of Family Medicine Residents and Medical Students, which was held as a live event in Kansas City, Mo., for the first time since 2019.

    Choucair offered several examples from his own career about how physicians can help improve the health of their communities. (He also noted that his mother’s opinion of his work improved considerably when he was named White House national vaccinations coordinator in January 2021.)

    He urged students and residents to focus not just on their own patients but to “think upstream to be able to make a difference.”

    It was one of Choucair’s own patients who forced him to take a wider view of health. As a young family physician in Rockford, Ill., Choucair had a patient in her 30s who struggled with bipolar disorder and homelessness. She died of hypothermia while sleeping in a park.

    “Judy didn’t choose to be homeless,” said Choucair, who noted that policies in the city and state hadn’t done enough to prioritize housing. “I made a commitment to work with organizations that focus on creating a community where everyone has an equal opportunity to thrive. It inspired me to me to be in this space.”

    As senior vice president and chief health officer of Kaiser Permanente, Choucair is part of an organization working to improve access to affordable housing in its communities. In 2018, Kaiser launched a Thriving Communities Fund, with the aim of creating and preserving 15,000 units of affordable housing by 2025. The health care system, which has 12.6 million members in eight states and Washington, D.C., announced in April that it was doubling the fund to $400 million with a new goal of 30,000 units by 2030.

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    Kaiser surveyed its members in 2020 and found that two-thirds of respondents had at least one unmet social need, and its members with unmet social needs were seven times more likely to report fair or poor mental health. The survey also revealed disparities. Black members were twice as likely to encounter housing instability. Hispanic members were twice as likely to report food insecurity.

    During the past three years, Choucair has overseen the launch of the nation’s largest social health network. Kaiser Permanente screens patients for social needs and connects them to community resources in all 40 of its markets.

    More than 40% of members reported struggling to buy food and pay bills, so Kaiser began identifying members who may be dealing with food insecurity and engaging them via text. To date, the program has helped nearly 100,000 people apply for and enroll in the Supplemental Nutrition Assistance Program. Choucair said the result has been roughly $34 million in SNAP benefits paid to Kaiser members and a $50 million economic impact in its communities.

    Kaiser also is helping ensure that its eligible members are receiving the child tax credit provided through the American Rescue Plan Act, he said.

    “When I was a resident, these types of efforts were not as advanced or scaled,” he said. “These are the kinds of opportunities you have now. We have to leverage our voices and connections to affect policy.”

    Choucair’s path in public health has its roots in family medicine. As a second-year medical student at the American University of Beirut, he chose a one-month elective rotation in family medicine in a rural area. He and two classmates knocked on doors to complete a community needs assessment.

    Lebanon was emerging from a 15-year civil war, and people were concerned about their crops and safety, he said.

    “People aren’t necessarily concerned about diabetes or heart disease,” he said. “They’re concerned about their homes, their next meals, their family and friends. It was the first time I was able to understand that my concerns about health needed to intersect with their concerns about their community.”

    No one is better positioned to understand that intersection than family physicians, he said.

    Choucair dreamed of immigrating to the United States, and came to Baylor as a family medicine resident. His vision of his new country was one of opportunity and success, but he found a different reality.

    “I was shocked by what I saw in Texas,” he said. “I saw lines of people at food banks, people sleeping under bridges. I didn’t expect to see homelessness, poverty and segregation in 1997.”

    Such conditions, he said, were not just tolerated, but sustained by policy.

    “The pandemic continues to reveal these truths,” said Choucair, who noted that people of color have suffered a disproportionate level of morbidity and mortality from COVID-19.

    As White House vaccinations coordinator, Choucair worked to ensure equitable distribution of vaccines. To date, about 20 million people have been vaccinated at federally qualified health centers where 62% of patients are minorities and more than 90% live far below the poverty line.

    Choucair said inequities in COVID vaccination rates are dropping, but more work needs to be done to address booster rates in minority communities.

    “We won’t be better prepared if we don’t center equity in everything we do,” Choucair said of preparing for the next health crisis. “We’ve learned a lot from the pandemic and response. I’m hoping we’re not going to make the same mistakes again.”

    It’s important, he said, to build trust and work collaboratively with community partners.

    As an example, Choucair highlighted Felisia Thibodeaux, executive director of the Southwest Community Corp., which serves elderly people in an underserved community in San Francisco. Thibodeaux and staff called hundreds of people in their neighborhood to encourage COVID vaccinations and provided rides to those who needed help. She’s credited with helping more than 1,200 people get vaccinated.

    “Find the Felisias in your community,” Choucair said. “To create a future that is just and equitable, you will need them as much if not more than they need you.”