Does it take a health crisis for partnerships to form that try to resolve issues like opioid addiction?
Yes, says Michael Englesbe, because everyone already has so much to do, so many daily priorities to tackle. “If it wasn’t for that day where I had to listen to those three stories [about people who had overdosed on opioids], I doubt I would have ever reached out to Chad and Jen and started plugging away at this problem,” he says.
“It does take a crisis, at least for people to listen,” Englesbe adds. “We started banging our drum and everyone was listening, and things started rolling.”
While Joneigh Khaldun agrees, she reminds the audience that “when it comes to the opioid epidemic, there have been issues with opioids in urban minority communities for decades,” along with people in those communities trying to address the epidemic.
“There wasn’t really that conversation or that excitement or that crisis during those times, and so I love that we’re all coming together now and bringing partners to the table,” she says.
“A crisis can often unmask deep, underlying disparities and disadvantage in the communities we serve,” says John Ayanian. He points to another health crisis, the recent hepatitis A outbreak in Michigan, and asks Khaldun for her perspective.
The hepatitis A outbreak has mostly occurred in southeastern Michigan, with about 20% of the cases in Detroit, Khaldun explains. The people at highest risk during this outbreak have been those who are homeless, making up about 50% of cases; those who struggle with substance use disorders — not just opioids, but marijuana and other substances, as well — and men who have sex with men.
“What we decided was, as a health department, we cannot do this alone,” Khaldun says. The HAV vaccine works if it’s received quickly enough, and so the Detroit Health Department partnered with hospital emergency departments to implement HAV vaccination programs, including screenings for those at highest risk.
“We as local public health went to our hospital partners and said, ‘Hey, this is a crisis that’s going on and this is how you can help,’” she says. “And they really stepped up to help us with this epidemic.”
From the NEJM Catalyst event Essentials of High-Performing Organizations, held at the University of Michigan’s Institute for Healthcare Policy and Innovation, July 25, 2018.