Health equity is a fundamental principle to ensure everyone has an equal opportunity to achieve good health. While New Hampshire is one of the healthiest states in the country overall, not everyone who lives here has a fair opportunity to achieve their full health potential. By understanding the challenges faced by underserved, underrepresented and marginalized communities and implementing targeted strategies, New Hampshire can start to make strides toward creating a more equitable healthcare landscape for everyone.

Henry Och, CEO of Harbor Care, a Nashua-based network of nonprofit health care, housing, and human services helping adults, children, and families of New Hampshire, recognizes the intrinsic connection between health and economic and social factors.

Affordability is the biggest Barrier to Health Equity

In New Hampshire and the United States overall, one significant barrier to health equity is the lack of access to affordable healthcare services. Residents with limited financial resources often struggle to access necessary preventive care, screenings, and treatment, leading to more severe health issues later on. Additionally, employment, housing, zoning, education, food security, and social inclusion, which are influenced by economic status, can also positively or negatively impact access to healthcare. And there are racial differences in all of these factors, leading to poorer health outcomes among people of color. Moreover, communities of color across the state face obstacles where “conditions—often referred to as social determinants of health—are key drivers of health inequities, placing those within these populations at greater risk for poor health outcomes,” according to the CDC.

The data show that Communities of Color , throughout the United States as well as New Hampshire, experience higher rates of illness and death across a wide range of health conditions, including diabetes, hypertension, obesity, asthma, and heart disease, when compared to their White counterparts.

With this in mind, Harbor Care's programs take a holistic approach to healthcare, considering the diverse needs of the communities they serve. By offering primary care, behavioral health services, dental care, and addiction treatment, they aim to ensure comprehensive care for their patients. Additionally, the organization provides support in areas such as skill-building, education, food security, and community-building activities, recognizing that these factors contribute to an individual's overall health.

Addressing Health Disparities through a Holistic Approach

As a Federally Qualified Community Health Center, Harbor Care plays a crucial role in addressing healthcare disparities within underserved communities. They provide services regardless of an individual's ability to pay. Beyond that, they offer interpretation services, patient education in multiple languages, and a diverse staff representative of the communities they serve. By focusing on eliminating language barriers, increasing representation, and ensuring access to care, Harbor Care aims to reduce racial and ethnic healthcare disparities prevalent in the United States.

Having access to health care is important for many different reasons. For example, if an individual does not maintain their health through regular primary care visits, then they might face underlying issues that are not treated until they become serious. And at that point, they either have to go to the emergency department or to an urgent care facility that might not be able to address their needs. Not to mention that some chronic diseases, like diabetes and hypertension, require regular care. 

Health disparities are systematic, and unjust inequalities result in differences in health status that are avoidable and unfair. The complex interaction of social determinants that include income and wealth, education, occupation, housing conditions, and access to healthy food, transportation, and healthcare services create challenges to achieving good health outcomes. Because of this, solutions have to be comprehensive to the whole person, not just focused on treating a medical condition. 

Building Community Partnerships

Achieving equity in healthcare and addressing social, societal problems such as poverty cycles requires collaboration between various stakeholders. Through partnerships with other nonprofit organizations and governmental agencies, communities can work together to meet the needs of vulnerable populations. Harbor Care actively participates in community initiatives such as the Greater Nashua Continuum of Care, where agencies collaborate to address homelessness and conduct outreach efforts to identify individuals in need of services.

Beyond community partnerships, other measures to drive health equity include expanding Medicaid coverage and increasing funding for Federally Qualified Community Health Centers. In addition, telehealth initiatives can help bridge the gap for those  who cannot take time off to get to appointments easily, those in rural areas, and those who cannot afford transportation;  enabling remote access to medical professionals and specialists. 

Promoting health literacy and providing culturally competent education about preventive care and chronic disease management is also relevant to empower individuals to make informed decisions about their health. Collaborating with community centers, schools, and healthcare providers can ensure that resources are accessible and tailored to specific population needs.

Lastly, collecting accurate and recent data on health outcomes across different demographics is essential for identifying disparities and designing targeted strategies to promote equity. Most of the administrative data in NH is limited in its ability to accurately collect information about race and ethnicity. Regular monitoring and analysis of health data can inform policymakers and healthcare providers about the progress made and areas that require further attention.

Achieving health equity in New Hampshire requires a concerted effort from all stakeholders involved. By addressing the barriers to access, promoting health education, and targeting social determinants of health, the state can move closer to ensuring that every resident, regardless of their background or socioeconomic status, has an equal opportunity to live a healthy life. Through collaboration, innovation, and a commitment to equity, New Hampshire can pave the way for a healthier and more equitable future for everyone.

Bio: Henry J. Och, President and CEO of Harbor Care, has more than 20 years of experience in non-profit healthcare. Henry is also a commissioned Infantry officer in the Massachusetts Army National Guard, where he currently holds the rank of Lieutenant Colonel. He has a master's degree from the Harvard University Extension School and a master's degree in Business Administration with a Healthcare Management concentration from the University of Massachusetts-Lowell. Henry volunteers his time and expertise as a member of several non-profit boards focused on the well-being of children and families, youth support, mentorship and empowerment, and social and economic justice. He is also an avid long-distance runner and has completed more than 30 full marathons, including 10 Boston Marathons.