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This past year, CHA introduced a new vision statement: We Will Empower Bold Change to Elevate Human Flourishing. It's an aspirational call to each of us in the Catholic health ministry. With just nine words, CHA's vision statement makes it clear that the health systems of tomorrow must be innovative and courageous, while embracing a mandate to further extend ourselves into all aspects of human flourishing.

The definition of the word flourish, "to grow or develop in a healthy or vigorous way, especially as the result of a particularly favorable environment," reminds me of Jesus' parable of the sower:

"'Hear this! A sower went out to sow.

And as he sowed, some seed fell on the path, and the birds came and ate it up.

Other seed fell on rocky ground where it had little soil. It sprang up at once because the soil was not deep. And when the sun rose, it was scorched and it withered for lack of roots.

Some seed fell among thorns, and the thorns grew up and choked it and it produced no grain.

And some seed fell on rich soil and produced fruit. It came up and grew and yielded thirty, sixty, and a hundredfold.'

He added, 'Whoever has ears to hear ought to hear.'"

(Mark 4:3-9)

Addressing human flourishing requires assessing the "soil" of our communities, not only what happens within our hospitals and clinics, but also the environments and conditions in which our patients live, work and play. As we know, human health is largely influenced by factors beyond the walls of our health care facilities. The structural, moral and social determinants of health have the greatest influence on overall well-being and are the main roadblocks to health equity in society.¹ For far too many in our communities, the conditions are vulnerable, rocky or choked off with thorns, preventing people from reaching their full potential and enjoying optimal health.

Fulfilling the vision of CHA, and the parable of the sower, requires us to address obstacles such as poverty, discrimination and their consequences, including lack of access to good jobs with fair pay, quality education, healthy foods, reliable housing and transportation, safe environments and affordable health care. Creating a favorable environment for everyone in our communities will require making bold change and empowering our teams at all levels of the health ministry. Yet, because the majority of influences on health are outside of health care, our solutions and efforts must be in partnership with the greater community. Health care cannot be the sole driver, but it can be a conduit for hope and a convener of services for those who have been historically neglected.

In recognition of this, like many of our peer organizations in Catholic health care, SSM Health has built robust health equity structures and goals into our work as a fully integrated health care delivery system. Whether discerning a strategic partnership, implementing a new line of service or simply asking ourselves what more we can do in daily pursuit of our mission, we include health equity and social determinants in the discussion. In addition, we acknowledge that health care is a major economic driver in the communities we serve, and because of this, we can make tangible investments to foster equitable change.

INVESTING IN OUR NEIGHBORHOODS
One example of SSM Health's work to drive greater equity structures in our communities is our partnership with the Healthcare Anchor Network, which recognizes that the path to equity is paved through economic development and focuses on hiring, purchasing and investing (see pages 59-61 for more details about this network's work). Through this work and other internal endeavors, we set significant goals to deliberately recruit, hire and develop talent from communities that have been historically disinvested. Furthermore, we have directed our purchasing power to engage in opportunities with diverse suppliers and service providers, from large construction projects to catering orders. As a result, some businesses that historically would not have been able to compete for our contracts are now engaging with SSM Health as part of an intentional, vibrant and equity-focused business ecosystem.

Even on a small scale, we can improve human flourishing. For example, SSM Health contracts with a St. Louis nonprofit bakery — one that employs and supports unhoused individuals — to produce loaves of bread for our employees at our annual Heritage Week events. Instead of turning to a large corporate bakery, we provide hope and opportunity for those trying to find a stable place in our community.

On a much larger scale, SSM Health is leveraging a portion of our investment portfolio for socially focused investment opportunities, such as affordable housing. The financial return is less than the market rate, but our social return is significant. In this same vein, instead of following the traditional outsourcing option, we are partnering with another local health care system to start a new health care laundry facility specifically in an urban St. Louis community that has been historically disinvested, providing good-paying jobs and helping to stabilize the neighborhood.

PRESERVATION OF THE EARTH
Sometimes, issues of health equity are global but must be addressed locally. Take climate change. The planet is warming due to human activities, and health care is a significant contributor. Unstable weather patterns are causing destructive events like floods and drought and creating environments where vector-borne infectious diseases can proliferate. These are existential threats to the health of our communities while generally affecting the poor and vulnerable more than others. While preservation of the Earth has always been a part of SSM Health's Franciscan heritage and mission, these factors have added urgency to our efforts. In 2022, we accepted the White House pledge to become carbon neutral by 2050 and are bringing this resolve to everything we do, such as reducing the use of particularly harmful anesthesia gases, expanding recycling programs, updating our electronics and lighting, limiting single-use products and installing solar panels to power some of our health ministries.² Reversing the damage done to our planet will take everyone's contribution — but as leaders in health care and health equity, we must lead by example.

ADDRESSING SOCIAL ISSUES
Of course, environmental management and community development are not our primary business, and our greatest opportunities to foster human flourishing remain in how we practice health care. As a Catholic health ministry, we have always known that our communities and patients face many social issues. Still, we have historically lacked organized methods to routinely understand the extent of their challenges and identify community-based organizations to help address them.

In 2023, we moved assertively to make the connection between the clinical and the social by instituting universal screening for the social determinants of health across our acute care patient population through the Epic electronic health record. Upon admission, all patients are screened for social challenges — including food insecurity, housing instability and other financial difficulties, such as inability to pay utilities — that can contribute to illness. By investing in an Epic-based system to streamline partnerships with community-based organizations, we can connect people with social-determinant needs with resources to address them.

SSM Health also made a commitment last year to address food insecurity and challenged all our leaders to identify local solutions. In Oklahoma City, that meant partnering with a neighboring church to operate an urban farm that grows and distributes fresh produce. Most of our health ministries now have food pantries. Some are affectionately called the "Bread Basket" in homage to our founding sisters, who more than 150 years ago carried baskets of food through the streets of
St. Louis to feed those in need. Through today's Bread Basket pantries, patients who screen positive for food insecurity are discharged with two or more days' worth of nutritious food for their household. To foster long-term food security, we partner with local food pantries and make "warm handoffs" — a method of direct communication — to experts who can help our patients with access to healthy food through more permanent community resources and programs.

TAKING BOLD STEPS
While SSM Health provides these services for anyone admitted to our health ministries, we also know that some populations have more significant issues and higher degrees of inequity, requiring a more specialized investment of time and effort.

The United States has one of the worst maternal mortality outcomes of any economically developed country, largely driven by poor outcomes for Black mothers.³ This has an outsized impact that is also extremely debilitating to communities because the mother is nearly always the anchor of the family, raising the children and providing stability. So, at SSM Health, we challenged ourselves to take bold steps and help stem this harmful trend.

At our Women and Infant Substance Help (WISH) Center in St. Louis, staff members are dedicated to taking care of women with substance use disorder from prenatal care through delivery and up to two years postpartum, helping to lead the way in substance use disorder treatment in pregnancy. Patients receive not only medical and prenatal care, but also holistic support to address behavioral health and social issues. Through love, patience and nonjudgmental support, their results have been nothing short of miraculous, and their stories make the heart ache for social justice.

Leveraging this work across our obstetrics practice, we invested in high-risk clinics, instituted universal maternal social determinant of health screening, built a referral database for community-based organizations and focused on food insecurity. In Madison, Wisconsin, women of color with social determinant of health issues are enrolled in ConnectRx, a unique partnership between health care systems in which community health workers and doulas provide holistic support throughout pregnancy.⁴

Another urgent clinical issue that greatly impacts people who are most neglected is behavioral and mental health. Left untreated, people with these issues often wind up living on the streets, estranged from their loved ones, unable to support their families, or worse, end up incarcerated or severely injured as a result of their mental illness. People with chronic health conditions have much poorer clinical outcomes if they also suffer from depression.⁵ And the number of behavioral health issues among adolescents and teens is a national crisis. SSM Health has made bold moves to address this significant challenge, including opening one of the nation's first behavioral health urgent care clinics in St. Louis and openly sharing the model with others in hopes it will be replicated.

At the clinic, patients who would otherwise end up in the chaotic world of the emergency room, waiting for hours to be seen, have acute issues quickly addressed by mental health professionals and are then connected to a local provider for sustained care through our multiple partnerships. This model decreased repeat emergency room visits and related admissions. It was so successful that we are opening a second clinic this spring to serve an even more vulnerable population.

The clinic also is located in St. Louis within our Long-Acting Injection clinic, which addresses the frequent and considerable issue of patients not sticking with their pharmacotherapy regimens. After patients stop taking their medications, it can quickly spiral into a crisis. The clinic allows patients with significant mental health challenges, such as bipolar disorder or schizophrenia, to come to the clinic monthly to receive their medications as an injection. This reduces the probability that highly vulnerable patients will stop taking their medications and creates lasting stability. The clinic's patients have realized tremendous benefits, including reconnecting with families, being able to hold down jobs, continuing in school, and avoiding trips to the emergency room or arrest by law enforcement.

SOWING THE SEEDS
As we reflect on CHA's vision statement and the year ahead, we must remember that it takes bold change and leadership to truly impact those things that contribute the most to health equity: the moral, social and structural determinants of health. We all want to see a community where every individual flourishes as God intends. Let's renew our commitment now to partnerships, innovation and investments that will improve the health and well-being of those we serve and create the good soil to fulfill Jesus' parable.

LAURA S. KAISER, FACHE is president and CEO of SSM Health in St. Louis. She served as the 2022-2023 chairperson for CHA's board of trustees.

NOTES

1. "Social Determinants of Health," Neighborhood Outreach Access to Health, https://noahhelps.org/sdoh/.
2. "Health Sector Commitments to Emissions Reduction and Resilience," U.S. Department of Health and Human Services, https://www.hhs.gov/climate-change-health-equity-environmental-justice/climate-change-health-equity/actions/health-sector-pledge/index.html.
3. Asima Ahmad, "America Has the Highest Maternal Mortality Rate among Developed Nations—and It's on the Rise. Here's Why We Are Facing a Pregnancy Health Crisis," Fortune, May 14, 2023, https://fortune.com/2023/05/14/america-highest-maternal-mortality-rate-among-developed-nationsand-rise-pregnancy-health-crisis-asima-ahmad/.
4. "Dane County Health Council and Partners Launch ConnectRx Wisconsin," SSM Health, April 14, 2022, https://www.ssmhealth.com/newsroom/2022/4/connectrx-wisconsin.
5. "Chronic Illness and Mental Health: Recognizing and Treating Depression," National Institute of Mental Health, https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health.