Community health needs bus tour: understanding social determinants of health and racism

ABSTRACT

Purpose of Study Racism, the social system in which certain groups of people are afforded opportunity while others are limited, based on race, is a social determinant of health (SDOH) that contributes greatly to health inequity. An interactive Community Health Needs Bus Tour at Arkansas Children's Hospital served to (1) increase intern knowledge of SDOH and racially-driven health inequity, while providing context to the patients and community we serve;and (2) connect residents to the organizations working to overcome these disparities. Methods Used Key SDOH were identified including food and housing insecurity, education, literacy, community and personal violence, and racism. Community organizations and landmarks were identified as "tour stops" to illustrate each SDOH and its impact. Each stop connected residents to a place where they would soon be referring patients with such needs in the future. A detailed script was developed. At each tour stop residents were given demographic data that highlighted the impact of health inequity. They also learned the positive impact of the organization. At "Hop On" tour stops, speakers from the individual organizations were invited on board the bus to share the specific impact of their work. The tour was also designed with two "Hop Off" stops, chosen to illustrate how Little Rock's unique history and racial division created much of the health inequity of today. At the Mosaic Templars Cultural Center, residents toured exhibits to learn and celebrate African American history and culture. At the Central High School Visitor Center, residents studied the history of the "Little Rock 9." These stops highlighted the impact of public policy and racism and sought to expand residents' cultural competency. The tour took place during Intern Orientation in June 2019 and 2022, with a gap due to COVID. Summary of Results: All participants were surveyed anonymously at the conclusion of the bus tour. 96% felt that the experience met its core objectives. 100% of all participants agreed or strongly agreed that they can apply what they learned on the Bus Tour to their work as a resident. Further, 100% of all participants agreed or strongly agreed that they had identified an organization or person they can collaborate with in the future. One resident reported the tour led to "better understanding the history and current socioeconomic context that may color interactions with future patients." Another resident reflected the experience was a "great reminder to keep in mind that regardless of patients' background, they all deserve the same standard of care." Conclusion(s) This type of interactive, community-based programming is effective in teaching SDOH, raciallydriven health inequity, and connecting residents to the patients and communities they serve. Further study could identify if these experiences specifically impact residents' perception on racism, health inequity, and bias. Copyright © 2023 Southern Society for Clinical Investigation.