Life Along the Trail
One of the first blog posts I wrote for CICOA was about the Monon Trail. I was a new resident in Indy and the trail ran past my apartment. The trail and the diversity of the people who use it are great examples of walkability, accessability and “communities for a lifetime.” Whether you are young, old, into serious exercise or simply out for a walk to the pub, the trail is there for everybody.
The Monon Rail Trail runs north and south, stretching through Westfield, Carmel, Broad Ripple, and past the Indiana State Fairgrounds, before it intersects the Indianapolis Cultural Trail downtown on Mass Avenue.
Recently I saw a map of the Monon Trail used to tell a different story—one that illustrates the social determinants of health. The map showed the familiar route from the heart of downtown to Westfield. But the map also included information about average life expectancy in the communities along the trail. Residents near the south of the trail have a life expectancy that is fourteen years lower than those at its northern end. Why? And, what can we do to address the disparity?
Researchers and healthcare providers are now focusing more on the social determinants of health—the economic and social conditions under which people live that impact their health. Social determinants are the primary drivers of why people remain healthy or become ill. Because most of life happens outside the doctor’s office or hospital, our conversations about health should be not limited to medical treatment.
Many residents of Central Indiana live in neighborhoods that are considered “food deserts,” with no grocery stores within two miles of their home. Mass transportation is limited. Many neighborhoods lack “walkability,” where there are no sidewalks, and the ones that exist “don’t go anywhere. ” In other areas, residents may be fearful of crime and reluctant to leave the house. The internet provides many opportunities to shop online, register for services or do research, but what if Wi-Fi is not available, or you cannot afford it? What benefit is health insurance if there are no healthcare providers in your area? What happens if you have no family members nearby to offer support and assistance?
CICOA works with many community partners to address these challenges. We participate in community coalitions, including the Indy Hunger Network,and Health By Design to help promote healthy living. We partner with healthcare providers and insurers and community organizations to coordinate access to services for our mutual clients and promote better health outcomes. We advocate for public policies that promote a better quality of life for Hoosiers of any age. And we celebrate the successes of older adults, people with disabilities and family caregivers in meeting their personal goals.
CICOA’s focus on the triple aim in healthcare (better health, better care and lower costs) is based upon our understanding of the impact of social determinants of health. CICOA is not a healthcare provider. We don’t own a hospital or dispense medications or provide medical treatment. But the services we provide help promote independence, dignity and quality of life of older adults, people of any age with a disability and the people who care for them. These include access to quality care, good nutrition, affordable and accessible housing, and supports for family caregivers. Here are a few examples:
• My Freedom allows a visually impaired father access to transportation to and from work. His shorter commute time allows him to pick up his kids from school. The reduction in his commute time from two hours to 20 minutes allows him time with his family. He exercises more and has lost weight.
• An elderly woman who is homebound struggles to get to the grocery story. With Meals & More, her diet has improved, and she eats more vegetables, fruit and protein.
• A Flourish care manager works with one of her clients to get her medications. Her health plan covers the prescription, but she has no way to get to the pharmacy. Together, they find pharmacist who delivers.
• An options counselor in the Aging & Disability Resource Center works with a new retiree to review Medicare Advantage plan options to find a plan that offer the best coverage for his medical treatment.
• A young adult with disabilities finds an accessible apartment and moves out of an institutional care setting into a home of her own with the help of Money Follows the Person.
These are just a few examples of how CICOA addresses social determinants and their impact on health. There are thousands more.
 Rush University has developed a similar map showing life expectancy along the Chicago Loop.
 This comment was shared by a young adult at a recent community forum. The town she lived in did not offer public transit and the sidewalk in her neighborhood did not extend beyond the subdivision.