Eps. 11 | More Than Medicine: The Real Factors Behind Health

Health is about so much more than what happens in a doctor’s office.
In this episode of EmpowerND, we sit down with Shelby Floberg, Community Health Integration Supervisor, and Allie Wanner, Community Health Worker at CHI St. Alexius Health, to talk about the real factors shaping health in our communities. From access to care to social and environmental influences, we explore what truly impacts outcomes and why it matters.
This conversation highlights the importance of meeting people where they are and addressing the barriers that often go unseen.
🎧 Watch now to learn how community-based support is changing the way we think about health

Contact Community Health Worker, Allie Wanner
📞 701-456-4897
✉️ allie.wanner@commonspirit.org

Contact Women Empowering Women Lay Health Ambassadors
Ambassadors can assist with appointment scheduling, Spanish translation, healthcare navigation, and program enrollment forms.
📞 Call or Text: 801-513-1340
Español:
Citas gratuitas, traducción, programación y navegación del sistema de salud están disponibles.
Llame o envíe un mensaje de texto al 801-513-1340

The EmpowerND Podcast is hosted by Women Empowering Women, a membership based non-profit organization dedicated to connecting, supporting, and educating women. Through community, events, and resources, Women Empowering Women helps women grow, build confidence, and explore their potential, supporting them every step of the way as they become the best version of themselves. To learn more about Women Empowering Women’s projects or how to become a member, visit wewnetwork.org.

Transcript

SPEAKER_01 0:00

Welcome back to Empower Indie Podcast. The Empower Indie Podcast is produced by Women Empowering Women, a nonprofit organization dedicated to connecting, supporting, and educating women to help them become the best versions of themselves. To become a member or learn more, visit wewnetwork.org. Maybe you have delayed an appointment because you could not get time off work. Maybe you have skipped a prescription because of cost. Maybe you have sat there not even knowing where to start or felt overwhelmed trying to navigate the system. The truth is, access to healthcare is about so much more than whether a clinic exists. It is about whether you can actually use the care in the middle of everything else you're balancing. Today we're talking about what access to healthcare really means, the barriers people are facing every day, and what support actually exists to help you navigate it. Let's get started.

SPEAKER_02 1:10

Can you guys introduce yourselves and tell us a little bit about what you do? Yeah, my name's Shelby Flohberg. I'm a community health integration supervisor. In my role, I support a healthcare-based community health worker program through supervising a team of community health workers that are located throughout central and western North Dakota.

SPEAKER_00 1:30

And I'm Allie Warner. I am the community health worker at CHI St. Alexis. And I work with patients to help navigate the healthcare system.

SPEAKER_01 1:41

Okay, so for our first question, what for someone who has never heard the term, what are social determinants of health in everyday terms?

SPEAKER_02 1:49

So social determinants of health are often also referred to as social drivers of health or health-related social needs. And they're just the non-medical conditions that are present in our everyday environment where we live, work, play, go to school, and et cetera. And facing barriers in relation to your social determinants of health can have a negative impact on both your health outcomes and also your everyday-to-day activities. And I'll let Ali give some examples of social determinants of health that she sees.

SPEAKER_00 2:23

So some things that I see in my position would be like lack of transportation, lack of food resources, being able to afford your medications, as well as things like not having the medical knowledge to be an advocate and an active member in your healthcare.

SPEAKER_01 2:55

You know, things like that that they really need and can't navigate. So what are some examples that people might recognize in their own lives that are not something that you've already mentioned?

SPEAKER_02 3:10

I would say a big one that is very common amongst just the normal person is general financial insecurity. And this can encompass such a wide range of needs, like Ali said, being able to afford your medication, being able to even go to the doctor and pay the $20 copay. So there's a lot that is encompassed inside of financial insecurity. Anything additional that you would say?

SPEAKER_00 3:49

And it's not healthy to not have people around. You know, just to relate to and to meet with. And that can really affect your health in the long term.

SPEAKER_01 4:05

So what does access to health care really mean?

SPEAKER_02 4:10

I like to say that access to health care doesn't just mean having care available to you, but your ability to access the care. So, like you mentioned, there's a lot of people that don't have access to a cell phone or access to Wi-Fi or a computer. So, how are they supposed to schedule those healthcare provider appointments? A lot of people don't have access to a vehicle or the funds to pay for public transportation to even get to the facility where healthcare is offered. And we see see this a lot in rural communities. Um, it's not just the distance, but also feeling overwhelmed in accessing the healthcare system when it's not close to you geographically.

SPEAKER_01 4:55

Something that I've actually noticed as a provider also is the access to the time limit, because if you have to work a certain amount of hours a week to be able to financially make it, the hours that are available to be able to seek healthcare are not conducive with meeting, you know, that need or being able to get a ride when you when it's during work hours or getting the time off or being able to, you know, afford to take time off. So especially those people that really do need the access, they can't leave work to go get the access, you know, even if they had a ride, they need the money too much to be at work to be able to leave. So then so then they're left without being able to go. Right. Yep. And we see that a lot, especially with like oil workers and and people that have like you know, jobs out of town or travel for work or things like that too.

SPEAKER_02 5:54

Yeah, or even someone that um needs child care, right? Being able to have adequate child care to be able to leave the home throughout the day to even go to a clinic appointment as well.

SPEAKER_01 6:06

Right. So, what in our rural communities um is a little bit more prevalent in when it comes to accessing and using health care that comes as a challenge?

SPEAKER_00 6:17

Um specialty care is a major issue in areas such as this. Um a lot of times I run into um people that need to go to Bismarck for appointments. Um, you know, if they don't have a working car or they don't have the funds to go. Um you know, that's a big barrier to try to get um somebody to an out-of-town appointment when we really only have a handful of services that can take people to Bismarck. Um not to mention the huge expense that that is for somebody if they're not covered by Medicaid.

SPEAKER_01 7:01

Right. So when we've already talked about kind of what the barriers are, what do you guys do when it comes to those barriers to be able to help people?

SPEAKER_02 7:10

Yeah, so Allie as a community health worker, I like to refer to her as the liaison between the healthcare system and the community. Um, so she's able to help patients um navigate not only the healthcare system, but also the community resource and services system, which can oftentimes be very overwhelming.

SPEAKER_01 7:30

What happens when social needs go unmet?

SPEAKER_00 7:35

There's, I mean, there's a wide range of things that that can happen. Um you know, it if you don't have enough food, um, you know, your your nutrition balance isn't going to be there. Um, you know, diabetics are gonna stay sick. Um, you know, the medications that we uh prescribe for you can only do so much. Um, you know, the the um devices that you need to um take care of, you know, to monitor your blood pressure, your weight. Um, you know, not everybody can afford those devices. Um, if you don't have those things at home, um, it's hard for you to be an active member in your healthcare.

SPEAKER_02 8:20

Yeah, and additionally, on kind of a more macro level, um, we see a big increase in emergency department utilization because people aren't coming in when they need to come in when they see those early signs and symptoms. Um, so they're waiting until they're so bad that they have to utilize the emergency department, utilize EMS ambulance services, um, which in the long run is an increased cost to the patient as well. So it's um unfortunate that they have to wait until it gets that bad.

SPEAKER_01 8:53

Right. And I've even seen some patients that, you know, they didn't have a ride to go get their insulin. So then because they didn't get their insulin, their blood sugars are rising, they know they're rising, but they know that EMS won't take them until their blood sugar is a certain level. And so then they wait until their blood sugar is a certain level so that they can get the ride to the doctor.

SPEAKER_02 9:10

Right.

SPEAKER_01 9:10

When it would have been solved in the beginning if they just had access to their insulin. You know? And so it's just like a cascading effect that affects all of the departments of all of the human service areas in in the end and and really ultimately impacts the patient.

SPEAKER_02 9:27

Right.

SPEAKER_01 9:28

So uh when someone is referred to resources, why can it still be so hard to actually get help?

SPEAKER_02 9:35

And I'll let Allie touch a little more on this since she's seeing this every day in the patients that she's referring out into the community. Um, but the ones that I can think of right now are long wait lists and really strict eligibility criteria that needs to be met for you to even apply for these services.

SPEAKER_00 9:54

Yeah, that's one of the biggest barriers that I run into. Um not only that, but just lack of services altogether. Um, you know, again, we maybe have, you know, a couple of services um, you know, to take care of people's medications or transportation. Um, you know, if those services aren't there, we can't help those people get to their appointments or help them get their medications or um anything that they need for their health care.

SPEAKER_01 10:27

So what needs um can you can you think of that that would need to change to make healthcare easier to access and actually use?

SPEAKER_02 10:38

The biggest thing would have to probably be transportation. Um getting their patient to their appointment is a priority, and you really can't do that without adequate transportation. So I would say um there definitely needs to be a stronger infrastructure when it comes to transportation resources, not only in our larger communities, but definitely those satellite, more rural communities that are accessing healthcare in the larger surrounding communities.

SPEAKER_00 11:08

I think um telehealth has brought a lot of or has opened a lot of doors in healthcare. Um but at the same time, like you said in the beginning, if the patient doesn't have a computer or you know, a cell phone, Wi-Fi, um, those services don't do him any good. Um, so even though it's such a a great, useful service, um, there's still other things that go with that. Um, that infrastructure thing, again, that um needs to be in place in order to utilize that system.

SPEAKER_01 11:43

So, what role do community health workers and community-based approaches play in that?

SPEAKER_02 11:47

The community health worker role is able to do a lot of advocating for the resource gaps that they're seeing in their everyday interactions with patients. Um, so Ali, along with all of the other community health workers in our program, are able to identify those gaps in resources that they're seeing and then go out to their community leaders, community-based organization leadership, and really advocate for the implementation of more resources for our community members.

SPEAKER_01 12:16

Right. And so these patients, you know, they have these experiences and sometimes their negative experiences, or they can't get what they need, or they've they've reached out and they've gone through some, you know, jumped through some of the hoops and still not been able to get help. So, how do you build that rapport with those patients to be able to help them in the future?

SPEAKER_00 12:37

Um, I think it's just taking the time uh to really build that trust between myself and the patient. Um, I'm fortunate that um I'm not on a time schedule like the rest of the providers are. Um, you know, I can bring patients back to my office again, um, just to have those one-on-one conversations and really get a feel for what the patients truly need. Um I like to call them, you know, they become my friends, you know. Um they after a while, they just I feel like they trust me. Um, and it's a lot easier to get the help that you need from somebody that you trust. Um and that's one of my key goals is to try to repair those relationships with healthcare.

SPEAKER_02 13:29

Yeah, and something that's really unique about the community health worker role is that usually community health workers are long-term residents of the communities that they support. So they know all of the community resources. They've already done all the networking within their community. Um, so they're able to meet the patient where they're at. Um, if a patient is struggling and you know, does not trust the health quick care system, they're able to go meet up with the patient, let's say at the local library, at a local coffee coffee shop, um, just so the patient is comfortable. So I think going that extra step um really helps build that rapport with patients as well.

SPEAKER_01 14:07

Yeah, what would you say to someone who's hesitant to seek health care? I would say come see me. And I think, you know, even knowing like as a provider, I still need your help, you know, like I had to bring family to you to be able to help because I wasn't sure how to navigate some of the stuff. So it doesn't, it's not just limited to to um someone that doesn't have insurance or doesn't have, you know, healthcare. It's anyone that's struggling to navigate the system. What does success look like in this work, both on a system level and for an individual person?

SPEAKER_02 14:44

On a system level, I think the overall goal is to increase successful health outcomes. Um, and we really can only do that by not only addressing the conditions that we're diagnosing, but also the conditions that our patients are living in every single day.

SPEAKER_00 15:02

Uh, on an individual level, um, nothing makes me happier and more proud to see one of my patients be successful in their own health care. Um, whether that's um, you know, bringing their A1C down, um, you know, finding their own transportation for an appointment, or, you know, learning to how to navigate the um health and human services or the Medicaid system. Um, that's a big win for people when they they feel like they have control over their own health care.

SPEAKER_01 15:33

Right. And even just um scheduling an appointment, you know, being able to navigate the building itself and know where to go and not feel like they're lost. I think all of those are still successes. Definitely. No success is too small. Yes. So, what is one thing you want someone struggling to access healthcare to know right now?

SPEAKER_02 15:56

I would want them to know that there have been a lot of changes in the recent years when it comes to healthcare and their focus on social determinants of health. Um, there's a lot more supports in place to help them navigate the healthcare system, but then also when they leave the healthcare system and they're out back in the community again. Um, so whether that be a community health worker or a social worker or a case coordinator, there's a lot more um roles in place to help support patients who are accessing the healthcare system.

SPEAKER_00 16:30

We're kind of uh looking at the the bigger picture of health care in smaller sections. Um and whatever whatever the patient's need is, um there's usually somebody there to help them. Um they just need to ask those questions and get the help that's available to them.

SPEAKER_01 16:50

Yeah, and I think it's important, especially in our community, we are really fortunate to have so many healthcare facilities and so many physical therapists, so many mental health workers, so many, you know, clinics, all of those different aspects where they have a lot of choices and they have a lot of areas to go to for different specialties too. So if they're not finding what they need, you know, at one place they can go to the other place. And knowing that all of those healthcare professionals all hope and want them to get the care that they need and that they're looking for. So just knowing that that there are other places that they can go, you know, for each service. Because I think that sometimes it's hard for people to navigate when there's a wait list or they can't get in for a while. And our community is pretty fortunate to have so many resources for them and places to go. Definitely. Okay, so as we wrap up today's conversation, I think the biggest takeaway is this. If you ever have, if you have ever struggled to access healthcare, you're not alone. And it is not a personal failure. So if you're listening and feeling stuck, this is your reminder that support exists. Shelby and Allie, thank you for the work that you do and for your sharing your insight with us today. And to our listeners, if this conversation resonated with you, share it with someone who might need it. Until next time, stay informed, stay empowered, and we will see you on the next Empower N D podcast.