If you’d like to add 10–15 years to your life expectancy, then you might start with eating a balanced diet, exercising, avoiding stress, and getting regular checkups. You might not think about your education, job, income, and ability to build wealth as health interventions—but they are, according to Dr. Jason Purnell, BJC HealthCare’s vice president of community health improvement. Purnell served as the principal investigator for the 2014 For the Sake of All project, which looked at the health and well-being of African-Americans in St. Louis. One troubling finding from the report: Residents of certain affluent St. Louis ZIP codes can have up to an 18-year difference in life expectancy than their under-resourced neighbors only a few miles away.
“I’ve been saying for several years now that when people think about health, they think about health care in the provision of medical care,” Purnell says. “What we know is that that only accounts for a relatively small contribution to the explanation of health outcomes. It is these larger social, economic, and structural factors that have a significant impact on people’s health outcomes like life expectancy, disease, and disability. We know, for instance, that the life expectancy difference between the top 1 percent of income earners and the bottom 1 percent of income earners is 15 years for men and 10 years for women. We’re not going to solve for health equity with just medical care alone.”
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Two years ago, when the COVID-19 pandemic hit and revealed inequities in our region that made some people more likely to be exposed to the virus and experience severe disease, it was the first time that most of us considered health disparities. Some health care professionals shouted from the rooftops that health care needed to focus on more than medical treatment. Now BJC HealthCare has released a new plan to start to fix health inequities, specifically in the city and North St. Louis County. The health care organization is trying to address the roots of the problem: poverty, education, and housing. It’s also addressing diabetes, access to healthful food, infant and maternal health, and health and wellness in schools. One of the most interesting aspects of the plan, however, is BJC financially investing more in the community by leveraging its balance sheet and partnering with Midwest BankCentre and St. Louis Community Credit Union.
Putting Together a Plan
Three pillars of BJC’s plan focus on:
- Diabetes and healthy food access: BJC’s Christian Hospital has a pilot program that partners with the North Sarah Food Hub to provide prepared meals, meal kits, and nutrition counseling for patients who are either food insecure or financially insecure and also have uncontrolled diabetes. BJC wants to scale this program while continuing to improve access to healthy food.
- Infant and maternal health: Purnell cites the statistic that Black infants in both the city of St. Louis and St. Louis County are roughly three times more likely to die before their first birthdays than white infants. The health care organization is looking into expanding partnerships with doulas, integrating more doulas into clinical settings, and exploring how Medicaid can help compensate them. “A focus on doulas is really a result of evidence that we have that this kind of continuous support, particularly for Black moms who are delivering babies, results in fewer emergency C-sections, less need for pain medication, and greater satisfaction with the birthing experience,” Purnell says.
- School health and wellness: BJC wants to help provide more wraparound services for schools, including behavioral health and behavioral wellness services. This planning, Purnell says, “was highly influenced by organizations like Alive & Well Communities that are doing work around trauma and toxic stress in schools and communities and other places. Their voice at the table was critical to our thinking about not just providing mental health services but also creating environments that are conducive to overall behavioral wellness.”
Its anchor strategy, however, seeks to leverage its role as a major employer in the region and purchaser of goods and services to address the wealth and wage gap. BJC wants to:
- Hire, promote, and retain Black employees while creating more opportunities through apprenticeships and internships
- Increase local economic development in areas that have faced disinvestment by purchasing goods and services
- Support the growth of local Black-owned businesses through targeted supplier diversity efforts
One way BJC is acting on this anchor strategy is by taking a portion of its banking to Midwest BankCentre so that the bank can do more small business lending, real estate lending, and make other loans.
When Midwest BankCentre’s chairman and CEO Orvin Kimbrough began at the bank, in 2019, he met with BJC president and CEO Rich Liekweg. “[We discussed] Midwest BankCentre’s aspirations to make reasonably priced capital more accessible to more people in the St. Louis region, specifically, low- to moderate-income people,” Kimbrough remembers. “Really just talking about this idea of ‘bank your values.’”
Kimbrough has a background in social work—and he sees how economics impacts everything. One of the ways to promote better health in a community, he says, is to make sure that residents have access to traditional banking services, mortgages, and capital to start or scale a small business. “If you think about how you create wealth, it’s homeownership, and it’s having money to start or scale a small business,” he says.
“Sometimes we have financial institutions who may have branches in certain neighborhoods, but they are only taking deposits,” Kimbrough continues. “They’re not necessarily issuing credit. And the reason that they’re not issuing credit is because some communities are viewed as higher risk. Sometimes that higher risk is a symptom of a broader systemic issue—working-class people, living hand to mouth.”
BJC’s deposits mean that Midwest BankCentre can take on a little more risk. “What BJC did was essentially said, ‘We will deposit [this] dollar amount in your low- to moderate-income branches tied to these 20-plus ZIP codes, and we would like for you to do more lending in these 20-plus ZIP codes,’” Kimbrough says.
This is not charity, he points out—it’s a capital play. Independent of BJC, Midwest BankCentre committed to incremental lending in these communities—$200 million in capital over the next five years. They want to create a demand for the loans, and BJC’s deposits ensure they will have enough to meet the market demand that they’re trying to drum up.
There are more barriers to financial accessibility than physical place, of course. Some communities don’t feel comfortable at traditional financial institutions. “We’ve got to change that mindset,” Kimbrough says. “One of the challenges is being present with allies in the community who are ambassadors for these communities.” Midwest BankCentre also helps customers with a basic financial education. A year ago, they created a small-business academy in which they help customers identify what it will take to start a small business, including the basic questions that a bank will ask about credit, collateral, and cash flow.
A Ripple Effect
Can a single loan really improve community health? Amira Jahic, the owner of AJ Wellness Pharmacy on Jefferson Avenue, became a Midwest BankCentre customer before the partnership with BJC. Her story, however, illustrates the kind of transformation that BJC’s deposits could make in the health and vibrancy of a community.
After the pharmacy Jahic worked at closed in March 2021, she decided she wanted to open her own. She applied for a loan with a few banks, but she was denied because she didn’t have enough collateral. A friend told her about Midwest BankCentre.
“I kind of wanted to give up, but then something in the back of my mind told me to try one more time,” Jahic says. She reached out and began working with a loan officer; six weeks later, Midwest BankCentre approved her. She opened AJ Wellness Pharmacy in July 2021. “It felt really good knowing that somebody’s putting their trust into my work,” she says. “They’re saying, ‘Hey, maybe this woman can actually accomplish something.’”
Jahic’s model prioritizes personalized care for her customers. She is originally from Bosnia, and her pharmacy staff of six speaks English, Bosnian, Spanish, and Vietnamese to help communicate in patients’ native languages and ensure that prescription directions are translated correctly and easy to understand. Five times a month, the pharmacy staff visit nursing homes to ensure that residents are taking their medications as prescribed and that they aren’t doubling up on certain meds prescribed by different doctors, which can be dangerous. They also paint, play bingo, or sing karaoke to connect with them outside of the pharmacy setting. Jahic and her staff act as advocates for their patients, many of whom they can recognize by voice over the phone. They can help them navigate the process of signing up for Medicare, which is sometimes complicated. “If they don’t have good health insurance, we can try to put them in a Medicare Advantage plan, so they can get all of those benefits,” Jahic says.
St. Louisans, Kimbrough stresses, don’t have to be big anchor institutions to influence their communities through their bank and to start to effect this type of change. “If more people thought intelligently about their financial services and what they ask of their financial institutions, it could create a ripple effect,” he says. “Ask your financial institutions how much they are investing in these communities that really have the potential to turn the tide for the St. Louis region from an economic standpoint. Improvement in these 20-plus ZIP codes represent not just the improved health and well-being of individuals in these ZIP codes, but it represents improved health and well-being for the region, and our ability to attract more companies and more individuals into the region.
“You don’t have to be a big BJC to leverage your balance sheet,” says Kimbrough. “You, as an individual citizen of St. Louis, can leverage your balance sheet.”
