As the nation continues to struggle with the problem of health-care coverage for everyone, there’s been an emerging effort to move beyond insurance issues and focus on the social and demographic determinants of health. These markers, known collectively as “population health,” include such things as public safety, housing, nutrition and clean air.
Few local leaders have embraced population health more whole-heartedly than San Diego County’s Nick Macchione. As director of health and human services, he operates Live Well San Diego, an ambitious plan to get all community stakeholders to help residents live healthier, happier lives.
If that sounds painfully simple, that’s because Macchione wants it to be. Programs intended to help people, Macchione says, should be guided with “potent simplicity.” That doesn’t make them easy to run.
But what started out as a 10-year vision is now a way of life for San Diegans. Live Well San Diego encompasses everything from a countywide 5k race, support groups for caregivers, mammograms and mental health screenings, to cooking classes and insurance counseling. County employees, health-care organizations, private businesses and ordinary residents have pitched in to pursue the program’s goals. Macchione and his colleagues like to point out that life expectancy in San Diego County is now 82.3 years, far above the national average. That can’t be traced directly to Live Well San Diego, but it’s an effective motivator.
Other jurisdictions seem to be taking notice. San Diego County has teamed up with Allegheny County in Pennsylvania and Maricopa County in Arizona, as well as six states in Mexico, to help them implement their own Live Well programs.
But it’s not all sunshine and healthy living. San Diego County has the fourth-largest homeless population in the country. That statistic is one of the reasons the county merged its health and human services department with its housing department in July, creating one superagency under Macchione’s leadership. The idea that housing and health are intrinsically linked is starting to gain serious momentum around the country, and San Diego County is ahead of the curve.
Macchione, who is 48, understands the impact effective social services programs can have because he once relied on them. His family left Italy when he was a toddler, and he spent his youth in New Jersey housing projects with the children of other immigrants. “I grew up knowing food assistance could help supplement your diet, and receiving health care from the nuns in the parish,” he says. “I recognized the impact that government could have on your life in both positive and negative ways.”
After working for public agencies in New Jersey as an infectious disease specialist, Macchione moved to San Diego and became deputy human services director in 1998. With the agency merger that took effect this summer, he now manages more than 6,000 employees and an annual budget of more than $2 billion. “He’s quite the empire builder,” says Greg Cox, a San Diego County supervisor. “It’s paid big dividends for us. He’s done a marvelous job at tearing down the silos that are so typical of many government agencies.”
-- By Mattie Quinn
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