Simulation Shows Links Between Health and Income

Text by Amy Kotlarz, photos by John Schlia

For Dianne Cooney Miner, who was portraying a single father with two children, taking in a boarder seemed like a good decision to make ends meet during a poverty simulation March 26 at the Radisson Hotel Rochester Riverside.

The choice became more difficult when her children complained that the boarder scared them. But Cooney Miner’s family needed the extra income, so she allowed him to continue to rent a room.

“It’s the first time ever in my whole life that I had to let the welfare of my children not be important,” Cooney Miner said. “I wanted to keep them safe, but money in our home was most important.”

In real life, Cooney Miner is the dean of the Wegmans School of Nursing at St. John Fisher College and a member of the Regional Commission on Community Health Improvement, a group of decision makers brought together by Finger Lakes Health Systems Agency to improve health outcomes. Cooney Miner participated in the simulation sponsored by the agency, which brought together some of the area’s top leaders and gave them a sense of some of the gut-wrenching decisions people living at or below the poverty line make every day: choices between food or medicine, having a car or paying rent, or between going to the doctor or going to work.

The simulation was something Miner said she would like some of her nursing students to experience as well, a thought that other participants echoed following the event. Others said the lessons learned during the experience needed to be used to reduce barriers to care and improve health outcomes for those in poverty.

“It was great,” said Melanie Funchess, director of community engagement for the Mental Health Association. “I just hope they are able to translate this into sustainable change.”

The simulation was facilitated by Rhonda O’Connor, director of community engagement for Visions for Change, a Syracuse-based nonprofit that helps people become self-sufficient through education, support and systemic change. O’Connor also facilitated the simulation earlier this year for a group gathered by ACT Rochester.

Finger Lakes Health Systems Agency decided to sponsor the simulation to make it available to more people as it focuses on improving health outcomes for the community, said Wade Norwood, chief program officer. The agency has found through its analysis of regional health data that even though improvements in health outcomes have been realized, those at the bottom of the economic ladder have not seen comparable gains.

For instance, the community’s blood pressure control rate has improved by 14 percent in the past five years, but the control gap between those at the top and bottom of the economic ladder has widened, FLHSA staff found.

“Those who live at the lower socioeconomic strata are not experiencing health improvement as rapidly as those who live at the higher strata,” Norwood said. “What we are doing is working, it’s just not working as well for everyone.”

To demonstrate how poverty can be a barrier to health improvement, the simulation assigned people to various roles in a family. An artificially compressed time schedule and a flurry of activity, punctuated by minutes spent in forced waiting, helped to simulate the experiences of a person in poverty attempting to access services, pay bills and go about their daily lives.

Elements outside the participants’ control were also introduced, such as a sneaky robber, an unscrupulous landlord and fate cards, which dealt participants a challenge or an opportunity, such as an eviction or outside help with lights or heat.At one point, the lights in the room dimmed as participants collectively forgot or were unable to pay their electric bills.

After the simulation, O’Connor noted that the stress of living in poverty affects children as much as adults.

“Can you imagine all the stress they are under at such a young age?” she asked the group during a debriefing period.

Kelly A. Reed, Monroe County commissioner of Human Services and a simulation participant, said county staff members benefited from stepping into the shoes of the members of the public who seek services from the county.

“Every engagement we have with them should be relationship-building and should instill hope,” said Reed said.

Norwood said FLHSA and its partners will work to apply lessons from the simulation to their work in the future.

“We now know that transportation is a health improvement conversation,” he said to the group following the simulation. “We will now feel very comfortable talking about family court policy and practice and how it relates to schools, because now we will say that is absolutely appropriate to a health improvement conversation. And we will be courageous enough to say that conversations about poverty and economic development also need health and those involved in health improvement. I can promise you that this will not be a conversation that will be forgotten.”