J Health Care Poor Underserved. 2021;32(2):638-653. doi: 10.1353/hpu.2021.0093.
Cross-sector collaboration and systems alignment to promote a culture of health can address social determinants of health (SDH), improve family well-being, and create a more equitable society. This paper documents our attempt to align Temporary Assistance for Needy Families (TANF) and Medicaid to promote health through a trauma-informed program, The Building Wealth and Health Network (The Network). The Network successfully integrated into traditional TANF and addresses SDH through peer-group programming where caregivers heal from adversity and build financial skills. We identify three challenges to alignment of TANF and Medicaid: 1) TANF's culture of compliance, 2) societal and systems-level forces including racism and discrimination, 3) misaligned partnerships (values, priorities, structure, and capability). For each challenge, we propose solutions including incentives for innovation and partnership, and promotion of racial equity initiatives, including reparations. By highlighting challenges and solutions we seek to strengthen current approaches to achieve health equity through systems alignment.
跨部门合作和系统调整以促进健康文化可以解决健康的社会决定因素（SDH），改善家庭福祉，并创造一个更加公平的社会。本文记录了我们通过一个创伤知情项目——财富与健康网络（The Network），尝试将“补充营养援助计划”（TANF）和“医疗补助”（Medicaid）进行调整以促进健康的努力。该网络成功地融入了传统的 TANF，并通过同伴群体计划解决了 SDH，在该计划中，照顾者从逆境中恢复并建立金融技能。我们确定了 TANF 和 Medicaid 调整的三个挑战：1）TANF 的合规文化，2）包括种族主义和歧视在内的社会和系统层面的力量，3）不匹配的伙伴关系（价值观、优先事项、结构和能力）。对于每个挑战，我们都提出了解决方案，包括创新和伙伴关系的激励措施，以及促进种族公平倡议，包括赔偿。通过强调挑战和解决方案，我们旨在加强当前通过系统调整实现健康公平的方法。
