In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Aaron Shirley, MD.
This profile was published in the December, 2012 issue of HealthLeaders magazine.
"I hear a lot about studies but the people here have been studied enough. They need medical care."
Aaron Shirley, MD, a retired Jackson, Miss., pediatrician, believes that a primary healthcare model developed in Iran can be used to improve the health of the residents of Mississippi's poverty-stricken Delta Region.
The Iranian health house model is an integrated network that includes hospitals, primary care facilities and "health houses" in Iran's poor rural communities. Services are provided by community health workers who live in and know the localities they serve.
Shirley has spent a lifetime developing programs and outreach for the poor in Mississippi. He was a civil rights activist, the only African-American pediatrician in Mississippi at one time, and the first African-American resident at the University of Mississippi Medical Center. In the 1960s, he worked at the first community health center in the Mississippi Delta. He is credited with installing wells to provide clean drinking water in the area. In 1993, Shirley was awarded a MacArthur Foundation Fellowship, (an award often referred to as a genius grant) for his healthcare leadership.
In the mid-1990s he worked with a group to transform a failing shopping center into a medical mall that provides health services to the poor. In 2009 on a trip to Iran, Shirley witnessed the Iranian health house system firsthand.
"The Iranian experience was the driving force for pursuing HealthConnect," which Shirley says he started about two-and-a-half years ago. HealthConnect is designed, in part, to reduce admissions and emergency department visits at the Central Mississippi Medical Center in Jackson.
In Mississippi, there is the same "general population and similar disparities," Shirley says of the Iranian communities. "You translate the 2,000 people in a neighborhood of a rural city or town, and you've got the same problems." After seeing the Iranian model in action, Shirley says he thought: "Why couldn't we have the same model here? It proved effective there."
His goal is to open 15 health houses in the Delta Region north of Jackson. To date two health houses have opened in schools. "We said, ‘Wow, these schools are located in the village; we got a roof, windows, electricity, now let's train community health workers in that school space," Shirley recalls.
A hallmark of the Iranian system is that the healthcare workers are part of the community they serve. Shirley says the school locations provide the neighborhood connections that are particularly important in the Delta Region where a patient may have the best of intentions to follow doctor's orders, but may lack the resources to do so. That's not something a person might be comfortable confiding to a physician, he explains, but community health workers are from the Delta and more likely to be aware of a patient's personal situation.
Shirley says the two health houses have already helped reduce hospital admissions and he's eager to get more health houses up and running. He says politics—both state and federal—has limited the project's reach so far. "I hear a lot about studies but the people here have been studied enough. They need medical care."
UnitedHealthcare has provided some seed money and Shirley is trying to garner support from healthcare policy makers. It is frustrating, Shirley says, that in spite of the fact that "we spend millions and millions of dollars doing things the same way and getting the same results that a different approach is either threatening or misunderstood."
Shirley was born and raised in Jackson, and his wife, Ollye, is from the Mississippi Delta region. The couple has four children, all of whom work in healthcare. None became physicians, however.
"They remember how hard I worked," he says with a laugh.
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
