Social Determinants of Health – Who Should Lead The Way?

I recently had the opportunity to attend the Annual Thought-Leadership on Access Symposium (ATLAS) [you can read more about my observations at the conference here]. During one of the panel discussions, Kate Walsh, President & CEO of Boston Medical Center (BMC) asked this thought-provoking question:

Where does the hospital end and the community begin?

Her question has stuck with me for over a week, so I thought it would be interesting to explore this in more depth with the HCLDR community, specifically as it relates to healthcare’s role in addressing the social determinants of health.

The World Health Organization defines social determinants of health (SDOH) as “The conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.”

In recent years, several key aspects of SDOH have come into focus:

  • Access to healthcare providers (primary care, urgent care, hospitals, mental health, etc)
  • Access to fresh, health food
  • Access to transportation (for work as well as for medical appointments)
  • Proximity to pharmacies

In the US, changes to reimbursement models have thrust healthcare organizations into a leadership role in addressing SDOH. To put it plainly, hospitals and other healthcare providers are now financially incentivized to keep their patients healthy and out of their EDs.

In Canada, Australia, UK and other countries with publicly funded healthcare systems, the push to reduce the cost of care has put the spotlight on addressing SDOH via community health programs, which are extensions of the existing healthcare system.

When Walsh posed her question at ATLAS, she prefaced it with a statement that healthcare organizations are increasingly taking an active leadership role in addressing SDOH. In my conference travels this past year, I have heard stories of healthcare organizations that have:

  • Educated patients on the safe use of hot plates
  • Produced & distributed flyers on how to turn down the temperature of water heaters to prevent scalding
  • Held classes on how to plan meals using fresh produce from local markets
  • Paid for rideshares to get patients to appointment
  • Paid for delivery of medications to patients

This is brand new territory for many organizations and it blurs the lines between healthcare provider and community center.

Should we expect healthcare organizations to be the leaders of fight to address SDOH? Is it sustainable if they are? Is there a better group to lead? Should it be left up to locally elected officials?

In 2017, Leavitt Partners conducted a survey of US physicians [registration required] to determine their sentiments on SDOH. They found that “although most physicians agree that SDOH matter for patient health, most physicians do not currently believe addressing these social issues are their responsibility”. As an example, the survey found that 66% of physicians believe help with transportation would benefit their patients. However, 69% of physicians do not believe doctors or insurance plans are responsible for providing that assistance.

The authors of the Leavitt survey, concluded that other groups need to get involved in addressing SDOH – employers and public health authorities. They cited the example of GE’s Healthcities program which showed reductions in ED visits by GE employees.

Employers, like GE, have a financial incentive to keep their employees healthy – perhaps more incentive than healthcare providers do. In addition, companies would benefit from the goodwill that would be generated by publicizing how much they care for their staff. Just imagine if your employer helped to provide transportation to medical appointments or paid leave to take care of a loved one.

In fact, that maybe a reason why healthcare organizations are getting involved – because of the trust SDOH programs garner from the community. But over the long-term is that enough to keep them involved?

Join us Tuesday October 1st at 8:30pm ET (for your local time click here) when we will be discussing the following topics:

  • T1 Do you see healthcare organizations sustaining their efforts to address the social determinants of health or do you see their involvement declining in the future?
  • T2 Are healthcare organizations the right champions to be leading the fight against social determinants like poverty, access to fresh food, etc?
  • T3 What could healthcare organizations do to rally support from local communities so there is more shared responsibility for health initiatives?
  • T4 Does community involvement increase, decrease or not affect the trust you have for a healthcare organization?

References

Winfield, Lia. DeSalvo, Karen. Muhlestein, David. “Social Determinants Matter, But Who Is Responsible?”, Leavitt Partners, 2018, https://leavittpartners.com/whitepaper/social-determinants-matter-but-who-is-responsible/, accessed 29 September 2019 (requires registration)

Lee, Josh and Thomas, Sarah. “Addressing social determinants of health in hospitals”, Deloitte, https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/addressing-social-determinants-of-health-hospitals-survey.html, accessed 29 September 2019

Sukel, Kayt. “Social Determinants of Health Play Growing Role in Hospital, Payer Strategies”, Managed Healthcare Executive, 3 December 2018, https://www.managedhealthcareexecutive.com/article/social-determinants-health-play-growing-role-hospital-payer-strategies, accessed 29 September 2019

Sullivan, Hannah R. “Hospitals’ Obligations to Address Social Determinants of Health”, AMA Journal of Ethics, March 2019, https://journalofethics.ama-assn.org/article/hospitals-obligations-address-social-determinants-health/2019-03, accessed 29 September 2019

Luthi, Susannah. “Collide or collaborate? Community health centers and hospitals work through their overlap”, Modern Healthcare, 17 February 2018, https://www.modernhealthcare.com/article/20180217/NEWS/180219923/collide-or-collaborate-community-health-centers-and-hospitals-work-through-their-overlap, accessed 29 September 2019

Artiga, Samantha and Hinton, Elizabeth. “Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity”, Kaiser Family Foundation, 10 May 2018, https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/, accessed 29 September 2019

McNeill, Ted. “Family as a Social Determinant of Health: Implications for Governments and Institutions to Promote the Health and Well-Being of Families”, Longwoods, 14 October 2010, https://www.longwoods.com/content/21984/healthcare-quarterly/family-as-a-social-determinant-of-health-implications-for-governments-and-institutions-to-promote-t, accessed 29 September 2019

Image Credit

Photo by Mihály Köles on Unsplash

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