April 9, 2019; Shelterforce
These are times of great changes in health care. Hospitals and health systems have come to recognize, in the words of Brian Castrucci, CEO of the Beaumont FoundationY John Auerbach, CEO of the Trust for America's health, "That medical care alone can not address what really makes us sick."
The rising costs of medical care and the worsening of life expectancy are the results of a worn-out social safety net, economic and housing instability, racism and other forms of discrimination, educational disparities, nutrition inadequate and the risks within the physical environment. These factors affect our health long before the health care system gets involved.
However, the change is not easy. For example, NPQ has cited the work of Pritpal Tamber, Who said Health Donors in November 2017, "there is a risk that the initiatives resulting from the growing enthusiasm of the health sector for influencing social determinants are too limited to achieve the objective, since they leave out the knowledge and power of those most affected by it. the same challenges that seek direction. "A little over a year ago, NPQ famous that "health insurers, while willing to modify payment models and consider some changes in what they will pay, have yet to understand the more fundamental nature of the need for a system change and the empowerment of the community inherent in the idea that health, ultimately, is much, much more than health care. "
In Shelterforce, Castrucci and Auerbach make a similar observation. "Hospitals and health care systems have begun to address these social determinants of health through initiatives that buy food, offer temporary shelter or cover transportation costs for high-risk patients," they write, but add, " when it is analyzed more closely. "These articles are not about improving the social and economic conditions underlying the communities to promote better health for all, but about mediating the individual social needs of patients."
The result is decidedly mixed. Nobody, much less Castrucci and Auerbach, want to discourage what they call "invaluable" assistance for individual patients, but efforts to address poor health at the community level where the impact would be greatest are still insufficient.
Even the Secretary of Health and Human Services of the United States (HHS), Alex Azar, has noticed the difference. In a speech last November., Azar noted that "we can not simply write a recipe for healthy meals, a new home or clean air."
Castrucci and Auerbach point out that "health care navigators and similar improvements to medical care can not change the availability of resources in the community. They can not increase the minimum wage, increase the availability of paid sick leave or improve the quality of our educational system. These are the systemic changes that are necessary to truly address the causes of ill health. "
Fortunately, some policies that directly affect the health of the community are being implemented. Castrucci and Auerbach pointed out that in Kansas City, Missouri, "Voters recently approved a ballot initiative that allows health inspectors to respond to tenants' complaints about a wide range of housing conditions, funded by an annual rate of $ 20 per unit for homeowners." They add that
National initiatives offer states and local communities a road map to identify and implement gold standard strategies to improve public health. In an initiative known as Impact on health in 5 years (or HI-5), the Centers for Disease Control and Prevention (CDC) developed a list of 14 evidence-based policies to improve the health of the population. CityHealth, an initiative of the Beaumont Foundation and Kaiser Permanente, offers city leaders a package of nine policy solutions that can help millions of people live longer and better lives.
As Castrucci and Auerbach observe, removing mold from a patient's apartment, feeding a patient in need of food or providing an exercise program on site is different from removing mold from a complete apartment building, providing community access to healthy foods or reduce the risk Cost of exercise options available to all. The risk, they add, is that "redefining the meaning of 'social determinants' is mainly due to the immediate social needs of expensive patients and makes it more difficult to focus on the systemic changes needed to address the causes fundamentals of ill health. " Steve Dubb