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Social Determinants of Health Depend on Healthy Governance

Social Determinants of Health Depend on Healthy Governance

“Thrive,” by Ron MaderJune 5, 2019; MedCity NewsIf we respond just to a person’s medical needs, we won’t keep them healthy. A recently published study, sponsored by the Kaiser Permanente Health System, supports the conclusion that good health requires strong communities. “Safe housing, balanced meals, transportation, and social support are essential to Americans’ health and well-being,” it says, but “Americans across demographic segments face challenges meeting these needs, leading to significant negative impacts on physical and mental health.”Kaiser’s research found that patients and experts agree.Social needs rival traditional health care considerations in importance. Americans take a holistic view of health, believing that safe housing, reliable transportation, healthy meals and supportive social relationships are nearly as important as access to doctors and medication.[…]More than a quarter of Americans have endured health risks stemming from unmet social needs, and Americans with unmet social needs are significantly more likely to experience poorer physical and mental health than their counterparts without unmet needs.According to MedCity News, the impact of these social determinants of heath is personal, not theoretical. Twenty-eight percent of Americans report “a barrier to health due to a social need, ranging from paying for food or rent over medication to the inability to see a doctor regularly due to an unstable housing situation.”Survey respondents reported that housing and food costs make up more than half of the budget, whereas healthcare makes up 9 percent of the budget. Only 44 percent of survey respondents said they could cover a $500 emergency expense from an emergency fund or their cash on hand.To respond to the need Kaiser perceived among its patients, they launched Thrive Local, a mechanism to coordinate medical services with a network of social service providers. Kaiser Permanente Chief Community Health Officer Bechara Choucair said in a statement, “When we ask our members if they’ve had to skip a meal lately, if they can afford their medications, or if they have reliable transportation, we know the answers to those questions can tell us as much about their future health as their blood pressure tells us. When we can prevent negative health outcomes with access to social services, we can make our communities healthier for the 68 million people living there.”However, when NPQ covered the launch of Thrive Local earlier this year, we pointed out an unaddressed issue: the costs of expanding an already overburdened safety net.What’s not entirely clear is who will pay for these social services; will it be the health system? Municipalities? Charitable organizations? For the model to work, some of the $3.5 trillion the US spends on health care each year needs to move to funding the underfunded social service agencies and nonprofits that support social needs.Even this would not adequately address the housing, transportation, educational, safety, and environmental components a comprehensive vision of health requires. It goes beyond the ability of the philanthropic community to underwrite. It requires, as NPQ has noted in its reporting on efforts to put the comprehensive vision of health into practice, “a shift in power.”Kaiser is doing the right thing with its investment in bringing a holistic view of healthcare into practice. Putting $200 million toward expanding affordable housing is a significant commitment, yet when the current need for new and affordable housing in its home state of California exceeds three million homes and apartments, it’s overshadowed. To address the array of unmet needs among the social determinants of heath would require local, state, and federal policymakers to do the politically impossible. National priorities would need to change, allocated revenues would need to be redirected, and additional sources of funding would need to be found. Last November, NPQ covered the work of Pritpal Tamber of the nonprofit Bridging Health and Community, who emphasizes that health requires people to have a “sense of control over their lives, which requires agency.” Perhaps, when thinking about comprehensive healthcare, we need to think about healthy and human-focused governance as another key determinant.—Martin Levine

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