Investing in Interventions That Address Non-Medical, Health-Related Social Needs Proceedings of a Workshop (2019) / Chapter Skim
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2 Setting the Stage
2 Setting the Stage
Pages 5-20
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• A confluence of biological advances and the availability of policy options creates a unique set of opportunities to effect change with regard to the trajectory of U.S. health care spend ing.
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, followed by a panel session that laid the groundwork for the rest of the day's presentations and discussions. The panelists were John Auerbach, President and Chief Executive Officer of Trust for America's Health; Dave Chokshi, Chief Population Health Officer for New York City Health + Hospitals; and Monica Bharel, Commissioner of the Massachusetts Department of Health.
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Giroir believes that a confluence of biological advances and the availability of policy options creates a unique set of opportunities to effect change with regard to the trajectory of U.S. health care spending.
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County Health Rankings & Roadmaps 2019. delays in cognitive development, is endemic in some parts of the southern United States that lack modern sanitation.
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He also noted that one of four priorities for the Secretary of HHS, Alex Azar II, is to transform the nation's health care system to one that pays for value, which will most certainly include addressing the social determinants of health as part of the value equation. Giroir emphasized how important it was for the workshop to begin assembling the theoretical and academic knowledge bases that will be required to create such a value-based agenda.
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Giroir responded that both he and the Secretary of HHS are considering how to do that. Part of his job is to preach on a daily basis to senior administration officials that health is not just a medical care issue.
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He noted that HHS recently announced a $350 million project that will study four communities for 3 years to determine whether a comprehensive approach that includes housing and social services can reduce drug overdose rates by 40 percent.1 Elizabeth Marshall from the Society for Public Health Education asked Giroir if his office was working on addressing some of the social determinants that affect pregnant women, and he replied that HHS is taking a deep dive into maternal mortality and maternal health care. He noted that the department is broadening this effort to include the mother– child dyad.
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Solutions to social determinants of health require "changing the law or implementing a policy that affects an entire community." His examples included significantly increasing affordable housing, improving economic or educational opportunities, or reducing racial and other discrimination. Social determinants of health are the root causes of nonmedical, health-related social needs, and Auerbach said it is important to distinguish between these two different -- but related -- concepts because they require different approaches to address them.
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For example, health care organizations may choose to implement screening for non-medical social needs and provide in-house assistance with social services. However, those organizations are likely to work in partnership with, or even help establish, communitybased organizations to provide various services outside of the health sector, such as food or housing assistance.
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For example, the federal earned income tax credit provided $27 million in income assistance to 44,000 families in Vermont, reducing poverty levels in the state. He also noted that fair hiring regulations, such as state Ban the Box laws that require employers to consider a job candidate's qualifications first, without the stigma of having checked a box on their job application denoting they had been arrested or convicted of a crime, can increase employment of those who have served time in jail or prison.
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He added that it is important that sectors outside of health care have the resources, beyond those provided by the health care sector and insurers, to invest in housing, combat segregation at the community level, and create economic security and quality educational opportunities throughout the community. ADDRESSING HEALTH-RELATED SOCIAL NEEDS AT NEW YORK CITY HEALTH + HOSPITALS Dave Chokshi started his presentation by recognizing that people have been working on the social determinants of health for decades.
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The key domains in which the organization is working to better serve its patients include housing stability and quality, food security, legal services, and income support. In the legal services domain, for example, New York City Health + Hospitals has established one of the largest medical–legal partnerships in the nation with the New York Legal Assistance Group to deal with a range of issues, including immigration, housing, employment, and other issues that can adversely affect health.
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Massachusetts's regulations requires DoN applicants to set aside 5 percent of capital expenditures for addressing state-defined health priorities through community-based health initiatives that engage the community to address social determinants of health. The department's health priorities focus on violence, the social environment, housing, employment, education, and the built environment to tackle those areas that the state's mortality and morbidity data indicate are the highest areas of inequity: mental health and wellness, homelessness and housing stability, substance use disorder, and preventable chronic disease.
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Bharel suggested creating mechanisms to help bring together the health system and community-based social services and to establish templates that would guide state efforts to better account for how community benefit funds are spent. Toward that end, Auerbach proposed creating a fund that CDC could use to provide a grant that each state and large city would use to create a social determinants unit headed by someone who can connect multiple stakeholders and hold them accountable for how they are spending community benefit funds.
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Responding to a question from Marilyn Lynk of the Adventist HealthCare Center for Health Equity and Wellness, Bharel explained that the 5 percent set-aside for community health benefits is separate from any community benefit funds a health system might also be spending. Between 2015 and spring of 2019, that 5 percent added up to more than $143 million in obligations going to communities.
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20 ADDRESS NON-MEDICAL, HEALTH-RELATED SOCIAL NEEDS The final comment in this session came from Lawrence McNeely with the American Diabetes Association, who noted that bending the curve for type 2 diabetes, for example, will require taking action early in life, which means thinking about what happens in the family unit, both during pregnancy and in the early years of life. This is a collective action problem that will require long-term investments, and he wondered who will provide those investments.
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