My cousin Arlene got married in Detroit at the classic Book Cadillac Hotel on July 23, 1967, a Sunday afternoon wedding. When Daddy drove us back out to our suburban home about 30 minutes from the fancy hotel, the car radio was tuned to WWJ Newsradio 950, all news all the time.
As soon as Daddy switched on the radio, we were shocked by the news of a riot breaking out in the city, fires and looting and gunshots and chaos in the Motor City.
Two days later, my father, who did business with Mom-and-Pop retail store owners in the city, drove us back into Detroit to witness, first-hand, the devastated shops, neighborhoods, and livelihoods.
This was my early education in the social determinants of health (SDoH), which I will relate today in a talk at the HealthXL Global Gathering hosted in Lake Nona, FL, at GuideWell Health’s Innovation CoRE.
I’ll be joined on a panel brainstorming social innovation for health by Charles Nader, Co-Founder/CEO at Doc.com, Carlos Rodarte of Health Catalyst, and Naveen Rao of Patchwise Labs.
My personal take on my portion of this quartet is that, “We Can’t Lyft Our Way Out of This.”
“This,” being the scenarios illustrated by people – health consumers, patients, caregivers, all hungry for health citizenship, illustrated here by their signs of SDoHs curated in this second slide from my PowerPoint deck. These are people in want and need of education, a good and secure job, food, safe and clean housing, health care access, and clean water, air, and stable climate (that would be Greta Thunberg holding her sign for a “school strike for the climate”).
In the past decade, I’ve been spending a lot of time considering SDoH through a variety of lenses across the health/care ecosystem, including care providers like hospitals, health insurance companies, pharma and life science, retail health care front doors, and non-profits and foundations.
A growing number of organizations serving each of these health care industry segment stakeholders has taken on an SDoH to help bridge patients’-peoples’ needs, whether for food security or a warm place to sleep. These projects are laudable and positive signs of corporate responsibility beyond investor shareholders. The recent update among Business Roundtable members for “an economy that serves all Americans” re-commits the largest U.S. companies to benefit communities beyond stockholders is a trend in this direction which I applaud.
But if you look at the top line of my Social Determinants of Health graphic at the top of this post, taken from my book HealthConsuming: From Health Consumer to Health Citizen, you find that it’s socioeconomic status that makes the largest contribution to human health — in a proportion well beyond healthcare.
We can see evidence beyond green shoots that the topic of SDoH has reached mainstream adoption; some significant programs are,
- 14 health systems coming together to form the Healthcare Anchor Network to fund $700 million toward social determinants to reduce economic, racial and environmental disparities that negatively impact community health
- Kaiser Permanente investing $200 million to address homelessness along with the organization’s Thrive Local initiative to link social services to people in the community who need them
- UnitedHealthcare addressing affordable housing through a $400 million investment, thus far, which also bundles in on-site health care services
- Geisinger’s Food Farmacy attending to nutrition security and food-as-medicine building the evidence in the field for noncommunicable disease management
- Loneliness is increasingly recognized as an impactful influence on positive health outcomes, having found that social isolation can increase the risk of premature death by 50%. To address this challenge, Medicare Advantage programs from Aetna and Humana are working with Papa which connects “grandchildren on demand” with older people to bolster social connections.
These social determinants are inter-related and multi-factorial: if we have one SDoH risk, we’ll tend to have others, such as low educational attainment and poor job security, which can then lead to food and housing insecurity and eventually social isolation.
Given the root-of-the-root of the SDoH challenges come out of socio-economic status, we truly can’t “Lyft” our way out of this scenario through addressing any one determinant. Ultimately, public policy should and must bake health into all policies, from agriculture and transportation to labor laws and health care access.
Health Populi’s Hot Points: Here’s little Janie in her tutu, about the time Daddy drove us into Detroit around July 30, 1967, to witness the devastation in Detroit and get an up-close idea what his friends would face in rebuilding their businesses, communities and family lives in the coming days, weeks, months, and years.
For Detroit, it’s both a long- and short-time to consider between the years from 1967 to 2019. That’s five decades, from the early Civil Rights Era in the 1960s and founding of Medicare and Medicaid, to the 2000s and implementation of the Affordable Care Act — which had a positive impact of improving peoples’ financial wellness through expanding access to health care.
Health care access is a indeed a necessary part of this equation, but it’s not sufficient. We cannot expect even the most well-intentioned health care stakeholder organizations alone to provide the sole prescription to the epidemic of health disparities and inequities. It will take the village, collaboration across industry silo in local communities, from non-profits to industry to retailers, schools, and faith-based institutions. And solving this across the United States will also require a national/Federal commitment to each other as health citizens who own and don’t just rent our health care.