This wasn’t your typical discussion about social determinants of health. Today at Day 2 of this year’s Forbes Healthcare Summit in New York City, one of the sessions bore the title, “Four Solutions to Improving the Social Determinants of Health, Right Here, Right Now.”
Yes, that’s the word “solutions” in the title. Not “problems” or “99 problems” or “yeah, such is life.” Social determinants of health (SDOH) are the “conditions in the places where people live, learn, work, and play” that “affect a wide range of health risks and outcomes,” according to the Centers for Disease Control and Prevention (CDC). It’s been established over and over again that your environmental, social, job, and economic situations can greatly affect your health. In the words of Spandau Ballet, this much is true.
A big problem, though, is how these SDOH issues have been discussed or handled or, rather, not handled to date. Using the voice of Homer Simpson, most of the discussions have been like “d’oh, what do we do about this massive problem?” What do we do about the fact that people of different geographies, different races, different ethnicities, different genders, and different socioeconomic statuses can face very, very different conditions at their homes, their neighborhoods, their workplaces. These in turn can lead to very different health risks and outcomes. For many conferences, meetings, and studies, the conclusions have been “d’oh”, these are big, big problems, let’s break for some coffee and talk about something else.
Well with the title of session including the words “four solutions” and “right here, right now,” there was no waiting in this session for the coffee break. The moderator, Stephen K. Klasko, M.D., M.B.A., President of Thomas Jefferson University and Chief Executive Officer (CEO) of Jefferson Health, jumped right into what the title said, right then. His opening remarks briefly included the following statements:“For way too long, discussing social determinants of health has been an academic exercise,” and “we have always talked about the problems without talking about the solutions,” and “(he was) excited to talk about solutions.”
So, rather than waste any more words, let’s get to the solutions that the panel discussed:
Solution 1: Improve people’s diets and access to healthy food.
There is a saying that “the way to a man’s heart is through his stomach.” Well, change the word “man” in this saying to “person” and add a bunch of other organs to the word “heart.” Since diet can affect so many aspects of health, it’s not surprising that one of the solutions that emerged involved food. Jaewon Ryu, M.D., J.D., the President and CEO of Geisinger Health and a panelist, pointed to Geisinger’s “Fresh Food Pharmacy” program that has been delivering fresh foods to their patients in the community as well as offering cooking lessons and other social support to encourage cooking. He indicated that they have already seen associated decreases in diabetes rates.
The program showed that the way to better primary care may also be through the stomach. “What has been unexpected has been the increase in patient engagement,” Ryu added. He described how there have been subsequent increases in usage of primary care services. As he said, the program gave patients, “the feeling like they have hope in improving their health.”
Another panelist, Jean C. Accius, Ph.D., Senior Vice President of AARP, emphasized that reducing food insecurity can have a “ripple effect,” because areas of food insecurity also have higher levels of diabetes. Indeed, the word “fudge ripple” can have multiple meanings.
Solution 2: Improve the physical environment such as increasing housing options, transportation options, and parks.
Of course, your environment is not like a grocery store. There are other things besides food. Accius mentioned that besides trying to get Klasko to join the AARP, many of AARP efforts have focused on creating more “age-friendly communities.” He emphasized that we need to “think about how to create more livable communities.” That includes, in his words, ensuring “greater housing options and greater transportation options.” Accius mentioned how the AARP has been providing community grants, 159 grants worth about $ 1.6 million dollars, to make such changes. They’ve been funding the construction of fitness parks to get people moving and have helped open 19 parks so far this year. He stated that a goal is to “have an AARP sponsored park in every state.”
Solution 3: Improve access to the Internet.
These days, there’s much talk about the possibility of mobile and Internet-based approaches improving the health of communities. Ah, but there’s one problem with that. Many people still don’t have reliable access to the Internet or are adept at navigating the Internet. Ryu mentioned that many areas covered by Geisinger, “don’t even have broadband.” One of the panelists, Carina Edwards, is the CEO of Quil, a joint venture between Independence Health Group and Comcast NBCUniversal that was founded in 2018. She described how they were offering Internet services to many homes for less than $ 10 a month. “We need to get people connected” and “give people a base level of education,” on how to use and navigate the Internet.
Solution 4: Better understand the needs of individuals and bring care to them.
All of the panelists agreed that healthcare needs to better understand the needs of patients. Not patients as one big glutinous mass, but as a range of different individuals. Edwards warned, “we can’t just assume that everyone is the same,” and talked about how there is a need to better understand individuals, who they are and what they are. Ryu explained how Geisinger covers “wide swathes of geography,” including those that are fairly rural, explaining that “when it is difficult for people to get to care, you have to bring care to the people.”
Panelist Kevin E. Lofton, CEO of CommonSpirit Health, explained that currently healthcare systems “wait until people get sick.” He said that except for birth and plastic surgery, no one wants to come to healthcare. “We need to move upstream when (patients) are consumers. We need to design our system based on what consumers want.” Lofton mentioned how CommonSpirit Health has partnered with the Robert Wood Johnson Foundation to institute a program in which health coaches do home visits to better understand the living situations of patients. He gave an example of health coaches finding that “a man didn’t even have a working refrigerator.”
Solution 5: Integrate health care with retail.
While “Four Solutions” was in the title of the session, the panel did offer a bonus solution, and who doesn’t like an extra bonus. This solution emerged when Klasko asked the panel to “dream about the future” to discuss what may occur over the next decade. Ryu offered the possibility of “healthcare getting together with retail. Integrating retail more with the healthcare system.” An example emerged earlier in the panel conversation when Lofton mentioned how CommonSpirit Health had invested in building a movie theater in a town in the middle of Minnesota that didn’t previously have access to such a venue.
Solution 6: Develop and use technology to bridge the gaps in social determinants.
If you want a bonus-bonus solution, the panel offered: find ways to develop and use technology can overcome current gaps and disparities in SDOH. Edwards mentioned how Quil was trying to facilitate the use of Internet-based technology. The other panelists talked about how technology can help better understand what consumers need and want. Klasko wondered whether drones could be used to delivery food to locations that are food desserts, that don’t currently have access to healthy food.
Solution 7: Re-structure financial incentives to motivate addressing social determinants.
With two extra solutions, why stop there? Klasko and the panel briefly discussed a seventh key solution: re-structuring financial incentives to further motivate the aforementioned. Klasko re-quoted and slightly modified the Upton Sinclair that “it is hard to get someone to do something when their salary depends on them not doing it.” As Ryu said, programs that address social determinants can substantially reduce costs for the payer side.
Solution 8: Changing the focus of healthcare in general.
To conclude the panel, Klasko did offer another quote, this time from former NBA star point guard Jason Kidd: “We’re going to turn this team around 360 degrees.” Kidd wasn’t referring to healthcare but rather a basketball team. Nonetheless, as long as you ignore the specific math of this quote, the idea is the same: the emphasis of healthcare has to turn a completely new direction. After the session, Klasko told me that there is an “urgent need for healthcare to better address social determinants, which is 80% of health. Too long has social determinants been relegated to the end of a meeting or conference. And the conclusion in these meetings has been, we can’t do anything about it.” He said that he was encouraged that social determinants occupied such a prominent part of the Forbes Healthcare Summit program and that actual solutions were being discussed. “At Jefferson, our model is healthcare with no address.”
Certainly, the solutions discussed in the session will not be the only solutions. These alone won’t necessarily eliminate disparities in social determinants. But the session, the discussion, and discussed solutions are a good start. After all, if we want to really address health, the address of healthcare can’t just be hospitals and clinics.