Social Factors Could Be the X Factor

The delivery of healthcare is not a new problem for the US. There are disparities within care from quality to cost to access. This is typically due to influences such as employment, food security, and housing, otherwise known as the social determinants of health. Many leading health experts and organizations, including the World Health Organization, have stressed how significant these factors are in influencing health outcomes.

The social determinants have been known for quite some time and changes are in the works to buffer their effects. However, Kathleen Noonan, adjunct senior fellow at Penn’s Leonard Davis Institute of Health Economics and CEO of Camden Coalition of Healthcare Providers, explains that the root cause is the disconnected health system. Public health initiatives are not aligned with current healthcare delivery.

Investment in health needs to start where the most community impact can occur.

Public health is the backbone of preventative medicine, offering the most sustainable, cost-efficient form of healthcare delivery. The current fee-for-service model being used for diagnosis and treatment is not incentivizing practitioners to look at the bigger picture of the population’s health, ultimately increasing the total dollar amount spent in healthcare. Rather, investments in health need to start where the most community impact can occur. 

Progress is being made in the form of some important initiatives. The IMPaCT program founded in 2011 by Shreya Kangovi, a senior fellow at Penn’s Leonard Davis Institute of Health Economics and associate professor of medicine at the Perelman School of Medicine, is a prime example. This program, as part of the Penn Center for Community Health Workers, hires from within local communities to provide social support and advocacy services to high-risk patients. Through randomized clinical trials, this program has been shown to reduce hospital days by 65% while improving the quality of care while in-patient. Kangovi’s secret? Looking at the patient holistically.

While this is promising, Dave A. Chokshi, chief population health officer for NYC Health and Hospitals and an attending physician at Bellevue Hospital, warns not to solve one problem by creating another as it is the most vulnerable who will get hurt the most. This goes for both physiological and behavioral health concerns due to how extensively the two intersect. Experts also caution approaching problems with one-size-fits-all solutions. The beauty of communities across the nation is the diversity of populations. With help from lead public health officials, change from the bottom up needs to be inspired to holistically heal and further prevent disease.