Policy and Practice April 2019

from our partners By Brian Castrucci and John Auerbach

Meeting Individual Social Needs Falls Short of Addressing Social Determinants of Health

U ntil recently, efforts to improve the health of Americans have focused on expanding access to quality medical care. Yet there is a growing recognition that medical care alone cannot address what actually makes us sick. Increasing health care costs and worsening life expectancy are the results of a frayed social safety net, economic and housing instability, racism and other forms of discrimination, educational dispari- ties, inadequate nutrition, and risks within the physical environment. These factors affect our health long before the health care system ever gets involved. Hospitals and health care systems have started to address these social determinants of health through initia- tives that buy food, offer temporary housing, or cover transportation costs for high-risk patients. The prevalence

and initial success of these efforts are clear in headlines such as: “What Montefiore’s 300% ROI from Social Determinants Investments Means for the Future of Other Hospitals,” 1 “Social Determinants of Health Gain Traction as UnitedHealthcare and Intermountain Build New Programs” 2 and “How Addressing Social Determinants of Health Cuts Healthcare Costs.” 3 But when you take a closer look, these articles aren’t about improving the underlying social and economic conditions in communities to foster improved health for all—they’re about mediating patients’ individual social needs. If this is what addressing the social determinants of health has come to mean, not only has the definition changed, but it has changed in ways that may impede efforts to address those conditions that impact the overall health of our country.

In 2008, the World Health Organization’s Commission on the Social Determinants of Health defined those determinants 4 as the “conditions in which people are born, grow, live, work, and age” and “the fundamental drivers of these conditions.” This term prioritizes a broad, community- wide focus on the underlying social and economic conditions in which people live, rather than the immediate needs of any one individual. While health care leaders have realized that programs to buy food, offer temporary housing, or cover ridesharing programs are less expensive than providing repeat health care services for their highest cost patients, such patient-cen- tered assistance does not improve the underlying social and economic factors that affect the health of everyone in a community. While targeted, small-scale social interventions provide invaluable

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