Policy and Practice April 2019

Exhibit 1

community health navigators, it will be challenging, if not impossible, for public health advocates to make the case for proven policies like alcohol sales control, complete streets, and healthy food procurement. Words matter. Common definitions ensure that we understand each other. When health care leaders and public health officials use “social determi- nants of health” to mean different things, it becomes more difficult for us to engage meaningfully with com- munity partners, who will struggle to differentiate between these comple- mentary but different approaches. This may seem like semantics, but when we use this term too broadly, we risk losing the specificity needed when calling on partners to make far-reaching social change, and we weaken our ability to implement the community-level efforts necessary to improve community health. And, ultimately, that doesn’t help any of us get healthier. Published by Project HOPE/Health Affairs by Brian Castrucci and John Auerbach. “Meeting Individual Social Needs Falls Short of Addressing Social Determinants of Health.“ Health Affairs Blog (Millwood), January 16, 2019. The published post is archived and available online at http://bit.ly/2Vohmbs. Reference Notes 1. See http://bit.ly/2UvbAax 2. See http://bit.ly/2FZnP7b 3. See http://bit.ly/2YORY0D 4. See http://bit.ly/2U1Hrf2 5. See http://bit.ly/2uMlvKH 6. See http://bit.ly/2WKQmTC 7. See https://washex.am/2Ie8KAy 8. See http://bit.ly/2YORY0D 9. See http://bit.ly/2YLYPIh 10. See http://bit.ly/2uL7j4i 11. See http://bit.ly/2K6Ihra 12. See http://bit.ly/2G1kPYb 13. See http://bit.ly/2FPAyYY 14. See http://bit.ly/2CX8qT3 15. See http://bit.ly/2I8xOsy 16. See https://www.debeaumont.org 17. See https://about.kaiserpermanente.org Brian Castrucci is CEO of the de Beaumont Foundation. John Auerbach is the President and CEO of Trust for America’s Health.

are often less clear. 18 Redefining the meaning of “social determinants” to be mostly or only about the immediate social needs of expensive patients makes it harder to focus on the systemic changes necessary to address root causes of poor health. Words Matter: For Understanding. For Clarity. For Change. In 2003, David Kindig and Greg Stoddart 19 offered a comprehensive definition of population health. Twelve years later, Kindig expressed concern that the use of the term had grown too broad, writing that it’s “growing use, most notable in the Triple Aim and in clinical settings, has resulted in a conflicting understanding of the term today.” 20 Is the term “social determinants” heading for a similar fate? If we, even inadvertently, imply that the social determinants of health can be solved by offering Uber rides to individual patients or by deploying

upstream than medical interventions, but not yet far enough. Social needs are the downstreammanifestations of the impact of the social determi- nants of health on the community. Improvements in our nation’s health can be achieved only when we have the commitment to move even further upstream to change the community conditions that make people sick. The demand for social needs interventions won’t stop until the true root causes are addressed. This should ring especially true as the movement to Accountable Health Communities and value-based care gains momentum. Any success these new payment structures enjoy will be short-lived if the underlying social conditions in the communities where they work remain unchanged. While the allure of short-term economic gains frommediating patients’ social needs nearly ensures media and stake- holder attention, the incentives to advance policy, legislation, and regula- tion to improve health more broadly

18. See http://bit.ly/2TXGLar 19. See http://bit.ly/2CYR6x5 20. See http://bit.ly/2Vn8Rxj

Graphic courtesy of authors

April 2019   Policy&Practice 27

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