by Brian Castrucci John Auerbach: For More, Go Here
Hospitals and health care systems have started to address these social determinants of health through initiatives that buy food, offer temporary housing, or cover transportation costs for high-risk patients.
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.
Efforts To Address Social Needs Are Necessary, But Not Sufficient.
These strategies mitigate the acute social and economic challenges of individual patients, but they do so without implementing long-term fixes. They are often limited to a small segment of the population – those who are in the worst health and have the greatest health care costs. Meanwhile, those patients who do not rank among the “sickest and most expensive” are ignored.
This isn’t about picking one approach over another – we need social and economic interventions at both the community and individual levels. We often discuss health using the metaphor of a stream, with upstream factors bringing downstream effects. Social needs interventions create a middle stream (Exhibit 1). They are further upstream than medical interventions, but not yet far enough. Social needs are the downstream manifestations of the impact of the social determinants 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.
