Social Determinants of Health (SDoH) are all the rage, we see it discussed by hospitals, physicians, IT companies, health plans, academia, community non-profits, government, and the list goes on and on. It’s amazing how rapidly addressing SDoH has sprung up as “the solution”, and it may in fact be. But before we get too excited we need to consider that approaches to solve SDoH need to be operationalized and who does what, how the approaches are overseen, and accountability will make or break the outcomes.
The current behavior of the majority of sectors reminds me of a kid’s soccer game. If you’ve ever watched one you’ve no doubt seen a mass of children tightly arranged around the ball, each one trying to kick it, while 98% of the field is wide open.
Effective teams spread out, each one playing their role, in their assigned space while being held accountable.
If we’re not careful, our current efforts to address the Social Determinants of Health in each of our communities will experience the same thing, a promising approach will be replaced by the next healthcare shiny object; not because the concept was wrong, but because the execution was flawed.
So how should these efforts be organized, who should be in charge and who should be accountable for what? Here’s an interesting photo to ponder as an example, it’s used quite often in presentations about obesity, behavior change and in just a few instances, Social Determinants of Health.
Audience – “Ha ha, that’s the lazy American, just look at them driving and walking the dog, they are the source of our obesity problem. We need behavior change. They need to get out of that car and walk.”
And in response to the clamor, in rushes our current healthcare system “get out of our way, we have come to solve the obesity problem, we are going to do it by addressing the new-fangled shiny object, Social Determinants of Health.”
And the overall system say’s “fine, let’s hold the hospitals and doctors accountable for the obesity problem by establishing quality measures and value-based reimbursement and penalize them when their patients are overweight, or our health measures don’t improve.”
And run towards the problem we all go.
But, perhaps the healthcare system shouldn’t run in so fast or forcefully to the ball, perhaps the healthcare system shouldn’t be the one to kick it at all.
A better response might be “Wait are you/we sure? Can we really fix this? I don’t see any sidewalks? Is the neighborhood safe?” Or the myriad of other issues associated with Social Determinants of Health.
As Bones, Doctor McCoy might say, “ Dammit Jim, I’m a Doctor, not a sidewalk builder, engineer, grocer, community non-profit, housing authority or police officer.”
And if it’s not the healthcare system that can solve these problems, perhaps, someone else should lead these effort’s, resulting in the healthcare system focusing on their unique and needed areas of expertise. Playing their role on the field as a team member.
To solve the SDoH, the most critical role the healthcare system should be addressing is the oft forgotten Triple Aim concept of “lowering the costs of healthcare”. It’s estimated that 30% or maybe more of healthcare is waste, unnecessary, fraud etc., that’s a meager trillion dollars that we could and need to free up to provide funds to the groups building the sidewalks, opening grocery stores, creating safe neighborhoods, improving education and the rest of the issues we know so well. Addressing the SDoH should not require new funds, the money is there already, it just needs to be released.
And when it comes to focus and accountability, I’m not just picking on the healthcare system. Those in government, non-profits, IT etc., need to play a role, by working in their unique space, on the field. And in that role, they too need to be held accountable. Just as the healthcare system has waste that needs to be freed up or eliminated, many community organizations and government players have been working for years in their communities yet the statistics on health status are no better or getting worse. What benefit has the community gotten from those services? And in the IT world many companies have promised interoperability, increased efficiency, improved outcomes, yet we still haven’t seen it. Unfortunately, the list of poorly executed systems crosses all players.
It’s time to organize a broad-based coalition, not led by the healthcare system, but led by the community with the healthcare system at the table (and not the biggest vote either), each sector bringing their expertise, playing their position and being held accountable. If we all run to kick the ball, try to be the coach, go after that shiny object called Social Determinants of Health, we’ll end up right where we are; just older, having squandered another goal scoring opportunity.