Healthcare leaders urge full court press on social determinants of health
DETROIT—Healthcare organizations must go beyond pilot programs to truly meet the social needs of vulnerable patients, said leaders speaking Dec. 3 at Modern Healthcare’s Critical Connections: Social Determinants of Health Symposium.
“We keep bailing the boat out with a bucket, but sooner or later we’re going to sink,” said Brian Castrucci, CEO of the de Beaumont Foundation, a not-for-profit that along with Kaiser Permanente in 2017 established a program to help cities implement evidence-based policies to improve the health of their residents.
“Whatever we’re doing is not enough,” said Wright Lassiter III, president and CEO of Detroit-based Henry Ford Health System who served as opening keynote speaker. “If you serve a vulnerable community as many of us do, the reality is that community is not as healthy as it needs to be.”
Castrucci said policy changes would benefit providers, whom he believes were unfairly “conned” to take on social needs as a result of the U.S. underfunding social service programs.
Renee Branch Canady, CEO of the Michigan Public Health Institute, said the country’s capitalist model hinders traction on public health. “We must define public health as those things that a society accomplishes together for its citizenship,” she said.
Lassiter pointed to Henry Ford’s initiative to reduce the rate of infant mortality in Detroit. In 2017, more than 15 out of every 1,000 African-American babies born died. That rate was more than two times what the state experienced.
So, Henry Ford and three other local health systems launched the Women-Inspired Neighborhood Network, which connects at-risk mothers with community health workers and access to prenatal and postnatal care services. The program has seen huge success, with just one death reported since the beginning of September.
The health system has since gone upstream to help increase wealth in one of the nation’s poorest big cities. It created apprenticeship and job training programs and changed hiring requirements by no longer asking applicants about prior felony convictions.
Roy Wilson, president of Wayne State University, pointed to the success of the school’s no-debt degrees for eligible Detroit high school graduates. To date, 117 people have enrolled in the program.
But these initiatives are the exception. Dr. Kimberlydawn Wisdom, Henry Ford’s chief wellness and diversity officer, cited an often-fraught relationship between healthcare professionals.
“Medicine and public health need marriage counseling,” she said. “There’s a clash of the cultures, it’s messy and complicated when they work together but also amazingly rewarding when you can get them to collaborate.”
Dr. Georges Benjamin, executive director of the American Public Health Association, urged hospital leaders to advocate for policy change.
“Health systems need to show up at a housing hearing, a zoning hearing for liquor stores,” he said. “If you don’t show up, you’re going to continue to spend millions and millions of dollars to fix things that were clearly preventable.”
“If you serve a vulnerable community as many of us do, the reality is that community is not as healthy as it needs to be.”
Wright Lassiter III President and CEO Henry Ford Health System
CityHealth, the Kaiser/de Beaumont initiative, promotes nine policies to improve community health: earned sick leave; accessible high-quality pre-kindergarten; affordable housing; safe walkable streets; safer alcohol sales; raising the age of tobacco sales to 21; smokefree public spaces; stringent food safety and restaurant inspection ratings; and healthy food procurement.
Census reporting periods are opportunities to work with policymakers on large-scale initiatives, advised Dr. John Jay Shannon, outgoing CEO of Cook County Health in Chicago, one of the country’s largest public health systems.
But any program should be carefully assessed to gauge impact and value.
Toledo, Ohio-based Promedica announced at the conference its investment, along with OSF HealthCare and several other healthcare organizations, in a firm to analyze clinical and demographic data to better design interventions and show the financial impact of those efforts. CEO Randy Oostra said it would help the system “refine, screen and take action.”
Dr. Brian Klausner, chief medical officer for North Carolina-based health system WakeMed Health’s accountable care organization, collects medical data alongside data from jails and homeless shelters to show how underfunding housing and behavioral healthcare services can increase healthcare costs.
Ultimately, however, several speakers agreed that there was one major societal ill that healthcare might not have a say in.
“There will never be a Z code to solve racism,” Castrucci said, referring to an ICD-10 code that represents reasons for healthcare encounters.
“Invariably when you’re talking about social determinants of health, you’re talking about racial disparity and it’s important for all of us to provide a safe space to allow people to think differently,” said Gene Woods, CEO of Atrium Health, in his closing panel discussion. Atrium clinicians are trained to practice that at each of its 14 million patient encounters, he said.
Garth Graham, president of the Aetna Foundation, was hopeful that diversity and inclusion efforts could help stem the impact of institutional racism. “Understanding the lived experience is important to fixing it,” he said. ●
“We must define public health as those things that a society accomplishes together for its citizenship.”
Renee Branch Canady CEO Michigan Public Health Institute