Hospitals are breaking down barriers to address social determinants

Dr. Jay Bhatt, senior vice president and chief medical officer of the American Hospital Association, was a guest at the Blue Cross Blue Shield Association’s "Health Huddle" at the 2019 Aspen Ideas: Health festival, exploring how a community’s social conditions can affect health and quality of life long before hospital or medical care is needed.

Dr. Bhatt spoke recently with BCBS ProgressHealth, sharing more about how hospitals are going beyond their walls to address barriers to better health.

Q. How do social determinants impact individual and community health? Why is it so important to address them?

We need to start with distinguishing social determinants from social risks and systemic issues, such as those pertaining to health equity. Social determinants are the underlying structural, social and economic conditions – such as food, housing or transportation insecurity or social isolation – that influence the health outcomes of patients. Social risks are an individual’s nonmedical needs – such as lack of stable housing or homelessness, limited access to healthy food, insufficient transportation options or an unsafe environment – that affect anyone in the community served by a hospital and impact an individual’s ability to stay healthy and recover from illness. 

Social determinants require working upstream to implement systemic, policy and environmental changes. It’s important for hospitals and health systems to help address social determinants and social, or nonmedical, risks. This requires cross-sector partnerships and collective action as well as approaches that broadly affect where people live, work and play.

Q. What role do hospitals play? How can a brick and mortar hospital reach beyond its traditional walls to tackle barriers to better health?

Addressing social determinants of health requires hospitals to develop sustainable community partnerships that are meaningful and supported. Under our present system, just doing our best or working harder isn't enough. We need new ideas and bold approaches to improve people’s lives and health by improving their communities. For example, through the American Hospital Association’s Institute for Diversity and Health Equity and the Hospital Community Cooperative (HCC), we’re making it easier for hospitals and community organizations to develop and lead interventions that reduce health care disparities and promote health equity among the populations we serve. It involves local people working together to transform the conditions and outcomes that matter to their community.

Q. What are some examples?

Here are some ways that hospitals are addressing social risks:

• Addressing food insecurity and poor diet by developing food pharmacies to help meet the needs of patients and forming community partnerships to create urban gardens and food pantries.
   
• Partnering with ride-share services to increase access to health services.
   
• Deploying financial and human resources to improve local economies, for example, by hiring and buying locally or investing in affordable and supportive housing projects.  
   
• Partnering with other hospitals in the area, community development, financial organizations and education partners to help jumpstart small businesses that impact economic mobility and health outcomes.

Q. These problems have been growing for some time and are complex. How long do you think it will take to see some significant results from these efforts?

Hospitals and health systems are making significant progress as more evidence demonstrates the impact of interventions, improved outcomes for patients and a return on investment.

In our HCC, hospitals and health systems serving as anchor organizations are making advancements in their community that, ultimately, lead to reducing health disparities. For example, CHRISTUS St. Vincent Health System, in Santa Fe, N.M., is providing housing for women who are 55 and older or who are medically fragile and experiencing homelessness after the closure of a shelter. The long-term goal is to replicate and expand the program to address homelessness across the region. Additionally, the hospital has a partnership with the mayor’s office to address social determinants. UChicago Medicine is building a collaborative network of social service organizations, called the Social Service Alignment Learning Collaborative (SSALC), to effectively gather data and coordinate services for vulnerable populations experiencing 10 or more unmet social needs. The HCC online resource hub provides expert advice and tools for hospitals and communities to identify, develop and deploy partnerships that address social factors most important to their communities. More examples of efforts to address barriers to better health and the impact can be found here.

We are learning and providing new, bold pathways and approaches to address these health issues. Given that there is ripening of the environment and increasing recognition of the need to address health, progress will continue. We can already see some impacts in the short term, and others will take longer to come to fruition.

Q. Where do you see this focus on social determinants moving in the future? How will these efforts continue to shape health care?

I imagine a future where hospitals and health systems share responsibility with community and cross-sector partners in addressing social determinants and social risks. This means all are working together to break down silos, consolidate and organize resources for collective action,  identify evidence-based strategies and share best practices to bring those strategies to scale. These approaches will help begin to cohesively achieve health equity, creating communities where health care disparities are greatly reduced or no longer exist and everyone has an opportunity to be healthy.