Congress needs to act on the social determinants of health
There’s plenty of gridlock in Washington — not just between parties, but more recently even within parties — that makes it tough to do any real governing. So when an issue arises with bipartisan support, especially on a topic that’s so important and politically-charged as healthcare, lawmakers are implored to act.
The Social Determinants Accelerator Act of 2021 (HR 2503) is a bipartisan piece of legislation introduced in the House by Reps. Cheri Bustos (D-Ill.), Tom Cole (R-Okla.), Jim McGovern (D-Mass.), and Markwayne Mullin (R-Okla.) and co-sponsored by more than 40 of their colleagues. There’s good reason why support of this bill transcends party politics, and the most glaring is the indisputable evidence we’ve seen over the past 18 months about how the healthcare crisis caused by the pandemic has so negatively and disproportionally impacted people and communities with high social risk.
This isn’t just good policy because helping people is the right thing to do. It also makes good fiscal sense. If you look across the globe, there’s a common thread between most countries that have been able to control healthcare costs: They focus on the whole person by integrating health and social programs together.
It’s time for the U.S. to take greater steps towards this comprehensive approach too. We’ve tried in the past, as recently as 2019 when similar “Social Determinants Accelerator” bills were introduced in the House and Senate, but only withered away into obscurity. This time needs to be different.
For years, we’ve seen specific and ample evidence that social factors can impact up to 80 percent of health outcomes. To say that another way, the decisions you make with your doctor, care you get from a medical professional, or drugs you take only influence about one-fifth of your total health. With national healthcare costs creeping to nearly 20 percent of GDP, it’s foolish to not place a more concerted effort on the social factors that play such a big role in keeping people healthy (or unhealthy) and how they impact costs.
What are ‘social determinants’?
Social determinants of health (SDOH) refer to socioeconomic conditions such as housing, food, transportation, finances and health literacy that can impact the health and wellbeing of a community and the people in it. For an example of how these factors intertwine to influence healthcare costs and health outcomes so heavily, consider the 34 million Americans living with diabetes. Health literacy is a very important factor to controlling this complex disease and allowing people to live their fullest and healthiest lives. But even if a person knows how to manage insulin dosing, exercise and eat healthy, are they able to? Can they afford insulin and healthy food? Do they live close enough to a pharmacy and healthy food options? If not, do they have reliable transportation to get there?
These are all real issues that together are part of the reason why America spends $327 billion a year — or one in every seven healthcare dollars — treating diabetes and its complications.
As a physician, I’ve seen the challenges related to SDOH firsthand and experienced how difficult it is to care for a person with an obstructed view into all the barriers that truly impact their health and wellbeing.
Something clicked seven years ago when I was talking to my mother, a social worker who ran a non-profit for 32 years in southwestern Virginia that included Meals on Wheels. It struck me that the information social workers have about the people they’re trying to help, when compared to a family physician, is far superior. Meals on Wheels, for example, can see if people are socially isolated, what’s in the fridge, or how close the nearest grocery store is. This information truly matters, and understanding it can be much more impactful than a doctor writing a prescription or telling someone to eat healthy without a comprehensive understanding of what else is going on in their life.
The gap between healthcare and social care is exactly what the Social Determinants Accelerator Act is designed to address. It instructs the Secretary of Health and Human Services (HHS) and Administrator of the Centers for Medicare and Medicaid Services (CMS) to establish an interagency, technical advisory council with representatives from the departments of labor, agriculture, education, transportation, housing and urban development and other federal agencies.
At its core, the Social Determinants Accelerator Act is about information and data sharing, and that’s exactly where we need to focus to begin creating positive change at scale. We need data and analytics to identify where social risk exists — and quantify the impact it’s having on people and communities. These insights enable organizations to strategically intervene by fine tuning existing programs or creating new ones for sustainable and measurable outcomes.
The Social Determinants Accelerator Act would take a step in this direction, providing grants and targeted technical assistance for communities to create innovative, evidence-based approaches that coordinate health and social services. It would encourage improvements in cross-sector information exchange for greater coordination and accountability. And it would empower the inter-agency council to identify best practices and facilitate a national dialogue around barriers to success.
The budget for this legislation is $25 million per year between 2022 and 2026. When you consider that the U.S. spends $3.8 trillion each year on healthcare, the budget for this much-needed project is certainly not that big — but the stakes definitely are.
The pandemic was a clarion wakeup call that demonstrated the inextricable link between healthcare and social care. In order to improve health and wellbeing in our communities while reducing the total cost of care, it’s imperative that we understand that link better. We need to act now.
Trenor Williams, MD, is a family physician, entrepreneur, former health system executive and consulting leader, and founder and CEO at Socially Determined, a technology company for organizations committed to addressing the social determinants of health.
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