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It’s always been a challenge for the health care system that much of what affects a person’s health happens outside the doctor’s office—and beyond the reach of even the most attentive physician.
Those hard-to-manage factors are many, from behavioral ones (a person’s eating, exercise habits) to socially-determined ones (like whether the individual has access to fresh, healthy food, a walkable neighborhood, or a safe home) to matters of mental health. And they can be costly, both in terms of their human toll and in terms of health care dollars that go towards managing chronic disease, which accounts for the vast majority of America’s health care spending.
“As a physician you might have the best hospital set-up, or healthcare set-up, or outpatient practice set-up, but if your patients are facing what seem to be these insurmountable social challenges sometimes it can be paralyzing,” said Kate Mascitti, an infectious disease specialist based in Bethlehem, Penn. with the St. Luke’s University Health Network. “How can I fix this diabetic foot ulcer infection if my patient weighs 400 pounds and they can’t afford their insulin, and they have no one to help care for them at home? It’s challenging.”
How can health systems better care for patients given these challenges and the social disparities that underlie many health problems? Mascitti, along with several other expert panelists speaking at a Fortune virtual event on what it takes to reinvent hospitals offered four starting points.
Measurement
How well do we measure health outside the hospital and the factors (or social determinants of health, as they’ve often called) that drive population health?
“We have an abundance of data. We have no agreement on which data set to use,” said Georges Benjamin, executive director of the American Public Health Association. “We could start with a small meaningful subset of data and grow it over time to make sure it’s uniform so we’re all looking at the same numbers and interpreting it the same way.”
Mascitti thinks more pointed data measurement on social determinants of health would make addressing them more of a focus for health systems: “Just shining a spotlight on it, making it a measure of quality—then I think people are able to focus on it, do research around it.”
Engaging the broader community
“In order to really improve the health and wellbeing of whole community, you have to engage a range of other actors who don’t necessarily see health as their primary level responsibility,” said Benjamin, who mentioned that includes school boards as well local business, housing, and transportation communities. He points to the number of school-age children who were unable to participate in virtual school this spring—something that experts say is a development and health-bearing issue—because they lack access to broadband internet. Finding solutions requires a partnership across multiple sectors.
To make such partnerships happen, he encourages health care providers to show up as “unanticipated messengers” to meetings and policy-making settings where they may not be expected to influence conversation and make health a focus for the broader community.
“If you really want to deal with lead exposure in kids, you have to show up at zoning hearings, at meetings of the real estate board. You have to show up to places where the law not being enforced,” said Benjamin.
Creative, out-of-the-hospital solutions
To provide free dental care, vision checks and eye glass fittings to kids who needed them, Mascitti’s employer—St. Luke’s University Health Network—sends mobile health vans to schools. During the COVID-19 outbreak as patients missed critical visits to their doctors for fear of catching the coronavirus, the system, like many others, turned to telemedicine. But, inspired by the success of its drive-through COVID testing operation, it also decided to offer drive-through vaccinations to ensure COVID concerns didn’t keep parents from immunizing their children, says Mascitti, who added that thinking more creatively about how to serve the population is key to addressing some of the out-of-the-hospital health challenges.
Building trust by better reflecting the communities serves
As the pandemic has made clear, it’s hard to deliver good, effective, and equal health care when the patient doesn’t trust the provider, the system, or science in general. Whether due to the day’s politics, historical wrongs and inequalities, or just the complicated, non-transparent ways of American health care, distrust in the system is often exacerbated by the fact that providers are often not representative of the populations they’re serving.
“Our nation has been struggling to increase the number of African-American and Hispanic physicians in our society. No matter what we do, the rug keeps getting pulled from under those efforts,” said Benjamin, who added that aside from prioritizing those initiatives, an effort should be made to train all physicians to be more “culturally competent.”
Kyu Rhee, chief health officer for IBM agreed. “This issue of communication and trust, cultural competency is so essential and foundational to everything in health,” he noted, adding that from his own experience as a physician, team members who reflect the community often play an important trust-brokering role.
Adrienne Kennedy, a board member of the National Alliance on Mental Illness (NAMI), explained the organization was very intentional about representation for that reason.
“We have young people speaking out about the emergence of their own mental health issues. We want to make sure they are culturally competent,” she said. “If they’re going to a Black or brown community, that they are Black or brown themselves with that kind of range of understanding [is important].”
She noted it’s also important to think about community representation when the health care system is devising solutions for populations. “It’s so important to have the lived experience voices involved in the mix,” she said. “What people will offer once they get engaged—this trust factor is so important.”
