Former state Senator Kemp Hannon and a panel of highly credentialed physicians have launched Hofstra’s State of H.O.P.E. series, an insightful survey on the impact of the social determinants of health in clinical and policy settings.
An acronym for Healthcare Opportunities and Policy Exchange, State of H.O.P.E. is sponsored by Hofstra’s School of Health Professions and Human Services. Hannon, who is also a Health Policy Fellow at Hofstra, said the conversation over the last decade has shifted, and is now focused on managed care, nursing homes, health centers, and community-based organizations. How do they best create a network that improves patient care?
“If we were talking about health 10 years ago,” Hannon said, “we might have been opening up a lecture on how to better fee-for-service, how to better bill… we’ve moved light years from there, but we’re not landed yet.”
The Social Vulnerability Index
“If you happen to live in the south side of Cook County, Chicago your longevity would be 69 years old,” says Dr. Ram Raju, MD, Senior Vice President and Community Health Investment Officer, Northwell Health. “If you go to the north side of Cook County Chicago your longevity is 81 years old. So, 12 years you get just by crossing over the Chicago River.”
After 19 years of studying the demographics of longevity disparity across the country Dr. Raju found: “We spend less and less on social services and more and more on healthcare… we figured out that we have only worked on the systems and the best treatment. We did not care about [the environment] where [patients] go back… you treat asthma with the best medication then you send them back to the same apartment which produces asthma in the first place because of mold and rodents.” Instead, Dr. Raju argues we should think of patients as seeds and their environment – the social determinants in their lives – as the soil around them. The health of a seed is compromised when placed in soil depleted of nutrients.
Northwell Health is piloting a social vulnerability index to quantify and align social risks with health risks. “Northwell collects the data on a 15-question questionnaire about social issues. We put that through an algorithm and then it assigns a code, 1 to 10… it basically picks up your social issues and then refers you to the community-based organizations and other government agencies,” Dr. Raju explained.
Deja Vu All Over Again
Before he was Executive Vice President and Chief Clinical Officer for Catholic Health Services of Long Island, Dr. Patrick O’Shaughnessy, MD, worked in emergency rooms throughout Long Island, Queens, and Manhattan. “You see the same things over and over again,” he said. “I realized the overarching majority of what led people to the emergency room were driven by the social determinants of health: did they have enough food… access to housing, were they able to even afford and take their medications… public policy influences healthcare outcomes. We’re approaching 20% of the GDP. It’s not sustainable. But if you’re going to bend the cost curve, you have to bend the disease curve… you have to get upstream of it [and] begin to influence the things that drive chronic disease burden.”
Echoing Dr. Raju, Dr. O’Shaughnessy pointed out that only ten percent of premature death and disease burden is driven by healthcare and acute care, compared to the 60% driven by social determinants.
“Public policy does make an impact. Look at smoking and tobacco use. Look at the issues we had with disease burden relative to that from the 40s and 50s to today,” Dr. O’Shaunghnessy said. “We made tremendous impacts because of public policy to smoking cessation, taxation for cigarettes, smoke free zones, all these things that drive behavior that led to reductions in overall smoking.”
“We should do more things like paying for annual wellness visits” to catch diseases early, which reduces costs overall, he said.
Holly Seirup, Dean of the School of Health Professions, said the State of H.O.P.E. series is aimed at creating a continuing dialogue about the region’s health care challenges.
“Our State of H.O.P.E. program is the first in a series of events designed to bring together health leaders to debate these issues,” Seirup said. . “From wellness visits, to proposed legislation and dealing with food deserts, the panel offered many suggestions for dealing with the social determinants of health. It truly was a lively conversation.” Listen to the full conversation on social determinants of health and the panel’s recommendations for better healthcare.