Housing, Food, Gun Violence: Providers Seek to Shrink Health Gaps
Original article written by Joseph P. Williams for U.S News
Hospitals and health systems are getting more serious about tackling health disparities tied to social problems.
Awake at 4 a.m. one morning last November, Felicia Silva of Albuquerque, New Mexico, assumed the dull ache in her left shoulder was a cramp – or maybe she'd slept on it wrong. She pushed through the pain and went to work, but her colleagues, seeing her disorientation and hearing her stutter, urged her to get medical help. Hours later, Silva found herself at Presbyterian Rust Medical Center in nearby Rio Rancho, diagnosed with a minor stroke and admitted for treatment.
She didn't realize it at the time, but Silva had benefited from a growing movement in medical care that considers patients' access to healthy food and stable housing and relief from financial stress to be as important to address as their blood pressure, heart rate and the images from an MRI. Hospitals, health systems and federally subsidized clinics are increasingly focused on the "social health" of patients – external factors, called social determinants of health, that have short- and long-term impacts on their physical well-being.
"Trying to help patients address their social needs is really an important emerging issue for health care managers," says Amanda Brewster, assistant professor of health policy and management at the University of California–Berkeley. "We've really seen increased attention to this topic for the past five or 10 years. And there's quite a lot of research going on across the U.S. to try to figure out what are the best ways of doing this."
At the same time, more systems are creating C-suite positions focused on achieving health equity. Rush University Medical Center, Mass General Brigham, CommonSpirit Health and Nationwide Children's Hospital, among others, have all added equity officers. The 174-year-old American Medical Association hired its first chief health equity officer in 2019: Dr. Aletha Maybank, who previously directed the Center for Health Equity within New York City's public health department.
A 2020 report published in Health Affairs indicates that 57 health systems nationwide had spent some $2.5 billion on programs addressing social determinants of health. While the lion's share of that sum has gone to housing, other programs address issues ranging from food insecurity to transportation and job training.
Types of Support
In Toledo, Ohio, for example, ProMedica chipped in $11.5 million to Ebeid Neighborhood Promise, a $50 million neighborhood development project focused in part on health, education, jobs, family stability and social and educational services.
Using a "credible messenger" to make a bedside visit – "someone from their community, that's gone through what they've gone through, who's been injured before, been in that bed," Evans says – the hospital looks to redirect the patient away from violence, offering a range of services to help with everything from battling the effects of poverty to education and job training.
Partnerships with other organizations are key to hospitals' ability to improve patients' situations, Brewster says; the medical community can't solve the problem alone. "It does take a village, if you will," agrees Barbara Petee, chief advocacy and government relations officer at ProMedica and executive director of the Root Cause Coalition, a nonprofit organization that links the health care industry with community groups to share ideas and best practices and partner to address socially-driven health disparities.