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Social Determinants

Are CEOs obligated to address social determinants of health?

The second in a two-part series focusing on how chief executives can lead health care organizations in advancing health equity with data and community partnerships.

Tom Sullivan | October 28, 2020

The business case and ROI of incorporating social determinants data and programs into the broader enterprise strategy are often discussed against the feel-good value of doing what’s best for the community or population. But another consideration is whether or not it is actually incumbent upon CEOs to do so?

“The fact of the matter is that we have the obligation to do what we can within our organizations and in our communities,” said Steppe Mette, Senior Vice Chancellor for University of Arkansas for Medical Science Health and CEO, UAMS Medical Center.

To advance social determinants and health equity, CEOs can lead their organization’s efforts to drive change in two areas:

    • Leveraging data to improve health equity
    • Building scalable models and community partnerships to address social determinants of health

This article will examine the need for building scalable models and partnerships for social determinants. The first installment focused on leveraging data to improve health equity.

“The social factors and the structural racism are embedded into our structures and flow into living conditions or social determinants and then flow into risk behaviors, injury, disease and mortality,” said Mandy Cohen, MD, Secretary, North Carolina Department of Health and Human Services. “We’re all having the recognition that health has to be thought about more broadly.”

How social determinants are addressed today
Health Evolution Forum preliminary survey data illustrates how participating health care organizations are approaching the following social determinants of health:

Transportation:

    • Do not currently address – 33%
    • Partner with a community organization – 25%
    • Use a combination of internal programs and external partnerships – 25%
    • Run an internal program or initiative – 17%

Housing:

    • Do not currently address – 25%
    • Partner with a community organization – 42%
    • Use a combination of internal programs and external partnerships – 33%
    • Run an internal program or initiative – 0%

Food insecurity:

    • Do not currently address – 8%
    • Partner with a community organization – 25%
    • Use a combination of internal programs and external partnerships – 58%
    • Run an internal program or initiative – 8%

Collaboration will be key to scaling
ChenMed CEO Chris Chen, MD, explained that his organization identifies crucially underserved areas and has discovered a strong retraction of health care providers within many of those neighborhoods. The opposite is true in wealthy areas as health care facilities and workers are expanding in number.

“We have to figure out how to fix these problems, but you can’t do it if you don’t have any boots on the ground,” Chen said. “Enabling the right people, with proper incentives, to solve non-clinical barriers to health is actually what drives better health.”

That makes partnering with public health, Federally Qualified Health Centers, community-based organizations, faith communities, food banks and others unrelated to health care critical to scaling social determinants.

Tosan Boyo, Senior Vice President of Hospital Operations, John Muir Health, who also recently served as the Chief of Operations for the San Francisco COVID-19 Command Center, said during the center’s work reducing the number of people congregating, improving masking and essentially building an army of contact tracers, relationships with community-based organizations and FQHC’s was critical.

“These are nonprofit organizations that have been building relationships in different parts of San Francisco that have historical ties in the city for years and years,” Boyo said. “They know the communities better than we do and they don’t always have to be tied to health.”

Mette added that establishing scalable and workable social determinants programs or solutions for organizations is not enough without forging partnerships.  

“We can’t be focused on the walls of our clinic, the walls of our hospital,” Cohen said. “The world is becoming larger and more complex and we as leaders in health care need to embrace that complexity and figure out where we want to spend our time and our resources in order to drive the outcomes we all want.”

Next steps
To identify best practices that are already working in some sectors of the industry and then disseminate those broadly, the Health Evolution Forum, consisting of nearly 200 provider, payer and life sciences CEOs, ratified Community Health and Advancing Health Equity Work Groups to address both leveraging data to advance equity and building scalable models and community partnerships to address social determinants of health.

Progress toward the Work Group on social determinants goals will be measured by the organizations adopting evidence-based best practices as well as those forming community partnerships to improve social determinants.

“Fundamental societal inequity issues require a multipronged approach,” Mette said. “But there are pragmatic best practices that can be brought to bear.”

About the Author

Tom Sullivan, EVP & Editor-in-Chief of Digital Content

Tom Sullivan brings more than two decades in editing and journalism experience to Health Evolution. Sullivan most recently served as Editor-in-Chief at HIMSS, leading Healthcare IT News, Health Finance, MobiHealthNews. Prior to HIMSS Media, Sullivan was News Editor of IDG’s InfoWorld, directing a dozen reporters’ coverage for the weekly print publication and daily website.