Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why it’s time to improve the social determinants of health

Ira Nash, MD
Policy
May 1, 2015
Share
Tweet
Share

It has been known for a long time that “health care” — all the stuff that we do, prescribe and provide — is a minor determinant of how “healthy” any of us is. Overall health, or more technically, the variability in health outcomes, is much more dependent on the combination of genetics, personal behavior (think smoking and seat belts), environmental factors and socioeconomic status than it is on health care.

I was thinking about that when I read in the New York Times about how some health care provider systems, driven by the need to cut costs, are starting to address some of the non-medical social needs of their patients. These kinds of innovative community-based interventions started to get traction after they were highlighted by an influential profile by Atul Gawande in the New Yorker. Their diffusion has been driven by the expansion of novel payment models that have started to reward providers for reducing utilization of services like ER visits and hospitalizations, the very services that they have traditionally been paid for.

From a society-wide perspective, all this makes perfect sense and is long overdue. No rational person would want to preserve the situation described the county health official quoted in the Times: “We’d pay to amputate a diabetic’s foot, but not for a warm pair of winter boots.” That said, I see at least two big challenges to straightening this all out.

The first problem in ridding “the system” of the perversion of paying for amputations but not boots is that we don’t really have a health care “system.”  We have an unholy mess of independent actors and government agencies without any ability to make it rational from a society-wide perspective. Sure, there are pockets of integration and global oversight, like the Veterans Administration, or state governments, which are responsible for an array of social welfare and health benefits.

But even within these bureaucracies, it is a real challenge even for well-meaning individuals to work across the barriers of separate budget lines and programmatic responsibility. It is not a simple matter (and may even be illegal) to transfer funds from, say, a diabetes clinic to a homeless shelter, even if more services at the latter would improve the health of diabetics.

The action lately has largely been to start to hold health care providers accountable for health outcomes instead of compensating them for the provision of services. In general, I think that is a good thing, but it raises the second challenge: Health care providers may not be any good at providing the non-health care services that people need to be healthy. Why should we expect physician practices and hospitals, which have evolved over decades to become what they are now, to be able to morph into effective social welfare agencies?

Frankly, if I were paying the bills (and let’s not forget that as taxpayers, we are all paying part of it) I’d be inclined to pay us less for care and pay others more to improve the social determinants of health.

Ira Nash is a cardiologist who blogs at Auscultation.

Prev

Why are affordable drugs so expensive?

May 1, 2015 Kevin 0
…
Next

When is it OK to secretly record your doctor?

May 1, 2015 Kevin 13
…

Tagged as: Primary Care

Post navigation

< Previous Post
Why are affordable drugs so expensive?
Next Post >
When is it OK to secretly record your doctor?

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Ira Nash, MD

  • Let’s stop trying to change what doctors do

    Ira Nash, MD
  • Keeping up with the rapid developments in mobile health technology

    Ira Nash, MD
  • Not all doctors are physicians

    Ira Nash, MD

More in Policy

  • How locum tenens work helps physicians and APPs reclaim control

    Brian Sutter
  • Why Medicaid cuts should alarm every doctor

    Ilan Shapiro, MD
  • Why physician voices matter in the fight against anti-LGBTQ+ laws

    BJ Ferguson
  • The silent toll of ICE raids on U.S. patient care

    Carlin Lockwood
  • What Adam Smith would say about America’s for-profit health care

    M. Bennet Broner, PhD
  • The lab behind the lens: Equity begins with diagnosis

    Michael Misialek, MD
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Mastering medical presentations: Elevating your impact

      Harvey Castro, MD, MBA | Physician
    • Why the fear of being forgotten is stronger than the fear of death [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • Why the fear of being forgotten is stronger than the fear of death [PODCAST]

      The Podcast by KevinMD | Podcast
    • How a rainy walk helped an oncologist rediscover joy and bravery

      Dr. Damane Zehra | Physician
    • How inspiration and family stories shape our most meaningful moments

      Arthur Lazarus, MD, MBA | Physician
    • A day in the life of a WHO public health professional in Meghalaya, India

      Dr. Poulami Mazumder | Physician
    • Why women doctors are still mistaken for nurses

      Emma Fenske, DO | Physician
    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Mastering medical presentations: Elevating your impact

      Harvey Castro, MD, MBA | Physician
    • Why the fear of being forgotten is stronger than the fear of death [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • Why the fear of being forgotten is stronger than the fear of death [PODCAST]

      The Podcast by KevinMD | Podcast
    • How a rainy walk helped an oncologist rediscover joy and bravery

      Dr. Damane Zehra | Physician
    • How inspiration and family stories shape our most meaningful moments

      Arthur Lazarus, MD, MBA | Physician
    • A day in the life of a WHO public health professional in Meghalaya, India

      Dr. Poulami Mazumder | Physician
    • Why women doctors are still mistaken for nurses

      Emma Fenske, DO | Physician
    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why it’s time to improve the social determinants of health
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...