Social Determinants Of Health & Medical Homes

Executive Briefing | by | March 28, 2014

Monica E. Oss
Monica E. Oss

As we were wrapping up our research on the unique health issues and recidivism issues of the justice-involved population (see A New Opportunity To Serve Justice-Involved Consumers and The ROI Of Recidivism Prevention), I received a notice about a new report from the Institute of Medicine (IoM), Applying a Health Lens to Decision Making in Non-Health Sectors.  After reading the report, I was struck by the implications for (and affirmation of) the need for behaviorally-focused medical homes for some consumer groups – whether individuals with cognitive disorders, with multiple chronic conditions, or unique social needs.

The report’s theme was reflected in one quote from David Williams, Harvard’s Florence and Laura Norman Professor of Public Health, on September 19, 2013, at the IoM Roundtable on Population Health Improvement.  He said:

Health is largely determined by factors situated outside of the health care delivery System. The health care system generally functions to provide care to those who have become sick. Yet, it is where people live, learn, work, play, and worship that most influences their opportunities and chances for being healthy. Social policies can make it easier or harder for people to make healthy choices.

The report discusses the many factors that are determinants of health – housing, family structure, violence, education, and income. But what struck me about those factors was the importance of “place” in determining an individual’s health status.  Place determines level of pollution and environmental risk, water quality, access to transportation, accessibility to healthy food, the ability to get exercise safely, and much more.

The way to address these determinants? The report recommendations – with its emphasis on “health in all policies” – focused on five long-term policy approaches:

  1. Building the perspective of health into all policy making.
  2. Including an explicit focus on health equity in policy making.
  3. Convening, enabling, and supporting cross-sectoral collaborations.
  4. Developing consensus-based standard data and methods for surveillance systems linking health, health equity, and the determinants of health.
  5. Investing in strengthening community capacity and potential for community advocacy.

But, while we’re waiting for the slow wheels of policy change to turn, I was struck by the implications for emerging medical home models – particularly the medical homes serving the 5% of the population using 50% of the health care resources (see 5% of U.S. Residents Use 50% of Medical Resources and Five Percent of Americans Responsible for Half of U.S. Health Spending).  The report called for cross-sector collaboration at the community level – and gave some great examples, including Every Body Walk!, Convergence Partnership, and Valley Hi HEAL (Healthy, Eating, Active Living) Zone.

By design or by default, cross-sector collaboration at the individual level is becoming the role of the medical home – helping individuals address the issue of variability in their own social framework for health.  This is even more evidence that medical homes for a select group of individuals need equal parts of expertise in health care, behavioral health, and community services.



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