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The Essential Facts of Life Are the Foundation of Health
February 19, 2018

The Essential Facts of Life Are the Foundation of Health

Dr Sharp is an emergency physician at Kaiser Permanente’s Los Angeles Medical Center and a research scientist at the Research and Evaluation Department. He is a former Robert Wood Johnson Clinical Scholar and his work aims to improve the effectiveness and affordability of healthcare by embedding research methods and rigor into care improvement efforts. His research has identified gaps in healthcare quality and has described the impact of quality improvement interventions designed to narrow those quality gaps. Dr Sharp’s work has improved antibiotic stewardship, emergent care of ischemic stroke, appropriate use of diagnostic CT imaging and the acute evaluation of chest pain. He is also currently working to identify and address social determinants of health within the healthcare delivery system.
Hurricanes, earthquakes, fires and other natural disasters can leave a trail of destruction, and they can illuminate underlying problems that previously existed. Puerto Rico offers an example of how Hurricane Maria has elucidated significant predicaments that existed before the hurricane with the island’s power utility infrastructure.

Puerto Rico has been a territory of the United States since the Treaty of Paris in 1899 and Puerto Ricans are citizens of the United States, yet months after Hurricane Maria, nearly half of the people of Puerto Rico are still without power. In the same way Puerto Rico can learn and grow from the issues brought to light after the recent hurricanes, the US health system needs to learn from the current “disaster” of high costs, political discord, and disparities in healthcare quality that currently exist. We suggest that in both cases, basic human needs, like food, water and shelter should be re-prioritized toward the top of the agenda.

Henry David Thoreau taught a core truth that can inform efforts to improve our health and well-being. Whether after a hurricane or as we look to reform our health system, fronting the essential facts of life (food, water, and shelter) should be the foundation to build upon.

During a recent humanitarian mission to Puerto Rico, my companions and I worked to repair roofs, and provide solar-powered lights and water filters. As an emergency physician, my education and training were of little benefit to the group (since, fortunately, nobody fell from a roof). However, it was abundantly clear that our goal to help rebuild roofs and provide light and water were for more important to the health of those we visited than any medicines or healthcare I could have offered. To improve health, the essentials of food, housing, and water must be available and should be prioritized over medications, surgeries, and therapies, because without the basic necessities the medical treatments will have little benefit.  

The National Academy of Medicine, and other healthcare organizations1 are beginning to recognize that healthcare and basic social needs cannot be separated. Many are now emphasizing the importance of identifying and addressing the medical and nonmedical factors impacting health simultaneously as a standard part of care delivery. Historically, county health systems and other government, religious, and community organizations have been the ones focused on assisting individuals and communities with food, shelter, utilities, and other basic needs.

Though social workers and case managers have, in many instances, provided herculean efforts to help many people in the healthcare setting, these efforts have been low priorities for the overall organization, largely haphazard and poorly coordinated. Why is it we don’t know which of our diabetics are food insecure? Which of our “high-utilizing” patients have no power or utilities in their home? Are 30-day hospital readmissions more closely linked to a lack of transportation for follow-up than a patient’s clinical status?

Emergency departments (ED) are frequently the entry point to healthcare for the disadvantaged and the primary reason for many patient’s visits has much more to do with their social circumstances than their medical needs. It’s ironic when the public is shocked and surprised when hospitals don’t feed, clothe, and house patients without identifiable medical problems. The broadly disseminated, unfortunate circumstances of a woman in need of the “essential facts of life” in Maryland recently is a case example.2 She was released from a Baltimore hospital into the cold with only a hospital gown, and the event was captured by a passerby leading to public outcry. The response of readers and the public illustrates the expectation most people have that health systems address the nonmedical needs of those seeking healthcare.



 
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