Dr Clifford Goodman Discusses How Healthcare Should Address Social Determinants of Health

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If we’re really truly serious about being outcomes oriented in healthcare, we can’t come near accomplishing what we’d like to accomplish without direct intervention with regard to social determinants, explained Clifford Goodman, PhD, senior vice president and director, Center for Comparative Effectiveness Research, The Lewin Group.

Transcript

Social determinants of health have been gaining a lot of attention-how involved do you think healthcare should be in addressing social determinants?

With regard to social determinants of healthcare and outcomes, in particular, it’s about time we’re realizing how important they are. I’ve seen credible estimates saying that social determinants of healthcare outcomes account for perhaps anywhere from 40% to 60% of differences and outcomes. This is not an inconsequential amount, and if we’re really truly serious about being outcomes oriented in healthcare, we can’t come near accomplishing what we’d like to accomplish without direct intervention with regard to those social determinants.

Also, we’re finding out, and to somewhat our chagrin, that the social determinants are many and they are diverse. We’ve got to deal with housing, education, food insecurity, domestic abuse, and on and on and on; lead in the paint and lead in the water. We’re just going to have a ceiling effect. If we don’t address these social determinants of health, there’s just so much we can accomplish. There’s not enough headroom to accomplish what we need until we address social determinants of health. I would expect that integrated delivery networks and other organizations in healthcare that are responsible for longitudinal management of populations are kind of getting queued into this a lot better than others, but we’ve got a lot of work to do.

How ready to get involved with addressing social determinants of health is the US healthcare system?

Some sectors of our healthcare system are more ready than others to address those needs in social determinants. If you are an integrated delivery network, if you have responsibility to manage a population, you have the incentive and you’ve got the perspective to care about social determinants of health.

However, as we all know, our health care system is set in certain ways to manage what we’ve done for decades. Fee-for-service for what doctors do, what hospitals do, what laboratories do, and what pharmaceuticals do. The system is not set up to be sufficiently integrated to breach those silos across these different systems. How do you hook up a traditional healthcare system to housing insecurity or homeless? How do you hook that up to a poor educational system? How do you hook that up to the water system?

We’re not designed to do this. We don’t get paid, we don’t get incentivized to be as broad as we need to be. So, we have a long way to go. There are, again, integrated delivery networks and other groups that care about managing populations have more to say about this, and I hope greater leverage.