Google “Social Determinants of Health” and one will quickly discover a kind of litany of data pointing to a certain definition of “health” defined by the World Health Organization (WHO) as “A state of complete physical, mental and social well-being not merely the absence of disease or infirmity,” and socioeconomic barriers, which may prohibit equitable access to good health and wellness (Healthcare) more completely among diverse populations.
Nevertheless, the heart of the matter is equitable access to good health and wellness. Meaning healthcare. However, such is not the case. Instead, healthcare is burdened by the very weight of the healthcare inequity both the institutions of healthcare and health policy foster. For as long as healthcare policy has existed within the US inequity in healthcare has existed. In an era of value-based care, which was designed, in part, to quell healthcare inequity there remains pockets of Fee For Service care delivery and ongoing discussions surrounding Block Grant Funding healthcare policy as an alternative to the Patient Protection And Affordable Care Act.
Truth About Social Impact
It was not until healthcare delivery revenue erosion was linked to avoidable hospital readmissions associated with unaddressed Social Determinants did the US healthcare market begin to pivot on this subject, which is to say reimburse for the provision of community-based organization resources, i.e., Federal Government “Social Impact Partnership.” Concerning; the Social Impact Partnership will pay “regardless of whether outcomes have been met.” The $66,290,000 earmarked for the initiative is a drop in the well by comparison to the economic burden of healthcare inequity, which over a three year period extrapolated may generate an estimated at $1.4 Trillion avoidable deficit within the US economy.
While community resources, which serve the at-risk patient population, have long existed it was not until evidence of an ROI or return on investment was firmly linked to addressing SDoH did the US healthcare market initiate significant action towards investment in SDoH solutions. In 2018 “The ROI of Addressing Social Determinants of Health” became the most read article for this online publication during that year for the American Journal for Managed Care. Sitting at the table with company leaders who ultimately published this article I would introduce to them for the first time the idea and need for an SDoH ROI calculator, which was ultimately created. It was clear to me, based on my previous healthcare industry experience the SDoH ROI calculator was arguably the missing link to SDoH SaaS US healthcare market penetration. At that time the founding company leadership team, due to overly limited healthcare market or health economic knowledge were unaware of the value of a healthcare product or service cost-benefit or economic calculator in healthcare.
Motivation Born of Economics and Inequity
The loss of an estimated $17 billion dollars linked to avoidable hospital readmissions year over year is a significant amount of money. Social Determinants of Health avoidable costs were affirmed by more robust observation, which suggested: “Social Determinants of Health represented an estimated $1.7 Trillion opportunity to slash US healthcare spending.” Thus, if one could keep individuals out of the hospital who would otherwise return not for clinical care but rather unmet social needs then overutilization and total cost of care, notwithstanding patient experience, would be markedly transformed. In theory. Hence the modern-day exodus, and the parting of the red sea of status quo, moreover, patient social and clinical care delivery shifted beyond hospital walls.
However, the issue is much more complex. Healthcare, like any business worth its salt, must deliver on its value proposition. Unfortunately, US healthcare fails dismally in this regard notwithstanding measures of progress. The gravest of a contemporary example of inequity, which the world is witnessing in real-time, is within the United States of America during our Coronavirus Pandemic:
“In New York City, the virus is killing black and Latino residents at twice the rate it’s killing white residents. In a report released April 8 by the city, officials revealed that the COVID-19 death rate for Hispanic residents was nearly 23 per 100,000 people, and for black residents, it was 20 per 100,000 people. The death rate for whites and Asians was 10 per 100,000 and 8 per 100,000, respectively.
Chicago’s racial disparity is even higher, with black residents accounting for 72% of the city’s COVID-19 deaths, when blacks make up about 29% of the city’s population, according to NPR. At the state level, Michigan health officials released data on April 2 showing that 40% of the state’s coronavirus-related deaths were black residents, 26% were white residents, 30% were unknown and 4% were “mixed race or other.”
On Sunday, New Mexico Gov. Michelle Lujan Grisham said in an interview that a quarter of the residents who have tested positive for coronavirus are Native American when Native Americans make up 6% of the population. And Maryland’s Department of Health released a report April 9 finding that black residents make up 52% of coronavirus-related deaths, though black residents comprise 31% of the state’s population. Gov. Larry Hogan requested that the department continue to publish all data available on racial and ethnic breakdowns of COVID-19 cases.” When a solution is formed for economic benefits one can bet their bottom dollar (the last one) something is missing. In matters of COVID-19 inequity what’s missing is addressing systemic racism and implicit bias that may poison the auspice of healthcare delivery.
Being Black May Be Hazardous to Your Health
Most profound; for contemporary Public Health experts to say or infer, within the US, one was unaware of the inequity a pandemic may leave in its wake among black and brown-skinned Americans, “The poor and marginalized at-risk” this should be concerning to All Americans. The evidence was clear, abundant, and has been well documented for decades “Being black in America may be hazardous to your health.” As a result, bold preemptive measures such as intentional allocation of COVID-19 tests and minority community COVID-19 education measures should have been priority number one! This becomes more frustrating as one witness Florida Governor Ron Desantis says “National Guard ramps up coronavirus testing in Nursing Homes.” The same measures could have been taken to ramp up testing within at-risk underserved communities by Governors across the US. Why wasn’t this the case? This the question that must be answered with courageous truth.
According to evidence of health disparity within the US, moreover, “Healthy People 2020, Racial and ethnic minorities living in poverty may also have more adverse health outcomes among African Americans and, similarly, racial disparities are found among black children. The handwriting was on the wall. Leading up to COVID19 US States such as New York, Louisiana, Illinois and others had significant measures in place to address SDOH, moreover, to prevent avoidable hospital readmissions linked to avoidable hospital readmissions. Addressing SDoH was touted by all SDoH SaaS organizations as moving the needle on healthcare disparity. Nevertheless, morbidity, mortality rates, and pandemic grew profoundly disproportionate among black and brown people. The economic impact of failing to adequately respond to the well-known history of healthcare inequity issues and their known causes, i.e., systemic implicit bias, and unaddressed social determinants (transportation, housing, poverty, education, and digital divide) has placed a Nation and its people in the gravest of danger.
Learning Today for A Better Tomorrow; The Way Forward
There must be a commitment to overcome and to strive beyond social determinants of health, poverty, and systemic implicit bias within healthcare, education, and their respective policy. Meaning, the time is now to arrive at that moment in time where there are no barriers to good health, wellness, education, and well-paying jobs for those who want them. There is a role the healthcare clinician and Provider may play as well. Understanding the difficulty of overcoming inherent implicit bias healthcare providers must leapfrog into the realm of Artificial Intelligence data capability that fosters quantitative objective clinical care and more effective patient triage. NGO and GOV health industry must take the guesswork and psyche of implicit bias that leads to healthcare inequity out of the healthcare delivery process as much as is humanly possible with urgency.
Such solutions exist and the return on investment will be priceless and far-reaching exposing potential once buried alive by antiquated norms and mores undergirded by the philosophical tradition of healthcare professionals and healthcare policymakers weighed down by status quo and gradualism. The way forward is the commitment to follow and pull through in order to remove the very barriers that limit, discourage, and prevent each of us who desire to be what we ought to be from becoming what we ought to be.
In a world and Nations where we are inextricably connected by the untapped richness of our individual humanity, it is unnatural to do nothing to mitigate social determinants, inadvertent implicit bias, and their effect. “No lie can last forever.” The recoil of veiled buried lies inevitably emerges as a crisis exponentially more devastating than they may have been had they been addressed from their outset. This requires a culture of leadership urgency, courage, and boldness. The silver lining of COVID-19 is not that we will rid the world of it, but rather it is the lessons we have garnered to learn from and, the world-changing wisdom of humanity’s innate interconnectedness and striking potential that awaits therein. Let us no longer deprive one another of the absence of disease, good health, wellness, well-being, and education as we move forward.
The Objects in the Mirror Are Closer
In the final analysis, What will you do with the magic of this moment? Someday, COVID-19 will be a faded image in the rearview of history. Will we heed lessons learned; the Real Value of public, population, and community health, and/or healthcare, and the healthcare professional? Will we miss once again the auspice of evolution; transform the psyche of many among us who cling to false constructs of failed traditions and philosophies of agenda ridden policy? Will there be a reckoning of humanity; no matter the origins of one’s culture we are one?
Nevertheless or more, in the final analysis, it will remain forever clear that whatever affects one directly, affects all indirectly, and none of us can never be what we ought to be until our neighbor, fellow-nation, fellow-man and fellow-woman may become what each and all ought to be. This is “the interrelated structure of reality.” Working towards this end, may we draw from this moment in history we share the lessons of courage, patience, tolerance, understanding, and wisdom that carried us through. Let’s not waste precious time on what we may have done wrong but rather the solutions that will tell the story of how well we have become and responded. We will always be in it together. Objects in the mirror may be closer than they are. We are one.
About JohnMatthew Douglas
JohnMatthew Douglas is the President and Founder of iPressForward LLC and has over 20 years of diverse US healthcare sector experience. During the span of his healthcare career, JohnMatthew has evolved to more greatly serve the community, population, and public health, most notably Social Determinants of Health. JohnMatthew’s passion to serve community and US healthcare delivery fuels his tireless career commitment.
In recent years under the company name iPressForward, LLC Doughlas has consulted venture capital investment firms, marketing agencies, and global startups sharing his passion, wisdom, and subject matter expertise understanding of social determinants of health, healthcare group purchasing, community health, and US healthcare delivery and systems.