In December 2011, the Robert Wood Johnson Foundation published results from an opinion survey conducted with the American Medical Association concerning the influence of social conditions on medical care.
The physicians surveyed reported social conditions and important connections to health were powerful influencers, and they had limited experience, ability and understanding to address these obstacles. The survey results indicated that an average 80% of physicians agreed social conditions had great influences over their treatment strategies and they were ill equipped to deal with such matters.
Social conditions are prominent in low-income and many elderly populations and especially those with disabilities. They are driven by income, complicated family and structural societal deficiencies. The healthcare establishment has historically called these issues “social determinants of health.” Social determinants have been acknowledged for decades and were aggressively addressed during the Great Society's War on Poverty. Despite these valiant efforts, social conditions persist as dominant influences on healthcare. Governmental and professional strategies to improve healthcare for all have heavily focused on expanding insurance coverage to increase access and prevent illness. While these strategies are vitally important, they have not overcome the impact of social conditions and communities often have not organized infrastructures to do so. Successful healthcare interventions in part require cooperation, communication and consistent follow up. Social and cultural barriers can be obstacles to these requirements. Research underscores this as well, suggesting that up to 60% of health outcomes are influenced by social, behavioral and environmental factors.
Mathewson
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The HSC Health Care System in Washington, D.C., has addressed social conditions for populations with disabilities and special healthcare needs for more than 100 years through a variety of approaches. It provides family education and training in the hospital setting and community, and healthy home environments for families with special-needs populations. This includes support for housing improvements, lead assessments, transportation financing for medical visits, advice on nutrition and partnering with other community resources. We also provide intensive outreach for community and family supports by offering social and recreational activities and events.
We have recently opened a new initiative: The National Youth Transitions Center is organized to assist and guide families with special-needs members in transition from youth to adulthood and dependence to independence. It is an effort to prepare young adults for their future. The NYTC is a collaborative effort involving more than 50 organizations dedicated to populations with disabilities. Currently, the HSC Health Care System serves thousands of children and youths with special needs in programs that have multiple chronic disease conditions. Our social programs and strategies enable the prospect of achieving better medical outcomes and more efficient use of resources. The major lesson learned is that social conditions matter and must be addressed to allow medical care to work more effectively in our society.
Thomas Chapman
President and CEO
John Mathewson
Executive vice president for strategy and operations
The HSC Health Care System
Washington
