There’s an ongoing discussion about lifespan vs. “healthspan”—can a long life be accompanied by high quality of life? This is one place where the social determinants of health can enter the equation, correct?
Dr. Jay Want: I think the data shows that. The truth is, if you’re wealthy in this country, it doesn’t matter where you live. You’ll live about the same amount of time. It does make a big difference for the lowest quartile of income, depending on the metropolitan area where you live, mostly on the theory that has to do with how those localities address the social determinants of health.
Dr. Kimberlydawn Wisdom: No question. The social determinants are certainly one way we know to increase that quality of life. We oftentimes say health occurs where we live, learn, work, play and pray. Health doesn’t occur in the doctor’s office; it doesn’t occur in the operating room. Of course those things are very important, but health occurs in the community.
What are some other roadblocks to a healthier population, within the social determinants of health or beyond?
Want: I have to start with costs and say that healthcare has become really unaffordable in this country. It’s been unaffordable for individuals for a long time. Now it’s getting unaffordable for larger entities, for companies, for states, for the federal government, frankly. So when it comes to other things that could lead to prosperity in our society, we don’t have as much money to do those—including care for the disadvantaged.
Wisdom: One way to address health of a community is to have people not be hospitalized, not have to go to the emergency department, but receive care through primary-care visits. Of course, if you need hospitalization, we’re there for you. But we don’t want that to be your regular pattern of care because we haven’t addressed your clinical and social needs.
As health systems and other stakeholders work to address the social determinants, what about the more systemic issues that really need policy solutions and larger public resources?
Want: Basically, the one type of entity that’s intended to have the interest of the population is government. I think in this country we’ve seen a deteriorating confidence in government and its efficacy. …The pandemic was a real wake-up call, that our public health capabilities aren’t what they need to be. I think we’ve been kind of starving the public health infrastructure for decades.
Wisdom: Policy work is always important because it helps us to have the ability to sustain our efforts on many issues. We are looking, as just one example, at policy proposals at the state level related to the reimbursement of community health workers so they can systematically help address social needs. … And of course health systems are engaged with the American Hospital Association, which works to drive change on our behalf.