While addressing social needs has become the buzz in Medicaid, a blog in Health Affairs brings new clarity to how even the best efforts by health care providers fall short of addressing the underlying social determinants that perpetuate poor health. No doubt, there are many successes to be touted as the health care system helps individuals (generally with high cost and complex issues) with stable housing, nutritious food, or connections to community resources that provide services for social needs. These efforts provide documented evidence of savings in health care costs but they do little to address the root causes of poor health that exist at the community level.
As someone who has been following the growing interest in and potential for leveraging Medicaid to address the social determinants of health, I too have been caught up in equating tackling social needs in health care to addressing social determinants of health. But I have also been frustrated because most efforts in Medicaid are directed toward high costs/high needs populations; the generally-healthy population of children aren’t targeted with these interventions. The fact is, as authors Brian Castrucci and John Auerbach point out in their Health Affairs blog, addressing individual social needs doesn’t resolve the underlying root causes that impact our nation’s health. This is particularly true for children, many of who live in poverty that impacts their health and long term success in school and as adults.
To be fair, addressing individual social needs (which can save money in health care costs) and enacting policies to address community level social determinants are both needed if we are to change the trajectory of health in America. Health care leaders have been clear that the system alone cannot resolve all of the factors that impact health. Without assuring economic security, quality education, safe neighborhoods and healthy environments for low-income families, we will simply continue to fill up the health pipeline with adults who have chronic health conditions that are rooted in the conditions they experience as children.
Even if the health care system could do more to address every child’s social needs, it will overwhelm the social services safety net in this country. We all know that the U.S. spends half as much more on health care than any other industrialized nation. But when you look at combined spending on health care and social needs, the U.S. doesn’t rank among the top ten countries. If you want more on this topic, check out Elizabeth Bradley and Lauren Taylor’s book “The Great American Paradox: Why Spending More is Getting Us Less.”
Health care advocates have been instrumental to the successful efforts to expand, protect, and improve health care coverage for children, low-income families, and other vulnerable populations. As advocates, we know how to drive policy change. We are increasingly interested in how Medicaid can be leveraged to address social needs for specific individuals or populations. But simply leveraging Medicaid to address individual social needs won’t be enough. It’s important to recognize that much broader policy change is needed to address the social and economic conditions that affect community health. As a country, we need to prioritize a broad, community-wide focus on the underlying social and economic conditions in which people live. The Health Affairs blog highlights a few initiatives that look promising.
Our political system, which governs policy, isn’t geared to long range planning. But that’s our challenge – to educate leaders at all levels of policymaking who will think well beyond the next election cycle. The future health of our nation depends on it.
