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Tag: Social Determinants of Health

The Social Context and Vulnerabilities that Challenge Health Care in the San Joaquin Valley of California

By ALYA AHMAD, MD

Call it what you want, white privilege and health disparity appear to be two sides of the same coin. We used to consider ethnic or genetic variants as risk factors, prognostic to health conditions. However, the social determinants of health (SDOH) have increasingly become more relevant as causes of disease prevalence and complexity in health care.

As a pediatric hospitalist in the San Joaquin Valley region, I encounter these social determinants daily. They were particularly evident as I treated a 12-year old Hispanic boy who was admitted with a ruptured appendix and developed a complicated abscess, requiring an extensive hospitalization due to his complication. Why? Did he have the genetic propensity for this adverse outcome? Was it because he was non-compliant with his antibiotic regimen? No.

Rather, circumstances due to his social context presented major hurdles to his care. He had trouble getting to a hospital or clinic. He did not want to burden his parents—migrant workers with erratic long hours—further delaying his evaluation. And his Spanish-speaking mother never wondered why, despite surgery and drainage, he was not healing per the usual expectation.

When he was first hospitalized, his mother bounced around in silent desperation from their rural clinic to the emergency room more than 20 miles from their home and back to the clinic, only to be referred again to that same emergency room. By the time he was admitted 2 days later, he was profoundly ill. The surgeon had to be called in the middle of the night for an emergency open surgical appendectomy and drainage. Even after post-operative care, while he was on broad-spectrum intravenous antibiotics, his fevers, chills and pain persisted. To avoid worrying his mother, he continued to deny his symptoms. Five days after his operation, he required another procedure for complex abscess drainage.

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Your Wealth is Your Health

By KIM BELLARD

We’ve been spending a lot of time these past few years debating healthcare reform.  First the Affordable Care Act was debated, passed, implemented, and almost continuously litigated since.  Lately the concept of Medicare For All, or variations on it, has been the hot policy debate.  Other smaller but still important issues like high prescription drug prices or surprise billing have also received significant attention.

As worthy as these all are, a new study suggests that focusing on them may be missing the point.  If we’re not addressing wealth disparities, we’re unlikely to address health disparities.  

It has been well documented that there are considerable health disparities in the U.S., attributable to socioeconomic statusrace/ethnicitygender, even geography, among other factors.  Few would deny that they exist.  Many policy experts and politicians seem to believe that if we could simply increase health insurance coverage, we could go a long way to addressing these disparities, since coverage should reduce financial burdens that may be serving as barriers to care that may be contributing to them.

Universal coverage may well be a good goal for many reasons, but we should temper our expectations about what it might achieve in terms of leveling the health playing field.

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A System that Fails Migrant and Seasonal Agricultural Workers

Connie Chan
Brooke Warren
Phuoc Le

By PHUOC LE, MD, CONNIE CHAN, and BROOKE WARREN

I recently took care of Rosaria[1], a cheerful 60-year-old woman who came in for chronic joint pain. She grew up in rural Mexico, but came to the US thirty years ago to work in the strawberry fields of California. After examining her, I recommended a few blood tests and x-rays as next steps. “Lo siento pero no voy a tener seguro hasta el primavera — Sorry but I won’t have insurance again until the Spring.” Rosaria, who is a seasonal farmworker, told me she only gets access to health care during the strawberry season. Her medical care will have to wait, and in the meantime, her joints continue to deteriorate.

Migrant and seasonal agricultural workers (MSAW) are people who work “temporarily or seasonally in farm fields, orchards, canneries, plant nurseries, fish/seafood packing plants, and more.”[2] MSAW are more than temporary laborers, though— they are individuals and families who have time and time again helped the US in its greatest time of need. During WWI, Congress passed the Immigration and Nationality Act of 1917[3] because of the extreme shortage of US workers. This allowed farmers to bring about 73,000 Mexican workers into the US. During WWII, the US once again called upon Mexican laborers to fill the vacancies in the US workforce under the Bracero Program in 1943. Over the 23 years the Bracero Program was in place, the US employed 4.6 million Mexican laborers. Despite the US being indebted to the Mexican laborers, who helped the economy from collapsing in the gravest of times, the US deported 400,000 Mexican immigrants and Mexican-American citizens during the Great Depression.

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Announcing Winners for the RWJF Innovation Challenges

SPONSORED POST

By CATALYST @ HEALTH 2.0

Three finalists for the Robert Wood Johnson Foundation Home and Community Based Care and Social Determinants of Health Innovation Challenges competed live at the Health 2.0 Conference on Monday, September 16th! They demoed their technology in front of a captivated audience of health care professionals, investors, provider organizations, and members of the media. Catalyst is proud to announce the first, second and third place winners.

Home and Community Based Care Innovation Challenge Winners

First Place: Ooney 

Second Place: Wizeview

Third Place: Heal 

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RWJF Innovation Challenge Finalists To Compete Live at Health 2.0

SPONSORED POST

By CATALYST @ HEALTH 2.0

Catalyst is excited to announce the finalists for Robert Wood Johnson Foundation’s Home and Community Based Care and Social Determinants of Health Innovation Challenges! The three finalists from each Challenge will compete in an exciting Live Pitch on September 16th, from 2:30-4:30pm, at this year’s Health 2.0 Conference in Santa Clara. They will demo their technology in front of a captivated audience of health care professionals, investors, provider organizations, and members of the media. The first place winners will be featured on the Conference Main Stage, September 17th at 3:15pm. Winners will be awarded $40,000 for first place, $25,000 for second place, and $10,000 for third place.

If you are attending the Health 2.0 Conference, join us to see the finalists showcase their innovative solutions. 

Home & Community Based Care Innovation Challenge Finalists

  • Heal – Heal doctor house calls paired with Heal Hub remote patient monitoring and telemedicine offer a complete connected care solution for patients with chronic conditions.  
  • Ooney – PrehabPal, a home-based web-app for older adults, delivers individualized prehabilitation to accelerate postoperative functional recovery and return to independence after surgery.
  • Wizeview – A company that uses artificial intelligence to automate and organize information collected during home visits, supporting the management of medically complex populations at the lowest cost per encounter. 

Social Determinants of Health Innovation Challenge Finalists

  • Community Resource Network – The Social Determinants of Health Client Profile, a part of the Community Resource Network, creates a whole-person picture across physical, behavioral, and social domains to expedite help for those most at risk, fill in the gaps in care, and optimize well-being.
  • Open City Labs – A company that matches patients with community services and government benefits that address SDoH seamlessly. The platform will integrate with HIEs to automate referrals, eligibility screening & benefits enrollment.
  • Social Impact AI Lab – New York – A consortium of nonprofit social services agencies and technology providers with artificial intelligence solutions to address social disconnection in child welfare.
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THCB Spotlights | Jacob Reider, CEO of Alliance for Better Health

Today on THCB Spotlights, Matthew talks to Jacob Reider. Jacob is the CEO of Alliance for Better Health, one of New York State’s 25 Performing Provider Systems which work to reduce unnecessary or preventable acute care utilization for Medicaid members by improving the health of communities. Alliance for Better Health has a new approach to this—they’ve created an Independent Practice Association (IPA) called Healthy Alliance IPA to pull together community based organizations focused on improving health and addressing the social and behavioral aspects of health. Their approach helps the 29 organizations within the IPA negotiate funding and creates an infrastructure for integrating social determinants of health into health care. Watch the interview to find out how this is going to work in practice.

‘I Apologize for What You Are About To See’

By HILARY HATCH, PhD

The growing movement to include the patient voice in medicine through Motivational Interviewing, patient-reported outcomes, social determinants of health and shared decision-making

One day in 2011, as a part of my research on ways to improve patient-provider communication about health behaviors, I was shadowing Dr. G., a talented young internist with a cheerleader demeanor. He marched through 12 afternoon patient appointments with confidence and purpose. But when he saw the name of the last patient on his schedule, he turned pale, faced me and said, “I apologize for what you are about to see.”

I must have looked confused. He repeated, “I apologize for what you are about to see.”

We walked into the exam room. I’m not sure either one of us knew what to expect. The patient, a white, obese man, was seated, doubled over. He had a wad of paper towels jammed in his mouth. He threatened to pull out his own, presumably abscessed, tooth. He refused to see a dentist because he had no dental coverage, no money and no one to borrow money from. He said he would use pliers to pull his tooth, but stayed put, rocking in his seat. At the computer, the young doctor’s white-knuckled hand gripped his mouse. Click. Click. Click. He searched the patient’s chart aimlessly for help. Alerts kept popping up about the patient’s missing A1C results. It took two minutes, but it felt like 20.

Dr. G. left the room and came back a few minutes later. He gave the patient the name of a dentist who would see him at no cost. I suspected Dr. G. had called the dentist and said he would pay for the appointment out of his own pocket. The patient hugged Dr. G. He only wanted help, and Dr. G. wanted to help. The tension was resolved for the moment.

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Announcing the Robert Wood Johnson Foundation SDoH & Home and Community Based Care Innovation Challenges Semi-Finalists!

SPONSORED POST

By CATALYST @ HEALTH 2.0

Health disparities domestically and globally can often be attributed to social determinants of health (SDoH). According to Healthy People 2020, SDoH are conditions and resources in the environments in which “people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Examples of these include: resources to meet daily needs (e.g. access to and quality of housing and food markets), educational opportunities, employment opportunities, and transportation. Despite well-established literature on the importance of SDoH, these factors are often overlooked and excluded in health care frameworks. 

Concurrently, health services provided in traditional settings such as hospitals and clinics can be expensive and inaccessible. There are a large number of communities, from rural areas to major cities, that are in need of high-quality care. Innovative technologies can mitigate these challenges. Home and community-based care models coupled with digital tools provide the opportunity to serve patients where they feel most comfortable in a cost-effective manner. 

In an effort to spur creativity in the SDoH tech environment and improve the landscape of home based care, the Robert Wood Johnson Foundation and Catalyst partnered to launch two Innovation Challenges on Social Determinants of Health and Home and Community Based Care

For the SDoH Challenge, innovators were asked to develop novel digital solutions that can help providers and/or patients connect to health services related to SDoH. Over 110 applications were submitted to the SDoH Challenge. For the Home and Community Based Care Challenge, applicants were asked to create technologies that support the advancement of at-home or community-based health care. Nearly 100 applications for Home and Community Based Care Challenge were received. 

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Health in 2 Point 00, Episode 84 | Health 2.0 HIMSS Europe, Part 2

Slide into Health in 2 Point 00 (or rather, Health 2.0 HIMSS Europe) with Jess and I today! On Episode 84, Jess asks me about the big news that CVS has now made it possible for employees to get reimbursed for Big Health’s Sleepio, an insomnia digital therapeutic, and about Atrium Health’s $10 million investment in an affordable housing plan, addressing the social determinants of health. Hear some of my key takeaways from the conference so far, too. –Matthew Holt

Role of Innovation in Addressing Social Determinants of Health

SPONSORED POST

By CATALYST @ HEALTH 2.0

Nearly a decade has passed since Healthy People 2020 positioned social determinants of health (SDoH) at the forefront of healthcare reform. As defined by the report, SDoH are the “conditions in the environment in which people are born, live, learn, work, play, worship, and age, that affect a wide range of health, functioning, and quality of life outcomes.” Examples of social determinants include:

  • Resources to meet daily needs (e.g., safe housing and local food markets)
  • Educational, economic, and job opportunities
  • Community-based resources in support of community living and opportunities for recreational and leisure-time activities
  • Transportation

The ability to influence social determinants largely falls outside of the health care system’s reach. Therefore, a key to address opportunities for health involves collaboration between health care and different industries such as education, housing, and transportation. Both the public and private sectors have made significant efforts to bridge the gap between physical, mental, and social care by experimenting with non-traditional partnerships.

The Center for Disease Control and Prevention (CDC) has spearheaded multiple programs with government agencies and community partners to achieve the goals outlined in Healthy People 2020. One of the most notable successes is the Childhood Lead Poisoning Prevention Program, an initiative by the CDC with the Department of Housing & Urban Development and the U.S. Environmental Protection Agency. Through housing rehabilitation, enforcement of housing and health codes, and partnerships with healthcare experts, the program helped Healthy People 2020 exceed their target of reducing blood lead level in children.

Other programs such as the “National Program to Eliminate Diabetes Related Disparities in Vulnerable Populations,” leveraged community partners and resources to increase food security, health literacy, and physical spaces for active living. In one of their projects, the program partnered with community health workers (promotoras) who spoke Spanish to engage with Hispanic/Latino communities where participation to Diabetes Self-Management Education (DSME) was low. The community health workers provided linguistically and culturally-sensitive materials that effectively increased participation in DSME among the targeted population. The outcomes from such initiatives have inspired more health and community organizations to work together to reduce health disparities.

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