In what is being called a great first step by the integrative health community, Congress has proposed bipartisan legislation to help manage costs and improve outcomes for Medicaid recipients with help on a state and community level. The Social Determinants Accelerator Act introduced in July 2019 proposes planning grants and technical assistance to help communities address non-medical needs that are linked to health, such as food security, employment and housing stability.
The proposed legislation, which has been endorsed by groups like the American Hospital Association and Aligning for Health, an association working to address such social determinants to health, suggests a growing recognition among political leaders that good health encompasses more than just addressing disease states and that social determinants like income equality, poor public transportation, and housing instability can also impact health and well-being.1
The new bill is a positive first step, according to Margaret Chesney, professor of medicine and former director of the Osher Center of Integrative Medicine, at the University of California, San Francisco School of Medicine, as well as a special advisor to IHPC. “This bill provides opportunities to reach out and encourage Congress to consider the importance of health in general and highlight a very important problem—that in many cases health is determined more by zip code than genetic code. Where we live, the schools in our neighborhood, the availability of low cost healthy fruits and vegetables, the presence of safe spaces to be outdoors, are all major determinants of our health status and longevity.”
While the bill is a step forward, it doesn’t go far enough, she added. The focus of the bill is more on addressing individual social needs such as food insecurity or lack of transportation. Facilitating access to these services is helpful but falls short of addressing the on-going needs. Actually addressing social determinants requires looking at the policies that create the conditions which lead to poor health, according to Sharad Kohli, M.D., IHPC Policy Committee co-chair. “Integrative clinics,” he noted, “including many federally qualified health centers, are uniquely situated to address all of the factors that influence health including working on an individual clinical level with patients using both conventional and complementary health approaches, by directly working with patients to address their specific social needs, and by advocating for policy change that can lead to healthier communities.”2
There are integrative medicine clinics and programs, for example, that not only strive to combine the best of complementary and conventional care, but also to help individuals, families and communities create social and physical environments that are conducive to health. Perhaps we can build on the interest of lawmakers in this bill to help them move toward taking bolder steps to address social determinants of health. Though the legislation recognizes the importance of communities and hospitals linking people to existing available resources, there are still significant gaps to address in these programs. For example, Chesney noted, the recent water problem in Newark, N.J., where the city delivered cartons of water to certain points in the city where contamination was a problem, but seniors in three-story walkup apartments couldn’t access it.
And the fact is, Americans are not getting the most efficient and cost-effective healthcare. Statistics show that among industrialized nations – Japan has the highest longevity – at 84.2 years and their health care cost is $4,766 per capita. In contrast, the U.S. life expectancy is 78.6 years and our health care costs are $10,586 per capita, more than twice that of Japan.3
“If we want to address the extremely high cost of healthcare, which is more than $10,000 per capita and our mortality rate, which is increasing rather than decreasing, then we have to look at the whole picture and need to make it possible to have a healthy lifestyle,” Chesney explained.
If people have to take three buses across town to get to the food bank, that is not going to address the need. A better approach is to place food banks in hospitals. Chesney noted the preventative food pantry program at Boston Medical Center. “You see the doctor and get your recommendations for diet, say for diabetes, and then you go down a few floors and get the recommended food from the food bank. That is integrative medicine!”
“Groups like IHPC are in an ideal position to advocate for bold ideas to help create healthier zip codes,” Chesney added. One such idea, she highlighted is the Morehouse Community Health Worker Training Program4 for High School Students and Young Adults, which offers youth skills that can be directly translated into a meaningful job and a career path for their lives. At the same time, these youth learn positive health skills that they can share with their peers and families. And that, Chesney added, will engage them in helping to change the world in which they live.
- Castrucci BC, Fielding J, Auerbach J. Social determinants of Health—health isn’t just bugs and bacteria. The Hill. 4 2019.
- Castrucci BC, Auerbach J. Meeting individual social needs falls short of addressing social determinants of health. Healthaffairs. Jan. 16, 2019.
- Organization for Economic Co-operation and Development, 2019. oecd/healthstat/life-expectancy-at-birth.htm and Data.oecd/healthres/health-spending.htm.
- Morehouse School of Medicine. Community Health Worker Training Program for High School Students and Young Adults. https://www.msm.edu/Education/PipelinePrograms/hscommunityhealthworker.php