Healthcare must look inward to better address social determinants of health, Berwick says

Doctor with patient
Healthcare systems need to do more to invest in social determinants of health, and need to look in-house first, Don Berwick of IHI said. (Getty/wutwhanfoto)

ORLANDO, FLORIDA—The healthcare industry must explore how their own institutions are contributing to major social issues such as institutional racism in order to really tackle the “monsters” of social determinants on health.

That was a key message from Donald Berwick, the president emeritus and senior fellow at the Institute for Healthcare Improvement during the group’s annual forum this week in Orlando, Florida. Berwick’s comments come as the healthcare industry is taking a long look at social determinants such as food insecurity, transportation and housing.

Berwick made a plea to healthcare system leaders that it's a moral imperative to tackle social issues inextricably linked to healthcare outcomes.

"I think over the next decade we had better find a way to invest in working on social determinants of health," Berwick told reporters during a briefing Monday. "What would lead us to go through the dramatic changes, business models, social investment, regulation and legislation that would allow us to focus on true causes."

RELATED: Executive Spotlight—Don Berwick on how federal health policy is 'backpedaling'

One part of that is for healthcare system leaders to treat their workforce better.

“Do you have a living wage? Is structural racism a part of your system? Are there people on the borderlines of food security and homelessness who work for you?” Berwick asked.

Leaders also need to use the economic heft of their organizations to help underserved areas. Berwick pointed to Rush Medical Center in Chicago that picked an area of the city that had a 16-year gap in life expectancy.

“Now they are saying they will move their supply chain,” he said, noting that Rush is also investing in construction in that area. “Use your money to work on equity. That doesn’t cost you a nickel. You are just taking your nickels to a different area and helping create jobs.”

Healthcare systems also need to work on criminal justice issues, essentially acting as a safety net for people that are leaving incarceration.

“Could you work with police departments and correctional institutions to reach services and help in there?” Berwick said.

Hospitals also need to be “political.”

“Instead of arguing for higher hospital reimbursement, which is their main agenda, how about arguing for proper distribution of social investments in causes of illness,” said Berwick, former head of the Centers for Medicare & Medicaid Services during the Obama administration.

RELATED: Former CMS administrator Don Berwick on why healthcare can't afford to accept inequality anymore

Individual healthcare workers and practitioners also need to get involved and political.

“Doctors and nurses have a lot of voice and credibility,” he said in an interview with reporters before his keynote address Wednesday. “What are you talking about in your communities and social systems? Are you writing op-eds and contributing to local literature on the problems I talked about?”

Meanwhile, the insurance industry has made small steps in tackling social determinants, Berwick said. For example, some insurers have developed risk assessments to spot patients with food insecurity.

“You are seeing almost every insurance company doing something creative on trying to work community costs,” he said. “It is a tiny proportion of the effort compared to what we need. In the end they don’t have a strong incentive to move their work towards costs.”

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