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For those who question the far-reaching impact of political determinants of health, Population Health Professor Geoffrey Roche recounts this story:
In an effort to identify and improve social determinants of health (SDOH), a community health system partnered with local universities to send medical students, pharmacy students, and undergraduates to meet with patients in their homes.
Working with frequent ER visitors, students identified a particularly alarming situation. A patient with C.O.P.D. and numerous chronic health issues had been living in an egregiously neglected rental building with a significant toxic mold problem.
“Housing, healthcare laws, zoning, you name it, all impact the social determinants of health,” says Roche, SVP of National Healthcare Practice and Workforce Partnerships, Core Education Services, PBC.
After considerable effort, program leaders were able to report the negligent landlord and secure new housing for the patient. However, the remedies arrived too late for the patient to make a significant recovery.
“People have this belief that we don’t have to deal with [political] issues,” Roche continues. “The reality of it is, our healthcare system is always going to have to deal with those issues, even in value-based care. They’re going to come through the emergency room, it’s going to be very expensive, and everyone is going to be impacted until we recognize our opportunity to do our work here.”
Speaking on FinThrive’s Healthcare Rethink podcast, Roche identified three ways healthcare and political leaders can begin that work of addressing political determinants of health. These are his recommendations.
1. Study both social and political determinants of health.
Social determinants—such as housing stability, food insecurity, and access to transportation—account for up to 80% of health outcomes, and they’re heavily influenced by politics.
Case in point: When Pennsylvania leaders drilled into SDOH data, they found that areas of significant health inequity were also redlined communities where discriminatory lending practices in the pre-civil rights era had prevented residents from moving to better resourced neighborhoods.
“You can still see the impact of those decisions back then on the health outcomes of the individuals who live in those regions now,” Roche says. “Unfortunately, a lot of those individuals have family members who were impacted disproportionately and have continued to be impacted even after all this time.”
Still today, many of the most challenging social determinants are influenced or even instigated at the policy level—from toxic-chemical exposure, to food deserts, to public transportation access. Public health leaders can make meaningful change by learning to recognize the interplay between political and social determinants of health.
Reading list: To learn more about how politics and policy influence health outcomes Roche recommends “The Political Determinants of Health” by Daniel E. Dawes.
2. Connect the healthcare ecosystem, including provider, payer, and pharma.
Political determinants of health are meaningfully improved when all the constituents speak together with one voice.
The political landscape is often fragmented, Roche notes, with lobbyists, health systems, payers, and pharma working their own corporate social responsibility initiatives and championing adjacent goals. Small inroads are made here and there, but systemic change is eluded.
Systemic change happens when all of healthcare and life sciences come together as one ecosystem, putting a stake in the ground, and making sure lawmakers know they’re unified in this work.
“We can’t say we’re working toward health equity without actual, intentional efforts of coming together,” Roche says.
3. Use data more effectively—at the federal, state, and local level.
We no longer have to guess which patients are likely to be readmitted to the hospital or who may miss follow-up care because they have no way to get to appointments.
“If you use the data correctly, we can not only change lives, but we can also change how people think of this issue,” Roche says.
Start with the Health Equity Tracker, Roche says. Offered by the Satcher Health Leadership Institute at the Morehouse School of Medicine, it’s the first tool designed to pull in data with health equity in mind. Fully interactive, the tracker can show an individual county’s risk for excessive drinking or where suicide rates are highest across the entire United States. Employed at the federal, state, and local levels, data can be used to target outreach and fund programs that will improve health equity and outcomes.
FinThrive’s data tools, for example, helped AmeriHealth Caritas DC, a managed care plan in Washington D.C., support a critical member population that was vulnerable to hospital readmission and high-cost ER visits. Partnering with local organizations, the health plan launched medical respite facilities to provide members facing housing instability a safe and supportive place to heal after hospital discharge.
Drilling into data also reveals another critical insight, according to Roche: health inequities are far more pervasive than we think. Improving outcomes requires that we acknowledge our ALICE neighbors—Asset Limited, Income Constrained, Employed families who are unable to afford the basics of housing, child care, food, transportation, healthcare, and technology.
“We’ll never address these issues until we realize that health inequities literally exist
everywhere we live,” Roche says. “It impacts all of us, and we’ve got to be willing to take the next step,
to get into good trouble, to address these issues.”
To learn more, watch our political and social determinants of health podcast with Geoffrey Roche.
Tune Back In
Roche will be returning to the podcast with Author Daniel Dawes. Dawes is the director of the Satcher Health Leadership Institute at Morehouse School of Medicine who has been at the forefront of recent major federal health policy negotiations in the United States.
About Geoffrey Roche
Geoffrey M. Roche, MPA, is an accomplished leader with a passion for healthcare innovation, future-focused strategy, transformation, cultural change, diversity, equity, and inclusion, and workforce impact. He currently serves as the Senior Vice President, National Health Care Practice & Workforce Partnerships for Core Education. He is also an Adjunct Instructor of Health Administration in the MBA/MHA Program at Moravian University and Corporate Faculty member in the Population Health program at Harrisburg University of Science and Technology.
