NYAPRS Note: This year’s NYAPRS Executive Seminar, April 24-5, offers several unique opportunities to explore means of affecting and measuring the social determinants of health that our communities experience, several of which are explored in the article below. Dr. Jeffrey Brenner from NJ will join us at the seminar to discuss behavioral health from a geographic and public health perspective, providing a framework for his innovative use of “hotspotting” as a means of locating environmental and cultural impacts on behavioral health treatment. A strategic policy panel including NY’s Deputy Secretary of Health Courtney Burke and Medicaid Director Jason Helgerson will offer background on the way current and future policy interventions will specifically target employment, housing, and jail diversion. And breakout sessions investigating housing options, cultural competence, and new approaches to paying for alternative crisis response will be led by experts from around NYS. Join us at this year’s seminar to discover how NY is leading the way in conceptualizing behavioral health from the perspective of social determinants, and learn about new opportunities for funding and best practice implementation. Register for the Executive Seminar here; save with early registration through April 4!
Social Determinants Of Health & Medical Homes
Open Minds; Monica Oss, 3/28/2014
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As we were wrapping up our research on the unique health issues and recidivism issues of the justice-involved population (see A New Opportunity To Serve Justice-Involved Consumers all members and The ROI Of Recidivism Prevention all members), I received a notice about a new report from the Institute of Medicine (IoM), Applying a Health Lens to Decision Making in Non-Health Sectors. After reading the report, I was struck by the implications for (and affirmation of) the need for behaviorally-focused medical homes for some consumer groups – whether individuals with cognitive disorders, with multiple chronic conditions, or unique social needs.
The report’s theme was reflected in one quote from David Williams, Harvard’s Florence and Laura Norman Professor of Public Health, on September 19, 2013, at the IoM Roundtable on Population Health Improvement. He said:
Health is largely determined by factors situated outside of the health care delivery System. The health care system generally functions to provide care to those who have become sick. Yet, it is where people live, learn, work, play, and worship that most influences their opportunities and chances for being healthy. Social policies can make it easier or harder for people to make healthy choices.
The report discusses the many factors that are determinants of health – housing, family structure, violence, education, and income. But what struck me about those factors was the importance of “place” in determining an individual’s health status. Place determines level of pollution and environmental risk, water quality, access to transportation, accessibility to healthy food, the ability to get exercise safely, and much more.
The way to address these determinants? The report recommendations – with its emphasis on “health in all policies” – focused on five long-term policy approaches:
- Building the perspective of health into all policy making.
- Including an explicit focus on health equity in policy making.
- Convening, enabling, and supporting cross-sectoral collaborations.
- Developing consensus-based standard data and methods for surveillance systems linking health, health equity, and the determinants of health.
- Investing in strengthening community capacity and potential for community advocacy.
But, while we’re waiting for the slow wheels of policy change to turn, I was struck by the implications for emerging medical home models – particularly the medical homes serving the 5% of the population using 50% of the health care resources (see 5% of U.S. Residents Use 50% of Medical Resources premium members and Five Percent of Americans Responsible for Half of U.S. Health Spending premium members). The report called for cross-sector collaboration at the community level – and gave some great examples, including Every Body Walk!, Convergence Partnership, and Valley Hi HEAL (Healthy, Eating, Active Living) Zone.
By design or by default, cross-sector collaboration at the individual level is becoming the role of the medical home – helping individuals address the issue of variability in their own social framework for health. This is even more evidence that medical homes for a select group of individuals need equal parts of expertise in health care, behavioral health, and community services.
Sincerely,
Monica E. Oss
Chief Executive Officer, OPEN MINDS