There are glaring disparities caused by gender, race, ethnicity, and sexual orientation, as well as socioeconomic status, disability and trauma.
So much routinely happens in the arena of the social determinants of health (SDoH) and SDoH mental health, and last week was no exception. In fact, every week, there’s another study (if not five or 10) that speak to the glaring disparities caused by gender, race, ethnicity, and sexual orientation, as well as socioeconomic status, disability, trauma, and more. Then another five or 10 headlines emerge, each with its own twist of the data. At the end of the day, we see articles that start with the words, “social determinants of health may be associated with.”
Specifically, the past week saw reporting on the following issues:
- Safety-net profitability;
- Access to appropriate mental health services;
- Access to virtual health amid COVID-19;
- Stroke mortality;
- Longstanding access to care issues for seniors;
- Less-than-optimal care in rural communities;
- Increased Black maternal health mortality; and
- The highest national health expenditures to date ($3.8 trillion for 2019), a figure that’s expected to reach at least $8 trillion by 2028.
Now, as a doctoral candidate, I truly value reputable and seminal data. However, in discussing the glaring onslaught of SDoH data with colleagues, there is one constant theme. There are no “mays” associated with these studies. The SDoH impact morbidity, mortality, and thus health and behavioral health outcomes. The industry must go beyond the data to strategic and dedicated action that accounts for the various moving parts:
- Substantial funding for staffing, community-based resources, and other primary, secondary, and tertiary prevention;
- Reimbursement (and yes, let’s get those ICD-10-CM Z codes expanded, and formally implemented by all entities and across all levels of care);
- Meaningful public policy at the state and federal levels to bridge the gaps in care that impact a rising number of citizens;
- Quality metrics that define accountability for holistic health equity by organizations; these efforts can’t only exist on paper, strategic action, or quality improvement plans. They must also transcend short-term fixes to extend to meaningful long-term quality measures that inform and change the culture of practices; kudos to NCQA on their efforts to advance HEDIS and incorporate health equity. Outcome measures must go beyond length of stay, readmissions, and denials of care, as well as morbidity and mortality review; they must define the obstacles that prompt these realities, then action plans.
- Engagement in cross-sector collaborations with key stakeholders who get it and will do what is needed to fix it: healthcare organizations, insurers, funding entities, community-based organizations, practitioners, product developers, and others. These coalitions exist, and I’m fortunate to be involved in several, from the Gravity Project to RISE Association. They are inspirational and give me hope regarding the industry’s ability to build an informed health and behavioral health sector.
Research and seats at the table are valuable, but it’s time to disrupt the status quo, coordinate, and implement longer-term action. We asked our Monitor Mondays listeners how much their organizations are engaged in sustainable SDoH solutions, and received answers that speak volumes; view them here.
Programming Note: Listen to Ellen Fink-Samnick’s live reporting of the social determinants of health (SDoH) every Monday during Monitor Mondays, 10 a.m. Eastern.