Population health will see you now
The World Health Organization now considers the social determinants of health to be the bulk of health care. This is long overdue, but as pioneers of the population health movement, my colleagues and I consider this an understatement.
We estimate that 80% of individual health is due to non-medical factors, including crime, poverty, education and opioid abuse. The silver lining of Covid is that people are finally paying attention to large-scale social, economic and environmental issues that impact the health outcomes of disparate groups of people – the health of the population – but that’s only a beginning.
An “inequality engine”
In April 2020, Professors Anne Case and Angus Deaton wrote in The New York Times that the current health system is an “engine of inequality”. Unfortunately, they have it all figured out. The pandemic has revealed the primacy of social determinants in terms of who lives and who does not. Now we in the health sector have to ask very difficult questions that have been avoided for too long. For example, how do we take care of populations that may put us at economic risk? How do we stratify care across populations? How do we coordinate care across communities?
In the past, these issues were considered public health issues. They now fall under the “roof” of population health. The central pillar supporting this roof is made up of epidemiology, behavioral and environmental sciences – all key tenets of the traditional approach to public health. However, there are other pillars, including the quality and safety of the care we provide, its cost, and public policy considerations.
At the height of the pandemic, lines for food exceeded lines for medical aid here in Philadelphia. The inequality inherent in our system ensured that the death rate of people of color would be much higher than that of others. Covid was a witches brew of disaster and increased mortality for minority populations.
Although it is too late to declare victory over Covid – and, unfortunately, we already have another population health crisis on our hands – let us not wait to recognize the breadth and depth of the problems we are confronted. Plus, let’s tackle them with the right tools. If our core business is improving health, then let’s strengthen all these pillars to improve the roof over our heads. Of course, this raises another question: how are we going to be paid to implement these changes?
Healthcare is a $4 trillion business, and at least $1 trillion of that amount adds no value except corporate profits. So one idea might be to redirect those funds to actual health care.
Apart from a small minority, most physicians feel like outsiders victimized by the health care system. Almost 42% of physicians report symptoms of burnout, especially physicians in critical care, emergency medicine, family medicine, internal medicine, neurology, and urology. I have a daughter who was on the frontline of Covid as a primary care physician. I understand; expecting doctors to heal themselves is simplistic during and after a pandemic.
In contrast, research indicates that we can reduce burnout if we empower providers to improve social determinants. Why not allow doctors to write a dietary prescription, connect patients with community organizations for help, and mandate behavioral consultations? If we can give providers the tools to help the underserved, burnout goes down. We know that physicians are not social workers, but they can (and should) lead the charge to implement the population health paradigm. All they need is a voice and the right tools.
For example, it is essential that suppliers at least have a single, unified patient file. Especially as we adapt to telehealth and virtual care, organizations need to have a framework that enables rapid exchange of data between members of care teams. Indeed, population health intelligence is another essential pillar, as well as an important subset of population health that encompasses predictive analytics, augmented intelligence, and artificial intelligence. We can and should create a Covid patient registry that protects privacy. From the tsunami of collected data, we would glean actionable insights into at-risk populations. I also hope that we will see digital health care that continues to reduce marginal costs. This will allow us to reach much larger populations at a lower cost than ever before.
Imagine if we could go upstream to turn off that sick faucet, rather than constantly cleaning the floor. What if the population of Philadelphia had been healthier before the Covid? If we had paid more attention to the social determinants, we would have been much more proactive. The chance of reducing the incredible death rate in minority populations would have been much greater if we had paid attention to obesity, smoking, heart disease, exercise, nutrition and other issues. “soft”. Why didn’t we do this? No one was leading the way, probably because there was no profit incentive.
We know health care is big business, but even more so, it is the last common track across all social determinants. He constantly reframes what it means to take good care of the population. I firmly believe that we can still establish an exemplary model of population health, a system that promotes the inclusion of all factors associated with a patient’s health in order to provide care that is as comprehensive as possible.
Photo: marsmeena29, Getty Images