Growing Focus on ‘Social Determinants of Health’

Issues like poverty, food insecurity, housing status, and violence play a huge role in public and individual health

Virtua’s “mobile farmers market” is stocked with fresh fruits and veggies. The vehicle tours communities in need and sells produce at half the wholesale price.
When staff at a behavioral health program in Camden realized chronic hunger was fueling the hyperactivity they witnessed among many students every day, they found ways to add breakfast and lunch to the schedule.

Leaders at Virtua, the healthcare network behind the program, also discovered these children were going home to empty pantries, so they partnered with a local food bank to create supper “snack packs” the kids could take home after school.

The investment quickly led to better outcomes in the program, Virtua said, and studies suggest the addition of healthy food is also likely to help these youngsters avoid obesity and chronic medical conditions down the road.

The work is based on a growing understanding of the role “social determinants” – issues like poverty, food insecurity, housing status, and violence — play in public and individual health. Some experts suggest these factors may play a greater role in an individual’s health than either clinical care or personal behavior.

Efforts to incorporate this concept into federal policy date back more than a decade, and the state Department of Health built on this work to create Healthy New Jersey 2020, which seeks to improve population health and reduce health disparities.

Three essential goals

Providers are also adopting these models as they seek to implement healthcare’s “triple aim” — improving patient experience, benefitting population health, and reducing per-capita costs. Now that access to healthcare has been expanded significantly through the federal Affordable Care Act, the focus has shifted to the triple aim, and addressing the social determinants of health is seen as a key strategy in achieving these goals, experts agree.

“We’ve been working on enhancing population health programs for some time now,” explained Suzanne Ghee, an assistant vice-president for community health with Virtua, which operates three hospitals and a network of other care facilities in South Jersey. “Treating people outside the walls of the hospital is really the future of healthcare.”

This interest led Virtua to spotlight social determinants of health in their recent Healthcare Collaborations Summit, held last Friday in Philadelphia, in partnership with Aetna. The event included a keynote address from Dr. James Marks, the executive vice president of the Robert Wood Johnson Foundation, which has done extensive work on public health, and featured sessions on the importance of safe housing and food security, the use of telemedicine, and efforts to better integrate care. (RWJF also supports NJ Spotlight.)

“We thought, if we’re facing these issues, I’ll bet other providers are as well,” Ghee said. The event was a huge success, she said, and sparked a number of conversations around possible future partnerships.

‘Wave of the future’

“Partnerships, collaborations, sharing of ideas — that’s the wave of the future,” Ghee added, noting that there are currently few ways to get paid for some aspects of this work through traditional funding sources, like Medicaid.

In late September, the “Believe in a Healthy Newark” initiative — funded in part by RWJF — hosted a conference that explored how the social determinants of health impact two communities in that city. Sessions tackled nutrition, housing, asthma, and adverse childhood experiences, which also play a key role in future health.

“It is important for me to emphasize the fact that our main agenda is to address the social determinants of health — factors like education, income, employment, access to care, and the neighborhood you live in and the safety of that neighborhood, said Dr. Denise Rodgers, a Rutgers professor and director of the Urban Health and Wellness Institute, who led the Newark conference. These factors determine about 40 percent of an individual’s health, she said, while 30 percent is related to diet, exercise, and other personal behaviors and 20 percent is governed by clinical care.

This approach has also been used by the Camden Coalition of Healthcare Partners, which pioneered a number of innovative models for treating vulnerable communities that are now being applied nationwide. The coalition has focused increasingly on social supports, like safe shelter, and its “housing first” program is seen as an effective way stabilize the lives of individuals with multiple health and welfare needs. Jared Susco, the group’s COO, talked about this work at the Virtua conference.

The Trenton Health Team has worked with a variety of public and private partners on similar strategies to address nutrition needs and food insecurity in that city; together these organizations have supported urban gardens, a farmers market, and healthier options at corner stores. The group recently received a grant to address diabetes that they plan to use in part to create a mobile produce service of some kind.

To help fill the “food desert” in New Jersey’s largest city, Newark Beth Israel Medical Center created an urban garden, farmers market, and a hydroponic greenhouse that opened last year as part of its Wellness Program. Barbara Mintz, systems vice president for RWJ/Barnabas Health, which oversees Beth Israel, also shared updates at Virtua’s conference on their work on these projects.

To address food insecurity in South Jersey, Virtua also launched a “mobile farmers market” last spring, Ghee explained. Working with local partners to stock a bus with fresh fruits and veggies, the vehicle tours communities in need and sells produce at half the wholesale price – or even less if shoppers have SNAP, or food stamp, benefits. A dietician also rides the bus to help educate people on nutrition and food options.

“That program has been wildly successful,” Ghee said. “It’s authentic population health.”

But surveys conducted by staff on the bus suggest the need remains significant: 44 percent of the respondents said they worried about where they would get their next meal, Ghee said. Those findings underscore the importance of addressing social concerns, she said, efforts that can pay off significantly by keeping people healthier.

“It’s a critical investment,” Ghee said. “We have to treat people before we meet them” in a hospital or doctors office, she added.

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