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Thought Leaders: Reducing Racial Disparities in Healthcare

Pam Nicholson was featured in the September edition of MCOL Thoughtleaders newsletter. The question asked was:

“Is SDoH funding and coordination by Health Plans, Health Systems, Government and other institutions the most effective approach in reducing racial disparities in healthcare in the short-term, or should a different approach be given the highest priority?”

As a former CSO of a large health system, I was committed to the mission of improving the health of the communities we served. To serve the community (whole person) meant addressing the physical and mental health needs and impacting the environment and socioeconomic factors through shared programs, funding, and advocacy to address public policy. Improved health happens when resources and services are provided to areas of need, not necessarily when we ask the community to come to our facilities.

There are at least a dozen different Social Determinants of Health (SDoH), which impact disparities in health. These include geography, income levels, educational opportunities, employment, workplace conditions, access to health insurance, gender inequity, social services, racial discrimination, food insecurity, public safety, and affordable housing and utilities. While medicine has made fantastic progress over the past two centuries, many of our public health challenges remain eerily similar to the mid-19th century when British Social reformer Edwin Chadwick published his findings documenting the disparities in health and sanitary conditions among the more and less affluent segments of British Society. According to the Institute for Medicaid Innovation, socioeconomic and environmental factors account for 50% of overall health outcomes; 30% are tied to health behaviors. Quality healthcare services only make up 20% of health outcomes.

We can be successful in addressing SDoH if the objectives are clear and measurable. Starting with an understanding of the community (population health and geography) and utilizing public data sources such as demographic, public health, and economic data will provide a path towards improvement. When we address racial equity and the impact of COVID-19 on jobs, education, and mental health, all parties need to understand the realities and fears and raise awareness and develop solutions in partnership with the community they are serving.

Some health systems have found that value-based contracting for a population can be beneficial if it includes coordination of care along the entire continuum. Also, health systems have found that partnering with those who provide additional resources is critical to success.

Value-based care has motivated numerous health systems and health plans to make non-traditional investments in housing, transportation, care at home, and community gardens addressing the whole person, not just the physical. Real impact takes true collaboration and coordination.

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