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Until recently, efforts to improve the health of Americans have focused on expanding access to quality medical care. Yet there is a growing recognition that medical care alone cannot address what actually makes us sick. Increasing health care costs and worsening life expectancy are the results of a frayed social safety net, economic and housing instability, racism and other forms of discrimination, educational disparities, inadequate nutrition, and risks within the physical environment. These factors affect our health long before the health care system ever gets involved.
Hospitals and health care systems have started to address these social determinants of health through initiatives that buy food, offer temporary housing, or cover transportation costs for high-risk patients. The prevalence and initial success of these efforts are clear in headlines such as: “What Montefiore’s 300% ROI from Social Determinants Investments Means for the Future of Other Hospitals,” “Social Determinants of Health Gain Traction as UnitedHealthcare and Intermountain Build New Programs,” and “How Addressing Social Determinants of Health Cuts Healthcare Costs.” But when you take a closer look, these articles aren’t about improving the underlying social and economic conditions in communities to foster improved health for all – they’re about mediating patients’ individual social needs. If this is what addressing the social determinants of health has come to mean, not only has the definition changed, but it has changed in ways that may impede efforts to address those conditions that impact the overall health of our country.