Dr Rachel Gold on Why Healthcare Needs to Help Address Social Determinants of Health

While healthcare providers shouldn’t be expected to provide additional services outside of healthcare, they should be able to make referrals to things like child care or food banks, said Rachel Gold, PhD, MPH, investigator at the Kaiser Permanente Northwest Center for Health Research and lead research scientist at OCHIN.

Transcription:

How involved should healthcare be in addressing social determinants? Is there a line where it is no longer the healthcare system’s job to address a social need?

My hope is that we’re going to make the shift to addressing patients’ social needs because it’s starting to become so obvious that social determinants affect, not only, both health and health outcomes, but also affect healthcare costs. And, you know, as a society, that cost issue motivates, so if we could save money by making sure the patients don’t develop full diabetes, or don’t have a heart attack.

If we can address social determinants as a way to prevent patients from incurring more costs in the healthcare system, that’s a real motivator. I’m hopeful that the healthcare system and the healthcare providers will be motivated to addressing social determinants because of its potential impact on cost. I’m hoping that this is a way that we’ll be able to get to addressing social determinants.

Your question is that is there a limit to where the healthcare system will intervene, and, well, the limit is, I think, that in a lot of cases the healthcare providers aren’t going to necessarily be the ones to provide the housing or the food, they’re going to want to just get the patients to the resources they can. Now, there are some that do. I’m aware of some healthcare providers that do kind of a food bank at the clinic, or they provide some kind of child care at the clinic, but that’s few and far between, and it’s hard to sustain financially those kinds of services. So, maybe a simpler answer to that question is, I don’t think healthcare providers should be asked to provide the social services, and I don’t think they feasibly can, but helping them make those referrals, connect to the community, and connect to resources and agencies is, I think, within their purview.

The other way you might want to think about this is in terms of, what is the healthcare setting? I mentioned primary care, family medicine, and pediatrics, and it’s going to make much more sense for those kinds of providers. I think when you’re talking about some inpatient care, it may just be a whole different set of issues that, frankly, I haven’t thought about. I know there are folks that do care management social work after a hospital discharge to make sure the patients are going home after surgery and have appropriate care or some type of support system that makes a lot of sense, but it might depend on what kind of care you’re getting and what kind of system it is. So, if you’re checking out of a hospital, there might be certain social factors that healthcare system would take on versus what your primary care provider and their team is willing to take on.