Dr Robert Groves: Society's Role in Addressing Social Determinants of Health

Robert Groves, MD, executive vice president and chief medical officer, Banner|Aetna, discussed whether health systems should invest in social determinants of health, with concerns raised about the role of government responsibility and the effectiveness of current approaches, while emphasizing the need for long-term solutions and societal health development.

Transcript

You helped to moderate a panel discussion on ideas from “Health Systems and Social Services: A Bridge Too Far?” in which the authors disagreed that health systems should invest in the social determinants of health. Do you agree or disagree with the points made in this commentary?

Yeah, you know, most of the panel I think came in on the side of yes, of course, we need to invest in social determinants. It's our job to maintain the health of the community. And they have a solid argument. I'm not suggesting that that's not so. As I mentioned earlier, I think we need to ask the question, though, how should that happen? The other danger in doing this, frankly, is that if we're intervening—meaning health systems and health payers—then that allows government to shirk their responsibility to intervene. It makes it maybe harder to get the policies in place that actually might contribute to long-term health. And I think everybody there understood that point of view and will take it into consideration.

I don't think things are going to change much, right? It is profitable to do rescue social services and it is better for the patient to do rescue social services, at least those individual patients. It's kind of like the story of the guy who's wandering along and on the beach, he sees all these starfish that have died off and washed ashore, and they can't get back out to the sea. So he starts throwing them back out to the sea, one by one, and a passerby looks at him and says, “You know, that's futile, you're never going to make a difference.” And he tosses another one out there and says “It makes a difference to this one.” That's kind of the trap that we're stuck in. Of course, it makes a difference. Of course, it is a smart investment or systems wouldn't be doing it. The question is, is it the best use of that money? And is it not the taxpayers’ responsibility to determine what they want their communities to look like, and where funds for social support go? But in the absence of a significant change, I don't see systems stopping doing what they're doing until and unless we learn that there's a better way, or that this doesn't actually lead to the kinds of long-term savings and the reduction in the cost of health care, which has to be our primary goal right now. We find that out, I think we'll see a change, we tend to go down a road for quite a while before we change.

It reminds me of a Winston Churchill quote that I go to often, he said that you can absolutely count on the United States to do the right thing after they've tried everything else. And I think we're in the “after they try everything else” phase of health care reform right now. There's an immense amount of complexity in the health care system as it's built up over the years. There are a lot of dollars at stake and there's also a long tradition of being slow to change. And for good reason. You don't want to make sudden moves when you have somebody's life in your hands. So it is not unpredictable that this would be a long, hard slog with lots of side trails and dead ends. But I do believe we're making progress. I'm reminded every time I talk to one of my mentors, Dr Brent James, who's now at Stanford and consults internationally on health care and is a guru of quality and has been for decades. You know, he has taught me to be grateful for the advances that we've seen in health care over the last 40 to 50 years. They are absolutely amazing and we can't lose sight of that. But we must figure out a better way to pay for it and we must figure out ways to get in front of this wave of chronic illness that is overwhelming us and start to develop healthy societies. That's our charge.