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More is needed to address social determinants of health

Community members stack their hands in the middle of a circle. Ram Raju, MD, highlights what needs to be done to address social determinants of health and improve the health of our communities.

Ram Raju, MD: Recent legislation is a step in the right direction, but the government will need to jump head in to improve the health of underserved communities

The US Congress made history last month, not because Democrats and Republicans teamed to introduce the bipartisan Social Determinants Accelerator Act, but because for the first time government is looking to address what is known as “social determinants of health.”

The legislation includes up to $25 million in federal funds to create a grant program that would help states and local governments concentrate on improving access to health care, healthy foods, transportation and stable housing.

Make no mistake: this is and should be celebrated. However, it is a mere baby step. And many more steps are necessary to make the needed impact. According to the federal Health Resources and Services Administration, there are 138 areas deemed as “medically underserved areas/populations” in New York alone. Twenty-five million dollars wouldn’t fix a fraction of these communities.

Effective change is needed

Despite health care successes, the reality is that a person’s health is actually determined by his or her lifestyles, behaviors and socioeconomic factors.

Where you live plays an enormous role in how long you live. Long Island is one of the wealthiest areas of the country, but numerous low-income neighborhoods are mere blocks away from communities inhabited by multi-millionaires. One is the historically wealthy Garden City, where life expectancy is 87 years, and the historically underrepresented Hempstead, where life expectancy is 74 years.

Access to safe housing, good schools, healthy food and parks and recreation, the prevalence of crime and drugs, the practice of safe sex — all of these are factors that contribute to huge disparities in life expectancy. Even if people receive the finest health care, they still won’t be healthy if they’re obese, smoke, drink too much and don’t exercise. And even if they correct bad habits, they can’t do much if their living situations are causing an unhealthy lifestyle — children won’t find relief for severe asthma if their homes are enveloped in black mold.

The only way to change this narrative is to strengthen and expand access to social services, especially in underserved areas.

A growing wave

Health care organizations already have dialed in to doing their part.

Last year, Northwell Health partnered with Island Harvest, Long Island Cares Inc., The Harry Chapin Food Bank, God’s Love We Deliver, US Foods and Baldor to start Food as Health, which helps communities deemed as “food deserts” by delivering healthy foods to homes where residents are hampered by chronic illness due to poor nutrition. Northwell also is collaborating with Chicago-based startup NowPow to utilize a platform that connects patients to community-based organizations.

For-profit organizations are delving into this movement, too. In late July, CVS and Aetna announced a new partnership with Unite Us — an organization that provides a person-centered platform to help build and manage their health and social services.

Bringing it to scale

Private philanthropy has been the driving force for these initiatives. These efforts should be maximized.

Healthy people make for healthy and thriving communities. It’s also the right thing to do. And when it comes to making a true impact, we will need government to do more than dip its toe in the water.

The Social Determinants Accelerator Act is a good start, but we need government to jump head in and go to scale.

Ram Raju, MD, is senior vice president and community health investment officer at Northwell Health. He joined the health system in 2016 after serving as president and chief executive of NYC Health + Hospitals.

This op-ed appeared in Newsday.

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