This examining health inequities series is created as a part of being a student in Examining Health Inequities at the University of Alabama at Birmingham, where I am challenged to examine health inequities and provide my own opinion.
Summary and assessment of Moving Upstream: How Interventions that Address the Social Determinants of Health can Improve Health and Reduce Disparities
Summary
Health outcomes are determined by more than the traditional medical interventions that happen within a medical facility. The Social Determinants of Health (SDoH) play a critical role in the health outcomes of populations in communities across the United States. Moving Upstream: How Interventions that Address the Social Determinants of Health can Improve Health and Reduce Disparities, identifies six key themes in society that affect an individual’s health;
- Neighborhood living conditions
- Opportunities for learning and capacity for development
- Employment opportunities and community development
- Prevailing norms, customs, and processes
- Social cohesion, civic engagement, and collective efficacy
- Health promotion, disease prevention, and healthcare opportunities
This article effectively identifies research studies that measured the positive impact of interventions that targeted a non-medical need that resulted in an improvement of health outcomes. This topic should be of the utmost importance to anyone that has interest in reducing the financial cost of healthcare, improving health outcomes, and the overall wellness of society.
Importance of this information to society
In 2020, the United States spent $4.1 trillion on healthcare expenses, accounting for 19.7% of the nation’s GDP, approximately 8% higher of GDP than other high-income countries. In comparison to 10 other high-income countries, the U.S. ranks last in overall health outcomes, even though healthcare spending is significantly higher. An improvement in how healthcare is managed will improve overall health outcomes and reduce the financial burden, allowing for the investment of these resources to develop the U.S. in other needed areas. Multiple studies have already shown the positive financial implications of SDoH focused interventions.
Interventions focused in the community on SDoH needs also create opportunities for new community programming that will benefit all residents and develop potential employment opportunities. These interventions and programs will also lead to a mindset shift for what healthcare means in America. Today, healthcare is very reactionary with less focus on preventative actions. The Anticipatory Care Model (one of many approaches referenced) imparts the belief that individuals need to receive incentives beyond brief visits with a physician and health education pamphlets, healthcare needs to be focused on relationships and preventative actions.
Strong supporting evidence
This article provided a compelling case due to the large volume of research studies conducted on programs focused on non-medical interventions that had positive health outcomes. There were over a dozen programs referenced that focused on multiple types of interventions in areas of early childhood development, legal support, community and neighborhood development, and even income support assistance. All of these studies had similar positive results where the intervention was focused on a non-medical need but greatly impacted health outcomes like blood pressure, pregnancy, BMI, and many other healthcare outcomes.
The United States and most high-income countries are heavily influenced by a nation’s GDP and current economic status. Oftentimes a program or policy is measured based upon the financial return on investment. This is often challenging in healthcare, especially in a bloated U.S. healthcare system. This article identified two effective programs that improved healthcare outcomes and created a positive financial return on investment. The Nurse-Family Partnership Program resulted in improved prenatal behavior, pregnancy outcomes, postnatal behaviors, maternal employment, child development and created a $17,000 return to society for each family that engaged in the program. Additionally the Perry Preschool Program, an early childhood academic enrichment program improved childhood academic performance, reduced risky behaviors, and resulted in a return of $17 to society for every $1 that the program spent. These programs create clear pathways for how healthcare outcomes can improve while also reducing financial expenses.
Weak supporting evidence
While this article presented multiple strong points and a variety of studies, there were opportunities to present more diverse studies and outcomes. Of the approximate 12 studies presented, six of the studies were focused on pregnancy or early childhood development outcomes. The article was weak in presenting as many positive studies in other areas of SDoH interventions. Additionally, the article specifically stated, “…ample evidence documenting effectiveness existed for only two interventions: early childhood development programs for low-income children and rental assistance programs for low SES families.”. This article was weak in expounding upon this statement, including why some studies have been successful and why some studies have not been. Multiple studies also referenced challenges is being able to isolate what specific event may have improve the health outcome.
The studies highlighted throughout the article referenced multiple programs that were run by organizations, but very few references were made to the role that local, state, and federal government has or should be playing. The Civil Rights Act impact on health outcomes was explained, but these studies were never explained in further detail and an opportunity was missed to further describe policies focused on SDoH that have been employed across the United States that have helped or hurt healthcare outcomes. This has critical implications due to the government playing a key role in funding opportunities and sustainability of future programs and interventions.
Erik Angus 