Most individuals only think about their health when seeking treatment for a condition or during their annual doctor visit – if they have a primary physician at all. This behavior presents a challenge because care provided in a clinical setting accounts for merely 20 percent of our overall health, according to the Institute for Clinical Systems Improvement.
The remaining 80 percent of our health is impacted by our behaviors, environment and socioeconomic factors—such as how much (or little) we exercise, if we live in a walkable, safe neighborhood, or if we can afford necessary healthcare services, nutritional food and prescription medications.
Together, these determinants illustrate a more complete picture of what it takes to help people get healthier and maintain a healthy lifestyle. As our nation's healthcare providers strive to deliver greater value and best meet the needs of the modern consumer-oriented patient, we should be factoring non-medical influences into our care approach.
It's unclear who exactly is responsible for addressing the systemic barriers to health—such as a lack of affordable housing, healthy food options or economic opportunity among our most disadvantaged patients. Survey results published this month by Leavitt Partners found that while most physicians believe that social determinants of health impact patient care outcomes, most do not believe that physicians are responsible for managing this variable.
The responsibility of managing and responding to the impact of social determinants proves to be a challenge, and these results should trouble any healthcare provider committed to helping people achieve good health. If we don't attempt to break down the barriers that stand in the way of our patients' journey to healthier lifestyles, who will?
To build a comprehensive, inclusive healthcare system, we must develop strategies that attack the principal barriers that prevent people from achieving and sustaining their health. This means engaging and empowering healthcare teams, led by physicians and advanced care clinicians, with the resources, support, and incentives to find new solutions and prioritize what matters most to the people they serve. The new models of care need to be developed to incorporate care navigators and community partners empowered to address factors barring people from living well.
To understand the promise of this approach, consider one factor that greatly influences a person's ability to access the healthcare they need: reliable, affordable transportation. While you might not think much about how we move about the world, for people in poverty, living too far from—or being priced out of—public transit options can literally isolate a person from seeking the care they need and deserve. Each year, approximately 3.6 million people miss or delay medical appointments due to transportation issues, according to the National Academy of Sciences. These missed appointments can lead to poor health outcomes and increased use of the emergency department – a tremendous social determinant barring access to care.
A far better use of resources would be for providers to subsidize transportation for our most vulnerable patients. Physicians agree, and the aforementioned survey found that two out of three doctors believe that efficient, affordable transportation would benefit their patients. For nearly two years now, Ascension has partnered with the ride-sharing service Lyft to ensure that our patients, who have a need for discounted or free transportation, have a way to and from their regular healthcare appointments. Through this partnership, we've provided approximately 43,000 rides for patients who otherwise might not be able to access or pay for transit to our sites of care. It's a simple investment that's having a huge impact not only on our patients, but—when coupled with smart public policies—the health of entire communities.
It will take all of us—including employers, community leaders, social service agencies, philanthropic organizations and government—to shift our way of thinking about health to include social determinants such as transportation. Healthcare leaders must reach beyond the walls of our hospitals and not wait for others to help our patients address their social needs when they are standing in the way of good health. And systems, hospitals and providers must work to remove, instead of adding to, the burden of addressing these complex issues.
As we look to the future of healthcare—one that's based on value, disease prevention and well-being rather than services and transactions—we all must recognize our role in addressing the root social determinants of health. It's a role we all stand to benefit from and, for love of our most vulnerable neighbors, family and friends, we are compelled to play.
Patricia A. Maryland, Dr.PH, is the President and CEO of Ascension Healthcare, a division of Ascension.