11 Ways To Advance Health Equity: A Psychiatrist’s Perspective

As a psychiatrist working with marginalized and underserved individuals, I see firsthand how poverty impacts health and timely access to healthcare.

How can we treat depression in a patient who doesn’t have a place to live? How can we encourage heart healthy behaviors if someone doesn’t have access to healthy food How can I teach stress-reduction to someone facing economic insecurity? The truth is, not very well.

Medical providers are under tremendous time pressure and are not often trained in what is called Social Determinants of Health (SDOH), referring to the conditions people live in, and Health-Related Social Needs (HRSN), referring to social and economic needs that individuals experience that affect their ability to maintain their health and wellbeing.

Even if providers are well-versed and committed to addressing factors that impact a person’s health and wellbeing, they often don’t have an effective strategy or institutional support for pinpointing health-related social needs and making referrals that get patients the support they need.

As an advisor to Emotivo Health, a startup that works to make mental health access more equitable by preventing burnout of therapists while increasing quality of evidence-based care, I’m excited about the ways technology-assisted intermediaries can standardize the screening process for addressing health-related social needs and make thoughtful referrals to support services. Start-ups like Emotivo help facilitate the ways in which providers can document and code for these social determinants of health in order to maximize impact. While we are far from a system that cares for all, I am hopeful about reducing healthcare disparities and providing a holistic approach to healthcare in the near future.

Technological and continued advocacy for a more equitable healthcare system can go a long way in the growing shift towards a more inclusive and holistic approach to healthcare which will crucially recognize and address not just the clinical aspects of health but also the social, economic, and environmental factors that impact a person’s health and wellbeing.

A more integrated approach to healthcare can lead to better health outcomes, particularly for vulnerable populations, and potentially reduce healthcare costs by addressing the root causes of health disparities. The integration of SDOH/HRSN into healthcare practice is a crucial step towards a more equitable and effective healthcare system. Here’s how:

Reduce health barriers, lower costs, and improve health outcomes

In 2022, the Department of Health and Human Services (HHS) published a report: Addressing Social Determinants of Health: Examples of Successful Evidence-BasedStrategies and Current Federal Efforts that highlights successful evidence-based strategies that can help reduce health barriers, lower costs, and improve health outcomes including the following:

1. Deploy “housing first” interventions that provide supportive housing to individuals with chronic health conditions including behavioral health conditions

2. Improve food access through healthy food environments, public benefit programs, health care systems, health insurers, and evidence-based nutrition standards

3. Provide non-emergency medical transportation which is shown to be cost-effective

4. Providing cash payments to families and income support for low-income individuals with disabilities

5. Prioritize early childhood care and education

6. Utilize multidisciplinary teams that support HRSNs

How communities can transform healthcare

In November 2023, the U.S. Department of Health and Human Services (HHS) released a Call To Action: Addressing Health-Related Social Needs in Communities Across the Nation, focused on integrating health and social care to improve overall health and wellbeing.

The Call To Action emphasized the role of community-based organizations in coordinating services across health care and social care sectors, as well as several other initiatives that address HRSNs, including:

7. Community Care Hubs: These serve as backbone organizations coordinating services across health care and social sectors as well as streamlining access to care and addressing SDOH.

8.  Data-Sharing Systems: Emphasis on developing data-sharing platforms, like Emotivo, that integrate health and social care information to improve service delivery.

9.  Community Partnerships: Encourages forming partnerships with local organizations, healthcare providers, and other stakeholders to address community-specific needs effectively.

10. Training and Workforce Development: Focuses on building a skilled workforce, including community health workers and peer support specialists, to address SDOH.

11. Innovative Funding Models: Discusses new funding approaches, including value-based care, to support these initiatives.

Recently, the Biden administration released a Social Determinants of Health Playbook, aiming to advance health equity. This comprehensive approach highlights the importance of collaboration among different sectors, including community-based organizations, healthcare systems, clinicians, payers, and public health departments.

Additionally, the Biden administration issued guidance to state Medicaid directors encouraging the incorporation of value-based strategies across their healthcare systems with the potential to address SDOH and reduce disparities within the health care system. This is expected to improve efficiency, quality of care, and health outcomes by addressing SDOH and disparities across the healthcare ecosystem by recognizing that factors like stable housing, nutritious food, quality education, and employment opportunities significantly impact wellbeing.

In early 2024, New York governor Kathy Hochul announced that the Centers for Medicare & Medicaid Services (CMS) had approved New York State’s 1115 Waiver Amendment to advance health equity, reduce health disparities and strengthen access to primary and behavioral health care across the state.

Legislative policy and reforms portend a paradigm shift in our approach to health and wellbeing and underscore the need for a healthcare model that goes beyond traditional clinical interventions to encompass the social, economic, and environmental factors that profoundly impact health outcomes.

By addressing the root causes of health disparities, such as poverty, lack of stable housing, inadequate nutrition, and limited access to quality education and employment opportunities, we can start to rectify these systemic inequities and, in the process, improve individual health outcomes and reduce overall healthcare costs.

The road ahead involves continued advocacy, fostering multi-sector collaborations, and continually adapting to the evolving healthcare landscape. However, the ultimate goal remains clear: a healthcare system that not only treats illness but actively promotes health and wellbeing for all, regardless of social or economic status.