Your well-being, your life expectancy, and your access to quality health care should never depend on your race, income, or hometown. That was the message delivered by AAMC leaders and a diverse group of experts who spoke at the 11th annual Atlantic Festival, held Sept. 24-26.
If this nation is going to achieve health equity, we must focus more fully on social determinants such as housing, transportation, and access to healthy food, Philip Alberti, PhD, AAMC senior director of health equity research and policy, told hundreds gathered in Washington, D.C. The three-day event, sponsored in part by the AAMC, brought together thought leaders on topics as varied as Brexit, climate change, and social justice.
In an interview with USA Today editorial page editor Bill Sternberg, Alberti noted that only about 20% of a person’s health reflects what happens in a clinic or hospital. “The other 80% has to do with conditions where we live,” he said. “For health care to work, the rest of the ecosystem has to work too.”
AAMC President and CEO David J. Skorton, MD, who joined Sternberg and Alberti on the main stage, told listeners that one of the social determinants of health “that keeps me up at night” is gun violence. Other concerns include access to care, affordability, the opioid epidemic, and the impact of mental health problems. The varied elements of our social environment “can gravely affect our lives and the lives of our loved ones,” Skorton noted.
While the country has far to go in creating environments that fairly promote the health and well-being of all, many communities and health care systems are working to address inequities, noted Aletha Maybank, MD, MPH, chief health equity officer of the American Medical Association, who spoke at an AAMC-sponsored session titled “Health Equity in America.”
For one, medical schools are working to transform the health care system by teaching future physicians that “health is beyond the walls of the doctor’s office.” In addition, more physicians are screening for social determinants of health — and then looking for ways to “connect those dots” to help meet those needs.
In Washington, D.C., providers can prescribe healthy food, noted LaQuandra Nesbitt, MD, MPH, director of the city’s Department of Health, and leaders are working to create affordable assisted living for Medicaid recipients.
She noted that different communities need different resources. “It’s not about giving everyone the same exact thing,” she said, “but making sure that each individual receives what they need.”
Malika Fair, MD, AAMC senior director of health equity partnerships and programs, pointed to systemic racism as a key obstacle to quality care. She recalled the shameful legacy of slavery and a lingering notion among some providers even today that black people don’t experience pain in the same way as white people.
Increasingly, though, she noted, medical schools and teaching hospitals are working with communities to address some of their most pressing concerns. In Cleveland, Ohio, for example, three academic medical centers created a consortium to stem infant mortality rates in a region that is ranked 99 out of 100 in preterm births. In Cincinnati, Ohio, a children’s hospital is working with local pharmacies to ensure that poor patients with asthma have access to needed medication. And in Florida, Florida International University Herbert Wertheim College of Medicine paired its students with social work students, nursing students, and other trainees to cut emergency department visits in half. In Tennessee, biomedical researchers at Meharry Medical College School of Medicine and Vanderbilt University School of Medicine are collaborating with local leaders to find out what health questions their communities most want to see answered.
Health equity and the opioid epidemic
The opioid crisis in particular has illuminated the challenges inherent in treating a disease that is often exacerbated by social inequities.
Sana Chehimi, director of policy and advocacy at the Prevention Institute, noted that individual adverse childhood experiences and community-wide traumas often merge to undermine mental health and well-being. “We have to address those adverse community experiences if we want to have not only healthy and resilient individuals but healthy and resilient communities.” She suggested that any settlement funds from opioid litigation be dedicated to tackling community concerns.
Kostas Skordas, director of research and evaluation for the Appalachian Regional Commission, spoke of the need to reduce the stigma of seeking addiction treatment, as well as providing a network of services to support those in recovery.
Finally, Rep. Cheri Bustos (D-Ill.) spoke of the “Social Determinants Accelerator Act” that she helped introduce in Congress July 25.
Bustos, who represents an area dotted with small towns, focused on health disparities in rural America. It took one hospital in her district 7 years to find a provider, she said. The act allocates about 20% of its funds to rural areas, but she added that social determinants of health need to be addressed everywhere.
To achieve that goal, several speakers noted, leaders must focus on the strengths that communities themselves have to offer. “Health equity is certainly about the challenges we face,” noted Garth Graham, MD, MPH, vice president of community health and impact for CVS Health and president of the Aetna Foundation. But, he added, “there’s also tremendous strength and power in those communities. We just need to unleash them.”