The organizers of the Root Cause Coalition’s First Annual National Summit on the Social Determinants of Health chose its title with optimism and considerable ambition. Its leaders intend to continue and expand the national conversation on the factors that shape the health of individuals and communities beyond clinical care. These include jobs, housing, education, safety, transportation and, perhaps most importantly, food insecurity.
More than 400 attendees from 38 states, including representatives from health care, government, business, the faith community, food banks and other community-based nonprofits, convened in Chicago in December to share their experiences in dealing with the root causes of socioeconomic and health inequities and to learn how their colleagues and national experts have taken on these challenges. Question-and-answer sessions following many presentations hit on several recurring concerns, including the role of race in health inequity and the special needs of seniors and rural communities.
The summit represented the culmination of the Root Cause Coalition’s freshman year and set the bar for its future goals. The national, nonprofit, member-driven coalition was co-founded in 2015 by the ProMedica health system, based in Toledo, Ohio, and the AARP Foundation. Its leaders, ProMedica President and CEO Randy Oostra and AARP Foundation President Lisa Marsh Ryerson, discovered their shared ambition to address the social determinants of health at an Alliance to End Hunger summit in Washington, D.C. in 2014. They launched the coalition with 15 inaugural partners including the American Hospital Association. The coalition’s chief aim is to improve individual and community health by fostering collaborative partnerships among health care organizations, universities, policymakers and grassroots outreach groups to address the social determinants of health and implement sustainable solutions to ensure that all Americans have an equal opportunity to live a healthy life.
Putting the issues in context
Root Cause Coalition Executive Director Barbara Petee welcomed Ryerson and Oostra, who shared theopening keynote address. They encouraged attendees to engage with each other throughout the conference to draw on their collective experience and resources.
Ryerson articulated the AARP Foundation’s focus on determinants that most affect older adults, including social isolation, housing, limited income and food insecurity. The latter, she emphasized, remains a major issue for many seniors, resulting in many interrelated poor health outcomes.
Oostra described ProMedica’s multiple initiatives to address the social determinants of health in northwest Ohio and southeast Michigan, from food reclamation and screening patients for food insecurity in hospitals and physicians’ offices to moving ProMedica’s headquarters to a former steam plant in downtown Toledo. The $60 million investment, scheduled for completion in the spring is designed to revitalize the inner city while providing employment for more than 1,000 area residents. The project underscores hospitals’ role as drivers of economic as well as physical health in their communities, Oostra said. Providing jobs, he added, “is one of the best things you can do for people.”
“To transform health care, we must focus as much on the social determinants of health as we do on clinical excellence,” Oostra concluded. “We need to work across boundaries, drive research and then scale our efforts.”
Other speakers on the first day of the summit included Donald Hinkle-Brown, president and CEO of the Reinvestment Fund, who described the fund’s mission to be a “catalyst for change by building a framework for community investment,” or investing with a social purpose. The fund integrates data analysis, policy and strategic investments to improve the quality of life in low-income neighborhoods by supporting the construction and sustainability of community anchors such as grocery stores, affordable housing, schools and health centers.
The AHA pledges ongoing support
In his keynote speech on the second day of the summit, AHA President and CEO Rick Pollack praised the coalition’s “valuable work in drawing attention to how food and other social determinants affect health.” He pledged the association’s continued partnership, adding that the AHA plans to bolster its own root-cause efforts.
“The hospital field is on the edge of a revolution in science, technology and care management,” Pollack said. “The key to achieving our vision of healthy communities means working outside the walls of our hospitals. By working together, we can build a future where hospitals are as much aligned with providing health as curing illness.”
Q&A with the surgeon general
After a round of breakout sessions, Vice Admiral Vivek Murthy, M.D., U.S. surgeon general, participated in a question-and-answer session with Root Cause Coalition Executive Director Petee and attendees. Petee asked Murthy how health care providers could work with community organizations to address the social determinants of health.
“Health care organizations need to act as conveners of all those who could make a difference,” Murthy said. “They need to use their powers of persuasion and share concrete examples of best practices. Many government leaders want to hear how hospitals and health systems have improved their communities’ health — the most compelling stories come from the folks on the ground.”
Involving all stakeholders in the difficult discussion around the link between health inequities and race is critical, Murthy said. “We must start those conversations locally, including in schools, bringing people together from different backgrounds,” he said. “The earlier we can start [these conversations], the more clearly we will see each other. Our mission as a country is to take down the walls that separate us.”
Asked if he planned to stay on with the Trump administration, he noted that he has two years left to serve in his post, but added, “I intend to continue as surgeon general as long as I feel I can make a contribution to our country.”
An audience member asked Murthy how the nation should deal with the opioid epidemic, which has recorded quadrupled overdose deaths since 1999, as well as an increase in HIV and hepatitis C infections from contaminated needles tied to the heroin epidemic. “We must change prescribing practices, provide better access to treatment and make naloxone [used to reverse overdose effects] readily available to paramedics,” Murthy said. “But most of all, we have to change how we see addiction in the U.S. The negative bias around it keeps people from seeking help — we need to eradicate that stigma.”
Urban League advocates for equity
Marc Morial, president and CEO of the National Urban League, echoed the call for stakeholder consensus in the final keynote of the summit, titled “Health Equity + Social Equity + Economic Equity = 21st Century Justice.”
“We must educate people about how economic, social and health disparities happen,” Morial said. “We have to keep our minds on this North Star of improved health outcomes and how and where they intersect with social and economic well-being.”
Morial also said the National Urban League would “support and defend the maintenance of the ACA [Accountable Care Act], even with its imperfections until we see something better,” adding that any revisions must cover as many Americans as affordably as possible and must not “gut” Medicaid expansion. That goal ties into four empowerment goals the Urban League plans to pursue in driving public policy over the next five years. “We want to ensure that every child is ready for college, life and work; that every American gets fair, affordable, decent housing; that everyone receives a living wage with good benefits; and that everyone has access to affordable health care solutions,” he said.
A breadth of breakout sessions
Eight breakout sessions on the second day of the conference covered a range of topics: “Taking the Clinic to the Community,” “Calling for Change in a Changing Climate,” “Nutrition as a Social Determinant of Health,” “Hospitals Aligned for Healthy Communities: Leveraging Investing, Purchasing and Hiring for Local Impact,” “Food is Medicine,” “From Independence to Social Isolation: Senior Issues are Everyone’s Issues,” “Insurance and Public Health” and “Housing and Health.”
Health systems including Ascension, Dignity Health, Loma Linda University Health and University Hospitals, academic institutions such as Brigham Young University and Harvard Law School’s Center for Health Law and Policy Innovation and related organizations like Feeding America, Community Health Services and the Democracy Collective shared statistics, initiatives and success stories.
David Zuckerman, manager of health care engagement for the Democracy Collective, emphasized the importance of hospitals, universities and local government as anchor institutions that provide “sticky capital” as employers, purchasers and investors that “stay put,” supporting and sustaining communities by providing financial security. “We must redefine economic development to focus more on local assets and community ownership,” Zuckerman said.
Anchor institutions by definition, he said, have a commitment to intentionally apply the long-term, place-based economic power of their institutions, along with their human capital assets, to improve the long-term health and well-being of their communities. Citing the national decline in factory jobs, Zuckerman said, “We need a new path to the middle class — and the economic impact of hospitals is tremendous.”
Danielle Price, director of community health engagement for University Hospitals in Cleveland, added that anchor institutions need to “focus on building wealth rather than attacking poverty” and called for hospitals to make diversity and local collaboration a priority in any economic development project they undertake, from construction to supporting community businesses.
AARP Foundation President Ryerson also said that addressing financial inequity is fundamental to the coalition’s work. “Poverty is the ultimate root cause,” she said. “Poverty is a racial, LGBT, ethnic, urban and rural problem — ultimately, it’s an American problem.”
Surgeon General Murthy’s words to the coalition’s organizers and attendees seemed to capture the overarching goals of the national summit best: “What you are doing is helping to shape the values of our country,” he said. “America is a promise about what kind of home we will build for each other. Our prosperity and our destiny are intertwined. A home where everyone has health and safety — this is the home we have to build.”
The Second Annual National Summit on the Social Determinants of Health Care is scheduled for Oct. 9–10 in Louisville, Ky. For more details, go to www.rootcausecoalition.org — Laurie Larson is a freelance writer in Chicago. •