February 22, 2016

Highlighting social determinants of health—beyond the usual suspects


At the June 27 Birnbaum Lecture and beyond, GHRI focuses on social factors that shape our communities’ well-being.

I had an amazing experience a few years ago. I helped produce two reports for the Institute of Medicine (now the National Academy of Medicine) on measuring social determinants of health. Based on input from experts in many fields, the reports summarize the impact that community factors, education, employment, stress, diet patterns, and other domains have on individual and population health. Our reports are more than an evidence review, though. Every domain we included is something that we can positively modify to make people’s health better.

An opportunity to improve community health

Here at Group Health Research Institute (GHRI), our regional work to modify social and behavioral determinants of health could expand dramatically in the near future. One feature of the proposed acquisition of Group Health by Kaiser Permanente is the creation of a $1.8 billion Group Health Community Foundation (GHCF). This foundation will focus on charitable and social welfare needs of people in Washington state, specifically around health and wellness.

GHCF, if created, will be a game changer. It will fund local studies, programs, and initiatives to improve health broadly. A particular focus could be reducing social, psychological, and behavioral disparities that prevent people from getting well-coordinated health care and services. The health determinants from the National Academy of Medicine report will provide a roadmap for the journey we can expect if the new GHCF gets up and running.

The 2016 Birnbaum Endowed Lecture

Dr. Leana Wen

To inspire our community as we begin this journey together, on June 27 in Seattle, GHRI will host Dr. Leana Wen, Baltimore City Health Commissioner, physician, and community health advocate. Dr. Wen will speak on “A shared vision: New perspectives on strengthening social determinants of health” at our 2016 Birnbaum Endowed lecture. This annual event, held since 2000, honors Bill and Hilde Birnbaum, two dedicated Group Health founders.

We have a lot to learn from Dr. Wen, with her expertise on community engagement. And, as the author of When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, we think she will be interested in how GHRI and Group Health are promoting wise, evidence-based care.

Accountable Health Communities

Another big story in this area is the five-year, $157 million Accountable Health Communities (AHC) program from the Centers for Medicare and Medicaid Services. The New England Journal of Medicine recently featured a commentary (subscription required) about the program. AHC will test ways to address health-influencing social needs such as housing, safety, and transportation for people who get Medicare and Medicaid benefits. The goal is improving their health while controlling costs and use of health services.

This goal is achievable because, as the commentary states, more than 95 percent of our health care spending is for direct medical services, even though 65 percent of U.S. preventable deaths are linked to modifiable behaviors and environmental exposures. This situation presents us with a challenge: How can we redress this imbalance while not increasing overall expenses? AHC have the opportunity to answer this question. Consider this: Suppose a person has repeated emergency room visits for asthma triggered by mold in a neglected house. Isn’t it better for the patient’s health and our health system’s finances to eliminate the root cause and rid the house of mold?

GHRI is working on social determinants of health through our Center for Community Health and Evaluation. We’re helping evaluate regional coalitions that will work collaboratively to improve community health. By bringing together representatives from sectors such as medicine, education, and housing, these partnerships can tackle big health issues together. More information is available in the summary of the first-year report of this program (which has a similar name but is a different initiative than AHC). The full report will be available soon.

At GHRI, we recognize the importance of social and behavioral determinants of health, and of disparities in our communities and elsewhere. It’s part of our mission to work for fair, affordable, comprehensive health care for all. We believe that reducing health disparities is the right thing to do and can have broad economic benefits if done well. (Read more about this topic in this New York Times article).

I’m looking forward to conversations with Dr. Wen about these issues during her visit. Please join us. Mark your calendars for Monday, June 27, 2016, and watch for email and mail notices about the 2016 Birnbaum Lecture at the Sheraton Seattle Hotel. See you there.


Eric B. Larson, MD, MPH
Executive Director, Group Health Research Institute
Vice President for Research, Group Health