Thinking Big: Can Ix Cure More than Health Care?
By Josh Seidman | Popularity: 20%Ok…well, not by itself. But follow with me for just a couple of minutes…
I attended an excellent briefing on Capitol Hill yesterday sponsored by the Institute for Alternative Futures in Conjunction with the Congressional Hispanic Caucus. The briefing, “The Health Disparities Collaboratives: Enhancing Quality and Reducing Disparities,” is part of the IAF’s Disparity Reducing Advances project, in which I have been involved for a few years.
Two of the central messages from all the excellent presenters (David Stevens, MD, Director, Quality Center, National Association of Community Health Centers; Paloma Hernandez, CEO, Urban Health Plan; Roland Gardner, CEO, Beaufort, Jasper, Hampton Comprehensive Health Services) were (not surprisingly):
- Targeted patient education that is tailored to the community’s needs and supported in a variety of ways and is designed to engage and empower people to manage their own health (basically information therapy or Ix) is critically important to successful health care interventions in underserved populations.
- No matter what these excellent CHCs do to improve health care services, these populations will continue to experience disparities because of the underlying poverty of their communities.
That got me thinking… If those interventions described (in #1 above) have been shown to have an enormous impact on the health of these populations, maybe Ix and related initiatives can be applied to a wide variety of challenges that underserved populations face — to help with education, employment, and ultimately, poverty itself.
Sometimes I need to be kept in check that Ix is not a panacea for health care (and I am well aware that it is part of a panoply of tactics needed to redesign health care delivery), but perhaps sometimes I also need to think bigger. Where are the opportunities to extend the principles, research and insights we have gained from years of Ix advancement to improve society more broadly?
I’m sure there are many examples out there, so please let me know where you see them.
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November 25th, 2008 at 12:13 pm
Hi Josh,
Thanks for the description of yesterday’s DRA Project Disparities Foresight Briefing on the Hill - we’ll have the slides and a summary up on our website shortly.
you are asking an important question - what is the role of IX in dealing with the social determinants of health? As you note health care alone will not eliminate health disparities. Health care is responsible for between 10% (McGinnis) and 25% (Clancy et. al) of the variance in health conditions. Overall the role of disparities and of the social determinants (e.g., housing, jobs, food, neighborhood safety, racism, and education) are not the central focus of health care. But when a health care provider gives a patient a prescription for nutrition or activity, that provider should be aware of the conditions in the patient’s environment that would reinforce or hinder compliance with the prescription. And as many community health centers and other providers have shown, they can cost effectively leverage those social determinants in support of the patient. THE DRA Project has 3 reports related to this at http://www.altfutures.com/draproject and we are both following the larger movement toward Health Equity and the question of the role of health providers leveraging the social determinants.
Its important to consider the role of Ix in supporting this.
Clem
November 25th, 2008 at 1:55 pm
Clem,
You make some good points. One thing that I think is worth pointing out in the McGinnis & Clancy data. I don’t have it handy, but I believe that one of the other categories is “health behaviors.” Certainly, one of the main objectives and outcomes of Ix is influencing health behaviors, so Ix already is tackling more than that 10-25% figure.
That said, there are still many social determinants that need to be addressed to deal with underlying health issues.
November 25th, 2008 at 3:54 pm
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