Influencing Social Determinants Of Health

Ram Raju, MD, senior vice president and community health investment officer at Northwell Health, still remembers two patients the finest clinical care couldn’t help. The first was a man who had blood drawn at Coney Island Hospital, where Dr. Raju was medical director more than a decade ago. When the results came back that evening, they revealed an electrolyte imbalance so dangerous the patient would almost certainly die without immediate treatment. The staff dropped everything to try to contact him.

But he’d given a fake phone number and address, probably because he was undocumented and feared deportation. “We never found him,” Dr. Raju said. “He just became part of New York’s statistics.”

Dr. Raju knew she was counting on chemotherapy to help her beat the disease, so he was surprised when he heard that she’d abandoned treatment. The patient’s reason proved tragically simple: Her landlord wanted to evict her in order to raise the rent, and had told her he would change the locks on her apartment the next time she left.

Want more on the latest in healthcare? Visit The Well by Northwell.

“She had two options — go get chemotherapy and be homeless, or stay in the home and die of cancer,” Dr. Raju said. “She chose to stay.”

These are just two examples of what public health experts call social determinants of health — life conditions that can help people stay healthy or make health all but impossible. Studies show that factors like housing and reliable access to nutritious food have a far greater impact on well-being than medical care.

Dr. Raju started building a team to tackle those social determinants when he came to Northwell in 2016. “We have to treat the whole person and not just the disease,” Dr. Raju said. “That is the only way to improve outcomes.”

Food as medicine

The Office of Community Health Investment’s first pilot projects have just started implementing real change.

One of the most basic social determinants of health is access to nutritious food, as in: Do you reliably have it? Studies show that 1.3 million people in communities served by Northwell are food insecure (that is, they don’t always have enough nutritious food).

For more healthcare articles, visit The Well by Northwell.

People who lack food security can need longer hospital stays and are more likely to need readmission. So the Office of Community Health Investment is collaborating with Long Island Jewish (LIJ) Valley Stream and Long Island Harvest on a new project called a Food as Health Center, where food is dispensed like medicine.

The newly launched Food as Health Center identifies patients who are food-insecure and provides a three-day supply of nutritious food; follows up to ensure they’re getting the nutrition they need; and assists eligible patients with enrolling in the federal Supplemental Nutrition Assistance Program (SNAP). A registered dietician provides guidance on eating right for their health condition. “The hope is that this will help some of the most vulnerable in our community get healthier faster and stay healthier longer,” said Stephen Bello, PA, executive director at LIJ Valley Stream.

Supercharging the fight against opioids

Staten Island struggles with an epidemic of opioid abuse more than any other borough. In 2015, it ranked highest among the boroughs for rate of death from overdose.

The Office of Community Health Investment is working with Staten Island Borough President James Oddo, Jonathan Morgenstern, PhD, director of addiction treatment at Northwell and other experts to develop a data-driven strategy to prevent, treat and reverse opioid abuse throughout the borough. Supporting clinical and nonclinical efforts that are already underway, the initiative will help Mr. Oddo determine the most effective path forward.

“We believe that rallying all of the important efforts on Staten Island around a set of clear, quantifiable priorities will allow us to make the most headway in this fight,” said Mr. Oddo. “That’s why we’re working with this team to identify key measures of progress in our battle against the opioid crisis.”

Harnessing the power of information

The team in the Office of Community Health Investment is also developing the Northwell Health Social Vulnerability Index (SVI) — another tool that will help the health system better treat and prevent disease. Using a variety of data from sources like the US Census Bureau and the US Department of Agriculture (which tracks food deserts), the SVI will identify the biggest barriers to staying well in each of the census tracts in Northwell Health’s service area, such as homelessness, hunger or crime that makes it unsafe to go outside for exercise. At the same time, internal data, such as records of past appointments, will shed light on a patient’s health history. The index will help Northwell get the biggest return from its community investment dollars. It will also allow clinicians to treat their patients more effectively.

Want more on the latest in healthcare? Visit The Well by Northwell.

“If a patient comes in and the treatment isn’t working, often the first thing a clinician will do is prescribe more medication,” said Dr. Raju. “But if the patient is living under a bridge, he’s not going to be able to take the medication. The most important treatment might be to refer the patient to the Long Island Coalition for the Homeless.”

Ultimately, these efforts — plus others, including a planned interactive digital platform that will provide patients with information about diet and lifestyle changes that can help with their medical conditions — may result in more effective care, with fewer interventions and lower doses of medication.

“Right now, in medicine, it’s like we’re pulling people out of a river,” Dr. Raju said. “All our skills and research just allow us to pull people out of the river faster. What we’re saying with this new approach is: Let’s go upstream and see why people are falling into the river in the first place. Let’s try to fix that.

Written by Lisa Davis

More from The Well by Northwell:

• Live With Less Stress In 4 Steps
• 5 Ways To Exercise At The Office

Photo credit: Getty Images