A prescription to address healthcare’s blind side

If you have read Michael Lewis’ book, The Blind Side, or seen the popular movie based on it, you know that the title refers to the fact that quarterbacks, who are typically right-handed, can’t see when a 300-pound opponent is charging at them from the left side. Not being able to see the full picture puts the quarterback directly in harm’s way and makes it harder for his team to succeed.

There’s a blind side to health care too, and it’s keeping us from doing what matters most to improve people’s health and deal with our long term medical costs.

A recent poll of physicians revealed that 4 out of 5 believe that unmet social needs — things like nutritious food, transportation, adequate housing and employment assistance — are leading to worse health outcomes for their patients. And those physicians do not feel confident in their capacity to do much about them.

We know that our zip code can be even more powerful than our genetic code when it comes to people’s health.  Indeed, the conditions people live in day in, day out—and where and how they live, learn, work and play—have a greater impact on their health than the medical  care they receive to repair the damage to their health.

We can, and simply must, do more to keep people as healthy as possible in the first place.  And that means taking a serious look at those factors in our neighborhoods, workplaces and schools that shape our health from the earliest years of life.

Clearly, though, our current system does not give providers the capacity to address these factors. Given the chance, the physicians who were polled would write prescriptions for things like routine physical activity, nutritious food, adult education, transportation assistance and housing. They estimated that nearly 1 out of every 7 prescriptions they write, in fact, would be for social needs of their patients and their families.

For most doctors today, however, their hands are tied. They can’t hand patients that right prescription of medical care and connections to community resources that can help them take action to improve their health where they live, learn, work and play. Failing to deliver on what their patients need is discouraging  to all caring physicians .

An organization called Health Leads has bridged this gap for physicians and patients in the six cities in which they currently operate. It empowers doctors to help remove the social barriers that keep people from taking the actions they need to be healthy. Doctors at facilities where Health Leads exists literally write prescriptions that help struggling families access basic resources like heat for their homes, subsidized child care or food for their kitchen tables. The program’s skilled college volunteers then navigate the complex web of social services and community resources to help patients “fill” the prescriptions. In so many cases, there is help available, but neither the family nor the physician knew about it or could effectively access it.   Health Leads is an innovative and promising model the Robert Wood Johnson Foundation is supporting and testing in hopes that it can take hold far more widely across the country.

But — and Rebecca Onie, the dynamic leader of Health Leads, would tell you this herself — more can and should be done.

As we struggle as a country to reduce health care costs while increasing access to medical care, we also need to think about how these unmet social needs make it harder for people to live healthier lives. Physicians overwhelmingly wish the health care system would cover the costs associated with connecting patients to services that address their social needs, because they have no doubt that doing so would improve their chances of helping people get – and stay – healthy.

I like to think that Lewis’ Blind Side metaphor also has a second meaning, by referring to the overlooked connection between care given at the doctor’s office or hospital and the larger social sphere where our lives – and our health – happen.  If our leaders across the health care sector—from providers to policy makers to insurers— can empower doctors to address social factors as an integral part of care delivery, we can realize dramatically better outcomes in the health of all Americans, and especially the most vulnerable among us.

James S. Marks is Senior Vice President and Director, Health Group, Robert Wood Johnson Foundation.

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  • Anonymous

    What needs to happen to make this possible? RX for transportation, food, housing sounds great – how do we responsibly make it work in this financial climate?

    • Anonymous

      Good comments both.  First I think we have been unaware how much things like housing, food, heat and transportation problems can hurt the health of people especially children and so the costs we are paying for medical care now include some of problems brought on by not having good food or housing.   Secondly there often exist ways to help in communities that physicians are not aware of or how to help their patients get access to them.  So the added/marginal costs to the system may be much less than expected.   Regardless as a nation we need to find a way to have less illness to be fixed- since hospital ER’s and care is so costly.  Further we need to make this happen as easily as we can and using existing programs or improving on them seem to be good ways to start.   The Health Leads approach is exciting to us because it does both of those things and uses volunteers to  do them. 

  • Anonymous

    Interesting question.  But are we sure it is more expensive to pay for these costs?  I wonder whether or not it will save money as it could reduce the number of repeat visits?

  • http://twitter.com/katellington Katherine Ellington

    I’m clear on the connection between health and zip code that creates a biology of disadvantage and preventable vulnerability.  Prior to medical school, I worked in community development. We often used words like moribund and pernicious in proposals to describe neighborhoods needing remedy. New housing, early childhood centers, workforce and economic development can shape healthier communities. It takes upstream efforts including leadership and policies to help reshape built environments for health. This is an investment strategy where the return is cost-effective and life saving.

    Patient charts (and electronic medical records) should include social determinants of health data enabling  clinical-decision making tools that would actually generate where necessary prescriptions for food, housing, jobs and safe environments. We should then advocate with these unfilled scripts to look for solutions as well as to our legislators and communities as evidence of the need for change. 

    I also hope that more will done to introduce the social determinants of health into the medical school curriculum as well as residency training with questions on board exams. This is health care’s blind side –  we all have more to learn and do.

    • Anonymous

      The World Health Organization’s definition of health, probably the most widely accepted one, states that health is more than the absence of disease.  It is a complete state of physical, mental and social well-being.  An aspiration to be sure.   But it changes how we think of health,  and the ways to promote, protect and preserve it. 
      We in health tend to believe that good health is what people want.  What they really want is a good life-warm personal relationships, fulfilling work, a sense of community and family, and accomplishment.   Good health is a crucial base that makes that kind of life more attainable and sustainable.  
      Your comment on zip code also highlights that the odds can stack against individuals if the community and societal framework is not there to make a healthy easier to attain.  If the neighborhood is not safe;  housing decrepit-moldy, infested, leaded;   good food distant, or costly or very inconvenient.   Think of a poor person with diabetes living in such a neighborhood who gets great health insurance -perhaps as good as someone in Congress.   That person can get meds, visit with the doctor as often as necessary, have feet, eyes, kidneys checked etc.   S/he will also be told to eat better, exercise-probably by walking.   S/he will be less likely to do so if safety and inconvenience are serious.   Diabetes progression will be faster, hospitalizations more likely , complications come earlier all due to things that are outside medical care.
      So I believe that community development and promotion of health, and medical care are fundamentally about helping people and families attain that broader fuller definition of health and the life we aspire to have.  Thanks for the comment. 

  • Anonymous

    This makes too much sense. Politics and the medical establishment would never go for it.