Improving health with limited means: addressing housing and education
By Austin Frakt
The second in a series of posts providing insights from our advisory committee members, the following is a brief interview with Heather Howard, J.D., Lecturer in Public Affairs at the Woodrow Wilson School of Public and International Affairs, Princeton University.
Howard is also a Faculty Affiliate at the Center for Health & Wellbeing, Princeton University, and director of State Health and Value Strategies, a program of the Robert Wood Johnson Foundation focused on assisting states with transforming their health care systems to be affordable, equitable and innovative.
Austin Frakt: What do you think are the top three most important health-related social needs?
Heather Howard: There are many, but economic inequality, affordable and safe housing, and access to quality education are certainly among the most important.
Who/what is most responsible for addressing health-related social needs? Federal government? State/local governments/communities? Health plans? Health systems or hospitals? Employers? Individuals?
All of these actors have a responsibility, but as a former state health official, and someone who works closely with state health officials now, I’m particularly interested in exploring the role of states, and especially what state Medicaid programs can (and should or should not) do. State policymakers are increasingly focused on social determinants of health not only because of the influence they have on health, but also because of the impact on Medicaid spending, usually one of the largest state budget items. For those twin reasons – improving health and using scarce public program dollars wisely – state Medicaid programs are beginning to address the social needs of patients, and officials are asking whether there is a broader role for health programs in addressing more of the upstream structural, social determinants of health.
What single thing could states do that would make the greatest impact in addressing health-related social needs?
We know, for example, that affordable, stable housing is linked to health and equity. But we don’t know nearly as much about how to support communities that foster well-being and the most effective ways to expand access to good housing, given limited resources. I’m excited about the prospects of this project helping to develop a research agenda on what policies work, are sustainable, and move us towards a Culture of Health.
What is an area of possible health-related social need for which we currently lack adequate evidence to guide action?
We think we know a lot about what affects health, but we don’t know about what interventions can actually help. Policymakers need more research on effective interventions, but given the urgency of the matter (and resource constraints), we also need to re-think what standard of evidence we require before undertaking policy interventions. States and other actors are already jumping in and working to address the social needs of residents in the absence of evidence. The work is happening so quickly that insights into what is working and what isn’t will be important to shape future efforts. Providing state health officials and others operating in this space with actionable recommendations about what works will help states invest in social determinants of health interventions that will yield the best outcomes for Medicaid beneficiaries.