July 22, 2019

When and how do we intervene to address health-related social needs?

By Austin Frakt

The following is an interview with Paula M. Lantz, PhD, Associate Dean for Academic Affairs, James B. Hudak Professor of Health Policy, Ford School of Public Policy, University of Michigan. Dr. Lantz is also a member of the Drivers of Health project advisory committee. This is the third post in a series of interviews with members of the project advisory committee.

Austin Frakt: What do you think are the top three most important health-related social needs?

Paula Lantz: I view health-related “social needs” as the manifestation within individuals of all of the midstream and upstream social determinants of health that work together to produce socially-patterned distributions of health and health inequities within communities and populations. Individuals and families experience downstream socially-related needs and problems as a result of the myriad ways in which health is socially driven and patterned. Among many important needs, I see income insecurity, inadequate housing (both in terms of quality and stability), and adverse childhood experiences as extremely important social needs/risk factors related to health and well-being across the life course.

Who/what is most responsible for addressing health-related social needs?

No one agency, institution or entity is responsible or “most responsible” for addressing health-related social needs because they are so varied and involve so many different private markets and public sectors. Local government, rather than the health care delivery system, is in the best position to assure and address the social conditions necessary for good community health, including addressing issues related to poverty alleviation, education, housing quality/security, and childhood maltreatment and other adverse childhood experiences.

What single thing could government do that would make the greatest impact in addressing health-related social needs?

There are multiple approaches that governments in partnership with the private sector could take to improve housing quality and security for low-income families. The relationship between housing and health and the myriad policy paths that could improve housing are nicely summarized in a Health Affairs policy brief by Lauren Taylor.

What is an area of possible health-related social need for which we currently lack adequate evidence to guide action?

The impact on health of different income security approaches (such as child allowances or guaranteed basic income) is extremely hard to study and as such lacks an empirical evidence base.

What is one common misunderstanding about social needs and social determinants of health? 

While the increased attention to the social determinants of health by the health care system has many positive elements, it has also led to increased attention and resource investment downstream at the individual level. This includes a lot of money being invested in consulting and business products related to “population health management.” Health care system approaches to the social determinants of health also often reinforce the long-standing conflation between “health” and “health care” and confuse the midstream and upstream drivers of health and health disparities with their downstream manifestations within individuals and families. I recently wrote about these concerns in a Milbank Quarterly article.