July 1, 2019

Why Social Isolation, Poverty & Low Health Literacy Matter

The following is a brief interview with David R. Nerenz, Ph.D., Director Emeritus, Center for Health Policy and Health Services Research, Vice-Chair for Research, Department of Neurosurgery, Henry Ford Health System. Dr. Nerenz serves on the Drivers of Health advisory committee.

This is the first in a series of posts providing insights from our advisory committee members.

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

David Nerenz: “I might start with social isolation or lack of social support, with living alone being a marker or indicator for the problem. Poverty, or specifically inability to afford essential treatments or other forms of health care, would be in the top three. I’m not sure that low health literacy is truly a “social” need, but I think it is very 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?

“As it stands now, I’d say state and local governments and communities. Individuals clearly bear some responsibility for their own decisions and their own actions, but some factors are outside the control of individuals.”

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

“I don’t know! I hope we can learn more about this during the project. I was very disappointed back 20 years ago or so in reading a large number of “Healthy Cities” or “Healthy Communities” reports. It was very hard to find anything at all that made a meaningful difference in any measure of health. I hope we know more and can do better now.”

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

“Perhaps all of them! Part of the problem about evidence is that the effects of interventions often depend a great deal on local circumstances. What works in one place may work less well, or not work at all, in another place. We have to think carefully about what kinds of evidence are most useful in evaluating potential actions about social determinants of health. It may be that consistent results from observational studies in a variety of environments will be more compelling and more informative than results of randomized, controlled trials in one or two settings.”