Can Hospitals and Health Systems Heal America’s Communities?

New York State largest private sector employers (in alphabetical order)
  • Columbia University
  • Home Depot
  • JPMorgan Chase Bank
  • Montefiore Hospital & Medical Center
  • Mount Sinai Hospital
  • North Shore-LIJ Health System
  • New York-Presbyterian University Hospital
  • University of Rochester
  • Walmart
  • Wegmans Food Markets
New York City largest private sector employers (in alphabetical order)
  • Columbia University
  • Consolidated Edison
  • JPMorgan Chase Bank
  • Memorial Sloan Kettering Cancer Center
  • Montefiore Hospital & Medical Center
  • Mount Sinai Hospital
  • New Partners Inc.
  • North Shore-LIJ Health System
  • New York-Presbyterian University Hospital
  • NYU Hospitals Center
4 out of 10 of the largest private sector employers in New York State and 7 out of 10 of the largest private sector employers in New York City are healthcare providers.

nyc life expectancies

Physicians, healthcare administrators, and hospital trustees face an important and historic leadership opportunity that our country and our communities desperately need. Hospitals and health systems throughout the country are beginning to build on their charitable efforts, beyond traditional corporate social responsibility, to adopt elements of an anchor mission in their business models and operations.
For most Americans, the term “healthcare” connotes accessing good quality doctors and getting treatment once ill, with a smattering of lifestyle actions that can be taken to try to prevent illness, such as exercise, diet, and supplements. Hospitals, many believe, exist to take care of sick people.
But in recent years, the healthcare sector has expanded its focus beyond illness treatment alone to what creates health in the first place, tackling the challenging social, economic, and environmental issues that, to a large extent, determine our health status, our outlook, and our life expectancy. These are the “social determinants of health,” a complex of factors related to where people are born, grow, work, live, and age. They represent the wider set of forces and systems shaping the conditions of daily life that drive health outcomes, such as inequality, social mobility, community stability, and the quality of civic life.
For over two decades, overwhelming evidence from the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention, and other sources suggests that social, economic, and environmental factors are more significant predictors of health than access to care. The University of Wisconsin Population Health Institute found that over 40 percent of the factors that contribute to the length and quality of life are social and economic; another 30 percent are health behaviors, directly shaped by socio-economic factors; and another 10 percent are related to the physical environment where we live and make day to day choices—again inextricably linked to social and economic realities. Just 10 to 20 percent of what creates health is related to access to care, and the quality of the services received.

sdoh2

An oft-cited observation these days is “Your zip code is more predictive of your health than your genetic code.” Take Cleveland, for example. The median household income in the inner-city neighborhood of Hough is $18,500; eight miles due east in the suburb of Lyndhurst, the median is $63,000. How does this translate in terms of health? In Hough (98 percent African American) the average life expectancy for a male is 64 years. In Lyndhurst (86 percent white) the average life expectancy for a male is 88 years. A difference of 24 years, in just 8 miles.

place2

Given the fact that 80 percent of an individual’s and a community’s health is related to the social determinants, health sector professionals are increasingly asking themselves, “How do we more effectively intervene ‘upstream’ to impact the forces that contribute to high rates of chronic and other diseases?” Yes, timely access to good quality care is incredibly important, especially when one is sick or injured. But more relevant to improving the population health status of the nation, and making care more affordable over time, is improving the conditions—employment, income, transportation, education and housing—in which people live. These are the forces that are driving much human suffering and corresponding healthcare costs. And just as human action—and inaction—have created these conditions, we now have the opportunity to engage our society to transform them.

Saving Gotham by Tom Farley

Saving Gotham by Tom Farley, MD, former New York City Health Commissioner:
Many of the behaviors that matter most to health involve consuming manufactured products—like cigarettes or soda—that are sold with aggressive corporate marketing…. There was no way to reduce smoking in New York City without cutting into sales of cigarettes, prompting Philip Morris to fight back. There was no way to slow the obesity epidemic or fight heart disease without changing what New Yorkers ate and tangling with Burger King and Coca-Cola. People leading those corporations, even as they understood the dangers of their products, were obligated to resist because their shareholders demanded larger profits.
…[S]aving lives in America today means fighting to protect people from the pervasive marketing of cigarettes, junk food, and other unhealthy products….
While the health department’s clashes were always against companies, the press often framed them as battles against average people. New Yorkers didn’t care about trans fats, but the press wrote that Mayor Bloomberg was taking away their French fries. Most New Yorkers endorsed smoke-free bars, but the press treated the Smoke-Free Air Act as a war on smokers. The press cast the battles as government versus citizen in part because the companies fed them that frame. A majority of New Yorkers initially supported “limiting the size of sugary drinks” sold in restaurants, but after the soda companies’ public relations blitz, a majority opposed the attempt to “ban soda.”
Battles like this required a different sort of health department. The health department of 1900 needed epidemiologist, microbiologists, sanitary engineers, inspectors, nurses, and doctors. The New York City health department of 2010 needed economists, lawyers, policy experts, data scientists, community activists, and specialist in using images and words in the mass media….
The UN secretary-general is right that the greatest limit to our becoming much healthier is not a lack of ideas or even a lack of money. It is a shortage of leaders who are willing to take action to save lives in the face of determined opposition.
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