More than Healthcare: Innovation and the Social Determinants of Health

On Tuesday, August 16, 2016, P2Health, a Bay Area organization promoting innovation and entrepreneurship in the healthcare system, hosted a panel discussion at Prevention Institute. The event focused on challenges and opportunities for system-wide change at the intersection of innovation and the social determinants of health. The speakers included:

• Moses Ike: investment manager, Dignity Health
• Dayna Long: Staff pediatrician; medical director, Center for Community Health and Engagement, UCSF Benioff Children's Hospital Oakland
• Shingai Samudzi: CEO and founder, ProjectVision
• Jessica Berthold: (moderator), communications manager, Prevention Institute

The conversation focused on how the social factors that shape health and equity impact the panelists' work, and where the panelists saw opportunities to embrace technology and innovation to improve health and equity. The speakers drew on their personal experiences, from funding large-scale health projects, to treating low-income patients and advising the White House on the Bridging the Word Gap initiative, to developing new technologies to track health behaviors.

The panelists identified several challenges to large-scale health system change including:

• The healthcare system too often relies on outdated systems, and can be slow to adopt innovations.
• New technologies like wearable health-tracking devices can widen, rather than narrow, the digital divide between low-income and more affluent patients, potentially providing the healthcare sector with an abundance of usable data on its healthiest and wealthiest patients, while leaving patients of greatest need behind.
• The healthcare system as a whole lacks capacity to understand and address the social determinants of health, particularly when it comes to the needs of low-income patients.

However, panelists also cited many promising developments, including:

• New approaches to medicine, like telehealth, to extend the reach of health services to populations without direct access to medical facilities.
• Willingness within the tech sector to track patient behavior on a broader scale.
• Opportunities for frontline practitioners to collaborate and network with individuals from tech and other sectors at community-based events and forums.

Highlights from Q&A:

Describe how the social determinants of health and/or how advancing health equity plays into your work.



Moses: Healthcare's transformation towards value-based care -- as opposed to fee-for-service -- has given birth to a lot of funding. There is a push to impact people's care without medication or equipment.



Dayna: I'm a pediatrician in Oakland. Ninety-eight percent of my patients are below poverty level; 70% run out of money by the month's end; 65% run out of food; 60% are concerned about mental health of caregiver of their children. As a healthcare organization, sometimes we have no way to meet these social needs that directly impact health outcomes.



Shingai: I look at analytics and behaviors and behavior change. To humanize the term 'social determinants,' I think about what you bring to the table when it comes to managing health; what is the density of opportunity to make the best decisions for your health? Where social determinants aren't strong, there is a low density of opportunity. Social determinants are the totality of a set of factors of determining how people behave.

What would you tell individuals in other sectors about the value of addressing the social determinants?



Moses: Tech is just beginning to understand the opportunity to disrupt healthcare. My example is telehealth. We are focused on investing in telehealth to bridge the transportation gap in rural communities... Telehealthcare immediately impacts their quality of life.



Dayna: When I first began to do capacity building for providers and community-based organizations to work collectively, I looked at a landscape of great work within silos. It was clear from beginning that smartest and best from different sectors do collaborate with each other. 



Shingai: Looking at things from a Human Centered Design perspective, things have to be usable to work. I think one thing the tech sector misses the mark on is the assumption that if we give someone an app, the problem is solved.

 

Talk about the digital divide between those who have or don't have access to technology

 

Dayna: The divide becomes clear when you're up at 3 AM trying to discharge a mother into the rain when her baby was just diagnosed with pneumonia. How will medications help when they go home (to no home) and can't fill prescriptions? We don't have the ability or time or systems to address the issues. 



Shingai: I immediately think of wearable devices. They're great if you have surplus time and income, but they miss the point for low-income residents. We have to ask, where are the opportunities to grab data from the daily life of a low-income resident to address their needs? If we don't address patient needs, we will never fix healthcare. 

 

Can you comment on the potential for innovation at a community level to change conditions that would allow people to choose more healthy behaviors -- that is, to increase access to parks, healthy food, transportation - community conditions that affect health?



Moses: I think it's crucial to have forums like this, where people have vested talents in tech and community, where they can put their heads together to innovate.



Shingai: Helping patients improve their ability to self-manage. My company's focus is to identify psychographics of a population that's being managed and understand different types of dynamics and how people interact with their environments. 

How would you advise an entrepreneur and funders?



Shingai: Spend more time hanging out with doctors and nurses, and even time in the ER. You don't understand healthcare until you understand daily decisions of care providers and -- from a patient perspective -- what it looks like within those hospital walls. For funders, I advise the same thing. There needs to be a level of, if not empathy, at least self-awareness. It's good to worry about the bottom line, but what is the endgame if your program doesn't work? [ROI cannot be the sole goal of a funder if they are going to undertake a major health initiative.]