SDOH initiatives took center stage at HLTH 2021, but will they really take shape off-stage?


MedCity News

A diagnosis of multiple sclerosis (MS) can turn even the most relaxed, imperturbable person into a full-time worry warden. Even during periods of prolonged remission, when symptoms are graciously held in check for weeks or even months, the disease has other ways of making itself felt. It lurks in the outer realms of your consciousness, always ready to derail your train of thought with concern about the next inevitable flare-up – when will it happen, where will it happen, and how bad will it be? It is questions like this that create the persistent background buzz of anxiety and fear in most MS patients, 43% of whom have an anxiety disorder, that is significantly higher than in the general population.

With that slight fear, I worked my way through the crowd of over 6,000 health professionals who had arrived last month for HLTH 2021 at the Boston Convention and Exhibition Center – an annual industry event that researchers, vendors, entrepreneurs and other health care executives for a series of keynotes, presentations and networking exercises; all with the stated aim of inspiring innovations and forging partnerships in the healthcare sector.

While the goals are to be commended, such events become all the more problematic for an MS patient in the midst of over 6,000 people all shaking hands, shuffling feet, and forcing smiles to an endless procession of new acquaintances. Live music, twirling party lights and countless eye-catching (and eardrum-bursting) shows openly vied for the attendees’ attention in the conference area.

As I emerged from the crowd, I spotted a vacant seat near the main stage and sat up straight as the lights dimmed for the opening ceremony. The presentation began with a short, animated video – a montage of around 15 current and attention-grabbing public health statistics. A mix of today’s gritty reality and tomorrow’s inspiring trends, the statistics aimed to address some of the most historically marginalized public health issues, including race, inequality, mental health, and addiction.

“From 2019 to 2020 we saw the biggest decline in life expectancy in the US since World War II,” boomed the narrator. “Disproportionate influence on people of color. Although people of color are almost five times more likely to be hospitalized with Covid, the majority of research neglects these communities.

“63% of our younger generations have significant symptoms of anxiety or depression,” the narrator continued. “The number of overdose deaths in the United States rose nearly 30% from 2019 to 2020, with the highest increase among adolescents.”

Though far from illuminating, the numbers were clearly effective. As I listened to the last two statistics – and watched the accompanying animation of a man collapsing with a pill bottle in hand – I thought of my brother, who had had a lifelong mental health problem that was left untreated. In the absence of quality care, he began self-medication at a young age and eventually died from the complications associated with alcohol abuse disorder.

Part of me was naturally encouraged to see traditionally marginalized issues like this being addressed so openly and honestly in this setting. Equally encouraging were the opening remarks by HLTH CEO and Co-Founder Jonathan Weiner, which included uncompromising calls for progressive action and the important role of Social Determinants of Health (SDOH) in patient outcomes.

“To solve the biggest problems, leaders need to get used to talking about disparities and understanding the root cause and the different approaches that need to be followed to support the health needs of different populations,” Weiner said.

It was a strong statement. And many other speakers would repeat the sentiment in the coming days, with vendors, CEOs and activists all seeming to align with the need to not only include SDOH in the standard care model, but also to address the injustices behind it. The conference schedule was filled to the brim with discussions on inequality, racial justice and the SDOH. With program titles such as “Systemic Health Activism: Designing for Equity”; “Achieving Social Equity in Healthcare”; and “Is Poverty the Root of SDOH?” there was no question that the organizers were invested in the topic.

But despite the encouraging coverage and bold, ambitious statements, there was a part of me that wasn’t that enthusiastic. Instead, this part of me couldn’t help but resist some of the grandiose statements about inequality and injustice. Despite all the passionate calls to action and carefully thought-out strategies – and the undeniable belief behind both – I always kept the same question in the back of my mind: “Have I never heard that before?”

Over the course of my decades-long career in health analytics, I have read, heard, and thought about a lot about SDOH. It is therefore not surprising that over the years I have come across some of the same ideas and feelings that were expressed at this year’s HLTH conference. What is surprising is how little has changed. To date, up to 80% of health outcomes in the United States are determined by social determinants such as race, income, and educational level. To this day, our health system allows the forces of inequality to operate our hospitals and clinics largely unseen and uncontrolled.

It’s like the industry has MS itself. Somewhere between the brain, where thoughts and intentions are clearly aligned, and the body, where those ideas and intentions do not manifest as action, there is a breakdown. Unlike a real MS patient, however, the industry doesn’t seem concerned. If at all, the industry professionals and decision-makers appear more confident and optimistic than ever. And maybe that’s because, unlike multiple sclerosis, there is a cure for the inequalities that plague our health care system. Year after year, event after event, we expand our understanding, refine our strategies, and develop new technologies that could help us identify and remedy these injustices. But it is time we followed our own calls and moved from talking to acting.

HLTH 2021 was encouraging. Despite the lingering déjà vu feeling, this was the first time SDOH had been the focus of such a large industry event. While it’s true that not everything that was said was truly newsworthy, it was the focus and ardor behind it. Even if SDOH was not the focus of a presentation, many of the speakers attached great importance to integrating them into their presentations in a meaningful way. And in the presentations that focused on such topics, there was an undeniable urgency behind her words that was inspiring even to a chronically concerned like me. And yes, I will continue to worry. I will continue to worry about my brother and the millions of people who still slip through the cracks. But alongside this worry there is now a little flame of optimism burning.

I am fairly certain that the societal determinants of health will again play a prominent role in speeches and presentations at next year’s HLTH conference and other major health events. The question is whether the discussions are dominated by refined statistical insights and fiery calls to action or real case studies and systemic audits that show tangible improvements in care.

For the first time, I am sure that progress will come. And while I still worry about how, when, and most importantly, who gets lost in the meantime, I know those details won’t be that important once we get there.

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