The health care sector wades into social justice, the UK digital health scene, and pharma nurses face scrutiny

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A slew of hospitals, health care companies and medical schools are putting real money into trying to fix social issues like unsafe neighborhoods or unhealthy diets that affect their patients.

It may seem obvious from an outsider’s point of view that patients dealing with these issues may not be emotionally equipped or financially stable enough to remember to fill and pick up a prescription or have enough gas to drive to a doctor’s appointment, but investing in the social determinants of health is largely a new idea for the U.S. health care system.

This must-read Health Affairs policy brief sets the stage: low-income Americans have higher rates of heart disease, stroke and diabetes. Members of families that earn less than $35,000 a year are five times more likely to report being nervous and sad all or most of the time than people who live in families that earn more than $100,000 a year. These families are more likely to report “catastrophic financial burden” due to out-of-pocket health care costs. And all of these socioeconomic factors disproportionately affect black Americans.

About 90% of the 8,774 physicians surveyed this year by The Physicians Foundation say that some of their patients are dealing with a social issue that is a “serious impediment to their health.” (This is also the first time the 7-year-old report has included a question about social determinants of health.)

But it’s not just doctors and hospital administrators who are paying attention to this issue.

“We're starting to see the [Centers for Medicare and Medicaid Services] and others, even commercial plans, invest money and time and energy in these things,” Lisa Suennen, managing partner at Venture Valkyrie (and former senior managing director at GE Ventures), said this week in a video interview.

Here are a few examples of new initiatives:

• Andy Slavitt, former acting head of the CMS, in May launched a venture fund focused specifically on health care startups serving underserved communities.
• Nationwide Children’s Hospital in Columbus, Ohio, has spent the last decade investing in the surrounding neighborhood, which has historically been racially segregated from downtown Columbus and with high rates of poverty. The hospital gave home-repair grants to homeowners and also bought and flipped vacant homes, selling them to buyers in the local median income range. The concept was to treat the neighborhood like a “patient,” according to an article in the journal Pediatrics. 
• Geisinger’s Fresh Food Farmacy provides food to certain patients with diabetes, in a bid to help control their blood sugar, HBA1C, cholesterol and blood pressure — and keep them out of the hospital.

Last month, the SIU School of Medicine in Springfield, Ill., created a department focused specifically on the social challenges unique to rural communities.

That program aims to do two things: educate future physicians who are going to practice in rural Illinois about this issue, and also reshape the programs that have been developed for urban settings to better fit a rural patient population, said Dr. Sameer Vohra, founding chair of the school’s department of population science and policy.

Of the 102 counties in Illinois, 46 don’t have a pediatrician. The nearest hospital in these rural communities is often 40 miles away, the nearest grocery store 20 miles away. “Geography is so important,” he said.

In small town America, the challenges are different than in urban communities. Many regions have lost their industries, and that leaves people questioning their identity, creating issues with mental illness and substance abuse. “That plays a lot into your health,” Vohra added. “It’s that much harder to have strong physical health as well.”

What’s one issue in your region that has the most impact on the health of your patients? Share your thoughts in the comments, using #TheCheckup.

What I’m Watching

1. Startups aim to rethink the U.K. health system. The National Health Service, the largest public health system in the world, is also the the world’s largest purchaser of fax machines, and health care startups in the U.K. are trying to bring the NHS into the 21st century. On the LinkedIn 2018 UK list of Top Startups, there are two digital health companies: Babylon Health and Medopad. (Keep in mind that no digital health startups made the U.S. list.) “As the NHS seeks to transform itself, a nascent digital health industry is popping up alongside it,” writes my colleague Beth Kutscher.

2. Nurses hired by drugmakers facing scrutiny. Whistleblower and state lawsuits have been filed against pharma companies that hire nurses to educate patients about medications and sometimes help with insurance, saying those nurses illegally promote specific drugs, according to Stat. That also mean patients often won’t switch to other versions of a similar medication, critics say. This issue isn’t new to health care. Many drugmakers got in trouble in the past for using their financial relationships with doctors to boost medication sales.

This week, Dan Neuwirth , founder and CEO of Envera Health , is weighing in on the items featured in #TheCheckup that caught his eye. Join him in the conversation below.

Providers turn their attention to the social issues that affect their patients, digital health startups try to modernize the NHS, and nurse educators employed by pharma come under scrutiny.

What's your take on this week’s stories? Share your thoughts in the comments.