The concept of social determinants of health (SDOH) is particularly useful for the field of intellectual and developmental disabilities (IDD). Of course, this is not new news because the field has been engaged in building the social determinants of health for over 40 years. By just looking at longevity of persons with IDD, we can see the beneficial – indeed extraordinary – impact of all that has been accomplished in the field.
Arthur Y. Webb
In fact, the aging of people with mild IDD appears to be equal to that of the general population.
Foremost, I am proposing that the field first understand the importance of SDOH, adopt its framework, and dig into gathering the data to capture the success of the field.
Social determinants of health are defined by the World Health Organization as “the conditions in which people are born, grow, live, work and age,” which are “shaped by the distribution of money, power and resources.” They include income, education, employment, housing, neighborhood conditions, transportation systems, social connections, and other social factors. Social determinants of health operate at multiple levels but are not the same as population health.
In “Meanings and Misunderstandings: Social Determinants of Health: A Lexicon for Health Care Systems,” authors Hugh Alderwick and Laura M. Gottlieb (Meanings and Misunderstandings: Social Determinants of Health: A Lexicon for Health Care Systems The Milbank Quarterly, 2019. Published by Wiley Periodicals Inc.) state that: “The language of the social determinants of health is currently in vogue in U.S. health care. Yet the same words and concepts, such as social determinants of health and population health, are often used in different ways—sometimes with very different objectives.”
Writing in Meeting Individual Social Needs Falls Short of Addressing Social Determinants of Health (Health Affairs Blog. January 5, 2020.) Brian Castrucci and John Auerbach (Health Affairs) tell us that many articles on SDOH “aren’t about improving the underlying social and economic conditions in communities to foster improved health for all – they’re about mediating patients’ individual social needs. If this is what addressing the social determinants of health has come to mean, not only has the definition changed, but it has changed in ways that may impede efforts to address those conditions that impact the overall health of our country. “
The New York State Department of Health has fully embraced SDOH and has formed a Bureau of Social Determinants of Health (SDH) to work with health plans, providers, community-based organizations, Performing Provider Systems (PPS), and Value Based Purchasing (VBP) contractors on special initiatives. Included are supportive housing, nutrition, and education.
The good news is that investments are being made in SDOH and the other good news is that this area has become a legitimate area for research. Slowly but directly the whole concept is being embraced by the health care sector.
Public policymakers need to balance the use of Medicaid to solve larger social issues while ensuring fiscal solvency and continuation of Medicaid core services. In New York, there is a serious fiscal crisis with ongoing funding of Medicaid that might compromise fiscal stability of providers thus making it hard to support SDOH investment. Although New York State is making investments in affordable and special housing—long overdue.
For the field of intellectual and developmental disabilities, there is great appreciation of how individuals persevere in making the best of their circumstances. Persons with IDD are resilient and have learned to tolerate all the newest policy reforms thrown at them even in the face of all the good intentions of making their lives better.
Health-care stakeholders in a national survey said that they face several barriers in trying to address social determinants in population health programs and in clinical care. A few factors were checked off: the lack of payment structures for non-medical approaches lead the way; the lack of effectiveness metrics for non-medical solutions; and the limitations on data sharing.
Conclusion
New York State has made a real commitment to persons with IDD and the vast array of services available to the field in New York.
The leaders in the field know from first-hand experience what the beneficial impact of SDOH is on persons with IDD but lack the data to present a compelling case. I would promote the idea that the framework of SDOH is a valuable way to examine the field of IDD and one that fairly presents the impact the field has had on the well-being of persons with IDD.
A simple step would be to start using the emerging language of SDOH as a way to describe what the field does. Our field is well known for sensitivity of language in referring to the individuals we serve.
Of course, the age-old challenge is to put together a data platform that help describe and measure the success of the field.
Arthur Y. Webb was the former commissioner of OMRDD (now OPWDD) from 1983 to 1990 and Executive Director of Division of Substance Abuse Services (now OASAS) from 1990 to 1992. Mr. Webb has held several senior executive positions in government and the nonprofit sectors. For the last ten years, he has been a consultant working with numerous nonprofits to translate public policy into innovative solutions. Presently is the Executive Director of the New York Integrated Network for Persons with Intellectual and Developmental Disabilities (a nonprofit collaboration of 12 providers). Contact: arthur@arthurwebbgroup.com or 917-716-8180.
