Removing barriers to health means shifting public policy

Bechara Choucair, MD, is senior vice president and chief community health officer at Kaiser Permanente. He previously served for five years as commissioner of the Chicago Department of Public Health and worked as senior vice president, safety net and community health, at Trinity Health. On Feb. 12, he will speak about social determinants of health at APHA’s Policy Action Institute.

Q: Why is it important to address the community-based social determinants of health?

A: Basic social needs — housing, food and transportation — are inextricably linked to good health. If these needs are not met, it is all but impossible for people to live the lives they want to live. And an individual’s ability to live a healthy, well-balanced life is a reflection of the health of the community.

These social drivers of health are foundational to well-being, but sadly, many Americans face challenges meeting these basic needs. In June of last year, Kaiser Permanente surveyed Americans about their unmet social needs; the results were stark:

• 68% of Americans experienced at least one unmet social need, and 1 in 4 reported that their unmetsocial need served as a barrier to health within the past year;
• 21% of Americans prioritized paying for food or rent over seeing a doctor or paying for medication; and
• Americans reporting unmet social needs were twice as likely as other respondents to rate their health as fair or poor.

These concerning trends spotlight the growing urgency to address social needs and remind us that the time to take action is now.

Q: How is Kaiser Permanente working to improve the health of the communities it serves?  <

A: At Kaiser Permanente, we believe everyone has the right to thrive. As an anchor institution in our communities, we’re uniquely able to advance total health by supporting physical health, mental health and social health — the economic, social and environmental conditions that drive health and equity for our members and for our communities.

As part of our ongoing work to improve these community conditions for health, we’re actively embedding social health into our operations to alleviate barriers to good health nationwide. Some of our recent work includes: 

• Advancing housing for health: We are a national partner with Community Solutions’ Built for Zero initiative, currently supporting 25 communities across America to strengthen their systems to drive population-level reductions in homelessness. We recently pledged $25M to the state of California to support a $750 million flexible funding pool across the state for supportive services and permanent housing. And we currently have three major regional and national capital funds to catalyze affordable housing preservation and production as part of our $200 million impact investing commitment.
• Ensuring food security: Our work to advance community health would be incomplete without our longstanding efforts to tackle one of the most basic of human needs — food. In August 2019, we initiated a multimodal outreach campaign to increase SNAP enrollment in California and continue to advocate for policies that make healthy food options more accessible and affordable for all.
• Addressing social needs: Recognizing there are many social needs that impact health, we have partnered with Unite Us to launch Thrive Local, a set of social health networks that will be available to our members and to communities at large. Thrive Local connects people with community services that can address an unmet social need, while helping health systems build a deeper understanding of social health to inform decision-making, increase prevention, reduce costs and increase health equity over time. The data captured through this effort — for both social needs and community services — will be used to help inform public policy conversations as well.

Creating real, sustainable improvements to the social health of our communities requires cross-sector partnerships with other organizations, health experts and policymakers, and I believe in the years ahead we will continue to see the benefits of these investments on the health of our communities.

Q: How should public health and health care professionals work together — and engage with elected leaders and policy experts — to address social determinants of health?

A: Removing barriers to health requires not just an investment in our communities, but also a concerted and continuing effort to shift public policy. I learned early on in my public health career the importance of bipartisan, long-term solutions at the federal, state and local level — and that everyone has a role to play.

It’s essential that we as public health professionals focus on shifting public policy to ensure people’s environments provide a safe and stable place to call home. As a physician, I was focused on helping my patients meet their medical needs. At Kaiser Permanente, I’m focused on going upstream to address the broader community conditions and social factors, such as food, transportation and housing.

Through our work with CityHealth, Kaiser Permanente is partnering with the de Beaumont Foundation to support our nation’s 40 largest cities in addressing a range of evidence-based policies that impact health, from complete streets to quality pre-K education, smoke-free indoor air and affordable housing. These policies change lives, driving home the need to address the social factors that impact health in order to optimize the health of our communities.

But no one entity can solve this problem alone. Health system leaders can join community-based organizations, policymakers, philanthropists, corporate leaders and others to create change.

Q: You’re also speaking on Feb. 13 at APHA’s invite-only Policy Leadership Summit. What do you hope that it and the Policy Action Institute will accomplish?

A: The goal of the Policy Leadership Summit is to align on a set of consensus-based key policy recommendations to advance food security, housing, income security, transportation and adolescent mental and behavioral health. By bringing together partners with unique expertise to discuss solutions to these challenging issues, we can improve conditions for health and well-being in our communities

We’re excited to be partnering with APHA and AcademyHealth to create a dialogue on how to more effectively address the social determinants of health and look forward to publishing a consensus agenda, along with a policy playbook and toolkit aimed at informing a national dialogue pertaining to social needs.

We can all step up and make a difference, and I’m encouraged to keep building on this momentum so that we can continue to address the social determinants of health and be a catalyst for changes that benefit those we serve.

Hear Choucair and other public health leaders discuss the links between policies and community health during the Feb. 12 Policy Action Institute. Thanks to APHA Live, the Association’s online event platform, participants can tune in to a live webstream of the event or watch it later on demand. Register now!