From 3M Health Information Systems
Changing with the times: A fresh look at the definition of health care
I have started to hear the phrase “social determinants of health” being interspersed with the phrase “health equity.” Although the two phrases are related, there are some fundamental differences in their definitions.
Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship and age that affect a wide range of health, functioning and quality-of-life outcomes and risks.1 These factors are both individual (such as my own propensity for eating potato chips) as well as communal (no pharmacy within walking distance of my apartment).
Health equity refers to the concept that health care should be “fair” in its allocation and delivery of health care related services and outcomes. According to the Robert Wood Johnson Foundation, “Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”2
We have long accepted that individuals have ownership for those risk factors under their control. For example, if I choose to drive erratically, I put myself at risk of getting into an accident. But what if the road is in disrepair? To what extent do we expect our communities to distribute risk equitably?
This definition of risk expands to social determinants of health: To what extent do we expect equitable availability of healthy food choices? Or reasonable access to a pharmacy? Building in safety nets to proactively address disparities so as not to disproportionately affect a population segment?
Our ever-evolving definition of health care must account for ownership of these elements of community risk which impact the equitable allocation of health care and the need for acute care. Health care has historically meant the delivery of services in response to an acute onset in reaction to an immediate need.
As a society, we have realized that we need to take responsibility for ensuring that there are available pharmacies to meet medication needs, that interpreter services are available and that, at a minimum, elements of risk are distributed such that we meet communities at their point of need rather than expecting individuals to overcome those systemic obstacles which prevent health equity. It is these social determinants which undermine health equity.
We have done this in other sectors: We work diligently to maintain heavily used roads. We offer food programs to our children in schools. We offer busing to our children to ensure that every child, regardless of transportation needs, has access to an education.
Going beyond acute onset and following the precedent set in other sectors, we must build out programs and processes that address community needs and distribute health care risk more equitably.
This is the new definition of health care.
Katie Christensen is a healthcare consulting manager within the Population and Payment Solutions group of 3M Health Information Systems.