Unmet Social Needs and Health

The Robert Wood Johnson Foundation (RWJF) recently released findings from a study of American physicians about the links between health and unmet social needs. These needs included basic necessities like adequate nutrition, access to public transportation, and safe housing. Physicians overwhelmingly identified unmet needs as fundamentally related to their patients' health conditions, particularly among lower-income patient populations. Unfortunately, four out of five doctors surveyed (a sample of 1000 primary care physicians and pediatricians) said they did not feel confident in their capacity to meet these needs, which limited the effectiveness of the care they provided. Over half of surveyed doctors said their patients did not have access to the resources they needed to stay healthy. As Jane Lowe of RWJF noted in a press release, "America’s physicians understand that our health is largely determined by forces outside of the doctor’s office. Housing, employment, income and education are key factors that shape our health, especially for the most vulnerable among us.”

I am encouraged to see broad support from physicians for expanding the capacity of the health care system to better address these social needs. When prompted to think about how they might write prescriptions for some of these currently unmet needs, doctors working in urban, low-income areas reported that, if they could, they would write prescriptions for employment assistance (52%), adult education (49%) and housing assistance (43%). While doctors also expressed concern about patients' lack of motivation to make health-conscious decisions, their widespread acknowledgment of lack of opportunity and stability as key drivers of poor health speak volumes.  A lack of living wage jobs and educational opportunities diminish individual ability to maintain good health. (Jamie Holmes, of the Global Assets Project, wrote a fascinating piece earlier this year about the concept of "depletable willpower," namely that the psychological energy required to make the difficult daily trade-off decisions that poverty requires leaves people will little capacity to make proactive, healthy choices later on. While not without its problems, this idea could be valuable to the discussion of the RWJF report.) Nevertheless, it is apparent that higher levels of education open vocational doors, provide opportunities to earn higher incomes, and in turn allow people to minimize their exposure to workplace hazards. Un- and under-employment greatly exacerbate susceptibility to financial instability in the face of crises, such as medical emergencies.  The cumulative effect of economic security on health is admittedly profound and difficult to quantify. However, this study adds to the conversation of health and wealth by demonstrating that physicians widely recognize how complex staying healthy can be in the face of numerous unmet needs.  

The Asset Building Program in California recently looked at some of these same concepts during a fall event series on the relationship between health and wealth.  Each event looked at the myriad ways health problems compound financial ones: through inadequate or nonexistent health insurance or through medical debt which damages families’ credit and contributes to financial and mental stress. Video footage and copies of the presentations from these events are available here. The links between physical and mental health and social and environmental conditions is a topic of growing discussion and the RWJF report is a welcome contribution to that conversation.