October Newsletter

My dog’s Halloween outfit!


Welcome to my October 2021 Living Conditions and Health newsletter. You can find past newsletters with additional background materials, and different stories and initiatives on my website and in my LinkedIn articles or posts. Join me in identifying and coordinating initiatives that advance health, health equity and community and healthcare redesign.

Shannah’s Insights and Reflections

The prolonged pandemic and its disparate impacts on health and the economy continue to fuel needed changes in how many stakeholders think about health services and the living conditions that negatively impact individuals and communities. The politics and misinformation that influence our country’s ability to embrace needed and sustained changes make the progress feel fragile. This months’ entries seem to support this perspective, but that may just be my bias.

An article, and the recent Bipartisan Policy Center report it reviews, discuss the need to expand flexibility for investing in Social Determinants of Health (SDOH) focusing mostly on Medicaid, but also seeking to address silos across Medicaid, Medicare and CHIP.  The report also addresses funding, research, and workforce needs for implementing non-medical and preventive services that have evidence of success. The recommendations are a critical set of steps in the right direction. Equal attention should be given to the many other silos of social services and community infrastructure supports and the many other Federal programs that have overlapping and adjacent service capabilities.

The Transforming Public Health System Data Commission report on Charting a Course for an Equity Centered Data System was supported by the RWJF. It establishes the importance for change, the steps and processes taken to formulate the findings and recommendations and calls to action for a broad range of stakeholders. The Commission and the report represent a substantial undertaking among organizations and consultants to look across the problems laid bare by the pandemic and worsened by systemic racism and related inequities that resulted in the declaration of racism as a public health crisis. This quote from the conclusion emphasizes the significance of inadequate data:

“The Commission recommendations make it clear that in our current system, data on health inequities are divorced from the history and community conditions that shape poor health outcomes, resulting in an incomplete picture of who is most impacted and why.”

Kaiser Family Foundation published Medicaid Director survey results regarding spending in fiscal years 2021 and anticipated spending in 2022. Trends all show sustained increases due to COVID and growing investment in SDOH and initiatives to address health equity.  Increased funding will likely continue until the COVID public health emergency is no longer in effect. Certain changes due to COVID are likely here to stay including Telehealth and initiatives focused on greater equity in areas that include maternal and child health, behavioral health and COVID outcomes and vaccinations.

Manatt published key takeaways from the Gray v. Dignity case about hospital price transparency. Specifically, it challenged the hospital’s failure to disclose an added ER charge on top of the charge for the treatment received in the ER. The added charge was $1,552 that came down to $879.19 after insurer payments and adjustments. The case went against the class action suit on behalf of ER patients. The decision stated there was no explicit requirement in either CA state or Federal law. The court also accepted the notion that price disclosure should not dissuade individuals in need of ER care to avoid such care. I don’t usually cover court proceedings about payment, but this decision seems to run contrary to the problem of debt burden for low-income individuals. While it may meet the letter of the law it would arguably worsen the ability of individuals to avoid large add-on charges that they cannot afford.

I’ve discussed data challenges regarding race and ethnicity in prior newsletters including the census. An article in the New York Times highlights the Census problems with the current race categories and suggests alternatives for 2030. I am a bit on the fence about whether shifting towards country of origin and parents’ country of origin are appropriate measures. I also worry that such measures could have a chilling effect on response while also having the potential for being misused in support of further discrimination. I welcome other thoughts and reactions.

A NORC study showed only 1% of Medicare patients had their social determinants tracked in 2018 – this study seemed extremely early in the uptick of recognition and adoption of the importance of SDOH. In other words, if they wanted to know the baseline in 2018 it was very close to zero.

SIREN picks

My picks for SIREN’s October’s newsletter are: the literature and scoping review of primary care-based interventions to address the financial needs of patients experiencing poverty and the Social Emergency Medicine: Principles and Practice book.

The literature review provides important context on the variability and complexity of what is happening in the US and globally. The review provides a table of screening tools that can be tailored to primary care providers’ needs. It breaks down the findings by targeted interventions and service providers and service users (patients) needs.   The book tackles critical health equity subjects in the context of emergency medicine where the evidence of social injustice is perhaps most evident. It would be interesting to compare the findings in this book with the Public Health Data Commission findings discussed above. The book needs to be purchased, but you can get overviews of the chapters and buy chapters of interest if you aren’t ready for the entire book.

My interests often align with the starred entries of the monthly newsletter. I encourage everyone to sign up for the SIREN newsletter on the home page to see where your interests align.


Two events flagged in the SIREN newsletter:

All In: Data for Community Health 2021 National Virtual Meeting – November 8-10, 2021 | Virtual  

AHA Community Health Improvement: Accelerating Health Equity Conference 2022
– May 10-12, 2022 | Cleveland, OH 

Modern Healthcare’s Social Determinants of Health Symposium, December 9,2021 Virtual price tag $99.00

NIH Rural Health Day Seminar, Structural-Level Determinants of Rural Health Disparities November 18, 2021

RISE Summit on Social Determinants, March 20-22, 2022, Nashville TN

Background and Definition

I have chosen the phrase “Living Conditions” rather than social determinants of health (SDOH) to make the concept more accessible.  This focus tracks with the Centers for Disease Control and Prevention’s SDOH definition “as conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

Go here for more information from CDC on its organizing SDOH framework in Healthy People 2020