Social determinants, moonshots, and near misses…

I remain surprised by blatant omissions and disregard for the larger context of how we talk about healthcare. The spectrum of investments in diagnostics and treatment blunts the upstream role of social determinants and the benefits of funding strategies at all stages of the lifespan. The chronicity of disease as we age seems to surprise those in research & development, health policy, and the media.

Advancements in how we manage escalating healthcare costs, state budgets, and fiscal policy stall in the face of information freely available and important to the ongoing dialogue.

If we don’t understand the drivers of escalating costs, waste, and access to care — or even worse — don’t find it relevant, what does that say about our society?

I invite you to explore the Distressed Communities Index before attempting to understand or contextualize the evolving healthcare ecosystem. I use this information daily especially when preparing to speak in a specific state or community. I have written about The Dunning-Kruger Effect — don’t let it happen to you.

The specific metrics visualized by DCI are listed below. I encourage you to spend time with interactive maps to gain a deeper understanding of what we talk about when discussing social determinants of health.

The DCI combines seven complementary metrics to present a complete and multidimensional picture of economic distress–or prosperity–in U.S. communities:
No High School Degree: Percent of the population 25 years and over without a high school degree
Housing vacancy: Percent of habitable housing that is unoccupied, excluding properties that are for seasonal, recreational, or occasional use
Adults not working: Share of the population 16 years and over that is not currently employed
Poverty: Percent of population living under the poverty line
Median income relative to state: Ratio of the geography’s median income to the state’s median income
Change in employment: Percent change in the number of individuals employed between 2010 and 2013
Change in business establishments: Percent change in the number of business establishments between 2010 and 2013

​The Distressed Communities Index

Too much cure, not enough prevention?

The Moonshot 2020, heralded as a huge advancement in scientific thought has also been criticized as too far reaching and not adequately focused on prevention. In the vein of, no good deed goes unpunished, there is still evidence to support a benefit in cancer prevention.

Otis Brawley, MD, the chief medical officer of the American Cancer Society states, discussing the Moonshot 2020, “It can accelerate development of more effective treatments for those with cancer, find more effective ways to prevent cancer, and find better ways to get treatments and prevention to the people.”

The surprising fact that the ACA barely became law in a society of people brought to their knees again and again by healthcare costs associated with devastating disease, pre-existing conditions, and limited access to services should explain why prevention is not a bigger focus.

A government that provides a society with education, clean water and air, nutrition, safe housing, and affordable healthcare must make necessary investments. The choice is whether they are able to do it the easy way or the hard way…what will you choose?

If upstream is dirty, downstream will be muddy — Tibetan Proverb

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