Last week, I defined the term social safety net – the network of public assistance programs across the nation. I want to take it a step further this week and explore the importance of cataloguing the public assistance programs and promoting its availability while also examining the viability and sustainability of the network itself. To start, let me talk a little about the concept of social determinants of health.
Social Determinants of Health
The Robert Wood Johnson Foundation and the University of Wisconsin Public Health Institute (2013) collaborated to create a population health model. Essentially, the model indicates that the 80/20-rule applies to health outcomes (as measured by mortality and morbidity). Twenty percent of health outcomes are driven in the clinical care setting while the remaining 80% is driven by health factors, social and economical factors and physical environmental factors (University of Wisconsin Public Health Institute, 2013). The heaviest weighted category in the model is social and economic factors (University of Wisconsin Public Health Institute, 2013). This category includes education, employment, income, family & social supports and community safety (University of Wisconsin Public Health Institute, 2013) that I translate to mean social determinants. This is particularly important when identifying support for low-income families and families in vulnerable circumstances.
Family & Social Supports and Health Disparity
The federal guidelines for poverty are updated annually by the United States Census Bureau and provide guidelines for calculating income levels often used by organizations to determine eligibility for social supports. For example, the 2013 guidelines indicate that families with a total household income of $23,550 or below (for a family of four) are considered low-income (United States Census Bureau, 2013). This family could qualify social safety net services like free and reduced lunch programs, free or reduced child care, nutrition and so on. However, the family would need to be aware that these programs exist and how to apply for them. Also, often, breadwinners in low-income families work more than one job and would need to take time away from work in order to access social safety net programs or health care programs for that matter. By contrast, families who are not considered low-income do not face the same barriers. Low-income families face greater social barriers to accessing health care than their counterparts in other socioeconomic circumstances thus reducing their mortality and morbidity rates and creating a health disparity. This is further complicated for families with disabilities (this term refers to families who have at least family member with a disability). Together I will refer to these populations as “vulnerable” because they are vulnerable to the policies that influence the social safety net designed to support them thus creating or influencing health disparity.
A Potential Solution
One potential solution to addressing the health disparity issue is ensuring that vulnerable families know about available social safety net services and creating methods to help them apply for these programs. Social safety net services are designed to help families with short-term social needs and one benefit is the reduction of social barriers to accessing healthcare and creating this link, in theory, will help reduce health disparities. There is a downside though. I have been analyzing the federal budget for the social safety net as well as the state level budgets to manage these programs. Funding for these programs has been declining despite increases in the number of people accessing them. The changes in budget and the increase in utilizers has had an impact on the network itself. Through the HealthConnections pilot at WellCare Health Plans, Inc., the network catalogued has grown from 2,500 organizations to more than 18,000 despite a 25% decrease in the available services. This deterioration is primarily due to lack of funding or strain from increased need.
Under the premise of the University of Wisconsin Public Health Institute model, the impact of changes to the social safety net could translate into a costly impact on health outcomes and the health care industry overall. There are local solutions being explore everyone like the HealthConnections model through WellCare Health Plans, Inc. While the model is designed to help a for-profit company connect with its local community partners for the benefit of the health of itsmembers and its operating communities, the health plan is working with members of The CommUnity Commitment and other partner organizations to quantify the impact of removing social barriers to accessing health care and the importance of the social safety net in improving health outcomes / reducing healthcare costs. The health care system is changing so rapidly but, as an industry, we cannot risk being rash in implementing changes that could lead to unintended but costly consequences.
United States Census Bureau. (2013, December 16). How the Census Bureau Measures Poverty. Retrieved December 16, 2013, from U.S. Census Bureau: http://www.census.gov/hhes/www/poverty/about/overview/measure.html
University of Wisconsin Public Health Institute. (2013, January 1). Our Approach. Retrieved December 16, 2013, from County Health Ranking: http://www.countyhealthrankings.org/our-approach