MedCity Influencers, Social Determinants, Health Services

The critical need for community investment

In comparison to other developed countries, we spend the least amount of money on social care and the most on medical, with the worst overall health outcomes. We must intentionally and strategically reallocate some healthcare dollars to invest in communities.


What does it mean when we talk about “community?” The word gets tossed around a lot by healthcare systems and payers, politicians and yes, technology companies, most with good intentions, all with a desire to find some magic bullet to decrease overutilization of hospitals and emergency departments, save money, and improve public health outcomes.

What would benefit us all is to remember is that at their core, communities are humans living their lives–not problems to be solved.

Basic Needs and Dignity (It’s not that complicated)
Long before “social determinants of health” and “community-based organization” were the terms du jour, there were advocates, leaders, and activists in some of the most underserved towns, cities, and regions, working tirelessly to help struggling families and individuals meet their basic needs, often with minimal resources. Because that’s all social determinants of health means–it’s a fancy term to describe the factors that actually affect people’s health more than anything else. Do they have a safe, clean place to live? Do they have access to nutritious, health-supporting food? Are there quality public places to walk, run, and play? Do children have the same educational opportunities and resources, regardless of where they live? Are there sufficient local mental and clinical health providers so that people can get the care they need without having to go to the hospital?

It seems simple. Eliminate barriers to care so all people have equitable access to the services they need, equal opportunities for economic prosperity, and they’re less likely to get sick, develop chronic diseases and co-morbidities, and land in the hospital time and again. By eliminating these barriers to care, we give communities a fighting chance. But historical inequities and policies designed to maintain the status quo have rendered the solution more complex than it should be.

Covid-19 Impact on Vulnerable Communities
The reality, as we all know, is that marginalized communities don’t have the same access and opportunities as their middle and upper-class neighbors. Whether in inner-cities, rural or suburban communities, resources are scarce, quality public transportation and housing are limited or inadequate, education is poorly funded and sub-par, and preventative health care sometimes just doesn’t exist. Black and Latino hospitalizations and deaths from COVID-19 are disproportionately higher than those of Whites or Asians, according to the CDC.

Now add into the equation a pandemic of this scale and the effects are devastating.

Throughout rural America, for example, there were already profound gaps in medical and dental care, with significant hospital closures and fewer local practitioners. Populations tend to be older, and much-needed resources far apart or non-existent.

And in cities, where neighborhoods are typically segregated, people are crowded into small spaces, and few have the luxury to shelter-in-place because they have to leave their homes to work, the virus has decimated communities.

We will learn many lessons from this moment in history, chief among them that we can no longer deny that decades of systemic and institutionalized neglect and marginalization of many lower socio-economic regions and communities of color have left them particularly vulnerable to this crisis, without a clear path to recovery once the immediacy has passed. Now consider the fact that 80 percent of someone’s overall health and well-being happens outside the four walls of healthcare, with scarce funding to provide those essential resources in communities, and it’s no wonder people are suffering.

National Public Health Infrastructure
Both the social care and healthcare sectors have been fragmented and siloed for too long. But we are not without hope or a plan. Planning is underway with local governments and community leaders to lay the foundation for technological infrastructure that, while not the solution alone, is the mesh that can connect all care providers, funders, policymakers within one shared ecosystem, with alignment around common goals.

Historically, community-based organizations have had to make the untenable choices between funding critical social programs or upgrading their technology and capacity. Because their mission is to help people–they naturally choose the first. Their budgets are built on grants, fundraising and philanthropy; unlike other sectors such as healthcare, they don’t get reimbursed specifically for their work, not at scale–yet.

These decisions shouldn’t be mutually exclusive–CBOs should be able to advance technologically AND continue to develop and grow programs that serve people. We need a future where social care is elevated to the same priority level as healthcare and community-based organizations are reimbursed when appropriate improved health interventions are delivered.

Long-term Strategy
While the immediate national response to Covid-19 was clinical, an underestimated aftershock of devastation is imminent–the unprecedented stress put on our human and social service systems. Although the unemployment rate fell from 14.7% in April to 11.1% in June, the US economy is still down 14.7 million jobs since February. This rate still remains higher than at any point since the Great Depression. Increasingly the top needs of families across the country revolve around having food on the table, a roof over their head, and utility assistance. We can’t solve this problem without an appropriate infrastructure to connect the high demand with appropriate supply. We cannot collectively allow history to repeat itself. In comparison to other developed countries, we spend the least amount of money on social care and the most on medical, with the worst overall health outcomes. We must intentionally and strategically reallocate some healthcare dollars to invest in communities, help them recover and get stronger, and most importantly, develop the resiliency to withstand the next inevitable crisis. Everyone deserves the opportunity to thrive, not just survive.

Taylor Justice, U.S. Army veteran, graduated from the United States Military Academy at West Point in 2006. He was commissioned as a Second Lieutenant in the US Army as an Infantry Officer and later received an honorable medical discharge from active duty. Taylor co-founded Unite Us in 2013 while enrolled at Columbia Business School, where he earned his MBA in 2014. Taylor is leading Unite Us on its mission to launch coordinated care networks across all 50 states. A key architect of Unite Us’ network in North Carolina, Taylor led the Unite Us team and supported their partners in creating NCCARE360, considered by some to be the most innovative statewide healthcare transformation endeavor in the country. In 2020, Taylor was named to Crain’s New York Business’ “40 Under 40” list. Driven by the belief that health begins in communities, Taylor advocates for national infrastructure that connects health and human service providers: a public utility to better support those in need.

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