While the importance of the social determinants of health is broadly recognized,† we are still learning how to integrate these with the healthcare system. As a consequent, the importance of the broader components of healthcare, e.g. behavioral health, dental health, public health, and social health, stay diminished despite evidence that they are the predominant contributors to death and disability. Even when integration is an explicit goal of a community based Coordinated Care Organization, a fundamental barrier stays; the current healthcare system is structured for separation more than integration.
Healthcare as medical services has become isolated. This isolation has contributed to unsustainable increase in direct healthcare expense that since the mid-1980s has grown faster than the economy supporting it. The negative consequences of medical costs are multiplied in every community through suppressed wages and growing pockets of poverty. None of this was intended. This is a wicked problem; the result of the mismatch between how real systems work and how we think they work.†† This is hard to see because we are looking at it from the wrong perspective.
Social determinants reframe the problem.
The reality is that medical services, like all biologic and social systems are complex and cannot be managed effectively in isolation. Social determinants help us see from the perspective of community.
Social determinants of health are community determinants of success. From the perspective of the community, in which medical services is but one sub-system, we can better appreciate its true interconnectedness and interdependency. The problem is not integrating community health services into a medical model; it is integrating medical services back into the community.
Integrating social determinants is a sandbox for changing healthcare delivery.
The integration of Social Determinants is fresh territory that needs a system model capable of dealing with complex environments. First, we need to step back from thinking in silos to see what is necessary to manage a wicked problem.
Better managing wicked problems
Today’s system science gives us the ability to better manage this wicked problem that confronts us. The concept can be boiled down to three ideas.
- An interconnected, adaptive Network is necessary to manage an interconnected, ever adapting environment (i.e., a Complex System).
- Self-organization around simple, purpose-guided rules will produce behavior that more effectively manages the reality of healthcare’s Complex environment.
- Purpose-guided behavior will achieve better outcomes in situations that have no fixed solutions and are to too wicked to understand.
We can leverage the properties of complexity and its underlying simple rules to solve problems that managed care interventions complicate and make worse. Already, projects are underway based on The Curandi Model of applied systems science that offer specific instances we can all learn from. These methods will reintegrate medical services into the broader healthcare system and improve value. Social determinants integration is the key to restoring the system to a more natural state.
Learning with Curandi.
The Curandi Model offers a new medium to align and measure purpose in a structure that adapts to solve problems. This is a game changing platform that supports:
- Managing wicked problems and situation
- Purpose oriented analytics
- Integrated research into all disciplines of healthcare and system science
- Flexible outcome based payment
- Distributed innovation where portable and scalable solutions can arise from any community
- New business models
- New healthcare markets
Curandi is a not for profit membership organization focused on healthcare as a living system. Its projects produce new experience, new knowledge, and new methodologies that are available to members and subscribers to the Curandi Knowledge Base.
† Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity
†† Paraphrased from Derek Cabrera: Systems Thinking 2.0 — Systems Thinking made simple: new hope for solving wicked problems