Social Determinants

GreenHouse principals are working to integrate science related to social determinants of health into health care delivery and health professional education. Our efforts include the development of Health Plus Social, an exploration of implications for the health professions; development of the nation’s first graduate nursing program in a school of social work; and development of the first academic roundtable on social determinants, research and professional development.

Cancer’s unwritten rules

Cancer patients’ lives are shaped as much by social norms as by the biology of their disease. GreenHouse and the Susan Poorman Blackie Foundation have partnered to develop the first-ever catalog of those norms – specifically, the social norms related to ovarian cancer.

Findings of our nationwide qualitative research – conducted through interviews with patients, their families and healthcare providers – can be accessed online throughout the process via The Ovarian Cancer Project. One example:  “For many women, the first signs of ovarian cancer don’t seem like medical symptoms at all. They show up as disruptions of their routines in diet, exercise, and lifestyle — areas where our culture often expects them to be fully competent managers of their own health.”

GreenHouse was enlisted in this research by Buck Dodson, SPB’s president and executive director. The effort is part of our portfolio of work furthering the translation of social determinants of health into improvements in the health care system. Our portfolio also includes our publication Health Plus Social and the graduate nursing program at the University of Southern California’s Suzanne Dworak-Peck School of Social Work.

Social health

hplussThere is now widespread agreement that social determinants – factors like race, class and zip code – have greater influence on our health than does our biology. But the health care system has been slow to evolve, leaving providers ill-equipped to help patients and others in need.

GreenHouse has jumped into the void, developing the publication Health Plus Social to explore social determinants and the implications for the training of health care professionals. The publication is part of our efforts as Innovator in Residence to give shape to the new graduate nursing program at the University of Southern California, the first such program housed in a school of social work.

“The basic reason for the neglect of social determinants in health care is that the system is primarily set up to treat acute, biomedical problems,” wrote the report’s editor, Andrew Benedict-Nelson. “Substantial work remains if we hope to translate our understanding of social determinants into practical, specific protocols for care on the individual or community level.”

Challenges like this are now being tackled in inter-professional collaborations, such as one GreenHouse helped launch in summer 2016.

Meet them where they live

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Mobile clinics could play a transformative role in the health care system — and not just as roving emissaries for hospitals.

That was the conclusion we reached in our work with Harvard Medical School and its own mobile clinic, Family Van. We concluded that the real value of mobile clinics is the way they literally meet patients where they live, upending the social norms of medicine. This helps mobile clinics improve patients’ adherence to treatment and sense of agency in their own care – precious knowledge in a shifting health care system.

“Imagine that we could assign a very attentive graduate student to every mobile clinic” Andrew Benedict-Nelson said in a GOOD Magazine article about our work. “With enough data from a variety of settings, researchers could hypothetically identify the crucial ways in which these health workers help patients feel safe, empowered, and open to medical advice.”

The insights – also captured in an article in Harvard Medical School News – informed our work in the social determinants of health, including development of the graduate nursing program at the USC Suzanne Dworak-Peck School of Social Work.

New norms for science

Since World War II, the United States has developed a powerful medical research enterprise centered on federal funding sources like the National Institutes of Health — often nicknamed “Big Science.” But the norms of Big Science will have to be adjusted if we’re going to help society’s most vulnerable people.

That was the conclusion we took away from the Islandwood Science in Nursing Roundtable, a three-day interdisciplinary gathering where we guided thinkers from nursing, social work, and public health as they reckoned with the social determinants of health. Working in teams, participants developed future scenarios for nursing science, targeting strategic milestones that would need to be achieved in coming decades if we are to address the American population’s most persistent inequities.

“Human subjects research seeks insights into standard models of human bodies and behaviors, just as we’ve always done with fruit flies and barnacles,” Andrew Benedict-Nelson wrote after the event. “But human beings aren’t barnacles — the people who are being left out of standard models matter. We need new ideas about how we can expand the vision of the sciences to include all the people they normally exclude.”

The event was part of our work developing the new graduate nursing program at the USC Suzanne Dworak-Peck School of Social Work and was guided by our research into the social determinants of health and professional education.

Relationship Rx

Amidst all the talk of new drugs and breakthrough technologies, many people forget that relationships are the unassailable key to medical care. We dug deep into those relationships in a couple of projects, including one profiled in Harvard Medical School News.

The subject of the story was our work with Family Van, a Harvard-based mobile health clinic serving disadvantaged neighborhoods in the Boston area. In that work, we learned that what made Family Van – and actually, all mobile health clinics – successful was not the way the vehicles traveled from community to community, but the kind of relationships they formed while they were there.

“If the systems in the medical field understand that medicine is more effective in a relationship between a caregiver and a patient,” Jeff Leitner said in the piece, “they will embrace it as a challenge they face and be more willing to utilize mobile medicine to its fullest.”

We also examined medical relationships – specifically, those driven by the patients – in our work with a health care start-up. We expanded on our work in this area through development of the advanced practice nursing program at the USC Dworak-Peck School of Social Work and in Health Plus Social, our published inquiry into the social determinants of health and professional education.