A few years ago, I saw a lovely patient who had gained a surprising amount of weight between visits. Surprised, because usually she takes great care of herself, I said, “Wow. You’ve gained 10 pounds since I saw you last. What’s going on?” She looked at me and told me that her finances were in dire straits. She explained that she gained weight because her budget did not allow her to buy healthy food. In fact, she told me that the bagged cookies she purchased at a local dollar store were the least costly way to keep her from feeling hungry.
My heart was heavy that day, as it always is when I hear that my patients are having trouble getting their basic needs met. I am fortunate to work in a practice that has social workers, so I was able to get some urgent help for her food insecurity. And yet I knew that it was going to be hard work to take off those 10 extra pounds, and that those pounds were going to make her knees sore and mess with her blood sugars and blood pressure.
I wish this were an uncommon event, but it’s not. According to a NEJM Catalyst blog post, social, environmental, and behavioral factors account for up to 60% of people’s health needs. The things we focus on so often in medicine account for just 10%.
One organization’s story: Stepping forward and making a change
Kaiser Permanente, a health care organization based in California, recognized that nations that focus on social needs — housing, food, transportation — often spend less on health care. So they decided to act on behalf of their patients and tackled the idea of meeting a patient’s social needs to help provide better health care. They didn’t build houses or grocery stores, but they did develop a system that engaged with existing community resources to help reach their neediest patients. By partnering with an exciting social enterprise organization called Health Leads, Kaiser developed a call center to help reach out to people who use a lot of health care resources. They found three out of every four patients they reached had at least one unmet social need. The most common were food insecurity, transportation problems, and difficulty paying utility bills. Kaiser’s program then connected these people with established community organizations who could help.
Putting “health” in a broader perspective
Perhaps few of you taking the time to read this blog have the kind of dire unmet social needs I mention above. But, I bet that every one of you has had a social need or a life challenge that has impacted your ability to take care of yourself. I see it all the time in parents of young children, caregivers of seniors — and, really, almost everyone I meet.
Our ability to be healthy depends on our ability to meet our own basic social, emotional, and physical needs. Articles like this one help us think about health a little bit more broadly. As the World Health Organization says, health is not just the absence of disease, but the presence of physical, mental, and social well-being. Doctors, nurses, and all health care providers need to engage with patients around their unmet needs — big and small — to help engage their patients to enhance their health and feel able to make important physical and behavioral changes.