Positioned for Transformation: Expanding the Scope of Health Care

In the Stanford Social Innovation Review’s “Realigning Health with Care,” authors Rebecca Onie, Paul Farmer and Heidi Behforouz express their collective belief that—in the United States—we need to expand our understanding of the scope of health care, where it’s delivered and who delivers it. They also make it clear that the time to do so is now if we are going to confront our country’s rising health care costs, primary care physician shortage and expansion of the ranks of those living in poverty or hovering just above it.

Onie, Farmer and Behforouz also propose that we need to look beyond our shores and borders for models for how to do so, pointing out that “in the developing world, there is no choice but to design health care systems that account for limited financial resources, scarce health care professionals and significant poverty.”

We couldn’t agree more.

Since 2009, the Robert Wood Johnson Foundation has supported Health Leads, the organization led by Rebecca Onie. Health Leads enables physicians and other health care providers in six U.S. cities to prescribe basic resources, such as food and heat, for their low-income patients—just as they would medication. The model recognizes that, too often, the fact that a family lives in a mold-infested apartment or doesn’t have enough food holds greater influence over whether they can improve their health than medical care or prescriptions. As Onie, Farmer and Behforouz explain, in addition to broadening the scope of health care, Health Leads broadens where it is delivered by using family resource desks in hospital waiting rooms to connect patients with these social resources. And it extends the health care workforce by relying on passionate and skilled college volunteers to work with patients to make those connections.

In addition, the Foundation’s Pioneer team has begun to look overseas for health care solutions that have the potential to be adapted here in the United States. We’re starting off slowly, trying to learn as much as possible from our peers at other foundations who have been funding health care programs overseas for years. For example, we’ve brainstormed with colleagues at the Center for Health Market Innovations, a program funded by the Bill & Melinda Gates Foundation and the Rockefeller Foundation, about scaling and replicating innovative programs and policies that are already improving health care delivery in low- and middle-income countries. 

With this same strategy in mind, we partnered with Ashoka Changemakers to conduct a competition to seek out health care solutions from abroad, announcing the winners last month. In fact, Onie, Farmer and Behforouz highlight one of the winners of the competition in their article: Brazil’s Associação Saúde Criança. Saude Crianca—like Health Leads—recognizes that health care goes beyond the doctor’s office; to be healthy, children under their care need to be able to live in safe homes where they are well-fed and the whole family is supported on a path out of poverty.

We’re also working with the International Partnership for Innovative Healthcare Delivery to explore how health care could be delivered at lower cost by using different models of where health care is delivered and by whom. As Onie, Farmer and Behforouz point out, the United States health care system often relies too heavily on doctors in circumstances where nurses or even community health care workers are skilled to be delivering services more efficiently and at lower cost.

Despite our agreement with Onie, Farmer and Behforouz, we see challenges ahead. To begin with, we need more champions—across all sectors—for programs such as Health Leads, Saude Crianca, or any other model that addresses the gap between a patient’s medical and social needs. To increase awareness and understanding and expand the pool of those willing to advocate for changes in the health care system, the Robert Wood Johnson Foundation, in partnership with Harris Interactive, released the results of a poll late last year highlighting the fact that the vast majority of physicians believe unmet social needs are leading directly to worse health for all Americans. In early April, we hosted an online discussion asking people to share their ideas on bridging the gap between physicians’ desire to address their patients’ social needs and their lack of time or sufficient staff to do so effectively.

In addition to finding champions, we need to continue to eliminate silos that make it difficult for health care providers to address the social factors that are defining their patients’ health outcomes. Hospitals are never going to become social service agencies and they shouldn’t; that's not their expertise. We need to “properly execute the solutions we already have” by building more successful integration between health care providers and those who have the know-how and capacity to respond to patients’ social needs.

As a foundation, we will continue to seek out innovative solutions—overseas and in the United States—and to evaluate the most promising to establish that they are effective and can be spread. Just because it works in Haiti does not mean it will work in Hartford. For those models and approaches we believe can be scaled, we will provide support to enable them to develop strategies for growth that reflect an understanding of which elements of the model or approach are essential for success.

We hope you’ll join us by sharing your ideas, partnering with us to help the most effective ideas achieve the scale they need to transform health on a major scale, and to champion efforts to “make sure that what we call ‘health care’ is broad enough to get the job done.”

As Rebecca Onie, Paul Farmer and Heidi Behforouz make clear, the time to do so is now.

Read more stories by Deborah H. Bae & Jane Isaacs Lowe.