The Robert Wood Johnson Foundation-supported Systems for Action research program is again soliciting proposals for new research studies that test novel strategies for aligning medical and social systems. The deadline of October 10 is fast approaching. So why do we need your new research ideas?
The fact is that our toolbox of research-tested strategies for addressing social determinants of health remains alarmingly sparse. Research has produced a large body of knowledge about how social, economic, and environmental circumstances influence health and health equity. We understand the problem better than ever before. Additionally, research has given us valid ways of identifying the populations and individual patients who experience unmet social needs that, if left unchecked, will contribute to adverse health outcomes. We understand who is at risk better than ever before, and we understand that all of us are adversely affected by social conditions that morph into health inequities. Most recently, research has begun to identify actions and interventions that appear effective in connecting patients to services and supports that can help address unmet social needs, such as the Health Leads program and its extensions, and the CMS Accountable Health Communities model. Increasingly, we understand that solutions are possible.
Unfortunately, individual interventions implemented in isolation have yet to achieve the scale and spread necessary to improve health and health equity for large segments of the U.S. population. Our existing systems are not configured to support these interventions. Delivery and financing systems for medical, social, and public health services operate largely in isolation from each other, despite pursuing many common goals and serving overlapping populations. These systems interact in complex and often poorly understood ways through fragmented funding vehicles; information systems; governance and decision-making structures; implementation rules and strategies; and professional practices. Fragmented and poorly coordinated health and social systems can easily blunt, overwhelm and undo even the very best social determinant interventions.
New research is needed that can help untangle the complex interactions of health and social systems and expose novel ways of coordinating systems to improve health and health equity. Very few research-tested models currently exist that describe how to align and coordinate the delivery and financing systems for medical, social, and public health services. We urgently need new studies that can help to fill up our toolbox of models that work.