Interwoven in this chapter are two themes that need to come
together: the connection between social determinants of health and
interprofessional care. First, we are clearly in an age when we need to
address population health. When we talk about that, we quickly get to the
factors that impact health that are not classically thought of as biologic
in nature—other than one’s genetic makeup—such as the environment
in which you live, education level, and level of income. All those factors
impact health. Second, if we want to have a healthy population or return
people to health, particularly those people with chronic diseases, then we
have to think about team-based care.
In regard to the first theme—population health—academic health
centers are beginning to understand both the need to address the social
determinants of health in education, research, and service delivery and
how to meet that need. As just one factor in a complicated landscape,
the trajectory of reimbursements further compels hospital partners to
make sure that they address the social determinants of health for the
populations they serve.
That links directly to the second theme—team-based care. Leaders of
academic health centers need to fully understand and embrace the fact
that healthcare, particularly in terms of addressing chronic diseases and
whether it is to return people to health or to keep people from getting
chronic diseases, is about much more than a physician or another kind
of healthcare provider seeing a patient, making a diagnosis, and writing
the correct prescription. It is about considering all the factors that affect
health—such as environment, education, income, toxic stress levels, and
so forth. Given that social determinants of health are beginning to be
acknowledged as core to the mission of academic health centers, we have
to commit to making sure that the students for whom we are responsible
are educated in a way that fosters “team.”
Thinking in this way has several important implications. For one, it
suggests that leaders of academic health centers need to think about—
and recruit for—the healthcare workforce in the context of teams. Our
workforces can no longer be just about physicians and nurses—they also
have to include social workers, lawyers, community health workers, and
all the other practitioners that contribute to care. That’s one thing that
leaders of academic health centers need to appreciate now.
That leads to a final point. As leaders of academic health centers, we
need to appreciate the fact that we were educated and have practiced in
an era when our education, training, delivery of healthcare, teaching of
healthcare, and our study of healthcare have all been very much siloed.
Given that, we cannot simply turn around and suddenly say to the faculty
and the academic health center workforce that it’s a whole new ballgame
and now we all have to work with each other.
While we underscore the importance of preparing students to work in an
environment that emphasizes teams, we have to be cognizant of the fact
that the very people that we are asking to educate those students were
not prepared that way. That’s perhaps a long-winded way of saying that
ongoing faculty and staff development will be critical components as we
move forward in team-based care.
Jay A. Perman, MD
President
University of Maryland,
Baltimore