Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health

Abstract

Policy Points Multisector collaboration, the dominant approach for responding to health harms created by adverse social conditions, involves collaboration among health care insurers, health care systems, and social services organizations. Social democracy, an underused alternative, seeks to use government policy to shape the civil (e.g., civil rights), political (e.g., voting rights), and economic (e.g., labor market institutions, property rights, and the tax‐and‐transfer system) institutions that produce health. Multisector collaboration may not achieve its goals, both because the collaborations are difficult to accomplish and because it does not seek to transform social conditions, only to mitigate their harms. Social democracy requires political contestation but has greater potential to improve population health and health equity.

sSocial Determinants of Health and Cumulative Incidence of Mortality among U.S. Adults without Major Chronic Diseases

“…25 Considering the existing literature and our findings, point-of-care intervention on individual social needs may miss important opportunities for primary prevention, which more widespread social services could provide. Yet there is not a clear path forward to re-imagining health in the U.S. without support for reshaping public policy and the social contract in the U.S. 29,30 To our knowledge, this is the first report of the impact of adverse SDOH on mortality within relatively healthy adults without known major chronic diseases. This analysis has several strengths, including the use of objectively determined chronic disease states, a nationally representative population, and a long duration of follow-up.…”

“…25 Considering the existing literature and our findings, point-of-care intervention on individual social needs may miss important opportunities for primary prevention, which more widespread social services could provide. Yet there is not a clear path forward to re-imagining health in the U.S. without support for reshaping public policy and the social contract in the U.S. 29,30…”