Health Affairs
Authors: Caroline F. Plott , Rachel L. J. Thornton, Irene Dankwa-Mullan, Ekta Punwani, Hema Karunakaram, Kyu Rhee, Kelly Jean Thomas Craig, and Joshua M. Sharfstein
US hospitals have some of the most highly trained practitioners, advanced medical treatments, and highest per capita health care spending in the world. Yet, people living in the US have worse health outcomes compared to most high-income nations. From 2015 to 2017, even before the COVID-19 pandemic, life expectancy in the US declined for the first time in nearly a century. In addition, substantial health disparities persist along racial, ethnic, and socioeconomic lines. The COVID-19 pandemic has accentuated and reinforced these disparities: In 2020, Black Americans’ life expectancy has been projected to decrease by three years and Hispanic Americans’ life expectancy by two years, while the country’s overall life expectancy decreased by one year compared to 2017.
This paradox is rooted in the social drivers of health. Economic, environmental, educational, and social factors impact rates of illness in the population. Solutions include investments in primary care and public health, efforts to address the social causes of disease, and a commitment to health equity, defined by the Robert Wood Johnson Foundation as when “everyone has a fair and just opportunity to be as healthy as possible.” The role of hospitals in contributing to these solutions is evolving. In 2017, the National Academies of Medicine found that the most effective hospital contributions to the care of socioeconomically disadvantaged populations are “community informed and patient-centered systems practices” that include (1) commitment to health equity, (2) data and measurement, (3) comprehensive needs assessment, (4) collaborative partnerships, (5) care continuity, and (6) engaging patients in their care. And the call for hospital rankings to incorporate community health and equity into their assessments is growing.