Health and wellness: Is zip code more important than genetic code?
The evidence exceeds the tipping point — that point where compelling ideas by necessity transform into action. The evidence? Unmet social needs significantly affect our health, especially our emotional wellbeing. In fact, it is often said that zip code is more important than genetic code in determining overall health and wellness.
More specifically, zip code-based health disparities include such factors as unhealthy housing, unsafe neighborhoods, proximity to pollutants, sub-quality food options, etc. As Beacon Health Options continues to recognize July as Minority Mental Health Awareness Month, it is important to examine how such social determinants of health (SDoH) affect the mental health and health in general of people of color. Approximately 39 percent of Black and 33 percent of Latino youth in the United States live in poverty — more than double the 14 percent poverty rate for non-Latino, White and Asian youth. Further, research shows that poor mental health is prevalent among individuals with lower incomes.
When we use the term ‘social needs’, many of us don’t think of healthcare. Yet, approximately, 40 state Medicaid programs are addressing SDoH through their managed care contracts and other avenues. The shift in focus is a positive sign as the personal costs are too great, and the downstream avoidable healthcare and societal costs are becoming unsustainable.
Supportive housing: An example of an SDoH solution
In a recent study, 17 Medicaid managed care organizations (MMCOs) representing care delivery in 10 states reported that housing, behavioral health, substance use and nutrition/food security were the most common areas of focus. Other MMCOs focused on specific populations, such as people formerly in prison.
It’s not surprising that housing is a common focus. Chronic homelessness is associated with high utilization of healthcare services and increased mortality. Further, people of color disproportionately represent homeless populations: Black Americans, for example, constitute more than 40 percent of the homeless population but represent only 13 percent of the general population. Specifically, housing instability is strongly associated with:
- High stress
- Poor mental health
- Low medication adherence
- Postponement of needed medical care
- Increased emergency room use/hospitalizations
Therefore, permanent supportive housing programs for chronically homeless individuals represent one of the most compelling arguments supporting SDoH investments.
For example, Beacon’s Massachusetts Behavioral Health Partnership, in collaboration with the Massachusetts Housing and Shelter Alliance, administers the Community Support Program for People Experiencing Chronic Homelessness (CSPECH). Once participants are housed, they meet with community support workers to coordinate access to physical, behavioral health, and social services. Individual lives improve and states can save money. One 2017 study found that per-person monthly costs were $765 lower in the 24th month following CSPECH entry than in the month prior.
More to be done
Housing is just one SDoH example of how we can move the needle on the mental health for people of color. In addition to cultural competency training as discussed in our last blog, there are other steps we can take to address inequitable mental health care. Below are some recommendations from researchers at the Health Disparities Unit at Massachusetts General Hospital on how to address barriers to care as they relate to SDoH:
- Integrate behavioral health services into other naturally occurring community-based settings, i.e., housing, employment support programs and faith-based organizations
- Promote use of peer specialist outreach — Address stigma and trust issues through certified peers with similar background and life experiences who can help with navigating housing, employment, educational and other services
- Increase use of telehealth and telephonic clinical solutions to help those people with transportation or other care-access issues
Regardless of one’s ethnicity or background, the most significant impacts to our health are socially determined. Not surprisingly, the path to a solution requires collaboration among diverse groups of people. Beacon Health Options calls upon all stakeholders to rethink how we think about healthcare — physical and behavioral — to address health disparities among people of color.