SDOH initiatives took center stage at HLTH 2021, but will they truly take shape off stage?

Being diagnosed with multiple sclerosis (MS) can transform even the most easygoing, unflappable individual into a full-time worrywart. Even in periods of extended remission, when symptoms are kept mercifully at bay for weeks or even months at a time, the disease has other ways of making its presence felt. Looming on the outer reaches of your consciousness, it’s always at-the-ready to derail your train of thought with worry about the next inevitable flare-up — when will it happen, where will it happen, and how bad will it be? It’s questions like these that generate the constant background hum of anxiety and fear experienced by most MS patients, 43% of which suffer from an anxiety disorder, significantly higher than the rate seen in the general population.

It was under this pall of low-grade anxiety that I picked my way through the crowd of 6,000-plus  healthcare professionals that had descended on Boston’s Convention & Exhibition Center last month for HLTH 2021 — an annual industry event that brings together researchers, providers, entrepreneurs, and other healthcare leaders for a series of keynotes, presentations, and networking exercises; all with the stated goal of inspiring innovation and forging partnerships in the healthcare sector.

While the goals are to be lauded, for an MS patient events like this become all the more problematic in the midst of 6,000-plus people, all shaking hands, shuffling feet, and forcing smiles for an endless procession of new acquaintances. Live music, twirling party lights, and countless eye-popping (and eardrum-bursting) displays all competed openly on the conference floor for the attendees’ attention.

Emerging from the throng of attendees, I spotted an open seat near the main stage and sat just as the lights dimmed for the opening ceremonies. The presentation started with a short, animated video — a montage of 15 or so timely and attention-grabbing public health statistics. The statistics were a blend of today’s bleak realities and tomorrow’s inspirational trends, and made a point of addressing some of the most historically marginalized subjects in public health, including race, inequality, mental health, and addiction.

“From 2019 to 2020 we experienced the largest decline in U.S. life expectancy since World War II,” the narrator boomed. “Disproportionately impacting people of color. Though people of color were nearly five times more likely to be hospitalized with Covid, the majority of research neglects those communities.”

“63% of our younger generations suffer from significant symptoms of anxiety or depression,” the narrator continued. “Overdose deaths in the United States jumped nearly 30% from 2019 to 2020, with the highest increase among youth.”

Although far from revelatory, the numbers were obviously impactful. Listening to the last two statistics — and watching the accompanying animation of a man collapsing with a bottle of pills in his hand — I couldn’t help but think of my brother, who suffered a lifetime of mental health problems that went untreated. In the absence of quality care, he began self-medicating at an early age, and ultimately passed away from complications associated with alcohol use disorder.

Part of me was of course encouraged to see traditionally marginalized subjects like these being addressed so openly and honestly in this setting. Equally encouraging were the opening remarks made by HLTH CEO and Co-founder, Jonathan Weiner, which included uncompromising calls for progressive action and addressed the important role played by social determinants of health (SDOH) in patient outcomes.

“To solve the biggest problems, leaders will need to become comfortable talking about disparities, and understanding the root cause and the various approaches that must be taken to support the health needs of different populations,” Weiner said.

It was a powerful statement. And many other speakers would echo the sentiment over the coming days, with providers, CEOs, and activists all seeming to align on the need for, not only incorporating SDOH into the standard model of care, but actually addressing the inequities behind them. The conference schedule was brimming with discussions of inequality, racial justice, and SDOH. With program titles like, “Systemic Health Activism: Designing for Equity”; “Achieving Social Justice in Health”; and “Is Poverty the Root of SDOH?,” there was no questioning the event organizers were invested in the subject.

But, despite the encouraging amount of coverage and bold, aspirational statements, there was a part of me that wasn’t so enthused. Instead, this part of me couldn’t help but bristle at some of the grandiose statements about inequality and injustice. Despite all the impassioned calls to action and carefully-considered strategies — and the undeniable conviction behind both — the same question kept lingering in the back of my mind: “Haven’t I heard this before?”

Over the course of my decades-long career in health analytics, I’ve read, heard, and thought a lot about SDOH. So it’s no surprise that, over the years, I’ve come across some of the very same ideas and sentiments expressed at this year’s HLTH conference. What is a surprise, is how little has changed. To this day, as much as 80% of health outcomes in the United States are driven by social determinants such as race, income, and educational attainment. To this day, our healthcare system allows the forces of inequity to run our hospitals and clinics, largely unseen and unchecked.

It’s as if the industry itself had MS. There’s a breakdown taking place somewhere between the brain, where thoughts and intentions are clearly aligned, and the body, where those ideas and intentions fail to manifest as action. Unlike an actual MS patient, though, the industry doesn’t seem worried. If anything, the industry professionals and decision-makers seem more confident and optimistic than ever before. And perhaps that’s because, unlike multiple sclerosis, there’s a cure for the inequities that plague our healthcare system. Year after year, event after event, we increase our understanding, refine our strategies, and develop new technologies that could help us identify and excise these injustices. But it’s time we heed our own calls, and turn from talk to action.

HLTH 2021 was encouraging. Despite the lingering sense of deja vu, this is the first time I’d seen SDOH take center stage at such a major industry event. While it’s true not everything being said was exactly newsworthy, the focus and fervor behind them were. Even when SDOH weren’t the focus of a presentation, many of the speakers made a point to incorporate them into their talks in a meaningful way. And for those presentations that did focus on such topics, there was an undeniable urgency behind their words that was inspiring, even for a chronic worrier like myself. And, yes, I’ll continue to worry. I’ll continue to worry about my brother and the millions of people just like him who are still being left to slip through the cracks. But, alongside that worry now burns a little flame of optimism.

I feel quite certain that social determinants of health will again play a significant role in the speeches and presentations of next year’s HLTH conference, and other prominent healthcare events. The question is, whether the discussions will be dominated by more refined statistical findings and fiery calls to action, or real world case studies and systemic audits demonstrating tangible improvements in care.

For the first time ever, I feel certain that progress will come. And while I still worry about how, when, and most of all who will be lost in the meantime – I know those details won’t matter as much once we’ve made it there.