The fish, lake, and groundwater: Driving towards disparities reduction: Equitable approaches to social care at an integrated health system in Northern California

Abstract

Introduction: The growing body of evidence shows associations between upstream social determinants of health and downstream health outcomes. Studies are increasingly documenting race and ethnic differences in social risk factors across all social determinants. Thus, healthcare industry stakeholders are joining the charge to support social needs. In response to these trends, the National Academies of Sciences, Engineering, and Medicine (NASEM) put forth a five-domain framework for health system integration of social care activities into the delivery of care. Methods: Set within the Northern California Integrated Health System (NCIHS), this dissertation employed a mixed-methods design. Manuscript 1 is a literature review that examines multilevel social care programs influenced by the 2019 NASEM framework. Manuscript 2 sources equitable social care activities through qualitative interviews with NCIHS patients, clinicians, and operational managers. Manuscript 3 utilized the Modified Delphi Method to gain leadership consensus and prioritization of said equitable social care activities. Results: Manuscript 1 describes 21 multilevel social care programs aligned with the NASEM framework. Findings questioned NASEM framework completeness, calling for it to address the family level of the socioecological model and more foundationally, structural determinants of health. In Manuscript 2, patients, frontline clinicians, and operational managers detailed equitable social care activities across the five domains of the NASEM framework: awareness, adjustment, assistance, alignment, and advocacy. Four equitable care principles emerged as foundational to the NASEM framework and called for: anti-racism, cultural responsivity, healing-centered engagement, and a whole-family approach in social care. Manuscript 3 included leadership review of 52 equitable social care activities and resulted in 20 activities gaining consensus for prioritization at NCIHS. Results of these inquiries informed the development of an "Equitable Social Care Integration Proposal" for NCIHS consideration. Conclusion: NCIHS can lean on the "Equitable Social Care Integration Proposal" to strengthen its social care programming. The four equitable care principles now informing the NASEM framework help recalibrate social care initiatives with the equity lens. The collective action from our patients, clinical frontline, operational managers, and senior leaders detailed in the final proposal can help drive for race/ethnic disparities reduction and promote health equity for NCIHS’ diverse members and communities