To improve Philly's healthcare system, first focus on poverty

If medical professionals were asked to identify the features that would make up an ideal healthcare system, I think there would be a lot of agreement. Most professionals would talk about themes such as quality care that is both affordable and accessible, data and cost transparency, and less bureaucracy.

While these themes are important, those of us in the Philadelphia region must look deeper into the economic and social conditions plaguing our city.  Specifically, our city's struggles with poverty and hunger — both social determinants of health — must be addressed to improve healthcare in our region.

Poverty is associated with higher rates of chronic diseases — such as diabetes, heart disease, stroke, obesity, depression, etc. — less access to healthcare, and worse health outcomes. According to the U.S. Census Bureau, more than one quarter of all Philadelphia residents lived below the federal poverty line in 2016 ($20,090 annually for a family of three).

Philadelphia also continues to see an increase in the number of people who live in households that struggle to afford sufficient food. In fact, a recent report by Hunger Free America showed that in the years 2014 through 2016, about 302,000 Philadelphians (about one in five of the city's residents) lived in food insecure households, lacking consistent access to enough food for an active, healthy life.

Additionally, a white paper published by The Food Research & Action Center states that those who are food insecure often use harmful coping strategies. These can include purchasing a low-cost diet that relies on nutrient-poor foods, forgoing preventative or needed medical care, and forgoing or delaying the purchase of prescribed medicines. These coping strategies can often lead to increased utilization of healthcare services and higher costs of medical care. Research shows that food insecure people in the U.S. incur an extra $1,800 in medical costs every year, accounting for $77.5 billion in additional health care expenditures.

Despite these alarming statistics, there still isn't enough focus regionally or nationally to combat these social determinants of health. Hospitals, doctors, and health insurers in our region must rethink their traditional partnerships and work together to develop collaborations that focus on the needs of the people affected by poverty and food insecurity — addressing issues such as accessibility, utilization, and education. The key to solving these problems will be working collaboratively to find meaningful solutions.

The serious consequences of poverty and hunger in our region have been researched and reported. Healthcare professionals now need to think about the enormity of the problem we are facing, take a step back to focus on the root issues, and come up with solutions to address them. Philadelphia should be the proving ground for an innovative solution.

Anthony V. Coletta, MD, MBA is executive vice president and president of Facilitated Health Networks at Independence Blue Cross.