Stimulus Funding, Equity, and Thinking Big: A Rare Opportunity to Apply Population Health Principles, Address Social Determinants of Health and Reduce Health Disparities for Decades to Come

The COVID-19 pandemic has played a leading role in making this the grimmest year in memory. It would be a measure of retribution if we respond by addressing long-standing inequities. Significant stimulus funding is our opportunity to think big. We can think big by applying population health principles to create the infrastructure for a meaningful and enduring response to social determinants of health and accompanying health disparities.

There is a flood of stimulus money that is nowavailable to local and state jurisdictions to address the impact of the COVID-19 pandemic. There is a good chance that much of this funding will be spent on short-term interventions limited by silos and scope, leaving little to show for our investment in the years to come. However, the intent of the funding is broad enough (reduce inequities) and the quantity of the funding is large enough to build a population health infrastructure that will endure and pay dividends for decades by unlocking access to services and elevating the quality of life in communities with the greatest disparities.

This is a rare opportunity to “think big” and create a health information infrastructure coupled with a system of peer navigators that supports communication between community based organizations, governmental agencies including public health, behavioral health, social services, schools, and jails, prisons, and probation, as well as health care providers. An effective secure information exchange service will break down silos between organizations, and a network of peer navigators (also called community health workers or promatores) will help individuals get the services they need.

As a primary care physician who has spent decades caring for patients and serving in medical director roles, I can attest to the disjointed nature of services that are provided. At the same time, a broad-based information exchange system linked with a network of peer navigators would lead to a more integrated and coordinated health care delivery system that will pay for itself many times over.

We are at a tipping point in health care, driven by the continued growth of value based care that emphasizes cost as well as quality, the availability of digital solutions to improve access, and the emergence of population health as a more holistic approach that encompasses the social determinants of health. We can also make long term investments in the people and communities most impacted by social determinants by addressing the two pillars of a long and healthy life- access to healthy foods and to exercise. We can do this by incentivizing the availability of fresh fruits and vegetables in food deserts and by working with communities to develop relatively inexpensive, safe and attractive walking trails and parks that can beautify and be a source of pride in long-neglected neighborhoods.

There is even the opportunity to apply a population health framework to address some of the most intractable problems in our cities, including homelessness, and access to medical, behavioral health, and substance use services. A more comprehensive approach will lead to significant savings and improvements in health care and quality of life across a range of educational and carceral measures.

None of what is proposed is particularly novel. What is different is we now have the big picture vision provided by population health to guide us, and the availability of stimulus funding to cities and states to make the necessary investments feasible.

It is rare to have the opportunity to tackle the range of inequities and disparities that have been so dramatically illustrated by the COVID-19 pandemic. Let’s use this moment in history to invest in an enduring population health infrastructure that addresses the social determinants of health and pays dividends in improved efficiency, reduced health disparities, and a more equitable society for generations to come.

Dr John Zweifler is a family physician with years of patient care, medical education, and medical administration experience. He currently works as a physician consultant with the Fresno County Dept of Public Health, and consultant with he Terry Group with a focus on population health. He is the author of the e-books, “Tipping Health Care in the Right Direction”, and “Pop Health.” He can be reached at john.zweifler@terrygroup.com