Rx: Gimme Shelter

homeOh, a storm is threat’ning
My very life today
If I don’t get some shelter
Oh yeah, I’m gonna fade away

. . .

Gimme, gimme shelter
Or I’m gonna fade away
  Rolling Stones


The Rolling Stones may have known more about population health than they realized.  It’s no surprise that homeless people have poorer health.  Homeless people literally fade away – that is, die — earlier than they would if they had a roof over their heads.  A bed is a very effective “medical treatment”, in this curious way.

Programs are starting to experiment with using shelter as treatment.  See New York Medicaid’s experiment and Robert Wood Johnson’s “Health Beyond Health Care.”   There is good reason to be hopeful that having shelter will not only improve health, but also have other positive results.

Medical care is our biggest focus when we talk about health, but in reality, medical care is a very small part of what makes “health”.  It’s the myriad factors of a person’s life – where he works, how much he earns, how many children he has, how much education he has.  These have a greater influence on his health than whether he has seen a doctor lately.  These other factors are called “social determinants of health”.

Other countries spend more on these social supports than the U.S.  That may be the reason that other countries can spend so much less on medical care, yet their people have as good or better health than Americans.  While the U.S. far outspends other countries on medical care, it looks downright miserly when it comes to social support.  For example, the U.S. ranks 25th out of 29 industrialized countries on early childhood education.  Our approach to social supports stems from our capitalist economy, or our philosophy of every-man-pursues-the-American-dream.  It’s hard to tell.

Meanwhile doctors write prescriptions that need to be stored at room temperature, which only works if you have a room to call your own.  Hospitals care for premature babies that then get discharged to an apartment with no heat.  A child with asthma visits the emergency room over and over again, each time returning to a house with forced hot air heat.

I applaud New York Medicaid for pushing the boundaries and seeing that shelter may be exactly what the doctor ordered.  I am glad that the Robert Wood Johnson Foundation is pressing the health debate toward these important social factors.  If our goal is truly to create health, then having our focus on the core ingredients of health will only help.

As the Rolling Stones put it . . .

I tell you love, sister, it’s just a kiss away
It’s just a kiss away

We are much further than a kiss away from better population health, but we may finally be heading in the right direction.

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