How Transportation Helps Address Socio-Economic Barriers
When we think of quality healthcare, we often forget to include social determinants of health (SDOH). Health professionals, healthcare institutions, and public health programs have taken a new perspective on socioeconomic problems, approaching SDOH as a direct link to improving overall health. But what is SDOH?
As defined by the ASPE Office of Health Policy, SDOH are the conditions where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes. For example, a low-income family living in a rural area often struggles to maintain quality nutrition because of food deserts. Therefore, socioeconomic barriers prevent certain groups from accessing quality living and, ultimately, quality healthcare.
While the importance of acknowledging SDOH is not in question, the “healthification,” or making SDOH a health problem, is debated.
The Healthification of SDOH
Drew Altman, CEO of KFF, argues for both perspectives, as he reviews when the “healthification” of specific socioeconomic problems is productive. One topic of discussion is the expansion of Medicaid programs taking on SDOH in their benefits packages.
Medicaid is a crucial healthcare lifeline for over 82 million low-income individuals in the United States, encompassing nearly 30% of the nation’s population. Given this extensive reach, it’s critical to recognize SDOH’s profound influence on such a significant portion of Americans.
Research indicates that clinical care accounts for only about 20% of the variation in health outcomes at the county level. In stark contrast, SDOH factors are estimated to influence up to 50% of these outcomes. This substantial disparity underscores the importance of addressing SDOH in healthcare policy and practice.
Medicaid and the Centers for Medicare & Medicaid Services (CMS) have progressively integrated SDOH into their benefits packages, significantly enhancing healthcare access for low-income populations. This approach has positively addressed health disparities and improved overall health equity.
One of the most proactive ways Medicaid and CMS are addressing SDOH is through the standard Medicaid benefit for NEMT (non-emergency medical transportation) services.
How Transportation Helps Fulfill Our Basic, Human Needs
Transportation and the “healthification” of SDOH are closely related for several reasons. When we reflect on the basic human needs for survival, American psychologist, Abraham Maslow, theorizes five hierarchical needs: physiological, safety, love and social, esteem, and self-actualization. Maslow argues that for every human to satisfy their basic human needs, they must fulfill each stage from physiological to self-actualization. So, where does transportation fit into the mix?
Let’s use the example of a woman in her late 70s, living alone, and has a physical disability that requires her to use a wheelchair. For her to fulfill her basic human needs (physiological), she needs access to water, food, shelter, heat, air, etc. To ensure these needs are met, she may need to go to a grocery store, for example. She is unable to drive, and her family does not have a wheelchair accessible vehicle to transport her safely. Without access to proper transportation options, she may miss medical appointments, may be unable to attend social gatherings, or something as simple as being unable to go grocery shopping alone.
Transportation supports individuals satisfy their basic human needs by providing a reliable solution to various socioeconomic and physical restrictions. Medicaid’s NEMT service for example, can provide this woman a solution to pick up healthy food options, using a wheelchair accessible vehicle, satisfying her physiological needs and safety needs. She can now attend social gatherings, increasing her social interactions, satisfying her love and social needs. She can reclaim autonomy and independence by doing tasks with minimal support from others, satisfying her esteem needs. And finally, having access to these resources will help her achieve her personal goals and desires, satisfying her self-actualization needs.
The “take away” is that access to transportation is the catalyst to improve one’s health outcomes. The absence of trustworthy methods to address basic human requirements may lead to serious health complications and vulnerabilities. 3.6 million Americans miss medical appointments each year due to transportation restrictions. Should an individual have physical or financial hurdles preventing them from getting where they need to go, this individual is then deprived of their healthcare and social needs. This is why the “healthification” of SDOH is vital when acknowledging the broader scope of healthcare and the potential solutions.
