Propelling a culture shift in medicine
Historically, health systems have been financially incentivized to treat sick people, as opposed to keeping people healthy, says Helena Hansen, MD, PhD. Financial incentives prioritized volume, not quality.
“It has been a good business model in terms of generating income,” Dr. Hansen says, “but the population served (at UCLA Health) doesn’t reflect Los Angeles and we really need to work on that.”
The United States spends the most per capita on health care, but has worse outcomes than other industrialized nations. Dr. Hansen says this is because the U.S. lags behind peer countries in integrating research and interventions around the social determinants of health.
The Health Equity Translational Social Science Research Theme (HETSS) has made significant strides in studying and promoting equitable health care since its launch in November 2020 by the UCLA Health System and David Geffen School of Medicine.
In the last 15 months, HETSS leadership Dr. Hansen and Rochelle Dicker, MD, have developed a mission statement, expanded the team, created a multidisciplinary advisory board, launched a webinar series and newsletter and continue to find and share funding opportunities to expand health equity research.
Dr. Hansen, who leads the Translational Social Sciences component, said in Jan. 2021, that her goal was to build an equity-centered patient care model with research collaborations among social scientists from the Arts and Sciences campus, life scientists, clinicians and clinical researchers at DGSOM.
HETSS aims to more directly address health equity and expand health care access on an institutional level. “We’ve been working on a vision for an institute that would cross north campus with south campus very firmly and institutionally link social scientists and social scholars,” says Dr. Hansen.
The cross-campus collaboration will explore the social determinants of health and how they fit into the fabric of the medical system.
“There’s this huge opportunity for UCLA to take the lead at a time when the whole country is looking for that kind of leadership,” Dr. Hansen says. “On the other hand, it’s challenging because the medical center hasn’t been organized this way up until now.”
Traditional model of medicine
Dr. Hansen says the traditional model for medicine in the U.S. is to focus on the individual.
“That's the kind of medical education I got when I was a medical student in the ‘90s – and it continues,” she says. “We've seen many decades of discourse around finding individual risk factors, as opposed to looking at what's risky about the environment that people live in.”
She says the U.S. has “cultural fantasies” about using molecular solutions for social problems— finding the right gene, pharmaceutical or device.
“I'm an addiction psychiatrist, so one of the things I've been documenting is how dangerous that fantasy is,” Dr. Hansen says. “The idea that our opioid overdose crisis stemmed from the idea that there can be this magic bullet solution to making opioids non-addictive, that's how oxycontin got to sell itself.”
The good news, she says, is that the U.S. is at a turning point and more willing to recognize that the approaches used for decades are failing patients.
One area of hope: the next generation of students and residents.
“They're really inspiring,” Dr. Hansen says. “They're coming in and saying we really need systemic change. This is the only thing that's going to improve our health outcomes.”
An example Dr. Hansen points to is the work of a collective of faculty, staff and trainees called REACH UCLA – Realizing Equitable Access to Care for Health.
Their goal is to widen access to UCLA Health for low-income individuals, particularly those covered by Medi-Cal. Historically, UCLA Health served fewer Medi-Cal patients than any other UC health system.
Members come from several different departments within the DGSOM, Fielding School of Public Health, UCLA Anthropology Department, the VA, UCLA Olive View Medical Center and Charles R. Drew University of Medicine and Health.
Since its founding 18 months ago, REACH has formed UCLA Health’s Medi-Cal Ambulatory Access Task Force and has obtained commitment for the development of a sickle cell center of excellence within UCLA Health.
Additionally, the number of primary care sites within UCLA Health that have been authorized to serve Medi-Cal patients has been expanded to 14 locations (from the initial 11 contracted with LA CARE) in response to REACH’s advocacy.
“There's just so much more that we can be doing and it's going to require systems-level change,” says Dr. Hansen. “So that's what we're up against. But one thing that's been so encouraging and a lesson learned is that we have so many allies in this work.”
Health equity is comprehensive care
Addressing the root causes and risk factors is the only way to care for people in a comprehensive way, says Rochelle Dicker, MD, who leads the Health Equity component of the Theme
“The idea is that the primary care doctor’s office would not just be about medicine, but also about social care, with all the resources as a portal of entry for social care needs ,” says Dr. Dicker.
Her vision, drawn from nearly 20 years of experience in violence prevention, is that the doctor’s office or trauma center would become a portal of entry to address everything from trauma to chronic disease and violence.
Though the idea is in the early stages of planning and funding, Dr. Dicker is hopeful that this model will become the bedrock of comprehensive care and cultural humility and address the social determinants of health.
“We hope to take better care of our patients in Los Angeles instead of just putting really expensive Band-aids on things,” she says.
In addition to the projects each of the leaders are driving, HETSS Research Theme has also launched a partnership with Charles Drew University.
Drs. Hansen and Dicker are calling the project a “co-lab,” with a cohort of students and residents that are training in social medicine. The goal is to integrate preventative care and interventions with cultural events, such as sporting events and community gatherings.
Other collaborations include a partnership with Daniel Geschwind, MD, PhD, director of the UCLA Institute for Precision Health and a health justice internship.
“We want people to know we’re here,” says Dr. Dicker, “and that our whole purpose is to integrate people who may have questions but not all the answers, and require another discipline to help with those answers.”
Learn more about the health justice internship, webinar series and research funding.