Keep your eyes on the prize — focusing on health care equity

Recently, one of us attended a health-system meeting that was called to address racial and ethnic disparities in hypertension control. The conversation quickly turned to screening for and addressing unmet individual health-related social needs (HRSNs), with no discussion of potential supports for patients, such as telemedicine visits, pharmacist appointments, or home blood-pressure monitoring. Throughout the United States, equity-focused quality-improvement activities are increasingly centered on HRSN screening, which raises ethical questions about the best allocation of resources.

HRSN screening and referral for related services are necessary components of high-quality care and have long been practiced at safety-net institutions. Systematic screening helps clinicians integrate social and medical care and captures individual-level data that can inform advocacy efforts. The health care sector should also partner with stakeholders in social services and with communities and policymakers to address structural social drivers of health (SDOHs) and advocate for increased funding for social services. Social service agencies and community-based organizations have greater knowledge of community needs and resources and can address social needs more effectively than health systems can, possibly at lower cost. We are concerned, however, that the prioritization of individual social-needs screening strips energy, attention, and resources from the most important equity prize in the health care sector: the provision of equitable, high-quality, trustworthy, longitudinal health care tailored to the needs and preferences of individual patients and communities.