The role of academic health centers in addressing health equity and social determinants of health

Elsewhere in this issue, Park and colleagues argue that academic health centers (AHCs) must partner with communities to address health disparities and social determinants of health (SDOH). Who is ultimately responsible for addressing them is in question. Countries that have been successful in improving the health of their populations have made these efforts a national priority by, among other things, ensuring universal health care coverage. To date, the United States has failed to adequately address these issues. Health care providers will have an important role to play in doing so, albeit a limited one. Under fee-for-service reimbursement, health care providers are paid for health care services and not for improving the health of populations. Capitated reimbursement might provide more of an incentive to focus on population health. Furthermore, AHCs are a heterogeneous group. Some are research-intensive referral centers, some are community providers, others are safety net providers, and still others are hybrids. Different types of AHCs will address SDOH differently. The scourge of poverty and associated health disparities and their underlying SDOH in the United States must be addressed. Providing affordable, comprehensive, universal health care must be a necessary first step. AHCs must educate about these issues, research and develop new approaches to ameliorate these inequities, and undertake appropriate demonstration projects in dealing with these disparities in well-defined populations. Health care providers, including AHCs, cannot take principal responsibility for issues beyond their scope and financial capabilities.