The SIREN Podcast · Social Interventions Research and Evaluation Network

What Should the Healthcare Sector’s Role Be in Addressing Adverse Social Drivers of Health?

·52 min·5 clips

Why does the U.S. healthcare sector fund social services when European countries don't do it at all?

This SIREN webinar features host Carolyn and panelists Seth Berkowitz, Sherry Giled, and Stacey Lindau, who debate the healthcare sector's expanding role in providing social services. Sherry Giled argues that healthcare systems should not directly fund or manage services like housing, citing a European model where these sectors remain separate. She references a *Health Affairs* article estimating U.S. health systems spend $2.5 billion annually on social services, questioning this allocation's efficiency. Giled proposes an alternative where hospitals accept Medicaid rate cuts if funds are redirected to state housing authorities, a scenario she finds unlikely. She expresses concern that hospitals serving high-need Medicaid populations are already strained and should focus on core clinical missions. Giled also worries that better-resourced academic medical centers prioritize clinical excellence and rankings over social needs. She fears healthcare systems might allocate social services based solely on medical need, ignoring other critical factors like education or employment stability. Giled distrusts that money intended for social services wouldn't eventually be diverted back to medical technology or expansion. Seth Berkowitz suggests healthcare involvement is justified when social services are integrated into clinical management, using physical therapy after surgery as an analogy. He believes programs addressing food insecurity within diabetes care could be appropriate for healthcare coverage. Stacey Lindau notes that healthcare has always engaged in social care, referencing George Engel's 1977 biopsychosocial model. She describes the historic Chicago Lying-In Hospital, which provided housing for pregnant women to reduce mortality, as an early example. Lindau emphasizes that frontline clinicians will always address immediate social barriers, like housing for cancer patients, due to their obligation to individual care. She advocates for policy innovation and real-time experimentation, using technology to improve social care systems. Berkowitz distinguishes between mitigating individual social needs and transforming underlying social inequalities through broader egalitarian policies. The conversation touches on nonprofit hospitals' tax-free status and whether taxing them could better fund community services through elected governments. Lindau connects current health system investments to value-based care models and community benefit requirements, noting most community benefit spending still covers uncompensated care. The tone is a balanced, academic debate among experts with differing perspectives on policy and practice. Listeners interested in health policy, social determinants of health, and healthcare system design will find this discussion valuable. Those seeking definitive answers or action-oriented advocacy might find the theoretical and political focus less engaging.

As heard by us

A careful debate about where healthcare should help, and where it should step back.

SIREN's webinar keeps a useful question in view: where the healthcare sector's job ends, and where social services have to take over, especially as CMS, NCQA, the Joint Commission, and state Medicaid efforts all press on the same problem.

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Why you'd press play

If you want a sober map of where healthcare's role ends and social services begin, start here.

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