Policy to address social drivers of health
The policy to address social drivers of health pillar includes research on the social risk and protective factors that influence health care and population health outcomes such as transportation, housing and home care. Below are examples of research, publications, faculty with relevant expertise, and CHPC briefs and initiatives related to research on policy to address social drivers of health.
Disparities in access to the Medicaid Transportation Benefit
Medicaid, unlike other insurers, is federally mandated to provide transportation services through its non-emergency medical transportation (NEMT) benefit. Recent data indicate gaps in transportation access among Medicaid enrollees, specifically for Black patients. Additionally, several states have argued that the benefit is unnecessary and sought federal approval to limit its eligibility.
A team of researchers from Weill Cornell Medicine and the Cornell Jeb E. Brooks School of Public Policy led by CHPC faculty members William Schpero and Jamila Michener are conducting a study titled “Racial and Ethnic Disparities in Access to the Medicaid Transportation Benefit and Implications for Patient Outcomes.” The study is evaluating racial and ethnic disparities in use of NEMT across states and how transportation barriers affect access to care and health outcomes. A key objective of the work is to estimate the effect of the benefit on disparities in patient outcomes, leveraging state-level variation in availability of NEMT as a natural experiment.
Homelessness
The U.S. is experiencing rising rates of homelessness, which research shows contributes to poor health outcomes. Our faculty research and evaluate the impact of policies to address homelessness.
Publications:
- Homelessness and Mental Illness: How Trump’s New Executive Order Could Backfire
- Inverse systems: national investments in homeless housing programs for veterans compared to non-veterans
- Understanding Hospitalized Patients with End-Stage Kidney Disease Experiencing Homelessness in the United States
Faculty:
Initiative on Home Care Work
Drs. Avgar (Cornell University), Sterling (Weill Cornell Medicine), and Dell (Cornell Tech) have been collaborating for the last 8 years. They now lead a new Initiative, “The Initiative on Home Care Work,” which aims to bring scientists, scholars, and clinicians together to improve care that happens in peoples’ home; this includes improving job quality and working conditions for the home care workforce, while also improving care and outcomes for patients. The Initiative is comprised of experts in labor relations and employment, medicine and healthcare, computer science and human centered design, and policy. Community partnership – locally, regionally, and nationally, is at the core of the Initiative’s activities. Additionally, trainees ranging from undergraduate to post-doctoral level are encouraged to join and lead studies. The team conducts both observational and intervention-based studies. Some recent studies include:
- Investigating the impact of unionization on home care workers’ wages, benefits and health using the Current Population Survey dataset, which found that unionization is an effective means of improving the financial well-being of direct care workers, a workforce that is currently facing challenging working conditions and high levels of turnover.
- Assessing the feasibility of wearable devices among home care workers (HCWs) caring for adults with chronic conditions, which examined HCWs health and wellbeing via activity tracking
- Evaluating the role of novel organizational models in home care, such as co-operative agencies (in which workers own part of the business), which found that care cooperatives may be effective in attracting and retaining home care workers.