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Words matter. They reveal who we are: our values, our priorities. As we use words to drive change, those words also change us. They shape our sense of what’s expected and what’s possible. They help us understand and act on important, complex ideas.
But, as these exchanges indicate, words can also be frustrating when people from different backgrounds don’t share the same frameworks and definitions.
Now more than ever, we need to get clear about what we mean when we use terms like ‘social needs’ or ‘social determinants of health.’
Why?
Every week brings news of novel policy initiatives, partnerships, and collaboratives. Just last week, for example, CMS announced new payment models that will place primary care physicians at greater risk for patients’ health outcomes and, presumably, their health-related social needs as well. In the last few days, we also learned of multi-sector collaboratives fighting against structural racism, hospitals turning parking lots into homes, and future upstreamists learning how to prescribe food.
But just as healthcare, social service, and public health leaders come together, we’re using different words, terms, and definitions to describe our values and priorities related to social determinants of health. Sometimes we connect different meanings to the same word. Other times, we use different terms to convey similar meaning. This lack of clarity and precision in communication is muddying the waters, making it harder for us to collaborate rapidly and effectively, making it harder for us to move upstream.
It’s time to unmuddy the waters. In our April 24th webinar, in conversation with Kathryn Verlander of the Center for Medicare and Medicaid Services and Dora Hughes of Georgetown University, we presented a Toolkit to help do just that.
The Upstream Communication Toolkit has three components:
- A Glossary of Upstream Terms that captures commonly used words and phrases that are regularly translated in clinical-community partnerships and multisector collaboratives.
- A Levels of HRSN & SDH Integration Framework that helps convey the meaning of these terms in the context of day-to-day partnership development. Created with input from leading experts around the country, the Framework helps healthcare and social service partners view and apply the Glossary of Upstream Terms along a spectrum of opportunities, with basic service coordination to address HRSNs on one end of the spectrum to full system integration to address SDH on the other.
- A Discussion Guide that not only helps partners clarify terms and meanings but also take on fundamental partnership challenges — like the need to balance financial and social returns and the potential for “medicalizing” social services. The Guide also provokes each partner to consider the role that each can play in addressing “the causes of the causes”, i.e. structural determinants like racism and income inequality.
These are hopeful times in health and human services, but they are also murky and complicated. We hope this toolkit helps to bring structure, organization, and clarity to the hard conversations we know are happening all around the county.
And, like the movement itself, the Toolkit is a work in progress. As we transform, as our language evolves, so will the Upstream Communication Toolkit. If you have comments on the Toolkit, thoughts or stories that could help shape this product, we’d love to hear from you.
Best,
Rishi Manchanda
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