Comments

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  Grace Corr October 8, 2020 at 5:58pm

  Intersession Meeting Discussion Questions:

  Tuesday 10/13/20 - 2pm ET

  1. Regarding the Thomsons’ current life situation, discuss which SDOH influences have had the greatest impact on them individually and as a family. From our workgroup’s perspective which issue(s) have had the greatest impact? 

  2. From your workgroup’s perspective, what is the root cause(s) that is maintaining the status quo or inhibiting systemic change efforts?

  3. What kinds of information do other workgroups possess that, if shared with your group could identify and help resolve systemic issues like the ones experienced by families represented in the Thomson scenario?

  4. Same question, but now focus on what kinds of information you have that could be valuable to the other workgroups?

  5. Identify 3 - 5 initial, achievable, actionable recommendations that, if implemented, could prevent system-level problems and/or begin to address root cause issues such as those experienced by the Thomsons.
• Paul October 6, 2020 at 9:25pm

  Assuming we coalesce on a strategy to reduce the primary conditions for a community's down-stream social determinants of unstable HEALTH, what would be the best tool for monitoring the progress of this strategy for a community, as measured by a realtime, community recognizable, and easily reportable HEALTH outcome?  Hint: joint community hospital, medical-staff, collaborative data commitment!
  • 

    Matthew Bishop > Paul October 16, 2020 at 12:40pm

    @Paul, great question! One of the most imporant actionable and achievable recommendations should be a committment to bipartisan, data and evidence driven policy and program evaluation. Donald Trump's censorship of the scientists at the CDC and other agencies has been extremely damaging to the administration of government. Core goals of the legislation would be to build a learning government that is enabled by a robust data infrastructure, educates the public, holds politicians accountable to their votes. Legislation to accomplish this would:

    • Fully fund an existing or new independent agency that would resemble the Congressional Budget Office.
      • This agency would evaluate legislation that is brought to a vote and follow all laws that are passed to see if the legislation accomplished its goals.
      • This agency would invest in bipartisan processes for determining "truth". For example, if the goal of the legislation is econmic advancement, the appointed professionals and scientists would agree on the metrics for measuring that goal.
      • Evaluation must include cross sector impacts (e.g. social determinants of health)
    • Invest in communication and design staff that would focus on communicating the results of the research to the American people. It is important that the educational component include the social determinants of health.
    • Invest in data exchange technology, so that data is easily accessible for policy analysis, and program evaluation.
    • Incentivize agencies to invest in programs that have impacts across agency siloes. This could be done by something akin to a value based care model applied across agencies.
      • This would mean harmonizing data definitions across agencies and sharing in funding when investments in one sector have impact in other sectors/agencies.
      • Once data definitions are harmonized government will be able to measure on an ongoing basis Community Population Well-being. 
    • To the extent that there is data available to track outcomes of legislation, track the records of elected officials. For example, an elected official could have a 95% our 100% accuracy on Education legislation, but a 58% on Health. Accuracy could be measured by did the legislation achieve it's goals. 
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  Matthew Bishop October 6, 2020 at 11:47am

  I just listened to an interview with Fareed Zakaria where he said that the USA spends 20X less than Germany on worker retraining programs. I went to look for other sources and found this OECD website with maps and data up to 2017. It showed that we spend 15X less than France and Denmark.
  
  https://data.oecd.org/socialexp/public-spending-on-labour-markets.htm

  

  Social protection - Public spending on labour markets - OECD Data

  Find, compare and share OECD data by indicator.
  • Paul > Matthew Bishop October 6, 2020 at 8:52pm

    The "X" axis on the charts presented by OECD use "% of GDP" to view labor spending trends and quite a different set of trends for Social Spending by USA as compared to Sweden, UK, and Germany (fairly comparable).  Remember also, our GDP in 2019 was $21 Trillion and Germany was $3 Trillion.   
• Paul October 5, 2020 at 11:14am

  Within the next 3 weeks, Robert D. Putnam will release the 16th of his series of books about the evolution of Social Capital within our nation's communities and their neighborhoods.  I refer principally to the books of HANGING TOGETHER (1984), MAKING DEMOCRACY WORK (1993), BOWLING ALONE (2000), DEMOCRACIES IN FLUX (2002), BETTER TOGETHER (2003), THE AGE OF OBAMA (2010), AMERICAN GRACE (2010), OUR KIDS (2015), and to be released this month THE UPSWING (2020).  The subtitle for the new release goes as follows: "How America Came Together a Century Ago and How It Can Do It Again."  

  I for one suggest that we as a group consider THE UPSWING as a must-read as the basis to ground our collaborative considerations for preventing, mitigating, and ameliorating the primary origins underlying the Social Determinants of health.  As a prelude, I offer the following citation from Professor Putnam that best summarizes his research on the changes of Social Capital that occurred after WWII.  It represents a published summary for a lecture he gave to an OECD sponsored conference in Europe.  SEE    https://smg.media.mit.edu/library/putnam.pdf

  https://smg.media.mit.edu/library/putnam.pdf
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  Matthew Bishop September 29, 2020 at 3:15pm

  

  Hi Everyone, I enjoyed the conversation with the kick off of the National Action Agenda. After some more thought and reading I realized we missed two big topics.
  
  Promotion of Entrepreneurship - Starting a successful small business can be a promising route out of poverty for some. Whereas immigrants are more likely to start businesses than native born Americans, women and racial and ethnic minorities are less likely than caucasians. Thus, programs to promote entrepreneurship could target underrepresented populations or be open to everyone and include:

  • Small Business Loans
  • Supporting Business Incubators that provide free/market reduced office rent and entrepreneur education
  • Increasing funding to Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) grant programs
  • Venture Funds that invest in startups - NYC investment Fund is one example. Several Nordic countries have created funds focused on specific industries like AI. Funds could also target people starting businesses based on their financial need helping people who don't have networks with rich people/family that act as early investors.

  Reading Michael Sandel, a political philosopher from Harvard, it is important to think about our underlyng assumptions. In his book, "The Tyranny of Merit" he questions whether our goal of equality of opportunity is misplaced. I will include a few quotes to rapidly get his thoughts across. The idea of the meritocracy implicitly assumes that those who work hard and play by the rules should be able to rise as far as their effort and talents will take them. However, the implication is that those who do not rise will have no one to blame but themselves. What ends up happening is that even though data shows that due to income, discrimination and many other things we do not start from a level playing field, even if we could magically guarantee it, we would know with 100% confidence that we have only ourselves to blame.
  
  He believes that Trump and Brexit are tied to people feeling they live in “the land of opportunity” and they blame themselves for not being successful. You can read more about it h

  https://www.theguardian.com/books/2020/sep/06/michael-sandel-the-po...

  Even if we could magically make everyone start from the same starting point, there will always be variation due to luck, why does the market reward Lebron James (basketball) but not the world’s best arm wrestler?

  What this says to me is that the foundational principle should validate the worthiness of every single person irrespective of who they are. A Universal Basic Income is the best way to do that. Sandel said it better: "Nearly 2/3 of the country do not have a 4 year university degree. So we should not create an economy that makes a 4-year university degree a necessary condition for dignified work and a decent life. We should focus on how to make things better whatever their credentials."
  
  What do you think?

  Michael Sandel: 'The populist backlash has been a revolt against the tyranny of merit' | Books | Th…

  The philosopher believes the liberal left’s pursuit of meritocracy has betrayed the working classes. His new book argues for a politics centred on di…