Academic health centers (AHCs) in the United States have had a leading role in educating the medical workforce, generating new biomedical knowledge, and providing tertiary and quaternary clinical care. Yet the health status of the U.S. population lags behind that of almost every other developed world economy. One reason is that the health care system is not organized optimally to address the major driver of health status, the social determinants of health (SDOH). The United States’ overall poor health status is a reflection of dramatic disparities in health that exist between communities and population groups, and these are associated with variations in the underlying SDOH. Improving health status in the United States thus requires a fundamental reengineering of the health delivery system to address SDOH more explicitly and systematically. The AHC’s tripartite mission, which has served so well in the past, is no longer sufficient to position AHCs to lead and resolve the intractable drivers of poor health status, such as unfair and unjust health disparities, health inequities, or the population’s SDOH.
AHCs enjoy broad public support and have an opportunity—and an obligation—to lead in improving the nation’s health. This Perspective proposes a new framework for AHCs to expand upon their traditional tripartite mission of education, research, and clinical care to include explicitly a fourth mission of social accountability. Through this fourth mission, comprehensive community engagement can be undertaken, addressing SDOH and measuring the health impact of interventions by using a deliberate structure and process yielding defined outcomes.
H.C. Smitherman is vice dean of diversity and community affairs, Wayne State University School of Medicine, Detroit, Michigan.
R.S. Baker is vice dean of medical education, Wayne State University School of Medicine, Detroit, Michigan.
M.R. Wilson is president, Wayne State University, Detroit, Michigan.
Acknowledgements: The authors are grateful to Anil N. F. Aranha, PhD; Lynn C. Smitherman, MD; Allison Guilliom, MLitt; Kristin Copenhaver; and Kevin Sprague, MD, of Wayne State University School of Medicine for efforts rendered with preparation of this manuscript.
Funding/Support: None reported.
Other disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.
Ethical approval: Reported as not applicable.
Correspondence should be addressed to Herbert C. Smitherman Jr., Wayne State University School of Medicine, Departments of Community Affairs, Med Ed/Office of Diversity & Inclusion & Internal Medicine, 9D - Wayne State University Health Center, 4201 Saint Antoine Drive, Detroit, MI 48201-2153; telephone: 313-966-5187; email: firstname.lastname@example.org.