Leadership Addressing the Social Determinants of Health

The research explores the complexity of leadership developing organizational capacity to address the social determinant of health. The cases cross the public and nonprofit sectors in California, USA. The research develops five... [ view full abstract ]

The research explores the complexity of leadership developing organizational capacity to address the social determinant of health. The cases cross the public and nonprofit sectors in California, USA. The research develops five case studies The California Endowment; the Sierra Health Foundation; the University of California, Center for Population Health Improvements; The Los Angeles County Department of Public Health; and a community based organization.

From a research perspective the use of case study methodology provides an approach that explains the “how” of a complex issue (Yin, 1994: 9). As the social determinants of health involves governance arrangements and decision-making processes, “…richly textured case studies” that are derived from field research can be more appropriate than other methods for developing a deep understanding of the complexities. (Heinrich, Hill, & Lynn, 2004: 13). The urgency, complexities, and consequences of leadership addressing the social determinants of health complexities are captured well in a framework developed by Don Kettl to explain “… wicked problems that defy our organizational and policy boundaries, these past models provide a poor guide for future action” (Kettl, 2006: 276–281). Kettl finds five features categorize these wicked problems:
• Looking back instead of looking forward
• Reforming instead of to governing
• Thinking vertically instead of horizontally
• Regulating instead of performing
• A misplaced veneration for outdated traditions instead of a focus on effective governance
Rather than relying on past models, this research draws on new examples to generate new intellectual capital needed to get traction on addressing the underlying social issues impeding individual and community health. The research draws on these cases as multiple sources of actionable research to support finding six sets of leadership practices,

1) The leadership lesson that emerges is that professional experience matters.
2) A focus on impact embraces accountability
3) Leaders use data to drive change
4) Financing Takes Different Forms
5) Partnerships for Traction
6) Success is by design, through strategy not accident.

Though listed as six sets of practices in a sequence that does not intend to imply that each practice stands alone. Rather, similar to Elinor Ostrom’s research findings (1990), these practices are nested with each other. The paper concludes with the limitations and implications of the findings.