If you were to pinpoint a top buzzword in the healthcare and pharma industries in recent years — aside from omnichannel or digital transformation — it would likely be health equity

Spurred on by the COVID-19 pandemic and Black Lives Matter protests during 2020, leaders in the healthcare marketing world have become far more attuned to the need to tackle health disparities.

However, actually getting to the nitty-gritty of those health disparities and seeing a real-life impact is often a more evasive task. Sean Granahan, president and general counsel at The Floating Hospital, a New York-based nonprofit provider organization, believes there’s far more work that can be done among healthcare players outside of the philanthropy world.

MM+M spoke with Granahan about The Floating Hospital’s mission and how there’s a critical need for the healthcare system to place social determinants of health (SDOH) — like housing, food, nutrition and other basic necessities – at the same level of importance as regular medical care.

This interview has been edited lightly for length and clarity.

MM+M: The Floating Hospital has quite a lengthy history when it comes to caring for low-income populations. Can you give some context as to how The Floating Hospital has honed in on addressing SDOH?

Granahan: The hospital goes back to 1866, which predates any type of Department of Health from a city perspective or a state perspective. Healthcare back in the 1800s consisted of things like milk and fresh air as penicillin wasn’t discovered until close to 1900. So for that 30-year interval, until the turn of the century, healthcare was about relief.

Back then there was no main sewer system, so there were cholera epidemics and dysentery. Malaria was huge at that time. The way to deal with hugely sick populations was to send them somewhere and get them away. That’s where the concept of floating hospitals came from — they would put people on barges, and if they survived, they’d come back.

We were unique at the time because we were focusing on the poor and doing it as a regular part of healthcare, rather than waiting for an epidemic. That’s what distinguished us at the beginning. We recognized there was a need for some form of primary medical care and some kind of health education [for the poorest populations in NYC]. The two went hand-in-hand with us back in 1866.

As healthcare evolved and became its own silo, we hung onto the relief. Throughout our history we’ve been providing everything from clothes, food, shelter and every necessity imaginable to the poorest populations in New York City. 

Those have historically been waves of immigrants: the great immigration waves of the late 1800s and early 1900s, as well as immigrants after World War I and World War II. The Floating Hospital has been there for all of that. Today, the great wave is migrants coming up from South America. That’s where we are now — in the trenches with that.

MM+M: What are some of the main health equity issues that these low-income populations in NYC face?

Granahan: There’s been a consistent humanitarian crisis in NYC over the last 50 years that nobody talks about: homeless mothers and children. Homeless parents can make up to 70% or more of NYC’s homeless population. These moms and kids find themselves either the product of eviction, domestic violence or intimate partner violence and are often the product of the foster care system.

The poorest populations suffer the worst from malnutrition. People don’t understand that because they feel if they get food, they’re OK. The problem is that food usually comes from a bid-out vending system, either through the Department of Homeless Services, schools or others and it’s generally not the most nutritious food.

The problem is a deeper and more systemic problem. There’s not much you can do for a diabetic if when they go home the only food options they have are carb-heavy, sugar-heavy, fat-heavy. It affects them in terms of obesity, diabetes and hypertension. 

The bigger issue is one of SDOH and we did extensive studies on that during COVID-19. We went to shelters, we spoke to families and deeply interviewed them. The results were exactly what we felt they would be, but it was in data form. Food insecurity is the most critical issue of homeless families and children, and eviction is always the boogeyman around the corner.

The issues are class-based as much as they are race-based. In the dialogue, they’re all getting conflated into one, but poverty is driving this engine. Unfortunately, in New York City the overwhelming majority of those who are most impoverished are Black or brown, and it has a profound effect on their health outcomes.

MM+M: The healthcare system is generally poised to treat illnesses once patients are at the clinic, rather than focus on some of these SDOH as you’ve mentioned. Why is it important to have major health players treating things like food insecurity with the same level of focus as developing new treatments, for example?

Granahan: Migrants come into the clinic in flip-flops and shorts, without owning a pair of socks or shoes. These are like 4-year-old kids. If you’re going to treat the poorest populations you have to treat them where and how you find them. We find them without proper clothing and scrambling to find proper food. 

You have to address those health equity issues because handing them a prescription for a runny nose when the kid is leaving in flip-flops isn’t going to help, not when it’s 20 degrees and snowing out.

MM+M: How can healthcare providers and companies take note of this and make addressing SDOH part of their core approach to care?

Granahan: You have to juggle necessity and relief in the context of healthcare. Finding the right type of food and addressing the effects of the wrong types of food goes along with combating the usual colds, flus, mental health issues and trauma. 

For migrants, it includes dealing with the trauma of uprooting yourself and making this incredible trek from South America to North America. A lot have done it on foot and the stories are incredible. It’s about trying to find them some type of solace within that realm.

We’re at a stage where we need to start focusing on young children and their trajectory if they don’t get housing or proper nutrition. It’s hit a proportion that’s enormous. If you think about homeless kids in school right now, the Department of Education reports anywhere from 100,000 to 115,000 homeless kids in the school system. You have more homeless kids in the NYC school system than you have people in Albany. That tells us, somehow, we need to do something.

There’s a lot of money in the corporate world being funded into solutions, but solutions don’t put a sandwich in a kid’s belly when they come into the hospital hungry. Charity does that. There has to be a recognition of the importance of being a direct service provider, which often gets lost in loftier goals that don’t seem to be making any particular difference.

We have to house people and figure out a way to provide them with consistent basic care that healthcare can augment — but not necessarily take the place of.