Ask if and how it distributes financial rewards and bonuses, if any. Are staff payments or salaries linked to measurable improvements in community health outcomes?

Mitch Katz directs the Los Angeles County Department of Health Services, the second-largest county health care system in the country. He described to me how economic incentives can stack up against upstream care. “Because there’s been little money toward prevention, there’s no payer or mechanism for prevention research like there is for medical res

healthbegins.org.)

In our shared imagination, the concept of health has been shaped by this downstream activity, where doctors and nurses discover and treat disease.

And even as we compensate for services, we pay a lot more for some services — like expensive, high-tech tests and procedures — than for others — like the time it takes a clinician to think, evaluate, come up with a plan, and help a patient follow it.

*For more insight on this type of model, I recommend two articles published in 2010: “A Framework for Public Health Action,” by Thomas R. Frieden, in the American Journal of Public Health, and “A Conceptual Framework for Action on the Social Determinants of Health,” by the World Health Organization.

The healthy housing program we had set up had helped thousands of children and adults like Veronica. We had worked with a community partner to set up a produce stand and resource guide to help families experiencing hunger and food insecurity. A medical-legal partnership we had created shortly after I started at the clinic was blossoming. Thousands

California, for instance, recently launched a Health in All Policies initiative to factor health into a wide swath of state decisions.

When clinicians don’t reflect the communities they serve, it becomes that much more difficult to understand health in its social context.