As the Symposium editors and Carle Foundation faculty Malcolm Hill and Julianna Sellett began the planning for the Medicalization of Poverty Symposium, it was clear that the Symposium presented an extraordinary opportunity to bring together people with tremendous knowledge, who could help bridge the medical mindset of acute care, which predominates still today, with value-based care, which has been discussed nationally for the last several years.¹ Many of the policies and actions in the healthcare arena today have been driven by risk models and decreasing reimbursements. There is, however, an increasing recognition of the impacts of social determinants not only of usage of healthcare services but of the health status of individual people, as the Symposium contributors amply demonstrate.^{Reference Bailey2}

There has been a dearth of discussion in society about whether healthcare is a “right or privilege.” This debate becomes very important as society decides how to allocate public expenditures to improve population health.^{Reference Jones and Kantarjian3} The U.S.A. model departs from that of many European countries. In Europe there is often separate support which blurs the lines between acute medicine and social policy programs, but this is not widely understood in the U.S.A.^{Reference Barvíková, Österle, Ranci and Pavolini4}

One can think of shifts from an acute medical care model to a more holistic approach as redefining the “H” in Hospital and now Healthcare. At one time in the nottoo-distant-past, “H” signified Hospital — that is, care was delivered only in an acute setting. Now we routinely consider how healthcare delivery — which in many instances occurs outside the four walls of acute care facilities — involves the broader healthcare community.

Many of the articles in this Symposium build on that simple but incredibly complex conceptual shift, as we try to define and connect many of the disparate impacts on our population's health with the care that is delivered. Consider Carle's focus and work on early childhood development through a specific project, Healthy Beginnings.⁵ We are exploring its impact on health outcomes through a long-term demonstration. Carle is the convener but just one of numerous community partners working to address the broad impacts of poverty and leverage the significant opportunities of education to alleviate poverty's effects. Like our partners, we recognize that this is a long-term commitment.

Structurally, as a healthcare system, such efforts begin to frame our vertically integrated health system in a much different way than it has been over the past 80 years.⁶ Addressing social determinants of health inherently requires collaboration, consensus building and small but persistent steps. Further, we need to make sure that those who continue to work in the older model in the provision of care do not feel as if they have been left behind as we try to define what the “H” means today and tomorrow.

Across this Symposium, the connections between the triangle of poverty, education, and healthcare leap out. This triangle is not new; it traces back to the 1960s and even earlier.^{Reference Stevens7} As we move towards demonstrating the value proposition in the delivery of our healthcare this exciting and challenging project will require the kind of very broad group of individuals assembled here, professionals and thought leaders who are willing to listen, compromise, and yet persistently push forward to what we envision healthcare can and should be