What, Why of Social Determinants of Health
Social determinants of health (SDoH) are items that contribute to the overall health and well-being of an individual and/or populations. They are “the conditions in which people are born, grow, live, work and age that shape health.” While health and access to health care are important, they make up what many see as a smaller portion what influences health outcomes overall. This is why government, community organizations, foundations, health care entities and others are working to address the broader societal and economic conditions that impact health.
Social Determinants of Health Frameworks
There are
various frameworks for SDoH. For example, the Centers for Disease Control’s
(CDC) Health
People 2020 initiative focuses on the following categories: education, health
and health care, economic stability, social and community context, and education.
The Kaiser
Family Foundation’s (KFF) description adds food to the list. Each broad
category also includes sub-categories. For example, under economic stability, employment
and income are factors that influence that. (See Figure 1)
Another approach is the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute’s annual County Health Rankings & Roadmaps. The RWJF/UW work looks at four categories that contribute to health outcomes. The categories are clinical care (20%), health behaviors (30%), social and economic factors (40%) and physical environment (10%). As you can see, this approach indicates 20% of health outcomes is tied to clinical care with the remaining 80% related to other social determinants.
What To Do About SDoH?
While it’s important to have a conceptual framework for understanding what drives health and health outcomes, the issue then becomes how to tackle SDoH in any meaningful way. The good news is that there is plenty of innovative work going on across the country.
Consider the issue of housing. Housing stability, quality, safety, and affordability all affect health outcomes. For example, poor quality housing could lead to or exacerbate chronic conditions like asthma. In this situation, access to air purifiers or air conditioning units would be a meaningful intervention for certain patients. Housing instability, on the other hand, can lead to repeated trips to the hospital when health conditions are not properly managed. UnitedHealthcare saw the linkage when viewing its own Medicaid data, which revealed stable housing led to better health management and fewer Emergency Room visits. Since then, they have invested hundreds of millions of dollars into affordable housing.
Food insecurity (lack of food or lack of nutritious food) has implications for health as well. Boston Medical Center (BMC) has been a pioneer in this area. In 2001 they launched their Preventive Food Pantry. Under this program, primary care providers refer patients who have special nutritional needs to the pantry via a “prescription.” BMC indicates the program is frequently used by patients with cancer, HIV/AIDS and chronic conditions. Each year, BMC provides 1,000,000 pounds of food and has served over 1,000,000 individuals in need since inception. In addition, BMC uses fresh food grown on its hospital rooftop garden to help stock the panty. Truman Medical Center’s Health Harvest Mobile Market brings fresh groceries to various stops in Kansas City. Similarly, ProMedica has a mobile market in Toledo, Ohio, and a grocery store, Market on the Green, specifically situated in an area food desert. And many others offer farmers markets locally.
In New York, Cityblock Health is working to provide access to primary care and behavioral health in underserved communities while addressing key social determinants that may impede access, such as transportation or connections to other assistance. Their approach brings care into the community, eliminating or reducing the need to travel elsewhere. However, transportation continues to be a barrier to many. This is where companies like Uber Health and Lyft are looking to partner with health care organizations to provide more convenient and dependable options for patients. The Centers for Medicare & Medicaid Services also recognizes the importance of transportation (and other SDoH) and will allow for this benefit to be included in Medicare Advantage plans beginning in 2020.
One final idea I am particularly interested in is the concept of “anchor institutions.” A health care anchor institution would look beyond its primary role of providing health/clinical care into how it can utilize all of its assets to the betterment of the community. I’ve written about what I think this could look like in my article on Creating Health Neighborhoods, but there are real-life examples of this playing out.
In 2017, the Healthcare Anchor Network was launched and includes large health care systems like Dignity Health and ProMedica. Their goal is to “reach a critical mass of health systems adopting as an institutional priority to improve community health and well-being by leveraging all their assets, including hiring, purchasing, and investment for equitable, local economic impact.” By doing so, the network believes it can “powerfully impact the upstream determinants of health….” A few examples of what anchor institutions are doing: social impact investments in the community, local housing, employing local tradespersons on construction projects, and local purchases for goods and services.
Whether you consider small, targeted approaches or a large, community-wide innovation, there are many options for addressing the unique needs of your community.
Additional resources:
- RWJF’s Culture of Health
- Democracy Collaborative
- County Health Rankings Resources, here and here.
- Root Cause Coalition
- Healthiest Cities Challenge
- Healthy People 2020
Jennifer Boese is the Director of Health Care Policy at CLA. She is a highly successful public policy, legislative, advocacy and political affairs leader, including working in both the state and federal government as well as the private sector. She brings over 20 years of government relations and public policy knowledge with her to CLA. Well over half of her career has been spent dedicated to health care policy and the health care industry, affording her a deep understanding of the health care market and environment, health care organizations and health care stakeholders. Her role at CLA is to provide thought leadership, policy analysis and strategic insights to health care providers across the continuum related to the industry's ongoing transformation towards value. A key focus of that work is on market innovations and emerging payment models. Her goal is to help CLA clients navigate and thrive in an increasingly dynamic health care environment.
Comments are closed.