Social Determinants of Health: An Introduction
What determines the reality of our health and health care costs? Is it time spent with a clinical expert? Genetics? The resources and technology deployed in a clinical care setting? Practitioner experience? All of these factors play a role in determining our health status (and the financial cost of care), but they play a significantly smaller role than you may think.
Our collective health is impacted dramatically by other less obvious, and potentially more significant factors that determine whether one develops a chronic disease, or ends up in a clinical care setting in the first place.
Research suggests many unfavorable health outcomes related to chronic diseases like Diabetes Mellitus Type II and Obesity (and the expenses associated with these chronic diseases) might be reduced, if not avoided altogether, by paying closer attention to environmental, geographical, cultural, and behavioral aspects of our lives (Choi, et al., 2018). These aspects, which are often the initiators of diseases like Diabetes and Obesity, relate to the broader discussion around ‘Social Determinants of Health’.
‘Social Determinants of Health’ (SDH), according to The World Health Organization are defined as “the conditions in which people are born, grow, live, work and age” and “the fundamental drivers of these conditions.” Essential details like reliable housing, access to transportation, proximity to healthy food, education, individual behavior, and income are a few key topics driving inquiry and conversation related to SDH (Bravemen and Gottlieb, 2014).
How, for example, can one live healthily without access to affordable nutritious food? If parents are abusing substances like drugs and alcohol, can we expect their children not to? If a family is spending the majority of its income on inadequate and unreliable housing, where are the resources for education and recreation that may drive toward healthier habits and more favorable decision-making?
Social Determinants are embedded into the day-to-day details of our lives. They are nuanced and complex, and it is clear that genetics and clinical care are not the sole determinants of our health and health care costs. The challenge is how best to confront this reality to create better outcomes. Providers cannot do it alone, especially without adequate incentives or infrastructure (CMS,Fact Sheet, 2017). Nor will money necessarily improve our behavioral choices or optimize our social environments.
Progress will call for education, aligned incentives, and community collaboration. Services like violence prevention programs, public transportation, and language interpretation, along with physical enhancements like parks and bike lanes are some examples of efforts toward improving social conditions in an effort to inspire healthy behaviors and limit friction for those who need care (Anderman, 2016).
Creating connections between populations, community resources, and clinical settings may allow individuals a better chance to develop favorable lifestyle habits, thus increasing the odds of leading a sustained healthy life. A recent effort called the The Accountable Health Communities Model has taken this idea into account, with the goal of engaging ‘bridge organizations’ to test various approaches aimed at connecting clinical and community resources and confronting health-related social needs by leveraging health screenings, referrals, and navigation services for select Medicaid and Medicare populations (CMS, 2018). And consider Wellville, a non-profit organization led by angel investor Esther Dyson, dedicated to confronting the negative impacts of SDH. Wellville has selected five communities across the U.S. and deployed health advisors to create leadership teams within those communities to improve key areas of focus like obesity prevention, tobacco use reduction, and community pride.
With social and socioeconomic realities playing a greater role on the choices we make, a web of committed community players involved and incentivized may reduce avoidable demands on the health system and lessen unnecessary costs. By digging into the Social Determinants of Health, getting ahead of problems before they arise, and making a concerted societal push for sustained healthy lifestyles, we should be able to significantly enhance the wellbeing and quality of life for all.
- Choi, Edwin, et al. “Determinants of Health.” Goinvo - Designing the Future of Healthcare, 26 July 2017, www.goinvo.com/features/determinants-of-health/.
- “Accountable Health Communities (AHC) Model Assistance and Alignment Tracks Participant Selection.” CMS.gov Centers for Medicare & Medicaid Services, 6 Apr. 2017, www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-04-06.html.
- Andermann, Anne. “Taking Action on the Social Determinants of Health in Clinical Practice: a Framework for Health Professionals.” U.S. National Library of Medicine, 6 Dec. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5135524/.
- Braveman, Paula, and Laura Gottlieb. “The Social Determinants of Health: It's Time to Consider the Causes of the Causes.” The Social Determinants of Health: It's Time to Consider the Causes of the Causes, U.S. National Library of Medicine, Jan. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC3863696/.
- “Accountable Health Communities Model.” Innovation Models | Center for Medicare & Medicaid Innovation, 3 May 2018, innovation.cms.gov/initiatives/ahcm/.
- “CMS Quality Strategy 2016.” CMS.gov Centers for Medicare & Medicaid Services, 2016, www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/CMS-Quality-Strategy.pdf.